Olfactory Bulb Volume and Morphology Changes in COVID-19 Patients With Olfactory Disorders Using Magnetic Resonance Imaging

OBJECTIVES

The aims of the study are to explore the morphological changes of olfactory bulb (OB) and olfactory sulcus in COVID-19 patients with associated olfactory dysfunction (OD) by measuring the OB volume (OBV) and olfactory sulcus depth (OSD) and to compare the measurement values with those of healthy individuals.

METHODS

Between March 2020 and January 2022, 31 consecutive hospitalized patients with a diagnosis of COVID-19 with anosmia and hyposmia who underwent brain magnetic resonance imaging and 35 normosmic control individuals were retrospectively included in the study. Bilateral OBV and OSD were measured and shape of the OB was determined based on the consensus by a neuroradiologist and an otorrhynolaryngologist.

RESULTS

The mean measurements for the right and the left sides for OBV (38 ± 8.5 and 37.1 ± 8.4, respectively) and OSD (7.4 ± 0.1 and 7.4 ± 1.0 mm, respectively) were significantly lower in COVID-19 patients with OD than those in control group (for the right and the left sides mean OBV 56.3 ± 17.1 and 49.1 ± 13.5, respectively, and mean OSD 9.6 ± 0.8 and 9.4 ± 0.8 mm, respectively). Abnormally shaped OB (lobulated, rectangular, or atrophic) were higher in patient group than those of controls.For the optimal cutoff values, OBV showed sensitivity and specificity values of 90.32% and, 57.14%, for the right, and 87.1% and 62.86% for the left side, respectively (area under the curve, 0.819 and 0.780). Olfactory sulcus depth showed sensitivity and specificity values of 90.32% and 94.29%, for the right, and 96.77% and 85.71%, for the left side, respectively (area under the curve, 0.960 and 0.944).

CONCLUSIONS

Decrease in OBV and OSD measurements in COVID-19 patients with OD at the early chronic stage of the disease supports direct damage to olfactory neuronal pathways and may be used to monitor olfactory nerve renewal while returning back to normal function.

The effect of interleukin-33 expression on prognosis in patients with nasopharyngeal carcinoma

INTRODUCTION

Interleukin-33 (IL-33) is a newly defined inflammatory cytokine that is a member of the interleukin-1 (IL-1) gene family. This cytokine is expressed in structural cells, such as the vascular endothelium, bronchial epithelial cells, keratinocytes, epithelial cells of the stomach, and fibroblastic reticular cells of lymphoid tissues. Several studies suggest that IL-33 plays a role in head-and-neck cancer. The aim of this study was to retrospectively examine IL-33 expression in nasopharyngeal carcinoma (NPC) and to evaluate its relationship between clinicopathological characteristics and prognosis.

METHODS

In this monocentric, retrospective analysis, the data of 43 cases diagnosed with primary NPC and 20 cases with normal nasopharyngeal tissue (diagnosed between 2014 and 2020) were evaluated regarding the relationship between the immunohistochemically analyzed IL-33 expression status and corresponding clinicopathological parameters.

RESULTS

The mean age was 56.9 years. The majority (67.4%) of the patients had an early tumor stage (T1-T2). IL-33 expression was positive in 56% of the cases. The five-year overall survival rate was 77% for all patients, 90% for the patients with positive IL-33 expression, and 55% for those without IL-33 expression (p = 0.008, univariate analysis). In multivariate analysis, IL-33 expression was shown to be the only independent prognostic marker for nasopharyngeal carcinoma (p = 0.014).

CONCLUSION

This retrospective study showed that IL-33 expression could be considered an independent factor affecting positively prognosis in NPC.

Effects of platelet-rich fibrin and dexamethasone on nerve regeneration after acute facial-nerve injury

BACKGROUND

Acute facial-nerve injury.

OBJECTIVE

To investigate the effects of platelet-rich fibrin (PRF) and dexamethasone on nerve regeneration.

MATERIALS AND METHODS

Thirty-six rats were randomly divided into six groups. Facial-nerve injury was created using a full-thickness incision in all groups except Group E. Next, primary anastomosis, PRF application, topical dexamethasone application, primary anastomosis with topical PRF and dexamethasone application, and no facial-nerve repair were performed in Groups A, B, C, D, and F, respectively. Clinical, functional, and structural improvements were evaluated at eight weeks.

RESULTS

The mean eye-closure movement score in Group B was significantly higher than that in Group F (p < .001). The mean whisker-movement score in Group B was significantly higher than that in Group F (p = .001). The mean amplitude of whisker movement in Group F was significantly lower than those in Groups A, B, C, and E, and the mean amplitude in Group D was significantly lower than that in Group E (p < .001). Furthermore, an improvement in nerve ultrastructure was observed in Group B.

CONCLUSION

PRF application has a positive effect on nerve recovery after anastomosis.

SIGNIFICANCE

Contribute to the literature to improve nerve regeneration.

Otolaryngology Residents' Attitudes, Experiences, and Barriers Regarding the Medical Research

Objective:

It was aimed to investigate the attitudes, experiences, and barriers towards scientific research among otolaryngology residents in Turkey.

Methods:

Anonymous data were collected via an online survey. The demographic characteristics and experience in scientific research were investigated in the first section of the survey. The attitudes of participants towards scientific research and the barriers to the scientific research were examined in the second section of the survey using 17 items.

Results:

The present study involved 119 otolaryngology residents continuing their education. It was determined that 68.1% of participants think that “participating in scientific research” is a part of otolaryngology training. In the present study, it was shown that the residents having journal club hours in clinics on regular basis participated in various steps of scientific research projects (p<0.05). Residents stated that they participated in the “literature review” stage of the preparation of a scientific publication (mean value of 2.58±1.88) most and in “verbal presentation in a congress” least (mean value of 0.74±1.44). It was determined that 80.7% of participants have not attended in any training on scientific research. It was found that the residents receiving structured scientific research training participated more in steps of scientific research projects which was statistically significantly (p<0.05).

Conclusion:

In our country, otolaryngology residents are very enthusiastic about having research education and participating in researches. However, residency students frequently have time deficiency, lack of knowledge-skill, and lack of financial support. Dedicated time should be allocated for research training and practice in specialty programs. Journal club activities should be organized on regular basis and integrated with research education. On the other hand, the scholarly activities of residents should be supported by means of various countrywide educational activities on research training.

Perception of male otolaryngologists on gender discrimination: a comparative study

Purpose

To gather information on perception of male otolaryngologists (MORLs) about gender discrimination towards female otolaryngologists (FORLs).

Methods

MORLs were invited to participate to an online survey. Minimum participation requirement was completion of at least their first year of residency. The responses were analyzed and compared vis-a-vis with the previously conducted similar survey among FORLs.

Results

Statistically significant responses on the Likert scale are classified in four main groups. MORLs and FORLs share the same views about financial factors, benefits and opportunities, housework as burden, establishing work–life balance and physical strength requirements. They have opposing views about FORLs being meticulous, exposed to more negative attitude of the opposite gender and men’s dominance in decision-making. FORLs don’t have consensus, but MORLs disagree about MORLs being favored in pursuing academic careers. On the other hand, MORLs don’t have consensus, but FORLs agree about patients having more confidence in MORLs.

Conclusion

MORLs don’t usually have any confrontation with FORLs in regards to the roles of women in the society such as their motherhood role. On the other hand, MORLs show rather a contradiction on their perception towards the gender discrimination mainly in achieving career goals by FORLs such as growing in the profession and holding managing roles. When the views of the both gender group are compared, MORLs don’t seem to fully acknowledge FORLs’ gender discrimination experience.

A Study on the Use of Massive Open Online Courses in Otorhinolaryngology After Graduation

Objective

The use of massive open online courses (MOOCs) in medical education and postgraduate education is becoming more and more widespread across the world. A survey study was carried out in Turkey to collect information and raise awareness about the use of MOOCs for educational and training purposes in the field of otorhinolaryngology after graduation.

Method

The prepared survey questionnaire was published on the online communication platform of the Turkish Otorhinolaryngology-Head and Neck Surgery Association, and volunteers were asked to fill-out the questionnaire by clicking the given link.

Results

A total of 210 volunteers participated in the survey study. Most of the volunteers (26.2%) were in the 36-40 age range. At the time of the study 53.8% of the volunteers were working as specialist doctors, 19.5% as residents, 10.5% as professors, 8.1% as associate professors, and 8.1% as assistant professors. Only 19 (9%) respondents ticked "yes" in response to the question "Are you familiar with the MOOC programs?" and only six (2.9%) of these respondents had attended a MOOC program. Evaluation of the correlation between academic title and awareness of MOOC programs showed that the instructors had a significantly higher level of MOOC awareness compared to the specialists and the residents (p=0.032).

Conclusion

Results of the survey revealed that the use of MOOC programs in postgraduate otorhinolaryngology education was low and the volunteers were not well-informed about this practice.

A Rare Tumor of Palatine Tonsils: Chondrolipoma

Chondrolipomas are benign mesenchymal tumors that have two mature tissues simultaneously and emerge as a result of cartilaginous metaplasia in lipomas. They rarely occur in the head and neck area (1%-4%), and occur more frequently in the 60-70 years age group. Although there are cases of the nasopharynx, tongue, lip, and neck reported in the literature, we have been able to find only two cases on tonsils. The case of a 17-year-old male patient, who presented to our clinic complaining of dysphagia and was diagnosed with tonsillar chondrolipoma, is described here, along with the radiological, clinical, and immunohistochemical findings, as well as the review of the literature.

Smartphone Based Audiometric Test for Confirming the Level of Hearing; Is It Useable in Underserved Areas?

OBJECTIVE

To determine the hearing levels of participants of a randomized group using a smartphone hearing application and to compare these results with the results from a pure-tone audiogram.

MATERIALS AND METHODS

A heterogenous group consisting of both normal-hearing and hearing-impaired participants were included in this study. Pure-tone audiogram thresholds were measured from 250 Hz to 8000 Hz, while smartphone measurements were obtained with a Samsung Galaxy GT-19500 S4 with a bundled headphone running the Hearing Test™ software (e-audiologia.pl), which was downloaded from the Google Play Store as a free application. We compared these results with those obtained from pure-tone audiograms performed by an audiologist as a reference.

RESULTS

Validity analysis indicated that the results for each ear and each frequency were excellent (>0.75). We assessed the mean difference between the pure-tone audiogram and the smartphone hearing test results and found the absolute difference to be less than 8.8 dB.

CONCLUSION

Smartphone hearing test applications are providing alternative tests that present low-cost solutions. Using the hearing application test may decrease the demand for audiological services in underserved areas. The study suggests that smartphone hearing test results are comparable to pure-tone audiometry results.

Is there a correlation between the clinical findings and the radiological findings in chronic maxillary sinus atelectasis?

OBJECTIVE

Silent sinus syndrome (SSS) is a clinical syndrome that occurs as a result of chronic maxillary sinus atelectasis (CMA) and is seen with progressive enophthalmos and hypoglobus. The aim of this study was to investigate the correlation between radiological findings and clinical findings in patients with radiologically asymmetrical reduced maxillary sinus volume.

MATERIAL AND METHOD

A comparison was made of patients with CMA through evaluation of paranasal sinus computed tomography, magnetic resonance imaging examination of maxillary sinus volume of the CMA side and the contralateral side, thickness of the retroantral fat tissue, infraorbital bone curve, uncinate process lateralisation measurement, middle concha diameter, and calculation of the change in location of the inferior rectus muscle.

RESULTS

The study included 16 patients. Although a statistically significant difference was determined between the healthy and the pathological sides in respect to maxillary sinus volume, thickness of the retroantral fat tissue, infraorbital bone curve, uncinate process lateralisation measurement, and middle concha diameter (p = 0.00, p = 0.002, p = 0.020, p = 0.020, p = 0.007), no significant difference was determined in respect to the change in location of the inferior rectus muscle (p = 0.154). A positive correlation was determined between the increase in sulcus depth and maxillary sinus volume and inferior orbital bone curve (p < 0.05).

CONCLUSION

In CMA patients suspected of having SSS, radiological maxillary sinus volume analysis, determination of retroantral fat thickness, measurement of the infraorbital bone curve, and measurement of the uncinate process lateralisation can be used as objective tests. However, it should be kept in mind that radiological findings may not always be compatible with the ophthalmological examination findings.

Do antithyroid antibodies affect hearing outcomes in patients with pediatric euthyroid Hashimoto's thyroiditis?

OBJECTIVES

Hashimoto's thyroiditis (HT) is the most common autoimmune thyroid disease in children. HT is a multifaceted disease with a variable clinicopathological presentation, including hearing impairment. It is known that hearing function is negatively affected in patients with thyroid disorders. The literature includes a very limited number of studies on hearing function in euthyroid pediatric patients with HT. The aim of this study was to determine the relationship between cochlear function and HT, independent of thyroid function.

MATERIALS AND METHODS

The study included 48 children and adolescents (42 females and 6 males) aged 9-18 years that were diagnosed as HT, and 30 gender- and age-matched healthy controls. Hearing was assessed via otoscopy, tympanometry, pure-tone audiometry, and measurement of distortion product otoacoustic emissions.

RESULTS

There weren't any significant differences in pure tone thresholds between the 2 groups based on pure-tone audiometry, except in the right ear at 6kHz and 8kHz. Distortion product otoacoustic emissions signal to noise ratios were significantly lower in the HT group than in the control group at 4 different frequencies (6kHz [left ear], 8kHz [left ear], 1.5kHz [right ear], and 6kHz [right ear]) (P<0.05). The signal to noise ratios at all frequencies were <6dB in 3% of left ears and 2.5% of right ears in the control group, versus 12.5% of left ears and 9.6% of right ears in the HT group. Distortion product amplitudes were significantly lower in the HT group than in the control group for both left and right ears at 1kHz, 1.5kHz, 3kHz, and 8kHz, and at 2kHz for left ears only (P<0.05).

CONCLUSIONS

The present findings show that cochlear function was lower in the HT group than in the control group. Accordingly, we think that hearing in patients with HT should be monitored periodically, even if their hearing thresholds are within normal limits. Thyroid autoimmunity appears to play an important role in a decrease in cochlear activity in pediatric HT patients.

Cochlear sensitivity in children with chronic kidney disease and end-stage renal disease undergoing hemodialysis

OBJECTIVES

Auditory system abnormalities commonly occur in patients with chronic renal disease and end-stage renal disease undergoing hemodialysis. The aim of this study was to determine the relationship between cochlear sensitivity and hemodialysis in dialytic and non-dialytic chronic kidney disease patients.

METHODS

The study included children aged 6-18 years that were divided into 3 groups: 36 non-dialytic patients with chronic kidney disease, 16 end-stage renal disease patients undergoing hemodialysis, and 30 healthy controls. Blood urea nitrogen, serum cystatin C levels, duration of chronic kidney disease, and the duration of hemodialysis were compared between the chronic kidney disease patients and end-stage renal disease patients undergoing hemodialysis. Hearing health was measured via tympanometry, pure-tone audiometry and distortion product otoacoustic emissions testing.

RESULTS

Distortion product otoacoustic emission amplitudes and signal-to-noise ratios were significantly lower at all frequencies tested in the non-dialytic and dialytic groups than in the control group (p<0.05). Patients with normal hearing had significantly lower distortion product otoacoustic emission amplitudes and signal-to-noise ratios than the healthy controls (p<0.05). The duration of CKD, the cystatin C level, and the blood urea level were not associated with hearing loss. The present findings suggest that there was a significant association between the duration of HD and hearing loss.

CONCLUSION

The present findings show that there was impaired cochlear function in the dialytic and non-dialytic patient groups, regardless of hearing loss, as compared to the control group. Patients with chronic renal disease-both dialytic and non-dialytic-should be monitored to prevent any further deterioration by avoiding potential ototoxic agents, even if their hearing thresholds are within normal limits.

Submandibular lateral epidermoid cyst: imaging findings of a rare case

Epidermoid cysts (EC) represent less than 0.01% of all oral cavity cysts. Lateral epidermoid cysts in the neck are very rare. A male patient aged forty-five had a complaint of painless swelling in the neck. A well-circumscribed hypo-echoic mass with internal echoes was detected in the right submandibular regionby ultrasonography. There were round areas inside the cyst with acoustic shadowing. The tissue hardness and the internal nature of the mass were evaluated with sono-elastography. Magnetic resonance imaging showed the mass's location and tissue properties in more detail. Magnetic resonance images revealed a well-circumscribed mass--hyperintense on T2-weighted images, hypo-intense on T1-weighted images--in the right submandibular region that had displaced the submandibular gland and mylohyoid muscle. There was no contrast enhancement in the mass on the contrast-enhanced fat-suppressed T1-weighted MR images. In this case report, we present the imaging features of a rare lateral EC in the submandibular region.

Nasal folliculosebaceous hamartoma with vascular-mesenchymal overgrowth in an infant

The nasal hamartoma is a rare non-neoplastic malformation or inborn error of tissue development, characterized by a mix of several tissue types. Folliculosebaceous cystic hamartoma is a distinct type of cutaneous hamartoma. We present a 3-month-old male infant who had nasal obstruction and who had a diagnosis of nasal folliculosebaceous cystic hamartoma after surgery.

A case of naso-ophthalmic myiasis

Myiasis is defined as an occupational disease and it is mainly seen in people who are in contact with animals, in particular sheep. We detected nasal and external ophthalmomyiasis caused by Oestrus ovis in a 33-year-old male who worked as a research assistant in the faculty of agriculture. The presenting complaints were severe foreign body sensation and discharge in the nose, cough, and foreign body sensation in the right eye. Ophthalmologic examination revealed many moving larvae in the right eye of the patient. Larvae were removed and nasolacrimal duct irrigation was performed through the inferior canaliculus. Endoscopic nasal examination also showed larvae colonies. The larvae were removed under local anesthesia and were taken to the parasitology laboratory, wherein Oestrus ovis was identified. Minimal endoscopic sinus surgery showed nonspecific chronic inflammation.

Pain prevention with intraoperative ketamine in outpatient children undergoing tonsillectomy or tonsillectomy and adenotomy

STUDY OBJECTIVES

To evaluate the effectiveness of ketamine in the prevention of postoperative pain after tonsillectomy.

DESIGN

Randomized, prospective, double-blind study.

SETTING

University hospital.

PATIENTS

90 ASA physical status I and II patients, aged 5 to 15 years, scheduled for tonsillectomy or adenotonsillectomy.

INTERVENTIONS

Patients were divided into three groups. The pain preventive group received intravenous (IV) ketamine 0.5 mg/kg in 2 mL saline before the tonsils were surgically removed, followed by a continuous IV infusion of ketamine at 6 micro/(kg/min). In the ketamine group, 2 mL saline was given before the tonsils were surgically removed; saline infusion (10 mL/h) was continued until bleeding control, and 0.8 mg/kg ketamine was given during bleeding control in 2 mL saline. In the control group, only saline was given.

MEASUREMENTS AND MAIN RESULTS

Cardiorespiratory system data, recovery from anesthesia and discharge parameters, tramadol requirement, and complications were recorded. Recovery from anesthesia and discharge parameters were similar among the groups. Total dose of tramadol was lower in the pain preventive group than in the other groups. In the pain preventive group, verbal pain scale scores were lower in the early postoperative period in the fourth and sixth hours (P < 0.05).

CONCLUSIONS

Ketamine decreases postoperative analgesic requirements and has analgesic effects when used before surgery in tonsillectomy/adenotonsillectomy.

The role of accompanying sinonasal abnormalities in the outcome of endonasal dacryocystorhinostomy

BACKGROUND

Acquired nasolacrimal duct obstruction may occur simultaneously and possibly as a consequence of sinonasal disease, because the nasolacrimal system is anatomically related to important nasal and sinus structures.

METHODS

Thirty-seven patients with nasolacrimal canal obstruction (42 eyes) were evaluated with paranasal sinus computerized tomography (CT) to determine the presence of sinonasal abnormalities if any. All of the patients underwent endoscopic dacryocystorhinostomy (end-DCR) and accompanying sinonasal pathology was treated also in the same session.

RESULTS

Paranasal sinus CT examinations revealed one or more sinonasal abnormalities in 26 (73.3%) patients. The postoperative success rate of end-DCR procedure in patients with sinonasal abnormalities was 82.8%, whereas this figure increased to 92.3% in patients without additional sinonasal disease. However, additional rhinological surgery did not affect the success rate of end-DCR procedure significantly (p = 0.640).

CONCLUSION

These data establish a positive correlation between sinonasal abnormalities and the presence of nasolacrimal outflow obstruction, but the additional rhinological surgery does not significantly affect the results of the end-DCR procedure.

[Psychiatric disorder profile in patients with chronic pharyngitis]

OBJECTIVES

We investigated the psychopathological condition of patients with chronic pharyngitis.

PATIENTS AND METHODS

The study included 27 patients (23 females, 4 males; mean age 41.7+/-10.4 years; range 21 to 63 years) who had persistent symptoms of chronic pharyngitis for more than six months, without any evidence for an acute infection on ENT examination and routine tests. Twenty-seven healthy subjects (23 females, 4 males; mean age 41.8+/-11.9 years) without any symptoms of chronic pharyngitis and a previous diagnosis of a psychiatric disorder formed the control group. All the patients and controls were assessed by a psychiatrist with the use of the Structural Clinical Interview for DSM-IV Disorders (SCID).

RESULTS

All the patients were diagnosed to have Axis I psychopathology. The most frequent pathologies were somatisation disorder (n=8, 29.6%) and dysthymic disorder (n=8). Five individuals (15.6%) in the control group received psychiatric diagnoses. Psychiatric disorders were 6.4 times more frequent in the patient group (p=0.00, CI=2.86-14.31). No significant differences were observed between the patient and control groups with respect to educational and occupational levels (p=0.263 and p=0.362, respectively). Comparisons with respect to risk factors associated with chronic pharyngitis showed no significant differences between the two groups.

CONCLUSION

We suggest that patients frequently presenting to ENT departments with repeated symptoms of chronic pharyngitis should also receive psychiatric assessment and support.

[Evaluation of predisposing factors and bacteriologic agents in pediatric rhinosinusitis]

OBJECTIVES

This study was conducted to investigate the predisposing factors and bacteriologic agents of acute rhinosinusitis in children.

PATIENTS AND METHODS

The study included 76 patients (47 girls, 29 boys; mean age 10.2 years; range 4 to 18 years) with acute rhinosinusitis. Following a detailed history, the patients were investigated by otolaryngologic examination including nasal endoscopy, allergy tests, Water's graphy, and aspiration cultures from the middle meatal region.

RESULTS

The leading complaints were nasal obstruction (92.1%), rhinorrhea (89.4%), and headache (51.3%). Allergy tests were positive in nine of 23 patients (30.3%) with a history of allergy. Concerning smoking, 39 patients (51.3%) had a secondary, two patients (2.6%) had a primary history. Sixteen patients (21.1%) had septal deviation, and 25 patients (32.9%) had benign adenoid tissue obstructing choanal spaces. Water's graphies showed pathology in 69 patients (93.2%). Cultures were positive in 51 patients (67.1%), with Streptococcus pneumoniae in 23 (41.1%), Haemophilus influenzae in 17 (30.4%), and beta-hemolytic streptococci in eight patients (14.2%). Treatment was comprised of ampicillin-sulbactam in 31 (40.8%), loracarbef in 20 (26.3%), and amoxicillin-clavulanate in 13 (17.1%) patients. After a year follow-up, recurrence was detected in 12 patients (15.8%). No significant effect of the size of adenoid tissue and allergy was found on the success of treatment (p>0.05).

CONCLUSION

Smoking, choanal obstruction by the adenoid tissue, anatomical variations, and allergy were the most frequent predisposing factors, while S. pneumoniae and H. influenzae were the commonest pathogens.