A rare presentation of langerhans cell histiocytosis tonsil infiltration: review of the literature: atypical presentation of langerhans cell histiocytosis.

Langerhans cell histiocytosis (LCH) is a rare disease that can infiltrate various organs. LCH presents with solitary organ involvement or as a multi-system disease. We present a patient who has tonsillary infiltration with LCH. A 74 year-old Caucasian male was admitted for swelling of the neck and difficulty swallowing for 3 months. Physical examination showed submandibular lymph node enlargement of approximately 3 cm and tonsil enlargement. A tonsillectomy and excisional biopsy of the lymph node were done. Histiocyte-like cell infiltration was seen in the tonsil biopsy. CD3, CD20, CD15, CD30, CD5, CD138, Lambda, Kappa, Bcl-2, ALK, CD23, CD10, Bcl-6, keratin, EMA, HMB-45, and Cyl D1 were negative. CD68, S-100, CD1a, and fascin were positive, and the Ki-67 proliferation index was 20 % in immunocytochemical staining. The most commonly infiltrated bones are the skull, femur, lower jaw, pelvis, and vertebrae in LCH. Oral or perioral lesions are present in 30 % of cases. Oral lesions most often involve bone loss, unexpected tooth loss, and gum inflammation. We administered oral prednisolone to our patient due to the presence of lytic lesion of the bone, mild anemia and a higher sedimentation rate, which was from a separate, explained cause. Isolated tonsillar involvement in adult LCH was reported in only 2 cases in the literature. There is no standard recommendation for treatment. Our patient responded well to steroid therapy.

Comparison of Acoustic and Stroboscopic Findings and Voice Handicap Index between Allergic Rhinitis Patients and Controls.

BACKGROUND: In our experience Allergic Rhinitis (AR) patients suffer from voice problems more than health subjects. AIMS: To investigate the acoustic analysis of voice, stroscopic findings of larynx and Voice Handicap Index scores in allergic rhinitis patients compared with healthy controls. STUDY DESIGN: Case-control study. METHODS: Thirty adult patients diagnosed with perennial allergic rhinitis were compared with 30 age- and sex-matched healthy controls without allergy. All assessments were performed in the speech physiology laboratory and the testing sequence was as follows: 1. Voice Handicap Index (VHI) questionnaire, 2. Laryngovideostroboscopy, 3. Acoustic analyses. RESULTS: No difference was observed between the allergic rhinitis and control groups regarding mean Maximum Phonation Time (MPT) values, Fo values, and stroboscopic assessment (p>0.05). On the other hand, mean VHI score (p=0.001) and s/z ratio (p=0.011) were significantly higher in the allergic rhinitis group than in controls. CONCLUSION: Our findings suggest that the presence of allergies could have effects on laryngeal dysfunction and voice-related quality of life.

Benign paroxysmal positional vertigo following septorhinoplasty.

We present 2 cases of benign paroxysmal positional vertigo (BPPV) following septorhinoplasty. Benign paroxysmal positional vertigo following septorhinoplasty is an unusual entity. Two young women who had difficulty in breathing and nasal deformity underwent septorhinoplasty. On the second and the third postoperative days, the patients experienced vertigo that was induced by position changes. Both patients had neither preexisting ear disease nor vertigo before the surgery. All the examinations were normal. With Dix-Hallpike maneuver, which is the criterion-standard test, the characteristic nystagmus was observed. Right posterior canal BPPV was diagnosed, and they were both treated with Epley canalith repositioning maneuver. Publications related to postsurgical vertigo are available in literature, but it is still an underdiagnosed disorder. We would like to mention about this rare entity and inform the surgeons that they must keep in mind that a patient who is complaining about vertigo or dizziness after the surgery should be observed and investigated for BPPV.

The Score For Allergic Rhinitis study in Turkey.

BACKGROUND: The clinical definition of allergic rhinitis (AR) is difficult to use in epidemiological settings of large populations where it is impossible to obtain the laboratory evidence of each immune response. However, the standardization of the definition of AR in epidemiological studies is of crucial importance. This study was designed to estimate the prevalence of AR in an adult general population with respect to seven distinct geographical regions in Turkey. METHODS: Individuals were evaluated with the Score for Allergic Rhinitis (SFAR) questionnaire for a national cross-sectional study. The Turkish version of the SFAR questionnaire was tested for clarity and sensitivity in a small sample of the general population. RESULTS: Among the 3967 interviewed subjects, the overall prevalence of AR was 29.6%, with regional variations (from 21.0% in the southeastern Anatolia region to 36.1% in the Marmara region). The prevalence was higher in women and in urban area of residence. CONCLUSION: This national survey confirmed the elevated prevalence of AR in Turkey. Our findings may contribute to the formulation of the public health policy and development of preventive and therapeutic strategies for AR in eastern Europe.