Development of an Algorithm to Determine Which Costal Cartilage to Harvest.

Rib graft is a common source of cartilage in rhinoplasty. Donor site choices for this resource were identified according to the authors who presented the introduction of this technique. However, the scientific basis of this valuable method lacks information, including the anatomical properties of costal cartilage. In this study, cartilage radioanatomy is examined and tested for if any estimators are present. A total of 148 thoracal CT scans of patients who applied to our facility were analyzed. Patients were divided per their sex and age of 35, and rib cartilage dimensions, including axial length between the sternal and costal ends of the cartilage (TotL), posteroanterior diameters at the sternal end (StDia), costal end (CosDia), the thickest part (MaxDia) as diametrical parameters and vertical height at the thickest part (h) were recorded. Length of the sternum (St), the axial length of the clavicle (ClavL), the distance of the sixth rib from the anterior axillary border (AntAx), and thorax circumferences at the level of both pectoralis major muscle origin (ThC) and nipples (BrC) were recorded. Statistical analyses were done for correlations. St, ClavL, ThC, and BrC were found to have the most correlated measurements in groups with the age of 35 and less of both genders, and the relations were lost in older groups. Thorax shape may change after the age of 35 years, but in younger patients, St in females and ClavL in males can be used as estimators of cartilage amount.

Diagnostic Contribution of Magnetic Resonance Imaging and Computerized Tomography in Patients with Unidentified Vertigo and Normal Neurologic Examination in Emergency Medicine.

Background: Vertigo and dizziness are common symptoms in patients presenting to emergency medicine (ED) clinics. Vertigo may be caused by peripheral or central origin. Routine imaging is not indicated; however, neuroimaging is increasing, and published studies have revealed a small number of positive findings on imaging modalities. Aims: The aim of this study was to investigate whether neurological imaging was necessary in patients classified as "unidentified vertigo," who were admitted to the emergency department with vertiginous complaints and not revealing typical peripheral vertigo findings and any neurological deficits. Materials and Methods: All patients with "dizzy symptoms" were included in the study. For patients who met the definition of "unidentified vertigo," experimental neurological imaging studies were done. Head computerized tomography (CT), magnetic resonance imaging (MRI) with gradient-echo sequences (GRE), and diffusion weighted images (DWI) were used for imaging. Patients who underwent neuroimaging in the ED were followed up for 6 months in Neurology and ENT clinics. Results: A total of 351 patients were included in the study. Experimental imaging was performed on 100 patients. CT detected a significant pathology associated with the vertigo complaint in only one patient. MRI results were similar to the CT results. MRI-GRE sequences showed some additional pathologies in 14 patients and 4 of them were thought to be related to vertiginous symptoms. None of the patients classified as "non-central causes of vertigo" in the neuroimaging group developed TIA or CVD during 6 months of follow-up. Conclusion: Head CT can be adequate to exclude life-threatening central pathology in "undifferentiated vertigo patients" and the addition of MRI did not add any diagnostic accuracy in ED management. Using the physical examination findings effectively to make a specific diagnosis may reduce misdiagnosis and improve resource utilization.

Replantation of Pediatric Scalp Avulsions.

Scalp avulsions are rare but can be quite morbid clinical manifestations. Pediatric patients are different from adults as they have not completed their physical, sexual, educational, or psychosocial development. Therefore, the devastation of a failed scalp replantation is much greater on these individuals, their whole future lives, and families. We present 2 consecutive pediatric cases retrospectively with the youngest successful replanted patient in Turkey and describe technical tips according to our experience.

Does turbinate reduction combined with septoplasty have better outcomes than septoplasty alone? A randomised, controlled study.

OBJECTIVE: This study investigated whether inferior turbinate reduction combined with septoplasty improves patients' outcomes, as assessed by objective and subjective methods. METHODS: A single-centre, parallel-group, randomised, open-label trial was conducted at a tertiary hospital ENT clinic. Patients who underwent septoplasty were divided into two groups: group A underwent septoplasty with radiofrequency ablation; group B underwent only septoplasty. All patients were assessed before and three months after surgery using acoustic rhinometry and peak nasal inspiratory flow measurements, as well as Nasal Obstruction Symptom Evaluation scale and Sino-Nasal Outcome Test-22 scores. RESULTS: Seventy-four patients completed the study (36 in group A and 38 in group B). The patients in both groups showed significant improvements in acoustic rhinometry and peak nasal inspiratory flow measurements and in Nasal Obstruction Symptom Evaluation scale and Sino-Nasal Outcome Test-22 scores after the surgery (p < 0.05). However, the differences between the groups were not significant (p > 0.05). CONCLUSION: Inferior turbinate ablation combined with septoplasty does not provide any more benefit to the objective and subjective outcomes of patients than septoplasty alone.

Body-related attentional bias as mediator of the relationship between body mass index and body dissatisfaction.

Body image disturbance, consisting of an affective (body dissatisfaction) and perceptual (body distortion) component, is not only found in eating disorders, but is also present in healthy individuals, affecting their psychological well-being and everyday life. A higher body mass index is associated with higher body dissatisfaction, whereas results in relation to body distortion are mixed. Furthermore, body dissatisfaction is associated with a weight-related attentional bias. This study aimed to investigate the mediating role of a weight-related attentional bias in the relationship between body mass index and body image disturbance. Forty-one college women took part in a virtual reality and eye tracking procedure, in which the illusion of owning a virtual avatar with their body measurements was induced. During this procedure, body-related attentional bias was measured and afterwards body image disturbance was assessed. Mediation analysis revealed that weight-related attentional bias mediated the relationship between body mass index and body dissatisfaction (but not distortion). These findings suggest that modifying weight-related attentional bias would be a useful treatment target for improving body dissatisfaction. In addition, virtual reality technology could serve as an innovative method for modifying attentional bias in an ecologically valid way. HIGHLIGHTS: This Virtual Reality and Eye-Tracking study expands our knowledge about the relation between body mass index, body-related attention and body image disturbances. The results suggest that attentional bias towards weight-related body parts mediates the relation between BMI and body dissatisfaction. On the contrary, the relation between BMI and body distortion was not significant.

Comparison of Cortical Auditory Evoked Potential Findings in Presbycusis with Low and High Word Recognition Score.

BACKGROUND: Deteriorated speech understanding is a common complaint in elderly people, and behavioral tests are used for routine clinical assessment of this problem. Cortical auditory evoked potentials (CAEPs) are frequently used for assessing speech detection and discrimination abilities of the elderly, and give promise for differential diagnosis of speech understanding problems. PURPOSE: The aim of the study was to compare the P1, N1, and P2 CAEP latencies and amplitudes in presbycusis with low and high word recognition score (WRS). RESEARCH DESIGN: A cross-sectional study design was used forthe study. Two groups were formed from the patients with presbycusis based on their scores on the speech recognition test. STUDY SAMPLE: Fifty-seven elderly volunteers participated in the study. The first group composed of 27 participants with high WRS, the other group composed of 30 participants with low WRS. DATA COLLECTION AND ANALYSIS: The CAEP waves were recorded from these participants using speech signals. Latencies and amplitudes of P1 -N1-P2 waves of the two groups were compared with the f-test statistic. RESULTS: There were significant prolongation of P1 and N1 latencies in presbycusis with low WRS when compared with presbycusis with a relatively high word score (p < 0.05). CONCLUSION: According to the result of the research, P1 and N1 latencies of presbycusis with low WRS were longer than the participants with high WRS. Factors affecting peripheral auditory system, such as stimulus sensation level, might be responsible for P1 and N1 latency prolongation of the low WRS group.

Wideband Tympanmetry Results of Bone Cement Ossiculoplasty.

OBJECTIVE: We aim to investigate hearing sensitivity and wideband tympanometry results in bone cement ossiculoplasty cases in present study. STUDY DESIGN: A prospective study. SETTING: Ossiculoplasty patients were grouped according to the anatomical location of bone cement application by surgery note. Ossiculoplasty and tympanoplasty patients were retrospectively invited to the clinic and evaluated. 30 bone cement ossiculoplasty cases as well as 30 Type I tympanoplasty cases (intact ossicular chain) and 30 healthy controls were included in the study and Wideband Tympanometry was performed. Tympanometric peak pressure, equivalent middle ear volume, static admittance, tympanogram width, resonance frequency, average wideband tympanometry and absorbance measurements were analyzed. RESULTS: A statistically significant improvement was observed in the hearing levels of all ossiculoplasty and type I tympanoplasty patients (p < 0.05). Bone cement ossiculoplasty groups demonstrated the remarkable differences than the type I tympanoplasty and control group in Wideband Tympanometry test parameters. In some parameters, malleus-stapes and manubriostapedioplasty groups demonstrated similarities to Type I tympanoplasty and control groups. CONCLUSION: Bone cement is an effective application for ossiculoplasty. Wideband tympanometry is a promising method for the evaluation of the middle ear dynamics.

Comparison of Cortical Auditory Evoked Potential Findings in Presbycusis with Low and High Word Recognition Score.

BACKGROUND: Deteriorated speech understanding is a common complaint in elderly people, and behavioral tests are used for routine clinical assessment of this problem. Cortical auditory evoked potentials (CAEPs) are frequently used for assessing speech detection and discrimination abilities of the elderly, and give promise for differential diagnosis of speech understanding problems. PURPOSE: The aim of the study was to compare the P1, N1, and P2 CAEP latencies and amplitudes in presbycusis with low and high word recognition score (WRS). RESEARCH DESIGN: A cross-sectional study design was used for the study. Two groups were formed from the patients with presbycusis based on their scores on the speech recognition test. STUDY SAMPLE: Fifty-seven elderly volunteers participated in the study. The first group composed of 27 participants with high WRS, the other group composed of 30 participants with low WRS. DATA COLLECTION AND ANALYSIS: The CAEP waves were recorded from these participants using speech signals. Latencies and amplitudes of P1-N1-P2 waves of the two groups were compared with the t-test statistic. RESULTS: There were significant prolongation of P1 and N1 latencies in presbycusis with low WRS when compared with presbycusis with a relatively high word score (p < 0.05). CONCLUSION: According to the result of the research, P1 and N1 latencies of presbycusis with low WRS were longer than the participants with high WRS. Factors affecting peripheral auditory system, such as stimulus sensation level, might be responsible for P1 and N1 latency prolongation of the low WRS group.

Endoscopic triple-C tympanoplasty: an alternative approach to anteriorly located tympanic membrane repair.

OBJECTIVE: Anteriorly located tympanic membrane perforations can negatively affect surgical success rates. This study aimed to present, using our case series results, endoscopic triple-C (composite chondroperichondrial clip) tympanoplasty as an alternative method in the repair of tympanic membrane anterior quadrant perforations. METHODS: This study included patients with a perforation sized greater than 3 mm, who had an anterior quadrant dominant perforation where the anterior portion could not be seen during microscopic examination; all underwent endoscopic triple-C tympanoplasty. RESULTS: Operating time was 30-79 minutes (mean, 46.6 minutes). The post-operative graft success rate at six months was 92 per cent (23 out of 25). Mean post-operative follow-up duration was 21.5 ± 7.3 months (range, 11-40 months), and no intratympanic cholesteatoma was observed. CONCLUSION: Endoscopic triple-C tympanoplasty is a comfortable, minimally invasive alternative method to repair anterior tympanic membrane perforations. The graft success rate and the degree of recovery from hearing loss were in accordance with the literature. However, more reliable results may be obtained in a larger series with longer follow-up times.

Correlation of quantitative MR imaging findings with symptoms in patients with incidentally detected inflammatory sinonasal disease.

PURPOSE: To assess the relationships between mucosal thickness, T1-weighted, T2-weighted signals and restricted diffusion on magnetic resonance imaging (MRI) with the degree of symptoms in patients with incidentally detected inflammatory sinonasal disease. MATERIALS AND METHODS: Conventional and diffusion-weighted MRI of 100 patients with incidental sinonasal mucosal thickening were prospectively evaluated. There were 53 men and 47 women, with a mean age of 44.6 years±15.17 (SD) (range: 18-81 years). Correlations between quantitative values (T1-signal, T2-signal and apparent diffusion coefficient [ADC]) and three different quality of life questionnaires (chronic sinusitis survey, sinonasal outcomes test-22 and nasal obstruction and septoplasty effectiveness scale [NOSE]) were searched using the Spearman correlation test. RESULTS: The mean SNOT-22 score was 35.81±20.36 (SD) (range: 0-83), CSS score was 4.64±3.42 (SD) (range: 0-14), and NOSE score was 5.91±4.84 (range: 0-18). All patients (100%) had maxillary sinus involvement. Ethmoidal sinus involvement was present in 57% of patients, frontal sinus involvement in 33% and sphenoidal sinus involvement in 27%. Morphologically, 40 patients (40%) had septal deviation, 41 (41%) had maxillary sinus retention cyst and 78 (78%) had hypertrophy of the conchae. No correlations were found between morphological abnormalities, quantitative values and patient scores in none of the questionnaires. CONCLUSION: Incidental morphological abnormalities or restricted diffusion of the paranasal sinuses on MRI do not correlate with the degree of symptoms in patients with incidentally detected inflammatory sinonasal disease.

Biomarkers of airway and systemic inflammation in obese asthmatic paediatric patients

Background: It is thought that airway inflammation is more common in obese asthmatic patients because inflammation is harder to control and does not respond well to glucocorticoid treatment. Objective: This study's aim was to investigate the effect of obesity on airway and systemic inflammation in children with asthma and to identify the biomarkers that play a role in this inflammation. Methods: The study included patients aged 6-16 years who were diagnosed with asthma in the paediatric allergy outpatient clinic of Bagcilar Training and Research Hospital in Turkey. Complete blood count parameters were compared between three groups: obese asthmatic (n = 43), obese non-asthmatic (n = 45), and non-obese non-asthmatic (control group, n = 30). Levels of high-sensitive CRP (hs-CRP), neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN), and matrix metalloproteinase-9 (MMP-9), and 25(OH)-vitamin D were compared between the groups. Results: No statistically significant differences were observed in 25(OH)-vitamin D, NGAL, OPN, hs-CRP, and MMP-9 levels between groups. There was a statistically significant negative correlation between FEV1/FVC and NGAL and MMP-9. Conclusion: This is the first study to investigate levels of hs-CRP, NGAL, OPN, MMP-9, and 25(OH)-vitamin D in obese asthmatic children. Larger studies with sputum and BAL examinations are required to determine the potential of biomarkers for identifying inflammation in obese asthmatic children (AU)

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Biomarkers of airway and systemic inflammation in obese asthmatic paediatric patients.

BACKGROUND: It is thought that airway inflammation is more common in obese asthmatic patients because inflammation is harder to control and does not respond well to glucocorticoid treatment. OBJECTIVE: This study's aim was to investigate the effect of obesity on airway and systemic inflammation in children with asthma and to identify the biomarkers that play a role in this inflammation. METHODS: The study included patients aged 6-16 years who were diagnosed with asthma in the paediatric allergy outpatient clinic of Bagcilar Training and Research Hospital in Turkey. Complete blood count parameters were compared between three groups: obese asthmatic (n=43), obese non-asthmatic (n=45), and non-obese non-asthmatic (control group, n=30). Levels of high-sensitive CRP (hs-CRP), neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN), and matrix metalloproteinase-9 (MMP-9), and 25(OH)-vitamin D were compared between the groups. RESULTS: No statistically significant differences were observed in 25(OH)-vitamin D, NGAL, OPN, hs-CRP, and MMP-9 levels between groups. There was a statistically significant negative correlation between FEV1/FVC and NGAL and MMP-9. CONCLUSION: This is the first study to investigate levels of hs-CRP, NGAL, OPN, MMP-9, and 25(OH)-vitamin D in obese asthmatic children. Larger studies with sputum and BAL examinations are required to determine the potential of biomarkers for identifying inflammation in obese asthmatic children.

A rare complication of tonsillitis: septic arthritis of the temporomandibular joint.

Septic arthritis of the temporomandibular joint (TMJ) is a rarely seen clinical condition. Such an infection may be encountered following infections in the head and neck region, with direct or haematogenous spread to the joint. This article presents the case of a patient with tonsillitis leading to septic arthritis of the TMJ and reports the results of a review of the literature.

Can temperament and character features of patients predict alcohol use after laryngectomy?

AIM: Patients with larynx cancer usually use alcohol besides tobacco. It has been reported earlier that nearly half of the patients who have undergone laryngectomy after larynx cancer diagnosis still continue to consume alcohol after the operation. The aim of this study was to compare the mood and character features of patients who do or do not consume alcohol during the postoperative period and thus to be able to predict the patients who will continue their alcohol use at the postoperative period. MATERIALS AND METHODS: The patients who have undergone partial or total laryngectomy operation were included in this study. To avoid early period treatment stress, it was required that the patients have completed their 6 months of postoperative period. The interviews made with the patients included filling out of the sociodemographic data form, TCI (temperament and character inventory), BDI (Beck depression inventory), BAI (Beck anxiety inventory), AUDIT (alcohol use disorders identification test) and CAGE (cut-down, annoyed, guilty, eye-opener) inquiry forms. RESULTS: 80 patients who admitted alcohol consumption at the time of larynx cancer diagnosis were divided in to two groups and, 40% (n = 32) of this patients continued alcohol consumption after laryngectomy (Group 1) and 60% (n = 48) cut down on their alcohol use (Group 2). A statistically significant difference was observed between Group 1 and Group 2 at AUDIT and CAGE score averages (P < 0.001, P < 0.001, respectively). When TCI data were compared between Group 1 and Group 2, patients who continued their alcohol use at the postoperative period had significantly higher novelty seeking scores compared to others (P = 0.03). CONCLUSION: Our data suggest that it may be possible in the preoperative period to predict the patients who will continue their alcohol use in the postoperative period and take precautions.

Evaluation of the antioxidant effects of melatonin on the larynx mucosa of rats exposed to environmental tobacco smoke.

OBJECTIVES: This study's aim was to investigate the effect of melatonin in terms of mitigating the effects of smoking on the laryngeal mucosa of rats exposed to environmental tobacco smoke. DESIGN: Rats were divided into four groups: Melatonin + Smoking group exposed to smoke with melatonin; Smoking group exposed to smoke without melatonin; Saline group not exposed to smoke without melatonin; Melatonin group not exposed to smoke with melatonin. CuZn-superoxide dismutase (CuZn-SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) activities were evaluated in plasma and tissues. Tissues were also examined the changes of squamous hyperplasia, keratosis, parakeratosis and epithelial hyperplasia by light microscope and the ultrastructural changes by electron microscope. RESULTS: Tissue SOD, CAT and GSH-Px activities were significantly higher in Saline and Melatonin groups than Melatonin + Smoking and Smoking groups. Plasma CuZn-SOD and CAT activities were significantly higher in Saline and Melatonin groups than Smoking group. Plasma GSH-Px showed no significant difference. The rate of epithelial hyperplasia was significantly higher in Smoking group than the other groups. The rate of parakeratosis was significantly higher in Smoking group than the other groups. The epithelial cells in Melatonin + Smoking group displayed, normal cell structure similar to those in Saline group under electron microscope. CONCLUSIONS: The study shows that smoking induces substantial pathological changes in the laryngeal mucosa and melatonin may have some beneficial effects in partially reversing smoking-induced laryngeal injury by inducing the expression of antioxidants; biochemical and histological outcomes also support these findings due to preventing tissue damage in laryngeal mucosa exposed to smoke.

Biomechanical strength of glass ionomer cement in incudostapedial rebridging.

OBJECTIVE: To study the biomechanical properties of glass ionomer cement used for incudostapedial rebridging. METHODS: Two groups were established based on the size of the gap between the incus and stapes (1.0 mm in group 1 and 2.0 mm in group 2). Glass ionomer cement was applied to the gaps, and compression tests were performed. Maximum force was measured at the fracture point, and was divided by the cross-sectional area to obtain the maximum compressive strength. RESULTS: No significant difference was found in the maximum force for the two groups (p = 0.312). The glass ionomer cement diameter was significantly higher in group 2 than in group 1 (p = 0.006). The maximum compressive strength was significantly higher in group 1 than in group 2 (p = 0.042). CONCLUSION: The fragility of bone cement used in this study was 25.5 per cent higher for a 2 mm gap than for a 1 mm gap. We speculate that the use of bone cement may be safer for the repair of smaller incudostapedial defects.

Effects of Different Local Anaesthetics on Oto-acoustic Emission Tests after Spinal Anaesthesia.

PURPOSE: To evaluate whether there is any effect of different local anaesthetic agents on hearing loss after spinal anaesthesia. METHODS: Thirty American Society of Anesthesiologists (ASA) I patients without a hearing problem were included in the study. Transient evoked oto-acoustic emissions (TEOAE) were examined. Patients were randomly separated into two groups: Group L, 15 mg isobaric levobupivacaine application and Group B, 15 mg isobaric bupivacaine application, for spinal anaesthesia. Oto-acoustic emission measurements were repeated on patients at the 24th hour after spinal anaesthesia application. RESULTS: No significant difference was found in the output values of the right and left ears according to the input values in group L at no kHz (p > 0.05). No significant difference was found in the output values of the right and left ears according to the input values in any kHz of Group B (p > 0.05). CONCLUSION: Fifteen milligrammes of isobaric bupivacaine and levobupivacaine had no significant difference on the effect of hearing loss after spinal anaesthesia. Hearing loss after spinal anaesthesia has many unknown issues, and deserves to be explored by performing many studies.

Comparison of skin effects of immediate treatment modalities in experimentally induced hydrofluoric acid skin burns.

Hydrofluoric acid (HF) burns cause immediate damage and painful long-term sequellae. Traditionally, chelating agents have been used as the initial treatment for such burns. We have introduced epidermal growth factor (EGF) into an HF model to compare EGF with Ca(2+) and Mg(2+) treatments; 40 Sprague Dawley rats were divided into five groups. Each rat suffered a 6 × 4 cm(2) burn induced by 40% HF. Group 1 had no treatment, group 2 had saline injected beneath the burn, group 3 received magnesium sulphate injections, group 4 received calcium gluconate and group 5 received EGF. Specimens were evaluated via planimetry and biopsy at intervals of 4, 8, 24 and 72 hours. Fluid losses were significantly less in the Mg(2+) and EGF groups. The EGF group had the smallest burn area, least oedema, least polymorphonuclear granulocyte (PMN) infiltration, most angiogenesis and highest fibroblast proliferation of any group (P < 0·005). EGF limited HF damage morphologically and histologically more effectively than Ca(2+) or Mg(2+). This finding indicates that HF treatment via growth factors may be an improvement over chelation therapy.

Importance of nasal septal cartilage perichondrium for septum strength mechanics: a cadaveric study.

OBJECTIVE: This study aimed to investigate the biomechanical qualities of the perichondrium and cartilage, and to determine the strength of the septal cartilage against bending forces. STUDY DESIGN: This paper describes an experimental cadaver study. MATERIALS AND METHODS: The nasal septal cartilages of 14 fresh cadavers (8 hours postmortem) were excised from the cadavers and cut into two strips: one with the perichondrium (group A) and one without perichondrium (group B). A bending test was then performed on the strips. RESULTS: The deflection of group A strips was larger than the deflection of group B strips. Flexural strength was also larger in group A strips compared to group B strips. The average modulus of elasticity was 122% higher in group A compared to group B. All conducted tests revealed statistically significant differences between groups. CONCLUSION: This study objectively shows that the perichondrium provides the cartilage with a 25% bending strength.