A randomized clinical study: outcome of submucous resection of compensatory inferior turbinate during septoplasty.

BACKGROUND: Septoplasty and/or turbinate surgery are commonly used surgical techniques for the treatment of mechanical nasal obstruction. The aim of this study was to define the effectiveness of submucous resection of a hypertrophied turbinate together with simultaneous septoplasty for the treatment of nasal obstruction. METHODS: Forty-two patients with septum deviation and compensatory contralateral inferior turbinate hypertrophy were recruited in this study. The inferior turbinate hypertrophy was diagnosed based on examination. The patients were randomly divided into two groups. In group A, a submucous resection was performed to treat a hypertrophied inferior turbinate, together with a septoplasty. In group B, only a septoplasty was performed. Acoustic rhinometry and rhinomanometry tests were conducted for an objective evaluation of nasal patency. A visual analog scale (VAS) was applied to the patients for the subjective evaluation of nasal obstruction complaints. RESULTS: The application of submucous resection intended to reduce a hypertrophied inferior turbinate led to a distinctive increase in cross-sectional area of nasal patency; however, when the two groups were compared, it was statistically significant only at the post-operative sixth month. There was no difference between the results of rhinomanometry. The subjective symptom scores were better in group A than in group B between the post-operative first to sixth month. CONCLUSION: Submucous resection of a hypertrophied inferior turbinate is necessary for the treatment of nasal obstruction.

The frequency of auditory neuropathy detected by universal newborn hearing screening program.

OBJECTIVE: Auditory neuropathy/auditory dyssynchrony (AN/AD) has become a well-accepted clinical entity. The combined use of oto-acoustic emissions (OAEs) and auditory brainstem response (ABR) testing in the universal newborn hearing screening (UNHS) has led to the easy recognition of this disorder. Although, we are now able to diagnose AN/AD reliably, little is known about its epidemiology, etiology, and especially the frequency of its occurrence. The primary goal of this study was to determine the frequency of AN/AD in the Western Anatolian region of Turkey. The secondary goal was to compare the detection rate of AN/AD before and after the implementation of the UNHS in the audiology department of Dokuz Eylul University Hospital. METHOD: Between 2005 and 2007, among the 23,786 newborns who were screened by automated click evoked oto-acoustic emissions (a-CEOAE) and automated auditory brainstem responses (a-ABRs), 2236 were referred to our department. All necessary audiological tests were performed for all the referred newborns. Among them, babies with deficient or abnormal ABR in combination with normal OAEs were considered as having AN/AD. These babies were evaluated with additional diagnostic audiological tests. Furthermore, comparison of the incidence of children diagnosed with AN/AD before and after the implementation of UNHS in our audiology department was also performed. RESULTS: Among the referred newborns, 65 had abnormal or deficient ABR test results. Ten of these 65 newborn babies (mean diagnostic age: 5.7 months) with hearing impairment showed electrophysiological test results that were consistent with AN/AD. The frequency of AN/AD in these 65 children with hearing loss was 15.38%. Moreover, the frequency of AN/AD within UNHS was found to be 0.044%. Seven of the 10 babies with AN/AD had hyperbilirubinemia as a risk factor, which is a high rate to be emphasized. On the other hand, the retrospective investigation of children diagnosed with AN/AD in the same audiology department between 1999 and 2005 (i.e. before the implementation of UNHS) revealed only 7 children, with an average diagnostic age of 34 months. CONCLUSION: After implementing the UNHS, the incidence of AN/AD in the audiology department increased from 1.16 to 4.13. Furthermore, the age of diagnosis of AN/AD decreased from 34 months to 5.7 months. This study shows that AN/AD, when screened, is a comparatively common disorder in the population of hearing-impaired infants. While newborn hearing screening provides early detection of babies with hearing loss, it also helps to differentiate AN/AD cases when the screening is performed with both a-ABR and automated oto-acoustic emission (a-OAE) tests. Thus, the routine combined use of a-ABR and a-OAE tests in UNHS programs, especially for the high-risk infants, can provide better detection of newborns with AN/AD. Furthermore, hyperbilirubinemia is merely an association and maybe etiologically linked.

Plexiform neurofibroma of the tongue: a case report of a child.

A three-year-old girl with a lingual plexiform neurofibroma treated by total excision is presented. Despite their occurrence in the head and neck region, neural sheath tumors are rarely encountered in the oral cavity. It is reported that 4-7% of patients affected by neurofibromatosis display oral manifestations. Neurofibromatosis is characterized by café-au-lait spots and cutaneous neurofibromas. Plexiform neurofibroma is said to be indicative of von Recklinghausen's disease (VRD) even though it may be the only manifestation of the disease. Generally, surgical resection represents the treatment of choice and the diagnosis can only be confirmed after histological examination. Affected patients need regular follow-up to detect malignant degeneration, an early recurrence or appearance of other manifestations of VRD.

Auditory neuropathy in children: diagnostic criteria and audiological test results.

OBJECTIVES: In this study, we evaluated pediatric patients with auditory neuropathy with regard to diagnostic criteria and audiological test results. PATIENTS AND METHODS: Hearing assessment was made in five children with auditory neuropathy (3 boys, 2 girls; age range 7 months to 6 years). The patients were tested with the use of acoustic immitance measures, transient evoked otoacoustic emissions (TEOAE), behavioral audiometry, and auditory brainstem responses (ABR). RESULTS: Transient otoacoustic emissions were recorded in all the patients in contrast to the lack of auditory evoked brainstem responses (i.e. there were no identifiable waves in all recordings). Another common feature was the absence of correlation between ABR, TEOAE, and behavioral test results. CONCLUSION: Of the above-mentioned measurements, otoacoustic emissions and the auditory brainstem responses, when used together, offer insight into preneural as well as neural function in the auditory system and thus, may form the necessary combination for the evaluation of hearing in children.

[The incidence of level I metastasis in laryngopharyngeal squamous cell carcinoma]. / Larengofarenjeal yassi epitel hücreli kanserlerde birinci bölgeye metastaz sikligi.

OBJECTIVES: We investigated the incidence of level I metastasis in patients with laryngeal and hypopharyngeal squamous cell carcinoma (SCC). PATIENTS AND METHODS: The records of 126 patients who underwent primary tumor excision with radical neck dissection (RND) or its modifications for laryngeal or hypopharyngeal SCC were retrospectively reviewed. Preoperative tumor and neck stages, the sites and the number of metastatic lymph nodes were recorded. Patients treated with selective neck dissection (SND) or preoperative chemotherapy and/or radiation therapy were excluded. RESULTS: Of 155 RND or modified RND performed for 113 laryngeal and 13 hypopharyngeal SCC, lymph node metastases were detected in 51 specimens, all of which spared level I. The most frequently involved levels were II and III. CONCLUSION: Selective neck dissection sparing level I may be appropriate for clinically and radiologically N0 patients with laryngopharyngeal carcinoma.