How does allergic rhinitis impact the severity of COVID-19?: a case-control study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a contagious disease whose symptoms and risk factors are newly described. Some allergic diseases, including asthma, have been defined as risk factors for a poor outcome in COVID-19. We aimed to investigate the role of another allergic disease-allergic rhinitis-in the severity of COVID-19. METHODS: This case-control study was conducted at Sakarya Educational and Research Hospital, Toyota Hospital and Yenikent State Hospital between March 18, 2020 and August 30, 2020. The study included a case group of 125 randomly selected patients who had been diagnosed with allergic rhinitis in advance of having COVID-19 and a control group of 125 patients without allergic rhinitis who were diagnosed with COVID-19. We evaluated all participants' statuses regarding smoking, symptoms, and hospitalization, as well as the length of their hospitalization and the number of their comorbidities. RESULTS: There were no statistically significant differences between the two groups regarding percentage of asymptomatic patients (p = 0.27), presence of smoking (p = 0.068), hospitalization status (p = 0.79), and hospitalization length (p = 0.55). From each group, two patients needed care in an intensive care unit (ICU). One patient from the case group and two from the control group died due to COVID-19. CONCLUSION: We found that allergic rhinitis did not affect the severity of COVID-19. However, we recommend that the literature be augmented with further studies on the COVID-19 prognosis of patients who have allergic rhinitis.

Effects of vaginal birth versus caesarean section on hearing screening results in a large series from the Aegean region.

Objective: To evaluate the effects of caesarian section (CS) versus vaginal birth (VB) delivery techniques on results from neonatal hearing screening tests (NHSTs).Design: Retrospective analysis.Study sample: A total of 10,767 neonates divided into two groups according to delivery technique underwent NHSTs. Those who failed TEOAE or AABR were sent for diagnostic ABR examination.Results: A total of 5620 of 6044 (92.9%) of the neonates in the CS group passed the TEOAE test bilaterally and 424 (7.1%) failed either unilaterally or bilaterally. In the VB group, 4496 of 4723 (95.1%) neonates passed the TEOAE test bilaterally, while the remaining 227 (4.9%) failed the test either unilaterally or bilaterally. Bilateral passing rate of TEOAE test results was significantly higher in the VB group than the CS group (p < 0.05). The AABR failure rate (unilaterally or bilaterally) was 1% in the CS group, which was significantly higher than that in the VB group (0.6%). Diagnostic ABR bilateral pass rate was not statistically different between the groups.Conclusions: Delivery method was shown to affect the results of NHSTs. We found that the rates of failing the TEOAE and screening AABR examinations were higher among neonates born by CS compared to VB.

Treatment of large persistent tracheoesophageal peristomal fistulas using silicon rings / Tratamento de fístula periestomal traqueoesofágica grande e persistente com anéis de silicone

Abstract Introduction: Tracheoesophageal peristomal fistulae can often be solved by reducing the size of the fistula or replacing the prosthesis; however, even with conservative techniques, leakage around the fistula may continue in total laryngectomy patients. Also, several techniques have been developed to overcome this problem, including injections around the fistula, fistula closure with local flaps, myofascial flaps, or free flaps and fistula closure using a septal perforation silicon button. Objective: To present the results of the application of silicon ring expanding the voice prosthesis in patients with large and persistent peri-prosthetic fistula. Methods: A voice prosthesis was fitted to 42 patients after total laryngectomy. Leakage was detected around the prosthesis in 18 of these 42 patients. Four patients demonstrated improvement with conservative methods. Eight of 18 patients who couldn't be cured with conservative methods were treated by using primary suture closure and 4 patients were treated with local flaps. As silicon ring was applied as a primary treatment in the 2 remaining patients and also, applied to 2 patients who had recurrence after suture repair and to 2 patients who had recurrence after local flap implementation. Silicon rings were used in a total of 6 patients due to the secondary trachea-esophageal fistula. Patients were treated with provox-1 initially and later with provox-2. At the time of leakage around the fistula, 6 patients had provox-2. Results: Fistulae were treated successfully in 6 patients, and effective speech of patients was preserved. Patients experienced no adaptation problem. Prosthesis changing time was not different between silicon rings expanded and normal prosthesis applied patients. Silicon ring combined voice prosthesis was used 26 times; there was no recurrence in fistula complication during 29 ± 6 months follow up. Conclusion: Silicon rings for modified expanded voice prosthesis seems to be an effective treatment for persistent peri-prosthetic leakage, for both, fistula closure and preserving the patients speech.

Resumo Introdução: Fístulas traqueoesofágicas persistentes podem ser resolvidas através da redução do tamanho da fístula ou substituição da prótese; no entanto, mesmo com técnicas conservadoras, o pertuito em torno da fístula pode continuar em pacientes com laringectomia total. Além disso, várias técnicas têm sido desenvolvidas para superar esse problema, inclusive injeções ao redor da fístula, fechamento da fístula com retalhos locais, retalhos miofasciais ou retalhos livres e fechamento da fístula com um botão septal de silicone. Objetivo: Apresentar os resultados da aplicação de anel de silicone para expansão da prótese vocal em pacientes com grandes fístulas periprotéticas persistentes. Método: Prótese vocal foi colocada em 42 pacientes após laringectomia total, e fístula foi detectada ao redor da prótese em 18 desses 42 pacientes. Quatro pacientes obtiveram melhora com métodos conservadores. Oito dos 18 pacientes que não obtiveram sucesso com métodos conservadores foram tratados usando sutura primária e quatro pacientes foram tratados com retalhos locais. Um anel de silicone foi aplicado inicialmente nos dois pacientes restantes e, também, aplicado a dois pacientes que tiveram recorrência após a técnica de sutura e a dois pacientes que tiveram recorrência após a utilização de retalho local. No total, seis pacientes receberam anéis de silicone em decorrência da fístula traqueoesofágica secundária. Os pacientes haviam sido tratados com provox-1 inicialmente e posteriormente com provox-2. No momento da detecção da fístula em torno do estoma, seis pacientes haviam recebido provox-2. Resultados: A fístula foi tratada com sucesso em seis pacientes. Além disso, após o tratamento a fala foi mantida de forma eficaz. Não houve problema de adaptação. O tempo de troca da prótese expandida com os anéis de silicone não foi diferente do tempo que se leva para a colocação da prótese normal. O anel de silicone combinado com a prótese vocal foi usado 26 vezes em pacientes na época da troca de prótese e não houve recorrência da fístula durante os 29 ± 6 meses de acompanhamento. Conclusão: Os resultados sugerem que em casos de grandes fístulas peri-prostéticas persistentes, anéis expandidos de silicone e prótese vocal modificada são eficazes tanto para o fechamento da fístula como para a manutenção da fala do paciente.

Treatment of large persistent tracheoesophageal peristomal fistulas using silicon rings.

INTRODUCTION: Tracheoesophageal peristomal fistulae can often be solved by reducing the size of the fistula or replacing the prosthesis; however, even with conservative techniques, leakage around the fistula may continue in total laryngectomy patients. Also, several techniques have been developed to overcome this problem, including injections around the fistula, fistula closure with local flaps, myofascial flaps, or free flaps and fistula closure using a septal perforation silicon button. OBJECTIVE: To present the results of the application of silicon ring expanding the voice prosthesis in patients with large and persistent peri-prosthetic fistula. METHODS: A voice prosthesis was fitted to 42 patients after total laryngectomy. Leakage was detected around the prosthesis in 18 of these 42 patients. Four patients demonstrated improvement with conservative methods. Eight of 18 patients who couldn't be cured with conservative methods were treated by using primary suture closure and 4 patients were treated with local flaps. As silicon ring was applied as a primary treatment in the 2 remaining patients and also, applied to 2 patients who had recurrence after suture repair and to 2 patients who had recurrence after local flap implementation. Silicon rings were used in a total of 6 patients due to the secondary trachea-esophageal fistula. Patients were treated with provox-1 initially and later with provox-2. At the time of leakage around the fistula, 6 patients had provox-2. RESULTS: Fistulae were treated successfully in 6 patients, and effective speech of patients was preserved. Patients experienced no adaptation problem. Prosthesis changing time was not different between silicon rings expanded and normal prosthesis applied patients. Silicon ring combined voice prosthesis was used 26 times; there was no recurrence in fistula complication during 29±6 months follow up. CONCLUSION: Silicon rings for modified expanded voice prosthesis seems to be an effective treatment for persistent peri-prosthetic leakage, for both, fistula closure and preserving the patients speech.

Caudal Septal Stabilization Suturing Technique to Treat Crooked Noses.

AIM: To rotate the nasal axis and septum to the midline using an L-strut graft and a novel caudal septal stabilization suturing technique to treat crooked noses. PATIENTS AND METHODS: Thirty-six patients were included in the study. First, an L-strut graft was prepared by excising the deviated cartilage site in all patients. Second, multiple stabilization suturing, which we describe as a caudal septal stabilization suturing technique with a "fishing net"-like appearance, was applied between the anterior nasal spine and caudal septum in all patients. This new surgical technique, used to rotate the caudal septum, was applied to 22 I-type and 14 C-type crooked noses. Correction rates for the crooked noses were compared between the 2 inclination types with angular estimations. RESULTS: Deviation angles were measured using the AutoCAD 2012 software package and frontal (anterior) views, with the Frankfurt horizontal line parallel to the ground. Nasal axis angles showing angle improvement graded 4 categories as excellent, good, acceptable, and unsuccessful for evaluations at 6 months after surgery in the study. The success rate in the C-type nasal inclination was 86.7% (±21.9) and 88% (±16.7) in the I-type. The overall success rate of L-strut grafting and caudal septal stabilization suturing in crooked nose surgeries was 87.5% (±18.6). "Unsuccessful" results were not reported in any of the patients. CONCLUSIONS: L-strut grafting and caudal septal stabilization suturing techniques are efficacious in crooked noses according to objective measurement analysis results. However, a longer follow-up duration in a larger patient population is needed.

The impact of topical and systemic enoxaparin sodium use on traumatic tympanic membrane perforation and myringosclerosis.

The objective of this study is to investigate the effect of topical and systemic enoxaparin sodium on the healing pattern of experimentally induced tympanic membrane perforation and formation of myringosclerosis. A total of 24 Wistar-Albino strain rats were included in the study. Standard myringotomies were performed on each rat. In the first group, isotonic serum physiologic was dropped on external ear canal (control group). Topical enoxaparin was dropped on external ear canal and daily topical doses of enoxaparin were dropped on external ear canal of the rats for 14 days (topical treatment group). Third group received subcutaneous injections of enoxaparin for 14 days (systemic treatment group). Five micrometer thick sections of the bullae of the rats were stained with H&E. Inflammation, edema and sclerotic lesions and neovascularization observed in the lamina propria layer of the tympanic membrane, and total thickness of the tympanic membrane were evaluated. In intergroup comparisons, significant difference in the distribution pattern of severity of inflammation in all three groups was not observed (p = 0.784, p > 0.05). Total TM thickness differed among all three groups (p = 0.028, p < 0.05). A statistically significant difference was observed between the systemic enoxaparin and the control groups (p = 0.022, p < 0.05). A statistically significant difference was observed between the topical enoxaparin and the control groups (p = 0.037, p < 0.05). However, comparison between the topical and systemic treatment groups could not reveal any statistically significant intergroup difference (p = 0.682, p > 0.05). A significant difference was not observed among three groups as for the distribution of myringosclerotic plaques, severity of edema and neovascularization in the lamina propria (p = 0.539, p > 0.05), (p = 0.063, p > 0.05), (p = 0.152, p > 0.05). Topical and systemic enoxaparin treatment did not prevent formation of sclerotic plaques; however, it decreased TM thickness significantly in comparison with the control group.

The Impact of Systemic and Local Administration of Ascorbic Acid on Traumatic Perforation of Tympanic Membrane and Myringosclerosis.

OBJECTIVE: In the present study, tympanic membranes (TM) harvested from myringotomized rats were analyzed histopathologically to compare the systemic and local effects of ascorbic acid on the development of myringosclerosis. MATERIALS AND METHODS: Forty male Wistar-Albino rats weighing between 350-400 g were included in this study. Under otomicroscopic examination, a standard 2-mm myringotomy incision was made on the posteroinferior quadrant of the TM of both ears. Rats were randomized into five groups as control, topical ascorbic acid 50 mg/kg, systemic ascorbic acid 50, 100, and 200 mg/kg groups, each group containing eight rats. On the 15th day of the study, the rats were decapitated, and bullas of the rats were extracted. Sections were stained with hematoxylin-eosin and examined through light microscopy. Inflammation, distribution width of plaques, edema, and neovascularization were observed on the lamina propria. Thickness of the TM was evaluated under the microscope and scored semiquantitatively. RESULTS: When intergroup comparisons of parameters related to total TM thickness were performed, differences between the control group and topical AA (ascorbic acid) or systemic treatment groups were found to be statistically significant (p<0.005). A statistically significant difference was detected among control, topical and systemic 200 mg/kg ascorbic acid groups for the edematous lamina propria (p=0.003 and p<0.05, respectively). CONCLUSION: For the total TM thickness, systemic and topical ascorbic acid use was effective when compared with the control group. It has been concluded that systemic use of higher doses of (200 mg/kg) ascorbic acid is beneficial in the resolution of the edematous lamina propria.

Detection of ideal reservoir level after laryngectomy using endoilluminator in voice rehabilitation.

OBJECTIVE: To assess the diagnostic value of a novel device, the endoilluminator, in patients who can or cannot attain effective speech after application of voice prosthesis. STUDY DESIGN: Prospective clinical study. METHODS: Thirty-four patients who underwent total laryngectomy and whose insufflation test was positive were included. As a result of efforts to develop an insufflation test that includes a light apparatus, we attained a device that we call an endoilluminator. We found that the area it illuminated when a patient achieved effective speech was a predictive factor for the test result. That is, patients for whom the upper part of the tracheostomy (where the standard tracheoesophageal fistula will be opened) was illuminated were categorized as the positive test group, whereas those for whom the neck skin above this region was illuminated were categorized as the negative test group. RESULTS: In 27 of the 34 patients, appropriate localization was determined using the endoilluminator, and these patients achieved effective speech. In the remaining seven patients, localization was inappropriate and they did not achieve effective speech during the first week, first month, or third month postpuncture. In further investigations of these seven patients, a pharyngoesophageal spasm was detected in five, and a pharyngoesophageal stricture was detected in two. CONCLUSION: Endoilluminator increases the success rate of the insufflation test by accurately predicting a patient's ability to achieve effective speech after application of voice prosthesis.

The physiological impact of high altitude on nasal and lower airway parameters.

The aim of this study was to investigate the impact of high altitude on nasal and lower airway parameters in a healthy population. This was a prospective study of 61 individuals who climbed to the summit of Mount Kackar, at 3,937 m. Peak nasal inspiratory flow rates were recorded in all participants at sea level and at the summit. In 32 participants who ascended to the summit, sea-level and summit peak expiratory flow rates and olfactory function were evaluated. A rise in altitude significantly decreased peak nasal inspiratory flow by a mean of 27.43%. Mean peak expiratory flow values measured at the summit were 8.94% lower than basal values. Between-value differences were statistically significant (p < 0.001, p < 0.05). At high altitude, there was a significant decrease in olfactory function, as determined by a significant reduction in smell detection (p < 0.05) and smell identification (p < 0.05). The effect of high altitude on nasal function was found to parallel that of the effect on lower airway function, together accounting for an adverse effect on airway flow rates. The nasal mucosa responded to high altitude with an increase in airway resistance and a consequent impaired sense of smell.

Assessment of the impact of altitude on nasal airflow via expiratory nasal sound spectral analysis.

The aim of the study was to evaluate the effects of high altitude (HA) on the expiratory nasal sound spectra. The design consisted of a prospective analysis. The study group consisted of 24 otorhinolaryngologists and a student (2 females, 23 males) climber of the mountain of Kackar in Rize, a city located in northeastern Turkey. The elevation of the highest peak of the Kackar Mountain is 3,937 m (12,920 ft) and that of mountain plateaus at about 3,000 m (9,800 ft). Nasal sound spectral analysis was performed on 25 subjects at 700 and 3,937 m, respectively. We found that sound intensity (dB) at high frequency (Hf) was below 18.6 dB in the subjects at low altitude, while the results were found to be above 25.1 dB in the subjects at HA during expiration. A correlation was observed between the degree of HA and 'Odiosoft-rhino' findings at Hf intervals of the subjects. At the top of the mountain, the sound intensities at low and medium frequency were observed to be significantly lower than at low altitude (p < 0.05). We concluded that Hf values of HA were significantly higher than at low altitude because of nasal congestion and also narrowing of the cross-sectional area of the nasal airway. Nasal conchal and mucosal congestion affects airflow through the nasal cavity at HA, transforming it from a laminar pattern to turbulent flow. We found significant increases in the sound intensity level at Hf in the sound spectra at HA. Awareness of the impact of HA in nasal airflow is important in the diagnosis and treatment of nasal obstruction symptoms.

Oropharyngeal leech infestation and therapeutic options.

This is a case report about a rare oropharyngeal foreign body causing oropharyngeal symptoms such as sore throat, dysphagia and hemoptysis. We reported a 7 year-old boy who had ingested a leech from a bottle which had been filled with water and it had attached to the palate within 4 days. The leech was identified as approximately 3 cm in length. Leech was removed under premedication by using monopolar cauterization. Although child infestation by a leech in the upper respiratory tract is very rare, it should be investigated when contaminated liquids are ingested. Electro cauterization should be borne in mind as a therapeutic option in the treatment of leech infestations in the upper respiratory tract under pre-medication in pediatric patients.

Permanent t-tube insertion in two patients with Hurler's syndrome.

Hearing loss in mucopolysaccharidosis is usually both conductive and sensorineural. The conductive component is attributable to serous otitis media secondary to dysfunction of the eustachian tube and chronic thickening of the mucosa of the middle ear. The conductive component may persist after myringotomy and insertion of short-term or long-term ventilation tubes. In Hurler's syndrome, death usually occurs in the first decade of life. In our study, we present two cases, a three-year-old girl and a four-year-old boy, who were diagnosed with Hurler's syndrome. Both children have a history of otitis media with effusion requiring repeated short-term ventilation tube insertions that were unsuccessful. Permanent t-tubes were inserted in both cases. Results showed an approximate 20 dB improvement in hearing sensitivity postoperatively for each patient.