Objective: To compare the effects of septal extension (SE) grafts and columellar strut (CS) grafts reinforced with septocolumellar sutures on nasal tip projection, rotation, and patient-reported outcomes in primary rhinoplasty using standardized photogrammetric analysis. Methods: This retrospective cohort study included 60 patients who underwent primary rhinoplasty between 2019 and 2024 (30 SE and 30 CS grafts reinforced with septocolumellar sutures). Nasal tip projection, rotation, and anthropometric parameters were assessed using Rhinobase software. Functional and esthetic outcomes were evaluated using the Nasal Obstruction Symptom Evaluation Questionnaire (NOSE) and Facial Aesthetic Quality of Life Questionnaire (FACE-Q). Results: The mean age was 27.8 years, and 70% of the participants were female. The mean postoperative follow-up was 9.5±2.7 months. Although baseline nasal length and tip projection were lower in the SE group, both techniques produced comparable postoperative improvements in nasal tip projection, rotation, and nasal length. Postoperative FACE-Q and NOSE scores were also similar between groups, despite lower preoperative FACE-Q scores in the SE group (p=0.003). Conclusion: CS grafts reinforced with septocolumellar sutures achieved functional and esthetic outcomes comparable to SE grafts. These findings suggest that septocolumellar suturing may compensate for the structural advantages traditionally attributed to SE grafts in primary rhinoplasty.
Objective: To describe the frequency and pattern of long-term postoperative swallowing abnormalities detected by flexible endoscopic evaluation of swallowing (FEES) after carbon dioxide (CO₂) laser transverse posterior cordotomy for bilateral vocal fold paralysis (BVFP), and to relate these findings to patient-reported and functional swallowing measures. Methods: This retrospective, single-center cross-sectional study included 17 adults with BVFP who had previously undergone CO₂ laser transverse posterior cordotomy and were evaluated at a single postoperative time point between January and June 2025. Swallowing safety and efficiency were assessed using FEES with boluses representing International Dysphagia Diet Standardisation Initiative levels 0 (thin liquid; dyed water), level 3 (moderately thick; dyed yogurt), and level 7 (regular; cracker). Airway invasion and pharyngeal residue were graded using the Penetration-Aspiration Scale and Yale Pharyngeal Residue Severity Rating Scale. Functional Oral Intake Scale (FOIS), Functional Outcome Swallowing Scale (FOSS), and Eating Assessment Tool-10 scores were also recorded. Results: All participants were female (n=17; mean age 60.9±13.3 years) with a mean postoperative follow-up of 70.6±41.6 months. Penetration was common across consistencies; thin-liquid aspiration occurred in one patient. Vallecular and pyriform sinus residue was observed in a subset of patients. Most maintained full or near-full oral intake (FOIS 7, 76.5%) with mild functional limitation (FOSS 1-2, 94.1%). Conclusion: This descriptive postoperative series contributes objective FEES-based long-term swallowing data after CO₂ laser transverse posterior cordotomy in BVFP. FEES frequently demonstrated penetration and pharyngeal residue despite generally preserved oral intake, but these findings should not be interpreted as a treatment effect because baseline swallowing data were unavailable.
To describe and assess the feasibility of a simple, low-cost retrograde transillumination technique for identifying and confirming the frontal sinus opening during endoscopic frontal sinus surgery in a small series of patients. This single-center descriptive surgical series, conducted between November 2024 and January 2025, included five patients who underwent endoscopic frontal sinus surgery. The technique’s five steps were standardized: angled endoscopic view (45°) of the frontal recess, probing the probable opening with angled instruments, darkening the room, placing the light source of the endoscope superomedial to the eyebrow, and observing a retrograde endonasal glow at the true ostium. In all cases, localization of the frontal opening was achieved by retrograde transillumination and independently verified with neuronavigation. Representative scenarios included nasal polyposis, pansinusitis, revision surgery (Draf III), and a pediatric patient with complicated sinusitis with epidural abscess. Retrograde transillumination enabled identification of the frontal sinus opening in all five cases and guided the extent of surgery (Draf IIa-b/III as indicated). It proved especially helpful when landmarks were distorted or when frontal recess cell variants obscured the pathway. In this limited series, retrograde transillumination appeared to be a pragmatic, cost-effective adjunct that complemented anatomical expertise, surgical experience, and neuronavigation for intraoperative localization of the frontal sinus opening. Larger comparative studies are needed to further evaluate its accuracy and generalizability.
The coronavirus disease-2019 (COVID-19) pandemic has led to a high prevalence of olfactory dysfunction (OD), a debilitating condition that significantly impacts quality of life (QoL). While most patients recover their sense of smell, a substantial number experience persistent COVID-OD. Olfactory training (OT) has emerged as a leading, non-invasive therapeutic strategy. A systematic review and meta-analysis were conducted on evidence retrieved from Web of Science, PubMed, Scopus, CENTRAL, and Embase through June 2025 for randomized controlled trials (RCTs) evaluating OT in patients with COVID-OD. The primary outcome was the change in objective olfactory scores, and the secondary outcome was the change in QoL scores. We used STATA software to pool outcomes using standardized mean differences (SMD) with 95% confidence intervals (CI). Ten RCTs involving 628 patients were included in the analysis. Compared to the control group, OT was associated with a significant improvement in objective olfactory scores [SMD=0.30, 95% CI (0.08, 0.51), p=0.01] and QoL [SMD=-0.40, 95% CI (-0.65, -0.15), p<0.001]. The heterogeneity among studies was low for both outcomes (I²=33.69% and I²=37.47%, respectively). OT significantly improves objective olfactory function and QoL in patients with COVID-OD. Despite these positive findings, the results should be interpreted with caution due to heterogeneity in OT protocols and variability among the included studies. Future large-scale, rigorously designed RCTs with standardized OT protocols are necessary to establish definitive clinical practice guidelines.
Internal carotid artery rupture in the middle ear is very rare and can be life-threatening. We report the case of a 78-year-old male with a history of chronic otitis media who presented with spontaneous, high-volume otorrhagia. Computed tomography imaging revealed a dissection of the petrous segment of the internal carotid artery with an associated pseudoaneurysm. As the rupture of the pseudoaneurysm was considered the cause of otorrhagia, endovascular stenting was performed. After hospital admission for monitoring and antibiotic treatment, the patient underwent subtotal petrosectomy, with no further episodes of hemorrhage.
This systematic review aimed to assess and integrate research on risk factors for congenital hearing loss (CHL), emphasizing genetic, infectious, perinatal, environmental, and sociodemographic influences. The review was prospectively registered with PROSPERO (CRD42022372879) and conducted according to PRISMA 2020 and PRISMA-S guidelines. A comprehensive search was performed across PubMed, Embase, Scopus, and Google Scholar using MeSH terms and free-text keywords related to CHL and its risk factors. Observational studies (cohort, case-control, cross-sectional) involving children with CHL and assessing genetic, infectious, perinatal, or environmental exposures were included. Data extraction was done independently by two reviewers, covering study characteristics, diagnostic methods, and measures of association (odds ratio, relative risk). Risk of bias was evaluated using the Newcastle-Ottawa scale for cohort/case-control studies and the Joanna Briggs Institute checklist for cross-sectional studies. Genetic factors such as GJB2 mutations, a positive family history, and consanguinity were consistently associated with CHL. Infectious etiologies, particularly congenital cytomegalovirus, were prominent across studies, with TORCH infections also commonly implicated. Perinatal risk factors, including neonatal intensive care unit admission, low birth weight, and hyperbilirubinemia, were frequently reported in affected children. Environmental exposures, especially to ototoxic medications, were noted as significant contributors, often acting synergistically with other risk factors like infections or genetic conditions. Sensorineural hearing loss, predominantly bilateral, emerged as the most common type reported. CHL is a multifactorial condition, with genetic and infectious causes being most prevalent. Targeted screening and preventive strategies addressing these risk domains are crucial for early detection and management.
Objective:This study evaluated the indications for cochlear implant (CI) that extend beyond the current criteria of the Health Implementation Communiqué (HIC) of the Turkish Social Security Institution. Methods:A retrospective review was performed on 27 patients who underwent CI, even though they did not meet the HIC criteria. All cases were approved by the Scientific Advisory Board on Auditory Implants of the Ministry of Health. Demographic, clinical, and audiological data, including pre- and post-operative pure-tone averages (PTA) and speech discrimination scores (SDS), were analyzed. Results:The cohort included 15 females and 12 males, with a median age of 17 years. Etiologies comprised congenital hearing loss (n=14), idiopathic sudden sensorineural hearing loss (n=3), post-meningitic hearing loss (n=2), Menière's disease (n=1), and other acquired causes. Exclusion from the HIC criteria was mainly due to age restrictions for bilateral CI, audiological thresholds outside defined limits, single-sided deafness, SDS above 30%, or a gap of more than four years between chronological and language age. Audiological outcomes from 22 patients revealed a median PTA with the CI alone of 35 dB hearing level and a median SDS of 58%, with significant improvement compared to baseline (p<0.001). While most patients demonstrated substantial benefit, 14.8% (cases 6, 17, 21, 25) exhibited poor performance (SDS <30%). Case analyses underscored the impact of etiology and duration of auditory deprivation on outcomes. Conclusion:CI beyond conventional reimbursement criteria can provide meaningful functional gains. Individualized, evidence-based, multidisciplinary evaluation supports broader access to hearing rehabilitation and is consistent with global trends in personalized auditory care.
Objective:The aim of this study is to investigate the clinical application value of exhaled nasal nitric oxide (nNO) in the pathological diagnosis and classification of epithelial remodeling in nasal polyps (NP). Methods:The differences between the nNO levels in patients with NP exhibiting different types of epithelial remodeling and the correlations between nNO and clinical data were retrospectively analyzed. The diagnostic value of nNO in NP was evaluated using receiver operating characteristic curves. Results:The levels of nNO in the control group were found to be significantly higher than those in the epithelial hyperplasia, goblet cell hyperplasia, and squamous metaplasia groups (p=0.001, p=0.001, p=0.02). Furthermore, the levels were found to be significantly higher in the squamous metaplasia group than those in the epithelial hyperplasia and goblet cell hyperplasia groups (p=0.025, p=0.018). The percentage and count of eosinophils in peripheral blood in the goblet cell hyperplasia group were significantly higher than in the control group (p=0.001). nNO levels were negatively correlated with the ethmoid-to-maxillary computed tomography score ratio (E/M ratio) and Lund-Mackay score (L-M score) in the epithelial hyperplasia group and the goblet cell hyperplasia group (r=-0.518, p<0.05; r=-0.640, p<0.01; r=-0.421, p<0.01; r=-0.599, p<0.001, respectively). Similarly, a negative correlation was identified between nNO levels and the L-M score in the squamous metaplasia group (r=-0.612, p<0.01). nNO levels exhibited moderate diagnostic value in differentiating non-chronic sinusitis patients from epithelial hyperplasia, goblet cell hyperplasia, and squamous metaplasia [area under the curve (AUC) =0.898, p<0.001; AUC=0.882, p<0.001; AUC=0.720, p=0.025, respectively]. Conclusion:nNO has been shown to have significant clinical value in the preliminary pathological diagnosis and prediction of NP lesions with nasal epithelial hyperplasia, goblet cell hyperplasia, and squamous metaplasia.
Laryngeal fracture is a rare but potentially life-threatening injury requiring prompt recognition and management due to the risk of airway compromise. We present the case of a 42-year-old man who presented to a tertiary center with symptoms of dysphonia and neck pain following blunt trauma sustained when a barbell fell on him while bench pressing without assistance. Computed tomography (CT) imaging confirmed a displaced fracture of the thyroid cartilage. He was managed conservatively with corticosteroids and high dependency unit airway monitoring. He recovered well and later resumed weightlifting with appropriate supervision. This case outlines the stages of assessment and management of laryngeal fractures, including airway evaluation, CT imaging and ear nose and throat (ENT) involvement. We discuss the benefit of conservative management in selected cases even when there are significant clinical findings and the importance of public health messaging to prevent such injuries. A high index of suspicion is essential for emergency physicians and ENT specialists when evaluating patients with neck trauma and voice changes.
Localized amyloidosis of the upper aerodigestive tract is an uncommon and benign condition characterized by extracellular amyloid deposition. While the larynx is the most frequently involved site, progressive, multifocal mucosal involvement remains exceedingly rare. We report the case of a 58-year-old male initially diagnosed with localized laryngeal amyloidosis confirmed via Congo red staining. The initial laryngeal lesions were excised using conservative endoscopic surgery to both confirm the diagnosis and alleviate symptoms. However, no additional treatment was recommended by the rheumatology department since the patient's further evaluations did not indicate a diagnosis of systemic amyloidosis. Over an 11-year follow-up period, sequential progression to the nasopharynx was observed after five years and to the nasal cavity after 11 years. The patient remained free of systemic involvement throughout, confirmed by comprehensive evaluations including serum and urine immunofixation, renal and hepatic panels, and 24-hour urine analysis. Symptomatic relief was achieved with a series of conservative surgical interventions addressing airway and auditory symptoms. The patient remains under active surveillance. This case highlights a rare, progressive pattern of localized amyloidosis involving contiguous mucosal sites in the upper aerodigestive tract. It underscores the importance of long-term follow-up, systematic evaluation to exclude systemic disease, and the efficacy of conservative surgical management. To our knowledge, this is the first reported case of progressive, segmental spread of localized amyloidosis involving the larynx, the nasopharynx, and the nasal cavity over more than a decade.
Objective:To develop an assessment tool for evaluating the ability of otorhinolaryngology (ORL) residents to perform rhinomanometry and acoustic rhinometry (R-AR), and therewith to assess their learning processes in acquiring R-AR skills. Methods:Firstly, a "procedural skill rating scale (PSRS)" was designed for the assessment process. The R-AR performances of 10 residents, each performing 20 procedures, were observed and scored using the PSRS. The correlation between the increase in the number of procedures performed, the improvement in scores, and the reduction in procedure duration was studied. Interrater reliability was evaluated independently by two raters using 20 R-AR procedures. Cronbach's alpha was calculated for reliability. Results:The correlation between the number of procedures performed and the increase in scores was r=0.911 (p<0.001) for rhinomanometry-PSRS and r=0.832 (p<0.001) for acoustic rhinometry-PSRS. Mean procedure duration was 2.11±0.39 minutes (min: 1.17, max: 3.95) for rhinomanometry and 1.55±0.34 minutes (min: 1.07, max: 3.19) for acoustic rhinometry. The correlation between the increase in the number of procedures performed and the reduction in duration was r=-0.937 (p<0.001). Interrater reliability was r=0.788 for rhinomanometry-PSRS and r=0.795 for acoustic rhinometry-PSRS (p<0.001). Cronbach's alpha was 0.971 for rhinomanometry-PSRS and 0.969 for acoustic rhinometry-PSRS. Conclusion:A valid and reliable assessment tool has been developed to evaluate ORL residents' skills in performing R-AR. Both tools are recommended for assessing ORL residents' proficiency and determining their achievement of competence.
Objective: Cochlear implant surgery enables individuals with severe hearing loss to regain auditory function. With the increasing number of implant recipients, complications have become more common, leading to a greater need for revision procedures. This study aimed to analyze and assess the underlying causes of revision surgeries performed in our clinic. Methods: This retrospective study reviewed 1,800 patients who underwent cochlear implantation in our clinic. Of these, 118 patients who required revision operations were included in the analysis. Causes of revision, observed complications, and demographic profiles of the patients were studied. Results: No significant differences were found in age, gender, implantation side, presence of inner ear anomalies, or etiology between patients with and without complications (p>0.05). Complications were observed in 22.9% of female patients (n=11) and 8.6% of male patients (n=6). The cochlear implant brand, failure type (soft or hard), and revision indication were not statistically related to complication status (p>0.05). Although not significant, complication rates were higher among patients who required revision due to device malfunction or cholesteatoma. Conclusion: Revision cochlear implantation should be considered in patients presenting with symptoms such as hearing deterioration, tinnitus, pain or swelling at the implant site, redness, delayed wound healing, or atypical facial sensations. This study summarizes our clinical experience and highlights the primary causes leading to revision cochlear implantation.
Dual ectopic thyroid tissue represents an exceedingly rare developmental anomaly, with only a handful of cases described in the literature. The simultaneous occurrence of two ectopic thyroid foci in the presence of a normally sited gland is particularly uncommon. We present the case of a 60-year-old Chinese woman who presented with a painless swelling in the left mid-lateral neck of six months’ duration. Clinical assessment and contrast-enhanced computed tomography suggested thyroid-like tissue in the mid-lateral neck area, while thyroid function tests remained normal. Fine needle aspiration cytology yielded benign follicular nodules, and radionuclide single photon emission computed tomography demonstrated two hyperfunctioning ectopic thyroid foci at the base of the tongue and in the left mid-lateral neck region, with preserved uptake in the orthotopic gland. The left neck mass was excised and confirmed histologically as thyroid tissue without evidence of malignancy. The patient made a full recovery with no further treatment required. This case illustrates the value of considering ectopic thyroid tissue in the differential diagnosis of neck masses, particularly when encountered in atypical locations.
Objective: Salivary gland tumors are common tumors of the head and neck region, and most are located in the parotid gland and the majority are benign. Parotidectomy, which is applied in the treatment of these tumors, is a very specific procedure in terms of both surgical technique and complications. Many quality of life (QoL) questionnaires have been used to evaluate the patient after parotid surgery; however, none are specific to parotidectomy. The Parotidectomy Outcome Inventory-8 (POI-8) was developed and validated in German to measure QoL after parotidectomy in patients with benign tumors. In this study, our aim was to translate POI-8 into Turkish and study its validity and reliability. Methods: Fifty patients had parotidectomy due to benign pathologies and they were included in the study. All participants were administered the Turkish version of the University of Washington QoL questionnaire (UW-QoL), which had previously been validated in Turkish, and the Turkish version of the POI-8, which was prepared with expert committee evaluation. Validity assessment, internal consistency analysis, intra-rater and inter-rater reliability assessment were performed for POI-8. Results: In the Turkish version of POI-8, a high level of intra-rater and inter-rater reliability was detected. A high-level, negative correlation was observed between POI-8 and UW-QoL. A strong internal consistency was detected with a high Cronbach’s alpha coefficient. Conclusion: POI-8, which we translated into Turkish and validated, can be used safely by head and neck surgeons to measure QoL after parotidectomy with its high reliability values.
We report a rare case of herniation of the flocculus cerebellaris into the internal auditory canal (IAC) and discuss the radiologic features and clinical implications in light of the current literature. A 19-year-old male with vestibular symptoms underwent high-resolution magnetic resonance imaging (MRI), which revealed cerebellar tissue within the right IAC. Multiplanar MRI sequences showed extension of the flocculus into the IAC with no evidence of mass effect or neurovascular compression. Herniation of the flocculus cerebellaris into the IAC is a rare anatomic variant that can mimic neoplastic lesions. Awareness of this entity is critical to avoid misdiagnosis and unnecessary intervention. This case report highlights the importance of a rare anatomical variant in the differential diagnosis.
Objective: The aim of this bibliometric analysis is to assess the evolving trends in animal research in otorhinolaryngology over two different time periods. Methods: Articles published in the Science Citation Index Expanded general otorhinolaryngology journals in 2005-2007 and 2018-2020 were retrieved. The relationship of these studies to the Replacement, Reduction, and Refinement (3Rs) principles, emphasizing evidence of Reduction, and Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines were examined, and the predominant subspecialties and the contributions of journals and countries were evaluated. Keyword, research focus, and citation analyses were performed using VOSviewer. Results: Despite a 51.8% increase in the total number of publications between the two study periods, the number of animal studies decreased by 41.5%, along with a 49.1% reduction in the number of animals used. In vivo studies lacking reported animal numbers constituted 10.9% in the first period and 10.3% in the second. “Cochlea” and “ototoxicity” were the most frequent keywords, with seven of the top ten appearing in both periods. Although 58.6% of the animal studies received ten or fewer citations, The Laryngoscope published the most animal studies and was the most-cited journal. Conclusion: This study underscores the importance of adopting the 3Rs and enhancing adherence to guidelines such as ARRIVE. Evaluating the outcomes of animal studies will be essential for responsible and impactful research in otorhinolaryngology. By revealing current research focuses, leading journals, and countries, this study also presents clues for future animal research in the field.
Sialolipoma is a rare benign salivary gland tumor, most commonly arising in the parotid gland. Its oncocytic variant is exceedingly uncommon, particularly in the submandibular gland. We report a 58-year-old woman presenting with a painless, enlarging left submandibular mass. Imaging revealed a heterogeneous fat-containing lesion with calcifications and suspicious lymphadenopathy, and fine-needle aspiration suggested a salivary gland neoplasm of uncertain malignant potential. The patient underwent submandibular gland excision with selective neck dissection. Histopathological examination confirmed oncocytic sialolipoma, and no recurrence was observed during 24 months of follow-up. A literature review identified only nine previously reported submandibular sialolipoma cases, several with oncocytic features. Preoperative findings, including calcifications and oncocytic cytology, may mimic malignancy. However, a well-circumscribed lesion composed of mature adipose tissue with salivary gland elements is diagnostic. Oncocytic sialolipoma of the submandibular gland is exceptionally rare. Despite its potential to mimic malignancy, it is benign, and complete excision provides definitive diagnosis and excellent prognosis.
