Single seventh day debridement compared to frequent debridement after endoscopic sinus surgery: a randomized controlled trial.

UNLABELLED: The aim of this study was to evaluate the postoperative debridement frequency following endoscopic sinus surgery. Individual randomized controlled trial. Sixty-two adult patients with a diagnosis of chronic rhino sinusitis (CRS) with nasal polyps (NP) and CRS without NP meeting the inclusion criteria were enrolled in this prospective study. The patients were randomized equally to frequent debridement (FD; at postoperative weeks 1, 2 and 4) or to a single debridement (SD; at postoperative week 1) after surgery. The outcomes were assessed with visual analog scale (VAS) for nine main symptoms concerning patient discomfort within the first 4 weeks, with the modified Lund-Kennedy endoscopic score (MLKES) at weeks 4 and 24 and with the sino-nasal outcome test-20 (SNOT-20) at week 24. Thirty-seven of the patients were male, and twenty-five were female. The mean age was 36.1 ± 13.5 in FD group and 39.2 ± 14.7 in SD group. In the SD group, the VAS scores at postoperative week four showed significantly less discomfort at visits (p = 0.004) and less negative effects on their work (p = 0.013). There was no statistically significant difference between the two groups in the week 4 and 24 MLKES and in the week 24 SNOT-20 scores (p > 0.05). The endoscopic findings did not show significant differences between the groups. Our data indicate that FD causes more discomfort at the required visits, more facial pain and more negative effects on patients' work; this method is not superior to postoperative single seventh day debridement in terms of the 24-week quality of life and endoscopic scores. LEVEL OF EVIDENCE: 1b.

Prevalence of otitis media with effusion among school age children in rural parts of Konya province, Turkey.

OBJECTIVES: This study aims to evaluate the current prevalence of serous otitis media (SOM) among school age children living in rural areas of Konya province located in southern Turkey. PATIENTS AND METHODS: This cross sectional study which was conducted between October 2012 and January 2013 included 2,352 children (1,179 males, 1,173 females; mean age 8.9±2.8 years; range 4 to 15 years) who attended 36 different primary schools in rural parts of the Konya province. Otologic complaints, findings, and tympanometry results were recorded. Diagnosis of SOM was obtained based on history, symptoms, abnormal otoscopy and tympanogram findings. RESULTS: The overall prevalence of SOM was 4.6%. The highest prevalence was at the age of four (11.2%). There was a significantly higher prevalence of SOM at the age of six (11.1%). The overall prevalence was higher in males (6.17%) compared to females (3.16%) in all age groups (p<0.05). CONCLUSION: Compared to the literature, overall prevalence of SOM in our study was lower. Development of preventive and therapeutic strategies in the first step health care service may have a considerable effect on this low rate.

Heparin binding-epidermal growth factor-like growth factor for the regeneration of chronic tympanic membrane perforations in mice.

We aim to explore the role of epidermal growth factor (EGF) ligand shedding in tympanic membrane wound healing and to investigate the translation of its modulation in tissue engineering of chronic tympanic membrane perforations. Chronic suppurative otitis media (CSOM) is an infected chronic tympanic membrane perforation. Up to 200 million suffer from its associated hearing loss and it is the most common cause of pediatric hearing loss in developing countries. There is a need for nonsurgical treatment due to a worldwide lack of resources. In this study, we show that EGF ligand shedding is essential for tympanic membrane healing as it's inhibition, with KB-R7785, leads to chronic perforation in 87.9% (n=58) compared with 0% (n=20) of controls. We then show that heparin binding-EGF-like growth factor (5 µg/mL), which acts to shed EGF ligands, can regenerate chronic perforations in mouse models with 92% (22 of 24) compared with 38% (10 of 26), also with eustachian tube occlusion with 94% (18 of 19) compared with 9% (2 of 23) and with CSOM 100% (16 of 16) compared with 41% (7 of 17). We also show the nonototoxicity of this treatment and its hydrogel delivery vehicle. This provides preliminary data for a clinical trial where it could be delivered by nonspecialist trained healthcare workers and fulfill the clinical need for a nonsurgical treatment for chronic tympanic membrane perforation and CSOM.

Second primary malignant peripheral nerve sheath tumor of the paranasal sinuses after nasopharynx carcinoma.

Malignant peripheral nerve sheath tumors are uncommon neoplasms that arise out of Schwann cells from the peripheral nerves, which rarely occur in the paranasal sinuses and nasal cavity. Especially with the increasing long-term survival of patients with nasopharynx carcinoma, second primary cancers can be diagnosed. Second primary cancers are not uncommon in patients with the prior radiation therapy. However, malignant peripheral nerve sheath tumor in the head and neck region after radiation is an exceedingly rare condition. We report the first case of malignant peripheral nerve sheath tumor of the paranasal sinuses as a second primary malignancy in a patient treated with radiation therapy for nasopharyngeal carcinoma 10 years ago.

Intramuscular cavernous hemangioma of the temporalis muscle.

Hemangiomas are frequent benign hereditary vascular tumors. Intramuscular hemangiomas, a distinctive type of hemangioma occurring within the skeletal muscle, account for less than 1% of all hemangiomas. They occur more often in the trunk and extremity muscles, whereas the involvement of the temporal muscle is extremely rare. A 34-year-old man with a mass in his left temporal fossa was admitted. Computed tomographic scan showed no erosion of the bone, and magnetic resonance imaging revealed an ovoid mass within the temporal muscle. The lesion was surgically excised, and histopathologic examination confirmed the diagnosis of cavernous hemangioma. The patient was not able to lift his left eyebrow right after the surgery. Two months after the surgery, the patient recovered from paralysis, and there was no recurrence of tumor 12 months after the surgery. We report the 27th cavernous hemangioma case of the temporalis muscle. Care must be taken to avoid possible stretch injury to facial nerve branches while resecting these tumors.

Dysphagia and airway obstruction due to large cervical osteophyte in a patient with ankylosing spondylitis.

Anterior cervical osteophytes are excessive bony formation of cervical vertebra bodies. They are common but rarely symptomatic lesions mostly seen in geriatric population. Large anterior cervical osteophytes may cause symptoms such as dysphagia, dyspnea, dysphonia, and odynophagia. They have been attributed to multiple etiologies including diffuse idiopathic skeletal hyperostosis, following trauma, cervical spondylitis, and infectious spondylitis. However, symptomatic large anterior cervical osteophyte with ankylosing spondylitis is extremely rare. Surgical excision is the main treatment for symptomatic cases. We report a case of a 53-year-old man with airway obstruction and dysphagia due to large cervical osteophyte who has a history of ankylosing spondylitis, and we also addressed the etiological factors and management of large symptomatic cervical osteophytes.