Evaluation of Nasal Mucociliary Clearance Time in COVID-19 Patients.

BACKGROUND: Coronavirus Disease 2019 (COVID-19) is a viral pandemic emerging in East Asia and spreading rapidly to the rest of the world and continuing in our country. The number of studies examining the symptoms of the otolaryngology system and organs in COVID-19 patients is limited. The purpose of this study is to show whether COVID-19 infections cause any changes in nasal physiology in adult patients by measuring the mucociliary clearance (MCC) time with the saccharin test. METHODS: One hundred one patients with laboratory-confirmed COVID-19 infection (group 1, n = 42 smokers and group 2, n = 59 nonsmokers) and 87 individuals without COVID-19 infection as the control group (group 3, n = 33 smokers and group 4, n = 54 nonsmokers) were included in the study. A saccharin test was used to evaluate the nasal MCC time. RESULTS: Mucociliary clearance test averages of the groups were determined as 473.571 ±â€Š263.684, 442.966 ±â€Š228.463, 468.333 ±â€Š267.367, 412.629 ±â€Š192.179 seconds, respectively. When the test durations were examined, the group with the most prolonged MCC duration was determined as the smoking COVID (+) patient group (473.571 ±â€Š263.684 seconds). The second group, with the most prolonged MCC duration, was determined as the smoking control group (468.333 ±â€Š267.367 seconds). No statistically significant difference was found in intergroup mucociliary clearance time (P = 0.760). CONCLUSION: Although the authors found that smoking and viral infections prolong the MCC duration in our study, they did not find a statistically significant difference between the groups in terms of MCC duration.

Classification of laryngeal injury in patients with prolonged intubation and to determine the factors that cause the injury.

OBJECTIVE: This study aims to evaluate injuries occurring in the larynx of patients intubated in intensive care units for a long time. STUDY DESIGN: Prospective clinical study. SETTING: Tertiary hospital. SUBJECT AND METHODS: Between April 15, 2019, and November 15, 2019, 40 patients who were hospitalized in intensive care units had a tracheotomy procedure due to prolonged intubation, and laryngeal structures were evaluated by direct laryngoscopy. The laryngeal structures were evaluated in four groups as glottic-supraglottic region, arytenoid vocal process, interaritenoid region and subglottic region. Edema, granulation and ulceration findings in these four regions were recorded. The injuries to the laryngeal structures were classified as stages 0-3. As a result of the data obtained, the relationship between the degree of laryngeal lesions and the factors that may cause these lesions was investigated. RESULTS: According to our classification, nine patients had stage 1, 16 patients had stage 2 and 15 patients had stage 3 laryngeal injury. There was no significant relationship between the stage of laryngeal injury and age, sex and diameter of the intubation tube. There was a statistically significant relationship between laryngeal injury and the day the tracheotomy was performed (p = 0.007). CONCLUSION: In patients that had prolonged endotracheal intubation, injury to the laryngeal structures is inevitable. To minimize this occurrence, tracheotomy should be performed for intubations that extend for more than seven days. When performing the tracheotomy, the laryngeal structures should be evaluated, necessary precautions should be taken for the traumatic lesions that are difficult to heal, and treatment should be started.

The evaluation of prognostic factors in endoscopic cartilage tympanoplasty.

PURPOSE: The aim of the present study was to evaluate the prognostic factors that may affect the success in endoscopic cartilage tympanoplasty and determine the outcomes of endoscopic cartilage tympanoplasty. METHODS: This study included 312 patients who underwent transcanal endoscopic type I cartilage tympanoplasty. The effects of sex, the affected side, the size of the perforation, the location of the perforation, the absence of myringosclerosis, external ear canal protrusion, the condition of the contralateral ear, and surgical experience on the rate of graft success and hearing improvement were investigated. RESULTS: The affected side, sex, location of the perforation, myringosclerosis, the condition of contralateral ear, and surgical experience did not significantly affect the surgical success (p > 0.05). However, the size of perforation and ear canal wall protrusion were significantly related to both functional and anatomical success (p < 0.05). CONCLUSION: Endoscopic transcanal type I cartilage tympanoplasty can be performed with a high anatomical and functional success rate. However, surgeons should be more careful and design a case-specific operation strategy in patients with external ear canal anterior wall protrusion and large perforations.

Bone turnover in chronic otitis media with bone destruction.

PURPOSE: This study aims to determine the relationship between bone destruction and bone turnover markers in patients with chronic otitis media (COM). METHODS: Subjects with COM were divided into two groups: those with and without bone destruction. Thirty-seven patients were included in the group with bone destruction; 30 patients were included in the group without bone destruction. The enzyme values were evaluated. RESULTS: There was no difference between the two groups in terms of enzyme levels of serum and urine. However, the osteocalcin, which is a bone formation marker, and the C-terminal telopeptide of type I collagen marker, which is bone destruction marker, were found to be lower in the group with bone destruction than the group without bone destruction. CONCLUSION: Data obtained in the present study suggest that the pressure necrosis theory and acid lysis theory provide the most valid explanations of bone destruction. However, the data provide limited preliminary information to clarify this mechanism.

Does Postauricular Incision Cause Auricula Protrusion After Tympanoplasty?

BACKGROUND: An ear surgery can be performed via transcanal, endaural, or postauricular approach according to the surgeon's desicion. The postauricular one is the most commonly performed approach. OBJECTIVE: The objective of this study was to evaluate whether preferring postauricular approach during ear surgery cause auricular protrusion in over time. METHODS: Thirty-six patients who underwent tympanoplasty operation with postauricular incision were included in this study. Any patient who was under 18 years of age, those with auricular deformity and patients who underwent tympanoplasty operation with mastoidectomy were excluded from this study. The distances from mastoid area to superior and mid-point of helix were measured preoperatively and 1 year postoperatively. RESULTS: A total of 36 patients' data were analyzed. There were 13 males and 23 females. The mean age was 28.2 ±â€Šyears (18-59). The preoperative mean distance from mastoid area to superior point of helix was 15.03 ±â€Š2.86 mm, whereas it was 17.92 ±â€Š2.96 mm at mid-helix level. At postoperative 1 year, the same distances were measured 14.67 ±â€Š3.12 mm and 17.25 ±â€Š3.17 mm, respectively. There were no statistically significant differences between preoperative and postoperative measures. CONCLUSION: Although the structures that provide the stability of the auricle are cut during postauricular sulcus incision, long-term follow-up of patients did not show any protrusion of auricula.

Postauricular Island Flap in Reconstruction of Auricula Tumor Defects.

The most common malignant tumor in humans is skin cancers. Skin cancers are most commonly seen in the head and neck region due to direct exposure to sunlight. Most frequently seen skin cancer in the auricula are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The aim of this study is to evaluate the results of postauricular island flap after resection of tumors in the auricula.Twelve patients aged 58 to 84 years were included in the study. Eight patients had BCC, 3 had SCC, and 1 had basosquamous carcinoma (BSC). The tumor was located at the cavum concha in 7 cases, antihelix in 3 cases, triangular fossa in 1 case and scapha in 1 case. Surgical procedure was performed under local anesthesia in 7 patients and under general anesthesia in 5 patients. Postauricular island flap was used in all cases. There were no early complications. Three patients had non-apparent narrowing of the auriculomastoid angle. The patients were followed for an average of 2.6 years between 1 and 9 years. Only one patient with basosquamous carcinoma of the cavum concha had recurrence at 19 months.We believe that the postauricular island flap may be a good alternative for the reconstruction of the defect after resection of tumors in the auricle due to its proximity to the surgical site, color matching, adequate thickness, good vascularization, aesthetic acceptance by the patient and completion of the procedure in one session.

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.

Outcomes of endoscopic transcanal type 1 cartilage tympanoplasty.

PURPOSE: We aimed to evaluate air-bone GAP (ABG), graft success and hearing gain according to the size and location of perforation in patients who underwent endoscopic transcanal type 1 cartilage tympanoplasty due to the tympanic membrane perforation and chronic otitis media. METHODS: The 104 patients (52 male and 52 female) who underwent endoscopic transcanal type 1 cartilage tympanoplasty, were evaluated retrospectively. Tragal cartilage grafts were utilized in all patients. Perforation size/location, duration of surgery, pre-operative and post-operative (6th month) average ABG, and pure-tone audiometric results (at 500-1000-2000-4000 Hz) as well as overall graft success were evaluated. RESULTS: The mean duration of surgery was 45.60 ± 17.39 min. Perforations were most frequently located in anterior quadrant with moderate sized. The post-operative air-conduction results were significantly improved at 500-1000-2000-4000 Hz frequencies. Similarly, pre-operative air-conduction pure-tone average (PTA) (35.36 ± 11.9 dB) was significantly decreased (22.34 ± 7.9 dB) after postoperative 6 months (p ≤ 0.001). The overall graft success rate was 93.2%. Moreover, pre-operative mean ABG (19.82 ± 7.4 dB) was significantly decreased (9.05 ± 4.3 dB) after postoperative 6 months (p ≤ 0.001). CONCLUSIONS: Endoscopic transcanal type 1 cartilage tympanoplasty achieved a high graft success rate, and improved hearing results, regardless of the perforations' location and size. Endoscopic tympanoplasty provides high patient safety and comfort in middle-ear surgery by wide visualization, easy applicability, short-operation duration, low complication risk, and less invasive approach.

Effect of Septoplasty on the Heart Rate Variability in Patients With Nasal Septum Deviation.

BACKGROUND: Nasal septum deformities (NSD) are one of the most common causes of upper airway obstruction. Heart rate variability (HRV) is a physiologic parameter that is affected by the balance between the sympathetic and parasympathetic tonus. OBJECTIVE: The aim of this study was to evaluate the effects of a septoplasty operation on HRV parameters as assessed by 24 hours ambulatory Holter recordings in patients with NSD. METHODS: The prospective study involved 54 consecutive patients (16 women and 38 men) who underwent septoplasty due to a marked C- or S-shaped NSD. Twenty-four-hour Holter monitoring was performed to all patients pre- and 2 months postseptoplasty operation. For the HRV analyses, the definitions of evaluated parameters were made according to the Task Force of European Society of Cardiology and the North American Society of Pacing and Electrophysiology on HRV. RESULTS: Low-frequency norm () (73 [68-86] versus 78 [70-81], P = 0.039) values were significantly increased after septoplasty whereas changes in other parameters were not statistically significant. CONCLUSION: The authors' study showed that low-frequency norm values were significantly increased after septoplasty operation in patients with NSD which may be interpreted as a decreased sympathetic tone.

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.

The effects of choanal atresia on development of the paranasal sinuses and turbinates.

PURPOSE: The objective of this study was to evaluate the volume of paranasal sinuses (PNS) and turbinate in patients with unilateral choanal atresia (CA). MATERIALS AND METHOD: Computed tomography images of PNS in 11 individuals with unilateral CA were evaluated retrospectively. Mucosal thickness and volume of the maxillary, frontal and sphenoidal sinuses were determined, in addition to the volume of the middle and inferior turbinate. The unaffected nasal side of patients was used as a control group for the measurements. The results comprised the measurements of the atresic side compared to those of the healthy side. RESULTS: There was no significant difference between the atresic and healthy side of the nose in patients with CA with respect to mucosal thickness and volume of the PNS (the maxillary, frontal and sphenoidal sinuses) and the middle and inferior turbinate (p > 0.050). CONCLUSION: The complete absence of nasal unilateral airflow had no effect on the development of the PNS and the middle and inferior turbinate. Moreover, mucosal thickness in the sinuses was similar to that in the control group.

Vestibular evoked myogenic potentials in patients with ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease with unknown etiology. Although sacroiliac joint involvement is the classic sign along with the formed immune mediators, it may result in immune-mediated inner ear disease and may cause damage to the audiovestibular system. Vestibular evoked myogenic potentials (VEMP) is a clinical reflex test used in the diagnosis of vestibular diseases and is performed by recording and evaluating the muscle potentials resulting from the stimulation of the vestibular system with different stimuli. The aim of this study is to evaluate the cervical VEMP test results in AS patients without vestibular symptoms. Thirty-three patients with AS and a control group of 30 healthy volunteers with similar demographic characteristics were evaluated in the study. VEMP wave latency, P13-N23 wave amplitude, and VEMP asymmetry ratio (VAR) values were compared between the groups. The relationship between clinical and laboratory findings of the AS patients and VEMP data were also investigated. Compared with healthy people, this study shows the response rate of patients with ankylosing spondylitis was reduced in the VEMP test, and P13-N23 wave amplitude showed a decrease in AS patients who had VEMP response (p < 0.001). There was no correlation between the clinical and laboratory findings and VEMP findings in patients with ankylosing spondylitis. The data obtained from this study suggest that AS may lead to decreased sensitivity of the vestibular system.

Acute airway compromise due to ruptured inferior thyroid artery aneurysm.

A cervical hematoma secondary to the spontaneous rupture of an aneurysm is an uncommon but catastrophic life-threatening condition because it can potentially obstruct the airway. Inferior thyroid artery aneurysm and rupture is a very rare clinical entity and only a limited number of cases have been reported in the literature. In this article, we present the case of a female patient who suffered from a rapidly enlarging cervical mass followed by a rapid onset of dyspnea as a result of rupture of an inferior thyroid artery aneurysm. The diagnosis was confirmed by magnetic resonance angiography, and delayed surgery resulted in an uneventful outcome. We aim to draw the attention of emergency physicians to this rare condition.

Bilateral temporomandibular joint luxation in a 6-month-old child: Case report.

BACKGROUND: Luxation of the temporomandibular joint (TMJ) is an acute condition associated with translocation of the condylar joint out of its functional position. Traumatic causes are more common in childhood, while non-traumatic causes are very rare. CLINICAL PRESENTATION: A 6-month-old patient was brought to a rural hospital emergency department with the inability to close her mouth. The patient was diagnosed with anterior TMJ luxation after the examination, and no additional imaging was requested. Reduction was performed with gas sedation accompanied by paracetamol for pain. CONCLUSION: In rare cases, non-traumatic TMJ luxation may be observed after excessive crying or vomiting in infants. Examination findings are generally sufficient for diagnosis. Reduction is performed with the classical manual method, especially in childhood. One issue that should not be ignored is the possibility of recurrence after dislocation.

The Relationship Between Benign Paroxysmal Positional Vertigo and Vitamin D.

Introduction Benign paroxysmal positional vertigo (BPPV) is a type of vertigo and its signs are short-time, severe attacks that occur in certain head and body positions. Recent studies have revealed that vitamin D deficiency correlates with BPPV and this is explained by cupulolithiasis and canalithiasis theories. Method In the present study, levels of serum vitamin D in the patients who were diagnosed as BPPV and those in the control group consisting of healthy individuals were investigated. In addition, it was examined whether vitamin D is influential on the rates of BPPV types. In our study, 258 patients who were diagnosed with BPPV after detailed ear-nose-throat and neurology examinations were examined. We compared the control group according to their ages, genders, and levels of vitamin D. In addition, we divided the BPPV group into two sub-groups according to their vitamin D levels (20-30 ng/ml and 20 g/ml lower), and each was compared by calculating vertigo types and ratios. Results The BPPV group included 187 females and 71 males, and their mean age was 43.70 ± 15.44. The control group consisted of 65 females and 35 males, and the mean age of this group was 44.63 ± 15.42. The mean vitamin D levels of the females and males were 18.42 ± 5.07 and 19.82 ± 5.11, respectively, in this study. On the other hand, the mean vitamin D levels of healthy females and males were found to be 30.88 ± 10.74. Conclusion Our study found that the vitamin D levels of the individuals in the BPPV group were statistically significantly lower than those of the individuals who were in the control group. However, it was observed that vitamin D did not affect the rate of vertigo subtypes.

Mucin receptors in chronic rhinosinusitis with nasal polyps.

BACKGROUND: Nasal polyps (NPs) are non-neoplastic, painless inflammatory lesions of the sino-nasal mucosa. Nasal polyp physiopathology is not yet fully understood. There are many potential etiologies of NP, including chronic infections, allergies, asthma, aspirin sensitivity, anatomical disorders, and genetic causes. OBJECTIVE: The purpose of our study was to immunohistochemically demonstrate the presence of mucin (MUC) receptors in chronic rhinosinusitis (CRS) with nasal polyps and determine the relationships between the presence of these receptors and clinical findings. MATERIAL AND METHODS: A total of 59 patients who underwent functional endoscopic sinus surgery due to CRS with NPs were included in the study. Groups with positive and negative MUC receptors were evaluated according to their clinical characteristics. RESULTS: According to the data we have obtained, surgery site quality and low-dose steroid response worsened with MUC5A receptor positivity and there were no significant relationships between MUC1 receptor positivity and clinical findings. CONCLUSION: According to our results, MUC5A receptor positivity was associated with impaired surgical site quality and a reduced response to low-dose systemic steroids by NPs.

Evaluation of age-related changes in middle-ear structures by wideband tympanometry.

BACKGROUND: Presbycusis is bilateral sensorineural hearing loss associated with the progressive degeneration of cochlear and central auditory pathways with aging. AIMS/OBJECTIVES: We aimed to reveal age-related changes in middle ear function by using wideband tympanometry (WBT). MATERIALS AND METHODS: Fifty-eight patients diagnosed with presbycusis were compared to 52 audiologically healthy participants. WBT measurement was performed on both ears via wideband click stimulus with a tympanometer device using probe tone frequencies of 226-8000 Hz. RESULTS: There were no statistically significant differences detected among the resonance frequencies or maximum absorbance ratios measured in both ears between groups (p > .05). The mean absorbance of the right and left ears at 4000 and 8000 Hz was statistically higher in the patient group than in the healthy controls (r = 0.038, 0.030; l = 0.015, 0.012). Moreover, mean compliance values were found to be significantly lower in the patient group than in the control group (r = 0.030 and l = 0.040). CONCLUSION: The significant differences detected in compliance and absorbance values for high frequencies in presbycusis patients were remarkable. Thus, it has been shown that WBT yields an advantage compared to traditional tympanometry in the diagnosis and treatment of middle ear diseases.

Effect of the prenatal electromagnetic field exposure on cochlear nucleus neurons and oligodendrocytes in rats.

Electromagnetic radiation from elecromagnetic field (EMF) sources has been an important health concern for a long time. The vast majority of this exposure is due to the widespread use of mobile phones, an important source of the EMF. The EMF generated by mobile phones may have adverse effects on the various biological structures that regulate the body system and function. In this study, it was aimed to evaluate histopathologically the effects of 900-megahertz (MHz) EMF application in the prenatal period on the development of the ventral cochlear nucleus, which is the first place of hearing in the brainstem, at various time points of the postnatal period in rats. In the study, Sprague-Dawley pregnant rats were divided randomly into two groups as the control group and the EMF group. The rats in the EMF group were exposed to a 900-MHz EMF every day until birth, while no EMF was applied to the rats in the control group. Auditory brainstem responses of both groups were recorded on the postnatal 13th day, the day the hearing starts. Newborn rats were sacrificed by anesthesia on days 7, 10, 15, and 30. Contrary to the control group, structural damage in cochlear nuclear neurons and oligodendrocyte cell structures and increased caspase-3 activity were observed in the postnatal period in the EMF groups. However, no significant difference was observed between the groups in terms of structural damage and caspase-3 activity at different stages of the postnatal period when cochlear nucleus development was observed. According to ABS, there was no significant difference between the average latency of waves in both groups. In conclusion, this study shows that 900-MHz electromagnetic waves propagated from mobile phones during the prenatal period have no harmful effects on the development of the ventral cochlear nucleus of rats.