Mortal condition in an unusual localization, analysis of isolated tongue and tongue base abscesses.

BACKGROUND: Tongue abscess (TA) is a very rare clinical condition and its treatment is very important. Surgical drainage is at the forefront in the treatment. Our study includes patients with tongue and tongue base abscesses. AIM: To discuss the clinical and laboratory findings of these patients emphasizing the underlying causes and treatment options with the largest patient series in the English literature. METHODS: We included patients with isolated TA who applied to our clinic between January 1, 2020 and January 1, 2023. Those who lack the recorded data, those who are not between the ages of 18-66, those who have not undergone surgery-interventional procedure, and those who have infection and/or abscess in another place were excluded from the study. RESULTS: There were two female (18%) and nine male (82%) patients in our series consisting of 11 patients. Their ages ranged from 18 to 66, and the mean ± SD was 48.63 ± 16.3. Considering the localization of the abscess, three anterior abscesses (27%), two lateral abscesses (18%), and six abscesses at the base of the tongue (54%) were detected. CONCLUSION: Tongue abscesses can cause acute upper airway obstruction and respiratory collapse. It may be necessary to act quickly for the tracheotomy procedure and this procedure can usually be performed under local anesthesia as intubation cannot be achieved. When we encounter an abscess in an unexpected organ, difficulties may be encountered in the management of the patient.

Pterygopalatine-Infratemporal Fossa Hydatid Cyst Resembling Cystic Tumor.

Hydatid cyst is an endemic disease in Mediterranean and Middle Eastern countries, Eastern European countries, East Africa, China, New Zealand, Australia. We aimed to present this educational case, which is endemic in our country and seen in a very rare localization, with the combined surgical approach, within the literature.

Do Lymph Node Ratio and Histopathologic Parameters Have Any Prognostic Value in Primary Parotid Gland Carcinomas?

Objective: To analyze the demographic characteristics and the pathological results of neck dissection in primary parotid gland (PG) cancer patients, and to investigate the effects of histopathological parameters (perineural invasion, lymphovascular invasion, and extracapsular spread), neck metastasis, stage and lymph node ratio (LNR) on survival. Methods: Patients who underwent parotidectomy for malignant PG tumors between 2000 and 2019 years were retrospectively reviewed from the medical records. Thirty patients who were treated with parotidectomy and neck dissection were included in the study. Lymph node ratio was calculated as the ratio of the number of metastatic lymph nodes (LN) to the total number of excised LNs. Tumor stage, regional LN metastasis, LNR, perineural invasion, lymphovascular invasion, and extracapsular spread were reviewed for the effects on survival with the Kaplan-Meier analysis. Results: The study included 17 (57%) male and 13 (43%) female patients. Their mean age was 67.93±16.90 years (range, 50-85 years). The average number of the excised LN was 26.03±11.79 (range, 3-50). Mean LNR was 0.16±0.26. The Kaplan-Meier analysis showed that neck metastasis (p=0.001) and LNR (p<0.001) were associated with shorter survival times compared to perineural invasion (p=0.818), lymphovascular invasion (p=0.154), extracapsular spread (p=0.410) and stage (p=0.294). In multivariate COX regression analysis, only LNR had a statistically significant difference (p=0.027) compared to the other parameters. Conclusion: The present study suggests that LNR and neck metastasis are associated with shorter survival times in PG cancers. Lymph node ratio can be used as a prognostic marker in these patients.

Results of 301 Parotidectomies: A Twenty-Year Experience of One Single Institution.

To evaluate demographic, clinical, surgical and histopathological results and complications of 301 parotidectomies performed in southern part of Turkey. The results of 297 patients undergoing 301 parotidectomies between 2000 and 2019 were retrospectively reviewed. Four patients underwent bilateral parotidectomy. Age, gender, side and size of lesion, postoperative facial nerve function (FNF) for benign tumors and types of surgery were evaluated. There were 172 male and 125 female patients. The mean age was 52.53 ± 16.67 years (range 11-90 years). Patients with malignant tumor had higher mean age than the patients with benign diseases (p < 0.001) and the mean age of Warthin tumor (WT) patients was significantly higher than pleomorphic adenoma (PA) (p < 0.001). There was a significant male dominancy in WTs than the PAs (p < 0.001). The mean size of the malignant tumors was significantly higher than the benign tumors (p = 0.012). The mean of cigarette smoking value (pack/year) was higher in WTs than the PAs (p < 0.001). WT incidence was slightly higher than PA in between years 2010 and 2019 (p = 0.272) compared to between years 2000 and 2009. Fine needle aspiration biopsy had a sensitivity of 96% and specificity of 78% for the benign tumors. Tumor location (p < 0.001) and tumor size (p = 0.034) had negative effect on the postoperative FNF. The incidence of WT had a significant rise in the last decade. Deep lobe tumors and increased tumor size had effect postoperative FNF. Experience of surgeon is more important than nerve monitoring to prevent facial paralysis. Partial superficial parotidectomy was available methods for small benign tumors in tail of the parotid gland.

Olfactory neuroepithelium in the middle turbinate: is there any impact on olfaction function after lateral marsupialization for concha bullosa surgery?

Abstract Introduction: The effect of the quantity of olfactory neuroepithelium in the middle turbinate on the postoperative olfactory function for middle turbinate concha bullosa patients has not yet been evaluated. Objective: The primary aim of this study was to investigate the olfactory structures in the middle turbinate by immunohistochemical analysis of the olfactory marker protein and to correlate the immunostaining results with the olfaction test results for patients with middle turbinate concha bullosa. Methods: Surgical materials of 18 middle turbinate concha bullosa patients who had undergone lateral marsupialization surgery were immunostained with olfactory marker protein antibodies. Smell diskettes olfaction test was applied to all of the study group patients both preoperatively and three months postoperatively. A visual analog scale was used to quantify the sense of nasal obstruction. Results: It was observed that the postoperative smell scores and the nasal obstruction visual analog scale values were significantly improved as compared to the preoperative values (p<0.05). In addition, there was a significant correlation between the smell score gain and the visual analog scale gain values (r = 0.682). Results also indicated no significant correlation between the olfactory marker protein staining scores and the smell scores (p > 0.05). Conclusion: This first paper demonstrated that the quantity of the olfactory mucosa in the middle turbinate was not a determining factor for the postoperative smell function degree for middle turbinate concha bullosa patients. The underlying cause of the olfactory deficit for middle turbinate concha bullosa patients seems to be obstruction related rather than the middle turbinate's olfactory mucosa containing status.

The effectiveness of propranolol, flunarizine, amitriptyline and botulinum toxin in vestibular migraine complaints and prophylaxis: a non-randomized controlled study / A eficácia de propranolol, flunarizina, amitriptilina e toxina botulínica nas queixas e profilaxia da migrânea vestibular: um estudo controlado não randomizado

Abstract Introduction: Vestibular migraine is the most common cause of spontaneous episodic vertigo in adult patients and the second most common cause of vertigo in patients of all ages. Objective: To assess the effectiveness of oral medication type (propranolol, flunarizine, and amitriptyline) and botulinum toxin A application on vestibular symptoms, headache severity and attack frequency for vestibular migraine patients. Methods: Sixty patients with vestibular migraine were enrolled. Thirty patients received botulinum toxin A treatment (B+ group) in addition to the oral medication, whereas 30 patients received only oral medication (B− group). Headache severity was evaluated with Migraine Disability Assessment Scale and vertigo severity was evaluated with Dizziness Handicap Inventory scale. Vestibular migraine attack frequencies in the last three months were also evaluated. Results: There was a statistically significant decrement in mean Dizziness Handicap Inventory scores, Migraine Disability Assessment Scale scores and vertigo attack frequencies after treatment for all patients, B+ and B− group patients (p < 0.001 for all). The mean Migraine Disability Assessment Scale score gains (p < 0.001) and vertigo attack frequency gains (p = 0.003) were significantly higher in the B+ patients than B− patients. Conclusions: Both B+ and B− group patients exhibited significant improvement in vestibular migraine attack frequencies, Dizziness Handicap Inventory score and Migraine Disability Assessment Scale score values. However, botulinum toxin A application had a more pronounced effect for Migraine Disability Assessment Scale score gain and vestibular migraine attack frequency values, but not for Dizziness Handicap Inventory score gain values. Thus, botulinum toxin A application should be considered for vestibular migraine patients whose headache severity degrees are more profound. The oral medication type (propranolol, flunarizine or amitriptyline) did not differ in influencing the vestibular migraine attack frequency, Dizziness Handicap Inventory score gain and Migraine Disability Assessment Scale score gain values.

Resumo Introdução: A migrânea vestibular é a causa mais comum de vertigem episódica espontânea em pacientes adultos e a segunda causa mais comum de vertigem em pacientes de todas as idades. Objetivo: Avaliar a eficácia da aplicação dos tipos de medicamentos orais (propranolol, flunarizina e amitriptilina) e da toxina botulínica tipo A sobre os sintomas vestibulares, intensidade da cefaleia e frequência das crises em pacientes com migrânea vestibular. Método: Sessenta pacientes com migrânea vestibular foram incluídos. Trinta pacientes receberam tratamento com toxina botulínica tipo A e medicação oral (Grupo B+), enquanto 30 pacientes receberam apenas medicação oral (Grupo B-). A intensidade da cefaleia foi avaliada pelo migraine disability assessment scale e a gravidade da vertigem foi avaliada com o dizziness handicap inventory. A frequência das crises de migrânea vestibular nos últimos três meses também foi avaliada. Resultados: Houve um decréscimo estatisticamente significativo na média dos escores do dizziness handicap inventory e migraine disability assesment scale e na frequência das crises de vertigem após o tratamento em todos os pacientes, p < 0,001 para todos os pacientes dos grupos B+ e B−. Os ganhos médios no escore do migraine disability assesment scale (p < 0,001) e na frequência das crises de vertigem (p = 0,003) foram significantemente maiores nos pacientes B+ do que nos pacientes B−. Conclusões: Os pacientes de ambos os grupos B+ e B− exibiram melhoria significativa na frequência das crises de migrânea vestibular e nos valores dos escores do dizziness handicap inventory e do migraine disability assesment scale. No entanto, a aplicação da toxina botulínica tipo A teve um efeito mais pronunciado para os valores de ganho no escore do migraine disability assesment scale e na frequência das crises de migrânea vestibular, mas não para os valores de ganho no escore do dizziness handicap inventory. Portanto, a aplicação de toxina botulínica tipo A deve ser considerada para pacientes com migrânea vestibular, cujos graus de intensidade da cefaleia são mais marcantes. O tipo de medicação oral (propranolol, flunarizina ou amitriptilina) não diferiu em relação à frequência das crises de migrânea vestibular e aos valores de ganho dos escores do dizziness handicap inventory e do migraine disability assesment scale.

Olfactory Neuroepithelium in Olfactory Cleft Polyps: Do They Have Any Effect on Olfaction Results After Endoscopic Sinus Surgery?

Objective: How the presence of olfactory structures in olfactory cleft polyps (OCPs) affect olfaction function outcomes after surgical removal has not yet been investigated. In this study we aimed to assess the presence of olfactory structures in OCPs and correlate these findings with olfactory outcomes after endoscopic sinus surgery (ESS). Methods: Twenty seven patients with OCP underwent preoperative topical and systemic steroid treatment and ESS. Biopsies from the middle meatal polyps (MMPs) and OCPs were immunohistochemically analyzed for olfactory marker protein (OMP). The smell diskettes olfaction test was applied to patients at baseline, after steroid treatment (AST) and after ESS. Results: OCPs exhibited OMP staining more commonly and intensely compared to MMPs (p=0.008), however, there were no correlations between OMP staining scores and any of the olfaction scores (p>0.05). Steroid treatment increased smell function significantly (p<0.001), however, there were no significant differences between AST and after ESS smell scores (p=0.17). There were significant correlations between smell gains AST and final smell gains after ESS (r=0.665, p<0.001). Conclusion: OCPs contain olfactory neuroepithelium more commonly and intensely than MMPs in nasal polyp patients. However, surgical importance of this finding is controversial because removal of these polyps did not decrease smell function postoperatively in our study. Nasal polyp patients who will take steroid treatment pre-operatively must be informed that the success of ESS on olfaction depends on the response of the steroid treatment and ESS AST might not have additional favorable effect on smell function.

The effectiveness of propranolol, flunarizine, amitriptyline and botulinum toxin in vestibular migraine complaints and prophylaxis: a non-randomized controlled study.

INTRODUCTION: Vestibular migraine is the most common cause of spontaneous episodic vertigo in adult patients and the second most common cause of vertigo in patients of all ages. OBJECTIVE: To assess the effectiveness of oral medication type (propranolol, flunarizine, and amitriptyline) and botulinum toxin A application on vestibular symptoms, headache severity and attack frequency for vestibular migraine patients. METHODS: Sixty patients with vestibular migraine were enrolled. Thirty patients received botulinum toxin A treatment (B+ group) in addition to the oral medication, whereas 30 patients received only oral medication (B- group). Headache severity was evaluated with Migraine Disability Assessment Scale and vertigo severity was evaluated with Dizziness Handicap Inventory scale. Vestibular migraine attack frequencies in the last three months were also evaluated. RESULTS: There was a statistically significant decrement in mean Dizziness Handicap Inventory scores, Migraine Disability Assessment Scale scores and vertigo attack frequencies after treatment for all patients, B+ and B- group patients (p<0.001 for all). The mean Migraine Disability Assessment Scale score gains (p<0.001) and vertigo attack frequency gains (p= 0.003) were significantly higher in the B+ patients than B- patients. CONCLUSIONS: Both B+ and B- group patients exhibited significant improvement in vestibular migraine attack frequencies, Dizziness Handicap Inventory score and Migraine Disability Assessment Scale score values. However, botulinum toxin A application had a more pronounced effect for Migraine Disability Assessment Scale score gain and vestibular migraine attack frequency values, but not for Dizziness Handicap Inventory score gain values. Thus, botulinum toxin A application should be considered for vestibular migraine patients whose headache severity degrees are more profound. The oral medication type (propranolol, flunarizine or amitriptyline) did not differ in influencing the vestibular migraine attack frequency, Dizziness Handicap Inventory score gain and Migraine Disability Assessment Scale score gain values.

Clinical and surgical factors affecting the prognosis and survival rates in patients with mucormycosis.

PURPOSE: To investigate the factors affecting disease specific mortality (DSM) in patients with mucormycosis. METHODS: This retrospective study included 24 patients diagnosed with mucormycosis and who had undergone surgical and medical treatment between 2010 and 2020. There were 14 male and 10 female patients whose mean age was 53.70 ± 16.87 years, range 18-83. We reviewed the factors affecting DSM, including the extent of disease (paranasal sinus, palatal, orbital or intracranial involvement) and blood parameters (BP) that are serum glucose level (SGL), white blood cell, neutrophil, lymphocyte counts, C-reactive protein and hemoglobulin levels. Also, the effect of SGL in diabetes mellitus and BP in hematological malignancies on DSM was additionally evaluated. RESULTS: Orbital (p = 0.001) and intracranial (p < 0.01) involvement had statistically significant effect on DSM but not the palatal involvement. When Cox regression analysis was employed to analyze the effect of multiple independent factors on DSM, only the extent of disease (p = 0.023) had statistically significant effect. Receiver operating characteristic analysis of SGL for diabetic patients demonstrated that the area under the curve was 0.917 (p = 0.016). A cut-off SGL of 360 mg/dl revealed an 83.3% sensitivity and 83.3% specificity for mortality outcome for diabetic patients having mucormycosis. CONCLUSION: Orbital or cerebral involvement is related to a poor prognosis, so early endoscopic nasal examination, diagnosis and treatment are of vital importance for DSM in mucormycosis. Serum glucose level over 360 mg/dl in uncontrolled diabetic patients with fever, ophthalmological findings and facial hypoesthesia should necessitate a consultation to an otolaryngologist and an endoscopic careful nasal examination.

Effectiveness of sialendoscopy on the symptoms of chronic obstructive sialadenitis and patient satisfaction degree.

OBJECTIVES: The purpose of this study was to assess the effectiveness of sialendoscopy (SE) on the symptom severity of chronic obstructive sialadenitis (COS) and patient satisfaction by using the Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire and the Patient Satisfaction Scores (PSS). PATIENT AND METHODS: COSS questionnaire was employed to 51 Turkish patients with COS before and three months after SE. Patients' satisfaction with SE was evaluated by analyzing the PSS. RESULTS: Gland preservation rate of the SE operation was 96.2%. The sialolith extraction rate was 74.2%. A significant decrease in the COSS scores of all of the patients in the study sub-groups was observed (p < 0.05). The effectiveness of SE was more pronounced for patients with sialolithiasis and submandibular gland (SG) involvement (p < 0.001, p = 0.03, respectively). Totally extracted stone and symptom duration were the only independent factors that significantly affected the COSS score gain values in patients with and without sialolithiasis, respectively (p < 0.001). There was a statistically significant correlation between COSS score gain values and PSS values. (r = 0.786) CONCLUSION: The benefit of SE was more pronounced in patients with sialolithiasis and SG involvement. Successful stone extraction and symptom duration were two independent factors that influenced both clinical improvement and patient satisfaction for patients with and without sialolithiasis, respectively. COSS questionnaire results correlated with the PSS values; thus, this questionnaire can also be used to evaluate the patients' satisfaction with SE.

Olfactory neuroepithelium in the middle turbinate: is there any impact on olfaction function after lateral marsupialization for concha bullosa surgery?

INTRODUCTION: The effect of the quantity of olfactory neuroepithelium in the middle turbinate on the postoperative olfactory function for middle turbinate concha bullosa patients has not yet been evaluated. OBJECTIVE: The primary aim of this study was to investigate the olfactory structures in the middle turbinate by immunohistochemical analysis of the olfactory marker protein and to correlate the immunostaining results with the olfaction test results for patients with middle turbinate concha bullosa. METHODS: Surgical materials of 18 middle turbinate concha bullosa patients who had undergone lateral marsupialization surgery were immunostained with olfactory marker protein antibodies. Smell diskettes olfaction test was applied to all of the study group patients both preoperatively and three months postoperatively. A visual analog scale was used to quantify the sense of nasal obstruction. RESULTS: It was observed that the postoperative smell scores and the nasal obstruction visual analog scale values were significantly improved as compared to the preoperative values (p < 0.05). In addition, there was a significant correlation between the smell score gain and the visual analog scale gain values (r = 0.682). Results also indicated no significant correlation between the olfactory marker protein staining scores and the smell scores (p > 0.05). CONCLUSION: This first paper demonstrated that the quantity of the olfactory mucosa in the middle turbinate was not a determining factor for the postoperative smell function degree for middle turbinate concha bullosa patients. The underlying cause of the olfactory deficit for middle turbinate concha bullosa patients seems to be obstruction related rather than the middle turbinate's olfactory mucosa containing status.

Surgical Outcomes of Transmastoid Facial Nerve Decompression for Patients With Traumatic Facial Nerve Paralysis.

OBJECTIVE: To evaluate the facial nerve function and audiological results of delayed (by at least one month after the insult) transmastoid facial nerve decompression (FND) in traumatic facial nerve paralysis (FNP). METHODS: Medical records of 57 patients with traumatic FNP were reviewed and surgical results of 13 patients (mean age 28.0 ± 17.67, range 3-67) undergoing transmastoid FND were analyzed. Preoperative and postoperative mean hearing thresholds were compared using 0.5, 1, 2, and 3 kHz. Facial nerve function was graded according to the House-Brackmann scale (HB) before and after surgery. HB scale results of grade III or better were accepted as good results postoperatively. RESULTS: Preoperative HB grades were V in 5 and VI in 8 patients. Twelve of 13 patients had good recovery of facial nerve function regardless of the operation timing. When mean preoperative and postoperative air-bone gap (ABG) values were compared (except the patients with total sensorineural hearing loss), the mean preoperative ABG was 33 ± 15.9 dB, and mean postoperative ABG was 17.2 ± 8.68 dB. There was a mean hearing gain of 15.8 dB after transmastoid facial nerve decompression surgery. Surgery and anesthesia-related complications were not seen in any patients. CONCLUSION: The transmastoid route can be used safely and effectively with elimination of the risks of craniotomy and middle fossa surgery for patients with traumatic FNP. Hearing improvement can be achieved by performing ossicular chain reconstruction during decompression surgery for patients with conductive or mixed hearing loss (HL).

Differential Expression of Ki-67 and P27 in Cholesteatoma Compared to Skin Tissue Predicts the Prognosis of Adult Acquired Cholesteatoma.

BACKGROUND: The aim of this study was to compare the differential Ki-67 and p27 staining properties of acquired cholesteatoma in adult patients for prognostic analysis. METHODS: Forty-two adult patients with acquired cholesteatoma were enrolled. The cholesteatoma and matched meatal skin tissues of the patients were immunostained with Ki-67 and p27 antibodies. Canal wall down mastoidectomy was performed in all patients. The differential staining properties--positive staining in the cholesteatoma and negative staining in the skin tissue (C+S-), negative staining in the cholesteatoma and positive staining in the skin tissue(C-S+)--were compared for bone erosion scores (BES), stage, and recurrence rates. RESULTS: Isolated findings in the cholesteatoma tissues, without matching with the skin tissues, demonstrated that stage and recurrence rates were not related to findings in the cholesteatoma tissues (P > .05). However, C+S- for Ki-67 and C-S+ for p27 are risk factors for worse prognosis including advanced stage (P < .001 for Ki-67 and P = .008 for p27), BES values (P < .001 for Ki-67 and P = .001 for p27), and recurrence rates (P < .001 for Ki-67 and P = .037 for p27). CONCLUSION: This is the first paper assessing the cholesteatoma prognosis according to the differential Ki-67 and p27 staining properties of cholesteatoma and healthy skin tissues. Cellular proliferation rate in the cholesteatoma is important but insufficient by itself for predicting the prognosis of cholesteatoma patients. Patients having lower basal levels of cellular proliferation rate and higher cellular activity in the cholesteatoma tissue are prone to worse prognosis with increased stage, recurrence rates, and degree of bone erosion.

Endoscope Assisted Subcochlear Approach for Symptomatic Petrous Apex Effusion.

ABSTRACT: Petrous apex effusions are rare disorders and usually occur in the petrous apex (PA) having well-aerated cells and it may present with several symptoms or can be diagnosed incidentally on imaging methods obtained for another reason. If there are persistent symptoms despite the conservative treatment in symptomatic patients, a surgical attempt can be considered. In patients with favorable hearing levels and with the well-pneumatized petrous bone, PA cells may be effectively drained through subcochlear or supracochlear approaches by preserving patient's hearing levels. In this case report, the authors presented a severe symptomatic patient with petrous apex effusion who did not respond to conservative treatment and petrous apex drainage was performed via the subcochlear approach.

Is There any Possible Role of Neurotrophin 3 in the Pathogenesis of Antrochoanal Polyp?

OBJECTIVE: Antrochoanal polyp (ACP) is a benign soft tissue lesion arising from the inner wall of the maxillary sinus that extends into the nasal cavity and choana. Although it was first explained by Killian in 1906, the underlying pathogenesis has not been yet fully understood. Neurotrophins have been demonstrated to have a possible role in the pathogenesis of allergic rhinitis, idiopathic rhinitis and nasal polyps. To date any study has not investigated the function of neuronal inflammation and neurotrophins in the development of ACP. The objective of this study was to investigate the possible effect of neurotrophin-3 (NT-3) in ACP pathogenesis. METHOD: Twenty adult patients with ACP who underwent endoscopic sinus surgery in our department were included in the study group. The control group included 15 patients with concha bullosa of middle concha who underwent lateral excisional surgery. Nasal tissue NT-3 staining scores were evaluated using immunohistochemical methods. Blood NT-3 levels of both groups were evaluated by enzyme-linked immunosorbent assay (ELISA). RESULTS: There were no statistically significant differences between these two groups regarding tissue NT-3 staining scores (p=0.843) and blood NT-3 levels (p=0.463). In addition, no statistically significant correlation has been observed between tissue NT-3 staining scores and blood NT-3 levels in both ACP (p=0.578) and control (p=0.359) group patients. CONCLUSION: NT-3-related neuronal inflammation does not seem to have any role in ACP pathogenesis.

Double-Layered (Cartilage Island + Extra Perichondrium) Graft for Type 1 Tympanoplasty.

OBJECTIVE: To compare the graft success rates and hearing results of single-layered (composite island) grafting (SLG) vs double-layered (composite plus second layer of perichondrium) grafting (DLG) for over-under type 1 tympanoplasty techniques. STUDY DESIGN: Retrospective chart review. SETTINGS: Tertiary center otorhinolaryngology clinic. SUBJECTS AND METHODS: Medical charts of the patients who underwent type 1 tympanoplasty via the microscopic technique by a single surgeon between 2015 and 2019 were analyzed. RESULTS: A total of 48 patients were included. The DLG (n = 26) group had higher graft take rates as compared to the SLG group (n = 22) for all patients (P = .038) and for moderate- to high-risk patients according to Middle Ear Risk Index (MERI) scores (P = .029) but not for patients with mild disease (P = .429) or myringosclerotic patients (P = .242). The DLG group exhibited higher air-bone gap closure (C-ABG) values as compared to the SLG group for all patients (P = .018). However, there was no noticeable difference in C-ABG values within the patients with successful grafting (P = .217). Only graft success status had a significant effect on C-ABG values when the multivariate linear regression was performed. (P = .016). Higher MERI scores and presence of myringosclerosis were related to the unsuccessful grafting (P < .01). CONCLUSION: DLG tympanoplasty is encouraged, especially for patients with higher MERI scores, to increase the graft success rates. Better hearing outcomes of DLG tympanoplasty were related to the higher graft success status of this technique; DLG had no additional hearing effect for patients with successful grafting. Higher MERI scores and presence of myringosclerosis were related to graft failure.

The effect of partial and total laryngectomy on couples' sexual functions in men with larynx cancer.

PURPOSE: To investigate effect of total or partial laryngectomies with or without adjuvant treatments on couples' sexual functions. METHODS: The study included 39 male patients with laryngeal cancer and their female partners who were sexually active. Twenty-six patients underwent total laryngectomy, and 13 had partial laryngectomy. Sexual functions were assessed with the International Index of Erectile Function (IIEF-5) questionnaire for erectile functions, the Male Sexual Health Questionnaire (MSHQ-4) for ejaculatory functions and the Female Sexual Function Index (FSFI) for female partners' sexual functions. RESULTS: The mean IIEF score significantly decreased from 21.51 ± 8.78 to 16.13 ± 9.6 after the surgery (p = 0.000). The mean MSHQ score significantly decreased from 12.95 ± 3.14 to 10.32 ± 4.59 after the surgery (p = 0.000). To investigate risk factors that might predict decreasing in post-operative erectile and ejaculatory function of the male patients, presence of pre-operative erectile dysfunction (p = 0.04) and additional treatment with chemo-radiation therapy were the predictors for decreases in erectile (p = 0.006) and ejaculatory functions (p = 0.036). The mean FSFI total score significantly decreased from 25.83 ± 7.42 to 13.45 ± 10.09 after the surgery (p = 0.000). CONCLUSION: Laryngectomies have negative impact on male erectile and ejaculatory functions, and also have negative effect on female partners' sexual functions. Presence of pre-operative erectile dysfunction and additional chemo-radiation therapy were the predictors to decrease in erectile and ejaculatory functions after surgery. Therefore, male patients and their female partners should be informed in light of these findings before laryngeal surgery and adjuvant therapy.

Radiologic Evaluation of Exiting Points of Supraorbital Region Neurovascular Bundles in Patients With Migraine.

PURPOSE: To reveal the presence and nature of exiting points of supraorbital region neurovascular structures and determine the distances of those structures to midline with computed tomography images by taking into account gender and sides in patients with migraine. METHODS: The study was conducted retrospectively on computed tomography images of 70 migraine and 70 control patients with a mean age of 39.5 ±â€Š13.8 years (range: 18-80). Presence and nature (foramen or notch) of exiting points of neurovascular structures in terms of side and gender in both groups, and the distances of these structures to the midline of the face were evaluated. RESULTS: In migraine and control groups, the most commonly seen structure was single notch. Coexistence of foramen and notch was statistically significant in migraine and female migraine groups than control and female control groups (P < 0.05). Bilateral presence of supraorbital structure was 51.4% in migraine group and 64.3% in control group patients. In all cases, foramen-midline distance was statistically significant longer than the notch-midline distance (P < 0.05). In migraine patients, no statistically significant difference was detected regarding distances of foramen and notch to midline in terms of side and gender. CONCLUSION: Consideration of variable presence and location of the supraorbital notch and foramen, analysis of computed tomography scan might be beneficial in preoperative planning of foraminotomy and fascial band release in adult migraine patients to prevent intraoperative complications. Also, coexistence is more frequent on left side in migraine patients that might cause overlooking those structures during surgery.

Treatment of Otomycosis in Ears with Tympanic Membrane Perforation is Easier with Paper Patch.

OBJECTIVE: To assess the effectiveness of paper patch closure of tympanic membrane perforation in patients with otomycosis and tympanic membrane perforation. METHODS: Fifty-six otomycosis patients with central tympanic membrane perforations were included in the study. Patients were randomized into two groups as patched (PG) and non-patched (NPG) groups. In both groups, Castellani's solution was applied to the external auditory canal. In PG patients, the perforated tympanic membrane was covered with carbon paper patch soaked in Castellani's solution to reduce ear canal humidity and to prevent fungi from passing from the ear canal to the middle ear mucosa. Paper patch was not used in NPG patients. RESULTS: There were statistically significant differences between the two groups in terms of severity scores in the first, second, third, fourth and sixth weeks of admission (p=0.004, p=0.018, p=0.001, p=0.009, and p<0.001, respectively). Time to complete recovery was statistically shorter in PG patients (p<0.001). Disease recurrence was statistically less among PG patients compared to NPG patients (p=0.025). CONCLUSION: Closing of perforation with paper patch and topical application of Castellani's solution was found to be an effective and safe method. The method eliminated otomycosis in a shorter period and reduced recurrence rate in patients with eardrum perforation.

False-Positive Laryngeal FDG Uptake During PET/CT Imaging: Reinke's Edema.

Positron emission tomography/computed tomography (PET/CT) is frequently used for diagnosing, staging, and following-up various malignancy types because it provides information on the site and metabolic activity of the tumor. Fluorodeoxyglucose (FDG) uptake by the normal laryngeal tissue is symmetric and low, whereas that under some non-malignant conditions of the larynx, such as vocal cord paralysis and Teflon granuloma, is asymmetrically increased. We reported the first case of histologically proven Reinke's edema causing false-positive laryngeal FDG uptake on PET/CT imaging. A clinician must be aware of these rare benign lesions in the case of increased FDG uptake, and histopathological investigation is mandatory to rule out malignancy for suspicious cases.