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Tonsil tissue is a very important component of the human immunity system, contributing to the functioning of the cellular and humoral defence system, especially in childhood. The endoplasmic reticulum (ER) is an organelle that has a very important function in the balanced functioning of cells, in which the accumulation of a cellular protein called ER stress occurs in case of dysfunction. ER stress influences the pathogenesis of many diseases and immune system functions. We aimed to investigate the relation between the diseases of tonsil tissue and ER stress response to elucidate the mechanisms of diseases related with the immune system. A prospective study was conducted in 46 children aged between 2 and 16 years who underwent tonsillectomy for chronic tonsillitis or tonsillar hypertrophy. Tonsil tissue was separated into two groups according to their size and evaluated in terms of ER stress markers and apoptosis markers by Real-time PCR and Western blot analysis. The ΔCT levels of ER stress markers (ATF4, ATF6, CHOP, GRP78, EIF2AK3, ERN1, GRP94) were greater in children with chronic tonsillitis (p

Background: Tongue-related complications can be seen in suspension laryngoscopy (SL) procedures.Aims/objectives: This study aimed to detect tongue edema associated with the pressure exerted by a ri...

Objective: Nasal polyposis (NP) is defined as persistent inflammation of the sinonasal mucosa intractable to medical and surgical treatment. Activin-A, is a pleiotropic cytokine in the transforming growth factor-b (TGF-β) superfamily and was shown to orchestrate the allergic inflammation in asthma via suppression of T helper-2 (Th2) cells, induction of regulatory T cells, and tissue repair. The purpose of this study was to investigate the role of the activin-A in pathophysiology of NP.Materials and Methods: According to the European Rhinosinusitis and Nasal Polyp criteria, 50 patients and 24 healthy subjects were included in the study. There were no significant differences across age and gender between the 2 groups (p>0.05). Samples from patients with NP (n=50; 11 women, 39 men) were acquired during endoscopic sinus surgeries. Middle turbinate specimens from patients without sinus disease and who were undergoing septoplasty were collected as controls (n=24; 3 women, 21 men).Results: Immunohistochemical staining with activin-A showed an increase in the staining intensity, number of glands and inflammatory cells in polyp specimens compared to healthy nasal mucosa. In contrast, no differences were found in fibroblasts and vascular density.Conclusion: We evaluated the expression of activin-A in NP tissue, which showed a slightly elevated expression compared to the controls. This might support the possible role of activin-A in the pathophysiology of NP. Clearer elucidation of the roles of activin-A and other mediators in tissue remodeling in NP may ensure more accurate targets for treatment and prevention of relapse.

To evaluate the olfactory function in primary Sjögren's syndrome (pSS) patients and investigate its correlation with dry eye parameters.Thirty-eight pSS patients (49.47 ± 10.06 years) and 20 healthy volunteers (47.40 ± 8.92 years) were enrolled in the study. All participants underwent ENT and eye examinations including a modified Connecticut Chemosensory Clinical Research Center (CCCRC) test, tear break-up time (TBUT), ocular surface staining (OSS) and Schirmer test. The parameters were compared between the two groups using Student-t test, and Pearson test was used to evaluate the correlations.Mean Schirmer and TBUT values were 2.39 ± 1.48 mm/5 min and 3.66 ± 1.5 sec in pSS and 18.30 ± 6.16 mm/5 min and 14.60 ± 3.64 sec in healthy subjects (p0.001, both). There was a significant decrease in mean odour threshold, odour identification, CCCRC and VAS scores in the pSS group (p0.001). Dry eye parameters showed moderate correlations with CCCRC parameters (r = 0.4-0.6, p0.001) and olfaction VAS score (r = 0.4-0.75, p0.05).There is a mild clinical impairment in smell sense in patients with pSS which seems to be correlated with dry eye parameters. Therefore, smell complaints should be queried in pSS patients suffering from severe dry eye.Difunzione olfattiva nella sindrome di Sjogren e correlazione con la xeroftalmia.Valutare la funzione olfattiva nei pazienti con sindrome di Sjögren primaria (pSS) e indagare la sua correlazione con la xeroftalmia.Nello studio sono stati arruolati trentotto pazienti con pSS (49,47 ± 10,06 anni) e 20 volontari sani (47,40 ± 8,92 anni). Tutti i partecipanti sono stati sottoposti a vista ORL e oculistica, inclusiva del test del Connecticut Chemosensory Clinical Research Center (CCCRC), Tear Break-up Time (TBUT), colorazione della superficie oculare (OSS) e test di Schirmer. I parametri sono stati confrontati tra i due gruppi utilizzando il test t di Student e il test di Pearson è stato utilizzato per valutare le correlazioni.I valori medi di Schirmer e TBUT erano 2,39 ± 1,48 mm/5 min e 3,66 ± 1,5 sec nel gruppo pSS e 18,30 ± 6,16 mm/5 min e 14,60 ± 3,64 sec nei soggetti sani (p0,001, entrambi). C’è stata una diminuzione statisticamente significativa della soglia media dell’odore, dell’identificazione dell’odore, dei punteggi CCCRC e VAS nel gruppo pSS (p0,001). I parametri dell’occhio secco hanno mostrato correlazioni moderate con i parametri CCCRC (r = 0,4-0,6, p0,001) e il punteggio VAS dell’olfatto (r = 0,4-0,75, p0,05).Esiste una lieve compromissione clinica del senso dell’olfatto nei pazienti con PSS che sembra essere correlata alla xeroftalmia. Pertanto, i disturbi dell’olfatto dovrebbero essere valutati nei pazienti con PSS che soffrono di grave secchezza oculare.

Background Vernal keratoconjunctivitis (VKC) is a chronic, severe allergic disease of the conjunctiva, which mostly affects young males in early to mid-childhood. There is a high incidence of asthma, allergic rhinitis (AR) and eczema among patients with VKC. It is unknown if VKC patients have abnormal olfactory dysfunction, and if so, whether this is related to AR. Objective Our aim was to evaluate olfactory function in children with VKC, with and without comorbid AR, in comparison to healthy children without VKC. Materials and Methods Thirty-nine VKC patients and 32 healthy children were included in the study. After eye and ear, nose and throat (ENT) examination, acoustic rhinometry and modified Connecticut Chemosensory Clinical Research Center (CCCRC) tests were performed and the test results were compared between VKC and control groups and between VKC children with or without AR. A p value Results The VKC group included 25 males (64.1%) with a mean age of 11.13 ± 3.22 years, while the control group included 26 males (81.3%) with a mean age of 12.50 ± 2.13 years (p > 0.05 for both age and gender). Fourteen VKC patients (35.9%) had either positive prick test or elevated serum specific IgE levels against house dust mites and pollens. Mean odor thresholds did not differ between the two groups (p = 0.084), while mean odor identification and CCCRC score were statistically significantly lower in VKC group (6.00 ± 1.02 and 6.81 ± 0.75, respectively) compared to control group (7.06 ± 0.77 and 7.5 ± 0.41, respectively) (p Conclusion Olfactory function was found to be mildly impaired in children with VKC, especially when co-associated with AR. Therefore, loss of smell should be asked as an extraocular symptom.

Seasonal allergic rhinitis (SAR) is common in children and hyposmia is a major symptom affecting the quality of life. The aim of the present study is to assess olfactory dysfunction in pediatric patients with SAR and correlate the results with acoustic rhinometry measurements.Forty children, diagnosed as moderate and severe SAR based on clinical findings, ARIA (Allergic rhinitis and it's impact on asthma) classification and prick test results were enrolled in the study. Endoscopic nasal examination, acoustic rhinometry, total nasal symptom score (TNSS) and Connecticut Chemosensory Clinical Research Center (CCCRC) tests were performed 'in season' (May-August) and 'out season' (November-February). Three patients who did not show up in 'out season' examinations were excluded from the study.The ages of the children ranged between 8 and 18 years with a hyposmia increased and odor identification decreased (p 0.005, p = 0.003, respectively), whereas no differences were found between odor thresholds and the discrimination values (p 0.05). Mean CCCRC value was obstruction score (r =-0.340, p = 0.04), subjective hyposmia (r = -0.44, p = 0.007) and TNSS (r = -0.494, p = 0.02). Although some of the acustic rhinometry parameters were lower during allergy season, there were no correlations between acoustic rhinometry parameters and CCCRS values.Nearly half of the children with AR reported a mild to moderate hyposmia during pollen season and there was a decrease in odor identification, which can be easily shown using a CCCRC test.

WOS: 000515628000003, PubMed: 31993765, Purpose Allergic rhinitis (AR), is an IgE-mediated inflammation of the nose. Regulatory T cells (Tregs) and inflammatory cytokines have been shown to play a critical role in allergic airway inflammation. The aim of the study was to compare the levels of blood T lymphocyte subsets and IL-10, IL-17 and neopterin concentrations in serum and nasal lavage of patients with AR compared to healthy subjects. Methods The study included 38 subjects with moderate-severe AR and 36 sex- and age-matched controls. Peripheral blood CD3+, CD3+CD4+ and CD4+CD25+Foxp3 percentages were evaluated using flow cytometry. Levels of IL-10, IL-17 and neopterin were measured both in serum and nasal lavage fluid with ELISA and HPLC, respectively. Results No difference was found in the percentages of T lymphocyte subsets between the two groups (p > 0.05). Serum IL-10 levels were similar (p > 0.05), whereas nasal IL-10 was lower in AR subjects compared to control group (2.22 +/- 0.91 and 3.12 +/- 1.45 pg/ml, respectively) (p < 0.05). Mean serum and nasal IL-17 were higher in AR (107.7 +/- 79.61 and 527.36 +/- 738.7 pg/ml) than the control group (76.29 +/- 28.94 and 328.9 +/- 430.8 pg/ml) (p < 0.05 and p > 0.05). There were no significant differences in serum and nasal neopterin levels (p > 0.05). Conclusions Although there were no differences in the distribution of lymphocyte subsets between the AR and control groups, the finding of higher levels of serum and nasal IL-17 and lower levels of nasal IL-10 support the cytokine imbalance in the pathogenesis of AR., Selcuk Universitesi [15102018]

WOS: 000511653200005, PubMed: 31542832, Purpose Our study aimed to evaluate the effects of chronic hypoxic state in Obstructive Sleep Apnea Syndrome (OSAS) on brainstem pathways using Vestibular Evoked Myogenic Potential (VEMP) test and to investigate the presence of new markers likely to be correlated with the severity of the disease. Methods The study was planned as prospective and double blind. A total of 60 patients (120 ears) diagnosed with mild, moderate and severe OSAS were included in the study and the patients are grouped as 20 patients in each group. Twenty volunteer healthy individuals (40 ears) shown to be without OSAS were included in the study. VEMP measurements were made in 60 study group patients (120 ears) and in 20 healthy controls (40 ears). The groups were compared in terms of variables such as the acquisition rate of oVEMP and cVEMP waves, interval between the waves, latency and amplitude of the waves. p < 0.05 values were considered as significant. Results The results of cVEMP test showed that the rate of wave acquisition in the moderate and severe OSAS groups was significantly lower than the control group and mild OSAS groups (p = 0.008). There was no difference between the control group and the mild OSAS group in terms of the rate of obtaining the wave (p > 0.05). In the moderate and severe OSAS groups, P1N1 amplitude and N1P2 amplitude values were found to be significantly lower than the mild OSAS group (p = 0.007 and p = 0.017, respectively). In the oVEMP test, there was no significant difference between the mild OSAS group and the control group in terms of the wave yield (p > 0.05); however, it was found that the rate of wave acquisition in the moderate and severe OSAS groups was significantly lower than the mild OSAS group (p = 0.041). There was inverse correlation between the N1P2 interval and P1N1 amplitude value and AHI in simple regression analysis and multiple regression analysis (p = 0.012 and p = 0.021; p = 0.009 and p = 0.040, respectively). Conclusion The negative effects of chronic intermittent hypoxia related with OSAS on the brainstem and vestibular system can be demonstrated by VEMP tests. Especially, the inability to obtain the wave is the most important finding showing this situation. Also, we think that N1P2 interval and P1N1 amplitude markers can be used to detect the subclinical negative effect of chronic hypoxia on vestibular nuclei in the brainstem., Selcuk UniversitySelcuk University [18401106], Financial support was received from Selcuk University (Project number; 18401106).

To evaluate serum 25-hydroxyvitamin D [25(OH)D3] levels of vernal keratoconjunctivitis (VKC) children.A total of 62 non-atopic healthy children (64.5% male, mean age 10.79 ± 3.3 years) and 29 VKC children (75.9%, mean age 12.17 ± 2.7 years) were included in the study. Serum 25(OH)D3 levels measured by HPLC were compared between the two groups and a p value of0.05 was considered as statistically significant.The mean serum 25(OH)D3 level of VKC group was significantly lower than in the control group (11.02 ± 5.16 ng/mL and 15.99 ± 7.36 ng/mL, respectively) (p = 0.002). Severe vitamin D deficiency (10 ng/mL) was detected in 48.3% of VKC children and 22.6% of the controls (p = 0.017). Time spent outdoors during daylight was higher in the control group (229.5 ± 101.2 min) compared with the VKC group (160.7 ± 65.9 min) (p = 0.008), and showed a significant correlation with serum 25(OH)D3 levels (Spearman rho = 0.812) (p0.001).Children with VKC should be evaluated for vitamin D deficiency, which might occur secondary to sun avoidance.

Congenital nasolacrimal duct cyst (CNLDC) is a rare neonatal condition that can be life threatening when it occurs bilaterally. Herein we report a neonate with bilateral CNLDC that caused respiratory distress and was treated successfully with surgery. Post surgery, the patient was discharged from hospital without any complications. The case details, differential diagnosis, and management of CNLDC are discussed, along with a review of the relevant literature.

Objective To evaluate the efficacy of topical mitomycin in providing the patency of the neochoanae in children undergoing transnasal endoscopic congenital choanal atresia (CA) repair. Methods A retrospective analysis of surgical results in CA patients who were treated in Selcuk University, Meram Medical Faculty, Department of Otolaryngology between November 2002 and November 2009 was performed. All patients underwent transnasal endoscopic approach using nasal telescopes and traditional sinus instrumentation together with a microdebrider. Mitomycin was used according to the senior surgeon's preference, and certainly not in a randomized fashion. After completion of surgery, mitomycin 0.4 mg/ml was applied to the neochoanae for 3 min. Postoperative stenting was performed in all patients. Results CA was unilateral in 8 subjects (mean age 71.8 ± 41.7 months; range 18 months–144 months) and bilateral in 12 subjects (mean age 4.6 ± 1.3 days; range 3–7 days). Among the subjects, 75% was female in both groups. Fourteen subjects under endoscopic repair without mitomycin, whereas mitomycin was used in 6 patients (4 bilateral, 2 unilateral). Stents were left at least 3 weeks postoperatively (mean 31 ± 10 days; range 21–45 days). The patients were followed-up at least 6 months (range 6–72 months). No symptomatic restenosis requiring further dilatations was seen in patients treated with preoperative mitomycin, whereas restenosis was detected in 6 subjects (42.9%) treated without mitomycin postoperatively within 6 months period (Fisher's Exact Test 2-sided, p = 0.12). These subjects underwent revision endoscopic repair with mitomycin and had no need for further dilatations with acceptable control of symptoms during a follow-up period ranging between 14 and 78 months. Conclusion Mitomycin improves the surgical treatment outcome of CA and reduces the rate of restenosis significantly without any complications. However, further prospective randomized studies are needed to fully investigate the benefits of mitomycin therapy in CA surgery.

A 15-year-old boy with oculomotor palsy in the left eye as the initial finding of neurofibromatosis type 2 (NF2) was presented. The eye motility examination revealed restriction in adduction, eleva...

The purpose of this study was to compare the mean duration and complication rates of cyanoacrylate application in head and neck incision closures to those performed with conventional sutures. Eighty patients who underwent head and neck surgical operations (20 thyroidectomies, 13 submandibular gland resections, 9 parotidectomies, 6 neck dissections in conjunction with other surgical procedures, 1 lateral rhinotomy, 1 thyroglossal cyst resection and 30 open neck biopsies) were included in the study. The incisions were closed either with interrupted suture technique (32 patients) or cyanoacrylate (48 patients). The duration of skin closure time was compared between the two groups with nonparametric Mann–Whitney U test and a P value

Objectives The aim of this case–control study was to investigate the symptoms of attention-deficit/hyperactivity disorder (ADHD) in children with vocal fold nodules (VNs). Methods Study group (SG) included children between 4 and 12 years. As a control group (CG), children between 4 and 12 years without VNs were included in the study. Parents of the participants completed the Conners’ Parent Rating Scale-Revised: Short Form (CPRS-RS) which was used to analyze the symptoms of ADHD. Results Forty-five children (30 boys and 15 girls) with VNs and 45 controls (30 boys and 15 girls) were enrolled in the study. Multivariate analysis of variance revealed that the CPRS-RS Hyperactivity and Oppositional Subscales were significantly higher in the SG than the CG (p

WOS: 000334063700016, PubMed: 25558647, Aim: To compare the efficacy of prednisolone, montelukast, and omalizumab in reducing allergic symptoms and inflammation at tissue level in an experimental allergic rhinitis model. Materials and methods: Forty Sprague Dawley rats were randomized into 5 groups as naive (NS/NC), sensitized/challenged (S/C) by subcutaneous ovalbumin antigen injection, and montelukast-, prednisolone-, and omalizumab- treated groups. A nasal allergen challenge was performed every day from day 20 to day 26. The number of sneezes and nasal/eye rubbing movements, IL-4 and CysLT levels in serum, nasal and bronchoalveolar lavage fluids determined by ELISA, and histopathological findings of nasal mucosa, sinus, and lung tissues were compared. Results: All of the treatments significantly controlled the allergic symptoms of sneezing and nasal/eye rubbing (P < 0.05). IL-4 and CysLT levels on days 20 and 26 were significantly higher in the S/C group compared to the NS/NC group (P < 0.05). Montelukast significantly decreased serum and nasal IL-4 and CysLT levels (P < 0.05), prednisolone decreased nasal lavage IL-4 and CysLT levels (P < 0.05), and omalizumab lowered nasal lavage CysLT levels (P < 0.05). Conclusion: Prednisolone, montelukast, and omalizumab were found to be effective in controlling the allergic symptoms of allergic rhinitis and upper/lower airway inflammation in an experimental allergic rhinitis model., TUBITAKTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [SBAG-108S402], This project was supported by a grant from TUBITAK (SBAG-108S402).

Angiolipomas of the neck are extremely rare; to our knowledge, only 2 cases have been previously reported. We report a new case, which occurred in a 28-year-old woman. The mass was totally resected, and the patient showed no recurrence at the 18-month follow-up.

Purpose: To determine the prevalence of systemic atopy and immunoglobulin (Ig) deficiencies in vernal keratoconjunctivitis (VKC).Methods: Sixty-seven VKC subjects (79.1% boys) with a mean age of 11.3 ± 4.3 years were included. Serum Ig levels and specific IgE levels were measured using the nephelometric method and reversed enzyme immunoassay with sandwich ELISA technique, respectively. The patients underwent epidermal skin tests with commercial extracts.Results: Family history of atopy and associated systemic allergies were detected in 32.8 and 40.3% of the subjects, respectively. Blood eosinophilia, elevated total, and specific IgE and positive skin tests were detected in 33.8, 42.2, 50, and 35% of the subjects, respectively. Out of 62 subjects, low levels of IgA, IgG, IgM, and IgG3 were detected in 12.9, 8, 6.5, and 1.6% of the patients, respectively.Conclusion: IgE-mediated mechanisms are involved in approximately 40% of VKC patients. A new finding was the higher incidence of Ig deficiency.

Objective To determine the prevalence of symptoms and signs of allergic rhinitis (AR) in children with vernal keratoconjunctivitis (VKC) and evaluate eustachian tube (ET) function using tympanometry. Methods The patients underwent an otolaryngological examination and symptoms of rhinorrhoea, nasal obstruction, nasal itching and sneezing were evaluated for the diagnosis of AR. Tympanometry was performed by a middle ear analyzer (Impedance audiometer AZ 26, Interacoustics A/S, Assens, Denmark). Blood samples were collected for determination of peripheral blood eosinophil count (PBEC) and serum total immunoglobulin E (IgE). Allergen sensitivity was also determined by skin prick test. Results The study included 26 males (96.3%) and 1 female (3.7%) with a mean age of 12.1 ± 4.4 years. Eight out of 27 subjects (29.6%) had blood eosinophilia and 11 out of 27 subjects had elevated serum IgE (40.7%). A positive skin prick test was identified for at least one allergen in 40% of patients (10/25 subjects). Symptoms and signs of AR were found in 10 subjects (37%). Median serum IgE level in subjects with AR (262.5 kU/L) was higher than without AR (40.2 kU/L) ( p = 0.08), whereas there were no differences in PBEC or eosinophilia percentage ( p > 0.05). Mean middle ear pressures in the right and left ears were −66.4 daPa (range between −268 and 4 daPa) and −57.3 daPa (range between −308 and 0 daPa), respectively. The tympanometry results were abnormal in 5 subjects (18.5%) (3 type C and 2 type B tympanogram). Three out of 10 VKC patients with AR (30%) and 2 out of 17 VKC patients without AR (11.8%) had abnormal tympanograms ( p = 0.33). Conclusion AR is commonly associated with VKC and subjects with AR are almost three times more likely to have ET dysfunction than those without. Therefore, opthalmologists should refer VKC patients to otolaryngologists to delineate associated AR and ET dysfunction. Conversely, patients with OME and/or AR who have persistent allergic eye symptoms may well benefit from opthalmologic evaluation for seasonal allergic conjunctivitis and VKC.

In this study, we evaluated the gender differences in body mass index (BMI), age and their effects on apnea-hypopnea index during total sleep time (AHI(TST)) in the Turkish population who were diagnosed with obstructive sleep apnea syndrome (OSAS) and compared them with data from the literature. A computerized database of 244 Turkish patients (194 males, 50 females) who had undergone overnight polysomnography (PSG) and diagnosed with OSAS at Bayindir Hospital sleep laboratory between October 2004 and January 2007 was reviewed. The male:female ratio of the patients was 3.88:1. Male patients were significantly younger compared to females (48.87 +/- 10.82 vs 52.94 +/- 12.14 years, respectively, P = 0.003). The BMI and AHI(TST) were similar in male and female patients (BMI = 29.52 +/- 4.63 vs 31.17 +/- 6.08 kg/m2, respectively, P = 0.083) (AHI(TST) = 27.45 +/- 22.97 vs 24.77 +/- 23.83, respectively, P = 0.149). For the male and female groups, AHI(TST) increased as BMI increased (P = 0.03, 0.04). The median values of AHI(TST) in male group, for the normal, overweight and obese + pathological obese groups were 12.45, 20.20 and 23.50, respectively, whereas the median values of AHI(TST) in female group were 11.10, 10.95 and 26.20, respectively. In the normal and obese + pathological obese groups, there was no statistically significant difference according to gender, whereas in the overweight group, male patients had significantly higher AHI(TST) (P = 0.02). There was no statistically significant difference between the male and female patients regarding the severity of OSAS (P = 0.358). However, there was a male tendency to moderate and severe OSAS in the normal and overweight BMI groups. In Turkish patients with OSAS, there was no gender difference in BMI and AHI(TST) and female patients were significantly older than the males. The OSAS was diagnosed in men nearly four times more often than in women.