Mucosal healing with lacrimal and double mucosal flaps endoscopic dacryocystorhinostomy - comparison with flap sacrificed technique: randomised, controlled study.

OBJECTIVE: This study aimed to compare two endoscopic dacryocystorhinostomy techniques: lacrimal and double nasal mucosal flaps, and endoscopic dacryocystorhinostomy without flap preservation. METHOD: This study was designed as a prospective randomised, controlled trial. Mucosal healing, granulation tissue formation and mucosal scar contracture were investigated after the surgery. RESULTS: Ninety patients were included in the study (lacrimal and double nasal mucosal flaps, 46; endoscopic dacryocystorhinostomy without flap preservation, 44). Nine (18.8 per cent) patients in the endoscopic dacryocystorhinostomy without flap preservation group and two patients (4.2 per cent) in the lacrimal and double nasal mucosal flaps group had inadequate wound healing (p = 0.025). Granulation tissue formation was detected in nine patients (18.8 per cent) in the endoscopic dacryocystorhinostomy without flap preservation group and in 1 patient (2.1 per cent) in the lacrimal and double nasal mucosal flaps group (p = 0.008). Functional success rates in the endoscopic dacryocystorhinostomy without flap preservation and lacrimal and double nasal mucosal flaps groups were 89.6 per cent and 97.9 per cent, respectively (p = 0.092). The operation time was similar in both groups (p = 0.122). CONCLUSION: The double mucosal flaps technique is a surgical procedure with satisfactory outcomes for the repair of mucosal defects and related issues.

Could edaravone prevent gentamicin ototoxicity? An experimental study.

OBJECTIVES: Clinical application of gentamicin may cause nephrotoxicity and ototoxicity. Our study is the first study to investigate the protective effects of edaravone against the gentamicin-induced ototoxicity. We investigated the protective effect of intraperitoneal (i.p.) edaravone application against gentamicin-induced ototoxicity in guinea pigs. METHODS: Fourteen guinea pigs were divided into two equal groups consisting of a control group and a study group. One-hundred sixty milligrams per kilogram subcutaneous gentamicin and 0.3 mL i.p. saline were applied simultaneously once daily to seven guinea pigs in the control group (group 1). One-hundred sixty milligrams per kilogram gentamicin was applied subcutaneously and 3 mg/kg edaravone was applied intraperitoneally once daily for 7 days simultaneously to seven guinea pigs in the study group (group 2). Following the drug application, auditory brainstem response measurements were performed for the left ear on the 3rd and 7th days. RESULTS: Hearing threshold values of the group 1 and group 2 measured in the 3rd day of the study were detected as 57.14 ± 4.88 and 82.86 ± 7.56, respectively. This difference was statistically significant ( p < 0.05). Hearing threshold values of the group 1 and group 2 measured in the 7th day of the study were detected as 87.14 ± 4.88 and 62.86 ± 4.88, respectively. This difference was statistically significant ( p < 0.05). CONCLUSION: A statistically significant difference between the average threshold values of edaravone-administered group 2 and that of group 1 without edaravone was found. These differences show that systemic edaravone administration could diminish ototoxic effects of gentamicin and the severity of the hearing loss.

Diagnosis of allergic rhinitis: inter-rater reliability and predictive value of nasal endoscopic examination: a prospective observational study.

OBJECTIVE: To determine the inter-rater reliability of nasal endoscopic findings and the feasibility of diagnosis of allergic rhinitis based solely on symptoms and nasal endoscopy. DESIGN: Prospective observational study. SETTING: University Teaching hospital. PARTICIPANTS: One hundred and eight patients were referred from the allergy clinic included in the study. MAIN OUTCOME MEASURES: Predictive value of symptoms and nasal endoscopic examination to diagnose allergic rhinitis and inter-rater reliability of the examination were evaluated. RESULTS: Logistic regression analysis of patient symptoms and nasal examination findings revealed no significant predictive power for any of the symptoms or examination findings. The Fleiss κ coefficient of the three raters was calculated. Inter-rater variability among the three physicians demonstrated that mucosal oedema (κ = 0,48, P < 0.001), polypoid degeneration of the inferior turbinate tail (κ = 0.48, P = 0.01), nasal polyps (κ = 0.96, P < 0.001) and nasal septal deviation (κ = 0.65, P = 0.01) showed significant inter-rater agreement. A low κ coefficient (0.29) was found, and the inter-rater variability among physicians in interpreting the characteristics of nasal secretions was significant (P = 0.04). The inter-rater variability among the three physicians suggested that turbinate hypertrophy (κ = 0.31) and turbinate colour (κ = 0.38) showed no significant inter-rater agreement. CONCLUSIONS: Patient symptoms and nasal endoscopy findings do not provide reliable diagnosis of allergic rhinitis. Turbinate colour and hypertrophy are believed to be related to allergic rhinitis; however, these were subject to marked inter-rater variability in this study.

An unusual location for a fungus ball: the concha bullosa.

OBJECTIVE: We report an unusual case of a fungus ball in the concha bullosa, without involvement of the paranasal sinuses. CASE REPORT: A 29-year-old woman presented complaining of nasal obstruction and postnasal discharge. Paranasal computed tomography demonstrated that the concha bullosa in the right middle turbinate was filled with a high-density material. The patient underwent endoscopic resection of the concha bullosa, during which a dark brown, cheese-like material was found. Histopathological examination of the excised specimen revealed a fungus ball. CONCLUSION: Fungus balls are non-invasive accumulations of dense fungal concretions that generally affect healthy individuals. In the sinonasal region, they occur most frequently in the maxillary sinus. Although fungus ball formation in the concha bullosa is unusual, it should be considered in the differential diagnoses of middle turbinate and sinonasal pathology.