Risk of respiratory distress in the patients who were applied nasal packing at the end of nasal surgery.

OBJECTIVE: This prospective study investigated the risk of respiratory distress in the patients who were applied nasal packing at the end of nasal surgery; and effects of nasal packing on consciousness level while the patients were awake or asleep, measured by Bispectral Index (BIS). METHODS: The study group consisted of 15 adult patients (10 male, 5 female), who were applied nasal packing at the end of nasal surgery. The control group consisted of 15 adult patients (10 male, 5 female), who received general anesthesia for various reasons. In the study and control groups, BIS index, respiratory rate, peripheral oxygen saturation, pulse per minute and blood pressure were measured at seven different times. RESULTS: There was no statistically significant difference between BIS indexes of the study and control groups. In the fourth hour after sleep (AS-4h), respiratory rate of the study group was significantly lower than that of the control group. In the fourth hour after the anesthesia (AA-4h), oxygen saturation value of the study group was lower than that of the control group. CONCLUSION: We conclude that in patients who are applied nasal packing at the end of nasal surgery; at AA-4h and AS-4h times, there may be risk of decrease in the oxygen saturation and respiratory rate parameters, respectively. Therefore, it is necessary to monitor non-invasive respiratory parameters and to give enriched oxygen by an oral catheter.

Evaluation of nasal symptoms and mucociliary function in patients with allergic rhinitis treated with chemosurgery using trichloroacetic acid.

PURPOSE: We treated allergic rhinitis with trichloroacetic acid (TCA) applied to the inferior turbinates. Further clinical evaluations were made to determine the effect of TCA application on symptoms of allergic rhinitis. We also report the results of measurement of the mucociliary transit time (saccharin time) and nasal airway resistance. MATERIALS AND METHODS: A group of 54 patients with perennial allergic rhinitis was treated with 80% TCA applied to the inferior turbinate. Further clinical evaluations were made to determine the effect of TCA application on symptom scores of allergic rhinitis. We also report the results of measurement of the mucociliary transit time (saccharin time) and nasal airway resistance in those cases. RESULTS: The most common complaint, nasal obstruction, improved effectively in 82% of cases, watery rhinorrhea in 86%, and sneezing in 86%, 1 year after treatment. A significant decrease in scoring was noted for subjective nasal obstruction, watery rhinorrhea, and sneezing. Nasal airway resistance was effectively reduced 1 year after treatment, and the difference was statically significant. In our study, saccharin time appeared to be shortened in the early and late periods after the TCA application. There was a statistical difference between the before- and after-treatment groups. CONCLUSIONS: We concluded that TCA treatment was quite effective for controlling nasal allergic symptoms and that it does not damage the mucociliary function.

Role of vascular endothelial growth factor in the pathogenesis of nasal polyps.

OBJECTIVE: This study was aimed at determining the expression of vascular endothelial growth factor (VEGF) in nasal polyps by immunohistochemical technique. METHODS: The study group consisted of 25 adult patients with nasal polyps who underwent functional endoscopic sinus surgery. Polyp tissues were taken from the maxillary and ethmoid sinuseses and the nasal cavity. The control group consisted of three adult patients without nasal polyps who underwent septoplasty operation. Their inferior turbinate biopsies were taken with written approval. VEGF positivity was scored by the Vascular Endothelial Growth Factor Positivity Index (VEGF-PI) in the subepithelial (VEGF-PI-SE) and deep (VEGF-PI-Deep) layers of the mucosa on a 0 to 3 scale, and the percentage of inflammatory cells per 100 cells was found. RESULTS: VEGF expression was identified as cytoplasmic staining in the vascular endothelium and inflammatory cells. In each of four groups (maxillary and ethmoid sinuses, nasal cavity, and control), no significant difference was present between VEGF-PI-SE and VEGF-PI-Deep scores. For the VEGF-PI-SE and VEGF-PI-Deep groups, nasal cavity scores were significantly higher. For plasma cell count, the nasal cavity value was significantly higher. As the plasma cell count increased, VEGF-PI-SE and VEGF-PI-Deep scores were also increased in all four groups. CONCLUSION: In the nasal cavity, VEGF expression is observed more, causing angiogenesis and an increase in the vascular permeability. In the paranasal sinuses, lower VEGF-PI results may show that contact inhibition reduces VEGF expression and thus the polyp growth rate.

Preincisional infiltration of tonsils with ropivacaine in post-tonsillectomy pain relief: double-blind, randomized, placebo-controlled intraindividual study.

OBJECTIVE: To determine whether pre-emptive ropivacaine has an influence on postoperative pain in adult patients undergoing tonsillectomy. DESIGN: A prospective, randomized, double-blind, placebo-controlled clinical trial. SETTING: University hospital. PATIENTS: The study included 20 adult patients undergoing elective tonsillectomy. Anesthetic induction and maintenance, dissection tonsillectomy, hemostasis techniques, and postoperative analgesic treatment were standardized for all patients. Before the onset of incision, one tonsillar fossa was administered 5 mL of 2% ropivacaine hydrochloride with epinephrine, whereas the other side received 5 mL of 0.9% saline with epinephrine and was designated as the control side. MAIN OUTCOMES MEASURES: For each side, postoperative pain, otalgia, operating time, amount of intraoperative blood loss, and postoperative hemorrhage were assessed. The intensity of postoperative pain was measured at rest and when the patient was drinking and was scored on a visual analogue scale. The patients were followed up for 10 days after surgery. RESULTS: There was no statistically significant difference in the amount of intraoperative hemorrhage and operation time between sides (p > .05). The constant postoperative pain in the ropivacaine side at rest was significantly less than in the placebo side on days 1, 2, 5, and 6 (p < .05). The post-tonsillectomy pain experienced in the ropivacaine side when swallowing was significantly less than that in the placebo side throughout the study period except on day 10 (p < .05). CONCLUSION: Based on the present findings, preincisional infiltration of ropivacaine 2% appears to be effective against both early and late postoperative pain, especially on swallowing, following tonsillectomy in adults.

The incidence of atopy in adults with recurrent secretory otitis media: screening with Phadiatop.

OBJECTIVES: This is a preliminary report of a relatively new method, Phadiatop, in screening atopic adult patients with recurrent secretory otitis media (SOM). The sensitivity and specificity, and its use in atopic adult patients with recurrent SOM were evaluated. PATIENTS AND METHODS: Eighty-four patients (54 females, 30 males; mean age 36.7; range 19 to 62 years) who were diagnosed as recurrent SOM were included in the study. The patients were evaluated with respect to history, laboratory tests, skin-prick test, and total IgE. Patients with at least one positive skin-prick test result and/or a high total IgE level with a positive history were considered to be in atopic status. RESULTS: According to certain criteria, atopy was detected in 31 of 84 patients. Negative Phadiatop values were found in all non-atopic patients as well as in one atopic patient. Among 31 patients having atopy, 30 patients showed positive Phadiatop values (specificity 1.00, sensitivity 0.97, positive predictive value 1.00, negative predictive value 0.98). CONCLUSION: These results indicate that Phadiatop is an effective test to detect atopy in patients with recurrent SOM.

Effect of oxymetazoline nasal spray on intraocular pressure and retrobulbar hemodynamics.

OBJECTIVES: To determine the effect of oxymetazoline nasal spray on intraocular pressure and retrobulbar hemodynamics in patients with open-angle glaucoma and to compare the results with those measured in healthy control participants. STUDY DESIGN: Controlled, prospective clinical trial. SETTING: University hospital. METHODS: Thirty patients with open-angle glaucoma and 30 healthy volunteers as controls were topically self-administered oxymetazoline nasal spray three times a day (one spray in each nostril of 0.05% concentration) for 5 days continuously. MAIN OUTCOME MEASURES: Intraocular pressure and retrobulbar hemodynamics were measured in glaucomatous and normal eyes at baseline and at the end of oxymetazoline application . RESULTS: Oxymetazoline nasal spray lowered intraocular pressure significantly in both the glaucoma group (p = .02) and the control group (p = .001) after 5 days of treatment. The systemic parameters in the glaucoma and control groups (systolic blood pressure, p = .14 and p = .17; diastolic blood pressure, p = .18 and p = .49; and pulse rate, p = .06 and p = .50, respectively) did not show statistically significant differences during the study period. Additionally, except with a significant decrease in the resistivity index of the central retinal artery in the glaucoma patients (p = .001), oxymetazoline nasal spray did not result in any significant changes in the retrobulbar hemodynamics in both the glaucoma and control groups. CONCLUSIONS: This study showed that a 5-day treatment with oxymetazoline nasal spray reduced intraocular pressure in both healthy controls and patients with glaucoma under treatment. In addition, it had no significant adverse effects on the retrobulbar hemodynamics.

Use of botulinum toxin type A for the treatment of masseteric muscle hypertrophy.

We investigated the effectiveness of botulinum toxin A intramuscular injection for the management of masseteric muscle hypertrophy. Five patients with masseteric muscle hypertrophy were treated with botulinum toxin A (Dysport, Beaufour Ipsen, France). Clinical photographs were obtained before and between 3 and 6 months after application. Four patients are pleased with their present facial appearance. However, one patient reported mild discomfort about his appearance. Neither local nor general adverse effects were noted. Botulinum toxin A is a safe, easy-to-use, and effective nonsurgical option in the management of masseteric muscle hypertrophy. Its use is associated with a high degree of patient and physician satisfaction.

Role of mast and goblet cells in the pathogenesis of nasal polyps.

In this study, the role of mast and goblet cells and eosinophils in the pathogenesis of nasal polyposis was investigated. The study group consisted of 28 adult patients (15 males, 13 females) with nasal polyposis who underwent functional endoscopic sinus surgery (FESS). All patients in the study group were examined with a questionnaire, an otolaryngologic examination, an endoscopic examination with 0 degrees and 30 degrees endoscopes, Waters' graphy, and axial and coronal computed tomography of the paranasal sinuses. The control group consisted of 10 adult patients without nasal polyp (7 males and 3 females) who underwent septoplasty. They gave written approval to enter the study. The polyp specimens from the study group were excised from four regions: the maxillary sinus, ethmoid sinus, sphenoid sinus, and nasal cavity. They were examined at x400 magnification by light microscopy, and only the slides with polypoid tissue were included in the study. Slides including a chronic inflammatory process without polypoid tissue were excluded from the study. The control group was composed of the slides of specimens from the inferior turbinate. Forty slides (10 in each group) in the study group and 10 slides in the control group were included in the study. The surgical specimens from the study and control groups were examined with a histochemical staining technique. In every surgical specimen, the type of epithelium and the numbers of goblet and mast cells and eosinophils were calculated in x400 high-magnification field in 10 areas on light microscopy, as well as the mean number of these cells, and for mast cells separately, cell count in the epithelium and the stromal layer of polyp tissue and total mast cell count, including both epithelial and stromal mast cells, were identified. Goblet cells, mast cells, and inflammation with eosinophils were observed in all sinonasal mucosa. The common epithelial type in the polyp tissue was pseudostratified ciliated cylindric epithelium, which contains goblet cells. Goblet cell numbers in the maxillary, ethmoid, and sphenoid sinuses and nasal cavity were found to be significantly higher than in the control group (p < .05). For total mast cell and eosinophil count, no statistically significant difference was found between all five groups. In each group, there was no statistically significant difference between goblet and mast cells. Increased goblet cells in sinonasal polyps indicated that systemic factors also affect nasal polyposis as much as local factors, such as airflow and mucosal contact. Surgical treatment of sinonasal polyps by FESS causes more sufficient air ventilation in the nasal cavity and paranasal sinuses. Therefore, the goblet cell density will decrease because of the exposure of the mucosal surfaces to the air. In particular, FESS and then the appropriate medical treatment may decrease the recurrence rates and increase the patient's comfort. The significantly increased goblet cell count in the sinonasal mucosa demonstrated the importance of these cells in the pathogenesis of nasal polyposis. Also, mast cells and eosinophils may have a role in the inflammatory processes, leading to nasal polyposis formation.

Effects of ropivacaine on transient-evoked otoacoustic emissions: a rabbit model.

The aim of this study was to investigate the effect of ropivacaine, a newer amide local anesthetic, on the ears of rabbits by using transient-evoked otoacoustic emissions (TEOAEs). Thirty rabbits were studied in a random block design of six groups of five animals each. There received intra-tympanically instilled single doses of 0.5 mg/kg, 1.0 mg/kg of ropivacaine, 0.5 ml of isotonic saline (control for intratympanic application), or intravenously administered single doses of 1.0 mg/kg, 2.0 mg/kg of ropivacaine and 1.0 ml of isotonic saline (control for intravenous application). Cochlear function was serially monitored using TEOAEs before administration and on the 1st and 15th days after administrations of ropivacaine or isotonic saline. The responses of TEOAEs were analyzed in terms of mean stimulus, stability, wave reproducibility and emission amplitudes at 1.0-4.0 kHz. We found no significant changes in the TEOAE responses of the baseline measurements in each group before administration and the responses at each interval in the same group after administration throughout the experiment (P > 0.05). Also, no significant difference was found between the group receiving ropivacaine administered intravenously or intratympanicly and the control group at each interval (P > 0.05). The data from the present study showed that ropivacaine, whether administered intravenously or intratympanically and even at a low or high dose, has no effects on the responses of TEOAEs in the early period. These findings encourage the use of ropivacaine as a safe agent without ototoxic effects in peripheral nerve blocks, epidural and intravenous regional anesthesia or even tinnitus therapy in the future.

CT assessment of the effect of fluticasone propionate aqueous nasal spray treatment on lower turbinate hypertrophy due to vasomotor rhinitis.

CONCLUSION: Fluticasone propionate (FP) aqueous nasal spray was objectively found to be effective and safe for the treatment of lower turbinate enlargement in patients with vasomotor rhinitis. OBJECTIVE: To assess the efficacy of FP aqueous nasal spray treatment in lower turbinate hypertrophy due to vasomotor rhinitis using CT. MATERIAL AND METHODS: Of 35 patients with hypertrophic lower turbinates due to vasomotor rhinitis, 20 were treated twice daily with FP aqueous nasal spray (200 microg/day) for 3 months continuously and 15 were treated with placebo vehicle as a control group. The local effect of the nasal spray was studied using CT and visual analog scales. RESULTS: Treatment with FP provided significantly greater relief from the symptom of nasal obstruction compared with placebo over the entire 3-month treatment period (p < 0.001). When the change from baseline was compared between the two groups, FP produced statistically significant reductions in the mucosal area of the lower turbinates and in the thickness of the nasal mucosa after 3 months (p < 0.05).

A prospective randomized controlled trial to determine if cryotherapy can reduce the pain of patients with minor form of recurrent aphthous stomatitis.

BACKGROUND: Tissue cooling has long been used in the management of both acute and chronic pain. OBJECTIVE: To determine whether the application of cryotherapy can reduce the pain of patients with minor form of recurrent aphthous stomatitis. STUDY DESIGN: Twenty adult patients who had 2 discrete aphthous stomatitides in the labial mucosa at the same time were included in this prospective, randomized, and placebo-controlled study. One of the 2 aphthous stomatitides was treated with cryotherapy, the other serving as a control. The pain of aphthous stomatitis was scored by the patient on a 6-point scale (from 0 to 5). The size of the aphthous stomatitis was also measured. RESULTS: At any interval, no statistical difference was found between the cryotherapy-treated aphthous stomatitis and the control in the change in the value of pain severity, nor was any statistical difference found in the change in the size of the aphthous stomatitis. However, a trend toward less pain in the aphthous stomatitis receiving cryotherapy was noted. CONCLUSION: These results suggest that application of cryotherapy on minor form of recurrent oral aphthous stomatitis has no beneficial analgesic effect compared to placebo.

Emotional effects of nasal packing measured by the Hospital Anxiety and Depression Scale in patients following nasal surgery.

The aim of this study was to test the validity of the Hospital Anxiety and Depression (HAD) Scale in patients who underwent nasal surgery as a method of screening for emotional disorders during their hospital stay. The study group consisted of 50 adult patients (29 male, 21 female) who underwent nasal surgery for different reasons, such as chronic sinusitis, nasal polyposis, and nasal septal deviation. Functional endoscopic sinus surgery and/or septoplasty were managed in these patients, and all of the patients had nasal packing applied bilaterally for 2 days. The HAD Scale was given to all of the patients 1 day before surgery and 1 day after surgery, with anterior nasal packing bilaterally during the hospital stay. The anxiety and depression levels of the male group were under the cutoff points. For the female group, the depression levels were under the cutoff points, and the anxiety levels were high in the preoperative period and decreased after the operation. Anxiety and depression levels in the pre- and postoperative periods for the male and female groups were analyzed by Paired t-test. No statistically significant result was found (p > .05). It was concluded that, for patients well informed about nasal packing and hospital conditions, nasal packing may be used safely, without any psychological disturbance. The HAD Scale should be a more useful screening method to diagnose emotional disorders, especially in patients who are hospitalized for a long time.

Relationship between tinnitus loudness level and internal jugular venous flow rate measured by coloured Doppler ultrasonography in patients with a high jugular bulb.

The aim of this study was to investigate the relationship between tinnitus loudness level (TLL) and internal jugular venous flow rate (IJVFR) in tinnitus patients with a unilateral high jugular bulb detected by temporal bone high-resolution computed tomography (HRCT). The study group consisted of 24 adult patients (13 male, 11 female) with a unilateral high jugular bulb. One ear suffered from tinnitus with a high jugular bulb was included into the study group. The ears without tinnitus and no high jugular bulb on temporal bone HRCT comprised the control group. All patients were evaluated with a history and physical and otolaryngologic examinations, and, using a questionnaire, TLLs were detected. The patency and flow rates in the internal jugular veins were measured by right and left internal jugular venous Doppler ultrasonography. The TLLs were "very quiet" in 1 (4.1%) patient, "intermediate loud" in 17 (70.9%) patients, and "very loud" in 6 (25.0%) patients. IJVFRs were not different in the study and control groups. In the study group, IJVFRs were not correlated with age. There was no relationship among TLLs and IJVFRs, dominance, dehiscence, and bony septum thickness between the high jugular bulb and the middle ear. TLLs were not affected by IJVFRs, dominance, dehiscence, and bony septum thickness in patients with a high jugular bulb. More detailed studies should be undertaken to determine the reason for the different TLLs in patients with a high jugular bulb.

The analysis of anterior skull base from two different perspectives: coronal and reconstructed sagittal computed tomography.

The aim of the study was to determine the heights of the anterior skull base and the distances between the anterior nasal spine and the skull base at three levels by means of coronal and reformatted sagittal images of computed tomography. The present study was performed on coronal and reformatted sagittal CT scans of 30 patients with sinonasal complaints. On the coronal view, the heights of the cribriform plate, the roof of ethmoid, and lateral lamella and the medial take-off angle between the ethmoid roof and cribriform plate were measured at different levels. On the reformatted sagittal images the distances from the nasal spine to the anterior cranial base at three different levels were measured. Then, the side-to-side variability of these measurements was statistically compared. The variations with normal distribution and abnormal distribution were analysed by paired t test and Wilcoxon paired-signed rank test, respectively. A statistically significant difference was detected only between the right and left sides in the height of the lateral lamella at the crista galli level (p < 0.05). The lateral lamella at the crista galli level on the left side was higher than on the right side. No statistically significant differences between the left and the right sides were noted in the heights and the distances of other data (p > 0.05). The normal anatomy of the anterior skull base has been described in detail on coronal and reconstructed sagittal computed tomography. These measurements may be helpful in the presurgical evaluation of patients undergoing endoscopic sinus surgery to optimize surgical safety.

Volume of components of labyrinth: magnetic resonance imaging study.

OBJECTIVE: To determine total inner ear fluid volume and cochlear and semicircular canal/vestibule volumes of a normal population to form a base for dimensional abnormalities of inner ear structures. STUDY DESIGN: Cross-sectional. SETTING: Academic otology and radiology practices. PATIENTS: Twenty-nine healthy volunteers (13 male patients and 16 female patients with an average age of 31 yr) without any known history of intrauterine infection or any exposure to ototoxic agents and no abnormality at physical examination from the standpoint of hearing loss were included. INTERVENTIONS: Twenty-nine volunteers underwent magnetic resonance imaging of the temporal region by means of thin-section T2-weighted sequences. The images were evaluated by the radiologist for the presence of any gross configurational abnormality. Fluid volume of each inner ear and components of labyrinth (cochlea, semicircular canals/vestibule) were calculated with the help of an online work station. MAIN OUTCOME MEASURE: To determine the volume of components of the labyrinth and total inner ear fluid, which may form a base for future studies about sensorineural hearing loss. RESULTS: The volumes of total inner ear fluid, cochlea, and semicircular canals/vestibule were calculated. The mean and standard deviation of total inner ear fluid volume, cochlear volume, and semicircular canal/vestibule volume were obtained for each volunteer. Results were assessed with the help of statistical tests. CONCLUSION: There was no statistically significant difference between right and left inner ear fluid volumes of male and female subjects. There was also no statistical difference between right and left inner ear volumes when age and sex were not concerned. During evaluation of volumes according to sex, the difference between right and left inner ear fluid volumes was also assessed. Left semicircular canal/vestibule volume of female subjects were found to be higher than that of male subjects. The difference between right and left semicircular canal/vestibule volumes of female subjects was higher than the difference between right and left semicircular canal/vestibule volumes of male subjects.

Cytokeratin expression pattern in congenital and acquired pediatric cholesteatoma.

Pediatric cholesteatoma can be classified as congenital or acquired based on clinical criteria. We studied the expression patterns of five distinctive cytokeratins in both types of cholesteatoma in order to improve understanding of their pathogenesis and origin. A comparable expression pattern for CK10, CK14, CK18, CK19 and 34betaE12 antigens was found in the matrix of congenital and acquired pediatric cholesteatoma. Our results demonstrate that congenital and acquired pediatric cholesteatoma exhibit an identical cytokeratin distribution pattern, suggesting that they share a common origin. Therefore, it seems possible that a portion of the so-called "acquired" cholesteatoma may actually originate from advanced congenital cholesteatoma with secondary destruction of the tympanic membrane in the pediatric patient population.

Efficacy of topotecan treatment on antioxidant enzymes and TBA-RS levels in submandibular glands of rabbits: an experimental study.

OBJECTIVE: The aim of this study was to investigate the effects of topotecan (Hycamtin), a topoisomerase I inhibiting anticancer agent, on antioxidant enzymes (SOD, CAT, and GSH-Px) and TBA-RS values of the submandibular glands of the rabbits. STUDY DESIGN AND SETTING: The study was conveyed in two groups (Group I, II) and control with a total of 24 rabbits. Eight rabbits in group I received intravenous (i.v.) topotecan (0.25 mg/kg once daily) for 3 days. Eight rabbits in group II received i.v. topotecan (0.5 mg/kg once daily) for 3 days. On the 15th day after administration of topotecan, submandibular glands were removed and levels of the SOD, CAT, and GSH-Px and the TBA-RS in the submandibular glands of the rabbits were examined. RESULTS: SOD, CAT, and GSH-Px values were significantly higher in high-dose topotecan group compared to control group (P < 0.05). SOD and TBA-RS values were significantly higher in high-dose topotecan group compared to low-dose topotecan group (P < 0.05). CONCLUSION: It was concluded that, to prevent the hazardous effects of oxygen free radicals due to topotecan, antioxidant enzymes SOD, CAT, and GSH-Px were increased. The higher levels of the TBA-RS values in group II showed that permanent damage was present because of high-dose topotecan administration in the submandibular glands of the rabbits.

Prevalence of Helicobacter pylori in patients with nasal polyps: a preliminary report.

OBJECTIVES: The aim of the study is to determine the presence of H. pylori in nasal polyps by both immunohistochemical staining with H. pylori antibody of biopsy specimens and enzyme-linked immunoadsorbent assay (ELISA) of sera. STUDY DESIGN: A prospective, controlled, clinical trial. METHODS: We enrolled 30 patients with nasal polyps and 20 controls with middle concha bullosa undergoing endoscopic sinus surgery (ESS). Blood samples of both the study and control groups were evaluated for anti-H. pylori specific immunoglobulin (Ig)G antibodies by ELISA. In addition, biopsy specimens of the removed polyps and the mucosal part of middle conchas were examined by the immunohistochemical analysis with H. pylori antibody. RESULTS: In the blood samples, specific IgG antibodies to H. pylori were found in 26 (86.7%) of 30 polyp patients and 17 (85%) of 20 controls. In 6 (20%) of the 30 patients, H. pylori was identified in the nasal polyp tissue, but it was not detected in the mucosal part of the middle concha specimens. No significant statistical difference was observed for H. pylori antibodies by ELISA among the patients with nasal polyps and the control group (Fisher's exact test, P = .59). However, there was a statistical difference between the polyp biopsy specimens and the control biopsy specimens by immunohistochemical staining (Fisher's exact test, P = .037). CONCLUSIONS: This study indicates that H. pylori was found in increased prevalence in the nasal polyps. However, further controlled epidemiologic studies would be necessary to confirm our results and clarify the potential underlying pathogenetic mechanisms.

Magnetic resonance imaging of cochlear modiolus: determination of mid-modiolar area and modiolar volume.

Modiolar deficiency has been reported as representing the mildest form of cochlear dysplasia. In this study the authors aimed to determine baseline values of the mid-modiolar area and modiolus volume in normal subjects. In this way they aimed to improve the detection of previously underdiagnosed subtle cochlear dysplasia in patients with sensorineural hearing loss.

Localization of T cells and subtypes in the paranasal sinus and turbinate mucosa in patients with chronic sinusitis.

The aim of this study was to quantitate total T lymphocytes (total CD3+ cells) and T-lymphocyte subtypes (CD4+ [T helper] and CD8+ [T suppressor] cells) in patients with chronic sinusitis who were treated with functional endoscopic sinus surgery (FESS) and to investigate the pathophysiology of persistent inflammation in chronic sinusitis. This prospective study was conducted in study and control groups. The study group consisted of 32 patients (20 male, 12 female) with chronic sinusitis who underwent FESS. The control group consisted of 8 nonsinusitis patients (5 male, 3 female) who underwent septoplasty. Specimens from the study group were excised from five regions: the uncinate process, maxillary and ethmoid sinuses, and middle and inferior turbinates. The specimens were examined with x10 magnification by light microscopy, and the slides with a severe inflammatory process were included. Punch biopsy of the control group was taken from the inferior turbinate with patients' written approval. The surgical specimens from the study and control groups were examined with an immunohistochemical staining technique with monoclonal antibodies against CD3, CD4, and CD8 surface antigens of T lymphocytes. In every specimen, the numbers of CD3+, CD4+, and CD8+ cells were calculated in 3 to 4 high magnification field on light microscopy, and the mean number of these cells in the epithelium, subepithelial layer of the lamina propria, and deep paraglandular layer of the mucosa was determined. Statistical analysis by Kruskal-Wallis analysis of variance and the Mann-Whitney U test with Bonferroni correction revealed that the CD3 epithelial layer value of the inferior turbinate (p = .030) and the CD4 deep layer value of the middle turbinate (p = .048) were significantly higher than the corresponding values of the control group. In the epithelial (p = .018) and subepithelial (p = .012) layers of the uncinate process group, in the epithelial (p = .050) and subepithelial (p = .012) layers of the ethmoid sinus group, and in the subepithelial (p = .018) and deep paraglandular (p = .012) layers of the middle turbinate group, the difference between the CD4+ and CD8+ cell counts was found to be statistically significant by the Wilcoxon signed rank test. The number of CD4+ cells was higher than the number of CD8+ cells. In conclusion, T cells play a role in the pathophysiology of chronic sinusitis. CD4+ T helper cells, in particular, are predominant at the initiation and regulation of inflammation. The uncinate process, ethmoid sinus, and middle and inferior turbinates have the main roles by T cells and subtypes in the defense system in chronic sinusitis.