E-ISSN 2602-4837
Tr-ENT: 28 (2)

Volume: 28  Issue: 2 - 2018

COVER
1.Cover

Pages I - III

ORIGINAL ARTICLE
2.Cochlear lateral wall and vestibular aqueduct in temporal bones with endolymphatic hydrops from patients with and without vestibular symptoms
Pelin Koçdor, Eric R Siegel, Michael M Paparella, Patricia Schachern, Sebahattin Cüreoğlu
doi: 10.5606/Tr-ENT.2018.84429  Pages 53 - 58
INTRODUCTION: This study aims to compare the stria vascularis and spiral ligament, and evaluate the bony arch around the vestibular aqueduct, in temporal bones with endolymphatic hydrops (EH) from patients with (EH+), and without (EH-) vestibular symptoms, compared to control temporal bones, to better understand the mechanism of vestibular symptoms in Meniere disease.
METHODS: A total of 30 temporal bones (twelve EH+, six EH-, and twelve controls from 27 subjects [mean age 72 years; range 61-89 years]) were retrospectively evaluated in this study. Exclusions were ototoxicity, systemic or neurologic diseases. Stria vascularis areas were measured in all cochlear turns. The spiral ligament was divided into four sections according to fibrocytes. The bony area around the vestibular aqueduct was evaluated according to cellular appearance.
RESULTS: Stria vascularis area between EH+ and EH- in any turn except upper middle was statistically insignificant. Loss of fibrocytes was not statistically different between any groups. Denuded osteoblasts, and diminished edges around bony layer of vestibular aquaduct were statistically different in EH+ and EH- (p=.0003).
DISCUSSION AND CONCLUSION: Lack of histopathologic differences in cochlear lateral walls between any group suggest that these changes might not be responsible for generation of vestibular symptoms. Significant degenerative changes in the vestibular aqueduct in EH+ compared to EH- bones may suggest a relationship of the vestibular aqueduct and vestibular symptoms.

3.Comparison of congenital and acquired cholesteatomas in pediatric patients
Emine Demir, Gorkem Atsal, Filiz Gulustan, Abdullah Dalgic, Levent Olgun
doi: 10.5606/Tr-ENT.2018.76476  Pages 59 - 65
INTRODUCTION: This study aims to present clinical data and surgical results of patients with congenital cholesteatoma (CC) and acquired cholesteatoma (AC).
METHODS: Pediatric cholesteatoma patients who underwent tympanomastoid surgery between January 2008 and June 2015 were evaluated retrospectively. Demographic data, clinical symptoms, surgical and post-surgical findings were recorded. Mastoid development was evaluated with preoperative temporal bone computed tomography. Areas with cholesteatoma were mapped intraoperatively and cholesteatoma was staged. Intraoperative stapes superstructure deformation was assessed. Postoperative hearing results were compared according to air bone gap (ABG) values. Statistical analysis was made by Mann-Whitney U and Kruskal Wallis test.
RESULTS: We analyzed 60 patients (9 CC and 51 AC) under 16 years of age and followed at least six months. In the CC and AC groups, mean age was 6.1 and 10.4 years, and mean follow-up was 28 and 32 months, respectively. While CC group patients were generally asymptomatic, AC group patients were diagnosed with complaints of otorrhea, otalgia and hearing loss. Mastoid development was better in CC group patients (p<0.001). Intraoperatively, the AC mostly covered two or more regions while CC was mostly in one region. There was more deformity of stapes superstructure in AC group patients (p=0.019). Recurrence rates were similar for CC and AC groups and for different types of surgeries (p=0.128). Functional postoperative hearing (ABG ≤10dB) was 44.4% in the CC group and 25.4% in the AC group.
DISCUSSION AND CONCLUSION: The AC is more common than the CC, mastoid development is worse and ossicles are affected more. There are no significant differences in recurrence rates of applied surgeries. However, postoperative hearing results are better in patients who external ear canal preservation, which has an advantage of not causing more mastoidectomy cavity problems. With the main condition of completely removing pathology, these techniques can easily be preferred in cholesteatoma surgery.

4.Thiol-disulphide homeostasis in chronic sinusitis without polyposis
Kazım Bozdemir, Arife Sezgin, Ahmet Akkoz, Özcan Erel, Mehmet Hakan Korkmaz
doi: 10.5606/Tr-ENT.2018.04453  Pages 66 - 70
INTRODUCTION: Oxidative stress plays a role in the pathogenesis of chronic mucosal inflammation in chronic sinusitis and we aimed to investigate a novel oxidative stress marker, thiol/disulphide homeostasis.
METHODS: A total of 60 subjects (30 chronic sinusitis patients and 30 healthy volunteers) were included in the study. Thiol/disulphide levels were analyzed with a newly developed method by Erel and Neselioglu.
RESULTS: The average native thiol value of the chronic sinusitis group was 475.6 μmol/L and 515.8 μmol/L in the control group. The total thiol was 509.4 and 552.2 μmol/L respectively for the chronic sinusitis and control groups. Chronic sinusitis patients had significantly lower native and thiol value than control group (p<.001 and p=.001). There was no significant difference between chronic sinusitis and control groups with respect to disulphide levels.
DISCUSSION AND CONCLUSION: Serum thiol and disulphide measurements can be used as a novel method for the reflection of inflammation for chronic rhinosinusitis patients.

5.A morphometric analysis of laryngeal anatomy: A cadaveric study
Necati Enver, Can Doruk, Erdoğan Kara, Hızır Aslıyüksek, Bora Başaran
doi: 10.5606/Tr-ENT.2018.35229  Pages 71 - 77
INTRODUCTION: This study aims to describe morphometric measurements of the laryngeal framework and discuss their implications for phonosurgery among Turkish subjects.
METHODS: Larynges from 40 male and 20 female fresh cadavers were extracted during autopsy in a forensic science institution between January 2015 and December 2015. Measurements were taken of the length of membranous and cartilaginous vocal fold (mVF, cVF), width and thickness of VF (wVF, tVF), anterior and posterior subglottic distance (AS, PS), width and height of thyroid cartilage (wTC, hTC), and distance between projection of anterior commissure to thyroid cartilage inferior border (pAC to TIB).
RESULTS: For all parameters, median and mean values were higher in male groups, but the differences were significant only in pAC to TIB, wTC, cVF and mVF groups (p<.05). No statistically significant difference between age groups was found. The location of AC was observed above the midpoint of the thyroid cartilage, and the mean distance between the pAC to TIB was 10.2±2.9 mm in males and 7.8±1 mm in females. The mean AS value was 13.14±3.67, whereas the posterior subglottic distance mean value was 7.14±1.35.
DISCUSSION AND CONCLUSION: Although sex is an important factor to define laryngeal morphometrics, age may not be a significant factor. The significant difference in mean distance from pAC to TIB among males and females is an important consideration in laryngeal framework surgery. However, studies with larger samples are needed to confirm our findings.

6.Anatomic and functional results in tragal cartilage tympanoplasty in adults: Correlation with prognostic factors
Isilay Oz, Seyra Hatice Erbek, Selim Erbek, Levent Naci Özlüoğlu
doi: 10.5606/Tr-ENT.2018.58269  Pages 78 - 84
INTRODUCTION: This study aims to evaluate the graft success and functional results of cartilage island graft tympanoplasties performed in adult patients.
METHODS: Medical records of patients operated on for chronic otitis media at our clinic were reviewed. One hundred and ninety-five patients (212 ears) older than 16 years of age that had undergone tympanoplasty operation and that had been followed up for at least six months postoperatively, were included in the study. The prognostic factors that could have impact on graft success were analyzed. The pure-tone average and postoperative gain in air-bone gap (ABG) were recorded as the mean of 0.5, 1 and 2 kHz thresholds.
RESULTS: Graft success was achieved in 191 patients (90%), and graft perforation occurred in 21 patients (10%). When the risk factors that might lead to graft perforation were analyzed separately, the presence of cholesteatoma (p=0.014), and not performing mastoidectomy during tympanoplasty (p=0.031) were significantly associated with graft perforation. The average preoperative ABG, including all types of tympanoplasty operations was 40.20±17.3 dB, and postoperative ABG was 30.14±19.21 dB (p<0.05)
DISCUSSION AND CONCLUSION: The presence of cholesteatoma and tympanoplasty without mastoidectomy were found to affect graft success negatively. Cartilage island graft is an effective technique for tympanic membrane closure and significant hearing improvement.

7.Clinical efficacy of combined treatment with trichloroacetic acid chemical cautery and steroid spray in allergic rhinitis with inferior turbinate hypertrophy
Sanjana Nemade, Pratibha Sampate, Kiran Shinde
doi: 10.5606/Tr-ENT.2018.81370  Pages 85 - 92
INTRODUCTION: Comparison between efficacy of combined treatment with trichloroacetic acid (TCA) chemical cautery and steroid nasal spray in the treatment of allergic rhinitis (AR) with inferior turbinate hypertrophy (ITH).
METHODS: A total of 132 patients with ITH due to AR were included in the study. Forty-four patients each were treated with TCA chemical cauterization of inferior turbinate (Group A), steroid nasal spray (Group B), or combined treatment with TCA cautery and steroid nasal spray (Group C). The Symptom Severity Grade (SSG) 1-5 based on a validated Questionnaire Sheet (QS) as well as Visual Analog Scale were documented before and after treatment.
RESULTS: Before treatment, the SSG was 3-5 in 37 (84%), 36 (81.8%), and 40 (90.9%) patients in groups A, B, and C, respectively. At six months post-treatment, SSG 1-2 was achieved in 20 patients (45.4%) in Group A, 18 patients (40.9%) in group B and 31 patients (70.4%) in Group C. Statistically significant improvement was found in patients who received the combined treatment.
DISCUSSION AND CONCLUSION: Combined treatment with TCA chemical cauterization of inferior turbinate and steroid nasal spray can be effective therapy for amelioration of symptoms of AR and ITH.

8.Transforming growth factor beta 1 (TGF-b1) in the pathophysiology of nasal polyp
Evrim Damcayırı Yeniel, Fatih Turan, Rana Bayram Kablan, Reşit Doğan Köseoğlu
doi: 10.5606/Tr-ENT.2018.78095  Pages 93 - 104
INTRODUCTION: This study aims to use immunohistochemistry to compare histopathological findings and transforming growth factor beta 1 (TGF-b1) levels in polyp tissue in cases of nasal polyp with histopathological findings and TGF-b1 levels in the nasal mucosa in patients with obstructive nasal deformity.
METHODS: The study group consisted of 20 patients. The control group consisted to 20 patients scheduled for nasal surgery due to septum deviation. Edema, mixed infection cell infiltration, eosinophil leukocyte infiltration and squamous metaplasia development were studied from hematoxylin-eosin stained slides containing polyp and conchal mucosa tissue specimens collected from the study and control groups. These were then assessed semi-quantitatively. The presence or absence of TGF-b1 antibody and positive reaction in the mucosal epithelium, submucosal glands, fibroblasts and inflammatory cells were evaluated immunohistochemically.
RESULTS: A positive association was determined between eosinophilia and edema on tissue staining with hematoxylin and eosin in cases of nasal polyp, while no edema was observed in any cases in the control group. Comparison of the control and study groups on immunohistochemical (TGF-b1 positive reaction) staining revealed no significant difference between epithelium, gland and fibroblast staining. Immunohistochemical staining of inflammatory cells was more pronounced in the study group.
DISCUSSION AND CONCLUSION: We conclude that TGF-b1 may play a role together with other mediators, although not alone, in the pathophysiology of nasal polyp.

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