Ossifying fibroma of the inferior turbinate.

Hypertrophy of inferior turbinate is a common condition, especially with nasal septum deviation. Sometimes, the cause of hypertrophy of inferior turbinate can be fibro-osseous lesions. Benign, rare, and non-aggressive fibro-osseous neoplasms such as ossifying fibroma can affect paranasal sinuses. Isolated inferior turbinate involvement is extremely rare in ossifying fibroma. In this article, we present a 28-year-old female suffering from nasal obstruction due to septal deviation and hypertrophy of inferior turbinate. Preoperative and postoperative investigation show that cause of hypertrophy of inferior turbinate is ossifying fibroma. To our knowledge, that this is the second case of ossifying fibroma reported in the English-language literature due to its isolated localization. However, if the patients with inferior turbinate hypertrophy are examined carefully, we can prevent unnecessary medical treatment and surgery for inferior turbinate hypertrophy.

Prevention of tracheal stenosis with pirfenidone after tracheotomy: An experimental study.

OBJECTIVES: In this study, pirfenidone's role about reducing tracheal stenosis by suppressing fibrosis and inflammation was examined. METHODS: Tracheotomy was performed on 14 rats, and their cannulas were fixed to tracheotomy area by stoma suture. Two working groups were established. Rats in the first group were given 15 mg/kg/day (1 mL pirfenidone solution) pirfenidone intraperitoneally for 10 days. In the second group as a control group, 1 mL saline solution was applied intraperitoneally. Ten days later, rats were decanulated and kept alive for 3 more weeks. Anesthetized rats were sacrificed on day 30. All rat tracheas were resected between the first and seventh rings. Epithelial damage, inflammation, and fibrosis were determined histopathologically; diameters of intratracheal lumen and their mucosal thickness parameters were determined histomorphometrically; and TGFß-1 (the growth factor beta), TNFα (tumor necrosis factor alpha), and IL-1ß (Interleukin-1 beta) values were determined immunohistochemically. RESULTS: According to the parameters of the control group, fibrosis; diameters of intratracheal lumen; and values of TGFß-1, TNFα, and IL-1ß were found to be statistically significant. CONCLUSION: In our study, it was found that pirfenidone reduces fibrosis and narrowing of intratracheal lumen diameter significantly. LEVEL OF EVIDENCE: NA Laryngoscope, 129:E178-E186, 2019.

Paraganglioma of the skull base: a case report.

Paragangliomas are rare benign neuroendocrine tumors derived from the extra-adrenal paraganglia of the autonomic nervous system. Here, we described a new case of a 75-year-old woman with paraganglioma arising in the middle and posterior cranial fossa with extended destruction of the skull base and clivus. She was admitted to our department with the complaint of severe respiratory distress due to vocal cord paralysis. We discussed its clinical, radiological, histopathological features and treatment modalities in the light of the current literature.

Serum leptin levels in patients with allergic rhinitis.

OBJECTIVE: To investigate the serum leptin levels in patients with allergic rhinitis during the symptomatic period. STUDY DESIGN AND SETTING: A randomized, prospective study was performed on 26 adult patients with allergic rhinitis and 20 control subjects with similar age, sex and body mass index in a tertiary otolaryngology center. RESULTS: Leptin levels were 28.8 +/- 14.1 ng/mL in the patients with allergic rhinitis, and 20.8 +/- 13.5 ng/mL in the control group respectively. The difference between the groups was statistically significant (p = 0.04). CONCLUSION: Serum leptin levels were found to be significantly higher in patients with allergic rhinitis in symptomatic period. SIGNIFICANCE: Apart from its primary role in the regulation of body weight and energy expenditure, leptin may have a role in the inflammatory process of the allergic rhinitis.

Central giant cell reparative granuloma of the mandible caused by a molar tooth extraction: special reference to the maneuver of drilling the surgical field.

Central giant cell reparative granuloma (CGCRG) is an uncommon benign, reactive osseous lesion usually located in the mandible and maxilla. Although it is histologically benign, it may be locally destructive. There is still controversy on its development and growth pattern. Surgery is the treatment traditionally recommended. In this article, we presented a 12 year-old girl CGCRG of the mandible caused by a molar tooth extraction and discussed its histopathological, clinical, radiological and therapeutic features in the light of the current literature. Also we described our additional surgical maneuver 'drilling the surgical field' after the removal of the lesion.

Glutathione S-transferase gene polymorphisms in presbycusis.

HYPOTHESIS: Glutathione and glutathione-related antioxidant enzymes are involved in the metabolism and detoxification of cytotoxic and carcinogenic compounds as well as reactive oxygen species. Reactive oxygen species generation occurs in prolonged relative hypoperfusion conditions such as in aging. The etiology of presbycusis is much less certain; however, a complex genetic cause is most likely. The effect of aging shows a wide interindividual range; we aimed to investigate whether profiles of (glutathione S-transferase (GST) M1, T1 and P1 genotypes may be associated with the risk of age-related hearing loss. PATIENTS AND METHODS: We examined 68 adults with presbycusis and 69 healthy controls. DNA was extracted from whole blood, and the GSTM1, GSTT1 and GSTP1 polymorphisms were determined using a real-time polymerase chain reaction and fluorescence resonance energy transfer with a Light-Cycler Instrument. Associations between specific genotypes and the development of presbycusis were examined by use of logistic regression analyses to calculate odds ratios and 95% confidence intervals. RESULTS: Gene polymorphisms at GSTM1, GSTT1, and GSTP1 in subjects with presbycusis were not significantly different than in the controls (p > 0.05). Also, the combinations of different GSTM1, GSTT1, and GSTP1 genotypes were not an increased risk of presbycusis (p > 0.05). CONCLUSION: We could not demonstrate any significant association between the GSTM1, GSTT1, and GSTP1 polymorphism and age-related hearing loss in this population. This may be because of our sample size, and further studies need to investigate the exact role of GST gene polymorphisms in the etiopathogenesis of the presbycusis.

Cytogenetic biomonitoring in children with chronic tonsillitis: micronucleus frequency in exfoliated buccal epithelium cells.

OBJECTIVE: To investigate the possible harmful cytogenetic effects associated with chronic tonsillitis by analyzing the micronucleus frequency and other nuclear abnormalities in exfoliated buccal epithelial cells. MATERIALS AND METHODS: The study consisted of 20 children with chronic tonsillitis, and 20 control subjects with similar age and sex. The ages ranged between 5 and 12 years old (mean age: 7.5). The patients were diagnosed as having chronic tonsillitis on the basis of history, throat culture and clinical examinations. Buccal cell samples were collected with a wooden spatula. The samples were then applied to clean microscope slides. Smears were air dried and fixed in methanol:acetic acid. Then slides were stained by the Feulgen reaction technique. Three slides were prepared for each subject and 1000 cells were evaluated per slide to determine the frequencies of micronucleus and other nuclear abnormalities (binucleats, karyorrhexis and karyolysis). Statistically, Mann-Whitney U-test was used to analyze and compare the data. RESULTS: The mean micronucleus frequencies in patient and control groups were 5.29+/-1.67 and 1.58+/-0.33, respectively. In the patient group, mean binucleus, karyorrhexis and karyolysis frequencies were 3.13+/-1.2, 2.04+/-0.64, and 1.74+/-0.47, respectively. However, in the control group, mean binucleus, karyorrhexis and karyolysis frequencies were 1.43+/-0.47, 1.26+/-0.45, and 0.88+/-0.27, respectively. The mean frequencies of all parameters in the patient group were higher than the control values, and the difference was found to be statistically significant (p<0.001). CONCLUSION: Our results revealed that children with chronic tonsillitis could be under risk of significant cytogenetic damage.

A case of intranasal schwannoma with bilateral nasal polyposis.

Schwannoma is a benign neoplasm originating from schwann cells of the peripheral nerve sheath, and its occurrence in the nasal cavity and paranasal sinuses is rare. We present a case of nasal schwannoma originating from the left nasal cavity, accompanied by bilateral nasal polyposis. A 66-year-old man presented with complaints of progressive left nasal obstruction, hyposmia, and headache. Anterior rhinoscopic and endoscopic examinations revealed a mass that almost completely filled the left nasal cavity. A polypoid mass was present in the right nasal cavity, as well. On computed tomography, the mass occupied the left ethmoidal cells, left maxillary sinus, left sphenoid sinus, and posterior area of the left nasal cavity. Endoscopic sinus surgery was performed under general anesthesia and the mass was completely removed via the nasopharynx because of its size. Endoscopic anterior ethmoidectomy was also performed in the right nasal cavity for nasal polyposis. Histopathological diagnosis of the left nasal mass was schwannoma. The patient was symptom-free with no recurrence after nine months.

Malondialdehyde and antioxidant enzymes in children with obstructive adenotonsillar hypertrophy.

OBJECTIVE: Free radical induced tissue damage has been implicated in the pathogenesis of several diseases. We aimed to investigate the role of free radicals and scavenging enzymes in children with obstructive adenotonsillar hypertrophy. MATERIALS AND METHODS: The study consisted of 29 children with obstructive adenotonsillar hypertrophy and 51 control subjects with similar age and sex. All the patients and/or their parents had complaints of snoring, mouth breathing, and pausing of breath during sleep for at least 6 months. All patients underwent an adenotonsillectomy operation under general anesthesia with curettage and cold dissection methods. Venous blood was taken preoperatively and 4 weeks postoperatively. After collection of blood samples into citrate (3.5 mg/ml blood) containing glass tubes, erythrocyte sediments were prepared for the analyses. Then malondialdehyde (MDA) level, and superoxide dismutase (SOD), glutathione peroxidase (GSHPx), and catalase (CAT) activities were measured. RESULTS: The levels of MDA and activities of SOD and GSHPx were significantly higher in the pre-tonsillectomy period than in the post-tonsillectomy period. However, CAT activity was not different in pre- and postoperative period. CONCLUSION: Our study supports the notion that oxidant and antioxidant defense mechanisms are altered in children with obstructive adenotonsillar hypertrophy, and this alteration improves after tonsillectomy.

The effect of L-carnitine on the prevention of experimentally induced myringosclerosis in rats.

The objective of this study was to investigate the possible effect of L-carnitine on the prevention of experimentally induced myringosclerosis. Twenty Sprague-Dawley rats were bilaterally myringotomized. The rats were divided into two groups randomly: group 1 which were intraperitoneally administered saline and group 2 which were intraperitoneally administered L-carnitine. Blood samples were collected for biochemical evaluation and the tympanic membranes were harvested after 28 days. Histopathological and immunohistochemical evaluation were done under light microscopy. The mean malondialdehyde levels were 3.9+/-0.9 in group 2, and 7.9+/-1.1 in group 1 (P<0.001), nitric oxide levels were 25.6+/-6.4 in group 2 and 30.8+/-8.2 in group 1 (P=0.14) and acetylcholinesterase was 1035+/-60 in group 2 and 678+/-35 in group 1 (P=0.001). Myringosclerosis was more frequent and severe in group 1 than group 2 (P<0.007). Immunoreactivity was seen in 16 of 20 tympanic membranes in group 2 and six of 20 tympanic membranes in group 1 (P=0.005). We conclude that L-carnitine diminishes the occurrence of myringosclerosis in rats after myringotomy possibly by antioxidant activity and decreasing the formation of reactive oxygen species.

Serum levels of antioxidant vitamins, copper, zinc and magnesium in children with chronic rhinosinusitis.

Reactive oxygen species including hydroxyl radicals, superoxide anions and hydrogen peroxide which are produced by activated granulocytes play an essential role in many biochemical processes and diseases. Oxidant-mediated tissue damage may be important in the development of chronic sinusitis. The aim of this study was to investigate the serum levels of antioxidant vitamins and elements in 24 children (14 boys and 10 girls, age range: 7-12 years, mean age: 9.2 years) with chronic rhinosinusitis, compared to 20 age and sex matched healthy children. Blood samples were collected in the morning before breakfast and prior to any medication. Vitamin A, E and C levels were determined using reagent kits for high performance liquid chromatography. Cu, Zn and Mg levels were analyzed by atomic absorption spectrometry. Vitamin E, vitamin C, Cu and Zn levels were significantly lower in the patients group than in the control group. However, vitamin A and Mg levels did not differ. In conclusion, serum levels of antioxidant vitamins and elements may be important in the pathogenesis and treatment of chronic rhinosinusitis in children.

The relationship between presbycusis and mastoid pneumatization.

Presbycusis is defined as the natural hearing loss accompanying aging, caused by degenerative changes in the inner ear. The etiology of presbycusis is uncertain. However, it would appear that a complex genetic cause is most likely. The determinants of mastoid size continue to be controversial. One of the pneumatization theories is the hereditary theory. In this study, the possible relationship between presbycusis and the extent of mastoid pneumatization was investigated. This study was carried out on 21 patients with presbycusis and 21 normal subjects of similar ages. The pneumatized volume was measured by computerized tomography. The temporal bone was scanned at 2 mm thickness intervals. Exposure (kV 130, mA105). The scan plane was parallel to the orbitomeatal line and the CT images covered the entire mastoid region. The average mastoid pneumatization in presbycusis group was 6.08 +/- 2.52 cm(3) in the right ear and 6.19 +/- 2.93 cm(3) in the left ear. However, in the control group it was 4.69 +/- 3.17 cm(3) in the right ear (p=0.12) and 5.10 +/- 3.49 cm(3) in the left ear (p=0.28). No significant difference was found between the presbycusis patients and normal subjects in terms of the volume of mastoid pneumatization.

Brainstem evaluation in children with primary nocturnal enuresis.

We investigated the brainstem integrity in children with primary nocturnal enuresis (PNE) using auditory brainstem responses (ABR), blink reflex and exteroceptive suppression of the masseter muscle. We examined 23 children with PNE (16 male, 7 female; mean age: 10.4 years) and 19 control subjects (11 male, 8 female; mean age: 11.8 years). ABR parameters such as wave latencies, amplitudes and interpeak latencies and blink reflex parameters such as R1 and R2 amplitude and latencies were not significantly different between the 2 groups. Although S2 parameters of the exteroceptive suppression of the masseter muscle were easily and completely obtained from the control subjects, in the PNE group S2 onset latency and duration were not recorded in 26% of the study children (n = 6) (P = 0.01). S2 duration time was significantly lowered in the enuretic group (left side: P = 0.001 and right side: P = 0.003). S2 duration time changes in the enuretic group supports a possible brainstem dysfunction in children with PNE.

The effect of fusafungine on post-operative pain and wound healing after pediatric tonsillectomy.

OBJECTIVE: To investigate the effect of fusafungine spray on pain and healing process after pediatric tonsillectomy. METHODS: Sixty children with ages between 4 and 14 years underwent tonsillectomy or adenotonsillectomy. The patients were randomly divided into three groups and each group consisted of 20 patients. Group 1 was treated with antibiotic (amoxicillin-clavulanic acid) plus analgesic (acetaminophen), group 2 was treated with fusafungine plus analgesic (acetaminophen) and group 3 was treated with only fusafungine. The average ages were 7.8 + 3.4, 6.6 + 2.9, and 8.2 + 3.7 for groups 1, 2, and 3, respectively. Clinical evaluations were made after the operation on the 1st (T1), 3rd (T3), 7th (T7), 10th (T10), and 14th days (T14). RESULTS: There was no significant difference in post-operative pain between study groups on the post-operative 1st, 3rd, and 7th days (P > 0.05), a statistically significant difference was present between groups 1 and 3, and groups 1 and 2 on the post-operative 10th and 14th day (P = 0.018 and 0.037, respectively). Pain was less in groups 2 and 3 than in group 1 on the 10th and 14th day. Also there was a significant difference in healing time of the tonsillary beds between groups 1 and 2, and groups 1 and 3 on the 10th and 14th post-operative day (P = 0.031 and 0.001, respectively). Healing was better in groups 2 and 3 than in group 1 on the 10th and 14th day. CONCLUSION: Fusafungine administration after tonsillectomy was found to be beneficial on post-operative pain and wound healing of tonsillary beds in pediatric population.

Expression of inducible nitric oxide synthase in antrochoanal polyps.

OBJECTIVE: Antrochoanal polyp (ACP) is a polypoid lesion originating from the maxillary sinus, emerging from the ostium and extending to the choana. Although the etiologic causes of ACP are not known completely, it presents a fairly uniform clinical appearance. Nitric oxide (NO) has an important role in non-specific immunoreactions and inflammation in various tissues and has a main regulatory role in airway function and seems to involve in pathomechanism of several respiratory system diseases. NO is synthesized by the effect of three isoforms of nitric oxide synthase i.e. inducible NOS (iNOS). Some studies revealed that ACP has some different characteristics from the ordinary nasal polyps. In the present study, in order to compare ACP with allergic and non-allergic nasal polyps (NANP), we detected and localized the iNOS expression and also evaluate some histological parameters. METHODS: Twenty-six cases were chosen from the files and four controls were used. The cases were separated as follows: normal inferior turbinate mucosa as control (n=4) ACPs (n=8), allergic nasal polyps (ANP) (n=9), and NANP (n=9). Five-micrometer thick sections were prepared from the paraffin sections of polyps and normal nasal mucosa to quantify the iNOS expression. iNOS protein was observed in the cytoplasm of epithelial and stromal inflammatory cells. iNOS protein expression in the groups was assessed according to the intensity of staining and histomorphological parameters, oedema, lymphocytic and eosinophilic cell infiltration were detected semi quantitatively. RESULTS: iNOS expressions, either stromal or epithelial, were not different from each other among the four groups. Although it is not statistically significant, we noted that ANP and ACP frequently showed moderate and severe iNOS protein expression in epithelial and stromal parts when compared with NANPs and controls. Also, iNOS expression was significantly higher in the stroma of the ANPs than NANPs (P=0.012). CONCLUSIONS: ACPs and ANPs have frequently showed moderate and significant epithelial and stromal iNOS expression. Further studies are needed in large groups to elucidate differences between ACP and the other nasal polyps.

Prevention of laryngotracheal stenosis with carnitine after tracheotomy: an experimental study on rats.

OBJECTIVE: We investigated the effect of carnitine on wound healing of trachea in tracheotomyzed rats. This study was undertaken to test the hypothesis that treatment with carnitine would protect the wound tissue, which was evaluated by measuring nitrite and nitrate, thus nitric oxide, malondialdehyde and cholinesterase in blood, and examining the histopathological changes. METHODS: Standard vertical tracheotomy was performed on 24 Wistar-Albino type rats. Then the animals were randomly divided into two groups; group A (the study group) was administered intraperitoneal carnitine 100 mg/kg for 10 days; group B (the control group) was administered intraperitoneal saline for 10 days. On the 10th day, all animals were decanulated. Three weeks later, cardiac blood samples were taken for biochemical assays and trachea specimens were harvested for histopathologic examination. RESULTS: In the carnitine-administered group, granulation tissue thickness resulting from the wound healing in the level of tracheotomy incision was lower compared to the control group (P < 0.01). When serum malondialdehyde levels were considered, a lower malondialdehyde level was found in the carnitine-administered group (P < 0.01). However, serum nitric oxide levels were close to each other in both groups (P > 0.05), while serum cholinesterase level was higher in the carnitine-administered group than in the control group (P < 0.01). CONCLUSION: Carnitine treatment partially prevents and significantly reduces the severity of tracheotomy induced laryngotracheal stenosis.

Microbiology of cerumen in patients with recurrent otitis externa and cases with open mastoidectomy cavities.

This study investigated the common flora of human cerumen in patients with recurrent otitis externa, and subjects who had been operated on and had an open mastoidectomy cavity from chronic otitis media. Cerumen samples were collected from three groups; group A (n = 20) consisted of patients with recurrent otitis externa, group B (n = 20) consisted of patients with an open cavity and group C (n = 30) consisted of healthy subjects. The mean of the microbial count was 3.4 x 10(4) in group A, 3.08 x 10(4) in group B and 2.48 x 10(4) in group C. The most commonly isolated microorganism from the three groups was Staphylococcus epidermidis. No growth was observed in five cases (25 per cent) in group A and in three cases (10 per cent) in group C. In group B antimicrobial growth was observed in all samples. In 46 (65 per cent) of the cerumen samples, the isolates were monomicrobial and 24 (35 per cent) of the cerumen samples were polymicrobial. The isolates were polymicrobial in 65 per cent of group A, 20 per cent in group B and 23.3 per cent in group C. In the process of investigating the microbial flora of cerumen in all the three groups, microbial growth was observed from all the samples from patients with an open cavity, unlike the other groups, and it was determined that the group with recurrent external otitis had the most abundant microbial flora.

[A review of antrochoanal polyps in 14 cases]. / Antrokoanal polipli 14 olgunun incelenmesi.

OBJECTIVES: We evaluated the clinical results of surgical treatment for antrochoanal polyps. PATIENTS AND METHODS: The study included 14 patients (9 males, 5 females; mean age 23 years; range 7 to 48 years). Skin prick test was performed and specific IgE responses were determined. Treatment involved endoscopic sinus surgery in 13 patients, and polypectomy combined with Caldwell-Luc operation in one patient. Follow-up examinations were performed in the postoperative first and sixth months. RESULTS: The polyps originated from the right (n=8) and from the left (n=6) maxillary sinuses. Nasal obstruction was found in all cases, with accompanying nasal discharge, sneezing, and postnasal discharge in four; snoring and mouth breathing during sleep in five patients, and sore throat and rhinorrhea in one patient. Allergy was determined in three patients. Computed tomography showed coexistent sinus diseases in nine patients. During surgery, the precise origin of the polyp was detected in four cases; being in the lateral wall in two, and in the posterior wall in two patients. Complications were minor hemorrhage in two cases, and synechia in three. Recurrence was observed in two patients. CONCLUSION: Endoscopic sinus surgery proved an ideal approach for antrochoanal polyps as it enables complete removal of the antral portion of the polyp, and simultaneous intervention to other sinus diseases.

[The effect of mometasone furoate on mucociliary clearance in patients with perennial allergic rhinitis]. / Perennial alerjik rinitte mometazon furoatin mukosiliyer aktiviteye etkisi.

OBJECTIVES: We investigated the effect of mometasone furoate on mucociliary clearance in patients with perennial allergic rhinitis. PATIENTS AND METHODS: The study included 25 patients (16 females, 9 males; mean age 30 years; range 18 to 50 years) with perennial allergic rhinitis. Mometasone furoate (nasal spray) was administered at a dose of 2 puffs (100 microgr) to each nostril daily for a month. Mucociliary clearance was evaluated by the saccharin test before and after treatment. RESULTS: The mean mucociliary clearance time was 6.89 +/- 0.64 minutes before the treatment and 7.18 +/- 0.54 minutes after the treatment. No significant delay in the mucociliary clearance was detected (p > 0.05). The mean mucociliary clearance time did not differ significantly between male and female patients (p > 0.05). CONCLUSION: The results suggest that mometasone furoate do not affect mucociliary clearance in patients with perennial allergic rhinitis.

[Distribution of allergens among allergic rhinitis patients living in Mersin region]. / Mersin yöresinde alerjik rinitli hastalardaki alerjen dagilimi.

OBJECTIVES: To determine the distribution of allergens among allergic rhinitis patients living in the Mersin region. PATIENTS AND METHODS: We investigated 346 allergic rhinitis patients (233 females, 113 males; mean age 32.3+/-14.1 years) who had symptoms and a positive prick test result. RESULTS: The history and clinical examination revealed that 161 patients (46.5%) had seasonal symptoms and 185 patients (53.5%) had perennial symptoms. Common pattern of multiple allergens were mite allergens (57.8%), grass mixture (32.1%), trees mixture (14.5%), cereals mixture (13.9%), weed mixture (7.2%), dog hair (5.5%), and cat fur (2.9%). According to the prick test results, sensitivity to one allergen was found in 96 patients (27.7%) and sensitivity to multiple allergens in 250 patients. CONCLUSION: The most common allergens were mites and pollens in the Mersin region. It was concluded that the distribution of allergens was associated with the climatic, environmental and socioeconomic features of the region.