Effects of topical sprays on allergy-induced nasal obstruction in children.

OBJECTIVES: This study aims to evaluate the efficacy of mometasone furoate nasal spray, intranasal azelastine, and isotonic sea water nasal spray in the management of allergy-induced nasal obstruction. PATIENTS AND METHODS: Between October 2007 and August 2008 60 patients (37 males, 23 females; mean age 9.8±2.6 years; range 7 to 16 years) with a history of allergic rhinitis were included in the study. Laboratory assays including the skin prick test, nasal smear, phadiatop, total immunoglobulin E (IgE), and complete blood count test were performed. The patients were classified into three groups including 20 in each, according to the topical treatment administered. Patients in group 1 received azelastine, group 2 received mometasone furoate nasal spray, and group 3 received isotonic sea water nasal spray. Nasal passage volume was calculated using an acoustic rhinometry device. RESULTS: Azelastine and mometasone furoate decreased nasal congestion and increased nasal cavity volume more effectively, compared to isotonic sea water nasal spray. CONCLUSION: Mometasone furoate and azelastine which decrease nasal congestion and increase nasal volume are effective in the management of allergic rhinitis in children.

Chronic otitis media with multiple complications.

Chronic otitis media (COM) is defined as persistent infection or inflammation of the middle ear and mastoid air cells. The proximity of the middle ear cleft and mastoid air cells to the intratemporal and intracranial compartments places structures located in these areas at increased risk of infectious complications. The complications of COM are divided into intracranial and extracranial complications. The development and appropriate use of antibiotics have led to a decrease in these potentially devastating complications. However, they continue to occur, and clinical vigilance is required for early detection and treatment. We reported a case with multiple complications, both intracranial and extracranial secondary to COM.

A giant juvenile nasopharyngeal angiofibroma.

Juvenile nasopharyngeal angiofibromas are locally growing and highly vascular tumors. They are primarily treated through surgical excision ranging from an open approach to an endoscopic approach. We presented a 20-year-old man with a giant juvenile nasopharyngeal angiofibroma that bilaterally obliterated the pterygopalatine fossa, invaded the sphenoid bone, and extended to the left nasal passage. His complaints were epistaxis and nasal obstruction. After embolization, the patient was treated surgically using the endoscopic approach and declared cured and discharged without any complications.

Anterior rhinomanometry and determination of nasal mucociliary clearance time with the saccharin test in children with Crimean-Congo hemorrhagic fever.

OBJECTIVES: Crimean-Congo hemorrhagic fever (CCHF), like other viral infections, may prolong mucociliary clearance time and increase nasal resistance in children. The aim of the present prospective case-control study was to study, using saccharin and anterior rhinomanometry tests, whether CCHF infections caused any change in nasal physiology. METHODS: Overall, 40 subjects, 20 of whom had CCHF (group 1) and 20 of whom were healthy controls (group 2), were enrolled in this study. The definitive diagnosis of CCHF infection was made based on typical clinical and epidemiological findings and detection of CCHF virus-specific IgM by ELISA or of genomic segments of the CCHF virus by reverse transcription-polymerase chain reaction. Anterior rhinomanometry was performed in all participants according to current recommendations of the Committee Report on Standardization of Rhinomanometry. A saccharin test was used to evaluate mucociliary clearance, and nasal mucociliary clearance time was assessed with the saccharin test as described previously. RESULTS: In our patients, the mean time from the application of saccharin crystals to the first feeling of a sweet taste was 6.77 ± 3.25 minutes (range 2-16 min). In terms of the mean time from the application of saccharin crystals to the first feeling of a sweet taste, there was no difference between two groups. The mean total air flow was 637.60 ± 76.18 mL/s (range 490-760 mL/s). The mean total nasal airway resistance was 0.24 ± 0.03 Pa/mL s (range 0.20-0.31 Pa/mL s). In terms of the degree of nasal air flow and nasal airway resistance and the total air flow and total nasal airway resistance of each nostril, there was no difference between the 2 groups. CONCLUSIONS: The results obtained in anterior rhinomanometry and saccharin test showed that there was no statistically significant difference between CCHF (+) patients and controls. These results suggest us that CCHF virus infection does not affect nasal physiology. However, this is the first study performed on this issue and further studies on larger series need to be performed.

Parotid tail pleomorphic adenoma extending to the parapharyngeal space.

Parapharyngeal space tumors are rare, accounting for 0.5% of head and neck neoplasms. Most of them are benign and originate in the salivary glands, especially the pleomorphic adenoma. We presented a 47-year-old man with parotid tail pleomorphic adenoma extending to the parapharyngeal space. The patient applied to our clinic with the complaints of a painless mass on his neck and in his mouth for 3 months. After fine needle aspiration biopsy, the mass was diagnosed as pleomorphic adenoma. The patient was hospitalized and operated in our clinic. As we see in literature review, parapharyngeal space tumors are rare, and most of them are pleomorphic adenomas arising from the deep lobe of the parotid gland and extend into the PPS.

Results of endoscopic endonasal dacryocystorhinostomy.

Nasolacrimal ductus obstruction cause Epifora. Two widely accepted treatment modalities are external and endoscopic dacryocystorhinostomy. Currently available rigid nasal endoscopes are safe for intranasal manipulation of structures of the nasal cavity, including the region of the lacrimal sac. Twenty-eight patients with complete stenosis of the nasolacrimal duct were treated with endoscopically controlled endonasal dacryocystorhinoslomy. Approximately 97% of the patients were symptom free, and 3% of these felt improved postoperatively. This procedure appears to be safe and effective, which should be considered as an alternative to external dacryocystorhinostomy for the surgical treatment of the nasolacrimal duct obstruction.

Evaluation of hearing in patients with familial Mediterranean fever.

Familial Mediterranean fever (FMF) is a common and well-understood hereditary periodic fever syndrome. Hereditary periodic fever syndromes include a group of multisystem diseases characterized by recurrent fever attacks with inflammation affecting skin, joints, and some other tissues. These are FMF, tumor necrosis factor receptor, tumor necrosis factor receptor associated periodic syndrome, hyperimmunglobulinemia D syndrome, Muckle-Wells syndrome, and familial cold urticaria. In literature, it is determined that some of these diseases cause hearing loss. In light of the foregoing, we thought that FMF patients may have the same type of subclinical hearing loss and, therefore, the hearing ability of these patients was evaluated with otoacoustic emission and high frequency audiometry tests.

Effect of extracorporeal shock waves on subcondylar mandibular fractures.

OBJECTIVE: The purpose of this pilot study was to evaluate the effects of extracorporeal shock wave therapy on healing of subcondylar mandibular fracture in rats. METHODS: Unilateral subcondylar fracture in 20 Wistar albino rats was used as a fracture model. Each rat was anesthetized 1 day after surgery, and extracorporeal shock wave therapy was performed. On the 21st day after surgery, animals were killed. Mandibles were dissected, all soft tissues were removed after sacrifice, and fractured and nonfractured hemimandibles were obtained from each rat. Histologic analyses were performed by a single pathologist blinded to the samples. RESULTS: The specimens' mean score in bone fracture healing was 7 (1.09) (range, 6-9) in group 1 and 2.57 (1.62) (range, 1-6) in group 2. With respect to the specimens' bone fracture healing score, there was a statistically significant difference between the 2 groups. CONCLUSIONS: As a result, our study showed that extracorporeal shock wave therapy accelerated the improvement of fractures in experimentally induced subcondylar mandibular fracture in the rat mandible. We believe that reducing the duration of improvement in subcondylar mandibular fractures by intermaxillary fixation along with extracorporeal shock wave theraphy would contribute to preventing complications such as ankylosis, fibrosis, and hypomobility occuring because of prolonged fixation.

Canalicular adenoma of the palate.

Canalicular adenomas are uncommon, benign epithelial neoplasm of the salivary glands that usually involve the upper lip and the buccal mucosa of elderly people. Differential diagnosis of the canalicular adenoma versus adenocarcinoma is important because it may result in unjustified radiotherapy or extensive and aggressive surgery. Despite the benign nature of canalicular adenomas, complete surgical removal and a regular clinical follow-up are recommended. The current study describes the diagnostic procedures, surgical management, and follow-up of a canalicular adenoma involving the palate of a 79-year-old man.

Tularemia and the oculoglandular syndrome of Parinaud.

An 18-year-old female came to our clinic with complaints of a tender lump just under her jaw on the left side and another lump in front of her left ear, ecchymosis around the eye and some redness in the eye at the same side. After administering antibiotic therapy for two days we suspected of tularemia and referred the patient to the Infectious Diseases Department. A serum sample was taken and a fine needle aspiration biopsy was performed. The patient was diagnosed with tularemia, the oculoglandular syndrome of Parinaud. Tularemia should also be kept in mind for differential diagnosis in patients with both ocular and glandular symptoms in endemic regions like Turkey and the appropriate therapy should be initiated immediately.

Primary malignant melanoma of the nasal cavity.

Primary malignant melanoma of the nose and paranasal sinus mucosa is a rare disease and seen in less than 1% among all melanomas. Malignant melanomas have 2 origins: cutaneous and mucosal. The mucosal form has a worse prognosis because of its aggressiveness compared with that of the cutaneous form. Mucosal melanomas often occur at a rate of 2% to 3% among all melanomas and are typically found in the nasal cavity and paranasal sinuses. Generally, it is more common in males and in those older than 50 years. In this study, 4 patients were observed at the Cumhuriyet University Faculty of Medicine; 2 of them were a 64-year-old man and an 82-year-old woman who had a malignant melanoma originating from the nasal septal mucosa, 1 patient was a 72-year-old woman whose malignant melanoma originated from the inferior turbinate, and 1 patient was a 77-year-old woman with a sinonasally located melanoma. The conditions of these patients were discussed under the light of literature instructions.

Tularemia and the oculoglandular syndrome of Parinaud

An 18-year-old female came to our clinic with complaints of a tender lump just under her jaw on the left side and another lump in front of her left ear, ecchymosis around the eye and some redness in the eye at the same side. After administering antibiotic therapy for two days we suspected of tularemia and referred the patient to the Infectious Diseases Department. A serum sample was taken and a fine needle aspiration biopsy was performed. The patient was diagnosed with tularemia, the oculoglandular syndrome of Parinaud. Tularemia should also be kept in mind for differential diagnosis in patients with both ocular and glandular symptoms in endemic regions like Turkey and the appropriate therapy should be initiated immediately.

Evaluation of cochlear function using transient evoked otoacoustic emission in children with Familial Mediterranean Fever.

OBJECTIVE: The aim of this study was to investigate cochlear functions in children with Familial Mediterranean Fever (FMF). METHODS: Fifty-six FMF patients (112 ears) and 30 healthy control subjects (60 ears) were included in the study. Transient evoked otoacoustic emission (TEOAE) was investigated. Numerical measurements of TEOAE, except the correlation percentage (%), included response amplitude (dB) and signal/noise (SN) ratio. RESULTS: There was no statistically significant difference in age and sex in the two groups. Mean TEOAE correlation percentage, signal/noise ratio, TEOAE amplitudes in 1, 1.5, 2, 3 and 4 Hz frequency values were not different between the two groups (p>0.05). CONCLUSIONS: In this study using the TEOAE test, we found that FMF did not cause outer cell hair damage in children. In the literature, there is no study on outer cell hair damage in children or adults with FMF, so this is the first investigational study.

TEMPS-A Temperament Scale Before and After Septoplasty in Patients with Nasal Septum Deviation.

The present study aimed to evaluate whether patients undergoing an operation for septum deviation exhibited a change in affective status. The temperament evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) was administered to all patients at the pre-operative and post-operative periods. The mean age of the patients was 32.46 ± 11.22 years. Of the patients, 34 (65.4%) were males and 18 (34.6%) were females. A significant difference was found between pre- and post-operative scores of the patients on all TEMPS-A subscales (p < 0.05). Patients with symptoms of upper airway obstruction may have mood disorders due to the decrease in blood oxygen levels. This condition can be corrected with septoplasty procedure. In the present study, it was demonstrated that patients had a better affective status post-operatively as compared to the pre-operative period.

Evaluation of cochlear involvement by transient evoked otoacoustic emission test in children with Crimean-Congo hemorrhagic fever.

OBJECTIVE: The aim of this study was to investigate cochlear involvement in child patients with Crimean-Congo hemorrhagic fever (CCHF) disease. METHODS: Twenty-eight CCHF disease patients (56 ears) and 26 sex- and age-matched healthy control subjects (52 ears) were included in the study. Pure-tone audiometry at frequencies 0.25, 0.5, 1, 2, 4, and 6 kHz, immittance measures including tympanometry and acoustic reflex testing, and transient evoked otoacoustic emission (TEOAE) testing were performed in the patients and controls. RESULTS: The proportion with a result of 'fail' for the TEOAE test in the CCHF patients was not statistically significant from the control group (p>0.05). CONCLUSIONS: CCHF disease does not impair cochlear function in children. The clinical course of CCHF among children seems to be milder than in adults.

A study of the prevalence of developmental anomalies of the external ear among preschool children in Sivas, Turkey.

The objective of the current study was to detect the prevalence of developmental anomalies of the external ear among children between aged 4-6 years old in Sivas, Turkey. This cross-sectional study was conducted among 1,096 preschool children. Among the 1,096 children examined, 8 had accessory auricle, and prevalence of the anomaly was calculated at 0.7%. Fifty-one prominent ear deformities (4.6%) were detected among the children. One limitation of the study is that the prevalence of developmental anomalies of the external ear may have been underestimated. In fact, such surveys should be conducted on large random or stratified samples of entire populations. Thus, the true prevalence could be slightly higher, and the apparent difference may not be a racial one.

Neoplasms of the salivary glands in a Turkish adult population

Objective: This retrospective study aimed to investigate the types and distribution of neoplasm of salivary glandsin a Turkish population.Study Design: The histological diagnosis records of the Department of Pathology at Cumhuriyet University were reevaluated for 125 patients who were treated for salivary gland tumors from 1987 to 2008. The neoplasms were analyzed for histological diagnosis, age, sex, and site. The histological diagnoses were analyzed according to the2005 WHO classification.Results: A total of 125 primary salivary gland neoplasms, consisting of 95 (76%) benign and 30 (24%) malignant groups were recorded. The most common major and minor salivary gland sites were the parotid (61.6%) and palatalglands (9.6%), respectively. Pleomorphic adenoma was the most frequent benign tumor followed by Warthin’stumor. Among the malignant group, adenoid cystic carcinoma was the most prevalent. Age for all cases rangedfrom 16-80 years; mean age was 41.97 years, with a female to male ratio of 1:1.15.Conclusions: Although there were some discrepancies, the characteristics of salivary gland tumors of Turkish patients are in line with those of patients from other countries according to tumor type, tumor site distribution,and age and sex of patients (AU)

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[Genetic constitution analysis of idiopathic sudden hearing loss]. / Idyopatik ani isitme kayipli olgularin genetik yapilarinin analizi.

OBJECTIVES: The purpose of this research is to understand the etiology of sudden hearing loss due to genetic factors in Turkish people. Determination of these genetic factors and better understanding of molecular pathogenesis may guide more realistic planning and treatment recommendations. PATIENTS AND METHODS: Forty patients (Group 1; 19 males, 21 females; mean age 37.9+/-15.6 years; range 9 to 76 years) who presented with sudden hearing loss to the Ear, Nose and Throat Clinic of Medical Faculty Hospital of Cumhuriyet University between January 2008 and June 2009, and were diagnosed with sudden hearing loss through history, physical examination and review of audiometric findings, and 20 healthy volunteers (Group 2; 14 males, 6 females; mean age 31.7+/-4.4 years; range 24 to 43 years) for the control group were included in this study. All Patients were evaluated by the genetic clinic for the GJB2, GJB3, GJB6 and WFS1 gene using multiplex ligation-dependent probe amplification (MLPA) method mutation analysis. RESULTS: No difference was found in the peripheral blood sample analyses of the two groups at WFS1 exon 8 and connexin 26, 30 and 31 gene zones using the MLPA method with respect to heterozygous mutation (p=0.291, p>0.05). In four patients in group 1 heterozygous mutation was detected at the target gene zone. Heterozygous mutation was in the WFS1 exon 8 zone in two patients; and in the WFS1 exon 1 zone in other two patients. CONCLUSION: Sudden hearing loss studies in the future should include connexin 26, connexin 30 and other gene mutations that may affect the function of the gap-junction located in the region of the cochlea stria vascularis (stV), basal membrane (BM), spiral limbus (Li) and spiral ligament (SL). These studies should be performed on larger series, and should include family members of patients with sudden hearing loss.

Neoplasms of the salivary glands in a Turkish adult population.

OBJECTIVE: This retrospective study aimed to investigate the types and distribution of neoplasm of salivary glands in a Turkish population. STUDY DESIGN: The histological diagnosis records of the Department of Pathology at Cumhuriyet University were reevaluated for 125 patients who were treated for salivary gland tumors from 1987 to 2008. The neoplasms were analyzed for histological diagnosis, age, sex, and site. The histological diagnoses were analyzed according to the 2005 WHO classification. RESULTS: A total of 125 primary salivary gland neoplasms, consisting of 95 (76%) benign and 30 (24%) malignant groups were recorded. The most common major and minor salivary gland sites were the parotid (61.6%) and palatal glands (9.6%), respectively. Pleomorphic adenoma was the most frequent benign tumor followed by Warthin's tumor. Among the malignant group, adenoid cystic carcinoma was the most prevalent. Age for all cases ranged from 16-80 years; mean age was 41.97 years, with a female to male ratio of 1:1.15. CONCLUSIONS: Although there were some discrepancies, the characteristics of salivary gland tumors of Turkish patients are in line with those of patients from other countries according to tumor type, tumor site distribution, and age and sex of patients.

[A case of severe rhinophyma]. / Ileri derecede rinofima: Olgu sunumu.

Rhinophyma is a benign disease of the nasal skin causing cosmetic and functional disturbances. Its etiology remains uncertain. Surgery is the most common treatment of choice. A 55-year-old man with severe rhinophyma was treated with total excision of the involved tissue and sebaceous glands, and the defect was reconstructed with full-thickness skin graft. No recurrence was seen during a two-year follow-up period, and cosmetic and functional outcome was satisfactory.