E-ISSN 2602-4837
Tr-ENT: 20 (4)

Volume: 20  Issue: 4 - 2010

ORIGINAL ARTICLE
1.The relationship between hypothyroidism and rhinitis
Ceren Günel, H. Sema Başak, Engin Güney
Pages 163 - 168
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Objectives: This study proposed relationship between rhinitis and
hypothyroidism and the possibility of whether hypothyroid patients
with symptoms of rhinitis could recover by treatment are investigated.
Patients and Methods: Twenty-five patients (19 females, 6 males;
mean age 42.2 years; range 19 to 65 years) diagnosed with hypothyroidism
and examined in our clinic by the same doctor between
February 2004 and February 2005 were included in the study. In
order to evaluate the symptoms of the patients, a detailed form
was filled. The degree of symptoms was determined with the visual
analog scale (VAS) by the patients. All patients underwent otorhinolaryngologic
examination including nasal endoscopy where the color
of nasal mucus, turbinate hypertrophy and rhinorrhea were recorded.
Nasal air flows were measured by peak-flow meter. Mucociliary
clearance was measured by the saccharin test. Following all the
measurements, patients were started on oral therapy with levothyroxin
sodium tablets by the ambulatory endocrinology clinic. When
the degree of serum thyroid stimulating hormone level fell below
4 μIU/dl, each complaint was re-evaluated by VAS and the examinations
were repeated. The measurements of nasal peak flow meter
and saccharine clearance time are repeated.
Results: The most frequent complaints of the patients were nasal
obstruction (48%), headaches (20%) and rhinorrhea (16%). Following
treatment, the complaints resolved significantly (p=0.005). The difference
between the turbinate hypertrophy and mucosal pallor before
and after treatment was significant (p=0.005). The clearance time
difference before and after treatment was highly significant (p=0.001).
The nasal peak flow meter results after treatment were also significantly
improved (p=0.001).
Conclusion: Besides other examinations, thyroid functions should
also be assessed in patients presenting with rhinitis symptoms.

2.Incudostapedial bridging ossiculoplasty with bone cement hearing results
Fatih Bora, Zeki Yücel, Serdar Ceylan, Erdal Oltulu, Timur Batmaz, Enver Avseren
Pages 169 - 172
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Objectives: This study describes the hearing results
of patients whose ossicles were reconstruction using
bone cement.
Patients and Methods: The medical records of
19 patients (11 males, 8 females; mean age 35,6
years; range 12 to 64 years) who underwent surgery
for chronic otitis media at Istanbul Education and
Research Hospital Otorhinolaryngology Department
between January 2006 and December 2009 were
evaluated. Bone cement reconstruction of the ossicular
chain was performed from incus to stapes in
the absence of a long arm or lenticular process
of the incus. The clinical data of the patients were
evaluated by otoscopic examination and audiometry.
Results: After incudostapedial rebridging ossiculoplasty
we performed; out of 19 patients, 10 had
20 dB gain while two patients had 15-20 dB gain
another two patients had 10-15 dB gain. The remaining
five patients didn’t have any significant gain. The
mean pre- and postoperative air-bone gaps of all the
patients were 36.5 and 20.4 dB respectively.
Conclusion: Incudostapedial rebridging ossiculoplasty
with bone cement is a cost-effective and
safe procedure that yields good hearing results in
selected patients.

3.Preventing cisplatin induced ototoxicity by N-acetylcysteine and salicylate
Müzeyyen Yıldırım, Hasan Mete İnançlı, Baver Samancı, Mehmet Faruk Oktay, Murat Enöz, İsmail Topçu
Pages 173 - 183
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Objectives: In this study we investigated if CP
induced ototoxicity could be prevented or reduced
by the use of salicylate and N-acetylcysteine.
Patients and Methods: Fifty-four patients (28
females, 26 males; mean age 37±9.5 years; range
29 to 71 years) who had cisplatin chemotherapy due
to solid organ tumors were enrolled in the study. The
patients were randomized into three groups, with
18 patients in each group. The first group (control
group) received cisplatin, second group received
N-acetylcysteine (NAC; 600 mg/day) with cisplatin
and the third group received salicylate (300 mg/day)
with cisplatin. All patients evaluated audiologically
including high frequency audiometry and auditory
brainstem response.
Results: The cisplatin-induced ototoxic damage
could be reduced in 10,000 and 12,000 Hz frequencies
when N-acetylcysteine was added to the cisplatin
therapy protocol. There was no decrease in the
hearing loss levels of the patients who were receiving
cisplatin with salicylate.
Conclusion: According to auditory brainstem
response testing results, there was no difference
detected between N-acetylcysteine or salicylate for
the amelioration of cisplatin induced ototoxicity.

4.Tuberculous lymphadenitis
İbrahim Sayın, Sultan Bişkin, Taliye Tuncer Çakabay, Zahide Mine Yazıcı, Ayşenur Meriç, Fatma Tülin Kayhan
Pages 184 - 190
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Objectives: In this study, we evaluate tuberculosis (Tbc)
lymphadenitis diagnosed patients age, gender, contact history,
history of smoking, socioeconomic status, lymphadenitis
localization, imaging techniques, fine needle aspiration
biopsy (FNAB) and excisional biopsy results.
Patients and Methods: Between February 2006 and
February 2008 104 patients were operated to determine
the etiology of their neck masses. Twenty-six patients (16
females, 10 males; mean age 36.9 years; range 16 to 52
years) who were diagnosed as Tbc lymphadenitis according
to pathology results were included in the study. Ear, nose and
throat examinations were performed in all patients routinely.
Hemogram, biochemical and serological tests were performed.
The patients were evaluated with anterior-posterior
chest radiographs and purified protein derivative (PPD) by
chest diseases consultation imaging methods and FNAB was
performed. All patients diagnosed with excisional biopsy of
neck mass. During the operation, tissue culture and Ziehl-
Neelsen method for staining was prepared.
Results: Out of 26 patients eight had a history of contact with
Tbc. One person had previously lung Tbc. Six patients had
previously received treatment because of Tbc lymphadenitis,
but didn’t complete the treatment. Neck ultrasonography
and neck computed tomography detected a solid mass in 16
patients and cystic mass in 10 patients. The 24 patients were
evaluated as positive PPD (>10 mm). None of the patients
had an association between active pulmonary Tbc and Tbc
lymphadenitis.
Conclusion: Suspicion is the most important step in the
diagnosis of Tbc lymphadenitis. In patients with low socioeconomic
status, previous Tbc contact, tabacco usage,
suppressed immune system, and particularly in those with
drainage from neck masses, Tbc lymphadenitis should be
considered in the differential diagnosis.

5.Efficacy of local heparinoids on preventing edema and ecchymosis after rhinoplasty
Mehmet Kelleş, Tamer Erdem, Yezdan Fırat, M. Tayyar Kalcıoğlu, Mustafa Akarçay, Erol Selimoğlu, Saim Yoloğlu
Pages 191 - 194
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Objectives: In this study, the effect of local heparinoids
on prevention of periorbital edema and ecchymosis
due to rhinoplasty was investigated.
Patients and Methods: Twenty patients (12 males,
8 females, mean age 23.3 years; range 19 to 34
years) who had bilateral osteotomy were randomly
administered postoperative local heparinoid on one
periorbital region, without performing any care in the
other one. One and a half centimeter of heparinoid
was applied once a day for nine days. The other
periorbital region was used as control group. The
heparinoid was applied additionally, 8 mg dexamethasone
i.v was administered to all patients 30 minutes
before the surgery and 24 hours after the surgery.
Photographs of each patient which were taken on
postoperative days 1, 3, 5 and 9 were evaluated as
double-blind by two observers. Scoring was performed
according to edema and ecchymosis scales.
Results: There was no statistical difference with
respect to edema and ecchymosis between local
heparinoid treated and control eyes.
Conclusion: No hypersensitivity to drugs occurred
in any patients. After analysing the scores, we
observed that heparanoids administered locally was
not effective in preventing periorbital edema and
ecchymosis after rhinoplasty (p>0.05).

6.Results of revision surgery for hearing failure in intact canal wall up tympanoplasty for chronic otitis media without cholesteatoma
Hatice Çelik, Sevim Aslan Felek, Necmi Arslan, Ahmet İslam, Asım Şafak, İlknur Haberal Can, Yunus Kantekin
Pages 195 - 199
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Objectives: This study assessed the audiometric results of revision
surgery in patients on whom previous canal wall up tympanoplasty had
been performed for chronic otitis media without cholesteatoma, and
investigated reasons for hearing improvement failure which required
revision surgery.
Patients and Methods: Seventy-two patients (49 females, 23 males;
mean age 35.4±12.9 years; range 11 to 64 years) suffering from chronic
otitis media without cholesteatoma, who had intact canal wall up tympanoplasty
and revision surgery due to bad hearing results between
March 2004 and September 2009, were evaluated retrospectively.
After evaluation of patients’ files, operative and audiological records,
findings during the surgery, postoperative follow-up, audiometric
results before revision surgery and the results in the last control after
revision surgery were analysed.
Results: Preoperative mean air-bone gap (ABG) decreased in all
patients from 31.2 dB to 19.9 dB after followed up for mean 26.7 months.
Air-bone gap values below 20 dB were 67%, below 30 dB were 83%,
hearing gain above 10 dB was found to be 58%. Comparision of pre- and
postoperative ABG values of the patients revealed statistically significant
difference (p<0.001). In addition to hearing loss, the reasons for revision
surgery were mucosal disease relapse in 10 patients, graft perforation
in 43 patients, otorrhea control in 15 patients. Findings during revision
surgery were relapse of mucosal diseases in 15 patients, insufficient
mastoidectomy in six patients, problems related to prosthesis in 29
patients, ossicular limitations (brid, hyalen and granulation) in 30 patients,
and ossicular necrosis in six patients. The decision for four patients was
changed from canal wall up tympanoplasty to canal wall down tympanoplasty.
Postoperative total hearing loss developed in one case.
Conclusion: The most important problem in revision of tympanoplasty
patients with hearing loss is related with stabilisation of columella. To
get successful hearing results, it is important to control disease and
provide a stable and safe continuity between the tympanic membrane
and vestibule.

CASE REPORTS
7.Analysis of genetic penetrance in the pedigree of cases with Van der Woude syndrome: report of five cases
Mehmet Bozkurt, Emin Kapı, Yalçın Külahçı, Fatih Zor, Erol Benlier, Mahmut Balkan, Nihal Kılınç, Necat İmirzalıoğlu, Samet Vasfi Kuvat
Pages 200 - 204
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Van der Woude syndrome is a congenital abnormality
characterized by labial cysts, accessory salivary
glands, pits, fistulas and paramedian sinuses of the
lower lips, and is frequently associated with cleft lip
and palate. This disease is the most common syndromic
cleft abnormality. The disease is characterized
by a single gene abnormality where craniofacial
morphogenesis is affected. It has an autosomal
dominant inheritance with involvement of 1q32-41
chromosomal locus. However, the gene expression
profile is variable and the disease may present in
some individuals with sinuses of the lower lips only.
We present results of analysis of genetic penetrance
in the pedigree of five cases with Van der Woude
syndrome together with a review of the literature.

8.Isolated hypoglossal nerve paralysis: a case report
Güçlü Kaan Beriat, Hande Ezerarslan, Sinan Kocatürk, Enes Özyar
Pages 205 - 209
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Cranial nerve paralysis is an uncommon complication
of radiotherapy for head and neck carcinomas
because cranial nerves are relatively resistant to
radiation. The incidence of this complication has
been declared to be 1-5% in different studies. Unlike
the other cranial nerves, isolated hypoglossal nerve
paralysis in patients who have been treated with
radiotherapy for nasopharyngeal carcinomas is a
worrisome sign of recurrence. We report a 45-year-old
male patient admitted to our clinics with complaints of
difficulty in moving his tongue and dysphasia five
years after combined radiotherapy and chemotherapy
for nasopharyngeal carcinoma. Recurrence of the
tumor was thought to be the cause of the isolated
hypoglossal nerve paralysis at first, however late
toxicity of radiotherapy was found to be the etiological
factor after detailed examinatons.

9.Submandibular gland pleomorphic adenoma in a seven-year-old child: a case report
Serap Köybaşı, Ahmet Emre Süslü, Erkan Tezcan, Halil İbrahim Atasoy, Yusuf Özgür Biçer, Çetin Boran
Pages 210 - 213
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Salivary gland neoplasms are rare in the pediatric
age group. Pleomorphic adenomas in the submandibular
gland are rarer. In this article, we present a
seven-year-old female with a slowly growing mass in
her right submandibular area. The firm, mobile and
painless mass was about 2x3 cm in size and with
bimanual palpation it was indiscriminated from the
submandibular gland. Magnetic resonance imaging
with contrast revealed a heterogeneous and
minimally lobulated mass within the submandibular
gland with clearly defined borders. Fine needle aspiration
biopsy revealed a diagnosis of pleomorphic
adenoma and we performed right submandibular
gland excision under general anesthesia. The histopathological
diagnosis was pleomorphic adenoma
with sparse mitotic figures that may be interpreted as
having a potential of malignant transformation. This
patient who was followed up for one year without any
complication is to our knowledge the youngest case
cited in the English-language literature.

10.An unusual localization of fungiform papilloma
Emine Aydın, Eren Taştan, Filiz Aydoğan, Muzaffer Çaydere
Pages 214 - 217
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In this article, we presented a 54-year-old male who
was admitted with complaints of nasal obstruction
with snoring and mouth breathing for one year.
Anterior rhinoscopy revealed a mass arising from the
inferior nasal concha on the left side. After computed
tomography evaluation, endoscopic examination
and incisional biopsy, the mass was removed en
bloc endoscopically. The histopathological analysis
resulted in a diagnosis of a fungiform papilloma.
Fungiform papillomas arise almost exclusively on the
nasal septum, while inverted papillomas predominantly
affect the lateral nasal wall. To our knowledge,
no previous report of fungiform papilloma involving
the inferior concha has been published in the English
literature.

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