Turkish Guideline for Diagnosis and Treatment of Allergic Rhinitis (ART).

OBJECT: To prepare a national guideline for Otorhinolaryngologist who treat allergic rhinitis patients. METHODS: The study was conducted by three authors, namely the writing support team. The support team made the study plan, determined the writing instructions, chose the subgroups including the advisory committee, the advisors for authors and the authors. A workshop was organized at the very beginning to explain the details of the study to the team. Advisors took the chance to meet their coworkers in their subgroups and determined the main headings and subheadings of the guideline, together with the authors. After key words were determined by the authors, literature search was done in various databases. The authors keep in touch with the advisors and the advisors with the advisory committee and the support group at every stage of the study. National and International published articles as well as the abstracts of unpublished studies, imperatively presented in National Congresses, were included in this guideline. Only Guideline and meta-analyses published in last seven years (2013-2017) and randomized controlled studies published in last two years (2015-2017) were included. After all work was completed by the subgroups, support team brought all work together and edited the article. RESULTS: A detailed guideline about all aspects of allergic rhinitis was created. CONCLUSION: The authors believe that this guideline will enable a compact and up-to-date information on allergic rhinitis to healthcare professionals. This guideline is the first in the field of Otolaryngology in Turkey. It should be updated at regular intervals.

Frequency of Epstein-Barr virus and human papilloma virus in patients with nasopharyngeal carcinoma.

PURPOSE: Nasopharyngeal cancer is a type of malignancy originating from the epithelial cells lining the nasopharynx. In genetic and environmental factors, infection with Epstein-Barr virus is one of the particular factors held accountable for the etiopathogenesis. Human papillomavirus has been associated with cervical, anogenital, and oropharyngeal cancers. The aim of the present study is to demonstrate the presence and incidence of Epstein-Barr virus and human papillomavirus in patients with nasopharyngeal cancer. METHODS: The information collected for these patients included age at the time of biopsy, gender, alcohol consumption and smoking, and histopathological type of nasopharyngeal cancer. Only patients for whom nasopharyngeal biopsy was performed as punch biopsy were included in the study. In situ hybridization was performed with formalin-fixed, paraffin-embedded tissue sections for Human Papillomavirus and Epstein-Barr virus nucleic acids obtained by means of automated Ventana BenchMark Medical system RESULTS: Utilizing in situ hybridization with samples obtained from 56 patients diagnosed with nasopharyngeal cancer. Epstein-Barr virus was positive in 41 out of the 56 (73.2%) patients, while human papillomavirus was positive in 3 (5.4%), and 1 patient (1.8%) had co-infection. Thirty seven (90.2%) of the 41 patients positive for Epstein-Barr virus were Type-2 according to WHO, while 4 (9.8%) were Type-1. All three patients (100%) with Human Papillomavirus positivity were Type-2 according to WHO. CONCLUSIONS: This study shows the close association between nasopharyngeal cancer and Epstein-Barr virus whereas such an association is not shown for Human Papillomavirus.

Late-term Effects of Surgery on Nasal Functions in Patients who Underwent Total Laryngectomy Surgery

Abstract Introduction There is a common opinion that losing airway functions in total laryngectomy patients cause changes in nasal physiological rates. Studies conducted to review the subject present gaps, especially in terms of objective measurements. Objective We evaluated late-term effects of surgery on nasal functions in patients who underwent total laryngectomy surgery more than two years ago. Methods We included in the study 22 patients who had undergone total laryngectomy, as well as 24 healthy subjects with similar demographic characteristics as the control group. We performed acoustic rhinometry for intranasal volume and cross-sectional area measurements, saccharin test formeasurement of nasalmucociliary clearance, and smell identification test for evaluation of olfactory function in the patient and control groups. We compared and statistically analyzed the data obtained from the groups. Results In our study, although late-term (>2 years) measurements were not statistically significant, we detected more nasal passage patency in the patient group than in the control group. In smell identification test, lower scores were obtained in the patient group. The difference between measurements in both groups was statistically significant. Conclusion We believe that since the upper respiratory tract is disabled due to tracheostomy in patients with total laryngectomy, atrophy occurs in the late term and, consequently, nasal mucociliary clearance is impaired. We also see diminished olfactory function in total laryngectomy patients.

Late-term Effects of Surgery on Nasal Functions in Patients who Underwent Total Laryngectomy Surgery.

Introduction There is a common opinion that losing airway functions in total laryngectomy patients cause changes in nasal physiological rates. Studies conducted to review the subject present gaps, especially in terms of objective measurements. Objective We evaluated late-term effects of surgery on nasal functions in patients who underwent total laryngectomy surgery more than two years ago. Methods We included in the study 22 patients who had undergone total laryngectomy, as well as 24 healthy subjects with similar demographic characteristics as the control group. We performed acoustic rhinometry for intranasal volume and cross-sectional area measurements, saccharin test for measurement of nasal mucociliary clearance, and smell identification test for evaluation of olfactory function in the patient and control groups. We compared and statistically analyzed the data obtained from the groups. Results In our study, although late-term (>2 years) measurements were not statistically significant, we detected more nasal passage patency in the patient group than in the control group. In smell identification test, lower scores were obtained in the patient group. The difference between measurements in both groups was statistically significant. Conclusion We believe that since the upper respiratory tract is disabled due to tracheostomy in patients with total laryngectomy, atrophy occurs in the late term and, consequently, nasal mucociliary clearance is impaired. We also see diminished olfactory function in total laryngectomy patients.

Frequency of Serous Otitis Media in Children without Otolaryngological Symptoms

Abstract Introduction Otitis media with effusion is the fluid in the middle ear with no signs or symptoms of acute ear infection. Objective This study aims to research the frequency of serous otitis media in patients referred to the pediatric clinic between 3-16 years of age without any active ear, nose, and throat complaints. Methods This study included 589 children patients (280 boys, 309 girls; mean age: 9.42; range 3-16) who were administered to the pediatric clinic without otolaryngologic complaints. Patients underwent examination with flexible nasopharyngoscopy for adenoid hypertrophy. An otorhinolaryngologist examined all children on both ears using an otoscope and tested with tympanometry. We used tympanometry results to diagnose SOM. Results The study included 589 patients that underwent fiber optic examination of the nasopharynx with an endoscope. Adenoid vegetation was present in 58 patients (9.8%) and was not detected in 531 patients (90.2%). We found serous otitis media in 94 (15.9%) patients. We obtained Type A tympanogram in 47 (81%) of 58 patients with adenoid vegetation, 6 (10.3%) Type B, and 5 (8.6%) Type C.When comparing 58 patients with adenoid vegetation with 538 patients without adenoid vegetation for serous otitis media, the frequency was not statistically significant (p > 0.05). Conclusion We believe that in children without any ear, nose, and throat complaints, it is possible to detect serous otitis media with adenoid vegetation. Thus, pediatric patients should undergo screening at regular intervals.

Frequency of Serous Otitis Media in Children without Otolaryngological Symptoms.

Introduction Otitis media with effusion is the fluid in the middle ear with no signs or symptoms of acute ear infection. Objective This study aims to research the frequency of serous otitis media in patients referred to the pediatric clinic between 3-16 years of age without any active ear, nose, and throat complaints. Methods This study included 589 children patients (280 boys, 309 girls; mean age: 9.42; range 3-16) who were administered to the pediatric clinic without otolaryngologic complaints. Patients underwent examination with flexible nasopharyngoscopy for adenoid hypertrophy. An otorhinolaryngologist examined all children on both ears using an otoscope and tested with tympanometry. We used tympanometry results to diagnose SOM. Results The study included 589 patients that underwent fiber optic examination of the nasopharynx with an endoscope. Adenoid vegetation was present in 58 patients (9.8%) and was not detected in 531 patients (90.2%). We found serous otitis media in 94 (15.9%) patients. We obtained Type A tympanogram in 47 (81%) of 58 patients with adenoid vegetation, 6 (10.3%) Type B, and 5 (8.6%) Type C. When comparing 58 patients with adenoid vegetation with 538 patients without adenoid vegetation for serous otitis media, the frequency was not statistically significant (p > 0.05). Conclusion We believe that in children without any ear, nose, and throat complaints, it is possible to detect serous otitis media with adenoid vegetation. Thus, pediatric patients should undergo screening at regular intervals.

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.

[The evaluation of the outcomes of nasal obstruction surgery by acoustic rhinometry measurements and effects of nasal obstruction on daytime sleepiness]. / Nazal obstrüksiyon cerrahi sonuçlarinin akustik rinometri ölçümleri ile degerlendirilmesi ve burun tikanikliginin gündüz uykululuk hali üzerine etkisi.

OBJECTIVES: In this study, we aimed to investigate the correlation between nasal obstruction findings of the patients who underwent nasal surgery, as assessed by analog scales for the patients and physician and acoustic rhinometry measurements and to establish the effect of nasal obstruction on daytime sleepiness. PATIENTS AND METHODS: Between August 2007 and September 2008, 55 patients (40 males, 15 females; mean age 30 years; range 15 to 56 years) who admitted with the complaint of nasal obstruction and underwent nasal surgery were included. Pre- and postoperative acoustic rhinometry measurements for both nasal cavities were performed. Nasal obstruction was graded by the analog scales for patients and physicians. Epworth Sleepiness Scale (ESS) was used for the evaluation of nasal obstruction on daytime sleepiness. RESULTS: In the preoperative period, a statistically significant correlation between the analog scales for the patients and physicians, and acoustic rhinometry values was found, while no statistically significant correlation was available in the postoperative period. A statistically significant correlation was also observed between pre- and postoperative analog scales for the patients and physicians. There was a statistically significant difference between the pre- and postoperative ESS scores. CONCLUSION: Acoustic rhinometry is a reliable method which provides objective data regarding the effects and outcomes of surgery. The analog scales are also useful to establish the degree of nasal obstruction. Nasal obstruction has an effect on increased complaints of daytime sleepiness.

Kikuchi-Fujimoto disease coexisted with Sjogren's syndrome.

Here we described a case of primary Sjogren's syndrome that coexisted with Kikuchi-Fujimoto disease.

The comparison of single-dose ceftriaxone, five-day azithromycin, and ten-day amoxicillin/clavulanate for the treatment of children with acute otitis media.

The aim of the study was to evaluate the efficacy of short-course antimicrobial therapies [single intramuscular dose of ceftriaxone (50 mg/kg, not exceeding 1 g), 5 days of azithromycin (10 mg/kg on day 1, then 5 mg/kg daily on days 2-5) and the traditional 10-day course of amoxicillin/clavulanate (90/6.4 mg/kg/day in 2 doses)] in children with acute otitis media (AOM). The study was conducted as a prospective, comparative, open randomized trial between February 2001 and April 2003, and 104 children were enrolled, with a mean age of 3.8 (2.3) years. The clinical and otoscopic assessments of the children were made on days 0, 3, 11 and 30 after admission, and tympanometry was performed on day 30. The patients were diagnosed and followed with a scoring system. Clinical success was achieved in 29/34 patients (85.3%) in the ceftriaxone group, 27/31 patients (87.1%) in the azithromycin group and 34/39 children (87.2%) in the amoxicillin/clavulanate group. The rate of persistence of middle-ear fluid did not differ between the three groups (p>0.05). During the one-month period, no recurrent case was observed. The most common drug-related adverse effects were associated with the gastrointestinal system. In conclusion, for the treatment of children with AOM, the clinical success of single-dose intramuscular ceftriaxone and of five-day azithromycin treatments was comparable to that of the traditional 10-day therapy with high-dose amoxicillin/clavulanate.

Bilateral choanal atresia in premature monozygotic twins.

Bilateral congenital choanal atresia is a relatively rare anomaly of the upper airway, which may cause life-threatening respiratory emergency and require rapid diagnosis and treatment. This condition usually occurs sporadically, but has also been rarely described in siblings. We present monozygotic premature twin infants with identical findings of bilateral choanal atresia and no other associated anomalies. To our knowledge, this is the first report of such an occurrence.

Supracricoid partial laryngectomy with cricohyoidopexy and cricohyoidoepiglottopexy: functional and oncological results.

Sixty-eight patients who presented with glottic and glottosupraglottic squamous cell carcinoma and who were managed in this department with supracricoid partial laryngectomy (SCPL) with either cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP), were retrospectively reviewed. The authors analysed the functional and oncological results of the patients. The median follow-up period was 62 months. The average times until decannulation and nasogastric feeding tube removal were 27.7 and 26.4 days, respectively. All patients were successfully decannulated. All patients were able to swallow, but one patient was unable to swallow and had recurrent aspiration. Better functional results were achieved in patients managed with CHEP procedure than the patients managed with CHP procedure. The five-year absolute and cause-specific actuarial survival rates (Kaplan-Meier method) were 78.6 per cent and 93.9 per cent, respectively. The five-year actuarial local control and nodal control rates were 89.5 per cent and 90.4 per cent, respectively. Local recurrence was statistically more likely in patients with positive resection margins (p <0.006). Overall, local control and laryngeal preservation were achieved in 95.6 per cent and 89.7 per cent, respectively. Supracricoid partial laryngectomy procedures (CHEP and CHP) are possible alternatives to total laryngectomy in the treatment of selected advanced glottic and glottosupraglottic carcinomas.

[Assessment of quality of life in patients with laryngeal cancer after surgical treatment]. / Larenks kanserli hastalarin cerrahi tedavi sonrasi yasam kalitesinin degerlendirilmesi.

OBJECTIVES: To evaluate quality of life of patients undergoing surgical treatment for larynx cancer and to compare quality of life between patients with total laryngectomy and partial laryngectomy. PATIENTS AND METHODS: Thirty-two questions were asked to patients who underwent total laryngectomy (22 subjects) or partial laryngectomy (24 subjects). These questions were based on the European Organization for Research on Treatment of Cancer questionnaires Quality of Life--C30 (EORTC-QoL-C30) and adapted to our nation. Patients with total laryngectomy and partial laryngectomy were compared according to the answers. RESULTS: We found significant statistical differences between total and partial laryngectomy patients in 12 questions. When functional disorders were evaluated, the most significant was one associated with communication. However, pain, smell disorders and increased secretion were associated with morbidity that resulted from the type of surgery. It was observed that patients with total laryngectomy were particularly affected psychologically and economically. CONCLUSION: Patients subjected to total laryngectomy experience serious physical and psycho-social disadvantages that arise from the treatment. In order to establish these negative effects and to minimize them, tools of assessment of quality of life should be developed. This assessment should be appropriate for our nation, providing information and psychological support for individuals and their families.

Effect of topically applied povidone-iodine on transient evoked otoacoustic emissions in guinea pigs.

The possible cochlear toxicity of topically applied povidone-iodine solution was investigated in guinea pigs by measuring transiently evoked otoacoustic emissions (TEOAEs). Seven adult pigmented guinea pigs (14 ears) with a normal acoustic pinna reflex were used. After the baseline TEOAE measurements, 0.1 mL of povidone-iodine solution was applied transtympanically into the middle ear in the study group. Saline solution and gentamicin were used as negative and positive control, respectively. TEOAE measurements were repeated on the 10th day, and four weeks after the first application. Tympanometric measurements were also carried out for both ears of all animals at the end of the study. Responses in all ears, which had povidone-iodine applied to them, disappeared in a way similar to those recorded in gentamicin-treated ears. Tympanometric measurements at the end of the study showed 'type A' tympanograms in all ears of all animals. The present study showed that povidone-iodine could have a cochleotoxic effect in guinea pigs. A study in humans with TEOAE before and after middle-ear surgery, where povidone-iodine can reach into the middle-ear cavity, may be useful for evaluating this result for clinical practice.

Unusual complication of tonsillectomy: taste disturbance and the lingual branch of the glossopharyngeal nerve.

Taste disturbance is an unusual complication of tonsillectomy of which there are very few reports in the literature. The possible causes of this rare complication are: (1) direct or indirect damage to the glossopharyngeal nerve or its lingual branch (LBGN), (2) lack of dietary zinc, and (3) habitual drug intake. We report a 41-year-old man, who complained of taste disturbance following tonsillectomy that was performed for chronic tonsillitis and unilateral (left) tonsillar hypertrophy. During surgery, hypertrophic tonsils were found to be sited deeply into the tonsillar bed, especially at the lower pole of the left tonsil. Pathologic examination following tonsillectomy revealed a keratinous cyst and chronic infection at the left tonsil, and lymphoid hyperplasia and chronic infection at the right tonsil. Although his complaint had been getting better, qualitative examination of his taste function revealed bilateral impairment of the sense of sweet taste on the base of his tongue two months after the surgery, and a taste disturbance of sweet taste on the left side persisted the 10th month after the surgery. His serum zinc value was normal, and he did not take any drug that could affect his sense of taste. Depending on the literature data, possible indirect damage to the LBGN was suspected as the cause of the taste disturbance. This symptom may be reversible within two years after tonsillectomy, but it can also be irreversible. Therefore, tonsillectomy should be performed with minimal trauma to the tonsillar bed, especially when there is an additional pathology extending into the lower pole, and such a patient should be informed of the risk of post-operative taste disturbance after tonsillectomy as being one of the rare complications of this surgery.