The association of nasal foreign bodies with type 1 hypersensitivity in children.

PURPOSE: This study aimed at investigating the type 1 hypersensitivity reaction frequency of children with nasal foreign body history. METHODS: From the medical records, we collected data regarding demographics (age and gender), symptoms, history of allergic diseases, physical examination, laboratory and test results, radiographic findings, the presence of any need for a second intervention, and complications. By reference to the presence of nasal foreign body history, two groups were constituted: the nasal foreign body group and the control group. Type 1 hypersensitivity frequency of the nasal foreign body group was compared with the control group. RESULTS: In the nasal foreign body group, 47 of 110 patients (42.7%) had a previous history of type 1 hypersensitivity reaction, while only 15 of 100 patients (15%) had a previous history of type 1 hypersensitivity reaction in the control group. The frequency of type 1 hypersensitivity reactions was significantly higher in patients with a history of nasal foreign body, compared to the patients without (p < 0.001, X2 = 19.35). CONCLUSION: Children with type 1 hypersensitivity reactions may be more likely to present with nasal foreign bodies. Physicians should pay more attention to the history of type 1 hypersensitivity reactions in children presenting with nasal foreign bodies.

Predictor parameters for poor prognosis in patients with sudden sensorineural hearing loss: fibrinogen to albumin ratio vs C-reactive protein to albumin ratio / Parâmetros preditores de mau prognóstico em pacientes com perda auditiva neurossensorial súbita: relação fibrinogênio/albumina vs. relação proteina C-reativa/albumina

Abstract Introduction Prognosis of sudden sensorineural hearing loss may be predicted using several parameters of laboratory blood analysis. Objective To identify and investigate the most significant indicator parameters related to the poor prognosis of sudden sensorineural hearing loss. Methods Eighty-eight patients were included, and three groups were constituted: non-recovery group with14 patients, recovery group with 33 patients and control group with 41 individuals. We compared fibrinogen-to-albumin ratio, C-reactive protein-to-albumin ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, white blood cell and hemoglobin of the groups. Then, we investigated the most significant indicator parameters related to the poor prognosis of sudden hearing loss. Results The mean hemoglobin, mean platelet-lymphocyte ratio and median white blood cell values did not significantly differ among three groups (p = 0.36, p = 0.86 and p = 0.79, respectively). A significant difference of median fibrinogen-albumin ratio, C-reactive protein-albumin ratio, neutrophil-to-lymphocyte ratio was evident among three groups (p < 0.001, p = 0.003 and p = 0.002, respectively). Median fibrinogen-albumin ratio, C-reactive protein-albumin ratio and neutrophil-to-lymphocyte ratio values were significantly greater in the non-recovery group, compared with the controls (p < 0.001, p = 0.003 and p = 0.005, respectively). Median fibrinogen-to-albumin ratio, C-reactive protein-to-albumin ratio and neutrophil-to-lymphocyte ratio were significantly greater in the recovery group, compared with the controls (p < 0.001, p = 0.013 and p = 0.005, respectively). Moreover, the median fibrinogen-albumin ratio was significantly greater in the non-recovery group compared with the recovery group (p = 0.017). However, no statistically significant difference of median C-reactive protein-albumin ratio, neutrophil-to-lymphocyte was evident between the non-recovery and recovery groups (p = 0.15). Conclusion Increased levels of fibrinogen-albumin ratio may be predictive for poor prognosis in patients with sudden sensorineural hearing loss.

Resumo Introdução O prognóstico de perda auditiva neurossensorial súbita pode ser previsto com vários parâmetros da análise laboratorial do sangue. Objetivo Identificar e investigar os parâmetros indicadores mais significativos relacionados ao mau prognóstico da perda auditiva neurossensorial súbita. Método Foram incluídos 88 pacientes e três grupos foram constituídos: grupo não recuperado, com14 pacientes; grupo com recuperação, 33 pacientes, e grupo controle com 41 indivíduos. Foram comparadas a relação fibrinogênio/albumina, proteína C-reativa/albumina, relação neutrófilos/linfócitos, relação plaquetas/linfócitos, glóbulos brancos e hemoglobina dos grupos. Em seguida, investigamos os parâmetros indicadores mais significativos relacionados ao prognóstico ruim da perda súbita de audição. Resultados A média de hemoglobina, média da relação plaquetas/linfócitos e mediana dos valores de glóbulos brancos não diferiram significativamente entre os três grupos (p = 0,36, p = 0,86 e p = 0,79, respectivamente). Uma diferença significante da média da relação fibrinogênio/albumina, proteína C-reativa/albumina e neutrófilos/linfócitos foi evidente entre os três grupos (p < 0,001, p = 0,003 e p = 0,002, respectivamente). Os valores da mediana da relação fibrinogênio/albumina, proteína C-reativa/albumina e relação neutrófilos/linfócitos foram significantemente maiores no grupo sem recuperação, em comparação com os controles (p < 0,001, p = 0,003 e p = 0,005, respectivamente). As medianas da relação fibrinogênio/albumina, relação proteína C-reativa/albumina e relação neutrófilos/linfócitos foram significantemente maiores no grupo com recuperação, em comparação com os controles (p < 0,001, p = 0,013 e p = 0,005, respectivamente). Além disso, a mediana da relação fibrinogênio/albumina foi significantemente maior no grupo não recuperado comparado ao grupo com recuperação (p = 0,017). No entanto, não houve diferença estatisticamente significante da mediana da relação proteína-C reativa/albumina e relação neutrófilos/linfócitos entre os grupos sem recuperação e com recuperação (p = 0,15). Conclusão Níveis elevados de relação fibrinogênio/albumina podem ser preditores de mau prognóstico em pacientes com perda auditiva neurossensorial súbita.

Eustachian tube dysfunction in sleep apnea patients and improvements afforded by continuous positive airway pressure therapy / Disfunção da trompa de Eustáquio em pacientes com apneia do sono e melhoria proporcionada pela terapia com pressão positiva contínua nas vias aéreas

Abstract Introduction Upper airway resistance may accompany eustachian dysfunction and alter middle ear pressure in patients with obstructive sleep apnea syndrome. Objective To investigate effects of obstructive sleep apnea syndrome and continuous positive airway pressure treatment on eustachian tube functions. Methods Forty-two mild obstructive sleep apnea syndrome patients, 45 moderate obstructive sleep apnea syndrome patients, 47 severe obstructive sleep apnea syndrome patients with continuous positive airway pressure therapy, 32 severe obstructive sleep apnea syndrome patients without continuous positive airway pressure therapy, and 88 individuals without sleep apnea (controls) were included. Tympanometric parameters of groups were compared. Results Right middle ear pressures in mild and moderate obstructive sleep apnea syndrome groups did not differ significantly from that of control group (p = 0.93 and p = 0.55), as was also true of the left middle ear pressures (p = 0.94 and p = 0.86). Right middle ear pressure was significantly higher in severe obstructive sleep apnea syndrome groups than in the control group, as was the left middle ear pressure (p < 0.001). Middle ear pressure (negative) was significantly lower in severe obstructive sleep apnea syndrome patients with continuous positive airway pressure therapy compared to those without (p < 0.001). Right ear type B and C tympanogram frequencies were significantly higher in patients with severe obstructive sleep apnea syndrome without continuous positive airway pressure therapy (12.4%) than in the controls (0%) (p = 0.02). Left ear type B or C tympanogram frequencies were significantly higher in patients with severe obstructive sleep apnea syndrome without continuous positive airway pressure therapy (21.9%) than in the controls (0%) (p = 0.002). Conclusion Mild and moderate obstructive sleep apnea syndrome did not affect middle ear pressure but severe obstructive sleep apnea syndrome may increase the (negative) middle ear pressure. In severe obstructive sleep apnea syndrome patients, long-term continuous positive airway pressure therapy may normalize middle ear pressure.

Resumo Introdução A resistência das vias aéreas superiores pode se acompanhar de disfunção da trompa de Eustáquio e alterar a pressão na orelha média em pacientes com síndrome da apneia obstrutiva do sono Objetivo Investigar os efeitos do tratamento da síndrome da apneia obstrutiva do sono com pressão positiva contínua nas vias aéreas nas funções da trompa de Eustáquio. Método Foram incluídos 42 pacientes com síndrome da apneia obstrutiva do sono leve, 45 pacientes com síndrome da apneia obstrutiva do sono moderada, 47 pacientes com síndrome da apneia obstrutiva do sono grave submetidos à terapia de pressão positiva contínua nas vias aéreas, 32 pacientes com síndrome da apneia obstrutiva do sono grave sem terapia de pressão positiva contínua nas vias aéreas e 88 indivíduos sem apneia do sono (controle). Os parâmetros timpanométricos dos grupos foram comparados. Resultados As pressões na orelha média direita nos grupos com síndrome da apneia obstrutiva do sono leve e moderada não diferiram significantemente das do grupo controle (p = 0,93 e p = 0,55), assim como nas pressões da orelha média esquerda (p = 0,94 e p = 0,86). A pressão na orelha média direita foi significantemente maior nos grupos com síndrome da apneia obstrutiva do sono grave do que no grupo controle, assim como a pressão na orelha média esquerda (p < 0,001). A pressão negativa na orelha média foi significantemente menor nos pacientes com síndrome da apneia obstrutiva do sono grave submetidos à terapia com pressão positiva contínua nas vias aéreas em comparação com aqueles que não receberam tratamento (p < 0,001). As frequências dos timpanogramas do tipo B e C da orelha direita foram significantemente maiores em pacientes com síndrome da apneia obstrutiva do sonograve que não receberam terapia com pressão positiva contínua nas vias aéreas (12,4%) do que nos controles (0%) (p = 0,02). As frequências dos timpanogramas do tipo B ou C na orelha esquerda foram significantemente maiores em pacientes com síndrome da apneia obstrutiva do sonograve que não receberam terapia com pressão positiva contínua nas vias aéreas (21,9%) do que nos controles (0%) (p = 0,002). Conclusão Síndrome da apneia obstrutiva do sono leve e moderada não afetou a pressão da orelha média, mas a síndrome da apneia obstrutiva do sono grave pode aumentar a pressão negativa da orelha média. Em pacientes com síndrome da apneia obstrutiva do sono grave, a terapia em longo prazo com pressão positiva contínua nas vias aéreas pode normalizar a pressão da orelha média.

The effects of intraday operation time on pain and anxiety of patients undergoing septoplasty / Os efeitos do tempo de cirurgia intradia na dor e ansiedade de pacientes submetidos à septoplastia

Abstract Introduction Anxiety and pain levels of septoplasty patients may vary according to intraday operation time. Objective To investigate the effects of septoplasty operation and intraday operation time on anxiety and postoperative pain. Methods Ninety-eight voluntary patients filled out the hospital anxiety and depression scale to measure the anxiety level three weeks before, one hour before and one week after surgery. Forty-nine patients were operated at 8:00 am (morning group); other 49 were operated at 03:00 pm (afternoon group). We used a visual analogue scale to measure postoperative pain. Preoperative and postoperative scores were compared, as were the scores of the groups. Results Median hospital anxiety and depression scale scores one hour before the operation [6 (2-10)] were significantly higher compared to the median scores three weeks before the operation [3 (1-6)] (p < 0.001), and one week after the operation [2 (1-6)] were significantly lower compared to the median scores three weeks before the operation [3 (1-6)] (p < 0.001). Hospital anxiety and depression scale scores one hour before the operation were significantly greater in the afternoon group [8 (7-10)], compared to the morning group [4 (2-6)] (p < 0.001). Postoperative first, sixth, twelfth and twenty-fourth-hour pain visual analogue scale scores were significantly higher in the afternoon group compared to the morning group (p < 0.001). Conclusion Septoplasty might have an increasing effect on short-term anxiety and postoperative pain. Performing this operation at a late hour in the day might further increase anxiety and pain. However, the latter has no long-term effect on anxiety.

Resumo Introdução Os níveis de ansiedade e dor em pacientes submetidos à septoplastia podem variar de acordo com o tempo de cirurgia intradia. Objetivo Investigar os efeitos da cirurgia de septoplastia e do tempo de cirurgia intradia na ansiedade e dor pós-operatória. Métodos Noventa e oito pacientes voluntários preencheram a Hospital Anxiety and Depression Scale (HADS) para medir o nível de ansiedade três semanas antes, uma hora antes e uma semana após a cirurgia. Quarenta e nove pacientes foram operados às 8h (grupo da manhã) e 49 foram operados às 15h (grupo da tarde). Usamos a Escala Visual Analógica para medir a dor pós-operatória. Os escores pré e pós-operatórios foram comparados, assim como os escores dos grupos. Resultados As medianas dos escores da HADS uma hora antes da operação [6 (2-10)] foram significativamente mais altas em comparação com as medianas dos escores da HADS três semanas antes da operação [3 (1-6)] (p < 0,001) e as medianas dos escores da HADS uma semana após a operação [2 (1-6)] foram significativamente mais baixas em comparação com as medianas dos escores três semanas antes da operação [3 (1-6)] (p < 0,001). Os escores da HADS uma hora antes da operação foram significativamente mais altos no grupo da tarde [8 (7-10)], em comparação ao grupo da manhã [4 (2-6)] (p < 0,001). Os escores da EVA para dor na primeira, sexta, 12ª segunda e 24ª hora do pós-operatório foram significativamente mais altos no grupo da tarde em comparação com o grupo da manhã (p < 0,001). Conclusão A septoplastia pode ter um efeito crescente sobre a ansiedade em curto prazo e na dor pós-operatória e a feitura dessa cirurgia em hora mais tardia pode aumentar ainda mais a ansiedade e a dor. No entanto, isso não tem efeito em longo prazo na ansiedade.

Long-term efficacy of expansion sphincter pharyngoplasty in obstructive sleep apnea syndrome.

PURPOSE: The aim of this study was to analyze both short-term and long-term results of the expansion sphincter pharyngoplasty surgery, which is commonly used in obstructive sleep apnea syndrome (OSAS) and to compare it with objective and subjective methods. METHODS: Patients who underwent expansion sphincter pharyngoplasty were included in the study. Polysomnography at postoperative sixth-month, Epworth Sleepiness Scale, and visual analog score of snoring (VAS) were used to assess short-term results. Epworth Sleepiness Scale (ESS) and visual analog score of snoring (VAS) at postoperative third-year were used for long-term results. Sixth-month and third-year data before and after the surgery were compared. Possible complications and morbidity rates related to surgery were evaluated. RESULTS: Of 39 patients, OSAS was assessed as mild in 16 (41%), moderate in 14 (36%), and severe in 9 (23%). Mean age of patients was 43.2 ± 7.5, and 21 were men (54%). According to postoperative six-month PSG data, the apnea hypopnea index (AHI) values decreased significantly from 25.2 ± 8.3 to 11.6 ± 6.9/h, p=0.012. There were decreases in ESS from baseline to 6-month and 3-years from 10.4, to 4.4, and 4.4, and VAS scores changed from 8.6 to 1.6 and 1.9, p<0.05. No serious complications were observed in patients in the early and late postoperative period. CONCLUSION: The expansion sphincter pharyngoplasty procedure is an important option for OSAS surgery with long-term effective results and low morbidity and complication rates.

The novel indicators of moderate to severe sleep apnea: fibrinogen to albumin ratio vs. CRP to albumin ratio.

PURPOSE: This study aimed at investigating the association of severity of obstructive sleep apnea with the markers of inflammation as fibrinogen to albumin ratio and C-reactive protein to albumin ratio. METHODS: We included 126 patients admitted to sleep disorders outpatient clinic. We constituted four groups by reference to the apnea-hypopnea index (mild-moderate-severe sleep apnea and control group). We investigated the difference of white blood cell, fibrinogen to albumin ratio, C-reactive protein to albumin ratio, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and hemoglobin among the groups. RESULTS: Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and hemoglobin did not significantly differ among four groups (p = 0.39, p = 0.06, and p = 0.31, respectively). A significant difference of fibrinogen to albumin ratio and C-reactive protein to albumin ratio was evident among four groups (p < 0.001). Fibrinogen to albumin ratio and C-reactive protein to albumin ratio did not significantly differ between the mild sleep apnea and control groups (p = 0.65, and p = 0.85, respectively), but were significantly greater in moderate sleep apnea group compared with the control group (p < 0.001 and p = 0.001, respectively). Also, fibrinogen to albumin ratio and C-reactive protein to albumin ratio were significantly greater in the severe sleep apnea group compared with the control group (p < 0.001). Fibrinogen to albumin ratio and C-reactive protein to albumin ratio did not significantly differ between the severe sleep apnea and moderate sleep apnea groups (p = 0.49, and p = 0.58, respectively). CONCLUSION: Higher fibrinogen to albumin ratio and C-reactive protein to albumin ratio may be predictive of inflammation in patients with moderate-to-severe sleep apnea.

The effects of intraday operation time on pain and anxiety of patients undergoing septoplasty.

INTRODUCTION: Anxiety and pain levels of septoplasty patients may vary according to intraday operation time. OBJECTIVE: To investigate the effects of septoplasty operation and intraday operation time on anxiety and postoperative pain. METHODS: Ninety-eight voluntary patients filled out the hospital anxiety and depression scale to measure the anxiety level three weeks before, one hour before and one week after surgery. Forty-nine patients were operated at 8:00am (morning group); other 49 were operated at 03:00pm (afternoon group). We used a visual analogue scale to measure postoperative pain. Preoperative and postoperative scores were compared, as were the scores of the groups. RESULTS: Median hospital anxiety and depression scale scores one hour before the operation [6 (2-10)] were significantly higher compared to the median scores three weeks before the operation [3 (1-6)] (p< 0.001), and one week after the operation [2 (1-6)] were significantly lower compared to the median scores three weeks before the operation [3 (1-6)] (p< 0.001). Hospital anxiety and depression scale scores one hour before the operation were significantly greater in the afternoon group [8 (7-10)], compared to the morning group [4 (2-6)] (p< 0.001). Postoperative first, sixth, twelfth and twenty-fourth-hour pain visual analogue scale scores were significantly higher in the afternoon group compared to the morning group (p< 0.001). CONCLUSION: Septoplasty might have an increasing effect on short-term anxiety and postoperative pain. Performing this operation at a late hour in the day might further increase anxiety and pain. However, the latter has no long-term effect on anxiety.

Eustachian tube dysfunction in sleep apnea patients and improvements afforded by continuous positive airway pressure therapy.

INTRODUCTION: Upper airway resistance may accompany eustachian dysfunction and alter middle ear pressure in patients with obstructive sleep apnea syndrome. OBJECTIVE: To investigate effects of obstructive sleep apnea syndrome and continuous positive airway pressure treatment on eustachian tube functions. METHODS: Forty-two mild obstructive sleep apnea syndrome patients, 45 moderate obstructive sleep apnea syndrome patients, 47 severe obstructive sleep apnea syndrome patients with continuous positive airway pressure therapy, 32 severe obstructive sleep apnea syndrome patients without continuous positive airway pressure therapy, and 88 individuals without sleep apnea (controls) were included. Tympanometric parameters of groups were compared. RESULTS: Right middle ear pressures in mild and moderate obstructive sleep apnea syndrome groups did not differ significantly from that of control group (p = 0.93 and p = 0.55), as was also true of the left middle ear pressures (p = 0.94 and p = 0.86). Right middle ear pressure was significantly higher in severe obstructive sleep apnea syndrome groups than in the control group, as was the left middle ear pressure (p < 0.001). Middle ear pressure (negative) was significantly lower in severe obstructive sleep apnea syndrome patients with continuous positive airway pressure therapy compared to those without (p < 0.001). Right ear type B and C tympanogram frequencies were significantly higher in patients with severe obstructive sleep apnea syndrome without continuous positive airway pressure therapy (12.4%) than in the controls (0%) (p = 0.02). Left ear type B or C tympanogram frequencies were significantly higher in patients with severe obstructive sleep apnea syndrome without continuous positive airway pressure therapy (21.9%) than in the controls (0%) (p = 0.002). CONCLUSION: Mild and moderate obstructive sleep apnea syndrome did not affect middle ear pressure but severe obstructive sleep apnea syndrome may increase the (negative) middle ear pressure. In severe obstructive sleep apnea syndrome patients, long-term continuous positive airway pressure therapy may normalize middle ear pressure.

Predictor parameters for poor prognosis in patients with sudden sensorineural hearing loss: fibrinogen to albumin ratio vs C-reactive protein to albumin ratio.

INTRODUCTION: Prognosis of sudden sensorineural hearing loss may be predicted using several parameters of laboratory blood analysis. OBJECTIVE: To identify and investigate the most significant indicator parameters related to the poor prognosis of sudden sensorineural hearing loss. METHODS: Eighty-eight patients were included, and three groups were constituted: non-recovery group with14 patients, recovery group with 33 patients and control group with 41 individuals. We compared fibrinogen-to-albumin ratio, C-reactive protein-to-albumin ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, white blood cell and hemoglobin of the groups. Then, we investigated the most significant indicator parameters related to the poor prognosis of sudden hearing loss. RESULTS: The mean hemoglobin, mean platelet-lymphocyte ratio and median white blood cell values did not significantly differ among three groups (p=0.36, p=0.86 and p=0.79, respectively). A significant difference of median fibrinogen-albumin ratio, C-reactive protein-albumin ratio, neutrophil-to-lymphocyte ratio was evident among three groups (p<0.001, p=0.003 and p=0.002, respectively). Median fibrinogen-albumin ratio, C-reactive protein-albumin ratio and neutrophil-to-lymphocyte ratio values were significantly greater in the non-recovery group, compared with the controls (p<0.001, p=0.003 and p=0.005, respectively). Median fibrinogen-to-albumin ratio, C-reactive protein-to-albumin ratio and neutrophil-to-lymphocyte ratio were significantly greater in the recovery group, compared with the controls (p<0.001, p=0.013 and p=0.005, respectively). Moreover, the median fibrinogen-albumin ratio was significantly greater in the non-recovery group compared with the recovery group (p=0.017). However, no statistically significant difference of median C-reactive protein-albumin ratio, neutrophil-to-lymphocyte was evident between the non-recovery and recovery groups (p=0.15). CONCLUSION: Increased levels of fibrinogen-albumin ratio may be predictive for poor prognosis in patients with sudden sensorineural hearing loss.

Evaluation of oral isotretinoin effects on hearing system in patients with acne vulgaris: Reversible or not?

Systemic isotretinoin is commonly used for severe acne treatment. It has many side effects, one of these is about hearing system, which has rarely been reported, also previous studies reported contradictory results about systemic isotretinoin and its association with hearing system. In this study, we aimed to investigate whether systemic isotretinoin affected on the hearing system or not. The study included 32 acne vulgaris patients (64 ears) who treated with oral isotretinoin 0.5 mg/kg body weight for at least 4 months and audiometric tests including pure-tone, speech, bilateral acoustic reflexes, and tympanometric measurements were performed at baseline, in the first week, in the first month, and third month of treatment, and sixth month after treatment. Audiometric tests were performed for right and left ears separately. A significant difference was found in the pure-tone thresholds (before treatment, first week, first month, third month of treatment, and sixth month after treatment) for the both ears at 8000 Hz (P < .001) and a significant decrease in the sixth month post-treatment pure-tone thresholds compared to pre-treatment thresholds at 8000 Hz. Additionally, a statistically significant increase was observed in serum LDL and triglyceride levels in the third month of treatment and a significant decrease at the sixth month after treatment (P < .001). Systemic isotretinoin caused bilateral hearing threshold changes in acne patients during the therapy but the changes improved after discontinuation. Therefore, our findings may provide safety using for dermatologists about hearing effects of isotretinoin, which is quite effective on severe acne.

A proinflammatory marker in chronic rhinosinusitis: serum calprotectin.

INTRODUCTION: Studies have shown that calprotectin has a strong pro-inflammatory effect. Elevated calprotectin levels in the serum can be used as a strong clinical marker indicating the presence of inflammation. OBJECTIVE: To investigate serum calprotectin levels in patients with chronic rhinosinusitis (CRS) and to determine the applicability of calprotectin as a potential molecular pro-inflammatory biomarker for CRS. METHODS: The study consisted of three groups: chronic rhinosinusitis with polyps (CRSwNP group), chronic rhinosinusitis without polyps (CRSwoNP), and healthy control. CRS patients with polyps were further divided into two groups depending on the presence/absence of Samter's triad. The Nose Obstruction Symptom Evaluation (NOSE) scale score and serum calprotectin value were evaluated in all participants. RESULTS: The mean serum calprotectin value was 79.5±11.8 ng/ml for the CRSwNP group, 71.3±16 ng/ml for the CRSwoNP group, and 61.9±11.6 ng/ml for the control group (p<0.001). The Samter's triad group had a significantly higher calprotectin value than the non-Samter's triad group (p=0.03). There was a significant correlation between the NOSE scores and calprotectin levels (rho=0.734, p<0.001). CONCLUSION: Serum calprotectin values were correlated with the severity of symptoms in patients with CRS; thus, it seems to be a valuable pro-inflammatory biomarker for the diagnosis of the disease and determining its severity. Further studies with larger series are needed to evaluate the preoperative and postoperative serum calprotectin values ​​in patients undergoing surgery.

A Novel Proposal for Classifying Pediatric Tonsillectomy Complications: Modified Clavien Classification.

Introduction Tonsillectomy is one of the most common operations performed in the otolaryngology practice and there does not exist a systematic classification for tonsillectomy complications in the prior literature. In this study, we aimed at presenting a novel classification system to the current literature and analyzing complications of pediatric tonsillectomy based on this novel classification system. Methods  A novel classification system based on modified Clavien classification was constituted for pediatric tonsillectomy complications. Medical records of 534 patients underwent tonsillectomy were retrospectively investigated and complication rates of tonsillectomy between children and adults were compared using this classification Results  In total, 454 pediatric patients (258 males and 196 females, age range = 3-17 years) who underwent cold-knife tonsillectomy were eligible for the study. To compare the complication rates of the pediatric patients with adults, 80 adults with tonsillectomy (50 males and 30 females, age range 18-46) were also included. In children, the most common complication was dehydration, seen in 13 (2.86%) patients. The most serious complication was tooth aspiration (Grade 4a), seen in only one (0.22%) patient. Fifteen (3.3%) pediatric patients experienced more than one complication. Overall complication rate of pediatric tonsillectomy was 10.13% (46 patients). In adults, the most common complication was postoperative bleeding, seen in 11 (13.75%) adult patients. The most serious complication was Grade 3a postoperative bleeding, seen in four (5%) patients. Overall complication rate of adult tonsillectomy was 21.25% (17 patients). Overall complication rate of pediatric tonsillectomy was significantly lower compared with the complication rate of adult tonsillectomy (10.13% vs. 21.25%, p = 0.004, X2 = 8.07). Conclusion  Modified Clavien classification is a novel and simple tool to analyze and categorize complications of pediatric tonsillectomy.

A Comprehensive Analysis of Histopathologic Examination Results of Tonsillectomy Specimens.

Objective This study aims to review the histopathologic results of tonsillectomy specimens, determine the rates of the tonsillectomy indications, and investigate the characteristics of asymmetric hypertrophy. Materials and Methods Medical records of 484 patients who underwent tonsillectomy were reviewed retrospectively. Descriptive data of adult and pediatric patients were presented as percentage. Comparisons between asymmetric and symmetric hypertrophy groups were performed to determine the features of asymmetric hypertrophy. Results The mean age of 484 patients who underwent tonsillectomy was 13 years (range: 3-69 years). While 372 (76.85%) patients were operated for infection, 100 (20.66%) were operated for tonsillar hypertrophy, 1 (0.21%) for a suspicion of malignancy, and 11 (2.27%) for other various reasons. Asymmetric hypertrophy was seen in 25 (5.16%) patients, whereas symmetric hypertrophy was seen in 75 (15.49%) patients. Malignancy was detected in three (0.61%) adult patients with asymmetric hypertrophy. Tonsillar tuberculosis was observed in one foreign patient with asymmetric hypertrophy. The presence of malignancy was higher in the asymmetric hypertrophy group (three patients [12%]) compared with the symmetric hypertrophy group (none) (p=0.002; X2=9.27). Median maximum specimen diameter was 3 cm (range: 1.15-5.5 cm) in the asymmetric hypertrophy group and 2.4 cm (range: 1.25-4.8 cm) in the symmetric hypertrophy group (p=0.08). The Friedman grade was significantly (p<0.001), positively, and strongly (r=0.885) correlated with the maximum specimen diameter. Conclusion Routine histopathologic examination of the tonsillectomy specimens might not be necessary for all patients, but it is recommended for the patients with a real asymmetry.

Is Nasal Septal Body Size Associated With Inferior Turbinate Hypertrophy and Allergic Rhinitis?

Nasal septal body is a thickened mucosal area of nasal septum with an unknown certain role. In this study, the authors aimed to investigate the association between the area, length, and width of the nasal septal body with inferior turbinate hypertrophy (ITH) and allergic rhinitis (AR). A total of 106 patients with ITH (54 with AR and 52 without AR), and 49 patients without ITH and AR (control group) were included in this study. Using axial and coronal paranasal computed tomography scans, the area, length, and width of nasal septal body were measured, and the mean values between the groups were compared. Mean area, length, and width of nasal septal body significantly differed among 3 groups (P < 0.001). Septal body area was significantly greater in ITH with AR group, compared to ITH without AR group (P < 0.001) and the control group (P < 0.001). Also, it was significantly greater in ITH without AR group compared to the control group (P < 0.001). Septal body width was significantly greater in ITH with AR group, compared to ITH without AR group (P < 0.001) and the control group (P < 0.001). Also, it was significantly greater in ITH without AR group compared to the control group (P < 0.001). Patients with ITH had a greater nasal septal body area, length, and width, compared to the patients without. Moreover, AR had an additional increasing effect on the area and width of the nasal septal body.

Is C-reactive protein to albumin ratio an indicator of poor prognosis in Bell's palsy?

PURPOSE: The aim of this study was to determine whether the C-reactive protein to albumin ratio was associated with the prognosis in patients with Bell's palsy. METHODS: Reviewing records of 79 patients diagnosed with Bell's palsy, 3 groups were constituted: recovered group (with a House Brackman grade of 1 or 2 after treatment, 56 patients), unrecovered group (23 patients) and control group (60 healthy individuals). Age, hemoglobin, C-reactive protein to albumin ratio, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, white blood cell and hemoglobin values were compared among the groups. RESULTS: Age, hemoglobin and platelet to lymphocyte ratio were not significantly different between the groups (p = 0.12, p = 0.31, p = 0.86 and p = 0.87, respectively). Median C-reactive protein to albumin ratio, neutrophil to lymphocyte ratio and white blood cell were significantly greater both in non-recovery group (p < 0.001) and recovery group (p = 0.001 and p < 0.001, respectively) compared to the control group. Additionally, median C-reactive protein to albumin ratio and neutrophil to lymphocyte ratio were significantly greater in the non-recovery group, compared to the recovery group (p = 0.002, and p < 0.001, respectively). However, median white blood cell did not significantly differ between the non-recovery and the recovery groups (p = 0.89). CONCLUSION: Higher C-reactive protein to albumin ratio and neutrophil to lymphocyte ratio were associated with poor prognosis in patients with Bell's palsy. C-reactive protein to albumin ratio might be the most significant indicator of poor prognosis in patients with Bell's palsy.

A Novel Predictor Parameter for Active Recurrent Aphthous Stomatitis: C-Reactive Protein to Albumin Ratio.

Objective Laboratory analysis results may provide an opportunity to predict the activity process of recurrent aphthous stomatitis. The goal of this study was to investigate whether there is a correlation between C-reactive protein to albumin ratio (CAR) and oral ulcer activity in patients with recurrent aphthous stomatitis. Materials and methods We included 72 patients (39 with active and 33 with inactive lesion) with recurrent aphthous stomatitis and 60 healthy controls. We compared blood test parameters including CAR, white blood cell count (WBC) and neutrophil to lymphocyte ratio (NLR) among the groups. Additionally, we investigated the most significant parameter for the activity of oral ulcers. Results NLR was significantly higher both in the active (p<0.001) and inactive lesion groups (p<0.001), compared to the control group but did not significantly differ between active and inactive lesion groups (p=0.17). A significant difference in median CAR (p<0.001) and WBC (p<0.001) was evident among the three groups. Median WBC was significantly higher in the active lesion group compared to the control group (p<0.001) but did not significantly differ between active and inactive lesion groups (p=0.095). Median CAR was significantly higher in the active lesion group, compared both to the inactive lesion group (p=0.002) and the control group (p<0.001). Median CAR was also significantly higher in the inactive lesion group compared to the control group (p<0.001). Median hemoglobin, platelet to lymphocyte ratio and mean platelet volume did not significantly differ among three groups (p=0.16, p=0.85, p=0.19, respectively). Conclusion CAR could be used as a predictive parameter for inflammation and activity of oral ulcers in patients with recurrent aphthous stomatitis.

Is type 1 tympanoplasty effective in elderly patients? Comparison of fascia and perichondrium grafts.

Background: Tympanoplasty is regularly performed in various ages but data about the procedure in elderly is insufficient. Objectives: To compare the success rates and hearing outcomes of fascia and perichondrium grafts used for tympanoplasty in patients >65 years and to evaluate the prognostic factors affecting the success of tympanoplasty. Methods: Reviewing records of 49 elderly patients underwent tympanoplasty, two groups were constituted: perichondrium (25 patients) and fascia (24 patients) groups. Ages, genders, perforation sides, type and location of perforation, graft success rates, functional success rates and air-bone gap (ABG) gains were compared. Results: Overall graft success rate was 85.7%. After a mean follow-up of 23.3 ± 8.32 months, overall mean ABG gain was 11.33 ± 8.42 dB. Overall median postoperative ABG value (9 dB) was significantly lower compared to the median preoperative value (24 dB) (p < .001). Graft success rate was higher in perichondrium group (96%) compared to fascia group (75%) (p = .04). Functional success rate did not significantly differ between perichondrium (68%) and fascia groups (62.5%) (p = .68). Conclusion and significance: Tympanoplasty is an effective procedure with a graft success rate of 85.7% in elderly. Both fascia and perichondrium are suitable materials; however, perichondrium had higher success rate.

The association between obstructive sleep apnea and hearing loss: a cross-sectional analysis.

PURPOSE: To determine if sleep apnea had significant effects on hearing functions and to investigate the polysomnography parameters that might be associated with hearing impairment in sleep apnea patients. METHODS: We included 120 patients who were admitted to sleep disorders outpatient clinic. We constituted four groups by reference to the apnea-hypopnea index (including control group), and compared the audiometric parameters of the groups. Additionally, we investigated the correlation of apnea-hypopnea index, desaturation index and min. oxygen saturations with pure-tone thresholds, speech recognition thresholds and speech discrimination scores. RESULTS: The median pure-tone thresholds at 250, 500, 1000, 2000, 4000 and 8000 mHz, the median speech recognition thresholds and the median speech discrimination scores on both ears did significantly differ among four groups (p < 0.001). Moderate sleep apnea affected high-frequency hearing functions and speech discrimination scores, and severe sleep apnea had significant effects on all hearing functions. Pure-tone thresholds and speech recognition thresholds on the both ears were positively correlated with apnea-hypopnea index and desaturation index, and negatively correlated with min. oxygen saturation (p < 0.001). Speech discrimination scores on the both ears were negatively correlated with apnea-hypopnea index and desaturation index, and positively correlated with min. oxygen saturation (p < 0.001). CONCLUSION: Obstructive sleep apnea syndrome (OSA) had several effects on hearing, and hearing impairment might be associated with the severity of OSA. Moderate OSA affected high-frequency hearing functions and severe OSA affected all hearing functions negatively.

Type 1 tympanoplasty in pediatric patients: Comparison of fascia and perichondrium grafts.

OBJECTIVE: The timing of tympanoplasty in the pediatric age group is an ongoing debate. The purpose of this study was to analyze and compare the success of grafts in type 1 tympanoplasty in pediatric patients, and to evaluate the prognostic factors that may affect its success. MATERIALS AND METHODS: A retrospective study of 42 pediatric patients who were younger than 18 years and underwent a primary type 1 tympanoplasty using tragal cartilage perichondrium and temporalis fascia from January 2013 to December 2018, were evaluated. A total of 42 medical records of children aged between 8 and 18 years (20 female, 22 male) were reviewed. Age, gender, co-morbidities, perforation size and location, type (central, marginal), pre- and post-operative hearing levels, mean air-bone gap (ABG), graft material (fascia, perichondrium), length of follow up and surgical outcomes were collected. RESULTS: The overall graft success rate was 83.3% (out of 35 patients). The graft success rate was significantly higher 95.2% (20/21) for the perichondrium group compared with 71.4% (15/21) for the temporal fascia group(p = 0.023). The functional success rate (postoperative air-bone gap<20 dB) obtained in the perichondrium group was 90.4% (19/21) and 85.7% (18/21) in the fascia group, respectively. After a mean follow-up of 27.5 ±â€¯11.55 months, the mean hearing improvement was 11.26 ±â€¯7.53 dBHL for overall the group. Presence of contralateral otitis media with effusion (OME) was found a risk for reperforation and bilateral perforations were negatively affected graft success rate (p < 0.01). Graft success did not affected by age, gender and type and location of perforation (p > 0.05). CONCLUSION: Both temporalis fascia and tragal cartilage perichondrium are suitable graft materials for pediatric tympanoplasty with 83.3% of graft success rate. Tragal cartilage perichondrium may be the first choice of graft material due to its high success rates. There were no significant differences between the fascia and perichondrium groups in terms of functional results. Reperforation is more likely to occur in bilateral perforations and contralateral OME, and should be treated with perichondrium or cartilage graft.

Does paranasal sinus development affect olfactory fossa depth and lateral lamella length?

OBJECTIVES: To investigate the olfactory fossa depths and lateral lamella lengths of patients with different types of developmental disorders of paranasal sinuses in comparison with normal controls. STUDY DESIGN: Retrospective, archival, radio-anatomical study. METHODS: We included 58 patients with maxillary sinus hypoplasia, 50 patients with frontal sinus hypoplasia/aplasia, 50 patients with sphenoid sinus hypoplasia/aplasia, and 40 normal controls. Reviewing paranasal computerized tomography scans, we noted the olfactory fossa depths and lateral lamella lengths of all the groups and compared between the hypoplasia groups and the control group. RESULTS: Compared with the normal controls, the maxillary hypoplasia group (P < 0.001), frontal hypoplasia/aplasia group (P = 0.004), and sphenoid hypoplasia/aplasia group had significantly deeper olfactory fossa (P = 0.003). The mean lateral lamella lengths in the type 1, type 2, and type 3 hypoplastic maxillary sinus groups were significantly greater compared with that in the control group (P < 0.001). Additionally, the mean lateral lamella lengths in the hypoplastic frontal sinus, aplastic frontal sinus, and hypoplastic sphenoid sinus groups were significantly greater compared with that in the control group (P < 0.001). CONCLUSION: The patients with pneumatization defects of the maxillary, frontal, and sphenoid sinuses had deeper olfactory fossa and longer lateral lamella related to increased risk of skull base injury during endoscopic sinus surgery. LEVEL OF EVIDENCE: 3 Laryngoscope, 129:2458-2463, 2019.