Current Inflammatory Status of Monocyte Ratios in Bell's Palsy.

OBJECTIVE: This study aims to investigate the contribution of monocyte/high-density lipoprotein (HDL) ratio (MHR) and monocyte/lymphocyte ratio (MLR) to the inflammatory process and the severity and prognosis of the disease in patients with Bell's palsy. MATERIALS AND METHODS: The study was designed retrospectively by analyzing our electronic database. A study group consisted of 48 patients who were referred to our clinic with Bell's palsy between January 2018 and June 2020. The control group consisted of 45 healthy individuals. Monocyte, HDL, neutrophil, lymphocyte, and platelet values were recorded. The hematological parameters obtained from the blood tests of the patients in the study group at the time of admission were statistically compared with the values in the control group. Radiologic images were also collected. RESULTS: The MHR value of the study group was 12.85±1.02, while the MHR value of the control group was 12.29±1.33, and it showed a statistically significant difference (p=0.027). However, no statistically significant difference between the groups was found in other parameters, including MLR, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR). A positive correlation was found between the MHR value and the House-Brackmann stage. The NLR value of the patients who showed contrast enhancement in facial nerves on MRI was found to be statistically significant compared to those without contrast enhancement. CONCLUSION: High MHR values in patients with Bell's palsy support the role of inflammatory and ischemic processes in etiopathogenesis. Further studies are needed to confirm our results in a multi-center manner with larger patient populations.

Debulking obstructing laryngeal cancers to avoid tracheotomy / Redução de volume tumoral em câncer obstrutivo de laringe para evitar traqueotomia

Abstract Introduction: Upper airway obstruction, secondary to neoplasms presenting with stridor, is traditionally treated by tracheostomy. However, this common procedure can potentially have an impact on the long-term outcome, with tumor implantation into the tracheostomized wound leading to peristomal recurrence after laryngectomy, with the risk of stomal recurrence. Objective: To describe our clinical experience with tumor debulking as an alternative treatment choice of tracheotomy in patients with advanced larynx cancer at a tertiary referral center. Methods: A retrospective chart review of 87 subjects who had advanced larynx cancer (T3/4) with airway obstruction from our institutional database was conducted. Medical records including demographics, daily notes during hospitalization, and operative notes were used for clinical data of patients. The strategy for maintaining the airway patency was tracheotomy (emergency or awake) and tumor debulking (laser or coblation). Endophytic and exophytic laryngeal tumors were also noted. Results: In 41/87 (47.1%) patients, a tracheotomy was performed as an initial treatment (11 were emergency, 30 were planned) to maintain airway patency. Tumor debulking was performed in 28 exophytic and 18 endophytic lesions by laser or coblation (17 and 29 patients, respectively). Tracheotomy was performed in 5 patients (4 endophytic, 1 exophytic) who could not tolerate debulking surgery due to aspiration, edema and dyspnea. Three of the them who required subsequent tracheotomy was in the laser group and two in the coblation group. The success rate of laser debulking was 82.35% (14/17) and 93.1% (27/29) for coblation. Conclusion: Tumor debulking is a safe and effective method to avoid awake tracheotomy in patients suffering from airway obstruction due to advanced larynx cancer.

Resumo Introdução: A obstrução das vias aéreas superiores com estridor, secundária a neoplasias, é tradicionalmente tratada com traqueotomia. No entanto, este procedimento comum pode potencialmente ter um impacto sobre o desfecho a longo prazo, com a implantação do tumor na ferida cirúrgica da traqueotomia, o que leva à recorrência peristomal após laringectomia, com o risco de recorrência do estoma. Objetivo: Descrever nossa experiência clínica com a redução do volume tumoral como tratamento alternativo à traqueotomia em pacientes com câncer avançado de laringe em um centro de referência terciário. Método: Foi realizada uma revisão retrospectiva de prontuários de 87 indivíduos com câncer avançado de laringe (T3/T4) com obstrução das vias aéreas em nosso banco de dados institucional. Registros médicos incluindo dados demográficos, anotações diárias durante a hospitalização e anotações operacionais foram utilizados como dados clínicos dos pacientes. A estratégia para manter a patência das vias aéreas foi a traqueotomia (emergência ou em pacientes acordados) e redução do volume tumoral (por laser ou coblation). Tumores endofíticos e exofíticos da laringe também foram anotados. Resultados: Uma traqueotomia foi realizada como tratamento inicial em 41/87 (47,1%) pacientes (11 foram de emergência, 30 foram eletivas) para manter a patência das vias aéreas. A redução do volume tumoral foi realizada em 28 lesões exofíticas e 18 endofíticas por laser ou coblation (17 e 29 pacientes, respectivamente). A traqueotomia foi realizada em 5 pacientes (4 endofíticos, 1 exofítico) que não podiam tolerar a cirurgia de redução de volume devido à aspiração, edema e dispneia. Três deles que necessitaram de uma traqueotomia subsequente estavam no grupo de laser e dois no grupo coblation. A taxa de sucesso da redução tumoral foi de 82,35% (14/17) para o laser e 93,1% (27/29) para coblation. Conclusão: A redução do volume tumoral é um método seguro e eficaz para evitar a traqueotomia com paciente acordado, nos casos de obstrução das vias aéreas devido ao câncer de laringe avançado.

Consequences of FFP3 mask usage on venous blood gases.

OBJECTIVES/HYPOTHESIS: To investigate the effect of FFP3 mask usage on venous blood gases (VBG) and some subjective symptoms METHODS: VBG analyses and subjective symptom questionary were obtained from 15 healthcare proffesionals before and after 4-h FFP3 mask usage. RESULTS: Wearing an FFP3 mask for 4 hours did not change any venous blood gas parameters between pre- and post-values, statistically. According to an 8-symptom questionary, only nausea did not show any significance. Headache, lightheadedness, visual difficulties, shortness of breath, palpitation, confusion, and difficult communication showed statistically significant difference between pre and post values. CONCLUSION: Four-hour use of FFP3 mask did not cause any significant VBG change. Although the participants complained about some subjective symptoms, this study indicated that long-term use of FFP3 mask did not cause any significant discomforts, and it was well tolerated.

Debulking obstructing laryngeal cancers to avoid tracheotomy.

INTRODUCTION: Upper airway obstruction, secondary to neoplasms presenting with stridor, is traditionally treated by tracheostomy. However, this common procedure can potentially have an impact on the long-term outcome, with tumor implantation into the tracheostomized wound leading to peristomal recurrence after laryngectomy, with the risk of stomal recurrence. OBJECTIVE: To describe our clinical experience with tumor debulking as an alternative treatment choice of tracheotomy in patients with advanced larynx cancer at a tertiary referral center. METHODS: A retrospective chart review of 87 subjects who had advanced larynx cancer (T3/4) with airway obstruction from our institutional database was conducted. Medical records including demographics, daily notes during hospitalization, and operative notes were used for clinical data of patients. The strategy for maintaining the airway patency was tracheotomy (emergency or awake) and tumor debulking (laser or coblation). Endophytic and exophytic laryngeal tumors were also noted. RESULTS: In 41/87 (47.1%) patients, a tracheotomy was performed as an initial treatment (11 were emergency, 30 were planned) to maintain airway patency. Tumor debulking was performed in 28 exophytic and 18 endophytic lesions by laser or coblation (17 and 29 patients, respectively). Tracheotomy was performed in 5 patients (4 endophytic, 1 exophytic) who could not tolerate debulking surgery due to aspiration, edema and dyspnea. Three of the them who required subsequent tracheotomy was in the laser group and two in the coblation group. The success rate of laser debulking was 82.35% (14/17) and 93.1% (27/29) for coblation. CONCLUSION: Tumor debulking is a safe and effective method to avoid awake tracheotomy in patients suffering from airway obstruction due to advanced larynx cancer.

Thiol-disulfide as a novel indicator of obstructive sleep apnea.

INTRODUCTION: Obstructive sleep apnea (OSA) is an oxidative stress disease, which has been considered to be a notable risk and associated with increased cardiovascular morbidity and mortality. Thiol-disulfide homeostasis is as a novel indicator of oxidative stress. OBJECTIVES: We aimed to evaluate thiol-disulfide homeostasis in a large patient population with OSA. METHODS: A total of 230 with OSA and 40 healthy controls were included in the study. Inclusion criteria for OSA patients are having apnoea-hypopnoea index of ≥5/hour, being more than 18 years of age and having no previous treatment for OSA. Thiol-disulfide analysis was done for the patients and control group. Blood thiol-disulfide homeostasis was analysed using the new automatic method, developed by Erel and Neselioglu. RESULTS: Among all OSA subjects, 149 (64.8%) were males and the mean ages of the patients were 53.38 ± 10.22. Total thiol, native thiol (SH) and disulfide (SS) levels were significantly lower in OSA group compared to the control group (P < .001, P < .001 and P = .039 respectively). Also, total thiol and native thiol (SH) were significantly different between the groups according to OSA severity (mild-moderate to severe OSA) (P < .001 and P < .001 respectively). Thiol-disulfide redox parameters were correlated with apnoea-hypopnoea index (AHI) scores. CONCLUSION: The present prospective study showed that thiol/disulfide homeostasis was unbalanced in OSA patients. Especially, in OSA patients have low level of thiol/disulfide redox parameters when compared to healthy subjects. Evaluating thiol-disulfide homeostasis in OSA may be a contributing aspect to assessment and monitoring of the patient.

Association of sleep time in supine position with apnea-hypopnea index as evidenced by successive polysomnography.

PURPOSE: The purpose of this study is to evaluate the impact of body position during sleep on apnea-hypopnea index (AHI) and night-to-night variability in polysomnography (PSG) parameters. METHODS: Totally, 30 patients with obstructive sleep apnea syndrome (OSAS) were assessed prospectively with successive PSGs performed. The patients were categorized as increased (group A), decreased (group B), and unchanged (group C) AHI between the first and second PSG evaluations performed at least 1-week interval. RESULTS: The mean AHI values were significantly higher in the second night (p = 0.02). A change in AHI was found in almost 85 % of the patients between two successive measurements. According to multivariate and correlation analyses and differences in total AHI in supine position (r = 0.897), it was found that the influence of the supine position was the primary factor contributing to the night-to-night variability. Supine AHI, non-supine AHI, and non-supine time findings did not add any significance on total AHI. CONCLUSIONS: The variability observed in the AHI seems related to amount of sleeping time spent in supine position, suggesting that mean AHI alone is not that reliable in the accurate diagnosis of OSAS severity. A thorough evaluation of AHI in supine and non-supine positions is needed in order to understand better the severity of OSAS.

A comprehensive study of oxidative stress in sudden hearing loss.

Little is known about the association between idiopathic sudden sensorineural hearing loss (ISSNHL) and oxidative stress. We investigated changes in a wide range of oxidants and antioxidants to create a comprehensive picture of oxidative imbalance. In the peripheral blood of 50 ISSNHL patients and 50 healthy subjects, total oxidant status (TOS), total antioxidant status (TAS), paraoxonase (PON), thiol/disulphide levels were measured. Moreover, a global oxidative stress index, reflecting both oxidative and antioxidant counterparts, was also calculated. One-way analysis between oxidative markers and severity of hearing loss were evaluated. The ISSNHL patients showed significantly higher TOS levels than controls (6.02 ± 3.17 vs. 4.5 ± 2.22; p = 0.018). The oxidative index was also significantly higher in patients than controls (0.39 ± 0.19 vs. 0.3 ± 0.14; p = 0.035). TAS, PON, native thiol, and total thiol were not altered. There was no statistical significance between oxidative markers and severity of hearing loss. The binary logistic regression model revealed that disulphide and TOS were associated with ISSNHL. There are alterations in a wide array of oxidants and antioxidants, with balance shifting toward increased oxidative stress in ISSNHL. Our findings may suggest endothelial dysfunction in ISSNHL etiopathogenesis.

Pathologic Evaluation of Routine Nasopharynx Punch Biopsy in the Adult Population: Is It Really Necessary?

OBJECTIVES: To retrospectively evaluate the patients who underwent nasopharyngeal biopsy with imaging and biopsy results, who have or don't have symptoms for nasopharyngeal pathology and to determine the ratio of the nasopharyngeal cancer cases and other pathologic conditions. METHODS: In this retrospective study, 983 patients who underwent endoscopic nasopharyngeal biopsy for symptomatic nasopharyngeal lesions were included. All pathological results, benign or malign was recorded and classified due to the patients' presenting symptoms such as symptomatic for nasopharyngeal pathology or asymptomatic. Computed tomography (CT) or magnetic resonance imaging (MRI) reports were also recorded separately as group A for malignancy or group B for not malignancy. RESULTS: Forty-five (4.6%) of 983 biopsies were malignant. In this group, there is no statistically significant difference between symptomatic and asymptomatic group. For malignant pathologies, the sensitivity of MRI was found 88.2% and CT was 61.5%. CONCLUSION: For early diagnosis of nasopharyngeal cancer, all patients admitted to Ear, Nose and Throat (ENT) referral clinics should be examined endoscopically irrespective of their complaints and suspicious cases should be investigated by imaging especially by MRI. If MRI report clearly indicates Thornwaldt cyst or reactive lymphoid hyperplasia and this result is compatible with endoscopic findings, biopsy may not be necessary. Apart from these cases, all suspected lesions should be biopsied.

A novel method for evaluation of oxidative stress in children with OSA.

OBJECTIVES: To evaluate the role of adenotonsillar hypertrophy and the outcomes of adenotonsillectomy (AT) on oxidative stress for obstructive sleep apnea (OSA) in children using a new method; thiol/disulfide homeostasis. METHODS: The study is consisted of 45 children with OSA and 38 healthy control subjects with similar age and sex. Children 3-12 years of age with OSA, defined as having an apnea/hypopnea index (AHI) of 5 or more in an overnight polysomnography, underwent adenotonsillectomy. OSA was classified as mild (1 ≤ AHI<10), moderate (10 ≤ AHI<20) or severe (AHI≥20). Venous blood samples were taken preoperatively and one month after surgery. The blood levels of thiol/disulfide homeostasis were assessed and compared between patients and control group, before and after adenotonsillectomy. RESULTS: Body mass index (BMI), mean age and gender distribution were similar between the study and control groups. Statistically significant higher disulfide levels and ratios were found in the study group compared to the control group; in patients with moderate to severe OSA compared to mild OSA; in the preoperative period compared to postoperative period (p < 0.001, for all). CONCLUSIONS: The current study provides preliminary evidence between oxidative stress and OSA in children with adenotonsillar. Adenotonsillectomy for OSA may result in a dramatic improvement in oxidative stress as measured by thiol/disulfide homeostasis.

Intrapolyp steroid injection for nasal polyposis: Randomized trial of safety and efficacy.

OBJECTIVES/HYPOTHESIS: Local and systemic steroid treatment is the mainstay of therapy for nasal polyposis. This study aims to evaluate the safety and effectiveness of intrapolyp steroid injection on nasal polyposis and to compare the outcomes with short-term oral steroid treatment. STUDY DESIGN: Prospective, randomized, controlled endoscopic clinical trial. METHODS: Ninety patients with nasal polyps were randomly assigned in a 1:1 ratio to receive oral prednisolone 1 mg/kg/day, tapering by 5 mg/day, for 2 weeks, or to receive intrapolyp steroid injection (40 mg/mL triamcinolone, 1 mL) for up to five times with intervals of 1 week. Both groups received fluticasone propionate nasal drops twice daily for 12 weeks after initial treatment. Total nasal symptoms scores and total nasal polyp scores of both groups were evaluated before and 3 and 6 months after treatment, whereas computed tomography (CT) scores were evaluated before and 6 months after treatment. Also, plasma cortisol and adrenocorticotropic hormone (ACTH) levels of the patients in the intrapolyp steroid injection group were evaluated before, during, and after treatment. RESULTS: A total of 211 injections were given to 45 patients, and no serious complications were observed. Both groups showed significant decrease in symptom score, polyp score, and CT score (P > 0.001), with no significant difference between groups (P > 0.05). Plasma cortisol and ACTH levels of the injected patients were in normal limits before treatment, 1 week after the first injection, and 1 week after the last injection. CONCLUSION: Intrapolyp steroid injection appears to be an effective and safe method for treatment of nasal polyps, with comparable results to oral short-term steroid treatment. LEVEL OF EVIDENCE: 1b. Laryngoscope, 126:1730-1735, 2016.

Oral Flurbiprofen Spray for Posttonsillectomy Pain.

OBJECTIVE: Tonsillectomy is still one of the most common surgical procedures, but there exists no standard guideline for pain management after tonsillectomy. Our aim is to determine whether oral spray of flurbiprofen reduces pain and has an influence on other morbid outcomes following tonsillectomy. STUDY DESIGN: Prospective, double-blind, randomized, placebo controlled. SETTING: Patients at Ataturk Training and Research Hospital, Ankara, Turkey. SUBJECTS AND METHODS: This study was performed on 84 patients (45 in flurbiprofen group, 39 in placebo group) who underwent tonsillectomy. The patients were randomly chosen, and each used oral spray of flurbiprofen 3 times daily or placebo solution at the same regimen. Efficacy was assessed by changes in Numeric Pain Rating Scale. Data were collected at postoperative days 1, 3, 5, and 7 for pain, bleeding, and healing. Data for Mallampati scores were also collected. RESULTS: There were no significant difference between groups with respect to the demographic data. The flurbiprofen group had statistically significant lower pain scores at days 1, 3, 5, and 7 (P = .000, P = .002, P = .001, P = .000, respectively). On days 3 and 7, pain scores were significantly different between different Mallampati groups (P = .049, P = .015, respectively). The flurbiprofen group required less analgesic than the placebo group during the study period on days 1, 3, 5, and 7 (P = .001, P = .001, P = .03, P = .001, respectively). Healing and side effects were not significantly different between the groups. CONCLUSION: In this study, topical use of flurbiprofen may reduce posttonsillectomy pain without any evidence of additional complications.

Unilateral sudden hearing loss: a rare symptom of Moyamoya disease.

A 38-year-old female patient experienced a sudden onset of unilateral sensorineural hearing loss due to Moyamoya disease. A detailed summary of audiological and neurological findings indicated that the sudden hearing loss might be due to Moyamoya disease resulting in occlusion of posterior and middle cerebral arteries. Intravenous prednisolone and trimetazidine dihydrochloride may improve hearing thresholds and speech understanding. To our knowledge, this is the first article in the literature reporting a case of sudden hearing loss as the first manifestation of Moyamoya disease in a young adult.

Consumer acoustic reflectometry: accuracy in diagnosis of otitis media with effusion in children.

OBJECTIVE: Acoustic reflectometry is a technique based on a sonar that enables the diagnosis of middle ear effusion. We aimed to evaluate the accuracy and diagnostic value of consumer type acoustic reflectometry device for determining middle ear effusion in children. METHODS: Acoustic reflectometry and tympanometries of 84 children, from 3 to 14 years of age, were done the day before they underwent adenoidectomy/adenotonsillectomy and myringotomy ± ventilation tube insertion under general anesthesia in the operating room with diagnosis of middle ear effusion. Their test results and the results of myringotomies, which is the golden standard technique in determination of otitis media with effusion, were compared. Specificity, sensitivity, positive and negative predictive values of both instruments in detecting middle ear fluid were determined. RESULTS: Otitis media with effusion was detected in 106 ears (63.1%) during myringotomy. The sensitivity and specificities of acoustic reflectometry were found to be 83.33% and 68.18%, and tympanometry were 84.48% and 84.62%, respectively. The positive predictive value was 75.12% for acoustic reflectometry and 88.56% for tympanometry, and negative predictive values of acoustic reflectometry and tympanometry were 87.66% and 89.2%, respectively. The sensitivity of the AR was comparable to tympanometry (p > 0.01), however the specificity, PPV and NPV of AR were lower than tympanometry (p < 0.001). CONCLUSIONS: Consumer type acoustic reflectometry is highly sensitive, objective and easy to perform technique for detecting otitis media with effusion, and it may help us to diagnose otitis media with effusion in early stages if used by family practitioners or parents.

Temporal bone fractures: evaluation of 77 patients and a management algorithm.

BACKGROUND: We aimed to evaluate the etiologies, otolaryngological features, radiological findings, management strategies, and outcomes of temporal bone fractures. METHODS: Seventy-seven temporal bone fracture cases were retrospectively evaluated for age and gender distribution, side of the fracture, etiology of injuries, the presence of blood otorrhea, tympanic membrane perforation, cerebrospinal fluid otorrhea, hearing loss, hemotympanum, and facial or other cranial nerve palsies, and computerized tomography reports. RESULTS: Nearly 55% of the cases were caused by traffic accidents and were predominantly male (76.6%). Otolaryngological presentations in order to frequency were early conductive hearing loss (65.8%), blood otorrhea (61.2%), hemotympanum (58.5%), tympanic membrane perforation (25.6%), facial nerve paralysis (12.3%), cerebrospinal fluid otorrhea (8.5%), and sensorineural hearing loss (5.4%). Most of the fractures were petrous (65.8%) and longitudinal type (51.2%). CONCLUSION: In this research, otolaryngological findings in order of frequency and treatment approaches were compared with literature findings and discussed in 77 temporal bone fracture cases. We formed a management algorithm for the systematic evaluation and treatment of temporal fractures.

Treatment of Pott's Puffy tumor with balloon sinuplasty: report of three cases.

Pott's Puffy tumor (PPT) is a rare entity characterized by subperiosteal abscess associated with osteomyelitis of the frontal bone. It is usually managed by surgical curettage of the osteomyelitic bone and long-term antibiotic therapy. Balloon catheter dilatation is a new technique which was recently introduced for the treatment of chronic rhinosinusitis. In this article, we present three PPT cases (two of them were secondary to endoscopic sinus surgery) who were successfully treated with balloon catheter dilatation and long-term antibiotherapy.

Papillary thyroid carcinoma with metastasis to the temporooccipital skull: a case report.

The patient was admitted to our clinic with the complaint of swelling in his left post-auricular region. The medical history revealed that he underwent thyroid surgery eight years ago and the specimen was reported as papillary thyroid carcinoma. Following required analyses, total thyroidectomy and biopsy from mastoid region were performed. Total thyroidectomy specimen was proved thyroid papillary microcarcinomas at five foci of the thyroid gland, while biopsy samples obtained from the mastoid region were reported as metastatic papillary thyroid carcinoma. The patient underwent radioactive iodine, followed by radiotherapy. In this article, we present a 61-year-old male patient with papillary thyroid carcinoma metastatic to the temporooccipital region, accompanied by multiple cranial nerve paralysis.

Tympanoplasty with island cartilage or temporalis fascia: a comparative study.

PURPOSE: To compare clinical and audiological outcomes of the type 1 tympanoplasties where conchal cartilage (island graft) and temporalis fascia were used as the graft material. PROCEDURES: In this retrospective study, the results of type 1 tympanoplasty operations (n = 50) in which cartilage and temporalis fascia were used for graft material were compared. RESULTS: Pre- and postoperative otoscopic findings of both groups were similar (p > 0.05). Preoperatively, the pure tone averages (PTAs) and hearing thresholds of the fascia and cartilage groups were similar (p > 0.05). However, postoperatively, the PTAs and air-bone gap closure were better with temporalis fascia compared to cartilage grafting (p < 0.05). On frequency-specific comparisons, the pure tone thresholds at the frequencies of 0.5, 1 and 2 kHz recovered better with temporalis fascia compared to cartilage (p < 0.05). Although the pure tone recovery was better at 4 kHz with temporalis fascia, the difference between the groups were not significantly different (p > 0.05). CONCLUSION AND MESSAGE: In conclusion, in contrast to many reports in the literature, temporalis fascia grafting seems better in our study than grafting with conchal cartilage.

Comparison of outcomes of simple polypectomy plus balloon catheter dilatation versus functional endoscopic sinus surgery in nasal polyposis: a preliminary study.

BACKGROUND: The aim of this study was to compare the outcomes of functional endoscopic sinus surgery (FESS) and simple polypectomy plus balloon catheter dilatation (BCD) in nasal polyposis. METHODS: Ten patients (six male and four female subjects) with nasal polyposis who underwent surgical treatment were included in this research. BCD was performed on one side of each patient's paranasal sinuses (after nasal polypectomy by microdebrider) while standard FESS was performed on the other side. Preoperatively, all patients were treated with oral methylprednisolone, 1 mg/kg per day, for 5 days, which was reduced and stopped on the 14th day. Pre- and postoperative endoscopic and radiological findings were compared. Endonasal endoscopic examination results were classified according to MacKay classification. Paranasal sinus computed tomography findings were evaluated according to Lund-MacKay classification. RESULTS: Pre- and postmedical treatment results of the patients were not significantly different according to MacKay classification. There was no significant difference between the results of FESS and BCD during 12-month follow-up period according to Lund-MacKay and MacKay classifications. There was significant improvement in the results obtained 1 and 12 months after FESS and BCD, respectively. The improvement was also radiologically evident. CONCLUSION: At 1 year postsurgery, polypectomy plus BCD is as effective as FESS. Longer-term studies are necessary to validate this technique.

Shall we resect the tip of manubrium mallei in tympanoplasty?

OBJECTIVES: In tympanoplasty operations if perforation is related with malleus handle, malleus handle is desepithelised. We planned this research to investigate whether the epithelial remnants remain as a result of this desepithelisation or not. METHODS: The 35 patients who were performed tympanoplasty operation were divided into two groups. In the first group which included 13 patients the tip portion of manubrium mallei were cut off without desepithelisation. In the second group which included 22 patients the tip portions of manubrium mallei were cut off after the meticulous desepithelisation. The presence of squamous epithelium was examined histopathologically on the specimens. RESULTS: Squamous epithelium was observed in 9 of the 13 non-desepithelised specimens and in 6 of 22 desepithelised specimens. CONCLUSION: In tympanoplasty operations despite careful desepithelisation, squamous epithelial remnants may remain on the malleus handle. So the tip of manubrium mallei could be resected to prevent the future development of cholesteatoma.

The role of the actinomyces in obstructive tonsillar hypertrophy and recurrent tonsillitis in pediatric population.

OBJECTIVE: To determine the prevalence of tonsillar Actinomyces in subjects with recurrent tonsillitis and those with obstructive tonsillar hypertrophy, and to determine the association between the presence of Actinomyces and tonsillar volume, and crypt abscess. SUBJECTS AND METHODS: A prospective designed cross-sectional study consisted of 90 children subjects who underwent tonsillectomy or adenotonsillectomy for recurrent tonsillitis and obstructive tonsillar hypertrophy. The subjects of recurrent tonsillitis (Group A) and obstructive tonsillar hypertrophy (Group B) were compared to the presence of Actinomyces. The relationship between the presence of Actinomyces and the presence of crypt abscess, and tonsillar volume were also compared. RESULTS: Actinomyces was found to be significantly more prominent in obstructive tonsillar hypertrophy group (61.5%) compared to recurrent tonsillitis group (26.6%) (p<0.001). Additionally, the mean tonsillar volume was significantly higher in tonsils with Actinomyces than those without (p<0.001). The histopathological study revealed that there was no significant inflammatory response to the existence of Actinomyces. CONCLUSION: According to the presented study, Actinomyces was seen more prominent in subjects with obstructive tonsillar hypertrophy compared those with recurrent tonsillitis. Furthermore Actinomyces had a pathological influence on tonsil size. This study showed there was a significant relation between Actinomyces and enlargement of tonsillar tissue. However, how causes tonsillar hypertrophy is not understood yet in tonsillar disease.