Laryngeal Botulinum Toxin Injection: Can It Be a Cause of Obstructive Sleep Apnea as an Adverse Effect?

Spasmodic dysphonia is a chronic voice disorder that is characterized by involuntary spasms of the laryngeal muscles during speech production. Botulinum toxin injection into to the laryngeal muscles is the most common and effective treatment of choice for symptoms of spasmodic dysphonia. We present a 44-year-old man with adductor spasmodic dysphonia who was diagnosed as having upper airway obstruction in a polysomnographic examination during sleep after a botulinum toxin injection.

Laryngoscopic Examination During the COVID-19 Pandemic: Turkish Voice Speech and Swallowing Disorders Society and Turkish Professional Voice Society Recommendations.

COVID-19 is highly transmissible and spreads rapidly in the population. This increases the occupational risk for health care workers. In otolaryngology clinic practice, patients with upper respiratory tract infection symptoms are common. Also, routine head and neck examinations such as oral cavity examination, nasal/nasopharyngeal examination, or video laryngostroboscopic evaluation are highly risky because of the aerosol formation. To emphasize this issue, two leading otolaryngology organizations in Turkey; 'Voice Speech and Swallowing Disorders Society', and 'Professional Voice Society' gathered a task force. This task force aimed to prepare a consensus report that would provide practical recommendations of the safety measurements during routine clinical care of laryngology patients. To fulfill this, universal aim, on the 2nd and 9th of May 2020, two web-based meetings were conducted by 20 expert physicians. This eighteen items list was prepared as an output.

The Turkish Version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V): A Reliability and Validity Study.

OBJECTIVE: The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) was developed to assess voice quality. The aim of this study was to develop a Turkish adaptation of CAPE-V and to evaluate the reliability and validity of the Turkish version. METHODS: To adapt the CAPE-V protocol to Turkish, six sentences were constructed to meet the phonetic requirements. The validity of the Turkish version of the CAPE-V was tested with inter-rater reliability, intrarater reliability, and GRBAS versus the CAPE-V judgments. Ninety-nine dysphonic and 83 healthy subjects were enrolled. RESULTS: High inter-rater and intrarater reliability (ICC > 0.88, r > 0.81, respectively) were obtained for all vocal parameters. The differences in the six CAPE-V parameters between healthy and dysphonic subjects were statistically significant (P < 0.0001). The correlations between CAPE-V and GRBAS scales were high in overall severity-grade and roughness parameters (r = 0.85, r = 0.82, respectively), the lowest correlation was the strain parameter (r = 0.66). CONCLUSION: The Turkish version of CAPE-V is a reliable and valid instrument for auditory-perceptual evaluation of the Turkish speaking population.

Curettage adenoidectomy versus endoscopic microdebrider adenoidectomy in children: A randomized controlled trial.

INTRODUCTION: Adenoidectomy is one of the most frequently performed surgical procedures with different techniques and technologies. Although curettage adenoidectomy (CA) has been practiced conventionally for many years, endoscopic microdebrider adenoidectomy (EMA) has emerged as an innovative surgical method. Comparing physiological effects, efficacy and safety of the endoscopic microdebrider adenoidectomy (EMA) and curettage adenoidectomy (CA) in pediatric population is aimed with this prospective, single-blind, randomized, controlled trial. METHODS: Sixty pediatric patients with type-A tympanogram according to Jerger classification in both ears before surgery were randomly assigned to receive the CA (n = 30) and the EMA (n = 30). Tympanometry evaluation for each ear was performed the day before surgery firstly and was repeated on days 1, 7 and 14 after surgery. Intraoperative time, complications during and after the operation were recorded. Postoperative pain was also evaluated for 10 days postoperatively. RESULTS: Tympanometric evaluation revealed significantly reduced middle ear peak pressure levels with the EMA than with the CA for each ear on day 1 after surgery and for only left ear on day 7 after surgery (P < 0.05). In addition, statistically significant reduced pain scores in postoperative first 3 days were related to the EMA (P < 0.05). There was no significant difference between the methods in terms of duration of surgery and complications. CONCLUSION: According to findings from this study, the EMA procedure may be as safe and rapid as the CA. Furthermore, the EMA may be more controlled and less invasive to the surrounding tissues. Further studies are advised to support these data.

Medially displaced common and internal carotid arteries presenting as a pulsatile mass: Clinicoradiologic analysis of 62 cases.

We conducted a prospective study to analyze the medially displaced courses of the common carotid artery (CCA) and the cervical segment of the internal carotid artery (ICA) in patients who were diagnosed with a pulsatile mass on nasopharyngolaryngoscopy and by clinicoradiologic findings. Our study group was made up of 62 patients-40 women and 22 men, aged 30 to 88 years (mean: 63.7)-who presented with a submucosal pseudomass or a bulging mass on the pharyngeal wall with obvious pulsation. For comparison purposes, we recruited a control group of 62 consecutively presenting patients who had been admitted to our Neurology Department with acute severe headache and who had undergone CT angiography based on a suspicion of an aneurysm or a vertebral or carotid artery dissection. A medially displaced carotid artery was identified in all patients in the study group. Two main course abnormalities were observed: (1) a pharyngeal superficial placement (PSP), consisting of a bulging or placement immediately adjacent to the naso-orohypopharyngeal lumen, and (2) a retropharyngeal midline placement (RMP), which entailed medialization of the carotid arteries to the midline. A PSP was observed in 11 patients, an RMP was found in 17 patients, and both were seen in 34 patients. The distance from the aberrant carotid artery to the pharyngeal wall and to the retropharyngeal midline of the retropharynx was measured at four levels: nasopharyngeal, retropalatal, retroglossal, and retroepiglottic in both groups. The mean distance was significantly shorter in the study group than in the control group at all four levels (p < 0.002). We conclude that the most likely diagnosis of a pulsatile mass detected on nasopharyngolaryngoscopy is an aberrant CCA or cervical ICA.

Paranasal Sinus Anatomic Variations Accompanying Maxillary Sinus Retention Cysts: A Radiological Analysis.

OBJECTIVE: The risk factors for the development of retention cysts of the maxillary sinuses (RCMs) are not clear, although RCMs are common findings on radiographic images. This study was conducted to evaluate the correlation between RCMs and other nasal-paranasal anomalies and to demonstrate the possible effects of these anomalies on the development of RCMs. METHODS: In the study, paranasal sinus computerized tomography (PNsCT) images from 5166 patients were retrospectively reviewed. Correlations between RCMs and osteomeatal complex obstruction, accessory ostium presence, abnormalities of the middle turbinate, and nasal septal deviation were analyzed in the PNsCT images. The paranasal sinus anomalies on the side of the RCMs were compared to the contralateral side. RESULTS: A total of 1880 RCMs were detected in 1429 (27.6%) of 5166 patients. At least one nasal-paranasal sinus anomaly was associated with 88.7% of the RCMs. In the descending order, accessory ostium presence, accessory ostium, middle turbinate anomalies, and nasal septal deviation are pathologies that accompany RCMs. When unilateral RCMs were compared with the normal side, significant correlations were observed between RCMs and osteomeatal complex obstruction, accessory ostium, and middle turbinate anomalies (p=0.001, p=0.016, and p=0.03, respectively). RCMs were commonly found on the same side as osteomeatal complex obstruction (p=0.001), middle turbinate anomalies (p=0.001), and accessory ostium (p=0.052). CONCLUSIONS: In this study, the coexistence of osteomeatal complex obstruction, accessory ostium, middle turbinate anomalies, and nasal septum deviation with RCMs was analyzed by investigating PNsCT findings in 5166 patients. The results show that RCMs are associated with pathologies that increase paranasal inflammation, such as osteomeatal complex obstruction, and are good markers for nasal-paranasal sinus anomalies. The presence of incidental RCMs should be a warning sign of nasal-paranasal sinus anomalies.

An Unusual Neck Mass: Ingested Chicken Bone.

BACKGROUND: Foreign bodies in the upper aerodigestive tract are frequently seen in otolaryngological practice, but migration of an ingested foreign body to the neck is a very rare condition. CASE REPORT: We present a 66-year-old woman admitted to our outpatient department with a painful neck mass. She had a history of emergency department admission 4 months prior with odynophagia after eating chicken meal. A physical examination revealed a painful and hyperemic mass on the left neck. Antibiotherapy did not relieve the patient's symptoms and signs. A 3-cm linear foreign body was observed in X-ray and computed tomography scans. The symptoms of the patient were relieved after excision of the foreign body. CONCLUSION: Although it is a rare situation, migration of a foreign body ingested through the aerodigestive tract to the neck should be kept in mind in the differential diagnosis of patients who present with neck masses.

Acoustic Voice Analysis of Young Turkish Speakers.

OBJECTIVE/HYPOTHESIS: One of the objective assessments of voice is acoustic analysis, particularly, the parameters fundamental frequency (F0), jitter, shimmer, and noise-to-harmonics ratio (NHR). Because the normative data for healthy native Turkish male and female speakers are lacking in the literature, this study aimed to obtain F0, perturbation parameters, and NHR in three sustained vowels (/Λ/, /i/, and /u/) among young Turkish speaking adults. METHODS: The native Turkish speakers with normal voice aged between 18 and 32 years were included in the study (44 women, 39 men). Voice samples were recorded using Computerized Speech Lab, and data were analyzed with the statistics software SPSS Statistics 21.0 (IBM Corp., Armonk, NY, USA). RESULTS: The F0 values of vowels /Λ/, /i/, and /u/ were greater for women (239.78 Hz, 251.97 Hz, and 250.29 Hz, respectively) than for men (127.11 Hz, 137.23 Hz, and 134.15 Hz, respectively). All shimmer values for all vowels and jitter values for /Λ/ and /u/ were found significantly low in men; however, no difference was found for jitter values of /i/ between genders. There is no effect of gender on NHR. Only in women, NHR of high vowels was found to be lower than that of vowel /Λ/. CONCLUSIONS: There is a significant difference for F0 values between the genders as expected. Comparisons of perturbation values were significantly different for some pairs of vowels. There was no significant difference between NHR values between the genders. These findings can be compared with Turkish speakers who have different voice disorders for the further studies.

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.

Reliability and validity of the Turkish pediatric Voice Handicap index.

OBJECTIVES: The aim of this study is to develop a Turkish version of the pediatric voice index (pVHI) and to evaluate its reliability and validity for cultural adaptation. METHODS: The original pVHI was translated to Turkish. It was administered to 151 parents of 40 dysphonic children and 111 non-dysphonic children. A cross-sectional descriptive model is used with two-sample methodology. The reliability, validity measures, sensitivity, specifity and receiver operating characteristics (ROC) analysis with AUC values were calculated. RESULTS: The findings showed that the Turkish version of the pVHI had highly significant validity, reliability and excellent internal consistency, sensitivity and specifity for functional, physical and emotional domains and the total score. CONCLUSIONS: The Turkish version of the pVHI is a valid and reliable tool to assess the parents' perception about their children with voice disorders.

Quantum molecular resonance-assisted phonomicrosurgery: preliminary experience.

The objective of this study was to evaluate the use of quantum molecular resonance (QMR) energy in phonomicrosurgery. Quantum molecular resonance energy (QMRE) is an innovative technology that provides low temperature cutting and coagulation of tissues and causes minimal tissue damage during the procedure. Because of these features, this technology may offer new possibilities in phonomicrosurgery. Twelve patients with vocal fold polyps underwent QMR-assisted phonomicrosurgery. The patients were evaluated before and after surgery at 1 and 3 months postoperatively by using the voice handicap index, laryngeal stroboscopy rating, acoustic voice analysis, and perceptual voice evaluation. The subjects were also evaluated by a patient self-assessment questionnaire at 3 months postoperatively. All parameters significantly improved after QMR-assisted phonomicrosurgery (P < .05). All of the patients also subjectively improved by self-rating. These results suggest that QMRE is a safe and potentially promising treatment in phonomicrosurgery. Yet, further studies should be conducted to confirm these results.

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.

Aural myiasis: case report.

Myiasis is the infestation of live vertebrates with dipterous larvae. Aural myiasis involves infestation of the external ear and/or middle ear. It is a rare clinical state that usually occurs in patients who have mental or physical disabilities. Although myiasis is a self-limiting disease, it can be associated with fatal complications like penetration within the central nervous system. We present a 87-year-old patient suffering from Alzheimer's disease with aural myiasis and also discuss the clinical presentation and efective therapies with a review of the literature.

Does topical anesthesia using aerosolized lidocaine inhibit the superior laryngeal nerve reflex?

OBJECTIVE: This study was designed to evaluate the effectiveness of topical lidocaine in attenuating the laryngeal reflex and blunting hemodynamic response by inhibition of the superior laryngeal nerve in laryngeal microsurgery, which would be helpful in preventing potential complications. STUDY DESIGN: A prospective, randomized, double-blind study. SETTING: Tertiary medical center. SUBJECTS AND METHODS: Fifty-four patients requiring glottic and supraglottic laryngeal microsurgery were randomly assigned to 1 of 2 groups, with equal numbers. Before surgery, 10% lidocaine was topically applied to the laryngeal surface of the epiglottis and vocal folds under direct vision in the study group and saline aerosol was applied in the control group. Heart rates, arterial blood pressure, and SPO2 were recorded at baseline, after induction, immediately before and after intubation, during the surgery, and upon extubation. Laryngospasm, agitation, and coughing were recorded during the recovery period. RESULTS: Heart rates, arterial pressure, and SPO2 did not differ significantly from baseline to postintubation period among the groups. SPO2 values measured similar in the remaining study. Heart rates and blood pressures were slightly decreased in the study group after lidocaine administration, but only blood pressure at pre- and post-extubation was significantly decreased in the study group (P < .05). Also laryngospasm and coughing were not statistically different between the 2 groups. There was an obvious gap between the 2 groups for agitation. Study group agitation was noted significantly lower (P < .05). CONCLUSION: These findings indicate that preoperative topical lidocaine application may be helpful in attenuating airway-circulatory reflexes in laryngeal microscopic surgery.

Blood levels of TNF-α, IL-10, and IL-12 in idiopathic sudden sensorineural hearing loss.

OBJECTIVES/HYPOTHESIS: To investigate the blood levels of TNF-α, IL-10, and IL-12 in the idiopathic sudden sensorineural hearing loss patients, and the change of these cytokine levels after treatment. STUDY DESIGN: Prospective clinical trial. METHODS: Twenty-three patients with idiopathic sudden sensorineural hearing loss and 20 healthy people were selected as study and control groups. Blood samples for TNF-α, IL-10, and IL-12 were taken before treatment and 6 weeks after treatment. The study group was given combined treatment including dexamethasone, heparin, pentoxifyline, vitamin B1, and B6 for 10 days, and was divided into two groups: treatment responders and treatment nonresponders. The treatment responders group was also divided into three groups according to most accepted criteria for improvement in the literature. Audiograms were taken before treatment and 6 weeks after treatment to determine the response to the treatment. RESULTS: There was no significant difference between pre- and posttreatment values of IL-10 and IL-12 in all study groups (P > 0.05). There was also no significant difference between pre- and posttreatment values of TNF-α in treatment responders (P > 0.05). Treatment nonresponders had more elevated posttreatment values of TNF-α than pretreatment values (P < 0.05). CONCLUSION: IL-10 and IL-12 may not play a critical role in idiopathic sudden sensorineural hearing loss. But our data supports the role of TNF-α in the pathophysiology of idiopathic sudden sensorineural hearing loss, and TNF-α receptor blockers may have benefits in these patients.

Glomus tumor of the proximal trachea: a case report.

Glomus tumors are uncommon benign neoplasms, which rarely occur in the trachea, usually originating from the posterior wall of the distal portion. Most of tracheal glomus tumors are located in the lower two thirds of the trachea. In this article, we present a 50-year-old male patient with a glomus tumor located on the upper third of the posterior wall of the trachea. A transoral endoscopic laser excision was performed. No finding suggesting tumoral regrowth at 36 months following surgery was found, as assessed by laryngoscopy and imaging studies.

Cholesteatoma of the concha bullosa: a case report.

INTRODUCTION: Cholesteatoma is a relatively common disease within the middle ear cavity, but rarely it manifests in the paranasal sinuses. There is, to the best of our knowledge, only one other published case of cholesteatoma inside the concha bullosa in the English language literature. CASE PRESENTATION: An 81-year-old Caucasian woman was admitted to our hospital complaining of nasal obstruction, headache and diplopia. After endoscopic and radiological evaluation a transnasal endoscopic approach was chosen. The diagnosis of cholesteatoma was established by histopathological evaluation of the mass inside the concha bullosa. CONCLUSION: Although it is rarely seen, cholesteatoma should be considered in the differential diagnosis of slow-growing and destructive paranasal masses.