Effects of Anatolian Propolis and Hypertonic Saline Combination Nasal Spray on Allergic Rhinitis Symptoms: A Prospective, Multicenter Study.

Objectives: This study aimed to evaluate how Rhinapi nasal spray affects symptoms of allergic rhinitis. Methods: In this prospective, multicenter, observational study, 10,000 patients (comprising 5028 males and 4972 females) exhibiting symptoms of allergic rhinitis (namely, nasal discharge, sneezing, nasal itching, and nasal obstruction) from different centers in different regions of Turkey were enrolled in the study between March 2022 and March 2023. All the patients wanted to participate in the study and were administered Rhinapi one puff to each nostril three times a day, for a period of 3 weeks. Total symptom scores, quality of life (QoL) scores, and otolaryngological examination scores were evaluated before and 3 weeks after treatment. Results: The scores for discharge from the nose, sneezing, nasal pruritus, and blockage of the nose all indicated improvement when compared to pre-medication and post-medication. This difference achieved statistical significance (P < .001). The mean total symptom score fell following treatment (P < .001): whilst the score was 11.09 ± 3.41 before administering Rhinapi; after administration, the average score was 6.23 ± 2.41. The mean QoL scores also altered after medication (P < .001), improving from a mean value of 6.44 ± 1.55 to a mean of 7.31 ± 1.24. Significant improvement was also noted in the scores for conchal color and degree of edema after the treatment had been administered (P < .001). Conclusion: The study demonstrates that Rhinapi nasal spray decreases total symptom scores, and results in improved QoL and otolaryngological examination scores. Propolis spray may be recommended for patients with allergic rhinitis alongside other treatments.

Can the Safe Surgical Margin Be Narrowed in Early-Stage Facial Basal Cell Carcinoma?

OBJECTIVE: To examine factors that affect the positive surgical margins of facial basal cell carcinoma (BCC) and investigate whether the surgical margin value can be narrowed in early-stage facial BCCs. METHODS: Ninety-five patients were divided into the three groups based on prognosis: good (n = 48), mixed (n = 32), and poor (n = 15). The good prognosis group (group 1) included nodular and superficial subtypes; the mixed prognosis group (group 2) included nodular-infiltrative, nodular-micronodular, and nodular-sclerosing subtypes; and the poor prognosis group (group 3) included infiltrative and micronodular subtypes. RESULTS: Groups 1 and 2 differed from each other significantly in terms of positive surgical margin (P = .002) and tumor thickness (P = .008), but group 3 did not (P = .851 and P = .804, respectively). With regard to surgical method (primary vs local flap repair), only tumor localization varied significantly (P < .001). CONCLUSIONS: Groups differed significantly in terms of surgical margin positivity, the distance of the tumor to the surgical margin, and the tumor thickness. The intact surgical margin was 2 mm on average in this study, and the authors suggest that it may be possible to revise the surgical margin values recommended in the literature.

Usage of Surgical Antibiotic Prophylaxis in Routine Otolaryngologic Surgeries in Turkey

Abstract Introduction: Inappropriate antibiotic use in the world leads to an increase in both health care costs and antibiotic resistance. Surgical antibiotic prophylaxis (SAP) is used by most surgeons, especially in the postoperative period. Objective The aim of the study is to determine the approach of ear, nose, and throat (ENT) specialists to surgical antibiotic prophylaxis in routine surgeries, and to raise awareness regarding inappropriate antibiotic use. Methods ENT specialists from all over Turkey participated in the study by filling out a data collecting form. The form consisted of 6 questions and was sent to specialists via email. Routine ENT operations such as adenoidectomy, tonsillectomy, adenotonsillectomy, ventilation tube application, septoplasty, rhinoplasty, septorhinoplasty (non-complicated), tympanoplasty, and simple mastoidectomy were chosen for the study. Data were analyzed statistically. Results The form results of 110 ENT specialists were evaluated. The rate of participants who used and did not use SAP was 77.3% and 22.7%, respectively. The SAP usage rates of septoplasty, rhinoplasty, and septorhinoplasty operations were 84.7%, 81.2%, and 75.3%, respectively. For tympanoplasty and ventilation tube application operations, the rates were 82.4% and 24.7%, respectively. Finallly, the SAP usage rates of adenoidectomy, tonsillectomy, and adenotonsillectomy were 57.6%, 75.3%, and 72.9%, respectively. Conclusion Otolaryngological surgeries are often classified as clean or clean-contaminated surgeries. In most studies in the literature, it is reported that SAP use is unnecessary in routine otolaryngological surgery. Providing inservice training, regularly updating the prophylaxis guidelines and sharing these guidelines with surgeons may prevent inappropriate SAP use.

Usage of Surgical Antibiotic Prophylaxis in Routine Otolaryngologic Surgeries in Turkey.

Introduction: Inappropriate antibiotic use in the world leads to an increase in both health care costs and antibiotic resistance. Surgical antibiotic prophylaxis (SAP) is used by most surgeons, especially in the postoperative period. Objective The aim of the study is to determine the approach of ear, nose, and throat (ENT) specialists to surgical antibiotic prophylaxis in routine surgeries, and to raise awareness regarding inappropriate antibiotic use. Methods ENT specialists from all over Turkey participated in the study by filling out a data collecting form. The form consisted of 6 questions and was sent to specialists via email. Routine ENT operations such as adenoidectomy, tonsillectomy, adenotonsillectomy, ventilation tube application, septoplasty, rhinoplasty, septorhinoplasty (noncomplicated), tympanoplasty, and simple mastoidectomy were chosen for the study. Data were analyzed statistically. Results The form results of 110 ENT specialists were evaluated. The rate of participants who used and did not use SAP was 77.3% and 22.7%, respectively. The SAP usage rates of septoplasty, rhinoplasty, and septorhinoplasty operations were 84.7%, 81.2%, and 75.3%, respectively. For tympanoplasty and ventilation tube application operations, the rates were 82.4% and 24.7%, respectively. Finallly, the SAP usage rates of adenoidectomy, tonsillectomy, and adenotonsillectomy were 57.6%, 75.3%, and 72.9%, respectively. Conclusion Otolaryngological surgeries are often classified as clean or clean-contaminated surgeries. In most studies in the literature, it is reported that SAP use is unnecessary in routine otolaryngological surgery. Providing inservice training, regularly updating the prophylaxis guidelines and sharing these guidelines with surgeons may prevent inappropriate SAP use.

The role of the rhinostomy ostium size on functional success in dacryocystorhinostomy.

INTRODUCTION: Endonasal and external dacryocystorhinostomy procedures have both been used for the treatment of post-saccular obstruction of the lacrimal system. Functional success of these surgeries depends on several factors. OBJECTIVE: To evaluate the status of the rhinostomy ostium with endonasal and external approaches in dacryocystorhinostomy operations and to determine the effect of ostium size on postoperative functional success. METHODS: The charts of the patients operated in our hospital between May 2017 and January 2019 were analyzed retrospectively (ethical approval number: 2018-12.04). The patients that were operated in the ophthalmology and otolaryngology departments were included in the study. Endoscopic rhinostomy ostium measurements, punctum lavage findings and complications were recorded at 8 weeks postoperative at the earliest. RESULTS: When the 64 patient charts were reviewed (76 operations), the mean ostium width was 1.85±1.11mm in the endonasal approach group and 3.60±2.24mm in the external approach group. The mean ostium areas in endonasal and external group were 14.61±16.66mm2 and 56.05±60.41mm2, respectively. The ostium was anatomically patent and punctum lavages were negative in 11 patients (6 patients in the endonasal approach group and 5 patients in the external approach group) and these cases were considered as functional failures. The rhinostomy ostium was significantly wider in the external approach group, but this was considered ineffective on functional outcomes. CONCLUSION: Lacrimal duct stenosis can be successfully treated with endonasal and external methods. Tear drainage may be insufficient even in the presence of a patent ostium. Therefore, functional success should also be considered when evaluating the overall success of dacryocystorhinostomy. An anatomically patent ostium is definitely required, while it is believed that ostium size does not affect functional surgical success.

The role of the rhinostomy ostium size on functional success in dacryocystorhinostomy / O papel do tamanho do óstio da rinostomia no sucesso funcional em dacriocistorrinostomia

Abstract Introduction Endonasal and external dacryocystorhinostomy procedures have both been used for the treatment of post-saccular obstruction of the lacrimal system. Functional success of these surgeries depends on several factors. Objective To evaluate the status of the rhinostomy ostium with endonasal and external approaches in dacryocystorhinostomy operations and to determine the effect of ostium size on postoperative functional success. Methods The charts of the patients operated in our hospital between May 2017 and January 2019 were analyzed retrospectively (ethical approval number: 2018-12.04). The patients that were operated in the ophthalmology and otolaryngology departments were included in the study. Endoscopic rhinostomy ostium measurements, punctum lavage findings and complications were recorded at 8 weeks postoperative at the earliest. Results When the 64 patient charts were reviewed (76 operations), the mean ostium width was 1.85 ± 1.11 mm in the endonasal approach group and 3.60 ± 2.24 mm in the external approach group. The mean ostium areas in endonasal and external group were 14.61 ± 16.66 mm2 and 56.05 ± 60.41 mm2, respectively. The ostium was anatomically patent and punctum lavages were negative in 11 patients (6 patients in the endonasal approach group and 5 patients in the external approach group) and these cases were considered as functional failures. The rhinostomy ostium was significantly wider in the external approach group, but this was considered ineffective on functional outcomes. Conclusion Lacrimal duct stenosis can be successfully treated with endonasal and external methods. Tear drainage may be insufficient even in the presence of a patent ostium. Therefore, functional success should also be considered when evaluating the overall success of dacryocystorhinostomy. An anatomically patent ostium is definitely required, while it is believed that ostium size does not affect functional surgical success.

Resumo Introdução Dacriocistorrinostomia endonasal e externa têm sido usados para o tratamento de obstrução pós‐sacular do sistema lacrimal. O sucesso funcional dessas cirurgias depende de vários fatores. Objetivo Avaliar o status do óstio da rinostomia nas abordagens endonasal e externa em dacriocistorrinostomias e a importância do tamanho do óstio no sucesso funcional pós‐operatório. Método Os prontuários de pacientes operados em nosso hospital entre maio de 2017 e janeiro de 2019 foram analisados retrospectivamente (número de aprovação ética: 2018-12,04). Foram incluídos no estudo os pacientes operados nos setores de oftalmologia e otorrinolaringologia. Medidas do óstio da rinostomia endoscópica, achados à irrigação do ponto lacrimal e complicações foram registrados a partir da 8ª semana de pós‐operatório. Resultados Foram avaliados prontuários de 64 pacientes (76 operações); a largura média do óstio era de 1,85 ± 1,11 mm no grupo endonasal e de 3,60 ± 2,24 mm no grupo externa. As áreas médias do óstio no grupo endonasal e externa foram 14,61 ± 16,66 mm2 e 56,05 ± 60,41 mm2, respectivamente. O óstio estava anatomicamente pérvio e as irrigações do ponto lacrimal foram negativas em 11 pacientes (6 pacientes no grupo endonasal e 5 pacientes no grupo externa) e esses casos foram considerados como falhas funcionais. O óstio da rinostomia foi significativamente maior no grupo externo, mas sem relação com a eficácia nos resultados funcionais. Conclusão A estenose do ducto lacrimal pode ser tratada com sucesso com métodos endonasais e externos. A drenagem lacrimal pode ser insuficiente mesmo na presença de óstio pérvio. Portanto, o sucesso funcional também deve ser considerado ao avaliar o sucesso do procedimento. Embora um óstio anatomicamente patente seja necessário, o tamanho do óstio não afeta o sucesso cirúrgico funcional.

Comparison of the Baska Mask® and Endotracheal Tube on Hemodynamic and Respiratory Parameters in Septoplasty Cases.

Laryngeal mask (LM) types have been used as an airway device for an alternative to the standard endotracheal tube (ETT). One of the novel type of LM, the Baska Mask®, can be a safe alternative among the airway devices. The purpose of this study is to compare the effects of the new generation supraglottic airway device the Baska Mask® and the ETT on hemodynamic parameters (heart rate, mean arterial pressure), airway pressure and end tidal carbon dioxide (EtCO2) in patients undergoing general anesthesia. After the approval of the ethics committee, 70 patients who underwent septoplasty were included in the study. Written informed consent forms were taken from these patients. Demographic data of the patients were recorded. Hemodynamic data of patients were measured and recorded preoperative, during induction, at the time of intubation 1th, 3th and 5th minute and during extubation. Also, airway pressure and EtCO2 values of the patients were measured and recorded at the time of intubation, 1th, 3th and 5th minutes. Demographic data were similar in both groups. Mean arterial pressure, heart rate and airway pressure were lower in the group 2 (the Baska Mask® group) than in the group 1 (ETT group) and the difference was statistically significant (p<0.05). EtCO2 values were similar in both groups. No patients had tube leakage. In terms of hemodynamic and respiratory parameters the Baska Mask® is more advantageous than the ETT in short-term surgeries.

Do Intubation Devices Affect Middle Ear Pressure Dynamics?

Our study aimed to investigate the effects of different intubation devices on middle ear pressure (MEP) dynamics by evaluating MEP during stages of anesthesia.Sixty-one consecutive patients were randomly assigned to 2 groups: the classical endotracheal intubation group and the Baska Mask (a new laryngeal mask [LMA]) group. All patients received the same anesthesia protocol. The right and left MEP values of the patients were measured and recorded preoperatively, during the induction of anesthesia, at the time of intubation and at 5th minute of anesthesia.In group 1, the pressure values measured in the right ear during anesthesia induction, at the time of intubation and at 5th minute of anesthesia were 10.97 ±â€Š27.06, 16.77 ±â€Š29.40, and 21.64 ±â€Š90.31, respectively, compared to left ear values of 8.61 ±â€Š26.39, 18.77 ±â€Š37.84, and 38.61 ±â€Š56.96 daPa, respectively. In group 2, MEP values measured in the right ear during anesthesia induction, at the time of intubation, and at 5th minute of anesthesia were 9.53 ±â€Š20.43, 22.30 ±â€Š41.50, and 20.60 ±â€Š46.85 daPa, respectively, compared to left ear values of -4.26 ±â€Š25.17, 6.20 ±â€Š26.56, and 30.30 ± 65.17 daPa, respectively. MEP was statistically significantly increased in the classical endotracheal intubation group compared to the LMA group.We found that the increase in pressure is lower in patients receiving LMA compared to classical endotracheal intubation. The Baska Mask LMA is recommended in selected patients to prevent complications of MEP elevation.

The importance of calprotectin levels in obstructive sleep apnea syndrome severity.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is mostly seen in adult populations. It is known that increased levels of several inflammatory mediators play roles in OSAS and related comorbidities. Calprotectin is an inflammatory mediator that increases in some diseases such as Behçet's syndrome, bowel diseases and cardiovascular and cerebrovascular diseases. AIMS: The purpose of this study was to investigate whether calprotectin can be used as a biomarker in OSAS by determining the relation between serum calprotectin levels and OSAS severity. STUDY DESIGN: Cohort study. METHODS: A prospective study was planned. Eighty-three patients undergoing polysomnography were included in the study and evaluated prospectively. Thirty patients were classified as non-OSAS (group 1), 18 as mild OSAS (group 2), 15 as moderate OSAS (group 3) and 20 as severe OSAS (group 4). Calprotectin values were measured in the non-OSAS patients (group 1) and in the patients with OSAS (groups 2, 3 and 4). The OSAS groups were also compared with each other. RESULTS: Serum calprotectin values ranged between 70.61 and 1468.04 ng/ml. No significant difference in calprotectin levels was found between the OSAS and normal groups. However, statistically significantly increased calprotectin values were determined in the severe OSAS group (group 4) when all groups were compared. CONCLUSION: Calprotectin values were elevated in OSAS patients and it can be used as a marker of severe OSAS. Future studies can support our study.

Can CK-MB be used as a marker in benign paroxysmal positional vertigo attack?

OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the main causes of vertigo. More than 90% of cases of positional vertigo and nystagmus can be associated with BPPV. There is no known specific laboratory test for BPPV. Because of the possible muscle activity in BPPV (especially result of nause, vomiting and increasing heart rate) we thought the CK-MB levels may change in this situation. The purpose of this study was to investigate the relation between serum CK-MB levels and BPPV and attacks. MATERIALS AND METHODS: The medical records of 35 patients with BPPV presenting to our clinic between November 2014 and November 2015 were investigated retrospectively. Thirty-two control patients with no vertigo, muscular or cardiac disease and with measured CK-MB levels were randomized into a control group. Both groups' existing CK-MB levels were obtained from the patient records. CK-MB values measured before BPPV attack from 11 patients in the patient group were also recorded. RESULTS: The patient and control groups were similar in terms of demographic parameters. CK-MB values at time of attack in the patient group ranged between 5.4 and 38.9 (mean: 19.67 ± 6.81), while control group values ranged between 12 and 27.9 (mean: 20.31 ± 4.54). CK-MB values in 11 patients in the patient group measured before attack ranged between 8.9 and 24 (mean: 17.02 ± 4.97), and CK-MB values during attack ranged between 9 and 34 (mean: 19.74 ± 7.64). CONCLUSION: Although CK-MB elevation at time of attack was determined in patients with BPPV, this was not statistically significant.

A Rare Entity: Adult Asymptomatic Giant Vallecular Cyst.

Background. Cysts in the larynx are rare and generally asymptomatic. However, large cysts in adults can be symptomatic. If they are symptomatic, they typically present with respiratory and feeding difficulties. They are usually benign in terms of pathology. Several surgical techniques may be used for treatment. Case Report. A 56-year-old man presented to our clinic with hoarseness. Routine laryngeal examination revealed a giant mass and the larynx could not be visualized. At magnetic resonance imaging (MRI), a cystic mass originating from the vallecula was detected. There was no pathology at the glottic level. We planned tracheotomy for the airway and endoscopic surgery for excision. The mass was excised using CO2 laser and was reported as benign. Conclusion. An asymptomatic vallecular cyst may cause difficult intubation in any operation. It may also cause respiratory or other complications. Airway management should be led by an ear, nose, and throat surgeon, since tracheotomy may be required. Endoscopic excision with CO2 laser is a good choice for treatment in elective cases. In this report, we discuss the diagnosis and treatment of a patient with an asymptomatic giant vallecular cyst.

Comparison of dexmedetomidine and propofol used for drug-induced sleep endoscopy in patients with obstructive sleep apnea syndrome.

UNLABELLED: Backround: Surgical operations are alternative treatments in persons with Obstructive Sleep Apnea Syndrome who cannot tolerate continuous positive airway pressure therapy. Drug-Induced Sleep Endoscopy is a method with which somnolence is pharmacologically induced and collapse is evaluated through nasal endoscopy in patients with Obstructive Sleep Apnea Syndrome. AIMS: We aimed to evaluate efficiency of dexmedetomidine or propofol used for sedation in patients undergoing drug-induced sleep endoscopy. METHODS: A total of 40 patients aged between 18 and 65 years old in the ASA STATUS I-II group were included in the study. After premedication with midazolam 0.05 mg/kg intravenously, patients were randomly divided into two groups and administered intravenous (iv) propofol with the loading dose of 0.7 mg/kg for 10 minutes, followed 0.5 mg/kg/h infusion (Group P); or dexmedetomidine with the loading dose of 1 mcg/kg for 10 minutes, followed by 0.3 mcg/kg/h infusion (Group D). Haemodynamic and respiratuary parameters, Bispectral index score, Ramsey sedation score, time to achieve sufficient sedation, surgeon's and patients' satisfaction, postoperative Aldrete score and side effects were recorded. RESULTS: Time to achieve sufficient sedation, Bispectral index scores at 5, 10 and 15th. minutes intraoperatively, first Aldrete score in the recovery room, SpO2 values and respiratory rates all over the surgical procedure and in the recovery room were found lower in Group P (P<0.05). Bispectral index scores, mean arterial pressure and heart rate in the recovery room were significantly lower in Group D (P<0.05). CONCLUSION: Dexmedetomidine may be preferred as a safer agent with respecting to respiratory function compared with propofol in obstructive sleep apnea patients who known to be susceptible to hypoxia and hypercarbia.

Giant ethmoid osteoma originated from the lamina papyracea.

INTRODUCTION: Osteomas are slow- growing, benign tumors. They are the most common neoplasms of the paranasal sinuses. They are usually originates from the frontal and ethmoid sinus and much less frequently seen in the maxillary and sphenoid sinuses. Although the lamina papyracea is a part of ethmoid bone, a giant osteoma originated from the lamina papyracea is very uncommon. An osteoma of the paranasal sinus is usually asymptomatic. Headache, proptosis, epiphora, diplopia, dizziness, facial deformity, face pain and cerebral complications are possible symptoms. The treatment of the paranasal osteomas are controversial. CASE REPORT: A 65 year old patient that applied with stuffiness and headache to our clinic. She has had a smooth mass in the right nasal cavity. Paranasal sinus tomography showed an osseous lesion, the size of 4 x 3 cm, arising from the right lamina papyracea. The mass excised endoscopically and reported as osteoma histopathologically. There was no complication. After 9 months, there was no recurrence. CONCLUSION: Giant osteomas of paranasal sinuses, especially originated from the lamina papyracea are rare. They can be treated successfully by endoscopic approaches without any recurrence and complication despite its size.

Giant ethmoid osteoma originated from the lamina papyracea.

INTRODUCTION: Osteomas are slow- growing, benign tumors. They are the most common neoplasms of the paranasal sinuses. They are usually originates from the frontal and ethmoid sinus and much less frequently seen in the maxillary and sphenoid sinuses. Although the lamina papyracea is a part of ethmoid bone, a giant osteoma originated from the lamina papyracea is very uncommon. An osteoma of the paranasal sinus is usually asymptomatic. Headache, proptosis, epiphora, diplopia, dizziness, facial deformity, face pain and cerebral complications are possible symptoms. The treatment of the paranasal osteomas are controversial. CASE REPORT: A 65 year old patient that applied with stuffiness and headache to our clinic. She has had a smooth mass in the right nasal cavity. Paranasal sinus tomography showed an osseous lesion, the size of 4x 3 cm, arising from the right lamina papyracea. The mass excised endoscopically and reported as osteoma histopathologically. There was no complication. After 9 months, there was no recurrence. CONCLUSION: Giant osteomas of paranasal sinuses, especially originated from the lamina papyracea are rare. They can be treated successfully by endoscopic approaches without any recurrence and complication despite its size.