Turkish Archives of Otorhinolaryngology最新文献

Objective: Tracheostomy in the pediatric population is a technical and demanding procedure due to the smaller, more pliable trachea and the limited exposure of the operating field. It has been documented to have higher morbidity and mortality, especially among low birth weight and pre-term infants. A review of the existing literature shows that indications, epidemiology, and complications are changing dynamically, and no definite guidelines have been established.

Methods: A five-year retrospective observational study on pediatric tracheostomy was carried out at a pediatric tertiary care center. All children aged between 1 day and 18 years who had undergone tracheostomy were included. Case records of all children were analyzed meticulously for age, sex, indications, procedure, and complications of tracheostomy.

Results: During the study period, 148 children underwent tracheostomy at our pediatric tertiary care center. The most common indication for tracheostomy was neurological causes, noted in 77 patients (52.02%). The most common early postoperative complication was tube obstruction in 13 patients (8.78%), and the most common delayed postoperative complication was suprastomal collapse in 52 patients (35.13%). In total, 104 patients (70.27%) underwent successful decannulation.

Conclusion: Pediatric tracheostomy is a very demanding and challenging procedure owing to the alterations in the neck anatomy, variations in the airway, and several associated complications. There is a growing need to know the change in indications, complications, and overall outcome of pediatric tracheostomies for better care and efficient management of children requiring tracheostomies.

Objective: To compare the reliability of flexible nasal endoscopy and lateral neck radiography in grading adenoid hypertrophy preoperatively in children.

Methods: A retrospective study was performed at a single tertiary care center. Medical records of children who underwent adenoidectomy between January 2019 and December 2023 were reviewed. Preoperative adenoid size was assessed by radiography or endoscopy and compared to intraoperative grading, the reference. Adenoid hypertrophy was graded as mild (25-50%), moderate (51-75%), or severe (76-100%).

Results: A total of 360 patients, 199 males and 161 females, were included. The mean age was 4.29±2.39 years. Preoperative and intraoperative grading matched in 58% of cases using endoscopy and 44.5% using radiography (p=0.028). Accurate grading was 1.7 times more likely with nasal endoscopy than radiography [odds ratio=1.72; 95% confidence interval (1.06-2.79)].

Conclusion: Flexible nasal endoscopy is more reliable than radiography in preoperative grading of adenoid hypertrophy in children.

Objective: The purpose of this study was to calculate the vestibulo-ocular reflex (VOR) gain asymmetry ratios obtained from head impulse paradigm (HIMP) and suppression HIMP (SHIMP) tests in patients with unilateral definite Ménière's disease (MD) and to investigate their relationships with clinical, audiologic and vestibular parameters.

Methods: The study included 35 (18 female, 17 male) unilateral MD patients with a median age of 50 (24-65). All patients underwent pure-tone audiometry, video-nystagmography, including caloric test, and video head impulse test. The VOR gain asymmetry indices were computed and the demographic, clinical and audio-vestibular variables were analyzed.

Results: Mean HIMP lateral canal VOR gain asymmetry ratio was -11.27±25.276 and mean SHIMP lateral canal VOR gain asymmetry was -15.63±23.993. While differences in caloric response asymmetry ratios were observed among hearing-loss severity groups (p=0.05), HIMP and SHIMP asymmetry ratios did not differ. VOR gain asymmetry ratios showed significant differences among dizziness handicap inventory groups, SHIMP saccade group and visually enhanced VOR saccade group (p<0.05). Significant correlations were found between SHIMP and caloric asymmetry ratios with air-conduction pure-tone averages (r=-0.337, p=0.047 and r=-0.358, p=0.035), and between HIMP lateral canal asymmetry and hearing at 500 Hz (r=-0.362, p=0.032).

Conclusion: Our study confirmed that VOR gain asymmetry assessed by SHIMP and HIMP differs across hearing levels; and further that caloric response asymmetry is also correlated with audio-vestibular parameters in patients with unilateral MD.

Objective: In our study we analyzed the residency theses on vertigo in Türkiye by year, subject, and specialty with the aim of identifying academic trends.

Methods: A bibliometric review was conducted using the National Thesis Database (1972-2025). The search was performed with the keywords vertigo, vestibular, dizziness, and Ménière. Only medical specialization theses were included. Titles and abstracts were screened, and eligible theses were classified by year, specialty, and topic.

Results: A total of 180 theses were identified. The highest number of theses was produced between 2016 and 2020, followed by a decline after 2021. In the study period 103 theses were published in otorhinolaryngology, 29 in neurology, 10 in physical medicine and rehabilitation, 23 in emergency and family medicine, and 15 in other specialties. While studies showed an apparent increase in vestibular testing and rehabilitation in recent decades, these emphasized etiology and diagnostic approaches in the earlier years.

Conclusion: Most theses on vertigo were produced between 2016 and 2020, with otorhinolaryngology providing the most significant contribution. Over time, interest shifted from etiology and diagnosis towards vestibular testing and rehabilitation. The findings confirm that vertigo is a central subject in otorhinolaryngology, but also attracts growing attention in neurology, physical medicine and rehabilitation, emergency medicine, and family medicine.

Objective: Acute invasive fungal rhinosinusitis (AIFR) is a disease with rapid progression, and high mortality and morbidity rates. The objective of this study was to retrospectively study the clinical and surgical findings of diabetic AIFR patients who were recently followed up in our clinic, with a view to determining whether these findings are in accordance with the current literature on the subject.

Methods: The study cohort comprised 30 patients with a pathological diagnosis of invasive fungal sinusitis who were evaluated at Hatay Mustafa Kemal University Hospital, Department of Otorhinolaryngology, between 2017 and 2022 and subsequently underwent surgical intervention.

Results: A total of 30 patients were included in the study. Of these, 16 were male and 14 were female. All patients were diagnosed with diabetes mellitus. The patients were divided into two groups: those who did not survive (n=12) and those who survived (n=18). Significant differences were observed between the groups in age, presence of diabetic ketoacidosis at presentation, skull base involvement, C-reactive protein (CRP), leukocyte, and neutrophil counts at presentation (p=0.013, p<0.001, p=0.024, p=0.013, p<0.001, p<0.001, p<0.001, respectively).

Conclusion: In our study, age, the presence of diabetic ketoacidosis at presentation and CRP values were significantly higher in the non-surviving patient group, and this was consistent with the findings of previous studies. The presence of skull base involvement and significantly higher leukocyte and neutrophil values at presentation in the non-surviving patient group could be a new finding to focus on.

Metastases to the larynx from distant primary malignancies are quite rare, but they should be considered in the differential diagnosis of submucosal laryngeal lesions. An 80-year-old male presented to our clinic with complaints of productive cough and hoarseness. Videolaryngoscopy revealed submucosal fullness in the right hemilarynx, pushing the right band ventricle mucosa medially and causing evident narrowing of the airway. Histopathological evaluation and immunohistochemical staining of the endolaryngeal submucosal biopsy specimen, obtained from the right ventricular fold, was diagnosed as laryngeal metastasis of prostate adenocarcinoma. This case is presented due to the scarcity of laryngeal metastases from prostate adenocarcinoma and is discussed in the context of literature.

We present a rare case of a large fetal oropharyngeal teratoma (epignathus) diagnosed during the third trimester and managed successfully with a planned ex utero intrapartum treatment (EXIT) procedure followed by neonatal surgical resection. A 30-year-old pregnant woman was referred to our department at 29 weeks of gestation due to polyhydramnios and the detection of an oropharyngeal mass on ultrasound. Fetal magnetic resonance imaging confirmed a 5×5 cm heterogeneous mass filling the oral cavity, raising concern for airway obstruction at birth. At 32 weeks, spontaneous pre-term labor necessitated urgent EXIT. While fetoplacental circulation was maintained, a tracheostomy was performed to secure the airway, allowing for safe delivery and ventilation of the neonate. The newborn subsequently underwent successful transoral surgical excision of the mass, which was confirmed histologically as an immature teratoma. Postoperative recovery was uneventful, and the infant remained free of recurrence during a 24-month follow-up period. This case highlights the importance of prenatal diagnosis, fetal imaging, and multidisciplinary planning in the management of airway-compromising lesions. It also introduces the EXIT procedure to otolaryngologists as a critical and effective approach for ensuring airway patency in selected high-risk cases of congenital head and neck tumors.

In osteoplastic frontal sinus surgery, the precision of initial bony incisions is critically important. Conventional techniques such as 6-ft Caldwell radiographs, burr holes method, transillumination and navigation systems are widely used. Recently, publications on the use of three-dimensional (3D) printed models in surgical navigation have increased. We aimed to enhance the accuracy of 3D model navigation-a cost-effective and accessible method that can be used alone or alongside conventional approaches-by developing a novel facial mask component not previously described. We developed a patient-specific planning system using open-source segmentation software and a desktop 3D printer. Computed tomography scans were segmented to isolate the anterior table, the sinus walls, and the osteoma when present. A novel feature was the custom-designed facial mask, which ensured accurate alignment of the incision guide. The mask, designed from tissue landmarks, incorporated a locking cylinder mechanism. All parts were printed in polylactic-acid at a cost of approximately 1$, with production times under 8 hours. The system was tested on two patients. In case-1, a patient with an anterior table defect, the 3D-printed model provided accurate incision guidance when navigation failed intraoperatively. In case-2, a frontal sinus osteoma was visualized with 1:1 scale printed models, which facilitated surgical planning. Surgeons reported better anatomical orientation, increased confidence in performing incisions, and more effective preoperative and intraoperative planning. The application of a facial mask to the 3D model has shown promising initial results. Further refinements and comparative studies are needed to standardize production, demonstrate accuracy, and validate its broader clinical utility.