Effects of hyaluronic acid on the bone healing after lateral osteotomy: an experimental animal model.

OBJECTIVE: Postoperative comfort of the patients undergoing rhinoplasty might be poor because of edema and ecchymosis caused by lateral osteotomy. In this animal experiment, we aimed at performing a quantitative assessment of effects of hyaluronic acid usage on healing process of lateral osteotomy. METHODS: Fourteen New Zealand rabbits with a weight of 2000-2500 kg and an age of 8-12 weeks were included. Under anesthesia, nasal dorsums were exposed with midline incision and lateral osteotomies on both sides were performed using a 2 mm chisel. A hyaluronic acid-based mesh (Hyalonect®) (1 × 1 cm) was embedded on the left osteotomy areas of all rabbits. Right osteotomy areas were left blank as control group. Collagen density and capillary development were quantitatively compared. RESULTS: Convergence of fracture lines was observed in 6 (60%) of 10 samples from Hyalonect® group, while was observed in 4 (40%) of 10 samples from control group. Although a higher rate of convergence was seen in the Hyalonect® group (60% vs 40%), the difference was not statistically significant (p = 0.5). Median collagen score was 2 (1-3) in the Hyalonect® group and 1 (1-2) in the control group. Median capillary count value was 4 (1-23) in the Hyalonect® group and 3 (1-17) in the control group. Both collagen score and capillary count values were significantly greater in the in the Hyalonect® group compared with the control group (p = 0.023 and p = 0.019, respectively). CONCLUSION: The effects of hyaluronic acid-based meshes on the bone healing process of the lateral osteotomy area might be investigated furthermore, on more comprehensive studies, as a material facilitating collagen organization and capillary development.

Analysis of the Effect of Weight Loss on Eustachian Tube Function by Transnasal Videoendoscopy.

OBJECTIVE: To investigate the effect of weight loss after bariatric surgery on eustachian tube (ET) function with video endoscopy. MATERIALS AND METHODS: The present study was conducted as a prospective cohort and was completed with 19 patients. Three-step tympanometry (basal, Toynbee, Valsalva), dynamic slow-motion video endoscopy, and the Eustachian Tube Dysfunction Questionnaire-7 (ETDA-7) were applied to the patients preoperatively before bariatric surgery and in the postoperative 6th month. Dynamic slow-motion video endoscopy was graded between 0 and 3, or classified as patulous, as indicated in the literature. RESULTS: The mean body mass index of 6 male and 13 female patients decreased from 47.3 ±â€Š4.6 to 31.2 ±â€Š5.4. Grade decline (median 2 ±â€Š1) was experienced in all patients in DSVE, and 1 patient resulted as patulous ET. The ETDA-7 scores decreased in11 patients, remained stable in 7 patients, and increased in 1 patient with patulous ET. The statistical analysis of the preoperative and postoperative DSVE grading and ETDA-7 scores, excluding the patulous ET patient, was found to be significant (P  = 0.001 and P  = 0.003, respectively). There was no significant change in any of the tympanometry parameters (P > 0.05). CONCLUSIONS: Rapid weight loss with bariatric surgery results in an improvement in both the DSVE images and in the complaints of ET dysfunction in the majority of patients, but in some patients it may result in patulous ET. Therefore, preoperative evaluation of the ET with DSVE and questioning the patient's complaints are important in predicting patients who may develop patulous ET.

The effect of chemotherapy on olfactory function and mucociliary clearance.

OBJECTIVES: Olfactory sensory neurons and the olfactory mucosa are both important for optimal olfactory function. The potential nasal mucosal toxicity of chemotherapy regimens has not been assessed yet. The aim of this study was to objectively investigate the effect of chemotherapy on mucociliary clearance and olfactory function and to evaluate whether this effect differs between different chemotherapy regimens and age groups. PATIENTS AND METHODS: The study included consecutive patients admitted for the treatment of a variety of primary tumors (except head and neck and brain malignancies). Patients were evaluated for olfaction and mucociliary clearance before and immediately after completing the last session of chemotherapy cycles, according to the therapeutic protocol. For objective evaluation, the saccharine test was used for mucociliary clearance and the Sniffin' Sticks test for olfactory function. Of the 46 initial patients, 30 completed the study. Groups were formed according to the chemotherapy regimen (four groups: CA (doxorubicin + cyclophosphamide), Folfox (oxaliplatin +5-FU + folinic acid), DCF (docetaxel + cisplatin +5-FU), and GC (gemcitabine + cisplatin)) and according to age (two groups: < 55 years and > 55 years). RESULTS: In the overall analyses, significant deterioration was noted in both mucociliary clearance time and smell scores (olfactory threshold (OT), olfactory discrimination (OD), olfactory identification (OI), and the composite threshold-discrimination-identification (TDI) score). The changes in these scores showed no significant differences between chemotherapy groups. The decrease in OT and global TDI scores was more severe in the younger age group. CONCLUSIONS: Chemotherapy impairs both the mucociliary clearance and olfactory function in cancer patients. This might reflect the collective negative effect of chemotherapy on olfactory function, not only through the neurocytotoxic effect but also the cytotoxic effect on the nasal mucosa. In addition, the reduction in olfactory threshold and total olfactory function scores was seen to be more profound in younger patients, which could have been due to higher initial scores.

Evaluation of retinal vessel density and foveal avascular zone measurements in patients with obstructive sleep apnea syndrome.

PURPOSE: To compare retinal capillary plexus vessel densities, choroidal thickness, optic disc vessel densities and foveal avascular zone measurements between normal subjects and subjects with obstructive sleep apnea syndrome (OSAS) using spectral-domain OCT angiography (OCTA). METHODS: Forty eyes of patients with overall OSAS, 20 eyes of patients with mild-moderate OSAS, 20 eyes of patients with severe OSAS on polysomnography and 21 controls were evaluated with the RTVue-XR Avanti OCTA (Optovue, Inc., Fremont, CA). Superficial and deep retinal capillary plexus vessel densities, choroidal thickness and foveal avascular zone (FAZ) parameters (area, diameter, acircularity index of the FAZ, foveal density-300) were measured for all subjects. RESULTS: Superficial capillary plexus vessel densities of the groups were similar. Deep capillary plexus (DCP) vessel densities of all three OSAS groups decreased in the parafoveal region (< 0.001). In the perifoveal region, DCP vessel densities were decreased in the Overall OSAS group (p = 0.023) and in the Severe OSAS group (p = 0.021), whereas it was similar in the Mild-moderate OSAS group. Choroidal thickness decreased in all three OSAS groups (p < 0.001). All FAZ measurements and foveal density-300 measurements were similar compared to the control group. CONCLUSION: Our findings indicate that in severe OSAS patients, deep parafoveal, perifoveal vascular densities decrease and the choroid layer becomes thinner. When evaluating a patient with OSAS, it should be kept in mind that there may be eye involvement due to the disease.

Coexistence of frontal sinus hypoplasia with maxillary sinus hypoplasia: a radiological study.

The goal of this study was to determine whether frontal sinus hypoplasia coexists with maxillary sinus hypoplasia. Analyzing paranasal CT scans retrospectively, we included 86 patients who had a hypoplastic maxillary sinus at least on one side and 80 patients with bilateral normal maxillary sinuses (control group). We classified hypoplastic maxillary sinuses using the classification system previously defined by Bolger et al. (Otolaryngol Head Neck Surg 103(5):759-765, 1990). We classified the frontal sinuses as aplastic, hypoplastic, medium-sized, and hyperplastic; as previously defined by Guerram et al. (Am J Phys Anthropol 154(4):621-627, 2014). We compared the presence of frontal sinus hypoplasia using Chi-square test between the groups. The mean age of the maxillary sinus group was 43.2 (range 18-84) years. Of 86 patients, 33 (38.4%) had unilateral and 53 (61.6%) had bilateral maxillary sinus hypoplasia. Of 139 maxillary sinuses totally included, 73 (52.5%) were type 1, 51 (36.7%) were type 2 and 15 (10.8%) were type 3 hypoplastic maxillary sinuses. Of 332 frontal sinuses totally included, 25 (7.5%) were aplastic, 32 (9.6%) were hypoplastic, 172 (51.9%) were medium-sized, and 103 (31%) were hyperplastic. Of 86 patients with a hypoplastic maxillary sinus at least on one side, 29 (33.7%) had a hypoplastic and/or aplastic frontal sinus, while 10 (12.5%) had a hypoplastic and/or aplastic frontal sinus at least on one side in control group. Incidence of frontal sinus hypoplasia and/or aplasia was significantly higher in patients with maxillary sinus hypoplasia compared to the patients with bilaterally normal maxillary sinuses (χ2 = 10.384, P = 0.001). Maxillary sinus hypoplasia has a significantly higher coexistence with frontal sinus hypoplasia. This study may have an implication for anatomical studies about the development of the paranasal sinuses and paranasal sinus surgery as well as further morphological studies.

Localization of orbit in patients with maxillary sinus hypoplasia: a radiological study.

PURPOSE: We aimed to investigate the medial and inferior localization of orbit in patients with maxillary sinus hypoplasia using paranasal computerized tomography. METHODS: We included 76 patients who had a hypoplastic maxillary sinus at least on one side, and 76 patients with normal maxillary sinuses (control group). To assess the localization of orbit, we measured the distances from middle meatal antrostomy point to medial border of orbital medial wall and to the lower border of orbital floor in all patients. We performed statistical comparisons between the groups. RESULTS: Of 76 patients, 26 (34.2%) had unilateral and 50 (65.8%) had bilateral maxillary hypoplasia. Of 126 maxillary sinuses, 70 (55.6%) was type 1, 42 (33.3%) was type 2 and 14 (11.1%) was type 3 hypoplastic. The mean distance from antrostomy point to lamina papyracea was 4.36 ± 2.62 mm in the hypoplasia group, and 1.08 ± 1.7 mm in the control group. The mean distance from antrostomy point to orbital floor was 1.53 ± 1.73 mm in the hypoplasia group, and 1.87 ± 1.96 mm in the control group. Lamina papyracea showed a significant medial localization in the maxillary hypoplasia group as compared to the control group (p < 0.001). CONCLUSION: The orbit has a medial localization in patients with maxillary sinus hypoplasia resulting in a higher complication risk during endoscopic sinus surgery.

The Effect of Anterior Palatoplasty Plus Modified Expansion Sphincter Pharyngoplasty on Voice Performance in Obstructive Sleep Apnea Syndrome.

OBJECTIVE: We aimed to investigate the effect of anterior palatoplasty (AP) plus modified expansion sphincter pharyngoplasty (MESP) on voice performance in patients with obstructive sleep apnea syndrome (OSAS). METHODS: Fourteen OSAS patients who had AP + MESP procedure were included in the study. Voice performances of the patients were analyzed with acoustic voice analysis before surgery, and 6 months after surgery. RESULTS: Preoperative and postoperative F0, jitter percentage, and shimmer percentage were compared. Mean preoperative F0 was 129.85 Hz, and mean postoperative F0 was 138.07 Hz, with a significant difference in between (P = 0.017). Mean preoperative jitter percentage was 0.65, and mean shimmer percentage was 0.88, while those values were 0.67 and 0.84, respectively, in the postoperative period. The differences were not statistically significant (P = 0.801 and 0.652). CONCLUSION: The AP + MESP procedure performed for OSAS results in improvement of F0 in the long term; however, there were no differences in jitter percentage and shimmer percentage.

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 Effect of Septoplasty on Voice Performance in Patients With Severe and Mild Nasal Septal Deviation.

OBJECTIVE: The authors aimed to analyze the effect of septoplasty, performed in 2 groups with different grades of nasal septal deviation (NSD), on voice performance. METHODS: A total of 43 patients who had septoplasty due to NSD and were included in the study. The study groups were divided into 2 groups as groups A and B. The patients in group A had severe NSD, and 1 of the nasal cavity was obstructed totally or near totally. In group B, the NSD narrowed the nasal passage, and the deviation was not severe. The voice performance was analyzed preoperatively, and 1 month after surgery with both objective and subjective methods. Objective analysis included acoustic voice analysis, and measurement of F0, jitter %, shimmer %. Preoperative and postoperative F0, jitter %, shimmer %, and Voice Handicap Index-30 (VHI-30) were compared in groups A and B. RESULTS: F0 showed a statistically significant improvement after surgery in group A (P <0.001). Jitter %, shimmer %, and VHI-30 scores also improved after surgery, without any statistical significance. In group B, preoperative and postoperative F0, jitter %, and shimmer % were similar. However, VHI-30 scores showed a significant improvement postoperatively (P = 0.005). Comparison of groups A and B for improvements of the voice parameters revealed that group A showed improvements in all voice parameters, and the improvements of F0 and shimmer % were statistically significant. CONCLUSION: Septoplasty performed for severe NSD obstructing nasal lumen totally or near totally results in significant improvements in the voice performance.

The effect of obstructive sleep apnea syndrome and continuous positive airway pressure treatment on voice performance.

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) may affect voice performance due to alterations that occur in the upper respiratory tract. The aim of the study was to assess the effect of OSAS and continuous positive airway pressure (CPAP) treatment on voice performance. MATERIALS AND METHODS: Twenty-seven patients with moderate to severe OSAS (apnea-hypopnea index ≥15/h) who underwent polysomnographic examination and 28 age- and gender-matched normal control subjects were enrolled in the study. The patients and the control subjects completed Voice Handicap Index (VHI) questionnaires, and their acoustic voice analyses were performed. Fundamental frequency (F0), jitter %, and shimmer % parameters were statistically compared. Acoustic analyses were performed again 1 month after regular CPAP use in OSAS patients, and the parameters before and after the treatment were compared. RESULTS: F0 was 160.82 Hz, jitter was 0.70%, shimmer was 1.05%, and VHI was 1.18 in the control group. In OSAS patients before CPAP treatment, F0 was 157.04 Hz, jitter was 0.82%, shimmer was 1.33%, and VHI was 13.11. These results showed that shimmer and VHI parameters were significantly worse in OSAS patients. After CPAP treatment, F0 was 169.19 Hz, jitter was 0.62%, shimmer was 0.93% and VHI was 5.00. The differences were statistically significant in all parameters. CONCLUSION: The acoustic parameters of OSAS patients differed from those of the normal control subjects. The patients' voice performance improved after a regular use of CPAP treatment for 1 month.

[The effect of allergy on prognosis of surgically treated nasal polyposis]. / Alerjinin cerrahi olarak tedavi edilen nazal polipozis prognozuna etkisi.

OBJECTIVES: This study aims to investigate the effects of allergy existence on prognosis of surgically treated nasal polyposis. PATIENTS AND METHODS: This prospective study included 29 patients (22 males, 7 females; mean age 45.9 years; range 21 to 72 years) admitted to our clinic with nasal polyposis between January 2006 and December 2008. Patients were divided into two groups. Group 1 consisted of 11 patients who had positive results in skin prick test or whose positivity of allergy was confirmed by serum-specific immunoglobulin E, as a skin prick test was contraindicated. Group 2 included 18 patients who had negative allergy test results. Endoscopic and radiological evaluations of the patients were done preoperatively. Bilateral endoscopic sinus surgery was applied to all patients. RESULTS: Statistical analysis of pre- and postoperative endoscopic and radiological evaluation findings in group 1 showed a non-significant improvement (p>0.05). Statistical analysis of pre- and postoperative endoscopic and radiological evaluation findings in group 2 demonstrated a significant improvement (p<0.001, p<0.005 respectively). CONCLUSION: Response to surgical treatment is more limited in nasal polyposis patients with a positive allergy test.

[Importance of laryngologic examination in chronic cough]. / Kronik öksürükte larengolojik muayenenin önemi.

OBJECTIVES: This study aims to investigate the distribution of etiologic factors related to otorhinolaryngology in chronic cough patients with normal lung examination and spirometric findings, and also highlight the importance of videolaryngostroboscopic (VLS) examination with these patients. PATIENTS AND METHODS: Seventy-six patients (31 males, 45 females; mean age 48.0±15.5 years; range 18 to 83 year) who applied to pulmonology outpatient clinic with cough complaint for more than two months were included in the study. After being evaluated by a pulmonologist, patients were referred to otolaryngology outpatient clinic. To detect the underlying cause of cough, patients' detailed histories, and flexible fiberoptic endoscopy and VLS findings were reviewed. Reflux symptom index (RSI) was used for the diagnosis of gastroesophageal reflux. RESULTS: In RSI ≥13 group, posterior commissure edema was detected in 12 patients (42.9%), and posterior commissure hyperemia was detected in four patients (14.3%). These findings were statistically significantly higher than RSI <13 group (p=0.006 and p=0.016, respectively). No significant difference was present between the group of patients with allergic rhinitis and the group of patients without allergic rhinitis in terms of VLS findings. Mucopurulent secretion rate in posterior commissure in patients with acute sinusitis findings was statistically higher than patients without acute sinusitis findings (p<0.001). CONCLUSION: Chronic cough is a common symptom of many different diseases. Therefore, a multidisciplinary approach is important for diagnosis. Videolaryngostroboscopy is a valuable examination tool in the differential diagnosis of gastroesophageal reflux and acute sinusitis.

Investigation of lateral pharyngeal walls in OSAS.

The aim of this study is to investigate the relationship between the site of obstruction detected on Müller's maneuver and the polysomnography findings in patients with obstructive sleep apnea syndrome. This study is a prospective cohort study in a setting of Tertiary referral center. The study was performed on 87 patients (59 males and 28 females) with a mean age of 50 ± 10.34 years (range 20-83 years) who presented with the complaints of snoring, apnea, witnessed apnea and daytime sleepiness. The height and body weight of the enrolled patients were measured and the body mass indexes were calculated. The obstruction degrees of the soft palate and lateral pharyngeal walls at the level of the soft palate and the obstruction degrees of the tongue base and lateral pharyngeal walls at the level of the tongue base were determined using the Müller's maneuver. All patients underwent whole-night polysomnography at our hospital's Sleep Center. The apnea-hypopnea index values of the patients increased as their ages and body mass index values increased. There was a highly statistically significant correlation between apnea-hypopnea index and the obstruction degree of the lateral pharyngeal walls at the level of the tongue base on Müller's maneuver (p < 0.01). We found that the apnea-hypopnea index increased as the obstruction degree of the lateral pharyngeal walls increased on Müller's maneuver. In patients with obstructive sleep apnea syndrome, a high apnea-hypopnea index can be predicted if the obstruction degree of the lateral pharyngeal walls is high at the level of the tongue base on Müller's maneuver.

The predictive value of Muller maneuver in REM-dependent obstructive sleep apnea.

To our knowledge, no studies up to date have investigated the correlation of rapid eye movement (REM) dependent obstructive sleep apnea syndrome (OSAS) and Muller maneuver. The aim of this study is to investigate whether REM-dependent OSAS is predicted by the findings of the Muller maneuver. The study was conducted on 149 patients with witnessed apnea and daytime sleepiness. Muller maneuver was performed to all patients and the obstruction site was determined using a five-point scale. Then, polysomnography of the patient was obtained and the apnea-hypopnea indexes were determined in total sleep time, REM-dependent sleep and non-REM-dependent sleep. The correlations between the Muller maneuver findings and polysomnographic data were analyzed. The ages of the patients included in the study ranged between 25 and 73 years with a mean age of 49.3 ± 10.1 years. Their mean body mass index was 30.8 ± 5.1 kg/m(2) (range 21.9-55.4 kg/m(2)). The patients' mean apnea-hypopnea indexes in total sleep time was 28.1 and ranged between 5.4 and 124.3. REM-dependent OSAS was determined in 49 patients. When the data were analyzed, it was determined that there were no statistically significant correlations between tongue base or lateral pharyngeal band obstruction at the level of hypopharynx and the REM-dependent OSAS. At the level of the soft palate, the obstruction caused by the lateral pharyngeal bands or soft palate and REM dependency did not show any statistically significant correlation (p > 0.05). In conclusion, Muller maneuver does not provide useful data to predict REM dependency of OSAS.

Use of hyaluronic acid matrix in dorsal augmentation rhinoplasty.

Augmentation rhinoplasty sometimes is required for patients with saddle nose deformity caused by failed rhinoplasty or facial trauma; finding appropriate grafting material remains a significant problem for this procedure. We investigated hyaluronic acid matrix as an allograft for dorsal augmentation rhinoplasty in a rabbit model. We performed an osteotomy on the nasal bones of eight rabbits. Four animals were sham operated as the control group and four were administered a mixture of saline-gelled hyaluronic acid matrix and sliced cartilage. Ultrasonography and three-dimensional reconstruction tomography were performed at the end of the experimental period. After sacrifice of the animals, nasal tissues were examined for histopathology, and both collagen scores and number of capillaries were compared between the two groups. Increased collagen and capillaries were apparent in the hyaluronic acid matrix group compared to controls. The median collagen score was significantly greater for the hyaluronic acid matrix group than for the control group. Although the number of capillaries for the hyaluronic acid matrix group was greater than for the control group, the difference was not statistically significant. Three weeks is sufficient for adhesion of ends of fractures in clinical practice; however, we found no ossification at this time in either group. A hyaluronic acid matrix may be a useful alternative supplement for dorsal augmentation rhinoplasty. Development of collagen was commensurate with membranous ossification; however, assessment of complete ossification requires a longer experimental period.

Analysis of the Correlation of the Lamina Papyracea-to-Midline Distance with the Location of Anterior Ethmoidal Artery and Keros Classification.

The aim of the study was to investigate the relations between anatomical structures that are susceptible to inadvertent injuries during the surgery using preoperative computed tomography (CT) scans. 153 CT scans were reviewed and the distance from the lamina papyracea (LP) to the midline and the distance of the anterior ethmoidal artery (AEA) to the skull base were measured bilaterally. Also, the depth of olfactory fossa was measured and categorized using the Keros classification. The measurements were analyzed to determine whether LP-to-midline distance was correlated with the distance between the AEA and the skull base and Keros classification. Additionally, correlation of Keros classification with the distance from the AEA to the skull base was investigated. In a total of 306 measurements, 26 (%8.49) were classified as Keros type I, 200 (65.35%) as Keros type II and 80 (25.14%) as Keros type III. Statistically, LP-to-midline distances on the right and left sides were significantly associated with the distance from the AEA to the skull base on the same side (R:p < 0.001, L:p = 0.01) and the Keros classification on the same side (R:p < 0.001, L:p = 0.004). Also, a significant association was found between the Keros classification and the distance from the AEA to the skull base (R:p < 0.001, L:p = 0.02). The locations of anatomical structures are defined in relation to each other during the development of maxillofacial bones. CT scans should be examined and anatomical structures and relations among them reviewed very carefully before ESS. Otherwise, some accidental injuries may arise during the surgery while trying to avoid complications. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03931-x.

Elevated serum calprotectin as an inflammatory marker in obstructive sleep apnea.

OBJECTIVE: To investigate the serum calprotectin (SCal) levels and neutrophil/lymphocyte ratio (NLR) values in patients with obstructive sleep apnea (OSA). METHODS: Sixty-seven OSA patients and 46 healthy volunteers without any sleep disorders were included in the study. The patient group was divided into three subgroups according to the severity of OSA. The SCal levels and NLR values were compared among subgroups and between the experimental and control groups. RESULTS: The mean SCal level and NLR value were higher in the study group than in the control group (p = 0.002 and p = 0.001, respectively). The SCal levels were significantly higher in patients with severe OSA than in those with moderate and mild OSA (p = 0.004 and p = 0.001, respectively). DISCUSSION: Unlike NLR, the SCal level may inform the severity of OSA and could be used as an indicator for OSA.

[Inconsistency of the Epworth sleepiness scale results with the polysomnography findings in patients with sleep-disordered breathing]. / Uykuda solunum bozuklugu olan hastalarda Epworth uykululuk skalasi sonuçlarinin polisomnografi bulgulari ile uyumsuzlugu.

OBJECTIVES: This study aims to investigate the consistency of Epworth sleepiness scale (ESS) results and polysomnography (PSG) findings in the patients with sleep-disordered breathing (SDB). PATIENTS AND METHODS: A total of 109 patients (68 males, 41 females; mean age 48.6 years; range 20 to 77 years) who were admitted with the complaints of apnea, witnessed apnea and daytime sleepiness were included. The correlation among age, body mass index (BMI), and ESS and PSG findings were assessed. RESULTS: There was a positive and statistically significant correlation between the age and apnea-hypopnea index (AHI) (p<0.01). We observed that AHI figures increased with increasing age. There was also a positive and statistically significant correlation between the BMI and AHI (p<0.05). We found that AHI increased in parallel with BMI increase. There was, no statistically significant correlation among the AHI results based on the ESS assessment, the percentage of sleep under 90% of saturation, and the Arousal index (AI). CONCLUSION: The responses to the questions in the ESS may vary from individual to individual, depending on the socio-cultural and economic status. We believe, therefore, that a new Turkey-based questionnaire considering the lifestyle of our population would offer more useful information about sleep disordered breathing.

Acoustic parameter changes after bariatric surgery.

OBJECTIVE: To investigate the acoustic parameter changes after weight loss in bariatric surgery patients. MATERIALS AND METHODS: This prospective, longitudinal study was conducted with 15 patients with planned bariatric surgery, who were evaluated pre-operatively and at 6 months post-operatively. Fundamental frequency (F0), Formant frequency (F1, F2, F3, and F4), Frequency perturbation (Jitter), Amplitude perturbation (Shimmer) and Noise-to-Harmonics Ratio (NHR) parameters were evaluated for /a/, /e/, /i/, /o/, and /u/ vowels. Changes in the acoustic analysis parameters for each vowel were compared. The study group was separated into two groups according to whether the Mallampati score had not changed (Group 1) or had decreased (Group 2) and changes in the formant frequencies were compared between these groups. RESULTS: A total of 15 patients with a median age of 40 ± 11 years completed the study. The median weight of the patients was 122 ± 14 kg pre-operatively and 80 ± 15 kg, post-operatively. BMI declined from 46 ± 4 to 31 ± 5 kg/m2. The Mallampati score decreased by one point in six patients and remained stable in nine. Of the acoustic voice analysis parameters of vowels, in general, fundamental frequency tended to decrease, and shimmer and jitter values tended to increase. Some of the formant frequencies were specifically affected by the weight loss and this showed statistical significance between Group 1 and Group 2. CONCLUSION: The present study reveals that some specific voice characteristics might be affected by successful weight loss after bariatric surgery.HighlightsObesity reduces the size of the pharyngeal lumen at different levels.The supralaryngeal vocal tract size and configuration is a determinative factor in the features of the voice.Changes in the length and shape of the vocal tract, or height and position of the tongue can result in changes especially in formant frequencies in acoustic analysis.

Postoperative Audiometric Results of Patients with Otosclerosis in relation with High-resolution Computed Tomography and Intraoperative Macroscopic Findings.

OBJECTIVE: To analyse postoperative audiological findings in fenestral otosclerosis patients treated with stapedotomy, focal location-extensiveness findings on temporal high-resolution computed tomography (HRCT), and intraoperative macroscopic stapes footplate findings. Moreover, preoperative audiological findings were compared with HRCT and intraoperative macroscopic findings. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Department of Otorhinolaryngology, University of Health Sciences, Ankara Numune Training and Research Hospital, Turkey from January 2015 to January 2018. METHODOLOGY: Patients were classified according to the temporal bone HRCT findings into three groups based on otosclerotic focus location and extensiveness. Macroscopic classification was based on the intraoperative findings of blue and white footplate. Patients with obliterative otosclerosis were not included in the study. Preoperative and postoperative audiological findings as well as surgical success were investigated. Findings were compared with HRCT and macroscopic classification groups. RESULTS: Postoperative air bone gap (ABG) increased as HRCT class increased from 0 to 3, meaning a more extensive otosclerotic focus (p=0.002). The comparison of the audiological outcomes, in accordance with the intraoperative findings, revealed that the postoperative air conduction pure-tone averages (AC PTA), ABG and ABG difference were higher in the white footplate group, with statistically significant differences compared to blue footplate group (p = 0.039, p = 0.001 and p=0.029, respectively). CONCLUSION: Postoperative audiological findings were found to be correlated with intraoperative and HRCT findings. A white footplate seen at surgery or a more extensive otosclerotic focus on temporal HRCT indicates a suboptimal audiological outcome. HRCT findings should be taken into account when planning the surgery. Key Words: Otosclerosis, Temporal bone HRCT, Footplate color, Stapedotomy, Audiometry.