Evaluation of Nasal Mucociliary Clearance Time in COVID-19 Patients.

BACKGROUND: Coronavirus Disease 2019 (COVID-19) is a viral pandemic emerging in East Asia and spreading rapidly to the rest of the world and continuing in our country. The number of studies examining the symptoms of the otolaryngology system and organs in COVID-19 patients is limited. The purpose of this study is to show whether COVID-19 infections cause any changes in nasal physiology in adult patients by measuring the mucociliary clearance (MCC) time with the saccharin test. METHODS: One hundred one patients with laboratory-confirmed COVID-19 infection (group 1, n = 42 smokers and group 2, n = 59 nonsmokers) and 87 individuals without COVID-19 infection as the control group (group 3, n = 33 smokers and group 4, n = 54 nonsmokers) were included in the study. A saccharin test was used to evaluate the nasal MCC time. RESULTS: Mucociliary clearance test averages of the groups were determined as 473.571 ±â€Š263.684, 442.966 ±â€Š228.463, 468.333 ±â€Š267.367, 412.629 ±â€Š192.179 seconds, respectively. When the test durations were examined, the group with the most prolonged MCC duration was determined as the smoking COVID (+) patient group (473.571 ±â€Š263.684 seconds). The second group, with the most prolonged MCC duration, was determined as the smoking control group (468.333 ±â€Š267.367 seconds). No statistically significant difference was found in intergroup mucociliary clearance time (P = 0.760). CONCLUSION: Although the authors found that smoking and viral infections prolong the MCC duration in our study, they did not find a statistically significant difference between the groups in terms of MCC duration.

Endoscopic tympanoplasty: learning curve for a surgeon already trained in microscopic tympanoplasty.

The aim of this study was to evaluate the learning curve of endoscopic tympanoplasty for a surgeon already trained in microscopic tympanoplasty. We analyzed the clinical records of 81 patients who underwent transcanal endoscopic type 1 tympanoplasty and 30 control patients who underwent microscopic tympanoplasty between 2013 and 2015 in a tertiary hospital. All operations were performed by a single surgeon already trained in microscopic tympanoplasty. Patients were divided into four groups according to the date of surgery chronologically (group 1 early stage, group 2 intermediate stage, group 3 advanced stage and group 4 control). We evaluated the four groups according to surgery duration, audiometric results, and graft intake success. The operation duration shortened in accordance with the surgeon's experience and there were two subsequent steps during the learning curve: first, after 30 procedures; and second, after 60 procedures. The mean operation duration was 88.60 ± 21.10 min in group 1, and 62.00 ± 12.48 min in group 2. After 60 procedures, the mean operation duration was 43.81 ± 8.34 min in group 3. In the control group, the microscopic tympanoplasty duration was 69.93 ± 12.56 min. When we compared audiologic results (air conduction, bone conduction, and air-bone gap) and graft intake success rates, there were no significant differences between groups. Endoscopic tympanoplasty is a minimally invasive and effective technique. Mastering endoscopic tympanoplasty takes approximately 60 operations for a surgeon already trained in microscopic tympanoplasty. Graft intake success rates and hearing results are stable during the learning curve.

Increased Concomitant Nasal Procedure Frequency in Bilateral Endoscopic Dacryocystorhinostomy.

The etiology of primary nasolacrimal duct obstruction (NLDO) is unknown, and the disease may exist bilaterally in a small number of patients. Dacryocystorhinostomy (DCR) surgery is the recommended treatment for these patients, but concomitant nasal pathologies are believed to be related to decreased surgical success. The authors aim to assess the concomitant required nasal surgical procedure frequency for endoscopic surgical access retrospectively in bilateral and unilateral NLDO patients. Twenty-eight patients who underwent bilateral endoscopic DCR simultaneously and 30 patients who underwent unilateral endoscopic DCR were enrolled in this retrospective study. Required concomitant nasal procedure frequency was recorded. In the bilaterally applied DCR group, septoplasty, partial midline turbinectomy, and inferior nasal concha submucosal resection rates were 16 (57.1%), 5 (17.8%), and 3 (10.7%) patients, respectively. Septoplasty and concha bullosa resection were performed simultaneously in 2 patients. Also, uncinectomy was performed with septoplasty in 1 patient. The concomitant nasal surgery rate was 22 of 28 patients (78.6%). On the other hand, in the unilaterally applied DCR group, septoplasty, partial midline turbinectomy, and inferior nasal concha submucosal resection rates were 5 (16.7%), 1 (3.3%), and 2 (6.7%) patients, respectively. Both septoplasty and concha bullosa resection were done in 1 patient. Uncinectomy was performed on 1 (3.3%) patient. A concomitant surgery rate was observed in 8 of 30 patients (26.7%). Nasal pathology, which requires surgical intervention, is seen much more frequently in bilateral than in unilateral NLDO patients.

Retinal Nerve Fiber Layer Thickness Alteration in Apneic Children.

PURPOSE: We examined retinal nerve fiber layer (RNFL) thickness alterations in children with chronic upper airway obstructions (UAOs) and obstructive sleep apnea syndrome (OSAS). We also investigated whether it was affected by an adenotonsillectomy operation. METHODS: Forty-two children aged 3 to 8 years with chronic UAO resulting from adenotonsillar enlargement and 34 age-matched controls were included in the study. Patients underwent a Brouillette scoring questionnaire to be divided into mild (N = 10), moderate (N = 22), severe (N = 10), and total (N = 42) UAO groups. According to the scoring, the severe UAO group was defined as the severe OSAS group, the moderate group was suspicious for OSAS, and the mild UAO group was defined as the non-OSAS group. The patients' demographic data for age, sex, and body mass index were obtained. Ophthalmologic evaluations were performed with optical coherence tomography. Central corneal thickness, macular thickness, intraocular pressure (IOP), and RNFL thickness were measured. An adenotonsillectomy was performed on all patients, and eye examinations and scoring were repeated after the surgery. RESULTS: Higher IOP levels were obtained between the total UAO group and the control group (p > 0.05). There were significant differences between UAO groups and the control group except for the moderate UAO group. There was no significant difference in RNFL thickness (p > 0.05) between preoperative UAO groups and the control group. However, after surgery, some significant differences emerged in the superior, inferior, and average RNFL thickness (p < 0.05). Also, IOP levels were significantly lower in the mild, moderate, and total UAO groups after the operation (p < 0.05). CONCLUSIONS: Upper airway obstruction and OSAS seem to worsen some RNFL and IOP parameters in children, and eye examinations may be useful in these patients.

Increased mean platelet volume in patients with idiopathic subjective tinnitus.

Tinnitus is the perception of sound with no external stimulus and idiopathic subjective tinnitus is the most common type in adults. Mean platelet volume (MPV) alterations were shown in some inflammatory diseases and were evaluated as a clinically useful marker. Our aim was to investigate MPV alterations in idiopathic subjective tinnitus patients. A total of 101 patients and 54 age- and sex-matched healthy control subjects were enrolled in the study. Patients included in the study had complaints of tinnitus for at least 3 months. All patients underwent detailed otolaryngologic examination, blood sampling, pure tone audiometry, magnetic resonance imaging of ear, and vertebrobasilar artery Doppler ultrasonography to make the differential diagnosis of tinnitus. Blood sampling consisted of renal-liver-thyroid function tests, lipid profile, and complete blood count. All tests and examinations except the imaging modalities were also performed for the control group. There were no differences in age and sex distribution of groups. Mean platelet volume values were significantly increased in tinnitus patients when compared with controls (p = 0.001). We think that MPV can be qualified as a useful marker in tinnitus patients.

Simultaneous Bilateral Endonasal Endoscopic Dacryocystorhinostomy: A Low Cost, Fast, and Successful Method.

The etiology of primary nasolacrimal duct obstruction is largely unknown, and this disease may occur bilaterally in a small percentage of patients. In this retrospective study, the authors aimed to discuss the cost, operation time, complications, and success rate of simultaneous bilateral endonasal endoscopic surgery. Twenty-eight patients (16 female, 12 male) were enrolled in this study, with a mean age of 55 years old (range: 43-76). The success rate was 91% (51/56), and the mean operation time was 44 minutes. Only minor and transient complications were observed in 2 of the patients. Overall, the authors believe that a bilateral endoscopic dacryocystorhinostomy would be useful in a single session, based on its advantages of low morbidity, low cost, and high success.

Extranasopharyngeal angiofibroma of the posterior nasal septum: a rare clinical entity.

Angiofibroma of extranasopharyngeal origin is very rare. Although it is usually originated from any mucosal structure in the head and neck region, maxilla is the most common involvement site. The nasal septum is an exceptional anatomic site of an angiofibroma. Surgery is the best treatment modality and recurrence is very rare. Nasal septal angiofibromas must be considered in the differential diagnosis of nasal vascular masses arising from the nasal septum. In this article, we report a 37-year-old male case with nasal septal angiofibroma who underwent surgical resection of the tumor. This is the 16th case in the literature.

Pediatric tracheotomy: 3-year experience at a tertiary care center with 54 children.

The aim of this study was to evaluate the indications, complications and outcomes of pediatric tracheotomies at a tertiary care center. Data were obtained retrospectively from 54 patients who underwent tracheotomy from July 2007 to May 2010. Over the three-year period, 54 tracheotomies were performed. Thirty-two patients (59.3%) were male and 22 (40.7%) were female. The mean and median ages of the patients were 54 and 14 months (6 days-17 years), respectively. Twenty-six patients (48.1%) were under 1 year of age. The most common indication for tracheotomy was prolonged intubation (87%), followed by upper airway obstruction (13%). Five patients (9.2%) underwent tracheotomy under semiurgent settings. The overall complication rate was 29.6% (16/54). Early complications occurred in 7 patients (13%), including accidental decannulation in 2 patients, subcutaneous emphysema in 4 patients and hemorrhage in 1 patient. Late complications occurred in 9 patients (16.7%) (stomal granulation in 7 patients and stomal infection in 2 patients). Eight patients (14.8%) were decannulated successfully. No tracheotomy-related deaths occurred, with an overall mortality rate of 27.7% (15/54). Pediatric tracheotomy is a relatively safe procedure with a low incidence of procedure-related morbidities. The indication for the majority of the procedures was prolonged intubation (87%). The lower decannulation rate is related to the higher percentage of patients needing assisted ventilation and the relatively short follow-up period.

Injury Mechanism of Button Batteries in the Nasal Cavity and Possible Mitigation Strategies During Impaction.

OBJECTIVE/HYPOTHESIS: Button batteries (BBs) impacted in the nasal cavity can cause several complications. Understanding the injury mechanism and developing possible mitigation strategies can reduce these complications. STUDY DESIGN: Cadaveric sheep nasal septum model. METHODS: Lithium, alkaline, silver oxide, and zinc-air BBs were placed on segments of the nasal septum of cadaveric sheep. The BB voltage, tissue temperatures, and pH were measured every 30 minutes for 6 hours. Subsequently, 5 drops of lemon juice, apple cider vinegar, tea, Coke (Coca-Cola Co., Atlanta, GA), tap water, and normal saline were applied separately to the other segments with the lithium BBs every 10 minutes for 3 hours. The visible injuries and the necrosis depths were assessed through the tissue temperatures, pH, and the voltage changes. RESULTS: Both nonlithium and lithium BBs increased tissue pH without significant temperature changes. The 3V lithium BBs led to the greatest depth of necrosis, with a voltage loss of approximately 50% within the first 2 hours. Lemon juice and apple cider vinegar were the most effective liquids for reducing visible injury, pH, and necrosis without increasing the temperature during pre-removal time period. CONCLUSION: Nonlithium and lithium BBs caused alkaline tissue injury in a nasal septal model. Given the hazard severity, expedited BB removal is critical. For situations when removal cannot be immediately performed, further in vivo study is needed prior to considering human use of any pre-removal mitigation strategies in the nasal cavity. LEVEL OF EVIDENCE: NA Laryngoscope, 130:2487-2493, 2020.

Tularemia is becoming increasingly important as a differential diagnosis in suspicious neck masses: experience in Turkey.

Neck mass can be an initial finding of many diseases at any age. The differential diagnosis is broad and includes inflammatory, congenital and neoplastic lesions. We retrospectively analyzed charts of the 145 patients with neck mass and without known primary malignancy whose diagnoses were confirmed with histopathologic and serologic examination between July 2003 and July 2008. Twenty-six patients (17.9%) were diagnosed with tularemia. Before 2004, serologic testing for tularemia was not a part of our workup for patients with an inflammatory neck mass. Otolaryngologists should be familiar with head and neck manifestations of tularemia and consider the disease in the differential diagnosis of neck masses. The tularemia outbreak in central Black Sea region, Turkey in 2004 changed our approach to a patient presenting with neck mass.

Evaluation of choroidal thickness measurements in pediatric obstructive sleep apnea syndrome patients.

Bayraktar C, Simsek A. Evaluation of choroidal thickness measurements in pediatric obstructive sleep apnea syndrome patients. Turk J Pediatr 2017; 59: 62-67. Choroidal vascular impairment and obstructive sleep apnea syndrome (OSAS) related disorders have been shown in adults, but there have been no investigations with regard to the choroidal thickness measurements in children with OSAS. Our aim was to investigate this relationship in the early childhood period, which correlates with OSAS peak incidence due to adenotonsillar enlargement. One-hundred and nine pediatric OSAS patients and 42 age-sex matched controls were enrolled in this study. Nocturnal pulse oximetry was used to define the OSAS patients. Demographic data like age, sex and body-mass index were recorded. All of the subjects underwent complete otolaryngologic and ophthalmologic examination including visual acuity, intraocular pressure, central corneal thickness, axial length and choroidal thickness measurements. Overall, the 1,000 µm and 1,500 µm nasal choroid measurements were found to be significantly lower in the patient group (p < 0.05). However, only a poor inverse correlation emerged between the body-mass index (BMI) and the foveal center measurements in the patients. Observed alterations in the choroid may signify the initial impairment of known OSAS-related eye disorders, like glaucoma, floppy eyelid syndrome, and non-arteritic ischemic optic neuropathy. Ophthalmologists, otolaryngologists and pediatricians working together as a team may be able to prevent future eye diseases.

The effect of long-term use of intranasal steroids on intraocular pressure.

Long-term use of topical nasal steroids (especially older generation steroids) has been shown to elevate intraocular pressure (IOP), but newer intranasal steroids are thought to have a minimal effect on IOP because of their low bioavailability. This study aimed to investigate alterations in IOP with two commonly used intranasal steroids for a 6-month period of time. One-hundred allergic rhinitis patients, divided equally into two groups, used mometasone furoate and fluticasone furoate intranasal steroids for 6 months. IOPs were measured before treatment and repeated at the 3rd, 6th, 12th, and 24th weeks of treatment. The IOPs of the groups were then compared. No statistically significant alteration was observed between the groups during the treatment time period. It was found that new generation intranasal steroids can be used safely, and there may not be an increased risk of IOP elevation in prolonged use in normal healthy people.

Ocular blood flow alterations during inferior turbinate radiofrequency reduction under local anesthesia.

BACKGROUND: Ocular blood flow alterations and blindness are uncommon and less-known adverse effects of nasal local anesthetic infiltrations. Our aim was to investigate ocular blood flow alterations during radiofrequency (RF) tissue reduction of inferior turbinates with the patient under local anesthesia by using a noninvasive method with optical coherence tomography. METHODS: A total of 120 patients with inferior turbinate hypertrophy were prospectively randomized into two groups. In group 1, a total of 61 patients underwent RF tissue reduction while under local anesthesia with epinephrine. In group 2, a total of 59 patients underwent RF tissue reduction of inferior turbinates while under local anesthesia without epinephrine. Optical coherence tomography measurements were performed before surgery and at 5, 15, 30, 45, and 60 minutes after local anesthetic infiltration. RESULTS: Choroid thickness measurements decreased gradually after local anesthetic infiltration until 30 minutes and increased to the same plane with the baseline at 60 minutes in group 1 (p < 0.05). In group 2, the choroid thickness measurement was significantly decreased after local anesthetic infiltration at 15 and 45 minutes (p < 0.05). When the choroid thickness measurements were compared between the groups, in group 1 blood flow was significantly lower than in group 2 at 30 minutes (p < 0.05). CONCLUSION: We observed a statistically significant reduction in choroid circulation after local anesthetic with epinephrine infiltration into inferior turbinates. Otolaryngologists should be careful after local anesthetic infiltration, and monitor the vision. Further studies with larger series would be needed to discuss safety of local anesthetics.

Bilateral parotitis in a patient under continuous positive airway pressure treatment.

BACKGROUND AND OBJECTIVES: Many conditions such as bacterial and viral infectious diseases, mechanical obstruction due to air and calculi and drugs can cause parotitis. We present a case of unusual bilateral parotitis in a patient under non-invasive continuous positive airway pressure (CPAP) therapy for chronic obstructive pulmonary disease exacerbation in intensive care unit. CASE REPORT: A 36-year-old patient was admitted to intensive care unit with the diagnosis of chronic obstructive pulmonary disease exacerbation. Antibiotherapy, bronchodilator therapy and non-invasive positive pressure ventilation were applied as treatment regimen. Painless swellings developed on the 3rd day of admission on the right and a day after this on the left parotid glands. Amylase levels were increased and ultrasonographic evaluation revealed bilateral parotitis. No intervention was made and the therapy was continued. The patient was discharged on the 6th day with clinical improvement and regression of parotid swellings without any complications. CONCLUSIONS: Parotitis may have occurred after retrograde air flow in the Stensen duct during CPAP application. After the exclusion of possible viral and bacteriological etiologies and possible drug reactions we can focus on this diagnosis.

[Bilateral parotitis in a patient under continuous positive airway pressure treatment]. / Parotidite bilateral em paciente sob tratamento com pressão positiva contínua das vias aéreas.

BACKGROUND AND OBJECTIVES: Many conditions such as bacterial and viral infectious diseases, mechanical obstruction due to air and calculi and drugs can cause parotitis. We present a case of unusual bilateral parotitis in a patient under non-invasive continuous positive airway pressure (CPAP) therapy for chronic obstructive pulmonary disease exacerbation in intensive care unit. CASE REPORT: A 36-year-old patient was admitted to intensive care unit with the diagnosis of chronic obstructive pulmonary disease exacerbation. Antibiotherapy, bronchodilator therapy and non-invasive positive pressure ventilation were applied as treatment regimen. Painless swellings developed on the 3rd day of admission on the right and a day after this on the left parotid glands. Amylase levels were increased and ultrasonographic evaluation revealed bilateral parotitis. No intervention was made and the therapy was continued. The patient was discharged on the 6th day with clinical improvement and regression of parotid swellings without any complications. CONCLUSIONS: Parotitis may have occurred after retrograde air flow in the Stensen duct during CPAP application. After the exclusion of possible viral and bacteriological etiologies and possible drug reactions we can focus on this diagnosis.

Effect of preoperative mastoid ventilation on tympanoplasty success.

Purpose. This study was conducted with the aim of investigating the relationship between mastoid air cell volumes and graft success after tympanoplasty. Material and Methods. This study was performed retrospectively with patients undergoing type I tympanoplasty and antrostomy. A total of 57 patients (20-35.09% female and 37-64.91% male) with a mean age of 29.69 ± SD (range 12-56 years) were included in the study. The patients were invited for a control at the 1st, 3rd, and 12th months, and otoscopic examinations and audiometric tests were performed. The temporal bone computed tomography images were screened with the 4800 Dpi optic resolution scanner and transferred to the computer environment in JPG format in order to calculate the mastoid air cell volume, and the volumes were calculated using the Autocad 2007 program. Results. Although, the graft success was determined to be better in the well-ventilated group, no significant difference could be found between the groups in terms of graft success at the 1st, 3rd, and 12th months (P > 0.05). No statistically significant difference could be found between the three groups in terms of the preoperative and postoperative hearing gains (P > 0.05).

Is it really necessary to delay intranasal steroid treatment after FESS? An animal study.

OBJECTIVES: The aim of this study is to investigate the effect of early intranasal steroid administration on wound healing after sinus surgery. STUDY DESIGN: Randomized, placebo-controlled, blinded animal study. SETTING: Animal laboratory. SUBJECTS AND METHODS: Forty-two male New Zealand rabbits underwent bilateral 3-mm punch resection of the concha nasalis ventralis. The animals were divided into 3 groups: saline, late steroid, and early steroid. The saline group received saline drops, the late steroid group received saline drops for 7 days followed by intranasal mometasone furoate 50 µg/nostril/d, and the early steroid group received intranasal mometasone furoate (same dose) starting on postoperative day 1. The animals were sacrificed on postoperative days 10 and 21. Left nasal specimens were examined histopathologically with hematoxylin-eosin and matrix metalloproteinase-9 (MMP-9) stains. Right nasal specimens were examined with high-performance liquid chromatography, and hydroxyproline levels were measured as mg/g in wet tissue. RESULTS: Late steroid and early steroid groups were similar with regard to MMP-9 staining on days 10 and 21. On day 10, the early steroid group revealed significantly intense MMP-9 staining when compared with the saline group, and the late steroid and early steroid groups revealed significant fibrosis when compared with the saline group. Hydroxyproline levels were similar in all groups on day 10. The early steroid group revealed significantly higher hydroxyproline levels when compared with the late steroid group on day 21. CONCLUSION: Our findings showed that early intranasal steroid administration after sinus surgery in an animal model has no detrimental effects with regard to wound-healing parameters.