Extended endonasal endoscopic approach for anterior midline skull base lesions.

AIM: In recent years, extended endoscopic endonasal approach (EEEA) has been used as an alternative to transcranial approaches in the treatment of anterior midline skull base lesions. We retrospectively reviewed our cases operated using this technique and compared the results with current literature. METHOD: The data of 24 patients who were operated using EEEA in our department between 2010-2018 were retrospectively analyzed. The lesions were located in the midline between the posterior wall of the frontal sinus and tuberculum sella. Tumor locations, histopathological diagnoses, surgical techniques, outcomes and complications were documented. RESULTS: Eleven patients were female and 13 were male. Their ages ranged between 18-75 years (mean 40.5 years). Considering their locations; 12 were in the anterior fossa (50 %), 7 were in the tuberculum sella (29.1 %), and 5 were in both anatomic sites (20.8 %). Histopathologically, our series consisted of 15 meningiomas, 6 osteomas, 2 dermoid tumors and 1 metastatic carcinoma. We achieved gross total resection in 75 % of our patients. Ten patients presented with visual complaints and 7 of them improved postoperatively. Postoperative cerebrospinal fluid leakage (CSF) was observed in 3 patients and one of them developed meningitis and subsequently died of sepsis. CONCLUSION: Although the number of cases is low, EEEA seems like a safe, effective and well-tolerated treatment modality for anterior midline skull base lesions. But strict preventive measures should be taken for a possible CSF leak.

Sellar Defect Reconstruction with Vascularized Superior Turbinate Mucosal Flaps in Endonasal Endoscopic Transsellar Approach.

BACKGROUND: The pedicled nasoseptal flap (NSF) constitutes the primary reconstructive option for most skull base defects in endonasal endoscopic approaches. The superior nasal turbinate (ST) has received little attention. We report our preliminary experience with the use of the ST mucosal flap in selected cases. METHODS: We performed a retrospective review of patients who underwent endonasal endoscopic approaches and identified 9 patients who were reconstructed with vascularized ST mucosal flaps as part of a double-layer or triple-layer reconstruction. When there was no intraoperative cerebrospinal fluid (CSF) leak, we used a double-layer technique. If there was an intraoperative CSF leak, regardless of the quality of leakage, we preferred a triple-layer repair technique. In patients with high-flow leaks, triple-layer repair was performed using only autologous tissue grafts and flaps. RESULTS: Intraoperative CSF leaks were noted in 7 of 9 patients. Among them, 4 patients had low-flow CSF leaks (grade 1 and 2) and 3 patients had high-flow CSF leaks (grade 3). All reconstructions had complete defect coverage with the ST flaps and NSFs were preserved. All the flaps were viable at 4 weeks without a CSF leak or complication at the reconstruction site. There was no contraction or partial loss of the flap. After a mean follow-up period of 9 months, none of the patients required a flap revision, developed a mucocele, infection, or other complication. CONCLUSIONS: An ST flap can be used for the vascularized reconstruction of sellar defects if it is bilaterally available. This option should not be overlooked and wasted.

Anxiety and depression in patients with sudden one-sided hearing loss.

Sudden sensorineural hearing loss is a hearing loss of >30 dB in at least three consecutive frequencies that occurs in 3 days. The aim of this study was to investigate anxiety and depression caused by sudden, idiopathic, one-sided hearing loss. The levels of anxiety and depression in patients with this type of hearing loss were determined using the Beck Anxiety Scale (BAS) and the Beck Depression Inventory (BDI) at the time of the patient's first visit. In total, 56 patients (32 men and 24 women) with a mean age of 32.8 ± 9.9 years (range: 20 to 58 years) were selected as the patient group and 45 individuals without symptoms of anxiety and depression were selected as the control group. The mean pretreatment air-conduction threshold and bone-conduction threshold were 61.1 ± 26.1 and 49.4 ± 13.8, respectively. In the patient group, the pretreatment mean anxiety, depression, and hopelessness scores were 19.5 ± 10.7, 11.6 ± 8.4, and 6.2 ± 4.7, respectively. The control group's mean anxiety, depression, and hopelessness scores were 4.1 ± 3.0, 3.8 ± 2.1, and 1.8 ± 1.0, respectively. For all the tests, the difference between the patient group and the control group was statistically significant (p < 0.001 for all). Hearing levels were not correlated with scores on the BAS, BDI, and Beck Hopelessness Scale (p = 0.1, p = 0.6, and p = 0.4, respectively). In conclusion, the results of this study show that sudden hearing loss can cause anxiety and depression. Questioning patients with sudden hearing loss about symptoms associated with anxiety and depression might be useful, and a psychiatric consultation should be requested if necessary.

The effect of nasal polyposis related nasal obstruction on cognitive functions.

Chronic rhinosinusitis with nasal polyposis is a chronic inflammatory disease of the respiratory mucosa of the nasal cavity and paranasal sinuses. The aim of this study was investigate the effect of nasal obstruction related to chronic rhinosinusitis with nasal polyposis on cognitive functions. Patients with chronic rhinosinusitis with nasal polyposis causing bilateral total or near total nasal obstruction were enrolled in the study. Symptoms of nasal congestion, loss of smell, postnasal drip, headaches, snoring, concentration difficulties and blunted affect were evaluated by Visual Analog Scale. Brief symptom inventory test, Stroop test, visual aural digit span, serial digit learning test and P300 test were used to evaluate cognitive functions. Three months after treatment, the tests done before surgery were repeated and the results were compared. A total of 30 patients were included in the study. On the Visual Analog Scale, all symptoms showed significant postoperative improvement in all patients (p < 0.001 for all symptoms). Preoperative nasal congestion accompanied with impaired concentration were detected in 27 patients (90%), and these symptoms recovered in all these patients after treatment (p = 0.035) (correlation coefficient 0.4). Only 22 patients completed the neuropsychological tests. The mean preoperative Stroop test (23.16 ± 5.30), visual aural digit span test (24.68 ± 3.52), and serial digit learning test (16.18 ± 5.35) scores were showed significant improvement compared with mean postoperative Stroop test (21.12 ± 5.69), visual aural digit span test (26.45 ± 2.98), and serial digit learning test (19.31 ± 4.47) scores (p = 0.047, p = 0.022, p = 0.005 respectively). The postoperative P300 latency values improved in 19 (63%) patients. The preoperative and postoperative latency values for P300 showed a significant difference (p = 0.029), whereas the preoperative and postoperative amplitude values for P300 did not differ (p = 0.096). In conclusion, the results of this study indicate that chronic rhinosinusitis with nasal polyposis (CRSwNP) has negative effects on cognitive functions, such as the ability to focus and maintain concentration. These cognitive functions improve after the patients undergo endoscopic sinus surgery to treat their CRSwNP.

Anxiety, depression, and hopelessness in patients before and after treatment for peripheral facial paralysis.

We conducted a prospective study to investigate the effectiveness of pharmacologic treatment on alleviating facial paralysis, as well as the anxiety and depression that are associated with it. Our study population was made up of 105 patients-59 men and 46 women, aged 18 to 60 years (mean: 38.2)-who had acute idiopathic peripheral facial paralysis. Before treatment, paralysis was classified as House-Brackmann grade II or III in 44 patients (41.9%) and grade IV to VI in the remaining 61 (58.1%). After treatment, 73 patients (69.5%) improved to grade I, 29 (27.6%) were at grade II or III, and only 3 (2.9%) remained at grade IV or higher. Mean scores on the Beck anxiety inventory, the Beck depression inventory, and the Beck hopelessness scale were 20.30, 19.75, and 7.57, respectively, before treatment and 5.72, 5.68, and 2.85 afterward; the difference in all three measures was statistically significant (p < 0.001). We found no correlation between the degree of facial paralysis and anxiety levels (r = 0.094, p = 0.338) or depression levels (r = 0.181, p = 0.064). Clinicians should consider asking patients with peripheral facial paralysis about their feelings of anxiety, depression, and hopelessness and refer them for a psychiatric consultation if necessary.

Extended endoscopic endonasal approach to the ventral skull base lesions.

OBJECTIVE: With the use of multiple endoscopic endonasal surgical corridors, extended endoscopic endonasal approaches (EEEAs) are now being used to treat a wide range of ventral skull base lesions. Our aim was to present our experience with EEEAs to the ventral skull base lesions. PATIENTS AND METHODS: The study group consisted of 106 patients (57 men and 49 women) who underwent surgery for skull base lesions using EEEAs from 2010 to 2017. The EEEA was most commonly used for giant pituitary macroadenomas, sinonasal malignancies, cerebrospinal fluid (CSF) leaks, meningiomas, craniopharyngiomas, and fibro-osseous lesions. Four different approaches were used including transtuberculum-transplanum, transethmoidal-transcribriform, transclival, and transmaxillary-transpterygoidal. RESULTS: The overall gross total resection (GTR) rate for these diverse pathologies was 75.0% in 88 patients (excluding the operations performed for non-neoplastic pathologies). GTR was achieved in 100%, 77.8%, 75%, 75%, 72.2%, 62.5%, 60% of fibro-osseous lesions, giant/large pitutary adenomas, meningiomas, esthesioneuroblastomas, sinonasal malignancies, craniopharyngiomas, and chordomas, respectively. The overall rate of improvement in visual fields was 86%. The overall rate of CSF leak was 8.4%. Other surgical complications included intracerebral hematoma and tension pneumocephalus. The mortality rate was 0.9%. CONCLUSION: EEEA is a safe, well-tolerated and effective surgical treatment modality in the management of ventral skull base lesions. It should be performed with close interdisciplinary collaboration. Appropriate case selection is mandatory. However, despite improved reconstruction techniques, postoperative CSF leakage still remains a challenge.

A Modification to the Nasal Septal Chain Suture Which Improves Its Application.

INTRODUCTION: A novel modification to the nasal septal chain suture which makes its application easier and faster without using any special surgical instrument has been described in this study. The advantage of the modification was evaluated in terms of the suture application time. METHODS: A total of 40 patients with a mean age of 30.1 ±â€Š10.6 (18-58) years were evaluated in 2 groups. A nasal septal chain suture was applied with the previously described technique and the new modification for each group after the patients underwent septoplasty. The suture application time for all of the patients was recorded. RESULTS: The mean suture application time was 455.2 ±â€Š36.5 (380-530) seconds in the previous technique group and 404.7 ±â€Š29.4 (340-450) seconds in the modified technique group. The use of new modification of the technique was found to shorten the suture application time significantly (P < 0.001). CONCLUSION: The modified nasal septal chain suture that has been described in this study can be an option to nasal septal suturation since it can be used with absorbable or nonabsorbable materials, is easy to remove, and does not cause pain during suture removal.

Nasal Septal Chain Suture: A New Suturing Technique.

As a new technique for suturing the nasal septum, the nasal septal chain suture has been described in this study, and compared with nasal packing and the quilting suture technique in terms of patient comfort after septoplasty. A total of 75 patients were evaluated in 3 groups: Merocel nasal packing group, absorbable quilting suture group, and nonabsorbable nasal septal chain suture group. The symptoms of these patients were evaluated using the nasal obstruction symptom evaluation (NOSE) scale and rhinomanometry measurements. The NOSE scale values were significantly higher on the postoperative 1st and 3rd days in the nasal packing group (P < 0.001 and P < 0.001, respectively). The nasal resistance was significantly lower (P = 0.011) and the nasal airflow significantly higher (P < 0.001) in the suture groups on the postoperative 3rd day. The use of nasal packing was found to shorten the surgery duration significantly (P < 0.001), while there was no difference between the 2 suture groups (P = 1.000). There was significantly severe pain during the removal of the nasal packing when compared to the nasal septal chain suture removal (P < 0.001), but there was no difference in the bleeding (P = 0.460). Overall, nasal septal sutures significantly improve patient comfort during the postoperative period, when compared to nasal packing, with an earlier return to nasal respiration. The nasal septal chain suture that has been described in this study for the first time can be an alternative to nasal packing and the nasal septal suture techniques currently in use, since both absorbable and nonabsorbable materials can be used, it is easy to remove, and there is no pain during the suture removal.

Bilateral Nasoalveolar Cyst Causing Nasal Obstruction.

Nasoalveolar cysts, which originate from epithelial remnants of nasolacrimal duct, are nonodontogenic soft tissue lesions of the upper jaw. These cysts are thought to be developmental and are presented with fullness in the upper lip and nose, swelling on the palate, and sometimes nasal obstruction. Because of cosmetic problems, they are often diagnosed at an early stage. These lesions are mostly revealed unilaterally but also can be seen on both sides. In this case report, a patient who complained of nasal obstruction and then diagnosed with bilateral nasoalveolar cysts and treated by sublabial excision is presented and clinical features and treatment approaches are discussed with the review of literature.

Effects of Nasal Obstruction due to Nasal Polyposis on Nasal Resonance and Voice Perception.

OBJECTIVE: The aim of this study was to use subjective and objective methods to investigate the effects of total or nearly total nasal obstruction due to nasal polyposis on nasal resonance and voice perception. PATIENTS AND METHODS: A total of 63 nasal polyposis patients (53 men and 10 women), aged between 19 and 72 years (mean age 37.01 ± 13.70), were included in the study. The severity of the nasal obstruction was assessed using a visual analog scale. Nasal resonance and voice perception were evaluated subjectively by the voice handicap index (VHI)-10 questionnaire and objectively by computerized analysis (nasometry) before and after treatment of patients with nasal polyposis. RESULTS: Significant improvement was seen in the nasal obstruction values in all patients (100%; p < 0.001) and in the VHI-10 scores in 62 patients (98%; p < 0.001). Nasalance scores increased in all patients following treatment (100%; p < 0.001). CONCLUSION: Voice perception is negatively affected by nasal obstruction due to nasal polyposis, and changes in voice perception may arise after the surgery. Before the surgery, informing the patient about potential voice perception changes may be useful for the prevention of legal disputes.

Osteoma and Ectopic Tooth of the Left Maxillary Sinus: A Unique Coexistence.

BACKGROUND: Ectopic eruption of a tooth or osteoma rarely occurs within the maxillary sinus. Coexistence of these two rare entities in the maxillary sinus has never been reported in the English literature. CASE REPORT: Herein, we present a 21 year-old male patient with osteoma and ectopic tooth in the left maxillary sinus treated with the removal of the ectopic tooth by endoscopic sinus surgery and excision of the osteoma by the Caldwell-Luc procedure. CONCLUSION: Unique coexistence of two different entities in the maxillary sinus is most likely due to pediatric facial trauma. Pediatric patients with maxillofacial trauma should be carefully watched for dental injury both clinically and radiologically.

A Middle Cranial Fossa Dermoid Cyst Treated by an Endonasal Endoscopic Approach.

Dermoid cysts are rare, benign, congenital ectodermal inclusion cysts in the skull base, comprising skin supplements surrounded by squamous epithelium. In the period of embryological development, the cysts originate from ectodermal cells left behind in the cranial region by the closure of the neural tube and are primarily located at the midline, especially in the subarachnoid spaces. These lesions are usually asymptomatic and diagnosed incidentally. When the cysts reach large sizes, they can be symptomatic due to infection, rupture, or mass effect around neurovascular tissue. The cysts typically demonstrate accurate radiological diagnostic features. In this case report, we present a rare dermoid cyst in the middle cranial fossa, treated by an endonasal endoscopic approach. The endonasal endoscopic management of appropriate middle cranial fossa is discussed as a recent advance in the extended applications of endoscopic sinus surgery.

Evaluation of the changes in the nasal cavity during the migraine attack.

OBJECTIVES: There are some subjective symptoms involving the nasal cavity such as nasal congestion during a migraine attack. In this study, we aimed to evaluate the possible changes occurring in the nasal cavity during headache in patients with migraine. MATERIALS AND METHODS: Patients with migraine were studied. The control group consisted of patients with tension-type headache. The severity of the headache and accompanying complaints were assessed using visual analog scale, and the nasal mucosa was assessed through anterior rhinoscopy and endoscopy. Resistance of the nasal cavity was evaluated through anterior rhinomanometry. Data obtained during the attack periods and attack-free periods were compared. RESULTS: Twenty-five patients with migraine and 15 patients with tension-type headache were enrolled. It was found that 19 patients (76%) of the group with migraine and 5 patients of the group with tension-type headache were experiencing nasal congestion during the attack and that the differences between the groups were statistically significant (P < 0.05). The average of total nasal resistance in the patients with migraine was 0.57 ± 0.60 kPa/L/sn during migraine attacks and 0.28 ± 0.14 kPa/L/sn during attack-free periods. The average of total nasal resistance in the patients with tension-type headache was 0.32 ± 0.14 kPa/L/sn during attack periods and 0.31 ± 0.20 kPa/L/sn during attack-free periods. In the group with migraine, the change of nasal resistance between during the attack and attack-free periods was found statistically significant, whereas there was no statistically significant difference in the group with tension-type headache. CONCLUSIONS: According to the results of this study, complaints regarding nasal obstruction and nasal airway resistance increase during migraine attacks. Cause-and-effect relationship between nasal obstruction and pain is not clear, and clinical trials are needed to determine the effect of nasal obstruction treatment (mucosal decongestion, etc) on the complaint of pain.

Coexistence of Epstein-Barr virus and Parvovirus B19 in tonsillar tissue samples: quantitative measurement by real-time PCR.

OBJECTIVE: In this study, we aimed to investigate the presence and copy number of six different viruses in tonsillar tissue samples removed surgically because of chronic recurrent tonsillitis or chronic obstructive tonsillar hypertrophy. METHODS: In total, 56 tissue samples (tonsillar core) collected from 44 children and 12 adults were included in this study. The presence of viruses was investigated using a new TaqMan-based quantitative real-time PCR assay. RESULTS: Of the 56 tissue samples, 67.9% (38/56) were positive for at least one of the six viruses. Epstein-Barr virus was the most frequently detected virus, being found in 53.6% (30/56), followed by human Parvovirus B19 21.4% (12/56), human adenovirus 12.5% (7/56), human Cytomegalovirus 5.4% (3/56), BK polyomavirus 1.8% (1/56), and Herpes simplex virus 1.8% (1/56). Precancerous or cancerous changes were not detected in the tonsillar tissue samples by pathologic examination, whereas lymphoid hyperplasia was observed in 24 patients. In contrast to other viruses, B19 virus was present in high copy number in tonsillar tissues. The rates of EBV and B19 virus with high copy number (>500.000 copies/ml) were higher in children than in adults, and a positive relationship was also found between the presence of EBV and the presence of B19 virus with high copy number (P=0.037). CONCLUSIONS: It is previously reported that some viral agents are associated with different chronic tonsillar pathologies. In the present study, the presence of B19 virus in tonsillar core samples was investigated quantitatively for the first time, and our data suggests that EBV infections could be associated with B19 virus infections or could facilitate B19 virus replication. However, further detailed studies are needed to clarify this observation.

Types of endoscopic endonasal resections for sinonasal malignancies.

AIM: The aim of this study was to define the types of endoscopic endonasal resection for sinonasal malignancies according to their origin and extension. METHODS: Patients who underwent endoscopic endonasal surgery for the removal of malignant tumors of the nasal passages, paranasal sinuses, and the anterior cranial base between 2003 and 2010 were included in the study. Patients' data were collected retrospectively. Patients were grouped according to types of endoscopic tumor resection as follows: type I: en bloc resection, type II: resection of intranasal free part piecemeal and origin of tumor en bloc, type III: resection of intranasal free part and origin of tumor piecemeal with curative intent, and type IV: resection of intranasal free part and origin of tumor piecemeal with palliative intent or removal of tumor with positive margin. The follow-up period varied from 2 to 7 years (mean, 4.35 years). RESULTS: Twenty patients were included in the study. Five patients underwent type I, 6 patients type II, 4 patients type III, and 5 patients underwent type IV resection. No local tumor recurrence was seen after types I, II, and III resections, whereas 2 patients (10%) with the type IV resection had a local recurrence. Distant metastasis was observed in 4 patients (20%) postoperatively (1 patient in type I, 1 patient in type III, and 2 patients in type IV resection). Disease-specific death was 15% (1 case in type I and 2 cases in type IV). CONCLUSION: Classification of endoscopic tumor resection used in the present study may help preoperative planning.

[An evaluation of histopathological changes in ethmoid sinus mucosa after endoscopic sinus surgery]. / Endoskopik sinüs cerrahisi sonrasi etmoid sinüs mukozasindaki histopatolojik degisikliklerin degerlendirilmesi.

OBJECTIVES: This study aims to evaluate postoperative histopathological changes in ethmoid sinus mucosa in patients undergoing limited or extensive endoscopic sinus surgery (ESS) due to chronic rhinosinusitis. PATIENTS AND METHODS: A total of 120 patients (74 males, 46 females; mean age 33 years; range 18 to 56 years) with chronic rhinosinusitis who underwent limited ESS (n=40), extensive ESS (n=40) and septoplasty or septorhinoplasty (n=40) in our clinic between May 2009 and October 2010 were enrolled. The control group consisted of patients who underwent septoplasty and septorhinoplasty alone. We took samples from the anterior ethmoid sinus mucosa at postoperative sixth months for the patients who underwent ESS and intraoperatively for the control patients. Tissue slices of mucosa samples were investigated under light microscope in terms of epithelial erosion, squamous metaplasia, submucosal fibrosis, basal membrane thickening, submucosal edema and submucosal inflammation. Histopathological findings of limited and extensive ESS groups were compared to each other and the control group. RESULTS: The incidence of squamous metaplasia and submucosal fibrosis was significantly higher in extensive ESS group, compared to limited ESS group (p=0.003 and p<0.001, respectively). Both of ESS groups had significantly higher incidences of epithelial erosion, submucosal fibrosis, basal membrane thickening, submucosal edema, submucosal inflammation, compared to the control group (p<0.001). CONCLUSION: Our study results show that ethmoid sinus mucosa may be still abnormal at the postoperative sixth month following ESS, regardless of the extension of ethmoidectomy. These patients should be followed closely, as they may have recurrent rhinosinusitis in the postoperative period due to impaired mucociliary activity.

Predictors of surgical approaches for the repair of anterior cranial base encephaloceles.

Surgical approaches to the anterior cranial base have changed considerably with the introduction of endonasal endoscopic surgery. This study aims to define the factors which help in selecting the optimal surgical approach for the treatment of anterior cranial base encephaloceles. Patients who received treatment for anterior cranial base encephaloceles at our department between 1996 and 2011 were included in the study. Patients' charts were reviewed retrospectively to collect the necessary data. Treatment periods were classified as before 2000, between 2000 and 2005, and after 2005. The relationship between the treatment period, localization of encephalocele, symptoms related with the lesion, size of skull base defect, and selected treatment modality were investigated. Twenty-five patients, aged between 1 and 61 years with anterior encephaloceles were included in the study. Patients with small asymptomatic frontonasal and trans-ethmoidal encephaloceles (n = 5) were followed without surgery. An external approach with or without subfrontal craniotomy was mainly preferred for resection of sincipital encephaloceles (n = 10), especially with facial deformity. A subfrontal craniotomy approach was used for resection of basal encephaloceles in two cases before 2000. Two cases with sincipital encephaloceles and six cases with basal encephaloceles underwent pure endonasal endoscopic surgery after 2000. Cranial base defects of every size could be repaired using the endoscopic approach. Hydrocephalus and meningitis were the two complications seen after craniotomy in a follow-up period of 13-26 (mean 14.5) months. An external approach with or without craniotomy is needed for encephaloceles with external mass and facial deformity. Otherwise, sincipital and basal encephaloceles can be repaired successfully using the endonasal endoscopic approach.

Subcutaneous approximation suture for preventing soft tissue pollybeak deformity.

BACKGROUND: Pollybeak deformity due to abundant fibrosis formation in the supratip region after rhinoplasty is still a common problem. The aim of this study was to investigate the effects of a modified subcutaneous approximation suture on pollybeak deformity of soft tissue origin. METHODS: Three groups, each consisting of eight rabbits, were included in the study. Nasal skin was elevated with an open rhinoplasty approach in all groups. During closure of the skin, to minimize supratip dead space, a horizontal subcutaneous approximation suture was used in group I, external tape fixation was used in group II, and no further action was taken for supratip skin approximation in the control group. Full-thickness supratip skin biopsy specimens reaching down to the underlying cartilage tissue were taken from each subject on the 60th day after the operation. Thicknesses of subcutaneous scar tissues were measured histologically in all groups and compared. RESULTS: The mean thickness of the subcutaneous scar tissues was significantly lower (0.98 ± 0.32 mm) in group I than in group II (1.65 ± 0.61 mm; p = 0.036) and the control group (1.72 ± 0.49 mm; p = 0.019). However, there were no significant differences between group II and the control group in the mean thickness of subcutaneous scar tissues (p = 1.000). CONCLUSION: The findings of this study indicate that the subcutaneous approximation suture is effective for preventing excessive scar tissue formation in the supratip area after rhinoplasty in rabbits. Further clinical studies are needed to determine its efficacy in humans.

Relationship between nasal valve changes and nasalance of the voice.

OBJECTIVE: It is well known that the nasal cavity and paranasal sinuses affect the acoustic characteristics of the voice as resonators. Any expansion in nasal valve area, the narrowest segment of the nasal cavity, affects the nasal resistance and therefore has the potential to alter the nasalance. The aim of this study was to investigate the effect of nasal valve changes on nasalance of the voice by using an external nasal dilator strip that widens the nasal valve area. STUDY DESIGN: Before-and-after study. SETTING: Tertiary university hospital. SUBJECTS AND METHODS: Healthy volunteer subjects who had no nasal or voice-related complaints were enrolled in the study. All subjects underwent acoustic rhinometry and nasometry before and while wearing a commercially available external nasal dilator strip. The data with and without the nasal strip were compared. RESULTS: Twenty-five subjects were enrolled in the study. After the application of nasal strips, statistically significant increases were observed in the minimal cross-sectional area of the nasal valve. However, there were no significant changes in the nasalance measurements. CONCLUSION: Despite increasing the nasal valve area, application of the nasal strips did not cause any significant change in nasalance scores in healthy subjects, showing no relationship between the nasal valve and nasalance of the voice.