Correlations of Clinical and Audio-Vestibulometric Findings with Coexisting Anxiety and Depression in Ménière's Disease Patients.

INTRODUCTION: Ménière's disease (MD) is an inner ear disorder, characterized by vertiginous attacks, fluctuating sensorineural hearing loss, tinnitus, and a feeling of ear fullness. Endolymphatic hydrops has been proven as the underlying pathology. Frequently, psychopathologies accompany the disease. The aim of this study was to investigate the correlation of anxiety and depression with demographic, clinical, and audio-vestibular findings in MD patients. METHODS: The study included 40 consecutive unilateral MD patients. Demographic data (age, sex, education, employment, and marital status), clinical variables of drop attacks, the duration, frequency and severity of vertigo attacks, and tinnitus disturbance levels were recorded. Hearing threshold levels were graded between 1 and 4. Vestibulometric variables were taken as the presence of saccades and vestibulo-ocular reflex (VOR) gain deficits in the video head impulse tests (vHIT) and canal paresis in bithermal caloric tests. Becks's depression and anxiety scales were used for psychometric evaluations and graded by 4 and 5 from normal to severe and normal to very severe, respectively. RESULTS: The median age of the patients was 48.94 years, and the numbers of both sexes were almost equal (male/female = 19/21). All patients reported at least one vertigo attacks within the last year. The duration of attacks was most commonly (62.5%) 1-3 h, ranging from <1 h to 17 h. Most attacks were graded as mild (67.5%), and the frequency was 2-3 episodes per year in 22 (55%) patients. The number of attacks within the last year was 1-12. Three patients reported having drop attacks. Hearing loss in the affected ear was moderate/moderately severe in 20 (50%) patients. Thirty-seven (92.5%) patients had complaints of tinnitus. In vHIT, saccades and VOR gain deficits were found in 33 (82.5%) and 11 (27.5%) patients, respectively. Canal paresis was present in 18 (45%) patients. The depression and anxiety rates were 35% and 90%, respectively. Depression scores were correlated with education, marital status, and the presence of saccades. Anxiety was correlated only with tinnitus severity and VOR gain deficits. Depression and anxiety were also correlated. CONCLUSION: Vertigo appears to be more intrusive than the other MD symptoms, and a higher correlation with anxiety than depression was demonstrated in this cohort. However, depression was seen less among married and educated patients, suggesting the role of coping capability, and had more pronounced clinical/vestibulometric correlates. Overall, these results indicated that it is mainly the severity of organic/physiological pathology which determines the degree of depression and anxiety in MD rather than vice versa.

Comparison of three tonsillectomy techniques in children.

PURPOSE: Tonsillectomy is still one of the most common surgical procedures worldwide performed by otorhinolaryngologists. This single-blind randomized study aimed to compare cold dissection tonsillectomy, coblation tonsillectomy, and harmonic scalpel tonsillectomy in pediatric patients in respect of intraoperative blood loss, operating time, and postoperative pain and bleeding. METHODS: This single-blind randomized clinical trial evaluated 82 pediatric patients aged 3-16 years (mean age: 7.23 ± 3.26 years) applied with tonsillectomy between April 2017 and March 2020. Harmonic scalpel tonsillectomy was applied to 33 (40.2%) patients, the cold knife technique to 25 (30.5%), and coblation tonsillectomy to 24 (29.3%). RESULTS: There was no statistically significant difference between the three techniques in respect of postoperative pain levels and post-tonsillectomy bleeding rates. The intraoperative bleeding rate and mean operating time were determined to be significantly lower in the harmonic scalpel group (p < 0.05). CONCLUSION: Harmonic scalpel tonsillectomy is associated with a shorter operating time and lower intraoperative bleeding rates and similar postoperative pain score and postoperative bleeding rates compared with coblation tonsillectomy and cold dissection tonsillectomy. Harmonic scalpel tonsillectomy is a fast, safe, and effective method for tonsillectomy in children.

A Predictor of Difficult Airway: The Tasli Classification in Transnasal Flexible Laryngoscopy.

INTRODUCTION: Difficult airway is defined as difficulty or failure in one or more steps in upper airway management. Evaluation of the upper airway with physical examination methods and endoscopic devices is crucial in predicting difficult airway. The aim of this study was to evaluate bedside tests, Cormack Lehane (CL) and Tasli Classification (TC) scores of the patients and it was aimed to reveal the role of TC which will be performed preoperatively as a predictor of difficult tracheal intubation (DTI). METHODS: The study included a total of 98 patients who underwent surgical treatment under general anesthesia. Demographic data, including age, gender, and body mass index (BMI), and bedside tests consisting Modified Mallampati Classification (MMC), thyromental (TD) and sternomental (SD) distances, neck circumference (NC), interincisor distance (IID), CL and TC were recorded. RESULTS: Evaluation was made of 64 (65.3%) male and 34 (34.7%) female patients ranging in age from 18 to 84 years (mean age: 50.35 ± 0.47 years). The successfully intubated patients (SIP)  group comprised 68 (69.4%) patients, and the difficult intubation patients (DIP) group, 30 (30.6%). According to CL, the numbers of SIP and DIP constituting grade 1 was 29 (42.6%) and one (3.3%); grade 2a was 29 (42.6%) and one (3.3%); grade 2b was eight (11.8%) and three (10%); grade 3a was one (1.5%) and six (20%); grade 3b was one (1.5%) and 14 (46.7%) respectively. Grade 4 was only detected in the DIP group in 5 (16.7%) patients. According to TC, the numbers of SIP and DIP constituting grade 1 was 20 (29.4%) and 1 (3.3%); grade 2a was 37 (54.4%) and seven (23.3%); grade 2b was 10 (14.7%) and 18 (60%); grade 3 was one (1.5%) and two (6.7%) respectively. Grade 4 was only detected in the DIP group in two (6.7%) patients. CONCLUSION: The TC, CL, NC and BMI scores were higher in the DIP group and higher TC scores (grade 2b, 3, and 4) can be a predictor of difficult airway. However, it may be more beneficial to use TC as a complementary diagnostic tool with bedside tests such as NC, SM, TM and MMC, rather than used alone.