Q192R polymorphism in the PON1 gene and nasal polyp in a Turkish population.

The pathogenesis of nasal polyps is not completely understood. Oxidative damage contributes to polyp formation in the nasal mucosa. The paraoxonase 1 (PON1) enzyme is an important liver enzyme with high antioxidant activity. In this study, we investigated the correlation between Q192R genotypic polymorphism of the PON1 enzyme and nasal-polyp disease. The study examined 62 nasal-polyp patients and 88 controls. PON1 Q192R polymorphism was determined using polymerase chain reaction-restriction fragment length polymorphism. The genotype distribution of the PON1 gene was significantly different between nasal-polyp patients (QQ = 69.35%, QR = 25.81%, RR = 4.83%) and healthy controls (QQ = 52.27%, QR = 44.31%, RR = 3.40%). Our results suggest that the PON1 QQ genotype (odds ratio [OR] = 2.066, P = .036) is associated with a higher risk of developing the nasal-polyp disease while QR genotype (OR = 0.437, P = .021) showed a lower risk.

Evaluation of the intranasal steroid treatment outcomes in adenoid tissue hypertrophy with or without allergic rhinitis.

PURPOSE: To compare the intranasal steroid (INS) treatment outcomes in patients with adenoid tissue hypertrophy (ATH) with or without allergic rhinitis (AR). MATERIALS AND METHODS: Medical records of 96 children diagnosed with ATH were retrospectively examined. The pediatric version of the Score for Allergic Rhinitis (SFAR) questionnaire was used to determine the AR status of the patients and classify them. The children were divided into two groups based on the questionnaire: Group 1, low probability of AR (SFAR<9); and Group 2, high probability of AR (SFAR≥9). Intranasal mometasone furoate (100 µg/mL) was used to treat ATH for at least 3 months. The severity of nasal obstruction and snoring was evaluated using the visual analog scale (VAS) score, the adenoid/choana (A/C) ratios before and after treatment were compared, and the rate of patient referral to surgery was recorded among groups. RESULTS: The change in the A/C ratio within the group between before and after treatment was significant (both P < 0.001). However, the reduction in the adenoid size was more significant in Group 1 than in Group 2 (P = 0.025). A significant improvement in the VAS scores was observed between before and after treatment in both groups (P < 0.001). Furthermore, the rate of surgical referral of Group 1 was significantly lower than that of Group 2 (P = 0.035). CONCLUSIONS: INS treatment was found more successful for reducing A/C ratio in ATH without AR. Related with this, when considering the INS treatment for ATH, AR status should be kept in mind for predicting the treatment success.

Comparison of transnasal and transoral routes of microdebrider combined curettage adenoidectomy and assessment of endoscopy for residue: a randomized prospective study.

PURPOSE: The aim of this study is to investigate the frequency and locations of residual adenoid tissue in conventional curettage adenoidectomy (CA) via transnasal endoscopic examination at the end of the operation and to determine the most appropriate technique for residual adenoid tissue removal by transoral or transnasal microdebrider usage. METHODS: Sixty-three patients aged 4-12 years who were scheduled for CA were included in this randomized prospective study in a tertiary reference center. Patients who underwent CA had the endoscopic residual tissue exploration at the end of surgery. The amount and locations of residual tissue were recorded. Patients with > 20% residual tissue were divided into two groups according to randomization list for removing the residual tissue, depending on the use of transoral microdebrider (TOMD) and transnasal microdebrider (TNMD). Two procedures were compared in terms of duration, bleeding, pain, post-anesthesia care unit (PACU) transfer time, and complications. RESULTS: Residual tissue was detected in 38 patients (60.2%). The most common location of residual tissue was peritubal area (41.3%). The TOMD group had lower surgical duration, blood loss, pain scores and shorter PACU transfer time (p = 0.001, p = 0.002, p˂0.001, and p = 0.006, respectively). CONCLUSION: Endoscopic exploration at the end of CA should be considered to avoid residual tissue retention. Furthermore, if residual tissue is present, the use of TOMD is easier, faster, and associated with lower morbidity than the use of TNMD.

Which one is favorable in the elderly? Transoral rigid laryngoscopy or transnasal flexible fiberoptic laryngoscopy.

PURPOSE: To determine whether transoral rigid laryngeal endoscopy (TORLE) or transnasal flexible fiberoptic laryngoscopy (TNFFL) is more favorable for laryngeal endoscopic examination in the elderly population. METHODS: This randomized prospective study carried out in a tertiary reference center. TORLE or TNFFL were performed to patients who were over 65 years at their first visit according to randomization list. At their second visit, other method was performed. Patients' physiological parameters (Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and oxygen (O2) saturation before and immediately after laryngeal examination were recorded. Patients' pain-irritation, gag reflex, and dyspnea status were evaluated using visual analog scale after first and second endoscopic examinations. Further patient preferences for TORLE and TNFFL were recorded. RESULTS: Of 96 patients included in the study, 69.8% (n = 67) preferred TORLE while 30.2% (n = 29) preferred TNFFL. Major factor influencing patient preferences was pain-irritation in TNFFL. Pain-irritation scores were significantly higher in TNFFL than those in TORLE (p < 0.001). However, no significant difference was found between two methods with respect to gag reflex and dyspnea scores (p = 0.194, p = 0.327, respectively). In TORLE, there was no statistically significant difference between the values measured before and after examination in terms of SBP, DBP, HR, and O2 saturation (p = 0.641, p = 0.134, p = 0.119, p = 0.414, respectively). However, in TNFFL, statistically significant decrease was observed after examination in HR and O2 saturation (p < 0.001, p < 0.001, respectively). CONCLUSION: TORLE is more suitable for laryngeal examination in elderly patients since it is more comfortable for patient and does not change physiological parameters.

Effect of prilocaine and its combination with tramadol on anxiety and pain during nasal packing removal.

PURPOSE: To investigate the effect of local usage of prilocaine and its combination with tramadol on the pain and anxiety levels of patients during nasal packing removal. METHODS: A total of 117 patients who were treated with the Merocel nasal packing after septoplasty were included in the study. Patients whose Merocel nasal packings infiltrated with prilocaine (P group), prilocaine combined with tramadol 1 mg/kg (P + T1 group), prilocaine combined with tramadol 2 mg/kg (P + T2 group), or normal saline solution (Control group) before nasal packing removal were compared for their pain, sedation, and anxiety related to this removal procedure. The visual analog scale (VAS), Ramsay sedation scale (RSS), and State-Trait Anxiety Inventory (STAI) scale were assessed to evaluate the pain, sedation, and anxiety levels of the patients. RESULTS: Groups were found similar according to sex, age, and preoperative STAI scores. The VAS score was significantly lower in P, P + T1, and P + T2 than control group during nasal packing removal (p < 0.001, p < 0.001, and p < 0.001, respectively). However, state anxiety inventory (STAI-S) and RSS were found significantly improved only in P + T1 and P + T2 (STAI-S: p = 0.032, RSS: p = 0.002, STAI-S: p = 0.000, RSS: p < 0.001, respectively). In the comparison of P + T1 and P + T2, no significant difference was found in VAS, RSS, and STAI-S (p = 0.604, p = 0.154, and p = 0.264, respectively). CONCLUSION: The combined infiltration of prilocaine and tramadol 1 mg/kg into the nasal packing is effective in reducing the pain and anxiety of patients during nasal packing removal.

Evaluating the Effect of Infraorbital Region Taping Procedure on Patient Anxiety, Satisfaction, Edema, and Ecchymosis Level on Primary Septorhinoplasty.

AIM: This study aims to evaluate the effect of infraorbital region taping on patients' postoperative edema and ecchymosis, satisfaction levels, and anxiety during follow-up. METHODS: A total of 64 patients who underwent septorhinoplasty were included in this randomized controlled prospective study. According to the randomization list, the taping group's (TG) infraorbital region was taped with adhesive strips. Others were included in the control group and were classified as the nontaping group. Two blinded physicians evaluated the degree of edema and ecchymosis according to the photographs of patients taken on the first, second, fifth, and seventh postoperative days. Patient's appearance satisfaction was evaluated for ecchymosis levels. State anxiety inventory (STAI-S) and trait anxiety inventory (STAI-T) were used to measure preoperative and postoperative anxiety levels of patients. RESULTS: The degree of ecchymosis and edema were not significantly different except on the first day in the TG (P = 0.01, P = 0.01, respectively). Significant increment was found in the TG on first, second, and fifth days based on the satisfaction levels of patients for their appearance (P = 0.05, P = 0.03, P = 0.04, respectively). Preoperative STAI-S and STAI-T were similar for the groups (P = 0.78, P = 0.17, respectively). However, postoperative STAI-S of the TG were significantly lower compared with those of the nontaping group except seventh day (P < 0.05). CONCLUSION: Infraorbital taping did not decrease the edema and ecchymosis except on the first postoperative day. However, it had a significant ameliorating effect on patients' anxiety and satisfaction levels.

Transseptal Subperichondrial Endoscopic Hypophysectomy With Preservation of Vital Nasal Structures.

INTRODUCTION: Pituitary surgery involving different techniques is often applied to the excision of benign adenomas. Operative interventions involved various approaches and techniques. Endoscopic transsphenoidal approach is the less traumatic route to the sella turcica, avoiding brain retraction, and also permitting good visualization, with lower rates of morbidity and mortality. Although mortality of pituitary surgery decreased by advances in surgical techniques morbidities such as synechiae formation, anosmia, bleeding, nasal septal perforations, drying, and incrustation due to traumatization of the nasal structures such as septum, nasal mucosa, and middle concha are the current problems in pituitary surgery. Here, the authors described an endoscopic transseptal subpericondrial hypophysectomy with minimal damage to normal anatomy and physiology and discussed advantages of this technique. METHODS: The authors performed endoscopic transseptal subpericondrial hypophysectomy to 2 patients and evaluated intraoperative and postoperative results. RESULTS: No complication was noted during surgery or postoperative period with endoscopic transseptal subpericondrial hypophysectomy technique. CONCLUSIONS: Endoscopic transseptal subpericondrial hypophysectomy is a safe technique and, requires only a short surgery time and does not require the removal of any physiological tissue or cause any bleeding.

Protective Effect of Selenium Against Cisplatin-Induced Ototoxicity in an Experimental Design.

Cisplatin is an effective chemotherapeutic agent in the treatment of several types of malignant solid tumors but its clinical use is associated with ototoxicity. In the present study, we investigated the effect of selenium administration on lipid peroxidation (malondialdehyde [MDA]) and cisplatin-induced ototoxicity in rats. Healthy wistar albino rats (n = 21) were randomly divided into 3 groups: control (C), cisplatin (Cis), cisplatin and selenium (Cis+Se). Cisplatin was administered for 3 days to Cis and Cis+Se groups. Cis+Se group received selenium 5 days before cisplatin injection and continued for 11 consecutive days. Hearing thresholds and lipid peroxidation (MDA) levels of the rats were recorded before injections and at the end of experimental protocol. The cochleas of animals were harvested for histologic and immunuhistochemical examinations. In biochemichal analyses, pretreatment with selenium prevented the elevation of MDA levels in Cis+Se group rats. Moreover, animals in Cis+Se group had better hearing threshold levels than animals in cis group. Samples obtained from the animals in Cis group revealed extensive loss of the normal microarchitecture of the organ of Corti. On the other hand, animals in Cis+Se group exhibited a preservation of the morphology of the organ of Corti and outer hair cells. In the immunohistochemical examinations of cochlear tissues stained with anti-caspase-3, a higher degree of immunopositivity was found in the Cis group. When Cis+Se group and Cis group were compared, significantly less immunopositivity occurred in the Cis+Se group (P < 0.05). Thus, it appears that pretreatment with selenium may reduce cisplatin-induced ototoxicity in rats.

Nasal Mucociliary Clearance in Adenoid Hypertrophy and Otitis Media with Effusion.

Mucociliary clearance (MCC), which exists in many systems, is the first defensive mechanism of the human body. Nasal MCC has an important role in transporting the secretions of the nasal cavity and paranasal sinuses along with the trapped inhaled pathogens to the nasopharynx. Physiologic or pathologic situations that effect nasal MCC, such as temperature, humidity, nasal obstruction, allergic rhinitis, chronic infections, etc., lead to impaired MCC and related local or circumjacent system disorders. With this perspective, when a unified airway with a multiple disease principle is considered, investigating the relationship between adenoid hypertrophy (AH), otitis media with effusion (OME) and nasal MCC is logical. In this review, histological and physiologic properties of nasal MCC and its possible role involving pathologic situations such as AH and OME is discussed together with recent literature findings.

Maxillary Sinus Aeration in Allergic Rhinitis.

OBJECTIVE: We aimed to investigate the relationship between allergic rhinitis, which is an important reason of nasal obstruction, and maxillary sinus aeration. PATIENTS AND METHODS: Three hundred fifteen patients who have a complaint of nasal obstruction and scheduled to undergo skin prick test (SPT) with a suspicion of allergic rhinitis (AR) were enrolled for this study. Thirty-two patients with positive SPT result and 30 patients with a negative SPT result were determined as group 1 and 2 (control group), respectively. A 3-dimensional reconstruction of computed tomography images of the 62 patients was used to assess and calculate maxillary sinus volumes (MSVs). RESULTS: Total maxillary sinus volumes were measured as 21.87 cm(3) and 30.15 cm(3) in group 1 and group 2, respectively. A statistically significant difference was observed between the MSVs of the groups (P < 0.001). CONCLUSION: Total maxillary sinus volumes were found to be significantly smaller for patients with a positive SPT compared to patients with a negative SPT. Thus, we may conclude that AR has a negative impact on maxillary sinus aeration.

Uncinatotomy: performing endoscopic sinus surgery without an uncinectomy.

BACKGROUND: The results of endoscopic sinus surgery performed for chronic rhinosinusitis are controversial. For a better surgical outcome, different surgical techniques involving an uncinectomy as the primary step of the operation have been proposed. The surgery should resolve the pathophysiologic problems caused by the disease and preserve the normal anatomy and physiology. We developed a technique to remove the pathology localized to isolated maxillary and anterior ethmoid cells, without excising the uncinate process. The infundibular area was exposed with medialization of the uncinate with a bipedicle flap prepared 1.5 cm from the insertion of the uncinate to the nasal wall, and then the sinus pathology was removed. At the end of the surgery, the uncinate was returned to its original position. METHODS: We performed this new technique to 3 patients and evaluated postoperative results. RESULTS: Primary disease was eradicated, and no complication was noted. CONCLUSIONS: With this technique, it is possible to perform all steps of sinus surgery without excising any anatomic structure.

Primary acquired nasolacrimal duct obstruction: is it really related to paranasal abnormalities?

PURPOSE: To investigate whether there is an association between primary acquired nasolacrimal duct obstruction and paranasal computed tomography (CT) findings. MATERIALS AND METHODS: The study cohort consisted of paranasal CT images from 40 patients being treated for unilateral primary nasolacrimal duct obstruction (PANDO) and the reformatted coronal temporal CT images of 71 control subjects who attended the ENT clinic with the complaint of vertigo and tinnitus. A radiologist masked to the clinical situation of participants, investigated the paranasal CT findings of the PANDO and control patients retrospectively. The side, localization, and angle of the septal deviation as well as the thickness and lateralization angle of the inferior turbinate's were recorded. Additionally maxillary and ethmoid sinusitis, concha bullosa, Agger nasi cell formation, and osteomeatal complex status were evaluated. RESULTS: No significant difference was found between the paranasal abnormality incidence in the PANDO and non-PANDO sides of the patients or the control group. Only the side of the septal deviation correlated with the side of the PANDO (p = 0.008). CONCLUSIONS: The incidence of PANDO may not be directly related to paranasal abnormalities. Further large-scale studies should be performed to clarify the relationship between paranasal abnormalities and PANDO.

Septoplasty: under general or sedation anesthesia. Which is more efficacious?

The objective of the study was to assess the more efficacious anesthesia method in septal surgery. The prospective study was conducted at an academic secondary referral center. A prospective chart review of 60 patients, between the ages of 16 and 65, who underwent septal surgery under general (GA) or sedation (SDA) anesthesia during 1-year period was done. Mean age of the patients was 44.30 ± 13.29. Patients were divided into two groups according to the anesthesia method: general (group 1) or sedation (group 2). Intraoperative hemodynamic variables, surgery time, intraoperative blood loss volume, length of hospital stay, postoperative vomiting and nausea, postoperative pain score according to the visual analog scale (VAS) and cost analysis of each method were compared. Thirty-six males and 24 females with a mean age 44.30 ± 13.29 were included to the study. Total operation time, operation time, intraoperative and postoperative bleeding volume, postoperative nausea and vomiting, duration of hospital stay after surgery, were better in group 2. Postoperative pain scores and patient satisfaction about surgery were not statistically different. Cost of anesthesia in group 1 per patient was $44.35 ± 10.81 and in group 2, $16.29 ± 11.88 (p < 0.01). Hospital stay after surgery was much longer in group 1 than group 2 (p < 0.01). Using SDA is better in many ways including cost-effectiveness than using GA for septoplasty operation.

Patient specific or routine preoperative workup in septoplasty: which one is cost-effective?

This study aimed at determining the limits of preoperative investigation and calculate estimated cost analysis in septoplasty with and without turbinate surgery. A retrospective chart review. The study was conducted at secondary referral center. A retrospective chart review of patients who have undergone septoplasty over a 1-year period was performed. The need for routine (battery testing) versus patient specific preoperative workup of 380 septoplasty patients was evaluated. Mean age of the patients was 31.5 ± 4.6. The patients were classified into three groups according to preoperative routine laboratory testing results: (1) normal group (2) abnormal group and (3) abnormal out of action limit group. Medical records were revaluated by an anesthesiologist and ear nose throat doctor according to preoperative American Society of Anesthesiologists guidelines to calculate estimated possible costs in case of patient specific preoperative workup. Three hundred seventy-seven patients were within ASA 1 group and three patients were within ASA 2. According to preoperative battery testing results, 5.8% of the patients (n = 22) were in group 1, 93.4% (n = 355) were in group 2, 0.8% (n = 3) were in group 3. Surgery was postponed due to concomitant pathologies for about 44 days (10-180 days) in four patients (1.1%). Preoperative routine laboratory testing costs were calculated as $41.08 ± 6.69 (40.25-128.78) per patient. When medical records were reevaluated retrospectively, estimated cost per patient would be $8.91 ± 10.40 (7.18-79.91) if patient specific preoperative workup were done. Individual preoperative testing would save $12,226.78 annually and total cost would decrease from $15,612.41 to $3,385.62. (p = 0.001). Patient-specific preoperative workup is more cost effective than routine battery testing in septoplasty with and without turbinate surgery.

Endonasal endoscopic excision of a rare tumor: nasal bone osteoid osteoma.

BACKGROUND: Osteomas are slow-growing, benign tumors that frequently occur in paranasal areas; are detected by their symptoms, depending on their location and size, or incidentally on radiologic examination; and rarely arise from the nasal bone. We present an isolated nasal bone osteoma--which has not, to our knowledge, been reported previously--that was excised using an endoscopic endonasal approach via intercartilaginous incision and reconstructed with MEDPOR. METHODOLOGY: A 21-year-old male patient attended the Mardin State Hospital ENT Clinic with the complaint of a slowly enlarging mass on the left side of the nose. The clinical, radiologic, and histologic findings pointed to a diagnosis of nasal bone osteoma. RESULTS: An endoscopic-assisted endonasal approach was performed, and defect was reconstructed with MEDPOR. At postoperative 6-month evaluation, no recurrence was observed, and the cosmetic result was satisfying in both external and intranasal views. CONCLUSIONS: In the removal of rare nasal bone osteomas, endoscopic endonasal surgery could be preferred over an external approach because of its favorable cosmetic results, comfort for the patient, and graft viability.

A Rare Laryngeal Foreign Body Case: Postcricoid Total Dental Prosthesis.

In this case report, 60-year-old patient who aspirated total dental prosthesis into the postcricoid region was presented with patient's history, clinical findings, radiologic examinations and surgical treatment with comparison of literature data. To our literature knowledge, this is the first total dental prosthesis detected in postcricoid region. This was unusual because it did not cause any respiratory disorders such as laryngospasm and asphyxia, although it led to mucosal abrasions in a wide area of esophageus. Laryngoscope, 134:2331-2334, 2024.

Comparison of incus interpositioning technique versus glass ionomer cement application in type 2 tympanoplasty.

Objective of this study is to compare glass ionomer cement application and incus interpositioning techniques in patients who have chronic otitis media, conductive hearing loss with intact tympanic membrane and who undergo hearing reconstruction of staged surgery using a retrospective chart review in the setting of Ministry of Health Ankara Training and Research Hospital ENT Clinic, Turkey. We retrospectively evaluated patients who underwent otological surgery and hearing reconstruction with auto graft incus during 2005-2008 or glass ionomer cement during 2008-2010. Patients who had cholesteatoma, stapes fixation and tympanosclerosis were excluded. Postoperative mean follow-up time of 107 patients was 9.8 months (6-38 months, 83.2 % of them was ≤ 9 months). Postoperative pure tone hearing thresholds, graft status, gain scores and air bone gaps were recorded. Intact graft, dry ear on the operated side and ABG scores less than 20 dB were accepted as surgical success. Preoperative ABG score was 30.6 ± 7.93 dB in glass ionomer (group I) and 33.6 ± 11.99 dB in incus interpositioning (group II). Postoperative ABG scores were 13.6 ± 10.40 and 22.6 ± 12.39 dB, respectively, in group I and II. Success of closure in ABG scores was obtained in both groups (p < 0.001). Gain scores in group I were better (p = 0.035). Graft success (p = 0.020) correlated with gain score. Results showed that the glass ionomer cement application is a good, cost-effective technique, easy to perform and yields better hearing scores and lower complication rates compared to incus interpositioning technique.

Extranasopharyngeal angiofibroma of the nasal septum: a rare clinical entity.

Angiofibromas (AFs) are benign, potentially local aggressive, and rich vascular neoplasms that originate from posterior lateral wall of the nasopharynx in adolescent males. However, they could be encountered in sites other than nasopharynx. The maxillary sinus is the most common location of extranasopahryngeal AFs. The nasal septum is an extremely rare location, and only 15 cases had been reported in literature. In this present case, an unusual extranasal AF originating from the anterior part of the nasal septum is reported with its clinical, laboratory, and treatment options and theories proposed to explain the origin of extranasopharyngeal AFs are discussed.

Effects of nasal septum deviation and concha bullosa surgery on the frequency and financial burden of acute rhinosinusitis.

BACKGROUND: Nasal septum deviation/concha bullosa (DNS)/(CB) are known to be predisposing factors in the pathophysiology of acute rhinosinusitis (ARS). However, the effects of surgical treatment of these pathologies on ARS have not been adequately investigated. AIMS: To reveal the effects of the surgical treatment of DNS and CB on the frequency of the ARS, the use of antibiotics (ABs), and the direct cost incurred. METHODS: Medical records of the patients who had undergone successful surgery for DNS/CB and were diagnosed with ARS in the preoperative and postoperative 3-year period were retrospectively analyzed. The average annual number of ARS examinations of the patients, the number of ABs prescribed, and prescription, examination, and total health system costs were compared. RESULTS: Fifty-three patients (33 men (62%) and 20 women (38%)) were included in the study. There was a statistically significant decrease in the mean annual number of examinations for ARS, the number of ABs prescribed, prescription, examination, and total health system costs (p < 0.05) in the postoperative period compared with the preoperative period. CONCLUSIONS: The present study determined that successful surgeries performed in patients with DNS/CB resulted in a significant decrease in the average annual number of examinations performed for ARS, number of AB prescriptions, and prescription, examination, and total health system costs. With these results, it seems beneficial to direct patients to surgery within the framework of the health policies of countries to reduce the frequency and financial burden of ARS in DNS/CB patients.

Surprising cause of respiratory distress in child: laryngeal leech.

Foreign body aspiration is a major problem that can cause respiratory distress and oral bleeding in a child. Leeches are rarely seen foreign bodies in the larynx. Generally, they live in springwater and can be aspirated by drinking. They can cause respiratory distress, oral bleeding, and anemia, if diagnostic process is delayed. When leeches are detected, urgent diagnosis and treatment are necessary. In this case, we present a 7-year-old child examined in the emergency service with these symptoms. A dark green living body in the larynx was detected and removed urgently under sedo-analgesia. The living body was seen as a leech that is 5 cm in length.