Respiratory problems and associated factors following endoscopic balloon dilatation procedure in children with acquired subglottic stenosis.

OBJECTIVES: Endoscopic balloon dilatation (EBD) offers a safe and non-invasive surgical option for the treatment of subglottic stenosis. Patient selection is important to achieve good results and to detect which patients are more prone to the development of complications. The aim of this study was to determine predictors of postoperative problems and early complications in primary EBD surgeries. METHODS: A retrospective analysis was made of patients with acquired subglottic stenosis who were operated on with the EBD technique between January 2010 and December 2019 in the Otolaryngology-Head and Neck Surgery Department of Baskent University Hospital. Demographic data including the age and sex of the patients were collected together with etiology, presence of chromosomal or craniofacial anomaly (C/CA), duration of prolonged intubation (DPI), and extubation dilatation timeframe (EDT). Intra and postoperative follow-up data were recorded of the need for intubation or tracheotomy, development of desaturation, and grade and type of stenosis. RESULTS: The male to female ratio was 2:1. The patients comprised 42 males and 22 females with a mean age of 296.52 ± 551.93 days. The cause of prolonged intubation was surgery for congenital heart disease in 50 (78.1%) patients and prematurity in 14 (21.9%). The type of lesion was acute granulation in 44 (72.1%) and chronic granulation in 17 (27.9%) patients. C/CA was determined in 13 patients, the mean grade of stenosis was 76.33 ± 15.21%, mean DPI was 25.25 ± 35.49 days, and mean EDT was calculated as 78.23 ± 373.82 days. Desaturation following endoscopic balloon dilatation developed in 26 (40.6%), orotracheal intubation was required in 10 (15.6%), tracheotomy in 10 (15.6%), and cardiopulmonary arrest occurred in 4 (6.25%). Prematurity, a longer duration of preoperative intubation, longer time from extubation to dilatation, older age, and higher grade of stenosis were determined as factors associated with postoperative early respiratory complications. CONCLUSION: EBD indication should be carefully considered in children with acquired subglottic stenosis. To achieve better results and minimise complications, EBD should be performed without delay.

The Role of Nutritional and Dietary Habits in Etiology in Pediatric Vocal Fold Nodule.

OBJECTIVES: In pediatric pediatric vocal fold nodule (VFN) patients, different causes have been suggested in the development of the vocal cord nodule, including laryngopharyngeal reflux (LPR). It is known that the content of consumed foods, obesity, and other dietary behaviors are among the risk factors for the development of reflux. The aim of this study was to evaluate dietary and food consumption habits in pediatric VFN patients. METHODS: This prospective-controlled study included 50 children with VFNs (age range 5-14 years) and 50 age-matched children without any voice disorders as a control group. BMI values of each participant were evaluated according to age-percentile range. The voice usage habits and personality structure of all the children were questioned. All patients underwent laryngeal examination and voice analysis. The Turkish Pediatric Voice Handicap Index (t-PVHI) and Child Voice Handicap Index-10 (t-CVHI) were completed by patients or their parents. The examination findings of all patients were evaluated with the reflux finding score (RFS), and their complaints were questioned with the reflux symptom index (RSI). In addition, eating and drinking at night, fast eating and excessive food consumption habits and the frequency of consumption of packaged foods defined as junk food, carbonated beverage were questioned. The data obtained were compared statistically between the two groups. RESULTS: There was no significant difference between the study and control groups in terms of age, gender distribution, median BMI value, voice usage habits, and personality structure. In the study group, t-PVHI, t-CVHI, jitter, schimmer values, the mean RFS, and RSI scores were significantly higher than those of the control group. The number of children with high consumption of junk food and carbonated drinks was higher in the study group. There was no significant difference between the two groups in terms of dietary habits. CONCLUSION: Food consumption habits may play a role in childhood voice problems in this population.

Evaluation of Oropharyngeal Dysphagia in Elderly Patients with Pharyngeal Aberrant Internal Carotid Artery Using the Eating Assessment Tool-10 (EAT-10).

Pharyngeal aberrant internal carotid artery (PAICA) has been reported to be a cause of oropharyngeal dysphagia (OD) in case reports. However, as there have been no clinical studies, the relationship between PAICA and OD is not clear. The aim of this study was to investigate the perception of OD in elderly PAICA patients using the Eating Assessment Tool-10 (EAT-10). A study group (Group 1) was formed of patients diagnosed with PAICA from the visualization of a pulsatile mass in the pharynx in flexible fiberoptic endoscopic examination and carotid magnetic resonance angiography tests, and a control group (Group 2) was formed of age-matched healthy volunteers. The study group was subdivided as patients with unilateral PAICA (Group 1a) and patients with bilateral PAICA (Group 1b). The Turkish version of the EAT-10 was applied to all the participants. Total EAT-10 points of ≥ 3 were accepted as abnormal. Normal (< 3) and abnormal (≥ 3) total EAT-10 points were determined in 88.9% (24/27) and 11.1% (3/27), respectively, of the control group, in 55.2% (16/29) and 44.8% (13/29) of Group 1, in 70.6% (12/17) and 29.4% (5/17) of Group 1a, and in 33.3% (4/12) and 66.7% (8/12) of Group 1b. A statistically significant difference was determined between the control group and Group 1 and Group 1b in respect of abnormal (≥ 3) EAT-10 total points (p = 0.007, p = 0.001, respectively). No statistically significant difference was determined between the control group and Group 1a (p = 0.227). Problems (EAT point ≥ 1) in item 4 (swallowing solids takes extra effort) were experienced by 13 (44.8%) patients in Group 1, 9 (75%) patients in Group 1b, and 5 (18.5%) subjects in the control group (p < 0.05). These results demonstrated that unilateral PAICA does not significantly affect swallowing, whereas bilateral PAICA created a significant negative effect. These patients experience more problems when swallowing solid food.

Reliability and Validity of the Turkish Version of the Glasgow-Edinburgh Throat Scale: Use for a Symptom Scale of Globus Sensation in Turkish Population.

OBJECTIVE: In this study, we aimed to translate the Glasgow-Edinburgh Throat Scale (GETS) into Turkish and test its reliability and validity. METHODS: A total of 69 patients with globus sensation and no signs of otolaryngologic or gastroenterological disease in etiology were included in the study. The patients were asked to complete the translated Turkish version (GETS-T) of GETS and the Hospital Anxiety and Depression Scale (HADS). RESULTS: The Cronbach's alpha coefficient of the patients in the study group was calculated based on the 12 questions in the GETS-T scale and found as 0.868. The correlation between the GETS-T total score and the total HADS score in the study group was found to be very low and statistically insignificant. As a result of factor analysis, it was found that the first 10 problems in GETS-T were divided into two sub-groups, unlike GETS. CONCLUSION: Translation of GETS into Turkish (GETS-T) showed high reliability and validity, suggesting that translation and cross-cultural adaptation was appropriate. The GETS-T can be used in studies about globus pharyngeus in future.

Comparison of the Effects of 2 Surgical Techniques Used in the Treatment of Concha Bullosa on Olfactory Functions.

INTRODUCTION: Concha bullosa (CB), which is pneumatization of the concha, is one of the most commonly seen anatomic variations of the lateral nasal wall. OBJECTIVE: To investigate the effects on olfactory function of lateral turbinectomy and crushing methods used in the surgical treatment of CB. METHODS: The study included a total of 47 patients operated on for a diagnosis of CB and nasal septum deviation. The patients comprised 22 females and 25 males, with bilateral CB in 18 cases and unilateral in 29 cases. Intervention was made to a total of 65 CB. The cases were separated as those applied with septoplasty and lateral turbinectomy in group 1 (n = 34) and those applied with the septoplasty and crushing method in group 2 (n = 31). The olfactory function of the patients was evaluated preoperatively and at 3 months postoperatively with the Brief Smell Identification Test. RESULTS: A statistically significant increase was determined in the postoperative smell test results compared with the preoperative values in both group 1 (P = .021) and group 2 (P = .001). When the change in the smell test results from preoperative to postoperative was compared between the groups, the increase in group 2 was determined to be statistically significantly greater (P = .002). CONCLUSION: The results of this study showed that the crushing method in surgical treatment of CB increased olfactory functions more than the lateral resection method, and as the improvement in olfactory functions was greater, this demonstrated that only increasing the nasal cavity is not sufficient and the nasal mucosa should be protected as far as possible.

Laryngoscopic Examination During the COVID-19 Pandemic: Turkish Voice Speech and Swallowing Disorders Society and Turkish Professional Voice Society Recommendations.

COVID-19 is highly transmissible and spreads rapidly in the population. This increases the occupational risk for health care workers. In otolaryngology clinic practice, patients with upper respiratory tract infection symptoms are common. Also, routine head and neck examinations such as oral cavity examination, nasal/nasopharyngeal examination, or video laryngostroboscopic evaluation are highly risky because of the aerosol formation. To emphasize this issue, two leading otolaryngology organizations in Turkey; 'Voice Speech and Swallowing Disorders Society', and 'Professional Voice Society' gathered a task force. This task force aimed to prepare a consensus report that would provide practical recommendations of the safety measurements during routine clinical care of laryngology patients. To fulfill this, universal aim, on the 2nd and 9th of May 2020, two web-based meetings were conducted by 20 expert physicians. This eighteen items list was prepared as an output.

The effect of N-acetyl cysteine on biofilm layers in an experimental model of chronic otitis media.

OBJECTIVE: The aim of this study was to investigate the efficacy of N-acetylcysteine (NAC) on biofilm layers and on the course of disease in chronic otitis media. METHODS: Twenty-five rats that were induced with chronic otitis media (COM) were separated into three groups. In Group 1 (N = 18), 0.2% ciprofloxacin + 0.1% dexamethasone sodium phosphate + 0.5 mg/ml NAC solution was locally injected to the right ear of the rats; in Group 2, (N=18) 0.2% ciprofloxacin + 0.1% dexamethasone sodium phosphate was locally injected to the left ear of the rats. No treatment was applied to either ear of rats in Group 3 (N = 5). Histopathological and scanning electron microscope (SEM) evaluations were performed in all groups. RESULTS: SEM revealed biofilm formation in all COM induced groups. No significant difference was seen between groups 1 and 2 in terms of suppuration levels, fibrosis, inner ear involvement, infection staging and biofilm formation (p > 0.05). CONCLUSIONS: In this study, while histopathological and SEM evaluation revealed no effect of 0.5 mg/ml NAC on the biofilm layer in COM-induced rats, further studies with NAC at different concentrations are still needed on different types of experimental animals.

The role of nasopharyngeal examination and biopsy in the diagnosis of malignant diseases / O papel do exame clínico e da biópsia de nasofaringe no diagnóstico de doenças malignas

Abstract Introduction: In direct proportion to the increasing rate of nasopharynx examinations applied, the early diagnosis and treatment of lesions in this region is possible. At times the clinical findings and the biopsy results are not consistent, so biopsies may have to be repeated. Objectives: The aim of this study was to evaluate the distribution of pathology test results obtained from cases of nasopharynx biopsy, to determine with which methods determination most often was made, and to investigate which kinds of cases required the biopsy to be repeated. Methods: The study included a total of 1074 patients (500 female, 574 male) who underwent nasopharyngeal biopsy in our clinic between June 2011 and June 2017. Data were obtained from patient records of age, gender, clinical findings, imaging findings if available and pathological diagnosis. The pathological diagnoses were separated into 3 main groups as chronic nasopharyngitis, benign cytology and malignant cytology. Results: The examinations resulted in 996 cases reported as chronic nasopharyngitis, 47 as benign cytology and 31 as malignant cytology. Of the 31 malignant lesions, diagnosis was made in 15 patients (48.4%) with a single biopsy, and in 16 patients (51.6%), as a result of the pathology report when 2 or more biopsies were taken. In the comparison of the benign and malignant lesions in respect of the need for repeated biopsies, the cases determined with malignancy were found to have a statistically significantly higher rate of repeated biopsy (p < 0.001). Conclusion: In comparison with cases of benign tumor, a statistically significantly greater number of repeated biopsies were required in cases diagnosed as malignant tumors to confirm the pathological diagnosis or when there was continued suspicion of malignancy. Therefore, when there is clinical suspicion, even if there are no findings of malignancy on the first biopsy, the biopsy should be repeated expeditiously.

Resumo Introdução: Em proporção direta à taxa crescente de exames de nasofaringe que são feitos, o diagnóstico precoce e o tratamento de lesões nessa região têm sido possíveis. Nem sempre os achados clínicos e os resultados da primeira biópsia são consistentes, levando à necessidade de biópsias repetidas. Objetivos: Avaliar a distribuição dos resultados dos testes histopatológicos obtidos pela biópsia de nasofaringe, determinar quais métodos foram mais frequentemente usados na identificação e investigar os casos nos quais a biópsia precisou ser repetida. Método: O estudo incluiu 1.074 pacientes (500 mulheres, 574 homens) submetidos a biópsia de nasofaringe em nossa clínica entre junho de 2011 e junho de 2017. Os dados foram obtidos dos prontuários dos pacientes e incluíram idade, sexo, achados clínicos, achados de imagem e diagnóstico histopatológico. Os diagnósticos histopatológicos foram separados em três grupos principais como nasofaringite crônica, citologia benigna e citologia maligna. Resultados: Os exames resultaram em 996 casos laudados como nasofaringite crônica, 47 como citologia benigna e 31 como citologia maligna. Das 31 lesões malignas, o diagnóstico foi feito em 15 (48,4%) com uma única biópsia e em 16 (51,6%), quando duas ou mais biópsias foram feitas. Na comparação das lesões benignas e malignas em relação à necessidade de biópsias repetidas, os casos determinados como malignos mostraram uma taxa estatisticamente maior de biópsia repetida (p < 0,001). Conclusão: Em comparação com os casos de tumores benignos, um número estatisticamente maior de biópsias repetidas foi necessário em casos diagnosticados como tumores malignos, para confirmação do diagnóstico histopatológico ou na suspeita continuada de malignidade. Portanto, quando há suspeita clínica, mesmo que não haja achados de malignidade na primeira biópsia, ela deve ser repetida tão logo seja possível.

The role of nasopharyngeal examination and biopsy in the diagnosis of malignant diseases.

INTRODUCTION: In direct proportion to the increasing rate of nasopharynx examinations applied, the early diagnosis and treatment of lesions in this region is possible. At times the clinical findings and the biopsy results are not consistent, so biopsies may have to be repeated. OBJECTIVES: The aim of this study was to evaluate the distribution of pathology test results obtained from cases of nasopharynx biopsy, to determine with which methods determination most often was made, and to investigate which kinds of cases required the biopsy to be repeated. METHODS: The study included a total of 1074 patients (500 female, 574 male) who underwent nasopharyngeal biopsy in our clinic between June 2011 and June 2017. Data were obtained from patient records of age, gender, clinical findings, imaging findings if available and pathological diagnosis. The pathological diagnoses were separated into 3 main groups as chronic nasopharyngitis, benign cytology and malignant cytology. RESULTS: The examinations resulted in 996 cases reported as chronic nasopharyngitis, 47 as benign cytology and 31 as malignant cytology. Of the 31 malignant lesions, diagnosis was made in 15 patients (48.4%) with a single biopsy, and in 16 patients (51.6%), as a result of the pathology report when 2 or more biopsies were taken. In the comparison of the benign and malignant lesions in respect of the need for repeated biopsies, the cases determined with malignancy were found to have a statistically significantly higher rate of repeated biopsy (p<0.001). CONCLUSION: In comparison with cases of benign tumor, a statistically significantly greater number of repeated biopsies were required in cases diagnosed as malignant tumors to confirm the pathological diagnosis or when there was continued suspicion of malignancy. Therefore, when there is clinical suspicion, even if there are no findings of malignancy on the first biopsy, the biopsy should be repeated expeditiously.

The effect of poly-p-dioxanone plate on the protection and vitality of cartilage: An animal study.

OBJECTIVES/HYPOTHESIS: In septorhinoplasty, septal, auricular, and costal cartilage are often used as autologous graft. Autologous grafts are preferred in nasal reconstruction. The aim of this study was to histopathologically examine the tissue compatibility and the effect on the stability and cartilage vitality of poly-p-dioxanone (PDS) plates. STUDY DESIGN: Ten adult New Zealand rabbits were used. METHODS: Ten New Zealand rabbits were used. Septal and auricular cartilage sections were removed; one of the two cartilage grafts was left plain, and the other was sutured to a PDS plate. Grafts were placed into the back of the rabbits. After 12 weeks, the graft material was examined microscopically. RESULTS: The specimens did not cause any significant foreign body reaction. Within 3 months, a significant degree of color, stability, and stiffness was lost. Microscopically, inflammation, necrosis, and cartilage cell degeneration scores were statistically significantly lower in the grafts using PDS (P < .05), and the vascularization, collagen, and cartilage proliferation scores were found to be statistically significantly higher (P < .05). No statistically significant difference was determined in respect of the bone proliferation scores (P > .05). CONCLUSIONS: The use of PDS plates together with cartilage provided mechanical support to the graft. Therefore, changes that disrupt the integrity of the graft, such as inflammation, necrosis, and cartilage cell degeneration, were reduced, and changes that provide greater stability, such as vascularization, collagen, and cartilage proliferation, were increased. LEVEL OF EVIDENCE: NA Laryngoscope, 129:E129-E134, 2019.

Pediatric Vocal Fold Nodule Etiology: What Are Its Usual Causes in Children?

OBJECTIVES: In this study, the relation between phonotrauma and presence of siblings and social activities was investigated, and the incidence of voice disorders in the mothers of children with vocal fold nodules was studied with objective (clinical voice analysis) and subjective (laryngostroboscopy, Voice Handicap Index) methods. METHODS: Twenty-nine children with vocal fold nodules (age range 5-14 years), 45 age-matched children without any voice disorders as a control group, and their mothers were included in the study. All patients had laryngostroboscopy and clinical voice analysis, and their mothers filled out the Pediatric Voice Handicap Index. We noted the most common place or situation where children used their voice in excessively high volume according to their mothers, including home, school, sportive activities, and singing or reciting poem activities, to recognize the major cause of phonotrauma. In addition, presence of siblings was recorded. RESULTS: It was found that 15 patients (51.7%) had younger siblings, seven patients (24.1%) had older siblings, five patients (17.2%) had both younger and older siblings, and two patients (6.8%) did not have any siblings. It was seen that excessive usage of high-volume voice at home had a correlation with presence of only younger siblings, and both younger and older siblings tended to cause phonotrauma at home (86.7%). Additionally, eight boys (44.4%) reported presence of sportive activities, whereas none of the girls had such an activity (P = 0.012). CONCLUSION: Presence of siblings seems to be an important factor for vocal nodule formation. Maternal relationship does not seem to be a major factor for vocal misuse.

The effect of tacrolimus on facial nerve injury: Histopathological findings in a rabbit model.

HYPOTHESIS: Tacrolimus helps healing of facial nerve injury. BACKGROUND: Positive effects of tacrolimus on axon regeneration and healing of injured peripheral nerves (eg. sciatic nerve) have been reported in the literature. Tacrolimus may be an additional treatment method that could improve the nerve healing after surgical treatment of cut injury of facial nerve. METHODS: 20 New Zealand rabbits were randomly separated into control and study groups of 10. In control group, no medical treatment was given after facial nerve anastomosis, and the animals were followed up for 2months. In the study group rabbits were given 1mg/kg/day tacrolimus subcutaneously for 2months after the facial nerve anastomosis. The histopathologic findings of axon regeneration like axon myelination were analyzed in both groups under electron and light microscopy. The data obtained in the groups were compared. RESULTS: Greater axon diameters, thicker myelin sheaths, and higher total number of myelinated axons were found in the tacrolimus group, suggesting better regeneration in this group when compared to the control group. There was less vacuolar degeneration in the study group. All these findings suggest that tacrolimus positively affects healing after facial nerve anastomosis. CONCLUSION: The results of this study indicate that tacrolimus has favorable effects on the healing process of the facial nerve after end-to-end anastomosis. Tacrolimus may be a promising agent in the future for nerve regeneration following traumatic facial paralysis surgery.

Is Allergic Rhinitis a Factor That Affects Success of Tympanoplasty?

OBJECTIVE: The aim of the present study was to investigate the effect of allergic rhinitis on the success of the operation in chronic otitis surgery by using score for allergic rhinitis (SFAR). MATERIALS AND METHODS: In the present study; 121 patients, who underwent type 1 tympanoplasty were examined retrospectively. SFAR of all patients were recorded. The graft success rates of 26 patients with allergic rhinitis (AR) and 95 patients with no allergic rhinitis group (NAR) were compared. RESULTS: While the graft success rate in NAR group was 89.5%, this rate was 80.8% in the AR group. However, the difference between groups was not statistically significant (p = 0.311). CONCLUSION: These findings suggest that allergic rhinitis decreases the graft success rate of the pathologies occurring in eustachian tube, middle ear and mastoid although statistically significant difference wasn't found. Prospective studies with larger patient groups are required in order to evaluate this pathology.

Improvement of Pulmonary Functions Following Septoplasty: How Are Lower Airways Affected?

OBJECTIVES: Nasal septal deviation is a frequent cause of increased nasal airway resistance. A narrow nasal airway would result in a decreased airflow into the lungs. The aim of the present study was to evaluate the alterations of the pulmonary functions following septoplasty using spirometry and 6 minutes walking test (6mWT). And reveal the correlation of symptom score improvement with nasal obstruction symptom score (NOSE) and sino-nasal outcome test (SNOT22) questionnaires following surgery. METHODS: Thirty patients with obvious nasal septal deviations were enrolled in the study. All patients had a detailed otorhinolaryngologic examination, filled NOSE/SNOT22 questionnaires, performed spirometry and 6mWT preoperatively. One month after surgery, NOSE/SNOT22 questionnaires filled by subjects and spirometry with 6mWT were performed again, and the results were compared. RESULTS: The mean total walking distance was 702.3±68.2 m preoperatively, and it improved to 753.2±72.6 m postoperatively (P<0.001). Total tour count increased from 11 (range, 10.8 to 12.0) to 12 (range, 11 to 13.3), and the difference was found statistically significant (P<0.001). When the preoperative and postoperative mean 6mWT results were compared, diastolic blood pressure increased from 70 to 80 mmHg (P=0.031), heart rate increased from 83.5±13.2 to 90.1±12.5 bpm (P=0.017), dyspnea rate decreased from 1 to 0 (P=0.002), and fatigue scores reduced from 2 to 1 (P=0.003). Evaluation on spirometry findings revealed that FIF50% (maximum inspiratory flow at 50% of forced vital capacity [FVC]) scores and peak expiratory flow (PEF) values improved significantly after surgery. Septoplasty improves the nasal breathing pattern. While reducing FEF50% (maximum expiratory flow at 50% of FVC)/FIF50%, it increases PEF and FIF50% values. In addition, as shown by 6mWT, exercise capacity improves following surgery. Postoperative NOSE and SNOT22 scores reduced markedly compared to preoperative values (P<0.001). CONCLUSION: These findings suggest that nasal septal surgery has a positive effect on pulmonary functions, and this can be an important clue for the relationship of lung disorders and nasal obstruction.

The effect of inlay butterfly cartilage tympanoplasty technique on compliance.

CONCLUSION: IBCT technique should be preferred owing to its high graft survival rate and ABG gain. While no significant difference was found in middle ear pressures between ears that underwent IBCT and normal ears, compliance values were found to be decreased in patients undergoing IBCT. However, the lack of correlation between ABG gain and compliance values indicated that compliance increase had no effect on post-operative ABG results. OBJECTIVE: The aim of the present study was to compare tympanometric and audiological parameters in patients undergoing inlay butterfly cartilage tympanoplasty (IBCT) with their normal ears and to determine their difference with normal ear tympanometric parameters. METHODS: Overall, 25 patients that underwent an operation between August 2010-May 2014 were included in the present study. In 13 of these patients, the ear that did not undergo operation was normal. 0.5, 1, 2, 4 kHz pure sound average values, tympanometric measurements and compliance values of normal and operated ears were compared. RESULTS: The graft survival rate in patients was found to be 92%. Mean pre-operative air-bone gap (ABG) was 16.4 ± 5.4 in patients, while mean post-operative ABG was 10.9 ± 5.8, with a statistically significant difference (p = 0.001) While there was no significant difference between operated and normal ears of patients in terms of middle ear pressure (0.441), compliance values were significantly higher in normal ears than those in operated ears (0.032). When post-operative ABG gain was compared with compliance values, no significant correlation was found between ABG gain and compliance measurements (r = -0.025 and p = 0.936).

The impact of pregnancy on nasal resonance.

OBJECTIVES: This study aims to investigate the possible impact of hormonal changes on nasal resonance during pregnancy. PATIENTS AND METHODS: Between January 2013 and June 2013, a total of 101 pregnant women (mean age 27.1±5.8 years; range 18 to 41 years) visiting obstetric clinics for routine antenatal checkups were included in the study. The control group was consisted of 99 patients (mean age 29.2±6.6 years; range 18 to 42 years) without any nasal complaints. Nasal symptoms were assessed using the Nasal Obstruction Symptom Evaluation (NOSE) Scale. Nasalance scores were calculated by nasometry. The results were compared between study and control groups. RESULTS: The mean nasalance score in pregnant women (40.4±7.8) were statistically significantly lower than the control group (44.7±6.4) (p<0.001). The nasalance score was 43.2±7.0 for the first trimester, 41.1±6.6 for the second trimester, and 39.2±8.8 for the third trimester. There was no statistically significant difference in nasalance scores within three trimesters. The mean nasalance scores of the second and third trimesters were statistically significantly lower than the control group (p<0.001). The NOSE scores were found to be statistically significantly higher in the third trimester (2.9±2.6) than the second trimester (1.1±1.9) (p<0.001). CONCLUSION: These findings indicate that nasalance scores fall in pregnancy, leading to the development of hyponasal voice.

Patient Characteristics and Frequent Localizations of Rhinoliths.

OBJECTIVE: A rhinolith is a rare entity affecting all people in all age groups. It is defined as a mineralized foreign body. The purpose of the present study was to reveal the distribution in age and gender and the localization, side, and prominent symptoms of rhinoliths to identify the risk groups and characteristics of the rhinoliths in a large case series. METHODS: A retrospective review was performed from the medical charts of 28 patients who were diagnosed with rhinolith and underwent surgery between May 2011 and January 2015 in Ankara Research and Training Hospital. All data, including age, gender, duration of symptoms, localization of the lesion and accompanying pathologies, were documented. RESULTS: In total, 28 patients (18 females and 10 males) with a mean age of 26.2±16.6 (5-62) years who were diagnosed with rhinolithiasis were reviewed. Nasal obstruction (71.4%) and nasal discharge (64.3%) were the most common complaints. The rhinolith was located in the right nasal cavity in 24 patients and in the left in four; this difference was statistically significant (p<0.001). There were 11 accompanying pathologies including nasal septal deviation (n=6), nasal polyposis (n=2), concha bullosa (n=2), and adenoid vegetation (n=1). In 21 (75%) patients, the most common site was the nasal base of the cavity between the inferior turbinate and the nasal septum. CONCLUSION: If unilateral right-sided nasal obstruction with foul-smelling purulent discharge is detected in a young adult and a nasal examination reveals a mass in the floor of the cavity, a rhinolith should be strongly considered in the differential diagnosis.

Glass ionomer application for vocal fold augmentation: Histopathological analysis on rabbit vocal fold.

OBJECTIVES/HYPOTHESIS: The aim of this study was to investigate the use of glass ionomer cement (GIC) as an injection material for vocal fold augmentation and to evaluate the biocompatibility of the material. STUDY DESIGN: Ten adult New Zealand rabbits were used. METHODS: Under general anesthesia, 0.1-cc GIC was injected to one vocal fold and the augmentation of vocal fold was observed. No injection was applied to the opposite side, which was accepted as the control group. The animals were sacrificed after 3 months and the laryngeal specimens were histopathologically evaluated. RESULTS: The injected and the noninjected control vocal folds were analyzed. The GIC particles were observed in histological sections on the injected side, and no foreign body giant cells, granulomatous inflammation, necrosis, or marked chronic inflammation were detected around the glass ionomer particles. Mild inflammatory reactions were noticed in only two specimens. The noninjected sides of vocal folds were completely normal. CONCLUSION: The findings of this study suggest that GIC is biocompatible and may be further investigated as an alternative injection material for augmentation of the vocal fold. Further studies are required to examine the viscoelastic properties of GIC and the long-term effects in experimental studies. LEVEL OF EVIDENCE: NA.

Correlation Between the Septal Body and the Nasal Turbinates in Patients With Deviated Nasal Septum.

OBJECTIVE: The purpose of this study was to evaluate the degree of deviation and the sizes of nasal turbinates and the septal body (SB) on each side separately and to compare the 2 sides, and to evaluate if there is a correlation between SB size and middle and inferior turbinate (IT) sizes on each side. MATERIAL AND METHODS: A retrospective analysis was made of paranasal computerized tomography scans obtained randomly from the database. Computerized tomography was performed at 120 kVp and 100 mA with 2 mm slice thickness. The study comprised 199 paranasal computerized tomography scans on each of which the width of the SB, the degree of deviation, and the width of the inferior and middle turbinates (MTs) were measured on each side separately. RESULTS: In cases of moderate and severe deviation, the sizes of the SB, the MT, and IT contralateral to the deviation were statistically significantly larger than those on the ipsilateral side (P < 0.001). There was a negative correlation between SB size and the MT and IT sizes in each nasal cavity. CONCLUSIONS: The SB is a dynamic structure and may play a role in regulation of nasal airflow.