E-ISSN 2602-4837
The Turkish Journal of Ear Nose and Throat - Tr-ENT: 17 (2)
Volume: 17  Issue: 2 - 2007
ORIGINAL ARTICLE
1.Evaluation of Ki-67 expression in recurrent cases of cholesteatoma
Arif Şanlı, İlter Tezer, Mustafa Paksoy, Sedat Aydın, Ümit Hardal, Nagehan Barşık Özdemir
Pages 65 - 69
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Objectives: Recurrences are still a challenge despite
appropriate techniques in cholesteatoma surgery. This
study was designed to evaluate the level of Ki-67 expression
in recurrent cases of cholesteatoma.
Patients and Methods: The study included 32 patients
(18 males, 14 females; mean age 34 years; range 12 to 63
years) who underwent surgery for otitis media. Of these,
19 patients had cholesteatoma, and eight patients had
recurrent cholesteatoma. Five patients who underwent
tympanoplasty for chronic otitis media comprised the control
group. All the patients with cholesteatoma underwent
radical mastoidectomy. At surgery, tissue samples of
cholesteatoma were taken and prepared for immunohistochemical
staining. In controls, retroauricular skin samples
were used. The two patient groups with cholesteatoma
were compared with respect to Ki-67 expression.
Results: Increased cellular proliferation was detected
in both groups of cholesteatoma. No significant difference
was found between two cholesteatoma groups
with respect to Ki-67 staining (p>0.05). Compared to
the controls, patients with cholesteatoma and those
with recurrent cholesteatoma had significantly higher
levels of Ki-67 staining (p<0.05 and p<0.01, respectively).
Conclusion: Our results suggest that, despite a higher
degree of proliferation in recurrent cholesteatoma cases,
treatment failures may be mainly associated with the surgical
technique, accompanying infections, and the type of
cholesteatoma.

2.An evaluation of parotid gland masses
Hüsamettin Yaşar, Haluk Özkul, Ayşegül Verim, Emre İlhan, Numan Kökten, Gökçe Dereci
Pages 70 - 74
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Objectives: We retrospectively evaluated patients who
underwent surgery for parotid gland masses.
Patients and Methods: A total of 50 patients (25 females,
25 males; mean age 48.5 years; range 18 to 76 years) who
underwent surgery for parotid gland masses were evaluated
with regard to age, sex, preoperative diagnostic methods,
histopathologic diagnoses, and surgical techniques.
Results: Preoperative diagnostic studies included ultrasonography,
fine-needle aspiration biopsy, computed tomoghraphy
and magnetic resonance imaging. Histopathological diagnoses
were benign in 33 patients (66%), malignant in nine patients
(18%), and tumor-like pathologies in eight patients (16%), the
most common being pleomorphic adenoma (n=28, 56%),
Warthin’s tumor (n=4, 8%), and squamous cell carcinoma (n=4,
8%). Superficial and total parotidectomies were performed in
40 (80%) and 10 (20%) patients, respectively. Nine patients
with malignant tumors also had neck dissection and postoperative
radiotherapy. Mortality occurred in one patient with metastasis
to the parotid gland. One patient with lipoma developed
recurrence two years after surgery. Follow-up was five years in
28 patients (56%), three years in 12 patients (24%), and two
years in five patients (10%). Complete and transient facial
paralysis developed in 10 patients and five patients following
total and superficial parotidectomy, respectively.
Conclusion: Superficial parotidectomy is the minimal surgery
for parotid gland masses. If the deep lobe of the gland is
involved, total parotidectomy should be performed with
preservation of the facial nerve. In malignant tumors neck dissection
and postoperative radiotherapy should be added.

3.Screening of the mitochondrial 12S rRNA (MTRNR1) gene in probands with sensorineural hearing loss
Yaprak E. Çırçır, Armağan İncesulu, Mustafa Tekin
Pages 75 - 80
Objectives: We investigated mitochondrial DNA
12S rRNA (MTRNR1) gene mutations as a cause of
hearing loss in probands with or without a history of
aminoglycoside use.
Patients and Methods: The study included 70
patients (40 females, 30 males; age range 3 to 42
years) with nonsyndromic sensorineural hearing
loss. Eleven probands had a history of aminoglycoside
use before the onset of hearing loss. All cases
were first screened and found to be negative for the
GJB2 (connexin 26) gene mutations. The
m.1555A>G mutation was screened using the PCRRFLP
technique. The entire 12S rRNA gene was
later screened with the PCR-TTGE technique followed
by direct sequencing.
Results: Of 11 patients with a history of aminoglycoside
use, one patient was found to have the
m.1555A>G mutation. Two probands with no history
of aminoglycoside use exhibited the m.750A>G
polymorphism. No pathogenic base substitutions
were detected in the remaining patients.
Conclusion: Apart from the common aminoglycoside
ototoxicity-related DNA change, m.1555A>G,
we could not identify a common mitochondrial 12S
rRNA mutation associated with hearing loss in
Turkey. Screening of larger series may document
rare alterations.

4.Lipid peroxidation and antioxidant levels in patients with laryngeal carcinoma
Yavuz Fuat Yılmaz, Filiz Akbıyık, Ümit Tuncel, Adnan Ünal
Pages 81 - 84
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Objectives: Reactive oxygen species (ROS) play
an important role in the pathogenesis of cancer. The
aim of this study was to investigate the extent of lipid
peroxidation and ROS in laryngeal cancer tissues.
Patients and Methods: We determined glutathione
(GSH) and malondialdehyde (MDA) activities as
markers of lipid peroxidation in laryngeal tumor specimens
and tumor-free adjacent tissues of 30 patients
with squamous cell carcinoma.
Results: Compared to the tumor-free specimens,
the level of GSH was significantly low (p<0.001)
whereas MDA, a lipid peroxidation product, showed
a significant increase (p<0.01) in cancer tissues. No
significant differences were found in MDA and GSH
levels between patients with early (n=14) and
advanced (n=16) tumor stages (p>0.05).
Conclusions: Decreased antioxidant capacity of
laryngeal cancer tissues results in elevation of
free oxygen radicals and increased lipid peroxidation.
Free radical metabolism may be involved in
the pathogenesis of laryngeal cancers.

5.Transnasal endoscopic repair of choanal atresia
Semih Mumbuç, Erkan Karataş, Cengiz Durucu, Enver Özer, Muzaffer Kanlıkama
Pages 85 - 89
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Objectives: We evaluated the results of endoscopic
repair for choanal atresia.
Patients and Methods: Ten patients (2 males, 8
females) underwent transnasal endoscopic repair for
choanal atresia. Involvement was unilateral in five
cases and bilateral in five cases. Unilateral patients
were treated at a mean age of 22.6 years (range 1 to
44 years), while bilateral cases were treated within the
first six days of life. Two patients with bilateral involvement
had associated polydactyl and tracheoesophageal
fistula, respectively. The mean follow-up
period was 26 months (range 8 to 56 months).
Results: No postoperative complications such as significant
hemorrhage, injury to the skull base, cerebrospinal
fluid fistula, septal perforation, or granulation
tissue formation were encountered. All the patients
had choanal patency at the end of six months.
Conclusion: Endoscopic repair of choanal atresia
is effective in both unilateral and bilateral cases.

6.Endoscopic transnasal sphenoidotomy with or without ethmoidectomy
Adil Eryılmaz, Engin Dursun, Güleser Saylam, Celil Göçer, Muharrem Dağlı, Hakan Korkmaz
Pages 90 - 95
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Objectives: We evaluated endoscopic transnasal
sphenoidotomy (ETNS) with or without ethmoidectomy
in patients with inflammatory sphenoid sinus disease
(ISSD).
Patients and Methods: A retrospective review was
conducted in 42 patients (17 males, 25 females; mean
age 41 years; range 17 to 67 years) who underwent
ETNS with (n=37) or without (n=5) ethmoidectomy for
ISSD. The disase was staged according to our staging
system based on computed tomography findings.
Results: Postnasal drainage was the most common
symptom (n=37, 88.1%). Chronic rhinosinusitis was
accompanied by sinonasal polyps in 25 patients
(59.5%). Five patients (11.9%) had isolated sphenoid
disease and 16 patients (38.1%) had unilateral disease.
Five patients (11.9%) had stage 1, 15 patients (35.7%)
had stage 2, and 22 patients (52.4%) had stage 3 disease.
Surgery involved 68 sides. Ethmoidectomy was
used in 63 sides of 37 patients, eight of whom required
a supplementary procedure. At least one complication
was seen in eight patients (19%), including severe perioperative
hemorrhage (n=2), early postoperative hemorrhage
(n=2), minor injuries to the lamina papyracea
(n=4), and synechiae (n=5).
Conclusion: In patients with isolated ISSD, the direct
approach to the sphenoid sinus by ETNS without ethmoidectomy
is a favorable technique, whereas ETNS
with ethmoidectomy is necessary for patients with
concurrent disease in other paranasal sinuses.

7.Sensitivity and specificity of fine needle aspiration biopsy in parotid masses
M. Zafer Uğuz, H. Kazım Önal, Özlem Özger Eroğlu, Demet Etit
Pages 96 - 99
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Objectives: We aimed to determine the sensitivity
and specificity of fine needle aspiration biopsy
(FNAB) in patients with parotid masses.
Patients and Methods: The study included 29
patients (15 males, 14 females; mean age 52 years;
range 20 to 83 years) who underwent FNAB and
parotidectomy for parotid masses. After a detailed
history taking, otorhinolaryngologic and systemic
examinations were performed. Neck ultrasonography
and, when needed, neck computed tomography
were used. Superficial parotidectomy was performed
in 20 patients and total parotidectomy in nine
patients.
Results: The results of FNAB were reported as benign
in 21 patients (72.4%), malignant in six patients (20.7%),
and suspicious in two patients (6.9%). Postoperative
histopathologic diagnoses were reported as benign in 17
patients (58.6%) and malignant in 12 patients (41.4%).
The sensitivity and specificity rates for FNAB were
54.6% and 100%, respectively. The most common
histopathological diagnosis was pleomorphic adenoma
(n=7, 24.1%), followed by mucoepidermoid carcinoma
(n=4, 13.8%), and Warthin’s tumor (n=3, 10.3%).
Conclusion: Preoperative FNAB for parotid masses
plays an important role in planning surgery.

8.The effect of topical mitomycin-C application before or after incisional myringotomy on patency times of guinea pig tympanic membrane perforations
Cenk Evren, Mehmet Eken, Günay Ateş, Ziya Bozkurt, Arif Şanlı
Pages 100 - 104
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Objectives: The aim of this study was to investigate
the effect of topical mitomycin-C application before
or after incisional myringotomy on patency times
and to asess its use as an alternative to ventilation
tube insertion.
Materials and Methods: Nineteen guinea pigs were
divided into two groups. In the study group (n=11),
mitomycin-C was applied in a concentration of 0.4
mg/ml over the perforation for five minutes before
(n=6) or after (n=5) incisional myringotomies in both
ears. Control animals (n=8) received 0.1 ml 0.09%
NaCl for the same duration. Evaluations were made
on days 1, 3, 5, 7, 10, 14, and 21. The patency
times, otorrhea, and other complications were
recorded.
Results: Compared to controls (7.0±1.5 days), the
mean patency times of perforations were significantly
longer in mitomycin-C treated groups before (11.6±5.2
days) and after (14.2±4.7 days) incisional myringotomies
(p<0.05). Patency times did not differ significantly
between the two mitomycin-C groups. None of
the ears exhibited permanent perforation.
Conclusion: The length of patency provided by mitomycin-
C is not sufficient for optimal ventilation in
otitis media with effusion. However, in cases requiring
shorter patency times mitomycin-C application
before or after myringotomy may be an alternative to
ventilation tube insertion.

CASE REPORTS
9.Lipoid proteinosis in the mouth and laryngeal structures: a case report
Gökhan Güvener, Cumali Kocabay, Gülben Erdem Huq, Şerife Karagülle, Fatih Bora
Pages 105 - 107
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Lipoidproteinosis is an uncommon autosomal recessive
disorder characterized by accumulation of hyaline
material in the skin, oral and laryngeal mucosa.
A 23-year-old woman presented with complaints of
hoarseness and dryness of the mouth. Yellowish
papular deposits were noted in the oral and laryngeal
mucosa on physical examination, and in vocal
cords and laryngeal structures during laryngoscopy.
The lesions were removed and histopathologic diagnosis
was made as lipoidproteinosis. A slight
improvement was obtained in hoarseness. A control
examination after two years showed an increase in
the extent of hoarseness and new deposits in the
vocal cords. The lesions were removed by microlaryngeal
surgery.

10.Multiple osteomas in the frontal and ethmoid sinuses: a case report
Seda Türkoğlu, Erdinç Aydın
Pages 108 - 111
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Osteomas are the most common benign tumors of the
paranasal sinuses. They may be seen at all ages and
show a male preponderance. A 54-year-old male
patient presented with a complaint of nasal obstruction.
Computed tomography of the paranasal sinuses
showed three osteomas, nearly 5 mm in size, in both
ethmoid sinuses and the right frontal sinus. Inquiry into
the Gardner’s syndrome was negative. No surgical
treatment was performed at the patient’s discretion. To
our knowledge, the presence of multiple osteomas in
the frontal and ethmoid sinuses has not been reported
in the English literature.

11.Hemangiopericytoma of the parotid gland: a case report
Fatih Öktem, Emin Karaman, Aydın Mamak, Süleyman Yılmaz, Sibel Erdamar
Pages 112 - 115
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Hemangiopericytomas are uncommon neoplasms of
vascular origin that mostly arise from extremities,
retroperitoneum, and pelvic fossa. They are rarely found
in the parotid gland. A 35-year-old female patient presented
with a swelling in the right preauricular region.
Fine-needle aspiration biopsy performed twice yielded
an extraordinary amount of blood. A cytological diagnosis
could not be made. Computed tomography
showed a homogenous, well-shaped mass in the
parotid gland. Superficial parotidectomy was performed.
Histopathological diagnosis was made as hemangiopericytoma.
No evidence for local recurrence or distant
metastasis was seen within a follow-up of 36 months.

12.Classic Kaposi’s sarcoma of the tongue: a case report
Erdinç Aydın, Volkan Akdoğan, Beyhan Demirhan, Levent N. Özlüoğlu
Pages 116 - 119
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An 81-year-old male patient presented with a painful
mass in the tongue that showed a progressive growth
within the past two months. Examination revealed a
polypoid mass in the midline of the tongue, purple in
color, and 1.5x1.5 cm in size. There was no palpable
lymph node on neck examination. An excisional biopsy
was performed with adequate surgical margins. The
histopathological diagnosis was Kaposi’s sarcoma.
Clinical and radiological evaluations did not show any
systemic involvement. An HIV test was negative. He
was referred to the medical oncology department. No
recurrence was detected during a year follow up.

13.Sudden hearing loss in a patient with a 3-mm acoustic tumor
İsmail Yılmaz, Seyra Erbek, Selim Erbek, Özlem Ulusoy, Tarkan Çalışaneller
Pages 120 - 125
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Sudden sensorineural hearing loss (SNHL) accounts
for 1% of all SNHL cases. It has been reported that
acoustic neuroma may be present up to 47.5% of
patients with sudden SNHL. A 55-year-old man presented
with sudden hearing loss in his left ear of 45-day
history. Audiologic and transient evoked otoacoustic
emission tests showed near-total hearing loss and
absence of emissions in the left ear, respectively.
Electronystagmography showed left canal paralysis
and lack of response to the Kobrak test. The interpeak
interval I-V latency and interaural amplitude differences
in wave V latency were prolonged in auditory brainstem
response. Computed tomography showed an increase
in the diameter of the left internal acoustic canal, and
magnetic resonance imaging (MRI) revealed an intracanalicular
mass, 3 mm in size, originating from the left
cochlear nerve. Another mass (18x17 mm) was detected
that filled the right pontocerebellar cistern, suggesting
a meningioma, but this was not thought to exert an
obvious shift effect contributing to the development of
left-sided hearing loss. Despite treatment with a
tapered course of fluocortolone for 18 days the
patient’s hearing level did not change. He was included
in a follow-up with MRI at six-month intervals.

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