E-ISSN 2602-4837
The Turkish Journal of Ear Nose and Throat - Tr-ENT: 9 (5)
Volume: 9  Issue: 5 - 2002
ORIGINAL ARTICLE
1.The efficacy of droperidol, metoclopramide, propofol and ondansetron for the prevention of nausea and vomiting following middle ear surgery
Turgut Karlıdağ, İrfan Kaygusuz, Azize Bestaş, Erol Keleş, Erhan Demirbağ, Şinasi Yalçın
Pages 331 - 336
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Objectives: The efficacy and reliability of prophylactic antiemetic
therapy with low dose propofol, droperidol, metoclopramide
and ondansetron were evaluated in a randomized, doubleblind,
and prospective design.
Patients and Methods: A total of 101 ASA I-II patients (34
females, 67 males; age range 16 to 53 years) undergoing
middle ear surgery for chronic otitis media or its sequelae
were randomly assigned to receive prophylactic antiemetic
therapy with propofol (n=21, 0.5 mg/kg), droperidol (n=19, 20
mg/kg), metoclopramide (n=23, 0.2 mg/kg), ondansetron
(n=21, 4 mg), and placebo (n=20, 0.9% NaCl). All drugs were
administered intravenously five minutes before extubation.
Resul t s: In the early postoperative period (0 to 3 hours), the
percentages of patients free from nausea and vomiting were
100% with droperidol, 71.4% with ondansetron and propofol,
52.1% with metoclopramide, and 35% with placebo.
Ondansetron (90.4%) was found the most effective to prevent
and control nausea and vomiting during the postoperative
3 to 24 hours, followed by droperidol (84.2%), propofol
(57.1%), metoclopramide (47.8%), and placebo (40%).
Compared with controls, the number of patients without nausea
and vomiting was significantly greater in each treatment
group but metoclopramide (p<0.05). No significant differences
were detected with respect to adverse effects.
Conclusion: Droperidol and ondansetron seem to exert the
highest efficacy to prevent nausea and vomiting during the
postoperative 0 to 3 hours and 3 to 24 hours, respectively.

2.Hyperbaric oxygen treatment in sudden hearing loss after unsuccessful medical treatment
Ender İnci, Ferhat Erişir, Mehmet Ada, Özcan Öztürk, Ender Güçlü, Fatih Öktem, Murat Toprak
Pages 337 - 341
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Objectives: We evaluated the efficacy of hyperbaric
oxygen (HBO) treatment in patients with sudden
hearing loss unresponsive to medical treatment.
Pat i ents and Methods: Fifty-one patients (37 males,
14 females; mean age 37 years; range 9 to 63 years)
with sudden hearing loss were treated with HBO following
unsuccessful medical treatment. Time elapsed from
the occurrence of sudden hearing loss ranged between
15 to 45 days. Treatment included two sessions daily for
the first three days, followed by a single daily session, to
make 20 sessions of 90 minutes. Treatment was discontinued
because of early recovery in two patients.
Audiometric examinations were made at the end of
every five sessions. The patients were classified
according to age, gender, and audiogram curves.
Re sults: The mean hearing thresholds were 75.3 dB and
65.6 dB before and after treatment, respectively. Recovery
was rated as complete in two patients (3.9%), moderate in
two patients (3.9%), mild in 19 patients (37.25%), and as
no recovery in 28 patients (54.9%). No significant differences
were found between the patient groups in terms of
improvement and hearing gain (p>0.05).
Conclusion: We propose that HBO be resorted to
when other means of medical treatment proves
unsuccessful in patients with sudden hearing loss.

3.Evaluation of hearing performance in cochlear implant patients
Emre A. Yücel, Ayşen Erdil, Nesil Keleş, Mehmet Ali Solmaz, Kemal Değer
Pages 342 - 345
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Objectives: To determine the speech perception
levels of cochlear implant patients and to evaluate
the possible effects of implant type, duration of deafness,
and bacterial meningitis on the patients’ hearing
performance.
Patients and Methods: A three-section test battery
on speech perception was administered to 21 cochlear
implant patients (12 males, 9 females; mean age 25
years; range 9 to 40 years). The patients’ performance
was assessed with respect to single- or multi-channel
implant design, duration of hearing loss, and etiologic
factors of hearing loss.
Results: The overall mean success score was 74.6
(range 49-100). No significant difference was found
between patients using single- or multi-channel
implants. The mean score of 12 patients whose duration
of hearing loss was below the average (8.2 years)
was significantly higher than those of nine patients
with a longer history of hearing loss (85.7 versus 59.6,
p=0.001). Patients with meningitis-associated hearing
loss exhibited a significantly lower performance than
those presenting with other etiologic factors (61.9 versus
84.1, p=0.001).
Concl u s i o n: Early diagnosis and rehabilitation are
essential to achieve better performance following
cochlear implantation.

4.The effect of nasal packing with or without an airway on arterial blood gases during sleep
Özgür Yiğit, Uğur Çınar, Berna Uslu, Gökhan Akgül, Ebru Topuz, Burhan Dadaş
Pages 347 - 350
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Objectives: We investigated the effect of postoperatively
applied nasal packing with or without an airway
on partial arterial oxygen (PaO2) and carbon dioxide
( PaCO2) pressures during sleep.
Patients and Methods: The study included 40 patients
(24 men, 16 women; mean age 29 years; range 18 to
60 years) who underwent septoplasty operation. The
patients were randomly assigned to postoperative nasal
packings with (n=20) or without (n=20) an airway. PaO2
and PaCO2 levels were measured during sleep on the
preoperative night and on the postoperative first and
second nights. The findings were compared.
Results: No significant differences were found
between the preoperative and postoperative PaO2 and
PaCO2 levels obtained with nasal packing containing
an airway. However, the mean PaO2 level measured
on the postoperative second night significantly
decreased in patients wearing a nasal packing without
an airway, when compared with the mean preoperative
value and with that obtained from the other group
on the same night (p<0.05). On the other hand,
increases in the mean PaCO2 levels did not reach significance.
In both groups, postoperative PaO2 and
PaCO2 values were within acceptable limits. No signs
of hypoxia or hypercapnia were detected.
Conclusion: To prevent decreases in the PaO2 levels,
the use of nasal packings with an airway seems to be
more appropriate in patients susceptible to hypoxia.

5.The efficacy of combined medical treatment (antihistaminics, steroids, and macrolide antibiotics) in patients with nasal polyposis: preliminary results
Gökhan Kuran, Sinan Kocatürk, Selma Kurukahvecioğlu, Ünsal Erkam
Pages 352 - 357
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Objectives: We evaluated the efficacy of combined medical treatment in cases with bilateral nasal polyposis without a history of any surgical or medical treatment.
Patients and Methods: Twenty-five patients (19 males, 6 females; mean age 45 years; range 30 to 60 years) who had not received any treatment for bilateral nasal polyposis were included. Treatment was comprised of an oral anti-histaminic agent (single dose daily for 3 weeks), and a topical steroid (as a nasal spray, twice daily for 6 months) and a single dose of intramuscular systemic steroid. Patients who did not respond to this therapy at the end of three weeks were administered a macrolide antibiotic (clarithromycin). The results were evaluated before treatment, and three weeks and six months after treatment with the use of a patient questionnaire, computed tomography and endoscopic examination findings.
Results: The patients’ complaints improved by 85.5% and 79% at the end of three weeks and six months, respectively (p<0.005). Radiologic improvement was found to be 64% at the end of six months (p<0.005). The overall decrease in the size of the polyps was significant (p<0.005). No treatment-associated complications were encountered.
Conclusion: Significant improvement achieved favors the use of combined medical treatment before surgery in selected patients with nasal polyposis.

6.Orbital decompression by endoscopic transnasal and transantral approach in thyroid-associated ophthalmopathy
Harun Cansız, Kemal Tuskan, Nuran Kalekoğlu, Özcan Öztürk, Ender İnci, Halit Pazarlı, Nihat Şekercioğlu
Pages 358 - 362
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Objectives: We evaluated the results of orbital decompression in patients with Graves’ disease.
Patients and Methods: Orbital decompression was performed by endoscopic transnasal medial wall approach and transantral inferior wall approach in 18 eyes of 12 patients (8 males, 4 females; mean age 41 years; range 24 to 65 years). The degree of exophthalmos was evaluated with the use of the Hertel exophthalmometer preoperatively, and postoperatively in the 24th hour, first and third months.
Results: At the end of the third month, exophthalmos decreased by a mean of 4.4 mm (range 3 to 7 mm). Visual acuity and field defects improved considerably in all patients. Complications occurred in three cases (25%) including diplopia, displacement of one eye inferiorly, and maxillary sinusitis caused by the encroachment of the adipose tissue upon the ostium.
Conclusion: With the increasing ease of surgical procedures and enhanced experience on the part of surgeons, successful treatment of exophthalmos has become possible with decreased complication rates.

7.Gastric pull-up in hypopharyngeal and cervical esophageal cancers
Şafak Dağlı, E. Evrim Ünsal, Osman Arıkan, Cafer Özdem
Pages 363 - 367
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Objec t i v e s: Gastric pull-up is a common technique in the
reconstruction of gastrointestinal continuity following
surgery for the primary esophageal and hypopharyngeal
tumors with involvement of the esophagus. We evaluated
the results of surgery in patients with cervical esophageal
and hypopharyngeal cancers.
Pati ents and Methods: Eleven patients (4 women, 7 men;
mean age 46 years; range 18 to 70 years) underwent surgery
for hypopharyngeal and cervical esophageal epidermoid
carcinoma. Surgery included pharyngolaryngoesophagectomy,
subtotal thyroidectomy, and gastric pull-up in all
patients. In addition, nine patients had radical neck dissection
on the involved side and modified radical neck dissection
on the contralateral side. One patient had bilateral radical
neck dissection. Patients who were alive were followedup
for a mean period of 27 months (range 14 to 46 months).
Res u l t s: The one-, two-, and three-year survival rates
were 54% (6/11), 36% (4/11) and 18% (2/11), respectively.
Three patients died from early postoperative
complications, two from organ failure due to locoregional
recurrence (7th month) and to distant metastasis
(11th month).
Conclusion: Despite the small size of the study, the
results favor the use of gastric pull-up in selected
patients with cervical esophageal and hypopharyngeal
cancers.

CASE REPORTS
8.Metastasis to infraclavicular lymph nodes in head and neck cancer: a report of three cases
Burak Erdamar, Yusufhan Süoğlu, Erkan Kıyak, Mehmet Güven, Günter Hafız, İsmet Aslan
Pages 368 - 371
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Metastasis predominantly occurs via the lymphatic system in head and neck tumors. The disturbance of the lymphatic system in the cervical region resulting from neck dissection or radiotherapy may result in unusual patterns of metastasis in patients with recurrent tumors. This is more frequent when the recurrent tumor invades the myocutaneous flap used for the primary reconstruction. We encountered three patients (2 men, 1women) with infraclavicular lymph node metastasis. All were previously treated by surgery, postoperative radiation therapy, and reconstruction with the use of the pectoralis major myocutaneous flap.

9.Synovial sarcoma arising from the hypopharynx: a case report
Çetin Vural, Aslı Batur Çalış, Bilge Bilgiç, Misten Demiryont, Aras Şenvar
Pages 372 - 375
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Synovial sarcoma is a relatively rare soft tissue tumor.
About 3 to 10% of cases arise in the head and neck,
with the majority in the parapharyngeal region. We
hereby report a 22-year-old male patient with synovial
sarcoma confined to the hypopharynx. Treatment
included wide surgical excision followed by radiotherapy.
It is of interest that the lesion recurred 12 years
after the initial primary surgery for synovial sarcoma
at the same site. The patient has been disease-free
for five years.

10.Two cases of nasal natural killer T-cell lymphoma
Volkan Işıksaçan, İlhan Topaloğlu, Güler Berkiten, Kamil Peker
Pages 376 - 379
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Nasal natural killer T-cell lymphoma is a very aggressive
and destructive disease with a poor prognosis. We
hereby present two male patients in whom diagnostic
problems and a mortal course were encountered. One
patient (age 31 years) had progressive ulceration in the
nasal area. Two biopsies that had been taken elsewhere
were inconclusive. The other patient (age 40
years) was referred with a previous histopathologic
diagnosis of squamous cell carcinoma. He complained
of an unhealing wound in the hard palate. Biopsies
were repeated in each case. Diagnosis was made by
immunohistochemical examination. Both patients died
shortly after the diagnosis. The importance of obtaining
an adequate and deep biopsy sample and employing
sophisticated immunohistochemical examination is
emphasized for accurate diagnosis.

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