The Effect of Unilateral Concha Bullosa on Olfactory Bulb Volume: an Assessment by Magnetic Resonance Imaging.

BACKGROUND: In this study, the authors compared the right and left olfactory bulb volumes by magnetic resonance image findings of patients with unilateral concha bullosa (CB). METHODS: The cranial magnetic resonance imaging studies of 24 patients having unilateral CB were reviewed. There were 10 males and 14 females ranging in age from 29 to 51 years (mean age, 29 ±â€Š15.2 years). The volumes of both olfactory bulbs (contralateral and ipsilateral to the concha bullosa side) were calculated by using the computer program. RESULTS: The average values for olfactory bulb volumes were 46.57 ±â€Š8.03 mm in the CB side of the nasal cavity and 54.80 ±â€Š10.031 mm in the normal side of the nasal cavity. We found a statistically significant difference in olfactory bulb volume between the contralateral and ipsilateral to the concha bullosa side of the patients (t = -3.08 and P < 0.01 for CB side, t = -3.47 and P < 0.01 for left normal side). CONCLUSION: Our results may point out a possible relationship between CB and ipsilateral decreased olfactory bulb volume, yet the exact mechanism still remains unclear. Decreased nasal air flow on the CB side may be attributed to the pathophysiologic mechanism of this finding. Also, the significant reduction in olfactory bulb volumes ipsilateral to CB compared with the contralateral olfactory bulb volumes seems to support our hypothesis.

Olfactory Bulb Volume Changes in Patients With Nasal Septal Deviation.

OBJECTIVES: The olfactory bulb (OB) plays a pivotal role in the processing of olfactory information. The aim of this study was to investigate the OB volume changes and its possible associations with nasal septal deviation. STUDY DESIGN: Cross-sectional study. SETTING: Otolaryngology Department of Bozok University School of Medicine and Neurology Department of Yozgat State Hospital. SUBJECTS AND METHODS: Ninety patient's cranial magnetic resonance imaging (MRI) studies (46 males and 44 females, mean age 36 ±â€Š13.4 years; range 18-56 years) with isolated nasal septal deviations were recruited for the study. Olfactory bulb volumes in all study subjects were evaluated in T2-weighted coronal MRI images by planimetric manual contouring. RESULTS: Nasal septal deviation angles were found to range between 5° and 23.21° (mean 13.6°â€Š±â€Š3.58°). The right-sided deviations included 17 mild (<9°, Group I), 20 moderate (9°-15°, Group II), and 16 severe (15° and up, Group III) patients. The left-sided deviations included 14 mild (<9°, Group I), 13 moderate (9°-15°, Group II), and 10 severe (15° and up, Group III) subjects. Olfactory bulb volumes were calculated in both right- and left-sided deviation groups. In the patients with left-sided septal deviations of Groups I, II, and III, the left OB volumes of Groups I, II, and III were 46.49 ±â€Š3.87, 47.46 ±â€Š3.36, and 60.68 ±â€Š5.65 mm and the right OB volumes were 53.37 ±â€Š3.76, 56.47 ±â€Š4.43, and 76.69 ±â€Š6.84 mm, respectively. The statistical evaluation of the right OB volumes did not produce significant difference between Groups I and II (P = 0.73). The authors demonstrated statistically significant differences in comparison of Groups I to III and Groups II to III (P = 0.002 and P = 0.016, respectively). In the right septal deviation group for Groups I, II, and III, mean volumes of right OB volumes were 45.59 ±â€Š4.46, 48.63 ±â€Š3.78, and 61.35 ±â€Š5.84 mm, respectively, and the left OB volumes were 54.67 ±â€Š4.73, 57.65 ±â€Š4.53, and 75.84 ±â€Š7.67 mm, respectively. There was no statistically significant difference between Groups I and II (P = 0.95) left OB volumes in the right-sided deviation group, but statistically significant difference was demonstrated in Groups I to III and Groups II to III compartments (P = 0.002 and P = 0.003). CONCLUSION: In our study, while mild and moderate septal deviations lacked any significant affect on OB volumes, severe deviations were found to have significant impact on these parameter. Additionally the contralateral OB volumes in the severe septum deviation group were significantly bigger when compared to the ipsilateral OB volumes. Further multidisciplinary studies are required to evaluate the clinical significance of OB volume changes in diagnosis and follow-up of several otolaryngologic or nonotolaryngologic diseases.

Does fibromyalgia have an effect on hearing loss in women?

Background/aim: Fibromyalgia (FM) patients may have several neuroendocrine dysfunctions, resulting in a hypervigilant sensory output that may be responsible for sensorineural complaints. In this study, we evaluated the audiological findings of a cohort of female fibromyalgia patients. Materials and methods: Between 1 September 2012 and 1 June 2013, 35 female FM patients, followed by the Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bozok University, were recruited for the study. The patients were referred to the Department of Otolaryngology for routine otolaryngological and audiological evaluations. Age range was between 30 and 65 years, with a mean age of 48.10 years. The control group consisted of 25 healthy female volunteers ranging from 32 to 65 years (mean age: 45.52). All subjects were audiologically tested, including tympanometric evaluation. Low- and high-frequency audiometry was carried out by a single experienced investigator under standard audiometric testing conditions.Results: At low frequencies, the mean air conduction threshold values between the two groups were not statistically significant. At high frequencies, the mean air conduction threshold values and tympanometric values between the FM and control groups were statistically significant (P < 0.05 for both). Conclusion: Our results point to a pathophysiologic link between FM and the development of audiological abnormalities in these patients.

The relation between childhood obesity and adenotonsillar hypertrophy.

Childhood obesity is a common and significant public health problem all over the world. As a well-known fact obese children have an increased risk of obesity-associated comorbidities, including obstructive sleep apnea, diabetes, and cardiovascular disorders at an earlier age compared to their normal weight peers. They also have an increased risk of poor self-esteem, greater body dissatisfaction, and increased peer teasing that lead to a lower health-related quality of life. While the presence of adenoid hypertrophy and increased rate of obstructive sleep apnea frequently co-exists in majority of cases. We have limited knowledge about the effect of adenotonsillar hypertrophy on development of childhood obesity. In this study, we aimed to investigate the association between obesity, presence of adenotonsillar hypertrophy and the quality of life parameters in obese children as measured by the OSA-18 quality of life questionnaire. Fifty obese children aged between 3 and 18 years and 50 age- and gender-matched otherwise children were enrolled to the study. All subjects were routinely examined by the otolaryngologist before enrollment. The size of adenoid hypertrophy was measured using lateral cephalometric radiographs. The tonsils were also graded using the schema recommended by Brodsky et al. We used OSA-18 questionnaires to evaluate the subjects' quality of life issues. We found, 34 % of obese group had tonsillar hypertrophy while the rate was 6 % in control group. Similarly 16 % of obese group had tonsillar hypertrophy compared to only 4 % in non-obese group. It was also noted that total OSA-18 scores of obese group were significantly higher than those of non-obese group. In subgroup analysis of obese group, total OSA-18 score of obese subjects with either adenoid and/or tonsillar hypertrophy was significantly higher than that of obese subjects without adenoid or tonsillar hypertrophy. As the related literature suggests that the impact of adenotonsillar size on OSA symptoms is prominent especially in children under 7 years of age, but its impact on the development of childhood obesity is still controversial. Our results revealed a possible relation between adenotonsillar hypertrophy and obesity rates. Further studies on larger populations should be planned to better define the real impact of adenotonsillar hypertrophy in obese children.

Coexistence of anxiety sensitivity and psychiatric comorbidities in patients with chronic tinnitus.

BACKGROUND: Tinnitus refers to the objective or subjective perception of a series of sounds most frequently described as ringing in the ear or within the head itself. Anxiety and depressive disorders frequently accompany this complaint. In this study, we aimed to investigate the presence of psychiatric symptoms and the degree of anxiety sensitivity in patients with chronic tinnitus. METHODS: Fifty patients with chronic tinnitus who had been followed up for at least 6 months or longer were enrolled in this study. All subjects completed the Anxiety Sensitivity Index-3 (ASI-3), Stait-Trait Anxiety Inventory (STAI), and Symptom Check List-90-Revised (SCL-90-R) questionnaires. Fifty healthy volunteers were given the same tests and a statistical comparison of the psychometric outcome data was done for subjects with and without chronic tinnitus. RESULTS: Patients with chronic tinnitus demonstrated higher statistically meaningful scores than the healthy group. Comparison between chronic tinnitus group and control group scores showed that patient group has a high rate of statistically significant results than controls; ASI-3, STAI-2, SCL-90-R GSI, SCL-90-R Somatization, SCL-90-R Depression, SCL-90-R Anxiety (z=-8.00, P<0.01), SCL-90-R Phobic Anxiety. CONCLUSION: Higher scores for anxiety sensitivity and other psychiatric symptoms in patients with chronic tinnitus reflects the prevalence of psychiatric disorders such as depression, anxiety, somatoform disorder, and chronic tinnitus. The finding of more psychiatric comorbidity in patients with chronic tinnitus indicates that planning and follow-up in both otolaryngology and psychiatry is necessary to improve the overall results of treatment.

The effects of regular hot black tea consumption on nasal carriage of methicillin-resistant Staphylococcus aureus.

OBJECTIVES: This study aims to evaluate the possible relationship between oral consumption of hot black tea and methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in a mid-sized town population in central Anatolia. PATIENTS AND METHODS: Nasal swabs were taken from a total of 109 subjects (53 females, 56 males; mean age 34.4 years; range 18 to 65 years) including 55 non-tea drinkers and 54 subjects consuming more than 10 cups of tea a day. The MRSA positivity in the nasal cultures was investigated. RESULTS: In the tea consumer group MRSA was cultured in 10 subjects. Twenty-one subjects' nasal cultures were positive for MRSA in the non-tea drinkers. We found a statistically significant difference in the nasal MRSA carriage among tea drinkers and non-tea drinkers. CONCLUSION: Our study findings indicate a lower incidence of nasal MRSA carriage in tea drinkers, suggesting that certain soluble tea compounds may exhibit some antibacterial properties when consumed orally.

Comparison of topical anesthetic effects of lidocaine, prilocaine, ropivacaine, and bupivacaine in transnasal fiberoptic nasopharyngolaryngoscopy.

BACKGROUND: This study was designed to investigate the topical anesthetic efficacy of four different solutions including lidocaine spray, bupivacaine, ropivacaine, and prilocaine used in patients undergoing transnasal fiberoptic nasopharyngolaryngoscopic examination (TFL). METHODS: The study included 200 patients who underwent anterior rhinoscopy and TFL examination as a part of routine otolaryngological evaluation in our outpatient clinics. Of these, 111 were female and 89 were male patients. The mean age of the patients was 32 ± 8 years (aged between 19 and 55 years). The patients were randomly divided into five groups. Five groups received one of the local anesthetics studied in our trial (10% lidocaine, 0.5% ropivacaine, 0.25% bupivacaine, 2% prilocaine, and saline solution) in each right side of the nose for 10 minutes before TFL. Each separate examination was performed on the right side of the nasal cavity. After the examination, the patients were asked to note the intensity of the pain that they have experienced during the TFL, by using a 100-mm visual analog scale (VAS). RESULTS: The mean VAS scores were 2.08 (SD, 0.62) in the lidocaine group, 2.21 (SD, 0.66) in the prilocaine group, 3.92 (SD, 0.58) in the ropivacaine group, 4.15 (SD, 0.64) in the bupivacaine group, and 6.35 (SD, 0.65) in the saline solution group. The lidocaine and prilocaine groups had significantly better VAS scores versus ropivacaine, bupivacaine, and saline solution groups (p < 0.05). CONCLUSION: To provide ideal examination comfort and optimum patient tolerability during TFL evaluation of upper respiratory airway topical lidocaine and prilocaine applications were found to be more efficacious and effective medication for anesthesia of the intranasal mucosa compared with bupivacaine and ropivacaine solutions.

A comparative study on the impact of intra-articular injections of hyaluronic acid, tenoxicam and betametazon on the relief of temporomandibular joint disorder complaints.

OBJECTIVE: The aim of this study was to compare the efficacy of intra-articular injections of three different agents with well known anti-inflammatory properties. MATERIALS AND METHOD: Between April 2010 and January 2013 a total of 100 patients who were diagnosed as temporomandibular joint disorder in the Department of Otolaryngology at Bozok University School of Medicine were prospectively studied. Patients with symptoms of jaw pain, limited or painful jaw movement, clicking or grating within the joint, were evaluated with temporomandibular CT to investigate the presence of cartilage or capsule degeneration. In the study group there were 55 female and 45 male patients who were non-responders to conventional anti-inflammatory treatment for TMJ complaints. The patients were randomly divided into four groups consisting of a control group and three different groups who underwent intra-articular injection of one given anti-inflammatory agent for each group. We injected saline solution to intra-articular space in the control group. Of three anti-inflammatory agents including hyaluronic acid (HA, Hyalgan intra-articular injection, Sodium hyaluronate 10 mg/ml, 2 ml injection syringe, Bilim Pharmaceutical Company, Istanbul, Turkey); betamethasone (CS, Diprospan flacon, 7.0 mg betamethasone/1 ml, Schering-Plough Pharmaceutical Company, Istanbul, Turkey) and; tenoxicam (TX, Tilcotil flacon, 20 mg tenoxicam/ml, Roche Pharmaceutical Company, Istanbul, Turkey) were administered intra-articularly under, ultrasonographic guidance. Following the completion of injections the, changes in subjective symptoms were compared with visual analogue scales, (VAS) scores at 1st and 6th weeks' follow-up visits between four groups. RESULTS: The HA group did significantly better pain relief scores compared to the, other groups at 1st and 6th weeks (p < 0.05). TX and CS groups' pain scores were better than control group values (p < 0.05, for both agents). The pain relief effect of TX was noted to decrease significantly between the 1st and 6th week (p < 0.05) (Fig. 1). We did not observe the same pattern in HA, CS and control (saline) groups between 1st and 6th week (p > 0.05). CONCLUSION: We found that HA produced better pain relief scores when compared to the other anti-inflammatory agents studied. The main disadvantage of HA is its relatively higher cost. Additionally it does not have a reimbursement status by state or private health insurance systems in Turkey. Despite the lower VAS scores, intra-articular TX and CS may be assessed as more economic alternatives to intra-articular HA injections.

[Forestier's syndrome: a rare cause of dysphagia]. / Forestier sendromu: Nadir bir disfaji nedeni.

Forestier's syndrome (diffuse idiopathic skeletal hyperostosis) is characterized by ossification of the anterolateral aspect of at least four contiguous vertebral bodies. The exact etiology is unclear. Diagnosis is made by radiologic examinations. In this report, we present a case of Forestier's syndrome who admitted with complaints of dysphagia, cervical pain and dyspnea. The diagnosis was based on radiological examinations. Clinic and radiological characteristics of our case were discussed in the light of literature data.

The comparison of histological results of experimentally created facial nerve defects repaired by 2 different anastomosis techniques: classic suture technique or tissue adhesives for nerve anastomosis?

OBJECTIVE: The objective of this study was to compare the histological regeneration characteristics of nerve fibers at the anastomosis lines performed by classic suture technique or a tissue adhesive (N-butyl-2-cyanoacrylate). METHODS: The control group consisted of 7 rabbits. The 21 rabbits were randomly divided into 3 groups based on the harvesting week. In the study group following preparation of facial nerve bilaterally, a 0.5-cm segment of facial dorsal buccal nerve was resected, and the defect was repaired with a nerve graft, which was harvested from sural nerve of the same side by 8-0 nylon suture technique and by application of N-butyl-2-cyanoacrylate on the other side. RESULTS: Electron microscopic examination at consecutive second, fourth, and sixth days (corresponding to 4th, 8th, and 12th week in human subjects) revealed increased nerve degeneration findings in N-butyl-2-cyanoacrylate group when compared with microsuture repair technique. CONCLUSIONS: We conclude that N-butyl-2-cyanoacrylate is not an appropriate material for nerve anastomosis.

The correlation of serum levels of leptin, leptin receptor and NO x (NO 2 (-) and NO 3 (-)) in patients with obstructive sleep apnea syndrome.

The aim of this study was to investigate the relations between nitric oxide (NO) and leptin levels in a cohort of untreated adult Obstructive sleep apnea syndrome (OSAS) patients. Between June 1, 2012, and January 1, 2013, we evaluated a total of 58 subjects including 36 OSAS patients and 22 healthy controls, both polysomnographically confirmed. Following the completion of polysomnographic evaluation, serum samples were taken at 08:00. Leptin, leptin receptor, NO2 (-) and NO3 (-) levels were analyzed by commercial ELISA kits. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 16.0 (SPSS Inc., Chicago, IL, USA). There was no statistically significant difference between the OSAS patients and control groups with relation to the demographic parameters and body mass index (p > 0.05). Significantly higher serum leptin and plasma NO levels were found in OSAS patients compared to the controls (p < 0.001). In this study, higher leptin levels which were positively correlated with NO levels in OSAS group may indicate a possible link with increased incidence of airway pathologies in these patients.

Orbital complication of balloon sinuplasty.

Balloon sinuplasty (BS) is a relatively new conservative approach, first licensed for the treatment of chronic rhinosinusitis in 2006. The philosophy of the technique is to improve impaired sinus drainage by enlarging stenosed or obstructed natural sinus ostiums. The recent improvements in balloon sinuplasty made virtually all paranasal sinus ostiums to be safely accessible with this technique. Compared to classical endoscopic technique, the main advantage of balloon sinuplasty is the low complication rate reported. It is very seldom to encounter major complications related to critical structures such as orbits and skull base. Since its first description, very few severe complications directly attributable to the technique have been reported in literature as of today. In this article, we report a case of medial orbital wall fracture developed due to the pressure of the inflated balloon in a balloon sinuplasty procedure.

Does rheumatoid arthritis have an effect on audiovestibular tests?

The study aimed to determine the characteristics of hearing loss, vestibular responses and the incidence of vestibular disturbances in RA patients. This prospective study was performed at the Otolaryngology Department of Bozok University School of Medicine between May and November 2012. Eighty-one RA patients (69 women and 12 men) with a mean age of 40.8 ± 13.4 years (23-67 years) and 81 healthy controls (67 women and 14 men) with a mean age of 41.3 ± 13.8 years (24-66 years). Each subject was tested with low and high-frequency audiometry by a single experienced investigator under standard audiometric testing conditions. For each set of tests, mean values of air and bone conduction at each frequency and tympanometric values were calculated for the study groups. Videonystagmography (VNG) including smooth pursuit, saccade, positional, and caloric tests were also performed. The mean air conduction threshold values at high frequencies (4,000, 6,000, and 8,000 Hz) in RA group were lower than control groups. The difference between mean air conduction threshold values of the control groups against RA group at high frequencies were statistically significant (p < 0.05). There was no statistically significance between the two groups in tympanometric values (p < 0.05). VNG testing revealed central abnormalities in twenty patients (24.69%), peripheral abnormalities in five patients (6.17%), and mixed abnormalities in six patients (7.4%). There was no association between VNG abnormalities in patients with RA and age, sex, duration of disease, accompanying vertigo complaint, the laboratory findings and hearing levels (p < 0.05). Our findings suggest an association of RA and audiovestibular system dysfunction regardless clinical and demographic situation of patients. We assume the hearing and vestibular disturbances in RA are more prevalent than previously recognized. Also hearing losses in high frequencies in RA patients may be considered as an indicator of cochlear involvement in this disease.

The impact of ankylosing spondylitis on audiovestibular functions.

In this study, we aimed to evaluate the audiovestibular functions in the patients with ankylosing spondylitis (AS). This prospective study was performed in collaboration by the Otolaryngology and Rheumatology Departments of Bozok University School of Medicine between May 1, 2012, and January 1, 2013. We studied 80 subjects consisting of 40 AS patients (37 men and 3 women) in whom the diagnosis confirmed by the criteria of New York and 40 healthy controls (35 men and 5 women). All participants were evaluated by routine audiologic (including tympanometric evaluation, pure-tone audiograms, speech tests) and vestibular studies (including spontaneous nystagmus, gaze, optokinetic, saccadic movements, smooth pursuit, caloric test and Dix-Hallpike tests). The tympanometric values did not show a statistically significant difference between the AS group and the healthy subjects (p > 0.05). At low frequencies (250, 500, 1,000, and 2,000 Hz) pure-tone audiologic evaluations also proved statistically non-significant results at mean air conduction thresholds (ACT) and bone conduction thresholds (BCT) between the AS and control groups (p > 0.05). At high frequencies (4,000, 6,000, and 8,000 Hz), the ACTs and BCTs in AS group were lower than control group which was statistically significant (p < 0.05). The results of spontaneous nystagmus, gaze, optokinetic, canal paresis and saccadic movement tests between the two groups were statistically insignificant (p > 0.05). The comparison of smooth pursuit and Dix-Hallpike tests reached statistical significance (p < 0.05). Videonystagmographic test (VNG) revealed central abnormalities in 7 patients (17.5 %), peripheral abnormalities in 16 patients (40 %), and mixed abnormalities in 3 patients (7.5 %). Our findings suggest a possible association between AS and audiovestibular system dysfunction. We assume that the hearing and vestibular disturbances in AS are more prevalent than previously recognized.

Is there a relationship between symptoms of patients and tomographic characteristics of styloid process?

OBJECTIVES: To investigate the angulations and length of the styloid process (SP) on three-dimensional computed tomography (3D-CT) images between the patients having elongated SP complaints and those without any stylalgia symptoms. PATIENTS AND METHODS: One hundred patients underwent 3D-CT evaluation of the bilateral temporomandibular joints to investigate for symptomatic elongated styloid process (ESP) at our institution. The differences between the mean angulations and lengths of the SP and comparisons between patient and control groups were analyzed by student t test. RESULTS: In study group, mean length of styloid processes was 40.7 ± 10.8 mm on the right and 40.3 ± 10.9 mm on the left. Mean medial angles of SP were measured as 22.60 ± 4.0 on the right side and 22.60 ± 4.5 on the left side. In the same group, mean anterior angles of SP were 16.10 ± 6.9 on the right and 16.70 ± 7.1 on the left side. The "in-group" comparisons of lengths, medial and anterior angles did not produce statistically significant results. The comparison of medial angulations between the symptomatic and asymptomatic patients was the only statistically meaningful result in our study. CONCLUSION: 3D-CT has several advantages according to conventional tomography for visualization of head and neck anatomy. The increase of medial angulation of SP may be responsible for the development of complaints in ESP.

Ischemic optic neuropathy after carotid body tumor resection.

Incidence estimates for postoperative vision loss after nonocular surgery range from 0.013% for all surgeries up to 0.2% following spine surgery. The most common neuro-ophthalmologic causes of postoperative vision loss are the ischemic optic neuropathies (IONs), either anterior or posterior.This complication of case reports suggests that a combination of prolonged surgery in the prone position, decreased ocular perfusion pressure, blood loss and anemia/hemodilution, and infusion of large quantities of intravenous fluids are some of the potential factors involved in the etiology of postoperative ION. The specific pathogenesis and risk factors underlying these neuro-ophthalmic complications remain unknown, and physicians should be alert to the potential for loss of vision in the postoperative period. We report the only cases of ION after carotid body tumor resection in the literature and review current theories regarding the etiology and diagnosis of vision loss.

Audiovestibular functions in noninsulin-dependent diabetes mellitus.

CONCLUSION: This study supports the proposition that vestibular dysfunction and sensorineural hearing loss (SNHL) may be considered among the complications due to noninsulin-dependent diabetes mellitus (NIDDM). OBJECTIVE: The aim of this study was to evaluate the audiovestibular functions in patients with NIDDM and to determine if there is any correlation between audiovestibular dysfunction and the duration of the disease. METHODS: A total of 104 patients diagnosed with NIDDM and 104 nondiabetic control subjects made up the study group. Diabetic patients were also divided into subgroups of ≤7 years and >7 years according to the duration of the disease. Pure-tone audiometry (PTA), speech recognition scores (SRS), impedance audiometry, and vestibular function tests (VFT) were performed for all of the patients. RESULTS: Hearing thresholds in all frequencies (except at 500 Hz for bone conduction) and SRS values were statistically significant in patients with NIDDM and control subjects, but there was no statistically significant difference according to the duration of the disease. Statistically significant alterations were present in VFT in patients with NIDDM compared with the control subjects. In the diabetic group, only failure in the saccade test was statistically significant according to the duration of the disease.

Ocular surface culture changes in patients after septoplasty.

AIM: To investigate the interrelationships between pre- and postoperative microbiological changes by taking samples from both eyes of 40 patients who underwent septoplasty due to septal deviation. MATERIALS AND METHODS: Forty patients diagnosed with septal deviation who underwent a septoplasty operation under general anesthesia were enrolled in this study. The study was conducted on 40 patients who met the inclusion criteria and attended follow-up visits. One day before the operation and 48 h after the operation, cultures were taken individually from the conjunctivas and puncta of both eyes and sent to the microbiology laboratory. RESULTS: Patients who were candidates for nasal surgery due to their symptoms and clinical examination results were randomly selected and 40 of these completed the study. No statistically significant differences in bacterial growth were observed between the eyes before the operation (P > 0.05). There were, however, statistically significant differences between the eyes in terms of bacterial growth in the postoperative period (P < 0.05). Pathogenic bacterial cultures were grown in 47 eyes in the postoperative period, and this finding was statistically significant. In the eye cultures, the most commonly isolated pathogens were S. epidermidis, and S. aureus. CONCLUSION: Although the indicated microorganisms isolated from the patient groups were grown in cultures, there were neither clinical symptoms nor signs related to ocular infections.

Does bone mineral density have an effect on hearing loss in postmenopausal patients?

OBJECTIVES: An age-related decline in the bone mineral density (BMD) of the temporal bone, specifically in the segments that house the middle and inner ear, has been suggested as an additional risk factor for sensorineural hearing loss. We evaluated the effect of BMD on hearing loss in postmenopausal patients. METHODS: This study involved 120 postmenopausal women who were referred between May 1,2012, and September 1, 2012. The age range was 50 to 55 years (mean, 52.7 +/- 2.3 years). The subjects were divided into three groups according to the results of BMD measurements. Of these, 30 were control subjects with normal BMD values, 45 had osteopenia, and 45 had osteoporosis. Each subject was tested with low- and high-frequency audiometry by a single experienced investigator under standard audiometric testing conditions. For each set of tests, mean values of air and bone conduction at each frequency and tympanometric values were calculated for the osteopenia, osteoporosis, and control groups. RESULTS: All three groups were designed to have similar mean ages and roughly equal durations of menopause and body mass indexes. At low frequencies (0.25, 0.5, 1, and 2 kHz), the differences in the mean air conduction threshold values among the three groups were not statistically significant (p > 0.05). At high frequencies (4, 6, and 8 kHz), the difference in the mean air conduction threshold values between the osteopenia and control groups was not statistically significant (p > 0.05), but that in the osteoporosis group was statistically significantly higher than those in the osteopenia and control groups (p < 0.05). At low frequencies (0.5, 1, and 2 kHz), the differences in the mean bone conduction threshold values among the three groups were not statistically significant (p > 0.05). At 4 kHz, the difference in the mean bone conduction threshold values between the osteopenia and control groups was not statistically significant (p > 0.05), but that in the osteoporosis group was statistically significantly higher than those in the osteopenia and control groups (p < 0.05). There was no statistically significant difference among the three groups in tympanometric values (p > 0.05). CONCLUSIONS: We conclude that patients with low BMD values should routinely be counseled for an audiological assessment to detect any change in hearing thresholds.

Comparison of ropivacaine, bupivacaine, prilocaine, and lidocaine in the management of pain and hemorrhage during nasal pack removal.

BACKGROUND: This study investigates the effects of local anesthetics application on pain and hemorrhage caused by nasal pack removal. METHODS: The study included 140 patients. Of these, 72 were women and 68 were men. The mean age and weight of the patients were 33.67 ± 10.2 years (range, 21-63 years) and 69.6 ± 13.6 kg. The patients were divided randomly into four groups. Three of the four groups received one of the local anesthetics studied in our trial (lidocaine + adrenaline, 0.25% bupivacaine, or 2% prilocaine) before removal of the nasal packing material and the control group received saline solution. Local anesthetics and 0.9% saline solution were applied to Merocel nasal packs 15 minutes before removal. Each patient was given a questionnaire where verbal analog score and amount of postoperative hemorrhage was noted. RESULTS: The mean pain score was 3.5 ± 1.2 (median, 4; range, 3-5) in the lidocaine group, 4.5 ± 1.2 (median, 4; range 3-5) in the prilocaine group, 4.7 ± 1.3 (median, 6; range, 3-5) in the bupivacaine group, and 6.35 ± 1.2 (median, 6; range, 5-7) in the saline group during nasal packing removal. The lidocaine group had significantly better pain scores versus other groups (p < 0.05). Bupivacaine and prilocaine had significantly better pain scores versus the control group, respectively. Analysis of bleeding scores after pack removal showed that all three study groups had significantly better bleeding scores versus the control saline group (p < 0.05). The lidocaine group had significantly less bleeding score than bupivacaine and prilocaine groups (p < 0.05). CONCLUSION: Topical lidocaine application before removal of nasal packs in patients who undergo nasal septal surgery can decrease discomfort and bleeding and improve patient tolerance.