Effects of hyaluronic acid-collagen nanofibers on early wound healing in vocal cord trauma.

BACKGROUND: Vocal cord scarring is the most crucial obstacle in voice quality after surgery. This study aimed to evaluate the effectiveness of hyaluronic acid (HA)-collagen nanofibers on the healing of vocal cords after surgical trauma. METHOD: Right vocal cords of 12 New Zealand white rabbits were traumatized, and the experimental group was received 1.08 mg/75 ml topical HA-collagen nanofiber (Gelfix® spray) for 3 days. Three animals in each group were sacrificed on the 7th day, and the remaining of the animals were sacrificed on the 21st day. The laryngeal specimens in the experimental and control groups were examined histopathologically. RESULT: The 7th-day H&E staining evaluation revealed pink, dense, and thin collagen fibers. Besides, the collagen content was scattered and irregular in the experimental group. The 21st-day assessment showed that the collagen bundles in the granulation tissue were almost with the same formation in both of the groups. Masson Trichrome staining on the 7th day of the study showed that the collagen fiber bundles were less frequent in the control group than the experimental group. The 7th-day Van Gieson staining analysis showed that the pattern of reticular fibers was more regular with the parallel formation in the experimental group than the control group. CONCLUSION: HA-collagen nanofiber can be used in diseases that impair voice quality due to the thickening of the lamina propria layer in the vocal cord and impaired viscoelasticity due to fibrosis after tissue trauma.

Correlation of sleep-disordered breathing and laryngopharyngeal reflux: a two-channel triple-sensor pHmetry catheter study.

PURPOSE: To investigate the relationship between sleep-disordered breathing with gastroesophageal reflux (GER) and laryngopharyngeal reflux (LPR) using a two-channel triple-sensor pHmetry catheter. METHODS: The study was carried out on a total of 34 people with complaints of snoring, witnessed apnea and daytime sleepiness. 24-h pH monitoring with a two-channel, triple-sensor antimony pH catheter was applied to individuals simultaneously with polysomnography (PSG) on the day they would sleep in the sleep laboratory. Obstructive sleep apnea syndrome (OSAS) severity and reflux grade were compared with each other. Data obtained from PSG and pHmetry results were numerically compared with each other. The relationship between apnea, hypopnea, and arousal periods and reflux episodes was then examined by overlaying pHmetry graphics for each patient. RESULTS: A total of 34 individuals (18 males-52.9% and 16 females-47.1%), age ranging from 27 to 71 years (mean 50.5 ± 11.0) participated in the study. GER was detected in 52.9% and LPR in 85.3% of the patients. In 35.3% of cases, pathologic GER was not observed despite LPR detection. No statistically significant relationship was found between the numerical values of apnea-hypopnea index (AHI) and arousal numbers and reflux parameters of individuals and between OSAS severity and LPR and GER (p > 0.05). There was no statistically significant correlation between respiratory events and reflux episodes with regard to timing (p > 0.05). CONCLUSION: The prevalence of GER and LPR is found to be high in patients with sleep-disordered breathing. There is no significant relationship between OSAS severity and GER and LPR grade or respiratory events and reflux episodes with regard to timing.

Effects of parenteral papaverine and piracetam administration on cochlea following acoustic trauma.

INTRODUCTION: Noise exposure, the main cause of hearing loss in countries with lot of industries, may result both in temporary or permanent hearing loss. The goal of this study was to investigate the effects of parenteral papaverine and piracetam administration following an acoustic trauma on hearing function with histopathologic correlation. MATERIALS AND METHODS: Eighteen Wistar albino rats exposed to noise for 8 h in a free environment were included. We divided the study population into three groups, and performed daily intraperitoneal injections of papaverine, piracetam, and saline, respectively, throughout the study. We investigated the histopathologic effects of cellular apoptosis on inner hair cells (IHCs) and outer hair cells (OHCs) and compared the distortion product otoacoustic emissions (DPOAEs) thresholds among the groups. RESULTS AND DISCUSSION: On the 3rd and 7th days, DPOAE thresholds at 8 kHz were significantly higher both in papaverine and piracetam groups compared with the control group (P = 0.004 for 3rd day, P = 0.016 and P = 0.028 for 7th day, respectively). On the 14th day, piracetam group had significantly higher mean thresholds at 8 kHz (P = 0.029); however, papaverine group had similar mean thresholds compared to the control group (P = 0.200). On the 3rd and 7th days following acoustic trauma, both IHC and OHC loss were significantly lower in both papaverine and piracetam groups. On the 7th day, the mean amount of apoptotic IHCs and OHCs identified using Caspase-3 method were significantly lower in both groups, but the mean amount identified using terminal deoxynucleotidyl transferase dUTP nick end labeling method were similar in both groups compared to the control group. CONCLUSION: We demonstrated the effects of papaverine and piracetam on the recovery of cochlear damage due to acoustic trauma on experimental animals using histopathologic and electrophysiologic examinations.

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

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

A new suggestion for the Epworth Sleepiness Scale in obstructive sleep apnea.

The aim of this study was to suggest a new cutoff score for the Turkish version of Epworth Sleepiness Scale (ESS) in the patients with obstructive sleep apnea. In this study, the data of 483 patients who were admitted to our clinic with the complaints of daytime sleepiness and witnessed sleep apnea were reviewed retrospectively. The correlation between ESS and polysomnography (PSG) findings were assessed, and cutoff score of the Turkish version of the ESS was investigated. The mean apnea-hypopnea index (AHI) was 27.71 ± 26.69 eV/h, the mean ESS score was 8.42 ± 4.88. According to AHI, a statistically significant difference between ESS scores was detected (p = 0.001; p < 0.01). According to AHI (AHI ≥ 5, AHI ≥ 15 and AHI ≥ 30) the best cutoff score for ESS score was found as 8. The answers that were given to the ESS questions differ according to their sociocultural and economic condition. These results indicate that a score of 8 or higher on the ESS would seem a more appropriate cutoff score to suspect clinically relevant sleepiness in the Turkish population.

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.

Ototoxicity of Topical Castellani Solution and Boric Acid in Alcohol: an Experimental Study on Rats.

The aim of this study is to determine the ototoxicities of boric acid in alcohol (BAA) and Castellani solutions by means of distortion product otoacoustic emission (DPOAE). A total of 28 rats were randomly divided into four groups, each group consisting of 7 animals. Then, 0.1 mL Castellani solution, 0.1 mL BAA (4% boric acid solution prepared with 60% alcohol), 0.2 mL (40 mg/mL) gentamicin and 0.2 mL saline were dropped to right outer ear canals of rats in groups 1, 2, 3 and 4 respectively, twice a day, for 14 days. DPOAE values obtained on days 0 and 14 were statistically compared for the values obtained at 750-8000 Hz frequencies. A statistically significant decrease was found on day 14 compared to day 0 values in Castellani group at all frequencies (p < 0.05). In BAA group, there was a statistically significant decrease between frequencies 1500 and 8000 Hz on day 14 (p < 0.05).We found that Castellani and BAA were ototoxic. BAA and Castellani solutions should be avoided in patients with tympanic membrane perforations, ventilation tubes and open mastoid cavities.

Does the Change in the Indications of Endoscopic Sinonasal Surgery Continue? Data between 1994-2018.

OBJECTIVE: Endoscopic sinonasal surgery (ESS) has changing over the years in parallel with the developments in endoscopy devices, video-imaging techniques, and surgical instruments. In the present study we investigated whether the indications of patients who underwent surgery over a period of 25 years have accommodated to these changes. METHODS: We retrospectively evaluated 1173 patients who underwent surgery in our clinic from 1994 through 2007, and 954 patients who underwent surgery from 2008 through 2018. The patients were divided into three groups as follows: chronic rhinosinusitis with polyps (CRSwNP), chronic rhinosinusitis without polyps (CRSsNP), and others. The changes in the indications during the first 14 years and the following 11 years were compared, and the results were statistically evaluated. RESULTS: A significant decrease was observed in the number of patients who underwent surgery following the diagnosis of CRSsNP (p<0.001). In addition, a statistically significant increase was found in CRSwNP (p<0.001) and other (p<0.001) indications. CONCLUSION: When ESS indications identified in our clinic were reviewed, it was observed that the increasing trend in CRSwNP rate in the first 14 years continued, there was a significant increase in non-CRS indications in the last 11 years, and there has been an increase in patients with fungal sinusitis, especially in this group.

Sensorineural hearing loss after radiotherapy for head and neck tumors: a prospective study of the effect of radiation.

INTRODUCTION: In the treatment of head and neck cancers, the cochlea may be damaged if it is within the radiotherapy (RT) area; however, the severity and mechanism of such damage have yet to be clearly defined. The purpose of this study was to analyze the rates of early- and late-stage sensorineural hearing loss (SNHL) in patients receiving RT due to head and neck cancer and to investigate the reliability of distortion product otoacoustic emissions (DPOAEs) measurements and audiometric evaluation. STUDY DESIGN: Prospective. METHOD: The study included 38 ears of 19 patients scheduled for RT due to head and neck cancer diagnoses. The patients received RT at a fractioned dose of 200 cGy (5 d/wk) and were evaluated pretreatment and posttreatment (1st and 12th mo), both audiometrically and with DPOAE measurement. Any decrease greater than 10 dB was considered SNHL. The amplitudes of DPOAE measurements were statistically compared. RESULTS: The audiometric evaluation performed in the 1st posttreatment month showed no SNHL in any of the patients, whereas in the 12th month, 47% of the ears had SNHL. In all the patients that developed SNHL, the amplitudes obtained in DPOAE measurements in the first posttreatment month were statistically significantly lower. CONCLUSION: The results of the present study show that DPOAE measurement is a reliable method for determining which patients are at risk of developing SNHL in the early post-RT period.

Development of maxillary accessory ostium following sinusitis in rabbits.

OBJECTIVES/HYPOTHESIS: Maxillary accessory ostium is one of the anatomical variations that may play a role in the development of chronic maxillary sinusitis. Although some authors claim that accessory ostia develop following acute maxillary sinusitis, it is not clear whether they are congenital or acquired. STUDY DESIGN: Animal experimental study. METHODS: Ten New Zealand type rabbits were used in the study. In phase 1, lateral nasal walls of five New Zealand type rabbits were examined for the presence of natural and accessory ostia of the maxillary sinus and any area resembling fontanelles in humans. In phase 2, experimental sinusitis was induced in the right sides of the other five rabbits. Following sacrifice, lateral nasal walls were examined for the development of accessory ostia. RESULTS: Six of the ten sides of phase 1 animals contained a membranous part in the medial wall of the maxillary sinus resembling the fontanelles in humans (60%). None of them had an accessory maxillary ostium. Accessory ostia developed in two of the five sides with sinusitis (40%). CONCLUSIONS: We have shown for the first time that accessory maxillary ostia develop following experimental sinusitis in rabbits. Further studies in humans are indicated.

The effects of merocel and glove finger tampon applications on the nasal septum mucosa of rabbits.

OBJECTIVE: The use of tampons after nasal septum surgery is important for both prevention of postoperative bleeding and stabilization of the nasal flaps and the septum. One of the most important factors in achieving rapid postoperative recovery is the choice of the nasal tampon material, among many, to produce minimal damage on the nasal mucosa. In this study, the histopathological effects of the glove finger and merocel tampons, which are commonly used in clinical applications, have been investigated on the nasal mucosa of rabbits. MATERIALS AND METHODS: In this study, merocel and glove finger tampons were used for nasal packing in one-sided nasal cavities of 16 adult New Zealand rabbits. The animals were randomized into two groups, each consisting of eight animals. The tampons were removed after 48 hours. RESULTS: Histological examination showed that if the merocel was in a glove finger, it did not create any damage to mucosal integrity and lamina propria. However, in the group where merocel was used directly, the epithelium of the nasal mucosa was shortened and demonstrated loss of cilia and in four of the eight specimens, it was partly from lamina propria. CONCLUSION: It is concluded that the use of merocel in glove finger tampon leads to a lesser degree of damage in the lamina propria, and may facilitate rapid mucosal wound healing postoperatively.

Comparison of levo-bupivacaine and lidocaine for postoperative analgesia following septoplasty.

The aim of this study is to compare the efficacy of levo-bupivacaine, a long-acting local anesthetic and lidocaine in postoperative analgesia following septoplasty. 112 patients randomized into two groups were included in the study. 56 patients were operated using levo-bupivacaine and 56 using lidocaine as the local anesthetic. All patients were asked to mark their pain levels on a Visual analogue scale (VAS) at 1st, 2nd, 4th, 6trh 8th, 12th, and 24th hours postoperatively. In addition, the amount of analgesics used by each patient was recorded. The results indicated that the VAS scores of the levo-bupivacaine patients were significantly lower within the postoperative 4 hours (p < 0.05) compared to the lidocaine group. In the levobupivacaine patients the earliest time for analgesic need was delayed (p < 0.001) and the total amount of analgesics used was significantly lower when compared to lidocaine group (p < 0.001). In conclusion, levo-bupivacaine is effective for obtaining postoperative analgesia following septoplasty with local anesthesia. When compared to lidocaine, it increases the postoperative comfort of the patients by reducing pain levels.

Cervical sympathetic chain schwannoma: two different clinical presentations.

In this report we present 2 cervical sympathetic chain schwannoma (CSCS) cases with different clinical presentations, one being a pulsatile neck mass associated with Horner's syndrome and the other being an asymptomatic neck mass. CSCS usually presents as an asymptomatic neck mass and atypical findings such as Horner's syndrome and/or pulsation may occur in rare cases. Pulsatile CSCSs are generally diagnosed as carotid body tumors at initial workup and patients are referred to vascular surgeons. The differences in symptomatology, the preoperative management, and the importance of differential diagnosis are discussed.

[Lipid peroxidation and antioxidant levels in patients with laryngeal carcinoma]. / Larenks karsinomlu hastalarda lipid peroksidasyonu ve antioksidan seviyeleri.

OBJECTIVES: Reactive oxygen species (ROS) play an important role in the pathogenesis of cancer. The aim of this study was to investigate the extent of lipid peroxidation and ROS in laryngeal cancer tissues. PATIENTS AND METHODS: We determined glutathione (GSH) and malondialdehyde (MDA) activities as markers of lipid peroxidation in laryngeal tumor specimens and tumor-free adjacent tissues of 30 patients with squamous cell carcinoma. RESULTS: Compared to the tumor-free specimens, the level of GSH was significantly low (p<0.001) whereas MDA, a lipid peroxidation product, showed a significant increase (p<0.01) in cancer tissues. No significant differences were found in MDA and GSH levels between patients with early (n=14) and advanced (n=16) tumor stages (p>0.05). CONCLUSION: Decreased antioxidant capacity of laryngeal cancer tissues results in elevation of free oxygen radicals and increased lipid peroxidation. Free radical metabolism may be involved in the pathogenesis of laryngeal cancers.

A Rare Complication of Chronic Otitis Media: Cerebellar Abscess.

Chronic otitis media (COM) and its associated complications are currently less common because of the popularity of imaging modalities such as computed tomography and magnetic resonance imaging and the increased use of antibiotics. Patients can be treated without any complications owing to early diagnosis. Despite all these new developments and opportunities, complications of autogenous cerebellar abscess may develop and be fatal. In this case report, we present our own clinical experience regarding a patient with cerebellar abscess as a complication of COM.

An atypical esthesioneuroblastoma of the inferior nasal cavity and maxillary sinus: report of a case.

Esthesioneuroblastoma is a rare malignant tumor of the nasal cavity that originates from the olfactory epithelium. In this paper a very rare clinical presentation of this tumor is described. The tumor originated from the maxillary sinus and alveolar process, and was independent of the olfactory region. The patient was a 14-year-old girl presenting with facial swelling and nasal obstruction. Paranasal computed tomography showed a mass filling the right nasal cavity, infiltrating the alveolar process, eroding the anterior wall of the maxilla and invading the subcutaneous tissues of the cheek. Fine-needle aspiration and incisional biopsies identified an esthesioneuroblastoma. After neoadjuvant chemotherapy, we performed a right subtotal and left inferior maxillectomy and reconstructed the maxillary defect with a permanent obturator. At 2 years' follow-up the patient is free of recurrence.

Can postoperative pains following tonsillectomy be relieved by honey? A prospective, randomized, placebo controlled preliminary study.

OBJECTIVE: To compare the effectiveness of acetaminophen versus acetaminophen-plus-honey following pediatric tonsillectomy and adenoidectomy. DESIGN: Prospective, randomized, and placebo controlled clinical trial. SETTING: Tertiary care facility in Ankara, Turkey. PATIENTS: Sixty consecutive tonsillectomy patients randomized to two groups. INTERVENTIONS: The acetaminophen group was treated with antibiotics (amoxicillin-clavulonic acid), acetaminophen and placebo, acetaminophen-plus-honey group was treated with antibiotics (amoxicillin-clavulonic acid), acetaminophen, and honey. Visual analogue scale (VAS) was applied for subjective assessment of postoperative pains, while the number of painkillers taken daily and awakening at night due to pain were used for objective assessment. The amount of epithelization was used for assessment of tonsillary fossa recovery. OUTCOME MEASURES: The difference between acetaminophen and acetaminophen-plus-honey groups was statistically significant both in terms of VAS and number of painkillers taken within the first 2 postoperative days (p<0.001). Although there was no statistically significant difference between groups regarding the VAS scores on the 3rd postoperative day and after, the number of painkillers taken differed significantly until the 8th postoperative day (p<0.001 for first 7 postoperative days; p=0.003 for 8th day). No significant difference was found between groups regarding the number of awakening at night (p=0.36). Tonsillary fossa epithelization was more rapid in the acetaminophen-plus-honey group (p<0.001). CONCLUSION: Oral administration of honey following pediatric tonsillectomy may relieve postoperative pain and may decrease the need for analgesics. Prospective, randomized, and double-blind studies should further be conducted in order to confirm the data obtained in this study and develop a standard protocol to achieve maximum clinical efficiency.

Schwannoma originating from the infraorbital nerve: a case report.

A 16-year-old female admitted to otolaryngology outpatient clinic with the complaints of pain and replacement of her left eyeball upwards. Radiological imaging demonstrated a solid mass inferior to the left globe. The anterior wall of the maxilla was thinned and the mass pushed the orbital floor inferiorly. Following subciliary incision, the bone over the mass was removed from the orbital rim and the mass was exposed. The mass originated from the infraorbital nerve. The mass was excised and the orbital rim, malar region and the orbital floor were reconstructed by a titanium mesh. The histopathological report was "schwannoma". Seven cases of schwannomas arising from the infraorbital nerve reported in English literature. In this paper we report a case of infraorbital schwannoma and review the literature.

Nasal chondromesenchymal hamartoma, a rare pediatric tumor: Case report.

Nasal chondromesenchymal hamartoma has characteristic clinicopathological features and it is accepted as the upper airway analogue of mesenchymal hamartoma of the chest wall. It is a rare lesion and only 31 cases have been reported in the English literature until 2014. In this article, a 13-year-old nasal chondromesenchymal hamartoma case is presented, which is the first nasal chondromesenchymal hamartoma case from Turkey. Although, nasal chondromesenchymal hamartoma has been accepted as a benign lesion, the possibility of malignant transformation should be kept in mind, and detailed histologic examination should be performed particularly in adult nasal chondromesenchymal hamartoma cases.