The Diagnostic Value of Fine Needle Aspiration Biopsy in Parotid Tumors.

The aim of this study was to investigate the diagnostic accuracy rates of the patients who underwent an operation for parotid mass, by comparing their fine needle aspiration biopsy (FNAB) cytology results with the final pathology. A total of 136 patient files of those who applied to Otorhinolaryngology clinic due to parotid mass and underwent parotidectomy procedure between 2010 and 2020 at a tertiary center were scanned retrospectively. Database on patient age, gender, preoperative FNAB results, and final surgical histopathology results was created. The mean age of the patients was 48.26 ± 17.37 Superficial parotidectomy was performed to 108 (79.4%) and total parotidectomy to 28 (20.6%) of the patients. The sensitivity of FNAB was found as 85.2%, specificity as 96.2%, positive predictive value as 85.2%, negative predictive value as 96.2% and accuracy as 94.0%. It is found that FNAB has the high specificity and high negative predictive value with high diagnostic accuracy on detecting preoperative malignancy in parotid gland. We think that FNAB is a significant, necessary and safe method in the diagnosis of parotid lesions in preoperative sense.

Simultaneous idiopathic bilateral sudden hearing loss - characteristics and response to treatment / Perda auditiva súbita bilateral idiopática simultânea - características e resposta ao tratamento

Abstract Introduction The aetiology of sudden hearing loss is poorly defined; however, infectious, vascular and neoplastic aetiologies are presumed to be responsible. In addition, the aetiology of bilateral sudden hearing loss is also unknown. Objective The objective of this study is identify the characteristics and treatment response of simultaneous bilateral sudden hearing loss. Methods This is a case-control study that practised in tertiary care academic centre. 132 patients with sudden hearing loss who were treated with systemic steroid and hyperbaric oxygen together were included. 26 patients had bilateral sudden hearing loss and 106 patients had unilateral sudden hearing loss. Patients were evaluated with clinical, audiological and radiological examinations and laboratory tests were done. Findings and response to treatment of the patients were compared. Results The mean ages of patients with unilateral and bilateral sudden hearing loss were 42.0 years and 24.5 years respectively with a statistically significant difference (p < 0.001). Immune response markers were more prevalent in bilateral sudden hearing loss. Pre-treatment audiologic thresholds were 69.1 dB for unilateral sudden hearing loss and 63.3 dB for the left ears and 67.6 dB for the right ears for bilateral sudden hearing loss without significant difference. Post-treatment average hearing threshold in unilateral sudden hearing loss was 47.0 dB and 55.4 dB for the left ears and 59.0 for the right ears in bilateral sudden hearing loss. Average hearing improvement in unilateral sudden hearing loss group was significant (p < 0.001) in spite of it was not significant in bilateral sudden hearing loss group for both ears. Between the groups; there was a significant difference for hearing improvement favouring unilateral sudden hearing loss (p < 0.001). Tinnitus scores decreased significantly in both groups of patients (p < 0.001) in spite of there was no significant difference between the groups of patients. Conclusion Patients with bilateral sudden hearing loss showed lower age, worse prognosis and higher rate of positive immune response markers. Cardiovascular risk factors seem to have an important role in the aetiology of unilateral cases whereas this importance was not present in bilateral ones.

Resumo Introdução A etiologia da perda auditiva súbita ainda não está bem definida; contudo, presume-se que as etiologias infecciosas, vasculares e neoplásicas sejam as responsáveis. Além disso, a etiologia da perda auditiva súbita bilateral também é desconhecida. Objetivo O objetivo desse estudo foi identificar as características e a resposta ao tratamento de perda auditiva súbita bilateral simultânea. Método Este é um estudo de caso-controle realizado em um centro de atenção terciária. Foram incluídos 132 pacientes com Perda Auditiva Neurossensorial Súbita (PANS) que foram tratados com esteroides sistêmicos e oxigênio hiperbárico. 26 pacientes tiveram PANS bilateral e 106 pacientes tiveram PANS unilateral. Os pacientes foram avaliados com exames clínicos, audiológicos, radiológicos e exames laboratoriais. Os achados e a resposta ao tratamento dos pacientes foram comparados. Resultados As idades médias dos pacientes com PANS unilateral e bilateral foram 42,0 anos e 24,5 anos, respectivamente, com diferença estatisticamente significante (p < 0,001). Os marcadores de resposta imune foram mais prevalentes na PANS bilateral. Os limiares audiológicos pré-tratamento foram 69,1 dB para PANS unilateral e 63,3 dB para a orelha esquerda e 67,6 dB para a orelha direita para PANS bilateral, sem diferença significativa. O limiar médio de audição pós-tratamento em PANS unilateral foi de 47,0 dB e 55,4 dB para a orelha esquerda e 59,0 para a orelha direita em PANS bilateral. A melhora auditiva média no grupo com PANS unilateral foi significativa (p < 0,001), apesar de não ser significativa no grupo com PANS bilateral para ambas as orelhas. Houve diferença significativa entre os grupos na melhora auditiva favorecendo a PANS unilateral (p < 0,001). Os escores de zumbido diminuíram significativamente em ambos os grupos de pacientes (p < 0,001), apesar de não ter havido diferença significativa entre os grupos de pacientes. Conclusão Os pacientes com PANS bilateral eram mais jovens, tinham pior prognóstico e maior taxa de marcadores de resposta imunológica positiva. Os fatores de risco cardiovasculares parecem ter um papel importante na etiologia dos casos unilaterais, ao passo que essa importância não estava presente nos casos bilaterais.

Simultaneous idiopathic bilateral sudden hearing loss - characteristics and response to treatment.

INTRODUCTION: The aetiology of sudden hearing loss is poorly defined; however, infectious, vascular and neoplastic aetiologies are presumed to be responsible. In addition, the aetiology of bilateral sudden hearing loss is also unknown. OBJECTIVE: The objective of this study is identify the characteristics and treatment response of simultaneous bilateral sudden hearing loss. METHODS: This is a case-control study that practised in tertiary care academic centre. 132 patients with sudden hearing loss who were treated with systemic steroid and hyperbaric oxygen together were included. 26 patients had bilateral sudden hearing loss and 106 patients had unilateral sudden hearing loss. Patients were evaluated with clinical, audiological and radiological examinations and laboratory tests were done. Findings and response to treatment of the patients were compared. RESULTS: The mean ages of patients with unilateral and bilateral sudden hearing loss were 42.0 years and 24.5 years respectively with a statistically significant difference (p<0.001). Immune response markers were more prevalent in bilateral sudden hearing loss. Pre-treatment audiologic thresholds were 69.1dB for unilateral sudden hearing loss and 63.3dB for the left ears and 67.6dB for the right ears for bilateral sudden hearing loss without significant difference. Post-treatment average hearing threshold in unilateral sudden hearing loss was 47.0dB and 55.4dB for the left ears and 59.0 for the right ears in bilateral sudden hearing loss. Average hearing improvement in unilateral sudden hearing loss group was significant (p<0.001) in spite of it was not significant in bilateral sudden hearing loss group for both ears. Between the groups; there was a significant difference for hearing improvement favouring unilateral sudden hearing loss (p<0.001). Tinnitus scores decreased significantly in both groups of patients (p<0.001) in spite of there was no significant difference between the groups of patients. CONCLUSION: Patients with bilateral sudden hearing loss showed lower age, worse prognosis and higher rate of positive immune response markers. Cardiovascular risk factors seem to have an important role in the aetiology of unilateral cases whereas this importance was not present in bilateral ones.

Differences of the Voice Parameters Between the Population of Different Hearing Tresholds: Findings by Using the Multi-Dimensional Voice Program.

OBJECTIVES: To compare voice parameters in subjects with different hearing level. METHODS: The evaluation consisted of Multi-Dimensional Voice Program (MDVP) and electroglottography. Group 1 consisted of normal hearing subjects which is bilateral average hearing better than 25 decibels (dB) whereas group 2 consisted of patients who have bilateral average hearing between the 25 and 60 dB and group 3 consisted of patients who have bilateral average hearing between the 60 and 90 dB. The evaluations were performed on males and females separately. RESULTS: In female subjects, fundamental frequency (F0), absolute jitter, %jitter and soft phonation index (SPI) were significantly different between the group 1 and group 2. Also, we detected significant difference on maximum phonation time (MPT), fundamental frequency, absolute jitter and %jitter, and variable F0 (vF0) values between group 1 and group 3. Male subjects demonstrated significant difference between the group 1 and group 2 in MPT, absolute jitter, %jitter, vF0, and SPI parameters. Between the group 3 and group 1; differences in absolute jitter, %jitter, shimmer, %shimmer, vF0, and SPI were also significant. CONCLUSION: This study concluded that even mild to moderate hearing losses may affect voice patterns in adults and also females and males react differently to hearing loss in some parameters.

The Anatomical Relationship Between Recurrent Laryngeal Nerve and First Tracheal Ring in Males and Females.

OBJECTIVES: Despite the modern advances in thyroid surgery, recurrent laryngeal nerve (rln) paralysis is still a critical problem. In order to decrease the rate of this complication, rln anatomy has been studied intensively. In our study, we aimed to recognize the relationship of rln and landmarks of the first tracheal ring. METHODS: Eighty-six female and 18 male patients who were undergone total thyroidectomy were included in this study. Trachea vertical height (tvh), right recurrent laryngeal nerve height (rrh), left recurrent laryngeal nerve height (lrh), right recurrent laryngeal nerve to trachea anterior face median raphe distance (rrd), left recurrent laryngeal nerve to trachea anterior face median raphe distance (lrd), right recurrent laryngeal nerve respect to trachea ratio (rrtr), and left recurrent laryngeal nerve respect to trachea ratio (lrtr) parameters of all patients were measured and compared in males and females using independent t-test and measurements on both right and left sides were compared statistically without sex discrimination. RESULTS: There were no significant differences between groups in tvh, rrh, rrd, lrd, rrtr, and lrtr parameters. Lrh parameter was significantly higher in males than in females (P<0.04). Comparison of right and left sides revealed that lrh was significantly higher than rrh (P<0.001), lrd was significantly higher than rrd (P<0.001), and rrtr was significantly higher than lrtr (P<0.001). CONCLUSION: In this study, we have shown that in all cases the rln was located around the lower half of trachea vertical length and at this level left rln was located significantly deeper than the right side.

Detection of incidental pulmonary embolism with multi-slice computed tomography in cancer patients.

The aim of this study is to show the frequency of incidentally found (pulmonary thromboembolism) PTE in oncological patients and evaluate dispersion of incidents in terms of underlying primary tumor and seek risk factors associated with incidental PTE. Among one thousand oncology patients, 46 (4.6%) individuals found to have incidental PTE. Of positive patients, the highest proportion (24%) was belong to breast cancer group (n=11). The most common location for pulmonary emboli was the lower lobe branch of right pulmonary artery (n=33, 71.7%). Evident PTE had not been reported in final radiology reports of 21 cases.

Early postoperative recovery after intracranial surgical procedures. Comparison of the effects of sevoflurane and desflurane.

PURPOSE:: To compared the effects of sevoflurane and desflurane on early anesthesia recovery in patients undergoing to craniotomy for intracranial lesions. METHODS:: After IRB approval, the study included 50 patients aged 18-70 years who had ASA physical statuses of I-II and were scheduled for intracranial surgery. Patients were randomly divided into two groups: sevoflurane and desflurane. Anaesthesia was routinely induced in all patients followed by desflurane 5%-6% or sevoflurane 1%-2%. Moreover remifentanil infusion (0.05-0.2 mcg/kg/min) was adjusted to maintain mean arterial pressure (MAP) within 20% baseline and heart rate <90 bpm. Postoperatively, patients were evaluated over time for responses to painful stimulus, eye opening, hand squeezing, extubation, orientation and time required to achieve a Modified Aldrete Score of 9-10. Parametric and non-parametric data were assessed using Student's t- and Mann-Whitney U tests, respectively. A p<0.05 was taken as statistically significant. RESULTS:: The times to responses to painful stimuli (7.7±2.7 vs. 4.8±1.7 min.; p<0.001), emergence (9.5±2.81 vs. 6.3±2.2 min.; p<0.001), hand-squeezing (12.1±2.9 vs. 8.2±2.3 min.; p<0.001), extubation (10.1±2.87 vs. 7.1±1.6 min.; p<0.001), orientation (15.3±3.2 vs. 10.3±2.7 min.; p<0.001) and Aldrete score of 9-10 (23.3±6.1 vs. 15.8±3.8 min.; p<0.001) were significantly lower with desflurane-based anaesthesia vs. sevoflurane-based anaesthesia. CONCLUSION:: Desflurane yields early recovery functions and facilitates early postoperative neurologic examinations of intracranial surgery patients.

Early postoperative recovery after intracranial surgical procedures. Comparison of the effects of sevoflurane and desflurane

ABSTRACT PURPOSE: To compared the effects of sevoflurane and desflurane on early anesthesia recovery in patients undergoing to craniotomy for intracranial lesions. METHODS: After IRB approval, the study included 50 patients aged 18-70 years who had ASA physical statuses of I-II and were scheduled for intracranial surgery. Patients were randomly divided into two groups: sevoflurane and desflurane. Anaesthesia was routinely induced in all patients followed by desflurane 5%-6% or sevoflurane 1%-2%. Moreover remifentanil infusion (0.05-0.2 mcg/kg/min) was adjusted to maintain mean arterial pressure (MAP) within 20% baseline and heart rate <90 bpm. Postoperatively, patients were evaluated over time for responses to painful stimulus, eye opening, hand squeezing, extubation, orientation and time required to achieve a Modified Aldrete Score of 9-10. Parametric and non-parametric data were assessed using Student's t- and Mann-Whitney U tests, respectively. A p<0.05 was taken as statistically significant. RESULTS: The times to responses to painful stimuli (7.7±2.7 vs. 4.8±1.7 min.; p<0.001), emergence (9.5±2.81 vs. 6.3±2.2 min.; p<0.001), hand-squeezing (12.1±2.9 vs. 8.2±2.3 min.; p<0.001), extubation (10.1±2.87 vs. 7.1±1.6 min.; p<0.001), orientation (15.3±3.2 vs. 10.3±2.7 min.; p<0.001) and Aldrete score of 9-10 (23.3±6.1 vs. 15.8±3.8 min.; p<0.001) were significantly lower with desflurane-based anaesthesia vs. sevoflurane-based anaesthesia. CONCLUSION: Desflurane yields early recovery functions and facilitates early postoperative neurologic examinations of intracranial surgery patients.

A case of oculoglandular tularemia resistant to medical treatment.

Tularemia is a zoonotic disease of the northern hemisphere. Oculoglandular tularemia is the rarest form, comprising 1.4-4.2% of all cases. We present a patient with oculoglandular tularemia that did not respond to gentamicin to demonstrate the need for prolonged antimicrobial treatment and surgical intervention.

Laryngeal foreign body mimicking croup.

Foreign body aspiration can be a fatal problem in all groups of ages. However, it is a leading cause of accidental deaths in children. Especially in the pediatric age group, diagnosis can be delayed because of various challenges. Children younger than 3 years carry the highest risk, as they are inclined to explore objects with their mouths. In most cases of inhaled foreign body, a positive history of aspiration is obtained. We are reporting a case of laryngeal foreign body that is mistreated for 1 week as a croup syndrome.

Rapidly progressive thyroid mass: amyloid goiter.

Amyloidosis is a disease of unknown etiology characterized by the accumulation of an amorphous proteinaceous material in various organs and tissues of the body. Amyloid goiter is an exceedingly rare pathologic condition due to massive amyloid infiltration of the thyroid tissue. Amyloid goiter occurs in association with both primary and secondary systemic amyloidosis, more commonly in the latter. Preoperatively, it simulates a multinodular goiter, and surgical intervention is often necessary to establish a diagnosis and to relieve compressive symptoms of a neck mass. We present the case of an 85-year-old female patient who presented with a rapidly enlarging goiter. Histologic examination confirmed amyloid goiter.