Health-Related Quality-of-Life Outcomes after Transoral Robotic Surgery for T1 and T2 Supraglottic Laryngeal Carcinoma Compared to the Transcervical Open Supraglottic Approach.

INTRODUCTION: This prospective controlled study evaluated and compared health-related quality of life (HRQOL), after transoral robotic supraglottic laryngectomy (TORSGL) versus transcervical open supraglottic laryngectomy (TCOSGL) in patients with T1 and T2 supraglottic laryngeal carcinoma (SLC). METHODS: The TORSGL group comprised 14 patients, and the TCOSGL group comprised 13 patients. All 27 patients completed the European Organization for Research and Treatment of Cancer 30-item core quality-of-life questionnaire version 3.0 (EORTC QLQ-C30), the European Organization for Research and Treatment of Cancer head-and-neck cancer-specific module (EORTC QLQ-H&N35), before treatment and during the early and the late postoperative periods. RESULTS: The present prospective study demonstrated the near-term postoperative HRQOL of patients with T1 or T2 SLC treated with TORSGL (Group A) or TCOSGL (Group B). On comparison of EORTC QLQ-C30 data for the two groups in the early postoperative period, all functional subscale scores and global health status scores were statistically significantly lower (all p < 0.05) in Group A than in Group B and in the late postoperative period, other than the cognitive function score (p = 0.450), all functional subscale scores and global health status scores were statistically significantly lower (all p < 0.05) in Group A than in Group B. On comparison of the EORTC QLQ-H&N35 data for the two groups in the early postoperative period, except for the teeth problems scale score (p = 0.061), all symptom scale scores were statistically significantly lower in Group A than in Group B (all p < 0.05) and in the late postoperative period, the speech, social eating, social contact, and coughing scale scores were statistically significantly lower (p = 0,0215, p = 0.021, p = 0.01, p = 0.011, respectively) in Group A than in Group B. HRQOL parameters recovered in the late postoperative period in both groups; recovery was better in Group A. DISCUSSION/CONCLUSION: This study suggested that TORSGL may provide patients with a better HRQOL than those TCOSGL, especially in the early period, but also in the late period.

Comparação de métodos de tratamento tópico utilizados na epistaxe anterior recorrente: ensaio clínico randomizado / Comparison of topical treatment methods used in recurrent anterior epistaxis: a randomized clinical trial

Resumo Introdução: A epistaxe recorrente é uma doença comumente vista por especialistas em otorrinolaringologia, médicos de emergência e pediatras. O fato de que muitas modalidades de tratamento estejam sendo pesquisadas e nenhum método único de tratamento seja universalmente aceito apoiam ainda mais essa informação. Objetivo: Comparar a eficácia clínica do uso de pomada antisséptica tópica, pomada descongestionante tópica e tratamentos de cauterização química, que são frequentemente usados em epistaxe anterior recorrente, tanto isoladamente como em combinação. Método: Entre agosto de 2017 e fevereiro de 2018, 137 pacientes diagnosticados com epistaxe anterior recorrente foram divididos aleatoriamente em 5 grupos. O grupo I foi tratado com pomada antisséptica tópica, o grupo II com pomada descongestionante tópica, o grupo III foi submetido a cauterização química, o grupo IV foi tratado com pomada antisséptica tópica + cauterização química e o grupo V com pomada descongestionante tópica + tratamento de cauterização química. Todos os pacientes foram contatados por telefone 2 semanas e um mês após o tratamento e perguntados sobre a presença (falha) ou ausência (sucesso) de pelo menos um episódio de epistaxe. Pacientes com comorbidades foram excluídos. O sucesso do tratamento foi analisado estatisticamente. Resultados: Não houve diferença significante (p > 0,05) entre os grupos em relação à taxa de sucesso no 15° dia após o tratamento. Os grupos IV e V tiveram maiores taxas de sucesso no 30° dia após o tratamento em comparação com os grupo I e II (p < 0,05). No grupo III, o sucesso do tratamento no 30° dia não foi diferente dos outros 4 grupos (p > 0,05). Conclusão: Embora o número de pacientes que melhoraram com a cauterização química (grupo III) tenha sido maior em nosso estudo, nenhuma diferença significante foi observada nas modalidades de tratamento único (grupos I - III) no 14° dia e no 30° dia após o tratamento. Embora não tenha sido observada diferença estatisticamente significante entre os tratamentos combinados (grupos IV - V) e os tratamentos simples (grupos I - III) na 2ª semana após o tratamento, os tratamentos combinados foram significantemente mais eficazes no 1° mês.

Comparison of topical treatment methods used in recurrent anterior epistaxis: a randomized clinical trial.

INTRODUCTION: Recurrent epistaxis is a common medical problem faced by ENT specialists, emergency physicians, and pediatricians. The facts that many treatment modalities are being searched and no single treatment method is universally accepted yet support this information. OBJECTIVE: We aimed to compare the clinical efficacy of topical antiseptic ointment, topical decongestant ointment and chemical cauterization treatments, which are frequently used in recurrent anterior epistaxis, both singly and in combination. MATERIAL-METHODS: Between August 2017 and February 2018, 137 patients who were diagnosed with recurrent anterior epistaxis were randomly divided into 5 groups. group I received topical antiseptic ointment, group II received topical decongestant ointment, group III received chemical cauterization, group IV received topical antiseptic ointment + chemical cauterization and group V received topical decongestant ointment + chemical cauterization treatment. All patients were phoned 2 weeks and 1 month after the treatment and questioned about the presence (failure) or absence (success) of at least 1 episode of epistaxis. Patients with comorbid diseases were excluded. Treatment success was statistically analysed. RESULTS: There was no significant difference (p > 0.05) between the groups in the success rate at 15th day after treatment. Group IV and group V had higher success rates at 30th day after treatment compared with group I and group II (p < 0.05). In group III 30th day treatment success was not different from the other 4 groups (p > 0.05). CONCLUSION: Although the number of patients who improved with chemical cauterization (group III) was higher in our study, no significant difference was observed in single treatment modalities (group I‒III) at 14th day and 30th day after treatment. Although no statistically significant difference was observed between combined treatments (group IVV) and single treatments (group I‒III) in the 2nd week after treatment, combined treatments were significantly more effective in the 1st month.

Emotional and behavioral problems in children and adolescents with hearing loss and their effects on quality of life.

PURPOSE: Determination of mental functions in children with hearing loss is important in improving the quality of life of the child. Many scales have been developed for this purpose. In this study, it was aimed to determine the emotional and behavioral effects of both the child with hearing loss and the parent in the hearing loss and device process, and to investigate the effect of this situation on the quality of life. METHODS: Forty-five children aged 7-17 years with sensorineural hearing loss with audiometric methods and 32 healthy controls without hearing problem were included in the study. All children received a Powers-Weakness Questionnaire-Self-Reporting Scale, Strengths and Difficulties Questionnaire, Child Anxiety and Depression Scale, and Kid-KINDL Quality of Life Scale. In all parents, the Parental Statement of Powers-Weaknesses Questionnaire and the Kid-KINDL Quality of Life Scale parental form questionnaires were applied. RESULTS: In the patient group, both mother (p = 0.001) and father (p = 0.027) education levels were significantly lower than the control group. The success rate of the sick children was lower than that of healthy children (p = 0.013). According to the surveys, the quality of life scale and all subscales were significantly lower in the patient group than in the control group (p < 0.05 for each). Child depression inventory score was also significantly higher in the patient group (p = 0.005). CONCLUSIONS: Data obtained in the study indicate that children with hearing disabilities should be closely monitored and undergo a better rehabilitation process in terms of both anxiety and depression and their quality of life. According to our findings, since the parents of hearing-impaired children are observed to have a low level of education, it is seen that these families should be educated more closely in approaching children and improving their quality of life.

Anatomical Factors in Children with Orbital Complications Due to Acute Rhinosinusitis.

INTRODUCTION: The role of the anatomical variations and severity of acute rhinosinusitis (ARS) in the development of ARS complications is still an unknown issue. Regarding this, the present study evaluated the relationship between the severity of ARS and anatomical nasal variations in pediatric patients with ARS-related orbital complications. MATERIALS AND METHODS: This study was conducted on 134 pediatric patients with orbital complications related to ARS. The data related to patients' demographics, complication types, and involved side were collected. Nasal sides were also compared in terms of the Lund-Mackay score (LMS), osteomeatal complex (OMC) obstruction, Keros classification, presence of agger nasi cells (AGC), concha bullosa, Haller cells, Onodi cells, septal deviation, and lower turbinate hypertrophy. RESULTS: The comparison of LMSs indicated a significant difference between the complicated and contralateral sides (8.37±2.44 vs. 5.62±2.71; P<0.0001). In addition, there was a significant difference between the complicated and contralateral sides in terms of the OMC scores (P<0.0001). The rates of lower turbinate hypertrophy and AGC on the complicated side were higher than those on the contralateral side (P=0.021 and P<0.00; respectively). CONCLUSION: As the results indicated, anatomical variability in adjacent structures affects the development of ARS-related orbital complications in pediatric patients.

Infected Concha Bullosa with Fungus.

INTRODUCTION: Concha bullosa is the most common variation of the middle turbinate of the paranasal sinuses. When it causes nasal obstruction, osteomeatal unit dysfunction, or rarely chronic infection, surgery is required. CASE REPORT: We present a fungal infection of concha bullosa, which is a rare indication for surgery of the concha bullosa. A 59-year-old female patient presented with hemifacial pain on the right side, which had lasted for 2 months. There were no pathological findings in her endoscopic nasal examination. Advanced examination by paranasal computed tomography (CT) revealed bilateral concha bullosa variation and soft tissue density in the right concha bullosa. As the biopsy taken from concha bullosa demonstrated fungal hyphae, endoscopic surgical treatment was performed. CONCLUSION: We stress the importance of the CT in hemifacial pain by this rare case report, in which endoscopic nasal examination was normal. Fungal infection in the concha bullosa is rare, and infected concha bullosa is a pathology to be considered in the differential diagnosis in patients with complaints of hemicranial headache.

Does Pediatric Obstructive Sleep Apnea Syndrome Cause Systemic Microvascular Dysfunction?

The aim of this study was to evaluate whether pediatric obstructive sleep apnea syndrome (OSAS) secondary to adenoid hypertrophy causes systemic microvascular dysfunction. This is a prospective single-blinded case-control study. As the patient group, 81 patients diagnosed to have OSAS secondary to adenoid hypertrophy at our hospital between January 2016 and May 2016; as the control group, 26 healthy pediatric volunteers who presented to the hospital for health screening were included in this study. Three groups of OSAS patients were defined as mild, moderate, and severe respectively, according to the lateral nasopharynx x-ray. Patients with comorbid diseases were excluded from the study. For microvascular dysfunction, videocapillaroscopic evaluation was performed at the nailfold and capillary density (CD) and postocclusive reactive hyperemia (PORH) values were measured and statistical analysis between the groups was performed. The duration of complaints in all patients with OSAS was at least 6 months and <1 year. CD measurement in the control group and mild, moderate, and severe OSAS group was 94.1 ±â€Š7.9, 96.9 ±â€Š11, 94.7 ±â€Š8.4, and 93.7 ±â€Š9.4, respectively, with no significant difference between the groups (P > 0.05). PORH measurement in the control group and mild, moderate, and severe OSAS group was 95.6 ±â€Š8.6, 97.9 ±â€Š10.1, 96 ±â€Š8.7, and 93.9 ±â€Š9.3, respectively, with no significant difference between the groups (P > 0.05). OSAS secondary to adenoid hypertrophy in pediatric patients was demonstrated to cause no dysfunction in microvascular circulation and carried no cardiovascular risk in the early period.

Interobserver Consistency of Drug-Induced Sleep Endoscopy in Diagnosing Obstructive Sleep Apnea Using a VOTE Classification System.

OBJECTIVES: To explore the interobserver consistency of drug-induced sleep endoscopy (DISE) for patients with obstructive sleep apnea syndrome (OSAS) and review the current literature. METHODS: In total, 55 patients with an apnea-hypopnea index >5, as determined by on overnight sleep study, were included in this study, 45 males and 10 females, with an average age of 46.87 ±â€Š10.06 years old (range, 19-71). For all OSAS patients, DISE was performed by the same surgeon, which was recorded digitally. The video recordings of DISE were evaluated independently by 3 experienced surgeons who were asked to note his or her decisions as the pattern, site, and degree of upper airway collapse using a VOTE (velum, oropharynx lateral wall, tongue base, and the epiglottis) classification system. RESULTS: Interobserver consistency in the diagnosis of velum-related obstruction in anteroposterior, lateral, and concentric configurations ranged from poor to good. Only significant interobserver consistency among observers A and B was obtained in the diagnosis of oropharynx-related obstruction in the lateral configuration (concordance 60.0%, kappa: 0.365, P < 0.05). Interobserver consistency in the diagnosis of the tongue-related collapse in an anteroposterior configuration, the epiglottis-related collapse in an anteroposterior and lateral configuration ranged from fair to moderate (all kappa values >0.20, all P values < 0.05). CONCLUSION: Our data suggested that the interobserver consistency of DISE ranged from poor to good. Therefore, further studies with larger numbers of patients are needed to standardize DISE procedures, training, and interpretation.

Comparison of drug-induced sleep endoscopy and Müller's maneuver in diagnosing obstructive sleep apnea using the VOTE classification system / Comparação entre endoscopia com sono induzido por fármacos e manobra de Müller no diagnóstico de apneia obstrutiva do sono usando o sistema de classificação VOTE

Abstract Introduction: Knowledge of the site of obstruction and the pattern of airway collapse is essential for determining correct surgical and medical management of patients with Obstructive Sleep Apnea Syndrome (OSAS). To this end, several diagnostic tests and procedures have been developed. Objective: To determine whether drug-induced sleep endoscopy (DISE) or Müller's maneuver (MM) would be more successful at identifying the site of obstruction and the pattern of upper airway collapse in patients with OSAS. Methods: The study included 63 patients (52 male and 11 female) who were diagnosed with OSAS at our clinic. Ages ranged from 30 to 66 years old and the average age was 48.5 years. All patients underwent DISE and MM and the results of these examinations were characterized according to the region/degree of obstruction as well as the VOTE classification. The results of each test were analyzed per upper airway level and compared using statistical analysis (Cohen's kappa statistic test). Results: There was statistically significant concordance between the results from DISE and MM for procedures involving the anteroposterior (73%), lateral (92.1%), and concentric (74.6%) configuration of the velum. Results from the lateral part of the oropharynx were also in concordance between the tests (58.7%). Results from the lateral configuration of the epiglottis were in concordance between the tests (87.3%). There was no statistically significant concordance between the two examinations for procedures involving the anteroposterior of the tongue (23.8%) and epiglottis (42.9%). Conclusion: We suggest that DISE has several advantages including safety, ease of use, and reliability, which outweigh MM in terms of the ability to diagnose sites of obstruction and the pattern of upper airway collapse. Also, MM can provide some knowledge of the pattern of pharyngeal collapse. Furthermore, we also recommend using the VOTE classification in combination with DISE.

Resumo Introdução: O conhecimento do local da obstrução e do padrão de colapso das vias respiratórias é essencial para determinar o tratamento cirúrgico e clínico corretos de pacientes com Síndrome de Apneia Obstrutiva do Sono (SAOS). Para este fim, vários testes e procedimentos de diagnóstico foram desenvolvidos. Objetivo: Determinar se a Endoscopia de Sono Induzido por Fármacos (DISE) ou Manobra de Müller (MM) seria mais bem-sucedida na identificação do local de obstrução e do padrão de colapso das vias respiratórias superiores em pacientes com SAOS. Método: O estudo incluiu 63 pacientes (52 do sexo masculino e 11 do sexo feminino) que foram diagnosticados com SAOS em nossa clínica. As idades variaram de 30 a 66 anos e a idade média foi de 48,5 anos. Todos os pacientes foram submetidos a DISE e MM e os resultados destes exames foram caracterizados de acordo com a região/grau de obstrução, bem como a classificação VOTE. Os resultados de cada teste foram analisados de acordo com o nível das vias respiratórias superiores e comparados por análise estatística (teste estatístico kappa de Cohen). Resultados: Houve concordância estatisticamente significativa entre os resultados da DISE e MM para os procedimentos que envolvem configuração anteroposterior (73%), lateral (92,1%) e concêntrica (74,6%) do véu palatino. Os resultados da parte lateral da orofaringe também estavam em concordância entre os testes (58,7%). Os resultados da configuração lateral da epiglote estavam em concordância entre os testes (87,3%). Não houve concordância estatisticamente significativa entre os dois exames para os procedimentos que envolvem a parte anteroposterior da língua (23,8%) e epiglote (42,9%). Conclusão: Sugere-se que a DISE apresenta várias vantagens, como segurança, facilidade de uso e confiabilidade, que superam a MM em termos da capacidade de diagnosticar locais de obstrução e o padrão de colapso da via respiratória superior. O MM pode também fornecer algum conhecimento sobre o padrão de colapso da faringe. Além disso, recomendamos o uso da classificação VOTE em combinação com DISE.

Treatment of tongue base masses in children by transoral robotic surgery.

The feasibility and effectiveness of transoral robotic surgery (TORS) in children with tongue base masses (TBMs) were evaluated. Eight pediatric patients who were treated with TORS for TBMs between January 2010 and January 2016 at a tertiary hospital included in the study. All pathologies were congenital lesions: four were lingual thyroglossal ductus cysts (LTGDCs), one was a minor salivary gland tumor, one was a vallecular cyst, one was a bronchogenic cyst, and one was an ectopic thyroid tissue. TORS was performed successfully in all cases. The mean robotic set-up and exposure time was 13.0 ± 2.1 min (range 10-16 min) and the mean robotic surgery time was 8.8 ± 6.9 min (range 4-25 min). Estimated blood loss was lower than 5 ml for one patient and lower than 50 ml for another one. The remaining patients' estimated blood loss was lower than 10 ml. No patient required tracheostomy intra- or post-operatively. Only one minor complication occurred on day 10 after surgery (minor bleeding), which was resolved without intervention. No major complications or recurrence were observed. Better visualization and small, flexible arms allow surgeons to treat TBM faster and easily using TORS. This leads to decreased morbidity compared to open and transoral endoscopic/microscopic surgical methods. In the future, we believe that TORS may become the gold standard method for the treatment of pediatric TBM with continued development of robotic technology.

Comparison of drug-induced sleep endoscopy and Müller's maneuver in diagnosing obstructive sleep apnea using the VOTE classification system.

INTRODUCTION: Knowledge of the site of obstruction and the pattern of airway collapse is essential for determining correct surgical and medical management of patients with Obstructive Sleep Apnea Syndrome (OSAS). To this end, several diagnostic tests and procedures have been developed. OBJECTIVE: To determine whether drug-induced sleep endoscopy (DISE) or Müller's maneuver (MM) would be more successful at identifying the site of obstruction and the pattern of upper airway collapse in patients with OSAS. METHODS: The study included 63 patients (52 male and 11 female) who were diagnosed with OSAS at our clinic. Ages ranged from 30 to 66 years old and the average age was 48.5 years. All patients underwent DISE and MM and the results of these examinations were characterized according to the region/degree of obstruction as well as the VOTE classification. The results of each test were analyzed per upper airway level and compared using statistical analysis (Cohen's kappa statistic test). RESULTS: There was statistically significant concordance between the results from DISE and MM for procedures involving the anteroposterior (73%), lateral (92.1%), and concentric (74.6%) configuration of the velum. Results from the lateral part of the oropharynx were also in concordance between the tests (58.7%). Results from the lateral configuration of the epiglottis were in concordance between the tests (87.3%). There was no statistically significant concordance between the two examinations for procedures involving the anteroposterior of the tongue (23.8%) and epiglottis (42.9%). CONCLUSION: We suggest that DISE has several advantages including safety, ease of use, and reliability, which outweigh MM in terms of the ability to diagnose sites of obstruction and the pattern of upper airway collapse. Also, MM can provide some knowledge of the pattern of pharyngeal collapse. Furthermore, we also recommend using the VOTE classification in combination with DISE.

Impact of Laryngopharyngeal Reflux on the Levels of Depression and Anxiety in Patients With Obstructive Sleep Apnea Syndrome.

OBJECTIVES: The aim of the study was to assess the impact of the presence of laryngopharyngeal reflux (LPR) on the level of depression and anxiety in patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: A nonrandomized, prospective clinical study. METHODS: In total, 62 patients with an apnea-hypopnea index >5 were included in this study. Each patients completed the 21-item Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Epworth Sleepiness Scale (ESS), and Reflux Symptom Index (RSI). Patients were diagnosed with LPR based on laryngeal examination and symptom presentation, with RSI score >13. The patients were divided into 2 groups based on the presence of LPR. In group A, all patients were diagnosed with LPR. In group B, the patients had no diagnosis of reflux disease. RESULTS: The mean RSI was 3.86 ±â€Š2.46 in group B and 17.2 ±â€Š6.34 in group A. The mean ESS scores did not differ between the groups (P = 0.107). Mean BAI and BDI scores were both higher in group A than in group B (P = 0.016 and P = 0.011, respectively). There was no correlation between RSI and BAI scores (r = -0.237; P = 0.063), BDI scores (r = 0.191; P = 0.138), or ESS scores (r = 0.210; P = 0.102). A positive correlation was found between RSI and apnea-hypopnea index scores (r = 0.338; P = 0.007). CONCLUSION: The authors observed significantly higher levels of depression and anxiety in patients with LPR and OSAS. The authors suggest that the presence of LPR induces depression and anxiety in patients with OSAS and vice versa. Further studies involving larger numbers of patients are needed to confirm these initial findings.

Management of Laryngoceles by Transoral Robotic Approach.

OBJECTIVES: Laryngoceles are air-filled sacs which communicate with the laryngeal lumen. When filled with mucus or pus, they are called laryngomucoceles and laryngopyoceles, respectively. Transoral robotic surgery (TORS) is a new and remarkable technique that expands its usefullness in otorhinolaryngology. Conventional treatments for laryngoceles were previously performed using external approaches, with aesthetically unfavorable and less function-sparing results. Transoral laser microsurgical approaches for laryngoceles were seldom reported. It is aimed to present authors' clinical experience on laryngocele management with TORS which is a rather new technique. STUDY DESIGN: A retrospective patient serial. METHODS: Patients were evaluated for demographic data, type of lesion, reasons for hospital admittance, complaint duration, and previous surgery. Robotic surgery panel including anesthesia time, duration of surgery, need for tracheotomy, postoperative care, follow-up, and recurrence rates were also summarized. RESULTS: Six men (mean age 51.7 years; range 41-62) with laryngoceles underwent successful TORS. Dyspnea and hoarseness were the main complaints. Two patients had undergone previous laryngeal surgery due to laryngeal cancer, with no recurrence of malignancy at admittance for laryngocele. Three had simple laryngocele, 2 had laryngomucocele, and 1 had laryngopyocele. No laryngoceles recurred and no complication such as dysphonia or prolonged dysphagia occurred. CONCLUSION: Transoral robotic surgery was found superior in safety, technical feasibility and curative effectiveness, when compared with classical methods, especially due to absence of skin incisions. Surgical modalities for laryngocele excision should be directed toward a curative target including cosmetic and functional success, technical achievability, and surgically curative methods. Transoral robotic surgery provided all these features.

Multilevel Combined Surgery With Transoral Robotic Surgery for Obstructive Sleep Apnea Syndrome.

OBJECTIVE: To evaluate the results of combined multilevel surgery with transoral robotic surgery (TORS) in patients with obstructive sleep apnea/hypopnea syndrome for multilevel upper airway obstruction. METHODS: Subjects who underwent combined sleep surgery via TORS were evaluated. The drug-induced sleep endoscopy was used in diagnosing the presence of level-specific upper airway collapse and to detect the type of surgery. Pre- and postoperative Apnea-hypopnea index, Epworth sleepiness scale lowest oxygen saturation, total operation time, robotic set-up time and robotic surgery time, blood loss value, and complications were recorded. RESULTS: Twenty five subjects were identified. All subjects underwent base of tongue (BOT) + epiglottoplasty. The tracheotomy was not performed for any patient. Overall, 72% of patients met the criteria for cure, 8% met the criteria for cure, and 20% of patients met the criteria for failure. There was a significant decrease between preoperative and postoperative Apnea-hypopnea index scores (28.7 ±â€Š17.8 SD versus 9.4 ±â€Š12.4, P = 0.000) and Epworth sleepiness scale scores (13.5 ±â€Š2.8 versus 3.4 ±â€Š1.6, P = 0.000). There was a significant increase between preoperative and postoperative ED SPO2 levels (80.7 ±â€Š7.6 versus 82.6 ±â€Š18.1, P = 0.001). CONCLUSION: TORS BOT, epiglottoplasty, and multilevel procedures in patients with obstructive sleep apnea/hypopnea syndrome can be regarded as feasible, safe, and effective technique.

Etiological classification of presbycusis in Turkish population according to audiogram configuration.

OBJECTIVES: This study aims to classify age related hearing loss in Turkish population according to Schuknecht audiometric configurations for presbycusis and investigate the most common etiologies. PATIENTS AND METHODS: A total of 1,134 patients (568 males, 566 females; mean age 70.5±7.7 years; range 55 to 80 years) with age related hearing loss were included in the study. Audiograms of patients were classified into three categories: high frequency steeply sloping (HFSS), flat, and high frequency gently sloping (HFGS). Speech discrimination scores were evaluated and compared. RESULTS: In the study population, HFSS audiogram configuration was the most frequently observed (48.5%), followed by HFGS configuration (26.9%), and flat configuration (24.5%), respectively. While HFSS audiogram configuration was statistically significantly more common in males, flat audiogram configuration was statistically significantly more common in females (p=0.0001). HFSS group mean air conduction threshold were statistically significantly higher than flat and HFGS groups (p=0.0001). No statistically significantly difference was detected in terms of speech discrimination scores between three groups (p=0.796). CONCLUSION: Results of this study suggest that, in Turkish population, while sensory presbycusis is more common in males, strial presbycusis is more common in females. No difference was detected in terms of the prevalence of cochlear presbycusis in males and females (p=0.0001).

Forensic age estimation by spheno-occipital synchondrosis fusion degree: computed tomography analysis.

The analysis of ossification points plays a considerable role in forensic age estimation. Although traditional methods are still in use, researchers are working on different age estimation procedures especially within the development of radiologic methods. One of these methods is to define spheno-occipital synchondrosis fusion degree. Spheno-occipital synchondrosis, an important growth point on cranial base, provides noteworthy information about age estimation through its late stage ossification nature. This study aimed to investigate spheno-occipital synchondrosis fusion degree for age estimation in the Turkish population. In our study, 1-mm-sectioned computed tomography images of 638 (399 men and 139 women) subjects within the age of 10 to 25 years were retrospectively examined. It is stated in our study that spheno-occipital syncondrosis fusion begins superiorly and progresses inferiorly until it is completed. Spheno-occipital syncondrosis is known to be totally open at the mean (SD) age of 11.5 (1.5) years in men and 10.7 (0.8) years in women. In addition, fusion degree is known to be increased with age. Fusion starts approximately 2 years earlier in women than in men, and the process of fusion completes at the age of 17 years in both sexes. An analysis of fusion degree between sex groups showed significance at the age of 11 to 15 years, and Spearman rank correlations indicate a significant positive relationship between age and degree of spheno-occipital fusion (P < 0.001; men, ρ = 0.714; women, ρ = 0.698). Consequently, 5-staged analysis of spheno-occipital synchondrosis fusion degree in use with 1-mm computed tomography images will be helpful for age estimation between 11 and 17 years.

Transoral robotic supraglottic partial laryngectomy.

OBJECTIVE: Transoral robotic supraglottic laryngectomy is a new surgical way to perform endolaryngeal resection of supraglottic laryngeal carcinoma. The aim of this report was to present our initial experience about transoral robotic supraglottic laryngectomy for early supraglottic cancer. METHODS: Subjects with early squamous cell carcinoma (T1-T2) of supraglottic region who managed using transoral robotic surgery in a tertiary referral center were included in the study. The technique of robot-assisted resection, intraoperative blood loss, mean robotic operating time, pathologic margin status, postoperative extubation, need for a tracheotomy, and length of hospitalization, complications, duration of oral nutrition, and neck dissection and radiotherapy needs were evaluated. RESULTS: Thirteen subjects (12 men, 1 woman) with T1-T2 supraglottic carcinoma were successfully operated on with transoral robotic surgery. In all subjects, negative margins were obtained. The mean total robotic surgery time was 31.6 (SD, 16.2) minutes (range, 20-80 minutes). Mean total blood loss was less than 40 mL. Subjects started oral nutrition with a mean of 10.8 (SD, 8.9) days (range, 4-30 days) postoperatively. The mean hospitalization was 15.4 (SD, 10.4) days (range, 7-42 days). CONCLUSIONS AND RELEVANCE: Transoral robotic supraglottic laryngectomy with the da Vinci robotic system can be regarded as a feasible, safe, and effective technique. Although short-term results seem discouraging, long-term results are needed to evaluate the oncologic safety.

Robot-assisted removal of a posterior pharyngeal wall mucoepidermoid carcinoma.

This report presents a rare case of a mucoepidermoid carcinoma of the posterior pharyngeal wall of the hypopharynx. Excision of the lesion was performed by transoral robotic surgery (TORS). The rarity of hypopharyngeal mucoepidermoid carcinoma and the technical advantages of TORS are presented and discussed in this study.

Timely management of penetrating neck trauma: Report of three cases.

In head and neck surgery, penetrating neck injuries are uncommon. The neck contains many important structures, so such trauma can cause significant morbidity and mortality. A patient with penetrating neck trauma should be examined promptly in the emergency room. If possible, damaged tissue and organ fragments should be preserved carefully.