Applied surgical methods and outcomes in crooked nose rhinoplasty.

OBJECTIVE: In this retrospective and multicentric study, we investigated applied surgical methods in rhinoplasty for crooked nose deformity. PATIENTS AND METHODS: The retrospective data for 300 crooked nose deformity cases (191 males and 109 females) were used in our study. Classification of the initial deformities was performed as (1) I-shaped crooked nose deformity, (2) C-shaped crooked nose deformity, (3) Reverse C-shaped crooked nose deformity, and (4) S-shaped crooked nose deformity. As an operation technique, L-strut septoplasty was performed. The applied surgical methods in rhinoplasty to correct the crooked nose are evaluated and classified. RESULTS: Our results showed that initial deformities in crooked nose patients were I-shaped crooked nose deformity (34%), C-shaped crooked nose deformity (28%), Reverse C-shaped crooked nose deformity (21.3%), and S-shaped crooked nose deformity (16.7%). L-strut septoplasty was performed, and the results of the applied methods to correct the crooked nose were evaluated and classified. It was noticed that more than one procedure was applied to each case: (1) double-side lateral osteotomy (86.6%), (2) wedge bone resection on one side of the osteotomy (7.3%), (3) single-side lateral osteotomy (6%), (4) symmetric spreader grafts (56%), (5) asymmetric spreader grafts (10.6%), (6) shaving of the transverse wing of dorsal septum (8%), (7) correction of deviated dorsal septum (16.3%), (8) displaced anterior nasal spine (12.6%), (9) clocking suture (dorsal septal rotation suture) (9%), (10) dorsal septal scoring and splinting graft (8.3%), and equalizing lateral cruses (12.6%). CONCLUSIONS: I-shaped and C-shaped crooked nose deformities were mainly detected in crooked nose deformity patients. Correcting the crooked nose, double-side lateral osteotomy, and symmetric spreader grafts were the most applied techniques to correct the crooked nose. Other rhinoplasty techniques were also applied to these patients; more than one technique was needed.

A novel technique in septal perforation: Fascia lata and costal cartilage sandwich graft.

BACKGROUND: Nasal septum perforation (NSP) is an anatomical defect of the mucosa, cartilage/bone of nasal septum and septoplasty is the most common cause of it. A perforated septum rarely heals on its own, it is more likely to get worse. The success for large perforations is approximately 78%, it is harder to be successful in vertically larger perforations. We introduce a new technique to close large perforations by the fascia lata and costal cartilage sandwich graft (FLSG). The main advantage of this technique is that the fascia lata eliminates the opening between the septal mucosal flaps in case the septal mucosal flaps may not meet each other. PATIENTS AND METHODS: 16 cases presenting with nasal septum perforation were repaired with the FLSG technique. Grafts were harvested, the perforation was accessed through open rhinoplasty approach, FLSG is inserted and sutured. RESULTS: 16 cases consisting of 9 males (56.25%) and 7 females (43.75%) were operated. The age range was between 20 and 43 years (mean 32.6 ± 6.94). 3 cases (18.75%) had medium and 13 cases (81.25%) had large NSP. 8 cases (50%) were smokers. Nine month postoperatively, all medium NSP were closed. During this period, 14 NSP (87.5%) medium size NSP achieved complete closure, while the remaining two NSP that were yet to close had large defects (>2 cm) and smokers. CONCLUSION: FLSG is an effective, easy, and novel technique in NSP repair and the postoperative controls have proven a high success rate even in large NSP.

Does the radioactive iodine dose affect smell, taste sensation and nose function?

OBJECTIVE: To detect whether the adverse effects of post-operative radioactive iodine therapy following differentiated thyroid cancer on smell, taste and nasal functions were associated with radioactive iodine dose. METHODS: Fifty-one patients who had undergone total thyroidectomy because of differentiated thyroid cancer were divided into two groups depending on the post-operative radioactive iodine therapy dose: low dose group (50 mCi; 21 patients) and high dose group (100-150 mCi; 30 patients). The Sniffin' Sticks smell test, the Taste Strips test and the 22-item Sino-Nasal Outcome Test were performed on all patients one week before therapy, and at two months and one year following therapy. RESULTS: Statistically significant differences were detected in the Sniffin' Sticks test results, total odour scores, total taste scores and Sino-Nasal Outcome Test results between the assessment time points. There was no statistically significant difference between the low and high dose groups in terms of odour, taste or Sino-Nasal Outcome Test scores either before or after therapy. CONCLUSION: Radioactive iodine therapy has some short- and long-term adverse effects on nasal functions and taste and odour sensations, which affect quality of life. These effects are not dose-dependent.

Evaluation of serum ischaemia-modified albumin levels in patients with Bell's palsy.

OBJECTIVE: This prospective study aimed to evaluate the relationship between serum ischaemia-modified albumin levels and Bell's palsy severity. METHODS: The study included 30 patients diagnosed with Bell's palsy and 30 healthy individuals. The patients were separated into three disease severity groups (grades 2, 3 and 4) according to House-Brackmann classification. Blood samples were collected from all participants and the results compared between groups. RESULTS: Significant differences in serum ischaemia-modified albumin were found between the study and control groups (p < 0.001); values were significantly higher in the study group than in the control group. CONCLUSION: The significantly higher levels of serum ischaemia-modified albumin in the study group suggest that Bell's palsy pathogenesis is associated with oxidative stress.

Nasal eosinophilia in nasal smears of patients with persistent and intermittent allergic rhinitis.

BACKGROUND: Eosinophils are the principal effector cells involved in the pathogenesis of allergic rhinitis. Cell numbers increase in non-allergic rhinitis patients with eosinophilia, aspirin hypersensitivity and nasal polyposis, as well as in allergic rhinitis patients. Exfoliative nasal cytology can be used in the differential diagnosis of allergic rhinitis. OBJECTIVE: To evaluate nasal eosinophilia in nasal smears of patients with mild, persistent and intermittent allergic rhinitis. METHODS: The study comprised 60 patients with allergic rhinitis and 20 healthy volunteers. The patients were divided into intermittent and persistent allergic rhinitis groups. Nasal smear status, eosinophil numbers and Total Nasal Symptom Scores were compared. RESULTS: Nasal smear results were pathological in 40 of 60 allergic rhinitis patients, which was significantly higher than the rate in controls. The mean nasal eosinophilia score was significantly higher in the intermittent allergic rhinitis than in the persistent allergic rhinitis group (p = 0.029). There was a positive correlation between nasal eosinophilia score and Total Nasal Symptom Score (r = 0.652; p < 0.05) in persistent allergic rhinitis and intermittent allergic rhinitis patients. CONCLUSION: The nasal smear test is inexpensive, objective and simple to perform, and should be part of the diagnostic investigation.

Effects of CyberKnife therapy for vestibular schwannoma on hearing: a retrospective study.

OBJECTIVES: To evaluate the effects of CyberKnife stereotactic radiotherapy for the treatment of vestibular schwannoma on hearing, as evaluated by audiological tests. METHODS: Patients with vestibular schwannoma were evaluated before and after CyberKnife radiosurgery. Evaluation included pure tone thresholds, speech discrimination scores, auditory brainstem responses and radiological signs. RESULTS: The study comprised 26 patients diagnosed with vestibular schwannoma and subsequently treated with CyberKnife radiosurgery. The mean follow-up time was 16.4 months. The mean post-treatment hearing preservation rate was 69.23 per cent. There was no significant relationship between hearing loss after treatment and patient age, radiation dosage during treatment, or size of tumour. With regard to auditory brainstem responses, patients with hearing loss following treatment had a significantly higher inter-peak latency between waves I-III than patients with preserved hearing. CONCLUSION: Stereotactic CyberKnife radiosurgery is an excellent alternative treatment modality for patients with vestibular schwannoma, and results in acceptable preservation of hearing. Residual hearing following CyberKnife therapy is not significantly affected by factors such as age, size of tumour or dosage of treatment.

The use of an ostial stent does not increase the success rate of endoscopic dacryocystorhinostomy.

OBJECTIVE: This prospective, controlled study assessed how placing a stent into a newly formed ostium affects ostial patency, success and complication rates in endoscopic dacryocystorhinostomy patients. METHODS: In group 1 (40 eyes of 36 patients), both silicone tube intubation and tube stenting were performed. In group 2 (36 eyes of 34 patients), only silicone tube intubation was performed. Success, operative time and post-surgical complications were investigated two months post-operatively in each group. RESULTS: The success rates were 92.5 per cent and 83.3 per cent for groups 1 and 2 respectively, but the difference was not statistically significant (p = 0.294). The complication rates also differed between the two groups, but this was again insignificant. CONCLUSION: Compared with the use of a silicone tube alone, the addition of an ostial stent did not significantly increase the success rate of endoscopic dacryocystorhinostomy.

How does electronic cigarette smoking affect sinonasal symptoms and nasal mucociliary clearance?

OBJECTIVE: is to evaluate the sinonasal symptom scores and mucociliary clearance (MCC) after starting to use electronic cigarette METHODOLGY: This prospective randomized single-blind clinical trial was conducted between March 2013 and November 2013. Patients (n=98) admitted to smoking cessation clinic were divided into two groups; Electronic cigarette smokers (group 1) and non-electronic cigarette smokers (group 2). SNOT-22 and saccharin transit time for MCC were evaluated before starting electronic cigarettes and after the third months. RESULTS: SNOT-22 scores and MCC time were evaluated between groups and within groups after 3 months. SNOT 22 scores and MCC measurements showed no difference between groups before the cessation of cigarette smoking (p >0.05). SNOT 22 results of both groups revealed statistically significantly lower scores after the three months (p < 0.05). However, SNOT-22 scores of group 2 was significantly better than group 1 (p > 0.05). Comparison of MCC results of group 2 revealed statistically significantly lower scores after the three months (p < 0.05). However, group 1 did not show any significant difference after three months (p > 0.05). There was a significant difference between the groups at the third month measurements (p < 0.05). CONCLUSIONS: Although EC is widely used as a method of quitting smoking, it has negative effects on the sinonasal symptoms and MCC.

How do voice restoration methods affect the psychological status of patients after total laryngectomy?

OBJECTIVE: This study investigated the relationship between psychological well-being and different voice rehabilitation methods in total laryngectomy patients. METHODS: The study enrolled 96 patients who underwent total laryngectomy. The patients were divided into three groups according to the voice rehabilitation method used: esophageal speech (24 patients); a tracheoesophageal fistula and Provox 2 voice prosthesis (57 patients); or an electrolarynx (15 patients). The participants were asked to complete the Turkish version of the Voice Handicap Index-10 (VHI-10) to assess voice problems. They were also asked to complete the Turkish version of the Perceived Stress Scale (PSS), and the Hospital Anxiety and Depression Scale (HADS). The test scores of the three groups were compared statistically. RESULTS: Patients who used esophageal speech had a mean VHI-10 score of 10.25 ± 3.22 versus 19.42 ± 5.56 and 17.60 ± 1.92 for the tracheoesophageal fistula and Provox 2 and electrolarynx groups respectively, reflecting better perception of their voice. They also had a PSS score of 11.38 ± 3.92, indicating that they felt less stressed in comparison with the tracheoesophageal fistula and Provox 2 and electrolarynx groups, which scored 18.84 ± 5.50 and 16.20 ± 3.49 respectively. The HADS scores of the groups were not different, indicating that the patients' anxiety and depression status did not vary. CONCLUSION: Patients who used esophageal speech perceived less stress and were less handicapped by their voice.

Three-dimensional placental volume and mean grey value: Normal ranges in a Turkish population and correlation with maternal serum biochemistry and Doppler parameters.

The aim of this study is to evaluate the relationship between three-dimensional (3D) ultrasound measurements of placenta at 11-13(6) weeks' gestation and maternal serum levels of pregnancy associated plasma protein-A (PAPP-A), free beta human chorionic gonadotrophin (fßhCG), Doppler parameters in early pregnancy. This prospective study consisted of 334 singleton pregnancies at 11-13(6) weeks' gestation. Placental volume and placental volumetric mean grey values were evaluated. The placental volume (cm(3)) was analysed using the Virtual Organ Computer-aided AnaLysis (VOCAL) imaging program and 3D histogram was used to calculate the volumetric mean grey value (%). Mean maternal age was 28.35 ± 7.55. Mean gestational age was 12.29 ± 0.68 weeks. Placental volume was 77.04 ± 35.74 cm(3). Mean grey value of the placenta was 34.38 ± 8.02%. Correlation analysis revealed that placental volume was significantly correlated with the crown-rump length (r = 0.173, p = 0.002), gestational week (r = 0.116, p = 0.036), ductus venosus pulsatility index (r = -0.101, p = 0.04) and maternal weight (r = 0.099, p = 0.037). There was a significant relation between the mean grey value of the placenta and maternal age (r = 0.131, p = 0.02), nuchal translucency (r = -0.109, p = 0.048), PAPP-A (r = 0.108, p = 0.04) and fßhCG (r = 0.104, p = 0.042). Volumetry of the placenta can be carried out with a high percentage of 1st trimester pregnancies. Volumetry during the 1st trimester could be helpful because of the less advanced state of placentation. This examination is easy to perform and the measurements can be acquired correctly and quickly.

The alteration in placental volume and placental mean grey value in growth-restricted pregnancies assessed by 3D ultrasound (Growth Restriction & 3D Ultrasonography).

We aimed to evaluate the volumetric and echogenic alterations in placentas between the intrauterine growth restriction (IUGR) and normal pregnancies using three-dimensional ultrasound and virtual organ computer-aided analysis (VOCAL) software. This case-control prospective study consisted of 48 singleton pregnancies complicated by IUGR and 60 healthy singleton pregnancies matched for maternal age, gestational age and parity. Placental volume (PV) and placental volumetric mean grey values (MGV) were evaluated. PV (cm(3)) was analysed using the VOCAL imaging analysis program, and 3D histogram was used to calculate the volumetric MGV (%). PV was 278.50 ± 63.68 and 370.98 ± 97.82 cm(3) in IUGR and control groups, respectively (p = 0.004). MGV of the placenta was 38.24 ± 8.41 and 38.24 ± 8.41 in IUGR and control groups, respectively (p = 0.30). receiver operator curve (ROC) curve analysis revealed that area under curve was 0.731 for PV. Correlation analysis revealed that PV was significantly associated with estimated fetal weight (r = 0.319, p = 0.003), biparietal diameter (r = 0.346, p = 0.002), head circumference (r = 0.269, p = 0.019), abdominal circumference (r = 0.344, p = 0.002) and femur length (r = 0.328, p = 0.004). PV was inversely related to the umbilical artery pulsatility index (r = - 0.244, p = 0.017). To the best of our knowledge, this is the first study evaluating volumetric MGV in IUGR placentas by comparing them with healthy pregnancies. Our study showed that PV diminishes significantly in IUGR pregnancies, whereas volumetric MGV does not alter significantly.

Eight years of clinical findings and biopsy results of nasopharyngeal pathologies in 1647 adult patients: a retrospective study.

OBJECTIVES: We performed an 8-year retrospective study to evaluate the presentation, clinical findings and nasopharyngeal biopsy results of adult nasopharyngeal pathologies. METHODOLOGY: This study included 1647 patients (801 males and 846 females) admitted to outpatient clinics. All patients underwent a nasopharyngeal biopsy for a nasopharyngeal mass. In addition, a blind biopsy was taken if there was suspicion of nasopharyngeal carcinoma, even in the absence of a mass lesion. The pathological diagnoses were analysed on the basis of the age, sex and clinical presentation of the patients. RESULTS: Patient age ranged between 18 and 85 years; the mean was 36 years. Patient age differed significantly between those with benign and malignant disease (p=0.000); the risk of malignancy increased with age. Benign disease was found in 97.4% of the patients. Reactive lymphoid hyperplasia was the most common condition; it was found in 92.71% of benign cases. Undifferentiated nasopharyngeal cancer was the most common malignant disease, being found in 82.95% of all nasopharyngeal malignancies and in 4.43% of all nasopharyngeal disease. The most common symptom was nasal obstruction. The other main symptoms were hearing loss and neck mass. Neck mass was associated with malignancy. CONCLUSIONS: Benign disease of the nasopharynx is more common than malignant pathology in patients with a nasopharyngeal mass. Although adenoidal tissue undergoes regression in the adolescent period, this tissue may present as the chief cause of nasal obstruction in adults. Age and symptoms may predict malignant disease.

Effectiveness of azelastine nasal spray in the treatment of adenoidal hyper-trophy in children.

AIM: To evaluate the effects of topical azelastine treatment on symptoms related to adenoid hypertrophy and the size of adenoid tissue in children. MATERIAL AND METHODS: In total, 60 children who were found to have adenoid hypertrophy were included. A questionnaire on nasal symptoms, nasal endoscopy and skin prick tests was administered to all patients. All patients had complaints of chronic nasal obstruction symptoms and nasal endoscopy showed > 75% choanal obstruction, attributable to adenoid pads. The adenoid/nasopharyngeal areas were calculated. All of the patients underwent azelastine nasal spray therapy (1 spray per nostril, twice daily; 0.28 mg/dose) for 30 days. After 1 month, all children were reassessed. The efficacy of therapy, symptoms, adenoid / nasopharynx ratio, and obstruction ratio, obtained by endoscopy, were compared. RESULTS: Azelastine treatment was well tolerated by all patients. After the first treatment period, the severity of symptoms, endoscopic grade, and adenoid size decreased in all of the 60 patients. There were significant improvements in total subjective symptoms (nasal obstruction, rhinorrhea, cough, snoring, and obstructive sleep apnea) post-treatment. CONCLUSIONS: Azelastine nasal spray may be useful in decreasing adenoid pad size and the severity of symptoms related to adenoidal hypertrophy. Hippokratia 2014; 18 (4): 340-345.

Emergence of West Nile virus infections in humans in Turkey, 2010 to 2011.

In 2010, 47 human cases of West Nile virus (WNV)infection, including 12 laboratory-confirmed and 35 probable cases, were identified in Turkey. These were the first cases detected during routine surveillance.The patients were from 15 provinces, mainly located in the western part of the country. Incidence was 0.19/100,000 with a maximum of 1.39 in Sakarya province.Forty of the total 47 cases showed neuroinvasive manifestation. Median age was 58 years with a range of four to 86. Ten of the patients died. Enhanced surveillance in humans and animals and mosquito control measures were implemented. The WNV infections were included in the national notifiable diseases list as of April 2011. In 2011, three probable and two confirmed cases of WNV infection were diagnosed in provinces where infections had been detected in the previous year, supporting a lower activity than 2010. However,detection of WNV infections in humans in 2010 and 2011 consecutively, may indicate that WNV has become endemic in the western part of Turkey. Field epidemiological studies were undertaken to understand more about the nature of infection in Turkey.

Response to vasoconstrictor agents by detrusor smooth muscles from cisplatin-treated rats and antioxidant treatment.

The effects of melatonin and quercetin on the contractile responses of cisplatin-treated rat detrusor smooth muscle were tested. Detrusor strips obtained from four separate rat groups (control, cisplatin, melatonin+cisplatin and quercetin+cisplatin) were mounted in 25 mL organ baths containing Krebs-Henseleit solution (KHS) at 37°C, continuously gassed with 95% O2 and 5% CO2. The vasoconstriction induced by acetylcholine (ACh) and potassium chloride (KCl) were compared within the groups. Furthermore, histopathological parameters such as edema, congestion, inflammatory cells, microvascular proliferation, fibrosis, eosinophil, mast cells and epithelial damage were noted. In routine experiments ACh and KCl triggered concentration-dependent contractions. Pretreatment with cisplatin increased the sensitivity but not the maximal response to ACh and KCl. In rats treated with melatonin or quercetin before cisplatin, the EC50 values, but not the maximal response, to both agents were significantly higher than in the cisplatin-treated (CII) group. Histopathological parameters such as edema, congestion, inflammatory cells, microvascular proliferation, fibrosis, eosinophil, mast cells and epithelial damage were all higher in the cisplatin-treated group than in the controls. Melatonin pretreatment significantly decreased mast cell numbers and epithelial damage when compared to cisplatin treatment alone but these effects were not recorded with quercetin pretreatment. These results demonstrate for the first time that melatonin can attenuate urinary bladder injury produced by cisplatin treatment.

Vasoprotection by melatonin and quercetin in rats treated with cisplatin.

Cisplatin-based chemotherapy has a variety of vascular side effects. The aim of the present study was to evaluate the beneficial effect of melatonin and cisplatin on the alterations in vascular reactivity and structure of cisplatin-treated rats. Phenylephrine (PHE) and KCl-caused concentration-dependent contractions of rat aorta. Pretreatment with cisplatin increased the sensitivity but not the max response to PHE and KCl. In rats treated with melatonin or quercetin before cisplatin, the EC50 values, but not the maximal response to both agents were significantly higher than cisplatin-treated group. Compared to the control group, cisplatin-treatment significantly reduced the luminal area of the aorta. In melatonin and quercetin-treated aortas the luminal area values were significantly higher than cisplatin-treated group. The results demonstrate for the first time that melatonin and quercetin treatment may protect the aorta in cisplatin-based chemotherapy.

Effectiveness of corticosteroids in otitis media with effusion: an experimental study.

OBJECTIVE: The aim of the present study was to investigate the dose-related effectiveness of corticosteroids in the management of otitis media with effusion, by using the objective assessment techniques of tympanometry and cytokine measurement. MATERIALS AND METHODS: The eustachian tubes of 42 male rats were obstructed. Thirty-six subjects with effusion were randomly divided into three equal groups: controls; 0.5 mg/kg/day corticosteroid; and 1 mg/kg/day corticosteroid. Concentrations of interleukin-1beta and tumour necrosis factor alpha in the middle-ear effusions were analysed using enzyme-linked immunosorbent assay. RESULTS: An effusion occurred on the 14th post-operative day and was present on the 30th post-operative day in the control group. Otomicroscopic examination and tympanometric measurement showed an improvement in the intervention groups. There was a significant difference between both intervention groups and the control group for both interleukin-1beta and tumour necrosis factor alpha concentrations (p 0.05). CONCLUSION: The study confirmed a short term beneficial effect of systemic steroids on resolution of otitis media with effusion in a rat model. Our results support the theory that corticosteroids significantly decrease concentrations of both interleukin-1beta and tumour necrosis factor alpha. In our model, the 0.5 mg/kg corticosteroid dose was as effective as the 1 mg/kg corticosteroid dose. Further studies should be carried out to determine the optimal dose and duration of corticosteroids in the treatment of otitis media with effusion.