E-ISSN 2602-4837
Tr-ENT: 28 (1)

Volume: 28  Issue: 1 - 2018

COVER
1.Cover

Pages I - III (48 accesses)

ORIGINAL ARTICLE
2.Investigating the tympanic membrane blood supply: A preliminary cadaver study
İsa Kaya, Arın Öztürk, Servet Çelik, Okan Bilge, Sercan Göde, Tayfun Kirazli
doi: 10.5606/Tr-ENT.2018.92972  Pages 1 - 3 (64 accesses)
INTRODUCTION: This study aims to investigate the arterial and venous vascularization of the tympanic membrane (TM) with colored vessel embalming procedure in fresh cadaver heads, as a guide for minimally invasive tympanoplasty procedures.
METHODS: This study was performed on two fresh frozen cadaver heads (4 ears, 1 male, 1 female). After vessel embalming procedure the TM was examined with rigid endoscopes and the mini vascular plexuses of the TM and external auditory canal were observed.
RESULTS: There is increased vascularization of the posterior superior part of the TM, and the main blood supply derives from the mallear region. The posterior half of the tympanic membrane has richer perfusion compared to the anterior half.
DISCUSSION AND CONCLUSION: Awareness of the vascular pattern of the TM allows modification of manipulations during tympanoplasty; the poorly vascularized anterior part of the TM must be protected for successful graft healing.

3.The relationship between onset of single sided deafness and educational achievement
Mert Cemal Gökgöz, Murat Bınar, Hamdi Taşlı, Songül Özdemir, Bülent Satar
doi: 10.5606/Tr-ENT.2018.78278  Pages 4 - 8 (58 accesses)
INTRODUCTION: This study aims to determine if there is an association between onset of single sided deafness (SSD) and education level in Turkish males who are diagnosed with SSD.
METHODS: A total of 238 male patients aged between 18 and 47 years, diagnosed as SSD before 10 years old, were prospectively enrolled. According to the onset time of SSD, patients were divided into three groups as under two years old, between 2-5 years old, and between 5-10 years old.
RESULTS: The results showed that onset time of SSD affected educational achievement. Although total of 238 patients had been diagnosed SSD before the age of 10 years, no significant relationship was recognized between the patients with SSD and normal
ones in terms of educational level.
DISCUSSION AND CONCLUSION: According to results of this study, children with SSD and their families should be encouraged that this situation will not impact their educational developments in the future.

4.Topographic landmarks in the evaluation of surgical time, morbidity and complications of tracheotomy
Sema Zer Toros, Çiğdem Kalaycık Ertugay, Başak Çaypınar, Elif Akyol Şen, Çiğdem Tepe Karaca, Ayşegül Verim, Çagatay Oysu
doi: 10.5606/Tr-ENT.2018.67915  Pages 9 - 14 (52 accesses)
INTRODUCTION: This study aims to measure some topographic points and distances in the neck and investigate the effect of these topographic measurements on operative duration and complication rate.
METHODS: This observational prospective study included 65 patients (38 males, 27 females; mean age 66.1±12.1 years; range 23 to 85 years) who were performed conventional open tracheotomy Haydarpasa Numune Training and Research Hospital between May 2012 and July 2014. Patients’ age, gender and weight (body mass index), duration of the procedure, and peri- and postoperative complications were recorded. Mentum (M)-suprasternal notch (SN) and cricoid cartilage (CC)-SN distances were measured with a measuring tape. Neck circumference was measured at the levels of CC and cricothyroid membrane.
RESULTS: Operative duration was significantly longer in obese patients compared to normal weight and overweight patients (p=0.002; p=0.026; p<0.05). Perioperative complication rate was significantly lower in normal weight patients than overweight and obese patients (p=0.004; p<0.01). There was a statistically significant inverse correlation between the CC-SN distance and operative duration (r=-0.431; p=0.001; p<0.01). M-SN distance was significantly shorter in patients with perioperative complications (p=0.003, p<0.01).
DISCUSSION AND CONCLUSION: According to the study results, operative duration lengthens and perioperative complication rate increases as the weight increases and the neck length shortens.

5.Outcomes of perichondrium and composite cartilage-perichondrium island grafts in type 1 tympanoplasty: A Randomized Controlled Trial
Ruhi Aydın, Mehmet Emrah Ceylan, Abdullah Dalğıç, Ufuk Düzenli, Çağrı Çelik, Levent Olgun
doi: 10.5606/Tr-ENT.2018.75032  Pages 15 - 20 (47 accesses)
INTRODUCTION: In this study we compared patient outcomes after placement of perichondrium and cartilage-perichondrium grafts and explored the advantages and disadvantages of the two graft materials in terms of graft viability and hearing improvement.
METHODS: Sixty patients with chronic otitis media undergoing type 1 tympanoplasty using the underlay technique were randomly divided into two groups, a perichondrium graft (PER) group (n=30) and a cartilage graft (CG) group (n=30). We obtained audiograms; measured pre- and postoperative airway thresholds, air-bone gap gains and anatomical graft success rates, and recorded Middle Ear Risk Index (MERI) scores.
RESULTS: The success rates did not differ significantly between the two groups (PER group [90%, n=27]; CG group [96.7%, n=29]; p>0.05). We found no significant between-group differences in postoperative bone and airway changes, hearing gains, or mean MERI values (all p>0.05).
DISCUSSION AND CONCLUSION: The success rates of tympanoplasty does not differ between grafts containing perichondrium or island cartilage. Thus, island cartilage grafts should be placed not only in cases at risk but also in those undergoing standard tympanoplasty.

6.The effect of experimental hypothyroidism on nasal mucosa
Yeşim Başal, Ceren Günel, Nuket Özkavruk Eliyatkın, Gökhan Cesur, Aylin Eryılmaz
doi: 10.5606/Tr-ENT.2018.91370  Pages 21 - 25 (73 accesses)
INTRODUCTION: This study aims to investigate the histopathological changes in nasal mucosa and alterations in thyroid hormone receptors in an experimental postnatal hypothyroidism model.
METHODS: Twenty-one Wistar albino newborn rats born from the pregnant rats were enrolled in this prospective randomized study and were divided into two groups: Group 1 (n=11, methimazole, MMI -induced hypothyroidism group) given MMIwater, and Group 2 (n=10, control group), normal tap water. When the offspring reached 90 days, they were decapitated and the nasal mucosa was removed. Thyroid hormone receptor (TR-a, TR-b) status was assessed by immunohistochemical staining.
RESULTS: The difference between hypothyroidism and control groups regarding inflammation was statistically significant (p<0.001), as were the differences between hypothyroidism and control groups regarding edema and vascular proliferation (p<0.001, p=0.001). Staining was identified in sebaceous gland structures with immunohistochemical staining for thyroid hormone receptors. No statistically significant difference was found between the hypothyroidism and control groups regarding TR-a and TR-b.
DISCUSSION AND CONCLUSION: Thyroid hormone receptors are present in nasal mucosa. Edema, inflammation, and vascular proliferation occur in nasal mucosa due to hypothyroidism.

7.Expression of roundabout receptor family members 1 and 2 in laryngeal squamous cell carcinoma and correlation with clinical and pathological parameters
Ayşe Eren, Ender Coşkunpınar, Kadir Serkan Orhan, Deniz Kanlıada, Önder Şahin, Mustafa Ömür Köse, Turgay İşbir, İlhan Yaylım
doi: 10.5606/Tr-ENT.2018.02779  Pages 26 - 33 (50 accesses)
INTRODUCTION: This study aims to investigate whether there is a role of ROBO-1, ROBO-2 and TGM-3 gene expression levels in the development of laryngeal cancer.
METHODS: The study was completed with 29 patients who underwent total or partial laryngectomy due to squamouscell laryngeal cancer. Gene expression analysis was performed by quantitative real-time polymerase chain reaction (qRT-PCR). Expression ratios were transformed into fold changes and reported as relative expression. Obtained fold changes were compared between different tumor grades in addition to normal tissue samples.
RESULTS: The ROBO-1, ROBO-2 and TGM-3 genes were expressed at a lower level than the control group.
DISCUSSION AND CONCLUSION: Our study results showed that there was no correlation between ROBO-1, ROBO-2 and TGM-3 gene expression and development of laryngeal cancer.

8.Effects of methotrexate in a toluene diisocyanate-induced allergic rhinitis rat model
Sibel Alicura Tokgöz, Gökçe Şimşek, Erkan Vuralkan, Ömer Bayır, Fulya Köybaşıoğlu, Murat Çalışkan, Ömer Beşaltı, İstemihan Akın
doi: 10.5606/Tr-ENT.2018.22556  Pages 34 - 39 (52 accesses)
INTRODUCTION: This study aims to investigate the therapeutic effect of low-dose topical administration of methotrexate (MTX) in a toluene diisocyanate (TDI)-induced allergic rhinitis rat model.
METHODS: The experiments were performed on 18 healthy male Wistar albino rats weighing between 250-270 g. Rats were divided into four study groups: control group (n=5), sham group (n=3), steroid group (n=5), and MTX group (n=5). After the drugs were administered, multiple biopsies were taken bilaterally from the nasal mucosal areas and evaluated histologically for fibrosis, loss of cilia and goblet cells, edema, squamous cell metaplasia, and vascular proliferation.
RESULTS: Fibrosis, loss of cilia cells, edema, and vascular proliferation were significantly lower in both MTX and steroid groups than in the control group (p<0.05). There were no statistically significant differences with respect to histopathological parameters between the steroid group and the MTX group (p>0.05). There were no statistically significant differences with respect to loss of goblet cells and squamous cell metaplasia among the studied groups (p>0.05).
DISCUSSION AND CONCLUSION: Methotrexate may be an alternative or adjuvant therapeutic agent in allergic rhinitis.

CASE REPORTS
9.Facial nerve abnormality on parotidectomy for Warthin tumor in a case of aural atresia
Murat Bınar, Ümit Aydın, Ömer Karakoç, Mert Cemal Gökgöz, Hamdi Taşlı
doi: 10.5606/Tr-ENT.2018.98372  Pages 40 - 43 (46 accesses)
To our knowledge, the coexistence of Warthin tumor and ipsilateral aural atresia has not been reported before. This situation may affect facial nerve structure and present a surgically challenging situation during superficial parotidectomy. A 68-year-old woman with right aural atresia was operated on due to a parotid mass below the atretic ear. Computed tomography and intraoperative findings demonstrated unusual properties of the facial nerve: (i) Extratemporal beginning was more superiorly located, (ii) Facial trunk was relatively longer and more vertical, (iii) Buccal, marginal mandibular, and cervical branching from the unique ring structure of the facial nerve. All facial nerve branches were preserved after careful dissection and the lesion was completely excised. Final histopathologic diagnosis was Warthin tumor. In order to preserve the facial nerve during parotid surgery and to avoid morbidity, it is necessary for surgeons to be familiar with different types of extratemporal facial nerve anatomy especially in cases of additional anomalies such as aural atresia.

10.Tubercular osteomyelitis of the clivus
Poonam Sagar, Anoop Raj, Vikram Wadhwa, Ishwar Singh
doi: 10.5606/Tr-ENT.2018.49932  Pages 44 - 47 (42 accesses)
A 24-year-old girl presented with non-specific headache and diplopia. Nasal endoscopy showed a polypoidal mass in the nasopharynx. Computed tomography and magnetic resonance imaging revealed erosion of the clivus. Nasopharyngeal biopsy clinched the diagnosis of tuberculosis. She was put on antitubercular therapy, but developed seizures, bilateral ptosis and obstructive hydrocephalous, which were relieved by a ventriculo-peritoneal shunt. However, the patient developed infarction of the basal ganglia and thalamus and died due to cardiorespiratory arrest.

11.Chronic mastoiditis associated with leukocyte adhesion deficiency type 1: A case report
Cömert Şen, Can Doruk, Mehmet Çelik, Levent Aydemir, Kadir Serkan Orhan
doi: 10.5606/Tr-ENT.2018.98608  Pages 48 - 51 (35 accesses)
Adhesion molecules work for leukocytes to infiltrate to the site of inflammation. Deficiencies of these molecules can disturb neutrophil migration and thus inflammation. This group of illnesses is named leukocyte adhesion deficiency (LAD) syndromes. Mastoiditis is a very rare and unexpected complication. CD 18 count is the prognostic factor and might affect the treatment modalities. We report the case of a six-year-old girl with LAD type 1 who presented with chronic mastoiditis and the treatment of this unusual presentation.

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