Is intrauterine exposure to COVID-19 infection a risk factor for infant hearing loss?

PURPOSE: To determine whether exposure to intrauterine COVID-19 infection causes congenital or late-onset hearing loss in infants. MATERIAL AND METHOD: The hearing screening results of infants born in a tertiary hospital between March 2020 and April 2022 with and without a history of intrauterine exposure to COVID-19 infection (36 infants each) were retrospectively analyzed within one month after birth in all infants and additionally at six months after intrauterine COVID-19 infection exposure in the study group. The automated auditory brainstem response (AABR) test was used for the hearing evaluation. RESULTS: The polymerase chain reaction test was negative in study group exposed to intrauterine COVID-19 infection. The number of infants admitted to the intensive care unit (ICU), and the length of ICU stay were significantly higher in this group (p < 0.01). Six infants (16.6 %) in the study group failed the first AABR test bilaterally, but five of these infants passed the second AABR test. A bilateral severe sensorineural hearing loss was detected in one infant (2.77 %). All the infants in the study group underwent the AABR test again at six months, and all infants, except this infant, passed the test. In the control group, five infants (13.88 %) failed the first AABR test bilaterally, but they all passed the second test. CONCLUSIONS: Exposure to COVID-19 infection in the intrauterine period does not cause congenital or late-onset hearing loss (within six months) in infants; therefore, gestational COVID-19 infection is not a risk factor for infant hearing loss.

Analysis of cochlear implant revision surgeries.

PURPOSE: This study aimed to evaluate the reasons for cochlear implant (CI) revision surgeries in pediatric and adult groups. METHODS: A total of 490 CIs were used for 423 patients between August 2005 and August 2019. Among these, patients who underwent a CI revision surgery were identified retrospectively. The reasons for CI revision surgeries were classified mainly as medical problems and device failure. These were also determined according to implant brands. RESULTS: Of 423 patients with a CI surgery, 27 (6.3%) underwent a CI revision surgery. The revision implant rate was 4.9% for the pediatric group and 1.4% for the adult group. Five patients underwent a CI revision surgery due to medical problems (23.8%) and 16 due to device failure (76.2%) in the pediatric group, while 3 patients (50.0%) underwent a CI revision surgery due to medical problems and 3 (50.0%) due to device failure in adults. CONCLUSIONS: A CI surgery is safe for patients with severe-to-profound sensorineural hearing loss, although a CI revision surgery has some potential. Device failure is the most common cause in children. It may be due to early implantation, frequent fall when children learn walking, or impaired vestibular function.

Is Transnasal Endoscopic Marsupialization Sufficient in Thornwaldt Cysts?

OBJECTIVE: Thornwaldt cyst is a rare nasopharyngeal lesion that develops from primitive notochord residues. The aim of this study is to evaluate the long-term results of transnasal endoscopic marsupialization surgery in the treatment of Thornwaldt's cyst, its success and its qualification in the treatment. METHOD: The data of 21 patients who underwent transnasal endoscopic marsupialization surgery for symptomatic Thornwaldt cyst in our hospital between 2009 and 2015 and followed up regularly after the operation were reviewed retrospectively. RESULTS: Eleven patients were female and 10 were male. The mean age of the patients was 35.5 years (15-60). All patients underwent transnasal endoscopic marsupialization as a surgical technique. No intraoperative and postoperative complications were observed. In all cases, the complaints regressed postoperatively. There was no recurrence at 4-year follow-up. CONCLUSION: Transnasal endocopic marsupialization as a surgical method can be performed safely in Thornwaldt cyst cases because of its easy applicability, short surgical time, low recurrence rates and efficacy in treatment.

Three layer interlocking: a novel technique for repairing a nasal septum perforation.

OBJECTIVE: Many techniques to repair a septal perforation using local flaps with or without an interpositioning graft with various rates of success have been described. Our aim was to describe a new and relatively easy technique for repairing these perforations. METHODS: Twenty-two patients with nasal septal perforations smaller than 2 cm in diameter were operated on between 2010 and 2012 at Eskisehir Osmangazi University. The described 3-layer interlocking method was applied to repair the septal perforation in all of the cases. RESULTS: Twenty-two patients were operated on using this technique. The follow-up time ranged from 30 months to 10 months, with a mean follow-up time of 20.9 months. In 19 of the 22 patients, complete closure of the perforation was achieved (86.3%). We did not encounter any early or late postoperative complications. CONCLUSION: A novel technique that uses a temporalis fascia-conchal cartilage complex as an interpositioning material to repair septal perforations is described. This complex was endoscopically introduced to the perforation after elevating the edges of the perforation. We concluded that the low morbidity, short operating time, and high success rate make this technique a good choice for repairing small- to medium-sized perforations.

The round window diameter in congenital aural atresia and comparison with sensorineural hearing loss and control group.

OBJECTIVE: The aim of this study was to measure round window (RW) diameters in patients with congenital aural atresia (CAA) or sensorineural hearing loss (SNHL) and a normal control group and to analyze whether differences exist between these groups. METHODS: Temporal bone computed tomographic scans of 12 patients with CAA (5 males, 7 females) aged 1 to 50 years (median age, 6 years), 12 patients with SNHL (8 males, 4 females) aged 2 to 32 years (median age, 5 years), and 11 patients (3 males, 7 females) aged 2 months to 53 years (median age, 8 years) randomly selected from a pool of patients with unilateral chronic otitis media or cholesteatoma were reviewed. We measured RW diameter on oblique reconstruction planes. To prevent possible individual differences, skull width was measured. RESULTS: There were no statistically significant differences between all groups for skull width. Both RW diameter and RW membrane width were found smaller in the CAA group than both SNHL group and control group with statistical significance, whereas there were no statistically significant differences between the SNHL group and the control group. CONCLUSIONS: We found that both the RW diameter and RW membrane width in CAA were smaller than those in the control group. If this finding is supported in future studies, the production of floating mass transducer with different sizes may be useful. We suggest that RW diameter should be measured in each patient before operation and thus a floating mass transducer with the appropriate caliber should be chosen.

Differentiation of peripheral and non-peripheral etiologies in children with vertigo/dizziness: The video-head impulse test and suppression head impulse paradigm.

OBJECTIVES: To identify the etiology of vertigo/dizziness and determine the effectiveness of the video-head impulse test (vHIT) and the suppression head impulse paradigm (SHIMP) tests in distinguishing between peripheral and non-peripheral etiologies in children who presented to the otolaryngology department with complaints of vertigo/dizziness. METHODS: The vHIT and SHIMP tests were applied to the children. The vestibulo-ocular reflex (VOR) gain and saccade parameters were compared. RESULTS: In 27 children presenting with vertigo/dizziness, the most common etiological factor was inner ear malformation (IEM) (n = 6/27, 22.2%), followed by cochlear implant surgery (11.1%) and migraine (11.1%). Vestibular hypofunction was indicated by the vHIT results at a rate of 60% (9/15 children) and SHIMP results at 73.3% (11/15 children) among the children with a peripheral etiology, while these rates were 8.3% (1/12 children) and 25% (3/12 children), respectively, in the non-peripheral etiology group. SHIMP-VOR and vHIT-VOR gain values had a moderate positive correlation (p = 0.01, r = 0.349). While there were overt/covert saccades in the vHIT, anti-compensatory saccade (ACSs) were not observed in the SHIMP test (p = 0.041). The rates of abnormal vHIT-VOR gain (p = 0.001), over/covert saccades (p = 0.019), abnormal vHIT response (p = 0.014), ACSs (p = 0.001), and abnormal SHIMP response (p = 0.035) were significantly higher in the peripheral etiology group. CONCLUSIONS: IEM was the most common etiological cause, and the rate of vestibular hypofunction was higher in these children with peripheral vertigo. vHIT and SHIMP are effective and useful vestibular tests for distinguishing peripheral etiology from non-peripheral etiology in the pediatric population with vertigo/dizziness. These tests can be used together or alone, but the first choice should be the SHIMP test, considering its short application time (approximately 4-5 min) and simplicity.

Septal stapler use during septum surgery.

Although discussions regarding nasal packing are still ongoing, to eliminate any possible complications, surgeons have used nasal packing for many years. Septoplasty is one of the most frequently performed operations by head and neck surgeons. Any methods to diminish the surgical time or bring comfort to the surgeon will be well appreciated. In this study, we attempted to demonstrate the usefulness of the stapler method by comparing preoperative and postoperative results from the visual analog scale (VAS), nasal obstruction symptom evaluation (NOSE), rhinosinusitis quality of life questionnaire (RQLQ), and acoustic rhinomanometry values. In addition, we evaluated pain scores, postoperative complications, and breathing after nasal packing, stapling, and trans-septal suturing techniques. Patients were divided into three groups. In the first group, deviated cartilage was removed or repositioned and mucoperichondrial flaps were closed with a bioresorbable stapler after septoplasty. Four or five staples were placed on the septum. In the second group, the septum was sutured continuously with 4/0 Pegelak (Dogsan TR). In the third group, Merocel packs were used without any sutures and were kept for 48 h. Nasal packing leads to patient discomfort after septal surgery; however, there is no difference in patient comfort between closing the mucoperichondrial flaps by suturing the septum or using a stapler. After surgery, there were no differences between the groups in terms of successful breathing. This situation was assessed by endoscopic examination and acoustic rhinomanometry. Thus, there was no objective or subjective difference. Stapling increases the doctor's comfort level and surgical time is optimized. Although experienced surgeons can easily suture the septum, less experienced ones have some difficulty; therefore, stapling may provide more benefit to the latter. Further, four staples are sufficient to close the septum.

Evaluation of nasal airway alterations associated with septorhinoplasty by both objective and subjective methods.

The aim of functional septorhinoplasty is to create an esthetically elegant nose and harmony in the face by preserving nasal function as well as maintaining or restoring adequate airway. Since nasal complaints are usually subjective, it may be difficult to evaluate the functions objectively. In the present study, we aimed to investigate the alterations in nasal function associated with septorhinoplasty by using both objective and subjective methods. The study population consisted of 40 patients who underwent septorhinoplasty and 40 healthy controls. Before and after the operation, visual analog scale, acoustic rhinometry, rhinomanometry, and Odiosoft-Rhino test were applied to all patients and controls. There were significant differences in all parameters both before and after the operation. While a significant difference was obtained between the patient and control groups in terms of preoperative values, no significant difference was found between postoperative values of these groups. Both objective and subjective methods are important in evaluations.

Investigation of the presence of biofilms in chronic suppurative otitis media, nonsuppurative otitis media, and chronic otitis media with cholesteatoma by scanning electron microscopy.

OBJECTIVE: Biofilms have been shown to play a major role in the pathogenesis of otolaryngologic infections. However, very limited studies have been undertaken to demonstrate the presence of biofilms in tissues from patients with chronic otitis media (COM) with or without cholesteatoma. Our objective is to study the presence of biofilms in humans with chronic suppurative and nonsuppurative otitis media and cholesteatoma. Study Design. In all, 102 tissue specimens (middle ear, mastoid tissue, and ossicle samples) were collected during surgery from 34 patients. METHODS: The samples were processed for the investigation of biofilms by scanning electron microscopy (SEM). RESULTS: Our research supports the hypothesis in which biofilms are involved in chronic suppurative otitis media, cholesteatoma, and, to a lesser degree, chronic nonsuppurative otitis media. There were higher rates in hypertrophic and granulated tissue samples than in normal mucosa. In addition, the presence of biofilms was significantly higher in the middle ear mucosa compared with the mastoid and ossicle samples. CONCLUSION: In the clinic, the careful use of topical or systemic antimicrobials is essential, and, during surgery, hypertrophic tissue must be carefully removed from normal tissue.

Acute Otitis Media with Intracranial and Intratemporal Complications: A Case Study.

Acute otitis media continues to be one of the most common infections today and a major cause of the prescription of antibiotics in the pediatric age group. Complications of this condition are rare, especially when antibiotic therapy is started early; however, complications related to acute otitis media cause dramatic morbidity. This report provides a review related to a case of acute otitis media with bilateral intracranial and intratemporal complications.

Diode laser treatment of hypertrophic inferior turbinates and evaluation of the results with acoustic rhinometry.

Inferior turbinate hypertrophy is the most common cause of chronic nasal obstruction. When conservative medical treatment options fail in patients with inferior turbinate hypertrophy, reduction of the inferior turbinate can be performed using surgical techniques. Laser-assisted turbinate surgery has the advantages of limited tissue trauma and reduced bleeding. We evaluated the effectiveness and outcomes of using a diode laser (λ = 980 nm) in turbinate reduction. Our study included 62 patients with symptoms of nasal obstruction due to hypertrophic inferior turbinates, who did not respond to medical treatment (≥ 1 year). Patients were treated with diode laser between January 2009 and December 2010 in our ENT (ear, nose, and throat) department. Subjective outcome of severity of nasal obstruction was assessed on a standard 10-cm visual analog scale (VAS). Acoustic rhinometry was used to measure nasal patency. The cross-sectional areas 1, 2, and 3 and the volumes between 2.5 and 5.5 cm were measured. VAS scores and acoustic rhinometry measurements were performed preoperatively and 1, 6, and 12 months after surgery. The mean follow-up was 13.1 ± 1 months. The mean operation time was 3 min per turbinate; no nasal packing was necessary. We did not observe any major complications. Both subjective and objective evaluations showed significant improvement. VAS scores improved, the mean MCA2, MCA3, and V2-5 measurements increased significantly 1 year after surgery. In the first year after surgery, 53 of 62 (85.4%) patients reported marked improvements in nasal breathing. Our results showed that, objectively and subjectively, the success rates in diode laser-assisted turbinate reduction were satisfactory. The diode laser, being one of the most portable and least expensive of the lasers available for turbinate surgery, makes it possible for turbinate reduction to be performed under topical anesthesia within a short period of time with excellent patient acceptance.

Use of cone beam computed tomography in otolaryngologic treatments.

Cone beam computed tomography (CBCT) allows us to evaluate 3-dimensional (3D) morphology of the maxillofacial skeleton and also used in dentomaxillofacial imaging to solve complex diagnostic and treatment planning problems such as craniofacial fractures, temporamandibular dysfunctions or sinus imaging. CBCT uses a rectangular or round 2D detector, which allows a single rotation of the gantry to generate a scan of the entire region of interest. Technological and application-specific factors such as development of compact, relatively low-cost, high-quality, large, flat-panel detector arrays; the availability of low-cost computers with processing power sufficient for cone beam image reconstruction; the fabrication of highly efficient radiograph tubes capable of multiple exposures necessary for cone beam scanning at prices lower than those currently used for fan beam CT; and limited volume scanning (e.g., head and neck) eliminating the need for subsecond gantry rotation speeds make this possible. The objective of this study is to review published evidence for CBCT having an important role in ORL treatments. We aimed to review all the available literature about the CBCT imagination in ORL treatments. Systematic literature search was performed using PubMed and Ovid. Additional literature was retrieved from reference lists in the articles. Systematic analysis of the literature from 1998 to 2010 was performed. A total of 40 abstracts were evaluated independently by two members of the project group, and 38 articles were included in the review.

In vitro study on immune response modifiers as novel medical treatment options for cholesteatoma.

OBJECTIVES: To investigate cytokine profile of cholesteatoma and to collect information about important intercellular signaling pathways by establishing two different cell culture models, to block important intercellular signaling pathways in cholesteatoma by applying immune system modifier drugs to develop alternative medical therapy options for cholesteatoma. METHODS: To observe the pathogenesis of cholesteatoma and to apply the immunomodulatory drugs, cholesteatoma tissue culture models were constituted with HEKa cells and cholesteatoma keratinocytes, which were obtained from 3 patients who underwent operations for cholesteatoma. Medicines including 5-fluorourasil, imiquimod, cyclosporine, and tacrolimus were applied on both cholesteatoma keratinocytes and HEKa cells. After 48 h of incubation, IL-1, IL-6, IL-8, IL-10, TNF-α, and Ki67 levels were measured to determine cell viability rates. RESULTS: In the cholesteatoma control group, IL-6 and TNF-α levels were found higher than in the HEKa control group. All repurposed drugs in the study demonstrated anti-inflammatory, anti-proliferative, and cytotoxic effects on cholesteatoma. Imiquimod and tacrolimus in particular are potential treatment prospects for cholesteatoma due to their strong anti-inflammatory and cytotoxic effects. CONCLUSION: Medical therapy options for cholesteatoma are still missing and surgery is not the ultimate solution. We have focused on intercellular inflammatory processes, which play significant roles in the pathogenesis of cholesteatoma in our paper. Inflammation and proliferation of cholesteatoma decreased after all repurposed drug applications in our study. Anti-inflammatory and anti-proliferative effects of tacrolimus and imiquimod was more significant than other drugs in the study. For this reason, tacrolimus and imiquimod should be examined in depth with in vivo studies in terms of efficacy and safety for medical treatment of cholesteatoma.

An Experimental Comparison of the Analgesic and Anti-Inflammatory Effects of Safflower Oil, Benzydamine HCl, and Naproxen Sodium.

The study aims to establish how feasible a natural therapy option (safflower oil) is in the treatment of postoperative pain. Naproxen sodium has already been experimentally proven to be effective for this purpose. Accordingly, the analgesic and anti-inflammatory effects of safflower oil were compared with those obtained with benzydamine HCl and naproxen sodium. Forty-two, healthy, adult female rats of Wistar albino species were divided at random into six groups of seven rats. The intervention allocation was as follows: Group No. 1-physiological saline 0.9%; Group No. 2-safflower oil 100 mg/kg; Group No. 3-safflower oil 300 mg/kg; Group No. 4-benzydamine HCl 30 mg/kg; Group No. 5-benzydamine HCl 100 mg/kg; and Group No. 6-naproxen sodium 10 mg/kg. Following allocation of treatment, pain was induced experimentally and tested in various ways (hot plate test, tail-pinching test, and writhing test) and the efficacy of each treatment in providing peripheral and central analgesia was evaluated. The second stage consisted of providing different treatments to four groups (groups 7-10) of seven rats each, chosen at random. The allocations were as follows: Group No. 7-physiological saline 0.9%; Group No. 8-safflower oil 300 mg/kg; Group No. 9-benzydamine HCl 100 mg/kg; and Group No. 10-naproxen sodium 10 mg/kg. To create experimental inflammation, 2% formaldehyde was injected into the experimental animal's paw and the resulting edema was measured and recorded for a 10-day period. Edema inhibition was calculated as a percentage. The rats were sacrificed and the paw and stomach dissected for histopathological examination. The data were used for statistical analysis, using the Shapiro-Wilk, Kruskal-Wallis H test, and two-way analysis of variance. In the tail-pinching test, it was determined that a 300 mg/kg dose of safflower oil shows central spinal analgesic efficacy and this effect is close in magnitude to 10 mg/kg of the reference material, naproxen sodium. In the squirming test, it was observed that the 100 and 300 mg/kg doses of safflower oil had a peripheral analgesic effect when compared with the serum physiological (placebo) group. The peripheral efficacy of 300 mg/kg safflower oil was found to approximate that of 10 mg/kg naproxen sodium. In rats treated with benzydamine HCl 100 mg/kg, similar peripheral analgesic efficacy to naproxen sodium 10 mg/kg was noted. In the hot plate test, no difference in the analgesic efficacy between the various agents was found. The change in inhibition of edema between the 1st and 10th days was most marked in rats receiving naproxen sodium 10 mg/kg. A significant difference was determined in the safflower oil 300 mg/kg and benzydamine HCl 100 mg/kg groups (P < .001). Regarding histopathology findings in the rat paw, significant differences were seen in venous congestion between placebo and safflower oil 300 mg/kg and in inflammation between the control and benzydamine HCl 100 mg/kg groups. Regarding the histopathology findings in the rat stomach, significant differences were observed in venous congestion between placebo and safflower oil 300 mg/kg; in damage to the epithelium between placebo and safflower oil 300 mg/kg and between naproxen sodium 10 mg/kg and safflower oil; and in cell infiltration and development of edema between placebo and safflower oil 300 mg/kg. It is predicted that further research into safflower oil and benzydamine HCl will create opportunities to develop analgesic-anti-inflammatory therapeutics of a novel kind for the treatment of postoperative pain and inflammation.

Acoustic Analysis of Soccer Fans in Acute Phonotrauma After the Match.

OBJECTIVES: Acute phonotrauma is the result of sound production by shouting or straining one's voice. In this study, we aimed to investigate the acute changes in the vocal folds and voices of soccer fans who voluntarily applied to our clinic after the soccer match where they engaged in acute phonotrauma. There are no other studies in the literature conducted on a similar sample group. STUDY DESIGN: This is a case-control study. METHODS: Videolaryngostroboscopic (VLS) examination, acoustic voice analysis, and Voice Handicap Index (VHI) questionnaire were performed on 29 voluntary soccer fans included to the study before the match and at the first hour after the match. The values obtained were compared statistically with each other and with 29 control groups without voice pathology. RESULTS: The jitter, shimmer, and normalized noise energy values measured after the match increased significantly statistically compared with the pre-match level, but harmonic noise ratio value decreased significantly (P < 0.05). VHI scores increased significantly after the match according to the pre-match scores (P < 0.05). In the VLS examinations, there was no difference in the images before and after the match. CONCLUSIONS: It has been concluded that people who are using their voices loudly and intensely by shouting during the match are exposed to sound changes after the match, and if this situation becomes persistent, it may cause permanent voice pathologies. It is thought that VHI and acoustic voice analysis should be done together with VLS for diagnosis and follow-up of voice changes for which the VLS examination alone is not sufficient.

Efficacy of Platelet-Rich Plasma on Fat Grafts in the Repair of Tympanic Membrane Perforations: An Experimental Study.

OBJECTIVE: We investigated the use of autologous platelet-rich plasma (PRP) to improve the success rate of fat graft myringoplasty in perforated tympanic membranes of rats. MATERIALS AND METHODS: A total of 20 healthy Wistar albino female rats were divided into two groups. In Group 1, the left tympanic membranes were perforated and grafted with a fat graft that was harvested from the inguinal region. In Group 2, the left tympanic membranes were perforated, and a fat graft was also harvested from the inguinal region. Then, the fat was soaked in 0.5 mL PRP and grafted at the perforation. After the procedure, the rats were examined, and the graft situation was assessed at 3, 5, 7, 10, and 14 days. All of the rats were sacrificed 21 days after perforation, and a histopathological examination was made. RESULTS: We compared fat graft histopathological and otomicroscopic findings between the groups. While we did not observe graft rejections in Group 2, we saw 1 case of graft rejection in Group 1. In the histopathological examination, PRP prevents fat graft resorption by the terms of the adipocyte area, granulation tissue area, and vacuolization area. CONCLUSION: This study demonstrated the efficacy of fat grafts prepared with PRP on rat tympanic membranes. The fat graft with PRP did not statistically improve the success rate compared to the graft without PRP. Histopatologic findings of the study showed that PRP prevents fat graft resorption. Further studies are needed to further examine the advantages of the graft with PRP.

Lingual Osseous Choristoma.

An osseous choristoma is a rare benign lesion consisting of normal bone tissue; it is seen in abnormal locations. It is most often seen in the posterior 1/3 of the tongue in the head. Its etiopatogenesis is controversial, and till date, less than 100 cases have been reported in the literature. Although a lingual osseous choristoma is asymptomatic, in some patients, symptoms such as swelling sensation in the throat, globus pharyngeus, dysphagia, retching, nausea, and sore throat have been reported. In this article, a 41-year-old female patient admitted to our clinic with throat pain and globus pharyngeus who underwent an excision from the region of radix lingua and the result of histopathological examination was reported as "osseous choristoma" was presented and related literature is reviewed.

The Analysis of Patients Operated for Frontal Sinus Osteomas.

OBJECTIVE: Paranasal sinus osteomas are benign tumors that are smooth-walled, slow-growing, and induced by bone tissue. Although their most common localization is the frontal sinus, some osteomas are seen in the ethmoid, maxillary, and sphenoid sinuses. Frontal sinus osteomas are often asymptomatic; however, when they become symptomatic, headache is the most common complaint. In this study, we aimed to analyze the postoperative results of patients who were diagnosed with frontal sinus osteoma and were operated with appropriate surgical techniques. METHODS: We retrospectively evaluated 14 patients who were diagnosed with frontal sinus osteoma and were operated in our department between March 2009 and July 2014. The following parameters were analyzed: patients' age and gender, complaints at the time of admission to our clinic, pathological findings from physically examination, tumor features observed in preoperative paranasal sinus computed tomography (size and localization), surgical methods applied, intra- and postoperative complications, and recurrence rates. All patients preoperatively provided informed consent. RESULTS: Of the 14 patients, 7 were males and 7 were females, with a mean age of 40.57 years. A total of 11 (79%) osteomas were located within the frontal sinus and 3 (21%) within the frontal recess. External surgical approach was performed to 11 patients, endoscopic approach was performed to 2 patients and external and endoscopic approach was performed to 1 patient together. CONCLUSION: Although the preferred surgical method in frontal sinus osteoma depends depended on size and localization of tumors, experience of surgeon is also important. Although the external surgical approach is appropriate for large and laterally localized osteomas, the endoscopic approach is appropriate for small and inferomedially localized osteomas. In both surgical approaches the site of origin should be drilled.

Effect of grapefruit juice on bioavailability of montelukast.

OBJECTIVES/HYPOTHESIS: The aim of this study was to investigate possible interactions between grapefruit juice and montelukast for up to 4 hours. STUDY DESIGN: A prospective, crossover study with 23 healthy volunteers was performed in two sessions. METHODS: In the first session, volunteers were treated with oral montelukast 10 mg once daily with 250 ml water. After a 10-day washout period, the same volunteers were treated with 10 mg montelukast with 250 ml grapefruit juice. Blood samples were collected 2, 3, and 4 hours after drug administration and kept at -80°C after both applications. Plasma samples were analyzed for montelukast concentration. RESULTS: The mean plasma concentration of montelukast across all time intervals was significantly greater (P = 0.0001) for those given grapefruit juice (517, 484, and 440) versus those treated with water (366, 356, and 292). Moreover, with respect to the time the sample was collected, there was no significant difference (P = 0.13) in the mean total plasma concentration up to 4 hours after montelukast ingestion for either group. There was a significant difference between the groups according to the area under curve with regard to marginal and cumulative values for all different time intervals (P < 0.05). CONCLUSIONS: Plasma concentration of montelukast was higher when administered with grapefruit juice, as compared to with water. This may have been due to the effect of grapefruit on liver metabolism of montelukast and the cytochrome P450 system.