The performance of critical flicker frequency on determining of neurocognitive function loss in severe obstructive sleep apnea syndrome.

This study aimed to compare the critical flicker frequency (CFF) and the mail-in cognitive function screening instrument (MCFSI) tests' effectiveness in diagnosing neurocognitive function losses in patients having severe obstructive sleep apnea syndrome (OSAS). A total of 85 subjects (47 patients with a diagnosis of severe OSAS and 38 healthy controls) were included into the study. MCFSI scores greater than or equal to five and CFF scores less than 39 Hz were considered abnormal. Demographic and polysomnographic parameters of patients with OSAS were studied, and correlations between the MCFSI, CFF scores and Epworth Sleepiness Scale (ESS) scores were analysed. The mean age of the patients was 49.6 ± 12.0 years. In the OSAS group, the CFF score was found to be low when compared with the control group, while the MCFSI score was found to be high. Pathological CFF scores (<39) were found in 13 patients (27.7%) in the OSAS group, while pathological MCFSI scores (≥5) were found in 19 patients (40.4%). CFF scores were found to be low in only 26% of the patients with OSAS who were found to have high MCFSI scores. MCFSI scores were high in only 38% of the patients with OSAS who were found to have low CFF scores. There was a significant correlation between ESS and CFF scores. In conclusion, the usefulness of the CFF test in determining cognitive function loss in patients with OSAS needs to be demonstrated via studies which utilize a larger sample size.

A Rare Concha Variation: Coronal Cleft.

Nasal turbinates are embryologically derived from a series of outgrowths from the foetal lateral nasal wall. These outgrowths form a series of ridges, referred to as "ethmoturbinals" and have several vital functions. Several different turbinate variations have been reported so far. The authors presented 3 patients of coronal clefted concha who were diagnosed with magnetic resonance imaging. Computed tomography scans and nasal endoscopic examinations are also performed subsequently. These patients are the first coronal clefted concha cases in the literature and also the first radiological study defining concha cleft. This shows paucity of data documenting variations in the lateral nasal wall. Understanding the anatomy and the anatomic variations of the nasal cavity and nasal turbinates is critical to guide the procedure due to its close proximity to vital structures such as orbita and skull base, especially for functional endoscopic sinus surgery that is a widely used technique nowadays.

The impact of the cochlear-carotid interval on tinnitus perception.

PURPOSE: We hypothesized that the cochlear-carotid interval (CCI), which is defined as the smallest distance along the petrous segment of the internal carotid artery and basal turn of cochlea, may be associated with direct stimulation of hair cells, thereby affecting tinnitus perception. The aim of this study was to investigate the relationships between the CCI, tinnitus perception, and accompanying hearing loss in patients with tinnitus. METHODS: The CCI on both sides was measured independently by two observers from the temporal 3D b-FFE MR images of 25 patients with tinnitus and 20 age/gender matched control subjects. The relationships between CCI, tinnitus visual analog scale (VAS), and tinnitus handicap inventory (THI) were investigated. RESULTS: CCI ranged 0.2-5.6 mm (1.9 ± 1.5) on the right and 0.1-5.4 mm (2.2 ± 1.6) on the left side in the patient group and 0.5-5.4 (1.9 ± 1.4) mm on the right and 0.3-6.7 (2.3 ± 1.7) on the left side in the control group. The differences between the two groups were not statistically significant (p > 0.05). CCI showed a strong negative correlation with THI and VAS scores on both sides. Correlation of audiologic findings with CCI revealed a significant negative correlation with pure tone average of the ipsilateral ear most affectedly at high frequencies. CONCLUSION: The strong negative correlation of CCI with tinnitus-related distress and accompanying sensorineural hearing loss predominantly at high frequencies suggests that further studies on patients with tinnitus that focus on this small area may help to improve the knowledge of tinnitus pathophysiology.

The relationships between the clinical and polysomnographic findings and the olfactory function in patients with obstructive sleep apnea syndrome.

PURPOSE: This study aimed to investigate the relationships between the clinical and polysomnographic findings and the olfactory test results in patients with obstructive sleep apnea syndrome (OSAS). METHODS: Four groups were established: non-snoring controls (group 1), non-apneic snorers (group 2), mild-moderate OSAS (group 3), and severe OSAS (group 4). The polysomnographic findings, otorhinolaryngologic findings, Epworth Sleepiness Scale (ESS), and Sniffin' Sticks olfactory test results of the four groups were compared. The relationships between the clinical data and the olfactory parameters were evaluated. RESULTS: Group 4 had the worst odor identification and discrimination scores. Non-apneic snorers also had worse odor parameters compared with the non-snorer controls. A significant negative correlation was found among the ESS, apnea-hypopnea index (AHI), mean arterial oxygen saturation, and odor identification and discrimination. Significant negative correlations were found between the tongue and tongue base sizes and among all olfactory parameters. CONCLUSION: Our study revealed olfactory dysfunction in patients with OSAS. A strong negative correlation between the olfactory parameters and the severity of sleep apnea was also found. Olfactory tests may be used to predict the presence and severity of OSAS in the future.

Comparison of autogeneous and homogeneous nasal dorsal onlay grafts in an experimental design.

An experimental model was used for the comparative evaluation of autogeneous and homogeneous nasal dorsal onlay cartilage grafts. This study was conducted on 18 adult white New Zealand male rabbits. Nasal septal cartilage (NSC), sliced nasal septal cartilage (SNSC) and auricular cartilage (AC) grafts were prepared in autogeneous and homogeneous forms and placed into the subcutaneous pockets of the nasal dorsum of rabbits. After a period of 3 months, the animals were painlessly killed, and each site was analyzed histologically for inflammation, neovascularization, fibrosis and resorption. Inflammation, fibrosis and neovascularization were found to be significantly more extensive in the homogeneous graft groups and autogeneous SNSC group 3 months after implantation. Resorption was significantly high in both homogeneous and autogeneous AC groups and significantly low in the autogeneous and homogeneous SNSC groups. There was no significant difference between the homogeneous and autogeneous grafts in terms of resorption rates. In conclusion, the results of this experimental study demonstrate that resorption was lesser than expected in the sliced cartilage graft and that homologous cartilage graft applications had activity and reliability similar to that of autogenous cartilage grafts.

After myringotomy, can topical Mesna application be an alternative method to ventilation tube application?

Sodium-2-mercaptoethanesulfonate (Mesna) is a mucolytic substance that is also used for chemically assisted tissue dissection in otological surgery. We investigated the effects of Mesna as a chemical agent on the closing time of perforation of the eardrum in an experimental animal model. We performed simple myringotomy with a knife on 44 tympanic membranes of 22 rats. Four rats were excluded from the study because of serosity in their ears. Rats were divided into two study groups and a control group. These groups were the Mesna-administered group (Group A) (8 rats, 15 tympanic membranes), the saline-administered group (Group B) (8 rats, 14 tympanic membranes) and the control (native) group (6 rats, 11 tympanic membranes) (Group C). We applied Mesna locally for 20 min following myringotomy. Examination was made with an otoendoscope on days 1, 2, 3, 5, and 7, and patency rates were recorded. According to our results, we found that the closing time of the tympanic membrane was significantly longer in the Mesna group than in the saline administrated and native group. After myringotomy procedure, the application of a single dose of Mesna may contribute to the recovery duration of middle-ear pathologies by delaying the closing time of tympanic membrane perforation. However, Mesna cannot be an alternative method for the application of ventilation tubes.

Impact of Multilevel Surgical Treatment on Mean Platelet Volume in Patients With Obstructive Sleep Apnea Syndrome.

BACKGROUND AND OBJECTIVES: Mean platelet volume (MPV) is a potential marker of platelet reactivity. Increased MPV levels are shown to be the predictor of cardiovascular diseases, hypertension, and stroke. Previous studies demonstrated increased MPV levels in patients with obstructive sleep apnea syndrome (OSAS). The aim of this study was to examine the impact of 1-stage multilevel surgical treatment on MPV levels in patients with OSAS. METHODS: Preoperative and postoperative 6-month hematologic parameters as well as polysomnographic findings of 42 patients, who underwent 1-stage multilevel surgery for treatment of moderate or severe OSAS, were compared. RESULTS: In the comparisons of preoperative and postoperative apnea-hypopnea index (AHI) and MPV values, statistically significant decreases were detected There was a significant positive correlation between the decrease in mean AHI and decrease in MPV levels. CONCLUSIONS: One-stage multilevel surgery targeting the obstruction at the retropalatal and tongue-base levels was found to be effective in decreasing AHI and MPV. Mean platelet volume may be a new index to indicate the success of OSAS surgery.

Multidimensional scale of perceived social support in patients with obstructive sleep apnea syndrome.

Social support is a very important aspect of debilitating diseases. Obstructive sleep apnea syndrome (OSAS) is a common disabling disease that impairs a patient's quality of life and affects a patient's environment. The Multidimensional Scale of Perceived Social Support (MSPSS) is used to measure the perception of the sufficiency of social support for individuals. The aim of this study is to evaluate the relationship of the MSPSS to the Apnea-Hypopnea Index (AHI), age and gender in patients with OSAS. In this study, 183 subjects with a diagnosis of OSAS were enrolled. Patients were evaluated with the MSPSS in terms of age, gender and polysomnography results. According to the results of this study, the MSPSS has found to be higher in men than in women with OSAS and higher in moderate-severe OSAS than in mild OSAS. The MSPSS can be an important indicator of how patients cope with the disease.

A rare cause of abnormal epiglottic mobility and dyspagia: calcification of the epiglottis.

The dynamic function of the epiglottis plays an important role in preventing the aspiration of foods into the trachea during deglutition. Abnormal epiglottic movement may cause swallowing and aspiration problems. Epiglottic calcification is a rare cause of abnormal epiglottic movement pattern and dysphagia. In this report, we present a case of epiglottic calcification caused by dysphagia and discuss the clinical and radiologic features of this very rare condition.

A rare cause of dysphagia in children: lymphangiomatous polyp of the palatine tonsil.

Oropharyngeal and tonsillar masses are a very rare cause of dysphagia in children. In this article, we describe a rare cause of dysphagia in children, a lymphangiomatous lesion of the palatine tonsil, and discuss the clinical and histopathologic features of these lesions.

A rare cause of unilateral parotid gland swelling: compensatory hypertrophy due to the aplasia of the contralateral parotid gland.

In this clinical report, 3 cases, admitted to the ears, nose, throat outpatient clinic with the complaints of unilateral swelling in the parotid region and facial asymmetry, are presented. In the etiology, contralateral parotid gland aplasia with compensatory hypertrophy and sialosis was detected. With this rare condition, clinical and radiological features of this anomaly are discussed.

Anomalous relationship of coexisting ipsilateral recurrent and nonrecurrent inferior laryngeal nerves during thyroid surgery.

One of the most important complications of thyroid surgery is inferior laryngeal nerve injury. Variations of inferior laryngeal nerve may increase the risk of iatrogenic injury. Coexistence of ipsilateral nonrecurrent laryngeal nerve and recurrent laryngeal nerve is a very rare variation, and sufficient data are not available on the anatomical and functional relationship of the 2 branches and probable clinical outcomes resulting from the injury of one of them. Herein, we present a case with coexistence of nonrecurrent laryngeal nerve and ipsilateral recurrent laryngeal nerve and discuss the clinical importance of this rare variation.

Giant congenital epiglottic cyst presenting with airway obstruction at birth.

Congenital laryngeal cysts (CLCs) are rare and may be fatal. Although CLCs have the potential to cause severe airway obstruction and death, these are not common presentations at birth. The most common CLCs are the aryepiglottic cysts, with the epiglottic cysts being the least common. In this report, a newborn with severe airway obstruction at birth, caused by a giant congenital epiglottic cyst, is presented.

Giant atypical lipomatous tumor/well-differentiated liposarcoma of the neck.

Liposarcoma of the head and neck represents approximately 1% of head and neck sarcomas. Atypical lipomatous tumor/well-differentiated liposarcoma rarely occurs in the neck. The size of the neck liposarcomas rarely exceeds 10 cm during presentation. Surgical excision is the treatment of choice for liposarcomas. We report a very unusual size, which has not been reported to our knowledge, of an atypical lipomatous tumor of the neck, reaching a size of 25 × 22 cm. The patient underwent complete resection of the lesion without morbidity. Three months after the surgery, the patient is free of recurrence.

Parasympathetic overactivity in patients with nasal septum deformities.

Nasal septum deformities (NSD) are one of the most frequent reasons for nasal obstruction presented with a reduction in nasal airflow and chronic mucosal irritation. Nasocardiac reflex which includes afferent stimulus with maxillary division of the trigeminal nerve and the efferent pathway of the heart via the vagus nerve is not a well-known part of autonomic nervous system (ANS). Heart rate variability (HRV) is a parameter reflecting the ANS activity on heart. The purpose of this study is to evaluate ANS functions in patients with NSD by HRV analysis. Twenty-nine patients with NSD and 26 control subjects were included in the study. The diagnosis of NSD was made with history, symptoms, anterior rhinoscopy, and nasal endoscopic examination. 24-h ambulatory electrocardiographic recording was performed by a 3-channel recorder. HRV parameters were obtained by analyzing these parameters. Baseline features were similar in patients and controls (mean age: 31 ± 8 in the patients, 32 ± 9 in control subjects; P = NS). Night-RMSSD (the square root of square of mean square differences of successive NN intervals) (47 ± 21, 34 ± 13; P = 0.008), night-PNN50 (the number of interval differences of successive NN intervals greater than 50 ms) (24 ± 16, 14 ± 10; P = 0.007), 24-h-RMSSD (39 ± 18, 27 ± 12; P = 0.004), and 24-h-PNN50 (16 ± 12, 9 ± 7; P = 0.016) were significantly higher in patients than controls. Other HRV parameters were not significantly different between two groups. Changes in these parameters demonstrated an increased parasympathetic tone and discordance in sympatho-vagal activity in NSD.

Anomalous relationship of the retromandibular vein to the facial nerve as a potential risk factor for facial nerve injury during parotidectomy.

Finding and protecting the facial nerve are a challenge for the surgeon performing parotid surgery. The abnormal relationship between the retromandibular vein and facial nerve and its branches may increase the risk of facial nerve injury during surgery. In this clinical report, we have reported a 41-year-old female patient with pleomorphic adenoma undergoing superficial parotidectomy, and we have discussed a new variation of facial nerve-retromandibular vein relationship.

Utilization and dissection for endoscopic sinus surgery training in the residency program.

OBJECTIVE: To develop an animal cadaver model that would allow residents to learn functional endoscopic sinus surgery as a complementary model. STUDY DESIGN: Prospective experimental study. PATIENTS AND METHODS: Two of our first-year residents were included in the study, and each operated on 5 sheep noses. All the routine steps of endoscopic sinus surgery were performed, except for sphenoidotomy, and their success and complication scores were recorded. The residents' performance for maxillary antrostomy, ethmoidectomy, and frontal sinusotomy in sheep cadaver noses were evaluated by the authors. Predissection and postdissection computer tomography assessed the completeness of dissection. Images were analyzed for maxillary antrostomy, frontal sinusotomy, residual ethmoid cells and partitions, and residual frontal recess cells. The first and last 5 sides of residents were analyzed together as the first 10 sides (group 1) and last 10 sides (group 2). RESULTS: Group 2 had significantly better outcomes for frontal sinusotomy and ethmoidectomy (P = 0.011 and P = 0.003, respectively). The mean duration of procedures for group 1 was 15.7 minutes and that for group 2 was 10.3 minutes (P = 0.000). The difference was not significant between the 2 groups when comparing the success rates of maxillary antrostomy and the complication rates (P > 0.05). CONCLUSIONS: The nasal cavity of the sheep is anatomically similar to the human nasal cavity, and the model using sheep cadaver for endoscopic sinus surgery training is a cost-effective and useful model for the first step of the learning curve.

Otorhinolaryngologic examination in obstructive sleep apnea syndrome: the correlation between the severity of sleep disorder and physical examination.

OBJECTIVES: The aim of this study was to compare nasopharyngeal examination findings with those of polysomnography, which is considered to be the gold standard, in positional and nonpositional obstructive sleep apnea syndrome (OSAS) patients. PATIENTS AND METHODS: The study included 374 patients (215 males, 159 females; mean age 44.9 years; range 11 to 77 years) presenting with OSAS or simple snoring. Patients underwent polysomnography recordings and otorhinolaryngologic examination including fiberoptic nasopharyngoscopy with the Müller maneuver. The correlation of the data scoredwith the polysomnographic findings and body mass index (BMI) was investigated. The findings were assessed using the Mann Whitney U-test (anatomic findings) and Student t-test (Müller maneuver). RESULTS: Body mass index was correlated with apnea-hypopnea index (AHI), AHI-Lateral AHI-supine, the grade of the tongue base and neck circumference (p<0.05). In general, the dominant level of obstruction was at the soft palate level in patients with severe OSAS. There was a positive correlation between the grade of lateral obstruction at the soft palate level and AHI and AHI-lateral (p=0.01, p=0.02, respectively). The grade of anteroposterior obstruction at the tongue base level had a significant correlation with AHI- total and AHI-supine (p<0.05). The grade of the tonsillar hypertrophy revealed significant correlation with AHI-total and AHI-supine (p<0.05). There was no significant correlation between the degree of the nasal septal deviation and AHI (p>0.05). CONCLUSION: When upper airway obstruction is evaluated, AHI and positional AHI values should be used separately.

Association between facial nerve second genu angle and facial canal dehiscence in patients with cholesteatoma: evaluation with temporal multidetector computed tomography and surgical findings.

INTRODUCTION: Otitis media, mastoiditis or the pressure effect of tumorous lesions such as cholesteatoma can be the cause of facial canal dehiscence and facial nerve paralysis. The most common segment involved in dehiscence is the tympanic segment and the second most common is the lateral aspect of the facial canal in the oval window area. OBJECTIVE: To determine the prevalence of the facial canal dehiscence and the relationship between the angle at the second genu of the facial nerve and facial canal dehiscence. METHODS: We evaluated the surgical findings in 113 patients who underwent surgery for cholesteatoma. Facial canal dehiscence was detected in 62 of the 113 patients. Patients were divided into two groups: Group 1, with dehiscence of the facial canal and Group 2, without dehiscence of the facial canal. RESULTS: The mean angles at the second genu of the facial nerve in Groups 1 and 2 were 117.8°±9.63° and 114°±9.9°, respectively. There was a statistically significant difference between the mean angles at the second genu for the two groups (p=0.04). CONCLUSION: In patients with dehiscence of the facial canal, the angle at the second genu was found to be wider than those without dehiscence.