Early hearing loss detection in gout using extended high frequency audiometry.

OBJECTIVE: The study aimed to analyse the hearing levels of patients with gout using extended high frequencies (EHFs) audiometry. Thus, we aimed to reveal the early detectability of potential hearing losses. DESIGN: Comparative cross-sectional study. SETTINGS: A single centre patient was diagnosed with gout disease. PARTICIPANTS: Two groups consisted of 32 patients with gout and 32 healthy volunteers. MAIN OUTCOME MEASURES: The primary outcome was hearing thresholds in pure tone (PT) audiometry and EHFs audiometry. Also, the association between audiometric results and haematological and biochemical parameters were evaluated. RESULTS: There was no significant difference between groups in terms of mean hearing thresholds in PT audiometry. But, at all frequencies above 4000 Hz (4000-18 000 Hz), the hearing thresholds were significantly higher in patients with gout. Also, the hearing thresholds above 8000 Hz were positively correlated with serum uric acid levels. Hearing thresholds at higher frequencies were positively correlated with haemoglobin levels and negatively correlated with high-density lipoprotein levels. CONCLUSION: To our knowledge, this is the first study in the literature demonstrating the high frequency of hearing loss in patients with gout using EHFs audiometry. We consider that using EHFs audiometry should have an important place in the early detection of potential hearing losses in gout patients.

The protective effect of Naringenin against ovalbumin-induced allergic rhinitis in rats.

BACKGROUND: Allergic rhinitis (AR) is a ubiquitous chronic disease with a growing incidence. We aimed to investigate the protective effect of naringenin against AR induced in rats. METHODS: Thirty-two Sprague Dawley rats were divided into four groups of eight animals each. Group 1 represented the control group. The other 24 rats were sensitized with intraperitoneal 0.3 mg ovalbumin (OVA) and 30 mg aluminum hydroxide every other day for 14 days to induce AR. Ten microliters OVA was administered to both nostrils by inhalation for the following seven days to provoke AR. Group 2 represented the AR group and received no treatment. Group 3 was treated as the reference group and received 5 mg/kg desloratadine every day between days 15 and 21. Group 4 received 100 mg/kg naringenin orally between days 15 and 21. All animal's sneezing and nasal itching scores were recorded on day 22. The rats were then sacrificed. Serum total IgE, IL4 and IL5 values were studied, and nasal structures were extracted 'en bloc' for histopathological examination. RESULTS: Significant clinical recovery was achieved in the group treated with naringenin. Serum total IgE, IL4 and IL5 values in the naringenin group were significantly lower than in the AR group, and significant histopathological improvement was observed compared to the AR group. CONCLUSIONS: Naringenin produced significant clinical, biochemical and histopathological benefits in rats with induced AR. These effects suggest that naringenin is a promising agent for the treatment of AR.

The amendatory effect of hesperidin and thymol in allergic rhinitis: an ovalbumin-induced rat model.

PURPOSE: Allergic rhinitis is an immunoglobulin-E (Ig-E)-mediated response driven by type 2 helper T cells. Hesperidin and thymol are biological agents that possess antioxidant and anti-inflammatory characteristics. The purpose of this study was to investigate the effects of hesperidin and thymol in rats with ovalbumin-induced allergic rhinitis. METHODS: Thirty adult Sprague-Dawley rats were randomly assigned into five groups, each containing six animals. The first group constituted the negative control group, while the remaining groups were exposed to an ovalbumin-induced model of allergic rhinitis. In the provocation stage, 4 mL/kg saline was administered to the positive control group, 10 mg/kg desloratadine to the reference group, 100 mg/kg hesperidin to the hesperidin group, and 20 mg/kg thymol to the thymol group, all by gastric lavage for 7 days. Nasal symptoms were scored on day 22. Rats were then sacrificed, and intracardiac blood specimens were collected to measure plasma total Ig-E, IL-5, IL-13, total antioxidant capacity (TAC), and total oxidant status (TOS) levels. Nasal tissues were extracted for histopathological and immunochemical examination. RESULTS: Nasal symptom scores were highest in the positive control group, while hesperidin and thymol ameliorated these symptoms to the same extent as desloratadine. Ig-E, IL-5, IL-13, and TOS levels increased, while TAC levels decreased significantly in the allergic rhinitis group compared to the other groups. Significant improvement in these parameters was observed in both the hesperidin and thymol groups. At histopathological and immunohistochemical examination of the nasal cavity, severe allergic inflammation and severe TNF-α expression was determined in rats from the allergic rhinitis group. Mild inflammatory changes and mild TNF-α expression were observed in all three treatment groups. CONCLUSION: Both hesperidin and thymol were effective in suppressing allergic symptoms and inflammation in the treatment of allergic rhinitis.

Does a single-dose preemptive intravenous ibuprofen have an effect on postoperative pain relief after septorhinoplasty?

PURPOSE: Septorhinoplasty is a surgical procedure widely employed by otolaryngologists and plastic surgeons. The purpose of this study was to investigate the effects of a single pre-emptive dose of iv ibuprofen on postoperative pain and opioid consumption in patients undergoing septorhinoplasty. MATERIAL AND METHODS: 50 patients scheduled for septorhinoplasty were included in this prospective, randomized, double-blinded study. Control group (n = 25) was administered 100 mL iv saline solution 30 min preoperatively, while Ibuprofen group (n = 26) received 800 mg ibuprofen iv. in 100 mL saline solution. Intravenous fentanyl was administered with a Patient Controlled Analgesia device after surgery for postoperative pain management. Postoperative pain was evaluated using a Visual Analogue Scale (VAS) with 0 representing no pain and 10 the worst pain possible. RESULTS: VAS scores at 10, 20, and 30 min and at 1, 2, 4, 8, 12 and 24 h were lower in the ibuprofen group than in the control group (p < 0.05). Total fentanyl consumption was lower in the ibuprofen group compared to the placebo group (148.8 ±â€¯86.4 mcq vs 338.00 ±â€¯81.00 mcq), respectively. CONCLUSION: We suggest that the pre-emptive use of iv ibuprofen at a dosage of 800 mg 30 min before septorhinoplasty will be beneficial in reducing opioid consumption and pain scores.

The ameliorative effect of berberine and coenzyme Q10 in an ovalbumin-induced allergic rhinitis model.

PURPOSE: Berberine and coenzyme Q10 (CoQ10) are agents with anti-inflammatory and antioxidant characteristics. The purpose of this study was to investigate the effectiveness of berberine and CoQ10 on allergic rhinitis. METHODS: This study involved 30 Sprague-Dawley rats, and allergic rhinitis model was established with induction of ovalbumin. Rats were randomized into five groups. The first represented the control group, in which no allergy was established. The second represented the allergy group, in which allergy was induced but no treatment was given. In the remaining three groups, following induction of allergy, desloratadine at a dose of 10 mg/kg was given to Group 3, 100 mg/kg dose of berberine to Group 4, and 20 mg/kg dose of CoQ10 to Group 5. Nasal symptom scores, and plasma immunoglobulin-E, interleukin (IL)-4, IL-13, malondialdehyde (MDA) and nitric oxide (NO) levels were examined at the end of the study. Rats' nasal tissues were also subjected to histopathological immunohistochemical examination. RESULTS: Nasal symptom scores, and plasma immunoglobulin-E, IL-4, IL-13, MDA and NO levels increased significantly in rats with induced allergic rhinitis. Berberine and CoQ10 significantly reduced these elevated levels. CoQ10 was also found as effective as desloratadin in terms of nasal symptom scores and biochemical parameters. At histopathological examination, severe allergic inflammation was observed in rats from allergic rhinitis group. At all treatment groups, the histopathological changes were significantly improved and only a mild inflammation was determined. Also, immunochemistry showed a significant improvement in all three treatment groups. Coenzyme Q10 and berberine were both effective in suppressing allergy symptoms. CONCLUSION: We think that berberine and coenzyme Q10 can usefully be employed as therapy due to their antioxidant and anti-inflammatory effects in an experimentally induced allergic rhinitis model.

Preoperative Serum Thyroglobulin Level as a Useful Predictive Marker to Differentiate Thyroid Cancer.

INTRODUCTION: Thyroid cancer is the most common endocrine system cancer. Although fine-needle aspiration biopsy is the most commonly used method for diagnosis, it is not always sufficient. The aim of this study was to investigate the influence of preoperative serum thyroglobulin (Tg) concentration on differentiated thyroid cancer risk. MATERIAL AND METHODS: A total of 133 patients who underwent total thyroidectomy due to various indications at the Ear-Nose-Throat Department, Ataturk University Medical School, between April 2015 and December 2015, were included in this prospective study. Histopathological diagnosis and preoperative Tg levels were compared. Receiver operating characteristic (ROC) analysis was used for detection of the cut-off to discriminate malignant from benign thyroid masses using preoperative Tg as a variable. RESULTS: Malignant pathology (differentiated thyroid carcinoma) was detected in 59 out of 133 patients (44.4%) and benign pathology in 74 (55.6%). A statistically significant difference in preoperative Tg value was detected between malignant and benign cases (p < 0.05). CONCLUSION: The prevalence of differentiated thyroid carcinoma was higher among patients with a preoperative serum Tg value > 188.5 ng/mL, and this may thus be used as a marker for the diagnosis of this malignancy.

Rare Location for Pilonidal Sinus: the Nasal Dorsum.

Pilonidal sinuses are recurrent chronic inflammatory lesions which may occur due to penetration of hair particles into skin. Herein, the authors report a pilonidal sinus case that is unusually seen on nasal dorsum and totally excised with the open technique rhinoplasty method. A 20-year-old male patient was admitted to the authors' outpatient clinic with complaints of dysmorphism and discharge from nasal dorsum. Physical examination revealed a swelling in nasal dorsum and hair-containing fistula. Excision was performed with an open rhinoplasty approach. Histo-pathology examination revealed pilonidal sinus. While pilonidal sinus is usually located in sacro-coccygeal region, it may also be seen in atypical localizations like nasal dorsum. Although the prediagnosis of a hair-containing lesion usually includes dermoid cyst, pilonidal sinus should also be considered and histo-pathological examination should certainly be performed. It is a problematic condition when it is symptomatic; however, management and treatment of the disease is easy when correct diagnosis is made.

Stabilization of total ossicular replacement prosthesis using cartilage "shoe" graft.

PURPOSE: We aimed to determine the effect of a cartilage shoe graft placed between the foot of the TORP and the stapes footplate on hearing improvement and long-term displacement rates. MATERIALS AND METHODS: Patients who underwent TORP ossiculoplasty were divided into two groups. The TORP-alone group consisted of 32 patients who underwent TORP placement without cartilage shoe graft and served as the control group. The study group consisted of 56 patients who underwent placement of cartilage shoe graft together with TORP. Pure-tone audiometry was administered to all patients before and 3, 6 and 12 months after surgery. Indications for surgery, surgical technique used, postoperative complications, and air and bone conduction thresholds at 500, 1000, 2000 and 4000 Hz were recorded for all patients. RESULTS: No significant difference in postoperative air-bone gaps was observed between the groups. The number of patients with air-bone gaps less than 20 dB was 14 (25%) in the study group and 8 (25%) in the control group. There was no significant difference in changes in air-bone gaps between the groups. Dislocation of the prosthesis was observed in 3 patients in the study group (5.3%) and 4 in the control group (12.5%). There was less dislocation of the prosthesis in the study group, but the difference was not statistically significant. CONCLUSION: Placement of a cartilage graft between the footplate of the stapes and the foot of the prosthesis may have positive effects on long-term hearing improvement and rates of prosthesis displacement. Further research with larger patient numbers is needed to identify the advantages of shoe graft.

Pharmacological agents used for treatment and prevention in noise-induced hearing loss.

Noise is a stress factor that causes auditory, psychological and physiological effects. The realization that sudden loud noises or chronic exposure to noise in social and working environments can cause hearing loss has led to increased interest in noise-induced hearing loss (NIHL). The best means of preventing primary damage is protection against noise. Since this protection is not always possible for various reasons, the use of pharmacological agents to prevent or treat NIHL should also be considered. The purpose of this study is to discuss current pharmacological protection and treatment options in the light of the literature, since no such extensive reviews have been performed to date, including agents used for protection against and treatment of NIHL. We reviewed both animal and clinical studies, and these are discussed separately for ease of comprehension. For each agent, first animal studies, then clinical studies, if available, are discussed. We also performed a two-step search of the literature. In the first step, we searched the terms "noise induced hearing loss", "treatment" and "protection" in Pubmed. Based on the results obtained, we identified the agents used for the treatment of and protection against NIHL. In the second step, we searched the names of the agents identified in the first step, together with the term "noise induced hearing loss," and reviewed the results.

Cephalometric Measurements With Multislice Computed Tomography in Patients With Obstructive Sleep Apnea Syndrome.

INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is characterized by episodes of upper respiratory tract obstruction, decreased oxygen saturation, and sleep fragmentation during sleep, as well as excessive daytime somnolence. Cephalometric analysis offers distance, angle, area, and volume measurements between separate reference points belonging to bony and soft tissues on a film. Cephalometric measurements made with multislice computed tomography (CT) are quite helpful for standardization of measurements and obtaining highly reliable results. The aim of the current study was to make cephalometric measurements with multislice CT in OSAS patients and compare their results with those of a healthy control population. The authors also aimed to determine, which cephalometric parameters might be more valuable for diagnosis of OSAS. MATERIALS AND METHOD: This study included 30 patients who were diagnosed with severe OSAS (apnea-hypopnea index >30) by an overnight polysomnography study, performed for suspected OSAS and 10 healthy controls without snoring or apnea who underwent three-dimensional head & neck multislice CT for any indication. All patients underwent a three-dimensional head & neck multislice CT to make cephalometric measurements and compare them across the groups. RESULTS: ANS-PNS (anterior and posterior nasal spine), Go-Gn, and UP-PhW distances, as well as sella-nasion-A and sella-nasion-B angles, were significantly lower in the OSAS group compared with the controls (P < 0.05). Mandibulas plane -H, UD, TT-EA, ANS-B, PNS-TB, TT-TB, B-N, and PNS-PhW distances were significantly higher in the patient group compared with the controls (P < 0.05). CONCLUSIONS: Our study reached the conclusion that some cephalometric measurements showed significant differences in patients with obstructive sleep apnea compared with the control group, and hence may lead to a susceptibility to having OSAS. Cephalometric measurements performed with multislice CT have come to the forefront as one of the most important tools for diagnosis of OSAS. An inferiorly located hyoid bone may be most commonly responsible for apnea episodes. It was also concluded that an inferiorly located hyoid bone might have been the result of maxillomandibular underdevelopment.

Comminuted Frontal Sinus Fracture Reconstructed With Titanium Mesh.

Frontal sinus fractures (FSF) are relatively uncommon maxillofacial injuries. The most common cause of FSF is motor vehicle accidents with 62% percentage. Management of FSF depends on type of fracture, associated injuries, and involvement of naso-frontal duct. In this report, the authors presented a patient with comminuted fracture of anterior wall of frontal sinus reconstructed with titanium mesh. A 40-year-old man presented with depression of the frontal bone, facial pain, and epistaxis consisting of a motor vehicle accident. Computerized tomography scan revealed multiple comminuted fractures of anterior wall of frontal sinus and fractures of left orbital medial and superior walls. Titanium mesh was used for reconstruction. Postoperative course was uneventful. The titanium mesh, which is easy to handle with no complications, may provide excellent frontal contour after comminuted anterior wall fractures.

Nasal Vestibular Furunculosis Presenting as the Rudolph Sign.

Nasal furunculosis is a deep infection of hair follicle within the nasal vestibule. In this report, the authors presented a 49-year-old woman with 4-day history of focal red area and tender swelling on the tip of her nose. On physical examination, together with a swelling at nasal vestibulum, erythema, and edema on the skin of nasal tip were observed, which is called the Rudolph Sign. The patient was treated with intranasal topical mupirocin and oral sodium fusidate. Because nasal furunculosis may lead to serious complications such as ophthalmic vein thrombosis and cavernous sinus thrombosis, early diagnosis and effective treatment is essential.

Bone mineral density in patients with obstructive sleep apnea syndrome.

PURPOSE: Obstructive sleep apnea syndrome (OSAS) is a disorder that is characterized by repetitive pauses in breathing during sleep. Airway obstruction episodes can lead to ischemia or hypoxia in tissues. Hypoxia may also have an effect on bone metabolism. In this study, we aim to investigate both the bone metabolic abnormalities and bone mineral density (BMD) in OSAS patients compared to individuals without OSAS. METHODS: Twenty-one male patients with OSAS and 26 control subjects, also male, enrolled in this study. Serum calcium, phosphorus, alkaline phosphatase, and urinary desoxypiridinoline levels were measured in all participants, and BMD was evaluated using DEXA (Hologic QDR 2000). The BMD was measured in the lumbar spine (L1-L4), the femoral neck, and total femur region. RESULTS: No statistically significant difference was noted between the two groups with respect to demographic data, except for body mass index (BMI). We adjusted the statistical analyses in line with the BMI and noted significant differences between OSAS patients and control subjects with regard to lumbar L1-L4 t score, lumbar L1-L4 BMD, and femoral neck BMD values (p ≤ 0.001). We find significant correlations with lumbar L1-L4 BMD (r = -0.4; p = 0.023) and lumbar L1-L4 t score values (r = -0.5; p = 0.012). CONCLUSION: Our study indicates that there is a relationship between OSAS and osteoporosis. However, further controlled studies comprising a greater number of patients are needed to investigate the relationship between osteoporosis and OSAS.

Efficacy of intravenous magnesium sulfate infusion on postoperative pain and quality of recovery for septorhinoplasty: a randomized controlled study.

BACKGROUND: The pain that occurs after septorhinoplasty is an important factor affecting the comfort of the patient. OBJECTIVES: To investigate the effect of perioperative intravenous magnesium sulfate infusion on postoperative pain and quality of recovery in patients underwent septorhinoplasty surgery. MATERIAL AND METHODS: One hundred twenty patients who underwent septorhinoplasty were randomly divided into two groups. Magnesium group received intravenous magnesium after induction of anesthesia (30 mg/kg), then infused until the end of the surgical procedure (9 mg/kg). The placebo group received the same volume of saline infusion. The VAS score was used for postoperative pain assessment, and the Quality of Recovery-40 (QoR-40) score was used for the assessment of recovery status. RESULTS: The postoperative 30 min, 1st, 2nd, 4th (p < .001) and 24th hour (p < .05) VAS scores of the patients in the magnesium infusion group were significantly lower compared to the placebo group. Also; in terms of physical comfort (p < .001), emotional state (p < .05), psychological support, pain and total score values (p < .001), patients in magnesium group had significantly higher QoR-40 scores than those in placebo group. CONCLUSION: Intraoperative magnesium infusion, which is widely used in many surgeries to provide controlled hypotension, also contributes significantly to patient comfort with its positive effect on postoperative pain and recovery scores.

The Protective Efficacy of Hesperidin and Thymol on Radiation-Induced Submandibular Gland Damage.

OBJECTIVE: The purpose of this study was to employ biochemical, histopathological, and immunohistochemical methods to reveal the effectiveness of hesperidin and thymol in preventing radiotherapy-associated submandibular gland injury. METHODS: A total of 48 female Sprague Dawley rats were randomly assigned into six groups of eight animals each. Group 1 represented the control group. Group 2 was regarded as hesperidin Group, and the rats received only hesperidin. Group 3 was regarded as thymol Group, and the rats received only thymol. Group 4 was regarded as a Radiotherapy Group, and the rats were exposed to radiotherapy at a dose of 15 Gy. Group 5 was regarded as hesperidin + Radiotherapy Group, and rats received hesperidin at a dose of 100 mg/kg daily for 1 week prior to radiotherapy exposition. Group 6 was regarded as thymol + Radiotherapy Group, and rats received thymol at a dose of 100 mg/kg daily for 1 week prior to radiotherapy exposition. Rats were sacrificed after radiotherapy and submandibular glands were dissected for biochemical and immunohistochemical evaluations. RESULTS: We have shown that, thanks to their strong antioxidant and anti-inflammatory properties, hesperidin and thymol minimize the damage caused by radiation toxicity by decreasing oxidant levels and increasing antioxidant enzyme levels in the submandibular gland. We found that thymol showed more protective activity than hesperidin in terms of effectiveness on radiation toxicity. CONCLUSION: Hesperidin and thymol exhibit histopathological, immunochemical, and biochemical protection against radiation-related submandibular gland injury. To our knowledge, this is the first study in the literature in this field. LEVEL OF EVIDENCE: N/A Laryngoscope, 133:1885-1892, 2023.

A rare cause requiring consideration in the differential diagnosis of neck masses: tularemia.

INTRODUCTION: Tularemia is a zoonotic disease caused by the Gram-negative coccobacillus Francisella tularensis. It is frequently overlooked in the differential diagnosis of neck masses because of its rarity. The purpose of this study is to report cases diagnosed with tularemia among patients presenting to our clinic with neck masses and to share our experience. METHODOLOGY: Patients presented to our hospital with cervical masses and diagnosed with tularemia were included in this retrospective study. Medical files of all patients were evaluated, and physical examination findings, titration values, date of diagnosis, location of the abscess or mass, place of residence, occupation, drinking water sources, sedimentation (SED), C-reactive protein (CRP), and white blood cell (WBC) values were recorded. RESULTS: Seventy-six patients were included in the study. Forty patients (52.6%) were living in rural villages and 36 (47.4%) in urban areas. Thirty-one (40.8%) were engaged in animal husbandry and 29 (38.2%) in agriculture. In terms of drinking water sources, 59 patients (73.6%) obtained water from the mains, while 10 (13.32%) used well water. The most frequently observed clinical findings were swelling in the neck, sore throat, lethargy, and fever. Neck swelling frequently occurred in levels II and III. CONCLUSIONS: Since tularemia is rare and there are no specific clinical findings, diagnosis may be problematic. Ear, nose and throat (ENT) specialists should be familiar with the clinical symptoms of tularemia in the head and neck region and should consider a preliminary diagnosis of tularemia in the differential diagnosis of persistent neck masses.

Evaluation of effect of septoplasty on nasal mucosal dryness using intranasal Schirmer test.

BACKGROUND: Septal deviation causes the air entering the nose to encounter resistance and leads to turbulent flow formation by disrupting laminar air flow. In the literature, the Schirmer test has been recommended to evaluate the moistening of the nasal mucosa. AIMS/OBJECTIVES: The purpose of this study was to evaluate the degree of nasal humidification using the intranasal schirmer test in patients with septal deviation and to reveal changes in mucosal dryness and humidity in both nasal cavities following septoplasty surgery. MATERIAL AND METHODS: Fifty-three patients with septal deviation detected at endoscopic rhinoscopic examination and scheduled for surgery were enrolled. Schirmer test was performed twice, at a one-month interval, pre- and postoperatively and test records were compared. RESULTS: The Schirmer test value for the deviated side of the septum was significantly lower than that for the contralateral side, for both nasal cavities. Schirmer test values increased significantly on the side of the septal deviation compared to the preoperative values. CONCLUSIONS AND SIGNIFICANCE: Septoplasty surgery performed for septal deviation significantly and reduces nasal mucosa dryness so increases Schirmer test results on the deviated side. We attribute this to septal deviation impairing air flow in the nasal cavity and causing nasal mucosa dryness.

Systemic immune inflammation index in differentiated thyroid cancers.

Objective: The aim of this study was to investigate the relationship between differentiated thyroid carcinomas (DTCs), histopathological findings and systemic immune-inflammation index (SII) [neutrophil (N) x platelet (P) / lymphocyte (L)] values. Methods: 93 patients with DTC were included. N, P and L levels were measured, and the relationship between the SII and histopathological findings was determined. The results were compared with the values of 33 healthy controls. Results: SII values were significantly higher in the patient group than in the control group (p = 0.000). Tumour pathology diagnosis had no significant effect on SII (p = 0.90). Perineural lymphovascular and capsule invasion and extrathyroidal extension also had no significant effect on SII values. SII was significantly higher in patients with more than one tumour focus (p = 0.01). No significant relationship was determined between tumour diameter and SII. Conclusions: SII is higher in patients with DTC compared to the healthy population. High SII values may be associated with multifocality. According to the results of this study, SII does not affect the histological type, perineural, lymphovascular and capsule invasion, or extrathyroidal extension of DTC.