Otorhinolaryngology Outpatient Clinic Research Articles

Balance Control Impairments in Usher Syndrome.

To explore postural disability in Usher Syndrome (USH) patients using temporal posturographic analysis to better elucidate sensory compensation strategies of deafblind patients for posture control and correlate the Activities-specific Balance Confidence (ABC) scale with posturographic variables. Thirty-four genetically confirmed USH patients (11 USH1, 21 USH2, 2 USH 4) from the Otolaryngology Outpatient Clinic and 35 controls were prospectively studied using both classical and wavelet temporal analysis of center of pressure (CoP) under different visual conditions on static and dynamic platforms. The functional impact of balance was assessed with the ABC scale. Classical data in the spatial domain, Sensorial Organization Test, and frequency analysis of the CoP were analyzed. On unstable surfaces, USH1 had greater CoP surface area with eyes open (38.51 ± 68.67) and closed (28.14 ± 31.64) versus controls (3.31 ± 4.60), p < 0.001 and (7.37 ± 7.91), p < 0.001, respectively. On an unstable platform, USH consistently showed increased postural sway, with elevated angular velocity versus controls with eyes open (USH1 [44.94 ± 62.54]; USH2 [55.64 ± 38.61]; controls [13.4 ± 8.57]) (p = 0.003; p < 0.001) and closed (USH1 [60.36 ± 49.85], USH2 [57.62 ± 42.36]; controls [27.31 ± 19.79]) (p = 0.002; p = 0.042). USH visual impairment appears to be the primary factor influencing postural deficits, with a statistically significant difference observed in the visual Sensorial Organization Test ratio for USH1 (80.73 ± 40.07, p = 0.04) and a highly significant difference for USH2 (75.48 ± 31.67, p < 0.001) versus controls (100). In contrast, vestibular (p = 0.08) and somatosensory (p = 0.537) factors did not reach statistical significance. USH exhibited lower visual dependence than controls (30.31 ± 30.08) (USH1 [6 ± 11.46], p = 0.004; USH2 [8 ± 14.15], p = 0.005). The postural instability index, that corresponds to the ratio of spectral power index and canceling time, differentiated USH from controls on unstable surface with eyes open USH1 (3.33 ± 1.85) p < 0.001; USH2 (3.87 ± 1.05) p < 0.002; controls (1.91 ± 0.85) and closed USH1 (3.91 ± 1.65) p = 0.005; USH2 (3.92 ± 1.05) p = 0.045; controls (2.74 ± 1.27), but not USH1 from USH2. The canceling time in the anteroposterior direction in lower zone distinguished USH subtypes on stable surface with optokinetic USH1 (0.88 ± 1.03), USH2 (0.29 ± 0.23), p = 0.026 and on unstable surface with eyes open USH1 (0.56 ± 1.26), USH2 (0.072 ± 0.09), p = 0.036. ABC scale could distinguish between USH patients and controls, but not between USH subtypes and it correlated with CoP surface area on unstable surface with eyes open only in USH1(ρ = 0.714, p = 0.047). USH patients, particularly USH1, exhibited poorer balance control than controls on unstable platform with eyes open and appeared to rely more on proprioceptive information while suppressing visual input. USH2 seems to use different multisensory balance strategies that do not align as well with the ABC scale. The advanced analysis provided insights into sensory compensation strategies in USH subtypes.

A Rare Case of Clear Cell Carcinoma of the Tongue Base: A Case Report

Clear cell carcinoma is a rare variant of salivary gland carcinoma, and its occurrence in the tongue base is even rarer. We present a case of a 55-year-old female patient with clear cell carcinoma of the tongue base. The patient initially presented with a 3-month history of palpable tongue mass, leading to her visit to the otolaryngology outpatient clinic. The patient underwent a complete resection of the tumor under general anesthesia. Postoperative follow-up imaging studies showed no evidence of recurrence.This case report highlights the diagnostic and management challenges associated with clear cell carcinoma of tongue base and demonstrates that a high index of suspicion is required to diagnose clear cell caricnoma, given its rarity and overlapping features with other clear cell neoplasms.

The evaluation of patients apply for septorhinoplasty in terms of body perception, disability, depression and social phobia

Objective: Psychiatric suitability is an important parameter that is evaluated together with anatomical suitability when deciding on rhinoplasty surgery. There is no matter how successful the treatment or surgery is, the results are not satisfactory in individuals with psychiatric symptoms. In order to make a broader assessment to determine psychiatric suitability, we aimed to evaluate the body perception, disability, depression and social phobia in individuals who applied for rhinoplasty surgery. Method: In this study, patients were planned to be included who applied to …………………… University Hospital Otorhinolaryngology outpatient clinic between 1/1/2019 - 1/1/2020. Among the patients, 50 volunteers who applied with the complaints of dissatisfaction with the aesthetic appearance of the nose and underwent septorhinoplasty were included in the case group. In the control group, 50 patients who applied to the Otorhinolaryngology outpatient clinic and had any complaints other than nasal deformity and were not planned for aesthetic any other operation were included. Results: There was no statistically significant difference found in terms of body image, disability, depression and social phobia. Conclusion: It has been confirmed that depression and body image do not show significant changes in patients who will undergo septorhinoplasty, and the information that disability and social phobia are not effective has been brought to the literature. Further studies with larger samples are needed on preoperative psychiatric evaluation.

The Diagnosis of Granulomatosis With Polyangiitis When Serology and Biopsies are Negative.

Granulomatosis with polyangiitis (GPA) is a potentially fatal condition which often manifests in the head and neck. Currently, diagnosis relies on antineutrophil cytoplasmic autoantibody (c-ANCA) serology and mucosal or renal biopsy. However, a significant proportion of patients with GPA limited to the head and neck are seronegative and biopsy negative. This study evaluates the role of clinical diagnosis of GPA in the absence of positive laboratory findings. Case series with chart review. Academic Tertiary Medical Center. This was a retrospective review of 143 patients treated in an outpatient otolaryngology clinic at a tertiary care hospital for known or suspected GPA from 1998 to 2021. Presenting symptoms, C-ANCA status at initial presentation, biopsy results, long-term serology results, and time to initiation of treatment were analyzed. Twenty-six of 143 (18.2%) patients were seronegative; only 3 of these patients (12%) had positive biopsies. Seventeen (73.9%) of these patients presented with nasal and sinus disease and 12 (52.2%) presented with airway involvement. Only 4 (17.4%) patients had renal involvement. Delay in treatment of patients with negative laboratory workup ranged from 0 months to 11 years. All patients who were seronegative and/or biopsy negative at presentation responded clinically to immunosuppressive therapy. GPA cases are often limited to the upper respiratory tract, making diagnosis difficult, particularly in seronegative patients. These results suggest that, when GPA is suspected, despite negative serology, the diagnosis of GPA should be made on clinical grounds, and empiric therapy encouraged to prevent delay in treatment.

Quantification of Heavy Metals in the Nasal Turbines of Smokers and Nonsmokers.

Cigarette smoke is known to contain toxic heavy metals. In this study, heavy metal levels in the nasal turbinate tissues of smokers and nonsmokers were measured and compared with Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). Forty patients who come to the Otorhinolaryngology outpatient clinic due to nasal obstruction and are given an appointment for partial turbinate reduction operation due to inferior turbinate hypertrophy, according to their smoking status, were divided into two groups: those who had smoked one pack/day for at least 10 years and those who had never smoked. The levels of heavy metals (Al, As, Ba, Cd, Cr, Co, Cu, Pb, Mn, Hg, Ni, Se, and Ag) were compared by ICP-MS in nasal turbinate tissues. Al (p = 0.002), Cr (p < 0.001), Co (p < 0.001), Ni (p = 0.001), Cu (p < 0.001), As (p < 0.001), Se (p < 0.001), Ag (p < 0.001), Cd (p = 0.001), Ba (p = 0.008), Hg (p < 0.001), and Pb (p < 0.001) values in the smoker group were found to be significantly higher than the values of nonsmokers. Although the Mn level was high in smokers, no significant difference was observed (p = 0.299). Smoking can cause nasal and sinus problems. In this study, we observed that the smoking group had significantly higher levels of almost all the heavy metals investigated in the nasal turbinate tissues. As smoking damages, the mucociliary system and the mucosa, heavy metals from cigarettes may accumulate further and cause harm to the nasal tissues. 3 Laryngoscope, 134:3562-3567, 2024.

Etiology and Antifungal Sensitivity Test in Otomycosis Caused by Candida Sp

Otomycosis is a common fungal infection of the external auditory meatus frequently diagnosed in otolaryngology outpatient clinics. Resistance to antifungals is currently a significant concern, with intrinsic and acquired resistance increasing among isolates that cause fungal infections. The purpose of this research was to identify Candida species causing otomycosis and determine the pattern of antifungal susceptibility among these Candida species. A prospective study was conducted in the Margono Soekarjo General Hospital and Department of Microbiology, Faculty of Medicine, Universitas Jenderal Soedirman Purwokerto, Indonesia, from April – September 2022. Forty-seven (47) clinical samples of otomycosis were collected from 41 patients and then isolated bedside on fungal culture media and was prepared on an object glass for direct microscopic examination of the specimens. Fungal identification was performed using 10% potassium hydroxide (KOH) to observe fungal elements. Samples were cultured on Saboraud dextrose agar (SDA) media with chloramphenicol and Czapek dox agar. The Germ Tube Test was used to identify Candida while yeast-specific identification and antifungal susceptibility assay using a rapid commercial kit was applied for specific identification of the fungus. Antifungal susceptibility patterns were obtained using the Integral System Yeast Plus (ISYP) media pack. Candida parapsilosis was the most prevalent Candida species discovered in this study, accounting for approximately 41.66%, which was followed by Candida tropicalis (25%) and Candida krusei (12.5%), whereas Candida albicans only accounted for 4.1% of the specimens. All Candida species were sensitive to flucitosine and ketoconazole, whereas the voriconazole sensitivity rate reached 96%. This study concludes that Candida parapsilosis is the most prevalent species of Candida in otomycosis, and that all Candida species are sensitive to Flucitosine, ketoconazole, and voriconazole.

Knowledge, attitudes and practices of patients with chronic pharyngitis toward laryngopharyngeal reflux in Suzhou, China

BackgroundThis study aimed to investigate the knowledge, attitudes and practices (KAP) of patients with chronic pharyngitis in Suzhou, China toward laryngopharyngeal reflux (LPR).MethodsThis cross-sectional study was conducted in patients with chronic pharyngitis in Suzhou, China at the otolaryngology outpatient clinic of the First Affiliated Hospital of Soochow University between November, 2022, and May, 2023. Data was collected through a self-designed online questionnaire encompassing the sociodemographic characteristics and three dimensions of KAP. The questionnaire was administered using SoJump, and data were exported from this platform. Subsequently, statistical analysis, including Structural Equation Modeling, was performed using SPSS 22 software to evaluate the KAP scores.ResultsA total of 487 valid questionnaires were collected, with 275 (56.35%) female patients. The mean score of KAP were 4.76 ± 2.93 (possible range: 0–11), 33.10 ± 4.46 (possible range: 8–40), 31.29 ± 6.04 (possible range: 8–40), respectively. Pearson’s correlation analysis showed significant positive correlations between knowledge and attitude dimensions (r = 0.413, P < 0.001), knowledge and practice dimensions (r = 0.355, P < 0.001), and attitude and practice dimensions (r = 0.481, P < 0.001). Structural equation modeling revealed that education exhibited positive effect on knowledge (β = 0.476, P < 0.001) and attitude (β = 0.600, P < 0.001), and having family history of chronic pharyngitis showed positive effect on knowledge (β = 0.580, P = 0.047), experienced with reflux symptoms showed positive effect on knowledge (β = 0.838, P = 0.001) and attitude (β = 0.631, P = 0.085). Moreover, knowledge showed positive effect on attitude (β = 0.555, P < 0.001) and practice (β = 0.351, P < 0.001). Attitude, in turn, showed positive effect on practice (β = 0.511, P < 0.001).ConclusionPatients with chronic pharyngitis had inadequate knowledge, positive attitudes and suboptimal practices toward LPR. Education, family history of chronic pharyngitis, experienced with reflux symptoms might have effect on their KAP.

Environmental impact on pediatric epistaxis and the utility of diagnostic studies: A single-institutional review

ObjectivesPediatric epistaxis is a multifactorial disease entity. The objective of this study is to determine the socioeconomic and air-quality contributions to pediatric epistaxis. The study also evaluates the utility of diagnostic lab work as a predictor of bleeding rates and need for operative intervention. MethodsA case series of pediatric patients treated in an outpatient Otolaryngology clinic at a tertiary care children's hospital in 2021 for epistaxis was performed. Patients with nasal bone trauma (n = 8), consult while inpatient (n = 7), and those with nasal masses (n = 2) were excluded; 181 patients met inclusion criteria. Demographic, clinical, socioeconomic, and air quality (tropospheric ozone, particulate matter) data were recorded. Associations with persistent bleeding and operative interventions were evaluated using logistic regression, Wilcoxon rank-sum, and Spearman rank correlation. ResultsOf the 181 patients, 75 (41.4%) were female. Forty-six of 181 (25.4%) had associated allergic symptoms. Twenty-six patients had allergy testing; 14/26 (53.8%) of these had positive results. Re-bleeding was more common in those with allergic symptoms (OR: 2.42, 95% CI: 1.22–4.78, p = 0.01). Patients with re-bleeding lived in counties with more days with ozone over the US standard (median 5 days, range 0–32 days) compared with those with no re-bleeding (median 3 days, range 0–32 days, p = 0.007). There was also an association between the number of visits for re-bleed and percent below poverty level (ρ = 0.259, p = 0.03) as well as the number of days with particulate matter levels over the US standard (ρ = 0.343, p = 0.01). Coagulopathy was present in 9/54 (16.7%) patients, with the majority being Von Willebrand disease (5/54, 9.3%). Easy bruising was not significantly associated with positive lab results. ConclusionsEnvironmental pollution, living in a zip code with more residents below the poverty level, and allergic rhinitis were positively associated with recurrent epistaxis. Understanding the geographic background of presenting patients may help direct workup and treatment options.

Features and Associated Comorbidities of Laryngomalacia in Saudi Arabia.

Laryngomalacia (LM) is defined as the collapse of supraglottic structures during inspiration, resulting in intermittent airflow impedance and associated stridor. LM is the most prevalent cause of congenital stridor in newborns. The aim of this study is to determine the features and associated comorbidities of LM in Saudi Arabia and to delineate the diagnostic and therapeutic measures used, based on the severity of the case and related comorbidities. This is a three-year retrospective study of children diagnosed with LM and treated in the pediatric otorhinolaryngology outpatient clinic at Maternity and Children Hospital, Dammam, Saudi Arabia, between January 2018 and January 2022. The inclusion criteria were patients with signs and symptoms of LM who are younger than 14 years old. The diagnosis of LM was based on clinical evaluation and confirmed by nasopharyngolaryngoscopy in awake patients and/or direct laryngoscopy and scoping under general anesthesia with spontaneous ventilation for dynamic evaluation. The Olney classification was used for the morphological classification of LM. The exclusion criteria were patients lost to follow-ups. Follow-up duration was two years minimum. A total of 52 patients were included in the study. Among the participants, females accounted for 71% and males accounted for 29% of cases. Our results were in accordance with the relevant literature, except for the higher prevalence of LM in full-term neonates who were found to account for 69.2% of the cases. Understanding the patterns and characteristics of breathing may help clinicians distinguish the noisy breathing of LM from other illnesses because infants are frequently misdiagnosed with these conditions.

Surgeon Information-Sharing, Parent Verbal Engagement, and Parent Knowledge of Pediatric Adenotonsillectomy.

We characterize clinician information-sharing and parent verbal engagement during pediatric adenotonsillectomy consultations and evaluate whether these behaviors relate to disease-specific knowledge for parents of children with obstructive sleep-disordered breathing (OSDB). Mixed-methods sequential explanatory analysis. Outpatient otolaryngology clinics. We analyzed audio-recorded communication during outpatient encounters for children undergoing initial evaluation for adenotonsillectomy. We identified discrete triadic instances of clinician discussion of individual risks and benefits, parent verbal responses coded as passive ("Right") or active ("Would that repeat the recovery time?"), and corresponding parent answer (correct or incorrect) on a postconsult knowledge questionnaire. Primary outcomes included parent knowledge and decisional conflict. We qualitatively analyzed substantive questions asked by parents during the encounter. In 30 consults, clinicians (n = 8) provided 156 instances of discussion (101 risk, 55 benefit), to which parents provided 34% active responses. Clinician discussion of risks and benefits was associated with greater parent knowledge (odds ratio [OR] = 3.70, 95% confidence interval [CI]: 2.25-6.09; P < .001), however parent active engagement was not associated with greater parent knowledge (OR = 1.04, 95% CI: 0.42-2.58, P = .93). Parents demonstrated greater knowledge of benefits than risks (χ2 = 23.16, V = 1.13; P < .001). Parents who responded actively (OR = 0.26, 95% CI: 0.09-0.72; P = .010) or had greater knowledge (OR = 0.41, 95% CI: 0.21-0.81; P = .010) had less decisional conflict. Clinician information-sharing was associated with greater parent knowledge about OSDB treatment. Greater parent engagement and knowledge were independently associated with less decisional conflict. These findings may inform clinicians' approaches to counseling and engaging parents in decisions for surgery.

Concordance of the ACR TI-RADS Classification With Bethesda Scoring and Histopathology Risk Stratification of Thyroid Nodules

Although most thyroid nodules are benign, 10% to 15% of them harbor cancer. Thyroid ultrasonography is useful for risk stratification of nodules, and American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) classification provides recommendations for fine-needle aspiration cytology (FNAC) based on objective ultrasonographic features of these nodules. To validate the concordance of ACR TI-RADS classification with Bethesda classification and histopathology. This retrospective cohort study was performed to evaluate the concordance of ACR TI-RADS classification with Bethesda classification and histopathology and was conducted in Singapore General Hospital Outpatient Otolaryngology clinic in March 2021 to May 2021. Data analysis was performed in May 2021. Results were deemed concordant when ACR TI-RADS recommendations aligned with Bethesda scores. Conversely, results were classified as nonconcordant with Bethesda scores and/or histopathology results when nodules that were recommended for FNAC yielded benign results or nodules that were not recommended for FNAC yielded malignant results. A total of 446 patients (370 women [83%]; mean [range] age, 60 [24-89] years) who underwent ultrasonography of the thyroid and ultrasonography-guided thyroid FNACs were identified. A total of 492 of 630 nodules (78.1%) were benign on FNAC (Bethesda II). Score 3 ACR TI-RADS nodules yielded the highest negative predictive values: 94.6% (95% CI, 92.9%-95.9%; P < .001) compared with Bethesda scoring and 100.0% (95% CI, 15.8%-100.0%; P = .003) compared with histopathology. Score 4 or 5 ACR TI-RADS nodules yielded positive predictive values of 2.8% and 16.2%, respectively, compared with Bethesda scoring and 6.1% and 66.7%, respectively, compared with histopathology. Small (<1.5 cm) ACR TI-RADS nodules of scores of 4 and 5 that were not recommended for FNAC yielded a malignant risk of 5.7% and 25.0% on Bethesda 5 and 6, respectively. On surgical excision, 5 of 46 (10.9%) ACR TI-RADS 4 nodules and 15 of 21 (71.4%) of ACR TI-RADS 5 nodules were confirmed to be malignant. Among nodules initially not recommended for FNAC, histopathology-proven cancer was found in 4 of 13 (30.7%) and 3 of 6 (50.0%) of nodules, respectively. These findings suggest that ACR TI-RADS score 3 nodules have a low risk of cancer and should be considered for FNAC only if nodules are 2.5 cm or larger. Patients with small (<1.5 cm) ACR TI-RADS 4 and 5 nodules should be appropriately counseled for FNAC to exclude cancer.

Local and systemic side effects of the coronanovac vaccine

Objective: Vaccines are biological products that provide protection against diseases by stimulating the immune system. Our aim in this study is to examine local and systemic side effects after inactivated coronavirus vaccination. In addition, when these side effects started, how long they lasted and their effect on daily life were evaluated. Methods: 224 healthcare workers who met the study criteria and were vaccinated against coronavirus in Adana City Training and Research Hospital were included in the study. A questionnaire prepared by us was filled in for these patients in which we inquired about the local and systemic side effects of the vaccine, the onset of side effects, their duration, whether they affect daily life, the need for drug use, and some demographic data. The survey results were evaluated with the SPSS statistical program. Local and systemic side effects were evaluated according to age, gender, allergy status, onset time, duration of effect, effect on daily life, and use of medical treatment. Results: At least one side effect was observed in 73.2% of 224 patients, while no side effects were observed in 26.8%. Being under the age of 35, being female, and being allergic increased the side effects (p:0.0027, p:0.001, p.0.031). In the logistic regression analysis, it was seen that being a woman was more effective (p.0.002). The most common local side effect was at the injection site pain was 76.2%, the most common systemic side effect was weakness 40.9%. 85.6% of local side effects and 70.4% of systemic side effects were seen in the first 24 hours. 71.3% of local side effects and 70.1% of systemic side effects lasted less than 24 hours. Conclusion: Inactivated covid-19 vaccine causes side effects in the majority of patients.In the otorhinolaryngology outpatient clinic, attention should be paid to the side effects of the coronovac vaccine in female patients under the age of 35 who have allergies.

Persistent Postural-Perceptual Dizziness (PPPD) and quality of life: a cross-sectional study.

To determine if Persistent Postural-Perceptual Dizziness (PPPD) is associated with increased burden of dizziness and quality of life. Secondly, if this association is present, to determine if it can be explained by differences in anxiety and/or depression between patients with PPPD and dizzy patients without PPPD. Cross-sectional study performed in an outpatient otolaryngology clinic, including patients 18-67years referred from primary care for suspected vestibular disease with chronic dizziness. Patients underwent clinical examination and completed the following questionnaires: Dizziness Handicap Inventory (DHI), RAND-12 Health Status Inventory and Hospital Anxiety and Depression Scale (HADS). Scores in DHI and RAND-12 were compared between patients diagnosed with PPPD and patients without PPPD. 202 patients were included. 150 (74%) were women and 37 (18%) were diagnosed with PPPD. Patients in the PPPD group had increased burden of dizziness and reduced quality of life (QoL) as shown by a higher mean DHI score (49.2 vs. 30.8; p < 0.001) and reduced mean RAND-12 physical score (39.0 vs. 44.6; p = 0.004). After adjusting for age, gender and HADS, PPPD was associated with a 15.3 (p < 0.001) points increase in DHI score, and a 4.0 (p = 0.020) points decrease in RAND-12 physical score. Patients with PPPD have a higher burden of dizziness and a lower physical health-related quality of life (HRQoL) compared to other dizzy patients. The difference was evident also after adjusting for anxiety and depression, illustrating how PPPD is a different entity than these common psychiatric conditions.

The Trend of the Burden of Allergic Rhinitis Pre- and Post-COVID-19 Pandemic in the Urban Population of Perak, Malaysia.

This study aims to determine the trend of allergic rhinitis (AR) prevalence in a tertiary hospital between 2017 and 2022, and to compare its prevalence pre- and post-COVID-19 pandemic. This was a cross-sectional study involving the extraction of all Malaysian patients' medical records who were diagnosed with AR and attended the otorhinolaryngology outpatient clinic of a government-funded tertiary hospital in Malaysia between 2017 and 2022. 3,744 cases out of the 57,968 first-encounter outpatient visits to the otorhinolaryngology clinic were extracted for analysis. Overall, the prevalence of AR cases ranged from 1.83 to 9.23% between 2017 and 2022. There was a significant drop of 21.38 to 70.22% between the pre- and post-COVID-19 pandemic (p < 0.001). Males (0.34 to 1.60%) were more prevalent in the 6 to 18 year old than females (0.09 to 1.23%). The trend shifted with age, whereby females (0.50 to 2.45%) experienced a higher prevalence than males (0.21 to 1.77%) as they aged from 19 to 59. The Malay (1.01 to 4.59%) demonstrated a two-time higher prevalence than the Chinese (0.30 to 2.01%) and Indian (0.40 to 2.14%) ethnicities. After stratifying by gender and ethnicity, Indian women (0.17 to 1.09%) had a higher rate of AR than their Chinese counterparts (0.12 to 0.99%) across all years. The AR prevalence consistently ranged from 8.14 to 9.23% pre-pandemic. A remarkable drop was observed post-pandemic, ranging from 1.83 to 6.40%. A gender shift from male to female predominance as age progressed. The Malay had the highest prevalence of AR.

Early Diagnosis of Central Disorders Mimicking Horizontal Canal Cupulolithiasis

Horizontal Canal Cupulolithiasis (hc-BPPV-cu) can mimic a pathology of central origin, so a careful examination is essential to prevent misdiagnosis. Retrospective cross-sectional cohort study of 45 patients suffering from suspected hc-BPPV-cu. We recorded whether patients first presented through an ENT Emergency Department (ED) or through an Outpatient Otolaryngology Clinic (OC). We found statistically significant differences (p < 0.05) between the OC versus the ED in relation to the time between symptom onset and first assessment (79.7 vs. 3.6 days, respectively), the number of therapeutic maneuvers (one maneuver in 62.5% vs. 75.9%, and more than one in 25.1% vs. 13.7%), and multi-canal BPPV rate (43.8% vs. 3.4%). hc-BPPV-cu did not resolve in 2 patients (12.5%) from the OC and in 3 (10.3%) from de ED, all of which showed central pathology. There are no prior studies that analyze the approach to hc-BPPV-cu in the ED. The benefits of early specialist input are early identification of central positional nystagmus, a decrease in symptom duration, reduced number of therapeutic maneuvers required for symptom resolution, and lower rates of iatrogenic multi-canal BPPV. A comprehensive approach to hc-BPPV-cu in the ED allows both more effective treatment and early identification of central disorder mimics.

The effects of the COVID-19 pandemic on pediatric patients with otitis media with effusion

Otitis media with effusion (OME) is a frequently self-limiting middle ear fluid accumulation. During the COVID-19 pandemic, there was a decrease in patient referrals to pediatric Otorhinolaryngology (pENT) outpatient clinics. The aim of this study was to compare the patients who presented at our pENT outpatient clinic with OME during the pandemic with patients who presented during the equivalent period before the pandemic, and to investigate the effects of pandemic measures on OME. The study included patients aged 1-15 years who presented at the pENT Outpatient Clinic due to OME. Four groups were created based on the date of March 2020, when the first COVID-19 case was recorded in Turkey. The groups were formed as one for each year from March 2018 to March 2022. The total number of patients admitted to the pENT outpatient clinic was recorded. Group 1 (March 2018-March 2019) included 1338 patients diagnosed with OME, which constituted 12% of the total number of patients. Group 2 (March 2019- March 2020) included 1238 patients, Group 3 (March 2020-March 2021) 241 (8%), and Group 4 (March 2021-March 2022) 432 (9.4%). From this study, it was observed that the greater attention paid to the mask, social distance and hygiene rules during the COVID-19 pandemic, and the implementation of distance education decreased the frequency of upper respiratory tract infections, and had a positive effect on the number of OME cases.

A pyocele of the frontal sinus as a complication of chronic sinusitis – a case report

Introduction: Pyocele is a rare complication of sinusitis that is usually associated with stenosis of the ostium of the sinus caused by inflammation, trauma. Case report: A 68-year-old woman was admitted to the Otolaryngology Clinical Department of the University Hospital in Krakow, Poland because of a tumor of the right frontal bone which was painful during palpation. In anamnesis the patient reported previous laryngological surgeries associated with the treatment of chronic sinusitis. The conducted medical imaging presented the destruction of the walls of both the right and left frontal sinuses caused by pathological changes penetrating to the orbit and adhering to the dura mater. The clinical and radiological picture suggested the diagnosis of empyema of the paranasal sinus (pyocele). The patient was scheduled for bilateral endoscopic frontoethmoidectomy and the surgery ended without complications. Nowadays, the patient remains under follow-up in the outpatient otolaryngology clinic. Discussion: The main disease entity, which should be included in the differential diagnosis of pyocele is the retention cyst of the sinus. The vast majority of pyocele cases are caused by superinfection of a mucocele by bacteria (in the described case the bacterial culture of the lesion content revealed the presence of Citrobacter koseri). An efficient and sufficient method of treatment of pyocele of paranasal sinuses is their endoscopic drainage. Conclusion: In the diagnosis of pyocele, the most important are data from anamnesis, physical examination and results from computed tomography and magnetic resonance imaging. Treatment is mainly based on properly performed surgery, pharmacotherapy and consecutive rehabilitation. Endoscopic surgery is an effective procedure and its early use often prevents serious complications resulting from the expansion of the lesion.

Telemedicine in an Otolaryngology Clinic Serving the Incarcerated Population.

There is a paucity of data investigating the effect of implementation of telehealth on vulnerable populations, particularly the incarcerated. Our objective is to evaluate patient and physician satisfaction with telehealth (telephone visits) used in an outpatient otolaryngology clinic serving the incarcerated population. Incarcerated patients who were served by otolaryngologists via telephone visits from a large tertiary care center from June 2021 to January 2022 were included (n = 20) in this pilot study. Patient and physician satisfaction with the encounters were evaluated using the Telehealth Satisfaction Questionnaire and a modified physician satisfaction questionnaire, respectively. Consultations for various otolaryngological complaints were completed via telephone for incarcerated patients including hearing loss, tinnitus, facial fracture, dysphonia, and tonsillitis. Mean patient and physician satisfaction scores were high at 4.25 ± 0.12 and 4.65 ± 0.13 respectively (score range 1-5). Patient satisfactions subdomain scores were 3.92 ± 0.13 for quality of care provided, 3.99 ± 0.13 for similarity to face-to-face encounter, and 4.2 ± 0.17 for perception of the interaction. Imaging or audiogram was available prior to appointment in 60% of cases, with labs, imaging, or audiogram ordered after in 40% of cases and initial pharmaceutical treatment provided to 10% of patients. 45% of patients required follow up in-person, while 40% were discharged pro re nata, and 15% were followed up with another phone visit. There was no statistically significant association between demographic or clinical characteristics and patient or physician satisfaction scores. Consultations for various otolaryngological complaints were completed via telephone with high patient and physician satisfaction within an incarcerated population in this pilot study. Telephone visit is likely a feasible alternative format that can advance otolaryngological care. Studies with larger sample sizes are required to ensure quality of care and advance social justice for this chronically underserved population.

Seroprevalence of Francisella tularensis in patients with neck mass complaints

Aim: Tularemia is a zoonotic disease endemic in the northern hemisphere. The causative agent of the disease is Francisella tularensis. F.tularensis is endemic in Turkey, predominantly in the Marmara and Black Sea regions, and causes small outbreaks. This study aimed to investigate the seroprevalence of F.tularensis in patients admitted to the Otorhinolaryngology outpatient clinic with the complaint of neck mass by using two different methods.Methods: Serum samples were collected from patients who were admitted to the Otorhinolaryngology outpatient clinic of Dicle University Faculty of Medicine Hospitals between January 2021 and December 2021 with the complaint of neck mass. A commercially available immunochromatographic lateral flow test (ICT) and a single-assay chemiluminescence test (CHT) were used to detect F.tularensis antibodies. Rose-Bengal test was performed on all sera to determine cross-reactions with antibodies produced in brucellosis. Brucella immunocapture agglutination tests (BCT) were performed on the sera of patients with positive screening tests.Results: The ages of patients diagnosed with neck mass ranged between 14–70 years, with a mean age of 44.5±12.1 years. Sixty two (62%) of the patients were male, and 38 (38%) were female. When the test results were evaluated, two sera were positive for F.tularensis by both ICT and CHT methods. The first serum tests were negative for Brucella. The titer of the second serum in the chemiluminescence test was low positive.Conclusion: Tularemia should be considered in the differential diagnosis of patients presenting with neck mass complaints, especially in patients living in rural areas, and specific diagnostic tests should be performed. In addition, a more comprehensive seroprevalence study supported by molecular testing techniques to be conducted in Diyarbakır will provide clearer data on the extent to which tularemia affects our region and which subspecies is the causative agent.

Caudal Septal Deviation Surgical Techniques

Background: Caudal septal repair is hard to confront in otolaryngology and plastic surgeon, due to cartilage memory. It causes nasal obstruction or esthetical problems to the nasal base and columella. Although different modalities have been described for the treatment of this abnormality, these techniques not only improve the function but also preserve or improve the appearance of the nose. Objective: The objective was to discuss the different surgical conservative procedures that can be used to treat alterations of the caudal septum and change the position of the cartilage in the midline and find which is the best. Patients and Methods: A descriptive study was conducted on 40 patients who aged 20–40 years, had attended the Otolaryngology Outpatient Clinic in Al Karama Teaching Hospital, Baghdad, Iraq, between October 2016 and March 2020, and with a history of obstructed nose; conservative nasal septal surgery was done for them depending on the severity. Results: Regarding the result of the type of surgery, the patients were satisfied with their esthetic and functional perfection; patients with preoperative nasal obstruction reported improved breathing. In scoring technique with (NOSE) score pre and postoparative results were 58.21 and 22.66, in reshaping technique were 60.66 and 17.21 as a pre and postoparative results and in batten graft the results were 62.34 and 20.26 as a pre and postoparative results alternatively. Reshaping and batten graft techniques are better results than the scoring technique. Conclusion: The study outcomes that the approaches for improvement of caudal septal deviation are safe and effective. The approach of surgery will depend on the severity of the deviation.