Angiotensin-Converting Enzyme (ACE) I/D and Alpha-Adducin (ADD1) G460W Gene Polymorphisms in Turkish Patients with Severe Chronic Tinnitus.

OBJECTIVE: Tinnitus is described as a disturbing sound sensation in the absence of external stimulation. We aimed to investigate whether there is any relationship between severe chronic tinnitus and angiotensin-converting enzyme (ACE) I/D and α-adducin (ADD1) G460W gene polymorphisms. MATERIALS AND METHODS: The patient group and control group consisted of 89 and 104 individuals, respectively. The evaluation of tinnitus was performed using the Strukturiertes Tinnitus-Interview (STI). The Tinnitus Handicap Inventory (THI) was used to evaluate the tinnitus severity. Polymerase chain reaction (PCR) and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) techniques were used for genotyping. RESULTS: With regard to the ACE I/D polymorphism, there was no significant difference in genotype and allele frequencies between the patient group and control group. However, a statistically significant difference was found in genotype (p<0.01) and allele frequencies (p=0.021) of the ADD1 G460W gene polymorphism. Combined genotype analysis showed that the ACE II /ADD1 GW genotype was statistically significantly higher in the patient group than in the control group (X2: 7.15, p=0.007). The odds ratio value of the GW genotype was 2.5 (95% CI=1.4-4.7) (p<0.01). CONCLUSION: Our results demonstrate an association between ADD1 G460W gene polymorphism and susceptibility to severe chronic tinnitus. It was found that the GW genotype increased the disease risk by 2.5-fold compared with other genotypes. This indicates that ADD1 G460W polymorphism could be an important factor in the pathophysiology of tinnitus.

MBL, P2X7, and SLC11A1 gene polymorphisms in patients with oropharyngeal tularemia.

CONCLUSION: A significant association was found of oropharyngeal tularemia with SLC11A1 allele polymorphism (INT4 G/C) and MBL2 C + 4T (P/Q). These results indicate C allele and Q allele might be a risk factor for the development of oropharyngeal tularemia. AIM: This study aimed to investigate the relationship of SLC11A1, MBL, and P2X7 gene polymorphism with oropharyngeal tularemia. METHODS: The study included totally 120 patients who were diagnosed with oropharyngeal tularemia. Frequencies of polymorphisms in the following genes were analyzed both in the patient and control groups in the study: SLC11A1 (5'(GT)n Allele 2/3, Int4 G/C, 3' UTR, D543N G/A), MBL (MBL2 C + 4T (P/Q), and P2X7 (-762 C/T and 1513 A/C). RESULTS: Among all polymorphisms that were investigated in this study, SLC11A1 gene showed a significance in the distriburtion of polymorphism allelle frequency at the INT4 region. Frequency of C allele was 54 (28%) in patients with oropharyngeal tularemia, and 31 (13%) in the control group (p = 0.006 and OR = 1.96 (1.21-3.20)). An association was detected between MBL2 C + 4T (P/Q) gene polymorphism and oropharyngeal tularemia (p < 0.005 and OR = 0.30 (0.19-0.48)). No significant relation was found between P2X7 (-762 C/T and 1513 A/C) gene polymorphism and oropharyngeal tularemia in this study (p > 0.05).

Assessment of Hematological Factors Involved in Development and Prognosis of Idiopathic Sudden Sensorineural Hearing Loss.

OBJECTIVE: The aim of this study was to investigate the possible effects of routine hematological parameters on the development and prognosis of idiopathic sudden sensorineural hearing loss in patients applying to our clinic. STUDY DESIGN: A retrospective clinical study. SETTING: One academic health center from 2008 to 2014. PATIENTS AND INTERVENTION: One hundred forty patients with sudden hearing loss and 132 healthy controls were included in the present study. RESULTS: Patients having idiopathic sudden sensorineural hearing loss were divided into 2 subgroups based on whether they recovered (complete, partial, and slight recovery) (Group 1; n = 83, 59.3%) or not (Group 2; n = 57, 40.7%) during the follow-up term. Group 1, Group 2, and the controls differed statistically significantly in terms of neutrophil-to-lymphocyte ratio (P = 0.001), platelet-to-lymphocyte ratio (P = 0.001), lymphocytes % (P = 0.001), mean corpuscular hemoglobin (P = 0.019), mean corpuscular hemoglobin concentration (P = 0.015), platelet (P  = 0.001), mean platelet volume (P = 0.001), platelet distribution width (P = 0.009), and glucose (P = 0.001). The study groups and the controls did not have any significant difference in terms of other laboratory parameters affecting the prognosis of Idiopathic sudden sensorineural hearing loss. CONCLUSIONS: The results the authors obtained showed that laboratory parameters such as lymphocyte, lymphocyte%, platelet, mean platelet volume, platelet distribution width, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration may be indicative for prognosis and treatment success in groups of patients suffering idiopathic sudden sensorineural hearing loss in whose etiology many factors play a role.

Effects of rapid maxillary expansion on nasal mucociliary clearance.

OBJECTIVE: To evaluate the changes in nasal mucociliary clearance in orthodontic patients after rapid maxillary expansion (RME) therapy. MATERIALS AND METHODS: Forty-two children (25 boys and 17 girls) participated in this study. The RME group consisted of 21 patients (mean age, 13.8 years), who had undergone RME at the initiation of orthodontic treatment. The control group consisted of 21 subjects (mean age, 13.6 years), who were attending the department of orthodontics for active orthodontic treatment. The nasal mucociliary clearance was assessed by the saccharin test. Saccharin transit times (STTs) were measured for each treated subject before expansion (T1), after RME (T2), and after a 3-month retention period (T3). Records were obtained at the same time intervals for each group. RESULTS: The STT decreased significantly in the RME group after expansion and retention (P < .05). A statistically significant difference was found when the STTs of the control and RME groups were compared after expansion and retention (P < .05). CONCLUSIONS: The STTs of young orthodontic patients with maxillary narrowness and without any history of nasal or systemic disease were within normal limits. However, RME increased the mucociliary clearance in patients who had maxillary narrowness, having positive effects on nasal physiology and increasing nasal cavity volume.

Is the time from the onset to the treatment a prognostic indicator for hearing recovery in idiopathic sudden sensorineural hearing loss?

OBJECTIVES: This study aims to investigate whether the time from the onset of symptoms to the start of treatment is a prognostic indicator in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). PATIENTS AND METHODS: In this study, 96 patients (58 males, 38 females; mean age 37.8±2.5 years; range 16 to 67 years) who were diagnosed with ISSNHL in our clinic between January 1992 and April 2010 were retrospectively analyzed. All patients were treated with dextran 40 (rheomacrodex), pentoxifyllin, vitamin B complex and vitamin C regimen over 10 days with hospitalization and bed rest. The patients were tested by pure-tone audiometry. Audiograms were obtained on alternate days and at the end of the treatment. RESULTS: There was a complete recovery in 45 (60%) of 75 patients whose treatment was started in the first seven days, while a partial recovery was observed in 17 (22.66%) and no recovery was observed in 13 (17.33%). There was a complete recovery in two (9.52%) of 21 patients whose treatment was started after the eighth day, while a partial recovery was observed in seven (33.33%) and no recovery was observed in 12 (57.14%). CONCLUSION: Our study results suggest that treatment outcomes are better in the patients presenting to hospital at an early stage of loss of hearing.

CT and MR Imaging in a Large Series of Patients with Craniofacial Fibrous Dysplasia.

BACKGROUND: In this retrospective review of patients with craniofacial fibrous dysplasia (FD), the clinical and radiological findings of CT and MR scan were analyzed. MATERIAL/METHODS: The study material included 32 patients, at 9 to 68 years of age that were directed for differential diagnostics of several disorders in the head. We recorded CT and MRI data related to the lesion number, location, sidedness, appearance, and sex of the cases with craniofacial FD. RESULTS: Of 32 patients involved in this study, 17 had monostotic and 15 had polyostotic involvement pattern. Bones most commonly involved by monostotic involvement in females were, in descending order, mandibular, maxillary, and sphenoid bones, while the sphenoid bone was involved the most in males. Leontiasis ossea was observed in 2 patients. Sclerotic and mixed lesion types were more common in both females and males. In T1- and T2-weighted MRI sequences, hypointensity was more common compared to hyperintensity or heterogeneous intensity. The type of enhancement of lesions was found similar after contrast medium administration. CONCLUSIONS: In the presence of craniofacial FD during CT or MRI imaging of the head, a detailed description of FD lesions may provide an important clinical benefit by increasing radiological experience during the diagnostics of this rare disorder.

The effect of topical mometasone furoate nasal spray on carriage of Staphylococcus aureus.

OBJECTIVES: This study aims to examine the effect of topical mometasone furoate nasal spray on nasal Staphylococcus aureus (S. aureus) colonization in the treatment of allergic rhinitis. PATIENTS AND METHODS: Between January 2012 and February 2013, 53 patients having perennial allergic rhinitis symptoms (37 females, 16 males) and 53 healthy controls (36 females, 17 males) were included in the study. Nasal cultures were obtained and evaluated before and after the treatment in allergic rhinitis patients who were admitted to the ear, nose and throat (ENT) outpatient clinic and receiving a mometasone furoate nasal spray treatment (200 mcg/day) once a day for one-month. In healthy controls, nasal cultures were obtained and evaluated once. RESULTS: In allergic rhinitis patients, five cultures were positive for S. aureus before the treatment while the number of cultures positive for S. aureus was six after the treatment. There was no significant difference in the pre-treatment and post-treatment S. aureus colonization between the patient group and controls (p>0.05). CONCLUSION: Mometasone furoate nasal spray used in the treatment of allergic rhinitis appears to be ineffective for nasal S. aureus colonization.

[Evaluation of shrinkage of surgical margins on tongue specimens following formalin fixation]. / Formalin fiksasyonu sonrasi dil örneklerinde cerrahi sinir küçülmesinin degerlendirilmesi.

OBJECTIVES: This study aims to evaluate the alterations in distances to the surgical margins on sheep tongue specimens, through resection, formalin fixation, frozen section, and microscopic examination. MATERIALS AND METHODS: Fifty fresh sheep tongues were used in the study. A metal plate was fixed on the lateral aspect of each tongue to represent tumor tissues. A total of 40 specimens with either 1 cm or 2 cm distances as surgical safety margins of the surrounding plate were prepared using either scalpel or monopolar cautery (10 specimens were prepared for each group). Additional 10 specimens with 1 cm safety margins were prepared using either scalpel or monopolar cautery (5 specimens per group) for frozen section examination. Distances to the metal plates before resection were compared with the ones which were determined after resection, frozen section examination, 24-hour formalin fixation and microscopic examination. RESULTS: Distances to the surgical margins were found to be decreased in all specimens after resection, 10% formalin fixation and microscopic examination. The distances to the surgical margins were observed to be reduced by 6.5-7.5% on average after resection, 10-12% on average after formalin fixation and 30% on average after microscopic examination, compared to the baseline values. The level of shrinkage was reduced by 6.3-10% following microscopic section preparation during frozen section examination. CONCLUSION: Seven to eight-millimeter distance to the surgical margin at minimum should be maintained to achieve a 5 mm in height surgical safety margin during sheep tongue resection. The distance defined by the pathologist may be multiplied with 1.42 to estimate around in-situ distance to the surgical margins. Therefore, 1.42 may be used as a corrective factor for sheep tongue tissues.

Oxaliplatin and ototoxicity: is it really safe for hearing?

BACKGROUND/AIM: Oxaliplatin is an effective and widely used chemotherapeutic agent in the treatment of many solid tumors. The most common side effects are peripheral neuropathy, gastrointestinal toxicity, and neutropenia. There have been some case reports about ototoxicity with oxaliplatin, but no clinical trials. In this trial, we explored whether or not oxaliplatin has ototoxic effects. MATERIALS AND METHODS: A total of 18 patients, 14 with colorectal cancer and 4 with pancreatic cancer, were included in this study. Four patients (22%) were treated with a capecitabine and oxaliplatin (CapeOx) regimen, and 14 patients (78%) were treated with fluorouracil, leucovorin, and oxaliplatin (FOLFOX-6). Patients' pretreatment and posttreatment hearing levels were assessed with high-frequency audiometry and otoacoustic emission tests. RESULTS: The median time between the first and the last oxaliplatin doses was 3.2 months (range: 2-7 months). There was no hearing loss in tests conducted for both ears of patients at frequencies of 500, 1000, 2000, 4000, 6000, 8000, 12,000, and 16,000 Hz. There was no difference between the pretreatment and posttreatment otoacoustic emission tests. CONCLUSION: Oxaliplatin is a reliable agent in terms of ototoxicity.

Comparison of the effects of desflurane and sevoflurane on middle ear pressure: a randomized controlled clinical trial.

OBJECTIVE: The aim of the present study was to compare the effects of two inhalation anesthetics, desflurane and sevoflurane, on middle ear pressure. METHODS: After we obtained written consent from the patients and the approval from our institutional ethical committee, we included 56 ASA I-II patients aged between 18 and 60 years in this study. They were randomly divided into two groups of 28 patients each. Desflurane 4-6% (Group D) or sevoflurane 1-2% (Group S) were used for anesthesia management in patients. Baseline tympanometry was carried out and recorded before the induction of anesthesia on both ears, and 3 more measurements were done and recorded 5, 15 and 30 min after induction. RESULTS: In both groups, middle ear pressure values were found to be significantly elevated when compared to baseline measurements (p < 0.05). When middle ear pressure was compared between the groups, no difference was found between the values obtained at baseline and at 5 min in Group S, while especially the values obtained at 15 min revealed significantly higher middle ear pressures in Group D. CONCLUSION: It was observed that the increase in middle ear pressure caused by sevoflurane was significantly lower than that caused by desflurane.

Effects of topical sprays on allergy-induced nasal obstruction in children.

OBJECTIVES: This study aims to evaluate the efficacy of mometasone furoate nasal spray, intranasal azelastine, and isotonic sea water nasal spray in the management of allergy-induced nasal obstruction. PATIENTS AND METHODS: Between October 2007 and August 2008 60 patients (37 males, 23 females; mean age 9.8±2.6 years; range 7 to 16 years) with a history of allergic rhinitis were included in the study. Laboratory assays including the skin prick test, nasal smear, phadiatop, total immunoglobulin E (IgE), and complete blood count test were performed. The patients were classified into three groups including 20 in each, according to the topical treatment administered. Patients in group 1 received azelastine, group 2 received mometasone furoate nasal spray, and group 3 received isotonic sea water nasal spray. Nasal passage volume was calculated using an acoustic rhinometry device. RESULTS: Azelastine and mometasone furoate decreased nasal congestion and increased nasal cavity volume more effectively, compared to isotonic sea water nasal spray. CONCLUSION: Mometasone furoate and azelastine which decrease nasal congestion and increase nasal volume are effective in the management of allergic rhinitis in children.

Voice disorder in patients with Fibromyalgia.

OBJECTIVE: To investigate several perceptual, acoustic and aerodynamic voice evaluation parameters in Fibromyalgia patients. METHODS: A total number of 30 Fibromyalgia patients had voice evaluations by means of laryngostroboscopy, acoustic analysis (jitter, shimmer, and harmonic to noise ratio), aerodynamic measurements (maximum phonation time, s/z ratio), and perceptual analysis (GRBAS and Voice Handicap Index-10 scales). Data obtained from the patients was compared to control subjects. RESULTS: Mean intensity was found to be significantly higher in control subjects (73.70±4.73dB) than Fibromyalgia patients (64.50±6.92dB), (p<0.001). There was no statistically significant difference in fundamental frequency, perturbation parameters (jitter and shimmer) and harmonic to noise ratio between groups. Maximum phonation time in control subjects (22.53±4.95s) was found to be significantly longer than Fibromyalgia patients (16.07±4.87s), (p<0.001), and s/z ratio was found to be nearly equal between patients (1.00±0.24) and control subjects (0.96±0.16). On the basis of perceptual evaluation by using a GRBAS scale, the patients showed a mean score of 2.50±1.97 and the control group showed a mean score of 0.56±1.04 (p<0.001). "Grade" and "asthenia" parameters of GRBAS scale in Fibromyalgia patients were significantly different from the parameters of control group (p<0.001). The Voice Handicap Index-10 scales revealed a mean score of 7.90±7.58 in Fibromyalgia patients and 1.83±2.82 in control subjects (p<0.001). CONCLUSION: Fibromyalgia impairs perceived voice quality either in patient self evaluated or in clinician evaluated rating scales. Furthermore, the results confirm that Fibromyalgia caused short maximum phonation time and low voice intensity. This study is the first report with regards to voice evaluation in Fibromyalgia and in order to make a generalization further researches are needed.

A giant juvenile nasopharyngeal angiofibroma.

Juvenile nasopharyngeal angiofibromas are locally growing and highly vascular tumors. They are primarily treated through surgical excision ranging from an open approach to an endoscopic approach. We presented a 20-year-old man with a giant juvenile nasopharyngeal angiofibroma that bilaterally obliterated the pterygopalatine fossa, invaded the sphenoid bone, and extended to the left nasal passage. His complaints were epistaxis and nasal obstruction. After embolization, the patient was treated surgically using the endoscopic approach and declared cured and discharged without any complications.

Anterior rhinomanometry and determination of nasal mucociliary clearance time with the saccharin test in children with Crimean-Congo hemorrhagic fever.

OBJECTIVES: Crimean-Congo hemorrhagic fever (CCHF), like other viral infections, may prolong mucociliary clearance time and increase nasal resistance in children. The aim of the present prospective case-control study was to study, using saccharin and anterior rhinomanometry tests, whether CCHF infections caused any change in nasal physiology. METHODS: Overall, 40 subjects, 20 of whom had CCHF (group 1) and 20 of whom were healthy controls (group 2), were enrolled in this study. The definitive diagnosis of CCHF infection was made based on typical clinical and epidemiological findings and detection of CCHF virus-specific IgM by ELISA or of genomic segments of the CCHF virus by reverse transcription-polymerase chain reaction. Anterior rhinomanometry was performed in all participants according to current recommendations of the Committee Report on Standardization of Rhinomanometry. A saccharin test was used to evaluate mucociliary clearance, and nasal mucociliary clearance time was assessed with the saccharin test as described previously. RESULTS: In our patients, the mean time from the application of saccharin crystals to the first feeling of a sweet taste was 6.77 ± 3.25 minutes (range 2-16 min). In terms of the mean time from the application of saccharin crystals to the first feeling of a sweet taste, there was no difference between two groups. The mean total air flow was 637.60 ± 76.18 mL/s (range 490-760 mL/s). The mean total nasal airway resistance was 0.24 ± 0.03 Pa/mL s (range 0.20-0.31 Pa/mL s). In terms of the degree of nasal air flow and nasal airway resistance and the total air flow and total nasal airway resistance of each nostril, there was no difference between the 2 groups. CONCLUSIONS: The results obtained in anterior rhinomanometry and saccharin test showed that there was no statistically significant difference between CCHF (+) patients and controls. These results suggest us that CCHF virus infection does not affect nasal physiology. However, this is the first study performed on this issue and further studies on larger series need to be performed.

Parotid tail pleomorphic adenoma extending to the parapharyngeal space.

Parapharyngeal space tumors are rare, accounting for 0.5% of head and neck neoplasms. Most of them are benign and originate in the salivary glands, especially the pleomorphic adenoma. We presented a 47-year-old man with parotid tail pleomorphic adenoma extending to the parapharyngeal space. The patient applied to our clinic with the complaints of a painless mass on his neck and in his mouth for 3 months. After fine needle aspiration biopsy, the mass was diagnosed as pleomorphic adenoma. The patient was hospitalized and operated in our clinic. As we see in literature review, parapharyngeal space tumors are rare, and most of them are pleomorphic adenomas arising from the deep lobe of the parotid gland and extend into the PPS.

Evaluation of nasal mucociliary activity in iatrogenic hypothyroidism.

Our aim was to evaluate the effects of iatrogenic, acute and deep hypothyroidism on nasal mucociliary clearance. A total of 46 patients undergoing total or near total thyroidectomy for differentiated thyroid cancer between March and June 2012, and scheduled to undergo radioactive iodine (I-131) ablation therapy followed with an induced hypothyroidism for routine screening were included in the study. Mucociliary clearance test was made during hypothyroid and euthyroid periods in all the patients included in the study. Of the 46 patients included in the study, 37 (%80.4) were females, 9 (%19.6) were males, and the average mucociliary clearance times were 16.78 and 9.58 min during hypothyroid and euthyroid periods, respectively. When the results were compared statistically, mucociliary clearance time measured during hypothyroidism period was found to be significantly longer than the one measured during euthyroid period. Mucociliary clearance time was found to be long during iatrogenic acute and deep hypothyroid periods. During these periods, patients should be followed closely for lower and upper respiratory tract infections.

Results of endoscopic endonasal dacryocystorhinostomy.

Nasolacrimal ductus obstruction cause Epifora. Two widely accepted treatment modalities are external and endoscopic dacryocystorhinostomy. Currently available rigid nasal endoscopes are safe for intranasal manipulation of structures of the nasal cavity, including the region of the lacrimal sac. Twenty-eight patients with complete stenosis of the nasolacrimal duct were treated with endoscopically controlled endonasal dacryocystorhinoslomy. Approximately 97% of the patients were symptom free, and 3% of these felt improved postoperatively. This procedure appears to be safe and effective, which should be considered as an alternative to external dacryocystorhinostomy for the surgical treatment of the nasolacrimal duct obstruction.

Evaluation of hearing in patients with familial Mediterranean fever.

Familial Mediterranean fever (FMF) is a common and well-understood hereditary periodic fever syndrome. Hereditary periodic fever syndromes include a group of multisystem diseases characterized by recurrent fever attacks with inflammation affecting skin, joints, and some other tissues. These are FMF, tumor necrosis factor receptor, tumor necrosis factor receptor associated periodic syndrome, hyperimmunglobulinemia D syndrome, Muckle-Wells syndrome, and familial cold urticaria. In literature, it is determined that some of these diseases cause hearing loss. In light of the foregoing, we thought that FMF patients may have the same type of subclinical hearing loss and, therefore, the hearing ability of these patients was evaluated with otoacoustic emission and high frequency audiometry tests.

Subcutaneous emphysema and pneumomediastinum complicating a dental procedure.

Cervicofacial emphysema and pneumomediastinum are rarely observed complications of dental interventions. The complications are associated with the use of a high-speed air-turbine dental drill. It is a potentially life-threatening condition, but the majority of cases are self-limiting and benign. We describe a patient with remarkable subcutaneous emphysema, pneumomediastinum, and partial pneumothorax after right second mandibular molar extraction. Dentists and physicians more often attribute the rapid onset of dyspnea in patients after a dental procedure to an allergic reaction to the anesthesia used during the procedure. Dentists and physicians should be aware that soft tissue emphysema can cause acute swelling of the cervicofacial region after dental procedures, which may mimic an allergic reaction.