Destructive Fibrosarcoma of the Maxillary Sinus.

Paranasal fibrosarcoma of nasal cavity and paranasal sinuses is a very rare malignant tumor. It is usually presented with nasal obstruction and epistaxis. In this clinical report, clinical symptoms, pathogenesis, and treatment principles of a paranasal fibrosarcoma originating from the right maxillary sinus and obstructing the right nasal passage are discussed.A 55-year-old male patient was admitted to the authors clinic with complaints of nasal obstruction and epistaxis lasting for 2 years. Anterior rhinoscopy revealed a mass lesion which obstructed the right nasal passage and caused frequent epistaxis. An opacity consistent with soft tissue lesion which was originated from the right maxillary sinus and filled the right nasal passage was observed in paranasal tomography. Magnetic resonance imaging revealed that the mass lesion was contrasted. Tumor was seen to erode orbital floor, and lateral and anterior walls of the maxillary sinus. Biopsy result was reported as papilloma. The patient was treated with Denker approach as anterior wall of the maxillary sinus was eroded by the tumor lesion and the mass lesion was excised. The patient received postoperative radiotherapy as pathological diagnosis was reported as paranasal fibrosarcoma.

The effects of septoplasty surgery on serum oxidative stress levels.

The aim of this study is to compare the total antioxidant status (TAS), total oxidant status (TOS), and paraoxonase (PON1) serum levels in patients who have undergone septoplasty (NSD). Forty-six patients (mean age 33.7) aged between 18 and 50 years who were diagnosed with nasal septal deviation (NSD) were included in the study. The TAS, TOS, and PON1 levels were compared in the serum samples obtained 1 month before the septoplasty and 3 months after surgery. There was a significant increase in mean TAS after septoplasty (1.041 vs. 1.124 mmol/L, p = 0.011). The mean TOS decreased significantly after septoplasty (20.631 vs. 5.946 mmol/L, p = 0.011). The mean pre- and postoperative PON1 levels were similar (326.93 ± 215.22 vs. 275.20 ± 167.76 U/L, p = 0.253). Increased TAS and decreased TOS after septoplasty show that patients with NSD are under oxidative stress that is relieved following septoplasty.

Evaluation of auditory and cochlear functions in ankylosing spondylitis patients according to the site of involvement.

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease of unknown origin with a prevalence rate about 1% in the population. Audiovestibular dysfunction is encountered in AS and sensorineural hearing loss is the most common form. The present study aimed to evaluate auditory and cochlear function in AS patients according to the site of involvement. A total of 47 patients followed for AS in the rheumatology outpatient clinic and 30 healthy controls were enrolled in the study. Subgroups of AS were identified according to the site of involvement. The participants underwent complete otolaryngological examination together with audiometry, otoacoustic emission and tympanometry tests. Disease Activity Index (BASDAI) was determined in the AS group. Hearing loss was detected in seven patients (15%) in the AS group and in four subjects (8%) in the control group. There was statistically significant difference between the patient and control groups in terms of mean bone conduction hearing level at 4000 hertz (Hz) in the right and left ears (p = 0.028, p = 0.049). There was no significant difference between the subgroups of AS in terms of overall auditory and cochlear functions. No correlation was determined between auditory values and Disease Activity Index and CRP (p > 0.05 for all). Our results reveal that AS has minimal effect on auditory and cochlear functions. The effects of subgroups of AS on auditory functions were comparable. The authors concluded that BASDAI and CRP are not convenient in monitoring auditory functions of AS patients.

Can Platelet Indices Be New Biomarkers for Subjective Tinnitus?

OBJECTIVES: Mean platelet volume (MPV) is one of the platelet function indices that reflect the platelet production rate and functions. The MPV levels are increased by vascular occlusion, acute or chronic syndromes, and vasculitis, whereas infections, autoimmune diseases, and inflammatory situations reduce these levels. In this study, the authors investigated whether there was a relationship between platelet indices and subjective tinnitus. METHODS: In this retrospective study, the authors evaluated platelet indices in subjective tinnitus patients. One hundred patients with subjective tinnitus and 100 healthy, age and sex-matched subjects were enrolled to the study. Audiometer and laboratory results were recorded. Comparative multivariate analyses between indicator factors and hearing outcomes were conducted. RESULTS: Mean platelet volume is significantly lower in subjective tinnitus group (P < 0.001). Platelet count and platelet distribution width are higher in the subjective tinnitus than control group (P < 0.001, P < 0.003, respectively). CONCLUSION: The authors' findings indicate that subjective tinnitus appears to be characterized by autoimmune and inflammatory events. Considering the decreasing MPV levels, MPV may be used to evaluate subjective tinnitus as an helper indicator.

Survivin expression correlates with nodal metastasis in T1-T2 squamous cell carcinoma of the tongue.

In this study, the correlation between neck metastasis and recurrence was investigated by studying specimens of tongue squamous cell carcinoma patients immunohistochemical with survivin antibodies in the primary biopsy. A retrospective review was conducted at the Academic University Hospital. 46 patients who had squamous cell carcinoma of the tongue, who underwent various types of glossectomy and neck dissections between 1991 and 2008, were evaluated. The patient's sex, TNM staging, differentiation and recurrence rates were analyzed. There were 20 T1 patients and 26 T2 patients; 27 of the patients were N0 and 19 had metastatic lymph nodes in the neck. Survivin antibodies were applied with streptavidin-biotin method to the sections that were prepared from the primary tumor biopsy specimens of the patients. The correlation between neck metastasis and recurrence and survivins' immunohistochemical staining was analyzed with statistical methods. There were no significant differences between the patient's age, sex, tumor's T stage, tumor differentiation and survivin staining density. Survivin staining was positive in 15 (79 %) of 19 patients with neck metastasis, while it was positive in 16 (59 %) of 27 patients without neck metastasis. Eleven (79 %) of the 14 patients who had recurrence and all 6 patients who had neck recurrence only were stained by survivin. Expression of nuclear and cytoplasmic survivin can be a useful marker for predicting cervical lymph node metastasis in T1-T2 tumors in tongue SCC.

Albumin Levels in Patients With Chronic Rhinosinusitis With Nasal Polyp.

OBJECTIVES: We aim to provide useful evidence on the relationship between the albumin levels and chronic rhinosinusitis with nasal polyp (CRSwNP) and its potential use as an inexpensive, reliable, and independent prognostic marker of CRSwNP. MATERIALS AND METHODS: Forty-five patients with CRSwNP and 45 healthy individuals were included in the study. Serum albumin levels were determined. The serum albumin levels of the study and control groups were compared to determine whether there is a statistically significant difference. RESULTS: The mean albumin level of the study group was 4.65 ±â€Š0.38, the median value was 4.70. The mean albumin level of the control group was 4.84 ±â€Š0.39, the median value was 4.90. There was a statistically significant difference between the albumin levels of the study and control groups (P = 0.045, P < 0.05). CONCLUSION: The albumin levels were found to be statistically significantly lower in patients with CRSwNP. This result may contribute to the diagnosis of CRSwNP and identifying its prognosis.

The Efficacy of Levobupivacaine Hydrochloride-Dexamethasone Infiltration for Post-Tonsillectomy Pain in Adults.

OBJECTIVE: The aim of the study is to evaluate the efficacy of peritonsillar infiltration of a levobupivacaine hydrochloride and dexamethasone combination for post-tonsillectomy pain in adult patients. METHODS: A total of 40 patients were included in this double-blind, randomized, and placebo-controlled study. The patients were equally randomized into 2 groups by means of sealed envelopes. The study group (SG) received peritonsillar levobupivacaine hydrochloride and dexamethasone infiltration and the control group (CG) received peritonsillar saline infiltration. Pain scores at the second, fourth, eighth, 12th, 16th, and 24th hours and the second to seventh days after operation were recorded by the patients in each group using a visual analog scale. Duration of surgery and the total amount of blood loss during the surgery were also recorded for each patient. RESULTS: All pain scores in the SG were lower than those in the CG; however, the difference was significant at the second, 12th, and 16th hours, and the second and third day (P < 0.05). Postoperative morbidity parameters, including otalgia, nausea, vomiting, fever, halitosis, and bleeding were similar between the 2 groups. Total amount of analgesic consumption in the SG was significantly lower than in the CG on each day of the week after tonsillectomy. CONCLUSIONS: Peritonsillar infiltration of a levobupivacaine hydrochloride and dexamethasone combination may provide pain reduction and decrease analgesic consumption in the postoperative period after adult tonsillectomy.

The Effect of Nasal Septal Deviation on Frontal and Maxillary Sinus Volumes and Development of Sinusitis.

The purpose of this study was to determine the possible role of nasal septal deviation on volume of maxillary and frontal sinuses. Between February 2011 and October 2013, paranasal sinus computed tomography (CT) findings of 732 patients (410 males, 322 females) who were admitted to Ear Nose and Throat Department of Kayseri Research and Training Hospital were retrospectively analyzed. By excluding the other coexistent sinonasal pathologies, 83 consecutive patients with nasal septal deviations were included in the study. The volume of each maxillary and frontal sinus (ipsi- and contralateral to the deviation side) was also calculated using the computer program. There was no statistically significant difference between ipsilateral and contralateral maxillary sinus volumes in group 1 and group 3 (P > 0.05). There was a statistically significant difference between ipsilateral and contralateral maxillary sinus volumes in group 2 (P < 0.05). There was no statistically significant difference between ipsilateral and contralateral frontal sinus volumes in group 1, group 2, and group 3 (P > 0.05). Moderate septal deviation significantly affects the volume of maxillary sinus. Mild and severe septal deviation does not significantly affect the volume of maxillary sinus. Effect of septal deviation on frontal sinus volume was not detected. The probability to encounter maxillary and frontal sinusitis ipsilateral to the all septum deviation groups was significantly increased in both right- and left-sided subjects.

Pinkus tumor at the nostril floor.

Fibroepithelioma of Pinkus is a variant form of basal cell carcinoma that clinically presents as a single or multiple red plaques or flesh-colored nodules without ulceration. It is usually located in the trunk, inguinal, or crural areas and only rarely occurs on the mucocutaneous junction. A 70-year-old female patient presented with a mass at the left nostril, which had first appeared about 1 year earlier. A single nontender red lesion was about 1 cm, and its base was on the mucocutaneous junction at the floor of the left nostril. Wide local excision was carried out with an adequate resection margin (5 mm) under local anesthesia. Microscopic examination showed tumoral pathologic sections of skin tissue fragments were observed; tumoral structure into the stroma is composed of proliferating basaloid cells (forming an interanastomosing pattern); around the tumor islands is rimming palisade, and infiltration of mononuclear cells around the tumor is moderate. The specimen exhibited no atypia, and the margin of excised mass was clear. The patient is being monitored for any possible local recurrence.

Another advantage of the transseptal suture: shortens the duration of waking up after anesthesia.

AIM: The aim of this study was to investigate the effects of transseptal suturing against 3 different types of nasal packings with respect to pain, operating time, and postoperative complications after nasal septal surgery. PATIENTS AND METHODS: Two hundred twenty-eight patients (aged between 18 and 58 y) undergoing nasal septal surgery were included in the study. After surgery, 4 types of nasal packing were used: (1) transseptal suturing (group A: 57 patients), (2) internal nasal splint (group B: 57 patients), (3) Merocel standard 8-cm packing without airway (group C: 57 patients), and (4) soft paraffin gauze dressing (group D: 57 patients). RESULTS: Regarding the mean operating time, there was no statistically significant difference among groups B, C, and D (P > 0.05). However, when the operating times observed in the said 3 groups were compared with those observed in group A, the difference was statistically significant (P < 0.05). The mean (SD) postoperative pain score within 1 to 48 hours was 2.9 (1.3; median, 2) in group A, 6.3 (1.4; median, 6) in group B, 7.5 (1.1; median, 7) in group C, and 7.7 (1.8; median, 7) in group D. Starting from the postoperative 48th hour, internal nasal splint, Merocel packing, and soft paraffin gauze dressing were significantly more painful compared with transseptal suturing (P < 0.05). When compared with the other groups, extubation period and postoperative care unit stay were shorter in the transseptal suturing group (P < 0.05). Regarding infection, hematoma, synechia, or perforation, there was no statistically significant difference among the groups (P > 0.05). CONCLUSIONS: Transseptal suturing technique is a useful alternative to packing, with only a minor increase in operating time. Particularly, transseptal suturing shortens extubation time and postoperative care unit stay.

The contribution of computed tomography to nasal septoplasty.

PURPOSE: The aim of this study was to determine the contribution of computed tomography (CT) scanning to nasal septoplasty. METHODS: The study included 76 patients, on whom septoplasty was planned to be performed because of deviated nasal septum. The patients were divided into 2 groups: those who had a CT scan (group 1, study group) and those who did not have a CT scan (group 2, control group) before septoplasty. Pathologic anatomic structures accompanying deviated septum and surgical interventions performed in addition to septoplasty were determined. The patients were asked the degree of improvement in nasal air passage obstruction, and 2 groups were compared with each other. RESULTS: Group 1 included 40 patients, and group 2 had 36 patients. In group 1, the pathologic findings determined along with deviated septum were concha bullosa in 14 patients, retention cyst of the maxillary sinus in 2 patients, paradox middle nasal concha in 2 patients, inferior concha hypertrophy in 18 patients, frontal osteoma in 1 patient, antrochoanal polyp in 1 patient, and chronic sinusitis (maxillary, ethmoidal, frontal) in 7 patients. Lateral resection was performed for concha bullosa; out-fracture with submucosal cauterization was performed on the patients with inferior concha hypertrophy, and endoscopic sinus surgery was performed for the patients with chronic sinusitis and antrochoanal polyp. CONCLUSIONS: Computed tomography is able to recognize some pathologic findings that cannot be found on physical examination and is helpful to decide the location and the type of the surgery. Additional surgical interventions owing to CT performed before the septoplasty are much more helpful to relieve the patient's nasal air passage obstruction.

Gastroesophageal reflux disease in children with chronic otitis media with effusion.

OBJECTIVE: We aimed to evaluate a possible relation between gastroesophageal reflux disease and middle ear effusion in children. METHODS: Children who came to ear, nose, and throat (ENT) department with the symptoms of hearing loss or aural fullness and diagnosed as OME by examination and tympanometry were included into the study. Children were reviewed gastroesophageal reflux disease symptoms including the following: (a) airway symptoms: stridor, frequent cough, recurrent croup, wheezing, nasal congestion, obstructive apnea, hoarseness, and throat clearing; (b) feeding symptoms: frequent emesis, dysphagia, choking: gagging, sore throat, halitosis, food refusal, regurgitation, pyrosis, irritability, failure to thrive, and anemia. Diagnosis is made with at least one positive test of radionuclide gastroesophageal scintigraphy or 24 h pH probe in the patients with reflux. ENT findings were also examined between gastroesophageal reflux disease positive and gastroesophageal reflux disease negative groups. RESULTS: Approximately 39 (54.9%) of 71 children had at least 1 positive test for gastroesophageal reflux disease. Between the gastroesophageal reflux disease-positive and gastroesophageal reflux disease-negative groups, symptoms of reflux were not significantly different. Two pooled variables were created: airway complex (stridor, frequent cough, throat clearing), and feeding complex (irritability, pyrosis, failure to thrive). Percentage of positive symptom complexes were no statistically different between gastroesophageal reflux disease-positive and gastroesophageal reflux disease-negative groups (>0.05). Ear, nose, and throat disorders (including rhinitis/sinusitis, adenoid hypertrophy, tonsillitis/pharyngitis, and laryngitis) were more frequent in gastroesophageal reflux disease-positive group. Tonsillitis/pharyngitis was significantly different between the gastroesophageal reflux disease positive and gastroesophageal reflux disease-negative groups. CONCLUSIONS: Upper respiratory tract infections were seen more frequently in gastroesophageal reflux disease positive group. Children who present with gastroesophageal reflux disease symptoms are more likely to have a positive gastroesophageal reflux disease test. However, no concordance may be found between the complaints and gastroesophageal reflux disease findings. For this reason, a decision about gastroesophageal reflux disease should not only be made by looking to complaints; diagnostic tests must also be performed.

Effect of Education and Regular Examination on the Prevalence of Head Louse Infestations in Adana

Objective: The current study provides training to parents and teachers about pediculosis in schools in three villages in Adana to measure their knowledge level by conducting surveys and to determine the prevalence of pediculosis in these foci. Methods: Pre- and post-questionnaires including 30 questions about pediculosis were handed to parents and teachers. The answers were analyzed with the Pearson correlation analysis. Overall, 418 school pupils s were examined for lice. The results of the head louse control were analyzed by the chi-square test and t-test. Results: We observed that the level of awareness increased in parents and teachers. Additionally, the gender of both teachers and parents was determined as the most important factor in increasing this awareness. Because of interventions for the control of head and lice, the prevalence of pediculosis decreased from 15.22% to 1.71%. Conclusion: It is very important that parents and teachers are aware of the health problems related to pediculosis, while regular combing of school children may be essential for the control of this common infestation.

Increased Atherosclerosis Correlates with Subjective Tinnitus Severity.

The aim of the present study was to investigate whether increased intima media thickness was associated with the severity of subjective non-pulsatile tinnitus and hearing loss. Data of the patients who came to Otorhinolaryngology Department of Isparta Government Hospital with subjective non-pulsatile tinnitus complaint, between January 2012 and June 2013, were evaluated retrospectively. A total of 215 patients were included in the present study. Hearing tests, biochemical analysis, tinnitus handicap inventory (THI), visual analogue scale (VAS) and doppler ultrasonography results of the patients were reviewed and recorded. The patients were classified into two groups as those having an increased intima media thickness and those having a normal intima media thickness. The said groups were compared with respect to age, gender, THI, VAS, hearing test findings and lipid values. Moreover, THI and VAS groups were compared with respect to intima-media thickness. In the group having increased intima-media thickness, THI and VAS average, frequency of hypertension, total cholesterol, low density lipoprotein and triglyceride averages and mean frequencies obtained by hearing test were significantly higher. Comparison of THI and VAS groups showed that intima-media thickness was significantly different between those having a mild tinnitus and those having a severe tinnitus. Increased intima-media thickness was associated with the severity of subjective non-pulsatile tinnitus and hearing loss. For this reason, the carotid system should be examined in subjective non-pulsatile tinnitus patients.

Serum Oxidative Stress Levels in Patients with Nasal Septal Deviation.

OBJECTIVE: Comparison of the total oxidant status (TOS), total antioxidant status (TAS) and paraoxonase (PON1) serum levels in patients with nasal septum deviation (NSD) and healthy subjects. METHODS: The TAS, TOS, and PON1 serum levels of 47 patients with NSD (mean age 35.3) and 50 healthy subjects (mean age 37.8) were compared in this study. RESULTS: We found significantly higher TAS levels in the control group (p<0.001). The mean TAS value was 1.196 mmoL/L in the control group, whereas it was 1.046 mmoL/L in the NSD group. On the other hand, TOS was significantly higher in the NSD group (p<0.001). We found that the mean TOS value was 6.600 mmoL/L in the control group, and 20.194 mmoL/L in the NSD group. The NSD and control groups had similar PON1 levels (p=0.446). The mean PON1 value was 279.64 U/L in the control group, and 324.21 U/L in the NSD group. CONCLUSION: We detected higher TOS and lower TAS levels in patients with NSD compared to healthy subjects. These results indicate that patients with NSD are exposed to oxidative stress.

Protective role of misoprostol in prevention of gentamicin ototoxicity.

OBJECTIVES: To demonstrate potential protective effect of misoprostol on cochlear toxicity caused by gentamicin with electrophysiological tests and histopathological studies. MATERIALS AND METHODS: The study included 80 ears of 40 rats with normal hearing threshold and DPOAE value in both ears. Animals were assigned into 4 groups. The rats were randomized into 4 groups. Group I (n = 10): Gentamicin, Group II (n = 10): Gentamicin plus misoprostol, Group III (n = 10): Saline; Group IV (n = 10): Misoprostol. All drugs used in the study were given once daily for 15 days. DPOAE and ABR measurements were repeated after drug administration. Subsequently, the rats' cochleae were examined histopathologically. Baseline DPOAE and ABR values were compared to those obtained after drug exposure and cochlear toxicity was evaluated in electrophysiological manner. RESULTS: When At baseline, there were no significant differences in DPOAE responses at frequencies of 1001, 1501, 2002, 3003, 4004, 6006 and 7996 Hz among groups. However In DPOAE test, statistically significant difference was observed between the pre-study basal values and post-study results in groups other than gentamicin + misoprostol group. Additionally, It was found that there was a significant difference in DPOAE response at frequency of 4004 Hz obtained at baseline and after drug exposure according to measurements of epithelial vacuolization in stria vascularis. While ABR threshold values were compared at baseline, there were no significant difference in ABR threshold values of left and right ear between groups. Histopathologically it was also found that there were significant differences measurements of epithelial vacuolization in stria vascularis and inflammation among groups (p < 0.05). CONCLUSION: By these results, misoprostol, a potent antioxidant, has protective effect against cochlear damage, and that may be a safe alternative.