Is the superior laryngeal nerve really safe when using harmonic focus in total thyroidectomy? A prospective randomized study.

BACKGROUND: Harmonic focus (HF) was introduced in thyroid surgery in an effort to reduce operation time and complications. OBJECTIVE: The present study aimed to compare function of superior laryngeal nerve and incidence of other postoperative complications in total thyroidectomies using HF and conventional ligation (CL). METHODS: The trial is a randomized single-center, single-blinded study. Patients aged ≥ 18 years scheduled for total thyroidectomy were considered for participation. An ultrasonic dissector was used for coagulation and cutting in the HF group, while the standard technique was used in the CL group. Demographic, surgical data, and complications were recorded. Data were analyzed using SPSS for Windows. RESULTS: Of 244 eligible patients, data of 206 patients who completed the study were analyzed. The groups were similar in terms of age, sex, and indication for operation. The mean operative time in the HF group was significantly shorter than that in CL group (p=0.01). Drain necessity, duration of drainage, duration of postoperative hospitalization, and the incidence of postoperative complications was similar in the groups (p>0.05). The external branch of the superior laryngeal nerve and recurrent laryngeal nerve palsy were noted in three and two patients in the HF group and in two and one patients in the CL group at 6 months. CONCLUSION: To the best of our knowledge, this is the first study comparing conventional technique with HF in total thyroidectomy, focusing on the function of the external branch of the superior laryngeal nerve using laryngostroboscopy; results showed that HF is as safe as the conventional technique.

The role of Onodi cells in sphenoiditis: results of multiplanar reconstruction of computed tomography scanning / Papel das células de Onodi na esfenoidite: resultados da tomografia computadorizada com reconstrução multiplanar

Abstract Introduction Onodi cells are the most posterior ethmoid air cells and extend superolateral to the sphenoid sinus. These cells are also intimately related with the sphenoid sinus, optic nerve, and carotid artery. Radiologic evaluation is mandatory to assess for anatomic variations before any treatment modalities related to the sphenoid sinus. Objective To evaluate the effect of Onodi cells on the frequency of sphenoiditis. Methods A retrospective analysis was performed in 618 adult patients who underwent high-resolution computed tomography between January 2013 and January 2015. The prevalence of Onodi cells and sphenoiditis was evaluated. Whether the presence of Onodi cells leads to an increase in the prevalence of sphenoiditis was investigated. Results Onodi cell positivity was observed in 326 of 618 patients and its prevalence was found to be 52.7%. In the study group, 60.3% (n = 73) were ipsilaterally (n = 21) or bilaterally (n = 52) Onodi-positive, whereas 39.7% (n = 48) were Onodi-negative (n = 35) or only contralaterally Onodi-positive (n = 13). Of the control group, 48.3% (n = 240) were Onodi-positive and 51.7% (n = 257) were Onodi negative. The co-existence of Onodi cells ipsilaterally was observed to increase the identification of sphenoiditis 1.5-fold, and this finding was statistically significant (p < 0.05). Conclusion The prevalence of sphenoiditis appears to be higher in patients with Onodi cells. However, it is not possible to state that Onodi cells are the single factor that causes this disease. Further studies are needed to investigate contributing factors related to sphenoiditis.

Resumo Introdução As células de Onodi são as células etmoidais mais posteriores, que se prolongam superolateralmente ao seio esfenoidal. Essas células também se encontram em íntima relação com o seio esfenoidal, o nervo óptico e a artéria carótida. Para análise de variações anatômicas antes da implantação de qualquer modalidade terapêutica relacionada ao seio esfenoidal, a avaliação radiológica é obrigatória, Objetivo Nosso objetivo foi avaliar o papel das células de Onodi na frequência de esfenoidite. Método Em nosso estudo, foi feita uma análise retrospectiva em 618 pacientes adultos que se submeteram à tomografia computadorizada de alta resolução entre janeiro de 2013 e janeiro de 2015. Avaliamos a prevalência de células de Onodi e de esfenoidite. Investigamos se a presença de células de Onodi leva a um aumento na prevalência de esfenoidite. Resultados A positividade para células de Onodi foi observada em 326 de 618 pacientes e sua prevalência foi de 52,7%. No grupo de estudo, 60,3% (n = 73) eram CO-positivas: ipsilateral (n = 21) ou bilateralmente (n = 52); e 39,7% (n = 48) eram CO-negativas (n = 35) ou apenas contralateralmente CO-positivas (n = 13). No grupo de controle, 48,3% (n = 240) eram CO-positivas; e 51,7% (n = 257) eram CO-negativas. Observamos que a coexistência de CO ipsilateralmente aumentava em 1,5 vez a associação com esfenoidite e esse achado foi estatisticamente significante (p < 0,05). Conclusão A prevalência de esfenoidite parece ser maior em pacientes com células de Onodi, mas não é possível afirmar que elas são isoladamente o fator causador dessa doença. Novos estudos precisam ser feitos para uma investigação dos fatores contributivos relacionados à esfenoidite.

The role of Onodi cells in sphenoiditis: results of multiplanar reconstruction of computed tomography scanning.

INTRODUCTION: Onodi cells are the most posterior ethmoid air cells and extend superolateral to the sphenoid sinus. These cells are also intimately related with the sphenoid sinus, optic nerve, and carotid artery. Radiologic evaluation is mandatory to assess for anatomic variations before any treatment modalities related to the sphenoid sinus. OBJECTIVE: To evaluate the effect of Onodi cells on the frequency of sphenoiditis. METHODS: A retrospective analysis was performed in 618 adult patients who underwent high-resolution computed tomography between January 2013 and January 2015. The prevalence of Onodi cells and sphenoiditis was evaluated. Whether the presence of Onodi cells leads to an increase in the prevalence of sphenoiditis was investigated. RESULTS: Onodi cell positivity was observed in 326 of 618 patients and its prevalence was found to be 52.7%. In the study group, 60.3% (n=73) were ipsilaterally (n=21) or bilaterally (n=52) Onodi-positive, whereas 39.7% (n=48) were Onodi-negative (n=35) or only contralaterally Onodi-positive (n=13). Of the control group, 48.3% (n=240) were Onodi-positive and 51.7% (n=257) were Onodi negative. The co-existence of Onodi cells ipsilaterally was observed to increase the identification of sphenoiditis 1.5-fold, and this finding was statistically significant (p<0.05). CONCLUSION: The prevalence of sphenoiditis appears to be higher in patients with Onodi cells. However, it is not possible to state that Onodi cells are the single factor that causes this disease. Further studies are needed to investigate contributing factors related to sphenoiditis.

Large Frontoorbital Osteoma Causing Ptosis.

Osteomas are the most frequent benign tumor of the paranasal sinuses. The commonest site is the frontal sinus but intraorbital extension of frontal osteoma is rare. Here, the authors report a 15-year-old adolescent boy who presented with left superior orbital rim swelling and ptosis. Waters radiography and computed tomographic scan revealed a bone density mass in the left frontal sinus with upper orbital wall extension. The tumor was removed via open eyebrow incision. The histopathologic evaluation was consistent with osteoma.

The role of the mean platelet volume and neutrophil-to-lymphocyte ratio in peritonsillar abscesses / O papel do volume plaquetário médio e a relação neutrófilos/linfócitos em abscesso periamigdaliano

Abstract Introduction: Peritonsillar abscess is a serious infectious disease of the tonsillar tissue. Treatment generally requires both medical and surgical approaches to relieve the symptoms. Recently, in addition to clinical follow-up, some inflammatory markers, such as the mean platelet volume and neutrophil-to-lymphocyte ratio, have been considered to be additional inflammatory monitoring markers in inflammatory diseases. Objective: The aim of this study was to describe the role of mean platelet volume and neutrophil-to-lymphocyte ratio in patients with peritonsillar abscess. Methods: A retrospective study was conducted in 88 patients with peritonsillar abscess and 88 healthy individuals. We analyzed the white blood cell count, neutrophil count, lymphocyte count, platelet count, C-reactive protein, mean platelet volume and neutrophil-to-lymphocyte ratio values and compared them among the patient and control groups. Results: The mean platelet volume levels were significantly higher in the peritonsillar abscess pretreatment group than in the peritonsillar abscess posttreatment group and the control group. A mean platelet volume value of 8.7 was the optimal cut-off value for evaluating the sensitivity, specificity, positive predictive value and negative predictive value of 75%, 65.9%, 68% and 72%, respectively. The neutrophil-to-lymphocyte ratio levels were significantly higher in the peritonsillar abscess pretreatment group than in the peritonsillar abscess post-treatment group and the control group. A neutrophil-to-lymphocyte ratio value of 3.08 was the optimal cut-off value for evaluating the sensitivity, specificity, positive predictive value and negative predictive value of 90.9%, 90.9%, 90.9% and 90.9%, respectively. While the white blood cell count, neutrophil count, lymphocyte count and C-reactive protein values were significantly different among the patient and control groups (p < 0.05), the platelet count was not significantly different among the patient and control groups (p > 0.05). Conclusion: The mean platelet volume and neutrophil-to-lymphocyte ratio values made us think that these parameters were quick, inexpensive and reliable inflammatory follow-up parameters and could be easily integrated into daily practice for peritonsillar abscess treatment except platelet count.

Resumo Introdução: O abscesso periamigdaliano (APA) é uma doença infecciosa grave do tecido tonsilar. O seu tratamento geralmente requer uma abordagem medicamentosa e cirúrgica para o alívio dos sintomas. Recentemente, além do acompanhamento clínico, alguns marcadores inflamatórios, como o volume plaquetário médio (VPM) e a relação neutrófilos/linfócitos (RN/L), foram considerados marcadores de monitoramento adicionais em doenças inflamatórias. Objetivo: O objetivo deste estudo foi descrever o papel os VPM e a RN/L em pacientes com APA. Método: Estudo retrospectivo realizado com 88 pacientes com ATP e 88 indivíduos saudáveis. Analisamos a contagem de leucócitos, neutrófilos, linfócitos, plaquetas, proteína C-reativa (PCR), VPM e RN/L e a comparamos os valores entre o grupo de pacientes e grupo controle. Resultados: Os níveis de VPM eram significativamente maiores no grupo APA pré-tratamento que no grupo APA pós-tratamento e no grupo controle. Um valor de corte de 8,7 para o VPM foi considerado ideal para avaliar sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de 75, 65,9, 68 e 72%, respectivamente. Os níveis da RN/L eram significantemente maiores no grupo APA pré-tratamento que no grupo APA pós-tratamento e no grupo controle. Um valor de 3,08 para a RN/L foi o valor de corte ideal para avaliar sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de 90,9, 90,9, 90,9 e 90,9%, respectivamente. Enquanto a contagem dos valores de leucócitos, neutrófilos, linfócitos e PCR foi significantemente diferente entre os grupos de pacientes e controle (p<0,05), a contagem de plaquetas não foi (p>0,05). Conclusão: Os valores de VPM e RN/L sugerem que estes são parâmetros inflamatórios de acompanhamento rápido, barato e confiável, e que podem ser facilmente integrados à prática diária para o tratamento de APA, exceto pela contagem de plaquetas.

Pediatric Type 1 Cartilage Tympanoplasty: Comparison between Graft Success Rates and Hearing Results in Adults.

OBJECTIVE: It is an ongoing debate whether tympanoplasty should be performed in the pediatric age group. The purpose of this study was to analyze and compare the anatomical and functional outcomes of type I cartilage tympanoplasty in children and adults. MATERIALS AND METHODS: The file records of patients who underwent type 1 cartilage tympanoplasty were retrospectively reviewed. In total, 133 patients who underwent type 1 tympanoplasty for chronic otitis media were included. Tragal cartilage grafts were used in all patients. The patients were divided into two groups: pediatric (age≤16 years, n=54) and adult (age>18 years, n=79) groups. The graft success rates and hearing results between the two groups were compared. RESULTS: The graft success rate was 90.2% (120/133) in the study group. At the end of the 24-month follow-up, the graft was intact in 48 of the 54 (88.9%) patients in the pediatric group and 72 of the 79 patients in the adult group (91.1%) (p=0.769). The functional success rate (postoperative air-bone gap<20 dB) obtained in the study group was 90.2% (120/133). The functional success rate was 88.9% (48/54) in the pediatric group and 91.1% (72/79) in the adult group (p=0.255). CONCLUSION: The graft success rates and hearing results obtained with cartilage grafts are similar in children and adults. Therefore, cartilage grafts may be safely used in pediatric patients, similar to their use in adults.

A comparative study of transcanalicular diode laser supported endoscopic dacryocystorhinostomy and non-laser endoscopic dacryocystorhinostomy.

OBJECTIVE: The primary surgical procedure for nasolacrimal duct obstruction is dacryocystorhinostomy (DCR). The purpose of this study was to compare non-laser endoscopic dacryocystorhinostomy (NL-EnDCR) and transcanalicular diode laser-supported endoscopic dacryocystorhinostomy (TDLS-EnDCR). MATERIALS AND METHOD: The data of patients who underwent DCR with the diagnosis of epiphora and chronic dacryocystitis between the years 2010 and 2016 were examined retrospectively. The patients who underwent NL-EnDCR and TDLS-EnDCR were included in the study. Success of the procedure was defined as the complete disappearance of epiphora, and lack of anatomical occlusions with lacrimal serum irrigation. RESULTS: 74 patients who met the study criteria were included in the study. 39 patients (21 males and 18 females) who underwent TDLS-EnDCR were assigned as Group 1, and their mean age was 46 (33-64). 35 patients (18 males and 17 females) who underwent NL-EnDCR were assigned as Group 2, and their mean age was 48 (24-81). In the postoperative follow-ups, no watering of the eyes was demonstrated in 34 (87.2%) out of 39 patients in Group 1 (TDLS-EnDCR), and 22 (62.9%) out of 35 patients in Group 2 (NL-EnDCR), and that the newly formed ostium was clear with serum irrigations. A statistically significant difference in success rate was observed between the two groups (p=0.028). CONCLUSIONS: The TDLS-EnDCR procedure was more successful than NL-EnDCR with respect to the outcomes assigned. Use of transcanalicular diode laser in endoscopic DCR may increase the success of endoscopic DCR.

Sudden Pediatric Hearing Loss: Comparing the Results of Combined Treatment (Intratympanic Dexamethasone and Systemic Steroids) With Systemic Steroid Treatment Alone.

OBJECTIVE: The aim of the present study was to compare hearing improvements obtained with combined intratympanic and systemic steroid therapy, and systemic steroid therapy alone in pediatric patients with idiopathic sudden sensorineural hearing loss (SSHL). STUDY DESIGN: Retrospective. SETTING: Tertiary referral hospital. PATIENTS: Pediatric patients with SSHL. INTERVENTIONS: The patients were divided into two groups, based on the method of steroid administration: Group 1 (systemic therapy group, n = 23) was treated with oral methylprednisolone alone whereas Group 2 (combination therapy group, n = 26) was treated with combination of oral methylprednisolone and intratympanic dexamethasone injections. MAIN OUTCOME MEASURES: Pre- and post-treatment audiograms were compared with pure-tone averages (PTAs) in each group. Two treatment groups were also compared. The final hearing assessment was performed 4 weeks after completion of the treatment. RESULTS: The mean PTAs before and after the treatment were 61.86 ±â€Š23.99 and 42.65 ±â€Š32.69 dB in Group 1 (p = 0.001), and 70.07 ±â€Š29.74 and 38.85 ±â€Š32.28 dB in Group 2 (p = 0.001). Pure-tone gain was 20.00 ±â€Š15.02 dB in Group 1, and 31.69 ±â€Š28.29 dB in Group 2. Comparison of two groups for post-treatment PTA and pure-tone gains did not yield any statistically significant differences (p = 0.388 and p = 0.132, respectively). CONCLUSION: Significant hearing improvement may be obtained with use of systemic steroids alone, or simultaneous administration of systemic and intratympanic steroids in pediatric patients with SSHL. Although we did not have a control group, two treatment options appear to offer similar hearing improvements in the pediatric age group higher than the rates obtained with placebo when previous studies in the literature are taken into account.

The role of the mean platelet volume and neutrophil-to-lymphocyte ratio in peritonsillar abscesses.

INTRODUCTION: Peritonsillar abscess is a serious infectious disease of the tonsillar tissue. Treatment generally requires both medical and surgical approaches to relieve the symptoms. Recently, in addition to clinical follow-up, some inflammatory markers, such as the mean platelet volume and neutrophil-to-lymphocyte ratio, have been considered to be additional inflammatory monitoring markers in inflammatory diseases. OBJECTIVE: The aim of this study was to describe the role of mean platelet volume and neutrophil-to-lymphocyte ratio in patients with peritonsillar abscess. METHODS: A retrospective study was conducted in 88 patients with peritonsillar abscess and 88 healthy individuals. We analyzed the white blood cell count, neutrophil count, lymphocyte count, platelet count, C-reactive protein, mean platelet volume and neutrophil-to-lymphocyte ratio values and compared them among the patient and control groups. RESULTS: The mean platelet volume levels were significantly higher in the peritonsillar abscess pretreatment group than in the peritonsillar abscess posttreatment group and the control group. A mean platelet volume value of 8.7 was the optimal cut-off value for evaluating the sensitivity, specificity, positive predictive value and negative predictive value of 75%, 65.9%, 68% and 72%, respectively. The neutrophil-to-lymphocyte ratio levels were significantly higher in the peritonsillar abscess pretreatment group than in the peritonsillar abscess post-treatment group and the control group. A neutrophil-to-lymphocyte ratio value of 3.08 was the optimal cut-off value for evaluating the sensitivity, specificity, positive predictive value and negative predictive value of 90.9%, 90.9%, 90.9% and 90.9%, respectively. While the white blood cell count, neutrophil count, lymphocyte count and C-reactive protein values were significantly different among the patient and control groups (p<0.05), the platelet count was not significantly different among the patient and control groups (p>0.05). CONCLUSION: The mean platelet volume and neutrophil-to-lymphocyte ratio values made us think that these parameters were quick, inexpensive and reliable inflammatory follow-up parameters and could be easily integrated into daily practice for peritonsillar abscess treatment except platelet count.

An Asymptomatic Foreign Body in the Nose in an Eighteen-Year-Old Patient: Button Battery.

Foreign bodies lodged in the upper airway are a common occurrence in children. Many unusual foreign bodies in the nose have been reported as foreign bodies like nuts, plastic toy parts, beads, and so forth. Most of these produce minimal morbidity but button batteries due to their early chemical disintegration require early surgical intervention. Here, we report a case of button battery lodged in the nose for several years with a symptom of nasal obstruction and chronic sinusitis.

Sudden sensorineural hearing loss: Is antiviral treatment really necessary?

OBJECTIVES: It was aimed to investigate the necessity of antiviral agents in the ISSHL treatment. METHODS: In this study, the patients, diagnosed with sudden hearing loss and admitted in the first 7 days of hearing loss were divided into two groups; a combination therapy was administered to one of the groups, and famciclovir was administered to the other group as an antiviral treatment in addition to the combined therapy. Both groups were compared in terms of levels of recovery. RESULTS: No statistically significant difference was found in the recovery rates between the two groups (p=0.7). CONCLUSION: In this study, the additional antiviral treatment was found to have no effect on the remission rates in patients with ISSHL treated with combined therapy.

A Rare Cause of Acute Respiratory Distress: Cervical Ranula.

Plunging or cervical ranula is a mucus extravasation pseudocyst arising from the sublingual gland that is located below the mylohyoid muscle. Clinically, if large enough, cervical ranulas can affect swallowing, speech, chewing, and even breathing. The acute presentation of ranulas, which are clinically known as slow-growing, painless masses, is rare. In this study, we present a case of cervical ranula that grew in a short period of 3 days and resulted in respiratory distress and that was operated in our clinic.

Effectiveness of radiofrequency cryptolysis for the treatment of halitosis due to caseums.

OBJECTIVE: To evaluate the effectiveness of radiofrequency (RF) cryptolysis for caseum-induced halitosis. STUDY DESIGN: Clinical retrospective study. SETTING: Otorhinolaryngology Head and Neck Surgery Department of Konya Training and Research Hospital in Turkey. SUBJECTS AND METHODS: Thirty-four patients with caseum-induced halitosis were included. Eight were male (23.5%) and 26 were female (76.5%). Their mean age was 28.29 ± 9.3 (range: 17-48) years. The mean duration of complaint of halitosis before RF cryptolysis was 53.41 ± 42.6 months (range: 6-182 months). The Finkelstein test, organoleptic measurements, and visual analog scale (VAS) were performed before and 12 months after RF cryptolysis. RESULTS: Before RF cryptolysis, all patients had a positive Finkelstein's test result, organoleptic measurements revealed that three (8.82%) had serious halitosis, 24 (70.58%) had average halitosis, and seven (20.58%) had mild halitosis, and the mean VAS score was 6.82 ± 1.45. The follow-up period after RF cryptolysis was 12 months. After the single RF cryptolysis session, 26 patients (76.47%) were negative for Finkelstein's test, organoleptic assessments revealed that 26 (76.47%), six (17.64%), and two (5.88%) showed complete, partial, and no recovery, respectively, (p<0.001), and the mean VAS score was significantly better at 1.88 ± 2.5 (p<0.001). Thirty-two patients (94.1%) exhibited a decrease in VAS score. CONCLUSION: RF cryptolysis is a cost-effective, safe, and easily applicable modality for the treatment of halitosis due to caseums in the crypts of the palatine tonsils.