Objective: This study aimed to evaluate the impact of spreader graft placement during cosmetic rhinoplasty on both objective acoustic measures and subjective voice quality. Methods: In this prospective, double-blind, controlled study, volunteers who underwent open structural rhinoplasty by the same surgeon between September 2022 and January 2025 were included. Participants were divided into two groups: Group A (with spreader grafts) and Group B (without spreader grafts). Voice recordings were obtained preoperatively and three months postoperatively in a dedicated voice and speech laboratory. All participants provided informed consent and completed the Turkish version of the Voice Handicap Index-10 (VHI-10) before and after surgery. Objective voice analysis was conducted using the Computerized Speech Lab (CSL) system and Multi-Dimensional Voice Program (MDVP) software (Kay Elemetrics Corp., Lincoln Park, NJ, USA). Acoustic parameters ‒ fundamental frequency (f0), jitter, jitter percentage, shimmer, shimmer percentage, and Noise-to-Harmonics Ratio (NHR) ‒ were measured from sustained /a/ phonations. Spectrographic analysis assessed formant frequencies (F1–F4) during production of nasal consonants (/m/, /n/) and the nasalized vowel /i/ in the word mini. Results: In Group A, significant postoperative differences were observed only in F3 and F4 formant values for /m/. In Group B, significant changes were detected in shimmer (dB), jitter, and formant values (F2, F3, F4 for /n/ and F3, F4 for /m/). Postoperative group comparison revealed significant differences in F4 for /m/, F3 for /n/, and F3 for the nasalized vowel /i/. Regarding subjective measures, VHI-10 scores significantly increased postoperatively only in Group B. Preoperative VHI-10 scores did not differ significantly between groups, while postoperative scores showed significant differences. Conclusion: Cosmetic rhinoplasty may affect voice parameters, particularly formants F3 and F4, essential components of the singer’s and actor’s formant cluster. Spreader grafts appear to preserve these frequencies, suggesting their importance in patients who professionally rely on voice quality. Level of evidence: According to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence, this study qualifies as Level 1b evidence, as it is a prospective, double-blind, randomized controlled trial evaluating the effectiveness of an intervention.

INTRODUCTION:Our study aimed to reveal whether septoplasty and inferior turbinate reduction significantly impact the acoustic properties of nasalized syllables and alter subjective and objective voice parameters. MATERIALS AND METHODS:Forty patients with nasal septal deviation and bilateral grade 2 ≤ inferior turbinate hypertrophy who underwent septoplasty and bilateral inferior turbinoplasty were enrolled. Participants completed the VHI-10, VAS, and NOSE scales preoperatively and at 6 months postoperatively. Changes in VAS and NOSE scores were calculated as VASchange and NOSEchange values. Voice recordings of the sustained vowel /a/ and the word /mini/ were analysed using MDVP. Acoustic analysis was performed with the sustained vowel /a/, and spectrographic analysis was conducted with the consonants /m/, /n/, and the vowel /i/ in /mini/. Recordings were taken preoperatively and at 6 months postoperatively. Statistical analysis compared pre- and postoperative values for significant changes using SPSS Version 21.0 (IBM Corp.; Armonk, NY, USA). RESULTS:A statistically significant decrease in VAS and NOSE scores was observed at 6 months postoperatively (p < 0.05). No significant difference was found in VHI-10 scores (p > 0.05). Acoustic analysis showed a significant change in pre- and postoperative F0 values (p < 0.05), but not in jitter, jitter%, shimmer, shimmer%, and NHR (p > 0.05). Spectrographic analysis revealed significant postoperative changes in the F3 and F4 formants of consonants /m/, /n/, and vowel /i/ in the word /mini/. A significant correlation was found between postoperative changes in F3 and F4 formant values for consonants /m/ and /n/ with the VASchange value. For the NOSEchange value, a significant correlation was found only with the change in the F3 formant value for the consonant /m/. CONCLUSION:Nasal surgeries, particularly septo-turbinoplasty, can influence voice timbre by modifying F3 and F4, which is of notable concern for professional voice users, such as singers and actors, due to the potential impact on the singer's formant cluster and overall vocal quality. Although it may not be appropriate to generalise for all rhinological surgeries, the significant changes in the F3 and F4 formants in a specific and refined patient group suggest that caution should be exercised in such surgeries, especially for professional voice users.

Objective: To compare functional outcome of microscopic and endoscopic approach regarding type of ossiculoplasty. Methods: In this retrospective study, cases who had undergone type-II and type-III tympanoplasty between February 2007 to September 2019 were divided into two groups according to the type of approach as microscopic and endoscopic. In cases with type-II reconstruction; Partial Ossicular chain Replacement Prosthesis (PORP), incus interposition and bone cement were used in order of frequency. Whereas in cases with type-III reconstruction, only Total Ossicular chain Replacement Prosthesis (TORP) was used. The average Air Bone Gap (ABG) was determined pre- and post-operatively for the calculation of Air Conductance Gain (ACG). The ACG, pre- and post-operative ABG values of each group were compared with regard to the type of ossiculoplasty. Results: A total of 79 cases consisting of 32 females and 47 males who had undergone type-II and type-III tympanoplasty were enrolled. No statistically significant difference between microscopic and endoscopic approach was found in terms of ACG (p = 0.42), pre-(p = 0.23) and postoperative ABG (p = 0.99). We did not find any significant difference in terms of ACG, pre- and postoperative ABG between two approaches for type-II and type-III reconstructions (p>0.05). Conclusions: According to the current study, endoscopic approach in type-II and type-III reconstruction is at least reliable as microscopic approach regarding functional outcome. Since both techniques have similar functional results, other factors (anatomic characteristics, habitude of the surgeon and duration of the surgery) should be considered when choosing the technique. Level of evidence: In the current paper we present a retrospective comparative study of two different approaches of a particular type of otologic surgery. Level of evidence corresponds to level III.

•Tympanostomy tube placement in chronic otitis media with effusion is found to be functionally efficient in the long term.•Functional efficacy was also supported by tympanometry.•Timing of audiometric evaluation throughout the long term (9–22 months) does not affect the audiometric outcomes.•Our findings may be used to develop an algorithm or guideline for the timing of follow up after tympanostomy tube placement.

Purpose We aimed to assess if there is a significant change in voice of pregnant women by the end of third trimester. Materials and methods Forty-nine pregnant women were enrolled in this study between April 2019 and March 2020. Subjective and objective voice evaluation was conducted in the third trimester and three months after delivery. The Turkish version of the VHI-10 questionnaire was filled out by every participant. GRBAS scale was used for perceptual voice evaluation. Acoustic analyses were conducted by Multi-Dimensional Voice Program (MDVP) (Computerized Speech Lab, Kay Elemetrics Corporation, Lincoln Park, NJ). Fundamental frequency (fo), Jitter percent (Jitt), Shimmer percent (Shim), noise to harmonic ratio (NHR), maximum phonation time (MPT), voice turbulence index (VTI), vocal intensity, and scale parameters were categorized as predelivery (a) and postdelivery (b). Results Comparison of acoustic parameters of the third trimester with the third month postpartum revealed statistically significant increases for fo (p = .013), MPT (p = .008), and vocal intensity (p <=.001) as well as a significant decrease for VTI (p <= .001). No statistically significant difference was found for NHR, Jitt, and Shim. Comparison of both VHI-10 and GRBAS scores revealed statistically significant decreases. Conclusions Disturbances in certain vocal parameters suggest that vocal abnormalities observed during pregnancy are mainly due to anatomical alterations of the lower respiratory system. It would be appropriate to warn pregnant women about bad vocal habits and vocal hygiene. In addition, it would be appropriate to recommend professional voice support to pregnant women who use their voices intensively due to their profession.

Introduction: Pregnancy rhinitis is a common sex hormone-related otorhinolaryngological disorder. There are some epidemiological and physiological studies on pregnancy rhinitis, but histopathological and biomolecular changes have not been studied thoroughly. Objectives: The receptors VPAC1 and VPAC2 are known for their roles in allergic rhinitis. On the other hand, activation of subclinical allergy has been suggested in the pathophysiology of pregnancy rhinitis. Therefore, we aimed to compare the physiological and gestational pattern of VPAC1 and VPAC2 expression in rat nasal mucosa. Methods: Twenty adult Wister albino female rats were enrolled into the study. Two groups constituted as 10 control (group A) and 10 pregnant (group B) rats. They were fed ad libitum and sheltered at room temperature (22(circle)+/- 2(circle)C). The rats were sacrificed at the 20th day of gestation by intraperitoneal injection of 400mg/kg Na-pentobarbitone. Then, 10-15mL of blood was taken, and samples were reserved for the detection of serum estradiol and progesterone levels by ELISA test. The nasal septum was resected and divided in half for immunohistochemical analyses and real time polymerase chain reaction testing of VPAC1 and VPAC2. Results: VPAC1 and VPAC2 were found to be in all layers of septal specimens, but the immunostaining of surface epithelium was more distinct in specimens of both groups. We demonstrated higher overall staining intensity in the pregnant group. PCR revealed significant increase in expression of VPAC1 (p=0.023) and VPAC2 (p=0.021) in pregnant group when compared with control group. In addition, we demonstrated upregulatory effect of estradiol and progesterone on the vasoactive intestinal peptide receptor expression. Conclusions: Gestational up-regulation of nasal VPAC1 and VPAC2 was shown both by PCR and immunohistochemical analysis. These findings support the hypothesis that PR is caused by the activation of subclinical allergy that is present before pregnancy.

Aim: There is very limited information concerning gestational course of chronic inflammatory diseases of the upper airway. In the current study, we tried to reveal biomolecular changes in the nasal mucosa during pregnancy regarding NFκb and MUC5AC. This way, we may have the opportunity to suggest new treatment strategies for pregnancy induced nasal disorders. Methods: Thirty adult female rats were separated into pregnant and control groups. Serum estradiole (E2) and progesterone (PG) levels were evaluated by ELISA. Nasal expression of NFκb and MUC5AC were analyzed by polymerase chain reaction testing. Relative expression of NFκb and MUC5AC was compared between two groups. In addition, the influences of PG and E2 levels on NFκb and MUC5AC were determined. Results: NFκb was significantly low (P=0.015), while MUC5AC was significantly high in pregnant rats (P=0.029). Serum PG had a significantly negative effect on NF-κB expression (P=0.027) and a significantly positive effect on MUC5AC expression (P=0.017). There was a positive correlation between estradiol and MUC5AC (P=0.017). Conclusions: In the current study, the physiological expression of NFκb and MUC5AC was shown for the first time by PCR in rat nasal mucosa. The effect of PG and E2 on the expression of these biomolecules in the context of pregnancy was also revealed. These findings have the potential to elucidate gestational inflammatory alterations in the upper airway.

OBJECTIVES:To find out if the ratio of facial nerve to facial canal diameter plays any role in the etiopathogenesis and grade of Bell's palsy. PATIENTS AND METHODS:Twenty-nine consecutive patients (16 females, 13 males) diagnosed with unilateral Bell's palsy were enrolled into the study. At admission, 5 patients were grade V, 11 were grade IV, 11 were grade III and 2 were grade II. The grade of Bell's palsy was documented by House-Brackmann facial nerve grading system at admission, 15th day, 1st month and 3th month. Temporal MRI and CT scans were obtained at the time of diagnosis. Diameter of facial nerve and facial canal at the middle of five different segments were measured equidistantly at the same workstation. Both sides of every patient (affected and unaffected) were measured by one radiologist who was not informed about the side of the paralysis. MRI and CT values of each segment were compared between affected and unaffected sides. In addition, FN/FC ratio of affected and non-affected sides was calculated and compared for each segment. We also analyzed if a relationship exists between above-mentioned measurements and the House-Brackmann grade. RESULTS:Considering MRI values; statistically significant thickening of facial nerve between affected and unaffected sides was found at labyrinthine (p = 0.012), tympanic (p = 0.023) and geniculate parts (p = 0.04). Considering CT values; statistically significant difference between affected and unaffected sides was not found at any segment. Comparison of FN/FC ratio of both sides revealed statistically significant increment of the affected side at labyrinthine segment (p = 0.015) and geniculate ganglion (p = 0.032). We determined positive correlation between diameter of FN and HB grade at labyrinthine segment (p = 0.03, R = 0.531). On the other hand, we determined negative correlation between diameter of FC and HB grade at labyrinthine segment (p < 0.001, R = -318). A positive correlation between HB grade and FN/FC ratio was found only at the labyrinthine segment (p = 0.003, R = 0.673). CONCLUSION:FN/FC ratio of labyrinthine segment and geniculate ganglion was found to be increased in patients with Bell's palsy. In addition, a positive correlation was determined between this ratio and grade of Bell's palsy particularly at labyrinthine segment. Basing the current study, if FN decompression is recommended in Bell's palsy patients with objective findings of bad prognosis, conservative surgery targeting the labyrinthine segment and geniculate ganglion alone might be safer.

Amaç: Benign vokal kord patolojilerinde ses terapisi ve fonocerrahinin etkinliğini belirlemek. Materyal Metot: Manisa Celal Bayar Üniversitesi KBB polikliniğine Eylül 2015-Mayıs 2019 tarihleri arasında ses kısıklığı ile başvuran ve akustik ses analizi yapılan 79 (35 K, 44 E) hasta çalışmaya dahil edilmiştir. Ses analizinde hastanın başvuru sırasında ve tedavi sonrası 3. ayda auidio-technica AT2005USB marka mikrofon ile alınan kayıtları karşılaştırılmıştır. Akustik analiz çok boyutlu ses analiz programı (Multi-Dimensional Voice Program- MDVP) kullanılarak yapılmıştır. F0, vF0, Jitter, Shimmer, APQ, NHR ve VTI parametreleri analiz edilmiştir. Ses kayıtları alınmıştır. Ses analizi değerleri gurup bazında tedavi öncesi ve sonrası “eşli örneklem t testi” kullanılarak karşılaştırılmıştır. Veriler ortalama ± standart sapma (SD) olarak sunulmuştur. Güven aralığı 95% ve p

Pregnancy rhinitis may lead predisposition to Obstructive Sleep Apnea Syndrome which is associated with critical comorbidities effecting both mother (preeclampsia, hypertension) and newborn (intrauterine growth retardation, low apgar score). We aim to unveil if nasal TREK-1 and AQP5 expression changes during pregnancy. We proposed that these two proteins may take part in the biomolecular background of Pregnancy Rhinitis. Twenty adult Wister albino female rats were enrolled into the study. Two groups constituted as 10 control (group A) and 10 pregnant (group B) rats. We sacrificed the rats at 21th day of gestation by intraperitoneal injection of 400mg/kg Na-pentobarbitone. Intracardiac blood sample was taken before the pulse died out. Serum estradiol (E2) and progesterone (PG) levels were determined by ELISA. Nasal septum with its mucoperichondrium was resected and sent for real time polymerase chain reaction testing. Relative TREK-1 (p=0.001) expression of group B was found to be significantly higher than group A. Relative AQP5 (p=0.003) expression was also found to be significantly higher in group B than group A. E2 was found to upregulate AQP5 expression (p=0.032) while downregulate TREK1 expression (p=-0.011). On the other hand, PG was also found to upregulate nasal AQP5 expression (p=0.024) but not TREK1 expression (p=-0.071). TREK1 and AQP5 take part in pregnancy related biomolecular changes of nasal mucosa. Namely, expression of TREK1 decreases while expression of AQP5 increases during pregnancy. These findings support the researchers asserting triggered allergy as the etiology of PR.

OBJECTIVES:TWIK-related potassium channel-1 (TREK-1) and Aquaporin 5 (AQP5) are involved in epithelial integrity and fluid transport, respectively. In this study, we aimed to compare physiological and gestational patterns of TREK-1 and AQP5 location and expression in rat larynx. Our secondary objective was to reveal the effect of estradiol (E2) and progesterone (PG) on these two biomolecules. METHODS:This study was conducted on 20 Wister albino female rats which were assigned as control (group A) and pregnant group (group B). The rats were sacrificed at 20th day of pregnancy. Blood was obtained directly from the ventricle for detection of serum E2 and PG levels. Larynx was resected for immunohistochemical analyses and real-time polymerase chain reaction testing for detection of TREK-1 and AQP5 staining and expression, respectively. RESULTS:Relative TREK-1 (P = 0.035) and AQP5 (P = 0.019) expression was found to be significantly high in group B when compared with group A. We found positive correlation between serum E2 levels and both biomolecules (TREK-1; P = 0.018, AQP5; P = 0.016). We also found positive correlation between serum PG levels and both biomolecules (TREK-1; P = 0.001, AQP5; P = 0.019). TREK-1 immunostaining was found to be higher in surface epithelium and lamina propria of vocal cord mucosa. AQP5 was particularly found to be located in basement membrane and adjacent superficial lamina propria. We revealed the physiological and gestational pattern of laryngeal TREK-1 and AQP5 expression for the first time. Gestational expression of both TREK-1 and AQP5 was found to be increased. Stimulatory effect of E2 and PG on laryngeal TREK-1 and AQP5 expression was also revealed. CONCLUSIONS:We revealed upregulatory effect of E2 and PG on laryngeal TREK-1 and AQP5 expression. Based on this finding, it can be suggested that TREK-1 and AQP5 play role in biomolecular processes leading gonadocorticoid-related voice changes.

Objective: To determine the efficacy of voice therapy and phono-surgery in benign vocal cord pathologies. Materials and Methods: 79 (35 K, 44 E) patients who were admitted to the ENT clinic of Manisa Celal Bayar University between September 2015 and May 2019 with hoarseness and who underwent voice analysis were included in the study. Auidio-technica AT2005USB microphone was utilized for comparison of voice at the time of admission and at the 3rd month after treatment. Acoustic analysis was done using a multi-dimensional sound analysis program (MDVP). F0, vF0, Jitter, Shimmer, APQ, NHR and VTI parameters were analyzed. Voice parameters were compared on a group basis before and after treatment by using “paired sample t test”. Data are presented as mean ± standard deviation (SD). The confidence interval was considered statistically significant at 95% and p <0.05 (IBM SPSS Statistics for Windows, Version 21.0.; Armonk, NY, IBM Corp.).

ObjectiveThe aim of this study is to reveal physiological expression and distribution of nuclear factor-kappa B (NF-κB) and MUC 5 subtype AC (MUC5AC) in rat laryngeal mucosa and to find out the effect of pregnancy and glucocorticoid treatment on these biomolecules.MethodsThis animal experiment was done in Experimental Animals Research and Application Center of Manisa Celal Bayar University in accordance with the accepted policy on the use of animals. A total of 30 young, adult Wister albino female rats were randomized into a control group (group A), a pregnant group (group B), and a steroid administered group (group C). Sacrification was done by injection of sodium-pentobarbitone (400 mg/kg) solution via intraperitoneal route in all groups. Serum estradiole (E2) and progesterone (PG) were determined by enzyme-linked immunosorbent assay. The relative expression and distribution of NF-κB and MUC5AC in laryngeal mucosa was studied both by immunohistochemistry (IHC) and polymerase chain reaction testing. Expression and immunohistochemical localization of NF-κB and MUC5AC was evaluated by light microscopy (Olympus BX41). In statistical analyses; relative expression of NF-κB and MUC5AC were compared on group basis. The effect of E2 and PG levels on these biomolecules was also evaluated.ResultsNF-κB was found to be significantly low both in group B (P < 0.05) and C (P < 0.001) when compared with group A, while MUC5AC was found to be significantly high both in group B (P < 0.05) and group C (P < 0.05) when compared with group A. Concerning IHC; NF-κB was found to be expressed in epithelium and lamina propria. MUC5AC was found to be expressed particularly in the epithelial layer in all groups. Statistically significant negative correlation between PG and NF-κB expression (P = 0.048), but no correlation between PG and MUC5AC expression (P = 0.487) were revealed. On the other hand, no correlation was found between E2 and the expression of relevant biomolecules (NF-κB [P = 0.270], MUC5AC [P = 0.829]). We also did found a significant negative correlation between the expression of NF-κB and MUC5AC (P = 0.031).ConclusionsIn this study, the physiological expression of NF-κB and MUC5AC in rat laryngeal mucosa was shown for the first time both by polymerase chain reaction and IHC. The impact of pregnancy and glucocorticoid treatment on the expression and distribution of these biomolecules was also revealed. The expression of NF-κB was found to be decreased while the expression of MUC5AC was found to be increased both by pregnancy and glucocorticoid treatment. The inhibitory effect of serum PG on NF-κB expression in rat laryngeal mucosa was also shown for the first time. The expression of MUC5AC was found to be increased both in pregnant and glucocorticoid administered group. Negative correlation between NF-κB and MUC5AC expression was also revealed in rat larynx for the first time. These findings may partially unclose the histochemical background of voice changes caused by pregnancy and as well as by glucocorticoid treatment.

Laryngeal fracture is a rare and life threatening entity which is caused by blunt or penetrating neck trauma. Majority of laryngeal fractures are closed type and caused by blunt neck trauma. They frequently left underdiagnosed due to their closed nature and accompanying multisystem trauma. Besides, open laryngeal fracture is exceptional and seen particularly in penetrating neck traumas like gunshot injuries. We describe an unusual case of open laryngeal fracture in which the patient was totally breathing from the wound as if a coniotomy had done. A 23-year-old male presented to the emergency department after getting involved in a motorcycle accident resulting with a blunt injury to the neck. The patient was breathing from a horizontal open neck wound below the level of the thyroid cartilage. Computed tomography revealed a laryngeal fracture involving thyroid, cricoid and the first ring of trachea. Given the extent of the injury, a laryngeal reconstruction was done. 6 weeks after surgery he had no stridor, with evidence of full vocal cord mobility on both sides. Early diagnosis is indispensable because it may cause acute airway compromise or significant long term squeal like dysphonia, aspiration, airway stenosis and tracheoesophageal fistula. In laryngeal fracture cases trans-oral intubation may lead irremediable results especially in comminuted fractures or if there’s arytenoid dislocation. Thus, in suspicion of laryngeal fracture associated with airway compromise one should always discuss tracheotomy rather than trans-oral intubation

Objective: We aimed to clarify the safety of open surgical tracheotomy performed by supervised residents, and the impact of "reason for hospitalization" on complication rates in open surgical tracheotomy technique. Methods: In this retrospective cohort study, the medical files and documents of 277 patients who underwent open surgical tracheotomy (OST) over a period of 12 years from October 2005 to July 2017 were analyzed. Forty four patients were excluded due to emergent tracheotomy and presence of malignancy. Remaining 223 cases were divided into two groups as "OSTs done by supervised residents" and "OSTs done by attending surgeons". Age, gender, reason for hospitalization, observation time and complications were noted. The overall minor and major complication rates and each complication rate were compared with regard to the operating surgeons. Results: No statistically significant difference between two groups was demonstrated in terms of observation time (p=0.127). Minor complication rate for residents and attending surgeons was 14.7% and 17.5%, whereas major complication rate was 6.3% and 5.0%, respectively. No significant difference was found between two groups both in terms of minor (p=0.58) and major (p=0.43) complication rates. No risk of "reason for hospitalization" on minor and major complications was found (p=0.06, p=0.15). Conclusion: Open surgical tracheotomy performed by supervised residents is as safer as the ones performed by the attending surgeons. The study also showed that "reason for hospitalization" does not potentiate the occurrence of tracheotomy related complications.

Impact of graft type on anatomical and functional outcome in type-I tympanoplasty. Objective: There is a general opinion that cartilage grafting in type-1 tympanoplasty has better anatomical outcomes when compared with fascia and perichondrium. But, regarding functional outcomes, however, although the literature is mainly in agreement about acceptable hearing gains, there is an on-going dispute on this matter. The aim of this study was to evaluate anatomical and functional outcomes in type-I tympanoplasty according to grafting materials. Methods: In this study, 154 cases who had undergone type-I tympanoplasty over a period of nine years were enrolled and divided into three groups according to graft type: i.e., fascia, perichondrium and cartilage. Pure tone audiometry was reviewed pre- and post-operatively (one year after surgery) for functional outcomes. The average air-bone gap (ABG) and air-conduction gain (ACG) were also determined pre- and post-operatively for each case. Tympanic membrane perforation was documented in terms of involved percentage and site. Results: A significant difference in air conduction gain between cartilage and other grafts (perichondrium (p<0.001), fascia (p<0.001)) was found, while no difference was found between fascia and perichondrium (p=0.720). There was no significant difference between groups in terms of anatomical outcomes (p=0.615). Conclusions: The majority of relevant studies are retrospectively designed, leading to a graft selection bias, while the impact of the site and size of perforation, which may have a confounding effect, is not taken into account. In this study, graft selection bias was eliminated by determining the distribution of the perforation site and size on a group basis. A comparable anatomical, but decreased functional, outcome for cartilage grafting when compared with TMF and perichondrium was revealed.

Objective: Open surgical tracheotomy (OST) and percutaneous dilatational tracheotomy (PDT) are commonly used for securing airway in intubated critically ill patients.The purpose of this study was to compare the safety of OST and PDT, particularly in intubated critically ill patients.Methods: The medical records of intubated critically ill patients who underwent tracheotomy between August 2006 and July 2017 were analyzed retrospectively.Minor and major complication rates were compared according to the tracheotomy technique.Preoperative intubation time, postoperative decannulation time, reason for hospitalization, and demographic data, including the Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, were evaluated.Results: A total of 332 cases were enrolled into the study.The minor and major complication rates for both techniques were 27.2%, 8.8%, 9.7% and 3.2%, respecti-vely.Minor and major complication rates were higher in the OST group (p=0.01,p=0.03, respectively).The rate of every single complication was also compared on groups' basis.Accidental decannulation (p=0.02) and pneumothorax (p=0.05) were found to be significantly frequent in the OST group.There was no impact of the preoperative intubation time on the minor (p=0.20) and major complication (p=0.29)rates found.There was no statistically significant difference regarding the postoperative decannulation time (p=0.32).Also, there was no statistically significant difference between two groups in terms of the APACHE II (p=0.69) and SOFA (p=0.37)scores.However, a statistically significant difference between the groups in terms of overall survival was found, in favor of PDT (p<0.001). Conclusion:This study revealed that PDT is safer than OST, particularly in intubated critically ill patients.

Introduction: The exact etiology of Bell's palsy still remains obscure. The only authenticated finding is inflammation and edema of the facial nerve leading to entrapment inside the facial canal. Objective: To identify if there is any relationship between the grade of Bell's palsy and diameter of the facial canal, and also to study any possible anatomic predisposition of facial canal for Bell's palsy including parts which have not been studied before. Methods: Medical records and temporal computed tomography scans of 34 patients with Bell's palsy were utilized in this retrospective clinical study. Diameters of both facial canals (affected and unaffected) of each patient were measured at labyrinthine segment, geniculate ganglion, tympanic segment, second genu, mastoid segment and stylomastoid foramen. The House-Brackmann (HB) scale of each patient at presentation and 3 months after the treatment was evaluated from their medical records. The paired samples t-test and Wilcoxon signed-rank test were used for comparison of width between the affected side and unaffected side. The Wilcoxon signed-rank test was also used for evaluation of relationship between the diameter of facial canal and the grade of the Bell's palsy. Significant differences were established at a level of p = 0.05 (IBM SPSS Statistics for Windows, Version 21.0.; Armonk, NY, IBM Corp). Results: Thirty-four patients - 16 females, 18 males; mean age ± Standard Deviation, 40.3 ± 21.3 - with Bell's palsy were included in the study. According to the HB facial nerve grading system; 8 patients were grade V, 6 were grade IV, 11 were grade III, 8 were grade II and 1 patient was grade I. The mean width at the labyrinthine segment of the facial canal in the affected temporal bone was significantly smaller than the equivalent in the unaffected temporal bone (p = 0.00). There was no significant difference between the affected and unaffected temporal bones at the geniculate ganglion (p = 0.87), tympanic segment (p = 0.66), second genu (p = 0.62), mastoid segment (p = 0.67) and stylomastoid foramen (p = 0.16). We did not find any relationship between the HB grade and the facial canal diameter at the level of labyrinthine segment (p = 0.41), tympanic segment (p = 0.12), mastoid segment (p = 0.14), geniculate ganglion (p = 0.13) and stylomastoid foramen (p = 0.44), while we found significant relationship at the level of second genu (p = 0.02). Conclusion: We found the diameter of labyrinthine segment of facial canal as an anatomic risk factor for Bell's palsy. We also found significant relationship between the HB grade and FC diameter at the level of second genu. Future studies (MRI-CT combined or 3D modeling) are needed to promote this possible relevance especially at second genu. Thus, in the future it may be possible to selectively decompress particular segments in high grade BP patients.

Purpose: To compare perioperative and postoperative outcomes of the first and following 50 cases of transcanalicular laser dacryocystorhinostomy performed by a surgeon team. Methods: Results of 124 eyes of 115 patients who had a diagnosis of distal obstruction of the lacrimal drainage system and underwent transcanalicular laser dacryocystorhinostomy procedures were retrospectively detected. Initial 50 eyes were considered as group 1; 74 following eyes were accepted as group 2. Groups were compared regarding age, gender, total surgical time, time for creation of osteotomy, pain score, bleeding score, anatomic and functional success rates. Results: The average total surgical time was 43.2 ± 6.0 minutes (range: 31 to 65 minutes) in group 1, and 30.0 ± 6.4 minutes (range: 21 to 57 minutes) in group 2 (p < 0.001). Laser osteotomy creation required 25.0 ± 4.2 minutes (range: 14 to 34 minutes) in group 1, and 14.6 ± 3.6 months (range: 9 to 28 minutes) (p < 0.001). Intraoperative pain and bleeding scores were significantly better in group 2 (p < 0.001 and p < 0.001 respectively). Success rate was 54.0% in group 1, and 85.1% in group 2 (p < 0.001). Conclusion: The results of current study clearly showed that increased experience of a surgeon results with improvement of better surgical outcomes. Initial studies about a novel technique should make clear if the study cases are the beginning cases of the authors.

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