Culturally modified olfactory test adapted to East-Turkey: A comparison with Sniffin' Sticks.

BACKGROUND: Although the "Sniffin' Sticks" test (SST) is a widely used odor test, aplicability of odor tests is limited because of the high cost of the test and the regional-cultural differentiation of odor recognition. We aimed to evaluate our regional odor norms by applying the SST with a Modified odor test (MOT) we created for this study, and to develop a test similar to the SST, which was less expensive and probably had a higher odor definition for our region. METHODS: This study includes 201 healthy volunteers: 91 men and 110 women over the age of 18 were included in the study. Tests were compared by applying the SST and MOT to all volunteers. RESULTS: In all subjects, for the SST: the mean Threshold score (TS), Discrimination score (DS), and Identification score (IS) were, respectively, 10.73 ± 2.35, 11.11 ± 11.94 and 11.32 ± 2.15. TheTDI mean score was found to be 33.11 ± 5.9. In the TDI score, the 10th percentile value was found to be 26. For the MOT, the mean TS(mTS), DS(mDS), and IS(mIS) were 10.88 ± 2.31, 12 ± 2.06, and 11.95 ± 2.07, respectively, the modified test TDI(mTDI) mean was 34.68 ± 6.47. The mTDI 10th percentile value was found to be 26. In all volunteers, there was no statistically significant difference between the two tests for the mean threshold score, while the difference in the mean discrimination score, the average identification score, and the average TDI (thresold, discrimination, sum of identification scores) score was statistically significant (P < .01). CONCLUSION: This study is the first study to compare the SST and the MOT in our region. Making low-cost modifications by adding more probable smells to the smell tests and using them in studies involving more participants will be more meaningful in evaluating normative odor scores and will result in more widespread use.

Effect of caffeic acid phenethyl ester on myringosclerosis development in the tympanic membrane of rat.

Myringosclerosis is hyalinization and calcification of certain areas of the tympanic membrane, especially the fibrous lamina propria layer and appears as white sclerotic lesions. Ventilation tube insertion is one of the most performed operations in the pediatric otorhinolaryngology practice to treat chronic otitis media with effusion. Myringosclerosis is a very common sequela of ventilation tube insertion. In this experimental study, our aim was to show the histopathological effects of caffeic acid phenethyl ester on myringosclerosis development in rat tympanic membrane after myringotomy. The rats were randomly categorized into four experimental groups including the comparison group (n = 4), non-treated group (n = 7), the saline (control) group (n = 7), the caffeic acid phenethyl ester group (n = 7). Non-treated group did not receive any treatment for 15 days. Saline (2.5 mL/kg, intraperitoneal) was administered to the third group once a day for 15 days. Fourth group received caffeic acid phenethyl ester intraperitoneally once a day at a dose of 10 µmol/kg for 15 days. Myringotomy was performed on the right tympanic membrane of all rats except comparison group using a sterile pick with the help of an operating microscope. Histopathological examination of myringosclerosis formation was done by a pathologist under light microscope. In histopathological analysis of groups, the severity of inflammation was milder in caffeic acid phenethyl ester group compared to non-treated and saline groups (p < 0.05). There was less myringosclerotic plaques in caffeic acid phenethyl ester group than in non-treated and saline groups (p < 0.05). TM thickness measurements were very close to each other in non-treated and saline groups. The tympanic membrane thickness of caffeic acid phenethyl ester group was much thinner than the other two groups (p < 0.05). Caffeic acid phenethyl ester decreases inflammation severity and the formation of myringosclerotic plaques. These two effects resulted in thinner tympanic membranes of rats which were treated with caffeic acid phenethyl ester. As a result, caffeic acid phenethyl ester has potential preventive effects on myringosclerosis development after myringotomy and ventilation tube insertion.

The effects of oral isotretinoin (13-Cis retinoic acid) on the inner ear: a prospective clinical study.

PURPOSE: The purpose of this study was to investigate the effect of oral isotretinoin, a drug used in the treatment of acne vulgaris, on hearing function determined by serial audiology examinations. METHODS: Forty patients with acne vulgaris were included in this study. Nine patients were excluded from the study because of inconsistent follow-up. The hearing of each participant was tested with pure tone audiometry and transient evoked autoacoustic emissions before and two and four weeks after treatment with isotretinoin (0.3-0.6 mg/kg/day) in the remaining 31 patients (62 ears). RESULTS: The differences between the mean values of the pre-treatment and post-treatment pure tone hearing thresholds at 1000, 2000, 4000 and 6000 Hz frequencies were statistically significant (p < 0.05), but there was no significant difference between the pre-treatment and post-treatment values at 250 and 500 Hz frequencies (p > 0.05). The difference between the pre-treatment and post-treatment signal-noise ratio values of the transient evoked autoacoustic emissions was not significantly different (p > 0.05). CONCLUSION: Our results suggest that the use of isotretinoin may cause bilateral hearing threshold changes. Further animal and human studies are required to investigate and characterize isotretinoin-induced neurophysiological alterations in hearing.

Effects of caffeic acid phenethyl ester on wound healing of nasal mucosa in the rat: an experimental study.

PURPOSE: Wound healing of the nasal mucosa is a highly complex process that restores the anatomical and functional integrity of tissue that has been exposed to trauma. In this experimental study, our aim was to use histopathological examination to investigate the effects of caffeic acid phenethyl ester on the wound healing of rat nasal mucosa after mechanical trauma. MATERIALS AND METHODS: The rats were randomly divided into 3 experimental groups: a non-treated group (n=7), a control saline group (n=7) and a caffeic acid phenethyl ester group (n=7). The non-treated group received no treatment for 15 days. The second group was administered saline (2.5 mL/kg, intraperitoneal) once a day for 15 days. The third group received caffeic acid phenethyl ester intraperitoneally at a dose of 10 µmol/kg once a day for 15 days. At the beginning of the study, unilateral mechanical nasal trauma was induced on the right nasal mucosa of all rats in the three groups using a brushing technique. Samples were stained using hematoxylin and eosin solution and were examined by a pathologist using a light microscope. RESULTS: The severity of inflammation was milder in the caffeic acid phenethyl ester group compared with that in the non-treated and saline groups (P<0.05). The subepithelial thickness index was lower in the experimental group (P<0.05). Goblet cell and ciliated cell loss was substantially reduced in the experimental group compared with the non-treated and saline groups (P<0.05). CONCLUSIONS: Caffeic acid phenethyl ester decreases inflammation and the loss of goblet cells and ciliated cells. Therefore, caffeic acid phenethyl ester has potential beneficial effects on the wound healing of nasal mucosa in the rat.

Patients with congenital choanal atresia treated by transnasal endoscopic surgery.

Congenital choanal atresia (CCA) is defined as a congenital failure in the development of communication between the nasal cavity and nasopharynx in newborns. It is the most common congenital anomaly of nose. Most of the patients presented with unilateral CCA. Neonates with bilateral CCA have severe respiratory distress after birth. Airway control with orotracheal intubation should be done immediately to save the life of neonate with bilateral CCA. After airway control, surgery should be performed as soon as possible. The aim of surgery is to create a patent nasal passage and to prevent restenosis with minimal morbidity. Transnasal endoscopic surgery of CCA has become the most popular treatment method. The retrospective review of 33 patients with CCA was presented in this study. The patients who were diagnosed at the neonate period and operated on in 6 months after birth were grouped as I (neonate). The patients who were diagnosed 6 months after birth were grouped as II (child-young adult). All patients were treated by transnasal endoscopic surgery. Stent were put in all patients to prevent restenosis. Although the restenosis rate was higher in group I (53.8%) than in group II (23.1%), it did not cause a statistically significant difference. Overall success rate of our surgical approach was 61.5%. Despite the surgical developments and many treatment modalities, restenosis is still the most challenging problem in CCA.

Cultural adaptation of an olfactory test: the odour in bottle test. [corrected].

OBJECTIVES: To compare the size of the nasal septal body (SB) and inferior turbinate (IT) of subjects grouped by sex and age. METHOD: We measured SB and IT areas (in cm2) bilaterally in computed tomography (CT) sections of 150 paranasal sinuses from 72 males and 78 females. RESULTS: The right and left SB areas were smaller in females than in males. In the ≤ 25-year-old group, the right IT (RIT) was significantly smaller in females than in males. In the 26-35 and 46-45 age groups, the right SB (RSB) was significantly smaller in females than in males. CONCLUSION: The nasal SB may play a role in nasal physiology similar to a turbinate and help support optimal airflow. The vascular and glandular structures of the SB should be investigated in detail, and minimal invasive procedures should be performed in nasal surgery to avoid damaging essential structures.

The protective role of caffeic acid phenethyl ester against streptomycin ototoxicity.

OBJECTIVE: The aim of this experimental study was to investigate the efficacy of caffeic acid phenethyl ester (CAPE) in the prevention of streptomycin-induced ototoxicity. MATERIALS AND METHODS: Thirty-two adult Wistar albino rats were divided into 4 groups: control (n = 8), streptomycin (n = 8), CAPE (n = 8), and streptomycin + CAPE (n = 8). Rats were tested with distortion product otoacoustic emissions (DPOAEs) before drug administration. The animals in all groups were killed under general anesthesia on the 45th day following last DPOAE measurements. Hearing results were analyzed statistically to determine differences in amplitudes of DPOAE. Also, the cochleas of each rat were evaluated by histopathological and immunohistochemical examination. RESULTS: Significant difference was not observed in cochlear hair cells in the control and CAPE groups. In the streptomycin group, severe degeneration of hair cells and increased apoptotic cells were observed. In the streptomycin + CAPE group, although some deteriorations were observed, hair cells were mostly preserved. The DPgram of the streptomycin and streptomycin + CAPE groups was significantly deteriorated (P < .05). The analysis of the DPgram results revealed statistically significant differences between the groups of streptomycin and streptomycin + CAPE (P < .05). CONCLUSIONS: Caffeic acid phenethyl ester treatment attenuated hair cells injury in the inner ear, possibly via its antioxidant effect. Prophylactic administration of CAPE for streptomycin ototoxicity ameliorated hearing deterioration in rats.

The relationship between pneumatized middle turbinate and the anterior ethmoid roof dimensions: a radiologic study.

The development of pneumatized middle turbinate may affect anterior ethmoid roof formation. The aim of this study was to investigate the relationship between the pneumatized middle turbinate and the dimensions of the anterior skull base structures using computed tomography scans. The coronal reconstructed images of the computed tomography scans were evaluated retrospectively. The lateral and medial ethmoid roof points, the width of the cribriform plate (CP), and the anterior ethmoid roof were identified at the first coronal cut, which was determined by the infraorbital nerve. The pneumatized middle turbinates were measured on the axial, vertical, and sagittal planes. The images of 101 patients were evaluated. The mean axial diameters of the pneumatized middle turbinate on the right and left sides were between 6.93 and 4.95 mm, respectively. The correlation between the axial diameters of the pneumatized middle turbinate and the width of the anterior ethmoid roof (termed AER width) was significant for both sides and gender (p < 0.05). There was a higher correlation on the right side where the pneumatized middle turbinate was observed more frequently (r = 0.357). The relationship between CP width and the diameters of the pneumatized middle turbinate was not significant (p > 0.05) for both sides. Iatrogenic lesions of the skull base occur predominantly in the lateral lamella of the CP. The risk of this complication may decrease with increasing of the AER width. Pneumatized middle turbinate may cause an increase in the width of the anterior ethmoid roof and provide more reliable endoscopic intervention of the anterior skull base and frontal sinus.

Management of orbital complications of sinusitis in pediatric patients.

The most common reason of orbital infections is sinusitis. Orbital complications of sinusitis are mostly seen in children. Loss of vision and intracranial infections are among the complications of sinusitis. Prompt diagnosis and treatment is very important in the management of orbital complications. The orbital complication can be in the form of cellulitis or abscess. A retrospective review of 26 pediatric patients with orbital complications due to sinusitis was presented in this study. Of 26 patients, there were 13 cases of preseptal cellulitis, 2 cases of orbital cellulitis, and 11 cases of subperiosteal abscess. We grouped the preseptal and orbital cellulites in one category and the subperiosteal abscess in the other. All patients in the cellulitis group recovered by medical treatment. All the patients were treated by surgical drainage. Early diagnosis and appropriate treatment method are vital for the treatment of orbital complications secondary to sinusitis.

Evaluation of hyperactivity, attention deficit, and impulsivity before and after adenoidectomy/adenotonsillectomy surgery.

OBJECTIVE: The objective of this study was to determine the severity of attention deficit, hyperactivity, and impulsivity symptoms in patients with obstructive airway problems scheduled to undergo adenoidectomy or adenotonsillectomy operation. The effects of the surgical treatment on these symptoms will also be investigated in a case-control design. METHODS: This prospective study included 63 patients (29 girls, 34 boys) who were operated on at the Department of Otorhinolaryngology, Dicle University Medical School, between January 2010 and May 2011 because of obstructive symptoms caused by adenoid or adenotonsillar hypertrophy. The age range of the patients was between 4 and 13 years. The control group consisted of 33 (17 girls, 16 boys) healthy children. RESULTS: Among the patients, 15 children underwent adenoidectomy because of adenoid hypertrophy; 13 patients had adenotonsillectomy because of adenotonsillar hypertrophy, and the remaining patients underwent adenotonsillectomy related with chronic or recurrent tonsillitis with adenoid hypertrophy. Based on the preoperative data, statistically significant difference was observed between the patient and control groups. The patients' attention deficit, hyperactivity, and impulsivity symptoms preoperatively and postoperatively have shown statistically significant differences. CONCLUSIONS: Attention deficit, hyperactivity, and impulsivity symptoms were common among the children who show signs of airway obstruction due to adenotonsillar hypertrophy. Adenoidectomy or adenotonsillectomy operations were both observed to be associated with improvement in these symptoms.

[External auditory canal osteoma resulting in cholesteatoma which is complicated with meningitis]. / Kolestatoma neden olan ve menenjit ile komplike olan dis kulak kanali osteomu.

Osteoma of external auditory canal is a unilateral benign tumor which usually presents with no symptoms. They only cause symptoms when cerumen collection or conduction type hearing loss occurs. They are the most common osseous lesions of the temporal bone. It very rarely presents with cholesteatoma. So far, no osteoma case concomitant with, cholesteatoma and meningitis has not been reported. In this article, we report an interesting case presenting with external auditory canal osteoma, cholestatoma and meningitis concomitantly who was treated successfully using the canal Wall-down mastoidectomy technique.

Histopathologic results of long-term sildenafil administration on rat inner ear.

OBJECTIVES: Sildenafil, a selective inhibitor of phosphodiesterase type 5, is widely used for the treatment of erectile dysfunction. Although cochlear effects of phosphodiesterase type 5 inhibitors remain still unclear because of inadequate data, some evidence that recently emerged indicates that these medications may be responsible for hearing impairment. In the present study, we aimed to examine the histopathologic effects of long-term sildenafil use on the cochlea in a rat model. METHODS: The study was performed with adult male Wistar albino rats. The control group was fed on standard laboratory diet. The study group was applied orally with sildenafil therapy, 1.5 mg/kg once a day for 45 days. Rats were anesthetized and decapitated. Each temporal bone was dissected, and the cochleas were removed en bloc. The inner-ear biopsy specimens were examined histologically with hematoxylin and eosin and caspase 3 immunoreaction under light microscopy. RESULTS: Hematoxylin and eosin staining showed no distinctive difference between the control group and the sildenafil group. With immunohistochemical examination, caspase 3 immunoreactivity was observed in the sildenafil group. In the control group, caspase 3 immunoreactivity was not observed. CONCLUSIONS: The caspase 3 immunoreactivity in the sildenafil group was strongly associated with an increase in apoptotic events in the cochlea. Long-term use of sildenafil can cause hearing impairment through increased apoptosis.

Deep neck space infections: a retrospective review of 173 cases.

PURPOSE: The purpose of this study is to review our recent experience with deep neck infections and emphasize the importance of radiologic evaluation and appropriate treatment selection in those patients. MATERIALS AND METHODS: The records of 173 patients treated for deep neck infection at the Department of Otolaryngology and Head and Neck Surgery of Dicle University Hospital during the period from 2003 to 2010 were retrospectively reviewed. Their demography, symptoms, etiology, seasonal distribution, bacteriology, radiology, site of deep neck infection, durations of the hospital admission and hospital stay, treatment, complications, and outcomes were evaluated. The findings were compared to those in the available literature. RESULTS: Dental infection was the most common cause of deep neck infection (48.6%). Peritonsillar infections (19.7%) and tuberculosis (6.9%) were the other most common cause. Pain, odynophagia, dysphagia, and fever were the most common presenting symptoms. Radiologic evaluation was performed on almost all of the patients (98.3%) to identify the location, extent, and character (cellulitis or abscesses) of the infections. Computed tomography was performed in 85.3% of patients. The most common involved site was the submandibular space (26.1%). In 29.5% of cases, the infection involved more than one space. All the patients were taken to intravenous antibiotic therapy. Surgical intervention was required in 95 patients (59.5%), whereas 78 patients (40.5%) were treated with intravenous antibiotic therapy alone. Life-threatening complications were developed in 13.8% of cases; 170 patients (98.3%) were discharged in stable condition. CONCLUSION: Despite the wide use of antibiotics, deep neck space infections are commonly seen. Today, complications of deep neck infections are often life threatening. Although surgical drainage remains the main method of treating deep neck abscesses, conservative medical treatment are effective in selective cases.

[Acinetobacter baumannii: a rare cause of deep neck infection]. / Acinetobacter baumannii: Derin boyun enfeksiyonunun nadir bir nedeni.

Deep neck infections, which are originated from upper respiratory tract, are bacterial infections involving deep structures of the neck. Unless diagnosed and managed appropriately, these infections may progress rapidly, leading to severe morbidity and mortality. Although, Acinetobacter baumannii plays a significant role in several nosocomial infections, ear nose throat physicians are usually unfamiliar with this bacteria and it is rarely isolated in deep neck infections. In this article, we present a serious case of deep neck infection in which Acinetobacter baumannii was cultured from the abscess. The patient was treated successfully with antibiotic and surgical drainage.

Double thyroglossal duct cyst located in the hyoid region and the tongue base: an unusual coexistence.

Thyroglossal duct cysts originate from persistent epithelial remnants of the thyroglossal duct that are present during the descent of the thyroid gland from the foramen cecum to its final position in the anterior neck. Thyroglossal duct may persist anywhere along the descent from the tongue to the thyroid. Lingually localized thyroglossal duct cysts are congenital lesions of the pharynx, which are very uncommon and may cause morbidity and mortality if not treated expeditiously. Double thyroglossal cysts and the complete failure of the obliterative process of thyroglossal duct are very rare in the literature. In this article, we describe a case of two cysts derived from the same thyroglossal duct, one in the hyoid region and the other in the tongue base. To our knowledge, this coexistence has not been described previously in the literature.

Preventing cisplatin induced ototoxicity by N-acetylcysteine and salicylate.

OBJECTIVES: In this study we investigated if CP induced ototoxicity could be prevented or reduced by the use of salicylate and N-acetylcysteine. PATIENTS AND METHODS: Fifty-four patients (28 females, 26 males; mean age 37+/-9.5 years; range 29 to 71 years) who had cisplatin chemotherapy due to solid organ tumors were enrolled in the study. The patients were randomized into three groups, with 18 patients in each group. The first group (control group) received cisplatin, second group received N-acetylcysteine (NAC; 600 mg/day) with cisplatin and the third group received salicylate (300 mg/day) with cisplatin. All patients evaluated audiologically including high frequency audiometry and auditory brainstem response. RESULTS: The cisplatin-induced ototoxic damage could be reduced in 10,000 and 12,000 Hz frequencies when N-acetylcysteine was added to the cisplatin therapy protocol. There was no decrease in the hearing loss levels of the patients who were receiving cisplatin with salicylate. CONCLUSION: According to auditory brainstem response testing results, there was no difference detected between N-acetylcysteine or salicylate for the amelioration of cisplatin induced ototoxicity.

Assessment of Bone Conduction Thresholds After Surgical Treatment in Patients with Labyrinthine Fistula.

OBJECTIVE: This study aimed to analyze the bone conduction thresholds before and after surgery in chronic otitis media patients with cholesteatoma who had labyrinthine fistula and whose cholesteatoma matrix had been completely cleaned. METHODS: The study was performed between 2013 to 2017 with 23 chronic otitis media patients who had labyrinthine fistula with cholesteatoma and who were operated at the Department of Otorhinolaryngology of Dicle University School of Medicine. Patients were assessed by anamnesis and examination and when necessary, by temporal computerized tomography and diffusion magnetic resonance imaging. Bone conduction thresholds at frequencies of 500, 1000, 2000, and 4000 Hz were determined by audiometric examination and they were compared before and after surgery. RESULTS: Of the 23 patients, 12 were female and 11 were male; their age range was 10-55 (26.04±14.13) years. In the post-operative period, it was possible to conduct audiological follow-up on 20 patients. In these follow-ups, 16 patients showed no change in bone conduction thresholds, two patients showed worsening, and two showed improvement. When pre- and post-operative bone conduction thresholds at each frequency were compared separately, no significant difference was found (p=0.937). No statistically significant difference was found between the pre- and post-operative means at the four frequencies (p=0.712). CONCLUSION: In this study, we found that to reduce complications relating to cholesteatoma, it might be necessary to completely remove the matrix especially in the case of type 1 and 2 labyrinthine fistulas.

Neutrophil-Lymphocyte Ratio as a Prognostic Factor in Laryngeal Carcinoma.

Aim of this study; investigate whether neutrophils/lymphocyte ratio (NLR) could be used as a prognostic factor in larynx cancer. The correlation between preoperative peripheral blood NLR and age, gender, smoking, alcohol use, clinical stage and differentiation degree was examined. One hundered fourty-four patients in Dicle University Department of Otorhinolaryngology between the years of 2005 and 2014 were included in the study. Clinical and preoperative laboratory data of patients were screened retrospectively from archive files of otorhinolaryngology and the pathology results were screened retrospectively from archive files of pathology. The study was approved by the local ethics committee of the department and carried out in accordance with the declaration of Helsinki as amended in 2013. Statistical analyses were performed using the SPSS 15.0 software package for Windows (SPSS inc., Chicago, IL, USA). There was a significant difference between NLR and clinical stage (p = 0.003) smoking (p = 0,001) and alcohol use (p = 0.001). When NLR was analyzed in detail according to the degree of tumor differentiation; significant differences were observed between G1 and G2 (p = 0.007) and between G1 and G3 (p = 0.001). Light of these findings, NLR is a cheap and easily accessible marker which can be used as a prognostic faxtor in laryngeal cancer. It is thougkt to shed light on the studies which will be conducted with more patients.

A case of solitary angiokeratoma circumscriptum of the tongue.

Angiokeratoma circumscriptum is an uncommon vascular entity. The lesion is present at birth and usually involves the lower extremities. A 9-year-old girl presented with multiple pink-colored, small-raised lesions in the dorsal part of her tongue, which had been present since birth. There was no history of trauma, cold injury, or similar lesions elsewhere in her body. She complained of pain and rare bleeding from the lesions after eating hard foods. Physical examination showed multiple, grouped, erythematous, shiny papules mostly in the dorsal aspect of the tongue. There were no other lesions in other parts of the oral mucosa. After an incisional biopsy of the lesion, the diagnosis was made as solitary angiokeratoma circumscriptum.

Auricular mucormycosis: a case report.

Mucormycosis is a rare, saprophytic, invasive, and fulminant fungal disease. It occurs in immunocompromised patients such as those with diabetes mellitus or blood dyscrasia, or in patients under immunosuppressive therapy. A 17-year-old female patient with diabetic ketoacidosis presented with a black-colored lesion in the auricle and external ear canal. Physical examination showed necrosis of the auricle, external ear canal, and neighboring skin. She also had facial paralysis. Debridement of the necrotic tissues was performed and the samples were submitted for microbiologic and histopathologic examination, which showed nonseptate hyphae. Postoperatively, systemic amphotericin B was empirically administered. The patient died on the seventh day.