Is There a Change in the Treatment of T1 Glottic Cancer After CO2 Laser? A Comparative Study with Cold Steel

Objective: Carbon dioxide (CO2) laser provides high local control and disease-specific survival rates with minor morbidity and good quality of life in transoral cordectomy. We aimed to compare the oncological outcome and survival between cold steel and CO2 laser in the treatment of early glottic cancer.Methods: In this retrospective study, the participants were divided into two groups. The first group comprised patients who were operated upon between 2001 and 2007 using cold steel (group 1, n=38), and the second group comprised patients who were operated upon between 2008 and 2016 using CO2 laser (group 2, n=88). Both groups were compared regarding age, gender, pathological grade, T stage, type of cordectomy, margin status, anterior commissure involvement, follow-up, locoregional recurrence, and disease- free survival (DFS).Results: The overall survival rate and DFS were similar between the two groups (94.7% vs. 98.9% and 100% vs. 98.9%, respectively), and no association was found between surgical margin positivity and local recurrence. However, a significant association between the presence of anterior commissure involvement and recurrence was found in all 126 patients (p=0.016). Local recurrence was significantly higher in the group 2 (p=0.024), but it did not affect overall survival and DFS in these patients (100% vs. 94.1%).Conclusion:Although CO2 laser excision is considered to be superior to cold steel regarding surgical time and bleeding control, the local recurrence rates were found to be higher with the laser than the cold steel. Thus, we argue that cases should be selected more carefully concerning the anterior commissure, depth of tumor invasion lateral to vocal muscle, difficulty at endoscopic exposure for lesions with anterior commissure involvement, and reliability of surgical margins at frozen sections

Why Do We Not Need CT in Patients Who Undergo Type I Tympanoplasty?

Objective:High-resolution computed tomography (HRCT) has gained wide acceptance in diagnostic work-up of suppurative chronic otitis media. Most ear surgeons order HRCT to make a rational operative plan, especially in the presence of symptoms, such as refractory otorrhea with bad odor, epithelial debris at retraction pockets, and defects in bony walls of the middle ear. The aim of this study was to show the lack of necessity of preoperative HRCT by evaluating its predictive value in patients who underwent type I tympanoplasty.Methods:The study included a patient group who underwent tympanoplasty with dry perforation and normal middle ear mucosa. The intraoperative findings of 43 patients were compared with preoperative HRCT and audiogram findings.Results:There was no significance between preoperative air conduction threshold and existence of ossicular erosion in HRCT. HRCT incorrectly predicted the presence of cholesteatoma in two patients. The positive predictive value of HRCT in detecting soft or granulation tissue was 4/14 (28.57%). The sensitivity and specificity of HRCT in the diagnosis of ossicular chain status were 9.09% and 90.62%, respectively.Conclusion:HRCT plays an important role in the assessment of patients with suppurative chronic otitis media and cholesteatoma. However, preoperative HRCT in patients who have undergone type I tympanoplasty is not necessary. It has no benefit and also leads patients to unnecessary radiation exposure

The importance of preoperative nasal endoscopy in addition to conventional radiographs and computerized tomography in patients with chronic sinusitis

Kronik sinüzitli hastalarda cerrahi tedavinin yönlendirilmesi ve operasyon sırasında ortaya çıkabilecek komplikasyonlardan kaçınmak için preoperatif diagnostik değerlendirme zorunludur. Bu çalışmanın amacı; uygun medikal tedaviye rağmen, şikayetleri devam eden kronik sinüzitli hastaların preoperatif değerlendirilmesinde düz (konvansiyonel) radyografiler, yüksek rezolüsyonlu koronal paranazal sinüs BT ve nazal endoskopinin etkinliğinin karşılaştınlmasıdır. Anamnezi kronik sinüzit ile uyumlu, ayrıntılı fizik muayene ve düz radyografik tetkiklerden geçirilen 43 hasta retrospektif olarak değerlendirildi. Bütün hastalara koronal planda yüksek rezolüsyonlu BT uygulandı. Endoskopi şartlarına uygun 30 hasta da rijit ve/veya fleksibl nazal endoskopi ile değerlendirildi. Paranazal sinüslerdeki(maksiller, etmoid, frontal ve sfenoid) anatomik varyasyonlar ve mukozal değişiklikler kaydedildi. BT referans alınarak düz radyografilerin sensitivite ve spesifiteleri bulundu. Çalışmamızda BTde tüm olguların 40 (%93)'ında mukozal anormallikler bulundu. Diğer 3 hastadan 2'sine obstrüktif semptomlar nedeniyle konka bulloza cerrahisi uygulandı. 1 hastaya da rinojenik kaynaklı başağrısı nedeniyle paradoksal orta konka cerrahisi uygulandı. Patolojinin en sık görüldüğü alan anterior etmoid bölge (orta mea) idi. Düz radyografilerle yapılan değerlendirmede; bütün sinüslerin %47.4'ünde mukozal değişiklik bulunurken, BTde bunların %42.2'si doğrulandı. Aynı zamanda sinüslerin %19.5'i düz radyografilerle tamamen normal olarak değerlendirilirken, BT bulgularında patolojik sonuçlar bulundu. Tümünün değerlendirilmesinde düz radyografi ile BT uyumu %75.3 bulundu. Diagnostik olarak BT ve nazal endoskopinin birlikte kullanıldığı bu olgularda nazal kavite bulguları değerlendirildi. İki muayene arasında %87 korelasyon bulundu.Sonuç olarak; 1) Kronik sinüzitli hastalarda düz radyografilerin tanısal değeri vardır. Ancak cerrahi öncesi değerlendirmede yalnız başlarına kullanılmamalıdır, 2) BT öncesi yapılacak nazal endoskopi gerekli olmayan BT çekimlerini azaltabilecektir, 3) Preoperatif değerlendirmede birbirinin tamamlayıcısı olan BT ve nazal endoskopinin birlikte kullanılması gereklidir, 4) BT tanısal amaçlı olarak kullanılmamalı, cerrahi girişim düşünülen hastalarda ve nadiren, klinik değerlendirmenin yeterli görülmediği durumlarda tercih edilmelidir, 5) Maksiller sinüs hastalığının tanı ve takibinde yüksek sensitiviteleri nedeniyle düz radyografiler tek başlarına kullanılabilir, 6) Paranazal sinüs anatomik varyasyonları kronik sinüzitli hastalarda etyolojik ve predispozan faktör olark kabul edilebilir.In patients with chronic sinusitis, pre-operative diagnostic evaluation is needed, to plan surgical procedure and to avoid the complications during the surgery. The aim of this study; is to compare the efficacy of direct (conventional) radiographies (DR), high resolution coronal paranasal sinus computed tomography (CT) and nasal endoscopy in the pre-operative evaluation of chronic sinusitis patients with persistent complaints, despite appropriate medical therapy. 43 patients with a history, detailed physical examination and plain x-rays, consistent with chronic sinusitis were retrospectively evaluated. All patients underwent coronal high resolution paranasal sinus computed tomography. Detailed complete nasal rigid and/or flexible endoscopy was available in 30 patients. The anatomic variations and mucosa! changes in paranasal sinuses (maxiller, ethmoid, fronthal, sphenoid) were noted. The specifity and sensitivity of DR were calculated using CT findings as a reference point. In our study 40 (%93) of all patients showed mucosal changes on CT. 2 of other 3 patients underwent concha bullosa surgery for obstructive sympthoms. In the other patient, paradoxal middle concha surgery was applied for rhinogenic headache. Pathology was most frequently found in the anterior etmoid region (middle meatus). Using DR we found mucosal anomalies in %47,4 of all sinuses, where as %42.2 were confirmed with CT. %19.5 of all sinuses were normal with DR, besides anormal by CT. There was an overall %75,3 correlation between DR and CT. In patients using CT and nasal endoscopy together as diagnostic parameter, nasal cavity findings are evaluated. Confirmation of the two techniques was %87. In conclusion; 1) DR has a diagnostic value in chronic sinusitis but they shouldn't be used as the single diagnostic tool in pre-operative evaluation, 2) Nasal endoscopy before CT scanning, can reduce unnecessary CT scannings, 3) In pre-operative evaluation the contemporary techniques, CT and nasal endoscopy must be used together, 4) CT shouldn't be used as a diagnostic method. It can be used pre-operative planning and rarely when clinical evaluation is insufficient, 5) Because of the high sensitivity values, DR can be used alone in the diagnosis and fallow-up method of maxillary sinus disease, 6) Paranasal sinus anatomic variation sare etiologic and predisposing factor of chronic sinusitis

Two-stage aural atresia and stenosis surgery with the use of synthetic skin substitute

Conclusion. With this technique, patency rates achieved in congenital external ear canal (EAC) atresia/stenosis and improvement in hearing were evaluated as 'good' and 'satisfactory', respectively. Objectives. We aimed to test the efficacy of a novel two-stage technique in preventing restenosis following atresioplasty. Patients and methods. Nine patients with congenital EAC atresia/stenosis comprised our cases. We performed 10 atresioplasties using the two-stage technique described below. In the first stage, the ear canal is drilled and its wall is covered with a synthetic skin replacement that induces proliferation of a soft tissue; in the second stage this is lined underneath with split thickness skin graft. Operations were complemented with tympanoplasties in five of the patients. Results. Nine (91%) of 10 operations carried out with the technique were largely successful in terms of patency. The achieved average hearing gain was air conduction/bone conduction (Ac/Bc): 31.33/9.44 dBHL (21.89 in the air-bone gap), while the postoperative air-bone conduction gap was changed to <30 dBHL in eight (88.9%) of the patients

The Consideration of Diffusion MR Imaging, Dynamic Contrast-Enhanced MR and T2 Relaxation Time Measurements in Distinguishing of Cholesteatoma with Chronic Otitis Media

WOS: 000337898000004Purpose: The aim of our study is to investigate the contribution of DWI, DCE-MRI, ADC measurements and T2 relaxometry in diagnosis of distinguishing cholesteatoma and COM Materials and Methods: Our study is created by retrospectively reviewing MR images of a digital archive of totally 41 patients that were clinically or surgically diagnosed as COM and cholesteatoma. DWI, ADC values, T2 relaxation time, and CEP of lesions between the two groups were compared statistically. CEP was qualitatively evaluated. ROC analysis and McNemar statistics test were performed. Level of significance was determined as p0.05). When the groups were assessed according to the CEP, 13 of the COM cases showed type 1 (progressive heterogeneous enhancement), 2 cases did not show enhancement (type 3) and 6 cases showed type 4 (progressive homogeneous enhancement). Nineteen patients with cholesteatoma showed type 2 (rim-like enhancement), 1 case showed type 4. Statistical analysis of CEP revealed significant differences between types 1 and 2 (p<0.001), between types 2 and 3 (p=0.005) and between types 2 and 4 (p<0.001). Conclusion: DWI, ADC values and DCE-MRI may be beneficial in detecting cases of cholesteatoma of a high percentage

Turkish Guideline for Diagnosis and Treatment of Allergic Rhinitis (ART)

Object: To prepare a national guideline for Oto-rhinolaryngologist who treat allergic rhinitis patient