Expression Levels of Glutathione S-Transferase and Cytochrome P450 Isoenzymes in Nasal Polyp Tissue.

Nasal polyps are benign sinonasal masses composed of eosinophils and extracellular edema. Pathogenesis of the polyp formation is unclear but several studies strongly suggest a correlation with infection, inflammation and allergy conditions. Our aim is to investigate the potential link between allergy and nasal polyp in tissue level. Nasal polyp group included 60 patients whose diagnosis was confirmed with biopsy and the control group included 38 healthy patients. Tissue sample of the control group was taken from inferior turbinate mucosa under local anesthesia and nasal polyp tissue was collected from functional endoscopic sinus surgery. The glutathione S-transferase (GST) and cytochrome P450 (CYP) isoenzyme expressions of the tissue samples were investigated under light microscopy and graded by a senior pathologist. GSTP1 protein expression was significantly higher in tissue samples from nasal polyp group compared to that of control group (p < 0.05). However, CYP1A1, GSTM1 and GSTA1 isoenzymes were not different between the two groups (p > 0.05). We have found that GSTP1 isoenzyme was elevated in nasal polyp tissue compared to the control. The increase in protein expression of GSTP1 might have occured as a tissue response to the increased oxidative stress thus suggesting a role of GSTP1 in polyp formation.

A Retrospective Analysis of Nasopharyngeal Biopsy Results in Adult Patients.

Introduction The widespread use of endoscopic evaluation in otolaryngology practice enables early diagnosis and treatment of nasopharyngeal cancers. This study aimed to evaluate the complaints, endoscopic examination findings, preferred radiological imaging methods, and pathology results of patients who underwent endoscopic nasopharyngeal biopsy. Methods Medical records of 956 patients (543 males and 413 females) who underwent nasopharyngeal biopsy between 2013 and 2018 were analyzed retrospectively. Age, gender, application complaint, endoscopic imaging findings, preferred radiological imaging methods, and biopsy results of the patients were retrospectively analyzed. The patients were grouped as benign and malignant according to their pathological diagnosis. Statistical evaluation was made between the benign and malignant groups in terms of parameters. Results The age range of the patients was 16-88 years. Pathology results of 102 patients were reported as malignancy. The most common malignancy was undifferentiated non-keratinized carcinoma (2.5%). The most frequently reported benign pathology was chronic nonspecific inflammation. The most common complaint was nasal congestion, which was observed at a rate of 63.1%. The most frequently requested radiological imaging was MRI with 43.1%. Conclusion The image of the masses found during endoscopic examination is very important to make a decision of malignancy. Even if the repeated biopsy is performed in patients with biopsy due to suspicious mass or with additional symptoms for nasopharyngeal carcinoma, radiological imaging is important for the exclusion of malignancy.

The Effect of Antioxidant Agents on Cisplatin-Induced Laryngeal Histological Alterations in Rats.

The larynx-related adverse effects that depend on cisplatin decrease patient comfort and many antioxidants have been used to eliminate these side effects. We aimed to identify the laryngeal mucosal changes imposed by cisplatin and investigated whether antioxidants, and their healing effects on these changes, may help reduce laryngeal complications in patients resulting from adverse effects in the larynx. A rat model was designed to evaluate the effects of cisplatin on the larynx and the protective role of antioxidants. Single-dose cisplatin was given both intraperitoneally alone and additionally administered with p-coumaric acid, melatonin, resveratrol, vitamin D, and oleic acid over 5 days. Whole larynges were dissected and evaluated histologically, histochemically, and immunohistochemically. Varying degrees of mucosal changes cisplatin group, but neither erosion nor an ulcer was observed. Numerous variable histological effects of antioxidants were observed on cisplatin exposed laryngeal mucosa. The most obvious effects of cisplatin were edema. The results of the study showed that resveratrol was the most preventive antioxidant agent against cisplatin-dependent mucosal changes. The highest increase in the Ki67 index was in the oleic acid group. Vitamin D increased stromal cyclooxygenase-2 expression that may have an effect on increasing mucosal damage.

Nasal Congenital Panfollicular Nevus.

Congenital nasal midline lesions are rarely observed pathologies. While relatively frequently encountered lesions are dermoid cyst, glioma, encephalocele, nasal polyp and epidermoid cyst, an other very rare reason is the congenital panfollicular nevus. The treatment of this syndrome appearing with a recurrent discharge in clinic is the surgical excision. We will hereby present the excision of the case of congenital panfollicular nevus with three different fistula openings.

The effect of curcumin on healing in an animal nasal septal perforation model.

OBJECTIVES/HYPOTHESIS: We investigated the effect of intranasal topical curcumin on nasal septum mucosa wound healing in a nasal septal perforation model produced in rabbits. STUDY DESIGN: Experimental study. METHODS: Fourteen male New Zealand rabbits were included in the study. For each rabbit, 5-mm-diameter circular perforations were created at 5 mm away from the columella to the nasal septum. Curcumin (study group) and saline (control group) were administered intranasally once daily for 10 days. At the end of the 10th day, the animals were sacrificed and the nasal septum specimens were sent for histological examination. Epithelial regeneration and degeneration, cartilage degeneration and regeneration, presences of fibroblast, eosinophil, acute/chronic inflammatory and giant cells, capillary density, amounts of granulation tissue and collagen, and macroscopic closure rate of perforation parameters were compared in each group. RESULTS: Epithelial and cartilage regeneration, and the amounts of collagen and granulation tissue were significantly higher in the curcumin group compared to the control group (P < .05). No statistically significant difference was found in comparison of other parameters (P > .05). CONCLUSIONS: Topical application of curcumin improves the wound-healing process of nasal septum perforation in the animal model. Therefore, curcumin can be used as a safe and effective medical agent to prevent the development of septal perforation. LEVEL OF EVIDENCE: NA Laryngoscope, 129:E349-E354, 2019.

A Giant Cervical Lymphangioma.

Cervical lymphangiomas are benign congenital malformations of lymphatic system usually seen in children under 2 years of age. It is rare in adults. They can be seen in any part of the body but the most common area in the neck region is posterior triangle. They usually present as asymptomatic masses. There are various ways of treatment, but the most common treatment modality is surgical resection. Here, the authors present a giant lymphangioma in the neck region of an adult who is treated with surgical resection without any complication.

Glutathione S-transferase enzyme activity and protein expression in patients with recurrent tonsillitis and idiopathic tonsillar hypertrophy.

OBJECTIVES: The palatine tonsil is a significant part of the secondary immune system. Tonsillitis and idiopathic tonsillar hypertrophy (ITH) are the most common pathologies of this component. Although there are studies on their pathogenesis, there is insufficient study of the role of antioxidant agents. Glutathione S-transferase (GST) isozymes contribute to the antioxidation reactions in the tissue via the glutathione pathway. The purpose in this study was to reveal the levels of the GST enzyme activity and protein expression of GSTP1 and GSTA1 isozymes in patients with tonsillitis and tonsil hypertrophy, and to investigate their role in the pathogenesis of these diseases. MATERIALS AND METHODS: Sixteen patients with recurrent tonsillitis and 5 patients with ITH and were included in the study. Cytosolic extracts were prepared from post-tonsillectomy tissues of both patient groups and GST enzyme activities were measured. RESULTS: The expression of GSTP1 was found to be significantly higher than GSTA1 in tissue samples of patients with ITH and recurrent tonsillitis (P<0.001). Increased GST activity and GSTP1 isozyme expression were shown in patients with recurrent tonsillitis compared to the idiopathic tonsillar hypertrophy study group. There was a positive correlation between the expressions of GSTP1 (P=0.040; r=0.47). CONCLUSION: Increased GST activity and GSTP1 isozymes were demonstrated histologically in the pathogenesis of ITH and recurrent tonsillitis. We believe that the data of changes in antioxidant capacity, obtained from studies with more extensive and larger samples, would support our findings.

Frontal Mucocele Extended Orbita and Endoscopic Marsupialization Technique.

Mucocele is benign, slow-growing, mucous-filled cystic lesions that arise in the paranasal sinuses. It causes progressive distension of the bony walls and induces compressive symptoms. Surgical treatment of paranasal sinus mucoceles includes endoscopic approach or external approach. The authors report a patient of frontal mucocele who presented with a history of progressive unilateral protrusion. Computed tomography scan revealed a large mucocele of the frontal sinus with orbital extension on the same side. He was successfully treated with endoscopic marsupialization without any serious complications.

The Effect of the Cholesterol Levels on Noise-Induced Hearing Loss.

Introduction Noise-induced hearing loss (NIHL), which is one of the most common occupational diseases among industrialized populations, is associated with longstanding exposure to high levels of noise. The pathogenesis of NIHL is not clear, but some genes and their activity at the tissue level have been investigated. Hypercholesterolemia, which can disturb the microcirculation, can be one of the underlying pathologies in hearing loss. Objective To investigate the relationship between NIHL and hypercholesterolemia. Methods The study group was selected among workers who had an occupational exposure of 85 dB of noise for at least 10 years. The audiologic assessment was recorded at seven frequencies (500 Hz, 1,000 Hz, 2,000 Hz, 3,000 Hz, 4,000 Hz, 6,000 Hz and 8,000 Hz). A total of 456 workers were included in the study and divided into two groups: the control group (252 patients) and the NIHL group (204 patients). After the audiologic measurement, blood samples were taken and investigated for blood cholesterol levels. According to these results, the groups were compared. Results Both groups were similarly distributed regarding age and occupational exposure time ( p > 0.05). We could not detect any association between cholesterol levels and noise-induced hearing loss ( p < 0.05). According to logistic regression analyses, the odds ratios are not significant for both hypercholesterolemia and hypertriglyceridemia ( p > 0.05). Conclusion Noise-induced hearing loss is still a common occupational problem that can be prevented by hearing conservation programs and occupational health and safety training. Still, we know little about the relationship between NIHL and hypercholesterolemia. According to our findings, we cannot detect any relationship. Controlled studies and studies with human individuals can be made possible in the future with diagnostic innovations in tissue imaging and tissue microcircular sampling.

The Effect of the Cholesterol Levels on Noise-Induced Hearing Loss

Abstract Introduction Noise-induced hearing loss (NIHL), which is one of the most common occupational diseases among industrialized populations, is associated with longstanding exposure to high levels of noise. The pathogenesis of NIHL is not clear, but some genes and their activity at the tissue level have been investigated. Hypercholesterolemia, which can disturb the microcirculation, can be one of the underlying pathologies in hearing loss. Objective To investigate the relationship between NIHL and hypercholesterolemia. Methods The study group was selected among workers who had an occupational exposure of 85 dB of noise for at least 10 years. The audiologic assessment was recorded at seven frequencies (500 Hz, 1,000 Hz, 2,000 Hz, 3,000 Hz, 4,000 Hz, 6,000 Hz and 8,000 Hz). A total of 456 workers were included in the study and divided into two groups: the control group (252 patients) and the NIHL group (204 patients). After the audiologic measurement, blood samples were taken and investigated for blood cholesterol levels. According to these results, the groups were compared. Results Both groups were similarly distributed regarding age and occupational exposure time (p > 0.05). We could not detect any association between cholesterol levels and noise-induced hearing loss (p < 0.05). According to logistic regression analyses, the odds ratios are not significant for both hypercholesterolemia and hypertriglyceridemia (p > 0.05). Conclusion Noise-induced hearing loss is still a common occupational problem that can be prevented by hearing conservation programs and occupational health and safety training. Still, we know little about the relationship between NIHL and hypercholesterolemia. According to our findings, we cannot detect any relationship. Controlled studies and studies with human individuals can be made possible in the future with diagnostic innovations in tissue imaging and tissuemicrocircular sampling.

Do male and female patients with chronic neck pain really have different health-related physical fitness, depression, anxiety and quality of life parameters?

AIM: The purpose of this study was to investigate whole body physical fitness parameters such as maximal aerobic capacity (VO2 max), muscle strength, trunk flexibility, daily physical activity, pulmonary function, body composition, anxiety and depression, as well as other disease-related changes in patients with chronic neck pain (CNP), and to compare them with healthy controls. METHOD: Eighty patients (40 male, 40 female) with CNP and 80 (40 male, 40 female) controls were included in this study. VO2 max, handgrip and back-leg strengths, trunk flexibility, daily physical activity, pulmonary function test (PFT), body composition and pressure pain threshold (PPT) measurements were carried out. Neck disability index (NDI), Beck anxiety inventory (BAI), Beck depression inventory (BDI), Pittsburg sleep quality index (PSQI), and Short-Form health survey (SF-36) questionnaires were applied to all participants. RESULTS: Handgrip and back-leg strengths and suboccipital and paraspinal-C7 PPTs and health-related quality of life (HRQoL) were lower, and PSQI, BAI and BDI were higher, in female patients with CNP, compared to healthy controls; whereas, VO2 max and HRQoL were lower, and body fat percantage and PSQI were higher, in male patients with CNP, compared to healthy controls. Trunk flexibility and PFT values were not significantly different between the patients and the controls in both genders. CONCLUSION: We suggest that, on the basis of gender, consideration of not only the neck region but also whole body physical fitness, anxiety and depression parameters in patients with CNP might be helpful to the development of more benefical strategies for illness management.

Effect of adenoid hypertrophy and pulmonary function tests in children with mild asthma.

OBJECTIVES: This study aims to assess the effect of adenoid hypertrophy on asthma in children with mild asthma. PATIENTS AND METHODS: Between September 2010 and September 2012, 63 children (42 males, 21 females; median age 10.5 years; range 6 to 14 years) admitted to our clinic with asthma complaint were included in this study. These children were evaluated for adenoid hypertrophy, symptoms of asthma, medical treatment, pulmonary function tests at the beginning of the study and at the end of second month. RESULTS: There was no correlation between initial pulmonary function tests and adenoid hypertrophy. But we observed significantly lower forced vital capacity values in children with prominent adenoid hypertrophy (p=0.033). While there was no significant difference in pulmonary function tests in terms of inhaled steroid usage (p>0.05), final forced mid-expiratory flow rate (FEF25-75) values were statistically higher in patients who were using nasal steroids (p=0.015). CONCLUSION: Consequently, significantly higher values of FEF25-75 in the group that used nasal steroid suggest that adenoid hypertrophy affects the airway obstruction. Moreover, absence of airway obstruction symptoms in patients with mild adenoid hypertrophy suggests pulmonary function tests may help to decide performing adenoidectomy.

Extranodal Marginal Zone Lymphoma of the Parotid Gland.

Non Hodgkin lymphomas correspond to 25 % of all head and neck cancers. These rare tumors only include less than 5 % of malign tumors in parotid region. Differential diagnosis of these tumors cover many malign and benign tumors of the parotid gland. Definite diagnosis depends on sufficient tissue material of parotidectomy specimen. Treatment modality is surgical removal of the lesion with or without additional radiation and chemotherapy depending on the stage of the tumor. Prognosis is better than other forms of the B-cell lymphoma. We present a 54 year old woman who suffered from progressively and slowly growing mass on parotid region, without any inflammatory disease or chronic infection, diagnosed with mucosa associated lymphoid tissue lymphoma of the parotid gland. Parotid gland was totally excised by superficial parotidectomy and there is no recurrence after 5 years postoperative period.

A Giant Plunging Sublingual Dermoid Cyst Excised by Intraoral Approach.

OBJECTIVE: Dermoid and epidermoid cysts are rare cysts of the head and neck region, which should be considered in differential diagnosis of sublingual mass, constituting 0.01 % of all oral cavity cysts. There are suspected theories regarding the basis of the pathology. CASE REPORT: 30-year-old male referred to our clinic with a chief complaint of sublingual mass which had been present for many years but the lesion enlarged over the past 3 years. MRI examination revealed a giant cystic mass which was 3.6 × 3.9 mm in diameter and medially located at sublingual region. TREATMENT AND PROGNOSIS: Intraoral approach was preferred for surgery and no recurrence or complaints were detected during follow-up period. CONCLUSION: When a cystic mass is detected on the floor of oral cavity, we must consider dermoid cysts for differential diagnosis. Surgery is the only treatment. If possible, intraoral approach should be preferred because of its perfect cosmetic results.

Complicated Giant Pilomatrixoma of the Parotid Region.

OBJECTIVE: Pilomatrixoma (calcifying epithelioma of Malherbe) is a benign soft tissue tumour arising from dermis or subcutaneous tissue which should be considered in differential diagnosis of preauricular lesions especially when skin fixation is present. CASE REPORT: Twenty-three year old male referred to our clinic with complaint of left preauricular swelling over 18 months which enlarged and became painful in the last 2 months. Because the lesion showed signs of infection, surgery was planned after medical therapy was completed. FNAB suggest pleomorphic adenoma as preliminary diagnosis. US or MRI showed no specific feature. TREATMENT AND PROGNOSIS: Total excision, superficial parotidectomy with facial nerve sparing was performed after regression of infectious signs. Postoperatively no recurrence was detected. CONCLUSION: Pilomatrixomas are benign tumours but have diagnostic difficulties according to clinical and cytologic findings. This rare lesion should be kept in mind to avoid misdiagnosis as malign parotid tumours, particularly in the presence of skin change.

Oxytocin as a protective agent in cisplatin-induced ototoxicity.

PURPOSE: Cisplatin is a potent chemotherapeutic drug with serious side effects such as ototoxicity which is characterized by irreversible, bilateral, progressive sensorineural hearing loss. Oxytocin, which is a well-known hormone secreting during pregnancy, has antioxidant and antiinflammatory effect. Our study aims to test and compare the effect of intratympanic (IT) and intraperitoneal (IP) oxytocin on cisplatin ototoxicity with DPOAE. METHODS: A total of 24 Wistar albino rats were randomly divided into four groups: Group 1 received 0.1-0.3 ml IT saline + IP saline solutions for 4 days (n = 6), Group 2 received cumulative dose of 20 mg/kg IP cisplatin divided into two equal doses in first and second days of experiment + 0.1-0.3 ml IT saline for 4 days, Group 3 received same dose of cisplatin as Group 2 + 0.1-0.3 ml IT oxytocin for 4 days, and Group 4 received same dose of cisplatin as Groups 2 and 3 + IP oxytocin with dose of 1 mg/kg. DPOAE was performed prior to procedure and at the end of the experiment on day 5. RESULTS: Group 2 showed severe ototoxic effect of cisplatin according to DPOAE result (p < 0.05). When compared with Group 2, DPOAE amplitude reductions were smaller in Group 3 (3.2, 3.8, 4.5, 6.3 and 7.6 kHz) (p < 0.05) and Group 4 which is statistically significant in 5.4, 6.3 and 7.6 kHz (p < 0.05). When Group 3 and Group 4 were compared, reductions were smaller in 2.7 and 3.2 kHz in Group 3 (p < 0.05). CONCLUSION: In this study, we showed the protective effect of IT and IP oxytocin on cisplatin ototoxicity. We suggest oxytocin in cisplatin ototoxicity, especially via IT route even with high-dose cisplatin.

Anthracosis: An unusual cause of vocal fold paralysis.

Anthracotic pigmentation in the bronchial mucosa is a bronchoscopic finding of pneumoconiosis, or evidence of heavy atmospheric soot. This pigmentation in the tracheobronchial mucosa is surrounded by calcified or noncalcified lymph nodes. Anthracosis is not a previously known cause of left vocal fold paralysis. We present what we believe to be the first reported case of anthracosis-caused vocal fold paralysis.

Evaluation of the Effect of Betahistine on Noise-Induced Hearing Loss Using Distortion Product Otoacoustic Emission and Scanning Electron Microscopy.

OBJECTIVE: To evaluate the protective effect of betahistine on noise-induced hearing loss (NIHL) using scanning electron microscopy (SEM) and distortion product otoacoustic emission (DPOAE). MATERIALS AND METHODS: A total of 8 adult albino guinea pigs were used in this study (study group: n=4 and control group: n=4). DPOAE measurements of both groups were performed before the procedure. Two hours before noise exposure, 0.9% NaCl solution was injected perorally to the control group and betahistine was administered through a peroral catheter to the study group. Both groups were then exposed to 105-dB sound pressure level (SPL) 4-kHz frequency-based narrow-band noise for 2 h per day for 5 days. DPOAE measurements were performed again on the 6th day and cochleae were dissected and examined by SEM on the 7(th) day. RESULTS: Regarding the results of DPOAE, NIHL was observed in both groups on the 6th day (p<0.05). Loss, flattening, and fusion, which are findings of permanent hearing loss, were determined in the stereocilia of the inner and outer hair cells by SEM. These findings were evaluated as signs of permanent increase in the threshold. When DPOAE measurements and SEM results were evaluated in the study group, no significant difference was observed in NIHL compared with the control group (p>0.05). CONCLUSION: In our study, it was observed that simultaneous administration of betahistine during noise had no protective effect on permanent increase in the threshold. However, further studies on noise and long-term use of betahistine can be performed.

A Giant Lymphangioma on the Neck.

Lymphangioma is a congenital malformation of the lymphatic system, which is located mostly on the head and neck region. Most of the cases are seen at age younger 2 years. It is rare in adult population and when detected, it can be treated with surgical excision. We present a 50-year-old patient with giant lymphangioma on the posterior cervical region of the neck treated by surgical treatment successfully.

Effect of Transtympanic Injection of Melatonin on Cisplatin-Induced Ototoxicity.

OBJECTIVE: Cisplatin is a chemotherapeutic agent that is widely used in cancer treatment. Numerous side effects have been detected, one of which is ototoxicity. Melatonin, a product of the pineal gland, has a neuroendocrinoimmunological role in vertebrates. In the present study, we investigated the effects of melatonin on cisplatin-induced ototoxicity. MATERIALS AND METHODS: Twenty-four Wistar albino rats were divided into three groups. Group 1 was administered both intraperitoneal and transtympanic saline; Group 2, 12 mg/kg of intraperitoneal single-dose cisplatin and transtympanic saline; and Group 3, 12 mg/kg of intraperitoneal single-dose cisplatin and 0.1 mg/mL of transtympanic melatonin for 5 days. Before and after the procedure, distortion product otoacoustic emissions and auditory brainstem responses of all the rats were measured. At the end of the procedure, the cochleas of the rats were investigated at the microscopic level. RESULTS: Group 3 had lesser threshold shift in otoacoustic emissions and auditory brainstem responses at all frequencies than Group 2 (p<0.005). The difference was not significant between Group 1 and Group 3. On the microscopic level, more epithelial loss and less TNF staining were detected in Group 2 than in Group 3. CONCLUSION: As an antioxidant and immune modulator, melatonin is effective against cisplatin ototoxicity. Both hearing thresholds and tissue investigations supported this conclusion. Melatonin can also be used to treat cisplatin ototoxicity using transtympanic local application in lower doses.