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Angiofibromas rarely localize in extranasopharyngeal sites. The most common site for extranasopharyngeal angiofibromas is the maxillary sinus. The ethmoid and sphenoid sinuses, nasal septum, middle and inferior turbinates, conjunctiva, molar and retromolar region, and larynx are other sites where extranasopharyngeal angiofibromas have been reported. Only one case of buccal extranasopharyngeal angiofibroma has been reported to date. We present a case of buccal extranasopharyngeal angiofibroma that was excised completely following embolization and we also review the literature. [ABSTRACT FROM AUTHOR]

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

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

Objective: Postoperative comfort of the patients undergoing rhinoplasty might be poor because of edema and ecchymosis caused by lateral osteotomy. In this animal experiment, we aimed at performing a quantitative assessment of effects of hyaluronic acid usage on healing process of lateral osteotomy., Methods: Fourteen New Zealand rabbits with a weight of 2000-2500 kg and an age of 8-12 weeks were included. Under anesthesia, nasal dorsums were exposed with midline incision and lateral osteotomies on both sides were performed using a 2 mm chisel. A hyaluronic acid-based mesh (Hyalonect ® ) (1 × 1 cm) was embedded on the left osteotomy areas of all rabbits. Right osteotomy areas were left blank as control group. Collagen density and capillary development were quantitatively compared., Results: Convergence of fracture lines was observed in 6 (60%) of 10 samples from Hyalonect ® group, while was observed in 4 (40%) of 10 samples from control group. Although a higher rate of convergence was seen in the Hyalonect ® group (60% vs 40%), the difference was not statistically significant (p = 0.5). Median collagen score was 2 (1-3) in the Hyalonect ® group and 1 (1-2) in the control group. Median capillary count value was 4 (1-23) in the Hyalonect ® group and 3 (1-17) in the control group. Both collagen score and capillary count values were significantly greater in the in the Hyalonect ® group compared with the control group (p = 0.023 and p = 0.019, respectively)., Conclusion: The effects of hyaluronic acid-based meshes on the bone healing process of the lateral osteotomy area might be investigated furthermore, on more comprehensive studies, as a material facilitating collagen organization and capillary development., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

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

Objective: To determine whether septoplasty is an effective factor on the voice in patients with varying degrees of nasal septum deviation., Study Design: Descriptive study., Place and Duration of Study: Ankara Numune Training and Research Hospital, Ear Nose Throat Clinic, Ankara, Turkey, from November 2018 to March 2019., Methodology: A total of 69 patients formed groups I, II and III. Groups I, II and III consisted of patients with mild, moderate and severe nasal deviation, respectively. All patients underwent septoplasty under general anesthesia. Subjective and objective voice analyses were performed for each patient preoperatively and at the postoperative third month., Results: There was no statistical difference between the mean pre- and postoperative voice handicap ındex-30 (VHI-30) scores in group I and group II. Postoperative mean VHI-30 scores were significantly lower in group III. In groups I and II, the differences between the mean pre- and postoperative fundamental frequency (F0), frequency perturbation (jitter), amplitude perturbation (shimmer) and noise-to-harmonics ratio (NHR) values were not statistically significant. While the differences between the mean preoperative and postoperative F0, jitter and NHR values in group III were not statistically significant, mean postoperative shimmer value was lower than preoperative one with significantly difference., Conclusion: Septoplasty affects the voice positively in patients having severe septum deviation.

Objective: To determine the effect of Körner's septum (KS) on graft success and hearing in patients who were treated with type 1 tympanoplasty., Study Design: An observational study., Place and Duration of Study: Department of Otorhinolaryngology, University of Health Sciences, Ankara Numune Training and Research Hospital, Turkey, from July 2013 to July 2018., Methodology: Patients undergoing type 1 tympanoplasty were divided into 2 groups as patients with KS and without KS (WKS), according to the findings of high-resolution computed tomography of the temporal bone. Two different grafts (fascia and cartilage) in two groups (KS and WKS) were compared for graft success rate of different graft materials and pre- and postoperative hearing levels. The effect of the presence of KS on hearing was examined., Results: The anatomical graft success rate of type 1 tympanoplasty was 75.9% in the KS group and 88.5% in the WKS group (p = 0.026). In the presence of KS, graft success rate decreased with the use of a fascia graft (p = 0.044). In the presence of KS, the use of cartilage graft did not affect functional hearing; whereas, poor functional outcomes were obtained in ears operated using a temporalis fascia graft in the KS group than in the WKS group (p = 0.003)., Conclusion: KS adversely affects graft success in type 1 tympanoplasty. Cartilage should be preferred as the graft material for patients with KS.

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

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

Objectives: In this study, the relation between phonotrauma and presence of siblings and social activities was investigated, and the incidence of voice disorders in the mothers of children with vocal fold nodules was studied with objective (clinical voice analysis) and subjective (laryngostroboscopy, Voice Handicap Index) methods., Methods: Twenty-nine children with vocal fold nodules (age range 5-14 years), 45 age-matched children without any voice disorders as a control group, and their mothers were included in the study. All patients had laryngostroboscopy and clinical voice analysis, and their mothers filled out the Pediatric Voice Handicap Index. We noted the most common place or situation where children used their voice in excessively high volume according to their mothers, including home, school, sportive activities, and singing or reciting poem activities, to recognize the major cause of phonotrauma. In addition, presence of siblings was recorded., Results: It was found that 15 patients (51.7%) had younger siblings, seven patients (24.1%) had older siblings, five patients (17.2%) had both younger and older siblings, and two patients (6.8%) did not have any siblings. It was seen that excessive usage of high-volume voice at home had a correlation with presence of only younger siblings, and both younger and older siblings tended to cause phonotrauma at home (86.7%). Additionally, eight boys (44.4%) reported presence of sportive activities, whereas none of the girls had such an activity (P = 0.012)., Conclusion: Presence of siblings seems to be an important factor for vocal nodule formation. Maternal relationship does not seem to be a major factor for vocal misuse., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

BACKGROUND Nasal septal perforation (NSP) may alter nasal airflow patterns and physiology. To the best of our knowledge, no studies in the English literature have investigated the effect of NSP and its treatment on polysomnographic parameters. In this study, we aimed to investigate polysomnographic parameters in patients with NSP as well as changes in those parameters after treatment of NSP. MATERIAL AND METHODS Nineteen patients diagnosed with NSP were included in the study. All patients had baseline and post-procedure polysomnographies (PSG) after insertion of silicone septal button for closure of NSP. RESULTS Both median AHI [5.30 (14.40) vs. 2.40 (14.50)] and median supine AHI [10.00 (42.10) vs. 6.60 (37.00)] decreased after correction of the perforation. There was a large reduction in median supine AHI in patients with a perforation size >66 mm2 [10.10 (34.15) vs. 1.60 (28.30)]. CONCLUSIONS We conclude that NSP did not cause any deterioration in objective sleep parameters as determined by PSG, other than a decrease in REM sleep duration and an increase in supine AHI. Correction of NSP did not affect REM duration and supine AHI decreased after treatment.

Background: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) give information about many diseases. An increase in inflammation markers occurs in patients with obstructive sleep apnea syndrome (OSAS)., Objectives: The aim of this study is to determine the relationship between OSAS and NLR and PLR values., Material and Methods: Two hundred eighty four patients with complaints of snoring and excessive daytime sleepiness were included in the study. Polysomnography had been performed on all patients and the control group. Fourty eight of these patients with apnea-hypopnea index (AHI) less than 5 (pure snoring) were included in the control group, 67 patients with AHI between 5 and 14.9 in the mild OSAS group, 61 patients with AHI between 15 and 29.9 in the moderate OSAS group and 108 patients with AHI more than 30 in the severe OSAS group. NLR and PLR values were calculated from the complete blood count (CBC) analysis of the patients and control group. The OSAS and control groups were compared by age, gender, body mass index (BMI) and PSG parameters as well as NLR and PLR values., Results: The PLR value in the OSAS group was found to be less than in the control group (p=0.006). As the non-REM AHI increased, the value of PLR decreased. As the nocturnal time spent with arterial oxygen saturation<90% increased, the value of NLR was determined to increase., Conclusions: NLR and PLR values can give valuable information in OSAS.

Introduction: Inhaled steroids are widely used for persistent cough treatment. Although the side effects of long-term inhaled steroids have been well described in the literature, their laryngeal side effects after short-term use have not yet been defined. The aim of this study was to evaluate the effect of 1 month application of inhaled steroid treatment on voice parameters in patients with subacute or chronic cough. Furthermore, the efficacy of inhaled steroids on cough was investigated, as well., Material and Methods: This study included 46 patients (27 females and 19 males) with a persistent cough lasting at least 3 weeks and treated with inhaled steroids. All patients were examined by a pulmonologist and lung auscultation where a posteroanterior chest X-ray and spirometry were performed. The patients were also examined by an otolaryngologist. Anterior rhinoscopy, flexible fiberoptic nasopharyngoscopy, and laryngostroboscopy were performed. Also, the patients' acoustic voice analyses were performed and recorded using a multidimensional voice program. Cough symptom index (CSI) scores were used to evaluate the response to treatment. Patients with an underlying disease that was unresponsive to inhaled steroids were excluded from study. The 46 patients were administered inhaled budesonide 400 mcg twice a day, for 1 month, and their acoustic voice analyses were performed again at the end of the treatment. In addition, CSI scores were determined after stopping medication., Results: When pretreatment and posttreatment acoustic voice analysis parameters (Fo, Jita, Jitt, Shim, APQ, vAm, and NHR) were compared, statistically significant differences were detected for vAm (P = 0.001) and F0 (P0.003). After treatment with inhaled steroids, the CSI score reduced from 3 to 1 (median), and the difference was statistically significant., Conclusions: Inhaled budesonide treatment in the proper dose seems to be an effective treatment for persistent cough, in the selected patient group. In addition, short-term budesonide application did not cause any negative effects on the voice parameters in these patients. These findings may be related to the steroid formulation used, the application method, and the duration of treatment. Further studies are needed on a larger group of patients with different formulations of inhaled steroids to clarify aforementioned issues., (Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

The aim of this study is to investigate the thyroid functions and its correlation with polysomnography findings in obstructive sleep apnea patients. This study was conducted on 203 patients evaluated with the complaints of snoring, witnessed apnea and daytime sleepiness and established polysomnography (PSG) indication between May 2008 and August 2011. All patients' nocturnal PSG recordings were carried out. The thyroid function was classified as euthyroid, subclinical hypothyroidism and clinical hypothyroidism after analyzing serum TSH and free T4 values. The correlation between the data obtained from PSG records and thyroid function values was statistically compared. Apnea hypopnea index obtained from PSG was in the range of 5.4-132.9/h, and mean value was 32.7/h. The lowest oxygen saturation level was in the range of 20-92 %, and the mean value was 76.4 %. According to PSG results, 55 patients (27.09 %) had mild obstructive sleep apnea syndrome (OSAS), 48 patients (23.65 %) had moderate OSAS and 100 patients (49.26 %) had severe OSAS. On evaluation of the thyroid function test results, 10.8 % (n = 22) of the patients were defined to have subclinical hypothyroidism and 1.97 % (n = 4) clinical hypothyroidism. We found a total of 12.77 % subclinical and clinical hypothyroidism in patients with OSAS. Though the incidence of hypothyroidism was pretty high in patients with OSA, there was no statistically significant correlation between thyroid functions and polysomnography findings. We suggest that evaluation of the thyroid functions is important and necessary in patients with OSAS. Polysomnography findings do not correlate statistically with thyroid function tests, addressing the need for thyroid screening for all OSAS patients.

The importance of clinical assessment and its contribution to the diagnosis of neck masses was investigated in patients presenting with a neck mass. In our study, we collected the medical history of a total of 127 patients, including 66 males and 61 females, who presented with a neck mass. Physical exams, endoscopic examinations, laboratory tests, a variety of imaging studies, and fine-needle aspiration biopsies were performed. The relationship between age, duration and location of the neck mass, FNAB results, and definitive histopathological diagnosis were investigated as well as the correlation between the consensus diagnosis reached after the evaluation of the medical history, physical examination and imaging studies, and definitive histopathological diagnosis. A strong and positive relationship (p < 0.01) was found between patients' ages and the definitive diagnosis established by histopathological examination. There was no statistically significant relationship (p > 0.05) between the duration and location of the neck mass and definitive diagnosis established by histopathological examination. And no statistically significant relationship (p > 0.05) was found between FNAB results and definitive histopathological diagnosis. Although no statistically significant relationship was found between the characteristics of neck masses and age, duration and location of masses and FNAB results, there was a statistically significant correlation between the pre-diagnosis estimated by ENT specialists and definitive diagnosis established by histopathological examination. A strong and positive relationship (p < 0.01) was found between clinical pre-diagnosis and definitive diagnosis established by histopathological examination. In patients presenting with a neck mass, the diagnosis should be made based on the medical history, physical examination, radiologic imaging and FNAB results, treatment decisions should be based on those findings.

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

Objective: Allergic rhinitis is inflammation of the nasal mucosa following exposure to allergens. A few studies have investigated how the Allergic Rhinitis and its Impact on Asthma classification correlates with symptom severity and skin prick test results in allergic rhinitis patients. Our objective was to evaluate such a correlation., Materials and Methods: The study population consisted of 268 patients who had allergic symptoms and were diagnosed with allergic rhinitis., Results: Analysis of the Allergic Rhinitis and its Impact on Asthma classification with regard to symptom severity revealed that there were statistically significant differences between the groups for nasal symptoms, wheezing, eye itching/watering and eye redness. Symptom frequency and severity increased gradually towards the moderate to severe persistent allergic group. There was a statistically significant difference between the groups for grass pollen and house dust mite allergy., Conclusion: The Allergic Rhinitis and its Impact on Asthma classification, which takes symptoms and quality of life into consideration in addition to allergen exposure, is a useful classification system for allergic rhinitis.

Carotid-cochlear interval (CCI) is the minimal distance between petrous segment of internal carotid artery (ICA) and basal turn of cochlea. Pulsations of the ICA might create fluid pressure changes and direct stimulation of hair cells on the basilar membrane of basal turn of cochlea which is responsible for mid-tone frequencies. The purpose of this study was to investigate whether CCI has a role in the etiology of mid-tone hearing loss and to obtain reference measurements of CCI on MRI. A total of 117 subjects were consecutively enrolled into this retrospective study during a 4 month period. All examinations were performed on a 1.5 T MRI system. The images were transferred to the workstation and reformatted. The CCI was measured on reformatted 3D FIESTA images. The audiologic findings were correlated. We reviewed the temporal MRI studies of 90 consecutive patients [M/F: 48/42, Mean age 45.6 ± 16.6 (10-78)]. As a total 180 sides were evaluated. The CCI ranged from 0 to 9 mm. The CCI didn't exhibit a significant association with subject age or gender. There were no significant differences between readers or sides. There were statistically significant correlation between CCI and level of frequency and degree of hearing loss (p = 0.004 and p = 0.002). The knowledge of CCI is essential prior to otosurgical procedures. There was linear correlation among CCI and level of frequency and degree of hearing loss. CCI of the group including all types of middle frequency hearing loss was longer compared to the normal group.

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

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

Hemolacria is a very rare entity which literally means "bloody tears". Conjunctivitis, capillary hemangioma, conjunctival telangiectasia, trauma, retrograde epistaxis and nasal and paranasal neoplasms may play a role in its etiology. In our case report, a 11-year-old female patient who presented with the complaint of bilateral epistaxis accompanied by bloody tears that had been present for 2 years and whose endoscopic examination revealed hyperemia and increased vascularity in the nasal cavity mucosa was discussed together with a review of the literature., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

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

Objectives/hypothesis: To electrophysiologically and histomorphologically demonstrate the effects of intratympanic corticosteroids administered following an acoustic trauma on cochlear hair cells., Methods: The trial was performed on 16 Wistar albino rats. The rats underwent distortion product otoacoustic emissions (DPOAE) measurement before the acoustic trauma, and subsequently rats were exposed to noise. Following acoustic trauma, the otoacoustic emission measurement was repeated. The rats were divided into two groups, a study group and a control group. The study rats were injected with methylprednisolone via the intratympanic route throughout the study. In the control group, the rats were injected daily with saline. After performing repeated otoacoustic emission measurements, one rat in each of the groups was sacrificed and their cochleae isolated., Results: The histological investigation performed after the 1st week revealed a statistically significantly higher rate of apoptotic cells in the inner and particularly the outer hair cells of the rat cochleae in the control group compared to the study group. Early measurement of DPOAE within the 1st week demonstrated significantly better amplitudes in the study group compared to controls. The otoacoustic emission assessment performed on the 14th day demonstrated statistically similar DPOAE values between the two groups., Conclusions: Intratympanic methylprednisolone injection administered following an acoustic trauma appears to reduce cochlear outer hair cell loss. The impact on hearing loss is less certain. Early measurement of DPOAE within the 1st week shows significantly better amplitudes in the study group compared to controls. However at 2 weeks, there is no statistically significant difference in DPOAE amplitudes between the study and control group., (Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.)

The ossicles may be affected through the mass effect of the pathological tissue in chronic otitis media. Ossicular reconstruction may be accomplished using the patients' own ossicles or with alloplastic materials. Glass ionomer ossiculoplasty is a fast, efficient, safe and cost-effective method and it has been used more frequently in recent years. Forty-six patients who had surgery for chronic otitis media were included in this study. All patients had an incus long process defect and a normal stapes superstructure. Ossicular reconstruction was performed using glass ionomer cement (GIC) (Ketac-Cem, Espe Dental AG, Seefeld, Germany) in 23 patients (group 1), while incus interposition was performed in other 23 patients (group 2). Preoperative and postoperative air pure tone averages of the group 1 patients were 42.8 and 35.2 dB, respectively (p < 0.01). These values were 42.9 and 34.5 dB in group 2 (p < 0.01). Two groups were similar with respect to postoperative hearing gain (p > 0.05). The air bone gap of group 1 was 27 dB preoperatively and 20.7 dB postoperatively. These values were 28.7 and 20.2 dB, respectively, in group 2. The closure of air bone gap was statistically significant in both the groups (p < 0.01, p < 0.01). The comparison of the mean gains of the air bone gap revealed no difference between the groups (p > 0.05). In conclusion, the use of both GIC ossiculoplasty and incus interposition are efficient methods for reconstruction of incus long process and one is not superior to the other. A larger study population may be useful for comparison of these methods.

This study aimed to investigate the association of inflammatory changes of upper and lower airways in a rabbit model of acute rhinosinusitis. The study included six adult albino rabbits. The sinuses of one animal were injected with saline solution and the animal was served as sham control. Other animals were implanted with intranasal S. aureus soaked-absorbable gelatin sponge. Acute rhinosinusitis was induced and subjects were sacrificed at the end of the second week. Tissue samples from all levels of the airway were obtained. They were evaluated for the presence of inflammatory changes histologically. A scoring system for airway inflammation was used for quantitative assessment of the degree of inflammation. Structural changes in the epithelial and stromal layers of the upper and lower airway structures were analyzed, as well. The animal of which the sinuses were injected with saline solution developed neither acute rhinosinusitis nor lower airway inflammation. In contrast, the animals in which acute rhinosinusitis was induced demonstrated significant upper and lower airway inflammation histologically. Inflammatory changes ranged from engorgement of blood vessels and polymorphonuclear cell proliferation within the capillaries, in the perivascular tissue of the epithelium or in the lamina propria and to epithelial disruption. Nasal airway inflammation scores (2.86 ± 1.81) were significantly higher than lower airway scores (1.36 ± 0.77), (P < 0.01). We obtained a generalized mucosal inflammatory response against localized bacterial inflammation in a rabbit model of acute rhinosinusitis, confirming the suggestion of 'one airway--one disease' from a bacterial infection point of view.

The aim of this study was to investigate and compare histopathological and computerized tomographic (CT) findings of experimental acute sinusitis in an animal model. The noses of five healthy rabbits were inoculated with a gelatin sponge impregnated with a solution containing Staphylococcus aureus, and one healthy rabbit acted as the control. The animals were sacrificed on the tenth day, following the acquisition of paranasal CT scans. Specimens were obtained from the lateral nasal walls, and the ethmoid and maxillary sinuses of the animals for histopathological examination. Histopathological and CT findings were compared. Various degrees of epithelial disorganization, foci of ruptured epithelial cells, and inflammatory cell infiltration in the lamina propria were seen in the histopathological examinations of the five study rabbits, and mucosal thickening and soft tissue density were noted in their CTs. There was no correlation between the histopathological and CT findings. It was shown that CT did not reflect the acute changes in the sinus mucosa. Patients with chronic sinusitis must be evaluated for a chronic process. Computerized tomographic scans should not be obtained in acute sinusitis cases. In this way, both unnecessary radiation exposure and economic waste can be avoided.

Objectives: In patients who underwent primary and revision surgery for chronic otitis media, the types of revision surgery, most frequently observed regions of cholesteatoma, hearing results and the status of graft membrane were evaluated., Patients and Methods: Forty-three of 495 patients (21 males, 22 females; mean age 38.4+/-15.2 years; range 15 to 76 years) with chronic otitis media who underwent revision surgery in our clinic between May 2003 and March 2009 were evaluated retrospectively. Indications for revision surgery were recurrence of the disease in 32 patients (74.4%) and reconstruction of hearing in 11 patients (25.6%). Forty patients (93.0%) underwent revision surgery once and three patients (7.0%) underwent revision twice. Over an average of 3.2 (range 1 to 6) years follow-up after primary and revision surgery, the types of revision surgery, the most frequently observed regions of cholesteatoma, hearing results and the status of graft membrane were assessed., Results: Recurrence of cholesteatoma in revision surgery was seen in 28 patients (65.1%). Out of 27 patients, 23 patients (85.1%) showed intact graft membranes and four patients (14.8%) showed perforated graft membranes., Conclusion: In revision surgery, the first goal is to eliminate the disease. The management of chronic otitis media with cholesteatoma is surgery. Because of high postoperative recurrence rates, long-term follow-up is necessary.

Conclusion: The results suggest that vitamin A can prevent scar formation in the vocal fold after surgery., Objectives: This study aimed to evaluate the effects of topically applied vitamin A on healing after vocal fold trauma., Materials and Methods: Vocal folds of 20 adult rabbits were traumatized unilaterally. Ten of them were treated with topical application of vitamin A and the others served as controls. All animals were sacrificed after 10 days. Vocal folds were resected for analysis by light microscopy., Results: The untreated vocal folds showed extensive deposition of collagen and fibroblast on light microscopy and vocal folds treated with vitamin A showed less deposition. There was a significant difference between the two groups according to the percentage of collagen and fibroblasts in the lamina propria (p<0.01).

Problems/objectives: Nasal septal abscesses are usually formed following nasal trauma or haematoma. A nasal septal abscess is defined as a collection of purulent material (pus) between the cartilage or bony septum and the mucoperichondrium or mucoperiosteum. Sinusitis and periorbital cellulites have been reported among the etiological factors and the complications., Methodology: A case of posttraumatic nasal septal abscess is reported in a 35-year-old male patient., Results: Frontal, ethmoid, and sphenoid sinusitis, as well as periorbital cellulites were seen to accompany the septal abscess. The abscess was surgically drained and intravenous antibiotherapy was instituted., Conclusion: Nasal trauma patients should be carefully assessed for posttraumatic haematoma and abscess formation, so that possible complications can be avoided by taking appropriate therapeutic measures.

After the widespread use of endoscopic sinus surgery and paranasal sinus computed tomography, many variations of nasal turbinates have been described. In addition to the most common one-middle turbinate pneumatization (concha bullosa)-superior and inferior turbinate pneumatizations have also been described. Secondary and accessory middle turbinates that can mimic real middle turbinate are anomalies described in recent years. Paradoxical middle turbinate and bifid inferior turbinate are very rarely encountered anomalies and can be easily recognized in paranasal tomography but can be overlooked by endoscopical examination. In the present study, the computed tomography images of 384 patients were evaluated for nasal turbinate variations, as well as their relations to mucosal pathologies. The most frequent variation was found to be concha bullosa; the least frequent one was found to be bifid inferior turbinate. In 1 of our patients, 5 of the 6 turbinates were found to have pneumatization, which is extremely rarely encountered in the literature. In this study, the prevalence of the variations of the turbinates and their association with chronic rhinosinusitis were investigated.

Objective: We aimed to investigate the origin of hearing loss with relevance to auditory brainstem responses and otoacoustic emissions in patients with Duane's retraction syndrome (DRS)., Materials and Methods: 17 patients with DRS were included in the study. 14 patients were diagnosed as DRS type 1 and the remaining three as type 3. The control group consisted of nine healthy subjects. Pure tone audiogram, auditory brainstem response, as well as distortion product otoacoustic emissions were recorded in all the patients and the controls., Results: Among the 17 patients with DRS, 15 demonstrated normal hearing according to pure tone audiogram. One patient with DRS had profound sensorineural hearing loss with a pure tone average of 110 dB, and one patient had moderate sensorineural hearing loss with a pure tone average of 60 dB. Auditory brainstem response latencies of the waves I, III and V, and interwave latencies were calculated in 15 patients with DRS and were compared with the control group. There was statistically significant increase in wave I latency of left ear in the DRS group compared to the controls (P<0.05). Amplitudes of distortion product otoacoustic emissions were also recorded at frequencies of 2, 3, 4, 6, and 8 kHz in both groups and the comparison of the DRS patients and controls revealed no statistically significant difference., Conclusions: We recommend auditory examinations be undertaken in patients with DRS by auditory brainstem response tests, as well as distortion product otoacoustic emissions, whereas all patients with normal results should be followed-up for future hearing loss.

Objective: The microdebrider has been widely used in rhinologic surgery in the last few years, and there are reports on its use for inferior turbinate reduction. Computed tomography (CT) is commonly employed to show the reduction in the inferior turbinate after surgery; however, measurements on the scans are rarely made., Design: A prospective study., Setting: A tertiary research and training hospital., Methods: We investigated the effectiveness of microdebrider reduction in inferior turbinate hypertrophy in 12 turbinates of 9 patients., Main Outcome Measures: Mean bone thicknesses were measured in CT in the anterior and middle portions of the inferior turbinates as an objective parameter. Preoperative and postoperative visual analogue scale scores for symptoms and endoscopic grading of the inferior turbinates were also used., Results: In the postoperative period, visual analogue scale scores for nasal obstruction decreased significantly. Endoscopic grading revealed that the inferior turbinates were significantly smaller in the postoperative period. Postoperative mean bone thicknesses measured in CT in the anterior and the middle portions of the inferior turbinates were significantly smaller than the preoperative ones; however, there was no significant difference between the measurements of the medial and lateral soft tissue thicknesses., Conclusions: We suggest microdebrider turbinate surgery as a reliable alternative method for inferior turbinate reduction, especially in case of hypertrophy of the turbinate bone. Measurement of the inferior turbinate size in paranasal CT is a useful objective method for evaluation of the inferior turbinate hypertrophy and the assessment of the surgical outcomes.

An elongation of the internal carotid artery should be classified as a tortuosity or a kink. Tortuosity of the carotid artery is rarely seen in otolaryngologic practice. In videolaryngoscopic examination, bilateral pyriform sinus narrowing was found in one patient and unilateral pyriform sinus narrowing in the other patient. Computed tomographic scans showed tortuous internal carotid artery in both patients. Awareness of the possible internal carotid artery tortuosity is very important to prevent serious complications during laryngeal and pharyngeal surgical procedures.

Rhinoliths are uncommon mineralized masses that form as a result of calcification of an endogenous or exogenous nidus. The most common manifestations of rhinolithiasis are unilateral nasal discharge, nasal obstruction, and facial pain. The diagnosis is made by nasal endoscopy and computed tomography. The differential diagnosis includes chronic inflammation, osteomyelitis, benign tumors (e.g., calcified nasal polyps, ossifying fibromas, osteomas, and chondromas), and malignant tumors (e.g., osteosarcomas, chondrosarcomas, and squamous cell carcinomas). Rhinoliths may cause rhinosinusitis, erosion of the nasal septum and medial wall of the maxillary sinus, and perforations of the palate. To the best of our knowledge, the occurrence of a nasal polyp associated with rhinolithiasis has not been previously reported in the English-language literature. In this article, we describe such a case.

Ethmomaxillary sinus is a variation of the posterior ethmoid cells. It is formed by the extension of the posterior ethmoid cells into the maxillary sinus and drains into superior nasal meatus. It is incidentally seen on paranasal sinus computerized tomography (CT) scans. Its prevalence has been reported as 0.7 and 2% in two studies. In this study, paranasal CT scans of 466 patients were investigated for the presence of ethmomaxillary sinus. The patients had paranasal CT with the preliminary diagnoses of septal deviation, chronic inflammatory paranasal sinus disease and nasal turbinate disorders. The ethmomaxillary sinus was present in nine of those patients (1.93%). It was septated in one of them. The CTs were further investigated for other anatomical variations and co-existent mucosal disease of the paranasal sinuses.

Objective: To assess how surgical indications for endoscopic sinonasal surgery have changed over time., Material and Methods: The surgical indications of 1173 patients who underwent endoscopic sinonasal surgery between 1994 and 2007 were reviewed retrospectively., Results: Preoperative diagnoses were chronic sinusitis without nasal polyps in 511 patients (43.6%), chronic sinusitis with nasal polyps in 434 (36.9%), concha bullosa in 113 (9.6%), nasal mass in 66 (5.6%), and others in 49 patients (4.1%). Over 60% of patients had surgery for chronic sinusitis without nasal polyps between 1994 and 1999, whereas nearly 60% of patients who underwent surgery between 2001 and 2007 had chronic sinusitis with nasal polyps., Conclusions: Reasons for the decrease in the number of the patients with chronic sinusitis without nasal polyps and the increase in the number of patients with chronic sinusitis with nasal polyps might include: 1) Administration of maximal medical therapy; 2) Increased recognition of the possibility for false positive opacifications in computed tomography and increased understanding that not all anatomical variations predispose to sinusitis; 3) More careful "profit and loss" discussions with patients as our postoperative experience increased; 4) More patients with nasal polyps underwent endoscopic sinonasal surgery as surgical skills improved, and recurrences remained common.

Hypoplasia and aplasia of maxillary sinus, maxillary sinus septae, ethmomaxillary sinus, superior meatus-draining maxillary sinus, and over-pneumatization are the variations of maxillary sinuses. Findings such as uncinate process abnormality, orbital enlargement, sphenomaxillary plate, canine fossa elevation, infraorbital fissure enlargement, thickening of the sinus wall and mucosal pathologies can be seen together with these variations. The aim of this study is to determine the incidence and morphology of the anatomical variations of maxillary sinus and accompanying structures. A total of 330 consecutive paranasal sinus computed tomography scans of the patients presenting with sinonasal complaints at our ENT department were assessed for maxillary sinus anatomical variations and related structures. There were 134 (20.3%) anteriorly and 17 (2.5%) posteriorly localized maxillary sinus bony septa. The position of antral septa was frequently vertical at anterior, and horizontal at posterior. We found significant correlation between the anteriorly localized maxillary sinus septa and infraorbital fissure enlargement. Maxillary sinus hypoplasia was found in 31 (4.6%) maxillary sinuses. Seven (1.0%) ethmomaxillary sinuses were assessed. Significant correlation was found between maxillary sinus hypoplasia and orbital enlargement. Presence of mucosal pathology was significant in patients with maxillary sinus septa, but there was no difference when it was compared with the mucosal pathology in the nonseptated group. There was no significant correlation between other anatomical variations and mucosal pathologies. Determining the anatomical variations of maxillary sinus and accompanying structures in patients planning endoscopic sinus surgery will significantly help with providing surgical orientation and preventing possible complications.

Objective: Rheumatoid arthritis is a systemic autoimmune disorder that involves many body joints including the temporomandibular joint. The frequency of temporomandibular joint involvement based on clinical and radiological findings is rather diverse and involvement may manifest as pain, restricted range of movement and locking of the joint. The aim of this study is to investigate and correlate the clinical, laboratory and magnetic resonance imaging findings in patients with rheumatoid arthritis., Methodology: The temporomandibular joint involvement in 43 patients with rheumatoid arthritis, whose diagnoses were based on the revised 1987 criteria of the American College of Rheumatology, were evaluated using clinical examination, laboratory findings and magnetic resonance imaging., Results: Temporomandibular joint involvement was clinically observed in 28 patients (65.1%), and radiologically in 33 patients (76.7%). The most frequent physical examination finding, a "click" in the joint upon opening of the mouth, was found in 21 (48.8%) patients. The most frequently observed radiological finding was synovial proliferation seen in 22 (51.1%) patients. A statistically significant correlation was observed between erythrocyte sedimentation rate and the findings on magnetic resonance imaging; between the rheumatoid factor results and physical examination findings; and between the findings of the physical examination and magnetic resonance imaging., Conclusion: The erythrocyte sedimentation rate, the rheumatoid factor results, and the findings on magnetic resonance imaging were found to be important in indicating temporomandibular joint involvement in rheumatoid arthritis. Further studies are necessary to specify the risk factors in more detail.

Chondromas of the larynx are rare neoplasms; only a few examples of cartilaginous tumors affecting hyoid bone have been reported. A 33-year-old woman presented with a neck mass on the left carotid triangle. The patient's computed tomography and magnetic resonance imaging revealed a heterogenous mass, which seemed to originate from the left greater cornu of hyoid. The mass was excised using a transcervical approach with left greater cornu of hyoid bone. The pathologic diagnosis was chondroma of hyoid. Expert radiologic and pathologic review is mandatory in cartilaginous neoplasms of the larynx. Cartilaginous neoplasms of the hyoid should be included in the differential diagnosis of neck masses at the carotid triangle.

Removal of the soft tissue lesions from the maxillary sinus is sometimes difficult and time consuming in endoscopic sinus surgery. Failure of endoscopic removal may necessitate combination of canine fossa approach and endoscopic approach. Our new instrument, 'Derevator', is designed for easy removal of the pathological soft tissue lesions from the maxillary sinus through middle meatal antrostomy. Derevators are available for both adults and children. Suction-tipped ones are also available.

Pleomorphic adenomas originating from the minor salivary glands are rare in the nasal cavity. Total surgical excision is the preferred treatment for pleomorphic adenomas. Lateral rhinotomy, midfacial degloving, transpalatal surgery and endoscopic surgery are among the surgical approaches. Endoscopic tumor removal produces less morbidity, reduces blood loss during surgery, decreases hospital stay, avoids external scars and excessive unnecessary resection, enables the surgeon to better visualize the tumor margins, and has a low recurrence rate. However, only 3 pleomorphic adenomas of the nasal septum have been removed by the endoscopic approach to date. In this paper we report on a case of pleomorphic adenoma of the nasal septum that was removed successfully by the endoscopic approach without any recurrences.

Fibrous dysplasia (FD) is a non-neoplastic fibro-osseous lesion. Paranasal sinus involvement is infrequent. Involvement of the frontal sinus, sphenoid sinus, and middle turbinate is rare, and only sporadic cases have been reported in the literature. Nasal turbinates and especially the inferior turbinate are the least involved bones of the craniofacial region. To the best of our knowledge, only one case with McCune-Albright syndrome had FD of the inferior turbinate. Here, we report a rare case with FD of inferior and middle turbinates and review literature concerning FD of the craniofacial region.

Problem/objective: Iatrogenic epidermal cysts have been reported in various locations following otological surgical procedures. Especially after endaural incisions, surgeons may implant squamous epithelium into underlying tissue. An epidermal cyst of the parotid region may appear years after ipsilateral ear surgery., Methodology: A cystic lesion in the superficial lobe of the parotid gland was identified by computed tomography and ultrasonography in a 30-year-old man with a history of myringoplasty and endaural surgery. A superficial parotidectomy was performed to remove the mass., Results: The mass was histopathologically diagnosed as an epidermal cyst., Conclusion: If a cystic lesion is present in the parotid gland in a patient with a history of otologic surgery, it must be considered that the mass is of epidermal origin.

The minimum inhibitory concentrations (MIC, microg ml-1) of itraconazole and terbinafine against overall 34 Aspergillus isolates from the external ear canals with otomycosis have been determined with M38-P microdilution method suggested by National Committee for Clinical Laboratory Standards (NCCLS). MIC intervals in 48 h determined by taking MIC-2 value of itraconazole (the lowest drug concentration causing 50% inhibition of visible fungal growth) and MIC-0 value of terbinafine (the lowest drug concentration causing 100% inhibition of visible fungal growth) as a basis have been found as follows: 0.125-1 and 0.06-0.5 microg ml-1 for A. niger (22 strains), 0.06-0.25 and 0.06-0.125 microg ml-1 for A. flavus (10 strains), 0.125 and 0.125-0.5 microg ml-1 for A. terreus (two strains). It has been observed that both of the antifungal agents showed an in vitro activity against all Aspergillus species tested.

Background: The role of silent aspiration of nasal secretions in the pathogenesis of asthma has often been questioned., Objective: To investigate the presence of pulmonary aspiration of nasal secretions during sleep in patients with chronic sinusitis and asthma and in healthy controls., Design: Prospective, controlled trial., Subjects: The study included 13 patients with chronic sinusitis and asthma and 12 healthy controls. The diagnoses were based on history, physical examination findings, radiologic assessments, and pulmonary function test results., Interventions: A radioactive tracer was prepared by diluting 10 mCi of technetium 99m-labeled macroaggregated albumin in 10 mL of physiologic saline. At 10 PM, just before the patients went to sleep, the solution was sprayed into their nostrils. The subjects were examined with a gamma camera to obtain views of the thorax at 8 AM the following morning. The average counts of the lungs and background and the actual lung counts (average lung count minus average background count) were determined., Results: The average counts of the lungs were significantly greater than the average counts of the background in both the sinusitis-asthma group (P =.001) and the control group (P =.002). The difference in the actual counts of the lungs was not significant between the 2 groups (P =.79)., Conclusions: The nasal secretions were aspirated into the lungs both in patients with sinusitis and asthma and in healthy adults during sleep, and the relative amounts that were aspirated did not differ significantly between the 2 groups (P =.79). The amount of the aspirated material alone is probably not responsible for the pathogenesis of asthma in patients with chronic sinusitis.

Otomycosis usually requires long-term treatment and tends to recur. This study was performed on 87 patients with the clinical diagnosis of otomycosis and 20 controls in order to determine the pathogenic agents, predisposing factors and a cost-effective treatment. The predisposing factors included wearing head clothes (74.7 per cent), presence of dermatomycoses (34.5 per cent) and swimming (27.6 per cent). The most common pathogenic fungus was Aspergillus niger (44.8 per cent) in the otomycosis group. The only isolate was Candida albicans in the control group (2.5 per cent). We concluded that administration of four per cent boric acid solution in alcohol and frequent suction cleaning of the ear canal might be a cost-effective treatment for otomycosis since 77 per cent of the patients were treated effectively this way. Eighty per cent of the resistant cases had mixed fungal-bacterial infections, and 50 per cent of them had dermatomycoses. These resistant cases were treated by administration of tioconazole ointment.