Endoscopic versus microscopic ossiculoplasty: Does the functional outcome vary according to the type of osciculoplasty?

Abstract Objective: To compare functional outcome of microscopic and endoscopic approach regarding type of ossiculoplasty. Methods: In this retrospective study, cases who had undergone type-II and type-III tympanoplasty between February 2007 to September 2019 were divided into two groups according to the type of approach as microscopic and endoscopic. In cases with type-II reconstruction; Partial Ossicular chain Replacement Prosthesis (PORP), incus interposition and bone cement were used in order of frequency. Whereas in cases with type-III reconstruction, only Total Ossicular chain Replacement Prosthesis (TORP) was used. The average Air Bone Gap (ABG) was determined pre- and post-operatively for the calculation of Air Conductance Gain (ACG). The ACG, pre- and post-operative ABG values of each group were compared with regard to the type of ossiculoplasty. Results: A total of 79 cases consisting of 32 females and 47 males who had undergone type-II and type-III tympanoplasty were enrolled. No statistically significant difference between microscopic and endoscopic approach was found in terms of ACG (p = 0.42), pre-(p = 0.23) and postoperative ABG (p = 0.99). We did not find any significant difference in terms of ACG, pre- and postoperative ABG between two approaches for type-II and type-III reconstructions (p>0.05). Conclusions: According to the current study, endoscopic approach in type-II and type-III reconstruction is at least reliable as microscopic approach regarding functional outcome. Since both techniques have similar functional results, other factors (anatomic characteristics, habitude of the surgeon and duration of the surgery) should be considered when choosing the technique. Level of evidence: In the current paper we present a retrospective comparative study of two different approaches of a particular type of otologic surgery. Level of evidence corresponds to level III.

Endoscopic versus microscopic ossiculoplasty: Does the functional outcome vary according to the type of osciculoplasty?

OBJECTIVE: To compare functional outcome of microscopic and endoscopic approach regarding type of ossiculoplasty. METHODS: In this retrospective study, cases who had undergone type-II and type-III tympanoplasty between February 2007 to September 2019 were divided into two groups according to the type of approach as microscopic and endoscopic. In cases with type-II reconstruction; Partial Ossicular chain Replacement Prosthesis (PORP), incus interposition and bone cement were used in order of frequency. Whereas in cases with type-III reconstruction, only Total Ossicular chain Replacement Prosthesis (TORP) was used. The average Air Bone Gap (ABG) was determined pre- and post-operatively for the calculation of Air Conductance Gain (ACG). The ACG, pre- and post-operative ABG values of each group were compared with regard to the type of ossiculoplasty. RESULTS: A total of 79 cases consisting of 32 females and 47 males who had undergone type-II and type-III tympanoplasty were enrolled. No statistically significant difference between microscopic and endoscopic approach was found in terms of ACG (p = 0.42), pre-(p = 0.23) and postoperative ABG (p = 0.99). We did not find any significant difference in terms of ACG, pre- and postoperative ABG between two approaches for type-II and type-III reconstructions (p > 0.05). CONCLUSIONS: According to the current study, endoscopic approach in type-II and type-III reconstruction is at least reliable as microscopic approach regarding functional outcome. Since both techniques have similar functional results, other factors (anatomic characteristics, habitude of the surgeon and duration of the surgery) should be considered when choosing the technique. LEVEL OF EVIDENCE: In the current paper we present a retrospective comparative study of two different approaches of a particular type of otologic surgery. Level of evidence corresponds to level III.

Role of VPAC1 and VPAC2 receptors in the etiology of pregnancy rhinitis: an experimental study in rats / O papel dos receptores VPAC1 e VPAC2 na etiologia da rinite gestacional: um estudo experimental em ratos

Abstract Introduction: Pregnancy rhinitis is a common sex hormone-related otorhinolaryngological disorder. There are some epidemiological and physiological studies on pregnancy rhinitis, but histopathological and biomolecular changes have not been studied thoroughly. Objectives: The receptors VPAC1 and VPAC2 are known for their roles in allergic rhinitis. On the other hand, activation of subclinical allergy has been suggested in the pathophysiology of pregnancy rhinitis. Therefore, we aimed to compare the physiological and gestational pattern of VPAC1 and VPAC2 expression in rat nasal mucosa. Methods: Twenty adult Wister albino female rats were enrolled into the study. Two groups constituted as 10 control (group A) and 10 pregnant (group B) rats. They were fed ad libitum and sheltered at room temperature (22°±2°C). The rats were sacrificed at the 20th day of gestation by intraperitoneal injection of 400mg/kg Na-pentobarbitone. Then, 10 - 15 mL of blood was taken, and samples were reserved for the detection of serum estradiol and progesterone levels by ELISA test. The nasal septum was resected and divided in half for immunohistochemical analyses and real time polymerase chain reaction testing of VPAC1 and VPAC2. Results: VPAC1 and VPAC2 were found to be in all layers of septal specimens, but the immunostaining of surface epithelium was more distinct in specimens of both groups. We demonstrated higher overall staining intensity in the pregnant group. PCR revealed significant increase in expression of VPAC1 (p = 0.023) and VPAC2 (p = 0.021) in pregnant group when compared with control group. In addition, we demonstrated upregulatory effect of estradiol and progesterone on the vasoactive intestinal peptide receptor expression. Conclusions: Gestational up-regulation of nasal VPAC1 and VPAC2 was shown both by PCR and immunohistochemical analysis. These findings support the hypothesis that PR is caused by the activation of subclinical allergy that is present before pregnancy.

Resumo Introdução: A rinite gestacional é um distúrbio comum da otorrinolaringologia relacionado a hormônios sexuais. Existem alguns estudos epidemiológicos e fisiológicos sobre rinite gestacional, mas as alterações histopatológicas e biomoleculares ainda não foram estudadas completamente. Objetivo: Os receptores VPAC1 e VPAC2 são conhecidos por seu papel na rinite alérgica. Por outro lado, a ativação da alergia subclínica tem sido sugerida na fisiopatologia da rinite gestacional. Portanto, objetivamos comparar o padrão fisiológico e gestacional da expressão de VPAC1 e VPAC2 na mucosa nasal de ratos. Método: Vinte ratas fêmeas Wistar albinas adultas foram incluídas no estudo. Os dois grupos foram divididos em 10 ratas; controle (grupo A) e 10 ratas prenhes (grupo B). Elas foram alimentadas ad libitum e abrigadas em temperatura ambiente (22° ±2° C). Sacrificamos as ratas no 20° dia de gestação por injeção intraperitoneal de 400 mg/kg de sódio-pentobarbital. Em seguida, foram coletados 10 a 15 mL de sangue e as amostras foram reservadas para a detecção dos níveis séricos de estradiol e progesterona pelo método Elisa. O septo nasal foi ressecado e dividido em 2 para análises imuno-histoquímicas e testes de reação em cadeia da polimerase em tempo real, RT-PCR, de VPAC1 e VPAC2. Resultados: VPAC1 e VPAC2 foram encontrados em todas as camadas da amostra septal, mas a imunocoloração do epitélio de superfície foi mais distinta nas amostras de ambos os grupos. Demonstramos maior intensidade geral de coloração no grupo gestante. A reação de polimerase em cadeia revelou aumento significante na expressão de VPAC1 (p = 0,023) e VPAC2 (p = 0,021) no grupo gestante quando comparado ao grupo controle. Além disso, demonstramos um efeito up-regulador do estradiol e progesterona na expressão do receptor peptídeo intestinal vasoativo. Conclusão: A up-regulação gestacional dos receptores VPAC1 e VPAC2 nasais foi demonstrada tanto por reação de polimerase em cadeia quanto por análise imuno-histoquímica. Esses achados corroboram a hipótese de que a rinite gestacional é causada pela ativação de alergia subclínica presente antes da gestação.

Role of VPAC1 and VPAC2 receptors in the etiology of pregnancy rhinitis: an experimental study in rats.

INTRODUCTION: Pregnancy rhinitis is a common sex hormone-related otorhinolaryngological disorder. There are some epidemiological and physiological studies on pregnancy rhinitis, but histopathological and biomolecular changes have not been studied thoroughly. OBJECTIVES: The receptors VPAC1 and VPAC2 are known for their roles in allergic rhinitis. On the other hand, activation of subclinical allergy has been suggested in the pathophysiology of pregnancy rhinitis. Therefore, we aimed to compare the physiological and gestational pattern of VPAC1 and VPAC2 expression in rat nasal mucosa. METHODS: Twenty adult Wister albino female rats were enrolled into the study. Two groups constituted as 10 control (group A) and 10 pregnant (group B) rats. They were fed ad libitum and sheltered at room temperature (22°±2°C). The rats were sacrificed at the 20th day of gestation by intraperitoneal injection of 400mg/kg Na-pentobarbitone. Then, 10-15mL of blood was taken, and samples were reserved for the detection of serum estradiol and progesterone levels by ELISA test. The nasal septum was resected and divided in half for immunohistochemical analyses and real time polymerase chain reaction testing of VPAC1 and VPAC2. RESULTS: VPAC1 and VPAC2 were found to be in all layers of septal specimens, but the immunostaining of surface epithelium was more distinct in specimens of both groups. We demonstrated higher overall staining intensity in the pregnant group. PCR revealed significant increase in expression of VPAC1 (p=0.023) and VPAC2 (p=0.021) in pregnant group when compared with control group. In addition, we demonstrated upregulatory effect of estradiol and progesterone on the vasoactive intestinal peptide receptor expression. CONCLUSIONS: Gestational up-regulation of nasal VPAC1 and VPAC2 was shown both by PCR and immunohistochemical analysis. These findings support the hypothesis that PR is caused by the activation of subclinical allergy that is present before pregnancy.

The Role of TREK-1 and AQP5 in Gonadocorticoid-Related Voice Disorders.

OBJECTIVES: TWIK-related potassium channel-1 (TREK-1) and Aquaporin 5 (AQP5) are involved in epithelial integrity and fluid transport, respectively. In this study, we aimed to compare physiological and gestational patterns of TREK-1 and AQP5 location and expression in rat larynx. Our secondary objective was to reveal the effect of estradiol (E2) and progesterone (PG) on these two biomolecules. METHODS: This study was conducted on 20 Wister albino female rats which were assigned as control (group A) and pregnant group (group B). The rats were sacrificed at 20th day of pregnancy. Blood was obtained directly from the ventricle for detection of serum E2 and PG levels. Larynx was resected for immunohistochemical analyses and real-time polymerase chain reaction testing for detection of TREK-1 and AQP5 staining and expression, respectively. RESULTS: Relative TREK-1 (P = 0.035) and AQP5 (P = 0.019) expression was found to be significantly high in group B when compared with group A. We found positive correlation between serum E2 levels and both biomolecules (TREK-1; P = 0.018, AQP5; P = 0.016). We also found positive correlation between serum PG levels and both biomolecules (TREK-1; P = 0.001, AQP5; P = 0.019). TREK-1 immunostaining was found to be higher in surface epithelium and lamina propria of vocal cord mucosa. AQP5 was particularly found to be located in basement membrane and adjacent superficial lamina propria. We revealed the physiological and gestational pattern of laryngeal TREK-1 and AQP5 expression for the first time. Gestational expression of both TREK-1 and AQP5 was found to be increased. Stimulatory effect of E2 and PG on laryngeal TREK-1 and AQP5 expression was also revealed. CONCLUSIONS: We revealed upregulatory effect of E2 and PG on laryngeal TREK-1 and AQP5 expression. Based on this finding, it can be suggested that TREK-1 and AQP5 play role in biomolecular processes leading gonadocorticoid-related voice changes.

Impact of pregnancy on voice: a prospective observational study.

PURPOSE: We aimed to assess if there is a significant change in voice of pregnant women by the end of third trimester. MATERIALS AND METHODS: Forty-nine pregnant women were enrolled in this study between April 2019 and March 2020. Subjective and objective voice evaluation was conducted in the third trimester and three months after delivery. The Turkish version of the VHI-10 questionnaire was filled out by every participant. GRBAS scale was used for perceptual voice evaluation. Acoustic analyses were conducted by Multi-Dimensional Voice Program (MDVP) (Computerized Speech Lab, Kay Elemetrics Corporation, Lincoln Park, NJ). Fundamental frequency (fo), Jitter percent (Jitt), Shimmer percent (Shim), noise to harmonic ratio (NHR), maximum phonation time (MPT), voice turbulence index (VTI), vocal intensity, and scale parameters were categorized as predelivery (a) and postdelivery (b). RESULTS: Comparison of acoustic parameters of the third trimester with the third month postpartum revealed statistically significant increases for fo (p = .013), MPT (p = .008), and vocal intensity (p≤.001) as well as a significant decrease for VTI (p≤ .001). No statistically significant difference was found for NHR, Jitt, and Shim. Comparison of both VHI-10 and GRBAS scores revealed statistically significant decreases. CONCLUSIONS: Disturbances in certain vocal parameters suggest that vocal abnormalities observed during pregnancy are mainly due to anatomical alterations of the lower respiratory system. It would be appropriate to warn pregnant women about bad vocal habits and vocal hygiene. In addition, it would be appropriate to recommend professional voice support to pregnant women who use their voices intensively due to their profession.

Impact of Pregnancy and Glucocorticoid Treatment on NF-κB and MUC5AC in Mucosa of Rat Larynx.

OBJECTIVE: The aim of this study is to reveal physiological expression and distribution of nuclear factor-kappa B (NF-κB) and MUC 5 subtype AC (MUC5AC) in rat laryngeal mucosa and to find out the effect of pregnancy and glucocorticoid treatment on these biomolecules. METHODS: This animal experiment was done in Experimental Animals Research and Application Center of Manisa Celal Bayar University in accordance with the accepted policy on the use of animals. A total of 30 young, adult Wister albino female rats were randomized into a control group (group A), a pregnant group (group B), and a steroid administered group (group C). Sacrification was done by injection of sodium-pentobarbitone (400 mg/kg) solution via intraperitoneal route in all groups. Serum estradiole (E2) and progesterone (PG) were determined by enzyme-linked immunosorbent assay. The relative expression and distribution of NF-κB and MUC5AC in laryngeal mucosa was studied both by immunohistochemistry (IHC) and polymerase chain reaction testing. Expression and immunohistochemical localization of NF-κB and MUC5AC was evaluated by light microscopy (Olympus BX41). In statistical analyses; relative expression of NF-κB and MUC5AC were compared on group basis. The effect of E2 and PG levels on these biomolecules was also evaluated. RESULTS: NF-κB was found to be significantly low both in group B (P < 0.05) and C (P < 0.001) when compared with group A, while MUC5AC was found to be significantly high both in group B (P < 0.05) and group C (P < 0.05) when compared with group A. Concerning IHC; NF-κB was found to be expressed in epithelium and lamina propria. MUC5AC was found to be expressed particularly in the epithelial layer in all groups. Statistically significant negative correlation between PG and NF-κB expression (P = 0.048), but no correlation between PG and MUC5AC expression (P = 0.487) were revealed. On the other hand, no correlation was found between E2 and the expression of relevant biomolecules (NF-κB [P = 0.270], MUC5AC [P = 0.829]). We also did found a significant negative correlation between the expression of NF-κB and MUC5AC (P = 0.031). CONCLUSIONS: In this study, the physiological expression of NF-κB and MUC5AC in rat laryngeal mucosa was shown for the first time both by polymerase chain reaction and IHC. The impact of pregnancy and glucocorticoid treatment on the expression and distribution of these biomolecules was also revealed. The expression of NF-κB was found to be decreased while the expression of MUC5AC was found to be increased both by pregnancy and glucocorticoid treatment. The inhibitory effect of serum PG on NF-κB expression in rat laryngeal mucosa was also shown for the first time. The expression of MUC5AC was found to be increased both in pregnant and glucocorticoid administered group. Negative correlation between NF-κB and MUC5AC expression was also revealed in rat larynx for the first time. These findings may partially unclose the histochemical background of voice changes caused by pregnancy and as well as by glucocorticoid treatment.

The ratio of facial nerve to facial canal as an indicator of entrapment in Bell's palsy: A study by CT and MRI.

OBJECTIVES: To find out if the ratio of facial nerve to facial canal diameter plays any role in the etiopathogenesis and grade of Bell's palsy. PATIENTS AND METHODS: Twenty-nine consecutive patients (16 females, 13 males) diagnosed with unilateral Bell's palsy were enrolled into the study. At admission, 5 patients were grade V, 11 were grade IV, 11 were grade III and 2 were grade II. The grade of Bell's palsy was documented by House-Brackmann facial nerve grading system at admission, 15th day, 1st month and 3th month. Temporal MRI and CT scans were obtained at the time of diagnosis. Diameter of facial nerve and facial canal at the middle of five different segments were measured equidistantly at the same workstation. Both sides of every patient (affected and unaffected) were measured by one radiologist who was not informed about the side of the paralysis. MRI and CT values of each segment were compared between affected and unaffected sides. In addition, FN/FC ratio of affected and non-affected sides was calculated and compared for each segment. We also analyzed if a relationship exists between above-mentioned measurements and the House-Brackmann grade. RESULTS: Considering MRI values; statistically significant thickening of facial nerve between affected and unaffected sides was found at labyrinthine (p = 0.012), tympanic (p = 0.023) and geniculate parts (p = 0.04). Considering CT values; statistically significant difference between affected and unaffected sides was not found at any segment. Comparison of FN/FC ratio of both sides revealed statistically significant increment of the affected side at labyrinthine segment (p = 0.015) and geniculate ganglion (p = 0.032). We determined positive correlation between diameter of FN and HB grade at labyrinthine segment (p = 0.03, R = 0.531). On the other hand, we determined negative correlation between diameter of FC and HB grade at labyrinthine segment (p < 0.001, R = -318). A positive correlation between HB grade and FN/FC ratio was found only at the labyrinthine segment (p = 0.003, R = 0.673). CONCLUSION: FN/FC ratio of labyrinthine segment and geniculate ganglion was found to be increased in patients with Bell's palsy. In addition, a positive correlation was determined between this ratio and grade of Bell's palsy particularly at labyrinthine segment. Basing the current study, if FN decompression is recommended in Bell's palsy patients with objective findings of bad prognosis, conservative surgery targeting the labyrinthine segment and geniculate ganglion alone might be safer.

The Safety of Open Surgical Tracheotomy Performed by Otorhinolaryngology Residents.

OBJECTIVE: We aimed to clarify the safety of open surgical tracheotomy performed by supervised residents, and the impact of "reason for hospitalization" on complication rates in open surgical tracheotomy technique. METHODS: In this retrospective cohort study, the medical files and documents of 277 patients who underwent open surgical tracheotomy (OST) over a period of 12 years from October 2005 to July 2017 were analyzed. Forty four patients were excluded due to emergent tracheotomy and presence of malignancy. Remaining 223 cases were divided into two groups as "OSTs done by supervised residents" and "OSTs done by attending surgeons". Age, gender, reason for hospitalization, observation time and complications were noted. The overall minor and major complication rates and each complication rate were compared with regard to the operating surgeons. RESULTS: No statistically significant difference between two groups was demonstrated in terms of observation time (p=0.127). Minor complication rate for residents and attending surgeons was 14.7% and 17.5%, whereas major complication rate was 6.3% and 5.0%, respectively. No significant difference was found between two groups both in terms of minor (p=0.58) and major (p=0.43) complication rates. No risk of "reason for hospitalization" on minor and major complications was found (p=0.06, p=0.15). CONCLUSION: Open surgical tracheotomy performed by supervised residents is as safer as the ones performed by the attending surgeons. The study also showed that "reason for hospitalization" does not potentiate the occurrence of tracheotomy related complications.

Our Experience with Percutaneous and Surgical Tracheotomy in Intubated Critically Ill Patients.

OBJECTIVE: Open surgical tracheotomy (OST) and percutaneous dilatational tracheotomy (PDT) are commonly used for securing airway in intubated critically ill patients. The purpose of this study was to compare the safety of OST and PDT, particularly in intubated critically ill patients. METHODS: The medical records of intubated critically ill patients who underwent tracheotomy between August 2006 and July 2017 were analyzed retrospectively. Minor and major complication rates were compared according to the tracheotomy technique. Preoperative intubation time, postoperative decannulation time, reason for hospitalization, and demographic data, including the Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, were evaluated. RESULTS: A total of 332 cases were enrolled into the study. The minor and major complication rates for both techniques were 27.2%, 8.8%, 9.7% and 3.2%, respectively. Minor and major complication rates were higher in the OST group (p=0.01, p=0.03, respectively). The rate of every single complication was also compared on groups' basis. Accidental decannulation (p=0.02) and pneumothorax (p=0.05) were found to be significantly frequent in the OST group. There was no impact of the preoperative intubation time on the minor (p=0.20) and major complication (p=0.29) rates found. There was no statistically significant difference regarding the postoperative decannulation time (p=0.32). Also, there was no statistically significant difference between two groups in terms of the APACHE II (p=0.69) and SOFA (p=0.37) scores. However, a statistically significant difference between the groups in terms of overall survival was found, in favor of PDT (p<0.001). CONCLUSION: This study revealed that PDT is safer than OST, particularly in intubated critically ill patients.

The role of facial canal diameter in the pathogenesis and grade of Bell's palsy: a study by high resolution computed tomography / O papel do diâmetro do canal facial na patogenia e grau de paralisia de Bell: estudopor tomografia computadorizada de alta resolução

Abstract Introduction: The exact etiology of Bell's palsy still remains obscure. The only authenticated finding is inflammation and edema of the facial nerve leading to entrapment inside the facial canal. Objective: To identify if there is any relationship between the grade of Bell's palsy and diameter of the facial canal, and also to study any possible anatomic predisposition of facial canal for Bell's palsy including parts which have not been studied before. Methods: Medical records and temporal computed tomography scans of 34 patients with Bell's palsy were utilized in this retrospective clinical study. Diameters of both facial canals (affected and unaffected) of each patient were measured at labyrinthine segment, geniculate ganglion, tympanic segment, second genu, mastoid segment and stylomastoid foramen. The House-Brackmann (HB) scale of each patient at presentation and 3 months after the treatment was evaluated from their medical records. The paired samples t-test and Wilcoxon signed-rank test were used for comparison of width between the affected side and unaffected side. The Wilcoxon signed-rank test was also used for evaluation of relationship between the diameter of facial canal and the grade of the Bell's palsy. Significant differences were established at a level of p = 0.05 (IBM SPSS Statistics for Windows, Version 21.0.; Armonk, NY, IBM Corp). Results: Thirty-four patients - 16 females, 18 males; mean age ± Standard Deviation, 40.3 ± 21.3 - with Bell's palsy were included in the study. According to the HB facial nerve grading system; 8 patients were grade V, 6 were grade IV, 11 were grade III, 8 were grade II and 1 patient was grade I. The mean width at the labyrinthine segment of the facial canal in the affected temporal bone was significantly smaller than the equivalent in the unaffected temporal bone (p = 0.00). There was no significant difference between the affected and unaffected temporal bones at the geniculate ganglion (p = 0.87), tympanic segment (p = 0.66), second genu (p = 0.62), mastoid segment (p = 0.67) and stylomastoid foramen (p = 0.16). We did not find any relationship between the HB grade and the facial canal diameter at the level of labyrinthine segment (p = 0.41), tympanic segment (p = 0.12), mastoid segment (p = 0.14), geniculate ganglion (p = 0.13) and stylomastoid foramen (p = 0.44), while we found significant relationship at the level of second genu (p = 0.02). Conclusion: We found the diameter of labyrinthine segment of facial canal as an anatomic risk factor for Bell's palsy. We also found significant relationship between the HB grade and FC diameter at the level of second genu. Future studies (MRI-CT combined or 3D modeling) are needed to promote this possible relevance especially at second genu. Thus, in the future it may be possible to selectively decompress particular segments in high grade BP patients.

Resumo Introdução: A etiologia exata da paralisia de Bell ainda permanece obscura. Os únicos achados confirmados são a inflamação e o edema do nervo facial (NF) que levam ao aprisionamento no canal facial. Objetivo: Identificar se há alguma relação entre o grau de paralisia de Bell e o diâmetro do canal facial e também estudar qualquer possível predisposição anatômica do canal facial para a paralisia de Bell incluindo as partes que ainda não foram estudadas. Método: Os prontuários médicos e exames de tomografia computadorizada de 34 pacientes com paralisia de Bell foram avaliados neste estudo clínico retrospectivo. Os diâmetros de ambos os canais faciais (acometidos e não acometidos) de cada paciente foram medidos no segmento labiríntico, gânglio geniculado, segmento timpânico, segundo joelho, segmento mastoideo e forame estilomastoideo. As escalas de House-Brackmann (HB) de cada paciente na apresentação inicial e três meses após o tratamento foram avaliadas a partir de seus prontuários. O teste t de amostras pareadas e o teste dos postos sinalizados de Wilcoxon foram usados para comparação de largura entre o lado acometido e o lado não acometido. O teste de postos sinalizados de Wilcoxon também foi usado para avaliação da relação entre o diâmetro do canal facial e o grau de paralisia de Bell. Diferenças significativas foram estabelecidas em um nível de p = 0,05 (IBM SPSS Statistics for Windows, versão 21.0; Armonk, NY, IBM Corp). Resultados: Foram incluídos 34 pacientes - 16 mulheres, 18 homens; idade média ± desvio padrão (DP), 40,3 ± 21,3 com paralisia de Bell. De acordo com o sistema de classificação do nervo facial de HB, oito pacientes eram de grau V, seis de grau IV, 11 de grau III, oito de grau II e um de grau I. A largura média no segmento labiríntico do canal facial no osso temporal acometido foi significativamente menor do que o equivalente no osso temporal não acometido (p = 0,00). Não houve diferença significativa entre os ossos temporais acometidos e não acometidos no gânglio geniculado (p = 0,87), segmento timpânico (p = 0,66), segundo joelho (p = 0,62), segmento mastoide (p = 0,67) e forame estilomastoideo (p = 0,16). Não houve relação entre o grau de HB e o diâmetro do canal facial no nível do segmento labiríntico (p = 0,41), segmento timpânico (p = 0,12), segmento mastoideo (p = 0,14), gânglio geniculado (p = 0,13) e forame estilomastoideo (p = 0,44), mas houve uma relação significativa no nível do segundo joelho (p = 0,02). Conclusão: O diâmetro do segmento labiríntico do canal facial foi um fator de risco anatômico para a paralisia de Bell. Também houve relação significativa entre o grau de HB e o diâmetro do CF no nível do segundo joelho. Estudos futuros (RM-TC combinadas ou modelagem 3D) são necessários para promover essa possível relevância especialmente no segundo joelho. Assim, no futuro, pode ser possível descomprimir segmentos específicos em pacientes com alto grau de PB.

The role of facial canal diameter in the pathogenesis and grade of Bell's palsy: a study by high resolution computed tomography.

INTRODUCTION: The exact etiology of Bell's palsy still remains obscure. The only authenticated finding is inflammation and edema of the facial nerve leading to entrapment inside the facial canal. OBJECTIVE: To identify if there is any relationship between the grade of Bell's palsy and diameter of the facial canal, and also to study any possible anatomic predisposition of facial canal for Bell's palsy including parts which have not been studied before. METHODS: Medical records and temporal computed tomography scans of 34 patients with Bell's palsy were utilized in this retrospective clinical study. Diameters of both facial canals (affected and unaffected) of each patient were measured at labyrinthine segment, geniculate ganglion, tympanic segment, second genu, mastoid segment and stylomastoid foramen. The House-Brackmann (HB) scale of each patient at presentation and 3 months after the treatment was evaluated from their medical records. The paired samples t-test and Wilcoxon signed-rank test were used for comparison of width between the affected side and unaffected side. The Wilcoxon signed-rank test was also used for evaluation of relationship between the diameter of facial canal and the grade of the Bell's palsy. Significant differences were established at a level of p=0.05 (IBM SPSS Statistics for Windows, Version 21.0.; Armonk, NY, IBM Corp). RESULTS: Thirty-four patients - 16 females, 18 males; mean age±Standard Deviation, 40.3±21.3 - with Bell's palsy were included in the study. According to the HB facial nerve grading system; 8 patients were grade V, 6 were grade IV, 11 were grade III, 8 were grade II and 1 patient was grade I. The mean width at the labyrinthine segment of the facial canal in the affected temporal bone was significantly smaller than the equivalent in the unaffected temporal bone (p=0.00). There was no significant difference between the affected and unaffected temporal bones at the geniculate ganglion (p=0.87), tympanic segment (p=0.66), second genu (p=0.62), mastoid segment (p=0.67) and stylomastoid foramen (p=0.16). We did not find any relationship between the HB grade and the facial canal diameter at the level of labyrinthine segment (p=0.41), tympanic segment (p=0.12), mastoid segment (p=0.14), geniculate ganglion (p=0.13) and stylomastoid foramen (p=0.44), while we found significant relationship at the level of second genu (p=0.02). CONCLUSION: We found the diameter of labyrinthine segment of facial canal as an anatomic risk factor for Bell's palsy. We also found significant relationship between the HB grade and FC diameter at the level of second genu. Future studies (MRI-CT combined or 3D modeling) are needed to promote this possible relevance especially at second genu. Thus, in the future it may be possible to selectively decompress particular segments in high grade BP patients.

Pregnancy rhinitis in Turkish women: Do gestational week, BMI and parity affect nasal congestion?

OBJECTIVE: To determine the cumulative incidence of pregnancy rhinitis along with prevalence in different trimesters and to find out whether gestational age, BMI and parity have any effect on pregnancy related nasal congestion. METHODS: In the prospective protocol at the obstetrics outpatient clinic, 167 pregnant women were enrolled consecutively. According to exclusion criteria, 67 of them were excluded. Visual-Analogue-Scale (VAS), Nasal-Obstructive-Symptom-Evaluation (NOSE) scale and Discharge-Inflammation-Polyps/Oedema (DIP) scoring were utilized for diagnosis of pregnancy rhinitis. Besides, weight, length, age, parity and week of pregnancy were recorded. RESULTS: Total prevalence of pregnancy rhinitis was 17.17% and cumulative incidence was 38.89%. Our study revealed significant relation of NOSE score with both gestational week (r=0.474, p=0.001) and BMI (r=0.301, p=0.003). VAS score was significantly related with gestational week (r=0.409, p=0.001) and BMI (r=0.270, p=0.007). DIP score was found to be correlated only with gestational week (r=0.375, p=0.001). CONCLUSION: Cumulative incidence of pregnancy rhinitis was 38.89%. Nasal congestion was significantly associated with BMI and gestational week. Patients should be informed about unfavorable fetal and maternal outcomes of pregnancy related nasal congestion which is triggered by obesity and excessive weight gain in pregnancy.

Pleomorphic adenoma of lateral nasal wall presenting with epiphora.

We report a rare case of pleomorphic adenoma arising from the lateral nasal wall which was incidentally detected at a very early stage. A 38-year-old man presented to the ophthalmology department with a 2-year history of epiphora from the left eye. He was referred to otorhinolaryngology department as a candidate for endoscopic dacryocystorhinostomy. Nasal endoscopy revealed a polypoid mass on the left lateral nasal wall arising near the uncinate process and protruding into the middle meatus. Endoscopic excision of the mass and a concomitant endoscopic dacryocystorhinostomy and functional endoscopic sinus surgery were done. Histopathological examination was compatible with pleomorphic adenoma having tumour-negative surgical margins. He was free from the disease 24 months after the surgery.

Coexistence of actinomycosis and sialolithiasis in the submandibular gland.

Actinomycosis of the submandibular gland is unusual. A 55-year-old male presented with a right, painless submandibular mass of four-year duration. Physical examination revealed a 4 x 3-cm mass in the submandibular region. Ultrasonography-guided fine needle aspiration from the lesion showed microorganisms compatible with actinomyces colonies in the glandular tissue. The diagnosis was made as actinomycosis of the right submandibular gland accompanied by sialolithiasis. The patient was treated with penicillin G (10 million U/day) for three months, followed by 3 g/day oral penicillin for six months. After this medication, physical examination showed no decrease in the size of the mass and the clinical features remained unchanged. Submandibular gland excision under general anesthesia was performed.