The Role of Substance P Receptor Antagonists in Allergic Rhinitis: Ovalbumin-Induced Rat Model.

OBJECTIVE: Substance P is a peptide from the tachykinin family, which is found in peripheral and central nervous systems, causing vasodilation and increased secretion in the nasal mucosa. In this study, we aimed to investigate whether the experimental model of allergic rhinitis will cause allergic changes in the larynx and to compare the effects of aprepitant, a substance P antagonist, on nasal symptoms in allergic rhinitis, and histopathological changes in the nasal and laryngeal mucosa with antihistamine and leukotriene receptor antagonists (LTRA). STUDY DESIGN: An experimental animal study. METHOD: The study was carried out on 34 healthy 8-12 weeks old female Sprague Dawley rats in 5 groups. The rats in which an experimental allergic rhinitis model was created with ovalbumin were scored by observing their nasal symptoms, and nasal and laryngeal mucous membranes included in the study were evaluated histopathologically after medications. RESULTS: As a result of the analysis of the data obtained from the study, antihistamine and LTRA significantly reduced the symptoms of nose scratching and sneezing, while aprepitant did not affect nasal symptoms. In the histopathological examination of the larynx, effects that would make a significant difference were found in the allergy group when compared to the control group. On the larynx, aprepitant reduced pseudostratification significantly compared to the allergy group. CONCLUSION: Aprepitant provides histopathological changes in the treatment of allergic rhinitis, but does not have sufficient effect on nasal symptoms. The effect of aprepitant on the larynx has not been clearly demonstrated. LEVEL OF EVIDENCE: NA Laryngoscope, 133:2891-2897, 2023.

The additive value of continuous positive airway pressure treatment on psychological symptoms.

OBJECTIVE: To screen psychological problems of patients with obstructive sleep apnea syndrome (OSAS) by utilizing the psychological symptom screening test Symptom Checklist-90-Revised (SCL-90-R) and to evaluate the effect of continuous positive airway pressure (CPAP) treatment. METHODS: The SCL-90-R and Epworth Sleepiness Scale (ESS) test were applied to 66 patients with Apnea-Hypopnea Index (AHI ≥ 30/h) using CPAP device and 20 healthy individuals; the test results were compared. RESULTS: The age of the patients ranged from 28 to 67 years, and the patient group comprised 54 males (81.8%) and 12 females (18.2%). The AHI scores ranged from 30.05 to 99.80, with a mean of 49.34 ± 21.40. Significant improvement was seen in 6 of the 11 SCL-90-R scores in CPAP-treated patients. CONCLUSION: The authors conclude that the SCL-90-R test may be appropriate for evaluating the response to CPAP treatment in OSAS patients and monitoring the psychosocial effects of treatment.

A severe headache due to pigmented villonodular synovitis in a rare location: facial nerve on temporomandibular joint. A case report.

BACKGROUND: Pigmented villonodular synovitis (PVNS) is an infrequent benign tumor-like proliferative lesion developing from the synovial membranes of the joint, tendon sheath, and bursa. CLINICAL PRESENTATION: A 44-year-old woman with numbness on the right side of her face, severe headaches, and swelling in temporomandibular region is presented. On head and neck magnetic resonance imaging, an encapsulated mass approximately 2 cm was detected. The fine-needle aspiration biopsy resulted as suspicion of mesenchymal tumor. A complete resection with the capsule was performed over the temporal branch by monitoring of the facial nerve. The final histopathologic examination resulted as a giant cell tendon sheath tumor. CONCLUSION: Headache is not the main symptom in PVNS, but in severe pain spreading from the temporomandibular region, physical examination should be done carefully for slight swelling, and the possibility of pigmented villonodular synovitis should be considered. Because of the high recurrence rate, en bloc resection is necessary.

Nasal Mucociliary Clearance and Sinonasal Symptoms in Healthcare Professionals Wearing FFP3 Respirators: A Prospective Cross-Sectional Study.

INTRODUCTION: The purpose of the present study was to assess nasal mucociliary clearance (NMC) and sinonasal symptoms of healthcare professionals wearing filtering facepiece-3 (FFP3) respirators. METHODS: This prospective cross-sectional study was conducted at a large tertiary care academic center. Thirty-four healthcare professionals working at a coronavirus disease-19 patient care unit were included in the study. Visual analog scale (VAS) scores of sinonasal symptoms (nasal discharge, postnasal discharge, nasal blockage, hyposmia, facial pain/pressure, facial fullness, headache, fatigue, halitosis, cough) and the NMC times of the participants were assessed immediately before wearing FFP3 respirators and after 4 h of work with FFP3 respirators. RESULTS: The mean age of the participants was 28.82 ± 4.95 (range, 26-31) years. Twenty participants were female and 14 were male. After wearing the FFP3 respirators for 4 h, a statistically significant increase was observed in total VAS scores for all sinonasal symptoms and NMC times (p < 0.001). When the VAS score of each sinonasal symptom was evaluated separately, a statistically significant increase was found for VAS scores of nasal discharge, postnasal discharge, nasal blockage, hyposmia, facial pain/pressure, and facial fullness (p < 0.05). CONCLUSION: The present study shows that nasal mucosal functions might be affected significantly after 4 h of using FFP3 respirators. The long-term effects and clinical significance of these short-term changes should be investigated on healthcare professionals in further studies.

Mean platelet volume and neutrophil to lymphocyte ratio in patients with tinnitus: a case-control study / Volume plaquetário médio e relação neutrófilos/linfócitos em pacientes com zumbido: estudo de caso-controle

Abstract Introduction: Different theories have been proposed on the etiology of tinnitus, including metabolic and audiologic causes. We suggest that mean platelet volume and neutrophil to lymphocyte ratio levels change in tinnitus, indicating microcirculatory disturbance and inflammatory process in the etiopathogenesis of tinnitus. Objectives: We aimed to evaluate the mean platelet volume and neutrophil to lymphocyte ratio in patients with tinnitus in comparison to healthy controls. Methods: Retrospective case-control study. Two-hundred and eighty-seven patients aged 18-59 years and diagnosed with tinnitus in the Ear, Nose, and Throat Clinic between December 2014 and May 2017 (patient group) and 275 healthy individuals who applied for a hearing screening within the same time period (control group). Demographics, concomitant diseases, laboratory results, and audiometric data were recorded. Mean platelet volume and neutrophil to lymphocyte ratio were the outcome measures. Patients with hearing loss due to presbycusis or another reasons, and patients with anatomical disorders in the external and middle ear were excluded from the study by using physical examinations, pure audio audiometry results and radiological imaging. The upper age limit was set at 59 to exclude presbycusis patients. Results: The ratio of female patients was higher in patient group than control group (58.5%, n = 168 vs. 49.4%, n= 127; respectively; p = 0.033). The mean age of patient group was significantly higher than those of control group (44.89 ± 10.96 years and 38.37 ± 10.65 years, respectively; p = 0.001). The percentage of subjects with high mean platelet volume level was significantly higher in patient group than control group (9.4%, n = 27, and 3.1%, n = 8 respectively; p = 0.008). The mean neutrophil to lymphocyte ratio was higher in patients with tinnitus than control group (1.95 ± 1.02 and 1.67 ±0.57, p = 0.012). A neutrophil to lymphocyte ratio level of 2.17 and above is associated with 1.991 times higher risk of tinnitus (odds ratio = 1.99, 95% confidence interval 1.31-3.02). Conclusion: High mean platelet volume and neutrophil to lymphocyte ratio values are associated with idiopathic tinnitus, suggesting the role of vascular pathologies in etiology of tinnitus. Tinnitus may be a sign of underlying systemic or local disorders. Therefore, patients with tinnitus should undergo detailed evaluation including hematological indices.

Resumo Introdução: Diferentes teorias já foram propostas sobre a etiologia do zumbido, inclusive causas metabólicas e audiológicas. Acreditamos que os níveis do volume plaquetário médio e da relação neutrófilos/linfócitos se alteram no zumbido, sugerem distúrbio microcirculatório e processo inflamatório na etiopatogenia do zumbido. Objetivo: Avaliar o volume plaquetário médio e a relação neutrófilos/linfócitos em pacientes com zumbido em comparação com controles saudáveis. Método: Estudo de caso-controle retrospectivo, com 287 pacientes entre 18 e 59 anos e diagnosticados com zumbido na Clínica de Otorrinolaringologia entre dezembro de 2014 e maio de 2017 (grupo pacientes) e 275 indivíduos saudáveis que solicitaram uma triagem auditiva no mesmo período (grupo controle). Foram registrados dados demográficos, doenças concomitantes, resultados laboratoriais e dados audiométricos. O volume plaquetário médio e a relação neutrófilos/linfócitos foram as medidas de desfecho. Pacientes com perda auditiva por presbiacusia ou por outros motivos e pacientes com distúrbios anatômicos na orelha externa e média foram excluídos do estudo por meio de exame físico, resultados de audiometria tonal pura e imagens radiológicas. O limite de idade superior foi fixado em 59 anos para excluir pacientes com presbiacusia. Resultados: A proporção de pacientes do sexo feminino foi maior no grupo de pacientes do que no grupo controle (58,5%, n = 168 vs. 49,4%, n = 127; respectivamente; p = 0,033). A média de idade do grupo de pacientes era significantemente maior do que a do grupo controle (44,89 ± 10,96 anos e 38,37 ± 10,65 anos, respectivamente; p = 0,001). A porcentagem de indivíduos com nível alto de volume plaquetário médio foi significantemente maior no grupo de pacientes do que no grupo controle (9,4%, n = 27 e 3,1%, n = 8, respectivamente; p = 0,008). A relação neutrófilos/linfócitos média foi maior nos pacientes com zumbido do que no grupo controle (1,95 ± 1,02 e 1,67 ±0,57, p = 0,012). Um nível de relação neutrófilos/linfócitos de 2,17 e acima está associado a um risco 1,991 vez maior de zumbido (odds ratio = 1,99, Intervalo de Confiança de 95% 1,31 a 3,02). Conclusão: Altos valores de volume plaquetário médio e relação neutrófilos/linfócitos estão associados ao zumbido idiopático, sugerem o papel de doenças vasculares na etiologia do zumbido. O zumbido pode ser um sinal de distúrbios sistêmicos ou locais subjacentes. Portanto, pacientes com zumbido devem ser submetidos a uma avaliação detalhada, inclusive índices hematológicos.

The Role of Fusion Technique of Computed Tomography and Non-echo-planar Diffusion-weighted Imaging in the Evaluation of Surgical Cholesteatoma Localization.

Objective: In recent years, the fusion of computed tomography (CT) and non-echo-planar diffusion-weighted magnetic resonance imaging (non-EPI DWI) has been preferred in cholesteatoma localizations. This study aimed to investigate the role of CT and non-EPI DWI fusion imaging in cholesteatoma localizations. Methods: This retrospective study included 39 patients who underwent chronic otitis media operation [mean age of 35.10±15.33 years (18-67 years), 64.1% female, and 35.9% male] and had preoperative high-resolution temporal bone CT and non-EPI DWI examinations. Images were sent to the Advantage Workstation VolumeShare 7 for fusion. These selected images were fused on the workstation and were manually corrected by the radiologist. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracies of fused images of CT and non-EPI DWI were evaluated according to anatomic cholesteatoma localizations based on surgical data. Results: The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracies of non-EPI DWI for detecting cholesteatomas were 97.14%, 75.00%, 97.14%, 75.00%, and 94.87%, respectively. Three true-negative, one false-positive, and one false-negative case were observed according to surgical results in detecting the presence of a cholesteatoma with non-EPI DWI. Moderate agreement was determined between the surgical and radiological results in detecting the presence of a cholesteatoma (k=0.721). Detecting the lesion of localization on the fused images compared to surgical found an almost perfect agreement in the mastoid antrum (k=0.948), strong agreement in the hypotympanum and mastoid cells (k=0.894), moderate agreement in the epitympanum (k=0.653), and weak agreement in those in the mesotympanum (k=0.540). Conclusions: The surgeons' determinations are supported by the guidance of temporal CT and non-EPI DWI fused images. Therefore, preferring the fusion imaging technique could increase the quality of life by reducing unnecessary operations.

Mean platelet volume and neutrophil to lymphocyte ratio in patients with tinnitus: a case-control study.

INTRODUCTION: Different theories have been proposed on the etiology of tinnitus, including metabolic and audiologic causes. We suggest that mean platelet volume and neutrophil to lymphocyte ratio levels change in tinnitus, indicating microcirculatory disturbance and inflammatory process in the etiopathogenesis of tinnitus. OBJECTIVES: We aimed to evaluate the mean platelet volume and neutrophil to lymphocyte ratio in patients with tinnitus in comparison to healthy controls. METHODS: Retrospective case-control study. Two-hundred and eighty-seven patients aged 18-59 years and diagnosed with tinnitus in the Ear, Nose, and Throat Clinic between December 2014 and May 2017 (patient group) and 275 healthy individuals who applied for a hearing screening within the same time period (control group). Demographics, concomitant diseases, laboratory results, and audiometric data were recorded. Mean platelet volume and neutrophil to lymphocyte ratio were the outcome measures. Patients with hearing loss due to presbycusis or another reasons, and patients with anatomical disorders in the external and middle ear were excluded from the study by using physical examinations, pure audio audiometry results and radiological imaging. The upper age limit was set at 59 to exclude presbycusis patients. RESULTS: The ratio of female patients was higher in patient group than control group (58.5%, n=168 vs. 49.4%, n=127; respectively; p=0.033). The mean age of patient group was significantly higher than those of control group (44.89±10.96 years and 38.37±10.65 years, respectively; p=0.001). The percentage of subjects with high mean platelet volume level was significantly higher in patient group than control group (9.4%, n=27, and 3.1%, n=8 respectively; p=0.008). The mean neutrophil to lymphocyte ratio was higher in patients with tinnitus than control group (1.95±1.02 and 1.67±0.57, p=0.012). A neutrophil to lymphocyte ratio level of 2.17 and above is associated with 1.991 times higher risk of tinnitus (odds ratio=1.99, 95% confidence interval 1.31-3.02). CONCLUSION: High mean platelet volume and neutrophil to lymphocyte ratio values are associated with idiopathic tinnitus, suggesting the role of vascular pathologies in etiology of tinnitus. Tinnitus may be a sign of underlying systemic or local disorders. Therefore, patients with tinnitus should undergo detailed evaluation including hematological indices.

Fine-Needle Aspiration Cytology of Salivary Gland Tumors Before the Milan System: Ten Years of Experience at a Tertiary Care Center in Turkey.

Objective: The role of fine-needle aspiration cytology (FNAC) is well established for preoperative evaluation of patients with salivary gland lesions. However, the lack of a uniform system for salivary gland FNAC has limited its effectiveness. In recent years, the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has been in use around the world to report the cytology results. We aimed to investigate the efficacy and accuracy of FNAC examined according to pre-MSRSGC era dichotomous benign/malignant classification in salivary gland tumors. Methods: Patients who underwent surgery between January 2011 and December 2020 due to major salivary gland tumors were retrospectively analyzed. Two hundred and four patients were included in the analysis. Preoperative FNAC results and final histopatological diagnoses were grouped as benign or malignant. Final histopatological diagnoses were compared with the preoperative FNAC results. Also, sensitivity, specificity, and accuracy of the preoperative FNAC results, as well as the agreement between both tests were investigated. Results: The sensitivity, specificity, accuracy, positive and negative predictive values of the preoperative FNAC for the diagnosis of malignancy were 59.09%, 97.85%, 93.75%, 76.47%, and 95.29%, respectively. There was a moderate agreement between the preoperative FNAC results and final histopatological diagnoses. Conclusion: The accuracy of the preoperative FNAC and the information given about malignancy risk are the most important criteria for patient management and decision-making. The MSRSGC, which consists of a six-tiered classification rather than a dichotomous "yes/no" system, may contribute to patient management and decision-making by increasing the efficacy and accuracy of FNAC.

The Quality, Reliability, and Popularity of YouTube Education Videos for Vestibular Rehabilitation: A Cross-sectional Study.

HYPOTHESIS: Vestibular rehabilitation (VR) education videos on YouTube are poor-quality and unreliable. BACKGROUND: YouTube has become a health information source. Recent studies have determined that videos on YouTube contain misleading and inappropriate information for different medical conditions. The aim of the present study was to assess the quality and reliability of VR education videos. METHODS: A search was performed using the keywords vertigo, vertigo treatment, vertigo exercise, and vestibular rehabilitation, on YouTube. The first 50 videos for each keyword were analyzed. Videos were divided into four groups according to the video source: Group 1: universities/occupational organizations, Group 2: medical ad/profit-oriented companies, Group 3: independent users, and Group 4: others (news/media/state institution). The quality and reliability of videos were evaluated regarding the modified DISCERN criteria, the modified Journal of the American Medical Association (JAMA) benchmark criteria, and global quality scores (GQS). RESULTS: Among the 200 videos analyzed, 103 were included. The main video source was medical ad/profit-oriented companies (60.2%). The mean modified DISCERN criteria score, the mean modified JAMA benchmark criteria score, and the mean GQS value of the videos were found as low (2.46 ±â€Š1.37, 2.09 ±â€Š1.23, and 2.67 ±â€Š1.38, respectively). Videos uploaded by universities/occupational organizations (25.2%) had statistically significant higher modified DISCERN criteria scores, modified JAMA benchmark criteria scores, and GQS values compared with the other groups (p < 0.001). CONCLUSION: Online information about VR education on YouTube was of poor quality and unreliable. Expert vestibular providers should be aware of these inappropriate sources and educate patients regarding the poor-quality of videos and also aim to provide more quality and reliable sources of information.

Paget Schroetter Syndrome and Chylothorax After Rhinoplasty.

ABSTRACT: Paget-Schroetter syndrome is a rare clinical condition characterized by subclavian vein thrombosis following repetitive upper extremity effort. In this case, we presented a 35-year-old female patient who underwent septorhinoplasty in our clinic. A swelling of the left part of the neck extending to the clavicle was detected 4 hours after the operation. Computed tomography of the thorax revealed a pleural effusion at the base of the left lung and a computed tomography angiogram demonstrated a recanalized left subclavian vein thrombosis. History of the patient clarified that she had moved to another house and had lifted heavy furnitures 4 days before the surgery. The patient was diagnosed with Paget Schroetter syndrome followed by chylothorax. Paget-Schroetter syndrome followed by chylothorax could be presented after a surgical intervention of the head and neck. Early diagnosis is essential to reduce the risk of ongoing morbidity and mortality.

Is ossicular chain fixation predictable for tympanosclerosis on preoperative temporal bone computed tomography?

PURPOSE: To report the predictability of ossicular chain (OC) fixation on preoperative temporal bone computed tomography (TBCT) in chronic otitis media (COM) with tympanosclerosis (TS). METHODS: Fifty-six patients who had surgery for COM in our ear, nose and throat clinic between 2015 and 2017 were included in this retrospective case-control study. The patients were equally divided into two groups as those with TS and without TS. The complaint of preoperative otorrhea, values of incudostapedial joint (ISJ) angulation on preoperative TBCT scans, postoperative long-term hearing results, and postoperative complications were compared between the two groups. RESULTS: There was a statistically significant difference between the ISJ angulations of the operated and healthy sides in the COM group with TS (102.27 ± 7.92 and 91.90 ± 5.59 degrees, respectively, p < 0.001). However, no statistically significant difference was observed between the ISJ angulation of the operated and healthy sides in the COM group without TS (95.04 ± 4.86 and 94.35 ± 4.57 degrees, respectively, p > 0.05). In addition, when the ISJ angulations of the operated sides of the two groups were compared, it was statistically significantly higher for the TS group compared to the non-TS group (102.27 ± 7.92 and 95.04 ± 4.86 degrees, respectively, p < 0.001). CONCLUSION: Increased ISJ angulation may indicate OC fixation. COM cases with TS can be predicted by the measurement of ISJ angulation on preoperative TBCT.

Vascular Occlusion Role in the Etiopathohegenesis of Idiopathic Sudden Sensorineural Hearing Loss: Risk Analysis with Hematological Parameters.

OBJECTIVE: To evaluate the concomittant metabolic disorders, mean platelet volume (MPV), and neutrophil to lymphocyte ratio (NLR) in patients with idiopathic sudden sensorineural hearingloss (SSNHL) in comparison to healthy controls. STUDY DESIGN: Case-control study. PLACE AND DURATION OF STUDY: Department of Otorhinolaryngology, Head and Neck Surgery, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Turkey, from December 2016 to May 2019. METHODOLOGY: Fifty-five patients aged 18-59 years and diagnosed with idiopathic SSNHL and 145 healthy individuals who applied for a hearing screening within the same time period (control group). Demographics, concomitant diseases, laboratory results, and outcome of pure tone audiometers were recorded. MPV and NLR were the outcome measures. RESULTS: The percentage of individuals with high MPV level was 10.9% in the idiopathic SSNHL group, it was identified as 2.8% in the control group (p = 0.040). The average NLR was higher in patients with idiopathic SSNHL than control group (1.7 (1.42-2.20) and 1.5 (1.29-1.88), p = 0.004). A NLR level of 2.01 and above is associated with 2.881 times higher risk of idiopathic SSNHL (odds ratio 2.881, 95% confidence interval 1.427-5.817). CONCLUSION: High MPV and NLR values are associated with idiopathic SSNHL, suggesting the role of vascular pathologies in etiology of idiopathic SSNHL. Therefore, patients with idiopathic SSNHL should undergo detailed evaluation including hematological indices. Key Words: Idiopathic sudden sensorineural hearing loss, Mean platelet volume, Neutrophil to lymphocytes ratio.

The Effects of Empiric Antireflux Treatment on Laryngopharyngeal and Gastroesophageal Reflux Disease.

OBJECTIVES: This study aims to investigate the effects of empiric lansoprazol therapy on laryngopharyngeal (LPR) and gastroesophageal (GOR) reflux symptoms and laryngological findings. METHODS: Sixty-seven patients with suspected LPR related symptoms were prospectively analyzed in this study. Following eleven symptoms were asked to patients using LPR symptom questionnaire; sore throat, throat burning, throat clearing, globus sensation, cough, halitosis, dysphonia, dysphagia, postnasal dripping, vocal fatigue and sputum. GOR symptoms were evaluated with the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) questionnaire consist of twelve symptoms. Posterior larynx, arytenoids and interarytenoid area were evaluated with a 70° endoscope. Erythema, edema and nodularity were graded separately using 4 point severity scale to examine laryngeal signs. All patients were treated using 30 mg lansoprazole once daily for four weeks. After the end of medication, symptoms and laryngoscopic signs were evaluated again with the same method. The pretreatment and posttreatment values were compared with statistical analyses. RESULTS: There was a statistically significant decrease in LPR symptom scores and total scores of FSSG. The severity of nodularity in the posterior larynx, arytenoids and interarytenoid area was improved after treatment. There was no statistically significant difference in erythema on each area larynx. Edema in the posterior larynx and interarytenoid area was improved but there was no change on the edema of arytenoids. CONCLUSION: A short period of empiric antireflux treatment has a significant improving effect on all LPR symptoms and most of GOR symptoms. However, it was insufficient on laryngeal signs. Further research is needed to investigate longer times of treatment for the complete resolution of symptoms and signs.

Measurement of the depth of facial nerve at the level of stylomastoid foramen using MR imaging in Bell's palsy.

OBJECTIVES: To investigate whether the depth of the facial nerve from the skin surface as it exits the stylomastoid foramen differs between the paralyzed and unaffected sides in patients with Bell's palsy. METHODS: Forty-three patients (23 females, 20 males; mean age 43.8 ±â€¯15.2 years) diagnosed with Bell's palsy between January 2014 and June 2017 were retrospectively reviewed and those who had a cranial MR imaging performed within 10 days upon admission to hospital were included in the study. The axial postcontrast CUBE sequence was utilized for the measurement of the facial nerve depth. Age, gender, and body mass index (BMI) as well as concomitant chronic diseases, were also noted. The severity of facial paralysis was graded using the House-Brackmann (HB) scoring system. RESULTS: The facial nerve depth was significantly lower on the paralytic side compared to the unaffected side (32.9 ±â€¯5.4 mm vs. 36.9 ±â€¯5.1 mm, respectively; p = 0.007). The facial nerve depth on the paralytic side was not statistically different in the female patients compared to male patients (31.2 ±â€¯4.6 mm vs. 34.7 ±â€¯5.7 mm, respectively; p = 0.270). The facial nerve depth on the paralytic side was not correlated with patients' age (r = 0.288; p = 0.999), BMI (r = 0.215, p = 0.999), and HB scores (r = 0.031; p = 0.999). CONCLUSION: In our study cohort of patients with Bell's palsy, the facial nerve in the paralytic side is located more superficially as it exits the stylomastoid foramen when compared to the contralateral side. Therefore, the depth of the facial nerve may potentially play a key role in the etiology of Bell's palsy, which should be further evaluated.

Simultaneous Coexistence of Complications of Chronic Otitis Media in the Same Case.

Chronic otitis media (COM) is a common clinical entity, but the incidence of COM complications has declined recently due to broad use of antibiotics. Independent of this, these complications are still a significant challenge in otorhinolaryngology practice because of high morbidity and mortality rates. The most common etiologic diagnosis was cholesteatomatous COM. Simultaneous coexistence of complications of COM in the same case is a rare situation, and the present report describes a case with mastoiditis, Bezold abscess, lateral sinus thrombophlebitis, meningitis, and paraspinal abscess.

The Effect of Nasal Functions on the Integrity of Grafts after Myringoplasty.

OBJECTIVE: We aimed to evaluate the effects of nasal functions for the integrity of grafts after myringoplasty. METHODS: In our study 78 patients who underwent myringoplasty operation between 2011-2013 were included. Group I was defined as the group with an intact tympanic membrane following surgery. Group II was defined as the group with a tympanic membrane perforation following surgery. Group I consisted of 44 and Group II consisted of 34 patients. Subjective and objective measurements of nasal functions, Eustachian tube function (ETF), and allergic status were performed using nasal obstruction symptom evaluation (NOSE) scale, visual analog scale (VAS), and the score for allergic rhinitis (SFAR) questionnaires and acoustic rhinometry and saccharin test. It was investigated whether there was any difference between these two groups in terms of these parameters. RESULTS: There was statistically no significant difference between groups according to the age, sex and the presence of tubal dysfunction and allergic rhinitis (p>0.05). In the group of intact tympanic membranes, the likelihood of right ear being the operated one was significantly higher compared to the group of myringoplasty failures (p=0.037). The VAS and NOSE scales did not show any significant difference between groups in terms of successful outcome of myringoplasty (p>0.05). The nasal congestion index (NCI) and the mucociliary clearance (MCC) did not show any significant difference between groups in terms of successful outcome of myringoplasty (p>0.05). CONCLUSION: This study has shown that nasal functions measured by objective and subjective methods had no effects on the success of myringoplasty.

Effect of laryngopharyngeal reflux on the improvement of chronic rhinosinusitis without polyposis after primary endoscopic sinus surgery.

OBJECTIVES: This study aims to investigate the influence of laryngopharyngeal reflux on the improvement of chronic rhinosinusitis (CRS) in patients who underwent endoscopic sinus surgery (ESS). PATIENTS AND METHODS: A total of 48 patients (28 males, 20 females; mean age 41.6±15.1 years; range 18 to 75 years) with CRS without polyposis were assessed for the presence of gastric reflux with Reflux Symptom Index (RSI) and Reflux Finding Scores (RFS) before undergoing primary ESS. Patients with a RSI >12 and RFS >7 were included in the reflux(+) and those with either score under these cutoffs in the reflux(-) group. Improvement scores were accepted as the difference between preoperative scores and postoperative sixth-month Lund-Mackay Radiology Scores, Lund-Kennedy Endoscopy Scores (LKES), and Sinusitis Symptom Scores (SSS). RESULTS: There was no significant difference between improvements of the reflux(+) and reflux(-) groups in terms of radiology, endoscopy, and symptom scores (p>0.05). However, preoperative and postoperative six-month radiology scores were significantly higher in reflux(+) patients (p<0.01). Also, postoperative six-month LKES were significantly higher in reflux(+) patients. No statistically significant differences were detected between preoperative and postoperative six-month SSS in reflux(+) or reflux(-) patients. CONCLUSION: Laryngopharyngeal reflux was associated with worse radiology and endoscopy scores in CRS without polyposis; however, it had no role on the improvement scores after primary ESS.

Efficacy of multimodality approach to sudden hearing loss.

OBJECTIVES: This study aims to investigate whether addition of intratympanic steroid (ITS) to systemic steroid and hyperbaric oxygen (HBO) is effective in the treatment of sudden hearing loss (SHL). PATIENTS AND METHODS: Between January 2008 and October 2011, 58 patients diagnosed with SHL were enrolled in the study. Twenty patients (11 males, 9 females; mean age 45.3±21 years; range 24 to 66 years) who received systemic steroid and HBO composed group 1, while 38 patients (19 males, 19 females; mean age 41.6±16 years; range 25 to 61 years) who received ITS in addition to systemic steroid and HBO composed group 2. RESULTS: Post-treatment hearing improvement was statistically significant in both groups in terms of the mean pure tone according to the Siegel's criteria (p<0.05). Treatment was successful at 55% of patients in group 1 and 63% in group 2. Despite increased success rate with the addition of ITS, it did not indicate statistical significance (p>0.05). However, there was a strong statistically significant difference in terms of profound hearing loss over 90 dB (p<0.05). None of six patients (0%) with profound hearing loss in group 1 benefited treatment, while addition of ITS to the treatment yielded success in six of 12 patients with profound hearing loss (50%) in group 2 (p<0.05). CONCLUSION: Addition of ITS to systemic steroid and HBO treatment may yield better results in patients with SHL. However, ITS injection seems beneficial for patients with profound SHL.

Is septoplasty effective on habitual snoring in patients with nasal obstruction?

We aimed to find out whether snoring relieve with nasal surgery in patients with nasal obstruction. Sixty-four patients who underwent septoplasty under general anesthesia with complaint of nasal obstruction and snoring at Haydarpasa Numune Education and Research Hospital were enrolled in the study. All patients were evaluated by otolaryngological examination. Septal deviation was graded as mild, moderate and severe with endoscopy. Variables examined included age, sex, body mass index. All patients also completed the questionnaires, including Nose Obstruction Symptom Evaluation scale (NOSE), Epworth Sleepiness Scale (ESS), and Snore Symptom Inventory (SSI) before and after septoplasty. NOSE scale, ESS, and SSI scores showed statistically significant improvement after nasal surgery (p < 0.01) but we could not find any statistically significant association between septal deviation grading and improvement in scores of NOSE scale, ESS, and SSI (p > 0.05). Added to this, the association between body mass index (BMI) and improvement in scores of NOSE scale, ESS, and SSI did not reach statistical significance (p > 0.05). Our results demonstrated that septoplasty is effective on the subjective parameters of nasal obstruction in habitual snorers irrespective of the nasal septal deviation and severity of BMI.

Is hearing loss in infants associated with risk factors? Evaluation of the frequency of risk factors.

OBJECTIVES: To evaluate the frequency of risk factors and their influence on the evoked otoacoustic emission (OAE) of infants. METHODS: All newborns between November 2009 and June 2012 in Haydarpasa Numune Education and Research Hospital were tested on distortion evoked OAE screening test. Total of 2,284 infants were examined. Sex, maternal infectious disease, birth type (vaginal birth or caesarean sectio), birth weight, familial hearing loss, intermarriage of parents, hyperbilirubinemia, intensive care were analyzed as risk factors. RESULTS: Total of 2,284 neonates were screened (1,220 males and 1,064 females) for the presence of OAE in both ears. Vaginal delivery, maternal infections during pregnancy, intermarriage of parents relative, low birth weight(<1,500 g) are related risk factors to failure of screening with OAE in our study. There was no statistically significant difference in sex ratios, birth weight, familial hearing loss, hyperbilirubinemia, and intensive care stay. CONCLUSION: Risk factors are only as useful as their predictive power. Not enough is known about which risk factors are relevant, which babies have the risk factors, or which babies will fail to attend follow-up, the effectiveness of targeted hearing loss testing is questionable at this point in time. A system needs to be developed to clarify which risk factors are discoverable, predictive and useful.