Quantification of Heavy Metals in the Nasal Turbines of Smokers and Nonsmokers.

OBJECTIVES: Cigarette smoke is known to contain toxic heavy metals. In this study, heavy metal levels in the nasal turbinate tissues of smokers and nonsmokers were measured and compared with Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). METHODS: Forty patients who come to the Otorhinolaryngology outpatient clinic due to nasal obstruction and are given an appointment for partial turbinate reduction operation due to inferior turbinate hypertrophy, according to their smoking status, were divided into two groups: those who had smoked one pack/day for at least 10 years and those who had never smoked. The levels of heavy metals (Al, As, Ba, Cd, Cr, Co, Cu, Pb, Mn, Hg, Ni, Se, and Ag) were compared by ICP-MS in nasal turbinate tissues. RESULTS: Al (p = 0.002), Cr (p < 0.001), Co (p < 0.001), Ni (p = 0.001), Cu (p < 0.001), As (p < 0.001), Se (p < 0.001), Ag (p < 0.001), Cd (p = 0.001), Ba (p = 0.008), Hg (p < 0.001), and Pb (p < 0.001) values in the smoker group were found to be significantly higher than the values of nonsmokers. Although the Mn level was high in smokers, no significant difference was observed (p = 0.299). CONCLUSIONS: Smoking can cause nasal and sinus problems. In this study, we observed that the smoking group had significantly higher levels of almost all the heavy metals investigated in the nasal turbinate tissues. As smoking damages, the mucociliary system and the mucosa, heavy metals from cigarettes may accumulate further and cause harm to the nasal tissues. LEVEL OF EVIDENCE: Level 3 Laryngoscope, 2024.

Comparison of innate lymphoid cells from tissue and blood in chronic tonsillitis and tonsillar hypertrophy.

OBJECT: Recurrent tonsillitis and tonsillar hypertrophy are two common diseases in children for which tonsillectomy is the definitive solution. The underlying causes of both diseases are not fully known. The aim of this study was to identify the predominant innate lymphoid cells in both diseases of the palatine tonsils, which are known to play an important role in the immune system. METHODS: Children who underwent tonsillectomy were divided into two groups as recurrent tonsillitis and tonsillar hypertrophy according to the indication for surgery. The proportions of innate lymphoid cell (ILC) groups and IFN-gamma, IL-10 and IL-17 secreting T lymphocyte cells were determined in tonsil and blood samples obtained during surgery. Local and peripheral immune responses were evaluated. Innate immune responses and acquired immune responses were compared. RESULTS: The results of our study showed that the proportions of the innate lymphoid cell 1 group (ILC1) were similar in tonsil tissue in patients with recurrent tonsillitis and tonsil hypertrophy, with no statistically significant difference. It was observed that the innate lymphoid cell 2 group (ILC2) was the predominant group in tonsil hypertrophy, the innate lymphoid cell 3 group (ILC3) was the predominant innate lymphoid cell group in recurrent tonsillitis, and the proportion of IL-17 secreting T lymphocytes in blood and tonsillar mononuclear cells was higher in recurrent tonsillitis patients than in tonsil hypertrophy patients. CONCLUSION: With the results obtained, the predominant innate lymphoid cells in the pathogenesis of both diseases were identified and local and peripheral responses were compared. These findings may be a guide for possible medical treatments for both diseases in the future.

The reliability and validity of the Turkish version of the Facial Disability Index.

PURPOSE: To translate and cross-culturally adapt the Turkish version of the Facial Disability Index (FDI) and evaluate its psychometric properties, including reliability and validity. METHODS: Translation of the original FDI was followed by international guidelines. Paralysis classification was evaluated with House-Brackman Rating System (HBGS). Patients completed Short Form-36 (SF-36) along with the Turkish version of the FDI and refilled the Turkish FDI one week later. Internal consistency and test-retest reliability were analyzed using Cronbach's alpha coefficient and intraclass correlation coefficient (ICC), respectively. Construct validity was assessed by calculating the Spearman's correlation coefficient. Also, exploratory factor analysis was carried out by identifying the factor structure of the scale. RESULTS: After the pre-test of the Turkish FDI, there was no need for linguistic and cultural adaptation. The internal consistency of the physical function subscale was high (0.82). The social/well-being subscale's Cronbach alpha (0.63) was within the acceptable range. Test-retest reliability was excellent (ICC of physical function = 0.91 and social/well-being = 0.93, p < 0.05). The physical function subscale was correlated with the PF subscale of SF-36 and HBGS (r = -0.837 and 0.292, respectively; p < 0.05). Besides, the social/well-being function subscale was correlated with HBGS and all subscales of SF-36, except RP (p < 0.05). Factor analysis results of the Turkish FDI were similar to the other version studies. CONCLUSION: The Turkish version of the FDI is a valid and reliable questionnaire in patients with peripheral facial paralysis.IMPLICATIONS FOR REHABILITATIONThe Turkish version FDI is the first Turkish tool translated cross-culturally adapted for specific assessment of facial paralysis.The Turkish version of the FDI is a valid and reliable questionnaire and can be used in all native Turkish speaking patients in peripheral facial paralysis.This assessment tool can be used in clinical routine and research settings to evaluate facial paralysis.

Excellent Result With the Use of Single-Dose OK-432 in Cervical Macrocystic Lymphangioma.

Though the lymphangioma is a benign neoplasm, it may make an invasion to vital structures by progressively growing. For lymphangioma, which progressed in such a way, surgical treatment has high morbidity and recurrence risk. On these cases, OK-432 is a frequently used sclerotherapy agent. The authors report the result they obtained by the use of single-dose OK-432 on an inoperable pediatric cervical macrocystic lymphangioma case and also their experiences.

Stabilization of total ossicular replacement prosthesis using cartilage "shoe" graft.

PURPOSE: We aimed to determine the effect of a cartilage shoe graft placed between the foot of the TORP and the stapes footplate on hearing improvement and long-term displacement rates. MATERIALS AND METHODS: Patients who underwent TORP ossiculoplasty were divided into two groups. The TORP-alone group consisted of 32 patients who underwent TORP placement without cartilage shoe graft and served as the control group. The study group consisted of 56 patients who underwent placement of cartilage shoe graft together with TORP. Pure-tone audiometry was administered to all patients before and 3, 6 and 12 months after surgery. Indications for surgery, surgical technique used, postoperative complications, and air and bone conduction thresholds at 500, 1000, 2000 and 4000 Hz were recorded for all patients. RESULTS: No significant difference in postoperative air-bone gaps was observed between the groups. The number of patients with air-bone gaps less than 20 dB was 14 (25%) in the study group and 8 (25%) in the control group. There was no significant difference in changes in air-bone gaps between the groups. Dislocation of the prosthesis was observed in 3 patients in the study group (5.3%) and 4 in the control group (12.5%). There was less dislocation of the prosthesis in the study group, but the difference was not statistically significant. CONCLUSION: Placement of a cartilage graft between the footplate of the stapes and the foot of the prosthesis may have positive effects on long-term hearing improvement and rates of prosthesis displacement. Further research with larger patient numbers is needed to identify the advantages of shoe graft.

Comminuted Frontal Sinus Fracture Reconstructed With Titanium Mesh.

Frontal sinus fractures (FSF) are relatively uncommon maxillofacial injuries. The most common cause of FSF is motor vehicle accidents with 62% percentage. Management of FSF depends on type of fracture, associated injuries, and involvement of naso-frontal duct. In this report, the authors presented a patient with comminuted fracture of anterior wall of frontal sinus reconstructed with titanium mesh. A 40-year-old man presented with depression of the frontal bone, facial pain, and epistaxis consisting of a motor vehicle accident. Computerized tomography scan revealed multiple comminuted fractures of anterior wall of frontal sinus and fractures of left orbital medial and superior walls. Titanium mesh was used for reconstruction. Postoperative course was uneventful. The titanium mesh, which is easy to handle with no complications, may provide excellent frontal contour after comminuted anterior wall fractures.

Primary Giant Echinococcosis of the Neck.

The authors report an isolated echinococcosis in a 17-year-old girl presented with swelling of right neck approximately 12 cm in diameters with no evidence of the disease elsewhere in the body. A thorough search of the literature revealed only a few cases of isolated cervical echinococcosis. Surgical procedure was planned for our case with the guidance of the magnetic resonance imaging, which showed right cystic mass and within a laminar membrane. Histopathologic report confirmed echinococcosis. In summary, this current study shows that in the differential diagnosis of the cystic masses localized in the neck in the endemic regions, echinococcosis should be suggested. In these patients, the careful assessment of the magnetic resonance imaging evaluation before the surgery would extremely facilitate either the diagnosis or the surgery planning.

Congenital Sialolipoma in an Infant.

Sialolipoma is a newly recognized tumor of the major and minor salivary glands and represents only 0.3% of all salivary gland tumors. Only 3 cases of congenital sialolipoma are available in the literature. In the current case, we performed a total parotidectomy with facial nerve preservation on a 12-week-old infant exhibiting huge mass in the parotid region. Histopathology results showed sialolipoma. There was no recurrence at the 18-month follow-up. Although it is a very rare disease in infants, congenital sialolipoma should be kept in mind in patients with parotid mass. The primary treatment is parotidectomy with facial nerve preservation.

Nasal Vestibular Furunculosis Presenting as the Rudolph Sign.

Nasal furunculosis is a deep infection of hair follicle within the nasal vestibule. In this report, the authors presented a 49-year-old woman with 4-day history of focal red area and tender swelling on the tip of her nose. On physical examination, together with a swelling at nasal vestibulum, erythema, and edema on the skin of nasal tip were observed, which is called the Rudolph Sign. The patient was treated with intranasal topical mupirocin and oral sodium fusidate. Because nasal furunculosis may lead to serious complications such as ophthalmic vein thrombosis and cavernous sinus thrombosis, early diagnosis and effective treatment is essential.

The Relationship between the Localization, Size, Stage and Histopathology of the Primary Laryngeal Tumor with Neck Metastasis.

OBJECTIVE: In this study we aimed the investigate the laryngectomy (partial and total) and neck dissection (functional, radical) in patients undergoing larynx identified as a result of the operation of primary tumour localization, size, stage and histopathology of the relationship between neck metastasis. MATERIALS AND METHODS: The files of 118 patients who has had operation of laryngectomy (partly, total) and neck dissection (functional, radical) because of larynx cancer in the Ear Nose and Throat (ENT) Clinic in the last ten years (1997-2007) have been evaluated retrospectively. RESULTS: 116 of them were male and 2 of them were female. Age average was 56+/-22. 189 neck dissections have been applied to 118 patients. While in supraglottic tumours, 55.2% cervical metastasis and 28.9% occult metastasis have been determined, in transglottic tumours 35.1% cervical metastasis and 18.9% occult metastasis have been determined. It has been seen that while the cervical metastasis ratio of tumours bigger than 4 cm is 55.8%, the tumours smaller than 4 cm is 27.27% (p=0.002). The cervical metastasis rate has been determined as 26.3% in T1 cases, 25.8% in T2 cases, 40.6% in T3 cases and 58.3% in T4 cases. In tumours with advanced T stage, the rate of cervical metastasis has been seen more than the ones with early T stage (p=0.027). Cervical metastasis has been determined as 27.3% in good differential (G1) tumours, 53.4% in medium differential (G2) tumours, and 74.1% in bad differential (G3) tumours (p=0.005). CONCLUSION: Considered in the light of clinical parameters specified in the cervical lymph node metastasis, N0 patients with laryngeal cancer, tumour, according to the anatomical location as unilateral or bilateral elective neck dissection should be performed and histopathological specimens taken in the event of a positive detection of metastases concluded that postoperative radiotherapy should be performed.

Bilateral parotid swelling with blindness.

We report a case of a 32-year-old woman who presented with bilateral parotid gland enlargement. She had no systemic symptoms such as fever, cough, and weight loss. She had bilateral blindness for a long time. The results of a physical examination revealed a bilateral firm, painless mass in the parotid region. A computed tomographic scan showed no clear lymphadenopathy in the neck but showed localized infiltrates and multiple pulmonary nodules with enlargement of the mediastinal and axillary lymph nodes in the chest. The patient underwent a superficial parotidectomy. A histopathologic finding revealed an epithelioid noncaseating granuloma, which is consistent with sarcoidosis. In summary, this current study shows that sarcoidosis should be considered in the differential diagnosis of all painless swelling of the parotid gland, especially in women, which could be an earlier complaint.

Evaluation of right ventricular functions in patients with nasal polyposis: an observational study.

OBJECTIVE: The aim of this study was to assess the right ventricular functions in patients with nasal polyposis using the strain (S) and strain rate (SR) echocardiography. METHODS: A prospective, cross-sectional observational study was performed. The study included 40 patients with nasal polyposis (NP) (Group 1), and 25 healthy controls (Group 2). The study comprised patients with Stage 2 and Stage 3 nasal obstruction and no symptoms that could be associated with right ventricular heart failure. Longitudinal peak systolic strain (PSS) and peak systolic strain rate (PSSR) were measured from the basal-mid and apical segments of the right ventricle free wall. Student's t-test, Pearson's correlation analysis and Bland-Altman test were used for statistical analysis. RESULTS: Pulmonary arterial systolic pressure was significantly higher in group 1 than group 2 (31.2 ± 5.8, 19.7 ± 4.3, respectively, p<0.001). PSS and PSSR values at the basal, mid and apical segments of the right ventricular lateral wall of the group I were significantly lower compared to the control group (p<0.001, p=0.002 and p=0.002 for PSS, p=0.003, p<0.001 and p<0.001 for PSSR, respectively). The comparison of Stage 2 and Stage 3 NP patients revealed a significant difference only in the SR measurement of the right ventricular mid segment (p=0.002). There was a significant correlation between the systolic pulmonary arterial pressure (sPAP) and right ventricular S and SR values (p<0.001). CONCLUSION: In this study, S/SR echocardiography showed a subclinical deficit of the right ventricular longitudinal functions in patients with NP who are considered to have normal right ventricular functions.

Glomuvenous malformations in the buccal area.

Glomuvenous malformations (GVMs) are relatively rare lesions in the head and neck area. A 30-year-old woman presented to our clinic with a large mass on the right buccal area with tenderness and hypersensitivity to palpation. The lesion was excised totally under general anesthesia. Microscopic evaluation and immunostaining method confirmed the diagnosis of GVM. We concluded that a solitary form of GVMs as a large mass on the buccal region could occur, and a mass with tenderness and hypersensitivity on palpation could be significant in its differential diagnosis.