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.

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.

OBJECTIVES:The aim of the present study was to determine the efficacy of propranolol treatment in patients with vestibular migraine by the Visual Analog Scale, Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale, and Vestibular Disorders Activities of Daily Living Scale (VADL) and its effect on the quality of life.MATERIALS AND METHODS:The study population consisted of 38 patients with vertigo/dizziness who underwent routine evaluation and vestibular examinations, were diagnosed with definitive vestibular migraine, and received the same medical treatment protocol (propranolol). The questionnaires and scales that were applied to the patients before and after treatment were evaluated. The results were evaluated with 95% confidence interval, and p<0.05 was accepted as statistically significant.RESULTS:The mean age of the patients was 47.55 (18-75) years, and 27 (71%) patients were female, and 11 (29%) were male. The mean total scores of the DHI before and after treatment were 50.21±22.39 (range: 8-92) and 9.31±9.86 (range: 0-58), respectively (p<0.001). The degree of disability after treatment was low in all patients (p<0.001). The total scores of the VADL before and after treatment were 186.63±79.65 (range: 32-280) and 55.52±51.89 (range: 28-273), respectively (p<0.001). There was no correlation between these two scales (p=0.235).CONCLUSION:To our knowledge, this is the first study to evaluate both the efficacy of propranolol treatment and its effects on the quality of life in vestibular migraine. The severity, frequency, and number of attacks and disability scores were reduced, and the quality of life was improved in patients with vestibular migraine with propranolol treatment.

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

Objective: To investigate and compare the levels of efficacy of dexamethasone and nimodipine that are known for their neuroprotective properties on cisplatin ototoxicity in a rat model.Methods: The study included 24 male Wistar Albino rats that generated distortion product otoacoustic emission (DPOAE) response.The rats were randomized into three groups.Group 1 (n=8) was taken as the Control Group and administered intraperitoneal cisplatin at a dose of 5 mg/kg on days 1, 3 and 5, adding to a cumulative dose of 15 mg/kg in total.Afterwards, intratympanic saline solution of 0.1-0.3ml was administered on days 5, 10 and 15.In Group 2 (n=8) the same cisplatin protocol was used followed by intratympanic dexamethasone administered on days 5, 10 and 15 at a dose of 0.1-0.3ml.In Group 3 (n=8) the same cisplatin protocol was used followed by intratympanic nimodipine administered on days 5, 10 and 15 at a dose of 0.1-0.3mL.In all groups DPOAE was measured before (Day 1) and after (Day 5) cisplatin administration and after intratympanic treatment (Day 20).After the final measurement all rats were sacrificed and histopathologically examined.The study complied with the guidelines for the care and utilization of animals set forth by the Declaration of Helsinki.Results: Cisplatin have caused hearing loss at all frequencies, with more significance at higher frequencies (p<0.005).In the group that received intratympanic nimodipine, improvement was identified in the mean emission levels at 4000, 6000 and 8000 Hz.The improvement at 8000 Hz was found statistically significant compared to the control group (p<0.005).In the group that received intratympanic dexamethasone, improvement was seen in the mean emission levels at 1500, 3000, 4000, 6000 and 8000 Hz.The improvement levels at 6000 Hz and 8000 Hz were found statistically significant compared to the control group (p<0.005).When the efficacy outcomes of intratympanic nimodipine and dexamethasone were compared, the improvement in the dexamethasone group at 8000 Hz was found significant.Comparison of all groups for degeneration and TUNEL staining showed that the control group which was given cisplatin + saline solution had the highest level of degeneration and apoptotic cells.It was concluded that dexamethasone was the best application in terms of degenerative changes as well as in reducing apoptotic cells.Conclusion: Evaluation of DPOAE and histologic data showed that dexamethasone and nimodipine were autoprotective in rats which autotoxicity was induced by cisplatin.Our study is the first to demonstrate that nimodipine, both histologically and at high frequencies, has a significant healing effect, albeit less than dexamethasone.Accordingly, further experimental and clinical studies are needed on this subject.

OBJECTIVESThis study aimed to evaluate the efficacy of the repositioning maneuver on quality of life in elderly patients with dizziness and/or vertigo.MATERIALS AND METHODSThis controlled, prospective randomized clinical trial was conducted in elderly patients aged 65 years and above with a positive history of benign paroxysmal positional vertigo (BPPV), presence of vertigo, and no observable nystagmus during the Dix-Hallpike test, so-called Subjective BPPV (S-BPPV). Individuals were evaluated by visual analog scale (VAS) and dizziness handicap inventory (DHI). Groups were defined as treatment (treated with Epley maneuver bilaterally) or no treatment control (no treatment modality or canalith repositioning maneuver). Ten days after the first assessment, all patients were reassessed using VAS and DHI.RESULTSA total of 50 patients were randomized into two groups: 25 to the treatment group, and 25 to the control group. No significant differences were observed for baseline VAS and total DHI scores between the groups (p=0.636, p=0.846, respectively). On the other hand, after the reassessment, VAS and total DHI scores were both significantly reduced in the treatment group (p<0.001, p<0.001, respectively), but no reduction in either score was found in the control group (p=0.216, p=0.731, respectively).CONCLUSIONThis study showed that elderly patients with S-BPPV benefit from the Epley maneuver, in particular global and disease-specific quality of life.

Objective: The Dizziness Handicap Inventory (DHI) is a questionnaire that is frequently used for patients with vestibular system disorders. The aim of this study was to evaluate the feasibility and reliability of the "e-DHI" smartphone application, which calculates DHI scores. Methods: Web-based iOS and Android smartphone applications (e-DHI) were developed to evaluate the DHI. After completing the questionnaire, the DHI total score and subscores (physical, functional and emotional) were assessed and results were noted and sent to the e-mail address. Twenty-five otorhinolaryngologists and neurologists were enrolled in the study to apply the DHI to the authors sequentially using the conventional assessment method and the e-DHI (randomized by priority). The questionnaire was applied by both methods, and for each method, the time required to complete the questionnaire, to calculate the DHI score, and the total time required were noted. Results: Three of the 25 doctors were excluded from the study due to a calculation error with the conventional evaluation method. The mean total time required for completing and scoring the questionnaire was shorter when the DHI was evaluated with the e-DHI application (160 +/- 32.2 seconds) compared with the classic assessment method (289 +/- 65.9 seconds) (p<0.001). There was no significant difference between the two methods in terms of the time taken to complete the questionnaire (p=0.269). However, the calculation periods were statistically significantly shorter with the digital application compared with the conventional method (p<0.001). Conclusion: The present study showed that the DHI could be applied more quickly, more comfortably, and safely (with higher accuracy) using the e-DHI smartphone application.

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.

Introduction: Systemic inflammatory biomarkers are promising predictive and prognostic factors for solid cancers. The neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio are used to predict inflammation and used as biomarker in several malignancies. Objective: The purpose of this study was to demonstrate the diagnostic, predictive and prognostic role of neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio in patients with laryngeal neoplasms. Methods: A retrospective study was conducted on medical records involving 229 patients with benign, premalignant and malignant laryngeal neoplasms between 2002 and 2015. The diagnostic, predictive and prognostic role of neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio were evaluated using uni- and multivariate analysis. Results: The neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio were not statistically different between patients with benign, premalignant and malignant laryngeal neoplasms. Both neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio were predictive factors for stage, lymph node metastasis, and distant metastasis. Patients with high neutrophil-lymphocyte ratio value (≥4) had a poor prognosis when compared with patients with low neutrophil-lymphocyte ratio value (5 year, Overall Survival: 69.0% vs. 31.1%, p < 0.001; 5 year, disease free survival: 70.0% vs. 32.7%, p ˂ 0.001; 5 year, locoregional recurrence free survival: 69.7% vs. 32.0%, p < 0.001). Furthermore, neutrophil-lymphocyte ratio was an independent prognostic factor for 5 year: Overall survival (HR = 2.396; 95% CI 1.408-4.077; p = 0.001), Disease free survival (HR = 2.246; 95% CI 1.322-3.816; p = 0.006) and locoregional recurrence free survival (HR = 2.210; 95% CI 1.301-3.753; p = 0.003). Conclusion: Pretreatment neutrophil-lymphocyte ratio is a useful and reliable predictive and prognostic biomarker for patients with laryngeal carcinoma.

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.

Ceruminous adenoma is an extremely rare condition that arises in the external auditory canal. The right ear canal in a 32-year-old man was obstructed by a ceruminous adenoma mimicking otitis externa and its symptoms. The lesion was resected under microscopic view using a transcanal approach. There were no tumor-related symptoms postoperatively and he has been disease free for 1 year after surgery.

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.

The prognosis is suboptimal in patients with locoregionally advanced laryngeal carcinoma even after multimodality protocols. The purpose of this study was to determine the potential influential factors that have an impact on the development of locoregional recurrence, distant metastasis, and oncological outcomes in patients with locoregionally advanced laryngeal carcinoma who had surgical multimodality protocols. A sample size of 85 cases was determined based on a power of 90% and an effect size of α 2 = 0.05. A retrospective analysis of 357 patients with a diagnosis of laryngeal cancer between 2002 and 2015 was performed. Eighteen variables based on sociodemographic, clinical, histopathological and treatment data were analyzed. Medical records of 85 consecutive patients with locoregionally advanced laryngeal carcinoma who underwent surgical multimodality protocols were reviewed. Five-year overall, disease-specific, disease-free, locoregional recurrence-free and distant metastasis-free survival were 68.7, 78.0, 69.6, 68.9 and 69.2%, respectively. Extracapsular extension was an independent predictive factor for locoregional recurrence. Pathologic tumor volume was an independent predictive factor for distant metastasis. pT-stage was an independent prognostic factor for 5-year overall survival, disease-free survival, locoregional recurrence-free survival and distant metastasis-free survival. High volume, pT4a laryngeal tumors with extracapsular extension are associated with a high risk of locoregional recurrence and distant metastasis; and have poor oncological outcomes in patients with locoregionally advanced laryngeal carcinoma treated with surgical multimodality protocols.