Sphenoethmoid Cell: The Battle for Places Inside of the Nose Between a Posterior Ethmoid Cell and Sphenoid Sinus: 3D-Volumetric Quantification.

BACKGROUND: Sphenoethmoid cells may be above the sphenoid sinus with/ or without con-tact to optical nerve. Although sphenoethmoid cells are theoretically considered to possibly influence the sphenoid sinus volume, we could not find any study in the literature on this issue. AIMS: The aim of our study was to detect sphenoethmoid cells and measure the sphenoid sinus vol-ume using multiplanar computerized tomography and also investigate the correlation between the presence of sphenoethmoid cells and the sphenoid sinus volume. METHODS: Retrospectively 141 patients who had available paranasal computerized tomography images were included in this study. The sphenoid sinus volumes of each patient were calculated individually for each side, and the relationship between the presence of sphenoethmoid cell and sphenoid sinus volume was investigated. RESULTS: Sphenoethmoid cells were detected at 106 (37.5%) of the total 282 sides in 141 patients. No gender difference was observed. The total sphenoid sinus volume was significantly lower in the group of patients who had bilateral sphenoethmoid cells than in the sphenoethmoid cell negative group. In patients with a unilateral sphenoethmoid cell, a significant decrease in the sphenoid sinus volume was observed only for the side where the sphenoethmoid cell was located. CONCLUSION: It was observed that the sphenoethmoid cells caused a significant reduction in the sphe-noid sinus volume on the side where they were located. In the case of low sphenoid sinus aeration, the sphenoethmoid cell should be kept in mind. Further studies with an extended patient series are required to explore this issue.

The role of Onodi cells in sphenoiditis: results of multiplanar reconstruction of computed tomography scanning / Papel das células de Onodi na esfenoidite: resultados da tomografia computadorizada com reconstrução multiplanar

Abstract Introduction Onodi cells are the most posterior ethmoid air cells and extend superolateral to the sphenoid sinus. These cells are also intimately related with the sphenoid sinus, optic nerve, and carotid artery. Radiologic evaluation is mandatory to assess for anatomic variations before any treatment modalities related to the sphenoid sinus. Objective To evaluate the effect of Onodi cells on the frequency of sphenoiditis. Methods A retrospective analysis was performed in 618 adult patients who underwent high-resolution computed tomography between January 2013 and January 2015. The prevalence of Onodi cells and sphenoiditis was evaluated. Whether the presence of Onodi cells leads to an increase in the prevalence of sphenoiditis was investigated. Results Onodi cell positivity was observed in 326 of 618 patients and its prevalence was found to be 52.7%. In the study group, 60.3% (n = 73) were ipsilaterally (n = 21) or bilaterally (n = 52) Onodi-positive, whereas 39.7% (n = 48) were Onodi-negative (n = 35) or only contralaterally Onodi-positive (n = 13). Of the control group, 48.3% (n = 240) were Onodi-positive and 51.7% (n = 257) were Onodi negative. The co-existence of Onodi cells ipsilaterally was observed to increase the identification of sphenoiditis 1.5-fold, and this finding was statistically significant (p < 0.05). Conclusion The prevalence of sphenoiditis appears to be higher in patients with Onodi cells. However, it is not possible to state that Onodi cells are the single factor that causes this disease. Further studies are needed to investigate contributing factors related to sphenoiditis.

Resumo Introdução As células de Onodi são as células etmoidais mais posteriores, que se prolongam superolateralmente ao seio esfenoidal. Essas células também se encontram em íntima relação com o seio esfenoidal, o nervo óptico e a artéria carótida. Para análise de variações anatômicas antes da implantação de qualquer modalidade terapêutica relacionada ao seio esfenoidal, a avaliação radiológica é obrigatória, Objetivo Nosso objetivo foi avaliar o papel das células de Onodi na frequência de esfenoidite. Método Em nosso estudo, foi feita uma análise retrospectiva em 618 pacientes adultos que se submeteram à tomografia computadorizada de alta resolução entre janeiro de 2013 e janeiro de 2015. Avaliamos a prevalência de células de Onodi e de esfenoidite. Investigamos se a presença de células de Onodi leva a um aumento na prevalência de esfenoidite. Resultados A positividade para células de Onodi foi observada em 326 de 618 pacientes e sua prevalência foi de 52,7%. No grupo de estudo, 60,3% (n = 73) eram CO-positivas: ipsilateral (n = 21) ou bilateralmente (n = 52); e 39,7% (n = 48) eram CO-negativas (n = 35) ou apenas contralateralmente CO-positivas (n = 13). No grupo de controle, 48,3% (n = 240) eram CO-positivas; e 51,7% (n = 257) eram CO-negativas. Observamos que a coexistência de CO ipsilateralmente aumentava em 1,5 vez a associação com esfenoidite e esse achado foi estatisticamente significante (p < 0,05). Conclusão A prevalência de esfenoidite parece ser maior em pacientes com células de Onodi, mas não é possível afirmar que elas são isoladamente o fator causador dessa doença. Novos estudos precisam ser feitos para uma investigação dos fatores contributivos relacionados à esfenoidite.

The role of Onodi cells in sphenoiditis: results of multiplanar reconstruction of computed tomography scanning.

INTRODUCTION: Onodi cells are the most posterior ethmoid air cells and extend superolateral to the sphenoid sinus. These cells are also intimately related with the sphenoid sinus, optic nerve, and carotid artery. Radiologic evaluation is mandatory to assess for anatomic variations before any treatment modalities related to the sphenoid sinus. OBJECTIVE: To evaluate the effect of Onodi cells on the frequency of sphenoiditis. METHODS: A retrospective analysis was performed in 618 adult patients who underwent high-resolution computed tomography between January 2013 and January 2015. The prevalence of Onodi cells and sphenoiditis was evaluated. Whether the presence of Onodi cells leads to an increase in the prevalence of sphenoiditis was investigated. RESULTS: Onodi cell positivity was observed in 326 of 618 patients and its prevalence was found to be 52.7%. In the study group, 60.3% (n=73) were ipsilaterally (n=21) or bilaterally (n=52) Onodi-positive, whereas 39.7% (n=48) were Onodi-negative (n=35) or only contralaterally Onodi-positive (n=13). Of the control group, 48.3% (n=240) were Onodi-positive and 51.7% (n=257) were Onodi negative. The co-existence of Onodi cells ipsilaterally was observed to increase the identification of sphenoiditis 1.5-fold, and this finding was statistically significant (p<0.05). CONCLUSION: The prevalence of sphenoiditis appears to be higher in patients with Onodi cells. However, it is not possible to state that Onodi cells are the single factor that causes this disease. Further studies are needed to investigate contributing factors related to sphenoiditis.

New routes of allergen immunotherapy.

OBJECTIVES: Allergen immunotherapy is the only cure for immunoglobulin E mediated type I respiratory allergies. Subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) are the most common treatments. In this article, we reviewed new routes of allergen immunotherapy. METHODS: Data on alternative routes to allow intralymphatic immunotherapy (ILIT), epicutaneous immunotherapy (EPIT), local nasal immunotherapy (LNIT), oral immunotherapy (OIT), and oral mucosal immunotherapy (OMIT) were gathered from the literature and were discussed. RESULTS: ILIT features direct injection of allergens into lymph nodes. ILIT may be clinically effective after only a few injections and induces allergen-specific immunoglobulin G, similarly to SCIT. A limitation of ILIT is that intralymphatic injections are required. EPIT features allergen administration by using patches mounted on the skin. EPIT seeks to target epidermal antigen-presenting Langerhans cells rather than mast cells or the vasculature; this should reduce both local and systemic adverse effects. LNIT involves the spraying of allergen extracts into the nasal cavity. Natural or chemically modified allergens (the latter, termed allergoids, lack immunoglobulin E reactivity) are prepared in a soluble form. OIT involves the regular administration of small amounts of a food allergen by mouth and commences with low oral doses, which are then increased as tolerance develops. OMIT seeks to deliver allergenic proteins to an expanded population of Langerhans cells in the mucosa of the oral cavity. CONCLUSIONS: ILIT, EPIT, LNIT, OIT, and OMIT are new routes for allergen immunotherapy. They are safe and effective.

Necessity of mastoidectomy in patients with chronic otitis media having sclerotic mastoid bone: a retrospective clinical study.

OBJECTIVES: This study aims to investigate the efficiency of mastoidectomy during tympanoplasty procedures in patients having sclerotic mastoid bone with dry or dried up tympanic cavity. PATIENTS AND METHODS: The study included 146 patients (66 males, 80 females; mean age 28.6 years; range 16 to 52 years) having sclerotic mastoid bone who underwent tympanoplasty between March 2010 and March 2013. Patients were divided into two groups: group A (34 males, 58 females; mean age 25.8 years; range 17 to 47 years) underwent only tympanoplasty, while tympanoplasty + mastoidectomy were performed on group B (32 males, 22 females; mean age 29.8 years; range 16 to 52 years). All outcomes were evaluated including the actual state of the tympanic membrane graft and level of hearing. RESULTS: While postoperative perforation and retraction rates were not significantly different between the two groups, results of group A were superior to group B in terms of operation duration and hearing results. CONCLUSION: Mastoidectomy is not an efficient procedure in chronic otitis media patients having sclerotic mastoid bone with dry or dried up tympanic cavity.

Clinical features of deep neck infection: analysis of 77 patients.

OBJECTIVES: This retrospective study aims to detect the prognostic factors which affect the duration of hospital stay and evaluate the complications which develop in patients with deep neck infection. PATIENTS AND METHODS: The study included 77 patients (40 males, 37 females; mean age 42.4±20.1 years; range 11 to 88 years) treated with a diagnosis of deep neck infection in our clinic between November 2006 and November 2012. Patients' demographic and clinical features were analyzed to detect their associations with development of complications and hospitalization time. RESULTS: Odontogenic origin and submandibular localization were the most frequently observed clinical appearance. Of eight patients (10.4%) who developed serious complications, two (2.6%) died. Age, comorbidity, presence of anemia alone, Ludwig's angina and retropharyngeal involvement were associated with increased rate of complications (p<0.05); while sex, antibiotic usage prior to admittance and primary location of infection were not related (p>0.05). Submandibular localization and absence of leucopenia reduced the risk of complications (p<0.05). The mean duration of hospital stay was 12.9±8.7 days (range 2-59 days). Age, presence of comorbidity and development of complications extended the hospitalization period (p<0.05). CONCLUSION: In spite of the improvements in diagnosis and treatment, deep neck infection may be an important cause of mortality if complications develop. Comorbid anemia, Ludwig's angina and retropharyngeal involvement were identified as the strongest predictors in terms of development of complications. Duration of hospital stay extended in patients who developed complications.

Comparison of nasal mucociliary clearance in adenoid hypertrophy with or without otitis media with effusion.

OBJECTIVE: To investigate pre- and postoperative mucociliary clearance in patients with adenoid hypertrophy or combined with otitis media with effusion. METHODS: Patients were divided into two groups: Group 1-patients with adenoid hypertrophy (AH), and Group 2-patients with AH and otitis media with effusion (AHOME). In all patients, AH size was recorded, and the Andersen saccharin and methylene blue tests were conducted before and 1 month after surgery to obtain mucociliary clearance time (MCT). Nasal cavity length was measured intraoperatively to establish mucociliary clearance velocity (MCV). Patients with allergic rhinitis, active infection, and history of nasal or ear surgery were excluded. RESULTS: This study included 64 patients with a mean age of 8.34 ± 2.98 years (range: 3-18 years). Pre- and postoperative MCT were 14.60 ± 4.83 and 9.48 ± 2.63 min in Group 1 and 16.03 ± 4.31 and 12.12 ± 3.78 min in Group 2, respectively. Pre- and postoperative MCV were 0.77 ± 0.30 and 1.16 ± 0.42 mm/min in Group 1 and 0.67 ± 0.16 and 0.89 ± 0.28 mm/min in Group 2, respectively. MCT and MCV were significantly improved postoperatively in both groups (p<0.001). In addition, the postoperative MCT and MCV of Group 1 were significantly better than those of Group 2 (p<0.001). Exposure to cigarette smoking and adenoid size had negative correlations with mucociliary clearance. CONCLUSIONS: Otitis media was associated with impaired mucociliary clearance and further studies should be performed to demonstrate the causes of this deficiency.

Bipolar cautery tonsillectomy using different energy doses: pain and bleeding.

OBJECTIVE: Tonsillectomies are the most frequently applied operations in the ENT practice. Even though different surgical tonsillectomy techniques have been used, bipolar cautery is the most frequently used one. Our aim was to compare postoperative bleeding rates, pain scores and recovery times in tonsillectomies performed by using bipolar cautery in Joules (1Watt·sec or Ws) calculated by multiplying Watts by the duration of cauterization. METHODS: Adenotonsillectomy and tonsillectomy patients, admitted to the Department of otorhinolaryngology of Izmir Ataturk Training and Research Hospital and Mardin State Hospital, between January 2007 and December 2012 constituted the study group prospectively. The patients divided into 4 groups due to the energy they exposed. RESULTS: Patients in Group 1 recovered most rapidly (mean recovery time, 13.9 ± 1.8 days). Statistically significant results were obtained between Groups 1 and 4 and also Groups 2 and 4 when recovery times of the patient groups were evaluated with Bonferroni correction test. CONCLUSION: As a result, for hemostatic control, electrocauterization should be used at lower doses and short-term as possible so as to decrease frequency of bleeding episodes, alleviate postoperative pain and accelerate wound healing.

Complications of tracheoesophageal puncture and speech valves: retrospective analysis of 47 patients.

OBJECTIVES: This study aims to evaluate the complications of tracheoesophageal puncture (TEP) for voice restoration and speech valves in patients undergoing total laryngectomy. PATIENTS AND METHODS: Between January 2006 and June 2011, 47 male patients (mean age 62.8±1.2 years; range 41 to 80 years) who underwent TEP and speech valve for voice restoration after total laryngectomy were retrospectively analyzed. Secondary TEP was performed and Provox indwelling voice prosthesis were inserted in all patients. Demographic, disease and treatment characteristics of patients were recorded. Complications related to TEP and speech valves, the management of complications and clinical conditions of complete closure of TEP were also recorded. RESULTS: Tracheoesophageal puncture and speech valve related complications were observed in 20 patients. The majority of complications were minor complications including granulation tissue formation (n=2, 4.2%), deglutition of prosthesis (n=6, 12.7%) and TEP enlargement/leakage around prosthesis (n=9, 19.1%). Major complications were observed in three patients. Two of them were life-threatening complications; a mediastinitis (n=1, 3.1%) and paraesophageal abscess (n=1, 3.1%), and both appeared in the first month of the postoperative period. The overall complication rate was 42.6% during mean follow-up of 15.3 months. Tracheoesophageal fistula enlargement (n=9, 19.1%) was the most common minor complication and the most common cause of complete closure of TEP in this study. CONCLUSION: Tracheoesophageal puncture for voice restoration is not an entirely innocent procedure without any complications. Patients should be monitored for TEP-related complications in the early and late postoperative period.