The effect of N95 and surgical masks on mucociliary clearance function and sinonasal complaints.

PURPOSE: The aim of this study was to reveal the effect of N95 and surgical masks on mucociliary clearance function and sinonasal complaints. METHODS: Sixty participants were enrolled in this study, including 30 people in N95 mask group and 30 people in surgical mask group. Two interviews, three days apart, were performed with all participants. The participants were asked not to use any mask before the first interview while they were asked to use the determined mask just before the second interview for 8 h. In both interviews, the mucociliary clearance times (MCTs) were measured and participants were asked to score ten distinct sinonasal complaints using visual analog scale (VAS). Data obtained from first interview were named pre-mask data, data obtained from second interview were called after-mask data. In both groups, pre-mask MCTs and VAS scores were compared with after-mask MCTs and VAS scores. RESULTS: After-mask MCTs (mean = 13.03 ± 6.05 min) were significantly longer than pre-mask MCTs (mean = 10.19 ± 4.21 min) in N95 mask group (p = 0.002). No significant difference was found between after-mask and pre-mask MCTs (mean = 12.05 ± 5.21 min, mean = 11.00 ± 5.44 min, respectively) in surgical mask group (p = 0.234). When after-mask VAS scores were compared with pre-mask VAS scores, it was found that N95 mask use increased nasal blockage and postnasal discharge, surgical mask usage increased nasal blockage. CONCLUSION: While the use of N95 mask leads to nasal blockage and postnasal discharge, surgical mask use results in nasal blockage. N95 masks cause impairment in mucociliary clearance function. But all these effects are mild. Surgical masks have not been found to have any effect on mucociliary clearance function.

Effect of Deviated Nasal Septum on Choriodal Thickness.

INTRODUCTION: Nasal septal deviation (NSD) is one of the major causes of upper airway obstruction. Chronic hypoxia and hypercapnia due to NSD may affect the choroidal blood flow and may change the choroidal thickness (CT). In this study, the authors aimed to research the assessment of CT before and after septoplasty in patients with NSD. METHODS: Ninety-two patients who underwent septoplasty surgery with the diagnose of nasal septum deviation and 58 patients for control group were enrolled to the study. CT values measured before and three months after septoplasty surgery. RESULTS: CT values were subfoveal 272.51 ±â€Š27.62, nasal 245.50 ±â€Š21.22, temporal 248.35 ±â€Š30.25 and subfoveal 232.09 ±â€Š44.17, nasal 222.09 ±â€Š38.82,temporal 227.12 ±â€Š28.80 for the control and NSD groups, respectively (P < 0.001). Also choroid thickness values (subfoveal 232.09 ±â€Š44.17, nasal 222.09 ±â€Š38.82, temporal 227.12 ±â€Š28.80; subfoveal 252 ±â€Š18.90, nasal 228 ±â€Š22.12, temporal 240 ±â€Š25.80) were significantly different in patients with NSD, before and after septoplasty procedure, respectively (P < 0.001). CONCLUSION: To the authors' knowledge this is the first study investigating choroid thickness measurements before and after septoplasty in patients with NSD. We found significant correlation between NSD and CT. After septoplasty surgery at 3rd month, CT increased significantly in comparision with the preoperative values.

Comparison of two routes in nasal passage for transnasale flexible fiberoptic laryngoscopy.

PURPOSE: Present study compares two routes in nasal passage for transnasal flexible fiberoptic laryngoscopy (TNFFL). METHODS: Included in the study were 60 patients who were split equally into Group 1 and Group 2 and all underwent TNFFL. The tip of endoscope was introduced between the septum and inferior turbinate along the nasal floor in Group 1 and between the inferior turbinate and middle turbinate in Group 2. O2 saturation, heart rate, systolic blood pressure, diastolic blood pressure of patients were taken 30 min before and immediately after procedure. Patients were asked to rate the pain-irritation, gag reflex, dyspnea they experienced during procedure using visual analogue scale. Two routes were compared in terms of physiological effects and patient comfort. RESULTS: No statistically significant difference was found between two groups in terms of physiological effects or patient comfort. When values recorded immediately after procedure were compared with baseline values, a significant decrease was observed in O2 saturation and heart rate in Group 1 and Group 2, respectively. No clinically detectable symptoms were observed in the patients. CONCLUSION: Decreases in O2 saturation and heart rate may be regarded as physiological effects of TNFFL. No significant difference between two routes was noted in the present study in terms of physiological effects and patient comfort during TNFFL. Introducing the endoscope between the inferior and middle turbinates may be a comfortable and safe option, particularly if the endoscope cannot be advanced along the nasal floor due to septum deviation, septal crest, inferior turbinate hypertrophy.

Women in otolaryngology in Turkey: Insight of gender equality, career development and work-life balance.

OBJECTIVE: The aim of this study is to collect information about the demographics, academic ambitions, job satisfactions, career development and work-life balance of female otorhinolaryngologists (FORL) in Turkey and to determine their experiences with, and attitudes towards gender discrimination throughout their academic careers. STUDY DESIGN AND SETTING: A prospective survey study. SUBJECTS AND METHODS: The study was aimed to include all FORL who completed their residency program. An online survey was used to collect their responses. RESULTS: Out of 208 invitations, 156 FORL participated to the survey. The mean age of the participants was 39.7 ±â€¯6.1 (29-75) years. 16.6% of the FORL used to occupy or still occupying administrative positions in their respective medical centers; 15.4% of them used to be assigned or still being assigned to a duty in otorhinolaryngology associations. Gender discrimination was 2.5 fold higher (p = 0.006 OR: 2.55 (95% CI 1.31, 4.99) in departments where there were no female faculty members. 53.2% of the female surgeons were both physically and psychologically harassed for their gender during their residency programs to deter from completing their program in otolaryngology. This finding is 4.1 fold higher than those who stated that they had not been exposed to any such gender discrimination (p = 0.001 OR: 4.094 (95% CI 2.22, 7.57). CONCLUSION: Healthcare policy-makers and institutions should consider taking all the necessary actions to prevent gender discrimination in order to increase job satisfaction and achievements of female specialists in the field of otorhinolaryngology.

Flexible CO2 Laser Treatment for Subglottic Stenosis.

OBJECTIVES: To assess the efficacy and safety of flexible fiber CO2 laser surgery for subglottic stenosis and to present retrospective experience of 14 patients treated with flexible fiber CO2 laser system. To determine the characteristics, management protocols, prognostic factors, and postoperative outcomes of the sample. METHODS: Retrospective review of patients with subglottic stenosis undergoing flexible fiber CO2 laser surgery at the tertiary medical center. All demographic and clinical data were collected, radiologic and endoscopic evaluations were performed to assess the characteristics of stenosis. Myer-Cotton grading scale was used for classification of stenotic area. RESULTS: All patients have subglottic stenosis due to intubation-related causes and inappropriate tracheostomy procedure. The duration of intubation period ranged from 15 days to 4 years; 11 patients have grade III stenosis according to Myer-Cotton system and there was cricoid involvement in 2 patients. The mean follow-up period was 5.2 months and postoperative decannulation was achieved in 10 patients (71.4%). CONCLUSIONS: Subglottic stenosis is the difficult situation to manage minimal invasively. Flexible fiber CO2 laser surgery is safe and effective in the management of properly selected patients and can be used as a first option for patients.

The effects of dust storms on quality of life of allergic patients with or without asthma.

OBJECTIVES: This study aims to investigate the quality of life of allergic patients with or without asthma during dust storms. PATIENTS AND METHODS: A total of 148 allergic patients (66 males, 82 females; mean age 35.7±15.5 years; range 18 to 65 years) were classified as those with (group 1, n=80) or without (group 2, n=68) concomitant asthma between January 2012 and January 2013. The quality of life [Short Form-36 (SF-36)] scores, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), nasal symptom and visual analog scale (VAS) scores at the time of diagnosis were obtained. The particulate matter (PM10) and sulfur dioxide (SO2) values of that day from the General Directorate of Meteorology were recorded. The day of dust storm and PM10 and SO2 measurements along with SF-36, RQLQ, nasal symptom and VAS scores were recorded again. RESULTS: The absolute change in the RQLQ subparameters including eye and nasal symptoms, practical problems and global scores was statistically significant (p=0.022, p=0.036, p=0.026 and p=0.032, respectively). There were statistically significant changes in the SF-36 subgroups of general health, physical functioning, vitality, and mental health (p=0.026, p=0.042, p=0.008 and p=0.026, respectively). In the multivariate logistic regression model, specific and general quality of life was 4.6 times worse in RQLQ and 3.8 times in SF-36 after the dust storm in patients with asthma, while 2.1 times worse in RQLQ and 1.9 times in SF-36 in patients with pure allergic rhinitis. The attributable risk of asthma was found to be 2.5 times higher in RQLQ and 1.9 times higher in SF-36. CONCLUSION: Dust storms may deteriorate the quality of life of patients with allergic rhinitis and asthma and lead to related personal and societal problems.

Uncinatotomy: performing endoscopic sinus surgery without an uncinectomy.

BACKGROUND: The results of endoscopic sinus surgery performed for chronic rhinosinusitis are controversial. For a better surgical outcome, different surgical techniques involving an uncinectomy as the primary step of the operation have been proposed. The surgery should resolve the pathophysiologic problems caused by the disease and preserve the normal anatomy and physiology. We developed a technique to remove the pathology localized to isolated maxillary and anterior ethmoid cells, without excising the uncinate process. The infundibular area was exposed with medialization of the uncinate with a bipedicle flap prepared 1.5 cm from the insertion of the uncinate to the nasal wall, and then the sinus pathology was removed. At the end of the surgery, the uncinate was returned to its original position. METHODS: We performed this new technique to 3 patients and evaluated postoperative results. RESULTS: Primary disease was eradicated, and no complication was noted. CONCLUSIONS: With this technique, it is possible to perform all steps of sinus surgery without excising any anatomic structure.

Comparison of nasal mucociliary clearance in adenoid hypertrophy with or without otitis media with effusion.

OBJECTIVE: To investigate pre- and postoperative mucociliary clearance in patients with adenoid hypertrophy or combined with otitis media with effusion. METHODS: Patients were divided into two groups: Group 1-patients with adenoid hypertrophy (AH), and Group 2-patients with AH and otitis media with effusion (AHOME). In all patients, AH size was recorded, and the Andersen saccharin and methylene blue tests were conducted before and 1 month after surgery to obtain mucociliary clearance time (MCT). Nasal cavity length was measured intraoperatively to establish mucociliary clearance velocity (MCV). Patients with allergic rhinitis, active infection, and history of nasal or ear surgery were excluded. RESULTS: This study included 64 patients with a mean age of 8.34 ± 2.98 years (range: 3-18 years). Pre- and postoperative MCT were 14.60 ± 4.83 and 9.48 ± 2.63 min in Group 1 and 16.03 ± 4.31 and 12.12 ± 3.78 min in Group 2, respectively. Pre- and postoperative MCV were 0.77 ± 0.30 and 1.16 ± 0.42 mm/min in Group 1 and 0.67 ± 0.16 and 0.89 ± 0.28 mm/min in Group 2, respectively. MCT and MCV were significantly improved postoperatively in both groups (p<0.001). In addition, the postoperative MCT and MCV of Group 1 were significantly better than those of Group 2 (p<0.001). Exposure to cigarette smoking and adenoid size had negative correlations with mucociliary clearance. CONCLUSIONS: Otitis media was associated with impaired mucociliary clearance and further studies should be performed to demonstrate the causes of this deficiency.

Septoplasty: under general or sedation anesthesia. Which is more efficacious?

The objective of the study was to assess the more efficacious anesthesia method in septal surgery. The prospective study was conducted at an academic secondary referral center. A prospective chart review of 60 patients, between the ages of 16 and 65, who underwent septal surgery under general (GA) or sedation (SDA) anesthesia during 1-year period was done. Mean age of the patients was 44.30 ± 13.29. Patients were divided into two groups according to the anesthesia method: general (group 1) or sedation (group 2). Intraoperative hemodynamic variables, surgery time, intraoperative blood loss volume, length of hospital stay, postoperative vomiting and nausea, postoperative pain score according to the visual analog scale (VAS) and cost analysis of each method were compared. Thirty-six males and 24 females with a mean age 44.30 ± 13.29 were included to the study. Total operation time, operation time, intraoperative and postoperative bleeding volume, postoperative nausea and vomiting, duration of hospital stay after surgery, were better in group 2. Postoperative pain scores and patient satisfaction about surgery were not statistically different. Cost of anesthesia in group 1 per patient was $44.35 ± 10.81 and in group 2, $16.29 ± 11.88 (p < 0.01). Hospital stay after surgery was much longer in group 1 than group 2 (p < 0.01). Using SDA is better in many ways including cost-effectiveness than using GA for septoplasty operation.

Sneezing and runny nose: should allergy testing be routinely performed?

The need for routine determination of rhinitis subtypes by allergy testing and the relevance between symptoms and allergy were evaluated. A retrospective study at a tertiary hospital, ENT clinic. One hundred and twenty-seven adult patients with sneezing and runny nose for at least 6 months for the last two consecutive years were included. The age range was 16-60. Allergy testing was only positive in 43.4% of the patients. Excluding mixed rhinitis, persistent sneezing and runny nose were mostly related to anatomical deformities, mainly septal deviation followed by vasomotor rhinitis. Persistent sneezing and runny nose may be caused by different etiologies other than allergy. Determination of rhinitis subtypes is important for accurate treatment of patients with these symptoms. Taking appropriate medical history and performing a good physical exam with objective allergy testing are highly recommended.

Inferior turbinate composite graft for repair of nasal septal perforation.

BACKGROUND: Repair of nasal septal perforations is one of the most challenging procedures in nasal surgery. The aim of this prospective clinical study was to determine the efficacy of using an inferior turbinate composite graft (ITCG) for the repair of nasal septal perforation. METHODS: Between 2009 and 2011, 27 consecutive patients with nasal septal perforation underwent endoscopy-assisted, endonasal septal perforation repair by using an ITCG alone or in combination with bipedicled mucosal advancement flap. RESULTS: Complete closure of the perforation was achieved in 24 of 27 (88.8%) patients, and incomplete closure was observed in 2 patients with medium-sized perforation and 1 patient with large perforation. CONCLUSION: The ITCG technique provides three-layer repair of the defect under no tension in closure of small perforations located anteriorly, posterior perforations with mucosal atrophy, or previous unsuccessful surgical repair. In graft-depleted revision rhinoplasty cases with small-sized septal perforations, this technique provides a simple solution with autogenous grafts. In cases involving larger perforations, the ITCG technique can easily be combined with bipedicled flap and allows for more options to solve a challenging problem. Current data from this prospective study suggest that this surgical technique may be used in the repair of nasal septal perforation.

A different type of branchial fistula as part of a branchiootorenal syndrome.

We describe an extremely rare case of a complete fistula, a combination of the first 2 branchial arches as a component of branchiootorenal syndrome. A 13-year-old girl presented with the complaint of intermittent drainage from bilateral preauricular and right lower neck external openings. A contrast fistulogram revealed a complete fistula. Diagnostic features and surgical techniques are discussed in detail.

[Results of revision surgery for hearing failure in intact canal wall up tympanoplasty for chronic otitis media without cholesteatoma]. / Kolesteatomsuz kronik otitis media için uygulanan intakt kanal duvar timpanoplasti sonrasi basarisiz isitme için uygulanan revizyon cerrahisi sonuçlari.

OBJECTIVES: This study assessed the audiometric results of revision surgery in patients on whom previous canal wall up tympanoplasty had been performed for chronic otitis media without cholesteatoma, and investigated reasons for hearing improvement failure which required revision surgery. PATIENTS AND METHODS: Seventy-two patients (49 females, 23 males; mean age 35.4+/-12.9 years; range 11 to 64 years) suffering from chronic otitis media without cholesteatoma, who had intact canal wall up tympanoplasty and revision surgery due to bad hearing results between March 2004 and September 2009, were evaluated retrospectively. After evaluation of patients' files, operative and audiological records, findings during the surgery, postoperative follow-up, audiometric results before revision surgery and the results in the last control after revision surgery were analysed. RESULTS: Preoperative mean air-bone gap (ABG) decreased in all patients from 31.2 dB to 19.9 dB after followed up for mean 26.7 months. Air-bone gap values below 20 dB were 67%, below 30 dB were 83%, hearing gain above 10 dB was found to be 58%. Comparision of pre- and postoperative ABG values of the patients revealed statistically significant difference (p<0.001). In addition to hearing loss, the reasons for revision surgery were mucosal disease relapse in 10 patients, graft perforation in 43 patients, otorrhea control in 15 patients. Findings during revision surgery were relapse of mucosal diseases in 15 patients, insufficient mastoidectomy in six patients, problems related to prosthesis in 29 patients, ossicular limitations (brid, hyalen and granulation) in 30 patients, and ossicular necrosis in six patients. The decision for four patients was changed from canal wall up tympanoplasty to canal wall down tympanoplasty. Postoperative total hearing loss developed in one case. CONCLUSION: The most important problem in revision of tympanoplasty patients with hearing loss is related with stabilisation of columella. To get successful hearing results, it is important to control disease and provide a stable and safe continuity between the tympanic membrane and vestibule.

[Repair of nasal septal perforation with different intranasal flap techniques and their outcomes]. / Nazal septal perforasyonun farkli intranazal flep teknikleri ile onarimi ve sonuçlari.

OBJECTIVES: The aim of this study was to reveal the efficacy of different nasal mucosal flap techniques in the repair of nasal septal perforation. PATIENTS AND METHODS: Between April 2006 and May 2009 21 patients (12 males, 9 females; mean age 36.6+/-12.7 years; range 17 to 60 years) with the complaints of nasal obstruction, bleeding, crusting, whistling during inspiration, and pain and in whom septum perforation was detected were operated on and they were included in this study. The patients were followed-up for an average of 16.9 months (3 to 35 months). Cross-stealing technique was performed on 11 patients while advancement flap was performed on three patients and rotation flap was performed on seven patients. Patients were followed-up for at least three months before the evaluation of the postoperative results. RESULTS: Complete closure was observed in 16 out of 21 patients (76.2%) and partial closure in one patient (4.8%). In four patients (19%) perforation was not closed and its size remained unchanged. CONCLUSION: In the literature, many different surgical techniques have been described for the repair of nasal septal perforation. The main aim of the repair is not only the closure of perforation but also the restoration of normal function and physiology in the nose. In order to achieve this, the most physiologically and anatomically suitable method is the closure of nasal septal perforation with three layers composed of two mucoperichondrial flaps and one interpositional graft. Although cross-stealing technique may be an anatomically and physiologically feasible option for the closure of small-middle sized perforation located anteriorly, the highest success rates are obtained with advancement and rotation flaps when the location and size of perforation are considered.

Cutaneous horn on the upper lip associated with squamous cell carcinoma.

Cutaneous horn is a protrusion from the skin consisting of cornified material. It usually appears on exposed skin areas especially on the head and neck. A 70-year-old woman applied to our clinic with a hard, conical, black-grey 2 cm lesion on the upper lip. On physical examination, there was no palpable lymph node in the neck other than the lesion. Diagnosed to be cutaneous horn, the lesion was completely removed together with 4-5 mm surrounding tissues under local anaesthesia. The histopathological examination reported this lesion to be cutaneous horn with well differentiated squamous cell carcinoma at its base. No recurrences or metastasis were detected within a follow-up period of 5.5 years. It should be kept in mind that cutaneous horns may be associated with premalignant and malignant lesions at the base, masking numerous conditions.

The nasal septum: an unusual presentation of metastatic renal cell carcinoma.

A 45-year-old woman with metastatic renal cell carcinoma to the nasal septum was presented in this study. Metastatic neoplasms of the paranasal region are so rare that they have been usually reported as case reports. Although there are reported cases of renal cell carcinoma to the paranasal sinuses, this case was unique in that it is an isolated metastasis to the nasal septum. The clinical presentation, radiologic and pathologic investigations, and the treatment of patient with surgery and chemotherapy with sunitinib malate (Sutent) were discussed.

Sialolipoma of the parotid gland.

A 33-year-old male patient with a slow-growing, painless, well-circumscribed soft tissue mass on the left parotid region is presented. The clinical impression was that of a benign salivary gland tumor. The tumor was situated in the superficial lobe of the gland, and a superficial parotidectomy was performed, with preservation of the facial nerve. Histopathologic examination results revealed a sialolipoma of the parotid gland and a lesion that consisted of both mature adipose tissue and glandular elements. Sialolipomas share similar clinical features with conventional lipomas of the salivary glands. Preoperative diagnosis is generally difficult, and computed tomographic scanning is useful in defining these benign parotid gland masses. Superficial parotidectomy is the usual surgical treatment for parotid gland superficial lobe lipomas, with near-total absence of recurrence.

The expression of MMP-2, MMP-7, MMP-9, and TIMP-1 in chronic rhinosinusitis and nasal polyposis.

OBJECTIVES: To investigate the expression and clinical significance of MMP-2, MMP-7, MMP-9, and TIMP-1 in patients with nasal polyposis (NP) and chronic rhinosinusitis (CRS). STUDY DESIGN: Prospective study. SUBJECTS AND METHODS: This study involved 54 patients. There were three groups: nasal polyposis group, chronic rhinosinusitis group, and control group. Specimens were collected during endoscopic sinus surgery. Each sample was immunohistochemically examined. RESULTS: Expression of MMP-2 was found significantly increased in NP, whereas MMP-7 expression was found significantly increased in CRS (P < 0.001). TIMP-1 was significantly high in control group compared to CRS and NP (P < 0.001 and P = 0.002, respectively). CONCLUSIONS: Different regulation type of activation of MMPs has been found in these two diseases. If MMP-2 expression is intense in the mucosa, then this ends with polyp formation; if MMP-7 expression is intense, it ends with CRS or stays as CRS.

Acoustic rhinometry in the objective evaluation of childhood septoplasties.

OBJECTIVE: The aim of this study was to evaluate results of septoplasty during childhood objectively with the help of acoustic rhinometry (AR). METHODS: Twenty-six children aged between 6 and 15 years who had septoplasty for nasal septal deviation during year 2002 were included in this study. Twenty-one patients who had no nasal septal deformities and nasal symptoms were included as control group. The study group was divided into two subgroups: Group 1 with only anterior septal deviation (8 patients) and Group 2 with both anterior and posterior septal deviations (18 patients). Acoustic rhinometry was performed one day preoperatively and 4 months postoperatively. Preoperative and postoperative minimal cross-sectional areas (MCSA), total volumes (TV), MCSA and TVs on pathologic side were compared. Acoustic rhinometry was performed 2 months interval in control group. Patients and parents were asked about the effectiveness of surgery subjectively. RESULTS: There was a statistical significance between preoperative and postoperative MCSAs of Groups 2 and 1+2. There was no statistical significance for Group 1. There was statistical significance between control group and Groups 1, 2, 1+2 in terms of MCSAs, MCSAs on pathologic side and TVs on pathologic side. There was statistical significance in terms of preoperative and postoperative MCSAs, TVs, MCSAs and TVs on pathologic side in patients with subjective well being postoperatively. There was no statistical significance in patients without any subjective postoperative improvement in terms of preoperative and postoperative MCSAs and MCSAs on pathologic side while TVs and TVs on pathologic side were statistically significant. CONCLUSIONS: Surgery is successful in children. But it should be restricted to only the pathologic area and should be conservative. Acoustic rhinometry is an objective method for the evaluation of nasal septal deformities and surgical success. Further studies are needed to see long-term success of septal surgery in children.

Sudden hearing loss due to large vestibular aqueduct syndrome in a child: should exploratory tympanotomy be performed?

A 16-year-old girl applied to our ENT clinic with a 3-day history of right hearing loss, tinnitus, and pressure in the right ear. She had had surgery for right perilymph fistula two times, one at the age of 7 and the second at the age of 9. She had recovered after both of these surgeries. This time she had exploratory tympanotomy and perylymh fistula was detected. Computerized tomography investigation obtained after 5 days postoperatively showed bilateral large vestibular aqueducts and otherwise normal inner ear structures. Thyroid function tests and neck palpation were normal. It was an unusual case with both large vestibular aqueduct syndrome (LVAS) and simultaneous spontaneous perilymph fistula.