Olfactory Dysfunction in ß Thalassemia Major Patients Treated With Iron-Chelating Agents.

Ocular and ophthalmological adverse effects may be seen in ß-thalassemia major (BTM) patients treated with regular blood transfusions and iron-chelating agents. We hypothesized that olfactory dysfunction may be present in this population. In this study, we aimed to investigate olfactory dysfunction in patients with BTM and determine the etiological factors. A total of 43 patients with BTM were included in the study. Forty-three patients without any nasal complaints, history of facial trauma, or nasal surgery were included as the controls. All participants had nasal endoscopy. The iron-chelating agents used, their duration of use, as well as hemoglobin and ferritin levels of the BTM patients were recorded. Sniffin' Sticks test (SST) was used to assess olfactory functions, and BTM and control groups were compared for the results. The correlations of SST scores with the other study parameters were analyzed. Eight (18.6%) of 43 patients in the BTM group had hyposmia while none of the patients in the control group had hyposmia (P < .001). Older age, low-hemoglobin level, and longer use of deferoxamine were found to be correlated with olfactory dysfunction. Olfactory dysfunction may be seen in BTM patients treated with iron-chelating agents. The results of this study suggest that screening for olfactory function may be needed in routine follow-up of BTM patients.

Olfactory dysfunction in ß-thalassemia major patients treated with iron-chelating agents.

Ocular and ophthalmologic adverse effects may occur in patients with ß-thalassemia major (BTM) treated regularly with blood transfusions and iron-chelating agents. We hypothesized that olfactory dysfunction may be present in this patient population. We aimed to investigate olfactory dysfunction in patients with BTM and to determine etiologic factors. A total of 43 patients with BTM were included in the study. Forty-three subjects without nasal complaints, history of facial trauma, or nasal surgery were included as the controls. All participants had nasal endoscopy. The use of iron-chelating agents by patients with BTM and their duration of use were recorded, as well as hemoglobin and ferritin levels. The Sniffin' Sticks test (SST) was used to assess olfactory function, comparing results between the BTM and control groups. The correlations of SST scores with the other study parameters were analyzed. Eight (18.6%) of 43 patients in the BTM group and none of the subjects in the control group had hyposmia (p < 0.001). Older age, low hemoglobin level, and longer use of deferoxamine were found to be correlated with olfactory dysfunction. Olfactory dysfunction can occur in patients with BTM treated with iron-chelating agents. The results suggest that screening for olfactory function should be part of the routine follow-up of patients with BTM.

Does positive airway pressure therapy improve olfactory function?

BACKGROUND: Olfactory function deteriorates in patients with severe obstructive sleep apnea syndrome (OSAS). The effect of positive airway pressure (PAP) therapy on olfactory function has not been investigated before. In this study, we aimed to investigate the role of PAP therapy on olfactory impairment in patients with OSAS. METHODS: Thirty patients who had OSAS and planned for PAP therapy were included in the study. All participants underwent a detailed otorhinolaryngological examination and polysomnography. The "Sniffin' Sticks" test was used for the analysis of olfactory function. The participants underwent the smell test before the PAP therapy, and about 3 months after the therapy. Pretreatment and posttreatment results were compared. RESULTS: The pretreatment and the posttreatment apnea-hypopnea index (AHI) were 57.6 ± 29.8/hour and 9.5 ± 7.9/hour, respectively. Odor threshold (OT), odor discrimination (OD), odor identification (OI), and threshold-discrimination-identification (TDI) scores significantly increased after PAP therapy (p = 0.001, p = 0.002, p = 0.001, and p = 0.001, respectively). The pretreatment and posttreatment total TDI scores were 28.48 ± 4.71 and 32.50 ± 3.88, respectively (p = 0.001). CONCLUSION: This study demonstrates olfactory dysfunction in patients with OSAS. We achieved a significant improvement in olfactory function of patients with OSAS after PAP therapy. Further studies are needed to illuminate the pathogenesis of olfactory dysfunction in OSAS, and the role of PAP therapy on olfactory improvement.

Nodular Fasciitis of the Neck Causing Emergency: A Case Report.

Nodular fasciitis is a benign, reactive, tumor-like lesion composed of fibroblasts and myofibroblasts. It typically occurs in the extremities and the trunk. Head and neck localization is 13-20%. As it grows rapidly, clinicians frequently misdiagnose it as an aggressive or a malignant lesion. Some lesions show moderate cellularity, mild cellular atypia, and mitosis histologically causing pathologists to over-diagnose the lesion as a malignant tumor. It is important to diagnose nodular fasciitis correctly to avoid unnecessary additional surgery and treatment. We report the case of an 82-year-old woman who was admitted to the emergency department with a one-month history of progressive shortness of breath. We found a mass in the patient's neck, invasive to the trachea, which was the cause of her symptom. Complete radical surgery of the mass with the larynx was impossible due to her general status. The mass was treated by local radiotherapy; however, no regression was seen in the size of the mass. The patient is still on follow-up with only symptomatic medical support for airway obstruction.

Pediatric Sialadenosis Due to Valproic Acid.

Sialadenosis is a rare entity characterized by bilateral diffuse, painless swelling of the parotid glands. Its etiology is not clear; however, it may occur due to adverse effects of some drugs. To our knowledge, sialadenosis due to valproic acid has not been reported in the literature up to date in any child. In this article, the authors presented a child who developed sialadenosis due to valproic acid, and improved after stopping use of the drug.

The Incidence of Ototoxicity in Patients Using Iron Chelators.

OBJECTIVE: In this study, we aimed to detect the incidences of ototoxicity in patients with hemoglobinopathies taking deferoxamine (DFO), deferiprone, and deferasirox using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) scale to obtain more objective data. MATERIALS AND METHODS: Fifty-five transfusion-dependent patients were evaluated in this study. The NCI CTCAE scale was used to assess ototoxicity levels. The average ferritin and hemoglobin levels, the type of iron chelator, and the duration of therapy of all the patients were recorded. RESULTS: Ototoxicity was observed in 15 patients (31.9 %), all of whom were taking DFO. The median age was 19.5 (6-43) in patients without ototoxicity and 29 (16-50) in those with ototoxicity; this difference was statistically significant (p<0.05). The median ferritin and pre-tx Hb levels were 1391 ng/mL and 9.06 mg/dL, respectively, in patients with ototoxicity and 986.7 ng/mL and 9.24 mg/dL, respectively, in those without ototoxicity; these differences were not significant (p>0.05). Ototoxicity was not observed in the eight patients who used only deferasirox and deferiprone. CONCLUSION: The ototoxicity incidence with DFO at doses below 50 mg/kg/day was 27.3%. Deferiprone and deferasirox were not associated with ototoxic effects in patients taking these drugs.

Sudden bilateral hearing loss after organophosphate inhalation.

Sudden bilateral hearing loss are seen rarely and the toxic substance exposure constitutes a small part of etiology. A Fifty-eight-year-old woman admitted to our clinic with sudden bilateral hearing loss shortly after chlorpyrifos-ethyl exposure. Otolaryngologic examination findings were normal. The patient had 40 dB sensorineural hearing loss (SNHL) on the right ear and 48 dB SNHL on the left ear. Additional diagnostic tests were normal. The conventional treatment for sudden hearing loss was performed. On the second week following organophosphate (OP) exposure the patient's hearing loss almost completely resolved. OP's are heavily used in agriculture and should be taken into consideration as an etiologic factor in sudden hearing loss.

Mean Platelet Volume as a Potential Predictor of Cholesteatoma in Children.

OBJECTIVES: Cholesteatoma is a chronic inflammatory clinical disorder, and it may cause hearing loss and various complications due to its destructive nature. Mean platelet volume (MPV) is a prothrombotic and proinflammatory marker. The aim of this study is to investigate predictive values of MPV, neutrophil-to-lymphocyte ratio, erythrocyte distribution width, and platelet lymphocyte ratio in cholesteatomatous or noncholesteatomatous pediatric chronic otitis media. METHODS: In this study, the authors retrospectively analyzed 24 patients with cholesteatomatous chronic otitis media, 9 patients with noncholesteatomatous chronic otitis media, and 36 age- and sex-matched healthy controls. Cholesteatomatous and noncholesteatomatous chronic otitis media groups were compared with each other, and with controls for WBC, MPV, erythrocyte distribution width, neutrophil-to-lymphocyte ratio, and platelet lymphocyte ratio. RESULTS: Mean platelet volume was significantly lower in patients with cholesteatoma (8.17 ±â€Š1.22 fL) compared with the control group (10.42 ±â€Š0.87 fL) (P <0.001). Region of conversion curve analysis showed that the cutoff level of 9.5 fL for MPV was an independent predictor for cholesteatoma with a high sensitivity (86%) and specificity (84%). Cholesteatomatous and noncholesteatomous chronic otitis media patients were similar for other parameters studied. CONCLUSION: Mean platelet volume may be used as a fast-to-obtain, reliable, and inexpensive marker with a high predictive level to indicate cholesteatoma in children.

Impaired olfactory function in patients with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is an endocrine disorder which affects 6.6% of women of child-bearing age. Although olfactory dysfunction is frequent in the population and it negatively affects quality of life, neither physicians or patients consider this important. This case-control study included 30 patients diagnosed with PCOS, and 25 healthy age-matched controls. Sniffin' sticks tests (BurghartGmbH, Wedel, Germany) were used to analyze olfactory functions, and the Beck Depression Inventory was used to evaluate depressive symptoms. The total odor score was significantly lower in the PCOS group compared to the control group (p<0.005). The Beck depression score was higher in the PCOS group (p<0.005). There was a negative correlation between the total odor score and the Beck Depression Score. Patients with PCOS have impaired olfactory function. This might be related to depressive disorders that are also observed in those patients.

Pneumatization of crista galli in pre-adult and adult stages / Neumatización de la crista galli en etapas pre adultas y adultas

The sinonasal region in humans is one of the regions that commonly shows anatomical variations. These variations can be easily diagnosed by paranasal CT evaluation. One of these variations is Crista galli pneumatization. In recent years, there have been opinions supporting the hypothesis that pneumatization originates from the frontal sinus. In this study, we planned to evaluate whether the presence of Crista galli pneumatization varied in pre-adult and adult periods. In this retrospectively designed study, 218 coronal paranasal CT images collected between 2012 and 2013 were evaluated. Patients were divided into two groups according to age under or over 18 years. In the group under the age of 18 (97 cases), pneumatization was detected in 2.1 % of samples, while in the group over the age of 18 (121 cases), crista galli pneumatization was observed in 15.7 % of samples. According to these results, crista galli pneumatization was found to increase in adulthood. Considering that the frontal sinus is in a rudimentary state at birth, it is radiographically detected first at 6 years of age, and reaches its main size in puberty, this increase in pneumatization runs parallel to the development of the frontal sinus. Consequently, this supports the opinion that crista galli pneumatization originates from the frontal sinus.

La región nasosinusal en los seres humanos con frecuencia muestran variaciones anatómicas. Estas variaciones se pueden diagnosticar fácilmente mediante la evaluación por tomografía computadorizada (TC) de los senos paranasales. Una de estas variaciones es la neumatización de la Crista galli. En los últimos años, se ha apoyado la hipótesis de que ésta neumatización se origina en el seno frontal. En este estudio fue evaluada la presencia de neumatización de la Crista galli y su posible variación en los períodos pre-adultos y adultos. Se realizó un estudio retrospectivo donde se evaluaron 218 imágenes de TC coronal de senos paranasales, recogidas entre 2012 y 2013. Los pacientes fueron divididos en dos grupos según la edad, menores o mayores de 18 años. En el grupo de menores de 18 años (97 casos), se detectó neumatización en el 2,1 % de las muestras, mientras que en el grupo de mayores de 18 (121 casos), se observó neumatización de la Crista galli en el 15,7 % de las muestras. De acuerdo con estos resultados, la neumatización de la Crista galli aumenta en la edad adulta. Teniendo en cuenta que el seno frontal se encuentra en un estado rudimentario en el nacimiento, se detecta radiográficamente a los 6 años de edad alcanzando su tamaño principal en la pubertad; este aumento de la neumatización es paralelo al desarrollo del seno frontal. En consecuencia, esto apoya la opinión de que la neumatización de la Crista galli se origina en el seno frontal.

Neutrophil-Lymphocyte Ratio in Patients with Adenoidectomy.

INTRODUCTION: Obstructive Sleep Apnea syndrome (OSA) is the most serious consequence of adenoid hypertrophy (AH) and it is one of the most common reasons of nocturnal hypoxia in children. There is some information about the relationship between childhood OSA and atherosclerosis or cardiac diseases. In this study, we evaluated the relationship between, neutrophil-lymphocyte ratio (NLR) and AH which is the most frequent cause leading OSA in children. AIM: Thus we aimed to contribute about subject of preoperative and postoperative NLR values in patients undergoing adenoidectomy that there is limited information. MATERIALS AND METHODS: The study group comprised 76 children undergoing adenoidectomy. A preoperative and 3(rd)-month postoperative complete blood cell count was performed to calculate the NLR values in all patients. The NLR values were calculated as the ratio of neutrophils to lymphocytes in peripheral blood. Data analysis was performed using SPSS 15. RESULTS: The mean NLR (min - max) was 1.0 (0.16-3.57) preoperatively and 1.06 (0.35-4.95) 3 months postoperatively (p = 0.052> 0.05). Haemoglobin 12.9 ± 0.95 (preop) 12.94 ± 0.91 (postop) (p= 0.522), WBC (min-max) 7.75 (3.90-14.99) 7.8 (4-15.64) (p= 0.297 <0.005), platelet 344.5 ± 98.7 328.4 ± 68.9 (p<0,005). CONCLUSION: There is limited information in the English literature. This study has investigated the association between the NLR and adenoidectomy. The results of the present study demonstrate that the NLR is not a statistically significant inflammatory factor. So, NLR values do not appear related to stage of upper airway obstruction.

Intramuscular hemangiomas of the head and neck: Three case reports.

Hemangiomas are tumors of vascular origin that frequently occur on the skin and mucosal surfaces in the pediatric age group. Hemangiomas located in skeletal muscles are called intramuscular hemangiomas. Intramuscular hemangiomas mostly occur in the extremities and the trunk. In this article, 3 cases of surgically treated intramuscular hemangiomas that could not be diagnosed by routine preoperative investigations are presented in light of recent literature.

The Causes of Persistent and Recurrent Nasal Obstruction After Primary Septoplasty.

OBJECTIVES: Septoplasty is the most frequently performed surgical procedure in patients with nasal obstruction. However, nasal obstruction may persist or recur after septoplasty in some patients. In this study, the authors aimed to determine the causes of nasal obstruction after septoplasty. METHODS: Fifty consecutive patients who admitted to our clinic with the complaints of persistent or recurrent nasal obstruction after primary septoplasty and had revision surgery between 2011 and 2015 were included in this study. Demographic data and physical examination findings of the patients were recorded. RESULTS: There were 33 men (66%) and 17 women (34%) with a mean age of 37.3 ±â€Š10.5 (range, 21-57) years. Deviation of perpendicular plate of ethmoid bone (44%), inferior turbinate hypertrophy (36%), concha bullosa (26%), caudal septal deviation-nostril asymmetry (20%), and alar collapse (6%) were the pathologies that were unaddressed during primary surgery. The iatrogenic causes of nasal obstruction after septoplasty were collumellar retraction-nasal tip ptosis (46%), nasal synechiae (20%), nasal septal perforation (10%), and saddle-nose/flat nose deformity (10%). CONCLUSIONS: Iatrogenic deformities due to surgery and pathologies ignored during primary surgery may cause persistent/recurrent nasal obstruction after primary septoplasty. A detailed physical examination and objective tests showing the site of nasal obstruction, an extensive surgical plan that covers all diagnosed pathologies, and a careful postoperative care must be undertaken to prevent undesired postoperative results.

Effect of vitamin B12 deficiency on olfactory function.

BACKGROUND: Vitamin B12 plays a major role in the maintenance of central and peripheral nervous systems. Vitamin B12 deficiency may affect the spinal cord, brain, optic nerve, and peripheral nerve functions; however, the effect of vitamin B12 deficiency on olfactory function has not been studied, so our study aimed to investigate that. METHODS: Thirty-nine patients with low vitamin B12 levels and 34 controls were included in the study. All participants had detailed otorhinolaryngological examinations and laboratory tests. The Sniffin' Stick test was used for analysis of olfactory function. The 2 groups were compared for smell test results. Correlations of smell test results with demographic and laboratory data were investigated in the vitamin B12-deficient group. RESULTS: The threshold discrimination identification scores were (mean ± standard deviation) 28.04 ± 5.58 and 35.10 ± 2.84 in the vitamin B12-deficient and control groups, respectively (p < 0.001). In the vitamin B12-deficient group, hyposmia and anosmia were evident in 56.4% and 5.1% of the patients, respectively, but no subjects in the control group had olfactory dysfunction (p < 0.001). Correlation analysis showed that age and odor identification score showed a negative correlation (p < 0.001); however, there was a positive correlation between threshold, discrimination and identification (TDI) score and vitamin B12 levels. CONCLUSION: In this study, we showed for the first time that olfactory dysfunction may be present in patients with vitamin B12 deficiency. Apart from a negative correlation of age with odor identification score, none of the other parameters studied showed correlations with olfactory dysfunction.

Giant Dermoid Cyst Causing Dysphagia and Dyspnea.

Dermoid cysts are benign lesions seen in young adults. The second most common localization is the floor of the mouth. They are usually asymptomatic over years but can be symptomatic due to secondary changes or the size. Herein, we report a case of 19-year-old woman who applied to emergency service with dyspnea, dysphagia and enlarging of a mass in the submental region. The patient cannot be entubated because of the mass pushing the tongue base backward closing the laryngeal view. Elective tracheostomy was performed for providing airflow during the operation. After the operation a cystic mass fulfilled with keratin lined by keratinized stratified squamous epithelium in addition to the dermal appendages such as sweat glands and follicular structures were seen histopathologically and the case was diagnosed as dermoid cyst of the submental region. In such patients with quick enlarging of mass causing airway obstructions, the tracheostomy can be the preferable method because of the difficulties in entubation.

Post-traumatic refractory multiple canal benign paroxysmal positional vertigo: a case report.

Benign paroxysmal positional vertigo (BPPV) is the most prevalent form of peripheral vertigo and is seen in a significant number of patients who present at neurology and ear, nose, and throat clinics. Various maneuvers may be used to determine the affected canal based on observation of specific nystagmus signs, and may also be used for treatment. Multiple canal pathology can make diagnosis and treatment more difficult. Presently described is case of BPPV with multiple canal pathology and traumatic etiology that was resistant to treatment.

Vibrio alginolyticus Associated Chronic Myringitis Acquired in Mediterranean Waters of Turkey.

Vibrio alginolyticus was originally classified as biotype 2 of Vibrio parahaemolyticus. Most clinical isolates are recovered from superficial wounds or the external ear infections. V. alginolyticus is acknowledged to be nearly nonpathogenic in humans. The reason for presence of V. alginolyticus's virulence is uncertain. We describe a chronic myringitis case in a 47-year-old female due to V. alginolyticus. According to her anamnesis, it was detected that she had sea bathing history in Mugla Coast in Turkey. Pure isolation of V. alginolyticus was obtained from external auditory canal's culture. Investigation and antimicrobial susceptibility of the isolate were performed by the automatized BD Phoenix system and Kirby-Bauer disk diffusion method, respectively. The bacteria were sensitive to all antibiotics. This case was presented to pay attention to Vibrio alginolyticus infections.

[Impact of markedly nasal septal deviation on 24-hour rhythm Holter findings]. / Belirgin nazal septal deviasyonlarin 24 saat ritim Holter bulgularina etkisi.

OBJECTIVES: This study aims to investigate any impact of nasal septal deviations on cardiac arrhythmias and heart rates by performing 24-hour rhythm Holter analysis before and after septoplasty accompanied by Nasal Obstruction Symptom Evaluation (NOSE) scale. PATIENTS AND METHODS: The study included 21 male patients (mean age 33 years; range 18 to 55 years) who underwent septoplasty between September 2013 and August 2014. Patients were performed 24-hour rhythm Holter electrocardiography analysis preoperatively and at postoperative third month. Supraventricular and ventricular extrasystoles were recorded pre- and postoperatively. Operation efficiency was measured with NOSE scale. RESULTS: Of the 21 patients, ventricular and supraventricular extrasystoles were observed in seven patients (33%) in the preoperative period. Mean age of patients with arrhythmia (mean age 51 years; range 18 to 55 years) was statistically significant higher compared to patients without arrhythmia (mean age 30 years; range 23 to 55 years) (p=0.012). Extrasystoles decreased in seven patients in the postoperative period. Average, minimum, and maximum heart rates did not change statistically significant in the postoperative period. CONCLUSION: The fact that septoplasty decreased arrhythmias indicates that nasal septum deviations may be associated with cardiac arrhythmias. Septoplasty had no effect on heart rates. Performing septoplasty in the early period may prevent future cardiac complications in indicated patients.