Hyperbaric oxygen versus steroid in facial nerve injury: an experimental animal study.

OBJECTIVE: The aim of this experimental study was to evaluate the effects of hyperbaric oxygen, methylprednisolone and combined hyperbaric oxygen-methylprednisolone treatments on traumatic facial nerve regeneration in rats. SUBJECTS AND METHODS: After exposure to facial nerve injury, four groups of rats were created with five subjects in each group: Group 1 (hyperbaric oxygen), group 2 (control), group 3 (combined hyperbaric oxygen-methylprednisolone), group 4 (methylprednisolone). Facial nerve specimens from sacrificed animals were examined for axonal degeneration, vascular congestion, macro vacuolization, axon diameter and thickness of myelin sheath. RESULTS: There were significant differences with regard to axonal degeneration, vascular congestion and axon diameter between group 3 and the control group. In addition to lower axonal degeneration and vascular congestion, a larger diameter of axons was observed in group 3. There were significant differences with regard to vascular congestion and axon diameter between group 4 and the control group. We observed thicker myelin and lower axonal degeneration in group 3 compared with group 4. CONCLUSION: The combination therapy with hyperbaric oxygen and methylprednisolone had an additive beneficial effect on regeneration of the facial nerve and may provide better treatment outcomes than methylprednisolone or hyperbaric oxygen therapy alone.

Role of allergy in children with adenotonsillar hypertrophy.

OBJECTIVE: The goal of this prospective study is to investigate the correlation between allergen sensitivity and radiographic evaluation of adenoidal obstruction and tonsil size. SUBJECTS AND METHODS: A total of 82 children with upper airway obstructive symptoms were evaluated for their tonsil size. All patients underwent digital lateral soft tissue radiographs. Assessment of nasopharyngeal obstruction in radiographs was done according to the Cohen and Konak method. Skin prick tests with multitest applicator including 14 allergens were carried out to investigate their allergic background. RESULTS: All children reacted positive to at least one of the 14 allergens tested. We found a statistically significant correlation between tonsil size and skin prick tests (P < 0.01). However, there was no statistically significant correlation between the adenoid size and skin prick test results (P > 0.05). CONCLUSIONS: Although the degree of nasopharyngeal obstruction caused by adenoid hypertrophy does not increase with the degree of positivity to specific allergens in skin prick tests, allergic sensitivity may play an important role in children with tonsillar hypertrophy.

Histological evaluation of rat larynx in experimental polycystic ovary syndrome model.

This study aimed at studying the histopathological effects of hyperandrogenemia and estrogen deficiency on larynx mucosa in experimentally designed polycystic ovary syndrome of female rats. Two groups of experimental polycystic ovary syndrome model were composed in healthy female rats by per oral letrozole administration of for 21 and 42 days. Also a control group which only took vehicle (saline) for 42 days was designed. Laryngeal mucosa and ovaries of all animals were examined histopathologically by light microscopy and the serum hormone levels were analyzed using a solid-phase, two-site chemiluminescent enzyme immunometric assay. Statistically significant edema, vascular engorgement, inflammation, cilia loss and differentiation of goblet cell distribution were observed when the control group and study groups were compared (p < 0.01). In serum hormonal analysis there was a significant increase in levels of androgens and decrease in levels of estrogens. In addition, polycystic appearance of ovaries in letrozole-administered groups and normal appearance of ovaries in control group have been proven histopathologically. Polycystic ovary syndrome which causes estrogen deficiency and hyperandrogenemia in fertile ages resulted in histopathological changes in laryngeal mucosa.

Choanal fungus ball mimicking a tumour.

We report the first case of an isolated choanal fungus ball in a 28-year-old man with a previous history of nasopharyngeal carcinoma, who was treated with radiotherapy 14 years ago. The initial diagnosis was a recurrent tumour or a secondary neoplasm. Histopathological examination confirmed a fungal infection. There are no previous reports of a fungus ball located at the posterior choanal region. Although it has been reported that bacteriology of sinonasal region would be different in irradiated patients, there is no study reporting fungal infections in irradiated patients in English literature. In this report, the clinical presentation, relevant radiologic findings and management of sinonasal fungus ball and its relationship with previous radiotherapy were discussed with the literature knowledge.

Audiological and graft take results of cartilage reinforcement tympanoplasty (a new technique) versus fascia.

Our objective is to compare hearing and graft take results of temporal muscle fascia tympanoplasty and cartilage reinforcement tympanoplasty. Seventy seven patients are classified into two groups: Group 1 included 37 patients for whom cartilage graft, harvested from symba concha, is used as reinforcement under temporalis muscle fascia anteriorly and Group 2 included 40 patients for whom only temporalis muscle fascia is used in type 1 tympanoplasty. A pure-tone audiometry is done within 1 week prior to surgery and at 6 months postoperatively. There is statistically significant difference between postoperative graft take results among groups. In both groups postoperative anterior TM perforation is encountered most commonly. Success rate of cartilage reinforcement tympanoplasty in revision patients is 100% but temporal muscle fascia tympanoplasty's is 66%. There is no statistically significant difference between preoperative and postoperative air conduction gain of TM intact patients. The results indicated that Cartilage reinforcement myringoplasty technique under anterior of the temporal muscle fascia significantly increases the graft take ratios in high-risk perforations and it also does not affect hearing levels. Therefore, the authors suggest usage of cartilage reinforcement tympanoplasty technique under anterior of the temporal muscle fascia which is an easy and applicable technique to increase graft take ratios, particularly in patients with preoperative anterior and subtotal TM perforations.

The effects of obstructive sleep apnea syndrome due to adenotonsillar hypertrophy on the cardiovascular system in children.

Obstructive sleep apnea syndrome (OSAS) due to adenotonsillar hypertrophy (ATH) is a common and important problem in children. OSAS can lead to significant cardiopulmonary complications, poor growth and problems with learning and behavior. Many studies in the literature show that OSAS due to ATH causes pulmonary hypertension, ventricular hypertrophy and systemic hypertension in the pediatric population. In this review, we discuss the effects of ATH on cardiac function. It is well known that as a child grows, the nasopharyngeal passage becomes enlarged, helping to improve OSAS. Based on this, we discuss the possible positive effect of this age-related improvement on the obstruction of cardiovascular disturbances. Finally, the possible relationship between the duration of OSAS and the timing of surgery with the permanency of cardiovascular disturbances is discussed.

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.

A study to detect Helicobacter pylori in adenotonsillar tissue.

We conducted a prospective study to investigate the possibility of Helicobacter pylori colonization on tonsillar and adenoid tissues. Our study group was made up of 84 consecutively presenting children aged 4 to 12 years who had undergone adenotonsillectomy or adenoidectomy with or without ventilation tube insertion. The excised specimens were analyzed by rapid urease testing and histopathologic examination to detect H pylori. Histologic sections were subjected to hematoxylin and eosin staining and Giemsa staining as performed in routine gastric biopsies. We found no H pylori colonization in any specimen. Therefore, we consider the possibility of H pylori colonization of adenotonsillar tissue unlikely, even though the authors of some recent studies have reported such a finding. Other means of detecting possible H pylori colonization in the upper aerodigestive tract rely on invasive biopsy procedures, which are difficult to use in clinical practice. Therefore, on the basis of our findings and our review of the literature, we conclude that looking for H pylori in the upper aerodigestive tract is not only clinically useless, but damaging, as well.

Do the laryngopharyngeal symptoms and signs ameliorate by empiric treatment in patients with suspected laryngopharyngeal reflux?

OBJECTIVES: In clinical practice, antireflux medication is given almost always empirically without pH monitorization. We aimed to evaluate the improving effect of empiric antireflux treatment on layngopharyngeal symptoms and signs in patients with gastroesophageal reflux (GER) and suspected laryngopharyngeal reflux (LPR) according to reflux symptom index (RSI) and reflux finding score (RFS). METHODS: GER was determined by esophagogastroduedonoscopy and biopsy in 127 patients. RSI and RFS were calculated for each patient. The patients with a pathology other than LFR which may be responsible from laryngopharyngeal symptoms and signs were excluded from the study. Fifty patients whom were thought to have LPR according to RSI and RFS comprised the study group. After 12-weeks of antireflux treatment, RSI and RFS were calculated again. The statistical analyses were made according to the changes in the severity and frequency of each symptom and sign. RESULTS: There was statistically significant improvement in RSI and RFS after treatment when compared with initial scores. There was statistically significant improvement in severity of all symptoms and signs. Although there was quantitively decrease in frequency of some signs and symptoms, complete resolution of the disease was not observed generally. CONCLUSION: Empiric antireflux treatment according to RSI and RFS is an effective method. Antireflux treatment has a significant improving effect on laryngopharyngeal symptoms and signs. There may be needed longer times of treatment for complete resolution of symptoms and signs.

Histopathological effects of estrogen deficiency on larynx mucosa in ovariectomised rats.

Laryngeal manifestations due to estrogen deficiency have been studied in the literature. But to date, the possible histopathological changes of laryngeal mucosa due to estrogen deficiency have not been studied. Therefore, our objective was to determine the histopathological changes of laryngeal mucosa in ovariectomised rats in order to clarify effects of estrogen deficiency on laryngeal tissue. The study is a randomized trial and was conducted at the animal care facility of Haydarpasa Numune Education and Research Hospital. Twenty-one Wistar rats were used throughout the experiment. There were six rats in the sham-operated control group. And others were divided into two groups (4, 8 weeks) according to follow-up time after ovariectomy. We observed significant changes 4 weeks after ovariectomy when we assessed subepithelial edema, inflammation, cilia and goblet cell loss (p < 0.01). It was shown that estrogen deficiency after ovariectomy in rats caused changes in laryngeal tissue when it was studied histopathologically.

Unilateral sinonasal symptoms.

OBJECTIVE: The aim of the study was to describe the pathology in patients with unilateral sinonasal symptoms and to identify variables that may predict neoplastic pathology. STUDY DESIGN: Retrospective chart review. METHODS: A retrospective analysis was completed on 207 consecutive patients with sinonasal symptoms, most of whom underwent functional endoscopic sinus surgery from 2005 to 2008. Of the charts reviewed, 63 patients had unilateral sinonasal symptoms with unilateral opacification of paranasal sinus computed tomography scans. Presenting symptoms and radiographic, surgical, and pathologic findings were analyzed. RESULTS: All 63 patients underwent surgical management for their symptoms, and specimens were sent for pathologic evaluation. There were 12 cases of antrochoanal polyp, 14 of nasal polyposis, 8 of chronic rhinosinusitis, 7 of concha bullosa, 4 of retention cyst in maxillary sinus, 2 of mucocele, 3 of oroantral originated cyst, and 13 cases of benign or malign neoplastic diseases, some of which were extremely rare cases such as pleomorphic adenoma, ameloblastoma, schwannoma, myxoma, and non-Hodgkin lymphoma. Nasal discharge was more common in inflammatory than neoplastic disease. However, epistaxis was more common in neoplastic disease. CONCLUSIONS: A wide variety of pathologic findings present with unilateral sinonasal symptoms. A careful history, examination, and radiographic studies can often determine the responsible disease process. Histologic confirmation remains obligatory for diagnosis. There are also some rare cases, which should be considered in differential diagnosis of unilateral polyp or mass lesion on nasoendoscopy.

How does reflux affect laryngeal tissue quality? An experimental and histopathologic animal study.

OBJECTIVE: To investigate the histopathologic changes in intact laryngeal epithelium and mucosa exposed to endogenous gastric acid and pepsin in an experimental model of reflux. STUDY DESIGN: Randomized trial. SETTING: The study was conducted at the animal care facility of Haydarpasa Numune Education and Research Hospital. SUBJECTS AND METHODS: Eighteen healthy 200- to 220-g, 20-week-old Sprague-Dawley rats were used. The animals were divided into three groups according to exposure time (1-, 4-, and 12-week exposures), and four rats were examined as controls who underwent sham operation. An experimental model of gastroesophageal reflux was induced. After exposure, the animals were euthanized, and their larynges were removed. The histopathologic changes in the larynx were observed under a light microscope. RESULTS: The mean scores for inflammation in the control, one-, four-, and 12-week groups were 0.75 ± 0.50, 1.75 ± 0.50, 2.20 ± 0.45, and 1.94 ± 0.87, respectively. However, mean scores for vascular engorgement in the control, one-, and four-week groups were 0, and in the 12-week group was 2.0 ± 0.70. The mean scores for subepithelial edema in the control, one-, four-, and 12-week groups were 1.00 ± 0, 1.75 ± 0.95, 1.80 ± 0.45, and 2.20 ± 0.84, respectively. However, mean scores for keratinization for the control, one-, and four-week groups were 0, and for the 12-week group was 1.60 ± 0.55. When we compared inflammation, vascular engorgement, subepithelial edema, and keratinization mean scores between the control and study groups, there were statistically significant increases (P = 0.005, P = 0.001, P = 0.043, P = 0.002, respectively). CONCLUSION: Our findings suggest that reflux induces significant histopathologic changes in larynx mucosa.

Adenotonsillar hypertrophy: Does it correlate with obstructive symptoms in children?

OBJECTIVE: The goal of this study is to determine the correlation of clinical symptoms of UAO (upper airway obstruction) with radiographic evaluation of adenoidal obstruction and tonsil size in children with adenotonsillar hypertrophy and to evaluate the usefulness of lateral neck radiography. STUDY DESIGN: Prospective study. SETTING: Haydarpasa Numune Research and Education Hospital, Istanbul, Turkey. SUBJECTS AND METHODS: This study analyses 95 children with one or more of the symptoms of UAO. Clinical symptoms were assessed by a standardized questionnaire evaluating the severity of symptoms. All patients underwent otolaryngologic examination and their tonsil sizes were graded. 74 of 95 patients underwent digital lateral soft tissue radiographs. Assessment of nasopharyngeal obstruction in radiographs was done according to four different methods. RESULTS: We did not find statistically siginificant correlation between symptom scores and radiologic measurements according to Johanneson (r=0.072, p=0.544, p>0.05) and Crepeau (r=0.034, p=0.773, p>0.05). The correlations between OSA score and Cohen and Konak's method and AN ratio were weak and not statistically siginificant (p=0.133, r=0.176; p=0.290, r=0.125 respectively; p>0.05). But, we found a statistically siginificant correlation between the tonsil grade and symptom scores (r=0.216, p=0.036, p<0.05). CONCLUSION: Our results have demonstrated that radiologic measurements of the nasopharyngeal obstruction do not correlate with clinical symptoms of UAO, but clinical assessment of tonsil size does.

Does reflux have an effect on nasal mucociliary transport?

CONCLUSION: Gastroesophageal and laryngopharyngeal reflux were found to have no effect on nasal mucociliary transport. OBJECTIVE: Gastroesophageal and laryngopharyngeal reflux have been recognized as causative factors for chronic rhinosinusitis but no definite mechanism has been described yet. We aimed to determine whether gastroesophageal and laryngopharyngeal reflux impair nasal mucociliary transport. METHODS: This was a prospective cohort study in a tertiary referral center. Fifty patients with both laryngopharyngeal and gastroesophageal reflux comprised the study group. Reflux syndrome index and reflux finding score were calculated for each patient before and after treatment. Antireflux medication was given for 12 weeks. The control group consisted of 30 healthy volunteers. Nasal mucociliary transport was assessed by means of the saccharine test. It was performed before and after the treatment. Statistical analysis was performed using the saccharine test results of the study and control groups. RESULTS: No statistical difference was found between the saccharine test results of the study group and control group before treatment. The differences between the pretreatment and post-treatment reflux symptom index and reflux finding scores were statistically significant. The difference between the post-treatment saccharine test results of the patients in whom reflux scores returned to normal and those with remaining high scores was not statistically significant.

Does thyroid gland examination by palpation alter serum hormone levels?

OBJECTIVES/HYPOTHESIS: The goal of this study was to investigate the effects of routine thyroid gland palpation on serum thyroid hormone levels. STUDY DESIGN: Prospective study at Haydarpasa Numune Research and Education Hospital, Istanbul, Turkey. METHODS: This study was carried out in two groups with a total of 50 consecutive adults. Group I consisted of 20 patients (12 female and 8 male, aged 20-48 years) with a diagnosis of nodular thyroid disease confirmed by ultrasound imaging techniques. The second group consisted of 30 otherwise healthy subjects (17 female and 13 male, aged 18-50 years) referred for neck and thyroid ultrasound and with no thyroid pathology detected. Thyroid gland palpations were performed by the same physician. Blood samples were obtained before and 2 hours after thyroid gland palpation. Serum total T3 (TT3), total T4 (TT4), free T3 (FT3), free T4 (FT4), thyroid stimulating hormone (TSH), and thyroglobulin (TG) measurements were made. RESULTS: We found that routine palpation in the first group caused a significant increase in serum TT3 (P < .05), FT3 (P < .01), FT4 (P < .05), and TG (P < .05) levels. In the second group, TT3 (P < .01), FT3 (P < .05), FT4 (P < .05), and TG (P < .05) levels also increased significantly after palpation. Differences in TSH and TT4 levels were not significant in any of the groups (P > .05). CONCLUSIONS: Preliminary data proposing a possible effect of routine thyroid gland palpation on serum thyroid hormone levels suggest that serum thyroid hormone measurements should be performed before any manipulation of the gland, including palpation, to avoid misdiagnosis.

Is there a relation between mastoid aeration and Körner's septum?

The purpose of this study is to investigate the prevalence of Körner's septum (KS) in temporal bones with varying degrees of pneumatization and to evaluate any relationship between the degree of pneumatization and the presence of KS. Data were obtained retrospectively from 356 temporal bone high-resolution computed tomography of 178 patients who underwent tympanoplasty. Mastoid bone pneumatization was classified as aerated, diploic and sclerotic. The presence of Körner's septum was also investigated. The relationship between the presence of Körner's septum and the type of mastoid pneumatization was assessed. KS was encountered in 98 out of total 356 ears. Prevalence of KS was not statistically different between aerated (31%, n = 36), diploic (24.7%, n = 27) and sclerotic mastoids (26.9%, n = 35; p > 0.05). In conclusion, there is no relationship between the presence of KS and the degree of pneumatization. The presence of KS does not necessarily corroborate the presence of poor pneumatization.

How does childhood otitis media change the radiological findings of the temporal bone?

CONCLUSION: Inflammatory changes in the middle ear mucosa since childhood may affect mastoid pneumatization without a change in the position of the sigmoid sinus. Also, despite the fact that recurrences of inflammatory middle ear disease lead to bone destruction, we did not see any relationship between the childhood otitis media and bone destruction. OBJECTIVE: To assess radiological findings in temporal bone in both healthy ears and diseased ears in patients with unilateral chronic otitis media since their childhood. METHODS: Twenty-five patients who had unilateral otological symptoms, such as recurrent otalgia, purulent otorrhea or hearing loss since their childhood were included in the study. Assessment of radiological parameters was performed using a quantitative digital image processing computed tomography program. RESULTS: Mastoid volume values in the chronic otitis media group were significantly smaller when compared with those of a healthy group (p < 0.05). In healthy and diseased mastoid groups, there were no significant differences between groups when we assessed Henle spine-sigmoid sinus (HS-SS) distances. There was a significant correlation (p = 0.001) in both the groups when we compared mastoid volume values with HS-SS distances. There was ossicular discontinuity in two cases and in one patient tegmen tympani was not intact in diseased ears.

Investigation of gastric pepsinogen in middle ear fluid of children with glue ear.

CONCLUSION: The presence of pepsinogen in middle ear effusion (MEE) supports the relationship between gastroesophageal reflux (GER) and otitis media with effusion (OME). Measurement of pepsin/pepsinogen can be considered as a simple and reliable method for assesment of reflux in children. However, further research is needed to establish a definite association between GER and OME before beginning antireflux treatment in the management of MEE. OBJECTIVE: The aim of this study was to investigate the relationship between GER and chronic OME, and to confirm the presence of gastric enzyme in the MEE of children with OME. METHODS: This was a prospective study. MEE and blood samples were obtained from 42 children undergoing tympanostomy tube placement. Total pepsinogen concentrations of effusions and serum samples were measured with a commercial ELISA using a human pepsinogen I specific antibody. Albumin levels of effusions and serum samples were also measured with ELISA for comparison with pepsinogen levels. RESULTS: Measurable pepsinogen was present in all MEEs from patients, with levels higher than the serum values. The difference between the levels of pepsinogen measured in MEE and serum was statistically significant (p < 0.01), but albumin levels were higher in serum than in MEE and the difference was statistically significant (p < 0.01).

Histological changes of rat soft palate with exposure to experimental laryngopharyngeal reflux.

OBJECTIVE: The possible effects of laryngopharyngeal reflux (LPR) on laryngeal and otologic disorders have been studied in the literature. There have been no reports explaining the possible effects of LPR on the soft palate. Therefore, in this study, we investigated the histopathologic changes in the rat soft palate using an experimental model of reflux. SUBJECTS AND METHODS: Eighteen healthy 200-220-g 20-week-old Sprague-Dawley rats were used. The animals were divided into three groups according to exposure time (1, 4, and 12 week exposures), and four rats were examined as controls who had undergone sham operation. An experimental model of gastroesophageal reflux was induced under general anesthesia. After exposure, the animals were sacrificed, and their soft palates were removed. The histopathological changes in the soft palates were observed under a light microscope. RESULTS: Submucous gland hyperplasia, inflammation, subepithelial edema, vascular engorgement, muscular atrophy and dilated glandular excretory duct were compared among the groups. Submucous gland hyperplasia, subepithelial edema, inflammation, vascular engorgement, muscular atrophy and dilated glandular excretory duct were significantly different in the exposure groups compared with the control group. CONCLUSION: On the basis of histopathological evaluations, our findings suggest that reflux affects the soft palate, which suggests that these pathological changes may reflect the relationship between LPR and airway obstruction.

[Efficacy of clinical examination and computed tomography at T-staging of laryngeal carcinoma]. / Larenks kanseri T-evrelemesinde klinik muayene ve bilgisayarli tomografinin etkinligi.

OBJECTIVES: The purpose of this study is to investigate the accuracy rates of tumor T-staging and the efficacy of methods used at T-staging. PATIENTS AND METHODS: Forty-seven laryngeal carcinoma patients (6 females, 41 males; mean age 57.9+/-9.8 years; range 38 to 81 years) who underwent surgery at Haydarpasa Numune Education and Research Hospital 2nd Ear Nose Throat Clinic between March 2003 and June 2008 were included in the study. T-staging of the tumors were separately determined according to their clinical examination, computed tomography (CT) findings, and their correlation between these methods. Staging according to histopathological examination was accepted as real accurate staging. Rates of accurate staging according to postoperative histopathological examination results were evaluated under guidance of the literature. RESULTS: When their accuracy rates in determining histopathological T-stages of tumors were compared, there were no significant differences between the methods. The rates of accuracy in determining histopathologic T-stage of tumors were 40% by clinical examination; 66% by CT; and 76% when both methods were used together. The most successful results were obtained at the tumors of glottic region. Among the patients whose tumors had been staged inaccurately by clinical examination, 71% were underestimated while 29% were overestimated. Underestimation and overestimation of stagings were found to be 37% and 63%, respectively, with CT examination. CONCLUSION: Success of staging increases when clinical examination is used in together with CT. While there is a tendency towards underestimation of T-stage when staging is done only by means of clinical examination, this tendency is towards overestimation when CT is used alone. Thus, combination of clinical examination findings with CT is necessary for an accurate T-staging of a laryngeal cancer.