Editor- In-Chief: Title proper: Otolaryngology - Open Journal (OTLOJ) Subject: Otolaryngology Publisher: Openventio Publishers Dates of publication: 2016 Frequency & Medium: Yearly , Online Language: English Country: India Indexed by: CROSSREF , ROAD , THE KEEPERS Title DOI of the Journal: http://doi.org/10.17140/issn.2470-4059
Background Coronavirus disease-2019 (COVID-19) has been associated with a wide range of opportunistic fungal infections. Many coun tries have seen an unprecedented rise in cases of COVID-19-associated mucormycosis (CAM). The purpose of this study is to identify the correlation between the COVID-19 epidemic and mucormycosis. Our study also provides details on factors causing CAM. Methods A retrospective study from November 2020 to February 2022 includes four cases of COVID-19-associated rhino-orbital mu cormycosis treated at Habib Thameur Hospital’s ENT Department. Results The mean age of patients was 67.5-years, 75% were males, and the most frequent underlying conditions were diabetes mellitus (100%). The median time interval between the diagnosis of COVID-19 and the first evidence of mucormycosis infection was 15-days; two patients required hospitalization in a COVID unit, and two patients received oxygen therapy at home. All patients received corticosteroid therapy at a dose of 1 mg/kg/d for an average of 10-days. Treatment using antifungals and surgery was described in all the patients. Amphotericin B deoxycholate was used in 75% and lipid formulation in 25%. Two patients pre sented renal insufficiency due to amphotericin B; the doses were adapted with good evolution. In that report, the case fatality rate was 75%. Conclusion Mucormycosis is a fatal fungal infection that usually affects patients with altered immunity. Several cases of mucormycosis in people with COVID-19 have been increasingly reported worldwide. Diabetes mellitus (DM), steroid overdose, immunosuppres sion, and high iron levels, combined with other factors such as prolonged hospitalization, unhygienic conditions, and the use of ventilators, combine to create an ideal environment for contracting mucormycosis. Lastly, there is a need to create awareness about fungal diseases among clinicians in order to help identify early symptoms and restrict the spread of lethal fungal diseases. A collaborative team of otolaryngologists, ophthalmologists, anesthesiologists, and resuscitators will be required in hospitals to accelerate optimal management.
Morphometric Dimensions of Male Auditory Ossicles among Nigerian Population
Introduction The auditory ossicles transfer sound vibrations in the tympanic membrane from the middle ear to the inner ear. These ossicles are located in the petrous part of the temporal bone and they form a chain across the tympanic cavity from the tympanic mem brane to the oval window. Aim The present study was aimed at providing the morphometric dimensions of the male auditory ossicles among the Nigerian population. Materials and Methods The study was carried out on 94 malleus (R=44, L=50), 70 incus (R=34, L=36), and 27 stapes (R=10, L=17) auditory ossicles collected from 57 unidentified adult male cadavers from the departments of anatomy of various universities in Nigeria. The various parameters were taken with the help of a digital vernier caliper and weighed with Mettler Toledo weighing balance. Results This study revealed no statistically significance difference (p>0.05) between morphometric measurements of the bones of the right and left side except in the malleus. The mean weights (mg) of the malleus, incus and stapes were 22.04, 27.02, and 3.34, respectively. The mean lengths (mm) of the malleus and incus were 8.02 and 6.73, respectively and the mean length of footplates in stapes was 1.94 mm. The mean width of the incus was 4.12 mm and the mean width of the footplate in stapes was 2.88 mm. Conclusion The three auditory ossicles are morphometrically identical in both ears except the malleus. The precise measurements of the os sicles have been reported in this study among the adult male Nigerian population which would be very helpful in forensic study. Variations were observed in the dimensions of the ossicles when compared with previous studies which may be due to racial or regional factors as the values from published authors are from Asian and Caucasian populations
Mental Health of Audiologists and Speech Language Pathologists in India during COVID-19: A Survey
Introduction The World Health Organization (WHO) declared coronavirus disease-2019 (COVID-19), the most current coronavirus epi demic, a global pandemic on March 11, 2020. Healthcare personnel were significantly impacted by social isolation regulations and the pandemic. The purpose of the present study was to assess the impact of the COVID-19 pandemic on speech-language pathologists’ and audiologists’ mental health in India. Methods In order to meet the objectives of the current study, the General Health Questionnaire (GHQ-12) was utilized as a screening tool for psychological problems faced by Indian audiologists and speech-language pathologists. The poll gathered replies from 153 audiologists and speech-language pathologists working in India. Results The results of the current study showed that 51.80% of audiologists and speech-language pathologists experienced stress. Be tween 10 and 15% of audiologists and speech-language pathologists, have trouble focusing, making decisions, and dealing with challenges. Fifteen to twenty-five percent (15-25%) of professionals struggle to contribute meaningfully beyond obstacles are unable to engage in daily activities, lose confidence, and feel unworthy. Conclusion According to the findings of the current study, 30-50% of audiologists and speech-language pathologists in India experienced poor mental health during the COVID-19 outbreak. The current study showed how crucial it was to provide psychological as sistance and treatment for the workforce of audiologists and speech-language pathologists throughout subsequent COVID-19 pandemic waves.
Pinna Swelling an Angiolymphoid Hyperplasia with Eosinophilia: A Rare Case Report
Pinna swelling that is angiolymphoid hyperplasia is a benign lesion that needs to be discussed. Most of the time it affects the face in that preauricular area involved, where it appears as a tiny erythematous lesion. Here we reported a case of a 24-years female patient who presented to us at the hospital with left ear pinna swelling for 7-years.
Effectiveness of Endoscopic Pitch Raising Surgery in Male to Female Transsexual Individuals
Aim This study was performed to investigate the effectiveness of two endoscopic techniques for transsexual females. Method Web of Science, Google Scholar, and PubMed databases were searched for studies suitable for inclusion in this meta-analysis. Studies in which Wendler’s glottoplasty or laser-assisted voice adjustment were analysed for the data criteria. Studies which in cluded pre-operative and post-operative fundamentals frequency values were selected. Five articles were included in the present study (total of 94 cases). As dependent groups were used in these studies, standardized mean differences were obtained using a random effect model. Analyses were performed using the meta for package for the R-statistical program. Results than the pre-operative mean values. Conclusion Keywords Standardized mean values before and after operations were very different and post-operative mean values were significantly higher Endolaryngeal surgical techniques are valuable for pitch elevation.
A Case of Glomus Tympanicum During Stapedotomy Surgery for Otosclerosis
Glomus tympanicum is a tumor classified as a paraganglioma. We report a case of a 66-year-old female with two middle ear pa thologies: an incidental finding of a glomus tympanicum during stapedotomy surgery for otosclerosis
Effectiveness of Identafi® in Evaluation of Precancerous Oral Lesions
Aim To examine the role of the Identafi® device in early diagnosis of the nature of oral lesions. Results Buccal mucosal lesions that diagnosed Kreatosis were the most seem lesion in oral area. Conclusion Keywords Identafi® It has been observed that the indentative device provides convenience to the physician in the early diagnosis of precancerous oral lesions and some tissue formations that may be overlooked can be reached
Awareness of Ototoxicity among Medical Doctors in Assam
Introduction Previous literature has reported ill-effect of ototoxic drug on hearing and balance. Present study investigated awareness among medical doctors for the same. Method A total of 55-medical doctors of multiple specialties from Assam, India participated in the present study. A total of 14 questions with Likert Scale based scoring pattern were framed and validated for the present study. Results Conclusion Keywords Outcome of the present study showed high awareness percentage about side effect ototoxic drugs was obtained, which was a satisfying outcome. While low audiological referral and consultation awareness was identified as an area of concern
A New Mindset: Artificial Intelligence in Digital Hearing Aids
Artificial intelligence (AI) has a wider scope of its applications in every domain nowadays. Artificial intelligence in general, refers to the field of computer science which generates, uses com puter programs to solve complex problems and provides intelli gent solutions.1 For this procedure, several different rules, algo rithms, and software can be used.
Agenesis of the Thyroid Isthmus: A Case Report
Agenesis of the thyroid isthmus is a rare entity with a incidence rate of 0.5 and 10%. Thyroid isthmus agenesis could be associ ated with ectopic thyroid tissue or agenesis of the thyroid lobes. We discuss a case of a multinodular goitre which presented with morphological variations which was not detected on ultrasonography of the neck
The Effectiveness of Inferior Turbinoplasty in Children with Nasal Obstruction
Objective To evaluate the effectiveness of medial flap inferior turbinoplasty for the treatment of nasal obstruction in children. Patients and Methods This study was conducted at the ear nose throat (ENT) Department at Minia University Hospital, Minia, Egypt which include 40 children with bilateral nasal obstruction due to bilateral hypertrophied inferior turbinates that did not respond to medical treatment for 3 successive months in the form of (systemic antihistamines, systemic and local decongestant drugs and local cor ticosteroid spray) who attended the ENT outpatient clinic. All patients were subjected to turbinate reduction through medial flap inferior turbinoplasty. Results Conclusion Keywords Forty patients with bilateral hypertrophied inferior turbinates were assessed. Ninety days after surgery, 90% of patients trans formed from severe or moderate degrees of nasal obstruction “pre-operatively” to mild degree or completely with no nasal obstruction; 80% of patients had grade I improvement in nasal obstruction and 14 patients had only grade II improvement; only 10% of patients had crustation. Medial flap inferior turbinoplasty is safe and effective in the treatment of nasal obstruction in children with almost no complica tions was recorded.
Outcomes of Vocal Fold Immobility After Pediatric Cardiovascular Surgery
Objectives Cardiovascular surgery is increasingly performed in children for congenital malformations of the heart and great vessels. Ob served as vocal fold immobility, recurrent laryngeal nerve injury is a well-described complication. As overall outcomes improve and patients live longer, the sequelae of vocal fold immobility amplify insignificance. Families are often unaware of the long term issues related to vocal fold immobility especially with regard to need for alternative alimentation routes. We report on the incidence of use of feeding tubes, the timing of vocal fold function return and need for additional aerodigestive interventions. Methods We reviewed 65 patients <2-years who underwent cardiovascular surgery at a tertiary center from 2008-2013 and were diagnosed post-operatively with vocal fold immobility by fiberoptic examination. Results Patent ductus arteriosus and hypoplastic left heart syndrome were the most common of the cardiovascular anomalies included. The majority (92%) had unilateral left immobility. Recovery of motion was observed in 29% ranging from 1-month to 3-years. Hypoplastic left heart syndrome had a significant negative correlation with recovery. Forty-six percent required gastrostomy tube placement either to supplement their oral intake or to completely meet their nutritional needs. Forty-eight percent required sub sequent aerodigestive surgery including direct laryngoscopy/bronchoscopy (22%), tracheostomy (8%) and vocal fold injection (5%). Conclusion Counseling of families and primary care providers regarding the impact of pediatric vocal fold immobility after cardiac surgery should include the high potential requirement for supplemental alimentation as well as the need for feeding and speech therapy. Longitudinal otolaryngology and speech pathology care is imperative with vocal fold immobility since the majority of these pa tients do not experience functional recovery and may require further interventions over time
Coexistence of Tuberculosis and Metastatic PUBLISHERS Undifferentiated Carcinoma of Nasopharynx in Cervical Lymph Node
The coexistence of a head and neck cancer and a lymph node tuberculosis is rarely described. The problem is essentially diagnos tic. We report the case of a patient with cervical lymphadenopathy and non suspect swelliing of nasopharynx. Histopathological study of lymph node reveled an association of a tubercular adenitis and a metastasis of a squamous cell carcinoma.
Undifferentiated nasopharyngeal carcinoma (UCNT); Lymph nodes metastasis
A Case of Pleomorphic Adenoma Metastasising to Contralateral Supraclavicular Lymph Node
Introduction Pleomorphic adenomas are the most common benign parotid tumours in all populations. Management always consists of a cura tive superficial parotidectomy. However, rare cases described, in which these histological benign tumors metastasize to distant sites. We present an example of a recurrent parotid pleomorphic adenoma with a contralateral supraclavicular lymph node metas tasis after several surgical interventions. Case report In this case, we reported reported a case of 29-years male with extensive metastasis in submandibular, submental and also very Conclusion recurrence and distant metastasis
Surgical Treatment of Laryngeal Haemangioma Laser CO2 Excision: Our Experience in Adult Patients
Introduction Haemangioma is a benign vascular tumor, of endothelial origin, that affects the head and neck region in 60% of cases. Laryngeal localization is rare. Case Presentation In the last 9-years, we observed three cases of laryngeal haemangioma, two females, and one male. All patients underwent to surgical excision. None of the three cases had intraoperative complications. Discussion Conclusion Keywords The elective treatment of laryngeal haemangiomas remains controversial. In our cases, we opted for laser excision and we noticed that the risk of haemorrhages was particularly low, without no post-surgery complications. We believe that due to the low morbidity and the fast-clinical recovery after treatment with definitive problem resolution, surgical treatment with laser CO2 should be always considered for treatment of laryngeal haemangioma.
Nonmedical Treatment (Voice Therapy) for Vocal Nodules in Children
Introduction Voice disorders due to vocal nodules have been a major cause of voice problems in school-aged children. Several behaviors such as excessive speaking, shouting too loudly, yelling may contribute to voice disorders due to vocal nodules, vocal polyps, vocal cysts, etc. Hoarseness due to vocal nodules may have an impact on their overall communication, social and educational development. Many treatment approaches exist which attempt to treat vocal nodules and hoarseness related to it such as surgery (medical treat ment), voice therapy (nonmedical), vocal hygiene, etc. Even after the surgical treatment voice therapy plays a crucial role for fur ther prevention and care for reoccurring of vocal nodules. Voice therapy holds a significant role in the treatment of vocal nodules. Aim This mini-review attempts to summarize studies on the efficacy of voice therapy for vocal nodules especially in school-aged children. Method A literature search was conducted using an electronic database such as PubMed, Google Scholar, and Google for the keywords “voice therapy” in “school aged children”. The results from the literature studies were summarized in a narrative manner. Results Existing findings from the literature review and the present review support the efficacy of voice therapy as a treatment option for vocal nodules. Various databases searched for the references related to the headings such as efficacy of voice therapy for vocal nodules in school children which were included in this mini-review were published from 1976 to 2018. Conclusion Treatment of voice disorders in children is one of the most challenging and difficult concerns for professionals. Voice disorders affect the overall development of the child in terms of oral communication and educational participation. Though many treat ment modalities have been adapted for treating adult voice disorders but their efficacy in children is still a debatable concern. No one fixed voice therapy technique that can be generalized for all children and its time period/sessions. Several key factors play an important role in case of children learning these techniques such as child learning behaviors, environment, and parental participation, etc. But among all other treatments nonmedical (voice therapy) approach has been found to be helpful for vocal nodules in school-aged children. For effective voice management in school-aged children with hoarseness due to vocal nodules, the holistic approach may be up taken involving school teachers, parents, active participation of child and clinician to prevent such voice problems
Increased Epulis Gravidarum Prevalence in Women with Both Nasal and Oral Symptoms
Background Hormonal variations during pregnancy are frequently linked with functional mucosal alterations both at oral and nasal level. Clini cal manifestations of this mucosal involvement can be described generally as pregnancy rhinitis and pregnancy stomatitis and gingivitis. The sexual hormones produced during pregnancy have an important role in the development of rhinitis and gingivitis. Epulis gravidarum affects about 5-10% of pregnant, being defined as a hyperplastic and inflammatory lesion which origins from the buccal mucosa and mainly from gingival tissues. Objective To define whether the coexistence of nasal and oral symptoms should be considered as a major risk factor for the development of epulis gravidarum. Materials and Methods From November 2010 to January 2017, 228 pregnant women were examined during the weeks of gestation, two and four months after partum. They underwent a clinical examination at enrollment (t0), after 2 months (t1), at ninth month of gestation (t2), 2 months after childbirth (t3) and 4 month after childbirth (t4). Were also administered two anamnestic questionnaires concerning the risk factors and nasal and oral symptoms. Patients were divided into 4 groups according to the symptoms of questionnaires: Group A, including women with no nasal and oral risk; Group B, including women with nasal symptoms and no oral involvement; Group C, including pregnant women with oral symptoms and no nasal involvement; and Group D including women with both oral and nasal involvement. Results and Conclusion Our study reveals a statistic significative difference (p=0.01) between the frequency of epulis in pregnant women presenting only gingival symptoms (Group C) compared to those which manifest simultaneously nasal and gum symptoms (Group D). In fact, our results seem to suggest that pregnant women who present both nasal and gum symptoms have an increased risk of develop ing epulis.
Evaluation of the Effects of Resonance Voice Therapy in Children with Vocal Fold Nodules
Purpose We evaluated objective, auditive perceptual and subjective changes in the voices of children who underwent resonance voice therapy to treat vocal fold nodules. Methods We included 30 children with vocal fold nodules. All were evaluated prior to therapy and 6 and 8 weeks after therapy commenced via acoustic voice analysis, the grade, roughness, breathiness, asthenia, strain (GRBAS) scale, and the Turkish version of the pedi atric voice handicap index. Fundamental frequency, jitter, and shimmer were recorded. The results were compared. Results Conclusion Keywords The overall success rate was 86%. All data acquired before therapy differed significantly from those obtained after therapy. Resonance voice therapy is effective for children with vocal fold nodules.
Combined Epley and Semont Maneuver in Benign Paroxysmal Positional Vertigo
Introduction Benign paroxysmal positional vertigo is defined as a short, episodic, transient vertigo caused by changes in the position of the head. Objectives In this study, the effects of combined Epley and Semont maneuvers were investigated in patients with vertigo who were detected with some pathology in the posterior semicircular canal. Methods This prospective study, which was conducted between December 2016 and January 2018 at our clinic, included 196 patients with a typical history and positive Dix-Hallpike test with Videonystagmography (VNG). The patients were randomized into three groups as those who were subjected to the Epley, Semont or combined maneuvers. The patients were reevaluated after the first day, first week and first month following the maneuver. Evaluation of treatment response was based on the VNG test. Results Treatment rates of the Epley Group patients were 69.35% on the first day, 75.80% after the first week and 85.48% after the first month. The treatment rates of the Semont Group patients were found to be 63.26% on the first day, 75.51% after the first week and 81.63% after the first month. On the other hand, the treatment rates of the combined group patients were 85.88% on the first day, 90.58% after one week and 95.29% after one month. The treatment rate registered with the combined maneuver was found to be significantly higher than those in the Epley Group and the Semont Group (χ2 = 6.685, p<0.05; χ2 = 6.346, p<0.05). Six months after recovery, recurrence was registered in four patients in the Epley Group (6.4%) and five patients in the Semont Group (10.2%). Conclusion The results show that utilization of combined maneuvers in our study increased the success rate.
Noise Induced Hearing Loss in Indian Railway Loco Pilots: Are We Aware?
Background Rail engine drivers are known as loco pilots. Rail engines produce noise of around 100 dB. Loco pilots are continuously exposed to such loud noise as a result of their occupation. Hence, hearing ability is at jeopardy due to their occupation. Objective To assess noise induced hearing loss in Indian loco pilots by pure tone audiometry (PTA). Methods A cross sectional study which included 30 loco pilots and 50 control subjects. All were between 40-50 years. Hearing assessment was done by PTA after fulfilling inclusion and exclusion criteria. All the data was statically analyzed using SPSS software version 21. The level of significance p<0.05 was considered as significant. Results The mean age of loco pilots was 44.6±2.9 years (Mean±2SD) and of control was 42.8±2.1 years (Mean±2SD). The mean pure tone average in loco pilots was 31.5±5.5 dB in right ear and 30.5±6.8 dB in left ear. Thus, loco pilot group was having mild hearing impairment. On comparing both ears threshold in the groups, the difference was statically significant (p value< 0.01) and Pearson correlation was >0.9. Conclusion Our study shows mild hearing impairment in loco pilots. There is positive correlation between hearing loss and occupation. They are at more risk of hearing loss as compared to normal population attributable to their occupation. Safeguarding their hearing ability is a challenge.
Pure Tone Audiometry (PTAPure Tone Audiometry (PTA)
Nasal Manifestations in Granulomatosis with Polyangiitis: A Case Report and Review of the Literature
Granulomatosis with polyangiitis (GPA) is an anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides of medium and small arteries, characterized by necrotizing granulomatous inflammation of the upper and lower respiratory tract with coexist ing glomerulonephritis. We report a case of GPA in a patient presenting with a six-month history of spontaneous epistaxis, nasal obstruction and frontal headache. Nasal endoscopy showed a large nasal septum perforation and an anterior translucid mass in the right nasal fossa. Findings were confirmed by computed tomography (CT) scan with contrast. The patient underwent func tional transnasal endoscopic removal of the mass; histological examination showed tissue features suggestive of GPA; dosage of c-ANCA e p-ANCA antibodies confirmed GPA diagnosis. Nasal septum perforation has long been recognized as a feature of GPA, in which granulomatous destruction of nasal cartilage can result in perforation and saddle-nose deformity. Prompt diagno sis of GPA is important to initiate therapy which may be life-saving and organ sparing
The Origin of Facial Palsy in Multiple Sclerosis
Multiple Sclerosis (MS) is an autoimmune neurodegenera tive disease that affects several people especially in North America and Canada. In 2013, 33 individuals over 100,000 were affected from MS; the estimated increase for 5 years of observation ranged from an average of 4.7 per 100,000 in high-income coun tries to just 0.04 per 100,000 in the low-income countries.1 Women are more affected than men (2.3-3.5:1), but in men, the disease is usually more aggressive and has a worse prog nosis than in women.2 MS is a demyelinating disorder in which the immune system attacks the neural structures in the central nervous system (CNS)3; this mechanism is determined by a particular class of cells- Microglia- thathave been identified as responsible of the degenera tive process. These cells, that belong to the macrophage family, have the ability to move and they can easily migrate in different part of CNS4 and due to their two different phenotypes, an aggres sive one, called M1, that induce neurodegeneration and, a protec tive phenotype (M2) that has neuroprotective ability3 they may be induce demyelination and regeneration in different phases of MS, as for example, in the relapsing and remitting disease.
Surgıcal Techniques for the Treatment of Concha Bullosa: A Systematic Review
Concha bullosa, a pneumatized middle turbinate, is one of the most common anatomic variants of the lateral wall of the nose. As previously described in literature the most common anatom ical variations are ager nasi, septal deviation and concha bullosa respectively Objectives As there is no defined technique for surgery of concha bullosa the aim of this article is to review the literature and compare dif ferent techniques used for concha bullosa reduction. Methods A structured review of the PubMed, Embase and Cochrane Collaboration databases (Cochran Central Register of Controlled Trials, Cochran Database of Systemic Reviews) was undertaken, using the terms: conchabullosa, turbinoplasty, partial middle turbinectomy and pneumatized middle turbinate. Results Total of 142 articles were found and only articles addressing surgical procedures of concha bullosa with available full-text articles were included, and only 16 articles were eligible for our criteria. Conclusion A variety of surgical techniques are described to deal with symptomatic concha bullosa. According to this review, the most pre ferred technique is lateral laminectomy of the middle turbinate. There is a need for larger populated and objectively evaluated comparison studies to be done
Post-Radiation Sphenoidal Mucocele in a Patient Treated for Nasopharyngeal Cancer
The paranasal sinus mucoceles are epithelial-lined cystic lesions containing mucus or mucopurulent fluid. Several theories have been advanced to explain their occurrence. Previous trauma and sinus surgery are the most common cause. Mucoceles following radiotherapy are rare. We report the case of a sphenoidal mucocele in a 62-year-old woman who had received radiotherapy 13 years ago for a nasopha ryngeal carcinoma. Marsupialisation through an endoscopic transnasal approach was performed. No evidence of recurrence seen after 12 months of follow-up
Giant Parathroid Adenoma With Thoracic Extension: A Case Report
A 31-year-old female patient was addressed to our consultation for management of hypercalcemia secondary to primary hyper parathyroidism. The physical examination results were normal. The technetium sestamibi (99mTc MIBI) parathyroid scintigraphy showed a large fixation area next to the inferior pole of the left lobe of the thyroid. Cervical computed tomography (CT) scan showed a 6 cm tissue lesion in the inferior pole of the thyroid’s left lobe. The patient was operated through a classical cervical inci sion, extracting successfully a 6 cm brown lesion. The histopathological study has confirmed the diagnosis of a giant parathyroid adenoma weighing 84 g
Facial Paralysis after Trauma: A Simplified Method to Find and Repair the Facial Nerve
This study aims to identify the digastric nerve as an alternative to access the facial nerve in case of post-traumatic facial nerve paralysis. Study design Retrospective study. Setting Tertiary care hospital. Subjects and Methods Eleven peripheric facial paralysis cases between 2005-2016 following trauma to the parotid gland are presented. Initial emergency treatments were done elsewhere but all returned back to treat facial paralysis after 11-18 months to our institute. The digastric nerve was identified and a facial-hypoglossal nerve anastomosis was performed. Results Pre-operative House-Brackmann scores were 6 for all cases. Post-operative scores were between 3 and 4. Pre-operative needle electromyography revealed no motor unit action potentials; after 7 months post-operatively, we had motor unit action potentials in every case. Conclusion In cases of trauma and secondary approaches of the parotid gland, a safe step for finding the facial nerve is to find the digastric nerve and follow it through the main trunk.
Importance of Keros Classification in Surgery
Objective: The relationship between the cribriform plate and the uncinate process may be elaborated with the help of the Keros classification. The observations were analysed using high-resolution computed tomography (HRCT). Additionally, the relationship between the superior attachment of the uncinate process, the existence of concha bullosa, and the different types of ethmoid roofs were examined. Methods: Five-hundred and sixteen subjects complaining of sinonasal disorders between 2015 and 2016 were enrolled retrospectively at the Okmeydani Training and Research Hospital, Department of Otolaryngology. HRCT scans of 1-mm sections were obtained. Keros classification was used for the measurement of the depth of the olfactory fossa as follows: Keros I: 1-3 mm, Keros II: 3-7 mm, and Keros III: 7-16 mm. Results: Fifty-one point nine percentage of cases were of Keros type II, 27.7% of type III, and 20.3% of type I. In 82.4% of the reported cases, the uncinate process was attached to the lamina papyraceae, in 11% of the cases it was attached to the middle nasal turbinate, and in 6.4% cases to the skull base. A concha bullosa was observed in the right nasal cavity in 13.8% of the cases, in the left nasal cavity in 11% of the cases, and bilaterally in 16.3% of the cases. Variances observed in the Keros types were not statistically significant with respect to sex (p>0.05). Concha bullosa was significantly more frequently seen in females (53.1%) relative to males (p=0.001). Conclusion: Endoscopic sinus surgery (ESS) is the primary mode of treatment for chronic sinus diseases. In this procedure, a proper assessment of the vital structures is very important to avoid further complications. In the present study, it has been suggested that determining the depth of the ethmoid roof is necessary to avoid injuring the bony lamella, which can lead to cerebrospinal fluid rhinorrhea.
Comparison of Tonsillectomy Techniques and their Histopathological Healing Patterns
Objective: This study aims to identify the tonsillectomy method offering the lowest post-opera tive morbidity, complications and the best healing pattern. Study Design: Prospective, randomized, double-blinded study. Setting: Tertiary care hospital. Subjects and Methods: One hundred and eighty adult male patients complaining of recurrent tonsillitis were enrolled in the study. All the participants were randomly assigned to one of the techniques, including cold knife tonsillectomy (CLST, n=30), electrocautery (ELCTR, n=30), Sutter radiofrequency tonsillectomy (SRF, n=30), plasmacision (PLCS, n=30), coblation (CBL, n=30) and thermal welding (THRWL, n=30). The age of the patient, operative time, bleeding control time, need for additional cautery, amount of blood loss, the degree of difficulty of the technique, post-operative pain in the 1st, 3rd and the 5th days and post-operative complications were recorded. Results: The SRF group had the least operative time between 3 to 20 minutes (average 10.4±4.28 min. The longest operative time with THRWL ranged between 17-28 minutes (average 22.66 ±4.36 min.) (p<0.00001). CLST showed the least, while PLCS was characterised with the most pain in the 3rd post-operative day (p=0.0026). On the 5th day, the pain scores were similar to that of the 3rd day (p=0.0037). Histopathologically, necrosis was least in CBL and most in PLCS (p<0.00001). Vascular proliferation was least in SRF and most in CBL (p<0.00001). Lymphocyte and histocyte migration was least in the CBL and most in the PLCS (p<0.00001). Conclusion: Although, inexpensive, CLST is accompanied by a significant amount of intra operative blood loss and operative time. SRF, CBL and THRWL techniques seemed to have reasonable post-operative pain, lower amounts of blood loss and lower tissue reactions.
Chronic Otitis Media with Facial Palsy: An Unexpected Etiology
Chronic otitis media is a commonly observed disease worldwide. Facial palsy in a patient can be attributed to many causes. Facial paresis with chronic otitis media is almost al ways attributable to facial palsy. This article reports the clinical condition of a patient in whom the etiology of facial paresis was not conventional. However, the unexpected etiology that was observed could not be located in any pre-existing literature related to facial paresis.
Assisted-Endoscopic Submandibular Gland Resection Using Lateral Oral Vestibule Approach
Transoral approach using the floor of the mouth to resect submandibular gland has been in practice since a long time; however, the clinical application of the vestibular approach is a relatively novel approach. As per my knowledge, the vestibular approach has only been implemented to resect the thyroid gland , with the clinical application of transoral transvestibular endoscopic approach in the surgical removal of the thyroid gland being reported for the first time by Wilhelm et al.1 Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is currently in use in various institutions. TOETVA has been proposed, introduced and clinically performed in various countries including South Korea, Thailand, India, China, Taiwan, Singapore, USA, Mexico, Japan, Ecuador and Italy.1-4 We present our opinion on the clinical procedure of TOETVA. The surgical procedure is carried out using a three-port technique at the oral vestibule, by placing one 10-mm port for a 30° endoscope and two additional 5-mm ports for the dissecting and coagulating instruments. CO2 insufflations pressure is maintained at 6 mmHg. An anterior cervical sub-platisma space is created from the oral vestibule down to the sternal notch, lateral to the sternocleido muscles. Thyroidectomy is performed endoscopically using conventional endoscopic instruments and intraoperative neuromonitoring (IONM)