ENT Updates

Volume 13 Issue 3 (2023)

Original Article

Impact of Drain Usage on Postoperative Outcomes in Thyroidectomy Patients: Pain Intensity and Hospital Stay Duration

Background: Thyroidectomy is a widely adopted surgical procedure for treating thyroid diseases. Despite its frequent application, postoperative complications like vocal cord paralysis, hypocalcemia, hematoma, and seroma can occur. A debate on the use of drains after thyroidectomy has persisted in the surgical community, with concerns about potential bleeding, occlusion, and the actual beneft of drains.

Methods: A retrospective study was conducted on 122 patients who underwent thyroidectomy from January 2022 to May 2023. Patients were categorized into 2 groups: those with drains (n=62) and those without drains (n=60). Metrics like surgical duration, postoperative pain, length of hospital stay, and complications were recorded. A visual analog scale was employed to measure postoperative pain. Statistical analysis was performed using Statistical Package for the Social Sciences Statistics software, version 28.0.

Results: There was no signifcant difference between the 2 groups in terms of age, gender, indication for surgery, and various complications. However, patients with drains experienced signifcantly higher pain scores on the frst postoperative day. Furthermore, the group with drains had a notably longer duration of hospital stay compared to the group without drains.

Conclusion: Our fndings suggest that drain usage after thyroidectomy may intensify postoperative pain and extend hospital stays. Surgeons should meticulously evaluate the benefts and drawbacks of drain insertion in thyroidectomy procedures, as routine usage might be unnecessary.

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Original Article

Differences Between Neurotologist and General Radiologist in Reporting High-Resolution Computed Tomography for Otosclerosis

Background: To compare the reporting of high-resolution computed tomography of temporal bones for otosclerosis by general radiologists and a neurotologist within a tertiary-care hospital.

Methods: A retrospective review of temporal bone high-resolution computed tomography reports of surgically confrmed otosclerosis patients obtained between 2011 and 2020 was performed at a single tertiary-care center. For comparison, the high-resolution computed tomography reports of all patients performed by the general radiologists and the preoperative patient image evaluation notes of the senior neurotologist were reviewed from the medical records. The main outcome measure was the correct identifcation of otosclerosis on HRCT.

Results: A total of 42 patients (47 ears) were included in the study. The neurotologist correctly diagnosed otosclerosis in 31 of 47 images (66.0%) and the general radiologists correctly diagnosed otosclerosis in only 3 of 47 images (6.4%). The number of correct diagnoses were signifcantly different when made by the neurotologist and the general radiologist (X² = 25.14, P < .001, McNemar test).

Conclusion: The results of this study show that a radiologist without suffcient experience in the feld of neurotology may have a low detection rate of otosclerosis in high-resolution computed tomography of the temporal bone, as is consistent with the literature. In the light of this study, it can be concluded that more experienced eyes (neuroradiologist, neorotologist) are required to diagnose otosclerosis in HRCT than a general radiologist.

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Original Article

Differential Diagnosis of Dizziness in Patients Who Had Carotid Vertebral Artery Doppler for Arterial System Diseases

Background: Carotid vertebral Doppler ultrasonography (CVDU) is performed frequently in patients with dizziness. If a pathology is discovered, usually, it is accepted as a cause of dizziness. Our objective was to investigate the ratio of dizziness in patients tested with CVDU for arterial system diseases and make differential diagnoses of dizziness for its real cause.

Methods: A total of 195 patients undergoing CVDU were included. Among them, 20 patients reported dizziness and were referred for further examination, while the remaining 175 patients were included as controls. Advanced balance tests were performed for a differential diagnosis of dizziness. The two groups were then compared in terms of carotid narrowing, intima–media thickness (IMT), and vertebral artery resistive index (RI).

Results: Among the dizziness patients, 10 exhibited abnormal IMT, 11 showed a pathological vertebral artery resistive index, and 6 had carotid narrowing. However, when comparing the control group with the vertigo group, no signifcant differences were found in terms of pathological values observed in CVDU (P > .05). Within the vertigo group, the causes were further categorized: Ten patients had evident peripheral disease, 2 had migraine vestibulopathy, 1 had persistent postural-perceptual dizziness (3PD), 2 had orthostatic hypotension, and 1 had congenital nystagmus. One patient was considered to have vertebrobasilar insuffciency, and 3 patients were suspected to have central vascular pathology.

Conclusion: It was known that several patients who sought medical attention due to vascular disease also reported experiencing dizziness. However, it was determined that most dizziness cases were unrelated to vascular disease.

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Original Article

Incidence and Anatomy of Tubarial Salivary Gland in Local Indian Population

Background: Tubarial salivary glands were frst discovered and reported in the year 2021 by Valstar et al and were named “tubarial salivary glands” depending upon their location. The presence of these glands is believed to play a major role in helping oncologists and otorhinolaryngologists in radiation therapy planning and surgical management, thus improving the quality of life of patients. The main objective is to study the incidence of tubarial salivary glands in the local Indian population and assess its anatomical characteristics using magnetic resonance imaging (MRI) scans.

Methods: Magnetic resonance images of 60 scans were examined from the database, and analysis was performed using the T2 weighted (T2W) sequences. The presence of the tubarial salivary glands, their position and number, and the size of the glands were examined on the MRI scans by an experienced radiologist.

Results: The glands were identifed bilaterally in all 60 MRI scans. The average dimensions for the right and left glands were 39.4 mm × 15.3 mm × 6.5 mm and 38.9 mm × 15.4 mm × 6.6 mm, respectively. The age-wise distribution of the presence of glands showed a statistically signifcant increase in the size of the glands with increasing age groups (P < .05).

Conclusion: We observed a soft tissue structure in the anatomical site of the previously documented tubarial salivary glands on T2W MRI images. The structure’s intensity was comparable to that of a typical parotid gland. The fndings of our study offer crucial evidence in favor of the long-contested presence and identifcation of a novel salivary gland.

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