E-ISSN 2602-4837
The Turkish Journal of Ear Nose and Throat - Tr-ENT: 20 (6)
Volume: 20  Issue: 6 - 2010
ORIGINAL ARTICLE
1.Prevalence of chronic otitis media in the young male population in Turkey
Murat Salihoğlu, Ümit Hardal, Hakan Cıncık
Pages 273 - 276
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Objectives: In this study, we investigate the prevalence
of chronic otitis media (COM) in young men.
Patients and Methods: Twenty thousand consecutive
young men (mean age 22 years) who were under election
for high performance military positions were examined
by two otolaryngologists in the Military Hospital,
İzmir. The otologic examination findings were noted. We
evaluated the patients who have tympanic membrane
perforation, retraction, adhesion, myringosclerosis and
the patients who had underwent surgery before.
Results: Three-hundred and fifty-five young men (1.77%)
had COM. Other findings were retraction (n=66; 0.33%),
adhesion (n=36; 0.18%), myringosclerosis (n=720; 3.6%)
and cerumen (n=3200; 16%). We found out that five
(0.025%) of the cases had radical mastoidectomy surgery
and 16 (0.08%) of them had tympanoplasty.
Conclusion: The prevalence of COM in young
men is 1.77%. Although our study has a limitation
because all of our samples are young men, the study
is unique due to its large sample size.

2.Quality of life before and after surgery in patients with nasal polyposis
Mehmet Özgür Pınarbaşlı, Hamdi Çaklı, Melek Kezban Gürbüz, Cemal Cingi, Erkan Özüdoğru
Pages 277 - 284
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Objectives: The postoperative symptoms, paranasal computed
tomography (CT) findings and quality of life of the
patients who had undergone surgical treatment for nasal
polyposis were evaluated.
Patients and Methods: This study included 32 patients (18
females, 14 males; mean age 43 years; range 14 to 64 years)
who applied to our clinic between January 2008 and January
2009 and were operated on with diagnosis of pure nasal
polyps. In addition, 36 healthy volunteers were randomized
to the control group. The patients were evaluated before
and after surgery, on the 3rd week and 3rd month with routine
ear nose and throat physical examination and through the
Short Form-36 (SF-36) questionnaire as the nasal symptom
scores and quality of life. The SF-36 questionnaire was used
in the control group as well. In this SF-36 questionnaire the
patients were evaluated for eight domains. Control paranasal
CT findings at 6th months after surgery were compared
with the CT findings before surgery.
Results: We determined improvement of nasal symptoms
in patients (nasal obstruction, headache, loss of sense of
smell, rhinorrhea and posterior rhinorrhea) at the 3rd week
and 3rd month after surgery compared to before surgery
(p<0.05). We also determined improvement in the domains
of SF-36 questionnaire (general healthy, physical functioning,
problems of emotional role, social functioning, pain,
vitality and mental health) at the 3rd week and 3rd month after
surgery compared to before surgery (p<0.05). Control paranasal
CT findings of patients at 6th months after surgery was
also improved significantly compared to before (p<0.001).
Conclusion: We determined improvement in all symptoms and
quality of life for a short period of time after the surgical treatment
performed on patients with nasal polyposis. The paranasal
CT has an important place for diagnosis and treatment.

3.Alterations of NIS expression in functioning thyroid nodules
Hülya Ilıksu Gözü, Dilek Yavuzer, Handan Kaya, Selahattin Vural, Haluk Sargın, Cem Gezen, Mehmet Sargın, Sema Akalın
Pages 285 - 292
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Objectives: This study aimed to analyze both the level
and the cell site of the sodium-iodide symporter (NIS)
protein expression in autonomously functioning thyroid
nodules (AFTNs) and extranodular thyroid tissues. In
addition, this study sought to compare the clinical results
of patients with the levels of human NIS (hNIS) protein
expression.
Patients and Methods: The histological slides consisted
of 36 AFTNs and 31 extranodular thyroid tissues from
28 patients (5 males, 23 females; mean age 54.5±11.0
years; range 37 to 72 years) who underwent surgery for
toxic multinodular goitre. The expression of NIS protein
was investigated by immunohistochemistry in paraffinembedded
tissue sections using anti-hNIS monoclonal
antibody by the labeled streptavidin-biotin method.
Results: The percentage of hNIS positive follicular cells
was significantly higher in the AFTNs (13.33±12.09) than
in the extranodular thyroid tissues (1.35±3.03). Staining
for hNIS was mostly confined to the cell membrane in the
AFTNs (88.9%) and in the extranodular thyroid tissues
(54.5%). The clinical parameters and nodule volume did
not establish any correlation with hNIS immunoreactivity.
Conclusion: Our data indicate that functioning nodules
express higher amounts of NIS protein than the extranodular
thyroid tissue, but the level of hNIS immunoreactivity
was lower than had been reported in the previous
literature. This result may be due to interindividual variability
between different populations, and iodine status.
Furthermore, the localization of the NIS protein might not
give an indication of its functional status.

EXPERIMENTAL STUDY
4.Reconstruction of large nasal septal perforations with a three layer galeal pericranial flap: an anatomical and technical study
Bahar Keleş, Kayhan Öztürk, Aynur Emine Çiçekçibaşı, Mustafa Büyükmumcu
Pages 293 - 298
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Objectives: In this study, a modified surgical method
was carried out to repair large nasal septal perforations
with a galeal pericranial flap using endoscopic technique.
Materials and Methods: Six adult human cadavers
were dissected by applying the classic open rhinoplasty
technique. Large perforations were created in
the septal cartilages. To repair the perforations, we
prepared galeal pericranial flaps with supraorbital
neurovascular pedicles and calvarial bone grafts under
endoscopic visualization. The flaps were inserted
between the upper lateral cartilages and folded into
three layers. The flaps were sutured to the nasal mucosa
with absorbable sutures. The length, the width, the
size of the flaps and the perforations were measured
using an electronic caliper and a flexible ruler.
Results: The mean length and width of the flap pedicles
were measured as 26.8±5.1 mm (range 20 to 32 mm)
and 19.3±2.6 mm (range 15 to 23 mm), respectively.
In addition, the mean length and the width of the flaps
were 54.1±4.9 mm (range 50 to 60 mm) and 51.6±7.8 mm
(range 45 to 63 mm), respectively. All of the nasal septal
perforations were repaired with a galeal pericranial flap.
Conclusion: The galeal-pericranial flap is well-vascularized
and similar to the nasal mucosa for tissue thickness.
Therefore, reconstruction with galeal-pericranial
flaps can be an alternative surgical technique for repair
of large nasal septal perforations.

5.The effect of melatonin on experimentally-induced myringosclerosis in rats
Kadir Çağdaş Kazıkdaş, Ensari Güneli, Kazım Tuğyan, Güven Erbil, Tuncay Küme, Nazan Uysal, Osman Yılmaz, Bülent Şerbetçioğlu
Pages 299 - 304
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Objectives: This study determined the preventive effect
of melatonin on the occurrence of experimentally-induced
myringosclerosis of the tympanic membrane (TM).
Materials and Methods: Twenty Wistar albino-type rats
weighing approximately 300 g each were randomly separated
into two groups and myringotomized on the left
TMs: group 1 rats (n=6) received intraperitoneal melatonin
injections 10 mg/kg/day whereas group 2 rats (n=12) were
treated with physiological serum only. The remaining two rats
were served as the control group for histological comparison
and standardization. After 15 days of treatment, myringotomized
membranes were examined by otomicroscopy and
harvested for histopathological evaluation. The functional
effect of myringosclerotic plaques in the TMs of the two
groups were compared with tympanometric measurements.
Results: Tympanic membranes in group 2 revealed extensive
myringosclerotic plaques, on the other hand, TMs in
group 1 showed faint or no existence of myringosclerosis.
The mean magnitude of the maximum admittance from
group 2 measured by tympanometry reduced to about 40%
of the values obtained from group 1 (Z=–2,067, p=0.041). The
mean magnitude of the maximum admittance from melatonin
group was very close to the mean tympanometric value of
non-myringotomized Wistar albino rats, demonstrating a
functional outcome.
Conclusion: The occurrence of myringosclerosis following
experimental myringotomy can be hindered by systemic
melatonin treatment.

CASE REPORTS
6.Laser excision of a typical carcinoid tumor of the larynx: a case report
Raşit Cevizci, Barış Karakullukçu, Michiel W.M. van den Brekel, Alfons J. Balm
Pages 305 - 308
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Neuroendocrine carcinomas of the larynx include a
range of rare tumors which have variable biologic
behavior, affecting treatment and prognosis. Among
these, typical carcinoid tumors are the least common
type. Prognosis of typical carcinoid tumor is better
than atypical carcinoid tumor and small cell carcinoma
of the larynx. Conservation surgery is the preferred
treatment modality. Transoral CO2 laser surgery
can be a good alternative for appropriate cases
because of the functional results and less morbidity.
In this article, a 71-year-old female presented with
complaints of feeling a mass during swallowing.
Fiberoptic examination of the larynx revealed a mass
located on the right aryepiglottic fold and biopsy
revealed the tumor as a typical carcinoid tumor. We
describe CO2 laser excision of a typical carcinoid
tumor of the larynx in this case report.

7.A rare cause of nasal obstruction: giant invasive nonfunctioning pituitary adenoma
Güçlü Kaan Beriat, Cem Doğan, Şefik Halit Akmansu, Demet Karadağ, Handan Doğan
Pages 309 - 313
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Nasal obstruction is a very rare symptom caused
by a pituitary adenoma. A 57-year-old man admitted
to our clinic with bilateral nasal obstruction for the
last six months. Endoscopic examination revealed
soft pinkish pulsatile tissues in both nasal cavities.
Radiologic investigation revealed a suprasellar mass
extending to the frontal lobes, spheno-ethmoidal
sinuses and nasal cavities. He had bitemporal superior
quadrant hemianopsia. Pituitary hormone levels
were normal. Biopsies were taken from the patient
endonasally. Pathological evaluations and laboratory
findings were compatible with nonfunctioning
pituitary adenoma.

8.Management of laryngeal hemangioma in adults: a case report
Murat Doğan, Ozan Bağış Özgürsoy, Sami Engin Muz, Muharrem Gerçeker, Gürsel Dursun
Pages 314 - 317
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Hemangiomas are the most common vascular tumors mostly
(60%) seen in the head-neck region. Head-neck hemangiomas
are seen frequently in the oral cavity, rarely in the
larynx. Adult laryngeal hemangiomas are rare and often
seen in the supraglottic region, therefore causing dysphagia/
dysphonia. We presented two-cases with laryngeal hemangioma,
discussed the diagnosis, treatment and follow-up of
adult cavernous hemangiomas. A forty-one-year-old female
patient applied to hospital with hoarseness and breathing
difficulty lasting for three years. A cavernous hemangioma
located on laryngeal surface of the epiglottis was excised
through a transoral endoscopic approach. The patient had
no symptoms after the operation but on the postoperative 34th
month follow-up she was admitted to our clinic again because
of difficulty during swallowing. Relapsed hemangioma was
diagnosed and reoperated by open surgery (laryngofissure).
After reoperation the patient had symptomatic relief in three
months and videolaryngoscopic examination showed granulation
tissue. The patient’s regular follow-up was continued.
A forty-year-old female other patient was applied to hospital
with hoarseness and swallowing difficulty worsening in three
months. Hemangioma located in the postcricoid area with
extensive to hypopharynx-esophagus junction was diagnosed.
The location of the lesion in imaging techniques was
evaluated with the thoracic surgery and gastroenterology
department and we decided not to do any operation and
follow-up patient by considering the severity of symptoms,
location of leison and complications of operation.

9.Nerve sheath myxoma of the upper lip: a case report
Erkan Ekşi, İncila Öztop
Pages 318 - 320
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Nerve sheath myxoma is a benign tumor that rarely
occurs in the lip area. In this article, a 28-year-old
woman admitted with a complaint of painless swelling
in the upper lip is presented. The lesion was
excised, and histopathological and immunohistochemical
examinations were performed. There are
only five reported cases in the available literature.
Although very rare, nerve sheath myxoma should
be considered in the differential diagnosis of lip
mass and widely excised to avoid local recurrence.
The patient is under clinical control with no signs of
recurrence after 16 months.

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