Hakan Birkent

Primary parotid tuberculosis mimicking parotid neoplasm: a case report.

IntroductionTuberculosis of the parotid gland is a rare clinical entity which causes some difficulties in diagnosis because of the similarities in presentation to that of a neoplasm. Diagnosis mainly relies in the treating physician having a high index of suspicion. The diagnosis is generally overlooked by otolaryngologists and most cases are undergoing unnecessary surgery.Case presentationA 20-year-old male presented with a mass in the right parotid region. The mass had been present for one year. Physical examination revealed a mobile, non-tender mass occupying the superficial lobe of the right parotid gland. Radiologic investigations revealed a well-defined, solid, mass lesion located in the posterior part of the superficial lobe of the right parotid gland. A provisional diagnosis of a neoplasm of the parotid gland was made and a right superficial parotidectomy was performed. Histopathologic examination of the specimen was reported as tuberculosis of the parotid gland. The patient was commenced on antitubercular chemotherapy.ConclusionAlthough rare, tuberculosis should be kept in mind and considered in the differential diagnosis of patients presenting with a solitary tumor in the parotid gland in order to avoid unnecessary surgery.

Prospective study of voice outcomes and patient tolerance of in‐office percutaneous injection laryngoplasty

In‐office percutaneous injection laryngoplasty is a common treatment for glottal insufficiency. Our objective was to prospectively study voice outcomes and patient tolerance of the procedure.

Dosage changes in patients with long-term botulinum toxin use for laryngeal dystonia

OBJECTIVE: To investigate the dosage consistency of botulinum toxin injections in patients with long-term treatment for laryngeal dystonia. STUDY DESIGN: Chart review. SUBJECTS AND METHODS: Patients with laryngeal dystonia who had received at least 20 injections to the thyroarytenoid muscle were selected. Change of botulinum toxin dose, patient-reported effective weeks, and intervals between injections were investigated; data from the first five injections were excluded to eliminate initial dose titration. RESULTS: Fifty-five patients with an average follow-up of 12.5 years were identified. Mean dose of botulinum toxin was 2.37 ± 1.6 U at the sixth injection; there was a decrease in mean dose over time, which became statistically significant at the 13th injection with a mean dose of 2.02 ± 1.16 U. Mean duration of good effect and treatment intervals showed no significant change over time. CONCLUSION: Botulinum toxin dose needed for a constant response in treatment of laryngeal dystonia decreases over time, without any accompanying change in effective weeks and intervals.

Relationship between nasal cavity volume changes and nasalance

OBJECTIVES The patency and volume of the nasal cavity affect the acoustic characteristics of the voice. The aim of this study was to investigate the effect of a nasal decongestant on nasal volumes and nasalance scores, and to determine the relationship between these measures. METHODS Acoustic rhinometry and nasometry were performed in a group of 21 adult volunteers both prior to and following application of a nasal decongestant. The relationship between changes in nasalance scores and acoustic rhinometric parameters was investigated. RESULTS After the application of nasal decongestant, statistically significant increases were observed in nasalance scores and in all of the acoustic rhinometric parameters assessed (i.e. minimal cross-sectional area, three cross-sectional areas, three volumes and total volume). However, no significant correlation was found between the changes in nasalance scores and acoustic rhinometric parameters. CONCLUSIONS Nasal decongestion causes an increase in nasalance scores and nasal cavity volumes. However, the findings of this study indicate that changes in nasalance scores may result from factors other than nasal cavity volume changes.

Nasalance scores for normal-speaking Turkish population.

ObjectiveThe aim of this study was to obtain normative nasalance scores for adult and children subjects speaking Turkish language and obtain a reference for normality when nasality is evaluated. MethodsMean nasalance scores were obtained from 35 normal-speaking children aged 7 to 13 years, and 125 adults aged 18 to 69 years during the repetition of 3 nasalance passages that were categorized according to the amount of nasal consonants (oral, oronasal, and nasal passages). The Nasometer (model 6400) was used to obtain nasalance scores for the 3 reading passages. ResultsGroup mean ± SD nasalance scores of children for oral passage, oronasal passage, and nasal passage were 15.14 ± 4.81, 37.76 ± 4.42, and 49.23 ± 6.95, respectively. Nasalance scores for the adult group were 13.46 ± 6.26, 37.84 ± 6.13, and 50.28 ± 7.77, respectively. There were significant differences in mean nasalance scores for oral versus nasal materials both for children and adult groups. ConclusionsThe present study provides normative nasalance scores for Turkish-speaking children and adults. The results indicated acceptable differentiation between oral and nasal materials.

SUBMANDIBULAR TRIANGLE MASSES

Objective The study aims to analyze the demographic data of a large case series operated on because of submandibular triangle mass for more than 10 years and presents a review of the literature. Materials and Methods The charts of patients who underwent surgical intervention for submandibular triangle mass between January 2000 and November 2010 were reviewed. The medical history, age, sex, duration of symptoms, clinical presentation, preoperative investigations, and histopathologic diagnosis were reviewed. Results The study included 66 subjects; 12 patients (18.2%) with submandibular sialolithiasis, 18 patients (27.2%) with sialadenitis, 10 patients with lymphadenitis (15.1%), and 26 patients (39.3%) with tumors. Of the tumors, 23% was malignant and 77% was benign. Benign tumors of submandibular gland comprised 22.7% and malign tumors of submandibular gland comprised 3% of all submandibular mass. The most common benign tumor was pleomorphic adenoma. The most frequent histopathologic diagnoses of submandibular masses originated from the submandibular gland, and these comprised 71.2% of all submandibular mass pathologies. The main symptom was a painless mass. Ultrasonography was the most common preoperative diagnostic procedure. Fine-needle aspiration biopsy was performed in 26 patients. A clear diagnosis could not be provided in 3 (12%) patients. Conclusion Infectious conditions and benign tumors are more frequent than malign tumors in the submandibular region. The histopathologic diagnoses mainly consisted of submandibular sialadenitis, sialolithiasis, pleomorphic adenoma, and lymphadenitis. Ultrasonography is the first option of radiologic evaluation. Fine-needle aspiration biopsy is a very useful and usually sufficient diagnostic procedure for histopathologic diagnosis. Excisional biopsy can be performed when the fine-needle aspiration biopsy failed.

Prospective Study of the Impact of Thyroid Hormone Replacement on Objective Voice Parameters

Objectives: Hypothyroidism has long been considered to have an impact on phonation. In this study, objective evaluation of vocal function in women with hypothyroidism was performed in order to characterize potential dysphonia; their subsequent response to thyroid hormone replacement was prospectively studied. It was hypothesized that thyroid hormone replacement therapy in this cohort would have an objectively measurable impact on vocal function. Methods: Prospective evaluation of objective voice parameters and concurrent determination of serum thyroid status was executed both before and after thyroid hormone replacement in a cohort of patients who had had total thyroidectomy. Objective voice parameters before and after treatment were compared. Results: Twenty-four female subjects were recruited over an 18-month period. After surgery, all subjects were hypothyroid (mean thyroid-stimulating hormone level, 81.38 mIU/L; range, 25.26 to 100.00 mIU/L) before replacement. After hormone therapy, their mean thyroid-stimulating hormone level dropped to 1.20 mIU/L (range, 0.28 to 3.83 mIU/L). The mean fundamental frequency significantly increased from a pretreatment average of 223.48 ± 36.10 Hz to 237.64 ± 38.81 Hz. Other measured voice parameters (jitter, shimmer, amplitude perturbation quotient, pitch perturbation quotient, noise-to-harmonics ratio, and maximum phonation time) were not affected. Conclusions: Thyroid hormone replacement therapy following total thyroidectomy has a measurable impact on mean fundamental frequency in female patients. The mechanism of this effect is not known.

Airway and Respiration Parameters Improve Following Vocal Fold Medialization: A Prospective Study.

Objectives/Hypothesis: Laryngeal medialization procedures such as injection laryngoplasty (IL) and thyroplasty type 1 (TT1) are standard techniques for the treatment of glottic insufficiency related to unilateral vocal fold paralysis (UVFP). These procedures reliably improve the voice and may also improve swallowing function. Despite the association of laryngeal paralysis with airway regulation, there is little published on the effect of UVFP and its surgical treatment on respiration. The aim of this prospective study was to evaluate the aerodynamic outcomes of UVFP patients before and after vocal fold medialization, either by IL or TT1. Methods: Consecutive patients with dysphonia due to UVFP were included in this prospective study between 2012 and 2014. Nineteen patients were investigated (5 females, 14 males) with a mean age of 37.05 ± 17.8 years. Eight patients were treated by IL while 11 patients received TT1. The patients were subjected to Modified Medical Research Council (MMRC) and Borg dyspnea scales, maximum phonation time (MPT) measurement, spirometry, and cycle ergometry, pre- and postoperatively at 2 months. Results: There was a statistically significant increase in MPT from 5.5 ± 3 seconds to 11.2 ± 4.9 seconds postoperatively (P < .001). The MMRC and Borg dyspnea scales also showed significant improvement postoperatively (P < .001, P = .006, respectively). The change in spirometric parameters (peak expiratory flow, forced expiratory volume in 1 second, forced vital capacity, and peak inspiratory flow) were nonsignificant, while there was a significant improvement in cycle ergometry test postoperatively (P = .018). Conclusion: Laryngeal medialization procedures such as IL and TT1 improve UVFP patients’ respiration-related quality of life and aerodynamic performance with no significant changes in spirometry.

Influence of age and gender on dose and effectiveness of botulinum toxin for laryngeal dystonia

To evaluate the influence of age and gender on the required dose and resulting efficacy of botulinum toxin injection for adductor laryngeal dystonia.

Impact of patient-related factors on the outcomes of office-based injection laryngoplasty

In‐office percutaneous injection laryngoplasty (IL) is a common treatment for glottal insufficiency. The objective of this prospective study was to determine if voice outcomes from IL are affected by age, gender, or initial disease severity.