Evaluation of corneal endothelium using specular microscopy in patients with obstructive sleep apnea syndrome.

PURPOSE: In the present study we evaluate the corneal endothelium using specular microscopy in patients with obstructive sleep apnea syndrome (OSAS). METHODS: The study included a total of 100 patients including 35 patients with mild OSAS, 34 patients with moderate OSAS and 31 patients with severe OSAS, and the right eyes of 30 patients as a control group. Patients were examined to exclude the possibility of ocular diseases. Cellular density in the cornea epithelium (cell/mm2), corneal thickness (µ), percentage of hexagonal cells (%) and the coefficient of variation were evaluated using a specular microscope. RESULTS: Corneal thickness was significantly decreased in all OSAS groups when compared to the control group (p = 0.002), while no significant difference was identified among the OSAS groups. The corneal endothelial cell density, percentage of hexagonal cells and coefficient of variation were significantly different between the OSAS groups and the control group (p < 0.001). CONCLUSION: More significant impairments were noted in the corneal endothelium of the patients in the OSAS group than in the control group, and specular microscopy is in valuable in the follow-up and treatment of such patients.

A Useful Approach to I-Shaped Crooked Nose Correction: Cross-Spreader Graft Technique.

OBJECTIVES: Correction of crooked nose with long-term functional and aesthetic success remains a great challenge for rhinoplasty surgeons. The aim of this study was to present the aesthetic and functional results of the cross-spreader graft technique applied for the correction of I-shaped crooked nose. METHODS: A retrospective examination was made of 25 patients applied with open technique rhinoplasty using cross-spreader graft for the correction of I-shaped crooked nose between March 2016 and June 2019. The functional results of the patients were evaluated using the Nasal Obstruction Symptoms Evaluation scale. The Rhinoplasty Outcomes Evaluation was used to evaluate the subjective aesthetic results, and the external nose deviation angle was measured from the frontal aspect to evaluate the objective aesthetic results. RESULTS: Evaluation was made of 25 patients comprising 11 males and 14 females with a mean age of 26.64±7.08 years. The post-operative mean NOSE and ROE scores were significantly improved compared to the preoperative values (p<0.001). A statistically significant improvement was determined in the deviation angle values from preoperative to postoperative (p< 0.001). CONCLUSION: According to the current study functional and aesthetic results of the cross-spreader graft technique applied for the correction of I-shaped crooked nose, this new technique appears to be an effective method for the treatment of I-shaped crooked nose deformity. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A comparative study on the effects of flexible and rigid laryngoscopy techniques on intraocular pressure.

OBJECTIVES: This study compared the impact of transoral rigid laryngoscopy (TORL) and transnasal flexible laryngoscopy (TNFL) methods on intraocular pressure (IOP). METHODS: This study included 100 patients, with 50 patients undergoing a TORL, and 50 patients a TNFL. Before procedure IOP values were recorded by an ophthalmologist using Icare Pro tonometry, also immediately post procedure, and at the 15th, 30th and 60th minute after laryngoscopy. RESULTS: Both groups were similar in terms of age, gender, mean body mass index (BMI), and pre-laryngoscopy IOP values. When the TNFL and TORL groups were compared, no significant differences were observed between pre-laryngoscopy, and 60th minute IOP values (p = 0.891, p = 0.149, respectively). IOP values measured immediately after laryngoscopy, and at the 15th and 30th minute were significantly higher in the TORL group (p < 0.001, p < 0.001, p = 0.002, respectively). CONCLUSIONS: We demonstrated higher IOP fluctuations in the TORL group, when compared to the TNFL group. For this reason, TNFL may be considered a safer method for evaluating laryngeal tissues in conditions that require lower IOP fluctuation as in glaucoma. However, further studies are required to clarify the exact effects of IOP fluctuations during TNFL and TORL in patients with glaucoma.

Impact of gastric Helicobacter pylori infection on nasal mucociliary clearance.

OBJECTIVES: This study aimed to investigate the relationship between the presence of gastric Helicobacter pylori (HP) infection and nasal mucociliary clearance (NMC) time and to analyze the effect of HP eradication on NMC time. MATERIALS AND METHODS: Patients who underwent gastric biopsy and had a positive result for HP constituted the study group, while the control group consisted of the patients who had a negative biopsy result. Two groups were compared in terms of NMC times. Quadruple medication therapy was given to HP-positive patients for 14 days for eradication and NMC time was measured again in these patients 8 weeks after eradication. Statistical analyses were performed with SPSS software (version 22.0; SPSS, Chicago, Illinois, USA). RESULTS: There were 60 patients in the study group (HP +), while the control group (HP -) included 50 patients. Mean NMC times were 12.86 ± 2.62 and 8.32 ± 2.24 for the study and control groups, respectively (p < 0.001). Pre- and post-eradication mean NMC times of the HP + patients were 12.71 ± 2.58 and 8.62 ± 1.39, respectively (p < 0.001). CONCLUSION: We determined that NMC time was significantly higher in HP-positive patients when compared with HP-negative patients, and the NMC times went back to normal after eradicating the HP infection. Because NMC dysfunction plays an essential role in the pathogenesis of chronic rhinosinusitis (CRS), we propose that eradication of HP can have positive effects on the prognosis of CRS. Further studies are needed to establish this relationship.

Effect of Deviated Nasal Septum on Choriodal Thickness.

INTRODUCTION: Nasal septal deviation (NSD) is one of the major causes of upper airway obstruction. Chronic hypoxia and hypercapnia due to NSD may affect the choroidal blood flow and may change the choroidal thickness (CT). In this study, the authors aimed to research the assessment of CT before and after septoplasty in patients with NSD. METHODS: Ninety-two patients who underwent septoplasty surgery with the diagnose of nasal septum deviation and 58 patients for control group were enrolled to the study. CT values measured before and three months after septoplasty surgery. RESULTS: CT values were subfoveal 272.51 ±â€Š27.62, nasal 245.50 ±â€Š21.22, temporal 248.35 ±â€Š30.25 and subfoveal 232.09 ±â€Š44.17, nasal 222.09 ±â€Š38.82,temporal 227.12 ±â€Š28.80 for the control and NSD groups, respectively (P < 0.001). Also choroid thickness values (subfoveal 232.09 ±â€Š44.17, nasal 222.09 ±â€Š38.82, temporal 227.12 ±â€Š28.80; subfoveal 252 ±â€Š18.90, nasal 228 ±â€Š22.12, temporal 240 ±â€Š25.80) were significantly different in patients with NSD, before and after septoplasty procedure, respectively (P < 0.001). CONCLUSION: To the authors' knowledge this is the first study investigating choroid thickness measurements before and after septoplasty in patients with NSD. We found significant correlation between NSD and CT. After septoplasty surgery at 3rd month, CT increased significantly in comparision with the preoperative values.

Evaluation of emergence agitation after general anaesthesia in rhinoplasty patients: Inhalation anaesthesia versus total intravenous anaesthesia.

BACKGROUND: Emergence agitation (EA) is a clinical condition that occurs early in recovery from general anaesthesia, and reduces patient comfort. The aim of this study was to compare the effects of low-flow sevoflurane anaesthesia and total intravenous anaesthesia (TIVA) on agitation in rhinoplasty patients, and to determine the frequency of EA in low flow sevoflurane anaesthesia after rhinoplasty. MATERIAL AND METHODS: A total of 90 rhinoplasty patients, under general anaesthesia were included in this prospective randomised study. After induction of anaesthesia, propofol infusion was initiated in the TIVA group (n = 45), and sevoflurane was administered in the SEVO group with a fresh gas flow of 1 l/min and MAC (minimum alveolar concentration) 1-1.1 (n = 45). Early emergence times, Richmond agitation-sedation scale (RASS), Boezaart scale, Likert scale and incidences of nausea/vomiting were recorded at the end of surgery. RESULTS: Early emergence time was significantly shorter in the TIVA group, than in the SEVO group (p < 0.001). Intraoperative bleeding was significantly lower in the TIVA group, than in the SEVO group (p = 0.005), and surgical field image quality and surgeon satisfaction were better in the TIVA group (p = 0.016, p < 0.001). The ratio of patients with RASS > +1 for all patients was 35.6% at 0 min, postoperatively. This rate was 12.2% (n = 11) in the TIVA group, and 23.3% (n = 21) in the SEVO group (p = 0.028). CONCLUSIONS: In rhinoplasty, TIVA caused shorter early emergence times, less bleeding, high surgeon satisfaction, and lower EA scores when compared with low flow sevoflurane anaesthesia.

Comparison of two routes in nasal passage for transnasale flexible fiberoptic laryngoscopy.

PURPOSE: Present study compares two routes in nasal passage for transnasal flexible fiberoptic laryngoscopy (TNFFL). METHODS: Included in the study were 60 patients who were split equally into Group 1 and Group 2 and all underwent TNFFL. The tip of endoscope was introduced between the septum and inferior turbinate along the nasal floor in Group 1 and between the inferior turbinate and middle turbinate in Group 2. O2 saturation, heart rate, systolic blood pressure, diastolic blood pressure of patients were taken 30 min before and immediately after procedure. Patients were asked to rate the pain-irritation, gag reflex, dyspnea they experienced during procedure using visual analogue scale. Two routes were compared in terms of physiological effects and patient comfort. RESULTS: No statistically significant difference was found between two groups in terms of physiological effects or patient comfort. When values recorded immediately after procedure were compared with baseline values, a significant decrease was observed in O2 saturation and heart rate in Group 1 and Group 2, respectively. No clinically detectable symptoms were observed in the patients. CONCLUSION: Decreases in O2 saturation and heart rate may be regarded as physiological effects of TNFFL. No significant difference between two routes was noted in the present study in terms of physiological effects and patient comfort during TNFFL. Introducing the endoscope between the inferior and middle turbinates may be a comfortable and safe option, particularly if the endoscope cannot be advanced along the nasal floor due to septum deviation, septal crest, inferior turbinate hypertrophy.

Measurement of mucociliary clearance in the patients with multiple sclerosis.

OBJECTIVES: The aim of the present study was to measure nasal mucociliary clearance (NMC) time in the patients with MS and to compare the findings with healthy population. METHODS: Totally 97 individuals including 47 patients with relapsing-remitting multiple sclerosis and 50 healthy volunteers were enrolled into the study. Saccharin clearance test was performed on both groups and NMC time was measured. Data analysis was performed by SPSS version 24.0 statistics program (SPSS Inc., Chicago, Illinois, USA). Statistical tests were interpreted at p < 0.05 significance level. RESULTS: The NMC time averages in MS patients and healthy control group were 12.43 ± 4.05 min and 8.14 ± 2.87 min, respectively; the difference between the groups was significant (p < 0.001). There was a statistically strong association between NMC time values and Expanded Disability Status Scale (EDSS) values in MS patients (r = 0.817, p < 0.001). CONCLUSION: We found nasal mucociliary transport time longer in MS patients than healthy population in the present study. To the best of our knowledge, there is not any study conducted about this topic in the literature. We believe that our findings would shed a light on further studies.