E-ISSN 2602-4837
Tr-ENT: 28 (3)

Cilt: 28  Sayı: 3 - 2018


Sayfalar I - III

Surgical treatment of hypopharyngeal cancer
Selçuk Güneş, Bora Başaran, İsmet Aslan, Ökkeş Erkan Kıyak
doi: 10.5606/Tr-ENT.2018.22931  Sayfalar 105 - 111
INTRODUCTION: This study aims to evaluate our department’s approach to the treatment of hypopharyngeal tumors, the features of the tumors, the survival analyses and to present our results in the light of the literature.
METHODS: Eighty-one hypopharyngeal tumor patients and four patients with undefined primary origin, those patients with undefined origin have tumors that infiltrate both hypopharynx and cervical esophagus, totally 85 patients (56 males, 29 females; mean age 54.6±13.4 years; range, 23 to 81 years) who underwent surgical treatment, were included in this study. Demographic data, tumor characteristics, and treatment protocols were recorded retrospectively.
RESULTS: Patients were classified on the primary subsite of the hypopharynx: 51% originated from the sinus piriformis, 29% from the postcricoid area, 15% from the posterior wall of the pharynx and only 5% from the cervical esophagus. The relationship between sex and hypopharyngeal subsite was statistically significant (p<0.001); postcricoid tumors were more prominent in female patients. Also, patients with a history of tobacco use had a tendency for tumors originating from the piriform sinus (p<0.001). Additionally, highly significant differences were revealed between clinical and pathological T and N staging (p<0.001). Estimated 60-month survival rate was 45%.
DISCUSSION AND CONCLUSION: The majority of patients in the study group were not old-aged or alcohol consumers; particularly none of the female patients had any bad habit as a predisposing factor suggested in the etiology. The relationships between tumor site and smoking show that if the campaign against smoking is successful, the rate of sinus piriformis cancer will decrease. For a significant number of patients, primary surgical reconstruction was possible, which shortens postoperative recovery time and accelerates postoperative adjuvant therapy. Therefore, survival rates were found to be high.

Incidence of thyroid gland invasion in locally advanced laryngeal carcinoma
Tuğba Naciye Doğan, Evrim Ünsal Tuna, Aydın Acar, Melih Çayönü, Süleyman Boynueğri, Özgur Gülten, Seçil Kayalı Dinc, Zehra Betul Paksoy
doi: 10.5606/Tr-ENT.2018.03521  Sayfalar 112 - 115
INTRODUCTION: This study aims to determine the frequency of thyroid gland invasion in patients with locally advanced laryngeal carcinoma who were treated with total laryngectomy and neck dissection as well as hemi- or total thyroidectomy.
METHODS: Between April 2000 and February 2016, 127 patients (123 males, 4 females; mean age 57 years; range, 41 to 74 years) who underwent total laryngectomy and neck dissection with laryngeal squamous cell carcinoma were retrospectively reviewed in our clinic. Patients’ demographic characteristics, preoperative tumor stage, postoperative laryngectomy pathology report, tumor invasion, neck lymph node invasion and thyroid gland invasion were evaluated.
RESULTS: In 127 patients, 43 with subglottic extension, extralaryngeal extension and cricothyroid membrane invasion underwent total or hemithyroidectomy in addition to laryngectomy and neck dissection. Squamous cell carcinoma infiltration was found in one patient (2.3%) in the thyroid gland. This patient was diagnosed as T4N1M0 in the pathological stage. Thyroid cartilage invasion and subglottic extension were detected in the preoperative evaluation.
DISCUSSION AND CONCLUSION: Thyroidectomy is performed in our clinic only when subglottic extension, extralaryngeal invasion or cricothyroid membrane invasion is present. Hence, thyroid gland invasion is not common in carcinoma of the larynx. For this reason, we recommend selective thyroidectomy to protect patients from the morbidity of routine thyroidectomy.

Pediatric vestibular schwannomas: Evaluation of clinical features, treatment strategies and long-term results of 10 cases
İbrahim Başar, Şahin Hanalioğlu, Fırat Narin, Burçak Bilginer
doi: 10.5606/Tr-ENT.2018.57966  Sayfalar 116 - 125
INTRODUCTION: This study aims to analyze and discuss the epidemiology, clinical-radiological features, differential diagnosis, histopathological characteristics, treatment strategies and long-term follow-up results of pediatric vestibular schwannomas (VSs) treated at a single institution.
METHODS: Medical records of 10 pediatric patients (3 males, 7 females; mean age 14.9±2.3 years; range 11 to 18 years) who were operated for VSs in our department between January 2000 and December 2017 were retrospectively reviewed. The prognostic variables were age, gender, neurological examination at the time of application, radiologic findings, localization, associated factors, amount of resection (total [100%], near total [90-100%] or subtotal [<90%] resection), histopathological grading and adjuvant treatment.
RESULTS: Two patients had neurofibromatosis type 2 (NF2), while others were sporadic cases. Mean age at diagnosis was 14.9±2.3 years. Major presenting symptoms and signs were hearing loss, tinnitus, headache, imbalance, hemiparesis and facial numbness. Patients had an average of 2.5±1.0 years of symptom duration. In eight of 10 patients, total or near-total tumor resection was achieved. Although the facial nerve was anatomically preserved in all patients, early facial dysfunction occurred in 60%. At the end of an average follow-up of 9.4±5.0 years, 80% of patients had normal or acceptable facial nerve function (House-Brackmann grade I or II), whereas two patients had permanent facial paralysis (House-Brackmann grade V or VI). Tumor progression and recurrence were observed in two patients.
DISCUSSION AND CONCLUSION: Pediatric VSs are rare tumors commonly associated with NF2. Expected long-term survival necessitates effective treatment. Microsurgery is a powerful strategy with possibility of total tumor removal and minimal morbidity rates. Radiosurgery can be used particularly in residual or recurrent tumors or those not exceeding 2-3 cm, although long-term results are not well known in children.

Subjective feeling of nasal obstruction and its response to nasal steroids in the elderly
Serap Sahin Önder, Basak Caypınar Eser, Asli Şahin Yılmaz, Sema Zer Toros, Cağatay Oysu
doi: 10.5606/Tr-ENT.2018.47965  Sayfalar 126 - 131
INTRODUCTION: This study aims to compare the effectiveness of topical nasal steroids for nasal obstruction symptoms between advanced age patients and young-middle age patients based on acoustic rhinometry values and correlations with mucociliary clearance.
METHODS: Our study population consisted of 27 advanced aged patients (15 males, 12 females; mean age 67 years; range, 65 to 76) (group 1) and 36 young-middle aged patients (20 males, 16 females; mean age 36.1 years; range, 15 to 49 years) (group 2). Patients with a history of allergic rhinitis (AR) with positive skin prick tests were referred from the Department of Respiratory Medicine. All patients were evaluated with objective and subjective methods before and after using topical nasal steroids for six weeks. We used rhinometric evaluation and saccharin test as objective methods and assessed patients with nasal obstruction symptom evaluation (NOSE) and visual analog scale (VAS) as subjective methods.
RESULTS: Baseline subjective scores of group 1 were significantly lower than group 2 (p<0.05). Percent change of VAS and NOSE scores were markedly higher in group 2 compared to group 1 (p<0.05). There was no significant difference between groups in terms of the change in saccharin time following nasal steroid treatment (p>0.05). Baseline total minimum cross-sectional area (MCA3) and total volume of nasal cavity (VOL3) values of group 1 were significantly higher than group 2 (p<0.05). The change of MCA3 and VOL3 values did not differ between the groups before and after treatment with nasal steroids (p>0.05).
DISCUSSION AND CONCLUSION: In this study, we have shown that the elderly have reduced awareness of their nasal symptoms of AR. We have demonstrated that topical treatment with nasal steroids was more effective in the young-middle age group subjectively.

Normative auditory brainstem response values to chirp stimulus in adults with normal hearing
Ahmet Fevzi Parlak, Alper Köycü, Hatice Seyra Erbek
doi: 10.5606/Tr-ENT.2018.29392  Sayfalar 132 - 140
INTRODUCTION: This study aimed to establish normative values for our clinic by determining Wave V latency and amplitudes with chirp stimulus in adults with normal hearing.
METHODS: A total of 62 (31 males, 31 females; range, 18-60 years) individuals who had no complaints related to hearing and normal otoscopic examinations participated in the study. The participants were divided into two groups, of those age 18-39 years and 40-60 years. In the auditory brainstem response (ABR) recording parameters, CE-Chirp stimuli were used in repeated frequency rarefaction polarity at the rate of 33.1/sec. For the recording window, a setting of 15 milliseconds was selected and a frequency range of 50-1500 Hz for the recording filter. At each level of intensity, 1500 samples were collected and averaged.
RESULTS: At 90 dB nHL, Wave I could not be obtained in 17 subjects and Wave III in 14 subjects. In Wave V values obtained from all of the subjects, the highest amplitude (0.41±0.12 microvolt) was determined as 70 dB nHL and the lowest latency (4.62±0.34 millisecond) 90 dB nHL. In the evaluation according to gender, the Wave V latencies were more delayed in males than in females. In the age-group evaluation, Wave V latencies were more delayed in the 40-60 years age group than in the younger age group.
DISCUSSION AND CONCLUSION: With CE-Chirp ABR over 70 dB nHL, as there was upward spread of excitation, the wave formations obtained were distorted and amplitudes decreased. Therefore, the determination of the threshold at sound levels of 70 dB nHL and below was considered appropriate for use as a diagnostic method.

Transtracheal high-frequency jet ventilation in a patient with limited mouth opening for endolaryngeal surgery: A case report
Demet Altun, Ozge Kilic, Can Doruk, Ali Emre Camci
doi: 10.5606/Tr-ENT.2018.22932  Sayfalar 141 - 144
In this article, we report a case describing the airway management and anesthetic technique of a 47-year-old male patient undergoing endolaryngeal surgery with extremely limited mouth opening due to previous maxillofacial trauma. An excisional biopsy was planned after laryngoscopic examination for a possible pathological right vocal cord irregularity. Anterior open laryngofissure approach under transtracheal high-frequency jet ventilation was performed after reviewing all possibilities. Neither direct laryngoscopy nor any endolaryngeal instrument placement was possible in this case. This approach was considered the most preferable choice to provide an unobstructed surgical field and safe gas exchange without requiring additional invasive procedure.

Anterior atticotomy technique in otology: A review article
Yavuz Uyar, Ziya Saltürk, Ayça Başkadem Yılmazer
doi: 10.5606/Tr-ENT.2018.41736  Sayfalar 145 - 153
Techniques used in modern otology have been developed and refined over the years to maximize effectiveness. Mastoidectomy using a posterior approach is favored in chronic otitis media surgery, but we believe that exploration of anterior atticotomy, or the excision of the lateral wall of the attic, would be useful. During atticotomy, the attic is revealed and the opening is then extended to the antrum and mastoid cells. Atticotomy avoids unnecessary procedures, such as a wide (extended) mastoidectomy and provides better exposure of the sinus tympani, facial recess, and hypotympanum. It avoids the complications involved with Korner’s septum, an anterior sigmoid sinus, and a low-lying dura. In this article, we review indications, techniques, and complications and present the advantages and disadvantages of this technique in detail.

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