Parathyroid scintigraphy and minimal invasive surgery in parathyroid adenomas.

OBJECTIVES: This study aims to identify the diagnostic capacity of the technetium 99m sestamibi scintigraphy with single photon emission computed tomography for localizing parathyroid pathologies. PATIENTS AND METHODS: Data of 13 patients (4 males, 9 females; mean age 49.23 years; range 27 to 63 years) who had minimally invasive parathyroidectomy due to primary hyperparathyroidism at the Haseki Training and Research Hospital Ear-Nose-Throat clinic between January 2013 and December 2013 were retrospectively analyzed. Two patients were excluded due to incomplete documentation. RESULTS: Mean preoperative parathyroid hormone and calcium levels were 284.36 (134-1,083 pg/mL) and 11.9 (10.7-13.5 mg/dL), respectively. The operation was deemed adequate if intraoperative parathyroid hormone dropped by 50% from the preoperative level or frozen section analysis showed hypercellular gland or adenoma. Only sestamibi scintigraphy results were consistent with focal exploration findings in all patients. Focal exploration and parathyroid adenoma excision via minimally invasive parathyroidectomy were successfully carried out in 10 patients with single adenoma confirmed by sestamibi. CONCLUSION: Technetium 99m sestamibi scintigraphy with single photon emission computed tomography and frozen section analysis may provide more meaningful information and be more advantageous compared to other preoperative localization techniques.

Hearing outcomes after suppurative chronic otitis media surgery.

OBJECTIVES: This study aims to compare the hearing outcomes after canal wall up mastoidectomy (CWUM) and canal wall down mastoidectomy (CWDM). PATIENTS AND METHODS: Ninety-two patients (74 males, 18 females; mean age 30.1 years; range 9 to 67 years) who were diagnosed with chronic suppurative otitis media (CSOM) between January 2009 and May 2011 were enrolled in this retrospective study. Based on hospital data, patients were separated into two groups as having mucosal or squamous disease. Patients were also categorized into two groups based on the type of mastoidectomy: CWUM (n=51) and CWDM (n=41). Hearing results between the groups were evaluated using the air-bone gap (ABG) recorded by audiogram before surgery and at three months after ossiculoplasty. Relationship between obtained hearing results and performed ossiculoplasty techniques were also discussed. RESULTS: We were able to perform ossiculoplasty in 42.3% (n=39) of patients diagnosed with CSOM. Presurgical ABG in CWUM and CWDM groups were 35.38±10.82 dB and 37.92±5.80 dB, respectively. Postsurgical ABG value was ≤20 dB in 27% of CWUM patients and 7.7% of CWDM patients. Mean hearing gain of patients with active squamous disease was 3.8 dB in CWUM group and 11.9 dB in CWDM group (p<0.5). CONCLUSION: The pathology affecting the middle ear had influence on the hearing results of the two groups. Canal wall down mastoidectomy may be a beneficial procedure to improve hearing in patients with CSOM.

Increased carotid artery intima-media thickness in patients with tympanosclerosis: Common risk factors with atherosclerosis?

We investigated the relationship between tympanosclerosis, known atherosclerotic risk factors, and the intima-media thickness of bilateral carotid arteries using ultrasonography. A total of 122 patients admitted to our clinic with chronic otitis media between 2005 and 2010 were included in the study. The study group consisted of 61 patients with tympanosclerosis; the control group comprised 61 patients without tympanosclerosis. Internal carotid artery intima-media thickness (CAIMT), total cholesterol, triglyceride, low- and high-density lipoprotein cholesterol, C-reactive protein, and homocysteine levels were measured in all patients. Homocysteine, low-density lipoprotein, total cholesterol, and triglyceride levels in the study group were higher compared with those of the control group (p < 0.05). Right and left CAIMT was greater in the study group versus the control group (p ≤ 0.001). In conclusion, atherosclerosis and tympanosclerosis were associated with identical risk factors; in the tympanosclerosis group, CAIMT was increased significantly.

Validity of acoustic rhinometry in the evaluation of patients with adenoid hypertrophy.

Reliability of acoustic rhinometry (AR) for preoperative diagnosis and decision of surgery in children with adenoid hypertrophy were investigated in this study. Fifty-five children who cannot tolerate nasal endoscopic examination were included. The AR was performed preoperatively and postoperatively 1 month later. The volume of distance between the 6th and 10th centimeters in rhinogram curve was calculated for evaluating the adenoid notch (AN) region. The volume of AN region was compared with each patient's volume of the adenoid tissue removed with adenoidectomy. Whereas the median adenoid specimen volume was 2.0 (1.0-2.0) cm3 in 23 patients with complaint of nasal obstruction, median AN volumes in the rhinogram curve was 2.3 (0.8-5.2) cm3. All children whose preoperative nasopharyngeal volume was 4.2 cm3 or less had increased volume in the area representing the nasopharynx on rhinogram. We found a statistically significant relationship between the AN and the adenoid specimen volume (P = 0.000, r = 0.797). The sensitivity and specificity were found as 61.2% and 95.8%, respectively. We concluded that the children whose preoperative nasopharyngeal volumes were measured as 4.2 cm3 or less by AR could benefit more from adenoidectomy.

Sinonasal tract malignancies: prognostic factors and surgery outcomes.

BACKGROUND: Cancers of the sinonasal region are rare and its survival rate remains poor because most of the patients are asymptomatic and diagnosed in advanced stages with surrounding important structures. OBJECTIVES: This study attempted to analyze the clinical and histological features in addition to survival and prognostic factors of surgical treatment of sinonasal cancers. PATIENTS AND METHODS: A retrospective cohort study, involving 36 patients with sinonasal cancer who were treated with surgery in our hospital between 2000 and 2010, was performed. Patients were selected based on the convenience sampling. Patients treated with radiotherapy and/or chemotherapy were excluded from the analysis. Clinical symptoms and histologic findings of patients as well as malignant tumor staging and its prognosis were collected from archives. RESULTS: We found that overall 3 and 5-year survival rates of subjects were 52.8%, and 41.6%, respectively. There was a negative correlation between the clinical stage and survival. There was a significant difference between infrastructural and suprastructural localization in 5-year survival rate (P = 0.018). In the present study, there was a strong relationship between the local control and overall survival (P < 0.01). Overall 5-year survival rate was similar in patients both in the exenterated orbit and preserved orbit (P > 0.05). CONCLUSIONS: The present study has demonstrated that clinical stage, suprastructural tumor, and the presence of tumor- positive resection margins are the most significant prognostic factors affecting local tumor control and survival. As a result of this study, these tumors should be treated in early stages by surgical margin of resection followed by adjuvant radiotherapy.

The effects of tumor size, degree of differentiation, and depth of invasion on the risk of neck node metastasis in squamous cell carcinoma of the oral cavity.

Cervical lymph node metastasis is the most important prognostic factor in patients with head and neck carcinoma. We retrospectively analyzed the effects of three different variables-tumor size, degree of differentiation, and depth of invasion-on the risk of neck node metastasis in 50 adults who had been treated with surgery for primary squamous cell carcinoma of the oral cavity. Primary tumor depth and other pathologic features were determined by reviewing the pathology specimens. Preoperatively, 36 of the 50 patients were clinically N0; however, occult lymph node metastasis was found in 13 of these patients (36.1%). The prevalence of neck node metastasis in patients with T1/T2 and T3/T4 category tumors was 51.5 and 58.8%, respectively. The associations between the prevalence of neck node metastasis and both the degree of differentiation and the depth of invasion were statistically significant, but there was no significant association between neck node metastasis and tumor size. We conclude that the prevalence of neck lymph node metastasis in patients with squamous cell carcinoma of the oral cavity increases as the tumor depth increases and as the degree of tumor differentiation decreases from well to poor, as has been shown in previous studies. It is interesting that tumor size, which is the most important component of the TNM system, was not significantly associated with neck node involvement.

[Evaluation of the oropharyngeal tularemia cases admitted to our hospital from the provinces of Central Anatolia]. / Orta Anadolu Bölgesi Illerinden Hastanemize Basvuran Orofaringeal Tularemi Olgularinin Degerlendirilmesi.

Tularemia caused by the bacterium Francisella tularensis is a zoonotic infection which has re-emerged in Turkey in recent years as water-borne endemics. Oropharyngeal form is the most frequently reported form of the disease from Turkey. The aim of this study was to evaluate the clinical and laboratory findings of oropharyngeal tularemia patients admitted to ear, nose & throat outpatient clinic between January-March 2010. A total of 10 patients (age range: 16-80 years, mean age: 43.9 years; nine were male) inhabiting in the provinces in Central Anatolia, Turkey, were admitted to our hospital with the complaints of fever, sore throat and painful cervical lump. They have been previously diagnosed as tonsillo-pharyngitis at different medical centers and empirical antibiotic therapy has initiated, however, their complaints have not recovered. Endoscopic laryngoscopic examination revealed that oropharynx, larynx and hypopharynx were normal. Physical examination of the neck yielded localized fixed masses with diameters between 2-7 cm. The lesions were localized at right submandibular (n= 4), upper jugular (n=3) and one of each at left posterior cervical, left submandibular and left jugulodigastric regions. The patients were hospitalized with the pre-diagnosis of "neck mass with unknown origin" for further investigation and treatment. The mean white blood cell count of the cases was 9730 (7500-15.100) cells/µl; the mean erythrocyte sedimantation rate was 68.7 (46-85) mm3/hours and the mean C-reactive protein level was 4.3 (1.5-7.4) µg/dl. Salmonella, Brucella, Toxoplasma gondii, rubella, cytomegalovirus, herpes simplex virus, Epstein-Barr virus and viral hepatitis serology did not indicate acute infections. Serum and tissue samples were sent to Refik Saydam National Public Health Agency in order to test for tularemia, namely culture, microagglutination test (MAT), direct fluorescence antibody (DFA) test and in-house polymerase chain reaction (PCR). All of the patients (10/10) were found positive for tularemia by F.tularensis MAT yielding antibody titers of ≥ 1:640. Lymph aspirate samples could be collected from seven cases and of them 5 (71.4%) were found positive by PCR, while 3 (42.9%) were positive by DFA test. PCR which was performed with the use of RD1 primers yielded F.tularensis subsp. Holarctica. The cultures of blood, urine, lymph aspirates and throat swabs were negative for F.tularensis growth. Of 10 patients two had the history of animal contact and four had consumed fountain water. Nine of the cases were treated with 10 days streptomycin and one with doxycycline, and all were discharged with complete cure. In conclusion, tularemia should be considered in the differential diagnosis of patients with painful lumps in the neck and didn't recover with empirical antibiotic therapy directed against tonsillopharyngitis, particularly in endemic areas.

Extranasopharyngeal angiofibroma originating from the nasal septum: a case report.

Angiofibromas (AFs) originate predominantly in the nasopharynx and posterior nasal cavity. The incidence of these lesions is less than 0.5% among all neoplasms of head and neck. They originate outside the nasopharynx rarely and can therefore be misdiagnosed. The nasal septum is an extremely rare site. Only four cases of extranasopharyngeal angiofibromas arising in the nasal septum have been reported so far. We report here a case of a vascular mass arising from the nasal septum in a 19-year-old boy which was extirpated by submucousal resection endonasally. Histopathology confirmed it to be a case of angiofibroma.

Repair of subtotal tympanic membrane perforations with Seprafilm.

OBJECTIVES: We studied the experimental use of Seprafilm, a sheet-like film form of hyaluronic acid, in the repair of subtotal perforations of the tympanic membrane (TM), and the durability of such repairs. METHOD: The research was conducted on 42 Sprague-Dawley rats. Right TMs of all rats were subtotally and thermally perforated in the same fashion. Seprafilm was applied to the perforated TMs of the 21 rats comprising the experiment group. The perforated TMs of the remaining 21 rats, the control group, were left to heal spontaneously. RESULTS: The mean healing times were recorded as 7.8 +/- 0.6 days for the Seprafilm group and 14.9 +/- 1.1 days for the control group (p < 0.001). CONCLUSIONS: These results suggest that Seprafilm may be a possible first choice (before the decision to operate) in subtotal perforations, considering its easy application and patient follow-up.