Assessment of intracranial pressure with ultrasonographic measurement of optic nerve sheath diameter on patients undergoing suspension direct laryngoscopy.

PURPOSE: The study aims to examine the effect on intracranial pressure by calculating the optic nerve sheath diameter (ONSD) using ultrasound in patients who underwent suspension direct laryngoscopy. METHODS: Thirty-three patients who underwent suspension direct laryngoscopy were included in this prospective observational study. ONSD measurement was performed using a high-frequency linear probe. The ONSD basal (T0) value was determined using ultrasound in the supine position before the induction. Ultrasonography was used to record ONSD in the Boyce Jackson position (T1) just before inserting the laryngeal blade, in the Boyce Jackson position just before removing the laryngeal blade (T2), and in the supine position (T3) just before extubation. RESULTS: A statistically significant rise (p < 0.001) was seen between the patients' baseline ONSD values and the values at T1, T2, and T3. The optic nerve sheat diameter level recorded prior to withdrawing the laryngeal blade (T2) was considerably greater than the ONSD level calculated instantly before insertion of the laryngeal blade (T1) (p < 0.001). The ONSD value prior to extubation (T3) following the removal of the laryngeal blade was considerably smaller than the ONSD value prior removing the laryngeal blade (T2) (p < 0.001). CONCLUSIONS: This study found that when the laryngeal blade is mounted during the suspension direct laryngoscopy surgery, there is a significant increase in ultrasonographically measured ONSD and increased the ONSD even further during the time the mouth gag was remained in situ. This is the first research to indicate that measuring ONSD with ultrasonography during suspension direct laryngoscopy raises intracranial pressure.

External ear anatomy and variations in neonates.

It is aesthetically important that the auricle has a natural and beautiful shape. The sizes, position and symmetry of normal auricle are used for different purposes in different disciplines. A deformation in the auricle of neonates and its size or location on the face may indicate a possible anomaly. The aim of this study is to investigate the normal sizes, anomaly types, anomaly rates and the relationship between hearing screening test results and auricular anomaly of the neonatal auricle. The length, width, angle, and distance measurements of the auricle were made in neonates (n = 550). Anomaly types of auricle were observed. Goniometer was used to measure angles; digital caliper and ruler were used to measure lengths. Anomalies were detected by the method of observation. In the morphometric data of the neonatal auricle, differences were determined in length and width values in terms of gender. Various types of anomalies were observed in the right ear of 96 participants and in the left ear of 103 participants. Normal auricle size, position and symmetry are important for surgical reconstructions, hearing aid design, producing data banks on gender, age and ethnicity, and providing reference information for multiple diagnostic and forensic procedures. Recognition and early detection of auricular anomalies play an essential role in clinical diagnosis and their correction with special devices.

The Effect of Anteriorly Located Sigmoid Sinus on Postoperative Hearing Gains: A Case-Control Study.

There are many studies on the effects of temporal bone anatomical variations on a mastoid pneumatization. Considering the effects of the anatomic variations on mastoid pneumatization, it is considered that many anatomic variations may affect graft success rates and postoperative hearing threshold gains. We aimed to evaluate the effects of various anatomic variations on postoperative hearing gains among patients undergoing tympanoplasty. This retrospective cohort study conducted in a tertiary-care university hospital. This study enrolled 57 patients who underwent primary type 1 tympanoplasty operation using the temporal muscle fascia. The patients were divided into two groups as those with an anteriorly located sigmoid sinus (group 1), and no anatomic variation (group 2). Airway gain values at the frequency range of 250 Hz-8000 Hz and pure tone average (PTA) value were calculated preoperatively and at postoperative sixth month. The gains attained by the patient groups with anatomic variations were compared with group 2. There were significant differences between Group 1 and Group 2 in terms of the airway frequencies of 250, 500, 2000, 4000 Hz, and PTA value. We detected a lesser postoperative hearing gain in patients with an anteriorly located SS. We believe that anatomic variations that may affect middle ear and mastoid cavity may also affect postoperative hearing gain.

Effect of rhinophototherapy on nasal congestion in patients with seasonal allergic rhinitis.

OBJECTIVE: The aim of the present study was to objectively and subjectively evaluate the effects of adding rhinophototherapy to intranasal beclomethasone dipropionate to treat nasal congestion in patients with seasonal allergic rhinitis. METHOD: Seventy-five seasonal allergic rhinitis patients were randomly divided into two groups. Patients in Group 1 received intranasal beclomethasone dipropionate for two weeks and patients in Group 2 had rhinophototherapy added to the same medical therapy as Group 1. The effectiveness of treatments was evaluated with the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), Nasal Obstruction Symptom Evaluation scale (NOSE) questionnaires and active anterior rhinomanometry. RESULTS: After treatment, significant improvement was observed in Group 2 vs Group 1 in terms of RQLQ (p = 0.011) and NOSE (p = 0.001) scores. In Group 2, significant differences were observed between before and after treatment for inspiratory total nasal resistance (p = 0.004). However, no significant differences vs. baseline were observed in Group 1. CONCLUSION: Our study shows that adding intranasal phototherapy with a combination of UVA, UVB and visible light therapy to nasal beclomethasone dipropionate treatment objectively improves nasal patency in patients with seasonal allergic rhinitis.

Evaluation of cervical vestibular evoked myogenic potential measures using different stimulus types in patients with posterior canal benign paroxysmal positional vertigo.

Background: Cervical Vestibular Evoked Myogenic Potential (cVEMP) measurements still do not have standard normative values in posterior canal benign paroxysmal positional vertigo (BPPV).Aim/Objectives: We aimed to compare cVEMP recordings obtained with different stimuli applied in two different intensities in posterior canal BPPV patients.Methods: Thirty-four patients with unilateral posterior canal BPPV were included in the patient group. In cVEMP recordings obtained with different stimulus intensity [95 dB HL and 105 dB HL] and different stimuli[tone-burst cVEMP (T-cVEMP) and click cVEMP (C-cVEMP)].Results: When the C-cVEMP and T-cVEMP findings were compared in the patient group, differences were observed only in peak-to-peak p1-n1 amplitude values in the measurements performed with 95 dB stimulus. However, T-cVEMP measurements performed with 105 dB stimulus showed that both p1 and n1 latency values ​were longer and peak-to-peak p1-n1 amplitude values ​were higher than C-cVEMP measurements.Conclusions and significance: We recommend using priorly tone-burst stimulus for measurements with 105 dB HL in cVEMP evaluations we will perform in posterior BPPV patients. Both stimulants can be used when 95 dB HL stimuli is used.

Evaluation of the effect of Boyle-Davis mouth gag on intracranial pressure in patients undergoing adenotonsillectomy by using ultrasonographic optic nerve sheath diameter measurement.

OBJECTIVE: We aimed to evaluate the effect of an increase in intracranial pressure (ICP) due to sympatho-adrenergic response caused by mouth gag and tongue depressor during adenotonsillectomy by measuring the optic nerve sheath diameter (ONSD) by ultrasonographic method. METHODS: Forty patients (age range 3-12 years) who underwent adenotonsillectomy were included in the study. All patients underwent surgery under general anesthesia with endotracheal intubation. Boyle-Davis mouth gag was used during the procedure. ONSD measurement was performed and a high-frequency linear probe. All ONSD measurements were performed by a single investigator experienced in the use of ultrasound. Ultrasonographically measured ONSD before induction was accepted as baseline (T0) value. Immediately after insertion of the mouth gag (T1), just before removal of the mouth gag (T2), and just before extubation (T3), ultrasonographic measurements of ONSD were recorded. RESULTS: When patients' baseline ONSD values were compared with the values obtained in T1, T2, T3, and a statistically significant increase was detected. The ONSD value measured before removing the mouth gag (T2) was significantly higher than the ONSD value measured immediately after the insertion of the mouth gag (T1). The ONSD value measured just before extubation (T3) and after removal of the mouth gag was significantly lower than the ONSD value (T2) measured just before removal of the mouth gag. When heart rate, mean arterial pressure (MAP), peripheral oxygen saturation (SpO2) values of T0, T1, T2, T3 were compared, any statistically significant difference was not observed. When end-tidal carbon dioxide level (etCO2) and peak inspiratory pressure (PIP) values of T1, T2, T3 were compared, any statistically significant difference was not observed. CONCLUSION: This study showed that the Boyle-Davis mouth gag used during the adenotonsillectomy operation resulted in a significant increase in the diameter of the optic nerve sheath measured ultrasonographically and increased the ONSD even further during the time the mouth gag was remained in situ. In children with intracranial pathologies who will undergo adenotonsillectomy or those with increased ICP-related risk factors, the risks that may arise from the effect of the Boyle-Davis mouth gag on ICP should be considered.

The relationship of high-frequency distortion product otoacoustic emission (DPOAE) values with hematological parameters in tinnitus patients.

PURPOSE: In this study, we aimed to investigate whether there is any positive or negative correlation between high-frequency distortion product otoacoustic emission (DPOAE) values and mean platelet volume (MPV) and neutrophil/lymphocyte ratio (NLR) in tinnitus patients. METHODS: The study was performed with 52 volunteers (27 females, 25 males) aged between 35 and 50 years who presented with tinnitus to the otolaryngology outpatient clinic of a tertiary care center. Pure voice audiometric examination, DPOAE measurement, complete blood count values of the study participants were examined. RESULTS: In both ears, a significant and negative correlation was observed between 4000 and 8000 Hz airway and 4000 Hz bone conduction pathways with NLR rates (p < 0.05). A statistically significant relationship was found between the bone conduction pathway PTA and discrimination values for both ears and NLR s (p < 0.05). A positive correlation was detected between NLRs and DPOAE measurements recorded at 4444 Hz, 5000 Hz, 8000 Hz, 8889 Hz, 10,000 Hz and 11,429 Hz frequencies in the right and 4444 Hz, 5000 Hz, 6154 Hz, 8000 Hz, 10,000 Hz and 11,429 Hz frequencies in the left ears, respectively (p < 0.05). CONCLUSIONS: We concluded that there is a significant correlation between high-frequency pure tone audiometry measurements and high frequency DPOAE measurements and NLR. Further studies are needed to determine the utility of NLR as a marker for the recognition and follow-up of hearing loss in patients with tinnitus.

A Survey Focusing on Lucid Dreaming, Metacognition, and Dream Anxiety in Medical Students.

INTRODUCTION: The aim of this study was to examine the level of lucidity and its relation with metacognitive beliefs and dream anxiety in medical students. METHODS: Nine hundred sixteen medical students were enrolled in the study. The participants were assessed with the Lucidity and Consciousness in Dreams Scale (LuCiD), the Metacognition Questionnaire-30 (MCQ-30), and the Van Dream Anxiety Scale (VDAS). RESULTS: There was no significant difference in mean total lucidity score between females and males, but there were some significant sex differences in subscales of lucidity, and control was significantly higher in male students, while realism, thought, and dissociation were significantly higher in female students. In addition, females had more dream anxiety levels, higher total MCQ-30 scores, and higher cognitive confidence and uncontrollability scores according to Metacognition Questionnaire-30 than males. We also found that the mean lucidity level was positively correlated with the mean total metacognition score and the mean total dream anxiety level. DISCUSSION: Our results suggest that female medical students tend to have more realistic dreams (p=0.018), have more logical thoughts during dreaming (p=0.011), and have a more dissociative experience during dreaming (p=0.028), while male medical students have more controlled dream events (p=0.002). There seem to be differences according to lucidity features between sexes, and the relationship between subdomains of lucidity and metacognition might lead to new therapeutic approaches to several psychiatric disorders such as anxiety disorders.

Prevalence of Allergic Rhinitis in Children in the Trabzon Province of the Black Sea Region of Turkey.

OBJECTIVE: We aimed to determine the prevalence of allergic rhinitis in children aged 12-15 years who lived in the Trabzon Province, specify possible risk factors, and compare the data obtained with those of the other studies conducted in our country and in other countries. METHODS: First, 1372 students from nine primary schools determined according to the recommendations of Department of Public Health and approval of The Provincial Directorate of Health were screened in their schools with questionnaire forms. Second, students providing the response "yes" to the first and/or second questions in the questionnaire forms were considered as possible allergic rhinitis patients and invited to our clinic. Then, 246 students were subjected to a skin prick test. Data were collected with the evalution of questionnaire and skin prick test results together. RESULTS: The prevalance of allergic rhinitis in children between 12 and 15 years age was found to be 14.5% in Trabzon. Female gender was found to be a relative a risk factor for allergic rhinitis (p=0.015). The prevalence of allergic rhinitis in children whose both parents were smoking was significantly higher than that in children whose only one parent was smoking or both parents were nonsmokers (p=0.0024). In addition, living in an apartment flat (p=0.015) and owing pets (p=0.04) were detected to be other risk factors for allergic rhinitis. CONCLUSION: According to our investigations, this is the first prevalence study in Trabzon, which is the largest settlement in the Eastern Black Sea Region. The prevalence of allergic rhinitis in children was found to be 14.5%. Female gender, smoking habits of the parents, owing pets, and living in an apartment flat are risk factors for allergic rhinitis.

Comparison of Radiofrequency Thermal Ablation and Microdebrider-Assisted Turbinoplasty in Inferior Turbinate Hypertrophy: A Prospective, Randomized, and Clinical Study.

OBJECTIVE: To compare the effectiveness of radiofrequency thermal ablation with those of microdebrider-assisted turbinoplasty, we designed a prospective, randomized clinical study. METHODS: Forty patients suffering from nasal obstruction due to bilateral inferior turbinate hypertrophy were enrolled. Half of the patients were operated by radiofrequency thermal ablation, while the other half underwent microdebrider-assisted turbinoplasty. The outcomes of both techniques were compared in terms of symptomatology, nasal patency, and mucociliary transport. RESULTS: A statistically significant difference existed between the two groups with respect to nasal obstruction and the frequency of obstruction at the first post-operative week and first and third post-operative months (p<0.05). Rhinomanometry detected a significant decrease in nasal resistance values in both surgical groups compared to the preoperative values. The mucociliary transport time was significantly prolonged in the first postoperative week and first postoperative month in microdebrider-assisted inferior turbinoplasty group. CONCLUSION: Both radiofrequency thermal ablation and microdebrider-assisted turbinoplasty are effective techniques for treating inferior turbinate hypertrophy. The treatment modality should be individually determined, and parameters such as tissue healing, volume reduction, and mucociliary activity must be taken into account.

Tumor site and disease stage as predictors of quality of life in head and neck cancer: a prospective study on patients treated with surgery or combined therapy with surgery and radiotherapy or radiochemotherapy.

In this prospective study, we compared the short-term quality of life (QOL) of two subgroups of head and neck cancers: oropharyngeal and laryngeal cancers. Patients treated with curative surgery, were asked to participate in the study using the EORTC QLQ-C30 and H&N35 questionnaires to examine QOL. The oropharynx group consisted of 32 (48 %) patients, while the larynx group consisted of 35 (52 %) patients. All patients were treated with either curative surgery alone or curative surgery combined with adjuvant radiotherapy or radiochemotherapy. The questionnaires were handed out pre- and post-therapy (10 months). At baseline, an impaired overall QOL (=EORTC QLQ-C30 global score) with a value of 53.4 for the whole patient collective was found; the overall QOL after 10 months improved (60.2, p < 0.05). Between the two patient groups, there was no difference in the global score after 10 months. The oropharynx patients described more problems with fatigue and oral cavity associated. The main symptoms in the larynx group were loss of sensual function and coughing. The present investigation revealed that the general post-therapy QOL in two subgroups of head and neck cancer reached a satisfying level.

Giant sialolith of submandibular gland: report of a case†.

Sialolithiasis is one of the most common diseases of salivary glands in middle-aged patients. Sialoliths are localized in submandibular glands in nearly 80% of the reported cases and they are classified as 'giant' in case any dimension exceeds 15 mm. Giant sialolith in submandibular gland is a rare disorder. Here, an unusual case of giant sialolith in submandibular gland is reported. A 42-year-old man referred with complaints of recurrent pain and swelling in the left submandibular area. Computerized tomography revealed a calcified mass of 42 × 17 mm size within the submandibular gland. Excision was performed in the submandibular gland and a giant sialolith of 35 mm length localized in the body of the gland was detected. The postoperative period was uneventful and the patient fully recovered.

Verruca vulgaris of the tongue: a case report with a literature review.

UNLABELLED: Verruca vulgaris (common warts) is a benign lesion of skin and mucous membranes caused by human papillomavirus (HPV). The lesions are typically self-limited but may vary in size and number. The occurrence on the tongue is extremely rare. To the best of our knowledge, only one verruca vulgaris existing in the tongue had been reported in the literature. CASE PRESENTATION: A rare case of verruca vulgaris of the tongue occurring in a 36-year-old Caucasian male is presented with a discussion on ethiopathogenesis and the treatment methods. Verruca vulgaris must be remembered in the differential diagnosis of tongue lesions and surgical treatment may provide satisfactory outcomes.

Nasal expiratory sound analysis for evaluation of nasal patency in perennial allergic rhinitis patients treated with nasal corticosteroids.

PURPOSE: To assess the efficacy of nasal expiratory sound analysis in determining the degree of nasal obstruction. MATERIALS AND METHODS: We have analyzed and recorded the expiratory nasal sounds in 18 healthy controls and in 30 patients with inferior turbinate hypertrophy before and after the administration of nasal corticosteroid treatment. Analysis consisted of the time-expanded waveform, spectral analysis with time-averaged fast Fourier transform and waveform analysis of nasal sound. RESULTS: Before treatment, an increase in sound intensity at high frequency was observed in the sound analyses of the patients, whereas after treatment, a decrease in sound intensity at high frequency was noted in the sound analyses of the patients. The differences between the patients and the control group were statistically significant. Data obtained with the Odiosoft-Rhino method were correlated with symptom scores and endoscopic examination. CONCLUSION: Expiratory nasal sound is a practical and objective tool, which can be reliably used not only for the assessment of the degree of nasal blockage but also for the comparison of different treatment alternatives.

Wegener's granulomatosis with an atypical presentation as acute tonsillitis.

Wegener's granulomatosis (WG) is a rare necrotizing granulomatous vasculitis of unknown etiology commonly involving vessels, the upper and lower respiratory system and the kidneys. There are various symptoms and signs of WG due to a wide spectrum of involvement sites. The initial presentation of the disease as intraoral lesions is rare. In this paper, a case of WG that presented with a necrotic lesion confined to the right tonsil before other symptoms and signs occurred is described. The diagnosis was established based on the clinical presentation and the histopathological findings of the characteristic inflammatory pattern.

Upper airway obstructions and chronic otitis media: a clinical study.

PURPOSE: To investigate if pathologies causing upper airway obstructions are correlated with chronic otitis media. MATERIALS AND METHODS: One hundred fourteen patients with chronic otitis media and 114 healthy controls were enrolled in this study. Nasal septal deviation, Friedman and Mallampati scores were assessed for upper airway obstructions. Chronic suppurative otitis media was classified into tubotypmanic (n=80) and atticoantral (n=34) subtypes. Number of patients with septal deviation with a convexity to the same side as the affected ear in each CSOM subgroup was compared with chi-square test. The mean Mallampati and Friedman scores in tubotympanic disease group, atticoantral disease group and healthy controls were compared using Kruskal-Wallis test. RESULTS: Septal deviation occurred more frequently on the same side of ear pathology in patients with tubotympanic chronic suppurative otitis media (p=0.0005). Such a difference was not observed between the controls and patients with atticoantral chronic suppurative otitis media (p=0.718). No significant difference was noted between patients and controls in terms of Mallampati and Friedman scores (p=0.602 and p=0.836, respectively). Subtypes of chronic suppurative otitis media were not different from each other in terms of Mallampati and Friedman scores either (p=0.718 and p=0.708). CONCLUSION: Our results indicate that septal deviations may commonly occur on the same side with chronic otitis media. Therefore, septal deviations must be carefully investigated during the preoperative assessment of patients with CSOM. Elucidation of any possible causal relationship calls for further trials in larger series.

Comparison of nasal hyperosmolar xylitol and xylometazoline solutions on quality of life in patients with inferior turbinate hypertrophy secondary to nonallergic rhinitis.

BACKGROUND: The purpose of this study was to objectively determine and compare the efficacy and effectiveness of xylitol solution (Xlear Nasal Sprey®) compared with xylometazoline and physiological saline with respect to quality of life (QoL) in patients with nasal congestion. METHODS: A prospective, randomized study was performed in 42 patients who had nasal obstruction and hypertrophied turbinate mucosa that was refractory to medical treatment. The study population was randomized into 3 groups according to the application of xylometazoline, physiological saline, and xylitol hyperosmolar solution. The efficacy of treatment was evaluated objectively (4-phase rhinomanometry) and subjectively (visual analogue scale VAS.) before and after the application of the nasal solutions. QoL was evaluated by means of Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). RESULTS: VAS scores and 4-phase rhinomanometry scores were better in the group treated with xylometazoline compared to those treated with xylitol or saline. The xylitol procedure yielded better results than the saline procedure, but differences were not statistically significant in both objective and subjective evaluation methods. For overall QoL, there was a significant improvement from baseline for the xylometazoline and xylitol groups. However, the improvement in the xylometazoline group was significantly greater than that obtained in the xylitol group. CONCLUSION: Xlear Nasal Spray® is an effective modality in the treatment of nasal congestion and has positive effect on the QoL of patients. Further studies are needed in order to plan an ongoing treatment of Xlear Nasal Sprey® at certain intervals for continuous relief of symptoms and a better and longstanding QoL.

A stereological study on the correlation of inferior turbinate hypertrophy and paranasal sinus disease.

The objective of this study is to investigate the correlation between inferior turbinate size and paranasal sinus opacification on computerized tomography (CT) scans. Paranasal sinus CT scans of a total of 185 patients (92 males, 93 females) were examined in terms of sinus opacification. Sizes of the inferior turbinates were measured using stereological method and these sizes in normal and opacified paranasal sinuses are compared using one-way analysis of variance. Scans of 185 patients (93 female, 92 male) aged between 12 and 84 (mean 37.85 ± 16.27) years were examined in this study. Sizes of the inferior turbinates were found to be increased significantly in case of opacification of ipsilateral maxillary and anterior ethmoid sinuses (p = 0.000 and p = 0.4, respectively) on both sides. On the other hand, such a relationship could not be demonstrated for sizes of inferior turbinates with opacified or non-opacified posterior ethmoid, frontal and sphenoid sinuses. In conclusion, the combination of CT and the Cavalieri principle can provide an unbiased, direct, and assumption-free estimate of the regions of interest. The presented method can be efficiently applied without any need for special software, additional equipment, or personnel than that required for routine CT in daily use. Paranasal sinus disease, especially the inflammatory diseases of maxillary and anterior ethmoid sinuses, must be carefully investigated in cases with inferior turbinate hypertrophy.

Desloratadine-montelukast combination improves quality of life and decreases nasal obstruction in patients with perennial allergic rhinitis.

BACKGROUND: The effects of desloratadine-montelukast combination on quality of life (QoL) and nasal airflow of patients with perennial allergic rhinitis (PAR) has not been reported. The objective of this work was investigate the efficacy of desloratadine-montelukast combination on nasal obstruction and health-related quality of life (HRQL) of patients with PAR. METHODS: The patients with PAR (n = 40) were assessed using acoustic rhinometry (AcR) and Rhinoconjunctivitis QoL Questionnaire (RQLQ) before therapy. Desloratadine-montelukast fixed-dose combination treatment was applied to every patient once daily. The AcR and RQLQ score were reevaluated at the first and third months; and statistical comparison of pretreatment and posttreatment results was performed. RESULTS: Nasal symptoms and signs such as itching, sneezing, discharge, congestion, and edema, and color change of turbinates have been decreased after treatment. In AcR, minimum cross-sectional area (MCA) measurements and volume results were increased after the treatment. Correlation was found between the volume results and nasal discharge and/or congestion in right nasal passages. In left nasal passages, statistical relation was observed between the MCA and itching and/or change of turbinate color (p < 0.05). A significant decrease in the overall RQLQ score was determined at the first and third months of therapy. The difference between scores at baseline and end of the first and third months for all domains was statically significant (p < 0.001). The treatment difference in change from the first month to the end of the third month was statistically significant (p < 0.05). CONCLUSION: Desloratadine-montelukast combination therapy causes subjective and objective decrease in nasal obstruction, reduces the other symptoms of PAR and improves the disease-specific QoL.