Clinical features of deep neck infection: analysis of 77 patients.

OBJECTIVES: This retrospective study aims to detect the prognostic factors which affect the duration of hospital stay and evaluate the complications which develop in patients with deep neck infection. PATIENTS AND METHODS: The study included 77 patients (40 males, 37 females; mean age 42.4±20.1 years; range 11 to 88 years) treated with a diagnosis of deep neck infection in our clinic between November 2006 and November 2012. Patients' demographic and clinical features were analyzed to detect their associations with development of complications and hospitalization time. RESULTS: Odontogenic origin and submandibular localization were the most frequently observed clinical appearance. Of eight patients (10.4%) who developed serious complications, two (2.6%) died. Age, comorbidity, presence of anemia alone, Ludwig's angina and retropharyngeal involvement were associated with increased rate of complications (p<0.05); while sex, antibiotic usage prior to admittance and primary location of infection were not related (p>0.05). Submandibular localization and absence of leucopenia reduced the risk of complications (p<0.05). The mean duration of hospital stay was 12.9±8.7 days (range 2-59 days). Age, presence of comorbidity and development of complications extended the hospitalization period (p<0.05). CONCLUSION: In spite of the improvements in diagnosis and treatment, deep neck infection may be an important cause of mortality if complications develop. Comorbid anemia, Ludwig's angina and retropharyngeal involvement were identified as the strongest predictors in terms of development of complications. Duration of hospital stay extended in patients who developed complications.

Endoscopic endonasal transsphenoidal surgery for pituitary adenomas.

OBJECTIVE: The objective of this study was to report the efficacy, safety, and outcomes of endoscopic endonasal transsphenoidal techniques for pituitary adenomas. PATIENTS AND METHODS: A retrospective data analysis of 32 patients who underwent endoscopic endonasal transsphenoidal surgery for pituitary adenoma between February 2011 and December 2013 was performed. The patients' demographic data, clinical presentations, radiologic findings, recurrence rates, and complications were analyzed. RESULTS: There were 14 men and 18 women with age ranging from 23 to 74 years (mean age, 48.6 y). Functioning and nonfunctioning tumors were present in 22 (68.8%) and 10 patients (31.2%), respectively. Among the functioning adenomas, 8 patients (25%) had growth hormone-secreting adenomas, 6 patients (18.8%) had prolactinomas, 5 patients (15.6%) had adrenocorticotropic hormone-secreting adenomas, 2 patients (6.2%) had follicle-stimulating hormone/luteinizing hormone-secreting adenomas, and 1 patient (3.1%) had thyroid-stimulating hormone-secreting adenomas. Of the 32 patients, 20 (62.5%) had pituitary macroadenomas and 12 patients (37.5%) had microadenomas. Total-subtotal tumor resection was achieved in 75% and 45% of the microadenomas and macroadenomas, respectively. Radiologically, 60% of the macroadenomas had suprasellar and carvenous sinus extension. Postoperative cerebrospinal fluid leaks occurred in 3 patients. Two patients developed temporary diabetes insipidus. CONCLUSIONS: Endoscopic transsphenoidal surgery is an effective and safe treatment for most patients with pituitary adenoma and could be considered the first-choice therapy in these patients.

Therapeutic efficacy of the combination of intratympanic methylprednisolone and oral steroid for idiopathic sudden deafness.

OBJECTIVE: The purpose of this study was to compare the efficacy of systemic steroid alone and combined with intratympanic methylprednisolone in the treatment of patients with idiopathic sudden sensorineural hearing loss. STUDY DESIGN: Prospective, randomized controlled trial. Settings Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey. SUBJECT AND METHODS: Seventy-nine patients who met the inclusion criteria for idiopathic sudden sensorineural hearing loss were included in this study. Patients were randomly divided into 2 groups according to treatment: group A received combination therapy (intratympanic methylprednisolone + oral steroid) and group B received oral steroid alone. Of the 79 patients included, 6 patients missed the 1-month follow-up visit. Overall, 73 patients (37 combination group, 36 oral steroid group) who completed the 1-month follow-up and study intervention were included in the per-protocol analysis. Both the relationship between certain prognostic factors and the clinical outcome after treatment were analyzed. RESULTS: Combination therapy showed significant hearing improvement and speech discrimination scores compared with the use of systemic steroids alone (P < .05). In hearing outcomes in patients with severe hearing loss, combination therapy had statistically significant hearing improvement compared with oral steroid alone (P < .05). CONCLUSION: We recommend that combination therapy can be considered as initial treatment especially for patients with severe hearing loss.

Orbital apex syndrome as a sign of unsuspected breast carcinoma.

Breast cancer, the most common form of cancer among women, rarely metastasizes to the paranasal sinuses and skull base. The disease usually proceeds insidiously, remaining asymptomatic until ocular symptoms appear. Orbital involvement is frequently seen in metastatic disease of the paranasal sinuses and skull base, but orbital apex syndrome is rare. Early presentation with clinical features of acute ethmoiditis can delay the diagnosis of metastatic disease. Here, we report the case of a 43-year-old woman with breast cancer who presented with orbital apex syndrome secondary to the skull base and paranasal sinus metastasis.