Is septoplasty effective on habitual snoring in patients with nasal obstruction?

We aimed to find out whether snoring relieve with nasal surgery in patients with nasal obstruction. Sixty-four patients who underwent septoplasty under general anesthesia with complaint of nasal obstruction and snoring at Haydarpasa Numune Education and Research Hospital were enrolled in the study. All patients were evaluated by otolaryngological examination. Septal deviation was graded as mild, moderate and severe with endoscopy. Variables examined included age, sex, body mass index. All patients also completed the questionnaires, including Nose Obstruction Symptom Evaluation scale (NOSE), Epworth Sleepiness Scale (ESS), and Snore Symptom Inventory (SSI) before and after septoplasty. NOSE scale, ESS, and SSI scores showed statistically significant improvement after nasal surgery (p < 0.01) but we could not find any statistically significant association between septal deviation grading and improvement in scores of NOSE scale, ESS, and SSI (p > 0.05). Added to this, the association between body mass index (BMI) and improvement in scores of NOSE scale, ESS, and SSI did not reach statistical significance (p > 0.05). Our results demonstrated that septoplasty is effective on the subjective parameters of nasal obstruction in habitual snorers irrespective of the nasal septal deviation and severity of BMI.

A rare tumor of nasal cavity: glomangiopericytoma.

Glomangiopericytoma is a rare vascular neoplasm characterized by a pattern of prominent perivascular growth. A 72-year-old woman was admitted to our clinic complaining of nasal obstruction, frequent epistaxis, and facial pain. A reddish tumor filling the left nasal cavity was observed on endoscopy and treated with endoscopic excision. Microscopically, closely packed cells interspersed with numerous thin-walled, branching staghorn vessels were seen. Glomangiopericytoma is categorized as a borderline low malignancy tumor by WHO classification. Long-term follow-up with systemic examination is necessary due to high risk of recurrence.

Clinical outcome parameters for necrotizing otitis externa.

OBJECTIVE: To investigate the duration of time elapsed between the onset of symptoms for necrotizing external otitis (NEO) and admission to hospital that may play a role in patient outcome. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Fourteen consecutive male patients with NEO with no improvement from the previous course of antibiotherapy and with findings of osteomyelitis on temporal bone CT, MRI, and positive detection of Tc-99m methylene diphosphonate on temporal bone, admitted as inpatients between 2008 and 2012. INTERVENTION(S): Medical treatment of NEO and surgical debridement. MAIN OUTCOME MEASURE(S): Patients were divided into 2 groups according to median time elapsed between onset of symptoms and hospitalization (<30 d or >30 d). HbA1c, fasting blood sugar, erythrocyte sedimentation rate, C-reactive protein, pain intensity, radiologic grade, improvement since diagnosis, and total time to cure were compared according to the groups. The relationships between the laboratory data were analyzed to determine the parameters associated with time to recovery. RESULTS: Otalgia was significantly worse in patients who were admitted to hospital greater than 30 days after symptom onset (Mann-Whitney U test, p < 0.002). Blood glucose increased related to delayed admission time (p < 0.001). CRP results were independently elevated from the admission time (p < 0.112). There was a statistically significant difference between groups according to ESR levels and recovery time (Mann-Whitney U test, p < 0.004 and p < 0.01). There was a positive correlation between HbA1c levels and recovery time in Group 1 and between ESR levels and recovery time in Group 2 (r = 0.872, p = 0.044; r = 0.630, p = 0.039). CONCLUSION: Clinical, laboratory, and outcome data worsen later than 30 days in NEO.

Role of nasal packing in surgical outcome for chronic rhinosinusitis with polyposis.

OBJECTIVES/HYPOTHESIS: To analyze the differences between biodegradable and nondegradable nasal dressings with regard to their effects on wound healing in the short and medium term and on surgical outcomes in the long term, after endoscopic sinus surgery (ESS). STUDY DESIGN: A prospective, randomized, partly blinded, controlled trial. METHODS: A total of 56 patients undergoing bilateral ESS for chronic rhinosinusitis with polyposis were enrolled and randomized to receive biodegradable (Nasopore; Stryker, Hamilton, ON, Canada) on one side and nondegradable packing (Merocel; Medtronic Xomed, Minneapolis, MN) on the opposite side. Postoperative morbidities (pain, bleeding, facial edema, nasal blockage) related to dressings were assessed on postoperative day 6. Wound healing (edema, crusting, secretions, synechia, granulation tissue formation, and percentage re-epithelialization) were evaluated at 2 weeks, 1 month, 3 months, and 6 months using modified Lund-Kennedy scores. Long-term assessment at 12 months was done using validated Lund-Kennedy scores. RESULTS: Morbidities related to nondegradable packing were significantly higher than with degradable packing (Wilcoxon signed rank test, P<.01). Pain, bleeding, nasal blockage, and facial edema were significantly less with absorbable packing. No statistically significant difference was found between sinonasal cavities packed with biodegradable or nondegradable materials with regard to healing scores and percentage of re-epithelialization at 2 weeks, 1 month, 3 months, 6 months, and surgical outcomes at 1 year (P>.05). However, healing at 6 months was correlated with the preoperative Lund-Mackay radiology and surgery scores (Spearman's rho correlation test, P<.05 and P<.01, respectively). CONCLUSIONS: No significant healing or surgical outcome differences were found between biodegradable and nondegradable packing. However pain, bleeding, nasal blockage, and facial edema were lower with biodegradable packing. LEVEL OF EVIDENCE: 1b.

The effect of duration of merocel in glove finger with tetracaine solution on septoplasty morbidity.

OBJECTIVE: We aimed to decrease the postseptoplasty morbidities depending on nasal packing by using Merocel within glove finger moistened with tetracaine 0.25% solution. STUDY DESIGN: The study was designed as a randomized prospective study. SETTING: A university hospital in Turkey. SUBJECTS AND METHODS: Our study consisted of 80 patients who underwent septoplasty. The Merocel nasal tampon within glove finger was inserted after surgery in the study group and removed after 24 or 48 hours. Merocel was moistened with tetracaine 0.25% solution after insertion into the nasal cavity and just before removal. The morbidities and normal breathing time were recorded and compared with those of the control group. RESULTS: The postseptoplasty morbidities were significantly decreased in the study group compared with those in the control group. The morbidities were also improved after removal of tampons after 24 hours compared with 48 hours. However, the normal breathing time was prolonged when the nasal tampons were removed after 24 hours. CONCLUSIONS: The glove finger provides comfortable removal of nasal packing. The Merocel tampons might be safely removed just after 24 hours postoperatively without any complication.

Hyperbaric oxygen versus steroid in facial nerve injury: an experimental animal study.

OBJECTIVE: The aim of this experimental study was to evaluate the effects of hyperbaric oxygen, methylprednisolone and combined hyperbaric oxygen-methylprednisolone treatments on traumatic facial nerve regeneration in rats. SUBJECTS AND METHODS: After exposure to facial nerve injury, four groups of rats were created with five subjects in each group: Group 1 (hyperbaric oxygen), group 2 (control), group 3 (combined hyperbaric oxygen-methylprednisolone), group 4 (methylprednisolone). Facial nerve specimens from sacrificed animals were examined for axonal degeneration, vascular congestion, macro vacuolization, axon diameter and thickness of myelin sheath. RESULTS: There were significant differences with regard to axonal degeneration, vascular congestion and axon diameter between group 3 and the control group. In addition to lower axonal degeneration and vascular congestion, a larger diameter of axons was observed in group 3. There were significant differences with regard to vascular congestion and axon diameter between group 4 and the control group. We observed thicker myelin and lower axonal degeneration in group 3 compared with group 4. CONCLUSION: The combination therapy with hyperbaric oxygen and methylprednisolone had an additive beneficial effect on regeneration of the facial nerve and may provide better treatment outcomes than methylprednisolone or hyperbaric oxygen therapy alone.

Effect of nose skin on the columellar incision scar in a Turkish population.

OBJECTIVES: To investigate the causes of columellar scar formation in a Turkish population in relation to nasal skin thickness, texture, and type and discuss possible solutions for better results. STUDY DESIGN: Prospective, clinical study. SETTING: Otorhinolaryngology department of a tertiary hospital. METHODS: The preoperative dermal thickness of 50 consecutive patients undergoing "external approach" septorhinoplasty was measured (using a 14 MHz ultrasound probe) at the midportion of the right and left nostril, tip, supratip, and columella. Surgery was performed using a middle columellar gullwing incision. All patients had a minimum follow-up of 6 months after surgery. Assessment of the columellar scar was performed according to the Stony Brook Scar Evaluation Scale modified for columellar scars. The mean values of skin thickness measurements, skin type (according to the Fitzpatrick skin classification scale), skin texture (oily, combination, normal, dry, and sensitive types), smoking habit, and patient gender were recorded and compared with the columellar incision scar scores. RESULTS: There was no statistically significant difference in healing between the skin thickness of the tip, supratip, left nostril, right nostril, columella and mean skin thickness values, skin types (Fitzpatrick 2, 3, 4, 5), skin textures, and smoking with regard to columellar scar formation (P > .05). However, men healed significantly better than women (P < .05). CONCLUSIONS: The columellar incision heals independently of the influence of skin thickness; texture; Fitzpatrick skin types 2, 3, 4, and 5; and smoking. Male gender seems to be a significant factor in healing.

External auditory canal microbiology and hearing aid use.

OBJECTIVE: The aim of this study was to determine the presence and nature of bacterial flora on hearing aids and the ears of this population. We wonder if the microbiology of the ears with hearing aid wearing differs from the other ear. SETTING: Tertiary referral center. DESIGN: A prospective, clinical study. SUBJECTS AND METHODS: Three samples were taken, one from the surface of the hearing aid's ear mold; one from the hearing aid-wearing ear canal and the last one from the ear without hearing aid. Samples were cultured to determine qualitatively and quantitatively the pathogenic microorganisms present. RESULTS: A total of 123 samples, obtained from 41 hearing aid users, were analyzed. Methicillin-resistant coagulase-negative staphylococci, methicillin-susceptible Staphylococcus aureus, methicillin-resistant S. aureus, Pseudomonas aeruginosa, Escherichia coli, Acinetobacter species, Staphylococcus auricularis, and Stenotrophomonas maltophilia were identified organisms. CONCLUSIONS: We identified unexpected microorganisms both on hearing aids and hearing aid using ears. This study demonstrates that using hearing aid alters the ear canal flora. To avoid otitis externa, it is important to use an appropriate hygiene routine to clean and disinfect hearing aids and ear molds.

Nasal obstruction and unilateral chronic otitis media: evaluation by acoustic rhinometry.

OBJECTIVES: In a prospective study at Umraniye Research and Education Hospital, we aimed to evaluate the differences in acoustic rhinometric findings between the affected and nonaffected sides in patients with unilateral chronic otitis media (COM) and to investigate whether unilateral COM correlates with the side of nasal obstruction. METHODS: Fifty-five consecutive patients with unilateral COM were involved in this study. All patients were evaluated with acoustic rhinometry, the Nasal Obstruction Symptom Evaluation (NOSE) scale, and measurement of their nasal mucociliary transport time. RESULTS: The mean cross-sectional area 1, mean cross-sectional area 2, volume 1, and volume 2 values were not different between the affected and nonaffected sides (p > 0.05). The NOSE score had a reverse correlation with the mean cross-sectional area 2 (p < 0.05) and volume 2 (p < 0.01) of the affected side. Saccharin time was not correlated with the acoustic rhinometric values of the affected side (p > 0.05). CONCLUSIONS: These findings do not support the hypothesis that unilateral COM is correlated with the side of nasal obstruction.

Role of allergy in children with adenotonsillar hypertrophy.

OBJECTIVE: The goal of this prospective study is to investigate the correlation between allergen sensitivity and radiographic evaluation of adenoidal obstruction and tonsil size. SUBJECTS AND METHODS: A total of 82 children with upper airway obstructive symptoms were evaluated for their tonsil size. All patients underwent digital lateral soft tissue radiographs. Assessment of nasopharyngeal obstruction in radiographs was done according to the Cohen and Konak method. Skin prick tests with multitest applicator including 14 allergens were carried out to investigate their allergic background. RESULTS: All children reacted positive to at least one of the 14 allergens tested. We found a statistically significant correlation between tonsil size and skin prick tests (P < 0.01). However, there was no statistically significant correlation between the adenoid size and skin prick test results (P > 0.05). CONCLUSIONS: Although the degree of nasopharyngeal obstruction caused by adenoid hypertrophy does not increase with the degree of positivity to specific allergens in skin prick tests, allergic sensitivity may play an important role in children with tonsillar hypertrophy.

Choanal fungus ball mimicking a tumour.

We report the first case of an isolated choanal fungus ball in a 28-year-old man with a previous history of nasopharyngeal carcinoma, who was treated with radiotherapy 14 years ago. The initial diagnosis was a recurrent tumour or a secondary neoplasm. Histopathological examination confirmed a fungal infection. There are no previous reports of a fungus ball located at the posterior choanal region. Although it has been reported that bacteriology of sinonasal region would be different in irradiated patients, there is no study reporting fungal infections in irradiated patients in English literature. In this report, the clinical presentation, relevant radiologic findings and management of sinonasal fungus ball and its relationship with previous radiotherapy were discussed with the literature knowledge.

Is there a relation between mastoid aeration and Körner's septum?

The purpose of this study is to investigate the prevalence of Körner's septum (KS) in temporal bones with varying degrees of pneumatization and to evaluate any relationship between the degree of pneumatization and the presence of KS. Data were obtained retrospectively from 356 temporal bone high-resolution computed tomography of 178 patients who underwent tympanoplasty. Mastoid bone pneumatization was classified as aerated, diploic and sclerotic. The presence of Körner's septum was also investigated. The relationship between the presence of Körner's septum and the type of mastoid pneumatization was assessed. KS was encountered in 98 out of total 356 ears. Prevalence of KS was not statistically different between aerated (31%, n = 36), diploic (24.7%, n = 27) and sclerotic mastoids (26.9%, n = 35; p > 0.05). In conclusion, there is no relationship between the presence of KS and the degree of pneumatization. The presence of KS does not necessarily corroborate the presence of poor pneumatization.

Long-term histologic changes in nasal mucosa after total laryngectomy.

Objective. To determine the long-term histopathologic changes in nasal mucosa and the relationship between progression of the histopathologic changes and the duration without air current stimulation. Material and Method. Biopsies were taken from the inferior turbinates of 11 laryngeal cancer patients after total laryngectomy. Specimens were stained with hematoksilen-eosin and several histopathologic parameters were examined under light microscopy. Results. All of the patients demonstrated at least one histopathologic abnormality (100%, n = 11). Goblet destruction and stromal fibrosis were the most common findings (81%, n = 9), followed by focal epithelial atrophy and subepithelial seromusinous gland destruction (45%, n = 5), neovascularization and congestion (36%, n = 4), complete epithelial atrophy and mixoid degeneration (27%, n = 3). According to the duration between laryngectomy and biopsy, patients were grouped in to three: group 1; less than 12 months (36%, n = 4), group 2; 12-36 months (18%, n = 2), and group 3; more than 36 months (45%, n = 5). Only congestion was found to be decreased as the duration increased (P < .005). Conclusion. In laryngeal cancer patients histopathologic changes occur in nasal mucosa eventuate due to the cessation of air current stimulation, however there was no relation between progression of the histopathologic findings and the duration of cessation.

Does adenoid hypertrophy really have effect on tympanometry?

OBJECTIVE: The goal of this study is to determine the correlation between the radiographic measurements of adenoid size and tympanometric findings. STUDY DESIGN: Prospective study. SETTING: Haydarpasa Numune Research and Education Hospital, Istanbul, Turkey. SUBJECTS AND METHODS: Nine five consecutive children complaining of one or more of the symptoms of upper airway obstruction (UAO) (presence of snoring, mouth breathing or difficulty in breathing during sleep, obstructive breathing or apnea during sleep) were included in the study. Symptom severity was assessed by a standardized questionnaire. All patients underwent digital lateral soft tissue radiographs. Assessment of nasopharyngeal obstruction in radiographs was done according to four different methods. Tympanometry was used to evaluate the middle ear. RESULTS: Of 190 ears, 79 were type A, 49 were type B and 62 were type C tympanograms. The symptom severity of 14 patients was graded as mild, 56 patients as moderate and 25 patients as severe. There was no statistically significant difference between UAO symptom severity groups and tympanogram types (p>0,05). Each one of the four methods of radiologic measurements of the adenoid enlargement showed no statistically significant difference between the tympanogram types (p>0,05). CONCLUSION: The adenoid hypertrophy in both means of radiologic measurements and symptom severity does not correlate with the changes in tympanograms. These findings do not support the hypothesis that adenoidal size plays a major role in the etiopathogenesis of middle ear effusion (MEE).

Do patients with sclerotic mastoids require aeration to improve success of tympanoplasty?

CONCLUSION: We could not find any significant difference in the results for graft success rate and functional hearing results between the myringoplasty and tympano-mastoidectomy groups. So mastoidectomy may not be necessary for successful tympanic membrane reconstruction and hearing improvement. OBJECTIVE: To investigate the effect of aerating mastoidectomy on the surgical success rate of myringoplasty. METHODS: This was a retrospective study. Data were analyzed from 92 patients who underwent surgical repair of tympanic membrane perforations due to chronic suppurative otitis media (CSOM) without cholesteatoma. Tympano-mastoidectomy was performed in 46 patients with a small sclerotic mastoid. The other 46 patients underwent myringoplasty without mastoidectomy. Patients were evaluated for success in tympanic membrane reconstruction and hearing levels after a minimum follow-up duration of 1 year. RESULTS: Tympanic membrane perforation closure was successful in 76.1% (n = 35) of the 46 patients undergoing myringoplasty and in 78.3% (n = 36) of the 46 patients undergoing myringoplasty with mastoidectomy. The difference between the closure rates of the two groups was not statistically significant (p > 0.05). The difference between the two groups for hearing gain was also not statistically significant (p > 0.05).

Bilateral aberrant internal carotid arteries: a case report presenting with pulsatile middle ear discharge.

An aberrant internal carotid artery (AICA) is a rare vascular anomaly. Misdiagnosis may lead to massive hemorrhage or other life threatening complications during even a minor surgical procedure of the tympanic membrane or middle ear. Knowledge of this rare entity is essential to any surgeon who undertakes myringotomy and middle ear surgery. Only 14 cases of bilateral AICA were reported in literature. We present a very rare case with bilateral AICA presenting with pulsatile middle ear discharge from his left ear and left sided conductive hearing loss. Tympanic membrane perforation and middle ear discharge were evaluated inaccurately as chronic otitis media on otoscopic appearance. The definitive diagnosis made after CT (computed tomography) and MRA (MR angiography). Otolaryngologists should keep in mind that the diagnosis of AICA may be obscured by chronic otitis media without radiologic examination. In this report, clinical presentation, relevant radiologic findings and management of AICA were discussed with the literature knowledge.

Schwannoma of the tongue in a child.

Schwannomas are tumors of the peripheral nerves originating in the nerve sheaths that account for 1% of benign tumors located in the oral cavity. The tongue as a whole is the most common location for intraoral schwannomas to occur; however, it is quite rare to diagnose schwannoma in children. We are contributing a report of a 13-year-old child with a 1-year history of slowly growing swelling on the anterior part of corpus of the tongue. The patient complained of the disturbance to mastication and phonation. Diagnosis was confirmed by excisional biopsy. Histologic identification of Antoni A and B areas along with strong and diffuse staining with S-100 stain pathologically completed the diagnosis of schwannoma.

Effect of ototopical ciprofloxacin-dexamethasone on myringotomy in a rat model.

OBJECTIVE: To examine the potential of ototopical ciprofloxacin-dexamethasone (CDX) to delay the closure of myringotomy perforation and to evaluate its effect on inflammation. STUDY DESIGN: Prospective, randomized, and controlled. METHODS: Effusion is obtained in the right middle ear of 24 rats by blocking nasopharyngeal opening of eustachian tube by fibrin glue. Left middle ears of 30 rats remained healthy. Animals were randomly classified into three groups; each containing eight right ears with effusion and 10 rats with healthy left ear. Bilateral myringotomy was applied to all rats and randomly divided into three groups. First group received CDX, second group received serum physiologic (SF) for 14 days. Third group served as control. Otomicroscopy was performed by days 7, 14 and 28 to assess wound healing. On day of 28, all animals were humanly euthanized in order to pathological examination of the tympanic bullas. RESULT: CDX group showed lesser perforation closure ratios both in healthy and diseased ears. Inflammation was found to be lesser at CDX group in comparison to other groups. CONCLUSION: Closure of the myringotomy perforation can be modulated by ototopical CDX treatment. This delaying of wound healing may be attributed to antiinflammatory action of dexamethasone.