Determining the Thyroid Gland Volume Causing Tracheal Compression: A Semiautomated 3D CT Volumetry Study.

Background and objectives: Increased thyroid gland volume (TV) may bring about tracheal compression, which is one of the causes of respiratory distress. The aim of this study was to investigate the relationship between TV and the severity of tracheal compression independent of patients' symptoms using semiautomated three-dimensional (3D) volumetry (S3DV) reconstructed from computed tomography (CT) scans. Cut-off TVs leading to different levels of tracheal narrowing were evaluated. Materials and Methods: One hundred sixty-three contrast-enhanced head and neck CT examinations were retrospectively assessed. TVs were measured by S3DV. The degree of tracheal compression was measured at the point where the greatest percent reduction in the cross-sectional area of the trachea adjacent to the thyroid gland was observed. To determine the severity of compression, the tracheal compression ratio (TCR) was defined (TCR = A1 (the narrowest cross-sectional area of trachea)/A2 (the largest cross-sectional area of trachea)). Results: The mean tracheal narrowing was 15% (TCR = 0.85 ± 0.15) in the study population. Patients with more than 15% tracheal compression had significantly higher TV values than those with less than 15% tracheal compression (p < 0.001). In addition, a significant correlation was found between TV and tracheal compression (p < 0.001). Moreover, the receiver operating characteristic (ROC) curve analysis revealed that the cut-off levels for TV that predict a tracheal narrowing of 10%, 20%, 30%, and 40% were 19.75 mL, 21.56 mL, 24.54 mL, and 30.29 mL, respectively (p < 0.05). Conclusions: This study objectively demonstrated that larger thyroid glands cause more severe compression on the trachea. The results may be helpful during the decision-making process for thyroidectomies to be performed due to compression symptoms.

Reliability and validity of the Turkish Nose Obstruction Symptom Evaluation (NOSE) scale

Background/aim: The aim of this study was to validate the Turkish Nasal Obstruction Symptom Evaluation (T-NOSE) scale. Materials and methods: The NOSE scale was translated into Turkish. A prospective study was conducted involving adult subjects with nasal obstruction and a control group. The patients were divided into three groups, namely nasal septum deviation (NSD), septoplasty, and control groups. Internal consistency, test-retest reliability, validity, responsiveness, and the magnitude of the effect of surgery were all investigated. Results: In total, 253 subjects were enrolled in the study. Cronbach's alpha was 0.938 and 0.942 upon test and retest, respectively, which proved good internal consistency. The mean kappa value was 0.82, indicating a high level of reproducibility. The difference between postoperative and control groups was not statistically significant (P < 0.05). The T-NOSE score of the NSD group was 65.67 ± 16.77, while it was 10.75 ± 12.25 for the control group (P < 0.01). The mean score improved following septoplasty (P < 0.001). The magnitude of the effect of surgery was considered high. The correlation between the visual analogue scale and NOSE scores was 0.948. Conclusion: The T-NOSE scale is a valid instrument with good internal consistency, reliability, reproducibility, validity, and responsiveness.

Chronic sialadenitis due to the stone inside the accessory duct of submandibular gland.

PURPOSE: Sialolithiasis is the most common cause of chronic sialadenitis. In this case report, intraoperative finding of an accessory submandibular duct, obstructed with stone, originating from the same gland nearby the main Warthon's duct, is presented. CASE REPORT: A 22-year-old male patient, suffering from eating-related pain and swelling in his left submandibular region, was diagnosed with left sublandibular gland sialadenitis with radiologically manifested sialolithiasis, and gland excision was advised. Surgery was performed under general anesthesia. When the full anatomical scenery was delineated before excision of the gland, we surprisingly encountered two submandibular ducts originating from ipsilateral gland, one of them was obstructed with stone. After two ducts were ligated, the gland with sialolith was excised. According to histopathologic examination, the duct obstructed with stone was identified as the accessory duct and the other one was the main Wharton's duct. Postoperative days were uneventful; no neurologic complication was observed. CONCLUSIONS: Otolaryngologists should be aware of anatomic variations of the submandibular duct(s) to avoid possible complications, especially intraoperatively, because rutine preoperative radiologic preparation does not include investigation of possible accessory ducts.

Solitary Supraclavicular Fossa Masses.

OBJECTIVE: The aim of this study is to present the diagnostic spectrum of solitary supraclavicular fossa (SCF) masses in a Turkish context. The demographic data of the patients and the effectivity of the diagnostic tools are also discussed to improve current diagnostic strategies. PATIENTS AND METHODS: The charts of patients who underwent surgical intervention for solitary SCF mass of an unknown etiology between January 2005 and January 2015 were reviewed. Patients presenting evidences of synchronous cancers and patients with a history of previous cancers were excluded. The data encompassing the demographics of the patients, the discriminative specifications, the histopathological diagnosis of the masses, and the diagnostic tools used in the workup period were noted. The descriptive data are presented and statistical analyses were performed using the Mann-Whitney test, Fisher exact test, and Chi-squared tests. RESULTS: In total, 44 male (76%) and 14 (24%) female patients were enrolled in the study. Thirty-five masses (60%) were located in the left SCF and 23 masses (40%) in the right. The masses were categorized as neoplastic (n = 31, 53%), inflammatory (n = 18, 31%), and congenital (n = 9, 16%). The 44 (76%) masses in our series were lymph nodes (LNs), and 25 (57%) of them were malign, whereas 19 (43%) were either inflammatory or benign. Male sex (P = 0.027) and the size of the mass (P = 0.017) were significantly related to malign LNs. The patients' ages and sides of the masses were not significantly different between the malign and benign LN groups. CONCLUSIONS: Lymph nodes constitute the majority of solitary SCF masses. Although imaging techniques and fine needle aspirations are routinely applied, excisional biopsies are necessary in most cases to reach an exact diagnosis and to plan a definitive treatment regime in this presented series.

Life Priorities in Head and Neck Cancer Patients Between Ages of 45 to 65.

Diseases in head and neck cancer patients and applied therapies according to former affect life quality to a higher extent. In this paper, life priorities in 49 patients with head and neck cancer who referred to Gulhane Military Medical Academy for diagnostic and therapeutic purposes and the relationship between these priorities and sociodemographic properties have been studied. Following life priorities have been observed more important for the patients: to communicate with people in social places, to eat without any help by themselves, external appearance, taste and odor sense, continuing sexual life. Other priorities have been observed less important for the patients: attending social activities like cinema and theater, swimming pool and sea sports, money required for check-ups, necessities like time. Besides, these necessities do not show dissimilarities to any significant extent according to sociodemographic properties of the patients.

The Practicability of Transnasal Esophagoscopy and the Evaluation of Patient's Perception: A Prospective Study.

OBJECTIVES: Transnasal esophagoscopy (TNE) is a relatively new diagnostic procedure in the evaluation of patients with globus sensation and dysphagia. Enabling doctors to examine all of the upper aerodigestive system without the need for sedation, this technique is becoming more popular among otolaryngology specialists. The aim of this study is to evaluate the practicability of TNE and tolerability of patients to the test. METHODS: The study group consisted of 314 patients who were admitted to the swallowing center of a tertiary medical institution with the symptoms of dysphagia and globus sensation. In addition to other diagnostic procedures, patients were informed of the TNE and the necessary consents were obtained. Before the examination, patients were asked to foresee the level of discomfort they would presumably feel, according to the information they had. After the TNE, patients were asked to score the real level of discomfort they experienced during the test. A visual analog scale was used to note the levels. The duration of the tests and any complications were also noted. RESULTS: We could not perform TNE in 12 of the 314 patients due to nasal obstruction, intractable retching and vasovagal syncope (7, 4, and 1 patients, respectively). The average discomfort score foreseen before the test was 4.7±1.4 (mean±standard deviation). The post-procedure discomfort score was 1.6±1.1, and the difference was statistically significant (P<0.001). The average time to perform the TNE was 5 minutes (range, 3 to 13 minutes). Except for minor epistaxis in 7 patients (2%), no complications occurred. CONCLUSION: According to our results, TNE is an easy and well-tolerated procedure, it may be logical to tell the patient that the procedure will be less annoying and irritating than they assume. It is also a time saving procedure with low complication rates.

Epiglottic cyst as an etiological factor of globus sensation.

BACKGROUND/AIMS: Globus is a subjective complaint that describes a sensation of a lump or a foreign body in the throat. Despite being a well-known and common clinical condition, the etiological factors have not been definitely elucidated yet. The study was set up to ascertain the relationship between epiglottic cysts and globus sensation. MATERIALS AND METHODS: All patients undergoing investigation and treatments for globus sensation were included in the study. Patients with epiglottic cysts but no other possible causes of globus sensation were constituted the series of patients. Patients were asked to assess the levels of complaint before and after the carbon dioxide (CO2) laser excisions of the cysts. RESULTS: Epiglottic cysts were found in 10 (5.4%) of the 182 patients. Three of these 10 patients who had concomitant diseases or conditions that may cause globus sensation and one patient who refused the surgery were excluded from the study. All the remaining six patients reported relief of the globus sensation after the CO2 laser excisions of the cysts. CONCLUSION: Our results, obtained from this limited series, indicated that epiglottic cysts may be considered as one of the etiological factors of globus sensation.

Parathyroid adenoma upstaging the lung cancer.

Mediastinal staging of NSCLC with noninvasive methods such as PET/CT can be misleading when a mediastinal disease accompany. Histopathologic confirmation should be made before any treatment plan. Herein, we presented a case of parathyroid adenoma upstaging the lung cancer.

Minor salivary gland neoplasms.

OBJECTIVE: This study aimed to investigate the clinical presentation, histopathologic and epidemiological aspects, as well as the treatment modalities and outcomes of patients with minor salivary gland tumors (MSGTs). SUBJECTS AND METHODS: A series of 23 patients with MSGTs were reviewed retrospectively. RESULTS: This study included 11 (48%) benign and 12 (52%) malignant tumors of minor salivary glands. Minor salivary gland tumors were more common in men (70%) than in women (30%). The mean age was 31.3 years for benign tumors and 46.3 years for malignant tumors. Pleomorphic adenoma was the most common benign tumor, followed by myoepithelioma. Mucoepidermoid carcinoma and adenoid cystic carcinoma were the most common malignant tumors. The most common symptom was a painless mass of the palate. Surgical treatment was performed in all patients. Adjuvant radiotherapy was used in 3 malignant tumors. Twenty-three patients were followed-up for a median of 5 years. Two patients with malignant tumors underwent a second surgery for postoperative local recurrence. They were successfully treated with the second surgery. CONCLUSIONS: Minor salivary gland tumors are relatively uncommon neoplasms of the head and neck region. There is limited literature on MSGTs. This study provides a versatile approach for MSGTs from demographic data and clinical presentations to treatment modalities and treatment outcomes.

Submandibular triangle masses.

OBJECTIVE: The study aims to analyze the demographic data of a large case series operated on because of submandibular triangle mass for more than 10 years and presents a review of the literature. MATERIALS AND METHODS: The charts of patients who underwent surgical intervention for submandibular triangle mass between January 2000 and November 2010 were reviewed. The medical history, age, sex, duration of symptoms, clinical presentation, preoperative investigations, and histopathologic diagnosis were reviewed. RESULTS: The study included 66 subjects; 12 patients (18.2%) with submandibular sialolithiasis, 18 patients (27.2%) with sialadenitis, 10 patients with lymphadenitis (15.1%), and 26 patients (39.3%) with tumors. Of the tumors, 23% was malignant and 77% was benign. Benign tumors of submandibular gland comprised 22.7% and malign tumors of submandibular gland comprised 3% of all submandibular mass. The most common benign tumor was pleomorphic adenoma. The most frequent histopathologic diagnoses of submandibular masses originated from the submandibular gland, and these comprised 71.2% of all submandibular mass pathologies. The main symptom was a painless mass. Ultrasonography was the most common preoperative diagnostic procedure. Fine-needle aspiration biopsy was performed in 26 patients. A clear diagnosis could not be provided in 3 (12%) patients. CONCLUSION: Infectious conditions and benign tumors are more frequent than malign tumors in the submandibular region. The histopathologic diagnoses mainly consisted of submandibular sialadenitis, sialolithiasis, pleomorphic adenoma, and lymphadenitis. Ultrasonography is the first option of radiologic evaluation. Fine-needle aspiration biopsy is a very useful and usually sufficient diagnostic procedure for histopathologic diagnosis. Excisional biopsy can be performed when the fine-needle aspiration biopsy failed.

A comparative study on efficiency of middle ear pressure equalization techniques in healthy volunteers.

OBJECTIVE: To compare success rates of middle ear inflation device (Ear Popper (©)), Valsalva maneuver and Toynbee maneuver in middle ear pressure equalization in healthy adults. MATERIALS AND METHODS: Adult volunteers with otoscopically healthy ears were enrolled to the study. In a prospective setting, 60 ears of 35 volunteers were divided into two groups according to eustachian tube (ET) functions tested using the nine step inflation deflation test. Group A: good eustachian tube function at nine step inflation deflation test (30 ears), Group B: possible dysfunction of the ET at nine step inflation deflation test (30 ears). All the volunteers performed Valsalva maneuver, Toynbee maneuver and Ear Popper(©) application, respectively. The efficiencies of all the three techniques were statistically compared first overall, then paired-wise between the two groups. RESULTS: There was no statistical difference in success rates of middle ear pressure equalization techniques in 60 ears, regardless of ET function results (Valsalva and Toynbee maneuvers 51.7% effective, Ear Popper(©) 43.3% effective). There was also no statistical difference among the middle ear pressure shifts obtained by these three techniques. In almost half of the subjects in whom at least one technique was unsuccessful, the other two was effective. When the groups were separately compared; there was no significant difference between Valsalva and Toynbee maneuvers, whereas Ear Popper(©) was found more effective in Group A (56.7% vs. 30%, p=0.037). CONCLUSION: No statistical difference in equalization of the middle ear pressure was found among Valsalva maneuvers, Toynbee maneuvers and Ear Popper(©) in healthy adults under physiological conditions. Using alternative techniques may improve the success individually when a technique fails.

Choanal polyp originating from the nasal septum: septochoanal polyp.

Most of the nasal polyps arise from the lateral walls of the nasal cavity. Nasal polyps originating from the nasal septum with choanal extension are extremely rare. We report a case of large choanal polyp that arised from the posterosuperior aspect of the nasal septum, and extended down to the oropharynx. A 52-year-old woman presented with a two-year history of progressive nasal obstruction and snoring. Findings of anterior rhinoscopy were in normal limits. We think that the term "septochoanal polyp" which, as far as we know, has not been mentioned in the literature before, can be used for this rare lesion.

Repair of transected facial nerve with mesenchymal stromal cells: histopathologic evidence of superior outcome.

OBJECTIVES/HYPOTHESIS: Despite advanced surgical techniques, clinical results of the transected facial nerve are still far from the desired outcome. Mesenchymal stromal cells (MSCs) were shown to transdifferentiate into Schwann cells and express some growth factors beneficial in peripheral nerve injury. We aimed to document histopathological improvement obtained from application of the homograft bone marrow-derived MSCs immediately after conventional anastomosis of a transected facial nerve branch in rats, and to compare the results with those nerves anastomosed only. STUDY DESIGN: Animal, prospective, and controlled study. METHODS: The study was performed in 15 rats. The right buccal branch was completely transected and repaired with epineural sutures. The right-side anastomosis was additionally treated with MSCs thereafter. The right marginal mandibular branch was kept intact, but in contact with MSCs. The left buccal branch was transected and repaired in a similar fashion except for MSC application. The left-side marginal mandibular branch was left intact. Rats were sacrificed at month 1, 3, and 6. Four branches of each rat were sampled, and nerve segments distal to the anastomosis were histopathologically examined. RESULTS: The examination revealed that intact nerve segments and nerve segments in contact with MSCs had completely normal appearance regardless of the time interval. Samples from the nerves anastomosed and treated with MSCs did better than those nerves anastomosed only in terms of axonal organization and myelin thickness. CONCLUSIONS: This preliminary report witnessed beneficial effects of MSCs application onto the injured facial nerve as evidenced by the histopathological examination.

Middle ear barotrauma with hyperbaric oxygen therapy: incidence and the predictive value of the nine-step inflation/deflation test and otoscopy.

We conducted a prospective study to determine the incidence of middle ear barotrauma in patients who were undergoing hyperbaric oxygen therapy (HBOT). We also investigated the value of the nine-step inflation/deflation test and otoscopic findings before and immediately after the initial HBOT session in predicting barotrauma in an attempt to establish some criteria for prophylaxis. The study was conducted on 36 ears of 18 adults who had no history of eustachian tube dysfunction. Patients were being treated with HBOT for sudden hearing loss, wound-healing complications, or complications of diabetes. After 7 days of HBOT, barotrauma was seen in 12 of the 18 patients (66.7%) and in 18 of the 36 ears (50.0%). The nine-step inflation/deflation tests, which were performed before and immediately after the initial HBOT session, were not predictive of barotrauma (p = 0.095 before and p = 0.099 after). However, otoscopic findings obtained immediately after the first session of HBOT were predictive of barotrauma, with a sensitivity and specificity of 83 and 100%, respectively. We conclude that patients with even minor positive pathologic findings on otoscopy immediately following HBOT are at increased risk of middle ear barotrauma if HBOT is to be continued without prophylaxis.

Primary parotid tuberculosis mimicking parotid neoplasm: a case report.

INTRODUCTION: Tuberculosis of the parotid gland is a rare clinical entity which causes some difficulties in diagnosis because of the similarities in presentation to that of a neoplasm. Diagnosis mainly relies in the treating physician having a high index of suspicion. The diagnosis is generally overlooked by otolaryngologists and most cases are undergoing unnecessary surgery. CASE PRESENTATION: A 20-year-old male presented with a mass in the right parotid region. The mass had been present for one year. Physical examination revealed a mobile, non-tender mass occupying the superficial lobe of the right parotid gland. Radiologic investigations revealed a well-defined, solid, mass lesion located in the posterior part of the superficial lobe of the right parotid gland. A provisional diagnosis of a neoplasm of the parotid gland was made and a right superficial parotidectomy was performed. Histopathologic examination of the specimen was reported as tuberculosis of the parotid gland. The patient was commenced on antitubercular chemotherapy. CONCLUSION: Although rare, tuberculosis should be kept in mind and considered in the differential diagnosis of patients presenting with a solitary tumor in the parotid gland in order to avoid unnecessary surgery.

Chyle Fistula after Neck Dissection for an Unusual Breast Cancer Recurrence.

BACKGROUND: Chyle fistula is one of the rare complications of neck dissections. Even though no consented algorithm for the management of this entity has been established yet, conservative treatment options including somatostatin analogues have been suggested as an adequate modality for low output fistulas. CASE REPORT: Here we present a patient with a right-sided neck fistula which was resistant to conventional treatment, and was finally treated by surgery. The neck dissection was performed for a malignant right neck mass that was accepted as the lymph node metastasis of formerly treated papillary thyroid carcinoma. The pathology of the specimen revealed a contralateral neck metastasis of previously treated breast carcinoma. CONCLUSION: We assume that consecutive surgeries on axillary and neck lymph pathways resulted in such a complicated and exceptional case.

Analytic view to concordance between electrocochleography and caloric test in Meniere's disease.

We aimed to investigate if there is a concordance between summation potential (SP)/action potential (AP) ratio and unilateral weakness in patients with definite-Meniere's disease. There were two groups, a group of unilateral definite-Meniere patients who received no treatment and another group of control subjects. Twenty-six patients were identified as complying with the defined criteria. Fifteen healthy subjects with no hearing and balance disorders were assigned to the control group. Arithmetic mean of the four-tone average of thresholds at 0.5, 1, 2, and 3 or 4 kHz, SP/AP ratio and degree of unilateral weakness were calculated. The number of patients was tabulated based on the presence of abnormal SP/AP ratio and unilateral weakness. Co-occurrence of unilateral weakness and elevated-SP/AP ratio was investigated with reference to the stage of the disease. A correlation was sought among pure-tone average, SP/AP ratio and degree of unilateral weakness in a pair-wise manner. Unilateral weakness and abnormal SP/AP ratio were identified in 53.8% and 38.4% of the patients, respectively. Co-occurrence of unilateral weakness and abnormal SP/AP ratio was observed in 34.6% of the patients. However, it was noticed that this co-occurrence gradually increased when the disease progressed. Mean SP/AP ratio also gradually increased as the stage progressed. Of pair-wise correlations among pure-tone average, SP/AP ratio and degree of unilateral weakness, a weak correlation (r = 0.383) was found only between SP/AP ratio and degree of unilateral weakness with marginal significance (P = 0.053). We concluded that co-occurrence of unilateral weakness and elevated SP/AP ratio increases when the disease progresses. This co-occurrence is less encountered in earlier stages. This difference might be resulted from a difference in distension capability of the endolymphatic space of the cochlea and the vestibule. Albeit weak, there was a correlation between mean SP/AP ratio and degree of unilateral weakness, which suggests that the disease parallelly disturbs the lateral semicircular or cochlear functions especially in advanced stages.

The effect of radiofrequency volumetric tissue reduction of soft palate on voice.

The surgical techniques used for snoring and OSA treatment include partial/complete resection or tissue reduction of the oropharyngeal structures such as uvula, tonsilla palatinas, soft palate, lateral pharyngeal tissues and tongue base. So it is predictable for these techniques to affect the resonating volume of the vocal tract and therefore the speech sounds. The goal of this study was to evaluate whether radiofrequency volumetric tissue reduction (RFVTR) of the soft palate can cause voice changes by altering the formant frequencies and fundamental frequency of vowels. A prospective study of 26 habitual snorers and mild obstructive sleep apnea patients (apnea-hypopnea index, <10 in all cases) were investigated before and 6 weeks after RFVTR. The patients received one Somnoplasty RFVTR treatment of 1,400 J per treatment session: 700 J into the midline and 350 J on each side of the soft palate with a maximum temperature of 80 degrees C. Acoustic evaluation was made by the Multidimensional Voice Program. The mean fundamental frequency (MF0) and the first three formant frequencies (F1, F2, F3) of four sustained vowels /a/, /e/, /i/ and /o/ were determined. Comparison between preoperative and postoperative acoustic analysis of the MF0 and F1, F2, F3 of sustained vowels revealed no significant change. The findings of the study indicate that RFVTR of the soft palate as a treatment for snoring and mild forms of OSA does not have a significant impact on the mean fundamental frequency and formant frequencies of vowels. These results seem to be important in management of patients with concerns about postoperative vocal quality, such as singers and professional speakers.

Clinical relevance of ceramide metabolism in the pathogenesis of human head and neck squamous cell carcinoma (HNSCC): attenuation of C(18)-ceramide in HNSCC tumors correlates with lymphovascular invasion and nodal metastasis.

It has been documented previously that defects in the generation of C(18)-ceramide, a product of ceramide synthase 1 (CerS1), also known as longevity assurance gene 1 (hLASS1), play important roles in the pathogenesis and/or progression of HNSCC. However, whether altered levels of ceramide generation in HNSCC tumors have any clinical relevance remains unknown. In this study, the levels of endogenous ceramides were measured in tumor tissues of 45 HNSCC patients as compared to their normal tissues using high-pressure liquid chromatography/mass spectrometry (LC/MS), and then possible link between ceramide levels and the clinical parameters of HNSCC were examined. The data showed that the levels of C(16)-, C(24)-, C(24:1)-ceramides were significantly elevated in the majority of tumor tissues compared to their normal tissues, while the levels of only C(18)-ceramide were significantly decreased in HNSCC tumors, especially in tumor tissues of male patients. Importantly, it was also shown here that decreased C(18)-ceramide levels in HNSCC tumor tissues were significantly associated with the higher incidences of lymphovascular invasion, and pathologic nodal metastasis. Importantly, attenuation of C(18)-ceramide was also positively linked to the higher overall stages of the primary HNSCC tumors. Therefore, these data suggest, for the first time, that the defects in the generation/accumulation of C(18)-ceramide might have important clinical roles in HNSCC, especially in lymphovascular invasion and nodal disease.