The effect of autosomal dominant polycystic kidney disease on mucociliary clearance.

PURPOSE: Autosomal dominant polycystic kidney disease (ADPKD) is a renal disease with genetic transmisson. Mutations in the PKD1 and PKD2 genes, which encode integral membrane proteins of the cilia of primary renal tubule epithelial cells, are seen in ADPKD. The aim of this study was to evaluate the sinonasal epithelium, which is epithelium with cilia, by measuring the nasal mucociliary clearance time, and to investigate the effect of ADPKD on nasal mucociliary clearance. METHODS: The study included 34 patients, selected from patients followed up in the Nephrology Clinic, and 34 age and gender-matched control group subjects. The nasal mucociliary clearance time (NMCT) was measured with the saccharin test. RESULTS: The mean age of the study subjects was 47.15 ± 14.16 years in the patient group and 47.65 ± 13.85 years in the control group. The eGFR rate was determined as mean 72.06 ± 34.26 mL/min in the patient group and 99.79 ± 17.22 mL/min in the control group (p < 0.001). The NMCT was determined to be statistically significantly longer in the patient group (903.6 ± 487.8 s) than in the control group (580 ± 259 s) (p = 0.006). CONCLUSIONS: The study results showed that the NMCT was statistically significantly longer in patients with ADPKD compared to the control group, but in the linear regression analysis results, no correlation was determined between eGFR and NMCT.

Assessment of Subjective and Objective Voice Analysis According to Types of Sulcus Vocalis.

INTRODUCTION: Sulcus vocalis (SV) subtypes are difficult to diagnose. Non-invasive techniques are sometimes not feasible in the diagnosis. The study aims to demonstrate the effectiveness and applicability of objective and subjective voice analysis combined with videolaryngostroboscopic examination (VLS) in the diagnosis of SV types. MATERIAL AND METHODS: This is a retrospective study that includes patients who presented to Phoniatric outpatient clinic with complaints related to voice and diagnosed with SV on VLS examination between 2017-2020. The SV type was determined based on VLS findings and the patients were categorized into respective groups. Between- and within-group assessment of objective and subjective voice analysis of SV types was conducted. RESULTS: 47 patients were included in the study; Type I, Type II, Type III SV patients were 16, 17, and 14 in number, respectively. Fundamental frequency (F0) and Shimmer (%) values were significantly high in Type II and III SV cases, whereas the Maximum Phonation Time (MPT) was significantly low. GRBAS, Voice Handicap Index -10 (VHI-10), Reflux Symptom Index (RSI) scores were statistically significantly high in pathological SV and Voice Related Quality of Life (V-RQOL) scores were low. A moderate correlation between VHI-10 and V-RQOL and between RSI and V-RQOL was detected. CONCLUSIONS: Objective and subjective voice analysis in Type II and III SV show a significant difference compared to Type I SV. The use of objective and subjective voice analysis combined with VLS examination can be helpful in the diagnosis of SV types.

Voice Disorders in Lower Primary School Teachers: An Observational Study.

INTRODUCTION: Voice problems are very common among teachers, and etiology-based methods are used in the diagnosis and treatment process. Our study aims to reveal the changes in subjective voice analysis during the diagnosis and treatment process of dysphonia in lower primary school teachers. METHODS: The nature of the study is a prospective observational one designed for lower primary school teachers in Kahramanmaras conducted between the year 2015 and 2019 and evaluations for parameters including sociodemographic characteristics, laryngeal lesions and pre- and post-treatment scales such as Voice Handicap Index-10 (VHI-10), Reflux Symptom Index (RSI) and Hospital-Anxiety Depression Scale (HADS) for treatment subgroups were made. Statistical analysis was analyzed using SPSS. RESULTS: Three hundred and fifty-one lower primary school teachers were included in the study. A statistically significant difference was found for the development of dysphonia in terms of sociodemographic features such as smoking, professional experience and crowdedness of classroom. Changes in RSI, VHI-10 and HADS values after treatment were clinically significant in all treatment groups. While there was a significant post-treatment improvement in terms of RSI in patients with granuloma and laryngopharyngeal reflux disorders, the VHI-10, and HADS assessments revealed a significant difference in clinical recovery compared to laryngeal lesions. CONCLUSION: The RSI, VHI-10 and HADS values for various laryngeal pathologies were found to be high in dysphonic teachers. An improvement was observed in the scale scores upon the application of treatment modalities. This situation emphasizes the importance of questionnaire survey in the diagnosis, treatment, and follow-up process of dysphonia.

The effect of type 1 diabetes mellitus on voice in pediatric patients.

PURPOSE: The aim of this prospective case-control study was to determine the effect on the voice of type 1 diabetes mellitus (T1DM) in paediatric patients. MATERIALS AND METHODS: The study included patients aged 6-18 years followed up for at least 1 year because of T1DM, and a control group of age and gender-matched healthy volunteers. Following an Ear, Nose, and Throat (ENT) examination, all subjects underwent flexible endoscopic laryngeal examination. Fasting venous blood samples were taken in the morning for the examination of fasting blood glucose (FBG), HgbA1C, and kidney, liver, and thyroid function tests. Data were recorded from the patient files of age, gender, comorbidities, and the development of diabetes-related complications. Voice recordings were taken and the Voice Handicap Index (VHI)-10 form was completed. The patients and control group were compared in respect of the parameters of fundamental frequency, jitter, shimmer, and acoustic voice quality index (AVQI). RESULTS: Evaluation was made of 64 children and adolescents as 32 in the patient group (Group 1) and 32 healthy control subjects (Group 2). Group 1 comprised 17 females and 15 males with a mean age of 12.75 ± 3.23 years. Group 2 comprised 17 females and 15 males with a mean age of 12.75 ± 3.33 years. In Group 1, mean disease duration was 5.21 ± 3.17 years (range, 1-13 years), the FBG value was mean 216.6 ± 122.3 mg/dl, mean HgbA1c was 10.7 ± 2.8, as ≤ 7 in 4 patients, 7-9 in 4, and > 9 in 24. Maximum phonation time (MPT) was determined as 10.66 ± 3.6 secs in Group 1 and 12.11 ± 4.43 in Group 2. VHI was determined as 2.33 ± 3 in Group 1 and 2.31 ± 2.77 in Group 2. No statistically significant difference was determined between the groups was determined in respect of acoustic analysis, perturbation parameters, AVQI and body mass index. CONCLUSIONS: This study is the first to have investigated the effects of T1DM on the voice in paediatric patients. The study results showed that the AVQI value was higher in the patient group but not to a statistically significant level. Therefore, there is a need for further studies with larger samples. The current study can be of guidance for further studies in this field.

Evaluation of vitamin D levels and biochemical markers in infants diagnosed with laryngomalacia.

Background/aim: The pathology of laryngomalacia is still not clear. The aim of this study was to investigate the relationship between vitamin D levels and laryngomalacia, and to evaluate vitamin D levels according to the classification of laryngomalacia. Materials and methods: This retrospective study was conducted in the Kahramanmaras Sütçü Imam University Medicine Faculty's Otorhinolaryngology Clinic between June 2014 and January 2021. Laryngomalacia was classified. Laboratory tests for all patients included calcium (Ca), phosphorus (P), parathormone (PTH), blood urea nitrogen (BUN), creatinine (Cre), alanine transaminase (ALT), and 25-hydroxy vitamin D (25-OH-D). Results: Evaluations were performed for 64 infants with laryngomalacia, including 41 male and 23 female infants with a mean age of 4.6 ± 3.0 months, and a control group of 64 healthy infants with a mean age of 4.5 ± 2.8 months. A statistically significant difference was determined between the laryngomalacia group and the control group with respect to 25-OH-D and PTH levels (p < 0.001). When data were examined according to laryngomalacia types, a statistically significant difference was determined between the groups for 25-OH-D, Ca, P, PTH, and ALT values. The 25-OH-D level was statistically significantly lower in the severe laryngomalacia group than in the mild and control groups (p < 0.001). A statistically significant difference was determined between the moderate and severe laryngomalacia groups and the control group regarding PTH levels (p < 0.001). Conclusion: Vitamin D deficiency may have a role in the etiology of laryngomalacia, and this view is supported by the finding that there was a decrease in vitamin D levels associated with laryngomalacia classification. In addition, the reduction in PTH levels in infants with laryngomalacia may be explained by the change in Ca metabolism. It would be appropriate for further studies to investigate the response to vitamin D replacement therapy in patients with moderate and severe laryngomalacia.

Does Maras powder affect the nasal mucociliary clearence?

PURPOSE: Many studies have been conducted about the effect of cigarettes and other tobacco products on mucociliary clearance. However, there has been no study of the relationship between mucociliary clearance and Maras powder, which is a smokeless tobacco product. The aim of this study was to evaluate the effect of Maras powder use on mucociliary clearance through comparisons with cigarette smokers and those who used no tobacco products. METHODS: The study included 75 male volunteers, aged 23-54 years. Group 1 (n: 25) comprised subjects who do not use any tobacco products, Group 2 (n: 25) those who smoked cigarettes, and Group 3 (n: 25) those who used Maras powder. The saccharin test was used to evaluate mucociliary clearance and the time was recorded in seconds. The groups were statistically compared in respect of mean age and mucociliary clearance time (MCCT). RESULTS: The mean MCCT was determined to be 645.8 ± 200 secs for the whole study sample, 497 ± 108 secs for Group 1, 796 ± 200 secs for Group 2, and 644 ± 161 secs for Group 3. The difference between the groups in respect of MCCT was statistically significant (p < 0.001). No statistically significant difference was determined between the groups in respect of mean age (p = 0.730). CONCLUSION: The study results demonstrated that the nasal mucociliary clearance time was prolonged both by cigarettes and by the use of Maras powder, and that this time was prolonged more by cigarette smoking than the use of Maras powder.

Management of Basal Cell Carcinomas: Clinical Experience.

Objective: Basal cell carcinomas (BCC) mostly originate from the head and neck region. Main goal in BCC treatment is to achieve both aesthetic and functional results while observing the principles of tumor surgery. We report our experience regarding the clinical, histopathological features and surgical treatment results of head and neck basal cell carcinomas in the light of the literature. Methods: Files of patients with head and neck BCCs treated surgically in two university hospitals were retrospectively analyzed. Sociodemographic variables, location and size of tumor, pathological subtype, recurrence ratio, complications and technique of reconstruction were evaluated. Results: We analyzed 119 tumoral lesions in 105 patients of whom 55 (52.4%) were male and 50 (47.6%) were female. Their mean age was 67.3±12 years. The nasal region was the most common location area (n=42, 35.3%). Mean tumor size was 12.6 mm and tumor size range was 2-85 mm. The most commonly used reconstruction techniques were flap surgery, followed by primary closure, and skin grafts. Conclusion: It is important to remove the tumor with a clear surgical margin at least 4 mm and evaluate the five surgical margins with frozen sections intraoperatively. Operations are often performed under local anesthesia and are well tolerated by patients. The most common flaps used in the reconstruction are not only easy to learn but also sufficient in most cases. Skin grafts are good choices in defects located in the cavum concha and the external meatus.

The effect of Ramadan fasting on nasal mucociliary activity and peak nasal inspiratory flow.

PURPOSE: In this study, we aimed to investigate the effect of Ramadan fasting (RF) on nasal mucociliary clearance (MCC) and peak nasal inspiratory flow (PNIF). METHODS: Sixty-two (41 male and 21 female) healthy subjects who stated that they would fast continuously during the month of Ramadan were included in this prospective study. Day 0 (baseline), 1st day (after one day of RF), and 29th (after 29 days of RF) nasal mucociliary clearance time (MCT) with saccharine test and PNIF values were determined. Subject weights (SW) were measured on Day 0 and Day 29. The obtained data were analyzed statistically. RESULTS: The mean of SW on day 0 was 78.53 ± 10.95 kg, and the mean of SW on Day 29 was 78.69 ± 10.87 kg. There was no significant difference in terms of SW (p = 0.251, p > 0.05). A significant difference was found between the MCT and PNIF values measured on different study days (p < 0.05). The MCT values for Day 29 were significantly higher than the values for other days (p < 0.05). There was no significant difference between the MCT values on the first day and the baseline (p = 0.891, p > 0.05). The PNIF values for Day 29 were significantly higher than the values for other days (p < 0.05). The PNIF values on the first day were significantly higher than the baseline (p = 0.008, p < 0.05). CONCLUSION: The present study showed that RF leads to MCT prolongation and PNIF increase. Ramadan fasting causes deterioration in nasal airway defense and improvement in nasal respiration.

Hearing Impairments as an Overlooked Condition in Kidney Transplant Recipients.

It is not known whether hearing disorders improves with kidney transplantation. One of the neurotoxic effects of immunosuppressive drugs may be unrecognized hearing loss. In this study, our aim was to evaluate the hearing disorders in kidney transplant patients. Hearing problems in 46 kidney transplant patients [eGFR ≥ 60 ml/min/1.73 m2 (30 Tacrolimus, 16 mTOR inhibitor users)], 23 hemodialysis patients, and 20 healthy controls were evaluated with a questionnaire and high-frequency audiometry. More than half (58.7%) of the transplant patients had at least one hearing problem. Hearing loss was observed in 50%, 60.9% and 76.1% of the transplant patients at 8,000, 16,000 and 20,000 Hz. Hearing thresholds of transplant and hemodialysis patients increased from 4,000 to 20,000 Hz and was higher than that of controls. Hearing thresholds were higher at 1,000-2,000 Hz in patients using tacrolimus and at 16,000-20,000 Hz in patients using mTOR inhibitor. No correlation was found between hearing threshold and blood tacrolimus or mTOR inhibitor levels. Most kidney transplant and hemodialysis patients have hearing loss at higher frequencies than medium frequencies. Hearing loss in chronic kidney patients is likely to be permanent and kidney transplantation may not improve hearing problems. Hearing problems may be more pronounced at medium frequencies in patients receiving tacrolimus but at higher frequencies in patients receiving mTOR inhibitors.

Characteristics of Benign Paroxysmal Positional Vertigo Following an Earthquake.

INTRODUCTION: Benign Paroxysmal Positional Vertigo (BPPV) is a commonly encountered peripheral vestibular disorder. People exposed to massive earthquakes experience intense and long-term problem associated with dizziness. The purpose of our study is to investigate this relationship and to demonstrate the efficacy of the treatment modalities used in the management of patients with post-earthquake dizziness. METHODOLOGY: The study was carried out by examining the retrospective records of patients who presented with dizziness to the otorhinolaryngological outpatient unit before and after the Elazig earthquake that occurred on 24th Jan 2020. Parameters evaluated include patients' age and gender, onset of dizziness, accompanying symptoms and comorbidities, videonystagmography (VNG) findings, pre- and post-treatment Visual Analogue Scale (VAS), Dizziness Handicap Inventory (DHI), and Hospital Anxiety and Depression Scale (HADS). RESULTS: The number of patients who presented with dizziness to our outpatient clinic after the earthquake and were included in our study totaled 84. The number of patients who visited the outpatient clinic before the earthquake was identified to be 75. In the earthquake related group, while there was a statistically significant difference between residual symptoms (RS) and the need for repetitive repositioning maneuvers, there was no statistically significant difference detected for age, gender, and comorbidities. Also, no statistically significant difference was found in the pre- and post-treatment assessments of VAS, DHI, and HADS median values in the earthquake group. CONCLUSION: There was a remarkable increase in the number of patients presenting with dizziness in the early post-earthquake period. Management of these patients may differ from the classic BPPV. Residual symptoms appearing after performing repositioning maneuvers can be more commonly seen among these patients.

Evaluation of Nasal Mucociliary Clearance, Nasal Obstruction Symptom Evaluation, and Epistaxis Severity Score in Isotretinoin Treatment.

OBJECTIVES: The study aims to investigate the possible side effects of isotretinoin use on the nasal mucosa with objective methods in the treatment of acne vulgaris. METHODS: Before the treatment, nasal mucociliary clearance time (MCT) was measured in all patients. Also all patients were asked to complete the questionnaires about the nasal dryness (visual analog scale [VAS]), nasal obstruction (Nasal Obstruction Symptom Evaluation [NOSE]), and presence of epistaxis (Epistaxis Severity Score [ESS]). Both MCT and questionnaires were reevaluated in patients who completed the treatment. RESULTS: The results of 101 patients were evaluated. Before treatment, mean duration of nasal mucociliary clearance (NMC) was 9.55 ± 1.30 minutes, nasal dryness (VAS) value was 2.7 ± 0.7, NOSE score was 2.1 ± 1.1, and ESS score was 1.2 ± 0.7; after treatment, the duration of NMC was 13.80 ± 2.29 minutes, VAS value was 3.3 ± 1.1, NOSE score was 3.2 ± 1.3, and ESS score was 2.1 ± 1.2 (P = .018, .150, .027, .011, respectively). CONCLUSION: The nasal mucosa is adversely affected in patients due to regular use of isotretinoin in the acne treatment, anamnesis should be checked in all nasal surgeries, and routine ear nose throat control should be recommended for these patients.

Arteriovenal Malformation in Parotid Gland.

Arteriovenous malformation (AVM) is an abnormal vascular formation where the artery and vein are connected directly to each other without capillary connections. Although it is common in the head and neck region, AVMs located in the parotid gland are quite rare. A 12-year-old female patient presented to our clinic with a mass in her left cheek area. As a result of physical examinations and tests, she was diagnosed with an AVM limited to the left parotid gland superficial lobe. Clinical follow-up was performed for AVM which has no sign except for prominence with Valsalva and surface temperature increase. The case was presented with a literature review.