Effects of hyaluronic acid on the bone healing after lateral osteotomy: an experimental animal model.

OBJECTIVE: Postoperative comfort of the patients undergoing rhinoplasty might be poor because of edema and ecchymosis caused by lateral osteotomy. In this animal experiment, we aimed at performing a quantitative assessment of effects of hyaluronic acid usage on healing process of lateral osteotomy. METHODS: Fourteen New Zealand rabbits with a weight of 2000-2500 kg and an age of 8-12 weeks were included. Under anesthesia, nasal dorsums were exposed with midline incision and lateral osteotomies on both sides were performed using a 2 mm chisel. A hyaluronic acid-based mesh (Hyalonect®) (1 × 1 cm) was embedded on the left osteotomy areas of all rabbits. Right osteotomy areas were left blank as control group. Collagen density and capillary development were quantitatively compared. RESULTS: Convergence of fracture lines was observed in 6 (60%) of 10 samples from Hyalonect® group, while was observed in 4 (40%) of 10 samples from control group. Although a higher rate of convergence was seen in the Hyalonect® group (60% vs 40%), the difference was not statistically significant (p = 0.5). Median collagen score was 2 (1-3) in the Hyalonect® group and 1 (1-2) in the control group. Median capillary count value was 4 (1-23) in the Hyalonect® group and 3 (1-17) in the control group. Both collagen score and capillary count values were significantly greater in the in the Hyalonect® group compared with the control group (p = 0.023 and p = 0.019, respectively). CONCLUSION: The effects of hyaluronic acid-based meshes on the bone healing process of the lateral osteotomy area might be investigated furthermore, on more comprehensive studies, as a material facilitating collagen organization and capillary development.

The association of nasal foreign bodies with type 1 hypersensitivity in children.

PURPOSE: This study aimed at investigating the type 1 hypersensitivity reaction frequency of children with nasal foreign body history. METHODS: From the medical records, we collected data regarding demographics (age and gender), symptoms, history of allergic diseases, physical examination, laboratory and test results, radiographic findings, the presence of any need for a second intervention, and complications. By reference to the presence of nasal foreign body history, two groups were constituted: the nasal foreign body group and the control group. Type 1 hypersensitivity frequency of the nasal foreign body group was compared with the control group. RESULTS: In the nasal foreign body group, 47 of 110 patients (42.7%) had a previous history of type 1 hypersensitivity reaction, while only 15 of 100 patients (15%) had a previous history of type 1 hypersensitivity reaction in the control group. The frequency of type 1 hypersensitivity reactions was significantly higher in patients with a history of nasal foreign body, compared to the patients without (p < 0.001, X2 = 19.35). CONCLUSION: Children with type 1 hypersensitivity reactions may be more likely to present with nasal foreign bodies. Physicians should pay more attention to the history of type 1 hypersensitivity reactions in children presenting with nasal foreign bodies.

Evaluation of oral isotretinoin effects on hearing system in patients with acne vulgaris: Reversible or not?

Systemic isotretinoin is commonly used for severe acne treatment. It has many side effects, one of these is about hearing system, which has rarely been reported, also previous studies reported contradictory results about systemic isotretinoin and its association with hearing system. In this study, we aimed to investigate whether systemic isotretinoin affected on the hearing system or not. The study included 32 acne vulgaris patients (64 ears) who treated with oral isotretinoin 0.5 mg/kg body weight for at least 4 months and audiometric tests including pure-tone, speech, bilateral acoustic reflexes, and tympanometric measurements were performed at baseline, in the first week, in the first month, and third month of treatment, and sixth month after treatment. Audiometric tests were performed for right and left ears separately. A significant difference was found in the pure-tone thresholds (before treatment, first week, first month, third month of treatment, and sixth month after treatment) for the both ears at 8000 Hz (P < .001) and a significant decrease in the sixth month post-treatment pure-tone thresholds compared to pre-treatment thresholds at 8000 Hz. Additionally, a statistically significant increase was observed in serum LDL and triglyceride levels in the third month of treatment and a significant decrease at the sixth month after treatment (P < .001). Systemic isotretinoin caused bilateral hearing threshold changes in acne patients during the therapy but the changes improved after discontinuation. Therefore, our findings may provide safety using for dermatologists about hearing effects of isotretinoin, which is quite effective on severe acne.

The novel indicators of moderate to severe sleep apnea: fibrinogen to albumin ratio vs. CRP to albumin ratio.

PURPOSE: This study aimed at investigating the association of severity of obstructive sleep apnea with the markers of inflammation as fibrinogen to albumin ratio and C-reactive protein to albumin ratio. METHODS: We included 126 patients admitted to sleep disorders outpatient clinic. We constituted four groups by reference to the apnea-hypopnea index (mild-moderate-severe sleep apnea and control group). We investigated the difference of white blood cell, fibrinogen to albumin ratio, C-reactive protein to albumin ratio, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and hemoglobin among the groups. RESULTS: Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and hemoglobin did not significantly differ among four groups (p = 0.39, p = 0.06, and p = 0.31, respectively). A significant difference of fibrinogen to albumin ratio and C-reactive protein to albumin ratio was evident among four groups (p < 0.001). Fibrinogen to albumin ratio and C-reactive protein to albumin ratio did not significantly differ between the mild sleep apnea and control groups (p = 0.65, and p = 0.85, respectively), but were significantly greater in moderate sleep apnea group compared with the control group (p < 0.001 and p = 0.001, respectively). Also, fibrinogen to albumin ratio and C-reactive protein to albumin ratio were significantly greater in the severe sleep apnea group compared with the control group (p < 0.001). Fibrinogen to albumin ratio and C-reactive protein to albumin ratio did not significantly differ between the severe sleep apnea and moderate sleep apnea groups (p = 0.49, and p = 0.58, respectively). CONCLUSION: Higher fibrinogen to albumin ratio and C-reactive protein to albumin ratio may be predictive of inflammation in patients with moderate-to-severe sleep apnea.

Is C-reactive protein to albumin ratio an indicator of poor prognosis in Bell's palsy?

PURPOSE: The aim of this study was to determine whether the C-reactive protein to albumin ratio was associated with the prognosis in patients with Bell's palsy. METHODS: Reviewing records of 79 patients diagnosed with Bell's palsy, 3 groups were constituted: recovered group (with a House Brackman grade of 1 or 2 after treatment, 56 patients), unrecovered group (23 patients) and control group (60 healthy individuals). Age, hemoglobin, C-reactive protein to albumin ratio, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, white blood cell and hemoglobin values were compared among the groups. RESULTS: Age, hemoglobin and platelet to lymphocyte ratio were not significantly different between the groups (p = 0.12, p = 0.31, p = 0.86 and p = 0.87, respectively). Median C-reactive protein to albumin ratio, neutrophil to lymphocyte ratio and white blood cell were significantly greater both in non-recovery group (p < 0.001) and recovery group (p = 0.001 and p < 0.001, respectively) compared to the control group. Additionally, median C-reactive protein to albumin ratio and neutrophil to lymphocyte ratio were significantly greater in the non-recovery group, compared to the recovery group (p = 0.002, and p < 0.001, respectively). However, median white blood cell did not significantly differ between the non-recovery and the recovery groups (p = 0.89). CONCLUSION: Higher C-reactive protein to albumin ratio and neutrophil to lymphocyte ratio were associated with poor prognosis in patients with Bell's palsy. C-reactive protein to albumin ratio might be the most significant indicator of poor prognosis in patients with Bell's palsy.

Is Nasal Septal Body Size Associated With Inferior Turbinate Hypertrophy and Allergic Rhinitis?

Nasal septal body is a thickened mucosal area of nasal septum with an unknown certain role. In this study, the authors aimed to investigate the association between the area, length, and width of the nasal septal body with inferior turbinate hypertrophy (ITH) and allergic rhinitis (AR). A total of 106 patients with ITH (54 with AR and 52 without AR), and 49 patients without ITH and AR (control group) were included in this study. Using axial and coronal paranasal computed tomography scans, the area, length, and width of nasal septal body were measured, and the mean values between the groups were compared. Mean area, length, and width of nasal septal body significantly differed among 3 groups (P < 0.001). Septal body area was significantly greater in ITH with AR group, compared to ITH without AR group (P < 0.001) and the control group (P < 0.001). Also, it was significantly greater in ITH without AR group compared to the control group (P < 0.001). Septal body width was significantly greater in ITH with AR group, compared to ITH without AR group (P < 0.001) and the control group (P < 0.001). Also, it was significantly greater in ITH without AR group compared to the control group (P < 0.001). Patients with ITH had a greater nasal septal body area, length, and width, compared to the patients without. Moreover, AR had an additional increasing effect on the area and width of the nasal septal body.

The association between obstructive sleep apnea and hearing loss: a cross-sectional analysis.

PURPOSE: To determine if sleep apnea had significant effects on hearing functions and to investigate the polysomnography parameters that might be associated with hearing impairment in sleep apnea patients. METHODS: We included 120 patients who were admitted to sleep disorders outpatient clinic. We constituted four groups by reference to the apnea-hypopnea index (including control group), and compared the audiometric parameters of the groups. Additionally, we investigated the correlation of apnea-hypopnea index, desaturation index and min. oxygen saturations with pure-tone thresholds, speech recognition thresholds and speech discrimination scores. RESULTS: The median pure-tone thresholds at 250, 500, 1000, 2000, 4000 and 8000 mHz, the median speech recognition thresholds and the median speech discrimination scores on both ears did significantly differ among four groups (p < 0.001). Moderate sleep apnea affected high-frequency hearing functions and speech discrimination scores, and severe sleep apnea had significant effects on all hearing functions. Pure-tone thresholds and speech recognition thresholds on the both ears were positively correlated with apnea-hypopnea index and desaturation index, and negatively correlated with min. oxygen saturation (p < 0.001). Speech discrimination scores on the both ears were negatively correlated with apnea-hypopnea index and desaturation index, and positively correlated with min. oxygen saturation (p < 0.001). CONCLUSION: Obstructive sleep apnea syndrome (OSA) had several effects on hearing, and hearing impairment might be associated with the severity of OSA. Moderate OSA affected high-frequency hearing functions and severe OSA affected all hearing functions negatively.

Coexistence of frontal sinus hypoplasia with maxillary sinus hypoplasia: a radiological study.

The goal of this study was to determine whether frontal sinus hypoplasia coexists with maxillary sinus hypoplasia. Analyzing paranasal CT scans retrospectively, we included 86 patients who had a hypoplastic maxillary sinus at least on one side and 80 patients with bilateral normal maxillary sinuses (control group). We classified hypoplastic maxillary sinuses using the classification system previously defined by Bolger et al. (Otolaryngol Head Neck Surg 103(5):759-765, 1990). We classified the frontal sinuses as aplastic, hypoplastic, medium-sized, and hyperplastic; as previously defined by Guerram et al. (Am J Phys Anthropol 154(4):621-627, 2014). We compared the presence of frontal sinus hypoplasia using Chi-square test between the groups. The mean age of the maxillary sinus group was 43.2 (range 18-84) years. Of 86 patients, 33 (38.4%) had unilateral and 53 (61.6%) had bilateral maxillary sinus hypoplasia. Of 139 maxillary sinuses totally included, 73 (52.5%) were type 1, 51 (36.7%) were type 2 and 15 (10.8%) were type 3 hypoplastic maxillary sinuses. Of 332 frontal sinuses totally included, 25 (7.5%) were aplastic, 32 (9.6%) were hypoplastic, 172 (51.9%) were medium-sized, and 103 (31%) were hyperplastic. Of 86 patients with a hypoplastic maxillary sinus at least on one side, 29 (33.7%) had a hypoplastic and/or aplastic frontal sinus, while 10 (12.5%) had a hypoplastic and/or aplastic frontal sinus at least on one side in control group. Incidence of frontal sinus hypoplasia and/or aplasia was significantly higher in patients with maxillary sinus hypoplasia compared to the patients with bilaterally normal maxillary sinuses (χ2 = 10.384, P = 0.001). Maxillary sinus hypoplasia has a significantly higher coexistence with frontal sinus hypoplasia. This study may have an implication for anatomical studies about the development of the paranasal sinuses and paranasal sinus surgery as well as further morphological studies.

Localization of orbit in patients with maxillary sinus hypoplasia: a radiological study.

PURPOSE: We aimed to investigate the medial and inferior localization of orbit in patients with maxillary sinus hypoplasia using paranasal computerized tomography. METHODS: We included 76 patients who had a hypoplastic maxillary sinus at least on one side, and 76 patients with normal maxillary sinuses (control group). To assess the localization of orbit, we measured the distances from middle meatal antrostomy point to medial border of orbital medial wall and to the lower border of orbital floor in all patients. We performed statistical comparisons between the groups. RESULTS: Of 76 patients, 26 (34.2%) had unilateral and 50 (65.8%) had bilateral maxillary hypoplasia. Of 126 maxillary sinuses, 70 (55.6%) was type 1, 42 (33.3%) was type 2 and 14 (11.1%) was type 3 hypoplastic. The mean distance from antrostomy point to lamina papyracea was 4.36 ± 2.62 mm in the hypoplasia group, and 1.08 ± 1.7 mm in the control group. The mean distance from antrostomy point to orbital floor was 1.53 ± 1.73 mm in the hypoplasia group, and 1.87 ± 1.96 mm in the control group. Lamina papyracea showed a significant medial localization in the maxillary hypoplasia group as compared to the control group (p < 0.001). CONCLUSION: The orbit has a medial localization in patients with maxillary sinus hypoplasia resulting in a higher complication risk during endoscopic sinus surgery.

Cochlear changes in serous labyrinthitis associated with silent otitis media: A human temporal bone study.

PURPOSE: To determine histopathological findings in the cochlea of human temporal bones with serous labyrinthitis. MATERIALS AND METHODS: We compared human temporal bones with serous labyrinthitis (20 cases) associated with silent otitis media and without serous labyrinthitis (20 cases) to study location of serous labyrinthitis, the degree of endolymphatic hydrops, number of spiral ganglion cells and hair cells, loss of fibrocytes in the spiral ligament, and areas of the spiral ligament and stria vascularis. RESULTS: The serous labyrinthitis caused significant loss of outer hair cells in the lower basal (P=0.006), upper basal (P=0.005), and lower middle (P=0.011) cochlear turns, and significant increase in the degree of endolymphatic hydrops than the control group (P=0.036). No significant difference was found in the loss of inner hair cells, in the number of spiral ganglion cells and fibrocytes in the spiral ligament, and in areas of the stria vascularis and spiral ligament (P>0.05). CONCLUSIONS: Serous labyrinthitis resulted in significant loss of outer hair cells and significant increase in the degree of endolymphatic hydrops.

Histopathologic ear findings of syphilis: a temporal bone study.

To the best of our knowledge, histopathologic studies of syphilitic ears have generally focused on hydropic changes; so far, no such studies have investigated peripheral vestibular otopathology using differential interference contrast microscopy, in patients with syphilis. For this study, we examined 13 human temporal bone samples from 8 patients with a history of syphilis. Using conventional light microscopy, we performed qualitative histopathologic assessment. In addition, using differential interference contrast microscopy, we performed type I and type II vestibular hair cell counts on each vestibular sense organ with minimal autolysis; in which the neuroepithelium was oriented perpendicular to the plane of section. We then compared vestibular hair cell densities (cells per 0.01 mm² surface area) in the syphilis group vs. the control group. In the syphilis group, we observed precipitate in the endolymphatic or perilymphatic spaces in 1 (7.7 %) of the samples and endolymphatic hydrops in eight (61.5 %) of the samples. Hydrops involved the cochlea (four samples) and/or saccule (four samples). In addition, the syphilis group experienced a significant loss of type II vestibular hair cells in the maculae of the utricle and saccule, and in the cristae of the lateral and posterior semicircular canals, as compared with the control group (P < 0.05).

A rare location for sarcoma metastasis: The temporal bone.

Skeletal sarcoma metastasis is relatively rare; moreover, for this type of metastasis, the temporal bone is also a rare location. The temporal bone appears to be affected by metastatic tumors in discrete histopathologic patterns, with characteristic clinical presentations. In this study, we analyzed the records of 6 patients with skeletal sarcoma metastasis to the temporal bone, with an emphasis on histopathologic sections of human temporal bones. The most common site of sarcoma metastasis in the temporal bone was petrous apex in our series. Physicians should keep in mind that a sarcoma patient may manifest with ear findings due to temporal bone metastasis.

The predictive value of Muller maneuver in REM-dependent obstructive sleep apnea.

To our knowledge, no studies up to date have investigated the correlation of rapid eye movement (REM) dependent obstructive sleep apnea syndrome (OSAS) and Muller maneuver. The aim of this study is to investigate whether REM-dependent OSAS is predicted by the findings of the Muller maneuver. The study was conducted on 149 patients with witnessed apnea and daytime sleepiness. Muller maneuver was performed to all patients and the obstruction site was determined using a five-point scale. Then, polysomnography of the patient was obtained and the apnea-hypopnea indexes were determined in total sleep time, REM-dependent sleep and non-REM-dependent sleep. The correlations between the Muller maneuver findings and polysomnographic data were analyzed. The ages of the patients included in the study ranged between 25 and 73 years with a mean age of 49.3 ± 10.1 years. Their mean body mass index was 30.8 ± 5.1 kg/m(2) (range 21.9-55.4 kg/m(2)). The patients' mean apnea-hypopnea indexes in total sleep time was 28.1 and ranged between 5.4 and 124.3. REM-dependent OSAS was determined in 49 patients. When the data were analyzed, it was determined that there were no statistically significant correlations between tongue base or lateral pharyngeal band obstruction at the level of hypopharynx and the REM-dependent OSAS. At the level of the soft palate, the obstruction caused by the lateral pharyngeal bands or soft palate and REM dependency did not show any statistically significant correlation (p > 0.05). In conclusion, Muller maneuver does not provide useful data to predict REM dependency of OSAS.

Evaluation of comorbidities in patients with OSAS and simple snoring.

AIM: OSAS is a disease characterized by repetitive air flow constraint or cessation due to airway collapse. Diseases that frequently coexist with OSAS and simple snoring were evaluated in this study. MATERIALS AND METHODS: This study was conducted in the Otorhinolaryngology Department of the Ankara Numune Hospital between April 2008 and April 2010 with 130 patients who presented with the complaints of snoring, witnessed apnea, and daytime drowsiness. Presence of chronic disease was compared to the demographics, BMIs, Epworth Scale scores, polysomnography, and physical examination findings. RESULTS: Comorbid diseases were present in 56 (43.1%) of the patients, and the most presented disease group was cardiovascular system diseases. Age, BMI, daytime drowsiness, and frequency of septum deviation were observed at higher rates in patients with chronic disease. Age, BMI, and frequency of septum deviation were associated with cardiovascular diseases. Endocrine disease was found to increase with decreased oxygen saturation. Neuropsychiatric diseases were associated with daytime drowsiness and age. The mean age was lower in cases with cigarette smoking compared to cases without. CONCLUSION: Frequency of the comorbidities mostly increased with age as expected. Comorbid diseases were also associated with obesity and daytime drowsiness. Cigarette smoking was associated with early-age disease.

Use of hyaluronic acid matrix in dorsal augmentation rhinoplasty.

Augmentation rhinoplasty sometimes is required for patients with saddle nose deformity caused by failed rhinoplasty or facial trauma; finding appropriate grafting material remains a significant problem for this procedure. We investigated hyaluronic acid matrix as an allograft for dorsal augmentation rhinoplasty in a rabbit model. We performed an osteotomy on the nasal bones of eight rabbits. Four animals were sham operated as the control group and four were administered a mixture of saline-gelled hyaluronic acid matrix and sliced cartilage. Ultrasonography and three-dimensional reconstruction tomography were performed at the end of the experimental period. After sacrifice of the animals, nasal tissues were examined for histopathology, and both collagen scores and number of capillaries were compared between the two groups. Increased collagen and capillaries were apparent in the hyaluronic acid matrix group compared to controls. The median collagen score was significantly greater for the hyaluronic acid matrix group than for the control group. Although the number of capillaries for the hyaluronic acid matrix group was greater than for the control group, the difference was not statistically significant. Three weeks is sufficient for adhesion of ends of fractures in clinical practice; however, we found no ossification at this time in either group. A hyaluronic acid matrix may be a useful alternative supplement for dorsal augmentation rhinoplasty. Development of collagen was commensurate with membranous ossification; however, assessment of complete ossification requires a longer experimental period.

Anterior epitympanic recess volume and Cog process length in temporal bones with Körner's septum: A radio- anatomical investigation.

OBJECTIVE: Körner's septum is a dense bony lamina dividing the mastoid cavity into superficial squamous and deeper petrosal portions at the level of antrum. In this study, we aimed at investigating the association of the Körner's septum with the length of the Cog process and the volume of anterior epitympanic recess (AER), using the 3-dimensional reconstruction models based on high resolution computed tomography sections of the temporal bone. METHODS: Using OsiriX software for MacOS (version 3.8.1, Pixmeo), we measured the volumes from three- dimensional models of anterior epitympanic recess. Anterior epitympanic recess volumes and Cog process lengths of the temporal bones with and without Körner's septum were compared. RESULTS: Cog process length was significantly higher, and AER volume was significantly lower in patients with Körner's septum compared to the patients without. (p < 0.001). Additionally, Cog process length was significantly (p = 0.008), negatively, but weakly (rho= -0.24) correlated with AER volume. CONCLUSION: Temporal bones with Körner's septum had a longer Cog process and a smaller AER.

Predictor parameters for poor prognosis in patients with sudden sensorineural hearing loss: fibrinogen to albumin ratio vs C-reactive protein to albumin ratio.

INTRODUCTION: Prognosis of sudden sensorineural hearing loss may be predicted using several parameters of laboratory blood analysis. OBJECTIVE: To identify and investigate the most significant indicator parameters related to the poor prognosis of sudden sensorineural hearing loss. METHODS: Eighty-eight patients were included, and three groups were constituted: non-recovery group with14 patients, recovery group with 33 patients and control group with 41 individuals. We compared fibrinogen-to-albumin ratio, C-reactive protein-to-albumin ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, white blood cell and hemoglobin of the groups. Then, we investigated the most significant indicator parameters related to the poor prognosis of sudden hearing loss. RESULTS: The mean hemoglobin, mean platelet-lymphocyte ratio and median white blood cell values did not significantly differ among three groups (p=0.36, p=0.86 and p=0.79, respectively). A significant difference of median fibrinogen-albumin ratio, C-reactive protein-albumin ratio, neutrophil-to-lymphocyte ratio was evident among three groups (p<0.001, p=0.003 and p=0.002, respectively). Median fibrinogen-albumin ratio, C-reactive protein-albumin ratio and neutrophil-to-lymphocyte ratio values were significantly greater in the non-recovery group, compared with the controls (p<0.001, p=0.003 and p=0.005, respectively). Median fibrinogen-to-albumin ratio, C-reactive protein-to-albumin ratio and neutrophil-to-lymphocyte ratio were significantly greater in the recovery group, compared with the controls (p<0.001, p=0.013 and p=0.005, respectively). Moreover, the median fibrinogen-albumin ratio was significantly greater in the non-recovery group compared with the recovery group (p=0.017). However, no statistically significant difference of median C-reactive protein-albumin ratio, neutrophil-to-lymphocyte was evident between the non-recovery and recovery groups (p=0.15). CONCLUSION: Increased levels of fibrinogen-albumin ratio may be predictive for poor prognosis in patients with sudden sensorineural hearing loss.

Eustachian tube dysfunction in sleep apnea patients and improvements afforded by continuous positive airway pressure therapy.

INTRODUCTION: Upper airway resistance may accompany eustachian dysfunction and alter middle ear pressure in patients with obstructive sleep apnea syndrome. OBJECTIVE: To investigate effects of obstructive sleep apnea syndrome and continuous positive airway pressure treatment on eustachian tube functions. METHODS: Forty-two mild obstructive sleep apnea syndrome patients, 45 moderate obstructive sleep apnea syndrome patients, 47 severe obstructive sleep apnea syndrome patients with continuous positive airway pressure therapy, 32 severe obstructive sleep apnea syndrome patients without continuous positive airway pressure therapy, and 88 individuals without sleep apnea (controls) were included. Tympanometric parameters of groups were compared. RESULTS: Right middle ear pressures in mild and moderate obstructive sleep apnea syndrome groups did not differ significantly from that of control group (p = 0.93 and p = 0.55), as was also true of the left middle ear pressures (p = 0.94 and p = 0.86). Right middle ear pressure was significantly higher in severe obstructive sleep apnea syndrome groups than in the control group, as was the left middle ear pressure (p < 0.001). Middle ear pressure (negative) was significantly lower in severe obstructive sleep apnea syndrome patients with continuous positive airway pressure therapy compared to those without (p < 0.001). Right ear type B and C tympanogram frequencies were significantly higher in patients with severe obstructive sleep apnea syndrome without continuous positive airway pressure therapy (12.4%) than in the controls (0%) (p = 0.02). Left ear type B or C tympanogram frequencies were significantly higher in patients with severe obstructive sleep apnea syndrome without continuous positive airway pressure therapy (21.9%) than in the controls (0%) (p = 0.002). CONCLUSION: Mild and moderate obstructive sleep apnea syndrome did not affect middle ear pressure but severe obstructive sleep apnea syndrome may increase the (negative) middle ear pressure. In severe obstructive sleep apnea syndrome patients, long-term continuous positive airway pressure therapy may normalize middle ear pressure.

The effects of intraday operation time on pain and anxiety of patients undergoing septoplasty.

INTRODUCTION: Anxiety and pain levels of septoplasty patients may vary according to intraday operation time. OBJECTIVE: To investigate the effects of septoplasty operation and intraday operation time on anxiety and postoperative pain. METHODS: Ninety-eight voluntary patients filled out the hospital anxiety and depression scale to measure the anxiety level three weeks before, one hour before and one week after surgery. Forty-nine patients were operated at 8:00am (morning group); other 49 were operated at 03:00pm (afternoon group). We used a visual analogue scale to measure postoperative pain. Preoperative and postoperative scores were compared, as were the scores of the groups. RESULTS: Median hospital anxiety and depression scale scores one hour before the operation [6 (2-10)] were significantly higher compared to the median scores three weeks before the operation [3 (1-6)] (p< 0.001), and one week after the operation [2 (1-6)] were significantly lower compared to the median scores three weeks before the operation [3 (1-6)] (p< 0.001). Hospital anxiety and depression scale scores one hour before the operation were significantly greater in the afternoon group [8 (7-10)], compared to the morning group [4 (2-6)] (p< 0.001). Postoperative first, sixth, twelfth and twenty-fourth-hour pain visual analogue scale scores were significantly higher in the afternoon group compared to the morning group (p< 0.001). CONCLUSION: Septoplasty might have an increasing effect on short-term anxiety and postoperative pain. Performing this operation at a late hour in the day might further increase anxiety and pain. However, the latter has no long-term effect on anxiety.

Association of Blood Subgroups With PCR Test Positivity and Lung Involvement in Patients With COVID-19.

Objective The goal of this study was to investigate whether blood group type caused susceptibility to COVID-19 infection. Methods Two hundred and eleven consecutive patients admitted with various symptoms associated with COVID-19 were included. We compared the AB0 and Rh subgroup distributions between patients with a positive polymerase chain reaction (PCR) test result and the patients without. We compared the AB0 and Rh subgroup distributions between patients with lung involvement and patients without. Additionally, comparisons were performed between the patients both with positive PCR result and lung involvement, and the patients with a negative PCR result. Results No significant difference of ABO and Rh subgroup distributions was evident between patients with and without a positive PCR test result (p=0.632 and p=0.962). No significant difference of ABO and Rh subgroup distributions was evident between the patients with and without lung involvement (p=0.097 and p=0.797). No significant difference of ABO and Rh subgroup distributions was evident among patients both with PCR positivity and lung involvement, patients with only PCR positivity, and the patients with negative PCR test results (p=0.3 and p=0.993). Conclusion All blood group types seem to have an equal risk of COVID-19 infection. Everyone should follow the precautions to avoid the COVID-19 infection.