Background and Objectives: This study investigated the association of supratubal recess (STR) volume with chronic otitis media (COM), mastoid pneumatization, and age using three-dimensional (3D) high-resolution computed tomography (HRCT). Materials and Methods: A retrospective analysis was performed on 152 adult patients who underwent surgery for COM and 35 control subjects (70 ears) who underwent cochlear implantation. STR dimensions (width, length, and height) were measured on preoperative HRCT, and STR volume was calculated using Horos software (v4.0.0, macOS) through manual segmentation validated by two blinded radiologists. STR volume was analyzed in relation to mastoid pneumatization type (pneumatized, diploic, and sclerotic), age, and disease subgroup (chronic suppurative otitis media [CSOM] vs. chronic non-suppurative otitis media [CNSOM]). Results: STR volume was significantly higher in pneumatized mastoids compared with diploic and sclerotic types (p < 0.001), with sclerotic mastoids showing the greatest reduction. Univariate analysis showed no significant baseline STR volume differences among CSOM, CNSOM, and controls (mean volumes ± SD: 12.46 ± 6.39, 12.51 ± 7.19, and 13.18 ± 4.90 mm3; p = 0.751). However, multivariable regression indicated that both CSOM (β = 0.220, p = 0.002) and CNSOM (β = 0.416, p < 0.001) were positively associated with STR volume compared to controls, while diploic (β = -0.519, p < 0.001) and sclerotic (β = -0.665, p < 0.001) mastoids were associated with significantly lower STR volumes compared to pneumatized mastoids. Age showed a positive trend without reaching statistical significance (p = 0.053), and sex was not a significant predictor (p = 0.385). Reliability analyses demonstrated good intraobserver agreement (ICC = 0.88) and moderate-to-good interobserver consistency. Conclusions: STR volume is strongly influenced by mastoid pneumatization and independently associated with disease type, whereas age-related changes in adulthood and sex are negligible. 3D HRCT volumetry offers a deeper anatomical understanding of the supratubal recess and may facilitate more comprehensive anatomical and radiological evaluations.

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.

This case report presents successful bilateral cochlear implantation (CI) in a pediatric patient with neurobrucellosis complicated by bilateral profound sensorineural hearing loss (SNHL) and irreversible bilateral vision loss. The report highlights the positive impact of CI on auditory perception and speech development in this complex clinical context. A 14-year-old girl developed acute bilateral blindness and subsequently experienced rapidly progressive bilateral SNHL despite appropriate antibiotic therapy for neurobrucellosis. In the 12th month following the onset of neurobrucellosis symptoms, she developed bilateral profound SNHL. Comprehensive preoperative audiological evaluation—including pure-tone audiometry, otoacoustic emissions, and auditory brainstem response testing—revealed absent otoacoustic emissions and cochlear microphonics, with no wave V responses at 100 dB nHL bilaterally. These findings functionally excluded auditory neuropathy spectrum disorder and indicated cochlear hair cell involvement rather than retrocochlear or central auditory pathway dysfunction, supporting the potential for favorable CI outcomes. Bilateral CI was performed via the transmastoid facial recess approach within one month after the diagnosis of bilateral profound SNHL. Postoperative outcomes were excellent, with a Categories of Auditory Performance score of 7 and 100% sentence recognition at 22 months postoperatively. Vision loss remained unchanged. This case underscores that, although neurobrucellosis-related SNHL may theoretically affect any part of the auditory pathway, timely diagnosis and appropriate patient selection can provide satisfactory hearing and speech outcomes through CI in pediatric neurobrucellosis.

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.

BACKGROUND: To compare the quality of life scores of children with monoaural cochlear implants (CIs) aged 4-16 with those of normally hearing (NH) children and parents' reports. METHODS: The KINDL-R questionnaire that measures health-related quality of life (HRQoL) was delivered to 72 children aged 4-16 years and their parents. The children were divided into 3 subgroups of 4-7, 8-11, and 12-16 years and asked to report their quality of life from their own perspectives. The parents were divided into 2 subgroups for 4-7 aged and 8-16 aged children and were asked to report their child's quality of life status from their perspectives. The QoL scores of children with CI in the 3 subgroups were compared with the scores of their parents and NH peers. RESULTS: The total scores of children with CIs in all subgroups were significantly worse than NH peers. The total scores of parents and children with CIs in all subgroups revealed no statistically significant differences. In the correlation analysis, the age of implantation was negatively correlated with the total score both in 8-11 (ρ: -0.777) and 12-16 year subgroups (ρ: -0.591). Similarly, the implant usage duration was positively correlated with the total score in all age groups. CONCLUSION: Children with CI experience worse QoL status than their NH peers. The possible causes of the lower QoL scores following cochlear implantation must be investigated. Reports from parents on their children's QoL status are reliable.

BACKGROUND AND OBJECTIVES:Idiopathic sudden sensorineural hearing loss (ISSHL) is a rapid loss of hearing, exceeding 30 dB in at least 3 consecutive frequencies within 3 days, without any identifiable cause despite thorough investigations. Currently, the etiology and pathogenesis of ISSHL have not been fully elucidated. This study aimed to assess the size of the cochlear nerve in patients with ISSHL and explore its relationship with pretreatment audiograms and treatment response. Subjects and. METHODS:A total of 125 patients (59 [47.2%] women; mean age 47.7±13.8 years [minimum-maximum: 21-76]) and 60 healthy participants (27 [45%] women; mean age 45.7±16.8 years [minimum-maximum: 20-76]) as a control group were included in this study. The size of the cochlear nerve was assessed on the affected side, compared to the control group, as well as on the unaffected side. Pretreatment and posttreatment audiological values were also analyzed. RESULTS:The cross-sectional area (CSA), vertical diameter (VD), and horizontal diameter (HD) of the CN were found to be smaller on the affected side of ISSHL patients compared to the control group (p<0.01; p=0.04; p=0.02, respectively). In the study group (affected side of ISSHL patients), there were no significant differences in VD, HD, and CSA values between pretreatment audiogram types (p=0.23; p=0.53; p=0.39, respectively), and initial hearing levels (p=0.16; p=0.22; p=0.23, respectively). Furthermore, there were no significant differences in VD, HD, and CSA values between the recovery groups according to Furuhashi criteria (p=0.18; p=0.37; p=0.27, respectively). CONCLUSIONS:The size of the CN may be a risk factor for ISSHL, but it does not affect the type of audiogram curves and was not prognostic in terms of treatment response.

OBJECTIVE:To compare the efficacy of tonsillectomy and expansion sphincter pharyngoplasty (ESP) in the surgical treatment of obstructive sleep apnea (OSA). METHODS:OSA patients with Friedman grade III-IV tonsil hypertrophy diagnosed with polysomnography were separated into two groups according to the surgery performed, as the classic tonsillectomy group (Group 1) and the ESP group (Group 2). The primary endpoint of the study was to determine the Apnea-Hypopnea Index (AHI) value. RESULTS:Group 1 comprised 24 patients with median preoperative AHI of 19.7 and postoperative AHI of median 11.8 (p = .0001). Group 2 comprised 29 patients with median preoperative AHI of 25.1 and postoperative AHI of median 16.3 (p = .0001). Nine (37.5%) of the 24 patients in Group 1 accepted as cure (79.1%). Eight (27.5%) of the 29 patients in Group 2 accepted as cure (72.4%). CONCLUSION:There was no superiority of ESP over tonsillectomy in patients with lateral pharyngeal obstruction.

Objective: To investigate whether the distance between the two retromolar trigones (RMTs) with the distance between the two posterior plicas (PPs) affects obstructive sleep apnea syndrome (OSAS) and to determine a physical examination method that can be used in the selection of patients to be referred to polysomnography (PSG).Methods: The study included 86 OSAS patients and 29 healthy controls. RMTs and PPs were measured using a caliper-like device. The values obtained from these measurements were evaluated in both groups.Results: The PPs were narrower, and the RMTs-PPs, RMTs-PPs/RMTs, and RMTs/PPs values were greater in the OSAS group (p < .05) compared to the control group. The cut-off values were 0.612 for RMTs-PPs/RMTs and 2.589 for RMTs/PPs. The specificity of these values for OSAS was 97%, and sensitivity was 57% and 58%, respectively.Conclusion: The presented method may play a role in preventing unnecessary PSG among patients with suspected OSAS.

Objetivo: Comparar e investigar los parámetros de la tomografía de coherencia óptica (OCT) de los lados sanos y afectados de pacientes con pérdida auditiva neurosensorial súbita idiopática (PANSI). Método: La evaluación ocular bilateral de los pacientes diagnosticados con PANSI se realizó con OCT. Se registraron los valores de espesor del complejo de células ganglionares (CCG) y de la capa de fibras nerviosas de la retina (CFNR), y se examinaron las diferencias entre los dos ojos. Resultados: Se evaluaron 39 pacientes, con una edad media de 44.82 ± 14.90 años. Se determinó que el grosor de la CFNR de los ojos era una media de 89.87 ± 3.65 μm en el lado afectado y 103.87 ± 3.98 μm en el lado de control sano (p = 0.0001). Se determinó que el CCG medio era 90.46 ± 3.49 μm en el lado afectado y 103.77 ± 3.96 μm en el lado de control sano (p = 0.0001). Conclusiones: Se encontró una diferencia estadísticamente significativa entre los ojos sanos y afectados de pacientes con PANSI con respecto al CCG medio y al espesor medio de la CFNR. La OCT podría ser una técnica útil para medir esta degeneración neuronal.

OBJECTIVE:The objective of the study is to compare the optic coherence tomography (OCT) parameters of the healthy and affected sides of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) and to investigate the relationships between these and the improvement in hearing levels. METHODS:A bilateral eye evaluation of patients diagnosed with ISSNHL was performed with OCT. The ganglion cell complex (GCC) and retina nerve fiber layer (RNFL) thickness values were recorded and the differences between the two eyes were examined. RESULTS:An evaluation was made of 39 patients with a mean age of 44.82 ± 14.90 years. The RNFL thickness of the eyes was determined to be mean 89.87 ± 3.65 µm on the affected side and 103.87 ± 3.98 µm on the healthy control side (p = 0.0001). The mean GCC was determined to be mean 90.46 ± 3.49 µm on the affected side and 103.77 ± 3.96 µm on the healthy control side (p = 0.0001). CONCLUSIONS:A statistically significant difference was observed between the healthy and affected eyes of patients with ISSNHL with respect to mean GCC and mean RNFL thickness. OCT could be a useful technique for measuring this neural degeneration.

OBJECTIVE The MAP3K8 protooncogene participates in the MEK-1, MKK-6, SAPK, NFAT, and NF-kB signaling pathways. HNSCC was shown to have overexpressed the MAP3K8 gene and chromosomal duplications; however, to the best of our knowledge, no study has linked MAP3K8 SNPs to HNSCC susceptibility in the Turkish population. In this study, it was aimed to determine whether single-nucleotide changes in the MAP3K8 gene are risk factors in the Turkish HNSCC patient group.METHODS Sixty-one HNSCC patients and 30 healthy volunteers from Turkiye were included in this study. Genomic DNA isolation was performed from peripheral blood samples. The MAP3K8 chromosome gene region 10:30451254-30451972 was amplified by PCR reaction and sequencing was carried out by Sanger sequencing protocol. RESULTS In the chromosome 10:30451254-30451972 region of MAP3K8 gene, 203 SNP codes were scanned. Among them, rs303426 polymorphism was found as statistically significant between HNSCC patient and control group. The results indicated that people who carry A allele either as being homozygote or heterozygote have more risk in developing HNSCC.CONCLUSION MAP3K8 mutations are extremely rare in HNSCC. The results of this study may be important by showing the relationship between this rare MAP3K8 SNP with the risk of HNSCC in Turkish patient group.

Besides the variations in genomic DNA, mitochondrial DNA (mtDNA) mutations are also responsible for many diseases, including cancer. MtDNA among individuals from the same and different ethnic groups is highly polymorphic. In the present study, we screened mitochondrial CO-1 and ND4 gene sequences of Turkish head and neck squamous cell carcinoma (HNSCC) patient group and examined the possible relationship between CO-1 and ND4 gene mutations and the development of the disease. Sixty unrelated Turkish HNSCC patients and thirty six unrelated healthy volunteers from different geographic regions of Turkey were included in this study. Total DNA isolation from blood samples were carried out and amplification of CO-1 and ND4 gene regions of mtDNA were performed by PCR reaction. PCR products were purified and sequencing was carried out by Sanger sequencing. Two mutations in CO-1 gene were identified and among them A6272d mutation was found as statistically significant in the studied HNSCC patient group with respect to control group (p 0.05). Also differences in the alpha helix structure of the protein in patients with mutations were observed. Two mutations (A11251G and T11017TA) in the ND4 gene region were identified, however, none of these mutations were seem to be responsible for the disease development (p 0.05). However, we cannot detect a statistically significant alteration between patient and control groups for ND4 gene (p 0.05). These differences can be due to ethnic differences.

Objective: This study aimed to investigate the expression of estrogen receptor beta 2 receptor in laryngeal squamous cell carcinomas and its relationship with lymph node metastasis. Methods: Histopathological specimens of laryngeal squamous cell carcinoma patients who underwent laryngectomy and neck dissection were evaluated retrospectively. The patients were divided into 2 groups according to the presence of lymph node metastasis. Estrogen receptor beta 2, Ki-67, and p53 antibodies were studied by immunohistochemical methods in the tumoral and non-tumoral tissue specimens. The evaluation of immunohistochemical staining pattern was evaluated with Allred scores. The difference between tumoral and non-tumoral tissues of estrogen receptor beta 2 Allred scores and the relationship of lymph node metastasis with Allred scores of estrogen receptor beta 2 were examined and correlated with Ki-67 and p53 expression. Results: This study included 26 patients in lymph node metastasis (+) group and 46 patients in lymph node metastasis (−) with a total number of 72 patients. There was a significantly higher estrogen receptor beta 2 Allred score of tumoral tissue with respect to non-tumoral tissue (P < .001). Nevertheless, there was no significant relationship between lymph node metastasis (+) group and lymph node metastasis (−) group according to tumoral tissue ERβ2 Allred score (P=.092). Conclusion: Estrogen receptor beta 2 expression was demonstrated significantly in the tumoral tissue of the laryngeal squamous cell carcinoma patients Cite this article as: Kaya Çelik E, Han Ü, Mutlu M, et al. Expression of estrogen receptor beta 2 in laryngeal cancer and its relationship with lymph node metastasis. B-ENT 2022;18(3):184-189.

Introduction:. The gap junction beta 6 (GJB6) gene encodes connexin 30. This protein plays critical role in tissues and is responsible for the formation of gap junctions, which have a wide variety of physiological functions. Disease-associated variants of GJB6 cause non-syndromic hearing loss (HL) and skin lesions. We herein describe a Turkish girl who was diagnosed with HL and in whom genetic analysis revealed a causal variant of GJB6. Case presentation:. The 1-year-old girl patient was diagnosed with bilateral HL when she was 1 month old. Apart from this, the patient’s motor/mental development and physical examination were normal. As a result of the analysis with the multi-gene panel, the causative genomic change, c.175G>A(p.Gly59Arg) in the GJB6 gene was determined as heterozygous. Segregation analysis proved the same genotype in the patient’s mother and grandfather. The patient’s mother and grandfather had bilateral HL and palmoplantar hyperkeratosis phenotype. The patient was diagnosed with Clouston syndrome, and genetic counseling was provided to her family. Discussion:. Causal variants of GJB6 cause skin manifestations and signs of HL. Molecular diagnosis of these patients is a valuable tool for clinicians in reaching their optimal treatment and clinical management. Conclusion:. In syndromic cases in which many organs are affected, the determination of the causative gene is important in directing the patients to appropriate observation, screening, and treatment strategies.

Objectives: This study aims to investigate the effect of acupuncture treatment on hearing and tinnitus in patients with sudden sensorineural hearing loss (SNHL) refractory to treatment. Patients and Methods: Between January 2013 and May 2015, a total of 25 patients (8 males, 17 females; median age: 43.3 years; range, 18 to 65 years) resistant to medical treatment who underwent acupuncture as salvage therapy were retrospectively analyzed. The patients were evaluated with pure-tone audiometry, Speech Discrimination Score (SDS), and Tinnitus Handicap Inventory (THI) at pre-treatment (T0), and after 10th (T1) and 20th sessions (T2) of acupuncture. Results: Hearing loss evaluated according to the four-frequency pure-tone average (PTA; 500, 1,000, 2,000, and 4,000 kHz) showed a statistically significant improvement at the end of the 10th session of acupuncture (p=0.017). There was also a significant improvement in the PTA values of the worst three consecutive frequencies at the end of the 20th session (p=0.034). A significant improvement in SDS (p=0.022) and THI (p<0.001) was found at the end of the 20th session. Conclusion: Acupuncture treatment yields promising results in the improvement of PTA. The therapeutic effect of acupuncture is also evident in the treatment of tinnitus secondary to SNHL.

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.

Background and Aim: Compliance is the adherence of the patient to continuous positive airway pressure (CPAP) therapy after his/her decision to start treatment. The aim of this study is to evaluate the compliance to CPAP therapy in a large patient population and the results were presented after 5 years of follow-up period in order to emphasize long-term compliance with CPAP treatment in the light of the literature.

Head and neck cancer (HNC) is one of the most common malignancies in the world. HNC is a group of cancers that starts in the mouth, nose, throat, larynx, sinuses, or salivary glands. According to this section of the body parts; induction of cancer can be associated with CO2 and oxidative stress. The aim of this study is to assess the activities of carbonic anhydrase (CA), catalase (CAT), paraoxonase1 (PON1), and xanthine oxidase (XO) activities in 89 HNC patients and 115 healthy volunteers. Paraoxonase1 activity was found lower in HNC cancer patients. There is no statistically significant difference between patients and controls for catalase, carbonic anhydrase, and xanthine oxidase enzyme levels. According to this results, paraoxonase1 levels could be a candidate as an oxidative marker in HNC patients, but further studies are needed to investigate the other type of cancer related PON1 and the other enzyme levels.

Objective: The aim of this study was to evaluate preoperative inflammatory biomarkers in patients who underwent surgical treatment with the indication of bilateral inferior turbinate hypertrophy.Materials and methods: Eighty patients who applied to our otorhinolaryngology clinic with complaints of chronic nasal obstruction and 79 clinically healthy individuals were included in the study.This was a retrospective study.Evaluation was performed on the patient records.Hemogram values of 80 patients were compared with 79 clinically healthy individuals.Both groups were compared with respect to WBC (White Blood Cell), L (Lymphocyte), N (Neutrophil), PLT (Platelet), M (Monocyte) counts, N/L (Neutrophil/Lymphocyte ratio), PLT/L (Platelet/Lymphocyte ratio), M/L (Monocyte/Lymphocyte ratio), M/WBC (Monocyte/leucocyte ratio), and N/WBC (Neutrophil/leucocyte ratio).P<0.05 was accepted as the level of statistical significance.Results: In intergroup evaluation, a statistically significant difference was not found between groups as for WBC, N, and PLT counts.However two groups were statistically significantly different regarding L, and M values (p=0.026,p=0.000, and p<0.05, respectively).Besides a statistically significant difference was not found between two groups as for N/L, PLT/L, and N/WBC ratios.However a statistically significant difference was observed between both groups regarding M/L, and M/WBC ratios (p=0.000,p=0.000, and p<0.05, respectively).Conclusion: Easily calculated M/L, and M/WBC ratios with low cost can be used as auxiliary parameters in the evaluation of patients with inferior turbinate hypertrophy.

BACKGROUND:Dysphagia and pain are most common problems after soft palate surgery in obstructive sleep apnea (OSA) patients.OBJECTIVE:The aim of this study was to compare the postoperative pain scores and presence of dysphagia in patients who underwent anterior palatoplasty (AP) or uvulopalatal flap (UPF) surgeries.MATERIALS AND METHODS:In this prospective study, AP or UPF was performed on the patients with mild or moderate OSA. Daytime sleepiness of all patients was evaluated with Epworth sleepiness scale (ESS). Snoring, pain and dysphagia complaint of the patients was evaluated with visual analog scale (VAS).RESULTS:In both AP and UPF groups, VAS snoring and ESS scores decreased significantly after operation. VAS pain and dysphagia scores were determined to be significantly higher in UPF compared with the AP.CONCLUSION AND SIGNIFICANCE:Since the success rates of surgical interventions to the soft palate are similar, preferring surgical approaches with a less damage to the life quality of patients after operations is more rational. In this regard, AP, which is technically quite simple with a short operation time and fewer postoperative complaints affecting life quality such as pain or dysphagia may be preferred in selected patients with OSA.