The Effect of Unilateral Concha Bullosa on Olfactory Bulb Volume: an Assessment by Magnetic Resonance Imaging.

BACKGROUND: In this study, the authors compared the right and left olfactory bulb volumes by magnetic resonance image findings of patients with unilateral concha bullosa (CB). METHODS: The cranial magnetic resonance imaging studies of 24 patients having unilateral CB were reviewed. There were 10 males and 14 females ranging in age from 29 to 51 years (mean age, 29 ±â€Š15.2 years). The volumes of both olfactory bulbs (contralateral and ipsilateral to the concha bullosa side) were calculated by using the computer program. RESULTS: The average values for olfactory bulb volumes were 46.57 ±â€Š8.03 mm in the CB side of the nasal cavity and 54.80 ±â€Š10.031 mm in the normal side of the nasal cavity. We found a statistically significant difference in olfactory bulb volume between the contralateral and ipsilateral to the concha bullosa side of the patients (t = -3.08 and P < 0.01 for CB side, t = -3.47 and P < 0.01 for left normal side). CONCLUSION: Our results may point out a possible relationship between CB and ipsilateral decreased olfactory bulb volume, yet the exact mechanism still remains unclear. Decreased nasal air flow on the CB side may be attributed to the pathophysiologic mechanism of this finding. Also, the significant reduction in olfactory bulb volumes ipsilateral to CB compared with the contralateral olfactory bulb volumes seems to support our hypothesis.

Olfactory Bulb Volume Changes in Patients With Nasal Septal Deviation.

OBJECTIVES: The olfactory bulb (OB) plays a pivotal role in the processing of olfactory information. The aim of this study was to investigate the OB volume changes and its possible associations with nasal septal deviation. STUDY DESIGN: Cross-sectional study. SETTING: Otolaryngology Department of Bozok University School of Medicine and Neurology Department of Yozgat State Hospital. SUBJECTS AND METHODS: Ninety patient's cranial magnetic resonance imaging (MRI) studies (46 males and 44 females, mean age 36 ±â€Š13.4 years; range 18-56 years) with isolated nasal septal deviations were recruited for the study. Olfactory bulb volumes in all study subjects were evaluated in T2-weighted coronal MRI images by planimetric manual contouring. RESULTS: Nasal septal deviation angles were found to range between 5° and 23.21° (mean 13.6°â€Š±â€Š3.58°). The right-sided deviations included 17 mild (<9°, Group I), 20 moderate (9°-15°, Group II), and 16 severe (15° and up, Group III) patients. The left-sided deviations included 14 mild (<9°, Group I), 13 moderate (9°-15°, Group II), and 10 severe (15° and up, Group III) subjects. Olfactory bulb volumes were calculated in both right- and left-sided deviation groups. In the patients with left-sided septal deviations of Groups I, II, and III, the left OB volumes of Groups I, II, and III were 46.49 ±â€Š3.87, 47.46 ±â€Š3.36, and 60.68 ±â€Š5.65 mm and the right OB volumes were 53.37 ±â€Š3.76, 56.47 ±â€Š4.43, and 76.69 ±â€Š6.84 mm, respectively. The statistical evaluation of the right OB volumes did not produce significant difference between Groups I and II (P = 0.73). The authors demonstrated statistically significant differences in comparison of Groups I to III and Groups II to III (P = 0.002 and P = 0.016, respectively). In the right septal deviation group for Groups I, II, and III, mean volumes of right OB volumes were 45.59 ±â€Š4.46, 48.63 ±â€Š3.78, and 61.35 ±â€Š5.84 mm, respectively, and the left OB volumes were 54.67 ±â€Š4.73, 57.65 ±â€Š4.53, and 75.84 ±â€Š7.67 mm, respectively. There was no statistically significant difference between Groups I and II (P = 0.95) left OB volumes in the right-sided deviation group, but statistically significant difference was demonstrated in Groups I to III and Groups II to III compartments (P = 0.002 and P = 0.003). CONCLUSION: In our study, while mild and moderate septal deviations lacked any significant affect on OB volumes, severe deviations were found to have significant impact on these parameter. Additionally the contralateral OB volumes in the severe septum deviation group were significantly bigger when compared to the ipsilateral OB volumes. Further multidisciplinary studies are required to evaluate the clinical significance of OB volume changes in diagnosis and follow-up of several otolaryngologic or nonotolaryngologic diseases.

Ischemia-modified albumin, brain natriuretic peptide, and growth differentiation factor-15 levels in patients with nasal polyps.

OBJECTIVE: Nasal polyps (NP) are a chronic inflammatory disease of the nasal mucosa; their etiology is suspected to involve oxidative stress. Growth differentiation factor-15 (GDF-15), brain natriuretic peptide (BNP), and ischemia-modified albumin (IMA) are biomarkers used especially in the early diagnosis and follow-up of cardiovascular diseases. The aim of this study was to assess levels of serum GDF-15, BNP, and IMA in patients with NP and to compare them with those of healthy subjects. METHODS: This was a prospective study enrolling 41 patients with NP and 48 healthy controls, all aged 18-65 years and referred to the Department of Otorhinolaryngology, Head and Neck Surgery, between January 2014 and February 2015. After a 12-h fast, venous blood (3mL) was drawn and centrifuged (3000rpm, 10min) to collect serum. Blood samples were drawn before endoscopic sinus surgery in the NP group. Serum GDF-15, BNP, and IMA levels were measured. RESULTS: GDF-15, BNP, and IMA levels of patients with NP were statistically significantly higher than in controls and GDF-15 values were higher than the normal upper limit. GDF-15, BNP, and IMA levels were significantly correlated in both groups. CONCLUSIONS: As GDF-15 is a marker of chronic inflammation and oxidative stress, our finding of increased serum GDF-15 in patients with NP supports the hypothesis that its pathogenesis involves chronic inflammation and oxidative stress.

The relation between childhood obesity and adenotonsillar hypertrophy.

Childhood obesity is a common and significant public health problem all over the world. As a well-known fact obese children have an increased risk of obesity-associated comorbidities, including obstructive sleep apnea, diabetes, and cardiovascular disorders at an earlier age compared to their normal weight peers. They also have an increased risk of poor self-esteem, greater body dissatisfaction, and increased peer teasing that lead to a lower health-related quality of life. While the presence of adenoid hypertrophy and increased rate of obstructive sleep apnea frequently co-exists in majority of cases. We have limited knowledge about the effect of adenotonsillar hypertrophy on development of childhood obesity. In this study, we aimed to investigate the association between obesity, presence of adenotonsillar hypertrophy and the quality of life parameters in obese children as measured by the OSA-18 quality of life questionnaire. Fifty obese children aged between 3 and 18 years and 50 age- and gender-matched otherwise children were enrolled to the study. All subjects were routinely examined by the otolaryngologist before enrollment. The size of adenoid hypertrophy was measured using lateral cephalometric radiographs. The tonsils were also graded using the schema recommended by Brodsky et al. We used OSA-18 questionnaires to evaluate the subjects' quality of life issues. We found, 34 % of obese group had tonsillar hypertrophy while the rate was 6 % in control group. Similarly 16 % of obese group had tonsillar hypertrophy compared to only 4 % in non-obese group. It was also noted that total OSA-18 scores of obese group were significantly higher than those of non-obese group. In subgroup analysis of obese group, total OSA-18 score of obese subjects with either adenoid and/or tonsillar hypertrophy was significantly higher than that of obese subjects without adenoid or tonsillar hypertrophy. As the related literature suggests that the impact of adenotonsillar size on OSA symptoms is prominent especially in children under 7 years of age, but its impact on the development of childhood obesity is still controversial. Our results revealed a possible relation between adenotonsillar hypertrophy and obesity rates. Further studies on larger populations should be planned to better define the real impact of adenotonsillar hypertrophy in obese children.

Transseptal Suturing Reduce Patient Anxiety after Septoplasty Compared to Nasal Packing.

BACKGROUND: We measured postoperative anxiety in patients who underwent transseptal suturing or nasal packing after septoplasty. MATERIALS AND METHODS: Transseptal suturing was performed on Group 1 patients and nasal splints with airway were placed after septoplasty in Group 2 patients. Postoperative 48-h anxiety levels of both groups were measured using the State-Trait Anxiety Inventory (STAI) clinical assessment scale, prior to removal of nasal packing in Group 2. RESULTS: Transseptal suturing was performed after septoplasty in 28 patients and nasal packing in 34 patients. The State-Trait Anxiety Inventory clinical assessment state (STAI-S) and trait (STAI-T) instruments were used to measure postoperative anxiety. The STAI-S scores were found 35.00 in the transseptal suturing group and 43.8 in the nasal packing group; the difference was found significant (p < 0.05). The STAI-T scores were found 42.6 in the transseptal suturing group and 45.7 in the nasal packing group; the difference was not found significant (p > 0.05). The rate of minor hemorrhage was found 10.7% in Group 1 patients. CONCLUSIONS: Transseptal suturing is simple and reliable when performed after septoplasty. The technique is painless and comfortable, and reduces patient anxiety (compared to that associated with nasal packing) with only a minor increase in operating time and hemorrhage.

Concha Bullosa Mucopyocele: a Case Report.

Concha bullosa (CB) is among the most common anatomic variations of sinonasal anatomy. Although usually asymptomatic, CB can occasionally cause nasal obstruction or headache. Obstructions within the mucociliary transport system can develop into a mucocele or mucopyocele. A 48-year-old female, with a history of progressive headache and nasal obstruction, was referred to our department. Paranasal sinus tomography revealed a nasal mass in the left nasal cavity resembling a mucopyocele in the middle turbinate. Under general anesthesia, the purulent material was aspirated, and the lateral part of the left turbinate was resected. Mucopyoceles are common within the paranasal sinuses, but uncommon with CB; thus, they should be considered in patients with a large hyperemic nasal mass.

The effects of regular hot black tea consumption on nasal carriage of methicillin-resistant Staphylococcus aureus.

OBJECTIVES: This study aims to evaluate the possible relationship between oral consumption of hot black tea and methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in a mid-sized town population in central Anatolia. PATIENTS AND METHODS: Nasal swabs were taken from a total of 109 subjects (53 females, 56 males; mean age 34.4 years; range 18 to 65 years) including 55 non-tea drinkers and 54 subjects consuming more than 10 cups of tea a day. The MRSA positivity in the nasal cultures was investigated. RESULTS: In the tea consumer group MRSA was cultured in 10 subjects. Twenty-one subjects' nasal cultures were positive for MRSA in the non-tea drinkers. We found a statistically significant difference in the nasal MRSA carriage among tea drinkers and non-tea drinkers. CONCLUSION: Our study findings indicate a lower incidence of nasal MRSA carriage in tea drinkers, suggesting that certain soluble tea compounds may exhibit some antibacterial properties when consumed orally.

Comparison of topical anesthetic effects of lidocaine, prilocaine, ropivacaine, and bupivacaine in transnasal fiberoptic nasopharyngolaryngoscopy.

BACKGROUND: This study was designed to investigate the topical anesthetic efficacy of four different solutions including lidocaine spray, bupivacaine, ropivacaine, and prilocaine used in patients undergoing transnasal fiberoptic nasopharyngolaryngoscopic examination (TFL). METHODS: The study included 200 patients who underwent anterior rhinoscopy and TFL examination as a part of routine otolaryngological evaluation in our outpatient clinics. Of these, 111 were female and 89 were male patients. The mean age of the patients was 32 ± 8 years (aged between 19 and 55 years). The patients were randomly divided into five groups. Five groups received one of the local anesthetics studied in our trial (10% lidocaine, 0.5% ropivacaine, 0.25% bupivacaine, 2% prilocaine, and saline solution) in each right side of the nose for 10 minutes before TFL. Each separate examination was performed on the right side of the nasal cavity. After the examination, the patients were asked to note the intensity of the pain that they have experienced during the TFL, by using a 100-mm visual analog scale (VAS). RESULTS: The mean VAS scores were 2.08 (SD, 0.62) in the lidocaine group, 2.21 (SD, 0.66) in the prilocaine group, 3.92 (SD, 0.58) in the ropivacaine group, 4.15 (SD, 0.64) in the bupivacaine group, and 6.35 (SD, 0.65) in the saline solution group. The lidocaine and prilocaine groups had significantly better VAS scores versus ropivacaine, bupivacaine, and saline solution groups (p < 0.05). CONCLUSION: To provide ideal examination comfort and optimum patient tolerability during TFL evaluation of upper respiratory airway topical lidocaine and prilocaine applications were found to be more efficacious and effective medication for anesthesia of the intranasal mucosa compared with bupivacaine and ropivacaine solutions.

A comparative study on the impact of intra-articular injections of hyaluronic acid, tenoxicam and betametazon on the relief of temporomandibular joint disorder complaints.

OBJECTIVE: The aim of this study was to compare the efficacy of intra-articular injections of three different agents with well known anti-inflammatory properties. MATERIALS AND METHOD: Between April 2010 and January 2013 a total of 100 patients who were diagnosed as temporomandibular joint disorder in the Department of Otolaryngology at Bozok University School of Medicine were prospectively studied. Patients with symptoms of jaw pain, limited or painful jaw movement, clicking or grating within the joint, were evaluated with temporomandibular CT to investigate the presence of cartilage or capsule degeneration. In the study group there were 55 female and 45 male patients who were non-responders to conventional anti-inflammatory treatment for TMJ complaints. The patients were randomly divided into four groups consisting of a control group and three different groups who underwent intra-articular injection of one given anti-inflammatory agent for each group. We injected saline solution to intra-articular space in the control group. Of three anti-inflammatory agents including hyaluronic acid (HA, Hyalgan intra-articular injection, Sodium hyaluronate 10 mg/ml, 2 ml injection syringe, Bilim Pharmaceutical Company, Istanbul, Turkey); betamethasone (CS, Diprospan flacon, 7.0 mg betamethasone/1 ml, Schering-Plough Pharmaceutical Company, Istanbul, Turkey) and; tenoxicam (TX, Tilcotil flacon, 20 mg tenoxicam/ml, Roche Pharmaceutical Company, Istanbul, Turkey) were administered intra-articularly under, ultrasonographic guidance. Following the completion of injections the, changes in subjective symptoms were compared with visual analogue scales, (VAS) scores at 1st and 6th weeks' follow-up visits between four groups. RESULTS: The HA group did significantly better pain relief scores compared to the, other groups at 1st and 6th weeks (p < 0.05). TX and CS groups' pain scores were better than control group values (p < 0.05, for both agents). The pain relief effect of TX was noted to decrease significantly between the 1st and 6th week (p < 0.05) (Fig. 1). We did not observe the same pattern in HA, CS and control (saline) groups between 1st and 6th week (p > 0.05). CONCLUSION: We found that HA produced better pain relief scores when compared to the other anti-inflammatory agents studied. The main disadvantage of HA is its relatively higher cost. Additionally it does not have a reimbursement status by state or private health insurance systems in Turkey. Despite the lower VAS scores, intra-articular TX and CS may be assessed as more economic alternatives to intra-articular HA injections.

The comparison of histological results of experimentally created facial nerve defects repaired by 2 different anastomosis techniques: classic suture technique or tissue adhesives for nerve anastomosis?

OBJECTIVE: The objective of this study was to compare the histological regeneration characteristics of nerve fibers at the anastomosis lines performed by classic suture technique or a tissue adhesive (N-butyl-2-cyanoacrylate). METHODS: The control group consisted of 7 rabbits. The 21 rabbits were randomly divided into 3 groups based on the harvesting week. In the study group following preparation of facial nerve bilaterally, a 0.5-cm segment of facial dorsal buccal nerve was resected, and the defect was repaired with a nerve graft, which was harvested from sural nerve of the same side by 8-0 nylon suture technique and by application of N-butyl-2-cyanoacrylate on the other side. RESULTS: Electron microscopic examination at consecutive second, fourth, and sixth days (corresponding to 4th, 8th, and 12th week in human subjects) revealed increased nerve degeneration findings in N-butyl-2-cyanoacrylate group when compared with microsuture repair technique. CONCLUSIONS: We conclude that N-butyl-2-cyanoacrylate is not an appropriate material for nerve anastomosis.

Is there a relationship between symptoms of patients and tomographic characteristics of styloid process?

OBJECTIVES: To investigate the angulations and length of the styloid process (SP) on three-dimensional computed tomography (3D-CT) images between the patients having elongated SP complaints and those without any stylalgia symptoms. PATIENTS AND METHODS: One hundred patients underwent 3D-CT evaluation of the bilateral temporomandibular joints to investigate for symptomatic elongated styloid process (ESP) at our institution. The differences between the mean angulations and lengths of the SP and comparisons between patient and control groups were analyzed by student t test. RESULTS: In study group, mean length of styloid processes was 40.7 ± 10.8 mm on the right and 40.3 ± 10.9 mm on the left. Mean medial angles of SP were measured as 22.60 ± 4.0 on the right side and 22.60 ± 4.5 on the left side. In the same group, mean anterior angles of SP were 16.10 ± 6.9 on the right and 16.70 ± 7.1 on the left side. The "in-group" comparisons of lengths, medial and anterior angles did not produce statistically significant results. The comparison of medial angulations between the symptomatic and asymptomatic patients was the only statistically meaningful result in our study. CONCLUSION: 3D-CT has several advantages according to conventional tomography for visualization of head and neck anatomy. The increase of medial angulation of SP may be responsible for the development of complaints in ESP.

Audiovestibular functions in noninsulin-dependent diabetes mellitus.

CONCLUSION: This study supports the proposition that vestibular dysfunction and sensorineural hearing loss (SNHL) may be considered among the complications due to noninsulin-dependent diabetes mellitus (NIDDM). OBJECTIVE: The aim of this study was to evaluate the audiovestibular functions in patients with NIDDM and to determine if there is any correlation between audiovestibular dysfunction and the duration of the disease. METHODS: A total of 104 patients diagnosed with NIDDM and 104 nondiabetic control subjects made up the study group. Diabetic patients were also divided into subgroups of ≤7 years and >7 years according to the duration of the disease. Pure-tone audiometry (PTA), speech recognition scores (SRS), impedance audiometry, and vestibular function tests (VFT) were performed for all of the patients. RESULTS: Hearing thresholds in all frequencies (except at 500 Hz for bone conduction) and SRS values were statistically significant in patients with NIDDM and control subjects, but there was no statistically significant difference according to the duration of the disease. Statistically significant alterations were present in VFT in patients with NIDDM compared with the control subjects. In the diabetic group, only failure in the saccade test was statistically significant according to the duration of the disease.

Comparison of ropivacaine, bupivacaine, prilocaine, and lidocaine in the management of pain and hemorrhage during nasal pack removal.

BACKGROUND: This study investigates the effects of local anesthetics application on pain and hemorrhage caused by nasal pack removal. METHODS: The study included 140 patients. Of these, 72 were women and 68 were men. The mean age and weight of the patients were 33.67 ± 10.2 years (range, 21-63 years) and 69.6 ± 13.6 kg. The patients were divided randomly into four groups. Three of the four groups received one of the local anesthetics studied in our trial (lidocaine + adrenaline, 0.25% bupivacaine, or 2% prilocaine) before removal of the nasal packing material and the control group received saline solution. Local anesthetics and 0.9% saline solution were applied to Merocel nasal packs 15 minutes before removal. Each patient was given a questionnaire where verbal analog score and amount of postoperative hemorrhage was noted. RESULTS: The mean pain score was 3.5 ± 1.2 (median, 4; range, 3-5) in the lidocaine group, 4.5 ± 1.2 (median, 4; range 3-5) in the prilocaine group, 4.7 ± 1.3 (median, 6; range, 3-5) in the bupivacaine group, and 6.35 ± 1.2 (median, 6; range, 5-7) in the saline group during nasal packing removal. The lidocaine group had significantly better pain scores versus other groups (p < 0.05). Bupivacaine and prilocaine had significantly better pain scores versus the control group, respectively. Analysis of bleeding scores after pack removal showed that all three study groups had significantly better bleeding scores versus the control saline group (p < 0.05). The lidocaine group had significantly less bleeding score than bupivacaine and prilocaine groups (p < 0.05). CONCLUSION: Topical lidocaine application before removal of nasal packs in patients who undergo nasal septal surgery can decrease discomfort and bleeding and improve patient tolerance.

The possible associations of septal deviation on mastoid pneumatization and chronic otitis.

OBJECTIVES: The purpose of this study was to determine the role of nasal septal deviation on volume of mastoid air cells and possible relationship to chronic otitis. MATERIALS AND METHODS: Between May 2010 and September 2012, paranasal sinus computed tomographic findings of 825 patients (470 male and 355 female subjects) who were treated in Ear Nose and Throat Department of Bozok University Medical Faculty were retrospectively analyzed. By excluding the other coexistent sinonasal pathologies, 100 patients (45 male and 55 female subjects; mean age, 37.7 ± 10.4 yr; range, 18-70 yr) with nasal septal deviations were recruited for the study. The convex side of the septal curvature was accepted as the direction of deviation. The findings were grouped according to the radiologically measured angle of nasal septal deviations. The deviation angle of the nasal septum was described as follows: mild (<9 degrees), moderate (9-15 degrees), or severe (≥ 15 degrees). The volume of each mastoid air cells was also calculated using the computer program. Chronic otitis was defined a abnormality criteria of the normal temporal scan. Criteria for a normal temporal bone were as follows: 1) absence of bony destruction or sclerosis; 2) absence of fluid or mass in any of the temporal bone air spaces; and 3) the presence of "normal" air cells. RESULTS: There were 45 male and 55 female subjects (mean age, 37.7 ± 10.4 yr; range, 18-70 yr). Nasal septal deviation angles were found to range between 5 and 28.1 degrees (mean, 14 ± 1.2 degrees). The left-sided deviations included 16 mild (<9 degrees, Group I), 15 moderate (9-15 degrees, Group II), and 17 severe (≥ 15 degrees, Group III) subjects. The right-sided deviations included 18 mild (<9 degrees, Group I), 16 moderate (9-15 degrees, Group II), and 18 severe (≥ 15 degrees, Group III) cases. We could not demonstrate a statistically significant difference between the right mastoid cell volumes of the Group I and Group II in left-sided deviation cases (p = 0.51). In the same side comparison of Group I to Group III and Group II to Group III, the mastoid cell volume differences were found to be significantly meaningful (p = 0.00 and p = 0.00, respectively). Identical results were yielded in the right-sided septal deviation group related to the mastoid cell volumes of Group I and Group II and Group I to Group III and Group II to Group III comparisons (p = 0.55, p = 0.00, and p = 0.011, respectively). In both right and left deviation groups, ipsilateral and contralateral mastoid cell volume comparisons produced statistically significant results (p = 0.04 and p = 0.003, respectively). The presence of chronic otitis findings were significantly increased in both groups (p = 0.00). Statistical significance was set at p < 0.05. CONCLUSION: Our findings suggest that mastoid cell volumes tend to be larger at the contralateral side of the severe septum deviations.

[Genetic basis of head and neck cancers and gene therapy]. / Bas ve boyun kanserlerinin genetik temeli ve gen tedavisi.

Surgery and combinations of traditional treatments are not successful enough particularly for advanced stage head and neck cancer. The major disadvantages of chemotherapy and radiation therapy are the lack of specificity for the target tissue and toxicity to the patient. As a result, gene therapy may offer a more specific approach. The aim of gene therapy is to present therapeutic genes into cancer cells which selectively eliminate malignant cells with no systemic toxicity to the patient. This article reviews the genetic basis of head and neck cancers and important concepts in cancer gene therapy: (i) inhibition of oncogenes; (ii) tumor suppressor gene replacement; (iii) regulation of immune response against malignant cells; (iv) genetic prodrug activation; and (v) antiangiogenic gene therapy. Currently, gene therapy is not sufficient to replace the traditional treatments of head and neck cancers, however there is no doubt that it will have an important role in the near future.