Comparisons of Auditory and Vestibular Functions After Septorhinoplasty Performed with the Micro-compass Saw Technique and the Classical Technique.

AIM: To evaluate hearing and labyrinth functions following different osteotomy types (micro-compass saw, osteotome, and no osteotomy) performed in septorhinoplasty operations. MATERIAL AND METHOD: The study included 74 patients operated between January 2020 and March 2022, separated into 3 groups: Group 1: 24 patients (16 females and 8 males): osteotome was used for the osteotomy; Group 2: 24 patients (12 females and 12 males): micro-saw was used for osteotomy; and Group 3: 26 patients (17 females and 9 males): open technique septoplasty with no osteotomy. At 1 day before and 1 week after the operation, all the patients underwent audiological examination, tympanometry, vestibular evoked myogenic potentials (c-VEMP), video head impulse test (v-HIT), videonystagmography (VNG), and distortion product otoacoustic emission (DPOAE) tests. RESULTS: In the c-VEMP tests, significant differences were determined between the groups in respect of N1, P1, and N1-P1 latencies and N1-P1 amplitudes before and after the operation. In the v-HIT test, the change in right-side posterior gain postoperatively was statistically significant in the micro-saw group (p<0.05). The postoperative right lateral canal values were determined to be statistically significantly increased in the micro-saw group compared to the osteotome group (p<0.05). CONCLUSION: This is the only study in the literature to have determined vestibular effects with the evaluation of such a wide range of techniques. Previous studies in the literature have found no effect of osteotomy technique on the balance and hearing systems. The results of this study demonstrated that the preoperative and postoperative difference between the osteotomy techniques had an effect on the balance system. The change in the balance tests following an operation with classic osteotomy shows a greater predisposition to benign positional vertigo. In this sense, the micro-saw can be considered safer. Level of Evidence II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The effect of type 1 diabetes mellitus on voice in pediatric patients.

PURPOSE: The aim of this prospective case-control study was to determine the effect on the voice of type 1 diabetes mellitus (T1DM) in paediatric patients. MATERIALS AND METHODS: The study included patients aged 6-18 years followed up for at least 1 year because of T1DM, and a control group of age and gender-matched healthy volunteers. Following an Ear, Nose, and Throat (ENT) examination, all subjects underwent flexible endoscopic laryngeal examination. Fasting venous blood samples were taken in the morning for the examination of fasting blood glucose (FBG), HgbA1C, and kidney, liver, and thyroid function tests. Data were recorded from the patient files of age, gender, comorbidities, and the development of diabetes-related complications. Voice recordings were taken and the Voice Handicap Index (VHI)-10 form was completed. The patients and control group were compared in respect of the parameters of fundamental frequency, jitter, shimmer, and acoustic voice quality index (AVQI). RESULTS: Evaluation was made of 64 children and adolescents as 32 in the patient group (Group 1) and 32 healthy control subjects (Group 2). Group 1 comprised 17 females and 15 males with a mean age of 12.75 ± 3.23 years. Group 2 comprised 17 females and 15 males with a mean age of 12.75 ± 3.33 years. In Group 1, mean disease duration was 5.21 ± 3.17 years (range, 1-13 years), the FBG value was mean 216.6 ± 122.3 mg/dl, mean HgbA1c was 10.7 ± 2.8, as ≤ 7 in 4 patients, 7-9 in 4, and > 9 in 24. Maximum phonation time (MPT) was determined as 10.66 ± 3.6 secs in Group 1 and 12.11 ± 4.43 in Group 2. VHI was determined as 2.33 ± 3 in Group 1 and 2.31 ± 2.77 in Group 2. No statistically significant difference was determined between the groups was determined in respect of acoustic analysis, perturbation parameters, AVQI and body mass index. CONCLUSIONS: This study is the first to have investigated the effects of T1DM on the voice in paediatric patients. The study results showed that the AVQI value was higher in the patient group but not to a statistically significant level. Therefore, there is a need for further studies with larger samples. The current study can be of guidance for further studies in this field.

Voice Disorders in Lower Primary School Teachers: An Observational Study.

INTRODUCTION: Voice problems are very common among teachers, and etiology-based methods are used in the diagnosis and treatment process. Our study aims to reveal the changes in subjective voice analysis during the diagnosis and treatment process of dysphonia in lower primary school teachers. METHODS: The nature of the study is a prospective observational one designed for lower primary school teachers in Kahramanmaras conducted between the year 2015 and 2019 and evaluations for parameters including sociodemographic characteristics, laryngeal lesions and pre- and post-treatment scales such as Voice Handicap Index-10 (VHI-10), Reflux Symptom Index (RSI) and Hospital-Anxiety Depression Scale (HADS) for treatment subgroups were made. Statistical analysis was analyzed using SPSS. RESULTS: Three hundred and fifty-one lower primary school teachers were included in the study. A statistically significant difference was found for the development of dysphonia in terms of sociodemographic features such as smoking, professional experience and crowdedness of classroom. Changes in RSI, VHI-10 and HADS values after treatment were clinically significant in all treatment groups. While there was a significant post-treatment improvement in terms of RSI in patients with granuloma and laryngopharyngeal reflux disorders, the VHI-10, and HADS assessments revealed a significant difference in clinical recovery compared to laryngeal lesions. CONCLUSION: The RSI, VHI-10 and HADS values for various laryngeal pathologies were found to be high in dysphonic teachers. An improvement was observed in the scale scores upon the application of treatment modalities. This situation emphasizes the importance of questionnaire survey in the diagnosis, treatment, and follow-up process of dysphonia.

Assessment of Subjective and Objective Voice Analysis According to Types of Sulcus Vocalis.

INTRODUCTION: Sulcus vocalis (SV) subtypes are difficult to diagnose. Non-invasive techniques are sometimes not feasible in the diagnosis. The study aims to demonstrate the effectiveness and applicability of objective and subjective voice analysis combined with videolaryngostroboscopic examination (VLS) in the diagnosis of SV types. MATERIAL AND METHODS: This is a retrospective study that includes patients who presented to Phoniatric outpatient clinic with complaints related to voice and diagnosed with SV on VLS examination between 2017-2020. The SV type was determined based on VLS findings and the patients were categorized into respective groups. Between- and within-group assessment of objective and subjective voice analysis of SV types was conducted. RESULTS: 47 patients were included in the study; Type I, Type II, Type III SV patients were 16, 17, and 14 in number, respectively. Fundamental frequency (F0) and Shimmer (%) values were significantly high in Type II and III SV cases, whereas the Maximum Phonation Time (MPT) was significantly low. GRBAS, Voice Handicap Index -10 (VHI-10), Reflux Symptom Index (RSI) scores were statistically significantly high in pathological SV and Voice Related Quality of Life (V-RQOL) scores were low. A moderate correlation between VHI-10 and V-RQOL and between RSI and V-RQOL was detected. CONCLUSIONS: Objective and subjective voice analysis in Type II and III SV show a significant difference compared to Type I SV. The use of objective and subjective voice analysis combined with VLS examination can be helpful in the diagnosis of SV types.

Evaluation of vitamin D levels and biochemical markers in infants diagnosed with laryngomalacia.

Background/aim: The pathology of laryngomalacia is still not clear. The aim of this study was to investigate the relationship between vitamin D levels and laryngomalacia, and to evaluate vitamin D levels according to the classification of laryngomalacia. Materials and methods: This retrospective study was conducted in the Kahramanmaras Sütçü Imam University Medicine Faculty's Otorhinolaryngology Clinic between June 2014 and January 2021. Laryngomalacia was classified. Laboratory tests for all patients included calcium (Ca), phosphorus (P), parathormone (PTH), blood urea nitrogen (BUN), creatinine (Cre), alanine transaminase (ALT), and 25-hydroxy vitamin D (25-OH-D). Results: Evaluations were performed for 64 infants with laryngomalacia, including 41 male and 23 female infants with a mean age of 4.6 ± 3.0 months, and a control group of 64 healthy infants with a mean age of 4.5 ± 2.8 months. A statistically significant difference was determined between the laryngomalacia group and the control group with respect to 25-OH-D and PTH levels (p < 0.001). When data were examined according to laryngomalacia types, a statistically significant difference was determined between the groups for 25-OH-D, Ca, P, PTH, and ALT values. The 25-OH-D level was statistically significantly lower in the severe laryngomalacia group than in the mild and control groups (p < 0.001). A statistically significant difference was determined between the moderate and severe laryngomalacia groups and the control group regarding PTH levels (p < 0.001). Conclusion: Vitamin D deficiency may have a role in the etiology of laryngomalacia, and this view is supported by the finding that there was a decrease in vitamin D levels associated with laryngomalacia classification. In addition, the reduction in PTH levels in infants with laryngomalacia may be explained by the change in Ca metabolism. It would be appropriate for further studies to investigate the response to vitamin D replacement therapy in patients with moderate and severe laryngomalacia.

Does Maras powder affect the nasal mucociliary clearence?

PURPOSE: Many studies have been conducted about the effect of cigarettes and other tobacco products on mucociliary clearance. However, there has been no study of the relationship between mucociliary clearance and Maras powder, which is a smokeless tobacco product. The aim of this study was to evaluate the effect of Maras powder use on mucociliary clearance through comparisons with cigarette smokers and those who used no tobacco products. METHODS: The study included 75 male volunteers, aged 23-54 years. Group 1 (n: 25) comprised subjects who do not use any tobacco products, Group 2 (n: 25) those who smoked cigarettes, and Group 3 (n: 25) those who used Maras powder. The saccharin test was used to evaluate mucociliary clearance and the time was recorded in seconds. The groups were statistically compared in respect of mean age and mucociliary clearance time (MCCT). RESULTS: The mean MCCT was determined to be 645.8 ± 200 secs for the whole study sample, 497 ± 108 secs for Group 1, 796 ± 200 secs for Group 2, and 644 ± 161 secs for Group 3. The difference between the groups in respect of MCCT was statistically significant (p < 0.001). No statistically significant difference was determined between the groups in respect of mean age (p = 0.730). CONCLUSION: The study results demonstrated that the nasal mucociliary clearance time was prolonged both by cigarettes and by the use of Maras powder, and that this time was prolonged more by cigarette smoking than the use of Maras powder.

Could computed tomography histogram analysis add value to the diagnosis of cholesteatoma?

BACKGROUND: To investigate the potential role of computed tomography (CT) histogram analysis in differentiating cholesteatoma (CHS) and non-cholesteatoma (NCHS). METHODS: We evaluated 77 temporal bone CT images (from November 2016 to February 2020) that were obtained preoperatively (mean age, 37.10±17.27 years in CHS; 36.72±16.08 years in NCHS group). Histogram analyses of the resulting XML files were conducted using the R Project 3.3.2 program. ROC analysis was used to find threshold values, and the diagnostic efficiency of these values in differentiating CHS-NCHS was determined. RESULTS: The CT images of 41 CHS (53.25%) and 36 NHCS cases (46.75%) were evaluated. There was a statistically significant difference between the CHS and NCHS group in terms of the mean, maximum, and median values (p = 0.036, p = 0.006, p = 0.043). When examining the ROC curve obtained from the mean of these parameters, area under the curve (AUC) is determined as 0.638, and when the threshold value is selected as 42.55, the mean value was determined to have a sensitivity of 86.50% and specificity of 56.10% in differentiating CHS-NCHS.

Turkish Guideline for Diagnosis and Treatment of Allergic Rhinitis (ART).

OBJECT: To prepare a national guideline for Otorhinolaryngologist who treat allergic rhinitis patients. METHODS: The study was conducted by three authors, namely the writing support team. The support team made the study plan, determined the writing instructions, chose the subgroups including the advisory committee, the advisors for authors and the authors. A workshop was organized at the very beginning to explain the details of the study to the team. Advisors took the chance to meet their coworkers in their subgroups and determined the main headings and subheadings of the guideline, together with the authors. After key words were determined by the authors, literature search was done in various databases. The authors keep in touch with the advisors and the advisors with the advisory committee and the support group at every stage of the study. National and International published articles as well as the abstracts of unpublished studies, imperatively presented in National Congresses, were included in this guideline. Only Guideline and meta-analyses published in last seven years (2013-2017) and randomized controlled studies published in last two years (2015-2017) were included. After all work was completed by the subgroups, support team brought all work together and edited the article. RESULTS: A detailed guideline about all aspects of allergic rhinitis was created. CONCLUSION: The authors believe that this guideline will enable a compact and up-to-date information on allergic rhinitis to healthcare professionals. This guideline is the first in the field of Otolaryngology in Turkey. It should be updated at regular intervals.

Characteristics of Benign Paroxysmal Positional Vertigo Following an Earthquake.

INTRODUCTION: Benign Paroxysmal Positional Vertigo (BPPV) is a commonly encountered peripheral vestibular disorder. People exposed to massive earthquakes experience intense and long-term problem associated with dizziness. The purpose of our study is to investigate this relationship and to demonstrate the efficacy of the treatment modalities used in the management of patients with post-earthquake dizziness. METHODOLOGY: The study was carried out by examining the retrospective records of patients who presented with dizziness to the otorhinolaryngological outpatient unit before and after the Elazig earthquake that occurred on 24th Jan 2020. Parameters evaluated include patients' age and gender, onset of dizziness, accompanying symptoms and comorbidities, videonystagmography (VNG) findings, pre- and post-treatment Visual Analogue Scale (VAS), Dizziness Handicap Inventory (DHI), and Hospital Anxiety and Depression Scale (HADS). RESULTS: The number of patients who presented with dizziness to our outpatient clinic after the earthquake and were included in our study totaled 84. The number of patients who visited the outpatient clinic before the earthquake was identified to be 75. In the earthquake related group, while there was a statistically significant difference between residual symptoms (RS) and the need for repetitive repositioning maneuvers, there was no statistically significant difference detected for age, gender, and comorbidities. Also, no statistically significant difference was found in the pre- and post-treatment assessments of VAS, DHI, and HADS median values in the earthquake group. CONCLUSION: There was a remarkable increase in the number of patients presenting with dizziness in the early post-earthquake period. Management of these patients may differ from the classic BPPV. Residual symptoms appearing after performing repositioning maneuvers can be more commonly seen among these patients.

Evaluation of preoperative and postoperative serum interleukin-6, interleukin-8, tumor necrosis factor α and raftlin levels in patients with obstructive sleep apnea.

BACKGROUND: Raftlin is a large, major lipid raft protein of cell membranes. Raftlin levels have not been previously examined in patients with obstructive sleep apnea (OSA). Our study aimed to evaluate the changes in raftlin, interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor alpha (TNFα) values from the preoperative state to the third month postoperatively in patients undergoing expansion sphincter pharyngoplasty for OSA. METHODS: Of 60 patients, 10 patients had mild OSA (AHI 5-14), 10 moderate (AHI 15-29), 10 severe (AHI ≥ 30), and 30 with AHI < 5 formed a control group. Preoperatively and at 3 months post-operatively, IL-6, IL-8, TNFα, and raftlin values were measured. RESULTS: Preoperatively, mean raftlin levels were 914.4 ± 62.7 pg/mL for controls, 910.0 ± 42.5 pg/mL in mild, 1000.5 ± 63.3 pg/mL in moderate, and 1386.3 ± 101.4 pg/mL in severe groups, with moderate and severe groups significantly elevated compared to controls (p < 0.001). Preoperatively to 3 months post-operatively, raftlin levels decreased significantly in each OSA group (p < 0.05). Levels of IL-6, IL-8 and TNFα followed similar patterns at baseline and after surgical intervention. CONCLUSIONS: Raftlin levels at the third postoperative month decreased significantly compared with preoperative levels in parallel with other markers of inflammation.

Comparison of the efficacy of surgical tracheostomy and percutaneous dilatational tracheostomy with flexible lightwand and ultrasonography in geriatric intensive care patients.

AIM: To compare the applicability, technical difficulties and postoperative complications of surgical tracheostomy and percutaneous dilatational tracheostomy with the flexible lightwand + ultrasonography method applied because of prolonged intubation to geriatric patients in the intensive care unit. METHODS: A retrospective evaluation was made of 76 patients who received surgical tracheostomy (group 1) and 78 patients who received percutaneous dilatational tracheostomy (group 2). The patients were evaluated in respect of demographic data, duration of intubation, length of stay in the intensive care unit and discharge status, and after the intervention, the development of tube-related complications, early stage local complications and late-stage complications. RESULTS: The time from intubation to tracheostomy was determined as 22.73 ± 15.23 days in group 1 and 12.65 ± 7.64 days in group 2. The mortality rate of patients in group 1 was determined to be statistically significantly higher than that of group 2 (P = 0.048). When evaluated in respect to early and late complications, nine early- and seven late-stage complications developed in group 1, and three early- and three late-stage complications developed in group 2 (P = 0.05). In the evaluation of factors related to mortality, the time from intubation to tracheostomy (r = 0.249, P = 0.01) and the presence of a comorbidity (r = 0.325, P = 0.004) were determined to have a positive correlation with the development of mortality. CONCLUSION: Percutaneous dilatational tracheostomy with the flexible lightwand + ultrasonography technique is a safe, rapid and effective method with the advantage of management in respect to early complications, such as bleeding, and can be used safely in the geriatric patient population in intensive care conditions. Geriatr Gerontol Int 2020; ••: ••-••.

G protein coupled oestrogen receptor 1, aromatase, 17ß-HSD and cAMP level in mutational falsetto.

OBJECTIVES: Puberphonia or mutational falsetto (MF) is seen more in males, and hormonal changes are considered to be among the aetiological causes. Therefore, the aim of this study was to investigate the molecules [G protein-coupled oestrogen receptor 1 (GPER-1), aromatase, 17-beta-hydroxysteroid dehydrogenase (17ß-HSD), cyclic adenosine monophosphate (cAMP) levels] related to receptors and pathways in patients with MF. METHODS: The study included 30 MF patients and a control group of 30 healthy individuals. Voice recordings were made of the MF patients and acoustic analyses were applied. The serum GPER-1, aromatase, 17ß-HSD, cAMP levels and TSH, estradiol, prolactin, progesterone, and testosterone levels were evaluated in venous blood samples. RESULTS: In the MF patients, the GPER-1 level determined of mean 3.68 (1.95-4.26) pg/ml, 17 beta dehydrogenase of 5.25 (2.73-6.77) ng/ml, and cAMP of 24.62 (11.62-30.35) ng/ml were statistically signficantly higher than those of the control group (p = 0.008, p = 0.002, p = 0.003, respectively). The aromatase level in the MF patients was found to be 3.48 (2.01-4.91) and the difference between the two groups was not statistically significant (p = 0.067). CONCLUSION: The GPER-1, 17ß-HSD, and cAMP levels were found to be higher in the MF patients than in the control group, suggesting that they could be of importance in the diagnosis and treatment of MF.

Morphometric Analysis of Sphenoid Sinus in Patients With Nasal Septum Deviation.

This retrospective study aimed to assess the association of the volume and types of the sphenoid sinus with deviated nasal septum by analyzing multislice computed tomography images. A total of 93 patients with a deviated nasal septum and 70 healthy controls were included in the study. Patients with sinonasal morbidities other than deviation were excluded. Three-dimensionally reconstructed computed tomography images of the study participants were acquired. A total of 326 sphenoid sinus volumes from the patient and control groups were obtained and compared between the groups. Sphenoid sinus volumes and the angle of the deviation were measured for standardization and assessment of the severity. Deviated nasal septum was found on the right in 49.5% (n = 46) and on the left in 50.5% (n = 47) of the study participants. Deviation angles were in the range from 7.2° to 22.4° and the mean value was 13.2°â€Š±â€Š5.0°. The measured volumes were in the range from 1.8 cm to 9.6 cm with a mean of 4.8 ±â€Š1.5 cm. In the control group, the median values for the sphenoid sinus volumes were 4.40 cm (0.80-8.90 cm) on the right and 4.20 cm (0.90-8.70 cm) on the left. In the study group, sphenoid sinus volumes were found to be statistically significantly different between those on the ipsilateral and contralateral side of the septal deviation. Sphenoid sinus volumes were significantly smaller on the same side with septal deviation compared with those on the contralateral side. There was no statistical relationship between the presence of septal deviation, age and gender, and the type of sphenoid sinus.

Protective and therapeutic effects of milrinone on acoustic trauma in rat cochlea.

OBJECTIVE: The aim of this study was to investigate the potential protective and therapeutic effects of milrinone, a specific phosphodiesterase (PDE) III inhibitor, on acoustic trauma-induced cochlear injury and apoptosis. METHODS: A total number of 30 healthy Wistar albino rats were evenly divided into five groups as follows: group 1 was assigned as control group; group 2 and 3 were assigned as low-dosage groups (0.25 mg/kg) in which milrinone was administered 1 h before acoustic trauma (AT) and 2 h after AT, respectively; group 4 and 5 were assigned as high-dosage groups (0.50 mg/kg) in which the drug was administered 1 h before AT and 2 h after AT, respectively. Except control group, all treatment groups received a single dosage of milrinone for 5 days. Distortion product otoacoustic emissions (DPOAE) measurements were recorded before AT as well as at second and fifth post-traumatic days. At the end of fifth day, all rats were sacrificed and the cochlea of the rats was removed for histopathological evaluation. In addition, the groups were compared in terms of apoptotic index via caspase-3 staining. RESULTS: In terms of signal-to-noise ratio (SNR), there was no statistically significant difference among the groups following AT (p > 0.05). After 5 days of milrinone treatment, the best SNR values were found in group 5, though all groups did not statistically differ (p > 0.05). In histopathological evaluation, vacuolization, inflammation, and edema scores in all treatment groups were statistically lower than those of the control group (p < 0.05). In group 2 and 4 where the drug was administered before AT, the inflammation and apoptosis index was lower than those of group 3 and 5 where the drug was administered after AT (p < 0.0001). CONCLUSION: We reveal that milrinone has a protective effect on cochlear damage in the experimental acoustic model of rats. This protective effect was more apparent following the pre-traumatic milrinone administration, and is associated with its effect on decreasing inflammation and apoptosis. Based on DPOAE measurements following AT, especially in the group 5 (high-dosage group), milrinone may also have a therapeutic effect.

Voice Acoustic Analysis of Pediatric Vocal Nodule Patients Using Ratios Calculated With Biomedical Image Segmentation.

OBJECTIVE: The aim of this study was to determine nodules using newly developed software with a computer-assisted visual process technique for the calculation of size. The effects of the ratios of nodule base and width were evaluated with voice acoustic analysis. METHODS: A total of 72 patients with pediatric vocal nodule were evaluated. Nodules were marked with the ImageJ News program on photographs obtained from the video recordings in the videostroboscopic examination and classified according to the Shah et al scale. Segmentation was applied automatically. The ratios were taken as base of nodule/width and base of nodule/vocal cord. In the voice acoustic analysis, basic frequencies (mean F0), jitter (local %), shimmer (local %), and harmonicity (mean harmonics-to-noise [mean HNR]) were evaluated. RESULTS: A statistically significant negative correlation was determined between the mean F0 value and the nodule base/width ratio (P = 0.042, r = -0.240). A negative statistically significant relationship was determined between jitter (%) and vocal nodule base/width (P = 0.009, r = -0.305). A statistically significant positive correlation was determined between mean HNR and vocal nodule base/width (P = 0.034, r = 0.324). In discriminant analysis, correct classification of the Shah et al scale degrees of the classifying variables was 73.6%. CONCLUSION: Through collaboration with the biomedical engineering department, the results of this study determined new ratios in patients with pediatric vocal nodule. In voice acoustic analysis, the mean F0 was more affected by the width of the nodule, mean HNR was affected by the length of the base of the nodule, and jitter (%) was affected by the width of the nodule.

Clinical and Histopathological Findings of Chordomas: a Case Report.

Chordomas are rare malignant tumors that develop from the residual of embryonic notochord. These tumors may be seen along the spine and have a local aggressive progression. Skull base chordomas often originate from the clivus as localization. These tumors are usually found to be overgrown when they are diagnosed. They are locally invasive and rarely develop distant metastasis. These chordomas cannot usually be completely removed due to their localization. Because these tumors are advanced at the time of diagnosis and are adjacent to important structures, they are among the tumors with high rates of mortality and morbidity. Surgery and/or radiotherapy is administered for the treatment.

Does the neutrophil-to-lymphocyte ratio have any importance between subjects with obstructive sleep apnea syndrome with obesity and without obesity?

INTRODUCTION: An increase in the incidence of OSAS (obstructive sleep apnoea syndrome) has been seen due to the reported association between OSAS and obesity. Subjects are predisposed to cardiovascular disease due to systemic inflammation caused by the interactions between obesity and OSA. Inflammatory markers could be used to predict the degree of systemic inflammation, which could be a prognostic factor for future adverse events such as metabolic risks. One marker that has recently started being used as an indicator of systemic inflammation is neutrophil-to-lymphocyte ratio (NLR). MATERIALS AND METHODS: The aim is to evaluate NLR, which is a easily measured parameter of systemic inflammation in OSAS subjects with and without obesity. 155 subjects were assigned to four different groups according to their body mass indices. Comparisons of white blood cell, neutrophil, lymphocyte, NLR values and anthropometric measurements were done for each group. RESULT: The NLR and neutrophil counts of group 4 were statistically significant and higher than those of groups 1, 2 and 3. The lymphocyte counts of group 4 were the lowest amongst all groups, these values were lower than the lymphocyte counts of groups 1, 2 and 3 with statistically significant differences (p< 001). A positive correlation was found between the body mass index and lymphocyte count values of obese OSAS subjects (r= 0.027, p= 353). CONCLUSIONS: The NLR ratio was found to be increasing by obesity grade and reveals that the associated inflammatory response also increases. The NLR ratio might be used as an inflammatory marker in obese OSAS subjects.

Obstructive sleep apnea is associated with increased QT corrected interval dispersion: the effects of continuous positive airway pressure / Apneia obstrutiva do sono está associada a maior dispersão do intervalo QT corrigido: efeitos da pressão positiva contínua nas vias aéreas

Abstract Introduction: Severe obstructive sleep apnea is associated with increased QT corrected interval dispersion and continuous positive airway pressure is thought to improve this arrhythmogenic marker. Objective: The aim of the study was to determine the decrease of ratio of cardiovascular risk in patients with obstructive sleep apnea. Methods: The study included 65 patients with severe obstructive sleep apnea who had an apnea-hypopnea index score of >30. Each patient underwent 12-channel electrocardiogram monitoring and polysomnography. Patients with an apnea-hypopnea index score of <5 were used as the control group. The control group also underwent electrocardiogram monitoring and polysomnography testing. The QT corrected interval dispersion levels of both groups were calculated. Three months after continuous positive airway pressure treatment, electrocardiogram recordings were obtained from the 65 patients with severe obstructive sleep apnea again, and their QT corrected interval dispersion values were calculated. Results: There were 44 male and 21 female patients with severe obstructive sleep apnea syndrome. The age, gender, body mass index, initial saturation, minimum saturation, average saturation, and desaturation index were determined in both groups. The QT corrected intervals of the obstructive sleep apnea patients (62.48 ± 16.29 ms) were significantly higher (p = 0.001) than those of the control group (29.72 ± 6.30 ms). There were statistically significant differences between the QT corrected values before and after the continuous positive airway pressure treatment, with pretreatment QT corrected intervals of 62.48 ± 16.29 ms and 3-month post-treatment values of 41.42 ± 16.96 ms (p = 0.001). There was a positive and significant correlation between QT corrected interval dispersion periods and the apnea-hypopnea index and hypopnea index in obstructive sleep apnea patients (p = 0.001; r = 0.71; p = 0.001; r = 0.679, respectively). Conclusion: Continuous positive airway pressure treatment reduced the QT corrected interval dispersion in patients with severe obstructive sleep apnea. In addition, shortening the QT corrected interval dispersion periods in patients with severe obstructive sleep apnea may reduce their risk of arrhythmias and cardiovascular disease.

Resumo Introdução: A apneia obstrutiva do sono grave está associada a uma maior dispersão do intervalo QT corrigido e acredita-se que a pressão positiva contínua nas vias aéreas melhore esse marcador arritmogênico. Objetivo: Determinar a diminuição da razão de risco cardiovascular em pacientes com apneia obstrutiva do sono. Método: O estudo incluiu 65 pacientes com apneia obstrutiva do sono grave que apresentavam índice de apneia-hipopneia > 30. Cada paciente foi submetido à monitoração por eletrocardiograma de 12 derivações e polissonografia. Os pacientes com escore de índice de apneia-hipopneia < 5 foram utilizados como o grupo de controle. O grupo de controle também foi submetido à monitoração por eletrocardiograma e teste de polissonografia. Os níveis de dispersão do intervalo QT corrigido dos dois grupos foram calculados. Três meses após o tratamento com pressão positiva contínua nas vias aéreas, os registros de eletrocardiograma foram novamente obtidos dos 65 pacientes com apneia obstrutiva do sono grave e seus valores de dispersão do intervalo QT corrigido foram calculados. Resultados: Havia 44 pacientes do sexo masculino e 21 do feminino com síndrome de apneia obstrutiva do sono grave. Idade, sexo, índice de massa corporal, saturação inicial, saturação mínima, saturação média e índice de dessaturação foram determinados em ambos os grupos. Os intervalos QT corrigido dos pacientes com apneia obstrutiva do sono (62,48 ± 16,29 ms) foram significativamente maiores (p = 0,001) do que os do grupo controle (29,72 ± 6,30 ms). Houve diferenças estatisticamente significativas entre os valores de QT corrigido antes e após o tratamento com pressão positiva contínua nas vias aéreas, com intervalos QT corrigido pré-tratamento de 62,48 ± 16,29 ms e três meses pós-tratamento, de 41,42 ± 16,96 ms (p = 0,001). Houve uma correlação positiva e significativa entre os períodos de dispersão do intervalo QT corrigido e o índice de apneia-hipopneia e índice de hipopneia em pacientes com apneia obstrutiva do sono (p = 0,001; r = 0,71; p = 0,001; r = 0,679, respectivamente). Conclusão: O tratamento com pressão positiva contínua nas vias aéreas reduziu a dispersão do intervalo QT corrigido em pacientes com apneia obstrutiva do sono grave. Além disso, o encurtamento de dispersão do intervalo QT corrigido em pacientes com apneia obstrutiva do sono grave pode reduzir o risco de arritmias e doenças cardiovasculares.