E-ISSN 2602-4837
The Turkish Journal of Ear Nose and Throat - Tr-ENT: 16 (4)
Volume: 16  Issue: 4 - 2006
ORIGINAL ARTICLE
1.Intraoperative planning and inset principles of fibula osteoseptocutaneous flap in compound or composite oromandibular defect reconstruction
Betül Gözel Ulusal, Ali Engin Ulusal, Ming Huei Cheng, Fu Chan Weı
Pages 145 - 154
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Objectives: The use of free fibular osteocutaneous
flap was evaluated in the reconstruction of compound
and composite mandibular defects.
Patients and Methods: The study included 30 patients
(27 males, 3 females, mean age 52.6 years; range 42
to 66 years) who received free osteoseptocutaneous
fibular flap for the reconstruction of compound or composite
oromandibular defects following surgical tumor
ablation. Five patients with extensive skin defects
accompanying lateral mandible and oral defects also
received free anterolateral thigh perforator flap. Other
patients were treated with conventional fibular osteocutaneous
flap or its chimeric form. The mean follow-up
period was 19.4 months (range 8 to 38 months).
Results: With the applied technique, a successful
functional and aesthetic restoration was achieved without
total flap failure and with minimal donor site morbidity.
Infection and fascial abscess encountered in
one patient were treated with debridement and antibiotic
therapy. In one patient who developed osteonecrosis
in the neomandibula, the plate was removed and
debridement was performed in the 13th month.
Conclusion: By appropriate flap planning and
placement, reconstruction of large oromandibular
tumors with osteocutaneous fibular flaps provides
successful functional and aesthetic restoration.

2.The use of serum and nasal eosinophilic cationic protein in the evaluation of the effectiveness of immunotherapy in patients with allergic rhinitis
Rauf Tahamiler, Murat Yener, Salih Çanakçıoğlu
Pages 155 - 159
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Objectives: We investigated the use of eosinophilic
cationic protein (ECP) as an indicator of clinical efficiency
of specific immunotherapy (SIT) in patients
with allergic rhinitis sensitive to house dust mites.
Patients and Methods: Specific immunotherapy was
administered to 49 patients (20 males, 29 females;
mean age 34.2 years; range 16 to 66 years) with
perennial allergic rhinitis. Nasal secretion and serum
ECP levels were measured before, at the 6th month
of, and two years after completion of, treatment.
Comparisons were made within the patient group and
with a control group of 16 healthy subjects (10 males,
6 females; mean age 23 years; range 17 to 26 years).
Results: Pretreatment nasal ECP levels were significantly
higher than those found after the treatment
(p<0.001). Nasal ECP levels measured before SIT
were significantly different from those of the control
group (p<0.05). However, serum ECP levels did not
differ significantly between the two groups (p>0.05).
Serum ECP levels in the patient group tended to
decrease with treatment (p>0.05).
Conclusion: We conclude that, in addition to the
symptoms and clinical findings, nasal ECP measurement
may be a reliable and suitable laboratory
method to monitor and evaluate the effectiveness of
treatment.

3.Transcanal butterfly cartilage tympanoplasty
Barış Karakullukçu, Engin Acıoğlu, Muhammet Pamukçu
Pages 160 - 163
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Objectives: This study evaluated the long-term
results of transcanal butterfly cartilage tympanoplasty
technique in adult patients.
Patients and Methods: Transcanal butterfly cartilage
tympanoplasty was performed in 11 adult
patients (7 males, 4 females; mean age 30 years;
range 21 to 45 years) with chronic otitis media. The
operations were performed under general or local
anesthesia. Perforation diameters ranged from 2 to
6 mm. The mean follow-up period was 9.5 months.
Results: At the end of the follow-up period, perforations
closed in 10 patients (90.9%). In one patient,
reperforation occurred in the second month. The
mean preoperative and postoperative air-bone gaps
obtained in 10 patients were 18 dB and 6.5 dB,
respectively.
Conclusion: Butterfly cartilage tympanoplasty technique
was very effective to close central, small tympanic
membrane perforations associated with minimal
hearing loss.

4.Microorganisms isolated from middle ear cultures and their antibacterial susceptibility in patients with chronic suppurative otitis media
H. Cem Gül, Ali Kurnaz, Vedat Turhan, Oral Öncül, Alahattin Pahsa
Pages 164 - 168
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Objectives: This study sought to determine
causative microorganisms of chronic suppurative
otitis media and their antibacterial susceptibility.
Patients and Methods: Bacteriologic results of middle
ear swabs, agent microorganisms, and their susceptibility
to antibiotics were evaluated in 70 patients (65
males, 5 females; mean age 21.1±1.3 years; range 19
to 25 years) with chronic suppurative otitis media.
Results: No bacteria were isolated in 14% of the
patients. Of 60 patients in whom bacteria were isolated,
the most common bacteria was Pseudomonas
aeruginosa (23%), followed by Staphylococcus aureus
(18%), and Proteus spp. (17%). P. aeruginosa strains
were susceptible to ceftazidime and imipenem (100%),
ciprofloxacin (92%), and amikacin and gentamycin
(85%); S. aureus strains were susceptible to methicillin
and vancomycin (100%), ciprofloxacin (91%), sulbactam-
ampicillin (73%), and gentamycin and trimethoprim-
sulfamethoxazole (63%). Proteus strains were
susceptible to ciprofloxacin (100%), ceftazidime (90%),
and imipenem and gentamycin (70%).
Conclusion: Appropriate knowledge of antibacterial
susceptibility of microorganisms will contribute to
rational antibiotic usage and the success of treatment
for chronic suppurative otitis media.

5.Assessment of patients with sudden hearing loss by transcranial Doppler ultrasonography
Haldun Şan, Abdullah Taş, Cem Uzun, Talip Asil, Recep Yağız, Ahmet R. Karasalihoğlu
Pages 169 - 172
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Objectives: We evaluated the utility of transcranial Doppler
ultrasonography in determining the vascular pathology in
patients with sudden hearing loss.
Patients and Methods: The study included 13 patients (11
males, 2 females; mean age 46.6±17.7 years; range 18 to
66 years) with a diagnosis of sudden hearing loss. Patients
having chronic otitis media or other middle ear diseases or a
history of surgery in the affected ear were excluded. All the
patients were evaluated by pure-tone audiometry, impedance
audiometry, transient evoked otoacoustic emissions,
auditory brainstem responses, and transcranial Doppler
ultrasonography. The results were compared with those of a
control group of 19 age- and sex-matched healthy subjects
(12 males, 7 females; mean age 46.8±6.9 years; range 33 to
58 years) who did not have any ear disease or a history of
ototoxic drug intake or working in a noisy environment, and
no pathology on otoscopic and audiometric examinations.
Results: Compared to the normal ear, the mean blood flow
and systolic flow velocities of the vertebral artery were significantly
decreased, and the mean pulsatile index was significantly
increased on the affected side. The mean flow
velocity of the basilar artery in the patient group was lower
than that found in the control group.
Conclusion: Transcranial Doppler ultrasonography can be
used for the evaluation of vascular involvement of the vertebral
and basilar arteries in patients with sudden sensorineural
hearing loss.

6.An etiological study in a school for the deaf and radiological findings
İsmail Külahlı, Abdulhakim Coşkun, İbrahim Ketenci, Mehmet Şentürk, Kürşat Canöz
Pages 173 - 177
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Objectives: The causes of sensorineural hearing
loss were assessed in a population of students in a
school for the deaf.
Patients and Methods: Ninety-one students (34 girls,
57 boys; mean age 10.6 years; range 7 to 20 years)
from a school for the deaf were evaluated together with
their their family tree. Otolaryngologic, ophthalmologic,
and systemic physical examinations and audiologic
and radiologic investigations were performed.
Results: Sensorineural hearing loss was of genetic
origin in 32.9% of the students. No etiologic factor
could be determined in 31.9% of the cases. Infectious
diseases (38.3%) and consanguinity (26.3%) were
found as the most common etiologic factors in nongenetic
and genetic sensorineural hearing losses,
respectively.
Conclusion: Sensorineural hearing losses due to
infectious diseases and consanguineous marriages
are preventable conditions. The incidence of sensorineural
hearing losses will decline if these two
conditions are controlled.

7.Psychiatric disorder profile in patients with chronic pharyngitis
Hülya Eyigör, Giray Arıhan, Filiz Ergin, Yasemin Barlık
Pages 178 - 182
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Objectives: We investigated the psychopathological
condition of patients with chronic pharyngitis.
Patients and Methods: The study included 27
patients (23 females, 4 males; mean age 41.7±10.4
years; range 21 to 63 years) who had persistent symptoms
of chronic pharyngitis for more than six months,
without any evidence for an acute infection on ENT
examination and routine tests. Twenty-seven healthy
subjects (23 females, 4 males; mean age 41.8±11.9
years) without any symptoms of chronic pharyngitis and
a previous diagnosis of a psychiatric disorder formed
the control group. All the patients and controls were
assessed by a psychiatrist with the use of the Structural
Clinical Interview for DSM-IV Disorders (SCID).
Results: All the patients were diagnosed to have Axis I
psychopathology. The most frequent pathologies were
somatisation disorder (n=8, 29.6%) and dysthymic disorder
(n=8). Five individuals (15.6%) in the control
group received psychiatric diagnoses. Psychiatric disorders
were 6.4 times more frequent in the patient
group (p=0.00, CI=2.86-14.31). No significant differences
were observed between the patient and control
groups with respect to educational and occupational
levels (p=0.263 and p=0.362), respectively).
Comparisons with respect to risk factors associated
with chronic pharyngitis showed no significant differences
between the two groups.
Conclusion: We suggest that patients frequently
presenting to ENT departments with repeated symptoms
of chronic pharyngitis should also receive psychiatric
assessment and support.

CASE REPORTS
8.Non-Hodgkin’s lymphoma of the parotid gland
Erdinç Aydın, M. Volkan Akdoğan, Hasan Yerli, B. Handan Özdemir, Beyhan Demirhan
Pages 183 - 188
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Most of the primary malignant lymphomas of the salivary
glands originate from the parotid gland. We presented two
patients who were admitted with a painless mass in the
parotid region and diagnosed to have lymphoma. Physical
examination of a 66-year-old male patient showed a relatively
mobile, painless, and firm mass at the inferior aspect
of the right parotid gland. Ultrasonography, computed
tomography (CT), and magnetic resonance imaging (MRI)
were performed and a needle biopsy was obtained from the
solid lesion extending from the right parotid superficial lobe
to the medial deep lobe. Pathological examination revealed
large B-cell lymphoma. The patient was treated according to
the CHOP chemotherapy protocol. The second patient had
undergone surgery for orbital lymphoma and received
CHOP chemotherapy. On physical examination, there was a
painless mass in the parotid cauda on the left and a subcutaneous
lymph node, 0.5x1 cm in size, inferior to the parotid
cauda. Computed tomography and MRI showed an irregularly
contoured solid lesion, 2x1 cm in size, in the posteroinferior
aspect of the superficial lobe. Lymph node biopsy
yielded a diagnosis of small cell malignant lymphoma. The
patient was referred to the medical oncology department for
staging, further investigation, and planning of the treatment.

9.An alternative method for the correction of enophthalmos: deep lateral orbital approach
Burçak Tümerdem, İsmail Kuran
Pages 189 - 192
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Both increased orbital volume due to inadequate
orbital floor reconstruction and loss of orbital volume
may result in enophthalmos. Enophthalmos, vertical
dystopia, and “lateral scleral show” deformity were
detected in a 33-year-old female patient who presented
with periorbital deformities after three operations
for the correction of traumatic zygomatic fracture.
First, vertical dystopia was repaired by reinforcing
the orbital base with cranial bone grafting.
Since enophthalmos was not successfully corrected,
orbital volume augmentation was performed using
the deep lateral wall through an upper eyelid crease
incision. The only postoperative complaint was
edema which was controlled by application of ice.

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