Test-retest reliability and discriminatory power of multidimensional voice analysis program.

OBJECTIVES: The objectives of this study were to evaluate and compare the test-retest reliability of acoustic parameters (jitter [%], shimmer [%], noise-to-harmonic ratio [NHR], and voice turbulence index [VTI]) by using multidimensional voice program, and to detect the discriminatory power of the acoustic measures with respect to dysphonic voices and normal voices. DESIGN, SETTING, PARTICIPANTS, AND METHODS: Fifty-four (25 male and 29 female) participants with voice disorders and fifty-one (27 male and 24 female) participants with normal voices were enrolled in this study. They were assessed by anamnesis, visual examination, auditory perceptual assessment (GRBAS), and acoustic measurements. The intraclass correlation coefficient was used to determine the test-retest reliability. The effect size (d value) and p value obtained from the t-test were used to determine the discriminatory power. RESULTS: In the normal group, good reliability was observed for jitter, shimmer, and NHR, and moderate reliability was observed for VTI. With regard to the dysphonic group, jitter, shimmer, and VTI were moderately reliable, and the NHR had good reliability. Meanwhile, the discriminatory powers of jitter and shimmer were evaluated as 'medium', and those of NHR and VTI as 'small'. CONCLUSION: The reliability and discriminatory powers of our acoustic measures were high compared with most other studies. Their level of reliability and discriminatory power can be maximised by using stringent rules. However, attaining an excellent level of reliability and discriminatory seems infeasible power owing to the variable characteristic of voice. Therefore, acoustic measures should be adopted as a complementary tool.

Revision of cartilage tympanoplasty with endoscopic butterfly inlay myringoplasty.

PURPOSE: While the use of cartilage graft for revision tympanoplasty is quite common, the data on the revision of cartilage tympanoplasty are limited. Our study aims to present the results of our patients who underwent endoscopic butterfly inlay myringoplasty for the revision of cartilage tympanoplasty. METHODS: Demographic data, ear sides, perforation locations, graft success rates and hearing results of the patients who underwent endoscopic butterfly inlay myringoplasty for revision of cartilage tympanoplasty between Sep 2017 and Jan 2020 were evaluated. RESULTS: A total of 17 patients with 7 (41%) females and 10 (59%) males were included in our study. Eight of the ears (47%) were right and nine (53%) were left. Perforation locations included ten (59%) anterior, six (35%) inferior, and one (6%) posterior. The graft success rate of our study was 100%. No changes were observed in post-operative air conduction, bone conduction and air-bone gap values compared to the pre-operative period (p > 0.05). CONCLUSIONS: Endoscopic butterfly inlay myringoplasty for the revision of cartilage tympanoplasty is considered to be a safe surgical technique with satisfactory anatomical and hearing results.

Comparison of Quality of Life Before and After Septoplasty With Short Form-36.

The authors aimed to evaluate quality of life after septal surgery with Short Form-36 survey, and the effectiveness of the survey. Nasal symptoms (nasal obstruction, facial pain, catarrh), and general quality of life (using the Turkish version of the Short Form-36 questionnaire) were assessed preoperatively and at 1st and 6th postoperative months. Acoustic rhinometry and rhinomanometry were assessed preoperatively and at 6th postoperative month. Data from 78 patients were analyzed. This prospective clinical study was conducted on patients complaining of nasal obstruction with nasal septal deviation. Seventy-eight patients were included in the study. Fourty-two patients (53.8%) were male and 36 patients (46.2%) were female. At 1st postoperative month, nasal obstruction, facial pain and catarrh scores significantly improved in all, 46, 18 patients, respectively (P < 0.0001). At 6th postoperative month, scores nonsignificantly worsened by 1 point in 12, 6, 12 patients, respectively. Nasal volume significantly increased and total resistance significantly decreased at 6th month (P < 0.0001). Compared to preoperative values, all items except social function and bodily pain significantly increased at 1st postoperative month. Compared to values at 1st postoperative month, only bodily pain score decreased at 6th postoperative month. One patient presented with septal perforation. Septoplasty is a well-established technique to reduce nasal obstruction and improve quality of life. SF-36 may be used as a reliable measure of changes in quality of life after septal surgery.

Bilateral same-day endoscopic tympanoplasty.

PURPOSE: Although bilateral same-day tympanoplasty is a faster and more comfortable procedure for patients, it is rarely performed due to its theoretical risks. The present study aims to evaluate the results of patients who underwent bilateral same-day endoscopic tympanoplasty. MATERIALS AND METHODS: In this study, 26 patients and 52 ears were evaluated. Postoperative anatomic success rate, pre- and postoperative hearing test results, hearing gains and postoperative complications were recorded. RESULTS: Postoperative anatomic success rate was 92.3% (48/52). Audiological tests revealed the preoperative air-bone gap (ABG) as 19.1 ± 8.8 (7-35) dB and postoperative ABG as 9.8 ± 5.7 (5-25) dB. Postoperative ABG decreased significantly (p: <0.001) and 9.2 ± 4.6 (2-23) dB hearing gain was obtained. We did not observe any significant complications. CONCLUSION: Bilateral same-day endoscopic tympanoplasty is a feasible surgical procedure with good anatomic and functional outcomes, low complication rate and good postoperative patient comfort.

Endoscopic type 1 cartilage tympanoplasty in children.

OBJECTIVES: Endoscopic type 1 tympanoplasty using cartilage grafts for repair of chronic tympanic membrane perforation is increasing. The aim of this study was to evaluate the results of endoscopic type 1 cartilage tympanoplasty in children. MATERIALS AND METHODS: Patients under 18 years of age who underwent type 1 cartilage tympanoplasty between January 2013 and February 2019 were retrospectively evaluated. Anatomic success rate was calculated according to the intact status of the graft. Air conduction (AC), bone conduction (BC), air-bone gap (ABG) and hearing gain were calculated using pure tone audiometry tests at pre-operative, and 6th month postoperative period. Patients with postoperative ABG ≤20 dB were considered as functionally successful. RESULTS: The study included 56 patients (6 bilateral) and 62 ears. The anatomic success rate of our study was 91.9% (57/62). Preoperative AC was 36.4 ± 6.5 (21-50) dB, BC was 7.8 ± 3.7 (5-25) dB, and ABG was 28.6 ± 6.9 (10-41) dB. Postoperative AC was 24.5 ± 8.8 (7-45) dB, BC was 7.6 ± 3.4 (5-19) dB, and ABG was 16.9 ± 7.4 (2-32) dB. There was no change in postoperative BC (p: 0.683), whereas AC, and ABG significantly decreased (p < 0.001). Mean hearing gain was 12.1 ± 6.2 (3-26) dB and the functional success rate was 72.5% (45/62). CONCLUSION: Endoscopic type 1 cartilage tympanoplasty, a minimally invasive surgical procedure, provided successful functional and anatomical results at the pediatric population.

Endoscopic butterfly inlay myringoplasty for large perforations.

PURPOSE: Nowadays, the use of otoendoscopy is becoming increasingly popular in ear surgery. Data on endoscopic tympanoplasty are quite current but not yet sufficient. This study aims to present the anatomical and functional results of endoscopic butterfly inlay myringoplasty in large perforations. METHODS: The graft success rates and audiological outcomes of 26 ears of 23 patients who underwent endoscopic cartilage inlay myringoplasty due to large perforation (more than two-thirds of the area of tympanic membrane) from March 2016 to August 2018 were evaluated. RESULTS: The mean follow-up period was 13.3 ± 7.1 (6-32) months. Graft success rate was 96% (25/26 ears). The preoperative mean air-bone gap (ABG) was 21.4 dB and postoperative mean was 14.4 dB. Significant improvement was observed in postoperative air-bone gap values compared to preoperative period (p 0.005). CONCLUSIONS: Endoscopic inlay butterfly myringoplasty is a safe surgical technique and has satisfactory anatomic and audiological outcomes in large tympanic perforations.

Otologic Findings Based on no Complaints in a Pediatric Examination

Abstract Introduction the otological evaluation is highly significant in those branches of medicine in which the general evaluation of the patient is conducted by general practitioners and pediatricians. Objectives To investigate the otologic findings and their incidences in the sample, which consisted of patients who presented to the pediatric outpatient clinic with nonotologic complaints. Methods Patients, aged between 2 and 16 years, who had neither otorhinolaryngological complaints nor history of surgery by the otolaryngology (ear, nose and throat, ENT) department were included in the present study. The findings detected in the external auditory system and in the tympanic membranes as well as the otorhinolaryngologists' otologic examination findings of the referred patients were recorded from the files of each patient along with the applied medical and surgical treatments, and diagnostic investigations. Results Of a total of 973 patients evaluated, 129 (13.2%) were referred to the ENT outpatient clinic due to any otologic pathology. In the otorhinolaryngological examinations, false positivity was detected in 12 (1.2%) patients, and pathological findings were detected in 117 (12%) patients who received the following diagnoses: 68 (6.9%) had otitis media with effusion(OME); 37 (3.8%) had cerumen impactions; 8 (0.8%) had acute otitismedia (AOM); 2 (0.2%) had ticks in the external auditory canal; 2 (0.2%) had a retraction pocket in tympanic membrane; 1 (0.1%) had unilateral central dry perforation of the tympanic membrane; and 1(0.1%) had congenital cholesteatoma. Conclusion Any complications and sequelae that may develop due to any pathologies and predominantly infections can be prevented by an early diagnosis, which can be made by means of a simple examination, performed merely with an otoscope. Pediatricians and general practitioners should be in close contact with otorhinolaryngologists regarding the pathologies they identify. (AU)

Otologic Findings Based on no Complaints in a Pediatric Examination.

Introduction the otological evaluation is highly significant in those branches of medicine in which the general evaluation of the patient is conducted by general practitioners and pediatricians. Objectives To investigate the otologic findings and their incidences in the sample, which consisted of patients who presented to the pediatric outpatient clinic with non-otologic complaints. Methods Patients, aged between 2 and 16 years, who had neither otorhinolaryngological complaints nor history of surgery by the otolaryngology (ear, nose and throat, ENT) department were included in the present study. The findings detected in the external auditory system and in the tympanic membranes as well as the otorhinolaryngologists' otologic examination findings of the referred patients were recorded from the files of each patient along with the applied medical and surgical treatments, and diagnostic investigations. Results Of a total of 973 patients evaluated, 129 (13.2%) were referred to the ENT outpatient clinic due to any otologic pathology. In the otorhinolaryngological examinations, false positivity was detected in 12 (1.2%) patients, and pathological findings were detected in 117 (12%) patients who received the following diagnoses: 68 (6.9%) had otitis media with effusion(OME); 37 (3.8%) had cerumen impactions; 8 (0.8%) had acute otitis media (AOM); 2 (0.2%) had ticks in the external auditory canal; 2 (0.2%) had a retraction pocket in tympanic membrane; 1 (0.1%) had unilateral central dry perforation of the tympanic membrane; and 1(0.1%) had congenital cholesteatoma. Conclusion Any complications and sequelae that may develop due to any pathologies and predominantly infections can be prevented by an early diagnosis, which can be made by means of a simple examination, performed merely with an otoscope. Pediatricians and general practitioners should be in close contact with otorhinolaryngologists regarding the pathologies they identify.

The course of lower cranial nerves within the neck: a cadaveric dissection study.

PURPOSE: To evaluate the course of lower cranial nerves (CNs) within the neck in relation to surrounding structures and anatomic landmarks via a cadaveric dissection study. METHODS: A total of 70 neck dissections (31 bilateral, 8 unilateral) were performed on 39 adult fresh cadavers [mean (SD) age: 38.5 (11.2) years, 29 male, 10 female] to identify the course of lower CNs [spinal accessory nerve (SAN), vagus nerve and hypoglossal nerve] within the neck in relation to surrounding structures [internal jugular vein (IJV), common carotid artery (CCA)] and distance to anatomical landmarks (cricoid cartilage, hyoid bone, digastric muscle). RESULTS: SAN travelled most commonly anterior to IJV (51.4%) at the level of jugular foramen, while travelling lateral to IJV at the post belly of digastric (55.7%) and inferior to digastric muscle (90%) in most neck dissections. Vagus nerve travelled lateral to CCA in majority (94.3%) of dissections, while medial (2.9%), posterolateral (1.4%) and posterior (1.4%) positions were also noted. Average distance of hypoglossal nerve was 27.7 (9.7) mm to carotid bifurcation, 9.3 (3.9) mm to hyoid bone, and 54.7 (18.0) mm to the inferior border of cricoid cartilage. CONCLUSION: In conclusion, our findings indicate that anatomic variations are not rare in the course of lower CNs within the neck in relation to adjacent structures, and awareness of these variations together with knowledge of distance to certain anatomic landmarks may help the surgeon to identify lower CNs during neck surgery and prevent potential nerve injuries.

Effects of gadolinium-based contrast agents on submandibular gland tissue in rats.

AIM: The aim of this prospective animal study is to investigate the influence of multiple administrations of macrocyclic ionic (gadoteric acid) and linear nonionic (gadodiamide) gadolinium-based contrast agents (GBCA) on submandibular gland tissue (SGT) of the rats. MATERIAL AND METHOD: Twenty-four Sprague Dawley female rats were included the study. Group 1 was determined as a control group (n = 6). Group 2 was determined as saline group (n = 6). Group 3 was determined as Omniscan group (n = 6) and received only intraperitoneal (IP) 0.1 mmol (0.2 mL/kg)/kg gadodiamide for 8 days. Group 4 was determined as Dotarem group (n = 6) and received only IP 0.1 mmol (0.2 mL/kg)/mg/kg gadoteric acid daily for 8 days. On the 9th day of the administration, the rats were sedated with ketamine and xylazine through IP injection. The right SGT was removed after sedation. Histopathological and immunohistochemical changes in SGT were evaluated. RESULTS: The SGT of the Omniscan and Dotarem groups decreased SGT acini surface area, and serous acinar cells number were observed. On the other hand, no pathology was observed. Mucous acinar cells' caspase-3 positivity for the same markers in Omniscan and Dotarem sections was similar to the control group. However, Omniscan and Dotarem groups serous acinar cells were caspase-3 (+) staining. The intensity of serous acinar cells' caspase-3 (+) for the same markers in Dotarem sections was similar to the Omniscan group. The results also revealed in the analysis of the mean area of the acinus area of the SGT; there were significantly decreased Dotarem group rats when compared to control rats (p < 0.05). CONCLUSION: We consider that numerical increased apoptosis results arise from repeated doses of GBCAs. Being aware of this effect of the contrast agent may have significance for the chronic sialo-adenitis patients group when used for recurrent contrasted MRI for diagnosis of diseases like MS which requires in follow-up. We should be aware about the frequently contrasted MRI in routine investigations.

Mechanism of action of allergen immunotherapy.

BACKGROUND: Allergen immunotherapy (AIT) leads to the production of antiallergen immunoglobulin (IgG) or "blocking antibody" in the serum and an increase in antiallergen IgG and IgA in nasal secretions. There is also a decrease in the usual rise in antiallergen IgE that occurs after the pollen season. METHODS: In this paper, mechanisms of action of allergen immunotherapy is reviewed. RESULTS: Regulatory T (Treg) cells and their cytokines, primarily interleukin (IL) 10 and transforming growth factor beta, suppress T-helper type 2 immune responses and control allergic diseases in many ways. AIT induces a shift in the proportion of IL-4-secreting T-helper type 2 cells in favor of IL-10-secreting inducible Treg cells specific for the same allergenic epitope that increases in number and function. Different types of inducible Treg control several facets of allergic inflammation. There are two main types of immunotherapy: subcutaneous immunotherapy and sublingual immunotherapy. Subcutaneous immunotherapy is efficacious and is indicated for the reduction of seasonal symptoms. Sublingual immunotherapy involves the regular self-administration and retention of allergen extract under the tongue for 1-2 minutes before the extract is swallowed. The allergens cross the mucosa in 15-30 minutes and are then captured by tolerogenic dendritic cells and processed as small peptides. Next, via the lymphatic system, a systemic immune response is created to produce an early decrease in mast cell and basophil degranulation. CONCLUSION: AIT is indicated for the treatment of moderate-to-severe intermittent or persistent symptoms of allergic rhinitis. AIT can be administered to those >5 years of age and has been shown to be safe in children as young as 3 years of age. In this article, AIT and other types of immunotherapies were discussed as well as the indications for immunotherapy.

High sensitization to house-dust mites in patients with allergic rhinitis in the eastern Black Sea region of Turkey: A retrospective study.

OBJECTIVES: Identification of the most common aeroallergens to which patients are sensitized in a specific area is important in the diagnosis and treatment of allergic rhinitis (AR). We determined the distribution of aeroallergens, detected by skin-prick tests (SPT), in adult patients with AR in the Eastern Black Sea region of Turkey and compared the results with the other regions of Turkey and in the world. METHODS: The medical records of SPT performed on 1457 patients with symptoms of AR (with regard to the Allergic Rhinitis and its Impact on Asthma 2008 guidelines) between March 2010 and March 2013 were analyzed retrospectively. SPT were carried out with the same panel, which included grass; weeds; trees; mold; epidermal mixtures; and with two house-dust mite (HDM) extracts, Dermatophagoides pteronyssinus and Dermatophagoides farinae. RESULTS: In 1229 of 1457 patients (84.4%), there were positive reactions for at least one aeroallergen on the SPT. The most common aeroallergen was the HDM D. pteronyssinus (84% [n = 1033]) followed by D. farinae (78.2% [n = 962]). Grass pollen sensitivity (70.8% [n = 871]) was higher than tree or weed pollen sensitivity in this region. CONCLUSIONS: The most common aeroallergens in AR are HDMs of D. pteronyssinus and D. farinae in the Eastern Black Sea region in Turkey. Our study may help in developing environmental control strategies for AR.

Endoscopic transcanal stapes surgery: our technique and outcomes.

OBJECTIVES: This study aims to evaluate the outcomes of endoscopic stapes surgery in terms of hearing gain and complications. PATIENTS AND METHODS: The medical records of 31 patients (13 males, 18 females; mean age 41.5±8.6 years; range 23 to 60 years) who underwent endoscopic stapes surgery in our clinic between April 2013 and June 2015 were retrospectively analyzed. The mean preoperative and postoperative pure tone bone conduction, air-bone gap, postoperative air-bone gap gain, duration of surgery and complications were evaluated. RESULTS: The right ear was operated on 15 patients and the left ear on 16 patients. The mean postoperative air-bone gap was statistically significantly improved, compared to preoperative values (p<0.001). The mean air-bone gap gain was 25.5±7.0 dB. CONCLUSION: Our study results suggest that endoscopy is a safe method which can be used in stapes surgery.

Vestibular evoked myogenic potentials in patients with ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease with unknown etiology. Although sacroiliac joint involvement is the classic sign along with the formed immune mediators, it may result in immune-mediated inner ear disease and may cause damage to the audiovestibular system. Vestibular evoked myogenic potentials (VEMP) is a clinical reflex test used in the diagnosis of vestibular diseases and is performed by recording and evaluating the muscle potentials resulting from the stimulation of the vestibular system with different stimuli. The aim of this study is to evaluate the cervical VEMP test results in AS patients without vestibular symptoms. Thirty-three patients with AS and a control group of 30 healthy volunteers with similar demographic characteristics were evaluated in the study. VEMP wave latency, P13-N23 wave amplitude, and VEMP asymmetry ratio (VAR) values were compared between the groups. The relationship between clinical and laboratory findings of the AS patients and VEMP data were also investigated. Compared with healthy people, this study shows the response rate of patients with ankylosing spondylitis was reduced in the VEMP test, and P13-N23 wave amplitude showed a decrease in AS patients who had VEMP response (p < 0.001). There was no correlation between the clinical and laboratory findings and VEMP findings in patients with ankylosing spondylitis. The data obtained from this study suggest that AS may lead to decreased sensitivity of the vestibular system.

Endoscopic butterfly cartilage myringoplasty.

CONCLUSION: Based on the results of this study, it is believed that, in appropriate patients with tympanic membrane perforation, the endoscopic butterfly cartilage myringoplasty can be applied, with a shorter operation time, high graft success rate, and low risk of complications. OBJECTIVE: The aim of this study was to evaluate the results of the endoscopic butterfly cartilage myringoplasty in terms of the graft success rate and hearing gain. METHODS: Forty-five ears of the 42 patients who were subjected to endoscopic butterfly cartilage myringoplasty surgery between January 2013 and December 2014 were included in this study. The archival records of the patients were reviewed retrospectively, evaluating the pre-operative and post-operative hearing results and post-operative graft success rates in the early and late periods. RESULTS: The graft success rates were 97.8% (44/45 ears) and 95.6% (43/45 ears) at the post-operative 1- and 6-month follow-ups, respectively. When the post-operative air conduction hearing thresholds were compared, significant improvement was seen at post-operative 1- and 6-month follow-ups in the hearing thresholds, when compared to the pre-operative levels (p < 0.001).

Acute airway compromise due to ruptured inferior thyroid artery aneurysm.

A cervical hematoma secondary to the spontaneous rupture of an aneurysm is an uncommon but catastrophic life-threatening condition because it can potentially obstruct the airway. Inferior thyroid artery aneurysm and rupture is a very rare clinical entity and only a limited number of cases have been reported in the literature. In this article, we present the case of a female patient who suffered from a rapidly enlarging cervical mass followed by a rapid onset of dyspnea as a result of rupture of an inferior thyroid artery aneurysm. The diagnosis was confirmed by magnetic resonance angiography, and delayed surgery resulted in an uneventful outcome. We aim to draw the attention of emergency physicians to this rare condition.

Prevalence of Otitis Media with Effusion among Primary School Children in Eastern Black Sea, in Turkey and the Effect of Smoking in the Development of Otitis Media with Effusion.

The aim of this study was to determine the prevalence of otitis media with effusion (OME) in primary school children in Rize (Eastern Black Sea Region) and the impact of tobacco smoke exposure in the development of OME in primary school children. This study involved a total of 2960 children who appeal for ENT examination to our department at Rize Training and Research Hospital between November 2007 and April 2009. All children were evaluated with regard to OME and exposure to cigarette smoke. Pure tone audiometry and tympanometry tests and pneumatic otoscopy were performed on the children who were diagnosed with OME by otoscopic examination. The association between the children diagnosed as OME and exposure to cigarette smoke was evaluated. The prevalence of OME in this study was 9.86% (292/2960). Exposure to cigarette smoke was a statistically significant factor in development of OME (P < 0.0001). Environmental factors such as smoking are important in the development of OME. To prevent delayed diagnosis or development of this disease, parents must be informed about the preventable risk factors and symptoms for the development of OME.