Relationship between otitis media with effusions and pediatric obesity.

The aim of this study was to investigate the relationship between obesity and otitis media with effusion. 471 cases with ages between 4 and 12 years were included. Of the 471 cases, 204 cases (97 girls, 107 boys) were diagnosed OME, the study group, 267cases (127 girls, 140 boys) were the control group. Body mass index of the two groups were compared to each other. The average body mass index for girls in all age groups was 17.93 ± 1.92 (n: 97) for cases with OME and 16.67 ± 1.28 (n: 127) for the control group.(p < 0.05). The average BMI for boys in all age groups was 18.25 ± 1.98 (n: 107) for cases with OME and 16.30 ± 1.26 (n: 140) for the control group. (p < 0.05). Children with a BMI greater than or equal to the 85th percentile were considered to be overweight or obese. Regarding the girls, of the 97 cases with OME, 23 cases were overweight, whereas of the 127 control cases, 7 cases were found to be overweight. This difference was statistically significant (p < 0.05). Regarding the boys, of the 107 cases with OME, 29 cases were overweight, whereas of the 140 control cases, 13 cases were found to be overweight. This difference was also statistically significant (p < 0.05). It is concluded that childhood obesity and overweight may play a role as a predisposing factor in the development of OME. It is also noted that even if a child is in the normal range of BMI percentile (less than 85th percentile; not obese or overweight), as the BMI increases, the relative risk of developing OME increases.

Turkish Guideline for Diagnosis and Treatment of Allergic Rhinitis (ART).

OBJECT: To prepare a national guideline for Otorhinolaryngologist who treat allergic rhinitis patients. METHODS: The study was conducted by three authors, namely the writing support team. The support team made the study plan, determined the writing instructions, chose the subgroups including the advisory committee, the advisors for authors and the authors. A workshop was organized at the very beginning to explain the details of the study to the team. Advisors took the chance to meet their coworkers in their subgroups and determined the main headings and subheadings of the guideline, together with the authors. After key words were determined by the authors, literature search was done in various databases. The authors keep in touch with the advisors and the advisors with the advisory committee and the support group at every stage of the study. National and International published articles as well as the abstracts of unpublished studies, imperatively presented in National Congresses, were included in this guideline. Only Guideline and meta-analyses published in last seven years (2013-2017) and randomized controlled studies published in last two years (2015-2017) were included. After all work was completed by the subgroups, support team brought all work together and edited the article. RESULTS: A detailed guideline about all aspects of allergic rhinitis was created. CONCLUSION: The authors believe that this guideline will enable a compact and up-to-date information on allergic rhinitis to healthcare professionals. This guideline is the first in the field of Otolaryngology in Turkey. It should be updated at regular intervals.

The relationship between nasal mucociliary clearance time and the degree of smoking dependence in smokers with obstructive sleep apnea syndrome.

INTRODUCTION: The aim of this study was to investigate the relationship between nasal mucociliary clearance time (NMCT), degree of smoking dependence, cumulative smoking burden and OSAS severity in smokers. MATERIAL AND METHODS: 123 patients (Group 1) with OSAS and 92 healthy controls (Group 2) were included in the study. Group 1 was divided into smokers (Group 1a) and non-smokers (Group 1b). In Group 1a, cumulative smoking burden and Fagerström nicotine dependence test (FNDT) were questioned. Saccharin test was applied to Groups 1 and 2. Student-t, Mann-Whitney-U, Anova, Kruskal-Wallis tests were used to compare the means. RESULTS: NMCT was higher in Group 1 than Group 2 (p = 0.005). The duration of NMCT was higher in Group 1A than Group 1B (p = 0.002). In Group 1a, NMCT values of mild and moderate OSAS patients were longer than in Group 1b (p = 0.02, p = 0.01, respectively). NMCT values of patients with mild dependence were shorter than those with moderate or severe dependence (p = 0.032, p < 0.001, respectively). CONCLUSION: Mucociliary clearance time was higher in smokers with OSAS than non-smokers. While OSAS has a negative effect on mucociliary clearance, smoking also exacerbates the condition.

Does Septorhinoplasty-Related Periorbital Edema Affect Intraocular Pressure and Retina?

BACKGROUND: Open rhinoplasty has been performed for over 50 years. Rhinoplasty procedures have a risk of complications and it is important to follow each step diligently in order to avoid complications. Periorbital edema is the most common complication of septorhinoplasty. As far as we are aware, there are no studies in the available literature examining the impact of the septorhinoplasty on intraocular pressure and the retina. OBJECTIVES: The aim of this study was to evaluate the effects of septorhinoplasty-related periorbital edema on intraocular pressure and the retina by means of objective tests. METHODS: Ten patients with phase 4 periorbital edema (5 males and 5 females) who underwent open rhinoplasty with bilateral lateral osteotomies were enrolled in the study. All the patients were examined by an eye specialist for visual acuity, intraocular pressure, retinal nerve fiber layer, and ganglion cell complex pathologies with optical coherence tomography preoperatively and postoperatively on the seventh day. RESULTS: Preoperative and postoperative best-corrected visual acuity; intraocular pressure; average, superior, and inferior retinal nerve fiber layer thickness; and total, superior, and inferior ganglion cell complex thickness in both eyes for all patients were within normal limits. There was no statistical difference between preoperative and postoperative values (P > .05). CONCLUSION: We concluded that periorbital edema after septorhinoplasty causes no significant complications affecting intraocular pressure and visual acuity. We believe that when osteotomies and local anesthetic injections are undertaken correctly, periorbital complications do not affect vision.

Associations Between Olfactory Impairment and Cognitive Functions in Patients with Parkinson Disease.

INTRODUCTION: Olfactory impairment and cognitive impairment are common non-motor symptoms in Parkinson's disease (PD). Olfactory impairment may be present even many years before the main symptoms of the disease develop. The associations between olfactory loss and cognition in PD are evaluated in this study. METHODS: 31 patients with PD and 31 healthy subjects were included in this study. The Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr Scale (H&Y Scale) were administered to all subjects. Butanol threshold test and Sniffin'Sticks test were used to assess olfaction. The Mini Mental State Examination (MMSE) and Clock Drawing Test (CDT) and Stroop Color Word Test (SCWT) were used to assess cognition. RESULTS: The Sniffin'Sticks test scores were significantly lower in the Parkinson group in comparison to the control group (p<0.001). The rate of anosmia was 90% in the PD group while this rate was found to be 54.8% in control group (p=0.005). A significant correlation was found between butanol test scores and stoop 5 and 5 errors. Significant correlations were found between the Sniffin'Sticks scores and MMSE scores (p=0.047) and orientation (p=0.041) and language (p=0.003) functions of the MMSE test. Worse olfaction was associated with worse memory. CONCLUSIONS: In PD, olfactory impairment correlates with cognitive impairment and olfactory tests may be used to predict the likelihood of developing dementia in this patient population.

The Association Between Olfaction and Taste Functions with Serum Ghrelin and Leptin Levels in Obese Women.

Purpose: To investigate the olfaction and taste functions in obese female patients and the association between serum ghrelin and leptin levels compared with healthy controls. Methods: Fifty-two obese women, who have a body mass index >30 kg/m2, and 15 healthy women were included in the study. After 8 hrs fasting, blood samples were taken for serum biochemical parameters, ghrelin, and leptin level measurement. For the quantitative assessment of olfactory function, all participants underwent an N-butanol threshold test and odor identification test using 12 Sniffin' Sticks® fragrance sticks. The gustatory function was tested by administering a whole-mouth above threshold test using sucrose solutions. Results: The sucrose taste threshold score in obese women was significantly higher than the controls (P = 0.004). We found positively significant correlation between serum ghrelin levels and n-butanol threshold scores in obese women (r = 0.300, P = 0.031). N-butanol smell threshold was not significantly different between the two groups (P = 0.149), while the Sniffin' Sticks smell test scores were significantly lower in obese women compared with the controls (P = 0.007). Serum leptin levels were also significantly higher in obese women (P < 0.001) although there was no significant difference in serum ghrelin levels between the two groups (P = 0.768). There was no correlation between serum leptin levels and Sniffin' Sticks scores, n-butanol, and sucrose taste threshold scores in obese women. Conclusions: These results might suggest that leptin, which is an anorexigenic peptide, may have a negative effect on taste and smell functions. More studies are warranted to elucidate the exact role of ghrelin secretion on olfaction and taste functions.

The Effect of Hypnosis on Intraoperative Hemorrhage and Postoperative Pain in Rhinoplasty.

This prospective, randomized study investigated the effects of preoperative hypnosis on hemorrhage and pain in open septorhinoplasty (SRP). Twenty-two patients undergoing SRP under general anesthesia were included and equally divided into two groups. Patients in the hypnosis group (HG) received a total of three sessions of hypnotic induction. The first two sessions occurred 3 days and 1 day prior to surgery, respectively, and the last session was in the hospital the day of surgery. The other 11 patients constituted the control group (CG). Compared with the CG, the HG's intraoperative use of total remifentanil and the visual analog scale scores at the 2nd and 3rd postoperative hours were significantly lower (p < .05). Hypnosis did not affect the quality of the surgical field. However, preoperative use of hypnosis decreased intraoperative remifentanil requirements and postoperative pain.

Evaluation of olfaction and taste function in type 2 diabetic patients with and without peripheral neuropathy.

AIMS: Olfaction and gustation in patients with diabetes mellitus have great significance on quality of life, and their impairment may result in possible hazards. A limited number of studies have been performed to determine the alteration of both gustatory and olfactory function in type 2 diabetic patients with diabetic peripheral neuropathy (DPN). The aim of this study was to determine whether type 2 diabetic patients, with and without DPN, exhibit major olfactory and gustatory dysfunction using validated and dependable techniques. METHODS: An observational-analytical case-control study was conducted. Sixty patients with type 2 diabetes mellitus (T2DM) and 30 healthy control subjects with a mean age of 57.1 ± 8.4 were included in the study. Patients with T2DM were recruited from the endocrinology outpatient clinic. After clinical evaluation and electromyography examination, patients with T2DM were divided into the 2 groups, with and without DPN. After a 10-hour fasting period, blood samples were taken for the measurement of serum creatinine, lipids, and HbA1c. For the quantitative assessment of olfactory function, all participants underwent butanol threshold test and odour identification test. Gustatory function was tested administering a whole-mouth above-threshold test using sucrose solutions. RESULTS: The control subjects showed significantly higher Sniffin' sticks and butanol threshold scores than the diabetic patients without DPN (P = .001 and P = .009). No significant difference was found in the gustatory function test between these 2 groups (P = .116). Diabetic patients with DPN had lower Sniffin' sticks scores, butanol threshold scores, and higher sucrose thresholds compared to the controls (P < .001, P < .001, and P = .002). There were no significant differences between diabetic patients with or without DPN regarding Sniffin' sticks scores, butanol threshold, and sucrose thresholds (P = .302, P = .181, and P = .118). CONCLUSION: In conclusion, this study demonstrates that T2DM is associated with olfactory and gustatory dysfunction. The fact that there was no difference between the diabetic patients with and without DPN elicits the idea of central neuropathy. This novel finding might facilitate the addition of olfactory and gustatory tests to the methodological spectrum of afferent pathway investigations.

Can We Improve Pressure Feedback Methods in Vestibular Evoked Myogenic Potentials by Applying Custom Pressures?

OBJECTIVE: The aim of the present study was to use constant and customized pressure levels to improve the feedback method of the blood pressure cuff technique in order to decrease intra-subject and inter-subject variability. MATERIALS AND METHODS: The study was conducted in two stages. In the first stage, the relationship between the pressure level generated in the blood pressure cuff and electromyographic response in the sternocleidomastoid (SCM) muscle was investigated. In the second stage, vestibular evoked myogenic potential (VEMP) measurements were made using a custom-built VEMP chair at a constant pressure level of 40 mmHg (P40) or at 50% of the maximum pressure (Pmax50%) that could be generated by the SCM muscle. RESULTS: VEMP measurements were performed on 100 volunteers consisting of 48 males and 52 females whose ages were between 20 and 68 years. The response rate was 41% on a subject basis and 53% on an ear basis. Response rates were similar in males and females, and they decreased with age. The response rate was significantly lower in 11% of the volunteers who could not generate the stipulated 80 mmHg pressure level. Response rates obtained with P40 and Pmax50% were similar, and p13 and n23 latencies and p13-n23 amplitudes obtained from both sides were also similar. Amplitudes were higher in Pmax50% measurements compared to P40, and amplitudes obtained with P40 levels showed greater variance compared to Pmax50%. CONCLUSION: The use of Pmax50% provided reduced variation compared to P40; however, it did not have significant clinical implications. Further studies are needed for the control of many factors that are related to amplitude variability.

Olfactory and erectile dysfunction association in smoking and non-smoking men.

The studies evaluating the effect of smoking on olfaction reveals opposite results. In vitro and animal studies and epidemiological evidence from volunteers and patients, demonstrated the association between olfaction and erectile functions. In smoking man the reduction of olfactory acuity could adversely affect sexuality. The aim of the present study was to investigate the relationship between erectile dysfunction (ED) and olfactory dysfunction (OD) by comparing a group of healthy adult men with a group of smoking adult men. This prospective study involved 62 volunteers, who were recruited and divided into two groups; one consisted of 35 smoking adult men, and the other included 27 healthy non-smoking men. All participants in both groups were examined in detail for any condition with the potential to cause OD. They all had a normal genitourinary system suffered from no circulatory diseases, diabetes mellitus, hypertension, coronary artery disease nor hyperlipidemia; they had no history of medication affecting genitourinary system. Butanol threshold test and sniffin' stick® (Burghart, Wedel; Germany) screening test was used to asses olfactory functions in both groups. Participants' sexual desire was assessed using an International Index of Erectile Function (IIEF-5) scale. The means of sniffin' sticks scores, butanol threshold scores and IIEF-5 scores were statistically higher in non-smoking group. Butanol threshold scores and sniffin' sticks scores are correlated statistically with IIEF-5 in non-smoking and smoking groups. This study found an association between olfaction and erectile function in smoking and non-smoking men. As far as we know this study is the third published study to show the relationship olfactory and erectile function. In the future studies electrophysiological olfactory methods could be used to confirm in large cohorts the results obtained by the psychophysical approach.

Modified Continuous Mucosal Connell Suture for the Pharyngeal Closure After Total Laryngectomy: Zipper Suture.

OBJECTIVES: Pharyngocutaneous fistula is a serious complication after total laryngectomy, and there are some risk factors stated in the literature. The surgical suture techniques are not studied so much. The aim of this study is to evaluate the effectiveness of 'modified continuous mucosal Connell suture' on the incidence of pharyngocutaneous fistula after total laryngectomy. METHODS: This is a retrospective case series study based at a tertiary center with 31 patients who underwent total laryngectomy between July 2011 and December 2013. Pharyngocutaneous fistula formation after total laryngectomy was evaluated with the patients who underwent modified continuous mucosal Connell suture for pharyngeal repair. RESULTS: Pharyngocutaneous fistula was observed in only one patient (3.2%) who had a history of previous radiotherapy, and it was spontaneously healed within 6 days by conservative treatment. CONCLUSION: We defined a new suture technique for the pharyngeal repair after total laryngectomy. This technique is a simple modification of continuous mucosal Connell suture. We named it as zipper suture. It is effective in the prevention of pharyngocutaneous fistula for pharyngeal reconstruction after total laryngectomy.

Topical bupivacaine compared to bupivacaine infiltration for post-tonsillectomy pain relief in children: a prospective randomized controlled clinical study.

The objective of this study is to compare the topical administration of bupivacaine hydrochloride, saline and bupivacaine hydrochloride infiltration on post-tonsillectomy pain in children. Sixty children undergoing tonsillectomy were enrolled in the study. Patients were randomized into three groups using sealed envelopes. Group 1 (n = 20) received topical 0.5 % bupivacaine hydrochloride, group 2 (n = 20) received topical 0.9 % NaCl (saline), and group 3 (n = 20) received 0.5 % bupivacaine hydrochloride infiltrated around each tonsil. Pain was evaluated using McGrath's face scale. Pain scores in topical bupivacaine hydrochloride group was significantly lesser than the topical saline group at 5th, 13th, 17th and 21st hours, until the 6th day (p < 0.017). Moreover, pain scores of topical bupivacaine hydrochloride group was superior to bupivacaine hydrochloride infiltration group at 5th, 13th, 17th hours and 2nd, 3rd, 4th and 5th day (p < 0.017). There were significantly lesser morbidities in topical bupivacaine hydrochloride than saline group in 1st and 4th day (p < 0.017). Topical administration of bupivacaine hydrochloride proved to provide more efficient pain control than bupivacaine hydrochloride infiltration.

Is local ointment or cauterization more effective in childhood recurrent epistaxis.

OBJECTIVES: To compare the efficacy of nasal antiseptic ointment and silver nitrate cautery in the treatment of children with recurrent epistaxis. METHODS: In this prospective and randomized study, a hundred children with recurrent epistaxis were assigned into two groups. In group 1, patients underwent silver nitrate cauterization, in group 2 patients were treated with nasal antiseptic ointment (oxytetracycline hydrochloride-polymyxin B sulfate); and both groups were followed for 3 months. All of the patients were investigated for allergy with skin prick test. RESULTS: The ages of patients were similar in both groups (group 1: 9.2±2.7; group 2: 8.2±2.2; p=0.069). Thirty-eight percent of the patients in group 1 and 52% of the patients in group 2 had epistaxis in the three months follow-up. The difference between groups was not significant (p=0.159). Thirteen (26%) of the patients in group 1 and 12 (24%) of the patients in group 2 were found to have allergic symptoms and positive prick test. The rate of allergy was similar in both groups (p=0.817). CONCLUSION: Nasal antiseptic ointment and silver nitrate cauterization were found to have similar outcomes in the treatment of recurrent epistaxis.

Effects of levobupivacaine versus bupivacaine infiltration on postoperative analgesia in pediatric tonsillectomy patients: a randomized, double-blind, placebo-controlled study.

OBJECTIVES: We compared the effects of levobupivacaine hydrochloride, bupivacaine hydrochloride, and saline injections in alleviating posttonsillectomy pain. METHODS: Between November 2009 and April 2010, we recruited 60 patients (36 male and 24 female) between 2 and 12 years of age into the study. After informed consent was obtained from the parents, patients admitted for tonsillectomy were randomized into 3 groups by means of sealed envelopes. Group 1 (20 patients; mean age, 6.45+/-2.78 years) received 0.9% sodium chloride (saline solution), group 2 (20 patients; mean age, 5.60+/-2.70 years) received 0.25% levobupivacaine hydrochloride, and group 3 (20 patients; mean age, 5.85+/-2.43 years) received 0.5% bupivacaine hydrochloride infiltrated around each tonsil. Pain was evaluated with McGrath's face scale. RESULTS: The postoperative pain scores at 1 and 5 hours were similar among the groups (p>0.05). The pain scores in the levobupivacaine group were lower than those in the saline group at 13 hours (p<0.017). The pain scores in the bupivacaine and levobupivacaine groups were significantly lower than those in the saline group from 17 to 21 hours until day 6 (p>0.017). There was no difference between the levobupivacaine and bupivacaine groups (p>0.017). CONCLUSIONS: Local infiltration of levobupivacaine is a relatively safe and effective method and is equivalent to use of bupivacaine for posttonsillectomy pain.

The reliability of SleepStrip as a screening test in obstructive sleep apnea syndrome.

OBJECTIVES: This study aims to assess the reliability of SleepStrip as a screening test in obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: Seventy-two patients (50 males, 22 females; mean age 51.4±11.1 years; range 20 to 74 years) with OSAS were included in this prospective, non-randomized double-blinded single cohort study between May 2008 and February 2009. Patients who underwent an attended overnight polysomnography (PSG) and consented to participate in the study were asked to use SleepStrip device within the week following PSG recording. The apnea-hypopnea index (AHI) was compared with the SleepStrip score (Sscore). RESULTS: The mean body mass index of patients was 31.1±4.3. Both AHI and Sscore were obtained in 64 patients. There was a strong correlation between Sscore and AHI (r=0.76, p<0.001). The sensitivity and specificity of the SleepStrip were 94.4% and 93.5% when used to diagnose cases with AHI = or >40. The sensitivity and specificity of the SleepStrip was reduced to 80% and 87.2% when AHI threshold was chosen as = or >25 and 83.3% and 76.5% for AHI = or >15 respectively. CONCLUSION: There is a strong correlation between SleepStrip and AHI. SleepStrip was found to be effective in diagnosing severe OSAS with AHI = or >40, however, its diagnostic capability was reduced in patients with lower AHI's who constitute the main target of screening.

Topical bupivacaine compared to lidocaine with epinephrine for post-tonsillectomy pain relief in children: a randomized controlled study.

OBJECTIVE: To compare the topical administration of bupivacaine hydrochloride, lidocaine hydrochloride with epinephrine and saline in alleviating post tonsillectomy pain. STUDY DESIGN: A double-blind prospective randomized controlled clinical study. METHODS: Between November 2008 and March 2009, 60 patients (32 males and 28 females) between ages of 1.5 and 15 years were recruited into the study. After informed consent was obtained from the parents, patients, admitted for tonsillectomy, were randomized into three groups using sealed envelops. Group 1 (20 patients, mean age 5.2±1.7) received topical lidocaine hydrochloride (20 mg/ml) with 0.00125% epinephrine. Group 2 (20 patients, mean age 6±3.7) received topical 0.5% bupivacaine hydrochloride and group 3 (20 patients, mean age 6.7±3.6) received topical saline. RESULTS: The post-operative pain scores at 1h were similar among the groups (p=0.29). Pain scores in bupivacaine hydrochloride group were significantly lesser than the saline group at 5th, 13th, 17th and 21st hours, until the sixth day (p<0.017). Moreover, pain scores of bupivacaine hydrochloride group were superior to lidocaine hydrochloride group starting at 17 h, until fourth day (p<0.017). Pain scores of lidocaine hydrochloride group were lesser than saline group in the first and fifth days (p<0.017), whereas, there was no significant difference at other times. CONCLUSION: Topical administration of bupivacaine hydrochloride proved to provide more efficient pain control than both saline and lidocaine without any drug related complication.

Hot saline irrigation for control of intraoperative bleeding in adenoidectomy: a randomized controlled trial.

OBJECTIVE: To investigate the efficiency of hot (50 degrees C) saline irrigation for hemostasis after adenoidectomy. STUDY DESIGN: A prospective, controlled, randomized study to investigate hot saline solution in hemostasis of adenoidectomy. SETTING: A tertiary care pediatric hospital. SUBJECTS AND METHODS: A group of 120 children, undergoing adenoidectomy alone, were randomized into two groups, either the room-temperature (25 degrees C) or 50 degrees C saline group, at the start of the operation. RESULTS: One hundred and twenty consecutive patients were enrolled in the study. Age ranged from 1.5 to nine years (mean +/- SD: 4.5 +/- 1.9 years vs 4.9 +/- 1.8 years, 25 degrees C vs 50 degrees C saline groups). There were 36 males and 24 females in the control group (25 degrees C saline group), and 30 males and 30 females in the 50 degrees C saline group. Compared to patients in the control group, 50 degrees C saline reduced the operative time by 3.1 minutes (95% confidence interval [CI] 1.79-4.41, P = 0.001) and reduced the time for hemostasis by 1.77 minutes (95% CI 0.83-2.70, P = 0.008). CONCLUSION: The present study demonstrated that the 50 degrees C saline irrigation was more effectual for postadenoidectomy hemostasis in comparison to room-temperature (25 degrees C) saline irrigation by providing a lesser hemostasis time and requiring lesser need of recurettage and electrocauterization.

Pediatric tracheotomies: a 37-year experience in 282 children.

OBJECTIVE: To study the outcomes, complications, and indications for pediatric tracheotomies performed at a tertiary referral center. METHODS: A retrospective review of hospital records from 1968 to 2005 was conducted to assess all pediatric patients who had undergone tracheotomies. RESULTS: A total of 282 tracheotomies were performed on patients under 16 years of age. The median age at tracheotomy was 27 months. Upper airway obstruction (infectious diseases, n=101; laryngeal anomalies, n=33; trauma, n=36; tumor, n=33) was the most common indication for tracheotomy (n=203; 72%). Lesser number of patients (n=79; 28%) required tracheotomy for prolonged ventilation. Decannulation was carried out successfully in 71 patients (35%). Total complication rate was 18%; only three patients (1%) died from tracheotomy-related complications, with an overall mortality rate of 19%. CONCLUSIONS: Pediatric tracheotomies were associated with a low incidence of procedure-related mortality and morbidity and successful decannulation in 35% of cases. The majority of procedures were performed due to upper airway obstruction which were most commonly caused by infectious diseases.

Nasal pepsin assay and pH monitoring in chronic rhinosinusitis.

OBJECTIVES/HYPOTHESIS: The primary objective of this study was to determine the relationship between chronic rhinosinusitis (CRS) and laryngopharyngeal reflux (LPR). We also investigated the diagnostic value of pepsin in nasal lavage by means of fluorometric assay as compared with 24-hour dual-probe pH monitoring. STUDY DESIGN AND METHODS: This is a controlled, prospective study from a retrospective dataset of 33 patients recruited for endoscopic sinus surgery between 2005 and 2006 in a tertiary care referral center (Hacettepe University Medical Center). All patients underwent 24-hour dual-probe pH monitoring and nasal lavage fluid investigation for pepsin. A fluorometric pepsin assay using casein-fluorescein isothiocyanate in nasal lavage fluid was used to detect LPR. The control group included 20 patients who were proven not to have sinusitis. RESULTS: A higher incidence of pharyngeal acid reflux events was found in patients with CRS (29 of 33, 88%) compared with the control patients (11 of 20, 55%). The difference was statistically significant (P = .01). The fluorometric pepsin assay was correlated to the results of 24-hour dual-probe monitoring for LPR diagnosis with a 100% sensitivity and 92.5% specificity. These data suggest that an association between CRS and LPR is present and that the detection of pepsin in nasal lavage fluid may provide a noninvasive and feasible method of LPR screening.

Clear otorrhea: a case of Munchausen syndrome in a pediatric patient.

This paper reports a case of Munchausen syndrome in a pediatric patient. An 11-year-old girl presented with the complaint of clear fluid otorrhea. She underwent numerous investigations with deception of the physicians. The literature with respect to Munchausen syndrome in the pediatric patient is reviewed. Diagnosis of Munchausen syndrome is difficult especially during the initial assessment, although suspicion might be aroused by inconsistencies in the patient's history and discrepancies between signs and symptoms.