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Background/aim Because of close relations to important anatomical structures such as cavernous sinus and optic nerve, sphenoid sinus variations must be well trained by the Otolaryngologist who has an interest in endoscopic sinus surgery. Newly defined sphenoseptal cell (SSC) is one of those variations that may lead to insufficient endoscopic sinus surgery outcomes if not defined preoperatively with imaging studies. The present study aimed to present the main characteristics of this special type of nasal cell. Materials and methods In this study 610 paranasal sinus CT scans were analyzed and reviewed retrospectively between May 2018 and December 2019. Also, endoscopic findings of SSC, that cause a surgical catastrophe in identifying skull base and sella are presented during transnasal transsphenoidal pituitary surgery. Results According to its definition and relation to the sphenoid sinus and the skull base, an SSC was seen in 21 scans of 610 patients (3.4%), 11 were women (55%) and 10 were men (45%). Conclusion Although an SCC is a rare variation of nasal air cells, preoperative diagnosis of this cell is of paramount importance in some patients during endoscopic transnasal surgery for the identification of skull base.

Objective: To reveal the incidence and predictive parameters of occult cervical lymph node metastasis (LNM) in patients with cN0 laryngeal squamous cell cancer (LSCC) who underwent surgery as definitive treatment. Methods: Patients with cN0 laryngeal cancer who had undergone elective neck dissection together with partial or total laryngectomy between January 2006 and November 2020 were retrospectively analyzed. Clinical and histopathologic predictors of occult metastasis were also analyzed. Follow-up data were used to obtain recurrence and survival analysis. Results: A total of 86 patients with a mean age of 62.5 years were included in the study. Occult LNM was detected in 15 (17.4%) patients. Tumor grade, pT stage, thyroid cartilage invasion, and extralaryngeal extension were found to predict occult neck metastasis in univariate analysis. The mean follow-up time was 60.7 months and in the survival/recurrence analysis, pT stage, tumor location, tumor grade, presence of occult metastasis, pre-epiglottic space involvement. and extralaryngeal extension were found to predict poorer outcome. Conclusion: Overall occult LNM is low (17.4%) in N0 laryngeal cancer, but the presence of LNM is a poor prognostic factor. Correct determination of the neck status and proper treatment is crucial. The incidence of LNM is very low in T1–T2 stages and well-differentiated tumors. The “wait and see” strategy may be applied in T1–T2 cases as well as selected T3 cases with well-differentiated tumors.

This study aimed to analyze laboratory and radiological imaging results in the prediction of treatment strategy in patients with deep neck infections. Eighty-three patients (55 (66.3%) men, mean age: 38.2±14.5 years) were included in the study. Patients were divided into three groups according to the treatment strategy: group 1 received only antibiotic treatment, group 2 underwent abscess drainage with needle puncture in addition to antibiotic treatment, and group 3 underwent surgical drainage with antibiotic treatment. Laboratory outcomes, imaging methods, duration of hospital stay, treatment strategy, and clinical outcomes were analyzed.According to the laboratory results, complete blood count values did not vary among the three groups, but C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values were higher in group 3 (p

Background/aim We aimed to revealthe incidence and predictive role of insulin resistance and distorted oral glucose tolerance test in nondiabetic patients withBell’s Palsy (BP). Materials and methods Eighty-sixpatients with BP and 28 control subjects; all with normal blood glucose levels and no history of diabetes, were enrolled in the study. We investigated insulin resistance (IR) in all subjects, in terms of HOMA-IR greater than 2.7. Sixty-two of the patients also underwent an oral glucose tolerance test (OGTT). Results The mean HOMA-IR value was significantly increased in patients, compared to the control group (3.2 vs 1.6; P < 0.01). IR was detected more in BP patients than in controls (P < 0.05). The patients with higher HOMA-IR values had more severe facial dysfunction at the initial presentation and complete recovery time took longer than the patients with normal HOMA-IR value (75 days vs 42 days; P < 0.05). Following a 2h-OGTT, impaired glucose tolerance and newly diagnosed DM were found in 60% of the patients. Recovery time was significantly longer in prediabetics and newly diagnosed diabetic patients than in patients with normal glycemia (68 days, 52 days, and 32 days, respectively; P < 0.01). Conclusion There is a strong linkage between HOMA-IR value and BP prognosis so HOMA-IR value may have a significant role of predicting BP prognosis at presentation.

To investigate the prognostic value of the magnetic resonance imaging in Bell's palsy patients.Patients who were diagnosed and treated with Bell's palsy between October 2013 and March 2016 retrospectively selected. House-Brackmann grades, pre- and post-treatment pure tone audiograms, stapedial reflexes were analyzed and magnetic resonance imaging (MRI) scans with gadolinium-based contrast agents were evaluated. Contrast-enhanced segments of the facial nerve were determined. MRI findings were compared statistically with pre- and post-treatment grade, recurrence rate of Bell's palsy, MRI scanning timing, presence of stapes reflexes and posttreatment recovery data.No significant correlation was observed between pretreatment House-Brackmann grades and enhancement (p0.05). Similarly, there was no significant correlation between clinical recovery and enhancement (p0.05). Also, no significant correlation was observed between MRI scanning time, the recurrence rate of Bell's palsy and MRI findings (p0.05). None of the MRIs showed neoplastic contrast enhancement.The routine use of the contrast-enhanced temporal MRI is not recommended in the diagnosis and monitoring of Bell's palsy patients, because the contrast enhancement pattern of the facial nerve has no effect on the prognosis of Bell's palsy. MRI should be used in cases that do not heal despite treatment, for the differential diagnosis of facial nerve tumors and in patients who are candidates for surgical decompression.

11th International Ear Nose Throat Diseases and Head and Neck Surgery Congress -- APR, 2014 -- -- Ankara, TURKEY, WOS: 000458367000031, PubMed: 30761884, Backround/aim: Papillary thyroid carcinomas (PTC) frequently metastasize to regional lymph nodes. Our purpose was to investigate the predictive role of tumor location for lymph node metastasis pattern in PTCs. Materials and methods: Medical records of 110 PTC patients were reviewed retrospectively. Tumor location was determined as upper, middle, and lower pole according to ultrasonography (USG) findings. The effects of age, sex, tumor size, and location on lymph node metastasis were investigated. Results: The series comprised 87% females (n = 96) and 13% males (n = 14). Forty-three patients had central neck metastasis (CNM) and 14 had lateral neck metastasis (LNM). Upper pole tumors (UPT) metastasized to the central neck (CN) at a lower rate (17.6%) than middle (40.0%) or lower (48.5%) poles overall (P = 0.104), while it was at a significantly lower rate (13.3%) in the PTC group (P < 0.05). UPTs (n = 17) metastasized to the lateral neck (LN) almost 2-fold more. It was observed that 3 of 4 UPTs spread directly to the LN without CNM. Conclusion: In our opinion, UPTs have propensity to demonstrate metastasis to LN rather than the CN in PTCs. Therefore, UPTs should be evaluated meticulously in terms of LNM. New studies could suggest that CN dissection is not performed for low-risk PTCs in UPTs.

Objectives To use multifrequency multicomponent tympanometry (MF-MCT) for evaluating the middle ear mechano-acoustics of children with a history of ventilation tube (VT) insertion and to determine the effects of tube insertion sequelae on middle ear function. Methods A prospective case-control study in a tertiary referral center involving 26 children (51 ears) aged 3–15 years. The children had undergone VT insertion surgery at least one-year previously and had no other known ear diseases. In addition, 13 age-matched healthy controls (26 ears) with no prior history of ear disease were included. The patients and control subjects underwent an otoscopic examination, standard 226 Hz tympanometry, and MF-MCT. Results In 13.7% of cases, the VT was still in place in the operated ears. Post-operative myringosclerosis and/or eardrum retraction were noticed in 30% of ears with intact tympanic membranes in the patient group. While patients exhibited a great variability of tympanometric types (with standard 226 Hz tympanometry and tympanometric patterns with 1000 Hz MF-MCT), all cases in the control group had type A tympanograms and 3B1G patterns. Conclusion The effects of VT treatment on the mechano-acoustics of the middle ear have been revealed in this study. It has also been determined that VT application may increase the mass effect on the middle ear functions, which can be detected in the tympanometric shape and pattern.

Background/aim To evaluate the clinical and histopathological effects of fetal brain tissue derived mesenchymal stem cells (FBTMSC) and fibrin glue (FG) on the facial nerve (FN) regeneration in rats with traumatic FN injury. Materials and methods Twenty-eight Sprague Dawley rats were included in the study and divided into 4 groups. Traumatic FN injury (FP) was created by a surgical clamp compression to the main trunk of left FN in all groups. In the control group (group 1) no treatment was applied, in group 2 (FBTMSC group) 2 × 106 FBTMSC was injected, in group 3 (FG group) only FG was applied, in group 4 (FBTMSC and FG groups) both FBTMSC and FG were applied to the injured section of the nerve. The FN functions were evaluated clinically, immediately after the procedure and at 3rd, 5th, and 8th weeks postoperatively. The FNs of all subjects were excised after the 8th week; then the rats were sacrificed. The presence of stem cells in the injured zone was assessed using bromo-deoxyuridine (BrdU), and apoptosis was determined by the TUNEL method. Results After the damage, total FP was observed in all subjects. Statistically significant functional improvement was observed in group 4 compared to all other groups (P < 0.005). TUNEL-positive cell count was statistically significantly higher in the control group than the other groups (P < 0.001). TUNEL-positive cell count was statistically significantly lower in group 4 than the other groups. The proportion of BrdU-stained cells in group 4 (5%) was higher than group 2 (2%). Conclusion Clinically and histopathologically FBTMSC applied with FG may play a promising role as a regenerative treatment in posttraumatic FP.

Acute suppurative thyroiditis is a very rare and life-threatening endocrine emergency. Thyrotoxicosis is a rare condition accompanying acute suppurative thyroiditis. While the majority of the cases in the literature are caused by different reasons, spontaneous development is very rare. We present a patient with acute suppurative thyroiditis who presented to our clinic with thyrotoxic findings, and we compared the case to the literature. A 31-year-old male patient was admitted to our clinic with a complaint of progressive neck pain, swelling and redness on midline neck, fever, and palpitations. On physical examination, swelling, redness and tenderness were detected on the neck region that was consistent with the thyroid location. He presented with tremor on the hands, tachycardia and agitation. Thyroid function tests were compatible with thyrotoxicosis, but there were findings supporting the presence of infection in biochemistry tests. On his radiological evaluations, a heterogeneous lesion divided with small septs was observed, with consolidation areas in the left thyroid lobe. In fine needle aspiration biopsy, 2mL of purulent fluid could be aspirated due to the presence of small, separated consolidation areas. He initiated on antibiotic therapy, propranolol, steroid and symptomatic treatment. Eikenella corrodens was detected on the culture antibiogram. Antibiotic therapy was continued for 14 days due to less symptoms and better biochemical values. After treatment, the patient had normal thyroid function, had relief of fever and redness of the neck, and was followed-up. It should be kept in mind that acute suppurative thyroiditis may develop spontaneously with the findings of thyrotoxicosis, with no risk factors.

Defects in mucosal healing after sinonasal surgery cause infection, scar formation causing obstruction, relapse of the disease within a shorter period and revision surgery. The present study aimed to create a functional ciliated epithelium using a stem cell and stem cell sheet of adipose tissue origin and to show such regeneration ultra-structurally on experimentally injured rabbit nasal epithelium. This was an experimental animal study and basic research. A total of 18 white New Zealand rabbits were divided into three groups. The medial wall of the maxillary sinus of the subjects was peeled off bilaterally. No additional procedure was applied to the subjects in Group 1. In Group 2, adipose tissue-derived mesenchymal stem cell was implanted on the wound edges of the subjects. In Group 3, a stem cell sheet of three layers was laid onto the defect area. All subjects were killed after 3 weeks. The presence of the stem cell stained with bromo-deoxyuridine was assessed with a light microscope, whereas cilia density, ciliated orientation and cilia structure were evaluated with a scanning electron microscope. Ciliary densities in Group 2 and Group 3 were statistically superior compared to the control group (p

Background/aim This study aims to determine the therapeutic superiority of the addition of intratympanic steroid or hyperbaric oxygen therapy to systemic steroid treatment in idiopathic sudden sensorineural hearing loss as initial treatment, and evaluate the long- term results of salvage treatment. Materials and methods This study was a retrospective clinical trial with a total of 96 patients with idiopathic sudden sensorineural hearing loss. Patients were divided into 3 groups. Group 1 (n: 32) received systemic steroid treatment. Group 2 (n: 32) received the Group 1 protocol plus intratympanic steroid treatment. Group 3 (n: 32) received the Group 1 protocol plus hyperbaric oxygen treatment. Pretreatment and postinitial audiologic evaluations were performed, and the hearing outcome was analyzed with Furuhashi criteria. All patients, except those who experienced total recovery after initial treatment, were directed to salvage treatment. Audiologic assessment was performed again after salvage treatment and a mean follow-up period of 36.5 months. Results Each group was homogenous according to demographics, audiologic data, and prognostic factors. There was no statistically significant difference in recovery and success rate within the 3 groups after initial treatment. (P: 0.66, P: 0.248, respectively). Successful results were obtained after salvage treatment in only 3 patients (5%). These patients received follow-up treatment at a mean of 36.5 months, but there was no spontaneous recovery after the end of salvage treatment. Conclusion The addition of intratympanic steroids or hyperbaric oxygen to systemic steroids caused no significant hearing improvement as the initial treatment of idiopathic sudden sensorineural hearing loss. The efficacy of salvage treatment was limited, and there was no spontaneous hearing improvement after the long-term follow-up.

Background: Head and neck paragangliomas are slowly growing benign tumors and they originate from specialized neural crest cells.Aims/objectives: This study aimed to express the safety of paragangl...

Giris: Aterosklerotik hastaliklar dunyada onemli bir morbidite ve mortalite nedenidir. Periferik arterlerde aterosklerotik degisiklikler sik rastlanmaktadir. Biz bu calismada alt ekstremitebilgisaraylitomografianjiografi (BTA) cekilen hastalarda iliak arter bifurkasyon seviyesinde plak dagilimlarini ve plaklarin yapisal ozelliklerini degerlendirmeyi amacladik. Gerec-Yontem: BTA cekilen ve iliakbifurkasyon seviyesinde plak saptanan 37 olgunun 67 alt ekstremitesiretrospektif olarak dahil edildi.Calismada elde edilen verilere ait betimsel degerler hasta sayisi, ortalama, standart sapma seklinde verildi. Kategorik veriler sayim ve yuzde olarak verildi. Bulgular: Ocak 2018-ocak 2019 tarihleri arasinda hastanemizde alt ekstremite BTA cekilen 37 olgunun 67 alt ekstremitesi retrospektif olarak calismaya dahil edildi. Iliak arter bifurkasyonunda en sik plak ana iliak arterlerde saptandi. Kadran olarak plaklar en sik olarak posterior kadran ikinci siklikta ise medial kadranda plak saptandi.Plaklar en sik olarak kalsiye idi. Yapi olarak ikinci siklikta mikst tip plak saptandi. Sonuc: Iliak arter bifurkasyonunda en sik plak ana iliak arterlerdedir. Kadran olarak plaklar en sik olarak posterior kadrandir.Plaklar en sik olarak kalsifiyedir.

IBCT technique should be preferred owing to its high graft survival rate and ABG gain. While no significant difference was found in middle ear pressures between ears that underwent IBCT and normal ears, compliance values were found to be decreased in patients undergoing IBCT. However, the lack of correlation between ABG gain and compliance values indicated that compliance increase had no effect on post-operative ABG results.The aim of the present study was to compare tympanometric and audiological parameters in patients undergoing inlay butterfly cartilage tympanoplasty (IBCT) with their normal ears and to determine their difference with normal ear tympanometric parameters.Overall, 25 patients that underwent an operation between August 2010-May 2014 were included in the present study. In 13 of these patients, the ear that did not undergo operation was normal. 0.5, 1, 2, 4 kHz pure sound average values, tympanometric measurements and compliance values of normal and operated ears were compared.The graft survival rate in patients was found to be 92%. Mean pre-operative air-bone gap (ABG) was 16.4 ± 5.4 in patients, while mean post-operative ABG was 10.9 ± 5.8, with a statistically significant difference (p = 0.001) While there was no significant difference between operated and normal ears of patients in terms of middle ear pressure (0.441), compliance values were significantly higher in normal ears than those in operated ears (0.032). When post-operative ABG gain was compared with compliance values, no significant correlation was found between ABG gain and compliance measurements (r = -0.025 and p = 0.936).

Dysphagia and pain are most common problems after soft palate surgery in obstructive sleep apnea (OSA) patients.The aim of this study was to compare the postoperative pain scores and presence of dysphagia in patients who underwent anterior palatoplasty (AP) or uvulopalatal flap (UPF) surgeries.In this prospective study, AP or UPF was performed on the patients with mild or moderate OSA. Daytime sleepiness of all patients was evaluated with Epworth sleepiness scale (ESS). Snoring, pain and dysphagia complaint of the patients was evaluated with visual analog scale (VAS).In both AP and UPF groups, VAS snoring and ESS scores decreased significantly after operation. VAS pain and dysphagia scores were determined to be significantly higher in UPF compared with the AP.Since the success rates of surgical interventions to the soft palate are similar, preferring surgical approaches with a less damage to the life quality of patients after operations is more rational. In this regard, AP, which is technically quite simple with a short operation time and fewer postoperative complaints affecting life quality such as pain or dysphagia may be preferred in selected patients with OSA.

Aim: The aim of this study was to investigate the relationship between tinnitus and the factors that cause the tendency to thrombosis in terms of gender.Material and Methods: Fifty-five consecutive patients who admitted to our clinic with the complaint of idiopathic subjective tinnitus were included in this study. Routine ENT (ear nose throat) examinations and pure tone audiometry test were performed. Prothrombin time (PT), partial thromboplastin time (PTT), total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, Triglycerides, antithrombin III (AT III), protein C, protein S, homocysteine, antiphospholipid and anticardiolipin antibodies were examined in blood samples of patients. Temporal bone magnetic resonance imaging (MRI) was performed all patients. The results of the patients were compared in terms of gender and age groups (40 age).Results: The study was completed with 47 patients. Twenty-four of the patients were female and 23 were male. Both genders groups were similar in terms of age and pure tone average. Antiphospholipid and anticardiyolipin antibodies (IgG and IgM) were found as negative in all patients. Homocysteine levels were found to be statistically significantly higher in males than females (p=0.015; respectively 13.38±5.98 µmol/L and 9.87±3.11 µmol/L). AT III and Protein S levels were lower in males than females although this difference was not statistically significant (respectively p=0.07 and p=0.08)Conclusion: In this study, an association was shown between hyperhomocysteinemia and tinnitus, especially in males. Keywords: Tinnitus; tinnitus of vascular origin; thrombosis; gender role.

Small interfering RNA (siRNA)-based gene silencing strategy has high potential on suppressing specific molecular targets, involved in cancer progression. However, the lack of an effective nanocarrier system that safely delivers siRNA to its target still limits the clinical applications of siRNA. This study aimed to develop albumin-sericin nanoparticles (Alb-Ser NPs) as a novel siRNA delivery system for laryngeal cancer treatment. Nanoparticle formulations composed of albumin and sericin at different ratios (1:1, 2:1, 1:2 w/w) were synthesized by desolvation method. The nanoparticles were modified with poly-L-lysine (PLL) for siRNA binding and decorated with hyaluronic acid (HA) to target laryngeal cancer cell line, Hep-2. HA/PLL/Alb-Ser NPs were individually loaded with siRNAs for casein kinase 2 (CK2), Absent, Small, or Homeotic-Like (ASH2L), and Cyclin D1 genes, which are overexpressed in Hep-2 cells. Downregulation of genes was confirmed by real-time PCR (RT-PCR). Size, morphological, and thermogravimetric characterizations revealed that Alb-Ser NPs having 2:1 (w/w) ratio are the most optimized formulation. Between 36.8 and 61.3% of siRNA entrapment efficiencies were achieved. HA/PLL-siRNA/Alb-Ser (2:1) NPs-mediated gene silencing resulted in a significant inhibition of cell growth and induction of apoptosis in cells. Our findings showed that HA/PLL/Alb-Ser (2:1) NPs were promising as a siRNA carrier.

Development of thyroid nodule during pregnancy is rare, however the cancer rate of this nodule is high. Herein, we present medical outcomes of three pregnant women who were operated with the diagnosis of differentiated thyroid carcinoma in the light of literature. As sonographic findings of three cases showed malignant characteristics, fine needle aspiration biopsy (FNAB) was performed. Cytological examination result was reported as papillary thyroid carcinoma (PTC). Surgery was performed in the second trimester in all cases. One case underwent total thyroidectomy with neck dissection at level III and VI and two cases underwent total thyroidectomy with neck dissection at level VI. Pathological examination result was also reported as PTC. Lymph node metastases in the dissected materials were detected. During the intraoperative and early postoperative period, no complications occurred and no findings of recurrence or residues were observed during one-year follow-up following surgery. In conclusion, as the first trimester has an increased risk of congenital malformations, elective surgery should be performed at the second trimester, if applicable. In pregnants with malignant sonographic features and PTC confirmed by FNAB, surgery can be applied safely by taking precautions during pre-/peri- and postoperative period. These patients should not be given premedication for anesthesia, should be properly positioned and teratogenic agents should be avoided. After surgery, mother and fetus should be monitored closely.

Objective:This study aimed to evaluate patients with tinnitus in terms of mean platelet volume and platelet distribution width, and to explore neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio, recently reported in the literature as being possible inflammation markers.Methods:This study comprised 64 tinnitus patients and 64 age-matched healthy controls. Statistical significance level was accepted as p < 0.05.Results:Mean platelet volume (t = 3.245, p = 0.002) and platelet distribution width (Z = 3.945, p < 0.001) were significantly higher in the patient group than the control group.Conclusion:The results suggest that a prothrombotic condition might play a role in the pathophysiology of tinnitus.

The aim of choanal atresia (CA) surgery is to achieve bilateral nasal patency. Among the different methods of CA repair, the endoscopic transnasal approach has gained recent popularity with the advent of endoscopic instruments and techniques. This article describes our experience regarding CA repair that was done either using or not using a stent in different periods of time in our department. Between February 2006 and February 2016, a total of 29 patients aged 2 days–53 years underwent endoscopic transnasal CA repair. While in early years stents were used to maintain nasal patency, since 2010, all cases were repaired endoscopically without stenting. Of the 29 patients, 8 were excluded because of inadequate follow-up data. The mean follow-up time for the remaining 21 patients after surgery averaged 53 months (range 12–111 months). Intranasal stents were used in 5 of 21 patients for 8 out of 32 operative sides. Of the 8 stented neochoanae, 6 (75%), restenosed at a mean time of 15.2 weeks (5–24). The restenosis rate was 25% (6/24 nasal sides) in 16 patients who underwent stentless repair. In unilateral CA, 2 of 10 (20%) patients underwent atresia repair using stents and only these cases restenosed after surgery in this group. Of the 11 patients with bilateral disease, 5 (45.4%) underwent revision surgeries. In the bilateral group, 2 of 3 (66.6%) stented patients required revision surgeries, whereas 3 of 8 (37.5%) patients who underwent stentless repair relapsed. In one patient, we have experienced an alar cartilage injury intraoperatively caused by drilling. The transnasal endoscopic repair has proved to be effective and yielded long-term satisfactory results. The use of stent seems to have no advantage over a stentless repair regarding maintenance of a patent nasal airway. Patients experienced restenosis more frequently with stenting.

Aim: We aimed to show the effectivity of chirp stimulus and to compare with tone-burst and click stimulus during ocular VEMP (oVEMP) and also to exhibit same stimulation response pattern in utricle as seen in cochlea. Material and Methods: A total of 85 healthy volunteers without any vestibular and otologic disease history were enrolled in this study. Three different types of air conduction stimuli (tone-burst, click and chirp) were used for the oVEMP test. N1, P1 latencies, N1P1 amplitudes and asymmetry ratios were investigated for each stimulus type according to age subgroups and sex.Results: The ratio of presence of oVEMP response was found to be 94.1%, 82.1% and 98.8% with tone-burst, click and chirp stimuli respectively. The latencies were significantly shorter in chirp stimulus with respect to others in both ears. The amplitudes were also significantly larger in chirp stimulus with respect to other in both ears. According to analysis of N1P1 asymmetry ratios, N1 and P1 latency asymmetry, there were no statistically significant difference in these values within each stimulus types.Conclusion: oVEMP is more practical, easier, faster and less invasive method. oVEMP results with chirp stimulus have shorter latency and higher amplitude and more clear waveform morphology with higher ratio of response when compared to click and tone-burst stimulus. As a result, chirp is a reliable and suitable stimulus type for oVEMP analysis. In the light of these unique results with chirp stimulus, utricular hair cells may have similar frequency specific tonotopic organization as seen in cochlea.

Background/aim: The aim of this study was to investigate alterations in voice parameters among patients using continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea syndrome. Materials and methods: Patients with an indication for CPAP treatment without any voice problems and with normal laryngeal findings were included and voice parameters were evaluated before and 1 and 6 months after CPAP. Videolaryngostroboscopic findings, a self-rated scale (Voice Handicap Index-10, VHI-10), perceptual voice quality assessment (GRBAS: grade, roughness, breathiness, asthenia, strain), and acoustic parameters were compared. Results: Data from 70 subjects (48 men and 22 women) with a mean age of 44.2 ± 6.0 years were evaluated. When compared with the pre-CPAP treatment period, there was a significant increase in the VHI-10 score after 1 month of treatment and in VHI- 10 and total GRBAS scores, jitter percent (P = 0.01), shimmer percent, noise-to-harmonic ratio, and voice turbulence index after 6 months of treatment. Vague negative effects on voice parameters after the first month of CPAP treatment became more evident after 6 months. Conclusion: We demonstrated nonsevere alterations in the voice quality of patients under CPAP treatment. Given that CPAP is a long-term treatment it is important to keep these alterations in mind.

Nasal gliomas are rarely seen, congenital, benign and nonhereditary lesions. These are not true tumors that occur due to extradural malposition of ectopic glial tissue during embryologic development. These are generally diagnosed during childbirth and may have an intracranial extension with fibrous stalk. Treatment of these masses that cause nasal obstruction and cosmetic deformity according to location, is total excision. In this case report, we present an extranasal glioma case whose surgery was done when she was 11 days old. Nasal gliomas are congenital midline lesions in the newborn period and it is necessary to be careful in differential diagnosis and during surgery due to possible intracranial extension.

Thyroidectomy has been used for the treatment of thyroid disease for more than 100 years. In spite of the advancement of surgical techniques, there is still a risk of laryngeal nerve injury. The risk of partial or complete injury still depends on some surgical and disease-related factors. The aim of this study is to show the partial injury and to establish these risk factors via laryngeal electromyographic analysis (LEMG) in postthyroidectomy patients with normal vocal cord motion and mucosal anatomy. Patients who had undergone thyroid surgery were enrolled in this prospective study. LEMG analysis was performed to all patients with normal vocal cord mobility preoperatively and was repeated after the first and the third months of surgery. Thyroarytenoid (TA) and cricothyroid (CT) muscles were used to evaluate recurrent and external branch of superior laryngeal nerves, respectively. Four of the 32 patients had mild-to-moderate degrees of partial LEMG changes during preoperative LEMG analysis of TA and CT muscles on each side. After 3 months of surgery, there was a statistically significant worsening of LEMG findings in the right and left external branches of superior and left recurrent laryngeal nerves. Disease and surgery-related risk factors were analyzed. However, there was no significant relationship on the progression of LEMG findings according to these parameters. This is the first prospective study which supports the risk of progression of LEMG changes in patients with normal laryngoscopic examination after thyroid surgery. No reliable significant risk factor was found influencing the LEMG progression.

The following study has been carried out to compare the effectiveness of logon and tone burst acoustic stimulation to elicit vestibular evoked myogenic potential (VEMP) responses. The methods and the subjects include 31 healthy adult volunteers (62 ears) who were enrolled in this study. Two different acoustic stimuli, logon (L-VEMP) and tone burst (T-VEMP), were used to elicit VEMP responses in each subject. Bilateral recordings with simultaneous binaural acoustic stimulations were used during VEMP recordings. During the recording period, the subjects were in supine position with their head elevated. The results observed were that the response rate of p1n1 wave was 91.9% for L-VEMP and 88.7% for T-VEMP. The response rate of n2p2 wave was 80.6% for L-VEMP, and 75.8% for T-VEMP. There were no significant differences between the two groups with respect to the latencies of p1, n1, n2 and p2, p1n1 and n2p2 interval, and p1n1 and n2p2 amplitude. The conclusion was that there was no difference between logon and tone burst stimulation with respect to VEMP response rates and VEMP parameters. Therefore, they are not superior to each other.

Aim: This study aimed to evaluate the alterations in the nasal flora in patients who underwent endoscopic endonasal surgery for chronic rhinosinusitis with nasal polyps (CRSwNP). Material and Methods: This prospective study included 30 patients diagnosed with CRSwNP who were resistant to medical treatment and recommended for surgery. The nasal cavity was sampled two times, first preoperatively on the day of operation and postoperatively in the 4th week. Patients were divided into two groups according to their culture results, including normal flora bacteria and potential pathogen production. Results: In the preoperative swab samples, 3 (11.1%) patients had no bacterial growth, 16 (59.3%) patients had a normal flora, and potential pathogens were detected in 8 (29.6%) patients. However, postoperatively, 3 (11.1%) patients had no bacterial growth, 13 (48.1%) patients had a normal flora, and potential pathogens were detected in 11 (40.7%) patients during the postoperative period. No significant difference was found between preoperative and postoperative culture results in terms of the number of patients with normal flora, potential pathogens, and no bacterial growth (p=0.676). The most common microorganism in the normal flora group preoperative and postoperative period was coagulase-negative Staphylococcus (77.8%, 51.9%, respectively), and the most common microorganism in the potential pathogen group was Staphylococcus aureus (18.5% and 25.9%, respectively). Comparing preoperative and postoperative culture results according to isolated potential pathogen microorganism types, no statistically significant difference was observed for any microorganism in the potential pathogen group (p>0.05).Conclusion: As a result, no correlation between nasal polyps’ surgery and potential pathogens was detected. Keywords: Chronic rhinosinusitis; culture; nasal polyps; flora; potential pathogens; bacteria; Staphylococcus aureus; coagulase; transnasal endoscopic surgery; pseodomanas.

The aims of this study are to reveal patient compliance and satisfaction in hearing aid-prescribed adult population and to determine the relevant clinical factors. The study was designed retrospectively, and those patients who have been using hearing aid for at least 6 months were invited for evaluation. Demographical data, hearing aid type (digital vs analog), general satisfaction, and daily usage time were asked. Then, the Hearing Aid Satisfaction Questionnaire (HASQ) was applied to all patients which included visual analog scale (VAS)-based 10 questions about the effects of hearing aid on social communication, efficiency, cosmetics, life quality and cost. Totally 400 patients were included in the study. The HASQ was confirmed to be highly reliable by "Kaiser Meyer Olkin and Bartlett Sphericity" tests after exclusion of aid-cost question. There was a negative correlation between age and satisfaction, and a positive correlation between hearing aid usage time (years) and satisfaction (p

Atrophic rhinitis is a chronic inflammatory disease characterized by progressive atrophy of nasal mucosa. Cedecea davisae, a rare pathogen, is a new member of Enterobacteriaceae family. In this article, we report a patient with atrophic rhinitis whose culture test revealed Cedecea davisae. The patient was operated due to accompanying posterior ethmoid mucocele. Levofloxacin and nasal irrigation were administered for two months. Significant improvement was observed in patient's complaints and nasal signs at postoperative sixth month. In conclusion, Cedecea davisae has been thought to cause atrophic rhinitis and mucocele in this patient. Patient recovered with simple treatment. These bacteria should be kept in mind as a causative agent for atrophic rhinitis.

Kimura's disease is a rare chronic inflammatory disorder with an unknown etiology which presents with the involvements of salivary glands and subdermal tissue in the head or neck region, in particular. Besides the most common manifestations of the disease; as the involvements of preauricular region, submandibular region, cervical lymph nodes and major salivary glands, nephrotic syndrome, as an additional systemic pathology, may be also seen due to glomerulonephritis. The differential diagnosis is made with the identification of characteristic histological features as follicular hyperplasia, eosinophil infiltration, and proliferation of the postcapillary venules. Although Kimura's disease may occasionally resemble angiolymphoid hyperplasia with eosinophilia, both have different clinical and histological features. In this case report, we discuss the clinical, histopathological features and treatment of a 57-year-old male patient admitted with a slowly progressing mass in his right buccal region for almost two years, which was approximately 3x3 cm in diameter and soft to palpation, and was excised completely by an intraoral approach and reported histopathologically as Kimura's disease in the light of literature.

Conclusion: This method is an easy, non-expensive, and effective technique in bilateral vocal cord paralysis to improve glottic airway and clinical performance. Objective: To evaluate the effectiveness of ‘suture arytenoid laterofixation’ surgery in bilateral vocal cord paralysis. Materials and methods: A retrospective analysis of patients’ medical history undergoing ‘suture arytenoid laterofixation’ surgery for bilateral vocal cord paralysis. This technique was applied under general anesthesia with both microlaryngoscopy and video-monitoring. Two 16 g needles and one 1/0 nylon thread were used for the procedure with 1 cm skin incision; no tracheotomy or tissue excision was required. Pre–post-operative photographs of the glottic region were taken from the endoscopic records, and the areas of rima glottis openings were calculated with the Image-J programme. Results: Forty-seven patients were analyzed. The mean pre–post-operative rima glottis areas were 1.11 ± 0.56 and 2.24 ± 0.93 mm 2 , respectively (p < 0.001). Five patients with previous tracheotomy were decannulated within a few days after the operation. In three patients, mild complications developed in the early post-operative period (two laryngeal edemas, one submucosal hematoma). Tracheotomy was performed to only one pregnant patient in the post-operative first day. None of the patients had granulation formation or synechia.

Objective: In this study, we aimed to investigate the effect of variations in renal pelvic angle on urinary calculi development. Materials and methods: A total of 2456 unenhanced abdominal CT scans were retrospectively evaluated and 262 kidneys of 131 patients were compared. Patients included in this study were identified and qualified as follows: Having unilateral calculi, having no calculi or a history of calculi in contra-lateral side and having totally normal renal morphology. Results: The mean angle of kidneys with calculi was 55 ± 9°, while the average angle measurement was 61 ± 11° in kidneys without calculi. The mean angle measured from the kidneys with calculi was statistically smaller (p < 0.001). Conclusion: Our study suggests that the possibility of calculi development in kidneys, which have more anteriorly localized pelvic angulation tends to be significantly higher in individuals, who did not have any congenital or acquired renal pathology before. © 2015 © 2015 Taylor & Francis.

OBJECTIVES This study aims to report our experience on surgical repair of nasal septal perforations (NSP) using bilateral intranasal advancement/rotation flaps with open septoplasty technique. PATIENTS AND METHODS Medical records of 28 consecutive patients who were operated for NSP in our clinic between January 2009 and February 2013 were retrospectively analyzed. Demographic features of the patients and surgical results were evaluated. RESULTS The most common cause of NSP was previous septal surgery in 18 (64%) of the patients. Nasal crusting was the most common symptom in 21 patients (75%). Perforation size ranged from 10 to 30 mm in diameter. Septoplasty was performed in five patients, while septorhinoplasty was performed in three patients simultaneously to the NSP repair. Nasal septal cartilage and auricular chonchal cartilage were used to support the nasoseptal skeleton, if required. There were no major intra- or postoperative complications. The mean postoperative follow-up period was 23 months. During follow-up, there was mild columellar retraction in five patients (18%). Nasal septal perforation was closed successfully in 24 patients (86%). Pinpoint perforation remained in two patients and perforation size was smaller than 5 mm in two patients. CONCLUSION Closing the NSP with bilateral intranasal advancement/rotation flaps has a comparable high success rate. Therefore, this technique can be easily applied to small-medium sized septal perforations.

Spontaneous splenic artery aneurysm (SAA) is a rare but a lifethreatening condition. Thus, early diagnoses may increase the chance of survival. A 52-year-old female patient was admitted to the emergency department with a pain that starts from the chest and epigastric region and radiates to back and left arm. The patient prediagnosed as having acute myocardial infarct and was under observation when acute abdomen and hemorrhagic shock developed. After further investigation, the patient was diagnosed as having SAA and has undergone a successful surgery. The patient was fully cured and discharged from the hospital on the seventh postoperative day. The patient originally presented with SAA, although she was primarily observed in the emergency department with acute myocardial infarct diagnosis because of similar symptoms and clinical findings to cardiovascular diseases. When changes in the clinical picture occurred, the patient was reevaluated and had undergone an operation because of SAA rupture. Therefore, physicians should take into consideration of aneurysm rupture in the differential diagnosis of the cardiovascular conditions; otherwise, the patient may lose his/her life. © 2014 Elsevier Inc.

The objective of this study is to compare pure tone audiometry and auditory steady-state response (ASSR) thresholds in normal hearing (NH) subjects and subjects with hearing loss. This study involved 23 NH adults and 38 adults with hearing loss (HI). After detection of behavioral thresholds (BHT) with pure tone audiometry, each subject was tested for ASSR responses in the same day. Only one ear was tested for each subject. The mean pure tone average was 9 ± 4 dB for NH group and 57 ± 14 for HI group. There was a very strong correlation between BHT and ASSR measurements in HI group. However, the correlation was weaker in the NH group. The mean differences of pure tone average of four frequencies (0.5, 1, 2, and 4 kHz) and ASSR threshold average of same frequencies were 13 ± 6 dB in NH group and 7 ± 5 dB in HI group and the difference was significant (P = 0.01). It was found that 86% of threshold difference values were less than 20 dB in NH group and 92% of threshold difference values were less than 20 dB in HI group. In conclusion, ASSR thresholds can be used to predict the configuration of pure tone audiometry. Results are more accurate in HI group than NH group. Although ASSR can be used in cochlear implant decision-making process, findings do not permit the utilization of the test for medico-legal reasons.

Acute appendicitis, which requires immediate surgical intervention, is an important diagnosis in patients with acute abdomen. However, developmental abnormalities may interfere with the preoperative diagnosis and surgical treatment in some cases. Agenesis and atresia of the cecal vermiform appendix is an extremely rare clinical diagnosis. In addition, preoperative diagnosis may be difficult in some cases. Thus, diagnosis of the congenital absence of the vermiform appendix requires a thorough exploration of the retrocecal and ileocecal regions. A 59-year-old male was admitted from the emergency services with right lower abdominal pain. A celiotomy was performed with the suspicion of acute appendicitis. However, an atresia of the vermiform appendix was observed. The patient's appendix was thus removed. Pathological examination confirmed suppurative appendicitis. This case underlines the importance of the clinical entity for surgeons who may deal with a similar case. © 2013 Baishideng. All rights reserved.