Anatomical Analysis of the Eustachian Tube in the Temporal Bone Through the Middle Fossa Window.

PURPOSE: This cadaveric anatomical study aimed to explore precise morphometric measurements of the eustachian tube (ET) and adjacent structures in the middle cranial fossa, focusing on identifying reliable surgical landmarks when traditional markers are compromised due to tumors or trauma. METHODS: Twenty-two temporal bones from 11 adult cadavers (mean age: 75.70 ± 13.75 yr, range: 40-90 yr; sex: 5 females and 6 males) were dissected bilaterally. Surgical tools, including an operation microscope, endoscope, and digital caliper, were used for meticulous measurements. Parameters such as ET dimensions, distances between key points, and relevant angles were quantified, ensuring precise anatomical data. RESULTS: ET width at the foramen spinosum (FS) level, the midline level, and the eustachian orifice level were measured as 2.18 ± 0.68, 2.42 ± 0.70, and 2.30 ± 0.74 mm, respectively. The distances from the zygomatic root (ZR) to FS, ET, superior semicircular canal (SSC), and internal carotid artery (ICA) were 29.61 ± 2.56, 23.28 ± 2.61, 26.53 ± 2.56, and 32.61 ± 3.69 mm, respectively. The angles between SSC-ZR-ICA and FS-ZR-ICA were measured as 36.57 ± 10.32 and 13.63 ± 3.72 degrees, respectively. No statistical difference was found between right-left or male-female measurements ( p > 0.05). CONCLUSION: The present study offers invaluable insights for neurotological surgeons performing middle fossa approaches. ET and ZR may serve as crucial reference points, enhancing surgical orientation and minimizing risks during complex procedures. These precise anatomical data may empower surgeons, ensuring safer and more confident middle cranial fossa operations, even in challenging clinical scenarios.

Mortal condition in an unusual localization, analysis of isolated tongue and tongue base abscesses.

BACKGROUND: Tongue abscess (TA) is a very rare clinical condition and its treatment is very important. Surgical drainage is at the forefront in the treatment. Our study includes patients with tongue and tongue base abscesses. AIM: To discuss the clinical and laboratory findings of these patients emphasizing the underlying causes and treatment options with the largest patient series in the English literature. METHODS: We included patients with isolated TA who applied to our clinic between January 1, 2020 and January 1, 2023. Those who lack the recorded data, those who are not between the ages of 18-66, those who have not undergone surgery-interventional procedure, and those who have infection and/or abscess in another place were excluded from the study. RESULTS: There were two female (18%) and nine male (82%) patients in our series consisting of 11 patients. Their ages ranged from 18 to 66, and the mean ± SD was 48.63 ± 16.3. Considering the localization of the abscess, three anterior abscesses (27%), two lateral abscesses (18%), and six abscesses at the base of the tongue (54%) were detected. CONCLUSION: Tongue abscesses can cause acute upper airway obstruction and respiratory collapse. It may be necessary to act quickly for the tracheotomy procedure and this procedure can usually be performed under local anesthesia as intubation cannot be achieved. When we encounter an abscess in an unexpected organ, difficulties may be encountered in the management of the patient.

Pterygopalatine-Infratemporal Fossa Hydatid Cyst Resembling Cystic Tumor.

Hydatid cyst is an endemic disease in Mediterranean and Middle Eastern countries, Eastern European countries, East Africa, China, New Zealand, Australia. We aimed to present this educational case, which is endemic in our country and seen in a very rare localization, with the combined surgical approach, within the literature.

Rare Cause of Severe Dyspnea After Tracheotomy-Negative Pressure Pulmonary Edema.

Deep neck infections are serious conditions and can present with acute upper airway obstruction. Our priority in the treatment is to ensure airway safety, and tracheotomy may be needed to overcome the upper airway obstruction. Unceasing dyspnea after tracheotomy should suggest serious pulmonary pathologies in patients with upper airway obstruction due to deep neck infection. Acute/chronic obstruction resolved after tracheotomy or upper respiratory tract surgical procedures of obstructive sleep apnea patients can turn into severe dyspnea with pulmonary edema. In this report, we present a 46-year-old male patient with negative pressure pulmonary edema as a complication of tracheotomy. The tracheotomy was performed due to severe upper airway obstruction secondary to a deep neck infection. The importance of early diagnosis and prompt treatment of this rare entity after unceasing dyspnea despite tracheotomy is discussed in the light of the current literature.

Do Lymph Node Ratio and Histopathologic Parameters Have Any Prognostic Value in Primary Parotid Gland Carcinomas?

Objective: To analyze the demographic characteristics and the pathological results of neck dissection in primary parotid gland (PG) cancer patients, and to investigate the effects of histopathological parameters (perineural invasion, lymphovascular invasion, and extracapsular spread), neck metastasis, stage and lymph node ratio (LNR) on survival. Methods: Patients who underwent parotidectomy for malignant PG tumors between 2000 and 2019 years were retrospectively reviewed from the medical records. Thirty patients who were treated with parotidectomy and neck dissection were included in the study. Lymph node ratio was calculated as the ratio of the number of metastatic lymph nodes (LN) to the total number of excised LNs. Tumor stage, regional LN metastasis, LNR, perineural invasion, lymphovascular invasion, and extracapsular spread were reviewed for the effects on survival with the Kaplan-Meier analysis. Results: The study included 17 (57%) male and 13 (43%) female patients. Their mean age was 67.93±16.90 years (range, 50-85 years). The average number of the excised LN was 26.03±11.79 (range, 3-50). Mean LNR was 0.16±0.26. The Kaplan-Meier analysis showed that neck metastasis (p=0.001) and LNR (p<0.001) were associated with shorter survival times compared to perineural invasion (p=0.818), lymphovascular invasion (p=0.154), extracapsular spread (p=0.410) and stage (p=0.294). In multivariate COX regression analysis, only LNR had a statistically significant difference (p=0.027) compared to the other parameters. Conclusion: The present study suggests that LNR and neck metastasis are associated with shorter survival times in PG cancers. Lymph node ratio can be used as a prognostic marker in these patients.

The Relationship Between American College of Radiology Thyroid Imaging Reporting and Data System (ACR TIRADS) and Fine Needle Aspiration Cytology (FNAC) ; in Geriatric Thyroid Pathologies.

Introduction: The world population is getting older with each passing year.Thyroid cancer is the most common endocrinological cancer and its incidence is increasing in all populations. Although the increase in prevalence has been attributed more to the increased use of imaging methods and to the higher sensitivity of ultrasonography (USG) by some authorities, there are also studies suggesting a real increase.In our study, it was aimed to examine the USG and fine needle aspiration cytology (FNAC) results of thyroid nodules in the geriatric age group and to discuss them in the light of the literature. Methods: Files of 129 geriatric patients with thyroid nodules detected in the University Of Health Sciences Adana City Training and Research Hospital between 2018 and 2020 were retrospectively analyzed.The USG characteristics of the patients were categorized by scoring according to the ACR TIRADS system. FNAC diagnoses were grouped according to the Bethesda classification. Results: According to the ACR TIRADS grading, 4 patients (3.1%) were benign, 58 patients (45%) were not suspicious, 38 patients (29.5%) were mildly suspicious, 25 patients (19.4%) were moderately suspicious, and 4 patients (3.1%) were highly suspicious.In our study, although USG provided very valuable information in the approach to thyroid nodules, no relationship was found between TIRADS in the geriatric age group and FNAC results in our study (p = 0.117). Conclusion: We think that the approach to thyroid nodules in geriatric patients requires closer follow-up not only with USG data but also with clinical and history-based findings. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03215-w.

Diagnostic and therapeutic approaches in deep neck infections: an analysis of 74 consecutive patients / Abordagens diagnósticas e terapêuticas em infecções cervicais profundas: uma análise de 74 pacientes consecutivos

Abstract Introductıon: Deep neck infections are a group of diseases with serious complications and mortality, which can occur as a result of common diseases in the community and which have surgical and medical treatment options. Objectives: Patients ages, genders, complaints, physical examination findings, hospitalization complaints, history of antibiotic use before the application, additional diseases, radiological tests and analysis of examinations, type of treatment method, antibiotic agents selected in treatment, bacterial culture results, duration of hospitalization, complications, mortality rates were systematically recorded. In the study, anaerobic bacterial factors, which are difficult to produce in routine, were produced by considering special transport conditions and culture media. Methods: A total of 74 patients who were hospitalized in the Department of Otorhinolaryngology, University of Mersin, between 01.07.2016 and 01.07.2017 for deep neck infection were evaluated prospectively. The study included 37 female and 37 male patients. The ages of the patients ranged from 1 to 69 and the mean age was 31 years. Results: According to the analysis of the obtained data, there was a statistically significant relationship between the patients with additional diseases and the treatment modalities of the patients (p = 0.017). The surgical treatment rate was increased in this group of patients. In patients with a history of antibiotic use, it was found that patients in the pediatric group were in hospital longer in terms of length of stay compared to adults (p = 0.036). In adult patients who underwent surgery, the absorptive long axis was found to be longer in mm than in patients receiving isolated medical treatment (p = 0.008). Conclusions: Deep neck infections is a disease group that seriously concerns public health, with significant mortality and morbidity. Ensuring airway safety of patients should be the first intervention. Abscesses located lateral to the tonsil capsule may not drain adequately without concomitant tonsillectomy.

Resumo Introdução: As infecções cervicais profundas constituem um grupo de doenças com graves complicações e mortalidade, que podem ocorrer como resultado de doenças comuns na comunidade e que têm opções de tratamento médico e cirúrgico. Objetivo: Detectar bactérias anaeróbias e comparar a eficácia do tratamento médico-cirúrgico em diferentes faixas etárias. Método: Foram sistematicamente registrados idade dos pacientes, sexo, queixas, achados do exame físico, queixas na hospitalização, histórico de uso de antibióticos, doenças adicionais, exames radiológicos e análise dos exames, tipo de tratamento, agentes antibióticos selecionados no tratamento, resultados de cultura bacteriana, duração da hospitalização, complicações e taxas de mortalidade. No estudo, culturas bacterianas anaeróbias, difíceis de obter rotineiramente, mesmo considerando-se condições especiais de transporte e meios, foram obtidas. Foram avaliados prospectivamente 74 pacientes internados no Departamento de Otorrinolaringologia da Universidade de Mersin, entre 01.07.2016 e 07.07.2017, devido a infecção cervical profunda. O estudo incluiu 37 pacientes do sexo feminino e 37 do masculino. A idade dos pacientes variou de 1 a 69 anos e a média foi de 31. Resultados: De acordo com a análise dos dados obtidos, houve uma relação estatisticamente significante entre os pacientes com doenças adicionais e as modalidades de tratamento dos pacientes (p = 0,017). A taxa de tratamento cirúrgico foi maior nesse grupo de pacientes. Em pacientes com histórico de uso de antibióticos, verificou-se que aqueles do grupo pediátrico permaneceram mais tempo hospitalizados em comparação aos adultos (p = 0,036). Nos pacientes adultos submetidos à cirurgia, verificou-se que o eixo longo absortivo era mais longo em mm do que nos pacientes que receberam tratamento médico isolado (p = 0,008). Conclusão: As infecções cervicais profundas constituem um grupo de doenças que são preocupantes na saúde pública, com sua mortalidade e morbidade. Garantir a segurança das vias aéreas dos pacientes deve ser a primeira intervenção. Os abscessos localizados lateralmente à cápsula tonsilar podem não apresentar drenagem sem a tonsilectomia.

Diagnostic and therapeutic approaches in deep neck infections: an analysis of 74 consecutive patients.

INTRODUCTiON: Deep neck infections are a group of diseases with serious complications and mortality, which can occur as a result of common diseases in the community and which have surgical and medical treatment options. OBJECTIVES: Patients ages, genders, complaints, physical examination findings, hospitalization complaints, history of antibiotic use before the application, additional diseases, radiological tests and analysis of examinations, type of treatment method, antibiotic agents selected in treatment, bacterial culture results, duration of hospitalization, complications, mortality rates were systematically recorded. In the study, anaerobic bacterial factors, which are difficult to produce in routine, were produced by considering special transport conditions and culture media. METHODS: A total of 74 patients who were hospitalized in the Department of Otorhinolaryngology, University of Mersin, between 01.07.2016 and 01.07.2017 for deep neck infection were evaluated prospectively. The study included 37 female and 37 male patients. The ages of the patients ranged from 1 to 69 and the mean age was 31 years. RESULTS: According to the analysis of the obtained data, there was a statistically significant relationship between the patients with additional diseases and the treatment modalities of the patients (p = 0.017). The surgical treatment rate was increased in this group of patients. In patients with a history of antibiotic use, it was found that patients in the pediatric group were in hospital longer in terms of length of stay compared to adults (p = 0.036). In adult patients who underwent surgery, the absorptive long axis was found to be longer in mm than in patients receiving isolated medical treatment (p = 0.008). CONCLUSIONS: Deep neck infections is a disease group that seriously concerns public health, with significant mortality and morbidity. Ensuring airway safety of patients should be the first intervention. Abscesses located lateral to the tonsil capsule may not drain adequately without concomitant tonsillectomy.

Loss of Smell in COVID-19 Patients: New Biomarkers.

Patients with emerging anosmia may be asymptomatic carriers of coronavirus disease 2019 infection requiring self-isolation; otherwise, there are risks of facilitating the spread of the disease.This study aims to evaluate the loss of smell with visual analogue scale and to determine the relationship between the loss of smell and blood parameters.All patients' coronavirus disease 2019 swab cultures were polymerase chain reaction positive and pneumonia was found in computed tomographies consistent with oronavirus disease 2019. The study was conducted on 114 patients hospitalized between 01.11.2020 and 31.12.2020 in the Otorhinolaryngology coronavirus disease 2019 Service of University of Health Sciences Adana City Training and Research Hospital and followed up by us.A score of 10 indicates that the olfactory function is completely normal in all patients undergoing visual analogue scale, and a score of 0 indicates that they cannot smell anything. Patients who received visual analogue scale scored 10 points were categorized as Group 1 and others as Group 2. Statistical significance level was determined as p < 0.05. A statistically significant difference was found between Group 1 and Group 2 in terms of visual analogue scale smell score, neutrophil, lymphocyte, neutrophil-lymphocyte ratio. Visual analogue scale smell score, neutrophil count, neutrophil-lymphocyte ratio value were found to be lower in Group 2 and lymphocyte count was found to be higher. Neutrophil, lymphocyte, neutrophil/lymphocyte ratio, platelet, platelet/lymphocyte ratio, which are also used in nasal diseases, may be used to detect loss of smell, predict, and even determine the prognosis of loss of smell if supported by further studies.

Effects of Infertility on Voice in male patients.

Purpose: In this study, we aimed to determine the differences in normospermic, oligospermic and azoospermic infertile men by performing voice analysis and to discuss this in the light of the literature. Methods: 71 male patients who applied to the urology clinic due to infertility and were then referred to us were included in the study. Hormone analysis and spermiogram were requested from the patients for routine infertility tests. Testosterone, Follicle stimulating hormone (FSH), Luteinizing hormone (LH), Prolactin levels of the patients were recorded. Age and spermiogram results were recorded. According to the spermiogram results, the patients were categorized as Group 1 (azoospermic), Group 2 (oligospermic), Group 3 (normospermic). Voice Handicap Index-10 Turkish version (VHI-10) was applied to the patients and the results were recorded. Results: The age of the infertile patients ranged from 20 to 37. The mean age was 28.23. The distribution of the patients was 21 patients in Group 1, 40 patients in Group 2, and 10 patients in Group 3. The mean Testosterone level of the patients was 2.78; mean FSH level 12.14; mean LH level 7.26; mean Prolactin level was 8.1. The mean VHI-10 scores of the patients were 10.52. The fundamental frequency F0 Hz (mean pitch) values of the patients were 176,468; jitter % (frequency perturbation jitter) values average 0.25; shimmer % (amplitude perturbation shimmer) values average 2,322; HNR dB values averaged 24,862. Conclusions: Testosterone is more effective on the voice, especially in male individuals.It would be more logical to think that many hormones, growth factors and local factors are effective instead of a single hormone.

Morphometric properties of the fallopian canal: comparison of two nations with different ethnic origins.

PURPOSE: To determine the widths of fallopian canal segments (labyrinthine segment, geniculate ganglion, tympanic segment mastoid segment and stylomastoid foramen), in two nations with different ethnic origins, and to analyze the differences in between. METHODS: We retrospectively analyzed temporal computerized tomographies of 102 individuals including 38 Turks and 64 Syrians. The widths of right and left labyrinthine (LS), tympanic (TS), mastoid (MS), geniculate ganglion (GG) and stylomastoid foramen (SF) segments of the fallopian canal were measured. RESULTS: The narrowest segment was LS (right: 1.04 ± 0.23 mm, left: 1.03 ± 0.22 mm) and the widest segment was SF (right: 1.82 ± 0.41 mm, left: 1.85 ± 0.35 mm). From the widest to the narrowest, the widths of the FC segments were sorted as SF > GG > MS > TS > LS. The widths of the fallopian canal segments were similar between right and left sides, and between males and females (p > 0.05). Our results indicated that both right and left GG were significantly wider in Turks (p < 0.001 for both), however right LS (p < 0.001) and left TS (p = 0.005) were significantly wider in Syrian refugees. Two groups did not show any differences for the widths of other FC segments (p > 0.05). CONCLUSIONS: Nations of different ethnic origins may have differences concerning the widths of some segments of the fallopian canal. Further studies with a larger sample size including clinical data of the patients are needed to clarify our findings, and to determine whether these differences have any clinical implications.

Surgical Outcomes of Transmastoid Facial Nerve Decompression for Patients With Traumatic Facial Nerve Paralysis.

OBJECTIVE: To evaluate the facial nerve function and audiological results of delayed (by at least one month after the insult) transmastoid facial nerve decompression (FND) in traumatic facial nerve paralysis (FNP). METHODS: Medical records of 57 patients with traumatic FNP were reviewed and surgical results of 13 patients (mean age 28.0 ± 17.67, range 3-67) undergoing transmastoid FND were analyzed. Preoperative and postoperative mean hearing thresholds were compared using 0.5, 1, 2, and 3 kHz. Facial nerve function was graded according to the House-Brackmann scale (HB) before and after surgery. HB scale results of grade III or better were accepted as good results postoperatively. RESULTS: Preoperative HB grades were V in 5 and VI in 8 patients. Twelve of 13 patients had good recovery of facial nerve function regardless of the operation timing. When mean preoperative and postoperative air-bone gap (ABG) values were compared (except the patients with total sensorineural hearing loss), the mean preoperative ABG was 33 ± 15.9 dB, and mean postoperative ABG was 17.2 ± 8.68 dB. There was a mean hearing gain of 15.8 dB after transmastoid facial nerve decompression surgery. Surgery and anesthesia-related complications were not seen in any patients. CONCLUSION: The transmastoid route can be used safely and effectively with elimination of the risks of craniotomy and middle fossa surgery for patients with traumatic FNP. Hearing improvement can be achieved by performing ossicular chain reconstruction during decompression surgery for patients with conductive or mixed hearing loss (HL).

Effect of Using N95 and Surgical Masks on Otoacoustic Emission in Cochlear Outer Hair Cells.

INTRODUCTION: Distortion product otoacoustic emission (DPOAE) was measured to investigate the effect of mask use and type on oxygen saturation on cochlear function in health care professionals during the COVID-19 pandemic. MATERIAL AND METHODS: Group 1 participants wore surgical masks; Group 2 participants wore N95 masks. Distortion product otoacoustic emission and oxygen saturation were measured in both groups before and after mask use. RESULTS: Comparison of signal-to-noise ratio (SNR) values before and after surgical mask use in DPOAE measurements of group 1 revealed statistically significant difference in the right and left ears. Comparison of the SNR values in DPOAE measurements of group 2 before and after 8 hours of N95 mask use revealed statistically significant differences in the right ear at 988, 2963, 4444, and 8000 Hz and in the left ear at 8000 Hz. CONCLUSION: We found that prolonged mask use may affect the outer hair cells in the cochlea, causing deterioration in DPOAE values.

A Rare Cause of Recurrent Cerebral Ischemia and Syncope: Eagle Syndrome.

Eagle syndrome is defined as symptomatic elongation of the styloid process or calcification of the stylohyoid and stilomandibular ligament. The syndrome was described by WW Eagle in 1937. The styloid process is located between the internal and external carotid arteries and laterally in the tonsillar fossa. Patients with cerebrovascular ischemia causing syncope or hemiparesia due to Eagle syndrome are rarely published in the literature. The authors presented a patient with recurrent cerebrovascular attacks due to long styloid process.

Surgical Treatment of Rhinosinusitis-Related Orbital Complications: Factors Affecting Irreversible Blindness.

If left untreated, rhinosinusitis can rarely cause a devastating complication irreversible blindness (IB). Despite new technologies in endoscopic sinus surgery and use of new broad-spectrum antibiotics, IB outcome is still a problem for surgically treated orbital complication of paranasal sinus infection (OCPSI) patients, and factors leading to IB outcome are not actually known. The aim of this study was to assess the factors leading to the IB outcome for surgically treated OCPSI patients. Results of 25 surgically treated OCPSI patients in our clinic were combined with surgically treated OCPSI patients reported through the PubMed database search from the year 2007. Patients were divided into 2 groups: IB group and recovery group. Patients having at least 1 immune status-related additional risk factor (ARF) were more common in the IB group, having an at least 1 ARF had 1.683 risk value of IB outcome (RR: 1.683, P = 0.006). IB patients had statistically significant higher mean (21.87 ±â€Š40.35, P = 0.005) time interval (days) (TI) between onset of ophthalmological symptoms and surgical intervention compared to recovery group patients (2.92 ±â€Š2.53). ROC curve analysis for an estimation of IB outcome according to the TI value demonstrated that a cut-off value of ≥2.5 days had the ideal sensitivity (87.5%) and specificity (71.9%) that resulted in IB outcome. (80.5% power, P = 0.008) IB and recovery group patients did not differ according to orbital complication type according to Chandler's classification (P = 0.492) and white blood cell count status (P = 0.584). In conclusion, OCPSI patients with ARFs and delayed admission after onset of orbital symptoms have a higher risk of IB outcome. These patients deserve prompt evaluation and early surgical intervention to prevent blindness. With future studies, new surgical criteria, including the ARF status and onset of ophthalmological symptoms (≥2.5 days) may be added to classical surgical criteria to prevent IB for OCPSI cases.

Sudden Sensorineural Hearing Loss in the Only Hearing Ear: Large Vestibular Aqueduct Syndrome.

Sudden hearing loss in the only hearing ear cases are rarely published in the English literature; most of the cases are idiopathic. It is an otologic emergency needing urgent treatment. Delayed diagnosis can interfere with patient's social life with interrupting the verbal communication. In this case report we presented a 33-year-old female patient having sudden sensorineural hearing loss in the only hearing ear diagnosed as bilateral large vestibular aqueduct syndrome.

Calcitonin-negative neuroendocrine tumor of thyroid gland mimicking anaplastic carcinoma: an unusual entity.

Medullary thyroid cancer is the neuroendocrine tumor (NET) of thyroid with mostly both secreting calcitonin and immunohistochemically showing calcitonin positivity. Occasionally; NETs of thyroid may have little or no calcitonin expression. We present a case of serum calcitonin negative and immunohistochemically calcitonin-negative staining tumor with positive reaction to neuroendocrine markers synaptophysin and chromogranin-A. The patient's right vocal cord was paralytic and thyroid mass was huge with descending to thorax till hilar region. We discussed diagnostic difficulties and way of treatment about NETs of thyroid with the light of current literature with this case.