Effects of Esterified Hyaluronic Acid, Adipose Tissue, and Blood Glue on Survival of Diced Cartilage Grafts.

OBJECTIVES: Diced cartilage grafts are used for correcting nasal dorsal deformities and irregularities. However, cartilage resorption is among most common problems after rhinoplasty. The purpose of this experimental study was to investigate the effects of esterified hyaluronic acid, adipose tissue, and blood glue on the viability of diced cartilage grafts. METHODS: A total of 24 Wistar albino rats were used for the study. Cartilage grafts were obtained from 1 side ear and diced. The rats were divided into 4 groups (6 in each group): bare diced cartilage (group 1), diced cartilage wrapped with adipose tissue (group 2), diced cartilage blended with blood glue (group 3), and diced cartilage wrapped with esterified hyaluronic acid (group 4). The grafts were inserted into the subcutaneous pockets of the back of same rat. After 2 months follow-up specimens were harvested for histopathological and dimensional examination. The sections were stained with Hematoxylin and Eosin, Masson-Trichrome, and Elastic Van-Gieson. Chronic inflammation, loss of chondrocyte nucleus, vascularization, foreign body reaction, collagen content of matrix, and extent of elastic fiber were assessed under light microscopy. RESULTS: Foreign body reaction in adipose tissue and blood group was significantly higher than bare cartilage and esterified hyaluronic acid group ( P = 0.001). With respect to loss of chondrocyte nucleus esterified hyaluronic acid group had significant higher rate of nucleus loss than other groups ( P = 0.002). CONCLUSIONS: This study suggests that blood glue, esterified hyaluronic acid and autologous adipose tissue have not beneficial effects in improving viability of diced cartilage grafts.

Percutaneous rhinolift procedure for droopy tip.

OBJECTIVE: Droopy tip may lead to functional impairment due to nasal valve insufficiency. There are several techniques available in order to correct under rotated tip, including sutures, resection and grafting. The major drawback of these standart procedures is the correction of nasal cartilage framework rather than droopy skin envelope. In this study, we demonstrated the long-term results of percutaneous rhinolift procedure which aids in the correction of cartilage framework position and droopy skin at the same time, in patients who had isolated nasal tip ptosis. METHODS: Seventeen patients with nasal tip ptosis who underwent rhinolift procedure under local anesthesia, between September 2016 and February 2017, included in the study. Nasal obstruction was evaluated by Nasal Obstruction Symptom Evaluation (NOSE) Scale and Visual Analog Scale (VAS) before the procedure, and 1st month and 3rd month after the procedure. Long-term follow-up scores were also analyzed. RESULTS: There was a significant difference between preoperative NOSE scores and 1st, 3rd month and long-term follow-up scores (p < 0.001). When we analyzed the VAS scores of patients, there was significant difference between preoperative scores and 1st month, 3rd month and long-term follow-up scores (p < 0.001). DISCUSSION: Suspension sutures have been used to hang and lift the ptotic tissues of nasal tip. In this study, we found that rhinolift procedure is an effective method for droopy nasal tip cases especially with excess skin volume who cannot undergo a major invasive surgical operation. IMPLICATIONS FOR PRACTICE: It is a conservative and cheap method which does not require general anesthesia.

Diagnostic challenges in cervical tuberculous lymphadenitis: A review.

Tuberculosis is a very serious disease and incidence is once again on the rise. Lymph node tuberculosis is one of the most common extrapulmonary manifestations of tuberculosis. In differential diagnosis of chronic, painless cervical lymphadenopathy, cervical tuberculous lymphadenitis should be kept in mind. A high index of suspicion is needed for diagnosis of tuberculous lymphadenitis, which is known to mimic a number of pathological conditions. This article reviews epidemiology, clinical manifestations, and diagnostic techniques for cervical tuberculous lymphadenitis.

How does parental smoking affect nasal mucociliary clearance in children?

Correlation between passive smoking and nasal mucociliary clearance (MCC) in pediatric population has not been reported before. Therefore, in this study, we aimed to investigate the relationship between environmental tobacco smoke and nasal MCC in children whose parents smoke in or outside the house. Three groups of subjects were evaluated: control group (group 1) with 18 children who were not exposed to environmental smoke, 15 passive smokers living with at least one adult household member smoking outside the house (group 2), 17 passive smokers living with at least one adult household member smoking inside the house (group 3). Parents of children were asked to answer our questions regarding their smoking history, and nasal MCC time was assessed for all individuals of the 3 groups. The mean MCC value in control group, group 2 and group 3 were 7.33 ± 2.91, 10.00 ± 4.78 and 12.41 ± 3.44, respectively. Differences between the mean nasal MCC values of the groups were statistically significant (p < 0.01). The comparison of MCC values between control group and group 2 did not reveal significant difference, but since p value was very close to significance level, in larger series it could be significant. (p = 0.067). Also, when we compared the MCC values between group 2 and group 3, there was no significant difference (p = 0.173). But, the difference between MCC values of control group and group 3 was statistically significant (p < 0.001). Parental smoking both inside or outside the house seemed to increase nasal mucociliary clearance time when they are compared with healthy controls. Further studies with larger study groups also measuring direct quantitative doses of smoking are needed to verify this important issue.

Histopathological characteristics of nasal polyps in smokers and non-smokers.

OBJECTIVE: It is known that cigarette smoking causes squamous metaplasia in upper and lower airways. We hypothesized that in patients with nasal polyposis, nasal polyps of smokers might reveal some histopathological changes and there might be an increased neoplasia risk. Therefore, in this study, we aimed to explore the effects of smoking on nasal polyp histopathology and clinical measures. STUDY DESIGN: Retrospective chart review. SETTING: Fatih Sultan Mehmet Education and Research Hospital. MATERIAL AND METHODS: Thirty smoker and 47 non-smoker patients with nasal polyposis who underwent endoscopic sinus surgery between 2007 and 2011 were enrolled in this study to assess effect of smoking on histopathological characteristics of nasal polyps and clinical measures such as endoscopy score, computed tomography score of Lund-Mackay, Nasal Obstruction Symptom Evaluation (NOSE) Scale, presence of allergy and asthma, and blood eosinophil level. RESULTS: No statistically significant differences were found between smoker and non-smoker groups with regard to histopathological findings. Also, there were no significant correlation defined by endoscopy, computed tomography, and NOSE scores of patients between 2 groups. Smoking did not have a significant effect on the presence of allergy or asthma. But blood eosinophil levels were found to be significantly high in the smoker group. CONCLUSION: This is the first clinical study that investigates the effect of smoking on nasal polyp histopathology. In spite of the fact that smoking is associated with histopathological changes in respiratory mucosa, we did not find any significant change in histopathological characteristics of nasal polyps in smokers.

Co-occurrence and possible role of sinonasal anomalies in primary acquired nasolacrimal duct obstruction.

OBJECTIVE: Our objective was to determine the co-occurrence of sinonasal anomalies and primary acquired nasolacrimal duct obstruction. METHODS: A total of 41 patients were enrolled in the study, of which 41 had primary unilateral acquired nasolacrimal duct (NLD) obstruction. All patients included in the study were evaluated by anterior rhinoscopy, endoscopic nasal examination, and paranasal sinus computed tomography (CT) in order to reveal significant nasal and paranasal pathology. RESULTS: A significant increase was noted in the rate of concha bullosa, inferior turbinate hypertrophy, osteomeatal complex disease, and maxillary sinusitis in favor of the study group (P < 0.05). Nasal septal deviation, irregularity of middle turbinate, paradoxical middle turbinate, ethmoidal sinusitis, and Onodi cell and agger nasi cell incidence were found to be high in the study group. However, none of this increase was statistically significant (P > 0.05). CONCLUSIONS: Although primary acquired NLD obstruction seems to be an ophthalmologic problem, rhinologic problems have great importance in etiology. Detailed endoscopic examination and preoperative paranasal sinus computed tomography will reveal the possible role of nasal and paranasal structures adjacent to lacrimal sac in etiology of NLD obstruction. This will be effective both on conservative treatment and postoperative success in patients scheduled for surgery.

Is there any predictor for tinnitus outcome in different types of otologic surgery?

Our objective was to determine the effect of different types of otologic surgeries on tinnitus symptoms. Our study consisted of 63 patients who were operated between January and June 2011. Variables such as age, sex, presence of systemic diseases, location and size of the perforation, duration of dry period, type of otological surgery, peroperative presence of cholesteatoma, timpanosclerotic plaques and ossicular chain discontinuity were evaluated. Audiologic evaluation by pure tone audiometry and assessment of THI scores were conducted before surgery and 12 weeks after surgery. There was a very significant difference between preoperative and postoperative mean THI scores (p < 0.01). There was no significant effect of presence of ossicular discontinuity, cholesteatoma, tympanosclerotic plaques, type of surgery or duration of symptoms on the difference of preoperative and postoperative THI scores (p > 0.05). There was a significant positive relationship between audiological gain and THI scores (r = 0.355, p < 0.01). In our study, we investigated the relationship between many types of otological surgeries including some preoperative and peroperative pathological findings and tinnitus. As a result, we found that postoperative audiologic gain is an important factor determining outcome of tinnitus in these types of otological surgeries.

Role of allergy in primary acquired nasolacrimal duct obstruction.

OBJECTIVE: Our objective was to determine the role of allergy in primary acquired nasolacrimal duct obstruction. METHODS: A total of 41 patients were enrolled in the study, 41 of whom had primary unilateral acquired nasolacrimal duct obstruction. All patients included in the study were evaluated by anterior rhinoscopy, endoscopic nasal examination, and multiprick skin test to reveal allergic rhinitis. RESULTS: Allergy incidence was found to be high in study group. This was statistically significant (P < 0.05). CONCLUSIONS: Although primary acquired nasolacrimal duct obstruction seems to be an ophthalmologic problem, rhinologic problems have great importance in etiology. Detailed endoscopic examination and multiprick skin test will reveal the possible role of allergic rhinitis. This may increase the success rate both of the conservative treatment options and of the surgical treatment.

Audiological and graft take results of cartilage reinforcement tympanoplasty (a new technique) versus fascia.

Our objective is to compare hearing and graft take results of temporal muscle fascia tympanoplasty and cartilage reinforcement tympanoplasty. Seventy seven patients are classified into two groups: Group 1 included 37 patients for whom cartilage graft, harvested from symba concha, is used as reinforcement under temporalis muscle fascia anteriorly and Group 2 included 40 patients for whom only temporalis muscle fascia is used in type 1 tympanoplasty. A pure-tone audiometry is done within 1 week prior to surgery and at 6 months postoperatively. There is statistically significant difference between postoperative graft take results among groups. In both groups postoperative anterior TM perforation is encountered most commonly. Success rate of cartilage reinforcement tympanoplasty in revision patients is 100% but temporal muscle fascia tympanoplasty's is 66%. There is no statistically significant difference between preoperative and postoperative air conduction gain of TM intact patients. The results indicated that Cartilage reinforcement myringoplasty technique under anterior of the temporal muscle fascia significantly increases the graft take ratios in high-risk perforations and it also does not affect hearing levels. Therefore, the authors suggest usage of cartilage reinforcement tympanoplasty technique under anterior of the temporal muscle fascia which is an easy and applicable technique to increase graft take ratios, particularly in patients with preoperative anterior and subtotal TM perforations.

Effect of type I tympanoplasty on the quality of life of children.

OBJECTIVES: Quality-of-life issues related to chronic otitis media (COM) include physical symptoms, emotional symptoms, hearing loss, speech symptoms, social symptoms, and parents' emotional symptoms. In this study we evaluated the effects of tympanoplasty on the quality of life of pediatric patients. METHODS: In a questionnaire-based outcome study, we reviewed 56 of 78 pediatric patients with COM who were treated with type I tympanoplasty at our institution between December 2008 and February 2010. All patients were asked to fill out the COM-5 questionnaire with their parents, before operation and 6 months after operation. Preoperative and postoperative total ear scores, preoperative and postoperative ear scores with an intact tympanic membrane, preoperative and postoperative ear scores with a perforated tympanic membrane, and preoperative and postoperative audiological results were assessed. RESULTS: After type I tympanoplasty, 45 patients (80.3%) had successful closure of the tympanic membrane, but 11 patients (19.7%) had unsuccessful closure of the tympanic membrane. There was a significant decrease in physical suffering, hearing loss, emotional distress, activity limitations, and caregiver's concerns scores in patients with intact tympanic membranes after operation (p < 0.01). CONCLUSIONS: Children with COM had a significant increase in their quality of life after successful tympanoplasty. Our results also suggested that tympanoplasty was successful in pediatric patients with COM.

A study to detect Helicobacter pylori in adenotonsillar tissue.

We conducted a prospective study to investigate the possibility of Helicobacter pylori colonization on tonsillar and adenoid tissues. Our study group was made up of 84 consecutively presenting children aged 4 to 12 years who had undergone adenotonsillectomy or adenoidectomy with or without ventilation tube insertion. The excised specimens were analyzed by rapid urease testing and histopathologic examination to detect H pylori. Histologic sections were subjected to hematoxylin and eosin staining and Giemsa staining as performed in routine gastric biopsies. We found no H pylori colonization in any specimen. Therefore, we consider the possibility of H pylori colonization of adenotonsillar tissue unlikely, even though the authors of some recent studies have reported such a finding. Other means of detecting possible H pylori colonization in the upper aerodigestive tract rely on invasive biopsy procedures, which are difficult to use in clinical practice. Therefore, on the basis of our findings and our review of the literature, we conclude that looking for H pylori in the upper aerodigestive tract is not only clinically useless, but damaging, as well.

Histopathological effects of estrogen deficiency on larynx mucosa in ovariectomised rats.

Laryngeal manifestations due to estrogen deficiency have been studied in the literature. But to date, the possible histopathological changes of laryngeal mucosa due to estrogen deficiency have not been studied. Therefore, our objective was to determine the histopathological changes of laryngeal mucosa in ovariectomised rats in order to clarify effects of estrogen deficiency on laryngeal tissue. The study is a randomized trial and was conducted at the animal care facility of Haydarpasa Numune Education and Research Hospital. Twenty-one Wistar rats were used throughout the experiment. There were six rats in the sham-operated control group. And others were divided into two groups (4, 8 weeks) according to follow-up time after ovariectomy. We observed significant changes 4 weeks after ovariectomy when we assessed subepithelial edema, inflammation, cilia and goblet cell loss (p < 0.01). It was shown that estrogen deficiency after ovariectomy in rats caused changes in laryngeal tissue when it was studied histopathologically.

Unilateral sinonasal symptoms.

OBJECTIVE: The aim of the study was to describe the pathology in patients with unilateral sinonasal symptoms and to identify variables that may predict neoplastic pathology. STUDY DESIGN: Retrospective chart review. METHODS: A retrospective analysis was completed on 207 consecutive patients with sinonasal symptoms, most of whom underwent functional endoscopic sinus surgery from 2005 to 2008. Of the charts reviewed, 63 patients had unilateral sinonasal symptoms with unilateral opacification of paranasal sinus computed tomography scans. Presenting symptoms and radiographic, surgical, and pathologic findings were analyzed. RESULTS: All 63 patients underwent surgical management for their symptoms, and specimens were sent for pathologic evaluation. There were 12 cases of antrochoanal polyp, 14 of nasal polyposis, 8 of chronic rhinosinusitis, 7 of concha bullosa, 4 of retention cyst in maxillary sinus, 2 of mucocele, 3 of oroantral originated cyst, and 13 cases of benign or malign neoplastic diseases, some of which were extremely rare cases such as pleomorphic adenoma, ameloblastoma, schwannoma, myxoma, and non-Hodgkin lymphoma. Nasal discharge was more common in inflammatory than neoplastic disease. However, epistaxis was more common in neoplastic disease. CONCLUSIONS: A wide variety of pathologic findings present with unilateral sinonasal symptoms. A careful history, examination, and radiographic studies can often determine the responsible disease process. Histologic confirmation remains obligatory for diagnosis. There are also some rare cases, which should be considered in differential diagnosis of unilateral polyp or mass lesion on nasoendoscopy.

How does reflux affect laryngeal tissue quality? An experimental and histopathologic animal study.

OBJECTIVE: To investigate the histopathologic changes in intact laryngeal epithelium and mucosa exposed to endogenous gastric acid and pepsin in an experimental model of reflux. STUDY DESIGN: Randomized trial. SETTING: The study was conducted at the animal care facility of Haydarpasa Numune Education and Research Hospital. SUBJECTS AND METHODS: Eighteen healthy 200- to 220-g, 20-week-old Sprague-Dawley rats were used. The animals were divided into three groups according to exposure time (1-, 4-, and 12-week exposures), and four rats were examined as controls who underwent sham operation. An experimental model of gastroesophageal reflux was induced. After exposure, the animals were euthanized, and their larynges were removed. The histopathologic changes in the larynx were observed under a light microscope. RESULTS: The mean scores for inflammation in the control, one-, four-, and 12-week groups were 0.75 ± 0.50, 1.75 ± 0.50, 2.20 ± 0.45, and 1.94 ± 0.87, respectively. However, mean scores for vascular engorgement in the control, one-, and four-week groups were 0, and in the 12-week group was 2.0 ± 0.70. The mean scores for subepithelial edema in the control, one-, four-, and 12-week groups were 1.00 ± 0, 1.75 ± 0.95, 1.80 ± 0.45, and 2.20 ± 0.84, respectively. However, mean scores for keratinization for the control, one-, and four-week groups were 0, and for the 12-week group was 1.60 ± 0.55. When we compared inflammation, vascular engorgement, subepithelial edema, and keratinization mean scores between the control and study groups, there were statistically significant increases (P = 0.005, P = 0.001, P = 0.043, P = 0.002, respectively). CONCLUSION: Our findings suggest that reflux induces significant histopathologic changes in larynx mucosa.

Adenotonsillar hypertrophy: Does it correlate with obstructive symptoms in children?

OBJECTIVE: The goal of this study is to determine the correlation of clinical symptoms of UAO (upper airway obstruction) with radiographic evaluation of adenoidal obstruction and tonsil size in children with adenotonsillar hypertrophy and to evaluate the usefulness of lateral neck radiography. STUDY DESIGN: Prospective study. SETTING: Haydarpasa Numune Research and Education Hospital, Istanbul, Turkey. SUBJECTS AND METHODS: This study analyses 95 children with one or more of the symptoms of UAO. Clinical symptoms were assessed by a standardized questionnaire evaluating the severity of symptoms. All patients underwent otolaryngologic examination and their tonsil sizes were graded. 74 of 95 patients underwent digital lateral soft tissue radiographs. Assessment of nasopharyngeal obstruction in radiographs was done according to four different methods. RESULTS: We did not find statistically siginificant correlation between symptom scores and radiologic measurements according to Johanneson (r=0.072, p=0.544, p>0.05) and Crepeau (r=0.034, p=0.773, p>0.05). The correlations between OSA score and Cohen and Konak's method and AN ratio were weak and not statistically siginificant (p=0.133, r=0.176; p=0.290, r=0.125 respectively; p>0.05). But, we found a statistically siginificant correlation between the tonsil grade and symptom scores (r=0.216, p=0.036, p<0.05). CONCLUSION: Our results have demonstrated that radiologic measurements of the nasopharyngeal obstruction do not correlate with clinical symptoms of UAO, but clinical assessment of tonsil size does.

Is there a relation between mastoid aeration and Körner's septum?

The purpose of this study is to investigate the prevalence of Körner's septum (KS) in temporal bones with varying degrees of pneumatization and to evaluate any relationship between the degree of pneumatization and the presence of KS. Data were obtained retrospectively from 356 temporal bone high-resolution computed tomography of 178 patients who underwent tympanoplasty. Mastoid bone pneumatization was classified as aerated, diploic and sclerotic. The presence of Körner's septum was also investigated. The relationship between the presence of Körner's septum and the type of mastoid pneumatization was assessed. KS was encountered in 98 out of total 356 ears. Prevalence of KS was not statistically different between aerated (31%, n = 36), diploic (24.7%, n = 27) and sclerotic mastoids (26.9%, n = 35; p > 0.05). In conclusion, there is no relationship between the presence of KS and the degree of pneumatization. The presence of KS does not necessarily corroborate the presence of poor pneumatization.

How does childhood otitis media change the radiological findings of the temporal bone?

CONCLUSION: Inflammatory changes in the middle ear mucosa since childhood may affect mastoid pneumatization without a change in the position of the sigmoid sinus. Also, despite the fact that recurrences of inflammatory middle ear disease lead to bone destruction, we did not see any relationship between the childhood otitis media and bone destruction. OBJECTIVE: To assess radiological findings in temporal bone in both healthy ears and diseased ears in patients with unilateral chronic otitis media since their childhood. METHODS: Twenty-five patients who had unilateral otological symptoms, such as recurrent otalgia, purulent otorrhea or hearing loss since their childhood were included in the study. Assessment of radiological parameters was performed using a quantitative digital image processing computed tomography program. RESULTS: Mastoid volume values in the chronic otitis media group were significantly smaller when compared with those of a healthy group (p < 0.05). In healthy and diseased mastoid groups, there were no significant differences between groups when we assessed Henle spine-sigmoid sinus (HS-SS) distances. There was a significant correlation (p = 0.001) in both the groups when we compared mastoid volume values with HS-SS distances. There was ossicular discontinuity in two cases and in one patient tegmen tympani was not intact in diseased ears.

Investigation of gastric pepsinogen in middle ear fluid of children with glue ear.

CONCLUSION: The presence of pepsinogen in middle ear effusion (MEE) supports the relationship between gastroesophageal reflux (GER) and otitis media with effusion (OME). Measurement of pepsin/pepsinogen can be considered as a simple and reliable method for assesment of reflux in children. However, further research is needed to establish a definite association between GER and OME before beginning antireflux treatment in the management of MEE. OBJECTIVE: The aim of this study was to investigate the relationship between GER and chronic OME, and to confirm the presence of gastric enzyme in the MEE of children with OME. METHODS: This was a prospective study. MEE and blood samples were obtained from 42 children undergoing tympanostomy tube placement. Total pepsinogen concentrations of effusions and serum samples were measured with a commercial ELISA using a human pepsinogen I specific antibody. Albumin levels of effusions and serum samples were also measured with ELISA for comparison with pepsinogen levels. RESULTS: Measurable pepsinogen was present in all MEEs from patients, with levels higher than the serum values. The difference between the levels of pepsinogen measured in MEE and serum was statistically significant (p < 0.01), but albumin levels were higher in serum than in MEE and the difference was statistically significant (p < 0.01).