Original Research: Aerosolized Lidocaine: Effective for Safer Arousal After Suspension Laryngoscopy.

AIM: To examine the systemic and local effects of the lidocaine on the larynx and trachea which is applied after the end of the surgery and through various application methods. STUDY DESIGN: Randomized controlled prospective study. METHOD: The study is composed of patients who underwent suspension laryngoscopy (SL) for benign laryngeal diseases (cysts, polyp, granuloma, etc) and American Society of Anesthesiologists (ASA) I, between January 2017 and January 2018. The patients were randomly divided into 3 groups. In the first group nothing is applied at the end of the surgery and called as control group, second group received 7 pufs of aerosolized 10% lidocaine solution (70 mg) over larynx and trachea and third group received cotton swaps that impregnated in 1 ml of 20 mg lidocaine solution over surgical area for 1 minutes. Operation and arousal times, heart rate and mean arterial blood pressure levels were noted and compared. Also laryngospasm, cough, and agitation scores were obtained during arousal. RESULTS: 64 patients were included in the study. Laryngospasm was not observed in any of the patients. In group 2 (aerosolized lidocaine group), patients' blood pressure remained similar while increased in other groups (P < 0.05). Agitation scores were significantly lower in group 2 compared to the other groups (P = 0.012). Cough reflex is observed less in group 2 but result was not statistically significant (P = 0.13) CONCLUSION: The usage of aerosolized lidocaine after suspension laryngoscopy is very effective in blocking the stimulation of superior laryngeal nerve and sympathetic nerves which were responsible for the pressor reflexes. The inhibition of these reflexes before or during arousal could secure a safer arousal.

The follow-up results of newborn hearing screening of Gaziosmanpasa Taksim Research and Training Hospital.

AIM: This study aimed to present the results of newborns who were referred to advanced audiology centers after newborn hearing screening, and to determine concordance of our results with the American Academy of Pediatrics guidelines about the ages of hearing loss, aid fitting, and cochlear implantation. MATERIALS AND METHODS: A total of 7502 newborns were screened in Gaziosmanpasa Taksim Research and Training Hospital between March 2014 and June 2016 using the transient otoacustic emissions test as the first two steps and automated auditory brainstem response test for the third step. Newborns who had risk factors were screened using the automated auditory brainstem response only. Newborns who failed the screening tests were referred to advanced audiology centers. RESULTS: Of the 7502 newborns, 6736 (90%) completed the screening. The ratio of hearing loss was 0.08%. Six of 62 newborns who failed auditory brainstem response test and were referred to advanced audiology centers had severe bilateral hearing loss. One of the patients was not fitted with a hearing aid because the family refused it. The other one was not fitted an aid and did not undergo cochlear implantation because of severe and treatment-resistant acute otitis media. The age of diagnosis for the rest was before three months, and except for one patient, hearing aid fitting was before six months. The age of cochlear implantation was 12 months for two patients and 14 months for two patients. CONCLUSION: Ninety percent of patients completed the screening, the age of diagnosis for hearing loss was before three months and aid fitting was before six months, except for one patient. The results of the study were compatible with the diagnosis and treatment guidelines of the American Academy of Pediatrics.

Eustachian tube diameter: Is it associated with chronic otitis media development?

OBJECTIVE: To evaluate the effect of ET diameter on Chronic Otitis Media (COM) pathogenesis. STUDY DESIGN: Retrospective. SUBJECTS AND METHODS: Patients with unilateral COM disease are included in the study. The connection between fibrocartilaginous and osseous segments of the Eustachian Tube (ET) on axial Computed Tomography (CT) images was defined and the diameter of this segment is measured. The measurements were carried out bilaterally and statistically compared. RESULTS: 154 (76 (49%) male, 78 (51%) female patients were diagnosed with unilateral COM and included in the study. The mean diameter of ET was 1947mm (Std. deviation±0.5247) for healthy ears and 1788mm (Std. deviation±0.5306) for diseased ears. The statistical analysis showed a significantly narrow ET diameter in diseased ear side (p<0.01). CONCLUSION: The dysfunction or anatomical anomalies of ET are correlated with COM. Measuring of the bony diameter of ET during routine Temporal CT examination is recommended for our colleagues.

Modified Mallampati Score Improves Specificity of STOP-BANG Questionnaire for Obstructive Sleep Apnea.

BACKGROUND: An accurate, clinical screening tool for obstructive sleep apnea (OSA) that identifies patients for further diagnostic testing would assist in the diagnosis of this comorbidity. One example, the STOP-BANG questionnaire (SBQ), has been validated as a screening tool with high sensitivity. However, its specificity may result in a high false-positive rate. The aim of this study to determine if addition of the Modified Mallampati score to the SBQ improves its specificity. METHODS: The authors studied 162 patients referred to the Sleep Disorders Clinic at Yedikule Chest Disease Education and Research Hospital. All patients were prospectively screened for risk of OSA using the SBQ, their oral anatomy was assessed by Modified Mallampati scoring, and sleep quality characterized by polysomnography. Polysomnography results were reviewed when available and the predictive performance of the SBQ and the modified SBQ scoring models were compared. RESULTS: In the authors' study an SBQ score ≥3 yielded sensitivities of 0.85, 0.86, and 0.91 for Apnea-Hypopnea Index (AHI) ≥5/h, AHI ≥15/h, and AHI ≥30/h, respectively, and specificities of 0.09, 0.10, and 0.18. The modified SBQ with a cutoff of ≥4 (>3) points for AHI levels of >5, >15, and >30 yielded respective sensitivities of 0.84, 0.86, and 0.91 and specificities of 0.25, 0.26, and 0.27. CONCLUSIONS: The author's results from indicated the modified SBQ with a cutoff of >3 points in this study was more specific than the standard SBQ but no less sensitive, and may be used in identifying OSA patients for further diagnostic evaluation or avoiding unnecessary testing.

An assessment of olfactory function in patients with laryngopharyngeal reflux disease.

CONCLUSIONS: The results reported here indicate that there was a statistically significant difference in the olfactory functions of laryngopharyngeal reflux patients vs the healthy group. To the best of the authors' knowledge, this study is the first to evaluate the olfactory function of patients diagnosed with laryngopharyngeal reflux using an objective method, 24-h pH monitoring. OBJECTIVES/HYPOTHESIS: The aim of this study was to investigate olfactory functions in laryngopharyngeal reflux (LPR) patients and compare the results with healthy controls. METHODS: A total of 60 participants; 30 men and women with a diagnosis of laryngopharyngeal reflux and 30 healthy controls, were included in the study. Patients in the laryngopharyngeal reflux group were evaluated by the Reflux Symptom Index (RSI), Reflux Finding Scores (RFS), and finally 24-h pH monitoring to confirm the diagnosis of laryngopharyngeal reflux. The Sniffin' Sticks olfactory test results of the laryngopharyngeal reflux and control groups were compared, and the relationship between the study findings and the olfactory parameters were evaluated. RESULTS: The odor threshold, odor discrimination, odor identification, and TDI scores of the laryngopharyngeal reflux group were significantly lower than those of the control group. Also there was a statistically significant negative correlation detected between the olfactory test and some symptom and finding scores.

The importance of voice analysis in evaluating the effectiveness of reflux treatment.

OBJECTIVES: This study aims to investigate the effects of reflux treatment in voice disorders in laryngopharyngeal reflux (LPR) patients using acoustic analyses and the relationship between scoring systems. PATIENTS AND METHODS: A total of 84 LPR patients (18 males, 66 females; mean age 43.1±11.3 years; range 18 to 73 years) were evaluated using reflux symptom index (RSI), reflux findings score (RFS), videolaryngostroboscopic examination, and acoustic analysis with Dr. Speech 4 before LPR treatment and at the first and third months after treatment. RESULTS: Maximum phonation time, fundamental frequency (F0), jitter, and shimmer scores did not show any statistically significant alteration at the posttreatment period according to pretreatment scores (p>0.05). However, the alteration in Harmonics-to-Noise ratio and Signals-to-Noise ratio scores were statistically significant (p=0.017 and p=0.003, respectively). Reflux symptom index results showed significant positive correlation with F0 at the pretreatment, and at posttreatment first and third month evaluations (Spearman's rank correlation coefficient [rho]=0.246, p=0.024; rho=0.300, p=0.006; rho=0.305, p=0.005, respectively). CONCLUSION: The relationship between the parameters of acoustic analysis and RSI and RFS values seems to be controversial for diagnosis and follow-up of LPR patients, requiring further investigations.

Peak nasal inspiratory flowmetry for selection of patients for radiofrequency ablation of turbinates.

OBJECTIVES: Our goals were to investigate (I) the effectiveness of the topical vasoconstrictor test (TVT) and peak nasal inspiratory flow (PNIF) measurement for the selection of patients with inferior turbinate hypertrophy (ITH) who will benefit from radiofrequency ablation (RFA) of the turbinates and (2) the efficacy of the TVT and PNIF in follow-up of treatment outcomes. METHODS: Patients with bilateral chronic nasal obstruction due to ITH underwent assessment with a visual analog scale (VAS) and PNIF before and after the TVT. Twenty patients with symptom improvement according to VAS and PNIF results were enrolled in the study. These patients underwent RFA, and PNIF and VAS scores were determined before and I and 6 months after the TVT. These results were compared to evaluate the preoperative prediction of RFA treatment success. RESULTS: Radiofrequency ablation of the turbinates resulted in significant changes in objective and subjective scores. Preoperative (baseline) subjective and objective responses to decongestant were positively correlated (P = .024 and P < .05, respectively). Preoperative (baseline) objective responses to decongestant were significantly correlated with the objective outcomes of surgery (P = .006 and P < .05, respectively). CONCLUSION: The combined use of PNIF and the TVT allows for the preoperative prediction of the success of RFA and the selection of patients who will benefit most from RFA.

Bacteriological evaluation of tonsillar microbial flora according to age and tonsillar size in recurrent tonsillitis.

Although numerous studies based on the bacteriology of the tonsil have been carried out, none of them analyzed the variation of tonsillar flora with respect to both age and tonsillar size. The purpose of this study was to isolate the facultative and obligate anaerobes both from the surface and the core of tonsils in recurrent tonsillitis as well as to analyze the variation of isolated bacterial strains according to age and tonsillar size. A prospective study was performed on 111 patients who underwent tonsillectomy. We analyzed the differences between the bacterial pathogens in recurrent tonsillitis and semi-growth estimates with regard to age and tonsillar grade. Among 111 cases, 604 bacterial strains of 21 different from the tonsil superficial and core were isolated. The most common facultative anaerobic species isolated from the surface and core were Coagulase-negative staphylococci, Alpha-hemolytic streptococci and Diphtheroid bacilli in all subgroups except patients below 8 years old. The most commonly obligate anaerobic species isolated from the core were Propionibacterium acnes, Prevotella melaninogenica and Peptostreptococcus anaerobius. We found no significant difference in the cultured bacteria with respect to age and tonsillar size. The study subgroups did not differ in the occurrence of semiquantitative growth estimates of 3-4+. Our study demonstrates that there is polymicrobial aerobic and anaerobic flora in tonsils with regardless of patient's age and tonsillar size. This polymicrobial spectrum of bacteria may contribute to recurrence and to the failure of conservative treatment of these cases and therefore leads to surgical therapy.

A rare tumor of the parapharyngeal space: angiomyxolipoma.

Parapharyngeal space tumors are uncommon, most are salivary gland tumors (50%), and they are often pleomorphic adenomas. Neurogenic tumors are the second most common primary tumors of all neoplasms in the parapharyngeal space (30%). Angiomyxolipoma is a very rare form of lipoma. Up until now, only 12 cases located on different sides of the body were reported. Presented here is a case report of a patient with an angiomyxolipoma of the parapharyngeal space. A 17-year-old boy had a slowly growing, painless mass on the left side of the neck. During the oropharyngeal examination, medial displacement of the left tonsilla palatina was observed. Magnetic resonance imaging findings were of a 6 × 5.5 × 3-cm "dumbbell"-shaped parapharyngeal mass. A fine needle aspiration of the mass showed no specific histopathology. The patient underwent a transparotid-transcervical approach for the excision of the tumoral mass under general anesthesia. Although an angiomyxolipoma is a rare form of lipoma, it is a pathology that should be kept in mind for the differential diagnosis of parapharyngeal tumors.

Effects of Ramadan fasting on serum immunoglobulin G and M, and salivary immunoglobulin A concentrations.

OBJECTIVE: To investigate the effects of Ramadan fasting on serum concentrations of immunoglobulin (Ig)G and IgM, and salivary IgA concentrations. METHODS: Blood and saliva samples were collected one week before and during the last week of Ramadan from healthy male volunteers. Albumin, total lymphocyte count, electrolytes, and IgG and IgM concentrations were determined in serum; salivary IgA concentrations were measured. Anthropometric measurements were also recorded. RESULTS: Samples were collected from 35 subjects (mean age 35.86 years, range 20-59 years). Weight, body mass index, albumin levels and the nutritional risk index decreased significantly during Ramadan fasting compared with before fasting. In addition, Na(+) and Cl(-) electrolyte levels were significantly decreased during Ramadan. Serum IgG concentrations decreased significantly during Ramadan compared with before fasting, but were still within the normal range. Salivary IgA concentrations also decreased significantly, whereas serum IgM levels did not change. Lymphocyte numbers increased significantly, but there was no correlation between Ig levels and lymphocyte count. CONCLUSION: Ramadan fasting did not result in severe immunological disturbances.

The effect of medical treatment on voice quality in allergic rhinitis.

To evaluate the change in the voice quality of patients with allergic rhinitis (AR) after medical treatment. The study enrolled 69 subjects: 39 with high serum-specific IgE levels to inhalant allergens as the study group and 30 healthy individuals as controls. All patients were evaluated using the total nasal symptom score (TNSS) and voice handicap index-10 (VHI-10) and then underwent an acoustic voice analysis. After 1 month of treatment with mometasone furoate nasal spray (two 50-µg puffs in each nostril once daily) and desloratadine (5-mg tablet once daily), the patients repeated the surveys and acoustic voice analysis. The results before and after treatment were compared. The TNSS and VHI-10 scores decreased significantly after treatment (p < 0.01). After treatment, the acoustic analysis parameters improved significantly and were similar to the control group, and the maximum phonation time increased significantly (p < 0.05). The voice quality of patients with AR is improved with medical treatment.

Differences in Mucociliary activity of volunteers undergoing Ramadan versus Nineveh fasting.

This study, aimed to evaluate the difference in mucociliary clearance among volunteers who underwent Ramadan versus Nineveh fasting regimens as well as the difference between the fasting period and 4 weeks following the fasting period in both groups. In this study, two different fasting groups were established: Ramadan (fasting for an average of 15 h for 29 consecutive days, n = 40) and Nineveh (60 h of nonstop fasting, n = 26). Subjects in each group underwent saccharin testing twice: at the end of the fasting period prior to resumption of eating and at 4 weeks after the end of Ramadan or Nineveh fasting. Statistical analysis was performed using the Mann-Whitney U-test, Wilcoxon, Chi-square, and paired t test. A p value less than 0.05 was considered statistically significant. Forty subjects who underwent Ramadan fasting and 26 subjects who underwent Nineveh fasting were included in this study. Of the 66 study participants, 34 (51.5 %) were men and 32 (48.5 %) were women. Their median age was 31 years (range 17-70 years) for Nineveh fasting subjects and 40 years (range 17-70 years) for Ramadan fasting subjects. Chi-square tests revealed no significant difference between the Ramadan and Nineveh fasting groups in gender (p = 0.418), and the Mann-Whitney U-test showed no difference in age. A statistically significant difference was found in the mucociliary clearance time between the Nineveh fasting and non-fasting periods (p = 0.013). Using Wilcoxon signed-rank tests, we found no significant difference in the mucociliary clearance time between the Ramadan fasting and control (4 weeks after the fasting period) periods (p = 0.121). The percentage difference between the fasting and control periods was similar between groups and was not statistically significant for the Ramadan and Nineveh fasting groups (p = 0.086). The results of the present study indicated that long-term fasting with hypohydration contributed to the deterioration of nasal mucociliary clearance. Our data indicate that optimal hydration, sleep patterns, and fasting times contribute to proper mucociliary clearance.