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Paragangliomas are rare in the larynx. When they do occur there, the most common subsite is the supraglottic compartment. Unlike other neuroendocrine tumors of the larynx, laryngeal paragangliomas are three times as common in women as in men. Although a preoperative biopsy is often performed to establish the diagnosis, this procedure carries a considerable risk of bleeding, which may necessitate a tracheotomy to secure the airway. Immunohistochemical staining is useful in the differential diagnosis to distinguish aparagangliomafrom other neuroendocrine tumors. Computed tomography and/or magnetic resonance imagingwith preoperative angiography and possible embolization are important to obtain prior to treatment. Surgical excision is the treatment of choice. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the effects of papaverine on experimentally induced myringosclerosis (MS). MS is characterized by hyaline degeneration and calcification of the lamina propria of the tympanic membrane and can adversely affect hearing function if left untreated. The study examined the potential effects of both systemic and topical applications of papaverine on this process., Materials and Methods: In the study, 20 Wistar albino rats were used. The rats were divided into 4 groups and different treatment methods were applied in each group. In group 1, myringotomy was performed, but no additional intervention was performed. In group 2, saline-impregnated gelfoam was applied after myringotomy. In groups 3 and 4, topical and systemic applications of papaverine hydrochloride were performed. Tympanic membranes were examined under a microscope after 21 days, and the severity of MS and histopathologic changes were evaluated., Results: The papaverine-treated groups observed a significant increase in otomicroscopic sclerosis, the degree of inflammation, and tympanic membrane thickness. The degree of fibrosis was higher in group 3 compared with the other groups. The results showed that papaverine administration increased the occurrence of MS., Conclusion: This study suggests that papaverine may increase MS through its vasodilating effect. Vasodilation is thought to cause an increase in oxygen-derived free radicals, which may contribute to the pathogenesis of MS. The results suggest that the effects of papaverine on MS should be carefully evaluated., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Objective: Noise-induced hearing loss is one of the leading causes of permanent hearing loss in the adult population. In this experimental study, the authors aimed to investigate the effectiveness of hypoxia and normoxia preconditioned olfactory stem cells against noise trauma., Methods: Twenty-seven female guinea pigs were enrolled. Two guinea pigs were sacrificed for harvesting olfactory tissue and 1 for examining the architecture of the normal cochlea. The remaining 24 guinea pigs were exposed to noise trauma for 1 day and then randomly divided into 3 groups: intracochlear injection of (i) normoxic olfactory stem cells, (ii) hypoxic olfactory stem cells, and (iii) physiological serum. Auditory brainstem response (ABR) measurement was performed before and 2 weeks after noise trauma and weekly for 3 weeks following intracochlear injection. Both click and 16 kHz tone-burst stimuli were used for detection of ABR., Results: No significant difference was noted between the groups before and 2 weeks after noise trauma. ABR thresholds detected after intracochlear injections were significantly higher in the control group compared with stem cell groups. However, no significant difference was detected between the stem cell groups. Fluourescence microscopy revealed better engraftment for hypoxic stem cells. Light and electron microscopy examinations were consistent with predominant degenerative findings in the control group, whereas normoxic group had more similar findings with normal cochlea compared with hypoxic group., Conclusion: Olfactory stem cells were demonstrated to have the potential to have beneficial effects on noise trauma., Competing Interests: The authors report no conflicts of interest, (Copyright © 2024 by Mutaz B. Habal, MD.)

Objective: Vitamin D has been demonstrated to play a protective role in carcinogenesis. Polymorphisms of the vitamin D receptor (VDR) genes and 24-α-hydroxylase (encoded by CYP24A1) may affect the outcome of some cancers. This study examines the effects of the VDR gene and CYP24A1 single nucleotide polymorphisms on the outcome of supraglottic larynx cancer., Patients and Methods: Patients diagnosed with supraglottic larynx cancer between 2017 and 2022 were enrolled. Single nucleotide polymorphisms of the VDR gene (rs2228570, rs731236, rs7975232, rs11574113, rs11168267 and rs11168266) and CYP24A1 gene (rs4809960, rs6022999, rs6068816, rs2259735 and rs2296241) were investigated. All patients were followed up for any evidence of local recurrence, regional recurrence, distant metastasis, and second primary tumor development. Cox regression analysis was performed to evaluate the prognostic value of single-nucleotide polymorphisms (SNPs). Kaplan-Meier method was used for survival analysis., Results: 87 patients were included. The mean follow-up time was 45.02±24.47 months. Cox regression analysis for locoregional recurrence revealed that the hazard ratio of rs731236 GG was 2.098 (95% CI, range: 1.047-4.202, p=0.037). Locoregional recurrence for rs731236 AA, AG, and GG were 38.6%, 23.1%, and 53.3%, respectively. In the presence of rs731236 GG polymorphism, disease-specific survival was significantly shorter (47.63±7.48 months, p=0.015), and disease-free survival (45.71±6.3 months) was significantly shorter (p=0.040). Rates of metastases and second primary tumors were not significantly different between SNPs., Conclusions: This study has demonstrated the possible effects of VDR rs731236 SNP on the locoregional recurrence and prognosis of supraglottic larynx cancer.

Background: Intratympanic steroids (ITS) in treating sudden sensorineural hearing loss (SSNHL) have become more widespread., Aim: This study investigates whether ITS treatment provides additional benefits when combined with systemic steroids (SS) in patients with severe and profound SSNHL., Materials and Methods: Patients diagnosed with severe and profound SSNHL were divided into two groups: SS group and SS combined with ITS group. Pure-tone audiometry was performed before and three months after treatment completion. The pure-tone average (PTA), frequency-specific hearing gains, and average values were compared between the groups., Results: The study included 57 patients (27 SS, 30 ITS), with a mean age of 50.09 ± 15.56. Before treatment: SS PTA 84.40 ± 15 dB HL, ITS 87.50 ± 9.38 dB HL (p = 0.36). After treatment: SS 62.2 ± 23.13 dB HL, ITS 65.17 ± 12.19 dB HL (p = 0.55). Average hearing gain: SS 22.19 ± 13.81 dB HL, ITS 22.33 ± 12.24 dB HL (p = 0.96). Frequency-specific gains were similar (p > 0.05). SS group: 12 slight improvement, 10 no improvement, 3 partial, 2 complete recovery. ITS group: 23 slight improvement, 6 no improvement, 1 partial., Conclusion: In our study, combining ITS with SS treatment did not provide additional benefits in treating severe and profound SSNHL., Competing Interests: Declaration of competing interest No conflict of interest was declared by the authors., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: The aim of this paper was to evaluate the change in 25-hidroxyvitamin D (25(OH)D) levels before and during the COVID-19 pandemic., Methods: In this retrospective, cross-sectional and methodological study included 86,772 patients (18-75 years) samples who were admitted to the Izmir Dokuz Eylul University Hospital (latitude and longitude (Turkey): 27 E 09; 38 N 25, respectively) for various reasons and whose 25(OH)D levels were measured in the biochemistry unit between 2019-2020 and 2020-2021 (before and during the COVID-19 outbreak). A time series analysis of monthly averages for 25(OH)D was performed. For the purpose of seasonal study, the mean levels of 25(OH)D are grouped by years. Data were modeled in terms of 25(OH)D levels using the MATLAB Curve Fitting Toolbox., Results: There was no significant difference between the sexes according to 25(OH)D levels (p>0.05). 25(OH)D levels were significantly higher in the summer months and lower in the winter months (p<0.001). When comparing the spring months, 25(OH)D levels in 2020 (18 ± 10) were found to be significantly lower than in 2019 (22 ± 12) (p<0.001); on the contrary, when examined based on the summer, autumn, and winter months, it was determined that 25(OH)D levels increased in 2020 (summer: 25 ± 13, autumn: 25 ± 14, and winter: 19 ± 10) compared to 2019 (summer: 23 ± 11, autumn: 22 ± 10, and winter: 19 ± 11) (p<0.001). In the estimates curve obtained with an error margin of 11% in the time series analysis, it was estimated that the 25(OH)D averages after the pandemic would be similar to those before the pandemic., Conclusions: Restrictions, partial or complete closures, and curfews can significantly affect individuals' 25(OH)D levels during the COVID-19 outbreak. There is a need for multicenter studies with larger populations covering different regions to strengthen and support our results., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Arayıcı et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To examine the complication rate in adult patients during and after cochlear implantation., Methods: A retrospective chart review was conducted of patients who had undergone cochlear implantation at a tertiary referral centre between 2009 and 2018. All complications and their treatments were categorised as either minor or major, as well as intra- or post-operative., Results: The records of 392 patients with 395 implants were reviewed. The mean follow-up period was 89 ± 65.5 months (range, 6-408 months). The mean age of patients was 46 ± 15.2 years (range, 19-84 years). Sixty-two patients (16 per cent) had minor complications and 31 (8 per cent) had major complications., Conclusion: Although cochlear implantation has the potential for significant intra- and post-operative complications, the actual complication rate is relatively low, and it can therefore be considered a safe procedure.

Background: It is aimed to investigate the incidence of cerebrospinal fluid gusher in cochlear implantation and the association between cerebrospinal fluid gusher and inner-ear malformations in adult and pediatric patients., Methods: A retrospective case review of 1025 primary cochlear implantation procedures was performed. Patients with inner-ear malformation or cerebrospinal fluid gusher during primary cochlear implantation were included and divided into 2 groups according to age: pediatric and adult groups., Results: The incidence of inner-ear malformation was 4.19% (17/405) and 7.6% (47/620) in the adult and pediatric groups, respectively. There was a significant difference in the incidence of inner-ear malformation in the pediatric group. The incidence of cerebrospinal fluid gusher was 0.9% (4/405) and 4.1% (26/620) in the adult and pediatric groups, respectively. There was a significant difference in the incidence of gusher between the adult and pediatric groups., Conclusion: The incidence of a cerebrospinal fluid gusher is higher in the pediatric group, compared to adults due to a higher rate of inner-ear malformation. Inner-ear malformation poses a risk factor for cerebrospinal fluid gusher.

Abstract: We aimed to evaluate whether the nasal septum deviation affects the development of sinonasal structures. Patients who had undergone paranasal sinus computed tomography (PNS-CT) imaging due to nasal obstruction were divided into 3 groups according to the septal deviation angle; group I: 0° to 9°, group II: 10° to 15°, and group III: >15°. The features of sinonasal structures were recorded when evaluating PNS-CT. There were totally 234 patients, 119 patients in group I, 68 in group II, and 47 in group III. On the opposite side of the deviation, keros 3 was significantly more in group III ( P < 0.001). Although the incidence of concha bullosa and agger nasi cell were not affected by the degree of deviation ( P > 0.05), the incidence of Haller and Onodi cells were significantly higher in group III ( P < 0.001). In addition, all cells were observed more in the opposite side of the deviation in each group ( P < 0.001). Maxillary sinus retention cysts and hypoplasia of maxillary and frontal sinuses, as an indicator of the low pneumatization of the sinuses, are seen more on the same side of nasal septum deviation, increasing with the degree of deviation increases ( P < 0.001). Nasal septum deviation affects the development of sinonasal structures by affecting the pneumatization. Preoperative PNS-CT evaluation is important in order to be aware of the situations that we may encounter during surgery and to provide adequate treatment., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by Mutaz B. Habal, MD.)

Objective: This study aimed to evaluate and compare cases of simultaneous and consecutive bilateral cochlear implantation from the perspective of the duration of anaesthesia, surgical complications and hospitalisation., Method: Fifty patients with simultaneous bilateral cochlear implantation (group 1) and 47 patients with consecutive bilateral cochlear implantation (group 2) were included in this study. The two groups were compared in terms of the duration of anaesthesia, the duration of surgery, radiological findings, the complications and the post-operative hospitalisation time., Results: Group 1 had a significantly shorter operation time than group 2 (p < 0.01). The mean total operation time was 189 minutes in group 1. In group 2, the mean operation times for the first and second surgery were 134 minutes and 136 minutes, respectively, and the total operation time for both surgical procedures in group 2 was 270 minutes. The duration of post-operative hospitalisation of the patients in group 1 was significantly shorter than the total post-operative hospitalisation after both operations for the patients in group 2 (p < 0.01)., Conclusion: In conclusion, if there is no anatomical problem that may lead to a prolonged operation time or any risk regarding anaesthesia, simultaneous bilateral cochlear implantation can be performed safely.

Hypothesis: The ototoxic effects of aminoglycosides are well known. Gentamicin carries a substantial risk of hearing loss. Gentamicin is widely used to combat life-threatening infections, despite its ototoxic effects. Calcium dobesilate is a pharmacologically active agent used to treat many disorders due to its vasoprotective and antioxidant effects. We investigated the therapeutic role of calcium dobesilate against gentamicin-induced cochlear nerve ototoxicity in an animal model., Methods: Thirty-two Sprague Dawley rats were divided into four groups: Gentamicin, Gentamicin + Calcium Dobesilate, Calcium Dobesilate, and Control. Preoperative and postoperative hearing thresholds were determined using auditory brainstem response thresholds with click and 16-kHz tone-burst stimuli. Histological analysis of the tympanic bulla specimens was performed under light and transmission electron microscopy. The histological findings were subjected to semiquantitative grading, of which the results were compared between the groups., Results: Gentamicin + Calcium Dobesilate group had, on average, 27 dB better click-evoked hearing than Gentamicin group (p < 0.01), whereas the difference was not significant with 16-kHz tone-burst stimuli (p > 0.01). Histologically examining the Control and Calcium Dobesilate groups revealed normal ultrastructural appearances. The Gentamicin group showed the most severe histological alterations including myelin destruction, total axonal degeneration, and edema. The histological evidence of damage was significantly reduced in the Gentamicin + Calcium Dobesilate group compared with the Gentamicin group., Conclusion: Adding oral calcium dobesilate to systemic gentamicin was demonstrated to exert beneficial effects on click-evoked hearing thresholds, as supported by the histological findings.

Objective: The aim of this study was to investigate the effects of intracordal estradiol and dexamethasone injection on wound healing in vocal fold injuries., Study Design: A prospective controlled animal study was carried out., Setting: This study was conducted at a tertiary center., Subjects-Methods: Ten rabbits were randomly divided into two groups. As surgical procedure, cordotomy technique was performed in the middle third of the vocal folds bilaterally. In the first group, 0.1 mL of dexamethasone was injected into the right side, and 0.1 mL of saline was injected into the left side. In the second group, 0.1 mL of estradiol was injected into the right side, and 0.1 mL of saline was injected into the left side. Animals were sacrificed after 1 month and laryngeal specimens were evaluated histopathologically., Results: No statistically significant difference was observed in terms of inflammatory response, epithelial thickness, type I and III collagen, and hyaluronic acid parameters in dexamethasone and estradiol injections compared to the saline injection. In terms of elastin level, estradiol injection demonstrated statistically higher values compared to the saline injection. Elastin level of dexamethasone injected vocal folds was not statistically different compared to the saline injection. No significant differences were observed in terms of inflammatory response, epithelial thickness, type I and III collagen, and hyaluronic acid parameters between the estradiol and dexamethasone injected vocal folds., Conclusion: It is thought that the effects of estradiol or dexamethasone injections may have similar effects on wound healing in vocal fold injuries. Intracordal estradiol injection has positive effects on tissue elastin levels., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the course of lower cranial nerves (CNs) within the neck in relation to surrounding structures and anatomic landmarks via a cadaveric dissection study., Methods: A total of 70 neck dissections (31 bilateral, 8 unilateral) were performed on 39 adult fresh cadavers [mean (SD) age: 38.5 (11.2) years, 29 male, 10 female] to identify the course of lower CNs [spinal accessory nerve (SAN), vagus nerve and hypoglossal nerve] within the neck in relation to surrounding structures [internal jugular vein (IJV), common carotid artery (CCA)] and distance to anatomical landmarks (cricoid cartilage, hyoid bone, digastric muscle)., Results: SAN travelled most commonly anterior to IJV (51.4%) at the level of jugular foramen, while travelling lateral to IJV at the post belly of digastric (55.7%) and inferior to digastric muscle (90%) in most neck dissections. Vagus nerve travelled lateral to CCA in majority (94.3%) of dissections, while medial (2.9%), posterolateral (1.4%) and posterior (1.4%) positions were also noted. Average distance of hypoglossal nerve was 27.7 (9.7) mm to carotid bifurcation, 9.3 (3.9) mm to hyoid bone, and 54.7 (18.0) mm to the inferior border of cricoid cartilage., Conclusion: In conclusion, our findings indicate that anatomic variations are not rare in the course of lower CNs within the neck in relation to adjacent structures, and awareness of these variations together with knowledge of distance to certain anatomic landmarks may help the surgeon to identify lower CNs during neck surgery and prevent potential nerve injuries.

Objective of this study is to determine the etiology of patients applied with revision endoscopic dacryocystorhinostomy (DCR) and to evaluate the operation results.The patients were retrospectively evaluated in respect of demographic data, the time from primary to revision surgery, revision etiology, the use of bicanalicular silicone nasolacrimal tube (BNLT), the time to postoperative removal of the silicone tube, and the success of the revision surgery.The study included 27 patients applied with revision endoscopic DCR between January 2013 and January 2016. The mean age of the patients was 46.7 ± 11.7 years. The mean time from the first operation to revision surgery was 7.2 ± 6.1 months (range, 1-24 months). During the endoscopic DCR, synechia was observed in 2 (7.4%), granulation tissue in 7 (25.9%), inadequate bone window in 5 (18.52%), and membranous scar around the ostium in 22 (81.4%) patients. More than 1 etiologic problem was determined in 8 patients. During the revision procedure, BNLT was applied to 12 (44.4%) patients. At the final follow-up examination, the complaint of epiphora had completely recovered in 18 (66.6%) patients and there were in 9 (33.3%) patients. The mean time to removal of the BNLT was 1.7 ± 0.57 months (range, 1-3 months).The most common cause of recurrent epiphora in endoscopic DCR was the formation of membranous scar. The use of the mucosal flap technique in primary surgery and the application of BNLT to all patients in revision surgery may increase the functional success rate.

Objectives: To evaluate the satisfaction with life among mothers of pediatric cochlear implant candidates regarding implant surgery and sociodemographic factors., Materials and Methods: Mothers of 160 pediatric patients with profound sensorineural hearing loss who underwent unilateral cochlear implant surgery were included. A questionnaire form with items on sociodemographic-familial characteristics and Satisfaction with Life Scale (SWLS) was employed via face-to-face interview method before and 12 months after the implant surgery., Results: The SWLS scores significantly improved after the implant surgery [from 19.1 (7.0) to 28.9 (4.0), p<0.000]. Being unemployed vs. employed [17.9 (6.9) vs. 24.0 (5.3), p=0.000], having another child with hearing disability [13.5 (5.7) vs. 19.7 (6.9), p=0.001], younger (12-24 months) vs. older (>24 months) age of the child at the time of implant surgery [7.1 (0.4) vs. 19.7 (6.6), p=0.001], absence vs. presence of regular follow-up visits [13.0 (0.0) vs. 19.4 (7.1), p=0.002], and presence vs. absence of change in social life after the diagnosis of disease [17.3 (6.5) vs. 20.9 (7.1), p=0.001] were associated with significantly lower SWLS scores among mothers. SWLS scores were positively correlated with patient's age at the time of implant surgery (r=0.206, p=0.009), whereas negatively correlated with the number of household members (r=-0.406, p=0.000) and number of children (r=-0.310, p=0.000)., Conclusion: In conclusion, our findings revealed the association of cochlear implantation with a significant increase in mother's life satisfaction, despite the unemployment, presence of another child with hearing disability, and crowded household. Our findings emphasize on the consideration of family systems with special attention to mother's emotional experiences and occupational competence in the intervention programs.

Objective: To identify the vertebral artery blood flow in different head positions in patients with positional vertigo with no specific diagnosis., Methods: Patients with history of vestibular symptoms associated with changes in head position were enrolled into the study. Healthy volunteers were evaluated as control group. Doppler ultrasonography examination of the cervical segment of the vertebral arteries was performed under three different head positions: (i) supine position, (ii) head hyperextended and rotated to the right side and (iii) head hyperextended and rotated to the left side., Results: In the study group, right and left vertebral artery blood flow was significantly lower in the ipsilateral hyperextended position compared to standard supine position (respectively p = .014; p = .001), but did not differ significantly when compared between the standard supine and contralateral hyperextended positions (respectively = .959; p = .669). In the control group, left and right vertebral artery blood flow did not differ significantly when the head was hyperextended to the right or left sides compared to standard supine position (p > .05)., Conclusions: Our data demonstrated that the etiology of vestibular complaints in patients with undiagnosed positional vertigo might be related to impairment in vertebral artery blood flow according to head positions.

Objective: Radioiodine therapy (RIT) is frequently utilized as an adjunctive treatment option for differentiated thyroid carcinoma following surgical intervention. The side effects of RIT are considered to emerge as a result of radioiodine accumulation in non-thyroidal tissues capable of iodine uptake. We aimed to evaluate the effects of RIT on auditory function., Materials and Methods: Patients who had undergone total thyroidectomy and diagnosed to have differentiated thyroid carcinoma were analyzed. Those who were given RIT were included. Pure-tone audiometry and distortion product otoacoustic emission (DP-OAE) results were recorded along with patient demographics, RIT dose, and thyroid hormone profiles, both before and 3 months after RIT., Results: Here, 63 patients were enrolled. Following RIT, audiometric thresholds at 0.25, 0.5, 4, and 8 kHz in addition to pure-tone average increased significantly; however, the change in DP-OAE results was not statistically significant at any frequency. The RIT dose had no effect on auditory function., Conclusion: In this study, we found some deleterious effects of RIT on audiometric thresholds, with no significant effect on DP-OAE results.

Objective: Aminoglycosides, used to combat with life-threatening infections, have a substantial risk of hearing loss. Nigella sativa is an annual herbaceous plant and used for treatment of many diseases for ages. We aimed to investigate the protective role of intratympanic nigella sativa oil against gentamicin induced hearing loss in an animal model., Methods and Materials: Twenty eight guinea pigs were randomly divided into four groups: i-control, ii- Intratympanic nigella sativa oil (IT-NSO), iii- Intraperitoneal gentamicin (IP-G) and iv- Intraperitoneal gentamicin and intratympanic nigella sativa oil (IP-G + IT-NSO). Preoperative and postoperative hearing thresholds were determined with auditory brainstem response with click and 8 kHz tone-burst stimuli. Histological analysis of the cochlea specimens were performed under light microscope. Semiquantitative grading of the histological findings was carried out and compared between the groups., Results: Highest posttreatment hearing thresholds were detected in IP-G group. Posttreatment mean hearing threshold of the IP-G group with click stimulus was significantly higher than the IP-G + IT-NSO group (p = 0.004). whereas the difference was not significant with 8 kHz tone-burst stimulus (p = 0.137). Both IP-G and IP-G + IT-NSO groups had significantly higher hearing thresholds compared to control and IT-NSO groups (p > 0.05). Histological examination of the control and IT-NSO groups demonstrated normal appearance of cochlear nerve, stria vascularis and organ of Corti. IP-G group showed the most severe histological alterations including hydropic and vacuolar degenerations, hair cell damage and deformation of the basilar mambrane. Histological evidence of damage was significantly reduced in IP-G + IT-NSO group compared to IP-G group., Conclusion: Addition of intratympanic NSO to systemic gentamicin was demonstrated to have beneficial effects in hearing thresholds which was supported by histological findings., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: To evaluate the functional integrity of the facial nerve and blink reflex (BR) pathways in asymptomatic patients who underwent cochlear implantation (CI)., Study Design: Case series with planned data collection., Setting: Tertiary referral center., Subjects and Methods: Twenty-four deafened patients with unilateral CI who had no complications were enrolled. Bilateral compound muscle action potentials (CMAPs) of the facial nerve were recorded over the nasalis and occipitalis muscles, whereas BR responses were recorded over the orbicularis oculi after supraorbital nerve stimulation. All recordings were performed when the external part of the implant was in place (CIp) and after its removal (CIr), except occipitalis recordings, which were performed only after removal. The amplitude and latency of CMAP were measured to evaluate the axonal integrity of the zygomatic and posterior branches of the facial nerve. Latency, amplitude, and duration of the BR were measured to investigate the integrity of trigeminofacial connections., Results: The amplitude and latency of CMAP over the nasalis muscle were bilaterally normal, and the difference between CIp and CIr was not statistically significant. No CMAP of the occipitalis muscle was recorded in 4 (16.7%) patients, and low-amplitude responses were recorded on the implant side of 20 (83.3%). Amplitudes of the contralateral R2 response were higher in the CIp condition versus the CIr condition (P = .031). There were no differences among other BR components., Conclusion: During functioning of the CI system, excitability of the facial circuit may increase either through the facial motor nucleus or through removal of the inhibitory effect of the descending pathway., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.)

Objective: Fine-needle aspiration biopsy (FNAB) is widely used in the management of salivary gland masses. Its main advantage is its ability to differentiate benign from malignant disease. In this study, we aimed to evaluate the diagnostic ability of FNAB in salivary gland masses., Methods: The records of patients who had undergone FNAB before parotidectomy or submandibular gland excision between 2005 and 2013 were retrospectively analyzed. FNAB results were classified as negative, positive, suspicious for malignancy, and non-diagnostic. Preoperative FNAB results were compared with definitive histopathological results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of FNAB results were calculated., Results: A total of 285 patients were enrolled. Among them, 230 (80.7%) had parotid gland and 55 (19.3%) had submandibular gland masses. Following a definitive histopathological examination, the most common benign tumor was pleomorphic adenoma (52.6%), whereas malignant tumors were mucoepidermoid carcinoma (2%) and squamous cell carcinoma (2%). The sensitivity, specificity, PPV, NPV and accuracy of FNAB results were 76.9%, 95.4%, 75%, 95.9%, and 92.6%, respectively. The rate of a suspicious cytology was 5.2% (15 patients) and that of a non-diagnostic cytology was 8.8% (25 patients)., Conclusion: FNAB is a safe and simple diagnostic tool for the diagnosis of salivary gland masses and has a relatively high sensitivity and specificity. It may provide valuable information for patient counselling and surgical planning. The major drawbacks include a lower sensitivity than specificity and a relatively high rate of non-diagnostic results., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Objective: To evaluate the effectiveness of malleus to stapes bone cement rebridging (MS-BCR) for Austin Kartush group A ossicular defects and compare the audiological results with incus interposition (IP) and incus to stapes bone cement rebridging (IS-BCR)., Methods: Patients for whom type 2 tympanoplasty had been performed in a tertiary referral center were examined. Revision cases and those with graft failure were excluded. Three treatment groups were IS-BCR, IP, and MS-BCR. Preoperative and postoperative audiological results were compared., Results: A total of 92 patients were enrolled. The IS-BCR was performed in 42 (45.65%), IP in 18 (19.56%), and MS-BCR in 32 (34.78%) patients. Postoperative mean air bone gap was 20.1 ± 9.8 dB HL and did not differ significantly between the groups (P = .271). Postoperative mean air bone gap less than 20 dB HL was achieved in 23 (54.7%) patients in IS-BCR, 10 (55.5%) patients in IP group, and 24 (75%) patients in MS-BCR group (P = .06). Mean closure in air bone gap was 14.0 ± 11.6 dB HL. The changes in mean and frequency-specific air bone gap were not significantly different between treatment groups (P > .05)., Conclusion: Malleus to stapes bone cement rebridging may provide hearing results comparable to IS-BCR and IP., (© The Author(s) 2015.)

Objective: The objective was to identify and evaluate factors that may influence the recovery rate in patients with idiopathic sudden sensorineural hearing loss (ISSNHL)., Materials and Methods: A retrospective analysis was performed for patients with sudden sensorineural hearing loss between 2009 and 2013. Those with an identified etiology were excluded. The patients were divided into four treatment groups: (i) systemic corticosteroids (SC) only, (ii) SC+low-molecular-weight heparin (LMWH), (iii) SC+hyperbaric oxygen (HBO), and (iv) SC+LMWH+HBO. Recovery was evaluated according to Siegel's criteria. Age, initial hearing level, onset, treatment and audiogram types, comorbidities, and associated tinnitus and vestibular symptoms were investigated for their impact on prognosis., Results: Two hundred five patients with ISSNHL were included. Recovery was seen in 59% of the patients. The complete recovery rate was significantly lower in patients older than 60 years and in patients presenting with profound hearing loss. Different audiogram curves had no significant effect on recovery. Sudden hearing loss was accompanied by tinnitus in 107 (52.1%) patients and vestibular symptoms in 55 (26.8%); however, neither was noted to affect prognosis. Different treatment combinations did not significantly affect prognosis. However, hypertension and a delay in treatment by more than 10 days from the onset of hearing loss were associated with a worse prognosis., Conclusion: Profound hearing loss, older than 60 years, a delay in treatment by more than 10 days, and hypertension were negative prognostic factors in this study, whereas, the type of audiogram curve and addition of HBO to SC did not affect prognosis.

Objective: To evaluate the validity of early (within 3 wk) and late-term (after 3 wk) electroneurography (ENoG) findings in Bell's palsy (BP) to predict the prognosis., Study Design: Retrospective case review., Setting: Tertiary referral center., Patients: Patients with peripheral facial paralysis with no identified cause. All patients were given the same treatment., Intervention(s): House Brackmann (HB) grading and ENoG., Main Outcome Measures: The records of 38 patients with BP were retrospectively analyzed. This study included only those patients who had been followed up for at least 4 months on a regular basis or until complete recovery. ENoG was performed for orbicularis oculi and orbicularis oris muscles and degeneration ratio was calculated separately. Correlation between HB grading and ENoG findings, relationship between duration for maximum recovery and ENoG findings, and also initial HB grading and recovery rate were investigated., Results: Complete recovery rate was significantly higher in patients with HB grades I to III at initial examination. A significant correlation was found between HB grading and degree of ENoG degeneration at the 7th and 14th days of FP. Patients with degeneration less than 80% for orbicularis oculi and less than 65% for orbicularis oris had significantly better and faster recovery than those with higher level of degeneration (p < 0.05)., Conclusion: ENoG and HB grading during first to fourth weeks of BP are useful prognostic indicators. Serial ENoG examinations are recommended to predict the status of neural degeneration and the prognosis of the palsy. However, ENoG in late term may not be compatible with clinical facial function.

Objective: Nonorganic hearing loss (NOHL) is a lack of consistency in audiological testing. Although NOHL is relatively rare, it is important to identify suspicious patients. This study was designed to evaluate the effectiveness of Stenger test and acoustic reflexes test (ART) in the evaluation of patients with suspicious of unilateral NOHL., Study Design: A prospective study Methods: In this study, 474 adult patients with suspicious unilateral profound or total hearing loss were included. Pure tone audiometry (PTA), speech audiometry, Stenger test, ART and click-evoked auditory brainstem response (ABR) measurements were performed. The sensitivity, specificity and predictive values of the Stenger test and ART for unilateral, profound to total NOHL were assessed by comparing these with the results of ABR., Results: The sensitivity and specificity of the Stenger test in verifying unilateral, profound hearing loss were 99% and 57%, respectively. The positive and negative predictive values of the test were 88% and 97%, respectively. The sensitivity and specificity of the ART in verifying unilateral, profound hearing loss were 96% and 60% at 1000 Hz and 98% and 60% at 2000 Hz, respectively. The positive and negative predictive values of the ART were 50% and 97% at 1000 Hz, and 75% and 97% at 2000 Hz, respectively., Conclusion: The Stenger test and ART are widely used for the evaluation of unilateral or asymmetrical NOHL. In our opinion, these tests are significantly powerful. More difficult cases require ABR to verify nonorganic hearing loss and to exclude specific diagnoses that may imitate NOHL.

Septorhinoplasty aims to improve not only the esthetic appearance but also breathing function of the nose. Although the esthetic improvement can be judged by the patient and the surgeon easily, evaluation of nasal breathing is more complicated. Besides the subjective symptom scores given by the patient, some objective methods have been developed. One of the most widely used of these objective methods is acoustic rhinometry, which gives valuable information about the cross-sectional areas and volumes of the nasal airway as a function of distance from the nostril. Since the introduction of acoustic rhinometry, many papers were reported regarding its efficiency with some conflicting conclusions. Septorhinoplasty has the potential to narrow the nasal airway, especially if it includes lateral osteotomies and hump reduction. We aimed to evaluate the role of rhinoplasty on nasal obstruction with the help of subjective symptom scores and acoustic rhinometry. The study consisted of 26 patients who underwent septorhinoplasty. Before and after surgery, the symptom scores and findings of acoustic rhinometry were collected both before and after decongestion of the nasal mucosa. Symptom scores decreased on both sides, which were statistically significant (p < 0.05), however, the changes in cross-sectional areas of the nasal airway were not statistically significant (p > 0.05). The correlation between the symptom scores and acoustic rhinometry findings was not significant for all levels. The effect of septorhinoplasty on nasal airway and some important maneuvers to protect against nasal obstruction are discussed.

Metaplasia is the conversion of one adult tissue or cell type into another tissue or cell type. Although osseous metaplasia has been described in many parts of the body, it is rarely encountered in the head and neck region, especially in nasal polyps. This article reports a case of unilateral sinonasal polyp containing areas of osseous metaplasia in a 44-year-old woman presenting with nasal obstruction. Also included are a brief discussion of osseous metaplasia in the head and neck region and a literature review.

The aim of this study was to investigate the effects of four different types of nasal packs on pain, nasal fullness and postoperative bleeding following septoplasty. Prospective randomised double blind study was conducted. The study group included 119 patients who underwent endonasal septoplasty under general anaesthesia. Four types of nasal packing materials were utilized: (1) Merocel standard 8-cm nasal dressing without airway, (2) Doyle Combo splint (DCS), (3) Merocel in a glove finger and (4) Vaseline gauze. All packs were removed at the 48th hour (±3 h) after the surgery. Three different variables were investigated following the surgical procedure: (1) pain, (2) nasal fullness and (3) bleeding after removal of the nasal packing material. DCS produced the greatest pain at the first and sixth postoperative hours. At the first postoperative day, the greatest pain score was reported for Merocel in the glove finger and the least for Merocel. The pain scores during the removal of the nasal packings were highest for Merocel and lowest for Merocel in the glove finger. DCS had the lowest nasal fullness score. Bleeding ratio was highest for Merocel, followed by Vaseline gauze, DCS and Merocel in the glove finger. Many different commercially available packing materials are presently used, each with inherent advantages and disadvantages. We evaluated the pain, nasal fullness and bleeding potential of four nasal packing materials and determined that Merocel had the highest pain potential during removal and the highest rate of bleeding following removal.

Idiopathic sudden sensorineural hearing loss is a rare disorder of unknown pathogenesis in which hearing is lost partially or totally. About 60 treatment modalities have been described. We aimed to compare the efficacy of hyperbaric oxygen, oral steroid, intratympanic steroid therapy and their combinations in idiopathic sudden sensorineural hearing loss patients. Files of patients who were followed up between 2004 and 2010 in our clinic were examined retrospectively. Patients were divided into four groups according to the therapy received: Oral steroid, oral steroid + hyperbaric oxygen, intratympanic steroid and hyperbaric oxygen. Treatment success was assessed by Siegel criteria and mean gains using pre-treatment and post-treatment audiograms. 217 patients and 219 ears were examined. The proportion of patients responding to therapy was the highest in the oral steroid + hyperbaric oxygen group with 86.88% (53/61) followed by the oral steroid group with 63.79% (37/58), the intratympanic steroid group with 46,51% (20/43) and the hyperbaric oxygen group with 43.85% (25/57). The proportion of patients who had complete recovery was the highest in the oral steroid + hyperbaric oxygen group with 42.6% (26/61) followed by the oral steroid group with 19.0% (11/58), the hyperbaric oxygen group with 17.5% (10/57) and the intratympanic steroid group with 11.6% (5/43). The oral steroid + hyperbaric oxygen group has the highest mean hearing gain among all groups (p < 0.05). Idiopathic sudden sensorineural hearing loss patients receiving oral steroid + hyperbaric oxygen combination therapy have a higher likelihood of recovery than patients receiving oral steroids, hyperbaric oxygen or intratympanic steroids alone.

Malignant peripheral nerve sheath tumor (MPNST), which originates in Schwann cells, is uncommon in the head and neck. These highly aggressive sarcomas are characterized by local recurrence and distant metastasis. Many are associated with neurofibromatosis type 1; the survival rate in such cases is poorer than the rate associated with tumors that arise de novo. Hypercellularity and pleomorphism are cardinal microscopic features. Immunohistochemical staining is widely used to determine S-100 positivity and a Ki-67 score, either of which may establish the prognosis. We present a case of MPNST of the neck that arose in a 17-year-old girl, who was also found to have a parapharyngeal neurofibroma. The cervical mass was excised (intraoperative complications precluded removal of the parapharyngeal mass) and radiotherapy was administered, but the patient experienced a recurrence within 2 months. Another surgery was performed, and this time both tumors were removed. At 1 year of follow-up, the patient was without disease, but in postoperative year 2, she died from complications of a cervical recurrence and mediastinal metastasis.

Myxomas are benign mesenchymal tumors of uncertain etiology. They can arise from odontogenic tissue, as well as from the sinonasal tract and from the facial and temporal bones, apparently from nonodontogenic mesenchyme. Although histologically benign, myxomas are locally invasive. Histopathology demonstrates a characteristically hypocellular lesion with loose stellate cells. We describe the case of a 48-year-old woman with a nonodontogenic maxillary sinus myxoma that invaded the sphenoid sinus and pterygopalatine fossa. We removed the mass via a combined endoscopic and gingivobuccal approach. The rarity of a nonodontogenic sinonasal myxoma extending into the sphenoid sinus and pterygopalatine fossa is the basis for our presentation of this case.

Benign tumors of the nerve sheath are of 2 types: schwannoma and neurofibroma. Neurofibromas are most commonly found with neurofibromatosis type 1 and characterized by incorporation of the nerve fibers within their matrix. Both benign and malignant tumors can affect the facial nerve. These tumors can be intrinsic or extrinsic; in other words, it can originate from the facial nerve itself or from a contiguous structure or a metastatic disease. Actually, extrinsic tumors are far more common than intrinsic tumors. Intraparotid location of benign tumors of the facial nerve sheath is considered a rare event compared with intratemporal location.

The case of a 29-year-old patient with active laryngeal tuberculosis predominantly involving the epiglottis, without pulmonary disease, is presented. The predominant symptoms are dysphagia, odynophagia, and hoarseness. Laryngeal carcinoma, which shares almost the same symptoms and signs, should be ruled out immediately. Laryngeal tuberculosis is discussed with a brief literature review.

The objective of the prospective study is to examine the laryngeal changes by laryngeal videostroboscopy and electromyography (EMG) regarding new-onset dysphonia in asthmatic patients taking inhaled corticosteroids (ICS). Laryngeal changes and electrophysiological status of the laryngeal muscles were evaluated by these methods in 12 patients both at the time of presentation of dysphonia and after cessation of therapy. Laryngeal changes of our patients were mucosal edema, erythema, thickening, adduction deficit, nodule and irregularity in videostroboscopy. Significant correlations were found between laryngeal pathology and dosage and duration of ICS therapy. We detected myopathy by EMG in most of the patients. Also, EMG revealed that cricothyroid muscle was much more affected than thyroarytenoid muscle. In conclusion, we consider that steroid myopathy or mucosal inflammatory theory alone is not sufficient to explain the etiopathogenesis of dysphonia in asthmatic patients taking ICS. The laryngeal mucosal changes were detected by laryngeal videostroboscopic examination in some asthmatic patients, with dysphonia using ICS, and/or laryngeal myopathy was found by laryngeal EMG in some of them in this study. Thus, various factors may have role simultaneously in the occurrence of dysphonia.

Hypoglossal schwannoma is a rarely encountered skull base lesion that has generally both intracranial and extracranial parts. This article reports a case of hypoglossal schwannoma that is purely extracranial and presents itself only with persistent headache. Magnetic resonance imaging delineated a mass at the skull base that consisted of both cystic and solid components, consistent with a nerve sheath tumor. Cervical approach was chosen, and the mass was completely removed. Postoperatively, the patient developed hypoglossal nerve palsy because the hypoglossal nerve was sacrificed. Hypoglossal schwannomas are briefly discussed with a literature review.

A case of a 43-year-old white woman who was admitted to our clinic with the complaints of chronic sinusitis and wound infection after Caldwell-Luc operation performed for chronic sinusitis is presented. Necrotic lesion then extended to the nasal cavity and skin of the face. The biopsy revealed natural killer/T-cell lymphoma. The patient was treated with chemotherapy; however, the patient died owing to sepsis. Sinonasal lymphoma is a rare disease. It is managed with chemotherapy and radiotherapy. The prognosis is poor. A high index of clinical suspicion is required for early diagnosis.

Background and Aims: Paragangliomas of the head and neck are highly vascular lesions originating from paraganglionic tissue located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity (jugulotympanic paragangliomas) and should be considered in the evaluation of all lateral neck masses. The aim of this study is to review an institutional experience in the management of these tumors., Materials and Methods: Twenty-six patients with 27 paragangliomas were treated in our institution during a period of 7 years (2000-2007). There were 15 women (57.6%) and 11 men (42.4%) with a mean age of 33.5 years. A painless lateral neck mass was the main finding in 16 patients (61.5%). There was no evidence of a functional tumor. Carotid angiography was performed on all of our patients (100%) to define the vascular anatomy of the lesion. Twenty-two paragangliomas (of the 25 operated paragangliomas; 88%) underwent selective embolization of the major feeding arteries. We performed surgery on 24 (92.3%) patients. Two patients were treated with radiotherapy., Results: Most lesions were paragangliomas of the carotid bifurcation (n = 14 [51.8%]), whereas 6 patients were diagnosed with jugular (22.2%), 1 with a vagal (3.7%), 1 with a tympanic paraganglioma (3.7%), 2 with jugulotympanic paraganglioma (7.4%), and 1 with laryngeal paraganglioma (3.7%). In 1 patient (3.8%), bilateral paragangliomas in the carotid bifurcation were detected. There was an evidence of malignancy in all cases (3.8%). Preoperative embolization has proven successful in reducing tumor vascularity in approximately 22 (of 25 who accepted surgery; 88%) paraganglioma patients. The common preoperative complication was vascular injury, which occurred in 6 (23%) of 26 patients; the main postoperative complication was transient cranial nerve deficit in 4 (15.3%) of 26 patients; and a permanent Horner syndrome was documented in 2 patients (7.6%). Cerebrospinal fluid leak occurred in 1 patient (3.7%). Postoperatively, stroke was occurred in 1 patient (3.7%). Two patients with jugular paraganglioma were treated with irradiation because of skull base extension with significant symptomatic relief., Conclusions: The primary therapeutic option for paragangliomas is complete excision of tumor with preservation of vital neurovascular structures. Combined therapeutic approach with preoperative selective embolization followed by surgical resection is the safe and the effective method for complete excision of the tumors with a reduced morbidity rate.

Conclusion: Odiosoft-Rhino (OR) is a non-invasive test that is completed in an extremely short period of time. It is easy to perform and little patient cooperation is needed. OR is safe and could be used in the rhinological setting if further improved., Objective: To evaluate nasal obstruction objectively with a new technique, OR, and to compare the results with a widely accepted method, rhinomanometry, in normal subjects., Subjects and Methods: OR and anterior RMM were performed in 79 subjects without any rhinologic symptoms and signs. Visual analogue scales (VAS) of nasal obstruction, nasal airway resistance and nasal expiratory and inspiratory sounds were analysed., Results: VAS of nasal obstruction was found to be correlated with OR findings of expiration at 2000-4000 Hz frequency interval on both sides (r = 0.564, p < 0.01 for the left side, r = 0.533, p < 0.01 for the right side). Correlations were found (p < 0.05) between left 2000-4000 Hz in expiration OR and left expiration RMM, left 4000-6000 Hz in expiration OR and left expiration RMM, right 2000-4000 Hz in expiration OR and right expiration RMM, and right 4000-6000 Hz in expiration OR and right expiration RMM. No correlation was seen between VAS, anterior RMM and OR at inspiration in any interval.

Alveolar soft part sarcoma (ASPS) is a rare malignancy. It has generally a poor prognosis. Survival depends on the presence of metastases. Approximately, one-fourth of the cases are encountered in the head and neck region, mostly in the orbits and tongue. Surgery is accepted as the most effective treatment, radiotherapy and chemotherapy may be used as adjuvant treatments. Since it is a highly vascular tumor, profuse bleeding may occur during surgery. In this article, we report a case of ASPS occurring in the larynx, an extremely rare location for this rather unusual tumor. To our knowledge, only three cases of laryngeal ASPS have been previously reported in the English literature.

Objectives: Quality of life in patients with chronic rhinosinusitis is affected more than many other chronic diseases. In this study, we evaluated the validity of the Rhinosinusitis Disability Index (RSDI) in assessing deterioration in the quality of life., Patients and Methods: The Rhinosinusitis Disability Index consisting of 30 items was administered to 355 patients (206 males, 149 females; mean age 41 years; range 21 to 57 years) with chronic rhinosinusitis before and after treatment and to 112 healthy controls (44 males, 68 females; mean age 35 years; range 18 to 48 years). A detailed history was taken from the patients and skin-prick test was performed to eliminate allergic rhinitis. The scores of patients and physicians were compared. The score of the RSDI is inversely proportional to the quality of life., Results: Spearman rank correlation test yielded a coefficient of 0.42 for comparisons between pre- and post-treatment scores and physician evaluation. Coefficients for correlations between the patients' and physicians' scores before and after treatment were 0.62 and 0.59, respectively. The mean RSDI scores of the patients before and after treatment were 35.2+/-14.3 and 13.9+/-10.8, respectively, compared to a score of 8.4+/-8.8 of the control group. Only 72.4% of the patients could answer the questions by themselves., Conclusion: If properly administered, the RSDI is a reliable method in evaluating quality of life; however, it is affected by the socioeconomic and education levels of the participants.

Objective: To evaluate the practicability of Odiosoft-Rhino (OR), a new experimental method for assessing the nasal airflow and resistance, in normal subjects and to compare the results with acoustic rhinometry (AR) findings., Study Design and Setting: OR and AR were carried out in 72 healthy subjects. Their visual analogue scales of nasal obstruction, minimal cross sectional areas (MCA(1) and MCA(2)), and nasal expiration sounds were analyzed and noted for both nasal cavities., Results: Statistically significant correlations (P < 0.05) were found between OR and AR in 2,000 to 4,000 Hz and 4,000 to 6,000 Hz with MCA(1) and MCA(2)., Conclusions: OR is a noninvasive and rapid test. It is easy to carry out and requires little patient cooperation. It seems that it may give compatible results with other reliable methods that assess nasal airflow., Significance: We assume that OR is a sensitive method for evaluating nasal airflow in normal subjects in an easy way., Ebm Rating: A-1b.