The Effect of Hormone Replacement Treatment on Hearing Function in Hypothyroid Patients.

Congenital hypothyroidism causes physiologic, morphologic and developmental abnormalities of the auditory system. However, the effect of acquired hypothyroidism and hormone replacement treatment (HRT) on hearing function is still controversial. This study aimed to investigate hearing impairment and the effect of HRT on hearing function in patients with acquired hypothyroidism. MATERIALS AND METHODS: Fifty hypothyroid patients were included in this study. Levothyroxine (0.05-0.2 mg/dl) was used for HRT and its dosage was gradually increased until the patients became euthyroid. Otoscopy and microscope was used to evaluate tympanic membrane and hearing thresholds and pure tone avarages (PTA) were estimated by using pure tone audiometry before and after treatment. RESULTS: Patients with lower baseline free T4 (FT4) had significantly higher air conduction PTA (p < 0.05). Negative correlation between the severity of hypothyroidism and hearing gain were found (p < 0.05). Hearing improvements were at 250 and 8000 Hz after HRT. CONCLUSION: Due to the correlation between baseline FT4 and hearing impairment in a negative direction, disease severity may have an effect on hearing impairment. In addition, patients with lower FT4 and higher thyroid-stimulating hormone levels had lower PTA improvement after HRT. HRT may not significantly improve hearing disorders in severe hypothyroidism.

Adenotonsillar hypertrophy: correlation between obstruction types and cardiopulmonary complications.

OBJECTIVES/HYPOTHESIS: To evaluate the association of upper airway obstruction (UAO) type and cardiopulmonary complications in children. The effect of obstruction type on quality of life and severity of obstructive symptoms were also investigated. STUDY DESIGN: Cross-sectional study. METHODS: A Brodsky scale and adenoid-nasopharynx ratio (ANR) were used to categorize tonsil and adenoid size, respectively. The patients were divided into four groups according to obstruction type: adenoid hypertrophy only (ANR ≥ 0.63, tonsil grade 1 or 2), adenoid and tonsil hypertrophy (ANR ≥ 0.63, tonsil grade 3 or 4), tonsillar hypertrophy only (ANR < 0.63, tonsil grade 3 or 4), and normal (ANR < 0.63, tonsil grade 1 or 2). Mean pulmonary artery pressure (MPAP), tricuspid annular plane systolic excursion (TAPSE), and right ventricle myocardial performance index (RVMPI) were evaluated for each patient. The obstructive sleep apnea questionnaire (OSA-18) and Brouilette symptom score questionnaire were completed by each child's parents. RESULTS: MPAP was higher in patients with adenoid hypertrophy and adenoid and tonsil hypertrophy in comparison with the normal group. The P values were .079 and .055, respectively, when comparing TAPSE and RVMPI measurents in adenoid and tonsil hypertrophy and normal patients. A significant correlation was found between ANR and MPAP, RVMP, and TAPSE. The patients in the adenoid and tonsil hypertrophy group had the highest Brouilette symptom and OSA-18 scores. CONCLUSIONS: Patients with adenoid and tonsil hypertrophy are at a higher risk for cardiopulmonary complications, poorer quality of life, and more severe UAO symptoms and should have priority for surgical treatment to prevent cardiopulmonary complications.

Orofaciodigital syndrome.

Orofaciodigital syndrome is a very rare entity with X-linked dominant inheritance characterized by oral, facial, and digital anomalies. Thirteen different types have been described in the literature to date. Of these, orofaciodigital syndrome type I has the highest incidence. Renal and central nervous system malformations may accompany the oral, facial, and digital anomalies. We report a case of orofaciodigital syndrome type I in a 9-year-old girl. The patient was admitted with a complaint unrelated to the syndrome. The coexistence of an oral anomaly with a digital anomaly in this patient led us to search for other possible anomalies. Ultrasonography revealed a diagnosis of polycystic kidneys. Physicians must be mindful of the external appearance of patients with this syndrome and be aware of life-threatening anomalies possibly associated with it.

The role of computed tomography scanning in chronic otitis media.

The purpose of this study was to determine the role of high-definition computed tomography (CT) in chronic otitis media (COM) patients and to present which parameters were useful or misleading for preoperative evaluation for management. Fifty cases of COM that underwent preoperative CT scanning at a tertiary referral center were retrospectively analyzed. Their CT scan reports were compared with the operative findings. The patients had undergone tympanoplasty with or without mastoidectomy for COM between April 2008 and January 2010. Patient charts were used to obtain the necessary data. In 62% (31/50) of cases, the CT scan showed the presence of cholesteatoma. Operative findings revealed cholesteatoma in 61.8% (19/31) of these cases. However, when a bone eroding soft tissue mass involved the epitympanum on CT, the presence of cholesteatoma was observed in 83.3% (15/18) of cases intraoperatively. Cholesteatoma was present in the mastoid or middle ear intraoperatively in 77.7% (7/9) of patients with an external ear bony canal defect found on CT. Despite 89.7, 85.29, and 90% agreement ratios for dehiscence of facial canal, lateral semicircular canal, and tegmen, respectively, CT could not detect dehiscence of these anatomic structures successfully. Based on these results, CT scanning has limitations but is a useful adjunct for the surgical management of COM patients.

The effect of adenotonsillectomy on serum insulin like growth factors and the adenoid/nasopharynx ratio in pediatric patients: a blind, prospective clinical study.

OBJECTIVES: Obstructive adenoid and tonsillar hyperplasia may present with retardation of growth. An adenoid-nasopharynx (A/N) ratio determined by means of lateral cephalometric radiographs has long been used as a diagnostic tool in the assessment of adenoid size. This study was designed to investigate the effect of adenotonsillectomy on insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) levels and correlation between A/N ratio and IGF-I and IGFBP-3 levels. METHODS: Patients (n=48) that had been operated on our clinic with a diagnosis of adenotonsillar hypertrophy between July 2009 and January 2010 were included in the study. The routine ear-nose and throat examination was done in all patients. Blood samples were taken, and lateral cephalometric radiographs were obtained preoperatively and repeated at 6-9 months (mean 7.2 ± 1.0 mo) following tonsillectomy and adenoidectomy. The chemiluminescent enzyme-linked immunosorbent method was used to IGF-I and IGFBP-3 levels. Each cephalometric radiograph was evaluated by a blinded radiologist. The A/N ratio was calculated using the Fujioka method. RESULTS: When the preoperative and postoperative results were compared, a statistically significant increase in serum IGF-I and IGFBP-3 and a decreased A/N ratio were found. However, although correlation between the Δ(preoperative-postoperative difference) IGFBP-3 and ΔA/N ratio was 40%, it was not statistically significant. Additionally, no statistically significant correlation between the ΔIGF-I and ΔA/N ratio was found. CONCLUSIONS: The results of the present study indicate that adenotonsillectomy could result in the relief of nasopharyngeal obstruction and have a positive effect on growth in children by decreasing the A/N ratio and increasing IGF-I and IGFBP-3. There was no correlation between the ΔA/N ratio and ΔIGF-I and ΔIGFBP-3 levels.

Effects of ovariectomy and estrogen replacement therapy on laryngeal tissue: a histopathological experimental animal study.

OBJECTIVE: To determine the histopathological effect of estrogen deficiency and hormone replacement treatment on laryngeal tissue in ovariectomized rats. STUDY DESIGN: Animal study. SETTING: The study was conducted at the animal experiment laboratory of Marmara University School of Medicine, Istanbul, Turkey. SUBJECTS AND METHODS: Six-month-old female Wistar albino rats were divided into the following 3 groups (n = 8 per group): sham-operated control, ovariectomized, and ovariectomized with estrogen replacement. Rats in the ovariectomized with estrogen replacement group received 17 ß-estradiol valerate (200 µg/kg, subcutaneously) once a week. Animals were killed after 8 weeks of intervention. RESULTS: Significant changes were observed in the ovariectomized group when edema in lamina propria, inflammation in squamous, respiratory epithelia and lamina propria, pseudostratification, and cilia loss were assessed. Except cilia loss, there were no significant differences in the assessments between the sham-operated control and ovariectomized with estrogen replacement groups. CONCLUSIONS: On the basis of histopathological evaluations, it was shown that estrogen replacement helped to improve laryngeal changes due to experimentally induced menopause.

[Evaluation of the duration of postoperative pain control obtained with bupivacaine injection into the tonsillar region in children who underwent tonsillectomy]. / Tonsillektomi yapilan çocuklarda tonsiller bölgeye bupivakain enjeksiyonu ile saglanan ameliyat sonrasi agri kontrolü süresinin degerlendirilmesi.

OBJECTIVES: In this study the effectiveness of postoperative pain control and its probable duration, in the group of pediatric tonsillectomy patients after peroperative application of long acting local anesthetic agent bupivacain to tonsillar fossa is searched. PATIENTS AND METHODS: Our study is a prospective, double-blind, case-control study. A total of 80 children consisting of 50 cases (24 girls, 26 boys; mean age 8.4 ± 2.1 years; range 6 to 12 years) and 30 controls (16 girls, 14 boys; mean age 8.1 ± 1.7 years; range 6 to 12 years) undergoing tonsillectomy were included in this study. Before tonsillectomy 2 ml (0.5 mg/ml) adrenaline-free bupivacain (Marcain, AstraZeneca) injected both of tonsillar fossa in study group, and normal saline injected with the same technique to control group. Face scale is used for pain measurement in both groups. Pain scores were measured at 2, 6, and 24 hours, seventh day and during the first oral intake postoperatively in both groups. RESULTS: We found a significant difference in postoperative second and sixth hours value, when compared control and study groups (p<0.001). No significant difference is found in postoperative 24th hours and first week between study and control group (p>0.001). In our study preincisional bupivacain infiltration makes significant reduction in postoperative pain according to placebo at postoperative second and sixth hours. In both groups at postoperative 24th hours and first week we ascertain significant pain reduction according to postoperative second and sixth hours, but no difference is found between study and control group. CONCLUSION: Intraoperative preincisional bupivacain injection is useful in postoperative pain control at early period of time in children undergoing tonsillectomy. But it has no effect in pain reduction after 24 hours.

Effect of adenotonsillectomy on endothelin-1 and C-reactive protein levels in children with sleep-disordered breathing.

OBJECTIVE: This study aimed to evaluate the influence of adenotonsillectomy on the plasma concentration of endothelin-1 (ET-1) and C-reactive protein (CRP) in children with sleep-disordered breathing (SDB). The relationship between quality of life and ET-1 levels was also evaluated. SETTING: Tertiary referral center. STUDY DESIGN: Before-and-after case series. METHODS: Fasting blood samples for ET-1 and high-sensitivity CRP were drawn preoperatively in all patients and at 3 to 4 months postoperatively. The Obstructive Sleep Apnea-18 (OSA-18) survey and Brouilette symptom score were completed by each child's parents during the same time periods. RESULTS: The mean ET-1 level decreased from 3.51 ± 0.93 fmol/mL to 2.67 ± 0.69 fmol/mL postoperatively (P < .01). OSA-18 survey scores and Brouilette symptom scores also decreased in the postoperative period (P < .01). When comparing moderate and severe cases to mild cases according to Brouilette scores, ET-1 levels were significantly higher in moderate and severe cases (P < .01). There was a significant correlation between ET-1 and the OSA-18 survey scale (r = 0.442; P = .001). Although CRP levels decreased from 0.63 ± 1.19 mg/dL to 0.31 ± 0.23 mg/dL postoperatively, this was not statistically significant. CONCLUSION: Adenotonsillectomy effectively lowered plasma ET-1 levels in children with SDB and thus may have reduced their related risk for cardiovascular disease. In addition, adenotonsillectomy improved quality of life in this group.

Effect of type I tympanoplasty on the quality of life of children.

OBJECTIVES: Quality-of-life issues related to chronic otitis media (COM) include physical symptoms, emotional symptoms, hearing loss, speech symptoms, social symptoms, and parents' emotional symptoms. In this study we evaluated the effects of tympanoplasty on the quality of life of pediatric patients. METHODS: In a questionnaire-based outcome study, we reviewed 56 of 78 pediatric patients with COM who were treated with type I tympanoplasty at our institution between December 2008 and February 2010. All patients were asked to fill out the COM-5 questionnaire with their parents, before operation and 6 months after operation. Preoperative and postoperative total ear scores, preoperative and postoperative ear scores with an intact tympanic membrane, preoperative and postoperative ear scores with a perforated tympanic membrane, and preoperative and postoperative audiological results were assessed. RESULTS: After type I tympanoplasty, 45 patients (80.3%) had successful closure of the tympanic membrane, but 11 patients (19.7%) had unsuccessful closure of the tympanic membrane. There was a significant decrease in physical suffering, hearing loss, emotional distress, activity limitations, and caregiver's concerns scores in patients with intact tympanic membranes after operation (p < 0.01). CONCLUSIONS: Children with COM had a significant increase in their quality of life after successful tympanoplasty. Our results also suggested that tympanoplasty was successful in pediatric patients with COM.

Traumatic arteriovenous fistula of the upper lip: a case report.

Traumatic arteriovenous fistula (AVF) is often challenging to diagnose and manage. Those involving the external carotid artery or its branches occur relatively rarely. We present a case of a vascular mass of the upper lip at the right side with a previous history of blunt trauma. AVF of the upper lip can be successfully managed with the preservation of lip function and the cosmetic appearance through surgical excision without embolisation if there is good local access to the lesion.

Salivary gland choristoma of the middle ear in a child with situs inversus totalis.

Salivary gland choristoma of the middle ear cavity is an extremely rare entity. It is thought to be a developmental abnormality and may be associated with abnormalities of adjacent structures. We report a case of salivary gland choristoma of the middle ear with prominent Körner's septum in a 7-year-old girl with situs inversus totalis. Situs inversus totalis is the mirror image reversal of the normal position of the internal organs and frequently associated with other congenital anomalies. This patient is the first reported case with situs inversus totalis, having middle ear salivary gland choristoma and prominent bilateral Körner's septae. The management and the differential diagnosis of this condition are discussed with the review of the literature.

Effect of upper airway obstruction on pulmonary arterial pressure in children.

OBJECTIVE: Our aim was to examine the elevation of pulmonary arterial pressure in children with upper airway obstruction caused by adenotonsillar hypertrophy according to their disease severity assessed with symptom scoring and to demonstrate the profit for echocardiographic monitorization of the children with adenotonsillar hypertrophy regardless of their clinical status. METHODS: Thirty-nine children with a diagnosis of upper airway obstruction caused by adenotonsillar hypertrophy were included for the study. There were 16 female and 23 male patients. Ages of the children were between 3 and 10 years with a mean age of 5.78+/-1.98. Twenty children composed the control group with a similar age and sex distribution but without any sign and symptom of upper airway obstruction. Mean pulmonary arterial pressures were measured by Doppler echocardiography preoperatively and 6 months postoperatively. Symptom scores were calculated for each patient in the study group to assess their disease severity. The significances of changes and relations between pressure levels and symptom scores were calculated by statistical package for social sciences (SSPS) computer program in terms of Student's test, chi(2)-test and Mc Nemar's test. RESULTS: Mean pulmonary arterial pressure were 26.26+/-5.40 (14-36) preoperatively, 16,61+/-2.68 (10.15-22.3) postoperatively and 16.54+/-2.63 (10.5-21.7) in the control group. There were a statistically significant decrease at pressure levels postoperatively and a significant difference from the levels in the control group (Student's t-test, p<0.01). We found no correlation between the pressure levels and disease severity assessed in terms of symptom scoring. CONCLUSION: This study showed that upper airway obstruction caused by adenotonsillar hypertrophy causes significant elevation of pulmonary arterial pressures and adenotonsilectomy is an absolute therapeutic method in these children. Every child with adenotonsillar hypertrophy has some probability of having pulmonary hypertension regardless of his or her disease severity. Therefore, performing echocardiographic examination to all children with adenotonsillar hypertrophy is beneficial for assessing the cardiopulmonary status of the patient and may be useful at decision making for adenotonsilectomy.

[The correlation of vascular endothelial growth factor with angiogenesis and p53 gene in laryngeal squamous cell carcinoma]. / Larenksin skuamöz hücreli kanserlerinde vasküler endotelyal büyüme faktörünün anjiyogenez ve p53 geni ile iliskisi.

OBJECTIVES: Angiogenesis is a fundamental process in tumor growth and metastasis. Vascular endothelial growth factor (VEGF) is a key regulator of angiogenesis and it has been identified in a wide variety of malignancies, including head and neck squamous cell carcinoma. However, the regulation of VEGF expression in tumor angiogenesis is not well defined. The tumor-suppressor gene p53 is thought to regulate VEGF. In this study, we examined the role of p53 gene in VEGF expression. PATIENTS AND METHODS: Clinical records of patients who underwent total or partial laryngectomy between 1999 and 2002 were reviewed. Of these, paraffin-embedded specimens of 27 patients (27 males; mean age 55 years; range 39 to 74 years) with a diagnosis of larynx epidermoid carcinoma were immunostained to evaluate VEGF expression, p53 gene status, and microvessel density (MVD). Variables were statistically examined. RESULTS: Vascular endothelial growth factor positive staining was detected in 11 (40.7%) and p53 mutations were identified in 16 (60%) tumors. No association was detected between p53 mutations and VEGF expression (p>0.05). Statistical analysis gave a clear correlation between tumor vascularity and VEGF expression (p<0.05). Vascular endothelial growth factor negative tumors showed a lower mean number of microvessels per microscopic field (29.6+/-6.6) than VEGF positive tumors (40.8+/-15.2). P53 and VEGF expression, and MVD were not correlated with the T-stage, N-status, tumor localization, and histological grading (p>0.05). CONCLUSION: The higher microvessel density in VEGF positive tumors supports the importance of VEGF for tumor angiogenesis in laryngeal carcinoma. However, our results do not support the hypothesis concerning a p53 regulation in the angiogenic process through a VEGF up-regulation.

[Nasal schwannoma: a report of two cases]. / Nazal schwannom: Iki olgu sunumu.

Schwannomas are benign neoplasms arising from Schwann cells of peripheral, cranial and autonomic nerves. Schwannomas of the head and neck comprise 25% to 45% of all schwannomas; however, nasal and paranasal schwannomas account for 4% of these tumors. In this report, two cases of nasal schwannoma are presented. One was a 67-year-old female patient whose tumor completely filled the right nasal cavity and extended beyond the maxillary and ethmoid sinuses. The other patient was a 10-year-old child who had a tumor in the left lateral nasal wall, which is a rare case considering her age. A lateral rhinotomy approach was used in the first patient due to the wide extension of the tumor. In the second case we preferred the intranasal approach because the tumor had limited extension. No recurrences were seen in the postoperative follow-up periods.

[Ethmoid sinus osteoma with orbital extension]. / Orbital yayilimli etmoid sinüs osteomu.

Osteoma is the most common neoplasm of the paranasal sinuses. A fifty-year-old woman who had presented with complaints of protrusion of the eyeball and double vision was referred to our department with a diagnosis of proptosis. Computed tomography of the paranasal sinuses and the orbits showed a high-density mass of 2x3 cm, involving the left ethmoidal cells laterally, the left maxillary sinus superomedially, the left orbit inferomedially, and the nasal cavity superiorly. The mass was removed through the external ethmoidectomy approach. Postoperatively, all visual functions improved. The pathologic diagnosis was osteoma.