Turkish Guideline for Diagnosis and Treatment of Allergic Rhinitis (ART).

OBJECT: To prepare a national guideline for Otorhinolaryngologist who treat allergic rhinitis patients. METHODS: The study was conducted by three authors, namely the writing support team. The support team made the study plan, determined the writing instructions, chose the subgroups including the advisory committee, the advisors for authors and the authors. A workshop was organized at the very beginning to explain the details of the study to the team. Advisors took the chance to meet their coworkers in their subgroups and determined the main headings and subheadings of the guideline, together with the authors. After key words were determined by the authors, literature search was done in various databases. The authors keep in touch with the advisors and the advisors with the advisory committee and the support group at every stage of the study. National and International published articles as well as the abstracts of unpublished studies, imperatively presented in National Congresses, were included in this guideline. Only Guideline and meta-analyses published in last seven years (2013-2017) and randomized controlled studies published in last two years (2015-2017) were included. After all work was completed by the subgroups, support team brought all work together and edited the article. RESULTS: A detailed guideline about all aspects of allergic rhinitis was created. CONCLUSION: The authors believe that this guideline will enable a compact and up-to-date information on allergic rhinitis to healthcare professionals. This guideline is the first in the field of Otolaryngology in Turkey. It should be updated at regular intervals.

[Chronic pain in bone anchored hearing aids]. / Kemige implante isitme cihazlarinda kronik agri.

The complications of bone anchored hearing aids are very rare. The most seen postoperative complication is soft tissue reaction locally occuring around the titanium implant. Chronic headache is a rarely seen complication related to bone anchored hearing aids application. We presented a patient having complaints of chronic headache and burning sensation after bone anchored hearing aids application. Follow up for one year after the operation, despite the local and systemic therapies, there was no improvement of symptoms and the device was compulsorily removed. This rare complication of bone anchored hearing aids application is reviewied in the literature and probable reasons of failure are discussed.

Comparison of Inferior Turbinate and Uncinate Process Angulation with Normal Population in Patients with Septal Spur.

The presence of septal spur may cause various pathologies by affecting the development of the inferior turbinate, osteomeatal unit and uncinate process. We aimed to compare the changes of the angle with inferior turbinate and the maxillary medial wall of the uncinate process in patients with septal spur by normal population. In the study, 138 patients with septal spur and unilateral septum deviation and 83 patients without septum deviation were evaluated retrospectively. The angles of the inferior turbinate and the uncinate process with the medial wall of the maxilla were measured at the ostemaetal unit level. The changes of the inferior turbinate and the uncinate process with the maxilla medial wall compared to the opposite side of the deviated side and the normal population were compared. Angle of the inferior turbinate with the medial wall of the maxilla is significantly smaller in the side with septum deviation to the side without septum deviation and normal population and significantly large in the side without septum deviation to normal population. Angle of the uncinate process with the medial wall of the maxilla is significantly large in the side with septum deviation to the side without septum deviation and normal population and significantly smaller in the side without septum deviation to normal population. Presence of septum base crest are thought to cause structural changes at the inferior turbinate and the uncinate process. We recommend to break the inferior turbinate at the concave side in patients with basal crest.

Psychosocial effects of otoplasty in adult patients: a prospective cohort study.

OBJECTIVE: This prospective study investigated changes in psychosocial status following otoplasty. METHODS: All patients who participated in the study filled a sociodemographic form that included age, gender, educational status and job preoperatively. Body Image Scale (BIS), Social Appearance Anxiety Scale (SAAS) and Rosenberg Self-Esteem scale (RSES) were completed prior to surgery and 6 months postoperatively. RESULTS: A total of 20 patients completed psychometric measures of body image, social appearance anxiety, and self-esteem. Of the patients (6 males, 14 females) whose charts were reviewed, the mean age was 24.05 ± 8.25 years (median 22 years: range 18-49) years. Six months post operatively BIS total scores were increased significantly relative to that of the baseline values (p = 0.005).SAAS scores were decreased significantly relative to that of the baseline values (p = 0.003). Although the postoperative RSES score tended to improve, it was not significantly different from the baseline value. The RSES scores showed significantly strong correlation with the SAAS scores (p < 0.001) and moderate correlation with the BIS scores at baseline (p = 0.013). None of the patients admitted for surgery had low self-esteem at baseline, with all patients categorized as having either moderate (n = 10, 50%) or high (n = 10, 50%) self-esteem. Following surgery, only one patient improved from moderate to high self-esteem. The baseline and postoperative BIS, SAAS, and RSES scores did not significantly differ between women and men. None of the other sociodemographic characteristics showed significant relationships with the three scales. CONCLUSIONS: Otoplasty can provide significant positive psychosocial benefits, even in an adult population. Therefore, this type of surgery should be offered to any patient seeking a solution to prominent ear-related psychosocial problems regardless of age.

Nasal Septum and External Nasal Deformity Similarities in Monozygotic Twins and Paranasal Computed Tomography Analysis.

Since identical twins occur as a result of the division of one egg, they have the same genetic structure. Therefore, their phenotypes and sex are also always the same. However, due to the effect of environmental factors, some of the characteristics of twins living in different regions appear to develop differently. In our case of 17-year-old maternal twins, we emphasized that nasal pathologies carried a genetic background in terms of their similarity in septum deviation and external nasal deformity, which were determined to have occurred without a history of trauma. The article has also been presented at 10th Turkish Rhinology Congress, 22-25 May, 2014 Antalya, Turkey.

The role of upper airway morphology in apnea versus hypopnea predominant obstructive sleep apnea patients: an exploratory study.

OBJECTIVE: The objective of this study was to investigate the association between upper airway morphology and apnea vs hypopnea predominance in patients with obstructive sleep apnea (OSA) syndrome. METHODS: A retrospective study on consecutively CT scans obtained from 54 OSA patients and 53 non-snoring controls. CT scans were measured to evaluate upper airway and surrounding structures' morphologic characteristics. OSA patients (matched for age, gender and body mass index) compared as two groups; apneic group: apnea ratio >50% and hypopneic group: hypopnea ratio >50%. Morphologic characteristics were analyzed using Kruskal-Wallis test and Pearson's correlation test. RESULTS: Apneic group (17 patients) showed 76.56% apnea rate and hypopneic group (37 patients) showed 78.46% hypopnea rate. Minimal lateral and anteroposterior dimensions of velopharynx in the apneic group (0.86 ± 0.73 and 0.21 ± 0.13 cm, respectively) was statistically lesser from that of the hypopneic group (1.2 ± 0.42 and 0.54 ± 0.22 cm, respectively). Minimum cross-sectional area of the velopharynx was also lesser in apneic group (0.21 ± 0.16 cm2) than that in hypopneic group (0.65 ± 0.38 cm2). Almost all upper airway parameters in both apneic and hypopneic groups were tended to be smaller than in controls. CONCLUSION: Decrease in airway volume does not signify the type of respiratory event, but significant narrowing of velopharynx in both dimensions; thus having the narrowest value below a certain level causes more apnea. Advances in knowledge: We did not find a similar study when we did a literature search, showing the relationship of apnea vs hypopnea predominance and upper airway parameters in CT in patients with OSA.

Ginkgo biloba and Lycopene are Effective on Cisplatin Induced Ototoxicity?

OBJECTIVE: The purpose of this study was to examine the anti-ototoxic impact of Ginkgo biloba extract and lycopene on the model of cisplatin-induced ototoxicity in rats. MATERIALS AND METHODS: Thirty-two Wistar albino rats were examined with the distortion product otoacoustic emission (DPOAE) test (MADSEN Capella2 ; GN Otometrics, ICS Medical, Chicago USA), and they were randomly divided into four groups. Group 1 (n=8) was defined as the healthy control group. Cisplatin was given intraperitoneally as single dose of 12 mg/kg to group 2 (n=8), group 3 (n=8), and group 4 (n=8). Group 2 was determined as ototoxic control group. G. biloba extract (100 mg/kg) was given to group 3, and 20 mg/kg lycopene was given to group 4 with orogastric feeding tube daily for 10 days. DPOAE test was repeated on day 10 on all the groups. Finally, histopathological examination was performed. The study has been lead in agreement with the principles by the Institutional Animal Care and Use Committee Review Board at Kocaeli University Medical Center (KOÜ HADYEK- 1/9-14). The animals were treated in accordance with protocols approved by this committee. RESULTS: When DPOAE tests were compared, there was no significant difference in the four groups before the application (p > 0.05). At the end of day 10, in groups 2 to 4, statistically significant changes were observed (p < 0.05). According to the cisplatin group, a significant increase in the DP-grams on G. biloba and lycopene groups was observed (p < 00.5). Corti organ and spiral ganglion neurons of groups 1, 3, and 4 were observed to have weak expression. Strong reactions were determined in organum spirale and some spiral ganglions of the cisplatin group. The striae vascularis damage on group 2 was found to be more significant more compared with groups 3 and 4. CONCLUSION: There is a protective effect of G. biloba and lycopene on cisplatin-dependent ototoxic rat model.

An often neglected area in crooked nose: middle turbinate pneumatization / Uma área frequentemente negligenciada no nariz torto: pneumatização da concha média

Abstract Introduction: Crooked or deviated nose is a deviation of the nose from the straight vertical position of the face. Extensive pneumatization of the middle turbinate, also called concha bullosa or bullous middle turbinate (BMT) is known to be one of the possible etiologic factors in nasal obstruction, recurrent sinusitis, and headache. There is no study concerning a link between BMT and crooked nose. Objective: To investigate the association between crooked nose and the presence of a BMT. Methods: A total of 199 patients who underwent open septorhinoplasty were retrospectively analyzed. Preoperative paranasal Computerized Tomography (CT) findings, preoperative photodocumentation, and anterior rhinoscopic examination findings were documented. Of the 199 patients, 169 were found to meet the criteria and were included in the study. CT scans were examined to note the presence of BMT, inferior turbinate hypertrophy, and septum deviation (SD). SDs and crooked noses were classified. Results: Ninety-four of 169 patients (56%) presented a crooked nose deformity and seventy-five of 169 patients (44%) presented a straight nose. While 49 (52%) crooked nose patients had a bulbous and extensive BMT, 20 patients with straight nose (26.6%) had a BMT. A statistically significant relationship was found between the presence of crooked nose and BMT, regardless of the side of the disease (p = 0.011). Conclusion: This study revealed a link between crooked nose and BMT.

Resumo Introdução: O nariz torto ou o nariz com desvio é um nariz com um desvio da posição vertical reta da face. A pneumatização extensa da concha média, também chamada de concha bolhosa ou concha média bolhosa (CMB), é conhecida por ser um dos possíveis fatores etiológicos da obstrução nasal, sinusite recorrente e cefaleia. Não há estudo relativo a uma associação entre CMB e nariz torto. Objetivo: Investigar a associação entre o nariz torto e a presença de CMB. Método: Foram analisados retrospectivamente 199 pacientes que se submeteram a septorrinoplastia aberta. Achados pré-operatórios paranasais à tomografia computadorizada (TC), fotodocumentação pré-operatória e exame rinoscópico anterior foram registrados. Dos 199 pacientes, observou-se que 169 atendiam aos critérios e foram incluídos no estudo. As TC foram examinadas para observar a presença de CMB, hipertrofia de conchas inferiores e desvio de septo (DS). Os DS e narizes tortos foram então classificados. Resultados: Dos 169 pacientes, 94 (56%) apresentavam uma deformidade de nariz e 75 (44%) apresentavam nariz reto. Enquanto 49 (52%) pacientes com nariz torto tinham CMB extensa, 20 pacientes com nariz reto (26,6%) tinham CMB. Uma relação estatisticamente significativa foi encontrada entre a presença de nariz torto e CMB, independentemente do lado da doença (p = 0,011). Conclusão: Este estudo revelou uma relação entre o nariz torto e CMB.

Evaluation of effects of anterior palatoplasty operation on upper airway parameters in computed tomography in patients with pure snoring and obstructive sleep apnea syndrome.

AIM: To investigate changes in upper airway volume parameters measured by computerized tomography scans in patients with surgically treated by anterior palatoplasty of whom having pure snoring and mild-moderate obstructive sleep apnea. METHOD: A prospective study on consecutively anterior palatoplasty performed pure snoring and obstructive sleep apnea patients. Computerized tomography scans were obtained preoperatively and following anterior palatoplasty procedure to measure changes in upper airway volume. Patients underwent diagnostic drug induced sleep endoscopy to assess the site of obstruction. Preoperative and postoperative measurements were compared using student's t test and Chi-square test. RESULTS: Twenty-two patients (16 men and 6 women, age 48.22 ± 9.23, body mass index 25.85 ± 2.57) completed the trial. Anterior palatoplasty was associated with an increase in total upper airway volume from 4.81 ± 1.73 cm3 before treatment to 6.57 ± 2.03 cm3 after treatment (p < 0.005). Change in soft palate thickness did not vary significantly (p < 0.039). The mean soft palate length has changed from 4.13 ± 0.41 to 3.93 ± 0.51 cm (p < 0.001). The preoperative and postoperative measurements of cross-sectional areas and volumes all showed significant difference except velopharynx minimal lateral airway dimension. The operational procedure increased the total upper airway volume much more in men than in women (p < 0.05). CONCLUSION: Results of this study indicate that anterior palatoplasty operation appears to produce significant increase in upper airway volume and cross sectional area. It does not seem to have an effect on lateral airway dimension. Computerized tomography is a quick and noninvasive imaging technique that allows for quantitative assessment of the velopharyngeal patency changes.

An often neglected area in crooked nose: middle turbinate pneumatization.

INTRODUCTION: Crooked or deviated nose is a deviation of the nose from the straight vertical position of the face. Extensive pneumatization of the middle turbinate, also called concha bullosa or bullous middle turbinate (BMT) is known to be one of the possible etiologic factors in nasal obstruction, recurrent sinusitis, and headache. There is no study concerning a link between BMT and crooked nose. OBJECTIVE: To investigate the association between crooked nose and the presence of a BMT. METHODS: A total of 199 patients who underwent open septorhinoplasty were retrospectively analyzed. Preoperative paranasal Computerized Tomography (CT) findings, preoperative photodocumentation, and anterior rhinoscopic examination findings were documented. Of the 199 patients, 169 were found to meet the criteria and were included in the study. CT scans were examined to note the presence of BMT, inferior turbinate hypertrophy, and septum deviation (SD). SDs and crooked noses were classified. RESULTS: Ninety-four of 169 patients (56%) presented a crooked nose deformity and seventy-five of 169 patients (44%) presented a straight nose. While 49 (52%) crooked nose patients had a bulbous and extensive BMT, 20 patients with straight nose (26.6%) had a BMT. A statistically significant relationship was found between the presence of crooked nose and BMT, regardless of the side of the disease (p=0.011). CONCLUSION: This study revealed a link between crooked nose and BMT.

Optimal time for intranasal splint removal after septoplasty: a prospective clinical study.

To investigate the effect of intranasal splint removal time on patient comfort and possible complications after septoplasty. One hundred and nine patients who had septoplasty operations were included in this study. The patients were divided into three groups. In the 1st group (n = 36), splints were removed on the 3rd day after septoplasty; in the 2nd group (n = 36), splints were removed on the 5th day; and in the 3rd group (n = 37), splints were removed on the 7th day. Pain and nasal fullness were evaluated with visual analog scale. Synechia, perforation, hematoma, infection and hemorrhage were recorded after the removal of the splints (postoperative 1, 8 and 24 weeks). For the 1st, 2nd, and 3rd groups, respectively, pain score was 1.96, 2.67, and 2.67; and nasal fullness score was 6.23, 6.04, and 5.48. Nasal synechia was detected in two patients in the 1st group and in one patient in the 2nd group. Early hemorrhage was detected in two patients in the 1st group and one patient in the 3rd group. Infection, septal perforation and hematoma were detected in three patients in the 1st group. There was no difference in hemorrhage, hematoma, synechia and perforation rates between the three groups. There are various opinions in the literature about the ideal removal time of intranasal tampons after septoplasty, but there is no consensus on this topic. Our study shows that removal time of intranasal splints has no effect on patient comfort or possible complications.

Effect of transtympanic betamethasone delivery to the inner ear.

To investigate the effect of transtympanic betamethasone administration on hearing function with histologic correlation, rats were divided into three transtympanic treatment groups: isotonic saline (group I, n = 10), gentamicin (group II, n = 10) and betamethasone (group III, n = 10). Distortion product otoacoustic emission thresholds were compared on day 10. Also histological effects on cellular apoptosis in both the inner and outer hair cells in organ of Corti and spiral ganglion neurons were evaluated. Distortion product otoacoustic emission thresholds were comparable (p > 0.05) between group I and group III in all measurements. Distortion product otoacoustic emission thresholds of group II were significantly elevated in all measurements when compared with group I (p < 0.05) and group III (p < 0.05). In the Terminal deoxynucleotidyl transferase dUTP Nick End Labelling (TUNEL), Caspase-3, Caspase-8 and Caspase-9 staining method the amount of apoptotic cells in group II were significantly elevated in all measurements compared with group I (p < 0.05). In the TUNEL staining method the amount of apoptotic cells in Group III were significantly elevated compared with group I in both the organ of Corti and spiral ganglion neurons (p < 0.05). The overall histological results revealed that the severity of cellular apoptosis caused by betamethasone was somewhere between isotonic saline and gentamicin. Transtympanic betamethasone does not affect inner ear function as measured by distortion product otoacoustic emission responses, but some increase in cellular apoptosis in the organ of Corti and spiral ganglion neurons was observed. These findings suggest that transtympanic betamethasone may have mild ototoxic effects. Further studies are needed to obtain precise results for transtympanic application of betamethasone.

[Mean platelet volume play a role in disease severity in patients with obstructive sleep apnea syndrome?]. / Tikayici uyku apne sendromunda ortalama trombosit hacminin hastalik siddetinde rolü var midir?

OBJECTIVES: This study aims to show the effects of nasal continuous positive airway pressure (CPAP) treatment on platelet activation in patients with severe obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: Forty-six patients (29 males, 17 females; mean age 48.2±7.6 years; range 40 to 56 years) with severe OSAS with apnea/hypopnea index (AHI) ≥30 were included in this study. Complete blood counts were analyzed and mean platelet volume (MPV) values were compared in patients before and after CPAP treatment at six months. RESULTS: The mean MPV values before CPAP were 8.9±1.3 (p<0.001), while the mean values were 7.7±1.1 (p<0.001) at six months after CPAP treatment in patients with severe OSAS. There was a statistically significant decrease in the MPV values after CPAP treatment. Patients' number of platelets which was measured six months after the CPAP treatment increased at a significant level compared to baseline (p<0.001). CONCLUSION: Continuous positive airway pressure treatment caused a significant decrease in the MPV values in patients with severe OSAS. As a negative acute phase reactant, MPV can be used as a marker to exert the cardioprotective effect of CPAP.

The association between septal deviation and the presence of a maxillary accessory ostium.

BACKGROUND: The etiology and the effects of the maxillary accessory ostium (MAO) are not well understood. The aim of this study is to investigate the association between septal deviation (SD) and the presence of an MAO. METHODS: Paranasal computed tomography (CT) scans of 1104 adult patients were studied retrospectively. Patients with chronic sinusitis, acute sinusitis, nasal polyposis, allergic rhinitis, paranasal sinus tumors, septal perforation, and unilateral or bilateral maxillary sinus hypoplasia/aplasia, as well as patients who had previously had nasal surgery or a history of nasal trauma, were not included in the study. Eight-hundred and seven patients were found to meet the criteria and were included in the study. CT scans were examined to note the presence of SD and MAO and the side of both diseases. RESULTS: A total of 807 patients were evaluated. SD and MAO were detected in 572 (70.9%) and 299 (37.1%) patients, respectively. A statistically significant relationship was found between the presence of SD and MAO, regardless of side of the disease (p = 0.002). The side of MAO showed a significant correlation with the direction of SD (p < 0.001). CONCLUSION: Our results revealed a link between SD and MAO. This relationship was correlated with the side of occurrence of the disease.

Evaluation of hearing and cochlear function by audiometric testing in patients with hyperemesis gravidarum.

INTRODUCTION: The aim of this study was to investigate cochlear functions in patients with hyperemesis gravidarum (HG). METHODS: Twenty-nine HG patients (58 ears) and 31 healthy control subjects (62 ears) were included. Audiometry testings at 250 and 500 Hz and 1, 2, 4, 8, 10, 12, 14, 16 kHz were performed to the patients and controls. RESULTS: Mean age of patients with HG was 26,5 ± 4,4 years and the mean age of control group was 28,0 ± 4,2 years. At the time of the tests mean gestational age of the HG group and controls were 9 and 11 weeks respectively. No differences were observed between the groups in tympanic membrane status, or other otolaringological evaluations. No significant differences were observed in audiometric tests at any frequencies between the groups (p values for all > 0.05). CONCLUSION: There was not a difference between pregnant cases with HG and cases with normal pregnancy in terms of audimetric tests. Cochlear functions are not affected remarkably in women with HG.

Hearing loss: an unknown complication of pre-eclampsia?

AIM: The aim of this study was to determine whether pre-eclampsia is a risk factor for cochlear damage and sensorineural hearing impairment. MATERIAL AND METHODS: This prospective case-control study consisted of 33 patients with pre-eclampsia and 32 normotensive pregnant patients as controls. All of the subjects underwent otoscopic examinations - pure tone audiometry (0.25-16 kHz) and transient evoked otoacoustic emission (1-4 kHz) tests - during their third trimester of pregnancy. RESULTS: The mean ages of the patients with pre-eclampsia and the control subjects were 29.6 ± 5.7 and 28.6 ± 5.3 years, respectively. The baseline demographic characteristics, including age, gravidity, parity number, and gestational week, were similar between the two patient groups. Hearing thresholds in the right ear at 1, 4, 8, and 10 kHz and in the left ear at 8 and 10 kHz were significantly higher in the patients with pre-eclampsia compared to the control subjects. The degree of systolic blood pressure measured at the time of diagnosis had a deteriorating effect on hearing at 8, 10, and 12 kHz in the right ear and at 10 kHz in the left ear. CONCLUSIONS: Pre-eclampsia is a potential risk factor for cochlear damage and sensorineural hearing loss. Further studies that include routine audiological examinations are needed in these patients.