Factors Affecting Success Rates in Endoscopic Repair of CSF Rhinorrhea.

Objectives: Our aim in this study is to assess the effect of factors such as age, etiology, defect size, application of lumbar drainage and surgical technique on Cerebrospinal Fluid (CSF) fistula repair success rates. Methods: The Electronic Medical Records (EMR) system of our clinic was retrospectively reviewed for cases that were operated between 2006 and 2020 for CSF fistula originating from anterior skull base with endoscopic transnasal technique. A total of 35 patients were included in the study. Patients were grouped according to the number of layers used in repair (two, three or four-layered reconstruction) and defect size (smaller than 5 mm, 5 to 10 mm and larger than 10mm), etiology, location of the defect and application of lumbar drainage as LD (+) and LD (-). Complications and CSF leak recurrence were compared between groups. Results: Recurrence rates in patients who had 2 layered reconstructions were significantly higher compared to patients who had 3 or 4 layered reconstructions (p=0.049). The recurrence rate in LD (+) group (41.7%) was significantly lower compared to LD (-) group (4.3%) (p=0.012). There were no significant difference in recurrence rates between groups in terms of age, defect size, defect location and etiology. Conclusion: In endoscopic transnasal repair of anterior skull base-derived bos fistulas, planning the reconstruction at least 3 times and applying lumbar CSF drainage increases the success rates.

Effects of submucoperichondrial application of platelet-rich plasma on nasal mucosal healing after septoplasty.

OBJECTIVE(S): Our aim is to investigate the effects of the submucoperichondrial application of Platelet Rich Plasma (PRP) on nasal mucosal healing after septoplasty surgery. METHOD(S): This prospective randomized observational study was conducted between July 2019 and February 2021, with 40 patients aged 18-60 years who underwent closed the only septoplasty operation for similar septal deviations. Patient divided into two group; 21 patients were placed in PRP group to which PRP was applied on all mucosal surface and submucoperichondrial area of septum and 19 patients were placed in control group to which saline solution was applied on same regions. Nasal obstruction score, mucociliary clearance time, presence of nasal crusting, and bleeding time were evaluated on 5th, 10th, 15th day after surgery and compared between groups. RESULTS: Intranasal crusting on day 10 was found to be lower in the PRP group (n:13 68.4 %) than control group (n:7 33.3 %) with a statistically significant difference (p = 0.028). The nasal obstruction score on day 10 and 15 were found to be lower in the PRP group (3,33 ± 2,75, 2,07 ± 2,20) (than the control group (5,44 ± 2,26, 3,37 ± 1,92) with a statistically significant difference (p = 0,003,p = 0,009). The mucociliary clearance rate was found to be higher and the bleeding time was found to be lower in the PRP group, but a statistically significant difference was not observed. CONCLUSIONS: Application of submucoperichondrial PRP could have beneficial effects on nasal mucosal repair, nasal crusting, and congestion after septoplasty surgery.

Comparison of the Otolaryngological Symptoms of Laboratory-Confirmed and Clinically Diagnosed COVID-19 Patients.

Objectives: Our aim is to determine prevalence, severity, duration of otorhinolaryngologic symptoms related to coronavirus disease 2019 (COVID-19), and correlation between the test results obtained by oronasopharyngeal swab and the symptoms of these regions by evaluating differences in ear, nose, and throat (ENT) symptoms between laboratory-confirmed COVID-19 patients and clinically and computed tomography (CT)-diagnosed COVID-19 patients. Methods: The study enrolled patients with a positive polymerase chain reaction (PCR) test diagnosed with COVID-19 that grouped as PCR (+), and those with repeated negative PCR tests but COVID-19 Reporting and Data System (CO-RADS) chest CT findings with high (CO-RADS 5) or very high (CO-RADS 6) similarity to COVID-19 that grouped as PCR(-)/CT(+). Demographic features, general symptoms, and otorhinolaryngological symptoms and severity of disease were evaluated and compared. Results: The most common ENT symptoms in the PCR(+) group were loss of taste (n=77), loss of smell, and sore throat with respective frequencies of 34.5%, 31.8%, 26.0%, and in PCR(-) CT (+) group loss of taste, loss of smell, and sore throat with respective frequencies 24.6%, 21.1%, and 18.4%. ENT symptom rates were found higher in PCR (+) group (65.0%) according to PCR(-)/CT(+) group (49.1%) with statistically significant difference (p=0.008). Loss of smell rates were found higher in PCR (+) group according to PCR(-)/CT(+) group with statistically significant difference (p=0.037). Conclusion: Loss of smell and taste were most common ENT symptoms in laboratory-confirmed COVID-19 cases. The presence of COVID-19 should definitely be considered in patients presenting with sudden loss of smell or taste. In addition, loss of smell and otolaryngologic symptoms were more common in laboratory-confirmed COVID-19 according to clinically and computed tomograpy diagnosed COVID-19 cases. There can be a correlation between positive sample region and symptom region. Location of symptoms must be considered for decision of sampling location.

What Is the Long-Term Findings of Olfactory and Taste Loss due to COVID-19?

Objectives: The objective of this study was to determine prevalance, severity, course, and long-term findings of smell and taste disorders of coronavirus disease 2019 (COVID-19) patients in mild-moderate and severe-critical disease spectrum. Methods: All adult patients conducted in our hospital with positive severe acute respiratory syndrome coronavirus 2 between March and April 2020 were surveyed during disease course and those with olfactory and taste loss were re-surveyed to determine the course and progress of these symptoms after at least 12-month follow-up. Demographic features and clinical findings were evaluated as well as disease severity. Results: A total of 77 patients with smell and/or taste loss symptoms were included in the study. At diagnosis, 58 (75.3%) patients had loss of smell and 75 (97.4%) had loss of taste. After a follow-up period of 12-14 months, 12 (15.6%) patients had ongoing loss of smell and six (8%) patients had ongoing loss of taste. Three (3.9%) patients complained of cacosmia and 5 (6.5%) complained of parosmia at follow-up. The presence of ongoing visual analog scale scores of smell and/or taste was not statistically significant between male and female patients. When presence and severity of symptoms were compared by disease severity, no statistically significant difference was found. Conclusion: Smell and taste loss seem to be among the presenting symptoms of COVID-19. The prognosis and the treatment of the smell loss and taste loss in COVID-19 patients remains unclear. To improve and accelerate recovery, the pathophysiology and the treatment options must be validated.

Giant Cell Angiofibroma in Sublingual Area: A Case Report and Review of Literature.

We present a case of Giant Cell-Rich Solitary Fibrous Tumor also known as Giant cell angiofibroma, occuring in sublingual region, to our knowledge, which has never been reported before. Forty-nine years old female who presented with painless, slowly growing mass in the sublingual region underwent excisional surgery and was diagnosed with giant cell-rich solitary fibrous tumor previously referred to as giant cell angiofibroma. In our report, we aimed to report the unusual localization of this rare tumor, examine the new nomenclature and classification of giant cell-rich solitary sibrous tumor or giant cell angiofibroma and review the literature regarding head and neck localization of this tumor.

Rhinolithiasis, a rare entity: Analysis of 31 cases and literature review.

OBJECTIVE: Rhinolithiasis is a rare condition which results from deposition of salt around a endogenous or exogenous nidus. In the literature, most of the reports are single case studies. In this study, we aimed to present the characteristics, symptoms, diagnosis, and treatment methods of 31 rhinolithiasis cases and to focus on the current literature. METHODS: We retrospectively reviewed 31 rhinolithiasis cases which have been diagnosed and treated in a tertiary care center between January 2014 and December 2018. Patient characteristics, presenting symptoms, concomitant sinonasal disorders, and type of surgery were noted. Descriptive statistics were carried out. RESULTS: Mean age was 25.4±15.7. The cases were comprised 14 female patients (45.2%) and 17 male patients (54.8%). The most common presenting symptom was nasal obstruction (71%). Malodorous unilateral rhinorrhea was present in 17 patients (54.8%). Epistaxis snoring and sleep apnea were other rare symptoms. In 21 of the cases (67.7%), rhinolith was located between inferior turbinate and septum which was the most common location seen in our series. The number of patients who were under the age of 18 was 13, in 2 of them, rhinolith was found to be formed around a plastic bead, and in 2 of them, fruit seeds were the nidus. The most common concomitant sinonasal pathology was septal deviation which was detected in 20 of the patients (64.5%), adenoid vegetation and nasal polyposis were other disorders. In 20 of the patients (64.5%), simple removal of the rhinolith using a forceps with the help of a rigid nasal endoscope was performed. Eight of the 17 patients had severe deviation and septoplasty was performed at the same time, which was the most common concomitant surgical intervention (25.8%). In 3 patients (9.6%), functional endoscopic sinus surgery was performed at the same time. CONCLUSION: Our series is one of the largest series in the literature. The most common presenting symptom was nasal obstruction followed by malodorous rhinorrhea. Accompanying sinonasal disorders should be addressed to improve the outcome. Rigid or flexible endoscopic examination should be used to detect a rhinolith. Computed tomography scan can diagnose a hidden rhinolith in a patient with nasal obstruction.

The role of red cell distribution width in the locoregional recurrence of laryngeal cancer / O papel da amplitude de distribuição de eritrócitos na recorrência locorregional do câncer da laringe

Abstract Introduction: Although the red cell distribution width has been reported as a reliable predictor of prognosis in several types of cancer, to our knowledge few reports have focused on the prognostic value of red cell distribution width in laryngeal carcinoma. Objective: We aimed to explore whether the pretreatment red cell distribution width predicted recurrence in laryngeal cancer patients is a simple, reproducible, and inexpensive prognostic biomarker. Methods: All laryngeal cancer patients who underwent curative surgery (n = 132) over a 7 year study period were evaluated. Data on demographics, primary tumor site, T-stage, N-stage, histological features (differentiation; the presence of perineural/perivascular invasion), treatment group (total laryngectomy or partial laryngectomy) or adjuvant therapy (chemotherapy/radiotherapy); laboratory parameters (complete blood count, including the pre-operative red cell distribution width), and disease-free survival rates were retrospectively reviewed. All cases were divided into three groups by the red cell distribution width tertile [<13% (25th percentile) (n = 31), 13-14.4% (50th percentile) (n = 72), and >14.4% (75th percentile) (n = 29)]. Results: High-red cell distribution width group included more patients of advanced age, and more of those with recurrent and metastatic tumors (p = 0.005, 0.048, and 0.043, respectively). Individuals with red cell distribution width >14.4% (75th percentile) had lower disease free survival rates than did those with red cell distribution width <13% (25th percentile) (p = 0.014). Patients with red cell distribution width >14.4% at diagnosis were at a higher risk of locoregional recurrence (hazard ratio = 5.818, 95% confidence interval (95% CI) 1.25-26.97; p = 0.024) than patients with a normal red cell distribution width (<13%). Conclusion: We found that the pretreatment red cell distribution width was independently prognostic of disease free survival rate in patients with laryngeal cancer and may serve as a new, accurate, and reproducible means of identifying early-stage laryngeal cancer patients with poorer prognoses.

Resumo Introdução: Embora a amplitude de distribuição de eritrócitos tenha sido relatada como um preditor confiável de prognóstico em vários tipos de câncer, que seja de nosso conhecimento, poucos estudos se concentraram no valor prognóstico dessa medida no carcinoma laríngeo. Objetivo: Avaliar se a amplitude de distribuição de eritrócitos pré-tratamento prevê a recorrência em pacientes com câncer de laringe como um biomarcador prognóstico simples, reprodutível e não dispendioso. Método: Foram avaliados todos os pacientes com câncer de laringe submetidos à cirurgia curativa (n = 132) durante sete anos. Dados demográficos, local do tumor primário, estágio T, estágio N, características histológicas (diferenciação; presença de invasão perineural/perivascular), grupo de tratamento (laringectomia total ou laringectomia parcial) ou terapia adjuvante (quimioterapia/radioterapia); parâmetros laboratoriais (hemograma, inclusive a amplitude de distribuição de eritrócitos pré-operatório) e a sobrevida livre de doença foram revisados retrospectivamente. Todos os casos foram divididos em três grupos pelo tercil da amplitude de distribuição de eritrócitos [< 13% (percentil 25) (n = 31), 13%-14,4% (percentil 50) (n = 72) e > 14,4% (percentil 75) (n = 29)]. Resultados: O grupo com amplitude de distribuição de eritrócitos elevado incluiu um número maior de pacientes com idade avançada e mais pacientes com tumores recorrentes e metastáticos (p = 0,005, 0,048 e 0,043, respectivamente). Os indivíduos com a amplitude de distribuição de eritrócitos > 14,4% (percentil 75) apresentaram taxas de sobrevida livre de doença menores do que aqueles com a amplitude de distribuição de eritrócitos < 13% (percentil 25) (p = 0,014). Pacientes com a amplitude de distribuição de eritrócitos > 14,4% no diagnóstico apresentaram maior risco de recorrência locorregional [Hazard Ratio = 5,818, intervalo de confiança de 95% (IC 95%) 1,25-26,97; p = 0,024] do que pacientes com a amplitude de distribuição de eritrócitos normal (< 13%). Conclusão: Verificamos que a amplitude de distribuição de eritrócitos pré-tratamento foi um fator prognóstico independente de sobrevida livre de doença em pacientes com câncer de laringe e pode servir como um novo parâmetro, preciso e reprodutível, para identificar pacientes com câncer de laringe em estágio inicial com piores prognósticos.

Does the reduction of inferior turbinate affect lower airway functions? / A redução da concha nasal inferior afeta as funções das vias aéreas inferiores?

Abstract Introduction: Although the nose and lungs are separate organs, numerous studies have reported that the entire respiratory system can be considered as a single anatomical and functional unit. The upper and lower airways affect each other either directly or through reflex mechanisms. Objective: In this study, we aimed to evaluate the effects of the radiofrequency ablation of persistent inferior turbinate hypertrophy on nasal and pulmonary function. Methods: Twenty-seven patients with bilateral persistent inferior turbinate hypertrophy without septal deviation were included in this study. All of the patients were evaluated using anterior rhinoscopy, nasal endoscopy, acoustic rhinometry, a visual analogue scale, and flow-sensitive spirometry on the day before and 4 months after the radiofrequency ablation procedure. Results: The post-ablation measurements revealed that the inferior turbinate ablation caused an increase in the mean cross-sectional area and volume of the nose, as well as in the forced expiratory volume in 1 s, forced vital capacity, and peak expiratory flow of the patients. These differences between the pre- and post-ablation results were statistically significant. The post-ablation visual analogue scale scores were lower when compared with the pre-ablation scores, and this difference was also statistically significant. Conclusion: This study demonstrated that the widening of the nasal passage after the reduction of the inferior turbinate size had a favorable effect on the pulmonary function tests.

Resumo Introdução: Embora o nariz e os pulmões sejam órgãos separados, numerosos estudos relataram que todo o sistema respiratório pode ser considerado como uma única unidade anatômica e funcional. As vias aéreas superiores e inferiores afetam uma à outra diretamente ou através de mecanismos reflexos. Objetivo: Avaliar os efeitos da ablação por radiofrequência em conchas nasais inferiores com hipertrofia persistente sobre a função nasal e pulmonar. Método: Foram incluídos neste estudo 27 pacientes com hipertrofia persistente bilateral de conchas inferiores sem desvio septal. Todos os pacientes foram avaliados com rinoscopia anterior, endoscopia nasal, rinometria acústica, escala visual analógica e espirometria sensível ao fluxo no dia anterior e quatro meses após o procedimento de ablação por radiofrequência. Resultados: As medidas pós-ablação demonstraram que a ablação das conchas nasais inferiores resultou em um aumento da área transversal média e do volume do nariz, bem como do volume expiratório forçado em um segundo, da capacidade vital forçada e do fluxo expiratório máximo dos pacientes. Essas diferenças entre os resultados pré e pós-ablação foram estatisticamente significantes. Os escores da escala visual analógica pós-ablação foram menores quando comparados com os escores pré-ablação e essa diferença também foi estatisticamente significante. Conclusão: O alargamento da passagem nasal após a redução do tamanho das conchas nasais inferiores teve efeito favorável nos testes de função pulmonar.

The role of red cell distribution width in the locoregional recurrence of laryngeal cancer.

INTRODUCTION: Although the red cell distribution width has been reported as a reliable predictor of prognosis in several types of cancer, to our knowledge few reports have focused on the prognostic value of red cell distribution width in laryngeal carcinoma. OBJECTIVE: We aimed to explore whether the pretreatment red cell distribution width predicted recurrence in laryngeal cancer patients is a simple, reproducible, and inexpensive prognostic biomarker. METHODS: All laryngeal cancer patients who underwent curative surgery (n=132) over a 7 year study period were evaluated. Data on demographics, primary tumor site, T-stage, N-stage, histological features (differentiation; the presence of perineural/perivascular invasion), treatment group (total laryngectomy or partial laryngectomy) or adjuvant therapy (chemotherapy/radiotherapy); laboratory parameters (complete blood count, including the pre-operative red cell distribution width), and disease-free survival rates were retrospectively reviewed. All cases were divided into three groups by the red cell distribution width tertile [<13% (25th percentile) (n=31), 13-14.4% (50th percentile) (n=72), and >14.4% (75th percentile) (n=29)]. RESULTS: High-red cell distribution width group included more patients of advanced age, and more of those with recurrent and metastatic tumors (p=0.005, 0.048, and 0.043, respectively). Individuals with red cell distribution width >14.4% (75th percentile) had lower disease free survival rates than did those with red cell distribution width <13% (25th percentile) (p=0.014). Patients with red cell distribution width >14.4% at diagnosis were at a higher risk of locoregional recurrence (hazard ratio=5.818, 95% confidence interval (95% CI) 1.25-26.97; p=0.024) than patients with a normal red cell distribution width (<13%). CONCLUSION: We found that the pretreatment red cell distribution width was independently prognostic of disease free survival rate in patients with laryngeal cancer and may serve as a new, accurate, and reproducible means of identifying early-stage laryngeal cancer patients with poorer prognoses.

Comparison of Postoperative Smoking Cessation Rates of Patients with Benign or Premalignant Vocal Cord Lesions.

OBJECTIVES: It has been determined that cigarette is a risk factor for squamous cell carcinomas of the oral cavity, esophagus, and larynx. We aimed to investigate the role of histopathological diagnosis of the lesion in smoker patients with vocal cord lesion on smoking cessation rates and to determine strategies to help them quit smoking. METHODS: In this prospective clinical study, we included 182 (112 male, 70 female) smoker patients who underwent direct laryngoscopy and biopsy due to premalignant (dysplasia) or benign (polyp, leukoplasia, nodule) vocal cord lesions between July 2014 and December 2017 at our clinic. Smoking habits (ex-smoker, current smoker) of all smoker patients were questioned at least 6 months postoperatively, and postoperative smoking cessation rates were compared. RESULTS: When the smoking cessation rates of the patients with benign and premalignant vocal cord lesions were evaluated, the smoking cessation rate of the patients with premalignant vocal cord lesions was 3.45 times higher than that of the patients with benign vocal cord lesions (OR, 3.45; 95% CI, 1.76-6.74) (p<0.001). The postoperative application rate of the patients to smoking cessation outpatient clinics was low (6%). Male patients with premalignant lesions were more likely to quit smoking than female patients (p=0.001). CONCLUSION: Patients with premalignant vocal cord lesions had higher smoking cessation rates. Premalignant vocal cord lesions require clinical follow-up and treatment because of the risk and potential for their transformation into in situ or invasive laryngeal carcinomas.

Sudden hearing loss due to oxaliplatin use in a patient with colon cancer.

Oxaliplatin is used to treat advanced colorectal cancer. Platinum-containing chemotherapeutic agents are known to be ototoxic. However, ototoxicity is rare with newer generation platinum-derived agents, such as oxaliplatin. This case report presents a rare case of sudden unilateral sensorineural hearing loss following intravenous (IV) infusion of oxaliplatin in a 64-year-old woman with advanced colon cancer. The hearing loss was severe and did not respond to treatment. To the best of our knowledge, this is the fifth reported case of oxaliplatin ototoxicity. Although oxaliplatin ototoxicity is rare, physicians must be aware of this important adverse effect, and an audiometric evaluation must be performed when necessary. Patients treated with oxaliplatin should be followed closely for early signs and symptoms of hearing loss, and if hearing loss is detected, treatment should be stopped immediately.

Comparative Analysis of Lateral Pharyngoplasty and Uvulopalatopharyngoplasty Techniques With Polisomnography and Epworth Sleepiness Scales.

Snoring is caused by the vibration of structures of the oral cavity, such as the soft palate, uvula, tonsils, base of the tongue, epiglottis, and lateral pharyngeal walls. When these structures collapse and obstruct the airway, apnea occurs. Obstructive sleep apnea syndrome (OSAS) is characterized by repeated periods of upper airway obstruction, a decrease in arterial oxygen saturation, and interrupted sleep. The prevalence of OSAS is 1% to 5% in men and 1.2% to 2.5% in women. Crucial factors in deciding the surgical approach include a detailed ear-nose-throat examination, Muller maneuver, sleep endoscopy, and apnea hypopnea index scores. Accepted treatments include continuous positive airway pressure (CPAP), surgeries of the base of the tongue and/or palate, and multi-level surgeries. It, however, is important to continue to evaluate the efficacies of such procedures. The authors evaluated the outcomes of 23 patients who underwent surgery for OSAS, using preoperative and postoperative polysomnography (PSG) and the Epworth sleepiness scale (ESS). The results were compared before and after surgery. In all, 14 patients had lateral pharyngoplasty and 9 had uvulopalatopharyngoplasty (UPPP). The PSG and Epworth scale values were significantly lower in both groups, postoperatively. Patients indicated that their quality of life had improved. In conclusion, the surgeries were successful. In line with the literature, our results indicate that lateral pharyngoplasty and UPPP can be used in appropriate patients. Longer-term studies on more patients will provide more detailed information in the future.

Adenoid Vegetation in Children with Allergic Rhinitis.

OBJECTIVE: Pediatric patients with nasal obstruction due to adenoid vegetation (AV) can also encounter allergic rhinitis (AR) as a comorbidity. The aim of the study was to estimate the incidence of mite sensitization and its effect on adenoid size in children who underwent adenoidectomy. METHODS: This prospective randomized study conducted between August and September 2014 included 84 children. Skin Prick Test (SPT) for inhalant allergens was preoperatively applied to all children who underwent adenoidectomy for nasal obstruction. Children were divided into two study groups: AV only (Group I) (n=52) and AV with Dermatophagoides Pteronyssinus and/or D. farinae allergy (Group II) (n=32). Postoperative specimen volumes, visual analogue scale (VAS) scores, and adenoid volumes measured using flexible fiberoptic nasopharyngolaryngoscopy were compared between the two groups. RESULTS: Postoperative specimen volume measures were higher in Group II compared with those in Group I (p<0.05). Furthermore, in preoperative endoscopic examination, adenoid volume measures were higher in Group II compared with those in Group I (p<0.05). Pre and postoperative VAS scores in SPT+ group were higher in the Group II (p<0.05) than those in Group I. CONCLUSION: We observed that children with AR tend to have an early onset of symptoms of adenoid hypertrophy. We believe that focusing on the management of role of allergy regarding these early symptoms will reduce the need for surgery in a large number of cases. We suggest that SPT must be performed in all children with AV and adenoid examination should not be neglected in children with AR.