A new horizon in the treatment of biofilm-associated tonsillitis

Objective: To demonstrate the efficacy of tonsil brushing in patients with chronic tonsillitis to remove the microbial biofilm on the tonsil surface using an in vitro model. Design: Specimens from patients undergoing tonsillectomy were evaluated prior to and following surface cleaning methods, including rinsing and brushing, using scanning electron microscopy (SEM). Patients: The study population consisted of 25 randomly selected patients with chronic tonsillitis. Interventions: Specimens were collected and divided into four portions. Each portion received distinct surface cleaning methods and was immediately fixed for SEM examination. Outcome measures: The biofilm layer on the surface of the tonsils was examined using SEM. The density of the biofilm layer and the degree of persistence of the biofilm after rinsing and brushing were measured. Results: The surface biofilm of the tonsils in the first group, which were neither brushed nor rinsed, revealed a thick layer of biofilm on the mucosal surface. The second group of tonsils, which were only rinsed, also showed a thick layer of biofilm. The third group of tonsils, which were rinsed following gentle brushing using a soft toothbrush, showed a reduction in the thickness of the biofilm layer. The fourth group of tonsils, which were brushed with a hard brush, was almost devoid of a biofilm layer. Conclusion: Our results demonstrate that rinsing does not effectively remove the biofilm layer on the tonsil surface. The use of a harder brush was identified as a more powerful means of removing biofilm compared with a soft brush

Hairy Neck Skin Flap in a Pharyngostoma: An Unusual Complication of Total Laryngectomy

Postoperative pharyngocutaneous fistula is a common complication after total laryngectomy. A 58-year-old man had a pharyngocutaneous fistula after a total laryngectomy. Because of the prolonged hospital stay and expensive postoperative care, he refused to stay in the clinic until fistula closure. After 7 months, he returned with a hairy neck skin flap in the fistula region. This case emphasizes the importance of appropriate postoperative wound care and the possibility of neck skin curling throughout the fistula tract during fistula closure

Noise Pollution in Different Hospital Policlinics of İstanbul/Turkey

Objective: This study was performed to measure and analyse noise levels measured in different public hospital policlinics. Methods: Noise levels in general policlinics of five different public hospitals were measured by using a RadioShack digital sound level meter. The measurements were made from 8: 15 to 16: 00 hours. They were recorded and were compared with World Health Organisation (WHO) guidelines for community noise. Results: The average LminA level in Centre 1 was 61 +/- 1.73 dB and LmaxA level was 80.14 +/- 1.34 dB. The measurements in Centre 2 noted an average LminA level of 62.7 +/- 1.7 dB, LmaxA level of 82.42 +/- 1.39. The average LminA level in Centre 3 was 63.14 +/- 2.41 dB, LmaxA level was 83.57 +/- 2.93 dB. The measurements in Centre 4 noted an average LminA level of 59.85 +/- 1.06 dB, LmaxA level of 74.85 +/- 1.34. The average measurements in Centre 5 were 59.57 +/- 3.5 dB for LminA, 75.28 +/- 2.92 dB for LmaxA. The highest noise levels were recorded in Centre 3, but the difference was not statistically significant (p>0.05). Conclusion: The WHO guidelines state that noise levels in hospital areas should be 35-40 dB in the daytime and 30-40 dB in the evening. Turkish Noise Control Regulations also restrict the noise levels to maximum 40 dB. Our results exceed these guidelines at all times

Noise Pollution in Biochemistry Laboratories of Different Hospitals in Istanbul/Turkey

Objective: To measure and analyse noise levels generated by different biochemistry analysers in public hospitals. Methods: Noise levels generated from different analysers were measured in biochemistry laboratories by using a sound level meter. Each device was operated separately and noise levels were measured for 15 minutes; the lowest and highest sound pressure levels were recorded and compared with the World Health Organisation (WHO) guidelines for community noise. Also, 20 laboratory workers were chosen randomly and their hearing levels were screened. Results: The highest noise level recorded from biochemical analysers was 81 dB with an average of 77.7 +/- 2.11 dB; the lowest noise level was 64 dB with an average of 66.9 +/- 1.66 dB. The average highest noise level of total blood count devices was 78.5 +/- 5.94 dB and the average lowest noise level was 66.3 +/- 7.05 dB. The average highest measurement of hormone analysers was 78.5 +/- 1.95 dB and the average lowest measurement was 66.1 +/- 4.53 dB. The average highest measurement of urine analysers was 75.3 +/- 5.39 dB and the average lowest measurement was 64.3 +/- 4.62 dB. The average highest noise level of centrifuge devices was 80.6 +/- 5.68 dB and the average lowest noise level was 69.2 +/- 5.75 dB. In the audiometric screening, the hearing thresholds were within normal levels. Conclusion: The WHO guidelines state that noise levels in hospital areas should be 35-40 dB in the daytime and 30-40 dB in the evening. Our results exceed these guidelines at all times

Investigation of the immunological changes and comparison of the microbiological flora of the tonsil surface and core in recurrent tonsillitis

Amaç: Rekürren tonsilliti olan hastalardan alınan tonsillerin yüzey ve merkez kültürlerinden elde edilen floraların karşılaştırılması ve tonsillerin içerisindeki immünolojik değişikliklerin incelenmesi. Gereç ve Yöntem: Çalışmaya Taksim Eğitim ve Araştırma Hastanesi Kulak Burun Boğaz Hastalıkları Kliniğinde kronik tonsillit tanısıyla tonsillektomi yapılmış olan 42 hasta dahil edilmiştir. Entübasyon ve orofarengeal aspirasyon yapıldıktan sonra, transoral yoldan tonsil yüzeylerinden kültür alınmıştır. Tonsillektomi yapıldıktan sonra her bir tonsil bistüri yardımıyla ikiye bölünmüş ve mikrobiyolojik analiz için merkez kültürleri alınmıştır. Tonsillerin diğer yarısı da, histopatolojik değerlendirme için patoloji laboratuarına gönderilmiştir. Bulgular: Örneklerden izole edilen bakteriler arasında ilk sırayı beta hemolitik streptokokun aldığı izlendi. Tonsillerin yüzey ve merkez kültürleri kıyaslandığında beta hemolitik streptokok ve alfa hemolitik streptokok izole edilme insidansları arasında istatistiki olarak anlamlı bir fark olmadığı görüldü (p>0.05). Merkez kültürlerde patojen mikroorganizma tespit edilme oranı yüzey kültürlere göre anlamlı olarak daha yüksekti (p<0.05). Germinal merkezlerde ortalama B hücre sayısı 79.35±11.68 ve T hücre sayısı 4.82±4.92 olarak saptandı. B ve T hücre sayıları arasındaki farkın istatistiki olarak anlamlı olduğu izlendi (p<0,0001 ). Sonuç: Rekürren tonsillitte yüzey kültürleri etken patojenleri tespit etmede yetersiz kalabilir.Objective: To compare the microbiologic flora from the surface and core cultures in patients with recurrent tonsillitis and to study the immunologic changes within the tonsils. Material and Methods: Forty &amp;#8211; two patients, who were treated by tonsillectomy for recurrent tonsillitis in Taksim Research and Training Hospital Otorhinolaryngology Department, were enrolled in this study. After intubation and following oropharyngeal aspiration, tonsillar surface cultures were taken transorally. Following tonsillectomy, each tonsil was divided into two using a scalpel and tonsil core cultures were taken for microbiological analysis. The other half of the tonsils were sent to pathology laboratory for histopahological evaluation. Results: The most frequent bacterium isolated from the samples was beta hemolytic streptococcus. When surface and core cultures of the tonsils were compared, no statistically significant difference was observed in the incidence of beta hemolytic streptococcus and alpha hemolytic streptococcus isolation (p&gt;0.05). Detection of pathogenic microorganism in the core cultures was significantly higher than the surface cultures (p&lt;0.05). In the germinal center mean B cell count was 79.35&plusmn;11.68 and mean T cell count was 4.82&plusmn;4.92. The difference of B and T cell counts was statistically significant (p&lt;0,0001). Conclusion: Surface cultures may be unable to detect the real pathogens in cases with recurrent tonsillitis

Effects of Neck Dissection and Radiotherapy on Short-Term Speech Success in Voice Prosthesis Restoration Patients

Objective. To compare the short-term speech success of voice prosthesis (VP) among patients who underwent total laryngectomy or total laryngectomy in combination with neck dissection and those who received postoperative radiotherapy. Materials and Methods. Thirty-two male patients treated for laryngeal squamous cell carcinoma were included. Nine patients underwent total laryngectomy and 23 underwent total laryngectomy combined with neck dissection, and 17 of the 23 with neck dissection were managed with postoperative radiotherapy (45-75 Gy). All of the patients had indwelling intraoperative placement of the Provox VP (Atos Medical AB, Horby, Sweden; and Entermed BV, Woerden, The Netherlands) at the time of the primary tracheoesophageal puncture (TEP) completed in conjunction with total laryngectomy. Patients with pharyngoesophageal myotomy and pharyngeal plexus neurectomy were excluded. Patients' speech success was perceptually evaluated 3-4 weeks after the surgery and 3-4 weeks after the cessation of radiotherapy, using a 1-3 scale (1 = failure to develop speech (aphonia); 2 = communicate with short phrases only; and 3 = communicate with fluency and long sentences). Results. No complications were noted with intraoperative prosthesis placement. No prostheses were dislodged in the postoperative period. Eighteen of 32 patients (56%) demonstrated successful speech (rating of 3). Nine patients (28%) demonstrated less successful speech (rating of 2). Five patients (16%) were found to be aphonic (P > 0.05). Of the nine patients who underwent total laryngectomy only, six were found to have successful speech (66.6%), one (11.1%) was found to have less successful speech quality, and two (22.2%) patients were aphonic (P > 0.05). Of the six patients who underwent total laryngectomy in combination with neck dissection, three had successful speech (50%), one (16.6%) had less successful speech, and two (33.3%) were aphonic (P > 0.05). Of the 17 patients who received postoperative radiotherapy, nine (52.9%) had successful speech, three (17.6%) had less successful speech, and five (29.4%) were aphonic (P > 0.05). Conclusion. Neck dissection and postoperative radiotherapy have no significant influence on short-term speech success in VP restoration patients. Primary TEP should be preferred in patients who have laryngectomy in combination with neck dissection and/or will have postoperative radiation therapy, as it provides early and successful voice restoration without interfering with radiation treatment and avoids a second surgical intervention