Expressions of MMP2, MMP9, and TIMP-1 in the inflammatory cells of nasal polyps: granulocytes, monocytes, and mast cells.

OBJECTIVE: We investigated the role of matrix metalloproteinase-2 (MMP-2) and MMP-9 in nasal polyp (NP) pathogenesis. PATIENTS AND METHODS: In group 1 (n = 24), polyp specimens were obtained from maxillary sinus, ethmoid sinus, and nasal cavity. In group 2 without NP (control) (n = 11), inferior turbinate samples were taken. Inflammatory cell count and MMP2, MMP9 and tissue inhibitor of metalloproteinase-1 (TIMP-1), positivity indexes (PIs) were evaluated. RESULTS: Granulocyte and mast cell-MMP2 and MMP9-PI were higher than the rate of monocyte-MMP2-PI and monocyte-MMP9-PI, respectively, in the ethmoid sinus, maxillary sinus, and nasal cavity. Mast Cell-TIMP1-PI was higher than the rates of granulocyte-TIMP1-PI and monocyte-TIMP1-PI in the maxillary sinus and was higher than the rate of monocyte-TIMP1-PI in the ethmoid sinus. CONCLUSIONS: Excessive MMP2 and MMP9, compared to TIMP1, are present in granulocytes and mast cells, respectively. With matrix MMPs, the extracellular matrix is destroyed, leading inflammatory cells to pass through, causing polypoid degeneration.

Is there a relationship between mastoid pneumatisation and facial canal dimensions?

OBJECTIVE: To evaluate mastoid pneumatisation and facial canal dimensions. METHOD: In this retrospective study, 169 multidetector computed tomography scans of temporal bone were reviewed. Facial canal dimensions were evaluated at the labyrinthine, tympanic and mastoid segments using axial and coronal multidetector computed tomography scans of temporal bone. Mastoid pneumatisation and facial canal dehiscence were evaluated. Facial canal dehiscence was measured if it was found to be present. RESULTS: This study showed that facial canal dimensions decreased in pneumatised mastoids. Facial canal dimensions in females were smaller than in males. Facial canal dehiscence was detected in 5.9 per cent and 6.5 per cent of the patients on the right and left sides, respectively. No correlations were found between facial canal dehiscence and mastoid pneumatisation. The length of dehiscence was 1.92 ± 0.44 mm (range, 0.86-2.51 mm) on the left side. In older subjects, left facial canal dehiscence was detected more, and the length of the dehiscence increased. CONCLUSION: This study concluded that during surgery, facial canal dehiscence should be kept in mind in order to avoid complications.

Olfactory bulb volume and olfactory sulcus depth in patients with Behçet's disease.

OBJECTIVE: To investigate olfactory bulb volume and olfactory sulcus depth in patients with Behçet's disease, using magnetic resonance imaging. METHODS: Cranial magnetic resonance imaging scans of 27 adults with Behçet's disease (10 males and 17 females) and 27 healthy controls were examined. Olfactory bulb volume and olfactory sulcus depth were measured on coronal, T2-weighted, spectral pre-saturation with inversion recovery sequences. RESULTS: Bilateral olfactory bulb volume and right-sided olfactory sulcus depth were significantly lower in the Behçet's disease group than in the control group (p < 0.05). Left-sided olfactory sulcus depth increased with Behçet's disease duration. In both groups, olfactory bulb volume was significantly higher in the left than the right side. There were no gender differences for olfactory bulb volume and olfactory sulcus depth. Positive correlations were determined between right- and left-sided olfactory bulb volume values and between right- and left-sided olfactory sulcus depth values. CONCLUSION: Behçet's disease may decrease olfactory functions, related to lower olfactory bulb volume and olfactory sulcus depth. The affected vascular system and possibly damaged neural system, nasal mucosal lesions, and prolonged nasal mucociliary clearance time may cause olfactory dysfunction. Patient follow up is recommended, with magnetic resonance imaging examinations of the olfactory system if necessary.

The role of endothelial nitric oxide synthase (eNOS) in the pathogenesis of sinonasal polyps.

OBJECTIVE: The pathogenesis of sinonasal polyps has not been known completely. We investigated the role of endothelial Nitric Oxide Synthase (eNOS) in the pathogenesis of sinonasal polyps. PATIENTS AND METHODS: Study group (Groups 1-3) consisted of nasal polyp samples of patients with sinonasal polyps; and control group consisted of inferior turbinate samples of patients without nasal polyp. In Group 1: 14 specimens from ethmoid sinus; in Group 2: 10 specimens from nasal cavity; in Group 3: 10 specimens from maxillary sinus; and in Group 4 (Control): 9 specimens from inferior turbinate were included. By immunohistochemical staining technique, eNOS Positivity Index in mucosal layers; and in the inflammatory cells were assessed. RESULTS: eNOS Positivity Index was higher at apical layer of epithelium; and perivascular and glandular parts of subepithelial layer. As a rate of mononuclear cells increased, eNOS positivity increased at basal part of epithelium. In eNOS Positivity Index of mononuclear cells increased ones, eNOS values also increased at glands of subepithelial layer. In nasal cavity, eNOS positivity index of all cells was significantly higher than that of the control group. Increased eNOS all cells positivity index values were seen with decreased glandular and endothelial eNOS values. In all cells group, fibroblasts were seen beside the mononuclear cells. It was observed that eNOS was not expressed in PMNC (mainly neutrophils), growing more in acute inflammatory process; and was expressed in MNCs and all cells group with fibroblasts which were the cells of chronic inflammatory process. Especially MNCs and fibroblasts may play a role in the polyp formation process. In males and in patients with longer polyp duration, eNOS values decreased. CONCLUSIONS: We concluded that eNOS Positivity Index was higher at apical layer of epithelium; and perivascular and glandular parts of subepithelial layer. eNOS plays role in vascular dilatation, increases in vascular permeability; increases in nasal secretion due to glandular secretion; and edema in subepithelial and deep layers of the mucosa by affecting glands. Irritant agents in the breathing air and environment may cause increase in eNOS values at apical part of epithelium and may promote polyp formation by vasodilatation and increased glandular secretion due to increased nitric oxide values. In elderly patients and in long standing polyps, eNOS values decreased causing more fibrotic polyps.

Inducible nitric oxide synthase (iNOS) in sinonasal polyp pathogenesis.

OBJECTIVES: We investigated the role of inducible nitric oxide synthase (iNOS) in the pathogenesis of sinonasal polyps. METHODS: Adult patients (21 men, 3 women) with nasal polyposis underwent functional endoscopic sinus surgery. Nine adults without polyps (6 men) who underwent septoplasty and/or rhinoplasty served as controls. Polyp specimens came from three regions: the maxillary sinus (10), ethmoid sinus (14), and nasal cavity (10). Control group samples (9) came from the inferior turbinate. Specimens were evaluated in eight mucosal layers for count and distribution of inflammatory cells and iNOS expression. An iNOS positivity index (PI) was determined for the epithelium (E), subepithelial layer of the lamina propria (SE), and deep paraglandular layer of the mucosa (D). RESULTS: Polymorphonuclear cell (PMNC) % values of the ethmoid and maxillary sinus and overall ethmoid sinus PI were significantly higher in the polyp group. Patients with longer polyp duration, D-perivascular (D-pv), and a higher Brinkmann index had decreased ethmoid sinus D PIs. However, in older patients and patients with longer polyp duration, perivascular PIs increased in maxillary sinus SE and D, respectively. Furthermore, as PMNC % and iNOS-PMNC PI increased, SE_glandular and epithelial_apical iNOS values decreased. In the ethmoid and maxillary sinuses, iNOS_D_. endothelial values increased but decreased in the nasal cavity. CONCLUSIONS: iNOS may play a role in sinonasal polyp pathogenesis, especially in mucosal SE and D layers. Increased vascular permeability, stromal edema, inflammatory cell migration into the stroma of the mucosa, and increased mucosal gland secretion may result in polyp formation.

Is there any correlation between chronic noise-induced hearing loss and mastoid pneumatization volume? A preliminary study.

OBJECTIVES: To investigate the possible association between chronic noise-induced hearing loss and the volume of mastoid pneumatization. METHODOLOGY: The study involved 46 subjects employed in the press and montage department of a gun factory: 28 in the study group with noise-induced hearing loss and 18 in the control group with no hearing loss. The volume of mastoid pneumatization was measured with computed tomography. Student's t test was used in the comparison of the mastoid volumes of the study and the control groups. RESULTS: The intergroup evaluations showed no significant difference between the study and control group with regards to age, use of substances or ototoxic drugs, systemic diseases, use of personal hearing protectors, duration of occupational and non-occupational noise exposure was observed (P > 0.05). The mean values of mastoid pneumatization in the study and the control groups were 9717.6 mm3 and 11005.8 mm3, respectively. Although the volume of mastoid pneumatization was smaller in the study group than in the control group, this difference was not statistically significant (P > 0.05). CONCLUSIONS: This preliminary study showed that there was no significant correlation between mastoid pneumatization volume and chronic noise-induced hearing loss. However, this correlation could be significant in further studies with a larger number of subjects.

Treatment of rhinophyma with radiofrequency: a case report.

PROBLEM: Rhinophyma is characterized by a slow progressive enlargement of the nasal skin that cannot resolve spontaneously. Clinically, the lower two-thirds of the nose becomes enlarged and hypervascular, developing a reddish-purple discoloration and a nodular appearance. It is believed that rhinophyma represents the end stage of acne rosacea. The treatment modalities are medical and surgical. CASE: This study describes a 62-year-old man with rhinophyma that was treated with a radiofrequency technique. The pathological examination was compatible with acne rosacea. After surgery, a broad-spectrum sunscreen was applied until reepithelialization was complete. CONCLUSION: We recommend the radiofrequency technique for treatment of rhinophyma.

Effects of subjective tinnitus on sleep quality and Mini Mental Status Examination scores.

OBJECTIVES: We investigated the effects of subjective tinnitus on sleep quality and Mini Mental Status Examination (MMSE) scores of participants. METHODS: The study group consisted of 15 patients, including 21 ears with tinnitus (6 bilateral, 9 unilateral). The control group consisted of 8 healthy patients with normal hearing and no tinnitus (16 ears). We assessed sleep quality using the Mini Sleep Questionnaire (MSQ) and mental health using the MMSE. RESULTS: Sleep delay (SD) was significantly higher in tinnitus patients (5.28 +/- 2.23) compared to controls (3.25 +/- 2.56) (p = 0.018). Subjective tinnitus loudness level (STLL) scores were higher and sleep quality was impaired in females, older patients, and patients with lower MMSE scores. Sleep quality was also worse in patients with longer tinnitus duration. In younger and well educated patients, MMSE scores were higher. Higher STLL scores and shorter tinnitus duration were associated with lower MMSE scores. Patients with newly developed tinnitus reported more disturbances and showed greater effects on mental and cognitive functioning. CONCLUSION: In subjective tinnitus patients, sleep delay values increased. Long tinnitus duration and high STLL scores may affects patients' cognitive functions as shown by decreased MMSE scores. Furthermore, mental status changes in tinnitus patients were frequently overlooked.

MR spectroscopy in a cervical abscess.

MR spectroscopy (MRS) has been used to analyse noninvasively tissues at a molecular level. Hydrogen and phosphorus MRS have been used for characterisation of intracranial solid and cystic masses, gynaecological tumours and lymph nodes. We report a cystic, tick-walled mass in the soft tissues of the neck. Single-voxel proton MRS revealed a prominent acetate peak at 1.92 ppm and a diagnosis of abscess was suggested. At operation a pyogenic neck abscess was confirmed, with culture of the pus.