Comparison of Quality of Life Before and After Septoplasty With Short Form-36.

The authors aimed to evaluate quality of life after septal surgery with Short Form-36 survey, and the effectiveness of the survey. Nasal symptoms (nasal obstruction, facial pain, catarrh), and general quality of life (using the Turkish version of the Short Form-36 questionnaire) were assessed preoperatively and at 1st and 6th postoperative months. Acoustic rhinometry and rhinomanometry were assessed preoperatively and at 6th postoperative month. Data from 78 patients were analyzed. This prospective clinical study was conducted on patients complaining of nasal obstruction with nasal septal deviation. Seventy-eight patients were included in the study. Fourty-two patients (53.8%) were male and 36 patients (46.2%) were female. At 1st postoperative month, nasal obstruction, facial pain and catarrh scores significantly improved in all, 46, 18 patients, respectively (P < 0.0001). At 6th postoperative month, scores nonsignificantly worsened by 1 point in 12, 6, 12 patients, respectively. Nasal volume significantly increased and total resistance significantly decreased at 6th month (P < 0.0001). Compared to preoperative values, all items except social function and bodily pain significantly increased at 1st postoperative month. Compared to values at 1st postoperative month, only bodily pain score decreased at 6th postoperative month. One patient presented with septal perforation. Septoplasty is a well-established technique to reduce nasal obstruction and improve quality of life. SF-36 may be used as a reliable measure of changes in quality of life after septal surgery.

The course of lower cranial nerves within the neck: a cadaveric dissection study.

PURPOSE: To evaluate the course of lower cranial nerves (CNs) within the neck in relation to surrounding structures and anatomic landmarks via a cadaveric dissection study. METHODS: A total of 70 neck dissections (31 bilateral, 8 unilateral) were performed on 39 adult fresh cadavers [mean (SD) age: 38.5 (11.2) years, 29 male, 10 female] to identify the course of lower CNs [spinal accessory nerve (SAN), vagus nerve and hypoglossal nerve] within the neck in relation to surrounding structures [internal jugular vein (IJV), common carotid artery (CCA)] and distance to anatomical landmarks (cricoid cartilage, hyoid bone, digastric muscle). RESULTS: SAN travelled most commonly anterior to IJV (51.4%) at the level of jugular foramen, while travelling lateral to IJV at the post belly of digastric (55.7%) and inferior to digastric muscle (90%) in most neck dissections. Vagus nerve travelled lateral to CCA in majority (94.3%) of dissections, while medial (2.9%), posterolateral (1.4%) and posterior (1.4%) positions were also noted. Average distance of hypoglossal nerve was 27.7 (9.7) mm to carotid bifurcation, 9.3 (3.9) mm to hyoid bone, and 54.7 (18.0) mm to the inferior border of cricoid cartilage. CONCLUSION: In conclusion, our findings indicate that anatomic variations are not rare in the course of lower CNs within the neck in relation to adjacent structures, and awareness of these variations together with knowledge of distance to certain anatomic landmarks may help the surgeon to identify lower CNs during neck surgery and prevent potential nerve injuries.

The therapeutic effect of thymoquinone on acoustic trauma-induced hearing loss in rats.

Thymoquinone has antioxidant properties. We hypothesized that thymoquinone may prevent or alleviate hearing loss induced by acoustic trauma. We aimed to study thymoquinone's effect on hearing function with distortion-product otoacoustic emissions and auditory brainstem response. Thirty adult Spraque Dawley rats were randomized into four groups following exposure to acoustic trauma for 4 h. Control group (n = 7) did not receive further treatment. Thymoquinone-20 (n = 8) and Thymoquinone-40 (n = 8) received 20 and 40 mg/kg of intraperitoneal thymoquinone, respectively. Corn-oil group (n = 7) received 1 ml of corn oil intraperitoneally. Hearing function of both ears was tested with distortion-product otoacoustic emission and auditory brainstem response before, and shortly after acoustic trauma, and 96 h following acoustic trauma. Post-trauma signal/noise ratios and wave V amplitude/latencies of all groups were significantly low compared with pre-trauma values, which indicate no preventive effect of thymoquinone. Rats in Thymoquinone-20 showed a significantly improved distortion-product otoacoustic emission and auditory brainstem response results at 4000 frequency and above in post-treatment tests (p < 0.05). Improvement in Thymoquinone-40 at the same frequencies was insignificantly inferior to Thymoquinone-20, yet superior to control and corn-oil groups (p < 0.05). We conclude that thymoquinone may not prevent acoustic trauma-induced hearing loss, however, at 20 mg/kg for 96 h, may repair the damage.

Does Helicobacter pylori exist in vocal fold pathologies and in the interarytenoid region?

The aim of this study was to investigate the existence of Helicobacter pylori (HP) in patients with benign and malignant vocal fold pathologies. This was a prospective clinical study conducted at a tertiary-care academic medical center. Fifty consecutive patients who had undergone microlaryngoscopy between August 2007 and July 2009 were included in the study. The patients with a reflux symptom index (RSI) above 12 and a reflux finding score (RFS) above 6 were accepted as having laryngopharyngeal reflux. Patients with urea breath test (UBT), HP-IgG, and HP cytotoxin-associated gene A (CagA)-IgG positivity were diagnosed as HP positive. During laryngoscopy, two surgical specimens were obtained, one from the primary vocal fold pathology and one from the interarytenoid region. The interarytenoid biopsy specimen was used for HP culture and PCR. The specimen from the vocal fold pathology was used to investigate the presence of HP. RSI was positive in 23 (46%) patients. The RFS positivity was 56%. The presence of HP was confirmed by UBT in 35 (70%), HP-IgG in 37 (74%), and HP CagA-IgG in 38 (76%) patients. There was no difference between RFS-positive and RFS-negative patients in terms of HP-IgG and UBT. None of the interarytenoid or vocal fold specimens showed the presence of HP. HP was not found in the histological specimens of vocal fold pathologies and the interarytenoid region. The presence of HP in the gastric mucosa does not have an effect on the RFS and RSI.

Evaluation of the effectiveness of topical ciprofloxacin and prednisolone in the prevention of myringosclerosis.

An antibacterial drug, ciprofloxacin, has been reported to modulate the inflammatory and immune responses on monocytes. Our objective is to evaluate the effectiveness of ciprofloxacin in the prevention of myringosclerosis that is created by myringotomy in rats and to compare it with prednisolone. In this study, 24 healthy Sprague-Dawley type rats of age 3-4 months and 250-300 g weight were used. Rats have been divided into three random groups. Topical ciprofloxacin was administered to the rats in the first group and topical prednisolone was administered to the rats in the third group; no medication was applied to their opposite ears and they were determined as control group. Prednisolone was administered to one ear of the rats and ciprofloxacin was administered to their opposite sides in the second group. After bilateral myringotomies the treatments were applied for 20 days as five drops two times a day. Otomicroscopic examination was made on the 10th day and reperforations were made when necessary. Rats were killed on the 21st day and temporal bone dissections were done. When we evaluate in terms of myringosclerosis and tympanic membrane thickness, in the first group, myringosclerosis and thickness have been observed in two of seven ears (28.6%) where ciprofloxacin was administered and in five of the seven ears (71.4%) where no treatment was applied. In the second group where prednisolone and ciprofloxacin were compared, myringosclerosis and thickness have been observed in six of the ten ears (60.0%) where prednisolone was administered and in four of the ten ears (40.0%) where ciprofloxacin was administered. In the third group, myringosclerosis and thickness have been observed in three of seven ears (42.9%) where prednisolone was administered and in four of the seven ears (57.1%) where no treatment was applied. All histopathological evaluations were made by one pathologist in a blinded manner. In our study, the effect of the ciprofloxacin and prednisolone was similar in preventing the experimental myringosclerosis and TM thickness in rats. When compared with the control groups, this preventive effect was more obvious in the ciprofloxacin treatment group than that of prednisolone.

Type 2 ossiculoplasty: prognostic determination of hearing results by middle ear risk index.

PURPOSE: The aims of this study were to investigate the prognostic impact of middle ear risk index on the postoperative hearing results in cases with type 2 ossiculoplasty; to compare the middle ear risk index results among primary, staged, and revision cases; and to compare the results of the prostheses used in ossicular reconstruction. MATERIAL AND METHODS: Records of 293 patients who had canal wall up tympanomasteidectomy and type 2 ossiculoplasty due to chronic otitis media between November 1995 and November 2007 were reviewed retrospectively. RESULTS: The mean preoperative air-bone gap was 32.6 dB, and it decreased to 15.2 dB after a mean follow-up period of 26.8 months postoperatively. The mean change of air-bone gap was 17.4 dB. Postoperative air-bone gap was 20 dB or less in 79% of the cases. The patients with dry perforations were in the low-risk group, and 91% of them had an air-bone gap of 20 dB or less. This value was 86% in the ones with intact malleus. The patients who had primary surgery were found in moderate risk group, whereas staged and revision groups were in the high-risk group. The air-bone gap was 20 dB or less in 84%, 78%, and 59%, respectively, of those groups. The difference between the primary and the revision groups reached a statistical significance. CONCLUSIONS: We had the best ossicular reconstruction results with glass ionomer cement, whereas the worst results were obtained with allograft partial ossicular replacement prostheses. We determined that risk-reducing factors such as dry ear, minimal ossicular chain defect, and intact malleus were important to have successful results. The middle ear risk index is a valuable tool for the surgeon to judge the risks and the probability success of the procedure as well as to make a good patient selection.

A unique case of a postrhinoplasty epidermoid cyst.

The first case of a postrhinoplasty cyst lined with unusual stratified squamous epithelium, unlike the other published mucous ones, is described in this article. There are two different theories accounting for this complication: namely mucosal herniation and the free graft theory. Although the cyst was very close to the marginal rim incision, there was no connection between the cyst and vestibuler skin. Thus the free graft theory is more logical than the herniation theory to explain the development of this cyst.

Cutaneous horn on the upper lip associated with squamous cell carcinoma.

Cutaneous horn is a protrusion from the skin consisting of cornified material. It usually appears on exposed skin areas especially on the head and neck. A 70-year-old woman applied to our clinic with a hard, conical, black-grey 2 cm lesion on the upper lip. On physical examination, there was no palpable lymph node in the neck other than the lesion. Diagnosed to be cutaneous horn, the lesion was completely removed together with 4-5 mm surrounding tissues under local anaesthesia. The histopathological examination reported this lesion to be cutaneous horn with well differentiated squamous cell carcinoma at its base. No recurrences or metastasis were detected within a follow-up period of 5.5 years. It should be kept in mind that cutaneous horns may be associated with premalignant and malignant lesions at the base, masking numerous conditions.

[Internal jugular vein thrombosis following functional and selective neck dissections]. / Fonksiyonel ve selektif boyun diseksiyonu sonrasi internal juguler ven trombozu.

OBJECTIVES: Internal jugular vein (IJV) thrombosis is a rare complication of functional and selective neck dissections. It increases morbidity and may seldom be fatal. We investigated the frequency of IJV thrombosis and its relationship with the dissection technique. PATIENTS AND METHODS: We evaluated 52 functional and selective neck dissections performed in 34 male patients (mean age 57 years; range 34 to 76 years) with head and neck cancer. Dissections were mainly performed by sharp dissection (n=27) or cautery (n=25). The patients were examined by Doppler ultrasonography with respect to IJV flow and thrombosis preoperatively, and at two weeks and at 3 to 6 months postoperatively. RESULTS: In the early postoperative period, thrombosis was observed in 7.4% (n=2) of the necks treated with sharp dissection and in 4% (n=1) of the necks treated with cautery. There was no statistically significant difference between the two groups with respect to IJV thrombosis. Late Doppler examinations showed complete recanalization of all thrombosed IJVs. CONCLUSION: Our data suggest that sharp dissection or cautery techniques performed in functional neck dissections do not differ with respect to the frequency of postoperative IJV thrombosis.

Intratympanic methylprednisolone for sudden sensorineural hearing loss.

OBJECTIVE: Corticosteroids are commonly used for the treatment of sudden sensorineural hearing loss (SSHL). In this study, the effectiveness of intratympanic (IT) corticosteroid injection was studied and compared with a control group on patients with SSHL who failed systemic corticosteroid treatment. MATERIALS AND METHODS: A total of 19 patients as a retreatment group (RG) and 18 patients as a control group (CG), all failed high-dose intravenous and oral corticosteroid treatments, were included in this study. These patients were invited back, and IT methylprednisolone was injected five times via 3-day intervals in RG and followed-up for a mean period of 24.9 months (range, 7-30 mo). Audiological evaluations were performed initially, a week after the completion of the injections, monthly in the following first 3 months, and at the end of follow-up period in RG. The CG was followed-up for 3 months after the completion of systemic corticosteroid treatment without any additional drug administration. RESULTS: The mean age was 52.6 years (range, 20-79 yr) in RG and 59.9 years in CG. The mean pure-tone average for speech frequencies (500-4,000 Hz) at baseline audiogram and at the first month, at the third month, and at last controls were 65.2 (range, 43-102 dB), 45.4 (range, 23-77 dB), 43.6 (range, 30-77 dB), and 44.5 (range, 33-77 dB) dB, respectively, in RG. The mean pure-tone averages for speech frequencies (500-4,000 Hz) at the end of systemic treatment and at third-month control were 63.5 (range, 44-98 dB) and 59.0 (range, 40-100 dB) dB, respectively, in CG. The hearing gain that is equal to or more than 10 dB was achieved in 14 patients (73.6%) at the last control in RG. No hearing gain could be detected in the CG. No serious side effect was observed with IT treatment. CONCLUSION: We conclude that IT methylprednisolone injection provides more significant hearing improvement for patients that failed with previous high-dose systemic corticosteroid administration than systemic corticosteroid treatment alone. So it may be the first-step medical treatment of idiopathic SSHL alone or at least may be combined with the systemic corticosteroid administration.

Acoustic analysis findings in objective laryngopharyngeal reflux patients.

OBJECTIVE: The aim of this study was to identify the effects of objective laryngopharyngeal reflux (LPR) on the acoustic parameters of patients by comparing their voice samples with that of control subjects. STUDY DESIGN: Prospective study in two tertiary reference hospitals. METHODS: 48 consecutive patients with symptoms related to LPR and 64 control subjects were included in the study. Suspected LPR patients underwent a 24-hour ambulatory pH monitoring, and 25 (52%) of them were shown to have objective LPR. Acoustical evaluation results of objective LPR patients were compared with that of symptomatic LPR patients and control subjects. RESULTS: All frequency perturbation values obtained from objective and symptomatic LPR patients were higher than the control subjects (P<0.01). Mean fundamental frequency, amplitude perturbation measures, and noise-to-harmonics ratio were not significantly different between groups. CONCLUSION: LPR patients have significantly different frequency perturbation values than control subjects.

Familial primary localized laryngeal amyloidosis in two sisters.

Laryngeal amyloidosis is rare, accounting for less than 1% of all benign laryngeal tumors. Although familial primary localized amyloidosis has been reported in other parts of the body, no familial cases have been reported in the larynx. Primary localized laryngeal amyloidosis was detected in two sisters whose ages were 35 years and 38 years, respectively. In the elder patient, a previous endolaryngeal biopsy for symptoms of dysphonia yielded no pathologic findings. Laryngoscopic examination of the patient showed a significant submucosal accumulation at the level of ventricles and vocal folds. The younger sister had a complaint of hoarseness for five years. The results of endolaryngeal biopsies performed in both patients were reported as amyloidosis. Further evaluations were negative for systemic amyloidosis. No surgical intervention was considered. The patients were monitored for more than two years without any other coexisting disease.

Oxidative Stress and Antioxidant Status in Patients with Bell's Palsy.

BACKGROUND: Bell's palsy (BP) is the most common acute mononeuropathy of unilateral facial paralysis. Immune, infective and ischaemic mechanisms are potential contributors to the development of BP, but the precise cause remains unclear. Recently, oxidative stress has been proposed as a risk factor of various idiopathic diseases. The aim of this study was to investigate the possible role of oxidative stress in patients with BP. METHODS: Thirty-two patients with BP and 30 healthy controls were included in this study. Serum total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) were measured by the Erel method. RESULTS: Serum TOS activities and OSI values were significantly higher in patients with BP compared with the control group (P <0.003 for all comparisons), whereas there was no significant difference between the groups in terms of TAS levels (P >0.05). CONCLUSIONS: The data suggest that oxidative stress is increased in BP. These results of high oxidative stress in patients with BP may be helpful to clarify the etiopathogenesis of BP and contribute to improvement in the management or prevention of the disease.

The Effects of Curcumin on Wound Healing in a Rat Model of Nasal Mucosal Trauma.

We explored the effects of topical curcumin on the healing of nasal mucosal wounds. A total of 32 Sprague-Dawley Albino rats were randomized in equal numbers into four groups, and unilateral nasal wounds were created using an interdental brush. Group 1 (the sham-control group) contained untreated rats with traumatized right-side nasal cavities; Group 2 and 3 rats were similarly traumatized and treated with topical curcumin (5 and 10 mg/mL) dissolved in dimethyl sulfoxide daily for 7 days after trauma; Group 4 rats were treated with topical dimethyl sulfoxide only. All rats were decapitated on day 15 and the healing sites evaluated by blinded observers in terms of the presence of cellular hyperplasia, goblet cell hypertrophy and degeneration, leucocytic infiltration, ciliary loss and degeneration, edema, and vascular dilation. On histopathological evaluation, all of cellular hyperplasia, leukocytic infiltration, and edema were significantly reduced in Group 3 compared with Group 1 (p = 0.001, p = 0.004, and p = 0.008, resp.). Thus, curcumin reduced the inflammatory response and significantly accelerated wound healing.

Endoscopic butterfly cartilage myringoplasty.

CONCLUSION: Based on the results of this study, it is believed that, in appropriate patients with tympanic membrane perforation, the endoscopic butterfly cartilage myringoplasty can be applied, with a shorter operation time, high graft success rate, and low risk of complications. OBJECTIVE: The aim of this study was to evaluate the results of the endoscopic butterfly cartilage myringoplasty in terms of the graft success rate and hearing gain. METHODS: Forty-five ears of the 42 patients who were subjected to endoscopic butterfly cartilage myringoplasty surgery between January 2013 and December 2014 were included in this study. The archival records of the patients were reviewed retrospectively, evaluating the pre-operative and post-operative hearing results and post-operative graft success rates in the early and late periods. RESULTS: The graft success rates were 97.8% (44/45 ears) and 95.6% (43/45 ears) at the post-operative 1- and 6-month follow-ups, respectively. When the post-operative air conduction hearing thresholds were compared, significant improvement was seen at post-operative 1- and 6-month follow-ups in the hearing thresholds, when compared to the pre-operative levels (p < 0.001).

Status of Neutrophils, Lymphocytes and Platelets in Patients with Recurrent Aphthous Stomatitis: A Retrospective Study.

INTRODUCTION: The aim of this study was to evaluate the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) in patients with recurrent aphthous stomatitis (RAS). MATERIALS AND METHODS: Eighty patients who were diagnosed with RAS between January 2014 and January 2016 were included in this study. Eighty age- and gender-matched healthy subjects were also enrolled as a control group. Neutrophil, lymphocyte, and platelet counts were compared between groups, in addition to NLR, PLR, and MPV values. RESULTS: There was no significant difference in terms of lymphocyte count, platelet count, PLR, or MPV values between the two groups (P>0.05). However, white blood count, neutrophil count, and NLR were significantly higher in patients with RAS compared with the control group (P<0.05). CONCLUSION: The present study revealed an increased NLR among RAS patients compared with healthy controls. This suggests that development of RAS involves an inflammatory process. We believe that NLR could be used as a cheap and simple marker of inflammation.

The evaluation of eustachian tube paratubal structures using magnetic resonance imaging in patients with chronic suppurative otitis media.

Conclusion Eustachian tube (ET) dysfunction, which plays a role in the pathogenesis chronic suppurative otitis media (CSOM), does not seem to be due to differences in paratubal structures. Objective The aim of this study was to compare the magnetic resonance imaging (MRI) findings of the paratubal structures of the ET between normal ears and ears in patients with CSOM. Methods The MRI records of 40 patients who underwent tympanomastoidectomy for a diagnosis of CSOM were reviewed retrospectively. The healthy ears served as the control group. The length, diameter, surface area and volume of the tensor veli palatini muscle (TVPM) and levator veli palatini muscle (LVPM) were measured, in addition to the diameter of the pharyngeal orifice of the ET, volume of the Ostmann fat pad, bimucosal thickness of the lumen of the ET, and mucosal thickness. Results In the pathological ears, the mean length of the TVPM and LVPM was 22.6 mm and 19.3 mm, the mean diameter was 3.2 and 5.3 mm, and the mean volume was 1.75 and 3.2 cm(3), respectively. In addition, the mean diameter of the pharyngeal orifice of the ET was 1.9 mm. There were no significant between-group differences in the paratubal structures (p > 0.05).

Endoscopic transcanal stapes surgery: our technique and outcomes.

OBJECTIVES: This study aims to evaluate the outcomes of endoscopic stapes surgery in terms of hearing gain and complications. PATIENTS AND METHODS: The medical records of 31 patients (13 males, 18 females; mean age 41.5±8.6 years; range 23 to 60 years) who underwent endoscopic stapes surgery in our clinic between April 2013 and June 2015 were retrospectively analyzed. The mean preoperative and postoperative pure tone bone conduction, air-bone gap, postoperative air-bone gap gain, duration of surgery and complications were evaluated. RESULTS: The right ear was operated on 15 patients and the left ear on 16 patients. The mean postoperative air-bone gap was statistically significantly improved, compared to preoperative values (p<0.001). The mean air-bone gap gain was 25.5±7.0 dB. CONCLUSION: Our study results suggest that endoscopy is a safe method which can be used in stapes surgery.

High sensitization to house-dust mites in patients with allergic rhinitis in the eastern Black Sea region of Turkey: A retrospective study.

OBJECTIVES: Identification of the most common aeroallergens to which patients are sensitized in a specific area is important in the diagnosis and treatment of allergic rhinitis (AR). We determined the distribution of aeroallergens, detected by skin-prick tests (SPT), in adult patients with AR in the Eastern Black Sea region of Turkey and compared the results with the other regions of Turkey and in the world. METHODS: The medical records of SPT performed on 1457 patients with symptoms of AR (with regard to the Allergic Rhinitis and its Impact on Asthma 2008 guidelines) between March 2010 and March 2013 were analyzed retrospectively. SPT were carried out with the same panel, which included grass; weeds; trees; mold; epidermal mixtures; and with two house-dust mite (HDM) extracts, Dermatophagoides pteronyssinus and Dermatophagoides farinae. RESULTS: In 1229 of 1457 patients (84.4%), there were positive reactions for at least one aeroallergen on the SPT. The most common aeroallergen was the HDM D. pteronyssinus (84% [n = 1033]) followed by D. farinae (78.2% [n = 962]). Grass pollen sensitivity (70.8% [n = 871]) was higher than tree or weed pollen sensitivity in this region. CONCLUSIONS: The most common aeroallergens in AR are HDMs of D. pteronyssinus and D. farinae in the Eastern Black Sea region in Turkey. Our study may help in developing environmental control strategies for AR.