Comparison of scar outcomes of alar flare region using absorbable and non-absorbable sutures: a single-blind study.

OBJECTIVE: Formation of scar on the face after septorhinoplasty may disturb the patient due to cosmetic concerns. One of the main factors affecting scar outcomes is probably the suture material used. The aim of this study was to examine the effect of different suture materials on scar outcomes of alar base in patients undergoing septorhinoplasty. METHODS: Thirty-one patients who underwent alar base intervention during primary septorhinoplasty were divided into two groups according to the suture material used as the Polypropylene group (n = 16), (Polypropylene, Prolene 6/0; Ethicon Inc., Somerville, NJ, USA) and the Polyglactin group (n = 15), (Irradiated polyglactin 911, Vicryl Rapid™ 6/0; Ethicon Inc., Somerville, NJ, USA). The scar outcomes of alar base were compared between the Polypropylene and Polyglactin groups. The modified Stony Brook Scar Evaluation Scale was used to measure wound healing results at one and 12-months postoperatively for objective evaluation. Patient satisfaction questionnaire was used for subjective evaluation. RESULTS: There were no statistically significant differences in the Stony Brook Scar Evaluation Scale and patient questionnaire scores between Polypropylene and Polyglactin groups. Irradiated Vicryl Rapid had poor cosmetic outcomes in the alar base when compared to polypropylene, indicating no statistically significant difference. CONCLUSION: Both sutures can be used for closure of alar base considering their advantages and disadvantages, in patients undergoing septorhinoplasty. LEVEL OF EVIDENCE: Treatment Benefits; Level 2 (Randomized Trial).

Is Routine Histopathologic Examination Necessary Following Tonsillectomy and/or Adenoidectomy Procedures in Pediatric Patients?

Tonsillectomy and/or adenoidectomy is the most common surgical procedure in ENT practice and the malignancy rate of tonsillar tissue is very rare. The purpose of the present study is to investigate the necessity of routine histopathologic examinations following tonsillectomy and/or adenoidectomy surgeries. A total of 385 patients between the age of 5 and 16 years who were admitted to our ENT clinic and underwent adenoidectomy and/or tonsillectomy between October 2008 and July 2015 participated in the study. Patient data such as age, sex, indication for surgery, and histopathologic findings were recorded prospectively. Histopathologic findings were analyzed for hyperplastic lymphoid parenchyma and malignancy. No malignancies were detected in the studied patients and all had hyperplastic lymphoid parenchyma. Unilateral tonsillar swelling, significant lesions on the tonsil or adenoid tissue, malignancy history in the head and neck region, or a mass in the neck region with weight loss must be examined histopathologically; however, we conclude that there is no need to perform histopathologic examination for patients for whom there is no clinical suspicion. A meta-analysis is needed in this regard.

[Subcutaneous emphysema after septoplasty: a case report]. / Septoplasti sonrasi subkutan amfizem: Olgu sunumu.

Subcutaneous emphysema is characterized by the presence of air in the connective tissue within the fascial planes. The etiology of subcutaneous emphysema includes trauma, iatrogenic causes, or spontaneous development. Head and neck subcutaneous emphysema is a well-defined and life-threatening condition. In case of a large amount of air leaks into the fascial planes, the air can also extend into the retropharyngeal, mediastinal, pleural, and retroperitoneal spaces beyond the subcutaneous layers. Although numerous maxillofacial surgical procedures can cause subcutaneous emphysema, septoplasty has not been reported previously. In this unique case, subcutaneous emphysema developed after elective septoplasty and involved the maxillofacial, retropharyngeal, deep cervical, and orbital regions. The patient was treated conservatively with antibiotic prophylaxis and the condition completely resolved by day 10 spontaneously. Herein, we discuss the available literature data and optimal management strategies for unusual cases of head and neck subcutaneous emphysema.

Diagnostic value of frequency-associated vestibular-evoked myogenic potential responses in Ménière's disease.

Thirty subjects with unilateral Ménière's disease (MD) and 18 age-matched controls underwent cervical (cVEMP) and ocular vestibular-evoked myogenic potential (oVEMP) testing using bilateral air-conducted stimulation (ACS) with stimulus frequencies of 500 and 1,000 Hz. The aim of this study is to determine the diagnostic value of frequency-associated responses in MD using oVEMP and cVEMP following 500- and 1,000-Hz ACS. In healthy controls and unaffected ears, responses to 500 Hz were found better than 1,000-Hz ACS in both oVEMP and cVEMP, while ears with MD responded to 1,000-Hz ACS better than to 500-Hz ACS in oVEMP. In cVEMP tests, affected ears responded to 500-Hz and 1,000-Hz ACS equally. Amplitude ratios of 1,000/500 Hz in both oVEMP and cVEMP were successful in differing affected ears from unaffected ears and healthy controls. This study showed frequency alteration of oVEMP and cVEMP can be used as a diagnostic test battery in MD.

Prognostic factors in type I tympanoplasty.

OBJECTIVE: To identify the preoperative factors that influence the success rate of type I tympanoplasty. METHODS: A total of 247 type I tympanoplasty procedures were included in the present study. We determined the effects of the following preoperative variables on the anatomical and functional outcomes of type I tympanoplasty in order to identify prognostic preoperative factors: age (<16 years vs. >16 years), history of ear surgery, state of the contralateral ear (healthy vs. diseased), size of perforation, presence of septal pathology, presence of adenoid disease and history of smoking. Additionally, we stratified the surgical procedures according to the type of graft materials used and analyzed the effects of the above preoperative variables on the success rates of each type of procedure separately in order to eliminate the confounding effect of surgical technique. RESULTS: The study was conducted on 217 subjects (130 females, 87 males) who underwent a total of 247 surgical procedures. The graft take rate was significantly higher after tympanoplasty with perichondrium-cartilage island flap (PCIF) grafts than after tympanoplasty with temporalis fascia (TF) grafts (87.8% vs. 72.3%, p=0.008). Young age (p=0.013), presence of adenoid hypertrophy (p=0.001) and abnormality of the contralateral ear (p=0.027) were associated with lower success rates after tympanoplasty with TF grafts. The success rate of tympanoplasty with PCIF grafts was not affected by any of the preoperative variables we tested. Postoperative audiometry showed that the improvement in hearing ability did not differ between patients who received TF grafts and those who received PCIF grafts (p=0.325). CONCLUSION: Tympanoplasty with cartilage grafts was associated with better graft takes and comparable hearing outcomes than those associated with tympanoplasty with TF grafts. In patients with risk factors such as contralateral ear disease, a young age or adenoid disease, cartilage-perichondrium grafts are preferable to TF grafts.

Histopathological analysis of tonsillectomy specimens: a report from Southeastern Anatolia.

OBJECTIVES: This study aims to evaluate the necessity of routine histopathological analyses of tonsillectomy specimens. PATIENTS AND METHODS: A retrospective review for 2,004 patients (1,048 males, 956 females; mean age 12.2 years; range 2 to 60 years) who underwent tonsillectomy between January 2009 and May 2013 was carried out at the Diyarbakir Training and Research Hospital, Turkey. Tonsillectomy specimens were fixed with formalin, and stained with hematoxylin and eosin before being sectioned and examined via light microscope. Chronic inflammation and lymphoid hyperplasia were considered non-significant pathological findings. Other pathological diagnoses including infectious processes, and benign and malignant neoplasms were regarded as significant pathological findings. RESULTS: Non-significant pathological findings -chronic inflammation, lymphoid hyperplasia or both- were observed in 1,972 patients. Significant pathological findings -epidermal cyst, mucocele, squamous papilloma, granuloma and squamous cell carcinoma- were observed in 32 patients. One patient was diagnosed with squamous cell carcinoma, and another had granulomatous disease diagnosed as tuberculosis. CONCLUSION: Histopathological examination is only necessary for patients with preoperative risk factors. Gross examination may be a good alternative since it is cost effective and not time consuming.

Neutrophil-to-lymphocyte ratio in patients with peripheral vertigo: a prospective controlled clinical study.

We aimed to investigate the relationship between peripheral vertigo and inflammation by using the neutrophil-to-lymphocyte ratio (NLR) as an inflammatory marker. We recruited 103 patients with peripheral vertigo (71 women, 32 men; mean age, 39.8 ± 14.7 years) who presented to the Otolaryngology Department of Dumlupinar University Hospital. Vertigo patients with systemic diseases, neurological disorders, malignancy or any inflammatory disease that could alter the NLR were excluded from the study. We also enrolled 103 age- and sex-matched healthy subjects (controls; 82 women, 21 men; mean age, 36.7 ± 13.5 years) who underwent routine checkups in our hospital. The vertigo patients underwent full otolaryngologic and neurologic examinations and audiometric tests to rule out any other pathology causing the peripheral vertigo. NLR was calculated in all subjects and was compared between the patient and control groups. There were no significant differences between the study and control groups in terms of lipid profiles, liver-function tests, white blood cell (WBC) count, hemoglobin level, mean platelet volume, and vitamin B12 and folate levels. The mean NLR was significantly higher in the patients than in the controls (P<0.05). In conclusion, this study, which was the first to investigate the relationship between the NLR and peripheral vertigo, found that the NLR is significantly higher among peripheral vertigo patients than among healthy controls. This result suggests that the NLR is a novel potential marker of stress in peripheral vertigo patients.

Effects of postural restriction after modified Epley maneuver on recurrence of benign paroxysmal positional vertigo.

OBJECTIVE: In the present study, we calculated the success rate of the modified Epley maneuver and determined the effectiveness of post-maneuver positional restriction in terms of the prevention of early and late recurrence. METHODS: The present study was conducted on 78 patients who had unilateral benign paroxysmal positional vertigo (BPPV) of the posterior semicircular canal (SCC) and who were treated in the Otorhinolaryngology Department of Susehri State Hospital. The Dix-Hallpike test was performed on all patients. After the involved canal was identified using this test, we guided patients through the modified Epley repositioning maneuver. A maximum of two maneuvers were performed in the same session. The patients were randomly divided into two groups. One group was not advised any positional restriction, while the second group was advised positional restriction for 10 days after the procedure. Recurrences during 1-90 days after the treatment were noted as early recurrences, while those that occurred after 90 days were noted as late recurrences. RESULTS: In the restriction group (n=39), repositioning was successful after a single maneuver in 32 (82.05%) patients and after two maneuvers in 5 (12.8%) patients. Repositioning failed in two (5.1%) patients. In the non-restriction group (n=39), repositioning was successful after a single maneuver in 31 (79.4%) patients and after two maneuvers in 6 (15.3%) patients. Repositioning failed in two (5.1%) patients. Thus, the success rate was 94.8% in each group. Early recurrence occurred in 3 (8.1%) of 37 patients in the restriction group and 2 (5.4%) of 37 patients in the non-restriction group (p>0.05). Late recurrence occurred in 5 (13.5%) of 37 patients in both the restriction and non-restriction groups (p>0.05). CONCLUSION: Postural restriction after a canalith repositioning procedure does not improve procedural success or decrease early and late recurrence rates. However, the number of patients was too small to detect a difference between both treatment groups.

Satisfaction outcomes in open functional septorhinoplasty: prospective analysis.

This study aimed to prospectively evaluate patient satisfaction by means of the Rhinoplasty Outcome Evaluation (ROE) questionnaire before and after functional septorhinoplasty. We carefully selected 62 patients (mean age, 31.8 years; 28 men, 34 women) who underwent open functional septorhinoplasty in the Otorhinolaryngology and Head Neck Surgery Department of Susehri State Hospital. Satisfaction analyses were carried out by means of the ROE questionnaire both before the surgery and at least 4 weeks after the surgery. Patients were divided according to age (≤ 25 vs >25 years) and follow-up duration (≤ 6 vs >6 months). In addition, patients were grouped according to their satisfaction scores: 0 to less than 50, bad outcome (group B); 50 to less than 75, good outcome (group G); and 75 or greater, perfect outcome (group P). The mean satisfaction score in all the patients significantly increased after functional septorhinoplasty (from 24.8 ± 14.6 to 70.1 ± 17.3; P < 0.001). Moreover, the increment in mean satisfaction scores did not differ with age or follow-up duration. We conclude that the ROE questionnaire can help surgeons select suitable candidates for functional septorhinoplasty who will most benefit from the surgery.

Advanced oxidation protein product level in children with chronic otitis media with effusion.

OBJECTIVE: To determine the level of advanced oxidation protein products (AOPPs) in children with chronic otitis media with effusion (COME), in an effort to elucidate the multifactorial etiology of this disease. METHODS: This study involved 25 COME patients and 30 healthy children (control group) recruited from the Ear, Nose and Throat (ENT) and Pediatric Departments, respectively, of the Haseki Research and Training Hospital. In the COME group, blood samples were collected before a middle ear operation, and middle ear fluid was sampled during the operation. Blood samples were also obtained from the control subjects. AOPP levels in the plasma and effusion fluid were measured by the spectrophotometric method. RESULTS: In the COME group, the mean AOPP levels in plasma and effusion fluid were 168.08 µmol/l and 412.75 µmol/l, respectively. In the control group, the mean plasma AOPP level was 141.54 µmol/l. The plasma AOPP levels did not significantly differ between the COME and control groups (p>0.05). In the COME group, however, the effusion fluid AOPP level (412.75 ± 204.54 µmol/l) was significantly higher than the plasma AOPP level (168.08 ± 68.45 µmol/l; p<0.01). CONCLUSION: We found that AOPP levels were elevated in the effusion fluid, but not in the plasma, of COME patients. Thus, COME was associated with protein oxidation abnormalities. Oxidative stress may play a role in the etiopathogenesis of COME, and AOPPs may be used as markers of oxidative stress; however, further studies are required to confirm these findings.

Repair of symptomatic nasoseptal perforations using mucosal regeneration technique with interpositional grafts.

Over the past 60 years, many surgical techniques have been developed for the repair of nasoseptal perforations. This study describes a safe and practical technique involving the 5-layer repair of symptomatic nasoseptal perforations without mucosal flaps. The present study involved 23 patients (17 men and 6 women) who had symptomatic nasoseptal perforations in the Otorhinolaryngology and Head Neck Surgery Department of Haseki Research and Training Hospital. Patients were treated using the mucosal regeneration technique. Follow-up examinations were performed at 3 and 6 months postoperatively. The surgery was considered successful if total closure was achieved. Nasal mucosal physiology was also assessed preoperatively and at 3 and 6 months postoperatively by measuring the nasal mucociliary clearance time by means of the saccharin test. The most common etiological factor was former nasal surgery (56.5%), followed by nasal trauma (26%). In 4 patients (17.5%), the perforations were idiopathic. The average preoperative perforation size was 1.74 ± 0.87 cm. Total closure of the perforation was achieved in 21 patients (91.3%), and only 2 patients had subtotal healing. The mean preoperative mucociliary clearance time was 19.3 ± 4.15 minutes, which significantly improved to 12.4 ± 3.53 minutes and 10.1 ± 3.21 minutes at 3 and 6 postoperative months, respectively. Mucosal regeneration technique with interpositional grafts can be used to safely and reliably repair medium-to-large nasoseptal perforations.

A practical method for assessing nasal skin quality.

Nasal skin quality is an essential indicator of rhinoplasty outcomes. The objective of this study was to collect data on the nasal skin thickness of randomly selected Turkish men and women. The study involved 50 male and 50 female subjects. We measured the nasal dorsal skin thickness by pinching the sides of the nose upwards to produce a skinfold and then measuring the thickness of this skinfold with a Castroviejo caliper [A&A, Almecon Instruments]. We also measured the thickness of the right and left alar walls with the same caliper. In the male subjects, the mean nasal dorsal thickness and the mean overall, right, and left alar wall thicknesses were 4.02 ± 0.71, 3.99 ± 0.69, 3.98 ± 0.69, and 4.00 ± 0.69 mm, respectively. The corresponding values in the female subjects were 3.38 ± 0.56, 3.45 ± 0.66, 3.43 ± 0.67, and 3.46 ± 0.65 mm. In Turkish men, a nasal dorsum measuring greater than 4 mm can be considered "thick." In Turkish women, the mean nasal dorsal and alar wall thicknesses were 3.38 and 3.45 mm, respectively. Values greater than these are considered "thick." Either nasal dorsal thickness or alar wall thickness may be measured in men, but both must be measured in women scheduled to undergo rhinoplasty. Dark nasal skin and oily nasal skin tend to be thicker.

Reduced olfactory bulb volume and diminished olfactory function in total laryngectomy patients: a prospective longitudinal study.

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.