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BACKGROUND: In the treatment of early stage laryngeal cancers, surgery (transoral laryngeal surgery (TOLS), open partial laryngeal surgery (OPLS) and radiotherapy (RT) are used. OBJECTIVES: Compare the oncological results of patients with early stage laryngeal squamous cell carcinoma (LSCC) treated with TOLS or RT. DESIGN: Retrospective SETTINGS: Tertiary training and research hospital PATIENTS AND METHODS: The participants were divided into patients who underwent TOLS and RT treatment. The groups were compared with each other in terms of local recurrence, regional recurrence, distant metastasis, 3 and 5-year overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS) and laryngectomy-free survival rates (LFS). MAIN OUTCOME MEASURES: The effects of TOLS and RT treatment on local control, regional control, OS, DFS, DDS and LFS in early stage laryngeal cancers. SAMPLE SIZE: 261 RESULTS: The mean follow-up time was 48 (26) months. There were 186 patients who underwent TOLS and 75 patients who underwent RT treatment. Gender, cigarette/alcohol consumption, tumor localization, anterior commissure involvement, tumor grades, recurrence rates and recurrence localizations of the groups were similar. The 5-year overall, disease specific, disease free and laryngectomy-free survival rates were 85.9%, 88%, 79.4%, 96.3% in the TOLS group and 74.3%, 76.7%, 72.3%, 85.2% in the RT group (P=.034, .065, .269, .060, respectively). CONCLUSIONS: TOLS had equal and good oncological outcomes on OS and DFS compared to RT. Anterior commissure involvement was statistically significant independent prognostic risk factor for DFS in both groups. The 5-year OS rate was greater in the TOLS groups (P=.034). LIMITATIONS: Retrospective, but to the best our knowledge, this is the first study in Turkey with a high patient volume and a long follow-up time.

Objective: Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder characterized by repeated upper airway collapse. As types of surgical modalities have been defned according to the level of airway obstruction, uvulopalatal fap and anterior palatoplasty are 2 of the main surgical options for patients with collapse in the soft palate and oropharynx region. The aim of our study is to show the efect of surgery on neutrophil–lymphocyte ratio, platelet–lymphocyte ratio, and mean platelet volume values in OSAS patients. Methods: The medical records of 125 patients with OSAS diagnosis in between January 2012 and December 2014 were evaluated retrospectively. Age, gender, body mass index, polysomnography results, Epworth Sleepiness scale (ESS), complete blood count values, and surgical results of the patients were evaluated. Results: A statistically signifcant decrease was observed in the mean apnea–hypopnea index, oxygen desaturation index, and ESS scores in the postoperative period (P < .001). Considering all patients, a statistically signifcant decrease was observed in th mean platelet volume (MPV) values in the postoperative period (P < .001) and no statistically signifcant change was observed in the mean neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) values (P = .808 and P = .117). In patients whose anterior palatoplasty (78 patients) results were considered successful, a statistically signifcant decrease was observed in MPV and PLR values (P < .001 and P = .038), while no signifcant change was observed in NLR values (P = .185). In those with successful uvulopalatal fap (47 patients) results, a statistically signifcant decrease was observed in MPV values (P < .001), while no signifcant change was observed in NLR and PLR values (P=.809 and P=.154). Conclusion: While it was observed that MPV values were associated with OSAS, no clear relationship was found between NLR and PLR values.

Objetivo: Comparar e investigar los parámetros de la tomografía de coherencia óptica (OCT) de los lados sanos y afectados de pacientes con pérdida auditiva neurosensorial súbita idiopática (PANSI). Método: La evaluación ocular bilateral de los pacientes diagnosticados con PANSI se realizó con OCT. Se registraron los valores de espesor del complejo de células ganglionares (CCG) y de la capa de fibras nerviosas de la retina (CFNR), y se examinaron las diferencias entre los dos ojos. Resultados: Se evaluaron 39 pacientes, con una edad media de 44.82 ± 14.90 años. Se determinó que el grosor de la CFNR de los ojos era una media de 89.87 ± 3.65 μm en el lado afectado y 103.87 ± 3.98 μm en el lado de control sano (p = 0.0001). Se determinó que el CCG medio era 90.46 ± 3.49 μm en el lado afectado y 103.77 ± 3.96 μm en el lado de control sano (p = 0.0001). Conclusiones: Se encontró una diferencia estadísticamente significativa entre los ojos sanos y afectados de pacientes con PANSI con respecto al CCG medio y al espesor medio de la CFNR. La OCT podría ser una técnica útil para medir esta degeneración neuronal.

Background Dysphagia is a geriatric syndrome. Changes in the whole body that occur with aging also affect swallowing functions and cause presbyphagia. This condition may progress to oropharyngeal and/or esophageal dysphagia in the presence of secondary causes that increase in incidence with aging. However, no study has been published that provides recommendations for use in clinical practice that addresses in detail all aspects of the management of dysphagia in geriatric individuals. This study aimed to answer almost all potential questions and problems in the management of geriatric dysphagia in clinical practice. Methods A multidisciplinary team created this recommendation guide using the seven-step and three-round modified Delphi method via e-mail. The study included 39 experts from 29 centers in 14 cities. Results Based on the 5W and 1H method, we developed 216 detailed recommendations for older adults from the perspective of different disciplines dealing with older people. Conclusion This consensus-based recommendation is a useful guide to address practical clinical questions in the diagnosis, rehabilitation, and follow-up for the management of geriatric dysphagia and also contains detailed commentary on these issues.

Head and neck cancer (HNC) is one of the most common malignancies in the world. HNC is a group of cancers that starts in the mouth, nose, throat, larynx, sinuses, or salivary glands. According to this section of the body parts; induction of cancer can be associated with CO2 and oxidative stress. The aim of this study is to assess the activities of carbonic anhydrase (CA), catalase (CAT), paraoxonase1 (PON1), and xanthine oxidase (XO) activities in 89 HNC patients and 115 healthy volunteers. Paraoxonase1 activity was found lower in HNC cancer patients. There is no statistically significant difference between patients and controls for catalase, carbonic anhydrase, and xanthine oxidase enzyme levels. According to this results, paraoxonase1 levels could be a candidate as an oxidative marker in HNC patients, but further studies are needed to investigate the other type of cancer related PON1 and the other enzyme levels.

A sixty-eight years old female patient with complete nasopharyngeal stenosis without any determined etiology is presented. She had complete nasal obstruction as well as obstructive sleep apnea syndrome. She was operated and dense, thick, avascular fibrotic tissues were excised and reconstructed with local flaps and skin graft. Only partial opening was achieved in the long term follow-up.

A 68-year-old man had a rapidly growing, painless neck mass, thought to be nodular goiter. Ultrasonography showed a giant, heterogeneous mass occupying the middle and superior poles and protruding outside of the left thyroid lobe. The results of the thyroid function tests were normal. Thyroid scintigraphy revealed a large hypoactive nodule in the left thyroid lobe. Complete surgical removal of tumor was performed and macroscopically demonstrated a well-demarked lesion outside the thyroid gland. Microscopically, the lesion was composed of fibroblast-like spindle cells in a patternless architecture and extensive stromal hyalinization. Immunohistochemistry showed positive reaction for CD34 in spindle cells and diffuse bcl-2 staining. The pathology was confirmed as solitary fibrous tumor. In the follow-up period after surgery, thyroid scintigraphy showed normal left thyroid lobe. Solitary fibrous tumor originated from or associated with thyroid gland is extremely rare. According to our knowledge, this is the first reported solitary fibrous tumor presenting like a cold thyroid nodule. This pathology must be considered for differential diagnosis of neck masses in the thyroid region.

The differential diagnosis of midline nasal masses includes inflammatory lesions, post-traumatic deformities, benign neoplasms, malignant neoplasms, congenital and vascular masses. Midline congenital lesions of the nose are rare congenital anomalies. Their incidence is estimated at 1 per 20,000 to 40,000 births consisting of gliomas, encephaloceles, and nasal dermoid sinus cysts. Nasal dermoid sinus cysts account for 1-3% of dermoid cysts overall and 11-12% of head and neck dermoids. Most lesions are diagnosed within the first three years of life but in some cases the diagnosis can be prolonged. We present an 18-year old and a two and a half-year old male patients who are concerned about drainage from the tip of the nose with recurrent infection and operated with a diagnosis of nasal dermoid sinus cyst.

Endoscopic sinus surgery (ESS)-associated risks mainly depend on the proximity of the sinuses to the orbit and anterior skull base. Skull base injuries are usually associated with dural tears and cerebrospinal fuidleaks, which are the leading causes of ascending meningitis and even brain abscesses. A 40-year-old man has a headache that came on suddenly and is an extremely painful, continuous headache accompanied by intermittent fatigue and blurred vision. The patient underwent ESS for chronic sinusitis 2 weeks ago at another hospital. Magnetic resonance examination of the brain depicted abnormal hyperintensity within the left frontal lobe. These fndings suggested the diagnosis of brain abscesses. The patient received an antibacterial treatment for 2 months. Finally, the patient recovered well.

Objective: In this study, we aimed to evaluate the effects of demographic data and comorbid diseases on the prognosis and treatment diagnosed with laryngeal squamous cell cancer (LSCC). Methods: Medical records of LSCC patients treated and followed up in a single referral center between 2008 and 2019 were retrospectively reviewed. In addition to the demographic data, the results of overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), locoregional-free survival (LRFS), and factors affecting recurrence were analyzed. Results: We included 573 patients with a mean age of 60.1±9.8 years. Of the 573 patients, 94.2% (540) were men, 93.7% (537) were smokers, 40.1% had at least one comorbid disease, and 69.8% (400) presented with glottic LSCC. The five-year OS, DSS, DFS, and LRFS rates for all cases were 65.7%, 79.9%, 67%, and 74.7%, respectively. In early-stage LSCC treatment, the rates of OS (p=0.008), DFS (p=0.024) and LRFS (p=0.01) were statistically significantly higher in the endolaryngeal laser surgery (ELS) group compared with the radiotherapy (RT) group. In advanced-stage LSCC treatment, total laryngectomy had statistically significantly higher five-year DFS (p=0.003) and LRFS (p=0.002) rates compared to chemoradiotherapy. Conclusion: Our study showed that ELS provided higher rates of OS, DFS, and LRFS compared to RT in the treatment of early-stage LSCC. Recurrence was significantly higher in supraglottic tumors, advanced-stage tumors, and in patients with clinical N positivity.

Abstract Background Reports of acoustic changes in the voice in individuals with Alzheimer's disease (AD) and the relationship of acoustic changes with age and cognitive status are still limited. Objective This study aims to determine the changes in voice analysis results in AD, as well as the effects of age and cognitive status on voice parameters. Methods The study included 47 (AD: 30; healthy: 17) women with a mean age of 76.13 years. The acoustic voice parameters mean fundamental frequency (F0), relative average perturbation (RAP), jitter percent (Jitt), shimmer percent (Shim), and noise‐to‐harmonic ratio were detected. The mini‐mental state examination (MMSE) was utilized. Results F0, Shim, Jitt, and RAP values were found to be statistically significantly higher in individuals with AD compared to healthy individuals. There was a significant negative correlation between MMSE and F0, Jitt, RAP and Shim, and the MMSE score had a significant negative effect on F0, Jitt, and RAP (p

ABSTRACT In this article, we present a case of diffuse follicular variant papillary thyroid carcinoma with pituitary metastasis, which is a rare cause of pituitary metastasis. The follicular variant of papillary thyroid carcinoma is an uncommon variant of papillary carcinoma. A 74-year-old male was presented with weakness, fatigue, and a decreased appetite. The patient was diagnosed with secondary adrenal and thyroid insufficiencies. Imaging revealed a pituitary mass with suprasellar extension, right cavernous sinus invasion, and optic chiasm compression. Thyroid ultrasonography revealed a nodule with a maximum size of 7.2cm in the right lobe. Cytological examination via fine-needle aspiration suggested papillary thyroid cancer. Total thyroidectomy with central and right lateral neck dissection confirmed the diagnosis of diffuse follicular variant of papillary thyroid carcinoma. Owing to visual field defects, the patient underwent transsphenoidal surgery. Histological and immunohistochemical evaluations confirmed pituitary metastasis from the papillary thyroid cancer. Radioactive iodine treatment and gamma knife radiotherapy of the pituitary gland were performed. The initiation of sorafenib treatment was deemed appropriate during the follow-up. A significant decrease in the thyroglobulin levels was observed after sorafenib treatment. Pituitary metastasis should be considered in patients diagnosed with hypopituitarism and pituitary lesions at initial evaluation. The presence of visual field defects may be an indication for neurosurgical intervention and guide both diagnosis and treatment. The management of papillary thyroid cancer and the role of treatment modalities in prognosis depend on the biological behavior of the tumor. Early diagnosis and multidisciplinary management are crucial for the treatment of these patients.

Objective:To investigate the prognostic value of the magnetic resonance imaging in Bell’s palsy patients.Methods: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.Results:No significant correlation was observed between pretreatment House–Brackmann grades and enhancement (p>0.05). Similarly, there was no significant correlation between clinical recovery and enhancement (p>0.05). Also, no significant correlation was observed between MRI scanning time, the recurrence rate of Bell’s palsy and MRI findings (p>0.05). None of the MRIs showed neoplastic contrast enhancement.Conclusion: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.

ABSTRACT: Objective: Hypercalcemia associated with the use of sodium-glucose transporter-2 (SGLT-2) inhibitors is very rare. Only 2 cases have been reported in the current literature. In these cases hypercalcemia occurred with the use of SGLT-2 inhibitors taken with thiazides and excessive calcium salts. We present a case of hypercalcemia and primary hyperparathyroidism diagnosed after dapagliflozin treatment. Methods: We describe the medical history, laboratory test results, parathyroid ultrasound, 4-dimensional computed tomography-magnetic resonance imaging, and histopathology findings of the patient. Results: A 49-year-old man with 5-year history of type 2 diabetes mellitus was found to have hypercalcemia with corrected calcium of 11.28 mg/dL (reference range [RR] is 8.8 to 10.6 mg/dL) 6 months after starting dapagliflozin. Previous records showed normocalcemia for many years. Parathyroid hormone level was 70.8 pg/mL (RR is 15 to 65 pg/mL) and 24-hour urinary calcium excretion level was 492 mg/day (RR is 100 to 300 mg/day). On parathyroid ultrasound, a 4 × 9 × 14-mm hypoechoic lesion inferior to the right thyroid lobe was detected. A 15 × 10 × 9-mm oval lesion was observed in the right paratracheal area. A lesion at T1 vertebra level was also seen on 4-dimensional computed tomography-magnetic resonance imaging. The patient underwent lower right parathyroidectomy. Histopathology confirmed the diagnosis of parathyroid adenoma. The patient was asymptomatic 3 months after the operation with a normal corrected calcium level of 9.2 mg/dL. Conclusions: SGLT-2 inhibitors could have unmasked an underlying mild hyperparathyroidism, as they can increase predisposition to hypercalcemia when used with medications causing it. Volume depletion caused by SGLT-2 inhibitors may also contribute to hypercalcemia. For these reasons, calcium levels should be monitored in patients taking SGLT-2 inhibitors. Abbreviations: FGF-23 fibroblast growth factor-23 PTH parathyroid hormone RR reference range SGLT-2 sodium-glucose transporter-2

ABSTRACT 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.

Objective: To evaluate the feasibility and value of sonoelastography in assessing non-thyroid neck masses.Methods: Non-thyroid neck masses requiring surgical interventions were evaluated using conventional B-mode ultrasonography (US) (size, short/long axis rate, shape, hilum, echogenity, calcification, necrosis, and peripheral edema) and sonoelastograpy (SE) with strain ratio (SR) and elasticity score (ES) before surgery. These parameters were compared with the histopathological examination.Results: In total, 116 non-thyroid neck masses (66 lymph node, 35 parotid gland, eight submandibular gland, and seven cervical mass) of 89 patients (51 men, 38 women) with a mean age of 50.3±15.1 (19-79) years were evaluated. Thirty-seven malignant lymph nodes (23 metastatic and 14 lymphoma), seven malignant parotid tumors, two malignant submandibular tumors, 29 benign lymph nodes, 28 benign parotid lesions, and six benign submandibular lesions were evaluated. Mean SR and ES values of malignant masses were 6.3/3.2 for lymph nodes, 5.5/3.3for the parotid gland, and 4.2/3 for the submandibular gland. Mean SR and ES values of benign lesions were 2.0/2.1 for lymph nodes, 4.4/3.2 for the parotid gland, and 3.2/3 for the submandibular gland. SR and ES were significantly higher for malignant masses compared with those for benign ones. SR was more predictive than ES in evaluating malignant lymph nodes. The area under the curve was 0.917(0.827-1.00) (p

Objective:To investigate the outcomes of superficial musculoaponeurotic system (SMAS) flap and classic techniques in superficial parotidectomy in terms of Frey’s syndrome (FS) and cosmetic satisfaction.Methods:In this study, a retrospective chart review of patients that underwent superficial parotidectomy was performed. These patients were divided into two subgroups: group 1 included patients in which the SMAS flap was harvested and group 2 comprised the remaining patients on whom classic superficial parotidectomy was performed. All the patients were evaluated clinically and with Minor’s starch-iodine test for FS. For the evaluation of the cosmetic results, the patient’s satisfaction was queried according to the incision scar and surgical field skin retraction/facial symmetry. Both groups were compared in terms of complications and numbness of surgical area.Results:Fifty-five patients (31 male and 24 female) with a mean age of 50.19 years were included in the study. Thirty-two patients were in group 1 and 23 in group 2. Thirteen patients (23.7%) described as having FS and six of them were in group 1, while seven were in group 2. Minor’s starch-iodine test was positive in nine patients in group 1 (28.1%) and six patients in group 2 (26.1%) (p=1.000). With regard to cosmetic satisfaction, eight patients (25%) stated mild discomfort from the incision scar and two patients (6.3%) stated cosmetic dissatisfaction for facial asymmetry in group 1. In group 2 for the same factors the number of patients were 11 (47.8%) and 2 two (8.7%), respectively (p=0.027). There were no statistically significant differences in means of complication and numbness (p>0.05).Conclusion:According to our study results, there was no superiority between both the groups in terms of FS and incision scar satisfaction. We determined that there was a significant benefit of SMAS flap application in the prevention of volume loss and surgical area retraction.

The aim of this case report is to demonstrate a very rare coincidental existence and management of the Killian- Jamieson diverticulum during thyroid surgery in a patient with dysphagia. An 18-year-old female patient with the complaints of progressive dysphagia and a rapidly growing mass at the anterior cervical region was undergone thyroid lobectomy. Coincidentally, a 2×2 cm Killian-Jamieson diverticulum was observed and simultaneously excised with the thyroid lobe, preserving the recurrent laryngeal nerve. Dysphagia is a frequent symptom, especially in patients with a rapidly growing thyroid mass. Thyroid surgeons should keep in mind that hypopharyngeal and upper esophageal pathologies can mimic the symptoms of a thyroid mass; therefore, detailed imaging techniques should be used for the differential diagnosis.

Objective:The aim of this study is to compare traditional cold knife tonsillectomy and plasma knife tonsillectomy.Methods:In this study, 15 patients underwent cold knife tonsillectomy, 15 patients underwent plasma knife tonsillectomy. The patients were then followed up in the postoperative days.Results:The operation time and intraoperative blood loss in cold knife tonsillectomy group was significantly greater than the plasma knife group (p0.05). Postoperative complications were similar for both groups (p=0.224). There was no significant correlation of complications and age (p=0.921). Operation time of the patients who had complications was not different from the patients who did not have complications (p=0.086). Pain scores in every follow up time for both groups was not significantly different (p>0.005).Conclusion:According to this data, plasma knife tonsillectomy was not found superior to cold knife tonsillectomy in the postoperative pain and complications but had positive effects on operation time and blood loss.

ObjectivesTo investigate the effect of rhinophototherapy with medical therapy on quality of life in persistent allergic rhinitis.MethodsA prospective, randomized study was being performed between December 2009 and March 2010. The study included 65 patients with persistent allergic rhinitis. The diagnosis was confirmed with positive skin tests. All of the patients had house dust mite allergies. We divided the patients into two groups. First group (n=33) was given topical mometasone furoate 200 mcg/day and levocetirizine 5 mg/day for a month. Rhinophototherapy was applied with the same medical therapy to the second group (n=32), twice a week for three weeks continuously. Rhinophototherapy included visible light, ultraviolet A and ultraviolet B. We evaluated patients before the treatment, at the first month and at the third month after treatment with rhinoconjunctivitis quality of life questionnaire, nasal symptom scores and visual analogue scale (VAS) scores.ResultsImprovements of all variables of the quality of life questionnaire, nasal symptom scores and VAS were statistically significant in the second group both on the first and the third months when compared with the first group.ConclusionAllergic rhinitis is a social problem and impairs quality of life. Rhinophototherapy with medical therapy improves the quality of life in allergic rhinitis.