Does systemic steroid deficiency affect inner ear functions?

PURPOSE: Today corticosteroids are employed for the treatment of various inner ear disorders. In this study we have investigated probable changes in hearing functions resulting from a deficiency of systemic steroid secretions. MATERIALS AND METHODS: Twenty four healthy female rats were used in our study, allocated into three groups (medical adrenalectomy, medical adrenalectomy+dexamethasone, no treatment). Audiological evaluations were conducted at the beginning of the study and on days 7, 14 and 21. Blood samples were taken at the beginning and at the end of the study and blood corticosterone levels were determined. RESULTS: While there were no significant differences between the basal, 7th, 14th and 21st day DPOAE values of group 1, their ABR threshold values showed significant increases. In group 2, there were no significant differences between the basal, 7th, 14th and 21st day DPOAE values. ABR thresholds of group 2 showed significant increases on days 7 and 14 as compared to their basal values, but there were no significant differences between the 21st day and basal ABR threshold values. There were no significant differences between the basal cortisol levels of the three groups. The mean cortisol level of group 1 on day 21 was found to be significantly lower than those of groups 2 and 3. CONCLUSION: The results of the study demonstrated that there were no significant changes in DPOAE values with the cessation of cortisol secretion, while there was a progressive increase in ABR thresholds, which could be overcome with cortisone replacement.

Dynamometric Analysis of Normative Auricular Stiffness and Comparison With Operated Prominent Ears.

AIM: Stiffness of the auricular cartilage is the main determining factor for the choice of operative technique of the prominent ear deformity. The aim of this study is to evaluate the stiffness of normal appearing ears objectively and quantitatively, compare the results with the operated prominent ear patients, and present prospective short-term dynamometric evaluation of the operated prominent ear patients. PATIENTS AND METHODS: A total of 190 volunteers without ear deformities were recruited and 9 age groups were formed: group (5-9), group (10-14), group (15-19), group (20-24), group (25-29), group (30-34), group (35-39), group (40-49), and group (50+). Total 28 ears (14 patients) with otoplasty were included in the study as group (operated 5-9) and group (operated 10-14). In addition, 3 patients with prominent ear deformity were prospectively followed for dynamometric changes that occur with otoplasty operation. The auriculocephalic angle (ACA) was measured once and auricle to scalp distance was measured at 4 different standardized levels. Ear stiffness was measured on each ear individually at 4 different points over the antihelix using digital computer-aided dynamometry. Each ear was compared in terms of ACA, distance, and dynamometric values. FINDINGS: Dynamometric values tend to increase with age, which increase and peak around 35 years of age and declines after 40 years of age. Measurements of the first 2 age groups were statistically different compared with the other groups. Postoperative dynamometric measurements (DNM) of group (operated 5-9) were similar with normative values of group (5-9) and postoperative satisfaction visual analogue scale (VAS) score was 92.8%. Postoperative DNM of group (operated 10-14) were higher compared with normative values of group (10-14) for each different measuring level and the postoperative satisfaction VAS score was 75.3. A total of 3 patients with prominent ears had lower dynamometric values preoperatively; these values approached closer to normative values of their age group postoperatively. CONCLUSIONS: Results show that auricular cartilage stiffens and malleability decreases with increased age. This stiffness peaks in the 35-39 age group and declines after 40 years of age. Dynamometric values increase, at all levels, suggesting increased cartilage stiffness is related to age. In the scope of these results, cartilage sparing techniques are more suitable for 5 to 14 years of age and cartilage-cutting techniques are more suitable for older patients.

Autospreading spring flap technique for reconstruction of the middle vault.

BACKGROUND: Reconstruction of the middle third of the nose is crucial and middle vault insufficiency is possible following dorsal reduction in a primary rhinoplasty unless additional surgical measures are taken. The aim of this study was to define a novel suturing technique autospreading spring flap for middle vault reconstruction by suturing only the medial aspect of both upper lateral cartilages with septal quadrangular cartilage in a unique mattress suture and to mimic the natural anatomical configuration of the upper lateral and septal cartilages. This technique is intended to create functionality with aesthetic dorsal lines. METHODS: Fifteen volunteers with a significant osseocartilaginous dorsal hump underwent open rhinoplasty. The middle vault was reestablished using the ASSF technique that appositions only the medial part of the upper lateral cartilages and suturing it to the dorsal septal cartilage. Appearance of the nose before and after the operation was evaluated by the patients using a visual analog scale. Acoustic rhinometry (AR) was carried out preoperatively and postoperatively to determine nasal valve patency. Preoperative and postoperative symptoms were evaluated and compared using the nasal obstruction symptom evaluation (NOSE) scale. RESULTS: Patients (mean age=32.2±6.3 years) were followed for a mean of 12.6 months. The preoperative NOSE score was 65.0±13 and the postoperative NOSE score was 7.7±10. Cosmetic evaluation revealed the mean patient preoperative VAS score was 32.5±20 and the postoperative VAS score was 88±9. AR revealed a mean minimal cross-sectional area of 1.56 cm2 that increased to 2.16 cm2 postoperatively. Intranasal total volume increased from 16.3 to 24.8 cm3 postoperatively. CONCLUSION: The newly defined autospreading spring flap suturing technique is a reliable method for reconstructing the nasal dorsum after humpectomy and for preventing middle vault and nasal valve collapse. The outcome was satisfactory, both aesthetically and functionally, but long-term follow-up is required. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Diode laser-assisted endoscopic dacryocystorhinostomy: a comparison of three different combinations of adjunctive procedures.

Chronic dacryocystitis is a frequently encountered condition which can be corrected by dacryocystorhinostomy. Today, the diode laser is increasingly put to use in such corrective operations. This study aims to answer the questions of which adjunctive procedures and which combinations of such procedures are necessary and effective in securing more successful outcomes in diode laser dacryocystorhinostomy. This prospective randomized study included eighty patients (13 male, 67 female) who underwent dacryocystorhinostomy in our hospital during the 2 year period of January 2009-January 2011. The patients were selected consecutively and were randomly allocated to three groups. Group 1 (30): diode laser + mitomycin C + silicone intubation; Group 2 (27): diode laser + silicone intubation; Group 3 (23): diode laser + mitomycin C. All patients were evaluated postoperatively on day 1, week 1, and on the 1st, 3rd, 6th, 12th, 18th, and 24th months. The postoperative evaluation consisted of preoperative and postoperative ostium measurements, recording postoperative complications, and calculating and comparing success rates and operative times. The mean ages of the patients were 63.4 for Group 1, 60.7 for Group 2, and 61.8 for Group 3. No statistically significant difference was found among the groups regarding pre- and postoperative ostium measurements. The success rates were 84.3, 80, and 76.9 % for Groups 1, 2, and 3, respectively. Complications noted in Group 1 were restenosis (3), premature silicone tube loss (1), development of granulation tissue (3), synechia (2), infection (2), and hemorrhage (3). Those for Group 2 were restenosis (5), premature tube loss (2), granulation (8), synechia (6), infection (3), and hemorrhage (4). Group 3 had 6 cases with stenosis, 5 with granulation, 3 with infection, 6 with synechia, and 5 with hemorrhage. The operative times of the groups were 25.5, 15.3, and 18.1 min, respectively, for Group 1, 2, and 3. All three groups had statistically significant differences regarding the duration of surgery, with p < 0.001, p < 0.001, and p = 0.002 for Group 1 and 2, Group 1 and 3, and Group 2 and 3, respectively. Our study showed that when diode laser DCR was combined with bicanalicular silicone intubation and intraoperative mitomycin C application, those adjunctive procedures, while increasing operative time, enhanced the success rate and diminished complications as compared to diode laser plus intubation and/or diode laser plus mitomycin C.

Comparison of chondrocytes produced from adipose tissue-derived stem cells and cartilage tissue.

OBJECTIVE: Spontaneous cartilage regeneration is poor after a cartilage defect occurs by trauma, surgical, and other reasons. Importance of producing chondrocytes from stem cells and using tissues to repair a defect is getting popular. The aim of this study was to compare the effects of injectable cartilage produced by chondrocytes differentiated from adipose tissue-derived mesenchymal stem cells and chondrocyte cells isolated directly from cartilage tissue. METHODS: Mesenchymal stem cells were isolated from rat adipose tissue and characterized by cell-surface markers. Then, they were differentiated to chondrocyte cells. The function of differentiated chondrocyte cells was compared with chondrocyte cells directly isolated from cartilage tissue in terms of collagen and glycosaminoglycan secretion. Then, both chondrocyte cell types were injected to rats' left ears in liquid and gel form, and histologic evaluation was done 3 weeks after the injection. RESULTS: Adipose-derived stem cells were strongly positive for the CD44 and CD73 mesenchymal markers. Differentiated chondrocyte cells and chondrocyte cells directly isolated from cartilage tissue had relative collagen and glycosaminoglycan secretion results. However, histologic evaluations did not show any cartilage formation after both chondrocyte cell types were injected to rats. CONCLUSIONS: Strong CD44- and CD73-positive expression indicated that adipose-derived cells had the stem cell characters. Collagen and glycosaminoglycan secretion results demonstrated that adipose-derived stem cells were successfully differentiated to chondrocyte cells.

Septal perforation repair: mucosal regeneration technique.

A novel method for repair of septal perforations. Fifteen volunteers with symptomatic septal perforations were recruited. Open technique rhinoplasty approach was preferred: auricular conchal cartilage graft with intact perichondrium on both sides was harvested and shaped to fit the perforated site and attached to the septum with absorbable sutures. All margins of the graft were covered with nasal mucosa. The severity of patient symptoms was assessed at preoperation, 3 and 6 months postoperatively via visual analogue scale (VAS). Crust formation, whistling, nasal blockage, epistaxis and overall comfort were evaluated. Mucosal physiology was assessed by nasal mucociliary clearance time. The mean age of the patients was 47.3 years. Average perforation size was 1.86 ± 0.78 cm. 14/15 (93.3%) perforations were repaired, and only one patient required revision surgery. VAS scores improved significantly (p < 0.001). Mean mucociliary clearance time improved from 17.6 ± 3.83 to 10.3 ± 3.30 min and 9.3 ± 3.36 min at 3 and 6 months, respectively. This is a novel, simple and safe method for repairing the deficient mucosal area in septal perforations up to 25 mm in diameter.

Reduction of cisplatin ototoxicity in rats by oral administration of pomegranate extract.

The aim of this study was to investigate the effectiveness of the oral administration of pomegranate extract (PE) as a protective agent against cisplatin-induced ototoxicity. The study included a prospective, controlled animal study Group 1 (n = 6), received no cisplatin or PE, and group 2 (n = 6) received cisplatin at 8 mg/kg/day for 3 consecutive days. Group 3 (n = 6) received not only cisplatin at 8 mg/kg/day for 3 consecutive days, but also received PE (100 µL/day) via gavage for 5 days prior to the cisplatin injection and for 3 days concomitantly with the cisplatin injections. To measure cisplatin ototoxic effects, "distortion product otoacoustic emissions" (DPOAE) were analyzed 3 days before and after the cisplatin injections. Histological changes in the cochleas were observed by light microscopy. Compared with group 3, the DPOAE amplitudes of group 2 decreased significantly. Among the groups, there was a statistically significant difference in basal and mid turn external ciliated cells (ECC) number, but there was no statistically significant difference in apical turn. Differences in stria vascularis (SV) changes were statistically significant between the groups, and the median score for SV injury was significantly greater in group 2 than in group 3. Differences in the median scores for SGC changes being significantly greater in group 2 than in group 3. In conclusion, these results indicated that oral administration of PE afforded statistically significant protection to the cochlea in rats from cisplatin toxicity, and thus, oral experimental dose of PE administration may have a protective effect against cisplatin ototoxicity in rats.

Eustachian tube function following total laryngectomy.

OBJECTIVE: The function of the Eustachian tube has been investigated in various conditions. However, its status has not been evaluated in total laryngectomized patients. This study was designed to investigate short-term and long-term changes of the Eustachian tube that occur following total laryngectomy. METHOD: We enrolled a total of 53 patients who have undergone total laryngectomy in a tertiary referral center. These patients were divided into 2 groups, as those within the last 2 years after surgery (group 1) and those more than 2 years after surgery (group 2). In addition, 51 healthy volunteers were studied as a control group (group 3). We tested Eustachian tube function with P1, P2, and P3. P1 is the tympanometric measurement while resting. P2 is the tympanometric measurement after the Toynbee maneuver. P3 is the tympanometric testing after the Valsalva maneuver. To evaluate the functionality of the Eustachian tube, we used the P1-P2 >10 daPa or Pmax - Pmin >15 daPa criteria. RESULTS: A statistically significant difference was not detected between Pmax - Pmin, P2, and P1-P2 values among the groups. Moreover, a statistically significant difference was also not detected between the right and left sides through the Pmax - Pmin values when assessing the groups among themselves. CONCLUSIONS: We determined that the functions of Eustachian tubes were not different between the patients who underwent total laryngectomy and the healthy volunteers at nearly the same age. The lack of active airflow in the upper respiratory tract following total laryngectomy has no effect on the function of the Eustachian tube in the short and long term.

Impact of smoking on p65 nuclear factor κB, p38 mitogen-activated protein kinase, and inducible nitric oxide synthase expression levels in oral mucosa.

OBJECTIVES: Smoking plays an important role in oral cancer development; however, the molecular carcinogenesis mechanism in oral mucosa is not well understood. The aim of this study was to examine and compare the levels of p65 nuclear factor κB (NF-κB), p38 mitogen-activated protein kinase (MAPK), and inducible nitric oxide synthase (iNOS) expressions between oral mucosa of nonsmoker and smoker volunteers. METHODS: Oral cheek mucosa was collected from 78 volunteers. Smokers were divided into 2 subgroups: light smokers (<40 pack years) and heavy smokers (≥ 40 pack years). Paraffinized tissue immunochemistry was carried out for p65 NF-κB, p38 MAPK, and iNOS expression with specific antibodies. Results were evaluated based on diffuseness and intensity of staining. RESULTS: Group 1 composed of 40 nonsmokers: 52.5% were female and 47.5% were male, with a mean age of 46.4 years. Group 2 composed of 38 smokers (20 light smokers, 18 heavy smokers): 39.5% were female and 60.5% were male, with a mean age of 48.9 years. Total immunohistochemical staining scores of smokers were significantly higher compared with those of nonsmokers in p65 NF-κB, p38 MAPK, and iNOS expression (P < 0.001). The highest p65 NF-κB, p38 MAPK, and iNOS expression levels were detected in the oral mucosa of heavy smokers. The expression of iNOS and p65 NF-κB in heavy smokers was significantly higher compared to that in light smokers (P < 0.01 and P < 0.05, respectively). Although p38 MAPK expressions were higher in heavy smokers compared with light smokers, the difference was not statistically significant (P > 0.05). CONCLUSIONS: Our results show for the first time the significant increase in the expression of p65 NF-κB and p38 MAPK in the oral mucosa of smokers. Levels of p65 NF-κB, p38 MAPK, and iNOS expression in the oral mucosa of smokers were related to the number of pack years.

[Our results with respect to uvulopalatopharyngoplasty in patients with snoring and obstructive sleep apnea syndrome]. / Horlama ve obstrüktif uyku apne sendromunda modifiye uvulopalatofarengoplasti sonuçlarimiz.

OBJECTIVES: In this study we evaluated the results of modified uvulopalatopharyngoplasty in patients with snoring and obstructive sleep apnea syndrome. PATIENTS AND METHODS: Twenty patients (9 females, 11 males; mean age 44.4 years; range 31 to 67 years) who were diagnosed to have obstructive sleep apnea syndrome and snoring and who underwent modified uvulopalatopharyngoplasty were evaluated prospectively. The patients were evaluated considering pre- and postoperative symptoms, polysomnography, and Epworth sleepiness scale. Postoperative polysomnography was performed in the 4th month at the earliest and in the 25th month at the latest. RESULTS: With respect to polysomnography, there were no significant differences between pre- and postoperative values except duration of apnea. However, there was significant decrease in postoperative values when compared to preoperative values regarding Epworth sleepiness scale. There were no significant differences between the patients followed up for four to eight months and those followed up for 12 to 25 months. CONCLUSION: Modified uvulopalatopharyngoplasty may be a method of choice in patients with obstructive sleep apne syndrome who are not compatible with continuous positive airway pressure or oral apparatus.

[Tuberculous lymphadenitis]. / Tüberküloz lenfadenitleri.

OBJECTIVES: In this study, we evaluate tuberculosis (Tbc) lymphadenitis diagnosed patients age, gender, contact history, history of smoking, socioeconomic status, lymphadenitis localization, imaging techniques, fine needle aspiration biopsy (FNAB) and excisional biopsy results. PATIENTS AND METHODS: Between February 2006 and February 2008 104 patients were operated to determine the etiology of their neck masses. Twenty-six patients (16 females, 10 males; mean age 36.9 years; range 16 to 52 years) who were diagnosed as Tbc lymphadenitis according to pathology results were included in the study. Ear, nose and throat examinations were performed in all patients routinely. Hemogram, biochemical and serological tests were performed. The patients were evaluated with anterior-posterior chest radiographs and purified protein derivative (PPD) by chest diseases consultation imaging methods and FNAB was performed. All patients diagnosed with excisional biopsy of neck mass. During the operation, tissue culture and Ziehl-Neelsen method for staining was prepared. RESULTS: Out of 26 patients eight had a history of contact with Tbc. One person had previously lung Tbc. Six patients had previously received treatment because of Tbc lymphadenitis, but didn't complete the treatment. Neck ultrasonography and neck computed tomography detected a solid mass in 16 patients and cystic mass in 10 patients. The 24 patients were evaluated as positive PPD (>10 mm). None of the patients had an association between active pulmonary Tbc and Tbc lymphadenitis. CONCLUSION: Suspicion is the most important step in the diagnosis of Tbc lymphadenitis. In patients with low socioeconomic status, previous Tbc contact, tabacco usage, suppressed immune system, and particularly in those with drainage from neck masses, Tbc lymphadenitis should be considered in the differential diagnosis.

The Need for Completion Thyroidectomy in Cases of Differentiated Thyroid Cancer.

There are no definitive criteria for the presence of malignancy in the opposite lobe in cases of unilateral lobectomy due to a thyroid mass in which the malignancy was diagnosed histologically. Study design is retrospective, cross sectional study. The present study included patients who underwent a lobectomy in our clinic between 2001 and 2016 with an initial diagnosis of atypia with undetermined significance or suspected malignancy according to fine-needle aspiration biopsy and adult patients who received a thyroidectomy based on thyroid cancer detected in pathological examinations. Tumor histopathological diagnosis, tumor size, and capsular, vascular, or lymphatic invasion were assessed in patients who received thyroid lobectomy. The presence of a multifocal tumor (52.3%) significantly increased the risk of malignancy in the opposite lobe over the risk association with a unifocal tumor (8.9%; p < 0001). In patients with a tumor diameter greater than 4 cm (83.3%), the risk of malignancy in the opposite lobe was higher than that in patients with a tumor diameter less than 4 cm (22.3%; p < 0.001). Significant differences were not observed between groups with and without vascular or capsular invasion of the opposite lobe (p = 0.913 and p = 0.840, respectively). We determined risk factors for the presence of multifocal disease in unilateral lobectomy materials; an aggressive tumor subtype and a size larger than 4 cm are the most important factors that increase the risk of malignancy in the opposite lobe. Level of evidence Level 4-Case-control studies.

Factors influencing the longevity and replacement frequency of Provox voice prostheses.

INTRODUCTION: This study aimed to assess the factors that influence the longevity and replacement frequency of Provox voice prostheses following their placement. METHODS: The medical records of 27 patients who received Provox voice prostheses after total laryngectomy and attended follow-up regularly between 1998 and 2012 were retrospectively reviewed. The success rate of the Provox voice prostheses (i.e. whether speech was achieved), quality of speech achieved, number and type of complications encountered, frequency of prostheses replacement and reasons for prostheses replacements were evaluated. RESULTS: All 27 patients were men and their mean age was 63.0 (range 43-78) years. The mean follow-up period was 60.3 (range 1-168) months. Fluent and understandable speech was achieved in 85.0% of the patients. The mean duration before prosthesis replacement had to be performed was 17.1 (range 1-36) months. The most frequent complication was fluid leakage through the prosthesis. There was a strong positive correlation of 77.1% between the longevity of prostheses and postoperative follow-up duration (r = 0.771; p < 0.01). CONCLUSION: The voice prosthesis is a tool that can be delivered in a practical fashion and replaced easily with no serious complications. It is a means by which speech can be restored, with a high success rate, after total laryngectomy. In the present study, we found that postoperative follow-up duration was the most important factor influencing the longevity of the Provox voice prosthesis.

A prospective randomized blinded clinical trial: large-volume nasal irrigation with fluticasone propionate in the early postoperative period following septoplasty.

BACKGROUND: The aim of this study was to compare 2 methods of nasal irrigation after septoplasty. The combined use of low-pressure, high-volume nasal saline (LPHVNS) irrigation, together with fluticasone propionate (FP) (LPHVNS+FP), was compared with high-pressure, low-volume nasal saline (HPLVNS) irrigation during the early postoperative period following septoplasty. METHODS: Seventy-three patients undergoing septoplasty for nasal obstruction were recruited for the study. The patients were randomly divided into 2 groups; nasal irrigation was applied for 4 weeks in both groups. Group 1 (n = 40) used HPLVNS irrigation. Group 2 (n = 33) used the LPHVNS+FP combination. The patients were evaluated using the visual analogue scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE), nasal examination scores, acoustic rhinometry, rhinomanometry, and peak nasal inspiratory flowmetry (PNIF) measurements. RESULTS: In group 2, the increase in VAS results was more prominent than in group 1. NOSE scores were significantly lower in group 2 than in group 1. The nasal examination revealed that group 2 had less edema and less crusting than group 1. The decrease in nasal airway resistance was significantly higher in group 2. The PNIF values increased to a significantly greater extent in group 2 than in group 1. CONCLUSION: Nasal irrigation with the LPHVNS+FP combination during the early postoperative period following septoplasty is an effective method, resulting not only in increased patient satisfaction and nasal air flow but also in decreased edema and crust formation.

[The incidence of allergic rhinitis in children with otitis media with effusion]. / Efüzyonlu otitis mediali çocuklarda alerjik rinit görülme sikligi.

OBJECTIVES: Many factors have been implicated in the etiopathogenesis of otitis media with effusion (OME). In this study, we investigated the role of allergy and the incidence of allergic rhinitis in patients with OME. PATIENTS AND METHODS: The study included 22 children (17 boys, 5 girls; mean age 7.8 years; range 2 to 12 years) with OME confirmed by findings of physical examination and tympanometry. Patients with high IgE levels and symptoms of allergic rhinitis were further investigated by skin prick tests and nasal smears. The results were compared with those of an age- and sex-matched control group (13 boys, 8 girls; mean age 7.8 years) with no symptoms of otolaryngological diseases. RESULTS: Symptoms of rhinitis, serum IgE levels, prick test and nasal smear findings suggested a diagnosis of allergic rhinitis in five children with OME (23%), and in one child (4.8%) in the control group. However, this difference did not reach significance (p>0.05). CONCLUSION: Identification and appropriate treatment of allergic rhinitis in patients with OME may increase the success rate of OME treatment.

The use of large volume low pressure nasal saline with fluticasone propionate for the treatment of pediatric acute rhinosinusitis.

OBJECTIVES: Fluticasone propionate and nasal saline irrigation have been used in the treatment of sinonasal diseases for a long time. Our study investigates the effect of the combination of large volume low pressure nasal saline irrigation and fluticasone propionate for the treatment of pediatric acute rhinosinusitis. METHODS: Ninety-one pediatric patients with acute rhinosinusitis were included in our study. The patients were randomized into two groups. The first group (n=45) was treated with standard therapy (antibiotherapy+nasal decongestant) for 2 weeks, the second group was treated with the large volume low pressure nasal saline+fluticasone propionate combination for 3 weeks. The clinical scores, radiologic evaluations (X-ray Waters view), peak nasal inspiratory flow (PNIF) measurements, total symptom scores and hematologic parameters (WBC, CRP, ESR) of the patients were evaluated and compared. RESULTS: There were no significant differences in between the two groups regarding age, gender, height and weight. Even though the clinical scores of Group 2 improved more rapidly, there were no significant differences in between groups regarding clinical scores by the 21st day. There were no significant differences in post treatment radiologic evaluations (Waters graphy). Both groups had significant improvement of their post treatment PNIF values, yet the improvement was more marked in Group 2 than in Group 1. The rhinorrhea, nasal congestion, throat itching and cough symptoms improved more rapidly in Group 2 than in Group 1. Post-treatment nose itching and sneezing symptoms were significantly less in Group 2. The values of hematologic parameters were significantly reduced at the end of the 3rd week in both groups. CONCLUSIONS: Our study is a first in investigating the combined use of large volume low pressure nasal saline and fluticasone propionate in acute pediatric rhinosinusitis, and the results reveal that the combination therapy was effective. Low pressure large volume nasal saline+fluticasone propionate combination can be employed as a new line of therapy for the treatment of pediatric acute rhinosinusitis, either by itself or combined with standard therapy.

Olfactory function and nasal manifestations of Behçet's disease.

OBJECTIVE: To investigate the effect of Behçet's disease on olfactory function, the nasal mucosa, and nasal symptoms. METHODS: A total of 30 patients with Behçet's disease and 30 healthy individuals volunteered to enroll in the study. Any condition leading to olfactory dysfunction was a criterion for exclusion. Nasal endoscopy was carried out individually, and nasal symptoms were assessed. An olfactory function assessment test defined by the Connecticut Chemosensory Clinical Research Center (CCCRC) was carried out. n-Butanol odor threshold and odor identification tests were performed, and the CCCRC test score (0: worst score; 7: best score) was calculated. The relationship between nasal findings, nasal symptoms, and olfactory function was evaluated. RESULTS: The mean age of each group was the late 1930s, and demographic differences were not significant. n-Butanol threshold test scores were 5.57 ± 1.0 and 6.47 ± 0.7 out of 7 for subjects with Behçet's disease and the healthy control group, respectively. Identification test scores were 4.93 ± 1.3 and 6.15 ± 0.8 out of 7 and the mean CCCRC scores were 5.25 ± 1.0 and 6.31 ± 0.6, respectively, with significant differences (p<0.001). Some nasal symptoms were significantly more common in patients with nasal findings, but no correlation was found between nasal findings and olfactory function. CONCLUSION: Although Behçet's disease has been shown to involve the nasal cavity, its effects on olfactory function are unknown. The significant difference in CCCRC scores suggests, for the first time, that olfactory dysfunction is associated with Behçet's disease. Nasal symptoms are associated with the presence of nasal lesions, but there is no correlation between nasal findings and olfactory function.

Evaluation of olfaction in patients with pemphigus vulgaris.

BACKGROUND: Pemphigus vulgaris (PV) is an autoimmune disease characterized by acantholysis. PV decreases quality of life and leads to morbidity and mortality. Although the association between PV and otolaryngeal disease has been studied, its effect on olfaction has not been investigated objectively and quantitatively. METHODS: Twenty-eight patients with PV and 28 healthy volunteers were included in the study. Lesions were identified via nasal endoscopic examination. Nasal symptoms (itching, obstruction, pain, bleeding, and crusting) were recorded. Volunteers were asked to evaluate their olfactory function via a visual analog scale. The Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test was performed (butanol threshold test and identification test), and the score was calculated as the mean ± SD. RESULTS: The mean age of the PV group (group 1: 10 male 18 female subjects) was 48.7 ± 8.9 years. The mean age of the control group (group 2: 17 male and 11 female subjects) was 48.0 ± 1.1 years. All nasal symptoms, except itching, were more severe in the PV group (p < 0.05). Nasal lesions were more common in the PV group (p = 0.0001). Evaluation of olfactory function revealed significantly lower scores in the PV group for both the butanol threshold test and the identification testing as well as the CCCRC total score (p = 0.001). PV patients with nasal lesions had significantly more nasal symptoms (p < 0.05). A negative correlation was found between the number of lesions and the olfactory scores in group 1 for the butanol threshold test, identification testing, and the CCCRC total scores, respectively (p = 0.002, p = 0.010, and p = 0.001, respectively). CONCLUSION: PV causes olfactory dysfunction leading to eventual hyposmia that decreases quality of life. We suggest that olfactory testing be included in PV evaluation for the diagnosis and treatment of hyposmia, when necessary.

Does adrenaline spraying over thyroidectomy area reduce bleeding?

BACKGROUND: Means to prevent and control intra- or postoperative bleeding remain a topic of utmost importance in thyroidectomy. In this randomised clinical trial, we used adrenaline spraying to see if it helps bleeding control and reduces drainage and hematoma formation after thyroidectomy. METHODS: After total thyroidectomy, 1 mg/ml adrenaline solution in 10 ml saline was sprayed all over the operation area by a syringe in 40 patients of "Adrenaline (+) Group". In the other 40 patients in "Adrenaline (-) Group", only standart total thyroidectomy was performed. Drainage amounts of 24 hours were recorded. RESULTS: Among 80 patients, 66 (82.5%) were female and 14 (17.5%) were male. The daily drainage amounts of the Adrenaline (+) Group were found statistically significantly lower than the Adrenaline (-) Group (p<0.05). In both of the groups, thyroid volumes were significantly correlated with the drainage amounts. "p" values were 0.008 and <0.001 in Adrenaline (+) and Adrenaline (-) Groups, respectively. CONCLUSIONS: Preliminary experience using adrenaline has been encouraging and it is useful as an adjunct to thyroid surgery in order to prevent hemorrhagia and give up drain placement. But prospective randomized trials using adequate patient numbers are still needed to validate efficacy and safety.