Effect of Hypertonic Saline during Flexible Nasopharyngeal Laryngoscopy: A Double-Blinded, Randomized, Controlled Trial.

OBJECTIVES: Flexible nasopharyngeal laryngoscopy (NPL) is a cost-effective, simple procedure that provides visualization of the nasal airways. However, it involves a number of challenges for both the clinician and the patient. Hypertonic saline nasal wash is used to prevent nasal secretion in acute/chronic sinusitis and after nasal surgery. We aimed to determine the efficacy of hypertonic saline by comparing the clinician's and patients' experiences during NPL. METHODS: This prospective, double-blinded, randomized, controlled study was performed at a tertiary referral university hospital. Two hundred patients were randomly divided into hypertonic saline, lidocaine, xylometazoline, and isotonic saline groups. During NPL, the clinician's experiences in terms of the quality of the field of view and the patients' experiences in terms of pain and discomfort resulting from the 4 premedication drugs were compared. RESULTS: The groups differed significantly in terms of the clinician's field of view, and patients' pain scores and levels of discomfort (P < 0.025). The field of view results were the highest in the hypertonic saline group, and the lowest in the lidocaine group. The pain scores were the lowest in the lidocaine group, whereas they were the highest in the hypertonic saline group. The discomfort scores were the lowest in the xylometazoline group, but the highest in the lidocaine and isotonic saline groups. CONCLUSION: The use of hypertonic saline facilitated the NPL procedure by improving the clinician's field of view. Moreover, intranasal hypertonic saline reduced the patient's discomfort. Intranasal hypertonic saline can be a good alternative to premedication before NPL.

The Relationship of Ankyloglossia With Gender in Children and the Ideal Timing of Surgery in Ankyloglossia.

INTRODUCTION: Ankyloglossia is a congenital condition that restricts tongue mobility. The aim of this study is to evaluate the relationship between gender and pediatric ankyloglossia and evaluate the planning of ideal timing of surgery. METHODS: The files of pediatric patients in the Turkish population treated surgically for tongue-tie between June 2014 to June 2018 were scanned retrospectively. RESULTS: Three hundred and eighty-two pediatric patients were included in the study. Of these, 115 (30.1%) were female and 267 (69.9%) were male. The prevalence of ankyloglossia was significantly higher in males than in females (P < .001). The age of the patients at time of surgery ranged from 1 day to 114 months. The most common indication was sucking/feeding difficulties (82%) in patients younger than 2 years, and the most common symptom was speech problems (67%) in patients aged 2 years and older. CONCLUSION: In our study, the prevalence of ankyloglossia in Turkish society was significantly higher in males. Frenectomy surgery is a safe procedure that can be performed on the first day of life in newborns.

Is the C-reactive protein/albumin ratio a prognostic and predictive factor in sudden hearing loss?

INTRODUCTION: Sudden hearing loss is a significant otologic emergency. Previous studies have revealed a coexistence of sudden hearing loss with chronic inflammation. The predictive importance of C-reactive protein/albumin values as a prognostic factor has been shown in various inflammatory and tumoral conditions. OBJECTIVES: The aim of this study was to determine whether the C-reactive protein/albumin ratio in sudden hearing loss can be used for prognostic purposes and whether there is a relationship between the neutrophil/lymphocyte ratio and the C-reactive protein/albumin ratio. METHODS: A retrospective examination was made of 40 patients diagnosed with idiopathic sudden hearing loss and a control group of 45 healthy subjects. The pure tone averages of all the patients were determined on first presentation and repeated at 3 months after the treatment. The patients were separated into 2 groups according to the response to treatment. The neutrophil/lynphocyte ratio and the C-reactive protein/albumin ratios were calculated from the laboratory tests. RESULTS: The patients included 16 females and 24 males with a mean age of 44.1±14.2 years and the control group was composed of 23 females and 22 males with a mean age of 42.2±13.8 years. The mean C-reactive protein/albumin ratio was 0.95±0.47 in the patient group and 0.74±0.13 in the control group. The difference was statistically significant (p=0.009). The mean C-reactive protein/albumin ratio was 0.79±0.12 in the response to treatment group and 1.27±0.72 in the non-response group, with no significant difference determined between the groups (p=0.418). The mean neutrophil/lymphocyte ratio was 3.52±3.00 in the response to treatment group and 4.90±4.60 in the non-response group, with no statistically significant difference determined between the groups (p=0.261). CONCLUSION: C-reactive/albumin ratio was significantly higher in patients with sudden hearing loss than in the control group. Although C-reactive protein/albumin ratio was found to be lower in sudden hearing loss patients who responded to treatment compared to those who did not, the difference between two groups was not statistically significant.

Investigation of Human Papillomavirus (HPV) and Epstein-Barr Virus (EBV) in antrochoanal polyps.

OBJECTIVES/HYPOTHESES: This study aimed to investigate the presence of HPV (HPV types 11 and 16) and EBV in antrochoanal polyps and to contribute to the current literature in this regard. STUDY DESIGN: A case-control study. METHODS: A total of 100 patients (including 43 patients undergoing surgery for antrochoanal polyp, 27 patients undergoing surgery for nasal polyp, and 30 patients undergoing surgery for hypertrophic inferior turbinate) were included in this study. DNA was isolated from formalin-fixed, paraffin-embedded samples with the aid of the Bioneer's AccuPrep Genomic DNA Extraction Kit. In the obtained genomic DNAs, while the detection of HPV DNA was performed using the nested-PCR method, the detection of HPV types 11/16 and EBV DNA was performed using the RT-PCR method. RESULTS: The mean age of the patients with antrochoanal polyp was 26.7 ±â€¯15.4 years (range 7-70). There were 20 (46.5%) women and 23 (53.5%) men in the antrochoanal polyp group. HPV DNA was positively detected using the nested-PCR method in 14 (32.6%) of the patients with antrochoanal polyp and in 3 (11.1%) of the patients with nasal polyp. HPV DNA was not detected in the hypertrophic inferior turbinate group (control group). There was a statistically significant difference between all groups in terms of HPV DNA positivity. In the antrochoanal polyp group, 2 patients had HPV 11 positivity and 12 patients had HPV 16 positivity. In the nasal polyp group, 1 patient had HPV 11 positivity and 2 patients had HPV 16 positivity. EBV DNA was positively detected in 16 (37.2%) of the patients with antrochoanal polyp, in 11 (40.7%) of the patients with nasal polyp and in 8 (26.7%) of the patients with hypertrophic inferior turbinate, respectively. There was no statistically significant difference between the groups in terms of EBV DNA positivity. CONCLUSIONS: This study demonstrates that there is a need for further studies investigating the presence of viruses in antrochoanal polyps.

Transnasal Endoscopic Removal of a Knife Causing Penetrating Brain Injury in a Child.

Transnasal penetrating brain injuries are rare and a medical emergency, which needs to be treated promptly. A 4-year-old male patient was brought to our emergency room with a knife sticking out of his nose. The patient was immediately taken to the operating room and the knife was removed under general anesthesia. No cerebrospinal fluid leakage or any bleeding was seen and so the operation was terminated. The authors herein report a penetrating brain trauma through to the cella turcica with a knife that improved without any sequelae at a child.

The role of Onodi cells in sphenoiditis: results of multiplanar reconstruction of computed tomography scanning / Papel das células de Onodi na esfenoidite: resultados da tomografia computadorizada com reconstrução multiplanar

Abstract Introduction Onodi cells are the most posterior ethmoid air cells and extend superolateral to the sphenoid sinus. These cells are also intimately related with the sphenoid sinus, optic nerve, and carotid artery. Radiologic evaluation is mandatory to assess for anatomic variations before any treatment modalities related to the sphenoid sinus. Objective To evaluate the effect of Onodi cells on the frequency of sphenoiditis. Methods A retrospective analysis was performed in 618 adult patients who underwent high-resolution computed tomography between January 2013 and January 2015. The prevalence of Onodi cells and sphenoiditis was evaluated. Whether the presence of Onodi cells leads to an increase in the prevalence of sphenoiditis was investigated. Results Onodi cell positivity was observed in 326 of 618 patients and its prevalence was found to be 52.7%. In the study group, 60.3% (n = 73) were ipsilaterally (n = 21) or bilaterally (n = 52) Onodi-positive, whereas 39.7% (n = 48) were Onodi-negative (n = 35) or only contralaterally Onodi-positive (n = 13). Of the control group, 48.3% (n = 240) were Onodi-positive and 51.7% (n = 257) were Onodi negative. The co-existence of Onodi cells ipsilaterally was observed to increase the identification of sphenoiditis 1.5-fold, and this finding was statistically significant (p < 0.05). Conclusion The prevalence of sphenoiditis appears to be higher in patients with Onodi cells. However, it is not possible to state that Onodi cells are the single factor that causes this disease. Further studies are needed to investigate contributing factors related to sphenoiditis.

Resumo Introdução As células de Onodi são as células etmoidais mais posteriores, que se prolongam superolateralmente ao seio esfenoidal. Essas células também se encontram em íntima relação com o seio esfenoidal, o nervo óptico e a artéria carótida. Para análise de variações anatômicas antes da implantação de qualquer modalidade terapêutica relacionada ao seio esfenoidal, a avaliação radiológica é obrigatória, Objetivo Nosso objetivo foi avaliar o papel das células de Onodi na frequência de esfenoidite. Método Em nosso estudo, foi feita uma análise retrospectiva em 618 pacientes adultos que se submeteram à tomografia computadorizada de alta resolução entre janeiro de 2013 e janeiro de 2015. Avaliamos a prevalência de células de Onodi e de esfenoidite. Investigamos se a presença de células de Onodi leva a um aumento na prevalência de esfenoidite. Resultados A positividade para células de Onodi foi observada em 326 de 618 pacientes e sua prevalência foi de 52,7%. No grupo de estudo, 60,3% (n = 73) eram CO-positivas: ipsilateral (n = 21) ou bilateralmente (n = 52); e 39,7% (n = 48) eram CO-negativas (n = 35) ou apenas contralateralmente CO-positivas (n = 13). No grupo de controle, 48,3% (n = 240) eram CO-positivas; e 51,7% (n = 257) eram CO-negativas. Observamos que a coexistência de CO ipsilateralmente aumentava em 1,5 vez a associação com esfenoidite e esse achado foi estatisticamente significante (p < 0,05). Conclusão A prevalência de esfenoidite parece ser maior em pacientes com células de Onodi, mas não é possível afirmar que elas são isoladamente o fator causador dessa doença. Novos estudos precisam ser feitos para uma investigação dos fatores contributivos relacionados à esfenoidite.

An Asymptomatic Foreign Body in the Nose in an Eighteen-Year-Old Patient: Button Battery.

Foreign bodies lodged in the upper airway are a common occurrence in children. Many unusual foreign bodies in the nose have been reported as foreign bodies like nuts, plastic toy parts, beads, and so forth. Most of these produce minimal morbidity but button batteries due to their early chemical disintegration require early surgical intervention. Here, we report a case of button battery lodged in the nose for several years with a symptom of nasal obstruction and chronic sinusitis.

Sudden sensorineural hearing loss: Is antiviral treatment really necessary?

OBJECTIVES: It was aimed to investigate the necessity of antiviral agents in the ISSHL treatment. METHODS: In this study, the patients, diagnosed with sudden hearing loss and admitted in the first 7 days of hearing loss were divided into two groups; a combination therapy was administered to one of the groups, and famciclovir was administered to the other group as an antiviral treatment in addition to the combined therapy. Both groups were compared in terms of levels of recovery. RESULTS: No statistically significant difference was found in the recovery rates between the two groups (p=0.7). CONCLUSION: In this study, the additional antiviral treatment was found to have no effect on the remission rates in patients with ISSHL treated with combined therapy.

Effectiveness of radiofrequency cryptolysis for the treatment of halitosis due to caseums.

OBJECTIVE: To evaluate the effectiveness of radiofrequency (RF) cryptolysis for caseum-induced halitosis. STUDY DESIGN: Clinical retrospective study. SETTING: Otorhinolaryngology Head and Neck Surgery Department of Konya Training and Research Hospital in Turkey. SUBJECTS AND METHODS: Thirty-four patients with caseum-induced halitosis were included. Eight were male (23.5%) and 26 were female (76.5%). Their mean age was 28.29 ± 9.3 (range: 17-48) years. The mean duration of complaint of halitosis before RF cryptolysis was 53.41 ± 42.6 months (range: 6-182 months). The Finkelstein test, organoleptic measurements, and visual analog scale (VAS) were performed before and 12 months after RF cryptolysis. RESULTS: Before RF cryptolysis, all patients had a positive Finkelstein's test result, organoleptic measurements revealed that three (8.82%) had serious halitosis, 24 (70.58%) had average halitosis, and seven (20.58%) had mild halitosis, and the mean VAS score was 6.82 ± 1.45. The follow-up period after RF cryptolysis was 12 months. After the single RF cryptolysis session, 26 patients (76.47%) were negative for Finkelstein's test, organoleptic assessments revealed that 26 (76.47%), six (17.64%), and two (5.88%) showed complete, partial, and no recovery, respectively, (p<0.001), and the mean VAS score was significantly better at 1.88 ± 2.5 (p<0.001). Thirty-two patients (94.1%) exhibited a decrease in VAS score. CONCLUSION: RF cryptolysis is a cost-effective, safe, and easily applicable modality for the treatment of halitosis due to caseums in the crypts of the palatine tonsils.

The hemostatic efficacy of Ankaferd Blood Stopper in adenoidectomy.

OBJECTIVE: To evaluate the efficacy of Ankaferd Blood Stopper (ABS) in the control of intraoperative and postoperative bleeding in adenoidectomy. METHODS: In total, 90 patients underwent traditional cold steel adenoidectomy and were then randomized to receive ABS or 0.9% physiological saline solution to obtain hemostasis. Objective data collected included time of operation and blood loss during operation. Visual analog scales (VAS) were used to record subjective data by the operating surgeon including bleeding following adenoid pack removal and ease of operation. RESULTS: In a comparison between patients in the ABS group (n = 46) and the control group (n = 44), those in the ABS group had significantly shorter operation times (9.11 ± 1.02 vs. 13.16 ± 3.96 min; p < 0.001) and less blood loss during the operation (20.19 ± 8.59 vs. 25.48 ± 12.96 ml; p ≤ 0.05) and a shorter hemostasis time (3.83 ± 0.8 vs. 5.82 ± 1.67 min; p < 0.001). Regarding hemorrhage after tampon removal, 40 patients (87%) in the ABS group and 17 patients (38.6%) in the control group did not suffer from hemorrhage (p < 0.001). Regarding ease of hemostasis, 40 patients (87%) in the ABS group experienced very easy or easy hemostasis while 26 patients in the control group did so (59.1%; p = 0.004). Patients in the ABS group returned to a regular diet earlier and had less use of analgesics at 7 days postoperatively. Use of electrocautery was less in the ABS group than in the control group (10.9 vs. 40.9%; p = 0.001). CONCLUSIONS: The side on which ABS was used showed significant differences in hemostasis time, blood loss, and ease of hemostasis. ABS appears to be safe and effective; it decreases intraoperative bleeding and reduces operating time when compared to traditional hemostasis methods after curette adenoidectomy.

Use of intratympanic dexamethasone for the therapy of low frequency hearing loss.

The objective was to assess the efficacy of intratympanic dexamethasone in treatment of sensorineural hearing loss at lower frequencies (LFSHL). The design is a prospective study. Eleven female and three male patients with LFSHL were included in this study. They were evaluated with pure-tone audiometry, acoustic admittance, transient evoked otoacoustic emission, and glycerol test. Seven, four, and three patients were seen within the mean of 2.86 +/- 1.35 (1-5), 18.25 +/- 2.36 (15-20), and 750 +/- 700 (60-1,460) days from onset of LFSHL, respectively. They were treated with daily intratympanic dexamethasone (ITD) injection and reviewed with repeated daily audiograms during the intratympanic treatment. As complementary treatment, they were given oral prednisolone 1 mg/kg (maximum 60 mg), with 10 mg decreasing doses for every 3 days. Results were compared with their unaffected ear. The mean +/- SD hearing level at 0.125 up to 1.5 kHz improved from 64.29 +/- 19.18 to 25.93 +/- 13.54 (P < 0.001), pure tone average improved from 62.7 +/- 25.7 to 22.9 +/- 17.8 (P < 0.001), speech reception thresholds improved from 34.6 +/- 29.45 to 17.5 +/- 16.38 (P = 0.028), speech discrimination scores improved from 65.7 +/- 39.8 to 84.6 +/- 24.7% (P = 0.024) with treatment. Complete recovery in 10 of 14 patients, partial recovery in 3 patients, was achieved after therapy; and in one patient the situation was unchanged. The mean hearing level at 0.125 up to 1.5 kHz was elevated from 45.6 +/- 17.5 to 9.1 +/- 10.3 dB (P < 0.001) when compared with unaffected ear. The mean recovery rate was 77.9 +/- 25.3%. ITD is an effective therapy for LFSHL.

Proliferating active cells, lymphocyte subsets, and dendritic cells in recurrent tonsillitis: their effect on hypertrophy.

OBJECTIVE: To investigate the causes of hypertrophy in recurrent tonsillitis with hypertrophy (RTTH). DESIGN: An immunohistochemical study of recurrent tonsillitis with or without hypertrophy and adenoid tissue. SETTING: Academic medical center. PATIENTS: The study population comprised 15 patients with RTTH, 15 patients with recurrent tonsillitis (RT), 9 patients with adenoid vegetation, and 6 controls. MAIN OUTCOME MEASURES: The following outcome measures were investigated: follicle number and follicular area and circumference; degree of papillary arrangement and keratin cyst in crypts; fibrosis; and density of S-100(+) cells, CD20(+) cells, CD45RO(+) cells, lymphocytes and plasma cells, and cyclin D(1)(+) cells in surface epithelium, crypt epithelium, extrafollicular area, and follicles. RESULTS: In the RTTH group, follicle number and follicular area and circumference, S-100(+) cell density in crypt and surface epithelium, and CD20(+) cell density in crypt epithelium were higher than in the RT group. The other measures were lower in the RTTH group than in the RT group. In patients with RTTH, the increase in follicle number and S-100(+) cell density in surface epithelium and decrease in cyclin D(1)(+) cell density in surface epithelium were significant. The number of CD45RO(+) cells was unchanged, while S-100(+) cell density increased in surface epithelium; however, in the RTTH group, CD20(+) cell density, together with cyclin D(1)(+) cell density, decreased in surface epithelium when compared with the RT group. Also, there was a 50% decrease in cyclin D(1)(+) cell density in follicles, but CD20(+) cell density decreased minimally in follicles. In the RTTH group, the increase or decrease in the number of cyclin D(1)-expressing cells was parallel with the increase or decrease in the number of CD20(+) cells in the areas without follicles. CONCLUSIONS: Tonsil hypertrophy occurred with follicular hyperplasia and hypertrophy. There is a deficiency of proliferating active cells in response to mitogenic stimulation in RTTH. New follicles might have formed with B cells supplied from other sites because of the deficiency of proliferating active cells.

[Castleman's disease in a patient with recurrent reactive lymphadenopathy]. / Tekrarlayan reaktif lenfadenopatili bir olguda Castleman hastaligi.

Castleman's disease is an uncommon benign disorder associated with progressive lymph node enlargement. It most commonly involves the mediastinum and involvement of the neck accounts for 6%. A 28-year-old male presented with a progressively enlarging left-sided neck mass. He had a history of excisional lymph node biopsy that yielded a histopathologic diagnosis of reactive lymphadenopathy. In our clinic, a repeat excisional biopsy was performed and the diagnosis was made as Castleman's disease. Although it is an uncommon cause of lymphadenopathy in the neck, Castleman's disease should be considered in the differential diagnosis of recurring lymphadenopathies. Repeated excisional biopsies may be necessary (from the largest lymph node when possible) to uncover the disease.

Nasal polyp diseases in allergic and nonallergic patients and steroid therapy.

OBJECTIVE: To investigate widespread disease causes, cellular-structural differences, and steroid response of nasal polyps (NPs). METHOD: Study group consisted of NPs, allergic-NPs, NPs with steroid therapy (ST), antrochoanal polyp (ACP), and controls. We investigated stromal eosinophil, mast cell, CD4+ and CD8+ cell counts and presence of squamous metaplasia, Ki-67 expression, intraepithelial eosinophils-mast cells, epithelial damage, edema, fibrosis, hyalinization, polymorphonuclear leukocyte, and glandular hyperplasia. RESULTS: In allergic-NPs, intraepithelial eosinophils and epithelial damage CD4+ were significantly higher than NPs and also, eosinophils, mast cells, intraepithelial eosinophils, and epithelial damage were significantly higher than ACP. Only stromal eosinophilic infiltration was significantly higher in NPs than ACP. There was significant increased glandular hyperplasia and decreased intraepithelial eosinophils, mast cells, CD4+ cells, squamous metaplasia, and epithelial damage with ST in allergic-NPs. There were no significant differences with ST in NPs. CONCLUSION: NPs in allergic and nonallergic patients may differ in their histology and in their histologic responses to ST. EBM RATING: B-3b.

A mean red blood cell volume loss in tonsillectomy, adenoidectomy and adenotonsillectomy.

OBJECTIVE: To calculate a mean red blood cell volume (RBCV) loss per kilogram (kg) in adenoidectomy, tonsillectomy, and adeno-tonsillectomy. MATERIALS AND METHODS: Pre- and post-operative complete blood cell count, and pre-operative clotting studies of 144 patients were measured. Total blood volume (75 or 70 ml/kg), pre- and post-operative RBCV (hematocritxtotal blood volume), RBCV loss, per kg RBCV loss and per cent RBCV loss were calculated. RESULTS: There was significant differences between pre- and post-operative RBCV, Hb, and Htc values for tonsillectomy, adenoidectomy and A&T groups, respectively (p<0.001 for all groups). We found a mean RBCV loss of 33 ml (5.56% of total RBCV) for adenoidectomy, 128 ml (10.63% of RBCV) for tonsillectomy and 60 ml (10.71% of RBCV) for A&T. RBCV loss per kg was 1.57+/-1.29 for adenoidectomy, 2.96+/-1.91 for adeno-tonsillectomy, and 3.02+/-1.66 for tonsillectomy. CONCLUSION: According to us, for management of the patients, knowledge of a mean nature loss of RBCV per kg is important because bleeding seems to be unavoidable in the intra-operative or maybe post-operative period in these operations.