Advanced oxidation protein product levels as a marker of oxidative stress in paediatric patients with chronic tonsillitis.

We aimed to determine whether advanced oxidation protein product (AOPP) levels can serve as a marker of oxidative stress in paediatric patients with chronic tonsillitis. Thirty children with chronic tonsillitis and 30 healthy children (control group) were recruited from the Otorhinolaryngology (ORL) and Paediatric Surgery departments, respectively, of Dumlupinar University Hospital. In the patient group, blood samples were collected before tonsillectomy, and tonsil tissue was sampled during the operation. Blood samples were also obtained from the control subjects. AOPP levels in the serum and tonsil tissue were measured by the spectrophotometric method. Serum AOPP levels were significantly higher in the patient group (13.1 ± 3.3 ng/ml) than in the control group (11.6 ± 2.3 ng/ml; P < 0.05). In addition, the mean AOPP level (41.9 ± 13.5 ng/mg protein) in the tonsil tissue in the patient group was significantly higher than the mean serum AOPP levels in the control and patient groups (P < 0.05). AOPP levels are elevated in the tonsil tissue and serum of patients with chronic tonsillitis compared to the serum AOPP levels in healthy controls. AOPPs may represent a novel class of pro-inflammatory molecules that are involved in oxidative stress in chronic tonsillitis. AOPPs may be used as a marker of oxidative stress in paediatric patients with chronic tonsillitis.

Assessment of nasal mucociliary activity in patients with Behçet's disease.

OBJECTIVE: To investigate nasal mucociliary clearance in patients with Behçet's disease. METHODS: Thirty patients with Behçet's disease, diagnosed on the basis of criteria defined by the International Study Group for Behçet's Disease, and 30 healthy individuals were recruited. In both groups, individuals with conditions that could affect nasal mucociliary clearance were excluded. Nasal mucociliary clearance time was evaluated using saccharin tests. The time between placement of a saccharin tablet and the tasting of the saccharin was measured and recorded as the saccharin clearance time. RESULTS: The mean nasal mucociliary clearance time was significantly longer in the Behçet's disease patients than in the control subjects (p < 0.001). Furthermore, there was a positive correlation between Behçet's disease duration and nasal mucociliary clearance time (p < 0.001, r = 0.882). CONCLUSION: The results suggest that nasal mucociliary clearance time is longer in Behçet's disease patients than in control subjects, and is positively correlated with disease duration.

Is blood type really a risk factor for epistaxis?

Is blood type really a riskfactorfor epistaxis? OBJECTIVES: To determine the association between ABO blood type and epistaxis. METHODS: This retrospective study involved 359 patients with idiopathic epistaxis. Patients with risk factors for bleeding, including anticoagulant use, thrombocytopenia, hypertension, liver diseases, elevated bleeding time, low coagulation factor levels, or any benign/malignant tumor, were excluded from the study. Thus, only patients with idiopathic epistaxis were included in this study. For the control group, blood-type information was retrieved from the database of the Turkish Red Crescent, the largest blood bank in Turkey. RESULTS: The distributions of blood types A, B, AB, and 0 were compared between the epistaxis and control groups. The distribution of blood types A and AB did not significantly differ between the epistaxis and control groups (P>0.05). Blood type B occurred significantly less frequently (P<0.05) and blood type 0 occurred significantly more frequently (P<0.001) in the epistaxis group than in the control group. CONCLUSIONS: Our study indicates that in the Turkish population, the 0 blood type is over-represented in patients with idiopathic epistaxis versus the general population. We conclude that blood type 0 is a risk factor for idiopathic epistaxis in the Turkish population.

Is there a relationship between premature hair greying and hearing impairment?

OBJECTIVE: There is evidence for a strong correlation between low bone mineral density and hearing loss. Furthermore, premature hair greying has been associated with low bone mineral density. Hence, this study aimed to investigate, for the first time, the relationship between premature hair greying and hearing impairment. METHODS: Fifty patients with premature hair greying (20 women and 30 men), aged under 40 years (mean, 30.1 ± 4.9 years), who had onset of hair greying in their twenties, were recruited, along with 45 age- and sex-matched healthy control subjects (17 women and 28 men; mean age, 28.7 ± 5.1 years). Each participant was tested with low frequency audiometry at 0.125 to 2 kHz, high frequency audiometry at 4 to 8 kHz, and extended high frequency audiometry at 9 to 20 kHz. RESULTS: Hearing thresholds were similar at all frequencies from 0.25 to 4 kHz (p > 0.05); however, significant hearing loss was observed at all frequencies from 8 to 20 kHz in the premature hair greying group compared with the control group (p < 0.05). CONCLUSION: Patients with premature hair greying had hearing impairment at extended high frequencies. Premature hair greying may be an important risk factor for hearing loss.

Cytotoxic Effects of Intranasal Midazolam on Nasal Mucosal Tissue.

The aim of this experimental study was to investigate the cytotoxic effects of intranasal midazolam on nasal mucosal tissue in rats. Forty healthy rats were randomly divided into 5 groups. Group 1 (n = 8) was the control group, group 2 (n = 8) received intranasal saline, group 3 (n = 8) received intranasal midazolam, group 4 (n = 8) received intraperitoneal saline, and group 5 received intraperitoneal midazolam (n = 8). Midazolam and saline were administered via intraperitoneal and intranasal routes at doses of 200 µg/kg. Nasal septal mucosal stripe tissues were removed at the 6th hour. All materials were evaluated according to Ki67 and p53 staining to evaluate proliferation and apoptosis, respectively, and hemotoxylin and eosin staining was performed for histopathology evaluation. Ki67 values and inflammation in group 3 were statistically higher compared to group 1, group 2, and group 4. P53 values in group 3 were statistically higher compared to group 1. Assessment of subepithelial edema between group 3 and the other groups revealed no statistically significant differences. Assessment of cilia loss between group 3 and group 1, group 2, and group 4 revealed no statistically significant difference. The evaluation of goblet cell loss between group 3 and group 1 revealed a statistically significant difference. Intranasal midazolam had adverse effects on nasal mucosa. However, intranasal midazolam is as safe as systemic midazolam administration with respect to nasal mucosa.

Neutrophil-to-lymphocyte ratio in patients with severe tinnitus: prospective, controlled clinical study.

OBJECTIVE: To determine the relationship between severe tinnitus and inflammation using the neutrophil-to-lymphocyte ratio as a marker of stress. METHODS: A total of 107 patients who had been suffering with severe tinnitus (tinnitus handicap inventory scale grades of 3-5) for at least 2 weeks were recruited. Patients underwent detailed ENT examinations and audiometric tests to exclude a relevant pathological cause of the tinnitus. Patients with systemic diseases, malignancy or inflammatory diseases that could alter neutrophil-to-lymphocyte ratio were excluded. A total of 107 age- and sex-matched healthy control participants were also recruited. Routine laboratory test results and neutrophil-to-lymphocyte ratio were compared between the patients and controls. RESULTS: Lipid profile, liver function, white blood cell count, haemoglobin level, mean corpuscular volume, and vitamin B12 and folate levels were similar among the patients and controls. However, mean neutrophil-to-lymphocyte ratio was significantly higher among the patients than the controls (p < 0.05). CONCLUSION: The findings of this novel study suggest that neutrophil-to-lymphocyte ratio should be considered during the evaluation of tinnitus patients as a potential clinical marker of tinnitus. Further studies are required to verify the findings.

Teaching 3D sculpting to facial plastic surgeons.

This article describes the authors' course, which takes facial plastic surgeons through specific exercises to demonstrate the esthetic impact of 3D manipulations of the nose and face. The course components are described, which include 3D assessment, exercises in manual dexterity, and improving imagination in sculpting facial and nasal features for the optimal esthetic result and match to a given facial shape. The overlap and relationship between a course in 3D sculpting in facial plastic surgery and current 3D tools for design and image analysis being used for facial plastic surgery are discussed.

Effects of estradiol-drospirenone on ocular and nasal functions in postmenopausal women.

BACKGROUND: Hormones may have an impact on the incidence and course of dry-eye syndrome, and also nasal obstruction, especially in postmenopausal women. The aim of this study was to investigate the effects of drospirenone 2 mg + estradiol 1 mg (Angeliq®, Bayer AG, Berlin, Germany) on ocular functions and nasal airflow in postmenopausal women. METHODS: Thirty-four postmenopausal women were recruited for the study. A questionnaire on ocular surface disease index (OSDI) was administered; after routine ophthalmologic examination, tear film break-up time (TBUT) and Schirmer tests were performed. Intraocular pressure was measured with a Goldmann applanation tonometer. Nasal airflow resistance values were measured using rhinomanometry. Participants were submitted to oral daily treatment with drospirenone 2 mg + estradiol 1 mg. The duration of the study was 6 months and the participants were studied in the basal condition and after 6 months of therapy. RESULTS: The OSDI score and intraocular pressure were significantly higher before treatment than after treatment (p<0.001); however, the results of the TBUT and Schimer test were significantly lower (p<0.05). Rhinomanometric values were better during drospirenone 2 mg + estradiol 1 mg therapy than those observed at baseline (p<0.001). CONCLUSIONS: Oral daily treatment with drospirenone 2 mg + estradiol 1 mg reduces the risks for ocular diseases and nasal obstruction in postmenopausal women.

Extraoral prostheses using extraoral implants.

The aim of this study was to evaluate extraoral prostheses and the use of extraoral implants in patients with facial defects. 10 cases were treated utilizing maxillofacial prostheses employing extraoral implants in five cases. 16 extraoral implants were installed. Seven implants were placed in irradiated sites in the orbital regions. Six implants were placed in mastoid regions and three in a zygoma region that was irradiated. Two implants failed before initial integration was achieved in irradiated areas. Using 14 extraoral implants as anchors, five extraoral prostheses were set. The other five cases were treated with extraoral prostheses without using extraoral implants due to cost and patient-related factors. The data included age, sex, primary disease, implant length, implant failure, prosthetic attachment, radiation therapy, and peri-implant skin reactions. The use of extraoral implants for the retention of extraoral prostheses has simplified the placement, removal, and cleaning of the prosthesis by the patient. The stability of the prostheses was improved by anchors. Clinical and technical problems are presented with the techniques used for their resolution. Using extraoral implants resulted in a high rate of success in retaining facial prostheses and gave good stability and aesthetic satisfaction.

Unusual case of laryngeal tumor (capillary hemangioma) obturating the larynx.

OBJECTIVES: Capillary hemangioma isolated to the free edge of the vocal fold is a rare clinical finding. We see many young patients, mostly infants under a year, who are having surgical intervention for laryngeal hemangiomas. A rapid proliferative phase occurs during the first 9 to 12 months of life; this followed by an involution phase that may be completed by 3 to 5 years of age, but can last up to 12 years. MATERIAL AND METHODS: We report the case of a 15-year-old boy who had hoarseness for a two-year related to a laryngeal mass which growth pattern was unknown. RESULTS: On endoscopic examination a polypoid mass, which was diagnosed as a capillary hemangioma later, appeared on the left vocal fold. The lesion was excised with cold-knife instrumentation by using mini-flap technique. CONCLUSION: The clinical and histopathological features and therapeutic options are discussed.

Does topical lidocaine with adrenaline have an effect on morbidity in pediatric tonsillectomy?

OBJECTIVE: To evaluate the efficacy of lidocaine with adrenaline on post-operative morbidity in pediatric patients after tonsillectomy. STUDY DESIGN: A double blind prospective randomized controlled clinical study. METHODS: The study is consisting of two groups of pediatric patients following tonsillectomy performed in a university hospital. One group received lidocaine with adrenaline soaked swabs packed in their tonsillar fossae while the control group received saline-soaked swabs. Chi-square and two-tailed unpaired Student's t-tests were used to compare the two independent groups. p<0.05 was accepted as statistically significant. RESULTS: No significant pain-relieving effect was seen in the lidocaine with adrenaline group (p>0.05) and also the other post-operative parameters such as nausea, fever, vomiting, odor, bleeding, otalgia and trismus were not statistically different between the two groups based on chi-square analysis (p>0.05). There were no complications associated with lidocaine and adrenaline. CONCLUSION: We suggest that application of topical lidocaine with adrenaline seems to be a safe and easy medication for local anesthetic use. However, in our study, lidocaine with adrenaline offered no advantage over placebo in the control of post-operative pain and other morbidity related factors following pediatric tonsillectomy. We therefore do not recommend topical application of lidocaine with adrenaline for reducing morbidity in pediatric tonsil surgery.

Nasopharyngeal aerobic bacterial flora and Staphylococcus aureus nasal carriage in deaf children.

OBJECTIVE: To determine the nasopharyngeal aerobic bacterial flora and Staphylococcus aureus nasal carriage in deaf children and the role of flora in deafness. STUDY DESIGN: A prospective, controlled study. METHODS: Nasopharyngeal and nasal swabs were collected from 87 deaf children with acquired etiology at Zonguldak primary school for the deaf and 56 healthy children. The children with genetic base (syndromic or nonsyndromic, familial or sporadic, AD, AR or X-linked recessive), and also with the history of drug exposure, head trauma, birth trauma, prematurity, hyperbilirubinemia and the viral diseases with high fever (like mumps and measles) were excluded from the study. Swabs were inoculated on to a variety of bacteriological culture media, which were then incubated in an appropriate atmosphere. Colonisation of Group A beta hemolytic streptococcus, Streptococcus pneumoniae, Haemophilus influenzae, Neisseria menengitidis, Moraxella catarrhalis and S. aureus in upper respiratory tract were investigated. Antimicrobial susceptibility testing of the isolates were determined according to National committee for clinical laboratory standards (NCCLS) guidelines. RESULTS: Although, the rates of colonization of the nasopharyngeal aerobic bacteria and nasal S. aureus did not differ significantly between deaf children and normal healthy subjects, less colonization rates were found in deaf children than normal healthy subjects. S. aureus was isolated from 18 (20.7%) deaf children. All S. aureus isolates from deaf children were susceptible to oxacillin. Penicillin susceptibility rate was 22.2%. CONCLUSION: It is considered that nasopharyngeal and nasal colonizations of deaf children with potentially pathogenic aerobic bacterial flora is not a significant risk factor for acquired infections when compared with healthy children.

Can post-adenotonsillectomy morbidity be reduced by intravenous 24 h hydration in pediatric patients following adenotonsillectomy?

OBJECTIVE: To determine the benefit of 24 h intravenous hydration for pediatric postoperative adenotonsillectomy patients. STUDY DESIGN: A prospective, randomized controlled clinical study. METHODS: The study is consisting of two groups of pediatric patients following adenotonsillectomy performed in a university hospital. One group received 24 h IV hydration at hospital while the other did not have IV hydration. Chi-square and two-tailed unpaired Student's t-tests were used to compare the two independent groups. P < 0.05 was accepted as statistically significant. RESULTS: Although the postoperative parameters such as nausea, fever, vomiting, odor, bleeding, otalgia and trismus were not statistically different between the two groups based on chi-square analysis (P > 0.05), a significant pain-relieving effect was seen in hydration group after the second day (P < 0.05). There were no complications associated with intravenous hydration. CONCLUSION: Results of the current study suggest that 24 h IV hydration can reduce postoperative pain in late postoperative period following adenotonsillectomy in children but does not offer much advantage over without IV hydration therapy based on a number of other parameters. Furthermore, it seems to be cost effective, safe and easy and even these are encouraging for further studies in the future.