E-ISSN 2602-4837
Tr-ENT: 29 (2)

Volume: 29  Issue: 2 - 2019

1.Cover

Pages I - IV

ORIGINAL ARTICLE
2.Evaluation of volumetric and morphological changes of vestibular schwannomas following CyberKnife therapy
Engin Ugur Yardimci, Melda Apaydin, Fazıl Gelal, Fatih Dag, Ali Olmezoglu, Ali Firat Sarp
doi: 10.5606/Tr-ENT.2019.36036  Pages 61 - 66
INTRODUCTION: This study aims to evaluate volumetric and morphological changes following CyberKnife radiotherapy of vestibular schwannomas.
METHODS: Between March 2011 and December 2013, a total of 39 patients (15 males, 24 females; mean age 52 years; range, 19 to 86 years) who underwent CyberKnife hypofractionated radiotherapy were retrospectively analyzed. Tumor volume calculations were done by manual segmentation. Tumor morphology was classified by arbitrary cystic scaling. Local tumor control, tumor progression, transient swelling rates, and changes in tumor morphology were evaluated.
RESULTS: Local tumor control and transient swelling rates were 87% and 46%, respectively. Cystic tumors responded better than solid tumors to treatment as evidenced by volume reduction rates (87% vs. 58%), although local control rates were not significantly different (93% vs. 83%). Transient swelling rates were significantly higher in cystic tumors than in solid tumors (67% vs. 29%). Post-treatment volume changes were not correlated with gender, age group, or pre-procedural tumor volume.
DISCUSSION AND CONCLUSION: CyberKnife radiotherapy is an effective way of achieving local tumor control in patients with vestibular schwannomas. Although higher rates of volumetric regression would be expected in more cystic tumors than more solid tumors, local control rates are similar.

3.A new landmark for superior semicircular canal: Spine of Henle
Rasim Yılmazer, Ömer Erdur, Ayça Başkadem Yılmazer
doi: 10.5606/Tr-ENT.2019.24855  Pages 67 - 71
INTRODUCTION: In this study, we aimed to investigate whether the spine of Henle could a new landmark for the localization of the superior semicircular canal (SCC).
METHODS: Between March 2014 and March 2015, a total of 30 adult cadaveric temporal bones were used in this study. All temporal bones were positioned and, then, canal-wall up mastoidectomy and facial recess approach were performed. The landmarks such as sigmoid sinus (SS), middle cranial fossa dura (MCFD), posterior cranial fossa dura (PCFD), SCCs, short process of the incus, facial nerve (FN), and chorda tympani nerve were identified. The shortest distances between the spine of Henle and the following structures were measured: (i) superior SCC; (ii) lateral SCC; (iii) posterior SCC; (iv) MCFD; (v) PCFD; (vi) SS; and (vii) FN. All measurements were performed using a digital caliper.
RESULTS: After excluding three temporal bones with absent spine of Henle, 27 temporal bones were studied. The mean distances between the spine of Henle and the superior, lateral and posterior SCCs, MCFD, PCFD, SS, and FN were 20.3±2.4, 15.9±2.1, 17.8±2.0, 13.7±2.9, 19.0±2.7, 14.9±3.6, and 15.8±1.7 mm, respectively. The distances between the spine of Henle and superior SCC were higher in the temporal bones, while the distances between the spine of Henle and MCFD were higher than the mean values. Similar differences were found for the distances between the spine of Henle and the lateral and posterior SCCs and PCFD.
DISCUSSION AND CONCLUSION: Based on our study results, the spine of Henle can be used as a landmark for the localization of the superior SCC during mastoidectomy and superior SCC surgeries.

4.A comparison of voice analysis results according to localization of vocal polyps in the vocal folds
Saime Sağıroğlu, Nagihan Bilal, İsrafil Orhan
doi: 10.5606/Tr-ENT.2019.65375  Pages 72 - 78
INTRODUCTION: This study aims to analyze the differences in voice acoustic analysis according to the localization of polyps in the vocal fold.
METHODS: Between January 2017 and June 2018, a total of 52 patients (38 males, 14 females; mean age 40.5 years; range, 23 to 61 years) with a vocal polyp were retrospectively analyzed. The length of the vocal fold was measured and the location of lesions were classified as anterior, anterior-middle, and middle. Fundamental frequency (F0mean, F0min, F0max), jitter, shimmer, noise harmonic ratio (NHR), and maximum phonation time (MPT) were also recorded.
RESULTS: Vocal polyps were localized in the anterior in 12, in the anterior-middle in 16, and in the middle in 24 patients. In the intra-group analyses, MPT, F0min, and NHR were found to be statistically significant. According to the overall average, MPT in the anterior group, shimmer and NHR in the anterior-middle group, and F0mean and F0min values in the middle group were found to be significant.
DISCUSSION AND CONCLUSION: In vocal polyps, MPT was shorter in anterior lesions, the F0 mean value was high in middle lesions, and voice quality was more affected in the anterior-middle lesions, as the vocal fold vibration stability was disrupted and the noise parameter was high.

5.The outcome of intratympanic steroid therapy as a salvage treatment for sudden sensorineural hearing loss
Emel Tahir, Kemal Keseroglu, Serap Er, Bülent Öcal, Ali Özdek, İstemihan Akın, Ömer Bayır, Mehmet Hakan Korkmaz
doi: 10.5606/Tr-ENT.2019.43531  Pages 79 - 85
INTRODUCTION: The aim of this study is to evaluate the outcomes of intratympanic steroid (ITS) treatment for idiopathic sudden sensorineural hearing loss (SSNHL).
METHODS: Between January 2014 and November 2016, medical charts of a total of 63 patients (47 males, 16 females; mean age: 44.2±17.5 years; range, 18 to 77 years) who were hospitalized due to SSNHL were retrospectively analyzed. The patients were divided into two groups as those who received standard treatment (Group 1, n=32) and those who received ITS treatment as a salvage treatment (Group 2, n=31). Treatment modalities and the results of pure tone audiometry tests were recorded. Recovery was assessed according to the Furuhashi criteria.
RESULTS: There was no significant difference in the hearing recovery rates between Group 1 and Group 2. In the patients receiving standard treatment, the recovery rate was significant (78%), while it was only 35.4% in the patients receiving ITS treatment (p=0.361).
DISCUSSION AND CONCLUSION: Although recent guidelines strongly recommend ITS treatment, in our study, ITS, which was started on Day 5 of admission, was not found to be superior to standard systemic treatment.

6.Frontoanterior supracricoid laryngectomy with epiglottoplasty
Nermin Başerer
doi: 10.5606/Tr-ENT.2019.44154  Pages 86 - 93
INTRODUCTION: In this study, we aimed to investigate the efficacy and safety of a modified technique, namely frontoanterior supracricoid laryngectomy (FASCL) with epiglottoplasty.
METHODS: A total of eight male patients (mean age 55 years; range, 53 to 68 years) with glottic cordo-commissural cancer underwent FASCL with epiglottoplasty between 2007 and 2018. Oncologic safety was ensured through the whole thyroid cartilage resection in the form of supracricoid partial laryngectomy (SCPL). Early laryngeal rehabilitation was given to all patients postoperatively.
RESULTS: Five patients were in Stage T1a-b and three patients were in Stage T2. Five patients with Stage T1a-b cordo-commissural cancer underwent FASCL with bilateral cordectomy. The postoperative period was uneventfully in all patients with early decannulation and nasogastric tube removal took place on the second postoperativ day. Functional rehabilitation duration of Stage T2 cancer was slightly prolonged due to wider endolaryngeal resection. In three patients staged T2 cordocommisural cancer decannülation was performed after 4 days and nasogastric tube was removed within the first weak du to larger endolaryngeal tissu resection in this stage.
DISCUSSION AND CONCLUSION: Our study results suggest that this modified technique followed by early laryngeal rehabilitation yields satisfactory postoperative laryngeal functions. In the laryngeal reconstruction, preservation of the thyroid's external framework maintenance of laryngeal situation and glottic reconstruction play the most important rol for functional rehabilitation. Total resection of thyroid cartilage provide oncological safety of this technique. Removal of the thyroid cartilage resection does not cause any laryngeal functional rehabilitation problem in the neo larynx.

7.Comparison of graft success rate between cartilage and fascia in endoscopic tympanoplasty: Our long-term results
Kemal Keseroğlu, Gökhan Toptaş, Ömer Bayır, Sibel Alicura Tokgöz, Bülent Öcal, Cem Saka, İstemihan Akın, Ali Özdek
doi: 10.5606/Tr-ENT.2019.70883  Pages 94 - 99
INTRODUCTION: This study aims to present our long-term results of endoscopic tympanoplasty and to compare the perforation closure rates of cartilage grafts versus fascia grafts.
METHODS: A total of 112 ears of 103 patients (35 males, 68 females; mean age 33.6 years; range, 9 to 78 years) who underwent endoscopic tympanoplasty due to chronic otitis media between October 2011 and July 2014 were included in this retrospective study. The operations were divided into two groups according to the graft material type as the fascia group (n=43) and cartilage group (n=69). Demographic data of the patients and perforation closure rates according to the graft material type used were recorded.
RESULTS: The mean follow-up was 51.4 months. The graft intake rate of the cartilage and fascia groups were 89.8% and 90.7%, respectively (p=1.000). The overall perforation closure rate was found to be 90.2%.
DISCUSSION AND CONCLUSION: Endoscopic tympanoplasty is an effective and less invasive new surgical access technique in otology in which satisfactory results for graft intake rates can be achieved even in the beginning stage. The cartilage graft use in endoscopic tympanoplasty also yields similar and comparable anatomic success results with the fascia graft.

8.May zonula occludens proteins regulate the pathogenesis of allergic rhinitis?
Özge Yılmaz, Esra Toprak Kanık, Ercan Pınar, Ahmet Türkeli, Elgin Türköz Uluer, Sevinç İnan, Hasan Yüksel
doi: 10.5606/Tr-ENT.2019.64936  Pages 100 - 106
INTRODUCTION: This study aims to investigate the expression pattern of zonula occludens (ZO) proteins, namely occludin, claudin-1, tricellulin, junctional adhesion molecules (JAM), and ZO-1, -2, and -3 in nasal mucosal biopsies of individuals with and without allergic sensitization.
METHODS: Between August 2011 and August 2012, a total of 69 patients (38 males, 31 females; mean age 28.0 years, range, 18 to 61 years) who underwent surgery for nasal septum deviation were included in this cross-sectional study. All patients underwent skin prick test with environmental allergen mixtures. Cup forceps biopsy samples were obtained from the inferior turbinate during septoplasty. These samples were stained immunohistochemically for occludin, claudin-1, tricellulin, JAM, and ZOs. Staining intensity was graded semi-quantitatively using the H-Score.
RESULTS: Of all patients, 14 were atopic. Occludin, claudin-1, and JAM scores were significantly lower in the mucosal samples from atopic patients, compared to the non-atopic patients (median 142.5 vs. 288, 153 vs. 296, and 156 vs. 312, respectively; p<0.001 for all). The ZO-1, -2, and -3 proteins were significantly lower in atopic patients (p<0.001 for all). The tricellulin, located at the intersection of three epithelial cells, was not significantly different between the two groups (208.5 vs. 195, respectively; p=0.686).
DISCUSSION AND CONCLUSION: Expression of the structural proteins of ZO decreases in the upper airways of asymptomatic atopic patients. These findings indicate that ZO may be an important determinant of atopic sensitization and, therefore, may be a potential target in the treatment of allergic rhinitis.

CASE REPORTS
9.Isolated otolithic dysfunction and vestibular rehabilitation results: A case report
Oğuz Yılmaz, Şeyma Tuğba Öztürk, Mustafa Bülent Serbetçioglu
doi: 10.5606/Tr-ENT.2019.55264  Pages 107 - 110
A 33-year-old male patient presented with dizziness which increased with head movements like a self-reported sensation of walking-on-pillows. Routine test results were within the normal range. The vestibular evoked myogenic potentials (VEMP) results were unable to be obtained and the sensory organization test (SOT) score was 7%. The patient was given a six-week customized vestibular rehabilitation program. After his complaints alleviated, his SOT scores were improved and VEMP waves were able to be obtained. In conclusion, clinicians should keep in mind that some patients may present with isolated otolith dysfunction and customized vestibular rehabilitation may offer benefits to these patients.

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