The Long Term Results of Hyaluronic Acid/Dextranomer Injection Laryngoplasty in Unilateral Vocal Fold Paralysis.

OBJECTIVE: This study was conducted to present the long-term functional outcomes of injection laryngoplasty (IL) with hyaluronic acid/dextranomer (HA/D) in unilateral vocal fold paralysis (UVFP). METHODS: A total of 40 patients who underwent HA/D injection for UVFP were enrolled. The acoustic analysis of the voice was evaluated with jitter percentage, shimmer percentage, maximum phonation time, harmonics-to-noise ratio, and fundamental frequency. The psychosocial effect of the voice was determined using the Voice Handicap Index-10. Fiberoptic endoscopic evaluation of swallowing was performed and 2 scales were used for quantification: a modified penetration-aspiration scale and a dysphagia score. All measurements were performed at preoperative day and postoperative months 1, 6, and 24. RESULTS: A statistically significant improvement was observed for all of the evaluated parameters except the maximum phonation time for postoperative months 1, 6, and 24 (P < .05). In the evaluation of the maximum phonation time, although there was a significant improvement for the postoperative months 1 and 6, no significant difference was observed between the postoperative 24th month and the preoperative value. CONCLUSIONS: HA/D injection laryngoplasty is an effective method both in the short- and long-term to improve voice and swallowing functions in patients with UVFP.

Functional Outcomes of the Hyaluronic Acid Injections in Patients Who Underwent Partial Laryngectomy.

OBJECTIVE: The purpose of this study was to investigate the effects of hyaluronic acid injection on dysphagia, aspiration, and voice problems in patients with persistent functional problems despite appropriate rehabilitation after partial laryngectomy. METHODS: Seventeen patients who underwent hyaluronic acid injection due to persistent swallowing, aspiration, and voice problems after partial laryngectomy surgery were included in the study. The hyaluronic acid injection was performed after 2 years of follow-up after partial laryngectomy surgery. Evaluation of swallowing was performed through a fiberoptic endoscopic evaluation of swallowing and was quantified using two scales: a dysphagia score and a modified penetration-aspiration scale. Voice Handicap Index-10 was used for the determination of the psychosocial handicapping effects of the voice. Jitter percent, shimmer percent, fundamental frequency, harmonics-to-noise ratio, and maximum phonation time were evaluated for the acoustic analysis of the voice. All measurements were performed at preoperative day and postoperative months 1, 6, and 24. RESULTS: A statistically significant improvement was observed for all of the evaluated parameters except the harmonics-to-noise ratio for postoperative months 1 and 6 (P < 0.05). There was no statistically significant difference between the postoperative sixth month and the preoperative value of the harmonics-to-noise ratio. A statistically significant improvement was observed between the postoperative 24th month and preoperatively for jitter percent, shimmer percent, fundamental frequency, maximum phonation time, dysphagia, and penetration aspiration score (P < 0.05). CONCLUSION: Surgical rehabilitation should be considered along with conservative treatments to improve swallowing and voice function after partial laryngectomy. Hyaluronic acid injection may be an effective method both in the short and long term for the surgical rehabilitation of persisting functional problems that may occur following partial laryngectomies.

Differences of the Voice Parameters Between the Population of Different Hearing Tresholds: Findings by Using the Multi-Dimensional Voice Program.

OBJECTIVES: To compare voice parameters in subjects with different hearing level. METHODS: The evaluation consisted of Multi-Dimensional Voice Program (MDVP) and electroglottography. Group 1 consisted of normal hearing subjects which is bilateral average hearing better than 25 decibels (dB) whereas group 2 consisted of patients who have bilateral average hearing between the 25 and 60 dB and group 3 consisted of patients who have bilateral average hearing between the 60 and 90 dB. The evaluations were performed on males and females separately. RESULTS: In female subjects, fundamental frequency (F0), absolute jitter, %jitter and soft phonation index (SPI) were significantly different between the group 1 and group 2. Also, we detected significant difference on maximum phonation time (MPT), fundamental frequency, absolute jitter and %jitter, and variable F0 (vF0) values between group 1 and group 3. Male subjects demonstrated significant difference between the group 1 and group 2 in MPT, absolute jitter, %jitter, vF0, and SPI parameters. Between the group 3 and group 1; differences in absolute jitter, %jitter, shimmer, %shimmer, vF0, and SPI were also significant. CONCLUSION: This study concluded that even mild to moderate hearing losses may affect voice patterns in adults and also females and males react differently to hearing loss in some parameters.

Isolated middle ear meningioma.

Meningiomas are slowly progressive, benign tumors that originate from meningothelial cells. Extracranial meningiomas, especially isolated middle ear meningiomas, are very rare. In this article, we report a rare secretory type primary middle ear meningioma which was histopathologically confirmed in a 46-year-old female patient who presented with otological and neurootological symptoms.

A case of oculoglandular tularemia resistant to medical treatment.

Tularemia is a zoonotic disease of the northern hemisphere. Oculoglandular tularemia is the rarest form, comprising 1.4-4.2% of all cases. We present a patient with oculoglandular tularemia that did not respond to gentamicin to demonstrate the need for prolonged antimicrobial treatment and surgical intervention.

Congenital hairy polyp of the soft palate.

Hairy polyp is an unusual developmental malformation that is most frequently seen as a pedunculated tumor in the neonate. They are benign lesions containing elements of both ectodermal and mesodermal origin. The symptoms of hairy polyps relate both to their location and their size. Larger lesions produce symptoms due to feeding difficulties and airway obstruction while smaller lesions cause intermittent symptoms resulting from a ball-valve type of obstruction. We present two cases of a soft palate hairy polyp causing respiratory and feeding difficulties and review the literature.

Recurrent and Massive Life Threatening Epistaxis due to Nasal Heroin Usage.

Epistaxis, active bleeding from the nose, is a common ear nose and throat emergency, and can be severe or even fatal. We report a severe life threatening recurrent massive nasal bleeding caused by intranasal heroin use that has not hitherto been reported in the English literature. A 24-year-old male who took heroin several times nasally presented with massive nasal bleeding. A blood transfusion and an operation to halt nasal bleeding were required. The patient did not experience a bleeding attack 2 months following cessation of nasal heroin use.

Evaluation and management of antrochoanal polyps.

Antrochoanal polyps (ACPs) are benign polypoid lesions arising from the maxillary antrum and they extend into the choana. They occur more commonly in children and young adults, and they are almost always unilateral. The etiopathogenesis of ACPs is not clear. Nasal obstruction and nasal drainage are the most common presenting symptoms. The differential diagnosis should include the causes of unilateral nasal obstruction. Nasal endoscopy and computed tomography scans are the main diagnostic techniques, and the treatment of ACPs is always surgical. Functional endoscopic sinus surgery (FESS) and powered instrumentation during FESS for complete removal of ACPs are extremely safe and effective procedures. Physicians should focus on detecting the exact origin and extent of the polyp to prevent recurrence.

Analgesic efficacy of topical tramadol in the control of postoperative pain in children after tonsillectomy.

PURPOSE: Pain control after tonsillectomy is still a controversial issue. Topical approaches have the advantage of pain control with good patient acceptability. Therefore, this study was conducted to evaluate the effects of topical tramadol on postoperative pain and morbidity in children undergoing tonsillectomy. METHODS: A prospective, randomized, double-blind, controlled clinical study was designed. Forty children aged between 4 and 15 years, ASA I-II, scheduled for elective tonsillectomy and/or adenoidectomy were randomized into two groups. For patients in Group T (n = 20) swabs soaked with 2 mg/kg tramadol diluted in 10 ml saline were applied to both of their tonsillar fossa for 5 min; in the control group (n = 20) swabs soaked with 10 ml saline were applied. Postoperative pain scores, bleeding, nausea, vomiting, abdominal discomfort, constipation, pain in the throat, painful swallowing, fever, otalgia, trismus, and halitosis were recorded at the first, fifth, thirteenth, seventeenth, twenty-first, and twenty-fourth postoperative hours and the week after tonsillectomy. RESULTS: Pain scores were found to be significantly lower at the 21st hour and on postoperative day seven in the tramadol group compared with the control group (p < 0.05). Mean daily pain scores ranged from Day 1: 0.34 (±0.21) to Day 7: 0.11 (±0.08) in the tramadol group and Day 1: 0.53 (±0.14) to Day 7: 0.42 (±0.15) in the control group. There were no significant differences in morbidity between the groups (p > 0.05). CONCLUSION: Topical 5% tramadol with its local anesthetic effect seems to be an easy, safe, and comfortable approach for pain management in children undergoing tonsillectomy.

Myringosclerosis after tympanostomy tube insertion: relation with tube retention time and gender.

OBJECTIVE: To determine relationship between myringosclerosis and tube retention time and sex in children with chronic otitis media with effusion who were treated with tympanostomy tube insertion. Also, the relationship between myringosclerosis both sex and initial age of tube insertion were investigated. METHODS: A total of 101 children (195 ears) were reviewed. Ears were divided into four groups according to retention time of tympanostomy tubes. Group I: Retention time of tympanostomy tube less than 6 months. Group II: Retention time of tympanostomy tube from 6 months to 12 months. Group III: Retention time of tympanostomy tube of 12 months or more. Group IV: Myringotomy group without tympanostomy tube insertion. RESULTS: The order of the myringosclerosis rates were as follows from the highest to lowest one; group III (44.1%), group II (42.4%), group I (14.3%), and group IV (7.7%). Myringosclerosis was more common in group I compared with group IV, but the difference was statistically not significant (p>0.05). There were no statistically significant differences in myringosclerosis rates between the group II and group III (p>0.05). On the other hand, statistically significant differences were observed in myringosclerosis rates between group I and group II (p<0.05), and between group I and group III (p<0.05); also similar significant differences were present in myringosclerosis rates between group IV and group II (p<0.05), and between group IV and group III (p<0.05). There was no significant difference between preschool age group and school age group. Myringosclerosis was observed in 40% of boys and in 51.2% of girls. CONCLUSION: Myringosclerosis is frequent in patients who underwent tympanostomy tube insertion. The frequency of myringosclerosis is much higher in tympanic membranes with tympanostomy tube insertion than tympanic membranes with myringotomy, and the location of sclerotic plaques does not always correspond to the tympanostomy area. The myringosclerosis rate was increased when the tympanostomy tubes stay on tympanic membrane for a long time. Highest myringosclerosis rates were observed if the extrusion time was 12 months or longer. In our analysis, sex and initial age of tube insertion were not significant factors for the development of myringosclerosis after extrusion of tympanostomy tubes.

Shepard grommet tympanostomy tube complications in children with chronic otitis media with effusion.

The objective of this study was to determine tympanostomy tube complications in children with chronic otitis media with effusion who were treated with Shepard grommet tympanostomy tube insertion. This tube type was selected as it is the most commonly used one in our clinic. The medical records of 162 ears of 87 children (52 male and 35 female) were reviewed retrospectively. The children were between 3 to 16 years old (mean age = 8.1 +/- 3.1). The patients were followed up 6-66 months (mean 23.3 +/- 14.9 months) after tympanostomy tube insertion. We reviewed age, sex, time to tube extrusion and complications. In all patients the indication for surgery was chronic middle ear effusion. Otorrhea occurred in nine ears (5.6%). Granulation tissue was seen in two ears (1.2%). Complications after tympanostomy tube extrusion included myringosclerosis (34.6%), persistent perforation (5.6%), atrophy (23.5%), retraction (16.7%) and medial displacement of tubes (1.2%). The average extrusion time was 8.5 +/- 4.6 months (range 1-24) for Shepard grommet tympanostomy tubes. Complications of tympanostomy tube insertion are common. Myringosclerosis, tympanic membrane atrophy and otorrhea are the most frequently appearing complications. But they are generally insignificant and cosmetic. Consequently, in the majority of these complications there is no need for any management.

Otitis media with effusion: recurrence after tympanostomy tube extrusion.

OBJECTIVE: The incidence rate of recurrence of otitis media with effusion (OME) in children after tympanostomy tube extrusion and the relationship between recurrence and tube retention time was investigated. Also relationship between recurrence rate and initial age of tube insertion was analysed. STUDY DESIGN: A retrospective case series of patients who had tympanostomy tube insertion. METHODS: A total of 91 children (169 ears) were reviewed. Ears of children divided into three groups according to retention time of tympanostomy tubes. Group I: tympanostomy tube retention time less than 6 months. Group II: tympanostomy tube retention time 6 months to 12 months. Group III: tympanostomy tube retention time 12 months or more. RESULTS: OME recurrence rate after tube extrusion was 20.7% in the study. The longer the tympanostomy tube retention time was the lower was the recurrence rate of OME. The comparison of the three groups indicated that recurrence rates were higher in group I (36.54%), than in group II (17.74%) and in group III (9.1%). There were statistically significant differences in recurrence rates between group I and group III, and between group I and II (p<0.05, p<0.05). However, the difference in recurrence rates between group II and group III was statistically not significant (p>0.05). In the preschool age group and school age group, the recurrence rates were 5.5% and 15.4%, respectively. There was no significant difference between these two groups (p>0.05). OME recurrence was observed in 9.9% of males and in 11% of females. There was no significant difference in recurrence rates between males and females (p>0.05). CONCLUSION: After extrusion of tympanostomy tube, children should be followed-up regularly for recurrence of OME. The shorter the retention time of tympanostomy tubes was the higher was the recurrence rate. For the treatment of OME the ideal type of tubes should have the lowest complication and recurrence rates. Further studies are needed to ascertain the relationship between the incidence of OME and optimal tympanostomy tubes duration of tube stay in tympanic membrane. Therefore, new studies with larger series are necessary to investigate the correlation between the recurrence rates and different tympanostomy tubes after extrusion of tubes.

The effects of topical levobupivacaine on morbidity in pediatric tonsillectomy patients.

OBJECTIVE: To reduce the post-tonsillectomy morbidity by swab soaked with 5 ml levobupivacaine hydroclorur (25 mg/10 ml). STUDY DESIGN: A double-blind prospective randomized controlled clinical study. METHODS: In this randomized double-blind study in group I (30 children, mean age 7.5+/-2.6) we tightly packed swab soaked with 5 ml levobupivacaine hydroclorur (25mg/10 ml) and in group II (21 children, mean age 7.9+/-3.7) we used 5 ml saline swabs into each of the two tonsillar fossae after tonsillectomy for 5 min. We used McGrath's face scale to compare the two groups in respect of pain control. RESULTS: There was statistically significant pain relieving effect in the levobupivacaine group in the first 24h (p<0.05). But after 24h pain relieving effect of levobupivacaine was not significant (p>0.05). We did not see any serious complications for both groups. Postoperative morbidity mean results (nausea, vomiting, fever, bleeding, halitosis and ear pain) were not statistically different between the two groups (p>0.05). CONCLUSION: Topical levobupivacaine seems to be a safe and easy medication for postoperative pain control in pediatric tonsillectomy patients.

Auditory evaluation in Parkinsonian patients.

Twenty Parkinson's disease (PD) patients (mean age 69.9 years) and 24 normal individuals' (mean age 63.8) both ears were investigated by brainstem auditory evoked potentials (BAEPs) and pure tone audiometry (PTA). There were no statistically significant age differences between the patients and control subjects. PTA results were significantly elevated for PD patients in 4,000 and 8,000 Hz (P < 0.05). Parkinsonian patients showed significantly increased latencies in wave V and I-V interpeak latencies (P < 0.05). The results of this study suggest that PTA and BAEPs could be affected in parkinson disease.

Does pregnancy-associated plasma protein A have a role in allergic rhinitis?

BACKGROUND: Pregnancy-associated plasma protein A (PAPP-A), also known as insulin-like growth factor binding protein 4 protease, is postulated to be a new inflammatory marker in various clinical situations such as cardiovascular events, dialysis, renal transplantation, and asthma. PAPP-A also is produced in high concentrations by trophoblasts during pregnancy. METHODS: We evaluated PAPP-A levels in allergic rhinitis patients and compared these with levels in healthy subjects. Thirty-one newly diagnosed allergic rhinitis patients and 29 healthy controls were included in the study. Serum PAPP-A, IgE, urea, creatinine, aspartate aminotransferase, creatine kinase (CK), CK-MB isoenzyme, total cholesterol, and triglyceride levels were determined. RESULTS: The serum PAPP-A level was significantly higher (p = 0.013) in the allergic rhinitis group (6.1 +/- 2.9 mU/L) than in the control group (4.5 +/- 1.7 mU/L). The PAPP-A level in patients with allergic rhinitis and asthma (6.1 +/- 2.3 mU/L) was not significantly different (p = 0.959) from that in patients with allergic rhinitis alone (6.1 +/- 3.3 mU/L). The serum PAPP-A level in allergic rhinitis patients who had turbinate hypertrophy (6.9 +/- 2.2 mU/L) had a tendency to be higher than that in patients who had no turbinate hypertrophy (5.5 +/- 3.2 mU/L); however, this difference was not statistically significant (p = 0.151). CONCLUSION: Increased PAPP-A activity may be involved in the inflammation and tissue remodelling that occurs in allergic rhinitis.

Vasoconstriction and analgesic efficacy of locally infiltrated levobupivacaine for nasal surgery.

BACKGROUND: In this study, we compared the use of preincisional lidocaine 2% with epinephrine (LA) and levobupivacaine 0.25% plain (LB) for postoperative analgesia and vasoconstriction in patients undergoing nasal surgery. METHODS: Sixty patients were randomly assigned to receive preincisional local infiltration under general anesthesia. Group LB received levobupivacaine 0.25%, and group LA received epinephrine plus lidocaine 2% (add volume injected). Intraoperative hemodynamic changes, pre- and postoperative hemoglobin and hematocrit values were recorded. Visual analog scale values 30 min and 1, 2, 8, 12, and 24 h postoperatively and the need for rescue analgesic treatment in the first 24 h of all patients was recorded. RESULTS: At 30 min and 1, 2, 8, and 12 h postoperatively, visual analog scale values were lower in group LB than in group LA (P < 0.0001, P = 0.002, P = 0.023, P < 0.0001, and P = 0.011, respectively). The analgesic requirement was significantly lower in group LB when compared with that in group LA (P = 0.038). Group LB had significant differences between preoperative and postoperative hemoglobin and hematocrit values (P = 0.014 and 0.025). Group LA had significant differences between preoperative and postoperative hemoglobin and hematocrit values (P = 0.031 and 0.024). CONCLUSIONS: We conclude that postoperative analgesia in nasal surgery with local infiltration of levobupivacaine was significantly more potent and longer lasting than that achieved by lidocaine plus epinephrine.

Does topical ropivacaine reduce the post-tonsillectomy morbidity in pediatric patients?

OBJECTIVES: To determine whether post-operative administration of topical ropivacaine hydrochloride decreases morbidity following adenotonsillectomy. STUDY DESIGN: Prospective, randomized, double-blind clinical trial. SETTING: University referral center; ENT Department. PARTICIPANTS: Fourty one children, aged 4-16 years, undergoing tonsillectomy. METHODS: Patients received 1.0% ropivacaine hydrochloride soaked swabs packed in their tonsillar fossae while the control group received saline-soaked swabs. Mc Grath's face scale was used to compare the two groups in respect of pain control. Chi-square and two-tailed unpaired Student's t-tests or Mann-Whitney-U-tests were used to compare the two independent groups. As 10 we made 11 comparison between groups, for Bonferroni correction, p<0.005 was accepted as statistically significant. RESULTS: Only first hour there was no significant pain-relieving effect seen in the ropivacaine group (p>0.05). The other hours and days there were statistically significance between the two groups (p<0.001). Also, the other post-operative parameters such as nausea, fever, vomiting, odor, bleeding, otalgia and trismus were not statistically different between the two groups. There were no complications associated with ropivacaine hydrochloride. No patients in this study suffered systemic side effects related to the use of this medication. CONCLUSION: Locally 1.0% ropivacaine administration significantly relieves the pain of pediatric tonsillectomy and, it is a safe and effective method. High concentrations of ropivaciane may produce clinically significant pain relief. It is more effective to reduce of post-operative analgesic requirement after first hour.