Evaluation of choroidal thickness measurements in patients with marked nasal septal deviation / Avaliação das medidas da espessura da coroide em pacientes com acentuado desviode septo nasal

Abstract Introduction: Chronic upper airway obstruction due to marked nasal septal deviation may cause chronic hypoxia. It may change the balance of the sympathetic-parasympathetic system and may affect blood flow in the choroid. Objective: To assess choroidal thickness measurements of patients with marked nasal septal deviation. Methods: The patients who had nasal obstruction symptoms diagnosed with marked nasal septal deviation by anterior rhinoscopy and nasal endoscopy and scheduled for septoplasty were included in the study. The control group consisted of age, sex and body mass index-matched healthy individuals. The choroidal measurements at the central fovea and 1000 µm away from the fovea in the nasal and temporal regions were performed using enhanced depth imaging optical coherence tomography. Results: In the study group, 52 eyes of 26 patients with a mean age of 26.34 ± 8.14 years were examined. In the control group, 52 eyes of 28 healthy individuals with a mean age of 26.69 ± 7.84 years were examined. There was no statistically significant difference in terms of choroidal thickness measurements between the groups (p > 0.05). Conclusion: Our results suggest that marked nasal septal deviation may not lead to significant hypoxia and sympathetic activation, resulting in deterioration of the choroidal blood flow and consequent choroidal thickening.

Resumo Introdução: A obstrução crônica das vias aéreas superiores devido a acentuado desvio do septo nasal pode causar hipóxia crônica. Pode alterar o equilíbrio do sistema simpático-parassimpático e afetar o fluxo sanguíneo na coroide. Objetivo: Avaliar as medidas da espessura da coroide em pacientes com acentuado desvio de septo nasal. Método: Foram incluídos no estudo pacientes que apresentavam sintomas de obstrução nasal, com diagnóstico de acentuado desvio de septo realizado por rinoscopia anterior e endoscopia nasal, e com septoplastia programada. O grupo controle consistiu de indivíduos saudáveis pareados por idade, sexo e índice de massa corporal. As medidas da coroide na fóvea central e a 1.000 µm da fóvea nas regiões nasal e temporal foram feitas com tomografia de coerência óptica com imagem de profundidade melhorada. Resultados: No grupo de pacientes, 52 olhos de 26 pacientes com média de 26,34 ± 8,14 anos foram examinados. No grupo controle, 52 olhos de 28 indivíduos saudáveis com média de 26,69 ± 7,84 anos foram examinados. Não houve diferença estatisticamente significante em termos de medidas da espessura da coroide entre os grupos (p > 0,05). Conclusão: Nossos resultados sugerem que desvios do septo nasal acentuados podem não levar à hipóxia significativa e ativação simpática, resultar na deterioração do fluxo sanguíneo coroidal e consequente espessamento da coroide.

Evaluation of choroidal thickness measurements in patients with marked nasal septal deviation.

INTRODUCTION: Chronic upper airway obstruction due to marked nasal septal deviation may cause chronic hypoxia. It may change the balance of the sympathetic-parasympathetic system and may affect blood flow in the choroid. OBJECTIVE: To assess choroidal thickness measurements of patients with marked nasal septal deviation. METHODS: The patients who had nasal obstruction symptoms diagnosed with marked nasal septal deviation by anterior rhinoscopy and nasal endoscopy and scheduled for septoplasty were included in the study. The control group consisted of age, sex and body mass index-matched healthy individuals. The choroidal measurements at the central fovea and 1000µm away from the fovea in the nasal and temporal regions were performed using enhanced depth imaging optical coherence tomography. RESULTS: In the study group, 52 eyes of 26 patients with a mean age of 26.34±8.14 years were examined. In the control group, 52 eyes of 28 healthy individuals with a mean age of 26.69±7.84 years were examined. There was no statistically significant difference in terms of choroidal thickness measurements between the groups (p>0.05). CONCLUSION: Our results suggest that marked nasal septal deviation may not lead to significant hypoxia and sympathetic activation, resulting in deterioration of the choroidal blood flow and consequent choroidal thickening.

The Effects of Riluzole on Cisplatin-induced Ototoxicity.

Introduction Riluzole (2-amino-6-trifluoromethoxy benzothiazole) is known as a neuroprotective, antioxidant, antiapoptotic agent. It may have beneficial effects on neuronal cell death due to cisplatin-induced ototoxicity. Objective To evaluate the effect of riluzole on cisplatin-induced ototoxicity in guinea pigs. Methods Twenty-four guinea pigs, studied in three groups, underwent auditory brainstem response evaluation using click and 8 kHz tone burst stimuli. Subsequently, 5 mg/kg of cisplatin were administered to all animals for 3 days intraperitoneally (i.p.) to induce ototoxicity. Half an hour prior to cisplatin, groups 1, 2 and 3 received 2 ml of saline i.p., 6 mg/kg of riluzole hydrochloride i.p., and 8 mg/kg of riluzole hydrochloride i.p., respectively, for 3 days. The auditory brainstem responses were repeated 24 hours after the last drug administration. The cochleae were analyzed by transmission electron microscopy (TEM). Results After drug administiration, for 8,000 Hz stimulus, group 1 had significantly higher threshold shifts when compared with groups 2 ( p < 0.05) and 3 ( p < 0.05), and there was no significant difference in threshold shifts between groups 2 and 3 ( p > 0.05). Transmission electron microscopy findings demonstrated the protective effect of riluzole on the hair cells and the stria vascularis, especially in the group treated with 8 mg/kg of riluzole hydrochloride. Conclusion We can say that riluzole may have a protective effect on cisplatin- induced ototoxicity. However, additional studies are needed to confirm these results and the mechanisms of action of riluzole.

Why do infants pull their ears?

OBJECTIVE: In this study, we aimed to evaluate the diagnoses of the infants who were admitted to our outpatient clinic with the complaint of pulling on the ear and to identify the related factors which may contribute to the diagnosis. METHODS: This prospective study included a total of 102 infants who were admitted to our hospital with the complaint of tugging and pulling on, touching, and rubbing the ears on the shoulder or pillow and shaking the head between July 2016 and July 2017. The complaints were evaluated throughout the day, and the application seasons, the person referred the patient to the ear, nose, and throat (ENT) specialist, the child development specialist and child psychiatrist, allergy and atopy histories, and the relationship between the results and diagnoses were evaluated. RESULTS: 46.1% of the patients had normal examination findings, while the second most common finding was cerumen in 37.2%, and the third one was otitis media with effusion (OME) in 16.7%. In infants who were directly referred by the family, normal and serological diagnosis were found to be statistically significantly higher than that of OME diagnosis, whereas in the infants referred by the family physicians and pediatrist, the OME was found to be statistically significantly higher than normal and cerumen levels. The presence of additional complaints in the OME group was found to be higher than normal and cerumen group. In those with complaints during the day, the most common finding was OME, while it was cerumen in those with complaints a few times in a day and normal examination finding in those tugging on their ears only, when they were falling asleep, indicating statistical significance. Of 47 infants with normal physical examination findings, 37 were assessed by the child psychiatrist, and depression was found in six of one of the parents during the family interviews. CONCLUSION: In this study, the majority of the infants referred to the ENT outpatient clinic had normal examination findings, while the rate of OME diagnosis was high. Considering the negative consequences of EOM in infants, the diagnosis of the EOM becomes extremely important. If there are no otologic pathologies in the majority of infants who were admitted with ear pulling and tugging, the possibility of different factors in etiology gives rise to thought. Therefore, further studies are required to prove this condition.

Pediatric Nasal Traumas: Contribution of Epidemiological Features to Detect the Distinction Between Nasal Fractures and Nasal Soft Tissue Injuries.

OBJECTIVES: Nasal bone is prone to injury due of its prominent position on the face. Epidemiologic surveys are necessary to investigate nasal traumas. The aim of the present study is to examine the distribution of trauma etiologies according to age, sex, and seasonality in pediatric patients who present with nasal trauma, and to classify the pathologies according to their etiology as nasal fractures or nasal soft tissue injuries. METHODS: A total of 200 pediatric patients aged between 0 and 18 years who were admitted to the emergency room with sustained nasal trauma between September 1, 2015 and August 1, 2016 and who were diagnosed with an either nasal fracture or nasal soft tissue injury were retrospectively analyzed. The relationship between the nasal bone fractures and nasal soft tissue injuries and age, sex, admission date, and trauma etiology were investigated. RESULTS: Of 200 patients, 70.5% were males and 29.5% were females with a mean age of 8.93 ±â€Š5.50 years. Of these patients, 33.0% were in the 0 to 5 years age group, 24.0% were in the 6 to 10 years age group, 18.5% were in the 11 to 14 years age group, and 24.5% were in the 15 to 18 years age group. Of these, 82.5% had a nasal soft tissue injury and 17.5% had a nasal fracture. The etiology of trauma was most commonly fall from a height in 42.5% of the patients. Impact injuries and falls were the most common etiologies in the 0 to 5 age group, falls were the most common etiologies in the 6 to 10 age group, sports injuries were the most common etiologies in the 11 to 14 age group, and physical assault was the most common etiology in the 15 to 18 age group (P = 0.001; P < 0.01). According to the paired comparisons, the rate of nasal fracture in the 0 to 5 age group was significantly higher than the rates in the 11 to 14 (P = 0.001) and 15 to 18 (P = 0.001) age groups (P < 0.05). The rate of nasal soft tissue injuries was significantly higher in the patients presenting to the emergency room with sustained impact injury to the nose or falls. The majority of the patients presenting with physical assault and sports injuries were males. Nasal soft tissue injuries were mostly seen in girls, whereas the rate of nasal fractures was higher in boys, which was directly proportional to the trauma etiology and severity of injury. The patients often presented in the summer season. CONCLUSION: Our study results suggest that age, sex, time of trauma, and type of trauma guide the diagnosis of specific pathologies in pediatric patients presenting with sustained trauma. These characteristics must be specifically questioned and taken into consideration in the follow-up and treatment.

Evaluation of choroidal thickness in children with adenoid hypertrophy.

OBJECTIVE: To assess choroidal thickness in children with adenoid hypertrophy versus normal controls using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: Twenty-six children (left and right eyes, total 52 eyes), which were scheduled to adenoidectomy with severe adenoid hypertrophy and 26 age, sex and body mass index-matched healthy subjects (left and right eyes, total 52 eyes) were included in the study. Choroidal thicknesses (CT) were evaluated using enhanced depth imaging optical coherence tomography. The CT measurement was taken at the fovea and 1000 µ away from the fovea in the nasal and temporal regions. The macular retinal thickness was also measured. RESULTS: There was no statistically significant difference in the CT of all regions between the groups (p > 0.05). No statistically significant difference was found between two groups in terms of macular choroidal thickness (p > 0.05). CONCLUSION: These results revealed that severe adenoid hypertrophy did not cause a significant effect on choroidal thickness. Short-term exposure to obstructive symptoms in children and preserved sympathetic-parasympathetic balance may explain this result.

Dorsal Augmentation of Saddle Nose Deformity With Toothpick-Shaped Costal Cartilage Grafts in the Secondary Septorhinoplasty.

Saddle nose deformity is a challenging complication of septoplasty or septorhinoplasty, characterized by underprojected cartilaginous dorsum. Nasal dorsal augmentation is a significant part of reconstructive surgery of saddle nose deformities. In this study, the authors aimed to discuss the results of using toothpick-shaped costal cartilage grafts in nasal dorsal augmentation of saddle nose deformity. Twelve patients who underwent nasal dorsal augmentation due to moderate to severe saddle nose deformity secondary to the previous septoplasty or septorhinoplasty were retrospectively reviewed. Costal cartilage grafts prepared in the shape of toothpicks were used in all patients. Costal cartilage was used as toothpick-shaped free grafts in 12 patients (female: 7, male: 5) with a mean age of 42 (range: 24-56) for dorsal augmentation in the secondary septorhinoplasty. All patients had a history of previous surgery (septoplasty, n = 9; and septorhinoplasty, n = 3). All patients were operated under general anesthesia with open technique septorhinoplasty. The mean follow-up was 18 (range: 9-48) months. In only 1 of the 12 patients, a postoperative complication was observed including an infection of the tip area in the second postoperative week. None of the patients experienced donor site complications or major graft resorption. All patients were satisfied with functional and esthetic outcomes. No revision surgery was needed in any patient. Toothpick-shaped costal cartilage grafts are useful in nasal dorsal augmentation of moderate to severe saddle nose deformity. This technique offers smooth camouflage, satisfactory accordance with the recipient region, and shorter operation time. In addition, it avoids the side effects from wrapping techniques such as foreign body reaction or additional donor site morbidities.

Relation Between the Type of Hospitals and the Decision of Adenotonsillectomy Indication.

OBJECTIVE: This study aims to apply tonsillectomy criteria, symptoms and outcomes proposed in earlier studies to investigate patients who were given tonsillectomy indications at different clinical centers but were treated in our clinical center. METHODS: The prospective sample of patients at the ear, nose, and throat clinic within our hospital consisted of 855 male patients and 684 female patients (1539 in total) with ages between 3 and 16 years old who had been given a tonsillectomy or adenotonsillectomy indication. The patients were allocated to 1 of 3 groups, depending on whether they had been treated in a public hospital, a private hospital, or a university/training research hospital. RESULTS: Of the total of 1539 patients, tonsillectomy indication criteria were exhibited by 966 of them (62.8%) but were absent in the rest of 573 patients (37.2%). Most of the 966 patients with tonsillectomy indication criteria had been treated in private hospitals (n = 546; 56.5%), while the others were treated in public hospitals (n = 309; 31.9%) or in university/training research hospitals (n = 111; 15.9%). Furthermore, the majority of the 966 patients (84.1%) received the tonsillectomy indication in just 1 examination, while some of them (n = 154; 15.9%) received it after follow-up appointments. CONCLUSION: Tonsillectomy decisions can pose difficulties for ear, nose, and throat specialists. Therefore, such decisions should be made based on assessment of clinical evaluation and follow-up, information from patients' parents, and the results of examination against the criteria outlined in the literature.

Association of Helicobacter pylori infection with olfactory function using smell identification screening test.

The aim of the present study is to investigate the role of Helicobacter pylori in olfactory function. Thirty-six patients (mean age 38.5) aged between 18 and 55 years who were diagnosed with H. pylori by gastric biopsies and age- and sex-matched 30 healthy adults (mean age 33.6) were included in the study. All participants underwent a detailed ear-nose-throat examination including endoscopic examination of the nasal cavity and laryngeal area, and olfactory tests were performed using the Sniffin' Sticks, a 12-item screening test (Sniffin'Sticks; Burghart, Wedel, Germany) and odor scores were recorded. The mean odor score was 7.9 ± 1.7 (range 2-10) in the patient group and 10.3 ± 1.4 (range 6-12) in the control group. There were significant lower scores in the patient group compared to the control group (p < 0.05). In conclusion, it is apparent that there is an association of H. pylori infection with olfactory dysfunction. H. pylori infection should be considered as possible etiological factors in patients with olfactory dysfunction.

Assessment of red blood cell distribution width and mean platelet volume in children with epistaxis.

OBJECTIVE: This study aimed to investigate whether there is a relationship between red blood cell distribution width, mean platelet volume and epistaxis in children. METHODS: Between January 2015 and July 2016, 105 children who were referred to our clinic with epistaxis and 100 sex- and age-matched controls were retrospectively analyzed. Red blood cell distribution width (RDW) and mean platelet volume (MPV) values were determined in both groups. RESULTS: RDW values were found significantly (P < 0.05) lower in the group with epistaxis than in the control group (11.95 ± 1.31 vs. 12.74 ± 1.21). MPV was 7.49 ± 1.33 in the group with epistaxis and 7.23 ± 1.06 in the control group, and there was no significant difference between the groups (p > 0.05). CONCLUSION: We found no difference between MPV values of both groups and significantly lower RDW values in children with epistaxis. Decreased RDW values were considered as an accompanying marker rather than a result of epistaxis. In addition, it may be thought that low RDW values may increase the bleeding tendency by disrupting the thrombotic activities. Further studies are needed to validate the relation of these parameters with epistaxis and its mechanisms.

Association Between Endocrine Diseases and Serous Otitis Media in Children.

OBJECTIVE: Otitis media with effusion (OME) is a condition in which fluid is retained in the middle ear cavity. The association between endocrine disorders and OME has not yet been determined. This study aimed to investigate the presence of OME in children diagnosed with an endocrine disease and the relationship between these two conditions. METHODS: The study was conducted on 918 pediatric patients (440 boys, 478 girls; mean age: 8.40, range 3-15 years) and 158 healthy controls (76 boys, 79 girls; mean age: 8.31, range 3-15 years). All children underwent an ear examination and a tympanometry performed by an otorhinolaryngologist. Tympanometry results were used to diagnose OME. RESULTS: OME was detected in 205 (22.3%) of 918 patients and in 19 (12.0%) of 158 subjects in the control group. The difference in frequency of OME between the two groups was statistically significant (p=0.003). CONCLUSION: The results of the study reveal that there may be a tendency towards the occurrence of OME in pediatric endocrinology patients.