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.

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.

Pterostilbene protects cochlea from ototoxicity in streptozotocin-induced diabetic rats by inhibiting apoptosis.

Diabetes mellitus (DM) causes ototoxicity by inducing oxidative stress, microangiopathy, and apoptosis in the cochlear sensory hair cells. The natural anti-oxidant pterostilbene (PTS) (trans-3,5-dimethoxy-4-hydroxystylbene) has been reported to relieve oxidative stress and apoptosis in DM, but its role in diabetic-induced ototoxicity is unclear. This study aimed to investigate the effects of dose-dependent PTS on the cochlear cells of streptozotocin (STZ)-induced diabetic rats. The study included 30 albino male Wistar rats that were randomized into five groups: non-diabetic control (Control), diabetic control (DM), and diabetic rats treated with intraperitoneal PTS at 10, 20, or 40 mg/kg/day during the four-week experimental period (DM + PTS10, DM + PTS20, and DM + PTS40). Distortion product otoacoustic emission (DPOAE) tests were performed at the beginning and end of the study. At the end of the experimental period, apoptosis in the rat cochlea was investigated using caspase-8, cytochrome-c, and terminal deoxyribonucleotidyl transferase-mediated dUTP-biotin end labeling (TUNEL). Quantitative real-time polymerase chain reaction was used to assess the mRNA expression levels of the following genes: CASP-3, BCL-associated X protein (BAX), and BCL-2. Body weight, blood glucose, serum insulin, and malondialdehyde (MDA) levels in the rat groups were evaluated. The mean DPOAE amplitude in the DM group was significantly lower than the means of the other groups (0.9-8 kHz; P < 0.001 for all). A dose-dependent increase of the mean DPOAE amplitudes was observed with PTS treatment (P < 0.05 for all). The Caspase-8 and Cytochrome-c protein expressions and the number of TUNEL-positive cells in the hair cells of the Corti organs of the DM rat group were significantly higher than those of the PTS treatment and control groups (DM > DM + PTS10 > DM + PTS20 > DM + PTS40 > Control; P < 0.05 for all). PTS treatment also reduced cell apoptosis in a dose-dependent manner by increasing the mRNA expression of the anti-apoptosis BCL2 gene and by decreasing the mRNA expressions of both the pro-apoptosis BAX gene and its effector CASP-3 and the ratio of BAX/BCL-2 in a dose-dependent manner (P < 0.05 compared to DM for all). PTS treatment significantly improved the metabolic parameters of the diabetic rats, such as body weight, blood glucose, serum insulin, and MDA levels, consistent with our other findings (P < 0.05 compared to DM for all). PTS decreased the cochlear damage caused by diabetes, as confirmed by DPOAE, biochemical, histopathological, immunohistochemical, and molecular findings. This study reports the first in vivo findings to suggest that PTS may be a protective therapeutic agent against diabetes-induced ototoxicity.

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 resveratrol on the histologic characteristics of the cochlea in diabetic rats.

OBJECTIVES/HYPOTHESIS: The aim of this study was to investigate changes in the cochlea and the potential dose-dependent effects of resveratrol (RSV) against diabetes mellitus (DM) ototoxicity. STUDY DESIGN: Animal model. METHODS: Twenty-four male Wistar albino rats were divided into four groups. Baseline distortion product otoacoustic emission (DPOAE) measurements were evaluated. Group I was the control group, group II was made diabetic with single-dose streptozotocin, and groups III and IV were rendered diabetic as group II and administered 10 and 20 mg RSV, respectively, intraperitoneally for 4 weeks. All animals were sacrificed after repeated DPOAE measurement. Apoptosis was investigated using caspase-3, Bax (Bcl-associated X protein), and TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling) staining. RESULTS: The DPOAE values in the diabetic group were found to be significantly lower compared with the other groups at 5,714 Hz and 8,000 Hz (P < .05). No significant difference in otoacoustic emission was detected in the comparison of the RSV doses (P > .05). The histopathologic investigation using caspase-3, Bax, and TUNEL staining showed that the mean rank of the diabetic group was significantly higher compared with the RSV10, RSV20, and control groups (DM > RSV10 > RSV20 > control) (P < .05). CONCLUSIONS: These results imply that RSV administration offered statistically significant protection for the cochleas of rats against diabetes. This protective effect improved histologically with higher doses. LEVEL OF EVIDENCE: NA Laryngoscope, 129:E1-E6, 2019.

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.

Comparison of anterior palatoplasty and uvulopalatal flap placement for treating mild and moderate obstructive sleep apnea.

We prospectively compared the efficacy of anterior palatoplasty and the uvulopalatal flap procedure for the treatment of patients with mild and moderate obstructive sleep apnea syndrome (OSAS). Our study group was made up of 45 patients who had been randomly assigned to undergo one of the two procedures. Palatoplasty was performed on 22 patients-12 men and 10 women, aged 28 to 49 years (mean: 39.2)-and the flap procedure was performed on 23 patients-14 men and 9 women, aged 28 to 56 years (mean: 41.3). Our primary outcomes measure was the difference in pre- and postoperative apnea-hypopnea index (AHI) as determined by polysomnography at 6 months after surgery. Surgical success was observed in 18 of the 22 palatoplasty patients (81.8%) and in 19 of the 23 flap patients (82.6%). Compared with the preoperative values, mean AHIs declined from 17.5 to 8.1 in the former group and from 18.5 to 8.6 in the latter; the improvement in both groups was statistically significant (p < 0.001). In addition, significant postoperative improvements in both groups were seen in mean visual analog scale (VAS) scores for snoring, in Pittsburgh Sleep Quality Index values, and in Epworth Sleepiness Scale scores (p < 0.001 for all). VAS scores for pain at rest were significantly lower in the palatoplasty group than in the flap group at 2, 4, and 8 hours postoperatively and on postoperative days 4 through 7 (p < 0.002). Likewise, VAS scores for pain during swallowing were significantly lower in the palatoplasty group at 2, 4, 8, and 16 hours and on days 4 through 7 (p < 0.009). We conclude that both anterior palatoplasty and uvulopalatal flap procedures are effective for the treatment of mild and moderate OSAS in patients with retropalatal obstruction. However, our comparison of postoperative pain scores revealed that anterior palatoplasty was associated with significantly less morbidity.

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.

Giant Hypopharyngeal Fibrovascular Polyp: A Case Report and Review of the Relevant Literature.

Fibrovascular polyps occur most commonly in the cervical esophagus and are extremely rare in the hypopharynx. In this paper, we report a case of fibrovascular polyp of a 52-year-old female, who presented with progressive dysphagia and weight loss and regurgitating a mass from her mouth. By the endoscopic examination, a polyp covered by normal mucosa with a wide stalk was detected at the hypopharynx. The pedicle of the mass was identified under general anesthesia and the 13 × 3 × 2 cm mass was completely resected perorally. Histopathological examination of the tumor showed oedematous subepithelial fibrous stroma, surrounded by squamous epithelium and containing many congested vascular structures. No recurrence was detected over one year of follow-up. This case highlights the need for clinicians to be aware of this rare entity and to develop the best approach to patient management.