The variations of osseous structure of the internal acoustic canal: an anatomical study.

OBJECTIVES: The internal acoustic meatus is an osseous canal that connects the inner ear to the posterior cranial fossa. It is located in the petrous portion of the temporal bone. A thin cribriform osseous plate known as the fundus is situated at the lateral end of the canal. This study assesses the structural and numerical variations of the fundus formations. METHODS: Fifty-four temporal bones of unknown gender and age were examined with the surgical microscope. RESULTS: The temporal bones analyzed were 46.2% right-sided and 53.7% left-sided. Only one temporal bone had two parallel transverse crests, while three had a single anterior crest that split into two branches posteriorly. The number of foramina at the transverse crest varied, with 29.6% having none, 48.1% having a single foramen, and 22.2% having several foramina. An anterior crest structure was seen in 53.7% of the temporal bones, with 5% having a slightly constricted entry to the facial canal. In cases with a single nerve foramen, 48.1% had one, while 51.8% had more than one, including examples with three or four foramina. A crest was found between the foramina of the single nerve in 7% of patients. Furthermore, a crest between the saccular nerve foramen and the high fiber foramina was seen in 25.9% of cases, and 5% had two saccular nerve foramina. CONCLUSION: We think that revealing the anatomical, structural and numerical variations in the fundus will be useful in explaining the disease-symptom relationship. LEVEL OF EVIDENCE: Level 4.

Angles of Needle Insertion for True Vocal Fold Access Via the Thyrohyoid and Cricothyroid Membranes of the Larynx.

OBJECTIVE: This study aims to provide an analysis of the cricothyroid and thyrohyoid membrane approaches for laryngeal injections in cadaveric vocal cords. The primary objective is to determine the optimal techniques, needle trajectories, and anatomical landmarks for accessing different regions of the vocal cords percutaneously. MATERIALS AND METHODS: The study was conducted on 23 adult cadavers, consisting of 8 females and 15 males. The cadaveric larynges were mounted vertically to ensure proper anatomical positioning. Both the cricothyroid and thyrohyoid membrane approaches were utilized for reaching the vocal cords. Measurements were taken for needle trajectories, angles, and distances to determine the optimal approach for accessing the anterior, middle, and posterior thirds of the vocal cord. RESULTS: Through the thyrohyoid membrane approach, the anterior, middle, and posterior thirds of the vocal cords can be accessed with the optimal needle insertion coronal angles of 15.46 ± 7.86°, 16.52 ± 7.15° and 18.29 ± 14.46°, and sagittal angles of 126.01 ± 9.65°, 116.67 ± 8.04° and 111.02 ± 8.86° respectively at a lateral distance of 1.92 ± 1.62 mm from the midline and 8.48 ± 2.73 mm below the vertical line. From the cricothyroid membrane approach, optimal coronal and sagittal insertion angles of the anterior, middle, and posterior thirds of the vocal cord were respectively: 158.95 ± 9.3°, 156.09 ± 11.59°, 152.4 ± 14.46°, 11.5 ± 7.77°, 21.83 ± 12.47° and 32.91 ± 12.59°. CONCLUSION: This analysis of the cricothyroid and thyrohyoid membrane approaches in cadaveric larynges provides valuable insights for clinicians and researchers in the field of laryngology. The findings serve as a reference for optimizing laryngeal injection techniques, enhancing patient outcomes, and minimizing complications.

Betahistine add-on therapy for treatment of subjects with posterior benign paroxysmal positional vertigo: a randomized controlled trial / Terapia adjuvante de betaistina para o tratamento de indivíduos com vertigem posicional paroxística benigna posterior: um ensaio clínico randomizado

Abstract Introduction Benign paroxysmal positional vertigo is a common vestibular disorder that accounts for one fifth of hospital admissions due to vertigo, although it is commonly undiagnosed. Objective To evaluate the effects of betahistine add-on therapy in the treatment of subjects with posterior benign paroxysmal positional vertigo. Methods This randomized controlled study was conducted in a population of 100 subjects with posterior benign paroxysmal positional vertigo. Subjects were divided into the Epley maneuver + betahistine group (group A) and Epley maneuver only (group B) group. Subjects were evaluated before and 1-week after the maneuver using a visual analog scale and dizziness handicap inventory Results One hundred subjects completed the study protocol. The Epley maneuver had an overall success rate of 95% (96% in group A; 94% in group B, p= 0.024). Groups A and B had similar baseline visual analog scale scores (6.98 ± 2.133 and 6.27 ± 2.148, respectively, p= 0.100). After treatment, the visual analog scale score was significantly lower in both groups, and was significantly lower in group A than group B (0.74 ± 0.853 vs. 1.92 ± 1.288, respectively, p= 0.000). The change in visual analog scale score after treatment compared to baseline was also significantly greater in group A than group B (6.24 ± 2.01 vs. 4.34 ± 2.32, respectively, p= 0.000). The baseline dizziness handicap inventory values were also similar in groups A and B (55.60 ± 22.732 vs. 45.59 ± 17.049, respectively, p= 0.028). After treatment, they were significantly lower in both groups. The change in score after treatment compared to baseline was also significantly greater in group A than group B (52.44 ± 21.42 vs. 35.71 ± 13.51, respectively, p= 0.000). Conclusion The Epley maneuver is effective for treatment of benign paroxysmal positional vertigo. Betahistine add-on treatment in posterior benign paroxysmal positional vertigo resulted in improvements in both visual analog scale score and dizziness handicap inventory.

Resumo Introdução A vertigem posicional paroxística benigna é um distúrbio vestibular comum, responsável por um quinto das internações hospitalares por vertigem, embora seja comumente não diagnosticada. Objetivo Avaliar os efeitos da terapia adjuvante com betaistina no tratamento de indivíduos com vertigem posicional paroxística benigna posterior. Método Este estudo randomizado controlado foi feito em uma população de 100 indivíduos com vertigem posicional paroxística benigna posterior. Os indivíduos foram divididos nos grupos: manobra de Epley + betaistina (grupo A) e manobra de Epley apenas (grupo B). Os indivíduos foram avaliados antes e uma semana após a manobra por meio da escala visual analógica EVA e do questionário dizziness handicap inventory. Resultados Cem indivíduos completaram o protocolo do estudo. A manobra de Epley demonstrou uma taxa de sucesso global de 95% (96% no grupo A; 94% no grupo B, p = 0,024). Os grupos A e B tiveram escores basais semelhantes na EVA (6,98 ± 2,133 e 6,27 ± 2,148, respectivamente, p = 0,100). Após o tratamento, o escore na EVA foi significantemente menor em ambos os grupos e foi menor no grupo A do que no grupo B (0,74 ± 0,853 vs. 1,92 ± 1,288, respectivamente, p = 0,000). A mudança no escore da EVA após o tratamento em comparação com a linha basal também foi significativamente maior no grupo A do que no grupo B (6,24 ± 2,01 vs. 4,34 ± 2,32, respectivamente, p = 0,000). Os valores basais no dizziness handicap inventory também foram semelhantes nos grupos A e B (55,60 ± 22,732 vs. 45,59 ± 17,049, respectivamente, p = 0,028). Após o tratamento, eles foram significantemente menores em ambos os grupos. A mudança no escore após o tratamento em comparação com a linha basal também foi significantemente maior no grupo A do que no grupo B (52,44 ± 21,42 vs. 35,71 ± 13,51, respectivamente, p = 0,000). Conclusão A manobra de Epley é eficaz no tratamento da vertigem posicional paroxística benigna. O tratamento complementar com betaistina na vertigem posicional paroxística benigna posterior resultou em melhoria tanto no escore da EVA quanto no do dizziness handicap inventory.

Betahistine add-on therapy for treatment of subjects with posterior benign paroxysmal positional vertigo: a randomized controlled trial.

INTRODUCTION: Benign paroxysmal positional vertigo is a common vestibular disorder that accounts for one fifth of hospital admissions due to vertigo, although it is commonly undiagnosed. OBJECTIVE: To evaluate the effects of betahistine add-on therapy in the treatment of subjects with posterior benign paroxysmal positional vertigo. METHODS: This randomized controlled study was conducted in a population of 100 subjects with posterior benign paroxysmal positional vertigo. Subjects were divided into the Epley maneuver + betahistine group (group A) and Epley maneuver only (group B) group. Subjects were evaluated before and 1-week after the maneuver using a visual analog scale and dizziness handicap inventory RESULTS: One hundred subjects completed the study protocol. The Epley maneuver had an overall success rate of 95% (96% in group A; 94% in group B, p =  0.024). Groups A and B had similar baseline visual analog scale scores (6.98 ±â€¯2.133 and 6.27 ±â€¯2.148, respectively, p = 0.100). After treatment, the visual analog scale score was significantly lower in both groups, and was significantly lower in group A than group B (0.74 ±â€¯0.853 vs. 1.92 ±â€¯1.288, respectively, p = 0.000). The change in visual analog scale score after treatment compared to baseline was also significantly greater in group A than group B (6.24 ±â€¯2.01 vs. 4.34 ±â€¯2.32, respectively, p = 0.000). The baseline dizziness handicap inventory values were also similar in groups A and B (55.60 ±â€¯22.732 vs. 45.59 ±â€¯17.049, respectively, p = 0.028). After treatment, they were significantly lower in both groups. The change in score after treatment compared to baseline was also significantly greater in group A than group B (52.44 ±â€¯21.42 vs. 35.71 ±â€¯13.51, respectively, p = 0.000). CONCLUSION: The Epley maneuver is effective for treatment of benign paroxysmal positional vertigo. Betahistine add-on treatment in posterior benign paroxysmal positional vertigo resulted in improvements in both visual analog scale score and dizziness handicap inventory.

Olfactory Cleft Width and Volume: Possible Risk Factors for Postinfectious Olfactory Dysfunction.

OBJECTIVES/HYPOTHESIS: Upper respiratory tract infections are a common cause of temporary and permanent olfactory dysfunction in the general population. Postviral or postinfectious olfactory loss (PIOL) develops only in rare cases. The aim of this study was to investigate the anatomical features of olfactory cleft (OC) in patients with PIOL to shed light on possible predisposing factors for PIOL. STUDY DESIGN: Retrospective study. METHODS: We retrospectively evaluated paranasal sinus computed tomography (CT) scan results of patients diagnosed with PIOL. A control group consisted of normosmic individuals who underwent paranasal sinus CT scans before septoplasty surgery. We compared the olfactory fossa depth, OC width, and volume on the CT scans of the PIOL and control groups. RESULTS: In total, 71 individuals fulfilled the study criteria (PIOL group, n = 32; control group, n = 39). There was no statistically significant difference in the olfactory fossa depth in the two groups. The OC width and volume in the PIOL group was found to be significantly increased than that in the control group (P < .001 for both). CONCLUSIONS: Patients with PIOL had increased OC width and volume than the healthy controls. An extra-wide olfactory cleft may be a predisposing factor in the pathogenesis of PIOL. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:5-9, 2021.

The temporal course of COVID-19 anosmia and relation to other clinical symptoms.

OBJECTIVE: This study aimed to define the clinical course of anosmia in relation to other clinical symptoms. METHODS: 135 patients with COVID-19 were reached by phone and subsequently included in the study. Olfactory functions were evaluated using a questionnaire for assessment of self-reported olfactory function. Patients were divided into four subgroups according to the presence of olfactory symptoms and temporal relationship with the other symptoms: group1 had only olfactory complaints (isolated, sudden-onset loss of smell); group2 had sudden-onset loss of smell, followed by COVID-19 related complaints; group3 initially had COVID-19 related complaints, then gradually developed olfactory complaints; and group4 had no olfactory complaints. RESULTS: In total, 59.3% of the patients interviewed had olfactory complaints during the disease course. The olfactory dysfunction severity during COVID-19 infection was significantly higher in group1 compared to groups 2 and 3. In groups1-3, the odor scores after recovery from COVID-19 disease were significantly lower compared to the status prior to disease onset. The residual olfactory dysfunction was similar between groups1 and 2, but was more evident than group3. Mean duration for loss of smell was 7.8 ± 3.1 (2-15) days. Duration of loss of smell was longer in groups1 and 2 than in group3. Odor scores completely returned back to the pre-disease values in 41 (51.2%) patients with olfactory dysfunction. Rate of complete olfactory dysfunction recovery was higher in group3 compared to groups1 and 2. CONCLUSION: In isolated anosmia cases, anosmia is more severe, and complete recovery rates are lower compared to the patients who have other clinical symptoms. LEVEL OF EVIDENCE: Level 4.

Middle ear osteoma causing Eustachian tube obstruction: A case report and literature review.

Middle ear osteoma is an extremely rare benign tumor of the middle ear. Due to its very slow growth rate and benign nature, osteoma of the middle ear can be found incidentally without causing any symptoms. The most common clinical signs are conductive hearing loss, the sense of fullness in the ear, tinnitus, and otorrhea. Small-sized osteomas can be misdiagnosed as otosclerosis without showing any signs other than conductive hearing loss. When the mass becomes very large, and symptoms caused by the tumor increase, treatment also becomes difficult. In this paper, we report a case of middle ear osteoma causing conductive hearing loss and effusion due to the effect of pressure on the middle ear ossicles and the Eustachian tube. We also present a review of the pertinent literature.

Ear nose throat-related symptoms with a focus on loss of smell and/or taste in COVID-19 patients.

PURPOSE: To determine the frequency and severity of general and ear nose throat (ENT)- related symptoms, especially smell and/or loss of sense of taste (STL) in COVID-19 disease, as well as to investigate the recovery process of STL. MATERIALS AND METHODS: Patients with a positive COVID-19 diagnosis were given a questionnaire consisting of general questions (age, sex, date of symptoms, smoking history, concomitant diseases), questions about the most obvious symptom at presentation (one option only), the severity and frequency of symptoms (general and ENT), and STL (recovery time and degree of recovery). RESULTS: The study population consisted of 172 patients, 18-65 years old (mean age, 37.8 ± 12.5 years; 51.2% female; 76.2% nonsmokers). Cough (n = 30, 17.4%) and loss of sense of smell (n = 18, 10.4%) were the most obvious general and ENT symptoms, respectively. Eighty-eight patients (51.2%) reported loss of sense of smell, and 81 patients (47.1%) reported loss of sense of taste. The mean recovery times for loss of sense of smell and loss of sense of taste were 8.02 ± 6.41 and 8.20 ± 7.07 days, respectively. The loss of sense of smell and loss of sense of taste were the unique symptoms in four (4.54%) and one (1.23%) patients, respectively. CONCLUSION: STL is a common symptom in COVID-19 and may be the first and/or only symptom of this disease. In patients presenting with STL complaints, surveillance for possible COVID-19 disease and screening tests will facilitate the struggle against the disease.

Effects of Peripheral Vertigo on Inflammatory and Immunologic Laboratory Markers.

The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) are markers of subclinical inflammation and atherothrombosis. We investigated whether these easily accessible blood count parameters are affected by peripheral vertigo (PV). We studied 142 patients who were diagnosed with PV and referred to our hospital along with 135 healthy patients who were free of inflammation as a control group. The patient group was divided into 3 study groups depending on the presence of benign paroxysmal positional vertigo (BPPV): BPPV, vestibular dysfunction (VD), and BPPV + VD. The total patient group and 3 subgroups were compared to the control group with respect to the NLR, PLR, and MPV. The NLR and PLR were calculated by dividing the neutrophil and platelet values by the lymphocyte value. Of 142 patients, 43, 71, and 28 patients comprised the BPPV, VD, and BPPV + VD groups, respectively. There was no statistically significant difference (P > .05) in the NLR, PLR, or MPV between the main patient group or the individual patient subgroups and the control group. Our findings suggest that NLR, PLR, and MPV do not change significantly either in BPPV or in other peripheral vestibular disorders.

The Ignored Parameter in the Diagnosis of Obstructive Sleep Apnea Syndrome: The Oxygen Desaturation Index.

OBJECTIVE: The apnea-hypopnea index (AHI) does not provide information about the apnea depth and length. We aimed to evaluate the correlation of the oxygen desaturation index (ODI) with AHI and the subjective symptoms because it is known that hypoxia plays an important role in morbidity and complications of obstructive sleep apnea syndrome (OSAS). METHODS: We reviewed the data of patients who applied to our clinic between 2010 and 2014 and underwent polysomnography (PSG) with a diagnosis of suspected sleep apnea. The demographic and anthropometric data of the patients were recorded. Epworth sleepiness scale (ESS) and values of AHI and ODI were analyzed in PSG. RESULTS: A total of 321 patients were divided into four groups, according to AHI as follows: 82 (25.5%) common snoring, 77 (24%) mild obstructive sleep apnea (OSA), 71 (22.1%) moderate OSA, and 91 (28.3%) severe OSA. A strong correlation was detected between AHI and ODI (p<0.005 and r=0.904) in all patient groups. There was a positive correlation between AHI and ESS (p<0.05 and r=0.435), but the correlation of ESS with ODI was stronger than that with AHI (p<0.05 and r=0.504). CONCLUSION: The subjective symptoms of sleep apnea syndrome seem to be closely related to oxygen desaturations. Hypoxia during apnea periods of OSA is important; therefore, we suggest that ODI is as valuable as AHI in diagnosing and grading the OSAS.

Castelman disease of the parotid gland: An unusual entity.

Castleman disease (CD) is a benign lymphoepithelial disorder characterised by abnormal growth of a lymph node. This disease may be seen anywhere along the lymphatic chain but it usually occurs in the mediastinum. Two clinical types (localised and generalised) and three histopathological types (hyaline vascular, plasma cell, and mixed) have been described. We present a case of a 35-year-old female patient with parotid CD of the hyaline-vascular type as an extremely rare entity. We also discuss recent updates on this disease.