Turkish Archives of Otorhinolaryngology最新文献

Objective: Obstructive salivary gland diseases were traditionally managed conservatively, with surgical treatment reserved for refractory cases only. These surgeries, ranging from papillotomy to sialadenectomy, often involved numerous complications. In the past two decades, sialendoscopy, a minimally invasive technique, has made tremendous progress due to its advantages. This study aims to describe the efficacy of combined approach sialendoscopy as a minimally invasive option for large-sized sialolithiasis that is not amenable to sialendoscopy alone.

Methods: It is an ambispective study of 12 patients over a span of 3.5 years at a tertiary care center conducted with all consenting patients who were treated with combined approach sialendoscopy. Ultrasonography and computed tomography of the patients was done. Therapeutic intervention in the form of combined approach sialendoscopy was done at the same sitting as diagnostic sialendoscopy and postoperative follow-up was conducted for a duration of six months.

Results: In this study of 12 patients undergoing sialendoscopy, glandular swelling was a universal presenting symptom, with 80% patients exhibiting meal-stimulated exacerbation and post-massage relief. Submandibular involvement predominated (83%), with parotid cases comprising the remainder. All patients had sialoliths >6 mm and underwent combined approach sialendoscopy, yielding a 100% immediate symptomatic resolution rate. Recurrence occurred in 16%, successfully managed with repeat sialendoscopy.

Conclusion: As endoscopy is integral to otorhinolaryngology, sialendoscopy represents the evolution of minimally invasive salivary gland surgery. This study highlights the different methods of combined approach sialendoscopy in managing larger as well as distally placed sialoliths, thus reinforcing its role as a superior gland-preserving modality.

Langerhans cell histiocytosis (LCH) is a complex disorder of the mononuclear phagocyte system. Laryngeal epithelioid hemangiomas are rare, benign vascular tumors in adults. Here, we report the first known case of the coexistence of LCH and epithelioid hemangioma in the larynx. A 42-year-old man presented with progressive swelling on the left side of the neck and hoarseness. Endoscopic examination revealed a mass obliterating the left pyriform sinus, false vocal cord, and aryepiglottic fold. Computed tomography (CT) showed a mass destroying the thyroid cartilage, extending to the left false and true vocal cords, and obstructing the airway. Fine-needle aspiration biopsy suggested hemangioendothelioma. However, histopathological examination after total laryngectomy revealed both LCH and epithelioid hemangioma. Positron emission tomography/CT indicated suspected LCH involvement of the pituitary gland and cervical lymph nodes. The patient was treated with chemotherapy. No recurrence was observed at the six-month follow-up. This case highlights the potential association between the mitogen-activated protein kinase pathway, LCH, and epithelioid hemangioma. It also emphasizes the importance of repeating a biopsy in cases of rare laryngeal tumors when initial results are inconclusive.

Objective: Schwannomas are benign tumors originating from the nerve sheath. Extracranial schwannomas account for 25-45% of schwannomas in the head and neck region. This study aimed to evaluate the clinical presentation, diagnostic modalities, and postoperative outcomes of extracranial non-vestibular head and neck schwannomas and to discuss the findings in the context of the literature.

Methods: Medical records of patients who underwent surgical treatment for extracranial schwannomas between 2014 and 2022 were retrospectively reviewed. A total of 25 patients met the inclusion criteria and were included in the study.

Results: The mean age of the patients was 49 years, with a male-to-female ratio of 16/9. The most common presenting symptom was painless swelling. The face was the most affected site, followed by the oropharynx and scalp. Preoperative imaging was performed in nine patients, with ultrasound being the preferred modality. Preoperative biopsy was conducted in only two patients. The mean follow-up duration was 54 months, with no reported recurrences.

Conclusion: This study represents the largest national series of extracranial head and neck schwannomas, providing valuable insights into their clinical presentation, diagnostic approach, and long-term outcomes.

Tonsillectomy is commonly performed in otorhinolaryngology clinics and is a relatively reliable procedure. Nevertheless, several complications, most notably postoperative bleeding, have been identified. Cervicofacial emphysema following tonsillectomy is exceedingly rare. This complication can lead to high-mortality outcomes, such as necrotizing fasciitis, mediastinitis, and pneumomediastinum. In this case report, we present the diagnosis and treatment of cervicofacial emphysema that developed on the third postoperative day in a 25-year-old female patient, along with a review of the relevant literature.

Objective: This study aims to assess the effectiveness of bone-anchored hearing instruments (BAHIs) in patients with chronic otitis media (COM), using objective and subjective measures. It is a multicenter, prospective trial involving patients with COM who have undergone surgical treatment and have been rehabilitated using BAHIs.

Methods: COM Questionnaire-12 (COMQ-12), Speech, Spatial, and Qualities of Hearing Scale (SSQ), World Health Organization (WHO) Quality of Life-BREF questionnaire, and audiometric tests were used for assessment.

Results: Twenty-eight patients were included. The average duration of COM was 20.1±13.32 years. Among the patients, 60.7% (17) were using hearing aids, with a mean usage duration of 10.8±10.7 years (ranging from 1 to 36 years). Seven patients received the PONTO device, two received the BAH aid (BAHA) connect system, and 19 were implanted with the BAHA attract system. COMQ-12, SSQ, WHO questionaries, and audiometric tests showed significant improvement, and the results were found stable during follow-up.

Conclusion: This study reinforces the effectiveness of BAHIs in improving hearing thresholds and quality of life for patients with COM.

Thyroglossal duct cyst (TDC) is a common congenital neck anomaly that typically presents as a midline neck mass and is most often diagnosed in the second decade of life. Although TDCs are generally painless and asymptomatic, infection of the cyst can lead to significant airway obstruction. We report the case of a 31-year-old male who experienced upper airway obstruction due to an acute TDC infection. We performed a curative modified Sistrunk procedure to relieve the obstruction during the acute episode. This case underscores the critical need for prompt diagnosis and intervention to prevent morbidity and mortality associated with airway emergencies in infected TDCs. We also discuss the challenges of managing an acutely infected TDC with emergent airway involvement, necessitating a more complex surgical approach.

Objective: The aim of this study is to assess the prevalence of tonsilloliths and investigate the potential role of nasal septal deviation (NSD) and/or chronic rhinosinusitis (CRS), with or without nasal polyps, in their development.

Methods: A retrospective analysis was conducted on computed tomography (CT) images of 3,516 patients obtained between January 2017 and December 2020. The presence of tonsilloliths was recorded along with NSD and CRS, with or without nasal polyps. The effects of age, gender, NSD, and CRS (with or without nasal polyps) on tonsillolith formation were analyzed. All CT images were re-evaluated for tonsilloliths, CRS, NSD and other pathological findings. The relationships between tonsillolith presence and NSD and CRS were statistically analyzed.

Results: A significant difference in age was observed between individuals with and without tonsillolith (p<0.001). Additionally, the prevalence of tonsillolith was markedly higher in patients diagnosed with NSD compared to those without this condition (p<0.001). Similarly, patients diagnosed with CRS exhibited a significantly increased incidence of tonsillolith when compared to individuals without CRS (p<0.001).

Conclusion: The incidence of tonsilloliths in this study was 27.6%. Tonsillolith prevalence increased with age, while no significant difference was observed based on gender. The presence of NSD, a condition associated with nasal obstruction, or CRS, an inflammatory disorder, was linked to a higher incidence of tonsilloliths.

Objective: This study aims to evaluate and improve the cadaver dissection training program given by the Turkish Otorhinolaryngology and Head and Neck Surgery Association's resident school. The program addresses goals, outcomes, content, implementation sequence, educational strategies, and the steps for evaluation and regulation.

Methods: The Kern educational program development model was used by the 2023-2025 ENT Resident School Management for cadaver dissection training: both qualitative and quantitative research methods were employed. A needs analysis was conducted with structured focus interviews with the 12 students accepted into the course. Dissection steps, educational resources, and dissection videos were shared with residents before the training. A personalized cadaver dissection training plan, aligned with the Curriculum Development and Standardization System, was developed and shared with the instructors. Post-training, the Kirkpatrick program evaluation model was used to conduct first and second-level program evaluations.

Results: The first-level evaluation revealed high satisfaction with the training program, and the second-level evaluation indicated a statistically significant increase between pre-test and post-test scores (p=0.015). There was a significant positive correlation between the total mastoidectomy success scale scores and the difference scores (pre- and post-test) (p=0.019; r=0.663), while no significant correlation was found for the endoscopic sinus surgery success scale scores (p=0.996).

Conclusion: The Resident School, developed by the members of the Turkish Otorhinolaryngology and Head and Neck Surgery Association, is a high-participation, skill-intensive training program. The program, conducted with great dedication, received high participant satisfaction and assessed knowledge and skill learning levels.

Fishing constitutes a widely practiced sport considered pleasant and harmless. Yet, there are specific risks associated with fishhook injuries specifically in the neck. To the best of our knowledge, only few articles on fishhook injury in the neck were reported in the literature. We present the case of a 57-year-old previously healthy male coming to the emergency department with a J-type fishhook accidentally lodged in his neck. Prompt management with bedside removal of the sharp foreign body from the neck was achieved with no subsequent complications. In this case report, literature review of fishhook types and injuries as well as management options of such penetrating injuries will be detailed.