Significance of Medial Osteotomy on the Olfactory Function in Patients Who Underwent Septorhinoplasty.

OBJECTIVE: This study was designed to explore the impact of medial osteotomy on olfactory function. METHODS: This nonrandomized, prospective study included 60 adult patients who underwent open technique septoplasty (group 1), rhinoplasty with only lateral osteotomy (group 2), and septorhinoplasty with medial and lateral osteotomies (group 3). Olfactory functions were evaluated by using the Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test. The CCCRC test includes the butanol threshold test and smell identification test using common smells. The butanol threshold test and smell identification test scores of each group were recorded preoperatively and at 1st and 4th months and compared. RESULTS: Each group is consisted of 20 patients. The preoperative smell identification test and butanol threshold test scores were similar in each group. The smell identification test, butanol threshold test, and CCCRC olfactory test scores of the 1st month were statistically significantly low in group 3. There was no statistically significant difference between the groups at 4th month postoperatively. CONCLUSION: The present study is the first analysis of the effect of medial osteotomy on olfactory function. Medial osteotomy may decrease the olfactory function in early time, but afterwards olfaction could recover at preoperative levels.

Does Pediatric Obstructive Sleep Apnea Syndrome Cause Systemic Microvascular Dysfunction?

The aim of this study was to evaluate whether pediatric obstructive sleep apnea syndrome (OSAS) secondary to adenoid hypertrophy causes systemic microvascular dysfunction. This is a prospective single-blinded case-control study. As the patient group, 81 patients diagnosed to have OSAS secondary to adenoid hypertrophy at our hospital between January 2016 and May 2016; as the control group, 26 healthy pediatric volunteers who presented to the hospital for health screening were included in this study. Three groups of OSAS patients were defined as mild, moderate, and severe respectively, according to the lateral nasopharynx x-ray. Patients with comorbid diseases were excluded from the study. For microvascular dysfunction, videocapillaroscopic evaluation was performed at the nailfold and capillary density (CD) and postocclusive reactive hyperemia (PORH) values were measured and statistical analysis between the groups was performed. The duration of complaints in all patients with OSAS was at least 6 months and <1 year. CD measurement in the control group and mild, moderate, and severe OSAS group was 94.1 ±â€Š7.9, 96.9 ±â€Š11, 94.7 ±â€Š8.4, and 93.7 ±â€Š9.4, respectively, with no significant difference between the groups (P > 0.05). PORH measurement in the control group and mild, moderate, and severe OSAS group was 95.6 ±â€Š8.6, 97.9 ±â€Š10.1, 96 ±â€Š8.7, and 93.9 ±â€Š9.3, respectively, with no significant difference between the groups (P > 0.05). OSAS secondary to adenoid hypertrophy in pediatric patients was demonstrated to cause no dysfunction in microvascular circulation and carried no cardiovascular risk in the early period.

Intratympanic steroid injection and hyperbaric oxygen therapy for the treatment of refractory sudden hearing loss / Injeção intratimpânica de corticoides e oxigenoterapia hiperbárica para o tratamento da perda auditiva súbita refratária

Abstract Introduction Controversy surrounds the use of salvage therapies to treat sudden sensorineural hearing loss (SSNHL), with no consensus on recommendations. While several studies have demonstrated the effectiveness of intratympanic administration of steroids (ITS) and hyperbaric oxygen (HBO) treatment, few have compared the efficacy of ITS and HBO therapy in patients with refractory SSNHL. Objective We evaluated the efficiency of ITS and HBO therapy in patients with refractory SSNHL. Methods Patients who did not adequately benefit from systemic treatment were evaluated retrospectively. Refractory patients were defined as those who gained less than 20 dB in hearing after initial treatment. All refractory patients were informed about salvage therapy options: ITS or HBO therapy, the advantages and disadvantages of which were explained briefly. ITS involved 4 mg/mL dexamethasone administered through a 25 gauge needle. Patients underwent HBO therapy in a hyperbaric chamber where they breathed 100% oxygen for 120 min at 2.5 atmospheric pressure. The hearing levels of both groups were evaluated before the salvage therapy and at 3 months after treatment. Improvements in hearing were evaluated according to the Furahashi criteria. We also compared the two therapies in terms of speech discrimination scores (SDSs) and the recovery of all frequencies. Results The salvage therapies generated similar results. Changes in pure tone averages and SDSs were similar for ITS and HBO therapy (p = 0.364 and p = 0.113). Comparison of SDSs and hearing thresholds at all frequencies showed similar levels of improvement. Conclusion ITS and HBO therapy produced similar improvements in SSNHL patients, but the sample size was too small to draw definitive conclusions. Further randomized controlled studies are needed to identify the best therapy for patients with refractory sudden hearing loss.

Resumo Introdução Há muita controvérsia sobre o uso de terapias de resgate para tratar a perda auditiva neurossensorial súbita (PANSS), sem consenso sobre as recomendações. Embora vários estudos tenham demonstrado a eficácia do uso de corticoides intratimpânicos (CIT) e o tratamento com oxigenoterapia hiperbárica (HBO), poucos têm comparado a eficácia da terapia ITS e HBO em pacientes com PANSS refratária. Objetivo Avaliamos a eficiência da terapia com CIT e HBO em pacientes com PANSS refratária. Método Pacientes que não se beneficiaram adequadamente do tratamento sistêmico foram avaliados retrospectivamente. Pacientes refratários foram definidos como aqueles que ganharam menos de 20 dB na audição após o tratamento inicial. Todos os pacientes refratários foram informados sobre as opções de terapia de resgate: terapia com CIT ou HBO, cujas vantagens e desvantagens foram explicadas brevemente. O CIT envolveu 4 mg/mL de dexametasona administrada através de uma agulha de calibre 25. Os pacientes foram submetidos à terapia HBO em uma câmara hiperbárica onde respiraram 100% de oxigênio por 120 min a 2,5 pressão atmosférica. Os níveis de audição de ambos os grupos foram avaliados antes da terapia de resgate e três meses após o tratamento. As melhorias na audição foram avaliadas de acordo com os critérios de Furahashi. Também comparamos as duas terapias em termos de Escores de Discriminação de Fala (EDF) e a recuperação de todas as frequências. Resultados As terapias de resgate demonstraram resultados semelhantes. As alterações nas médias de tons puros e nas EDF foram semelhantes para a terapia com CIT e HBO (p = 0,364 e p = 0,113). A comparação dos EDF e dos limiares de audição em todas as frequências mostrou níveis de melhoria semelhantes. Conclusão CIT e HBO produziram melhorias semelhantes nos pacientes com PANSS, mas o tamanho da amostra era muito pequeno para tirarmos conclusões definitivas. Estudos randomizados e controlados adicionais são necessários para identificar a melhor terapia para pacientes com perda auditiva repentina refratária.

Is corticosteroid a treatment choice for the management of peritonsillar abscess?

OBJECTIVE: To investigate the effect of the single systemic use of corticosteroid following drainage procedure in patients with peritonsillar abscess (PTA). METHODS: This retrospective case-control trial included 32 patients with the diagnosis of PTA between December 2013 and January 2016 in our clinic. Patients were divided into two groups based on the approaches of two authors for the treatment after PTA drainage. The study group included the patients treated with single dose systemic corticosteroid after PTA drainage. Other patients who had no corticosteroid treatment were in the control group. Two groups were compared based on time to oral intake, grade of trismus, pain severity and duration of hospitalization. RESULTS: Statistically significant differences between two groups were observed in terms of time to oral intake, grade of trismus, pain severity and length of hospitalization. The degree of trismus and pain severity significantly decreased in study group comparing to control group at the end of the first day. This difference disappeared at Day 7. Time to oral intake and the duration of hospitalization were shorter in the study group than in control group. CONCLUSION: Corticosteroid treatment following drainage procedure in patients with peritonsillar abscess improves pain severity and trismus thus it decreases time to oral intake and duration of hospitalization.

A Rare Cause of Intranasal Mass: Bilateral Ectopic Nasal Teeth.

INTRODUCTION: Ectopic teeth occur in a wide variety of sites, including the maxillary sinus, mandibular condyle, coronoid process, orbital, and nasal cavities. Reported symptoms and signs associated with nasal teeth include facial pain, external nasal deformities, foul-smelling rhinorrhea, recurrent epistaxis, and oronasal fistula. Ectopic teeth occurring bilaterally in the nasal cavity is very very rare. CASE REPORT: A bilateral intranasal ectopic teeth case, which is asymptomatic on the right side and symptomatic on the left side, is presented. The tooth on left side was extracted endoscopically. There were no complications. CONCLUSION: Extraction of an intranasal tooth under endoscopic guidance is an adequate treatment. If the ectopic intranasal tooth is asymptomatic, clinicians should follow with clinical examination and radiological imaging.

Vit D deficiency is a possible risk factor in ARS.

Vitamin D deficiency is effective in the development of acute rhinosinusitis and prolongation of inflammation by increasing inflammation in the sinonasal epithelium. Vitamin D deficiency is important in the development of bone barriers that prevent the complication of acute rhinosinusitis. Although Vitamin D levels may be a variable risk factor for various respiratory tract disorders, there are limited data on the role in sinonasal infections. Our aim was to investigate the association of 25-hydroxy-vitamin D (25OHD) levels with acute rhinosinusitis (ARS) and preseptal cellulitis complications. The type of the study is prospective case-control study. Fifteen patients in the pediatric age group with ARS-induced preseptal cellulitis complication were identified as Group 1, fifteen patients with ARS and without complication were identified as Group 2, and fifteen healthy volunteers were identified as Group 3. Serum 25OHD levels (nmol/l) were measured in addition to routine blood tests at the first admission of patients participating in the study. Statistical analysis was performed between groups. The ages of the cases ranged from 1 to 14 years with a mean of 5.62 ± 3.42 years. 55.6% of the cases (n = 25) were male; 44.4% (n = 20) were female children. As a result of classification in which vitamin D levels were compared with normal values, there was a statistically significant difference according to the presence of ARS (Group-1 and Group 2) and absence of ARS (Group-3) (p < 0.05). A statistically significant difference was also found between Group 1 and Group-3 (p < 0.05). Statistically significant difference between Group 1 and Group 3 suggests that lack of vitamin D predisposes to the complication of preseptal cellulitis. Comparison of Group 1 and 2 with Group 3 (normal subjects) suggests that Vit D has a protective effect against developing sinusitis.

The Predictive Value of Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratio for the Effusion Viscosity in Otitis Media With Chronic Effusion.

OBJECTIVE: The objective of the authors' study was to investigate the predictive value of the neutrophil-lymphocyte rate (NLR) and platelet-lymphocyte rate (PLR) in otitis media with effusion and the correlation of the effusion type with these ratios. STUDY DESIGN: Retrospective case-control study. METHODS: One hundred twenty-six pediatric patients diagnosed otitis media with chronic effusion and had ventilation tube inserted between October 2015 and July 2016 were included in the study group and 124 healthy children, who applied for the routine examination and had blood count analysis, were included in the control group. The patients in the study group were divided into 2 groups regarding the effusion viscosity, which was obtained from the patients' operation files. Seventy-one patients were included in the serous group and 55 patients in the mucous group. The NLR and PLR rates of the groups were compared and statistically evaluated. RESULTS: The average NLR and PLR rates were significantly higher in the study group than in the control group (P = 0.000, P = 0.004 respectively). Comparison of the serous and mucous groups with the control group revealed a significant difference between the control group and the serous group regarding the NLR and PLR (P = 0.000; P = 0.000 respectively), but not between the control group and mucous group (P = 0.694; P = 0.691 respectively). CONCLUSION: Neutrophil-lymphocyte rate and PLR had a predictive value for otitis media with effusion and additionally it was a laboratory indicator supporting the typing of the viscosity of the fluid accumulated in the middle ear.

Retropharyngeal Abscess Presenting With Sleep Apnea Syndrome.

Retropharyngeal abscess (RPA) is the second most common deep neck space infection after peritonsiller abscess in pediatric population. Major signs and symptoms on physical examination include fever, hypersalivation, odynophagia, reduced oral intake, sore throat, swelling on the neck, torticollis, limitation in neck mobility, and voice changes. In this paper, the authors present a case of RPA with unusual and interesting presenting symptoms in a 10-month-old infant that exhibit new-onset and worsening snoring and sleep apnea. The purposes of this manuscript are to present the authors' experience with this patient, to emphasize the diagnosis, clinical course, and management of RPA in infants, also to signify the importance of including RPA in the differential diagnosis of patients with sleep apnea syndrome.

Intratympanic steroid injection and hyperbaric oxygen therapy for the treatment of refractory sudden hearing loss.

INTRODUCTION: Controversy surrounds the use of salvage therapies to treat sudden sensorineural hearing loss (SSNHL), with no consensus on recommendations. While several studies have demonstrated the effectiveness of intratympanic administration of steroids (ITS) and hyperbaric oxygen (HBO) treatment, few have compared the efficacy of ITS and HBO therapy in patients with refractory SSNHL. OBJECTIVE: We evaluated the efficiency of ITS and HBO therapy in patients with refractory SSNHL. METHODS: Patients who did not adequately benefit from systemic treatment were evaluated retrospectively. Refractory patients were defined as those who gained less than 20dB in hearing after initial treatment. All refractory patients were informed about salvage therapy options: ITS or HBO therapy, the advantages and disadvantages of which were explained briefly. ITS involved 4mg/mL dexamethasone administered through a 25 gauge needle. Patients underwent HBO therapy in a hyperbaric chamber where they breathed 100% oxygen for 120min at 2.5 atmospheric pressure. The hearing levels of both groups were evaluated before the salvage therapy and at 3 months after treatment. Improvements in hearing were evaluated according to the Furahashi criteria. We also compared the two therapies in terms of speech discrimination scores (SDSs) and the recovery of all frequencies. RESULTS: The salvage therapies generated similar results. Changes in pure tone averages and SDSs were similar for ITS and HBO therapy (p=0.364 and p=0.113). Comparison of SDSs and hearing thresholds at all frequencies showed similar levels of improvement. CONCLUSION: ITS and HBO therapy produced similar improvements in SSNHL patients, but the sample size was too small to draw definitive conclusions. Further randomized controlled studies are needed to identify the best therapy for patients with refractory sudden hearing loss.

Is the Monocyte/HDL Ratio a Prognostic Marker of Idiopathic Sudden Hearing Loss?

OBJECTIVE: In this study, our aim was to investigate whether Monocyte/HDL ratio is a marker of the prognosis of the idiopathic sudden hearing loss (ISHL). STUDY DESIGN: Retrospective, case-control clinical trial. MATERIALS AND METHODS: 45 patients, who were diagnosed with idiopathic sudden hearing loss and were treated with the same therapy regime and 47 healthy volunteers, who applied to the hospital for routine controls and had audiological and laboratory examination between March 2014 and December 2015, were included in the study. Monocyte/HDL ratios of the patients in the study and control groups were calculated from the results of the blood counts and biochemical analysis. Additionally, the study group was divided into two sub-groups regarding their responses (responders and non-responders) to the treatment determined by the audiological examination, which was carried out after 3 months according to the Siegel criteria. The Monocyte/HDL ratios between the groups were statistically evaluated. RESULTS: There was no statistically significant difference between the MHRs of the study and control groups (p=0.574). However, the MHR was significantly higher in the non-responders? group compared with the responders? group, although they were treated with the same therapy regimen (p=0.005). CONCLUSION: There was no difference in MHRs between study and control groups. However, as MHR was higher in the patients with good prognosis compared with the patients with bad prognosis, we believe that regarding the ISHL, MHR is not a predictive value but might have prognostic marker.

Acute Palatal Perforation and Peroperative Repair Method During Septoplasty Operation.

Septoplasty is a frequent and relatively low-risk procedure in otolaryngology practice. Palatal perforation complication is very rare in the literature and only a few patients have been reported. In this clinical report, a patient with palatal perforation that has been developed and noticed during the septoplasty operation with no anatomical abnormality and alternative repair method are reported with video of the procedure.