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To assess the duration of clinical response after in-office vocal fold steroid injection (VFSI) for vocal fold (VF) scar.Demographic and clinical data for in-office VFSI occurring from 2017 to 2020 were collected. Two Speech-Language Pathologists (SLPs) used perceptual evaluation of voice and functional scales to evaluate blinded voice and laryngovideostroboscopy (LVS) samples collected pre- and post-injection across multiple timepoints.Blinded SLP ratings were used for 30 individual VFs undergoing initial injection in 18 patients. Persistent improvement in voice past 6 months was seen in 57% of patients after VFSI. Multiple measures of voice and amplitude, percent vibrating tissue, and closed phase predominance significantly improved at various follow-up timepoints on average.Accounting for patient heterogeneity and disease progression, in-office VFSI for VF scar is associated with sustained improvement in a subset of patients. Approximately half of patients can expect to experience a lasting improvement in voice. Future studies of larger scale are required to identify patient factors associated with long-term benefit.4 Laryngoscope, 2023.

Oropharyngeal dysphagia is one of the complications of endotracheal intubation. As expected, cases of dysphagia following coronavirus disease 2019 (COVID‐19) reported to date have all been intubated. We here report a case of sarcopenic dysphagia following severe COVID‐19 pneumonia in a nonintubated older adult. The patient was an 85‐year‐old male who was readmitted to the hospital with dysphagia and subsequent aspiration pneumonia in the first week after his discharge from the COVID‐19 unit. On physical examination, the patient was sarcopenic and malnourished. Flexible endoscopic evaluation of swallowing (FEES) revealed aspiration into the airway. Enteral feeding was initiated and the infusion rate gradually increased to achieve the desired protein‐energy targets. Control FEES 2 months after discharge showed recovery of swallowing function, with no apparent penetration or aspiration. Clinicians caring for patients with COVID‐19 should be aware that dysphagia, which is associated with increased mortality in older adults, may occur even in the absence of intubation. We recommend that the evaluation of dysphagia be part of the clinical assessment in older COVID‐19 patients with malnutrition or sarcopenia.

Background/aim: This study aimed to assess the inflammatory adverse reactions of vocal fold injection laryngoplasty with hyaluronic acid. Materials and methods: This study was a retrospective chart review of patients who underwent vocal fold injection augmentation with HA injection from January 2005 to September 2016 in nine different institutions. Demographic data, indication for injection, injection techniques, types of injection material, settings of procedure, and complications were reviewed. The types of complication, onset time, and management of complications were also noted. Results: In all, 467 patients were identified. The majority of patients had been injected under general anesthesia (n = 382, 84.7%). For injection material, two different types of hyaluronic acid were used: hyaluronic acid alone or hyaluronic acid with dextranomer. Complications occurred in nine patients (1.9%). The majority of complications were inflammatory reactions (n = 7, 1.47%). Main symptoms were dysphonia and/or dyspnea with an onset of 0 h to 3 weeks after the hyaluronic acid injection. Three patients were hospitalized, one of which was also intubated and observed in the intensive care unit for 24 h. Systemic steroids and antibiotics were the main medical treatment in the majority of cases. There was no statistical difference in complication rates between patients who received hyaluronic acid and those who received hyaluronic acid with dextranomer (P = 0.220). Conclusion: Hyaluronic acid can be considered as a safe substance for the injection of vocal folds with a low risk of inflammatory reaction.

Summary Objective Laryngeal framework surgery has been a topic of interest since last decades. To succeed with least morbidity, the most important step is mastering the anatomy of larynx. In this study, we aim to show the relation between body height and laryngeal morphometrics that are important during laryngeal framework surgeries. Data Sources Larynges of 187 fresh cadavers were dissected within 24 hours after death at the Council of Forensic Medicine. Methods Age, sex, weight, height, and a total of 12 measurements were taken from each cadaver. Results were subgrouped according to gender, age of 45, body height of 165 millimeters (mm), and thyroid cartilage height of 17 mm. These subgroups were compared for each measurement and ratio. Results A positive correlation was found between body height and thyroid cartilage height (hTC), thyroid cartilage width, vocal fold length, and distance from projection of anterior commissure (pAC) to inferior border of thyroid cartilage (TIB). Male gender, higher body heights, and higher thyroid cartilage heights significantly higher results were obtained. The ratio between pAC-TIB distance to hTC was found to be 0.54 in males and 0.52 in females, and this ratio was not statistically different in subgroups. Conclusion Although all of the laryngeal measurements were found to be statistically significant in patients with higher body height, the ratio between pAC-TIB distance to hTC was independent. Thus, especially in patients with body heights longer than average, it should be safer to use the midpoint of the thyroid cartilage as a landmark for anterior commissure.

To study the management of laryngopharyngeal reflux (LPR) among the subspecialties of practicing otolaryngology-head and neck surgeons and their trainees. A survey was sent to over 8000 otolaryngologists (OTOHNS) over 65 countries, utilizing membership lists of participating otolaryngological societies. The outcomes were answers to questions regarding LPR knowledge and practice patterns, and included queries about its definition, prevalence, clinical presentation, diagnosis, and treatment. Of the 824 respondents, 658 practiced in one specific otolaryngologic subspecialty. The symptoms and findings thought to be the most related to LPR varied significantly between subspecialists. Extra-laryngeal findings were considered less by laryngologists while more experienced OTOHNS did not often consider digestive complaints. Compared with colleagues, otologists, rhinologists and laryngologists were less aware of the involvement of LPR in otological, rhinological and laryngological disorders, respectively. Irrespective of subspecialty, OTOHNS consider symptoms and signs and a positive response to empirical therapeutic trial to establish a LPR diagnosis. Awareness regarding the usefulness of impedance pH-studies is low in all groups. The therapeutic approach significantly varies between groups, although all were in agreement for the treatment duration. The management of non-responder patients demonstrated significant differences among laryngologists who performed additional examinations. The majority of participants (37.1%) admitted to being less than knowledgeable about LPR management. LPR knowledge and management vary significantly across otolaryngology subspecialties. International guidelines on LPR management appear necessary to improve knowledge and management of LPR across all subspecialties of otolaryngology.

COVID-19 is highly transmissible and spreads rapidly in the population. This increases the occupational risk for health care workers. In otolaryngology clinic practice, patients with upper respiratory tract infection symptoms are common. Also, routine head and neck examinations such as oral cavity examination, nasal/nasopharyngeal examination, or video laryngostroboscopic evaluation are highly risky because of the aerosol formation. To emphasize this issue, two leading otolaryngology organizations in Turkey; ‘Voice Speech and Swallowing Disorders Society’, and ‘Professional Voice Society’ gathered a task force. This task force aimed to prepare a consensus report that would provide practical recommendations of the safety measurements during routine clinical care of laryngology patients. To fulfill this, universal aim, on the 2(nd) and 9(th) of May 2020, two web-based meetings were conducted by 20 expert physicians. This eighteen items list was prepared as an output.

Objectives: The number of citations an article receives is an important indication of its impact. The main objectives of this investigation provide readers with a practical guide in evaluating head and neck oncology literature and determine the characteristics of trends in ORL. Methods: This was a retrospective bibliometric analysis that did not involve human participant. The Thomson Reuters Web of Science was searched to determine the citations of all published HNO articles. Most cited 300 article analyzed and a total of 100 articles were included in our investigation under the topic search “Head AND NECK AND (cancer OR carcinoma OR oncology).” Articles include malignancies other than head and neck are excluded. The top 100 cited articles were selected and analyzed by 2 independent investigators. Country, Institution, First Author, Journal name, study design, cites per year information gathered and analyzed. Results: The journal with the highest number of top 100 cited articles was New England Journal Of Medicine with 19 paper, followed by The Journal of Clinical Oncology(17) and Cancer Research (12). The top article on the list (Radiotherapy plus cetuximab for squamous cell carcinoma of the head and neck-NEJM) has 2243 citations. A statistically significant association was found between the journal impact factor and the number of top 100 cited articles ( P < .05). The United States had the highest number of articles (63). John Hopkins is differed from other institutions with 15 contributing articles. Conclusion: Our analysis provides an insight into the citation frequency of top cited articles published in HNO to help recognize the quality of the works, discoveries and the trends steering the study of HNO. This is also a modern reading list for young HNO scientist.

The aim of this review is to present the current literature on pathophysiology, evaluation, and management of laryngeal dystonia. Recent evidence suggests loss of cortical inhibition, and sensory dysfunction plays an important role in the pathophysiology of laryngeal dystonia. New treatments addressing these changes include electrical stimulation for neuromodulation of the larynx, vibrotactile therapy, and sodium oxybate. Preliminary investigations are promising and these may impact the future of care for laryngeal dystonia patients. The current literature emphasizes a new understanding of the pathophysiology of laryngeal dystonia which has led to investigation of novel therapies.

The increasing availability of Internet as a health-care source causes both positive and negative effects on public health. Though reaching to information about diseases is faster and easier, the contents are not always correct and might be misleading. In our study, we aim to investigate the quality of YouTube™ videos on larynx cancer. A YouTube™ search by using terms “throat cancer” and “larynx cancer” was done and, after eliminating the irrelevant videos, the first 200 videos were evaluated by three authors on quality, content and usefulness by using a pre-developed questionnaire. Videos were categorized according to the type and uploader separately to two (testimonial and educational) and five groups (health care, university, individual users, television channel/news and undetermined), respectively. Videos that are uploaded by university-affiliated accounts have significantly better audiovisual quality score and have significantly higher accuracy and usefulness score results. Furthermore, the accuracy and usefulness scores of the educational group were found to be statistically higher than those of the testimonial group. Videos uploaded by universities and videos that are created for educational purposes are superior to other sources in terms of quality, accuracy and content. Patient information videos discussing common health problems should be prepared and disseminated only by universities or health-care institutions

Inhaled antibiotics have long been used for chronic lung infections, especially in patients with cystic fibrosis and increasingly for non-cystic fibrosis bronchiectasis. Amikacin liposome inhalation suspension (ALIS) has emerged as a promising treatment for Mycobacterium avium complex infection refractory to oral antibiotics. However, despite its efficacy, nearly one-half of patients in phase II and III trials experienced dysphonia as a treatment-associated adverse effect. Here, we describe a patient who experienced severe, acute-onset laryngitis while receiving ALIS for refractory M avium complex infection, prompting discontinuation of ALIS therapy. This is the first report directly describing vocal fold injury due to such therapy. Given the high frequency of dysphonia reported with ALIS, this case highlights the potential severity of laryngeal toxicity, the importance of coordination of care for patients receiving inhaled antibiotics for chronic pulmonary disease, and the need for better insight into mechanisms of toxicity.

Objective: To develop clinical tools assessing the refluxogenic potential of foods and beverages (F&B) consumed by patients with laryngopharyngeal reflux (LPR). Methods: European experts of the LPR Study group of the Young-Otolaryngologists of the International Federation of Oto-rhino-laryngological societies were invited to identify the components of Western European F&B that would be associated with the development of LPR. Based on the list generated by experts, four authors conducted a systematic review to identify the F&B involved in the development of esophageal sphincter and motility dysfunctions, both mechanisms involved in the development of gastroesophageal reflux disease and LPR. Regarding the F&B components and the characteristics identified as important in the development of reflux, experts developed three rational scores for the assessment of the refluxogenic potential of F&B, a dish, or the overall diet of the patient. Results: Twenty-six European experts participated to the study and identified the following components of F&B as important in the development of LPR: pH; lipid, carbohydrate, protein composition; fiber composition of vegetables; alcohol degree; caffeine/theine composition; and high osmolality of beverage. A total of 72 relevant studies have contributed to identifying the Western European F&B that are highly susceptible to be involved in the development of reflux. The F&B characteristics were considered for developing a Refluxogenic Diet Score (REDS), allowing a categorization of F&B into five categories ranging from 1 (low refluxogenic F&B) to 5 (high refluxogenic F&B). From REDS, experts developed the Refluxogenic Score of a Dish (RESDI) and the Global Refluxogenic Diet Score (GRES), which allow the assessment of the refluxogenic potential of dish and the overall diet of the LPR patient, respectively. Conclusion: REDS, RESDI and GRES are proposed as objective scores for assessing the refluxogenic potential of F&B composing a dish or the overall diet of LPR patients. Future studies are needed to study the correlation between these scores and the development of LPR according to impedance–pH study.

Objectives: This study aims to investigate causes of malpractice claims in head and neck practices in order to create more awareness and to prevent future claims. Patients and Methods: The database of the National Institute of Forensic Medicine NIFM was retrospectively reviewed between March 2005 and August 2017 and 219 malpractice cases related to the head and neck practices were found. Results: Of the 219 cases 122 55.7% were female and 97 44.3% were male. Of these cases, 194 were related to surgical procedures and 25 were related to non-surgical procedures. The most procedures included thyroidectomy, followed by tonsillectomy and open neck biopsy. The most frequent causes of claims were dyspnea n=53 and dysphonia n=49 after thyroidectomy. Of the 219 cases, 57 26% received a unanimous verdict of 'malpractice' deciding in favor of plaintiffs by the NIFM grand jury. No delinquency was found in the other 162 cases 74% . Conclusion: Physicians should be educated in the medicolegal aspects of malpractice and awareness should be raised accordingly. Despite the increasing number of studies, further research, collaboration with jurists and a universal language are required.

Introduction Gelsolin protein has important cellular functions, including cell motility and apoptosis. Altered gelsolin expression has been reported in several types of neoplasms, but clinicopathological features of gelsolin are currently unclear in patients with laryngeal squamous cell carcinoma. Objectives Our aim is to investigate the clinicopathological significance of gelsolin as a prognostic biomarker for laryngeal squamous cell carcinoma. Methods Tissue specimens from 168 patients with laryngeal squamous cell carcinoma were immunohistochemically assessed for the Gelsolin expression. Prognostic significance of Gelsolin and its interaction with clinical parameters was analysed. Results Gelsolin expression was confirmed in 70.2% of cases. Gelsolin expression is significantly associated with tumor stage, tumor grade, and locoregional recurrence. Kaplan–Meier survival curves revealed that Gelsolin expression inversely correlated with both disease-specific and overall survival. Conclusion This research is the first to demonstrate that Gelsolin expression is associated with a poor prognosis in laryngeal squamous cell carcinoma. Gelsolin is a novel promising biomarker and attractive target for the treatment of laryngeal squamous cell carcinoma.

This study investigated the effect of the structured Neurodevelopmental Therapy Method-Bobath (NDT-B) approach on the feeding and swallowing activity of patients with cerebral palsy (CP) and feeding difficulties. In addition to feeding and oral motor intervention strategies (OMIS), and nutrition-related caregiver training (NRCT), and the NDT-B, which was structured to increase trunk and postural control, was added to the therapy program. Forty patients with CP, with a mean age of 3.25 ± 0.927 years, were classified using the Gross Motor Function Classification System, Eating and Drinking Ability Classification System, and Mini-Manual Ability Classification System. The patients were randomly assigned into two groups as OMIS + NRCT (n = 20) and OMIS + NRCT + NDT-B (n = 20). The program was applied for 6 weeks, 2 days/week, for 45 min. The patients were evaluated using the Trunk Impairment Scale, Schedule for Oral Motor Assessment, and the Pediatric Quality of Life Inventory before and after 6 weeks. The trunk control of the OMIS + NRCT + NDT-B group was superior to the other group (P = 0.026). Although there was an improvement in the groups according to the subcategories of SOMA, the OMIS + NRCT + NDT-B group was superior in the trainer cup and puree subcategories of SOMA (P = 0.05). A significant correlation was observed between trunk control and oral motor functions in children with CP, and the eating function of children in the OMIS + NRCT + NDT-B group further improved. NDT-B-based neck and trunk stabilization exercises should be added to the treatment programs. Trial Registration NCT04403113.

To study the management of laryngopharyngeal reflux (LPR) among the subspecialties of practicing otolaryngology-head and neck surgeons and their trainees.A survey was sent to over 8000 otolaryngologists (OTOHNS) over 65 countries, utilizing membership lists of participating otolaryngological societies. The outcomes were answers to questions regarding LPR knowledge and practice patterns, and included queries about its definition, prevalence, clinical presentation, diagnosis, and treatment.Of the 824 respondents, 658 practiced in one specific otolaryngologic subspecialty. The symptoms and findings thought to be the most related to LPR varied significantly between subspecialists. Extra-laryngeal findings were considered less by laryngologists while more experienced OTOHNS did not often consider digestive complaints. Compared with colleagues, otologists, rhinologists and laryngologists were less aware of the involvement of LPR in otological, rhinological and laryngological disorders, respectively. Irrespective of subspecialty, OTOHNS consider symptoms and signs and a positive response to empirical therapeutic trial to establish a LPR diagnosis. Awareness regarding the usefulness of impedance pH-studies is low in all groups. The therapeutic approach significantly varies between groups, although all were in agreement for the treatment duration. The management of non-responder patients demonstrated significant differences among laryngologists who performed additional examinations. The majority of participants (37.1%) admitted to being less than knowledgeable about LPR management.LPR knowledge and management vary significantly across otolaryngology subspecialties. International guidelines on LPR management appear necessary to improve knowledge and management of LPR across all subspecialties of otolaryngology.

PURPOSE Awareness of variations in laryngeal anatomy among different age and gender groups is crucial during laryngeal framework surgery. The aim of this study is to demonstrate the relationship between gender and laryngeal radiologic morphometrics among different age groups and the applicability of important anatomical landmarks of laryngeal surgery. METHODS Laryngeal images of 180 adult patients older than 18 years of age were obtained by computed tomography and assessed. A total of 11 measurements of important laryngeal landmarks were taken from the patients' computed tomography images. Results were subgrouped according to gender and age, and these groups were compared for each measurement. RESULTS The majority of laryngeal measurements obtained in the study were higher in males than females, with the exception of the interlaminar angle. The mean interlaminar angle value was 88.27°± 14.99 for males and 103.04°± 14.81 for females (P

Professional voice users comprise 25–35% of the US working population, and their voice problems may interfere with job performance and impact costs for both employers and employees. Voice users can be grouped into four categories according to their dependence on their voice: Elite vocal performers (Level 1) always require maximum vocal performance and need superior voice quality, pitch, range, and volume; most professional singers and actors are part of this group. For professional voice users (Level 2), the voice is an essential part of their work life. They mainly need vocal endurance and stamina over prolonged periods, and voice quality is a secondary concern for them; teachers, lecturers, customer service workers, and fitness instructors are in this group. Nonvocal professional voice users (Level 3) would be able to perform their job with mild dysphonia, but they would be unable to fulfill their professional commitments if they had moderate or severe dysphonia; even if they could accomplish their work-related tasks, they would lack the vocal quality needed for their professional image. Lawyers, doctors, and managers are the main members of this group. Nonvocal nonprofessional voice users (Level 4) are the remaining individuals, who do not rely on their voice for their occupation. In this chapter, “professional voice user” refers to Levels 1–2. In this chapter, the role of allergic rhinitis for professional voice users is presented.

Objectives/hypothesis The aims of this work were 1) to investigate whether office laryngoscopy is an aerosol-generating procedure with an optical particle sizer (OPS) during clinical simulation on healthy volunteers, and 2) to critically discuss methods for assessment of aerosolizing potentials in invasive interventions. Study design Prospective quantification of aerosol and droplet generation during clinical simulation of rigid and flexible laryngoscopy. Methods Two healthy volunteers were recruited to undergo both flexible and rigid laryngoscopy. An OPS was used to quantify aerosols and droplets generated for four positive controls relative to ambient particles (speech, breathing, /e/ phonation, and /ae/ phonation) and for five test interventions relative to breathing and phonation (flexible laryngoscopy, flexible laryngoscopy with humming, flexible laryngoscopy with /e/ phonation, rigid laryngoscopy, and rigid laryngoscopy with /ae/ phonation). Particle counts in mean diameter size range from 0.3 to >10 μm were measured with OPS placed at 12 cm from the subject's nose/mouth. Results None of the laryngoscopy interventions (n = 10 each) generated aerosols above that produced by breathing or phonation. Breathing (n = 40, 1-3 μm, P = .016) and /ae/ phonation (n = 10, 1-3 μm, P = .022; 3-5 μm. P = .083; >5 μm, P = .012) were statistically significant producers of aerosols and droplets. Neither speech nor /e/ phonation (n = 10 each) were associated with statistically significant aerosols and droplet generation. Conclusions Using OPS to detect droplets and aerosols, we found that office laryngoscopy is likely not an aerosol-generating procedure. Despite its prior use in otolaryngological literature, an OPS has intrinsic limitations. Our study should be complemented with more sophisticated methods of droplet distribution measurement. Level of evidence 3 Laryngoscope, 130:2637-2642, 2020.

Objectives Progressive supranuclear palsy (PSP) is a neurodegenerative disease which results in cough and swallowing dysfunction and aspiration pneumonia. Relationships among vocal fold atrophy, cough, and swallowing have been identified in related diseases, but remain unknown in PSP. This study examined: 1) the prevalence of vocal fold bowing in PSP, and 2) the influence of vocal fold bowing on cough and swallowing in PSP. Study design Prospective Cohort Study. Methods Twenty-three participants with PSP completed instrumental assessments of cough and swallowing. Vocal fold bowing (BI) and swallowing safety (PAS) was assessed using flexible laryngoscopy. Measures of cough effectiveness were obtained using spirometry. Statistical analyses were used to determine the frequency of mild-moderate (BI > 0) and severe (BI > 12.2) bowing, and to assess the influence of BI on PAS and cough effectiveness in PSP. Results Fifty-two percent (n = 12) of participants exhibited severe bowing while 48% (n = 11) exhibited mild-to-moderate bowing. Voluntary cough peak expiratory flow rate (P = .01), as well as reflex (P = .02) and voluntary (P = .005) cough volume acceleration were lower for participants with severe BI when compared to mild-to-moderate BI. However, BI did not influence PAS (P > .05). Conclusions Findings from this study suggest that vocal fold bowing is highly prevalent in PSP and associated with reduced reflex and voluntary cough effectiveness. These findings provide insight into the pathophysiology of compromised airway protection in this patient population. Future studies should examine vocal fold atrophy as a treatment target for behavioral and medical intervention in PSP. Level of evidence 3 (Prospective Observational Study) Laryngoscope, 131:1217-1222, 2021.

Objectives: This study aims to describe morphometric measurements of the laryngeal framework and discuss their implications for phonosurgery among Turkish subjects. Patients and Methods: Larynges from 40 male and 20 female fresh cadavers were extracted during autopsy in a forensic science institution between January 2015 and December 2015. Measurements were taken of the length of membranous and cartilaginous vocal fold mVF, cVF , width and thickness of VF wVF, tVF , anterior and posterior subglottic distance AS, PS , width and height of thyroid cartilage wTC, hTC , and distance between projection of anterior commissure to thyroid cartilage inferior border pAC to TIB . Results: For all parameters, median and mean values were higher in male groups, but the differences were significant only in pAC to TIB, wTC, cVF and mVF groups p

Objective:This study aimed to evaluate migration of the receiver–stimulator after cochlear implantation using the subperiosteal pocket technique.Methods:A prospective clinical study was performed of 32 paediatric patients (aged between 12 months and 8 years; mean ± standard deviation, 28 ± 19 months) who underwent cochlear implantation in tertiary referral centres. The degree of migration was evaluated using measurements between the receiver–stimulator and selected reference points: the lateral canthus, tragus and mastoid tip. All distances were measured during and six months after surgery.Results:No receiver–stimulator migration was observed when using the subperiosteal pocket technique.Conclusion:Concerns about implant migration in the subperiosteal pocket technique are unwarranted: this is a safe technique to use for cochlear implantation.

EgeUn###, Introduction: Thyroidectomy is one of the most commonly performed surgical procedures. Preoperative patient education and postoperative management of complications are vital to avoid postoperative medicolegal problems. Objective: The aim of this study was to assess the attitudes of thyroid surgeons about voice and airway complications of the surgery and the approaches used to avoid or handle these complications. Methods: A questionnaire based on surgeons’ attitudes and behaviors on thyroidectomy was answered by 177 thyroid surgeons. Questions regarding demographic information, preoperative information methods, preoperative laryngeal examination, intraoperative nerve preservation techniques, and methods to avoid and handle postoperative complications were asked. Surgeons who completed the questionnaire were divided into three groups based on their annual volumes: less than 50 (low volume), 50–100 (middle volume), and more than 100 (high volume) for statistical analysis. The differences between the subgroups were compared using the chi-squared test. Results: During the preoperative disclosure, nearly all surgeons (97.2%) gave information about possible hoarseness; however, this high rate fell to 79.7% for possible voice changes, and to the lowest level of 36.7% for ability to change the voice pitch. Only 53.7% of the surgeons discussed the possibility of postoperative tracheostomy requirement. The surgeons with high annual volumes were found to perform vocal fold examination prior to a second surgery significantly higher than other groups (P=0.015). In the postoperative period, 84.2% of physicians indicated that they perform a laryngoscopic examination only for patients with voice problems. There was no statistically important difference between subgroups. Conclusions: Our study is unique to provide information from the surgeons’ perspective by evaluating preoperative patient information, and intraoperative and postoperative protective and curative methods. The training of residents and fellows who are expected to perform thyroidectomies can be revised to compromise all aspects of complications. © 2019 The Voice Foundation

OBJECTIVE To compare two different percutaneous bone-anchored hearing aid (BAHA) abutment systems regarding operation time, scar healing, quality of life, implant stability, audiologic results, and complications. MATERIALS AND METHODS The study involves a prospective multi-center clinical evaluation. Thirty-two consecutive patients who had undergone BAHA surgery from January 2011 to January 2013 in two tertiary centers were included in the study. The Glasgow Inventory Benefit Score was used to assess the patients at least 6 months after surgery. The operation time and complications were recorded. Implant stability quotient (ISQ) values were recorded using resonance frequency analysis. Holger's classification was used to evaluate skin reactions. RESULTS The mean length of the operation was 39.2±4 min for standard abutment and 18.3±5.7 min for hydroxyapatite-coated abutment. ISQ scores were significantly better for standard abutment in all tests. The mean total Glasgow Inventory Benefit Score was 39.3±19 for the standard abutment and 46.3±24.5 for the hydroxyapatite-coated abutment groups, but there was no statistical significance between the two groups. There was no difference in audiological improvement between the two groups after surgery. CONCLUSION Hydroxyapatite-coated abutment provided a shorter operation time that was significantly different from standard abutment. There were no significant differences between standard abutment and hydroxyapatite-coated abutment regarding audiologic improvement, quality of life, loading time, and complications.

Hyaluronic acid injection for medialization laryngoplasty is a safe procedure performed on patients with glottic incompetence. Laryngeal abscess formation as a complication of injection laryngoplasty is a very rare complication, and, as we know from the literature, there has been only one case of laryngeal abscess after injection laryngoplasty in a patient with a type-I laryngeal cleft. We document for the first time a laryngeal abscess resulting from hyaluronic acid injection laryngoplasty for unilateral vocal fold paralysis. Prompt evaluation of the patient was necessary. Our patient was treated with antibiotics and corticosteroids without a need for intubation. One year after injection, the patient's Voice Handicap Index-10 score was still good and within the range of normal values.

Objective Vocal fold nodules are benign vocal fold lesions that can adversely affect quality of life. Differential diagnosis and treatment modalities of this disease are variable and patients often tend to use online materials to learn the insights. Access to knowledge via Internet is very easy; however, it is important to choose wisely because false and biased information might lead the patient to an inappropriate decision. In this study, we have evaluated the quality, readability, and understandability of online materials for vocal fold nodules. Methods An Internet search was performed for “Vocal fold nodule,” “vocal fold nodule treatment,” and “voice therapy for vocal fold nodule” by using Google search engine. Readability of each website was evaluated by using www.readable.io . Understandability and actionability of pages were measured by using the Patient Education Materials Assessment Tool (PEMAT). In the end, DISCERN instrument was used to measure the quality of information presented. Results After exclusion, total of 26 web pages were evaluated during the study. Four web pages graded as A level, 5 as B level, 11 as C level, and 5 as D level for language use. Average grade level for all of the web pages is 11.14 ± 1.75. Overall understandability score was found 59.0+ 12.1 (26.7-77.1), and overall quality score was measured 34.95 + 6.58 (53.75-26.5). Conclusion The quality, readability, and understandability of the written materials are very low and in order for patients to read and learn from the online sources, contents of the written materials should be revised.

Summary Objectives Ulcerative laryngitis (UL) is challenging in terms of treatment and patient counseling, with few reports in the literature. This study describes UL patients and their clinical course including detailed voice and stroboscopic outcomes after treatment which have not been described in previous literature. Methods Single-institution, retrospective review of 23 UL patients. Demographics, historical factors, disease course, treatment, and outcomes are presented. Treatment results were compared to prior studies. Results Seventy four percent had inflammatory/infectious precipitating event. Average presenting Voice-Handicap-Index-10 (VHI-10) was 25 (range: 6–38) and average final VHI-10 was 9 (range: 0–26). Ninty five percent had improvement in VHI-10 (average decrease of 15). Only 50% had final VHI-10 within “normal” limits. Treatment comprised reflux medications (85%), antibiotics (22%), antifungals (39%), antivirals (52%) steroids (52%), and/or voice rest (65%). Average symptom duration before evaluation was 42 days; average follow-up was 6.8 months. Final laryngovideostroboscopy revealed no ulcers in 78%, but 65% had persistently decreased mucosal wave vibration. Average time to ulcer resolution was 2.25 months but resolution or plateau of voice symptoms occurred later, average 2.7 months. Multiple regression analyses revealed that younger age, shorter symptom duration, and antireflux treatment were significant predictors of decrease in VHI-10 (P Conclusions Most patients have good voice outcomes following resolution of UL, although vocal fold mucosal wave abnormalities may persist. This study provides the most detailed report of UL, disease course and treatment outcomes to date. Additionally, this study is also the first to suggest that earlier initiation of treatment may improve voice outcome after UL.

Meningiomas are common intracranial neoplasms but extracranial meningioma of the paranasal sinus is extremely rare. The recommended treatment of these meningothelial tumors is complete surgical excision. The authors report a 79-year-old woman presenting with facial pain and nasal obstruction for several months. Endoscopic nasopharyngeal examination showed a right nasal mass that arose from the nasopharynx and reached around the middle meatus. Gadolinium-enhanced magnetic resonance imaging showed a well-circumscribed nasopharyngeal mass, which originates from the right rosenmuller fossa and extends to the right nasal cavity. A biopsy was made with nasal endoscopy under local anesthesia for definitive diagnosis. Histopathologic examination was reported as benign meningothelial meningioma.In conclusion, physicians should keep in mind uncommon tumors in the nasal cavity and paranasal sinuses. Surgical resection is the primary treatment choice; however, close follow-up could be an option in patients with comorbidities.

Background:In recent years, the subperiosteal pocket technique has become popular for minimal access cochlear implantation. Many incision techniques have been described in cochlear implantation.Objective:This study aimed to demonstrate the safety and reliability of a new periosteal incision, called tailed Palva incision, in cochlear implantation.Methods:A total of 280 patients who underwent cochlear implantation with the subperiosteal pocket technique between June 2008 and January 2013 were included in the study.Results:The patients were followed up for between 11 and 74 months (mean ± standard deviation = 34 ± 19 months). No intracranial complications were seen during or after the operations. Additionally, there was no migration of the receiver-stimulator. Revision surgery was performed in eight patients (3 per cent), one of whom (0.4 per cent) had local flap failure and infection.Conclusion:This study shows that the tailed Palva incision facilitates easy insertion of the implant and, by creating a one-way obscured pocket, this technique also enhances stabilisation of the receiver-stimulator, thereby avoiding anterior migration.

OBJECTIVES This study aims to evaluate the effect of paratracheal lymph node (PTLN) metastasis on survival in patients with advanced laryngeal and hypopharyngeal cancer. PATIENTS AND METHODS Medical records of advanced laryngeal and hypopharyngeal cancers who underwent surgery between May 1995 and June 2008 were assessed and 78 of the patients (63 males, 15 females; mean age 55±11.3 years; range 25 to 76 years) who has PTLN metastasis were included in this study. The mean follow-up period was 23 months. Fifty-three patients had primary laryngeal cancer, and the remaining 25 patients had primary hypopharyngeal cancer. RESULTS Paratracheal lymph node metastasis was detected in eight (15%) of 53 patients with laryngeal carcinoma, six (42%) of 14 patients with postcricoid carcinoma, and one (14%) of seven patients with posterior pharyngeal wall carcinoma. Paratracheal lymph node metastasis was not detected in patients with pyriform sinus carcinoma (n=4). Paratracheal lymph node metastasis was detected in a total of 15 patients, of whom 11 had extranodal spread (ENS). Multivariate analysis showed that the presence of ENS was the most effective prognostic factor on the overall survival (p

Objective Primary mucosal malignant melanoma of the head and neck (HN-PMMM) is an aggressive and uncommon neoplasm. Herein, we present a series of 33 patients and the results of treatment, and aimed to determine prognostic factors in HN-PMMM. Methods Patients who were diagnosed as having HN-PMMM in our reference hospital, between 2005 and 2014 were evaluated. Thirty-three of these patients who had follow-up data were included. Surgical margin status was extracted from the original pathology reports. Archived materials were retrieved for the histopathologic findings: ulceration, necrosis, lymphovascular invasion, perineural invasion, pigmentation, and presence of an in situ component. Mitotic activity was evaluated using phosphohistone H3 (PHH3) immunohistochemical staining. Results We found an association of PHH3 mitotic activity with overall survival in a univariate analysis and to our knowledge, this is the first report among the available case series of HN-PMMM to evaluate mitotic activity using immunohistochemical staining. We also investigated the relationship between multicentricity and locoregional recurrence, which the authors believe is also a first. Conclusion PHH3 mitotic activity can be used a prognostic factor for head and neck mucosal malignant melanoma.

Amac : Calismanin amaci klinigimizde uygulanan sinonazal inverted papillom cerrahisinin sonuclarini analiz ederek rekurrens ve malignite uzerine etki eden klinik ve patolojik faktorleri ortaya koymaktir. Gerec ve yontem : 2008-2015 yillari arasinda Istanbul Tip Fakultesi KBB Kliniginde inverted papillom nedeniyle cerrahi tedavi uygulanan 52 hastanin sonuclari retrospektif olarak incelendi. Hastalarin demografik verileri, eski cerrahi, kaynaklandigi anatomik yer, evre, basvuru semptomlari ve cerrahi teknik bilgisi degerlendirildi. Bulgular : Inverted papillom tanisi ile tedavi edilen 52 hastanin yas ortalamasi 59.3±12.4 olup yas araligi 32-84’tur. 52 hastanin 41’i erkek, 11’i kadindi. Hastalarin Krouse evreleme sistemine gore 1’i T1, 4’u T2, 41’i T3, 6’si ise T4 olarak dagildigi saptanmistir. Toplamda 9 hastada yassi hucreli kanser veya displazi oldugu saptanmistir. Sigaranin nuks (p=0.289) ve gecirilmis eski cerrahi (p=0.748) uzerine etkisi olmadigi, eski cerrahi oykusunun multiple yerlesimle (p=0.043) anlamli olarak iliskili oldugu saptanmistir. Ortalama takip suresi 49.5±26.6 iken; minimum-maksimum takip suresi 2-96 ay idi. Ortalama nuks suresi 41.3 ay olarak bulundu. Sonuc : Inverted papillomun nuksunu onlemede en onemli faktor yerlesim yerinin tespit edilmesi ve tam olarak eksize edilmesidir. Sigara ve eski cerrahi oykusunun rekurrensle iliskisi gosterilememekle birlikte, multiple yerlesimin tekrarlayan cerrahi ile iliskili oldugu gorulmektedir. Daha net istatistiksel sonuclarin elde edilebilmesi icin daha genis vaka serileri ve kontrollu calismalara ihtiyac vardir. Anahtar Kelimeler: intranazal cerrahi; inverted papillom; neoplazm; paranazal sinus.

Purpose: Development of carcinoma is associated with epigenetic modifications. Methylation of CpG islands in the promoter regions can participate in gene silencing and promote tumor aggressiveness. The Fragile histidine triad (FHIT) gene, localized on chromosome 3, is a tumor suppressor gene and the abnormal methylation of FHIT. The FHIT regulates the G2/M cell cycle check point and apoptotic pathwaysin various types of cancer. Inactivation of FHIT due to methylation has been shown in breast, cervical, gastric and colon carcinomas. In our study, we evaluated the FHIT gene promoter methylation in patients with larynx carcinoma (LC). Experimental Design: Methylation of FHIT was investigated by bisulfite modification/methylation-specific polymerase chain reaction in tumors and matched normal tissue samples from 57 Turkish patients with LC. Results: The promoter region of the FHIT was methylated in 96.49% and 29.82% of the primary tumors and the corresponding normal tissue samples, respectively [p = 0.0001, chi-square = 14.2105, OR(95%CI) = 64.7(14.4-296.07)]. A methylation rate (less than 10%) was observed in 3.51% (2/57) and 70.18% (40/57) of tumor and normal samples, respectively. Moderate methylation levels (10-25%) were found in 3.51% (2/57) of the tumors and 1.75% (1/57) of the adjacent normal tissues. High methylation levels (>25%) were observed in 92.98% (53/57) and 28.07% (16/57) in the tumor and normal tissues, respectively. Conclusion: Methylation may play an important role in LC carcinogenesis. Although we found that there was significant association between the methylation levels of tumor and adjacent normal tissues, high methylation levels of the FHIT was observed in the tumors when compared to the levels in normal tissue. These results suggest that the methylation rates of FHIT gene may provide a suitable biomarker in LC carcinogenesis. Our study is still in progress to include a larger cohort of patients. Citation Format: Semra Demokan, Kubra Akalin, Cansu Ozkoklesen, Murat Ulusan, Necati Enver, Nejat Dalay. Investigation of the promoter methylation status of the FHIT (fragile histidine triad) gene in larynx cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4443.

Purpose: Methylation of CpG islands in the promoter regions of genes plays an important role in head and neck carcinogenesis. Overexpression of COX2 gene was recorded in various types of cancer in literature. In addition, the promoter region of the COX2 gene displayed high methylation in normal colorectal tissue and normal gastric tissue samples. On the other hand, it has recently been reported in two different gastrointestinal cancer studies, that low expression of COX2 was observed in some colorectal/gastric cancers and hypermethylation/related transcriptional silencing of COX2 gene is common in colorectal cancer. There is no study investigating the COX2 methylation status on head and neck cancer (HNC) in the literature. In our study we evaluated the COX2 gene promoter methylation in patients with HNC. Experimental Design: Methylation of the COX2 was investigated by bisulfite modification/methylation-specific polymerase chain reaction in tumors and matched normal tissue samples from 99 Turkish patients with HNC. Results: The promoter region of the COX2 was methylated in 53.5% and 65.6% of the primary tumors and the corresponding normal tissue samples, respectively [p = 0.082, χ2 = 3.02, OR(95%CI) = 0.602 (0.34-1.06)]. Considering the methylation levels observed in our previous studies, and published data on different cancer types, methylation levels 25%) were 30.3% and 58.6% in the tumor and normal tissues, respectively (p = 0.00006, χ2 = 19.24). The results were similar when a subgroup of 60 patients with larynx cancer from this cohort, were analyzed separately (p = 0.0006, χ2 = 14.87). Conclusions: Methylation may play an important role in HNC carcinogenesis. Although we found that there was no significant association between the methylation levels of tumor and adjacent normal tissues, high methylation levels of the COX2 gene were observed (>25%) in normal matched tissues when compared to the levels in HNC tumors. Citation Format: Semra Demokan, Cansu Ozkoklesen, Zubeyde Yalniz, Necati Enver, Murat Ulusan, Nejat Dalay. Analysis of promoter methylation levels of COX2 gene in Turkish patients with head and neck cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1059. doi:10.1158/1538-7445.AM2015-1059