Changes occurring in the nasal mucociliary transport in patients with one-sided septum deviation.

Septum deviation is the most commonly seen nasal pathology. Mucociliar activity can be affected by septum deviation that can be detected in many nasal pathologies. This study was aimed to compare the changes occurring in the mucociliary activities in both the nasal cavities of 20 patients with one-sided septal deviation and 20 healthy young individuals without septal deviation. The mucociliary activity of the right nasal cavity in healthy human beings and the mucociliary activity of the concave and convex sides of nasal cavities in patients with septal deviation were measured. Mucociliary clearance was measured by means of the rhinoscintigraphy technique. The mucociliary transport speed on the concave side was found to be significantly increased compared to the convex side and the control group. As a result, the mucociliary activity was within normal limits in patients with septum deviation who didn't have a nasal mucosal disease. Furthermore, the mucociliary activity was found to be increased on the concave side where the airflow was higher.

Effect of topical 5-fluorouracil on closure time of myringotomies created by a radiofrequency surgical unit in guinea pigs.

PURPOSE: To delay the closure time of myringotomy without inserting a ventilation tube by creating a myringotomies in guinea pigs by a radiofrequency surgical unit and using topical 5-fluorouracil (5-FU). BACKGROUND: Topical 5-FU was used successfully in glaucoma surgery to depress the proliferation of fibroblasts, but the effects of 5-FU in the myringotomy site in delaying closure are not known. The availability of the use of a radiofrequency surgical unit in performing myringotomy and the effects of a radiofrequency surgical unit myringotomy in the patency period of the myringotomy opening are not known. METHODS: A myringotomy in the tympanic membranes of 30 guinea pigs was created by using a radiofrequency surgical unit. Right ears of these guinea pigs were identified as the study group and sponges with 50 mg/ml 5-FU were applied topically. Saline-soaked sponges were applied to the left myringotomy site, which served as the control side for 15 minutes. Guinea pigs were separated into 2 groups. In Group 2, an additional 20 mg/ml 5-FU and saline solution were dropped into the right and left external ear on the fourth and on the 11th day, respectively. RESULTS: In all guinea pigs, it was found that all the left-ear myringotomy sites were closed at the end of the first week. In the right ears, the myringotomy sites were closed in 75% of Group 1 and in 80% of Group 2 at the end of the second week. In the histopathologic examination of tympanic membranes, there was no apparent difference between study and control sides, but a slight increase in inflammatory findings were encountered in the study sides. CONCLUSION: The closure time of the myringotomy site was delayed twice as much as in the control group in the site where topical 5-FU was applied, and the drop form of 5-FU did not create any additional delay in the closure time.

Pyocele of the middle turbinate: a case report.

Mucoceles are uncommon and the majority of cases occur in the frontoethmoidal complex. The accumulation of mucous secretion and eventual secondary infection may result in the formation of a pyocele of the middle turbinate, which is exceptionally rare. This case report presents a patient with a large pyocele of the middle turbinate invading the orbit. A 48-year-old woman presented with a three-week history of nasal obstruction, slight rhinorrhea, and headache. There was an external swelling of the nasal pyramid just near the medial canthus and right exophthalmos with bulging of the medial canthus of the ipsilateral eye. A computed tomography scan revealed a rounded, expansive lesion of soft tissue density. There was a thin compact bone at the margin. Under general anesthesia, resection of the lateral and inferior walls of the middle turbinate was performed. The large cystic mass was filled with pus. Exophthalmos and bulging of the medial canthus immediately disappeared. Histologic examination showed the mucocele wall with a ciliary respiratory epithelium.

Giant concha bullosa: a case report.

Concha bullosa is a relatively common anatomic variant that is in fact an enlarged pneumatized middle turbinate. We report a case of giant concha bullosa in a 21-year-old woman who had a history of nasal obstruction. Anterior nasal examination of the nasal cavity revealed bilateral nasal masses which were covered with normal mucosa. Nasal endoscopy of both nasal cavities was impossible because of total occlusion. Computed tomography showed a bilateral giant concha bullosa. Under general anesthesia, resection of lateral half of the concha bullosa was performed bilaterally by a transnasal endoscopic technique to achieve nasal airway patency.

[The effect of nasal packing with or without an airway on arterial blood gases during sleep]. / Hava yolu içeren ve içermeyen burun tamponlarinin uyku sirasinda arteryel kan gazlari üzerine etkisi.

OBJECTIVES: We investigated the effect of postoperatively applied nasal packing with or without an airway on partial arterial oxygen (PaO(2)) and carbon dioxide (PaCO(2)) pressures during sleep. PATIENTS AND METHODS: The study included 40 patients (24 men, 16 women; mean age 29 years; range 18 to 60 years) who underwent septoplasty operation. The patients were randomly assigned to postoperative nasal packings with (n=20) or without (n=20) an airway. PaO(2) and PaCO(2) levels were measured during sleep on the preoperative night and on the postoperative first and second nights. The findings were compared. RESULTS: No significant differences were found between the preoperative and postoperative PaO(2) and PaCO(2) levels obtained with nasal packing containing an airway. However, the mean PaO(2) level measured on the postoperative second night significantly decreased in patients wearing a nasal packing without an airway, when compared with the mean preoperative value and with that obtained from the other group on the same night (p<0.05). On the other hand, increases in the mean PaCO(2) levels did not reach significance. In both groups, postoperative PaO(2) and PaCO(2) values were within acceptable limits. No signs of hypoxia or hypercapnia were detected. CONCLUSION: To prevent decreases in the PaO(2) levels, the use of nasal packings with an airway seems to be more appropriate in patients susceptible to hypoxia.

[The relationship between the presence of Candida colonization in the oropharynx and on the Blom-Singer voice prosthesis and its effect on the length of prosthesis use]. / Orofarenkste ve Blom-Singer ses protezi üzerinde üreyen Candida kolonizasyonu arasindaki iliski ve bunun protez ömrü üzerine etkisi.

OBJECTIVES: We investigated the effect of oropharyngeal Candida colonization on the contamination of the Blom-Singer voice prosthesis and its lifetime. PATIENTS AND METHODS: The study included 26 male laryngectomized patients (age range 45 to 76 years) in whom the Blom-Singer low-pressure prosthetic valve inserted required removal due to improper functioning. All patients had postoperative radiotherapy. Patients who had nystatin therapy were excluded. At the time of removal, cultures were obtained from the esophageal end of the prosthesis and from the oropharynx to be examined with regard to Candida growth. RESULTS: Candida colonization was recovered from the cultures obtained on 20 prostheses (77%) and from 14 oropharyngeal specimens (54%). The presence of oropharyngeal colonization was always associated with that on prostheses. The average lengths of prosthesis use were 5.7 months (range 4 to 9 months) and 6.2 months (range 3 to 10 months) in patients with and without positive oropharyngeal Candida colonization, respectively (p>0.05). CONCLUSION: The results suggest that the presence of oropharyngeal Candida colonization has no effect on the prosthesis lifetime.

[The topographical anatomy of the external branch of the superior laryngeal nerve and its importance in thyroid surgery: a cadaver study]. / Süperior larenjeal sinirin eksternal dalinin topografik anatomisi ve tiroit cerrahisindeki önemi: Kadavra çalismasi.

OBJECTIVES: We investigated topographical anatomic features of the external branch of the superior laryngeal nerve (SLN) in relation to the superior thyroid artery (STA) and its vulnerability to injury in individuals with a normal thyroid size. STUDY DESIGN: Thirty fresh cadavers (18 females, 12 males; age range 20 to 50 years) with a normal thyroid size and no signs of abnormality in the neck were studied. The external branch of the SLN was identified and classified according to the system proposed by Cernea et al. RESULTS: The topographical relationship between the external branch of the SLN, the STA, and the upper pole of the thyroid gland was identified in 54 thyroid lobes (90%). Identification was not possible in six lobes because of bleeding or injury. The location of the external branch of the SLN was consistent with type 1 in 28 lobes (51.8%) and type 2 in 26 lobes (48.2%; type 2a in 37.1% and type 2b in 11.1%). No significant relationships existed between the type of the nerve, gender, and age, nor was there any symmetry with regard to the location of the external branch of the SLN in the same subject. CONCLUSION: Nearly half of the Turkish population with a normal thyroid gland size present high surgical risks during thyroid surgery because of the course of the external branch of the SLN.

[The effect of laryngectomy and postoperative radiotheraphy on thyroid gland functions]. / Larenjektomi ve izleyen radyoterapinin tiroit fonksiyonlari üzerine etkisi.

OBJECTIVES: We investigated the frequency of hypothyroidism in patients treated with total laryngectomy, hemithyroidectomy-isthmectomy, and postoperative radiotherapy for T3 or T4 larynx cancers. PATIENTS AND METHODS: Twenty-nine male patients (mean age 54 years; range 43 to 72 years) with T3 or T4 larynx cancers were prospectively included in the study. Preoperatively, thyroid function tests were normal in all the patients. Following radiotherapy, serum thyroid-stimulating hormone (sTSH), free triiodothyronine (FT3), and free thyroxine (FT4) levels were measured every three months at least for a year. Detection of an increased level of sTSH together with decreased or normal levels of FT3 and/or FT4 indicated clinical and subclinical hypothyroidism, respectively. The relationship was assessed between hypothyroidism and both age and radiotherapy dosage. Statistical analyses were made with the use of the Student's t- test and Mann-Whitney U-test. RESULTS: Following radiotherapy, thyroid function tests remained normal in 12 patients (41%), while 12 patients (41%) and five patients (18%) developed subclinical and clinical hypothyroidism, respectively. No significant relationship was found between age and thyroid dysfunction (p>0.05), whereas radiotherapy dosage was found in significant relationship with the development of hypothyroidism (p<0.05). CONCLUSION: Due to high rates of subclinical or clinical hypothyroidism following combined therapy, thyroid functions should be closely monitored in patients undergoing laryngectomy for T3 or T4 larynx cancers.

Short-term evaluation of over-under myringoplasty technique.

Over-under tympanoplasty is a technique aimed at eliminating the disadvantages of the two classical techniques of overlay and underlay myringoplasty, which are employed in repairing the tympanic membrane. In this retrospective study, a total of 104 patients underwent myringoplasty, which was performed by means of the underlay technique in 46 patients and over-under technique in 58 patients. The mean follow-up period was 11 months. In the first group of patients, the underlay technique was performed; the grafted membrane was placed medial to the remaining drum and the manubrium of the malleus. In the second group, the over-under technique was performed; the grafted membrane was placed under the remaining drum and over the malleus. The rate of success in the first group of 46 patients was 91.5%, and that of atelectasis was 19.5%. The rate of success in the second group of 58 patients was 94.9% and 12%, respectively. Lateralization of the graft was not observed in either of the groups. In the patients operated on by means of the underlay technique, the air-bone gap decreased by 16.55 dB this rate was 16.96 dB in those operated on by the over-under technique. The authors consider over-under tympanoplasty to be superior to the other two classical methods not only because of its effectiveness, but also because of the results achieved by this technique.