Effects of classical olfactory training in patients with COVID-19-related persistent loss of smell.

PURPOSE: The management of post-COVID-19 persistent olfactory dysfunction (OD) is uncertain. Currently, olfactory training is the only evidence-based therapy for post-viral OD. In this study, we evaluated the effectiveness of classical olfactory training (COT) in the treatment of post-COVID-19 persistent OD. MATERIALS AND METHODS: Patients with persistent OD after COVID-19 were assessed using the Sniffin' Sticks test. Fifty-one patients were then divided into two groups based on personal preference: the COT group (n = 31) included subjects who performed COT over 12 weeks, and the control group (n = 20) included subjects who did not receive any treatment. After the exclusion of eight patients, the olfactory performances of 43 patients were re-evaluated and compared to the baseline values. RESULTS: A significantly higher proportion of patients in the COT group improved their olfactory scores above the clinically important difference compared to the control group (40% versus 6%) (p = 0.014). The subjective smell improvement by COT was independent of age, gender, OD duration, presence of parosmia, or the initial olfactory score (all p > 0.05). CONCLUSION: Twelve weeks of COT appears to increase the olfactory sensitivity in patients with persistent OD following COVID-19.

Anterior maxillary wall and lacrimal duct relationship in pediatric patients - CT analysis for the feasibility of the prelacrimal recess approach.

OBJECTIVE: The purpose of the current study is to determine the age-related feasibility rate of the intranasal endoscopic prelacrimal recess approach (PLRA) in pediatric patients. METHODS: Computed tomography (CT) images of 379 patients under 18 years old were analyzed retrospectively. The anteroposterior dimensions of the medial bony wall of the prelacrimal recess (PLR) were measured on 758 sides. The feasibility of the PLRA was evaluated according to the criteria of Simmen et al., for each age and three age groups based on trends in the change of the width of the PLR. RESULTS: Less than half (45.9%) of pediatric maxillary sinuses (MS) were found to have the favorable anatomy (width of PLR >3 mm) to perform the PLRA. The cut-off value for age regarding the feasibility of the PLRA was nine years old. Following an evaluation of the groups, the proportions of the MS with favorable anatomy for the PLRA were 5.7% in Group I (age 0-4 years), 33.3% in Group II (age 5-8 years), and 55.1% in Group III (age 9-17 years). In group III, the feasibility rate for the PLRA was greater in boys (62.1%) than in girls (48.3%). No difference in the feasibility rate was found between the right and left sides. CONCLUSION: The overall feasibility rate for the PLRA in pediatric patients under 18 years of age is 46%. In patients aged 9-17 years, the feasibility rate for the PLRA is >50%.

Age-dependent differences of the depth of olfactory fossa in children.

OBJECTIVE: With this radio-anatomical study, we aimed to describe the distribution of the depth of the olfactory fossa based on the Keros classification in the pediatric population in our region and to reduce complication rates by providing normative data. METHODS: This was a retrospective study conducted with computed tomography imaging of the paranasal sinuses of 390 pediatric patients referred over a six-year period in Sakarya and Kocaeli University Faculty of Medicine. Patients were divided into 3 groups as 1-6, 6-12, and 12-18 years old. The depth of the olfactory fossa was measured and classified according to the Keros classification. The incidence of Keros asymmetries was also investigated. RESULTS: The distribution of the depth of a total of 780 olfactory fossa according to the Keros classification was 24.7% Keros I, 65.9% Keros II, and 9.4% Keros III. When the groups were evaluated with each other and within each group, it was seen that the prevalence of Keros I type was significantly higher in the first group (p<0.05), and the prevalence of Keros type II was significantly higher in the second and third groups (p<0.05). Apart from this, the number of Keros type III increased in the third group compared to the first two groups and showed a statistically significant difference (p<0.05). Among all patients, asymmetry of the olfactory fossa was detected in 29 patients (7.4%). Although the number of olfactory fossa asymmetry was low in group I, it was not significantly different between the groups (p>0.05). CONCLUSION: In our study, high Keros I rate and low Keros III rate in children aged 1-6 were remarkable. Especially for children under the age of six, questions arise about the validity of the Keros classification. More detailed studies in larger populations, in different ethnicities, and with various age groups are needed. LEVEL OF EVIDENCE: Level 3.

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.

The effect of sensory level electrical stimulation of the masseter muscle in early stroke patients with dysphagia: A randomized controlled study.

BACKGROUND: Dysphagia is a serious cause of morbidity and mortality in stroke patients. AIMS: As the first study in literature, we aimed to evaluate the effects of sensory-level electrical stimulation (SES) to bilateral masseter muscles in early stroke patients with dysphagia. SETTINGS AND DESIGN: This study was conducted at the Physical Medicine and Rehabilitation Clinic of our hospital between 2013 and 2015. MATERIALS AND METHODS: Ninety-eight patients with dysphagia within the first month after ischemic stroke were included in this study. Patients were evaluated by bedside screening tests (Bedside Dysphagia Score, Neurological Examination Dysphagia Score, Total Dysphagia Score, and Mann Assessment of Swallowing Ability test) and by flexible fibreoptic endoscopic evaluation of swallowing (FEES) methods. All patients were included in a traditional swallowing therapy. Patients were divided into two groups, namely the "stimulation group" and "sham group." SES was applied to bilateral masseter muscles. Evaluation parameters were compared between the groups before and after therapy. STATISTICAL ANALYSIS: The Friedman test, Wilcoxon Signed Rank test, Mann-Whitney U test, and Fisher exact test were used in this study. RESULTS: There was a significant improvement in dysphagia severity scores evaluated by bedside screening tests and FEES in cognitive and total functionality levels except in motor functional independence level in the stimulation group. In the sham group, there were no significant changes in the evaluation parameters. CONCLUSION: SES applied to bilateral masseter muscles may provide an effective treatment for both dysphagia and cognitive function in early stroke patients.

Detection of XRCC1 gene polymorphisms in Turkish head and neck squamous cell carcinoma patients: a comparative analysis with different populations.

PURPOSE: X-ray repair cross-complementing (XRCC1) is one of the most important genes for the maintenance of genomic integrity and protection of cells from DNA damage. Although tobacco and alcohol consumption are the major risk factors for the development of head and neck squamous cell carcinoma (HNSCC), sequence variation in XRCC1 gene may alter HNSCC susceptibility. Reports on the relationship between HNSCC and polymorphisms in XRCC1 gene have been inconsistent so far. The aim of this study was to investigate the association of XRCC1 Arg194Trp and Arg399Gln single nucleotide polymorphisms (SNP), smoking and alcohol consumption with the risk of HNSCC in Turkish population and also to compare to these results with the ones from both Turkish and different populations in the literature. The frequencies of Arg194Trp and Arg399Gln SNPs were studied in 55 HNSCC and 69 healthy individuals. METHODS: Genomic DNA was isolated from peripheral blood and SNP was genotyped by PCR-RFLP method. RESULTS: The genotype and allele frequencies of both polymorphisms were not statistically different between the HNSCC and control groups. On the other hand, smoking and chronic alcohol consumption were associated with risk of HNSCC, but there was no association between Arg194Trp, Arg399Gln polymorphisms, smoking and alcohol consumption in HNSCC cases. CONCLUSION: These results indicate that both Arg194Trp and Arg399Gln polymorphisms were not associated with the development of HNSCC in Turkish population. In addition, the allele frequencies of polymorphisms were in line with other Turkish population results that were studied previously. However, compared to different populations, there were marked differences in allele frequencies.

How does parental smoking affect nasal mucociliary clearance in children?

Correlation between passive smoking and nasal mucociliary clearance (MCC) in pediatric population has not been reported before. Therefore, in this study, we aimed to investigate the relationship between environmental tobacco smoke and nasal MCC in children whose parents smoke in or outside the house. Three groups of subjects were evaluated: control group (group 1) with 18 children who were not exposed to environmental smoke, 15 passive smokers living with at least one adult household member smoking outside the house (group 2), 17 passive smokers living with at least one adult household member smoking inside the house (group 3). Parents of children were asked to answer our questions regarding their smoking history, and nasal MCC time was assessed for all individuals of the 3 groups. The mean MCC value in control group, group 2 and group 3 were 7.33 ± 2.91, 10.00 ± 4.78 and 12.41 ± 3.44, respectively. Differences between the mean nasal MCC values of the groups were statistically significant (p < 0.01). The comparison of MCC values between control group and group 2 did not reveal significant difference, but since p value was very close to significance level, in larger series it could be significant. (p = 0.067). Also, when we compared the MCC values between group 2 and group 3, there was no significant difference (p = 0.173). But, the difference between MCC values of control group and group 3 was statistically significant (p < 0.001). Parental smoking both inside or outside the house seemed to increase nasal mucociliary clearance time when they are compared with healthy controls. Further studies with larger study groups also measuring direct quantitative doses of smoking are needed to verify this important issue.

Association between XRCC3 Thr241Met polymorphism and laryngeal cancer susceptibility in Turkish population.

DNA repair systems are essential for normal cell function. Genetic alterations in the DNA repair genes such as X-ray repair cross-complementing group 3 (XRCC3), can cause a change in protein activity which results in cancer susceptibility. The aim of this study was to investigate the association of XRCC3 Thr241Met single nucleotide polymorphism (SNP), smoking and alcohol consumption with the risk of laryngeal cancer in Turkish population. The frequencies of Thr241Met SNP were studied in 58 laryngeal cancer cases (SSC) and 67 healthy individuals. Genomic DNA was isolated from peripheral blood samples of both controls and laryngeal cancer cases. Thr241Met SNP was genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The genotype and allele frequencies of Thr241Met polymorphism were not statistically significant between the laryngeal cancer and control groups. Carrying mutant allele was not associated with the risk of laryngeal cancer. On the other hand, smoking and chronic alcohol consumption were associated with the risk of laryngeal cancer but there is no association between Thr241Met, smoking and alcohol consumption in laryngeal cancer cases. These results indicate that Thr241Met polymorphism was not associated with the development of laryngeal cancer in Turkish population. However, it should be kept in mind that the association of a polymorphism with cancer susceptibility can differ due to several factors such as cancer type, selection criteria, ethnic differences and size of the studied population.

Paradoxical giant inferior concha.

Anatomic variations of the middle and superior conchae are common, but inferior concha anomalies are rare. These anomalies have included pneumatization, agenesis, and duplication. We describe what we believe is the first reported case of a paradoxical curvature of the bony part of the inferior concha. The patient was a 13-year-old girl. The development of a huge inferior concha blocked the left nasal cavity and deviated the nasal septum to the contralateral side, resulting in bilateral obstruction. The patient was successfully treated with surgery.

[The correlation of vascular endothelial growth factor with angiogenesis and p53 gene in laryngeal squamous cell carcinoma]. / Larenksin skuamöz hücreli kanserlerinde vasküler endotelyal büyüme faktörünün anjiyogenez ve p53 geni ile iliskisi.

OBJECTIVES: Angiogenesis is a fundamental process in tumor growth and metastasis. Vascular endothelial growth factor (VEGF) is a key regulator of angiogenesis and it has been identified in a wide variety of malignancies, including head and neck squamous cell carcinoma. However, the regulation of VEGF expression in tumor angiogenesis is not well defined. The tumor-suppressor gene p53 is thought to regulate VEGF. In this study, we examined the role of p53 gene in VEGF expression. PATIENTS AND METHODS: Clinical records of patients who underwent total or partial laryngectomy between 1999 and 2002 were reviewed. Of these, paraffin-embedded specimens of 27 patients (27 males; mean age 55 years; range 39 to 74 years) with a diagnosis of larynx epidermoid carcinoma were immunostained to evaluate VEGF expression, p53 gene status, and microvessel density (MVD). Variables were statistically examined. RESULTS: Vascular endothelial growth factor positive staining was detected in 11 (40.7%) and p53 mutations were identified in 16 (60%) tumors. No association was detected between p53 mutations and VEGF expression (p>0.05). Statistical analysis gave a clear correlation between tumor vascularity and VEGF expression (p<0.05). Vascular endothelial growth factor negative tumors showed a lower mean number of microvessels per microscopic field (29.6+/-6.6) than VEGF positive tumors (40.8+/-15.2). P53 and VEGF expression, and MVD were not correlated with the T-stage, N-status, tumor localization, and histological grading (p>0.05). CONCLUSION: The higher microvessel density in VEGF positive tumors supports the importance of VEGF for tumor angiogenesis in laryngeal carcinoma. However, our results do not support the hypothesis concerning a p53 regulation in the angiogenic process through a VEGF up-regulation.

[Nasal schwannoma: a report of two cases]. / Nazal schwannom: Iki olgu sunumu.

Schwannomas are benign neoplasms arising from Schwann cells of peripheral, cranial and autonomic nerves. Schwannomas of the head and neck comprise 25% to 45% of all schwannomas; however, nasal and paranasal schwannomas account for 4% of these tumors. In this report, two cases of nasal schwannoma are presented. One was a 67-year-old female patient whose tumor completely filled the right nasal cavity and extended beyond the maxillary and ethmoid sinuses. The other patient was a 10-year-old child who had a tumor in the left lateral nasal wall, which is a rare case considering her age. A lateral rhinotomy approach was used in the first patient due to the wide extension of the tumor. In the second case we preferred the intranasal approach because the tumor had limited extension. No recurrences were seen in the postoperative follow-up periods.