The role of IL-25 and IL-33 in chronic rhinosinusitis with or without nasal polyps.

The role of IL-25 and IL-33 in the aetiology and pathogenesis of nasal polyps has been controversial in the literature. The objective of the study is to detect serum and tissue levels of IL-25 and IL-33 in patients with (CRSwNP) or without (CRSsNP) nasal polyps using enzyme-linked immunosorbent assay (ELISA). Study group consisted of 20 CRSwNP and 20 CRSsNP patients. Control group comprised of 20 volunteers who had been operated with septum deviation without any additional sinonasal pathology, allergy, systemic disease, or medication use. All groups preoperatively underwent paranasal CT examinations and sinonasal pathologies were recorded based on Lund-Mackay radiological staging system. IL-25 and IL-33 levels in serum and tissue samples were analyzed using the ELISA method. Serum IL-25 and IL-33 levels in CRSsNP, CRSwNP, and control groups did not differ statistically significantly (p = 0.345 and p = 0.338). Any statistically significant difference was not detected in mean tissue IL-25 levels among CRSsNP, CRSwNP, and control groups (p = 0.698). Mean tissue IL-33 level in the CRSwNP group was statistically significantly lower when compared with those of CRSsNP and control groups (p < 0.001 and p < 0.001, respectively). A statistically significant negative correlation was detected between tissue IL-33 levels and Lund-Mackay CT scores (r = -0.436 and p = 0.005). In the present study, we conceivably contributed to scarce number of studies conducted on this issue and we think that further studies will better clarify the role of IL-25 and IL-33 in the development of nasal polyps.

Is Presence of Vascular Loop in Magnetic Resonance Imaging Always Related to Tinnitus?

INTRODUCTION: One of the most common otological complaints is tinnitus in adults. When there is a complaint of unilateral tinnitus and retrocochlear pathology is suspected, imaging methods are applied. However, the imaging findings obtained may not always be compatible with the severity and localization of the tinnitus. AIM: The aim of the present study was to determine whether or not there was a significant correlation between the findings on magnetic resonance imaging (MRI) and the presence and severity of tinnitus in patients with the complaint of unilateral tinnitus. METHOD: The study included 44 patients with no loss of hearing who presented with the complaint of unilateral tinnitus. The relationship between tinnitus severity and vascular loop presence was investigated. RESULTS: Various types of vascular loop were determined in 14 patients. No statistically significant relationship was determined between the presence of vascular loop and the Tinnitus Handicap Inventory scores. CONCLUSION: The results of this study showed no significant difference in respect of the presence of vascular loop on the MRI findings of symptomatic and healthy ears. The presence of vascular loop on MRI is not always a pathological event and should be considered only as an examination finding that could be an anatomic variation.

Expression patterns of claudins 1, 4, and 7 and their prognostic significance in nasopharyngeal carcinoma.

PURPOSE: Tight junction (TJ) proteins in the cells organize paracellular permeability, and they have a critical role in apical cell-to-cell adhesion and epithelial polarity. In our study, the expression patterns of claudins 1, 4, and 7 and their relationship with prognosis were determined in patients with nasopharyngeal carcinoma. METHODS: Claudins 1, 4, and 7 were stained immunohistochemically in 18 biopsy samples of nasopharyngeal carcinomas that included non-neoplastic surface epithelium and dysplastic epithelium in addition to the tumor tissue. The files of these patients were scanned and the stage of disease and treatment received were obtained along with demographic data such as age and gender. RESULTS: Overexpression of claudins 1, 4, and 7 in non-neoplastic surface epithelium was found in 14 (77.7%), 16 (88.8%), and 10 (55.5%) cases respectively; in dysplastic surface epithelium overexpression was found in 8 (44.4%), 13 (72.2%), and 4 (22.2%) cases, respectively; and in invasive tumor areas overexpression was found in 13 (72.2%), 9 (50%), and 10 (55.6%) cases respectively. Increased claudin 4 expression was related to advanced stage (p=0.014). There was a significant relationship determined between claudin 4 and 7 expression and decreased survival (p=0.018, p=0.024, respectively). CONCLUSION: The fact that a statistically significant relationship was found between claudin 4 expression and advanced stage, and similarly a statistically significant relationship was found between claudin 4 & 7 expression and decreased survival gives rise to thoughts that especially claudin 4 and 7 could have different tumorigenic effects on nasopharyngeal carcinoma besides their known adhesion characteristics.

The usefulness of transcervical ultrasonography for the prediction of obstructive sleep apnea in children.

OBJECTIVE: It was aimed to investigate the role of tonsil ultrasonography(USG) in the diagnosis of pediatric OSAS. METHODS: Before tonsillectomy (±adenoidectomy) for OSAS, all patients tonsil USG and polysomnography (PSG) tests were performed. Tonsil volume was measured preoperatively with the Brodsky tonsil grading scale and by postoperative water displacement test. RESULTS: In total, 47 patients were included in the study. We observed a positive correlation between tonsil volumes measured by preoperative USG and water displacement test postoperatively. There was a statistically significant correlation between tonsil sizes measured by tonsil USG, PSG AHI and questionnaire scores(p < .05). CONCLUSION: Preoperative tonsil USG may be helpful test in children with suspected OSAS.

Effects of Anatolian Propolis and Hypertonic Saline Combination Nasal Spray on Allergic Rhinitis Symptoms: A Prospective, Multicenter Study.

Objectives: This study aimed to evaluate how Rhinapi nasal spray affects symptoms of allergic rhinitis. Methods: In this prospective, multicenter, observational study, 10,000 patients (comprising 5028 males and 4972 females) exhibiting symptoms of allergic rhinitis (namely, nasal discharge, sneezing, nasal itching, and nasal obstruction) from different centers in different regions of Turkey were enrolled in the study between March 2022 and March 2023. All the patients wanted to participate in the study and were administered Rhinapi one puff to each nostril three times a day, for a period of 3 weeks. Total symptom scores, quality of life (QoL) scores, and otolaryngological examination scores were evaluated before and 3 weeks after treatment. Results: The scores for discharge from the nose, sneezing, nasal pruritus, and blockage of the nose all indicated improvement when compared to pre-medication and post-medication. This difference achieved statistical significance (P < .001). The mean total symptom score fell following treatment (P < .001): whilst the score was 11.09 ± 3.41 before administering Rhinapi; after administration, the average score was 6.23 ± 2.41. The mean QoL scores also altered after medication (P < .001), improving from a mean value of 6.44 ± 1.55 to a mean of 7.31 ± 1.24. Significant improvement was also noted in the scores for conchal color and degree of edema after the treatment had been administered (P < .001). Conclusion: The study demonstrates that Rhinapi nasal spray decreases total symptom scores, and results in improved QoL and otolaryngological examination scores. Propolis spray may be recommended for patients with allergic rhinitis alongside other treatments.

Detection of human bocavirus in children with upper respiratory tract infection by polymerase chain reaction.

BACKGROUND: The aim of this study was to investigate whether in children with middle ear effusions (MEE), adenoid and tonsil tissues are associated with human bocavirus (HBoV). MATERIALS AND METHODS: A total of 124 patients (56 females (45.2%) and 68 males (54.8%)) with chronic adenotonsillitis and serous otitis media under the age of 15 were recruited. Two hundered four samples (113 adenoid (55.4%), 68 tonsil (33.3%), and 23 middle ear effusion (11.3%)) were analyzed for the presence of HBoV using polymerase chain reaction (PCR). RESULTS: HBoV was detected in only 6 (4.8%) adenoid tissue samples each belonging to a different patient. CONCLUSIONS: Our findings are consistent with the results of other studies, reporting approximately 5 - 10% of the samples being positive for HBoV. To understand the detailed role of HBoV in the etiology of RTI in children, further studies would be needed.

[The effect of operation success on middle ear ventilation in patients with nasal septal deviation]. / Nazal septum deviyasyonlu hastalarda ameliyat basarisinin orta kulak ventilasyonu üzerine etkisi.

OBJECTIVES: This study aims to evaluate the effect of septal deviation causing nasal obstruction and septal surgery on middle ear ventilation. PATIENTS AND METHODS: Twenty-five patients over 18 years of age (6 females, 19 males; mean age 24.7±6.1 years; range 18 to 38 years) who underwent septoplasty due to septal deviation with a normal baseline ear function were included in the study. Nasal obstruction was evaluated preoperatively and at three months postoperatively using visual analog scale and nasal obstruction symptom evaluation (NOSE) scale. Tympanometric tests were performed preoperatively and on seventh day, in the first month and third month postoperatively. RESULTS: There was a statistically significant difference in the mean NOSE score (p=0.00). The mean preoperative NOSE score was 55.5±16.4, while the mean postoperative (at 3 months) NOSE score was 19.0±7.7. The difference in preoperative and postoperative (at 3 months) NOSE scores was statistically significant (p=0.00). In the comparison of the preoperative and postoperative tympanometry results, no statistically significant difference was observed in middle ear pressures (p=0.375). There was no statistically significant relationship between postoperative NOSE scores and middle ear pressures (r=-0.10; p=0.943). CONCLUSION: Our study results showed that the success of septoplasty operation and operation success does not affect the ventilation and pressure of the middle ear significantly.

Cervical osteophytes: a rare cause of obstructive sleep apnea.

Uncertain etiology of cervical osteophytes, in particular emerging in geriatric population, is a rare skeletal system disease. Often, the cases are asymptomatic and may lead to symptoms such as dysphagia, cough, dyspnea, and dysphonia. We present a patient who had anterior osteophytes causing symptoms of severe obstructive sleep apnea (OSA), and literature on etiology of OSA has been reviewed. A 57-year-old male patient with complaints of snoring and cessation of breathing during sleep was referred to the ear nose throat clinic. Cervical radiograph and computed tomography showed the osteophytes in the anterior of the vertebral corpus at the level C1-2. In addition, bridging osteophyte was observed between C6 and C7 vertebrae. The patient's neck circumference was 41 cm, body mass index was 29 kg/m2, Epworth Sleepiness Scale score was 11, and apnea hypopnea index was 62. Surgery was recommended, but the patient refused. Continuous positive airway pressure titration was applied with 12.6 cm H2O pressure; apnea control was attained with an AHI of 2.7. One of the rare causes of OSA, a case of cervical vertebral osteophyte, was presented, and we would like to draw attention to the importance of ear nose throat examination in the diagnosis of OSA.

Serum hepcidin and paraoxonase levels in patients with severe, moderate, and mild obstructive sleep apnea hypopnea syndrome (OSAS): A comparison between OSAS patients and simple snoring patients.

OBJECTIVE: To investigate the importance of hepcidin and paraoxonase in obstructive sleep apnea syndrome (OSAS). METHODS: Eighty-eight patients with sleep disorders were included and divided into four groups: simple snoring (SS), mild, moderate, and severe OSAS. All patients underwent polysomnography. The hepcidin and paraoxonase levels were examined and compared between the groups. RESULTS: There were significant differences between the four groups in terms of paraoxonase levels. In the SS group, the paraoxonase value was significantly higher than in the other three groups. In the analysis, Apnea Hypopnea Index (AHI) was negatively correlated with paraoxonase levels. CONCLUSION: A significant difference was found between the OSAS groups with respect to paraoxonase enzyme, and a negative correlation with AHI was observed. Paraoxonase level could be used as a biomarker in OSAS. No significant data was found for hepcidin levels; therefore, hepcidin cannot be used as a biomarker in OSAS.

An evaluation of the change in serum SCUBE-1 levels with CPAP treatment in patients with severe obstructive sleep apnea.

OBJECTIVE: Signal peptide CUB-EGF domain-containing protein 1 (SCUBE-1) is a cell surface protein, wherein inflammation causes an increase in serum. The aim of this study was to compare serum SCUBE-1 levels in OSA patients and to investigate the serum SCUBE-1 change with CPAP treatment. METHODS: Blood samples were obtained from 61 severe OSA patients and from 25 control subjects evaluated as simple snorers. The 61 patients with severe OSA were treated with CPAP therapy and were recalled for follow up after 1 year. Evaluation was made after 1 year of CPAP therapy. RESULTS: Serum SCUBE-1 values were significantly higher in patients with severe OSA. The SCUBE-1 values significantly decreased after treatment with CPAP. CONCLUSION: Serum SCUBE-1 values in OSA patients showed a significant reduction in SCUBE-1 levels following 1 year of CPAP treatment.

[A fatal case of necrotizing fasciitis of the neck]. / Boyunda fatal seyreden nekrotizan fasiit olgusu.

Necrotizing fasciitis is a rare but life-threatening soft-tissue infection primarily involving the superficial fascia and subcutaneous tissue. Only early diagnosis and aggressive therapy including broad-spectrum antibiotics and surgical intervention can avoid systemic toxicity associated with a high mortality rate. Necrotizing fasciitis is rarely seen in the head and neck region. In this article, we report a fatal case of necrotizing fasciitis in the neck of 75-years-old female patient and reviewed the microbiology, diagnosis, treatment and prognosis of this rare infection together with literature data.

Changes in substance P levels of inferior turbinate in patients with mucosal contact headache.

INTRODUCTION: Mucosal contact headache is a referred pain that arises from contact between the nasal septum and the lateral nasal wall. Evidence supports the role of substance P in a contact headache such that release of substance P from sensory nerve endings causes inflammation and allergy. OBJECTIVES: This study aimed to determine possible differences in substance P levels in inferior turbinate hypertrophy creating a contact headache. METHODS: 28 patients who had contact headaches (study group) and 16 volunteers with no complaints were included in the study. Substance P levels in the inferior turbinate tissue samples were quantified using a commercially available substance P EIA kit. RESULTS: In the study group average substance P levels were 2.65±0.27pg/mg tissue (range: 0.61-5.44) and in the control group it was 1.77±0.27pg/mg tissue (range: 0.11-4.35). The difference was statistically significant between the two groups (p=0.0215). Average preoperative headache group visual analog scale scores was 5.93±0.38 (2-9) and the turbinate volume was 6.56±0.35cm3 (3.50-10.30). The control group turbinate volume was 4.71±0.39cm3 (2.50-7.70). We found a correlation between the visual analog scale scores and substance P levels such that substance P levels were higher in visual analog scale scores above 5 (p=0.001). CONCLUSION: This study demonstrates the relationship between intranasal contact headaches and increased mucosal substance P levels. We also found that there is no correlation with substance P levels and volume of the inferior turbinate.

Extranasopharyngeal angiofibroma originating from the nasal septum: a case report.

Angiofibromas (AFs) originate predominantly in the nasopharynx and posterior nasal cavity. The incidence of these lesions is less than 0.5% among all neoplasms of head and neck. They originate outside the nasopharynx rarely and can therefore be misdiagnosed. The nasal septum is an extremely rare site. Only four cases of extranasopharyngeal angiofibromas arising in the nasal septum have been reported so far. We report here a case of a vascular mass arising from the nasal septum in a 19-year-old boy which was extirpated by submucousal resection endonasally. Histopathology confirmed it to be a case of angiofibroma.

The risk of malignancy according to Milan reporting system of salivary gland fine-needle aspiration with Becton Dickinson SurePath liquid-based processing.

BACKGROUND: Fine-needle aspiration cytology (FNAC) is a noninvasive, safe, cost-effective, diagnostic procedure for the evaluation of salivary gland lesions and the selection of patients for surgery. The aim of this study was to analyze the risk of malignancy (ROM) according to the Milan reporting system of salivary gland FNA specimens using a liquid-based cytology (LBC) technique. METHODS: The cytological diagnosis of 459 cases between 2014 and 2017 was revised according to the Milan reporting system. The FNAC results of 129 cases with a histological diagnosis were compared with respect to the final diagnosis. The ROM for each category calculated. RESULTS: The ROM was high in the indeterminate and malignant categories, while the ROM in the benign neoplasm category was low. Sensitivity and specificity analyzed in two different ways were 95.1% and 88.8%, 81%, and 77.7%, respectively. CONCLUSIONS: When salivary gland lesions are evaluated together with clinical and radiological data, the LBC technique can be applied to salivary gland specimens based on the high diagnostic sensitivity and specificity in liquid-based samples reported according to the Milan system.

Does severe obstructive sleep apnea syndrome alter retrobulbar blood flow? A color Doppler ultrasound study.

PURPOSE: To evaluate extraocular orbital vessels with color Doppler ultrasound (CDU) and investigate the effects of severe obstructive sleep apnea (OSA) on retrobulbar blood flow. METHODS: Between February 2014 and September 2015, 30 patients with severe OSA (apnea-hypopnea index (AHI) > 30) and 28 controls were prospectively included in this study. Intraocular pressure (IOP) was measured with a Goldmann applanation tonometer, and CDU was used to evaluate the retrobulbar vessels. RESULTS: The mean AHI score for the OSA group was 63.2 ± 21.5 per hour. The IOP values were significantly higher in the severe OSA group (p < 0.05). The central retinal artery peak systolic velocity (PSV) (p < 0.05) and end-diastolic velocity (EDV) (p < 0.02), and the ophthalmic artery (OA) PSV and EDV, were found to be significantly lower in the OSA group (p < 0.05). CONCLUSION: Severe OSA causes an increase in IOP and a decrease in flow velocity in the retrobulbar circulation.

The effect of platelet-rich fibrin membrane on the repair of perforated tympanic membrane: an experimental study.

CONCLUSION: Platelet-rich fibrin (PRF) membrane could be used successfully in the repair of tympanic membrane perforation and wound healing. OBJECTIVES: To evaluate the effect of platelet-rich fibrin membrane in the repair of perforated tympanic membrane. METHODS: After otoscopic examination, a 3-mm perforation was made in the posterior quadrant of both tympanic membranes of 50 adult male Sprague-Dawley rats. Venous blood was withdrawn from the rats, then centrifuged. PRF was obtained in membrane form. The membrane was placed on the right tympanic membrane perforation. The perforations on the left side were left to spontaneously heal and, thus, formed the control group. Daily examinations were made of 20 rats and the time to healing of the tympanic membrane was recorded. The remaining 30 rats were separated into five groups of six, and histopathological examination was made. Evaluation was made in respect of the presence of oedema in the lamina propria, neovascularization, fibroblastic reaction, and inflammatory cells. RESULTS: The healing time of the tympanic membrane perforation was determined as mean 10.3 ± 2.18 days in the study group applied with PRF and 17 ± 2.40 days in the control group. Higher values in respect of fibrosis and neovascularization were obtained in the study group.

Is orienteering associated with allergic rhinitis in adolescents?

BACKGROUND: Allergic rhinitis (AR) is a disease that reduces athletic performance. Environmental allergen exposure is higher in outdoor sports (such as orienteering) than indoor sports. The main purpose of this study was to investigate the AR frequency in orienteers comparing with indoor athletes. METHODS: Sixty adolescent athletes (33 orienteers, 27 basketball players) enrolled this prospective study. AR diagnosis was made by both history (ISAAC questionnaire) and physical examination. Nasal endoscopy was performed to observe objective findings (concha hypertrophy, mucosal paleness, serosity, septum deviation, adenoid hypertrophy). Epidermal prick test, pulmonary function test, total IgE and serum eosinophil levels were also assessed. RESULTS: AR was diagnosed in 21 (35%) athletes. 14 (42.4%) were orienteers and 7 (25.9%) were basketball players (P=0.144). Endoscopic findings and skin test positivity were also seen at higher percentages in orienteers with no significance. Training age (sport duration), total IgE levels and skin test positivity were significantly higher in rhinitic orieenters than non-rhinitic orieenters (P=0.046, P=0.0001, and P=0.004, respectively). CONCLUSIONS: Although adolescent orieenters had some higher allergic parameters than indoor athletes, they were not found more susceptible to AR. It seems that the frequency of AR increases with longer training age in orieentering sport. This study is the first report about AR in adolescent orienteers. Future researchs should more focus on comparing allergic conditions between outdoor and indoor sports.

Pepsinogen identification in the middle ear fluid of children with otitis media with effusion.

OBJECTIVES: This study aims to investigate the presence and concentration of pepsin/pepsinogen in middle ear fluid and to discuss the potential mechanisms involved in the pathogenesis of this condition. PATIENTS AND METHODS: A total of 33 children (21 boys, 12 girls; mean age 5.7±2.4 years; range 3 to 13 years) diagnosed with otitis media with effusion and scheduled for operation were enrolled into the study. Fluids aspirated from the middle ear were assessed for the presence of pepsinogen and albumin and blood samples were drawn simultaneously for comparison. RESULTS: Mean pepsinogen concentration was statistically significantly higher in middle ear fluids compared with serum samples (262.4 ng/mL [range: 211.7 ng/mL - 301.1 ng/mL] versus 102.6 ng/mL [range: 80.7 ng/mL - 134.5 ng/mL], respectively) (p<0.001). On the other hand, mean albumin concentration was significantly lower (1.1 g/dL [range: 0.01 g/dL - 9.5 g/dL] versus 5.8 g/dL [range: 0.9 - 9.5 g/dL], respectively) (p<0.001). The highest pepsinogen concentration was detected in patients with purulent effusion (275.3 ng/mL). CONCLUSION: Our findings support the theory of gastro-esophageal reflux related pepsinogen transition to the middle ear and indicate that pepsinogen may a reliable biochemical marker for the assessment of gastro-esophageal reflux.

Smartphone Based Audiometric Test for Confirming the Level of Hearing; Is It Useable in Underserved Areas?

OBJECTIVE: To determine the hearing levels of participants of a randomized group using a smartphone hearing application and to compare these results with the results from a pure-tone audiogram. MATERIALS AND METHODS: A heterogenous group consisting of both normal-hearing and hearing-impaired participants were included in this study. Pure-tone audiogram thresholds were measured from 250 Hz to 8000 Hz, while smartphone measurements were obtained with a Samsung Galaxy GT-19500 S4 with a bundled headphone running the Hearing Test™ software (e-audiologia.pl), which was downloaded from the Google Play Store as a free application. We compared these results with those obtained from pure-tone audiograms performed by an audiologist as a reference. RESULTS: Validity analysis indicated that the results for each ear and each frequency were excellent (>0.75). We assessed the mean difference between the pure-tone audiogram and the smartphone hearing test results and found the absolute difference to be less than 8.8 dB. CONCLUSION: Smartphone hearing test applications are providing alternative tests that present low-cost solutions. Using the hearing application test may decrease the demand for audiological services in underserved areas. The study suggests that smartphone hearing test results are comparable to pure-tone audiometry results.

Sensorineural hearing loss in ß-thalassemia patients treated with iron chelation.

The predictive value of pure-tone audiometry (PTA) in the early detection of ototoxicity has been questioned, particularly in the higher frequencies. Otoacoustic emissions testing appears to be more sensitive to cochlear insult than conventional PTA. We conducted a cross-sectional descriptive study to compare the efficacy of distortion-product otoacoustic emissions (DPOAE) testing with that of PTA as a method of audiologic monitoring. Our study group was made up of 159 patients (318 ears)-69 males (43.4%) and 90 females (56.6%), aged 5 to 61 years (mean: 23.59 ± 12.55). All patients had been diagnosed with either ß-thalassemia major (BTM) or ß-thalassemia intermedia (BTI), and all had received at least 1 year of treatment within the previous year with an iron chelator-either deferasirox, desferrioxamine (deferoxamine in the United States), deferiprone, or a combination of desferrioxamine and deferiprone. PTA and DPOAE evaluations were performed by the same audiologist using the same audiometer for all patients. In the right ears, the overall incidence of ototoxicity as manifested by sensorineural hearing loss was 39.0% on PTA and 22.0% on DPOAE testing; in the left ears, the corresponding figures were 27.7 and 19.5%, respectively. There were no statistically significant differences in the incidence of ototoxicity between the BTM and BTI groups with any of the four different drug regimens on PTA (p = 0.765, p = 0.378, p = 0.265, and p = 0.579, respectively) or on DPOAE testing (p = 0.890, p = 0.263, p = 0.390, and p = 0.340, respectively). Based on these data, we found no significant difference between PTA and DPOAE testing in their ability to detect ototoxicity. We conclude that periodic testing with both PTA and DPOAE is necessary for patients with suspected ß-thalassemia in order arrive at a prompt diagnosis and initiate timely management.