Turkish Archives of Otorhinolaryngology最新文献

Objective: This study aimed to investigate squamous metaplasia in mastoid cells of patients undergoing surgery for chronic otitis media (COM) with or without cholesteatoma. Bone dust was stained with hematoxylin and eosin (H&E) for squamous cells and keratin and immunohistochemically for p63. Additionally, the feasibility of routine pathological examination of bone dust via H&E staining was evaluated for cost-effectiveness and for identifying patient groups needing advanced follow-up.

Methods: Thirty-one patients with COM were enrolled: 14 with cholesteatoma (study group) and 17 without cholesteatoma (control group). Mastoid bone dust obtained during surgery was examined specifically for the presence of squamous cells, keratin, and p63, with evaluation performed using H&E and immunohistochemical staining techniques. Findings were compared between the study and control groups.

Results: Keratin was significantly more frequent in the study group than in controls (43% vs. 6%, p=0.01). No significant differences were observed for squamous cell (p=0.43) or p63 expression (p=0.20). However, when any of the three markers were positive, a statistically significant difference was found between the groups (43% vs. 12%, p=0.049).

Conclusion: These findings suggest that the mastoid air cell systems of patients with cholesteatoma may be affected differently prior to cholesteatoma spreading to the mastoid system. This could be linked to microcirculation of inflammatory proteins, impaired aeration, and the formation of retraction pouches. These results align with the metaplasia theory as a possible explanation for the etiopathogenesis of acquired cholesteatoma.

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 ESS 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.

Objective: To assess the relation between cochlear duct length (CDL) and audiological outcome after cochlear implant surgery in prelingually deafened children.

Methods: In a prospective cohort study, 36 prelingually deaf children underwent cochlear implantation at All India Institute of Medical Sciences, Jodhpur. Preoperative high-resolution computed tomography (HRCT) and high-resolution T2 weighted sequences magnetic resonance imaging (MRI) of temporal bones were used to calculate CDL. Patients were followed up for 12 months postoperatively with visits every three months for audiological scoring (infant-toddler meaningful auditory integration scale and revised central auditory processing scores).

Results: Thirty-six candidates were included in the study. The mean CDL, as measured on temporal bone HRCT, was 32.72±1.278 mm, and, with MRI, was 33.4689±1.31. This study is suggestive of widely dispersed data (coefficient of variance <0.5), and hence, the hypothesis of "implantation in CDL close to 31.5 mm will give the best improvement in functional outcome scores" cannot be generalized. The improvement in functional outcome scores is likely attributable to other causes/multifactorial causation.

Conclusion: We found no relationship between CDL and audiological outcomes post-cochlear implantation in prelingually deaf children. Further research with larger sample sizes, prospective multicenter designs and extended follow-up periods is warranted to strengthen evidence in this area.

Objective: Heavy metal exposure has recently become a problem due to the increasing environmental pollution as urbanization expands. This prospective cross-sectional study was conducted to compare levels of heavy metals in the nasal concha of the patients living in urban and rural who underwent partial inferior concha resection.

Methods: Sixty-seven patients were divided into two groups: 38 rural patients and 29 urban patients. Partial inferior turbinate resection was performed in these patients with turbinate hypertrophy, and these tissues were examined for heavy metal levels. Lead (Pb), cadmium (Cd), zinc (Zn), copper (Cu), and manganese (Mn) levels were measured in inferior nasal concha by inductively coupled plasma- optical emission spectrometry.

Results: The levels of Cu (0.24±0.048 vs. 0.06±0.019 μg/g) and Zn (3.29±0.69 vs. 0.44±0.14 μg/g) of the rural patients were significantly higher compared to urban patients (p<0.001). There was no significant difference in the Cd level between groups. Pb (0.024±0.009 vs. 0.008±0.0002 μg/g) and Mn (0.273±0.01 vs. 0.174±0.05 μg/g) levels of urban patients were significantly higher than rural patients (p<0.001). Significance was considered at p<0.05.

Conclusion: Heavy metals accumulate in the nasal concha at different rates in rural and urban areas. In pathologies with unclear pathophysiology and potential for heavy metal accumulation, such as air pollution, it may be helpful to indicate the presence of heavy metals in the nasal turbinate's and measure their amounts for diagnostic purposes.

Objective: This study aims to evaluate the functional and clinical outcomes of single-session bilateral endoscopic type 1 tympanoplasty, with a focus on postoperative (post-op) hearing improvement and graft success rates in patients with chronic otitis media and tympanic membrane perforations.

Methods: Fifteen patients (30 ears) with bilateral dry tympanic membrane perforations underwent trans-canal endoscopic type 1 tympanoplasty using a tragal perichondrium graft. Preoperative (pre-op) and post-op audiometric data, including pure-tone averages (PTAs) and air-bone gap (ABG) measurements at various frequencies, were collected and analyzed.

Results: Functional success was defined as a post-op ABG <20 dB and PTA level improvements, while clinical success was determined by the presence of an intact tympanic membrane graft. The mean pre-op ABG significantly decreased post-oply in both ears, with an average ABG improvement of 25.00±7.32 dB at 500 Hz in the right ear and 18.00±8.41 dB in the left ear. The post-op PTA demonstrated an average gain of 27.00±7.51 dB in the right ear and 29.33±6.23 dB in the left ear. The functional success rate, defined as a post-op ABG <20 dB, was 93.33%, while clinical success, based on graft integrity, was also 93.33%.

Conclusion: Single-session bilateral endoscopic tympanoplasty is a safe and effective procedure with high functional and clinical success rates. It leads to significant hearing improvement and has minimal post-op complications.

Even facial fractures are common in the pediatric population, and the management of blowout fractures contains various surgical methods. Here, we report a child with a blowout fracture handled with transconjunctival endoscopic repair (TCER). A 9-year-old girl was referred with complaints of left eye swelling and erythema after blunt trauma. Physical examination revealed enophthalmos, hypoesthesia in the left cheek, and restriction of left eye movements upwards and downwards. Computed tomography showed a left orbital blowout fracture with herniation of the inferior rectus muscle and soft tissue into the maxillary sinus. TCER was performed. The patient's eye movements were normal one month after surgery. TCER of the orbital floor is a minimally invasive approach with no visible scar, small incision, less trauma to the orbital tissues, and a clear view of the surgical area. It can be used as a safe and successful alternative for orbital floor repair in the pediatric population.

Objective: This study aimed to investigate theory of mind skills and metacognitive functions in patients with tinnitus compared to healthy controls.

Methods: This prospective study included patients diagnosed with tinnitus at our otolaryngology and Head and Neck Surgery clinic and healthy controls matching their demographic characteristics. Patients diagnosed with tinnitus at our otolaryngology and head and neck surgery clinic, along with healthy controls matched for demographic characteristics, were included in the study. All participants completed the Reading the Mind in the Eyes Test (RMET), the metacognition questionnaire (MCQ-30), the Beck Depression Inventory (BDI), and the Tinnitus Handicap Inventory (THI). The relationship between the scales applied to the patient group regarding tinnitus was evaluated using Spearman's and Pearson's correlation tests.

Results: A total of 90 individuals diagnosed with tinnitus and 70 healthy controls participated in the study. There was no statistically significant difference in BDI scores between the groups (p>0.05). However, in the MCQ-30, the cognitive awareness subscale and the total score were significantly higher in the tinnitus group (p=0.003 and p=0.041, respectively). Additionally, RMET performance was lower in tinnitus patients compared to healthy controls (p=0.002). Certain subscales of the MCQ-30 showed a moderate positive correlation with THI.

Conclusion: Based on these findings, we suggest that evaluating tinnitus patients from a psychiatric perspective, providing psychosocial support, and assisting them in improving their communication skills could be beneficial.

Objective: This study aimed to evaluate the reliability and validity of the Turkish version of the Tinnitus Primary Function Questionnaire (TPFQ-T).

Methods: The study was conducted with 103 patients who had been experiencing tinnitus for longer than three months. All participants completed the TPFQ-T, the Beck Anxiety Inventory, the Beck Depression Inventory, the Pittsburgh sleep quality index, the Tinnitus Handicap Inventory and the magnitude estimation.

Results: Cronbach's alpha was 0.88. Cronbach's alpha was also computed for every one of the four subscales: a=0.67 for sleep, a=0.72 for hearing, a=0.86 for concentration, and a=0.75 for emotion. There was a correlation between the overall score obtained from the TPFQ-T and its subcategories and other questionnaires measuring corresponding factors.

Conclusion: Overall, the findings of this investigation show that the TPFQ-T is both reliable and valid. As a result, the current translated version of the TPFQ-T is suitable for patients who speak Turkish as their first language and serves as an effective tinnitus questionnaire.