Evaluation of sinonasal involvement in patients with asthma and chronic obstructive pulmonary disease.

Background: Asthma and chronic obstructive pulmonary disease (COPD) are the most common obstructive diseases. Based on the similarities, we aimed to evaluate sinonasal symptoms in patients with asthma or COPD, and compare the two diseases with regard to upper-airway involvement. Methods: Patients with asthma or with COPD who were followed up at Ankara University Immunology and Allergy or Chest Diseases Departments were included in the study. The participants went through pulmonary function tests, skin-prick tests, and disease severity assessment of either disease. Nasal endoscopic evaluations of all the patients were performed in the Department of Otorhinolaryngology. Lund-Mackay scoring was performed on the computed tomography of the paranasal sinus. Chronic rinosinusitis (CRS) diagnosis was made as recent guidelines. Results: A total of 112 subjects (number of women/men: n = 67/45; median age, 49 years [The range for IQR was 22 years]) were included in the study. Fifty-five patients had asthma, 33 had COPD, and 24 were healthy controls. Nasal symptoms were more frequent in the patients with asthma (patients with asthma, n = 52 [98%]; patients with COPD, n = 17 [52%]; controls, n = 9 [38%]) (p < 0.001). The median (IQR) 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire score was higher in the patients with asthma (33 [20-50]) than in the patients with COPD (8 [1.5-18.7]) and the control group (3.5 [0-18.7]) (p < 0.01). Patients with asthma had significantly higher prevalence rates of rhinosinusitis than did those in the COPD and the control groups (36%, 15.6%, 8.3%, respectively; p < 0.01). The SNOT-22 optimal cutoff score was calculated as ≥11 to detect the score limit for CRS prediction with the best sensitivity and specificity. Conclusion: As a result, patients with both asthma and COPD may have upper-airway symptoms. CRS, was primarily seen in the patients with asthma. Accordingly, SNOT-22 scores were higher in the patients with asthma than in those in the COPD and the control groups. A referral to the Ear Nose Throat department for further evaluation with nasal endoscopy and computed tomography of the paranasal may be required in a subgroup of patients.

Processes of Emotion Idioms Comprehension of Turkish-Speaking People with Wernice's Aphasia.

INTRODUCTION: Idioms are commonly used in everyday language to convey emotions figuratively. The ability to comprehend and use idioms that incorporate emotional elements is crucial for effective communication in daily life, particularly among people with aphasia (PwA). Despite the interest in understanding the process of emotion idiom comprehension in PwA, limited information is available in the literature. Therefore, this study aimed to investigate the process of emotion idiom comprehension in people with Wernice's aphasia (PwWA) and compare it with that of neurotypical individuals. METHODS: Sixty idioms were selected based on their syntactic and semantic features, and participants evaluated their imageability. Sixteen idioms were chosen for the study and two types of tasks were prepared: written idiom-picture matching and written idiom-written text matching. These tasks were administered to two groups: 11 PwWA and 11 neurotypical individuals. The results were analysed in terms of task performance, response type, syntactic and semantic features, and emotional content. RESULTS: The emotion idiom comprehension scores of PwWA group were significantly lower than those of the neurotypical participants. PwWA had greater difficulty with the written idiom-picture matching task and tended to rely on the literal meanings of the idioms. There were differences in the semantic features between the two groups. Among the emotional idioms, PwWA showed significant differences in the types of emotions they were able to comprehend. CONCLUSIONS: The findings of this study suggest that regardless of the syntactic content of idioms, PwWA's ability to comprehend emotion idioms is impaired, and they tend to interpret them more literally. This study provides a useful method for assessing emotional idiom comprehension in PwA.

The Role of 18F-FDOPA PET/CT in Recurrent Medullary Thyroid Cancer Patients with Elevated Serum Calcitonin Levels.

Objectives: To evaluate the diagnostic performance of 18F-dihydroxyphenylalanine (FDOPA) positron emission tomography/computed tomography (PET/CT) in the detection of medullary thyroid carcinoma (MTC) recurrence in patients with elevated calcitonin levels. Methods: The patients who had undergone 18F-FDOPA PET/CT imaging for elevated calcitonin levels after primary surgery of MTC were included in the study. addition, if available 18F-fluorodeoxyglucose (FDG) PET/CT and Gallium-68 (68Ga)- DOTATATE PET/CT images of the patients were evaluated retrospectively. The sensitivity and diagnostic performance of 18F-DOPA PET/CT were investigated. Results: A total of 14 patients (9 F and 5 M; median age: 45) were included in the analysis. Three patients had MEN IIA syndrome and 1 patient had MEN IIB syndrome, 10 patients had a diagnosis of sporadic MTC. Median calcitonin levels of the patients were calculated as 757.5 (min-max: 28.5-7911) pg/mL. Nine patients and 5 patients had undergone ultrasound and contrast-enhanced computed tomography (ceCT) of the neck, respectively, before 18F-FDOPA PET/CT imaging. 18F-FDOPA PET/CT revealed pathological uptake in the thyroid bed, lymph nodes, and distant organs in three, five and two patients, respectively. Median maximum standardized uptake value for the recurrent or metastatic lesions were calculated as 6.4 (min-max: 1.9-18.4). The sensitivity of 18F-FDOPA PET/CT in the detection of recurrent disease was calculated as 64%. Eight patients had 68Ga-DOTATATE PET/CT and 7 of them had 18F-FDG PET/CT within 3 months period before 18F-FDOPA PET/CT. 18F-FDOPA PET/CT revealed recurrent disease in 4 of 5 and 2 of the 5 patients who had negative 18F-FDG PET/CT and negative 68Ga- DOTATATE PET/CT, respectively. Conclusion: 18F-FDOPA PET/CT can detect recurrence in about two- thirds of patients with elevated calcitonin levels after primary surgery for MTC. Due to variable differentiation degree, different receptor status, and clinical behavior of MTC, all three radiopharmaceuticals can be beneficial and are complementary to each other in patient management.

Incidentally Found Killian-Jamieson Diverticulum During Thyroidectomy: A Case Report.

The aim of this case study is to demonstrate the very rare coincidental existence and management of a Killian-Jamieson diverticulum (KJD) during thyroid surgery. A 57-year-old woman was referred to our clinic with a malignant thyroid nodule and the complaint of a sore throat. There were no suspicions concerning a diverticulum on examining her with flexible laryngoscopy or ultrasound imaging. During the right central neck dissection, we noticed a 3 × 3 cm KJD and resected it while preserving the recurrent laryngeal nerve. After the successful operation, we questioned the patient and learned that for 1 year she had an occasional complaint of dysphagia. Postoperatively, there was no vocal cord palsy or hypocalcemia, and there was no pharyngoesophageal leak after oral alimentation. There was no recurrence or complaint for KJD or papillary carcinoma for 8 years follow-up. Nonspecific symptoms like a sore throat should be investigated, and patients should be questioned for all aerodigestive symptoms. If necessary, further investigation should be undertaken for a differential diagnosis.

Evaluation of laryngeal vascular changes with image1 s enhancement system in reference to the European laryngological society guideline.

OBJECTIVES: To assess the feasibility of using Image1 S™ endoscopic enhancement system for discrimination of the vascular patterns in laryngeal lesions. DESIGN: Forty patients presenting with benign, dysplastic and malignant laryngeal lesions were examined with Image1 S system. The vascular patterns were classified by a group of authors according to the European Laryngological Society (ELS) guideline, as perpendicular or longitudinal, in all lesions. The relationship between the vascular patterns and the pathological results was statistically analysed. Endoscopic images of the lesions were evaluated through an online survey by a group of otolaryngologists with different levels of clinical expertise and asked them to choose a diagnosis and a vascular pattern. The vascular pattern evaluations of the participants were compared to the authors' evaluations to determine the interobserver reliability. The final diagnostic judgements of the participants were compared with the definitive histopathological diagnoses. SETTING: Tertiary university hospital. PARTICIPANTS: Forty patients with laryngeal lesions and thirty otolaryngologists with different clinical experience levels. MAIN OUTCOME MEASURES: The study evaluates the usefulness of the Image1 S system for the detecting the vascular patterns associated with benign, dysplastic, and malignant lesions and measures the level of accuracy and inter observer agreement in detecting the final histopathology. RESULTS: Histopathological examination diagnosed 12 patients as benign, 12 dysplastic and 16 malignant. Using Image1 S, the vascular patterns were longitudinal in 11 lesions, perpendicular in 28 lesions and undetectable in 1 lesion. With white light, longitudinal pattern was observed in 14 lesions, perpendicular in 21 lesions and undetectable in 5 lesions. The correlation between the vascularisation pattern and the pathological diagnosis was found to be significant (p < .001). The qualitative evaluation of the vascular patterns by the two groups of observers showed significant reliability (κ = 0.63, p < .001). The agreement with the final diagnoses was also significant (κ = 0.56, p < .001). CONCLUSIONS: Image1 S endoscopic enhancement system with spectral modes provides an improved visibility of the vascular patterns defined by the ELS in laryngeal lesions. ELS classification can reliably distinguish benign lesions from suspected ones and can be applied even by less-experienced clinicians but the final diagnosis needs experience and should be confirmed with histopathology.

Functional and Oncological Outcomes of Open Partial Laryngectomy vs. Transoral Laser Surgery in Supraglottic Larynx Cancer.

OBJECTIVE: The aim of the presented study was to evaluate the outcomes of open partial laryngectomy (OPL) versus transoral laser surgery (TLS) in patients operated on for supraglottic laryngeal carcinoma based on functional parameters (duration of hospitalization, oral nutritional status and duration of transition to oral feeding, weaning status and duration after tracheotomy, and postoperative voice results) and oncological results (overall survival rate, disease-specific survival rate, recurrence, and presence of second primary tumors) in both groups. METHODS: All laryngeal carcinoma patients who had undergone either OPL or TLS in the period from January 2012 to March 2017 in our center and were followed-up at least for 36 months were included in the study. Statistical analyses were carried out using the t-test and the Mann-Whitney U test to compare the means, and the Kaplan-Meier test for survival analysis. RESULTS: Fifty patients (44 males and 6 females) met the study criteria, of whom 31 had undergone OPL and 19 TLS. Patients that underwent TLS had less tracheotomy needs, needed shorter hospitalization periods, and transitioned to oral feeding earlier, compared to those that underwent OPL. There were no significant differences between the two groups based on oral feeding rates and voice outcomes. The impact of TLS and OPL on organ preservation in supraglottic laryngeal cancer were comparable. For local recurrences, repeated endolaryngeal laser surgeries and adjuvant treatments could be used in the TLS patient group. There were no significant differences between the two groups based on overall survival rate and disease specific survival rate. CONCLUSION: Although no significant differences were found in our study between the two surgical procedures in terms of oncological outcomes, TLS appeared to produce better functional outcomes in supraglottic laryngeal carcinoma than OPL.

Respiratory Protective Equipment for Healthcare Providers During Coronavirus Pandemic: "Nec Temere, Nec Timide".

In otorhinolaryngology-head and neck surgery, there are several routine and surgical procedures applied to the upper airway that generate droplets and/or aerosols. Therefore, otorhinolaryngology-head and neck surgeons are at higher risk of being exposed to viral content. The COVID-19 pandemic has shaken the world with approximately 30 million affected cases and more than 900.000 deaths officially reported in more than 200 countries/regions from March 11th, 2020 to date (September 12th, 2020). All healthcare providers working at the frontlines of the fight against the COVID-19 are at risk of contracting the virus. In this review, we discuss the efficacy of the different types of respiratory protective equipment and remind about the surgery-based respiratory protection strategies in otorhinolaryngology and head and neck surgeries in the light of the latest literature.

Retroauricular Approach for Targeted Cochlear Therapy Experiments in Wistar Albino Rats.

BACKGROUND: As the idea of stem cell technology in the treatment of sensorial hearing loss has emerged over the past decades, the need for in vivo models for related experiments has become explicit. One of the most common experimental models for inner ear stem cell delivery experiments is the Wistar albino rat. AIMS: To investigate the surgical anatomy of the temporal bone of the Wistar albino rat with respect to the dissection steps, operative techniques and potential pitfalls of surgery. STUDY DESIGN: Animal experimentation. METHODS: Adult Wistar albino rats were operated on via the retroauricular approach under an operation microscope. The anatomy of the temporal bone, the surgical route to the temporal bulla and the inner ear were investigated. Technical details of surgical steps, complications and potential pitfalls during the surgery were noted. RESULTS: The study group consisted of 40 adult Wistar albino rats. The mean times to reach the bulla and to achieve cochleostomy were 4.3 (2-13 min) and 7.5 min (3.5-22 min), respectively. The mean width of the facial nerve was 0.84 mm (0.42-1.25 mm). The stapedial artery lay nearly perpendicular to the course of the facial nerve (88-93 °C). There were three major complications: two large cochleostomies and one massive bleed from the stapedial artery. CONCLUSION: The facial nerve was the key anatomical landmark in locating the bulla. By retrograde tracing of the facial nerve, it was possible to find the bulla ventral (inferior) to the main trunk. The facial nerve trunk was the upper limit when drilling the bulla. By dissecting the main trunk of the facial nerve and retracting cranially, a large drilling space could be achieved. Our results suggest that the retroauricular approach is an effective, feasible route for inner ear drug delivery experiments in Wistar albino rats.

Study of mouse induced pluripotent stem cell transplantation intoWistar albino rat cochleae after hair cell damage.

BACKGROUND/AIM: As the regeneration capacity of hair cells is limited, inner ear stem cell therapies hold promise. Effects of mouse induced pluripotent stem cells (IPSCs) on Wistar albino rats (WARs) with hearing impairment were investigated. MATERIALS AND METHODS: Thirty-five adult WARs with normal hearing were divided into 4 groups. Excluding the study group (n = 15), the other three groups served as control groups for ototoxicity and IPSC injection models. IPSC injections were performed via cochleostomy after a retroauricular approach. Auditory functions were evaluated with auditory brainstem responses (ABRs) before and after the injections. After a final hearing assessment the WARs were sacrificed and cochleae were extracted to see the biologic behavior of IPSCs in the inner ear by light microscopy and immunohistochemistry. RESULTS: There were no significant differences in the click-ABR thresholds in the study group after IPSC transplantation. The mean hearing threshold in the study group after ototoxic agent injection was 53.2 dB (10-90 dB). There was no significant difference between groups (P > 0.05) and no differentiated stem cells were observed immunohistochemically. CONCLUSION: Transplanted IPSCs did not show a therapeutic effect in this trial. We discuss potential pitfalls and factors affecting the therapeutic effect.

Reliability of Frozen Section Pathology in Transoral Laser Laryngectomy.

OBJECTIVE: To evaluate the reliability of frozen section analysis in transoral laser laryngectomy (TOLL). METHODS: A retrospective analysis was conducted for patients who underwent TOLL in a university hospital between January 2012 and February 2014. The grade of the tumor and the histopathological diagnosis were noted. The results of frozen section pathologies and routine histological examinations were compared. RESULTS: A total number of 84 sections from 21 patients with a mean age of 57.3 years were included in the study. All the patients were operated with superpulse continuous mode carbon dioxide laser with a power of 5-8 watts. Squamous cell carcinoma was histologically diagnosed in all patients. The tumor was grade 1 in 80.95% of the patients, grade 2 in 9.52%, and grade 3 in 9.52%. A routine histopathological examination confirmed the frozen section in 94.04% of the patients. CONCLUSION: Laser surgery is a commonly preferred treatment modality in early-stage laryngeal carcinomas, in particular. However, a safe surgical margin is a debate in transoral laser surgery. In light of our results, we can conclude that frozen section pathology is a reliable method to achieve safe surgical margins in TOLL.

Association of the tumor necrosis factor-alpha -308 G/A polymorphism with nasal polyposis.

Nasal polyposis (NP) is a chronic inflammatory disease in which several molecular and cellular interactions play important roles. Tumor necrosis factor-alpha (TNF-alpha) is a major pro-inflammatory cytokine with a key role in immune inflammatory responses in NP. Altered levels of TNF-alpha, which may occur due to polymorphisms in the TNF-alpha promoter region, may also be associated with NP susceptibility. Given these facts, we investigated the possible association of the TNF-alpha -308 G/A single nucleotide polymorphism (SNP) with NP. In this study, 97 consecutive adult patients with NP and 95 age- and gender-matched controls were recruited. For identification of SNP, restriction fragment length polymorphism analysis after polymerase chain reaction was carried out. The NP group had a significantly higher rate of polymorphism compared to controls (p = 0.015). Logistic regression analysis revealed that the presence of the TNF-alpha -308 G/A SNP is an independent risk factor for NP development (OR, 3.68; CI, 1.27-10.7; p = 0.016). The presence of a mutation failed to influence disease severity on the basis of resistance to medical and/or surgical treatment. This study suggests a possible linkage of a SNP in the TNF-alpha promoter with NP. These results need to be confirmed with multicentre studies for more precise interpretation and corroborative studies for investigating the influence of polymorphism on transcriptional activity.