Cephalometric Measurements With Multislice Computed Tomography in Patients With Obstructive Sleep Apnea Syndrome.

INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is characterized by episodes of upper respiratory tract obstruction, decreased oxygen saturation, and sleep fragmentation during sleep, as well as excessive daytime somnolence. Cephalometric analysis offers distance, angle, area, and volume measurements between separate reference points belonging to bony and soft tissues on a film. Cephalometric measurements made with multislice computed tomography (CT) are quite helpful for standardization of measurements and obtaining highly reliable results. The aim of the current study was to make cephalometric measurements with multislice CT in OSAS patients and compare their results with those of a healthy control population. The authors also aimed to determine, which cephalometric parameters might be more valuable for diagnosis of OSAS. MATERIALS AND METHOD: This study included 30 patients who were diagnosed with severe OSAS (apnea-hypopnea index >30) by an overnight polysomnography study, performed for suspected OSAS and 10 healthy controls without snoring or apnea who underwent three-dimensional head & neck multislice CT for any indication. All patients underwent a three-dimensional head & neck multislice CT to make cephalometric measurements and compare them across the groups. RESULTS: ANS-PNS (anterior and posterior nasal spine), Go-Gn, and UP-PhW distances, as well as sella-nasion-A and sella-nasion-B angles, were significantly lower in the OSAS group compared with the controls (P < 0.05). Mandibulas plane -H, UD, TT-EA, ANS-B, PNS-TB, TT-TB, B-N, and PNS-PhW distances were significantly higher in the patient group compared with the controls (P < 0.05). CONCLUSIONS: Our study reached the conclusion that some cephalometric measurements showed significant differences in patients with obstructive sleep apnea compared with the control group, and hence may lead to a susceptibility to having OSAS. Cephalometric measurements performed with multislice CT have come to the forefront as one of the most important tools for diagnosis of OSAS. An inferiorly located hyoid bone may be most commonly responsible for apnea episodes. It was also concluded that an inferiorly located hyoid bone might have been the result of maxillomandibular underdevelopment.

Neuropsychiatric symptoms, quality of sleep and quality of life in patients diagnosed with nasal septal deviation.

OBJECTIVES: This study aims to evaluate the psychiatric symptoms, quality of sleep, quality of life and the predictive factors affecting quality of sleep in patients diagnosed with nasal septal deviation (NSD). PATIENTS AND METHODS: Forty male patients (mean age 22.3±1.4 years; range 21 to 26 years) who admitted to the otorhinolaryngology (ORL) clinic of the Agri Military Hospital and diagnosed with NSD as a result of a through ORL examination between February 2009 and April 2009 and 36 healthy volunteer (mean age 21.7±1.0 years; range 21 to 25 years) controls, were included in this study. Pre- and postoperative evaluations were performed using the Quality of Life Scale (Short Form-36/SF-36), the Pittsburgh Sleep Quality Index (PSQI) and the Symptom Check List Revised (SCL-90-R). RESULTS: All patients and controls completed pre- and postoperative evaluations. No complications occurred. There was a statistically significant difference between the groups in the quality of sleep measures, in the SCL-90-R subscales of somatization, obsession, interpersonal sensitivity, depression, anxiety, phobic anxiety, hostility, paranoid thought, and psychoticism, additional scales and in physical health dimension of SF-36 Quality of Life Scale. CONCLUSION: Psychiatric symptoms are more common in patients with nasal septal deviation when compared to healthy controls. The impairments in nasal breathing in patients with NSD may cause a decline in the physical dimension of quality of life and a marked impairment in sleep quality.

Primary hyperparathyroidism presenting as a palatal and mandibular brown tumor.

Primary hyperparathyroidism is a fairly frequent pathologic diagnosis characterized by hypersecretion of parathyroid hormone, which results from adenomas in 80% to 85% of all cases. At clinical onset, the most common symptoms are hypercalcemia-related and some of them are pain due to kidney stones, polyuria, gastrointestinal, and neurologic disorders, whereas rarer symptoms are due to brown tumors and expansive lesions often found in fibrocystic osteitis. Brown tumors represent the terminal stage of the remodeling processes caused by an increased osteoclastic activity and fibroblastic proliferation during primary or secondary, albeit more seldom, hyperparathyroidism. The manifestation of primary hyperparathyroidism as skeletal disease has nearly disappeared in the last 2 decades. Cases are now most often diagnosed by the coincidental finding of asymptomatic hypercalcemia. Advanced screening techniques have made clinical evidence of bone disease rare. This article contains a case of brown tumor on the maxilla, palate, and mandible in addition to nephrectomy and proximal femur fracture, which are probably associated with primary hyperparathyroidism although less common nowadays. The diagnosis was suggested by the clinical history and confirmed by biochemical, radiologic, and histopathologic evidence. Excision of a parathyroid adenoma normalization of the metabolic status was then realized.

Evaluation by (99m)Tc-pertechnetate scintigraphy of the effect of levocetirizine on salivary glands function, in allergic rhinitis patients.

The purpose of this study was to assess the effect of levocetirizine (xyzal) on salivary glands function in patients with allergic rhinitis using technetium-99m pertechnetate ((99m)Tc-P) salivary gland scintigraphy. The study population consisted of 67 patients with allergic rhinitis and 31 healthy controls (14 males and 17 females, mean age 30.1+/-6.8 years). The patients were divided into two groups: an untreated patient Group of 32 patients, 17 males and 15 females, mean age 29.9+/-6.5 years and a levocetirizine-treated with 5mg.day(-1) for 4 weeks patient Group, consisted of 35 patients, 16 males and 19 females, mean age 33.5+/-7.8 years. All patients and healthy controls underwent salivary glands scintigraphy. After the intravenous administration of 185 MBq of (99m)Tc-P, dynamic salivary glands scintigraphy was performed for 25 min. By the time-activity curves, the following glandular function parameters were calculated for the parotid and submandibular salivary glands: uptake ratio, maximum accumulation, and ejection fraction. Our results showed: All functional parameters obtained for the untreated patient Group were significantly lower than for the levocetirizine-treated patient Group and healthy controls (P<0.05). There was no significant difference in any functional parameters between the levocetirizine-treated patient Group and healthy controls (P>0.05). In conclusion, results of our study indicate that patients with allergic rhinitis treated with levocetirizine showed a significantly higher salivary glands function compared with untreated patients and healthy controls. Levocetirizine treatment showed no side effects on salivary glands function.

Sinonasal Burkitt lymphoma presenting as a nasal polyposis in a pregnant woman.

The incidence of Burkitt lymphoma (BL) during pregnancy is rare. We report a case of nasal BL with symptoms mimicking chronic rhinosinusitis and extensive unilateral polyposis in a pregnant woman. Functional endoscopic sinus surgery was performed. Histopathologic examination suggested a BL, and chemotherapy was initiated. She was not given radiotherapy. She has kept free of disease for 9 months since the completion of treatment. When a physician is confronted with unusual localization among the polypoid tissue described here, a complete differential diagnosis must be done.

Hearing loss unusually caused by tubercular retropharyngeal abscess.

A 25-year-old man with complaints of neck pain for approximately 6 months and hearing loss accompanied by a feeling of obstruction of the left ear was presented. Findings from the oral cavity examination showed a retropharyngeal fluctuant, mildly tender mass. A conductive hearing loss of approximately 45 dB and a flat-shaped (type B) tympanogram were detected on the left ear. A magnetic resonance image of the neck demonstrated an abscess occupying the retropharyngeal space. Retropharyngeal space abscess was drained and sent both for pathologic and microbiologic analyses. Myringotomy and grommet ventilation tube insertion were performed in the left eardrum. The tube was removed 6 months later, but perforation on the insertion location did not close spontaneously. Therefore, we had to do myringoplasty 3 months later. Antitubercular drugs were given for a period of 9 months. There has been no previous report of a retropharyngeal tuberculous abscess with conductive hearing loss.

Otalgia due to the pleomorphic adenoma of uvula.

We report an unusual presentation of a salivary pleomorphic adenoma in the uvula. The adenoma caused otalgia and hypernasal speech in a patient without additional symptoms. The tumor was surgically excised with safe margins of the healthy tissue. After the excision of the mass, the new uvula was reconstructed through modified radiofrequency-assisted uvulopalatoplasty technique. After the treatment, the patient has remained disease-free for 1 year.

Treatment of primary snoring using modified radiofrequency-assisted uvulopalatoplasty.

Snoring is a common complaint, especially among the elderly individuals. In the treatment of snoring, many options, surgical or nonsurgical, are available. In this randomized study, we used a modified technique including some components of radiofrequency-assisted uvulopalatoplasty (RAUP) and Uvulopalatopharyngoplasty UPPP (modified-RAUP, MRAUP) and RAUP in a control group. A total of 60 patients (58 male and 2 female), 30 in each group (MRAUP and RAUP groups), with an average age of 38 +/- 9 years were included in the study. In the MRAUP group, in addition to the modified surgery, preoperative steroid injection was used as a preemptive analgesic and pre-incisional steroid injection and closure of the edges of the incision were performed to achieve better relief of pain. Snoring score, pain at rest and during swallowing, analgesic consumption and speech score were evaluated using standard 10 cm visual analog scales (VAS). Operation time and other complications were recorded. The patients in the MRAUP group had better pain scores, both at rest and during swallowing, and less analgesic consumption. Although operation time was longer in the MRAUP group compared to that of the RAUP group, snoring score, evaluated from day 1 to the 6th month after operation, was significantly better in the MRAUP group. Postoperative speech scores at each visit were similar in both groups. In the MRAUP group, 87% of the patients (26 patients) had a final VAS for snoring below 3, while in the RAUP group 63% of the patients (19 patients) were below 3 on the scale (P < 0.05). Thus, MRAUP seems to be a promising technique for surgery as a treatment for snoring.

The effects of methylprednisolone and cefazolin sodium on antioxidant status in experimentally induced maxillary sinusitis.

CONCLUSION: Sinusitis is accompanied by deteriorated antioxidant status, which can be alleviated with administration of cefazolin sodium or methylprednisolone. Steroids improve sinusitis when combined with antibiotics. OBJECTIVE: To evaluate the antioxidant status in response to treatment of maxillary sinusitis with methylprednisolone and cefazolin sodium. MATERIALS AND METHODS: Twenty-eight rabbits were inoculated with Staphylococcus aureus and then treated with saline, methylprednisolone, cefazolin sodium, and methylprednisolone plus cefazolin sodium, twice daily for 7 days. After the animals were sacrificed, mucosa samples were obtained to determine catalase (CAT), superoxide dismutase (SOD), and glutathione reductase (GPx) activities and levels of nitric oxide (NO) and malondialdehyde (MDA). RESULTS: Catalase activity among untreated rabbits and those treated with either methylprednisolone or cefazolin sodium was not different. Activities of SOD and GPx were lower for rabbits treated with cefazolin sodium than for those treated with methylprednisolone and for untreated rabbits (p<0.0001). Rabbits treated with cefazolin sodium had lower NO and MDA levels than those treated with methylprednisolone and untreated rabbits (p<0.0001). Combined administration of cefazolin sodium with methylprednisolone increased CAT, SOD, and GPx activities further and decreased NO and MDA levels further in comparison with their administration alone (p<0.0001).

Lingual cystic lymphangioma in an elderly patient.

A 67-year-old man presented with a multilobulated, soft lesion at the tip of the tongue, causing articulation problem. The patient stated that it had been present for more than 30 years. Oral examination showed a multilobular mass with a large base, 15 x 15 x 10 mm in size. Magnetic resonance imaging showed a multilocular cystic tumor. The patient underwent total excision. After surgery, tongue movement and sensation were normal. Histopathologic diagnosis was cystic lymphangioma.

Treatment of sinusitis with corticosteroids in combination with antibiotics in experimentally induced rhinosinusitis.

OBJECTIVES: The objective of this study was to investigate the effects of corticosteroids, antibiotics, and their combination in the therapy of experimental bacterial rhinosinusitis. METHODS: Twenty-eight rabbits underwent experimental induction of bacterial rhinosinusitis with Staphylococcus aureus. The animals were assigned randomly to 1 of 4 treatments (saline solution, methylprednisolone, cefazolin sodium, methylprednisolone-cefazolin sodium) for 7 days. After the treatment period, sinus mucosa samples of the animals were examined stereologically. In addition, mucosa samples were used in the determination of myeloperoxidase (MPO) activity. RESULTS: Methylprednisolone, cefazolin, and methylprednisolone-cefazolin had a positive effect on the reduction of neutrophil infiltration to the sinus mucosa in experimental bacterial rhinosinusitis as compared to the group treated with saline solution. However, the effects of methylprednisolone, cefazolin, and methylprednisolone-cefazolin did not significantly differ (p > .05). Similarly, the use of methylprednisolone, cefazolin, and methylprednisolone-cefazolin decreased MPO activity as compared to the group with saline solution (p < .05), and the difference among methylprednisolone, cefazolin, and methylprednisolone-cefazolin was statistically significant (p < .05). The most significant decrease in MPO (neutrophil marker enzyme) activity was determined in the animals treated with methylprednisolone-cefazolin (p < .05). CONCLUSIONS: Administering corticosteroids as an adjunct to antibiotics may accelerate the healing process in experimentally induced rhinosinusitis. In this model of rhinosinusitis, an MPO assay was supportive of this hypothesis, although stereological examination showed no statistically significant difference.

The effects of silica exposure on upper airways and eyes in denim sandblasters.

OBJECTIVE: Silicosis due to denim (or jean) sandblasters is newly described cause of silicosis. In such cases lungs are severely affected due to heavy exposure to silica without serious protection. We aimed to investigate whether silica had an effect on the upper airways and eyes. METHODS: The study included the patients recently diagnosed with silicosis. For comparisons, a control group was constituted. Firstly, a questionnaire was performed to obtain demographic and exposure characteristics of the cases. Later, routine nasal examination by endoscope and routine eye examination by slit-lamp microscope were performed to investigate presence of rhinitis and/or adenoid vegetation and eye findings associated with dust exposure, respectively, in both patient and control groups. Punch biopsies of the adenoid tissue were obtained using an endoscopic telescope with the patient under local anesthesia and sent for histopathologic examination. In addition, nasal pH and mucociliary clearance were investigated. Both pH and saccharin nasal transport time (SNTT) measurements were performed by two physicians, who reached a final consensus. RESULTS: The study group consisted of 83 male silicotics with an average age of 23 +/- 6 years, and the control group consisted of 84 age and gender matched healthy individuals. Their mean exposure time was 40 +/- 26 months. On routine nasal examination, silicotics had higher rates of rhinitis (28.9% versus 16.7%) mostly ipsilaterally (p = 0.01), adenoid vegetation (32.5% versus 13.3%/, p < 0.05), conjunctival hyperaemia (70% versus 45%, p < 0.001), pingueculae (68% versus 23%, p < 0.01), papillar formation (40% versus 28%), and higher nasal pH values (7.9 +/- 0.7 versus 6.9 +/- 0.6, p < 0.001), higher SNTT values (19.9 +/- 2.9 versus 10.9 +/- 1.9, p < 0.001) compared with the controls. CONCLUSION: The results of our study suggest that upper airways and eyes are considerably affected in the patients with silicosis. Thus, appropriate protection is required to prevent the development of such problems in denim sandblasters.

Evaluation of the effect of levocetirizine on nasal mucociliary clearance in allergic rhinitis patients by rhinoscintigraphy.

OBJECTIVE: The purpose of this study was to assess the effect of levocetirizine on nasal mucociliary clearance in allergic rhinitis patients using rhinoscintigraphy. METHODS: Twenty patients with allergic rhinitis (12 males and eight females, mean age 37.7 +/- 10.5 years) were evaluated. All the patients received levocetirizine (5 mg x day(-1)) for 4 weeks, and the speed of nasal mucociliary clearance was assessed before and after treatment. Twenty healthy controls (11 males and nine females, mean age 39.4 +/- 7.8 years) were also evaluated. RESULTS: The clearance values obtained for the treated group before and after treatment were significantly lower than those of the control group (P = 0.0001), but there was no significant difference in clearance speeds before and after treatment in the patient group (P = 0.444). CONCLUSION: The study demonstrated that levocetirizine did not affect the speed of nasal mucociliary clearance in allergic rhinitis patients, and that nasal mucociliary clearance can easily be evaluated by rhinoscintigraphy.

Effects of piracetam supplementation on cochlear damage occurring in guinea pigs exposed to irradiation.

In this study we aimed to determine the role of piracetam (PIR) in preventing radiation induced cochlear damage after total-cranium irradiation (radiotherapy; RT). Male albino guinea pigs used in the study were randomly divided into three groups. Group 1 (Control group) (n=11) received neither PIR nor irradiation, but received saline solution intraperitoneally (i.p.) and received sham irradiation. Group 2 (RT group) (n=32) was exposed to total cranium irradiation of 33 Gy in 5 fractions of 6.6 Gy/d for five successive days, with a calculated (alpha/beta=3.5) biological effective dose of fractionated irradiation equal to 60 Gy conventional fractionation, then received saline solution for five successive days i.p. Group 3 (PIR+RT group) (n=33) received total cranium irradiation, plus 350 mg/kg per day PIR for five successive days i.p. After the last dose of RT, the guinea pigs were all sacrificed at the 4th, 24th and 96th hours, respectively. Their cochleas were enucleated for histopathologic examination. It was observed that total cranium irradiation (RT group) promoted degeneration in stria vascularis (SV), spiral ganglion cells (SG), outer hair cells (OHC) and inner hair cell (IHC) of cochleas at these times (p<0.05). While in the PIR+RT group, there was no statistically significant difference on radiation-induced cochlear degeneration in SV and OHC at 4th (p>0.05) and IHC at 4th, 24th hours (p>0.05), there was a significant difference on radiation-induced cochlear degeneration in SV and OHC at 24th and 96th hours (p<0.05), IHC at 96th hour (p<0.05) and SG at 4th, 24th and 96th hours (p<0.05). There was no any cochlear degeneration in the control group. Piracetam might reduce radiation-induced cochlear damage in the guinea pig. These results are pioneer to studies that will be performed with PIR for radiation toxicity protection.

99mTc-labelled red blood cell single-photon emission computed tomography for the diagnosis and follow-up of juvenile nasopharyngeal angiofibroma.

AIM: To confirm the usefulness of blood pool scintigraphy with Tc-labelled red blood cells ((99m)Tc-RBCs) in the diagnosis and follow-up of juvenile nasopharyngeal angiofibroma. METHODS: A prospective study design was used. (99m)Tc-RBCs were prepared by a modified in-vivo method. After the rapid intravenous injection of 370-740 MBq of (99m)Tc-RBCs, dynamic imaging of 1-min duration was performed. After dynamic imaging, static acquisitions at 5 min (second phase: blood pool phase) and 2 h (third phase: static image) were obtained. In addition, single-photon emission computed tomography (SPECT) imaging was performed at 2 h. SPECT images were obtained using a rotating gamma camera (GE-Starcam 4000 XR/T). RESULTS: All patients showed no activity in the first phase and mild activity in the second phase (blood pool phase). All patients with juvenile nasopharyngeal angiofibroma showed a prominent increased activity in the third phase and in SPECT images. CONCLUSIONS: This study shows that blood pool scintigraphy with (99m)Tc-RBC SPECT is very accurate, easy to perform and a suitable alternative to pre-operative and post-operative imaging techniques, including computed tomography scan, magnetic resonance imaging (MRI) and MRI angiography, for the detection of juvenile nasopharyngeal angiofibroma.

Assessment of antibacterial activity of some topical otological solutions.

OBJECTIVES: Otological solutions have long been used in the treatment of the bacterial and fungal infections of the ear. We investigated antibacterial activity of some otic solutions against the most common bacteria isolated from discharging ears. STUDY DESIGN: Three solutions were used (Castellani's, Burrow's, and 2% salicyl alcohol) for 20 fresh isolates of each of the following organisms: Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa, Escherichia coli, and Enterobacter spp.. The activity of each solution was determined by the size of the zone of inhibition of bacterial growth. RESULTS: The Castellani's solution showed significantly larger average inhibition zones than the other solutions did (p<0.001). CONCLUSION: The Castellani's solution may be considered a good option against bacterial or mixed infections (bacterial and fungal) of the ear.

Anti-inflammatory effect of erythromycin on histamine-induced otitis media with effusion in guinea pigs.

In this study, the anti-inflammatory effect of erythromycin was investigated in a model of histamine-induced otitis media with effusion (OME). OME was induced in guinea pigs by the transtympanic injection of histamine solution into the middle-ear cavity. Guinea pigs were randomly assigned to one of three groups: control, erythromycin treatment, or methylprednisolone treatment. After histamine injection, the animals were treated with intraperitoneal medication for five days consecutively. Afterwards, the animals were sacrificed and the temporal bones were removed. The samples were examined stereologically. In the erythromycin-treated group, it was observed that neutrophil infiltration was significantly inhibited when compared to the control group. This result shows that erythromycin may produce a significant anti-inflammatory effect in this model of OME.

Evaluation of oxidative stress in erythrocytes of guinea pigs with experimental otitis media and effusion.

Oxygen free radicals (OFRs) have been implicated in the pathogenesis of an increasing number of diseases and inflammatory states. They may cause cell and tissue damage by their chemical modification of proteins, carbohydrates, nucleotides, and lipids. Under physiological conditions OFRs are part of normal regulatory circuits and are neutralized by antioxidants. Infections are one cause of increased OFR production. The aims of our study were to assess whether the increased oxidative stress in experimental otitis media with effusion (OME) is reflected in erythrocytes by lipid peroxidation and to survey the alterations in oxidant and antioxidant enzyme activities in experimental OME in guinea pigs. Erythrocyte total (enzymatic plus non-enzymatic) superoxide scavenger activity (TSSA), non-enzymatic superoxide scavenger activity (NSSA), superoxide dismutase (SOD), catalase (CAT), and xanthine oxidase (XO) activities, and malondialdehyde (MDA) level were measured in 6 guinea pigs with OME and in 6 controls. The TSSA, SOD, XO activities, and MDA level in experimental OME were significantly higher than in controls. No significant differences were found in erythrocyte NSSA and CAT activities. In experimental OME induced by histamine injection, increased OFR production was observed, suggesting that OFRs may play an important role in cell and tissue damage due to OME.

Primary nasopharyngeal tuberculosis in a patient with the complaint of snoring.

Isolated nasopharyngeal tuberculosis is a rare condition, even in endemic tuberculosis areas. The most common presentation of nasopharyngeal tuberculosis is with a cervical lymphadenopathy followed by nasal discharge or obstruction. Here we present a 58-year-old patient with nasopharyngeal tuberculosis whose only complaint was snoring. Her oropharyngeal and anterior rhinoscopic examination was normal. On endoscopic examination, mucosal oedema and hyperaemia of the nasopharynx was observed. There was no cervical lymphadenopathy. The tuberculin skin test was positive and histopathological examination of the biopsy taken from posterior nasopharyngeal wall supported the diagnosis of tuberculosis. After anti-tuberculosis therapy, the snoring stopped and the nasopharyngeal examination was normal.