Streptococcal Serology in Children With Stuttering.

Introduction: Stuttering is a pronunciation disorder represented by repetitive perpetuations, duplications, or freezes of spoken words or syllables, as well as nervousness and cognitive shunning. Group A beta-hemolytic Streptococcus (GABHS) can lead to pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). Many case reports have proposed that stuttering is the result of a PANDAS, and that it can be identified together with Tourette syndrome, which shares many clinical characteristics with stuttering. Aim: The purpose of this study was to examine the association between streptococcal serology and stuttering in children. Method: The participants in this study are 26 children who stutter (CWS; mean age = 8.3 + 3.1 years) and 25 children who do not stutter (CWNS; mean age = 9.2 + 2.9 years). Participants were matched in terms of age (±3 months) and gender. We analyzed serum antistreptococcal antibodies [antistreptolysin O (ASO), anti-deoxyribonuclease B (anti-DNase B), and antistreptokinase] in both groups. Results: In the CWS group, ASO, anti-DNase B, and antistreptokinase were significantly higher than in the CWNS group (P < .0001, P < .0001, P < .0001). Conclusion: The higher serum antistreptococcal antibody amounts in CWS suggest that an increased autoimmune response against GAHBS may be the etiology of childhood stuttering. It has been suggested that CWS should be examined for autoimmune reactions, especially to GAHBS.

Turkish Guideline for Diagnosis and Treatment of Allergic Rhinitis (ART).

OBJECT: To prepare a national guideline for Otorhinolaryngologist who treat allergic rhinitis patients. METHODS: The study was conducted by three authors, namely the writing support team. The support team made the study plan, determined the writing instructions, chose the subgroups including the advisory committee, the advisors for authors and the authors. A workshop was organized at the very beginning to explain the details of the study to the team. Advisors took the chance to meet their coworkers in their subgroups and determined the main headings and subheadings of the guideline, together with the authors. After key words were determined by the authors, literature search was done in various databases. The authors keep in touch with the advisors and the advisors with the advisory committee and the support group at every stage of the study. National and International published articles as well as the abstracts of unpublished studies, imperatively presented in National Congresses, were included in this guideline. Only Guideline and meta-analyses published in last seven years (2013-2017) and randomized controlled studies published in last two years (2015-2017) were included. After all work was completed by the subgroups, support team brought all work together and edited the article. RESULTS: A detailed guideline about all aspects of allergic rhinitis was created. CONCLUSION: The authors believe that this guideline will enable a compact and up-to-date information on allergic rhinitis to healthcare professionals. This guideline is the first in the field of Otolaryngology in Turkey. It should be updated at regular intervals.

Rised sudden sensorineural hearing loss during COVID-19 widespread.

BACKGROUND: Sudden sensorineural hearing loss (SSNHL) is commonly encountered in otolaryngologic practice. SARS-CoV-2 infection is typically marked by respiratory symptoms although neurologic manifestations of the disease have also been described. OBJECTIVE: We want to measure the incidence and clinical aspects of persons exhibiting in otolaryngology clinic (OC) with SSNHL during the COVID-19 widespread and in the constant interval of previous year. METHODS: We retrospectively inspected the medical information for admissions to OC in Eskisehir, Turkey, during the COVID-19 widespread to describe the patients SSNHL. Clinical knowledge was saved for each subject and corresponded with that of SSNHL subjects demonstrating in 2019. RESULT: Between 1 April and 30 September 2020, 68 patients admitted to OC for SSNHL; in 2019, there were 41 subjects, for an incidence rate ratio of 8.5 per 100.000 (95% CI 1.02-2.92) for the 2020 cohort. Of the 2020 group, forty-one patients (60.3%) presented with active or recent symptoms consistent with COVID-19 infection, compared with four (9.8%) in 2019 (p < 0.001). Furthermore, subjects in 2020 group were younger (-15.5 years, p = 0.0141) than 2019 group and demonstrated prolonged interim (+1.7 days, p < 0.001) between SSNHL initiation and OC petition. CONCLUSION: We detected increased incidence of SSNHL during the COVID-19 widespread compared to the same interval of the prior year; 60.3% of subjects confronting with SSNHL had signs that were harmonious with COVID-19.

Alteration of Auto-CPAP requirements in obstructive sleep apnea patients with COVID-19 history.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an infectious disease that leads to critical respiratory problems. Obstructive sleep apnea (OSA) is the most common sleep-associated breathing disease and is represented by repetitive experiences of constraint of the respiratory tract prompting to reduced or deficient breathing during sleep. Auto-Continuous positive airway pressure (Auto-CPAP) is a modality of respiratory ventilation used as gold standart in the treatment of OSA. OBJECTIVE: This study was performed to conclude the alteration of Auto-CPAP levels in OSA patients who had COVID-19 history. METHODS: Nineteen OSA patients who had cured COVID-19 and used Auto-CPAP were included in this study. Nightly Auto-CPAP 95th percentile pressure (95thpp), median CPAP pressure and AHI before COVID-19 disease and one month after COVID therapy were recorded from electronic cards of Auto-CPAP devices. RESULTS: Before COVID infection, average Auto-CPAP 95thpp was 8.56 ± 0.17 cm H2O. One month after COVID-19, average Auto-CPAP 95thpp was 9.78 ± 0.21 cm H2O (P < 0.01). While Median CPAP pressure was 7.49 ± 0.16 cm H2O before COVID, it was found to be 8.15 ± 0.19 cm H2O after the disease (P < 0.01). CONCLUSIONS: The increase in need of average Auto-CPAP 95thpp and median CPAP pressure in OSA patients who have had COVID-19 disease and use Auto-CPAP shows that this disease causes problems in both the lower and upper airways.

Effect of ketogenic diet versus regular diet on voice quality of patients with Parkinson's disease.

Diets that have effects on health problems can vary in their composition. Whilst following a regular diet (RD) a person typically consumes about 30% of calories from fat. Ketogenic diet (KD) is a form of diet whereby a person consumes as much as 90% of calories from fat. KD has been trialed as a treatment for neurological diseases and obesity. Parkinson's disease (PD) is a neurologic disease that impacts the quality of voice. Voice Handicap Index (VHI) is a test that gives information to clinical and physiological assessment about voice. We assessed the impact of KD and RD on voice quality (VQ). Seventy-four patients with PD who reported a voice disorder related to their disease were randomly assigned to the KD or RD groups. We investigated the VHI change of subjects before and 3 months after diet. Sixty-eight PD patients completed the study. Baseline VHI values did not differ significantly between groups. All mean VHI parameters improved in KD group (p˂ 0.001). Currently there are different therapies that address speech and voice disorders in patients with PD. As such KD may be an alternative therapy to improve VQ of patients with PD. A larger sample size is necessary to determine the role and pathophysiology of KD on VQ of PD patients.

New type of corona virus induced acute otitis media in adult.

Since late December 2019, a new type of coronavirus (CIVID-19) causing a cluster of respiratory infections was first identified in Wuhan-China. And it disseminated to all countries. Generally, COVID-19 cases have fever, cough, respiratory distress findings (dyspnoea, intercostal retraction, cyanosis etc.). In this paper, we have presented an adult otitis media case whom infected with COVID-19, but she have not any classical COVID-19 symptoms.

Effect of Modified Fujita Technique Uvulopalatoplasty on Oxidative DNA Damage Levels in Patients With Obstructive Sleep Apnea Syndrome.

Snoring is a social hindrance problem and it can cause life threatening problems. Because of this it must be taken seriously and must be treated. Although there are many ways for treating this problem, still uvulopalatopharngoplasty (UPPP) which is an accepted classical method maintains its importance. Antioxidant status in patients with snoring have been investigated. All studies investigated the effect of CPAP treatment on the level of antioxidant agents. In this study we have examined the effect of UPPP on the level of antioxidant agents in patients with snoring.

Evaluation of the efficacy of curcumin in experimentally induced acute otitis media in rats.

OBJECTIVES: We investigated the effect of curcumin (CMN) in the treatment of experimentally induced acute otitis media (AOM) in rats. METHOD: Thirty-two Sprague-Dawley female rats were used, yielding 64 temporal bones. Group 1 was the control group. For groups 2 to 4, AOM was induced experimentally, and saline, antibiotics (sulbactam-ampicillin), or CMN were administered for 14 days to groups 2, 3, and 4, respectively. During the histological examination, thickening of the tympanic membrane, damage to the epithelium, inflammation, and sclerosis were evaluated. RESULTS: The AOM+antibiotic and AOM+CMN groups exhibited reduced histological damage compared with the AOM+saline group. No significant differences in thickening of the tympanic membrane or damage to the epithelium or inflammation were observed between the AOM+antibiotic and the AOM+CMN groups. However, the sclerosis values of the AOM+CMN group were significantly lower than those of the AOM+antibiotic group. CONCLUSION: CMN treatment resulted in similar effects on the experimentally induced AOM model as did the antibiotic treatment. The efficacy of this treatment may be related to its effects on the production of various inflammatory cytokines. In light of the worldwide increase in antibiotic resistance and the mild side effects of CMN, we suggest that CMN therapy may be a promising option in AOM treatment.

Variance of melatonin and cortisol rhythm in patients with allergic rhinitis.

OBJECTIVE: Allergic rhinitis is an IgE-mediated inflammatory disease which effects 10%-50% of the normal population. The mechanism of its formation and the circadian rhythm of cortisol and melatonin in allergic rhinitis have not been investigated. STUDY DESIGN: Salivary levels of melatonin and cortisol were measured by radioimmunoassay in 35 newly diagnosed allergic rhinitis patients and in 23 control subjects matched for age and gender. RESULTS: In the study group; amplitude, baseline and peak levels of salivary melatonin were significantly decreased compared with healty controls (p<0.001). No differences were found in the acrophase and the peak duration of salivary melatonin between the study and control groups (p>0.05). In the study subjects, the circadian rhythm of cortisol was flattened when compared with the control group. The amplitude and the 24h mean levels of salivary cortisol in the study group were significantly lower than in the control group and the acrophase was delayed in patients compared with control subjects (p<0.001). CONCLUSION: The circadian rhythms of salivary melatonin and cortisol were found to be disrupted in patients with allergic rhinitis. These results may also be contributive data to explain the pathogenesis of allergic rhinitis and also they can be applicable as adjunctive therapeutic tools in the future and melatonin drugs might be an alternative in the therapy of resistant allergic rhinitis patients or allergic rhinitis patients who cannot use cortisol drugs.

Melatonin and cortisol rhythm in patients with extensive nasal polyposis.

PURPOSE: Extensive nasal polyposis is an inflammatory disease which effects 1%-4% of normal population. The mechanism of its formation and the circadian rhythm of cortisol and melatonin in ENP have not investigated. MATERIALS AND METHODS: Salivary levels of melatonin and cortisol were measured by radioimmunoassay in 31 patients with extensive nasal polyposis and in 27 control subjects matched for age and gender. In both groups none of the subjects did not have obstructive sleep apnea. RESULTS: The baseline and the peak levels of salivary melatonin in the extensive nasal polyposis group were significantly lower than in the control group (p<0.001). However, no differences were found in the acrophase and the peak duration of salivary melatonin between the study and control groups (p>0.05). The highest values of melatonin were recorded at 04:00 h in both the study and control groups. The amplitude and the 24 h mean levels of salivary cortisol in the extensive nasal polyposis group were significantly lower than in the control group (p<0.001). The acrophase was delayed by about 8 h in extensive nasal polyposis patients (p<0.001). CONCLUSION: The circadian rhythms of salivary melatonin and cortisol were found to be disrupted in patients with extensive nasal polyposis. These results may be applicable as therapeutic tools in the future and melatonin drugs might be useful in the therapy of nasal polyposis like cortisol drugs.

Panconcha bullosa: new definition in the literature.

Pneumatizated turbinates are named as concha bullosa in the literature. Concha bullosa is a frequently seen variation of the middle and superior turbinates. But concha bullosa in the inferior turbinate is rarely seen. But pneumatization of all turbinates in a person has not been published yet. Here is a 17-year-old adolescent girl who presented with concha bullosa in all turbinates.

Comparative study of intravenous opioid consumption in the postoperative period.

BACKGROUND: Intravenous patient-controlled analgesia (IV PCA) using opiods is an accepted method for delivering postoperative analgesia. The aim of this study was to compare fentanyl and tramadol with IV PCA after spinal anesthesia (SA) and general anesthesia (GA) following cesarean section (C/S). METHODS: Ninety women were randomly assigned to three groups (n=30). Group 1 was treated with IV fentanyl PCA after SA. Groups 2 and 3 were treated with IV fentanyl PCA and IV tramadol PCA after GA. Outcome measures were recorded for the first 24 h post-anesthesia. RESULTS: PCA use was significantly lower after SA (P<0.05). Eighteen patients in the SA Group and 27 patients and 24 patients from the GA groups required additional opioid. Opioid consumption and patient satisfaction were similar for groups after GA (P>0.05). 638.4 ± 179.1 µg fentanyl was consumed by patients of Group 2, 356.3 ± 87.0 µg fentanyl and 559.5 ± 207.0 mg tramadol was consumed by Group 1 and Group 3 respectively. There was no significant difference in the overall severity and incidence of nausea, drowsiness or pruritus. CONCLUSION: Our study shows that analgesic consumption and post-operative pain scores after SA in C/S decreased, without increase in adverse reactions.

An alternative management procedure after inadvertent dural puncture.

BACKGROUND: Accidental dural puncture during epidural blockade is a rare complication. Since postdural puncture headache (PDPH) is the most frequent complication, a wisely management method will also reduce the incidence of PDPH. METHODS: Five patients who had inadvertent dural puncture during the epidural procedure before hip or knee arthroplasty were included in this study. After dural puncture we drew back the epidural needle and placed an epidural catheter into the epidural space. RESULTS: Epidural anesthesia and postoperative epidural analgesia have been provided successfully in all cases. 20% showed PDPH. CONCLUSIONS: These results demonstrate the effectiveness of management skills after inadvertent dural punctures.

Impact of septoplasty on pulmonary artery pressure in patients with markedly deviated septum.

AIM: The nasal septal deviation (NSD) increases upper airway obstruction. This study aimed to measure the mean pulmonary arterial pressure (mPAP) of the patients with markedly deviated nasal septum and to determine the effect of septoplasty on the pulmonary arterial pressure. METHODS: Fifty-one patients with NSD (mean age, 37.1 [SD, 8.6] years; 27 men and 24 women) were included in the study. Thirty-five of the patients (22 men, 13 women) aged between 21 and 55 years (mean, 35.1 [SD, 8.9] years) comprised the control group. Mean pulmonary arterial pressure was measured in the preoperative period and postoperative third month. RESULTS: The mean preoperative mPAP value (25.4 [SD, 5.3]) of the study group was statistically significantly higher than that of the control group (20.5 [SD, 2.8]) (P = 0.000). There was a significant decrease in mPAP after the operation (20.6 [SD, 3.8]) (P = 0.000). Twenty-two of 51 patients had pulmonary arterial hypertension. CONCLUSION: Markedly deviated nasal septum significantly affected mPAP. Septoplasty was efficient in the treatment of patients with NSD.

Fixed drug eruption against rupatadine fumarate.

Second generation of antihistaminics have better therapeutic efficacy and more predictable pharmacological responses at lower doses than older compounds. However, new compounds have a reduced adverse reaction profile; clinicians can also encounter some unexpected adverse effects of these newer compounds. We report the first case of fixed drug eruption of rupatadine fumarate, which was confirmed by oral provocation test.

Neuropsychiatric symptoms, quality of sleep and quality of life in patients diagnosed with nasal septal deviation.

OBJECTIVES: This study aims to evaluate the psychiatric symptoms, quality of sleep, quality of life and the predictive factors affecting quality of sleep in patients diagnosed with nasal septal deviation (NSD). PATIENTS AND METHODS: Forty male patients (mean age 22.3±1.4 years; range 21 to 26 years) who admitted to the otorhinolaryngology (ORL) clinic of the Agri Military Hospital and diagnosed with NSD as a result of a through ORL examination between February 2009 and April 2009 and 36 healthy volunteer (mean age 21.7±1.0 years; range 21 to 25 years) controls, were included in this study. Pre- and postoperative evaluations were performed using the Quality of Life Scale (Short Form-36/SF-36), the Pittsburgh Sleep Quality Index (PSQI) and the Symptom Check List Revised (SCL-90-R). RESULTS: All patients and controls completed pre- and postoperative evaluations. No complications occurred. There was a statistically significant difference between the groups in the quality of sleep measures, in the SCL-90-R subscales of somatization, obsession, interpersonal sensitivity, depression, anxiety, phobic anxiety, hostility, paranoid thought, and psychoticism, additional scales and in physical health dimension of SF-36 Quality of Life Scale. CONCLUSION: Psychiatric symptoms are more common in patients with nasal septal deviation when compared to healthy controls. The impairments in nasal breathing in patients with NSD may cause a decline in the physical dimension of quality of life and a marked impairment in sleep quality.

Bilateral hemotympanum as a result of spontaneous epistaxis.

Hemotympanum is a rare condition and usually depends on a secondary reason. Therefore, idiopathic hemotympanum is rarely seen in the literature. In this paper, we report a case of this problem.

Effects of endoscopic sinus surgery on pulmonary artery pressure in patients with extensive nasal polyposis.

AIM: Extensive nasal polyposis (ENP) increases upper airway obstruction. This study aimed to measure the mean pulmonary arterial pressure (mPAP) of the patients with ENP and to determine the effect of endoscopic sinus surgery on the pulmonary arterial pressure. METHODS: Forty-seven patients with ENP (mean age, 37.3 [SD, 8.7] years; 29 male patients and 18 female patients) were included in the study. Thirty-two of the patients (19 male patients, 13 female patients) aged between 21 and 55 years (mean, 36.1 [SD, 8.5] years) comprised the control group. Mean pulmonary arterial pressure was measured in the preoperative period and postoperative third month. RESULTS: The mean preoperative mPAP value (26.1 [SD, 5.2]) of the study group was statistically significantly higher than that of the control group (20.6 [SD, 2.8]) (P=0.000). There was a significant decrease in the mPAP after the operation (20.9 [SD, 3.8]) (P=0.000). Twenty-six of 47 patients had pulmonary arterial hypertension. CONCLUSIONS: Extensive nasal polyposis significantly affected mPAP. Endoscopic surgery was efficient in the treatment of the patients with ENP.