Objective The aim of this study was to investigate whether COVID-19 during pregnancy is a risk factor for congenital hearing loss. Study Design Retrospective cohort. Setting Tertiary referral center. Patients Hearing screening test results of 60,223 newborns between March 2020 and May 2021 were screened using the national database. Newborn babies of 570 pregnant women with positive COVID-19 PCR test during pregnancy who met the study criteria were included in the gestational COVID-19 group, and 570 healthy newborns born in the same period were included in the control group. Intervention Diagnostic. Main Outcome Measure Results of up to three automatic auditory brainstem response tests in the first 30 days of life were used for newborn hearing screening. Results When the gestational COVID-19 and control groups were compared in terms of demographic data, there was no statistically significant difference for any of the variables (maternal age, gestational age, birth weight, neonate gender, mode of delivery, p > 0.05 for all variables). Of the mothers in the gestational COVID-19 group, 62 (10.9%) had COVID-19 in the first trimester, 181 (31.8%) in the second trimester, and 327 (57.3%) in the third trimester. When the first and second test results of newborn hearing screening were compared between the groups, the number of babies with hearing loss was higher in the gestational COVID-19 group than in the control group (p = 0.025; odds ratio, 1.357; 95% confidence interval, 1.039–1.774; p = 0.006; odds ratio, 4.924; 95% confidence interval, 1.410–17.193, respectively). For the third test results, hearing loss was detected in only one baby in both groups (p = 0.284). When the first, second, and third test results for newborn hearing screening were compared according to the trimesters when COVID-19 positivity was identified, the difference between trimesters was not found to be statistically significant (p > 0.05). Conclusion To the best of our knowledge, this is the largest study in the literature of the impact of COVID-19 on newborn hearing. The findings in the study suggest that gestational COVID-19 is not a risk factor for permanent congenital hearing loss. However, because the risk of detecting hearing loss is high in the first 15 days, we emphasize the importance of the third screening test.

Objectives: This study aims to investigate the value of Video head impulse test (vHIT) findings in peripheral vertigo diseases, especially in Benign paroxysmal positional vertigo (BPPV) in the acute period. Design: A prospective study was designed. Setting: Otorhinolaryngology and Audiology Clinic of the tertiary university , October 2017-September 2018. Participants: Patients diagnosed with peripheral vertigo included prospectively and consecutively in the study. Main outcome measures: Demographic characteristics of the patients and pathological SCC detected by examination and diagnostic maneuver for BPPV patients were recorded. Vestibulo-ocular reflex (VOR) gain was calculated in all patients and all six SCCs. Two sub-study groups were formed according to age (<50 or >50). Also VOR gain detected for BPPV, Vestibular neuritis (VN), and Meniere’s disease (MD). Results: 74 (82.2%) of the patients were Benign paroxysmal positional vertigo (BPPV), eight (8.9%) of patients were vestibular neuritis (VN), and eight (8.9 %) of them were Meniere’s disease (MD). Pathological deficiency of VOR for SCCs was detected in 49 of 74 (66.2%) patients with BPPV, all eight patients with VN (100%), and four of eight patients with Meniere’s disease (50%). The sensitivity and specificity calculated as 55.4% and 81.2% for BPPV patients. Conclusions: vHIT is a new protocol and provides objective findings for SCC functions in patients with peripheral vertigo. vHIT can be performed faster and easier than the caloric stimulation test for VN diagnosis with comparable results. However, vHIT does not provide sufficient results for BPPV to distinguish from other peripheral vestibular system diseases.

The aim of this study was to determine the most important risk factors in the development of otitis media with effusion (OME) in children with adenoid hypertrophy. A total of 539 patients undergoing surgery for adenoid hypertrophy (AH Group) (n = 429) or adenoid hypertrophy and otitis media with effusion (AH + OME Group) (n = 110) between February 2012 and February 2018 constituted the study group. Data were obtained on neonatal history (breastfeeding, bottle feeding), past health and medical history (presence of atopy or allergic rhinitis, snoring at night, cough, tonsillitis in the past 12 months), environmental factors (presence of pets, attending to daycare centers, district of school), family history (passive smoking at home, number of siblings, family size, parental education), and family income. The groups did not differ from each other for age (p = 0.684) and gender (p = 0.728). Our data support the presence of atopy or allergic rhinitis (p < 0.001), frequent (> 5) tonsillitis (p < 0.001), attending to daycare centers (p < 0.001), exposure to smoke (p < 0.001), having 3 or more siblings (p < 0.001), and 4 or more people in the household (p < 0.001) as the main risk factors for OME. Comprehensive knowledge of modifiable risk factors found in this study could help to minimise the complications of OME in children.

Introduction 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters such as; maximum standardized uptake values, standard metabolic tumor volume and otal lesion glycosis are important prognostic biomarkers in cancers. Objective To investigate the prognostic value of these parameters in patients with head and neck cancers. Methods We performed a retrospective study including 47 patients with head and neck cancer who underwent18F-fluorodeoxyglucose positron emission tomography/computed tomography prior to treatment. Standard metabolic tumor volume, otal lesion glycosis and standardized uptake were measured for each patient. The prognostic value of quantitative 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters and clinicopathologic variables on disease free survival and overall survival were analyzed. Results The median (range) standard metabolic tumor volume and otal lesion glycosis and standardized uptake were 7.63 cm3 (0.6-34.3), 68.9 g (2.58-524.5 g), 13.89 (4.89-33.03 g/mL), respectively. Lymph node metastases and tumour differentiation were significant variables for disease free survival and overall survival, however, all 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters were not associated with disease- free survival and overall survival. Conclusion Pretreatment quantities positron emission tomography parameters did not predict survival in head and neck cancer.

Address for Correspondence: Mustafa Yazır E-mail: muyazir66@gmail.com Received: 13.02.2019 Accepted: 06.03.2019 DOI: 10.5152/ejra.2019.118 ©Copyright 2018 by Turkish Rhinologic Society Available online at www.eurjrhinol.org Abstract Objective: The aim of this study was to evaluate clinical characteristics and surgical outcomes of paranasal sinus fungus ball. Material and Methods: We retrospectively examined clinical records including clinical presentations, radiologic findings, management, and outcomes of fungus ball who underwent functional endoscopic surgery for treatment between 2008-2019. The patients demographic data, clinical presentations, radiological findings and surgical outcomes were analysed. Results: The patients ages ranged between 30 and 76 years, mean age was 55.2. Most common symptoms were headache and facial pain.On computed tomography, the most common finding was sclerosis in bony walls of the sinus (78.3%). Magnetic resonance imaging revealed a marked low intensity on T2 weighted images in all cases (100%). All patients were treated with functional endoscopic sinus surgery. Conclusion: Fungus ball should be considered in patients with unilateral nasal symptoms and unexplained headache and facial pain. Endoscopic sinus surgery is the treatment of choice in all cases.

Various surgical techniques and approaches for addressing nasal valve collapse have been described in the literature. Still, new techniques continue to be developed and old techniques continue to be improved upon. The aim of the present study was to validate the use of the internal nasal valve expanding graft for middle vault reconstruction and to review the authors' experience using this technique. A total of 32 patients who underwent middle vault reconstruction were retrospective reviewed. Analysis using Visual Analogue Scale (VAS) and Nasal Obstruction Symptom Evaluation (NOSE)-scale was performed pre-and postoperatively. Visual Analogue Scale scores for nasal airflow per side were collected on a 10-point scale, with 1 indicating total obstruction and 10 indicating a perfect nasal airway. Nasal Obstruction Symptom Evaluation scale was used to assess nasal obstruction. Minimum follow-up period was 6 months after the operation. Pre- and postoperative VAS scores were used to assess degree of nasal valve collapse according to examination findings. It was significant that there was improvement in nasal valve collapse after surgery (P<0.05). Based upon pre-and postoperative calculations made using NOSE scores, there was significant improvement regarding nasal blockage or congestion, troubled breathing and sleeping, and air through nose during exercise, respectively (P<0.05). No complications in terms of septal perforation, hematoma, synechiae, or infection that required further intervention were noted at postoperative follow-ups. In conclusion, internal nasal valve expanding graft has now been shown to be successful for middle vault reconstruction in a group of appropriately selected patient.

Objective: To compare the functional outcomes and complications of stapedotomy with and without vein graft interposition Design: Retrospective case study Setting: Tertiary referral hospital Subjects: Sixty otosclerosis patients (66 ears) that underwent primary stapedotomy surgery and followed up for at least 6 months Interventions: Stapedotomy with vein graft interposition (n = 36) versus stapedotomy without interposition (n = 30) Main outcome measures: Mean postoperative 4-frequency (500Hz, 1000Hz, 2000Hz, 4000Hz) air-bone gap, postoperative hearing gains for individual frequencies, sensorineural hearing loss and vertigo Results: The mean postoperative 4-frequency (500Hz, 1000Hz, 2000Hz, 4000Hz) air-bone gap with interposition was significantly higher than without interposition (16.4 +/- 9.4 dB versus 10.7 +/- 7.4 dB, respectively). Analyses of postoperative hearing gains revealed higher gains without interposition in all frequencies, significant for frequencies at 500Hz and 1000Hz in AC, and 4000 Hz in BC thresholds. Although the frequency of sensorineural hearing loss and vertigo did not differ between groups, sensorineural hearing loss tended to be higher with vein graft interposition. Conclusion: Stapedotomy without interposition required less manipulation, thereby leading to satisfactory results without major complications. Difficulties in performing the vein graft interposition technique requiring more manipulations and skill may be a disadvantage. Prospective randomized studies with larger series comparing different techniques can better evaluate the results.

Objective: The aim of this study was to evaluate the efficacy of hyperbaric oxygen (HBO) therapy as salvage therapy in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) after failure of systemic therapy. Methods: Forty-eight consecutive patients with refractory ISSNHL were enrolled retrospectively. All patients were given systemic steroid therapy by tapered doses. In addition, forty-one patients received intratympanic dexamethasone injection. Hearing outcomes were determined by recovery rate according to Siegel's criteria and hearing gains in pure-tone average (PTA) measured by audiometry before and after HBO therapy. The effects of prognostic factors on hearing recovery were also evaluated. Results: Thirteen (27%) patients responded to HBO therapy. The remaining 35 (73%) patients did not show any improvement. After HBO therapy, significant improvement was found in mean hearing thresholds at all frequencies. Only the level of initial PTA level and gender were significantly associated with recovery. Patients with severe hearing loss (≥70 dB) had significantly better results. Conclusion: Salvage HBO therapy may be beneficial in patients with ISSNHL who failed to recover by primary combined steroid therapy. Further hearing recovery with salvage HBO therapy can be expected, particularly in patients with PTA greater than 70 dB.

Objective: To determine the frequency of p16 positivity in oral cavity and oropharyngeal squamous cell carcinoma (OC/OP-SCC) and to reveal whether there is a difference between p16-positive and -negative cases according to clinicopathological parameters.Methods: p16 antibody was retrospectively analyzed immunohistochemically in biopsies of 60 patients with OC/OP-SCC operated between 2007 to 2015. Comparison was performed for age, sex, smoking habit, alcohol consumption, site of the tumor, the level of keratinization, T stage, lymphovascular invasion, perineural invasion, recurrence of the tumor, and survival.Results: Of the 60 patients (18 females, 42 males), the median was 58 (range: 27 to 75) years. Seventeen patients were p16-positive, and 43 patients were p16-negative. Comparison of p16-positive and p16negative groups according to age, sex, T-stage, tumor subsite, tumor profundity, lymphovascular invasion, perineural invasion and survival was not statistically significant (p> 0.05). We found statistical difference between two groups according to tumor recurrence, smoking habit, and the degree of keratinization.Conclusion: In patients who underwent surgical treatment after the diagnosis of zOC/OP-SCC, p16 positivity may have a predictive role in terms of tumor recurrence.

Objective: To determine the frequency of p16 positivity in oral cavity and oropharyngeal squamous cell carcinoma (OC/OP-SCC) and to reveal whether there is a difference between p16-positive and -negative cases according to clinicopathological parameters. Methods: p16 antibody was retrospectively analyzed immunohistochemically in biopsies of 60 patients with OC/OP-SCC operated between 2007 to 2015. Comparison was performed for age, sex, smoking habit, alcohol consumption, site of the tumor, the level of keratinization, T stage, lymphovascular invasion, perineural invasion, recurrence of the tumor, and survival. Results: Of the 60 patients (18 females, 42 males), the median was 58 (range: 27 to 75) years. Seventeen patients were p16-positive, and 43 patients were p16-negative. Comparison of p16-positive and p16-negative groups according to age, sex, T-stage, tumor subsite, tumor profundity, lymphovascular invasion, perineural invasion and survival was not statistically significant (p>0.05). We found statistical difference between two groups according to tumor recurrence, smoking habit, and the degree of keratinization. Conclusion: In patients who underwent surgical treatment after the diagnosis of zOC/OP-SCC, p16 positivity may have a predictive role in terms of tumor recurrence.

OBJECTIVE:We investigated the value of lymph node density (LND) as a predictor of survival in patients with laryngeal squamous cell carcinoma (SCC) and positive neck node (pN+) after laryngectomy.STUDY DESIGN:Case series with chart review.SETTING:Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.SUBJECTS AND METHODS:We reviewed the records of 289 patients with newly diagnosed primary laryngeal carcinomas who underwent partial or total laryngectomy and combined neck dissection at a tertiary referral center between June 2006 and December 2014. Patients with pN+ laryngeal SCC (n = 101) were included in the study. Overall survival (OS) and disease-free survival (DFS) were used to evaluate the prognostic significance of LND.RESULTS:In 101 patients with pN+ laryngeal SCC, LND ≥0.09 and number of metastatic lymph nodes >4 were significantly associated with OS and DFS but not the overall tumor, node, and metastasis stage. Forward stepwise Cox regression analysis revealed that LND ≥0.09 was the only independent predictor of both DFS and OS. Furthermore, the odds ratio of LND ≥0.09 was 10 times higher in patients with regional recurrence when compared patients without regional recurrence.CONCLUSIONS:LND was the only independent prognostic predictor of OS and DFS in patients with pN+ laryngeal SCC. Moreover, patients with LND ≥0.09 were significantly associated with high risk of regional recurrence. Thus, patients with LND ≥0.09 are at high risk of regional recurrence and death and may be considered for adjuvant chemoradiation.

Objective: In laryngeal cancer the most suspected regions of invasion are preepiglottic space (PES), anterior commissure (AC), thyroid cartilage (TC), subglottic region (SR) and extralaryngeal spread (ELS). The objective of this study is to compare the results of preoperative computed tomography (CT) with postoperative histopathologic analysis in these critical regions for the total or partial laryngectomy. Methods: Eighty-nine patients, who had undergone total laryngectomy with a diagnosis of laryngeal cancer reported that squamous cell cancer (SCC) between 2005 and 2013, were reviewed retrospectively. All the patients, after the first application done total laryngectomy before flexible laryngoscopy, computed tomography for the neck and endoscopic biopsy with direct laryngoscopy. Histopathological results of PES, AC, TC, ELS and SR invasion are compared to preoperative CT findings and determined of specificity, sensitivity, false negative and false positive results and rate of accuracy. Results: All the patients were male, median age was 67 (range: 48 to 81) years. Fifty-six patients were in T4 and 33 patients in T3 stage. Compared to results between positive CT findings and negative histopathological examination; PES invasion in 41 patients/ 5 patients, AC invasion was found in 38/ 15 patients, TC invasion in 28/16 patients, SR invasion in 49/ 9 patients and ELS invasion in 25 /7 patients. Accuracy rate of computed tomography in these regions are 85%, 64%, 76%, 79%, and 83%, respectively. All the results especially thyroid cartilage invasion were statistically significant. Conclusion: In all regions invasion, CT has a low diagnostic reliability in high-grade laryngeal cancer in our study. We suggested that histopathological results are the gold standard intraoperatively for determining total or partial laryngectomy.

Objective: In laryngeal cancer the most suspected regions of invasion are preepiglottic space (PES), anterior commissure (AC), thyroid carti- lage (TC), subglottic region (SR) and extralaryngeal spread (ELS). The objective of this study is to compare the results of preoperative comput- ed tomography (CT) with postoperative histopathologic analysis in these critical regions for the total or partial laryngectomy. Methods: Eighty-nine patients, who had undergone total laryngecto- my with a diagnosis of laryngeal cancer reported that squamous cell cancer (SCC) between 2005 and 2013, were reviewed retrospectively. All the patients, after the first application done total laryngectomy before flexible laryngoscopy, computed tomography for the neck and endoscopic biopsy with direct laryngoscopy. Histopathological results of PES, AC, TC, ELS and SR invasion are compared to preoperative CT findings and determined of specificity, sensitivity, false negative and false positive results and rate of accuracy. Results: All the patients were male, median age was 67 (range: 48 to 81) years. Fifty-six patients were in T4 and 33 patients in T3 stage. Compared to results between positive CT findings and negative histopathological examination; PES invasion in 41 patients/ 5 patients, AC invasion was found in 38/ 15 patients, TC invasion in 28/16 patients, SR invasion in 49/ 9 patients and ELS invasion in 25 /7 patients. Accuracy rate of computed tomography in these regions are 85%, 64%, 76%, 79%, and 83%, respectively. All the results especially thyroid cartilage invasion were statistically significant. Conclusion: In all regions invasion, CT has a low diagnostic reliability in high-grade laryngeal cancer in our study. We suggested that histopathological results are the gold standard intraoperatively for deter- mining total or partial laryngectomy.

Objective We investigated the value of lymph node density (LND) as a predictor of survival in patients with laryngeal squamous cell carcinoma (SCC) and positive neck node (pN+) after laryngectomy. Study Design Case series with chart review. Setting Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey. Subjects and Methods We reviewed the records of 289 patients with newly diagnosed primary laryngeal carcinomas who underwent partial or total laryngectomy and combined neck dissection at a tertiary referral center between June 2006 and December 2014. Patients with pN+ laryngeal SCC (n = 101) were included in the study. Overall survival (OS) and disease-free survival (DFS) were used to evaluate the prognostic significance of LND. Results In 101 patients with pN+ laryngeal SCC, LND ≥0.09 and number of metastatic lymph nodes >4 were significantly associated with OS and DFS but not the overall tumor, node, and metastasis stage. Forward stepwise Cox regression analysis revealed that LND ≥0.09 was the only independent predictor of both DFS and OS. Furthermore, the odds ratio of LND ≥0.09 was 10 times higher in patients with regional recurrence when compared patients without regional recurrence. Conclusions LND was the only independent prognostic predictor of OS and DFS in patients with pN+ laryngeal SCC. Moreover, patients with LND ≥0.09 were significantly associated with high risk of regional recurrence. Thus, patients with LND ≥0.09 are at high risk of regional recurrence and death and may be considered for adjuvant chemoradiation.

Objectives: To compare the hearing results and graft take rates of the recently developed gold wire prosthesis with those of the hydroxyapatite partial ossicular replacement prosthesis in patients with chronic otitis media. Method: This retrospective study examined patients who underwent type 2 tympanoplasty with a minimum follow up of one year. The study population consisted of 32 patients in the partial ossicular replacement prosthesis group and 26 patients in the gold wire group. The main outcome measures were the graft success rate and level of hearing improvement. Complications and extrusion rates were also noted. Results: The graft take rate was 90.6 per cent for the partial ossicular replacement prosthesis group and 92.3 per cent for the gold wire group ( p = 0.848). Pre-operatively, there were no significant differences in the air or bone-conduction thresholds between groups. Post-operatively, the mean hearing gain was 18.5 ± 14.0 dB in the partial ossicular replacement prosthesis group and 16.5 ± 10.6 dB in the gold wire group ( p = 0.555). The mean air-conduction thresholds were 26.6 ± 12.4 and 32.6 ± 10.5 dB, respectively ( p = 0.027), and the mean bone-conduction thresholds were 9.7 ± 7.0 and 10.4 ± 6.4 dB, respectively ( p = 0.687). Conclusion: The success and complication rates provided by the gold wire prosthesis seem comparable to those of the hydroxyapatite partial ossicular replacement prosthesis.

The most common cause of laryngotracheal stenosis is long-term intubation in intensive care units. The patients that suffer dyspnea after being discharged from the intensive care unit, are often mistakenly diagnosed with asthma initially and are diagnosed with tracheal stenosis only after further examination. Rarely, some cases are idiopathic. Here, we present a patient who was diagnosed with asthma mistakenly because of progressive dyspnea which lasted for a long time. A detailed examination revealed stenosis in glottis of larynx and thoracic segments of the trachea. Segmental tracheal resection with end-to-end anastomosis was performed on distal tracheal stenosis, followed by a total cricoidectomy, thyrotracheal anastomosis and temporary T-tube insertion on glottic involvement subglottic stenosis . The patient was discharged home and followed as an outpatient.