The Effect of Bevacizumab and Propranolol on Nasal Polyposis.

Objective: This study aims to evaluate the effects of bevacizumab and propranolol from the point of view of a possible antiangiogenic effect in a model of primary nasal polyp (NP) tissue culture. Methods: NP samples of 21 patients and normal healthy nasal mucosa samples of 7 patients were cultured. Samples were divided into four groups as follows (healthy nasal mucosa, NP without any treatment, NP treated with propranolol, NP treated with bevacizumab). Cultured tissues were formalin fixed and paraffin embedded. Tissue sections and immunohistochemical VEGF-A, angiopoietin-1 (Ang-1), and angiopoietin-2 (Ang-2) expressions were evaluated. ELISA was also performed for each one of them. Results: Both propranolol and bevacizumab significantly decreased the expressions of VEGF-A and Ang-1, and they significantly increased the expression of Ang-2 in comparison to the control NP group. In the healthy nasal mucosa group, no significant expression of VEGF-A was seen, a slight (+) Ang-1 expression, and a high (+++) Ang-2 expression were observed. Conclusion: Bevacizumab and propranolol exert an antiangiogenic effect on NP tissues, mainly by decreasing VEGF-A and Ang-1 expression, increasing Ang-2 expression.

Turkish validation of the Sino-Nasal Outcome Test-22.

OBJECTIVES: The Sino-Nasal Outcome Test (SNOT)-22 is a widely used health-related quality of life questionnaire. This study aimed to conduct a translation and validation study of the SNOT-22 in the Turkish language. DESIGN: We achieved a convenient translation and cultural adaptation process to translate the original SNOT-22 into the Turkish language (observational prospective cohort study). SETTING: This study was conducted in a single tertiary-level university hospital. PARTICIPANTS: We performed reliability, validity and responsiveness analyses in 313 participants. One hundred eighty-nine of the participants were the chronic rhinosinusitis (CRS) group, and 79 healthy volunteers enrolled in the control group. Twenty-nine participants who underwent endoscopic sinus surgery for CRS were evaluated for pre-postoperative responsiveness analysis. MAIN OUTCOME MEASURES: Reliability (internal consistency and test-retest reproducibility), validity, responsiveness, sensitivity and specificity. RESULTS: The internal consistency coefficient (Cronbach's alpha) was 0.909 in the CRS test group, 0.955 in the CRS retest group, and 0.916 in the control group. The reliability value (Pearson correlation coefficient) of the test-retest group was 0.901. The validity was assessed by the independent sample t-test between the CRS and control groups and resulted in a significant difference (P < 0.001). Responsiveness was interpreted using the paired t-test between pre- and post-medical and pre- and post-surgical treatment groups; statistical analysis found significance in both groups (P < 0.001). When using the SNOT-22 cut-off value of 33.5, the sensitivity and specificity of the Turkish version of the SNOT-22 was 54.5% and 75.9%, respectively (95% CI, area under the curve (AUC): 0.69, range 0.624â€"0.756, P = 0.000). CONCLUSIONS: The authors suggest that the Turkish SNOT-22 is a valid, reliable, reproducible and responsive questionnaire.

Computed Tomographic Analysis: The Effects of Frontal Recess Morphology and the Presence of Anatomical Variations on Frontal Sinus Pneumatization.

The aim of this study is to describe the morphology of frontal recess area with its anatomical variations and to reveal if frontal recess morphology and the anatomical variations related to that region have effects on the pneumatization of the frontal sinuses. The frontal sinus and recess morphometry of 136 sides of 68 dry skulls were evaluated on multislice high-resolution computed tomography. The relationships between frontal sinus and frontal recess measurements were analyzed by correlation and linear regression analysis. The variables between the groups of anatomical variations were analyzed by Mann-Whitney U test and χ test or Fisher exact test. A positive relationship between the sagittal length of spina nasalis interna and morphometric measurements of frontal sinus was revealed (P <0.05). Agger nasi cells were present in 64.2% of sides, supraorbital ethmoid cells (SOECs) in 19.6%, type 3 frontal cells (FCs) in 18.9%, suprabullar cells in 24.3%, and frontal bulla was noted in 5.4%. Intersinus septal cells were observed in 16.2% of the skulls. There were statistically different increases in the measurements of frontal sinus morphometry in the presences of SOECs and type 3 FCs (P <0.05). The diameter of frontal sinus ostium was decreased in the presences of AN, SOEC, type 3 FC, and supraorbital ethmoid cell statistically (P = 0.049, P = 0.029, P = 0.043, P <0.001 respectively). In conclusion, frontal sinus pneumatization was affected by the spina nasalis interna and the presence of anatomical variations related to frontal recess or ostium region instead of the morphology of that area.

The classification of frontal sinus pneumatization patterns by CT-based volumetry.

PURPOSE: We aimed to define the classification of frontal sinus pneumatization patterns according to three-dimensional volume measurements. METHODS: Datasets of 148 sides of 74 dry skulls were generated by the computerized tomography-based volumetry to measure frontal sinus volumes. The cutoff points for frontal sinus hypoplasia and hyperplasia were tested by ROC curve analysis and the validity of the diagnostic points was measured. RESULTS: The overall frequencies were 4.1, 14.2, 37.2 and 44.5 % for frontal sinus aplasia, hypoplasia, medium size and hyperplasia, respectively. The aplasia was bilateral in all three skulls. Hypoplasia was seen 76 % at the right side and hyperplasia was seen 56 % at the left side. The cutoff points for diagnosing frontal sinus hypoplasia and hyperplasia were '1131.25 mm(3)' (95.2 % sensitivity and 100 % specificity) and '3328.50 mm(3)' (88 % sensitivity and 86 % specificity), respectively. CONCLUSIONS: The findings provided in the present study, which define frontal sinus pneumatization patterns by CT-based volumetry, proved that two opposite sides of the frontal sinuses are asymmetric and three-dimensional classification should be developed by CT-based volumetry, because two-dimensional evaluations lack depth measurement.

Sphenovomerine suture: a useful landmark for locating sphenoid sinus ostium.

AIM: The aim of this study was to determine whether the sphenovomerine suture (SVS) can be used as a landmark to localize the sphenoidal sinus ostium. METHODS: Endoscopic imaging was done on 152 skulls to identify ostium of the sphenoidal sinus, the SVS, and the articulation of sphenoidal process of palatine bone between the body of the sphenoid and the sphenopalatine foramen. The variables were as follows: (1) the distance between the medial border of the ostium and SVS (DSO-SVS); (2) the angle between them (ASO-SVS); (3) the distance between the inferior border of the ostium and the horizontal line (DSO-HL); (4) the distance between intersection point of the SVS-sphenoidal process of the palatine bone and the medial border of sphenopalatine foramen (DSPF-SVS); and (5) the number of sphenopalatine foramen. RESULTS: Of the 152 skulls, 289 sides were included in the study. The mean value for DSO-SVS was 3.15 (1.35) mm, DSO-HL was 5.99 (2.38) mm, DSPF-SVS was 7.07 (1.96) mm, and ASO-SVS was 5.99 (9.73) mm. As DSPF-SVS decreases, DSO-SVS and DSO-HL decrease with statistical significance (Ps = 0.02 and 0.001, respectively). The distribution of the numbers of sphenopalatine foramen was as follows: one 90%, two 9.7%, and four 0.3%. CONCLUSIONS: The horizontal distance between the SVS and the sphenopalatine foramen plays a significant role in identifying the location of sphenoid sinus ostium. As with the other landmarks, the SVS provides an additional benefit in locating the sphenoid sinus ostium for endoscopic sinus surgeons. The incidence of 4 sphenopalatine foramen is 0.3%.

Epistaxis management: is medical intervention required for inactive epistaxis?

OBJECTIVES: This study aims to discuss the management and the follow-up approach in patients with epistaxis. PATIENTS AND METHODS: A total of 367 patients with epistaxis (209 males, 158 females; mean age 52.6±18.3 years; range 18 to 85 years) admitted to the Adult Emergency Department of a university hospital between January 2000 and December 2004 were retrospectively analyzed. RESULTS: Of patients, 56.7% had an idiopathic bleeding. A significantly higher number of patients aged >50 years had high blood pressure on admission. Of 141 patients (38.49%) presenting without bleeding on admission, 20 required medical intervention for recurrent epistaxis. Conservative approaches were effective in stopping bleeding in 97.8% patients. The hospitalization ratio was 5.7%. CONCLUSION: Our study result show that endonasal endoscopic mucosal cauterization is an effective method for resistant-to-treatment cases and inactive bleeding on admission is not a restraint for further examination.

Reconstruction of Anterior Skull Base After Cleaver Trauma: Combined Use of Fascia Lata and Middle Turbinate Flap in a Patient with Concha Bullosa.

This video article presents a 47-year-old male patient who presented to the emergency department after a cleaver bounced off the grinding wheel and lodged between his eyebrows. The patient complained of clear nasal drainage since the trauma. Computed tomography showed a comminuted displaced fracture starting from the right frontonasal recess and extending along the right ethmoid roof. The patient underwent surgery. The skull base defect was reconstructed with a free fascia lata graft in the first operation. In the second session, the reconstruction of the skull base was reinforced with a flap that was prepared from the middle turbinate with the concha bullosa. The patient was followed for eight months. The patient's symptoms resolved completely and there was no evidence of rhinorrhoea or any other complication at the control examination. No complications were seen on control magnetic resonance imaging.

[Quantitative and qualitative analysis of four national otorhinolaryngology journals between 2002 and 2010]. / Dört ulusal KBB dergisinin 2002/2010 yillari arasindaki niceliksel ve niteliksel analizi.

OBJECTIVES: This study aims to perform a quantitative and qualitative analysis of four national peer-reviewed otorhinolaryngology journals between 2002 and 2010 and compare various parameters in 1990-1994 period. MATERIALS AND METHODS: The number of authors and female authors, gender of first author, city and the institution where the article was submitted, number of references and national references were noted separately for each article in all issues of four national peer-reviewed journals in years 2002, 2005 and 2010. Language of articles was noted and they were grouped under six main headings based on their subjects. Quantitative analysis was performed considering evidence-based medicine principle and evidence levels of articles were noted between 1 and 5. Statistical analysis was performed using Pearson chi-square and one-way ANOVA tests. RESULTS: A total of 424 articles including 143 in 2002, 147 in 2005 and 134 in 2010 in four national otorhinolaryngology journals were evaluated. The number of authors per article was found to be 4.49, indicating no statistically significant difference between the years (p>0.05). The mean number of female authors per article was 0.85. When the institutions submitted articles were assessed, number of publications from university hospitals was higher than the education hospitals and other health care services; however, this difference was reduced in 2010. In the evaluation of cited references, the mean number of references and national references per article increased from 16.90 to 18.12 and from 1.54 to 1.68 in 2002 and 2010, respectively. According to the articles categorized to their main subjects, it was found that most of the publications were related to upper respiratory/digestive tract and neck and the least was related to facial plastic surgery. The qualitative analysis in terms of evidence-based medicine revealed no articles with level 1 evidence through three years studied. CONCLUSION: It will be useful to make similar periodical studies to improve the quality of otorhinolaryngology journals and related articles in Turkey.

The relationship between bi-spectral index and VOTE score in evaluation of drug-induced sleep endoscopy: A systematic meta-analysis.

OBJECTIVE: The aim of this study was to investigate both the presence and severity of collapse in anatomical regions defined by the VOTE score (velum, orofarinx, tongue, and epiglottis), during drug induced sleep endoscopy (DISE) in patients diagnosed with obstructive sleep apnea, based on the bi-spectral index (BIS) sedation level. METHODS: In order to conduct a meta-analysis of articles examining the relationship between the VOTE score and BIS sedation level in determining the presence and severity of upper airway collapse during DISE, a literature review was performed. RESULTS: As a result of the search made in the specified databases, a total of 1864 articles were reached. Five articles included in this review that had sufficient statistical data to be included in the meta-analysis were found. A statistically significant correlation was found between the BIS sedation level and the areas of obstruction in the VOTE score. The strongest association is at the epiglottis level, followed by the velum, oropharynx, and tongue, respectively (CC: 0.639, CC: 0.53, CC: 0.49, and CC: 0.346, P < .001). In the subgroup analysis of publications with BIS sedation levels in the range of 60 to 65, the distribution in the epiglottis region was heterogeneous, and it was found to be statistically significant according to the random effect model (P < .001). The distribution in the tongue was homogeneous, and it was found to be statistically significant according to the fixed effect model (P < .001). When the publications in which the BIS sedation level is in the range of 65 to 75 are examined according to the areas of obstruction; the distribution in 4 anatomical regions was homogeneous and statistically significant according to the fixed effect model (P < .001). CONCLUSION: It was found that BIS sedation levels during DISE application in obstructive sleep apnea patients were associated with obstruction of the anatomical regions of the upper airway. The strongest association was found at the epiglottis level, followed by the velum, oropharynx, and tongue, respectively. It is helpful to monitor the sedation level with BIS in order to better define the collapsed areas during DISE application. However, more studies are needed to better understand the relationship between BIS sedation values and sleep stages.

A bibliometric analysis of obstructive sleep apnea and anesthesia.

To conduct a bibliographic analysis of obstructive sleep apnea (OSA) which has reached epidemic proportions and is a frequent, unknown, and important cause of perioperative morbidity and mortality, by examining the internationally most cited articles. For OSA, the most cited articles in the field of anesthesiology and reanimation, appropriate access terms were compiled and combined, and related publications were searched using the Thompson Reuters Web of Science Citation Indexing search engine. A total of 79 journal publications were found on OSA and anesthesia, with an average of 14.86 citations per article. The most cited publication was the "Society for Ambulatory Anesthesia Consensus Statement on Preoperative Selection of Adult Patients with Obstructive Sleep Apnea Scheduled for Ambulatory Surgery" published in the journal Anesthesia and Analgesia and was conducted by Joshi et al. It was found that 38 of the 79 studies reached as a result of the search were articles, and the average number of citations was 21.13. The Hirsch index of these articles, which were cited 803 times in total, was 15. A total of 31 articles (81.57%) were cited at least once, while the remaining 7 articles (18.43%) were not cited at all. The majority of the articles obtained are from the research fields of anesthesiology (n = 20; 52.63%), followed by otorhinolaryngology (n = 5; 13.15%), pediatrics (n = 5; 13.15%), respiratory system (n = 5; 13.15%), internal medicine (n = 4; 10.52%), and the rest were in various fields. Publications on "Obstructive Sleep Apnea" and "Anesthesia" have increased rapidly in the last decade. Anesthesia management and airway safety, patient management, including pain control in the postoperative period, and noninvasive mechanical ventilation treatment methods, such as continuous positive airway pressure, are hot topics.

Methotrexate for recurrent chronic rhinosinusitis with nasal polyps: A randomized, controlled, phase 2 clinical trial.

OBJECTIVE: This randomized, controlled, open-label, phase 2 clinical trial aimed to assess the efficacy and safety of low-dose methotrexate as maintenance therapy for recurrent postoperative chronic rhinosinusitis with nasal polyps (CRSwNPs). METHODS: Forty-one patients with CRSwNPs who experienced postoperative polyp recurrence(s) were randomly divided into three groups to receive one of the following treatments for 8 weeks: daily intranasal mometasone furoate monohydrate 200 mcg (control [intranasal corticosteroids (INCS)] arm, n = 13]); daily per oral methylprednisolone 8 mg (oral corticosteroids [OCS] arm, n = 14); and once weekly per oral 10 mg methotrexate (MTX arm, n = 14). All patients were assessed at three clinical visits according to the Lund-Kennedy endoscopic grading system (LKES), visual analog scale (VAS), Turkish version of the Sinonasal Outcome Test-22 (SNOT-22), peak nasal inspiratory flow (PNIF), butanol olfactory threshold test (BuOT), serum total IgE level, presence of peripheral eosinophilia, serum biochemical assays, and adverse events. RESULTS: All efficacy outcome measures significantly improved in all three groups, except for the nonrecovery of peripheral eosinophilia in the INCS group. There was no significant difference among the groups in terms of LKES scores. Scores for the Turkish version of the SNOT-22, PNIF, BuOT, and serum IgE levels were also similar among the groups. However, total VAS scores recovered significantly better in the INCS group than in the MTX group. Serum biochemical assays remained normal in all groups. Adverse events were minor and observed only in the OCS group. CONCLUSION: Low-dose MTX was a safe and effective maintenance therapy for patients with recurrent postoperative CRSwNPs.

Comparison of clinical and pathological staging in oral cavity cancers.

OBJECTIVES: This study aims to compare the clinical and pathological TN stages of patients with oral cavity cancer and to identify the factors leading to staging discrepancies. PATIENTS AND METHODS: The medical records of 125 patients (77 males, 48 females; mean age 57 years; range 19 to 82 years) who underwent primary tumor resection and neck dissection simultaneously for oral cavity cancer were retrospectively analyzed. Clinical and pathological TN stages of all patients were compared. Sensitivity, specificity and predictive values of clinical staging were calculated. RESULTS: Computed tomography (CT) with contrast which was used to examine the cervical lymph node metastasis showed a sensitivity of 71.9%, a specificity of 75%, a positive predictive value of 70.6%, and a negative predictive value of 76.1%. The diagnostic accuracy of CT for detecting mandibular invasion was as follows: sensitivity, 92.6%; specificity, 97%; positive predictive value, 96.1%; and negative predictive value, 94.3%. CONCLUSION: High correlation between clinical and pathological stages for assessment of mandibular invasion and neck metastasis supports the reliability of CT in our study. Diagnostic contribution of magnetic resonance imaging is necessary for assessment of extrinsic tongue muscle involvement; in cases of tongue cancer which are surrounded by induration on palpation and extending to the floor of the mouth.

A randomized clinical study: outcome of submucous resection of compensatory inferior turbinate during septoplasty.

BACKGROUND: Septoplasty and/or turbinate surgery are commonly used surgical techniques for the treatment of mechanical nasal obstruction. The aim of this study was to define the effectiveness of submucous resection of a hypertrophied turbinate together with simultaneous septoplasty for the treatment of nasal obstruction. METHODS: Forty-two patients with septum deviation and compensatory contralateral inferior turbinate hypertrophy were recruited in this study. The inferior turbinate hypertrophy was diagnosed based on examination. The patients were randomly divided into two groups. In group A, a submucous resection was performed to treat a hypertrophied inferior turbinate, together with a septoplasty. In group B, only a septoplasty was performed. Acoustic rhinometry and rhinomanometry tests were conducted for an objective evaluation of nasal patency. A visual analog scale (VAS) was applied to the patients for the subjective evaluation of nasal obstruction complaints. RESULTS: The application of submucous resection intended to reduce a hypertrophied inferior turbinate led to a distinctive increase in cross-sectional area of nasal patency; however, when the two groups were compared, it was statistically significant only at the post-operative sixth month. There was no difference between the results of rhinomanometry. The subjective symptom scores were better in group A than in group B between the post-operative first to sixth month. CONCLUSION: Submucous resection of a hypertrophied inferior turbinate is necessary for the treatment of nasal obstruction.

[Evaluation, diagnosis and treatment criteria for bacterial rhinosinusitis among primary health care physicians]. / Birinci basamak hekimleri arasinda akut bakteriyel rinosinüzit degerlendirme, tani ve tedavi ölçütleri.

OBJECTIVES: This study was planned to determine the evaluation criteria for acute bacterial rhinosinusitis (ABRS) among primary health care physicians. PATIENTS AND METHODS: This study was conducted with face-to-face survey method between April 2009 and June 2009. The physicians were asked to answer the prespecified questions about the etiopathogenesis, diagnosis and treatment criteria for ABRS by grading from 1 to 5. The demographic and undergraduate education information of the physicians, daily number of patients they see, the number of patients diagnosed with ABRS and family physicians specialization were asked. One hundred and forty two physicians visits were performed at 33 Health Centers or Public Health Centers. Sixty-nine doctors (34 males, 35 females; mean age 44.5±5.5 years; range 33 to 57 years) answered the survey. RESULTS: Medical experience was 20.0±5.5 years and 52.2% of the physicians were Family Physicians and 47.8% were General Practitioners. For diagnosis, the history (87.3%) and Waters X-ray (74.6%) were reported as the most utilized tools. Among antibiotics, amox-clu, cefuroxime axetil and levofloxacin were found to be preferred at rates of 80.9%, 76.1% and 60.3%, respectively. 74.6% and 96.8% of the physicians lacked the facility to perform radiological examination and culture, respectively. CONCLUSION: 48.6% of the visited physicians agreed to answer the questionnaire. According to the results of the survey, General Practitioners and Family Physicians involved in conducting the basic health services did not assimilate criteria for diagnosis and treatment of ABRS. Training targeting ABRS should be involved for postgraduate period.

Determination of Retronasal Olfactory Threshold Values.

OBJECTIVES/HYPOTHESIS: The aim of this study was to generate normative data of retronasal olfactory threshold values for normosmic and hyposmic individuals and to test the validity of that data by determining the discriminative power for normosmic/hyposmic differentiation. STUDY DESIGN: Prospective, descriptive and methodological study. METHODS: The orthonasal olfactory function of 20 normosmic and 20 hyposmic cases was evaluated using the Sniffin' Sticks Olfactory test. Sniffin' Sticks odor threshold, odor discrimination, and odor identification values and threshold discrimination identification (TDI) scores were recorded. A 13-item test battery previously prepared in our Rhinology Laboratory for retronasal olfactory threshold test that consisted of concentrated solutions prepared from 2:1 diluted 99% phenylethyl alcohol (PEA) and water was used. Each concentration was evaluated with water control, and if not answered correctly, the same process was continued by moving to a higher concentration series. Four consecutive correct answers were determined as the patient's retronasal olfactory threshold. RESULTS: A strong correlation was found between Sniffin' Sticks TDI scores and retronasal odor threshold values in the normosmic group (P < .001, r:0.67). A very strong correlation was found between Sniffin' Sticks TDI scores and retronasal olfactory threshold values in the hyposmic group (P < .001, r:0.81). Furthermore, receiver operating characteristic (ROC) analysis revealed that the sensitivity and the specificity of normosmic/hyposmic differentiation of retronasal olfactory threshold test was 95% and 100%, respectively. The diagnostic cutoff value was 8.5. CONCLUSIONS: This study shows that the retronasal olfactory test, a psychophysical odor test performed using an orally presented stimulus, can be used to differentiate normosmic and hyposmic cases. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:1608-1614, 2021.

Therapeutic effects of melatonin on an ovalbumin-induced allergic rhinitis model in rats.

OBJECTIVE: We aimed to investigate the therapeutic effects of melatonin in an experimental AR model. METHODS: Thirty-two Wistar rats were randomised into four groups (n = 8 each). The experimental AR model was established in the saline (SF), ethanol, and melatonin groups via intraperitoneal (i.p.) injections and intranasal application of ovalbumin. The SF, ethanol, and melatonin groups received daily i.p. saline, 2% ethanol dissolved in saline, and 10 mg/kg melatonin dissolved in 2% ethanol and saline. The control group received the same amount of i.p. and intranasal saline. Total nasal symptom scores were recorded in all rats on days 1 (baseline), 15, 20, 25, and 30. Serum ovalbumin-specific IgE, IL-13, and melatonin levels were measured on days 1 (baseline), 15, and 30. The nasal mucosa of all rats was scored histopathologically. RESULTS: The total nasal symptom scores and serum ovalbumin-specific IgE values of the SF, ethanol, and melatonin groups were significantly higher on day 15 than those of the control group. On day 30, the scores and serum ovalbumin-specific IgE values of the melatonin group were similar to those of the control, whereas the SF and ethanol groups had statistically higher scores. The histological scores of the SF and ethanol groups were significantly higher than those of the control and melatonin groups, but no significant difference was found between the melatonin and control groups. CONCLUSION: Melatonin reduced total nasal symptom scores and serum ovalbumin-specific IgE levels and improved histological inflammation parameters in the ovalbumin-induced rat experimental AR model.

Turkish Guideline for Diagnosis and Treatment of Allergic Rhinitis (ART).

OBJECT: To prepare a national guideline for Otorhinolaryngologist who treat allergic rhinitis patients. METHODS: The study was conducted by three authors, namely the writing support team. The support team made the study plan, determined the writing instructions, chose the subgroups including the advisory committee, the advisors for authors and the authors. A workshop was organized at the very beginning to explain the details of the study to the team. Advisors took the chance to meet their coworkers in their subgroups and determined the main headings and subheadings of the guideline, together with the authors. After key words were determined by the authors, literature search was done in various databases. The authors keep in touch with the advisors and the advisors with the advisory committee and the support group at every stage of the study. National and International published articles as well as the abstracts of unpublished studies, imperatively presented in National Congresses, were included in this guideline. Only Guideline and meta-analyses published in last seven years (2013-2017) and randomized controlled studies published in last two years (2015-2017) were included. After all work was completed by the subgroups, support team brought all work together and edited the article. RESULTS: A detailed guideline about all aspects of allergic rhinitis was created. CONCLUSION: The authors believe that this guideline will enable a compact and up-to-date information on allergic rhinitis to healthcare professionals. This guideline is the first in the field of Otolaryngology in Turkey. It should be updated at regular intervals.

Retronasal Olfaction Test Methods: A Systematic Review

Background: This report produces a bibliographic study of psychophysical tests proposed clinical assessments of retronasal olfaction. Aims: We review how these tests can be utilized and discuss their methodological properties. Study Design: Systematic review. Methods: We undertook a systematic literature review investigating the retronasal olfaction test methods. PubMed, the free online MEDLINE database on biomedical sciences, was searched for the period from 1984 to 2015 using the following relevant key phrases: "retronasal olfaction", "orthonasal olfaction", "olfaction disorders", and "olfaction test". For each of the selected titles cited in this study, the full manuscript was read and analyzed by each of the three authors of this paper independently before collaborative discussion for summation and analytical reporting. Two reviewers independently read the abstracts and full texts and categorised them into one of three subgroups as follow, suitable, not-suitable, and unsure. Then they cross-checked the results, and a third reviewer decided assigned the group "unsure" to either the suitable group or the not-suitable group. Fifty eight studies revealed as suitable for review by two authors whereas 13 found not suitable for review. The total amount of 60 uncertain (unsure) or differently categorized articles were further examined by the third author which resulted in 41 approvals and 19 rejections. Hence 99 approved articles passed the next step. Exclusion criteria were reviews, case reports, animal studies, and the articles of which methodology was a lack of olfaction tests. By this way excluded 69 papers, and finally, 30 original human research articles were taken as the data. Results: The study found that the three most widely used and accepted retronasal olfaction test methods are the retronasal olfaction test, the candy smell test and odorant presentation containers. All of the three psychophysical retronasal olfaction tests were combined with orthonasal tests in clinical use to examine and understand the smell function of the patient completely. There were two limitations concerning testing: "the lack concentrations and doses of test materials" and "performing measurements within the supra-threshold zone". Conclusion: The appropriate test agents and optimal concentrations for the retronasal olfaction tests remain unclear and emerge as limitations of the retronasal olfaction test technique. The first step to overcoming these limitations will probably require identification of retronasal olfaction thresholds. Once these are determined, the concept of retronasal olfaction and its testing methods may be thoroughly reviewed.

Metastatic Renal Cell Carcinoma of the Nasal Septum: A Case Report.

Metastatic lesions of the nasal cavity and paranasal sinuses are rare tumors. Carcinomas originating from intrapelvic organs play an important role in the differential diagnosis of these masses because of their paradoxic spread to the head and neck region. In this study we report a case with metastatic renal cell carcinoma of the caudal nasal septum.

[Circumferential subannular grafting technique in tympanoplasty: preliminary results]. / Timpanik membran greftlemesinde sirkümferensiyel subanüler yöntem: Ilk sonuçlar.

OBJECTIVES: We evaluated the preliminary results of the circumferential subannular grafting technique, which has been proposed as a modification of the standard underlay method. PATIENTS AND METHODS: Twenty patients (15 females, 5 males; mean age 32.4 years; range 13 to 65 years) with chronic otitis media were operated on with the use of the circumferential subannular grafting technique. The mean follow-up was 13.6 months (range 1 to 36). RESULTS: No complications were encountered related to graft survival or the external ear canal. The mean air-bone gap was 25.2+/-8.6 dB preoperatively and 15.8+/-7.4 dB postoperatively, with a mean decrease of 10+/-7.9 dB. CONCLUSION: Circumferential subannular grafting was found to be effective in restoring tympanic membrane perforations in all the quadrands. The main limitations of the technique are the need for surgical skills and the necessity of an intact or remnant manubrium mallei.