Comparison of preoperative anxiety, bruxism, and postoperative pain among patients undergoing surgery for septoplasty, endoscopic sinus surgery, and tympanoplasty.

Background: Septoplasty, endoscopic sinus surgery, and tympanoplasty are the most commonly performed elective functional ear-nose-throat surgeries. Aim: This study investigated the relationship between preoperative anxiety, bruxism, and postoperative pain in inpatient groups undergoing three different functional otorhinolaryngologic surgeries. Patients and. Methods: This study was conducted in a single center of a tertiary referral hospital. The patients (n = 90) who had undergone septoplasty (group A), endoscopic sinus surgery (group B), and tympanoplasty (group C) were included. The State-Trait Anxiety Inventory (STAI) questionnaire and the Amsterdam Preoperative Anxiety Information Scale (APAIS) were administered. To evaluate bruxism, a self-questionnaire was administered, and for the evaluation of pain, the visual analogue scale (VAS) was administered. Results: In group C, preoperative STAI and APAIS and early and late pain values were higher than in the other groups. When patients were divided into two groups according to the presence of bruxism. A significant difference was found between the preoperative STAI and immediate and late VAS values (P < 0.001). A strong correlation was observed between APAIS and early and late VAS values in group C (P < 0.001). Conclusion: Patients who will undergo tympanoplasty should be aware of the preoperative anxiety level and pain follow-up. Bruxism can be considered a vital follow-up parameter that manifests due to high preoperative anxiety. It may also be useful to examine preoperative bruxism and take appropriate measures due to its pain-increasing effect in patients.

Does the radioactive iodine dose affect smell, taste sensation and nose function?

OBJECTIVE: To detect whether the adverse effects of post-operative radioactive iodine therapy following differentiated thyroid cancer on smell, taste and nasal functions were associated with radioactive iodine dose. METHODS: Fifty-one patients who had undergone total thyroidectomy because of differentiated thyroid cancer were divided into two groups depending on the post-operative radioactive iodine therapy dose: low dose group (50 mCi; 21 patients) and high dose group (100-150 mCi; 30 patients). The Sniffin' Sticks smell test, the Taste Strips test and the 22-item Sino-Nasal Outcome Test were performed on all patients one week before therapy, and at two months and one year following therapy. RESULTS: Statistically significant differences were detected in the Sniffin' Sticks test results, total odour scores, total taste scores and Sino-Nasal Outcome Test results between the assessment time points. There was no statistically significant difference between the low and high dose groups in terms of odour, taste or Sino-Nasal Outcome Test scores either before or after therapy. CONCLUSION: Radioactive iodine therapy has some short- and long-term adverse effects on nasal functions and taste and odour sensations, which affect quality of life. These effects are not dose-dependent.

Evaluation of serum ischaemia-modified albumin levels in patients with Bell's palsy.

OBJECTIVE: This prospective study aimed to evaluate the relationship between serum ischaemia-modified albumin levels and Bell's palsy severity. METHODS: The study included 30 patients diagnosed with Bell's palsy and 30 healthy individuals. The patients were separated into three disease severity groups (grades 2, 3 and 4) according to House-Brackmann classification. Blood samples were collected from all participants and the results compared between groups. RESULTS: Significant differences in serum ischaemia-modified albumin were found between the study and control groups (p < 0.001); values were significantly higher in the study group than in the control group. CONCLUSION: The significantly higher levels of serum ischaemia-modified albumin in the study group suggest that Bell's palsy pathogenesis is associated with oxidative stress.

Nasal eosinophilia in nasal smears of patients with persistent and intermittent allergic rhinitis.

BACKGROUND: Eosinophils are the principal effector cells involved in the pathogenesis of allergic rhinitis. Cell numbers increase in non-allergic rhinitis patients with eosinophilia, aspirin hypersensitivity and nasal polyposis, as well as in allergic rhinitis patients. Exfoliative nasal cytology can be used in the differential diagnosis of allergic rhinitis. OBJECTIVE: To evaluate nasal eosinophilia in nasal smears of patients with mild, persistent and intermittent allergic rhinitis. METHODS: The study comprised 60 patients with allergic rhinitis and 20 healthy volunteers. The patients were divided into intermittent and persistent allergic rhinitis groups. Nasal smear status, eosinophil numbers and Total Nasal Symptom Scores were compared. RESULTS: Nasal smear results were pathological in 40 of 60 allergic rhinitis patients, which was significantly higher than the rate in controls. The mean nasal eosinophilia score was significantly higher in the intermittent allergic rhinitis than in the persistent allergic rhinitis group (p = 0.029). There was a positive correlation between nasal eosinophilia score and Total Nasal Symptom Score (r = 0.652; p < 0.05) in persistent allergic rhinitis and intermittent allergic rhinitis patients. CONCLUSION: The nasal smear test is inexpensive, objective and simple to perform, and should be part of the diagnostic investigation.

Effects of CyberKnife therapy for vestibular schwannoma on hearing: a retrospective study.

OBJECTIVES: To evaluate the effects of CyberKnife stereotactic radiotherapy for the treatment of vestibular schwannoma on hearing, as evaluated by audiological tests. METHODS: Patients with vestibular schwannoma were evaluated before and after CyberKnife radiosurgery. Evaluation included pure tone thresholds, speech discrimination scores, auditory brainstem responses and radiological signs. RESULTS: The study comprised 26 patients diagnosed with vestibular schwannoma and subsequently treated with CyberKnife radiosurgery. The mean follow-up time was 16.4 months. The mean post-treatment hearing preservation rate was 69.23 per cent. There was no significant relationship between hearing loss after treatment and patient age, radiation dosage during treatment, or size of tumour. With regard to auditory brainstem responses, patients with hearing loss following treatment had a significantly higher inter-peak latency between waves I-III than patients with preserved hearing. CONCLUSION: Stereotactic CyberKnife radiosurgery is an excellent alternative treatment modality for patients with vestibular schwannoma, and results in acceptable preservation of hearing. Residual hearing following CyberKnife therapy is not significantly affected by factors such as age, size of tumour or dosage of treatment.

How does electronic cigarette smoking affect sinonasal symptoms and nasal mucociliary clearance?

OBJECTIVE: is to evaluate the sinonasal symptom scores and mucociliary clearance (MCC) after starting to use electronic cigarette METHODOLGY: This prospective randomized single-blind clinical trial was conducted between March 2013 and November 2013. Patients (n=98) admitted to smoking cessation clinic were divided into two groups; Electronic cigarette smokers (group 1) and non-electronic cigarette smokers (group 2). SNOT-22 and saccharin transit time for MCC were evaluated before starting electronic cigarettes and after the third months. RESULTS: SNOT-22 scores and MCC time were evaluated between groups and within groups after 3 months. SNOT 22 scores and MCC measurements showed no difference between groups before the cessation of cigarette smoking (p >0.05). SNOT 22 results of both groups revealed statistically significantly lower scores after the three months (p < 0.05). However, SNOT-22 scores of group 2 was significantly better than group 1 (p > 0.05). Comparison of MCC results of group 2 revealed statistically significantly lower scores after the three months (p < 0.05). However, group 1 did not show any significant difference after three months (p > 0.05). There was a significant difference between the groups at the third month measurements (p < 0.05). CONCLUSIONS: Although EC is widely used as a method of quitting smoking, it has negative effects on the sinonasal symptoms and MCC.

How do voice restoration methods affect the psychological status of patients after total laryngectomy?

OBJECTIVE: This study investigated the relationship between psychological well-being and different voice rehabilitation methods in total laryngectomy patients. METHODS: The study enrolled 96 patients who underwent total laryngectomy. The patients were divided into three groups according to the voice rehabilitation method used: esophageal speech (24 patients); a tracheoesophageal fistula and Provox 2 voice prosthesis (57 patients); or an electrolarynx (15 patients). The participants were asked to complete the Turkish version of the Voice Handicap Index-10 (VHI-10) to assess voice problems. They were also asked to complete the Turkish version of the Perceived Stress Scale (PSS), and the Hospital Anxiety and Depression Scale (HADS). The test scores of the three groups were compared statistically. RESULTS: Patients who used esophageal speech had a mean VHI-10 score of 10.25 ± 3.22 versus 19.42 ± 5.56 and 17.60 ± 1.92 for the tracheoesophageal fistula and Provox 2 and electrolarynx groups respectively, reflecting better perception of their voice. They also had a PSS score of 11.38 ± 3.92, indicating that they felt less stressed in comparison with the tracheoesophageal fistula and Provox 2 and electrolarynx groups, which scored 18.84 ± 5.50 and 16.20 ± 3.49 respectively. The HADS scores of the groups were not different, indicating that the patients' anxiety and depression status did not vary. CONCLUSION: Patients who used esophageal speech perceived less stress and were less handicapped by their voice.

Eight years of clinical findings and biopsy results of nasopharyngeal pathologies in 1647 adult patients: a retrospective study.

OBJECTIVES: We performed an 8-year retrospective study to evaluate the presentation, clinical findings and nasopharyngeal biopsy results of adult nasopharyngeal pathologies. METHODOLOGY: This study included 1647 patients (801 males and 846 females) admitted to outpatient clinics. All patients underwent a nasopharyngeal biopsy for a nasopharyngeal mass. In addition, a blind biopsy was taken if there was suspicion of nasopharyngeal carcinoma, even in the absence of a mass lesion. The pathological diagnoses were analysed on the basis of the age, sex and clinical presentation of the patients. RESULTS: Patient age ranged between 18 and 85 years; the mean was 36 years. Patient age differed significantly between those with benign and malignant disease (p=0.000); the risk of malignancy increased with age. Benign disease was found in 97.4% of the patients. Reactive lymphoid hyperplasia was the most common condition; it was found in 92.71% of benign cases. Undifferentiated nasopharyngeal cancer was the most common malignant disease, being found in 82.95% of all nasopharyngeal malignancies and in 4.43% of all nasopharyngeal disease. The most common symptom was nasal obstruction. The other main symptoms were hearing loss and neck mass. Neck mass was associated with malignancy. CONCLUSIONS: Benign disease of the nasopharynx is more common than malignant pathology in patients with a nasopharyngeal mass. Although adenoidal tissue undergoes regression in the adolescent period, this tissue may present as the chief cause of nasal obstruction in adults. Age and symptoms may predict malignant disease.

Effects of systemic steroids on life quality in sinonasal polyposis.

OBJECTIVE: To determine the effectiveness of short-term glucocorticoid therapy on nasal polyposis. METHODOLOGY: A total of 60 patients with sinonasal polyposis were given oral glucocorticoid therapy (1 mg/kg) for 20 days. Patient symptoms were evaluated with the Sino-Nasal Outcome Test 20 (SNOT-20). Computerized tomography (CT) images of the paranasal sinus were acquired before and after treatment and were evaluated with the Kennedy scoring system. RESULTS: Evaluation of paranasal CTs showed complete disease resolution in 15 patients and partial disease resolution in 25 patients. Patients with complete and partial resolutions,based on CT images, exhibited significant decreases in disease stages. Statistical analysis revealed a significant change in the SNOT-20 results (P < 0.01). There were no statistically significant differences among the evaluations based on the paranasal sinus CTs, the SNOT-20, and the SNOT-20 combined with a subjective selection of the five most disturbing symptoms (SNOT-20(+5)) (P > 0.05). CONCLUSION: The results showed a strong correlation between radiological changes and improvements in quality of life, assessed with the SNOT-20 or the SNOT-20(+5).

Effectiveness of azelastine nasal spray in the treatment of adenoidal hyper-trophy in children.

AIM: To evaluate the effects of topical azelastine treatment on symptoms related to adenoid hypertrophy and the size of adenoid tissue in children. MATERIAL AND METHODS: In total, 60 children who were found to have adenoid hypertrophy were included. A questionnaire on nasal symptoms, nasal endoscopy and skin prick tests was administered to all patients. All patients had complaints of chronic nasal obstruction symptoms and nasal endoscopy showed > 75% choanal obstruction, attributable to adenoid pads. The adenoid/nasopharyngeal areas were calculated. All of the patients underwent azelastine nasal spray therapy (1 spray per nostril, twice daily; 0.28 mg/dose) for 30 days. After 1 month, all children were reassessed. The efficacy of therapy, symptoms, adenoid / nasopharynx ratio, and obstruction ratio, obtained by endoscopy, were compared. RESULTS: Azelastine treatment was well tolerated by all patients. After the first treatment period, the severity of symptoms, endoscopic grade, and adenoid size decreased in all of the 60 patients. There were significant improvements in total subjective symptoms (nasal obstruction, rhinorrhea, cough, snoring, and obstructive sleep apnea) post-treatment. CONCLUSIONS: Azelastine nasal spray may be useful in decreasing adenoid pad size and the severity of symptoms related to adenoidal hypertrophy. Hippokratia 2014; 18 (4): 340-345.

Submandibular hydatid cyst fistulized into the oral cavity.

UNLABELLED: Hydatid cysts of the head and neck are rare, even in regions where echinococcal infestation is endemic. Although complications, like cyst rupture and infection, may occur, an external fistula is extremely rare. This study examined a case of hydatid cyst that had fistulized in the right submandibular region of the oral cavity, which eroded the mandible. CASE REPORT: A 45 year-old female patient visited our clinic with complaints of a discharge that left a bad taste in her mouth that persisted for 1 month and a painless swelling in the right submandibular region that had slowly expanded over the past 5 months. A physical examination revealed a cystic mass located in the right submandibular region that had fistulized in the oral cavity. The results were consistent with a hydatid cyst. We performed submandibular gland exeresis and a marginal mandibulectomy to excise the hydatid cyst together with the fistulous tract.

Vitamin B12 levels in patients with tinnitus and effectiveness of vitamin B12 treatment on hearing threshold and tinnitus.

OBJECTIVES: The aim of this study was to determine vitamin B12 levels in patients with non-pulsatile tinnitus and to assess the efficacy of replacement treatment in tinnitus and hearing in patients with vitamin B12 deficiency. MATERIALS AND METHODS: We assessed 100 patients (mean age, 43.87, SD 10.12; 62 females, 38 males) and 20 healthy volunteers (9 females, 11 males). Patients whose blood serum vitamin B12 levels were below 180 pg/mL were deemed to be vitamin B12-deficient. The effect of vitamin B12 replacement treatment on hearing was examined using audiometric tests between 250 and 20000 Hz, and we compared results with a visual analogue scale (VAS) before and after treatment, which helped to produce an objective assessment of the therapeutic results in tinnitus. RESULTS: Tinnitus was found to be unilateral in 57% of cases (the right ear in 56% and the left ear in 44% of these cases) and bilateral in 43% of cases. Of the patients with tinnitus, 63 had low B12 vitamin levels, and 37 had normal B12 vitamin levels. No statistically significant difference was found with the control group levels (p = 0.80, odds ratio = 1.13). No significant change was observed in tinnitus severity after vitamin B12 therapy. Eight of these patients reported some relief in tinnitus on the VAS, but the rate of improvement was not significant (p > 0.05). In the tinnitus patients with low B12 vitamin levels, audiometric tests conducted after B12 vitamin treatment revealed a significant improvement in hearing levels only at the 250 Hz frequency. No change was observed at other frequencies. CONCLUSION: B12 replacement treatment was not effective in these patients with tinnitus. Some patients improved following vitamin B12 supplementation but the results were not significant. More studies are needed to find the reasons for, and effective treatment of, tinnitus since the aetiology of subjective tinnitus is highly variable.