A Tool for the Assessment of Swallowing Safety and Efficiency in Adults: Turkish Adaptation of Boston Residue and Clearance Scale.

The objective of this study was to create a Turkish language adaptation of the Boston Residue and Clearance Scale (BRACS), a validated and reliable tool. The BRACS scale was first translated into Turkish and a Turkish version was subsequently developed. Fiberoptic endoscopic examination of swallowing (FEES) was administered to collect data from 25 dysphagic patients who were hospitalized after a stroke. The recorded films were subjected to editing procedures to ensure their appropriateness for the assessment of swallowing disorders and were then dispatched to a panel of five speech and language therapists for evaluation using the adaptation of the BRACS instrument. The scoring by the experts was evaluated using both explanatory factor analysis (EFA) and confirmatory factor analysis (CFA). Convergent validity, item reliability, and construct (composite) reliability were measured by calculating the average variance extracted (AVE) values. For the 12 location items, EFA revealed 3 main latent factors: the laryngeal vestibule and the oropharynx and hypopharynx. The Turkish BRACS had excellent inter-rater reliability (Krippendorff's alpha coefficient values ranged from 0.93 to 0.95) and high internal consistency (Cronbach's alpha values ranged from 0.88 to 0.93). Inter-rater ICCs for the first and second sessions were 0.83 and 0.85, respectively. CFA showed that all fitted criteria reached acceptable or perfect fit levels. The findings indicated that the proposed factor structure was validated. The AVE values are between 0.61 and 0.73 which was taken as evidence of convergent validity. The Turkish adaptation of the BRACS tool demonstrates both reliablity and validity, rendering it a useful and credible tool for assessing residual severity, particularly in clinical settings.

A case report of sudden-onset auditory neuropathy spectrum disorder associated with Brown-Vialetto-Van Laere syndrome (riboflavin transporter deficiency).

OBJECTIVE: The purpose of this paper is to describe a child with auditory neuropathy spectrum disorder (ANSD) associated with Brown-Vialetto-Van Laere (BVVL) syndrome, which is a rare, inherited, neurodegenerative disorder that is caused by defects in riboflavin transporter genes. DESIGN: We report the audiological and clinical profile of a child who presented with a complaint of sudden loss of speech understanding associated with an atypical form of ANSD. He was later diagnosed with BVVL. STUDY SAMPLE: An 11-year-old boy with ANSD associated with BVVL. RESULTS: The patient's severe neurological symptoms improved within a year of supplementation with high doses of riboflavin. His fluctuating hearing loss and 0% WDS remained unchanged. The patient was able to use hearing aids without any discomfort after treatment initiation, but he stopped using them again due to a lack of benefit in speech understanding. Although cochlear implantation was recommended, the patient and his family decided not to consider it for another year since they still had hope for complete recovery. CONCLUSIONS: Sudden-onset ANSD can be the earliest sign of undetected BVVL syndrome. Early detection of BVVL is crucial since all symptoms can be reversible with an early intervention of high doses of riboflavin supplementation.

Nasopharyngeal Mass Diagnosed as Transsphenoidal Encephalocele in an Adult Patient.

Transsphenoidal encephalocele, a rare congenital malformation, is generally diagnosed during childhood when investigating the reason for complaints such as nasal obstruction and recurring cerebrospinal fluid fistula. In this adult patient, the authors identified an asymptomatic transsphenoidal encephalocele after requested monitoring of a pedunculated mass detected in the nasopharynx during nasal endoscopy. After evaluation, the authors decided to follow the patient. Few cases of transsphenoidal encephalocele have been reported, and even fewer have been reported in older patients, with no other anomaly or symptoms. The success of surgical treatment for these masses is debatable. The authors did not consider surgery for this asymptomatic case. With this case presentation, the authors wish to emphasize that without making radiologic assessments of any masses identified in a nasopharyngeal examination, it would be inappropriate to perform a biopsy or any intervention.

The morphology of the nasopharyngeal inlet in obstructive sleep apnea.

Routine flexible optic laryngoscopy (FOL) can visualize the airway from the nasopharynx to the hypopharynx in obstructive sleep apnea (OSA). With the tip of a flexible endoscope at the nasopharyngeal inlet (NPI), we can visualize the morphology of this area. We evaluated the effect of NPI morphology on OSA severity. Videos were obtained during FOL examinations of the NPI in 83 patients (11 females, 72 males; mean age 42.1 ± 9.5 years) and NPI morphology was examined. Two main morphologies were seen: wide and narrow. The narrow NPI group (n = 45) was further subdivided into kidney-shaped (n = 34), elliptical (n = 6), and circumferential (n = 5) groups. The wide NPI group (n = 38) was subdivided into circumferential (n = 20) and kidney-shaped (n = 18) groups. Mean Respiratory Disturbance Index (RDI) values were 30.38 ± 22.36 and 14.51 ± 13.9 in the narrow and wide groups, respectively. Mean RDI values were 45.32 ± 30.6, 23.74 ± 10.8, and 28.72 ± 21.5 in the narrow circumferential, elliptical, and kidney-shaped groups, respectively. Mean RDI values were 11.58 ± 12.91 and 17.8 ± 14.6 in the wide circumferential and kidney-shaped groups, respectively. RDI values were significantly lower in the wide morphology group (p < 0.0005). NPI morphology might predict OSA during routine FOL examination. Further analysis of the subgroups supported evidence of narrowing, reflected as higher RDI values.

Reliability of high-pitch ultra-low-dose paranasal sinus computed tomography for evaluating paranasal sinus anatomy and sinus disease.

OBJECTIVES: The aim of this study was to evaluate the reliability of high-pitch ultra-low-dose computed tomography (CT) for detecting important paranasal sinus anatomic landmarks and pathologies. MATERIALS AND METHODS: Sixty patients (22 females, 38 males) aged 15 to 67 years (mean age, 33.68 y; SD, 9.83 y) underwent high-pitch ultra-low-dose CT of the paranasal sinuses between February and June 2012. To determine the lowest possible dose for evaluation of the paranasal sinuses, the patients were divided into three groups randomly and prospectively. A different low-dose CT protocol was applied to each group. The image quality was assessed subjectively by a radiologist and an otorhinolaryngology head and neck surgeon independently using a 4-point grading scale (0 = structures could not be identified, 1 = indistinctly defined structures, 1.5 = relatively well-defined structures, 2 = very well-defined structures). Anatomic landmarks and mucosal structures were evaluated. Mean scores were evaluated to assess statistical significance. RESULTS: According to the anatomic landmark scoring, excluding the ethmoid foramen for ethmoid artery identification, all of the structures in all 3 groups were very well-defined structures. The ethmoid foramen for ethmoid artery identification was scored as either could not be identified or an indistinctly defined structure in all groups. On evaluating the mucosa of the paranasal sinuses, normal and pathologic mucosal structures were scored as very well defined in all of the patients. The interobserver agreement was excellent. CONCLUSION: High-pitch ultra-low-dose CT is a safe, reliable paranasal sinus screening tool.

Comparison of postoperative bleeding between submucosal uvulopalatopharyngoplasty and tonsillectomy.

BACKGROUND: The aim of this study was to compare the incidence of postoperative secondary hemorrhage for tonsillectomy and submucosal uvulopalatopharyngoplasty (smUPPP). MATERIALS AND METHODS: In this retrospective case series, the medical records of 404 patients who underwent tonsillectomy with unipolar electrocautery and smUPPP at our institution between January 2001 and December 2010 were reviewed. The patients were divided into two groups: Group 1 (198 patients) underwent tonsillectomy; Group 2 (206 patients) underwent smUPPP. Main outcome measures were incidence of bleeding or complications after tonsillectomy and smUPPP and the need for revision surgery. RESULTS: The mean age of Group 1 patients was 38.1 (±2.58) years and that of Group 2 was 37.7 (±2.25) years. Males were 51.3% of Group 1 and 46.7% of Group 2. No statistically significant difference in age or gender distribution was found between Groups 1 and 2. The incidence of secondary, delayed hemorrhage was 5.05% (10 patients) in Group 1 and 1.45% (three patients) in Group 2 (P = 0.05). The incidence of delayed hemorrhage requiring surgical treatment was 4.54% (nine patients) in Group 1 and 0.97% (two patients) in Group 2. CONCLUSION: In adults, smUPPP, which includes tonsillectomy, has a lower incidence of postoperative delayed hemorrhage than does tonsillectomy with unipolar cautery.

Multicentric evaluation of high and low power lasers on RIRS success using propensity score analysis.

In this study, we aimed to evaluate the effect of HPL on different parameters by different centers and urologists. While doing this, we evaluated different parameters by comparing HPL(High Power laser) and LPL(Low-power laser). This is an observational, retrospective, comparative, multicentric study of prospectively organised database. A total of 217 patients who underwent RIRS for kidney stones smaller than 2 cm in three different centers were included in the study. The patients were divided into two groups; LPL used (Group1, n:121 patients) and HPL used (Group2, n:96). Propensity score matching was done in the data analysis part. After matching, a total of 192 patients, 96 patients in both groups, were evaluated. There was no difference between the groups regarding age, gender, stone side, and stone location. The stone-free rate on the first day was 80.3% in Group 1, it was 78.1% in Group 2 (p = 0.9). In the third month, it was 90.7% in Group 1 and 87.5% in Group 2 (p:0.7).Hospitalization duration was significantly higher in Group 1. (2.35 ± 2.27 days vs. 1.42 ± 1.10 days; p < 0.001).The operation duration was 88.70 ± 29.72 min in Group1 and 66.17 ± 41.02 min in Group2 (p < 0.001). The fluoroscopy time (FT) was 90.73 ± 4.79 s in Group 1 and 50.78 ± 5.64 s in Group 2 (p < 0.001). Complications according to Clavien Classification, were similar between the groups(p > 0.05). According to our study similar SFR and complication rates were found with HPL and LPL. In addition, patients who used HPL had lower operation time, hospital stay, and fluoroscopy time than the LPL group. Although high-power lasers are expensive in terms of cost, they affect many parameters and strengthen the hand of urologists thanks to the wide energy and frequency range they offer.

Effect of uvulopalatopharyngoplasty on retropalatal region.

Flexible optic laryngoscopy (FOL) allows us to visualize the obstructive sleep apnea (OSA)-related airway passages. Retropalatal region is a part of upper airway contributing to the OSA. We aimed to demonstrate the changes in the retropalatal surface area (RPSA) after submucosal uvulopalatopharyngoplasty (smUPPP) in an attempt to exhibit enlargement as a predictor of surgical treatment. It is a prospective, case-control study and conducted at the Otolaryngology department in a university hospital. Twenty patients with OSA who underwent smUPPP were prospectively evaluated. Pre and postoperative respiratory disturbance index (RDI) and RPSA measurements were studied. Retropalatal region videos were obtained at the base of uvula during FOL. Photographic images were captured at the same level of a virtual horizontal line passing through the base of uvula posteriorly to measure RPSAs using AutoCad2004. RDI levels, RPSA measurements were compared using paired t test. Twenty patients underwent smUPPP. There were 17 (85 %) male and 3 (15 %) female. The mean age was 37 years. The RPSA measurements were between 18.41 and 144.102 (mean 63.39) preoperatively. The RPSA measurements were between 83.784 and 255.463 (mean 143.87) postoperatively. The RPSA measurements were significantly enlarged postoperatively (p < 0.0005). The mean RPSA increased from 63.39 ± 29.3 to 143.82 ± 57.8. The mean RDI decreased from 22.95 ± 19.2 to 9.0 ± 8.2 (p = 0.011). RPSA increases in smUPPP patients postoperatively, evidencing enlarged retropalatal region. Decreased RDI levels indicate amelioration in OSA. RPSA measurements can be used to predict UPPP surgical treatment success.

Evaluation of tissue response to Gore-Tex (expanded polytetrafluoroethylene) implantation.

OBJECTIVE/HYPOTHESIS: The aim of this study was to assess the tissue response to Gore-Tex (expanded polytetrafluoroethylene) in rats and compare the results of surgical placement modalities. STUDY DESIGN: Prospective animal study. MATERIALS AND METHODS: Experiments were performed in 18 young Sprague-Dawley rats that were divided into 3 groups. Gore-Tex patches were implanted subcutaneously over the periosteum in the first group and under the periosteum in the other groups. Gore-Tex was immersed in an antibiotic-containing solution in the third group. All animals were killed 4 weeks after the procedure. The tissue samples were stained with hematoxylin and eosin stain and evaluated using a light microscope. RESULTS: The Gore-Tex patches were displaced and not observed at the originally implanted sites in the first group. The Gore-Tex patches were observed at the originally implanted sites in the other groups. In group 1, edema and inflammation were prominent. In the second group, ossification was detected in 5 rats and foreign-body reaction and edema were identified in 1 rat. In the third group, all of the rats were found to have developed ossification, but no inflammatory reactions were observed. CONCLUSIONS: The results suggest that implanting synthetic graft materials immersed in an antibiotic solution at the subperiosteal plane provides better stabilization and low complication rates.

Bilateral internal laryngoceles mimicking asthma.

Laryngocele is an air-filled, abnormal dilation of the laryngeal saccule that extends upward within the false vocal fold, in communication with the laryngeal lumen. A case of 43-year-old male with bilateral internal laryngoceles, who has been treated as asthma for 4 years, is presented. The patient had dyspnea, cough, and excessive phlegm for a month and a late onset stridor. Flexible nasopharyngolaryngoscopy showed bilateral cystic enlargements of the false vocal folds and true vocal folds could not be visualized. Laryngeal CT without contrast enhancement showed bilateral internal laryngoceles. Submucosal total excision of bilateral cystic masses including parts of false vocal folds was performed. The symptoms resolved immediately after surgery. Although the incidence of internal laryngocele is rare, it should be remembered in the differential diagnosis of upper airway problems and diagnostic flexible nasopharnygolaryngoscopy is routinely indicated for airway evaluation in at-risk patients.

A comparison of methods of plasmapheresis for the treatment of late antibody mediated rejection in kidney transplant recipients.

INTRODUCTION: We compared the outcomes associated with plasma exchange (PE), double filtration plasmapheresis (DFPP), or immunoadsorption (IA) in the treatment of late antibody mediated rejection (AMR). METHODS: Sixty-nine kidney transplantation (KTx) recipients with late AMR were retrospectively categorized according to management with PE (n = 30), DFPP (n = 22) or IA (n = 17). Allograft loss was compared across treatment groups by Kaplan-Meier analysis and Cox regression. RESULTS: Study groups were similar regarding age, sex, donor type, kidney function, donor specific antibodies, and post-KTx follow-up time. Five-year graft survival trended higher with IA (70.6%) compared to PE (36.7%) and DFPP (27.3%) (p = 0.06). In multivariate Cox regression, baseline eGFR (HR per ml/min/1.73 m2 [95% CI]; 0.96 [0.94-0.99]), rituximab use (HR [95% CI]; 0.42 [0.21-0.84]), interstitial inflammation (i) (HR [95% CI]; 2.05 [1.13-3.69]), and transplant glomerulopathy (cg) (HR [95% CI]; 1.46 [1.13-1.87]) were associated with graft loss. CONCLUSION: These results motivate the need for continued assessment of rituximab and plasmapheresis in larger studies.

Efficacy and Safety of Sofosbuvir and Ledipasvir for Hepatitis C in Kidney Transplant Recipients: A Single-center Retrospective Observational Study

Background: Treatment using direct-acting antivirals provides high rates of sustained virologic response and a favorable safety profile for patients with chronic hepatitis C virus infection. However, data on the efficacy of direct-acting antivirals in kidney transplant recipients are still limited. Aims: To evaluate the safety and efficacy of fixed-dose sofosbuvir/ledipasvir combination in kidney transplant recipients. Study Design: Retrospective, observational, single-center study. Methods: Data of 29 kidney transplant recipients who received a fixed-dose safety and efficacy of fixed-dose sofosbuvir/ledipasvir combination for 12 or 24 weeks with or without ribavirin were analyzed. The primary outcome was SVR12, which was defined as undetectable HCV-RNA levels 12 weeks after the treatment. Secondary outcomes were graft function, proteinuria, and calcineurin inhibitor trough level variability. Results: The predominant hepatitis C virus genotype was 1b (n = 19, 65.6%). All patients achieved SVR12. No graft failures nor deaths were reported during the study period. Throughout and after the treatment, the levels of aspartate aminotransferase [21 (range: 18-29.5) to 16 (range: 14-20) U/l, p < 0.001] and alanine aminotransferase [22 (range: 15-34) to 14 (range: 12-17.5) U/l, p < 0.001] improved significantly, unlike bilirubin, hemoglobin, and platelet levels. Renal function remained stable. Dose adjustments for calcineurin inhibitors were required. Serious adverse events were not observed. Conclusion: Safety and efficacy of fixed-dose sofosbuvir/ledipasvir combination was effective and safe in kidney transplant recipients with hepatitis C virus. However, cautious monitoring of trough levels of calcineurin inhibitorss is needed due to potential drug-drug interactions during the treatment episode.

Risk factors for laryngopharyngeal reflux.

The aim of this study was to evaluate the demographic and clinicopathologic characteristics of gastroesophageal reflux disease (GERD) with and without laryngopharyngeal reflux (LPR) to determine the risk factors for the occurrence of LPR in patients with GERD. This is a retrospective study of GERD patients with and without LPR. From the outpatient computer program of our hospital we randomly enrolled 45 GERD patients with LPR into the first group and another 45 GERD patients without LPR to the second group. Medical records of the patients in both groups were examined. All patients underwent upper gastrointestinal system endoscopy. LPR was confirmed by laryngoscopy, and LPR-related laryngoscopy scoring. Non-erosive GERD (NERD), erosive GERD (ERD) and Barrett's esophagus (BE) were diagnosed by endoscopy and histopathology. Various clinical parameters including status of Helicobacter pylori (H. pylori) infection, topography of gastritis were analyzed. For therapy, lansoprazole in a dosage of 30 mg BID for at least 8 weeks were given to all patients in both groups. GERD patients with and without LPR were compared according to demographic, clinic, endoscopic and histopathological parameters. The results revealed that patients with LPR were younger than the patients without LPR (38.7 ± 10.2 years and 43.8 ± 11.5 years; p = 0.08); however, there was no statistical significance. Patients without LPR showed no gender predilection (55% male) while LPR patients showed male preponderance (71% male). In LPR group, 11 patients (24%) had NERD, while 28 (62%) and 6 (13%) patients had ERD and BE, respectively. Twenty-seven (60%) patients without LPR were diagnosed as NERD, 15 patients (33%) without LPR had ERD and only 3 patients (6.6%) showed the histological findings of BE. The patients in LPR group had higher body mass index. Hiatal hernia was more frequent in the patients with LPR (53%) than in the patients without LPR (24%) (p = 0.005). LPR patients had longer duration of reflux symptoms than the patients without LPR (p = 0.04). H. pylori status was not different in both groups but the patients without LPR had more corpus gastritis than the patients with LPR. Eight weeks of lansoprazole treatment was successful in 71% of patients with LPR, and 86% of patients without LPR. We concluded that male gender, hiatal hernia, longer duration of symptoms, high BMI, having ERD and BE seems as risk factors for the occurrence of LPR in patients with GERD. H. pylori status did not have any effect on the development of LPR. Corpus dominant gastritis may have a protective role against the development of LPR. Proton pump inhibitor therapy is less effective in patients with LPR.

Quantification of retropalatal region in obstructive sleep apnea.

OBJECTIVE: Flexible optic laryngoscopy (FOL) allows us to visualize the obstructive sleep apnea (OSA)-related airway passages. However, objective data presenting evidence of OSA through this perspective are lacking. The aim of this study was to quantify the surface area of the retropalatal region in control subjects and OSA patients utilizing FOL images. This was a prospective, case-control study. The study was performed at the otolaryngology department of a university hospital. SUBJECTS AND METHODS: Sixty-seven OSA patients in group 1 and 87 patients with no complaints of OSA in group 2 were evaluated. Retropalatal region photographs were captured at the base of uvula through endoscopic images. The retropalatal surface area (RPSA) was measured using AutoCAD. Groups 1 and 2 RPSA measurements were analyzed. The RPSA measurements of subgroups in group 1 were analyzed to document severity of OSA. RESULTS: Mean RPSA measurements in group 1 was 73.21 (SD, 31.99), and that in group 2 was 129.31 (SD, 26.54), respectively. Retropalatal surface area is significantly larger in group 2 when compared with group 1 (P = 0.0001). Twenty-four patients had mild (mean respiratory disturbance index [RDI], 10.83 [SD, 3.63], 26 had moderate (mean RDI, 20.9 [SD, 4.14]), and 17 had severe OSA (mean RDI, 52.13 [SD, 17.24]) in group 1. The mean RPSA measurements are 72.48 (SD, 28.9) in mild subgroup, 73.88 (SD, 30.5) in moderate subgroup, and 73.22 (SD, 39.59) in severe subgroup, showing no evidence of correlation between the severity OSA and RPSA measurements. CONCLUSIONS: The RPSA measurements are significantly larger in control subjects (group 2) when compared with OSA patients (group 1). This might implicate that RPSA measurements through FOL examination can be a predictor of OSA when screening patients.

Importance of placing Gore-Tex in the subperiosteal plane for augmentation rhinoplasty.

OBJECTIVE: The purpose of this study was to present the placement technique of Gore-Tex implants for nasal augmentation. METHODS: The study group comprised 32 patients of various nasal deformities who underwent consecutive rhinoplasty via open approach with Gore-Tex implant material for dorsal augmentation. A pocket is made subperiostally at the nasal dorsum. The implant is rinsed in antibiotic solution and placed in position. Complications due to Gore-Tex were observed during the follow-up period. RESULTS: There were 12 men and 20 women. The mean age was 28.4 years. There were 9 primary rhinoplasty and 23 revision rhinoplasty. Patients were followed up postoperatively for 12 to 24 months. During the postoperative follow-up period, no complications were encountered in this series of patients. The implants were stable and immobile under the skin. CONCLUSIONS: In the cases of nasal dorsum augmentation, Gore-Tex can be a suitable graft material. We recommend implanting graft materials at subperiosteal plane to provide better stabilization and low complication rates.

Incidental diagnosis of mastoiditis on MRI.

The aim of this study was to document patients with clinical mastoiditis who were reported to have mastoiditis by radiologists due to increased fluid signal intensity in the mastoid air cells on magnetic resonance imaging (MRI). Brain and temporal bone MRI reports between January 2004 and November 2009 were obtained from the radiology units of four different hospitals of the same Health Care Group. MRI reports for keyword mastoiditis and 406 patients were reported to have radiological mastoiditis on MRI due to increased fluid signal intensity. Otoscopic examination findings of 275 of these 406 radiological mastoiditis patients were documented and compared with MRI reports for clinical infectious otological disease. Forty-eight (17, 45%) (48/275) patients were found to have clinical otological disease on examination. The remainder of the patients (227/275, 82%) did not show any evidence of clinical otologic infectious disease. Of these 48 patients, 18 patients (37, 5%) had eustachian tube dysfunction, 13 patients (27%) had serous otitis media, nine patients (9%) had chronic otitis media, five patients (10%) had tympanosclerosis, and three patients (6%) had acute otitis media. The results of this study showed that MRI is not an effective diagnostic tool for mastoiditis. 82% of the MRI mastoiditis did not show clinical mastoiditis contradicting MRI reports. Fluid signal in the mastoid on MRI should not always be interpreted as mastoiditis by radiologists. Radiological mastoiditis does not necessarily point out to clinical mastoiditis.

Removing intranasal splints after septal surgery.

BACKGROUND: The aim of this retrospective chart review of the patients who had septal surgery with or without turbinate surgery was to compare the postoperative complication rates according to the time of intranasal-splint (INS) removal. METHODS: The data of 137 patients who underwent septal surgery with or without turbinate surgery at 2 different hospitals of Acibadem Health Care Group between January 2007 and March 2009 were retrospectively evaluated. The patients who had these risk factors were eliminated, and 96 patients were included in this study. The patients were divided into 2 groups according to splint-removal time. The first group comprises patients whose nasal splints were removed in 24 hours after surgery, and the second group comprises patients whose splints were removed 5 days after the surgery. Any bleeding, septal hematoma, and synechia after pack removal were recorded. Analysis of the rate of complications was done with the χ test. RESULTS: Sixty-five male and 31 female patients with a mean age of 32.4 years (range, 18-57 years) were included in the study groups. Septal surgeries were performed in association with turbinate surgery in all 96 patients. These patients were divided into 2 groups. In the first group (n = 50), INSs were removed in 24 hours after surgery. In the second group (n = 46), INSs were removed 5 days after surgery. Bleeding within the first postoperative week was not recorded in both groups. Late bleeding was recorded in 2% (n = 1) of group 1 and in 2.17% (n = 1) in group 2. Septal hematoma and synechia were not recorded in none of the groups. The results were not statistically significant (P = 1). CONCLUSIONS: The routine use of INSs after septoplasty and removing them 24 hours after septoplasty are sufficient to avoid postoperative complications, and it minimizes postoperative discomfort.

Placement technique of extended spreader grafts.

OBJECTIVES: This study aims to show the placement of extended spreader grafts in reductive septorhinoplasty operations to support the nasal bony vault as well as the middle cartilaginous structures. PATIENTS AND METHODS: Thirty-eight patients (16 males, 22 females; mean age 26.4 years; range 18 to 55 years) who underwent septorhinoplasty under general anesthesia via open approach between January 2008 and December 2010 were included in this study. Two separate cartilage grafts were placed end-to-end and secured to the septum on both sides after removing the cartilage and bony hump. These grafts not only transverse the full length of the middle one-third of the nose, also run approximately 1 cm under the nasal bones cephalically and the anterior septal angle caudally on both sides. The obtained data were evaluated retrospectively. Patients were followed up postoperatively for 7 to 24 months with a mean follow-up of 14 months. RESULTS: There was no significant bony vault collapse or irregularity, inverted-V deformity or middle-vault narrowing observed during the postoperative period. All of the patients were satisfied with the cosmetic and functional results. CONCLUSION: We think that extended spreader grafts are more beneficial not only in reconstructing the middle one-third of the nose but also in supporting the collapsed and/or distrupted nasal bony vault in reductive septorhinoplasty.

[Endonasal phototherapy in the treatment of allergic rhinitis]. / Alerjik rinit tedavisinde endonazal fototerapi.

OBJECTIVES: In this study, we assessed the effect of endonasal phototherapy on quality of life, nasal obstruction and the other symptoms in allergic rhinitis with visual analog scale (VAS), sinonasal outcome test-20 (SNOT-20), and acoustic rhinometry. PATIENTS AND METHODS: Twenty-four patients (6 males, 18 females; mean age 41.3±13.0 years; range 20 to 60 years) suffering allergic rhinitis refractory to anti allergic drugs for at least two years were enrolled in the study. Each patient underwent a total of six sessions of endonasal phototherapy with Rhinolight (Rhinolight Ltd, Szeged, Hungary) performed three times a week for two weeks. During course of the investigation, additional therapy was not applied to any of the patients. Before and one month after treatment, patients completed visual analog scale and SNOT-20 forms and nasal obstruction was evaluated with acoustic rhinometry. RESULTS: After the treatment, the mean VAS score and the mean total SNOT-20 score were found lower than the results before the therapy (p=0.0001, p=0.0001). A significant decrease was found in the scores of sneezing, nasal discharge, postnasal drainage, coughing after treatment (p=0.0001). During objective evaluation of nasal obstruction with acoustic rhinometry, no statistically significant difference was found between pre- and post-treatment findings. CONCLUSION: Endonasal phototherapy is an effective modality in the treatment of symptomatology in allergic rhinitis patients refractory to antiallergic drugs. It is detected that endonasal phototherapy has positive effects on the quality of life. However, no effect on nasal obstruction was found with acoustic rhinometry which is an objective method.

Initial complete blood count score and predicting disease progression in COVID-19 patients.

INTRODUCTION: Coronavirus has caused a pandemic since it was first detected in Wuhan in December 2019. The mortality rate is high in moderate and severe cases. Our study aimed to screen the CBC parameters as a useful predictive factor for COVID-19 resulting in critical illness. METHODS: A total of 285 patients with positive PCR results were analyzed. The median age was 55 (24-90), and 64.2% of patients were male. Sixty-eight percent of cases were hospitalized with moderate, 32% with severe disease at initial admission. RESULTS: We found that lymphocyte count <620/mcl, neutrophil-to-lymphocyte ratio (NLR) >6, and platelet to lymphocyte ratio (PLR) >350 were predictive of the outcome. We scored our cohort 0-3 for these three parameters. Patients with a score of 2-3 were more likely to have progressive disease, anti-cytokine treatment, intensive care admission, intubation, and death, compared to patients with a score of 0-1. Additionally, they tended to be hospitalized for longer (median 11.5 days, mean 15.6), compared to those with a score 0 or 1 (median 9 days, mean 11.3). Twenty-eight of 38 cases with scores of 2-3 were discharged (73.6%), whereas the rate was 89% for patients with a score of 0-1 (P=0.009). CONCLUSION: Based on the absolute lymphocyte count (<620/mcl, NLR >6, PLR >350), our three-parameter score was able to predict disease progression, and the likelihood of anti-cytokine treatment, intubation, and death. We think that COVID-19 patients presenting with moderate to severe pneumonia, and having scores of 2 or 3 on our scale, should be closely monitored and robustly supported.