Effect of applying head-shaking maneuver before Epley maneuver in BPPV.

INTRODUCTION: The Epley maneuver is applied in the treatment of benign paroxysmal positional vertigo, the BPPV. However, dizziness and balance problems do not improve immediately after the treatment. OBJECTIVE: In this study, the effectiveness of the head-shaking maneuver before the Epley maneuver was investigated in the treatment of BPPV. METHODS: Between March 2020 and August 2020, ninety-six patients with posterior semicircular canal BPPV were analyzed prospectively. The patients were divided into two groups: patients who underwent the Epley maneuver only in the treatment (Group 1) and patients who underwent the Epley maneuver after the head-shaking maneuver (Group 2). The results of the Berg balance scale and dizziness handicap index were evaluated before the treatment and at the first week after the treatment. RESULTS: The improvement in functional, emotional, and physical dizziness handicap index and Berg balance scale values after the treatment was found to be statistically significant in both groups. It was determined that the change in functional and physical dizziness handicap index and Berg balance scale values of the patients in Group 2 was statistically higher than those in Group 1. Although, the change in emotional dizziness handicap index values in Group 2 was higher than those in Group 1, no statistical significance was found between the groups. CONCLUSION: As a result of our hypothesis, we think that in the treatment of posterior semicircular canal BPPV, the otoliths adhered to the canal can be mobilized by the head-shaking maneuver, and this will contribute to the increase of the effectiveness of the Epley maneuver.

Longitudinal perioperative pain, neuromusculoskeletal complications and quality-of-life assessment in partial parotidectomy.

AIM: The aim of this study was to evaluate the pain, neuromusculoskeletal complications, and quality of life (QoL) in patients who had undergone partial parotidectomy (PP) for benign parotid tumors. PATIENTS AND METHODS: All patients were evaluated before (T0) and at 1 week (T1) and 1 month (T2) after surgery. The patients were assessed for cervical range of motion (ROM), neck pain (NRS), neuropathic pain (DN4), neck disability (NDI), facial disability (FDI), and the presence of facial neuropathy, and QoL. RESULTS: Twenty patients were included. A slight decrease was noted in cervical ROM, mild neck pain and disability were seen in T1. The DN4 score markedly increased at T1 (4.25) compared to T0 (0.1). Then it declined to 1.95 at T2. While there was no neuropathy in any of the patients at T0, it was present in 3 patients at T1. However, all improved at T2. QoL was negatively affected at T1 but showed improvement at T2. There was a significant correlation between NRS and NDI, FDI. CONCLUSION: Neuromusculoskeletal problems and impaired QoL may develop in patients who have undergone PP. It would be beneficial to evaluate these patients using a multidisciplinary approach and inform them before surgery.

Assessment of Smell and Taste Disorders in COVID-19: A Cross-sectional Study.

BACKGROUND: It has been reported worldwide that patients with a diagnosis of COVID-19 usually suffer a loss of smell and taste. In this study, we aimed to evaluate the relationship between the severity of the disease and the loss of smell and taste. In addition, we evaluated patients' smell and taste functions after recovery. METHODS: Between March and May 2020, 418 patients diagnosed with COVID-19 were divided into 3 groups: home-quarantined, hospitalized, and intensive care patients. The disease, smell, and taste functions of patients were evaluated with visual analog scores before diagnosis of COVID-19, during the disease, and fourth week after recovery. The types of smell loss and types of taste flavor loss occurring during the disease were questioned. RESULTS: In all 3 groups, changes in smell and taste loss during the disease were statistically detected (P = 0.001). The smell loss rates determined in groups 1 to 3 were 45%, 43.7%, and 31.2%, respectively. The taste loss rates determined in groups 1 to 3were 46.6%, 32.1%, and 31.2% respectively. The rate of patients with a total recovery of smell loss in groups 1 to 3 were 95.5%, 93.7%, and 100%, respectively (P = 0.768). The rate of patients with a total recovery of taste loss in groups 1 to 3 were 97.1%, 91.4%, and 100%, respectively (P = 0.423). CONCLUSION: COVID-19 causes significant loss of smell and taste in patients. The loss of smell and taste does not correlate with the severity of COVID-19 disease. The loss of smell and taste improves at a high rate after the disease.

Relationship between local and systemic inflammatory response and prognosis in laryngeal squamous cell carcinoma.

OBJECTIVE: Laryngeal squamous cell carcinoma (LSCC) is the most frequently seen head and neck malignancy. Despite improvements in the treatment modalities within the last 20 years, the desired improvement in survival outcomes has not been achieved yet which led researchers to investigate factors that might affect prognosis in LSCCs. METHODS: A total of 116 previously operated patients were included in this study. To assess systemic inflammation, neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were calculated. The cut-off values for NLR and PLR were accepted as 2.79 and 112, respectively. To evaluate intratumoral inflammation, hematoxylin-eosin stained tumor sections were evaluated. Tumor-infiltrating lymphocyte (TIL) densities in the tumor area were scored as 1+, 2+ and 3+. RESULTS: The mean overall survival was 29.5±17.7 months. In univariate analysis, a statistically significant correlation was seen between age group of 60 years, tumor stage, site and OS (p=0.025, p=0.026, p=0.029). There was no statistically significant relationship between PLR, NLR and TIL density and OS. In the multivariate analysis, the 60-year-old group and tumour stage were still significantly associated with the OS (p=0.033, p=0.046). CONCLUSION: Age and tumor stage were significantly associated with survival in our study, but contrary to the literature, no correlation was found between local and systemic inflammatory response.

Is serum bilirubin level a predictor factor in parotid gland carcinoma?

INTRODUCTION: Bilirubin levels have been associated with risk of several malignancies. The association between pretreatment serum bilirubin levels and overall survival of patients with parotid gland carcinoma is unclear. OBJECTIVES: In this study, we assessed the effect of serum bilirubin levels to overall survival in malignant parotid tumors. METHODS: This study included a total of 35 patients, 15 female and 20 male. The mean age of these patients was 60.7±14.5 years. All patients who were diagnosed with parotid gland carcinoma and underwent total parotidectomy between 2008 and 2018, were retrospectively assessed. The relationship between the overall survival of patients and total bilirubin, direct bilirubin, and indirect bilirubin levels was estimated. The receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off points. RESULTS: Patients with low direct bilirubin, total bilirubin and indirect bilirubin had significantly longer overall survival than those with high levels. Cut-off values for total bilirubin, direct bilirubin and indirect bilirubin were detected as 0.545mg/dL, 0.175mg/dL and 0.435mg/dL, respectively. CONCLUSION: In our study, we observed that increased preoperative bilirubin levels are associated with reduced survival time in the postoperative period of patients with parotid gland carcinoma.

The Effect of Extranodal Extension on Survival in Laryngeal Carcinoma.

It is known that lymph node metastasis lowers the survival rates in laryngeal carcinoma. This study aimed to investigate the effect of extranodal extension in lymph node metastasis on survival. The demographic characteristics and histopathologic results of 81 patients who underwent total laryngectomy and neck dissection due to advanced larynx squamous cell carcinoma between 2011 and 2018 were reviewed retrospectively. The patients were divided into 3 groups by lymph node metastasis status as reactive lymph node (group 1), lymph node metastasis without detected extranodal extension (group 2), and lymph node metastasis with detected extranodal extension (group 3). Survival analysis was performed between these 3 groups. In the patient population with a mean age of 61.56 years consisting of 6 females and 75 males, demographic characteristics between groups were comparable. Overall survival (OS) rates were detected to be 81% in group 1, 69.2% in group 2, and 61.5% in group 3. Two-year OS rates were detected to be 66.7% in group 1, 46.2% in group 2, and 38.5% in group 3. Statistical difference was detected between group 1 and group 3 both for OS and 2-year OS (P = .014, P = .008, respectively). No statistical difference was detected between group 2 and group 1, and between group 2 and group 3. In this study, we found a negative effect of detecting neck lymphadenopathy metastasis and extranodal extension on survival in patients who underwent total laryngectomy and neck dissection due to advanced laryngeal carcinoma.

Relationship Between Lacrimal Bone Thickness and Lacrimal Sac in Chronic Dacryocystitis.

BACKGROUND: Chronic inflammation in the lacrimal sac may lead to thickening of the surrounding bony tissues. This study aimed to assess the thickness of lacrimal bone surrounding the lacrimal sac, and the thickness of maxilla, based on the presence of purulent secretion in the lacrimal sac in patients who underwent EDCR. MATERIAL AND METHODS: Lacrimal bone thickness and the maximum and midpoint maxillary bone thickness of 70 patients (mean age of 49.07 years) who underwent EDCR, were assessed along 3 planes (upper, middle, and lower) using CT of the paranasal sinus. The patients were divided into 2 groups: the 1 who had purulent secretion in the lacrimal sac during the intraoperative period (Group 1) and another who did not have purulent secretion (Group 2). RESULTS: No significant difference was detected between the 2 groups in terms of maximum and midpoint maxillary bone thickness. The increase in the thickness of lacrimal bone in Group 1 was statistically significant in all the 3 planes as compared to that in Group 2. Cutoff values for the thickness of the upper, middle, and lower plane of lacrimal bone were detected to be 0.710 mm, 0.685 mm, and 0.675 mm, respectively. CONCLUSION: The presence of purulent secretion in the lacrimal sac, along with the detected increase in the thickness of the lacrimal bone, as assessed by CT, offers an insight on the lacrimal sac before the surgery.

Hearing Aid Problems in Elderly Populations.

The use of hearing aid (HA) may improve the hearing performance and ease the perceived negative consequences of hearing difficulties in elderly individuals. The aim of this study was to determine the problems experienced by elderly individuals with HA and to investigate the factors that could increase the use of HA. A total of 122 female and 127 male patients with a mean age of 76.79 ± 6.91 years who were recommended HA were evaluated. The following details were taken from the patients: age, gender, duration of hearing complaint, whether or not they received HA, number of family members, number of hours they used HA in a day, type of device, number of ears with HA, educational status, whether they continued to work, whether they were tested before taking the device, the reasons for not taking HA, and the reasons that reduce their use of HA. A total of 18 patients did not receive HA for the following reasons: 9 considered HA too expensive, 8 thought it would be difficult to use HA, and 1 did not like it because of its appearance. No significant difference was found in the patients' daily HA use duration, age, sex, number of immediate family members, education level, type of device, test before taking the device, and use of HA in single ear or bilateral ears. There was a significant difference in the daily HA use duration and whether the patients continued to work. We need to help reduce the problems associated with the use of HA to help older individuals have a more active role in society and help them in their health problems.

Comparison of Piezosurgery and Hammer-Chisel in Endoscopic Dacryocystorhinostomy.

BACKGROUND: In this study, we compared the advantages and disadvantages of piezosurgery and hammer-chisel used in endoscopic dacryocystorhinostomy (EDCR). MATERIAL AND METHODS: Between January 2012 and January 2016, 10 women and 8 men in whom piezosurgery was used (group 1) and 11 women and 7 men in whom hammer-chisel was used (group 2) during EDCR operations were compared retrospectively. Recurrence, operation time, postoperative bleeding, and operative cost were evaluated in patients who were followed for an average of 11.8 months. In addition, visual analogue scale (VAS) was used to assess pain at 6 hours postoperatively. RESULTS: No recurrence was observed in group 1, but recurrence was observed in 2 patients in group 2 (P = 0.685). There was no postoperative bleeding in both groups. The mean duration of operation was 30.6 ±â€Š8.2 minutes in group 1 and 46.8 ±â€Š9.5 minutes in group 2 (P = 0.038). The VAS score in group 1 was 2.7 ±â€Š1.4 and the VAS score in group 2 was 5.8 ±â€Š2.2 (P = 0.01). Piezosurgery costs an additional $325 for each patient while the use of the hammer-chisel does not incur additional costs. CONCLUSION: Piezosurgery causes shorter operation time, less recurrence, and less pain when compared with hammer-chisel.

The Effects of Prognostic Factors in Idiopathic Sudden Hearing Loss.

Introduction Sudden hearing loss is one of the otologic emergencies. The treatment of this disease is affected negatively by some prognostic factors. Objective In this study, the effects of early treatment initiation in patients with idiopathic sudden hearing loss and of prognostic factors in early treated patients were investigated. Methods Out of the 216 patients admitted between September 2007 and September 2015, 154 were identified as having idiopathic sudden hearing loss; they were followed-up for a mean time of 7.4 months, and evaluated retrospectively. The effects of several parameters on the success of the treatment were statistically evaluated, such as the time the treatment was initiated, being of the female gender, the severity of the hearing loss, having descending type audiogram patterns, being older than 60 years old, and the co-presence of vertigo. Results Success rates were found to be significantly higher in idiopathic hearing loss patients that were admitted within the first week ( p < 0.05) of the onset of the hearing loss. However, the outcomes were found to be similar when patients admitted within the first 3 days and 4-7 days after the occurrence of the hearing loss were compared ( p > 0.05). Parameters such as female gender, severe hearing loss, descending type audiogram, being older than 60 years old, and co-presence of vertigo didn't reveal statistically significant effects on the outcome ( p >0.05). Conclusion The aforementioned prognostic factors, which are well-known in the literature, did not have significant effects when the idiopathic sudden hearing loss treatment was initiated within the first 7 days of the onset of the hearing loss.

Comparison of Early Versus Delayed Oral Feeding After Total Laryngectomy in Terms of Pharyngocutaneous Fistula Development.

OBJECTIVE: There is still no consensus on the effect of early oral feeding and nasogastric tube feeding on the development of pharyngocutaneous fistula (PCF) after total laryngectomy. The aim of the present study was to compare the effects of early oral feeding and nasogastric tube (NGT) feeding after total laryngectomy on the incidence of PCF. METHODS: A total of 59 male and three female patients with a mean age of 61.65 (range 44-77) years who underwent total laryngectomy and bilateral neck dissection between May 2010 and June 2016 were evaluated retrospectively. Thirty-two patients started oral feeding on postoperative day three, and 30 patients started NGT feeding on postoperative day one following oral feeding on 7th day. Besides the investigation of the factors which can affect PCF formation, the incidence of PCF was also determined between the two groups of patients. RESULTS: Only preoperative albumin value was different between the groups in the determination of factors which can affect development of PCF. No statistical difference was found between the two groups in terms of the development of PCF and the length of hospital stay (p>0.05). CONCLUSION: To start oral feeding on postoperative day three or with a NGT feeding on postoperative day one following oral feeding on day seven did not affect the development of PCF and the length of hospital stay in patients who underwent total laryngectomy.

Relation between Ossicular Erosion and Destruction of Facial and Lateral Semicircular Canals in Chronic Otitis Media.

Introduction Chronic otitis media can cause multiple middle ear pathogeneses. The surgeon should be aware of relation between ossicular chain erosion and other destructions because of the possibility of complications. Objective This study aimed to investigate the rates of ossicular erosion in cases of patients with and without facial nerve canal destruction, who had undergone mastoidectomy due to chronic otitis media with or without cholesteatoma. Methods We retrospectively analyzed three hundred twenty-seven patients who had undergone tympanomastoidectomy between April 2008 and February 2014. We documented the types of mastoidectomy (canal wall up, canal wall down, and radical mastoidectomy), erosion of the malleus, incus and stapes, and the destruction of facial and lateral semi-circular canal. Results Out of the 327 patients, 147 were women (44.95%) and 180 were men (55.04%) with a mean age 50.8 ± 13 years (range 8-72 years). 245 of the 327 patients (75.22%) had been operated with the diagnosis of chronic otitis media with cholesteatoma. FNCD was present in 62 of the 327 patients (18.96%) and 49 of these 62 (79.03%) patients had chronic otitis media with cholesteatoma. The correlation between the presence of FNCD with LSCC destruction and stapes erosion in chronic otitis media with cholesteatoma is statistically significant ( p < 0.05). Conclusion Although incus is the most common of destructed ossicles in chronic otitis media, facial canal destruction is more closely related to stapes erosion.

Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Pediatric Patients with Idiopathic Sudden Hearing Loss.

OBJECTIVE: We investigated the significance of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios, which have recently been used in adults for the prognosis of idiopathic sudden hearing loss (ISHL), in the prognosis of idiopathic sudden hearing loss in a pediatric population. MATERIALS AND METHODS: A total of 13 males and 8 females younger than19 years with idiopathic sudden hearing loss were retrospectively examined between January 2008 and August 2016.The control group consisted of 12 healthy males and 12 healthy females. Patients were divided into two groups: those who recovered after treatment and those who did not. RESULTS: A statistical significance for the neutrophil-to-lymphocyte ratio was detected between the patient group and control group and between patients who recovered and those who did not (p<0.05). No statistical significance for the platelet-to-lymphocyte ratio was detected between the patient group and control group and between patients with recovery and those without recovery (p>0.05). CONCLUSION: The neutrophil-to-lymphocyte ratio is an important marker for the prognosis of idiopathic sudden hearing loss in pediatric patients, similar to its use in adult patients.

Comparison of Hydroxyapatite Prosthesis and Incus Interposition in Incus Defects.

OBJECTIVE: Chronic otitis media most commonly causes an ossicular chain defect in incus. Different materials can be used for repair of this defect. In this study, the hydroxyapatite prosthesis, used for repair of the incus defect, was compared with the incus interposition. METHODS: Between 2010 and 2016, 27 female and 16 male patients who underwent ossiculoplasty due to an incus defect were studied retrospectively. Patients' hearing results at the sixth month were compared. The hydroxyapatite prosthesis was used in 24 patients (group 1) and incus interposition was used in 19 patients (group 2) for the ossicular chain repair. Hearing gain at 500, 1000, 2000, and 4000 Hz between the two groups and the success rates in the two groups were compared. RESULTS: Successful hearing reconstruction was performed on 10 patients in each group (group 1, 41.6% and group 2, 52.9%). There was no statistically significant difference between groups both in terms of successful hearing and hearing gain at 500, 1000, 2000, and 4000 Hz. There was no extrusion of the materials used in both groups. CONCLUSION: As it does not have any additional cost and is easily shaped and biocompatibility problem is not encountered; we recommend using incus interposition primarily in incus defects.

Prognostic factors of recurrence and neck metastasis in oral carcinomas.

OBJECTIVE: To assess the effects of tumor size, proximity to midline and invasion depth of oral cancer of the tongue (TC) on neck metastasis and recurrence. METHODS: In this retrospective observational study, was conducted through a chart review of the 11 male and 9 female patients who underwent surgeries with the diagnosis of tongue squamous cell carcinoma and at least one side neck dissection. We wanted to assess effects of tumor size, proximity to midline, and invasion depth of TC, according to the surgical specimens and pre-operative magnetic resonance imaging, on neck metastasis and recurrence between 2007 and 2014. The study was conducted in a training hospital-based otorhinolaryngology clinic. Statistical analyses were performed to determine possible relationship between such tumor features and tumor recurrence and neck metastasis. RESULTS: Statistically significant relationship were detected between recurrence and the proximity of tumor to midline (p=0.031) and between invasion depth and neck metastasis (p=0.017). No relationship was found between tumor size and recurrence and neck metastasis (p=0.721 and p=0.827, respectively). CONCLUSIONS: Parameters like invasion depth and tumor proximity to midline might provide useful information about prognosis and may help to determine a treatment schedule in patients suffering fdrom cancer of the tongue. The present TNM classification might not be sufficient to provide enough information to determine prognosis and staging adequately in these patients.

Transoral versus transcervical approach to submandibular gland: techniques and outcomes.

OBJECTIVES: This study aims to evaluate the risks and benefits of the transoral approach for removal of the submandibular gland compared to the transcervical approach. PATIENTS AND METHODS: Twenty consecutive patients who underwent submandibular gland excision surgery via the transoral (6 males, 4 females; mean age 45.4 years) or transcervical (7 males, 3 females; mean age 44.1 years) approach between March 2009 and December 2014 were analyzed retrospectively. Age, surgical indications, complications, duration of hospitalization, and postoperative histopathological results were recorded and compared between two groups. RESULTS: Of 20 patients, 35% were previously treated with antibiotics. There were no significantly differences in demographic characteristics and postoperative histopathological results between the groups (p<0.05). Duration of hospitalization was statistically shorter in the patients operated via transoral approach (p<0.05). Relapsing sialoadenitis occurred in a patient who was operated by transoral approach due to the incomplete resection of the gland. CONCLUSION: The transoral approach for submandibular gland excision has several advantages over the transcervical approach in terms of cosmetic outcome, marginal mandibular nerve injury, and length of hospital stay.

Neck abscess: 79 cases.

OBJECTIVE: Neck abscess is a disease that might cause mortality and severe morbidity, if it is not treated urgently. In our study, patients with diagnosis of neck abscess in our clinic were analyzed retrospectively and presented in the light of the literature. METHODS: In our clinic, age distribution, source of infection, systemic disease, imaging methods that were used in diagnosis, preferred anaesthesia during drainage, abscess sites, culture results of abscess material, complications during treatment procedure, any antibiotherapy before admission and duration of hospitalization of 79 cases with neck abscess who were treated in the hospital between January 2008 and January 2015 were assessed. RESULTS: Cases in our study were aged between 1-79 (mean 28.3) years and 43 of them were female and 36 were male patients. Systemic diseases were determined in 19 of the cases. The most common systemic disease was diabetes mellitus. Abscesses were localized mostly at peritonsillar region and 13 of the cases were operated when abscess were in multipl localizations. In 74 of the cases, drainage was performed under local anaesthesia and in 5 cases under general anaesthesia. Four of these 5 cases, abscesses were localized within retropharyngeal region and 1 of them had multiple abscesses at various regions. Staphylococcus aereus was the most detected microorganism based on culture results. Three adult cases were followed up in the intensive care unit because of development of mediastinitis. One of these 3 cases exited because of sepsis. Hospitalization periods of 79 cases ranged between 2-21 days (mean 7.64 days). Hospitalization period of 19 cases with systemic diseases were 9.47 days (p<0.05) and statistically which were statistically significantly longer when compared with those without any systemic disease. CONCLUSION: Neck abscess must be diagnosed early and treated with surgical drainage and parenteral therapy because it might cause severe complications.

Diagnostic dilemma of parotid lipomas: imaging versus fine needle aspiration cytology.

Lipomas are common soft tissue neoplasms; however, they are found rarely in the parotid gland region. The purpose of this study was to analyze the diagnostic challenges of this rare condition. We performed a retrospective analysis of 11 patients with parotid lipomas, treated from November 2009 to February 2014. The mean age at diagnosis was 46.6 ± 2.9 years, and the study population included 8 males and 3 females. Computed tomography (CT) and/or magnetic resonance imaging (MRI) were performed in radiological diagnosis. Fine needle aspiration (FNA) was performed in all cases (including two times in five patients, for a total of 16 biopsies) and results were diagnostic in four instances. Specificities of the CT, MRI, and FNA cytology tests were 100%, 100%, and 25% respectively. CT and/or MRI scans were more reliable than FNA cytologies for accurate diagnosis of parotid lipomas.