Demographic and clinical characteristics of our patients diagnosed with laryngeal dystonia.

PURPOSE: Laryngeal dystonia (LD) is a focal dystonia affecting laryngeal musculature with no known etiology or cure. The present study evaluated the sociodemographic and clinical features of patients diagnosed with LD. MATERIALS AND METHODS: All patients diagnosed with LD at our University Hospital's Ear, Nose, and Throat Department between January 2017 and July 2023 were retrospectively analyzed. The study included 43 patients. RESULTS: Out of the 43 patients, 19 (44%) were male. At the time of diagnosis, the mean age of the patients was 35.1 years (ranging from 17 to 65 years). The mean elapsed time between the first symptom onset and the first diagnosis was 49.2 months (min. 4 months, max. 240 months). Of the participants, 94% had adductor-type LD. None of the patients had a family history of LD. Of the patients, 9 (20%) experienced a life-altering event or trauma just before the onset of symptoms. All patients who consumed alcohol reported symptom relief with alcohol intake. A total of 67.6% of patients stated that their symptoms were triggered by stress. All of our patients received at least one Botulinum toxin injection, with an average of 2.75 dosages per patient. CONCLUSION: The gender distribution was approximately equitable between males and females. There was a tendency for men to receive a diagnosis earlier than women following the manifestation of symptoms. A significant number of patients associate the emergence of their symptoms with a stressful event or traumatic experience. This study represents the initial investigation into the sociodemographic characteristics of patients within the Turkish population.

An unexpected complication of hypoglossal schwannoma surgery: Cerebrospinal fluid leakage-A case report and literature review.

BACKGROUND: Extracranial hypoglossal schwannoma is a rare tumor primarily treated with surgical excision. This article aims to highlight the potential for unexpected complications intraoperatively, such as cerebrospinal fluid leakage from skullbase to neck. METHODS: A previously healthy 23-year-old male presented with tongue numbness. Magnetic resonance imaging revealed a 17 × 20 mm nodular lesion adjacent to the cervical segment of the internal carotid artery. Surgical excision was scheduled due to suspicion of a neurogenic tumor. RESULTS: Intraoperatively, despite careful handling, cerebrospinal fluid leakage was observed. Manipulation of the mass caused detachment of proximal nerve fibers, potentially indicating avulsion of the hypoglossal nerve from the brainstem or nearby. Clear fluid leakage from the skull base was also noted. CONCLUSION: Thorough preoperative evaluation and patient education regarding potential complications are crucial. This article presents an unexpected complication encountered during surgical excision of extracranial hypoglossal schwannoma, emphasizing the need for awareness and preparedness in such cases.

A single-center multidisciplinary study analyzing thyroid nodule risk stratification by comparing the thyroid imaging reporting and data system (TI-RADS) and American thyroid association (ATA) risk of malignancy for thyroid nodules.

OBJECTIVES: The thyroid imaging reporting and data system (TI-RADS) and 2015 American Thyroid Association (ATA) guidelines are two well-known risk stratification systems for classifying thyroid nodules based on cancer risk. This study aims to evaluate the diagnostic efficacy of these two systems in predicting malignancy in patients undergoing thyroid surgery. METHODS: We studied data on 120 individuals who were scheduled to undergo surgery for benign or malignant nodular diseases of the thyroid gland between October 2017 and October 2019. The TI-RADS category and ultrasound pattern based on ATA guidelines were assigned to dominant thyroid nodule categories by two experienced radiologists blinded to patients' previous thyroid ultrasonography and fine-needle aspiration biopsy results. A pathologist with experience in thyroid diseases blinded to patients' sonographic and clinical data reviewed the thyroidectomy specimens. RESULTS: A total of 120 patients, 88 women and 32 men, were included in our study. Final histopathological results were as follows: 50% (n=60) papillary thyroid carcinoma, 36.6% (n=44) benign nodular thyroid diseases, 4.1% (n=5) follicular adenoma, 2.5% (n=3) hurtle cell adenoma, 1.7% (n=2) follicular thyroid carcinoma, 1.7% (n=2) medullary thyroid carcinoma, 1.7% (n=2) hurtle cell carcinoma, and 1.7% (n=2) follicular tumor of uncertain malignancy potential. The sensitivity, specificity, positive predictive value, and negative predictive value for TI-RADS were 80%, 56%, 72%, and 67%, respectively, and that for ATA were 80%, 64%, 76%, and 69%, respectively. CONCLUSION: The TI-RADS and ATA showed similar rates of sensitivity, specificity, NPV, and PPV. Our observed risk of malignancy was higher than expected for the ACR TI-RADS 3-5 categories and the very low, low, and intermediate suspicion risk strata in the ATA guidelines. We found no difference between observed and expected malignancy risk for the ACR TI-RADS 2's and ATA's high suspicion categories.

Thyroid Surgery and Inadvertent Removal of Parathyroids.

This study aimed to determine the incidence of inadvertent parathyroid removal during thyroid surgery and define its associated risk factors. In this single-center record-based study, we retrospectively analyzed the clinical and pathological records of 462 patients undergoing thyroidectomy. Incidental parathyroidectomy was detected in 61 of 462 patients (13.2%). The incidence of inadvertent parathyroid removal was 17.6% (36 of 205 patients) in patients having malign thyroid diseases, compared with 9.7% (25 of 257 patients) in patients with benign thyroid diseases (p = 0.045). Incidentally removed parathyroid tissue was intrathyroidal in 8 of the 61 patients. Thus, the ratio of intrathyroidal parathyroid tissue among all patients was 1.7% (8 out of 462). Central neck dissection was carried out in 40 patients (8.7%). Fourteen of these 40 patients (35%) had an incidental parathyroid in their specimen compared with 47 of 422 patients (11.1%) who did not undergo central neck dissection (p<0.001). Incidental parathyroidectomy occurred in 13.2% of patients undergoing thyroidectomy in our study. The majority of patients had one parathyroid identified in their specimen. Central neck dissection was significantly predictive for incidental parathyroidectomy. Well-trained senior otolaryngology residents can safely perform thyroid surgery with similar rates of incidental parathyroidectomy as their masters. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-021-02590-0.

From Diagnosis to Treatment of Human Otoacariasis: Demographic and Clinical Characteristics of Patients.

Objective: Otoacariasis is the presence of ticks and mites in the ear canals of humans or animals, and particularly common in rural areas. This study aimed to present the clinical characteristics of patients that presented with ticks in their ear canal. Methods: The study was conducted with a total of 425 patients with 527 ticks in their ear canal at the Mus Malazgirt State Hospital Ear-Nose-Throat Clinic between June 2019 and June 2020. The removed ticks were examined at the parasitology laboratory of Van Yüzüncü Yil University. Results: Of the 425 cases included in the study, 72% (n=306) were female and 28% (n=119) were male (mean age 40±20, minimum-maximum: 4 months-81 years). A total of 527 ticks were removed in the one-year period. Three-hundred-and-fifty-one patients had adult or nymph ticks, and 74 patients had a larval form of the tick. Of the patients with adult or nymph tick, foreign body sensation was the dominant symptom in 68.7% (n=242), whereas pain was the dominant symptom in 62% (n=46) of those with larval tick. In the comparison between groups, foreign body sensation was statistically significantly higher in the adult tick group, and pain was higher in the larval tick group (p<0.001). There were no systemic diseases related to the ticks in any of the cases. Conclusion: Ticks in the ear is endemic in Eastern Anatolia and poses a public health problem. Tick infestations could be minimized with various precautions and educating the general public on preventive methods. Our study is the largest series in the literature on cases with ear ticks.

Relationship of PPARG overexpression with prognostic parameters in papillary thyroid carcinoma.

Objectives: PAX8/PPARG chromosomal rearrangement is frequently seen in thyroid cancer, and PPARG overexpression has been shown in the follicular variant of papillary thyroid carcinoma, but not in papillary thyroid carcinoma other than the follicular variant. The main aim of this study was to investigate the frequency of PPARG overexpression among papillary thyroid carcinoma and if there were any variants of papillary thyroid carcinoma with PPARG overexpression other than the follicular variant. Methods: Immunohistochemical analysis of PPARG overexpression was performed using a PPARG monoclonal antibody in a series of 111 paraffin-embedded blocks of thyroid tumours. Of the patients in our study, 100 were diagnosed with papillary thyroid carcinoma, 9 with follicular adenoma and 2 with follicular carcinoma. Results: PPARG staining was detected in 19 of the 111 cases. Sixteen patients with PPARG overexpression had papillary thyroid carcinoma and 3 had follicular adenoma. Conclusion: PPARG overexpression was detected mainly in follicular-variant papillary thyroid carcinoma. Vascular invasion, lymphatic invasion, thyroid capsule invasion and lymph node positivity were lower in patients with PPARG overexpression.

A Very Rare Complication of Hyaluronic Acid Injection for Medialization Laryngoplasty: A Case With Laryngeal Abscess.

Hyaluronic acid injection for medialization laryngoplasty is a safe procedure performed on patients with glottic incompetence. Laryngeal abscess formation as a complication of injection laryngoplasty is a very rare complication, and, as we know from the literature, there has been only one case of laryngeal abscess after injection laryngoplasty in a patient with a type-I laryngeal cleft. We document for the first time a laryngeal abscess resulting from hyaluronic acid injection laryngoplasty for unilateral vocal fold paralysis. Prompt evaluation of the patient was necessary. Our patient was treated with antibiotics and corticosteroids without a need for intubation. One year after injection, the patient's Voice Handicap Index-10 score was still good and within the range of normal values.

Clinicopathologic Results of the Surgical Management of Thyroid Gland Pathologies.

OBJECTIVE: The aim of this study is to share our surgical approach and results in patients with benign and malignant thyroid diseases. METHODS: All patients who underwent thyroid gland surgery at our University Hospital Ear, Nose, and Throat Department between 2012 and 2017 were retrospectively analyzed. The study included 293 patients. RESULTS: Of the 293 patients included in the study, 76 (25.9%) were male and 217 (74.1%) were female. Mean follow-up period was 47.1 months. Patients' ages ranged from 4 to 77 years. In terms of the pathology, 160 patients had benign and 133 had neoplastic thyroid diseases. None of the patients who underwent thyroid surgery due to benign diseases required revision surgery. Recurrence occurred in 15 out of the 116 patients that were operated on for well-differentiated thyroid cancer. Out of these 15 patients with disease recurrence, 11 had biochemically incomplete responses and four had structurally recurrent diseases. CONCLUSION: Thyroidectomy, when performed safely and correctly, is a very effective way of treating both benign and malignant thyroid diseases. Total thyroidectomy or total lobectomy and isthmectomy are the gold-standard surgical approaches to prevent recurrence. A national form is needed regarding thyroid surgery for following up on patients and for the regular and systematic collection of data.