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 National and International published articles as well as the abstracts of unpublished studies, imperatively presented in National Congresses, were included in this guideline.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.

Evaluation of the effect of the mouth gag use on optic nerve sheath diameter of pediatric patients undergoing tonsillectomy or Adenotonsillectomy: An observational study.

BACKGROUND: A mouth gag is usually used during tonsillectomy and adenotonsillectomy surgeries, cleft palate repair, obstructive sleep apnea surgery, and intraoral tumor excision. The placement of the gag causes hemodynamic changes similar to laryngoscopy. The aim of this study was to evaluate the effect of mouth gag placement on the optic nerve sheath diameter (ONSD) of pediatric patients. The secondary aim was to assess the relationship between neck extension and changes in ONSD. METHODS: The trial was prospectively registered to the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618000551291) on 12.04.2018. This prospective, observational study was performed in a tertiary university hospital operating room between 01.05.2018-01.07.2018. Thirty-five children aged < 18 years, with ASA I status, who were scheduled for tonsillectomy and adenotonsillectomy surgeries were prospectively included in the study. Measurements of ONSD were performed (T0) after induction of anesthesia, (T1) after endotracheal intubation, (T2) after mouth gag placement, and (T3) 20 min after mouth gag placement. After the mouth gag was placed and the head was positioned for surgery, the degree of neck extension was calculated. RESULTS: All participants completed the study. There were significant differences in ONSD values at time points T1, T2, and T3 (p < 0.001, CI: - 0.09,-0.05; p < 0.001, CI: - 0.09,-0.05; p < 0.001, CI: - 0.05,-0.02; respectively). The maximum increase in ONSD was after intubation (0.69 ± 0.06 mm) and immediately after mouth gag placement (0.67 ± 0.07 mm). ONSD values continued to increase 20 min after gag placement (0.36 ± 0.04). There was no relation between the degree of neck extension and ONSD values (ß = 0.63, p = 0.715). CONCLUSIONS: The use of a mouth gag causes significant increases in ONSD measurements of children. Therefore, attention to the duration of mouth gag placement should be considered during surgery. TRIAL REGISTRATION: The trial was prospectively registered to the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618000551291 ) on 12.04.2018.

Evaluation of Liver Functions Based on Serum Aminotransferase Enzyme Levels in Patients with Obstructive Sleep Apnea Syndrome.

Obstructive sleep apnea syndrome (OSAS) is associated with fatty liver disease. In the present study, relations between alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels and the severity of OSAS and polysomnography parameters were investigated. The study included 194 patients with OSAS and 114 control patients. The patients underwent an overnight polysomnography (PSG) in the Sleep Laboratory. ALT and AST levels were compared between the patients and the controls and between the subgroups of the patients. ALT and AST levels were also compared with the PSG parameters REM AHI, NREM AHI and minimum O2 saturation separately. The mean ALT was 28.95 in the patients and 17.85 in the controls (p < 0.001) with a statistically significant difference and the mean AST was 23.62 in the patients and 16.53 in the controls with a statistically significant difference (p < 0.001). The patients with OSAS had significantly higher ALT and AST levels. The higher the ALT and AST levels were, the more severe the disease was, though the differences between the subgroups of the patients were not significant.

Does positive airway pressure therapy improve olfactory function?

BACKGROUND: Olfactory function deteriorates in patients with severe obstructive sleep apnea syndrome (OSAS). The effect of positive airway pressure (PAP) therapy on olfactory function has not been investigated before. In this study, we aimed to investigate the role of PAP therapy on olfactory impairment in patients with OSAS. METHODS: Thirty patients who had OSAS and planned for PAP therapy were included in the study. All participants underwent a detailed otorhinolaryngological examination and polysomnography. The "Sniffin' Sticks" test was used for the analysis of olfactory function. The participants underwent the smell test before the PAP therapy, and about 3 months after the therapy. Pretreatment and posttreatment results were compared. RESULTS: The pretreatment and the posttreatment apnea-hypopnea index (AHI) were 57.6 ± 29.8/hour and 9.5 ± 7.9/hour, respectively. Odor threshold (OT), odor discrimination (OD), odor identification (OI), and threshold-discrimination-identification (TDI) scores significantly increased after PAP therapy (p = 0.001, p = 0.002, p = 0.001, and p = 0.001, respectively). The pretreatment and posttreatment total TDI scores were 28.48 ± 4.71 and 32.50 ± 3.88, respectively (p = 0.001). CONCLUSION: This study demonstrates olfactory dysfunction in patients with OSAS. We achieved a significant improvement in olfactory function of patients with OSAS after PAP therapy. Further studies are needed to illuminate the pathogenesis of olfactory dysfunction in OSAS, and the role of PAP therapy on olfactory improvement.

Impaired olfactory function in patients with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is an endocrine disorder which affects 6.6% of women of child-bearing age. Although olfactory dysfunction is frequent in the population and it negatively affects quality of life, neither physicians or patients consider this important. This case-control study included 30 patients diagnosed with PCOS, and 25 healthy age-matched controls. Sniffin' sticks tests (BurghartGmbH, Wedel, Germany) were used to analyze olfactory functions, and the Beck Depression Inventory was used to evaluate depressive symptoms. The total odor score was significantly lower in the PCOS group compared to the control group (p<0.005). The Beck depression score was higher in the PCOS group (p<0.005). There was a negative correlation between the total odor score and the Beck Depression Score. Patients with PCOS have impaired olfactory function. This might be related to depressive disorders that are also observed in those patients.

The Causes of Persistent and Recurrent Nasal Obstruction After Primary Septoplasty.

OBJECTIVES: Septoplasty is the most frequently performed surgical procedure in patients with nasal obstruction. However, nasal obstruction may persist or recur after septoplasty in some patients. In this study, the authors aimed to determine the causes of nasal obstruction after septoplasty. METHODS: Fifty consecutive patients who admitted to our clinic with the complaints of persistent or recurrent nasal obstruction after primary septoplasty and had revision surgery between 2011 and 2015 were included in this study. Demographic data and physical examination findings of the patients were recorded. RESULTS: There were 33 men (66%) and 17 women (34%) with a mean age of 37.3 ±â€Š10.5 (range, 21-57) years. Deviation of perpendicular plate of ethmoid bone (44%), inferior turbinate hypertrophy (36%), concha bullosa (26%), caudal septal deviation-nostril asymmetry (20%), and alar collapse (6%) were the pathologies that were unaddressed during primary surgery. The iatrogenic causes of nasal obstruction after septoplasty were collumellar retraction-nasal tip ptosis (46%), nasal synechiae (20%), nasal septal perforation (10%), and saddle-nose/flat nose deformity (10%). CONCLUSIONS: Iatrogenic deformities due to surgery and pathologies ignored during primary surgery may cause persistent/recurrent nasal obstruction after primary septoplasty. A detailed physical examination and objective tests showing the site of nasal obstruction, an extensive surgical plan that covers all diagnosed pathologies, and a careful postoperative care must be undertaken to prevent undesired postoperative results.

Clinical and polysomnographic features of patients with Restless Legs Syndrome.

OBJECTIVE: To reveal clinical and polysomnographic features in patients treated for restless leg syndrome, and to examine the compatibility of sleep data and clinical features. METHODS: The study was conducted at the Department of Neurology, Ankara Numune Training and Education Hospital, Ankara, Turkey, and comprised patients who presented to the outpatient clinic between January and July 2014 who were diagnosed with restless leg syndrome based on the International RestIess Leg Syndrome Study Group criteria. Patients underwent polysomnography test in spontaneous sleep in a single room. SPSS 18 was used for statistical analyses. RESULTS: Of the 18 patients, 13(72%)were females and 5(28%)were males. Overall mean age was 51.56±11.57years (range: 23-66 years). Fourteen (77.8%) patients reported insomnia; 10(55.5%) patients had excessive daytime sleepiness; 13(72.2%) reported snoring; and 3(17%) had apnoea. Mean International Restless Legs Syndrome Study Group Rating Scale score was 26.11±7.9 (range: 16-40).Mean Epworth Sleepiness Scale score was 9.17±5.1 (range: 0-20). CONCLUSIONS: Restless leg syndrome was more common in women and the most common complaint was insomnia.

Effect of vitamin B12 deficiency on olfactory function.

BACKGROUND: Vitamin B12 plays a major role in the maintenance of central and peripheral nervous systems. Vitamin B12 deficiency may affect the spinal cord, brain, optic nerve, and peripheral nerve functions; however, the effect of vitamin B12 deficiency on olfactory function has not been studied, so our study aimed to investigate that. METHODS: Thirty-nine patients with low vitamin B12 levels and 34 controls were included in the study. All participants had detailed otorhinolaryngological examinations and laboratory tests. The Sniffin' Stick test was used for analysis of olfactory function. The 2 groups were compared for smell test results. Correlations of smell test results with demographic and laboratory data were investigated in the vitamin B12-deficient group. RESULTS: The threshold discrimination identification scores were (mean ± standard deviation) 28.04 ± 5.58 and 35.10 ± 2.84 in the vitamin B12-deficient and control groups, respectively (p < 0.001). In the vitamin B12-deficient group, hyposmia and anosmia were evident in 56.4% and 5.1% of the patients, respectively, but no subjects in the control group had olfactory dysfunction (p < 0.001). Correlation analysis showed that age and odor identification score showed a negative correlation (p < 0.001); however, there was a positive correlation between threshold, discrimination and identification (TDI) score and vitamin B12 levels. CONCLUSION: In this study, we showed for the first time that olfactory dysfunction may be present in patients with vitamin B12 deficiency. Apart from a negative correlation of age with odor identification score, none of the other parameters studied showed correlations with olfactory dysfunction.

Giant Dermoid Cyst Causing Dysphagia and Dyspnea.

Dermoid cysts are benign lesions seen in young adults. The second most common localization is the floor of the mouth. They are usually asymptomatic over years but can be symptomatic due to secondary changes or the size. Herein, we report a case of 19-year-old woman who applied to emergency service with dyspnea, dysphagia and enlarging of a mass in the submental region. The patient cannot be entubated because of the mass pushing the tongue base backward closing the laryngeal view. Elective tracheostomy was performed for providing airflow during the operation. After the operation a cystic mass fulfilled with keratin lined by keratinized stratified squamous epithelium in addition to the dermal appendages such as sweat glands and follicular structures were seen histopathologically and the case was diagnosed as dermoid cyst of the submental region. In such patients with quick enlarging of mass causing airway obstructions, the tracheostomy can be the preferable method because of the difficulties in entubation.

Association of Interleukin-10 gene promoter polymorphisms with obstructive sleep apnea.

BACKGROUND: Interleukin-10 (IL) is an anti-inflammatory cytokine that regulates normal sleep patterns, and recent studies have reported that it is a potential useful biomarker to identify presence and severity of sleep apnea syndrome (OSAS). Promoter polymorphisms of IL-10 gene have been associated with altered expression levels, which contributes to OSAS. OBJECTIVE: The aim of this study was to determine the prevalence of -1082 G/A, -819 C/T, and -592 C/A promoter polymorphisms of IL-10 gene in individuals with OSAS and controls. SUBJECTS AND METHODS: An open-label study was performed in the Otorhinolaryngology and Sleep Disorders Outpatient Clinics. One hundred four cases with OSAS were included as the study group, and 78 individuals without OSAS were included as the controls. DNAs were extracted from peripheral blood leukocytes, and the sites that encompassed those polymorphisms were identified by DNA sequencing analyses. Data were analyzed with SNPStats and multifactor dimensionality reduction (MDR) software. RESULTS: The prevalence of OSAS was higher in males in the study group when compared to controls (P = 0.0003). The IL-10-1082 G/A, -819 C/T, and -592 C/A SNPs, and their minor alleles were associated with a significantly increased risk for OSAS compared to the controls (P ˂ 0.05 for all). Furthermore, ATA haplotype frequency was significantly higher in the study group compared to the control group, but the GCC haplotype frequency was lower (P = 0.0001 and P = 0.0001). As indicated in MDR analysis, combinations of IL-10 gene were associated with OSAS in single-, double-, and triple-locus analyses. CONCLUSION: The prevalences of the IL-10 gene promoter polymorphisms were different in OSAS patients and the controls in Turkish population. IL-10 gene polymorphisms may lead to altered inflammatory cascade, which might contribute to OSAS. Further studies on larger cohorts are needed to validate our findings.

Relationship Between Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Obstructive Sleep Apnea Syndrome.

BACKGROUND: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) give information about many diseases. An increase in inflammation markers occurs in patients with obstructive sleep apnea syndrome (OSAS). OBJECTIVES: The aim of this study is to determine the relationship between OSAS and NLR and PLR values. MATERIAL AND METHODS: Two hundred eighty four patients with complaints of snoring and excessive daytime sleepiness were included in the study. Polysomnography had been performed on all patients and the control group. Fourty eight of these patients with apnea-hypopnea index (AHI) less than 5 (pure snoring) were included in the control group, 67 patients with AHI between 5 and 14.9 in the mild OSAS group, 61 patients with AHI between 15 and 29.9 in the moderate OSAS group and 108 patients with AHI more than 30 in the severe OSAS group. NLR and PLR values were calculated from the complete blood count (CBC) analysis of the patients and control group. The OSAS and control groups were compared by age, gender, body mass index (BMI) and PSG parameters as well as NLR and PLR values. RESULTS: The PLR value in the OSAS group was found to be less than in the control group (p=0.006). As the non-REM AHI increased, the value of PLR decreased. As the nocturnal time spent with arterial oxygen saturation<90% increased, the value of NLR was determined to increase. CONCLUSIONS: NLR and PLR values can give valuable information in OSAS.

Single-Nucleotide Polymorphisms on the RYD5 Gene in Nasal Polyposis.

Nasal polyposis (NP) is a chronic inflammatory disease. Several genes play major roles in the pathophysiology of the disease. We analyzed RYD5 gene polymorphisms to determine the effect of these variants or their genetic combinations on NP. We genotyped the RYD5 gene in 434 participants (196 patients with NP and 238 controls). Data were analyzed with SPSS, SNPStats, and multifactor dimensionality reduction (MDR) software. We genotyped 10 single-nucleotide polymorphisms (SNPs) in the RYD5 gene. RYD5 (+152G>T) (p.Gly51Va) has not been reported previously. The PolyPhen and PROVEAN predicted the missense mutation as deleterious, but sorting intolerant from tolerant (SIFT) did not. In the genotype analysis, we found that four SNPs (RYD5 [-264A>G], [-103G>A], [+57-14C>T], and [+66A>G]) were significantly associated with NP. The individuals with combined genotypes of six risk alleles (RYD5-264G, -103A, +13C, +57-14T, +66G, and +279T) had significantly higher risks for NP compared with the ones with one or four risk alleles. Haplotype analysis revealed that the two haplotypes were associated with risk of NP. As indicated by MDR analysis, RYD5 (-264A>G and -103G>A) and RYD5 (-264A>G, -177C>A, and -103G>A) were the best predictive combinations and they had the highest synergistic interaction on NP. In addition, RYD5 (+13C>T) was significantly associated with increased risk of both NP with asthma and NP with allergy and asthma. Some SNPs and their combinations in the RYD5 gene are associated with increased probability for developing NP. We emphasize the importance of genetic factors on NP and NP-related clinical phenotypes.

New Predictive Parameters of Bell's Palsy: Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio.

BACKGROUND: Bell's palsy is the most frequent cause of unilateral facial paralysis. Inflammation is thought to play an important role in the pathogenesis of Bell's palsy. AIMS: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are simple and inexpensive tests which are indicative of inflammation and can be calculated by all physicians. The aim of this study was to reveal correlations of Bell's palsy and degree of paralysis with NLR and PLR. STUDY DESIGN: Case-control study. METHODS: The retrospective study was performed January 2010 and December 2013. Ninety-nine patients diagnosed as Bell's palsy were included in the Bell's palsy group and ninety-nine healthy individuals with the same demographic characteristics as the Bell's palsy group were included in the control group. As a result of analyses, NLR and PLR were calculated. RESULTS: The mean NLR was 4.37 in the Bell's palsy group and 1.89 in the control group with a statistically significant difference (p<0.001). The mean PLR was 137.5 in the Bell's palsy group and 113.75 in the control group with a statistically significant difference (p=0.008). No statistically significant relation was detected between the degree of facial paralysis and NLR and PLR. CONCLUSION: The NLR and the PLR were significantly higher in patients with Bell's palsy. This is the first study to reveal a relation between Bell's palsy and PLR. NLR and PLR can be used as auxiliary parameters in the diagnosis of Bell's palsy.

[New predictive parameters of nasal polyposis: neutrophil to lymphocyte ratio and platelet to lymphocyte ratio]. / Nazal polipte yeni öngörücü parametreler: Nötrofil lenfosit orani ve trombosit lenfosit orani.

OBJECTIVES: This study aims to investigate the correlations between nasal polyposis (NP) and NP density with neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). PATIENTS AND METHODS: The study included 105 patients (72 males, 33 females; mean age 41.33±12.85 years; range 16 to 63 years) diagnosed as NP (NP group) and 83 healthy individuals (54 males, 29 females; mean age 44.01±8.50 years; range 18 to 62 years) (control group). Nasal polyposis density score was calculated with preoperative Lund-Mackay computed tomography grading system. Neutrophil to lymphocyte and PLR ratio values of NP and control groups were calculated and statistically compared. Neutrophil to lymphocyte and PLR values were statistically compared in terms of NP density in the NP group. RESULTS: Mean NLR value was 2.26 in the NP group and 1.75 in the control group with a statistically significant difference (p=0.001). Mean PLR value was 120.79 in the NP group and 109.84 in the control group with a statistically insignificant difference (p=0.073). CONCLUSION: Neutrophil to lymphocyte ratio value may be used as a novel marker that is easily administered in patients with nasal polyps and obtained with low-cost tests. New studies with larger patient series are needed for the value of PLR.

Evaluation of autoinflammatory disease genes in nasal polyposis.

BACKGROUND/AIM: To investigate cold-induced autoinflammatory syndrome 1 (CIAS 1) gene polymorphisms that cause autoinflammatory diseases in patients with nasal polyposis (NP). MATERIALS AND METHODS: The study included 30 patients diagnosed with NP and 30 healthy age-matched individuals as a control group. CIAS1 polymorphisms were assessed by DNA sequence analysis. Patients with nasal polyps and the control group were compared in terms of gene polymorphisms. Each of the 8 polymorphisms of the CIAS1 gene was analyzed separately in the patient group. RESULTS: The most frequently observed polymorphisms in the patient group were c.732G > A in 83%, c.663C > T in 23%, and c.1308C > A in 23% of the patients. c.732G > A polymorphism was evaluated separately. Guanine was transformed to adenine at the 732nd nucleotide position of the CIAS1 gene in the cDNA of chromosome 1. CONCLUSION: The CIAS1 gene c.732G > A polymorphism was thought to be responsible for an increase in disease susceptibility. The frequency of the "A" allele is higher in the patient group compared to the control group. Autoinflammatory diseases seem like a candidate to be one of these factors. This is the first report to define the role of autoinflammatory diseases among these factors.

The effect of obstructive sleep apnea syndrome and continuous positive airway pressure treatment on voice performance.

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) may affect voice performance due to alterations that occur in the upper respiratory tract. The aim of the study was to assess the effect of OSAS and continuous positive airway pressure (CPAP) treatment on voice performance. MATERIALS AND METHODS: Twenty-seven patients with moderate to severe OSAS (apnea-hypopnea index ≥15/h) who underwent polysomnographic examination and 28 age- and gender-matched normal control subjects were enrolled in the study. The patients and the control subjects completed Voice Handicap Index (VHI) questionnaires, and their acoustic voice analyses were performed. Fundamental frequency (F0), jitter %, and shimmer % parameters were statistically compared. Acoustic analyses were performed again 1 month after regular CPAP use in OSAS patients, and the parameters before and after the treatment were compared. RESULTS: F0 was 160.82 Hz, jitter was 0.70%, shimmer was 1.05%, and VHI was 1.18 in the control group. In OSAS patients before CPAP treatment, F0 was 157.04 Hz, jitter was 0.82%, shimmer was 1.33%, and VHI was 13.11. These results showed that shimmer and VHI parameters were significantly worse in OSAS patients. After CPAP treatment, F0 was 169.19 Hz, jitter was 0.62%, shimmer was 0.93% and VHI was 5.00. The differences were statistically significant in all parameters. CONCLUSION: The acoustic parameters of OSAS patients differed from those of the normal control subjects. The patients' voice performance improved after a regular use of CPAP treatment for 1 month.

Investigation of SCGB3A1 (UGRP2) gene arrays in patients with nasal polyposis.

The aim of the current study is to investigate the potential relationship between polymorphisms and nasal polyposis (NP) pathogenesis in the SCGB3A1 (UGRP2) gene, which is a member of the secretoglobin gene super family. Genotypic variations were studied by performing DNA sequencing in blood samples of 80 patients with NP and 70 healthy individuals to evaluate nucleotide changes and their positions that might be in the SCGB3A1 gene (promotor, splicing points, and exon distributions). In the SCGB3A1 gene, three single-nucleotide changes labeled IVS1-89 T>G, c. -183 G>T, IVS1-189 G>A were identified. IVS1-89 T>G and IVS1-189 G>A belong to the first intronic region of the gene, whereas c. -183 G>T was observed in the promoter region of the gene. The IVS1-89 T>G nucleotide change was observed in the patient and control groups, whereas c. -183 G>T and IVS1-189 G>A nucleotide changes were observed in the control group only. SCGB3A1 (IVS1-89) genotype frequencies between patients with NP and control group were not significantly different (p = 0.311). There was a statistically significant difference in the control group in comparison to patients with NP in terms of SCGB3A1 (c. -183 GT) and SCGB3A1 (IVS1-189 GA) frequency (p = 0.0045 and p = 0.009, respectively). The findings of the current study suggest that SCGB3A1-183 T and SCGB3A1 IVS1-189 A alleles might have a protective effect against NP, and that SCGB3A1 (-183 GT and IVS1-189 GA) genotypes should be studied in future population-based studies.

[Cervical lymphadenopathy: progressive transformation of germinal centers]. / Boyunda lenfadenopati: Germinal merkezlerin progresif transformasyonu.

Enlarged lymph node in the head and neck region is a common reason for referral to ear nose throat specialists. In the differential diagnosis of chronic lymphadenopathies, infection, lymphoproliferative disorders and progressive transformation of germinal centers should be considered. In this article, we report two cases of progressive transformation of germinal centers in the neck.