Intradermal Skin Testing in Allergic Rhinitis and Asthma with Negative Skin Prick Tests.

Taking medical history, physical examination, and performing some in vivo and in vitro tests are necessary for the diagnosis of allergy. Skin prick test (SPT) is considered as the standard method and first-line approach for the detection of allergic sensitization. Although mainly SPT is used for the detection of allergic sensitization, intradermal skin test (IDST) may be necessary, especially in patients with a negative SPT result. IDST is quite safe; however, is nowadays seldom used for detection of inhalant allergy and its value remains controversial. We aimed to investigate whether IDST is useful and necessary in diagnosis of respiratory allergies or not. This study involved 4223 patients with allergic rhinitis (AR) and/or bronchial asthma (BA). SPT results were positive in 2419 patients (57%) and negative in 1804 (43%). IDST was applied to 344 patients with marked allergic symptoms and with negative SPT results. Out of 344 patients, 152 (44%) showed allergic sensitization to IDST. The most commonly encountered allergic response was against the house dust mite (HDM) (32.6%). Allergic response against fungal spores was also relatively high (22%), while the pollen allergy rate (4.3%) was quite low. In BA patients with negative prick test, IDST made a significant contribution to the diagnosis of HDM allergy (p=0.003). To avoid missed diagnosis of AR and BA, particularly regarding  the HDM allergy, application of IDST may be beneficial; therefore, IDST should be considered as the next step after SPT for diagnosis of allergy prior to in vitro or provocation tests.

The Potential Protective Effects of 2-aminoethyl Diphenylborinate against Inner Ear Acoustic Trauma: Experimental Study Using Transmission and Scanning Electron Microscopy.

OBJECTIVE: In this prospective experimental study, we investigated the preventive effects of 2-aminoethyl diphenylborinate (2-APB) in rats exposed to acoustic trauma (AT). Light microscopic, transmission electron microscopic (TEM), and scanning electron microscopic (SEM) examinations were performed. MATERIALS AND METHODS: Eighteen healthy Wistar albino rats were divided into the following three groups: groups 1 (control), 2 (AT), and 3 (AT+APB). The rats in groups 2 and 3 were exposed to AT; in group 3 rats, 2-APB at 2 mg/kg was also administered, initially transperitoneally, after 10 min. RESULTS: During the light microscopic, TEM, and SEM examinations, the structures of the cochlear hair cells, stereocilia, and Deiter's cells were normal in the control group. In the AT group, the organ of Corti and proximate structures were damaged according to the light microscopic examination. During the TEM examination, intense cellular damage and stereocilia loss were detected, while during the SEM examination, extensive damage and stereocilia loss were observed. Decreased damage with preserved cochlear structure was detected during the light microscopic examination in the AT+APB group than in the AT group. During the TEM and SEM examinations, although stereocilia loss occurred in the AT+APB group, near-normal cell, cilia, and tectorial membrane structures were also observed in the AT+APB group compared with the AT group. CONCLUSION: 2-APB may have protective effects against AT damage of the cochlea. The main mechanism underlying this effect is the inhibition of the vasoconstriction of the cochlear spiral modiolar artery, thereby improving cochlear blood flow. We conclude that 2-APB may also be effective if used immediately following AT.

Maxillary Sinus Aeration in Allergic Rhinitis.

OBJECTIVE: We aimed to investigate the relationship between allergic rhinitis, which is an important reason of nasal obstruction, and maxillary sinus aeration. PATIENTS AND METHODS: Three hundred fifteen patients who have a complaint of nasal obstruction and scheduled to undergo skin prick test (SPT) with a suspicion of allergic rhinitis (AR) were enrolled for this study. Thirty-two patients with positive SPT result and 30 patients with a negative SPT result were determined as group 1 and 2 (control group), respectively. A 3-dimensional reconstruction of computed tomography images of the 62 patients was used to assess and calculate maxillary sinus volumes (MSVs). RESULTS: Total maxillary sinus volumes were measured as 21.87 cm(3) and 30.15 cm(3) in group 1 and group 2, respectively. A statistically significant difference was observed between the MSVs of the groups (P < 0.001). CONCLUSION: Total maxillary sinus volumes were found to be significantly smaller for patients with a positive SPT compared to patients with a negative SPT. Thus, we may conclude that AR has a negative impact on maxillary sinus aeration.

Primary acquired nasolacrimal duct obstruction: is it really related to paranasal abnormalities?

PURPOSE: To investigate whether there is an association between primary acquired nasolacrimal duct obstruction and paranasal computed tomography (CT) findings. MATERIALS AND METHODS: The study cohort consisted of paranasal CT images from 40 patients being treated for unilateral primary nasolacrimal duct obstruction (PANDO) and the reformatted coronal temporal CT images of 71 control subjects who attended the ENT clinic with the complaint of vertigo and tinnitus. A radiologist masked to the clinical situation of participants, investigated the paranasal CT findings of the PANDO and control patients retrospectively. The side, localization, and angle of the septal deviation as well as the thickness and lateralization angle of the inferior turbinate's were recorded. Additionally maxillary and ethmoid sinusitis, concha bullosa, Agger nasi cell formation, and osteomeatal complex status were evaluated. RESULTS: No significant difference was found between the paranasal abnormality incidence in the PANDO and non-PANDO sides of the patients or the control group. Only the side of the septal deviation correlated with the side of the PANDO (p = 0.008). CONCLUSIONS: The incidence of PANDO may not be directly related to paranasal abnormalities. Further large-scale studies should be performed to clarify the relationship between paranasal abnormalities and PANDO.

Association between atopy, mastoid pneumatization and tympanometric findings.

The purpose of this study was to reveal whether the presence of atopy plays any unfavorable role in the development of a healthy middle ear as evaluated by tympanometry or in the degree of mastoid pneumatization as measured by mastoid volume. 33 atopic patients with positive skin prick test results (atopic group) and 30 healthy subjects (control group) were included in this study. Tympanometric tests were performed in all participants, and the results were classified as type A to C. Mastoid cell volumes were measured by three-dimensional temporal computed tomography. Both the right and left mastoid volumes were significantly lower in the atopic group than in the control group. Tympanogram types among all participants showed that the number of individuals with abnormal tympanograms was significantly higher in the atopic group than in the control group. Moreover, the presence of atopy was found to be associated with an almost 4.5-fold increased risk of having an abnormal tympanogram. Individuals with abnormal tympanograms (type BB or CC) demonstrated significantly lower right and left mastoid volumes than did individuals with normal type A tympanograms. Atopic individuals demonstrated significantly lower right and left mastoid volumes than did subjects in the control group. This study suggests a direct association between atopy and mastoid cell volumes. It was found that the mastoid cell systems of atopic individuals are less pneumatized, and tympanometric measurements are worse in atopic subjects. Therefore, the authors suggest that when a medical or surgical treatment is planned for ear disease in atopic individuals, atopy is an important factor that should be taken into consideration.

Endonasal endoscopic excision of a rare tumor: nasal bone osteoid osteoma.

BACKGROUND: Osteomas are slow-growing, benign tumors that frequently occur in paranasal areas; are detected by their symptoms, depending on their location and size, or incidentally on radiologic examination; and rarely arise from the nasal bone. We present an isolated nasal bone osteoma--which has not, to our knowledge, been reported previously--that was excised using an endoscopic endonasal approach via intercartilaginous incision and reconstructed with MEDPOR. METHODOLOGY: A 21-year-old male patient attended the Mardin State Hospital ENT Clinic with the complaint of a slowly enlarging mass on the left side of the nose. The clinical, radiologic, and histologic findings pointed to a diagnosis of nasal bone osteoma. RESULTS: An endoscopic-assisted endonasal approach was performed, and defect was reconstructed with MEDPOR. At postoperative 6-month evaluation, no recurrence was observed, and the cosmetic result was satisfying in both external and intranasal views. CONCLUSIONS: In the removal of rare nasal bone osteomas, endoscopic endonasal surgery could be preferred over an external approach because of its favorable cosmetic results, comfort for the patient, and graft viability.

Detection of Helicobacter pylori in adenoid tissue by real-time polymerase chain reaction.

OBJECTIVES: This study aims to investigate the presence of Helicobacter pylori (H. pylori) using the real-time polymerase chain reaction (PCR) method in the adenoid tissues in children undergoing surgical operation due to adenoid hypertrophy. PATIENTS AND METHODS: Adenoid tissues of 23 children (8 girls, 15 boys; mean age 6.2 years; range 3 to 9 years) who were operated with the diagnosis of adenoid hypertrophy, tonsil + adenoid hypertrophy or tonsil + adenoid hypertrophy + serous otitis media in our clinic between January 2012 and April 2012 were examined. RESULTS: Of 23 patients, H. pylori was detected in the adenoid tissues of two (8.7%). Regurgitation was present in seven patients. However, no regurgitation was found in H. pylori-positive patients. CONCLUSION: In this study the presence of H. pylori in patients with adenoid hypertrophy has been demonstrated using PCR method. To be able to support the hypothesis that H. pylori has a place in etiology of adenoid hypertrophy, multicenter studies are warranted.

Nasal obstruction: comparison of radiofrequency with lateral displacement of the inferior turbinate and radiofrequency alone.

OBJECTIVE: To compare the outcomes of the nasal obstruction, the main symptom of the patients who underwent radiofrequency and lateral displacement of the inferior turbinate and patients who were treated with radiofrequency alone. METHODS: The prospective randomised study was conducted at the Department of Otorhinolaryngology and Head-Neck Surgery, Balikesir University Medical School, Balikesir, Turkey, between July and December 2012. It included 60 patients, diagnosed with allergic or non-allergic chronic rhinitis with inferior turbinate hypertrophy which was refractory to medical therapy. Half of the patients were treated with radiofrequency, and the rest with radiofrequency and lateral displacement. The main symptom of the patients was nasal obstruction. The frequency and degree of nasal obstruction were evaluated by patients' self-assessments using the standard 10-cm visual analogue scale. The evaluations were performed first pre-operatively and on the 1st, 3rd, 5th and 7th days postoperatively as well as at the end of the 4th week. SPSS 18 was used for statistical analysis. RESULTS: Nasal obstruction frequency and severity scores in patients treated with both radiofrequency and lateral displacement on post-operative days 3, 5 and 7 were found to be significantly lower (p<0.001) compared to the patients treated with only radiofrequency. CONCLUSIONS: The study demonstrated that radiofrequency and lateral displacement together is an effective method to prevent inferior turbinate oedema in the early post-operative period.

The aetiology underlying sinus headaches.

OBJECTIVE: Patients with sinus headaches usually complain of pain and pressure sensation around the sinuses and periorbital area; most are misdiagnosed with sinusitis and receive unnecessary treatment. This prospective study investigated the aetiology of sinus headache in patients with negative endoscopic or computed tomography (CT) scan findings. METHODS: This multicentre study included patients who could be followed regularly after being admitted to otorhinolaryngology outpatient or emergency units due to sinus headache, in whom endoscopic and radiological examinations did not show sinonasal pathology. The study group comprised patients with primary headache, according to International Headache Society criteria. Participants were followed monthly for 3 months and treatment response was evaluated as complete remission, partial remission or no response. RESULTS: The study included 98 patients. The main reason for diagnosing and treating sinus headaches that arose from neurovascular events was attributed to the accompanying symptoms, e.g. nasal obstruction, nasal discharge and sinus sensitivity. CONCLUSIONS: A better understanding of vascular event-derived headaches (especially migraine) and a detailed examination of patients via endoscopy and CT scanning are expected to minimize misdiagnosis rates, in patients with sinus headaches.

Odontogenic myxoma of the maxilla.

Myxomas are mostly seen in the 2(th) and 3(rd) decades. They rarely occur in childhood and maxillofacial region is rarely involved. The recurrence incidence is high. We report this unusual case occurring in a 9-year-old girl in the maxillofacial region and recurrence four months after initial treatment.

Matrix metalloproteinase-9 (MMP-9) in allergic nasal polyps.

Matrix metalloproteinases (MMPs) are known to play important roles in the invasion of nasal mucosa by inflammatory cells through degradation of extracellular matrix. Matrix metalloproteinase-9 (MMP-9) is considered to play a role in the pathogenesis of nasal polyp. The aim of the present study was to compare plasma MMP-9 levels of patients with nasal polyp of different etiologic origins, those with allergic nasal polyp (ANP) and non-allergic nasal polyp (NANP). In all, 29 patients (20 NANP and 9 ANP) and 20 healthy subjects were included in this study. Plasma MMP-9 levels were measured using ELISA. Plasma MMP-9 levels were higher (p<0.05) in ANP patients than in NANP patients and controls. In the group with ANP, plasma MMP-9 levels showed a positive correlation (p<0.05) with eosinophil counts. Plasma MMP-9 levels of NANP patients and control groups were similar (p>0.05). Moreover, that the highest levels of MMP-9 were in ANP patients may indicate the usefulness of this parameter in differentiating between the different etiologic origins of nasal polyp. Further studies are required to elaborate on the relationship between MMP-9 levels and allergic reactions.

[Transpalatal approach in juvenile nasopharyngeal angiofibroma]. / Juvenil nazofarenks anjiyofibromunda transpalatal yaklasim.

OBJECTIVES: Juvenile nasopharyngeal angiofibroma (JNA) cases treated with transpalatal approach were evaluated with respect to localization, complications, intraoperative blood loss, recurrence, and prognosis. PATIENTS AND METHODS: The study included 15 male patients (mean age 13 years; range 10 to 16 years) treated for JNA. The patients were classified according to the Chandler staging system. Transpalatal surgical excision was performed in 14 patients. Preoperative embolization of the maxillary arteries was performed in three patients. One patient with intracranial extension was treated with radiotherapy. The mean follow-up was 3 years and 7 months (range 7 months to 7 years). RESULTS: Three patients (20%) had Chandler stage II, 11 patients (73%) had stage III, and one patient (7%) had stage IV disease. The mean intraoperative blood loss was 575 ml in three patients with preoperative embolization, and 1,079 ml in those without embolization. The average intraoperative transfusion requirement was 2.3 units. Recurrences developed in three patients (20%), two of whom were treated by surgery and one by radiotherapy. CONCLUSION: Transpalatal surgical approach is effective in the treatment of JNAs localized in the nasopharynx, nasal cavity, and sphenoid sinuses, with minimal mortality and morbidity.

[Three cases of mucosal malignant melanoma of the nose and paranasal sinuses]. / Uç olguda burun ve paranazal sinüs mukozal malign melanomlari

We evaluated the clinical course and treatment of three patients who were found to have mucosal malignant melanoma of the nose and paranasal sinuses. The presenting complaint was recurrent epistaxis in all the patients. One patient had been followed-up for nasal polyposis for a long time. In older patients with recurrent epistaxis, endoscopic examination of the nasal cavity and obtaining a biopsy from suspected regions are essential for early diagnosis of mucosal malignant melanomas.

Prophylactic effect of pentoxifylline on radiotherapy complications: a clinical study.

OBJECTIVE: The purpose of this study was to assess the prophylactic effect of pentoxifylline (Ptx) on complications related to radiation. STUDY DESIGN AND SETTING: Seventy-eight patients who had postoperative radiotherapy for squamous cell carcinoma of the head and neck were enrolled into a prospective study. Patients were randomly assigned to the Ptx group (40 patients) and the control group (38 patients). Ptx was given to the patients at a dose of 400 mg 3 times a day orally to a total of 1200 mg. We noted radiotherapy complications in each group. RESULTS: Four patients were not able to tolerate this drug due to the development of gastrointestinal symptoms and dizziness. Late skin changes, fibrosis, and soft tissue necrosis were more severely in the control group than in the Ptx group (P < 0.05). We could find no positive effects on acute skin reactions and pain (P > 0.05). CONCLUSION: Our study suggests that Ptx has a prophylactic effect on the radiation complications. This can be explained by protective effect of Ptx against vascular pathology.

[Reconstruction of nasal cutaneous defects with the use of supratrochlear artery-based paramedian forehead flap]. / Nazal kutanöz defektlerin rekonstrüksiyonunda supratroklear arter bazli paramedyan alin flebi uygulamasi.

OBJECTIVES: We evaluated oncologic and functional results of paramedian forehead flap in the reconstruction of nasal cutaneous defects. PATIENTS AND METHODS: Supratrochlear artery-based paramedian forehead flap was employed in 14 patients (13 men, 1 woman; mean age 57 years; range 46 to 63 years) for the reconstruction of nasal cutaneous defects resulting from excision of squamous or basal cell carcinoma. No other treatment modalities were performed other than removal of the primary lesion. The mean follow-up was 42.4 months (range 8 to 83 months). RESULTS: None of the patients developed flap necrosis, local recurrences, or distant metastasis. Airway problems of varying extent were observed in 10 patients (71.4%), the severity of which became attenuated in time as the flap gained proper contraction. CONCLUSION: Acceptable functional and successful oncologic results can be obtained in the reconstruction with the use of paramedian forehead flap.

Papillary thyroid carcinoma metastasis to the parapharyngeal space.

Thyroid papillary carcinoma presenting as a pharyngeal mass is a rare clinical occurrence and has only been reported sporadically. We present here two patients who had papillary carcinoma metastasis of the thyroid gland to the parapharyngeal space. Each patient had a different clinical progress. Upward lymphatic spread of the tumor to involve the parapharyngeal space via the lateral retropharyngeal nodes was indicated. This pattern of spread is in keeping with Rouviere's description of a direct lymphatic pathway from the thyroid gland to the retropharyngeal nodes and parapharyngeal space.