Subacute and Recurrent Transient Perivascular Inflammation of the Carotid Artery (TIPIC syndrome) and Supraclavicular Lymphadenopathy Associated with Ipsilateral Intramuscular m-RNA COVID-19 Vaccine.

We describe a case of recurrent transient perivascular inflammation of the carotid artery (TIPIC) syndrome and associated supraclavicular lymphadenopathy after ipsilateral intramuscular administration of an mRNA-based COVID-19 vaccine.

The effects of acute hypoxia on audition: An experimental study.

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) is a health problem that has increasing importance in society. In the literature, many studies about an audition in patients with OSAS are present. In this study, the effects of hypoxia on an audition that develop during the apnea attacks in OSAS were investigated experimentally. METHODS: This study was conducted in Inonu University Audiology Laboratory after the approval of Inonu University Faculty of Medicine Experimental Animal Research Ethics Committee (Protocol Number: 2011/A-102). In this study, 15 Wistar albino rats with a weight of 250-300 g were used. Anesthesia was performed by 40 mg/kg Ketamine and 5 mg/kg Xylazine through intramuscular administration. The processes were applied in the silence. This study involved 15 rats with normal auditory functions. Only tracheotomy was performed in the control group. Auditory assays were administered with otoacoustic emission (DP gram) before and after the process. In hypoxia group, hypoxia was created by making apnea attacks that lasted at least 10 seconds after the tracheotomy process. Auditory assays using DP gram were performed before tracheotomy and during hypoxia in the hypoxia group. RESULTS: In the control group, statistically significant values were not found. In the hypoxia group, statistically significant differences were detected in high frequencies. CONCLUSION: In conclusion, cochlear reply decreased in high frequencies during hypoxia that was created by apnea attacks.

Ossicular chain erosion in chronic otitis media patients with cholesteatoma or granulation tissue or without those: analysis of 915 cases.

PURPOSE: The aim of this study was to evaluate the ossicular chain erosions (OCE) in chronic otitis media patients with cholesteatoma (COM-C) or without cholesteatoma (COM). MATERIALS AND METHODS: The OCE and preoperative hearing levels of a total of 915 patients were evaluated retrospectively. Patients were divided into three groups. Of the 915 patients, 615 (67.2%) had COM, 234 (25.6%) had COM-C, and 66 (7.2%) had chronic otitis media with granulation tissue (COM-G). RESULTS: OCE was found in 291 (31.8%) of 915 patients. OCE was found in 192 (82%) of 234 patients with COM-C, 21 (31.8%) of 66 patients with COM-G, and 78 (12.7%) of 615 patients with COM. CONCLUSION: The most commonly seen OCE was incus erosion, followed by stapes and malleus erosions. The results of this study show that there are more OCE in the COM-C group than in the COM-G and COM groups. To our knowledge, this study has the widest patient population in the literature focused on the OCE relation with COM, COM-C, and COM-G and its effect on the preoperative hearing level.

Congenital muscular torticollis in older children: treatment with Z-plasty technique.

Congenital muscular torticollis (CMT) is a common congenital disorder of the musculoskeletal system in neonates and infants. The aim of this study was to evaluate the results of inferior Z-plasty in older children with CMT. They had mean age of 10 years (range, 5-14 years) and were followed up for 1 to 6 years. Postoperative protocol included a neck exercise program composed of active and passive movements in all cases and immobilization with a cervical collar in only 4 patients. This study concluded that surgical management of older children with CMT using Z-lengthening gives excellent clinical and functional results. The procedure is much more effective than other techniques and relatively complication-free and safe. Postoperative cervical collar and a well-planed physiotherapy protocol go a long way toward ensuring good to excellent results. Early diagnosis and treatment are necessary for good results.

Comparison of clinical differences between patients with allergic rhinitis and nonallergic rhinitis.

We conducted a retrospective study to investigate the clinical differences between subtypes of rhinitis patients. Our findings were based on a detailed history and nasal examination. The study population was made up of 910 patients who had at least two rhinitis symptoms. These patients were categorized into one of three rhinitis groups: nonallergic rhinitis (NAR), seasonal allergic rhinitis (SAR), and perennial allergic rhinitis (PAR); there were 212 patients (23.3%) in the NAR group, 473 (52.0%) in the SAR group, and 225 (24.7%) in the PAR group. In addition to demographic data, we compiled information on the season when each patient presented, specific symptoms and their triggers, parental history, associated allergic diseases (e.g., skin, lung, and eye allergies), and nasal examination findings. The SAR patients represented the youngest of the three groups. Most SAR patients presented in spring and summer, and this group had the highest incidence of eye itchiness, pharyngeal itchiness, eye redness, and palatal itchiness. In terms of triggering factors, a visit to a green area was significantly more common in the SAR patients, while detergent odor, sudden temperature change, and cold air were significantly more common in the NAR patients. On nasal examination, a pale nasal mucosa was significantly more common in the NAR group. In clinical practice, it is crucial to differentiate between allergic and nonallergic rhinitis. We conclude that relevant information from the history can predict allergic rhinitis. Future studies of prevalence should take into consideration the important findings of our study, including the significance of age and the seasonality of exacerbation of rhinitis symptoms.

All concha bullosa: an undefined abnormality of the lateral nasal wall.

Pneumatization of the turbinates, are the anatomic variations of lateral nasal wall. Turbinate pneumatization, refers to the existence of air cell inside the turbinates. Pneumatization of the middle turbinate is common, whereas rare in the superior and especially inferior turbinate. In this report we presented a case who has bilaterally pneumatization of all conchas.

Metastatic renal cell carcinoma to the condyle of the mandible.

A 59-year-old woman who had left nephrectomy because of renal cell carcinoma (RCC) 3 years ago referred with trismus and a mass on her left temporomandibular joint. Computed tomography scan revealed an expanding lytic lesion on the left condyle of the mandible. Incisional biopsy was carried out. Histopathologic diagnosis was metastatic clear cell variant of RCC. Metastasis of RCC to the condyle of the mandible has not been reported yet. In this study, we presented a case of RCC metastasis to the condyle of the mandible.

[Efficacy of local heparinoids on preventing edema and ecchymosis after rhinoplasty]. / Lokal heparinoidlerin rinoplasti sonrasi ödem ve ekimozun önlenmesindeki etkinligi.

OBJECTIVES: In this study, the effect of local heparinoids on prevention of periorbital edema and ecchymosis due to rhinoplasty was investigated. PATIENTS AND METHODS: Twenty patients (12 males, 8 females, mean age 23.3 years; range 19 to 34 years) who had bilateral osteotomy were randomly administered postoperative local heparinoid on one periorbital region, without performing any care in the other one. One and a half centimeter of heparinoid was applied once a day for nine days. The other periorbital region was used as control group. The heparinoid was applied additionally, 8 mg dexamethasone i.v was administered to all patients 30 minutes before the surgery and 24 hours after the surgery. Photographs of each patient which were taken on postoperative days 1, 3, 5 and 9 were evaluated as double-blind by two observers. Scoring was performed according to edema and ecchymosis scales. RESULTS: There was no statistical difference with respect to edema and ecchymosis between local heparinoid treated and control eyes. CONCLUSION: No hypersensitivity to drugs occurred in any patients. After analysing the scores, we observed that heparanoids administered locally was not effective in preventing periorbital edema and ecchymosis after rhinoplasty (p>0.05).

Do comorbidities influence objective and subjective recovery rates of nasal polyposis?

OBJECTIVES: To investigate the clinical and laboratory outcomes both objectively and subjectively in nasal polyposis patients with or without comorbidity (CoM; asthma and allergy). PATIENTS AND METHODS: Thirty-three nasal polyposis patients (13 women and 20 men) were included into the study. Their mean age was 39.23 +/- 9.13 years. CoM(+) and CoM(-) nasal polyposis patients were compared with each other. Evaluations contained endoscopic nasal examination, acoustic rhinometry, rhinomanometry, visual analog scale score of nasal blockage, olfactory function score, respiratory function test, skin prick tests, and paranasal sinus computed tomography. RESULTS: Recovery was statistically significant in all observed evaluations for endoscopic and radiologic staging, nasal obstruction, and sense of smell compared with the first evaluation in all patients regardless of the subgroups. Although objective measurements of respiratory functions did not show any change, clinical improvement was detected in CoM(+) patients with a decrease of need to their antiasthmatic medical treatment. CONCLUSIONS: Results of CoM(+) patients led to no statistical difference when compared with CoM(-) subgroup. When applying predefined nasal polyposis treatment protocol, the polyp patients with CoMs do not need close follow-up compared to the patients without CoMs.

Endoscopic removal technique of a huge ethmoido-orbital osteoma.

Osteomas are slow-growing benign tumors of the paranasal sinuses. They originate from the sinus wall and generally fills the sinus cavity. Many osteomas are asymptomatic and diagnosed incidentally on radiographs. The well-circumscribed, dense bony appearance on radiographs is usually diagnostic. Osteomas become symptomatic when they extend to the orbit or cranium. We report a rare case of ethmoido-orbital osteoma. Case reports and a review of the literature concerning osteoma and surgical techniques are presented. Treatment is not recommended in asymptomatic osteomas. If treatment is indicated, external or endoscopic approach can be chosen. The choice of surgical approach depends on the size of the lesion, location, and the experience of the surgeon.

Effect of intranasal estrogen on vocal quality.

The objective of this study was to evaluate the effect of intranasal estrogen therapy on female vocal quality. Thirty-two women who had surgically induced menopause were included into the study group and examined through hall year for this study. Estrogen treatment was proposed to all of the patients. Twenty-three of them accepted the treatment protocols including oral (n=12) (2mg estradiol; Estrofem; Novo Nordisk, Denmark) and intranasal (n=11) (300 mc g 17beta-estradiol; Aerodiol; Servier, Chambray-les-Tours, France) form of estrogen. The rest of patients refused estrogen treatment and those patients constituted the control group (n=9). Vocal changes were evaluated with Voice Handicap Index (VHI) and acoustic analysis of voice variations (fundamental frequency [F0], SD F0, jitter, shimmer, normalized voice energy, and harmonics-to-noise ratio) at baseline and after 1-year follow-up. According to VHI, while voice improvement was not clear in oral estrogen group, it was significant at intranasal estrogen group. Voice quality in patients treated with hormone replacement therapy (HRT) was significantly higher than patients without HRT. But between two treatment groups, there were no any statistical discrepancy. According to acoustic analysis, vocal stability among the women who use HRT was significantly better than those who did not use. Intranasal estrogen exerted the most significant effects on vocal stability. The data of our study support that voice undergoes changes in lack of estrogen in surgically induced menopausal women. Taken together with the relevant studies, while oral estrogen replacement therapy shows a favorable influence on voice quality, it seems to be more pronounced with intranasal estrogen than oral form.

Second primary cancer occurrence on forehead flap after reconstruction of nasal carcinoma.

We reported a case of basal cell carcinoma on the flap which was initially treated with excision of squamous cell carcinoma and forehead flap reconstruction of nasal dorsum. After 8 years of reconstruction, basal cell carcinoma was developed on the flap surface. This may be due to a recurrence, or a second primary tumor, or an activation of a dormant tumor with perturbing factors like surgery. In this report, our purpose was to discuss the possible etiopathogenesis, most appropriate diagnostic procedures, and treatment protocol for a carcinoma of the flap which has been used to reconstruct the previous cutaneous cancer.

Isolated preauricular pits and tags: is it necessary to investigate renal abnormalities and hearing impairment?

We investigated the incidence and co-existence of hearing impairment and renal abnormalities in healthy children with preauricular tags and pits. Study population consists of 13,740 primary school children from routine health check. Thirty-five children with preauricular tags and pits were noted. Control group consisted of 91 patients without pits and tags, who underwent renal ultrasound and were scheduled to pediatric outpatient clinic. Urinalysis, renal ultrasound, otoacoustic emission were performed in both the groups. The prevalence of renal abnormality (1/36; 2.7%) and hearing impairment (1/36; 2.7%) in patients with preauricular tags and pits was similar to that of control group (3/91; 3.2% and 4/91; 4.3%) (P = 0.87, P = 0.64, respectively). According to our results, it is not necessary to investigate hearing or urinary abnormality in patients with preauricular tag or pit, unless there is an association of a syndrome or family history of hearing or renal impairment.

The effect of dexmedetomidine on middle ear pressure.

OBJECTIVE: Dexmedetomidine is a preferred anesthetic agent in otological surgery because it provides controlled hypotension and good surgical field visibility. The aim of this study was to evaluate the influence of this novel agent on middle ear pressure. STUDY DESIGN AND SETTING: This prospective clinical trial was performed in 60 patients who were scheduled for elective surgery. They received dexmedetomidine or saline infusion for 20 minutes before induction of anesthesia. Tympanometric measurements were recorded for both ears at preoperative, intraoperative, and postoperative states. RESULTS: Mean difference of tympanometric peak pressure from baseline was statistically significant between dexmedetomidine and control group at the 30th minute of operation (24.8 daPa, P = 0.003 for right ear; 20.5 daPa, P = 0.02 for left ear) and at the end of the operation (25.8 daPa, P = 0.01 for right ear; 28.1 daPa, P = 0.004 for left ear). CONCLUSIONS: Dexmedetomidine anesthesia raises the tympanometric parameters, but they never exceed the limits of normal.

The sensitivity of nasal eosinophilia in allergic rhinitis.

Evaluation of nasal epithelial samples is a part of clinical allergy practice. The aim of this study is to reveal the sensitivity of the nasal eosinophilia using Rhino-probe and Wright-Giemsa staining by means of all available nasal eosinophilia scoring systems. In 30 patients (12 males, 18 females; mean age = 31.6 years) with clinical diagnosis of allergic rhinitis, both sides of the nose were sampled. The content of the cupped tip of the probe has been prepared and stained for nasal cytological examination under oil immersion by light microscopy. Nasal eosinophilia has been assessed by scoring systems. The sensitivity of nasal eosinophilia has been revealed. The nasal eosinophilia scores have been compared between nasal sides (right or left nose) and also between the examiners' observations for the same sample. Sensitivity values of nasal eosinophilia according to previously described criteria in the literature have been found to be between 13.33 and 80%. As the agreements for the nasal eosinophilia diagnosis between the sides of the nasal cavity and between the blinded examiners, the criteria of nasal eosinophilia such as the ratio of eosinophils to neutrophils or to all inflammatory cells rendered different diagnoses between the examiners (P < 0.01). The results of nasal cavity sides and Meltzer-scoring yielded no differences (P > 0.05). The substantial intraindividual variations when comparing the results obtained from the nasal sides and low sensitivity reveal that the nasal cytology needs more objective and standardized methods for a better differential diagnosis of chronic rhinitis.

Auditory brainstem response in pediatric migraine: during the attack and asymptomatic period.

OBJECTIVE: The aim of this study was to evaluate the hearing parameters of children with migraine during ictal and interictal period. METHOD: 16 pediatric patients with migraine and normal otolaryngologic examination were evaluated. Hearing parameters were assessed with auditory brainstem response (ABR) testing between and during the migraine attacks. Binaural absolute latencies of waves I, III and V, interpeak latencies I-III, III-V and I-V of ABR in response to 80 dB nHL clicks were calculated. Initial findings were compared with those of 20 healthy volunteers. RESULTS: Peak latencies of wave V and interpeak latencies of I-V were prolonged during the attack in migraineurs on the left. The side of latency elongation was not affected by the side of headache. When these parameters were separately compared for gender, they were prolonged in boys during the attack in migraineurs; however in girls, while there was statistically significant difference at interpeak latencies of I-V, no significant difference was noted at peak latencies of wave V. CONCLUSIONS: ABR waves did not exceed clinical norms in migraine patients in headache-free period. But, important effects on sensorineural hearing parameters were detected during the attack. Our results indicated a transient impairment of the auditory brainstem function during the headache in pediatric migraine patients.

Internal nasal valve: revisited with objective facts.

OBJECTIVES: Comprehensive examination of the internal nasal valve (INV) using objective methods. STUDY DESIGN AND SETTING: In this prospective study, 248 nasal cavities were examined by nasal endoscopy, acoustic rhinometry (ARM), and rhinomanometry (RMM). RESULTS: Endoscopic examination allowed to suggest a novel classification of INV: convex, concave, sharp angle, blunt angle, twisted caudal border, and angle occupied by the septal body. The INV angle occupied with septal body type was found to have increased nasal resistances compared with the sharp-angled internal nasal valve type (P < 0.05). Convex, concave, and sharp-angle types of INV angles were found different (P < 0.01). CONCLUSIONS: INV should be examined objectively before any INV surgery. A novel description of the INV configurations and their effects on nasal respiration found in this study may increase our understanding and lead surgical approaches more adequately. A surgical attempt to augment INV angle value may impact positively on nasal resistance. EBM RATING: C-4.

Ancient schwannoma of the parotid gland: a case report and review of the literature.

Schwannomas are encapsulated benign tumours arising from nerve sheath cells, of which ancient schwannoma is one of five variants. Since the first description, only a few ancient schwannomas have been reported in different locations in the head and neck region. In the parotid gland, this tumour is very rare. In this report, a 41-year-old female patient with an ancient schwannoma of the parotid gland is presented and the data of this patient compared with other (comparable) cases described in the literature.

Nasal pyriform aperture stenosis in adults.

BACKGROUND: Congenital nasal pyriform aperture stenosis (CNPAS) leading to respiratory insufficiency in infants has been well documented. Nevertheless, the nasal pyriform aperture stenosis (NPAS) entity in adulthood has not been discussed at all. The normative data of the width of the pyriform aperture, which has not been revealed before, is necessary for evaluation of the adult subjects with nasal bony inlet stenosis. The aim of this study was to define the normative data about the pyriform aperture width measured in 80 adult subjects with paranasal sinus symptoms without nasal obstruction and, additionally, to report the surgical results of two representative cases with NPAS. METHODS: The nasal bony inlet width measurements have been achieved in axial computerized tomographic sections to establish normative data. The maximal distance between the nasal processes of the opposite maxillary bones was measured. Two adult males complaining of nasal obstruction with overt pyriform aperture stenosis were treated surgically via a sublabial approach. RESULTS: The mean widest dimension of the nasal pyriform aperture was 21.6 +/- 2.2 mm (range, 17-27 mm) in 80 adult subjects. This width was 21.9 +/- 2.1 mm (range 18-27 mm) in men and 21 +/- 2.2 mm (range, 17-26 mm) in women. Stenotic pyriform apertures in two patients were widened surgically by drilling via a sublabial approach from 12 and 10 mm to 24 and 21 mm, respectively. CONCLUSION: NPAS should be included in the list of differential diagnosis for nasal obstruction. Surgical enlargement using a sublabial approach was found an effective and adequate treatment in pyriform aperture stenosis.

[The effect of endoscopic sinus surgery on quality of life]. / Endoskopik sinüs cerrahisinin yasam kalitesi üzerine etkisi.

OBJECTIVES: We assessed the effects of endoscopic sinus surgery on quality of life of patients with nasal polyposis or chronic sinusitis. PATIENTS AND METHODS: Thirty patients (5 females, 25 males; mean age 36 years; range 17 to 58 years) who underwent endoscopic sinus surgery were prospectively evaluated. The diagnoses were nasal polyposis in 15 patients and chronic sinusitis in 15 patients. Primary and revision operations were performed in 23 patients and seven patients, respectively. The quality of life was evaluated before and six months after surgery with the use of the Chronic Sinusitis Survey (CSS), and Medical Outcomes Study Short Form-12 (SF-12). Prior to administration, the two questionnaires were translated and adapted to Turkish. Computed tomography (CT) findings were scored before and six months after surgery according to the Lund-Mackay system. The results of the surveys were compared with CT scores. RESULTS: The postoperative SF-12 and CSS scores of all the patients improved significantly. Computed tomography scores were not found in correlation with improvements in the SF-12 and CSS scores. CONCLUSION: Endoscopic sinus surgery results in significant improvement in the quality of life of patients with nasal polyposis and chronic sinusitis, which may not be reflected by CT scores.