Classification of laryngeal injury in patients with prolonged intubation and to determine the factors that cause the injury.

OBJECTIVE: This study aims to evaluate injuries occurring in the larynx of patients intubated in intensive care units for a long time. STUDY DESIGN: Prospective clinical study. SETTING: Tertiary hospital. SUBJECT AND METHODS: Between April 15, 2019, and November 15, 2019, 40 patients who were hospitalized in intensive care units had a tracheotomy procedure due to prolonged intubation, and laryngeal structures were evaluated by direct laryngoscopy. The laryngeal structures were evaluated in four groups as glottic-supraglottic region, arytenoid vocal process, interaritenoid region and subglottic region. Edema, granulation and ulceration findings in these four regions were recorded. The injuries to the laryngeal structures were classified as stages 0-3. As a result of the data obtained, the relationship between the degree of laryngeal lesions and the factors that may cause these lesions was investigated. RESULTS: According to our classification, nine patients had stage 1, 16 patients had stage 2 and 15 patients had stage 3 laryngeal injury. There was no significant relationship between the stage of laryngeal injury and age, sex and diameter of the intubation tube. There was a statistically significant relationship between laryngeal injury and the day the tracheotomy was performed (p = 0.007). CONCLUSION: In patients that had prolonged endotracheal intubation, injury to the laryngeal structures is inevitable. To minimize this occurrence, tracheotomy should be performed for intubations that extend for more than seven days. When performing the tracheotomy, the laryngeal structures should be evaluated, necessary precautions should be taken for the traumatic lesions that are difficult to heal, and treatment should be started.

Postauricular Island Flap in Reconstruction of Auricula Tumor Defects.

The most common malignant tumor in humans is skin cancers. Skin cancers are most commonly seen in the head and neck region due to direct exposure to sunlight. Most frequently seen skin cancer in the auricula are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The aim of this study is to evaluate the results of postauricular island flap after resection of tumors in the auricula.Twelve patients aged 58 to 84 years were included in the study. Eight patients had BCC, 3 had SCC, and 1 had basosquamous carcinoma (BSC). The tumor was located at the cavum concha in 7 cases, antihelix in 3 cases, triangular fossa in 1 case and scapha in 1 case. Surgical procedure was performed under local anesthesia in 7 patients and under general anesthesia in 5 patients. Postauricular island flap was used in all cases. There were no early complications. Three patients had non-apparent narrowing of the auriculomastoid angle. The patients were followed for an average of 2.6 years between 1 and 9 years. Only one patient with basosquamous carcinoma of the cavum concha had recurrence at 19 months.We believe that the postauricular island flap may be a good alternative for the reconstruction of the defect after resection of tumors in the auricle due to its proximity to the surgical site, color matching, adequate thickness, good vascularization, aesthetic acceptance by the patient and completion of the procedure in one session.

Preventing amikacin related ototoxicity with N-acetylcysteine in patients undergoing peritoneal dialysis.

Amikacin is a frequently used antibiotic in the treatment of peritoneal dialysis (PD)-related peritonitis. Ototoxicity is a well-known complication of amikacin for which increased oxidative stress and free oxygen radicals are thought to be responsible. In this study, the effect of N-acetyl-cysteine (NAC) on cochlear function and oxidant situation in the amikacin related ototoxicity in PD-related peritonitis patients are investigated. Forty-six patients who had their first PD-related peritonitis attacks receiving empirical amikacin treatment were enrolled in the study. The patients were randomized into two groups; the first group (n = 23) as NAC receiving and the second group (n = 23) as a placebo receiving, control group. Otoacoustic emissions were measured before, 1 week after and 4 weeks after the treatment. Oxidative stress measurements were performed concurrently in order to evaluate the effectiveness of NAC. The results of screening with otoacoustic emission testing after amikacin treatment showed that cochlear function is protected especially in higher frequencies in NAC group when compared with the control group. Evaluation of the antioxidant status of the two groups showed no differences in the basal values, but at the first week there was an increase in the NAC group compared with the control group, and this increase became significant at the fourth week. NAC is found to be safe and effective in amikacin-related ototoxicity in patients with PD-related peritonitis. We suggest a close monitoring of the patients receiving amikacin containing treatment protocols and if amikacin is administrated supplementing the treatment with NAC.

Voice Quality After Radiotherapy and Cordectomy in Early-Stage Glottic Carcinomas.

Laryngeal carcinomas are the most common upper respiratory tract cancers and most commonly involve the glottic region. The aim of this study is to evaluate the voice quality after radiotherapy (RT) and microsurgical cordectomy (MC) treatments using Voice Handicap Index (VHI) and Grade, Roughness, Breathiness, Astenicity, and Strain (GRBAS) perceptual evaluation scale in patients with early-stage glottic carcinoma. A total of 37 patients with early-stage glottic carcinomas, 19 patients had RT and 18 patients with MC, were included in our study. The patients were evaluated in terms of their sound quality by using VHI-10 and GRBAS perceptual assessment scale 3 months after the treatment was completed. Although the findings were better in favor of RT according to GRBAS perceptual assessment scale of patients who received RT (n = 19) and MC (n = 18), no statistically significant difference was found between the 2 groups (P = .613). Patients in both groups were evaluated with VHI-10, emotional (P = .036) and physiological (P = .038) scores were significantly higher in MC group and no significant difference was found in functional scores (P = .192). However, there was no statistically significant difference between the 2 groups in terms of voice quality (P = .185). In early-stage (Tis, T1a, T1b) glottic carcinoma, there was no significant difference between RT and MC in terms of voice quality. Therefore, the choice of treatment modality in patients with early-stage glottic carcinoma should be taken into account in terms of the patient's occupation, comorbid diseases, cost of treatment, hospital stay, and, most importantly, patient preference.

Endoscopic butterfly inlay myringoplasty: new technique extended perichondrium butterfly.

Background: Various graft materials and surgical methods are used in the treatment of tympanic membrane perforations.Aims/Objectives: The aim of this study was to evaluate the operation method and graft success of extended perichondrial butterfly myringoplasty performed by an endoscopic method and the hearing gain of patients.Material and Method: This was a retrospective study evaluating the hearing tests of 54 ears of 48 patients (28 male, 20 female) who underwent surgery between February 2017 and March 2019. Pure-tone audiometric results were analyzed preoperatively and six months postoperatively by recording the perforation size, the duration of surgery, and graft success.Results: The graft success rate was 98.1% (53/54 ears). The perforations were most frequently located in the anterior quadrant and were small-sized. The mean preoperative air-bone gap (ABG) was 17.4 ± 5.24 dB. The mean ABG was 9.2 ± 2.13 dB 1 month postoperatively and 8.5 ± 2.26 dB 6 months postoperatively (p < .005).Conclusions: The endoscopic inlay extended perichondrial butterfly myringoplasty method is safe and doesn't require tympanomeatal flap elevation. Moreover, it shortens hospitalization time, facilitates anatomical closure of the membrane, and sometimes closes perforations in the anterior part, which cannot be clearly evaluated after graft placement.

Transcanal Endoscopic Type 1 Cartilage Tympanoplasty in Children.

OBJECTIVE: Transcanal endoscopic type 1 tympanoplasty is a minimally invasive procedure that enables better visualization of deep and narrow spaces compared to conventional microscopic methods. In our study, we aimed to evaluate air-bone gap difference, graft success, and hearing gain according to the perforation size and location in pediatric patients who underwent transcanal endoscopic type 1 cartilage tympanoplasty. METHODS: Fifty pediatric patients who underwent transcanal endoscopic type 1 cartilage tympanoplasty for chronic otitis media were included in the study. Tragal cartilage grafts were used in all patients. Air conduction pure tone audiometry hearing results (500, 1000, 2000, and 4000 Hz), mean air-bone gap levels, operating times, postoperative gap closure, and graft success rates were evaluated. RESULTS: Mean operating time was 43.34±8.56 minutes. Overall graft success was 94% (47/50). Mean hearing levels at all frequencies (500, 1000, 2000, and 4000 Hz) were found to have significantly improved after the operation (p<0.001). Mean preoperative air conduction pure tone threshold and mean air-bone gap had statistically significantly improved by the 6th postoperative month (p<0.001). CONCLUSION: Transcanal endoscopic type 1 cartilage tympanoplasty was found to be a minimally traumatic, easy and safe method with a low complication rate. In pediatric patients, this method allows for high rates of anatomic and functional recovery with optimal surgery time regardless of the location and the size of the perforation.

Comparison of effects on voice of diode laser and cold knife microlaryngology techniques for vocal fold polyps.

AIM: To compare the effects on voice of endolaryngeal microsurgery (EMS) with cold instruments and a new method, "diode laser," for vocal fold polyps. PATIENTS AND METHODS: Fifty-one patients with vocal fold polyps suffering from dysphonia who were treated in the Erciyes University Department of Otolaryngology were included in the study. Voice analysis was performed in a soundproof room, holding the microphone 15 cm away from the patients' mouth and by recording a sustained [a] vowel for at least 10 seconds. Fundamental frequency (F0), Jitter, Shimmer, and noise-to-harmonic ratio (NHR) parameters were evaluated in terms of vocal analysis. All patients were asked for to fill in a questionnaire, after being informed about the voice handicap index (VHI). EMS was performed with a diode laser and cold knife on 26 and 25 patients, respectively. Patient follow-up was performed 8 weeks after surgery. Changes in F0, Jitter, Shimmer, and NHR values were measured and recorded. VHI was also completed and reassessed. RESULTS: There was a significant difference in each technique's VHI score between the preoperative and postoperative questionnaire (P < 0.001). Postoperatively, there was no significant difference in VHI scores between two groups (P > 0.05). There was a significant difference in voice analysis values measured preoperatively and at the postoperative controls for both groups (P < 0.05). Postoperatively, there was no significant difference in voice analysis values between two groups (P > 0.05). CONCLUSION: In the treatment of vocal polyps, EMS with both diode laser and traditional cold knife is effective.