OBJECTIVE:The aim of this study is to determine the relationships between demographic, clinical, and radiological characteristics of patients with unilateral sinonasal diseases and the type of pathology, and to present a new algorithm that can help clinicians in the management of these patients. METHOD:The study included 243 patients who underwent surgery because of unilateral sinonasal diseases between 2014 and 2022. Patients were first divided into inflammatory and neoplastic groups and the neoplastic group was divided into benign and malignant groups. RESULTS:Epistaxis and orbital complaints were seen significantly more in the neoplastic group, and anosmia/hyposmia in the inflammatory group. Epistaxis, orbital complaints, and pain were seen significantly more in the malignant group than in the benign group. On computed tomography scan, bone erosion and invasion of adjacent structures were seen significantly more in the neoplastic group and the malignant group. CONCLUSIONS:We present a new algorithm based on our clinical experience that can be used in the clinical management of unilateral sinonasal diseases.

Objetivo: Determinar las relaciones entre las características demográficas, clínicas y radiológicas de los pacientes con enfermedades sinonasales unilaterales y el tipo de patología, y presentar un nuevo algoritmo que pueda ayudar a los clínicos en el manejo de estos pacientes. Método: El estudio incluyó 243 pacientes intervenidos quirúrgicamente por enfermedades sinonasales unilaterales entre 2014 y 2022. Los pacientes se dividieron en primer lugar en grupos inflamatorio y neoplásico, y el grupo neoplásico se dividió en grupos benigno y maligno. Resultados: La epistaxis y las molestias orbitarias se observaron significativamente más en el grupo neoplásico, y la anosmia/hiposmia en el grupo inflamatorio. La epistaxis, las molestias orbitarias y el dolor se observaron significativamente más en el grupo maligno que en el benigno. En la tomografía computarizada, la erosión ósea y la invasión de estructuras adyacentes se observaron significativamente más en el grupo neoplásico y en el grupo maligno. Conclusiones: Presentamos un nuevo algoritmo basado en nuestra experiencia clínica que puede ser utilizado en el manejo clínico de las enfermedades sinonasales unilaterales.

Objective: Sinonasal papillomas are rare benign tumors. They challenge otorhinolaryngologists due to their high recurrence rate and malignant transformation. The aim of this study was to investigate the clinical and demographic factors associated with recurrence and/or malignancy of sinonasal papillomas. Methods: This retrospective study included 49 patients who were operated on between 2014 and 2020. Clinical and demographic characteristics of the patients were retrieved from the patients' records. Results: The recurrence rate was determined to be 12.2% and the malignancy rate was 8.2%. Recurrence was significantly higher in females, the advanced stage (T3 and T4), and papillomas located in the maxillary sinus. The recurrence rate was significantly lower in patients treated with the endoscopic surgery. Factors affecting malignancy were the presence of dysplasia and extension out of the paranasal sinuses. Conclusions: The results of this study showed that the factors affecting recurrence were gender, papilloma stage, type of surgery performed, and whether the tumor extended to the paranasal sinuses.

Objective: To investigate the association between clinical factors and post-tonsillectomy hemorrhage (PTH) including rebleeding episodes. Methods: The medical records of 1,082 patients who underwent tonsillectomy between May 2018 and April 2019 were reviewed. The entire study cohort included 431 (39.7%) children aged less than six years and 292 (26.9%) adults older than 15 years. Data on patient demographics, surgical indication, dissection technique, tonsils’ grade, postoperative analgesia, surgeon’s experience, the season of surgery, management of hemorrhage, length of hospital stay, and rebleeding episode were noted. Results: Postoperative hemorrhage occurred in 87 cases (8.0%) including 32 children (4.0% of children) and 55 adults (18.8% of adults). Age, surgical indication, tonsils’ grade, and postoperative use of non-steroidal anti-inflammatory drugs (NSAIDs) were risk factors found to be statistically significant for PTH in univariate analysis (p<0.05). Multivariable analyses identified patients older than 15 years and those who received postoperative NSAIDs to be risk factors of PTH [Odds ratio (OR): 15.5, 95% confidence interval (CI): 7.68-31.27, p<0.001, OR: 0.22, 95% CI: 0.11-0.44, p<0.001, respectively]. About one out of every 60 (1.5%) children had severe oropharyngeal bleeding, whereas every 12th (8.2%) patient of those aged >15 years had severe hemorrhages that warranted surgical hemostasis in the operating room (p<0.001). Conclusion: The risk of bleeding after tonsillectomy was significantly higher in adults and users of NSAIDs postoperatively. Also, the evidence of minor bleeding increased the risk of a second bleeding episode in adulthood.

Objetivo: Los papilomas sinonasales son tumores benignos poco frecuentes. Suponen un reto para los otorrinolaringólogos por su elevada tasa de recurrencia y transformación maligna. Investigar los factores clínicos y demográficos asociados con la recurrencia y con la malignidad de los papilomas sinonasales. Métodos: Estudio retrospectivo que incluyó 49 pacientes operados entre 2014 y 2020. Las características clínicas y demográficas se recuperaron de los registros de los pacientes. Resultados: Se determinó una tasa de recurrencia del 12.2% y una tasa de malignidad del 8.2%. La recurrencia fue significativamente mayor en las mujeres, en los estadios avanzados (T3 y T4) y en los papilomas localizados en el seno maxilar. La tasa de recidiva fue significativamente menor en los pacientes tratados con cirugía endoscópica. Los factores que afectaron a la malignidad fueron la presencia de displasia y la extensión fuera de los senos paranasales. Conclusiones: Los resultados de este estudio muestran que los factores que afectaron la recidiva fueron el sexo, el estadio del papiloma, el tipo de cirugía realizada y si el tumor se extendía a los senos paranasales.

BACKGROUND: In the treatment of early stage laryngeal cancers, surgery (transoral laryngeal surgery (TOLS), open partial laryngeal surgery (OPLS) and radiotherapy (RT) are used. OBJECTIVES: Compare the oncological results of patients with early stage laryngeal squamous cell carcinoma (LSCC) treated with TOLS or RT. DESIGN: Retrospective SETTINGS: Tertiary training and research hospital PATIENTS AND METHODS: The participants were divided into patients who underwent TOLS and RT treatment. The groups were compared with each other in terms of local recurrence, regional recurrence, distant metastasis, 3 and 5-year overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS) and laryngectomy-free survival rates (LFS). MAIN OUTCOME MEASURES: The effects of TOLS and RT treatment on local control, regional control, OS, DFS, DDS and LFS in early stage laryngeal cancers. SAMPLE SIZE: 261 RESULTS: The mean follow-up time was 48 (26) months. There were 186 patients who underwent TOLS and 75 patients who underwent RT treatment. Gender, cigarette/alcohol consumption, tumor localization, anterior commissure involvement, tumor grades, recurrence rates and recurrence localizations of the groups were similar. The 5-year overall, disease specific, disease free and laryngectomy-free survival rates were 85.9%, 88%, 79.4%, 96.3% in the TOLS group and 74.3%, 76.7%, 72.3%, 85.2% in the RT group (P=.034, .065, .269, .060, respectively). CONCLUSIONS: TOLS had equal and good oncological outcomes on OS and DFS compared to RT. Anterior commissure involvement was statistically significant independent prognostic risk factor for DFS in both groups. The 5-year OS rate was greater in the TOLS groups (P=.034). LIMITATIONS: Retrospective, but to the best our knowledge, this is the first study in Turkey with a high patient volume and a long follow-up time.

Endoscopic sinus surgery (ESS)-associated risks mainly depend on the proximity of the sinuses to the orbit and anterior skull base. Skull base injuries are usually associated with dural tears and cerebrospinal fuidleaks, which are the leading causes of ascending meningitis and even brain abscesses. A 40-year-old man has a headache that came on suddenly and is an extremely painful, continuous headache accompanied by intermittent fatigue and blurred vision. The patient underwent ESS for chronic sinusitis 2 weeks ago at another hospital. Magnetic resonance examination of the brain depicted abnormal hyperintensity within the left frontal lobe. These fndings suggested the diagnosis of brain abscesses. The patient received an antibacterial treatment for 2 months. Finally, the patient recovered well.

Background We aimed to test the clinical relevance of a newly introduced anatomical classification system of the frontal sinus and to investigate the relation between the frontal sinus type according to this system and the development of frontal sinusitis. We retrospectively evaluated the computed tomography images of 808 frontal sinuses of 404 patients and classified the sinuses as small, medium-sized, and large, based on their size and relation to the orbital roof. We related this classification to the presence or absence of the findings of frontal sinusitis including mucosal thickening, retention cyst/polyp, and/or fluid collection. Results We found that the most common frontal sinus type is medium-sized (65.84%), followed by the small (22.89%) and large (11.26%) types, respectively. There was no significant difference between the right and left sides in terms of frontal sinus type ( P <0.05). We recorded sinusitis in 28 (15.1%) small, 180 (33.8%) medium-sized, and 40 (43.9%) large sinuses. And we showed that the prevalence of sinusitis in medium-sized and large sinuses is significantly higher than that in small sinuses for both sides ( P values were 0.001 and 0.015, respectively for the right, and 0.005 and 0.001, respectively for the left side). Conclusion The result obtained in this study may be considered the first step in demonstrating the clinical benefit of this classification. However, there is no doubt that further comprehensive studies with large series are needed to fully determine the clinical relevance of this newly introduced classification system.

Introduction: Tegmen defect (TD) has a potential of intracranial spread of middle ear infection, meningoencephalic herniation (MEH), and cerebrospinal fluid leakage (CSFL). Especially the defects >1 cm with MEH or CSFL are generally repaired via the classical middle fossa or minicraniotomy technique. The aim of this study was to show the efficiency of the intracranial, extradural placement of the septal cartilage graft in the closure of the TD larger than 1 cm via the transmastoid (TM) approach. Methods: The demographic, preoperative, intraoperative, and postoperative data of 11 patients with chronic otitis media (COM) who had TD larger than 1 cm were reviewed retrospectively. Hospitalization time and hearing preservation with respect to MEH or CSFL were analyzed. Results: The most common etiology of TD was cholesteatoma (82%), and 91% of the patients had multiple COM surgery history. The mean TD size was 15.4 (10–25) mm. Fifty-five percent of the patients presented with either MEH or CSFL. The mean follow-up of the patients was 22.5 (8–42) months. There was no significant difference between preoperative and postoperative mean bone conduction thresholds. Mean hospitalization time was 5.2 (3–10) days. There was no significant difference in the hospitalization time between patients with MEH or CSFL and without MEH or CSFL. Neither recurrence nor graft infection was encountered. Conclusion: Extradural grafting with the septal cartilage in the large TD up to 25 mm can be repaired efficiently via the TM approach without application of a lumbar drainage.

Idiopathic subjective tinnitus has a complex pathophysiology in which not only cochlear and central classical auditory pathways but also nonclassical auditory pathways of different parts of the brain are involved. Vestibuloocular and vestibulocollic pathways are the central projections of utricle and saccule used in the vestibular evoked myogenic potential (VEMP) test. Aim of this study was to investigate the effects of idiopathic subjective tinnitus on vestibuloocular and vestibulocollic pathways via VEMP. We prospectively analyzed 30 unilateral idiopathic subjective tinnitus patient's cervical, ocular VEMP tests, tinnitus handicap index scores, symptom duration and compared with contralateral ear and 35 healthy volunteers. The latencies and amplitudes of P1 and N1 waves were recorded and pathologic wave criteria was calculated according to healthy volunteer's data. In cervical VEMP there were significant longer latencies of P1 and N1 waves with respect to contralateral ear and control group. In ocular VEMP test, N1 and P1 latencies and amplitudes were not significantly different. The percentages of pathologic wave of the tinnitus side were not significantly higher in both cervical VEMP and ocular VEMP tests with respect to contralateral side. Tinnitus handicap index scores and symptom duration had no relationship with latency and amplitude of VEMP tests. Although cervical VEMP P1 and N1 latencies were significantly longer, subjective tinnitus did not result in pathological alterations in the VEMP test. Presence of subjective tinnitus is not an influencing factor in the VEMP interpretation.

Background/aim:Because of close relations to important anatomical structures such as cavernous sinus and optic nerve, sphenoid sinus variations must be well trained by the otolaryngologist who has an interest in endoscopic sinus surgery. Newly defined sphenoseptal cell (SSC) is one of those variations that may lead to insufficient endoscopic sinus surgery outcomes if not defined preoperatively with imaging studies. The present study aimed to present the main characteristics of this special type of nasal cell.Materials and methods:In this study, 610 paranasal sinus CT scans were analyzed and reviewed retrospectively between May 2018 and December 2019. Also, endoscopic findings of SSC that cause a surgical catastrophe in identifying skull base and sella are presented during transnasal transsphenoidal pituitary surgery.Results:According to its definition and relation to the sphenoid sinus and the skull base, an SSC was seen in 21 scans of 610 patients (3.4%), 11 were women (55%) and 10 were men (45%).Conclusion:Although an SSC is a rare variation of nasal air cells, preoperative diagnosis of this cell is of paramount importance in some patients during endoscopic transnasal surgery for the identification of skull base.

Upregulation of the epidermal growth factor receptor (EGFR) gene has shown an important impact on the development of head and neck cancers due to its important regulation role on multiple cell signaling pathways. The aim of this study was to investigate the methylation pattern of the promoter region of the EGFR gene between head and neck squamous cell carcinoma (HNSCC) patients and a control group. Forty-seven unrelated HNSCC patients, clinically diagnosed at the Department of Otorhinolaryngology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey, and 48 unrelated healthy volunteers from different geographic regions of Turkey, were included in this study. Methylation status of the promoter region of the EGFR gene was detected by methylation-specific-polymerase chain reaction (MS-PCR). The correlation between EGFR gene promoter methylation profiles and clinical characteristics were examined using the χ2 test. Methylation was observed in 79.0% of HNSCC patients, whereas this ratio was 90.0% in healthy individuals. The results show that promoter region methylation of the EGFR gene was not associated with HNSCC development in the studied Turkish patient group. In addition, the methylation status of the EGFR gene promoter was not found to be related to age, gender or tumor stage.

Backgroud/Objectives: Transoral laser laryngeal microsurgery (LTLM) has been widely used in the treatment of early-stage glottic laryngeal squamous cell carcinoma (LSCC) for the past few decades. Although T stage, tumor grade, anterior commissure involvement, type of cordectomy, positive surgical margin, and postoperative additional therapies were accused as the prognostic factors for recurrence, there is still controversy about these data in the literature. The purpose of this study was to evaluate the oncological results of our patients with early glottic LSCC treated with LTLM as a single-modality therapy in a single-center study. Methods: Patients with early-stage (Tis-1–2/N0) glottic LSCC who underwent LTLM as a primary treatment from 2011 to 2019 were retrospectively reviewed. The clinicopathological factors and oncologic outcomes were analyzed. Results: One hundred and sixty-one patients were enrolled in this study. The 5-year overall (OS), disease-specific (DSS), disease-free (DFS), and laryngectomy-free survival rates were 84.5%, 97.9%, 79.2%, and 93.5%, respectively. The most common stage, histopathological type, and type of endoscopic cordectomy were T1 stage, well-differentiated cancer, and type 2 cordectomy, respectively. A positive surgical margin was defined in 20 (12.4%) patients. There was a significant relationship between histopathological grade and positive surgical margins (p = 0.038). OS and DSS rates of “wait and see” modality were lower, while DFS of radiotherapy was lower than that of other treatment modalities in patients with positive surgical margins, but the differences were not statistically significant. Nineteen (11.8%) patients had a recurrence. DSS was statistically significantly lower in patients with recurrence (p < 0.001). Conclusion: The results of our study showed that anterior commissure involvement, surgical margin positivity, and higher T stage statistically did not reduce survival rates in early-stage LSCC patients treated with LTLM. As the histopathological grade of the tumor worsens, the risk of surgical margin positivity increases. RT may have a negative effect on recurrence and organ preservation in the additional treatment of patient with positive surgical margins.

Background/aim To evaluate the clinical and histopathological effects of fetal brain tissue derived mesenchymal stem cells (FBTMSC) and fibrin glue (FG) on the facial nerve (FN) regeneration in rats with traumatic FN injury. Materials and methods Twenty-eight Sprague Dawley rats were included in the study and divided into 4 groups. Traumatic FN injury (FP) was created by a surgical clamp compression to the main trunk of left FN in all groups. In the control group (group 1) no treatment was applied, in group 2 (FBTMSC group) 2 × 106 FBTMSC was injected, in group 3 (FG group) only FG was applied, in group 4 (FBTMSC and FG groups) both FBTMSC and FG were applied to the injured section of the nerve. The FN functions were evaluated clinically, immediately after the procedure and at 3rd, 5th, and 8th weeks postoperatively. The FNs of all subjects were excised after the 8th week; then the rats were sacrificed. The presence of stem cells in the injured zone was assessed using bromo-deoxyuridine (BrdU), and apoptosis was determined by the TUNEL method. Results After the damage, total FP was observed in all subjects. Statistically significant functional improvement was observed in group 4 compared to all other groups (P < 0.005). TUNEL-positive cell count was statistically significantly higher in the control group than the other groups (P < 0.001). TUNEL-positive cell count was statistically significantly lower in group 4 than the other groups. The proportion of BrdU-stained cells in group 4 (5%) was higher than group 2 (2%). Conclusion Clinically and histopathologically FBTMSC applied with FG may play a promising role as a regenerative treatment in posttraumatic FP.

ABS TRACT Objective: To investigate the side effects of systemic corticosteroid (CS) treatment in the idiopathic sudden sensorineural hearing loss (ISSHL) and Bell’s palsy patients. Material and Methods: The patients were retrospectively evaluated for the major side effects of systemic CS. The patients with systemic diseases (hypertension and diabetes mellitus) were further investigated with respect to alterations on antidiabetic or antihypertensive drug regimens. The categorization was performed according to the dosage alterations of antidiabetic or antihypertensive drugs and the patients were divided into 3 groups: Group 1 (stable group), Group 2 (acute dysregulated group) and Group 3 (chronic dysregulated group). Results: Among the 276 patients, there was only one major complication which was a femur avascular necrosis during a mean follow up 4,5 months. In the diabetic group, the acute and chronic drug alteration was statistically significantly higher with respect to hypertensive group (p<0.001). HbA1c≥8% (64 mmol/mol) caused a significant increase in Group 3 ratio (p<0.05). Conclusion: The risk of major side effect of the systemic CS was extremely low (<1%). Corticosteroids in patients with hypertension did not alter the antihypertensive doses however, diabetic patients needed drug alteration. HbA1c level<8% (64 mmol/mol) can be used as a safety criterion for starting systemic CS therapy in the diabetic patients with ISSHL and Bell’s palsy.

Metastatic nodal disease is the most important prognostic factor in laryngeal cancer as in the other head and neck cancers. 1 Histologically identified regional metastasis is correlated with an increased risk for recurrence, and approximately 50% decrease in survival. 2Although the incidence of occult neck metastasis varies in relation with localization, stage, and differentiation of the laryngeal cancer, occult neck metastasis was reported as 30% in supraglottic laryngeal cancer, and 20% in T3-T4 glottic laryngeal ABS TRACT Objective: In this study, we aimed to determine ipsilateral and contralateral occult neck metastasis rate in patients who underwent bilateral neck dissection due to T1-T4 N0 laryngeal carcinoma, and put forward the need for bilateral neck dissection.Material and Methods: This study included 60 patients who underwent bilateral neck dissections due to T1-T4 N0 laryngeal carcinoma between 1998 and 2015.The patients were divided into three groups according to the localization of the tumor (supraglottic, glottic, and transglottic).Each group was divided into 3 subgroups as unilateral lesion, midline lesion, and unilateral lesion passing across the midline.The neck metastases were classified as ipsilateral, contralateral, or bilateral.Results: The tumor was supraglottic in 14, glottic in 13, and transglottic in 33 patients.There was neck metastasis in 9 of 60 patients (3 patients had N1, 3 patients had N2b, and 3 patients had N2c necks).Contralateral neck metastasis was not seen in any of the patients with unilateral tumors.Contralateral neck metastasis was not evident when there was not an ipsilateral neck metastasis.The rate of contralateral neck metastasis in presence of ipsilateral neck metastasis was 33% in supraglottic, 50% in glottic T4a, and 25% in transglottic tumors.Conclusion: The results of this study indicated that unilateral neck dissection was sufficient in all groups in case of unilateral tumors, and unilateral tumors passing across the midline when there is no ipsilateral neck metastasis, but bilateral neck dissection is needed in midline tumors.

OBJECTIVE:Functional endoscopic sinus surgery (FESS) and balloon sinus ostial dilation (BSD) are well-recognized minimally invasive surgical treatments for chronic rhinosinusitis without nasal polyps (CRSsNP) refractory symptoms to medical therapy. Patients on antiplatelet and anticoagulant therapies (AAT) usually are recommended to discontinue their medications around the period of endoscopic sinus surgery. The goal of this study is to assess the clinical experience of BSD in CRSsNP patients with concurrent anticoagulant or antiplatelet therapy.METHODS:A review of prospectively-collected clinical data from October 2012 to March 2017 were used to perform a cohort study of subjects with CRSsNP who met criteria for surgical intervention while on antiplatelet and anticoagulant therapy. Data were collected on demographics, details of the procedures, type of AAT used, pre- and postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores, and complications.RESULTS:Thirty-five patients underwent in-office BSD while on antiplatelet and/or anticoagulant therapy. The mean difference in pre- and postoperative SNOT-22 scores of 9.9 (SD 14.4, P < .001) was both statistically significant and exceeded the minimal clinically important difference of 8.9. Absorbable nasal packing was used for persistent bleeding immediately post-procedure in two patients. Intraoperative bleeding was associated with aspirin 325 mg and warfarin. FESS was required for further management of chronic sinusitis in four patients after anticoagulant/antiplatelet therapy could be discontinued. There were no systemic complications. None of the patients experienced significant bleeding events postoperatively after leaving the office.CONCLUSION:In-office BSD appears to be a safe alternative to endoscopic sinus surgery in select patients who cannot discontinue antiplatelet and anticoagulant therapy.LEVELS OF EVIDENCE:IV.

Amaç: Glomus karotikum, vagale ve jugulare tümörlerinde preoperatif yapılan endovasküler embolizasyon işlem sonuçlarının değerlendirilmesi amaçlandı.Gereç ve Yöntemler: 2012-2017 yılları arasında glomus tümörü nedeniyle 18 hastaya tanısal anjiyografi ve bazılarına da embolizasyon yapıldı. Hastaların demografik bilgileri, tümör tipleri, embolizasyon ve komplikasyon oranları analiz edildi. Tümör embolizasyonunun etkinliğine, girişim öncesi ve sonrası alınan anjiyografiler karşılaştırarak karar verildi. Hastalar girişim sonrası vital bulgular ve olası komplikasyonlar açısından en az 24-48 saat takip edildi.Bulgular: Tanısal anjiyografi yapılan 18 hastadan 10’una eş zamanlı embolizasyon da uygulandı. Altı hastada glomus jugulare, 1 hastada glomus vagale, 10 hastada glomus karotikum ve 1 hastada eş zamanlı glomus jugulare ve vagale mevcuttu. En sık embolize edilen arter %50 oranı ile asendan faringeal arterdi. Embolizasyon yapılan hastalarda tümör kan akımında en az %70 oranında bir azalma meydana geldiği saptandı. Yapılan işlemler ile ilgili herhangi bir komplikasyon oluşmadı. Sonuç: Endovasküler selektif arter embolizasyonu glomus tümörlerinin preoperatif tedavisinde güvenilir ve etkin bir yöntemdir.

YAŞLI BIREYLERDE YUTMA: KBB POLIKLINIĞINDE SESSIZ DISFAJI RISK DEĞERLENDIRMES