Opinions of Otorhinolaryngology Residents about Their Education Process.

OBJECTIVE: Our study was planned to get the views of residents about the Otorhinolaryngology (ORL) education process and to enlighten the studies to make this process more effective. METHODS: A questionnaire was sent to the residents who were still in the residency program in all education clinics via "Google Drive". Seventy-four of 354 residents responded and the answers were evaluated electronically. RESULTS: Fifty residents (67.56%) gave an affirmative answer to the question about the use of "Resident Log Book" and no difference was seen among the clinics. While 9 residents (12.16%) were reporting that they did not read any scientific papers, 43 (58.1%) reported they read less than three per month. Forty-one residents thougt that they were having a good and sufficient education. Seventeen residents (51.51%) who thought they were not having a sufficient education reported that the education period should be longer. When they were wanted to evaluate the education process, while 66 of them (89.18%) said "Exhausting", 52 (70.27%) said "Stressful", it was seen that the ones who said "Instructive" and "Rewarding" were 26 (35.13%) and 17 (22.97%) respectively. Further, 43 of 48 residents (89.58%) who were over the third year of their residency program indicated that they were unable to perform at least one procedure listed in the questionnaire after finishing their education. CONCLUSION: This study is important because it is the first study about the opinion of ORL residents and will help determine the current status in Turkey. This study will be useful for the preparation of educational programs and guides in the future.

Ear protrusion after tympanoplasty and the use of mastoid dressing.

OBJECTIVES: This study aims to assess possible wound complications of tympanoplasty and tympanomastoidectomy with or without postoperative mastoid dressing. PATIENTS AND METHODS: A total of 37 patients (22 females, 15 males; mean age: 23.88 years; range 9 to 64 years) who underwent middle ear or mastoid operations via postauricular incision were included in this prospective, randomized, controlled study. The patients were divided into two groups as having mastoid dressing (n=17) and nonmastoid dressing (n=20). Through a close follow-up, postoperative complications were noted and distance from mastoid scalp and auricular rim was measured. RESULTS: The mean mastoid-helix distance of non-mastoid dressing group was found 17.2 mm in operated and 16.9 mm in non-operated ears. The mean mastoid-helix distance of mastoid dressing group was 15.53 mm in operated ears and 16.47 mm in non-operated ears. Skin erythema was seen in a patient. There was no statistically significant increase in mastoid-helix distance (p>0.05). CONCLUSION: Tympanoplasty with or without mastoidectomy does not cause postoperative complication or protrusion of the ear, even if no mastoid dressing is used. Our study results suggest no benefit of mastoid dressing after tympanoplasty with or without mastoidectomy.

Grisel's Syndrome: A Rare Complication following Adenotonsillectomy.

Grisel's syndrome is a nontraumatic atlantoaxial subluxation which is usually secondary of an infection or an inflammation at the head and neck region. It can be observed after surgery of head and neck region. Etiopathogenesis has not been clearly described yet, but increased looseness of paraspinal ligament is thought to be responsible. Patients typically present with painful torticollis. Diagnosis of Grisel's syndrome is largely based on suspicion of the patient who has recently underwent surgery or history of infection in head and neck region. Physical examination and imaging techniques assist in diagnosis. Therefore, clinicians should be aware of acute nontraumatic torticollis after recently applied the head and neck surgery or undergone upper respiratory tract infection. In this paper, a case of an eight-year-old male patient who had Grisel's syndrome after adenotonsillectomy is discussed with review of the literature.

Sclerosing polycystic adenosis of the parotid gland presenting with a Warthin tumor.

Sclerosing polycystic adenosis (SPA) frequently presents as an isolated process, however it may involve adjacent benign salivary gland neoplasia. In this article, we present a 77-year-old female case with a 10-year history of a slow-growing mass of the left parotid gland of SPA presenting with a Warthin tumor. The patient underwent left superficial parotidectomy. The histopathological examination revealed SPA and multifocal Warthin tumor.

Combined medical and surgical therapy improves olfaction in patients with nasal polyposis.

OBJECTIVE: The aim of the present study was to evaluate the outcomes of combined oral steroid, nasal steroid and surgical therapy in patients with impaired olfaction due to nasal polyposis. PATIENTS AND METHODS: This prospective observational study was undertaken in the otolaryngology department of a university hospital. During the study, 19 nasal polyposis patients were evaluated three times, i.e. before oral steroid therapy, before surgery (after steroid therapy) and after surgery, with smell identification tests, acoustic rhinometry, subjective smell score, endoscopic grading and a visual analog scale for nasal obstruction. RESULTS: All subjective and objective measures were significantly improved after medical and surgical therapy (p < 0.01). The median smell identification score improved from 2 (interquartile range 0-4) to 5 (interquartile range 4-7) after combined therapy. Smell identification scores were found to be modestly correlated with all other examination findings. CONCLUSION: Combined therapy seems efficient in improving smell identification scores of nasal polyposis patients.

The efficiency of Nose Obstruction Symptom Evaluation (NOSE) scale on patients with nasal septal deviation.

OBJECTIVE: The aim in this study was to evaluate the efficiency of Nasal Obstruction Symptom Evaluation (NOSE) scale for septoplasty (without turbinate reduction) in comparison with other examination methods. METHODS: Prospective observational study was undertaken in otolaryngology department of university hospital. NOSE scale for quality of life assessment, visual analog scale for examination findings, acoustic rhinometry and coronal computed tomography were performed before and after septoplasty. The efficiency of NOSE scale to assess for septoplasty results and the correlation between NOSE scores and other techniques was analyzed. RESULTS: Twenty-seven patients underwent septoplasty; there was a very significant improvement in mean NOSE scores of patients (60.2 versus 11.28, p<0.01). There was no correlation between NOSE scores and acoustic rhinometry. Correlation was found between NOSE scores and examination and computed tomography findings (p<0.05). CONCLUSION: NOSE scale that is well correlated with examination findings and computed tomography, is very useful tool to evaluate the effectiveness of pure septoplasty.

[Hearing aid use and patient satisfaction]. / Isitme cihazi kullanimi ve hasta memnuniyeti.

OBJECTIVES: In this study, we assessed the hearing aid usage ratios and durations, patient satisfaction and the probable causes of disuse if they are not used. PATIENTS AND METHODS: A questionnaire with 16 questions was applied to the patients who were prescribed hearing aids in our clinic between January 2007 and December 2009. A total of 517 patients were called by phone. Hundred and seventy-nine of the patients (75 females, 104 males; mean age 60±23 years; range 17 to 94 years) participated in the trial. Hearing aid usage ratios and patients' satisfaction were determined and the factors influencing usage were statistically investigated. RESULTS: Hundred and forty-two of the patients used their hearing aids regularly and 37 of the patients either used their aids rarely or never used them. The most common cause reported for disuse was the frequent noise coming from the hearing aid. CONCLUSION: Failure to explain the usage of the hearing aids to the patients and age over 70 years have a statistically significant negative effect on the duration of hearing aid use and patient satisfaction.

How smell tests experience and education affect ENT specialists' attitudes towards smell disorders? A survey study.

The aim of the present study was to assess the effect of smell tests experience and education during residency or in general practice on ENT specialists' attitudes toward smell disorders in concern of their management strategies. Methodology included a voluntary and anonymous self-administered questionnaire survey conducted in Turkey and responses from 218 questionnaires were pooled and evaluated. Results stated that only 7.3% of the respondents reported currently using smell tests in their practice, and most of those had observed a smell test during their residency (p < 0.05) and received education on the olfactory disorders (p < 0.01). Furthermore, these doctors were more likely to manage patients with no assistance from other doctors or institutions (p < 0.01). Moreover, the doctors with more knowledge of smell disorders rated the symptom of smell loss as more important. We concluded that doctors who had training in smell disorders were confident in diagnosing and treating patients with smell disorders and were more likely to perform smell tests and assume all responsibility for diagnostic and treatment procedures. These results demonstrate the importance of both the residency and continuing medical education in training doctors who are confident to treat smell disorders.

Ankaferd blood stopper is more effective than adrenaline plus lidocaine and gelatin foam in the treatment of epistaxis in rabbits.

BACKGROUND: Epistaxis is an important emergency that can sometimes be life threatening without effective intervention. Persistent and recurrent bleeding can lead to aspiration, hypotension, hypoxia, or even severe and mortal cardiovascular complications. Providing prompt hemostasis is important, and the hemostatic method used must be easily and locally applicable, efficient, and inexpensive. OBJECTIVE: The aim of this study was to assess the hemostatic efficacy of Ankaferd Blood Stopper (ABS) in an experimental epistaxis model and to determine the histopathologic alterations with topical ABS application. METHODS: Twenty-eight New Zealand rabbits were evaluated in 4 study groups. Topical ABS, gelatin foam (GF), adrenalin + lidocaine (AL), and serum physiologic as negative control (C) were applied to the animals for controlling epistaxis. The bleeding was generated with a standard mucosal incision in all groups. Cotton pieces soaked with ABS, AL, C, and GF were applied to the nasal bleeding area. Time of hemostasis was recorded. Tissue samples were obtained after hemostasis for histopathologic examination. The samples were stained with hematoxylin and eosin (HE) and phosphotungstic acid hematoxylin (PTAH) and were examined under a light microscope. In this experimental study, the observers were blind to ABS, AL, and C but not to GF, because of its solid nature. RESULTS: Median durations required for hemostasis in ABS, AL, GF, and C groups were recorded as 30, 90, 90, and 210 seconds, respectively. The time until termination of bleeding in the ABS group was significantly shorter than that in the AL, GF, and C groups (P = 0.002, P = 0.002, and P = 0.001, respectively). On histopathologic evaluation, after staining with HE, minimal fibrin at the incision edges and a few extravasated erythrocytes were observed in the C, AL, and GF groups. In the ABS group, a dark amorphous material surrounded by fibrin, filling the space between the edges of incisions, was noticed. Fibrin was determined in the C, GF, and AL groups with PTAH stain and in the positive control group. In the ABS group, it was observed that the amorphous substance surrounded by fibrin seen in the HE sections was not stained with PTAH. CONCLUSIONS: Topical nasal ABS application controlled epistaxis faster than C, GF, and AL in this animal bleeding model. The bleeding model used here might fail to replicate the type of injury that would be likely to result in life-threatening bleeding in humans, which should be considered a limitation of the present study. The histopathologic findings in the nasal incision area suggest that ABS might affect global hemostasis by inducing a unique protein network formation, potentially representing a different mechanism of action among conventional antihemorrhagic applications.

A rare benign laryngeal tumor: angiomyolipoma.

Angiomyolipoma is a mesenchymal neoplasm containing adipose tissue, blood vessels, and smooth muscle fibers. Arising most frequently in the kidney, the tumor may exceptionally be at the head and neck region. The literature has 1 single published report of laryngeal angiomyolipoma, which was resected through laryngofissure. In this study, a 58-year-old man presented with laryngeal angiomyolipoma with swallowing discomfort. The tumor was removed by an endolaryngeal approach.

Bilateral aural myiasis (Wohlfahrtia magnifica): a case with chronic suppurative otitis media.

Myiasis is a disease caused by fly larvae and aural myiasis is a rare clinic condition often occuring in children or mentally retarded people. We report the case of an unusual presentation of a bilateral aural myiasis in a mentally retarded patient with bilateral chronic otitis media caused by the third instar larvae of Wohlfahrtia magnifica. Two larvae were located on the other ear canal while two additional larvae were located in the middle ear cavity and were removed through perforation of the tympanic membrane. Treatment of aural myiasis is based on removal of the maggots and cleansing of the ear with ethanol, chloroform or physiological saline. Physiological saline is preferred in patients who have tympanic membrane perforation. Myiasis is related to personal hygiene. Therefore, in order to decrease the incidence of these infestations, care and hygiene standards should be carried out for those at risk.

Prevalence of allergic rhinitis among the adult population in Turkey.

CONCLUSION: The prevalence of self-reported and physician-diagnosed allergic rhinitis (AR) exhibits significant variability across the seven geographical regions in Turkey. Our findings may contribute to the formulation of public health policy and development of preventive and therapeutic strategies for AR in Turkey. OBJECTIVE: The purpose of this study was to assess the prevalence of AR in the Turkish adult population, with emphasis on descriptive parameters in seven distinct geographical regions in Turkey. METHODS: The volunteers were evaluated with a custom-designed questionnaire for AR. Sample size for the study was calculated by allowing for 2% error in prevalence along with a 95% confidence interval (CI). At the end of the study, we reached 4125 volunteers. The data were analyzed with chi(2), ANOVA, and Tukey (post hoc) tests. RESULTS: A total of 4125 volunteers participated in the study; 2200 were female and 1925 were male. On the basis of self-reporting, 23.1% of the study population was considered to have AR (males 22.3%, females 23.8%). On the other hand, the prevalence of physician-diagnosed AR was 20.1% (males 19.7%, females 20.4%). The prevalence of self-reported AR was 23.8% in the urban and 18.4% in the rural areas.

Second primary cancer occurrence on forehead flap after reconstruction of nasal carcinoma.

We reported a case of basal cell carcinoma on the flap which was initially treated with excision of squamous cell carcinoma and forehead flap reconstruction of nasal dorsum. After 8 years of reconstruction, basal cell carcinoma was developed on the flap surface. This may be due to a recurrence, or a second primary tumor, or an activation of a dormant tumor with perturbing factors like surgery. In this report, our purpose was to discuss the possible etiopathogenesis, most appropriate diagnostic procedures, and treatment protocol for a carcinoma of the flap which has been used to reconstruct the previous cutaneous cancer.

The sensitivity of nasal eosinophilia in allergic rhinitis.

Evaluation of nasal epithelial samples is a part of clinical allergy practice. The aim of this study is to reveal the sensitivity of the nasal eosinophilia using Rhino-probe and Wright-Giemsa staining by means of all available nasal eosinophilia scoring systems. In 30 patients (12 males, 18 females; mean age = 31.6 years) with clinical diagnosis of allergic rhinitis, both sides of the nose were sampled. The content of the cupped tip of the probe has been prepared and stained for nasal cytological examination under oil immersion by light microscopy. Nasal eosinophilia has been assessed by scoring systems. The sensitivity of nasal eosinophilia has been revealed. The nasal eosinophilia scores have been compared between nasal sides (right or left nose) and also between the examiners' observations for the same sample. Sensitivity values of nasal eosinophilia according to previously described criteria in the literature have been found to be between 13.33 and 80%. As the agreements for the nasal eosinophilia diagnosis between the sides of the nasal cavity and between the blinded examiners, the criteria of nasal eosinophilia such as the ratio of eosinophils to neutrophils or to all inflammatory cells rendered different diagnoses between the examiners (P < 0.01). The results of nasal cavity sides and Meltzer-scoring yielded no differences (P > 0.05). The substantial intraindividual variations when comparing the results obtained from the nasal sides and low sensitivity reveal that the nasal cytology needs more objective and standardized methods for a better differential diagnosis of chronic rhinitis.

Contralateral normal ear after mastoid surgery: evaluation by otoacoustic emissions (mastoid drilling and hearing loss).

Mastoid drilling can cause transient hearing loss in the contralateral normal hearing ear. A study was designed to evaluate hearing in the contralateral normal ear before and after the mastoid surgery in a longitudinal manner and find out the duration of this temporary hearing loss. Twenty-two patients requiring mastoid surgery in their diseased ears, having contralateral normal ear were included. Pure tone audiometry and otoacoustic emissions (OAEs) were utilized for baseline evaluation. OAEs were repeated during the immediate postoperative period and daily up to the 6th postoperative day. The amplitudes of the OAEs of contralateral normal ears were found affected immediately after surgery and progressive improvement was detected with full recovery at 72-96 h. None of the patients had permanent deterioration in OAE amplitudes. The burs used during mastoid surgery can cause temporary hearing threshold changes in the contralateral ears. This adverse effect recovers spontaneously within 72-96 h postoperatively.

Internal nasal valve: revisited with objective facts.

OBJECTIVES: Comprehensive examination of the internal nasal valve (INV) using objective methods. STUDY DESIGN AND SETTING: In this prospective study, 248 nasal cavities were examined by nasal endoscopy, acoustic rhinometry (ARM), and rhinomanometry (RMM). RESULTS: Endoscopic examination allowed to suggest a novel classification of INV: convex, concave, sharp angle, blunt angle, twisted caudal border, and angle occupied by the septal body. The INV angle occupied with septal body type was found to have increased nasal resistances compared with the sharp-angled internal nasal valve type (P < 0.05). Convex, concave, and sharp-angle types of INV angles were found different (P < 0.01). CONCLUSIONS: INV should be examined objectively before any INV surgery. A novel description of the INV configurations and their effects on nasal respiration found in this study may increase our understanding and lead surgical approaches more adequately. A surgical attempt to augment INV angle value may impact positively on nasal resistance. EBM RATING: C-4.

Effect of nasal septal deviation on total ethmoid cell volume.

BACKGROUND: The aim of this study was to evaluate the effect of nasal septal deviation (NSD) on ethmoid cell volume and to determine whether there was any correlation between NSD grade and ethmoid cell volume. METHODS: Forty computerized tomography (CT) scans from patients with rhinosinusitis symptoms with NSD were evaluated. Septal deviations were classified into three groups according to the degree of deviation on CT. Ethmoid cell volumes were measured and the relationship between NSD and ethmoid cell volume was investigated. RESULTS: There was a moderate but significant negative correlation between the septal deviation angle and the percentage of the ethmoid cell volumes (p = 0.001, r = -0.5152, r2 = 0.2654). Total ethmoid cell volume on the ipsilateral side compared with the contralateral side was found to decrease as the degree of NSD increased. CONCLUSIONS: Nasal septal deviation affects the total ethmoid cell volume of the nasal cavity. The results of our study underline the role of ethmoid cell volume in the compensation mechanism equalizing the nasal cavity airflow changes due to NSD.

[Laser assisted eustachian tuboplasty: a case report]. / Lazer yardimli östaki tuboplastisi: olgu sunumu.

Surgical treatment of eustachian tube dysfunction is still challenging. Placement of a transtympanic ventilation tube may not be successful and may require multiple applications. We presented a 47-year-old male patient with chronic recurrent otitis media with effusion and retraction due to eustachian tube dysfunction, in whom the number of previous transtympanic tube insertions amounted to 18. He underwent laser assisted eustachian tuboplasty in both ears with endoscopic guidance under general anesthesia. The mucosal, submucosal, and partially the cartilaginous tissues in the posterior pillow of the nasopharyngeal orifice of the eustachian tube were ablated by Nd:YAG and holmium:YAG laser. Following surgery, air conduction thresholds decreased from 37 dB to 22 dB, and from 38 dB to 33 dB for the right and left ears, respectively. The preoperative tympanogram curve, which was of type B for both ears was found as type C-1 on the right side, and type C-2 on the left. Limited improvement seen in the left ear was ascribed to insufficient ablation of the posterior pillow of the eustachian tube. No complications were encountered within a follow-up of 12 months.

Dose-dependent dual effect of melatonin on ototoxicity induced by amikacin in adult rats.

The aim of this animal study was to reveal the dose-dependent effects of melatonin on aminoglycoside ototoxicity by utilizing distortion product otoacoustic emissions (DPOAEs). Forty-four adult (aged 12 months) rats were divided into five groups. Rats of the control group (group C) were injected with vehicle, while the melatonin group (group M) received melatonin (4 mg/kg per day); there were four rats in each of these groups. The study groups consisted of 12 rats per group, and they were treated as follows: 600 mg/kg per day amikacin (group A), amikacin plus a low dose (0.4 mg/kg per day) melatonin (group AML) and amikacin plus high dose (4 mg/kg per day) melatonin (group AMH) for 14 days. During the serial measurements on days 0, 5, 10 and 15, the DPOAE results of groups C,M and AML were not significantly changed. Amikacin ototoxicity findings for input/output (I/O) functions were detected on the 3rd measurement of the study in group A. High-dose melatonin clearly enhanced and accelerated amikacin-induced ototoxicity. The DP-gram amplitudes and I/O amplitudes were reduced, and I/O thresholds were increased in group AMH. Group AMH was the group that was affected the most and earliest by amikacin. Our study results showed that while low-dose melatonin protected the inner ear from ototoxicity, high dose melatonin facilitated amikacin-induced ototoxicity, possibly via the vasodilatory effect, leading to an increased accumulation of amikacin in the inner ear. Probably, the protective effect of the melatonin at a dose of 0.4 mg/kg per day is related to its antioxidant properties. Apparently, the vasodilatory effect of melatonin seems to be more prominent than its antioxidant effect in high doses.

Inferior oblique paresis, mydriasis, and accommodative palsy as temporary complications of sinus surgery.

A 15-year-old boy had temporary hypertropia, supraduction deficit, ipsilateral mydriasis, and accommodative paresis after bilateral endoscopic ethmoidectomy, bilateral partial inferior turbinectomy, septoplasty, and Caldwell-Luc procedures for chronic sinusitis. Postoperative imaging did not disclose any intra-orbital abnormalities. The patient was treated with oral prednisolone 70 mg/day on a tapering schedule. Within two months, the ophthalmic abnormalities had resolved. This is the second report to describe such findings, which are attributed to damage of the inferior division of the third cranial nerve secondary to manipulation of adjacent ethmoid tissues.