Assessment of the Clinical Use of Vestibular Evoked Myogenic Potentials and the Video Head Impulse Test in the Diagnosis of Early-Stage Parkinson's Disease.

OBJECTIVES: To explore the usefulness of vestibular tests including "vestibular evoked myogenic potentials" (VEMPs) and the video head impulse test (vHIT) in the early diagnosis of "idiopathic Parkinson's disease" (PD). MATERIALS AND METHODS: The study involved 80 participants including 40 patients (24 males, 16 females; age average 63.20 ± 7.94 years) with PD and 40 healthy individuals (18 males and 22 females; age average of 60.36 ± 7.68 years). The Modified Hoehn and Yahr (H&Y) scale was used to measure how Parkinson's symptoms progress and the level of disability. Patients with PD underwent cVEMPs, oVEMPs, and vHIT and the results were compared with those of 40 age-matched healthy control (HC) subjects. vHIT results and VEMP responses were registered in all patients and HCs. RESULTS: One-sided absent cVEMP responses were found in 6 (15%) patients with PD and 8 (20%) patients had bilaterally absent responses. Five (12.5%) patients had 1-sided absent oVEMP responses and it was bilateral in 6 (15%). Patients with PD had significantly shorter cVEMP P1, N1 latency, lower cVEMP amplitudes, and oVEMP amplitudes than the HC group. The cVEMP and oVEMP amplitude asymmetry ratio was significantly higher in the PD group (P < .05). Evaluation of vHIT results and vestibular-ocular reflex (VOR) gain between the groups revealed that anterior canal and posterior canal VOR gains results were remarkably lower in the PD group than in the HCs (P < .05). There was no difference in right and left lateral canal VOR gains between the groups (P > .05). CONCLUSION: The results of this study suggest that cVEMP and vHIT can be used to evaluate the vestibular system in patients with early-stage Parkinson's disease.

The efficacy of Kinesio taping on lymphedema following head and neck cancer therapy: a randomized, double blind, sham-controlled trial.

OBJECTIVE: The aim was to investigate the effectiveness of Kinesio taping for lymphedema following head and neck cancer therapy and its effect on patient compliance and quality of life. METHODS: A total of 66 patients with lymphedema following head and neck cancer therapy were randomly allocated to the therapeutic Kinesio taping group (n = 33) and the sham Kinesio taping group (n = 33). All participants received manual lymphatic drainage, Kinesio taping, and home exercises for the first four weeks, and only home exercises for the second four weeks. The tape measurements, a scale of external lymphedema, a scale of the internal lymphedema, and quality of life were evaluated in both groups. The perceived discomfort consisting of limitation of daily living activities, pain, tightness, stiffness, and heaviness were also recorded. RESULTS: When the group x time effect was evaluated, it was observed that external lymphedema was significantly reduced in both groups according to neck and face composite measurements (p < .001). However, in these measurements, a significant difference was found between the groups in favor of the KT group (p = .001, p = .032, respectively). At the end of the study, there was no significant difference in terms of internal lymphedema in both groups (p = .860). The quality of life parameters such as global health status and swallowing were significantly better in the Kinesio taping group (p < .001). There was no significant difference in the parameters of perceived discomfort between the two groups (p = .282, p = .225, p = .090, p = .155, p = .183, respectively). CONCLUSION: Kinesio taping is effective in tape measurements and positively affects the quality of life in lymphedema following head and neck cancer therapy.

Effects of nasal packing and transseptal suturing on swallowing after septoplasty.

PURPOSE: This clinical trial aimed to investigate the effects of different nasal packing methods and transseptal suture technique on swallowing after septoplasty. METHODS: This randomized prospective study consists of 180 consecutive patients with septal deviation. All the patients underwent septoplasty. All the patients were randomly assigned to three groups. In group A, transseptal sutures were used for septal stabilization. In group B, both nasal passages were packed with Merocel tampons for septal stabilization. In group C, both nasal passages were packed with Doyle silicone splints for septal stabilization. For the evaluation of swallowing, the Eating Assessment Tool (EAT-10) questionnaire and a visual analog scale (VAS) were administered to all the patients preoperatively and on the second and seventh postoperative days. RESULTS: One hundred and twenty two of the patients (67.7%) were female and 58 of them (32.2%) were male. The mean age was 32.41 ± 12.37 years (range: 18-57 years). Both EAT-10 and VAS scores on the second postoperative day were significantly higher than the preoperative scores in all the groups (p < 0.05). The transseptal suture group had significantly lower EAT-10 and VAS scores on the second postoperative day than the Merocel packing and silicone packing groups (p < 0.05). Both EAT-10 and VAS scores on the postop 7th day significantly decreased in all groups compared to the postop second day (p < 0.05). CONCLUSIONS: Septoplasty affects swallowing, regardless of whether a tampon is applied. Transeptal suturing has a lesser effect on swallowing than other techniques. Although silicone packing is a less invasive method, it negatively affects swallowing, similar to Merocel packing. The transseptal suture technique is more comfortable than the other techniques in terms of swallowing function in the postoperative period.

A new halitosis screening tool: halitosis finding score derivation and validation.

OBJECTIVE: The lack of a valid and appropriate halitosis screening survey prompted us to develop and validate a simple, 15-item questionnaire to be used as a screening tool to score halitosis for the daily practise. METHODS: After calculating the sample size, 200 participants were included in the study. All participants filled a 15-item questionnaire with the subsequent measurements of halitosis through the organoleptic scoring system and a halimeter. The application of questionnaire and the halitosis measurements were repeated 15 days after the first control. RESULTS: Mann-Whitney's U test was statistically significant between the halimeter measurements and Halfins scores (p=.000, p<.05). ROC curve is drawn due to halitometer analyses. The cut-off point was determined such as Halfins scores greater than 14 indicated halitosis (65.75 sensitivity, 66.04 specificity). The content validation and concurrent validity were proven successful. CONCLUSIONS: A new halitosis-specific screening tool called Halfins was proven as a valid diagnostic tool for measuring halitosis in the present study. Nevertheless, we believe this questionnaire could be used as complementary tool for the diagnosis of halitosis, seeing as its use alone is not able to firmly conclude the presence of halitosis in all cases, an organoleptic test or VSC assessment would still be necessary.

The role of thymic stromal lymphopoietin in the development of chronic otitis media with effusion.

PURPOSE: To investigate the effect of thymic stromal lymphopoietin on the development of chronic otitis media with effusion MATERIALS AND METHODS: This study was conducted on 40 patients who had adenoidectomy operation. The objects were divided into two groups. Group 1; adenoidectomy with chronic serous otitis media, group 2; adenoidectomy without chronic serous otitis media. Serum and tissue thymic stromal lymphopoietin levels were measured by ELISA. Serum and tissue TLSP levels, mast cell count, adenoid size were compared between the groups. RESULTS: Twenty-four (60%) of patients were female and 16 (40%) were male. Twenty patients (55%) had adenoid hypertrophy with chronic serous otitis media, and 18 (45%) had adenoid hypertrophy without chronic serous otitis media. The mean age of the patients was 6.21 ± 2.31 years. The mean mast cell count was significantly higher in group 1 compared with group 2 (p = 0.017). The mean tissue thymic stromal lymphopoietin measurement was also significantly higher in group 1 than group 2 (p = 0.023). However, there was no significant difference in regards to serum levels between the groups (p = 0.480). CONCLUSION: The number of mast cells as well as thymic stromal lymphopoietin levels in the adenoids of children was significantly high in the chronic serous otitis media patients. The release of thymic stromal lymphopoietin from the adenoid tissue plays a role in initiating and maintaining a local inflammatory reaction in the eustachian tube that may lead eventually to middle ear effusion in non-atopic patients.

The effect of platelet-rich fibrin (PRF) on wound healing, adhesion, and hemostasis after endoscopic sinus surgery in patients with nasal polyposis.

PURPOSE: Chronic rhinosinusitis (CRS) is one of the most common chronic diseases seen worldwide. Endoscopic sinus surgery (ESS) has become a widely accepted procedure for medically refractory chronic rhinosinusitis and nasal polyps. Prevention of revision surgery often depends on good wound healing and less adhesion formation. In recent years, the effects of platelet-rich fibrin (PRF) on tissue healing have been addressed in many surgical branches, especially for dental implant surgery and plastic surgery. METHODS: This prospective study was conducted with 50 patients who underwent endoscopic sinus surgery for the diagnosis of nasal polyposis. While the middle meatus in one nasal cavity was filled with PRF and supported with Nasopore, only Nasopore was used in the other nasal cavity middle meatus. The patients were followed up clinically at weeks 1, 2, 3, 4, 8, and 12 postoperatively. The assessor determined the presence of adhesion, crusting, bleeding, frontal ostium stenosis, granulation, and infection, and if present, the grades of these complications were scored according to a questionnaire. RESULTS: In our study, adhesion, infection, bleeding, granulation, and frontal ostium stenosis were less common in the PRF group, and a statistically significant difference was found between the groups. CONCLUSION: In our study, better results were obtained in terms of adhesion, infection, bleeding, granulation, and frontal ostium stenosis after ESS as a result of the effects of PRF on wound healing. The application of PRF is an inexpensive and easy procedure. PRF can be a good alternative to other types of tampons after ESS.

Analysis of snoring to determine the site of obstruction in obstructive sleep apnea syndrome.

BACKGROUND: The aim of this study was to integrate the physical findings of drug-induced sleep endoscopy with snoring sound analysis in patients with obstructive sleep apnea/hypopnea syndrome (OSAS) and to compare the findings with previously published data. METHODS: This was a prospective, non-randomized study. Participants were all candidates for surgical treatment of OSAS and formed three groups, retropalatal (RP) obstructions, retrolingual (RL) obstructions, and multilevel (ML) obstructions. At the time of DISE, recordings of concurrent snoring sounds were made. Mean pitch frequency, peak sound frequency, and fundamental frequency (Fo) components were determined. RESULTS: A total of 55 participants had mean age 46.2 ± 7.3 years, mean BMI 30.0 ± 3.7 kg/m2, and included 11 women (20%). Differences in mean pitch frequency, Fo, and peak sound frequency were all statistically significant between the RP and RL (p = 0.001), between ML and RL (p = 0.025) but were not significantly different between RP and ML. Mean pitch frequency of RP was lower than RL, and ML frequency was between RL and RP. The sound analysis graphics revealed RP waves with sharp peaks and lower frequencies and RL with smooth curves and higher frequencies. ML showed irregular patterns. Mean pitch frequency of RL was always above 400 Hz, whereas RP was below this value. CONCLUSIONS: It is feasible to apply sound analysis to determine the site of obstruction during DISE. Combining the data may help surgeons make more accurate assessments of the pattern of the disease.

Comparison of the Olfactory Functions in Conventional Endoscopic Sinus Surgery to the Balloon Sinuplasty in Frontal Sinus Surgery.

OBJECTIVE: Balloon sinuplasty is being used worldwide, however the olfactory functions after balloon sinuplasty are underestimated. The authors aimed to study the effects of conventional endoscopic sinus surgery (ESS) compared to the balloon sinuplasty on olfactory function. MATERIALS AND METHODS: Forty-four subjects were randomly divided into 2 groups as ESS and balloon sinuplasty. The olfactory functions of each subject were recorded preoperatively and at the 1st, 3rd, 6th, and 12th months postoperatively. RESULTS: The initial assessments of olfaction were the same in both groups. After the surgery, the olfactory functions were significantly better in those of ESS group (P < 0.05). CONCLUSION: The olfactory function is preserved better in the conventional surgery compared to the balloon catheter dilation of the frontal sinus.

Costal Cartilage and Costal Perichondrium Sandwich Graft in Septal Perforation Repair.

BACKGROUND: Repair of the septal perforation is a challenging procedure and there are many different surgical techniques. In this study, the authors present a novel method which the authors use costal cartilage and costal perichondrium sandwich graft as an interposition graft with bilateral opposing mucoperichondrial flaps. PATIENTS AND METHODS: Fourteen patients (5 females, 9 males) underwent septal perforation repair. All surgeries were performed through an open approach septoplasty technique. The edges of the perforation were incised to excise the mucosa with a thickness of 2 mm. Bilateral mucoperichondrial flaps were raised. Then costal cartilage and costal perichondrium were harvested from the rib. The cartilage was divided into a smaller piece which is 2 mm thick and 1 cm wider than perforation size. The prepared cartilage was wrapped with perichondrium to obtain a sandwich graft. This sandwich graft was placed between the mucoperichondrial flaps, corresponding to the perforation. RESULTS: After 9 months of follow-up, 11 (78%) of the 14 perforations were completely closed. Failure of the repair was observed in 3 patients; 2 of the perforations were medium size and one perforation was large size. No complications occurred. CONCLUSION: Using costal cartilage and costal perichondrium sandwich graft is a novel and useful technique especially in large septal perforations. Considering that septum surgery has an important role in the etiology of septum perforation, this method provides a good graft source for both perforation closure and simultaneous rhinoplasty surgery.

Histopathological Comparison of 2-Octyl Cyanoacrylate and Primary Suturing for Tongue Lacerations.

OBJECTIVE: To enable tongue incisions to be repaired more easily, rapidly, and practically, particularly in pediatric patients by using 2-octyl cyanoacrylate (OCA) tissue adhesive. METHODS: A single linear incision was made on the midline dorsal part of the tongue. Twenty-four rats were randomly divided into the four groups: Group 1 (n = 6), OCA healing at day 5; group 2 (n = 6), OCA healing at day 21; group 3 (n = 6), Vicryl healing at day 5; group 4 (n = 6), Vicryl healing at day 21. In groups 1 and 2, OCA was applied to the incision site. The incisions of the rats in groups 3 and 4 were closed using Vicryl sutures. Histopathological examination was compared between and within the groups at day 5 and 21. RESULTS: The operation duration was significantly shorter with OCA than with Vicryl sutures(P < 0.001). Regarding the histopathological results, there were no differences between group 1 and group 3 in epithelial regeneration, inflammation, fibroblastic activity, edema, presence of giant cells, fibrin deposition, ulceration, abscess formation, and granulation tissue. However, moderate infiltration of acute inflammatory cells was significantly more frequent in group 1 than in group 3. At day 5, the incidence of moderate foreign body residue was significantly higher in group 1 than in group 3. No difference was observed between group 2 and group 4 at day 21 (P > 0.05). CONCLUSION: OCA is a practical, rapid, and effective method for repairing tongue lacerations. Although infiltration by inflammatory cells and foreign bodies increased in the early period, the long-term results of OCA were indistinguishable from those of suturing.

[Short term olfactory memory and olfactory function after inhalation anesthetic agents: a randomized clinical trial]. / Memória olfativa de curta duração e função olfativa após anestésicos inalatórios: estudo clínico randomizado.

BACKGROUND AND OBJECTIVES: This clinical trial aimed to evaluate the effects of two different inhalation anesthetic agents on postoperative olfactory memory and olfactory function in patients who underwent micro laryngeal surgery. METHODS: This randomized prospective controlled study consisted of 102 consecutive patients with a voice disorder. The patients underwent micro laryngeal surgery for voice disorders under general anesthesia. Patients who did not meet inclusion criteria and/or declined to participate (n=34) were excluded from the study. Patients were divided into two groups. Four patients from Group 1 and four patients from Group 2 were lost to follow-up. Group 1 (n=30) received sevoflurane, and Group 2 (n=30) received desflurane during anesthesia. We compared the results by performing the pre-op and post-op Connecticut Chemosensory Clinical Research Center Olfactory test. RESULTS: Thirty-three patients (55%) were male and 27 (45%) were female. The mean age was 48.18±13.88 years (range: 19-70 years). Preoperative and postoperative olfactory functions did not show a significant difference within the groups postoperatively (p> 0.05). Preoperative and postoperative olfactory memory showed a significant decrease 3hours after the surgery (p <0.05). CONCLUSIONS: Olfactory functions and memory were not affected by desflurane in the early postoperative period. Although sevoflurane did not affect olfactory functions, it had a temporary negative effect on olfactory memory in the early postoperative period.

Short term olfactory memory and olfactory function after inhalation anesthetic agents: a randomized clinical trial / Memória olfativa de curta duração e função olfativa após anestésicos inalatórios: estudo clínico randomizado

Abstract Background and objectives: This clinical trial aimed to evaluate the effects of two different inhalation anesthetic agents on postoperative olfactory memory and olfactory function in patients who underwent micro laryngeal surgery. Methods: This randomized prospective controlled study consisted of 102 consecutive patients with a voice disorder. The patients underwent micro laryngeal surgery for voice disorders under general anesthesia. Patients who did not meet inclusion criteria and/or declined to participate (n = 34) were excluded from the study. Patients were divided into two groups. Four patients from Group 1 and four patients from Group 2 were lost to follow-up. Group 1 (n = 30) received sevoflurane, and Group 2 (n = 30) received desflurane during anesthesia. We compared the results by performing the pre-op and post-op Connecticut Chemosensory Clinical Research Center Olfactory test. Results: Thirty-three patients (55%) were male and 27 (45%) were female. The mean age was 48.18 ± 13.88 years (range: 19‒70 years). Preoperative and postoperative olfactory functions did not show a significant difference within the groups postoperatively (p > 0.05). Preoperative and postoperative olfactory memory showed a significant decrease 3 hours after the surgery (p < 0.05). Conclusions: Olfactory functions and memory were not affected by desflurane in the early postoperative period. Although sevoflurane did not affect olfactory functions, it had a temporary negative effect on olfactory memory in the early postoperative period.

Resumo Introdução e objetivos: O estudo avaliou o efeito pós-operatório de dois agentes anestésicos inalatórios distintos na memória olfativa de curta duração e na função olfativa em pacientes submetidos à microcirurgia de laringe. Método: O estudo prospectivo controlado randomizado avaliou, consecutivamente, 102 pacientes com alteração vocal submetidos à microcirurgia de laringe sob anestesia geral. Trinta e quatro pacientes não obedeceram aos critérios de inclusão e/ou não aceitaram participar do estudo e foram excluídos. Os pacientes foram divididos em dois grupos. Quatro pacientes do Grupo 1 e quatro do Grupo 2 foram perdidos durante o seguimento. O Grupo 1 (n = 30) recebeu sevoflurano durante a anestesia e o Grupo 2 (n = 30), desflurano. Comparamos resultados pré e pós-operatórios de memória olfativa e funções olfativas, realizando o Connecticut Chemosensory Clinical Research Center Olfactory test. Resultados: Foram incluídos um total de 33 (55%) homens e 27 (45%) mulheres. A idade média foi 48,18 ± 13,88 anos (variação: 19-70 anos). As funções olfativas pré e pós-operatórias não apresentaram diferença estatisticamente significante dentro dos grupos no pós-operatório (p > 0,05). A memória olfativa pré e pós-operatória não mostrou diminuição estatisticamente significante quando avaliada três horas após a cirurgia (p< 0,05). Conclusões: Memória e funções olfativas não foram alteradas pelo desflurano no pós-operatório imediato. Embora o sevoflurano não tenha alterado as funções olfativas, causou efeito temporário negativo na memória olfativa no pós-operatório imediato.

The effect of transcutaneous electrical nerve stimulation (TENS) on chronic subjective tinnitus.

OBJECTIVES: Chronic Subjective Tinnitus is a very highly prevalent disorder worldwide. There is no definitive treatment. The aim of this study is to investigate the efficacy of transcutaneous electrical nerve stimulation (TENS) applied to the auricula for treating tinnitus using the Depression Anxiety Stress Scales (DASS) and Tinnitus Handicap Inventory (THI). METHODS: The 60 patients were randomly divided into 3 groups of 20 patients. The first group (A) had one ear stimulated with TENS, and the second group (B) had both ears stimulated. Group C (placebo group) received no electrical or sound stimulation. All group patients received total of 10 sessions with a maximum of 4 days between the sessions. RESULTS: The THI and DASS scores decreased significantly after the treatment (p < 0.05). A significant difference was also observed between the groups after treatment (p < 0.05). While there was no difference between group A and B, it was shown that group C's post-treatment score was significantly higher than those of both groups (p < 0.05.) CONCLUSION: It is important to note that TENS has a therapeutic effect on subjective chronic tinnitus as well as a placebo effect.

A simple method to reduce halitosis; tongue scraping with probiotics.

OBJECTIVE: We aimed to assess the effects of probiotic implantation to the dorsum of the tongue against halitosis. MATERIALS AND METHODS: 100 participants were randomly divided into three groups as tongue back scraping (TS), probiotic implantation to the dorsum of the tongue (PB) and mouthwash alone as the control group (MW). Measurements were taken before the treatment, after the first month of treatment and one month after the cessation of treatment. RESULTS: Halimeter, winkel and woodlight scores were evaluated initially, in the first month and after the cessation of the treatment. All of MW measurements showed no difference throughout the study. All of TS measurements decreased significantly in the first month (p < 0.05) but rose again in the final count. All of PB measurements significantly decreased in the first month and kept their low levels after the cessation of the treatment (p < 0.05). CONCLUSION: Probiotics and tongue scraping are widely used against halitosis but they are not intended to be used together. In this study, we proposed and proved an effective method of probiotic implantation by tongue scraping and showed that halitosis did not recur after the cessation of the treatment.

The Effect of Gastric Helicobacter pylori Colonization on Nasal Functions.

The aim of this study is to investigate the effect of gastric Helicobacter pylori colonization on nasal functions. The study enrolled patients (n = 100) who underwent endoscopy for gastroesophageal reflux disease. Patients with laryngopharyngeal reflux (LPR) were identified by Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). Patients were divided into 2 groups: LPR (+) (n = 64) H pylori (+), RSI > 13, RFS > 7; LPR (-) (n = 36) H pylori (+), RSI < 13, RFS < 7. Visual analog scale (VAS), sinonasal outcome test-22 (SNOT-22), peak nasal inspiratory flowmeter (PNIF), mucociliary clearance (MCC), and olfactory tests were used to evaluate the nasal functions. The average VAS for nasal obstruction, PNIF, and MCC did not differ significantly between the LPR (+) and LPR (-) groups (P > .05). However, the average olfactory test scores were lower in the LPR (+) patients than the LPR (-) patients (P < .05). Also, the SNOT-22 scores were significantly higher in LPR (+) patients than in LPR (-) (P < .01). Nasal functions and symptom scores were also evaluated according to the H pylori grading. The PNIF, MCC, SNOT-22, and olfactory test results deteriorated as the gastric mucosal H pylori colonization increased (P < .05). In conclusion, nasal functions differed between LPR disease and GERD only, while the density of H pylori colonization in the gastric mucosa had an effect on nasal function.

Preservation of Autogenous Septal Cartilage for Revision Surgery.

The aim of this study is to find the ideal solution and the optimum temperature to protect the viability of the cartilage graft. This randomized prospective study consists of 30 patients with septal deviation. All patients had septoplasty operation for chronic nasal obstruction. Ten strips of cartilages were prepared from each excised septum and then immersed in formalin, alcohol (96%), saline (0,9%), gentamicin (80 mg), and cefazolin sodium (Cezol 1gr) solutions in a total of 300 vials. Those vials were stored for 6 months at both +4°C and -18°C temperatures. Two groups were compared with each other. 22 cases were male (73%) and 8 patients were female (7%). The age range was between 20 and 48 (average 25.34 ±â€Š4.09 years). Parameters at +4°C; the cartilage volume was not significantly different among the solutions (P >0.05). Necrosis was significantly lower in the alcohol (46.7%) compared to other solutions (P = 0.001). Calcification was lower in the gentamicin group (56.7%). The loss of metachromasia was lower in the alcohol solutions (P = 0.000). Parameters at -18°C; the loss of metachromasia was higher in the gentamicin group (56.7%) than the other solutions (P = 0.003). The authors observed no significance in the rates of necrosis, calcification, metaplasia, inflammation, vascularity, or fibrosis among the solutions (P >0.05). Less necrosis and metachromosis loss in the alcohol solution indicated that alcohol was more suitable for preservation of the cartilage. In addition, temperature degree for the preservation of the cartilage did not show any significant differences.

Camouflage of the Nasal Dorsum in Thin-Skinned Patients with Diced Cartilage Combined with a New Cross-Linked Hyaluronan (NCH) Gel and Blood: A New Method.

INTRODUCTION: Nasal dorsum irregularities after rhinoplasty are still one of the most common complaints among both surgeons and patients. In this study, we used a new cross-linked hyaluronan (NCH) gel and blood mixture as the stabilisation scaffold. Diced cartilage combined with the NCH gel and blood mixture was used for nasal dorsum camouflage. PATIENTS AND METHODS: Fifty-two thin-skinned patients (29 females and 23 males) underwent primary rhinoplasty including nasal dorsum enhancement with diced cartilage combined with the NCH gel and blood mixture. The cartilage tissue was diced into small pieces; then, 1 cc NCH gel and blood were added into diced cartilage. The mixture was delivered onto the nasal dorsum via dorsal retractor. RESULTS: After 1 year of follow-up, there were no irregularities in the nasal dorsum area observed, nor any displacement or absorbance of the camouflage material. No complications occurred. CONCLUSION: The use of diced cartilage combined with the NCH gel and blood is an effective, simple and safe method for nasal dorsum camouflage in thin-skinned patients in rhinoplasty. The NCH gel within the mixed graft also reduces adhesions at the osteotomy lines. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Assessment of Resonant Voice Therapy in the Treatment of Vocal Fold Nodules.

OBJECTIVE: This study aimed to evaluate objective and subjective changes in the voices of adults with vocal fold nodules who received resonant voice therapy. METHODS: Twenty-six female patients who had bilateral vocal fold nodules and 30 healthy women were included in the study. Patients were treated with vocal hygiene education and resonant voice therapy. Voice records were obtained for acoustic and aerodynamic analysis. Fundamental frequency, jitter, shimmer, and noise-to-harmonic ratio were analyzed for acoustic analysis. Maximum phonation time was used for aerodynamic evaluation. Voice Handicap Index 10 was completed by patients for subjective assessment. After 8 weeks of therapy analyses were repeated. RESULTS: Stroboscopic analysis revealed that 14 patients had total and 9 had partial regression. Fundamental frequency increased from 152.27 ± 28.34 to 199.56 ± 11.25 in study group and this was statistically significant. Jitter, shimmer, and noise-to-harmonic ratio improvements were also significant. Voice Handicap Index scores decreased from 22.25 ± 3.82 to 8.92 ± 5.48 and this was statistically significant. CONCLUSION: Our finding that resonant voice therapy improved objective and subjective parameters of vocal function in patients with vocal fold nodules indicates that it is an effective treatment for VFNs and should be considered a therapeutic option.

Histopathological Analysis of the Effects of Corticosteroids on Vocal Cords: Experimental Study.

Local treatment with corticosteroids results in side effects involving the upper respiratory tract including candidiasis, sore throat, and dysphonia. Although these effects are well known, they have not been evaluated using a histopathological approach. This study investigated the histopathological aspects of steroid-induced dysphonia. A total of 16 female Wistar albino rats were divided into two groups. The eight rats in the experimental group were given an inhaled dose of mometasone furoate daily for 4 weeks. The control group was kept at room temperature for 4 weeks. The vocal cords were evaluated histopathologically using hematoxylin and eosin staining. Both groups had typical epithelial lining and basal membranes. Inflammation differed between the two groups (P = 0.024). There were no differences in squamous metaplasia and hyperplasia (P = 0.302 and 0.302, respectively). This study revealed that inhaled corticosteroids inhibit mucosal immunity, and may result in reversible mucosal changes.

Comparison of the Effects of Cigarette Smoking on Male and Female Vocal Folds.

OBJECTIVE: To investigate effects of smoking cigarette on male and female larynges and compare them. METHOD: Eighteen adult Wistar Albino rats were included to study; 9 were male and 9 female. The exposure groups each contained 6 rats, and the control groups 3 rats. Six male constituted group 1 and 6 female constituted group 2. Group 1 and 3 were exposed to smoke. Group 2 and 4 were composed of 3 males and 3 females, respectively. Smoke from 10 cigarettes was delivered in each of the morning and afternoon daily for 1 month. At the end of 4 weeks, all rats were sacrificed and their larynges were evaluated histopathologically. RESULTS: Microscobic evaluation of epithelium of vocal folds revealed no significant difference between study groups. There was also no difference between study and control groups. Subepitelial tissue showed no difference between study groups but angiogenesis and inflammation were higher in study groups. Epithelial analysis of false vocal folds showed significant difference between study groups. Female epithelium showed more hyperplastic and metaplastic changes. CONCLUSION: Cigarette smoke damaged both the vocal folds and false vocal folds. The female false vocal folds were more susceptible to damage than the males.