Turkish Archives of Otorhinolaryngology最新文献

Objective: Vocal fold nodules (VFNs) are among the most common causes of dysphonia. Phono-laryngeal microsurgery, pharmacological treatments, and voice therapy (VT) have been used for treating VFNs. VT has been advocated as the primary treatment of choice. This study investigated the efficacy of the DoctorVox Voice therapy technique (DVT) for treating VFNs.

Methods: A total of 38 patients with VFNs and 40 individuals without any voice problem (control group) were included. All patients received the DVT program. Otorhinolaryngology examination, videolaryngostroboscopy (VLS), and acoustic analysis (SPL, mean F0, jitter %, shimmer %, NHR) were performed at pretreatment, one and six months after the end of treatment. The voice handicap index-10 (VHI-10) and the GRB scales were used for perceptual voice evaluation. GRB and VLS scorings were done blindly.

Results: Compared with the pretreatment values, the first- and the sixth-month values after treatment demonstrated a significant decrease in VHI-10 (19.5 vs. 5.1), GRB (2.3 vs 0.68 for G value) and VLS scores, SPL (54.4 vs 66.1 dB), F0 (201 vs. 227 Hz), jitter % (1.46 vs 0.85), shimmer % (3.27 vs 2.51), NHR (1.15 vs. 0.46) values among patients. Most of the voice parameters in the sixth month after the DVT program did not differ significantly from those of the control group.

Conclusion: The DVT was found to be an effective method in VFN treatment.

Orbital epidermoid cysts are uncommon lesions within the bony orbit with varied symptomatology related to both the eye and the sino-nasal system. They are often slow-growing cystic masses which may cause facial asymmetry and visual loss due to pressure symptoms. Cross-sectional imaging such as computed tomography and magnetic resonance imaging are contributory and useful for assessment of the size and actual extent and should be mandatory before planning any surgical intervention. Open approaches and needle aspiration have been traditionally described; however, the use of the rigid nasal endoscope in the intraorbital compartment is a useful adjunct for exploration of the extent of the lesion and for complete surgical clearance. In this report, a 69 years old female with an old post- traumatic orbital epidermoid cyst which was removed completely using an endoscope via transorbital route was presented with the review of literature.

Objective: Fabry disease is a rare hereditary lysosomal storage disease caused by the deficiency of alpha-galactosidase A (α-GLA). Although sensorineural hearing loss is common in Fabry disease, there are no studies in the literature that have screened a population with sensorineural hearing loss for Fabry disease. In this study, we aimed to screen a group of patients who were diagnosed with sensorineural hearing loss and underwent a hearing test for Fabry disease.

Methods: One hundred sixty eight patients who were aged 18-75 years and diagnosed with idiopathic hearing loss between July 2019 and January 2020 were included. In male patients, α-GLA enzyme activity was analyzed. Patients with low enzyme activity were identified and genetic testing was performed for mutations in the GLA gene. In females, only genetic testing was performed.

Results: Eighty four women and 84 men were included in the study. α-GLA enzyme activity was low in 11 of the 84 male patients (13%). One out of these 11 patients had a gene mutation for Fabry disease. Moreover, four relatives of this index patient were diagnosed with Fabry disease in family screening. GLA gene mutation was also found in one of the 84 female patients. Consequently, two (1.2%) of our 168 patients were diagnosed with Fabry disease by screening with enzyme activity and genetic testing.

Conclusion: Our study showed that screening for Fabry disease in patients with idiopathic sensorineural hearing loss without other specific findings might be a useful strategy for detecting new cases.

Deep neck space infections can cause antibiotic-resistant abscesses that can impinge on vital anatomical structures. Image-guided surgery systems using preoperative computed tomography (CT) imaging can be utilized to characterize pathology and assist surgeons in avoiding iatrogenic injury. This manuscript explores the presentation and unique CT-guided surgical management of an infratemporal fossa abscess in a 48-year-old male who presented with left-sided dental pain and facial swelling that had progressed despite antibiotics and dental extraction. CT-guided imaging can assist in localizing and protecting vital anatomical structures during deep neck abscess drainage and can prevent the potential risks and complications of classic surgical approaches.

Objective: To analyze the demographic characteristics and the pathological results of neck dissection in primary parotid gland (PG) cancer patients, and to investigate the effects of histopathological parameters (perineural invasion, lymphovascular invasion, and extracapsular spread), neck metastasis, stage and lymph node ratio (LNR) on survival.

Methods: Patients who underwent parotidectomy for malignant PG tumors between 2000 and 2019 years were retrospectively reviewed from the medical records. Thirty patients who were treated with parotidectomy and neck dissection were included in the study. Lymph node ratio was calculated as the ratio of the number of metastatic lymph nodes (LN) to the total number of excised LNs. Tumor stage, regional LN metastasis, LNR, perineural invasion, lymphovascular invasion, and extracapsular spread were reviewed for the effects on survival with the Kaplan-Meier analysis.

Results: The study included 17 (57%) male and 13 (43%) female patients. Their mean age was 67.93±16.90 years (range, 50-85 years). The average number of the excised LN was 26.03±11.79 (range, 3-50). Mean LNR was 0.16±0.26. The Kaplan-Meier analysis showed that neck metastasis (p=0.001) and LNR (p<0.001) were associated with shorter survival times compared to perineural invasion (p=0.818), lymphovascular invasion (p=0.154), extracapsular spread (p=0.410) and stage (p=0.294). In multivariate COX regression analysis, only LNR had a statistically significant difference (p=0.027) compared to the other parameters.

Conclusion: The present study suggests that LNR and neck metastasis are associated with shorter survival times in PG cancers. Lymph node ratio can be used as a prognostic marker in these patients.

Angiofibroma is a non-encapsulated, highly vascular tumor that usually originates in the nasopharynx. Laryngeal cases of extranasopharyngeal angiofibroma (ENA) are a very rare pathology, especially in children. Only eight ENA laryngeal cases have been described in the literature, and only one of them is a pediatric case. In this report we present an 11-year-old child with epiglottic ENA resected with transoral endoscopic ultrasonic surgery (TOUSS) with review of the literature. Because of reccurrence after five months he underwent re-excision with CO₂ laser. Recurrences in ENA are infrequent, but as demonstrated in our case, close endoscopic follow-up is mandatory in this location. Endoscopic hemostatic procedures like TOUSS and CO₂ laser ensure bloodless surgery for the management of this type of vascular laryngeal tumors.

Objective: In hopes of contributing to the decision about the best surgical option in tonsillectomy, we performed this work to compare the effectiveness of the thermal welding system (TW) and monopolar electrocautery (ME) tonsillectomy in terms of postoperative pain, postoperative bleeding, and operation time in patients undergoing tonsillectomy, to determine which procedure is most expected to enhance the postoperative quality of life.

Methods: Digital databases, including PubMed, Scopus, Cochrane, Web of Science, and Google Scholar, were systematically screened from inception up to October 2022. The included randomized controlled trials (RCTs) were evaluated for risk of bias via the Cochrane tool (version 2). The outcomes were summarized as risk ratio (RR) or mean difference/standardized mean difference (MD/SMD) with a 95% confidence interval (CI) in a random-effects model.

Results: The three RCTs that met our criteria were included in the study. Overall, 151 patients had been enrolled in these three RCTs, in which 75 and 76 were allocated to the TW and ME groups, respectively. The postoperative pain levels were substantially reduced, favoring the TW arm over the ME arm [n=2 RCTs, SMD=-0.39, 95% CI (-0.67, -0.12), p=0.005]. Also, the analysis revealed a substantial variation between the TW and ME arms in terms of operation time [n=2 RCTs, MD=3.29 minutes, 95% CI (1.42, 5.17), p=0.0006]. However, the analysis revealed no substantial variation between the TW and ME arms in term of postoperative bleeding [n=3 RCTs, RR=0.40, 95% CI (0.06, 2.62), p=0.34].

Conclusion: This meta-analysis revealed that postoperative bleeding for tonsillectomy were similar between the ME and TW techniques. However, TW showed lower postoperative pain levels than ME statistically but without achieving significant clinical advantage.

Objective: Cisplatin is a chemotherapeutic agent with an ototoxic effect that is frequently used in head and neck cancers. There are studies in the literature conducted with various antioxidant substances to protect and/or prevent ototoxicity. This study aims to investigate whether platelet-rich plasma (PRP) has a protective and therapeutic effect on cisplatin ototoxicity.

Methods: A total of 40 Sprague Dawley albino rats were divided into six groups as control group (n=6), PRP-only group (n=6), cisplatin group (n=6), cisplatin + PRP group (n=6), PRP + cisplatin group (n=6), and donor group (n=10). At the beginning of the study and the 8^th day, they were tested with distortion product otoacoustic emission (DPOAE). Assessment of DPOAE results was based on the signal-to-noise ratio in 2000, 3000, 4000, 6000, and 8000 Hz frequency bands. On the 8^th day, the rats were sacrificed. For histological examinations, the temporal bones were dissected and fixed. After hematoxylin and eosin staining, the tissues were evaluated by light microscopy.

Results: In the DPOAE tests performed on the 0^th and 8^th days of the cisplatin group, it was observed that cisplatin caused hearing loss in the rat ears. It was determined that the cisplatin group at 2000 Hz, 3000 Hz and 4000 Hz had a significant decrease in hearing compared to all groups (p<0.015), while the cisplatin group at 6000 and 8000 Hz was characterized by hearing loss at a higher rate than all groups (p<0.001). At the end of the study, negative effects of cisplatin on both cellular dimensions (cytoplasmic vacuolization, cell degeneration, dilatation, apoptotic cells, nerve degeneration) and hearing function were observed. No protective or therapeutic effect of PRP on cisplatin ototoxicity was observed.

Conclusion: Our study showed that platelet-rich plasma did not have a significant effect in the treatment of hearing loss due to cisplatin ototoxicity and in preventing hearing loss in rats.

Objective: The purpose of this study was to determine the factors affecting hearing aid use in children and investigate how these factors affected their subjective auditory performance.

Methods: The study was carried out with 34 children aged three to six years who had mild or moderate sensorineural hearing loss and had used a bilateral hearing aid for at least six months. The daily hearing aid usage times of children were collected with the help of data logging software. Parent-child interactions were assessed with the Maternal Behavior Rating Scale (MBRS) and Child Behavior Rating Scale (CBRS) scores. To assess the parents' levels of knowledge about hearing devices, the Hearing Aid Awareness Question Form for Parents, which was prepared by the researchers, was used. Finally, to evaluate the subjective hearing performance of the children, the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) survey was implemented.

Results: Strong and significant correlations were found between the MBRS and CBRS scores, the results obtained from some questions in the Hearing Aid Awareness Question Form for Parents, the overall PEACH score, the QUIET subscale score, and the NOISE subscale score (p<0.001). According to the multivariate linear regression analyses, it was observed that the use of the pediatric clip hearing aids holder (question 17) had a significant effect in decreasing both the overall PEACH score (β=-3.07, p=0.008) and the PEACH-NOISE subscale score (β=-1.88, p=0.012). A unit increase in the score given to question 24 of the Hearing Aid Awareness Question Form for Parents (i.e., using the hearing aids longer) caused a 2.35-fold increase in the PEACH-NOISE subscale score, a 1.74-fold increase in the PEACH-QUIET subscale score, and a 4.06-fold increase in the overall PEACH score.

Conclusion: Parent-child interaction and parents' knowledge about hearing aid use are important factors affecting hearing aid use in children. These factors also affect the children's subjective auditory performance. Parents should be given detailed information about hearing aid use and be more sensitive and responsive in their interactions with their children.

Objective: Correction of nasal tip projection (NTP) deformities involve techniques for the lower lateral cartilage of the nose. Previously, it would have been surgically difficult to perform the lateral crural overlay (LCO) technique for the second time in revision rhinoplasty in patients who already had undergone rhinoplasty with the LCO technique because of the length of the NTP. In this study, we evaluated the lateral crural segmental excision (LCSE) technique in patients with overprojected nasal tip in revision rhinoplasty.

Methods: We retrospectively studied the cases of 19 patients who had initially undergone rhinoplasty with the LCO technique for overprojected nasal tip, and later underwent revision rhinoplasty with the LCSE technique after insufficient NTP was observed on facial analysis between 2018 and 2022.

Results: Of the patients, 12 (63%) were male, with an average age of 29.6 years, and 7 (17%) patients were female, with an average age of 25.3 years. Using Goode's formula, NTP indexes of patients measured 79.4±1.8 preoperatively and 56.0±1.3 postoperatively. Stastically significant difference was observed between preoperative and postoperative values. None of the patients had malnutrition at the incision margins, and all patients recovered on time and without any problems. Granulation tissue was detected in the mucosa in only one patient.

Conclusion: The LCSE technique, with a short surgical time, recovery period without complications, and satisfactory nasal respiratory function, is preferred over a second LCO application in cases of NTP.