Osteochondroma of the coronoid process and joint formation with zygomatic arch (jacob disease): report of a case.

Jacob disease is a rare condition consisting of pseudo joint formation between enlarged mandibular coronoid process and the inner surface of the zygoma. We report a 16-years-old male patient with Jacob disease who presented with restricted mouth opening and swelling of the right zygoma. In this report, clinical, radiological, and histopathological findings of the Jacob disease and its surgical approach are discussed.

Relationship between Toxocara seropositivity and allergic rhinitis.

BACKGROUND: Allergic rhinitis is the most common chronic disease in the upper respiratory tract, requiring better diagnostic methodology to counteract its onslaught. The purpose of this study was to investigate the association between Toxocara seropositivity and allergic rhinitis. METHODS: Sixty-four consecutive patients with allergic rhinitis and 61 healthy volunteers in the control group were included in this study. The diagnosis of allergic rhinitis was defined by positive epicutaneous prick test. The diagnosis of toxocariasis was established by IgG and specific IgE antibodies against Toxocara by ELISA method. All cases were examined for intestinal parasites also. The seropositive cases with Toxocara were reevaluated for symptoms and signs of toxocariasis. RESULTS: Higher toxocariasis seropositivity (ELISA IgG; 28.1%) rate was determined in the patients with allergic rhinitis and compared with the control groups (11.5%; p < 0.05). Specific IgE seropositivity (17.2%) was high for the patients with allergic rhinitis compared with the control group (3.3%; p < 0.05). CONCLUSION: Our results show that there was a possible causal relationship between Toxocara infection and allergic rhinitis. Patients with allergic rhinitis from a region with high prevalence for this parasitic infection should be evaluated for Toxocara infection.

Microbiologic findings of sinusitis by a novel method for obtaining culture.

Many different methods have been described to obtain sinus culture from patients with chronic sinusitis. However, these methods presented limited information how they had prevented from the contamination with nasal flora. The purpose of this study is to demonstrate and describe a contamination-free technique to obtain culture from involved sinus during endoscopic sinus surgery (ESS). We prepared a cotton-tipped contamination-free swab. This applicator was inserted inside the sinus through ostium or inside the cavity directly established during ESS, and the swab was introduced directly into the implicated area. Thirty-five adult patients with chronic sinusitis who underwent ESS participated in the study. During ESS, the number of cultivated pathogenic microorganisms of the cultures obtained by our method was statistically significantly higher than the cultures obtained by the classic nasal cavity cultures (P = .0296). However, the number of cultivated bacteria (coagulase-negative Staphylococcus, alpha-hemolytic Streptococcus, and Corynebacterium spp.) after the contamination was lower than those of nasal cavity culture (P = .0296). During ESS, the identification of the pathogen in sinusitis with endoscopically guided narrow-bore sinus culture applicator is a reliable diagnostic method compared with the classic culture techniques.

Choanal polyp originating from the inferior turbinate presenting as nasal polyposis.

Although choanal polyps frequently arise from the maxillary sinus, a choanal polyp originating from the inferior turbinate is a rare entity. A 14-year-old girl who had a history of bilateral nasal obstruction with snoring, mouth breathing and nasal discharge for 10 years was presented. On endoscopic examination, a polypoid mass completely obliterated the right nasal cavity. The left choana was also totally occluded by the polypoid mass. Endoscopic polypectomy was performed and it was observed that the polyp originated from the right inferior turbinate. Choanal polyps arising from the inferior turbinate should be kept in mind in the differential diagnosis of unilateral nasal polypoid masses.

What is the relationship between chronic sinus disease and isolated nasal septal deviation?

OBJECTIVE: The aim of this retrospective study is to examine the role of isolated nasal septal deviation (NSD) in the pathogenesis of chronic rhinosinusitis (CRS). STUDY DESIGN AND SETTING: The interaction between isolated NSD and chronic sinus disease were retrospectively evaluated in 1452 patients. Out of 1452 patients, 152 patients were included in the study. Patients with anatomical variants other than NSD were excluded from the study. Patients with NSD were enrolled in the study group and patients without NSD were enrolled in the control group. RESULTS: There was no statistically significant difference between NSD group and non-NSD group with respect to the CRS. CONCLUSIONS: The mild to moderate degree of NSD was not a risk factor for chronic sinus disease. Only gross deviation of the nasal septum itself is a risk factor for the development of CRS. SIGNIFICANCE: Excluding the subjects with ostiomeatal anatomic variations has differentiated this study from the previously reported researches (isolated NSD).

The effect of topical corticosteroid on basic fibroblast growth factor in nasal polyp tissue.

BACKGROUND: The etiology of nasal polyposis and pathophysiological mechanisms of polyp formation is still poorly understood. Experimental models have suggested that nasal polyp growth requires extracellular matrix formation and is associated with fibroblast proliferation. Intranasal corticosteroids appear to be useful in reducing nasal polypoid lesions and the likelihood of polyp recurrence after surgery. Basic fibroblast growth factor (bFGF) is a potent angiogenesis factor and is mitogenic for a wide range of cell types. We investigated the alteration of bFGF levels in nasal polyp tissue after administration of topical corticosteroid. METHODS: Nasal polyp tissues were obtained from 36 patients with diffuse nasal polyposis before and after topical nasal steroid treatment. As a topical nasal steroid mometasone furoate was given for 4 weeks in a dosage of 200 microg/day. The bFGF levels were measured by competitive enzyme immunoassay method. RESULTS: The mean levels of tissue bFGF, before and after topical nasal steroid treatment, were 1485 +/- 826 ng/mg protein (range, 416-3434 ng/mg) and 1340 +/- 749 ng/mg protein (range, 330-3288 ng/mg), respectively. The levels of bFGF in nasal polyps were significantly lower than those before treatment after administration of topical nasal steroid (p = 0.011). CONCLUSION: Administration of topical nasal steroid decreases bFGF levels of nasal polyp. It may be suggested that one of the effects in diminishing the size of nasal polyps is by decreasing the bFGF.

Nitric oxide level in the nasal and sinus mucosa after exposure to electromagnetic field.

OBJECTIVE: The purpose of this study was to examine the changes in nitric oxide (NO) level in the nasal and paranasal sinus mucosa after exposure radiofrequency electromagnetic fields (EMF). STUDY DESIGN AND SETTING: Thirty male Sprague-Dawley rats were randomly grouped as follows: EMF group (group I; n, 10), EMF group in which melatonin received (group II; n, 10) and the control (sham operated) group (group III; n, 10). Groups I and II were exposed to a 900 MHz. Oral melatonin was given in group II. Control rats (group III) were also placed in the tube as the exposure groups, but without exposure to EMF. At the end of 2 weeks, the rats were sacrificed, and the nasal and paranasal sinus mucosa dissected. NO was measured in nasal and paranasal mucosa. RESULTS: The nasal and paranasal sinus mucosa NO levels of group I were significantly higher than those of the control group (group III) ( P < 0.05). However, there was no statistically significant difference between group II and the control group (group III) regarding NO output ( P > 0.05). CONCLUSION: Exposure to EMF released by mobile phones (900 MHz) increase NO levels in the sinus and nasal mucosa. SIGNIFICANCE: Increased NO levels may act as a defense mechanism and presumably related to tissue damage. In addition, melatonin may have beneficial effect to prevent these changes in the mucosa.

Intercellular adhesion molecule-1 expression in nasal polyps treated with corticosteroid.

PURPOSE: The aim of this study was to compare intracellular adhesion molecule-1 (ICAM-1) expression in nasal polyp cases who were administered topical corticosteroid and in middle turbinates. MATERIALS AND METHODS: Twenty-four patients with nasal polyps were included in the study group. These patients were treated with 100 microg budesonide in each nostril twice daily for 2 months before the surgery. Twenty-one nonatopic patients with concha bullosa were included in the control group. The specimens were taken from patients undergoing endoscopic surgery. RESULTS: In polyps, significantly higher mean ICAM-1 intensity scores were found by comparison with the control turbinates. CONCLUSIONS: Corticosteroid treatment in patients with nasal polyps does not diminish ICAM-1 to that of turbinate tissue. The initiating events in the formation of nasal polyps still occur in these patients despite treatment with the topical nasal steroid.

Allergic contact dermatitis prevalence in patients with eczematous external otitis.

Eczematous external otitis, because of its basic allergic nature, tends to be chronic or recurrent. The purpose of our study was to investigate the association between allergic contact dermatitis and chronic eczematous external otitis. Sixty-six patients with eczematous external otitis and 48 healthy volunteers were included in this study. All the patients were tested with an epicutaneous patch test. In the study group, the average recurrent attack rate was 6.1+/-1.5 (between 4-9 times during the last year) in the patch test positive eczematous external otitis patients, and 4.9+/-1.3 (between 4-8 times during the last year) in the patch test negative patients (p = 0.002). The epicutaneous patch test was positive in 19 (28.8%) out of 66 cases with chronic eczematous external otitis, and in 3 (6.3%) out of 48 cases in the control group. The difference between the two groups was statistically significant (p = 0.003). The most common reactions were due to neomycin sulfate and potassium dichromate in this study. These results suggest that, in some cases eczematous external otitis may be considered as a form of delayed type hypersensitivity to allergen stimuli. Patients suffering from eczematous external otitis symptoms should be investigated for allergens.

The role of free oxygen radicals on the development of otitis media with effusion.

OBJECTIVE: The purpose of this study was to determine if free oxygen radicals (FORs) and antioxidant enzyme activities have some role in pathogenesis of otitis media with effusion (OME) in children with adenoid hyperplasia. METHODS: Seventy-four patients were enrolled in three groups of this study. The study group (Group I) included 26 patients who had adenoidectomy with ventilation tube placement due to chronic OME. The control adenoid group (Group II) consisted of 28 age-matched patients who had adenoidectomy without ventilation tube insertion. Twenty children were included in the healthy control group (Group III). Erythrocyte malondialdehyde (MDA) levels, superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) enzyme activities were investigated in the venous blood sample. RESULTS: Erythrocyte MDA level and GSH-Px enzyme activity in the blood samples of study group (Group I) were significantly higher than those of Group II and Group III (P < 0.05). SOD enzyme activity in the blood samples of Group I was significantly lower than Group II (P < 0.05), and were significantly higher than Group III (P < 0.05). CAT enzyme activity of Group I was significantly lower than that of Group III (P < 0.05). However, there was no statistically significant difference between Group I and Group II regarding CAT antioxidant enzyme activity (P < 0.05). CONCLUSIONS: The inflammation of the middle ear increases the level of FORs in erythrocyte. FOR level is normally maintained at a steady state by antioxidant enzymes. When the antioxidant defense system is weakened, the increased FORs may contribute to OME formation. We supposed that, antioxidant vitamins C and E, and scavenger enzymes such as CAT, SOD and GSH-Px may be added in the management of OME.

Asymptomatic food hypersensitivity prevalence in patients with eczematous external otitis.

PURPOSE: The purpose of our study was to investigate the association between food hypersensitivity and eczematous external otitis. MATERIALS AND METHODS: In this cross-sectional study, 27 patients with eczematous external otitis and 16 healthy volunteer were included. The existence of food hypersensitivity was defined by positive epicutaneous prick test and specific immunoglobulin E (IgE) antibodies. RESULTS: Food allergy test was positive in 13 (48.1%) out of 27 cases with eczematous external otitis, and it was positive in 2 (12.5%) out of 16 cases in control group. The difference between 2 groups was statistically significant (P =.02). Specific IgE seropositivity (51.9%) was high in the patients with eczematous external otitis compared with the control group (12.5%) (P =.02). CONCLUSIONS: Food hypersensitivity may be a factor, which should be considered in eczematous external otitis patients. Patients suffering from eczematous external otitis symptoms should be evaluated for food hypersensitivity.

[Toxoplasmosis in patients with lymphoid hyperplasia of the head and neck]. / Bas-boyun bölgesi lenfoid hiperplazisi olan olgularda toksoplazmosis.

OBJECTIVES: To investigate the incidence of toxoplasmosis in patients with lymphoid hyperplasia of the head and neck. PATIENTS AND METHODS: In this study, 53 patients (32 males, 21 females; mean age 11.2+/-4.3 years, range 5 to 22) were investigated. There were hypertrophic tonsillitis in 13 patients, hypertrophic tonsillitis and adenoid hyperplasia in 22 patients, adenoid hyperplasia in 10 patients, and lymphadenopathy of the neck in eight patients. In venous blood samples, IgM and IgG antibodies for Toxoplasma gondii were investigated with the enzyme-linked immunoabsorbent assay (Axsym, Abbott). RESULTS: Positive IgG was determined in 23 patients (48%) with hypertrophic tonsillitis (n=6), hypertrophic tonsillitis and adenoid hyperplasia (n=10), adenoid hyperplasia (n=3), and lymphadenopathy of the neck (n=4). Positive IgM was determined in 5 patients (9.4%) with hypertrophic tonsillitis (n=1), hypertrophic tonsillitis and adenoid hyperplasia (n=1), and lymphadenopathy of the neck (n=3). CONCLUSION: Toxoplasmosis, which is known to cause lymphadenopathy, may be a reason for lymphadenopathy of the neck. Toxoplasmosis should be considered in the differential diagnosis of untreated patients with tonsillitis, adenoid hyperplasia, and chronic neck lymphadenopathy.

Rhinosinusitis among the patients with perennial or seasonal allergic rhinitis.

Although no hypothesis is universally accepted, allergic rhinitis (AR) may play an important role in the occurrence of rhinosinusitis. This study was carried out to investigate the frequency and severity of rhinosinusitis among patients with seasonal or perennial AR. This study included 73 patients with AR. Findings related to rhinosinusitis of these patients were demonstrated by computed tomography (CT), and were scored according to the Lund-Mackay CT scan staging system. Fifty-two of the 73 patients (71.2%) were shown to have findings of rhinosinusitis. Of these 52, twenty-four patients (77.4%) had perennial AR and 28 (66.7%) patients had seasonal AR. The mean total CT staging score of rhinosinusitis was 4.2 +/- 3.2 in patients with perennial AR and 2.6 +/- 1.3 in patients with seasonal AR. Although the frequency of rhinosinusitis among patients with perennial AR was higher than among seasonal ones, this was statistically insignificant (p = 0.32). But CT staging scores of rhinosinusitis among the patients with perennial AR were significantly higher than among the seasonal AR group (p = 0.014). Although there was no significant difference between the frequency of rhinosinusitis of seasonal and perennial AR, the severity of rhinosinusitis was more severe in cases with perennial AR, in this study. Early management of an allergic disease is essential if its long-term consequences are to be prevented or minimized.

New sinus culture applicator (Yariktas applicator).

Identification of the pathogen is crucial for the selection of an appropriate antibiotic in the management of sinusitis. We describe an original instrument that provides contamination-free culture from the sinus in endoscopic sinus surgery.

The biochemical analysis of tympanosclerotic plaques.

OBJECTIVE: We conducted a biochemical analysis of tympanosclerotic (TS) plaques. METHODS: Forty-five samples containing TS plaques were obtained from 45 patients. Qualitative and quantitative biochemical analyses were performed. TS plaques were evaluated macroscopically in respect to color and structure. RESULTS: Phosphate, calcium, ammonium, and cholesterol were detected in 44, 43, 35, and 7 samples, respectively. Mean calcium and phosphate levels and protein levels of samples were 2.5 +/- 2.6 mg/100 mg tissue, 0.16 +/- 0.11 mg, and 3.4 +/- 3.4 mg, respectively. TS plaques were dirty white in 20 samples, brunette in 13, yellowish in 4, white in 7, and brown in 1. The structure of TS plaques was hard in consistency in 23 samples, fibrous in 14 samples, and soft in 8 samples. CONCLUSION: The wider range of values and different mineral contents in our series might be explained by the fact that we had a much larger variety of tissues in various stages of the TS process. The color and the consistency of TS plaques are due to the discrepancy in their content and the amount of mineral, cholesterol, and protein.

Otogenic pneumocephalus management with butyl 2-cyanoacrylate.

The existence of air within the skull has been called pneumocephalus. Treatment of pneumocephalus is mostly managed surgically, especially in a tension pneumocaephalus when the pressure has to be alleviated. Dural defect can be treated with the suture technique and tissue adhesives such as butyl 2-cyanoacrylate (B 2-CA). Otogenic pneumocephalus due to dural defect can be managed with B 2-CA tissue adhesive cheap, safely, and effectively without complication. We thought it would be of interest to present a case of pneumocephalus due to traffic accident 12 years ago and managed with B 2-CA. It is concluded that B 2-CA fixation can be alternative for dural defect closure with suturing or other tissue adhesives.

[The beneficial effect of septoplasty on snoring]. / Septoplastinin horlama üzerindeki olumlu etkisi.

OBJECTIVES: This study sought to determine whether septoplasty played a favorable role on snoring complaints as well. PATIENTS AND METHODS: The study included 56 patients (40 males, 16 females; mean age 40 years; range 21 to 60 years) who underwent septoplasty operation for causes other than snoring. The patients' snoring complaints were evaluated and rated before and three months after surgery. RESULTS: Before surgery, 22 patients were found to have complaints of snoring. The snoring complaints improved after septoplasty in 16 patients (72.7%). The decrease in snoring complaints was found statistically significant (p<0.01). CONCLUSION: Improvement in snoring complaints in patients undergoing septoplasty operation emphasizes the need for investigating and treating septum deviations which are a primary cause of upper respiratory tract obstruction.

Facial wound closure with butyl 2-cyanoacrylate.

Butyl 2-cyanoacrylate (B2-CA), one of the least histotoxic cyanoacrylate derivatives used as a tissue adhesive extensively for facial and plastic, otolaryngological and dental surgery, produces a mild inflammatory response and is biodegradable. In this study, we histopathologically compared B 2-CA to suture on facial wounds of 21 rabbits. Two facial incisions were made on the chins. Left incisions were sutured (control group) and right ones were treated with B 2-CA (experimental group). The animals were divided into 7 groups and were sacrificed on days 1, 2, and 5 and weeks 1, 2, 3, and 4 after surgery. The wound areas were examined histopathologically for the epithelization, inflammation, granulation response, and for foreign body giant cells. Gradation of the histopathological findings yielded no significant difference between the experimental and control groups. Hence, we conclude that B2-CA used on facial wounds shows no more histotoxicity than sutures. Thus, B2-CA could provide an alternative and a possible superior method for closing incisions of facial and plastic surgery. In addition, B2-CA has the advantages of ease of application, immediate homeostasis, and excellent cosmetic results.

The role of free oxygen radicals in experimental otitis media.

Free oxygen radicals (FORs); have been implicated as important pathologic mediators in many diseases. Under physiological conditions FORs are part of normal regulatory circuits and neutralized by antioxidants, but an increased flux of FORs can cause tissue damage. Infections are one cause of increased FORs production. An important mechanism of tissue damage produced by FORs is the peroxidation of membrane lipids, which can be estimated by malondialdehyte (MDA) levels. The purpose of this study was to determine in 24 albino rabbits whether FORs play a role in the pathogenesis of otitis media experimentally induced by inoculating Streptococcus pneumonia into the right ear, with the left ear serving as a control. We examined the mucosa of each middle ear histopathologically and measured MDA levels in mucosa and serum. Serum MDA levels in infected rabbits were significantly higher than those in preoperative blood specimens (p<0.05). The MDA levels in mucosa were significantly higher in infected ears than in control ears (p<0.01). In the experimentally infected group, a correlation was found between MDA levels in serum and mucosa (p<0.05). In conclusion, serum and mucosa MDA indicating FORs production increased significantly in experimental otitis media. We considered that FORs might play a role in tissue damage caused by otitis media.

[The incidence of septal deviation in newborns]. / Yenidoganlarda septum deviasyonu.

OBJECTIVES: To determine the incidence of septum deviation and dislocation in newborns and to investigate relationships between these pathologies and maternal causes and the mode of delivery. PATIENTS AND METHODS: The study included 195 mothers and 200 newborns, of which 10 were twins. Vaginal and cesarean deliveries were performed in 147 (73.5%) and 53 (26.5%) newborns, respectively. All newborns were examined with the use of anterior rhinoscopy. The nasal pyramid, columella, and septum were assessed to detect septal deviation or dislocation. RESULTS: Twenty-three cases (15.6%) of vaginal delivery had septal deviation, while five (3.4%) had septal dislocation. In the newborns delivered by cesarean section, eight (15.1%) had septal deviation, but none had dislocation. Significant correlations were noted between pregnancy, delivery period, the way of delivery and the incidence of septal deviation and columella dislocation (p < 0.05). There was a significant correlation between head circumference and columella dislocation (p < 0.05). CONCLUSION: Since early reconstruction of the potential pathologies may be problem-solving, a careful rhinologic examination should be carried out in the newborns who have prolonged delivery, increased head circumference, and vaginal delivery.