Concomitant vagal neurofibroma and aplasia of the internal carotid artery in neurofibromatosis type 1.

We report the case of a patient with neurofibromatosis type 1 who had both aplasia of an internal carotid artery (ICA) and a vagal neurofibroma. To our knowledge, this is the first report in the literature of the simultaneous presence of these two rare disorders in a single patient. We believe that this is also the first report of an absence of an ICA in a patient with neurofibromatosis type 1. The patient was a 19-year-old woman who complained of a slowly growing neck mass. The mass occupied the right parapharyngeal space and upper cervical region. The patient had no other masses on physical examination, but widespread café au lait spots were evident. This led us to suspect the presence of a vagal neurofibroma. The tumor was removed, and pathology confirmed the diagnosis. No intracranial aneurysms were detected on cerebral angiography.

Sucralfate for posttonsillectomy analgesia.

Pain is one of the most troublesome complications of tonsillectomy. The pain appears as throat pain, otalgia, or both, and continues until mucosal recovery on the tonsillar fossae is complete. Some surgical and hemostasis techniques may increase pain. Analgesics, antibiotics, steroids, and local and topical anesthetics are used to relieve posttonsillectomy pain, but none has the desired effectiveness. The pain reliever must not increase bleeding and must have minimal side effects. Sucralfate, a basic amino salt of sucrose octasulfate, binds to the matrix protein of a peptic ulcer and produces a protective barrier. Tonsillectomy leaves two large ulcerous wounds, and sucralfate may bind those wounds as it does peptic ulcers. In this controlled study, the efficacy of sucralfate on posttonsillectomy throat pain, otalgia, analgesic requirement, degree of strength, bleeding, body temperature, and mucosal recovery is investigated in 80 patients. Sucralfate is found to significantly reduce throat pain and analgesic requirement after surgery.

Facial nerve paralysis in chronic suppurative otitis media: Ankara Numune Hospital experience.

Although the incidence of facial nerve paralysis (FNP) decreased with the use of contemporary diagnostic tools and the advent of antibiotics, it is still a challenging problem. In this retrospective study, the charts of 1188 patients with chronic suppurative otitis media (CSOM), treated between 1988 and 1996 in the First ENT Clinic of Ankara Numune Hospital, Turkey, were analysed to establish the pre-operative incidence of FNP in CSOM. There were 20 (1.7%) patients with FNP secondary to CSOM. Of these, 14 (70%) had cholesteatoma. There was a defect on the fallopian canal in 14 patients (70%) and it was most commonly located on the tympanic segment of the canal (35.7%). Paralysis was incomplete in all patients. A total of 14 patients had ear drainage more than 3 years. FNP was associated with vertigo in three patients (15%) and tinnitus in one patient (5%).

A new dosage regimen for topical application of ciprofloxacin in the management of chronic suppurative otitis media.

The clinical and bacteriologic efficacy of topically applied ciprofloxacin was studied in 60 patients with chronic suppurative otitis media. Two hundred fifty and 125 microg/ml concentrations of ciprofloxacin solutions were given to two groups of patients. The duration of therapy was determined according to the clinical cure at follow-up. More than 21 days of therapy was not needed in any patient. The clinical cure rate with 250 microg/ml ciprofloxacin was 78.1% at 14 days and with 125 microg/ml it was 83.3%. However, a 100% clinical cure rate and complete bacteriologic eradication was obtained in 21 days in both groups. In each group only one patient had otomycosis by the fourteenth day of therapy, although ear discharge had ceased. It was concluded that 125 microg/ml ciprofloxacin could be applied as successfully as 250 microg/ml, and the duration of therapy had to be at least 14 days. This new dosage regimen can be adopted as an optimal dosage for ototopical application of ciprofloxacin in chronic suppurative otitis media. It will also obviously decrease the expense of therapy.

Susceptibility of microorganisms isolated from chronic suppurative otitis media to ciprofloxacin.

In order to evaluate the susceptibility of the microorganisms isolated from chronic suppurative otitis media to ciprofloxacin, cultures of specimens from 127 patients with chronic suppurative otitis media and their antibiotic sensitivity results were examined. The most common aerobic isolates were Pseudomonas sp., Proteus sp., and Staphylococcus aureus with recovery rates of 40.7%, 21.6% and 19.1% respectively. Sensitivity results showed that 6.2% of Pseudomonas isolates, 2.9% of Proteus isolates, 10% of Staphylococcus aureus isolates and 8.3% of Escherichia coli isolates were resistant to ciprofloxacin.

An endoscopic and tomographic evaluation of patients with sinusitis after endoscopic sinus surgery and Caldwell-Luc operation: a comparative study.

To evaluate the outcome of surgery using objective methods in patients with sinusitis after endoscopic sinus surgery (ESS) and Caldwell-Luc operation, we randomly selected 37 Caldwell-Luc-operated and 40 ESS-applied cases. Selected patient groups were assessed and compared by endoscopic examination and computed tomography (CT). CT was found to be normal in 12% of Caldwell-Luc-operated sides in comparison to 75% of ESS-applied sides. Endoscopy revealed a patency rate of the windows as 48% in Caldwell-Luc-operated and 86.7% in ESS-applied sides. Fibrosis and abnormal bony changes of the maxillary sinus were encountered in more than half of Caldwell-Luc-operated cases. In conclusion, ESS has a much higher rate of cure compared to the Caldwell-Luc operation if subjective and objective evaluation methods (CT and endoscopy) are applied.

Morphometric evaluation of paranasal sinuses for endoscopic sinus surgery.

Endoscopic surgical treatment of paranasal sinus infections is currently being applied in many Otorhinolaryngology Clinics. Although high rates of success are reported with this treatment method, life threatening complications sometimes do occur due to disorientation, especially when angled telescopes are used. In order to avoid such complications, we evaluated the distances from the anterior nasal spine to various important anatomic structures encountered during endoscopic surgery. The measurements obtained by a morphometric anatomic study of cadavers are presented in this study. We believe that if surgery is carried beyond the measured distances, serious complications may ensue during endoscopic surgery.

Concha bullosa.

Concha bullosa is one of the most common, obstructive, anatomic variants seen in patients with sinusitis. In this study, a total of 160 patients with sinusitis were evaluated to study both the effects of concha bullosa on the distribution of opacification to the paranasal sinuses as well as the relations between the types of concha bullosa (CB) and ostiomeatal complex disease (OMCD). Our results show that CB does not necessarily have influence on the distribution of mucosal changes to paranasal sinuses. Furthermore, in the presence of OMCD, no significant difference statistically was found between patients with CB and those without. However, when the types of CB are considered, OMCD is found to be more frequent if the pneumatization is localized to the inferior half of the middle turbinate, such as in bulbous and extensive types of CB.