Association Between Anxiety, Depression, and Salivary Cortisol Levels in Patients with Recurrent Aphthous Stomatitis.

OBJECTIVE: Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease of the oral mucosa that commonly affects the general population. The objective of this study was to conduct a research in assesing the relationship between psychological disorders including anxiety, depression and salivary cortisol levels in patients with RAS. METHODS: Thirty-nine patients suffering from minor RAS were enrolled in the study after obtaining an informed consent. The control group consisted of 25 age and gender matched healthy individuals. All subjects were evaluated by using both psychological tests (Hamilton's anxiety rating scale [HARS] and Hamilton's depression rating scale [HDRS]) and physiological testing instrument (salivary cortisol level). RESULTS: While no statistical difference was found between the patients with RAS and controls for both salivary cortisol levels and anxiety, there was statisticaly significant difference between the groups for depression. CONCLUSION: There was no significant increase in salivary cortisol levels in patients with active disease when compared to the healthy subjects. But we found that depression scale values were significantly higher in patients with RAS.

An Epithelioid Hemangioendothelioma of the Head and Neck.

An epithelioid hemangioendothelioma (EHE) is a rare vascular tumor of the head and neck region, which carries a risk of recurrence and metastasis. Its etiology is still unclear. It frequently involves the lungs, liver, and bones. Rarely, it may manifest in other parts of the body. Pathologic immunohistochemical investigations are essential to make the definite diagnosis. As it is uncommon, there is no standardized protocol for the treatment of EHE. Herein, the authors report a rare patient with of an EHE localized in the head and neck region.

Posttravmatik frontoetmoidal mukopiyosel.

Paranasal sinus mucoceles are mucus-containing cystic structures with an epithelial lining that completely fills in the paranasal sinuses. Although they are benign in nature, they may result in the destruction of the surrounding bony structures over time. Clinical findings such as exophthalmia, visual impairment, and diplopia occur due to pressure of the fronto-ethmoidal mucocele on the orbita. Currently, the endoscopic intranasal approach is preferred in the treatment of paranasal sinus mucoceles due to its minimal morbidity and low recurrence rates. Here, we present a patient aged 12 years who had a right fronto-ethmoidal mucopyocele secondary to a probable trauma 2 years prior, which resulted in proptosis due to pressure on the orbita.

Values Range of Tympanometric Gradient in Otitis Media With Effusion.

INTRODUCTION: The aim of this study was to establish how reliable a given tympanogram is in predicting the presence or absence of a middle ear effusion, and to provide new views for the diagnostic information of tympanometry. The use of tympanometric gradient in addition to static admittance is the focus of this study. MATERIALS AND METHODS: The authors enrolled 146 female and 129 male patients. The participants were allocated into groups as follow: Group A1 consisted of 50 healthy children. Group A2 consisted of 86 children with otitis media with effusion. Group B1 consisted of 85 healthy adults. Group B2 consisted of 54 adults with otitis media with effusion. All diagnostic otoscopic examination and tympanometry were performed in both ears. The authors analyzed the distribution of tympanograms in patients with otitis media with effusion and healthy controls. RESULTS: When the right and left ear canal volume of either children or adults with otitis media with effusion compared with healthy controls, no statistically significant different was observed (P > 0.05). On the other hand, the statistically significant difference was detected for the values of compliance, pressure and gradient of either children or adults with otitis media with effusion compared with healthy controls (P < 0.05). CONCLUSION: The authors found the values range from 0.01 to 1.52 mL gradients (mean least value 0.15 mL) in adults and the values range from 0.01 to 0.93 mL gradients (mean least value 0.10 mL) in children in the presence of otitis media with effusion. The authors think that tympanometric gradient may be useful to detect the otitis media with effusion.

Genetic polymorphism of antioxidant enzymes in eosinophilic and non-eosinophilic nasal polyposis.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the paranasal sinuses, and its pathophysiology is not yet precisely known. It is suggested that oxygen free radicals play an important role in the pathogenesis of nasal polyposis. This study aimed to identify genetic polymorphisms of superoxide dismutase (SOD 2), catalase (CAT), and inducible nitric oxide synthase (iNOS) enzymes in eosinophilic CRSwNP and non-eosinophilic CRSwNP patients; the study also aimed to evaluate the effect of genetic polymorphism of antioxidant enzymes on CRSwNP etiopathogenesis. One hundred thirty patients, who received endoscopic sinus surgery due to CRSwNP, and 188 control individuals were included in this study. Nasal polyp tissues were divided into two groups histopathologically as eosinophilic CRSwNP and non-eosinophilic CRSwNP. Venous blood samples were taken from the patient and control groups. Polymorphisms in the Ala16Va1 gene, which is the most common variation of SOD-2 gene, and 21 A/T polymorphisms in catalase gene were evaluated with the restriction fragment length polymorphism method and -277 C/T polymorphism in the iNOS gene was evaluated with the DNA sequencing method. The GG genotype distribution for the (-277) A/G polymorphism in the iNOS gene was a statistically significant difference between eosinophilic CRSwNP and control groups (p < 0.05). The CC genotype distribution for the SOD2 A16V (C/T) polymorphism was not statistically significant in all groups (p > 0.05). The TT genotype distribution for the A/T polymorphism in catalase gene at position -21 was statistically significant differences in eosinophilic CRSwNP and control groups (p < 0.05). Increased free oxygen radical levels, which are considered effective factors in the pathogenesis of CRSwNP, can occur due to genetic polymorphism of enzymes in the antioxidant system and genetic polymorphism of antioxidant enzymes in eosinophilic CRSwNP patients might contribute to the pathophysiology.

Endoscopic cartilage butterfly myringoplasty in children.

OBJECTIVE: The present study evaluated the results of the graft success rate and hearing gain of children who underwent endoscopic inlay butterfly myringoplasty due to chronic otitis media. METHODS: The study included 32 pediatric patients aged between 8 and 17, who had endoscopic inlay butterfly myringoplasty with the diagnosis of chronic otitis media between September 2012 and January 2015 in Elazig Training and Research Hospital Otorhinolaryngology Clinic and Firat University Otorhinolaryngology Clinic. All patients' demographics, perforation size, and hearing status were examined. RESULTS: Tympanic membrane perforation was ≤3mm in 12 patients and between 3 and 6mm in 20 patients. The air-bone gap (ABG) of the patients was 18.5±6.29dB preoperatively, 8.81±3.53dB postoperatively second month, 8.09±3.55dB postoperatively sixth month, and 7.96±3.32dB postoperatively 12th month. Two (6.3%) of the patients had postoperative myringitis. Two (6.3%) patients had recurrent perforation in the postoperative follow-ups. CONCLUSION: In children, endoscopic inlay butterfly tympanoplasty is a surgical technique with short duration, high graft success, effective hearing reconstruction, and high levels of postoperative patient comfort.

Developmental delays in preschool children with adenotonsillar hypertrophy.

OBJECTIVES: This study aims to investigate the effects of adenotonsillar hypertrophy on general development, as well as fine and gross motor capabilities, social communication, and language development in children with adenotonsillar hypertrophy by applying the Denver Developmental Screening Test-II. PATIENTS AND METHODS: The study included 30 patients (12 boys, 18 girls; mean age 53.3±12.2 months; range 32 to 72 months) who were indicated for adenotonsillectomy due to adenotonsillar hypertrophy between February 2013 and July 2013. The control group comprised 30 children participants (12 boys, 18 girls; mean age 53.1±12.8 months; range 32 to 72 months) with no adenotonsillectomy indication. All participants included in the study were performed routine physical examination, flexible fiberoptic nasopharyngoscopy, and tympanometry. Brodsky scale and fiberendoscopic findings were used to categorize tonsil and adenoid sizes, respectively. Following ear, nose, and throat evaluation, a psychologist conducted Denver Developmental Screening Test-II in all participants blindly. RESULTS: Adenotonsillar hypertrophy patients had higher abnormal levels of general development (c2=7.13, p=0.028). Although patients and controls had similar levels of fine motor, gross motor, and personal-social development levels, there was a statistically borderline difference between them in terms of language development (t=1.82, p=0.074). CONCLUSION: The possibility of adenotonsillar hypertrophy should definitely be considered in children with delayed general and language developments.

[Ectopic thyroid tissue localized in submandibular region]. / Submandibüler bölge yerlesimli ektopik tiroid dokusu.

An ectopic thyroid tissue is often localized in the midline between the foramen caecum and mediastinum, while it is rarely laterally localized. Submandibular location of thyroid tissue is extremely rare. In this article, we report a 56-year-old female case admitted with a painless, non-tender, and firm mass in the right submandibular region. The patient was operated. The mass was detected to be separate from the right lobe of the thyroid. The histopathological examination result was reported as an ectopic thyroid tissue. Ectopic thyroid tissues should be considered in the differential diagnosis of submandibular masses.

Rosai-Dorfman Disease Originating from Nasal Septal Mucosa.

Rosai-Dorfman disease is a rarely seen disease with unknown etiology. Extranodal involvement is most commonly seen in the head and neck region. Histopathologically, it is characterized by histiocytic cell proliferation. This paper presents a case of a 15-year-old male patient who presented with nasal obstruction and was surgically treated for a mass filling in the left nasal meatus that was diagnosed to be Rosai-Dorfman disease by histopathological examination.

Open Versus Closed Septorhinoplasty Approaches for Postoperative Edema and Ecchymosis.

OBJECTIVE: The aim of this study was to compare periorbital edema and ecchymosis seen after closed (endonasal) and open (external) septorhinoplasty (SRP). METHODS: In total, 50 patients undergoing hump extraction and osteotomies were allocated to 2 groups. Group 1 consisted of 25 patients who underwent closed SRP. Group 2 consisted of 25 patients who underwent open SRP. Operation time, amount of intraoperative bleeding, and complications were recorded. Scoring of eyelid edema and periorbital ecchymosis was evaluated on the first, third, and seventh postoperative days using a scale of 0 to 4 by the first author. RESULTS: There was no statistically significant difference between the groups in terms of age, sex, or operation time. No significant difference was observed clinically or statistically in the scores of periorbital edema or ecchymosis between groups 1 and 2 on the first, third, and seventh postoperative days (P > 0.05). CONCLUSIONS: The authors observed no clinically or statistically significant difference in comparing periorbital edema and ecchymosis seen after closed and open SRP.

The efficacy of tranexamic acid and corticosteroid on edema and ecchymosis in septorhinoplasty.

The aim of this study was to investigate the efficacy of tranexamic acid (TA) and methylprednisolone on periorbital edema, ecchymosis, and intraoperative bleeding in patients who underwent open septorhinoplasty (oSRP). Seventy-five patients performing hump extraction and osteotomies were allocated into 3 groups as follows: group 1, 25 patients as control; group 2, 25 patients who were administered oral TA as first dose 1 g starting 2 hours before surgery, 3 g daily in divided doses (1 g, every 8 hours) for 5 days; and group 3, 25 patients who were administered a single dose of 1 mg/kg intravenous methylprednisolone at the beginning of the surgery. Operation time, amount of intraoperative bleeding, and complications were recorded. Scoring of eyelid edema and periorbital ecchymosis was evaluated on postoperative first, third, and seventh days using scale of 0 to 4 by 2 observers. In groups using TA and methylprednisolone, periorbital edema and ecchymosis scores were significantly lower compared with the control group (P < 0.05). No significant difference was seen clinically and statistically in preventing or decreasing both periorbital edema and ecchymosis between group 2 and group 3. Patients given TA showed significantly less intraoperative bleeding compared with controls and patients who were administered methylprednisolone. We observed that the administration of methylprednisolone significantly decreases periorbital edema and ecchymosis. Additionally, our results support that TA use in patients who underwent oSRP with osteotomies was found clinically and statistically effective for prevention of bleeding during oSRP operations and reduction of both periorbital edema and ecchymosis.

Evaluation of the effects of phototherapy on cochlear function in newborns.

OBJECTIVE: This study aimed to evaluate any potential effects of phototherapy on cochlear function in newborns using transient evoked otoacoustic emissions (TEOAEs). METHODS AND MATERIALS: Fifty-seven newborns, undergoing phototherapy for hyperbilirubinemia without any other risk factors, and a control group of 53 healthy newborns, were administered the TEOAE test prior to and following phototherapy. In the newborns undergoing phototherapy, otoacoustic emission (OAE) measurements obtained at baseline and following phototherapy were compared. Moreover, pre-phototherapy OAE measurements obtained in the newborns undergoing phototherapy were compared with the OAE measurements of the control group. RESULTS: In newborns undergoing phototherapy, there was no significant difference between pre- and post-phototherapy TEOAE amplitudes, nor in the reproducibility ratios. Similarly, no difference was found in the pre-treatment measurements of amplitude and reproducibility ratios between phototherapy-receiving newborns and controls (p>0.05). CONCLUSION: The normal TEOAE results observed in the newborns undergoing phototherapy suggest that phototherapy does not exert negative effects on the cochlea.

Evaluation of internal auditory canal structures in tinnitus of unknown origin.

OBJECTIVES: The aim of the present study was to evaluate the internal auditory canal (IAC) and the nerves inside it to define possible structural differences in cases with subjective tinnitus of unknown origin. METHODS: Cases applying to the ear, nose and throat department with the complaint of tinnitus with unknown origin and having normal physical examination and test results were included in the study (n=78). Patients admitted to the radiology clinic for routine cranial magnetic resonance imaging (MRI) and whose MRI findings revealed no pathologies were enrolled as the control group (n=79). Data for the control group were obtained from the radiology department and informed consent was obtained from all the patients. Diameters of the IAC and the nerves inside it were measured through enhanced images obtained by routine temporal bone MRIs in all cases. Statistical evaluations were performed using Student t-test and statistical significance was defined as P<0.05. RESULTS: Measurements of IAC diameters revealed statistically significant differences between the controls and the tinnitus group (P<0.05). Regarding the diameters of the cochlear nerve, facial nerve, inferior vestibular nerve, superior vestibular nerve, and total vestibular nerve, no statistically significant difference was found between the controls and the tinnitus group. CONCLUSION: Narrowed IAC has to be assessed as an etiological factor in cases with subjective tinnitus of unknown origin.

An investigation of atherosclerotic markers in patients with posterior semi-circular canal benign paroxysmal positional vertigo.

OBJECTIVES: This study aims to investigate the presence and incidence of arteriosclerosis in patients with benign paroxysmal positional vertigo (BPPV). PATIENTS AND METHODS: A total of 89 patients who were admitted to the ear, nose, throat outpatient clinic with complaint of vertigo and were diagnosed with BPPV based on the positive Dix-Hallpike test results were included (BPPV group) between January 2010 and July 2010. Data from otological asymptomatic controls (n=129) who were referred to the radiology department from other clinics for ultrasound examination were obtained. Intima-media thickness and arteriosclerosis measurements were carried out. Arteriosclerosis measurement was performed through a Doppler ultrasound. RESULTS: No statistically significant difference in carotid, femoral intima-media thicknesses and elastic modulus measurements between the controls and BPPV group. In the BPPV group, carotid artery cross-sectional compliance, cross-sectional distensibility, femoral artery cross-sectional compliance and cross-sectional distensibility were statistically significantly lower. CONCLUSION: Our study results suggest that atherosclerotic changes may play a role in the underlying etiology of BPPV.

Giant cell tumor of bone involving the temporomandibular joint and temporal bone.

Giant cell tumor is a primary bone tumor that usually originates from the epiphysis of the long bones and is rarely seen in the cranial region. Most frequently, the tumor develops in the sphenoid and temporal bones in the middle cranial fossa. Giant cell tumor generally shows diversity with respect to benignity, local invasiveness, and histology. Although surgical excision with negative surgical margin may lead to cure, adjuvant radiotherapy is still debated. The patient was admitted with a humming in the left ear and hearing loss. After radiologic examination, a mass with temporomandibular joint involvement as well as temporal and sphenoid bone localization was detected. The patient was diagnosed with giant cell tumor after a biopsy specimen was taken from the mass extending to the middle ear and destroying the temporomandibular joint. The current study reviewed the patient's clinical features, diagnosis, and treatment in light of the literature.

The effect of topical mometasone furoate nasal spray on carriage of Staphylococcus aureus.

OBJECTIVES: This study aims to examine the effect of topical mometasone furoate nasal spray on nasal Staphylococcus aureus (S. aureus) colonization in the treatment of allergic rhinitis. PATIENTS AND METHODS: Between January 2012 and February 2013, 53 patients having perennial allergic rhinitis symptoms (37 females, 16 males) and 53 healthy controls (36 females, 17 males) were included in the study. Nasal cultures were obtained and evaluated before and after the treatment in allergic rhinitis patients who were admitted to the ear, nose and throat (ENT) outpatient clinic and receiving a mometasone furoate nasal spray treatment (200 mcg/day) once a day for one-month. In healthy controls, nasal cultures were obtained and evaluated once. RESULTS: In allergic rhinitis patients, five cultures were positive for S. aureus before the treatment while the number of cultures positive for S. aureus was six after the treatment. There was no significant difference in the pre-treatment and post-treatment S. aureus colonization between the patient group and controls (p>0.05). CONCLUSION: Mometasone furoate nasal spray used in the treatment of allergic rhinitis appears to be ineffective for nasal S. aureus colonization.

Diagnostic challenge in papillary thyroid carcinoma with cervical lymphadenopathy, metastasis, or tuberculous lymphadenitis.

Papillary thyroid carcinoma (PTC) is the most frequent histological subtype of thyroid cancer. Total thyroidectomy with neck dissection is recommended for treatment. Tuberculous adenitis is a common cause of lymphadenopathy in endemic areas. Therefore, tuberculous lymphadenitis should be considered in the etiology of enlarged lymph nodes when PTC patients with risk factors such as tuberculosis present with cervical lymph node enlargement. Detailed evaluation of the neck metastasis of patients with PTC is necessary to avoid postoperative complications due to neck dissection. We present a 55-year-old female patient with tuberculous lymphadenitis mimicking metastatic lymph nodes from PTC.

Psychiatric disorders and symptoms severity in patients with adenotonsillar hypertrophy before and after adenotonsillectomy.

OBJECTIVE: The objective of this study was to compare the frequency of psychiatric disorders and the severity of psychiatric symptoms in patients with adenotonsillar hypertrophy with a healthy control group and investigate the potential improvement after adenotonsillectomy. MATERIALS AND METHODS: The study group consisted of 40 patients with adenotonsillar hypertrophy and a control group consisted of 35 healthy volunteers without adenotonsillar hypertrophy. A routine ear nose throat (ENT) examination, flexible nasopharyngoscopy and tympanometry were carried out. The same procedures were applied to the control group. The parents of all the participants were required to fill out the Early Childhood Inventory-4 form, the Strengths and Difficulties Questionnaire and a personal information form. At postoperative month six, the patients were re-examined, and their parents were required to fill out the same forms. RESULTS: Attention deficit hyperactivity disorders and sleep disorders determined with the Early Childhood Inventory-4 were more common in the patients with adenotonsillar hypertrophy than in the control group. There was a significant decrease in the rates of both types of disorders at postoperative month six. The total psychiatric symptom severity was higher in the patients with adenotonsillar hypertrophy and the following were more frequent: cases of attention deficit hyperactivity disorder, oppositional defiant disorder, symptom severity of anxiety disorders and sleep disorders determined with the Early Childhood Inventory-4, as well as emotional problems, attention deficit hyperactivity disorder problems, behavioural problems and peer problems determined with the Strengths and Difficulties Questionnaire parent-report form. There was a statistically significant decrease in all the other symptoms at postoperative month six, except for the severity of oppositional defiant disorder symptoms determined with the Early Childhood Inventory-4 and behavioural problems determined with the Strengths and Difficulties Questionnaire parent-report form. There were no differences in the severity of psychiatric disorders or symptoms between the adenotonsillar hypertrophy group and the control group at postoperative month six. CONCLUSION: Adenotonsillar hypertrophy is associated with psychiatric disorders and symptoms. Adenotonsillectomy ameliorated the symptoms and the severity of these disorders in most cases.

The prevelance of psichiatric symptoms in preschool children with adenotonsillar hypertrophy.

OBJECTIVES: The aim of this study was to determine the prevalence of psychiatric disorders and symptoms in preschool-age children who are indicated for operation due to adenotonsillar hypertrophy. MATERIALS AND METHODS: Forty-eight patients between the ages of three and five years with indication for adenotonsillectomy were included in the study, as well as 40 control patients. Cases underwent routine ear nose throat (ENT) examination, flexible nasopharyngoscopy and tympanometry. The Early Childhood Inventory-4 (ECI-4) parent form and Strengths and Difficulties Questionnaire (SDQ) parent form were completed by the parent caring for the child. The SPSS for Windows 16.0 program was used for statistical analysis. RESULTS: Groups were compared according to they received at least one psychiatric diagnosis measured by ECI-4, the group of adenotonsillar hypertrophy was diagnosed more than the control group. Attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and sleep disorders were detected at a higher rate in patients with adenotonsillar hypertrophy. It also was established that in the comparison of the severity of psychiatric symptoms determined by ECI-4, symptom severity of ADHD, ODD, anxiety disorders, and sleep disorders was higher in the adenotonsillar hypertrophy group than in the control group. In the evaluation of the SDQ parent form, it was determined that attention deficit, hyperactivity, behavioral, and peer relations problems occurred more frequently in the adenotonsillar hypertrophy group. CONCLUSIONS: In addition to oral respiration, snoring, and disordered breathing during sleep, adenotonsillar hypertrophy may also associated with psychiatric disorders and symptoms.

TEMPS-A Temperament Scale Before and After Septoplasty in Patients with Nasal Septum Deviation.

The present study aimed to evaluate whether patients undergoing an operation for septum deviation exhibited a change in affective status. The temperament evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) was administered to all patients at the pre-operative and post-operative periods. The mean age of the patients was 32.46 ± 11.22 years. Of the patients, 34 (65.4%) were males and 18 (34.6%) were females. A significant difference was found between pre- and post-operative scores of the patients on all TEMPS-A subscales (p < 0.05). Patients with symptoms of upper airway obstruction may have mood disorders due to the decrease in blood oxygen levels. This condition can be corrected with septoplasty procedure. In the present study, it was demonstrated that patients had a better affective status post-operatively as compared to the pre-operative period.