Assessment of taste functions in allergic rhinitis patients undergoing allergen-specific immunotherapy.

BACKGROUND: We evaluated taste functions of patients with perennial allergic rhinitis (AR) before and after allergen-specific immunotherapy (AIT). METHODS: The study was designed as a prospective clinical study in our tertiary care hospital. Patients (n = 21) who were diagnosed with perennial AR on the basis of physical examination, skin prick test of at least 3* for HDM allergen and treated with AIT were enrolled in this study. A control group (n = 21) was selected from patients who were given intranasal steroids (INS) for perennial AR. Both groups had self-reported hyposmia and subjective loss of the sense of taste before treatment. Taste strips (Burghart, Wedel, Germany) were used for the taste identification scores before and after 6 months treatment. RESULTS: A total of 42 subjects were included, with a mean age of 24.1 ± 7.9 years (range 15-43 years). Overall, the AIT group showed more of an improvement of taste function, observed in the total average test scores, compared to the INS group (p < 0.05), but no change was detected between the groups before treatment. No difference was found for the bitter taste scores between the study groups (p = 0.053). CONCLUSION: Subcutaneous allergen immunotherapy resulted in more of an improvement in taste function than intranasal steroids. Further studies are needed.

Dislocated Dental Prothesis Sitting at the Larynx in an Aphasic Patient: Potentially Fatal Situation.

INTRODUCTION: Foreign body in respiration tract is a life-threatening emergency and requires urgent treatment. The diagnosis and treatment requires awareness and suspicion of signs and symptoms of foreign body aspiration. CASE: A unique case of total dental prothesis aspiration of a 44-year-old aphasic patient is presented. The prothesis is completely removed from the larynx. DISCUSSION: Foreign-body aspiration is frequently suspected in children, it is rarely thought about in adults with subacute or chronic respiratory symptoms unless an evident history of an aspiration event is obtained. Facial trauma, dental procedures, central nervous system dysfunction due to stroke, mental retardation, metabolic encephalopathy, seizures, and alcoholism are precipitating factors in adults. Careful clinical history and physical examination is mandatory. Foreign bodies located in the laryngeal region are almost always treated with surgery. CONCLUSION: Loose dentures must be avoided especially in mental retarded, aphasic patients, and patients with central nervous system dysfunction.

A Bullet Lying Next to the Common Carotid Artery in the Neck of a Young Boy.

Penetrating neck trauma is most commonly caused by firearm discharge, and is potentially very dangerous, being associated with a high risk of mortality. A 12-year-old patient with a recent history of a gunshot wound to the neck was evaluated in detail; a bullet was located in close proximity to the left common carotid artery. Neck exploration was performed and the foreign body was removed without any complications. The management of the patient is discussed, as are contemporary approaches to the treatment of penetrating neck trauma. However, the choice of treatment for a stable patient with a penetrating neck injury remains controversial.

The Effect of External Approach Septoplasty on Olfactory Function.

OBJECTIVE: Septal deviation-induced nasal obstruction is frequently accompanied by hyposmia. The aim of this study was to evaluate the effect of external approach septoplasty on olfactory function. METHODS: Thirty patients (23 males, 7 females) who had external approach septoplasty were included in the study. The age interval was 18 to 60 years (mean 33±12 years). All subjects had olfactory function and acoustic rhinometry tests in both the pre- and postoperative periods (mean interval 6 weeks ± 3 weeks). Olfactory function was determined by the "Sniffin Sticks" test. The minimum cross-sectional area from the nostril to 2.20 cm backward was referred to as MCA1, and the minimum cross-sectional area from 2.20 to 5.40 cm was referred to as MCA2, determined by acoustic rhinometry. RESULTS: Olfactory threshold, discrimination, and identification function improved significantly after external approach septoplasty. A statistically significant difference was also detected between pre- and postoperative left MCA1 and left MCA2 of the nasal cavities. Postoperative hyposmic and anosmic patient improvement was statistically significant. CONCLUSION: External approach septoplasty has a beneficial effect on olfaction and this effect may be partly due to interactions between the increased perception of nasal air flow, as well as surgery-associated improvement in the internal nasal valve area.

Comparative Analysis of Lateral Pharyngoplasty and Uvulopalatopharyngoplasty Techniques With Polisomnography and Epworth Sleepiness Scales.

Snoring is caused by the vibration of structures of the oral cavity, such as the soft palate, uvula, tonsils, base of the tongue, epiglottis, and lateral pharyngeal walls. When these structures collapse and obstruct the airway, apnea occurs. Obstructive sleep apnea syndrome (OSAS) is characterized by repeated periods of upper airway obstruction, a decrease in arterial oxygen saturation, and interrupted sleep. The prevalence of OSAS is 1% to 5% in men and 1.2% to 2.5% in women. Crucial factors in deciding the surgical approach include a detailed ear-nose-throat examination, Muller maneuver, sleep endoscopy, and apnea hypopnea index scores. Accepted treatments include continuous positive airway pressure (CPAP), surgeries of the base of the tongue and/or palate, and multi-level surgeries. It, however, is important to continue to evaluate the efficacies of such procedures. The authors evaluated the outcomes of 23 patients who underwent surgery for OSAS, using preoperative and postoperative polysomnography (PSG) and the Epworth sleepiness scale (ESS). The results were compared before and after surgery. In all, 14 patients had lateral pharyngoplasty and 9 had uvulopalatopharyngoplasty (UPPP). The PSG and Epworth scale values were significantly lower in both groups, postoperatively. Patients indicated that their quality of life had improved. In conclusion, the surgeries were successful. In line with the literature, our results indicate that lateral pharyngoplasty and UPPP can be used in appropriate patients. Longer-term studies on more patients will provide more detailed information in the future.

Does the use of radiofrequency myringotomy for insertion of a ventilation tube reduce the incidence of myringosclerosis?

The aim of the present study was to determine the rate of myringosclerosis after radiofrequency (RF) myringotomy and ventilation tube (VT) insertion and compare it with that after the incisional myringotomy and VT insertion. Thirty children (60 ears), 2-16 years old (mean age 7.06 ± 2.77 years) who were planned to undergo surgical intervention for bilateral otitis media with effusion (OME), were included in this study. The children were treated by RF myringotomy of the right ear, incisional myringotomy of the left ear, and insertion of VTs into both ears. Both ears were examined intraoperatively for bleeding, and patients were evaluated for myringosclerosis formation with otomicroscopy at the end of the ninth month. Myringosclerosis was observed in 22 of the 60 ears. The overall incidence was 36.6 %. Fifteen (50 %) left ears showed myringosclerosis by otomicroscopy, and seven (23.3 %) right ears showed myringosclerosis. The rate of myringosclerosis of the right ear was significantly lower than that of the left ear (p < 0.05). In addition, intraoperative tympanic membrane bleeding was observed in 24 (40 %) of the 60 ears: 21 (70 %) left ears and three (10 %) right ears were perforated by RF. The tympanic membrane bleeding rate of the right ear was significantly lower than that of the left ear (p < 0.01). The present study is the first to determine the myringosclerosis rate after RF myringotomy and VT insertion. Our results indicate that VT insertion with RF myringotomy decreased the incidence of myringosclerosis.

Effects of systemic immunotherapy on olfactory function in allergic rhinitis patients.

OBJECTIVE: Allergic rhinitis (AR), a chronic inflammatory disorder of the nasal mucosa, affects approximately 20% of the world's population and often causes olfactory dysfunction. Conventional treatments cannot cure it, but only alleviate and control the symptoms. Systemic immunotherapy (SIT) is the only curative treatment for AR, but its positive effect on olfactory function has not been quantitatively demonstrated. We measured the olfactory function in patients using a "Sniffin' Sticks" test and analyzed the effects of subcutaneous SIT. METHODS: The study included 12 patients (aged 13-44 years) who were eligible to receive subcutaneous SIT to treat AR between 2010 and 2012 in the Department of Otolaryngology, Sisli Etfal Training and Research Hospital. A 3-step Sniffin' Sticks test was performed before and 18 months after subcutaneous SIT. The data collected before and after treatment were compared for each patient. RESULTS: The average scores for smell test parameters increased after treatment. Although improvements in the mean threshold, mean discrimination, and mean total scores were not significant, the mean identification score was significantly improved after treatment (P < 0.05). Age, sex, and smoking were not significantly related to the changes in the parameters. CONCLUSIONS: Subcutaneous SIT improved the olfactory performance in AR patients. Additional studies with larger patient populations and longer follow-up periods are needed to establish subcutaneous SIT as an effective treatment for olfactory disorders in these patients.

Does lack of glottic closure affect quality of life as a cause of constipation in laryngectomized patients?

The permanent disappearance of glottic closure eventually causes inadequate defecatory propulsion resulting in functional constipation. The aim of this study is to reveal functional constipation probably induced by lack of glottic closure in laryngectomized patients. The study was conducted in a prospective, tertiary care center. Forty patients who had undergone total laryngectomy (study group) and 30 who had undergone microlaryngoscopic surgery (control group) were evaluated. Based on the European Organisation for Research and Treatment of Cancer, Quality of Life Questionnaires C30, the presence of functional constipation was investigated using the Rome II diagnostic criteria and was confirmed by measurement of colonic transit time using a radiopaque marker test. Functional constipation and colonic transit time were found to be increased and statistically significant in laryngectomized patients (70 %) compared with the control group (26 %) (p < 0.01). Functional constipation is more prevalent among laryngectomized patients. When evaluating quality of life of patients undergoing laryngectomy, colorectal functions must be taken into consideration.

Effects of radiofrequency and intranasal steroid treatments on respiratory and olfactory functions in nasal obstruction.

OBJECTIVE: This study aimed to compare the effectiveness of radiofrequency ablation (RFA) and intranasal steroid (INS) treatments on respiratory and olfactory functions in patients with inferior concha hypertrophy and chronic nasal obstruction. STUDY DESIGN AND SETTING: This was a prospective clinical trial performed at a tertiary referral center. METHODS: We assessed patients with nasal obstruction between July 2011 and February 2012. The severity of the nasal obstruction in both groups was determined before treatment and 3 months after using a visual analog scale. For the purpose of an objective test, assessment was performed by the acoustic rhinometry. Using Sniffin' Sticks for test odor identification, the discrimination and thresholds were assessed in both groups. RESULTS: The visual analog scale score after treatment was significantly lower in each group. Radiofrequency ablation treatment significantly improved the right minimal cross-sectional area 1 (MCA1), mean MCA1, and volume 1, as well as the right MCA2, mean MCA2, volume 2, and total volume. In the INS group, improvement was detected for the left MCA1, mean MCA1, and volume 1. Minimal cross-sectional area 2, volume 2, and total volume improved significantly after RFA treatment, but not after INS treatment. CONCLUSIONS: Although RFA may be more effective in the posterior region of the nasal cavity, INS and RFA used in the treatment of inferior concha hypertrophy both had favorable effects on respiratory function. Intranasal steroid treatment provided improved discrimination and total score values, whereas RFA treatment improved only odor identification.

Is there a relationship between subjective pulsatile tinnitus and petrous bone pneumatization?

Our objective was to evaluate the relationship between subjective pulsatile tinnitus and petrous bone pneumatization. Twenty-five patients admitted between January 2012 and March 2012 were assessed. The control group data were obtained by assessment of petrous bone images of 25 cases in which paranasal sinus computed tomography (CT) was performed because of chronic sinusitis and in which no ear pathology was present. Temporal bone CT images of patients with subjective pulsatile tinnitus were compared with those of patients with no ear complaints. The presence of petrous bone pneumatization was evaluated by CT. Subjective pulsatile tinnitus complaints were present for 32 of 50 ears. Pneumatization was detected in the petrous bone of 22 (68.8%) of 32 ears with subjective pulsatile tinnitus. In the control group, 25 patients (50 ears) with no ear complaints were assessed. Petrous bone pneumatization was detected in 12 (24%) of 50 ears comprising the control group. There was a statistically significant difference between the 2 groups (P = 0.000 < 0.001). Petrous bone pneumatization might be the cause of the subjective pulsatile tinnitus.

Does the open rhinoplasty incision decrease nasal projection?

To evaluate the effects of open rhinoplasty incisions on tip projection using digitized photographs. Thirty-one patients, who underwent open technique rhinoplasty were prospectively included in the study. The lateral aspect photographs were taken before the operations. Following midcolumellar incision septal elevation was done until septal cartilage was shown. After replacing the skin totally back and suturing midcolumellar incision, the intraoperative photographs were taken. The projection indexes were measured by Goode method from the photographs and the measurements were compared. A statistically significant decline of the nasal projection was established after open technique approach. Open rhinoplasty approach led to the decrease of the nasal tip projection. This result was thought to be the effect of ligamentous disruption.

Efficacy of octyl-2-cyanoacrylate in type I tympanoplasty.

OBJECTIVE: To evaluate the safety and efficacy of octyl-2-cyanoacrylate for type I tympanoplasty. METHODS: This study involved 23 patients (14 females and 9 males) with chronic otitis media who underwent type I tympanoplasty. During surgery, the temporal fascia is placed underlying the eardrum remnant, and octyl-2-cyanoacrylate was dropped over the temporal fascia. The mean air-bone gap (ABG) at the 4 frequencies (500, 1000, 2000, and 4000) was calculated for each patient before and after surgery. These data were compared by Student t test. RESULTS: The mean follow-up was 10 months (range, 6-12 mo). Successful tympanic membrane grafting occurred in 21 patients (91.3%). Graft failure was seen in 2 patients. The mean preoperative ABG of the 23 patients was 19.3 (SD, 5.7) dB, and the postoperative ABG improved to a mean value of 8.2 (SD, 5.9) dB (P ≤ 0.0001). CONCLUSIONS: Octyl-2-cyanoacrylate is effective and safe in using as a compound on temporalis muscle fascia in type I tympanoplasty and can be used more widely in tympanoplasty.

Evaluation of exercise-induced bronchoconstriction and rhinitis in adolescent elite swimmers.

OBJECTIVE: Exercise-induced bronchoconstriction (EIB) without asthma and non-allergic rhinitis is frequently reported in athletes who are facing high-risk of airway dysfunctions such as elite swimmers. Therefore, we aimed to evaluate the effect of exercise on nasal and pulmonary functions, additionally to determine the prevalence of EIB and rhinitis in adolescent elite swimmers. METHODS: The study included 47 adolescent licensed-swimmers (26 males and 21 females) aged between 10 and 17 years old. The prevalence of asthma and allergic disease and the symptom severity scores measured before and after swimming training were assessed through an interview form which includes information related to our study goal. In addition, acoustic rhinometry was utilized to evaluate nasal airway, spirometry was utilized to evaluate EIB in accordance with standard protocols. RESULTS: Six swimmers had a history of allergic rhinitis (12.8%), while three (6.4%) had asthma. Post-swim mean forced vital capacity (FVC) was significantly higher than pre-swim FVC (p=0.019) and forced expiratory volume 1 (FEV-l)/FVC ratio was significantly lower than pre-swim FEV-l/FVC ratio (p=0.034). In addition, the prevalence of EIB was 8.5%. Moreover, level of nasal discharge statistically increased in post-swim period (p=0.003). CONCLUSION: We have documented that swimming cause's nasal discharge but do not effect nasal passages. In addition, we observed that the overall prevalence of EIB in swimmers was not different from that of the general population, furthermore swimming exercise significantly increased FVC of swimmers. Therefore, we concluded swimming training can be recommended for children diagnosed with asthma or allergic rhinitis.

Nasal Sprays Containing Mometasone Furoate for Relief of Post-Adenotonsillectomy Pain in Children: A Prospective Controlled Study.

OBJECTIVES: Adenotonsillectomy is one of most common surgeries performed in childhood. Post-operative pain associated particularly with tonsillectomy is still a problem for many physicians. Despite advances in surgical techniques, analgesics, or anti-inflammatory drugs, no unique strategy for post-tonsillectomy pain management has been suggested. The aim of this study is to investigate the analgesic effect of steroid containing nasal spray applied to tonsillar region after tonsillectomy. METHODS: Eighty-two patients were assigned into two groups as study and control. In study group, nasal spray containing steroid was applied to each tonsillar region after surgery for 5 days. Post-operative pain of all patients was assessed using a visual analog scale and results were compared. RESULTS: Pain decreased gradually over time in both the study and control groups. Although the pain scores from 4 h post-surgery to post-operative day 5 were not found to significantly decrease in children that used nasal spray containing steroid, these patients developed less pain on post-operative day 5,with statistical significance (p<0.05). CONCLUSION: Post-tonsillectomy pain was reported to increase around post-operative day 5, which coincides with the time of intense wound inflammation. Therefore, significant pain reduction on post-operative day 5 observed in children that used nasal spray with steroid may have clinical importance for overcoming this problem.

Unilateral osteotomies for external bony deviation.

OBJECTIVE: Deviated nose is a challenge for rhinoplasty surgeons. We applied a new technique to correct nasal bone asymmetry in selected patients. We assessed the efficacy of the technique and discussed the surgical outcomes. METHODS: We retrospectively analyzed 29 patients with deviated nose who received unilateral osteotomy alone or unilateral osteotomy with camouflage graft placement to the other side of the nose. Preoperative and postoperative photographs were studied to evaluate the outcomes. RESULTS: Twenty-nine unilateral osteotomies were done. Camouflage grafting was performed to 20 of the 29 patients. Nasal humps were removed in all patients. No postoperative complications occurred during the follow-up period. Twenty-six of 29 deviated noses were corrected with unilateral osteotomy. CONCLUSIONS: The unilateral osteotomy technique seems to be a useful method for correcting deviated nose.

Olfactory Function in Patients With Obstructive Sleep Apnea Using Positive Airway Pressure.

Previous studies reported that positive airway pressure (PAP) treatment may improve olfaction function in patients with obstructive sleep apnea (OSA) through various mechanisms. Olfactory function before and after PAP treatment is understudied regarding patient group at issue. The aim of this study is to investigate the contribution of PAP to olfactory function in patients with OSA. The study was conducted on 26 patients with OSA (10 females and 16 males, mean age 50.1 [9.3] years) who scheduled for PAP treatment. The Connecticut Chemosensory Clinical Research Center odor test was performed before and 4 months after PAP treatment. Patients were grouped (normal, anosmia, mild hyposmia, moderate hyposmia, and severe hyposmia) with respect to olfactory function by measuring odor test parameters, including threshold determination and identification. The odor test average scores of the patients after 4-month PAP treatment compared to pretreatment scores were increased and the difference was statistically significant (P = .002). In the apnea hypopnea index groups, statistically significant difference was found in the threshold and discrimination values regarding before PAP treatment (P = .038, P = .022, respectively). This study revealed that improvement in olfactory thresholds in patients with OSA receiving PAP treatment seems to improve olfactory dysfunction. This provides minimization of OSA consequences, including progressive upper airway inflammation, cognitive impairment, and associated olfactory dysfunction. Resolving the associations between olfactory function and PAP treatment is an important area for future research.

Comparison of the Oral Steroids, Macrolides and Combination Therapy in Nasal Polyposis Patients.

OBJECTIVES: In this study, our aim was to compare oral steroid therapy with macrolide therapy and with oral steroid + macrolide (combine) therapy in patients with nasal polyposis (NP). METHODS: All patients were treated with nasal steroid therapy for eight weeks and divided randomly into three groups as follows: Oral steroid group, oral macrolide group and combine group. All patients underwent endoscopic staging, radiological grading, odour testing and completed the sino-nasal outcome test-22 (SNOT-22) questionnaire before and after treatment. RESULTS: Significant improvement was observed in all parameters after treatment in all three groups. All parameters were significantly better in the combined group than in the macrolide group. Comparison of the oral steroid group and macrolide group revealed significantly better radiological grading and odour test changes for the oral steroid group, but no statistically significant differences existed according to endoscopic staging and SNOT-22. The post-treatment SNOT-22 score was significantly better in the combined group than in the steroid group. A comparison of the combined and steroid groups showed better results for the combined group for all parameters, but the differences were not significant. CONCLUSION: All treatment protocols were effective and the successful use of macrolide indicates its potential as an alternative in patients with contraindications to oral steroid treatment. The combined treatment may demonstrate significantly better results than steroid treatment alone if larger studies with more patients are performed.

Assessment of facial analysis measurements by golden proportion.

INTRODUCTION: The face is the most important factor affecting the physical appearance of a person. In facial aesthetics, there is a specific mathematical proportion, which is called golden proportion, used to measure and analyse facial aesthetic qualities in population. OBJECTIVES: The aim of this study was to measure the facial soft tissue proportions which would help to constitute a standard for facial beauty and diagnose facial differences and anomalies and to compare these proportions to the golden proportion. METHODS: One hundred and thirty-three (133) Turkish patients 18-40 years of age (61 females, 72 males) were involved in the study. Analysis of the photographs was performed by the same physician, and a software programme was used (NIH Image, version 1.62). Facial proportions were measured and differences from the golden proportions were recorded and grouped as normal (1.6-1.699), short (<1.6) and long (>1.699). RESULTS: According to the facial analysis results, the trichion-gnathion/right zygoma-left zygoma was assessed: 33.1% of the patients were in normal facial morphology, 36.8% were in long facial morphology and 30.1% were in short facial morphology, according to this proportion. The trichion-gnathion/right zygoma-left zygoma proportion was significantly higher in males than females (p<0.001). Statistically significant difference was noted in gender groups, according to the trichion-gnathion/right zygoma-left zygoma and the right lateral canthus-left lateral canthus/right cheilion-left cheilion proportions (p=0.001, p=0.028). CONCLUSION: Facial proportion assessments in relation to the golden proportion showed that a statistically significant difference was observed between gender groups. Long facial morphology was observed more in males (51.4%); normal (41%) and short (39.3%) facial morphology were more common in females. The measurements and proportions for facial balance in our study population showed that the facial width and height proportions deviated from the golden proportion.

Bilateral Synchronous Mucoepidermoid Carcinoma of the Parotid Gland.

Mucoepidermoid carcinoma is the most common malignant tumor of the parotid; however, its synchronous occurrence in both of the parotid glands is extremely rare. Herein, we presented a case of 53-year-old man with bilateral synchronous mucoepidermoid carcinoma of the parotid gland treated with surgery. The patient mainly complained of a painless mass in the left parotid gland. A mass located in the right parotid gland was incidentally detected by imaging. Based on cytopathology, left total parotidectomy was performed while preserving the facial nerve with ipsilateral neck dissection, and 5 weeks later, right superficial parotidectomy was performed. At the 3-year follow-up, there was no recurrence in the parotid regions and the neck. A detailed examination for parotid masses is suggested for identifying possible occult synchronous tumors in the contralateral side or in other salivary glands. A close follow-up is also recommended for the risk of future occurrence of metachronous tumors.