Volume 14 Issue 2 (2024)

Epidermoid cysts are benign lesions that can cause mechanical airway obstruction if present in the neck and extend into the mouth foor. A 30-year-old male patient presented with a large, painless swelling in the anterior aspect of the neck and mouth foor. Surgical excision was planned under general anesthesia, and awake nasal fberoptic intubation was the sole choice in view of restricted oral space secondary to swelling. This case report highlights the importance of planned awake nasal fberoptic intubation and the challenges involved in the airway management of such rare cases.

We report a case of a 58-year-old man with a history of nasal obstruction and recurrent epistaxis who underwent videonasolaryngoscopy after 9 months of symptoms. The frst images showed a hyperemic mass affecting the left middle turbinate up to the nasal cleft. Computed tomography described a mass with an expansive effect occupying the entire left frontal sinus and most of the left ethmoid cells, widening the frontal sinus drainage path, and creating a continuity break of the cribriform plate, the left papyraceous lamina, and the upper-third of the nasal septum. Magnetic resonance imaging suggested T1-isointensity and T2-hyperintensity, intense contrast uptake, and no involvement of meningeal or brain tissues. The patient underwent extended endoscopic surgery without previous endovascular embolization or adjuvant therapies. A contralateral inferior turbinate graft was applied over the cribriform plate. Histopathological examination suggested glomangiopericytoma (GPC), and immunohistochemistry confrmed the diagnosis with positive beta-catenin, smooth muscle actin, and cyclin D1. The patient presented no nasal symptoms up to a 9-month follow-up. Nasal endoscopy showed no tumor recurrence signal. Although fronto-ethmoidal GPC is a rare tumor and presents challenging surgical access, it can be safely excised by endoscopic surgery. However, careful short- and long-term endoscopic follow-ups remain necessary to prevent postoperative complications and maintain surveillance of recurrences.

Background: Acute invasive fungal rhinosinusitis (AIFRS) is a severe infection that affects the nasal cavity and paranasal sinuses, often seen in individuals with comorbidities such as diabetes mellitus and hemato-oncological diseases. This study aims to retrospectively analyze patients diagnosed with AIFRS from 2014 to 2023.

Methods: The study was a single-center, descriptive investigation focusing on demographic details, clinical presentation, radio-pathological features, and suggested management of AIFRS patients.

Results: Of the 25 patients involved in the study, with a mean age of 48 years, hematooncological diseases were the most common underlying condition (44%), followed by diabetes mellitus (28%). Fungal analysis revealed Aspergillus species (32%) and Mucor (24%). The most frequently involved site was the middle turbinate (84%), while the least affected was the inferior turbinate (36%). The mortality rate was 48%, primarily due to underlying hemato-oncological diseases (32%). Aspergillus (16%) and Mucor (16%) were the most commonly encountered pathogens in fatal cases.

Conclusion: Patients with diabetes mellitus, hemato-oncological diseases, or secondary immunodefciency undergoing steroid treatment should be vigilantly screened for AIFRS. Early diagnosis and prompt management are crucial to improve patient outcomes.

Background: Rigid telescopes, which provide wider surgical feld imaging, improved resolution, and high magnifcation capabilities, have recently found widespread use in ear surgery. This study aimed to review the outcomes and duration of operations in endoscopic transcanal tympanoplasty and to guide surgeons who have just started endoscopic ear surgery (EES).

Methods: This study included 47 outpatient or inpatient volunteers who underwent endoscopic transcanal tympanoplasty surgery at the Otolaryngology clinic between March 2021 and March 2023. The age and sex of the patients, the surgery duration, and the side of the operated ear were reviewed. The first 23 operated patients were compared with the last 24 operated patients in terms of the duration  of the operation. Postoperative graft success (anatomical success) in the patients at 6 months was reviewed. Hearing gain in patients was examined postoperatively at 6 months using an audiometry test with hearing thresholds at 0.5, 1, 2, and 4 kHz.

Results: Upon examination of the patients at 6 months, the graft success was 89.4%. There was a statistically signifcant recovery in all 4 frequencies based on the preoperative and postoperative hearing tests (P=.00). There was a signifcant decrease in the duration of the operation in patients who were operated in the later stages of the study (P=.00).

Conclusion: Although there is a learning curve associated with EES, this type of operation is based on team effort, and the surgery duration decreases over time, with the experience acquired by each healthcare provider included in the team.

Background: To evaluate prognostic factors and the effects of pharmacologic and non-pharmacologic therapeutic interventions on the recovery of patients with Bell´s Palsy (BP).

Methods: Cross-sectional study of patients admitted to a tertiary hospital with a diagnosis of BP between January 2010 and December 2020. Variables assessed: affected hemiface, degree of BP, comorbidities, smoking history, pharmacological treatment, physiotherapy and degree of recovery at third month.

Results: A total of 87 patients were enrolled. No statistically signifcant difference was found between patients treated with corticosteroids and those treated with corticosteroids in combination with antivirals. Similarly, no statistically signifcant difference was observed between patients who received physiotherapy and those who did not. Hypertension, smoking, and higher grade H-B were associated with incomplete recovery (P=.042, .014, .028, and .037, respectively) and were identifed as predictors of poor prognosis. A hypertensive patient is 3.020 times more likely to have an incomplete recovery than a normotensive patient (P=.047, CI: 1.017-8.967), while a smoker is 3.897 times more likely to have an incomplete recovery than a non-smoker (P=.018, CI: 1.263-12.208). Patients with H-B grade V are 10.714 times more likely to have an incomplete recovery than patients with H-B grade II (P=.046, CI: 1.046-109.784).

Conclusion: Hypertension, smoking, and higher H-B grade were signifcantly associated with incomplete recovery and poor prognosis. Patients treated with corticosteroids alone or in combination with antivirals showed no signifcant difference in the recovery rate. Similarly, no statistically signifcant difference was observed between patients who received physiotherapy and those who did not.

Background: Bone-anchored hearing instruments (BAHIs) are an important alternative solution for hearing loss in a particular group of patients. This study aims to examine shifts in attitudes about BAHIs among hearing health professionals over time.

Methods: A survey was designed to assess the knowledge and attitude of otorhinol aryngologists (ENT) and audiologists (Au) concerning BAHIs. The survey was administered in 2019 and 2023 at various conferences.

Results: The survey received 243 responses (122 in 2019 and 121 in 2023). Among these, 186 (77%) were from ENTs, while 49 (20%) were from Aus. Notably, the preference for using BAHI for conductive and mixed hearing loss cases increased from 19.3% to 47.9%. The number of individuals with prior experience decreased, yet those who applied BAHIs grew. Signifcant shifts were observed in patient selection based on hearing level, hearing loss type, and clinical condition. The profession and experience emerged as infuential factors in these changes.

Conclusion: While most subjects recognized the signifcance of hearing rehabilitation, their fundamental knowledge and familiarity with BAHIs remained limited. A broader implementation of educational and training initiatives focusing on BAHIs is essential to enhance understanding and profciency in this area.

Background: The purpose of this retrospective study is to identify independent factors and their combinations that could predict complications and long-term hospitalization in deep neck infection (DNI) patients.

Methods: We analyzed data from 169 patients that were hospitalized from 2012 to 2022 due to deep neck infections. In addition to evaluating patient characteristics, we identifed independent signifcant variables and their combinations that could predict complication occurrence and/or long-term hospitalization using multivariate analysis.

Results: According to the multivariate backward procedure, while only presence of comorbidity and neutrophil to lymphocyte rate (NLR) were found to be independent signifcant risk factors of complication (P=.011 and P=.020, respectively), site of origin (non-odontogenic), need for both medical and surgical treatment, C-reactive protein (CRP) and NLR were found to be signifcant risk factors predicting long-term hospitalization (P < 0.001, P < 0.001, P=0.037 and P=0.008, respectively). The discriminatory power of a combination of 3 variables (presence of comorbidity, NLR, and white blood leukocyte count) for the occurrence of DNI complications yielded an AUC (ROC) of 0.764. The discriminatory power of a combination of 4 variables (non-odontogenic origin, need for both surgical and medical treatment, CRP, and NLR) to identify DNIs requiring prolonged hospital stay yielded an AUC (ROC) of 0.900.

Conclusion: The final models obtained by the combination of variables for both complications and long-term hospitalization are promising for prognostic purposes.