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Introduction: This prospective controlled study evaluated and compared health-related quality of life (HRQOL), after transoral robotic supraglottic laryngectomy (TORSGL) versus transcervical open supraglottic laryngectomy (TCOSGL) in patients with T1 and T2 supraglottic laryngeal carcinoma (SLC)., Methods: The TORSGL group comprised 14 patients, and the TCOSGL group comprised 13 patients. All 27 patients completed the European Organization for Research and Treatment of Cancer 30-item core quality-of-life questionnaire version 3.0 (EORTC QLQ-C30), the European Organization for Research and Treatment of Cancer head-and-neck cancer-specific module (EORTC QLQ-H&N35), before treatment and during the early and the late postoperative periods., Results: The present prospective study demonstrated the near-term postoperative HRQOL of patients with T1 or T2 SLC treated with TORSGL (Group A) or TCOSGL (Group B). On comparison of EORTC QLQ-C30 data for the two groups in the early postoperative period, all functional subscale scores and global health status scores were statistically significantly lower (all p < 0.05) in Group A than in Group B and in the late postoperative period, other than the cognitive function score (p = 0.450), all functional subscale scores and global health status scores were statistically significantly lower (all p < 0.05) in Group A than in Group B. On comparison of the EORTC QLQ-H&N35 data for the two groups in the early postoperative period, except for the teeth problems scale score (p = 0.061), all symptom scale scores were statistically significantly lower in Group A than in Group B (all p < 0.05) and in the late postoperative period, the speech, social eating, social contact, and coughing scale scores were statistically significantly lower (p = 0,0215, p = 0.021, p = 0.01, p = 0.011, respectively) in Group A than in Group B. HRQOL parameters recovered in the late postoperative period in both groups; recovery was better in Group A., Discussion/conclusion: This study suggested that TORSGL may provide patients with a better HRQOL than those TCOSGL, especially in the early period, but also in the late period., (© 2022 S. Karger AG, Basel.)

Introduction: The aim was to explore the developmental relationships between the angles of septal deviations and the degree of the mastoid pneumatization., Materials and Methods: In total, 143 patients with a diagnosis of septal deviation who underwent septoplasty were included. The patients were divided into three groups in terms of the angles of the septal deviation. The angle of the septal deviations was defined as mild (<9 degrees), moderate (between 9 and 15 degrees) and severe (15 degrees and above). The degree of the mastoid pneumatization of each groups were compared., Results: In right-sided septal deviation subjects, the right mastoid air cell volumes of group mild, moderate and severe were 6,31±2,33 cm3, 5,20± 1,51 cm3, and 5,31±1,57 cm3, respectively. The mean right mastoid volumes of each groups did not differ in right-sided deviations subjects (P>0.05). The mean left mastoid volumes of each groups did not differ in right-sided deviations subjects (P>0.05). In right-sided septal deviation subjects, the mean volume of the right and left-sided mastoid air cells of each groups did not differ (P>0.05). In left-sided septal deviation subjects, the mean volume of the right and left-sided mastoid air cells of each groups did not differ (P>0.05)., Conclusions: No developmental relationships between the angles of septal deviations and the degree of the mastoid pneumatization was observed in the study.

Introduction: The role of the anatomical variations and severity of acute rhinosinusitis (ARS) in the development of ARS complications is still an unknown issue. Regarding this, the present study evaluated the relationship between the severity of ARS and anatomical nasal variations in pediatric patients with ARS-related orbital complications., Materials and Methods: This study was conducted on 134 pediatric patients with orbital complications related to ARS. The data related to patients' demographics, complication types, and involved side were collected. Nasal sides were also compared in terms of the Lund-Mackay score (LMS), osteomeatal complex (OMC) obstruction, Keros classification, presence of agger nasi cells (AGC), concha bullosa, Haller cells, Onodi cells, septal deviation, and lower turbinate hypertrophy., Results: The comparison of LMSs indicated a significant difference between the complicated and contralateral sides (8.37±2.44 vs. 5.62±2.71; P<0.0001). In addition, there was a significant difference between the complicated and contralateral sides in terms of the OMC scores (P<0.0001). The rates of lower turbinate hypertrophy and AGC on the complicated side were higher than those on the contralateral side (P=0.021 and P<0.00; respectively)., Conclusion: As the results indicated, anatomical variability in adjacent structures affects the development of ARS-related orbital complications in pediatric patients.

Objective: Although glottic level is an off-label use of da Vinci system, the feasibility and early-term outcomes of transoral robotic surgery (TORS) for the treatment of early-stage (Tis, T1, T2) glottic carcinoma have been documented. But little is known about the oncological outcomes. We investigated the oncological outcomes of TORS in patients followed at least three years and mean follow-up time was over five years., Methods: We retrospectively investigated patients with early glottic carcinoma (Tis, T1, T2) who underwent TORS cordectomy in a tertiary hospital between January 2010 and June 2018., Results: Forty-eight patients were enrolled in the study. Mean follow-up time was 65.6±16.6months. Only one patient died and overall survival rate was found 97.9%. Local recurrence occurred in five patients and disease free survival rate was found 89.6%. Anterior commissure involvement was occurred in 6 (12.5%) patients and local recurrence was seen two of them (33.3%). Synechia complication was occurred in 8 (16.7%) patients and local recurrence was seen three of them (36.7%). Although local recurrence rate was high in both anterior commissure involvement and synechia, only synechia reached to statistical significance for local recurrence (p: 0.027). The recurrences of four patients were treated with radiation therapy (RT) and the remaining one patient underwent total laryngectomy. Laryngeal preservation rate was found 97.9%., Conclusion: Our investigation of the oncological outcomes of TORS on early-stage glottic carcinoma revealed that TORS has similar results when compared with transoral laser microsurgery and RT in terms of recurrence, laryngeal preservation and survival rates. Synechia is also a cautionary complication for recurrence and must be followed closely. We expect that TORS usage will be wider if robotic technology works on innovative developments oriented to glottic area., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: To investigate the effect of the single systemic use of corticosteroid following drainage procedure in patients with peritonsillar abscess (PTA)., Methods: This retrospective case-control trial included 32 patients with the diagnosis of PTA between December 2013 and January 2016 in our clinic. Patients were divided into two groups based on the approaches of two authors for the treatment after PTA drainage. The study group included the patients treated with single dose systemic corticosteroid after PTA drainage. Other patients who had no corticosteroid treatment were in the control group. Two groups were compared based on time to oral intake, grade of trismus, pain severity and duration of hospitalization., Results: Statistically significant differences between two groups were observed in terms of time to oral intake, grade of trismus, pain severity and length of hospitalization. The degree of trismus and pain severity significantly decreased in study group comparing to control group at the end of the first day. This difference disappeared at Day 7. Time to oral intake and the duration of hospitalization were shorter in the study group than in control group., Conclusion: Corticosteroid treatment following drainage procedure in patients with peritonsillar abscess improves pain severity and trismus thus it decreases time to oral intake and duration of hospitalization., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objectives: To explore the interobserver consistency of drug-induced sleep endoscopy (DISE) for patients with obstructive sleep apnea syndrome (OSAS) and review the current literature., Methods: In total, 55 patients with an apnea-hypopnea index >5, as determined by on overnight sleep study, were included in this study, 45 males and 10 females, with an average age of 46.87 ± 10.06 years old (range, 19-71). For all OSAS patients, DISE was performed by the same surgeon, which was recorded digitally. The video recordings of DISE were evaluated independently by 3 experienced surgeons who were asked to note his or her decisions as the pattern, site, and degree of upper airway collapse using a VOTE (velum, oropharynx lateral wall, tongue base, and the epiglottis) classification system., Results: Interobserver consistency in the diagnosis of velum-related obstruction in anteroposterior, lateral, and concentric configurations ranged from poor to good. Only significant interobserver consistency among observers A and B was obtained in the diagnosis of oropharynx-related obstruction in the lateral configuration (concordance 60.0%, kappa: 0.365, P < 0.05). Interobserver consistency in the diagnosis of the tongue-related collapse in an anteroposterior configuration, the epiglottis-related collapse in an anteroposterior and lateral configuration ranged from fair to moderate (all kappa values >0.20, all P values < 0.05)., Conclusion: Our data suggested that the interobserver consistency of DISE ranged from poor to good. Therefore, further studies with larger numbers of patients are needed to standardize DISE procedures, training, and interpretation.

Objectives: The aim of our study was to see whether the neutrophil/lymphocyte ratio (NLR) and the platelet/lymphocyte ratio (PLR) are the markers of idiopathic sudden hearing loss to be used in prognosis or not., Materials and Methods: This study is a retrospective, case-control clinical trial. Forty-five patients diagnosed with idiopathic sudden hearing loss and treated with the same treatment protocol between March 2014 and December 2015 and 47 healthy volunteers coming to the hospital for a routine health check and accepting audiological and laboratory tests were included in our study. NLR and PLR values were calculated in consequence of complete blood count results obtained from the study and control groups. In addition, the study group was classified as treatment responsive and treatment unresponsive groups as a result of audiological examination performed after three months according to the Siegel criteria. NLR and PLR ratios between the groups were statistically evaluated., Results: Average NLR and PLR values were significantly higher in the study group compared to the control group (P<0.001). Average NLR ratio of the group, which was treated with the same protocol but did not respond to treatment was found to be significantly higher compared to the group which responded to the treatment (P<0.001). There was no significant change in average PLR ratio., Conclusion: Although NLR and PLR are two important markers that can be detected from peripheral blood samples of patients developing idiopathic sudden hearing loss and can be calculated easily, increased NLR values were also found to be related to poor prognosis., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Introduction: Tracheoesophageal peristomal fistulae can often be solved by reducing the size of the fistula or replacing the prosthesis; however, even with conservative techniques, leakage around the fistula may continue in total laryngectomy patients. Also, several techniques have been developed to overcome this problem, including injections around the fistula, fistula closure with local flaps, myofascial flaps, or free flaps and fistula closure using a septal perforation silicon button., Objective: To present the results of the application of silicon ring expanding the voice prosthesis in patients with large and persistent peri-prosthetic fistula., Methods: A voice prosthesis was fitted to 42 patients after total laryngectomy. Leakage was detected around the prosthesis in 18 of these 42 patients. Four patients demonstrated improvement with conservative methods. Eight of 18 patients who couldn't be cured with conservative methods were treated by using primary suture closure and 4 patients were treated with local flaps. As silicon ring was applied as a primary treatment in the 2 remaining patients and also, applied to 2 patients who had recurrence after suture repair and to 2 patients who had recurrence after local flap implementation. Silicon rings were used in a total of 6 patients due to the secondary trachea-esophageal fistula. Patients were treated with provox-1 initially and later with provox-2. At the time of leakage around the fistula, 6 patients had provox-2., Results: Fistulae were treated successfully in 6 patients, and effective speech of patients was preserved. Patients experienced no adaptation problem. Prosthesis changing time was not different between silicon rings expanded and normal prosthesis applied patients. Silicon ring combined voice prosthesis was used 26 times; there was no recurrence in fistula complication during 29±6 months follow up., Conclusion: Silicon rings for modified expanded voice prosthesis seems to be an effective treatment for persistent peri-prosthetic leakage, for both, fistula closure and preserving the patients speech., (Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Vitamin D deficiency is effective in the development of acute rhinosinusitis and prolongation of inflammation by increasing inflammation in the sinonasal epithelium. Vitamin D deficiency is important in the development of bone barriers that prevent the complication of acute rhinosinusitis. Although Vitamin D levels may be a variable risk factor for various respiratory tract disorders, there are limited data on the role in sinonasal infections. Our aim was to investigate the association of 25-hydroxy-vitamin D (25OHD) levels with acute rhinosinusitis (ARS) and preseptal cellulitis complications. The type of the study is prospective case-control study. Fifteen patients in the pediatric age group with ARS-induced preseptal cellulitis complication were identified as Group 1, fifteen patients with ARS and without complication were identified as Group 2, and fifteen healthy volunteers were identified as Group 3. Serum 25OHD levels (nmol/l) were measured in addition to routine blood tests at the first admission of patients participating in the study. Statistical analysis was performed between groups. The ages of the cases ranged from 1 to 14 years with a mean of 5.62 ± 3.42 years. 55.6% of the cases (n = 25) were male; 44.4% (n = 20) were female children. As a result of classification in which vitamin D levels were compared with normal values, there was a statistically significant difference according to the presence of ARS (Group-1 and Group 2) and absence of ARS (Group-3) (p < 0.05). A statistically significant difference was also found between Group 1 and Group-3 (p < 0.05). Statistically significant difference between Group 1 and Group 3 suggests that lack of vitamin D predisposes to the complication of preseptal cellulitis. Comparison of Group 1 and 2 with Group 3 (normal subjects) suggests that Vit D has a protective effect against developing sinusitis.

The feasibility and effectiveness of transoral robotic surgery (TORS) in children with tongue base masses (TBMs) were evaluated. Eight pediatric patients who were treated with TORS for TBMs between January 2010 and January 2016 at a tertiary hospital included in the study. All pathologies were congenital lesions: four were lingual thyroglossal ductus cysts (LTGDCs), one was a minor salivary gland tumor, one was a vallecular cyst, one was a bronchogenic cyst, and one was an ectopic thyroid tissue. TORS was performed successfully in all cases. The mean robotic set-up and exposure time was 13.0 ± 2.1 min (range 10-16 min) and the mean robotic surgery time was 8.8 ± 6.9 min (range 4-25 min). Estimated blood loss was lower than 5 ml for one patient and lower than 50 ml for another one. The remaining patients' estimated blood loss was lower than 10 ml. No patient required tracheostomy intra- or post-operatively. Only one minor complication occurred on day 10 after surgery (minor bleeding), which was resolved without intervention. No major complications or recurrence were observed. Better visualization and small, flexible arms allow surgeons to treat TBM faster and easily using TORS. This leads to decreased morbidity compared to open and transoral endoscopic/microscopic surgical methods. In the future, we believe that TORS may become the gold standard method for the treatment of pediatric TBM with continued development of robotic technology.

Introduction: Knowledge of the site of obstruction and the pattern of airway collapse is essential for determining correct surgical and medical management of patients with Obstructive Sleep Apnea Syndrome (OSAS). To this end, several diagnostic tests and procedures have been developed., Objective: To determine whether drug-induced sleep endoscopy (DISE) or Müller's maneuver (MM) would be more successful at identifying the site of obstruction and the pattern of upper airway collapse in patients with OSAS., Methods: The study included 63 patients (52 male and 11 female) who were diagnosed with OSAS at our clinic. Ages ranged from 30 to 66 years old and the average age was 48.5 years. All patients underwent DISE and MM and the results of these examinations were characterized according to the region/degree of obstruction as well as the VOTE classification. The results of each test were analyzed per upper airway level and compared using statistical analysis (Cohen's kappa statistic test)., Results: There was statistically significant concordance between the results from DISE and MM for procedures involving the anteroposterior (73%), lateral (92.1%), and concentric (74.6%) configuration of the velum. Results from the lateral part of the oropharynx were also in concordance between the tests (58.7%). Results from the lateral configuration of the epiglottis were in concordance between the tests (87.3%). There was no statistically significant concordance between the two examinations for procedures involving the anteroposterior of the tongue (23.8%) and epiglottis (42.9%)., Conclusion: We suggest that DISE has several advantages including safety, ease of use, and reliability, which outweigh MM in terms of the ability to diagnose sites of obstruction and the pattern of upper airway collapse. Also, MM can provide some knowledge of the pattern of pharyngeal collapse. Furthermore, we also recommend using the VOTE classification in combination with DISE., (Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

We conducted a prospective, randomized, double-blind, controlled clinical study to compare the efficacy and safety of the PlasmaBlade device and cold dissection for adult tonsillectomy. Our study group was made up of 20 patients-12 men and 8 women, aged 18 to 50 years (mean: 27.1)-who were undergoing a bilateral tonsillectomy. Each patient had one randomly chosen tonsil removed by the PlasmaBlade and the other by cold instrumentation. We compared the duration of surgery, the amount of intraoperative blood loss, the number of sutures required, the status of tonsillar fossa wound healing at 7 and 14 days postoperatively, the amount of postoperative pain, and postoperative complications. We found statistically significant differences in the amount of blood loss and the number of sutures in favor of the PlasmaBlade technique. No significant differences were observed in any of the other outcomes.

Objective: The aim of our study is to investigate whether systemic microvascular function affects the development and prognosis of sudden idiopathic hearing loss (SHL)., Type of Study: A prospective case-control study., Materials and Methods: Fifty patients diagnosed with SHL at our hospital between September 2015 and May 2016 were included as the SHL group, and 50 healthy volunteers who came to the hospital for medical screening were included in the control group. Thirty-one patients from the SHL group who responded to treatment and 19 patients who did not respond to treatment were identified according to the Siegel criteria and were grouped. Patients with comorbid disorders were excluded from the study. To determine microvascular function, the videocapillaroscopic examination was conducted from the nailfold, measuring the capillary density (CD) and post-occlusive reactive hyperaemia (PORH) values and statistical analysis was performed between the groups., Result: While CD was an average of 83.1 ± 6 in the SHL group, it was measured as 96.2 ± 10 in the control group. The CD value was significantly lower in the SHL group than the control group (P < 0.05). While the average PORH value in the SHL group was 80.5 ± 7.7, it was measured as 97.5 ± 10 in the control group. The PORH value was significantly lower in the SHL group than the control group (P < 0.05). The CD value did not differ significantly (P > 0.05) between the group that responded to treatment (83.4 ± 5.5) and the group that did not respond to treatment (82.7 ± 6.9). The PORH value was significantly lower (P < 0.05) in the group that did not respond to treatment (75.2 ± 7.9) than the group that did (83.8 ± 5.6)., Conclusion: To our best knowledge, our study is the first study in the literature. Although the role of specific mechanisms in SHL is not entirely understood, the capillaroscopic examination can show the importance of microvascular function in SHL. CD and PORH values were found to be low in SHL patients, and a low PORH value was found to be a factor of poor prognosis., (© 2016 John Wiley & Sons Ltd.)

Retropharyngeal abscess (RPA) is the second most common deep neck space infection after peritonsiller abscess in pediatric population. Major signs and symptoms on physical examination include fever, hypersalivation, odynophagia, reduced oral intake, sore throat, swelling on the neck, torticollis, limitation in neck mobility, and voice changes. In this paper, the authors present a case of RPA with unusual and interesting presenting symptoms in a 10-month-old infant that exhibit new-onset and worsening snoring and sleep apnea. The purposes of this manuscript are to present the authors' experience with this patient, to emphasize the diagnosis, clinical course, and management of RPA in infants, also to signify the importance of including RPA in the differential diagnosis of patients with sleep apnea syndrome.

Objectives: To investigate the relationships between the angle and length of the Eustachian tube (ET) (the ETa and the ETl) and the success rates of pediatric type 1 tympanoplasty., Study Design: A retrospective clinical chart review., Methods: In total, 51 children (31 females and 20 males; average age, 11.92 ± 3.46 years; age range: 7-18 years) who underwent cartilage type 1 tympanoplasty were included. Demographics and anatomical outcomes were recorded. The patients were divided into 2 groups in terms of anatomical success. In group A, all patients had intact grafts without perforation, retraction, or lateralization, and a dry ear, at 6 months postoperatively. In group B, reperforation of the tympanic membrane was evident 6 months postoperatively. The average ETa and ETl values of each group were measured on computed tomography images using a multiplanar reconstruction technique, and compared., Results: The ETa values of diseased ears of males and females were, respectively, 26.60 ± 6.42° and 23.29 ± 6.51°, compared to 27.25 ± 5.23° and 23.32 ± 4.61° for normal male and female ears, respectively. In group A, the ETa was 26.46 ± 6.82° in males and 22.95 ± 7.50° in females. In group B, the ETa was 26.85 ± 6.12° in males and 23.90 ± 4.45° in females. In group A, the mean ETl was 41.0 mm (29.6-45.3 mm) in males and 37.9 mm (32.0-44.5 mm) in females. In group B, the mean ETl was 40.5 mm (30.5-47.1 mm) in males and 38.0 mm (32.8-45.0 mm) in females. In group A, the ETa value of diseased ears did not differ between females and males, but in normal ears, the ETa was higher in males than females (P = 0.020 and P < 0.05, respectively). In group B, no difference was evident between the ETa values of normal and diseased ears (P > 0.05). No difference in the ETl values of diseased and normal ears, in either group, was apparent between females and males (both P > 0.05)., Conclusions: Neither the ETa nor the ETl affected the success rate of pediatric cartilage type 1 tympanoplasty. Further studies with larger numbers of patients are needed to compare anatomical outcomes after placement of various graft types and the effects of anatomical features of the ET on the success rate of pediatric tympanoplasty.

Objective: The objective of the authors' study was to investigate the predictive value of the neutrophil-lymphocyte rate (NLR) and platelet-lymphocyte rate (PLR) in otitis media with effusion and the correlation of the effusion type with these ratios., Study Design: Retrospective case-control study., Methods: One hundred twenty-six pediatric patients diagnosed otitis media with chronic effusion and had ventilation tube inserted between October 2015 and July 2016 were included in the study group and 124 healthy children, who applied for the routine examination and had blood count analysis, were included in the control group. The patients in the study group were divided into 2 groups regarding the effusion viscosity, which was obtained from the patients' operation files. Seventy-one patients were included in the serous group and 55 patients in the mucous group. The NLR and PLR rates of the groups were compared and statistically evaluated., Results: The average NLR and PLR rates were significantly higher in the study group than in the control group (P = 0.000, P = 0.004 respectively). Comparison of the serous and mucous groups with the control group revealed a significant difference between the control group and the serous group regarding the NLR and PLR (P = 0.000; P = 0.000 respectively), but not between the control group and mucous group (P = 0.694; P = 0.691 respectively)., Conclusion: Neutrophil-lymphocyte rate and PLR had a predictive value for otitis media with effusion and additionally it was a laboratory indicator supporting the typing of the viscosity of the fluid accumulated in the middle ear.

Objective: To determine the prevalence of Vidian canal types and dehiscence of the bony roof of the canal., Methods: This study included 594 patients (391 males and 203 females; average age, 32.43±11.98 years; range, 18-65 years). Computed tomography (CT) images were analyzed in terms of the prevalence of Vidian canal types and dehiscence of the bony roof of the canal., Results: Vidian canal types 1, 2, and 3 based on the sphenoid sinus body were found on the right side in 33.8%, 29.7%, and 6.5%, and on the left side in 36.4%, 27.4%, and 36.2% of the patients, respectively. Dehiscence of the bony roof of the canal was found on the right side in 22.2% of the patients and on the left side in 26.6%. In terms of Vidian canal types based on the sphenoid sinus floor, types 1, 2, 3, and 4 were found on the right side in 53.5%, 27.4%, 7.6%, and 11.5%, and on the left side in 54.9%, 26.6%, 6.6%, and 11.9% of the patients, respectively. On the right side, Vidian canal type 2 was significantly (p=0.002) more frequent in males than in females., Conclusion: When studying the complex anatomy of the sphenoid sinus, it is essential to consider Vidian canal types. Before endoscopic sinus surgery the Vidian canal and other anatomical structures should be carefully evaluated in all patients during preoperative paranasal sinus CT imaging to avoid complications., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Objective: The authors aimed to investigate the antiapoptotic mechanisms in nasal polyps that occur after glandular hyperplasia., Study Design: Retrospective histopathological analyses of patients with nasal polyps., Methods: The study comprised 54 patients (19 females; 35 males). Group-1 patients with a diagnosis of nasal polyposis; group-2 patients with a diagnosis of antrochoanal polyps; group-3 with a diagnosis of deviation of the nasal septum as a control group. Tissues were taken during their surgery and fixed in paraffin blocks, stained to detect galectin-3, and evaluated under a light microscope. Polymorphonuclear leukocytes on the surface epithelium, glandular epithelium, and connective tissue were divided into groups according to the intensity of galectin-3 staining: "mild," "moderate," and "strong." The percentage of stained tissue was also graded: <10%, 10% to 50%, 51% to 80%, and >80%. Hence, the extent of expression of galectin-3 and percentage of stained tissue was calculated., Results: Significant differences in the staining intensity of polymorphonuclear leukocytes for galectin-3 were observed between the 3 groups (P <0.01). Staining intensity in control group was significantly lower than that in group I and group II (P = 0.001; P <0.01). However, there was no significant difference between group I and group II (P >0.05)., Conclusion: These findings suggest that galectin-3 has a role in the formation of nasal polyps.

Temporal bone fractures can occur as a result of various head trauma. The most common cause of the hemotympanum is traumatic temporal bone fracture. Facial paralysis and hearing loss can be seen associated with temporal bone fracture. The development of the internal carotid artery aneurysm after temporal bone fracture is extremely rare. In this article, the authors evaluated carotid artery aneurysm that developed after temporal fracture and aneurism compressed by coagulated blood mass which showed itself as a hemotympanum. The internal carotid artery aneurysm that induced by temporal bone fracture and presented as hemotympanum has not been reported yet. This patient is the first case in the literature. Diagnosis, treatment, and follow-up options will be discussed in the light of current literature.

Objectives: To explore the relationships between the angle and length of the eustachian tube (ET) (the ETa and the ETl) and the success rates of type 1 tympanoplasty., Study Design: A retrospective clinical chart review., Methods: In total, 160 patients (81 females and 79 males; average age, 37.12 ± 12.46 years; age range: 18-65 years) who underwent cartilage type 1 tympanoplasty were included. Demographics and anatomical outcomes were recorded. The patients were divided into 2 groups in terms of anatomical success. The average ETa and ETl values of each group were measured on computed tomography images using a multiplanar reconstruction technique, and compared. A P value <0.05 was considered to reflect statistical significance., Results: In group A, the ETa of diseased ears was 27.74 ± 12.06° in males and 21.87 ± 7.58° in females. In group A, the ETa of normal ears was 27.53 ± 4.15° in males and 22.25 ± 4.67° in females. In group B, the ETa of diseased ears was 28.85 ± 6.19° in males and 22.91 ± 5.65° in females. In group B, the ETa of normal ears was 27.71 ± 5.23° in males and 23.72 ± 6.20° in females. In group A, the mean ETl of diseased ears was 42.1 mm (28.9-45.1) in males and 38.2 mm (31.0-44.7) in females. In group A, the mean ETl of normal ears was 41.9 mm (29.2-45.8) in males and 37.4 mm (30.5-44.1) in females. In group B, the mean ETl of diseased ears was 40.8 mm (30.2-47.4) in males and 37.9 mm (31.8-45.2) in females. In group B, the mean ETl of normal ears was 41.6 mm (30.0-45.0) in males and 39.1 mm (30.0-43.7) in females. In group A, the ETa value of diseased ears did not differ between females and males, but in normal ears the ETa was higher in males than females (P =0.002 and P <0.05, respectively). In group B, no difference was evident between the ETa values of normal and diseased ears (P >0.05). No difference in the ETl values of diseased and normal ears, in either group, was apparent between females and males (both P >0.05)., Conclusion: Neither the ETa nor the ETl affected the success rate of cartilage type 1 tympanoplasty. Further studies with larger numbers of patients are needed to compare anatomical outcomes after placement of various graft types and the effects of anatomical features of the ET on the success rate of type 1 tympanoplasty.

Objective: To investigate the effects of septoplasty on the acoustic parameters of voice., Methods: In total, 23 patients (seven females and 16 males; average age, 32.13±9.67 years; age range: 19-56 years) with a diagnosis of nasal septal deviation and who underwent septoplasty were included. Preoperative and on postoperative 30th day, acoustic analysis of voice was conducted for all patients. The recordings of /mana/ vowel were used to evaluate average fundamental frequency (F0), jitter, shimmer, and noise-to-harmony ratio (NHR). F0, shimmer percent, jitter percent, and NHR of two terms were compared. A p-value<0.05 was considered to indicate statistical significance., Results: A statistically significant change was not observed in F0 (p=0.741), jitter (p=0.930), and shimmer (p=0.128) measured preoperatively and on postoperative day 30. However, the increase in NHR measured on postoperative day 30 were statistically significant compared with preoperative NHR (p=0.017)., Conclusion: According to the findings of this study, except NHR value, no statistically significant changes on F0, jitter and shimmer were detected after septoplasty., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Introduction: Controversy surrounds the use of salvage therapies to treat sudden sensorineural hearing loss (SSNHL), with no consensus on recommendations. While several studies have demonstrated the effectiveness of intratympanic administration of steroids (ITS) and hyperbaric oxygen (HBO) treatment, few have compared the efficacy of ITS and HBO therapy in patients with refractory SSNHL., Objective: We evaluated the efficiency of ITS and HBO therapy in patients with refractory SSNHL., Methods: Patients who did not adequately benefit from systemic treatment were evaluated retrospectively. Refractory patients were defined as those who gained less than 20dB in hearing after initial treatment. All refractory patients were informed about salvage therapy options: ITS or HBO therapy, the advantages and disadvantages of which were explained briefly. ITS involved 4mg/mL dexamethasone administered through a 25 gauge needle. Patients underwent HBO therapy in a hyperbaric chamber where they breathed 100% oxygen for 120min at 2.5 atmospheric pressure. The hearing levels of both groups were evaluated before the salvage therapy and at 3 months after treatment. Improvements in hearing were evaluated according to the Furahashi criteria. We also compared the two therapies in terms of speech discrimination scores (SDSs) and the recovery of all frequencies., Results: The salvage therapies generated similar results. Changes in pure tone averages and SDSs were similar for ITS and HBO therapy (p=0.364 and p=0.113). Comparison of SDSs and hearing thresholds at all frequencies showed similar levels of improvement., Conclusion: ITS and HBO therapy produced similar improvements in SSNHL patients, but the sample size was too small to draw definitive conclusions. Further randomized controlled studies are needed to identify the best therapy for patients with refractory sudden hearing loss., (Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Objectives: The aim of the present study is to explore the correlation between the degree of the mastoid pneumatization and the angle (ETa) and the length of the Eustachian tube (ETl)., Study Design: The study design consisted of a retrospective clinical chart review., Methods: In total, 217 patients (110 females and 107 males; average age, 33.14 ± 12.88 years; age range: 18-65 years) were included in the study. The patients were divided into 3 groups in terms of the degree of the mastoid pneumatization. The mastoid pneumatization was measured between 0 and 5 cm for group A, between 5 and 10 cm for group B, and ≥10 cm for group C. The ETa and ETl of each group were compared., Results: The mean mastoid pneumatization of groups A, B, and C was 4.32 ± 1.96, 8.26 ± 2.68, and 11.94 ± 1.28 cm, respectively. The ETl of group A was lower than that of other groups statistically (P = 0.006 and 0.018, respectively). The mean ETl did not differ between the groups B and C (P = 0.698, >0.05, respectively). The ETa of each group did not differ (all P > 0.05). The mastoid pneumatization and the ETl were higher in males than in females (P = 0.004 and 0.001, respectively). The ETa did not differ between males and females (P = 0.0158). There was a positive correlation between the degree of the mastoid pneumatization and the ETl (r = 0.159/P = 0.002, <0.05, respectively)., Conclusions: The present study is thus the first to analyze the relationship between the degree of the mastoid pneumatization and the ETa and the ETl. We found a positive correlation between the degree of the mastoid pneumatization and the ETl.

Introduction: Various graft materials have been used to close tympanic membrane perforations. In the literature, there are few studies in pediatric populations comparing different graft materials. To our knowledge, there is no reported study that measured the thickness of the tragal cartilage in pediatric tympanoplasties. The tragal cartilage is not of uniform thickness in every patient., Objective: To compare anatomical and functional outcomes of temporalis fascia muscle and full-thickness tragal cartilage in type 1 pediatric tympanoplasties., Methods: In total, 78 patients (38 males, 40 females; average age 10.02±1.98 years; range, 7-18 years) who underwent type 1 tympanoplasties in our clinic were included. Demographics, anatomical, and functional outcomes were collected. Temporalis fascia muscle and tragal cartilage were used as graft materials. Tragal cartilage was used without thinning, and the thickness of tragal cartilage was measured using a micrometer. Anatomical and functional outcomes of cartilage and fascia were compared. Audiometric results comparing the cartilage and fascia groups were conducted at 6 months, and we continued to follow the patients to 1 year after surgery. An intact graft and an air-bone gap≤20dB were regarded as a surgical success. Results with a p-value<0.05 were considered statistically significant., Results: The graft success rate was 92.1% for the cartilage group compared with 65.0% for the temporal fascia group. In the fascia group, the preoperative air-bone gap was 33.68±11.44 dB and postoperative air-bone gap was 24.25±12.68dB. In the cartilage group, the preoperative air-bone gap was 35.68±12.94dB and postoperative air-bone gap was 26.11±12.87dB. The anatomical success rate in the cartilage group was significantly better than that for the fascia group (p<0.01). There was no statistically significant difference in functional outcomes between the fascia and cartilage groups (p>0.05). The average thickness of tragal cartilage in the pediatric population was 0.693±0.094mm in males and 0.687±0.058 mm in females., Conclusions: Our data suggest that the anatomical success rate for a cartilage tympanoplasty was higher than for a fascia tympanoplasty. Functional results with cartilage were not different than with fascia, even though we did not thin the tragal cartilage. However, further studies should focus on the interaction between the thickness of the tragal cartilage and the tympanoplasty success rate., (Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: In this study, our aim was to investigate whether Monocyte/HDL ratio is a marker of the prognosis of the idiopathic sudden hearing loss (ISHL)., Study Design: Retrospective, case-control clinical trial., Materials and Methods: 45 patients, who were diagnosed with idiopathic sudden hearing loss and were treated with the same therapy regime and 47 healthy volunteers, who applied to the hospital for routine controls and had audiological and laboratory examination between March 2014 and December 2015, were included in the study. Monocyte/HDL ratios of the patients in the study and control groups were calculated from the results of the blood counts and biochemical analysis. Additionally, the study group was divided into two sub-groups regarding their responses (responders and non-responders) to the treatment determined by the audiological examination, which was carried out after 3 months according to the Siegel criteria. The Monocyte/HDL ratios between the groups were statistically evaluated., Results: There was no statistically significant difference between the MHRs of the study and control groups (p=0.574). However, the MHR was significantly higher in the non-responders? group compared with the responders? group, although they were treated with the same therapy regimen (p=0.005)., Conclusion: There was no difference in MHRs between study and control groups. However, as MHR was higher in the patients with good prognosis compared with the patients with bad prognosis, we believe that regarding the ISHL, MHR is not a predictive value but might have prognostic marker.

Objectives: To evaluate the effect of the degree of the mastoid pneumatization on the success rate of cartilage type 1 tympanoplasty., Study Design: A retrospective clinical chart review., Methods: In total, 90 patients (44 females and 46 males; average age, 38.40 ± 11.12 years; age range: 21-65 years) who underwent cartilage type 1 tympanoplasty were included. Demographics and anatomical outcomes were recorded. The patients were divided into 2 groups in terms of anatomical success. In group A, all patients had intact grafts without perforation, retraction, or lateralization, and a dry ear, at 6 months postoperatively. In group B, reperforation of the tympanic membrane was evident 6 months postoperatively. The mastoid air cell volumes of each groups were compared., Results: The mean mastoid pneumatization in groups A and B was 5.32 ± 1.96  and 5.06 ± 2.12 cm, respectively. The mastoid pneumatization of diseased ears did not differ between the groups (P > 0.05). The mastoid pneumatization of diseased ears did not differ between males and females (P > 0.05). The mastoid pneumatization of normal ears did not differ between the groups (P > 0.05). The mastoid pneumatization of normal ears did not differ between males and females (P > 0.05)., Conclusions: The degree of mastoid pneumatization did not affect the success rate of cartilage type 1 tympanoplasty. Further studies with larger numbers of patients are needed to evaluate the relationship between the degree of the mastoid pneumatization and anatomical outcomes after placement of various graft types.

Aim: To rotate the nasal axis and septum to the midline using an L-strut graft and a novel caudal septal stabilization suturing technique to treat crooked noses., Patients and Methods: Thirty-six patients were included in the study. First, an L-strut graft was prepared by excising the deviated cartilage site in all patients. Second, multiple stabilization suturing, which we describe as a caudal septal stabilization suturing technique with a "fishing net"-like appearance, was applied between the anterior nasal spine and caudal septum in all patients. This new surgical technique, used to rotate the caudal septum, was applied to 22 I-type and 14 C-type crooked noses. Correction rates for the crooked noses were compared between the 2 inclination types with angular estimations., Results: Deviation angles were measured using the AutoCAD 2012 software package and frontal (anterior) views, with the Frankfurt horizontal line parallel to the ground. Nasal axis angles showing angle improvement graded 4 categories as excellent, good, acceptable, and unsuccessful for evaluations at 6 months after surgery in the study. The success rate in the C-type nasal inclination was 86.7% (±21.9) and 88% (±16.7) in the I-type. The overall success rate of L-strut grafting and caudal septal stabilization suturing in crooked nose surgeries was 87.5% (±18.6). "Unsuccessful" results were not reported in any of the patients., Conclusions: L-strut grafting and caudal septal stabilization suturing techniques are efficacious in crooked noses according to objective measurement analysis results. However, a longer follow-up duration in a larger patient population is needed.

Introduction: Sialadenoma papilliferum (SP) is a rare benign tumor, which originates from the minor salivary gland. It occurs at sites that have minor salivary glands, such as the palate, retromolar pads, buccal mucosa, and lips. The most common location for tumor development is on the hard palate. A differential diagnosis consists of ruling out other salivary gland tumors. Transoral robotic surgery (TORS) is a new technology used in head and neck surgery within certain centers around the world., Case Report: Herein, we present the first successful case of SP tumor removal by TORS., Conclusion: This particular case highlights the identification of this rare tumor in an unusual location. Furthermore, it demonstrates the utilization of TORS, leveraging the superior visualization to obtain excellent local control with minimal acute and long-term morbidity, in comparison to conventional transoral surgical approaches.

Septoplasty is a frequent and relatively low-risk procedure in otolaryngology practice. Palatal perforation complication is very rare in the literature and only a few patients have been reported. In this clinical report, a patient with palatal perforation that has been developed and noticed during the septoplasty operation with no anatomical abnormality and alternative repair method are reported with video of the procedure.

Objective: To evaluate the results of combined multilevel surgery with transoral robotic surgery (TORS) in patients with obstructive sleep apnea/hypopnea syndrome for multilevel upper airway obstruction., Methods: Subjects who underwent combined sleep surgery via TORS were evaluated. The drug-induced sleep endoscopy was used in diagnosing the presence of level-specific upper airway collapse and to detect the type of surgery. Pre- and postoperative Apnea-hypopnea index, Epworth sleepiness scale lowest oxygen saturation, total operation time, robotic set-up time and robotic surgery time, blood loss value, and complications were recorded., Results: Twenty five subjects were identified. All subjects underwent base of tongue (BOT) + epiglottoplasty. The tracheotomy was not performed for any patient. Overall, 72% of patients met the criteria for cure, 8% met the criteria for cure, and 20% of patients met the criteria for failure. There was a significant decrease between preoperative and postoperative Apnea-hypopnea index scores (28.7 ± 17.8 SD versus 9.4 ± 12.4, P = 0.000) and Epworth sleepiness scale scores (13.5 ± 2.8 versus 3.4 ± 1.6, P = 0.000). There was a significant increase between preoperative and postoperative ED SPO2 levels (80.7 ± 7.6 versus 82.6 ± 18.1, P = 0.001)., Conclusion: TORS BOT, epiglottoplasty, and multilevel procedures in patients with obstructive sleep apnea/hypopnea syndrome can be regarded as feasible, safe, and effective technique.

Objectives: Laryngoceles are air-filled sacs which communicate with the laryngeal lumen. When filled with mucus or pus, they are called laryngomucoceles and laryngopyoceles, respectively. Transoral robotic surgery (TORS) is a new and remarkable technique that expands its usefullness in otorhinolaryngology. Conventional treatments for laryngoceles were previously performed using external approaches, with aesthetically unfavorable and less function-sparing results. Transoral laser microsurgical approaches for laryngoceles were seldom reported. It is aimed to present authors' clinical experience on laryngocele management with TORS which is a rather new technique., Study Design: A retrospective patient serial., Methods: Patients were evaluated for demographic data, type of lesion, reasons for hospital admittance, complaint duration, and previous surgery. Robotic surgery panel including anesthesia time, duration of surgery, need for tracheotomy, postoperative care, follow-up, and recurrence rates were also summarized., Results: Six men (mean age 51.7 years; range 41-62) with laryngoceles underwent successful TORS. Dyspnea and hoarseness were the main complaints. Two patients had undergone previous laryngeal surgery due to laryngeal cancer, with no recurrence of malignancy at admittance for laryngocele. Three had simple laryngocele, 2 had laryngomucocele, and 1 had laryngopyocele. No laryngoceles recurred and no complication such as dysphonia or prolonged dysphagia occurred., Conclusion: Transoral robotic surgery was found superior in safety, technical feasibility and curative effectiveness, when compared with classical methods, especially due to absence of skin incisions. Surgical modalities for laryngocele excision should be directed toward a curative target including cosmetic and functional success, technical achievability, and surgically curative methods. Transoral robotic surgery provided all these features.

Objectives: The goal of this study was to review the main lesion types of the nasal skin and appropriate treatment strategies rather than to present a comprehensive list of all diseases that affect the skin that can involve the nose., Methods: We reviewed the main nasal skin lesion types and available treatment strategies. Nasal skin lesions were classified as benign, premalignant, or malignant., Results: Benign lesions of the nose include nonmalignant tumoral lesions (i.e., freckles, comedo, adenoma sebaceum [Pringle disease], hydrocystoma, fibrous papules, sebaceous hyperplasia, and rhinophyma), autoimmune and inflammatory conditions (i.e., pemphigus, sarcoidosis, systemic lupus erythematosus, facial eosinophilic granuloma, rosacea, herpes zoster infection, leishmaniasis, and leprosy), and vascular lesions (i.e., telangiectasis, hemangioma, and spider nevus). Premalignant lesions are actinic keratosis and keratoacanthoma; and malignant tumors are melanoma, basal cell carcinoma, and squamous cell carcinoma. Regardless of whether or not they are malignant, all facial lesions can yield significant cosmetic discomfort that should be evaluated carefully before commencing any curative or corrective intervention. In general, benign lesions are treated with dermabrasive modalities, such as trichloroacetic acid, phenol, salicylate, and laser ablation. Electrocautery, cryosurgery, and surgical excision are also used, although these methods may result in scar formation, which can sometimes be more problematic than the original lesion itself., Conclusion: Any disease that affects the skin, especially those diseases that are triggered by ultraviolet exposure, can involve the face and nose. Cosmetic defects due both to the lesion itself and the intervention must be discussed with the patient, preferably in the presence of a first-degree relative, before commencement of treatment. As a result of heterogeneity of skin lesions of the nose, appropriate education of general practitioners as well as otorhinolaryngologists is mandatory.

Objective: To investigate whether there is an association between metabolic syndrome and obstructive sleep apnea syndrome (OSAS) in obese adolescents., Methods: In total, 240 pubertal children or prepubertal children older than 11 y recruited consecutively from the pediatric endocrinology unit, obesity clinic. Patients with tonsillar and adenoid hypertrophy (grade 3/4), systemic illnesses, or chronic drug usage were excluded. After anthropometric measurement and laboratory study, patients were divided into two groups according to metabolic syndrome (MS): MS and non-MS. Overnight polysomnographic evaluation was performed and 104 subjects were included for statistical analysis. The two groups were compared in terms of sleep efficiency, number of awakenings per night, oxygen desaturation index, snoring time, and obstructive/central/ mixed apnea-hypopnea index (AHI)., Results: Of the obese adolescents, 51 had MS and 53 did not. The AHI was ≥ 1 in 25 of the 53 non-MS children (47.2%) and in 25 of the 51 MS children (49%). The median obstructive AHI value was 0.9 (0.2-2.4) and total AHI was 0.9 (0.2-2.5) in the MS group; these values were 0.9 (0.25-3.55) and 0.9 (0.3-3.55), respectively, in the non-MS group. Obstructive, central, mixed, and total AHI values in the MS and non-MS groups were not statistically significantly different (p > 0.05)., Conclusions: In our study, we did not find an association between MS and sleep apnea in obese adolescents., (© 2015 American Academy of Sleep Medicine.)

Aim: To investigate the relationship between body dysmorphic syndrome and self-esteem in rhinoplasty candidates., Results: A negative statistical correlation was evident between Rosenberg Self-Esteem Scale (RSES) and Body Dysmorphic Disorder Examination-Self Report (BDDE-SR) scores. In terms of responses to the first Body Dysmorphic Disorder Questionnaire (BDDQ) question, which focuses on general attitude toward body dysmorphic syndrome, the average RSES "YES" score was significantly less than the "NO" score. No significant differences appeared between RSES scores and scores for the 4th subgroup of BDDQ questions (subgroups A, B, and C; these questions explore how much time is spent daily on maintenance of bodily appearance). However, significant differences appeared between scores for the 4th subgroup of BDDQ questions and BDDE-SR scores. The average BDD-SR score of subgroup A (less than 1 hour spent on bodily maintenance) was significantly lower than those of group B (1-3 hours) and group C (more than 3 hours). However, no significant differences appeared in average BDD-SR scores between subgroups B and C., Materials and Methods: In this prospective study, 56 patients (31 females and 25 males) were evaluated preoperatively using the BDDQ, the BDDE-SR, and the RSES. Patients younger than 15 years and those with deformities caused by trauma were excluded., Conclusions: Rhinoplasty candidates had higher levels of body dysmorphic disorder (BDD). Although patients with low RSES scores were more likely to have BDD, rhinoplasty candidates were not notably deficient in self-esteem. However, in rhinoplasty candidates with low RSES scores, the frequency of BDD was elevated. Therefore, the authors suggest that rhinoplasty candidates with low RSES scores should be investigated carefully in terms of BDD.

This study investigated the role of drug-induced sleep endoscopy (DISE) in the surgical treatment planning of patients with obstructive sleep apnea syndrome (OSAS). This study was conducted using patients diagnosed with OSAS between January 2007 and March 2009, who were scheduled for surgical treatment. DISE was performed using propofol in patients considered to have upper respiratory tract obstruction as indicated by Muller's maneuver. After completing the sleep endoscopy, the patient was intubated and surgery was performed (tonsillectomy and uvulopalatopharyngoplasty). A successful operation was defined as a decrease in the respiratory disturbance index to below 5 or a decrease of ≥50 % following the operation. The study included 20 patients (4 female and 16 male) aged 19-57 years. No statistically significant correlation between modified Mallampati class and operation success or between the polysomnographic stage of disease and operation success was identified. A significantly high operation success rate was found in the group with obstruction of the upper airway according to DISE (p < 0.05), whereas a significantly low operation success rate was found in the group with obstruction of the lower airway according to DISE (p < 0.01). DISE may be used to identify the localization of obstruction for diagnostic purposes, and it can be helpful in selecting the treatment method.

Background: We evaluated the effects of tobacco smoking on functional outcomes of septoplasty and complication rates., Methods: In total, 183 patients (127 males, 56 females) who had septum deviations and underwent septoplasties from January 2012 to December 2013 were evaluated. Subjects were divided into three groups: non‑smokers (Group A), light smokers (<20 cigarettes/day, Group B), and heavy smokers (> 20 cigarettes/day Group C). Nasal Obstruction Symptom Evaluation (NOSE) scoring was used to evaluate the effects of tobacco smoking on septoplasty outcomes. Clinical evaluations were performed preoperatively and at one and six months postoperatively. Complications were evaluated during the clinical examinations., Results: No significant differences were seen between the preoperative and 1-month postoperative NOSE scores, the 1- and 6-month postoperative NOSE scores, or the preoperative and 6-month postoperative NOSE scores among the groups (p =0.352, 0.737, and 0.344, respectively). The overall complication rate also did not differ among the three groups (p =0.860)., Conclusions: Active smoking status does not affect operation outcomes and does not increase the postoperative complication rate among patients undergoing septoplasty. Although we should advise our patients to stop smoking because of its known harmful effects, smoking may not be a selection criterion for septoplasty. Hippokratia 2015; 19 (3): 219-224.

Objective: To assess the diagnostic value of a novel device, the endoilluminator, in patients who can or cannot attain effective speech after application of voice prosthesis., Study Design: Prospective clinical study., Methods: Thirty-four patients who underwent total laryngectomy and whose insufflation test was positive were included. As a result of efforts to develop an insufflation test that includes a light apparatus, we attained a device that we call an endoilluminator. We found that the area it illuminated when a patient achieved effective speech was a predictive factor for the test result. That is, patients for whom the upper part of the tracheostomy (where the standard tracheoesophageal fistula will be opened) was illuminated were categorized as the positive test group, whereas those for whom the neck skin above this region was illuminated were categorized as the negative test group., Results: In 27 of the 34 patients, appropriate localization was determined using the endoilluminator, and these patients achieved effective speech. In the remaining seven patients, localization was inappropriate and they did not achieve effective speech during the first week, first month, or third month postpuncture. In further investigations of these seven patients, a pharyngoesophageal spasm was detected in five, and a pharyngoesophageal stricture was detected in two., Conclusion: Endoilluminator increases the success rate of the insufflation test by accurately predicting a patient's ability to achieve effective speech after application of voice prosthesis., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

This study evaluated the effectiveness of vitamins A, C, and E, with selenium, in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL). This was a prospective, controlled study performed at a tertiary teaching and research hospital. Over a 32-month period, patients were treated with either our standard ISSNHL treatment regimen plus vitamins A, C, and E and selenium (ACE+ group) or with only our standard ISSNHL treatment regimen (ACE- group). The demographics, additional symptoms, mean initial and final hearing levels, mean hearing gain, and recovery data were compared between the two groups. The ACE+ group, consisting of 70 (55.5 %) patients, received vitamin A (natural beta-carotene, 26,000 IU), vitamin C (ascorbic acid, 200 mg), vitamin E (d-alpha-tocopherol, 200 IU), and selenium (50 μg) twice daily for 30 days in addition to our ISSNHL treatment regimen: methylprednisolone at an initial dose of 1 mg/kg body weight per day, tapered over 14 days; Rheomacrodex(®) [(10 g of dextran and 0.9 g of NaCl)/100 ml] 500 ml daily for 5 days; Vastarel(®) 20-mg tablet (20 mg of trimetazidine dihydrochloride) three times daily for 30 days; and ten 60-min hyperbaric oxygen (HBO) sessions (2.5 absolute atmospheres of 100 % O2), once daily, starting the day of hospitalization. The ACE- group comprised 56 (44.4 %) patients, who received only our ISSNHL treatment regimen. The mean hearing gains were 36.2 ± 20.3 dB in the ACE+ group and 27.1 ± 20.6 dB in the ACE- group. The mean hearing gain rates were significantly higher in the ACE+ group than in the ACE- group (p = 0.014). Treatment with vitamins A, C, and E and selenium was effective in ISSNHL patients undergoing treatment with methylprednisolone, dextran, trimetazidine dihydrochloride, and HBO, and might be more effective when the initial hearing level is below 46 dB.

Background: Pleomorphic adenomas (PAs) are the most common type of benign salivary gland tumours and usually originate from the major salivary glands. PA originating from the nasopharynx has rarely been reported in the literature., Case Report: A 62 year-old male presented with right aural fullness and subjective hearing loss. Otoscopic examination revealed an opaque and bulging tympanic membrane. Nasal endoscopic examination revealed a smooth mass arising from the right wall of the nasopharynx, obstructing the opening of the right Eustachian tube. The MRI showed a 1.3×2×1.3 cm sharply outlined and lobar mass in the right lateral wall of the nasopharynx. The tumour was meticulously detached from its attachment site and excised via the transnasal route under endoscopic visualisation., Conclusion: We reported pleomorphic adenoma in the nasopharynx in a patient who presented with serous otitis media that successfully resected with transnasal endoscopic surgery and discussed the treatment methods.

Objectives: To compare audiological outcomes of ventilation tube insertion(VTI) and myringotomy alone in association with adenoidectomy in patient with otitis media with effusion(OME)., Study Design: Retrospective clinical chart review., Subjects and Methods: In total, 148 patients (78 male, 70 female; average age of 6,02 ± 1,98 years, range 4 to 7 years) who had been underwent adenoidectomy in association with VTI or myringotomy alone in our clinic were included in this study. Demographics and audiological outcomes were collected. The patients were divided randomly into two groups, group A (72) were subjected to adenoidectomy with VTI and group B (76) were subjected to adenoidectomy with myringotomy. Audiological outcomes comparing the both groups at six months also continued to patients follow up to one year after surgery. Results with a p-value <0.05 were considered statistically significant., Results: The mean pure tone hearing threshold preoperatively in group A was 28.68 ± 11.72 dB, while it was 24.25 ± 12.68 dB in group B. At postoperative six months, the means in group A were 8.4 ± 2,32 dB, while the means were 10,4 ± 3,36 dB in group B. Statistical analysis showed statistically significant difference between the means of pure tone hearing thresholds in both groups during the whole follow up period (p<0.05)., Conclusion: Our data suggest audiological outcomes of VTI was higher compared with myringotomy alone in association with adenoidectomy. However, further studies with a higher number of patients are needed to compare the audiological outcomes of various ventilation tubes types.

Objectives: This study aims to classify age related hearing loss in Turkish population according to Schuknecht audiometric configurations for presbycusis and investigate the most common etiologies., Patients and Methods: A total of 1,134 patients (568 males, 566 females; mean age 70.5±7.7 years; range 55 to 80 years) with age related hearing loss were included in the study. Audiograms of patients were classified into three categories: high frequency steeply sloping (HFSS), flat, and high frequency gently sloping (HFGS). Speech discrimination scores were evaluated and compared., Results: In the study population, HFSS audiogram configuration was the most frequently observed (48.5%), followed by HFGS configuration (26.9%), and flat configuration (24.5%), respectively. While HFSS audiogram configuration was statistically significantly more common in males, flat audiogram configuration was statistically significantly more common in females (p=0.0001). HFSS group mean air conduction threshold were statistically significantly higher than flat and HFGS groups (p=0.0001). No statistically significantly difference was detected in terms of speech discrimination scores between three groups (p=0.796)., Conclusion: Results of this study suggest that, in Turkish population, while sensory presbycusis is more common in males, strial presbycusis is more common in females. No difference was detected in terms of the prevalence of cochlear presbycusis in males and females (p=0.0001).

Objective: Transoral robotic supraglottic laryngectomy is a new surgical way to perform endolaryngeal resection of supraglottic laryngeal carcinoma. The aim of this report was to present our initial experience about transoral robotic supraglottic laryngectomy for early supraglottic cancer., Methods: Subjects with early squamous cell carcinoma (T1-T2) of supraglottic region who managed using transoral robotic surgery in a tertiary referral center were included in the study. The technique of robot-assisted resection, intraoperative blood loss, mean robotic operating time, pathologic margin status, postoperative extubation, need for a tracheotomy, and length of hospitalization, complications, duration of oral nutrition, and neck dissection and radiotherapy needs were evaluated., Results: Thirteen subjects (12 men, 1 woman) with T1-T2 supraglottic carcinoma were successfully operated on with transoral robotic surgery. In all subjects, negative margins were obtained. The mean total robotic surgery time was 31.6 (SD, 16.2) minutes (range, 20-80 minutes). Mean total blood loss was less than 40 mL. Subjects started oral nutrition with a mean of 10.8 (SD, 8.9) days (range, 4-30 days) postoperatively. The mean hospitalization was 15.4 (SD, 10.4) days (range, 7-42 days)., Conclusions and Relevance: Transoral robotic supraglottic laryngectomy with the da Vinci robotic system can be regarded as a feasible, safe, and effective technique. Although short-term results seem discouraging, long-term results are needed to evaluate the oncologic safety.

Castleman disease (CD) is a benign lymphoepithelial disorder characterised by abnormal growth of a lymph node. This disease may be seen anywhere along the lymphatic chain but it usually occurs in the mediastinum. Two clinical types (localised and generalised) and three histopathological types (hyaline vascular, plasma cell, and mixed) have been described. We present a case of a 35-year-old female patient with parotid CD of the hyaline-vascular type as an extremely rare entity. We also discuss recent updates on this disease., (Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

The purpose of this study was to investigate the effectiveness of intratympanic steroids in patients with idiopathic sudden sensorineural hearing loss who did not respond to initial systemic steroid therapy. This retrospective study involved 51 patients, who did not respond to systemic steroids as a first-line treatment. Initial systemic steroid therapy consisted of administration of methylprednisolon intravenously (250 mg) at the first day and followed by orally (1 mg/kg) tapering for 14 days. Twenty-one patients accepted intratympanic treatment, and the remaining 30 patients who refused intratympanic treatment were evaluated as the control group. Steroids (dexamethasone drops, 1 mg/mL) were administered through a ventilation tube. Hearing was assessed immediately before treatment and 2 months after treatment. Recovery of hearing was defined as an improvement of >20 dB in the pure tone average. We tested 250, 500, 1,000, 2,000, 4,000, and 8,000 Hz frequencies for the pure tone audiometric evaluation. Statistically Student's t test, Mann-Whitney U test, Chi-squared and Fisher's exact tests were used. The pure tone average improved in 47.6% of the intratympanic group and in 10% of the control group (p = 0.002), with pure tone average improvements of 19.9 ± 16.5 and 4.76 ± 9.6 dB in the intratympanic and control groups, respectively. When the hearing threshold at each frequency was analyzed, improvements at all frequencies were significantly greater in the intratympanic steroid group when compared with the control group (p < 0.01). Intratympanic steroid administration is an effective therapy for sudden sensorineural hearing loss in patients, who are refractory to primary systemic steroid therapy.

Gender determination is an important step in identification. For gender determination, anthropometric evaluation is one of the main forensic evaluations. In the present study, morphometric analysis of maxillary sinuses was performed to determine gender. For morphometric analysis, coronal and axial paranasal sinus computed tomography (CT) scan with 1-mm slice thickness was used. For this study, 140 subjects (70 women and 70 men) were enrolled (age ranged between 18 and 63). The size of each subject's maxillary sinuses was measured in anteroposterior, transverse, cephalocaudal, and volume directions. In each measurement, the size of the maxillary sinus is significantly small in female gender (P < 0.001). When discrimination analysis was performed, the accuracy rate was detected as 80% for women and 74.3% for men with an overall rate of 77.15%. With the use of 1-mm slice thickness CT, morphometric analysis of maxillary sinuses will be helpful for gender determination.