E-ISSN 2602-4837
The Turkish Journal of Ear Nose and Throat - Tr-ENT: 9 (2)
Volume: 9  Issue: 2 - 2002
ORIGINAL ARTICLE
1.Genetic sensorineural hearing loss in childhood
Onur Turan, Fazıl Apaydın
Pages 99 - 105
Objectives: This study aimed to determine the severity, age of presentation, and genetic etiology in hearing handicapped children.
Patients and Methods: Three groups of children were studied: children who received treatment for hearing loss at the Otolaryngology Department of Ege University Hospital between 1993 and 1999 (1645 children) and throughout 2000 (212 children), and 443 students of İzmir Tülay Aktaş Deaf School during 1998 and 1999. All the children underwent otolaryngologic examination and a detailed history taking, audiometric examinations were undertaken in the second and third groups, as well. In children suspected of having a genetic etiology, the pedigrees were drawn and the mode of inheritance was determined.
Results: In the first group, awareness of the families to hearing loss and the presentation were at ages two and four, respectively. The most common accompanying anomaly was Down syndrome. Consanguinity was found in 27%, 8%, and 33%, respectively. Moderate to severe hearing loss was detected in 44% of the second group, and in 28% of the third group. Of the pedigrees obtained from 123 families, 86 were nonsyndromic and 27 were syndromic.
Conclusion: Genetic inheritance plays a substantial role in sensorineural hearing loss in children, with consanguinity being the major culprit. Detection of hearing losses at younger ages will improve the success of hearing rehabilitation programs.

2.Efficacy of topical ciprofloxacin and tobramycin in combination with dexamethasone in the treatment of chronic suppurative otitis media
İrfan Kaygusuz, Turgut Karlıdağ, Üzeyir Gök, Şinasi Yalçın, Erol Keleş, Erhan Demirbağ, Türkkan Öztürk Kaygusuz
Pages 106 - 111
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Objectives: To evaluate the efficacy of topical
ciprofloxacin and tobramycin with and without topical
dexamethasone in the treatment of chronic suppurative
otitis media without cholesteatoma.
Patients and Methods: The study included 103 ears of
80 patients (49 males, 31 females; mean age 31 years;
range 18 to 60 years) with chronic suppurative otitis
media without cholesteatoma. The patients were randomly
divided into four groups to receive topical applications
of either ciprofloxacin and tobramycin alone, or in combination
with dexamethasone. Cultures were obtained from
the ears preoperatively and 24 hours after treatment.
Results: Aerobic bacteria were isolated in 94.1% of patients
before the treatment, the most common being
Pseudomonas aeruginosa (38.9%). With dexamethasone,
the clinical response for ciprofloxacin and tobramycin
increased from 80% to 90% and from 70% to 75%, respectively,
but this improvement was not significant (p>0.03).
Addition of dexamethasone to ciprofloxacin decreased the
recovery period from 14 days to seven days, whereas no
change (7 days) was observed with tobramycin.
Conclusion: The efficacy of ciprofloxacin and
tobramycin were similar in the treatment of chronic suppurative
otitis media. Addition of dexamethasone to
ciprofloxacin decreased the treatment period.

3.The effect of hyperlipidemia on hearing function
Turgut Karlıdağ, Yasemin Açık, İrfan Kaygusuz, Şinas Yalçın, M. Yüksel Güngör, Erhan Demirbağ
Pages 112 - 116
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Objectives: We evaluated the effects of hyperlipidemia
on hearing function.
Patients and Methods: The study included 274
hyperlipidemic patients (176 females, 98 males; age
range 35 to 60 years) who manifested normal tympanic
membrane findings, no history of noise exposure,
and chronic systemic or ear diseases. Sixty
healthy subjects (36 females, 24 males) with normal
serum lipid levels were enrolled as controls. Subjects
who had elevated serum total cholesterol, triglyceride,
and very low density lipoprotein (VLDL) levels, and
normal lipid levels were divided into four groups and
their hearing functions were analysed with pure-tone
audiometry.
Results: Evaluation of all groups showed significantly
increased hearing levels at three frequencies in
female patients, and at six frequencies in male
patients (p<0.05). Significant increases in hearing levels
were observed both in females and males at 8000
Hz in three groups, at 6000 Hz in the VLDL group, and
in males at 2000 Hz in the total cholesterol and VLDL
groups (p<0.05). When both female and male patients
were evaluated together, the largest difference was
detected in the VLDL group at five frequencies.
Conclusion: The findings of our study suggest that
hyperlipidemia may have a role on the occurrence of
sensorineural hearing loss.

4.The incidence of septal deviation in newborns
Kemal Uygur, Murat Yarıktaş, Mustafa Tüz, Fehmi Döner, Asude Özgan
Pages 117 - 120
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Objectives: To determine the incidence of septum
deviation and dislocation in newborns and to investigate
relationships between these pathologies and
maternal causes and the mode of delivery.
Patients and Methods: The study included 195 mothers
and 200 newborns, of which 10 were twins. Vaginal
and cesarean deliveries were performed in 147
(73.5%) and 53 (26.5%) newborns, respectively. All
newborns were examined with the use of anterior
rhinoscopy. The nasal pyramid, columella, and septum
were assessed to detect septal deviation or dislocation.
Results: Twenty-three cases (15.6%) of vaginal
delivery had septal deviation, while five (3.4%) had
septal dislocation. In the newborns delivered by
cesarean section, eight (15.1%) had septal deviation,
but none had dislocation. Significant correlations
were noted between pregnancy, delivery period,
the way of delivery and the incidence of septal
deviation and columella dislocation (p<0.05). There
was a significant correlation between head circumference
and columella dislocation (p<0.05).
Conclusion: Since early reconstruction of the
potential pathologies may be problem-solving, a
careful rhinologic examination should be carried out
in the newborns who have prolonged delivery,
increased head circumference, and vaginal delivery.

5.Patient selection for near-total laryngectomy and oncologic results
Erkan Özüdoğru, Emre Cingi, Hamdi Çaklı, M. Cem Keçik, Cemal Cingi, M. Kezban Gürbüz
Pages 121 - 125
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Objectives: We reviewed preoperative, perioperative,
and postoperative findings and the survival data
to determine which patients may be appropriate for
near-total laryngectomy.
Patients and Methods: We reviewed hospital
records of 20 patients (all males; mean age 56.6
years; range 35 to 73 years) who underwent neartotal
laryngectomy. Indications for patient selection
for near-total laryngectomy and survival data were
evaluated in comparison with literature reports.
Results: The site of the tumor was the sinus pyriformis
in two, and the larynx in 18 patients. Thirteen patients
had T3, seven patients had T2 tumors. The lesions
were localized in the sinus pyriformis in two patients
with T2 tumors. The locoregional control rate at the end
of two years was 75%; two- and three-year survival
rates were 81.2% and 64.2%, respectively.
Conclusion: Following a detailed and meticulous
investigation in the preoperative period, near-total laryngectomy
seems to be appropriate in selected patients
with advanced laryngeal and hypopharyngeal tumors in
which partial laryngectomy procedures are not considered.
It may both provide cure and preserve phonation.
It may also be considered for functional purposes in
patients whose pulmonary functions are insufficient for
partial laryngectomy, in those in whom food aspiration is
inevitable after partial laryngectomy, and in those suffering
from lifelong food aspiration due to neurologic causes,
and for oncologic reasons in patients who develop
local recurrences after partial laryngectomy.

6.Comparison of palpation, ultrasound, and computed tomography in the evaluation of lymphatic neck metastasis
Uğur Çınar, Özgür Yiğit, Ebru Topuz, Gökhan Akgül, Murat Ünlü, Muzaffer Başak, İrfan Çelebi, Burhan Dadaş
Pages 126 - 130
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Objectives: We evaluated the diagnostic value of
palpation, ultrasonography (US), and computed
tomography (CT) in detecting neck metastasis in
head and neck cancers.
Patients and Methods: The study included 35 patients
(34 men, 1 woman; mean age 59 years; range 35 to 72
years) with laryngeal carcinoma. In addition to neck palpation,
17 patients and 27 patients had neck examinations
by US and CT, respectively. Histopathologic
results of the neck specimens were compared with
those obtained from palpation, US, and CT.
Results: The accuracy of CT, US, and palpation in
the evaluation of lymph nodes of the neck were
85%, 65%, and 80%, respectively. Ultrasonography
was found to have the highest sensitivity (100%), but
the least specificity (33%). The highest false positive
and false negative results were obtained by US
(42%) and palpation (10%), respectively.
Conclusion: Computed tomography proved superior
to palpation and US in the evaluation of neck
metastasis in patients with head and neck tumors.

CASE REPORTS
7.Laryngotracheal reconstruction of the congenital glotto-subglottic stenosis with autogenous thyroid cartilage interposition: a case report*
Orhan Özturan, Ahmet Kızılay, Murat Cem Minan, Semih Öncel, M. Tayyar Kalcıoğlu, Tamer Erdem
Pages 132 - 137
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Surgical correction of grade III glotto-subglottic stenosis
in a two-month-old girl was illustrated in a staged manner.
Firstly, a silicone keel was placed via anterior thyrotomy
following a tracheotomy. Secondly, laryngotracheal
reconstruction was performed by interposing an
autogenous thyroid cartilage anteriorly between the
edges of the longitudinally divided cricoid cartilage and
the upper tracheal rings. A stent was maintained for two
months. The glottis and subglottis appeared patent and
healed following removal of the stent. A meaningful
voice and rather comfortable respiration were observed
during a 13-month follow-up.The use of thyroid cartilage
autograft offers many advantages in laryngotracheal
reconstruction with considerably less technical difficulty

8.An unusual tracheobronchial aspiration in a patient with total laryngectomy
İmran Şan, Necat Alataş, İsmail İynen
Pages 139 - 141
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Laryngectomized patients use a variety of tools for tracheostomy
cleaning, some of which may vary greatly
depending on their sociocultural status. The use of inappropriate
tools may lead to complications. A seventyeight-
year-old male patient who had a history of total
laryngectomy 12 years ago presented with difficulty in
breathing and sputum production. Tracheoscopy
showed two nails and chest x-rays showed one nail that
had been aspirated during stromal care. The three ordinary
nails were removed under general anesthesia.
This case illustrates the need for detailed and consistent
education of laryngectomy patients on proper stomal
cleaning and on the associated complications that may
arise from the use of inappropriate tools.

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