E-ISSN 2602-4837
Tr-ENT: 29 (1)

Volume: 29  Issue: 1 - 2019

1.Cover

Pages I - IV

ORIGINAL ARTICLE
2.An analysis of preoperative sonographic findings and fine-needle aspiration biopsy results of thyroidectomy cases
Selçuk Güneş, Nuri Alper Şahbaz, Cevher Akarsu, Mustafa Çeli&775;k, Burak Olgun, Ahmet Cem Dural, İbrahim Sayın
doi: 10.5606/Tr-ENT.2018.74046  Pages 1 - 8
INTRODUCTION: This study aims to compare the preoperative sonographic findings, fine-needle aspiration biopsy (FNAB) and postoperative histopathological results in patients who underwent total thyroidectomy.
METHODS: A total of 884 patients (199 males, 685 females; mean age 46.8±12.7 years; range, 16 to 82 years) who underwent total thyroidectomy were included. Thyroid ultrasonography was performed in all patients with an initial diagnosis of thyroid nodules. Sonographic findings of thyroid nodules were evaluated. The sonographic characteristics were the number of nodules and sizes, having microcalcifications, having irregular margins and echogenicity. Sonographic malignancy scores were calculated due to sonographic findings. All thyroidectomy specimens were sent for pathological evaluation. The specimens were divided into two groups as benign and malignant groups, due to pathological evaluation. Groups were compared in terms of preoperative sonographic findings, FNAB and postoperative histopathological results.
RESULTS: The sonographic malignancy scores were statistically higher in malignant group than in benign group (p=0.001). Nodule size was smaller in malignant group than in benign group (p=0.001). Capsule irregularity rate was statistically higher in malignant group than in benign group (p=0.001). Hypoechogenicity rate was statistically higher in malignant group than in benign group (p=0.001). There was a statistically significant consistency between pathology and FNAB results (kappa=0.478, p=0.001). The sensitivity, specificity, positive predictive and negative predictive values of FNAB were 55.7%, 92.4%, 72.5% and 82.9%, respectively.
DISCUSSION AND CONCLUSION: Although the thyroid FNAB has acceptable sensitivity and specificity, it is not effective alone in establishing a decision of operation. Risk factors of thyroid malignancy should also be considered when assessing FNAB results.

3.Comparative immunohistochemical characteristics of benign and malignant major salivary gland tumors: A retrospective study
Saba Kiremitci, Serpil Dizbay Sak
doi: 10.5606/Tr-ENT.2019.21939  Pages 9 - 20
INTRODUCTION: This study aims to characterize the cellular components of major salivary gland tumors and to identify the differentiating markers between tumor subtypes.
METHODS: Between January 2006 and December 2010, a total of 83 patients (42 males, 41 females; mean age 50.2±15.8 years; range, 21 to 82 years) with major salivary gland tumors (n=12 mucoepidermoid carcinomas, n=8 adenoid cystic carcinomas, n=3 acinic cell carcinomas, n=4 salivary duct carcinomas, n=2 myoepitheliomas, n=5 basal cell adenomas, n=31 pleomorphic adenomas, and n=18 Warthin tumors) with myoepithelial and epithelial immunohistochemical markers (smooth muscle actin [SMA], calponin, S100, CD10, GFAP, p63, GCDFP15, GLUT1, 34ßE12, CK14, CK19, CD117, and galectin-3) were evaluated using tissue microarray method.
RESULTS: The GFAP, S100, CK14, p63, and CK5/6 expressions were significantly lower in the malignant tumors (p<0.05), whereas the expression of neither SMA, nor calponin was significantly different between benign and malignant tumors. The CK19 expression was significantly higher in malignant tumors (p=0.004). Diffuse CD117 expression favored an adenoid cystic carcinoma; GFAP expression favored a pleomorphic adenoma; 34ßE12, p63, and CK5/6 expression favored a mucoepidermoid carcinoma; and GCDFP15 favored a salivary duct carcinoma and acinic cell carcinoma.
DISCUSSION AND CONCLUSION: Our study results showed that distinct tumor types exhibited different preferences for various markers. We, therefore, suggest that immunohistochemical characteristics of myoepithelial cells, rather than the quantity per se, show a significant difference between malignant and benign salivary gland tumors and CK19 expression may indicate the malignant nature of a salivary gland tumor in difficult-to-diagnose tumors.

4.Ischemia-modified albumin levels in patients with idiopathic sudden sensorineural hearing loss
Ahmet Adnan Cırık, Muhammed Fatih Evcimik, Gözde Ülfer, Türkan Yiğitbaşı, Öztürk Aktaş
doi: 10.5606/Tr-ENT.2019.43153  Pages 21 - 27
INTRODUCTION: This study aims to investigate whether serum levels of ischemia-modified albumin (IMA) are associated with idiopathic sudden sensorineural hearing loss (ISSNHL).
METHODS: Between December 2015 and June 2017, a total of 17 patients (9 males, 8 females; mean age 49.4±18.0 years; range, 24 to 88 years) with ISSNHL and 24 age- and sex-matched healthy individuals (12 males, 12 females; mean age 44.5±13.3 years; range, 30 to 81 years) as the control group were included in the study. All patients underwent audiometric examination at the time of admission immediately before the beginning of the treatment and weekly after treatment initiation until one month using the Interacoustics AC40 audiometer. Serum IMA levels were evaluated using blood samples from the antecubital vein of both patient and control groups. The samples were centrifuged to separate the serum from the cells. Albumin cobalt binding test was used for IMA measurement.
RESULTS: The mean IMA level was 0.374±0.081 absorbance units (ABSU) (range, 0.205 to 0.536) in the study group at the time of diagnosis, 0.358±0.051 ABSU (range, 0.297 to 0.466) in the post-treatment period, at least four weeks after onset, and 0.358±0.053 ABSU (range, 0.281 to 0.434) in the control group. There was no statistically significant difference between the patient and control groups. The IMA levels of the patients with ISSNHL in the post-treatment period were lower than the onset of illness, although this difference was not statically significant (0.440).
DISCUSSION AND CONCLUSION: Our study results demonstrated that serum IMA levels in the patients with ISSNHL did not differ from the control group.

5.The efficacy of voice therapy in vocal cord nodules
Rasim Yılmazer, Gayem Köprücü Süzer, Yusufhan Süoğlu
doi: 10.5606/Tr-ENT.2019.02486  Pages 28 - 33
INTRODUCTION: This study aims to investigate the efficacy of voice therapy in the treatment of vocal cord nodules with subjective and objective measurements.
METHODS: The study included 20 female patients with vocal cord nodules. The patients were divided into two groups randomly as study and control groups. Ten patients in the study group (mean age 30.4±8.1 years; range, 21 to 47 years) received voice therapy and anti-reflux treatment. Ten patients in the control group (mean age 32.1±10.5 years; range, 18 to 49 years) received anti-reflux treatment and vocal hygiene education. Voice Handicap Index-10 (VHI-10) questionnaire was completed, the maximum phonation time (MPT) and s/z ratio were measured, acoustic and aerodynamic analyses were performed on voice recordings before and after the treatments for both groups. Pre- and post-treatment videolaryngostroboscopic examinations were performed and the results were compared.
RESULTS: Maximum phonation time increased in the study group (p=0.042) but did not change in the control group. There was no difference in either group in terms of VHI-10, s/z ratio, average fundamental frequency, mean sound pressure level or air flow rate. In the study group, one vocal cord nodule disappeared, five vocal cord nodules decreased in size, and four remained the same. In the control group, four vocal cord nodules remained the same and six decreased in size.
DISCUSSION AND CONCLUSION: The majority of the vocal cord nodules did not disappear with voice therapy while they decreased in size. We observed an increment only in the MPT.

6.Oral cavity cancers: A single-center study
Fetih Furkan Şahin, İsa Kaya, Göksel Turhal, Kerem Öztürk, Nurullah Serdar Akyıldız, Ümit Uluöz
doi: 10.5606/Tr-ENT.2019.14633  Pages 34 - 41
INTRODUCTION: This study aims to evaluate demographic characteristics, tumor characteristics, and survival outcomes of surgically treated patients with oral cavity cancer (OCC).
METHODS: A total of 459 OCC patients (269 males, 190 females; mean age 61.4±15.0 years; range, 18 to 90 years) who were treated with surgery between January 2000 and December 2015 were retrospectively analyzed. Demographic data, diagnosis, histopathological type, tumor origin, tumor stage, neck status, type of surgery, reconstruction technique, complications, follow-up duration, recurrence, and survival status were recorded.
RESULTS: The tumor originated from the lip in 134 (29.2%) of the patients. The histopathological diagnosis was a squamous cell carcinoma in 403 patients (87.8%). The five-year overall survival and disease-free survival rates were 69.5% and 60.8%, respectively. The five-year overall survival rate was significantly lower in patients with neck metastasis (p<0.05).
DISCUSSION AND CONCLUSION: Our study results suggest that regional lymph node metastasis, age, and surgical margin are the main factors affecting survival and prognosis in OCC.

7.One- versus two-session treatment in type IV tympanoplasty
suphi Bulğurcu, Ilker Burak Arslan, Ömer Uğur, İbrahim Çukurova
doi: 10.5606/Tr-ENT.2019.95914  Pages 42 - 46
INTRODUCTION: In this study, we aimed to compare hearing results, cholesteatoma recurrence, and costs of one- versus two-session treatment in patients undergoing type IV tympanoplasty.
METHODS: Between June 2013 and August 2015, a total of 37 patients (20 females, 17 males; mean age 32.5±13.5 years; range, 20 to 48 years) who were operated for chronic otitis media with cholesteatoma were included. Hearing reconstruction was done in one session in 19 patients (Group 1) and in two sessions in 18 patients (Group 2). All patients underwent type IV tympanoplasty with closed cavity.
RESULTS: The mean age was 40.4±10.7 years and 26.5±12.4 years in Group 1 and Group 2, respectively. Recovery of hearing in Group 2 was significantly better than in Group 1 (p=0.001). The mean length of hospitalization was 6.8±2.6 days in Group 1 and 14.6±3.2 days in Group 2. In Group 1, cholesteatoma recurrence was found in two patients during diffusion-weighted magnetic resonance imaging. In the second-look operations, cholesteatoma recurrence was found in four patients in Group 2. Total cost of surgery and care was significantly higher in Group 2 than in Group 1 (p=0.001).
DISCUSSION AND CONCLUSION: According to our study results, two-session operation seems to be more beneficial with successful hearing restoration without additional costs.

8.Holmium: yttrium aluminum garnet laser lithotripsy for salivary calculi: A preliminary experience of 31 procedures
Necdet Ozcelik, Gökhan Altın
doi: 10.5606/Tr-ENT.2019.78871  Pages 47 - 51
INTRODUCTION: This study aims to investigate the efficacy of holmium: yttrium aluminum garnet (Ho: YAG) laser as an intracorporeal lithotripter in the treatment of salivary calculi during sialendoscopy and to evaluate procedure-related complications.
METHODS: Between April 2014 and April 2016, a total of 31 patients (22 males, 9 females; mean age 38 years; range, 8 to 57 years) who were treated with laser sialendoscopy were included. The patients were postoperatively followed on a weekly basis for four weeks and every month, thereafter. Procedural success was defined as the absence of symptoms after a three-month follow-up.
RESULTS: Calculi were located in the parotid gland in eight of the patients and in the submandibular gland in 23 patients. The dimension of calculi varied between 2 to 12 mm. A 1.6 mm-Marchal all-in-one scope was used during sialendoscopy and the Sphinx 30, Lisa Laser was used as the laser device. In 27 of the patients, calculi were completely removed using laser sialendoscopy. In one of these cases, a second session was needed, since the patient definitely refused gland excision. In the second session, calculi were removed after breaking with laser lithotripsy. In four of these cases, calculi breaking process was unable to be completed with laser lithotripsy and open surgery was carried out. There was no canal perforation or nerve damage in any of the patients.
DISCUSSION AND CONCLUSION: Based on our study results, Ho: YAG lasertripsy is an effective and safe method in the treatment of salivary calculi. The use of Ho: YAG laser as an intracorporeal lithotripter increases the treatment success rate of salivary calculi with sialendoscopy.

9.Rhinolithiasis: Mineralogical, chemical composition, clinical and radiological features of rhinoliths
Taliye Çakabay, Selin Üstün Bezgin, Mahmut Cem Tarakçıoğlu, Murat Koçyiğit, Bilge Serin Keskinege, Safiye Giran Örtekin
doi: 10.5606/Tr-ENT.2018.36855  Pages 52 - 53
INTRODUCTION: This study aims to present our large series of rhinolithiasis and mineralogical, chemical composition and radiological features of rhinoliths to shed light into the etiology and pathogenesis of rhinolithiasis.
METHODS: A total of 35 patients (5 males, 30 females; mean age 24.7±15.0 years; range, 5 to 70 years) with rhinolithiasis treated in our hospital between January 2011 and March 2016 were retrospectively analyzed. All patients were divided into four groups according to their age: 0-10, 11-30, 31-50, and 51-70 years. Data including age, gender, signs and symptoms, and accompanying nasal and extranasal pathologies were recorded. Mineralogical, chemical analysis of rhinoliths, nasal swab examination findings, and psychiatric consultation results were evaluated.
RESULTS: A statistically significant difference was found in symptoms between the groups according to the age group. Mineralogical, biochemical analysis was performed for 13 patients. The analysis revealed calcium carbonate and magnesium phosphate in six patients, magnesium carbonate and magnesium phosphate in three patients, magnesium oxalate and magnesium phosphate in two patients, and calcium oxalate and calcium phosphate in two patients. Normal bacterial flora was found in nasal swab culture results. Only one patient was diagnosed with learning disorder on psychiatric consultation.
DISCUSSION AND CONCLUSION: Rhinoliths are nasal stones which leads to long-standing nasal obstruction and discharge and nasal and oral malodor. Physicians should be aware unusual presentations, complicated conditions, and co-existing pathologies which can be encountered. A detailed evaluation by rigid nasal endoscopy and radiological evaluation with paranasal sinus computed tomography should be performed.

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