Predicting the outcome after adenoidectomy-alone for adenoid hypertrophy causing sleep disordered breathing.

PURPOSE: By using preoperative parameters age, body mass index, nasopharyngeal obstruction as assessed using flexible videonasopharyngoscopy, and quality of life scores in patients undergoing adenoidectomy-alone because of adenoid hypertrophy causing sleep disordered breathing, we aimed to examine the relationship between the change in quality of life scores, and preoperative parameters and to develop a tool to predict the change. MATERIALS AND METHODS: Patients who were scheduled for adenoidectomy-alone in a 12-month period were included. Flexible videnonasopharyngoscopy of the nasopharynx was performed. Nasopharyngeal obstruction was measured by using Image J software. Preoperative quality of life was evaluated using OSA-18 quality of life survey. OSA-18 survey has 5 subcategories consisting of sleep disturbance (O1), physical suffering (O2), emotional distress (O3), daytime problems (O4), caregiver concerns (O5). A question about the overall quality of life(O6) was added. Postoperative OSA-18 domain scores were obtained at the 3-month-follow-up. Preoperative OSA-18 subscores were compared to postoperative subscores. Linear regression analysis to predict the proportional change in OSA-18 subscores was performed. RESULTS: Our study group consisted of 94 cases. Mean postoperative O1, O2,O3, O4 and O5 scores were significantly lower compared to the preoperative scores. Mean postoperative O6 score was significantly higher. Linear regression analysis was carried out for predicting change in O1(r2 = 0.686; p = 0.006), O5(r2 = 0.711; p = 0.003) and O6(r2 = 0.757; p = 0.001). CONCLUSION: Change in quality of life scores for sleep disturbance, physical suffering and general quality of life may be predicted by using preoperative parameters.

Is fine needle aspiration biopsy reliable in the diagnosis of parotid tumors? Comparison of preoperative and postoperative results and the factors affecting accuracy / A punção aspirativa com agulha fina é confiável no diagnóstico de tumoresde parótida? Comparação dos resultados pré e pós-operatórios e fatores que afetam sua precisão

Abstract Introduction: Fine needle aspiration biopsy is a valuable tool in preoperative evaluation of head and neck tumors. However, its accuracy in management of salivary gland tumors is debatable. Objective: We aimed to investigate the efficacy and the accuracy of fine needle aspiration biopsy in parotid gland tumors. Methods: Patients who underwent parotidectomy between January 2008 and June 2017 due to parotid gland tumor were examined retrospectively. Patients with both preoperative fine needle aspiration biopsy and postoperative surgical pathologies were included. Preoperative fine needle aspiration biopsy was categorized as benign, malignant or suspicious for malignancy. Surgical pathology was grouped as benign or malignant. Surgical pathology was compared with fine needle aspiration biopsy, and sensitivity, specificity, accuracy and agreement between both tests were investigated. Results: 217 cases were evaluated and 23 cases were excluded because the fine needle aspiration biopsy diagnosis was non-diagnostic or unavailable. 194 cases were included. The mean age of the patients was 47.5 ± 15.88 (7-82). There were 157 benign, 37 malignant cases in fine needle aspiration biopsy, 165 benign and 29 malignant cases in surgical pathology. The most common benign tumor was pleomorphic adenoma (43.3%), and malignant tumor was mucoepidermoid carcinoma (4.13%). The diagnostic accuracy for fine needle aspiration biopsy when detecting malignancy was 86.52%. Sensitivity and specificity were 68.96% and 89.63% respectively. Positive predictive value was 54.05% and negative predictive value was 94.23%. There was moderate agreement between fine needle aspiration biopsy and surgical pathology (κ = 0.52). The sensitivity was 54.54% in tumors less than 2 cm while 77.77% in larger tumors. In tumors extending to the deep lobe, sensitivity was 80%. Conclusion: Fine needle aspiration biopsy is an important diagnostic tool for evaluating parotid gland tumors. It is more accurate in detecting benign tumors. In tumors greater than 2 cm and extending to the deep lobe, the sensitivity of fine needle aspiration biopsy is high. The use of fine needle aspiration biopsy in conjunction with clinical and radiological evaluation may help to reduce false positive and false negative results.

Resumo Introdução: A punção aspirativa com agulha fina é uma ferramenta valiosa na avaliação pré-operatória de tumores de cabeça e pescoço. No entanto, sua precisão no tratamento de tumores de glândulas salivares é discutível. Objetivo: Nosso objetivo foi investigar a eficácia e precisão da punção aspirativa com agulha fina nos tumores da glândula parótida. Método: Pacientes submetidos à parotidectomia entre janeiro de 2008 e junho de 2017 por tumor de glândula parótida foram examinados retrospectivamente. Foram incluídos pacientes com punção aspirativa com agulha fina pré-operatória e histopatologia cirúrgica pós-operatória. A punção aspirativa com agulha fina pré-operatória foi categorizada como benigna, maligna ou com suspeita de malignidade. O histopatológico cirúrgico foi agrupado como benigno ou maligno. Os exames histopatológicos foram comparados com a punção aspirativa com agulha fina e a sensibilidade, especificidade, acurácia e concordância entre os dois testes foram investigadas. Resultados: Foram avaliados 217 casos e excluídos 23 porque o diagnóstico da punção aspirativa com agulha fina não foi conclusivo ou estava indisponível. Portanto, foram incluídos 194 casos. A média de idade dos pacientes foi de 47,5 ± 15,88 (7-82). Havia 157 casos benignos, 37 malignos na punção aspirativa com agulha fina e 165 benignos e 29 malignos na histopatologia. O tumor benigno mais comum foi o adenoma pleomórfico (43,3%) e o tumor maligno mais comum foi o carcinoma mucoepidermoide (4,13%). A acurácia diagnóstica da punção aspirativa com agulha fina na detecção de malignidade foi de 86,52%. A sensibilidade e especificidade foram de 68,96% e 89,63%, respectivamente. O valor preditivo positivo foi de 54,05% e o valor preditivo negativo foi de 94,23%. Houve concordância moderada entre a punção aspirativa com agulha fina e histopatológico (κ = 0,52). A sensibilidade foi 54,54% em tumores menores do que 2 cm e 77,77% em tumores maiores. Nos tumores que se estendiam até o lobo profundo, a sensibilidade foi de 80%. Conclusão: A punção aspirativa com agulha fina é uma importante ferramenta diagnóstica na avaliação dos tumores da glândula parótida. É mais precisa na detecção de tumores benignos. Em tumores maiores do que 2 cm que se estendem até o lobo profundo, a sensibilidade da punção aspirativa com agulha fina é alta. O uso dessa ferramenta em conjunto com a avaliação clínica e radiológica pode ajudar a reduzir os resultados falso-positivos e falso-negativos.

Is septoplasty effective rhinogenic headache in patients with isolated contact point between inferior turbinate and septal spur?

BACKGROUND: Rhinogenic headache is a painful sensation in the head and face due to intranasal contact point without any mass or inflammatory findings. Surgery is recommended in patients with nasal obstruction; however the approach in case of isolated mucosal contact point that does not cause obstruction is controversial. Our aim is to observe changes in the severity of headache in patients with isolated mucosal contact point and headache who do not complain of nasal obstruction. METHODS: Our study included patients with unilateral headache without any nasal and/or paranasal sinus pathology. We confirmed the presence of mucosal contact by nasal endoscopy and by computed tomography (CT). One hundred patients with isolated mucosal contact point without any problem in breathing were included in this study. All participants were treated by topical nasal corticosteroid for a month. Surgery was recommended to the patients with no satisfactory relieve of headache. Visual Analog Scales (VAS) were used to evaluate the severity of headache in patients at time of diagnosis (0 month), after a medical treatment (1st month) and after a surgical or medical treatment (6th month). The results were compared with each other statistically. RESULTS: There was a decrease in VAS values after a month of medical treatment in all patients with isolated contact point (Z = -8.352; p = 0.0). VAS values significantly improved after surgical treatment group (Z = -4.97; p = 0.0). However, VAS values of patients increased at 6th month in medical treatment group (Z = -5341 p = 0.0). After a successful surgical removal of mucosal contacts, the decrease of headache severity was more intense in patients with surgical treatment group than in the patients with medical treatment group (Z = -8.441; p = 0.0). CONCLUSION: Surgical correction provides a more effective outcome in patients with rhinogenic headache. However, it is difficult to convince that headache may improve with surgery in these patients especially with isolated mucosal contact point and without nasal obstruction. In order to prove the benefit of surgery, we believe that medical treatment can be used as a guide.

Is there any effect of anxiety and depression scores on the improvement of tinnitus after surgery in chronic otitis patients with tinnitus.

BACKGROUND: Tinnitus is a common disease in public. It is not only associated with neuronal, muscular, vascular pathologies, but also with related psychological parameters. In this study, we aimed to investigate the relationship between tinnitus, anxiety and depression in patients undergoing tympanoplasty. METHODS: Patients with tinnitus and operated for chronic otitis media were included in our study. Before and after the operation, tinnitus handicap inventory, beck anxiety and depression scales were filled and pre- and postoperative values were compared. In addition, our patients were divided into two groups as tinnitus improve and did not improve and differences between them were investigated. RESULTS: 148 patients were included in our study. Of 148 patients, 60 were male and 88 were female. There was no significant difference between the patients with and without tinnitus when the dermografic features, hearing levels and physical examination findings were compared. After the operation, the patients who did not improve tinnitus had higher levels of depression and depression than others (<0.001). CONCLUSION: As a result of our study, anxiety and depression scales of the patients whose tinnitus did not improve were found to be higher than the patients whose tinnitus improved.

Is fine needle aspiration biopsy reliable in the diagnosis of parotid tumors? Comparison of preoperative and postoperative results and the factors affecting accuracy.

INTRODUCTION: Fine needle aspiration biopsy is a valuable tool in preoperative evaluation of head and neck tumors. However, its accuracy in management of salivary gland tumors is debatable. OBJECTIVE: We aimed to investigate the efficacy and the accuracy of fine needle aspiration biopsy in parotid gland tumors. METHODS: Patients who underwent parotidectomy between January 2008 and June 2017 due to parotid gland tumor were examined retrospectively. Patients with both preoperative fine needle aspiration biopsy and postoperative surgical pathologies were included. Preoperative fine needle aspiration biopsy was categorized as benign, malignant or suspicious for malignancy. Surgical pathology was grouped as benign or malignant. Surgical pathology was compared with fine needle aspiration biopsy, and sensitivity, specificity, accuracy and agreement between both tests were investigated. RESULTS: 217 cases were evaluated and 23 cases were excluded because the fine needle aspiration biopsy diagnosis was non-diagnostic or unavailable. 194 cases were included. The mean age of the patients was 47.5±15.88 (7-82). There were 157 benign, 37 malignant cases in fine needle aspiration biopsy, 165 benign and 29 malignant cases in surgical pathology. The most common benign tumor was pleomorphic adenoma (43.3%), and malignant tumor was mucoepidermoid carcinoma (4.13%). The diagnostic accuracy for fine needle aspiration biopsy when detecting malignancy was 86.52%. Sensitivity and specificity were 68.96% and 89.63% respectively. Positive predictive value was 54.05% and negative predictive value was 94.23%. There was moderate agreement between fine needle aspiration biopsy and surgical pathology (κ=0.52). The sensitivity was 54.54% in tumors less than 2cm while 77.77% in larger tumors. In tumors extending to the deep lobe, sensitivity was 80%. CONCLUSION: Fine needle aspiration biopsy is an important diagnostic tool for evaluating parotid gland tumors. It is more accurate in detecting benign tumors. In tumors greater than 2cm and extending to the deep lobe, the sensitivity of fine needle aspiration biopsy is high. The use of fine needle aspiration biopsy in conjunction with clinical and radiological evaluation may help to reduce false positive and false negative results.

Two-Hour Follow-Up is Equivalent to One-Day Follow-Up of Posterior Canal Benign Paroxysmal Positional Vertigo.

OBJECTIVES: To evaluate short-term outcome for posterior canal benign paroxysmal positional vertigo (p-BPPV) after modified Epley's maneuver (mEM). MATERIALS AND METHODS: Patients who were diagnosed with p-BPPV between September 2017 and January 2018 in a tertiary care center were included. Patients were treated with mEM. Five follow-up points were set at one hour, two hours, one day, three days and one week. If Dix-Hallpike test (DH) was positive, mEM was performed and patient was scheduled for follow-up at the next follow-up point. If negative, the patient was accepted as completely resolved and scheduled for follow-up at one week. The proportion of completely resolved patients at each follow-up point, recurrence, lateral canal conversion rate and time were noted. A retrospective control group was created from patients treated for p-BPPV between April and August 2017. The outcome of the study and control groups were compared. RESULTS: There were 93 patients in study group. 63 (67.7%), 8 (8.6%), 3 (3.2%), 0 (0%) and 9 (9.7%) patients completely resolved at one-hour, two-hour, one-day, three-days and one-week follow-ups. 1.96±1.60 (1-5) mEMs were performed. Control group included 61 patients. At one-week follow-up a total of 83 (89.2%) patients in study group and 48 (78.7%) in control group were completely resolved(p=0.1043). In study group 5 (5.37%) of patients had lateral canal conversion within one day. 2(2.15%) had recurrence one day later after two-hour follow-up. The number of patients completely resolved at two-hour follow-up and before (76.34%) compared to the patients completely resolved at one-day follow-up and before (79.56%) were not significantly different (p=0.7235). CONCLUSION: Two-hour follow-up is equivalent to one-day follow-up of p-BPPV in terms of therapy outcome and adverse affects.

Investigation of Distances Between the Anterior Nasal Spine and Nasofrontal Beak, Basal Lamella, Skull Base, and Sphenoid Sinus on Paranasal Sinus Computed Tomography.

OBJECTIVE: The aim of this study was to investigate the distances between the anterior nasal spine and basal lamella (BL), skull base, nasofrontal beak (NfB), and the anterior wall of sphenoid sinus on computed tomography (CT) images. METHODS: A total of 160 patients who were seen at the otolaryngology clinic of our institution were evaluated with the help of the image processing software of the radiology department. Cases in which bony structures could not be seen clearly because of previous surgery or trauma were excluded. The distance between the anterior nasal spine; and NfB, the closest point of the skull base in the frontal recess (SB1), the closest point of the BL, the intersection of the line with which the distance to the BL was measured with the skull base (SB2) and the closest point of the anterior wall of the sphenoid sinus (Sp) were measured using multiplanar reconstruction. RESULTS: The images of 140 patients were examined. NfB, SB1, BL, SB2, and Sp were 5.14 ±â€Š0.46 (4.15-6.38) cm, 5.70 ±â€Š0.48 (4.31-7.03) cm, 4.84 ±â€Š0.44 (3.86-5.98) cm, 6.23 ±â€Š0.50 (5.13-7.35) cm, and 6.14 ±â€Š0.46 (5.04-7.36) cm, respectively. CONCLUSION: In our study group, the distances some of which were reported as constant values in the literature were found to have a range of up to 2 cm. Therefore, if distances between structures are to be used for orientation during endoscopic sinus surgery, they should be better measured preoperatively on paranasal sinus CT scan images instead of using predefined constant values.

Recurrence of Giant Cell Tumor of The Larynx.

Giant cell tumor of the larynx is a rare tumor. It was first reported by Wessely et al in 1940. Thirty-nine cases have been reported until now and together with the current case 2 recurrences were encountered. In this case report, our aim was to discuss conservative management because of the suspicion of recurrence. A 70-year-old male patient was admitted to our clinic with the complaint of hoarseness. A tumor measuring 1 × 1 cm located in the anterior half right vocal fold and extending to the anterior comissure was found on laryngeal endoscopy. Direct laryngoscopy and biopsy of the mass revealed giant cell tumor on histopathological examination. Tumor resection with cordectomy through laryngofissure and subsequently medialization thyroplasty were performed. Horaseness of the patient improved. On 2-year follow-up, a tumoral lesion suggesting recurrence was found on the vocal cord. Direct laryngoscopy and biopsy confirmed recurrence. Total laryngectomy was performed. This is the second case of recurrent giant cell tumor of the larynx. The therapy of choice should be selected considering the possibility of recurrence.

Histopathological comparison of bone healing effects of endonasal and percutaneous lateral osteotomy methods in rabbit rhinoplasty model.

INTRODUCTION: Lateral osteotomy is mainly performed either endonasally or percutaneously in rhinoplasty which is a frequently performed operation for the correction of nasal deformities. Both techniques have both advantages and disadvantages relative to each other. OBJECTIVE: The aim of this study was to compare the histopathological effects of endonasal and percutaneous osteotomy techniques performed in rhinoplasty on bone healing and nasal stability in an experimental animal model. METHODS: Eight one year-old New Zealand white rabbits were included. Xylazine hydrocloride and intramuscular ketamine anesthesia were administered to the rabbits. Endonasal osteotomy (8 bones) was performed in Group 1 (n=4), and percutaneous osteotomy (8 bones) in Group 2 (n=4). One month later the rabbits were sacrificed. Bone healing of the rabbits was staged according to the bone healing score of Huddleston et al. In both groups, nasal bone integrity was assessed subjectively. RESULTS: In the percutaneous osteotomy group, Grade 1 bone healing was observed in two samples (25%), Grade 2 bone healing in two samples (25%), Grade 3 bone healing in four samples (50%). In the endonasal osteotomy group, Grade 1 bone healing was observed in 6 samples (75%) and Grade 2 bone healing was observed in 2 samples (25%). In the percutaneous group, fibrous tissue was observed in 2, predominantly fibrous tissue and a lesser amount of cartilage was observed in 2 and an equal amount of fibrous tissue and cartilage was observed in 4 samples. In the endonasal group, fibrous tissue was observed in 6 samples, and predominantly fibrous tissue with a lesser amount of cartilage was observed in 2 samples. In both groups, when manual force was applied to the nasal bones, subjectively the same resistance was observed. CONCLUSION: Percutaneous lateral osteotomy technique was found to result in less bone and periost trauma and better bone healing compared to the endonasal osteotomy technique.

Comparison of Frey Syndrome Rates Following Superficial Parotidectomy and Partial Superficial Parotidectomy for Pleomorphic Adenoma.

PURPOSE: Comparison of Frey syndrome rates following superficial parotidectomy and partial superficial parotidectomy for pleomorphic adenoma. METHODS: Fifty patients diagnosed with pleomorphic adenoma and received surgical treatment at the Otolaryngology Department of Bagcilar Training and Research Hospital between January 2009 and October 2015 were reviewed retrospectively. The patients were specifically queried for Frey syndrome symptoms. The syndrome was investigated with Minor starch iodine test. The patients who underwent superficial parotidectomy were compared to those who underwent partial superficial parotidectomy in terms of Frey syndrome development and recurrence. RESULTS: In the partial superficial parotidectomy group, Frey syndrome symptoms were edema and increased sweating and burning sensation on the face in 7 patients (21.9%, P = 0.735). In the superficial parotidectomy group, 5 patients exhibited edema (27.8%), 3 exhibited increased sweating (16.7%), and 5 exhibited burning sensation (27.8%). Minor test results were positive for 7 patients in the partial superficial parotidectomy group (21.8%) and 5 patients were positive (27.8%) in the superficial parotidectomy group. No recurrence was found in either group during the 5-year follow-up. No significant difference was found between 2 groups in terms of postoperative complications and recurrence. CONCLUSION: In terms of their effect on Frey syndrome development, there is no significant difference between partial superficial parotidectomy and superficial parotidectomy.

The contribution of erectile elements to nasal patency: an examination with nasal sound analysis.

BACKGROUND: The objective of this work was to determine the role of nasal sound analysis using a software called Odiosoft-Rhino (OR) in evaluation of nasal erectile elements as a cause of nasal obstruction. Comparisons of nasal resistance, amplitude of the nasal sound frequency spectra, and visual analogue score (VAS) were made. METHODS: Nasal endoscopy, VAS, rhinomanometry (RMM), and OR were performed on 64 patients with inferior turbinate hypertrophy but without any other nasal problems, both untreated and 15 minutes after the application of topical decongestants (TDs). Results were compared and any correlation was investigated. RESULTS: For inspiration, the OR intervals for both sides at all 5 frequency intervals changes significantly with decongestion, except for the left side at 0.5 to 1 kHz. For expiration, the OR intervals for both sides changed significantly for 0.2 to 0.5 KHz and 2 to 4 kHz, but not for the other 3 frequency intervals. VAS correlated well with physical examination, both inspiratory and expiratory RMM, and 2 to 4 kHz inspiratory and expiratory nasal sound on both sides both before and after TD application. The 2 to 4 kHz inspiratory and expiratory nasal sound on both sides correlated well with inspiratory and expiratory RMM on both sides both before and after TD application. CONCLUSION: OR is an efficient and reliable method to evaluate the role of the erectile components in nasal patency in the absence of allergy or septal deviation. It is practical and may be used in routine clinical practice.

Nasal obstruction following septorhinoplasty: how well does acoustic rhinometry work?

Septorhinoplasty aims to improve not only the esthetic appearance but also breathing function of the nose. Although the esthetic improvement can be judged by the patient and the surgeon easily, evaluation of nasal breathing is more complicated. Besides the subjective symptom scores given by the patient, some objective methods have been developed. One of the most widely used of these objective methods is acoustic rhinometry, which gives valuable information about the cross-sectional areas and volumes of the nasal airway as a function of distance from the nostril. Since the introduction of acoustic rhinometry, many papers were reported regarding its efficiency with some conflicting conclusions. Septorhinoplasty has the potential to narrow the nasal airway, especially if it includes lateral osteotomies and hump reduction. We aimed to evaluate the role of rhinoplasty on nasal obstruction with the help of subjective symptom scores and acoustic rhinometry. The study consisted of 26 patients who underwent septorhinoplasty. Before and after surgery, the symptom scores and findings of acoustic rhinometry were collected both before and after decongestion of the nasal mucosa. Symptom scores decreased on both sides, which were statistically significant (p < 0.05), however, the changes in cross-sectional areas of the nasal airway were not statistically significant (p > 0.05). The correlation between the symptom scores and acoustic rhinometry findings was not significant for all levels. The effect of septorhinoplasty on nasal airway and some important maneuvers to protect against nasal obstruction are discussed.

Giant chondroma of the head and neck causing gross facial deformity.

Cartilaginous tumors in the head and neck region are rare. We report the case of a middle-aged man with a progressive swelling in the left cheek area who had been seen several times over the years at our otorhinolaryngology department. The progression of the swelling culminated in an extremely large tumor that grossly distorted the patient's face. Examination revealed that the mass had probably originated in the maxillary sinus; it eventually extended to the skull base, middle cranial fossa, and cavernous sinus. Several histologic examinations of biopsy specimens identified the mass as a chondroma. The unusual size and extension of the tumor indicated extensive surgery, but the patient refused. We discuss the natural history of this tumor, and we review the current literature on head and neck chondromas.

Macroglossia and generalized edema not due to hypothyroidism.

We present a 69-year-old male patient with the macroglossia, dysphagia and generalized edema. He was seen previously by other physicians and diagnosed as hypothyroidism. With thyroid stimulating hormone in normal range, tongue biopsy revealed primary systemic amyloidosis. Amyloidosis is the most common cause of macroglossia. Primary systemic amyloidosis should be suspected when laboratory does not support hypothyroidism especially if the enlarged tongue is firm and additional findings are present.

High-grade mucoepidermoid carcinoma of the larynx.

Laryngeal mucoepidermoid carcinoma is rare. Approximately 85 cases have been reported in the literature. There is no standardized treatment because of the rarity of the disease. A case of a 55-year-old man with laryngeal mucoepidermoid carcinoma, who was treated with total laryngectomy and postoperative radiotherapy, is presented, and current literature is reviewed.

Myofibroma of the zygomatic bone in an older child: a case report.

Myofibroma/myofibromatosis is a rare mesenchymal disorder that is part of a heterogeneous group of approximately 20 disorders that are classified primarily according to the proliferation of benign fibrous elements. These lesions can arise during a wide range of ages, with many occurring in the first decade of life, and they are slightly more common in males than females. The etiology of this disease is not well understood. Clinically, patients with myofibroma/myofibromatosis present with various signs, ranging from superficial, cutaneous, purplish macules to freely movable subcutaneous masses to deep-seated fixed lesions. The definitive diagnosis is made on histopathologic grounds. The destructive clinical behavior of myofibroma/myofibromatosis in the setting of insufficient pre- or perioperative diagnostic evaluations (e.g., a failure to perform fine-needle aspiration or frozen-section biopsy) may guide the clinician toward a radical surgical procedure rather than a simple excision.

Metastatic basal cell carcinoma.

Basal cell carcinoma (BCC) is the most common skin cancer with a high propensity for local recurrence. The incidence of metastases from BCC is rare. We report a 65-year-old man who had BCC of the medial canthus of the left eye. In the 10-year period, he had been operated on approximately 12 times because of local recurrences. Three years after the last operation, he had a suspicious lesion on the operated area and a lumbar pain. Radiologic examination showed multiple metastatic skeletal and liver lesions. He was referred to the oncology department for radiation therapy and chemotherapy.

Comparison of Odiosoft-Rhino and rhinomanometry in evaluation of nasal patency.

OBJECTIVE: To conduct a preliminary study testing the validity of the Odiosoft-Rhino (OR) in the evaluation of nasal patency in patients with nasal septal deviation and compare the results with visual analogue score (VAS) of nasal obstruction and rhinomanometry (RMM). METHODS: OR and RMM were performed on 68 patients with nasal septal deviation and 61 healthy controls. VAS, nasal resistance values and nasal sound analysis were noted for the left and right nasal cavities. RESULTS: There are statistically significant differences between VAS, RMM and nasal endoscopic findings between the patient and the control group. The OR results at expiratory and inspiratory 2000 - 4000 Hz and 4000 - 6000 Hz intervals for both nasal cavities show a statistically significant difference between the patient and control groups. Nasal endoscopic findings, RMM, OR results of the deviated sides in the 2000 - 4000 Hz interval correlate well with VAS. CONCLUSIONS: OR may be a practical test in assessment of nasal patency. OR at the 2000 - 4000 Hz interval shows a correlation with VAS. However, showing a correlation between a test and a variable is not the same as proving that it is a useful diagnostic test. Therefore, more studies with larger series are needed.

Efficacy comparison of oral steroid, intratympanic steroid, hyperbaric oxygen and oral steroid + hyperbaric oxygen treatments in idiopathic sudden sensorineural hearing loss cases.

Idiopathic sudden sensorineural hearing loss is a rare disorder of unknown pathogenesis in which hearing is lost partially or totally. About 60 treatment modalities have been described. We aimed to compare the efficacy of hyperbaric oxygen, oral steroid, intratympanic steroid therapy and their combinations in idiopathic sudden sensorineural hearing loss patients. Files of patients who were followed up between 2004 and 2010 in our clinic were examined retrospectively. Patients were divided into four groups according to the therapy received: Oral steroid, oral steroid + hyperbaric oxygen, intratympanic steroid and hyperbaric oxygen. Treatment success was assessed by Siegel criteria and mean gains using pre-treatment and post-treatment audiograms. 217 patients and 219 ears were examined. The proportion of patients responding to therapy was the highest in the oral steroid + hyperbaric oxygen group with 86.88% (53/61) followed by the oral steroid group with 63.79% (37/58), the intratympanic steroid group with 46,51% (20/43) and the hyperbaric oxygen group with 43.85% (25/57). The proportion of patients who had complete recovery was the highest in the oral steroid + hyperbaric oxygen group with 42.6% (26/61) followed by the oral steroid group with 19.0% (11/58), the hyperbaric oxygen group with 17.5% (10/57) and the intratympanic steroid group with 11.6% (5/43). The oral steroid + hyperbaric oxygen group has the highest mean hearing gain among all groups (p < 0.05). Idiopathic sudden sensorineural hearing loss patients receiving oral steroid + hyperbaric oxygen combination therapy have a higher likelihood of recovery than patients receiving oral steroids, hyperbaric oxygen or intratympanic steroids alone.

The effect of lidocaine, bupivacaine and ropivacaine in nasal packs on pain and hemorrhage after septoplasty.

We aimed to investigate the effects of local anesthetics soaked in Merocel nasal packs on hemorrhage and pain after septoplasty. The methodology includes a prospective double-blind study that was conducted in patients undergoing septoplasty because of nasal septal deviation. The study included 143 patients. The patients were divided into four groups. Each group received 1% lidocaine + 0.000625% adrenalin, 0.375% ropivacaine, 0.25% bupivacaine as study groups or 0.9% sodium chloride as a control group in their Merocel packs postoperatively. The local anesthetics or sodium chloride were reapplied at the eighth postoperative hour. Each patient was given a questionnaire where verbal analog score and amount of postoperative hemorrhage was noted. The statistical analysis was performed using two sided t test on each patient group at each time point. The results included the patients in the control group needing rescue drug most often. There was no statistically significant difference between bupivacaine and lidocaine plus adrenalin in the patients who requested rescue drug. The patients in the ropivacaine group requested rescue drug more frequently than the bupivacaine and lidocaine plus adrenalin groups. Bupivacaine group had significantly better pain scores versus control group at all intervals except for the first postoperative hour.The bupivacaine group had better pain scores versus ropivacaine and lidocaine plus adrenalin groups in the 4th, 8th and the 24th hours. The bupivacaine group had better pain scores versus lidocaine plus adrenalin in the 12th, 16th and the 20th hours. The ropivacaine group had significantly better pain scores versus control group in the 8th, 12th, 16th, 20th and 24th postoperative hours. The ropivacaine group scored better than lidocaine plus adrenalin group just in the 16th hour. The lidocaine plus adrenalin group had significantly better pain scores versus control group in 4th and 12th hours. There was no statistically significant difference between the study groups in terms of postoperative hemorrhage. We concluded that bupivacaine use in nasal surgery provides better analgesia at least in the first 8 h period and does not cause more bleeding. Topical bupivacaine application to nasal packs should be considered after septoplasty.