Is transoral sphenopalatine ganglion blockade more effective on postoperative pain than endoscopic sphenopalatine ganglion blockade?

PURPOSE: In this study, we aimed to examine and compare the effects of endoscopic SPGB and transoral SPGB on postoperative pain control and patient satisfaction in patients undergoing septoplasty. METHODS: Participants were randomly divided into three groups, no blockade (n:20), endoscopic SPGB (n:20), and transoral SPGB (n:20). Those who had no blockage were included in the control group. Demographic data of patients, such as age and sex, VAS (visual analogue scale) and postoperative pain scores (PPS) [determined at arrival in the post-anesthesia care unit (PACU) and after 2, 6, 12, and 24 h], general analgesic use (24 and 168 h after surgery) and postoperative Quality of Recovery (QoR-15) values were recorded and compare them. RESULTS: The PPS PACU of 2 h, 6 h, 12 h, and 24-h values of the transoral group were lower than the endoscopic and control groups (p < 0.001).The values of 24 h and 168 h of analgesic use in the transoral group were lower than in the control and endoscopic groups (p < 0.001).The average recovery QoR-15 scores at 12 h and 24 h differed according to the groups (p < 0.001) and the highest values were in the transoral group (p < 0.001). CONCLUSION: Transoral SPGB is more effective in postoperative pain control than endoscopic SPGB, it decreases the use of postoperative analgesics and improves postoperative recovery scores.

The Effects of the Newest Palatopharyngeal Surgery (Barbed Pharyngoplasty) on Voice Quality.

OBJECTIVES: This study aimed to examine the effects of barbed pharyngoplasty (BP) on voice quality in patients with Obstructive sleep apnea syndrome (OSAS) and to compare them with the anterior palatoplasty (AP) and expansion sphincter pharyngoplasty (ESP) surgeries. METHODS: The study included 329 patients who came to the Otorhinolaryngology Clinic of our hospital with symptoms of snoring and sleep apnea between January 2020 and 2022 and were referred to the sleep laboratory for polysomnography (PSG). AP surgery was recommended for those with retropalatal stenosis in the anteroposterior direction, and ESP surgery for those with lateral stenosis. BP was recommended for those with both anteroposterior and lateral retropalatal stenosis. 60 patients who met the study criteria were included in the study. All surgeries were performed under general anesthesia by the same otolaryngologist within 1 month at the latest after sleep endoscopy. Acoustic voice analysis was performed using the Praat voice analysis program preoperatively and postoperatively at 6 months. F0, jitter, shimmer, and NHR (noise-to-harmonic ratio) were compared between groups pre and postoperatively. RESULTS: F0 %, jitter %, shimmer %, and NHR % changes were highest in BP. Jitter, shimmer, and NHR decreased significantly in the BP group, whereas F0 increased significantly. Although the mean F0 increased in both AP and ESP groups, the greatest change was in the AP group following BP groups. Although the average jitter, shimmer, and NHR decreased in both groups, the greatest change was in the ESP group following BP groups. CONCLUSION: In patients with OSAS, BP surgery changed F0, jitter, shimmer and NHR more than AP and ESP surgeries, and effected the voice quality more positively.

Effect of Endotracheal Intubation on Voice.

OBJECTIVES: Following endotracheal intubation (ETI), voice changes can be observed quite frequently. Considering that the pressure that occurs increases as the duration of anesthesia with ETI increases, with the aim to contribute to literature, we realized objective acoustic analysis by grouping patients according to the length of surgical periods. We wanted to investigate both the impact of endotracheal intubation on the voice and how long this impact lasted by performing voice analyzes on the preoperative, postoperative first day and postoperative fifth day. MATERIAL AND METHODS: Patients were examined in three groups comprised of operations lasting less than 60 minutes depending on the operation time (1st group, n = 21), operations lasting between 60-120 minutes (2nd group, n = 21) and operations lasting longer than 120 minutes (3rd group, n = 18). For patients in all three groups, preoperative, postoperative first day and postoperative fifth day voice analyzes have been performed and compared statistically. RESULTS: With the evaluation made on the postoperative first day, it was found that the jitter%, shimmer% and shimmer dB values increased significantly as the operation time increased and it was observed that the HNR values decreased significantly (for jitter% P = 0,008, for shimmer% P = 0,027, for shimmer dB P = 0,025, for HNR P = 0,028). There was no significant difference between the postoperative first day F0 values and postoperative fifth day F0, jitter%, shimmer%, shimmer dB and HNR values in all three groups. CONCLUSION: It is possible to state that ETI makes changes in the voice in the early period, but the changes are normalized in the long term. However, multidisciplinary studies with larger patient groups are needed for more precise and clear judgments.

The Effect of Bilevel Positive Airway Pressure on Voice Quality.

OBJECTIVES: Inflammation of the upper airways, thickening of the lateral pharyngeal walls, elongation of the soft palate and uvula, hypertrophy of the tonsils and base of the tongue can be seen in obstructive sleep apnea syndrome patients. Changes in these structures may affect articulation and phonation, negatively affecting the quality of the voice. Positive airway pressure (PAP) treatment reduces the volume of the root of the tongue, dissolves the edema in the upper respiratory tract, increases the posterior pharyngeal area, and positively changes the quality of the voice. METHODS: A total of 151 people, 50 control group, and 101 patients, were included in the study between December 2020 and December 2021. The patient group was divided into two groups as continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP) users. All voice recordings were made in the control group and the patient group before and 3 months after CPAP and BPAP treatment, and were evaluated with the Praat (Paul, 2001) voice analysis program. The fundamental frequency of the sound (F0), frequency perturbation (jitter), amplitude perturbation (shimmer), noise-to-harmonic ratio (NHR) values were evaluated in the patient and control groups, and they were compared with each other before and after the treatment in the CPAP and BPAP groups. RESULTS: Before and after PAP treatment; the changes in F0, Jitter, Shimmer, and NHR in the CPAP and BPAP group were statistically significant (P < 0.05). While the F0 change before and after PAP treatment was the most in the CPAP group, the jitter, shimmer and NHR changes were the most in the BPAP group. CONCLUSIONS: Regular 3-month PAP treatment positively affects F0, jitter, shimmer and NHR values. The greatest F0 change is in the use of CPAP, the improvement in jitter, shimmer and NHR is the most in the use of BPAP.

Effectiveness of Surgical Treatment in Traumatic Facial Paralysis.

INTRODUCTION: In the etiology of facial nerve palsy, trauma is the most important. Our aim was to present our experience gained by evaluating the surgical approaches we have used in extratemporal and intratemporal facial nerve injuries and their long-term results, also to contribute to the consensus that will be formed on this subject. MATERIALS AND METHODS: Thirteen patients among 24 patients who underwent surgery with a diagnosis of traumatic facial paralysis were evaluated in this study. The clinical response of these patients to treatment was examined by classifying them according to the House-Brackmann classification in the preoperative and postoperative periods. RESULTS: Of the 13 patients, 9 had fractures due to temporal bone trauma, and 4 had nerve damage in the extratemporal part of the facial nerve. in the treatment, facial nerve decompression was performed using the middle fossa approach in 9 patients with temporal bone fractures. in the 4 patients with extratemporal facial nerve injury, graft repair or primary suturing was performed. in the postoperative period, the stages of the patients were III or below in 12 patients (92%), and only 1 (8%) patient remained in stage IV. DISCUSSION: When the postop conditions of the patients were examined according to House-Brackmann staging, it was observed that surgical treatment caused a significant improvement in the functions of the facial nerve. CONCLUSIONS: Our results showed that surgery was an effective treatment method in patients with indications for traumatic facial paralysis.

Vocal fatigue in doctors: evaluation with subjective and objective acoustic parameters.

AIM: The aim of this study was to investigate the voice problems with vocal loading in physicians. METHOD: It was planned to have two groups and thirty participants in each group. The participants were surgeon and nonsurgeon, male and female doctors (first group: 15 female +15 male nonsurgeon; second group: 15 female +15 male surgeon). Volunteers were also separated according to the duration of career, patients seen daily and polyclinic days weekly. Visual analog scale (VAS) scores and voice fatigue index (VFI) version 2 were applied. Objective measurements (F0, jitter, shimmer, harmonics-to-noise ratio) of acoustic evaluation according to the same variables were recorded. RESULTS: There was a statistically significant difference in the number of patients seen daily between the groups (<50 patients/day and >50 patients/day) in terms of VFI parts 1 and 2 averages. There was a statistically significant difference between branches (surgical vs. nonsurgical) in terms of VFI part 1 (p = .034). The tiredness of voice was prominent in the physicians who saw more patients and who had more workdays weekly and who were nonsurgeon (VFI part 1). Physical discomfort was more prominent in physicians whose duration of career was long and whose daily patients were more (VFI part 2) (p < .05).The number of patients seen daily and number of days to work did not affect objective acoustic parameters. Being experienced as year in women and being surgeon decreased the mean shimmer values in objective measurements (p < .05). CONCLUSION: Physicians experienced vocal fatigue (VF) in varying degrees according to the differences in working conditions.

The Importance of Multiple, Different Rhinoplasty Consultations in Patient Selection.

OBJECTIVE: We aimed to investigate the relationship between the number of visits to different physicians and postoperative satisfaction in patients undergoing primary septorhinoplasty by using the ROE survey. METHODS: Patients for whom we performed septorhinoplasty in the last 3 years were examined. Patients who visited 3 different physicians (including us) before the surgery were allocated to group 1. Patients who visited ≥ 4 physicians comprised group 2. We randomized 50 patients in each group. Rhinoplasty outcome evaluation (ROE) was performed twice for the preoperative evaluation and to determine the satisfaction in postoperative 6th month. RESULTS: Preoperative and postoperative ROE values were significantly lower in group 2 (p < 0.001). ROE values after surgery were 82% in group 1 and 68.92% in group 2. CONCLUSION: We think that it is more appropriate for patients who visit many surgeons to be evaluated more carefully and to be psychologically examined. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The Effect of Electronic Cigarettes on Voice Quality.

OBJECTIVES: Cigarette-associated diseases have frequently been detected in the field of otolaryngology. Cigarettes can cause changes in voice performance. The aim of the present study was to investigate the effect of e-cigarettes on voice performance compared with conventional cigarettes. MATERIALS AND METHODS: This is a cross-sectional study that included 81 healthy volunteers. To provide standardization, all patients were men. The patients were divided into three groups: e-cigarette users (group 1, n = 21), conventional cigarette users (group 2, n = 30), and nonsmokers who had never smoked (group 3, n = 30). The subjective and objective voice analyses were performed for all the three groups in the study. F0, jitter %, shimmer %, shimmer dB, harmonics-to-noise ratio (HNR) values, and Voice Handicap Index 10 were statistically compared between all groups. RESULTS: The mean Voice Handicap Index 10 values of the conventional cigarette users were higher than those of the e-cigarette users and control group. No significant difference regarding the F0, jitter, and shimmer percentage values between the groups was detected; however, a significant difference was detected regarding the shimmer dB and HNR values between the groups. The mean shimmer dB values of the conventional cigarette group were higher than those of the control group and electronic cigarette users, but the mean HNR values were lower than those of the control group and electronic cigarette users. CONCLUSIONS: The effects of e-cigarettes on voice were detected as mild compared with conventional cigarettes, according to the subjective and objective voice analysis results in our study.

Carotico-vertebral Doppler Ultrasonography in Patients with Idiopathic Vertigo.

BACKGROUND: In the present study, we investigated the relationship between caroticovertebral Doppler USG measurement results and Vertigo Symptom Scale-Short Form (VSS-SF) in patients with idiopathic vertigo. METHODS: Fifty patients with idiopathic vertigo and 30 healthy subjects were included into the study. Ear, Nose & Throat (ENT) examination, audiological examination, routine hemogram, biochemichal tests and temporal magnetic resonance imaging were performed to diagnose "idiopathic vertigo". By carotico-vertebral Doppler ultrasonography (USG), common carotid artery (CCA) area, intima media thickness; and vertebral artery dimension were measured on the right and left side of the study and control groups. RESULTS: CCA area values were not different between the study and control groups; and between the right and left sides of the each group. On the left side, intima media thickness and vertebral artery dimension values of the vertigo group were significantly higher than those of the control group. Correlation tests showed that CCA area and intima media thickness values on the right and left side were positively correlated with each other. Moreover, in patients with higher right; or left intima media thickness values, left vertebral artery dimensions decreased. Older age was associated with higher intima media thickness in right and left sides. When CCA values decreased on the right side, VSS-SF values increased; and patients' complaints for vertigo got higher. Linear regression analysis (Backward LR) results also showed that the significant compounding factor on VSS-SF was right CCA area. As right CCA area decreased, VSS-SF increased with more vertigo complaints. Whereas, vertigo complaints and VSS-SF decreased when right CCA increased. CONCLUSION: We concluded that a decrease in the right CCA were linked with higher VSS-SF scores and increasing vertigo symptoms. Whereas, a decrease in the left CCA area and left crabial blood supply are more important related to the left hemispheric dominance in right-handed people. Moreover, an increase in the intima media thickness was also detected in the vertigo patients and it probably causes a decrease in the central blood flow.

The effect of very low dose pulsed magnetic waves on cochlea.

INTRODUCTION: In daily life biological systems are usually exposed to magnetic field forces at different intensities and frequencies, either directly or indirectly. Despite negative results, the therapeutic use of the low dose magnetic field has been found in recent studies. The effect of magnetic field forces on cochlear cells is not clear in the literature. OBJECTIVE: In our study, we first applied in vivo pulsed magnetic fields to laboratory rats to investigate the effects on cochlea with distortion product otoacoustic emission test followed by histopathological examinations. METHODS: Twelve rats were included in this study, separated into two groups as study group and control group. The rats in the study group were exposed to 40Hz pulsed magnetic field for 1h/day for 30 days; the hearing of the rats was controlled by otoacoustic emission test. Also, their cochleas were removed and histochemical examination was performed by Caspase-3, Caspase-9, and TUNEL methods. RESULTS: A statistically significant difference was determined (p<0.05) when the hearing thresholds of the groups obtained by using 5714Hz and 8000Hz stimuli were compared by Kruskal-Wallis test. A significant reaction was observed in the study group, especially in the outer ciliated cells during immunohistochemical examinations by using Caspase-3 and Caspase-9 methods. A significantly positive difference was determined in the study group, especially at the outer ciliated cells and the support cells of the corti organ, when compared to the control group (p<0.05) by the TUNEL method. CONCLUSION: According to the results of our study, the very low dose magnetic field, which is considered to be used for therapeutic purposes recently, can cause both auditory function defects and histopathologic damage in cochlear cells.

Tonsillectomy pain control with IV dexamethasone, infiltrated dexamethasone and infiltrated bupivacaine; a randomised, double-blind, placebo controlled, prospective clinical trial.

OBJECTIVE: To compare effects of local and systemic administrations of dexamethasone and local bupivacaine on postoperative pain in patients who have had tonsillectomy.. METHODS: This randomised, double-blinded, placebo-controlled and prospective clinical trial was conducted at Adana Numune Training and Research Hospital, Turkey, between April and July 2016, and comprised patients who were undergoing tonsillectomy operation due to recurrent tonsillitis, chronic tonsillitis or tonsillar hypertrophy indication. Patients were randomly assigned to 4 equal groups. Group 1 was administered 0.5 mg/kg intravenous dexamethasone. Group 2 was given 0,5mg/kg dexamethasone diluted with 10 mL saline which was infiltrated into the peritonsillar regions. Group 3 received 2.5 mL of 0.5% bupivacaine infiltration. Group 4 was the control group and received peritonsillar saline infiltration. Pain was evaluated with visual analogue scale and the data obtained was analysed with SPSS 20.. RESULTS: Of the 60 patients, each group had 15(25%). Visual analogue scale values at the 15th minute was significantly lower in Group 1 compared to the other groups (p<0.05). Values of Group 4 were higher from the 1st hour through to the 24th hour compared to the other groups (p<0.05). Although there were no significant differences among the other groups, the lowest value of visual analogue scale was found in Group 1 in the 6th hour (p>0.05). Values of Group 4 at the 6th and 12th hours were significantly higher compared to Groups 1 and 2 (p<0.05). CONCLUSIONS: Intravenous dexamethasone, infiltrated dexamethasone and infiltrated bupivacaine were all found to be effective on postoperative pain.

Does glycerol have an effect on pain during nasal packing removal

Background/aim: The aim of this study was to investigate the efficacy of lubricating and moistening of Merocel nasal packs with glycerol on reducing pain and bleeding during nasal packing removal in patients who had undergone endoscopic sinus surgery or with epistaxis. Materials and methods: Fifty patients were included in the study. Glycerol was used on one side while saline was used on the other side of the same patient as a control. All patients were blinded to which side received glycerol and which side received saline. In the glycerol group, glycerol was infiltrated into the Merocel packing in the nasal cavity. In the saline group, 0.9% saline solution was infiltrated into the Merocel packing in the other nasal cavity of the same patient. Both applications were performed 15 min before removal of the packs. The patients were asked to score the severity of the pain that occurred in both nasal passages according to a visual analog scale (VAS). Bleeding was recorded as mild (no bleeding), moderate (leakage), and severe (active bleeding requiring intervention). Results: The mean VAS score was significantly lower in the glycerol group than in the saline group (3.02 vs. 4.86, P < 0.05). Although no significant difference was observed between the groups in the amount of bleeding, lower amounts of bleeding were seen in the side that received glycerol. Conclusion: Administration of glycerol is a cost-effective and easily performed method of analgesia for nasal packing removal in patients who undergo endoscopic sinus surgery or with epistaxis.

Evaluation of the effects of montelukast, mometasone furoate, and combined therapyon adenoid size: a randomized, prospective, clinical trial with objective data

Background/aim: The incidence of adenoid hypertrophy is 2%-3% in children. Adenoidectomy is a commonly performed procedure in children that may cause complications such as early or late bleeding (4%-5%), recurrence of adenoid tissue (10%-20%), and postoperative respiratory problems (27%). Therefore, medical therapy alternatives to adenoidectomy are important and must be tried before surgery. In this study, we investigated the efficacy of mometasone furoate, montelukast, and a combination of these drugs in pediatric patients with adenoid hypertrophy who were scheduled for reduction with medical therapy after not being recommended for surgery.Materials and methods: The study included 120 children with adenoid hypertrophy aged between 4 and 10 years. The patients were randomized into 4 separate groups, with 30 in each group. Group 1 received 100 µg of mometasone furoate per day, group 2 received 4/5 mg (for age) montelukast per day, and group 3 received mometasone furoate + montelukast. Medical therapy continued for 3 months in the treatment groups. Group 4, which comprised patients with mild symptoms, received no treatment and was the control group. The pre- and posttreatment adenoid tissue ratios in lateral neck radiographs were recorded in the four groups. Results: When radiologic measurements of adenoid-to-air passage were calculated, an improvement of 21.76% was observed in group 1 after treatment. The rate of improvement was 22.51% in group 2. There was a 21.79% reduction in adenoid size in group 3 after 3 months? treatment and 12.46% in the control group. There were statistically significant differences between pre- and posttreatment values in every single group administered corticosteroids, montelukast, and combined therapy (P < 0.05).Conclusion: According to our results, both montelukast and mometasone furoate therapies were similarly successful in treating adenoid hypertrophy. Combined therapy has no superiority over single-therapy treatment.