Possible Neoplastic or Proliferative Effects of Intra-Tympanic Platelet-Rich Plasma on the MiddleEarMucosa: A Myth or a Fact to Consider?

BACKGROUND: Platelet-rich plasma is a frequently used plasma-derived material; however, a possible neoplastic or proliferative effect is one of the limiting issues in its use. The aim of our experimental study was to investigate the long-term histological effects of platelet-rich plasma on the middle ear mucosa. METHODS: The rats were divided into 2 groups randomly (groups 1 and 2). Group 1 represented the control group and 8 rats were included in this group. To the left ear, 0.3 mL of normal saline solution was administered intra-tympanically. No injections were done to the right ears. Group 2 represented the platelet-rich plasma group and 11 rats were included. To the left ears, 0.3 mL of platelet-rich plasma and to the right ears 0.3 mL of normal saline solution was administered intra-tympanically. The intra-tympanic platelet-rich plasma injections were done twice with an interval of 1 week. All animals were sacrificed in the third month. The degree of mucosal thickness, the presence of metaplasia, atypical cells, myofibroblastic infiltration, angiogenesis, and acute or chronic inflammation were evaluated histopathologically. RESULTS: Histopathological findings in the right and left ears in each group were compared in itself. The degree of inflammation and mucosal thickness were significantly higher in the perforated and saline administered side, in group 1 (P < .001). In group 2, the degree of angiogenesis was significantly higher in the platelet-rich plasma administered side (P < .001). The degree of mucosal thickness was significantly higher in the saline administered side (P < .001). CONCLUSION: Considering the anti-inflammatory and regenerative features and its safety, intra-tympanic-PRP may, in the future, be an alterna- tive to current intra-tympanic treatment modalities.

The Effect of Curcumin on the Prevention of Myringosclerosis in Rats.

OBJECTIVE: The aim of this study was to investigate the preventative effect of oral curcumin (CMN) on myringosclerosis (MS) in an experimental rat model. METHODS: The study included 21 female Wistar albino rats randomly separated into three groups. Group 1 was given no treatment (control group). In Group 2 and Group 3, the tympanic membrane (TM) was perforated using a sterile ear pick. The rats in Group 3 were administered oral CMN 200 mg/kg/day. All rats were sacrificed after 16 days. Otomicroscopic and histopathologic examinations were performed on the tympanic membranes. RESULTS: Histopathologic examinations revealed that there were statistically significant differences between Group 2 and Group 3 in terms of MS degrees (p<0.001) and mean thicknesses of TMs (p<0.001), but there were no differences between Group 1 and Group 3. In respect of MS detected by otomicroscopy, a statistically significant difference was determined between Groups 1 and 2 (p<0.001) and between Groups 2 and 3 (p<0.01), but there was no significant difference between Group 1 and Group 3 (p=0.575). CONCLUSION: Orally administered CMN can prevent myringosclerosis formation in experimentally induced myringotomies.

The Effect of Oral Montelukast Administration in Cholesteatoma Development and Inflammation: An Experimental Animal Model.

HYPOTHESIS: We hypothesized that oral montelukast treatment could inhibit cholesteatoma formation in an experimental animal model. BACKGROUND: Inflammation and excessive proliferation have been described in the histopathology of cholesteatoma. The aim of this study was to determine the effect of oral montelukast on cholesteatoma development. METHODS: Eighteen healthy female Wistar albino rats weighing 250 g were chosen for the study. The animals were divided into two groups: group 1 received montelukast and group 2 was the control group. Intratympanic propylene glycol injection was administered into the left ears and physiologic serum was instilled into the right ears of the animals on the first, eighth, and fifteenth days. The effects of montelukast administration were evaluated by histological examination of the tympanic membrane and middle ear. RESULTS: Group 1 (montelukast group) showed significant differences in terms of cholesteatoma formation, granulation, epithelial invagination, and inflammation. Cholesteatoma formation in the left ear was observed in 2 (22%) and 8 (89%) rats in groups 1 and 2, respectively (p = 0.015). CONCLUSION: Development of cholesteatoma and inflammation was significantly lower in the montelukast-administered group. Thus, oral montelukast was found effective in preventing cholesteatoma formation.

Use of Thermoplastic Splint for the Treatment of Auricular Hematoma.

Auricular hematoma is commonly seen in ear nose and throat clinical practice and mostly caused by blunt trauma as a result of traffic accident, wrestling, boxing etc. If hematoma does not discharge, blood supply of the cartilage fails and this results with the necrosis of the auricular cartilage. Incision and drainage of the hematoma is the cornerstone of the surgical treatment and simple compression methods are limited in terms of their ability to eliminate the empty space. Various techniques have been described for the elimination of the death space such as; dental rolls, cotton bolsters, buttons, silastic sheets, etc but compression materials may be insufficient to apply this pressure because of irregular shape of auricle. Resolving these problems, the authors have used thermoplastic splint as a compressive material at 7 patients for elimination of the death space in auricular hematoma treatment.

Effect of probiotics in experimental otitis media with effusion.

OBJECTIVES: The article's aim was to investigate the effects of probiotics in the experimental otitis media with effusion. MATERIALS AND METHODS: Twenty-four male Wistar albino rats were used. They were divided into four groups. Experimental otitis media with effusion was created by intratympanic histamine injection. The effusion was confirmed by otomicroscopic examination 24 h after injection. Group 1; did not receive any treatment, group 2; received probiotics for 7 days after the detection of effusion, group 3; received probiotics for 7 days prior to injection of histamine, group 4; received probiotics for 7 days before injection of histamine and 7 days after detection of effusion. After detection of effusion, animals were sacrificed. Otomicroscopic evaluation was done to determine the effusion. In histopathological examination neutrophil leukocyte counts were determined in 25 areas of the sub-mucosa of the temporal bulla. RESULTS: The otomicroscopic ear effusions' healing rate in group 1 was 10%, in group 2 was 25%, in group 3 was 50%, and in group 4 was 100% (p < 0,013). The mean counts of submucosal neutrophil leukocyte from 25 areas of the temporal bulla of group 1 was 86,8 ± 24, group 2 was 66,5 ± 21, group 3 was 66,2 ± 16, and group 4 was 26,3 ± 6,5 (p < 0,001). CONCLUSION: Probiotics have a curative effect on the prevention and treatment of otitis media with effusion. This result may be related to their anti-inflammatory effects. Therefore, probiotics can be widely used in the age group at risk for otitis media with effusion as a complementary therapy by dietary supplements. LEVEL OF EVIDENCE: NA.

The role of nasopharyngeal examination and biopsy in the diagnosis of malignant diseases / O papel do exame clínico e da biópsia de nasofaringe no diagnóstico de doenças malignas

Abstract Introduction: In direct proportion to the increasing rate of nasopharynx examinations applied, the early diagnosis and treatment of lesions in this region is possible. At times the clinical findings and the biopsy results are not consistent, so biopsies may have to be repeated. Objectives: The aim of this study was to evaluate the distribution of pathology test results obtained from cases of nasopharynx biopsy, to determine with which methods determination most often was made, and to investigate which kinds of cases required the biopsy to be repeated. Methods: The study included a total of 1074 patients (500 female, 574 male) who underwent nasopharyngeal biopsy in our clinic between June 2011 and June 2017. Data were obtained from patient records of age, gender, clinical findings, imaging findings if available and pathological diagnosis. The pathological diagnoses were separated into 3 main groups as chronic nasopharyngitis, benign cytology and malignant cytology. Results: The examinations resulted in 996 cases reported as chronic nasopharyngitis, 47 as benign cytology and 31 as malignant cytology. Of the 31 malignant lesions, diagnosis was made in 15 patients (48.4%) with a single biopsy, and in 16 patients (51.6%), as a result of the pathology report when 2 or more biopsies were taken. In the comparison of the benign and malignant lesions in respect of the need for repeated biopsies, the cases determined with malignancy were found to have a statistically significantly higher rate of repeated biopsy (p < 0.001). Conclusion: In comparison with cases of benign tumor, a statistically significantly greater number of repeated biopsies were required in cases diagnosed as malignant tumors to confirm the pathological diagnosis or when there was continued suspicion of malignancy. Therefore, when there is clinical suspicion, even if there are no findings of malignancy on the first biopsy, the biopsy should be repeated expeditiously.

Resumo Introdução: Em proporção direta à taxa crescente de exames de nasofaringe que são feitos, o diagnóstico precoce e o tratamento de lesões nessa região têm sido possíveis. Nem sempre os achados clínicos e os resultados da primeira biópsia são consistentes, levando à necessidade de biópsias repetidas. Objetivos: Avaliar a distribuição dos resultados dos testes histopatológicos obtidos pela biópsia de nasofaringe, determinar quais métodos foram mais frequentemente usados na identificação e investigar os casos nos quais a biópsia precisou ser repetida. Método: O estudo incluiu 1.074 pacientes (500 mulheres, 574 homens) submetidos a biópsia de nasofaringe em nossa clínica entre junho de 2011 e junho de 2017. Os dados foram obtidos dos prontuários dos pacientes e incluíram idade, sexo, achados clínicos, achados de imagem e diagnóstico histopatológico. Os diagnósticos histopatológicos foram separados em três grupos principais como nasofaringite crônica, citologia benigna e citologia maligna. Resultados: Os exames resultaram em 996 casos laudados como nasofaringite crônica, 47 como citologia benigna e 31 como citologia maligna. Das 31 lesões malignas, o diagnóstico foi feito em 15 (48,4%) com uma única biópsia e em 16 (51,6%), quando duas ou mais biópsias foram feitas. Na comparação das lesões benignas e malignas em relação à necessidade de biópsias repetidas, os casos determinados como malignos mostraram uma taxa estatisticamente maior de biópsia repetida (p < 0,001). Conclusão: Em comparação com os casos de tumores benignos, um número estatisticamente maior de biópsias repetidas foi necessário em casos diagnosticados como tumores malignos, para confirmação do diagnóstico histopatológico ou na suspeita continuada de malignidade. Portanto, quando há suspeita clínica, mesmo que não haja achados de malignidade na primeira biópsia, ela deve ser repetida tão logo seja possível.

Effect of Folic Acid on Cisplatin-Induced Ototoxicity: A Functional and Morphological Study.

OBJECTIVES: The aim of our study was to investigate the effects of folic acid on cisplatin-induced ototoxicity. MATERIALS AND METHODS: Thirty Wistar albino rats were divided into five groups. Group I received intraperitoneal cisplatin (IP) 10 mg/kg/day and IP folic acid 10 mg/kg/day; Group II received IP cisplatin 10 mg/kg/day and IP physiological saline; Group III received IP cisplatin 10 mg/kg/day and intratympanic (IT) folic acid 0.15 mL/day; Group IV received IP cisplatin 10 mg/kg/day and IT physiological saline; and Group V received IT folic acid 0.15 mL/day. Before and after drug administration, plasma homocysteine, folic acid levels, and auditory brainstem evoked responses (ABR) were measured. The rats were then sacrificed, and the inner ears were processed for electron microscopy. RESULTS: The differences of ABR thresholds in Group I compared to Group II were significantly smaller at 4 kHz, 8 kHz, and 16 kHz, whereas they were smaller but not statistically significant at 12 kHz in ABR. The differences of ABR thresholds in Group III compared to Group IV were significantly smaller at 12 kHz, and smaller but not statistically significant at 4 kHz, 8 kHz, and 16 kHz. Cisplatin treatment resulted in the degeneration of the cells of the organ of Corti, stria vascularis, and spiral ganglion. The cells of the organ of Corti, stria vascularis, and spiral ganglion showed a partially preserved morphology in both Group I and Group III. CONCLUSION: Our study results suggests that folic acid is a potential agent in preventing cisplatin-induced ototoxicity.

The role of nasopharyngeal examination and biopsy in the diagnosis of malignant diseases.

INTRODUCTION: In direct proportion to the increasing rate of nasopharynx examinations applied, the early diagnosis and treatment of lesions in this region is possible. At times the clinical findings and the biopsy results are not consistent, so biopsies may have to be repeated. OBJECTIVES: The aim of this study was to evaluate the distribution of pathology test results obtained from cases of nasopharynx biopsy, to determine with which methods determination most often was made, and to investigate which kinds of cases required the biopsy to be repeated. METHODS: The study included a total of 1074 patients (500 female, 574 male) who underwent nasopharyngeal biopsy in our clinic between June 2011 and June 2017. Data were obtained from patient records of age, gender, clinical findings, imaging findings if available and pathological diagnosis. The pathological diagnoses were separated into 3 main groups as chronic nasopharyngitis, benign cytology and malignant cytology. RESULTS: The examinations resulted in 996 cases reported as chronic nasopharyngitis, 47 as benign cytology and 31 as malignant cytology. Of the 31 malignant lesions, diagnosis was made in 15 patients (48.4%) with a single biopsy, and in 16 patients (51.6%), as a result of the pathology report when 2 or more biopsies were taken. In the comparison of the benign and malignant lesions in respect of the need for repeated biopsies, the cases determined with malignancy were found to have a statistically significantly higher rate of repeated biopsy (p<0.001). CONCLUSION: In comparison with cases of benign tumor, a statistically significantly greater number of repeated biopsies were required in cases diagnosed as malignant tumors to confirm the pathological diagnosis or when there was continued suspicion of malignancy. Therefore, when there is clinical suspicion, even if there are no findings of malignancy on the first biopsy, the biopsy should be repeated expeditiously.

The effect of poly-p-dioxanone plate on the protection and vitality of cartilage: An animal study.

OBJECTIVES/HYPOTHESIS: In septorhinoplasty, septal, auricular, and costal cartilage are often used as autologous graft. Autologous grafts are preferred in nasal reconstruction. The aim of this study was to histopathologically examine the tissue compatibility and the effect on the stability and cartilage vitality of poly-p-dioxanone (PDS) plates. STUDY DESIGN: Ten adult New Zealand rabbits were used. METHODS: Ten New Zealand rabbits were used. Septal and auricular cartilage sections were removed; one of the two cartilage grafts was left plain, and the other was sutured to a PDS plate. Grafts were placed into the back of the rabbits. After 12 weeks, the graft material was examined microscopically. RESULTS: The specimens did not cause any significant foreign body reaction. Within 3 months, a significant degree of color, stability, and stiffness was lost. Microscopically, inflammation, necrosis, and cartilage cell degeneration scores were statistically significantly lower in the grafts using PDS (P < .05), and the vascularization, collagen, and cartilage proliferation scores were found to be statistically significantly higher (P < .05). No statistically significant difference was determined in respect of the bone proliferation scores (P > .05). CONCLUSIONS: The use of PDS plates together with cartilage provided mechanical support to the graft. Therefore, changes that disrupt the integrity of the graft, such as inflammation, necrosis, and cartilage cell degeneration, were reduced, and changes that provide greater stability, such as vascularization, collagen, and cartilage proliferation, were increased. LEVEL OF EVIDENCE: NA Laryngoscope, 129:E129-E134, 2019.

The Rate of Epistaxis Incidence in New-Generation Anticoagulants and Perioperative Approach in Otorhinolaryngological Practices.

Nose bleeding is a common situation seen in otorhinolaryngological practices. One of the greatest risk factors in nose bleeding is the use of anticoagulant medicine. With the medicine developed in recent years, the risk of nose bleeding due to the frequent use of anticoagulant and antiagregant is gradually increasing.The purpose of this study is to determine the effects of especially new-generation anticoagulants on nose bleeding. In addition, the use and complications of new-generation anticoagulants and antiagregants have been compiled in light of information obtained from the literature.Three hundred forty patients whose follow-up is conducted by the cardiology department and who use oral antithrombocytic medicine have been included in the study. It has been determined that 15% of these patients use new-generation oral anticoagulants (Rivaroksaban, apiksaban, dabigatran, danaparoid) and the other patients are treated with conventional antithrombocytic treatment (Aspirin, Warfarin, Enoksaparin sodium). The rate of nose bleeding in patients who use classical anticoagulants has been observed to be 28%. In 30 of these patients who had nose bleeding, while cauterization and buffering by otorhinolaryngology specialists, major intervention has not been necessary for any of the patients. While bleeding has been observed in 26% of the patients who use new-generation anticoagulants, bleeding that required operational intervention has taken place in 2 patients. Bleedings have been stopped surgically through a large number of cauterization and buffering.While the new-generation anticoagulants cause lower rate of bleeding, it has been observed that controlling these bleedings is more difficult.

Protective Effects of Caffeic Acid Phenethyl Ester on Fluoxetine-Induced Hepatotoxicity: An Experimental Study.

Background. The aim of the study was to analyse the effect of caffeic acid phenethyl ester (CAPE) on fluoxetine-induced hepatotoxicity in rats. Materials and Methods. Group I served as control. Group II received CAPE intraperitoneally. Group III received fluoxetine per orally. Group IV received fluoxetine and CAPE. The total antioxidant capacity (TAC), total oxidant status (TOS), oxidative stress index (OSI), and liver enzymes including paraoxonase-1 (PON-1), aspartate transaminase, and alanine transaminase levels were measured. Liver tissues were processed histopathologically for evaluation of liver injury and to validate the serum enzyme levels. Results. An increase in TOS and OSI and a decrease in TAC and PON-1 levels in serum and liver tissues of Group III were observed compared to Groups I and II. After treatment with CAPE, the level of TOS and OSI decreased while TAC and PON-1 increased in serum and liver in Group IV. Histopathological examination of the liver revealed hepatic injury after fluoxetine treatment and reduction of injury with CAPE treatment. Conclusion. Our results suggested that CAPE treatment provided protection against fluoxetine toxicity. Following CAPE treatment with fluoxetine-induced hepatotoxicity, TOS and OSI levels decreased, whereas PON-1 and TAC increased in the serum and liver.

Somatosensory Amplification, Anxiety, and Depression in Patients With Hepatitis B: Impact on Functionality.

In the present study, we aimed to determine the differences in body image along with anxiety and depression levels, and also to evaluate their impact on disability parameters in patients with hepatitis B.Our study comprised 77 patients with hepatitis B (n = 41, chronic active patients; n = 36, patients with inactive hepatitis B) and 53 healthy individuals (control group). Enrolled patients responded to several questionnaires, including a sociodemographic form, Sheehan Disability Scale (SDS), Hospital Anxiety and Depression Scale (HADS), and Somatosensory Amplification Scale.Patients with chronic active hepatitis B (CAHB) had higher levels of somatosensory perception than patients with inactive hepatitis B (IHB) and control group (P < 0.001, P = 0.001, respectively). Patients with CAHB had high scores on all the 3 domains of SDS (work/school, P < 0.001; social life, P < 0.001; and family life, P < 0.001). Also, patients with CAHB had a significantly higher HADS total score, HADS anxiety score, and HADS depression score than control group (P < 0.001, P < 0.001, P < 0.001, respectively). No significant difference was noted between patients with CAHB and patients with IHB with regard to HADS depression score; however, HADS anxiety and HADS total scores were significantly higher in the CAHB group (NS, P = 0.027, P = 0.035, respectively). Moreover, the IHB group exhibited higher scores for the work/school and social life domains of SDS than those of the control group (P = 0.008, P = 0.047).Although patients with CAHB may present with somatosensory amplification, anxiety, and depression, patients with IHB do not exhibit such symptoms. However, functionality is affected in both carrier and active patient groups. We believe that routine health checks of patients with hepatitis B should include psychiatric evaluation, psychiatric examination, and follow-up.

The impact of pregnancy on nasal resonance.

OBJECTIVES: This study aims to investigate the possible impact of hormonal changes on nasal resonance during pregnancy. PATIENTS AND METHODS: Between January 2013 and June 2013, a total of 101 pregnant women (mean age 27.1±5.8 years; range 18 to 41 years) visiting obstetric clinics for routine antenatal checkups were included in the study. The control group was consisted of 99 patients (mean age 29.2±6.6 years; range 18 to 42 years) without any nasal complaints. Nasal symptoms were assessed using the Nasal Obstruction Symptom Evaluation (NOSE) Scale. Nasalance scores were calculated by nasometry. The results were compared between study and control groups. RESULTS: The mean nasalance score in pregnant women (40.4±7.8) were statistically significantly lower than the control group (44.7±6.4) (p<0.001). The nasalance score was 43.2±7.0 for the first trimester, 41.1±6.6 for the second trimester, and 39.2±8.8 for the third trimester. There was no statistically significant difference in nasalance scores within three trimesters. The mean nasalance scores of the second and third trimesters were statistically significantly lower than the control group (p<0.001). The NOSE scores were found to be statistically significantly higher in the third trimester (2.9±2.6) than the second trimester (1.1±1.9) (p<0.001). CONCLUSION: These findings indicate that nasalance scores fall in pregnancy, leading to the development of hyponasal voice.

Glass ionomer application for vocal fold augmentation: Histopathological analysis on rabbit vocal fold.

OBJECTIVES/HYPOTHESIS: The aim of this study was to investigate the use of glass ionomer cement (GIC) as an injection material for vocal fold augmentation and to evaluate the biocompatibility of the material. STUDY DESIGN: Ten adult New Zealand rabbits were used. METHODS: Under general anesthesia, 0.1-cc GIC was injected to one vocal fold and the augmentation of vocal fold was observed. No injection was applied to the opposite side, which was accepted as the control group. The animals were sacrificed after 3 months and the laryngeal specimens were histopathologically evaluated. RESULTS: The injected and the noninjected control vocal folds were analyzed. The GIC particles were observed in histological sections on the injected side, and no foreign body giant cells, granulomatous inflammation, necrosis, or marked chronic inflammation were detected around the glass ionomer particles. Mild inflammatory reactions were noticed in only two specimens. The noninjected sides of vocal folds were completely normal. CONCLUSION: The findings of this study suggest that GIC is biocompatible and may be further investigated as an alternative injection material for augmentation of the vocal fold. Further studies are required to examine the viscoelastic properties of GIC and the long-term effects in experimental studies. LEVEL OF EVIDENCE: NA.

The effects of different environmental pH on healing of tympanic membrane: an experimental study.

In this study, we investigated the effect of environmental pH on healing of acute rat tympanic membrane perforations. Twenty Wistar albino rats were divided into four groups and used in the study. A large myringotomy was performed in the posteroinferior quadrants of both tympanic membranes. In left ears, topical pH 4 standard calibration solution was used in groups 1 and 3, and pH 7 standard calibration solution was used in groups 2 and 4. Right ears served as controls, and allowed for spontaneous healing. The solutions were applied for 2 days in groups 1 and 2, and for 7 days in groups 3 and 4. Healing was assessed by macroscopic closure of the tympanic membrane perforation, and histopathological analysis of lamina propria edema, neovascularization, inflammatory cells, and fibroblastic reaction in the temporal bones. pH 7 and pH 4 groups were similar for macroscopic closure of perforation on day 2; however difference was significant on day 7. The fibroblastic activity was significantly less on days 2 and 7 in pH 4 group. On day 7, there were significant differences between pH 4 and pH 7, and pH 7 and control groups for inflammatory cell infiltration. In conclusion, clinical and histopathological results of this study indicated that acidic environmental pH speeded up and shortened wound-healing process. By building up optimum environmental pH, a healthy healing may be achieved in acute tympanic membrane perforations.

Patient Characteristics and Frequent Localizations of Rhinoliths.

OBJECTIVE: A rhinolith is a rare entity affecting all people in all age groups. It is defined as a mineralized foreign body. The purpose of the present study was to reveal the distribution in age and gender and the localization, side, and prominent symptoms of rhinoliths to identify the risk groups and characteristics of the rhinoliths in a large case series. METHODS: A retrospective review was performed from the medical charts of 28 patients who were diagnosed with rhinolith and underwent surgery between May 2011 and January 2015 in Ankara Research and Training Hospital. All data, including age, gender, duration of symptoms, localization of the lesion and accompanying pathologies, were documented. RESULTS: In total, 28 patients (18 females and 10 males) with a mean age of 26.2±16.6 (5-62) years who were diagnosed with rhinolithiasis were reviewed. Nasal obstruction (71.4%) and nasal discharge (64.3%) were the most common complaints. The rhinolith was located in the right nasal cavity in 24 patients and in the left in four; this difference was statistically significant (p<0.001). There were 11 accompanying pathologies including nasal septal deviation (n=6), nasal polyposis (n=2), concha bullosa (n=2), and adenoid vegetation (n=1). In 21 (75%) patients, the most common site was the nasal base of the cavity between the inferior turbinate and the nasal septum. CONCLUSION: If unilateral right-sided nasal obstruction with foul-smelling purulent discharge is detected in a young adult and a nasal examination reveals a mass in the floor of the cavity, a rhinolith should be strongly considered in the differential diagnosis.

Rigid or flexible laryngoscope: The preference of children.

OBJECTIVE: The aim of this study was to evaluate the effects of flexible and rigid endoscopes using a visual analog scale and reveal which one is better tolerated by children. MATERIAL AND METHODS: The pediatric patients with voice disorders examined between July 2012 and October 2014 were included the study. Patients to whom endoscopic visualization had been applied several times were recalled for information about their preference of scope. No local anesthetics were used before both procedures. Pain sensation, gag reflex or vomiting and dyspnea or breathiness were evaluated and graded using a visual analog scale (VAS). RESULTS: A total of 35 patients (77.1% males, 22.9% females) with a median age of 11.3±1.8 years (range, 7-15 years) were analyzed. Group 1 consisted of patients who preferred videolaryngostroboscopy (VLS) and Group 2 consisted of patients who preferred flexible fiberoptic nasopharyngoscopy (FFN). Overall, 28 (80%) of the patients preferred videolaryngostroboscopy (VLS) while 7 (20%) of the patients preferred FFN examination. In these examinations 20 patients (57.1%) felt pain, 17 (48.6%) felt irritation, 5 (14.3%) had gag reflex, and 2 (5.7%) had dyspnea. According to this data, the VLS (VAS) scores regarding gag reflex (p=0.017) and dyspnea domains (p=0.022) of the group who preferred FFL were statistically higher than those of the VLS group. No statistically significant difference was determined between the genders in respect of the VLS and FFL scores in all domains. Pain and irritation were the most prominent findings in patients who were reluctant to be examined by FFL. Irritation was statistically significantly higher in Group 1 (p=0.004). Gag reflex was the most disturbing finding described by patients who were reluctant to be examined by VLS. CONCLUSION: In this study, most of the children (80%) preferred rigid laryngoscopy rather than flexible fiberoptic laryngoscopy. Pain and irritation were the most prominent findings for patients who were reluctant to be examined by FFL. Rigid laryngoscopy can be recommended rather than FFN for evaluation of children with vocal fold pathologies.

Reinke Edema: Watch For Vocal Fold Cysts.

Reinke edema is one of the common cause of dysphonia middle-aged population, and severe thickening of vocal folds require surgical treatment. Smoking plays a major role on etiology. Vocal fold cysts are also benign lesions and vocal trauma blamed for acquired cysts. We would like to present 3 cases with vocal fold cyst related with Reinke edema. First case had a subepidermal epidermoid cyst with Reinke edema, which could be easily observed before surgery during laryngostroboscopy. Second case had a mucous retention cyst into the edematous Reinke tissue, which was detected during surgical intervention, and third case had a epidermoid cyst that occurred 2 months after before microlaryngeal operation regarding Reinke edema reduction. These 3 cases revealed that surgical management of Reinke edema needs a careful dissection and close follow-up after surgery for presence of vocal fold cysts.

Does helicobacter pylori have a role in the etiology of adenoid hypertrophy?

To investigate whether there is any association between nasopharyngeal reflux and adenoid hypertrophy in children by using 24-h pH monitoring with dual probe and to determine whether Helicobacter pylori simply colonises in adenoid tissue or it is present there temporarily due to extraesophageal reflux. A prospective study at a tertiary referral center. Thirty-two patients who underwent adenoidectomy, aged ranged between 4 and 13 were included. All children with adenoid hypertrophy underwent 24-h pH monitoring with a dual probe. Proximal probe was placed in the nasopharynx. The presence of nasopharyngeal reflux and gastroesophageal reflux were investigated by 24-h pH monitoring. The presence of H. pylori was investigated in adenoidectomy samples by HP-fast test. Of the 32 patients who underwent adenoidectomy, 5 had nasopharyngeal reflux positivity while 27 patients did not show nasopharyngeal reflux positivity with pH monitorisation. Helicobacter pylori could not be detected in 5 nasopharyngeal reflux positive children while 3 of 27 nasopharyngeal reflux negative children showed H. pylori positivity, one of them in the mucosa and others in the core. This study demonstrated the high incidence of nasopharyngeal reflux and gastroesophageal reflux in adenoid hypertrophy and the possible colonisation of H. pylori in the adenoid tissue. This may change the assesment of children with adenotonsillar hypertrophy in near future. However, more placebo controlled and double blind studies and larger series are still needed to support this hypothesis.

Nasalance scores in pediatric patients after adenoidectomy.

OBJECTIVE: Adenoidectomy is one of the most frequently performed operations in childhood. Nasal obstruction and chronic infection are the basic indications for surgery. Nasometer measures both oral and nasal air pressure during loud speech, and calculates their ratio. The aim of this study was to compare the mean nasal values in patients who had adenoidectomy at different ages against a control group. METHODS: Eighty children between the ages of three and sixteen that had adenoidectomy in our clinic between 2006 and 2010 were compared against eighty age-matched controls who had not had nasal obstruction in their lifetime and were proven to have open nasal airways on physical examination. RESULTS: Statistical analysis of the data showed that mean nasalance scores were significantly lower in patients who had adenoidectomy before 6 years of age when compared to the ones who had the operation after the age of six. In addition, when we compared the children who had adenoidectomy before 5 years of age and between 5 and 6 years of age, we found that their nasalance scores were significantly lower when compared to those who had adenoidectomy after the age of six (p = 0.017 and p = 0.019, respectively). CONCLUSION: This study has shown that, even when adenoidectomy is performed, hyponasality may continue in clinically symptomatic patients under the age of six, and that there are no determined risk factors other than the early age.