Objective and Subjective Dysphagia Assessment in Inflammatory Bowel Diseases.

INTRODUCTION: Inflammatory bowel disease (IBD) is a chronic gastrointestinal disease that is separated into two types: ulcerative colitis (UC) and Crohn's disease (CD). Although dysphagia is a well-studied and important topic in head and neck cancers and neurological disorders, research on the relationship between IBD and swallowing problems is not yet elucidated. The aim of this study was to compare swallowing function in the UC and CD using objective and patient-reported evaluation modalities. METHODS: This was a prospective cross-sectional research with 86 patients (50 UC and 36 CD) treated at the gastroenterology department. The assessment includes flexible fiberoptic endoscopic examination (FEES). The penetration-aspiration scale, the functional oral intake scale (FOIS), the functional outcome swallowing scale (FOSS), the Eating Assessment Tool-10 (EAT-10) test, the Yale Pharyngeal Residue Severity Scale for vallecula (Yale PRSS-vallecula) and pyriform sinus (Yale PRSS-PS) were all used to determine extent of dysphagia. RESULTS: The CD group had higher EAT-10 scores than UC group (p = 0.014). In terms of PAS scores, there was no significant difference between the two groups in all three food types (water, yogurt, and crackers) (p > 0.05). There was not a statistically significant variance between the groups in terms of vallecular residue (p > 0.05) according to the Yale PRSS-vallecula. Based on the Yale PRSS-PS, the CD group had significantly more residue than the UC group with yogurt and cracker (p = 0.014 and 0.030, respectively). FOSS and FOIS scores did not vary significantly between the two groups (p > 0.05). CONCLUSION: CD impairs subjective and pharyngeal swallowing functions more than UC. It is obvious that swallowing should be assessed in patients with IBD.

Evaluation of Voice in Inflammatory Bowel Diseases.

INTRODUCTION: Inflammatory bowel diseases, which are among the most common chronic gastrointestinal diseases, can also affect the voice for different reasons.The aim of this study is to investigate acoustic, perceptual and subjective voice evaluation parameters in inflammatory bowel diseases (IBD). METHODS: This prospective case-control study included a total of 80 participants: 28 patients with ulcerative colitis (UC), 22 patients with Crohn's Disease (CD), and 30 healthy controls. Following the endoscopic examination, the fundamental frequency (F0), shimmer (dB), jitter (%), and harmonic/noise ratio (HNR) were measured. GRBAS (grade, roughness, breathiness, asthenia, strain) scale was used for perceptual evaluation, Voice Handicap Index-10 (VHI-10) Turkish version was used for subjective assessment. RESULTS: The F0 value was within normal limits in both disease groups in male and female participants and in the control group. Jitter and shimmer values were statistically higher in the UC and CD groups than the control group. HNR did not differ between CD and control, however it was statistically lower in the UC group when compared to both the control and CD group. The total GRBAS score did not differ between the UC and CD groups, however it was greater in IBD patients compared to the control group. However these differences were within normative parameters. Although total VHI-10 score did not differ between UC and CD groups, both had higher voice handicap than the control group. CONCLUSION: IBD might have an effect on the voice and voice quality. This disease group was discovered to have perceptual and subjective voice problems additionally.

Clinical significance of smell and taste dysfunction and other related factors in COVID-19.

PURPOSE: The objective of this study is to evaluate smell and taste dysfunction (STD) in coronavirus disease 2019 (COVID-19) positive and negative patients, and to assess the factors associated with STD in COVID-19 positive patients. METHODS: Patients who had been tested with the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for COVID-19 were identified, and according to the RT-PCR test results, patients were separated into Positive and Negative Groups. A telephone-based assessment was applied to both groups using the American Academy of Otolaryngology-Head and Neck Surgery Anosmia Reporting Tool. Patients in Positive Group were also asked to rate STD, nasal breathing, and anxiety in three different time periods (pre-/during-/post-COVID) using the visual analog scale (VAS). RESULTS: A total of 53 COVID-19 positive and 51 negative patients completed the surveys. STD was eightfold more frequent (OR 8.19; CI 95% 3.22-20.84) in the Positive Group. Of the 53 COVID-19 positive patients, 32 reported STD and 21 did not. 'Ground-glass appearance' on chest-computed tomography was more frequent and median lymphocyte count was significantly lower in COVID-19 positive patients with STD. During-COVID STD and nasal breathing VAS scores were significantly lower than the pre- and post-COVID scores. During-COVID STD scores were significantly correlated with anxiety scores (Spearman's rho-0.404, p = 0.022) but not correlated with nasal breathing scores. CONCLUSION: STD may be related to increased inflammatory response as well as damage of olfactory neuronal pathway or non-neuronal olfactory mucosa. Understanding the exact cause of chemosensory impairment in COVID-19 can be helpful in explaining the pathophysiology of the disease.

Cochlear Nerve Hypoplasia: Audiological Characteristics in Children and Adults.

BACKGROUND: Cochlear nerve deficiency is a general term used to describe both cochlear nerve hypoplasia (CNH) and cochlear nerve aplasia. Although these two conditions can have similar results on audiological evaluation, CNH yields more variation in audiological tests. OBJECTIVES: To describe the audiological characteristics of the CNH cases in our series in relation to radiological findings. METHODS: We reviewed the medical charts, audiological findings, and radiological findings on cases with CNH. We included cases with CNH in one ear or both ears. Out of 90 subjects with CNH, we included a total of 40 individuals (21 women and 19 men; 49 ears) in the current study. We reviewed and analyzed the participants' audiological test results according to the radiological findings. RESULTS: Cases with CNH showed variations according to the cochlear structure. There were 13 normal cochleae, 4 with incomplete partition type I, and 32 with cochlear hypoplasia. The accompanying cochlear apertures also showed variation: 17 were normal, 28 stenotic, and 4 aplastic cochlear apertures. The subjects displayed hearing loss ranging from moderate to profound; furthermore, 4 subjects had no response to sound whatsoever. The degree of hearing loss was not statistically significantly different with regard to the presence or absence of cochlear malformation with CNH (p > 0.005). We observed both sensorineural hearing loss and mixed-type hearing loss among the CNH cases. CONCLUSIONS: CNH is the presence of a cochlear nerve that is smaller in diameter than the facial nerve. It can be accompanied with other associated inner ear malformations of different degrees of severity. We observed degrees of hearing loss ranging from moderate to profound.

Acute Invasive Fungal Rhinosinusitis: Presentation of 19 Cases, Review of the Literature, and a New Classification System.

PURPOSE: The aim of this study was to determine the correlation between acute invasive fungal rhinosinusitis (AIFRS) and underlying diseases, micro-organisms, presenting symptoms, extent of disease, radiologic findings, and outcomes and propose a new classification system. MATERIALS AND METHODS: The data of 19 AIFRS cases were analyzed retrospectively. Magnetic resonance imaging and computed tomography were performed in all patients preoperatively. All patients underwent at least 1 surgical debridement. RESULTS: Hematologic diseases were the most common (52%) underlying diseases. Patients with type 2 diabetes and those with multiple etiologies causing immunosuppression had the lowest survival. Aspergillus and Mucoraceae species were isolated in 9 patients but were not associated with poor prognosis. Headache and nasal discharge or crusting were the most common presenting symptoms. Premaxillary involvement was significantly correlated with poor prognosis (P = .001). Unilateral involvement was correlated with poor prognosis, although this finding was not significant (P = .111). The overall mortality rate was 61.2%. Patients with neutropenia that was corrected had 80% survival (P = .014). Cessation of corticosteroids and regulating blood glucose levels in patients with immunosuppression from corticosteroid use resulted in 75% survival. CONCLUSION: There is no single curative treatment for AIFRS. For a favorable prognosis, underlying conditions must be treated in addition to surgical debridement and antifungals.

The Validity and Reliability of the Turkish Version of Preschool Hearing Environments and Reflection on Quality of Life Questionnaire.

PURPOSE: The purpose of this study was to assess preschool children's hearing-related quality of life and to introduce the scale, originally titled "Preschool Hearing Environments and Reflections on Quality of Life Questionnaire" (Preschool HEAR-QL), to the literature through Turkish adaption, validity, and reliability analyses. METHOD: Our study included 210 children aged 2-6 years: 110 with hearing loss (56 cochlear implant users and 54 hearing aid users) and 100 with normal hearing. Demographic data were collected and then the Preschool HEAR-QL, which was translated into Turkish, was administered twice at 15-day intervals. Confirmatory factor analysis was used to determine whether the factor structure found in the original scale development study was confirmed in our sample (construct validity). Cronbach's alpha, intraclass correlation scores, and the test-retest method were used to assess the scale's reliability as the findings were analyzed using paired samples t tests. RESULTS: The children with hearing loss had lower scores than their normal-hearing peers, and the difference was significant in the subdomains of behavior and attention, hearing environments, and communication. The subscale of the Preschool Period Listening Environments and their Reflections on Quality of Life Scale consists of 23 items, and Cronbach's alpha value was found as 0.922 in the first application and 0.926 in the second application (high reliability). In the model established for validity analysis, χ2/df = 2.156, root-mean-square error of approximation = 0.074, standard root-mean-square residual = 0.078, goodness-of-fit index = 0.830, adjusted goodness-of-fit index = 0.789, comparative fit index = 0.895, and Tucker-Lewis index = 0.881 (good model fit). In terms of test-retest reliability, the correlation between the two measurements was 0.837, and there was no statistical difference between the test-retest scores (p = .15). CONCLUSION: The Turkish version of the Preschool HEAR-QL scale was proven to be a valid and reliable scale for assessing the hearing-related quality of life of children aged 2-6 years. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25236949.

Comparing dysphonia severity index, objective, subjective, and perceptual analysis of voice in patients with multiple sclerosis and healthy controls.

BACKGROUND: Impairments in voice quality in Multiple Sclerosis (MS) have recently been investigated and different results were found. A voice-centered multidimensional assessment protocol with patient-reported outcome measures was conducted to evaluate all the aspects of the voice changes. OBJECTIVES: The study aimed to compare the objective, subjective, and perceptual measures of voice between the people with MS and the healthy control group. METHODS: A total of 128 participants, including 64 people with MS age, and gender-matched healthy controls were enrolled in the study. Subjective, objective, and auditory-perceptual voice assessments of the participants were performed. The auditory-perceptual evaluation was performed with GRBAS. The Dysphonia Severity index was computed for both groups. All the participants completed the Turkish version of The Voice Handicap Index-10 (VHI-10) and the Voice-Related Quality of Life (VRQoL). RESULTS: Acoustic and aerodynamic parameters of voice were found significantly different for both males and females between the MS and control group. DSI was found significantly different for both males and females in the MS group compared to the control group (p<0.05). All components of the GRBAS scale were significantly higher in the MS group (p<0.001). Using a multivariate regression model, it was determined that age, gender, EDSS score, number of MS attacks, and disease duration did not affect the DSI. The overall VHI-10 score was higher in the MS group (median=1.0 range= 0-28) and lower in the control group (median=0 range= 0-4). The mean VRQoL was lower in the MS group (median=95 range= 62.5-100) than in controls (median=100 range= 85-100) (p<0.001). CONCLUSION: Our results indicated that people with MS have significant differences in acoustic and aerodynamic parameters of voice compared to healthy individuals. A significant number of persons with MS are aware that their voice problem affects their quality of life. People with MS must be monitored for voice changes and a multidimensional voice assessment protocol should be implemented.

Effect of 2.45 GHz Microwave Radiation on the Inner Ear: A Histopathological Study on 2.45 GHz Microwave Radiation and Cochlea.

BACKGROUND: The present study aims to determine the possible low dose-dependent adverse effects of 2.45 GHz microwave exposure and Wi-Fi frequency on the cochlea. METHODS: Twelve pregnant female rats (n=12) and their male newborns were exposed to Wi-Fi frequencies with varying electric field values of 0.6, 1.9, 5, 10 V/m, and 15 V/m during the 21-day gestation period and 45 days after birth, except for the control group. Auditory brainstem response testing was performed before exposure and sacrification. After removal of the cochlea, histopathological examination was conducted by immunohistochemistry methods using caspase (cysteine-aspartic proteases, cysteine aspartates, or cysteine-dependent aspartate-directed proteases)-3, -9, and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL). Kruskal-Wallis and Wilcoxon tests and multivariate analysis of variance were used. RESULTS: Auditory brainstem response thresholds in postexposure tests increased statistically significantly at 5 V/m and above doses. When the number of apoptotic cells was compared in immunohistochemistry examination, significant differences were found at 10 V/m and 15 V/m doses (F(5,15)=23.203, P=.001; Pillai's trace=1.912, η2=0.637). As the magnitude of the electric field increased, all histopathological indicators of apoptosis increased. The most significant effect was noted on caspase-9 staining (η2 c9=0.996), followed by caspase-3 (η2 c3=0.991), and TUNEL staining (η2 t=0.801). Caspase-3, caspase-9, and TUNEL-stained cell densities increased directly by increasing the electric field and power values. CONCLUSION: Apoptosis and immune activity in the cochlea depend on the electric field and power value. Even at low doses, the electromagnetic field in Wi-Fi frequency damages the inner ear and causes apoptosis.

Patient reported voice handicap and auditory-perceptual voice assessment outcomes in patients with COVID-19.

PURPOSE: The purpose of this study is to compare patient-reported voice handicap and auditory-perceptual measures of voice between healthy individuals and COVID-19 patients, as well as to investigate the effect of clinical factors on voice quality. METHODS: COVID-19 patients (n = 138) and 90 healthy controls were included in the study. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) was used to grade voice samples based on overall severity, roughness, breathiness, strain, pitch, and loudness. The Voice Handicap Index-10 was completed by all participants (VHI-10). Physical (pVHI), emotional (eVHI) and functional (fVHI) subscores were calculated. Clinical data were collected (disease stage, CT grade, neutrophil/lymphocyte ratio, CRP, and symptoms). RESULTS: A statistically significant difference between patient and control groups in VHI-10 and CAPE-V scores was detected (p < 0.001). Except eVHI, total score and all subscale scores were higher in patients with COVID-19 as the pVHI was the most affected (η2 = 0.324) subscale. All scores of CAPE-V were significantly worse in patients with COVID-19 as highest impact of COVID-19 was on breathiness (η2 = 0.518). Pre-existing pulmonary comorbidity, dyspnoea and N/L was significantly associated with the VHI-10 overall score (ßpc = 4.27, ßdyspnoea = 5.69 and ßnl = 0.25). The overall severity of CAPE-V was significantly dependent on dyspnoea and pulmonary comorbidity (ßdyspnoea = 11.25, ßpc = 10.12). VHI ≥4 and CAPE-V overall severity ≥11 were good indicators of COVID-19 related dysphonia. CONCLUSIONS: COVID-19 causes patient-reported voice handicap and deteriorates auditory-perceptual measures of voice. COVID-19 related voice impairment was mainly associated with the decreased respiratory capacity.

Is It Hot or Cold? Which Humid Air Is Better for Vocal Hygiene?

OBJECTIVES: The purpose of this research is to determine which type of humid air should be suggested for vocal hygiene by demonstrating the effects of hot humid air and cold humid air on the vocal cord mucosa using different histological methods. STUDY DESIGN: Randomized controlled study. METHODS: Cold or hot humid air was applied to the rats for 30 minutes/day for 10 days using a humid air machine placed in a closed glass cage. The control group did not receive any treatment and were kept in their cages under normal laboratory conditions. The animals were sacrificed and their larynxes were removed on the 11th day. Histologically, lamina propria (LP) thickness was measured by Crossman's three stain and the number of mast cells in 1 square millimeter of lamina propria was measured by toluidine blue. In immunohistochemical staining, the intensity of zonula occludens-1 (ZO-1) staining was measured using a rabbit polyclonal antibody and scored from 0 (no staining) to 3 (intense staining). One-way ANOVA and Kruskal-Wallis tests were used to compare groups. RESULTS: The mean LP thickness was thinner in rats exposed to cold humid air (CHA) than in the control group (P = 0.012). In terms of LP thickness, other intergroup comparisons (cold vs hot and control vs hot) showed no statistically significant difference between groups (P > 0.05). The mean mast cell count did not differ between groups. The hot humid air (HHA) group had more intense ZO-1 staining than the other groups (P < 0.001). There was no difference in ZO-1 staining intensity between the control group and CHA group. CONCLUSION: HHA and CHA administration had no negative effects on inflammatory findings in the vocal cords (mast cell count or LP thickness). While HHA appears to strengthen the epithelial barrier (denser ZO-1 staining), the physiologic outcomes, such as bronchoconstriction, should be cautiously assessed.

Histological Effect of Emodin on Acute Vocal Fold Injury in a Rat Model.

OBJECTIVES: Emodin has beneficial effects on wound healing and reduces excessive fibrosis during tissue regeneration. Its positive effects on the wound-healing process were demonstrated on human fibroblasts. The aim of the present study was to evaluate the effectiveness of emodin application on acute vocal fold injury. MATERIALS AND METHODS: Twenty-four Wistar albino rats were divided into three groups: control, sham, and emodin group. The glottis was examined using a 30°-2.7 mm diameter telescope, and vocal folds was unilaterally wounded by a microscissor through the entire layer of the lamina propria down to the vocalis muscle. While no procedure(no acute injury of the vocal fold or an injection of saline/emodin) was applied to the control group, 0.5 cc of saline was injected into the sham group and 0.5 cc of emodin in the emodin group, just lateral to the vocal folds, with 27 gauge injectors. Animals were sacrificed on the 21st day after the procedure. After excised larynx experiments, serial sections were prepared from the vocal fold. Hematoxylin eosin and immunohistochemical staining were performed and fibroblast density, lamina propria thickness, and vessel formation were graded from 0 (none) to 3 (severe reaction). Transforming growth factor-beta 1 (TGF-ß1) and matrix metalloproteinase-9 (MMP-9) staining was used for immunohistochemical examinations. Four-point scoring scale for intensity being scored as 0 (no staining) to 3 (severeley stained) to quantify immonuhistochemical reaction. This scoring system was applied to vocal fold epithelium, lamina propria, vessel wall, and vocalis muscle tissues. The groups were compared with the Kruskal Wallis and Dunn tests. RESULTS: Histologically, there was no significant difference (P > 0.05) between the sham group and the emodin group in terms of fibroblast density, vessel formation, and lamina propria thickness. These parameters were higher (P < 0.05) in both groups compared to the control group. In the lamina propria and vessel wall, MMP-9 staining was more intense in the emodin group than in the sham group. TGF-ß1 staining of lamina propria, epithelial tissue, and vocalis muscle was significantly more intense in the emodin group than in the other groups. CONCLUSION: Emodin induced MMP-9 and TGF-1 staining in the vocalis muscle and epithelium, as well as TGF-1 staining in the lamina propria. In terms of fibroblast density, new vascular creation, and LP thickness in acute vocal fold damage, there was no difference between saline administration and emodin injection. It may increase fibroblast activation in the acute phase of wound healing, but its long-term effects should be further investigated.

Impact of Functional and Aesthetic Factors on Patient Satisfaction in Septorhinoplasty.

Objective: This study aimed to differentiate the functional or aesthetic factors affecting the result of septorhinoplasty and to determine the most important factor related to patient satisfaction. Methods: Rhinoplasty Outcome Evaluation (ROE) and Visual Analog Scale (VAS) for obstruction (VAS-O) and for appearance (VAS-A) were administered to fifty-five patients undergoing septorhinoplasty preoperatively and six months after the surgery. VAS scores were evaluated as follows: VAS-O (0: unblocked, 10: completely blocked) and VAS-A (0: worst appearance, 10: best appearance). ROE scores were calculated between 0 and 100. In order to examine the relationship between the measurements and determine the most powerful item that affects the overall ROE score, path analysis was performed, and the path coefficients were calculated. Results: The mean VAS-O and VAS-A scores before and after surgery were 6.85 and 4.36, and 3.91 and 7.22, respectively (p<0.001). The absolute value of mean difference was greater for VAS-A (-3.31) than VAS-O (-2.49), which also means appearance scores were more widely affected. The mean ROE score was increased from 46.36±9.28 to 78.85±11.70. VAS-A score had a significant impact on the overall ROE score (ß=0.782, p=0.001), while the VAS-O score had no impact. The least effective item on the overall ROE score was item 2 (ß=0.445), while the other items related to aesthetic outcome had higher Path coefficients. Conclusion: Although septorhinoplasty provides satisfactory results in both functional and aesthetic aspects, patients are more satisfied with the cosmetic outcomes.

Organic and functional dysphonias: comparison of Self-Assessment protocols by confirmatory factor analysis.

OBJECTIVE: This study aims to see if the effects of the sub-domains of the Voice Handicap Index-10 (VHI-10) and Voice Related Quality of Life (VRQoL) differ in organic (OD) and functional dysphonia (FD). METHOD: A total of 162 patients completed the validated Turkish versions of the Voice Handicap Index-10 (VHI-10) and Voice-Related Quality of Life (VRQoL). Physical (pVHI-10), emotional (eVHI-10) and functional (fVHI-10) sub-domains of VHI-10 and physical-functional (PF-VRQoL), socio-emotional (SE-VRQoL) dimensions of VRQoL were assessed. Confirmatory factor analysis (CFA) was used to compare the sub-domains of these questionnaires between diagnostic categories. RESULTS: The total and sub-domain scores of both VHI-10 and VRQoL were not statistically different between the two etiologic categories of dysphonia (MANOVA, p > .05). The total VHI-10 and total VRQoL scores were significantly and moderately correlated in both the OD and FD groups. During CFA, 4 models were constructed for the OD and FD groups for VHI-10 and VRQoL factors. There was no significant difference between OD and FD groups in terms of path coefficients of sub-domains (z test, p > .05). CONCLUSION: In terms of VHI-10 and VRQoL, the sub-domains of each questionnaire are equally important in both organic and functional dysphonia. Functional disorders do not depend only on "emotional" factors, and neither do organic problems. Factor analysis should be included when performing a study on patient-reported outcome measures.

Clinical, Prognostic, and Predictive Value of Olfactory Dysfunction for COVID-19: A Prospective Controlled Study.

OBJECTIVE: To evaluate the effect of olfactory dysfunction on the course and severity of COVID-19 and its prognostic and predictive significance for COVID-19. STUDY DESIGN: Prospective case-control study. SETTING: Ondokuz Mayis University School of Medicine. METHODS: Reverse transcription polymerase chain reaction (PCR)-positive patients, patients with COVID-19-related symptoms who had a negative PCR result, and healthy controls were included in the study. Clinicodemographic characteristics, inflammatory markers, and computed tomography stages were recorded. Disease progression and intensive care unit admission were registered. The visual analog scale (0, worst; 10, best) was used to evaluate subjective olfactory, taste, and nasal breathing ability, and the Sniffin' Sticks identification (SS-ID) test was used for psychophysical olfactory assessment. RESULTS: Mean SS-ID scores were significantly lower in the positive group (8.77) than in the negative (10.43) and healthy control (12.17) groups. VAS-smell scores were significantly lower and anosmia was more prevalent in PCR-positive patients (P < .01). SS-ID and VAS-smell scores were significantly correlated (r = 0.681, P < .001). The inflammatory parameters, pulmonary infiltration stage, disease progression, and ICU admission were not associated with SS-ID scores. A cutoff SS-ID score <9 resulted in 55.56% sensitivity in predicting COVID-19 positivity, and a cutoff VAS-smell score <8 yielded 72.22% sensitivity. CONCLUSION: Olfactory dysfunction was detected objectively and subjectively in the PCR-positive group, and no difference was found in terms of taste function and nasal breathing. The severity and prognosis of COVID-19 are not exclusively dependent on olfactory dysfunction. The degree of olfactory dysfunction can be useful in predicting PCR positivity.

Olfactory dysfunction in passive vs active smoking.

BACKGROUND: The aim of this study is to assess the olfactory functions of passive smokers compared to active smokers and nonsmokers. METHODS: This prospective case-control study included 30 nonsmokers, 30 passive smokers, and 30 active smoker participants. All groups were matched for gender and age. The Sino-Nasal Outcome Test 22 (SNOT-22) and Sniffin' Sticks test battery were administered to all subjects. Threshold (T), discrimination (D), and identification (I) scores were noted. Olfactory function was subjectively assessed as 0: severe dysfunction and 5: no problem. RESULTS: Overall, TDI scores of active smokers (24.78 ± 3.02) and passive smokers (24.90 ± 2.45) were significantly lower than nonsmokers (34.23 ± 3.46). There was no statistically significant difference between passive smokers and smokers (F (2,87) = 13.47, P < .001)). All subscores are negatively affected by active or passive smoking. The greatest impact of smoking was on threshold scores (η 2 T  = 0.719), followed by identification (η 2 I  = 0.353) and discrimination (η 2 D  = 0.282) scores. SNOT-22 and TDI scores were weakly (r = -.352) correlated as subjective assessment, and TDI scores were moderately correlated (r: .539) (P values < .001). Age and pack-years cigarette dosage had a negative effect on the TDI score (TDI = 26.386 - (0.084 × age) - (0.072 × Pack.Year)) according to stepwise linear regression model (F = 10.187; P = .001). CONCLUSIONS: Passive smoking has nearly the same adverse effect on olfactory function as active smoking. The threshold scores are the most negatively affected. The olfactory effect of cigarette smoke may not be directly related to nasal inflammation. Olfactory neuronal pathways should be investigated to elucidate the exact pathophysiology. LEVEL OF EVIDENCE: 3b.

The Effect of Parental Smoking on Voice-Related Quality of Life in the Pediatric Population.

OBJECTIVES: Exposure to cigarette smoke has significant effects on the respiratory mucosa. However, little is known about the effects of household smoke exposure on children's voice-related quality of life. The aim of this study was to elucidate the effect of parental smoking (PS) on voice-related quality of life in the pediatric population. SUBJECTS AND METHODS: The Pediatric Voice-related Quality of Life (PVRQoL) instrument was administered to the parents of 104 healthy children without any known voice disorder. The children were evaluated in two groups. The first group of children had no PS history and no household smoke exposure (non-PS group), in the second group, at least one parent of the child consumed tobacco products in the house (PS group). Social emotional and physical functional subdomains of the PVRQoL were also calculated. RESULTS: A total of 104 surveys were analyzed. The overall percentage of dysphonia in the PS group was 23.6%, whereas it was 6.1% in the non-PS group. The mean PVRQoL scores were 89.1 (±13.8) in the PS group and 97.7 (±4.7) in the non-PS group (P < 0.001). The mean physical functional-PVRQoL score was 35.4 (±7.2) in the PS group and 39.0 (±6.0) in the non-PS group. The mean social emotional-PVRQoL scores were 51.2 (±9.3) in the PS group and 57.2 (±5.6) in the non-PS group. The overall voice quality was significantly lower in the PS group than in the non-PS group. CONCLUSION: Exposure to PS has negative effects on voice-related quality of life in children that cannot be underestimated. Parents should be informed about the detrimental effects of passive smoking on the voice quality of their children. Inclusion of items in pediatric voice surveys about PS that lead to dysphonia would be suggested.

The Fibrin Glue Application Enhances Surgical Success Rate in Endonasal Endoscopic Dacryocystorhinostomy With Lacrimal Sac Preservation.

The purpose of this study to compare lacrimal sac flap preserving techniques with or without fibrin glue in patients undergoing endoscopic endonasal dacryocystorhinostomy. A retrospective study included 132 patients who underwent unilateral endonasal dacryocystorhinostomy between February 2011 and March 2016. Patients were divided into 2 groups: the nonfibrin glue group (n = 66) and fibrin glue anastomosis group (n = 66). Surgical success was defined as the patients' subjective report of relief of epiphora and objective endoscopic confirmation of ostium patency confirmed by a positive functional dye test. These parameters were compared between the 2 groups. Both groups were similar, in terms of demographic and clinical characteristics. The surgical success rate was significantly higher in the fibrin glue anastomosis group (95.5%) than in the nonfibrin glue group (84.8%; P = .041). Complication rate was 6.1% in the nonfibrin glue group, whereas in the fibrin glue anastomosis group, it was 4.5%. The complication rate was similar in both groups (P = .99). Creation of an anastomosis between the lacrimal sac flaps and the nasal mucosa using fibrin glue improves the outcome of endonasal endoscopic dacryocystorhinostomy.

A Novel Classification: Anomalous Routes of the Facial Nerve in Relation to Inner Ear Malformations.

OBJECTIVES/HYPOTHESIS: The objective of this study was to classify anomalous facial nerve (FN) routes and to determine their association with inner ear malformations (IEMs). STUDY DESIGN: Retrospective cross sectional study. METHODS: The computed tomography images of 519 patients (796 ears) with IEMs were retrospectively evaluated, and the abnormal routes of the FN were classified as: Meatal segment: type 1, normal internal auditory canal (IAC); type 2, narrow IAC; type 3, facial canal (FC) only; type 4: separate FC/duplicated IAC. Labyrinthine segment (LS): type 1, normal; type 2a/b/c, mild/moderate/severe anterior displacement; type 3, superior displacement; type 4: straight LS. Tympanic segment (TS): type 1, normal; type 2, superiorly displaced TS; type 3, TS at the oval window; type 4: TS inferior to the oval window; type 5: unclassified. Mastoid segment: type 1, normal facial recess (FR)/normal mastoid segment; type 2: narrow FR; type 3, unclassified. RESULTS: In meatal segment classification, a narrow IAC was common in ears with cochlear hypoplasia (CH) (76.1%), and only FC was common in ears with severe IEMs (62.7%) such as Michel deformity, common cavity, and cochlear aplasia. Incomplete partition-III has its unique superiorly displaced LS (100%). CH-IV also has its unique mild anterosuperior displacement. Ears with a superiorly displaced TS usually (93.1%) had aplastic or hypoplastic semicircular canals. The FR is likely to be narrow in CH and severe IEMs. CONCLUSIONS: The FN route is affected in IEMs, which must be kept in mind when operating on ears with IEMs. Especially in CH cases, all segments of the FN can be abnormal. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:E696-E703, 2020.

Screening of dysphagia by DYMUS (Dysphagia in multiple sclerosis) and SWALQoL (Swallowing quality of life) surveys in patients with multiple sclerosis.

BACKGROUND: Dysphagia is a life-threating symptom in patients with multiple sclerosis (MS) because aspiration pneumonia develops as a consequence of swallowing disorders. Dysphagia can be detected by using patient-reported outcome measures in order to prevent complications. OBJECTIVE: To identify the dysphagia prevalence, severity, and swallowing related quality of life (QoL), by using two validated dysphagia questionnaires. METHOD: Dysphagia in Multiple Sclerosis (DYMUS) and Swallowing Quality of Life (SWALQoL) questionnaires were collected from 64 patients with MS. RESULTS: The mean total SWALQoL score was 67.9 (±11.2) and the mean DYMUS score was 2.02 (±1.3). The highest mean SWALQoL subdomain score belonged to communication (76.7 ± 15.8), and the lowest score belonged to sleep (54.2 ± 12.2). There was a significant correlation between age and DYMUS and SWALQoL scores (r: 0.539 and r: -0.610 respectively, P < .001). Additionally, there was a significant moderate correlation between disease duration and DYMUS and SWALQoL scores (r: 0.693 and r: -0.697 respectively, P < .001). DYMUS and SWALQoL scores did not vary between males and females (P > .05). Patients with secondary progressive MS had higher DYMUS and lower SWALQoL scores (more dysphagia) than in primary progressive or relapsing-type MS. There was a strong, negative and statistically significant correlation between DYMUS and total SWALQoL scores (Spearman's rho: -0.862, p < .001). CONCLUSION: MS causes dysphagia and reduces QoL. Age, disease duration, and MS type are major factors that influence SWALQoL. DYMUS and SWALQoL are well correlated. DYMUS is an easy to answer tool that may advised for screening dysphagia in patients with MS.

Successful Use of a Cochlear Implant in a Patient with Bony Cochlear Nerve Canal Atresia.

The anatomical cause of congenital sensorineural hearing loss can be atresia of the bony cochlear nerve canal (BCNC). It has been reported that the cochlear nerve (CN) can be either hypoplastic or aplastic when the BCNC width is <1.5 mm radioanatomically. It is difficult to estimate the auditory-verbal abilities after cochlear implantation (CI) in patients with a hypoplastic CN. In such cases, it is also challenging to decide on the best treatment modality: CI or auditory brainstem implantation. In this case report, we present a 4-year-old male patient with BCNC atresia and the successful use of a cochlear implant; we also discussed the importance of audiological evaluation. A detailed radiological evaluation must be performed in every case following electrophysiological studies prior to CI. To accurately diagnose the pathology and select the surgical side, both computed tomography and magnetic resonance imaging scans should be used as complementary imaging methods in all CI candidates.