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.

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.

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.

Effects of the Autologous Platelet-Rich Plasma in Nasal Pack on Postoperative Quality of Life.

AIM: The authors aimed to research the effects of autologous platelet-rich plasma, which is known for the positive effects on wound healing, on postoperatif living quality of the patients after using on nasal surgery. METHODS: Patients who undergo nasal operation according to randomized patient's choice have been injected with saline merocel pack and platelet-rich plasma (PRP) in their nasal path. Postoperative is followed by 1 month; Nose Obstruction Symptom Evaluation (NOSE) scala score, bleeding, pain, and crust rate have been compared between 2 groups. RESULTS: As a result of the 1 month follow-up, it was seen that the treatment group experienced better results in terms of NOSE scale than the control group patients and this was significant difference in terms of NOSE. Less bleeding and crust was seen on the treatment group patients than the control group patients and statically significant difference was found. In terms of visual analogue scale score no statically significant difference was found between 2 groups. CONCLUSION: According to the authors' study on PRP, the authors found out that by using PRP wound can be healed faster in early period of postoperative. It was seen with the authors' research that on postoperative early period crusts, bleeding and postoperative complaints are lesser.

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.

Acupuncture Treatment in Patients with Chronic Subjective Tinnitus: A Prospective, Randomized Study.

Objective: This study investigated the effect, onset, duration of action, and short-term outcomes of acupuncture therapy for treating patients with severe chronic subjective tinnitus. Materials and Methods: This randomized controlled trial evaluated patients with chronic, idiopathic, and severe tinnitus. A total of 105 participants were divided into 2 groups using a randomization method: a study group who received verum acupuncture therapy (n = 53) and a sham acupuncture group (n = 52). Ten acupuncture sessions were given over 5 weeks. After treatment, each participant was monitored for up to 3 months according to changes on a visual analogue Scale (VAS), and Tinnitus Handicap Inventory (THI), and Pure-Tone Audiometry and Speech Discrimination (Interacoustics AC-40, Denmark) scores. Results: The VAS and THI scores were evaluated. A statistically significant difference was noted between the sham and verum acupuncture groups at post-treatment follow-up (P < 0.001). Decreases in the THI and VAS scores became significant in the second week of treatment (P < 0.001 and P < 0.001, respectively), but these scores increased again in the third month post-treatment (P < 0.001 and P < 0.001, respectively). Conclusions: Acupuncture is an effective treatment for patients with severe chronic subjective tinnitus. Patient complaints, decreased beginning at the second treatment week; however, in the third post-treatment month, the complaints reappeared. Maintenance acupuncture therapy is necessary for patients with tinnitus; this approach should be investigated in future studies.

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.

Status of Lactate Dehydrogenase, Neutrophil-lymphocyte Ratio, Mean Platelet Volume, and Platelet-lymphocyte Ratio in Bell's Palsy.

OBJECTIVE: The inflammatory and vascular disorders have been proposed in the pathogenesis of Bell's palsy (BP). Several studies investigated the role of inflammation and ischemia in BP using white blood cell (WBC) count and its subtypes. Here, we aimed to investigate lactate dehydrogenase (LDH), neutrophil-lymphocyte ratio (NLR), mean platelet volume (MPV), and platelet-lymphocyte ratio (PLR) in BP. METHODS: The study was conducted on 76 patients with BP and 60 healthy controls. The comparison of LDH, NLR, MPV, and PLR was made between groups. The relationships between LDH, NLR, MPV, and PLR were also investigated. RESULTS: The mean LDH concentrations and NLR were significantly high in BP group than in control group (p < 0.01, p < 0.05, respectively). There was no significant difference between groups in MPV and PLR (p = 0.195, p = 0.263, respectively). CONCLUSION: Our results support the diagnostic value of high LDH concentrations in BP patients. Further studies are needed to investigate the relationship between LDH and the severity and prognosis of BP.

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.

Increased neutrophil lymphocyte ratio and platelet lymphocyte ratio in malignant parotid tumors.

INTRODUCTION: Recently it has been reported that a high preoperative neutrophil-lymphocyte ratio and platelet-lymphocyte ratio may be related to increased recurrence risk, tumor aggressiveness, and worsened prognosis in various malignancies. OBJECTIVE: The objective of this research is to explore whether neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in parotid tumors may or may not be used as a cancer marker. METHODS: This retrospective research has been conducted on a total of 228 patients consisting of 83 healthy persons and 145 patients with a mass in the parotid gland, who applied to a tertiary referral center and underwent surgery. Patients have been divided into two groups by their histopathological findings as malignant or benign parotid tumor. A third group consisting of healthy people has been defined as the control group. Also the malignant parotid tumor group has been divided into two subgroups as early stage and advanced stage. The groups have been compared in terms of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and other laboratory data. RESULTS: The average neutrophil-lymphocyte ratio values of malignant parotid tumor, benign parotid tumor, healthy control groups were 2.51, 2.01, 1.79 respectively and the difference was statistically significant (p<0.001). There was no significant difference between advanced stage and early stage parotid tumor groups in terms of average neutrophil-lymphocyte ratio value (p=0.782). In dual comparisons, the platelet-lymphocyte ratio value of patients in the malignant group was found out to be statistically significantly higher than that of benign and control groups (p<0.001 and p=0.001 respectively). CONCLUSION: To the best of our knowledge our research is the first in the medical literature comparing neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in patients with parotid tumor. neutrophil-lymphocyte ratio and platelet-lymphocyte ratio can serve as cost-effective, repeatable, easily accessible, and helpful inflammatory markers in order to distinguish patients with malignant parotid tumor from healthy people.

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.

A Prognostic Marker in Idiopathic Sudden Sensorineural Hearing Loss: Serum Calprotectin.

OBJECTIVES: Calprotectin, a protein released by neutrophils, has been used in many studies as a biomarker showing the presence of inflammation. In this study, it was aimed to investigate the relationship between serum calprotectin level and response to the treatment of idiopathic sudden sensorineural hearing loss (ISSHL). METHODS: The present study is a prospective, cross-sectional historical cohort study. The study group consisted of 44 patients with ISSHL, and the control group consisted of 41 healthy volunteers without ear pathology. At the same time, patients in the study group were divided into three groups according to the response to ISSHL treatment (recovered, partially recovered, unrecovered). The relationship between the groups was statistically evaluated in terms of serum calprotectin levels. RESULTS: The mean serum calprotectin value was 75.67±19.48 ng/mL in the study group and 50.24±29.14 ng/mL in the control group (P=0.001). Serum calprotectin value according to the severity of hearing loss in the mild, moderate and severe was 66.20±8.82, 70.35±16.77, and 91.23±19.73 ng/mL, respectively. Serum calprotectin value in the severe group was significantly higher compared to the moderate and mild groups (P=0.004, P=0.001, respectively). Serum calprotectin value according to the treatment response in the recovered, partially recovered and unrecovered groups was 63.36±11.54, 80.17±12.06, and 85.33±22.33 ng/mL, respectively. Serum calprotectin value in the recovered group was significantly lower compared to the partially recovered and unrecovered groups (P=0.002, P=0.001, respectively). CONCLUSION: Serum calprotectin value informs the clinician about both the severity of hearing loss and the response to treatment. Hence, serum calprotectin can be used as an important biomarker in ISSHL patients for the determination of the prognosis of disease.

Comparison of temporalis fascia and tragal cartilage grafts in type 1 tympanoplasty in elderly patients.

OBJECTIVE: To investigate the success rates and hearing outcomes of temporalis fascia and tragal cartilage grafts used for type-1 tympanoplasty in the elderly (³65 years) METHODS: The medical records of 73 elderly patients who underwent type-1 tympanoplasty at our center between January 2010 and June 2017 were retrospectively reviewed for age, gender, perforation side, presence of contralateral perforation, type and location of perforation, graft material types, preoperative and postoperative hearing levels, and length of follow-up. RESULTS: The graft success rate was 83.5% (61 patients) for the entire group, 76.2% (32 patients) for the fascia group, and 93.5% (29 patients) for the cartilage group. The success rate for the cartilage group was significantly higher than that for the fascia group (P=0.048). The mean hearing gain was 12.5±7.6 and 8.9±6.1dB in the fascia and cartilage groups, respectively, and postoperative ABG was 10 dB or better in 29 (69.0%) and 19 (61.3%) patients, respectively. The mean hearing gain was significantly higher in the fascia group than in the cartilage group (P=0.028), whereas the mean ABG was significantly higher in the cartilage group than in the fascia group (P=0.009). The functional success rates were similar in both groups (P=0.490). CONCLUSION: Tympanoplasty is a safe and effective procedure in elderly patients with a 83.5% of graft success rate. Tragal cartilage may be the first choice of graft material due to its high success rates. The functional outcomes did not show significant differences between the fascia and cartilage groups.

Investigation of the Ototoxic Effect of Pembrolizumab Using a Rat Model.

Objective Programmed cell death protein-1 (PD-1) inhibitors that have been recently introduced for the systemic treatment of head and neck cancers offer the advantage of fewer side effects and more effective treatment than chemotherapy drugs. A review of the literature shows that the ototoxic side effects of the PD-1 inhibitor have not yet been fully elucidated. In this study, we aimed to investigate whether the PD-1 inhibitor has ototoxic activity using both electrophysiological and histopathological methods. Methods A total of 24 rats, 12 for the study group, and 12 for the control group were included in the study. The study group was administered the PD-1 inhibitor. The auditory brainstem responses (ABR) of the study and control groups were evaluated. At the end of the study, all animals were sacrificed, and their cochleae were examined by immunohistochemical staining. Results In the study group, the ABR values ​​were 13.95 ± 2.70 before treatment, 15.83 ± 1.94 at week 4 of treatment (p=0.024), and 15.00 ± 1.06 at week 7 (p=0.157). Furthermore, according to immunohistochemical staining, the cochlear hair cells were reduced in the study group compared to the control group. Conclusion It was determined that the PD-1 inhibitor showed ototoxic activity during the course of treatment, but this was spontaneously resolved during follow-up. The clinical significance of these findings should be supported by human studies.

Efficiency of Expansion Sphincter Pharyngoplasty in the Treatment of Obstructive Sleep Apnea Syndrome.

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent episodes of upper respiratory-tract obstruction during sleep and decrease in arterial oxygen saturation. Expansion sphincter pharyngoplasty (ESP) is a simple, safe, and effective method for the surgical treatment of OSAS. The aim of our study was to evaluate the efficacy of ESP with polysomnography (PSG) in OSAS patients. METHODS: This study was conducted on patients referred to our center for the treatment of snoring, apnea, witnessed apnea, and daytime sleepiness during 2010-2018. Overall, 67 patients (16 females, 51 males) who had PSG test at postoperative three months and were considered suitable with history, physical examination, and surgery after PSG were included in the study. Patients were classified into three groups according to OSAS severity: mild, moderate, and severe. Patient age, sex, body mass index (BMI), pre- and postoperative period apnea-hypopnea index (AHI), Epworth sleepiness scores, and PSG data were recorded. RESULTS: The mean BMI of all groups was 27.44±2.73. The postoperative AHI decreased from 18.26±2.23 to 8.01±0.97 (p<0.001). Surgical success rate was 67.2%; it was higher in females (p=0.047). The highest success rate was found in the mild OSAS group; however, this difference was not statistically significant when compared to the other groups (p=0.217). There were statistically significant improvement at postoperative Epworth sleepiness scores and minimum O2 saturations (p<0.001 and p=0.018, respectively). CONCLUSION: ESP is an effective and successful surgery in selected patients with lateral pharyngeal and retropalatal narrowing.