The additive value of continuous positive airway pressure treatment on psychological symptoms

OBJECTIVE

To screen psychological problems of patients with obstructive sleep apnea syndrome (OSAS) by utilizing the psychological symptom screening test Symptom Checklist-90-Revised (SCL-90-R) and to evaluate the effect of continuous positive airway pressure (CPAP) treatment.

METHODS

The SCL-90-R and Epworth Sleepiness Scale (ESS) test were applied to 66 patients with Apnea-Hypopnea Index (AHI ≥ 30/h) using CPAP device and 20 healthy individuals; the test results were compared.

RESULTS

The age of the patients ranged from 28 to 67 years, and the patient group comprised 54 males (81.8%) and 12 females (18.2%). The AHI scores ranged from 30.05 to 99.80, with a mean of 49.34 ± 21.40. Significant improvement was seen in 6 of the 11 SCL-90-R scores in CPAP-treated patients.

CONCLUSION

The authors conclude that the SCL-90-R test may be appropriate for evaluating the response to CPAP treatment in OSAS patients and monitoring the psychosocial effects of treatment.

Role of Cochlear Nerve Diameter as a Prognostic Indicator for Hearing Recovery in Older Adults with Idiopathic Sudden Sensorineural Hearing Loss

BACKGROUND

Idiopathic sudden sensorineural hearing loss is a disabling condition that lowers the quality of life specifically in older adults living alone. It is crucial to determine the outcome of the disease and to offer early treatment to prevent isolation caused by hearing impairment in this population. The objective of our study was to investigate whether the initial cochlear nerve thickness may predict the outcome of hearing recovery in older adults with idiopathic sudden sensorineural hearing loss.

METHODS

The study population was composed of older adults that were referred with idiopathic sudden sensorineural hearing loss in 1 ear. Long-term audiological data of the cohort were analyzed according to Siegel's criteria on hearing recovery and were grouped according to complete recovery or treatment failure. Cochlear nerve diameters of the diseased and safe ears of each group, measured on reformatted images on magnetic resonance imaging, at the fundus, in the mid-internal acoustic canal, and at the entry point into the Pons were compared in each group and between groups.

RESULTS

Mean cochlear nerve diameter was significantly larger in the recovered older adults (1.11 ± 0.27 mm) than in the non-recovered adults (0.94 ± 0.21 mm) at the mid-internal acoustic canal (Student's t-test, P < .05). Cochlear nerve thickness at mid-internal acoustic canal (≤0.8 mm) sensitivity for recovery failure was 89% and displayed an odds ratio 5.333, 95% CI (1.000-28.435).

CONCLUSION

Cochlear nerve thickness in mid-internal acoustic canal in non-recovered older adults with idiopathic sudden sensorineural hearing loss is significantly thinner than the completely recovered group. Older adults with mid-internal acoustic canal cochlear nerve greatest diameter cutoff level of ≤0.8 mm are 5.33 times more exposed to recovery failure.

Glass Particles in the Nasal Cavity for 30 Years and Squamous Cell Carcinoma: Is There a Relationship?

Nasal cavity tumors constitute a very small part of head and neck malignancies. Although paranasal sinus tumors due to the presence of backward foreign bodies, neoplasms of nasal cavity associated with a foreign body are extremely rare. In this article, we presented a rare case of carcinoma in the right nasal cavity which includes glass particles inside it, and the role of glass particles in carcinogenesis was discussed. The patient was a 55-year-old male with history of a car accident 30 years ago. During right medial maxillectomy via a right lateral rhinotomy approach, three pieces of glass beads, approximately 0.5 cm in size, were removed from the inside of the mass. The patient had also under gone postoperative radiotherapy. No complication emerged during the postoperative recovery period. The patient had been followed up with no finding of local recurrence for 12 months.

The Role of Fusion Technique of Computed Tomography and Non-echo-planar Diffusion-weighted Imaging in the Evaluation of Surgical Localization of Cholesteatoma

Objective:

In recent years, the fusion of computed tomography (CT) and non-echo-planar diffusion-weighted magnetic resonance imaging (non- EPI DWI) has been preferred in cholesteatoma localizations. This study aimed to investigate the role of CT and non-EPI DWI fusion imaging in cholesteatoma localizations.

Methods:

This retrospective study included 39 patients who underwent chronic otitis media operation [mean age of 35.10±15.33 years (18-67 years), 64.1% female, and 35.9% male] and had preoperative high-resolution temporal bone CT and non-EPI DWI examinations. Images were sent to the Advantage Workstation VolumeShare 7 for fusion. These selected images were fused on the workstation and were manually corrected by the radiologist. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracies of fused images of CT and non-EPI DWI were evaluated according to anatomic cholesteatoma localizations based on surgical data.

Results:

The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracies of non-EPI DWI for detecting cholesteatomas were 97.14%, 75.00%, 97.14%, 75.00%, and 94.87%, respectively. Three true-negative, one false-positive, and one false-negative case were observed according to surgical results in detecting the presence of a cholesteatoma with non-EPI DWI. Moderate agreement was determined between the surgical and radiological results in detecting the presence of a cholesteatoma (k=0.721). Detecting the lesion of localization on the fused images compared to surgical found an almost perfect agreement in the mastoid antrum (k=0.948), strong agreement in the hypotympanum and mastoid cells (k=0.894), moderate agreement in the epitympanum (k=0.653), and weak agreement in those in the mesotympanum (k=0.540).

Conclusions:

The surgeons’ determinations are supported by the guidance of temporal CT and non-EPI DWI fused images. Therefore, preferring the fusion imaging technique could increase the quality of life by reducing unnecessary operations.

Expression of miR-373 and its predicted target genes E-cadherin and CD44 in patients with laryngeal squamous cell carcinoma

Laryngeal squamous cell carcinoma (LSCC) is a genomically complex disease that is difficult to target, and efforts have been made to identify new treatment strategies and   molecular markers that might stratify patients and individualize options for treatment. miR-373 has diametrically opposed roles in different stages and types of cancers. miR-373 has been suggested to quantitatively control E-cadherin and CD44 expression. We studied the expression of miR-373, E-cadherin and CD44 in laryngeal squamous cell carcinoma and evaluated the association between the disease and clinical characteristics of patients. Tumor tissues were collected from 24 laryngeal cancer patients. Adjacent normal tissue samples were also obtained as controls. After RNA isolation, we assessed the miR-373, E-cadherin and CD44 levels. As endogenous controls, we used the small RNA U6 and GAPDH TaqMan® to normalize the levels of expression of miR-373, E-cadherin and CD44. The fold change in the expression of the genes in larynx tumor and control tissues was calculated using the 2-ΔΔCT method. miR-373 was significantly upregulated in seventeen tumor samples compared to controls. However, the expression levels of both E-cadherin and CD44 mRNA were found to be significantly downregulated in tumor versus control regions (p=0.026 and p=0.005, respectively). We did not find any significant difference in the expression levels of miR-373, E-cadherin or CD44 and cancer risk factors. miR-373, E-cadherin and CD44 may be involved in the etiopathogenesis of laryngeal cancer. It can be suggested that E-cadherin and CD44 are functional targets of miR-373, but we need further studies to investigate this hypothesis.

Verruciform Xanthoma of a Lower Lip Lesion: A New Case and Review of the Literature

A non-smoking man in his seventh decade presented with a lesion he had had for about 5 years on the right external surface of the lip 1 mm from the vermilion border. On physical examination, a yellowish-coloured, non-tender, verrucous mass of 0.5 × 0.7 cm was observed. A histopathological examination of the first 3-mm punch biopsy was non-diagnostic. The histopathological evaluation of a second, 5-mm-deep punch biopsy made by a pathology expert in oral lesions revealed a diagnosis of verruciform xanthoma. The key to the diagnosis of verruciform xanthoma is to recognize xanthoma cells. However, these cells may be insufficient in number in small and superficial biopsy material and overlooked by a pathologist especially when lacking knowledge of this uncommon lesion. Verruciform xanthoma of the lower lip at the vermilion border is an extremely rare entity described in 5 cases worldwide to date. We aimed to bring verruciform xanthoma to readers' attention for a differential diagnosis of lower lip diseases and to prevent overdiagnosis and overtreatment of this lesion unfamiliar to otorhinolaryngologists.

Outcomes of external septorhinoplasty in a Turkish male population

Introduction

The first and one of the most important steps in facial plastic surgery is accurate preoperative facial analysis and recording of data that may help the surgeon to check the outcomes of his/her techniques, promoting a surgeon's professional development.

Objective

To evaluate the esthetic outcomes of external septorhinoplasty relevant to ethnic facial harmony and to investigate the relationship of the columellar incision scar with the type of skin and columellar incision type in a Turkish population.

Methods

In total, 28 consecutive adult male patients with a mean age of 32.14 ± 10.66 years (range: 18–61 years) were included the study. Primary outcomes were preoperative and postoperative photogrammetric facial analyses of the patients including measurement of nasofrontal angle, nasolabial angle and nasal projection ratios (Gode) assessed according to the data derived from the Rhinobase program. Results were compared to facial proportions of the Turkish population. Columellar incision scar scores related to the Fitzpatrick skin type classification of the patients and columellar incision types used for the external approach were secondary outcomes of the study.

Results

Mean preoperative and postoperative nasofrontal angles were 148.04° ± 8.18° and 144.50° ± 7.15°, respectively, while mean preoperative and postoperative nasolabial angles were 87.59° ± 14.01° and 98.50° ± 9.71°, respectively. Mean preoperative and postoperative nasal tip projection ratios were 0.56 ± 0.05 and 0.60 ± 0.06, respectively. The differences between pre- and postoperative measurements were all significantly different and were in accordance with Turkish nasal harmony. Columellar inverted “V” incisions were performed in 15 (53.6%) patients while “V” incisions were used in 13 (46.4%) patients. Fitzpatrick skin Type 4 was seen in 46.42% of the patients, Fitzpatrick Type 3 in 46.42% and Fitzpatrick Type 2 in 7.14% of the patients. No significant difference was seen between columellar scar scores according to skin type and columellar incision type used for external septorhinoplasty.

Conclusions

This study demonstrated that outcomes for nasofrontal angle, nasolabial angle and nasal tip projection ratios analyzed using the Rhinobase program in patients who underwent external septorhinoplasty were similar to reference values for the Turkish population.

Are there possible associations between MnSOD and GPx1 gene variants for laryngeal cancer risk or disease progression?

Laryngeal squamous cell carcinoma (LSCC) is a multifaceted and genomically complex disease and cellular and preclinical studies have demystified wide ranging molecular mechanisms which underpin its development and progression and resistance against wide ranging molecular therapeutics. Oxidative stress is a widely studied molecular mechanism and reportedly involved in carcinogenesis. Increasingly it is being realized that accumulation of Reactive Oxygen Species (ROS) activates defensive mechanism to counteract oxidative stress induced damage. Manganese superoxide dismutase (MnSOD) and glutathione peroxidase (GPx) are important members of defensive machinery. We investigated whether the polymorphisms of MnSOD (Ala-9Val, rs4880) and GPx1 (Pro198Leu, rs1050450) are associated with LSCC and also evaluated possible interactions between these polymorphisms and various lifestyle factors or pathological features of patients. For this purpose, 67 LSCC patients and 73 healty controls were enrolled. Molecular assessment of MnSOD and GPx1 variants were determined with polymerase chain reaction-restriction fragment length polymorphism techniques. We found that the frequency of both heterozygous PL genotype and P allele was considerably higher in patients with advanced tumor stage (T3/T4) than in those with early tumor stage (T1/T2) (OR= 5.106; 95% CI=1.372-19.004; p<0.001, OR=5.787; 95% CI =1.564-21.414; p<0.001 respectively). Although the frequency of ValVal/LL combine genotype was significantly decreased (OR=0.204, 95% CI=0.055-0.760; p=0.021), the frequency of ValAla/PL combine genotypes was higher in patients with stage T3/T4 than in those patients with stage T1/T2 (p=0.027). Consequently, we have concluded that variants of GPx1 and MnSOD should not be considered as a risk factor of LSCC, only may be accepted as a prognostic markers. Use of new technologies such as metabolomics and deep DNA sequencing will prove to be helpful in developing a deeper knowledge related to how cancer cell metabolism adapts and provides a buffer against increased oxidative stress.

Extramedullary plasmacytoma of the frontal sinus: case report and Turkish literature review

Solitary extramedullary plasmacytomas (EMPs) are nonepithelial neoplasms of plasma cell origin categorized among non-Hodgkin lymphomas, without the bone marrow involvement and systemic spread seen in multiple myeloma. They are uncommon tumors comprising 3% of all plasma cell neoplasias. Although they usually occur in the upper respiratory tract, only 1 case of EMP localized to the frontal sinus has been reported in the English literature. We present in this report a rare case of EMP originated from the left frontal sinus leading to left eyeball proptosis and movement restriction. A survey of sinonasal EMPs in the Turkish literature is reported, as well. Paranasal computerized tomography and magnetic resonance imaging of a 69-year-old female who presented with left eyeball proptosis and left-sided headache revealed a solid mass in the left frontal sinus. Histopathological analysis of the completely excised mass supported the diagnosis of plasmacytoma. The definitive diagnosis of solitary EMP was confirmed with further investigations at hematology and oncology clinics. The patient was treated with surgery followed by local radiotherapy to the head and neck region, and she was disease-free at her 1-year follow-up. Treatment of sinonasal EMP is surgery alone or surgery combined with radiotherapy. Long-term follow-up is a requisite for systemic control because of the disease’s high potential to transform into multiple myeloma.

Auditory neuropathy in late preterm infants treated with phototherapy for hyperbilirubinemia

OBJECTIVE

To evaluate the prevalence of auditory neuropathy (AN) in late preterms treated with phototherapy for hyperbilirubinemia.

DESIGN

Prospective observational study comprising late preterms treated with phototherapy for hyperbilirubinemia. Newborns were screened with combined transient-evoked otoacoustic emissions (TEOAEs) / automated auditory brainstem responses (AABR). Infants who failed screening underwent diagnostic (ABR). Infants were all re-evaluated with AABR at one year.

STUDY SAMPLE

Eighty-five infants with a mean serum total bilirubin concentration of 22.3 ± 1.76 mg/dl; severe-hyperbilirubinemia (SH), and 102 infants with a mean serum total bilirubin concentration of 18.6 ± 1.26 mg/dl; non-severe hyperbilirubinemia (NSH) were included.

RESULTS

From 85 late preterms with SH, six (7.1%) failed screening and underwent diagnostic ABR for six weeks. AN was diagnosed in two (2%) infants with SH. Four (3.9%) of the 102 controls with NSH demonstrated failure at TEOAE/AABR. No AN was diagnosed in the control group at the diagnostic ABR. No statistically significant difference was found between infants treated with phototherapy for SH and NSH with regard to AN/AD either in the postnatal period or at one year. No correlation was found between serum bilirubin levels and ABR latencies or thresholds.

CONCLUSIONS

AN (2%) in late preterms treated with phototherapy for severe-hyperbilirubinemia was not higher than in those with non-severe hyperbilirubinemia.

External auditory canal microbiology and hearing aid use

OBJECTIVE

The aim of this study was to determine the presence and nature of bacterial flora on hearing aids and the ears of this population. We wonder if the microbiology of the ears with hearing aid wearing differs from the other ear.

SETTING

Tertiary referral center.

DESIGN

A prospective, clinical study.

SUBJECTS AND METHODS

Three samples were taken, one from the surface of the hearing aid's ear mold; one from the hearing aid-wearing ear canal and the last one from the ear without hearing aid. Samples were cultured to determine qualitatively and quantitatively the pathogenic microorganisms present.

RESULTS

A total of 123 samples, obtained from 41 hearing aid users, were analyzed. Methicillin-resistant coagulase-negative staphylococci, methicillin-susceptible Staphylococcus aureus, methicillin-resistant S. aureus, Pseudomonas aeruginosa, Escherichia coli, Acinetobacter species, Staphylococcus auricularis, and Stenotrophomonas maltophilia were identified organisms.

CONCLUSIONS

We identified unexpected microorganisms both on hearing aids and hearing aid using ears. This study demonstrates that using hearing aid alters the ear canal flora. To avoid otitis externa, it is important to use an appropriate hygiene routine to clean and disinfect hearing aids and ear molds.

Efficacy of Multimodality Approach at Sudden Hearing Loss

Objective: The etiological spectrum of sudden hearing loss is ample and ambiguous. The combined form of different treatment modalities geared toward the hypothetical etiologies given at once must work better theoretically . This study is a trial to see whether addition of intratympanic steroid to systemic steroid and hyperbaric oyygen treatment works better or not.

Method: Prospective randomized study in a tertiary referral hospital. Fifty-eight patients who presented with sudden hearing loss between 2008 and 2011 were enrolled into the study. Twenty patients who had received systemic steroid and hyperbaric oxygen composed group I while 38 patients who had received intratympanic steroid in addition to systemic steroid and hyperbaric oxygen composed group II.

Results: Posttreatment hearing improvement was statistically significant in both groups in terms of pure tone average according to Siegel’s criteria ( P < .05). Treatment was successful for 55% of patients in group I and 63% in group II. Although there is an increase in success rate with the addition of intratympanic steroid, this was not statistically significant ( P > .05). Regarding profound hearing loss over 90 dB, there seems a strong statistically significant difference. Treatment didn’t work in group I for a total of 6 patients (0%) while addition of intratympanic steroid to the protocol yielded success for 6 patients over 12 (50%) in group II ( P < .05).

Conclusion: Addition of intratympanic steroids to systemic steroid and hyperbaric oxygen yielded better results, but this was not statistically significant in general. However, intratympanic steroid injection seems beneficial for patients with profound sudden hearing loss.

Rhinolithiasis: a retrospective study and review of the literature

We conducted a retrospective analysis of 18 cases of rhinolithiasis treated in our clinic between 1990 and 2004. Age, sex, locations, diagnostic methods, and surgical technique were analyzed. Diagnosis was made by clinical examination and radiologic methods. Anterior rhinoscopy was performed in all patients and endoscopic evaluation in 14 patients. Plain-film x-rays of the paranasal sinus were taken in all patients, and computed tomography was performed in 5 patients. All rhinoliths were in the inferior meatus-11 right and 7 left. Patients' complaints were unilateral, foul-smelling rhinorrhea and nasal obstruction. Five patients also had headache, and 2 had cleft lip and palate. Rhinoliths were removed under local anesthesia in 12 patients and under general anesthesia in 6. An anterior rhinoscopic approach was used in 4 patients and an endoscopic approach in 14. Four of the patients underwent additional procedures, such as septoplasty, endoscopic sinus surgery, and adenoidectomy. Rhinolithiasis should be suspected in every case with unilateral, foul-smelling rhinorrhea and nasal obstruction. The treatment of choice is surgical removal under local or general anesthesia.

[An evaluation of parotid gland masses]

OBJECTIVES

We retrospectively evaluated patients who underwent surgery for parotid gland masses.

PATIENTS AND METHODS

A total of 50 patients (25 females, 25 males; mean age 48.5 years; range 18 to 76 years) who underwent surgery for parotid gland masses were evaluated with regard to age, sex, preoperative diagnostic methods, histopathologic diagnoses, and surgical techniques.

RESULTS

Preoperative diagnostic studies included ultrasonography, fine-needle aspiration biopsy, computed tomography, and magnetic resonance imaging. Histopathological diagnoses were benign in 33 patients (66%), malignant in nine patients (18%), and tumor-like pathologies in eight patients (16%), the most common being pleomorphic adenoma (n=28, 56%), Warthin's tumor (n=4, 8%), and squamous cell carcinoma (n=4, 8%). Superficial and total parotidectomies were performed in 40 (80%) and 10 (20%) patients, respectively. Nine patients with malignant tumors also had neck dissection and postoperative radiotherapy. Mortality occurred in one patient with metastasis to the parotid gland. One patient with lipoma developed recurrence two years after surgery. Follow-up was five years in 28 patients (56%), three years in 12 patients (24%), and two years in five patients (10%). Complete and transient facial paralysis developed in 10 patients and five patients following total and superficial parotidectomy, respectively.

CONCLUSION

Superficial parotidectomy is the minimal surgery for parotid gland masses. If the deep lobe of the gland is involved, total parotidectomy should be performed with preservation of the facial nerve. In malignant tumors, neck dissection and postoperative radiotherapy should be added.

Bilateral massive conchae bullosa mimicking intranasal tumors

We describe a case of bilateral massive conchae bullosa in a 76-year-old woman. She presented with a 2-year history of nasal obstruction and frontal headache. In light of these and other findings on anterior rhinoscopic and endoscopic examinations, we initially suspected nasal tumors. However, after a prebiopsy evaluation by computed tomography, we diagnosed bilateral massive conchae bullosa that did not impair sinus ventilation. Endoscopic surgery was performed, and the patient's symptoms abated.

Bilateral Massive Conchae Bullosa Mimicking Intranasal Tumors

We describe a case of bilateral massive conchae bullosa in a 76-year-old woman. She presented with a 2-year history of nasal obstruction and frontal headache. In light of these and other findings on anterior rhinoscopic and endoscopic examinations, we initially suspected nasal tumors. However, after a prebiopsy evaluation by computed tomography, we diagnosed bilateral massive conchae bullosa that did not impair sinus ventilation. Endoscopic surgery was performed, and the patient's symptoms abated.