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Boomerang-shaped vs. shield-shaped chondroperichondrial cartilage grafts for type 1 tympanoplasty in children: A study of 121 patients

November 3, 2017  |  Can Ozbay, MD; Fatih Kemal Soy, MD; Erkan Kulduk, MD; Riza Dundar, MD; Ahmet Yukkaldiran, MD; Osman Kadir Guler, MD; Ertan Koc


Many techniques and graft materials have been used for the reconstruction of the tympanic membrane. We conducted a retrospective study to compare anatomic and functional outcomes of type 1 tympanoplasty that we performed with boomerang-shaped chondroperichondrial cartilage grafts (BSGs) and shield-shaped chondroperichondrial cartilage grafts (SSGs) in pediatric patients. Our study population was made up 121 patients-61 boys and 60 girls, aged 7 to 16 years (mean: 12.4)-who had undergone a type 1 tympanoplasty. Patients were divided into two groups according to the grafting technique used; there were 59 patients in the BSG group and 62 patients in the SSG group. Ear examinations were performed at postoperative months 3, 6, 12, and 24, and pure-tone average (PTA) for air-conduction threshold values and air-bone gaps (ABGs) were evaluated at 0.5, 1.0, 2.0, and 4.0 kHz at the same visits. We also investigated the impact of the graft material on functional graft success and intergroup differences (if any) in surgical success. Mean postoperative follow-up periods were 30.5 and 30.2 months in the BSG and SSG groups, respectively. We found that the success rates for tympanic membrane reconstruction were not significantly different in the two groups (91.5 and 88.7%). Postoperatively, the mean PTA and ABG values in both groups at 3, 6, 12, and 24 months were significantly lower than the preoperative values (p < 0.05). There were no significant differences in mean PTA values between the two groups at 3, 6, 12, and 24 months. However, the extent of the decrease in PTA values in the BSG group at 3 months was significantly greater than that of the SSG group (p < 0.05). There were no significant differences in mean ABG values between the two groups at 3, 6, and 12 months, but at 24 months, the value was significantly higher in the BSG group (p < 0.05). Finally, the extent of the decrease in ABG in the BSG group at both 3 and 6 months was significantly greater than that of the SSG group (p < 0.05). We conclude that the BSG procedure is a reliable and safe method of performing pediatric tympanoplasty.

Olfactory dysfunction in beta-thalassemia major patients treated with iron-chelating agents

November 3, 2017  |  Serhan Derin, MD; Selvet Erdogan, MD; Murat Sahan, MD; Mehmet Fatih Azik, MD; Hatice Derin, MD; Yasar Topal, MD; Hatice Topal, MD


Ocular and ophthalmologic adverse effects may occur in patients with β-thalassemia major (BTM) treated regularly with blood transfusions and iron-chelating agents. We hypothesized that olfactory dysfunction may be present in this patient population. We aimed to investigate olfactory dysfunction in patients with BTM and to determine etiologic factors. A total of 43 patients with BTM were included in the study. Forty-three subjects without nasal complaints, history of facial trauma, or nasal surgery were included as the controls. All participants had nasal endoscopy. The use of iron-chelating agents by patients with BTM and their duration of use were recorded, as well as hemoglobin and ferritin levels. The Sniffin' Sticks test (SST) was used to assess olfactory function, comparing results between the BTM and control groups. The correlations of SST scores with the other study parameters were analyzed. Eight (18.6%) of 43 patients in the BTM group and none of the subjects in the control group had hyposmia (p < 0.001). Older age, low hemoglobin level, and longer use of deferoxamine were found to be correlated with olfactory dysfunction. Olfactory dysfunction can occur in patients with BTM treated with iron-chelating agents. The results suggest that screening for olfactory function should be part of the routine follow-up of patients with BTM.

Managing head and neck malignancy arising in a field of Crohn disease inflammation: Report of a case

November 3, 2017  |  Christina Yver, MD, MBA; Darshana Jhala, MD; Amanda Muir, MD; Devraj Basu, MD, PhD


Some of the clinical characteristics of Crohn disease of the head and neck overlap those of squamous cell carcinoma of the head and neck. We describe the diagnostic and therapeutic complexities we encountered in an unusual case of piriform sinus cancer that had arisen in a field of pharyngeal Crohn disease. Based on our initial failure to recognize the predominant inflammatory component of the lesion, we discuss the special considerations that must be made for the detection, staging, and management of head and neck cancer in Crohn disease patients. We further describe the multiple potential interactions among smoking, inflammation, and immunosuppression therapy in the colocalized pathogenesis of the two disease states.

Nasal smear eosinophils and allergic rhinitis

November 3, 2017  |  Indranil Pal, MS; Anindita Sinha Babu, MD; Indranil Halder, MD; Saumitra Kumar, MS


Our aim was to find out the association between nasal smear eosinophil count and allergic rhinitis (AR) and to determine a cutoff value that is significant for a diagnosis of AR. We also wanted to determine whether this count is related to the predominant symptoms, duration, or type and severity of AR, or to the presence of coexisting asthma. We selected 100 patients with a clinical diagnosis of allergic rhinitis across all age groups and an equal number of age- and sex-matched controls for the study. Their nasal smear eosinophil counts were recorded in terms of the number of eosinophils per high-power field (HPF). All patients were then clinically assessed for asthma and underwent spirometry. The data were recorded and appropriate statistical analysis done. The difference in the mean eosinophil counts of patients with AR and controls was found to be statistically significant (p = 0.000). A nasal smear eosinophil count of >0.3 per HPF had a 100% specificity and a 100% positive predictive value for AR. Asthma was associated with allergic rhinitis in 40% of patients; an association was not found between nasal smear eosinophil count and the symptoms, duration, type, and severity of allergic rhinitis or coexistent asthma. We conclude that an eosinophil count of >0.3 per HPF in nasal smears is a highly specific criterion for the diagnosis of AR. However, nasal smear eosinophil counts are poor indicators of the degree, duration, or type of upper or associated lower airway inflammation due to allergy.

Measles: A missed cause of acute tonsillitis

November 3, 2017  |  Wen-Sen Lai, MD; Yuan-Yung Lin, MD; Chih-Hung Wang, MD, PhD; Hsin-Chien Chen, MD, PhD

Although widespread measles vaccinations have resulted in a low incidence of measles in developed countries, clinicians should keep in mind the possibility of measles in patients with Koplik spots and acute tonsillitis.

Acrokeratosis paraneoplastica (Bazex syndrome)

November 3, 2017  |  Jerome R. Lechien, MD, PhD, MS; Mohamad Khalife, MD; Sven Saussez, MD, PhD

The first stage of acrokeratosis paraneoplastica involves symmetrical lesions in the ears, nose, and fingers.

Correlation between sensorineural hearing loss and chronic otorrhea

November 3, 2017  |  Fernanda Martinho Dobrianskyj, MS; Isis Rocha Dias Goncalves, DO; Yumi Tamaoki, DO; Edson Ibrahim Mitre, MD; Fernando A. Quintanilha Ribeiro, PhD


Many studies have attempted to correlate chronic otorrhea in children and in adults with the sensorineural hearing loss in the affected ear, with contradictory results. This loss might be the result of the likely toxicity of the bacteria involved, effects of inflammatory cytokines, or constant use of ototoxic antibiotics. All studies evaluated to date compared the affected ear with the normal contralateral ear. From the digitized archive of otologic surgery files of the Department of Otorhinolaryngology at Santa Casa de São Paulo School of Medical Sciences, the ears of patients with chronic otorrhea were evaluated visually and compared with the normal contralateral ears. Ears with otorrhea were also compared with ears of other patients with dry tympanic perforation. Ears with suppuration were evaluated for cholesteatoma. The duration of otorrhea was considered. The sensorineural hearing threshold was evaluated for the frequencies of 500, 1,000, 2,000, and 4,000 Hz. A total of 98 patients with chronic otorrhea and 60 with dry tympanic membrane perforation were evaluated. A correlation between sensorineural hearing loss and chronic otorrhea was observed when compared with both contralateral normal ears and dry perforated ears of other patients. No relationship between hearing loss and the duration of suppuration or cholesteatoma was found. Sensorineural hearing loss occurs in ears with chronic otorrhea. The duration of otorrhea and the etiology of suppuration did not influence the hearing loss.

Pediatric sinonasal desmoid tumor

November 3, 2017  |  Jonathan Choi, MD; Evan Walgama, MD; John McClay, MD; Pete S. Batra, MD, FACS; Ron B. Mitchell, MD

Desmoid-type fibromatosis is clinically characterized by a tendency for local recurrence but no metastatic potential.

Metal detection tests: Preventive tools for "Fiddler's Neck"

November 3, 2017  |  Brittanya A. Limone, MA, BS; Jacqueline Chen, BS; Sharon E. Jacob, MD

Markers of proliferation and cytokeratins in the differential diagnosis of jaw cysts

September 18, 2017  |  Nikola D. Zivkovic, PhD; Dragan S. Mihailovic, PhD; Milos S. Kostic, PhD; Ana S. Cvetanovic, MD; Zaklina Z. Mijovic, PhD; Maja V. Jovicic Milentijevic, PhD; Tijana V. Dencic, MD