Is There a Relationship between Voice Quality and Obstructive Sleep Apnea Severity and Cumulative Percentage of Time Spent at Saturations below Ninety Percent: Voice Analysis in Obstructive Sleep Apnea Patients.

Background and Objectives: Apnea hypopnea index is the most important criterion in determining the severity of obstructive sleep apnea (OSA), while the percentage of the total number of times which oxygen saturation is measured below 90% during polysomnography (CT90%) is important in determining the severity of hypoxemia. As hypoxemia increases, inflammation will also increase in OSA. Inflammation in the respiratory tract may affect phonation. We aimed to determine the effects of the degree of OSA and CT90% on phonation. Materials and Methods: The patients were between the ages of 18−60 years and were divided into four groups: normal, mild, moderate, and severe OSA. Patients were asked to say the vowels /α:/ and /i:/ for 5 s for voice recording. Maximum phonation time (MPT) was recorded. Using the Praat voice analysis program, Jitter%, Shimmer%, harmonics-to-noise ratio (HNR), and f0 values were obtained. Results: Seventy-two patients were included. Vowel sound /α:/; there was a significant difference for Jitter%, Shimmer%, and HNR measurements between the 1st and the 4th group (p < 0.001, p < 0.001, and p < 0.001, respectively) and a correlation between CT90% and Shimmer% and HNR values (p < 0.001 and p < 0.021, respectively). Vowel sound /i:/; there was a significant difference in f0 values between the 1st group and 2nd and 4th groups (p < 0.028 and p < 0.015, respectively), and for Jitter%, Shimmer%, and HNR measurements between the 1st and 4th group (p < 0.04, p < 0.000, and p < 0.000, respectively), and a correlation between CT90% and Shimmer% and HNR values (p < 0.016 and p < 0.003, respectively). The difference was significant in MPT between the 1st group and 3rd and 4th groups (p < 0.03 and p < 0.003, respectively). Conclusions: Glottic phonation can be affected, especially in patients whose AHI scores are ≥15. Voice quality can decrease as the degree of OSA increases. The increase in CT90% can be associated with the worsening of voice and can be used as a predictor in the evaluation of voice disorders in the future.

Facial canal dehiscence in patients undergoing surgery for chronic otitis media: analysis of 850 patients.

ntroductionIn all otologic surgeries, the facial nerve can be considered the most important structure that must be protected. The surgical damage risk of the facial nerve will be increased in presence of facial canal dehiscence (FCD).AimIn this study, we aimed to evaluate the FCD and its associated situations in patients with chronic otitis media undergoing mastoidectomy.Materials and Methods850 patients who performed ear surgery were reviewed. Patients who did not perform mastoidectomy were excluded. In patients, the ratios, localization of FCD, and association of facial canal dehiscence with cholesteatoma were researched. Association between FCD and closed-cavity tympanomastoidectomy, open-cavity tympanomastoidectomy, and radical mastoidectomy procedures, and also an association between FCD and primary or revision surgery was evaluated. ResultsFacial canal dehiscence was found in 8.4% of patients. The relationship between dehiscence and cholesteatoma was found significant (p<0.001). In the comparison of radical mastoidectomy and closed-cavity tympanomastoidectomy, dehiscence was higher in the radical mastoidectomy group (p<0.03). In revision cases, dehiscence was seen more frequently (p<0.003). FCD incidence was higher in adult patients than in pediatric patients (p<0.001). Twenty of 468 patients who were operated on for cholesteatoma had congenital cholesteatoma. ConclusionFacial canal dehiscence can be seen especially in cases with cholesteatoma and when performing radical mastoidectomy and revision surgeries. Therefore, a detailed evaluation of the status of facial nerve and determination of situations in which occurrence of FCD is more likely both preoperatively and intraoperatively will minimalize potential complications.Keywords: Cholesteatoma, tympanic, radical mastoidectomy, oval window, tympanomastoidectomy.

Endoscopic Transoral Resection of Tongue Base Ancient Schwannoma.

Schwannoma is a benign slow growing nerve sheath tumor that is typically encapsulated and composed of well-differentiated schwann cells. Schwannomas may take origin from different nerves such as cranial, spinal nerves, and the sympathetic chain. Approximately 25% to 45% of all occur in the head and neck only 1% of them are located in the oral cavity. However, it is quite rare to for schwannomas to form on the tongue base. Ancient schwannoma is the rarest, and also extremely rare in oropharynx. A 32-year-old female patient was admitted to our clinic with complaints of hoarseness, difficulty in swallowing, throat pain, snoring, and dyspnea. In examination, a smooth surfaced circumscribed mass, which originated from the tongue base was observed. In the magnetic resonance imaging, a 4.5 × 3 cm sized tongue base mass which narrowed the upper airway was detected. An endoscopic transoral excisional biopsy was performed. The histopathological diagnosis was determined as ancient schwannoma. The use of the endoscopic transoral approach can be suitable to protect the important anatomical structures, functions, and reduce the complications and esthetic concerns for the resection of tongue base schwannomas.

Endoscopic Transoral Resection of Parapharyngeal Osteoma: A Case Report.

Osteoma is a benign, mesenchymal, slow-growing, osteogenic tumor commonly occurring in the craniofacial bones and is characterized by the proliferation of compact or cancellous bone. Solitary osteomas can be classified as peripheral (parosteal, periosteal, or exophytic) when arising from the periosteum or central (endosteal) when arising from soft tissue. Peripheral osteoma occurs most frequently in the paranasal sinuses. Other locations include the orbital wall, temporal bone, pterygoid processes, external ear canal, and, rarely, the mandible. Osteomas in the oromandibular region often appear in the jaw in the canine fossa, hard palate, and maxillary sinus and in the lower jaw in the inner mandible and outer circumference and lingual side of the molar region. At radiologic imaging, a peripheral osteoma of the mandible appears as a well-circumscribed, round to oval, mushroom-like radiopaque mass with distinct borders. Computed tomography is the best imaging modality for determining the location and actual extension of the lesion. Parapharyngeal space tumors are rare tumors of the head and neck region. Benign tumors of the parapharyngeal space are more common than malignant tumors. A foreign body sensation in the pharynx, difficulty with deglutition, and hoarseness are symptoms generally related to the position of the tumor. Upper airway obstruction, painful throat, unilateral tinnitus, trismus, dysarthria, glossopharyngeal neuralgia, and cranial nerve palsies are other reported symptoms. This report presents the case of a huge osteoma of the left mandibular condyle extending to the parapharyngeal space.

Intracranial hemorrhagic infarct after local anesthesia on nasal mucosa: A case report.

INTRODUCTION: Epinephrine containing local anesthetics are used hemostasis in many cases. Otolaryngologists typically selected to decrease bleeding in surgery field for operations such as especially FESS (Functional Endoscopic Sinus Surgery), septoplasty, septorhinoplasty. In addition to known adverse effects of this local anesthetics agents they have rare complications too. PRESENTATION OF CASE: We presented intracranial hemorrhagic infarction in a 41-year-old male patient after using lidocaine with epinephrine for local anesthesia on nasal mucosa. DISCUSSION: There are some publications like this case in the literature. In our case, a hemorrhagic infarction developed after giving the adrenaline/lidocaine infiltration to make up a local anesthesia in the mucosa of the septum. There is not any reported case like this in the literature. CONCLUSION: We want to emphasize that all surgeons especially the ENT surgeons should be careful while using local anesthetic medicines which contains adrenaline for rare complication of intracranial hemorrhagic infarction. Another fact is that the patients must sign an informed consent form including those situations even for all minor surgical procedures to avoid a medicolegal problem.