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Objective: To evaluate the clinical and pathologic parameters associated with level IIb metastasis in transglottic laryngeal carcinoma. Methods: A total of 238 laryngeal squamous cell carcinoma patients admitted to our tertiary center and surgically treated between January 2006 and January 2014. Of these 238 patients, 134 patients with transglottic laryngeal SCC were enrolled in the study. The type of neck dissection, the location of histopathologically proven metastatic lymph nodes, clinical N and T stages were reviewed. Palpable lymph nodes were accepted clinically cN(+) and the opposite as cN(-). were as cN(+). Level IIb metastasis was diagnosed in 12 patients in the cN(+) group, and in two patients in the cN(-) group. Histopathological level IIb metastasis was shown in 14 of 134 patients, representing 16 of 268 neck dissection specimens. Level IIb metastasis was shown in the ipsilateral specimens in 12 patients and contralateral specimens in two patients. Forty-one of 134 patients presented cartilage invasion, and nine of them were diagnosed with level IIb metastasis. Conclusion: Thyroid cartilage invasion, the presence of level IIa invasion and advanced stage disease are the risk factors for level IIb metastasis. Therefore, level IIb should not be neglected during neck dissection in transglotticlaryngeal carcinoma. [ABSTRACT FROM AUTHOR]

Objective: To evaluate success of tympanoplasty type 1 in the treatment of patients with sclerotic mastoid bone. Methods: A retrospective study where 92 patients with noncholesteatomatous chronic suppurative otitis media were recruited during the period of 2010 to 2012. Patients were managed medically and after dryness of their perforations they were operated upon. Ninety-two patients underwent type 1 tympanoplasty alone without cortical mastoidectomy. Underlay technique with chondroperichondrial graft was performed for all patients. Results: Mean air-bone gap values were estimated and compared. In pre- and postoperative audiograms, air-bone gap values at 500, 1000, 2000 and 4000 Hz frequencies were determined. Pre- and postoperative mean air-bone gap values of the patients were 23.47±4.95 and 11.58±4.77 dB, respectively. Conclusion: Our study emphasizes the fact that overall satisfactory hearing outcome with adequate air-bone closure can be achieved irrespective of cortical mastoidectomy in the surgical treatment of noncomplicated chronic ear diseases. [ABSTRACT FROM AUTHOR]

The aim of this study was to introduce a new grafting technique in tympanoplasty that involves use of a boomerang-shaped chondroperichondrial graft (BSCPG). The anatomical and functional results were evaluated. A new tympanoplasty with boomerang-shaped chondroperichondrial graft (TwBSCPG) technique was used in 99 chronic otitis media patients with central or marginal perforation of the tympanic membrane and a normal middle ear mucosa. All 99 patients received chondroperichondrial cartilage grafts with a boomerang-shaped cartilage island left at the anterior and inferior parts. Postoperative follow-ups were conducted at months 1, 6, and 12. Preoperative and postoperative audiological examinations were performed and air-bone gaps were calculated according to the pure-tone averages (PTAs) of the patients. In the preoperative period, most (83.8 %) air-bone gaps were ≥16 dB; after operating using the TwBSCPG technique, the air-bone gaps decreased to 0-10 dB in most patients (77.8 %). In the TwBSCPG patients, the mean preoperative air-bone gap was 22.02 ± 6.74 dB SPL. Postoperatively, the mean postoperative air-bone gap was 8.70 ± 5.74 dB SPL. The TwBSCPG technique therefore decreased the postoperative air-bone gap compared to that preoperatively ( p = 0.000, z = −8.645). At the 1-month follow-up, there were six graft perforations and one graft retraction. At the 6-month follow-up, there were nine graft perforations and three graft retractions. At 12 months, there were seven graft perforations and four graft retractions. During the first year after the boomerang tympanoplasty surgery, graft lateralization was not detected in any patient. Retractions were grade 1 according to the Sade classification and were localized to the postero-superior quadrant of the tympanic membrane. The TwBSCPG technique has benefits with respect to postoperative anatomical and audiological results. It prevents perforation of the tympanic membrane at the anterior quadrant and avoids graft lateralization due to placement of the graft under the manubrium mallei. Given these benefits, the TwBSCPG technique seems to be a good alternative for grafting in tympanoplasties. [ABSTRACT FROM AUTHOR]

Objective: In the present study, thresholds of airway tone-burst auditory brainstem response (ABR), and pure-tone audiometry were compared, and correlations between threshold values obtained with classical audiometric methods, and pure-tone airway hearing in individuals with advanced, and very advanced sensorineural (S/N) hearing loss were investigated. Methods: Eighty patients with advanced and very advanced S/N hearing loss were included in the study. Pure-tone air conduction thresholds of advanced, and very advanced S/N hearing loss patients detected at 500, 2000 and 4000 Hz frequencies were compared with tone-burst ABR threshold values. Results: Our study population consisted of males with a mean age of 21.8±3.45. Mean differences between thresholds of tone-burst, and pure-tone audiometry were detected to be 4.75 dB, 6.25 dB, and 4.87 dB at stimulus frequencies of 500 Hz, 2000 Hz, and 4000 Hz, respectively. Conclusion: In conclusion, in patients with S/N hearing loss, a strong correlation is found between pure-tone audiometry thresholds, and electrophysiological thresholds obtained at 500, 2000, and 4000 Hz with tone-evoked ABR wave-V. Tone-ABR can be used as a reliable test in the diagnosis of patients with hearing loss in conditions where pure-audiometry cannot be performed. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: We investigated the outcomes of the endoscopic versus microscopic approach to type 1 tympanoplasty in pediatric patients. Methods: In this retrospective study, the outcomes of 61 ears of 60 pediatric patients (33 male and 27 female) who underwent type 1 tympanoplasty were evaluated. One patient underwent a bilateral operation. The age range of the patients was 7–16 years. Group 1 underwent tympanoplasty with an endoscopic technique (n =32), and Group 2 underwent tympanoplasty with the conventional microscopic technique (n =29). A boomerang-shaped chondroperichondrial graft was used in both groups. The outcomes were analyzed in terms of the hearing gain, duration of surgery, and graft success rate. Results: In both groups, the postoperative air–bone gap (ABG) was significantly lower than the preoperative ABG. There were no significant differences between the preoperative and postoperative ABG values (in dB) in either group. The mean operative duration in Group 1 was significantly lower than that in Group 2 (51.37 vs. 67.03min, respectively). In the preoperative evaluation, 65.6% of patients in Group 1 had larger perforations and 34.4% had smaller perforations. In Group 2, 58.6% and 41.3% of patients had larger and smaller perforations, respectively. Perforations were detected in two (6.25%), four (12.50%), and four (12.50%) of the patients in Group 1 at postoperative months 1, 6, and 12, respectively. Perforations were detected in two (5.71%) patients in Group 2 at postoperative months 1, 6, and 12. At 12 months postoperatively, there were smaller perforations in four (12.5%) of the children in Group 1 and in two (5.71%) of the children in Group 2. The difference between the perforation conditions (larger vs. smaller) was not significant in either group. The preoperative and postoperative increases in the ABG were associated. The operative duration was shorter in Group 1 than in Group 2. Conclusion: In pediatric patients undergoing type 1 tympanoplasty, especially if the external ear canal is narrow and the anterior canal wall is prominent, the endoscopic and microscopic approaches appear to give equal results in terms of easy visualization of the entire tympanic membrane and no requirement for extra intervention to evaluate the ossicular system. A shorter operative duration is an advantage of the endoscopic tympanoplasty technique. [Copyright &y& Elsevier]

Abstract: Objectives: This study investigated the effects of ascorbic acid and N-acetyl cysteine (NAC) antioxidants on the development of myringosclerosis (MS) in an experimental model. Methods: Myringotomies were performed in the ears of 15 guinea pigs, and Spongostan® pieces were placed on the perforated regions of the tympanic membrane. The subjects were divided randomly into three groups and treated with three different solutions on the Spongostan—group 1: (control, 0.9% saline), group 2 (ascorbic acid), and group 3 (NAC). On day 15 after treatment, specimens from the tympanic membranes were obtained and examined via light microscopy. Sclerosis and inflammation scores and the tympanic membrane thicknesses were evaluated. Immunohistochemical methods were used to evaluate the expression of VEGF, TGF-β, iNOS, and IL1-β in all groups. Results: Lower sclerosis and inflammation scores and reduced tympanic membrane thicknesses were observed in groups treated with NAC or ascorbic acid compared with the control group. Immunohistochemical studies revealed significantly less expression of VEGF, TGF-β, and iNOS in groups 2 and 3 compared with group 1. Additionally, IL1-β expression was significantly less in group 3 than in group 1. Compared with group 1, group 2 animals exhibited reduced inflammation in the lamina propria, fewer active fibroblasts, less leukocyte infiltration, and decreased thickness of the vessels; group 3 animals exhibited decreased numbers of active fibroblasts and collagen fibers in the lamina propria. Conclusions: Inflammation scores, cellular infiltration, and expression of VEGF, TGF-β, and iNOS were reduced by ascorbic acid and/or NAC treatments, thereby decreasing MS development. Decreased expression of IL1-β was observed only in animals treated with NAC. [Copyright &y& Elsevier]

Objective: To determine septal variations and rates of intrasinusal protrusions of optic nerve and internal carotid artery in sphenoid sinus. Methods: Retrospective analysis of spiral computed tomography scan-ning of paranasal sinuses of 218 patients diagnosed as acute/chronic sinusitis was performed. Bilateral sphenoid sinuses were evaluated as if a single sinus, septa of this sinus were evaluated in terms of number and configuration. Besides rates of optic nerve and internal carotid artery protrusions were determined. Results: A total of 5 types of septal variations were detected. A single complete septum (n=132; 60.5%), a single incomplete septum (n=66; 30.2%), double septum (complete + incomplete, n=6; 2.7%), two complete septa (n=9; 4.1%), and sphenoid sinuses without septum (n=5; 2.2%) were identified. Sixty-four percent of single septum was located in midline, while other types were found immediately right or left side of the midline. Besides, protrusions of optic nerve and inter-nal carotid artery were detected in 39 (17.8%) and 61 (27.9%) cases, respectively. Conclusion: Preoperative evaluation with computed tomography and surgical planning dependent on these findings are very important for endoscopic interventions and these approaches minimize potential major intraoperative complications. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Myringosclerosis (MS) is a pathological condition characterized by hyaline degeneration and calcification of the collagenous structure of the fibrotic layer of the tympanic membrane, which may develop after trauma, infection, or inflammation as myringotomy, insertion of a ventilation tube, or myringoplasty. The aim of our study was to both reveal and evaluate the impact of the factors that might be effective on the post-tympanoplasty development of myringosclerosis in the graft. MATERIALS and METHODS: In line with this objective, a total of 108 patients (44 males and 64 females) aged between 11 and 66 years (mean age, 29.5 years) who had undergone type 1 tympanoplasty (TP) with an intact canal wall technique and type 2 TP, followed up for an average of 38.8 months, were evaluated. In the presence of myringosclerosis, in consideration of the tympanic membrane (TM) quadrants involved, the influential factors were analyzed in our study, together with the development of myringosclerosis, including preoperative factors, such as the presence of myringosclerosis in the residual and also contralateral tympanic membrane, extent and location of the perforation, and perioperative factors, such as tympanosclerosis in the middle ear and mastoid cavity, cholesteatoma, granulation tissue, and type of the operation performed. For statistical analysis of data, independent samples t-test was used. RESULTS: Our study comprised 44 male and 64 female patients. Median postoperative follow-up period was estimated as 38.8 months. The rate of postoperative development of myringosclerosis in grafts was significantly higher in patients with already existing sclerotic foci in TM (p=0.001). The location of the perforation had no effect on the postoperative development of MS in the graft (p=0.521). No statistically significant difference was detected between the size of the perforation and formation of MS (p=0.581). Statistical analysis of both groups could not discern any significant intergroup difference as to the impact of the presence or absence of cholesteatoma on the development and extent of MS (p=0.604). Impact of tympanosclerosis on the postoperative development and extent of MS in the graft was significant (p=0.001). Presence or absence of granulation tissue on the development or extent of myringosclerosis was not detected (p=0.697). Myringosclerotic foci in the contralateral ears had a statistically significant effect on the postoperative development and extent of MS in the grafts (p=0.001). Type of surgery performed did not exert any significant effect on the development or extent of myringosclerosis (p=0.765). CONCLUSION: We have determined that the presence of myringosclerosis in the residual membrane and in the contralateral tympanic membrane and tympanosclerosis in the middle ear have a significant role in the development of postoperative myringosclerosis in the tympanic membrane, contrary to the type of the surgical intervention, location and extent of perforation, presence of cholesteatoma, and granulation tissue. [ABSTRACT FROM AUTHOR]

Objective: Tonsillectomies are the most frequently applied operations in the ENT practice. Even though different surgical tonsillectomy techniques have been used, bipolar cautery is the most frequently used one. Our aim was to compare postoperative bleeding rates, pain scores and recovery times in tonsillectomies performed by using bipolar cautery in Joules (1Watt·sec or Ws) calculated by multiplying Watts by the duration of cauterization. Methods: Adenotonsillectomy and tonsillectomy patients, admitted to the Department of otorhinolaryngology of Izmir Ataturk Training and Research Hospital and Mardin State Hospital, between January 2007 and December 2012 constituted the study group prospectively. The patients divided into 4 groups due to the energy they exposed. Results: Patients in Group 1 recovered most rapidly (mean recovery time, 13.9±1.8 days). Statistically significant results were obtained between Groups 1 and 4 and also Groups 2 and 4 when recovery times of the patient groups were evaluated with Bonferroni correction test. Conclusion: As a result, for hemostatic control, electrocauterization should be used at lower doses and short-term as possible so as to decrease frequency of bleeding episodes, alleviate postoperative pain and accelerate wound healing. [ABSTRACT FROM AUTHOR]

This study analyzed the ototoxic effects of boric acid solutions. Boric acid solutions have been used as otologic preparations for many years. Boric acid is commonly found in solutions prepared with alcohol or distilled water but can also be found in a powder form. These preparations are used for both their antiseptic and acidic qualities in external and middle ear infections. We investigated the ototoxic effect of boric acid solutions on guinea pigs. We are unaware of any similar, previously published study of this subject in English. The study was conducted on 28 young albino guinea pigs. Prior to application of the boric acid solution under general anesthesia, an Auditory Brainstem Response (ABRs) test was applied to the right ear of the guinea pigs. Following the test, a perforation was created on the tympanic membrane of the right ear of each guinea pig and small gelfoam pieces were inserted into the perforated area. Test solutions were administered to the middle ear for 10 days by means of a transcanal route. Fifteen days after inserting the gelfoams in all of the guinea pigs, we anasthesized the guinea pigs and removed the gelfoams from the perforated region of the ear and then performed an ABRs on each guinea pig. The ABRs were within the normal range before the applications. After the application, no significant changes were detected in the ABRs thresholds in neither the saline group nor the group administered boric acid and distilled water solution; however, significant changes were detected in the ABRs thresholds of the Gentamicine and boric acid and alcohol solution groups. We believe that a 4% boric acid solution prepared with distilled water can be a more reliable preparation than a 4% boric acid solution prepared with alcohol. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate how Rhinapi nasal spray affects symptoms of allergic rhinitis. Methods: In this prospective, multicenter, observational study, 10,000 patients (comprising 5028 males and 4972 females) exhibiting symptoms of allergic rhinitis (namely, nasal discharge, sneezing, nasal itching, and nasal obstruction) from different centers in different regions of Turkey were enrolled in the study between March 2022 and March 2023. All the patients wanted to participate in the study and were administered Rhinapi one puff to each nostril three times a day, for a period of 3 weeks. Total symptom scores, quality of life (QoL) scores, and otolaryngological examination scores were evaluated before and 3 weeks after treatment. Results: The scores for discharge from the nose, sneezing, nasal pruritus, and blockage of the nose all indicated improvement when compared to pre-medication and post-medication. This difference achieved statistical significance (P <.001). The mean total symptom score fell following treatment (P <.001): whilst the score was 11.09 ± 3.41 before administering Rhinapi; after administration, the average score was 6.23 ± 2.41. The mean QoL scores also altered after medication (P <.001), improving from a mean value of 6.44 ± 1.55 to a mean of 7.31 ± 1.24. Significant improvement was also noted in the scores for conchal color and degree of edema after the treatment had been administered (P <.001). Conclusion: The study demonstrates that Rhinapi nasal spray decreases total symptom scores, and results in improved QoL and otolaryngological examination scores. Propolis spray may be recommended for patients with allergic rhinitis alongside other treatments. [ABSTRACT FROM AUTHOR]

Objective: To report our experience about pedicled pectoralis major myocutaneous flap (PMMF) for the treatment of pharyngocutaneous fistula (PCF). Methods: Between June 2006 and September 2014, 202 consecutive total laryngectomies for laryngeal or hypopharyngeal squamous cell carcinoma were performed in our hospital. The medical records of the patients were retrospectively reviewed to document the development of a PCF. Results: PCF developed in 45 of 202 patients (22%) in the study group. Of these 45 patients, spontaneous closure with local wound care was achieved in 33 patients (73%). Remaining 12 patients required surgical closure with PMMF. Four of 12 patients (25%) had complications after surgical closure with PMMF. Radiotherapy had been performed before laryngectomy in 16 of 45 patients with PCF. Of these 16 patients who developed PCF and have had previous radiotherapy, spontaneous closure with local wound care was achieved in four cases, while PMMF was used in the remaining 12 cases. Conclusion: Pedicled pectoralis major myocutaneous flap is a good reconstructive option in the treatment of PCF formation following total laryngectomy surgery. [ABSTRACT FROM AUTHOR]

Objective: To investigate pre- and postoperative mucociliary clearance in patients with adenoid hypertrophy or combined with otitis media with effusion. Methods: Patients were divided into two groups: Group 1—patients with adenoid hypertrophy (AH), and Group 2—patients with AH and otitis media with effusion (AHOME). In all patients, AH size was recorded, and the Andersen saccharin and methylene blue tests were conducted before and 1 month after surgery to obtain mucociliary clearance time (MCT). Nasal cavity length was measured intraoperatively to establish mucociliary clearance velocity (MCV). Patients with allergic rhinitis, active infection, and history of nasal or ear surgery were excluded. Results: This study included 64 patients with a mean age of 8.34±2.98 years (range: 3–18 years). Pre- and postoperative MCT were 14.60±4.83 and 9.48±2.63min in Group 1 and 16.03±4.31 and 12.12±3.78min in Group 2, respectively. Pre- and postoperative MCV were 0.77±0.30 and 1.16±0.42mm/min in Group 1 and 0.67±0.16 and 0.89±0.28mm/min in Group 2, respectively. MCT and MCV were significantly improved postoperatively in both groups (p <0.001). In addition, the postoperative MCT and MCV of Group 1 were significantly better than those of Group 2 (p <0.001). Exposure to cigarette smoking and adenoid size had negative correlations with mucociliary clearance. Conclusions: Otitis media was associated with impaired mucociliary clearance and further studies should be performed to demonstrate the causes of this deficiency. [ABSTRACT FROM AUTHOR]

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]

The purpose of this report is to review the experience of our institution with conservative surgery for laryngeal cancer. In this retrospective study, a review was made of 85 patients treated with conservation surgery between 1998 and 2005. At least 2 years of follow-up period (mean 46.6 months) was achieved for all the patients. We evaluated age, tobacco and alcohol intake, T stage, histopathological differentiation and localization of tumor, subglottic extension, anterior commissure invasion, vocal cord mobility, surgical margins, type of surgery applied, and post-operative radiotherapy (pRT) applied. Local control and 2-year survival rates were estimated. We managed with horizontal, vertical, and horizontovertical laryngectomies in 55, 26, and 4 patients, respectively. 28 patients were scheduled to have pRT. The actuarial and overall local control rates were 82.4 and 94.1%, respectively. On univariable analysis, significant factors for increased recurrences were positive resection margins, low differentiation of tumor, alcohol consumption and incompletion of the planned pRT. The 2-year survival rate was 60 and 95.7% for patients with and without local recurrence, respectively. Conservation surgery is a safe procedure for laryngeal cancer in proper endications. [ABSTRACT FROM AUTHOR]

Wegener's granulomatosis is an idiopathic systemic disease characterized by necrotizing vasculitis with the formation of granulomatous lesions that involves the upper respiratory tract, the lungs and the kidneys. Limited forms of Wegener's granulamatosis confined to only head and neck are not rare where as it is unusual that the otologic symptoms are the primary manifestations of the disease. These patients can also be misdiagnosed as otitis media which can cause the deterioration of the disease. We presented here a patient admitted with bilateral otitis media and facial palsy as the first manifestation of Wegener's granulomatosis and was treated with antibiotics for nearly three months before the diagnosis. We conclude that early diagnosis of Wegener's granulomatosis requires a suspicion of the disease in the patients with otologic symptoms and/or facial paralysis if there is otitis media refractory to treatment. [ABSTRACT FROM AUTHOR]