Is septoplasty effective rhinogenic headache in patients with isolated contact point between inferior turbinate and septal spur?

BACKGROUND: Rhinogenic headache is a painful sensation in the head and face due to intranasal contact point without any mass or inflammatory findings. Surgery is recommended in patients with nasal obstruction; however the approach in case of isolated mucosal contact point that does not cause obstruction is controversial. Our aim is to observe changes in the severity of headache in patients with isolated mucosal contact point and headache who do not complain of nasal obstruction. METHODS: Our study included patients with unilateral headache without any nasal and/or paranasal sinus pathology. We confirmed the presence of mucosal contact by nasal endoscopy and by computed tomography (CT). One hundred patients with isolated mucosal contact point without any problem in breathing were included in this study. All participants were treated by topical nasal corticosteroid for a month. Surgery was recommended to the patients with no satisfactory relieve of headache. Visual Analog Scales (VAS) were used to evaluate the severity of headache in patients at time of diagnosis (0 month), after a medical treatment (1st month) and after a surgical or medical treatment (6th month). The results were compared with each other statistically. RESULTS: There was a decrease in VAS values after a month of medical treatment in all patients with isolated contact point (Z = -8.352; p = 0.0). VAS values significantly improved after surgical treatment group (Z = -4.97; p = 0.0). However, VAS values of patients increased at 6th month in medical treatment group (Z = -5341 p = 0.0). After a successful surgical removal of mucosal contacts, the decrease of headache severity was more intense in patients with surgical treatment group than in the patients with medical treatment group (Z = -8.441; p = 0.0). CONCLUSION: Surgical correction provides a more effective outcome in patients with rhinogenic headache. However, it is difficult to convince that headache may improve with surgery in these patients especially with isolated mucosal contact point and without nasal obstruction. In order to prove the benefit of surgery, we believe that medical treatment can be used as a guide.

Synthesis and inhibitory properties of some carbamates on carbonic anhydrase and acetylcholine esterase.

A series of carbamate derivatives were synthesized and their carbonic anhydrase I and II isoenzymes and acetylcholinesterase enzyme (AChE) inhibitory effects were investigated. All carbamates were synthesized from the corresponding carboxylic acids via the Curtius reactions of the acids with diphenyl phosphoryl azide followed by addition of benzyl alcohol. The carbamates were determined to be very good inhibitors against for AChE and hCA I, and II isoenzymes. AChE inhibition was determined in the range 0.209-0.291 nM. On the other hand, tacrine, which is used in the treatment of Alzheimer's disease possessed lower inhibition effect (Ki: 0.398 nM). Also, hCA I and II isoenzymes were effectively inhibited by the carbamates, with inhibition constants (Ki) in the range of 4.49-5.61 nM for hCA I, and 4.94-7.66 nM for hCA II, respectively. Acetazolamide, which was clinically used carbonic anhydrase (CA) inhibitor demonstrated Ki values of 281.33 nM for hCA I and 9.07 nM for hCA II. The results clearly showed that AChE and both CA isoenzymes were effectively inhibited by carbamates at the low nanomolar levels.

Prevalence of otitis media with effusion among primary school age-children and etiopathogenic examination.

A prevalence study was carried out in order to look into the etiopathogenic relation of otitis media with effusion (OME) in primary school-age children. The study included ENT examination and a questionnaire that was carried out in 4 randomly selected schools on 1,165 children. 143 of the cases (12.2%) had OME. A significant relation between OME and adenoid vegetation was found (P<0.01) while no significant relation between EOM and recurrent tonsillitis and allergic rhinitis was found (P>0.05). As a result, OME is a common disease that can lead to other hard-to-cure health problems and be costly if etiopathogenic factors are not resolved on time.

Topical levobupivacaine efficacy in pain control after functional endoscopic sinus surgery.

OBJECTIVE: The aim of this study was to find out the efficacy of a polyvinyl alcohol (PVA) sponge (Merocel Kennedy; Medtronic Xomed, Jacksonville, Florida) sinus pack soaked with levobupivacaine hydrochloride to control postoperative pain and analgesic need following functional endoscopic sinus surgery (FESS). STUDY DESIGN: The study was designed as a prospective, double-blind, randomized, controlled study. Forty-one patients who underwent FESS were included in the analysis. Setting A tertiary referral hospital in Turkey. MATERIALS AND METHODS: Patients who underwent FESS were divided into 2 groups. The PVA sponge sinus packs were soaked with 5 mL of levobupivacaine hydrochloride (chirocaine 25 mg/10 mL; Abbott, Nycomed Pharma AS, Elverum, Norway) in group I and with 5 mL of saline in group II. MAIN OUTCOME MEASURES: Postoperative pain levels were recorded using a visual analog scale (VAS score, 0-100) at 30 minutes and 1, 2, 8, 12, and 24 hours. RESULTS: There were no statistically significant differences between groups regarding age, sex, and American Society of Anesthesiologists status. Postoperative VAS values at 30 minutes and 1, 2, 8, 12, and 24 hours were significantly lower in group I than in group II (P < .05). Supplemental analgesia amount was significantly lower in group I than in group II (P = .003). CONCLUSION: Using levobupivacaine-soaked PVA sponge sinus packs after FESS is an effective, easy, and quick method to control postoperative pain, and it improves patient comfort and tolerability.

Maxillary sinus nonodontogenic myxoma extending into the sphenoid sinus and pterygopalatine fossa: case report.

Myxomas are benign mesenchymal tumors of uncertain etiology. They can arise from odontogenic tissue, as well as from the sinonasal tract and from the facial and temporal bones, apparently from nonodontogenic mesenchyme. Although histologically benign, myxomas are locally invasive. Histopathology demonstrates a characteristically hypocellular lesion with loose stellate cells. We describe the case of a 48-year-old woman with a nonodontogenic maxillary sinus myxoma that invaded the sphenoid sinus and pterygopalatine fossa. We removed the mass via a combined endoscopic and gingivobuccal approach. The rarity of a nonodontogenic sinonasal myxoma extending into the sphenoid sinus and pterygopalatine fossa is the basis for our presentation of this case.

Recurrent and Massive Life Threatening Epistaxis due to Nasal Heroin Usage.

Epistaxis, active bleeding from the nose, is a common ear nose and throat emergency, and can be severe or even fatal. We report a severe life threatening recurrent massive nasal bleeding caused by intranasal heroin use that has not hitherto been reported in the English literature. A 24-year-old male who took heroin several times nasally presented with massive nasal bleeding. A blood transfusion and an operation to halt nasal bleeding were required. The patient did not experience a bleeding attack 2 months following cessation of nasal heroin use.

Hearing evaluation in preeclamptic patients.

OBJECTIVE: To evaluate the pathological effects of preeclampsia on hearing levels in pregnant women by pure-tone audiometry and brainstem auditory-evoked potentials (BAEPs). METHODS: Both ears in 30 preeclamptic patients and 38 women with uncomplicated pregnancy matched by maternal age and gestational age were investigated based on BAEPs and pure-tone audiometry. Hearing thresholds were within the normal ranges in all subjects prior to pregnancy. We compared the results of hearing levels and auditory pathway functions between the two groups. RESULTS: Statistically significant differences in pure-tone audiometry results were found between the two groups (p < 0.05). However, these results were not clinically significant because all pure-tone thresholds were lower than 20 dB (normal hearing abilities). The differences between BAEPs were not statistically significant (p > 0.05). CONCLUSION: This study suggests that preeclampsia does not markedly affect hearing function unless it causes secondary vascular occlusion of microcirculation related to hearing.

Is routine histopathological analysis of nasal polyposis specimens necessary?

Our objective is to evaluate the incidence of unexpected pathologies in routine nasal polyposis specimens and necessity for histopathological evaluation of nasal polyps. A retrospective chart review of all patients who underwent nasal polyposis surgery between January 2004 and June 2010 were reviewed. The patients were divided into two groups. Group 1 consisted of patients with bilateral nasal polyposis. Group 2 consisted of patients with unilateral nasal polyposis. One hundred and seventeen patients (81 male, 36 female) were involved in this study. The mean age was 44.9 ± 17.7 years, ranging between 18 and 72 years. Group 1 consisted of bilateral nasal polyposis specimens. Eighty-five patients were identified with bilateral nasal polyposis. From these 85 patients, no specimens present any evidence of occult pathology on histopathological examination. Group 2 consisted of unilateral nasal polyposis specimens. There were two cases of allergic fungal sinusitis, two of inverting papilloma, one of mucocele, one of plasmacytoma, one of hemangioma, one of esthesioneuroblastoma, and one of schwannoma. Final histopathology of the remaining 23 patients was consistent with inflammation and/or nasal polyposis. We think that in cases of unilateral polyps histopathological examination of the entire material is mandatory. However, routine histological examination of bilateral nasal polyposis may possibly not be necessary in cases where the clinical assessment very clearly has not disclosed any unusual or suspicious signs.

The effect of ibuprofen on postoperative hemorrhage following tonsillectomy in children.

The objective of the study was to evaluate the effect of ibuprofen on hemorrhage after tonsillectomy in children. All charts of children, who underwent tonsillectomy with or without adenoidectomy, were reviewed. The age at the time of surgery ranged between 3 and 16 years (mean age = 7.55 ± 3.01 years). Children were divided into two groups based on the drugs used for postoperative pain relief. Group I received paracetamol after surgery. Group II received ibuprofen after surgery. A total of 62 patients received ibuprofen and 109 patients were given paracetamol. Post-tonsillectomy hemorrhage occurred in seven (4.1%) children, primary hemorrhage was noted in five patients and secondary hemorrhage occurred in two patients. While 3 of 62 children (4.8%) who were given ibuprofen had postoperative hemorrhage, 4 of 109 patients (3.7%) who were given paracetamol had hemorrhage There was no significant difference in hemorrhage rates between these two groups (p > 0.05). Hemorrhage following tonsillectomy is rare and frequently occurs in the early postoperative period. There is no significant increased risk of hemorrhage after ibuprofen administration and it can be used safely for post-tonsillectomy pain relief.

A rhinolith surrounded by a nasal polyp.

Rhinoliths are uncommon mineralized nasal mass in children and adolescents. We reported a case of unilateral rhinolith that presented as a nasal polyp. A 29-year-old woman who had right-sided nasal purulent discharge, nasal obstruction, intermittent epistaxis, and posterior nasal drip for 6 months was admitted to our department. Nasal examination revealed a nasal mass between the inferior turbinate and the nasal septum, presenting as a nasal polyp or a nasal tumor. Paranasal sinus computed tomographic scan confirmed a calcified mass in soft tissue. We removed the rhinolith and the soft tissue that was around it with a transnasal endoscopic approach. Histologic analysis of the soft tissue identified inflammatory nasal polypoid tissue.

Combined aplasia of sphenoid, frontal, and maxillary sinuses accompanied by ethmoid sinus hypoplasia.

OBJECTIVE: To report the case of a woman who had combined aplasia of sphenoid, frontal, and maxillary sinuses accompanied by ethmoid sinus hypoplasia. METHODS AND RESULTS: A 47-year-old woman presented with complaints of headache, nasal obstruction, and postnasal drainage. She had no previous history of either facial trauma or systemic diseases affecting the skeletal system. She had a history of functional endoscopic sinus surgery twice in an other institution. However, the surgeries did not significantly alter her symptoms. Coronal and axial computed tomographic scans of the nose and the paranasal sinuses showed poorly developed frontal, sphenoid sinuses, ethmoid cells, and very severe and profound hypoplasia (aplasia) of bilateral maxillary sinuses. CONCLUSIONS: To our knowledge, this patient seems to be the first case having combined aplasias of the sphenoid, frontal, and maxillary sinuses with hypoplastic ethmoid cells without any systemic or skeletal disease.

Efficacy of topical levobupivacaine in control of postoperative pain after septoplasty.

OBJECTIVE: To search the efficacy of using Merocele (Medtronic, Minneapolis, MN) soaked with 5 mL of levobupivacaine hydrocloride as a nasal pack in control of postoperative pain after septoplasty. DESIGN: The study was designed as a prospective, double-blind, randomized, controlled study. Forty-one patients who underwent septoplasty operation were included in the analysis. SETTING: A tertiary referral hospital in Turkey. MATERIAL AND METHODS: Forty-one patients undergoing septoplasty were divided into two groups. At the end of the operation, Merocele packs were placed inside the nasal cavity. In the levobupivacaine group, each Merocele pack was soaked with 5 mL of levobupivacaine hydrochloride (25 mg/10 mL), and in the control group, Merocele packs were soaked with 5 mL of saline. MAIN OUTCOME MEASURES: Postoperative pain levels were recorded using a visual analogue scale (VAS score, 0-100) at 30 minutes and 1, 2, 8, 12, and 24 hours. RESULTS: We did not find any significant difference between groups regarding age, gender, American Society of Anesthesiologists status, and body mass index. Postoperative VAS values at 30 minutes and 1, 2, 8, and 12 hours were significantly lower in the levobupivacaine group compared with the control group (p < .05). The need for supplemental analgesia was significantly lower in the levobupivacaine group compared with the control group (p < .01). CONCLUSION: Postoperative pain after septoplasty owing to nasal packing is an important problem, and using levobupivacaine-soaked Merocele as a nasal pack after septoplasty is an effective method for the control of this pain. It is a very easy, effective, and quick method and it improves patient comfort after septoplasty.

Evaluation and management of antrochoanal polyps.

Antrochoanal polyps (ACPs) are benign polypoid lesions arising from the maxillary antrum and they extend into the choana. They occur more commonly in children and young adults, and they are almost always unilateral. The etiopathogenesis of ACPs is not clear. Nasal obstruction and nasal drainage are the most common presenting symptoms. The differential diagnosis should include the causes of unilateral nasal obstruction. Nasal endoscopy and computed tomography scans are the main diagnostic techniques, and the treatment of ACPs is always surgical. Functional endoscopic sinus surgery (FESS) and powered instrumentation during FESS for complete removal of ACPs are extremely safe and effective procedures. Physicians should focus on detecting the exact origin and extent of the polyp to prevent recurrence.

The use of tacker and arthroscopy cannules in SILS cholecystectomy.

BACKGROUND: The invasiveness of laparoscopic cholecystectomy was further minimized by reducing the number of incisions with the introduction of single-incision laparoscopic surgery (SILS) cholecystectomy. In order to solve the challenges posed by SILS cholecystectomy, an increasing number of techniques have been reported with the advent of new surgical instruments and refinements to existing technology. We describe, in this article, two new techniques that utilize existing instrumentations: an access and a retraction technique. METHODS: A consecutive series of 23 selected patients with symptomatic cholelithiasis underwent SILS cholecystectomy from April 10, 2009 to August 12, 2009. The overall procedure was similar to SILS cholecystectomy described in the literature. Hovewer, the access technique, with small-size arthroscopy cannules, was used to overcome the technical difficulty resulting from the collision of large-size caps of the laparoscopy trocars, and the retraction technique with a tacker was used to suspend the fundus of the gallbladder without taking the risk of gallbladder perforation. RESULTS: All patients were female, and the mean age was 34 years (range, 27-65). The body mass index of all patients was below 30 kg/m(2). The use of arthroscopy cannules provided a wider range of movement, and the retraction of the gallbladder was achieved safely with the tacker. These techniques reduced the operative times considerably. CONCLUSIONS: Most of the challenges posed by SILS cholecystectomy can be easily solved with simple technical modifications.

Analgesic efficacy of topical tramadol in the control of postoperative pain in children after tonsillectomy.

PURPOSE: Pain control after tonsillectomy is still a controversial issue. Topical approaches have the advantage of pain control with good patient acceptability. Therefore, this study was conducted to evaluate the effects of topical tramadol on postoperative pain and morbidity in children undergoing tonsillectomy. METHODS: A prospective, randomized, double-blind, controlled clinical study was designed. Forty children aged between 4 and 15 years, ASA I-II, scheduled for elective tonsillectomy and/or adenoidectomy were randomized into two groups. For patients in Group T (n = 20) swabs soaked with 2 mg/kg tramadol diluted in 10 ml saline were applied to both of their tonsillar fossa for 5 min; in the control group (n = 20) swabs soaked with 10 ml saline were applied. Postoperative pain scores, bleeding, nausea, vomiting, abdominal discomfort, constipation, pain in the throat, painful swallowing, fever, otalgia, trismus, and halitosis were recorded at the first, fifth, thirteenth, seventeenth, twenty-first, and twenty-fourth postoperative hours and the week after tonsillectomy. RESULTS: Pain scores were found to be significantly lower at the 21st hour and on postoperative day seven in the tramadol group compared with the control group (p < 0.05). Mean daily pain scores ranged from Day 1: 0.34 (±0.21) to Day 7: 0.11 (±0.08) in the tramadol group and Day 1: 0.53 (±0.14) to Day 7: 0.42 (±0.15) in the control group. There were no significant differences in morbidity between the groups (p > 0.05). CONCLUSION: Topical 5% tramadol with its local anesthetic effect seems to be an easy, safe, and comfortable approach for pain management in children undergoing tonsillectomy.

Myringosclerosis after tympanostomy tube insertion: relation with tube retention time and gender.

OBJECTIVE: To determine relationship between myringosclerosis and tube retention time and sex in children with chronic otitis media with effusion who were treated with tympanostomy tube insertion. Also, the relationship between myringosclerosis both sex and initial age of tube insertion were investigated. METHODS: A total of 101 children (195 ears) were reviewed. Ears were divided into four groups according to retention time of tympanostomy tubes. Group I: Retention time of tympanostomy tube less than 6 months. Group II: Retention time of tympanostomy tube from 6 months to 12 months. Group III: Retention time of tympanostomy tube of 12 months or more. Group IV: Myringotomy group without tympanostomy tube insertion. RESULTS: The order of the myringosclerosis rates were as follows from the highest to lowest one; group III (44.1%), group II (42.4%), group I (14.3%), and group IV (7.7%). Myringosclerosis was more common in group I compared with group IV, but the difference was statistically not significant (p>0.05). There were no statistically significant differences in myringosclerosis rates between the group II and group III (p>0.05). On the other hand, statistically significant differences were observed in myringosclerosis rates between group I and group II (p<0.05), and between group I and group III (p<0.05); also similar significant differences were present in myringosclerosis rates between group IV and group II (p<0.05), and between group IV and group III (p<0.05). There was no significant difference between preschool age group and school age group. Myringosclerosis was observed in 40% of boys and in 51.2% of girls. CONCLUSION: Myringosclerosis is frequent in patients who underwent tympanostomy tube insertion. The frequency of myringosclerosis is much higher in tympanic membranes with tympanostomy tube insertion than tympanic membranes with myringotomy, and the location of sclerotic plaques does not always correspond to the tympanostomy area. The myringosclerosis rate was increased when the tympanostomy tubes stay on tympanic membrane for a long time. Highest myringosclerosis rates were observed if the extrusion time was 12 months or longer. In our analysis, sex and initial age of tube insertion were not significant factors for the development of myringosclerosis after extrusion of tympanostomy tubes.

Application of laparoscopy in the management of obscure gastrointestinal bleeding.

Gastrointestinal (GI) bleeding is considered obscure when it persists or recurs after negative endoscopy. Small bowel lesions account for approximately 1-fourth of cases of obscure GI bleeding. These lack specific clinical symtoms and signs, and tend to be inaccessible to routine examinations. The management of patients with intermittent obscure GI bleeding poses both diagnostic and therapeutic challenges. The aim of this study was to report the importance of laparoscopy in diagnosing and treating small bowel lesions responsible for obscure bleeding in 5 patients with subacute presentations. Data were collected from 2 hospitals' in-patient records and a prospective database. All patients underwent laparoscopic exploration. After the identification of the diseased segments, laparoscopy-assisted segmental resection of the small bowel and enteroentorostomy were carried out in all cases. This approach enabled a successful minimally invasive treatment of the obscure GI bleeding. The overall procedure was safe and our results were satisfactory.

Shepard grommet tympanostomy tube complications in children with chronic otitis media with effusion.

The objective of this study was to determine tympanostomy tube complications in children with chronic otitis media with effusion who were treated with Shepard grommet tympanostomy tube insertion. This tube type was selected as it is the most commonly used one in our clinic. The medical records of 162 ears of 87 children (52 male and 35 female) were reviewed retrospectively. The children were between 3 to 16 years old (mean age = 8.1 +/- 3.1). The patients were followed up 6-66 months (mean 23.3 +/- 14.9 months) after tympanostomy tube insertion. We reviewed age, sex, time to tube extrusion and complications. In all patients the indication for surgery was chronic middle ear effusion. Otorrhea occurred in nine ears (5.6%). Granulation tissue was seen in two ears (1.2%). Complications after tympanostomy tube extrusion included myringosclerosis (34.6%), persistent perforation (5.6%), atrophy (23.5%), retraction (16.7%) and medial displacement of tubes (1.2%). The average extrusion time was 8.5 +/- 4.6 months (range 1-24) for Shepard grommet tympanostomy tubes. Complications of tympanostomy tube insertion are common. Myringosclerosis, tympanic membrane atrophy and otorrhea are the most frequently appearing complications. But they are generally insignificant and cosmetic. Consequently, in the majority of these complications there is no need for any management.