The impact of bariatric surgery on eustachian tube dysfunction.

PURPOSE: We aimed to evaluate the relationship between acute loss of weight after 6 months of bariatric surgery and the occurrence of tubal dysfunction symptoms METHODS: We recruited 76 patients who had undergone bariatric surgery between 2018 and 2019. It was planned to see if the change in Body Mass Index (BMI) caused changes in the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores of individuals. Regardless of the questionnaire, patients were also asked for 3 symptoms (autophony, fullness in the ear, hearing their own breath in the ear) before and 6 months after bariatric surgery. RESULTS: The mean age of the study group was 39.32 ± 11.09 years and 80.3% percent of the patients were female. The mean weight loss of the patients at the 6th month was 44.67 ± 13.10 kg, and mean weight loss rate was % 35.06 ± 8.01. The incidence of hearing their own breath, autophony and fullness of the ear were 25%, 22.4% and 11.8%, respectively. The proportion of those experiencing any of these three complaints was 30.3% (n = 23). The ETDQ scores of the cases ranged from 7 to 27, with an average of 9.38 ± 4.28. There are 10.5% (n = 8) paints with a score of ≥ 14.5 as regarded as patients with Eustachian tube dysfunction (ETD). The mean age of patients with ETD was significantly higher (p < 0.05) than patients without ETD. Gender distributions, weight loss rates, smoking, previous operation and additional disease distributions do not show statistically significant differences between patients with and without ETD (p > 0.05). CONCLUSION: Present study indicated a 10.5% ETD incidence after bariatric surgery. ETDQ questionnaire can be used for ETD screening in patients who underwent bariatric surgery, which will be an overlooked complication in this group of subjects.

Nasal Septal Hematoma and Abscess in Children: An Uncommon Otorhinolaryngology Emergency Revisited.

OBJECTIVE: To evaluate the demographic factors, trauma type, treatment, and long-term results in patients with nasal septal hematoma (NSH) and nasal septal abscess (NSA) in pediatric age group. METHODS: Between the years 2006 and 2019, patients who received a diagnosis of NSA and NSH were included for the study. Demographic data, the surgical findings, and long-term follow-up results were recorded. RESULTS: A total of 68 patients were identified. Forty-five patients were diagnosed as NSA and 23 patients were diagnosed with NSA. Mean age of the patients was 7.00 ±â€Š3.33 years. Patients did not differ in terms of age, gender, and etiology. Mean duration of the symptoms was significantly high in NSA group (4.11 ±â€Š4.00 days for NSH and 7.61 ±â€Š7.71 days for NSA, P = 0.011). Associated nasal fracture was significantly high in NSH group. Previous nasal examination was significantly high in NSA group. Epistaxis was present significantly high in NSH group (P = 0.013). Fever and purulent nasal discharge was observed significantly high in NSA group. Forty-seven (n = 47) patients can be reevaluated for long-term deformity (NSH, n = 34 [72.34%] and NSA, n = 13 [27.65%]). Mean follow-up period of the patients was 8.7 years. In total, 61.7% of the patients experienced minor or major sequelae. Both NSA and NSH groups did not differ in terms of minor sequelae and major sequelae. No sequleae was significantly high in NSH group (for NSH n = 17/34-(50,0%); for NSA n = 1/13- (7,7%), p = 0.008). Both NSA and NSH groups did not differ in terms of no sequelae and minor sequelae. CONCLUSION: The NSH and NSA are uncommon conditions that needed prompt diagnosis and intervention.

Role of Apoptosis in the Pathogenesis of Nasal Polyps Based Upon Galectin-3 Expression.

OBJECTIVE: The authors aimed to investigate the antiapoptotic mechanisms in nasal polyps that occur after glandular hyperplasia. STUDY DESIGN: Retrospective histopathological analyses of patients with nasal polyps. METHODS: The study comprised 54 patients (19 females; 35 males). Group-1 patients with a diagnosis of nasal polyposis; group-2 patients with a diagnosis of antrochoanal polyps; group-3 with a diagnosis of deviation of the nasal septum as a control group. Tissues were taken during their surgery and fixed in paraffin blocks, stained to detect galectin-3, and evaluated under a light microscope. Polymorphonuclear leukocytes on the surface epithelium, glandular epithelium, and connective tissue were divided into groups according to the intensity of galectin-3 staining: "mild," "moderate," and "strong." The percentage of stained tissue was also graded: <10%, 10% to 50%, 51% to 80%, and >80%. Hence, the extent of expression of galectin-3 and percentage of stained tissue was calculated. RESULTS: Significant differences in the staining intensity of polymorphonuclear leukocytes for galectin-3 were observed between the 3 groups (P <0.01). Staining intensity in control group was significantly lower than that in group I and group II (P = 0.001; P <0.01). However, there was no significant difference between group I and group II (P >0.05). CONCLUSION: These findings suggest that galectin-3 has a role in the formation of nasal polyps.

Multilevel Combined Surgery With Transoral Robotic Surgery for Obstructive Sleep Apnea Syndrome.

OBJECTIVE: To evaluate the results of combined multilevel surgery with transoral robotic surgery (TORS) in patients with obstructive sleep apnea/hypopnea syndrome for multilevel upper airway obstruction. METHODS: Subjects who underwent combined sleep surgery via TORS were evaluated. The drug-induced sleep endoscopy was used in diagnosing the presence of level-specific upper airway collapse and to detect the type of surgery. Pre- and postoperative Apnea-hypopnea index, Epworth sleepiness scale lowest oxygen saturation, total operation time, robotic set-up time and robotic surgery time, blood loss value, and complications were recorded. RESULTS: Twenty five subjects were identified. All subjects underwent base of tongue (BOT) + epiglottoplasty. The tracheotomy was not performed for any patient. Overall, 72% of patients met the criteria for cure, 8% met the criteria for cure, and 20% of patients met the criteria for failure. There was a significant decrease between preoperative and postoperative Apnea-hypopnea index scores (28.7 ±â€Š17.8 SD versus 9.4 ±â€Š12.4, P = 0.000) and Epworth sleepiness scale scores (13.5 ±â€Š2.8 versus 3.4 ±â€Š1.6, P = 0.000). There was a significant increase between preoperative and postoperative ED SPO2 levels (80.7 ±â€Š7.6 versus 82.6 ±â€Š18.1, P = 0.001). CONCLUSION: TORS BOT, epiglottoplasty, and multilevel procedures in patients with obstructive sleep apnea/hypopnea syndrome can be regarded as feasible, safe, and effective technique.

Virtual Assessment of Sex: Linear and Angular Traits of the Mandibular Ramus Using Three-Dimensional Computed Tomography.

Morphometric analysis of the mandibular ramus (MR) provides highly accurate data to discriminate sex. The objective of this study was to demonstrate the utility and accuracy of MR morphometric analysis for sex identification in a Turkish population.Four hundred fifteen Turkish patients (18-60 y; 201 male and 214 female) who had previously had multidetector computed tomography scans of the cranium were included in the study. Multidetector computed tomography images were obtained using three-dimensional reconstructions and a volume-rendering technique, and 8 linear and 3 angular values were measured. Univariate, bivariate, and multivariate discriminant analyses were performed, and the accuracy rates for determining sex were calculated.Mandibular ramus values produced high accuracy rates of 51% to 95.6%. Upper ramus vertical height had the highest rate at 95.6%, and bivariate analysis showed 89.7% to 98.6% accuracy rates with the highest ratios of mandibular flexure upper border and maximum ramus breadth. Stepwise discrimination analysis gave a 99% accuracy rate for all MR variables.Our study showed that the MR, in particular morphometric measures of the upper part of the ramus, can provide valuable data to determine sex in a Turkish population. The method combines both anthropological and radiologic studies.

Estimation of forensic age using substages of ossification of the medial clavicle in living individuals.

Forensic age estimation based on staging of ossification of the medial clavicular bone is one of the methods recommended by the Study Group on Forensic Age Diagnostics of the German Association of Forensic Medicine. In the present study, we analyzed the stages of ossification of the medial clavicular epiphyses on thin-sliced (1 mm) computed tomography (CT) images using the substages defined within stages 2 and 3. The retrospective CT analysis involved 193 subjects (129 males, 64 females) ranging in age from 13 to 28 years. Spearman's correlation analysis revealed a positive correlation between age and ossification stage in both male and female subjects. Stage 3c was first observed at 19 years of age in both sexes and may thus serve as a valuable forensic marker for determining an age of 18 years. Although further research is needed on the ossification stages of the medial clavicular epiphyses, the present findings could contribute to existing reports on observers' experiences using CT analysis of ossification combined with analysis of substages.

Forensic age estimation by the Schmeling method: computed tomography analysis of the medial clavicular epiphysis.

The variability of anthropometric measures, such as the degree of ossification, among societies should be taken into account when estimating age. The degree of ossification of the medial clavicle can be determined with thin-section computed tomography (CT), which is one of the methods recommended by the Study Group on Forensic Age Diagnostics of the German Association of Forensic Medicine. The purpose of this retrospective study was to investigate the applicability of thin-section CT analysis of the degree of ossification of the medial clavicle in a Turkish population. We evaluated the CT images (1-mm slice thickness) of 503 patients (362 male, 141 female; age, 10-35 years) using the Schmeling five-stage method. The Spearman's correlation analysis revealed a positive correlation between age and ossification stage in both male and female patients (total group: rho = 0.838, p < 0.001; male: rho = 0.831, p < 0.001; female: rho = 0.856, p < 0.001). The linear regression analysis results indicated that the ossification stage of the medial clavicle is a good predictor when estimating age (r (2) = 0.735 for all patients, 0.734 for male patients, 0.741 for female patients). Sex differences in ossification stages were observed only for stage 1 and 4 ossification. We believe that future research could expand the database on this topic and contribute to improvements in this measurement method.

Vitamins A, C, and E and selenium in the treatment of idiopathic sudden sensorineural hearing loss.

This study evaluated the effectiveness of vitamins A, C, and E, with selenium, in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL). This was a prospective, controlled study performed at a tertiary teaching and research hospital. Over a 32-month period, patients were treated with either our standard ISSNHL treatment regimen plus vitamins A, C, and E and selenium (ACE+ group) or with only our standard ISSNHL treatment regimen (ACE- group). The demographics, additional symptoms, mean initial and final hearing levels, mean hearing gain, and recovery data were compared between the two groups. The ACE+ group, consisting of 70 (55.5 %) patients, received vitamin A (natural beta-carotene, 26,000 IU), vitamin C (ascorbic acid, 200 mg), vitamin E (d-alpha-tocopherol, 200 IU), and selenium (50 µg) twice daily for 30 days in addition to our ISSNHL treatment regimen: methylprednisolone at an initial dose of 1 mg/kg body weight per day, tapered over 14 days; Rheomacrodex(®) [(10 g of dextran and 0.9 g of NaCl)/100 ml] 500 ml daily for 5 days; Vastarel(®) 20-mg tablet (20 mg of trimetazidine dihydrochloride) three times daily for 30 days; and ten 60-min hyperbaric oxygen (HBO) sessions (2.5 absolute atmospheres of 100 % O2), once daily, starting the day of hospitalization. The ACE- group comprised 56 (44.4 %) patients, who received only our ISSNHL treatment regimen. The mean hearing gains were 36.2 ± 20.3 dB in the ACE+ group and 27.1 ± 20.6 dB in the ACE- group. The mean hearing gain rates were significantly higher in the ACE+ group than in the ACE- group (p = 0.014). Treatment with vitamins A, C, and E and selenium was effective in ISSNHL patients undergoing treatment with methylprednisolone, dextran, trimetazidine dihydrochloride, and HBO, and might be more effective when the initial hearing level is below 46 dB.

Transoral robotic supraglottic partial laryngectomy.

OBJECTIVE: Transoral robotic supraglottic laryngectomy is a new surgical way to perform endolaryngeal resection of supraglottic laryngeal carcinoma. The aim of this report was to present our initial experience about transoral robotic supraglottic laryngectomy for early supraglottic cancer. METHODS: Subjects with early squamous cell carcinoma (T1-T2) of supraglottic region who managed using transoral robotic surgery in a tertiary referral center were included in the study. The technique of robot-assisted resection, intraoperative blood loss, mean robotic operating time, pathologic margin status, postoperative extubation, need for a tracheotomy, and length of hospitalization, complications, duration of oral nutrition, and neck dissection and radiotherapy needs were evaluated. RESULTS: Thirteen subjects (12 men, 1 woman) with T1-T2 supraglottic carcinoma were successfully operated on with transoral robotic surgery. In all subjects, negative margins were obtained. The mean total robotic surgery time was 31.6 (SD, 16.2) minutes (range, 20-80 minutes). Mean total blood loss was less than 40 mL. Subjects started oral nutrition with a mean of 10.8 (SD, 8.9) days (range, 4-30 days) postoperatively. The mean hospitalization was 15.4 (SD, 10.4) days (range, 7-42 days). CONCLUSIONS AND RELEVANCE: Transoral robotic supraglottic laryngectomy with the da Vinci robotic system can be regarded as a feasible, safe, and effective technique. Although short-term results seem discouraging, long-term results are needed to evaluate the oncologic safety.

The use of maxillary sinus dimensions in gender determination: a thin-slice multidetector computed tomography assisted morphometric study.

Gender determination is an important step in identification. For gender determination, anthropometric evaluation is one of the main forensic evaluations. In the present study, morphometric analysis of maxillary sinuses was performed to determine gender. For morphometric analysis, coronal and axial paranasal sinus computed tomography (CT) scan with 1-mm slice thickness was used. For this study, 140 subjects (70 women and 70 men) were enrolled (age ranged between 18 and 63). The size of each subject's maxillary sinuses was measured in anteroposterior, transverse, cephalocaudal, and volume directions. In each measurement, the size of the maxillary sinus is significantly small in female gender (P < 0.001). When discrimination analysis was performed, the accuracy rate was detected as 80% for women and 74.3% for men with an overall rate of 77.15%. With the use of 1-mm slice thickness CT, morphometric analysis of maxillary sinuses will be helpful for gender determination.

Forensic age estimation by spheno-occipital synchondrosis fusion degree: computed tomography analysis.

The analysis of ossification points plays a considerable role in forensic age estimation. Although traditional methods are still in use, researchers are working on different age estimation procedures especially within the development of radiologic methods. One of these methods is to define spheno-occipital synchondrosis fusion degree. Spheno-occipital synchondrosis, an important growth point on cranial base, provides noteworthy information about age estimation through its late stage ossification nature. This study aimed to investigate spheno-occipital synchondrosis fusion degree for age estimation in the Turkish population. In our study, 1-mm-sectioned computed tomography images of 638 (399 men and 139 women) subjects within the age of 10 to 25 years were retrospectively examined. It is stated in our study that spheno-occipital syncondrosis fusion begins superiorly and progresses inferiorly until it is completed. Spheno-occipital syncondrosis is known to be totally open at the mean (SD) age of 11.5 (1.5) years in men and 10.7 (0.8) years in women. In addition, fusion degree is known to be increased with age. Fusion starts approximately 2 years earlier in women than in men, and the process of fusion completes at the age of 17 years in both sexes. An analysis of fusion degree between sex groups showed significance at the age of 11 to 15 years, and Spearman rank correlations indicate a significant positive relationship between age and degree of spheno-occipital fusion (P < 0.001; men, ρ = 0.714; women, ρ = 0.698). Consequently, 5-staged analysis of spheno-occipital synchondrosis fusion degree in use with 1-mm computed tomography images will be helpful for age estimation between 11 and 17 years.

Delayed-onset facial paralysis following cochlear implantation: a case study and comprehensive analysis.

OBJECTIVES: Cochlear implantation (CI) is a surgical intervention used to rehabilitate hearing in individuals, both pediatric and adult, with severe hearing loss. It is generally a safe procedure with rare postoperative complications. Facial nerve paralysis following cochlear implant surgery poses challenges in diagnosis and treatment. METHODS: This case report details a 48-year-old male who experienced delayed facial paralysis after cochlear implantation, an uncommon occurrence with limited documentation. RESULTS: The facial nerve palsy of the patient resolved by the third week with combined therapy. DISCUSSION: The etiology of this complication is not fully understood, with latent virus reactivation, particularly HSV and VZV, hypothesized as a probable cause. CONCLUSION: Successful management involves a combination of corticosteroids, antiviral therapy, and antibiotics, leading to a favorable outcome.

Navigating Early and Late Hematomas in Cochlear Implantation: A Tri-Case Analysis.

Cochlear implantation is a safe, popular procedure for severe hearing loss in both children and adults. Complications are categorized as major and minor, with hematomas and seromas being minor. This article discusses advanced diagnosis and treatment for three patients with post-implantation hematomas (two early, one late).

A prospective controlled trial comparing spontaneous closure and Epifilm® patching in traumatic tympanic membrane perforations.

The objective was to compare the outcomes of spontaneous closure and hyaluronic acid (HA) ester patching (Epifilm®) in subjects with traumatic tympanic membrane (TM) perforation. This was a prospective, controlled study performed at a tertiary teaching and research hospital. During 6-month period, subjects were divided into spontaneous closure (group A) and HA ester patch-Epifilm® (group B) group. Demographic data, presenting symptoms, closure rate, closure time and audiometric data were evaluated and compared between groups. In total, 155 subjects were evaluated. Group A consisted of 62.6 % (n = 97) of the subjects, whereas group B consisted of 37.4 % (n = 58) of the subjects. Group B had significantly shorter closure times when compared with group A (6.61 ± 4.59 vs. 10.60 ± 5.23 weeks, p = 0.001). When the closure time was evaluated according to perforation size both grade 1 and 2 perforations have significantly shorter closure times when compared with group A (6.33 ± 4.54 vs. 10.80 ± 5.69 weeks, for grade 1 and 6.650 ± 2.07 vs. 10.30 ± 4.32 weeks for grade 2 perforations). Closure rates were not significant between groups (85.6 % for group A and 94.8 % for group B). When the closure rate was evaluated according to perforation size no significant difference exists for grade 1, 2 and 3 perforations between groups. Both air conduction and air-bone gap were significantly improved in both groups. HA ester patch (Epifilm®) is a non-toxic material that can be used in traumatic tympanic membrane perforations. In this study, use of HA ester patching was resulted with earlier closure time but not resulted with higher closure rates.

Cervical cystic vagal schwannoma mimicking a type 3 second branchial cleft cyst: a case report.

In this article, we report a rare case of a cervical cystic vagal schwannoma mimicking a type 3 second branchial cleft cyst clinically, radiologically and cytologically. Although schwannoma is rare, it should be considered in the differential diagnosis of cystic neck masses. This article suggests that Doppler ultrasonography, computed tomography and fine needle aspiration biopsy findings may not be sufficient to provide the correct preoperative diagnosis of cystic lateral neck masses and further imaging techniques may be required.

Separating the Physician and Patient: A Paradigm Shift for Routine Otolaryngology Examinations in COVID-19-Like Aerosol-Contaminated Environments.

OBJECTIVE: To evaluate the attitudes of physicians and patients toward physical examination in physically separated environments using a laryngoscopic examination model. MATERIALS AND METHODS: Six experienced laryngologists performed laryngoscopic examinations in 30 patients in a closed-chamber examination unit. The physicians and patients were asked to compare all domains with their previous standard laryngoscopic examination experience using a 10-point visual analog scale (0, poor performance; 10, good performance), including effectiveness of communication, difficulty of examination, perception of safety against airborne transmission of COVID-19, applicability of the unit for future examinations, perception of protective environment, and overall comfort. RESULTS: All laryngoscopic examinations were performed successfully. Effectiveness of communication, difficulty of examination, perception of protective environment, and overall comfort did not differ between physicians and patients (P > .05 for all comparisons). However, both physicians and patients found the examination to be difficult. While physicians evaluated the system as safe against airborne transmission of COVID-19, patients were not confident that the system was safe (8.70 ± 1.93 vs 2.87 ± 2.37, respectively, P = .001). Physicians also gave a higher score to future applicability of the unit for examinations than patients (8.90 ± 1.42 vs 7.10 ± 2.62, respectively, P = .001). CONCLUSION: Physically separating the physician and patient is a feasible method of physical examination in aerosol-contaminated environments.

Optimizing Early Detection: Validating Obstructive Sleep Apnea-18 (OSA-18) in Turkish-Speaking Pediatric Patients.

Objective: Quality of life (QoL) assessments are increasingly important for evaluating the well-being of children with Obstructive Sleep Apnea Syndrome (OSAS). This study's objective is to culturally adapt and validate the Turkish version of the OSA-18 questionnaire, a commonly used tool for assessing QoL in children with OSAS. Methods: The OSA-18 questionnaire was translated and culturally adapted for use in the Turkish-speaking population. The study was conducted with 180 participants, 100 boys and 80 girls, with a mean age of 6.16±2.14 years. The participants were divided into two groups. The patient group comprised individuals with symptoms of OSAS based on clinical evaluation, including anamnesis, physical examination, and video recording of apnea and snoring. The patient group underwent adenotonsillectomy and their caregivers completed the Turkish version of the OSA-18 scale postoperatively. The control group comprised 90 children who were similar to the patient group in terms of gender and age. These children had no major complaints such as snoring, apnea, fatigue during the day, irritability, or distraction. In the physical examination of this group, no major tonsillar or adenoid hypertrophy, which causes significant stenosis in the upper airway, was observed. Internal consistency, reliability, validity, responsiveness, and factor analysis were assessed. Results: The Turkish version of the OSA-18 questionnaire demonstrated excellent reliability, with a Cronbach's alpha of 0.929. The test-retest results were not statistically different. Validity was confirmed through a positive correlation between the OSA-18 score and external parameters, such as the Mallampati score, and tonsil and adenoid size. We found a statistically significant reduction in OSA-18 scores postoperatively, signifying a robust responsiveness to the intervention. Conclusion: Our study confirms the suitability of the Turkish OSA-18 questionnaire for assessing the QoL in children with OSAS. This quick and easy-to-use tool will be valuable for future research on Turkish-speaking children with OSAS, aiding in the evaluation of pediatric OSAS and QoL.

Cochlear Implantation in Primrose Syndrome with a Novel ZBTB20 Gene Variant.

In this article, we aim to present details of the cochlear implantation procedure performed in a patient with Primrose syndrome, which is a rare genetic condition characterized by physical deformities, sensorineural hearing loss, and metabolic disorders. While its long-term prognosis is still under investigation, the absence of intraoperative and postoperative complications indicates promising findings. This designates cochlear implantation as a viable therapeutic approach for sensorineural hearing loss linked to Primrose syndrome. As cochlear implantation in cases with Primrose syndrome has not been discussed previously in the literature and our patient has recently been operated on, additional investigation is imperative to broaden the understanding of cochlear implant outcomes in this patient population.

Transoral robotic cordectomy for early glottic carcinoma.

OBJECTIVES: We assessed the feasibility, safety, and efficacy of transoral cordectomy performed for early glottic cancer with the da Vinci Surgical System. METHODS: Subjects with early cancer of the vocal cords who were treated with transoral robot-assisted cordectomy were included for study. Data regarding the ability to perform robot-assisted resection, volume of blood loss,robotic operating time,pathological margin status, postoperative extubation, complications, length of hospitalization, duration until start of oral nutrition, and need for a tracheotomy were evaluated. RESULTS: Ten men with T1 glottic carcinoma underwent successful transoral robotic cordectomy with negative margins. The mean total robotic surgery time was 21.6 +/- 6.75 minutes (range, 10 to 31 minutes). In all cases, the total blood loss was less than 20 mL. One subject needed a short-term tracheotomy and a nasogastric tube. The other 9 subjects started oral nutrition 6 to 24 hours after operation. The mean duration of hospitalization was 4.1 +/- 2.23 days. CONCLUSIONS: Transoral robotic cordectomy with the da Vinci Surgical System was found to be feasible, relatively safe, and effective. The lower morbidity rate was an advantage of this method. Transoral robotic surgery provides better exposure, visualization, and access than does transoral laser microsurgery. Cordectomy with transoral robotic surgery should be an alternative to external-approach cordectomy and transoral laser microsurgery.