Patients` evaluation for the surgical management of nasal obstruction.

STATEMENT OF PROBLEM: Surgery for nasal obstruction is performed to give a subjective benefit. We aimed to evaluate the surgical management of the nasal obstruction in the patient`s perception. METHODS OF STUDY: The study was performed prospectively with 134 patients over the age of 18. They were allotted to three groups according to the level of nasal obstruction by clinical examination. The G1 group had only a deviated nasal septum (DNS), G2 had DNS and hypertrophy of inferior turbinates, and G3 had nasal valve problems in conjunction with DNS. All the patients had surgery focused on obstructive pathologies. The study was conducted using three different scoring systems to determine the patients` evaluation of the surgical procedures. RESULTS: The study included more man than woman, with a mean age around 28 (wide range). Twenty six patients were in G1, 73 patients in G2 and 35 patients in G3. Total and general Glasgow Benefit Inventory (GBI) scores for each group showed improvement postoperatively. There was a significant difference between the groups for general GBI score, and Post-hoc test showed that the improvement of G1 was greater than of G3. The influence of the surgery on physical health, psycho-social function and social interaction scores for each group showed no changes postoperatively. There was a significant improvement in all Nasal Obstruction Septoplasty Effectiveness (NOSE) scores and Likert Scale scores for each group. The improvement of G1 and G2 were greater than G3 on the Likert Scale. CONCLUSION: Surgical management targeted to the region of obstruction improves symptoms and benefit in the patient`s perception.

Incus and stapes necrosis associated with diabetes mellitus.

Chronic otitis media is often associated with ossicular defects, the most frequent being necrosis of the long process of incus. Except for infection and cholesteatoma; trauma and local pressure by chorda tympani are uncommon causes leading to incus erosion. In the literature, no case of incus necrosis has been reported associated with type II diabetes mellitus (DM). A patient is presented in this report with incus and stapes suprastructure necrosis and associated type II DM who was admitted to the out-patient clinic with complaints of conductive hearing loss.

The role of allergy in recurrent otitis media with effusion.

OBJECTIVE: To compare the OME groups that improved when treated with adenoidectomy, VT and medication, and which of them recurred. METHODS: Twenty-two consecutive children with recurrent OME (11%) were selected among 200 children who had adenoidectomies and had been inserted a ventilation tube (VT) for OME. The patients were selected for allergy evaluation because of recurrent OME not responsive to medical therapy and adenoidectomy, requiring more than one myringotomy with tubes. The control group consisted of 24 healthy children that were treated with adenoidectomy and VT, and had no recurrence. RESULTS: Eight (36.4%) patients had positive skin tests for inhalant and food allergens. Two subjects of the control group (8.3%) had positive skin tests for inhalant and food allergens. This was statistically significant (p:0.032). A pattern to multiple positive nasal and food reactions was shown in the study group rather than in the control subjects. CONCLUSIONS: The possibility of allergy should be considered in OME cases that did not improve with drug treatment and adenoidectomy and VT insertion but recurred, and a thorough search for allergen was made for proper diagnostic and therapeutic management.

Free radical damage in nasal polyp tissue.

OBJECTIVE: To investigate whether the free radical injury in nasal polyp tissue exists or not. STUDY DESIGN: A prospective study in patients with nasal polyps. METHODS: Polyp specimens were obtained from 19 patients. Control specimens were acquired from 16 patients who underwent partial turbinectomy with concha bullosa free of rhinitis, sinusitis, and allergy, confirmed by endoscopic nasal examination, coronal paranasal sinus CT scan, and prick test. MDA levels of nasal polyps and control specimens were measured by using the method of Knudsen et al. RESULTS: The mean MDA levels of nasal polyps and control specimens were 38.2 +/- 5.1 (33.3-52.2) and 33.9 +/- 1.6 (32.6-37.4), respectively. MDA levels in NP were significantly higher compared with control specimens (P < 0.01). CONCLUSION: High level of MDA in nasal polyp tissue that represents FR increase supports the existence of cell injury in nasal polyp tissue. FRs should be considered in the development and life cycles of NP which is thought to have multifactorial pathogenesis.

Familial idiopathic facial palsy.

The etiology of idiopathic facial palsy (IFP) is still not defined. Familial inheritance has been found in 4-14% of cases. Among 116 patients with IFP admitted to the otolaryngology and neurology clinics at Kütahya State Hospital, 12 had positive family histories involving 10 different families. Review of the patients' histories showed that 13 members of families previously had IFP. In all, the 25 patients with familial IFP consisted of 12 males and 13 females and had an average age at onset of 34.3 years. Class I human leukocyte antigen (HLA) was investigated in 11 patients with familial IFP belonging to four separate families. The follow-up period was approximately 2 months. All cases except one recovered completely, with the latter patient having minimal contracture and facial paresis. However, HLA showed no significant increases in class I antigens. No notable difference was found in the clinical courses of patients with familial and non-familial IFP.

Malondialdehyde levels and superoxide dismutase activity in experimental maxillary sinusitis.

OBJECTIVE: Acute maxillary sinusitis is one of the most common diseases in human. Reactive oxygen metabolites (ROMs) produced also physiologically in the body, are normally neutralised by antioxidative enzymes such as superoxide dismutase (SOD). Infection is one of the causes of increased ROMs production. The most important mechanism of tissue damage produced by ROMs is the peroxidation of lipids found in cell membranes and it may be estimated by malondialdehyde (MDA) levels. The purpose of this study, is to investigate tissue damage caused by ROMs in maxillary sinusitis in 24 rabbits. METHODS: Experimental sinusitis was induced by blocking the right nose and inoculating Staphylococcus aureus into the right maxillary sinuses. Left maxillary sinuses were the control group. Animals were divided into three groups and killed at 3, 5 and 7 days. Mucosas of each maxillary sinus were examined histopathologically and MDA levels were determined. Blood samples were obtained preoperatively (control blood) and on killing days (experimental blood). Serum MDA levels and erythrocyte SOD activities were determined. RESULTS: All the infected sinuses displayed signs of the inflammation. MDA levels and SOD activities in the experimental blood samples were significantly higher than those of the control group (P < 0.05). Mucosal MDA levels in the experimental group were significantly higher than the controls (P < 0.01). CONCLUSIONS: In maxillary sinusitis caused by S. aureus an increased ROMs production was observed and it may contribute to tissue damage of sinusitis.

Effect of SC-41930, a potent selective leukotriene B4 receptor antagonist, in the guinea pig model of middle ear inflammation.

Arachidonic acid metabolites such as prostaglandins and leukotrienes have been shown to play an important role in the pathogenesis of otitis media (OM). Among these mediators, leukotriene B4 (LTB4) is one of the most potent inducers of inflammatory processes. SC-41930 has been shown to be a specific LTB4 receptor antagonist both in vitro and in vivo. In this study, anti-inflammatory effects of SC-41930 were investigated in a guinea pig model of OM induced by middle ear (ME) inoculation of killed Staphylococcus aureus. Outcome of treatment was determined by measurement of myeloperoxidase activity in the samples of ME mucosa, evaluation of temporal bone histopathology, and presence of ME fluids. Myeloperoxidase activity in the SC-41930-treated group was found to be significantly lower than that in the control group. Histopathology of temporal bones indicated decreased inflammation in the treated group as compared to the controls. In addition, ME fluids were absent in four out of six treated animals. These results demonstrate that SC-41930 can produce significant anti-inflammatory effects in this model of OM.