Atypical presentation of primary giant nasal septal mucopyocele.

Mucoceles are expansile, encapsulated, benign cystic lesions with the potential for adjacent bony remodeling and resorption. Previous nasal surgery, recurrent infections, allergies, and facial traumas are all possible causes of mucoceles involving mainly paranasal sinuses. When the mucocele is infected, it is referred to as mucopyocele. Nasal septal mucoceles seen in only very seldom cases might develop from pneumatized and infected nasal septa. In the current article, we present an interesting primary giant septal mucopyocele that destroys all paranasal cells as a tumoral lesion. The perpendicular plate of ethmoidal bone, vomer, and bilateral anterior and posterior ethmoidal cells were destroyed by mucopyocele. The nasal cavity was totally obstructed by lesions on both sides. On the left side, the lesion also eroded the left lateral nasal wall causing external swelling at the medial canthal region. This is the first case of a giant septal mucopyocele of its kind in the literature. Although nasal septal mucocele is very rare, it should be considered in differential diagnosis of intranasal masses.

Evaluation of brainstem auditory evoked response audiometry findings in children with tuberculous meningitis at admission.

OBJECTIVE: To determine the characteristics of Brainstem auditory evoked response (BAER) findings in children with tuberculous meningitis (TBM) at admission. METHODS: Twenty-seven children with highly probable TBM were admitted to the University Hospital. The control group was 23 healthy, age and sex matched subjects. Brainstem response audiometry recording was performed in all patients and controls. Ninety dB sound pressure level (SPL) was used for comparisons. The main BAER measurements analysed were the I-III, III-V, I-V interpeak intervals. In statistical analysis, t-test for independent groups were performed. At the same time, for interpeak intervals, values exceeding 2.5 standard deviations (S.D.) above the means of the normal controls were considered abnormal. To the result of BAER findings, HL was classified as mild (until 40 dBHL), severe (until 80 dBHL) and total HL (no hearing was detected). RESULTS: The latencies of interpeak intervals (except III-V latency at 10 per s) have significantly prolonged in comparison with controls. Mild HL was detected in four ears. In eight ears, any wave form could not be obtained at 110 dBSPL. Abnormal BAER result was seen in 13 of 54 ears (24%) at the click of 10 per s and five ears (12%) at the click of 50 per s. CONCLUSION: Abnormal BAER result was seen in 24% of patients with TBM before treatment. Depending on these findings, it can be inferred that hearing impairments must be lower than those values which was detected by BAER during the acute phase of TBM, since the abnormal BAER may be reversible following the illness, returning to normal with recovery.

Examination of the distribution of mast cells in the nasal mucosa of patients with seasonal allergic rhinitis.

OBJECTIVE: It is known that mast cells play an important role in pathogenesis of allergic rhinitis. In this study, we investigated the distribution of mast cells in the nasal mucosa of patients with seasonal allergic rhinitis during the pollen-season. METHODS: This study was carried out at the Faculty of Medicine, Dicle University, Turkey, during the grass-pollen season between, March and July in 2002. Twenty patients with seasonal allergic rhinitis (12 females and 8 males) and 20 healthy (10 females and 10 males) non-allergic controls were examined for the distribution and abundance of mast cells in nasal biopsies. Biopsies were performed in all patients and controls, once during natural provocation in the spring and were taken from the lower edge of the inferior turbinate using a forceps. The samples of nasal mucosa were fixed in 10% neutral buffered formaline, stained with 0.5% aqueous toluidine blue and hematoxylin and eosin were examined under a light microscope. RESULTS: Mast cells were observed in the nasal mucosa obtained from 12 patients (60%) and 5 patients (25%) controls cases (p=0.025). It was found out that intrapitelial mast cells are present in nasal mucosa samples of patients with SAR (seasonal allergic rhinitis) but not in the epithelium of non-allergic controls. CONCLUSION: The number of submucosal mast cells has considerably increased in the nasal mucosa samples of patients with SAR. Besides this, these cells are determined in great amounts in non-allergic individuals.

The effect of benzalkonium chloride on rabbit nasal mucosa in vivo: an electron microscopy study.

In this study we investigated the histopathological changes of nasal mucosa after the use of topical benzalkonium-chloride solution. In the study, 28 male New Zealand white rabbits were used. The animals were divided into two groups. In the first group, 50 micro l of 0.001% benzalkonium-chloride solution was sprayed into the right nostril and 50 micro l of 0.9% saline into the left twice daily for 14 days. In the second group, the same solutions were applied twice daily for 28 days. All of the biopsies from each nasal cavity were processed for electron microscopy. In the nostrils treated with 0.001% benzalkonium chloride, there were areas with obvious squamous cell metaplasia. Some cells showed broken cristae of the mitochondria. Degenerative changes in the supportive and olfactory cells, deformation of nuclei and the increase of heterochromatin were observed. The present investigation has shown that the application of topical benzalkonium chloride does induce degenerative morphologic changes in the nasal mucosa in rabbits in vivo.