Mean platelet volume and neutrophil to lymphocyte ratio in patients with tinnitus: a case-control study / Volume plaquetário médio e relação neutrófilos/linfócitos em pacientes com zumbido: estudo de caso-controle

Abstract Introduction: Different theories have been proposed on the etiology of tinnitus, including metabolic and audiologic causes. We suggest that mean platelet volume and neutrophil to lymphocyte ratio levels change in tinnitus, indicating microcirculatory disturbance and inflammatory process in the etiopathogenesis of tinnitus. Objectives: We aimed to evaluate the mean platelet volume and neutrophil to lymphocyte ratio in patients with tinnitus in comparison to healthy controls. Methods: Retrospective case-control study. Two-hundred and eighty-seven patients aged 18-59 years and diagnosed with tinnitus in the Ear, Nose, and Throat Clinic between December 2014 and May 2017 (patient group) and 275 healthy individuals who applied for a hearing screening within the same time period (control group). Demographics, concomitant diseases, laboratory results, and audiometric data were recorded. Mean platelet volume and neutrophil to lymphocyte ratio were the outcome measures. Patients with hearing loss due to presbycusis or another reasons, and patients with anatomical disorders in the external and middle ear were excluded from the study by using physical examinations, pure audio audiometry results and radiological imaging. The upper age limit was set at 59 to exclude presbycusis patients. Results: The ratio of female patients was higher in patient group than control group (58.5%, n = 168 vs. 49.4%, n= 127; respectively; p = 0.033). The mean age of patient group was significantly higher than those of control group (44.89 ± 10.96 years and 38.37 ± 10.65 years, respectively; p = 0.001). The percentage of subjects with high mean platelet volume level was significantly higher in patient group than control group (9.4%, n = 27, and 3.1%, n = 8 respectively; p = 0.008). The mean neutrophil to lymphocyte ratio was higher in patients with tinnitus than control group (1.95 ± 1.02 and 1.67 ±0.57, p = 0.012). A neutrophil to lymphocyte ratio level of 2.17 and above is associated with 1.991 times higher risk of tinnitus (odds ratio = 1.99, 95% confidence interval 1.31-3.02). Conclusion: High mean platelet volume and neutrophil to lymphocyte ratio values are associated with idiopathic tinnitus, suggesting the role of vascular pathologies in etiology of tinnitus. Tinnitus may be a sign of underlying systemic or local disorders. Therefore, patients with tinnitus should undergo detailed evaluation including hematological indices.

Resumo Introdução: Diferentes teorias já foram propostas sobre a etiologia do zumbido, inclusive causas metabólicas e audiológicas. Acreditamos que os níveis do volume plaquetário médio e da relação neutrófilos/linfócitos se alteram no zumbido, sugerem distúrbio microcirculatório e processo inflamatório na etiopatogenia do zumbido. Objetivo: Avaliar o volume plaquetário médio e a relação neutrófilos/linfócitos em pacientes com zumbido em comparação com controles saudáveis. Método: Estudo de caso-controle retrospectivo, com 287 pacientes entre 18 e 59 anos e diagnosticados com zumbido na Clínica de Otorrinolaringologia entre dezembro de 2014 e maio de 2017 (grupo pacientes) e 275 indivíduos saudáveis que solicitaram uma triagem auditiva no mesmo período (grupo controle). Foram registrados dados demográficos, doenças concomitantes, resultados laboratoriais e dados audiométricos. O volume plaquetário médio e a relação neutrófilos/linfócitos foram as medidas de desfecho. Pacientes com perda auditiva por presbiacusia ou por outros motivos e pacientes com distúrbios anatômicos na orelha externa e média foram excluídos do estudo por meio de exame físico, resultados de audiometria tonal pura e imagens radiológicas. O limite de idade superior foi fixado em 59 anos para excluir pacientes com presbiacusia. Resultados: A proporção de pacientes do sexo feminino foi maior no grupo de pacientes do que no grupo controle (58,5%, n = 168 vs. 49,4%, n = 127; respectivamente; p = 0,033). A média de idade do grupo de pacientes era significantemente maior do que a do grupo controle (44,89 ± 10,96 anos e 38,37 ± 10,65 anos, respectivamente; p = 0,001). A porcentagem de indivíduos com nível alto de volume plaquetário médio foi significantemente maior no grupo de pacientes do que no grupo controle (9,4%, n = 27 e 3,1%, n = 8, respectivamente; p = 0,008). A relação neutrófilos/linfócitos média foi maior nos pacientes com zumbido do que no grupo controle (1,95 ± 1,02 e 1,67 ±0,57, p = 0,012). Um nível de relação neutrófilos/linfócitos de 2,17 e acima está associado a um risco 1,991 vez maior de zumbido (odds ratio = 1,99, Intervalo de Confiança de 95% 1,31 a 3,02). Conclusão: Altos valores de volume plaquetário médio e relação neutrófilos/linfócitos estão associados ao zumbido idiopático, sugerem o papel de doenças vasculares na etiologia do zumbido. O zumbido pode ser um sinal de distúrbios sistêmicos ou locais subjacentes. Portanto, pacientes com zumbido devem ser submetidos a uma avaliação detalhada, inclusive índices hematológicos.

Mean platelet volume and neutrophil to lymphocyte ratio in patients with tinnitus: a case-control study.

INTRODUCTION: Different theories have been proposed on the etiology of tinnitus, including metabolic and audiologic causes. We suggest that mean platelet volume and neutrophil to lymphocyte ratio levels change in tinnitus, indicating microcirculatory disturbance and inflammatory process in the etiopathogenesis of tinnitus. OBJECTIVES: We aimed to evaluate the mean platelet volume and neutrophil to lymphocyte ratio in patients with tinnitus in comparison to healthy controls. METHODS: Retrospective case-control study. Two-hundred and eighty-seven patients aged 18-59 years and diagnosed with tinnitus in the Ear, Nose, and Throat Clinic between December 2014 and May 2017 (patient group) and 275 healthy individuals who applied for a hearing screening within the same time period (control group). Demographics, concomitant diseases, laboratory results, and audiometric data were recorded. Mean platelet volume and neutrophil to lymphocyte ratio were the outcome measures. Patients with hearing loss due to presbycusis or another reasons, and patients with anatomical disorders in the external and middle ear were excluded from the study by using physical examinations, pure audio audiometry results and radiological imaging. The upper age limit was set at 59 to exclude presbycusis patients. RESULTS: The ratio of female patients was higher in patient group than control group (58.5%, n=168 vs. 49.4%, n=127; respectively; p=0.033). The mean age of patient group was significantly higher than those of control group (44.89±10.96 years and 38.37±10.65 years, respectively; p=0.001). The percentage of subjects with high mean platelet volume level was significantly higher in patient group than control group (9.4%, n=27, and 3.1%, n=8 respectively; p=0.008). The mean neutrophil to lymphocyte ratio was higher in patients with tinnitus than control group (1.95±1.02 and 1.67±0.57, p=0.012). A neutrophil to lymphocyte ratio level of 2.17 and above is associated with 1.991 times higher risk of tinnitus (odds ratio=1.99, 95% confidence interval 1.31-3.02). CONCLUSION: High mean platelet volume and neutrophil to lymphocyte ratio values are associated with idiopathic tinnitus, suggesting the role of vascular pathologies in etiology of tinnitus. Tinnitus may be a sign of underlying systemic or local disorders. Therefore, patients with tinnitus should undergo detailed evaluation including hematological indices.

The Quality, Reliability, and Popularity of YouTube Education Videos for Vestibular Rehabilitation: A Cross-sectional Study.

HYPOTHESIS: Vestibular rehabilitation (VR) education videos on YouTube are poor-quality and unreliable. BACKGROUND: YouTube has become a health information source. Recent studies have determined that videos on YouTube contain misleading and inappropriate information for different medical conditions. The aim of the present study was to assess the quality and reliability of VR education videos. METHODS: A search was performed using the keywords vertigo, vertigo treatment, vertigo exercise, and vestibular rehabilitation, on YouTube. The first 50 videos for each keyword were analyzed. Videos were divided into four groups according to the video source: Group 1: universities/occupational organizations, Group 2: medical ad/profit-oriented companies, Group 3: independent users, and Group 4: others (news/media/state institution). The quality and reliability of videos were evaluated regarding the modified DISCERN criteria, the modified Journal of the American Medical Association (JAMA) benchmark criteria, and global quality scores (GQS). RESULTS: Among the 200 videos analyzed, 103 were included. The main video source was medical ad/profit-oriented companies (60.2%). The mean modified DISCERN criteria score, the mean modified JAMA benchmark criteria score, and the mean GQS value of the videos were found as low (2.46 ±â€Š1.37, 2.09 ±â€Š1.23, and 2.67 ±â€Š1.38, respectively). Videos uploaded by universities/occupational organizations (25.2%) had statistically significant higher modified DISCERN criteria scores, modified JAMA benchmark criteria scores, and GQS values compared with the other groups (p < 0.001). CONCLUSION: Online information about VR education on YouTube was of poor quality and unreliable. Expert vestibular providers should be aware of these inappropriate sources and educate patients regarding the poor-quality of videos and also aim to provide more quality and reliable sources of information.

Paget Schroetter Syndrome and Chylothorax After Rhinoplasty.

ABSTRACT: Paget-Schroetter syndrome is a rare clinical condition characterized by subclavian vein thrombosis following repetitive upper extremity effort. In this case, we presented a 35-year-old female patient who underwent septorhinoplasty in our clinic. A swelling of the left part of the neck extending to the clavicle was detected 4 hours after the operation. Computed tomography of the thorax revealed a pleural effusion at the base of the left lung and a computed tomography angiogram demonstrated a recanalized left subclavian vein thrombosis. History of the patient clarified that she had moved to another house and had lifted heavy furnitures 4 days before the surgery. The patient was diagnosed with Paget Schroetter syndrome followed by chylothorax. Paget-Schroetter syndrome followed by chylothorax could be presented after a surgical intervention of the head and neck. Early diagnosis is essential to reduce the risk of ongoing morbidity and mortality.

The Effects of Empiric Antireflux Treatment on Laryngopharyngeal and Gastroesophageal Reflux Disease.

OBJECTIVES: This study aims to investigate the effects of empiric lansoprazol therapy on laryngopharyngeal (LPR) and gastroesophageal (GOR) reflux symptoms and laryngological findings. METHODS: Sixty-seven patients with suspected LPR related symptoms were prospectively analyzed in this study. Following eleven symptoms were asked to patients using LPR symptom questionnaire; sore throat, throat burning, throat clearing, globus sensation, cough, halitosis, dysphonia, dysphagia, postnasal dripping, vocal fatigue and sputum. GOR symptoms were evaluated with the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) questionnaire consist of twelve symptoms. Posterior larynx, arytenoids and interarytenoid area were evaluated with a 70° endoscope. Erythema, edema and nodularity were graded separately using 4 point severity scale to examine laryngeal signs. All patients were treated using 30 mg lansoprazole once daily for four weeks. After the end of medication, symptoms and laryngoscopic signs were evaluated again with the same method. The pretreatment and posttreatment values were compared with statistical analyses. RESULTS: There was a statistically significant decrease in LPR symptom scores and total scores of FSSG. The severity of nodularity in the posterior larynx, arytenoids and interarytenoid area was improved after treatment. There was no statistically significant difference in erythema on each area larynx. Edema in the posterior larynx and interarytenoid area was improved but there was no change on the edema of arytenoids. CONCLUSION: A short period of empiric antireflux treatment has a significant improving effect on all LPR symptoms and most of GOR symptoms. However, it was insufficient on laryngeal signs. Further research is needed to investigate longer times of treatment for the complete resolution of symptoms and signs.

Measurement of the depth of facial nerve at the level of stylomastoid foramen using MR imaging in Bell's palsy.

OBJECTIVES: To investigate whether the depth of the facial nerve from the skin surface as it exits the stylomastoid foramen differs between the paralyzed and unaffected sides in patients with Bell's palsy. METHODS: Forty-three patients (23 females, 20 males; mean age 43.8 ±â€¯15.2 years) diagnosed with Bell's palsy between January 2014 and June 2017 were retrospectively reviewed and those who had a cranial MR imaging performed within 10 days upon admission to hospital were included in the study. The axial postcontrast CUBE sequence was utilized for the measurement of the facial nerve depth. Age, gender, and body mass index (BMI) as well as concomitant chronic diseases, were also noted. The severity of facial paralysis was graded using the House-Brackmann (HB) scoring system. RESULTS: The facial nerve depth was significantly lower on the paralytic side compared to the unaffected side (32.9 ±â€¯5.4 mm vs. 36.9 ±â€¯5.1 mm, respectively; p = 0.007). The facial nerve depth on the paralytic side was not statistically different in the female patients compared to male patients (31.2 ±â€¯4.6 mm vs. 34.7 ±â€¯5.7 mm, respectively; p = 0.270). The facial nerve depth on the paralytic side was not correlated with patients' age (r = 0.288; p = 0.999), BMI (r = 0.215, p = 0.999), and HB scores (r = 0.031; p = 0.999). CONCLUSION: In our study cohort of patients with Bell's palsy, the facial nerve in the paralytic side is located more superficially as it exits the stylomastoid foramen when compared to the contralateral side. Therefore, the depth of the facial nerve may potentially play a key role in the etiology of Bell's palsy, which should be further evaluated.

The Effect of Nasal Functions on the Integrity of Grafts after Myringoplasty.

OBJECTIVE: We aimed to evaluate the effects of nasal functions for the integrity of grafts after myringoplasty. METHODS: In our study 78 patients who underwent myringoplasty operation between 2011-2013 were included. Group I was defined as the group with an intact tympanic membrane following surgery. Group II was defined as the group with a tympanic membrane perforation following surgery. Group I consisted of 44 and Group II consisted of 34 patients. Subjective and objective measurements of nasal functions, Eustachian tube function (ETF), and allergic status were performed using nasal obstruction symptom evaluation (NOSE) scale, visual analog scale (VAS), and the score for allergic rhinitis (SFAR) questionnaires and acoustic rhinometry and saccharin test. It was investigated whether there was any difference between these two groups in terms of these parameters. RESULTS: There was statistically no significant difference between groups according to the age, sex and the presence of tubal dysfunction and allergic rhinitis (p>0.05). In the group of intact tympanic membranes, the likelihood of right ear being the operated one was significantly higher compared to the group of myringoplasty failures (p=0.037). The VAS and NOSE scales did not show any significant difference between groups in terms of successful outcome of myringoplasty (p>0.05). The nasal congestion index (NCI) and the mucociliary clearance (MCC) did not show any significant difference between groups in terms of successful outcome of myringoplasty (p>0.05). CONCLUSION: This study has shown that nasal functions measured by objective and subjective methods had no effects on the success of myringoplasty.

Is septoplasty effective on habitual snoring in patients with nasal obstruction?

We aimed to find out whether snoring relieve with nasal surgery in patients with nasal obstruction. Sixty-four patients who underwent septoplasty under general anesthesia with complaint of nasal obstruction and snoring at Haydarpasa Numune Education and Research Hospital were enrolled in the study. All patients were evaluated by otolaryngological examination. Septal deviation was graded as mild, moderate and severe with endoscopy. Variables examined included age, sex, body mass index. All patients also completed the questionnaires, including Nose Obstruction Symptom Evaluation scale (NOSE), Epworth Sleepiness Scale (ESS), and Snore Symptom Inventory (SSI) before and after septoplasty. NOSE scale, ESS, and SSI scores showed statistically significant improvement after nasal surgery (p < 0.01) but we could not find any statistically significant association between septal deviation grading and improvement in scores of NOSE scale, ESS, and SSI (p > 0.05). Added to this, the association between body mass index (BMI) and improvement in scores of NOSE scale, ESS, and SSI did not reach statistical significance (p > 0.05). Our results demonstrated that septoplasty is effective on the subjective parameters of nasal obstruction in habitual snorers irrespective of the nasal septal deviation and severity of BMI.

Is hearing loss in infants associated with risk factors? Evaluation of the frequency of risk factors.

OBJECTIVES: To evaluate the frequency of risk factors and their influence on the evoked otoacoustic emission (OAE) of infants. METHODS: All newborns between November 2009 and June 2012 in Haydarpasa Numune Education and Research Hospital were tested on distortion evoked OAE screening test. Total of 2,284 infants were examined. Sex, maternal infectious disease, birth type (vaginal birth or caesarean sectio), birth weight, familial hearing loss, intermarriage of parents, hyperbilirubinemia, intensive care were analyzed as risk factors. RESULTS: Total of 2,284 neonates were screened (1,220 males and 1,064 females) for the presence of OAE in both ears. Vaginal delivery, maternal infections during pregnancy, intermarriage of parents relative, low birth weight(<1,500 g) are related risk factors to failure of screening with OAE in our study. There was no statistically significant difference in sex ratios, birth weight, familial hearing loss, hyperbilirubinemia, and intensive care stay. CONCLUSION: Risk factors are only as useful as their predictive power. Not enough is known about which risk factors are relevant, which babies have the risk factors, or which babies will fail to attend follow-up, the effectiveness of targeted hearing loss testing is questionable at this point in time. A system needs to be developed to clarify which risk factors are discoverable, predictive and useful.

Relation of mean platelet volume with obstructive adenoid hypertrophy in children.

OBJECTIVE: Adenoid hypertrophy (AH) is a common etiology of chronic upper airway obstruction. Upper respiratory tract obstruction may cause chronic alveolar hypoventilation and pulmonary vasoconstriction. In one previous study in patients with obstructive sleep apnea (OSA), it has been claimed that mean platelet volume (MPV), an indicator of platelet activation is increased and that MPV has an important role in the pathophysiology of cardiovascular diseases. We investigated in our study if MPV can be used as an indicator of obstruction due to adenoid hypertrophy. METHODS: Our study includes 61 children that underwent adenoidectomy with a mean age of 7.12 (± 2.373). White blood cell, platelet count, MPV, platelet crit and platelet distribution width levels were measured before and 3 months after adenoidectomy. Children's symptoms for upper airway obstruction (UAO) (presence of snoring, mouth breathing or difficulty in breathing during sleep, obstructive breathing or apnea during sleep) were questioned in the preoperative and postoperative period by a standardized questionnaire. RESULTS: There was no significant difference between preoperative and postoperative mean values of MPV, hemoglobin, platelet count (p > 0.05). White blood cell levels were significantly higher in the preoperative period values compared with postoperative period values (p < 0.05). Preoperative UAO scores were significantly higher than the postoperative UAO scores. After stratification of the degree of obstruction (as mild, moderate and severe) there was no significant difference in between groups in terms of MPV values. CONCLUSION: There was no significant relation between MPV levels and obstructive adenoid hypertrophy.

Endoscopic posterior cordotomy with microdissection radiofrequency electrodes for bilateral vocal cord paralysis.

The purpose of this study is to evaluate the results of endoscopic posterior cordotomy using microdissection electrodes in patients with bilateral vocal cord paralysis. Eleven patients underwent endoscopic posterior cordotomy using a radiofrequency Arrowtip monopolar needle. Preoperative-postoperative exercise tolerance, airway, and voice evaluation were performed in all patients. Two patients required a secondary revision operation due to granulation and crust formation and respiratory problems. No other complications were encountered. Two patients with tracheotomy cannulas were decannulated on the third postoperative day. All patients had an adequate functional airway and good exercise tolerance compared with poor preoperative exercise tolerance. There was no significant difference between preoperative and postoperative Voice Handicap Index values (P > .05). The data indicated the safety, easy use, and efficiency of the microdissection radiofrequency electrodes in patients with bilateral vocal fold paralysis. This technique provides a reliable alternative to laser procedures.

Role of nasal packing in surgical outcome for chronic rhinosinusitis with polyposis.

OBJECTIVES/HYPOTHESIS: To analyze the differences between biodegradable and nondegradable nasal dressings with regard to their effects on wound healing in the short and medium term and on surgical outcomes in the long term, after endoscopic sinus surgery (ESS). STUDY DESIGN: A prospective, randomized, partly blinded, controlled trial. METHODS: A total of 56 patients undergoing bilateral ESS for chronic rhinosinusitis with polyposis were enrolled and randomized to receive biodegradable (Nasopore; Stryker, Hamilton, ON, Canada) on one side and nondegradable packing (Merocel; Medtronic Xomed, Minneapolis, MN) on the opposite side. Postoperative morbidities (pain, bleeding, facial edema, nasal blockage) related to dressings were assessed on postoperative day 6. Wound healing (edema, crusting, secretions, synechia, granulation tissue formation, and percentage re-epithelialization) were evaluated at 2 weeks, 1 month, 3 months, and 6 months using modified Lund-Kennedy scores. Long-term assessment at 12 months was done using validated Lund-Kennedy scores. RESULTS: Morbidities related to nondegradable packing were significantly higher than with degradable packing (Wilcoxon signed rank test, P<.01). Pain, bleeding, nasal blockage, and facial edema were significantly less with absorbable packing. No statistically significant difference was found between sinonasal cavities packed with biodegradable or nondegradable materials with regard to healing scores and percentage of re-epithelialization at 2 weeks, 1 month, 3 months, 6 months, and surgical outcomes at 1 year (P>.05). However, healing at 6 months was correlated with the preoperative Lund-Mackay radiology and surgery scores (Spearman's rho correlation test, P<.05 and P<.01, respectively). CONCLUSIONS: No significant healing or surgical outcome differences were found between biodegradable and nondegradable packing. However pain, bleeding, nasal blockage, and facial edema were lower with biodegradable packing. LEVEL OF EVIDENCE: 1b.

Does desloratadine alter the serum levels of montelukast when administered in a fixed-dose combination?

OBJECTIVES/HYPOTHESIS: The aim of this study was to investigate the serum levels of montelukast when administered alone or in combination with desloratadine. STUDY DESIGN: A prospective crossover study. METHODS: Twenty-three healthy volunteers were investigated in two sessions. Volunteers were given 10 mg of montelukast orally with 250 mL water in the first session. The same subjects were given 10 mg of montelukast in fixed combination with 5 mg desloratadine 10 days after first session. Blood samples were collected 2, 3, and 4 hours after drug administration, and kept at -80°C after both applications. Plasma samples were analyzed for montelukast concentration. RESULTS: Mean concentration values of both groups were not statistically different (P > .05), but the differences were statistically significant according to time (P < .05). Statistically significant difference was not found between the groups according to the area under curve on the basis of both marginal and cumulative values for all different time intervals (P > .05). CONCLUSIONS: The absorption rate of montelukast was not altered when administered with desloratadine. This study suggested that desloratadine does not influence the bioavailability of montelukast, and their combination therapy can be used safely.

Hyperbaric oxygen versus steroid in facial nerve injury: an experimental animal study.

OBJECTIVE: The aim of this experimental study was to evaluate the effects of hyperbaric oxygen, methylprednisolone and combined hyperbaric oxygen-methylprednisolone treatments on traumatic facial nerve regeneration in rats. SUBJECTS AND METHODS: After exposure to facial nerve injury, four groups of rats were created with five subjects in each group: Group 1 (hyperbaric oxygen), group 2 (control), group 3 (combined hyperbaric oxygen-methylprednisolone), group 4 (methylprednisolone). Facial nerve specimens from sacrificed animals were examined for axonal degeneration, vascular congestion, macro vacuolization, axon diameter and thickness of myelin sheath. RESULTS: There were significant differences with regard to axonal degeneration, vascular congestion and axon diameter between group 3 and the control group. In addition to lower axonal degeneration and vascular congestion, a larger diameter of axons was observed in group 3. There were significant differences with regard to vascular congestion and axon diameter between group 4 and the control group. We observed thicker myelin and lower axonal degeneration in group 3 compared with group 4. CONCLUSION: The combination therapy with hyperbaric oxygen and methylprednisolone had an additive beneficial effect on regeneration of the facial nerve and may provide better treatment outcomes than methylprednisolone or hyperbaric oxygen therapy alone.

Patient-reported outcomes after endonasal rhinoplasty for the long nose.

BACKGROUND: The long nose with an inferiorly rotated tip commonly results from a discrepancy between tip support and the downward forces of long septum, long upper lateral cartilage, and elongated lower lateral cartilage. Although many techniques have been described for surgical correction, very few studies were designed to include patient-reported outcomes. OBJECTIVE: The purpose of this study was to introduce our current management of long nose with drooping tips as well as to present the patient-reported outcomes of our case series of endonasal rhinoplasties. METHODS: This study prospectively analyzed 121 patients who underwent rhinoplasty for the correction of long nose with drooping tips. Study participants completed both a baseline questionnaire before the rhinoplasty operation and a postsurgical patient questionnaire 12 months following the operation, including the European QOL Questionnaire and Rhinoplasty Outcomes Evaluation Questionnaire. RESULTS: Mean values corresponding to the European QOL Questionnaire visual analog scale score significantly increased after surgery compared with baseline (P < 0.01). Mean values corresponding to self-care (P < 0.01), usual activities (P < 0.05), discomfort (P < 0.01), and anxiety (P < 0.01) showed significant decrease after surgery. A general and significant improvement of the mean Rhinoplasty Outcomes Evaluation Questionnaire scores by rhinoplasty increased from 20.14 ± 7.38 to 82.05 ± 12.8 (P < 0.01). CONCLUSIONS: Resection of the caudal portion of upper lateral cartilage may correct aesthetic problems in patients with long nose with a drooping tip in which a reduction in the width and the length of middle third of the nose is required. This study suggested an efficient method for aesthetic correction of long nose with the improved patient-reported outcomes.

External auditory canal microbiology and hearing aid use.

OBJECTIVE: The aim of this study was to determine the presence and nature of bacterial flora on hearing aids and the ears of this population. We wonder if the microbiology of the ears with hearing aid wearing differs from the other ear. SETTING: Tertiary referral center. DESIGN: A prospective, clinical study. SUBJECTS AND METHODS: Three samples were taken, one from the surface of the hearing aid's ear mold; one from the hearing aid-wearing ear canal and the last one from the ear without hearing aid. Samples were cultured to determine qualitatively and quantitatively the pathogenic microorganisms present. RESULTS: A total of 123 samples, obtained from 41 hearing aid users, were analyzed. Methicillin-resistant coagulase-negative staphylococci, methicillin-susceptible Staphylococcus aureus, methicillin-resistant S. aureus, Pseudomonas aeruginosa, Escherichia coli, Acinetobacter species, Staphylococcus auricularis, and Stenotrophomonas maltophilia were identified organisms. CONCLUSIONS: We identified unexpected microorganisms both on hearing aids and hearing aid using ears. This study demonstrates that using hearing aid alters the ear canal flora. To avoid otitis externa, it is important to use an appropriate hygiene routine to clean and disinfect hearing aids and ear molds.

Nasal obstruction and unilateral chronic otitis media: evaluation by acoustic rhinometry.

OBJECTIVES: In a prospective study at Umraniye Research and Education Hospital, we aimed to evaluate the differences in acoustic rhinometric findings between the affected and nonaffected sides in patients with unilateral chronic otitis media (COM) and to investigate whether unilateral COM correlates with the side of nasal obstruction. METHODS: Fifty-five consecutive patients with unilateral COM were involved in this study. All patients were evaluated with acoustic rhinometry, the Nasal Obstruction Symptom Evaluation (NOSE) scale, and measurement of their nasal mucociliary transport time. RESULTS: The mean cross-sectional area 1, mean cross-sectional area 2, volume 1, and volume 2 values were not different between the affected and nonaffected sides (p > 0.05). The NOSE score had a reverse correlation with the mean cross-sectional area 2 (p < 0.05) and volume 2 (p < 0.01) of the affected side. Saccharin time was not correlated with the acoustic rhinometric values of the affected side (p > 0.05). CONCLUSIONS: These findings do not support the hypothesis that unilateral COM is correlated with the side of nasal obstruction.

Effect of grapefruit juice on bioavailability of montelukast.

OBJECTIVES/HYPOTHESIS: The aim of this study was to investigate possible interactions between grapefruit juice and montelukast for up to 4 hours. STUDY DESIGN: A prospective, crossover study with 23 healthy volunteers was performed in two sessions. METHODS: In the first session, volunteers were treated with oral montelukast 10 mg once daily with 250 ml water. After a 10-day washout period, the same volunteers were treated with 10 mg montelukast with 250 ml grapefruit juice. Blood samples were collected 2, 3, and 4 hours after drug administration and kept at -80°C after both applications. Plasma samples were analyzed for montelukast concentration. RESULTS: The mean plasma concentration of montelukast across all time intervals was significantly greater (P = 0.0001) for those given grapefruit juice (517, 484, and 440) versus those treated with water (366, 356, and 292). Moreover, with respect to the time the sample was collected, there was no significant difference (P = 0.13) in the mean total plasma concentration up to 4 hours after montelukast ingestion for either group. There was a significant difference between the groups according to the area under curve with regard to marginal and cumulative values for all different time intervals (P < 0.05). CONCLUSIONS: Plasma concentration of montelukast was higher when administered with grapefruit juice, as compared to with water. This may have been due to the effect of grapefruit on liver metabolism of montelukast and the cytochrome P450 system.

Role of allergy in children with adenotonsillar hypertrophy.

OBJECTIVE: The goal of this prospective study is to investigate the correlation between allergen sensitivity and radiographic evaluation of adenoidal obstruction and tonsil size. SUBJECTS AND METHODS: A total of 82 children with upper airway obstructive symptoms were evaluated for their tonsil size. All patients underwent digital lateral soft tissue radiographs. Assessment of nasopharyngeal obstruction in radiographs was done according to the Cohen and Konak method. Skin prick tests with multitest applicator including 14 allergens were carried out to investigate their allergic background. RESULTS: All children reacted positive to at least one of the 14 allergens tested. We found a statistically significant correlation between tonsil size and skin prick tests (P < 0.01). However, there was no statistically significant correlation between the adenoid size and skin prick test results (P > 0.05). CONCLUSIONS: Although the degree of nasopharyngeal obstruction caused by adenoid hypertrophy does not increase with the degree of positivity to specific allergens in skin prick tests, allergic sensitivity may play an important role in children with tonsillar hypertrophy.

New modification of cephalic resection of lateral crus in endonasal rhinoplasty.

A successful rhinoplasty mainly depends on maintaining adequate nasal tip projection and achieving the desired tip refinement. In endonasal rhinoplasty, the surgeon can modify the tip anatomy while still preserving the key structural support mechanisms. Herein, we describe a new modification of retrograde technique for the resection of the cephalic margin of the lateral crus in endonasal rhinoplasty in which a combined resection of the cephalic margin of the lateral crus and its underlying mucoperichondrium are performed.