Wideband Tympanometry and Absorbance for Diagnosing Middle Ear Fluids in Otitis Media with Effusion.

BACKGROUND: Surgical tympanostomy tube insertion is a standard procedure in Otitis media with effusion after proper follow-up. During the surgery, the presence of serous or mucoid fluids, atelectatic tympanic membrane, or empty ear may be observed, despite all patients having the same diagnosis. A better method based on a non-invasive approach can help avoid unnecessary surgery. This study aimed to compare surgically confirmed otitis media with effusion with wideband tympanometry and absorbance tests. METHODS: A total of 122 children diagnosed with otitis media with effusion were included. Eighty healthy children were included as controls. Ears were divided into 4 groups: serous, mucoid, atelectasis, and empty. Resonance frequency, 226 Hz and 1000 Hz compliance, wideband peak pressure, and absorbance data were used for comparison. RESULTS: The most practical tests were the average of 500, 1000, and 2000 Hz absorbance according to positive likelihood ratio (4.8) and model 2 according to negative likelihood ratio (0.11). It was better than the standard 226 Hz and 1000 Hz compliance tests. Although some statistically significant parameters were observed between serous fluid and empty ear, they were not sufficiently impactful for a differential diagnosis. No parameter could help us differentiate between serous and mucous fluids. CONCLUSION: According to negative likelihood ratio (0.11), a person with normal middle ear is 9 times more likely to have negative test with the use of resonance frequency, wideband tympanometry, and average absorbance together. To differentiate serous fluid from the empty ear, using only 226 Hz or 1000 Hz compliance for surgical indication can potentially cause wrong decisions according to negative likelihood ratios.

Operating Room Educational Climate Scale for Surgical Specialty Residents: Scale Development and Validation.

AIM: To develop a scale in Turkish language for evaluating the surgical specialty residents? perceptions of educational climate in the operating room, with an emphasis on learning in the operating suite and planning the relevant change for improved and standardized training. MATERIAL AND METHODS: Three surgeons from different disciplines provided expert opinions and a focus group meeting was held on the necessity, scope, and specificity of the items. The 5-point Likert type draft scale consisted of 28 items including ten negative statements scored reversely and having total scores ranging between 28-140 points. There were 5 subscales: educational process, teamwork, communication, operating room infrastructure, and surgical skills education. For assessing the validity and reliability, 172 surgical specialty residents from three hospitals in different locations were asked to answer the paper-based scale items anonymously. Confirmatory factor analysis (CFA) was used to test validity, whereas Cronbach?s alpha reliability coefficients were calculated for internal consistency. RESULTS: CFA revealed a chi-square, standard deviation, chi-square/standard deviation, and a p-value of 783.73, 340, 2.27, and 0.001, respectively. Cronbach?s alpha coefficient for educational process, teamwork, communication, operating room infrastructure, and surgical skills education subscales were calculated to be 0.61, 0.61, 0.63, 0.70, and 0.72, respectively. Cronbach?s alpha coefficient for all items was 0.89. Results indicated acceptable construct validity and internal consistency of the scale. CONCLUSION: The newly developed scale was proven as a reliable and valid measurement instrument that can be used within the Turkish health system setting for assessing and improving the educational climate in the operating room.

The effect of face mask usage on the allergic rhinitis symptoms in patients with pollen allergy during the covid-19 pandemic.

PURPOSE: The study aims to evaluate the use of face masks on allergic rhinitis symptoms in pollen allergy patients who were compulsorily using face masks due to the covid-19 pandemic. MATERIALS AND METHODS: A 15-item questionnaire was developed following the study goals by a team experienced in allergic rhinitis. Then the records of patients who underwent allergy tests in our hospital between 2013 and 2019 were retrospectively analyzed. Fifty participants with isolated pollen allergy were included in the study. Patients who agreed to participate in the research answered the questions over the phone. RESULTS: Of the 50 participants, 30 (60%) were female and 20 (40%) were male, with a mean age of 34.34 ± 9.41 years. While the rate of participants who defined their nasal symptoms as severe-moderate in the pre-pandemic period was 92% (46 patients), this rate decreased to 56% (28 patients) during the pandemic when they used face masks. In ocular symptoms, the same rate decreased from 60% (30 patients) to 32% (16 patients). A statistically significant decrease was found in both nasal and ocular symptoms of patients after mask use (p < 0.001). The most regression in allergy symptoms was observed in sneezing (p = 0.029) and nasal discharge (p = 0.039). CONCLUSIONS: This study observed that the use of face masks reduced both nasal and ocular allergic rhinitis symptoms in individuals with pollen allergy. These results support the hypothesis that the use of face masks would reduce the severity of allergic rhinitis symptoms.

Bilateral choanal atresia in a 60-year-old man: A case report and review of the literature.

Choanal atresia is a congenital condition referring to the blockage of the posterior nasal cavity. As bilateral choanal atresia (BCA) causes complete nasal congestion, it usually results in death due to asphyxia in the newborn if no emergency intervention is performed. Therefore, it is very rare to see a patient with BCA who has reached an advanced age. There are only 11 adult cases reported in the recent literature. Here, we report a case of a 60-year-old man diagnosed with BCA and we discuss the clinical presentation and treatment modalities with a review of the literature.

Otolaryngology Residents' Attitudes, Experiences, and Barriers Regarding the Medical Research.

OBJECTIVE: It was aimed to investigate the attitudes, experiences, and barriers towards scientific research among otolaryngology residents in Turkey. METHODS: Anonymous data were collected via an online survey. The demographic characteristics and experience in scientific research were investigated in the first section of the survey. The attitudes of participants towards scientific research and the barriers to the scientific research were examined in the second section of the survey using 17 items. RESULTS: The present study involved 119 otolaryngology residents continuing their education. It was determined that 68.1% of participants think that "participating in scientific research" is a part of otolaryngology training. In the present study, it was shown that the residents having journal club hours in clinics on regular basis participated in various steps of scientific research projects (p<0.05). Residents stated that they participated in the "literature review" stage of the preparation of a scientific publication (mean value of 2.58±1.88) most and in "verbal presentation in a congress" least (mean value of 0.74±1.44). It was determined that 80.7% of participants have not attended in any training on scientific research. It was found that the residents receiving structured scientific research training participated more in steps of scientific research projects which was statistically significantly (p<0.05). CONCLUSION: In our country, otolaryngology residents are very enthusiastic about having research education and participating in researches. However, residency students frequently have time deficiency, lack of knowledge-skill, and lack of financial support. Dedicated time should be allocated for research training and practice in specialty programs. Journal club activities should be organized on regular basis and integrated with research education. On the other hand, the scholarly activities of residents should be supported by means of various countrywide educational activities on research training.

Risk analysis in persistent cervical lymphadenopathies: Malignant or benign?

OBJECTIVE: The objective of the study was to determine the parameters that can be used to predict malignancy in persistent cervical lymphadenopathies. METHODS: We retrospectively reviewed the files of 162 patients diagnosed with persistent cervical lymphadenopathy who underwent an excisional biopsy in our department between January 2011 and October 2019. Patient demographics and the size, side, duration, and localization of lymphadenopathy were recorded, and their relationship with histopathological results was investigated. Multiple regression analysis was used to determine the relationship between clinical parameters and malignancy. RESULTS: Of the 162 patients, 91 (56.2%) were male and 71 (43.8%) were female, and the mean age was 45.40±20.41 (2-84) years. Male gender (OR=3.099; p=0.003), increasing age (OR=1.029; p=0.002), short duration of lymphadenopathy (OR=0.989; p=0.048), and neck level V (OR=2.604; p=0.031) patients had a statistically significantly higher risk of malignancy. There was no statistically significant relationship between the side and size of the lymph node and the risk of malignancy (p>0.05). CONCLUSION: In our study, male gender was determined to be the most predictive risk factor for malignancy in patients with cervical lymphadenopathy, followed by lymph node neck level, increased age, and duration of the disease.

Allergy Practices in Otorhinolaryngology Residency Programs in Turkey: Quo Vadis?

OBJECTIVE: The aim of this study was to investigate how allergy practices in the otorhinolaryngology (ORL) residency departments in Turkey have changed over the last 20 years and to examine the current status in ORL residency training. METHODS: A 17-item questionnaire was developed following the study goals by a team experienced in allergy practices. The questionnaire was sent via e-mail to the program directors of all the 95 ORL residency departments in Turkey. RESULTS: A total of 60 (63.2%) program directors completed the questionnaire. We found that allergy testing and immunotherapy had been performed in 70% and 28.3%, respectively, at any time to date. The most common reason for discontinuing in allergy practices over time was "the changes introduced by the Turkish Social Security Institute as stated in the healthcare implementation communiqué" and "the difficulties in obtaining vaccine supplies from companies". Of all departments, allergy testing, immunotherapy, nasal smear, and nasal provocation tests were performed only by 35%, 8.3%, 28.3%, and 1.7%, respectively. CONCLUSION: Allergy practices have been increasingly used, especially in the 2000s, but came to a standstill upon the changes introduced by the Turkish Social Security Institute as stated in the healthcare implementation communiqué. These findings suggest that allergy training, in the recent years, has remained in the background in ORL residency programs in Turkey. To achieve standardization in allergy training in ORL residency programs, professional associations and authorities should develop solutions in cooperation with legislators.

A 25-Year Bibliometric Analysis of Allergic Rhinitis Publications from Turkey.

OBJECTIVE: To analyze the change over the 25 years period in the number of publications on allergic rhinitis from Turkey, and to compare the data of the four major relevant specialties. METHODS: A search was conducted over 25-years between1994 and 2019 using the keywords "allergic rhinitis" and "Turkey" in PubMed®, and "allerji", "alerji" and "rinit" in TRDizin®. The articles were grouped by specialty; namely, "Otorhinolaryngology (ORL)," "Pediatrics," adult "Pulmonary disease" and adult "Allergy/immunology," based on the affiliation of the first author. The total number of publications in each specialty group within the 25-year period were compared using a significance test for a difference in two proportions within the statistical assessment. RESULTS: The 25-year results revealed 624 and 213 publications in the PubMed® and the TRDizin® databases, respectively. When the number of publications in a specific field in both databases was examined, the highest number of publications were identified in the ORL group, followed by the Pediatrics group. The number of publications in the ORL group was statistically higher than those in the "Pulmonary diseases" and "Allergy/immunology" groups in both the PubMed® and the TRDizin® databases (p=0.0001). CONCLUSION: The analysis of the number of 25-year allergic rhinitis publications from Turkey revealed that the academic interest of otolaryngologists in allergic rhinitis was unaffected, despite the challenges experienced in practice, with an increasing number of publications noted. When the number of 25-year publications was examined, ORL recorded the highest number of publications among all specialties.

Prevalence of oropharyngeal high-risk human papillomavirus in tumor-free tonsil tissue in adults.

PURPOSE: To determine the prevalence of oropharyngeal high-risk human papillomavirus (HPV) in patients undergoing tonsillectomy by detection of high-risk HPV in tonsil tissues using the in situ hybridization (ISH) technique. MATERIALS AND METHODS: The patients who underwent tonsillectomy between 2014 and 2018 were examined retrospectively. The pediatric cases and patients who underwent tonsillectomy due to malignancy were excluded. The study included 270 adult cases selected by age and gender randomization. The tonsillar tissue of each case was re-examined by the pathology department, and the presence of high-risk HPV was investigated via the ISH technique. Multiple logistic regression models were used for predictions of different factors. RESULTS: The prevalence of high-risk HPV in the 270 patients (male: 154 [57%]; female: 116 [43%]; mean age: 36.44 ± 12.87 years) was found to be 6.7% (n = 18). The prevalence was found 8.4% in men and 4.3% in women; 8.9% in cases under the age of 40 and 2.9% in cases over the age of 40; and 10.9% in patients who underwent tonsillectomy for infectious indications and 2.3% for non-infectious indications. Multivariate analysis identified that the infectious indications for tonsillectomy were significantly associated with high-risk HPV positivity (OR 5.328; p = 0.009). CONCLUSIONS: The prevalence of oropharyngeal high-risk HPV was found to be 6.7% and higher in younger people and men. Additionally, the HPV positivity was found to be higher in patients who underwent tonsillectomy for infectious indications. To our knowledge, this is the first study that reports the correlation between recurrent tonsil infections and HPV positivity in tonsil tissue.

Perception of male otolaryngologists on gender discrimination: a comparative study.

PURPOSE: To gather information on perception of male otolaryngologists (MORLs) about gender discrimination towards female otolaryngologists (FORLs). METHODS: MORLs were invited to participate to an online survey. Minimum participation requirement was completion of at least their first year of residency. The responses were analyzed and compared vis-a-vis with the previously conducted similar survey among FORLs. RESULTS: Statistically significant responses on the Likert scale are classified in four main groups. MORLs and FORLs share the same views about financial factors, benefits and opportunities, housework as burden, establishing work-life balance and physical strength requirements. They have opposing views about FORLs being meticulous, exposed to more negative attitude of the opposite gender and men's dominance in decision-making. FORLs don't have consensus, but MORLs disagree about MORLs being favored in pursuing academic careers. On the other hand, MORLs don't have consensus, but FORLs agree about patients having more confidence in MORLs. CONCLUSION: MORLs don't usually have any confrontation with FORLs in regards to the roles of women in the society such as their motherhood role. On the other hand, MORLs show rather a contradiction on their perception towards the gender discrimination mainly in achieving career goals by FORLs such as growing in the profession and holding managing roles. When the views of the both gender group are compared, MORLs don't seem to fully acknowledge FORLs' gender discrimination experience.

A Novel Assessment Method With Ultrasound for Obstructive Tonsillar Hypertrophy in Children.

OBJECTIVES: To develop a new method for the objective evaluation of airway obstruction due to tonsillar hypertrophy using ultrasound (US) in children. METHODS: The oropharynx was examined in patients, and tonsil grades were evaluated according to the staging system of Brodsky et al (Int J Pediatr Otorhinolaryngol 1987; 13:149-156). The narrowest intertonsillar distance (ITD) and widest transverse length of the tongue base (TLTB) were then measured by US, and their ratio was calculated. The clinical value of US was investigated for the classification of tonsillar hypertrophies as nonobstructive or obstructive by matching the patients' clinical grades with the US data. RESULTS: A total of 102 patients (age range, 2-12 years) were included in the study. According to the Brodsky staging system, 44.1% and 55.9% of the patients were in nonobstructive (stages I and II) and obstructive (stages III and IV) tonsillar hypertrophy groups, respectively. The area under the curve was 0.991 (95% confidence interval, 0.977-0.999) according to a receiver operating characteristic curve analysis between the Brodsky staging and the ITD/TLTB ratio. The optimal cutoff value for the ITD/TLTB ratio for the diagnosis of obstructive tonsillar hypertrophy was found to be 0.3 or less, which had 96.5% sensitivity and 95.6% specificity. CONCLUSIONS: The degree of airway obstruction due to tonsillar hypertrophy can be objectively determined by US in children. An ITD/TLTB ratio of 0.3 or less was found to be compatible with obstructive tonsillar hypertrophy. This new and easily applicable evaluation method may provide considerable value and guidance for tonsillectomy decisions.

Salivary gland tumors: A 15-year experience of a university hospital in Turkey.

OBJECTIVE: To determine the demographic characteristics of benign and malignant salivary gland tumors in our department in the last 15 years. METHODS: In this study, the files of the patients who underwent salivary gland surgery between 2004 and 2019 in our department were analyzed retrospectively. A total of 366 patients whose diagnoses of salivary gland tumor histopathologically confirmed were included in this study. The demographic data of the patients and tumor localizations were recorded, and their relationships with histopathological results were examined. RESULTS: Of the 366 tumors, 292 (80%) of them was originated from the parotid gland, 52 (14%) from the submandibular gland, and 22 (6%) from the minor salivary gland. The male: female ratio was found as 1.2:1, and the mean age of the patients was 50.37 years. A total of 259 (70.8%) tumors were benign, and 107 (29.2%) were malignant. The most frequent benign tumor was pleomorphic adenoma, with 121 cases (46.7%). While pleomorphic adenomas constituted the majority of the benign tumors of the submandibular gland and minor salivary glands, Warthin tumor was detected more than pleomorphic adenoma in the parotid gland. The most common malignant tumor was mucoepidermoid carcinoma, with 26 cases (24.3%). CONCLUSION: The distribution of the salivary gland tumors detected in our department was found to be substantially similar to other worldwide series. Unlike the literature, we concluded that salivary gland tumors were seen slightly more in males, minor salivary gland tumors were relatively rare and Warthin tumors were more frequently detected in our region.

Validation of the Turkish Version of the Facial Nerve Grading System 2.0.

OBJECTIVE: We aimed to adapt the Facial Nerve Grading System 2.0 (FNGS 2.0) to Turkish and to investigate the validity and the reliability of the Turkish version. METHODS: The original FNGS 2.0 was translated into Turkish and validated by international standards. Six Turkish physicians, three specialists and three residents, independently rated the videos, two times each, of 40 adult facial palsy patients. Inter-rater and intra-rater reliability were assessed using the intraclass correlation coefficient (ICC) and Cronbach's alpha coefficient. As another indication of reliability, "generalizability" was also evaluated. For all analyses, a p value of <0.05 was considered statistically significant. RESULTS: ICC and Cronbach's alpha coefficients for the inter-rater reliability of the total score of the FNGS 2.0 were 0.970 and 0.979 for the first assessment, 0.973 and 0.979 for the second assessment, respectively. The intra-rater reliability ICC results for the total score of the FNGS 2.0 were 0.95, 0.976, 0.982, 0.956, 0.96 and 0.931 for the six raters, respectively. The generalizability coefficient was found as G=0.894. CONCLUSION: In this study, we adapted the FNGS 2.0 to Turkish, and confirmed its reliability and validity as a facial palsy scale. The Turkish version of the FNGS 2.0 can be safely used to assess.

Correlation between Surgical Outcome and Stage of Acquired Middle Ear Cholesteatoma: Revalidation of the EAONO/JOS Staging System.

OBJECTIVES: This study aimed to evaluate the intraoperative findings, recurrence rate, and hearing outcome of cholesteatoma surgery and correlate them with the newly proposed EAONO/JOS Joint Consensus Statement. MATERIALS AND METHODS: The records of 407 patients diagnosed with chronic otitis media and cholesteatoma between 2009 and 2017 were reviewed. After the exclusion of records with unsatisfactory surgical notes and anamnesis, 353 patients were included in the study. The 290 patients who had undergone primary surgery and 63 who had undergone revision surgery were evaluated separately. RESULTS: Total 162 of 290 (56%) patients had retraction pocket cholesteatoma and 128 of 290 (44%) patients had non-retraction pocket cholesteatoma. Eighty (28%) patients had stage I, 114 (39%) had stage II, 91 (31%) had stage III, and 5 (2%) had stage VI disease. The recurrence rate was 6.9% (20/290). The average age of these patients at the time of the second operation was 23.31±10.3 years. Twelve patients had (60%) recurrent cholesteatoma, and eight (40%) had residual cholesteatoma. Hearing outcome and surgical technique were significantly associated with the disease stage; however, the recurrence rate showed no such association. CONCLUSION: We concluded that the EAONO/JOS staging system is beneficial for estimating the postoperative hearing results and planning the surgical technique. However, there was no significant relationship between the recurrence rate and the EAONO/JOS staging system. We believe that additional factors, such as infection, ossicles, and invasion, predict the recurrence. Widespread use of the EAONO/JOS staging system will enable better evaluation of surgical outcomes and prognosis.

Validation of the Turkish version of the Sunnybrook facial grading system

Background/aim: To adapt the Sunnybrook facial grading system (SFGS) into Turkish and perform validation and reliability studies on the Turkish version. Materials and Methods: The original English version of the SFGS was translated into Turkish by performing a linguistic validity study based on international standards. The evaluators comprised 6 physicians. Evaluations were performed twice independently using the video recordings of 65 facial palsy patients. Synchronously, the House-Brackman facial grading system (HBFGS) was filled out to display concurrent validity. The intraclass correlation coefficient (ICC) and Cronbach's alpha was used for the examination of the inter- and intra-rater reliability. As another indication of reliability, the generalizability (G) was also examined. Results: The ICC for the inter-rater reliability for resting symmetry, symmetry of voluntary movement, synkinesis, and the composite score, which are 4 components of the SFGS, were determined, respectively, as 0.822, 0.956, 0.606, and 0.957 for the first evaluation, and 0.805, 0.965, 0.584, and 0.965 for the second evaluation. For the intra-rater reliability, the ICC were determined as 0.842, 0.956, 0.794, and 0.937, while the Cronbach's alpha coefficients were determined as 0.809, 0.956, 0.792, and 0.948, respectively. The G coefficient was determined as G = 0.772. For the concurrent validity, a strong correlation was found between the SFGS and HBFGS scores. Conclusion: The present study adapted the SFGS into Turkish, and demonstrated that the adapted scale was valid and reliable. The Turkish version can be used for the evaluation of facial palsy, the follow-up of treatment efficiency, and standardization in reporting outcomes with the international literature.

Detecting Intralabyrinthine Pressure Increase by Postural Manipulation with Wideband Tympanometry and Distortion Product Otoacoustic Emissions.

OBJECTIVE: Intracranial pressure increase is known to affect inner ear pressure through the cochlear and vestibular aqueducts. This finding forms a good model for inner ear pressure studies. Standard techniques used to detect this pressure increase are neither reliable nor easily repeatable or cheap. Studies with immitancemetry and otoacoustic emissions have been giving hopeful results. This study aims to confirm the results in the literature with wideband tympanometry and add a new parameter of otoacoustic emissions to inner ear pressure testing. METHODS: Wideband tympanometry (WBT) and distortion product otoacoustic emissions (DPOAE) tests were applied to 40 healthy participants in sitting, supine, and Trendelenburg positions. DPOAE were measured under ambient or peak pressure. Resonance frequency, tympanic peak pressure, 1000, 1500, 2000, 3000, 4000, and 6000 Hz frequencies in DPOAE were measured. RESULTS: The increase in the tympanic peak pressure and the decrease in resonance frequency (RF) due to position change were found statistically significant (p<0.01). Signal noise ratio (SNR) decrease at 1 kHz frequency and SNR increase at 2, 3, 6 kHz in the normal protocol, SNR decrease at 1 kHz in the pressurized protocol were found statistically significant (p<0.01). CONCLUSION: RF in WBT and 1 kHz DPOAE SNR parameters were found useful in supporting the diagnosis in pathologies that increase intracranial pressure and inner ear pressure. Future research may ease their widespread use in clinical practice as they are non-invasive and rapidly applicable.

Assessment of Tonsil Volume With Transcervical Ultrasonography in Both Children and Adults.

OBJECTIVES: To investigate the success of ultrasonography (USG) in the objective measurement of palatin tonsil volume in both children and adults and to compare those results with clinical findings. METHODS: Eighty-five patients, who were scheduled to undergo tonsillectomy with the indications of recurrent tonsillitis and obstructive sleep apnea syndrome, were included in the study. The tonsil grades of the patients were recorded according to the Friedman tonsil grading. The tonsil size and volume were measured with transcervical USG. After tonsillectomy, the volumes of the tonsils were calculated by the displacement method. The correlation between the obtained data was evaluated. In all analyses, P < .05 was accepted as a statistical level of significance. RESULTS: Fifty children and 35 adults were included in the study. In children, the mean actual volume ± SD of 100 tonsils was measured as 3.5 ± 1.45 mL, and the USG volume was 3.67 ± 1.59 mL; a high correlation was found between both methods (r = 0.842; P < .05). In adults, the mean actual volume of 70 tonsils was measured as 5.15 ± 2.25 mL, and the USG volume was 5.71 ± 2.98 mL; a moderate correlation was found between the methods (r = 0.589; P < .05). In children, a moderate correlation was found between the Friedman grading and the USG (r = 0.532; P < .05), and actual (r = 0.549; P < .05) tonsil volumes. In adults, a low correlation was found between the Friedman grading and the USG (r = 0.363; P < .05) and actual (r = 0.384; P < .05) tonsil volumes. CONCLUSIONS: Ultrasonography is a useful, accessible, and noninvasive imaging method for objective measurement of tonsil volume in adults and children.

Adaptation of "Objective Structured Assessment of Technical Skills" for Adenotonsillectomy into Turkish: A Validity and Reliability Study.

OBJECTIVE: To adapt an objective surgical assessment tool (OSATS) for adenotonsillectomy/tonsillectomy to Turkish. METHODS: A prospective longitudinal validation study was planned. Adenoidectomy items were added to the tonsillectomy OSATS. Data were collected from 80 real-time observed surgical performances. To examine interrater reliability, 25 performances were simultaneously scored by two evaluators. In total, 105 test forms were filled, and reliability and validity studies were conducted. RESULTS: Regarding reliability, Cronbach's alpha values were found to be >0.95, indicating very high internal consistency. For interrater reliability, a statistically significant positive correlation was found between the two evaluators' task-specific checklist (TSC) (p=0.0001; r=0.969) and global rating checklist (GRC) (p=0.0001; r=0.957). Between the TSC and GRC, there was a statistically significant positive correlation (p=0.0001; r=0.951). A model was developed using the generalizability theory, and the highest variances belonged to surgical processes. Regarding validity, the trainers' scores were significantly higher than the trainees' scores (p=0.0001). As surgical experience increased, both the TSC and the GRC scores significantly increased (p=0.0001). A trainee's first-ever 34 adenotonsillectomy performances were scored. A scatter plot of the obtained data showed that the trainee had gained more scores as the number of operations increased. CONCLUSION: The results indicate that adenotonsillectomy OSATS is a reliable and valid tool for the assessment of residents' surgical skills. This is the first OSATS developed for adenotonsillectomy in the Turkish literature. It is ready to be used in the operating room to provide constructive feedback and monitor the development of trainees' surgical skills in adenotonsillectomy.

The Effects of Surgical Treatment on Retina-Choroidal Findings in Patients With Obstructive Sleep Apnea Syndrome.

BACKGROUND AND OBJECTIVE: The purpose of this study was to determine the effect of surgical treatment on ocular findings in obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: The authors studied 34 eyes of 34 newly diagnosed OSAS patients. The sleep study was performed before and 6 months after expansion sphincter pharyngoplasty (ESP). Retinal nerve fiber layer (RNFL), choroidal thickness (CT), and retinal arteriolar caliber (RAC) analyses were performed using spectral-domain optical coherence tomography. Intraocular pressure (IOP) and ocular pulse amplitude were performed using the Pascal dynamic contour tonometer. RESULTS: The preoperative and postoperative Apnea Hypopnea Index scores and average oxygen saturation values were significantly different (P = .0001 and P = .001, respectively). There was no significant difference between the preoperative and postoperative RNFL thicknesses (P > .05). The preoperative subfoveal, nasal, temporal CT, and IOP were significantly different from the postoperative measurements (P = .006, P = .05, P = .036, and P = .0001, respectively). CONCLUSIONS: ESP had a significant influence on CT and IOP in patients with OSAS, maintaining a decrease in CT and IOP 6 months after surgery. The determination of these ocular findings may be useful to show the positive effects of ESP. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:35-42.].