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This randomized, controlled, open-label, phase 2 clinical trial aimed to assess the efficacy and safety of low-dose methotrexate (MTX) as maintenance therapy for recurrent postoperative chronic rhinosinusitis with nasal polyps (CRSwNP).Forty-one patients with CRSwNP who experienced postoperative polyp recurrence(s) were randomly divided into three groups to receive one of the following treatments for eight weeks: daily intranasal mometasone furoate monohydrate 200 mcg (control [INCS arm, n = 13]); daily per oral methylprednisolone 8 mg (oral corticosteroid [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 analogue scale (VAS), Turkish version of the Sinonasal Outcome Test-22 (SNOT-22), peak nasal inspiratory flow (PNIF), butanol olfactory threshold test (BuOT), serum total immunoglobulin E (IgE) level, presence of peripheral eosinophilia, serum biochemical assays, and adverse events.All efficacy outcome measures significantly improved in all three groups, except for the non-recovery 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.Low-dose MTX was a safe and effective maintenance therapy for patients with recurrent postoperative CRSwNP. This article is protected by copyright. All rights reserved.

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.

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

Yazıcı, Haşmet (Balikesir Author), Object: To prepare a national guideline for Oto-rhinolaryngologist 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.

Atopy is a tendency to produce Ig-E antibodies in response to allergens and to develop allergic clinical symptoms such as allergic rhinitis, allergic bronchial asthma, and atopic dermatitis. Among them, allergic rhinitis (AR) is a chronic inflammatory disease of the intranasal mucosa, characterized by nasal symptoms reducing the quality of life. Management of AR maintains entirely symptomatic and is intended only to relieve the undesirable effects of mediators resulting from the allergic inflammatory reaction. The only disease-modifying treatment is immunotherapy, which can eliminate the pathophysiology of the disease. However, it is a long-lasting modality with several limitations and contraindications. In recent years, melatonin has been evaluated in various allergic inflammatory disorders due to its anti-inflammatory and antioxidant properties and has been suggested as a promising therapeutic. The role of melatonin has not been investigated in the treatment of AR, even though AR has a similar pathogenesis to those of atopic dermatitis and allergic bronchial asthma. This review is aimed to examine the pathophysiological mechanism of AR and illuminate the common pathways with atopic dermatitis and allergic bronchial asthma to discuss the potential hypothetical therapeutic role of the melatonin in AR, similar to the other two atopic diseases.

Objective: The purpose of the study was to evaluate the infrastructure facilities of clinical trial units in Turkey to create descriptive information and perform a pilot strengths, weaknesses, opportunities, and threats SWOT analysis that describes the strengths to match them with the opportunities and aims to reduce weaknesses and threats. Methods: This study was conducted using the data provided by nine clinical trial units within the scope of a collaboration agreement signed with Turkish Clinical Research Infrastructure Network between April 2013 and December 2016, using a survey created and applied with Google Forms application. Descriptive statistics was used to summarize infrastructure and capacity questions. Mean and median were calculated to interpret the current data. A pilot SWOT analysis was performed to evaluate the clinical research environment in Turkey.Results: The number of clinical trials conducted varied over a wide range among the units. Most trials were conducted in the area of pediatrics, with the least number of trials being conducted in the area of endocrinology. Most units conducted national singlecenter trials with public funds. Physicians were mostly involved in clinical trials, and the number of nonprofessional healthcare personnel was limited. Application to the Ethics Committees and MoH was the most provided service among clinical trials units, where monitoring was the least provided service. None of the units had quality certification. A wide range of evaluations and suggestions concerning the clinical trial environment in Turkey was provided in this pilot SWOT analysis.Conclusion: As these weaknesses and threats with the data, provided by the units, are consistent with the concerns expressed by the national policy makers, suggestions expressed in the survey to improve the clinical research capacity and environment in Turkey should be considered for future actions

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.

A two-year-old girl patient, who presented to another center with three months of sore throat and one month of neck swelling with pain, was initiated antibiotherapy but no healing was achieved. Afterwards, the patient was directed to our clinic and an abscess was detected in magnetic resonance imaging extending in both lateral spaces of the neck. The patient was performed surgical drainage urgently. The wound was dressed with rifampicin and the patient was started parenteral antibiotherapy. A dramatic recovery was observed and no complication occurred in the patient.

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 0.624aeuro"0.756, P = 0.000). Conclusions The authors suggest that the Turkish SNOT-22 is a valid, reliable, reproducible and responsive questionnaire.

Objectives/Hypothesis Although medical intervention is the first option for treatment of nasal polyps, surgery is still a therapeutic option for symptomatic cases that do not respond or partially respond to medical intervention. However, there is a need for high-level evidence for the preoperative use of steroids in nasal polyposis surgery. We aimed to assess the perioperative effect of preoperative use of oral prednisolone for advanced-stage diffuse nasal polyposis. Study Design Prospective, double-blind, randomized, placebo-controlled study. Methods A visual analog scale (VAS) was evaluated for smell, nasal discharge, nasal obstruction, facial pressure, headache, butanol smell threshold, and peak nasal inspiratory flow (PNIF) before and after the use of study drug. Perioperative bleeding volume, visibility of operative field, operative time, hospital stay, and complication rate were also evaluated. Results The improvement in the corticosteroid group (CG) in the VAS scores, butanol thresholds, and PNIF values showed statistically significant differences compared to the placebo group (PG) (P

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 chi(2) 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

Objective Evaluation of neck metastasis incidence in surgically treated T2N0M0 glottic carcinoma patients and discussion the necessity of elective neck dissection in this subset of larynx carcinomas. Materials and methods The patients who were staged clinically and radiologically as T2N0M0 glottic carcinoma having surgical intervention for their primary tumor and elective neck dissection between March 1996 and July 2009 with at least 2 years of follow up were included in the study. The recordings of patients were evaluated retrospectively for primary tumor location, vocal cord mobility, type of laryngectomy and neck dissection, results of histopathological examination, number of dissected lymph nodes for each specimen and for local and regional failure during the follow up. Results In the 13-year study period, 24 consecutive patients with a mean age of 56.4 were treated surgically with 20 frontolateral, three vertical laryngectomies and one cricohyoido-epiglottopexy; 19 lateral and 5 functional neck dissections were performed for the necks. Histopathological examinations of the neck dissection specimens revealed an average of 32 lymph nodes (8–65) and there was no metastasis in any of these specimens. After an average 58 months of follow-up, only one patient had local failure and no patients had regional failure. Conclusion As occult metastasis was not detected in any of the neck dissection specimens in cT2N0M0 patients and no regional failure was experienced during the follow-up period, it was concluded that the neck could be followed up without performing elective neck dissection in the surgical management of cT2N0M0 glottic carcinoma patients.

We aimed to define the classification of frontal sinus pneumatization patterns according to three-dimensional volume measurements.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.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.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.

Objective: We aimed to investigate the diagnostic and therapeutic approaches in pharyngoesophageal perforation (PEP) following anterior cervical spine intervention (ACSI). Methods: We reviewed the records of four patients with PEP after ACSI. Symptoms, physical examination findings, imaging results, treatment, and follow-up characteristics were evaluated. Results: All four patients had undergone ACSI for either cervical trauma or cervical disc herniation with cervical cage reconstruction. Symptoms developed within the first 10 days of the postoperative period in three patients, and in the eighth month in one patient. Mucosal defects were detected during neck exploration in three patients. Reconstruction with primary suture and a local muscle flap was utilized in two patients. Three patients were discharged 3-8 weeks after surgical treatment. Conclusion: In cases of PEP after ACSI, a good prognosis can be achieved when symptoms are detected in the early period and reconstruction with local muscle flap is applied. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

Ameloblastic fibroodontoma (AFO) is a rare entity of mixed odontogenic tumors and frequently arises from posterior portion of the maxilla or mandible in first two decades of life. Herein, a 35-year-old woman with a noncontributory medical history who presented with a progressive left maxillary toothache, left maxillary first molar tooth mobility, and swelling in the left maxillary molar area for the last 2 months was reported. Radiologically, a tumor that originated from periapical area of the second mature molar teeth of maxilla was seen and additively unerupted tooth was not detected. The histopathologic examination revealed AFO. The patient is disease-free for five years after treated with limited segmental alveolectomy combining with Caldwell-Luc procedure.

Objective This experimental study evaluated the pathophysiological association of long-term potentiation (LTP)-mediated synaptic plasticity in tinnitus in 30 BALB/c mice. Materials and methods Baseline hearing levels and tinnitus perception were examined with startle reflex time and gap detection time measurements using an acoustic stimulus of a 6-kHz pure tone at 90 dB sound pressure level (SPL) on post-natal day 16. The acoustic trauma group was exposed to 6-kHz pure tone at 120 dB SPL on post-natal day 16. On post-natal day 17, the acoustic trauma group underwent re-measurements of hearing levels and tinnitus perception using an acoustic stimulus of 6-kHz pure tone at 100 dB SPL. Fifteen tinnitus-induced and fifteen control subjects were sacrificed on post-natal day 17, and LTP in the dorsal cochlear nuclei of each animal was examined. Results With respect to gap detection time, there were no statistically significant between-group differences; however, there was a statistically significant difference between the pre- and post-trauma period in the acoustic trauma group. Moreover, LTP was significantly higher in the acoustic trauma group than in the control group. Conclusion The results suggest that LTP underlies tinnitus pathogenesis.

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.

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.

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%.

Although medical intervention is the first option for treatment of nasal polyps, surgery is still a therapeutic option for symptomatic cases that do not respond or partially respond to medical intervention. However, there is a need for high-level evidence for the preoperative use of steroids in nasal polyposis surgery. We aimed to assess the perioperative effect of preoperative use of oral prednisolone for advanced-stage diffuse nasal polyposis.Prospective, double-blind, randomized, placebo-controlled study.A visual analog scale (VAS) was evaluated for smell, nasal discharge, nasal obstruction, facial pressure, headache, butanol smell threshold, and peak nasal inspiratory flow (PNIF) before and after the use of study drug. Perioperative bleeding volume, visibility of operative field, operative time, hospital stay, and complication rate were also evaluated.The improvement in the corticosteroid group (CG) in the VAS scores, butanol thresholds, and PNIF values showed statistically significant differences compared to the placebo group (PG) (P .05). The perioperative bleeding volume, visibility score, operative time, and hospital stay for CG/PG were 141 mL/384 mL, 2.4/3.4, 61 min/71.6 min, and 1.1 day/1.8 day, respectively (P .05). The difference between the complication rates for the two groups did not show any statistically significant difference (P = .214).Preoperative administration of systemic corticosteroids improves the perioperative visibility by reducing blood loss and shortens the operation time. We recommend the use of preoperative corticosteroid for the safety of the patients. The optimum dose and duration have not been established and require further studies.1b.

To investigate the role of intraoperative spinal accessory nerve monitoring in predicting postoperative shoulder function in spinal accessory nerve-sparing neck dissections.Prospective, double-blind clinical trial.Academic, tertiary care center.This study was performed on 20 neck sites of 17 consecutive patients who had neck dissections sparing the spinal accessory nerve. Threshold increment ≥0.25 mA and amplitude decrement ≥72% were classified as significant intraoperative neuromonitoring changes while lesser differences were classified as insignificant intraoperative neuromonitoring changes. All patients had intraoperative neuromonitoring recordings when the spinal accessory nerve was first identified and at the end of surgery. Postoperative shoulder function was evaluated neurophysiologically with electromyography and clinically with Constant-Murley Score; daily activity restrictions were evaluated with Activity Restriction Scale.Clinical assessment of shoulder functions at postoperative first and second months showed statistically significant deteriorations when compared with preoperative values (P.05). The shoulder function deterioration was statistically significantly less for patients with insignificant intraoperative neuromonitoring changes than patients with significant intraoperative neuromonitoring changes (P.05). Daily activity restriction deteriorations were present in both groups at first postoperative month (P.05). While they persisted in the group with significant intraoperative neuromonitoring changes during the second postoperative month (P.05), there was continuing recovery in the insignificant intraoperative neuromonitoring change group and statistical significance disappeared (P.05).Our results support the predictive value of spinal accessory nerve intraoperative neuromonitoring for determining shoulder function deterioration and activity restriction scores.

Calculus formation in salivary glands (sialolithiasis) is one of the most common diseases of the salivary glands and is most commonly seen in the submandibular gland. Not only can the stones be small and inside the duct, they may also get larger and reside inside the gland. We can easily see submandibular sialolithiasis perforating the floor of the mouth in cases having sialolithiasis for decades and not having any treatment and its transoral removal as we look in the medical literature. A 52-year-old lady who had rejected surgical treatment for submandibular sialolithiasis for 25 years is presented as a case in this study. Treatment of the case was performed effectively by taking out the calculus transorally with a simple intervention whose examination revealed that the calculus was seen to perforate the floor of the mouth. It is aimed to stress with this case that transoral removal of submandibular sialolithiasis that perforates the floor of the mouth without performing external approaches is a method that has to be thought in the first step.

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.

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 aim of this study is to evaluate the clinical, electroencephalographic and polysomnographic features of patients presenting with parasomnias. Cases who were admitted for differentiating parasomnias from epilepsy were included in the study. Clinical features of cases were recorded and routine sleep electroencephalography was obtained from all cases. Cases whose symptoms strongly suggested nocturnal seizure underwent all night video electroencephalography monitoring. Polysomnography was obtained to evaluate the quality of breathing from patients whose symptoms suggested obstructive sleep apnea. Twenty-three patients with no neurological disorder were included in the study. The mean age of the patients was 11.7 ± 2.8 [7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17] years. Twelve patients (52 %) presented with sleep terrors and 11 patients (48 %) presented with sleep walking. All of the patients underwent a routine sleep electroencephalographic study and 15 patients (65 %) whose symptoms strongly suggested nocturnal epilepsy underwent long-term video electroencephalographic evaluation. Ten patients (43 %) underwent polysomnographic study. Three patients (20 %) who underwent long-term video electroencephalographic evaluation were diagnosed to have nocturnal frontal lobe epilepsy and two patients (20 %) who underwent polysomnography had pathological sleep apnea. Eleven patients (48 %) had a psychiatric disorder like major depression, anxiety disorder, hyperactivity disorder and obsessive–compulsive disorder. Childhood cases presenting with parasomnias should be searched for nocturnal epileptic disorders, sleep disordered breathing and psychiatric disorders.

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.

Objective To provide information on the clinical characteristics and management of an uncommon congenital nasolacrimal system anomaly, intranasal nasolacrimal duct cyst. Methods Three patients treated with microdebrider assisted endoscopic marsupialization for intranasal nasolacrimal duct cysts were included in this study. Management and outcomes are compared to previous reports in the literature. Results Patients were presented in between 2007 and 2010. Diagnosis was made by clinical observation and endoscopic nasal examination. The first patient is a 1 year old child with congenital dacryocystocele presented as a right medial canthal mass and ipsilateral intranasal cyst. The second patient is a 60 days old child presented with nasal obstruction and feeding difficulty who was found to have bilateral intranasal cystic masses. The third patient was a 6 days old newborn with respiratory distress, whose nasal endoscopy revealed bilateral choanal atresia and left side intranasal cyst. All three cases were treated with nasal endoscopic marsupialization and no recurrence of symptoms and physical findings were found. Conclusions Intranasal nasolacrimal duct cysts may lead to nasal obstruction, respiratory distress and feeding difficulty. An otorhinolaryngologist should be consulted, as nasal endoscopy is fundamental for diagnosis. Microdebrider assisted endoscopic marsupialization is a safe and curative treatment.

Objective: Provide information on the clinical characteristics and management of an uncommon congenital nasolacrimal duct anomaly with intranasal cysts.Method: Three cases of intranasal nasolacrimal duct cysts are presented with a brief literature review. Patients were presented from 2007 to 2010. Diagnosis was made by clinical observation and endoscopic examination with a search for a cyst in the inferior meatus. The intranasal cysts were successfully treated with nasal endoscopic marsupialization.Results: We report 3 cases of congenital nasolacrimal duct anomaly with intranasal extension presenting as intranasal cystic masses. The first case is a 60 days old child presented with bilateral intranasal cystic masses that caused nasal obstruction and respiratory distress. The second case is a 1-year-old child presented with congenital dacryocystocele and coexisting ipsilateral intranasal cyst explored by nasal endoscopy. The last case is a 6 days old newborn presented with respiratory distress and found to ...

A B S T R A C T Objective: The purpose of this study was to investigate the antiinflammatory and antifibrotic effects of Nnitro L-arginine methyl ester (L-NAME) in experimentally induced myringosclerosis. Methods: Twenty Wistar albino rats were bilaterally myringotomized and divided randomly into four groups, each including five rats. Group I received no treatment, Group II was treated with topical saline solution, Group III received topical L-NAME and Group IV received intraperitoneally administered LNAME. After 2 weeks, the tympanic membranes were examined and scored by otomicroscopy regarding the extent of the myringosclerosis. Then the tympanic membranes were harvested and evaluated histopathologically by light microscopy. The intensity of inflammation and degree of myringosclerosis were evaluated, the mean thickness of tympanic membranes were also measured. Results: The tympanic membranes of Groups I and II showed extensive myringosclerosis in contrast to those of Groups III and IV which had significantly less or no changes (p < 0.05). The inflammation and fibroblastic activity of the lamina propria in the tympanic membranes of Groups III and IV were found to be significantly less pronounced (p < 0.05). The tympanic membranes were found to be significantly thicker in Groups I and II when compared with Groups III and IV (p < 0.05). Conclusion: Our results showed that both topical and intraperitoneal applications of L-NAME supressed inflammation, reduced fibroblastic proliferation and decreased the formation of myringosclerosis in myringotomized rat tympanic membranes.

The aim of this study was to assess the rate of complications of the microdébrider in endoscopic sinus surgery (ESS) for nasal polyposis.A retrospective study was done on the complications occurring during ESS for nasal polyposis and chronic rhinosinusitis (CRS) without nasal polyps in which a microdébrider had been used on 275 sides of 139 patients in a tertiary university practice setting.The mean sinus opacification scores in computed tomography, according to the Lund-Mackay staging system, were 9.2 +/- 2.28 for the nasal polyposis group and 4.8 +/- 1.54 for the CRS group. There was one major complication, a cerebrospinal fistula that was repaired during the surgery. The minor and major complication rates for the nasal polyposis group were 11.8% and 0.5%, respectively. The minor complication rate for the CRS group was 4%.Knowledge of endonasal anatomy, surgical experience, a bloodless operating field, and being careful about every colour change during the operation are the fundamental essentials for lowering the complication rate. With its lower incidence of complications, even in high-risk cases such as nasal polyposis, a microdébrider provides acceptable complication rates in ESS. Also, the severity of the disease is the main determining factor for the final complication rate.

We evaluated the preliminary results of the circumferential subannular grafting technique, which has been proposed as a modification of the standard underlay method.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).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.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.

Hypopharyngeal schwannoma is quite rare, with only nine cases presented in the literature to our knowledge. The presentation itself requires a distinction from malignant hypopharyngeal disease, which is usually the initial diagnosis. A transcervical approach and laryngomicrosurgery are two possible operating methods for the treatment of hypopharyngeal schwannoma. The selection of the surgical method depends on the size of the tumor. For this case, we preferred the transcervical approach without tracheotomy. In contrast to previous case reports, we were unable to trace the original nerve.