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The goal of this study was to compare conventional osteotomes and Magic Saws in terms of edema and ecchymosis, in rhinoplasty patients.A retrospective, case-control study.In this prospective, randomized study, we evaluated the results of 258 rhinoplasty patients who underwent osteotomy by either conventional osteotomes or new designed saws called; "Magic Saws." On postoperative days 2 and 7, the patients were photographed by the surgeon; photographs were evaluated by another otolaryngologist, blinded from the osteotomy procedure.There were no statistically differences between the groups, in terms of age, sex, weight, or average arterial blood pressure (P 0.05). The postoperative periorbital edema (days 2 and 7) and ecchymosis (day 2) scores were significantly higher in the conventional osteotomy group, as compared to Magic Saw group (P 0.05). However, on postoperative day 7, the differences in the periorbital ecchymosis scores between the groups, were not statistically significant (P 0.05).As compared to conventional osteotomes, Magic Saws were reported to be associated with minimal soft tissue injury, as well as decreased edema and ecchymosis, in the early postoperative period after rhinoplasty.

Background Numbness of the nasal skin is one of the most common complications following rhinoplasty. Objectives The present study investigated postoperative changes in nasal skin sensation among primary and revision rhinoplasty patients and evaluated the recovery outcomes for both groups. Methods A prospective, randomized blinded study was undertaken involving 100 primary and 34 revision open rhinoplasty patients and 50 volunteers as control group. Semmes-Weinstein monofilament testing was performed on 7 designated nasal points preoperatively and at postoperative months 1, 3, 6, and 12, and the results were evaluated. Results Among the primary rhinoplasty patients, the change in reduced sensation on pressure to the tip and infratip over time was significant (P Conclusions This study found that the sense of touch on pressure returned to normal, aside from at the tip and infratip, by the end of month 12 in primary rhinoplasty patients. The revision rhinoplasty patients, in turn, were observed to have reduced sensation on pressure by the end of month 12, with the greatest reduction at the tip, infratip, and columellar base. Level of Evidence: 3

Introduction: Submandibular glands are exposed to many effects due to diseases and therapeutic interventions. A study evaluating the effect of submandibular gland dysfunction on the parotid gland has not been presented in the literature. Objective: The aim of this study was to evaluate the histopathological changes in the parotid gland following submandibular gland failure. Methods: Three groups of seven randomly selected female New Zealand rabbits weighing 2500–3000 g were studied. Unilateral and bilateral submandibular glands were removed in Groups 1 and 2, respectively. No procedure was performed in Group III, the control group. The parotid glands were removed 30 days later. Histological parameters were evaluated and graded between 0 (none) and 3 (severe). Differences between groups were compared using the Mann–Whitney U test. Results: Mean mucus accumulation in acinar cells was 2.57 ± 0.53 and 1.71 ± 0.75 in Groups 1 and 2, respectively (p 0.05). This value was 0.28 ± 0.48 in Group 3, which was significantly lower than in Groups 1 and 2 (p 0,05). Esse valor foi de 0,28 ± 0,48 no Grupo 3, significativamente menor do que nos Grupos 1 e 2 (p

Objectives: This study aims to compare the serum, tonsil surface epithelial tissue and parenchyma levels of melatonin in children who underwent tonsillectomy due to recurrent tonsillitis. Patients and Methods: The study included 33 pediatric patients (17 males, 16 females; mean age 7.3 years; range, 3 to 10 years) scheduled for tonsillectomy surgery. Five milliliter venous blood samples and 25 g of two different types of tonsil tissues, parenchyma and capsule were collected from the patients and stored. High performance liquid chromatography was used for the determination of melatonin in plasma and tissue samples. Results: The tonsil surface tissue levels of melatonin were lower than the simultaneous plasma levels of melatonin (p

Objectives: There is no study in the literature that patients with clinically-proven PET were evaluated by Valsalva CT. We aimed to evaluate the merit of Valsalva computed tomography (CT) in patients who had clinically-proven patulous Eustachian tube (PET). Design: Case-series Setting and participants: We recruited patients with clinically-proven PET. Participants: Main outcome measures: All participants underwent temporal bone CTs while they were performing the Valsalva maneuver in the supine position. Standard axial plane CT images, along with multiplanar reconstruction and 3D Air volume rendering, were used to visualize the ET in its entirety. Results: Three patients (2 females, one male) with a total of 6 ears were included in the study. All patients had suggestive symptoms of PET, including aural fullness, aerophony, and autophony and underwent clinical examination and audiologic tests. In all ears, the whole Eustachian tube could be visualized with Valsalva CT. Conclusion: For the first time, we demonstrated the merit of Valsalva CT in visualization of the Eustachian tube in its entirety in patients with clinically diagnosed PET.

Purpose: The aim of this study to investigate the effect of bromelain-arnica gel combination on periorbital edema and ecchymosis seen after open septorhinoplasty. Methods: Sixty patients who performed open septorhinoplasty with osteotomies were included to the study. These patients were allocated into two groups: in group 1, 30 patients as control and in group 2, 30 patients as study group who were treated with topical bromelain-arnica gel after surgery. Scoring of eyelid edema and peroirbital ecchymosis were evaluated on the first, third and seventh postoperative days using scale of 0 to 4 used by observers. Results: We observed that the administration of topical bromelain-arnica gel after surgery was effective clinically and statistically in decreasing the score of both edema and ecchymosis in open septorhinoplasty with ostetomies. In group 2 patients, periorbital edema and ecchymosis scores were significantly lower compared to control group (p < 0.05). Conclusions: Our results support that topical administration of bromelain and arnica gel combination provided both clinically and statistically significant reduction in periorbital edema and ecchymosis following septorhinoplasty.

Objective The aim of this study is to evaluate the effects of these two methods (Nasal corticosteroids (NCS) and radiofrequency (RF) application) on conchal contractility utilizing objective rhinologic measurement parameters. Methods 82 patients were presented with the complaint of nasal obstruction and diagnosed with inferior turbinate hypertrophy and were included in the study. Patients in Group 1 received NCS for 12 weeks. Patients in Group 2 were administered RF to their inferior turbinates. Acoustic rhinometry and rhinomanometry tests with and without decongestant were performed. Results In the evaluation of the contractility difference of rhinometry parameters, there was not a significant difference among pre and postoperative acoustic rhinometric parameters in Group 1. Whereas in Group 2, postoperative contractility difference was significantly decreased compared to preoperative values. In the evaluation of the contractility difference of rhinomanometric parameters, no significant difference was found between pre and postoperative values in Group 1. However, postoperative contractility difference was significantly decreased compared to preoperative values in Group 2 in terms. Conclusion Because the RF procedure produces fibrosis in the vascular tissues, inferior turbinates do not have a shrinking response to decongestant administration. Administration of NCS administration maintains the contractility function compared to RF application.

The aim of this study is to show if cyclosporine has an antiallergic role in a rat model of ovalbumin-induced allergic rhinitis. The 54 rats were divided into six equal groups. The first group was a negative control group without induced allergic rhinitis; the second group a positive control with induced allergic rhinitis not receiving treatment. The remaining four groups, after induction of allergic rhinitis, received intranasal cyclosporine treatment in doses of 0.05, 0.1, or 0.2% or nasal steroid treatment. In the biochemical examination, on the surface of the tissue tumor necrosis factor (TNF) interferon (IFN), interleukin (IL)-5, IL-13, as well as IL-2, IL-4, IL-17A, and IgE were studied. Histologically, ciliary loss, increase of goblet cells, vascular congestion, and the degree of eosinophil infiltration were rated. In all treatment groups, on average, a significant reduction in all histological and biochemical values was found compared to the positive control group. Comparing each of the three cyclosporine-using groups with the group of nasal corticosteroid did not show any significant difference in the average scores. Cyclosporine nasal drops are effective to be used in an animal model of experimental allergic rhinitis without systemic effects.

OBJECTIVE The aim of this study was to evaluate the effect of suturation (tonsillary fossa closure) plus Surgicel application on postoperative bleeding and pain after tonsillectomies performed using a classical dissection method. STUDY DESIGN A prospective, randomized, double-blind, clinical trial was performed on 760 patients undergoing tonsillectomy or adenotonsillectomy during a 5-year period. METHODS After excluding patients with hemorrhagic disorder, chronic disease, and peritonsillar abscess, both tonsils were removed via classic dissection technique (cold knife or blunt dissection) and then electrocauterized for hemostasis. The tonsillar fossa randomly assigned to the treatment protocol (Group 1) was closed by sutures, following Surgicel application. The other side was unaltered and acted as the control (Group 2). Pain was evaluated every day for 10 days postoperatively, and bleeding was reported at any time. RESULTS A total of 760 patients (393 males, 367 females) between the ages of 4 and 35 years (mean age 13.46 ± 7.98) were included in the study. Bleeding was observed in 31 patients: 8 from Group 1; and 23 from Group 2 (95% confidence interval [CI], P

Summary Objective Diagnosis of laryngopharyngeal reflux (LPR) in clinical practice is generally made subjectively based on history, symptoms, and endoscopic assessment. This study presents the diagnostic role of the digital photographic assessment of the laryngopharyngeal region for LPR. Methods Seventy-two patients with LPR symptoms and 35 healthy volunteers were evaluated using the Reflux Finding Scores (RFS) and the Reflux Symptom Index (RSI). The results of these scales were recorded in 72 patients representing group 1 with LPR diagnosis; they returned after 1 and 2 months of treatment as groups 2 and 3, respectively. Thirty-five volunteers represented group 4. Laryngopharyngeal regions of all subjects were examined and photographed endoscopically. Red, green, and blue (RGB) values of particular oropharyngeal and laryngeal points were measured. Results RSI and RFS values of group 1 were significantly different from the other three groups, as were the scores of group 2; however, the comparison of the RSI and RFS values of groups 3 and 4 did not reveal a statistically significant difference. Laryngopharyngeal RGB values also duplicated statistical significance as above. Conclusion Measurement of RGB values can be a cheap and easy-to-use method to quickly provide objective and corroborative information to help in the diagnosis of LPR in conjunction with subjective methods.

The non-Hodgkin's lymphoma is a significant malignant disease that can involve in the extranodal region of the head and neck. It does not show any specific symptoms when it resides in this region. Swelling, pain and ulceration are important clinical findings. In this article, we report a 57-year-old male patient diagnosed with B cell non-Hodgkin's lymphoma by histopathologic examination, who had nasal blockage, snoring and headache complaints for one year, whose endoscopic nasal examination revealed a mass arising from the right inferior turbinate and the mass was removed surgically by endoscopic approach.

Objectives: The aim of this study was to assess the effectiveness of bilateral submandibular duct relocation and bilateral sublingual gland excision in combination with botulinum toxin A injection into the parotid glands in children with sialorrhea. Previously in the literature, either surgery or botulinum toxin injection but not their combination has been reported. Methods: Preoperative and at least 6-month postoperative assessments using the Drooling Severity Scale and Drooling Frequency Scale (Thomas-Stonell and Greenberg classification) and the Teacher Drooling Scale and by interviewing parents and caregivers face to face or via telephone were performed. Also, decreases in the daily number of bib changes and hourly frequency of saliva wiping were recorded as success. Complications were recorded. Results: The Drooling Frequency and Severity Scale, the Teacher Drooling Scale, daily number of bib changes, and hourly frequency of saliva wiping decreased significantly in 21 patients (95.5%) and remained unchanged in 1 patient (4.5%). Postoperative bleeding was observed in 1 patient (4.5%). Conclusions: Drooling is a complex problem that benefits from a multidisciplinary approach. Many treatment methods exist, each with advantages and disadvantages. In this study botulinum toxin A injection was applied in conjunction with bilateral submandibular duct relocation and bilateral sublingual gland excision surgery, achieving a success rate of 95.5%. Moreover, minimal complications and no recurrence after at least 6-month follow-up were observed. The authors therefore recommend further use of this combination treatment. Larger and longer term studies may also help clarify its effectiveness.

Objective:Systemic absorption of steroids is reasonable because of the lipophilic nature of steroids and high vascularity of the middle ear mucosa. To date, however, of the clinical trials designed to investigate this subject, to the best of our knowledge, none has been based on objective methods. This study aims to demonstrate whether the intratympanic administration of dexamethasone has any systemic effects.Methods:Seventeen patients had a total of five sessions of intratympanic dexamethasone treatment scheduled for every other day. The mean fasting blood glucose, serum cortisol, serum adrenocorticotrophic hormone (ACTH), and arterial blood pressure values of the patients were checked at each session before and after drug application.Result:There were no statistically significant differences identified between the pre- and post-treatment fasting blood glucose, serum cortisol, serum ACTH, and mean arterial blood pressure.Conclusion:This study shows that intratympanic steroids have no noticeable systemic steroidal side effects and are therefore safe to use; however, caution should be taken with patients suffering from diabetes mellitus, and they should be closely monitored.

Background: The aim of this study was to objectively compare nasal contractility in premenopausal and postmenopausal patients by means of rhinomanometry, acoustic rhinometry, and peak inspiratory nasal flow. Methods: Design: prospective, clinical case-controlled study. Setting: university tertiary-care hospital, referral center. Participants: the study included 97 participants divided into two groups: 49 postmenopausal (the study group) and 48 premenopausal (control) females. Nasal evaluations were made utilizing anterior rhinoscopy, peak inspiratory nasal flow, acoustic rhinometry, and anterior rhinomanometry. Results: The differences between before and after decongestant application of Minimal Cross-sectional Area (MCA) 1, Minimal Cross-sectional Area (MCA) 2, Peak inspiratory nasal flow (PNIF), Rhinomanometry (RMM), Flow, and Volume values were been statistically significant in both postmenopausal and premenopausal group (control). Conclusion: Before and after all the subjects were administered nasal decongestant, nasal contractility was evaluated using objective nasal tests (acoustic rhinometry, rhinomanometry, and peak inspiratory nasal flow. Results showed that erectile tissues were not affected after menopause: postmenopausal women have the same nasal contractility capacity as premonopausal women.

WOS: 000418528600006 PubMed ID: 28916414 Purpose: The aim of this study was to investigate nasal hygiene in intensive care patients and improve patient care using isotonic saline nasal spray. Material and methods: In the study group, over a period of ten days saline nasal spray was administered four times daily. Nasal treatment was not given to the control group. Each patient was examined with a flexible nasopharyngoscope before and after the treatment and a nasal culture was taken. Results: In the study group, the secretion score (1- absent; 2- serosal; 3- seropurulent and 4- purulent) mean value improved from 1.9 to 1.4. In the control group, the secretion score mean value had risen from 1.7 to 3.1. At the beginning of the study, there was no difference in secretion scores between the groups, but on the tenth day a statistically significant difference was found. Conclusion: The use of saline nasal spray in this group of intensive care patients was found to be effective in achieving nasal hygiene.

This study makes an analysis of the effect of Botulinum toxin type A on otitis media with effusion in rats.As part of the study, 24 male Wistar Albino rats were divided into three groups: Group 1: Botulinum toxin Type A and Histamıne (intratympanic 0.2 ml = 20 unit BTA); Group 2: Saline and Histamine (intratympanic 0.2 ml 0.9%); Group 3: Histamine (intratympanic 0.2 ml). Histamine (intratympanic 0.2 ml) was administered into the right ear for all groups. DPOAE and ABR tests were carried out on days 5, 10, 15 and 20 from the beginning of the study.There was no significant difference between DPOAE and ABR scores of the groups. In each group, the DPOAE scores for the right ear significantly decreased on day 5 when compared to the basal scores. In each group, there was no significant difference between days 5, 10 and 15 for the right ear.Botulinum toxin type A blocked the secretion of glands in the middle ear and showed no effect to prevent the formation of serous otitis. In addition, it was found out that Botulinum toxin did not lead to any morphological change in the cochlea.

Amac: Calismamizda merkezimizde dogan bebeklere yapilmis isitme tarama testlerinin sonuclari degerlendirilmistir. Gerec ve Yontemler: Calismamizda Haziran 2014 ile Ekim 2015 tarihleri arasinda merkezimizde dogan 1664 bebek incelendi. Gecici uyarilmis otoakustik emisyon ile yapilan tarama testlerinde testten gecme kriteri olarak en az 3 frekans bandinda en az 3 dB HL emisyon cevabi elde edilmesi alindi. Bebegin her iki kulaginda da gecme kriteri elde edildigi zaman testten gecti olarak kabul edildi. Bulgular: Calismaya 1664 bebek dahil edilmistir. Bebeklerin 1416’ si (%85.1) yapilan ilk TEOAE testini gecti. 248 (%14.9) yenidogan ilk testte kaldi. Ilk testte kalan bebeklerden 209’ u (%12.5) ikinci testten gecti. SONUC: Yenidoganlarda isitme kaybinin erken taninabilmesi, erken donemde tedaviye baslanabilmesi icin onem arzetmektedir. Bu sayede isitme kayipli cocuklarin tedavisine baslanabilecek ve dil ve konusma gelisimleri saglanabilecektir.

Low-dose administration of Aspartame (Ap) did not produce a significant ototoxic effect at the end of the 6th month. However, duration of the ototoxic effect is shortened and severity of the effect is increased as dose and duration of Ap administration is increased.While Ap toxicity has been studied in short- and long-term studies, its effects on hearing have not been investigated. This study was conducted to evaluate the effects of long-term consumption of Ap administered in various doses on hearing status of rats.The study included 54 female Wistar Albino rats. Ap was given for 6 months to the rats. The groups were assigned according to levels of Ap dosage. DPOAE and ABR tests were utilized for serial hearing evaluations. Serial hearing measurement times were designed as baseline, 1st week, 2nd week, 1st, 2nd, 3rd, and 6th months.While audiological parameters deteriorated with 100 mg/kg/day dose after the 3rd month, ABR thresholds were elevated and DPOAE values were significantly decreased in 500 mg/kg/day and 1000 mg/kg/day applications after the 2nd month. In 2000 mg/kg/day and 4000 mg/kg/day applications, deteriorations in audiological parameters were detected as early as the first and second months; respectively.

Background A prospective endoscopic and radiologic evaluation of long-term outcomes of crushing and crushing with intrinsic stripping, 2 minimally destructive techniques used for the surgical treatment of concha bullosa. Methods Forty-two patients who underwent concha bullosa surgery (a total of 55 conchae surgeries) were included in the study. The patients were allocated consecutively to either of the 2 groups: Group 1 (crushing, n = 28) and Group 2 (crushing with intrinsic stripping, n = 27). All procedures were performed endoscopically. The presurgical and 1-year postsurgical endoscopic nasal cavity images and computed tomography (CT) scans of all patients were recorded. Preoperative and postoperative measurements were compared using paired t test and Student t test. Results Gender and mean age of the 42 patients (55 conchae bullosa) were as follows: 23 males, mean age 25.6 (range, 18 to 41) years; 18 females, mean age 24.2 (range, 18 to 33) years. The patients were followed for 12.5 ± 1.3 months. Comparisons of both the grading of endoscopic images and the concha bullosa volumes measured in CT images before and after treatment showed significant postsurgical reductions in both groups; comparison between groups showed significant postsurgical decreases for Group 2 in both concha bullosa volumes and in endoscopic scoring (p < 0.05). Conclusion Crushing with intrinsic stripping is an effective and easy technique; when compared to crushing alone; this technique provides a significantly more decrease in middle concha volumes as demonstrated both by the CT and by endoscopic evaluations.

Introduction and Aim: The aim of the present study was to compare aural temperature measurements with conventional methods (axillary and oral) in patients with unilateral tympanic membrane perforation or myringosclerosis. The study also aimed to test the potential nasal use of infrared thermometer. Materials and Methods: Forty-four adult patients with monoaural tympanic membrane perforation and 29 adult patients with monoaural myringosclerosis were included in this prospective study conducted between June 2007 and November 2008. The contralateral ears of the patients were normal. Inter-aural, axillary, oral and nasal temperature measurement results of the patients were compared. Results: Similar measurement results were obtained from the two ears in patients with monoaural perforation (P = 0.7780, SD± 0.3189). Similarly, in patients with monoaural myringosclerosis, no statistically significant difference was found between the measurements from the normal and diseased ear (P = 0.9346, SD± 0.2244). Measurements obtained by using nasal infrared thermometer was significantly lower compared to aural, axillary and oral measurements (p

Objective One of the most frequent reasons of nasal obstruction and sleep apnea in pediatrics is adenoid hypertrophy. Remaining adenoid tissue can reoccur following hypertrophied adenoid removal and a second operation may be needed. Nasal corticosteroids are utilized in order to reduce adenoid hypertrophy and eliminate adenoidectomy operation. The purpose of our study is to assess the effect of nasal corticosteroid administration after adenoidectomy on adenoid regrowth and symptom scores. Material and method Seventy patients who had adenoidectomy were enrolled in our study. Patients were divided into two groups. Group I (35 patients) received Mometasone furoate (40 mcg/day per nostril) intranasal spray for 6 months, starting at postoperative week 3 after wound healing. As for Group II (35 patients), they received intranasal saline spray. Patients were followed up for one year. Every patient had flexible nasal endoscopy at postoperative week 3 and one year after the operation. Choana was scored according to its occlusion level by the adenoid tissue. Additionally, nasal obstruction symptoms (nasal congestion, dry mouth, snoring, nasal speaking, apnea and night coughing) were scored. Results Remaining adenoid tissue in the nasopharynx was comparable in flexible endoscopic assessment and no significant difference was seen between postoperative week 3 nasal obstruction scores. In the flexible endoscopic assessment completed in the twelfth month of the study, significant reduction was found in Group 1 compared to Group 2 in terms of adenoid size. When patients in both groups were compared, statistically significant reduction was observed in nasal obstruction symptom scores at the twelfth month. Conclusion This study has demonstrated that the use of steroid nasal spray following adenoidectomy significantly prevents regrowth and reduces nasal obstruction symptoms in the early period.

This study showed that short and long interval treatments achieved comparable success rates. There was no statistically significant difference in the rate of early and late recurrences between the two groups. Modified Epley maneuver can be applied in a short interval time with comparable success and recurrence rates which are as effective as in a long interval time.The Epley maneuver is called the particle repositioning or canalith repositioning procedure. If a short time interval in each position is effective, it will allow for reduced time and avoid unnecessary physical burden. How long of a stay in each position is not determined in the literature. There is an absence of comparative studies of the BPPV repositioning time. The aim of this study is to compare the treatment time in patients with benign paroxysmal positional vertigo (BPPV).Longitudinal prospective study.Outpatient practice in a tertiary care facility.Sixty consecutive patients with BPPV were included in this study. These patients were sequentially allocated to one of two groups (A or B). The interval times between each position in group A and B were 15 and 120 s, respectively. Modified Epley maneuver was performed in all patients. The maneuvers in both groups were exactly the same sequence of movements, except interval times.The mean age of the patients was 49.25 years (range =19-76 years). Of the 60 patients, 48 (80%) were women and 12 (20%) were men. Successful outcome was achieved in 26 patients (86.7%) after the first modified Epley maneuver in both groups. Three patients from each group (total six patients) responded to the third modified Epley maneuver and the remaining two patients did not respond to any modified Epley maneuver. Therefore, the Semont maneuver was applied with a successful result.

Objectives: The most common anatomic variations of nasal septum deviation, the second most common Concha Bullosa (CB) are seen on the nose. CB is the most common anatomic variation of the osteomeatal region. CB is often together with osteomeatal complex pathology. Septum, osteomeatal complex and infection investigated its relationship with CB, but are unknown in the developmental effects of inferior turbinate. The purpose of the present study was to evaluate the unilateral CB objectively the effect of the inferior turbinate.

Objective.To compare pediatric and adult age groups in terms of postoperative bleeding and pain following tonsillectomy performed by thermal welding system (TWS).Method.The study consisted of 213 patients, of whom 178 were children and 35 were adults. The mean age of the pediatric patients (81 girls and 97 females) was6.7±2.4years (range 3–13 years) and the mean age of the adults (20 males and 15 females) was21.8±7.07years (range 15–41 years). All of the patients were evaluated in terms of postoperative bleeding and pain following tonsillectomy performed by TWS.Results.Bleeding was detected in the late postoperative period in 11 pediatric and 7 adult patients and of them 2 pediatric and 3 adult patients controlled under general. Postoperative bleeding was significantly less prevalent in the pediatric age group compared to the adult age group (P=0.04). Likewise, postoperative pain was significantly less prevalent in the pediatric age group as compared to the adult age group (P<0.001).Conclusion.Both postoperative bleeding and pain following tonsillectomy performed by TWS were more prevalent in the adult age group compared to the pediatric age group.

Oronasal fistulas can occur as a complication and sometimes they are refractory to the adequate surgical interventions. Two patients of oronasal fistula were presented. The first one developed as a complication of nasal septal surgery. Following 2 failed operative closure, a custom-made silicone obturator resulted unexpectedly as the cure for the problem in this patient. Experience gained from this patient was utilized in the second presented patient by simply insertion of a tailored silicone obturator after elevation of the nasal lining under local anesthesia to the oronasal fistula transorally allowed closure without any formal surgical intervention. Silicone obturator application may be employed for curative treatment of the oronasal fistulas avoiding complex surgical treatments.

Edema persists for months after rhinoplasty. Numerous modalities have been described to counteract postoperative edema.To evaluate the effect of postrhinoplasty taping (PRT) on nasal edema and nasal draping.In this randomized clinical trial, 57 patients undergoing rhinoplasty at a tertiary reference center from August 1, 2014, to January 31, 2015, were assigned to a control group or to 2- or 4-week PRT groups. Baseline nasal thickness was measured with ultrasonography at the nasion, rhinion, supratip, and tip, and mean nasal skin thickness (MNST) was calculated. Participants in each group were categorized by the baseline MNST measurement from the lowest to greatest MNST; those in the upper half were categorized as having thick skin; those in the lower half, thin skin. The control group underwent no PRT after the removal of external packing. Patients in the 2- and 4-week PRT groups received additional taping during the allocated time. Data were collected from August 1, 2014, to June 31, 2015. Follow-up was completed on June 31, 2015, and data were analyzed from July 1 to August 1, 2015.Postoperative measurements of MNST were performed at the end of weeks 1, 3, and 5 and month 6.Of the 57 total patients (33 male and 24 female patients; mean [SD] age, 30.0 [11.7] years), 17 were in the 2-week PRT group; 20, the 4-week PRT group; and 20, the control group. Compared with the control group, 4-week PRT had a significant effect on the supratip (P = .001). Comparisons of MNST with the control group revealed significant effects of 2-week (P = .02) and 4-week (P = .007) PRT. The effect on the tip was not significant (P = .052). Postrhinoplasty taping had no effect in thin-skinned patients. Comparison among thick-skinned patients revealed a significant effect on the MNST (P = .01) and the rhinion (P = .02) but not the tip (P = .06) and supratip (P = .07).Postrhinoplasty taping helps the skin envelope to compress to the underlying framework and decrease postoperative edema. The procedure can be used particularly in thick-skinned patients, in whom skin draping and nasal refinement is crucial to the surgical outcome.1.clinicaltrials.gov Identifier: NCT02626585.

In the present experimental study, we sought to monitor distortion product otoacoustic emissions (DPOAEs) as an indicator of cochlear function, after sudden, total, and irreversible interruption of cochlear blood flow, to provide information on the time course of cochlear response to ischemia. Twenty rats with normal hearing function were included. Complete and abrupt ischemia was provided by decapitation. DPOAEs at 3-8 kHz frequencies were recorded at baseline and exactly every consecutive minute after decapitation, until emissions in all frequencies disappeared completely. Mean DPOAE values decreased significantly and progressively after decapitation for all frequencies. The mean duration of emissions was 8.20 ± 1.96 min (minimum 3 min, maximum 11 min). The longest durations of DPOAEs were observed with 4 and 5 kHz frequencies, and 3 and 6 kHz had the shortest durations. The outer hair cells exposed to acute ischemia seem to exhibit a rapid functional loss; thus, cautious handling of the cochlear vasculature and surrounding structures is necessary in surgical interventions. Additionally, our results provide some idea of the normal tolerance range of the cochlea to ischemia, which could be useful for future studies.

Objective Mometasone furoate (MF) is one of the commonly used topical steroids, particularly for patients with allergic rhinitis. However, its effect on the colonization of bacteria that may cause superinfections by suppressing the local immunity is not known. Thus, we investigated the effect of MF use on the nasal and nasopharyngeal microbial flora. Materials and methods Swab samples were taken from 35 patients who required MF monotherapy, just before and after one month of the treatment. Samples were maintained in Stuart's medium. Each swab was transferred to 1 ml of a sterile saline solution, then into the standard agar. After incubation under 5% carbon dioxide at 37 °C, colony number was detected per ml. Results Colony counts of nasal or nasopharyngeal microbial flora did not show any statistically significant alteration with one month use of MF. However, an increase in potential pathogens as well as normal flora bacteria was determined in five of the patients and six patients acquired new nasopharyngeal potential pathogens, mostly Moraxella catarrhalis , Pseudomonas aeruginosa and Staphylococcus aureus , following the use of MF. Conclusion The use of MF for one month did not statistically significantly change the nasal and nasopharyngeal flora. This study indicates that MF could be increase the colonization of the potential pathogens in some of the patients at the subclinical level particularly in the nasopharyngeal area.

The present study aimed to investigate the amount of residual adenoid tissue following the conventional adenoidectomy as compared with preoperative values. A total of 32 girls and 44 boys (range, 3-15 years) in whom adenoidectomy procedure was planned were included in the study. Adenoid tissue sizes before adenoidectomy and residual tissue sizes after conventional curettage adenoidectomy were measured by transnasal endoscopic examination and were recorded. Adenoid tissue size before and after adenoidectomy was compared. The mean age of the patients was 7.7 years (range, 3-15 years). Before adenoidectomy grade 4 adenoid tissue was noted in 43.4% (n = 33), grade 3 was noted in 28.9% (n = 22), grade 2 was noted in 25% (n = 19), and grade 1 was noted in 2.6% (n = 2) of the patients. Following adenoidectomy, no significant difference was noted with respect to residual adenoid tissue sizes of grade 4 and grade 3 patients (P = 0.75, P = 0.76). Transnasal endoscopic examination is suggested to be the most appropriate method to assess the amount of residual adenoid tissue after conventional curettage adenoidectomy. The residual adenoid tissue with the help of a microdebrider in case of a large residual adenoid tissue located in the choana are necessary for complete adenoidectomy. © 2012 Association of Otolaryngologists of India.

Objective The aim of this study was to investigate the developmental relationship between adenoid tissue volume and mastoid air cell volume, using a 3D reconstruction technique. Study design Cross-sectional retrospective study. Subjects and methods Multislice computed tomography (MSCT) images were obtained using three-dimensional (3D) reconstruction and volume-rendering techniques (VRT). The subjects were 63 boys and 37 girls, 3–16 years of age. The volumes of bilateral mastoid air cells and adenoids marked in axial–coronal–sagittal planes were calculated. The patients were grouped into three categories according to adenoid tissue volume, total mastoid volume (TMV), and age. Results No significant difference was noted between the right mastoid volume (RMV) and the left mastoid volume (LMV) or between age and sex ( p = 0.368; p = 0.549; p = 0.454). The incremental increase in adenoid tissue volume did not correlate with TMV ( r = −0.161, r = −0.279, r = 0.015). The incremental increase in TMV did not correlate with the volume of adenoid tissue ( r = 0.024, r = 0.148, r = 0.017). Conclusions No significant correlation was obtained between the incremental increase in adenoid tissue volume and TMV or the incremental increase in TMV and adenoid tissue volume. There does not seem to be a developmental relationship between adenoid tissue volume and TMV.

Objective: Betahistine augments cochlear blood flow and is currently used as an efficient therapeutic agent. Amikacin is used in a wide range of areas, but its ototoxic effect continues to be problematic. This study investigates the effect of betahistine on amikacin-induced ototoxicity. Methods: Thirty-two healthy rats were randomized to 4 groups of 8 rats in each group (amikacin, amikacin + betahistine, betahistine, and no treatment). Amikacin was administered intramuscularly to groups 1 and 2 for 14 days. Betahistine was delivered by oral gavage to groups 2 and 3 for 21 days. Distortion-product otoacoustic emissions (DPOAE) and auditory brainstem response (ABR) tests were conducted on all rats. Results: There were significant decreases in the DPOAE levels and significant increases in the ABR thresholds of the amikacin and amikacin + betahistine groups on the 7th, 14th, and 21st days, as compared to their basal values. The DPOAE levels of the amikacin + betahistine group significantly decreased on days 7, 14, and 21, and the ABR thresholds significantly increased on the same days, as compared to the amikacin group. Conclusion: Our study implies that amikacin’s ototoxic effects are augmented by the concurrent use of betahistine. Experimental and clinical research, supported by histopathological studies, is needed to affirm our findings.

Alpha-mannosidosis is an autosomal recessive lysosomal storage disease caused by deficiency of the enzyme acid-mannosidase. We present a case of two children with alpha-mannosidosis and bilateral recurrent serous otitis media. Six years of female and four-year-old male siblings referred to our department of otolaryngology clinic with fluid in the middle ear. Both of them had large head with prominent forehead, flat and wide nasal bridge, mental retardation, widely spaced teeth. Based on the otolaryngological examination and tests the pre-diagnosis of alpha-mannosidosis was suspected. Measuring acid alpha-mannosidase activity in leukocytes made for diagnosis. If the patient have early extrusion and infection of ventilation tubes of otitis media with effusion and other syndromally findings, one should take into account alpha-mannosidosis. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

Five patients in whom the serum paracetamol levels or the amount of ingested paracetamol was high enough to cause severe liver injury were treated with N-acetyl-cysteine (NAC) and a molecular absorbant recirculating system (MARS). MARS treatment was started as early as possible in order to prevent or retard the development of hepatocyte necrosis. Four of our five patients survived without liver transplantation, and one died due to brain oedema. The early commencement with NAC and MARS treatments in paracetamol intoxication might give enough time for the liver to regenerate and thus avoid liver transplantation.

Objective To determine the risk of postoperative hemorrhage associated with the use of analgesic drugs including paracetamol, metamizole sodium and ibuprofen after pediatric tonsillectomy. Patients and methods Three hundred and forty consecutive children with recurrent tonsillitis and/or obstructive symptoms were included in the study. Children were divided into three groups based on the drugs used for postoperative pain relief. Each group received paracetamol, metamizole sodium and ibuprofen following the surgery. The study of population was compared respect to postoperative bleeding. Chi-square test was used for statistical analysis. Results A total of 115 patients received ibuprofen, 115 patients were given metamizole sodium and 110 patients were given paracetamol. Posttonsillectomy hemorrhage occurred in fourteen (4.11%) children, consisting of primary hemorrhage in two patients and secondary hemorrhage in twelve patients. While 6 of 115 children (5.21%) who were given ibuprofen had postoperative hemorrhage, 4 of 115 children (3.47%) in metamizole sodium group and 4 of 110 patients (3.63%) in paracetamol group had hemorrhage. There was no significant difference with respect to hemorrhage rates between these three groups ( p Conclusion In our study we could not show significant risk of hemorrhage after using of ibuprofen, metamizole sodium and paracetamol administration and they can be used safely for posttonsillectomy pain.

Objective To compare the effects of, volatile anesthetics, desflurane and sevoflurane on intra-operative and postoperative bleeding in patients who underwent tonsillectomy and adenoidectomy. Material and method Totally 40 children (14 girl and 26 boys) aged between 2 and 16 years were included in this prospective randomized double-blind clinical trial. The patients underwent conventional cold tonsillectomy and curettage adenoidectomy under general anesthesia. For the maintenance of anesthesia, the patients were randomized into two groups; desflurane group and sevoflurane group, each including 20 subjects. Desflurane concentration was set between 4% and 6% (0.7–0.9 MAC), whereas sevoflurane concentration was set between 2% and 2.5% (0.7–0.9 MAC). The amount of perioperative bleeding in milliliters was measured by using separate aspirator bags for each patient. Results Desflurane caused significantly lower amount of perioperative bleeding compared to sevoflurane (p = 0.03). No significant difference was observed between the two groups in terms of age, body mass index and operation duration, respectively (p = 0.20, p = 0.49, p = 0.07). Conclusion Desflurane, which is one of the volatile anesthetics, leads to a lower amount of intraoperative bleeding than sevoflurane during tonsillectomy and adenoidectomy operations.

Background Pneumocephalus is a pathology characterized by air influx into the intracranial region. It may occur after head trauma and rarely after endoscopic sinus surgery. As the amount of air increases, this can cause neurological disorders with a mass effect and this condition is called tension pneumocephalus. Case description Our case is a 65-year-old woman. Tension pneumocephalus developed 12 h after endoscopic sinus surgery performed for nasal polypectomy. Since tension pneumocephalus developed very rapidly in the patient creating a herniation table, the patient was taken to theater immediately. A burr-hole was drilled into the skull and a small defect in the ethmoid roof was closed with a layered closure technique. Post-operative conservative treatment was applied (bed rest, raising the bed head, meningitis prophylaxis, loop diuretics, abstaining from maneuvers increasing the Valsalva). Discussion In the literature, it is stated that, in the case of a small defect, spontaneous resolution may be provided with conservative treatment, but as the size of the defect increases, neurological effects will occur more quickly and be more obvious. In our case, a herniation table developed leading to neurological and vital problems in a more rapid and more obvious way than in other tension pneumocephalus cases developing after endoscopic sinus surgery. We consider that this situation is related to a very small defect size. Conclusion Tension pneumocephalus is a complication rarely seen after endoscopic sinus surgery, but if it is not treated immediately, it may give rise to serious morbidity and mortality concerns. The clinical course developing after tension pneumocephalus may be very serious when very small defects are involved.

WOS: 000325448700029 PubMed ID: 24011939 Objective: The objective of this study was to compare the frequency of psychiatric disorders and the severity of psychiatric symptoms in patients with adenotonsillar hypertrophy with a healthy control group and investigate the potential improvement after adenotonsillectomy. Materials and methods: The study group consisted of 40 patients with adenotonsillar hypertrophy and a control group consisted of 35 healthy volunteers without adenotonsillar hypertrophy. A routine ear nose throat (ENT) examination, flexible nasopharyngoscopy and tympanometry were carried out. The same procedures were applied to the control group. The parents of all the participants were required to fill out the Early Childhood Inventory-4 form, the Strengths and Difficulties Questionnaire and a personal information form. At postoperative month six, the patients were re-examined, and their parents were required to fill out the same forms. Results: Attention deficit hyperactivity disorders and sleep disorders determined with the Early Childhood Inventory-4 were more common in the patients with adenotonsillar hypertrophy than in the control group. There was a significant decrease in the rates of both types of disorders at postoperative month six. The total psychiatric symptom severity was higher in the patients with adenotonsillar hypertrophy and the following were more frequent: cases of attention deficit hyperactivity disorder, oppositional defiant disorder, symptom severity of anxiety disorders and sleep disorders determined with the Early Childhood Inventory-4, as well as emotional problems, attention deficit hyperactivity disorder problems, behavioural problems and peer problems determined with the Strengths and Difficulties Questionnaire parent-report form. There was a statistically significant decrease in all the other symptoms at postoperative month six, except for the severity of oppositional defiant disorder symptoms determined with the Early Childhood Inventory-4 and behavioural problems determined with the Strengths and Difficulties Questionnaire parent-report form. There were no differences in the severity of psychiatric disorders or symptoms between the adenotonsillar hypertrophy group and the control group at postoperative month six. Conclusion: Adenotonsillar hypertrophy is associated with psychiatric disorders and symptoms. Adenotonsillectomy ameliorated the symptoms and the severity of these disorders in most cases.

We aimed to investigate the relationship between olfactory function and olfactory bulbus (OB) volume, disease duration and Unified Parkinson-s disease rating scale (UPDRS) scores in early stage idiopathic Parkinson-s disease patients. The University of Pennsylvania Smell Identification Test (UPSIT) was used for the evaluation of olfactory function. UPSIT scores for patients with Parkinson-s disease were significantly lower than controls. There was no significant difference between stage 1 and stage 2 patients. OS volumes were higher in stage 1 and 2 patients than controls, but there was no statistical difference between the three groups. No significant correlation was found between UPSIT and UPDRS total scores, nor between UPSIT scores and disease duration in stage 1 and 2 patients. According to our results, we propose UPSIT be used as a screening test to diagnose presymptomatic patients, but not OB volumes. (C) 2013 Elsevier Ltd. All rights reserved.

Saddle nose deformity presents a significant challenge to surgeons. The reconstruction of a saddle nose requires structural addition to the nasal dorsum and tip. Costal cartilage grafts have been utilized for fixing severe saddle nose deformity, but costal cartilage is notorious for early and/or late warping. In addition to well-known measures, the efficacy of a preventive surgical technique against warping was investigated in this study. Costal cartilage grafts were used in 18 patients with severe saddle noses. Due to recurrent and late warping of the grafts, an additional measure was taken in 23 patients with a comparable deformity. In these 23 patients, just before insertion the costal cartilage was transected on 75 % of its horizontal width every 2 mm, alternating between both sides along the entire length of the implant, a so-called “accordion technique.” With traditional measures early and/or late warping of the graft was observed in 7 (39 %) of 18 patients postoperatively. Two grafts warped so severely that they required revision surgery. On the other hand, additional use of the accordion technique prevented the costal cartilage from warping in all 23 cases. The warping complication rate was significantly higher in patients whose graft did not undergo the described accordion technique. The accordion technique is thought to break the recoil mechanism responsible for warping. Since incorporating this surgical technique, warping has not been seen in any saddle nose deformity patients treated by us in the last 5 years. This simple technique is strongly recommended in these cases. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

WOS: 000321535300008 PubMed ID: 23643332 Objectives: The aim of this study was to determine the prevalence of psychiatric disorders and. symptoms in preschool-age children who are indicated for operation due to adenotonsillar hypertrophy. Materials and methods: Forty-eight patients between the ages of three and five years with indication for adenotonsillectomy were included in the study, as well as 40 control patients. Cases underwent routine ear nose throat (ENT) examination, flexible nasopharyngoscopy and tympanometry. The Early Childhood Inventory-4 (ECI-4) parent form and Strengths and Difficulties Questionnaire (SDQ) parent form were completed by the parent caring for the child. The SPSS for Windows 16.0 program was used for statistical analysis. Results: Groups were compared according to they received at least one psychiatric diagnosis measured by ECI-4, the group of adenotonsillar hypertrophy was diagnosed more than the control group. Attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and sleep disorders were detected at a higher rate in patients with adenotonsillar hypertrophy. It also was established that in the comparison of the severity of psychiatric symptoms determined by ECI-4, symptom severity of ADHD, ODD, anxiety disorders, and sleep disorders was higher in the adenotonsillar hypertrophy group than in the control group. In the evaluation of the SDQ parent form, it was determined that attention deficit, hyperactivity, behavioral, and peer relations problems occurred more frequently in the adenotonsillar hypertrophy group. Conclusions: In addition to oral respiration, snoring, and disordered breathing during sleep, adenotonsillar hypertrophy may also associated with psychiatric disorders and symptoms.

Rhabdomyosarcomas are rare malignant tumors of the head and neck region. They originate from the mesenchymal cells and look like embryonal fetal muscle fibers. Rhabdomyosarcomas as morphologically in four main groups are classified embriyonal, botrioid, alveoler and pleomorphic. Head and neck area in three anatomical regions are defined in the placement of rhabdomyosarcomas. These region are orbital, parameningeal and nonparameningeal- nonorbital. Most common site is the orbital region. Other sites are the nasopharynx, middle ear, paranasal sinuses, nasal cavity, neck and larynx. Rhabdomyosarcoma generally has a poor prognosis. To improve the survey of the patients an interdisciplinary approach is necessary. Rhabdomyosarcoma is the most common soft tissue tumor in children. Majority of cases are seen first decade. It is a rare pathology, we evaluated in the literature of two parameningeal cases, which we diagnosed and operated in our clinic.

Patients with asthma, allergic rhinitis, or atopic dermatitis experience increased oxidative stress. We conducted a prospective study to examine the levels of advanced oxidation protein products (AOPPs) as an indicator of oxidative stress in 97 patients with allergic rhinitis who were followed in our clinic during a 3.5-month period. Of these 97 patients, 51 were treated with subcutaneous immunotherapy (SCIT), and 46 did not receive any treatment until the study was concluded. In each patient, allergic rhinitis and allergic sensitization were documented by the history, the findings on clinical examination, and the results of blood and skin-prick tests. Blood samples from each patient were analyzed to determine AOPP levels. We found that the mean serum AOPP level was significantly higher in the SCIT group than in the non-SCIT group (258.55 vs. 163.83 µmol/L; p = 0.0015). We conclude that as a known indicator of protein oxidation, the serum AOPP level is a marker of increased oxidative stress in response to allergen exposure in allergic rhinitis.

BACKGROUND This study was designed to investigate the effects of total laryngectomy on olfactory bulb (OB) volume and olfactory function prospectively. A prospective, longitudinal, randomized study was performed. METHODS Fifteen subjects with advanced cancer of the larynx were recruited. The OB volume was measured preoperatively and 6 months postoperatively using magnetic resonance imaging (MRI) and olfactory function was assessed using the Connecticut Chemosensory Clinical Research Center (CCCRC) test. A detailed otorhinolaryngological examination was conducted and abnormalities that could potentially cause olfactory dysfunction were excluded. An experienced radiologist segmented the MRI coronal slices manually for OB volume measurements. RESULTS The difference between the right and left OB volumes was not significant. OB volume decreased significantly 6 months postoperatively, from 64.2 to 47.1 mm(3) (p < 0.001). The CCCRC test results, scored out of 8, decreased significantly from 5.6 to 2.4 (p < 0.001) and all patients were either anosmic or hyposmic. CONCLUSION This longitudinal prospective study was the first to examine the cessation of olfactory stimulation in olfactory deficiency resulting from OB functional and structural changes.

WOS: 000315443000023 PubMed ID: 22941439 In bullous middle turbinate surgery, controversy exists over which side of the bullous middle turbinate should be removed, as the distribution of human olfactory neuroepithelium is unclear. This study evaluated whether the middle turbinate tissue of patients undergoing endoscopic concha bullosa surgery contains functional olfactory epithelium. This prospective clinical study was conducted in tertiary referable center. It detected 70 conchae bullosa in 48 patients with sinonasal symptoms, who underwent paranasal computed tomography (CT) that showed pneumatization of the middle concha. All samples were obtained under general anesthesia. Three samples were obtained from each bullous middle turbinate: one each from the anterior, medial, and lateral portions. The mucosa from each sample was stained with olfactory marker protein (OMP). In total, 210 middle turbinate samples were taken from 48 patients during endoscopic surgery for conchae bullosa. The patients were 22 females and 26 males. Of the 70 conchae bullosa, OMP-stained nerve tissue was found in the lateral, anterior and medial aspects of 57 (81.4 %), 42 (60.0 %) and 23 (32.8 %) of the bullous middle turbinates, respectively. OMP-stained nerve tissue was found in 122 (58.1 %) of the 210 bullous middle turbinate tissue samples. OMP-stained nerve tissue was found on the lateral surface of the bullous middle turbinate more often than the medial surface. Therefore, during the concha bullosa surgery, OMP-stained nerve tissue found at least in the medial part of concha, suggested that the opening of the medial part of middle concha.