Analysis of Ear Nose Throat Consultations Requested From the Pediatric Emergency Service in a Tertiary Hospital.

OBJECTIVE: The aim of this study is to examine the reasons and the methods of approach to the patients for the ear nose and throat (ENT) consultations requested from the patients who applied to the pediatric emergency department. METHODS: The files of 351 patients who applied to the pediatric emergency outpatient clinic and were asked for consultation from the ENT clinic were reviewed retrospectively. Demographic data, complaints on admission, diagnostic examinations, diagnoses, treatment methods, and hospitalizations were recorded. RESULTS: Of the patients included in the study, 190 (54.1%) were female and 161 (45.9%) were male. The median age of the patients was 4.0 years (3.0-8.0 years). The most common diagnoses after ENT examination are; 120 patients (34.2%) had foreign body (FB) in the nose, 58 patients (16.5%) had FB in the ear, 16 patients (4.6%) had FB in the throat, 16 patients (4.6%) had epistaxis, and 15 patients (4.3%) had Bell's palsy. According to age group, it was determined that FB in the nose and ear was more common in the 0- to 5- and 6- to 11-year age group, and Bell's palsy, FB in the ear and epistaxis were more common in the 12- to 17-year age group. A normal examination was also an important finding in 83 of the patients (23.6%). CONCLUSIONS: Foreign bodies are the most common reason for admission to the emergency services in children, and it is frequently seen between 0 and 5 years of age. Informing and raising awareness of parents on this topic will reduce both unwanted complications and ENT consultations along with admission to pediatric emergency services.

Comparison of Dorsal Preservation and Dorsal Reduction Rhinoplasty: Analysis of Nasal Patency and Aesthetic Outcomes by Rhinomanometry, NOSE and SCHNOS Scales.

BACKGROUND: Dorsal preservation techniques have been preferred and gained popularity in recent years. The current study compares the effects of dorsal preservation and dorsal reduction rhinoplasty on nasal patency and aesthetic outcomes by using Patient-Reported Outcome Measures (PROMs) and rhinomanometry. To our knowledge, this is the first study to compare dorsal preservation and dorsal reduction techniques with rhinomanometry. METHODS: This is a prospective study of 34 patients who underwent rhinoplasty between January 2021-June 2022. The patients were randomly selected preoperatively and divided into two groups as structural rhinoplasty (SR) and preservation rhinoplasty (PR). Nasal Obstruction and Symptom Evaluation (NOSE), Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) scales and rhinomanometric evaluation were performed preoperatively, at 3rd month and 12th month postoperatively. RESULTS: Nineteen patients (10 female, 9 male) were in SR group, 15 patients (7 female, 8 male) were in PR group. There was not significant difference in terms of age and gender between groups. In both groups, NOSE, SCHNOS-O and SCHNOS-C results were found to be significantly lower at postoperative 3rd and 12th month compared to preoperatively (p < 0.001 for the entire SR group, p = 0.001 for the entire PR group). There was no significant difference between groups in terms of PROMs. Mean total nasal volume (TNV) at 12th month were statistically higher than preoperative value in PR group (p = 0.031). Also there was no significant difference in SR group and between groups in terms of rhinomanometry results. CONCLUSION: Dorsal preservation with pushdown technique provides good functional and aesthetic results comparable with structural rhinoplasty. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . A well-designed prospective clinical trial.

Can Platelet Indices Be New Biomarkers for Subjective Tinnitus?

OBJECTIVES: Mean platelet volume (MPV) is one of the platelet function indices that reflect the platelet production rate and functions. The MPV levels are increased by vascular occlusion, acute or chronic syndromes, and vasculitis, whereas infections, autoimmune diseases, and inflammatory situations reduce these levels. In this study, the authors investigated whether there was a relationship between platelet indices and subjective tinnitus. METHODS: In this retrospective study, the authors evaluated platelet indices in subjective tinnitus patients. One hundred patients with subjective tinnitus and 100 healthy, age and sex-matched subjects were enrolled to the study. Audiometer and laboratory results were recorded. Comparative multivariate analyses between indicator factors and hearing outcomes were conducted. RESULTS: Mean platelet volume is significantly lower in subjective tinnitus group (P < 0.001). Platelet count and platelet distribution width are higher in the subjective tinnitus than control group (P < 0.001, P < 0.003, respectively). CONCLUSION: The authors' findings indicate that subjective tinnitus appears to be characterized by autoimmune and inflammatory events. Considering the decreasing MPV levels, MPV may be used to evaluate subjective tinnitus as an helper indicator.

Survivin expression correlates with nodal metastasis in T1-T2 squamous cell carcinoma of the tongue.

In this study, the correlation between neck metastasis and recurrence was investigated by studying specimens of tongue squamous cell carcinoma patients immunohistochemical with survivin antibodies in the primary biopsy. A retrospective review was conducted at the Academic University Hospital. 46 patients who had squamous cell carcinoma of the tongue, who underwent various types of glossectomy and neck dissections between 1991 and 2008, were evaluated. The patient's sex, TNM staging, differentiation and recurrence rates were analyzed. There were 20 T1 patients and 26 T2 patients; 27 of the patients were N0 and 19 had metastatic lymph nodes in the neck. Survivin antibodies were applied with streptavidin-biotin method to the sections that were prepared from the primary tumor biopsy specimens of the patients. The correlation between neck metastasis and recurrence and survivins' immunohistochemical staining was analyzed with statistical methods. There were no significant differences between the patient's age, sex, tumor's T stage, tumor differentiation and survivin staining density. Survivin staining was positive in 15 (79 %) of 19 patients with neck metastasis, while it was positive in 16 (59 %) of 27 patients without neck metastasis. Eleven (79 %) of the 14 patients who had recurrence and all 6 patients who had neck recurrence only were stained by survivin. Expression of nuclear and cytoplasmic survivin can be a useful marker for predicting cervical lymph node metastasis in T1-T2 tumors in tongue SCC.

Albumin Levels in Patients With Chronic Rhinosinusitis With Nasal Polyp.

OBJECTIVES: We aim to provide useful evidence on the relationship between the albumin levels and chronic rhinosinusitis with nasal polyp (CRSwNP) and its potential use as an inexpensive, reliable, and independent prognostic marker of CRSwNP. MATERIALS AND METHODS: Forty-five patients with CRSwNP and 45 healthy individuals were included in the study. Serum albumin levels were determined. The serum albumin levels of the study and control groups were compared to determine whether there is a statistically significant difference. RESULTS: The mean albumin level of the study group was 4.65 ±â€Š0.38, the median value was 4.70. The mean albumin level of the control group was 4.84 ±â€Š0.39, the median value was 4.90. There was a statistically significant difference between the albumin levels of the study and control groups (P = 0.045, P < 0.05). CONCLUSION: The albumin levels were found to be statistically significantly lower in patients with CRSwNP. This result may contribute to the diagnosis of CRSwNP and identifying its prognosis.

The Effect of Nasal Septal Deviation on Frontal and Maxillary Sinus Volumes and Development of Sinusitis.

The purpose of this study was to determine the possible role of nasal septal deviation on volume of maxillary and frontal sinuses. Between February 2011 and October 2013, paranasal sinus computed tomography (CT) findings of 732 patients (410 males, 322 females) who were admitted to Ear Nose and Throat Department of Kayseri Research and Training Hospital were retrospectively analyzed. By excluding the other coexistent sinonasal pathologies, 83 consecutive patients with nasal septal deviations were included in the study. The volume of each maxillary and frontal sinus (ipsi- and contralateral to the deviation side) was also calculated using the computer program. There was no statistically significant difference between ipsilateral and contralateral maxillary sinus volumes in group 1 and group 3 (P > 0.05). There was a statistically significant difference between ipsilateral and contralateral maxillary sinus volumes in group 2 (P < 0.05). There was no statistically significant difference between ipsilateral and contralateral frontal sinus volumes in group 1, group 2, and group 3 (P > 0.05). Moderate septal deviation significantly affects the volume of maxillary sinus. Mild and severe septal deviation does not significantly affect the volume of maxillary sinus. Effect of septal deviation on frontal sinus volume was not detected. The probability to encounter maxillary and frontal sinusitis ipsilateral to the all septum deviation groups was significantly increased in both right- and left-sided subjects.

Another advantage of the transseptal suture: shortens the duration of waking up after anesthesia.

AIM: The aim of this study was to investigate the effects of transseptal suturing against 3 different types of nasal packings with respect to pain, operating time, and postoperative complications after nasal septal surgery. PATIENTS AND METHODS: Two hundred twenty-eight patients (aged between 18 and 58 y) undergoing nasal septal surgery were included in the study. After surgery, 4 types of nasal packing were used: (1) transseptal suturing (group A: 57 patients), (2) internal nasal splint (group B: 57 patients), (3) Merocel standard 8-cm packing without airway (group C: 57 patients), and (4) soft paraffin gauze dressing (group D: 57 patients). RESULTS: Regarding the mean operating time, there was no statistically significant difference among groups B, C, and D (P > 0.05). However, when the operating times observed in the said 3 groups were compared with those observed in group A, the difference was statistically significant (P < 0.05). The mean (SD) postoperative pain score within 1 to 48 hours was 2.9 (1.3; median, 2) in group A, 6.3 (1.4; median, 6) in group B, 7.5 (1.1; median, 7) in group C, and 7.7 (1.8; median, 7) in group D. Starting from the postoperative 48th hour, internal nasal splint, Merocel packing, and soft paraffin gauze dressing were significantly more painful compared with transseptal suturing (P < 0.05). When compared with the other groups, extubation period and postoperative care unit stay were shorter in the transseptal suturing group (P < 0.05). Regarding infection, hematoma, synechia, or perforation, there was no statistically significant difference among the groups (P > 0.05). CONCLUSIONS: Transseptal suturing technique is a useful alternative to packing, with only a minor increase in operating time. Particularly, transseptal suturing shortens extubation time and postoperative care unit stay.

Evaluation of newborn hearing screening results of infants with phenylketonuria.

OBJECTIVE: The purpose of this study is comparing the newborn hearing screening failure rate between phenylketonuria (PKU) infants and matched healthy control infants. PATIENTS AND METHODS: Between April 2021 and April 2023, data obtained from the national newborn hearing screening program were examined for patients who presented to the pediatric metabolism clinic of Konya City Hospital with a clinical and genetic diagnosis of PKU. A healthy control group, matched for age and gender, was established. The newborn hearing screening test results, demographic information, and pregnancy data of infants with PKU and the control group were compared to assess risk factors. RESULTS: In the initial screening test, 23 out of 73 PKU infants (31.5%) and 12 out of 73 infants in the control group (16.4%) failed the test (p = 0.033). Among the 23 PKU infants who did not pass the first test, 9 (35%) also failed the second test and were referred. In contrast, all 12 infants in the control group who did not pass the first test passed the second test. The failure rate in the second test was significantly higher in PKU infants compared to the control group (p = 0.003). It was observed that the maternal age of PKU infants who underwent the second test was significantly higher than that of the control group (p < 0.029). Diagnostic hearing test results were found to be normal in all nine PKU patients who failed the secondary screening test and were referred to a tertiary center. CONCLUSION: In our study, it was determined that infants with phenylketonuria (PKU) who did not have any risk factors for hearing loss failed the hearing screening test significantly more than healthy infants.

Gastroesophageal reflux disease in children with chronic otitis media with effusion.

OBJECTIVE: We aimed to evaluate a possible relation between gastroesophageal reflux disease and middle ear effusion in children. METHODS: Children who came to ear, nose, and throat (ENT) department with the symptoms of hearing loss or aural fullness and diagnosed as OME by examination and tympanometry were included into the study. Children were reviewed gastroesophageal reflux disease symptoms including the following: (a) airway symptoms: stridor, frequent cough, recurrent croup, wheezing, nasal congestion, obstructive apnea, hoarseness, and throat clearing; (b) feeding symptoms: frequent emesis, dysphagia, choking: gagging, sore throat, halitosis, food refusal, regurgitation, pyrosis, irritability, failure to thrive, and anemia. Diagnosis is made with at least one positive test of radionuclide gastroesophageal scintigraphy or 24 h pH probe in the patients with reflux. ENT findings were also examined between gastroesophageal reflux disease positive and gastroesophageal reflux disease negative groups. RESULTS: Approximately 39 (54.9%) of 71 children had at least 1 positive test for gastroesophageal reflux disease. Between the gastroesophageal reflux disease-positive and gastroesophageal reflux disease-negative groups, symptoms of reflux were not significantly different. Two pooled variables were created: airway complex (stridor, frequent cough, throat clearing), and feeding complex (irritability, pyrosis, failure to thrive). Percentage of positive symptom complexes were no statistically different between gastroesophageal reflux disease-positive and gastroesophageal reflux disease-negative groups (>0.05). Ear, nose, and throat disorders (including rhinitis/sinusitis, adenoid hypertrophy, tonsillitis/pharyngitis, and laryngitis) were more frequent in gastroesophageal reflux disease-positive group. Tonsillitis/pharyngitis was significantly different between the gastroesophageal reflux disease positive and gastroesophageal reflux disease-negative groups. CONCLUSIONS: Upper respiratory tract infections were seen more frequently in gastroesophageal reflux disease positive group. Children who present with gastroesophageal reflux disease symptoms are more likely to have a positive gastroesophageal reflux disease test. However, no concordance may be found between the complaints and gastroesophageal reflux disease findings. For this reason, a decision about gastroesophageal reflux disease should not only be made by looking to complaints; diagnostic tests must also be performed.

Analysis of Newborn Hearing Screening Test Results of Children with Down Syndrome.

AIM: The aim of this study was to analyze newborn hearing screening test results of children with Down syndrome (DS). METHODS: The files of 84 children with DS and 84 healthy children (control group) admitted to the Pediatrics Polyclinics of the Konya Training and Research Hospital between January 2017 and June 2020 were retrospectively reviewed. RESULTS: Thirty-one of the 84 babies with DS were female (36.9%), and 53 were male (63.1%); 37 of the 84 babies in the control group were female (44%), and and 47 were male (56%) (P = .346). Fortty-eight (57.1%) of the 84 babies with DS and 17 (20.2%) of the 84 babies in the control group failed the first screening test (P < .001). It was determined that 24 (50%) of the 48 infants with DS who failed the first test also failed the second test and were referred, and all 17 infants in the control group who failed the first test passed the second test (P < .001). There was no significant difference in terms of birth weight, gestational week, and maternal age between infants with DS who failed and passed after the second screening test (P > .05 for all). CONCLUSION: Our study shows that birth weight, gestational age, and maternal age do not pose an additional risk for hearing loss in DS babies who do not have known risk factors for hearing loss.

The relationship between Covid-19 and mucociliary clearance.

BACKGROUND: The effect of Covid-19 infection on nasal mucociliary clearance (MCC) is unknown. AIMS/OBJECTIVES: The aim of this study is to investigate the relationship between Covid-19 and nasal MCC in terms of smoking, Covid-19 symptoms and treatment. METHODS: Thirty-six patients who were hospitalized in the pandemic ward due to Covid-19 and 36 volunteers (Covid-19 negative test result) who presented to the otolaryngology outpatient clinic with non-nasal symptoms were included in this study. The Saccharin test was performed in both groups to evaluate nasal MCC. RESULTS: The patients and control groups were not significantly different in terms of age and gender. The nasal MCC time was significantly higher in the patient group compared to the control group (19.18 ± 10.84 min and 13.78 ± 8.18 min, p = .003). CONCLUSIONS AND SIGNIFICANCE: In this study, we found that Covid-19 prolonged nasal MCC time regardless of age. We suggest that corticosteroids should be included in the treatment of Covid-19, both with its symptom reduction and its positive effect on MCC duration.

Increased Atherosclerosis Correlates with Subjective Tinnitus Severity.

The aim of the present study was to investigate whether increased intima media thickness was associated with the severity of subjective non-pulsatile tinnitus and hearing loss. Data of the patients who came to Otorhinolaryngology Department of Isparta Government Hospital with subjective non-pulsatile tinnitus complaint, between January 2012 and June 2013, were evaluated retrospectively. A total of 215 patients were included in the present study. Hearing tests, biochemical analysis, tinnitus handicap inventory (THI), visual analogue scale (VAS) and doppler ultrasonography results of the patients were reviewed and recorded. The patients were classified into two groups as those having an increased intima media thickness and those having a normal intima media thickness. The said groups were compared with respect to age, gender, THI, VAS, hearing test findings and lipid values. Moreover, THI and VAS groups were compared with respect to intima-media thickness. In the group having increased intima-media thickness, THI and VAS average, frequency of hypertension, total cholesterol, low density lipoprotein and triglyceride averages and mean frequencies obtained by hearing test were significantly higher. Comparison of THI and VAS groups showed that intima-media thickness was significantly different between those having a mild tinnitus and those having a severe tinnitus. Increased intima-media thickness was associated with the severity of subjective non-pulsatile tinnitus and hearing loss. For this reason, the carotid system should be examined in subjective non-pulsatile tinnitus patients.

[Projective identification in human relations]. / Insan Iliskilerinde Yansitmali Ozdesim.

Melanie Klein, one of the pioneers of Object Relations Theory, first defined "projective identification", which is regarded as one of the most efficacious psychoanalytic concepts after the discovery of the "unconscious". Examination of the literature on "projective identification" shows that there are various perspectives and theories suggesting different uses of this concept. Some clinicians argue that projective identification is a primitive defense mechanism observed in severe psychopathologies like psychotic disorder and borderline personality disorder, where the intra-psychic structure has been damaged severely. Others suggest it to be an indispensable part of the transference and counter-transference between the therapist and the patient during psychotherapy and it can be used as a treatment material in the therapy by a skillful therapist. The latter group expands the use of the concept through normal daily relationships by stating that projective identification is one type of communication and part of the main human relation mechanism operating in all close relationships. Therefore, they suggest that projective identification has benign forms experienced in human relations as well as malign forms seen in psychopathologies. Thus, discussions about the definition of the concept appear complex. In order to clarify and overcome the complexity of the concept, Melanie Klein's and other most important subsequent approaches are discussed in this review article. Thereby, the article aims to explain its important function in understanding the psychopathologies, psychotherapeutic relationships and different areas of normal human relations.

Results of a national study on the awareness of and attitudes toward acute otitis media (AOM) among clinicians and the estimated direct healthcare costs in Turkey (TR-AOM Study).

AIMS: Acute otitis media (AOM) is one of the most frequent diagnoses and reasons for prescribing antibiotics in children. The aims of this prospective study were the following: (1) to assess the continuing education of physicians and the sources of information about AOM; (2) to assess the current knowledge of and attitudes toward AOM as well as the compliance with AOM guidelines; (3) to evaluate opinions about vaccines against AOM; and (4) to estimate the potential costs of AOM on the healthcare system in Turkey. METHODS: This is a web-based cross-sectional survey of a national convenience sample of 600 physicians in Turkey (325 pediatricians (PEDs), 214 family physicians/general practitioners (FP&GPs) and 61 otolaryngologists (ENTs)). RESULTS: Approximately 38.6% of participants (39.4% of PEDs, 44.3% of GP&FPs and 14.7% of ENTs) stated that pneumatic otoscopy is essential for AOM diagnosis. Regarding the most common etiological agents of AOM in children, 54.2% of PEDs, 51.4% of FP&GPs and 57.4% of ENTs stated that the most common causative agents of AOM are Streptococcus pneumoniae and non-typeable Haemophilus influenzae. Nearly 76% of participants indicated they use direct antibiotic therapy when they diagnose AOM in certain situations. The first-line choice of antibiotic therapy is amoxicillin clavulanate, and 67% of participants prefer to use antibiotic therapy for 7-10 days. Approximately 31% of all participants stated that "viruses" are the main cause of AOM; however, 62% of these participants reported using antibiotic therapy. In comparison, 32% participants from private clinics prefer to treat AOM primarily with observation, a rate that is significantly higher than that of other clinical settings. Physicians who prefer to use observation strategy also prefer the combination of paracetamol and NSAIDs. Approximately 41% of participants have undergone postgraduate medical education on the topic of AOM. In total, 73% of all participant physicians believe that otitis media is a vaccine-preventable disease. With the information from all of the participants, the calculated mean cost per case of AOM is 28 ± 4 USD. In Turkey, the estimated incidence of AOM is 24,000-33,000 cases per 10,000 children <5 years of age (1,820,000-2,100,000 cases per year), and the estimated total cost of AOM is 61,152,000 USD (not including acute otitis media-related complications and otitis media-related hospitalizations). CONCLUSION: The medical and economic burden of AOM to the health economics in Turkey is considerable. Specific educational programs and evidence-based national guidelines concerning AOM should be implemented. Improving diagnostic accuracy with education will lead to improved management, judicious use of antibiotics, decreased antibiotic resistance, and potential economic benefits. A more prudent use of antibiotics would also lower the economic burden of this disease. Vaccination seems to be promising for the prevention of AOM.

A review of 116 cases of breastfeeding-associated hypernatremia in rural area of central Turkey.

We aimed to assess the incidence, neurologic and neurodevelopmental outcome of breastfeeding-associated hypernatremic dehydration among hospitalized neonates in rural area of central Turkey. A retrospective study was conducted at Gevher Nesibe Hospital over a 6-year period, to identify otherwise healthy term and near-term (> or = 35 weeks of gestation) breastfed neonates (<29 days of age) who were admitted with serum sodium concentrations of >150 mEq/l and no explanation for hypernatremia other than inadequate milk intake. The incidence of breastfeeding-associated hypernatremic dehydration among hospitalized term and near-term neonates (n = 5592) was 2.1%, occurring for 116 breastfed infants. More than one half of the infants admitted with breastfeeding-associated hypernatremia exhibited abnormal development at 12 or more months of age. Increased efforts are required to establish successful breastfeeding.

Dyskinesia and soft neurological signs in schizophrenia: a comparative study.

Objective. Several neurological abnormalities can be found at a greater frequency in patients with schizophrenia, including neurological soft signs (NSS) and signs of the "pyramidal" and "extrapyramidal" systems. We aimed to explore the frequency of movement disorders in patients with antipsychotic naïve schizophrenia and to compare and contrast with antipsychotic-treated patients and healthy controls. Methods. Twenty-two antipsychotic naive schizophrenic patients, 22 antipsychotic treated patients and 22 healthy control subjects were assessed by Neurological Evaluation (NES), Abnormal Involuntary Movements (AIMS), and Positive and Negative Syndrome (PANSS) Scales. Results. The NES scores of the never-medicated schizophrenic group were significantly higher than those of normal controls but did not differ significantly from the medicated group. Dyskinesia rates in the both schizophrenic groups were higher than in healthy controls. Medicated and non-medicated schizophrenic patient scores did not differ in AIMS with regard to facial and oral movements, but medicated patients scored higher than non-medicated subjects with respect to extremity movements. Conclusion. Our data suggest that: soft neurological signs and abnormal involuntary movements in the facial region are more prevalent in patients with schizophrenia, whether they are medicated or antipsychotic naïve. On the contrary, abnormal involuntary movements in the trunk and the extremities seem to be associated with medication.