Pediatric Tracheotomy: A Relatively Rare Indication Limited to Pediatric Intensive Care Subjects?

Objective:To evaluate indications, underlying conditions and outcome in pediatric tracheotomy subjects.Methods:Between January 2004 and September 2013, pediatric subjects who underwent a tracheotomy operation were included for study. All subjects were under the age of 14. Subjects’ primary diseases, indication of tracheotomy, age, gender and type of complications were recorded.Results:Forty five subjects were identified. The mean age of subjects was 26.3 months (range between 2 to 140 months). Twenty one (46.6%) subjects were under the age of 1 year. In 34 (75.5%) out of 45 subjects, tracheotomy indication was prolonged intubation. In the remaining 11 (24.4%) subjects, tracheotomy indication was upper respiratory tract obstruction. Thirteen (n=13- 28.8%) out of 45 experienced early complications and 2 (n=2-4.5%) out of 45 subjects experienced late complications. One tracheotomy related death occurred in the immediate period. Eight (18.1%) of subjects died during the study period from underlying conditions. Decannulation was successfully performed in 13 (36.1%) subjects. In the remaining 23 (63.8%) subjects, decannulation could not be done.Conclusion:All tracheotomies in this report were performed on pediatric intensive care subjects on an elective basis. No tracheotomy was performed for acute upper airway obstruction. Even when planned and elective tracheotomy is performed it still has significant mortality and morbidity

Hypothyroidism in Children with Serous Otitis Media

Objective:In this study, we aimed to evaluate the co-existence and prevalence of hypothyroidism in patients with otitis media with effusion (OME) and to determine the possible relationship between OME and hypothyroidism.Methods:The subject group consisted of 46 paediatric patients (26 boys, 20 girls), ranging in age from 4 to 14 years (mean age±SD 7.78±2.86 years), who were treated in the department of otorhinolaryngology for OME; the control group composed of 30 healthy children (20 boys, 10 girls), ranging in age from 3 to 14 years (mean age±SD 7.20±2.86 years). Triiodothyronine (Free T3), thyroxin (free T4), and thyroid-stimulating hormone (TSH) values of 46 children who were treated for OME, in addition to 30 healthy children, were evaluated.Results:Seven patients (15.2%) in the OME group, and one patient (3.3%) in the control group had subclinical hypothyroidism marked only by serum TSH elevations. All of the children in this study, regardless of whether from the subject or control group, had normal serum free T3 and free T4 levels. There was no significant difference between subject and control groups (p>0.05).Conclusion:Although there was no statistically significant difference between subject and control groups in this study, further studies with larger patient groups are needed to investigate the role of hypothyroidism in the aetiology of OME

Nowy marker hematologiczny dla idiopatycznych szumów usznych: współczynnik monocyty/HDL

Cel: Celem niniejszego badania było zbadanie związku, o ile on istnieje, między wartością MHR a idiopatycznym szumem usznym. Projekt badania: Prospektywne badanie kliniczno-kontrolne. Materiał i metody: Do badania włączono 89 pacjentów (grupa badana), u których od marca 2015 roku do czerwca 2016 roku w ambulatorium przyklinicznym zdiagnozowano idiopatyczne szumy uszne oraz 87 zdrowych osób, które zgłosiły się do szpitala w celu przeprowadzenia rutynowego badania lekarskiego i uzyskały prawidłowe wyniki badania audiometrycznego i otoskopowego (zdrowa grupa kontrolna). Próbki krwi pobierano od pacjentów podczas pierwszego badania. Współczynnik HDL (MHR – Monocyte/HDL rate) uzyskano przez prosty podział liczby monocytów przez poziom HDL. Współczynniki MHR uzyskane dla obu grup poddano analizie statystycznej. Wyniki: Liczba monocytów i wartość MHR były większe w grupie badanej, a poziom stężenia HDL był niższy w porównaniu z grupą kontrolną (p<0,05). W niniejszym badaniu wartość odcięcia dla MHR w odniesieniu do szumów usznych ustalono na 11. Wniosek: Współczynnik MHR okazał się wysoki u pacjentów z idiopatycznymi szumami usznymi. Uzyskany wynik wskazuje na udział zdarzeń miażdżycowych i stresu oksydacyjnego w etiologii szumów usznych

A New Hematological Marker for Idiopathic Tinnitus: Monocyte/HDL ratio

Aim: The aim of this study was to evaluate the association between the monocyte/HDL ratio (MHR) and idiopathic tinnitus. Study Design: Retrospective case-control study. Material-method: Eighty-nine patients with idiopathic tinnitus diagnosed on an outpatient basis between March 2015 and June 2016 and 87 healthy individuals who presented to our hospital for a routine health examination and had normal audiometry and otoscopy results were included in the study. Blood samples were obtained from patients during the first examination. The MHR was calculated as the ratio of the monocyte count to the HDL level. MHR ratios were compared statistically between the groups. Results: The monocyte count and the MHR were higher and HDL was lower in the study group compared to the control group (p< 0.05). The cut-off value of MHR for diagnosing tinnitus was 11. Conclusion: The MHR ratio was high in patients with idiopathic tinnitus, which supports the fact that atherosclerotic events and oxidative stress are implicated in the etiology of tinnitus

Transoral Robotic Approach for Schwannoma of the Larynx

We present a rare case of schwannoma of the supraglottic larynx in a 30-year-old woman with a 5-year history of dysphonia. Excision of the mass was performed by transoral robotic surgery (TORS) without complication using the robotic da Vinci Surgical System, 0-degree three-dimensional endoscope, 5-mm microinstruments compatible with the da Vinci robot, and an FK retractor. Transoral robotic surgery rendered good exposure that allowed complete tumor resection. An external approach and tracheotomy were not necessary in this case. We found that TORS was practicable, efficient, and nonhazardous for the resection of a supraglottic schwannoma. We propose TORS for the treatment of large benign and selected malignant laryngeal tumors

Forensic Age Estimation by Spheno-Occipital Synchondrosis Fusion Degree: Computed Tomography Analysis

The analysis of ossification points plays a considerable role in forensic age estimation. Although traditional methods are still in use, researchers are working on different age estimation procedures especially within the development of radiologic methods. One of these methods is to define spheno-occipital synchondrosis fusion degree. Spheno-occipital synchondrosis, an important growth point on cranial base, provides noteworthy information about age estimation through its late stage ossification nature. This study aimed to investigate spheno-occipital synchondrosis fusion degree for age estimation in the Turkish population. In our study, 1-mm-sectioned computed tomography images of 638 (399 men and 139 women) subjects within the age of 10 to 25 years were retrospectively examined. It is stated in our study that spheno-occipital syncondrosis fusion begins superiorly and progresses inferiorly until it is completed. Spheno-occipital syncondrosis is known to be totally open at the mean (SD) age of 11.5 (1.5) years in men and 10.7 (0.8) years in women. In addition, fusion degree is known to be increased with age. Fusion starts approximately 2 years earlier in women than in men, and the process of fusion completes at the age of 17 years in both sexes. An analysis of fusion degree between sex groups showed significance at the age of 11 to 15 years, and Spearman rank correlations indicate a significant positive relationship between age and degree of spheno-occipital fusion (P < 0.001; men, rho = 0.714; women, rho = 0.698). Consequently, 5-staged analysis of spheno-occipital synchondrosis fusion degree in use with 1-mm computed tomography images will be helpful for age estimation between 11 and 17 years

Którą z metod diagnostycznych należy stosować w celu rozpoznawania przerostu migdałka gardłowego u dzieci w poszczególnych grupach wiekowych?

Aim: This study aims to determine the age interval for which the flexible nasopharyngoscopy (FNP) and lateral nasopharyngeal X-ray radiography (LNX) used in the diagnosis of adenoid hypertrophy more effectively in a pediatric population. Study Design: Prospective Cohort Study. Materials and Methods: 281 pediatric patients (1 to 15 years old) who were admitted to our ENT outpatient clinic with the complaints of nasal obstruction, snoring, sleep apnea through April 2016 and February 2017 and who were examined with FNP with the pre-diagnosis of adenoid hypertrophy were included in our study. All FNP examinations were evaluated by a single physician. The degree of choanal obstruction was recorded as percentage (%) with the help of the adenoid tissue image. The patients were divided into four groups according to the quality of the endoscopic examination performed during FNP examination; optimal assessment (group-1), assisted optimal assessment (group-2), assisted suboptimal assessment (group-3), and inability to assess despite assistance (group-4). LNX was performed for the re-evaluation of adenoid tissue in the patients in Group-3 and 4. Statistical analysis was performed among the groups according to the ages of the patients. Results: Optimal images were obtained with FNP in the patients aged between 1 and 2 years and 8-15 years and the expected images were obtained for choanal obstruction. However, no image could be obtained with FNP for assessment of choanal obstruction in more than 30% of patients between the ages of 3 and 8 years (31.2% and 33.3%, respectively), also in more than 50% of the patients who were 4,5,6 and 7 years old (60.6%, 56.7%, 55.8%, 66 , 6%, respectively). For this reason, their degrees of choanal obstruction were determined with LNX. Conclusion: For the optimal assessment of adenoid hypertrophy, we suggest that using LNX for the pediatric patients who are 4, 5, 6 and 7 years old and using FNP for the other age groups are more appropriate methods respectively in order not to disturb the polyclinic process of physician and for patient compliance

Follow-up results of newborns after hearing screening at a training and research hospital in Turkey

WOS: 000384907700010PubMed ID: 27340984OBJECTIVE: This study aimed to present the follow-up results of newborns after universal newborn hearing screening at a Training and Research Hospital in Istanbul and to determine the ages of diagnosis, hearing aid fitting, and cochlear implantation in newborns with hearing loss. MATERIALS and METHODS: A total of 5985 newborns were screened between December 2009 and August 2011 using the transient evoked otoacoustic emission test as the first two steps and automated auditory brainstem response (ABR) test as the third step. Newborns who failed the screening tests were referred to a tertiary hospital for clinic ABR and were followed up at least for 2 years. RESULTS: Of 5985 newborns, 5116 (85.5%) completed the screening. Of 53 newborns who were referred to a tertiary hospital, 13 (0.25%) had a hearing impairment. The mean age of diagnosis, hearing aid fitting, and cochlear implantation were 6.1, 9.5, and 24.5 months, respectively. Among the risk factors for hearing impairment, neonatal intensive care (60%) and consanguineous marriage (50%) were the most common ones that were encountered. CONCLUSION: Our results were consistent with the national literature. Consanguineous marriage may be a risk factor for hearing impairment where it is commonly practiced because consanguineous marriage is significantly high in parents of deaf children. The ages of diagnosis and hearing aid fitting are still beyond the recommended ages by the Joint Committee on Infant Hearing

Timely management of penetrating neck trauma: Report of three cases

In head and neck surgery, penetrating neck injuries are uncommon. The neck contains many important structures, so such trauma can cause significant morbidity and mortality. A patient with penetrating neck trauma should be examined promptly in the emergency room. If possible, damaged tissue and organ fragments should be preserved carefully