Correction of Prominent Ears: Postauricular Muscle Relocation and Fibrofatty Tissue Excision.

ABSTRACT: In this study, we modified the combined Mustarde and Furnas type otoplasty technique and evaluated the postoperative results of the patients for symmetry and complications. Eighty prominent ears in 42 patients who underwent otoplasty between January 2017 and April 2019 were included in this study. The authors determined the amount of postauricular subcutaneous tissue to be removed according to the shape of skin incision and relocated the postauricular muscle as an adjunct to the Mustarde and Furnas otoplasty technique. All patients were followed-up at least 12 months postoperatively. The patients were also evaluated for early postoperative complications (bleeding, hematoma, perichondritis, wound infection, and skin necrosis), late postoperative complications (asymmetry, hypertrophic scars, suture extrusion, and recurrence), and patient satisfaction using objective and subjective methods.Considering all the patients, early complications consisted of minimal low-flow bleeding (n = 4 ears/4 patients), hematoma (n = 1), and perichondritis (n = 1). Late complications consisted of suture extrusion (n = 2 ears/2 patients), hypertrophic scars (n = 2 ears/2 patients), and asymmetry (n = 1). None of the patients presented with wound infection or skin necrosis. Revision otoplasty was unilaterally performed in only 1 patient with the complaint of asymmetry. A natural-looking, adequate correction, and symmetric ear shape were achieved in all patients except 1. In terms of patient satisfaction, 38 of 42 patients evaluated the outcome as "very good," 3 as "good," and only 1 as "poor." Our modified technique produced very satisfactory results and reduced the postoperative complication and asymmetry rates, as well as eliminating recurrence. The authors recommend this simple and safe procedure with excellent outcomes.

Evaluation of the use of Different Spreader Techniques in Primary Open Septorinoplasty in Terms of Nasal and Olfactory Functions.

BACKGROUND: In this study, the authors aimed to investigate the use of spreader and determine the efficacy and superiority of different spreader techniques in septorhinoplasty in terms of nasal and olfactory functions. METHODS: A total of 60 patients who had undergone septorhinoplasty with the open technique were included in the study. In addition to open septorhinoplasty, 20 patients also underwent bilateral spreader graft placement and 20 bilateral spreader flap placement. For the remaining 20 patients, open septorhinoplasty was performed without spreader grafts or flaps. The patients completed the Nasal Obstruction Symptom Evaluation (NOSE) scale consisting of five questions, and the Brief Smell Identification Test was used to detect olfactory dysfunction. RESULTS: The preoperative mean NOSE score of all patients was 10.87 (1-18), while the postoperative mean value was 1.83 (0-10). The preoperative mean olfactory score was 6.23 ±â€Š2.20 in all patients while it was 7.33 ±â€Š1.75 postoperatively. There was a statistically significant difference between the preoperative and postoperative NOSE and olfactory scores in all patients, but no statistically significant difference was observed between the three groups. CONCLUSION: Spreader graft or flap techniques used in septorhinoplasty are safe in terms of nasal obstruction and olfactory function, and there is no statistically significant difference between them.

The histopathological effects of reabsorbable polyethylene glycol hydrogel (Coseal) on epidural fibrosis in an experimental postlaminectomy model in rats

Background/aim: To investigate the histopathological effects of reabsorbable polyethylene glycol hydrogel (RPGH, Coseal) on epidural fibrosis (EF) following laminectomy in rats. Materials and methods: A total of 24 rats were equally divided into three groups. In the first group, no treatment was applied after laminectomy (control group, Group 1). In the second group, hemostasis was achieved after laminectomy, and 2 mm absorbable gelatin sponge soaked in saline was placed over the epidural space and the wound was closed (Group 2). In the third group, hemostasis was achieved following laminectomy, and 0.5 mL RPGH (Coseal, Group 3) was squeezed over the dura mater, and the wound was closed. A histopathological examination was undertaken to evaluate arachnoidal invasion and EF. Results: The results of EF in the Group 2 and Group 3 were significantly lower compared to the Group 1 (p = 0.023 and p = 0.002, respectively). No statistically significant difference was found between the Group 2 and Group 3 in terms of EF (p = 0.957). There was also no statistically significant difference between the mean arachnoidal invasion of the three groups (p > 0.171). However, the rate of arachnoidal invasion was the lowest in the Group 3. Conclusion: Intraoperative Coseal, a polyethylene glycol polymer, tends to reduce the risk of epidural fibrosis, although this is not statistically significant.

The Protective Effect of Platelet Rich Plasma Against Cisplatin-Induced Ototoxicity.

Cisplatin, a pharmacological agent widely used for treating many cancers, may cause serious side effects including ototoxicity, nephrotoxicity, and peripheral neuropathy. The present study aimed to investigate whether platelet-rich plasma (PRP) protects against cisplatin ototoxicity. Eight rats (16 ears) were divided into 2 groups: control group (4 rats, 8 ears) that received intratympanic saline and study group (4 rats, 8 ears) that received intratympanic PRP. Cisplatin (10 mg/day intraperitoneally) or vehicle was administered 2 times per day to the animals. Auditory brainstem responses were recorded preoperatively and postoperatively on day 4 and at week 3. The authors compared the morphological appearances of spiral ganglion cells and the organ of Corti and the density of spiral ganglion cells between treatment groups. The number of outer hair cells in the organ of Corti significantly decreased in the control group compared with that in the PRP group. Although no statistically significant difference was observed between the groups regarding ABR thresholds on day 4 (P = 0.083, a statistically significant difference was observed between groups at week 3 (P = 0.038). Our results suggest that PRP can prevent cisplatin-induced ototoxicity.

An Analysis of Association Between Nasal Bone Morphology and Sinonasal Anatomical Variations.

The goal of this study was to investigate the association between various sinonasal anatomical variations and the morphological features of lateral nasal bone, using paranasal computerized tomography (PNCT) sections. Two hundred and fifty patients who underwent a PNCT scan because of a prediagnosis of nasal septum deviation or sinusitis were included in the study. For each patient, presence of the following anatomical variations was determined on CT sections: length and thickness of nasal bone, thickness of intermediate nasal bone, pneumatized middle turbinate, paradox middle turbinate, Agger nasi cell, Haller cell, Onodi cell, supraorbital cell, pneumatized uncinate process, and nasal septal deviation. The effect of each anatomical variation on the length and thickness of the lateral nasal bone was investigated. The patients with bilateral pneumatized middle turbinate and the patients with bilateral Agger nasi cell had a thinner lateral nasal bone both on the right and the left sides compared to those without. The patients with bilateral Onodi cell and Agger nasi cell had a longer lateral nasal bone both on the right and the left sides compared to those without. The nasal bone thickness was significantly thicker on the deviation side than the contralateral nasal bone. The nasal bone length was significantly longer on the side of the septum deviation. In this study, we found that sex, presence of Agger nasi and Onodi cells, pneumatization of middle turbinate, and direction of nasal septal deviation influenced the morphology of the nasal bone. For successful nasal surgery, careful examination of preoperative anatomical variations is very important.

Morphometric evaluation of the pterygoid hamulus and upper airway in patients with obstructive sleep apnea syndrome.

PURPOSE: Many anatomical factors are known to cause obstructive sleep apnea syndrome (OSAS), but only few studies have examined the relationship between the morphology of pterygoid hamulus (PH), upper airway, and OSAS severity. This study aimed to investigate the relationship between the severity of OSAS and PH morphology and other anatomical variations of the upper airway. METHODS: The data of the patients who underwent polysomnography and diagnosed with OSAS were retrospectively reviewed, and those who underwent paranasal sinus computed tomography were determined. The patients were divided into three groups according to the apnea-hypopnea index (AHI) scores obtained from the polysomnography (mild, moderate, and severe). The relationship between PH thickness, length and interpterygoid distance, and the severity of AHI was investigated. RESULTS: Seventy-four patients were included in the study. In patients with severe OSAS (1.83 ± 0.29 mm), the PH bone thickness was significantly thicker compared to those with mild OSAS (1.59 ± 0.36 mm) (p = 0.03). When the interpterygoid distance and its ratio to the velopharyngeal length were examined, it was found significantly shorter in patients with severe OSAS than mild cases (p < 0.001; p = 0.045, respectively). CONCLUSION: Our results showed that OSAS severity was associated with hamulus thickness, interpterygoid distance, and the ratio of interpterygoid distance to VL. Our study provides further insight into the pathophysiology of sleep apnea, suggesting that morphometric evaluation of the pterygoid hamulus and upper airway measurements can assist clinicians in stratifying and determining the best treatment options for patients with OSAS.

Effect of mastoid bone pneumatization on the conformation and depth of the sinus tympani, a high-resolution computed tomography study.

PURPOSE: To investigate the relationship between mastoid pneumatization and the conformation and depth of the sinus tympani (ST) in patients with chronic otitis media (COM), based on the high-resolution computed tomography (HRCT) scans. METHODS: Two hundred and two patients affected by COM were included in the study. The patients were divided into three groups according to the extent of mastoid pneumatization on HRCT scans; pneumatized (group 1), diploic (group 2) or sclerotic (group 3). The variation in the ST area (types A, B, C) was assessed using a radiomorphological classification based on the relationship between the medial boundary of the ST and the third portion of the facial nerve. Depth of the ST was calculated by measuring the distance between the medial boundary of the ST and medial boundary of the third portion of the facial nerve RESULTS: There was a statistically significant difference between the groups in terms of the type of ST (p < 0.001). The mean depths of the ST were 1.59 ± 0.82 mm (0.00-2.80 mm) in group 1, 1.10 ± 0.79 mm (0.00-3.00 mm) in group 2 and 0.53 ± 0.63 mm (0.00-2.60 mm) in group 3. The groups were significantly different in terms of the depth of the ST (p < 0.001). CONCLUSION: A well-pneumatized mastoid is highly associated with a deep and posteriorly positioned ST with respect to the facial nerve. The preoperative HRCT scans of patients with cholesteatoma should be carefully evaluated to determine the conformation and depth of the ST.

Type 1 tympanoplasty in pediatric patients: a review of 102 cases.

BACKGROUND: The aim of this study was to investigate the success of type 1 tympanoplasty in pediatric patients with chronic otitis media, and to evaluate the prognostic factors that may influence its success. MATERIALS AND METHODS: Medical records of 102 children aged between 8 and 18 years (46 female, 56 male) who underwent type 1 tympanoplasty for chronic tympanic membrane perforation between January 2010 and July 2017 were reviewed. Age, gender, condition of contralateral ear (unilateral, bilateral), type (central, marginal) and location of perforation (anterior, posterior, inferior), graft material (fascia, cartilage), pre- and post-operative hearing levels, mean air-bone gap (ABG), surgical approach (postauricular, endaural) and length of follow up were recorded. RESULTS: Anatomical and functional success (ABG < 20 dBHL) rates were 86.3% (88 patients) and 74.5% (76 patients) after a mean follow-up of 32 ± 16.55 months, respectively. The mean hearing improvement was 10.77 ± 10.45 dBHL. The graft success rates were significantly higher in tragal cartilage group (95.1%) than in temporalis fascia group (80.3%) (p = 0.033). Graft success was negatively affected by contralateral perforation (p = 0.003). All patients with bilateral perforations and graft failure were in temporalis fascia group. Age, type and location of perforation and surgical approach did not influence graft success (p > 0.05). CONCLUSION: Our results showed that type 1 tympanoplasty can be performed effectively in pediatric population regardless of age, location and type of perforation and surgical approach. Bilateral perforations are prone to reperforation, and should be treated with cartilage graft.

Infiltration with lidocaine and adrenaline instead of normal saline does not improve the septoplasty procedure.

The aim of this study was to determine whether infiltration of local anesthetics with adrenaline improved septoplasty procedure when compared to normal saline. Eight-two patients undergoing septoplasty were randomized into two groups. In group 1, septal mucoperichondrium was infiltrated with lidocaine with adrenaline, and normal saline was used in group 2. Presence of intra-operative septal mucosal injuries, the amount of bleeding, arterial blood pressure, operation time as well as the quality of the surgical field and the convenience of finding the correct surgical plane as determined by the surgeon using a 5-point scale were compared between two groups. There were no significant differences for the amount of blood loss, mean arterial pressure, operation time, or scores for convenience of finding the correct surgical plane between the two groups. There was no significant difference for intra-operative simple (P = 0.631) and total (simple+severe) (P = 0.649) septal mucoperichondrial injuries between groups 1 and 2, either. However, severe mucoperichondrial injury rate was higher in the patients infiltrated with lidocaine and adrenaline (P = 0.026), and the quality of the surgical field was worse in the patients injected with normal saline (P = 0.0179). Infiltration of septal mucoperichondrium with lidocaine and adrenaline instead of normal saline was not advantageous in terms of objective parameters tested, including bleeding amount and duration of surgery as well as the of the total mucosal injury rate in septoplasty procedure.

Elevated serum calprotectin as an inflammatory marker in obstructive sleep apnea.

OBJECTIVE: To investigate the serum calprotectin (SCal) levels and neutrophil/lymphocyte ratio (NLR) values in patients with obstructive sleep apnea (OSA). METHODS: Sixty-seven OSA patients and 46 healthy volunteers without any sleep disorders were included in the study. The patient group was divided into three subgroups according to the severity of OSA. The SCal levels and NLR values were compared among subgroups and between the experimental and control groups. RESULTS: The mean SCal level and NLR value were higher in the study group than in the control group (p = 0.002 and p = 0.001, respectively). The SCal levels were significantly higher in patients with severe OSA than in those with moderate and mild OSA (p = 0.004 and p = 0.001, respectively). DISCUSSION: Unlike NLR, the SCal level may inform the severity of OSA and could be used as an indicator for OSA.

Evaluation of Anterior and Posterior Pillar Suturing Following Adult Tonsillectomy in Terms of Hemorrhage, Pain, and Dysphagia Complications.

Tonsillectomy is one of the most common surgical procedures performed by otolaryngologists. Postoperative complications, although rare, can be observed in tonsillectomy. This study aimed to investigate the effect of anterior and posterior pillar suturing on dysphagia, hemorrhage, and pain complications following tonsillectomy in adult patients. The study included 80 patients (32 males, 48 females; > 18 years) who underwent tonsillectomy. The patients were divided into two groups: Group 1, in which the tonsillar lodge was closed by anterior-posterior pillar suturing with a 3-0 chromic catgut suture after hemostatic compression and Group 2, in which the tonsillar lodge was exposed following hemostatic compression and bipolar cauterization. Post-surgical pain was assessed using the Numeric Rating Scale (NRS). Oropharyngeal dysphagia was evaluated using the Eating Assessment Tool (EAT)-10. None of the patients experienced postoperative primary hemorrhage. However, postoperative secondary hemorrhage was observed in seven patients, two from Group 1 and five from Group 2. There was no significant difference in postoperative hemorrhage between the two groups (p = 0.449). Furthermore, no statistically significant difference was observed between the two groups in terms of the NRS scores on postoperative day 1 and at postoperative week 2 (p = 0.130 and 0.142, respectively) or the EAT-10 scores at postoperative week 2 and postoperative month 6 (p = 0.925 and 0.090, respectively). Anterior-posterior pillar suturing, which is performed for hemorrhage control after tonsillectomy, is not superior to the conventional bipolar method in terms of postoperative dysphagia, hemorrhage, and pain.

Investigation of EGF, IL1-α and IL-6 levels and selected hematological parameters (NLR, MPV) in patients with the chronic cholesteatomatous otitis media.

In this study we aimed to investigate epidermal growth factor (EGF), interleukin (IL1)-α and IL-6 levels, and hematological parameters in the serum samples of patients with chronic cholesteatomatous otitis media (CCOM). This prospective included 40 patients who underwent surgery due to CCOM between June 2020 and May 2021. The stage of middle ear cholesteatoma was determined on each chart using the EAONO/JOS system. The control group comprised of 30 adults who were scheduled for septoplasty over the same period in our hospital, had no otological complaints, and had normal otological findings. The demographic, clinical, and laboratory data of the patients were obtained from the electronic medical record system of our hospital. The serum EGF, IL1-α and IL-6 levels, and hematological parameters (neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV)) were compared between the CCOM and control groups. Seven patients had Stage 1 and 33 patients had Stage 2 middle ear cholestatoma. There was no statistically significant difference between the CCOM and control groups in terms of age and gender (p=0.092 and p=0.616, respectively). The serum EGF and IL1-α levels of the CCOM group were statistically significantly higher than those of the control group (p=0.047 and p=0.013, respectively). No statistically significant difference was observed in the serum IL-6 levels of the CCOM and control groups (p=0.675). There was also no significant difference between the CCOM and control groups in terms of the mean NLR and MPV values ​​(p=0.887 and p=0.164, respectively). There was no significant difference between the Stage 1 and Stage 2 cholesteatoma subgroups in terms of the mean EGF, IL1-α, IL-6 levels (p=0.204, p=0.557 and p=0.613, respectively), and the mean NLR and MPV values (p=0.487, p=0.439, respectively). Increased serum EGF and IL1-α levels in patients with CCOM suggest that these cytokines may play a role in cholesteatomatous epithelial hyperproliferation.

Postoperative Anatomical and Functional Success Rates of Pediatric Patients with Chronic Otitis Media: Our Experiences.

The preoperative and postoperative pure-tone hearing thresholds and anatomical graft success of pediatric patients who underwent chronic otitis mediasurgery with various indications were evaluated and the factors affecting success were examined.Pediatric patients aged 6 to 18 years, who underwent ear surgery for various reasons between January 1, 2013 and January 1, 2020 were included in the study. All patients included in the sample were assessed in terms of age (< 13 and ≥ 13 years), disease type (cholesteatoma, tympanosclerosis, adhesive otitis media, chronic suppurative otitis media, isolated or traumatic tympanic membrane perforation), surgery performed (type 1 tympanoplasty, canal wall-up mastoidectomy, and exploratory tympanotomy), condition of the contralateral ear (unilateral/bilateral disease), graft material (temporal muscle fascia/tragal cartilage), preoperative and postoperative pure-tone audiometry thresholds and hearing gains, and postoperative sixth-month functional and anatomical graft success. Anatomical graft success and functional success were also evaluated according to the type of surgery performed, type of disease, type of fascia used in surgery, condition of the contralateral ear, and age. No statistically significant difference was found between the groups in terms of anatomical graft success and functional success according to the type of surgery performed (p = 0.414 and p = 0.123, respectively) and type of disease (p = 0.454 and p = 0.097, respectively). There was also no statistically significant difference between the anatomical and functional success of temporal muscle fascia and conchal cartilage grafts (p = 0.833 and p = 0.565, respectively). While no statistically significant difference was observed in graft success between the patients with and without contralateral ear disease, there was a statistically significant difference in functional success (p = 0.188 and p = 0.014, respectively). Although not statistically significant, it was observed that the anatomical graft success rates were decreased in patients with contralateral ear disease compared to those without bilateral disease (p = 0.188). There was no significant difference between age and anatomical graft success (p = 0.865) or functional success (p = 0.956). The type of disease in the diagnosed ear, presence of disease in the contralateral ear, and graft material used affect functional and anatomical graft success rates. Therefore, we believe that pediatric patients should be evaluated considering these factors in the preoperative period and the parents of these patients should be well informed about possible postoperative conditions.

Evaluation of the vestibular system in individuals with presbycusis using video head impulse test and videonystagmography.

BACKGROUND: Vestibulo-ocular reflex (VOR) function is expected to be normal in patients with presbycusis during sudden head rotations. AIM: This study aimed to determine whether presbycusis was accompanied by vestibular system pathologies. In addition, it was examined whether there was a difference existed between the patients with and without presbycusis in terms of normative data. MATERIALS AND METHODS: A total of 40 individuals were included in the study: 20 in the presbycusis group and 20 in the control group. The vestibular systems of both groups were evaluated using the video head impulse test and videonystagmography. RESULTS: The right and left lateral VOR gain values were decreased in the group with presbycusis compared to the control group. The difference between the two groups in the mean VOR gains in the right lateral canal and left lateral canal were statistically significant (p = .040 and p = .050, respectively). The air caloric tests of all individuals were found to be normal. CONCLUSIONS: This result suggests that the loss of vestibular hair cells and vestibular nerve degeneration in the lateral semicircular canal may be more severe in presbycusis than in the same age group with normal hearing.

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.

Investigation of the Effects of Internal and External Lateral Osteotomies on Periorbital Edema and Ecchymosis in Patients Undergoing a Septorhinoplasty.

OBJECTIVE: Periorbital ecchymosis and edema are common after septorhinoplasty surgery. This study aimed to compare internal and external lateral nasal osteotomies performed in septorhinoplasty in terms of postoperative ecchymosis and edema. METHODS: Patients who underwent septorhinoplasty between January 2020 and July 2020 in our clinic were included in the study. In all patients, right lateral nasal osteotomies were performed endonasally and left lateral nasal osteotomies externally. The postoperative 1st, 7th, and 14th day ecchymosis and edema scores of all patients were calculated separately for the two groups and compared. RESULTS: A total of 60 patients (29 females, 31 males) were included in the study. The mean age of the patients was 33.88 ± 10.30 years. No significant difference was observed between the two groups in terms of the postoperative periorbital ecchymosis scores on the first day and the first and second weeks (0.314, 0.344, and 0.468, respectively). There was also no significant difference between the two groups in terms of the postoperative periorbital edema scores on the first day and at the first and second weeks (0.272, 0.359, and 0.513, respectively). CONCLUSION: The results obtained from this study showed no significant difference in the periorbital ecchymosis and edema scores between the patients who had undergone septorhinoplasty with internal or external lateral osteotomies. Further multicenter studies are recommended to verify the findings of this study with a larger sample size.

Assessment of Patient Satisfaction With Primary Septorhinoplasty Using the Rhinoplasty Outcome Evaluation Questionnaire.

OBJECTIVE: To evaluate patient satisfaction according to demographic characteristics using the Rhinoplasty Outcome Evaluation (ROE) questionnaire. METHODS: In this retrospective observational study, a total of 60 patients that underwent septorhinoplasty were evaluated. The ROE questionnaire was administered to evaluate patient satisfaction after septorhinoplasty. RESULTS: There were 24 (40%) males and 36 (60%) females in the study. The mean age of the patients was 32.5 years. In the whole sample, the mean postoperative ROE score was 87.9. It was observed that the mean postoperative ROE score of the patients aged 30 and below was lower compared to the >30 age group (p < 0.001). Furthermore, the mean postoperative ROE score was significantly higher in male patients than in females (p = 0.019). CONCLUSION: We conclude that the ROE questionnaire is a simple and useful tool for evaluating septorhinoplasty outcomes. Demographic characteristics such as male gender and age > 30 are factors that positively affect the satisfaction of patients with septorhinoplasty.

A proinflammatory marker in chronic rhinosinusitis: serum calprotectin.

INTRODUCTION: Studies have shown that calprotectin has a strong pro-inflammatory effect. Elevated calprotectin levels in the serum can be used as a strong clinical marker indicating the presence of inflammation. OBJECTIVE: To investigate serum calprotectin levels in patients with chronic rhinosinusitis (CRS) and to determine the applicability of calprotectin as a potential molecular pro-inflammatory biomarker for CRS. METHODS: The study consisted of three groups: chronic rhinosinusitis with polyps (CRSwNP group), chronic rhinosinusitis without polyps (CRSwoNP), and healthy control. CRS patients with polyps were further divided into two groups depending on the presence/absence of Samter's triad. The Nose Obstruction Symptom Evaluation (NOSE) scale score and serum calprotectin value were evaluated in all participants. RESULTS: The mean serum calprotectin value was 79.5±11.8 ng/ml for the CRSwNP group, 71.3±16 ng/ml for the CRSwoNP group, and 61.9±11.6 ng/ml for the control group (p<0.001). The Samter's triad group had a significantly higher calprotectin value than the non-Samter's triad group (p=0.03). There was a significant correlation between the NOSE scores and calprotectin levels (rho=0.734, p<0.001). CONCLUSION: Serum calprotectin values were correlated with the severity of symptoms in patients with CRS; thus, it seems to be a valuable pro-inflammatory biomarker for the diagnosis of the disease and determining its severity. Further studies with larger series are needed to evaluate the preoperative and postoperative serum calprotectin values ​​in patients undergoing surgery.

Evaluation of Nivolumab for Ototoxic Effects: An Animal Study in Rats.

OBJECTIVES: The aim of this study was to assess whether nivolumab is ototoxic in rats and whether this ototoxicity is dose-dependent. MATERIALS AND METHODS: Twelve rats were divided into two groups: Group 1 (control group, 6 rats, 12 ears) received intraperitoneal saline for 14 days. Group 2 (study group, 6 rats, 12 ears) and received two doses of 3 mg/kg intraperitoneal nivolumab within 14 days. Auditory brainstem responses (ABRs) were performed preoperatively and 4 and 8 weeks postoperatively. We compared between the groups, morphologic appearance of spiral ganglion cells and organ of Corti and density of spiral ganglion cells (measured with conventional light microscope connected to a personal computer). RESULTS: In our control group, both spiral ganglion and organ of corti had a normal morphological appearance. In our study group, spiral ganglion cells had a normal morphological appearance. However, some sections showed possibly mild degenerative changes in the organ of corti. Of 12 samples in the study group, four had a significant loss of density of spiral ganglion cells compared to the control group. The baseline ABR thresholds did not significantly differ between the groups (p=0.713). There was no statistically significant difference between the groups regarding ABR thresholds at week 4 (p=0.347). However, a statistically significant difference was observed in the ABR thresholds at week 8 (p=0.045). CONCLUSION: The results of our study showed that nivolumab treatment has ototoxic effects. Based on our results, we recommend monitoring the changes in the hearing ability of chemotherapy patients.

Cautionary High-resolution Computed Tomography Findings for the Presence of Facial Canal Dehiscence in Patients with Cholesteatoma.

Objective This study aimed to investigate the abnormal high-resolution computed tomography (HRCT) findings in cholesteatomatous chronic otitis media (CCOM) patients preoperatively and the coexistence of abnormal HRCT findings with facial canal dehiscence (FCD) observed intraoperatively to identify the predictive factors associated with FCD. Methods The medical records of 151 CCOM patients who had undergone tympanomastoidectomy at our center were retrospectively examined in terms of the patients' age and gender, preoperative HRCT findings [scutum defect, posterior wall of external auditory canal (PWEAC) defect, lateral semicircular canal (LSSC) defect, tegmen defect, and sigmoid plate erosion]. Operation records containing information about FCD were also analyzed. Results The prevalence of FCD was found to be 33.8% (51/151). There was a significant correlation between the presence of scutum, PWEAC, LSSC, and tegmen defects and the presence of FCD. However, no statistically significant correlation was found between the presence of sigmoid plate erosion and the presence of FCD. The results of regression analysis of the coexisting pathologic findings for FCD showed that the risk of FCD was highest in patients with LSSC + scutum defects (34.3-fold increase), followed by LSSC + PWEAC defects (31.6-fold increase). Conclusion Our study revealed that the presence of scutum, PWEAC, LSSC, and tegmen defects on HRCT indicates a higher risk of FCD preoperatively. This risk is even greater when multiple abnormal findings coexist.