Volume 8 Issue 2 (2018)

In the present review, we aimed to evaluate the role of vitamin D in otolaryngological diseases. Since the recognition of vitamin D as a steroid hormone, it has attracted clinicians as a research issue due to its unique and complicated functions in human body processes. Numerous studies have investigated the association between vitamin D and human diseases, including in the otolaryngological field. However, although vitamin D alterations may theoretically be involved in the pathogenesis of several otolaryngological diseases, a clear association has not been demonstrated due to inconsistent results from the studies to date. Further randomized controlled trials with large patient populations are required to determine the exact role of vitamin D in otolaryngological diseases.

Objectives: This research was undertaken to determine the frequency of post-tonsillectomy hemorrhage (PTH) in one particular clinical setting and to assess which risk factors exist for PTH.

Methods: Following a retrospective case review of 892 patients who had gone through either tonsillectomy or adenotonsillectomy, a subgroup of 50 records were selected for detailed study. These 50 patients were then classified as either pediatric cases (aged under 16) or adult cases (aged over 16). Their risk factors were then assessed. Risk factors included: age, sex, surgical indication; type of surgery; time hospitalized post-operatively; timing of PTH (primary and secondary); management used to staunch bleeding and time in hospital following PTH.

Results: The overall rate of PTH was 5.6% (3.0% pediatric, 2.6% adult). All PTH instances were secondary and no primary type occurred. In comparing the adult and pediatric cases of PTH, there was no statistically significant difference (p>0.05) in terms of age, sex, time hospitalized post-operatively, management used to staunch bleeding or time in hospital following PTH. There was, however, a statistically significant difference (p<0.05) between groups in terms of surgical indication and timing of PTH (primary or secondary).

Conclusion: There was an increased frequency of secondary PTH in both groups. PTH typically happened between day 5 and 10 post-operatively. Patients need to be advised about this risk and show caution regarding factors that increase the risk of PTH after surgery.

Objectives: Bell palsy (BP), also known as idiopathic facial paralysis, is a unilateral, acute-onset, isolated lower motor neuron weakness. It accounts for 60% to 75% of all cases of unilateral facial paralysis. The estimated annual incidence ranges between 11 and 40 per 100.000 people, with 40.000 new cases each year in different parts of the world. The neutrophil/lymphocyte ratio (NLR), calculated as the ratio of absolute neutrophil count to absolute lymphocyte count, is an easily measurable and inexpensive systemic inflammation marker. This study investigated the association between the NLR and BP by comparing clinical characteristics and functional outcomes of patients with BP and healthy controls.

Methods: Thirty patients (24 women, 6 men) who presented to our clinic with BP between 2014 and 2016 were included in the study. The subjects underwent a general physical examination and an assessment of laboratory blood parameters. All patients were treated with prednisone, 1 mg/kg per day with a progressive dose reduction. The NLR was calculated as the simple ratio between absolute neutrophil and absolute lymphocyte counts.

Results: The mean (SD) NLR values were 2.141 (0.80) in patients with BP and 1.41 (0.46) in the control group. The difference between groups was significant (p=0.0001). There was a positive correlation between grade of facial paralysis and NLR values (r=0.663, p=0.0001). There was a positive correlation between prognosis of facial paralysis and NLR values (r=0.239, p=0.0251).

Conclusion: The NLR was a valuable marker in BP patients in this study. Moreover, this study demonstrated a linear relationship between the NLR and BP severity and prognosis.

Objective: Communication issues within clinical encounters are increasing within Turkey. To raise awareness of the problem and identify solutions, it was decided to undertake the current research.

Methods: Separate questionnaires, one for doctors, the other for patients, were prepared and distributed between May and July 2018 to 100 doctors plus 100 adult patients at either Adana Numune Hospital or Eskisehir Osmangazi University Hospital.

Results: Patients’ views: 60% responded that doctors give insufficient information in terms of quality and quantity. 80% stated that the doctor failed to convey a clear message. 40% described doctors as lacking enthusiasm in explaining the issue and curtailing the conversation. 40% felt that the inadequate length of the consultation contributed to a sense that the patient was undervalued by the doctor. 40% felt consultation times needed to be lengthened. 20% stated that the doctors listened inadequately. 30% felt that communication would be improved by better use of Turkish equivalents for latinate medical terms. 10% felt that the key element in communication was for doctors first to value patients. Doctors’ views: 100% felt they had the ability to explain, but that time constraints and patients’ inability to understand key elements hinder communication. 95% felt the issue rested with patients and their inability to comprehend. 60% considered the patients insufficiently educated or lacking adequate intellectual resources to understand. 90% proposed lengthening consultation times to improve communication.

Conclusion: Blaming either party is not the solution. Short consultation times are the root cause of miscommunication and need to increase if communication is to improve. Improvements in patients’ education may in the future lead to more fruitful clinical encounters. Clinicians must develop an effective communication style to create healthier relationships with their patients.

Objectives: The aim of this study was to look into how functional endoscopic sinus surgery (FESS) for CRSwNP without asthma affects lung function. The investigators aimed to determine any correlation between Lund-Kennedy scores, Lund-Mackay scores and pulmonary function.

Methods: All participants underwent nasal endoscopic examination and CT scanning paranasally. Lund-Kennedy endoscopy and Lund-Mackay CT scores were calculated and compared with postoperative findings. Statistical analysis was performed to compare preoperative and postoperative spirometry findings to assess efficacy of surgery on pulmonary function.

Results: There were no statistically significant differences between the Lund-Mackay scores for primary FESS and revision. Nevertheless, Lund-Kennedy scores did show evidence of greater statistical significance when comparing revision FESS and primary FESS (p=0.04) With respect to both primary and revision FESS patients there was no statistical significance between the preoperative values of FEV1, FEV1/FVC, FVC, and FEF25-75 and the same parameters measured one month postoperatively (p>0.05).

Conclusion: Our results reveal that FVC improves following FESS in cases of CRSwNP that are not also asthmatic. No relationship was demonstrable between how severe the disease is and how the lung functions. Further research that looks at FESS in asymptomatic cases of airway obstruction over more prolonged follow-up needs to be undertaken.

Objectives: We aimed to look into potential associations between specific biomarkers and trauma to Cranial Nerve VII (CNVII) in a rabbit model, focusing on whether endocrine studies have potential as biomarkers in this context.

Methods: 30 adult New Zealand rabbits with intact facial muscles were used for the research. Each animal underwent identical surgery by the same surgeon. The facial nerve divisions were exposed by incising below the level of the mandible. After dissection of the skin and subcutaneous layers, the buccal division of CNVII was located with the nerve stimulator and microscopic dissection and a section of nerve 10mm long was excised in each case from the buccal branch of CNVII. Blood samples were drawn 8 weeks and 12 weeks after nerve injury had been surgically induced. The samples from day 1, week 4 and week 8 were tested for the following levels: Testosterone, oestrogen, progesterone, free T3 and T4, Cancer antigen 19-9 (Ca19-9), folate, TPSA, FPSA, FSH, LH, CA15.3, CAE, AFP and prolactin.

Results: The levels of free T3 and T4 as well as testosterone, were down at 4th week, but at 8 weeks each had increased. Ca19-9 levels were also above the baseline. At 4 weeks, whilst oestrogen had markedly risen, progesterone had fallen. The statistical significance of the change in levels of free T3 and T4, testosterone, oestrogen, progesterone and FPSA was evaluated. For the group of animals with induced paralysis, the association between the lesion and testosterone, oestrogen, progesterone, free T3 and T4, Ca19-9, and folate levels were strong and at the level of statistical significance.

Conclusion: There were statistically significant alterations in the serum levels of free T3 and T4, testosterone, oestrogen, progesterone and FPSA at the 4 and 8 week intervals post surgically-induced CNVII injury. It is likely that rabbit pathophysiology resembles human pathophysiology in nervous injury, hence these six biomarkers may be of value in managing trauma or idiopathic degeneration of CNVII in humans. The authors hope this study will pave the way for future research in this area.

Objective: The purpose of this study is to investigate the effect of steroids on postoperative hearing outcome in patients with a clinical diagnosis of otosclerosis, who received intraoperative steroid treatment during surgery for conductive-type hearing loss.

Methods: Between January 2014 and January 2017, 106 patients, comprising 43 men (40.6%) and 63 women (59.4%) between the ages of 18-64 (mean age: 44.1 ± 11.5 years), who had been diagnosed with otosclerosis resulting in conductive-type hearing loss, were included in the study. The audiometric values obtained for patients who had received intraoperative intravenous steroids were analysed on a retrospective basis by comparing the pre- and post-operative situation. The group of all patients was then subdivided into two groups on the basis of whether or not they had received intraoperative steroids. These groups were then evaluated in terms of pre- and post-operative bone and air conduction levels and the differences investigated statistically.

Results: Postoperative bone conduction averages for all the patients in both Group 1 and Group 2 were significantly improved at all frequencies, except at 4000 Hz, compared to the preoperative mean value. However, there was no statistically significant difference observed between patients who did receive intra-operative single-dose IV corticosteroid injections and patients who did not receive IV corticosteroid injections group in terms of preoperative and postoperative air-bone conduction levels.

Conclusion: It is not necessary routinely to administer systemic corticosteroids in order to prevent perioperative sensorineural hearing loss during surgery for otosclerosis. However, perioperative corticosteroids may be helpful in preventing sensorineural hearing loss when there are conditions present that can lead to inner ear damage during the operation.

Objective: Chronic otitis media is the infection of the middle ear and mastoid air cells. Cholesteatoma is keratinized squamous epithelium formation in the middle ear. Although the two diseases may be recognized with clinical examination, sometimes it may not be possible. While treatment of chronic otitis media includes antibiotic therapy or surgery, cholesteatoma is treated surgically. In this study, we aimed whether quantitative measurement of the soft tissue density in the middle ear on temporal bone CT may be used as a criterion for discrimination of chronic otitis media and cholesteatoma.

Materials and Methods: A total of 45 patients were included in the study. Multi-slice CT images were obtained in supine position for temporal bone CT. The soft tissue density was measured using free hand and circle region of interest (ROI) techniques on temporal bone CT examinations.

Results: A statistically significant difference was not detected between cholesteatoma and COM with regard to HU values on temporal bone CT in ROC curve. P value and Mann Whitney U was not statistically significant.

Conclusion: As a result, soft tissue density measurement is not statistically significant for differential diagnosis of COM and cholesteatoma.

Objective: To analyze the indications, complications, and outcomes of pediatric tracheotomies.

Material and methods: All tracheotomies performed in a tertiary referral center between January 2011 and December 2015 were reviewed retrospectively. Demographic characteristics of patients, types of referral to hospital, tracheotomy indications, preoperative evaluation findings, surgical technique, postoperative care and complications, discharge and follow-up results were analyzed.

Results: A total of 152 pediatric patients underwent tracheotomy at our hospital during this five year period. The median age of patients at the time of tracheotomy was 15.8 months, ranging from 24 days to 17 years. Of the 152 patients, 91 had neurological diseases, 38 had cardiopulmonary diseases, 14 had craniofacial abnormalities, seven had upper airway obstruction, and two underwent tracheostomy for trauma. Eleven (7.2%) patients experienced early complications, and 15 (9.8%) experienced late complications. Twenty (13.1%) patients were decannulated during the follow-up period. Unfortunately, 9 patients (5.9%) died of primary disease and 3 patients (1.9%) died of tracheostomy-related complications

Conclusions: The majority of procedures were performed for diseases leading to prolonged mechanical ventilator support such as neurological and cardiopulmonary diseases. This study demostrates the importance of tracheotomy indications, which are the main predictors of decannulation rates. The other significant predictor is pulmonary complications that may cause permanent dependence of mechanical ventilator support as a result of pulmonary failure.

Objectives: Within the last few years, oto-endoscopes have been in use for inserting transtympanic ventilation tubes. However, in terms of published studies, only a limited number have investigated the efficacy of endoscopic myringotomy and tube placement in children. The aim of this prospective study was to evaluate the feasibility of endoscopic ventilation tube insertion in children by comparing the duration and outcomes of endoscopic versus microscopic technique.

Method: The study included 39 children in total (22 boys and 17 girls) aged 2-10 years and diagnosed with chronic otitis media with effusion (COME). In Group A, ventilation tube insertion was performed using oto-endoscopy in 15 patients (29 ears). In Group B, ventilation tube insertion was performed using surgical microscopy in 24 patients (44 ears).

Results: The mean operative time for the microscopic technique was significantly shorter than that of the endoscopic technique (P < 0.05). No serious perioperative complications related to the techniques used occurred.

Conclusions: In children, oto-endoscopic tube placement can be performed safely, but the duration of endoscopic tube placement is not shorter than that of microscopic tube placement.