Rhinitis medicomentosa and substance addiction.

BACKGROUND: Rhinitis medicomentosa (RM) is a form of non-allergic rhinitis caused by the use of nasal decongestants for longer than the recommended duration. Because of this problem of use, addiction to the drug occurs in individuals. In our study, we aimed to evaluate the susceptibility of RM patients to substance addiction. METHODS: The study was planned as a prospective, multicentric study between September 2022 and September 2023. Patients diagnosed with RM were included in the study. Beck depression scale, Drug use disorders identification test, Substance Abuse Proclivity Scale were applied to the patients participating in the study. The research data were analyzed electronically with SPSS program version 25. RESULTS: The study included 86 patients with an average age of 31 years. The average duration of medication use was 22 months. Age, gender, duration of nasal congestion, duration of drug use and smoking were not independent predictors for depression and substance use tendency. CONCLUSION: The relationship between RM and addictive substances is not clear. The tendency to use drugs did not increase in RM patients. In the light of these data, we think that there is no need for a practice other than routine functioning in the use of drugs and similar substances that are likely to cause addiction in RM patients.

Important aspect of hypoglossal nerve injury following gunshot wound; Can the clivus has a role? A case report.

Cranial nerve palsies after gunshot injury are not uncommon. We report the mechanism of isolated hypoglossal nerve paralysis caused by a gunshot. We report a 74 years old patient in whom a bullet entered through the right nostril and then ended up right occipital condyle. The only neurologic deficit was tongue deviation which resolved in one week. The bullet was not removed. The effect of clival slope may have an importance in this type of injury.

Comparison of effects of dexmedetomidine and amifostine against X-ray radiation-induced parotid damage.

Radiotherapy can be employed as a therapeutic modality alone in the early stages of cancer and is used together with other treatments such as surgery and chemotherapy in more advanced stages. However, exposure to ionizing radiation in association with radiotherapy affects several organs in the head and neck and can give rise to early and late side effects. Exposure to ionizing radiation used in radiotherapy is known to cause cell damage by leading to oxygen stress through the production of free oxygen radicals (such as superoxide radicals, hydroxyl radical, hydrogen peroxide, and singlet oxygen), depending on the total radiation dosage, the fractionation rate, radiosensitivity, and linear energy transfer. The purpose of the present study was to determine the potential protective role of a powerful and highly selective α2-adrenoreceptor agonist with a broad pharmacological spectrum against salivary gland damage induced by ionizing radiation exposure. Forty Sprague-Dawley rats were divided into five groups-control, ionizing radiation, ionizing radiation + dexmedetomidine (100 µg/kg), ionizing radiation + dexmedetomidine (200 µg/kg), and ionizing radiation + amifostine (200 mg/kg). Following exposure to ionizing radiation, we observed necrosis, fibrosis, and vascular congestions in parotid gland epithelial cells. We also observed increases in malondialdehyde (MDA) and cleaved Caspase-3 levels and a decrease in glutathione (GSH). In groups receiving dexmedetomidine, we observed necrotic epithelial cells, fibrosis and vascular congestion in parotid gland tissue, a decrease in MDA levels, and an increase in GSH. Dexmedetomidine may be a promising antioxidant agent for the prevention of oxidative damage following radiation exposure.

Revision of cartilage tympanoplasty with endoscopic butterfly inlay myringoplasty.

PURPOSE: While the use of cartilage graft for revision tympanoplasty is quite common, the data on the revision of cartilage tympanoplasty are limited. Our study aims to present the results of our patients who underwent endoscopic butterfly inlay myringoplasty for the revision of cartilage tympanoplasty. METHODS: Demographic data, ear sides, perforation locations, graft success rates and hearing results of the patients who underwent endoscopic butterfly inlay myringoplasty for revision of cartilage tympanoplasty between Sep 2017 and Jan 2020 were evaluated. RESULTS: A total of 17 patients with 7 (41%) females and 10 (59%) males were included in our study. Eight of the ears (47%) were right and nine (53%) were left. Perforation locations included ten (59%) anterior, six (35%) inferior, and one (6%) posterior. The graft success rate of our study was 100%. No changes were observed in post-operative air conduction, bone conduction and air-bone gap values compared to the pre-operative period (p > 0.05). CONCLUSIONS: Endoscopic butterfly inlay myringoplasty for the revision of cartilage tympanoplasty is considered to be a safe surgical technique with satisfactory anatomical and hearing results.

Test-retest reliability and discriminatory power of multidimensional voice analysis program.

OBJECTIVES: The objectives of this study were to evaluate and compare the test-retest reliability of acoustic parameters (jitter [%], shimmer [%], noise-to-harmonic ratio [NHR], and voice turbulence index [VTI]) by using multidimensional voice program, and to detect the discriminatory power of the acoustic measures with respect to dysphonic voices and normal voices. DESIGN, SETTING, PARTICIPANTS, AND METHODS: Fifty-four (25 male and 29 female) participants with voice disorders and fifty-one (27 male and 24 female) participants with normal voices were enrolled in this study. They were assessed by anamnesis, visual examination, auditory perceptual assessment (GRBAS), and acoustic measurements. The intraclass correlation coefficient was used to determine the test-retest reliability. The effect size (d value) and p value obtained from the t-test were used to determine the discriminatory power. RESULTS: In the normal group, good reliability was observed for jitter, shimmer, and NHR, and moderate reliability was observed for VTI. With regard to the dysphonic group, jitter, shimmer, and VTI were moderately reliable, and the NHR had good reliability. Meanwhile, the discriminatory powers of jitter and shimmer were evaluated as 'medium', and those of NHR and VTI as 'small'. CONCLUSION: The reliability and discriminatory powers of our acoustic measures were high compared with most other studies. Their level of reliability and discriminatory power can be maximised by using stringent rules. However, attaining an excellent level of reliability and discriminatory seems infeasible power owing to the variable characteristic of voice. Therefore, acoustic measures should be adopted as a complementary tool.

Bilateral same-day endoscopic tympanoplasty.

PURPOSE: Although bilateral same-day tympanoplasty is a faster and more comfortable procedure for patients, it is rarely performed due to its theoretical risks. The present study aims to evaluate the results of patients who underwent bilateral same-day endoscopic tympanoplasty. MATERIALS AND METHODS: In this study, 26 patients and 52 ears were evaluated. Postoperative anatomic success rate, pre- and postoperative hearing test results, hearing gains and postoperative complications were recorded. RESULTS: Postoperative anatomic success rate was 92.3% (48/52). Audiological tests revealed the preoperative air-bone gap (ABG) as 19.1 ± 8.8 (7-35) dB and postoperative ABG as 9.8 ± 5.7 (5-25) dB. Postoperative ABG decreased significantly (p: <0.001) and 9.2 ± 4.6 (2-23) dB hearing gain was obtained. We did not observe any significant complications. CONCLUSION: Bilateral same-day endoscopic tympanoplasty is a feasible surgical procedure with good anatomic and functional outcomes, low complication rate and good postoperative patient comfort.

Tympanomeatal flap creation in endoscopic stapedotomy: cautery vs. cold instrumentation.

PURPOSE: Bleeding is one of the most challenging issues for surgeons performing endoscopic stapedotomy. During creation and elevation of the tympanomeatal flap (TMF) prevention or control of bleeding greatly facilitates the safety and comfort in the next steps of the surgery. The aim of this study was to compare the effects of cautery versus cold instrumentation during creation of TMF at endoscopic stapedotomy surgery. METHODS: We investigated 15 patients TMF created with cautery and 14 patients with cold instrument, and compared bleeding scores, operation time, postoperative hearing, pain and complications between groups. RESULTS: The mean bleeding score was significantly lower in cautery incised patients compared to cold instrument patients (1.2 ± 0.9 vs. 2.3 ± 1, p = 0.005). Mean duration of surgery was also significantly shorter in cautery used patients (35.3 ± 6.8 vs. 48.8 ± 9.2 min, p < 0.001). There was no significant difference between postoperative pain, complications, wound healing, and auditory outcomes. CONCLUSIONS: Cautery may be a better choice for the creation of TMF in endoscopic stapedotomy surgery due to reduced bleeding, shorter operation time and increased comfort without causing any complications.

The evaluation of prognostic factors in endoscopic cartilage tympanoplasty.

PURPOSE: The aim of the present study was to evaluate the prognostic factors that may affect the success in endoscopic cartilage tympanoplasty and determine the outcomes of endoscopic cartilage tympanoplasty. METHODS: This study included 312 patients who underwent transcanal endoscopic type I cartilage tympanoplasty. The effects of sex, the affected side, the size of the perforation, the location of the perforation, the absence of myringosclerosis, external ear canal protrusion, the condition of the contralateral ear, and surgical experience on the rate of graft success and hearing improvement were investigated. RESULTS: The affected side, sex, location of the perforation, myringosclerosis, the condition of contralateral ear, and surgical experience did not significantly affect the surgical success (p > 0.05). However, the size of perforation and ear canal wall protrusion were significantly related to both functional and anatomical success (p < 0.05). CONCLUSION: Endoscopic transcanal type I cartilage tympanoplasty can be performed with a high anatomical and functional success rate. However, surgeons should be more careful and design a case-specific operation strategy in patients with external ear canal anterior wall protrusion and large perforations.

What Are We Missing From Asymmetric Relationship Between the Retinal Nerve Fiber Layer Thickness Profiles and Sphenoid Sinus Volume?

PURPOSE/AIM OF THE STUDY: Detailed analysis of retinal structure such as the retinal nerve fiber layer can be performed by spectral-domain optical coherence tomography (OCT). There are no published studies concerning a relationship between retinal nerve fiber layer and human sphenoid sinus volumes. We investigated this relationship. MATERIAL AND METHODS: Spectral-domain OCT. The peripapillary retinal nerve fiber layer (RNFL) thickness and sphenoid sinus volume estimation of both sides of sex-matched patients were retrospectively analyzed. RESULTS: The mean RNFL thicknesses at the left side (91.8 µm) were significantly smaller than the right side (94.5 µm) (P = 0.040). However, the mean left sinus volume (44.5 cm) is larger than the right side, (34.5 mm) (P < 0.005). Left and right differences of both parameters are statistically significant (P < 0.05). CONCLUSION: There is a negative correlation between mean RNFL thicknesses and mean sinus volumes. To our knowledge, this article is the first report demonstrating the asymmetry relationship between RNFL and sphenoid sinus volumes.

Endoscopic butterfly inlay myringoplasty for large perforations.

PURPOSE: Nowadays, the use of otoendoscopy is becoming increasingly popular in ear surgery. Data on endoscopic tympanoplasty are quite current but not yet sufficient. This study aims to present the anatomical and functional results of endoscopic butterfly inlay myringoplasty in large perforations. METHODS: The graft success rates and audiological outcomes of 26 ears of 23 patients who underwent endoscopic cartilage inlay myringoplasty due to large perforation (more than two-thirds of the area of tympanic membrane) from March 2016 to August 2018 were evaluated. RESULTS: The mean follow-up period was 13.3 ± 7.1 (6-32) months. Graft success rate was 96% (25/26 ears). The preoperative mean air-bone gap (ABG) was 21.4 dB and postoperative mean was 14.4 dB. Significant improvement was observed in postoperative air-bone gap values compared to preoperative period (p 0.005). CONCLUSIONS: Endoscopic inlay butterfly myringoplasty is a safe surgical technique and has satisfactory anatomic and audiological outcomes in large tympanic perforations.

First emerging objective experimental evidence of hearing impairment following subarachnoid haemorrhage; Felix culpa, phonophobia, and elucidation of the role of trigeminal ganglion.

Objective: The exact mechanism of phonophobia induced by subarachnoid hemorrhage (SAH) has not been understood well. This subject was investigated. Material and methods: This study was conducted on 25 rabbits. They divided into three groups: Five as control, five as SHAM, 20 as SAH group. All animals objected to 85 dB impulse noise by daily periods, and their phonophobic score values were examined by daily periods for 20 days. Their brains, trigeminal ganglia were extracted bilaterally. The normal and degenerated neuron densities of trigeminal ganglia were examined by stereological methods and compared with phonophobia scores. Results: Phonophobic score was 19-17, mean live neuron density (LND) of the trigeminal ganglia was 16.321 ± 2.430/mm3, and degenerated neuron density (DND) was 1.15 ± 0.120/mm3 in animals of control groups (n = 5). The phonophobic score was 17-14, LND: 14.345 ± 1.913/mm3, DND of the trigeminal ganglia was 1.150 ± 0.110/mm3 in SHAM group (n = 5). The phonophobic score was 14-8, LND: 12.987 ± 1.966/mm3, mean DND of the trigeminal ganglia was 2.520 ± 510/mm3 in animals with high phonophobia scores (n = 6). The phonophobic score was 7-4, LND: 9.122 ± 1.006, mean DND of the trigeminal ganglia was 5.820 ± 1.610/mm3, in animals with fever phonophobia scores (n = 9). Conclusion: An inverse relationship between DND trigeminal ganglion (TGG) and phonopobic score was found. The paralysis of tensor tympani muscle owing to trigeminal ganglia ischemia may be responsible for phonophobic clinical state in animals with SAH. In addition, there seems to be an important concern for the verbal component of GCS in SAH. These two important findings have not been published previously.

The relation between retrobulbar blood flow and posterior ocular changes measured using spectral-domain optical coherence tomography in patients with obstructive sleep apnea syndrome.

PURPOSE: To investigate the effect of posterior ocular hemodynamics on the retinal nerve fiber layer (RNFL), choroid thickness (CT) and central macular thickness (CMT) in patients with obstructive sleep apnea syndrome (OSAS) and to reveal the association with glaucomatous optic neuropathy. METHODS: The research was planned as a prospective, randomized study. The ophthalmic, retinal and posterior ciliary artery pulsatile index (PI) and resistive index (RI) were measured by colored Doppler sonography. RNFL thickness, CMT and CT were then measured by spectral-domain optical coherence tomography. RESULTS: Sixty subjects were divided into four groups-mild, moderate and severe OSAS and a control group. There were 16 subjects in the control group, 14 in the mild OSAS group, 15 in the moderate OSAS group and 15 in the severe OSAS group. Ophthalmic artery and central retinal artery PI and RI values of the OSAS patients did not show statistically significant difference than those of the control group, but posterior ciliary artery (PCA) PI and RI values were significantly higher. In addition, mean, superior and inferior RNFL thickness values were significantly lower than those in the control group. Moreover, the glaucoma prevalence of the OSAS patients in this study was 6.8% and all of these patients were in the severe OSAS group. CONCLUSION: PI and RI values of the PCA, which supplies the optic nerve, show a linear increase as the apnea hypoxia index values in OSAS. As the grade of OSAS improves, this situation leads to a more serious ischemic optic neuropathy. Furthermore, the prevalence of glaucoma in this study is found to be higher in the severe OSAS group.

Effects of gadolinium-based contrast agents on submandibular gland tissue in rats.

AIM: The aim of this prospective animal study is to investigate the influence of multiple administrations of macrocyclic ionic (gadoteric acid) and linear nonionic (gadodiamide) gadolinium-based contrast agents (GBCA) on submandibular gland tissue (SGT) of the rats. MATERIAL AND METHOD: Twenty-four Sprague Dawley female rats were included the study. Group 1 was determined as a control group (n = 6). Group 2 was determined as saline group (n = 6). Group 3 was determined as Omniscan group (n = 6) and received only intraperitoneal (IP) 0.1 mmol (0.2 mL/kg)/kg gadodiamide for 8 days. Group 4 was determined as Dotarem group (n = 6) and received only IP 0.1 mmol (0.2 mL/kg)/mg/kg gadoteric acid daily for 8 days. On the 9th day of the administration, the rats were sedated with ketamine and xylazine through IP injection. The right SGT was removed after sedation. Histopathological and immunohistochemical changes in SGT were evaluated. RESULTS: The SGT of the Omniscan and Dotarem groups decreased SGT acini surface area, and serous acinar cells number were observed. On the other hand, no pathology was observed. Mucous acinar cells' caspase-3 positivity for the same markers in Omniscan and Dotarem sections was similar to the control group. However, Omniscan and Dotarem groups serous acinar cells were caspase-3 (+) staining. The intensity of serous acinar cells' caspase-3 (+) for the same markers in Dotarem sections was similar to the Omniscan group. The results also revealed in the analysis of the mean area of the acinus area of the SGT; there were significantly decreased Dotarem group rats when compared to control rats (p < 0.05). CONCLUSION: We consider that numerical increased apoptosis results arise from repeated doses of GBCAs. Being aware of this effect of the contrast agent may have significance for the chronic sialo-adenitis patients group when used for recurrent contrasted MRI for diagnosis of diseases like MS which requires in follow-up. We should be aware about the frequently contrasted MRI in routine investigations.

Effect of Septoplasty on the Heart Rate Variability in Patients With Nasal Septum Deviation.

BACKGROUND: Nasal septum deformities (NSD) are one of the most common causes of upper airway obstruction. Heart rate variability (HRV) is a physiologic parameter that is affected by the balance between the sympathetic and parasympathetic tonus. OBJECTIVE: The aim of this study was to evaluate the effects of a septoplasty operation on HRV parameters as assessed by 24 hours ambulatory Holter recordings in patients with NSD. METHODS: The prospective study involved 54 consecutive patients (16 women and 38 men) who underwent septoplasty due to a marked C- or S-shaped NSD. Twenty-four-hour Holter monitoring was performed to all patients pre- and 2 months postseptoplasty operation. For the HRV analyses, the definitions of evaluated parameters were made according to the Task Force of European Society of Cardiology and the North American Society of Pacing and Electrophysiology on HRV. RESULTS: Low-frequency norm () (73 [68-86] versus 78 [70-81], P = 0.039) values were significantly increased after septoplasty whereas changes in other parameters were not statistically significant. CONCLUSION: The authors' study showed that low-frequency norm values were significantly increased after septoplasty operation in patients with NSD which may be interpreted as a decreased sympathetic tone.

Unilateral Isolated Hypoglossal Nerve Palsy Caused by Gunshot Injury.

Cranial nerve palsies after gunshot injury are not uncommon. However, in the literature, only 1 patient with isolated hypoglossal nerve paralysis caused by gunshot has been published. The authors describe a 34-year-old man suffering from unilateral isolated hypoglossal nerve palsy caused by gunshot injury as a second reported patient. The bullet entered maxillary sinus, and caused condylar fracture, then ended up C1-2 interspace. The bullet was surgically removed by a posterior approach. It is important to pay attention to hypoglossal nerve injury when confronted with a gunshot wound. The authors recommend early and sufficient surgical decompression.

The effects of choanal atresia on development of the paranasal sinuses and turbinates.

PURPOSE: The objective of this study was to evaluate the volume of paranasal sinuses (PNS) and turbinate in patients with unilateral choanal atresia (CA). MATERIALS AND METHOD: Computed tomography images of PNS in 11 individuals with unilateral CA were evaluated retrospectively. Mucosal thickness and volume of the maxillary, frontal and sphenoidal sinuses were determined, in addition to the volume of the middle and inferior turbinate. The unaffected nasal side of patients was used as a control group for the measurements. The results comprised the measurements of the atresic side compared to those of the healthy side. RESULTS: There was no significant difference between the atresic and healthy side of the nose in patients with CA with respect to mucosal thickness and volume of the PNS (the maxillary, frontal and sphenoidal sinuses) and the middle and inferior turbinate (p > 0.050). CONCLUSION: The complete absence of nasal unilateral airflow had no effect on the development of the PNS and the middle and inferior turbinate. Moreover, mucosal thickness in the sinuses was similar to that in the control group.

Investigation of the effect of the efficiency of noise at different intensities on the DNA of the newborns.

Hearing loss can occur in newborns exposed to high-level noise; noise exposure can cause more physiological stress and can lead to DNA damage. This study was designed to determine DNA damage in newborn rats exposed to sound at different concentrations. For this purpose, 28 newborn (3-6 days old) rats were divided into four groups of 7 rats in each group (Control and Groups of 40 decibel (dB), 70 dB, and 110 dB]. In the experimental groups, 40 dB, 70 dB, and 110 dB (7.5-15 kHz) of sound was applied to the experimental groups for 30 min a day for 7 days. DNA damage levels in the serums obtained from this study were determined by the enzyme-linked immunosorbent assay (ELISA) method. According to this, it was determined that DNA damage in the group exposed to 110 dB showed a statistically significant increase (P < 0.05) compared to the compared to the control, 40 dB, and 70 dB groups. Related to the subject, it was concluded that DNA damage may occur in newborns exposed to 110 dB or higher sound in neonatal units, wards, and home environments with newborn babies. Mothers should be warned about this situation and noise should be kept under 110 dB volume in the environments with the newborns.

Effects of long-term Doppler ultrasound exposure on cochlea and cochlear nucleus in prenatal period in an experimental model.

BACKGROUND: New generation Doppler ultrasonography (DUSG) application effects on cochlea and cochlear nucleus (CN) are unclear. We aimed to investigate the effects of new generation DUSG application at different frequencies in prenatal period on cochlea and CN in rats. OBJECTIVE: Twenty-four pregnant female rats were divided into three groups (n = 8). Group 1 was the control group and was not subjected to any treatment. Group 2 was determined as the USG every day (USGED) treatment group. Group 2 has received DUSG application every day from the 4th to 18th day (20 min/15 per day). Group 3 has received DUSG application as "2 days/one dose as every other day application" (USG2D1) from the 4th to 18th day (20 min/8 every other day). Twenty-four female rats were sacrificed in 21 days. Also, 24 pups were sacrificed after two days. First day after born, the cochlear activities of the right ears of all pups were examined using DPOAEs. Second day, neural tissues from CN were evaluated histopathologically and immunohistochemically. RESULTS: There was no any statistical difference between the groups in respect of histopathologically. USGED group showed mild caspase-3 positive neurons and glial cells. However, there was no significant difference between the USGED and other groups (p>.05). Similarly, the rats applied with USG2D1 had mild caspase-3 expression, but no significant difference between the USG2D1 and other groups (p>.05). Differences in DPOAE amplitudes, and therefore in cochlear activity, between the groups were revealed. The decrease in cochlear activity between the groups involved frequencies at 2, 8, 16, and 32 kHz (p<.05). CONCLUSIONS: Multiple administration of new generation DUSG to pregnant rats has not shown harmful effects on the cochlear neural tissue. High frequencies are more sensitive in cochlea to apply DUSG.

Laryngeal Cavernous Lymphangioma in an Adult Patient.

INTRODUCTION: Lymphangiomas are uncommon congenital lesions of the lymphatic system, and most of them are detected by the second year of life. Although head and neck region is the most common location, laryngeal involvement isextremely rare, and the literature is largely limited to few case reports. CASE REPORT: A 51-year-old male patient was admitted to the hospital with clinical history of hoarseness. Performed direct laryngoscopy revealed a pedunculated cystic mass located in the right ventricle of the larynx. The mass was totally excised, and the case was reported as cavernous lymphangioma. CONCLUSION: Isolated laryngeal lymphangioma is extremely rare in adults. The other benign lesions or inflammatory processes in this region can mimic laryngeal lymphangioma. Therefore, this entity should be kept in mind in differential diagnosis especially in adults, to avoid overtreatment.

Effects of Smoking on the Auditory System: Is There a Gender Difference?

The main aim of our study is to evaluate whether the effect of smoking on the auditory system shows gender differences. Another aim is to evaluate whether smoking has any influence on the absorbance of sound. There were 236 volunteers including 90 nonsmokers (42 females and 48 males) and 146 smokers (72 females and 74 males) in the study. Smokers were grouped according to pack-years of smoking as 5 to 10 pack-years, 11 to 20 pack-years, and more than 20 pack-years. Pure tone audiometry and wideband tympanometry were performed in all individuals. Both female and male smokers who consume more than 20 pack-years had significantly higher hearing thresholds at 4 and 6 kHz and significantly lower sound energy absorbance rates at 4, 6, and 8 kHz. Moreover, female smokers with a consumption of 11 to 20 pack-years had significantly higher hearing thresholds at 6 kHz and significantly lower sound energy absorbance rates at 6 and 8 kHz. Smoking causes hearing loss at high frequencies in both females and males, especially in a dose-dependent manner affecting individuals with a consumption of more than 20 pack-years. The sound energy absorbance is significantly reduced at 4, 6, and 8 kHz. In addition, these effects may occur in women with even less exposure.