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Septorhinoplasty is one of the most common elective surgical procedures in otolaryngology. The present study aimed to evaluate the anxiety levels of patients who underwent septorhinoplasty at different times, compare the information methods, and determine the understanding of the informed consent through recall rates of the complications explained in the informed consent process. The patients were divided into the following 2 groups: Group 1 (giving information 14 days before the surgery) and Group 2 (giving information 3 days before the surgery). For the preoperative anxiety measurement, the State anxiety scale of the State-Trait Anxiety Inventory (STAI) was used. All patients were asked to recall the complications they remembered from the consent form on the day before the surgery. Each group has consisted of 25 patients. No significant difference was found between the STAI-1 and STAI-2a anxiety scores between groups. In Group 1, the STAI-2b anxiety score was significantly lower than the STAI-1 and STAI-2a scores (P0.05). In Group 2, the mean score of STAI-2b was not significantly higher than the STAI-1 and STAI-2 scores (P0.05). When the STAI-2b scores of the two groups were compared, the scores of Group 2 were significantly higher (P0.05). The most commonly remembered complications were bruising and swelling in both of the groups. In conclusion, the authors believe that long-term cooperation between the surgical team and the patient will reduce the anxiety levels of the patients and increase patients' satisfaction, resulting in a significant reduction in the amount of potential legal processes.Level of Evidence: 2.

Objective: The Dizziness Handicap Inventory (DHI) is a questionnaire that is frequently used for patients with vestibular system disorders. The aim of this study was to evaluate the feasibility and reliability of the “e-DHI” smartphone application, which calculates DHI scores. Methods: Web-based iOS and Android smartphone applications (e-DHI) were developed to evaluate the DHI. After completing the questionnaire, the DHI total score and subscores (physical, functional and emotional) were assessed and results were noted and sent to the e-mail address. Twenty-five otorhinolaryngologists and neurologists were enrolled in the study to apply the DHI to the authors sequentially using the conventional assessment method and the e-DHI (randomized by priority). The questionnaire was applied by both methods, and for each method, the time required to complete the questionnaire, to calculate the DHI score, and the total time required were noted. Results: Three of the 25 doctors were excluded from the study due to a calculation error with the conventional evaluation method. The mean total time required for completing and scoring the questionnaire was shorter when the DHI was evaluated with the e-DHI application (160±32.2 seconds) compared with the classic assessment method (289±65.9 seconds) (p

OBJECTIVES: This study aimed to evaluate the efficacy of the repositioning maneuver on quality of life in elderly patients with dizziness and/or vertigo. MATERIALS and METHODS: This controlled, prospective randomized clinical trial was conducted in elderly patients aged 65 years and above with a positive history of benign paroxysmal positional vertigo (BPPV), presence of vertigo, and no observable nystagmus during the Dix-Hallpike test, so-called Subjective BPPV (S-BPPV). Individuals were evaluated by visual analog scale (VAS) and dizziness handicap inventory (DHI). Groups were defined as treatment (treated with Epley maneuver bilaterally) or no treatment control (no treatment modality or canalith repositioning maneu-ver). Ten days after the first assessment, all patients were reassessed using VAS and DHI. RESULTS: A total of 50 patients were randomized into two groups: 25 to the treatment group, and 25 to the control group. No significant differences were observed for baseline VAS and total DHI scores between the groups (p=0.636, p=0.846, respectively). On the other hand, after the reassessment, VAS and total DHI scores were both significantly reduced in the treatment group (p

There has been growing appreciation of the significant role played by the mucociliary transport system in the body. Mucociliary clearance is a critical host defense mechanism of the airways. Effective mucociliary clearance requires appropriate mucus production and coordinated ciliary activity. Mucociliary transport is responsible for primary innate immunity in the respiratory tract. In order to assess mucociliary transport and diseases resulting from mucociliary transport dysfunction, it is first necessary to understand the cellular anatomy and physiology that drive mucociliary function. The primary function of this epithelium is as a protective barrier. There are two different liquid layers coating the epithelial surface: the viscous outer gel layer and the thin inner periciliary layer. The gel layer of the mucus consists of mucin glycoproteins, secreted by goblet cells and submucosal glands. The mucin traps the bacterial compounds, pathogens, and inhaled debris, and coordinated ciliary activity propels the debris-laden mucus toward the glottis for elimination. This action is called mucociliary clearance. Ciliary disorders are divided into two categories: primary (inherited) and secondary (acquired). Primary ciliary dyskinesia (PCD) is a collection of genetic defects in cilia structure resulting in defective ciliary activity. Secondary ciliary dyskinesia (SCD) or acquired ciliary dyskinesia is a transient defect immunociliary clearance that occurs after viral or bacterial infection, tobacco smoke, pollutant exposure, as well as during allergic inflammation. In this chapter, clinical assessment of mucociliary disorders are discussed.

Regenerative medicine, using stem cells with or without scaffolds, allows surgeons to treat congenital or acquired defects with normal structure and functions. Although stem cell and regenerative medicine are nowadays used quite often in some areas of medicine, it is obvious that they are in their crawling stage in reconstructive surgery and in rhinology. However, it is not difficult to predict that it will become popular in the next few decades and will be among the treatment regimens in the guidelines. The various developments in isolation, duplication, and differentiation of stem cells and three-dimensional scaffolds suggest that some of the more frequently applied therapies may be shelved in the close future. Stem cells are categorized as embryonic stem cells, induced pluripotent stem cells and adult stem cells. Adult stem cells are generally preferred in practice nowadays due to ease of isolation and differentiation stages. The purpose of this section is to provide information on stem cell applications and regenerative medicine in rhinology at present and in close future.

Research using animal models gives human trials hope for recovery in many fields of regenerative medicine, although they are sometimes poor predictors for human experiences. Our goal was to investigate whether rat chondrocytes, differentiated from adipose-derived stem cells, could be transplanted using a new, easily shaped, bioactive glass scaffold, and to show the immunohistochemical results. Intraperitoneal and retroperitoneal adipose tissue was extracted from 6 male Wistar albino type rats. The fatty tissue samples were fragmented and incubated. Chondrogenic differentiation was carried out and collagen type II, bFGF, and Sox-9 immunohistochemical characterization analysis was performed. Differentiated chondrocytes were implanted on 13-93B3 bioactive glass scaffolds and transplanted into the right ears of the rats. As control, only the biomaterial was transplanted into the left ears of the rats. After 1 month, the rats were sacrificed and transplantation areas were examined immunohistochemically. Histological examination of control samples from the left ears revealed that the biomaterial was covered with connective tissue, its general structure was preserved, and resorption of the scaffold had started. In specimens from the right ears, the biomaterial was covered with connective tissue, its structure was preserved, cartilage cells were present around the biomaterial, and the presence of cartilage tissue was demonstrated immunohistochemically. In conclusion, 13-93B3 bioactive glass scaffold contributed to the formation of new collagen and the survival of chondrocytes, and is a promising new biomaterial that will prove very useful in regenerative medicine. © Copyright 2017 by Mutaz B. Habal, MD.

Introduction: Systemic inflammatory biomarkers are promising predictive and prognostic factors for solid cancers. The neutrophil–lymphocyte ratio and derived neutrophil–lymphocyte ratio are used to predict inflammation and used as biomarker in several malignancies. Objective: The purpose of this study was to demonstrate the diagnostic, predictive and prognostic role of neutrophil–lymphocyte ratio and derived neutrophil–lymphocyte ratio in patients with laryngeal neoplasms. Methods: A retrospective study was conducted on medical records involving 229 patients with benign, premalignant and malignant laryngeal neoplasms between 2002 and 2015. The diagnostic, predictive and prognostic role of neutrophil–lymphocyte ratio and derived neutrophil–lymphocyte ratio were evaluated using uni– and multivariate analysis. Results: The neutrophil–lymphocyte ratio and derived neutrophil–lymphocyte ratio were not statistically different between patients with benign, premalignant and malignant laryngeal neoplasms. Both neutrophil–lymphocyte ratio and derived neutrophil–lymphocyte ratio were predictive factors for stage, lymph node metastasis, and distant metastasis. Patients with high neutrophil–lymphocyte ratio value (≥4) had a poor prognosis when compared with patients with low neutrophil–lymphocyte ratio value (5 year, Overall Survival: 69.0% vs. 31.1%, p

Patient: Female, 32 Final Diagnosis: Pleomorphic adenoma Symptoms: Sleep disturbance Medication: — Clinical Procedure: Endoscopic assisted surgery Specialty: Otolaryngology Objective: Rare disease Background: Pleomorphic adenoma is the most common benign tumor arising in the salivary gland. The signs and symptoms of pleomorphic adenoma of the minor salivary glands vary, depending on the anatomical site involved. A rare case of pleomorphic adenoma of the posterior surface of the soft palate is reported that caused sleep disturbance, which was resolved with endoscopic surgical treatment. Case Report: A 32-year-old woman experienced snoring and mouth-breathing during sleep. Flexible fiberoptic nasopharyngoscopy imaging of the oropharyngeal passage showed obstruction by a tumor the soft palate, which obstructed the oropharyngeal passage. The tumor was excised using endoscopic-assisted transoral surgery and measure 3×2 cm in diameter. Histopathology showed a benign pleomorphic adenoma of the minor salivary gland. Following surgical excision of the tumor, the patient’s sleep improved. Conclusions: To our knowledge, this is the first case of a pleomorphic adenoma of the posterior surface of the soft palate, causing sleep disturbance, removed by endoscopic-assisted transoral surgery following pre-operative flexible fiberoptic nasopharyngoscopy imaging of the oropharyngeal passage.

Objective The goal of this study is to evaluate the impact of chronic rhinosinusitis with nasal polyps (CRSwNP) on sleep pattern and sleep quality before and after functional endoscopic sinus surgery using subjective and objective parameters. Methods Twenty-two patients with CRSwNP were evaluated. All subjects underwent assessment by nasal endoscopy, rhinomanometry and computed tomography. Sleep pattern and sleep quality were evaluated by Pittsburgh sleep quality index (PSQI) and polysomnography (PSG). All patients were reassessed 6 months after surgery. Results Nasal resistance decreased after the surgery (p < 0.001). Postoperative PSQI scores were significantly lower than preoperative scores (p < 0.001). The preoperative mean values of total apnea index and apnea-hypopnea index were 25.4 and 13.3, respectively. After surgery, the total apnea and apnea-hypopnea index had decreased significantly to 7.8 and 11.2, respectively (p = 0.009 and 0.019, respectively). Conclusion In patients with CRSwNP, functional endoscopic sinus surgery significantly ameliorates sleep pattern and sleep quality. CRSwNP may be a predisposing factor for sleep related respiratory disorders. © 2017 Elsevier B.V.

OBJECTIVE The goal of this study was to assess the effectiveness of auditory steady-state response (ASSR), determine the cut-off values for each frequency, and detect the best correlated frequencies when compared with the auditory brainstem response (ABR) thresholds in term babies under the age of 12 months. MATERIALS AND METHODS In total, 88 term babies with a mean age of 2.98 (1-11) months (174 ears) underwent ASSR and ABR tests. The ASSR thresholds for the frequencies of 500, 1000, 2000, and 4000 Hz were compared with the hearing level of the ABR thresholds. In the ABR test, a cut-off value of 30 dB nHL was selected for normal hearing. In addition, the best correlation between the ABR and ASSR thresholds and the estimated cut-off thresholds of ASSR for each of the abovementioned frequencies were obtained. RESULTS In total, 135 ears had values indicating normal hearing ability and 39 ears had hearing loss according to the ABR thresholds. Although statistically significant correlations were found between the ABR and ASSR thresholds at all frequencies in all groups, these correlations were not strong. On the other hand, a strong correlation was found between the responses of the ABR and ASSR thresholds at 4000 Hz in the hearing-impaired subjects. CONCLUSION Our findings suggest that ASSR may not be beneficial or reliable as a screening test. Thus, it is likely to be considered as a complementary test rather than an alternative to the ABR test.

Frontoethmoidal meningoencephalocele is a rare congenital malformation, which occurs due to a deficiency in neural tube closure. It may present as an external mass over the nose, nasal obstruction, rhinorrhea and attacks of central nervous system infections. Herein, the authors present a 3-month-old infant with naso-ethmoidal form of frontoethmoidal meningoencephalocele, who was operated on using a newly described approach that was performed under microscope.

Background Our male patients with chronic rhinosinusitis with nasal polyposis (NP) declare a better sexual function after functional endoscopic sinus surgery (FESS) with polypectomy. This study was planned to conduct the first prospective, controlled trial evaluating the possible relation between erectile dysfunction (ED) and NP by subjective and objective parameters. Methods Thirty-three male patients with NP and thirty randomly selected male control subjects were evaluated. All subjects underwent assessments of nasal endoscopy, rhinomanometry, body mass index (BMI), Epworth Sleepiness Scale, full in-laboratory polysomnograpy and serum levels of glucose, thyroid hormones, lipid profile, and testosterone. ED was evaluated by the erectile function domain of the International Index of Erectile Function (IIEF-EF) subjectively and nocturnal penile tumescence (NPT) objectively. The NP group was reassessed 6 months after FESS. Results The mean age, BMI, and laboratory tests of the patients and the control subjects had no significant difference. The well-recognized risk factors for ED were eliminated. Preoperative evaluation of the patients revealed that ED was present in 34 and 24% of the patients by IIEF-EF and NPT, respectively, which was significantly higher than the control group (p = 0.009 and p = 0.018, respectively). There was a significant improvement of ED in the assessment of IIEF-EF and NPT postoperatively (p = 0.014 and p = 0.037, respectively). Conclusion ED was determined in a high percentage of patients with NP and significantly ameliorated after FESS. NP might present a risk factor in the development of ED.

Background The potential transformation in the maxillary complex morphology is mostly complete during childhood. Recent studies suggest a nasal tissue remodeling both in the overlying mucosa and in the underlying sinus bone in nasal polyposis (NP). Our evaluation of computed tomography (CT) revealed that the maxillary arch is more flat and shallow in patients with chronic rhinosinusitis with NP. The purpose of this study was to determine the possible effects of NP to the maxillary arch morphology in adulthood and to investigate a possible remodeling of the maxillary bone during the course of NP. Methods A prospective study was performed on 25 patients. Grading of the polyps, acoustic rhinometry and rhinomanometry assessments, and CT scans were documented initially, 1 year after diagnosis, and 2 years postoperatively. Twenty-five subjects’ CT scans randomly selected from our CT database formed the comparison group. The plane angle between the maxillary alveolar processes (MAP) and the palatine process of the maxillary bone (MPP), and the depth of the maxillary arch of both groups were compared. Results The results pointed out that the maxillary arch was shallower and the bilateral angles between MAP and MPP were significantly greater than those of the comparison group in all evaluation periods. This difference was less at the end of the postoperative follow-up period. Conclusion Although it is a common belief that maxillofacial formation expires in childhood, this may not be the case under some special conditions such as NP in adulthood. NP might cause maxillary arch remodeling in adults.

Background: Herbal remedies predate written history and continue to be used more frequently than conventional pharmaceutical medications. Thymoquinone (TQ) is a traditional herb that has been used for its anti-inflammatory, antioxidant, and chemopreventive effects. Montelukast is a conventional medication used to treat allergic rhinitis and asthma. The aim of this research was to evaluate the effects of TQ and montelukast on human respiratory epithelium specifically addressing effects on cilia beat frequency (CBF). Methods: Well-differentiated human sinonasal epithelial cultures, grown at an air–liquid interface were treated with varying concentrations of TQ and montelukast. Changes in CBF were determined using the Sissons-Ammons Video Analysis system. Results: When applied to the basolateral surface, TQ showed a statistically significant dose-dependent increase in CBF with maximal stimulation at 30 minutes. Effects of montelukast on CBF showed both time and dose dependence with maximal stimulatory effect measured at 6 hours. Conclusion: The results of our study indicate that TQ and montelukast have dose-dependent effects on CBF, extending their mechanism of action in respiratory diseases. (Am J Rhinol Allergy 28, 122–125, 2014; doi: 10.2500/ajra.2014.28.4010) T he nose, paranasal sinuses, trachea, and lower airways are lined by a epithelium consisting primarily of two types of cells: mucus-producing goblet cells and ciliated cells. This epithelial layer comprises the mucociliary escalator, the primary mode of defense for the entire respiratory system. Mucus produced by goblet cells traps inhaled particulate and infectious debris, while the propulsive force generated by the ciliated cells transports this mucus blanket to the gastrointestinal tract for elimination.1 Respiratory cilia beat in a coordinated manner with a specific frequency and pattern.2 This organized beating clears debris-laden mucus toward the sinus ostia in well-established flow patterns and, ultimately, to the nasopharynx and glottis. It is important to note that during time of stress, such as exercise or infection, ciliary beat frequency (CBF) increases to accelerate mucus clearance.3–8 Rhinosinusitis (RS) is a clinically defined syndrome comprising a constellation of symptoms including rhinorrhea, nasal obstruction, facial pressure or pain, headache, and hyposmia. Although the etiology of the disease is not known, a combination of environmental exposures with an underlying genetic predisposition is proposed.9 Although most cases of RS are self-limiting, a subset becomes chronic RS (CRS) with symptoms lasting 3 months and ”characterized by persistent symptomatic, inflammation of the mucosa of the nose and paranasal sinuses.”10,11 Impaired function of the sinonasal ciliated mucosa with resultant stasis of sinonasal secretions is a key contributor to the pathophysiology of RS12 and is associated with significant local inflammation both in the presence and in the absence of bacterial infection.13 Thus, conventional disease management often includes systemic or topical glucocorticoids to decrease inflammation, systemic or topical antibiotics to combat bacterial infection, and decongestants or mucolytics to restore mucociliary clearance. In addition to conventional therapies, 40% of patients with RS use complementary and alternative therapies with over one-quarter using herbal preparations.14 The black seed of the Nigella sativa plant (Ranunculaceae family), native to south and southwest Asia, is a traditional herbal medicine used in Mediterranean countries, as well as Iran, Pakistan, and India. The primary biologically active constituent of N. sativa essential oil is thymoquinone (TQ), which has previously been shown to have antioxidant and anti-inflammatory effects, as well as anticancer effects.15 Additionally, TQ has been incorporated into traditional management strategies for the treatment of the common cold.16 Montelukast is a selective antagonist of cysteinyl leukotriene type 1 (CysLT-1) receptors. Montelukast effectively antagonizes the activities of CysLTs in recruiting and activating inflammatory cells, enhancing the vascular permeability and bronchial hyperactivity, and promoting airway remodeling.17 Clinical indications for leukotriene receptor antagonists are for the prophylaxis and treatment of allergic rhinitis and asthma. The goal of this study was to investigate whether these two unrelated compounds (TQ and montelukast) used in the management of various respiratory diseases, in addition to their previously described biological effects, also effect mucociliary clearance through modulation of CBF.

Ramsay-Hunt syndrome, herpes zoster oticus (HZO), derived its name from James Ramsay Hunt, who first described it in 1907. It is classically characterized by acute peripheral facial paralysis, herpetic eruptions on the auricle, and vestibulocochlear dysfunction due to the reactivation of varicella zoster virus (VZV). In this Case Report, the authors describe an HZO patient with simultaneous VZV encephalitis. To date, only eight cases of HZO associated with VZV encephalitis have been reported in the English literature. Therefore, the authors discuss all the aspects of this rare entity, including clinical examination, radiological evaluation, laboratory evaluation, and treatment options.