Incidence of hypothyroidism and its correlation with polysomnography findings in obstructive sleep apnea.

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

Comparison of glass ionomer cement and incus interposition in reconstruction of incus long process defects.

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

Comparison of Histopathological and CT Findings in Experimental Rabbit Sinusitis.

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

[Revision surgery for chronic otitis media: evaluation of indications and results]. / Kronik otitis media düzeltme ameliyatlari: Endikasyon ve sonuçlarinin degerlendirilmesi.

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

Traumatic nasal abscess concomitant with sinusitis: a case report.

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

Anatomical variations of nasal turbinates.

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

Tortuous internal carotid artery narrowing pyriform sinus: two cases.

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

The effect of topical doxycycline in the prevention of experimental tympanosclerosis.

OBJECTIVES: The aim of this study is to determine the effectiveness of topical doxycycline used in the process of experimental myringosclerosis and tympanosclerosis. STUDY DESIGN: A prospective experimental animal study. METHODS: Experimental tympanosclerosis was accomplished in 25 healthy adult guinea pigs by inoculation with 2.5 x 10(7) colony-forming units of type-3 Streptococcus pneumoniae microorganisms followed by bilateral myringotomy. While the animals' right ears received a topical doxycycline treatment daily, their left ears were left untreated and used as controls. Otomicroscopic examination was carried out weekly and healing tympanic membranes were remyringotomized. After a 6-week follow-up, the temporal bones of 24 of 25 animals were removed and light-microscopy examination was done regarding tympanic membrane myringosclerosis and middle ear mucosal sclerosis. RESULTS: Myringosclerosis was noticed to a lesser extent in the doxycycline-treated group when compared to the untreated control group. Light microscopy evaluation revealed a difference in the area and thickness of the sclerotic plaques of myringosclerosis of the tympanic membranes in the doxycycline-treated group and the control group, being significantly smaller and thinner in the treated group (P < .001, P < .04, respectively). Similarly, the area and thickness of the sclerotic plaques in the middle ear mucosa were significantly smaller and thinner in the doxycycline treated group (P < .001, P < .03). CONCLUSION: This study demonstrated that the potent matrix metallo-proteinase inhibitor doxycycline plays a preventive role in the development of experimentally induced tympanosclerosis.

Rhinolithiasis with a nasal polyp: a case report.

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

Microdebrider for reduction of inferior turbinate: evaluation of effectiveness by computed tomography.

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

Ethmomaxillary sinus.

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

Laryngeal involvement in systemic lupus erythematosus: report of two cases.

Systemic lupus erythematosus is a multisystem autoimmune disorder. Joint and skin involvements are the most frequent presenting features. Laryngeal involvement, however, is extremely rare. Symptoms of laryngeal involvement may range from mild hoarseness to life-threatening respiratory distress. In this article, 2 patients with systemic lupus erythematosus and laryngeal involvement are presented. The first patient had hoarseness and noisy respiration, and the second had cough and respiratory distress. Otorhinolaryngological examination revealed laryngeal inflammation in both. Our cases responded well to systemic corticosteroids. Patients with symptoms such as hoarseness, foreign body sensation in throat, and respiratory distress should be evaluated by an otorhinolaryngologist to rule out involvement of the laryngeal structures.

Hyoid chondroma presenting as an external neck mass.

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

Endoscopic resection of pleomorphic adenoma of the nasal septum.

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

Extranasopharyngeal angiofibroma of the cheek.

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

Pulmonary aspiration of nasal secretions in patients with chronic sinusitis and asthma.

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

Otomycosis in Turkey: predisposing factors, aetiology and therapy.

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

Concomitant otomycosis and dermatomycoses: a clinical and microbiological study.

Otomycosis tends to recur despite long-term treatment. To our knowledge, there is no study in the English literature concerning the clinical importance of concomitant otomycosis and dermatomycoses. We investigated the presence of dermatomycoses in 52 patients with otomycosis in order to document the clinical and microbiological importance of their coexistence. Dermatomycoses on the feet and/or hands were identified in 19 patients (36.5%). The most common pathogen for otomycosis was Aspergillus niger, while it was Candida albicans for the dermatomycoses. The same pathogenic fungi were isolated from the otomycosis and dermatomycoses in nine of the 19 patients (47.4%). Aspergillus niger was the most common shared pathogen. The pathogens isolated in concomitant dermatomycoses were common pathogens for the fungal infection of the ear ( Aspergillus niger, Aspergillus flavus, Aspergillus fumigatus, Candida albicans). It was concluded that the autoinoculation of the ear canal by pathogenic fungi might be possible in the presence of the untreated dermatomycoses. Dermatomycoses must be investigated in patients with otomycosis and must be treated simultaneously in order to prevent the recurrence of both.