Impact of Nasal Septal Surgery on Sleep Quality and Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: To evaluate the effect of nasal septal surgery on quality of life. METHODS: A total of 49 patients who underwent septoplasty and/or inferior turbinate radiofrequency operations for nasal septal deviation and inferior turbinate hypertrophy were prospectively enrolled in the study. All patients completed the adult attention-deficit/hyperactivity disorder scale (ADHD scale) and Pittsburgh sleep quality index (PSQI) before and after septoplasty. Acoustic rhinometric measurements were also recorded. RESULTS: Acoustic rhinometric measurements and PSQI showed statistically significant improvement after nasal surgery (P < 0.05), but no statistically significant difference was present between pre- and postoperative ADHD scores (P > 0.05). CONCLUSION: Besides the functional improvement of septoplasty, a long-lasting improvement in the quality of life is observed in patients with that undergo this surgery.

Co-occurrence and possible role of sinonasal anomalies in primary acquired nasolacrimal duct obstruction.

OBJECTIVE: Our objective was to determine the co-occurrence of sinonasal anomalies and primary acquired nasolacrimal duct obstruction. METHODS: A total of 41 patients were enrolled in the study, of which 41 had primary unilateral acquired nasolacrimal duct (NLD) obstruction. All patients included in the study were evaluated by anterior rhinoscopy, endoscopic nasal examination, and paranasal sinus computed tomography (CT) in order to reveal significant nasal and paranasal pathology. RESULTS: A significant increase was noted in the rate of concha bullosa, inferior turbinate hypertrophy, osteomeatal complex disease, and maxillary sinusitis in favor of the study group (P < 0.05). Nasal septal deviation, irregularity of middle turbinate, paradoxical middle turbinate, ethmoidal sinusitis, and Onodi cell and agger nasi cell incidence were found to be high in the study group. However, none of this increase was statistically significant (P > 0.05). CONCLUSIONS: Although primary acquired NLD obstruction seems to be an ophthalmologic problem, rhinologic problems have great importance in etiology. Detailed endoscopic examination and preoperative paranasal sinus computed tomography will reveal the possible role of nasal and paranasal structures adjacent to lacrimal sac in etiology of NLD obstruction. This will be effective both on conservative treatment and postoperative success in patients scheduled for surgery.

Histological evaluation of rat larynx in experimental polycystic ovary syndrome model.

This study aimed at studying the histopathological effects of hyperandrogenemia and estrogen deficiency on larynx mucosa in experimentally designed polycystic ovary syndrome of female rats. Two groups of experimental polycystic ovary syndrome model were composed in healthy female rats by per oral letrozole administration of for 21 and 42 days. Also a control group which only took vehicle (saline) for 42 days was designed. Laryngeal mucosa and ovaries of all animals were examined histopathologically by light microscopy and the serum hormone levels were analyzed using a solid-phase, two-site chemiluminescent enzyme immunometric assay. Statistically significant edema, vascular engorgement, inflammation, cilia loss and differentiation of goblet cell distribution were observed when the control group and study groups were compared (p < 0.01). In serum hormonal analysis there was a significant increase in levels of androgens and decrease in levels of estrogens. In addition, polycystic appearance of ovaries in letrozole-administered groups and normal appearance of ovaries in control group have been proven histopathologically. Polycystic ovary syndrome which causes estrogen deficiency and hyperandrogenemia in fertile ages resulted in histopathological changes in laryngeal mucosa.

Role of allergy in primary acquired nasolacrimal duct obstruction.

OBJECTIVE: Our objective was to determine the role of allergy in primary acquired nasolacrimal duct obstruction. METHODS: A total of 41 patients were enrolled in the study, 41 of whom had primary unilateral acquired nasolacrimal duct obstruction. All patients included in the study were evaluated by anterior rhinoscopy, endoscopic nasal examination, and multiprick skin test to reveal allergic rhinitis. RESULTS: Allergy incidence was found to be high in study group. This was statistically significant (P < 0.05). CONCLUSIONS: Although primary acquired nasolacrimal duct obstruction seems to be an ophthalmologic problem, rhinologic problems have great importance in etiology. Detailed endoscopic examination and multiprick skin test will reveal the possible role of allergic rhinitis. This may increase the success rate both of the conservative treatment options and of the surgical treatment.

Effect of Education and Social Anxiety on Acoustic, Perceptual and Aerodynamic Parameters of Adult Females.

In this study, we hypothesized that social anxiety disorder would be more common in women with lower education levels and that this could have a negative effect on acoustic parameters. A total of eighty-eight (88) healthy female volunteers were enrolled into the study. These volunteers were divided into two groups, which were categorized as those with graduation from elementary school or below (Group A, n = 42) and those with graduation from high school or above (Group B, n = 46). Personal anxiety and avoidance for all participants were evaluated using The Liebowitz Social Anxiety Scale. All subjects also underwent acoustic and aerodynamic voice analysis for evaluation of their objective voice quality and function. Additionally, the GRBAS scale was used for perceptual analysis. Social anxiety scores were higher in group A than group B (p < 0.05). In aerodynamic sound analysis, maximal phonation time was lower in group A than group B (p < 0.05). In perceptual sound analysis, the mean values of the GRBAS parameters for group B were lower than group A (p < 0.05). Mean F0 of Group-B was higher than Group-A in acoustic analysis (p < 0.05). However, there was no statistical difference in jitter, shimmer, NHR and HNR between the groups (p > 0.05). In this study, social anxiety and education has been shown to have an effect on voice in women. As the level of education increases, social anxiety decreases, and both maximum phonation time and fundamental frequency increase.

Effect of type I tympanoplasty on the quality of life of children.

OBJECTIVES: Quality-of-life issues related to chronic otitis media (COM) include physical symptoms, emotional symptoms, hearing loss, speech symptoms, social symptoms, and parents' emotional symptoms. In this study we evaluated the effects of tympanoplasty on the quality of life of pediatric patients. METHODS: In a questionnaire-based outcome study, we reviewed 56 of 78 pediatric patients with COM who were treated with type I tympanoplasty at our institution between December 2008 and February 2010. All patients were asked to fill out the COM-5 questionnaire with their parents, before operation and 6 months after operation. Preoperative and postoperative total ear scores, preoperative and postoperative ear scores with an intact tympanic membrane, preoperative and postoperative ear scores with a perforated tympanic membrane, and preoperative and postoperative audiological results were assessed. RESULTS: After type I tympanoplasty, 45 patients (80.3%) had successful closure of the tympanic membrane, but 11 patients (19.7%) had unsuccessful closure of the tympanic membrane. There was a significant decrease in physical suffering, hearing loss, emotional distress, activity limitations, and caregiver's concerns scores in patients with intact tympanic membranes after operation (p < 0.01). CONCLUSIONS: Children with COM had a significant increase in their quality of life after successful tympanoplasty. Our results also suggested that tympanoplasty was successful in pediatric patients with COM.

Histopathological effects of estrogen deficiency on larynx mucosa in ovariectomised rats.

Laryngeal manifestations due to estrogen deficiency have been studied in the literature. But to date, the possible histopathological changes of laryngeal mucosa due to estrogen deficiency have not been studied. Therefore, our objective was to determine the histopathological changes of laryngeal mucosa in ovariectomised rats in order to clarify effects of estrogen deficiency on laryngeal tissue. The study is a randomized trial and was conducted at the animal care facility of Haydarpasa Numune Education and Research Hospital. Twenty-one Wistar rats were used throughout the experiment. There were six rats in the sham-operated control group. And others were divided into two groups (4, 8 weeks) according to follow-up time after ovariectomy. We observed significant changes 4 weeks after ovariectomy when we assessed subepithelial edema, inflammation, cilia and goblet cell loss (p < 0.01). It was shown that estrogen deficiency after ovariectomy in rats caused changes in laryngeal tissue when it was studied histopathologically.

Diagnosis of anterior commissure invasion in laryngeal cancer.

The objective of the study is the invasion of anterior commissure (AC) by a laryngeal carcinoma has an oncological importance for the outcome. Detection of invasion is difficult due to particular anatomical features of this region. Therefore, we aimed to investigate the value of different diagnostic modalities for the detection of AC involvement at the patients with laryngeal carcinoma. Retrospective analysis of medical charts in a tertiary referral center. Records of preoperative clinical examination, computerized tomography (CT), peroperative examination and postoperative histopathological examination of 47 patients with laryngeal carcinoma were analyzed. The results of postoperative histopathological examination were accepted as true. Sensitivity, specificity, negative-predictive value, positive-predictive value and accuracy ratios were calculated for each modality. AC involvement was found to be positive in 23 patients according to the postoperative histopathological examination. Peroperative clinical examination was found to be superior to preoperative clinical examination and CT. In conclusion, classical multi-slice CT only on axial planes is not a reliable method to detect the invasion of AC. Preoperative clinical examination by suspension laryngoscopy under general anesthesia has an approximately 30% failure rate. Peroperative examination must not be neglected if possible.

Effect of Hyperbilirubinemia on Medial Olivocochlear System in Newborns.

OBJECTIVES: To evaluate medial olivocochlear efferent system of babies with hyperbilirubinemia with normal auditory brain stem responses. MATERIALS AND METHODS: This was a prospective study in a tertiary referral hospital. The study involved 40 hyperbilirubinemic and 44 healthy newborns. Cochlear and auditory activity of participants was evaluated by transient otoacoustic emissions (TOAEs) and brainstem auditory evoked response components (BAER). Medial olivocochlear (MOC) reflex was evoked with contralateral acoustic stimulation and recorded with TOAEs. RESULTS: A comparison of the MOC reflex activity between two groups with Mann Whitney U test revealed that MOC reflex activity were significantly decreased in the hyberbilirubinemic group for both ears (p<.05). This difference was significant for all frequencies in both ears. There was no significant relation between total serum bilirubin level and MOC reflex activity. CONCLUSION: Hyperbilirubinemic newborns had decreased MOC reflex activity. This may be indicative of future problems in speech discrimination and effective hearing in noisy background. Additional long cohort studies are needed to evaluate the clinical importance of MOC reflex measurements in this group. MOC reflex measurement has the potential to form part of the audiologic evaluation of newborns with hyperbilirubinemia in the future.

Effect of Body Mass Index on Auricular Morphology and Auditory Functions.

In this study, we aimed to investigate the relationship between the body mass index (BMI) and the morphometric properties of auricula and its acoustic gain characteristics. A total of 45 participants between 18 and 45 years of age were enrolled into the study. Participants' height and weight measurements were recorded for the BMI calculation. On both sides, the morphometric properties of the auricula were measured and recorded. Additionally, the participants were subjected to multidirectional dynamic real ear measurements (REMs) to specify the intensity and frequency values of the maximum hearing gain. Participants consisted of 24 women and 21 men. The mean BMI was 23.42. The mean auricular area was 22.70 cm2. Statistically significant positive correlation was found between the auricular area and BMI (r = 0.427, P = .03). The mean postauricular sulcus angle was 20.99°. The mastoid-helix distance was 16.07 mm. There was no statistically significant correlation between BMI level and postauricular sulcus angle and mastoid-helix distance (P > .05). The mean dynamic REM measurement was evaluated. The maximum acoustic gain at anterior, lateral, and posterior vectorial stimulation was calculated as 20.9, 24.2, and 20.7 dB Sound Presure Level (SPL), respectively. Statistically significant negative correlation was found between the three directions acoustic gain level and BMI in the statistical examination (r = -0.365, r = -0.386, r = -0.453, respectively, and P < .05 for all). The results of acoustic gain frequency were 2967.4, 2963, and 2934 Hz, respectively. There was no statistically significant correlation between acoustic gain frequency and BMI (P > .05). When participants were grouped according to their BMI, participants with a BMI >25 had a statistically significantly bigger auricular area and lower maximum acoustic gain when compared with those with BMI <25 (P < .05). We found that the auricular area increased with BMI. We think that this is related to soft tissue thickening of the auricula related to high BMI. In addition, we found that the acoustic gain level decreased inversely with BMI. We believe that the decrease in acoustic gain is due to the increase of acoustic resistance after the increase of soft tissue thickness. In conclusion, we think that BMI has a negative effect on auditory function according to findings in our study.

Comparison of Voice Quality and Cost Effectiveness of Endoscopic Cordectomy Using Microdissection Electrodes with Laser Cordectomy and Radiotherapy.

OBJECTIVE: To compare the acoustic parameters and the cost effectiveness achieved after endoscopic cordectomy using radiofrequency microdissection electrodes (ECRM) with those of transoral laser cordectomy and radiotherapy. METHODS: The study included 81 disease-free patients previously treated for early larynx carcinoma (30 with ECRM, 27 with transoral laser cordectomy, 24 with primary radiotherapy). Post-treatment voice analysis was performed in all patients. Additionally, the cost effectiveness of all treatment procedures was calculated. RESULTS: The GRBAS (G: Grade, R: Roughness, B: Breathiness, A: Asthenia, and S: Strain) scale showed a significant difference between the groups (p<0.001). The mean values for perceptive assessment score in the radiotherapy group were significantly lower than those in the ECRM group (p<0.05). There were no significant differences between the ECRM group and the transoral laser cordectomy group in terms of the perceptive assessment scores (p>0.05 for all). Percent jitter, percent shimmer and fundamental frequency (F0) were significantly different in the radiotherapy group than the ECRM and the transoral laser cordectomy groups (p<0.05). Maximum phonation time (MPT) in the radiotherapy group was significantly longer than the ECRM and transoral laser cordectomy groups (p<0.001). There were no significant differences between the ECRM group and the transoral laser cordectomy group in terms of the MPT (p>0.05). The mean cost of the ECRM technique was statistically lower than the other treatment techniques (p<0.05). Moreover, the length of hospital stay after ECRM was statistically significantly shorter than was after laser cordectomy (p<0.05). CONCLUSION: Objective and perceptive voice analysis after ECRM showed comparable results with transoral laser cordectomy, but poorer results than radiotherapy. Cost effectiveness of ECRM was found to be better than the other two treatment techniques.

Effect of upper airway obstruction on pulmonary arterial pressure in children.

OBJECTIVE: Our aim was to examine the elevation of pulmonary arterial pressure in children with upper airway obstruction caused by adenotonsillar hypertrophy according to their disease severity assessed with symptom scoring and to demonstrate the profit for echocardiographic monitorization of the children with adenotonsillar hypertrophy regardless of their clinical status. METHODS: Thirty-nine children with a diagnosis of upper airway obstruction caused by adenotonsillar hypertrophy were included for the study. There were 16 female and 23 male patients. Ages of the children were between 3 and 10 years with a mean age of 5.78+/-1.98. Twenty children composed the control group with a similar age and sex distribution but without any sign and symptom of upper airway obstruction. Mean pulmonary arterial pressures were measured by Doppler echocardiography preoperatively and 6 months postoperatively. Symptom scores were calculated for each patient in the study group to assess their disease severity. The significances of changes and relations between pressure levels and symptom scores were calculated by statistical package for social sciences (SSPS) computer program in terms of Student's test, chi(2)-test and Mc Nemar's test. RESULTS: Mean pulmonary arterial pressure were 26.26+/-5.40 (14-36) preoperatively, 16,61+/-2.68 (10.15-22.3) postoperatively and 16.54+/-2.63 (10.5-21.7) in the control group. There were a statistically significant decrease at pressure levels postoperatively and a significant difference from the levels in the control group (Student's t-test, p<0.01). We found no correlation between the pressure levels and disease severity assessed in terms of symptom scoring. CONCLUSION: This study showed that upper airway obstruction caused by adenotonsillar hypertrophy causes significant elevation of pulmonary arterial pressures and adenotonsilectomy is an absolute therapeutic method in these children. Every child with adenotonsillar hypertrophy has some probability of having pulmonary hypertension regardless of his or her disease severity. Therefore, performing echocardiographic examination to all children with adenotonsillar hypertrophy is beneficial for assessing the cardiopulmonary status of the patient and may be useful at decision making for adenotonsilectomy.

Oxidative Status in Patients with Benign Paroxysmal Positional Vertigo.

OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) is the most frequent peripheral vestibular disorder and is particularly seen among older patients suffering from vertigo. The brief vertigo attacks in and imbalance symptoms of BPPV are caused by freely floating otoconia within the semicircular canals. The aim of this prospective study was to evaluate the role of oxidative stress, using native thiol/disulfide (SH/SS) homeostasis as a novel indicator, in the etiology of BPPV. MATERIALS AND METHODS: The 62 participants in the study included 31 patients with BPPV and, as the control group, 31 healthy individuals without any cochleovestibular disorders. RESULTS: Patients with BPPV initially had significantly lower native SH levels and significantly lower SH/total thiol (TT) ratios, as well as significantly higher SS/SH and SS/TT ratios, than the healthy controls. After successful treatment of their vertigo, which was confirmed based on the results obtained from the second blood sample, patients with BPPV still had lower SH levels and SH/TT ratios and significantly higher SS/SH and SS/TT ratios than the healthy controls. CONCLUSION: Our results suggest a role of oxidative stress in the development of BPPV, through both calcium metabolism and the direct toxic effects of free oxygen radicals, including the triggering of apoptosis.

Change in nasal congestion index after treatment in patients with chronic rhinosinusitis with nasal polyposis.

BACKGROUND: The management of chronic rhinosinusitis with nasal polyposis (CRSwNP) involves both surgical and medical approaches, and remains a controversial subject. OBJECTIVE: The objective of this prospective, randomized, controlled trial was to compare the medical and surgical treatments of CRSwNP in terms of their effect on the nasal congestion index (NCI). METHODS: Forty-eight patients with CRSwNP were randomized either to medical or surgical therapy. Pretreatment and 3- and 6-month posttreatment assessments of the visual analog scale score, the 20-Item Sino-Nasal Outcome Test, saccharine clearance time, nasal endoscopy, and NCI measurement with acoustic rhinometry were performed. Forty-one subjects were included in the analysis. RESULTS: Both the medical and surgical interventions for CRSwNP resulted in significant improvement in the visual analog scale score, 20-Item Sino-Nasal Outcome Test, saccharine clearance time, and nasal endoscopic examination scores. There was no difference between the two groups in terms of the percentage change from baseline for any of the parameters at the 6-month posttreatment assessment. NCI showed no significant difference from baseline. Similarly, no significant difference was found between the medical and surgical groups in terms of their effect on the NCI (p > 0.05). CONCLUSION: Because NCI does not correlate with standard subjective measures in outcomes for this group of patients, it cannot be used as an outcome measurement of treatment of subjects with CRSwNP. Results of this prospective randomized study did not find any additional benefit of surgical therapy over medical therapy in subjects with CRSwNP.

Correlation between cVEMP and ABR for the Evaluation of Vestibular Migraine.

OBJECTIVE: Vestibular migraine (VM) is a clinical condition characterized by temporal overlap between vestibular symptoms and migraine. In this study, we aimed to determine the changes in vestibular myogenic potential (cVEMP) and auditory brainstem response (ABR) in patients with VM and migraine. MATERIALS AND METHODS: A total of 86 participants with no hearing loss or additional disease between the ages of 18 and 45 were enrolled in three different groups: group 1, VM; group 2, migraine without aura; and group 3, healthy controls. cVEMP and ABR were performed for all participants during attacks and attack-free periods. The differences between the right and left sides were calculated. RESULTS: There was no significant difference in cVEMP p13-n23 latencies between any of the groups. There were statistically significant differences related to cVEMP p13-n23 amplitudes between groups 1, 2, and 3. This significant difference originated from group 1 when compared with the other groups (p<0.05). When we compared the cVEMP results of patients with VM during attack and attack-free periods, a statistically significant decrease was determined in the p13-n23 amplitude values during the attack period (p<0.01). Additionally, when we compared group 1 and group 3, the wave V peak latencies in ABR were significantly prolonged in group 1 (p<0.05). CONCLUSION: cVEMP and ABR can be used as diagnostic criteria for patients with VM during attacks. Further studies with larger groups are needed to verify our findings.

Effects of polycystic ovary syndrome and menopause on rat soft palate and base of tongue.

OBJECTIVE: To investigate the histopathologic changes in rat soft palate and base of tongue by performing experimental polycystic ovary syndrome (PCOS) and menopause models. STUDY DESIGN: Experimental study. SETTING: The study was conducted at the animal care facility of Haydarpasa Numune Education and Research Hospital. SUBJECT AND METHODS: Thirty healthy female Albino Wistar rats were divided into 4 groups (PCOS study group [n = 10], per oral letrozole given; PCOS control group [n = 6], per oral saline given; menopause study group [n = 8], ovariectomized; menopause control group [n = 6], sham operated). At the end of the follow-up periods, all animals were euthanized, and soft palates and base of tongues of all groups were removed to observe the histopathologic changes. RESULTS: When we compared the PCOS study group with the PCOS control group, submucous gland hypertrophy, mast cell infiltration, vascular engorgement, and acanthosis were significantly different in the soft palate (P < .05), and in addition to these findings, lymphocyte infiltration, subepithelial edema, and dilated glandular excretory duct were significantly different in base of tongue (P < .05). When we compared the menopause study group with the menopause control group, only vascular engorgement was significantly different in the soft palate (P < .05), and in addition to this finding, submucous gland hypertrophy, lymphocyte infiltration, polymorphonuclear leukocyte infiltration, and subepithelial edema were significantly different in base of tongue (P < .05). CONCLUSION: Our findings suggest that PCOS and menopause induce significant histopathologic changes in the soft palate and base of tongue that are similar to the histopathologic changes seen in the soft palate and base of tongue of patients with obstructive sleep apnea syndrome.

Amniotic membrane covering for facial nerve repair.

Amniotic membranes have been widely used in ophthalmology and skin injury repair because of their anti-inflammatory properties. In this study, we measured therapeutic efficacy and determined if amniotic membranes could be used for facial nerve repair. The facial nerves of eight rats were dissected and end-to-end anastomosis was performed. Amniotic membranes were covered on the anastomosis sites in four rats. Electromyography results showed that, at the end of the 3(rd) and 8(th) weeks after amniotic membrane covering, the latency values of the facial nerves covered by amniotic membranes were significantly shortened and the amplitude values were significantly increased. Compared with simple facial nerve anastomosis, after histopathological examination, facial nerve anastomosed with amniotic membrane showed better continuity, milder inflammatory reactions, and more satisfactory nerve conduction. These findings suggest that amniotic membrane covering has great potential in facial nerve repair.

Analysis and comparison of changing in thyroid hormones after percutaneous and surgical tracheotomy.

OBJECTIVES: To evaluate the effect of the surgical and percutaneous tracheotomy on the thyroid hormones and their comparisons. MATERIALS AND METHODS: Between January and May 2010, the surgical and percutaneous tracheotomy had been performed on 40 patients with respiration problems. The thyroid hormone levels were measured just before, after one and three hour of the operation and than these measurements were compared statistically. RESULTS: The effect of the surgical and percutaneous tracheotomy on serum thyroglobulin (TG), free thyroxine (fT4), free triiodothyronine (fT3) and thyroid stimulating hormone (TSH) levels was found statistically significant. CONCLUSIONS: The surgeons should not forget the possible increase of the serum thyroid hormone levels after the surgical and percutaneous tracheotomy because of the systemic effects of thyroid hormones. The patients, especially who have cardiac rhythm problems, should be monitored for a while after these processes because the increase of serum thyroid hormones may cause undesired cardiovascular effects.

A study to detect Helicobacter pylori in adenotonsillar tissue.

We conducted a prospective study to investigate the possibility of Helicobacter pylori colonization on tonsillar and adenoid tissues. Our study group was made up of 84 consecutively presenting children aged 4 to 12 years who had undergone adenotonsillectomy or adenoidectomy with or without ventilation tube insertion. The excised specimens were analyzed by rapid urease testing and histopathologic examination to detect H pylori. Histologic sections were subjected to hematoxylin and eosin staining and Giemsa staining as performed in routine gastric biopsies. We found no H pylori colonization in any specimen. Therefore, we consider the possibility of H pylori colonization of adenotonsillar tissue unlikely, even though the authors of some recent studies have reported such a finding. Other means of detecting possible H pylori colonization in the upper aerodigestive tract rely on invasive biopsy procedures, which are difficult to use in clinical practice. Therefore, on the basis of our findings and our review of the literature, we conclude that looking for H pylori in the upper aerodigestive tract is not only clinically useless, but damaging, as well.