The surgical management of recurrent acute and chronic barosinusitis in sports self-contained underwater breathing apparatus (scuba) divers.

PURPOSE: The aim of this retrospective study is to evaluate the feasibility of functional endoscopic sinus surgery (FESS) with supplementary surgical procedures in scuba divers with recurrent acute barosinusitis (RABS) and chronic barosinusitis (CBS). METHODS: In this retrospective study, 25 divers were classified into RABS (n:11) and CBS (n:14) groups. The presentation of divers have been reviewed. The PNS CT images were scored according to Lund-Mackay (L-M) system. A score has been assigned to the extent of endoscopic procedures performed. The outcome of surgery and life quality were determined by SNOT-22 and dive-related questions (DRQ) tests. RESULTS: The average L-M score was 3.8 ± 2 for RABS and 12.2 ± 3.4 for CBS groups. L-M score of CBS group was found to be statistically higher than RBS group (p < 0.05). The FESS score of CBS group (8.7 ± 2.4) was higher than RABS group (5.6 ± 2) which showed that the endoscopic sinus procedures were performed more extensively in CBS group (p < 0.05). The difference between the preoperative and postoperative SNOT-22 scores indicates that the degree of sinus symptoms improved better in RABS group than CBS group (p < 0.05). When DRQ test was evaluated, RABS group showed a better improvement in diving performance symptoms than the CBS group (p < 0.05). CONCLUSION: Our study demonstrated that divers with RABS and CBS can be managed successfully with FESS and supplementary surgical procedures. The improvement in the RABS group was superior to the CBS group, a difference attributed to the severity of chronic inflammation in CBS.

Spindle cell lipoma of the hypopharynx.

OBJECTIVE: We report a rare case of a spindle cell lipoma with atypical clinical course. CASE REPORT: A 51 year old female patient referred to our clinic with feeling of mass in the throat she had had for two years. The patient described difficulty in swallowing. Indirect laryngoscopy did not reveal any masses at bilateral pyriform sinuses, and the mucosa had a natural appearance. However, a mass with a stalk was detected in the side of the mouth when the patient retched. Endoscopic monitoring of the mass revealed its origin to be the left sinus pyriformis. No pathological structures could be detected in the indirect laryngoscopy taken after the patient gulped again. The mass was shown by magnetic resonance imaging to extend into the esophagus. It was removed using suspension microlaryngoscopy. Postoperative control revealed a complete healing at the excision site. Immunohistochemical examination for pathological diagnosis indicated a spindle cell lipoma. CONCLUSIONS: Laryngeal and hypopharyngeal lipomas are rare forms of benign laryngeal neoplasms. Their asymptomatic course makes diagnosis difficult. The patient is presented here with related clinical and pathological features.

[The role of concha bullosa in nasal pathologies]. / Konka bullozanin nazal patolojilerdeki rolü

OBJECTIVES: We investigated the relationship between the size of concha bullosa (CB) detected by coronal paranasal sinus computed tomography (CT) and the frequency of sinonasal symptoms. PATIENTS AND METHODS: The study included 60 patients (39 females, 21 males; mean age 38.3 years; range 17 to 67 years) who had CB on CT scans and underwent endoscopic sinus surgery for symptoms of chronic sinusitis, nasal obstruction and/or headache. The patients were evaluated in three groups according to the ratio of the cross-section area of CB to that of the nasal cavity (NC); hence, group 1, 0-14%; group 2, 15-29%; and group 3, = or >30%. The relationship of CB/NC with clinical symptoms and nasal pathologies were examined. RESULTS: The presenting complaints were sinusitis in 28 (46.7%), nasal obstruction in 56 (93.3%), and headache in 36 (60%) patients. Concha bullosa was on the right side in 16 (26.7%), on the left side in 13 (21.7%), and bilateral in 31 patients (51.7%). Of 91 CB, 29 (31.9%) were in group 1, 43 (47.3%) were in group 2, and 19 (20.9%) were in group 3. The cross-section area of CB was greater than 1 cm2 in 25.6%, and less than 0.5 cm2 in 53.4%. The most common pathology accompanying CB was nasal septal deviation (n=36, 60%). The distribution of symptoms and accompanying pathologies was similar in the three groups. CONCLUSION: Our findings show that symptoms and accompanying pathologies do not differ in patients with varying sizes of CB.

Investigation of the effects of intranasal botulinum toxin type A and ipratropium bromide nasal spray on nasal hypersecretion in idiopathic rhinitis without eosinophilia.

Idiopathic rhinitis without eosinophilia is a group of frequently observed diseases, the aetiopathogenesis of which is not yet well known. One of the most disturbing symptoms for patients within this disease group is nasal hypersecretion. Although many different treatments have been tried for hypersecretion, nasal topical drugs form the basis of any such therapy today. Ipratropium bromide (IB) is a drug offirst choice in nasal hypersecretion therapy. It displays a parasympatholytic effect in topical use and antagonizes acetylcholine transport in efferent parasympathetic nerves, thus decreasing submucosal gland secretion, which is the cause of hypersecretion. Botulinum toxin type A (BTX-A) is among the alternative treatment choices that is increasingly used in symptomatic treatment of nasal hypersecretion. Our study was planned with the aim of comparing the effect of these two groups of drugs on nasal hypersecretion. Thirty-eight patients who were diagnosed with idiopathic rhinitis without eosinophilia were included in the study and were divided in 3 different groups: In the first group, a total of 10 units of BTX-A were injected into both nasal cavities. In the second group, 3x2 IB was injected into both nasal cavities for 4 weeks. The third group received intranasal physiologic saline as placebo. The patients were evaluated in terms of nasal hypersecretion with visual analogue scale prior to the treatment and at weeks 1, 2, 4, 8, and 12 during the follow-up period. Throughout the 8 weeks follow-up period, the patient complaints displayed a 41.2% decrease in the group that received BTX-A and a 61.4% decrease in the group which received IB, while no change was observed in the control group. Both drug groups were well tolerated by the patients, with no serious adverse or systemic effects. As a result, while IB and BTX-A differ in terms of method of application, they display a similar degree and duration of efficiency in hypersecretion therapy.

An alternative surgical approach for sublingual dermoid cysts: a case report.

A 52-year-old woman presented with a painless swelling in the floor of the mouth. She stated that it had existed there for 40 years and had undergone a gradual enlargement within the past year. Examination showed a mass, 5x4 cm in size. An aspiration from the lesion revealed a cyst. The lesion was removed by a U-shaped superior based flap. Histopathological examination showed stratified squamous epithelium lining the cystic lumen. This technique can be an alternative approach in such lesions because it protects the oral mucosa by providing good exposure, and prevents injury to the lingual nerve and submandibular duct.

[The effect of topical mitomycin-C application before or after incisional myringotomy on patency times of guinea pig tympanic membrane perforations]. / Kobay timpan membraninda mitomisin-C uygulamasinin insizyonel miringotominin kapanma süresine etkisi.

OBJECTIVES: The aim of this study was to investigate the effect of topical mitomycin-C application before or after incisional myringotomy on patency times and to asess its use as an alternative to ventilation tube insertion. MATERIALS AND METHODS: Nineteen guinea pigs were divided into two groups. In the study group (n=11), mitomycin-C was applied in a concentration of 0.4 mg/ml over the perforation for five minutes before (n=6) or after (n=5) incisional myringotomies in both ears. Control animals (n=8) received 0.1 ml 0.09% NaCl for the same duration. Evaluations were made on days 1, 3, 5, 7, 10, 14, and 21. The patency times, otorrhea, and other complications were recorded. RESULTS: Compared to controls (7.0+/-1.5 days), the mean patency times of perforations were significantly longer in mitomycin-C treated groups before (11.6+/-5.2 days) and after (14.2+/-4.7 days) incisional myringotomies (p<0.05). Patency times did not differ significantly between the two mitomycin-C groups. None of the ears exhibited permanent perforation. CONCLUSION: The length of patency provided by mitomycin-C is not sufficient for optimal ventilation in otitis media with effusion. However, in cases requiring shorter patency times, mitomycin-C application before or after myringotomy may be an alternative to ventilation tube insertion.

Evaluation of radiofrequency thermal ablation results in inferior turbinate hypertrophies by magnetic resonance imaging.

OBJECTIVES: Nasal obstruction caused by inferior turbinate hypertrophies is one of the most frequent problems in otolaryngology. Treatment of this disease may involve medical and surgical methods. Thermal ablation with radiofrequency energy has become quite popular in the recent years as one of the surgical methods used when medical therapy is not adequate. STUDY DESIGN: Prospective, clinical trial. METHODS: Thermal ablation with radiofrequency energy was used in this study on the inferior turbinates of 21 patients who had nasal obstruction caused by inferior turbinate hypertrophy only. The results were evaluated subjectively by preoperative and postoperative patient- and physician-assigned visual analogue scales and objectively by magnetic resonance imaging (MRI) investigation. RESULTS: By the end of the postoperative week 10, 64.76% recovery was detected according to the patient evaluation, and 40.75% recovery was detected according to the physician evaluation. Measurement of the average volumes of the inferior turbinates by MRI revealed a 8.70% postoperative reduction. The most significant change was detected in the anterior-posterior length measurement performed in the axial plane. CONCLUSIONS: These results suggest that thermal ablation with radiofrequency energy is an easily applied, efficient, and reliable technique in treatment of the inferior turbinate hypertrophy, and that anterior-posterior length measurement in the axial section of the inferior turbinate by MRI, which is thought as an objective evaluation method, could be an efficient diagnostic tool in detecting the efficiency of radiofrequency on inferior turbinate.

[The effect of topical application of 5-fluorouracil on patency times after incisional myringotomy of guinea pig tympanic membrane]. / Kobay timpanik membraninda insizyonel miringotomi sonrasi uygulanan 5-florourasilin miringotominin kapanma süresine etkisi.

OBJECTIVES: We investigated the effect of topical application of 5-fluorouracil after incisional myringotomy on the patency time and its use as an alternative to ventilation tube insertion. MATERIALS AND METHODS: Experimental tympanic membrane perforations were induced in two groups of guinea pigs. One group (20 tympanic membranes) was treated with a 50 mg/ml 5-fluorouracil-soaked sponge over the perforation for five minutes while the other (16 tympanic membranes) with saline-soaked sponges for the same duration. The patency times, otorrhea, and other complications were recorded. RESULTS: The mean patency of tympanic membrane perforations following incisional myringotomy was significantly longer in the 5-fluorouracil-treated group (11.3 days vs 7.0 days; p<0.01). None of the ears exhibited permanent perforation. CONCLUSION: The length of patency provided by 5-fluorouracil is not sufficient for optimal ventilation time in otitis media with effusion. However, in circumstances in which shorter patency times may provide sufficient ventilation, 5-fluorouracil application may be an alternative to ventilation tube insertion.

[Results of radiofrequency tissue ablation]. / Radyofrekans cerrahisi sonuçlarimiz.

OBJECTIVES: We evaluated the effectiveness of radiofrequency tissue ablation in respiratory obstruction due to snoring and turbinate hypertrophy. PATIENTS AND METHODS: Thirty-three patients (9 females, 24 males; mean age 35.3 years; range 19 to 55 years) underwent 38 submucosal probe applications in the inferior turbinate (n = 15), soft palate (n = 13), and both (n = 5). Applications were performed in four regions of the soft palate, and in the anterior, medial, or posterior regions of the inferior turbinate depending on the hypertrophic site. Evaluations were made prior to, in the second month, and at the end of the first year of treatment. Snoring was evaluated using the Epworth Sleepiness Scale and subjective assessment. Respiration was evaluated by a visual analog scale. Maximum follow-up period was one year. RESULTS: Subjective evaluations made at the end of the first year showed that snoring decreased in 44.5% and disappeared in 50%. No change was observed in 5.5%. According to the patients' subjective evaluations and clinical examination findings complaints of obstruction decreased by 65.4% and 45.61%, respectively. No significant complications occurred. CONCLUSION: Radiofrequency tissue ablation may prove to be useful in appropriate patients. It is minimally invasive, requires low power and heat, and no general anesthesia, and is associated with low complication risks.