Allergic rhinitis and its impact on asthma classification correlations.

OBJECTIVE: Allergic rhinitis is inflammation of the nasal mucosa following exposure to allergens. A few studies have investigated how the Allergic Rhinitis and its Impact on Asthma classification correlates with symptom severity and skin prick test results in allergic rhinitis patients. Our objective was to evaluate such a correlation. MATERIALS AND METHODS: The study population consisted of 268 patients who had allergic symptoms and were diagnosed with allergic rhinitis. RESULTS: Analysis of the Allergic Rhinitis and its Impact on Asthma classification with regard to symptom severity revealed that there were statistically significant differences between the groups for nasal symptoms, wheezing, eye itching/watering and eye redness. Symptom frequency and severity increased gradually towards the moderate to severe persistent allergic group. There was a statistically significant difference between the groups for grass pollen and house dust mite allergy. CONCLUSION: The Allergic Rhinitis and its Impact on Asthma classification, which takes symptoms and quality of life into consideration in addition to allergen exposure, is a useful classification system for allergic rhinitis.

Temporomandibular joint involvement in rheumatoid arthritis: correlation of clinical, laboratory and magnetic resonance imaging findings.

OBJECTIVE: Rheumatoid arthritis is a systemic autoimmune disorder that involves many body joints including the temporomandibular joint. The frequency of temporomandibular joint involvement based on clinical and radiological findings is rather diverse and involvement may manifest as pain, restricted range of movement and locking of the joint. The aim of this study is to investigate and correlate the clinical, laboratory and magnetic resonance imaging findings in patients with rheumatoid arthritis. METHODOLOGY: The temporomandibular joint involvement in 43 patients with rheumatoid arthritis, whose diagnoses were based on the revised 1987 criteria of the American College of Rheumatology, were evaluated using clinical examination, laboratory findings and magnetic resonance imaging. RESULTS: Temporomandibular joint involvement was clinically observed in 28 patients (65.1%), and radiologically in 33 patients (76.7%). The most frequent physical examination finding, a "click" in the joint upon opening of the mouth, was found in 21 (48.8%) patients. The most frequently observed radiological finding was synovial proliferation seen in 22 (51.1%) patients. A statistically significant correlation was observed between erythrocyte sedimentation rate and the findings on magnetic resonance imaging; between the rheumatoid factor results and physical examination findings; and between the findings of the physical examination and magnetic resonance imaging. CONCLUSION: The erythrocyte sedimentation rate, the rheumatoid factor results, and the findings on magnetic resonance imaging were found to be important in indicating temporomandibular joint involvement in rheumatoid arthritis. Further studies are necessary to specify the risk factors in more detail.

Bifid inferior turbinate: a case report.

OBJECTIVES: A bifid inferior turbinate is an extremely rare anatomical variation and has been reported in only two cases to date. Including the present report, the uncinate processes were missing in all three patients reported. It is suggested that, in the reported patient, bifid inferior turbinate coexisted with a developmental anomaly of the uncinate process, and that the bifid inferior turbinate represented two separate turbinates originating from the same site. CASE REPORT: We present the first reported case of bilateral bifid inferior turbinates, with a secondary middle turbinate, in a patient complaining of nasal obstruction. CONCLUSION: We suggest that the superior part of the bifid inferior turbinate may have been formed by severe medial displacement and inferior rotation of the uncinate process, and that the bifid inferior turbinate is an anatomical abnormality of the uncinate process.

Changes in indications for endoscopic sinonasal surgery over 14 years.

OBJECTIVE: To assess how surgical indications for endoscopic sinonasal surgery have changed over time. MATERIAL AND METHODS: The surgical indications of 1173 patients who underwent endoscopic sinonasal surgery between 1994 and 2007 were reviewed retrospectively. RESULTS: Preoperative diagnoses were chronic sinusitis without nasal polyps in 511 patients (43.6%), chronic sinusitis with nasal polyps in 434 (36.9%), concha bullosa in 113 (9.6%), nasal mass in 66 (5.6%), and others in 49 patients (4.1%). Over 60% of patients had surgery for chronic sinusitis without nasal polyps between 1994 and 1999, whereas nearly 60% of patients who underwent surgery between 2001 and 2007 had chronic sinusitis with nasal polyps. CONCLUSIONS: Reasons for the decrease in the number of the patients with chronic sinusitis without nasal polyps and the increase in the number of patients with chronic sinusitis with nasal polyps might include: 1) Administration of maximal medical therapy; 2) Increased recognition of the possibility for false positive opacifications in computed tomography and increased understanding that not all anatomical variations predispose to sinusitis; 3) More careful "profit and loss" discussions with patients as our postoperative experience increased; 4) More patients with nasal polyps underwent endoscopic sinonasal surgery as surgical skills improved, and recurrences remained common.

Derevator: a soft tissue elevator for maxillary sinus in endoscopic sinus surgery.

Removal of the soft tissue lesions from the maxillary sinus is sometimes difficult and time consuming in endoscopic sinus surgery. Failure of endoscopic removal may necessitate combination of canine fossa approach and endoscopic approach. Our new instrument, 'Derevator', is designed for easy removal of the pathological soft tissue lesions from the maxillary sinus through middle meatal antrostomy. Derevators are available for both adults and children. Suction-tipped ones are also available.

Fibrous dysplasia of inferior turbinate, middle turbinate, and frontal sinus.

Fibrous dysplasia (FD) is a non-neoplastic fibro-osseous lesion. Paranasal sinus involvement is infrequent. Involvement of the frontal sinus, sphenoid sinus, and middle turbinate is rare, and only sporadic cases have been reported in the literature. Nasal turbinates and especially the inferior turbinate are the least involved bones of the craniofacial region. To the best of our knowledge, only one case with McCune-Albright syndrome had FD of the inferior turbinate. Here, we report a rare case with FD of inferior and middle turbinates and review literature concerning FD of the craniofacial region.

An epidermal cyst in the parotid gland following ear surgery: a case report.

PROBLEM/OBJECTIVE: Iatrogenic epidermal cysts have been reported in various locations following otological surgical procedures. Especially after endaural incisions, surgeons may implant squamous epithelium into underlying tissue. An epidermal cyst of the parotid region may appear years after ipsilateral ear surgery. METHODOLOGY: A cystic lesion in the superficial lobe of the parotid gland was identified by computed tomography and ultrasonography in a 30-year-old man with a history of myringoplasty and endaural surgery. A superficial parotidectomy was performed to remove the mass. RESULTS: The mass was histopathologically diagnosed as an epidermal cyst. CONCLUSION: If a cystic lesion is present in the parotid gland in a patient with a history of otologic surgery, it must be considered that the mass is of epidermal origin.

In vitro activity of terbinafine and itraconazole against Aspergillus species isolated from otomycosis.

The minimum inhibitory concentrations (MIC, microg ml-1) of itraconazole and terbinafine against overall 34 Aspergillus isolates from the external ear canals with otomycosis have been determined with M38-P microdilution method suggested by National Committee for Clinical Laboratory Standards (NCCLS). MIC intervals in 48 h determined by taking MIC-2 value of itraconazole (the lowest drug concentration causing 50% inhibition of visible fungal growth) and MIC-0 value of terbinafine (the lowest drug concentration causing 100% inhibition of visible fungal growth) as a basis have been found as follows: 0.125-1 and 0.06-0.5 microg ml-1 for A. niger (22 strains), 0.06-0.25 and 0.06-0.125 microg ml-1 for A. flavus (10 strains), 0.125 and 0.125-0.5 microg ml-1 for A. terreus (two strains). It has been observed that both of the antifungal agents showed an in vitro activity against all Aspergillus species tested.

Isolated sphenoid sinusitis.

Isolated sphenoid sinusitis is a relatively rare clinical entity and can cause severe complications. Diagnostic nasal endoscopy using Hopkins telescopes and coronal and axial paranasal-sinus CT made the diagnosis of the sphenoid sinus disease easier. Eight out of 221 patients with paranasal sinus infection refractory to medical treatment--and treated surgically at the 2nd ENT Clinic of Ankara Numune Hospital between 1990-1995--had isolated sphenoid sinus infection. The most common symptom was headache felt in the retro-orbital region. Surgical procedure was intranasal endoscopic approach to the sphenoid sinus. The symptoms of the patients with isolated sphenoid sinusitis were completely resolved after surgery. As the literature is reviewed, it is concluded that endoscopic approach to the sphenoid sinus disease is the most appropriate method of surgery in order to reduce intra-operative morbidity and mortality.