Effects of chitosan and platelet-rich plasma on facial nerve regeneration in an animal model.

PURPOSE: There is still no widely-accepted local agent proven to be effective in nerve regeneration. We aimed to investigate the effects of chitosan gel and platelet-rich plasma MATERIALS AND METHODS: Electrophysiological measurements were performed before and immediately after injury. The injured nerves were covered with spongostan impregnated with the following agents: Group 1 (Control Group): Saline at a dose of 50 µl; Group 2: Chitosan (CHT) at a dose of 50 µl; Group 3: PRP at a dose of 50 ml; and Group 4: a solution of CHT with PRP (1:1). The final measurements were performed after 3 weeks and the injured nerve of each rat was removed. RESULTS: There were statistically-significant differences between the groups regarding the measurements of the after-treatment values of stimulus threshold (p < 0.05). The best improvement in electrophysiological measurement and histopathological evaluation was found in Group 4 (CHT-PRP). CONCLUSION: Chitosan gel has a positive effect on nerve healing and applying it along with PRP can enhance the effect of chitosan.

Increased age adversely affects the therapeutic effect of CPAP treatment for olfactory functions.

PURPOSE: The aim of this study was to compare olfactory functions pre- and post-CPAP treatment in patients with moderate to severe OSA, and to evaluate the factors that cause changes in olfactory functions. METHODS: Twenty-two patients who had completed regular usage of CPAP treatment for 2 months were included in this prospective study. Olfactory tests using Sniffin' Sticks were performed pre- and post-treatment. RESULTS: The mean age of the subjects was 47.6 ± 9.5 years. We did not find a significant change in olfactory functions after 2 months of CPAP treatment in our study group. When the patients were divided into two groups-those whose olfactory functions showed improvement and those whose functions did not-it was found that the mean age of the patients whose olfactory functions did not improve was significantly higher statistically. A significant adverse correlation was found between age and post-treatment olfactory functions, specifically in odour threshold and odour identification scores. CONCLUSIONS: Increased age adversely affects the therapeutic effect of CPAP treatment for olfactory functions.

The Relationship Between Nasal Septal Deviation and Paranasal Pneumatization.

OBJECTIVE: To investigate the impact of the presence and the severity of the nasal septal deviation (NSD) on the paranasal pneumatization. METHODS: Initially, the deviated and contralateral sides was compared to evaluate the impact of the presence of NSD on pneumatization. Then, NSD classification groups were categorized according to the severity of deviation degree; 1: mild (<9°), 2: moderate (9°-15°), and 3: severe (>15°). Pneumatization of all paranasal sinuses, osteomeatal complex (OMC), frontoethmoid recess (FER) and variant structures were compared according to the NSD classification groups separately both for the deviated and the contralateral sides. RESULTS: Although there was no statistically significant difference in pneumatization of the paranasal sinuses between the deviated and contralateral sides, a significant difference was observed in OMC and FER diameters. In the deviated side, there was statistically significant difference in ethmoid sinus volume, in FER and OMC diameters between NSD classification groups. In the contralateral side, FER and OMC diameters were found to be significantly different between group 1 and group 2 and between group 1 and group 3, respectively (P = 0.04 and 0.06, respectively). Both the presence and severity of the NSD did not statistically significant influence the pneumatization of variant structures, air cells and vital structures. CONCLUSION: The severity of NSD effects the ethmoid sinus volume. The relationship of FER and OMC with NSD is evident, however this may not always be in a proportional pattern. The paranasal pneumatization did not affect Keros type, bone integrity of carotid canal and optic canal.

The treatment efficacy of nasal polyposis on olfactory functions, clinical scoring systems and inflammation markers.

OBJECTIVE: The aim of this study was to investigate the effect of the medical and the surgical treatment on the olfactory functions, clinical scoring systems and inflammation markers in patients with nasal polyposis. In addition, the secondary aim was to investigate the correlation between those investigated parameters. SUBJECTS AND METHODS: A total of 30 patients, who completed the standardized medical and surgical treatment and also came to 3 months of follow-ups regularly after the surgery, were included in the study. The Sniffin' Sticks olfactory tests, radiological and the endoscopic stagings, liver-expressed chemokine (CCL16) and endothelin (ET) levels and sino-nasal outcome test-22 (SNOT-22) were performed at the initial and at the end of the study. RESULTS: The current study had four major findings: (1) significant improvement in odor functions after treatment was determined; however, the majority of the patients had been already hyposmic. (2) In addition, significant improvement was found in ET and CCL16 levels, SNOT-22 results, and radiologic and endoscopic stagings at the end of the study. (3) However, there was no correlation between the olfactory functions and the investigated parameters. (4) There was a positive correlation between polyp recurrence and ET levels. CONCLUSION: The standardized medical and surgical treatment provided a significant improvement in the olfactory functions. However, only one patient (3.3%) had become normosmic at the end of the study.

Lymph node yield and lymph node density for elective level II-IV neck dissections in laryngeal squamous cell carcinoma patients.

PURPOSE: To determine the minimum lymph node yield (LNY) in patients with laryngeal squamous cell carcinoma (LSCCs). METHODS: This retrospective study was performed in a tertiary care hospital setting and included 42 LSCC patients aged 39-81 years (females, n = 2; males, n = 40) who underwent a total or partial laryngectomy and elective bilateral level II-IV neck dissections (unilateral neck dissections: n = 84). RESULTS: The average LNY in the unilateral level II-IV lymph node dissections was 25.9 ± 10, and the average metastatic LNY was 0.9 ± 1.9. The unilateral neck dissections were grouped according to the number of lymph nodes. There was no significant difference between the groups in terms of the metastatic LNY (p = 0.5). The metastatic lymph node density (LND) (metastatic lymph node yield/LNY) was 0.043 for unilateral neck level II-IV neck dissections. A Cox regression analysis revealed no significant relationship between survival and the LNY and LND in bilateral neck dissections (p = 0.4 and p = 0.8, respectively). CONCLUSIONS: The results revealed no minimum number of lymph nodes that could reliably detect metastatic lymph nodes in LSCC patients.

The Impact of Septoplasty Operation on Odor Threshold Score and Symptom Severity According to the Nasal Septum Deviation Classifications.

OBJECTIVE: The authors aimed to determine the changes in the odor threshold and sinonasal outcome test-22 scores of the patients after septoplasty surgery in terms of nasal septum deviation classifications. METHODS: Forty-nine patients with nasal septum deviation, aged between 17 and 65, were included in our study. The sinonasal outcome test-22 scores questionnaire and the N-Butanol Threshold test were administered to the patients, 2 days before and 2 months after the septoplasty. RESULTS: The authors' study had 4 major findings: Odor threshold scores improved after septoplasty operation both for the narrower and the wider side of the nasal airway passage. The Vidigal classification for nasal septum deviation was best for predicting the changes for odor threshold scores after septoplasty operation. The nasal septum deviation in which the nasal septum was pushing the inferior turbinate to lateral nasal wall caused the most smell dysfunction according to the Vidigal classification. Unilateral vertical crest affecting the nasal valv area or the posterior part of the septum had the most negative effect on olfactory functions according to the Mladina classification. CONCLUSION: Septoplasty operation leads to improvement in odor threshold scores, and the Vidigal nasal septum deviation classification was best in predicting postoperative odor threshold changes.

Figure-of-Eight Suspension Suture in Open Technique Septorhinoplasty.

The aim of this study was to describe a novel surgical suture technique for achieving ideal nasal tip rotation and projection with nasal supratip angle. The figure-of-eight suspension suture (FOESS) technique was used in 68 patients who underwent open technique septorhinoplasty operation between the years 2013 and 2015. Fifty-four of the patients were female and 14 were male. The mean age of the patients was 28.2. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to the FOESS technique. Satisfactory results were obtained in the postoperative period after surgery. The FOESS technique generated power against the anterior-inferior tensile strength of the alar cartilages. Thus, it can be possible to shape the nasal tip rotation and projection in the desired dimensions. In addition, this technique helps us to create supratip break point and angle.

The Effect of Nasal Septal Perforation and its Treatment on Objective Sleep and Breathing Parameters.

BACKGROUND Nasal septal perforation (NSP) may alter nasal airflow patterns and physiology. To the best of our knowledge, no studies in the English literature have investigated the effect of NSP and its treatment on polysomnographic parameters. In this study, we aimed to investigate polysomnographic parameters in patients with NSP as well as changes in those parameters after treatment of NSP. MATERIAL AND METHODS Nineteen patients diagnosed with NSP were included in the study. All patients had baseline and post-procedure polysomnographies (PSG) after insertion of silicone septal button for closure of NSP. RESULTS Both median AHI [5.30 (14.40) vs. 2.40 (14.50)] and median supine AHI [10.00 (42.10) vs. 6.60 (37.00)] decreased after correction of the perforation. There was a large reduction in median supine AHI in patients with a perforation size >66 mm2 [10.10 (34.15) vs. 1.60 (28.30)]. CONCLUSIONS We conclude that NSP did not cause any deterioration in objective sleep parameters as determined by PSG, other than a decrease in REM sleep duration and an increase in supine AHI. Correction of NSP did not affect REM duration and supine AHI decreased after treatment.

The evaluation of olfactory function in individuals with chronic halitosis.

Halitosis and olfactory dysfunction may disrupt an individual's quality of life remarkably. One may ask whether halitosis has effects on olfactory functions or not? Thus, the aim of this study was to evaluate the olfactory abilities of subjects with chronic halitosis evaluated using the measurements of volatile sulfur compounds. This study was carried out in 77 subjects, with a mean age of 40.1±13.3 years, ranging from 18 to 65 years. Forty-three participants were diagnosed as halitosis according to the gas chromatography results and constituted the halitosis group. Also, a control group was created from individuals without a complaint of halitosis and also who had normal values for volatile sulfur compounds. Each subject's orthonasal olfactory and retronasal olfactory functions were assessed using "Sniffin' Sticks" and retronasal olfactory testing. The results showed that odor threshold scores were lower in participants with halitosis compared with controls. Also, hyposmia was seen more common in the halitosis group than in controls. Moreover, a significant negative correlation was found between odor threshold scores and volatile sulfur compounds levels, particularly with hydrogen sulfide and dimethyl sulfide levels. The results suggest that the chronic presence of volatile sulfur compounds may have a negative effect on olfactory function.

The Relationship between Age-Related Macular Degeneration and Olfactory Function.

BACKGROUND: Olfactory dysfunction is a common symptom of many neurodegenerative diseases, and age-related macular degeneration (AMD) is a late-onset neurodegenerative disease. OBJECTIVE: Thus, the aim of this study was to investigate olfactory functions in patients with AMD. METHODS: A total of 69 subjects with AMD and 69 age- and sex-matched healthy controls were enrolled. After a complete ophthalmic evaluation, the AMD patients were subclassified as early- and late-stage AMD. Psychophysical testing of olfactory function was performed using the validated Sniffin' Sticks test. RESULTS: This study was carried out in 138 subjects, with a mean age of 74.3 ± 8.9 years (range 51-89). The current investigation showed the following two major findings: (1) patients with AMD had decreased olfactory abilities, especially in odor discrimination and odor identification, even at early stages compared to controls, whereas patients had decreased olfactory abilities in all subtasks of olfactory testings in advanced stages of AMD disease, and (2) as the visual acuity of AMD patients decreased, the olfactory abilities of these patients worsened. CONCLUSION: This study demonstrated that AMD had significant negative effects on all orthonasal olfactory tasks, particularly in advanced stages. Similar to other neurodegenerative diseases, odor discrimination and identification seemed to be more affected than odor detection threshold tasks.

Postoperative changes in olfactory function after transcanalicular diode laser dacryocystorhinostomy.

PURPOSE: Transcanalicular diode laser dacryocystorhinostomy (TCL-DCR) is used much in recent years for the surgery of nasolacrimal duct obstruction (NLDO). Although TCL-DCR is accepted to be minimally invasive, safe, and effective, there is no report focusing on postoperative changes in olfactory function after this procedure. Hence, the aim of this current study was to investigate the changes in olfactory function after TCL-DCR procedure. MATERIALS AND METHODS: This study was carried out in 42 volunteers (16 men and 26 women) between the ages of 20 and 81 years. All participants received detailed lateralized olfactory tests preoperatively and at the postoperative first week, first month, third month, and sixth month. After lateralized olfactory tests were performed, the results were grouped according to the side of the nasal passage where the operation was performed for NLDO: the nonoperated side served as the control. RESULTS: The current investigation produced 2 major findings: (1) olfactory function decreased significantly after TCL-DCR procedure at the operated side of the nose compared with the nonoperated side; (2) olfactory abilities of the patients returned to normal within 3 months. CONCLUSION: The results of this study showed that transcanalicular diode laser could be used safely in terms of olfactory function for dacryocystorhinostomy. Temporary decrease of olfactory function on the side having TCL-DCR should be taken into account when obtaining informed patient consent.

A novel method for nasal dorsal reconstruction: permanent fixation using Kirschner wire-guided hidden sutures.

BACKGROUND: In this study, we aimed to present a novel application and use of Kirschner wire-guided suturing that is less invasive and allows permanent fixation for nasal dorsal reconstruction. METHODS: A total of 23 patients, who underwent surgery between 2009 and 2013, were included in this study: 19 with saddle nose deformity and 4 patients with keystone area damage, or collapse of the dorsal nasal support during primary septoplasty or rhinoplasty. The patients were asked to fill out a nasal obstruction symptom evaluation (NOSE) scale preoperatively and at the postoperative sixth month to assess breathing quality. The patients were followed up for complications such as nasal dorsal contour irregularity, dorsal collapse, as well as graft malposition and infections. The results of the surgeries were assessed on the basis of preoperative and postoperative examinations, septal support test, NOSE scale results, and photographic comparison. RESULTS: The mean (SD) NOSE scales were 78.91 (10.09) and 30.48 (10.71) in the preoperative and postoperative periods, respectively. The difference of mean NOSE scale was statistically significant (P < 0.001). None of the patients experienced nasal dorsal collapse or graft malposition. Two patients had nasal dorsal irregularity complaints owing to inadequate costal cartilage edge beveling. None of the patients had complications of suture reaction, suture visibility, or suture extrusion. All of the patients stated that they were happy with the cosmetic outcome. CONCLUSIONS: Permanent sutures introduced through channels made with the Kirschner wire provide a less invasive, cosmetically pleasing, and functional solution, promising more reliable results in the long term.

An investigation of retronasal testing of olfactory function in a Turkish population.

BACKGROUND: The aim of this study was: (1) to perform a preliminary study for the validation of ''retronasal olfactory testing'' in the Turkish population to find the best way to evaluate smell and taste disorders in Turkey; (2) to determine if cultural differences make application of the test more difficult; and (3) to determine the flavors that participants had not yet tasted by using the survey method. MATERIAL AND METHODS: The study included 330 volunteers. Orthonasal olfactory function was assessed psycho-physically using the "Sniffin' Sticks" olfactory test. Retronasal olfaction was assessed using a collection of 20 available food powders applied to the oral cavity. Also, all participants filled in a questionnaire of 50 items about the flavors they had not tasted before. RESULTS: The mean age of the participants was 26 ± 7.3 years. Participants were divided into 3 groups according to the "Sniffin' Sticks" test results: anosmia, hyposmia, and normosmia groups. Differences in retronasal olfaction scores were significant among the 3 groups. CONCLUSIONS: The retronasal olfactory test appeared to perform well, but modifications of odorized powders or granules and distracters used in the retronasal olfactory test, taking into account Turkish cultural differences, is likely to improve its performance.

Grade 4 tonsillar hypertrophy associated with decreased retronasal olfactory function: a pilot study.

Tonsillar hypertrophy is common in children, but it can also be present in adults. Enlarged tonsils, a significant anatomical barrier, may affect the flow of odor molecules from the oral cavity to the nasal passages, which has not yet been studied. Thus, we aimed to investigate the mass effect of palatine tonsillar hypertrophy on retronasal olfaction. This study was carried out in 146 subjects, with a mean age of 22.1 ± 2.2 years, ranging 20-29 years. An oropharyngeal examination of the participants was completed, and tonsillar hypertrophy was graded according to the subjective tonsil size scale. The participants were divided into four groups according to their tonsil size grading; then, each subject's orthonasal olfactory and retronasal olfactory functions were assessed using "Sniffin' Sticks" and retronasal olfactory testing. There were no differences observed between the groups in terms of age, gender, cigarette smoking, or alcohol consumption. In addition, there was no difference between the groups in terms of "Sniffin' Sticks" subtests and TDI scores. It was determined that the retronasal olfactory scores of the participants with grade 4 tonsil size were significantly lower than the retronasal olfactory scores of the participants with grade 1 tonsil size. The current investigation demonstrates that grade 4 tonsillar hypertrophy has significant negative effects on the retronasal route of olfactory sensing, when compared with grade 1 tonsillar hypertrophy.

The effect of high altitude on olfactory functions.

It is known that high-altitude trips cause nasal congestion, impaired nasal mucociliary transport rate, and increased nasal resistance, due to decreased partial oxygen pressure and dry air. It is also known that olfactory perception is affected by barometric pressure and humidity. The aim of the present study was to investigate whether olfactory function changes in relation to high altitude in a natural setting. The present study included 41 volunteers with no history of chronic rhinosinusitis or nasal polyposis. The study group consisted of 31 men (76 %) and 10 women (24 %); the mean age of the study population was 38 ± 10 years. Olfactory testing was conducted using "Sniffin' Sticks" at a high altitude (2,200 ms) and at sea level. Odor test scores for threshold and identification were significantly better at sea level than at high altitude (p < 0.001). The major finding of this investigation was that olfactory functions are decreased at high altitudes.

The effect of high altitude on nasal nitric oxide levels.

The aim of the present study was to investigate whether nasal nitric oxide (nNO) levels change in relation to high altitude in a natural setting where the weather conditions were favorable. The present study included 41 healthy volunteers without a history of acute rhinosinusitis within 3 weeks and nasal polyposis. The study group consisted of 31 males (76 %) and 10 females (24 %) and the mean age of the study population was 38 ± 10 years. The volunteers encamped for 2 days in a mountain village at an altitude of 1,500 m above sea level (masl) and proceeded to highlands at an altitude of 2,200 masl throughout the day. The measurements of nNO were done randomly, either first at the mountain village or at sea level. Each participant had nNO values both at sea level and at high altitude at the end of the study. The nNO values of sea level and high altitude were compared to investigate the effect of high altitude on nNO levels. The mean of average nNO measurements at the high altitude was 74.2 ± 41 parts-per-billion (ppb) and the mean of the measurements at sea level was 93.4 ± 45 ppb. The change in nNO depending on the altitude level was statistically significant (p < 0.001). The current investigation showed that nNO levels were decreased at high altitude even if the weather conditions were favorable, such as temperature, humidity, and wind.

Surgical approach and outcomes for revision surgery of the central neck compartment.

Revision surgery of the central neck compartment is still a controversial subject, and data are scarce in the literature regarding surgical approaches and outcomes. This might be a result of the small number of patients in need of revision of the central neck compartment. Therefore, the purpose of this study was to document the approach and outcomes for revision surgery of the central neck compartment performed in our clinic. The files of patients who had undergone revision surgery of the central neck compartment in the Clinic of Otorhinolaryngology, Ankara Numune Training and Research Hospital, between 2007 and 2013, were evaluated. The subjects included 61 patients who had previously undergone surgical intervention in the central neck compartment and had then undergone bilateral lymph node dissection covering at least levels 6 and 7 in our clinic. Patient ages ranged between 36 and 63 years (mean, 47.2 y; SD = 8.3 y). The complications seen after revision surgery were temporary recurrent laryngeal nerve palsy in 4 patients (6.6%), temporary hypocalcemia in 8 patients (13.1%), and permanent hypocalcemia in 3 patients (4.9%). No permanent recurrent laryngeal nerve damage, wound infection, or hematoma was encountered. Meticulous surgical dissection with identification of the recurrent laryngeal nerve and the implantation site of the parathyroid glands may safeguard against complications. Reoperative surgery in the central compartment of the neck allows the removal of recurrent/persistent disease and has acceptable morbidity.

Lateralized differences in olfactory function and olfactory bulb volume relate to nasal septum deviation.

One of the most common reasons for partial nasal obstruction is nasal septal deviation (NSD). The effect of a partial lateralized nasal obstruction on olfactory bulb (OB) volume remains unclear. Thus, the aim of this study was to investigate the side differences in olfactory function and OB in patients with serious NSD. Sixty-five volunteers were included: 22 patients with serious right NSD and 43 patients with left NSD. The patients' mean age was 22 years. All participants received volumetric magnetic resonance imaging scans of the entire brain and detailed lateralized olfactory tests. The majority of the patients exhibited an overall decreased olfactory function (as judged for the better nostril: functional anosmia in 3%, hyposmia in 72%, normosmia in 25%), which seems to be mostly due to the overall severe changes in nasal anatomy. As expected, olfactory function was significantly lower at the narrower side as indicated for odor thresholds, odor discrimination, and odor identification (P ≤ 0.005). When correlating relative scores and volumes (wider minus narrower side), a significantly positive correlation between the relative measures emerged for OB volume and odor identification, odor discrimination, and odor thresholds. Our study clearly highlights that septal deviation results in decreased olfactory function at the narrower side.

Is there an association between olfactory bulb volume and the Keros type of fossa olfactoria?

PURPOSE: The purpose of this study was to investigate the relationship between the volume of the olfactory bulb (OB), the depth of the olfactory sulcus (OS), the depth of the fossa olfactoria (FO), and the height of the OB. METHODS: A total of 54 patients participated (9 women and 45 men; mean [SD] age, 27 [38] y; range, 20-45 y). Magnetic resonance imaging was performed with a 1.5-T system (slice thickness, 1 mm). Measurements of the right and left OB volumes were performed through manual segmentation of the coronal slices. We measured the depth of the FO on the basis of Keros classification on coronal magnetic resonance images. The depth of the OS was measured on the coronal plane at the posterior tangent through the orbital globes. The height of the OB was measured on the coronal plane of the cribriform plate at the highest portion of the OB. RESULTS: The mean (SD) right OB volume was measured to be 52.21 (13.73) mm3 with a range between 33.90 and 95.70 mm3. The mean (SD) left OB volume was measured to be 53.98 (13.31) mm3 with a range between 31.20 and 94.10 mm3. Type 1, type 2, and type 3 Keros ratios of the FO bilaterally were 12.9% (7/54), 68.5% (37/54), and 3.7% (2/54), respectively. There was no significant relationship between the OB volume and ipsilateral Keros type of FO (right side: P = 0.208; left side: P = 0.164). Similarly, there was no significant relationship between the OB volume and depth of OS on both sides (right side: P = 0.073; left side: P = 0.065). There was no significant association between the Keros type of the right FO and depth of the OS (right side: P = 0.812; left side P = 0.863). CONCLUSIONS: We conclude that there is no statistical correlation between the OB volume and depth of the FO (Keros type). From the current study, it may be concluded that the depth of the FO may develop largely independent from OB volumes. The individuals without smell disorder have a wide range in OB volume. The method of OB volume measurement that we described is a valid measure of real OB volumes with high reproducibility.

The effect of hyperbaric conditions on olfactory functions.

OBJECTIVE: The aim of this study was to investigate the effect of increased atmospheric pressure (AP) on olfactory function. SUBJECTS AND METHODS: The present study included 40 healthy volunteers with no history of chronic rhinosinusitis and nasal polyposis. The experimental procedure consisted of two episodes: (a) baseline episode, with normal AP; 1 absolute atmosphere (atm abs) in a test room at sea level; (b) experimental episode, increased level of AP; 2.4 atm abs in the hyperbaric chamber. Sino-nasal outcome test-20, Trail Making Test A and olfactory testing were performed in each episodes. RESULTS: The study group consisted of 23 men (57.5%) and 17 women (42.5%); the mean age of the study population was 38.7 +/- 9 years (range 23-58 years). The current investigation produced two major findings: (1) the mean of odor threshold scores was significantly increased in the hyperbaric condition when compared to the normobaric condition; (2) rather, there was no significant change in odor discrimination and identification scores in the hyperbaric condition. CONCLUSION: Based on two measurements taken at two different barometric pressures and the same temperature and relative humidity, this study suggests that odor threshold scores increase under hyperbaric conditions.