Does septoplasty affect 24-h ambulatory blood pressure measurements in patients with type 2 and 3 pure nasal septal deviation?

PURPOSE: To investigate day, night and 24 h all blood pressure effects of septoplasty by comparing pre- and post-operative 24-h ambulatory blood pressure monitoring (ABPM) values of NSD patients undergoing septoplasty. MATERIALS AND METHODS: The prospective study included 20 patients with type 2 and 3 pure NSD (mean age, 23.60 ± 6.51) who underwent septoplasty in our clinic. Nasal obstruction symptom evaluation (NOSE) questionnaire was applied to each participant both pre- and post-operatively to evaluate their views on the severity of NSD and the effectiveness of surgical outcomes. A comprehensive ABPM examination was performed both 2 days before surgery and at three months postoperatively for each patient and the findings were compared among patients. RESULTS: Preoperative NOSE score was 87.75 ± 7.34% and the postoperative score was 12.50 ± 6.58% (p = 0.000). Following septoplasty, 24-h systolic blood pressure (24SBP) declined from 119.4 ± 9.9 mmHg to 112.2 ± 8.0 mmHg (p = 0.000), daytime SBP (DSBP) declined from 125.9 ± 11.0 mmHg to 117.9 ± 8.4 mmHg (p = 0.000), nighttime SBP (NSBP) declined from 112.7 ± 9.5 mmHg to 105.5 ± 7.9 mmHg (p = 0.000), 24-h pulse pressure (24PP) declined from 46.7 ± 10.1 mmHg to 44.0 ± 8.4 mmHg (p = 0.015), and mean daytime PP (DPP) declined from 46.9 ± 9.7 mmHg to 44.6 ± 8.6 mmHg (p = 0.026). CONCLUSION: The decline in NOSE percentages following septoplasty demonstrated that the satisfaction levels of the patients were increased. Upper airway obstruction secondary to NSD may affect ABPM measurements. Moreover, the significant decrease in the 24SBP, DSBP, NSBP, 24PP and DPP following septoplasty showed that NSD may cause cardiovascular risk and this risk may be prevented by septoplasty.

Effectiveness of quercetin in an experimental rat model of allergic rhinitis.

We aimed to investigate whether quercetin had a therapeutic effect in an experimental rat model of allergic rhinitis. The study was conducted with 35 rats, which were randomly assigned into 4 groups: group 1 (n = 5), sham group; group 2 (quercetin group, n = 10) received 80 mg/kg day quercetin; group 3 (steroid group, n = 10) received steroid (mometasone furoate); and group 4 (control group, n = 10), received ovalbumin alone. Rats were sensitized by administration of ovalbumin on alternate days over 14 days via an intraperitoneal route. On day 15, in addition to ovalbumin via an intranasal route, quercetin and steroid were given over 7 days to the corresponding groups. All rats were then sacrificed and nasal turbinates were evaluated histopathologically, and serum total IgE and ovalbumin (OVA)-specific IgE values were measured before and after treatment. A significant increase in OVA-specific IgE values was detected in all groups except sham group. A significant increase was detected in post-treatment total IgE levels in the control group, while no significant change was detected in the sham, quercetin, and intranasal steroid groups. On histopathological evaluation, it was observed that findings of allergic rhinitis were suppressed in the quercetin group when compared to the control group. In immunohistochemical evaluation, it was detected that COX-2 and VIP expressions were weaker in the quercetin group compared to the control group. Based on these findings, we conclude that quercetin was effective in allergic rhinitis induced by ovalbumin in rats both histopathologically and serologically.

Large radicular cyst in the maxillary sinus.

Radicular cysts (RCs) are the most common inflammatory jaw cystic lesions that occur infected and necrotic in teeth pulps. They account for more than 50% of all odontogenic cysts. Radicular cysts cause slowly progressive painless swelling. There are no symptoms until they become large. Enucleating the cyst is recommended with primary treatment. Here we describe a patient with a large RC with maxillary sinus involvement who underwent an endonasal endoscopic approach for complete resection. In conclusion, the endonasal endoscopic approach should be kept in mind for the resection of RC with maxillary sinus involvement because of its minimally invasive characteristics.

The systolic pulmonary artery pressure and the E/e' ratio decrease after septoplasty in patients with grade 2 and 3 pure nasal septal deviation.

INTRODUCTION: Nasal septal deviation may contribute to a wide range of symptoms including nasal obstruction, headache, increased secretion, crusting, mucosal damage, and loss of taste and smell. Excessive increase in the respiratory resistance, as seen in nasal septal deviation, results in reduced lung ventilation, thereby potentially leading to hypoxia, hypercapnia, pulmonary vasoconstriction. The deformities in the nasal cavity can be associated with major respiratory and circulatory system diseases. OBJECTIVE: To investigate cardiovascular effects of septoplasty by comparing pre- and postoperative transthoracic echocardiography findings in nasal septal deviation patients undergoing septoplasty. METHODS: The prospective study included 35 patients with moderate and severe nasal septal deviation (mean age, 23.91±7.01) who underwent septoplasty. The Turkish version of the nasal obstruction symptom evaluation, NOSE questionnaire, was administered to each participant both pre- and postoperatively in order to assess their views on the severity of nasal septal deviation, the effect of nasal obstruction, and the effectiveness of surgical outcomes. A comprehensive transthoracic echocardiography examination was performed both preoperatively and at three months postoperatively for each patient and the findings were compared among patients. RESULTS: Mean preoperative NOSE score was 17.34±1.62 and the mean postoperative score was 2.62±1.68 (p=0.00). Mean preoperative systolic pulmonary artery pressure value was 22.34±4.31mmHg and postoperative value was 18.90±3.77mmHg (p=0.00). Mean E/e' ratio was 5.33±1.00 preoperatively and was 5.01±0.90 postoperatively (p=0.01). The NOSE scores, systolic pulmonary artery pressure values, and the E/e' ratios decreased significantly after septoplasty (p<0.05 for all), whereas no significant difference was found in other transthoracic echocardiography parameters (p>0.05). CONCLUSION: The decrease in NOSE scores following septoplasty indicated that the satisfaction levels of the patients were increased. Upper airway obstruction secondary to nasal septal deviation may be a cardiovascular risk factor and may affect transthoracic echocardiography measurements. Moreover, the significant decrease in the systolic pulmonary artery pressure value and E/e's ratio following septoplasty indicated that negative echocardiographic findings may be prevented by this surgery.

Assessment of early atherosclerotic findings in patients with nasal polyposis.

OBJECTIVE: To investigate early markers of atherosclerosis in patients with nasal polyposis (NP) through measurements of carotid artery intima-media thickness (CIMT), flow-mediated vasodilatation (FMD) of the brachial artery and serum paraoxonase-1 (PON-1) activity. METHODS: Forty-five patients with NP were included in the study group and 45 healthy individuals in the control group. The diagnosis of patients with NP was predicated on anterior rhinoscopy, endoscopic nasal examination and coronal paranasal sinus computed tomography (CT). Measurements of CIMT and FMD of the brachial artery were performed by high-resolution ultrasonography. Serum PON-1 activity was evaluated by measuring the rate of paraoxon hydrolysis. RESULTS: Mean CIMT values were found to be increased in the NP group compared to the control group. However, mean FMD % values and serum PON-1 activity were significantly lower in the NP group compared to the control group. Moreover; the endoscopic polyps' scores and paranasal sinus CT scores were positively correlated with CIMT and negatively correlated with FMD % values and PON-1 activity. Disease duration also was positively correlated with CIMT and negatively correlated with FMD % values. CONCLUSION: Impaired FMD, increased CIMT and decreased serum PON-1 activity may be considered to be risk factors for accelerated atherosclerosis in patients with NP who may have subclinical atherosclerosis and be at risk for cardiovascular events in the future.