E-ISSN 2602-4837
The Turkish Journal of Ear Nose and Throat - Tr-ENT: 10 (5)
Volume: 10  Issue: 5 - 2003
ORIGINAL ARTICLE
1.Evaluation of cochlear function in patients with normal hearing and tinnitus: a distortion product otoacoustic emission study
Bülent Satar, Osman Kapkın, Yalçın Özkaptan
Pages 177 - 182
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Objectives: We investigated cochlear function in normalhearing
patients with tinnitus using distortion product otoacoustic
emissions (DPOAE).
Patients and Methods: The study included 20 normal-hearing
patients with tinnitus (13 males, 7 females; mean age 25
years; range 17 to 52 years) and 15 controls (10 males, 5
females; mean age 23 years; range 18 to 27 years) with normal
hearing. Both groups underwent routine audiological
tests including audiometry and tympanometry. Cubic
DPOAEs were recorded from both groups. Signal-to-noise
ratios (SNRs) lower than the 10th percentile of the control
values were regarded as abnormal or undetectable.
Results: Tinnitus was bilateral in seven patients and unilateral
in 13 patients. Seven patients with unilateral tinnitus and
all patients with bilateral tinnitus had a history of exposure to
noise. The mean perceived frequencies for tinnitus were 6.3
kHz and 6.2 kHz in the left and right ears, respectively.
Loudness was measured as 8 dB SL in the left ears, and 7
dB SL in the right ears. Compared to unilateral cases,
patients with bilateral tinnitus exhibited a higher percentage of
abnormal SNRs at most frequencies. Some asymptomatic
ears in the patient group had abnormal results.
Conclusion: These findings show that tinnitus in normalhearing
patients is often associated with varying degrees of
cochlear dysfunction. The results also suggest that tinnitus
may be regarded as an early manifestation of noise-induced
hearing loss in patients with a history of exposure to noise.

2.The incidence of hyperinsulinemia in patients with tinnitus and the effect of a diabetic diet on tinnitus
Oğuz Basut, Tuncel Özdilek, Hakan Coşkun, Levent Erişen, İlker Tezel, Selçuk Onart, İbrahim Hızalan
Pages 183 - 187
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Objectives: We investigated the incidence of hyperinsulinemia
in patients presenting with tinnitus and
evaluated the effect of diabetic diet on tinnitus.
Pat ients and Methods: Serum insulin levels were measured
and oral glucose tolerance test was performed in
52 patients (26 males, 26 females; mean age 50 years;
range 20 to 80 years) with idiopathic tinnitus. Those with
hyperinsulinemia were given a diabetic diet for four
months. A questionnaire was administered to all the
patients and the complaint of tinnitus was assessed
according to a rating scale before and after treatment.
The results were compared with those of 15 age-and
sex-matched controls.
Results: Hyperinsulinemia was detected in 76%
and 27% of the patients and the controls, respectively
(p<0.05). Oral glucose tolerance test was normal
in 48% of the patients, and in 80% of the controls
(p<0.05). Following a diabetic diet, the severity
of tinnitus complaints significantly decreased in
patients with hyperinsulinemia (p<0.0001).
Conclusion: Hyperinsulinemia may play an etiologic
role in tinnitus and a diabetic diet may result in significant
improvement in tinnitus complaints in this population.

3.Determination of allergen-specific IgE in patients with atopy or allergy symptoms
Murat Cem Miman, İbrahim H. Özerol, Orhan Özturan, Tamer Erdem
Pages 188 - 193
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Objectives: We investigated the role of specific IgE
assay in the diagnosis in patients found to be atopic
or allergic by history and physical examination.
Patients and Methods: Serum specific IgE levels
were measured by the chemiluminescent assay in
143 adults (58 females, 85 males; mean age 34.3
years; range 16 to 62 years) and in 113 children (62
girls, 51 boys; mean age 10.2 years; range 5 to 16
years) with rhinitis, asthma, or dermatitis. The
results were analyzed in six groups depending on
the specific IgE level (no specific IgE, very low, low,
moderate, high, and very high levels). The specific
IgE threshold for a negative or positive result was
accepted as 0.70 IU/ml. Allergen-specific IgE antibodies
were sought for 35 allergens in adults, and
for 19 allergens in children.
Results: Specific IgE levels were positive (>0.70
IU/ml) in 92 adults (64.34%) and in 50 children
(44.25%). Hypersensitivity to individual allergens
ranged between 20.08% and 41.96% in adults, and
between 17.70% and 28.32% in children. Fourteen
adults and eight children showed sensitivity to a single
allergen; the remaining patients were sensitive to
at least two allergens.
Conclusion: Detection of sensitivity to allergens is complementary
to findings obtained by history and physical
examination and may help to reveal allergic etiology in
patients presenting with a similar symptom profile.

4.An evaluation of surgical techniques and oncologic results in early glottic cancers
M. Kezban Gürbüz, Erkan N. Özüdoğru, Hamdi Çaklı, Emre Cingi, M. Cem Keçik, Cemal Cingi
Pages 194 - 198
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Objectives: We evaluated the surgical techniques
employed and survival rates in patients who were treated
for early glottic cancer.
Patients and Methods: The study included 29 patients (28
males, 1 female; mean age 59 years; range 47 to 73 years)
who underwent surgery for early glottic cancer. Surgical
techniques were employed in view of factors such as
involvement of the anterior commissure, the extent of subor
supraglottic invasion, and cord mobility. Two- and fiveyear
survival rates were calculated. TNM classification was
made according to the 1992 AJCC staging system.
Results: Preoperative tumor stages were TisN0 (n=2, 7%),
T1N0 (n=20, 69%), and T2N0 (n=7, 24%). Surgical techniques
included laryngofissure and cordectomy (n=9, 31%),
frontolateral laryngectomy (n=18, 62%), and vertical hemilaryngectomy
(n=2, 7%). Positive surgical margins were
reported postoperatively in 10 patients, eight of whom
remained tumor-free with (n=4) or without (n=4) radiation
therapy during the follow-up period, while two patients
underwent total laryngectomy because of local recurrences.
Three patients died due to causes other than the primary
disease. Two- and five-year survival rates were 88.8% and
80%, respectively.
Conclusion: Involvement of the anterior commissure, and
the extent of invasion to the subglottis, supraglottis, and the
laryngeal ventricle seem to play a major role in selecting the
most appropriate surgical technique in early glottic cancer.

CASE REPORTS
5.Laryngeal cysts: a report of three cases with varying presentations
Sudhakiran Kalavagunta
Pages 199 - 202
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Cysts in the larynx are not uncommon and assume
importance due to their potential to compromise the
airway. A series of three cases of laryngeal cysts is
presented. Voice, swallowing, and breathing are the
prime functions served by the upper aerodigestive
tract, and the three cases presented here illustrate
how each of these functions can be interfered with
by the development of laryngeal cysts. Despite the
presence of overlapping symptoms, there were only
subtle symptoms at the onset such as globus sensation
(case 1), worsening asthma (case 2), and
vocal fatigue (case 3). This case series highlights
the importance of understanding these subtle symptoms
and the need for a thorough search for these
benign but offending laryngeal cysts.

6.A functional and aesthetic solution for saddle nose deformity: the use of the inferior turbinate bone
Orhan Özturan, Tamer Erdem, Murat Cem Minan, Rezzan Erguvan
Pages 203 - 207
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The use of a new autologous material, the inferior
turbinate bone, for nasal augmentation is presented
together with surgical treatment of a 24-year-old male
patient with moderately severe saddle nose deformity.
In the postoperative period, no complications were
observed. Photographs and three-dimensional computed
tomography views obtained 13 months after the
operation showed that the reconstruction area was
highly free of postoperative resorption. The patient’s
complaints disappeared, and he was satisfied with
functional and cosmetic results. Moreover, a histologic
evaluation which was made to assess the depth of the
glandular component showed that the inferior turbinate
bone could be used over the nasal dorsum in a
smoother shape, retaining its overlying soft tissue.

7.A case of monostotic fibrous dysplasia of the maxillary sinus
L. Oktay Erdem, C. Zuhal Erdem, Şebnem Kargı
Pages 208 - 211
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Fibrous dysplasia is an uncommon benign disease of
the bone, with slow progression. Monostotic involvement
of the paranasal sinuses is rare. We report a 54-
year-old woman who had complaints of facial asymmetry,
chronic sinusitis, recurrent headaches, and nasal
obstruction for two years. Conventional radiography
showed opacification and expansion of the maxillary
sinus. Axial and coronal computed tomography scans
showed a heterogeneous mass that expanded the right
maxillary sinus, leading to nasal obstruction and cortical
thickening of the maxilla. No signs of destruction or erosion
in the cortical bone were identified. An endonasal
endoscopic biopsy was performed and the diagnosis of
fibrous dysplasia was confirmed histologically.

8.A case of necrotizing sialometaplasia in the upper lip
Ahmet Kızılay, Tamer Erdem, Bülent Mızrak, Tuba Bayındır, Orhan Özturan
Pages 213 - 215
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Necrotizing sialometaplasia is a benign, reactive, and
self-limiting inflammatory disorder with clinical and histologic
features resembling carcinoma. A fifty-eight-yearold
woman presented with a firm submucosal mass on
the right side of the upper lip, measuring 0.5 cm.
Histopathologic examination of the incisional biopsy
specimen was reported as adenoid cystic carcinoma,
resulting in removal of the mass with a large excision and
reconstruction of the primary site. However, final
histopathologic diagnosis of the excised mass was
necrotizing sialometaplasia. No recurrences occurred
during a three-year follow-up. This report draws attention
to the difficulty in distinguishing between necrotizing
sialometaplasia and adenoid cystic carcinoma.

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