Middle Ear Adenomatous Neuroendocrine Tumor: A Case Report and Review of Literature.

Middle ear adenomatous neuroendocrine tumor (MEANT) is a rare entity and accounts for approximately 2% of all middle ear tumors. Histologically, the presence of neuroendocrine and glandular structures has led to the use of a wide variety of terminologies such as adenoma, carcinoid tumor, and neuroendocrine tumor. The patients usually have nonspecific symptoms such as unilateral hearing loss, auditory fullness, tinnitus, and otalgia. There is no specific radiological finding. A definitive diagnosis is based on complete removal of the tumor and combined histopathology and immunohistochemical examination. In this case-report, we describe a patient with MEANT who complained of hearing loss and auditory fullness in her left ear. Otomicroscopy revealed a mass of polypoid tissue filling the left external auditory canal. In the pure tone audiometry test, the pure-tone average was reported as L45/5 R10/0, and the tympanogram was type B on the left ear. In temporal bone computed tomography, the soft-tissue mass located in the middle ear was found to extend to the antrum and the external auditory canal. Biopsy taken under local anesthesia from the visible mass in the external auditory canal was reported as MEANT and the diagnosis was confirmed by histopathology and immunochemistry after surgery.

Malignant Otitis Externa: How to Monitor the Disease in Outcome Estimation?

OBJECTIVE: Malignant otitis externa (MOE) is a serious disease affecting mainly the elderly diabetic patients that may result in mortality. It was aimed to evaluate the relationship between treatment responses and clinical and radiologic parameters among progress of the disease. Secondary aim was to present our clinical outcomes in the treatment of malignant otitis externa. METHOD: This study was retrospectively conducted in a single center. Reviewed data included history of complaints, duration of symptoms, addition of hyperbaric oxygen treatment, presence of surgical intervention, pathological findings, culture positivity and microorganism, laboratory findings, scintigraphy, imaging modalities and outcome of disease. RESULT: A total of 26 cases with malignant external otitis including 17 females (65.4%) and nine males (34.6%) patients were included in our study. Duration of symptoms before the initiation of treatment, and hyperbaric oxygen treatment did not positively influence the outcome. Inflammatory markers and Peleg staging significantly reflected the treatment response. CONCLUSION: Close monitoring of inflammatory parameters is the key point in the prediction of prognosis. Planning the management and predicting the outcomes rely on proper radiological and clinical assessment of the extent of disease. In the assessment of MOE, universal scoring systems should be preferred for pooling the data in comparable manner.

Topography of the lesion in idiopathic sudden sensorineural hearing loss.

INTRODUCTION: Etiology of ISSNHL includes cessation of vascular perfusion, viral infection and cochlear membrane injury. Precise location of injury should be defined for a target-oriented treatment. Vestibular complaints in ISSNHL are hypothesized as involvement of vestibule. Vestibular complaints can be either due to involvement of inner ear or neural tract at any level. OBJECTIVES: In the present study we aimed to demonstrate involvement of vestibular organs in the absence of vestibular symptoms. It was aimed to evaluate superior and inferior vestibular neural pathways. METHODS: c-vemp and o-vemp were applied to patients suffering ISSNHL without vertigo. Pure tone averages, audiogram configurations, degree of hearing loss were analyzed. Latencies of P1 and N1 waves, amplitudes of P1-N1 waves were evaluated. Asymmetrical vemp wave patterns were compared between two ears regarding difference of PTA. RESULTS: Latencies of c-vemp waves were longer and amplitudes were smaller. o-vemp parameters were similar on both sides. Positive correlation was observed between c-vemp latencies and degree hearing loss. CONCLUSION: Inferior vestibular nerve pathway is affected in the absence of vertigo in ISSNHL with spared superior vestibular nerve pathway. Damage in IVN pathway correlates with degree of ISSNHL.

Emotional and behavioral problems in children and adolescents with hearing loss and their effects on quality of life.

PURPOSE: Determination of mental functions in children with hearing loss is important in improving the quality of life of the child. Many scales have been developed for this purpose. In this study, it was aimed to determine the emotional and behavioral effects of both the child with hearing loss and the parent in the hearing loss and device process, and to investigate the effect of this situation on the quality of life. METHODS: Forty-five children aged 7-17 years with sensorineural hearing loss with audiometric methods and 32 healthy controls without hearing problem were included in the study. All children received a Powers-Weakness Questionnaire-Self-Reporting Scale, Strengths and Difficulties Questionnaire, Child Anxiety and Depression Scale, and Kid-KINDL Quality of Life Scale. In all parents, the Parental Statement of Powers-Weaknesses Questionnaire and the Kid-KINDL Quality of Life Scale parental form questionnaires were applied. RESULTS: In the patient group, both mother (p = 0.001) and father (p = 0.027) education levels were significantly lower than the control group. The success rate of the sick children was lower than that of healthy children (p = 0.013). According to the surveys, the quality of life scale and all subscales were significantly lower in the patient group than in the control group (p < 0.05 for each). Child depression inventory score was also significantly higher in the patient group (p = 0.005). CONCLUSIONS: Data obtained in the study indicate that children with hearing disabilities should be closely monitored and undergo a better rehabilitation process in terms of both anxiety and depression and their quality of life. According to our findings, since the parents of hearing-impaired children are observed to have a low level of education, it is seen that these families should be educated more closely in approaching children and improving their quality of life.

Is corticosteroid a treatment choice for the management of peritonsillar abscess?

OBJECTIVE: To investigate the effect of the single systemic use of corticosteroid following drainage procedure in patients with peritonsillar abscess (PTA). METHODS: This retrospective case-control trial included 32 patients with the diagnosis of PTA between December 2013 and January 2016 in our clinic. Patients were divided into two groups based on the approaches of two authors for the treatment after PTA drainage. The study group included the patients treated with single dose systemic corticosteroid after PTA drainage. Other patients who had no corticosteroid treatment were in the control group. Two groups were compared based on time to oral intake, grade of trismus, pain severity and duration of hospitalization. RESULTS: Statistically significant differences between two groups were observed in terms of time to oral intake, grade of trismus, pain severity and length of hospitalization. The degree of trismus and pain severity significantly decreased in study group comparing to control group at the end of the first day. This difference disappeared at Day 7. Time to oral intake and the duration of hospitalization were shorter in the study group than in control group. CONCLUSION: Corticosteroid treatment following drainage procedure in patients with peritonsillar abscess improves pain severity and trismus thus it decreases time to oral intake and duration of hospitalization.

Treatment of tongue base masses in children by transoral robotic surgery.

The feasibility and effectiveness of transoral robotic surgery (TORS) in children with tongue base masses (TBMs) were evaluated. Eight pediatric patients who were treated with TORS for TBMs between January 2010 and January 2016 at a tertiary hospital included in the study. All pathologies were congenital lesions: four were lingual thyroglossal ductus cysts (LTGDCs), one was a minor salivary gland tumor, one was a vallecular cyst, one was a bronchogenic cyst, and one was an ectopic thyroid tissue. TORS was performed successfully in all cases. The mean robotic set-up and exposure time was 13.0 ± 2.1 min (range 10-16 min) and the mean robotic surgery time was 8.8 ± 6.9 min (range 4-25 min). Estimated blood loss was lower than 5 ml for one patient and lower than 50 ml for another one. The remaining patients' estimated blood loss was lower than 10 ml. No patient required tracheostomy intra- or post-operatively. Only one minor complication occurred on day 10 after surgery (minor bleeding), which was resolved without intervention. No major complications or recurrence were observed. Better visualization and small, flexible arms allow surgeons to treat TBM faster and easily using TORS. This leads to decreased morbidity compared to open and transoral endoscopic/microscopic surgical methods. In the future, we believe that TORS may become the gold standard method for the treatment of pediatric TBM with continued development of robotic technology.

The Predictive Value of Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratio for the Effusion Viscosity in Otitis Media With Chronic Effusion.

OBJECTIVE: The objective of the authors' study was to investigate the predictive value of the neutrophil-lymphocyte rate (NLR) and platelet-lymphocyte rate (PLR) in otitis media with effusion and the correlation of the effusion type with these ratios. STUDY DESIGN: Retrospective case-control study. METHODS: One hundred twenty-six pediatric patients diagnosed otitis media with chronic effusion and had ventilation tube inserted between October 2015 and July 2016 were included in the study group and 124 healthy children, who applied for the routine examination and had blood count analysis, were included in the control group. The patients in the study group were divided into 2 groups regarding the effusion viscosity, which was obtained from the patients' operation files. Seventy-one patients were included in the serous group and 55 patients in the mucous group. The NLR and PLR rates of the groups were compared and statistically evaluated. RESULTS: The average NLR and PLR rates were significantly higher in the study group than in the control group (P = 0.000, P = 0.004 respectively). Comparison of the serous and mucous groups with the control group revealed a significant difference between the control group and the serous group regarding the NLR and PLR (P = 0.000; P = 0.000 respectively), but not between the control group and mucous group (P = 0.694; P = 0.691 respectively). CONCLUSION: Neutrophil-lymphocyte rate and PLR had a predictive value for otitis media with effusion and additionally it was a laboratory indicator supporting the typing of the viscosity of the fluid accumulated in the middle ear.

Is the Monocyte/HDL Ratio a Prognostic Marker of Idiopathic Sudden Hearing Loss?

OBJECTIVE: In this study, our aim was to investigate whether Monocyte/HDL ratio is a marker of the prognosis of the idiopathic sudden hearing loss (ISHL). STUDY DESIGN: Retrospective, case-control clinical trial. MATERIALS AND METHODS: 45 patients, who were diagnosed with idiopathic sudden hearing loss and were treated with the same therapy regime and 47 healthy volunteers, who applied to the hospital for routine controls and had audiological and laboratory examination between March 2014 and December 2015, were included in the study. Monocyte/HDL ratios of the patients in the study and control groups were calculated from the results of the blood counts and biochemical analysis. Additionally, the study group was divided into two sub-groups regarding their responses (responders and non-responders) to the treatment determined by the audiological examination, which was carried out after 3 months according to the Siegel criteria. The Monocyte/HDL ratios between the groups were statistically evaluated. RESULTS: There was no statistically significant difference between the MHRs of the study and control groups (p=0.574). However, the MHR was significantly higher in the non-responders? group compared with the responders? group, although they were treated with the same therapy regimen (p=0.005). CONCLUSION: There was no difference in MHRs between study and control groups. However, as MHR was higher in the patients with good prognosis compared with the patients with bad prognosis, we believe that regarding the ISHL, MHR is not a predictive value but might have prognostic marker.

Assessment of inferior turbinate radiofrequency treatment: Monopolar versus bipolar.

OBJECTIVE: The aim of this study is to compare the early results of monopolar (MP) and bipolar (BP) radiofrequency (RF) used in inferior turbinate hypertrophy treatment concerning aspects of patient and surgeon comfort. STUDY DESIGN: Prospective randomized single-blind study. MATERIALS AND METHODS: The study included 71 patients with inferior turbinate hypertrophy resistant to medical treatment. BP RF was applied to 36 patients. MP RF was applied to 35 patients. Patients received no other treatment during their 6 months of follow-up examinations. They were evaluated by their symptoms (nasal obstruction severity, nasal obstruction frequency, postnasal drip, nasal crusting, hyposmia, patient satisfaction, and preoperative pain) with a visual analogue scale (VAS) done preoperatively on the 1st and 7th days and then in the 1st, 3rd, and 6th months postoperatively. RESULTS: No significant difference was observed comparing the symptoms of patients after BP and MP inferior turbinate RF in long-term follow-up, whereas patients treated with MP RF showed early improvement in their symptoms on the 1st and 7th days postoperatively when compared to the BP group. The application time of MP RF was longer than that of the BP group. Pain during the operation was reported more frequently in the BP group. CONCLUSION: MP and BP RF treatment showed no difference in long-term efficacy. However, MP RF therapy showed early improvement in symptoms and less pain in patients than in the BP RF group.

Management of Laryngoceles by Transoral Robotic Approach.

OBJECTIVES: Laryngoceles are air-filled sacs which communicate with the laryngeal lumen. When filled with mucus or pus, they are called laryngomucoceles and laryngopyoceles, respectively. Transoral robotic surgery (TORS) is a new and remarkable technique that expands its usefullness in otorhinolaryngology. Conventional treatments for laryngoceles were previously performed using external approaches, with aesthetically unfavorable and less function-sparing results. Transoral laser microsurgical approaches for laryngoceles were seldom reported. It is aimed to present authors' clinical experience on laryngocele management with TORS which is a rather new technique. STUDY DESIGN: A retrospective patient serial. METHODS: Patients were evaluated for demographic data, type of lesion, reasons for hospital admittance, complaint duration, and previous surgery. Robotic surgery panel including anesthesia time, duration of surgery, need for tracheotomy, postoperative care, follow-up, and recurrence rates were also summarized. RESULTS: Six men (mean age 51.7 years; range 41-62) with laryngoceles underwent successful TORS. Dyspnea and hoarseness were the main complaints. Two patients had undergone previous laryngeal surgery due to laryngeal cancer, with no recurrence of malignancy at admittance for laryngocele. Three had simple laryngocele, 2 had laryngomucocele, and 1 had laryngopyocele. No laryngoceles recurred and no complication such as dysphonia or prolonged dysphagia occurred. CONCLUSION: Transoral robotic surgery was found superior in safety, technical feasibility and curative effectiveness, when compared with classical methods, especially due to absence of skin incisions. Surgical modalities for laryngocele excision should be directed toward a curative target including cosmetic and functional success, technical achievability, and surgically curative methods. Transoral robotic surgery provided all these features.

Skin diseases of the nose.

OBJECTIVES: The goal of this study was to review the main lesion types of the nasal skin and appropriate treatment strategies rather than to present a comprehensive list of all diseases that affect the skin that can involve the nose. METHODS: We reviewed the main nasal skin lesion types and available treatment strategies. Nasal skin lesions were classified as benign, premalignant, or malignant. RESULTS: Benign lesions of the nose include nonmalignant tumoral lesions (i.e., freckles, comedo, adenoma sebaceum [Pringle disease], hydrocystoma, fibrous papules, sebaceous hyperplasia, and rhinophyma), autoimmune and inflammatory conditions (i.e., pemphigus, sarcoidosis, systemic lupus erythematosus, facial eosinophilic granuloma, rosacea, herpes zoster infection, leishmaniasis, and leprosy), and vascular lesions (i.e., telangiectasis, hemangioma, and spider nevus). Premalignant lesions are actinic keratosis and keratoacanthoma; and malignant tumors are melanoma, basal cell carcinoma, and squamous cell carcinoma. Regardless of whether or not they are malignant, all facial lesions can yield significant cosmetic discomfort that should be evaluated carefully before commencing any curative or corrective intervention. In general, benign lesions are treated with dermabrasive modalities, such as trichloroacetic acid, phenol, salicylate, and laser ablation. Electrocautery, cryosurgery, and surgical excision are also used, although these methods may result in scar formation, which can sometimes be more problematic than the original lesion itself. CONCLUSION: Any disease that affects the skin, especially those diseases that are triggered by ultraviolet exposure, can involve the face and nose. Cosmetic defects due both to the lesion itself and the intervention must be discussed with the patient, preferably in the presence of a first-degree relative, before commencement of treatment. As a result of heterogeneity of skin lesions of the nose, appropriate education of general practitioners as well as otorhinolaryngologists is mandatory.

Comparative assessment of monopolar and bipolar radiofrequency surgery of inferior turbinate.

OBJECTIVE: The aim of this study was to compare early outcomes of monopolar (MP) and bipolar (BP) radiofrequency (RF) treatment of inferior turbinate hypertrophy from the perspective of both the patient and the surgeon. STUDY DESIGN: Prospective, randomized, single-blind study. MATERIALS AND METHODS: Seventy-one patients with inferior turbinate hypertrophy resistant to medical treatment. BP RF was used in 36 patients and MP RF in 35 patients, respectively. Patients received no other treatment during a 6-month follow-up. They were evaluated for symptoms such as nasal obstruction severity, nasal obstruction frequency, postnasal drip, nasal crusting, hyposmia, patient satisfaction, and preoperative pain with the use of a visual analogue scale (VAS) before surgery and then 1 and 7 days as well as 1, 3, and 6 months after surgery. RESULTS: No significant difference was observed regarding symptoms of patients after BP and MP inferior turbinate RF surgery in a long-term follow-up. Patients treated with MP RF showed early symptom improvement on days 1 and 7 days after surgery compared to the BP group. Procedure duration of MP RF was longer than that of BP RF. Pain during surgery was reported more frequently in the BP group. CONCLUSION: MP and BP RF treatment showed no difference in long-term efficacy. However, MP RF therapy was associated with early symptom improvement and less pain reported by patients in comparison to the BP RF group.