Are smartphones and low-cost external microphones comparable for measuring time-domain acoustic parameters?

PURPOSE: This study examined and compared the diagnostic accuracy and correlation levels of the acoustic parameters of the audio recordings obtained from smartphones on two operating systems and from dynamic and condenser types of external microphones. METHOD: The study included 87 adults: 57 with voice disorder and 30 with a healthy voice. Each participant was asked to perform a sustained vowel phonation (/a/). The recordings were taken simultaneously using five microphones AKG-P220, Shure-SM58, Samson Go Mic, Apple iPhone 6, and Samsung Galaxy J7 Pro microphones in an acoustically insulated cabinet. Acoustic examinations were performed using Praat version 6.2.09. The data were examined using Pearson correlation and receiver-operating characteristic (ROC) analyses. RESULTS: The parameters with the highest area under curve (AUC) values among all microphone recordings in the time-domain analyses were the frequency perturbation parameters. Additionally, considering the correlation coefficients obtained by synchronizing the microphones with each other and the AUC values together, the parameter with the highest correlation coefficient and diagnostic accuracy values was the jitter-local parameter. CONCLUSION: Period-to-period perturbation parameters obtained from audio recordings made with smartphones show similar levels of diagnostic accuracy to external microphones used in clinical conditions.

Intranasal Schirmer Test in Allergic Rhinitis: Relationship to Symptom Scores and Role in Determining Response to Treatment.

OBJECTIVES: The Intranasal Schirmer test (INS) is an easy to administer test that can yield objective measurement of the quantity of nasal secretion and has been studied in patients with various nasal and systemic pathologies; however, the role of INS in patients with allergic rhinitis remains unclear. Our aim was to determine the relationship between various allergic symptoms and the Intranasal Schirmer Test (INS) score and to evaluate the utility of INS in determining treatment effect in patients with allergic rhinitis. METHODS: This prospective study included patients with allergic rhinitis who were randomly divided into 3 treatment groups (nasal steroid only, oral antihistamine only, nasal steroid and oral antihistamine). For all patients, Total Nasal Symptom Score (TNSS) was used to measure symptom severity and INS was administered before and after treatment. Pre-treatment and post treatment TNSS and INS scores were compared between different treatment groups and within each group. RESULTS: The study included 120 patients, with 40 patients in each group. There were significant differences both in pre-treatment and post-treatment symptom severity score with changes of INS scores between treatment groups (P < .001 and P = .002, respectively). There was a significant difference between pre-treatment and post-treatment symptom severity scores and the INS score in each treatment group (P < .001). There was also a significant positive correlation between INS score and TNSS (r = .591 and P < .001). CONCLUSION: The Intranasal Schirmer Test can be used as an objective tool for patients with allergic rhinitis as an adjunct to subjective patient symptom reports and can also be used to determine the response to treatment.

Investigating the Role of Oxidative Stress in Benign Paroxysmal Positional Vertigo with Spot Urine.

Objectives: The objectives of this study were to evaluate the role of oxidative stress in benign paroxysmal positional vertigo (BPPV) by measuring urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG), 8-hydroxy-guanosine (8-OHG), and 8-hydroxy-guanine levels. Methods: Thirty-one adult female patients diagnosed with BPPV were included in this study. Patients with central pathologies and other peripheral causes of vertigo were excluded from the study. The patients were evaluated for oxidative stress during and after the BPPV attack with blood samples and spot urine tests. Depression, anxiety, and stress scale (DASS) questionnaire was used to evaluate emotional stress. A control group consisting of 30 age-matched healthy women was formed. Results: Urinary oxidative stress values during the attack were significantly higher than the post-treatment group and the healthy control group (p<0.05). There was no significant difference between the urinary oxidative stress values of the BPPV group after treatment and the healthy control group (p>0.05). DASS scores were significantly higher during the attack and after the treatment compared to the healthy control group (p<0.05). Conclusion: The increase in spot urinary 8-OHdG, 8-OHG, and 8-hydroxy-guanine levels can be used as a biomarker for oxidative stress in patients with BPPV. Furthermore, emotional stress can also trigger BPPV attacks by increasing oxidative stress.

Middle Ear Adenomatous Neuroendocrine Tumor: A Case Report and Review of Literature.

Middle ear adenomatous neuroendocrine tumor (MEANT) is a rare entity and accounts for approximately 2% of all middle ear tumors. Histologically, the presence of neuroendocrine and glandular structures has led to the use of a wide variety of terminologies such as adenoma, carcinoid tumor, and neuroendocrine tumor. The patients usually have nonspecific symptoms such as unilateral hearing loss, auditory fullness, tinnitus, and otalgia. There is no specific radiological finding. A definitive diagnosis is based on complete removal of the tumor and combined histopathology and immunohistochemical examination. In this case-report, we describe a patient with MEANT who complained of hearing loss and auditory fullness in her left ear. Otomicroscopy revealed a mass of polypoid tissue filling the left external auditory canal. In the pure tone audiometry test, the pure-tone average was reported as L45/5 R10/0, and the tympanogram was type B on the left ear. In temporal bone computed tomography, the soft-tissue mass located in the middle ear was found to extend to the antrum and the external auditory canal. Biopsy taken under local anesthesia from the visible mass in the external auditory canal was reported as MEANT and the diagnosis was confirmed by histopathology and immunochemistry after surgery.

Olfactory bulb volume in cochlear implant candidates as compared to age-matched control subjects: A potential marker of cognitive function for auditory information processing.

OBJECTIVE: To evaluate magnetic resonance imaging (MRI)-based olfactory bulb (OB) volumes in cochlear implant (CI) candidates with sensorineural hearing loss as compared to age-matched control subjects with normal hearing. METHODS: A total of 31 pediatric CI candidates (mean ± SD age: 7.0 ± 2.5 years, 51.6% were boys) with sensorineural hearing loss and 35 age-matched control subjects (mean ± SD age: 7.1 ± 2.5 years, 54.3% were boys) with normal hearing were included in this study. Data on demographic characteristics (age, gender) and right and left OB volume (mm3) on MRI using planimetric contouring method were recorded in patients and control groups. RESULTS: Median (min-max) values for right OB volume (80(50-120) vs. 90(50-160) mm3, p = 0.006) and left OB volume (70(50-120) vs. 90(50-170) mm3, p = 0.007) were significantly lower in CI candidates vs. controls, regardless of the gender and age. No significant difference was noted between right and left OB volume in CI candidate and control groups. Hearing loss subgroups of CI candidates including hereditary familial (n = 8), hereditary non-familial (n = 14) and mixed syndromic (9) subgroups were also similar in terms of patient demographics and OB volumes. There was a tendency for having lower left OB volume (60(50-120) vs. 80(60-110) mm3) in girls vs. boys in the CI candidate group, along with a tendency for lower left and right OB volume in candidates vs. controls, particularly at age 11 (median 120 vs. 80 mm3 and 120 vs. 60 mm3, respectively). No significant correlation of age was noted with right and left OB volume overall and in the study groups. CONCLUSION: In conclusion, our findings revealed lower left and right OB volumes in CI candidates compared to control subjects, regardless of age and gender, indicating the presence of baseline olfactory dysfunction in patients with hearing loss planned to undergo CI. Accordingly, MRI-based measurement of OB volume in the pre-surgical workup of CI candidates may serve as a marker of cognitive function enabling auditory information processing that may also correlate with post-operative CI outcomes.

Effect of the povidone iodine, hypertonic alkaline solution and saline nasal lavage on nasopharyngeal viral load in COVID-19.

OBJECTIVE: The present study aimed to investigate the in vivo activity of nasal irrigation (NI) with saline, NI with povidone-iodine (PVP-I) 1%, NI with a mix of hypertonic alkaline and PVP-I 1% against Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). DESIGN: This study was a prospective randomised clinical trial. SETTING: A multicenter study involving tertiary care centres. PARTICIPANTS: The study included adult outpatients whose qualitative SARS-CoV-2 RT-PCR tests in nasopharyngeal swabs were positive. One hundred twenty patients were divided into four equal groups. Standard COVID-19 treatment was given to Group 1, NI containing saline was added to patients' treatment in Group 2, NI containing 1% PVP-I solution was added to patients' treatment in Group 3, and NI containing 1% PVP-I solution and the hypertonic alkaline solution was added to patients' treatment in Group 4. MAIN OUTCOME MEASURES: On the first day of diagnosis (Day 0), nasopharyngeal swab samples were taken, on the third and fifth days the nasopharyngeal viral load (NVL) reduction in quantitative RT-PCR test was calculated. RESULTS: Between the zeroth to third days and zeroth to fifth days, the NVL reduction was significant in all groups (p < .05). In paired comparisons of groups, the NVL decrease in Group 4 in the first 3 days was significantly lower than all groups (p < .05). The NVL decrease in Groups 3 and 4 in the first 5 days were significantly lower than Group 1 (p < .05). CONCLUSION: This study revealed that the use of NI of 1% PVP-I and the hypertonic alkaline solution mixture was more effective in reducing NVL.

Use of Neutrophil-To-Lymphocyte and Platelet-To-Lymphocyte Ratio to Predict Early Postoperative Periorbital Edema and Ecchymosis After Primary Septorhinoplasty.

PURPOSE: To investigate the benefit of preoperative neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in predicting early postoperative periorbital edema and ecchymosis in patients undergoing primary septorhinoplasty. METHODS: Sixty patients in ASA-I (American Society of Anesthesiologists) who were scheduled for elective primary septorhinoplasty were prospectively included in the study. Periorbital edema and ecchymosis levels of the patients were scored on the postoperative second day. The relationship between early postoperative periorbital edema and ecchymosis levels and preoperative neutrophil, lymphocyte, platelet, NLR, and PLR values were investigated. RESULTS: The mean age of the 60 patients was 24.05 ± 6.83 years. The patients were divided into 2 groups according to the total periorbital edema scores in both eyes on the second day after surgery. There was no significant difference between the two groups in terms of neutrophil, platelet, and NLR ( P > 0.05). In addition, the lymphocyte count was found to be statistically significantly lower and PLR significantly higher in the group with high edema scores ( P < 0.05). When the patients were divided into groups according to their periorbital ecchymosis scores, no significant correlation was found between any blood values and periorbital ecchymosis ( P > 0.05). CONCLUSION: Preoperative PLR may be used to predict early postoperative periorbital edema in patients undergoing primary rhinoplasty. However, a blood value that can predict periorbital ecchymosis has not been determined yet.

The association of metabolic syndrome status with sensorineural hearing loss in pediatric obese patients.

OBJECTIVES: The prevalences of pediatric obesity and its associated comorbidities such as metabolic syndrome (metS) are rising. The aim of this study was to evaluate the association of metS status with sensorineural hearing loss in pediatric obese patients. METHODS: A two-center observationalprospective study was designed. In this study, 252 consecutive treatment-naive pediatric obese patients aged 5.8-17.8 yr in a tertiary pediatric Endocrinology outpatient clinic were prospectively enrolled. Following standard clinical and biochemical evaluations, the obese patients were diagnosed as having metabolic syndrome (metS) or not according to Internetional Diabetes Federation Criteria. All the patients were evaluated with tympanometry and pure tone audiometry tests after otomicroscopic examination. Comparative analyses of audiometric evaluations were performed between metS+ and metS- subgroups of the obese patients. RESULTS: The median age of the patients was 12.5 yr (range: 6.0-17.8 yr) and 56.3% of the patients were male. Metabolic syndrome was diagnosed in 82 (32.5%) patients. Age, gender distribution, history of the ventilation tube, and pubertal stage of the metS + patients and metS- counterparts were not statistically different (p > 0.05 for all). Pure tone hearing thresholds at all frequencies (125, 250, 500, 1k, 2k, 4k, 8k) were significantly higher in the metS + group then the metS- group (p˂0.05 for all). The tympanometry results were not statistically different between the two groups (p˃0.05). Abdominal obesity, hypertension, fasting hyperglycemia and dyslipidemia were not associated with increased hearing thresholds in metS + patients (p˃0.05 for all). CONCLUSION: Metabolic syndrome was associated with increased rates of subclinical hearing loss in our cohort. None of the investigated metS components emerged as a positive association with hearing loss in our cohort. Longitudinal follow-up of our cohort may help probe the causality of the association we found.

Validation and Clinical Application of the Turkish Version of the RhinoQOL Questionnaire in the Setting of Chronic Rhinosinusitis with Nasal Polyp Patients.

Objectives: Validation of the translations of questionnaires from foreign languages is important. Failure to validate surveys can lead to misapplication. Methods: A total of 64 patients who presented with nasal obstruction due to chronic rhinosinusitis with nasal polyps and 64 control subjects were included in this prospective instrument validation study. Translation and back-translation method was used to adapt the Rhinosinusitis quality of life (RhinoQOL) into Turkish. The test and retest reliability, internal consistency, reproducibility, construct validity, and sensitivity to change were assessed. Results: The mean±SD test and retest scores were similar in the control group. Cronbach correlation coefficients were 0.872, 0.873, and 0.959 for the test and were 0.799, 0.725, and 0.885 for the retest scores for the frequency, bothersomeness, and impact domains. Post-operative scores were significantly higher than pre-operative scores obtained for each domain of the RhinoQOL questionnaire in the patient group (p<0.001). Pre-operative scores for frequency, bothersomeness, and impact domains were significantly lower than the corresponding average test and retest scores for each domain in the control group (p<0.001), whereas other than significantly higher bothersomeness scores in patient versus controls (p=0.018), no significant difference was noted between post-operative scores and average test and retest scores. Conclusion: These results demonstrated that the Turkish translation is equivalent to the English version of RhinoQOL in terms of internal consistency, test and retest reliability, and construct validity, with good responsiveness to change and thus potential utility in the assessment of post-operative outcome.

Can Wideband Absorbance Be Used in the Detection of Ossicular Chain Defects?

Introduction: We aimed to compare the effectiveness of wideband absorbance in detecting ossicular chain discontinuity with intraoperative findings. Materials and Methods: In this study, 58 ears from 38 patients with chronic otitis media (COM) were included. Twenty-six ears with perforation and intact ossicular chain were determined as Group 1, 12 ears with perforation and ossicular chain defects were determined as Group 2, and 20 ears with normal hearing and intact tympanic membrane were determined as Group 3. The comparison of the groups was made considering the static (non-pressure) absorbance analysis performed using wideband tympanometry. Results: When perforation sites were evaluated in Group 1 and Group 2; there were 12 anterior perforations, 7 posterior perforations, and 19 subtotal perforations. Air conduction thresholds in Group 2 were significantly (P<0.05) higher than in Group 1, as expected in pure tone audiometry. When wideband absorbance (WBA) measurements were evaluated in all 3 groups, no significant difference (P>0.05) was found between the frequencies 226 to 1000 Hz. WBA measurements at 8 frequencies between 1888-2311 Hz in Group 1 were significantly lower than Group 3 (P<0.05). WBA measurements at 4 frequencies between 3462-3886 Hz frequencies in Group 2 were significantly lower than Group 1 (P<0.05). Conclusions: Our findings concluded that a significant decrease in absorbance values in the narrow frequency range may be valuable in predicting ossicular chain defects.

Do the Age of Implantation, the Widths of Internal Acoustic Canal and Bony Cochlear Nerve Canal Affect the Auditory Performance of Primary School Children with Bilateral Cochlear Implants?

Objective: To reveal the correlation between implantation age, the internal acoustic canal (IAC) width, bony cochlear nerve canal (BCNC) width, and auditory performance in primary school children with bilateral cochlear implantation (CI). Methods: Preoperative IAC and BCNC widths of 57 pre-lingually deaf children aged 7-11 years who had previously undergone bilateral CI in our institution were reviewed and cut-off values were calculated. Twenty-four patients who had additional problems and could not attend school and those who refused to participate in the study were excluded. The remaining 33 were invited to the hospital, and their speech perception tests, and language development scores were analyzed (16 of 33 patients had been operated on before the age of 24 months). Results: The cut-off values calculated from the 114 ears of 57 patients were 3.86 mm for IAC width and 1.56 mm for BCNC width. The auditory performances of the 33 patients after CI were not significantly different in the narrow and normal width groups. However, speech perception test results, and language development scores of patients implanted before the age of 24 months were significantly higher. Conclusion: There are some studies showing that children with bilateral sensorineural hearing loss have narrower IAC and BCNC widths. However, we concluded that the widths of the IAC and the bone cochlear nerve canal did not affect auditory performance. We found that implantation age is the single most important determinant of speech-language development after CI.

Long-Term Effects of Metal-on-Metal Cobalt-Chromium-Containing Prostheses Used in Total Knee Arthroplasty on Hearing and Tinnitus.

Objectives: We aimed to determine the long-term effects of metal-on-metal (MoM) cobalt (Co)-chromium-containing prostheses used in total knee arthroplasty (TKA) on hearing and tinnitus. Methods: A total of 88 patients with the normal otoscopic examination and normal blood B12 levels, consisting of 44 patients who had been using MoM Co-chromium-containing total knee prosthesis for more than 5 years, and 44 non-implanted patients with similar demographic characteristics, were randomly selected and included in the study. Patients with previous ear surgery, chronic middle ear disease, or conductive hearing loss were excluded from the study. All participants were evaluated with pure-tone audiometry (PTA), distortion product otoacoustic emission (DPOAE), tinnitus handicap inventory (THI), and tinnitus reaction questionnaire (TRQ). Results: The mean age of the 88 patients was 67.22±10.4 years. The mean age of 44 patients who underwent TKA at least 5 years ago was 72.89±7.18 years, 75% of these patients had bilateral prostheses, and the mean prosthesis duration was 11.00±5.08 years (range 5-25). The two groups were compared statistically using PTA, DPOAE, THI, and TRQ scores. When the patient groups with and without prostheses were compared in terms of hearing and tinnitus, we did not find a significant difference between the two groups (p>0.05). Conclusion: In our study, we observed that the long-term use of MoM Co-chromium total knee prostheses did not have an ototoxic effect, contrary to what was believed. We also found that prolonged prosthesis duration or undergoing bilateral surgery did not worsen hearing and tinnitus.

Thermal Characteristics of Different Types of Cochlear Implants in Pediatric Cochlear Implant Users: AComparative Digital-Infrared Thermal Imaging Analysis.

BACKGROUND: This study aimed to evaluate thermal characteristics of different types of pediatric cochlear implants METHODS: A total of 39 pediatric patients using Med-El (Synchrony®), Cochlear (Nucleus®), or Advanced Bionics (HiRes 90K®) type of cochlear implants were included. A digital infrared thermal imaging analysis was performed to measure the heating over the implant and the tissue heat- ing of the skin below and around the device, while skin thickness and visual analog scale scores were also recorded. RESULTS: Over the implant, heating values were significantly higher in the on-mode vs. off-mode of device for each type of implant (P ranged from <.05 to <.001). The implants groups were similar in terms of skin thickness, visual analog scale scores, on-mode values for heating over the implant, and the heating of the skin (below or around the device; <36°C for each), while the off-mode values for heating over the implant were significantly higher in the Med-El (Synchrony®) implants compared to other implants (median 31.75 vs. 31.30 and 30.20°C, P = .001). Skin thick- ness was negatively correlated with the heating over the implant (off-mode, r=-0.708, P < .001) and heating of the skin (around the device, r = -0.479, P = .028) in Advanced Bionics (HiRes 90K®) implants. CONCLUSION: Our findings emphasize that there is no hazard or discomfort from a cochlear implant in terms of heating of skin and no significant difference between 3 implant types in terms of skin thickness or tissue heating, whereas indicate the increased likelihood of thermal characteris- tics of implant to differ with respect to skin thickness in Advanced Bionics (HiRes 90K®) users.

Cochlear Implant Complications in a Tertiary Referral Center in Istanbul.

OBJECTIVE: All surgeons should inform the patients about complications and also their clinic's complication rates of cochlear implantation (CI). We aimed to review the complications of CI in 1,148 pediatric and adult patients. METHODS: It is a retrospective case review study enrolled in a tertiary referral center in Istanbul where CI was mostly performed. A total of 1,148 pediatric and adult CIs (unilateral or bilateral CI and revision surgery) performed by the same experienced surgeon in our institution were examined. Complications were noted as major and minor. RESULTS: The mean age of first CI of 702 children and 157 adult patients was 10.2 years (1-75 years). The overall complication rate was 13.68%, comprising 8.28% of minor and 5.4% of major complications. Swelling (wound seroma or hematoma) was the most common minor complication. The most common cause of major complications was related to implanted devices. Despite the high rates of minor complications in children, there was no statistically significant difference between children and adults (p = 0,194). CONCLUSIONS: Our clinic has a low major complication rate. Surgeons should be aware of postoperative complications, apply appropriate procedures, and inform patients about their surgical complication rates.

Voice Onset Time in Patients Using Speech Prosthesis After Total Laryngectomy.

AIM: Our study was carried out to investigate the presence of known differences in voice and articulation quality after total laryngectomy. Patients provided phonation with tracheoesophageal speech prosthesis. We recorded patients' voice onset time (VOT) values - an important parameter of acoustic analysis. METHODS: The study included 18 patients with total laryngectomy who received valvular speech prosthesis via a primary or secondary tracheoesophageal fistula between 2009 and 2011 at the Istanbul Training and Research Hospital Otorhinolaryngology Clinic. Twenty healthy male volunteers were included as the control group. All subjects produced the /pa/, /ta/, /ka/ syllables three times, and the VOT values were determined by recording the voices on a computer. RESULTS: A total of 38 male patients, 18 of which were patients with total laryngectomy and tracheoesophageal speech prosthesis (aged between 46 and 75 years, mean: 59) and 20 controls (aged between 50 and 70 years, mean: 58), were included in the study. The age distribution of the groups did not differ statistically (P > 0.05). In the total laryngectomy and tracheoesophageal speech prosthesis group, the VOT mean values of the /ka/ syllable were significantly lower than the control group, whereas the /pa/ (P = 0.848) and /ta/ VOT mean values (P = 0.809) were similar between groups. CONCLUSIONS: This study shows that there is no significant difference in the articulation of voiceless plosives, except for the /ka/ sound, between patients using speech prostheses after total laryngectomy and controls. For standardization of these measured values and their use in clinical practice, it may be beneficial to support this study with studies that involve more patients and examine different indicators showing the quality and intelligibility of other voice characteristics.

Microbiology and Drug Susceptibility Pattern of Bacterial Isolates from Patients with Chronic Suppurative Otitis Media at a Tertiary Care Hospital in Somalia.

Background: This study aimed to determine the microbiological profile and antibiotic susceptibility pattern of bacterial isolates obtained from patients with chronic suppurative otitis media (CSOM) presenting to the otorhinolaryngology clinic of a tertiary care hospital in Mogadishu, Somalia. Methods: A total of 225 patients diagnosed with chronic suppurative otitis media were included in the study. Samples of middle ear discharge were collected from each patient and cultured using standard microbiological techniques, and bacterial identification was performed. Drug susceptibility pattern was assessed according to the Clinical and Laboratory Standards Institute criteria. Results: The study sample (n=225) comprised 122 females and 103 males. Among 225 samples tested, bacterial growth was present in 200 (88.9%) and absent in 25 (11.1%) samples. Of 200 samples with bacterial growth, monomicrobial growth was detected in 176 (88%). Gram-positive bacteria were observed in 40 (22.7%) and Gram-negative bacteria in 136 (77.3%) samples. The bacteriology of the samples with monomicrobial growth consisted of (in decreasing frequency) Pseudomonas spp, Staphylococcus aureus, Escherichia coli, Coagulase-negative staphylococci, Proteus mirabilis, and Klebsiella sp. A high rate of resistance was detected against penicillin antibiotics, erythromycin, tetracycline, and co-trimoxazole. Resistance to cephalosporins, clindamycin, vancomycin, linezolid, daptomycin, quinupristin/dalfopristin, levofloxacin, meropenem, and ertapenem was low. Conclusion: While the frequencies of isolated bacterial species were consistent with other reports from the region, differences were observed in the antibiotic resistance of bacterial isolates when examined individually for each antibiotic. Further studies are warranted in the same region and different parts of Somalia, coupled with ongoing assessment of antibiotic susceptibility patterns in CSOM.

The Impact of Isotretinoin Therapy on the Nasal Skin Thickness and Elasticity: An Ultrasonography and Elastography Based Assessment in Relation to Dose and Duration of Therapy.

BACKGROUND: This study aimed to evaluate the impact of isotretinoin therapy on the nasal skin thickness and elasticity with regard to implications for rhinoplasty METHODS: A total of 40 acne vulgaris patients (mean±SD age: 20.9 ± 3.0 years, 65.0% were females) initiating oral isotretinoin treatment (0.25 mg/kg/day, n = 16 or 0.5 mg/kg/day, n = 24) were included in this prospective 4-month isotretinoin follow-up study. Ultrasonography assessments regarding nasal skin thickness (dermis and soft tissue) and elastography were repeated at second and fourth months of treatment. RESULTS: No significant difference was noted between isotretinoin dose groups in terms of second month and fourth month nasal skin thickness (dermis and soft tissue) values measured at any region. Each dose revealed significant decrease in dermis and soft tissue thickness from baseline at any region (p ranged < 0.001 to < 0.001), while only fourth month values at nasal tip and second month values at rhinion for dermis and only fourth month values at rhinion and glabella for subcutaneous tissue significantly differed from baseline (p < 0.01 for each) in the 0.25 mg and 0.50 mg dose groups, respectively. Elastography values at fourth month of isotretinoin treatment were significantly higher than pre-treatment and second month values in both 0.25 mg (90.4 ± 20.6 vs. 59.5 ± 21.8 and 76.4 ± 22.9, p < 0.01 for each) and 0.5 mg (86.7 ± 20.6 vs. 61.8 ± 23.2 and 76.9±24, p < 0.01 for each) dose groups. CONCLUSIONS: In conclusion, our findings revealed the association of isotretinoin treatment with a significant decrease in dermis and subcutaneous soft tissue thickness measured at each anatomical landmark, regardless of the treatment dose. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Possible effects of low testosterone levels on olfactory function in males / Possíveis efeitos dos baixos níveis de testosterona na função olfativa em homens

Abstract Introduction: Functions attributed to androgens have increased, ranging from the role in hypothalamic-pituitary-gonadal axis and reproductive behaviors to modulation of cognition, mood and some other functions. Sex differences and changes in circulating sex hormones affect human sensory function. In the literature, authors reported this kind of influence for olfaction predominantly in females. Objective: To investigate the effects of low testosterone levels on olfactory functions in males, in this prospective clinical study. Methods: Male patients diagnosed with prostate cancer were included. Thirty-nine patients with prostate cancer whose testosterone levels were lower than 50 ng/dL due to castration, were the study group. Thirty-one patients with prostate cancer who were not castrated with testosterone levels higher than 50 ng/dL were selected as the control group. Acoustic rhinometry and peak nasal inspiratory flow tests were performed for all participants; and for evaluation of olfactory function, both groups completed the Connecticut chemosensory clinical research center olfactory test. Results: The mean ages of the patients and controls were 69.6 ± 7.2 (57-89) and 66.3 ± 5.8 (50-78) years, respectively (= 0.039). There was a significant difference between groups in terms of testosterone levels (p < 0.0001). The multivariate logistic regression revealed testosterone level as the only predictive factor determining the difference between the groups. In terms of olfactory parameters, all scores were lower in the emasculated group (butanol threshold test p = 0.019, identification p = 0.059, and Connecticut center score p = 0.029) There was a significant correlation between testosterone levels and olfactory parameters (p = 0.023; p = 0.025 for identification and Connecticut center scores, respectively). Conclusion: Low testosterone levels in males have negative effects on olfactory functions. Further molecular research is required to understand the connection between testosterone and olfaction.

Resumo Introdução: As funções atribuídas aos andrógenos aumentaram, variam desde o papel no eixo hipotálamo-hipófise-gonadal e comportamentos reprodutivos até a modulação da cognição, humor e outras funções. As diferenças entre os sexos e as mudanças nos hormônios sexuais circulantes afetam a função sensorial humana. Na literatura, os autores relataram esse tipo de influência para o olfato, principalmente no sexo feminino. Objetivo: Investigar os efeitos dos baixos níveis de testosterona nas funções olfativas em homens, neste estudo clínico prospectivo. Método: Pacientes do sexo masculino com diagnóstico de câncer de próstata foram incluídos no estudo. Compreenderam o grupo de estudo 39 pacientes com câncer de próstata cujos níveis de testosterona eram inferiores a 50 ng/dL devido à castração. Foram determinados como grupo controle 31 pacientes com câncer de próstata que não foram emasculados, com níveis de testosterona superiores a 50 ng/dL. Testes de rinometria acústica e pico de fluxo inspiratório nasal foram feitos para todos os participantes; e para avaliação da função olfativa, ambos os grupos concluíram o teste olfativo do Connecticut chemosensory clinical research center. Resultados: A média da idade dos pacientes e controles foi de 69,6 ± 7,2 (57 ± 89) e 66,3 ± 5,8 (50 ± 78) anos, respectivamente (= 0,039). Houve uma diferença significante entre os grupos em relação a níveis de testosterona (p < 0,0001). A regressão logística multivariada revelou o nível de testosterona como o único fator preditivo que determinou a diferença entre os grupos. Em termos de parâmetros olfativos, todos os escores foram menores no grupo castrado (teste do limiar de butanol p = 0,019, identificação p = 0,059 e escore do Connecticut center p = 0,029). Houve uma correlação significante entre o nível de testosterona e os parâmetros olfativos (p = 0,023; p = 0,025 para identificação e escore do Connecticut center, respectivamente). Conclusão: Baixos níveis de testosterona em homens têm efeito negativo na função olfativa. Mais pesquisas moleculares são necessárias para entender a conexão entre testosterona e olfação.

Vocal Fold Submucosal Mesna Injection and Microflap Elevation in a Rabbit Model.

OBJECTIVE: Mesna triggers chemical dissection in tissues by breaking down disulfide bonds and is used during surgical dissections in several areas. In this study, we aimed to investigate the effect of submucosal mesna infiltration on microflap elevation and the histopathological findings of its effects on the vocal fold lamina propria in a rabbit model. METHODS: Eight adult male New Zealand white rabbits were used in the study. Each vocal fold was randomized, and 0.1 mL of mesna was injected into one-fold and 0.1 mL of saline to the contralateral fold. An incision was made on the epithelium and elevation was performed. The animals were sacrificed after two weeks, and the vocal folds were excised. Inflammatory response, fibrosis, and epithelial thickness were evaluated with hematoxylin eosin and Masson's Trichrome staining. Elevation time and histopathological features were compared between the two groups. RESULTS: The elevation time (20.9 ± 1.6 second) in the saline group was significantly higher (P < 0.05) than in the mesna group (15.0 ± 3.4 second). The inflammation (1.3 ± 0.5 vs. 1.1 ± 1.0, respectively) and fibrosis scores (1.0 ± 0.8 vs. 0.8 ± 0.7, respectively) did not differ significantly (P > 0.05 in both). Epithelial thickness (12.5 ± 4.7 vs. 10.3 ± 5.3, respectively) did not differ significantly (P ˃ 0.05) in the mesna and saline groups either. CONCLUSION: We determined that mesna facilitates the microflap elevation of the vocal folds in rabbits and does not damage the histological structure of vocal folds. This study encourages future studies to evaluate the use of mesna, now actively used across disciplines, in phonosurgery as well.

Malignant Otitis Externa: How to Monitor the Disease in Outcome Estimation?

OBJECTIVE: Malignant otitis externa (MOE) is a serious disease affecting mainly the elderly diabetic patients that may result in mortality. It was aimed to evaluate the relationship between treatment responses and clinical and radiologic parameters among progress of the disease. Secondary aim was to present our clinical outcomes in the treatment of malignant otitis externa. METHOD: This study was retrospectively conducted in a single center. Reviewed data included history of complaints, duration of symptoms, addition of hyperbaric oxygen treatment, presence of surgical intervention, pathological findings, culture positivity and microorganism, laboratory findings, scintigraphy, imaging modalities and outcome of disease. RESULT: A total of 26 cases with malignant external otitis including 17 females (65.4%) and nine males (34.6%) patients were included in our study. Duration of symptoms before the initiation of treatment, and hyperbaric oxygen treatment did not positively influence the outcome. Inflammatory markers and Peleg staging significantly reflected the treatment response. CONCLUSION: Close monitoring of inflammatory parameters is the key point in the prediction of prognosis. Planning the management and predicting the outcomes rely on proper radiological and clinical assessment of the extent of disease. In the assessment of MOE, universal scoring systems should be preferred for pooling the data in comparable manner.