Caregiver Burnout in Pediatric Laryngomalacia: The Role of Clinical and Psychological Factors.

INTRODUCTION: This study aims to assess caregiver burnout in relation to children diagnosed with laryngomalacia and identify factors influencing burnout levels. MATERIALS AND METHODS: A cohort of 101 caregivers of children with laryngomalacia was studied. Burnout was assessed using the Zarit burden interview (ZBI), while the Hamilton anxiety and Hamilton depression scales were employed to gauge psychological distress. The relationship between burnout and variables like the severity of laryngomalacia, the presence of comorbidities, the child's age, and caregiver demographics was examined using statistical tools in SPSS Statistics version 28.0 (IBM Corp., Armonk, NY, USA). RESULTS: Caregiver burnout decreased as the child's age increased. A direct correlation was observed between the severity of laryngomalacia and caregiver burnout. The presence of comorbidities in children increased caregiver burnout. Moreover, caregivers with increased levels of depression and anxiety exhibited higher burnout levels. No significant correlation was found between caregiver burnout and socioeconomic status or educational level. CONCLUSION: The severity of laryngomalacia, the child's age, the presence of comorbidities, and caregivers' psychological health are significant influencers of caregiver burnout. Healthcare professionals should offer targeted support to caregivers, addressing both their physical and psychological needs.

Turkish Guideline for Diagnosis and Treatment of Allergic Rhinitis (ART).

OBJECT: To prepare a national guideline for Otorhinolaryngologist who treat allergic rhinitis patients. METHODS: The study was conducted by three authors, namely the writing support team. The support team made the study plan, determined the writing instructions, chose the subgroups including the advisory committee, the advisors for authors and the authors. A workshop was organized at the very beginning to explain the details of the study to the team. Advisors took the chance to meet their coworkers in their subgroups and determined the main headings and subheadings of the guideline, together with the authors. After key words were determined by the authors, literature search was done in various databases. The authors keep in touch with the advisors and the advisors with the advisory committee and the support group at every stage of the study. National and International published articles as well as the abstracts of unpublished studies, imperatively presented in National Congresses, were included in this guideline. Only Guideline and meta-analyses published in last seven years (2013-2017) and randomized controlled studies published in last two years (2015-2017) were included. After all work was completed by the subgroups, support team brought all work together and edited the article. RESULTS: A detailed guideline about all aspects of allergic rhinitis was created. CONCLUSION: The authors believe that this guideline will enable a compact and up-to-date information on allergic rhinitis to healthcare professionals. This guideline is the first in the field of Otolaryngology in Turkey. It should be updated at regular intervals.

Platelet-rich plasma for laryngotracheal reconstruction: an experimental study.

OBJECTIVES/HYPOTHESIS: This study was designed to evaluate the graft healing effect of topical application of platelet-rich plasma (PRP) for laryngotracheal reconstruction (LTR) in a rabbit model. STUDY DESIGN: It is a prospective randomized control animal study. MATERIALS AND METHODS: Sixteen healthy New Zealand White rabbits were assigned to two groups of eight animals each. The control group underwent LTR with anterior auricular cartilage graft. The PRP group underwent the same surgical procedure plus PRP application over the anastomosis and surgical field. Two animals in the PRP group and two animals in control group died due to severe respiratory distress on postoperative days 10, 12, 15, and 18. Six rabbits (n = 3 for control group and n = 3 for PRP group) were sacrificed at 4 weeks, and six rabbits (n = 3 for control group and n = 3 for PRP group) were sacrificed at 8 weeks. Laryngotracheal regions were evaluated histopathologically. RESULTS: Macroscopically, the average anteroposterior and lateral diameter of the reconstructed region and the degree of lumen patency on postoperative 4th week and 8th week were not statistically different among two groups. There was no significant difference between the groups in terms of any of the microscopic findings when the analysis was made separately. However, analysis of the total number of rabbits has shown that new cartilage formation and angiogenesis were more pronounced in PRP group than control group. CONCLUSIONS: Application of PRP contributed to better healing in airway surgery by promoting a release of growth factors that stimulate new cartilage formation and angiogenesis.

Congenital midnasal stenosis: Conservative management.

INTRODUCTION: Congenital midnasal stenosis (MNS) is an extremely rare disease which may be life threatening, and shows difficulty in diagnosis and management. This case series summarizes superiority of using intranasal mometasone furoate spray (IMS) and continuous positive airway pressure (CPAP) to treat nasal obstruction in neonates with MNS. METHODS: This study reviewed six consecutive cases of MNS. RESULTS: Three patients were treated with IMS and CPAP. Two patients were treated with endoscopic balloon dilatation without stenting, followed by IMS and CPAP due to persisting nasal obstruction after the operation. One patient was treated with endoscopic balloon dilatation without stenting alone. CONCLUSION: This study is the first to review the use of CPAP and IMS as an effective therapy for some patients with MNS. It suggests that conservative management with CPAP and IMS may be an alternative therapeutic option to surgery.

Balloon Laryngoplasty for Pediatric Subglottic Stenosis: A 5-year Experience.

OBJECTIVE: The objective of this study was to present our experience and evaluate our results of endoscopic balloon laryngoplasty (BL) in children with subglottic stenosis (SGS) at a pediatric tertiary center over a 5-year period. METHODS: This study reviewed 41 pediatric patients diagnosed with acquired SGS who had undergone BL as the primary course of treatment. Cases were analyzed for details including patient demographics, SGS grade and length, timing and the type of surgery, presence of tracheostomy, comorbidities, postoperative management, complications and outcomes of balloon dilatation. RESULTS: Forty-one children (22 girls and 19 boys) who had undergone BL at a mean age of 26 months (range, 1 month to 14 years) were included in the study. Nineteen (46.3%) were diagnosed with acute SGS (12 thin stenosis, 7 thick stenosis) and 22 (53.7%) with chronic SGS (9 thin stenosis, 13 thick stenosis). The success rate of BL was 100% in patients with acute and chronic thin membranous stenosis. The effectiveness of BL was significantly higher in patients with acute thick stenosis than in patients with chronic thick stenosis (p=0.016). CONCLUSION: This study confirms that BL in patients presenting with acquired SGS with thin membranous stenosis, regardless of whether acute or chronic, can have a good prognosis. However, the results are less promising in cases of chronic thick stenosis.

Change in nasal congestion index after treatment in patients with chronic rhinosinusitis with nasal polyposis.

BACKGROUND: The management of chronic rhinosinusitis with nasal polyposis (CRSwNP) involves both surgical and medical approaches, and remains a controversial subject. OBJECTIVE: The objective of this prospective, randomized, controlled trial was to compare the medical and surgical treatments of CRSwNP in terms of their effect on the nasal congestion index (NCI). METHODS: Forty-eight patients with CRSwNP were randomized either to medical or surgical therapy. Pretreatment and 3- and 6-month posttreatment assessments of the visual analog scale score, the 20-Item Sino-Nasal Outcome Test, saccharine clearance time, nasal endoscopy, and NCI measurement with acoustic rhinometry were performed. Forty-one subjects were included in the analysis. RESULTS: Both the medical and surgical interventions for CRSwNP resulted in significant improvement in the visual analog scale score, 20-Item Sino-Nasal Outcome Test, saccharine clearance time, and nasal endoscopic examination scores. There was no difference between the two groups in terms of the percentage change from baseline for any of the parameters at the 6-month posttreatment assessment. NCI showed no significant difference from baseline. Similarly, no significant difference was found between the medical and surgical groups in terms of their effect on the NCI (p > 0.05). CONCLUSION: Because NCI does not correlate with standard subjective measures in outcomes for this group of patients, it cannot be used as an outcome measurement of treatment of subjects with CRSwNP. Results of this prospective randomized study did not find any additional benefit of surgical therapy over medical therapy in subjects with CRSwNP.

Platelet-rich fibrin plays a role on healing of acute-traumatic ear drum perforation.

OBJECTIVE: Our objective was to demonstrate the effects of platelet-rich fibrin (PRF) for the healing of acute ear drum perforation. METHODS: Thirty-two patients with acute traumatic ear drum perforations were randomly separated into 2 groups. In group 1 (n = 14), PRF was used for the repair of ear drum perforation; in group 2 (n = 18), we did not make any intervention. RESULTS: At initial inspection, perforation sizes were measured as 10.93 ± 3.58 mm in group 1 and 10.05 ± 4.02 mm in group 2. After 1 month, perforation sizes were 1.35 ± 2.53 mm in group 1 and 4.44 ± 3.34 mm in group 2 (P < 0.01). In the study group, the rate of ear drum closure was 64.3% and in the control group it was 22.2% (P < 0.05). CONCLUSION: Here we found that PRF is a biomaterial that quickens the healing of ear drum which is autogenous and simply prepared.

Relation of mean platelet volume with obstructive adenoid hypertrophy in children.

OBJECTIVE: Adenoid hypertrophy (AH) is a common etiology of chronic upper airway obstruction. Upper respiratory tract obstruction may cause chronic alveolar hypoventilation and pulmonary vasoconstriction. In one previous study in patients with obstructive sleep apnea (OSA), it has been claimed that mean platelet volume (MPV), an indicator of platelet activation is increased and that MPV has an important role in the pathophysiology of cardiovascular diseases. We investigated in our study if MPV can be used as an indicator of obstruction due to adenoid hypertrophy. METHODS: Our study includes 61 children that underwent adenoidectomy with a mean age of 7.12 (± 2.373). White blood cell, platelet count, MPV, platelet crit and platelet distribution width levels were measured before and 3 months after adenoidectomy. Children's symptoms for upper airway obstruction (UAO) (presence of snoring, mouth breathing or difficulty in breathing during sleep, obstructive breathing or apnea during sleep) were questioned in the preoperative and postoperative period by a standardized questionnaire. RESULTS: There was no significant difference between preoperative and postoperative mean values of MPV, hemoglobin, platelet count (p > 0.05). White blood cell levels were significantly higher in the preoperative period values compared with postoperative period values (p < 0.05). Preoperative UAO scores were significantly higher than the postoperative UAO scores. After stratification of the degree of obstruction (as mild, moderate and severe) there was no significant difference in between groups in terms of MPV values. CONCLUSION: There was no significant relation between MPV levels and obstructive adenoid hypertrophy.

[Transoral robotic surgery for sleep apnea syndrome]. / Uyku apne sendromunda transoral robotik cerrahi.

Obstructive sleep apnea syndrome (OSAS) is a multisystem disorder which adversely affects all body systems including cardiovascular system particularly and the quality of life. Although continuous positive airway pressure is an effective way of treatment in the treatment of OSAS, a substantial proportion of patients are not able to tolerate this treatment and seek for alternative treatment modalities. Transoral robotic lingual tonsillectomy is a novel technique for the surgical management of patients with OSAS. In this article, we report a 57-year-old female case with OSAS due to bilateral lingual tonsillar hypertrophy who underwent transoral robotic lingual tonsillectomy. To the best of our knowledge, this is the first case report of OSAS who underwent robotic lingual tonsillectomy in Turkish medical literature.

Peak nasal inspiratory flowmetry for selection of patients for radiofrequency ablation of turbinates.

OBJECTIVES: Our goals were to investigate (I) the effectiveness of the topical vasoconstrictor test (TVT) and peak nasal inspiratory flow (PNIF) measurement for the selection of patients with inferior turbinate hypertrophy (ITH) who will benefit from radiofrequency ablation (RFA) of the turbinates and (2) the efficacy of the TVT and PNIF in follow-up of treatment outcomes. METHODS: Patients with bilateral chronic nasal obstruction due to ITH underwent assessment with a visual analog scale (VAS) and PNIF before and after the TVT. Twenty patients with symptom improvement according to VAS and PNIF results were enrolled in the study. These patients underwent RFA, and PNIF and VAS scores were determined before and I and 6 months after the TVT. These results were compared to evaluate the preoperative prediction of RFA treatment success. RESULTS: Radiofrequency ablation of the turbinates resulted in significant changes in objective and subjective scores. Preoperative (baseline) subjective and objective responses to decongestant were positively correlated (P = .024 and P < .05, respectively). Preoperative (baseline) objective responses to decongestant were significantly correlated with the objective outcomes of surgery (P = .006 and P < .05, respectively). CONCLUSION: The combined use of PNIF and the TVT allows for the preoperative prediction of the success of RFA and the selection of patients who will benefit most from RFA.

Prediction of outcome of radiofrequency ablation of the inferior turbinates.

BACKGROUND: Radiofrequency ablation (RFA) of the turbinates is used commonly for nasal obstruction; however, there is no consensus on patient selection for this surgery. METHODS: In a prospective clinical study, 53 adult subjects with bilateral turbinate hypertrophy were evaluated subjectively and objectively with anterior rhinomanometry at baseline and at 1, 3, and 6 months post-RFA of turbinates. RESULTS: RFA of the turbinates resulted in a significant decrease in predecongestant and postdecongestant visual analogue scale (VAS) scores and resistance measurements at postoperative months 1, 3, and 6 (p < 0.001 for all). Preoperative baseline subjective response to the decongestant showed a positive correlation with postoperative first month subjective and objective outcome (p < 0.05). Preoperative baseline objective response to the decongestant showed a highly significant correlation with postoperative 1-month, 3-month, and 6-month objective outcomes of surgery (p < 0.05 for all). CONCLUSION: Objective measures do not correlate with long-term subjective satisfaction even when the nose is objectively patent in subjects who underwent inferior turbinate RFA. The patients' long-term subjective benefit from RFA surgery cannot be estimated after a rhinomanometry with topical decongestion is performed. Performing a rhinomanometry with topical decongestion may help only to estimate the patients' objective benefit from RFA surgery.

Topical Nigella Sativa for nasal symptoms in elderly.

OBJECTIVE: To compare the effects of intranasal application of black seed (Nigella Sativa) oil (NSO) and isotonic sodium chloride solution (ISCS) on nasal symptoms of the elderly. METHODS: In this prospective, crossover randomized controlled trial, 42 geriatric patients with nasal dryness and related symptoms were randomized to receive either 2 weeks of isotonic sodium chloride solution (ISCS) followed by 2 weeks of N. sativa oil (NG oil) or the same treatment in the opposite order. There was a washout period of 3 weeks in between the treatment periods. Subjective symptoms including nasal dryness, burning, obstruction, itching and crusting were evaluated by a visual analog scale. Mucociliary function was evaluated with saccharin test. RESULTS: Nasal dryness, obstruction and crusting improved significantly with the use of NSO compared to ISCS without any evidence of relevant carryover effects (p<0.05 for all for the difference in treatment). There was no significant difference between the effect of NSO and ISCS on nasal burning and itching (p>0.05 for all). There was no change in mucociliary clearance during any of the treatment periods. CONCLUSION: NSO is a better alternative to ISCS to treat nasal mucosa symptoms due to aging.

Endoscopic posterior cordotomy with microdissection radiofrequency electrodes for bilateral vocal cord paralysis.

The purpose of this study is to evaluate the results of endoscopic posterior cordotomy using microdissection electrodes in patients with bilateral vocal cord paralysis. Eleven patients underwent endoscopic posterior cordotomy using a radiofrequency Arrowtip monopolar needle. Preoperative-postoperative exercise tolerance, airway, and voice evaluation were performed in all patients. Two patients required a secondary revision operation due to granulation and crust formation and respiratory problems. No other complications were encountered. Two patients with tracheotomy cannulas were decannulated on the third postoperative day. All patients had an adequate functional airway and good exercise tolerance compared with poor preoperative exercise tolerance. There was no significant difference between preoperative and postoperative Voice Handicap Index values (P > .05). The data indicated the safety, easy use, and efficiency of the microdissection radiofrequency electrodes in patients with bilateral vocal fold paralysis. This technique provides a reliable alternative to laser procedures.

En bloc resection of epiglottic tumors with transoral robotic approach - preliminary results.

OBJECTIVE: This study aimed to identify whether it would be possible to excise epiglottic laryngeal tumors en bloc with a transoral robotic approach (TORS), ensuring that basic principles of oncologic surgery are followed. METHODS: TORS was performed on three patients at Umraniye Education and Research Hospital. All patients had T1 epiglottic tumors. Unilateral neck dissections were performed for node-positive patients (n = 2). Postoperative radiotherapy was administered to these two patients. RESULTS: None of the patients had positive surgical margins. The follow-up period on average was 14 months, no recurrences were observed in this follow-up period. Normal food intake was possible in all cases. Tracheostomy was not performed on any patient. No postoperative complications were observed. CONCLUSION: These preliminary results indicate that application of the da Vinci robotic surgical system for en bloc resection of supraglottic partial cancers is technically feasible and safe, with satisfactory oncological outcome and postoperative laryngeal function.

The role of mometasone furoate nasal spray in the treatment of adenoidal hypertrophy in the adolescents: a prospective, randomized, cross-over study.

Aim of this work is to find out whether the symptoms attributable to adenoid hypertrophy in adolescents may be treated with intranasal mometasone furoate (MF) application. To learn if adenoid hypertrophy in adolescents may decrease in size with intranasal MF. A prospective, double blind, randomized, cross-over study was conducted in 28 subjects (12-18 years) with adenoidal hypertrophy. Subjects used intranasal MF or placebo for a duration of 6 weeks with a wash out period of 3 weeks. Subjective symptoms and adenoid size were evaluated. At the initiation of the study, there was no significant difference between the mean symptom scores for any of the sinonasal symptoms between the two treatment groups. There was significant improvement in total subjective symptoms (nasal blockage, rhinorrhea, cough, snoring and disruption of quality of life scores) with MF compared with placebo. Analysis of the symptoms separately showed a significant positive effect of MF on all symptoms except for rhinorrhea. Nasal endoscopic evaluation failed to demonstrate any difference in the reduction of the adenoid size between the two groups. MF has significant advantage over placebo for the symptoms attributable to adenoid hypertrophy in adolescents.

Nasal obstruction and unilateral chronic otitis media: evaluation by acoustic rhinometry.

OBJECTIVES: In a prospective study at Umraniye Research and Education Hospital, we aimed to evaluate the differences in acoustic rhinometric findings between the affected and nonaffected sides in patients with unilateral chronic otitis media (COM) and to investigate whether unilateral COM correlates with the side of nasal obstruction. METHODS: Fifty-five consecutive patients with unilateral COM were involved in this study. All patients were evaluated with acoustic rhinometry, the Nasal Obstruction Symptom Evaluation (NOSE) scale, and measurement of their nasal mucociliary transport time. RESULTS: The mean cross-sectional area 1, mean cross-sectional area 2, volume 1, and volume 2 values were not different between the affected and nonaffected sides (p > 0.05). The NOSE score had a reverse correlation with the mean cross-sectional area 2 (p < 0.05) and volume 2 (p < 0.01) of the affected side. Saccharin time was not correlated with the acoustic rhinometric values of the affected side (p > 0.05). CONCLUSIONS: These findings do not support the hypothesis that unilateral COM is correlated with the side of nasal obstruction.

Emergency endoscopic vocal cord lateralization as an alternative to tracheotomy for patients with bilateral abductor vocal cord paralysis.

This study aimed at evaluating the results of emergent endoscopic permanent vocal cord lateralization instead of tracheotomy in patients with bilateral vocal cord paralysis who were admitted to the emergency service. Retrospective analysis was done of 13 patients with bilateral vocal cord paralysis admitted to emergency service with severe dyspnea. Patient information, paralysis etiology, operation times and follow-up data were reviewed. All 13 patients who underwent this procedure were females and the ages were ranging from 38 to 69 (average 52). Bilateral vocal cord paralysis was a result of thyroid surgery in all. Thyroid surgery was performed 8 months to 10 years (mean 41 months) before being admitted to the emergency service. The duration of procedure from intubation to closing skin incision ranged from 20 to 50 min (average 34 min). Patients were followed for a duration of 3 months to 10 years (average 24 months). In 12 of the patients adequate glottis chink was obtained and recovery from general anesthesia was uneventful without a need for tracheotomy. In one case, catheter placement was done with difficulty and a tracheotomy was performed as a temporary measure. Endoscopic vocal cord lateralization with submucosal cordectomy is a reliable alternative to tracheotomy even in emergency conditions for bilateral abductor vocal cord paralysis. Adequate air can be obtained in majority of cases and long term patency is satisfactory.

Anatomy and physiology of the upper airway.

The nose is the major portal of air exchange between the internal and external environment. The nose participates in the vital functions of conditioning inspired air toward a temperature of 37°C and 100% relative humidity, providing local defense and filtering inhaled particulate matter and gases. It also functions in olfaction, which provides both a defense and pleasure for the individual. Understanding normal physiology provides the basis for recognizing abnormalities.