Role of Peak Nasal Inspiratory Flow for Measuring the Effectiveness of Surgery in Children with Adenoidal Hypertrophy.

Objective Nasal airway obstruction in children is a frequent problem in otolaryngology practice. Adenoidal hypertrophy (AH) is the most common pathology in childhood that requires surgery. Nasal patency can be evaluated by subjective and objective methods. Unlike other methods, peak nasal inspiratory flow (PNIF) is portable and easy to perform. The need for patient compliance is the most important disadvantage of this method. We aimed to analyze the significance of PNIF for measuring the effectiveness of adenoidectomy as well as to compare PNIF with other subjective methods. Methods Two-hundred forty-five (245) patients aged between six and 11 years were evaluated. Seventy-seven (77) of them formed the study group and 168 formed the control group. Pre and post-surgery PNIF measurements, adenoid scores, and simple visual analog scale (sVAS) were recorded. Results The average PNIF value has significantly increased to 70.65 L/min from 33.02 L/min after adenoidectomy (p<0.01). The average PNIF value was 71.66 L/min in control subjects. High PNIF values were significantly correlated with low sVAS and adenoid scores postoperatively in the study group as compared with those of preoperative data (p<0.01). Conclusions PNIF has a satisfying correlation with nasal examination findings and other subjective methods to evaluate nasal obstruction and may provide unique and complementary information helpful for evaluating and improving the effects of adenoidectomy in children.

Effect of the Fascia Graft Size on Healing Rate of Cavities in Patients Undergoing CWD Tympanomastoidectomy: A Clinical Prospective Study.

OBJECTIVES: To evaluate the effects of size of temporal fascia graft on healing of the mastoid cavity in patients undergoing canal wall down (CWD) procedures. MATERIALS AND METHODS: The study included 32 patients (ages from 10 to 69 years) who were performed CWD tympanomastoidectomy from 2016 to 2018. Patients were divided into 2 different groups randomly based on size of fascia used in the operations. Group 1 consisted of 19 patients with temporal muscle fascia large enough to extend up to antrum by passing through over the facial ridge. Group 2 consisted of 13 patients with fascia of a size hardly enough to create a middle ear space, which were quite smaller than those the first group. It was also observed that whether or not the type of pathology (cholesteatoma, granulation tissue or both) had an effect to the epithelialization time of the cavity. RESULTS: Thirty-two patients met inclusion criteria. Nineteen patients were randomized to study (large fascia) group and 13 patients were to control (small fascia) group. The mean duration for epithelialization of cavities with study group-large grafts was 34.10 days and that was 39.76 days in control group-small grafts. According to type of pathology; in cases with cholesteatoma, with granulation, and cases of coexisting granulation with cholestatoma; the mean epithelialization times were 38.73, 31.33 and 34.42 days, with respectively. CONCLUSION: Placement of larger fascia graft to line the mastoidectomy cavity facilitate rapid epithelialization and healing in patients undergoing CWD tympanomastoidectomy. Further studies with larger groups would be beneficial to confirm this result in the aspect of statistical significance.

Effects of oral isotretinoin on normal and wounded nasal mucosa: an experimental study.

BACKGROUND: We aimed to investigate the effect of systemic isotretinoin therapy on normal and wounded nasal septal mucosa histopathologically in an experimental rabbit model. METHODS: Circular mucosal defect with a 7 mm diameter was made in the left septum of 12 New Zealand white rabbits. The rabbits were divided into two groups (six rabbits in each group) oral isotretinoin was given with olive oil at the operation day to the first group. The control group was only oil given group. The harvested septum mucosas were divided into four groups (1-wounded-drug given side, 2-unwounded and drug-given side, 3-wounded-control and 4-unwounded-control side). The diameter of the defect, mucosal thickness, epithelial thickness, ciliated cell level, goblet cell level and inflammation were evaluated every week for 4 weeks. RESULTS: At both wounded and normal side, thinning of normal respiratory ciliated epithelium was observed in the postoperative period. In study group at the wounded side; mean mucosal thickness was measured 139.66 µ (± 26.24), and in the control group, mean mucosal thickness was 238.33 µ (± 39.7) at the wounded side. (p < 0.001). The difference between the groups in thickness of normal septal mucosa was also statistically significant (p = 0.016) [190 µ (± 14.6) and 256.66 µ (± 44.66)]. The average cilia level was observed 1.16 in the wounded study group, while the average level was 2.33 in the wounded control group (p = 0.012). Average score measurements of the regenerated mucosa suggested that isotretinoin-given wounded animals have reduced goblet cell recovery, compared to the control both on the regenerated and unwounded mucosas (p = 0.007, p = 0.002, respectively). Inflammation was significantly higher in the wounded isotretinoin group (p = 0.018). CONCLUSION: Oral isotretinoin has negative effects on epithelial and ciliary regeneration, significantly reduces mucosal thickness and goblet cell counts of the normal and regenerated mucosa, causes severe inflammation and significant reactive changes.

Effect of Septoplasty on Cardiopulmonary Functions in the Patients With Nasal Obstruction.

OBJECTIVE: In this study, the authors aimed to investigate whether septoplasty has an effect on cardiopulmonary functions in the patients with nasal obstruction. METHODS: A total of 53 patients with nasal obstruction due to septum deviation were included in the study. All the patients were performed septoplasty operation. Echocardiography and spirometric analysis were performed to assess cardiopulmonary functions before and after the operation (6 months postoperatively). The same evaluation was done for the degree of nasal obstruction by visual analogue scale. The preoperative and postoperative values were compared with each other. RESULTS: Of the total 53 patients, 44 were males (83%) and 9 were female (17%). The mean age was 31.71 ±â€Š9.46. The preoperative and postoperative mean right ventricular volumes were 2.0736 and 2.0906, respectively. The preoperative and postoperative mean left ventricular volumes were 4.4264 and 4.3528, respectively. The preoperative and postoperative mean cardiac septal thicknesses were 0.9642 and 0.9358, respectively. The mean value of preoperative cardiac posterior wall thicknesses was 0.8849, whereas the postoperative value was measured as 0.8340. The preoperative and postoperative mean pulmonary artery pressures were 27.8302 mmHg and 23.6415, respectively, and this was statistically significant (P < 0.001). The preoperative and postoperative mean forced vital capacities (FVC) were 4.3221 and 4.5564, respectively, and this was statistically significant (P < 0.001). The preoperative and postoperative mean 1st second forced expiratory volumes (FEV1) were 3.6698 and 3.8085, respectively, and this was statistically significant (P < 0.001). The mean value of preoperative FEV1/FVC was 84.9811, whereas postoperative mean value was measured as 83.8019 and this was statistically significant (P < 0.001). CONCLUSION: In this study, the authors observed that septoplasty has positive effect on cardiopulmonary functions in the patients with nasal obstruction due to nasal septum deviation. The authors also claim that septoplasty may be a preventive procedure for future pathologies of cardiopulmonary functions.