Olfactory changes after endonasal endoscopic cerebrospinal fluid fistula repair: long-term outcomes.

OBJECTIVE: This study aimed to evaluate odour measurements after endoscopic repair of cerebrospinal fluid fistulas. METHOD: Demographic characteristics, cerebrospinal fluid leak location, surgical procedure, aetiology and smell test results were retrospectively reviewed. RESULTS: A total of 27 patients were included. The mean age was 43.52 years. The aetiology was spontaneous in 13 patients (48.1 per cent) and traumatic in 14 patients (51.9 per cent). The skull base defect was at the cribriform plate in 15 patients (55.6 per cent), the frontal sinus posterior wall in 4 patients (14.8 per cent), the sphenoid sinus posterior wall in 4 patients (14.8 per cent), around the anterior ethmoid artery in 2 patients (7.4 per cent), at the ethmoid roof in 1 patient (3.7 per cent) and at the sphenoid sinus posterolateral wall in 1 patient (3.7 per cent). After the comparison of pre-operative and post-operative values in identification, discrimination and threshold categories, a statistically significant difference was seen only in the threshold category (p = 0.014). CONCLUSION: The results demonstrated that endoscopic repair of cerebrospinal fluid leak is safe in terms of olfactory functions.

Oral steroids and intraoperative bleeding during endoscopic sinus surgery.

OBJECTIVES: Our main objective was to investigate the effect of preoperative oral steroids on intraoperative bleeding and quality of the surgical field during endoscopic sinus surgery (ESS). Our second objective was to determine whether the osteitis score could be used to predict the volume of intraoperative bleeding. METHODOLOGY: This double-blinded, randomized trial included 65 patients with chronic rhinosinusitis with nasal polyps. The corticosteroid group received oral prednisolone (1 mg/kg), administered to patients once daily for 2 days and then tapered down, with treatment completed on the day 10. The control group received placebo before the operation. Endoscopic exams were recorded, and preoperative sinus computed tomography scans were scored. Intraoperative blood loss was recorded. Quality of the surgical field was assessed by the surgeon, using a linear scale from 1 to 10. RESULTS: The mean bleeding volume was 239 ml in the corticosteroid group and 203 ml in control group. There was no significant difference between the groups (p = 0.495). Surgical field quality scores were higher in the corticosteroid group than in the control group, but the difference was not significant (p = 0.36). There was no statistically significant relationship between the bleeding volume and Kennedy Osteitis Scores in corticosteroid group (r = 0.225, p = 0.186) and control group (r = 0.084, p = 0.663). CONCLUSION: Our findings suggest that using oral corticosteroids, which have rare but serious side effects, is not necessary in the preoperative period. Furthermore, we found that the radiological osteitis score was not a suitable marker for predicting intraoperative bleeding volumes.

Chronic rhinosinusitis; histopathologic study of osteitis in surgery cases.

OBJECTIVE: To determine whether osteitis is associated with primary and revision surgery in patients with chronic rhinosinusitis (CRS) and to determine its relationship with mucosal inflammation. METHODOLOGY: Patients were divided into two groups based on a history of prior endoscopic sinus surgery (ESS). The primary surgery group included 74 patients who had ESS for the first time, and the revision surgery included 37 patients who had repeat ESS. Histopathological examinations were performed on specimens taken from the bony septa of the ethmoid with the overlying mucosa. RESULTS: The incidence of osteitis was 70.3% in patients in the revision surgery group and 56.8% in patients in the primary surgery group (p = 0.229). Osteitis was associated with tissue eosinophilia and a predominance of inflammatory cells (p = 0.01 and p = 0.01, respectively). CONCLUSIONS: Surgery may not be the primary cause of bone remodeling in the sinus area. Mucosal inflammation had no effect on the incidence of osteitis when it was associated with tissue eosinophilia in CRS. Patients with osteitis may benefit most from postoperative corticosteroid therapy to prevent further recurrence.

The effect of adenoid hypertrophy on tympanometric findings in children without hearing loss.

OBJECTIVES: This study aims to investigate the effects of adenoid hypertrophy on negative middle ear pressure and diagnostic efficiency of tympanogram in the detection of otitis media with effusion in children without parental suspicion of hearing loss. PATIENTS AND METHODS: Fifty-six children (26 boys, 30 girls; mean age 5.9±2.2 years; range, 3 to 12 years) who underwent adenoidectomy were analyzed using otoscopy, nasal endoscopy, and tympanometry (before 1 week and 3 months after adenoidectomy). RESULTS: The median negative middle ear pressure before the adenoidectomy was significantly higher from after adenoidectomy (p=0.045). Type B tympanogram were detected in 13 of the 112 ears preoperatively. About 17.9% (n=20) of the ears with otitis media with effusion were confirmed by myringotomy. CONCLUSION: Our study findings suggest that the adenoid hyperthrophy is associated with increased negative pressure in the middle ear. We believe that it is necessary to perform the middle ear examination and tympanometry in children before adenoidectomy and in children without parental suspicion of hearing loss, even.

[Evaluation of the effect of intranasal corticosteroid sprays on radiofrequency tissue ablation in the treatment of hypertrophied inferior turbinate]. / Alt konka hipertrofisinin tedavisinde uygulanan radyofrekans doku ablasyonuna intranazal kortikosteroid spreylerin etkisinin incelenmesi.

OBJECTIVES: This study aims to evaluate the effect of combining the confidingly preferred modality of radiofrequency (RF) application with intranasal corticosteroid spray treatment on the efficacy of RF and on the number of sessions in patients with hypertrophy of inferior turbinate. PATIENTS AND METHODS: Fifty patients (37 males, 13 females; mean age 42.9 years; range 15 to 74 years) who admitted with the complaint of nasal obstruction and were detected to have hypertrophied inferior turbinate by nasal endoscopy were enrolled in the study. The patients were divided into two groups, each consisting of 25 patients. Before the treatment, the severity of nasal obstruction was evaluated and scored by a visual analogue scale (VAS). Radiofrequency was applied to every patient. Control group received no medical treatment following RF application. Drug group received mometasone furoate nasal spray (MFNS) at a dose of 200 mcg once daily into both nasal passages for eight weeks following surgery. All patients were asked to return for a control visit at week eight after treatment. Radiofrequency application was repeated in patients who continued to have complaints of nasal blockage. At the end of treatment, patients were reevaluated and VAS scores were recorded. RESULTS: The improvement in VAS scores following treatment was statistically significant in both groups (p<0.05). When the two groups were compared, there was no statistical difference between the two groups before treatment; however there was an improvement in the post-treatment corticostreoid group (p<0.05). The mean session number was calculated to be 1.16 in the control group and 1.08 in the corticosteroid treatment group. The difference between the two groups was not statistically significant (p>0.05). CONCLUSION: We recommend the use of intranasal corticosteroids with RF applications to increase the efficacy of radiofrequency.

[The relationship between hypothyroidism and rhinitis]. / Hipotirodizm ve rinit arasindaki iliski.

OBJECTIVES: This study proposed relationship between rhinitis and hypothyroidism and the possibility of whether hypothyroid patients with symptoms of rhinitis could recover by treatment are investigated. PATIENTS AND METHODS: Twenty-five patients (19 females, 6 males; mean age 42.2 years; range 19 to 65 years) diagnosed with hypothyroidism and examined in our clinic by the same doctor between February 2004 and February 2005 were included in the study. In order to evaluate the symptoms of the patients, a detailed form was filled. The degree of symptoms was determined with the visual analog scale (VAS) by the patients. All patients underwent otorhinolaryngologic examination including nasal endoscopy where the color of nasal mucus, turbinate hypertrophy and rhinorrhea were recorded. Nasal air flows were measured by peak-flow meter. Mucociliary clearance was measured by the saccharin test. Following all the measurements, patients were started on oral therapy with levothyroxin sodium tablets by the ambulatory endocrinology clinic. When the degree of serum thyroid stimulating hormone level fell below 4 microIU/dl, each complaint was re-evaluated by VAS and the examinations were repeated. The measurements of nasal peak flow meter and saccharine clearance time are repeated. RESULTS: The most frequent complaints of the patients were nasal obstruction (48%), headaches (20%) and rhinorrhea (16%). Following treatment, the complaints resolved significantly (p=0.005). The difference between the turbinate hypertrophy and mucosal pallor before and after treatment was significant (p=0.005). The clearance time difference before and after treatment was highly significant (p=0.001). The nasal peak flow meter results after treatment were also significantly improved (p=0.001). CONCLUSION: Besides other examinations, thyroid functions should also be assessed in patients presenting with rhinitis symptoms.

An in vitro ES cell imprinting model shows that imprinted expression of the Igf2r gene arises from an allele-specific expression bias.

Genomic imprinting is an epigenetic process that results in parental-specific gene expression. Advances in understanding the mechanism that regulates imprinted gene expression in mammals have largely depended on generating targeted manipulations in embryonic stem (ES) cells that are analysed in vivo in mice. However, genomic imprinting consists of distinct developmental steps, some of which occur in post-implantation embryos, indicating that they could be studied in vitro in ES cells. The mouse Igf2r gene shows imprinted expression only in post-implantation stages, when repression of the paternal allele has been shown to require cis-expression of the Airn non-coding (nc) RNA and to correlate with gain of DNA methylation and repressive histone modifications. Here we follow the gain of imprinted expression of Igf2r during in vitro ES cell differentiation and show that it coincides with the onset of paternal-specific expression of the Airn ncRNA. Notably, although Airn ncRNA expression leads, as predicted, to gain of repressive epigenetic marks on the paternal Igf2r promoter, we unexpectedly find that the paternal Igf2r promoter is expressed at similar low levels throughout ES cell differentiation. Our results further show that the maternal and paternal Igf2r promoters are expressed equally in undifferentiated ES cells, but during differentiation expression of the maternal Igf2r promoter increases up to 10-fold, while expression from the paternal Igf2r promoter remains constant. This indicates, contrary to expectation, that the Airn ncRNA induces imprinted Igf2r expression not by silencing the paternal Igf2r promoter, but by generating an expression bias between the two parental alleles.