Infectious and Noninfectious Causes of Epiglottitis in Adults, Review of 24 Patients

Objective:The present study reports the etiological differences, clinical features, management, and patient outcomes between infectious and noninfectious causes of epiglottitis in adult patients.Methods:The medical records of 24 patients with infectious and noninfectious epiglottitis were investigated. Diagnosis was made by anamnesis and endoscopic examination. On admission, respiratory distress of patients was classified according to Freidman’s classification.Results:Fifteen patients were male, and nine patients were female. Their ages ranged between 24 and 69 years of age (mean, 43.4±11.6). In total, 16 patients were diagnosed with infectious epiglottitis, and eight patients were diagnosed with noninfectious epiglottitis. Of patients with noninfectious epiglottitis, two had angioedema, two had experienced organophosphate ingestion, one had experienced hot water aspiration, one had experienced hot milk aspiration, one had experienced foreign body aspiration (fishbone), and one had epiglottitis due to Behçet’s disease. Sore throat was the most common symptoms of infectious and noninfectious epiglottitis in our patients. Odynophagia was the second most common symptom of infectious epiglottitis, and muffled voice was the second most common symptom in noninfectious patients.Conclusion:Epiglottit is an emergency situation; when a patient is diagnosed with epiglottitis, close follow-up should be performed, and airway support should properly be maintained according to the degree of respiratory distress. Tracheostomy should be performed without hesitation, as needed

Ani işitme kaybında internal akustik kanal çapı

Objective: The purpose of our study was to determine the corelation between internal acoustic channel diameter and idiopathic sensorineural hearing loss. Material and Method: We defined sudden sensorineural hearing loss according to the criteria of Wilson as a 30-dB sensorineural hearing loss occurring in at least three contiguous frequencies in less than 3 days. The internal acoustic channel diameter all of the patients was measured from three dimensional temporal CT scan. Results: Of the 15 patients, 7 were male and 8 were female, ranging in age from 17 to 59 and the mean age was 39.6 years. The right ear was involved in 6 patients, and the left ear in 9. There was no statistically significant difference between the patients’ affected and intact ears (p>0.05). However, the mean diameter of affected side of the patients was narrower than those of healthy controls (p0.05). Ancak kontrol grubuyla karşılaştırıldığında etkilenen kulakta istatistiksel olarak anlamlı darlık tespit edildi (p<0.05). Sonuç: Bulgularımız kontrol grubuyla karşılaştırıldığında, idiyopatik ani işitme kaybı gelişen hastalarda internal akustik kanal çapının nispeten daha dar olduğunu ve bunun bir risk faktörü olabileceğini düşündürmektedir

Hyperbaric oxygen as adjuvant therapy in cervical necrotizing fasciitis

Nekrotizan fasiit önemli derecede morbidite ve mortalite ile ilişkili deri ve fasyanın ciddi bir enfeksiyonudur. Nekrotizan fasiit, baş ve boyunda tutulumu nadir olarak gözlenir. Servikal nekrotizan fasiitin standart tedavisi, intravenöz antibiyotik ve acil olarak cerrahi debridman uygulamayı içerir. Hiperbarik oksijen terapisi, nekrotizan fasiitin kontrolünde adjuvant olarak kullanılmaktadır. Birçok çalışmada hiperbarik oksijen kullanıldığında daha kısa hastanede kalma süresinin olduğu, mortalitenin ve cerrahi debridman sayısınının azaldığı ileri sürülmektedir. Bu çalışmada servikal nekrotizan fasiit tanısı konmuş olup boyunda geniş bir doku defekti olu- şan ve intravenöz antibiyotik, cerrahi debridman yanında adjuvant olarak hiperbarik oksijen terapisi uygulanan bir hasta sunulmuş ve ilgili literatür gözden geçirilmiştir.Necrotizing fasciitis is a serious infection of the fascia and skin associated with considerable morbidity and mortality. Necrotizing fasciitis rarely in- volves the head and neck. The standard treatment for cervical necrotizing fasciitis includes intravenous antibiotics and prompt surgical debridement. Hyperbaric oxygen therapy is used as adjunctive therapy in managing nec- rotizing fasciitis. Several reports suggest shorter hospital duration, reduced mortality, and decreased surgical debridement when hyperbaric oxygen is used. In this report, a patient who was diagnosed with cervical necrotizing fasciitis having a large tissue defect on her neck and was administered intra- venous antibiotics, surgical debridement, and adjuvant hyperbaric oxygen therapy is presented, and the related literature has been looked through

Evaluation of bcl-2, bax and c-erbB-2 Levels in Chronic Otitis Patients with or without Cholesteatoma

Objective:The aim of this study was to evaluate bcl-2, bax, and c-erbB-2 expressions in primary and secondary acquired cholesteatoma and to indicate the role of apoptosis and accompanying increased cellular proliferation in the pathogenesis of cholesteatoma.Methods:Samples obtained from the skin of the external ear canal (EEC) of patients operated for chronic otitis media (COM) without cholesteatoma constituted Group 1; samples from the EEC skin of patients in Group 3 operated for COM with cholesteatoma and from the EEC skin of patients in Group 4 constituted Group 2; samples obtained from the cholesteatoma matrix of patients operated for COM with primary acquired cholesteatoma constituted Group 3; and samples obtained from the cholesteatoma matrix of patients operated for COM with secondary acquired cholesteatoma constituted Group 4. The assessment of the positive cell ratio was based on the presence of the following findings and was semiquantitatively classified into four groups: 0, no staining; + cell staining (weak positive staining: 1%–33%); ++ cell staining (moderately positive staining: 34%–66%); and +++ cell staining (strong positive staining: 67%–100%).Results:Comparison of the staining scores of bcl-2, bax, and c-erbB-2 revealed a statistically insignificant difference in the staining of samples obtained from the EEC skin (p>0.05). Decreased bcl-2 expression and increased bax and c-erbB-2 expressions were determined in primary and secondary acquired cholesteatoma epithelium compared with the EEC skin of patients operated for COM with or without cholesteatoma, and the differences were found to be statistically significant (p<0.05).Conclusion:In acquired cholesteatoma epithelium, the finding of decreased bcl-2 expression as well as increased bax and c-erbB-2 expressions compared with the EEC skin is an indicator of the increase in both cellular proliferation and apoptosis

Importance of sonographic paratracheal lymph node evaluation in early autoimmune thyroiditis

Background/aim: To review the sonographic views of paratracheal lymph nodes (PLNs) in the diagnosis and during different stages of autoimmune thyroiditis. Materials and methods: Features of the PLNs (left and right), thyroid sonography, and laboratory data were investigated in 126 cases. Patients were divided into three groups by using thyroid sonographic criteria in the literature (group 1: control, group 2: early-stage/ indeterminate, group 3: definite thyroiditis). Indeterminate patients were followed up for 1 year and included as indeterminate/earlystage thyroiditis patients. Results: Percentage of right and left PLN was 13.3% and 46.2% in control cases, 21.2% and 80% in early-stage/indeterminate cases, and 41.3% and 88.5% in definite thyroiditis cases. Significant among-group differences were evident in terms of right and left PLNs presence (Pearson chi-squared test, P = 0.011 and P = 0.001). Conclusion: Careful and thorough review of the PLNs can ensure diagnosis of autoimmune thyroiditis even in cases of early stage of the disease and prevent false-negative diagnoses

Importance of Delphian lymph node evaluation in autoimmune thyroiditis : fact or fiction?

BACKGROUND: Our main objective was to evaluate the association between autoimmune thyroiditis and the Delphian lymph node during different stages of thyroiditis. MATERIAL AND METHODS: The relationships between the ultrasonography (US) results of thyroiditis and characteristics of the Delphian lymph node in different stages of AT were evaluated. Thyroid hormone and antibody levels were assessed. A total of 126 patients were divided into four groups according to the thyroid US findings: Group 1: control cases; Group 2: indeterminate cases; Group 3: established thyroiditis cases; Group 4: advanced-late stage thyroiditis cases. Indeterminate cases attended a 1-year follow-up, and the cases with a sonographic finding matching thyroiditis formed Group 2. RESULTS: The rate of Delphian lymph node presence in Group 4 was significantly higher than in Groups 1 and 2 (p0.05). Both the long and short axis measurements were significantly higher in Groups 2, 3, and 4 compared to those in the control group. However, the same increase was not observed in the long/short axis ratio. CONCLUSIONS: Both the presence and dimensions of the Delphian lymph node were highly correlated with the progress of autoimmune thyroiditis. Evaluating the Delphian lymph nodes might prevent missing a diagnosis of autoimmune thyroiditis

Morphometric analysis of sphenoid sinus in patients with nasal septum deviation

This retrospective study aimed to assess the association of the volume and types of the sphenoid sinus with deviated nasal septum by analyzing multislice computed tomography images. A total of 93 patients with a deviated nasal septum and 70 healthy controls were included in the study. Patients with sinonasal morbidities other than deviation were excluded. Three-dimensionally reconstructed computed tomography images of the study participants were acquired. A total of 326 sphenoid sinus volumes from the patient and control groups were obtained and compared between the groups. Sphenoid sinus volumes and the angle of the deviation were measured for standardization and assessment of the severity. Deviated nasal septum was found on the right in 49.5% (n=46) and on the left in 50.5% (n=47) of the study participants. Deviation angles were in the range from 7.28 to 22.48 and the mean value was 13.28±5.08. The measured volumes were in the range from 1.8 cm3 to 9.6 cm3 with a mean of 4.8±1.5 cm3. In the control group, the median values for the sphenoid sinus volumes were 4.40 cm3 (0.80- 8.90 cm3) on the right and 4.20 cm3 (0.90-8.70 cm3) on the left. In the study group, sphenoid sinus volumes were found to be statistically significantly different between those on the ipsilateral and contralateral side of the septal deviation. Sphenoid sinus volumes were significantly smaller on the same side with septal deviation compared with those on the contralateral side. There was no statistical relationship between the presence of septal deviation, age and gender, and the type of sphenoid sinus