Cochlear Implantation in Inner Ear Malformations: Considerations Related to Surgical Complications and Communication Skills.

INTRODUCTION: There are particular challenges in the implantation of malformed cochleae, such as in cases of facial nerve anomalies, cerebrospinal fluid (CSF) leaks, erroneous electrode insertion, or facial stimulation, and the outcomes may differ depending on the severity of the malformation. The aim of this study was to assess the impact of inner ear malformations (IEMs) on surgical complications and outcomes of cochlear implantation. METHODS: In order to assess the impact of IEMs on cochlear implant (CI) outcomes, 2 groups of patients with similar epidemiological parameters were selected from among 863 patients. Both the study group (patients with an IEM) and control group (patients with a normal inner ear) included 25 patients who received a CI and completed at least 1 year of follow-up. Auditory performance, receptive and expressive language skills, and production and use of speech were evaluated preoperatively and at least 1 year after implantation. Types of surgical complications and rates of revision surgeries were determined in each group. RESULTS: In the study group, the most common malformation was an isolated enlarged vestibular aqueduct (EVA) (44.8%). Overall, the patients with IEMs showed significant improvement in auditory-verbal skills. In general, the patients who had normal cochleae scored significantly better compared to patients with IEMs (p < 0.05). The complication rate was significantly lower in the control group compared to the study group (p = 0.001), but the rate of revision surgeries did not differ significantly (p = 0.637). CONCLUSION: It is possible to improve communication skills with CIs in patients with IEMs despite the variations in postoperative performances. Patients with EVA, incomplete partition type 2, and cochlear hypoplasia type 2 were the best performers in terms of auditory-verbal skills. Patients with IEMs scored poorly compared to patients with normal cochleae. CSF leak (gusher or oozing) was the most common complication during surgery, which is highly likely in cases of incomplete partition type 3.

The role of gold weight implants in the management of paralytic lagophthalmos.

BACKGROUND: The study aims to evaluate the usage of gold weight implants and monitor complaints and comfort of patients. METHODS: A hundred and ninety-one implantations performed between January 2009 and January 2019 were analyzed. Seventy-eight patients included in this study The average age of the patients was 51.3 ± 14.5 years. Forty-five (57.7%) of them were male and 33 (42.3%) female. Patient satisfaction was measured with a questionnaire containing the most common complaints related to gold weight in the literature through telephone surveys. RESULTS: The average follow-up time was 74.5 months. Ninety-three-point-five percent of subjects had operational causes, among which the most widespread was acoustic neuroma (44.9%). The average time between facial paralysis and implantation was 141.1 days. Implantation was performed 26.6 days on average after acoustic neuroma surgery and 3.2 days on average after temporal zone malignancy surgery. Thirty-eight patients had their implants removed over either complication (n = 14) or recovery (n = 24). Recovery was the fastest after facial nerve decompression (mean= 4.75 ± 3.6 (2-10) months) and the slowest after 7-12 cranial nerve transfer (mean= 18.3 ± 8.2 (3-31) months). Twenty-six-point-nine percent (n = 21) of patients had complications, of which the most common was extrusion (n = 10). The overall satisfaction rate was 88.5% with the highest in visual acuity and the lowest in continuous requirement for artificial tear. DISCUSSION: The gold weight implantation is an effective, reversible, and easy procedure significantly reducing complaints regarding paralytic lagophthalmos. Early implementation may be beneficial for ocular complications. A dynamic facial reanimation could terminate need of implant.

Long-Term Balance Outcomes in Vestibular Ablative Surgeries.

OBJECTIVE: To evaluate the long-term balance outcomes of vestibular nerve section (VNS) and labyrinthectomy (L) operations. The indirect outcomes will be the correlation of objective and subjective test results and an analysis of anterior-posterior versus medial-lateral computerized posturography (CP) scores. METHODS: This retrospective study evaluated objective CP and subjective Dizziness Handicap Inventory (DHI) results of patients who underwent VNS and L surgeries for Ménière's disease. RESULTS: A total of 55 (31 VNS and 24 L) patients were included in the study. The two operation groups were similar in terms of age, and mean time between surgery and the tests (p=0.465 and p=0.616) respectively. The vestibular and global scores at anterior-posterior CP showed statistically significant differences between the groups (p=0.000 and p=0.007) respectively in favor of the VNS group. In addition, the comparison of the vestibular CP scores of anterior-posterior and medial-lateral evaluations of the entire study population was lower in the medial-lateral evaluation (p=0.000). The mean DHI scores did not show statistically significant differences (p=0.359) between operation groups, nor did the correlation analysis between CP and DHI scores reveal statistical significance (p values >0.05). CONCLUSION: In the long term, objective balance outcomes are better for VNS patients than for L patients. Additionally, medial-lateral balance outcomes are more affected than anterior-posterior balance outcomes from unilateral ablative surgeries. Subjective balance perception is not different between the two surgery groups, and DHI scores do not show a correlation with CP scores.

Cochlear Implantation in Chronic Otitis Media with and without Cholesteatoma: Surgical Considerations and Auditory Outcomes.

INTRODUCTION: Cochlear implant (CI) surgery is a safe and standardized procedure in the presence of normal temporal bone anatomy. However, in the surgery of patients with chronic otitis media (COM), the surgeon may encounter several problems. The aim of this study was to evaluate the impact of COM with and without cholesteatoma on surgical and auditory outcomes of CIs. METHODS: The study group consisted of 39 patients with COM who received CIs. Age- and gender-matched 38 standard CI patients served as controls. The surgical techniques and complications, pure tone audiometry (PTA) scores, speech discrimination scores (SDS), and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire results of the groups were compared. RESULTS: The presence of COM was associated with a higher rate of complication than controls. Staging the surgeries, presence or absence of cholesteatoma, and type of surgical technique were not associated with surgical outcomes and complications (p > 0.05). There was no significant difference between the groups in terms of postoperative PTA scores, SDS, and IOI-HA scores (p > 0.05). CONCLUSION: Postoperative complications like device failure and skin breakdown are increased in cases of COM compared to standard CI surgeries. However, that increase is not associated with staging the surgeries, presence or absence of cholesteatoma, and type of ear surgery performed. It is advocated to close the external ear canal and eustachian tube without mastoid obliteration in the presence of a radical mastoidectomy cavity, which will decrease the postoperative complication rates and allow for radiological follow-up with computed tomography for the possibility of cholesteatoma recurrence. The auditory benefits of CI in patients with and without COM are comparable.

The Relationship of Vestibulo-Ocular Reflex With Self-Reported Dizziness Handicap in Patients With Vestibular Deafferentation.

The relationship between objective vestibular tests and subjective vestibular tests is a controversial topic. In this study, to contribute to this issue, the vestibulo-ocular reflex features and their relationship with balance perception at long-term follow-up in vestibular neurectomy (VN) and total labyrentectomy patients were evaluated. Prospectively, 19 VN and 18 labyrinthectomy patients were enrolled in this study. Patients underwent video head impulse test (VHIT) as objective vestibular test and dizziness handicap inventory (DHI) as subjective vestibular test when they attended to their control visit follow-up between March and September 2017. Lateral canal corrective saccades were classified as organized pattern and deorganized (scattered) pattern. In our results, the saccade pattern analysis (between organized and deorganized saccades) regarding the DHI scores gave P value as .039 for covert saccade pattern and .050 for overt saccade pattern. Therefore, we conclude that the presence of saccades, their patterns, and amplitudes provide extra information at assessing the results of the VHIT test, and the organized pattern of saccades is related to a stable vestibular system and better balance perception.

Canal wall down versus canal wall up surgeries in the treatment of middle ear cholesteatoma

Background/aim: To compare outcomes of canal wall up (CWU) and canal wall down (CWD) techniques in the treatment of middle ear cholesteatoma. Materials and methods: Medical records of 76 patients who had a primary surgery due to middle ear cholesteatoma between July 2015 and November 2017 were reviewed retrospectively. Hearing thresholds, speech discrimination scores (SDS), recurrences, and revision surgeries of CWU and CWD surgeries were compared. Results: Of 76 cholesteatoma cases, 40 (52.6%) had a CWU and 36 (47.4%) had a CWD operation. Postoperatively, the mean air conduction thresholds were significantly better in CWU compared to CWD surgeries (P = 0.016). The presence of the stapes and the type of reconstruction material used did not have a significant effect on auditory success rates (P = 0.342 and P = 0.905, respectively). Auditory success was affected by the status of the middle ear mucosa as well. The recurrence and revision rates did not differ between the surgical techniques (P > 0.05). Conclusion: Status of the middle ear mucosa and external auditory canal are important factors affecting the outcomes in cholesteatoma. Instead of a CWD surgery, a CWU surgery seems applicable in cases of cholesteatoma when the bone in the external auditory canal is not eroded by the disease.

Assessment of Cochlear Implant Revision Surgeries in a Cohort of 802 Patients.

OBJECTIVE: To assess the etiology, demographics, rates and outcomes of revision surgeries, and device survival rates after cochlear implantation. STUDY DESIGN: Retrospective case review. SETTING: Tertiary Otology & Neurotology center. PATIENTS: Cochlear implantees who received revision surgeries after implantation INTERVENTIONS:: Any surgical intervention, performed due to device failure or the major complications of cochlear implantation. MAIN OUTCOME MEASURE: Medical records of the patients who received cochlear implants (CIs) between July 2002 and March 2018 were reviewed retrospectively regarding postoperative complications. Demographic data, device survival rates, and causes of revisions were recorded. RESULTS: Totally, 924 implantations were performed in 802 patients. Eighty one (8.7%) of them underwent 102 revision surgeries. The most common causes of revision surgeries were device failures and flap related problems which were seen in 28 and 18 patients, respectively.Overall CI survival rate was 91.9% in a 10 years period, which remained almost stable after 10 years. Although age was not found to be related with device failure (p = 0.693), device loss rates were significantly higher in adult implantees than children (p = 0.006). CONCLUSION: Device failure seems the most common cause of revision. The revision surgeries are usually safe and help to resolve the problem although flap problems are the most difficult to treat and may necessitate multiple revision surgeries. The device failure rate may reach to a plateau after 6 years. Overall CI survival rate exceeds 90% in 10 years period, and then remains stable.

Temporal bone paragangliomas: 15 years experience.

INTRODUCTION: Temporal bone paragangliomas (TBPs) are benign tumors arising from neural crest cells located along the jugular bulbus and the tympanic plexus. In general surgical excision, radiotherapy and wait-and-scan protocols are the main management modalities for TBPs. OBJECTIVE: In this paper we aim to present our clinical experience with TBPs and to review literature data. METHODS: The patients who were operated for tympanomastoid paraganglioma (TMP) or tympanojugular paraganglioma (TJP) in our clinic in the last 15 years were enrolled in the study. A detailed patient's charts review was performed retrospectively. RESULTS: There were 18 (52.9%) cases with TMPs and 16 (47.1%) cases with TJPs, a total of 34 patients operated for TBPs in this time period. The mean age was 50.3± 11.7 (range 25-71 years). The most common presenting symptoms were tinnitus and hearing loss for both TMPs and TJPs. Gross total tumor resection was achieved in 17 (94.4%) and 10 (62.5%) cases for TMPs and TJPs, respectively. Five patients (31.2%) with TJP experienced facial palsy following the operation. For all the patients the mean follow-up period was 25.8 months (range 4-108 months). CONCLUSION: In conclusion, based on our findings and literature review, total surgical excision alone or with preoperative embolization is the main treatment modality for TBPs. However radiotherapy, observation protocol and subtotal resection must be considered in cases of preoperative functioning cranial nerves, large tumors and advanced age.

Does the Degree of Septal Deviation Affect Cribriform Plate Dimensions and Middle Turbinate Length?

OBJECTIVE: To investigate the effect of septal deviation severity on the dimensions of the lateral lamina of the cribriform plate (LLCP), middle turbinate length (MTL), and the angle of the lateral lamella of the cribriform plate (ALLCP). METHODS: Paranasal computed tomography (CT) scans of 148 patients with septum deviation (102 males, 46 females; age range 18-63 years) were retrospectively evaluated. The patients were divided into 3 groups according to the measured angle of nasal septal deviation as mild (<9°), moderate (9-15°), or severe (>15°). Height and width of LLCP, MTL, and ALLCP on both sides were measured and these parameters were compared between the groups according to the septal deviation side. RESULTS: The nasal septum was deviated to the right in 73 patients (49.3%) and to the left in 75 patients (50.7%). The LLCP dimensions, MTL, and ALLCP between the groups at the contralateral side were not statistically different (P > 0.05). The LLCP height, ALLCP between the groups at the ipsilateral side were not statistically different (P > 0.05). There was a significant difference in the LLCP width at the ipsilateral side between the groups (P = 0.039). The MTL at the ipsilateral side was significantly different between the groups (P = 0.003). CONCLUSION: The severity of nasal septum deviation in patients with nasal septum deviation affects the ipsilateral LLCP width and the ipsilateral MTL. These findings suggest that the increase in the severity of septum deviation in patients undergoing endoscopic sinus surgery does not increase the risk of possible damages that may occur in LLCP.

Leptin levels in children with obstructive sleep apnea syndrome.

INTRODUCTION: The aim of this study is to assess the effect of obstructive sleep apnea syndrome (OSAS) severity on leptin levels in children. PATIENTS AND METHODS: Children with habitual snoring underwent overnight polysomnography. Fasting venous blood samples were obtained between 8 AM and 9 AM, following the night of the sleep study. Children with an apnea-hypopnea index of ≥ 5/h were included in the moderate-to-severe OSAS group while those with an apnea-hypopnea index of < 5/h formed the mild OSAS/primary snoring group. RESULT: 47 children (51% male and 49% female; mean age 7.8 ± 2.6 years) were recruited. Twenty seven participants were diagnosed with moderate-to-severe OSAS, and twenty children who had AHI < 5 were included in the mild OSAS/primary snoring. The two groups did not differ regarding age, gender and body mass index z score (p> 0.05). Furthermore there were no differences in log serum leptin levels (p= 0.749). Log serum leptin levels correlated with the BMI z score in the whole study group (p= 0.001; r= 0.499) but they were not associated with apnea-hypopnea index, mean and lowest oxygen saturation during sleep. CONCLUSIONS: Serum leptin levels are affected by adiposity but not by OSAS severity among children with habitual snoring.

Histopathological Effects of Fibrin Glue and Cyanoacrylate on the Maxillary Sinus.

OBJECTIVE: To compare the histopathological effects of fibrin glue (FbGl) and cyanoacrylate (CyAc) on the maxillary sinus mucosa. METHODS: Twenty rabbits were divided into two groups of 10, and surgical defects were created in the maxillary sinuses. The right maxillary sinus was treated with FbGl in one group and with CyAc in the other group. As a control, the left maxillary sinuses of all rabbits were treated with sterile saline solution. One rabbit treated with CyAc died during the study and was excluded. On postoperative day 21, all animals were sacrificed. Maxillary sinus mucosa samples were studied to determine the extent of inflammation and fibrosis, foreign body reaction, cilia loss, increased osteogenesis in bony structures under the mucosa, and loss of serous glands. RESULTS: The FbGl group differed significantly from the CyAc and control groups in terms of a high degree of inflammation (p<0.001), fibrosis (p<0.001), foreign body reaction (p<0.001), cilia loss (p<0.001), and serous gland loss (p<0.001). In terms of osteogenesis, there were no significant differences between the FbGl and CyAc groups (p=0.650), while there was a significant (p=0.002) difference between these two groups and the control group. CONCLUSION: Histopathologically, CyAc had fewer side effects than FbGl. Further clinical studies are needed to demonstrate the validity of these results in humans.

Do the angle and length of the eustachian tube influence the development of chronic otitis media?

OBJECTIVES/HYPOTHESIS: To compare the eustachian tube (ET) angle (ETa) and length (ETl) of ears with and without chronic otitis media (COM), and to determine the relationship between ET anatomy and the development of COM. STUDY DESIGN: A retrospective case-control study. METHODS: The study group comprised 125 patients (age range, 8-79 years; 64 males and 61 females) with 124 normal ears and 126 diseased ears, including ears with chronic suppurative otitis media (CSOM) with central perforation, intratympanic tympanosclerosis (ITTS), cholesteatoma, and a tympanic membrane with retraction pockets (TMRP). ET angle and length were measured using computed tomography employing the multiplanar reconstruction technique. RESULTS: The ETa was significantly more horizontal in diseased versus normal ears of all study groups (P = .030), and there was no group difference in ETl (P = .160). ETl was shorter in CSOM versus ITTS ears and normal ears (P = .007 and P = .003, respectively) and in cholesteatoma versus TMRP ears (P = .014). In the unilateral COM group, there were no significant differences in the ETa or ETl of diseased versus contralateral normal ears (P = .155 and P = .710, respectively). The ETa was significantly more horizontal in childhood-onset diseased versus normal ears (P = .027), and there was no group difference in ETl (P = .732). The ETa (P = .002) and ETl (P < .001) were significantly greater in males than females. CONCLUSIONS: A more horizontal ETa and shorter ETl could be contributory (though not significantly) etiological factors in the development of COM. LEVEL OF EVIDENCE: 3b.

Unpredicted effects of Ankaferd® on cartilage tissue.

OBJECTIVE: This study aims to investigate the histopathological changes secondary to the administration of Ankaferd Blood Stopper® (ABS) into the auricular cartilage. MATERIALS AND METHODS: Both of the auricular cartilages of thirty New Zealand rabbits were marked with tattoo ink. A 0.2-cc ABS (study group, n: 30) and 0.2 cc physiological saline (control group, n: 30) were subcutaneously infused into the right auricle and left auricle, respectively. All layers were removed at 14 days. RESULTS: The ABS group had significantly higher level of fibrosis, necrosis, foreign body reaction, inflammation, and cartilage degeneration, compared to the controls. CONCLUSION: Our study results showed that ABS administration into a closed cavity led to a significantly increased fibrosis and necrosis in the auricular cartilage.

Effects of polylactic acid film on middle ear mucosa and cochlear function in Guinea pigs.

Our aim was to assess the effects of polylactic acid (PLA) on middle ear mucosa and cochlea, to be used as a film barrier for postoperative adhesion prevention in the middle ear. Twenty-one albino Guinea pigs were included in the study. A window was opened on both tympanic bulla and on one side PLA material was placed in the middle ear and on the other side only fenestration was performed and used as a control. All Guinea pigs underwent evaluation of tympanic membranes microscopically; functional hearing was analyzed by auditory brainstem responses preoperatively, in the first and the sixth month. All Guinea pigs were killed on the sixth month for histopathologic evaluation of their temporal bones. There was no statistical difference between both groups regarding hearing thresholds, interpeak wave latencies preoperatively and on first and the sixth months postoperatively. Histopathological evaluation revealed no specific changes. There was a mild local inflammation both in the PLA implanted and control ears. PLA film barrier most likely has no toxic effects on Guinea pig middle ear and does not show any ototoxic side effects.

The basaloid variant of squamous cell carcinoma of the larynx.

INTRODUCTION: Basaloid squamous cell carcinoma (BSCC) is a rare subtype of squamous cell carcinoma (SCC). Because of its rarity, both clinical and prognostic features of this variant are not well known. OBJECTIVE: In this study, we aimed to determine the frequency of BSCC and other SCC variants among all laryngeal SCC cases, and to determine clinical and prognostic features of BSCC variant. STUDY DESIGN: retrospective cohort study. Evidence level: Level 2b. MATERIAL AND METHODS: Records of the patients who had laryngeal SCC surgically treated at our institute between 2007 and 2013 were retrospectively reviewed. RESULTS: Among 198 subjects who had laryngeal SCC surgically treated, the frequency of the variants of SCC other than classical variant was 10.1% (20/198). The most common SCC variant was BSCC (6.6%). Eleven (84.6%) patients with BSCC were at an advanced stage at the presentation (p > 0.05). The 3-year overall survival and disease-free survival rates were 63% and 53% respectively. CONCLUSION: BSCC variant may be more common than previously reported. Since almost the half of patients experiences disease recurrence in the early period, multimodal treatment strategies should be employed at initial treatment, and a close follow-up is strongly recommended for this aggressive SCC variant.

The basaloid variant of squamous cell carcinoma of the larynx / O basaloide variante do carcinoma de células escamosas da laringe

INTRODUCTION: Basaloid squamous cell carcinoma (BSCC) is a rare subtype of squamous cell carcinoma (SCC). Because of its rarity, both clinical and prognostic features of this variant are not well known. OBJECTIVE: In this study, we aimed to determine the frequency of BSCC and other SCC variants among all laryngeal SCC cases, and to determine clinical and prognostic features of BSCC variant. Study design: retrospective cohort study. Evidence level: Level 2b. MATERIAL AND METHODS: Records of the patients who had laryngeal SCC surgically treated at our institute between 2007 and 2013 were retrospectively reviewed. RESULTS: Among 198 subjects who had laryngeal SCC surgically treated, the frequency of the variants of SCC other than classical variant was 10.1% (20/198). The most common SCC variant was BSCC (6.6%). Eleven (84.6%) patients with BSCC were at an advanced stage at the presentation (p > 0.05). The 3-year overall survival and disease-free survival rates were 63% and 53% respectively. CONCLUSION: BSCC variant may be more common than previously reported. Since almost the half of patients experiences disease recurrence in the early period, multimodal treatment strategies should be employed at initial treatment, and a close follow-up is strongly recommended for this aggressive SCC variant. .

INTRODUÇÃO: O carcinoma escamoso basaloide (CEB) é um raro subtipo do carcinoma de célula escamosa (CCE). Em decorrência de sua raridade, os aspectos clínicos e prognósticos dessa variante não são bem conhecidos. OBJETIVO: Determinar a frequência de CEB e de outras variantes do CCE entre todos os casos de CCE da laringe, assim como os aspectos clínicos e prognósticos da variante CEB. MÉTODOS: Trata-se de um estudo de coorte retrospectivo. Nível de evidência: 2b Os registros dos pacientes tratados cirurgicamente para CCE de laringe em nossa instituição entre 2007 e 2013 foram retrospectivamente revisados. RESULTADOS: Foram anotados 198 pacientes tratados cirurgicamente para CCE de laringe. A frequência das variantes de CCE diferentes da variante clássica foi 10,1% (20/198). A variante de CCE mais comum foi CEB (6,6%). Por ocasião da apresentação inicial, 11 (84,6%) pacientes com CEB estavam em estágio avançado (p > 0,05). Os percentuais de sobrevida geral após três anos e de sobrevida livre da doença foram 63% e 53%, respectivamente. CONCLUSÃO: A variante CEB pode ser mais comum do que o informado anteriormente. Considerando que praticamente metade dos pacientes sofre recorrência da doença em seu período inicial, devem ser introduzidas estratégias terapêuticas multimodais no tratamento inicial; além disso, recomendamos enfaticamente um cuidadoso seguimento para essa agressiva variante do CCE. .

Bilateral synchronous squamous cell tonsil carcinoma treated with chemoradiotherapy.

The incidence of numerous head and neck tumours is a known issue though bilateral synchronous tonsillar carcinoma reports are so uncommon that only 20 cases were found in a literature review. Most of these patients were treated with bilateral tonsillectomy followed by adjuvant radiotherapy. We report, to our knowledge, the first case of bilateral synchronous tonsillar squamous cell carcinoma treated only with chemoradiotherapy without tonsillectomy.

Giant mucocele originating from the middle concha in a 5-year-old child: a case report.

INTRODUCTION: Mucoceles are mucus-filled, epithelial-lined sacs that slowly develop in the paranasal sinuses when sinus or concha bullosa drainage is obstructed by inflammatory processes, trauma, or prior surgery. They are extremely rare in children. Symptoms usually arise from the nasal obstruction or compression of neighboring structures. CASE PRESENTATION: This case report describes a 5-year-old Turkish boy with a 3-year history of nasal obstruction. A computed tomography scan showed a well-defined soft tissue density lesion, seemingly originating in the region of the middle concha and was suggestive of a middle concha mucocele. The mass was removed by endoscopic sinus surgery. CONCLUSIONS: In the case of a child presenting with nasal obstruction, mucocele should be remembered in the differential diagnosis of intranasal tumors. Computed tomography and magnetic resonance imaging are helpful in making the diagnosis and endoscopic nasal surgery has proven successful in the treatment.

Unilateral inferior turbinate bone hypertrophy: is it compensatory or congenital?

BACKGROUND: This study evaluates the degree of the unilateral hypertrophied inferior turbinate (HIT) by computed tomography (CT) and determines and compares the enlargement of the turbinate bone and soft tissue in different parts of the HIT in pediatric and adult groups. METHODS: Both pediatric and adult patients were studied in two groups: those with a straight or nearly straight septum (n = 25 and 124, respectively) and those with deviation (n = 64 and 129, respectively). The cross-sectional area (CSA) of the IT bone and soft tissue were measured at anterior, middle, and posterior thirds of the IT in coronal CT sections. The ratio of CSA of the IT bone and soft tissue on two sides of the septum (interturbinate ratio [IR]) were calculated. IRs were then compared among straight septum and deviation groups for both the pediatric and the adult groups. RESULTS: IR of the bony concha CSA for the deviation group was significantly higher compared with the straight septum group in anterior, middle, and posterior segments in adults (p = 0.028, 0.018, and <0.001, respectively; independent samples t-test). The soft tissue component hypertrophy was prominent only in the middle segment (p = 0.15); however, there was no significant difference for pediatric patients. Also, there was a statistically significant difference between the adult group with septum deviation and the pediatric group with septum deviation for both soft tissue and bone components (p < 0.001 for all segments; independent samples t-test). CONCLUSION: We claim that these results indicate that skeletal and soft tissue IT hypertrophy seem to be compensatory and evolves with age rather than being congenital. Therefore, skeletal enlargement is prominent in anterior, middle, and posterior thirds of HIT in patients with septal deviation in adults but not in the pediatric group.

Correlation of symptoms with total IgE and specific IgE levels in patients presenting with allergic rhinitis.

OBJECTIVE: The objective of this study was to investigate the correlation of symptoms in patients with presumed allergic rhinitis on the basis of their medical history and physical examination with the levels of total immunoglobulin E (IgE) and specific IgE, and to question the necessity of these tests in diagnosis. METHODS: The records of 295 patients, who had at least two complaints of nasal itching, nasal obstruction, runny discharge and sneezing, and/or presumed as allergic rhinitis on physical examination findings were retrospectively screened. The correlation between the levels of IgE, specific inhalant IgE, and food-specific serum IgE were evaluated in these patients. RESULTS: A total of 70 cases (23.7%) were determined to have a total value of IgE under 20 U/ml, 113 cases (38.3%) with IgE values between 20 U/ml and 100 U/ml, and 100 cases with IgE values above 100 U/ml. Results of total IgE could not be obtained in 12 (4.06%) patients. Dermatophagoides farinae was the most common allergy in this group with 74 (68.5%) cases. CONCLUSIONS: The determination of IgE in allergic rhinitis is a supportive method. However, it cannot be recommended for routine use because of the time loss and high cost.