ENT Updates

Volume 13 Issue 1 (2023)

Review

Domenico Cotugno (1736-1822), Antonio Scarpa (1752-1832), and Alfonso Corti (1822-1876): The Most Important Discoveries of the Inner Ear Made by Young Italian Physicians—Domenico Cotugno

The 18th and 19th centuries bequeathed to modern science fundamental discoveries in microscopic anatomy. The most important findings regarding the ear were made by young Italian researchers: Domenico Cotugno, Antonio Scarpa, and Alfonso Corti. Domenico Cotugno was born in Ruvo di Puglia on January 29, 1736, into a modest family. He was only 24 years old when his first great work, De aquaeductibus auris humanae internae anatomica dissertatio, was published in 1760. Cotugno, who worked on fresh ear specimens collected from newborns or fetuses, discovered the existence of 2 aqueducts (Cochlear and vestibular). Thanks to his revolutionary dissection technique, he also detected the constant presence of labyrinthic fluid. He wrote that the aqueducts were filled with liquid and not with air, as was generally held according to the Aristotelian dogma of aer ingenitus, uncontested by scholars such as Falloppio, Eustachi, and Willis. Cotugno also stated that the perilymphatic and subarachnoid spaces communicated at the base of the brain. His theory of resonance and his description of anatomical ear structures laid the foundations of today’s comprehension of hearing.

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Original Article

Prognostic Value of Programmed Death Ligand-1 and Human Papilloma Virus Expression in Head and Neck Squamous Cell Carcinoma

Background: Human papilloma virus infection and programmed death-1/programmed death ligand-1 pathway play a role in the development of immune tolerance against the tumor. The aim of this study was to analyze the prevalence and prognostic value of human papilloma virus and programmed death ligand-1 expression in head and neck squamous cell carcinoma.

Methods: The study included 73 cases with oropharyngeal and oral cavity squamous cell carcinoma. The immunohistochemistry method was used to determine p16 and programmed death ligand-1 expression. Membranous staining in tumor cells of ≥5% was considered programmed death ligand-1 positive. Human papilloma virus status, programmed death ligand-1 expression, and prognostic associations were statistically analyzed.

Results: Median follow-up was 37.2 months (2-105 months). Of the total 73 patients, 61.6% (45/73) were p16 positive and 29% (21/73) were positive for programmed death ligand-1 expression by immunohistochemistry. There was no significant relationship between p16 and programmed death ligand-1 expressions (P=.62). Programmed death ligand-1 expression did not correlate with disease-free survival and overall survival (P=.62, P=.92, respectively). In regression analysis, the advanced stage (P=.011) was associated with poor overall survival, whereas p16 and programmed death ligand-1 independently did not affect overall survival (P > .05).

Conclusion: There was no correlation between tumor cell programmed death ligand-1 and human papilloma virus expression in oral cavity squamous cell carcinoma and oropharyngeal squamous cell carcinoma patients, and programmed death ligand-1 was not a prognostic biomarker associated with survival. The predictive and prognostic role of programmed death ligand-1 should be supported by multicenter prospective studies with larger patient populations.

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Original Article

Ear Nose Throat Foreign Bodies in Children: Impact of the COVID-19 Pandemic

Background: This study aimed to analyze the incidence of ear, nose, and throat foreign bodies in children in a tertiary reference center to determine whether the coronavirus disease-19 lockdown affected the frequency of hospital attendance.

Methods: A total of 752 children (aged 0-18) with ear, nose, and throat foreign bodies, who visited the otorhinolaryngology emergency department of a tertiary reference center between March 2019 and February 2021, were reviewed retrospectively. The 2 groups were formed based on the hospital admission date. Group 1 included patients admitted to the otorhinolaryngology emergency department in the 1-year pre-pandemic period from March 2019 to February 2020. Group 2 included patients admitted within the same timeframe during the pandemic (March 2020–February 2021). The age and sex of the patients and anatomic location and type of foreign body were compared between the 2 groups.

Results: No significant differences were detected between the 2 groups regarding the number of patients, age, sex, anatomic location of foreign body, or type of foreign body. Although not significant, the rate of exposure to dangerous foreign bodies such as sharp objects and magnets/batteries increased during the pandemic.

Conclusion: Our study shows that the coronavirus-19 pandemic had no impact on the frequency of hospital attendance and anatomic location or type of foreign bodies inserted in the ear, nose, and throat. A slight increase in the frequency of dangerous foreign body exposure might be important due to the higher morbidity rate.

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Original Article

Examination of the Clinic, Radiologic, and Demographic Characteristics of 436 Patients with Nasal Fracture

Background: The aim of this study is to retrospectively investigate the demographic characteristics, mechanism of injury, physical examination and radiological findings, types of fractures, accompanying injuries, and treatment methods of adult patients who presented with nasal fracture.

Methods: The data of 436 adult patients diagnosed with nasal fracture within a period of 2 years in a tertiary hospital were used for this study. Along with demographic characteristics of the cases, mechanism of injury, time interval between admission and injury, radiological methods applied, type of nasal fracture, accompanying injuries, presence of septal hematoma, whether reduction was performed or not, and whether it was a medico-legal case were investigated.

Results: Nasal fractures were more common in men, with a total of 301 (69%) male patients and a mean age of 36.2. Type I and II nasal fractures were the most common in both genders. Computed tomography was used in 198 (45.4%) patients, while direct radiography was used in 180 (41.3%) patients. The most common accompanying injury was maxillary bone fracture. Reduction was applied to 183 (42%) patients with nasal fractures. Septal hematoma was present in 4.8% of cases.

Conclusion: Nasal fracture is more commonly seen in men. Falling is the most common cause of nasal fracture in all age groups. Although it is no longer recommended as much for fracture investigation, direct radiography is still frequently used. The presence of septal hematoma should always be investigated in nasal fracture cases, and early intervention should be performed if septal hematoma is detected in order to prevent complications.

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