Is It Hot or Cold? Which Humid Air Is Better for Vocal Hygiene?

OBJECTIVES: The purpose of this research is to determine which type of humid air should be suggested for vocal hygiene by demonstrating the effects of hot humid air and cold humid air on the vocal cord mucosa using different histological methods. STUDY DESIGN: Randomized controlled study. METHODS: Cold or hot humid air was applied to the rats for 30 minutes/day for 10 days using a humid air machine placed in a closed glass cage. The control group did not receive any treatment and were kept in their cages under normal laboratory conditions. The animals were sacrificed and their larynxes were removed on the 11th day. Histologically, lamina propria (LP) thickness was measured by Crossman's three stain and the number of mast cells in 1 square millimeter of lamina propria was measured by toluidine blue. In immunohistochemical staining, the intensity of zonula occludens-1 (ZO-1) staining was measured using a rabbit polyclonal antibody and scored from 0 (no staining) to 3 (intense staining). One-way ANOVA and Kruskal-Wallis tests were used to compare groups. RESULTS: The mean LP thickness was thinner in rats exposed to cold humid air (CHA) than in the control group (P = 0.012). In terms of LP thickness, other intergroup comparisons (cold vs hot and control vs hot) showed no statistically significant difference between groups (P > 0.05). The mean mast cell count did not differ between groups. The hot humid air (HHA) group had more intense ZO-1 staining than the other groups (P < 0.001). There was no difference in ZO-1 staining intensity between the control group and CHA group. CONCLUSION: HHA and CHA administration had no negative effects on inflammatory findings in the vocal cords (mast cell count or LP thickness). While HHA appears to strengthen the epithelial barrier (denser ZO-1 staining), the physiologic outcomes, such as bronchoconstriction, should be cautiously assessed.

Organic and functional dysphonias: comparison of Self-Assessment protocols by confirmatory factor analysis.

OBJECTIVE: This study aims to see if the effects of the sub-domains of the Voice Handicap Index-10 (VHI-10) and Voice Related Quality of Life (VRQoL) differ in organic (OD) and functional dysphonia (FD). METHOD: A total of 162 patients completed the validated Turkish versions of the Voice Handicap Index-10 (VHI-10) and Voice-Related Quality of Life (VRQoL). Physical (pVHI-10), emotional (eVHI-10) and functional (fVHI-10) sub-domains of VHI-10 and physical-functional (PF-VRQoL), socio-emotional (SE-VRQoL) dimensions of VRQoL were assessed. Confirmatory factor analysis (CFA) was used to compare the sub-domains of these questionnaires between diagnostic categories. RESULTS: The total and sub-domain scores of both VHI-10 and VRQoL were not statistically different between the two etiologic categories of dysphonia (MANOVA, p > .05). The total VHI-10 and total VRQoL scores were significantly and moderately correlated in both the OD and FD groups. During CFA, 4 models were constructed for the OD and FD groups for VHI-10 and VRQoL factors. There was no significant difference between OD and FD groups in terms of path coefficients of sub-domains (z test, p > .05). CONCLUSION: In terms of VHI-10 and VRQoL, the sub-domains of each questionnaire are equally important in both organic and functional dysphonia. Functional disorders do not depend only on "emotional" factors, and neither do organic problems. Factor analysis should be included when performing a study on patient-reported outcome measures.

Impact of Functional and Aesthetic Factors on Patient Satisfaction in Septorhinoplasty.

Objective: This study aimed to differentiate the functional or aesthetic factors affecting the result of septorhinoplasty and to determine the most important factor related to patient satisfaction. Methods: Rhinoplasty Outcome Evaluation (ROE) and Visual Analog Scale (VAS) for obstruction (VAS-O) and for appearance (VAS-A) were administered to fifty-five patients undergoing septorhinoplasty preoperatively and six months after the surgery. VAS scores were evaluated as follows: VAS-O (0: unblocked, 10: completely blocked) and VAS-A (0: worst appearance, 10: best appearance). ROE scores were calculated between 0 and 100. In order to examine the relationship between the measurements and determine the most powerful item that affects the overall ROE score, path analysis was performed, and the path coefficients were calculated. Results: The mean VAS-O and VAS-A scores before and after surgery were 6.85 and 4.36, and 3.91 and 7.22, respectively (p<0.001). The absolute value of mean difference was greater for VAS-A (-3.31) than VAS-O (-2.49), which also means appearance scores were more widely affected. The mean ROE score was increased from 46.36±9.28 to 78.85±11.70. VAS-A score had a significant impact on the overall ROE score (ß=0.782, p=0.001), while the VAS-O score had no impact. The least effective item on the overall ROE score was item 2 (ß=0.445), while the other items related to aesthetic outcome had higher Path coefficients. Conclusion: Although septorhinoplasty provides satisfactory results in both functional and aesthetic aspects, patients are more satisfied with the cosmetic outcomes.

Effects of Subthalamic Nucleus Deep Brain Stimulation Surgery on Voice and Formant Frequencies of Vowels in Turkish.

AIM: To investigate the effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on acoustic characteristics of voice production in Turkish patients with Parkinson's disease (PD). MATERIAL AND METHODS: This study recruited 20 patients diagnosed with PD. Voice samples were recorded under the "stimulation on" and "stimulation off" conditions of STN-DBS. Acoustic recordings of the patients were made during the production of vowels /a/, /o/, and /i/ and repetition of the syllables /pa/-/ta/-/ka/. Acoustic analyses were performed using Praat. RESULTS: A significant difference in the parameters was observed among groups for vowels. A positive significant difference was observed between preoperative med-on and postoperative med-on/stim-on groups for /a/ and the postoperative med-on/ stim-on and postoperative med-on/stim-off groups for /o/ and /i/ for frequency perturbation (jitter) and noise-to-harmonics ratio. No significant difference was noted between the preoperative med-on and postoperative med-on/stim-off groups for any vowels. CONCLUSION: STN-DBS surgery has an acute positive effect on voice. Studies on formant frequency analysis in STN-DBS may be expanded with both articulation and intelligibility tests to enable us to combine patient abilities in various perspectives and to obtain precise results.

Does 3 Tesla Magnetic Resonance Imaging Have Adverse Effect on Cochlear Functions?

OBJECTIVE: The aim of this study was to investigate the effects of 3 Tesla (3T) magnetic resonance imaging (MRI) noise on cochlear functions. METHODS: The distortion product otoacoustic emission (DPOAE) test was applied to patients who were scheduled to have 3T MRI in the tertiary care center. Patients who revealed emission amplitudes at all frequencies (1, 1.5, 2, 3, 4, 6, and 8 kHz) in the DPOAE test before MRI were included in the study. After MRI, the DPOAE test was performed twice on 17 patients (33 ears) (immediately after MRI and 30 minutes after MRI). The changes in the results of the tests taken before MRI (pre-MRI), immediately after MRI (post-MRI 1), and at 30 minutes after MRI (post-MRI 2) in the DPOAE amplitudes at all frequencies were compared statistically. RESULTS: There was a significant difference between pre-MRI, post-MRI 1, and post-MRI 2 measurements at 3, 6, and 8 kHz. In pairwise comparisons; post-MRI 1 was statistically lower than post-MRI 2 at 3 kHz, and post-MRI 1 was statistically lower than pre-MRI and post-MRI 2 at 6 and 8 kHz. In addition, post-MRI 2 was significantly lower than pre-MRI at 8 kHz. CONCLUSION: According to these results, 3T MRI noise does not have any permanent negative impact on hearing functions. It can only cause DPOAE amplitude changes at high frequencies. This is a clinically negligible effect. Therefore, it can be considered that the 3T MRI examination with protective headphones does not cause any adverse side effects in terms of hearing functions.

Clinical significance of smell and taste dysfunction and other related factors in COVID-19.

PURPOSE: The objective of this study is to evaluate smell and taste dysfunction (STD) in coronavirus disease 2019 (COVID-19) positive and negative patients, and to assess the factors associated with STD in COVID-19 positive patients. METHODS: Patients who had been tested with the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for COVID-19 were identified, and according to the RT-PCR test results, patients were separated into Positive and Negative Groups. A telephone-based assessment was applied to both groups using the American Academy of Otolaryngology-Head and Neck Surgery Anosmia Reporting Tool. Patients in Positive Group were also asked to rate STD, nasal breathing, and anxiety in three different time periods (pre-/during-/post-COVID) using the visual analog scale (VAS). RESULTS: A total of 53 COVID-19 positive and 51 negative patients completed the surveys. STD was eightfold more frequent (OR 8.19; CI 95% 3.22-20.84) in the Positive Group. Of the 53 COVID-19 positive patients, 32 reported STD and 21 did not. 'Ground-glass appearance' on chest-computed tomography was more frequent and median lymphocyte count was significantly lower in COVID-19 positive patients with STD. During-COVID STD and nasal breathing VAS scores were significantly lower than the pre- and post-COVID scores. During-COVID STD scores were significantly correlated with anxiety scores (Spearman's rho-0.404, p = 0.022) but not correlated with nasal breathing scores. CONCLUSION: STD may be related to increased inflammatory response as well as damage of olfactory neuronal pathway or non-neuronal olfactory mucosa. Understanding the exact cause of chemosensory impairment in COVID-19 can be helpful in explaining the pathophysiology of the disease.

A rare cause of acute severe upper airway obstruction that required endotracheal intubation: adenoid hypertrophy.

Adenoid hypertrophy is one of the common causes of upper airway obstruction in children. It usually presents with sleep-related breathing disorders and associated findings generally occur around the age of 4 years. However, the development of acute upper airway obstruction due to adenoid hypertrophy is extremely rare. Acute upper airway obstruction due to adenoid hypertrophy in a patient aged under 1 year is an extremely unexpected condition. The aim of this case report was to contribute to the literature by reporting the presence of adenoid hypertrophy causing severe acute airway obstruction leading to endotracheal intubation in a 7-month-old male patient.

Screening of dysphagia by DYMUS (Dysphagia in multiple sclerosis) and SWALQoL (Swallowing quality of life) surveys in patients with multiple sclerosis.

BACKGROUND: Dysphagia is a life-threating symptom in patients with multiple sclerosis (MS) because aspiration pneumonia develops as a consequence of swallowing disorders. Dysphagia can be detected by using patient-reported outcome measures in order to prevent complications. OBJECTIVE: To identify the dysphagia prevalence, severity, and swallowing related quality of life (QoL), by using two validated dysphagia questionnaires. METHOD: Dysphagia in Multiple Sclerosis (DYMUS) and Swallowing Quality of Life (SWALQoL) questionnaires were collected from 64 patients with MS. RESULTS: The mean total SWALQoL score was 67.9 (±11.2) and the mean DYMUS score was 2.02 (±1.3). The highest mean SWALQoL subdomain score belonged to communication (76.7 ± 15.8), and the lowest score belonged to sleep (54.2 ± 12.2). There was a significant correlation between age and DYMUS and SWALQoL scores (r: 0.539 and r: -0.610 respectively, P < .001). Additionally, there was a significant moderate correlation between disease duration and DYMUS and SWALQoL scores (r: 0.693 and r: -0.697 respectively, P < .001). DYMUS and SWALQoL scores did not vary between males and females (P > .05). Patients with secondary progressive MS had higher DYMUS and lower SWALQoL scores (more dysphagia) than in primary progressive or relapsing-type MS. There was a strong, negative and statistically significant correlation between DYMUS and total SWALQoL scores (Spearman's rho: -0.862, p < .001). CONCLUSION: MS causes dysphagia and reduces QoL. Age, disease duration, and MS type are major factors that influence SWALQoL. DYMUS and SWALQoL are well correlated. DYMUS is an easy to answer tool that may advised for screening dysphagia in patients with MS.

Effects of submucosal PRP injection on wound healing in endonasal surgeries: an experimental study.

PURPOSE: To investigate the effects of submucosal platelet-rich plasma (PRP) injection on nasal mucosal wound healing after endoscopic sinus surgery. METHODS: 24 New Zealand white rabbits were randomly divided into three groups. To mimic surgery, injury was created using 3-mm punch forceps on ventral turbinate mucosa for all groups. Submucosal PRP was injected to the damaged mucosa in the first group (PRP group, n = 8), where 0.9% saline solution to the second group (saline group, n = 8) and no injection to the third one (control group, n = 8). All the animals were sacrificed 14 days after surgery; histopathological examination and hydroxyproline measurements were performed on the mucosa of all groups. RESULTS: Neutrophils, goblet cells, and collagen intensity were found significantly lower (p < 0.05) in PRP group than the control group. Also, the number of ciliary and goblet cells, and collagen intensity were found significantly lower (p < 0.05) in PRP group, than the saline group. In PRP group, hydroxyproline levels were found (p < 0.05) significantly lower than the saline and the control group, and no significant difference was found between the saline group and the control group (p > 0.05). CONCLUSION: There are many studies in literature showing the positive effects of PRP on wound healing. The results of this study also demonstrated positive effects of PRP on the nasal mucosa. According to these results, PRP injection to the injured nasal mucosa showed anti-inflammatory, mucus-softening, and synechia-reducing effects. Therefore, submucosal PRP injection after endonasal surgeries can be considered an effective application for maintaining nasal physiology.

Is there an association between the parameters of arterial stiffness and tinnitus?

Background: Increasing arterial stiffness is associated with atherosclerosis and there is an association between atherosclerosis and tinnitus may occur.Objectives: The aim of this study was to investigate the relationship between arterial stiffness and tinnitus using the central pulse-wave analysis method.Methods: This prospective, single center study included 98 participants, comprising 49 patients diagnosed with subjective idiopathic tinnitus (Group 1) and a control group of 49 healthy subjects (Group 2). The Mobil-O-Graph 24 h Pulse wave analysis (PWA) Monitor (I.E.M. GmbH, Stolberg, Germany) was used to determine the arterial stiffness and cardiovascular hemodynamic parameters. Central pulse pressure (CPP), Augmentation index and pulse wave velocity (PWV) were obtained with the device.Results: No statistically significant difference was determined between Groups in respect of age, smoking and hypertension (p > .05). Statistically significantly higher Central Pulse Pressure (CPP) values and pulse wave velocity were higher in Group 1 compared to the control group (p < .005). No statistical variation was detected in terms of the augmentation index (18.5 ± 11.3 vs 16.7 ± 10.3, p = .543).Conclusion: Our results marked that arterial stiffness is associated with tinnitus. The relationship was examined via oscillometric method, which is simple to perform and has been recommended in guidelines for the determination of cardiovascular event risk.

The Frequency of Human Papilloma Virus in Laryngeal Squamous Cell Carcinoma.

The association of HPV in laryngeal squamous cell carcinoma (LSCC) is investigated in several studies but controversial results are established. This study aimed to investigate the HPV DNA positivity in LSCC patients diagnosed and treated in two otorhinolaryngology referral centres in northern region of Turkey. The study was planned as a retrospective investigation of LSCC patients. Fifty-two formalin-fixed, paraffin-embedded (FFPE) tissue blocks of laryngeal cancers-diagnosed and treated between 2010 and 2016, were included. Polymerase chain reaction (PCR) method was used for detection of HPV genotypes. PCR amplification was successful in 40 of 52 patients. Among the 40 LSCC samples, HPV DNA was detected in one patient (2.5%). The evaluated HPV positivity in LSCC as low; but larger studies are needed to confirm this.

Comparison of findings of radiographic and fractal dimension analyses on panoramic radiographs of patients with early-stage and advanced-stage medication-related osteonecrosis of the jaw.

OBJECTIVES: The aim of this study was to compare the panoramic radiographs of patients with early-stage and advanced-stage medication-related osteonecrosis of the jaw (MRONJ) for differences in radiographic findings and fractal dimension (FD). STUDY DESIGN: Data were collected from the medical records of 66 patients confirmed as having MRONJ. Panoramic radiographs of 66 patients (group I; without bone exposure; and group II; with bone exposure) were evaluated for the following signs; osteolysis, cortical erosion, focal and diffuse sclerosis, sequestrum, lamina dura thickening, enhancement of the inferior alveolar canal (IAC), persistent alveolar socket, pathologic fractures, and enhancement of the external oblique ridge. FD values were also compared between groups. RESULTS: The signs of focal and diffuse sclerosis, sequestrum, and enhancement of the IAC were observed significantly more often in group II than group I (P < .05). The mean FD values were 1.42 ± 0.11 in group I and 1.44 ± 0.18 in group II and were significantly different only in 1 region but not significantly different overall. CONCLUSIONS: Radiographic alterations of bone structures appeared more frequently in patients with advanced stages of MRONJ. No significant difference was detected in the FD values among the tested regions except the cancellous bone above the mandibular canal on the distal side of the mental foramen.

Trabecular structure designation using fractal analysis technique on panoramic radiographs of patients with bisphosphonate intake: a preliminary study.

OBJECTIVE: This study was performed to evaluate the trabecular pattern of patients with cancer taking bisphosphonates on panoramic images using fractal dimension (FD) analysis by comparison with healthy subjects and to assess whether any difference exists between regions. METHODS: FD analysis was conducted using ImageJ 1.3 software (National Institutes of Health, Bethesda, MD, USA) with the box-counting method on panoramic radiographs of 33 patients taking bisphosphonates (13 males and 20 females) and 33 healthy sex- and age-matched individuals. RESULTS: FD values were higher (1.39 ± 0.14) in the study group than control group (1.38 ± 0.07) (p ≤ 0.05). No difference was detected in the FD values among the tested regions. The mean FD values in the control and study groups were as follows: region 1, 1.49 and 1.41 (p = 0.54); region 2, 1.36 and 1.37 (p = 0.84); region 3, 1.35 and 1.42 (p = 0.11); and region 4, 1.39 and 1.39 (p = 0.90), respectively. Female patients showed significantly lower values above the mandibular canal on the distal side of the second premolar and anterior to the mental foramen than did male patients (p ≤ 0.05). Age was unrelated to the FD in the study group (p ≥ 0.05). CONCLUSIONS: The FD values of the patients with cancer taking bisphosphonates were higher than those of the controls. FD analysis showed the potential for examining bone structure in panoramic radiographs. Studies with a larger sample size are necessary to confirm these results.

Cutaneous metastasis of colon adenocarcinoma.

Skin metastasis originating from colorectal cancer is a rare entity and usually signifies poor prognosis. We present a case of a 62-year-old male patient who presented with a cutaneous metastatic focus on his forehead after five years of the primary treatment of colon cancer. Complete response from the cutaneous metastasis nodule was achieved with radiotherapy. The patient is still alive and under a second-line palliative chemotherapy regimen because of the multiple liver metastases. It is important for physicians to be aware of skin metastasis in patients with an oncology history.

Evaluation of Anatomical and Volumetric Characteristics of the Nasopalatine Canal in Anterior Dentate and Edentulous Individuals: A CBCT Study.

OBJECTIVE: To examine the nasopalatine canal (NPC) anatomical and volumetric measurements in anterior edentulous (AE) and anterior dentate (AD) individuals and to compare these findings according to sex, age, shape, and severity of resorption in the premaxilla. METHODS: Two hundred cone beam computed tomography images were divided into 2 groups: AE and AD. The diameter, the length of the NPC and the width, the length of the buccal bone anterior to the NPC were measured and recorded. Linear and volumetric measurement results were evaluated in terms of age, sex, dental status, shape, and severity of resorption. RESULTS: No significant differences were observed between the AE and AD groups in terms of the NPC volume (P = 0.289). In the AE group, the spindle shape had the highest volume, and in the same group, with aging, the volume significantly increased (P = 0.00). The mean NPC volume was found to be statistically significantly larger in males than females (P = 0.02). A statistically significant relation was observed between NPC volume and resorption status. CONCLUSION: Severe bone resorption due to sustained edentation complicated implant surgery because of the increase in incisive and nasal foramen diameters and decrease in buccal residual bone dimensions. The NPC volume was found fewer in edentulous patients, and by the resorption, the volume was decreased.

Evaluation of the Characteristics and Association Between Schneiderian Membrane Thickness and Nasal Septum Deviation.

OBJECTIVE: Nasal septum deviation (NSD) is an anomaly that disturbs normal mucus drainage in sinuses, leading to recurrent sinusitis. Sinusitis, infections, and mucosal irritations are the potential causes of Schneiderian membrane thickening (SMT). The aim of this study was to evaluate the characteristics and association between NSD and SMT along with factors such as age, gender, and tooth groups using cone-beam computed tomography (CBCT) imaging. METHODS: The maxillary sinus and nasal cavity of 249 patients (136 females and 113 males) were examined retrospectively using CBCT. The statistical analysis was performed to determine the association between SMT, NSD, gender, and age. RESULTS: No statistically significant relation was detected between NSD and SMT. The NSD was found in 50.6% of patients without gender predilection. Age was not associated with the presence of NSD. The mean thickness of the membrane was least in the third molar region and highest in the first molar region. The average SMT was found to be higher in males for all the examined tooth areas (P ≤ 0.05). CONCLUSION: A retrospective evaluation of CBCT images emphasized the concept that NSD was not a factor that affected the thickening of maxillary sinus mucosa. The CBCT imaging could be used for evaluating the maxillary sinuses and nasal septum.