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Conclusion: All patients treated with this new lateralization technique had a good quality of life and no dyspnea at rest or upon exertion. We believe that this technique is an important addition to the many surgical techniques for the treatment of bilateral vocal cord paralysis (BVCP). Objectives: Most techniques used in the treatment of BVCP result in a prolapse of the laryngeal soft tissues into the endolarynx owing to Bernoulli's principle. We have developed a new lateralization technique to more effectively prevent this prolapse. Methods: The lateralization was initially tested on six cadaver larynges before being performed in five clinical cases with BVCP, who suffered from dyspnea at rest. Average follow-up was 17.6 months. As in type 1 thyroplasty, a rectangular piece of cartilage was excised horizontally from the thyroid lamina and placed on the defect in the vertical plane. Then, the vocal and ventricular folds were lateralized with crossing sutures, particularly in the posterior region. Results: Dyspnea was eliminated postoperatively. All patients were successfully decannulated. Postoperative voice quality was socially acceptable. Airways were improved postoperatively, as evaluated via fiberoptic laryngoscopy and CT. The mean preoperative and postoperative rima openings were 1.3 mm (range 0.5--2.6) and 6.4 mm (range 3.4--8.1), respectively. [ABSTRACT FROM AUTHOR]

Tympanosclerosis is a sequel of chronic otitis media characterized by the deposition of calcareous plaques following hyaline degeneration in the fibrous layer of the tympanic membrane and inside middle ear mucosa. It usually results from prior middle ear infections. In this study, results of treatment and clinical findings of the patients with tympanosclerosis are presented. Our objective is to determine the changes in middle ear caused by tympanosclerosis and intervene in the more problematic zone and find out the more useful treatment protocol for patients. Preoperative features, middle ear findings detected during surgery and postoperative hearing levels of the patients who were operated in our clinic between January 1996 and June 2006 due to tympanosclerosis were evaluated. Surgical treatment was performed on a total of 37 patients including 25 females and 12 males between ages of 11 and 71. Preoperative tympanic membranes perforations were presented at a rate of 91% and average airway bone gap was 37.8 dB. Bilateral involvement was present in 59%. Conductive-type hearing loss was present at a rate of 81%, whereas mixed-type hearing existed at a rate of 19%. Sclerotic plaques were most commonly localized in the attic with a rate of 72%. Post-op outcome was found to be 27% in the patients with air bone gap between 0–20 dB. The best hearing result belonged to type 1 patients. Cases in which stapes footplate was fixated had the worst result in terms of hearing. Teflon piston was only applied in one patient. Our tympanoplasty success was found to be 67%. The most common treatment method of tympanosclerosis is surgery. Stapedectomy is recommended in surgery instead of mobilization techniques. However, there is often recurrence and there is no curative treatment. Therefore rehabilitation with hearing device can be preferred as an adjunct. In the recent experimental studies, good results with topical or systemic agents have also been promising. [ABSTRACT FROM AUTHOR]

Nasal breathing is completely ceased after total laryngectomy. This results in some structural changes in the nasal mucosa, which has been described in numerous studies. This study investigates the changes that appear in the paranasal sinus mucosa. Eight patients who had undergone total laryngectomy at least 1-year ago were enrolled. Under general anesthesia, maxillary sinuses were examined with an endoscope inserted through canine fossa. 1–2 mm mucosal tissues for biopsy were taken from posterior wall of the maxillary sinus. Specimens were evaluated under an electron microscope. Control tissues for biopsy were obtained from two patients who had been operated for other reasons and analyzed under transmission electron microscopy. Results showed that in the control specimens, the epithelial cells appeared normal under transmission electron microscopy. Samples taken from two larygectomees in their first postoperative year were also completely normal. Samples from other larygectomees demonstrated ciliary loss, abundant degenerative vacuoles in ciliated epithelial cells and detachments in the interepithelial junctional complexes. The intracellular respiratory mechanisms such as the mitochondria, golgi complex and endoplasmic reticulum cisternae, and the integrity of the cellular or the nuclear membrane were spared. We conclude that the cessation of nasal breathing resulted in degenerative changes that could be reversible in the transmission electron microscopic examination of maxillary sinus mucosa. These changes emerged after 2 years following total laryngectomy. Nevertheless, these changes did not have any negative influence on the clinical outcome in this group of patients. [ABSTRACT FROM AUTHOR]

If the jugular bulb normally surrounded by a bony layer in jugular fossa is anatomically over the inferior surface of the bony annulus, in the middle ear or over the basal turn of cochlea, it is then named as high jugular bulb (HJB). It may be dehiscent or aberrant. It is reported to occur in 5% of the temporal bone specimens. In accordance with the literature jugular bulb compression, jugular vein ligation and embolization are suggested in such cases. In both of the presented cases, there was bleeding from jugular bulb during surgery and jugular bulb was compressed with bone wax and Surgicel, but sigmoid sinus has been compressed after failure to stop bleeding through jugular bulb compression. Venous MR angiographies showed no flow in postoperative controls. Although it is very rarely seen clinically, we present two HJB cases and different treatment perspectives accompanied by literature. [ABSTRACT FROM AUTHOR]