The role of meteorologic factors and air pollution on the frequency of pediatric epistaxis.

Fluctuations in atmospheric temperature, humidity, and air pollution are associated with the incidence of epistaxis. To date, no study in the literature has evaluated the effect of air pollution and meteorologic conditions on the pediatric population. We aimed to evaluate the effect of meteorologic factors and air pollution on the frequency of epistaxis in children. Children presenting to an outpatient clinical setting at a tertiary care hospital during a 5-year period (July 1, 2009, to June 30, 2014) and diagnosed with epistaxis formed the study population. Daily temperature and humidity parameters and average daily atmospheric water vapor pressure, average daily concentration of particulate matter <10 µm in diameter, and sulfur dioxide readings were obtained. The distribution of daily parameters was analyzed. Of the 1,559 children with the primary diagnosis of epistaxis, data from 1,330 children were analyzed after excluding patients with coexisting pathologies. Positive correlations were found between the frequency of epistaxis and both the average daily temperature and the difference between the maximum and minimum daily temperature. There was a negative correlation between the epistaxis frequency and the average daily humidity, the difference between the maximum and minimum daily humidity, the average daily concentration of particulate matter, and the sulfur dioxide levels. Our findings suggest that epistaxis in children is related to high temperatures and low humidity.

Coexistence of Lymphoepithelial Carcinoma of the Parotid Gland and Submandibular Gland Pleomorphic Adenoma.

Lymphoepithelial carcinoma is a variant of undifferentiated carcinoma with characteristic dense lymphoid stroma in which nasopharynx is site of predilection. Racial and geographic association and Epstein-Barr virus positivity in endemic areas are other characteristics of this rare neoplasm. Lymphoepithelial carcinoma accounts for only 0.4% of malignant salivary gland tumors. The authors present a patient with Epstein-Barr virus positive lymphoepithelial carcinoma of the parotid gland in a nonendemic region. Besides this, synchronous pleomorphic adenoma in the contralateral submandibular gland caused a challenge in making initial therapeutic decision.

Minimally Invasive Procedures for Laryngeal Carcinoma: Transoral Endoscopic Laser and Transoral Robotic Surgery.

Open partial or total laryngectomies with or without radiotherapy (RT) or chemoradiotherapy (CRT) are the only mainstays in the treatment of laryngeal carcinomas. However, minimally invasive procedures such as transoral endoscopic carbondioxide laser microsurgery (TLM) or transoral robotic surgeries (TRS) are now being increasingly used in selected patients. The laryngeal framework is not disturbed in these procedures; therefore, the postoperative swallowing function improves more rapidly, and routine tracheotomy is not usually required. Moreover, they have oncological results comparable with open procedures.

Submandibular Gland Surgery: Our Clinical Experience.

OBJECTIVE: The aim of this study was to assess the demographic findings and surgical results of patients who underwent submandibular gland excision at a tertiary care center. METHODS: The clinical characteristics and histopathological results of 45 patients who had undergone submandibular gland excision between 1997 and 2014 were evaluated in detail. RESULTS: Twenty-eight (62.2%) and 17 (37.8%) patients presented with a complaint of a painful mass and painless mass, respectively. Histopathologic investigation of the surgical specimens revealed sialolithiasis in 14 patients (31.1%), chronic sialadenitis in 16 (35.6%), benign tumor in 12 (26.7%), malignant tumor in two (4.4%), and mucocele extravasation in one. As complications, permanent paralysis of the marginal mandibular branch of the facial nerve was seen in one patient (2.2%), temporary paralysis of the marginal mandibular branch of the facial nerve was seen in seven (15.6%), orocutaneous fistula was seen in one (2.2%), and temporary paralysis of the hypoglossal nerve was seen in one (2.2%). CONCLUSION: This study revealed that in patients presenting with complaints of a submandibular gland mass, sialolithiasis, sialadenitis, and benign masses were the mostly diagnosed disorders. Transcervical submandibular gland excision is a satisfactory procedure with low complication and recurrence rates when it is performed on selected patients and obeyed to surgical techniques.

Oxidative stress and nasal polyposis: does it affect the severity of the disease?

BACKGROUND: Nasal polyposis (NP) is a chronic inflammatory disease and the waste products of this inflammation are reactive oxygen species composed of free radicals. Changes in oxidative status have already been revealed in NP. The aim of this study was to investigate the effect of oxidative status to the severity of the disease and the quality of life. METHODS: The study group included 24 patients with NP and 20 controls. The Turkish version of the Rhinosinusitis Disability Index, visual analog scale (VAS), polyp stage, computed tomography (CT) score, and the eosinophilic cationic protein (ECP) levels in nasal lavage (NAL) fluid were used to assess the severity of the disease. Malondialdehyde, nitric oxide (NO), and the total antioxidant status (TAS) levels in NAL fluids were measured representing the oxidative stress. RESULTS: NO values were correlated with nasal congestion (p = 0.031). TAS values were correlated with nasal obstruction (p = 0.039). ECP values showed correlation with all the nasal obstruction (p = 0.003), congestion (p = 0.009), rhinorrhea (p = 0.009), and VAS scores (p = 0.039). CONCLUSION: In NP, ECP levels detected in NAL fluid were significantly high and were correlated with the severity of the disease. Moreover, the severity of oxidative stress, in the forms of TAS and NO, is significantly correlated with the severity of the nasal obstruction and congestion, respectively.

Strabismus secondary to frontal sinus mucocele associated with nasal polyposis.

Paranasal mucoceles are regarded as slow-growing and benign lesions. They are usually recognized by otorhinolaryngologists, but a clinically relevant mucocele with orbital complications may present to an ophthalmologist. We report a 15-year-old's case with unilateral reduced ocular motility due to bilateral frontal mucocele associated with grade II nasal polyposis.

Risk of nasal septal perforation following septoplasty in patients with allergic rhinitis.

Nasal septal perforation (NSP) is an uncomfortable condition that usually has a negative effect on the quality of life and is frequently seen as a complication of nasal surgical procedures. The aim of this study was to evaluate the effect of allergic rhinitis (AR) on the occurence rates of septal perforation as a complication of septoplasty. The medical records of 352 patients who had septoplasty at our department between January 2006 and May 2009 were searched thoroughly and those with a follow-up period of at least 1 month were included in the study. Septal perforation rates were compared between two groups, one of which was formed by patients known to have AR besides septum deviation and the other with no history of AR. Of the 352 patients, 70 (19.8%) had accompanying AR. Only three patients (0.9%), two in the non-allergic group (NAG) and one in the allergic group (AG), were noted to have NSP after septoplasty. According to this clinical data, NSP rates were 1.4 and 0.7%, respectively, in AG and NAG. No statistical significance was found between the two groups (p = 0.487). AR had no impact on the risk of NSP after septoplasty. To our opinion, an appropriate surgical technique and a respectful approach to the tissue planes are the key points of avoiding undesired results.

Haloperidol: a possible medication for the treatment of exacerbation of intractable psychogenic sneezing.

Sneezing is one of the physiological defense mechanisms that develops generally due to nasal irritation. But intractable sneezing episodes are uncommon and generally detected among the adolescents. It is difficult to distinguish physiologic sneezing from psychogenic sneezing. Herein, we report a 12-year-old girl who was complaint with intractable sneezing. She was diagnosed as intractable psychogenic sneezing and haloperidol treatment was started. All symptoms had resolved completely within 2 weeks. As a result, haloperidol can be considered as a different treatment modality for intractable psychogenic sneezing.

Expression of a disintegrin and metalloproteinase 33 protein in nasal polyposis: an immunohistochemical study.

BACKGROUND: A disintegrin and metalloproteinase (ADAM)-33 is a member of matrix metalloproteinases. This protein takes a role in angiogenesis and airway remodeling in asthma. Because histopathological findings of airway remodeling in asthma and nasal polyposis (NP) are similar, the aim of this study was to evaluate the ADAM-33 expression in NP. METHODS: Immunohistochemical staining of specimens of 47 patients with NP and 8 patients with concha bullosa was performed to detect the expression of ADAM-33. Paraffin blocks were used to identify the expression of ADAM-33 polyclonal antibodies. Immunostaining of epithelial cells, stroma, mesenchymal cells of vessels, and inflammatory cells were analyzed by using light microscopy. RESULTS: Immunopositivity scores in epithelial cells in NP (median, 2; range, 1-3) were significantly higher than those of controls (median, 1.5; range, 1-2; p < 0.001). ADAM-33 staining was increased in the mesenchymal cells of vessels of nasal polyps (median, 2; range, 1-3) compared with control tissues (median, 1.5; range, 1-2; p = 0.006). Although the staining scores of fibroblasts in nasal polyp specimens were also high (median, 3; range 1-3), there was no statistical significance when compared with controls (median 2; range, 1-3; p = 0.228). ADAM-33 immunostaining was not related with the presence of allergies, asthma, and aspirin intolerance (p > 0.05). Moreover, no relationship was found between increased expression of ADAM-33 and the stages of polyp or computerized tomography scores (p > 0.05). CONCLUSION: This study suggests that the increased expression of ADAM-33 protein may have a role in the pathogenesis of NP.

[Epidemiological characteristics, distribution of allergens, and symptom severity in patients with perennial allergic rhinitis, living in Konya region]. / Konya yöresinde yasayan perennial alerjik rinitli hastalarda epidemiyolojik özellikler, alerjen dagilimi ve semptom ciddiyeti.

OBJECTIVES: We investigated epidemiological characteristics, distribution of allergens, and symptom severity of patients with perennial allergic rhinitis (PAR), living in Konya region. PATIENTS AND METHODS: The study included 165 adult patients (89 females, 76 males; mean age 34.5+/-10.7 years; range 18 to 68 years) diagnosed as having PAR based on clinical symptoms and skin prick test (SPT) results. Total IgE levels, distribution of allergens in SPT, and symptom severity were determined. RESULTS: The most frequent allergens were house dust mites (84.9%), followed by pollen mixture (42.8%), fungi (38.6%), and animal dander (36.7%). Serum total IgE levels were higher than normal in 30.3%. Age at onset of symptoms was = or <25 years in 45.2% of the patients. Patients with a university degree accounted for 46.5%. Urban and rural residents accounted for 66.2% and 33.8%, respectively. Coexisting asthma and aspirin allergy were detected in 2.9% and 2.2%, respectively. A family history of allergy was present in 22.3%. The most common nasal symptom was itching, but blocked nose had the highest severity score. CONCLUSION: In our region, house dust mites were the most frequent allergens, itchy nose was the most common symptom, and blocked nose had the highest symptom severity score in patients with PAR.

[Fungal allergy in chronic rhinosinusitis with or without polyps]. / Polipli veya polipsiz kronik rinosinüzitli olgularda mantar alerjisi.

OBJECTIVES: Fungi, by systemic or local allergic effect, may play a role in the pathogenesis of chronic rhinosinusitis (CRS). We investigated the incidence of fungal allergy in patients with CRS and its effect on the clinical characteristics of the disease. PATIENTS AND METHODS: The study included 127 patients, aged 18 years or over, with CRS (42 females, 85 males; mean age 43+/-12 years; range 19 to 78 years). Fungal allergy was determined by skin prick test and its effect was analyzed on blood eosinophil and total immunoglobulin E levels, the presence of polyps, and paranasal sinus computed tomography scores. RESULTS: Eighty-five patients (66.9%) were found to have allergy. The incidence of allergy did not differ between patients with and without polyps (p>0.05). House dust mites (62.2%) were the most frequent allergens. The incidence of fungal allergy was 38.8% in allergic patients. Isolated fungal allergy was detected in two patients (1.6%). The most frequent fungal allergens were Aspergillus, followed by Alternaria, and Penicillium. No association was found between fungal allergy and blood eosinophil and total immunoglobulin E levels, presence of polyps, or paranasal sinus computed tomography scores (p>0.05). CONCLUSION: The incidence of fungal allergy in patients with CRS was found to be high in this study. Tissue culture studies are required to determine the definitive relationship between fungal allergy and clinical features of CRS.

Expression of metalloproteinases MMP-2 and MMP-9 in antrochoanal polyps.

BACKGROUND: Matrix metalloproteinase (MMP) 2 and MMP-9 are known to cleave specifically type 4 collagen, which is a major structural component of basement membrane. This is an early step of inflammation. Because of this property they have been studied in chronic sinonasal disorders. The aim of this study was to determine the MMP-2 and MMP-9 expressions in an antrochoanal polyp (ACP). METHODS: We examined tissue samples from 10 ACPs, 10 diffuse nasal polyps, and 10 control nasal mucosa (CM) by immunohistochemistry for MMP-2 and MMP-9 expression. RESULTS: Most of epithelial and endothelial cells showed positive immunostaining for MMP-2 and MMP-9 in all tissue samples. MMP-2 staining of inflammatory cells showed no difference among the groups (p > 0.05). On the other hand, MMP-9+ inflammatory cells were found to be significantly increased in ACP and diffuse nasal polyps when compared with CM (p < 0.05). CONCLUSION: MMP-9-expressing inflammatory cells could play a role in the pathophysiology of ACP as well as nasal polyps.

[Castleman's disease in a patient with recurrent reactive lymphadenopathy]. / Tekrarlayan reaktif lenfadenopatili bir olguda Castleman hastaligi.

Castleman's disease is an uncommon benign disorder associated with progressive lymph node enlargement. It most commonly involves the mediastinum and involvement of the neck accounts for 6%. A 28-year-old male presented with a progressively enlarging left-sided neck mass. He had a history of excisional lymph node biopsy that yielded a histopathologic diagnosis of reactive lymphadenopathy. In our clinic, a repeat excisional biopsy was performed and the diagnosis was made as Castleman's disease. Although it is an uncommon cause of lymphadenopathy in the neck, Castleman's disease should be considered in the differential diagnosis of recurring lymphadenopathies. Repeated excisional biopsies may be necessary (from the largest lymph node when possible) to uncover the disease.

Subjective pulsatile tinnitus associated with extensive pneumatization of temporal bone.

Pulsatile tinnitus (PT), a rare otologic symptom, is frequently associated with identifiable and treatable causes. We report two cases of subjective PT due to extensive pneumatization of temporal bone around the internal carotid artery.

The role of allergy in the severity of nasal polyposis.

BACKGROUND: Although patients with nasal polyposis frequently exhibit concomitant allergy, there is limited information about the impact of allergy on the severity of nasal polyposis. The goal of this study was to evaluate the role of allergy in the severity of nasal polyposis. METHODS: Polyp sizes, computed tomography (CT) scores, skin-prick test results, blood total eosinophil count, serum levels of total immunoglobulin E, symptom scores, and recurrences were analyzed in 83 patients with nasal polyposis. The results were compared between allergic and nonallergic patients with nasal polyposis. RESULTS: No association was found between the presence of allergy per skin-prick testing and polyp size, CT opacification, symptom scores, or recurrences (p > 0.05). In allergic patients, only the serum total eosinophil count correlated strongly with the results of CT (p = 0.005) but not with other parameters (p > 0.05). CONCLUSIONS: The results of this study show that, although patients with nasal polyposis frequently have allergies, the presence of allergy does not correlate with polyp size, symptom scores or rate of recurrence.

Schwannoma of the external auditory canal: a case report.

BACKGROUND: Schwannomas are uncommon benign tumors of the external auditory canal. The clinical features, the differential diagnosis, and the surgical treatment of these lesions are discussed. CASE PRESENTATION: A 51-year-old patient presented with a mass obliterating the external auditory meatus. Excisional biopsy was performed. Diagnosis was reported to be schwannoma by histopathologic examination. CONCLUSION: Schwannoma, rarely seen in the external auditory canal, can be managed by a precise excision of the tumor via transmeatal approach.

Cochleovestibular dysfunction in ankylosing spondylitis.

Ankylosing spondylitis (AS) is a rheumatic disease characterized by chronic inflammation. The aim of this study was to evaluate the functions of the cochlea and the vestibular system in patients with AS. The study group consisted of 32 patients with AS and 30 healthy volunteers as a control group. Otorhinolaryngologic examinations were performed in all patients together with pure-tone audiometry, speech tests, impedancemetry, transient evoked otoacoustic emission (TEOAE) and electronystagmography (ENG). A significant difference was found between the 2 groups with regard to pure-tone averages at high frequencies in each ear (p < 0.05). The rates of reproducibility in TEOAE testing were significantly lower in patients with AS (p = 0.03). The signal-to-noise rates of the response values were lower at all frequencies in patients with AS, but a statistically significant difference was only observed at 2, 3 and 4 Hz (p < 0.05). ENG revealed pathologies in 11 patients with AS (34%), 8 of which were central (25%) and 3 of which were peripheral (9%). No correlation was found between cochleovestibular dysfunction and age, sex, disease duration, activity and medication taken. This study demonstrated that there is an association between AS and cochleovestibular dysfunction.

Vertigo in childhood: a clinical experience.

OBJECTIVE: Vertigo in childhood is a complaint consisting of a wide spectrum of diagnoses. The aim of this study was to evaluate pediatric patients with vertigo with normal eardrum and middle ear findings and discuss the differential diagnoses. METHODS: Patient records of 50 children under 18 years of age with vertigo as the chief complaint, examined at the Baskent University, Research and Application Centers at Konya and Adana otorhinolaryngology clinics between May 2003 and October 2005 were retrospectively reviewed. The questionnaires, laboratory tests including blood samples, audiological and vestibular tests, and final diagnoses were analyzed. Patients with perforated eardrums, otitis media with effusion, and acute upper respiratory tract infections were not included in the study. RESULTS: The study group consisted of 50 patients (33 females, 66%; 17 males, 34%), between 4 and 17 years of age (mean age, 11.5+/-3.9 years). Severe sensorineural hearing loss was present in one patient unilaterally (2%) and one patient bilaterally (2%). Bilateral low-frequency sensorineural hearing loss was present in one patient (2%). Electronystagmography revealed central vestibular abnormalities in three patients (6%). Canal paresis was established in six patients (12%). The Dix-Hallpike test was positive in six patients (12%). The most frequent cause of vertigo was migraine, occurring in 34% of patients (n=17). Other less-frequent etiologies of vertigo were benign paroxysmal vertigo (n=6; 12%), benign paroxysmal positional vertigo (n=6; 12%), psychogenic vertigo (n=5; 10%), epilepsy (n=3; 6%), metabolic disorders (n=3; 6%), vestibular neuritis (n=2; 4%), Meniere's disease (n=1; 2%), perilymphatic fistula (n=1; 2%), amblyopia (n=1; 2%), and unclassifiable (n=5; 10%). CONCLUSIONS: Migraine was found to be the most frequent presenting diagnosis in childhood vertigo, although several peripheral vestibular disorders also were diagnosed. Evaluation of vertigo in childhood should begin with a thorough neuro-otologic evaluation and include other relevant multidisciplinary team members as needed to avoid unnecessary effort and cost.