Asli Sahin-Yilmaz

Anatomy and physiology of the upper airway.

The nose is the major portal of air exchange between the internal and external environment. The nose participates in the vital functions of conditioning inspired air toward a temperature of 37°C and 100% relative humidity, providing local defense and filtering inhaled particulate matter and gases. It also functions in olfaction, which provides both a defense and pleasure for the individual. Understanding normal physiology provides the basis for recognizing abnormalities.

Platelet-Rich Fibrin Plays a Role on Healing of Acute-Traumatic Ear Drum Perforation:

Objective Our objective was to demonstrate the effects of platelet-rich fibrin (PRF) for the healing of acute ear drum perforation. Methods Thirty-two patients with acute traumatic ear drum perforations were randomly separated into 2 groups. In group 1 (n = 14), PRF was used for the repair of ear drum perforation; in group 2 (n = 18), we did not make any intervention. Results At initial inspection, perforation sizes were measured as 10.93 ± 3.58 mm2 in group 1 and 10.05 ± 4.02 mm2 in group 2. After 1 month, perforation sizes were 1.35 ± 2.53 mm2 in group 1 and 4.44 ± 3.34 mm2 in group 2 (P < 0.01). In the study group, the rate of ear drum closure was 64.3% and in the control group it was 22.2% (P < 0.05). Conclusion Here we found that PRF is a biomaterial that quickens the healing of ear drum which is autogenous and simply prepared.

En bloc resection of epiglottic tumors with transoral robotic approach – preliminary results

This study aimed to identify whether it would be possible to excise epiglottic laryngeal tumors en bloc with a transoral robotic approach (TORS), ensuring that basic principles of oncologic surgery are followed.

Immunoglobulin E-mediated food allergies among adults with allergic rhinitis

OBJECTIVE: To compare the prevalence of food allergy for peanut, shrimp, and milk in adults with allergic rhinitis and to determine predictive values of these allergens and total immunoglobulin E (IgE) to detect food allergies. STUDY DESIGN: Cross-sectional study. SETTING: University of Chicago Medical Center, Chicago, Illinois. SUBJECTS AND METHODS: We retrospectively analyzed in vitro enzyme-linked immunosorbent assays of adults with rhinitis. Subjects were tested for nine inhalants and three foods (peanut, shrimp, milk) and total IgE. Subjects with food allergy history were tested with additional foods. The sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of the allergens and total IgE to detect food allergies were calculated. RESULTS: A total of 283 subjects received in vitro tests. Fortyone percent tested negative and 59 percent tested positive for inhalants. The prevalence of subjects with a positive peanut or shrimp allergy in the inhalant-positive population was significantly greater than subjects with milk allergy (23.4% peanut [P = 0.008], 22.2% shrimp [P = 0.001], and 13.2% milk [P = 0.008], P = 0.001). For subjects with food allergy history, peanut had the best SP (100.0%), SE (28.1%), PPV (100.0%), and NPV (64.6%) in detecting allergies to other foods. In patients positive for the initial panel (inhalants and peanut), the SP, SE, PPV, and NPV of elevated total IgE was 71.4, 72.4, 77.8, and 65.2 percent, respectively. CONCLUSION: Peanut and shrimp were the most common foods encountered in adults with allergic rhinitis. Peanut was best in predicting other food allergies. Total IgE levels with inhalants plus peanut provided the optimal combination of SE, SP, PPV, and NPV. In vitro testing may be important to identify and prevent anaphylaxis to foods in adults.

Effect of Changing Airway Pressure on the Ability of the Human Nose to Warm and Humidify Air

Objectives: Nasal continuous positive airway pressure (CPAP) treatment causes nasal symptoms that are believed to result from the drying effects of the air on the nasal mucosa, and these symptoms affect compliance with therapy. We hypothesized that the increased air pressure on the nasal mucosa caused by positive pressure from CPAP would decrease the ability of the nose to warm and humidify inspired air, explaining these symptoms. Methods: We performed a 4-way crossover trial using CPAP pressures of −5, 0, +5, and +10 cm H2O in 10 subjects. The ability to warm and humidify inspired air was determined by measurement of the temperature of a fixed volume of cold, dry air entering and exiting the nostril and calculation of the amount of water supplied to the airstream by the nose. Results: The water content of air was unaffected at the pressures studied. Conclusions: The pressure of delivered CPAP does not affect the ability of the nose to warm and humidify inspired air.

Relation of mean platelet volume with obstructive adenoid hypertrophy in children

OBJECTIVE Adenoid hypertrophy (AH) is a common etiology of chronic upper airway obstruction. Upper respiratory tract obstruction may cause chronic alveolar hypoventilation and pulmonary vasoconstriction. In one previous study in patients with obstructive sleep apnea (OSA), it has been claimed that mean platelet volume (MPV), an indicator of platelet activation is increased and that MPV has an important role in the pathophysiology of cardiovascular diseases. We investigated in our study if MPV can be used as an indicator of obstruction due to adenoid hypertrophy. METHODS Our study includes 61 children that underwent adenoidectomy with a mean age of 7.12 (± 2.373). White blood cell, platelet count, MPV, platelet crit and platelet distribution width levels were measured before and 3 months after adenoidectomy. Childrens symptoms for upper airway obstruction (UAO) (presence of snoring, mouth breathing or difficulty in breathing during sleep, obstructive breathing or apnea during sleep) were questioned in the preoperative and postoperative period by a standardized questionnaire. RESULTS There was no significant difference between preoperative and postoperative mean values of MPV, hemoglobin, platelet count (p > 0.05). White blood cell levels were significantly higher in the preoperative period values compared with postoperative period values (p < 0.05). Preoperative UAO scores were significantly higher than the postoperative UAO scores. After stratification of the degree of obstruction (as mild, moderate and severe) there was no significant difference in between groups in terms of MPV values. CONCLUSION There was no significant relation between MPV levels and obstructive adenoid hypertrophy.

Prediction of outcome of radiofrequency ablation of the inferior turbinates

Radiofrequency ablation (RFA) of the turbinates is used commonly for nasal obstruction; however, there is no consensus on patient selection for this surgery.

Peak nasal inspiratory flowmetry for selection of patients for radiofrequency ablation of turbinates.

Objectives: Our goals were to investigate (1) the effectiveness of the topical vasoconstrictor test (TVT) and peak nasal inspiratory flow (PNIF) measurement for the selection of patients with inferior turbinate hypertrophy (ITH) who will benefit from radiofrequency ablation (RFA) of the turbinates and (2) the efficacy of the TVT and PNIF in follow-up of treatment outcomes. Methods: Patients with bilateral chronic nasal obstruction due to ITH underwent assessment with a visual analog scale (VAS) and PNIF before and after the TVT. Twenty patients with symptom improvement according to VAS and PNIF results were enrolled in the study. These patients underwent RFA, and PNIF and VAS scores were determined before and 1 and 6 months after the TVT. These results were compared to evaluate the preoperative prediction of RFA treatment success. Results: Radiofrequency ablation of the turbinates resulted in significant changes in objective and subjective scores. Preoperative (baseline) subjective and objective responses to decongestant were positively correlated (P = .024 and P < .05, respectively). Preoperative (baseline) objective responses to decongestant were significantly correlated with the objective outcomes of surgery (P = .006 and P < .05, respectively). Conclusion: The combined use of PNIF and the TVT allows for the preoperative prediction of the success of RFA and the selection of patients who will benefit most from RFA.

Topical Nigella Sativa for nasal symptoms in elderly

OBJECTIVE To compare the effects of intranasal application of black seed (Nigella Sativa) oil (NSO) and isotonic sodium chloride solution (ISCS) on nasal symptoms of the elderly. METHODS In this prospective, crossover randomized controlled trial, 42 geriatric patients with nasal dryness and related symptoms were randomized to receive either 2 weeks of isotonic sodium chloride solution (ISCS) followed by 2 weeks of N. sativa oil (NG oil) or the same treatment in the opposite order. There was a washout period of 3 weeks in between the treatment periods. Subjective symptoms including nasal dryness, burning, obstruction, itching and crusting were evaluated by a visual analog scale. Mucociliary function was evaluated with saccharin test. RESULTS Nasal dryness, obstruction and crusting improved significantly with the use of NSO compared to ISCS without any evidence of relevant carryover effects (p<0.05 for all for the difference in treatment). There was no significant difference between the effect of NSO and ISCS on nasal burning and itching (p>0.05 for all). There was no change in mucociliary clearance during any of the treatment periods. CONCLUSION NSO is a better alternative to ISCS to treat nasal mucosa symptoms due to aging.

Nasal Obstruction and Unilateral Chronic Otitis Media: Evaluation by Acoustic Rhinometry

Objectives: In a prospective study at Umraniye Research and Education Hospital, we aimed to evaluate the differences in acoustic rhinometric findings between the affected and nonaffected sides in patients with unilateral chronic otitis media (COM) and to investigate whether unilateral COM correlates with the side of nasal obstruction. Methods: Fifty-five consecutive patients with unilateral COM were involved in this study. All patients were evaluated with acoustic rhinometry, the Nasal Obstruction Symptom Evaluation (NOSE) scale, and measurement of their nasal mucociliary transport time. Results: The mean cross-sectional area 1, mean cross-sectional area 2, volume 1, and volume 2 values were not different between the affected and nonaffected sides (p > 0.05). The NOSE score had a reverse correlation with the mean cross-sectional area 2 (p < 0.05) and volume 2 (p < 0.01) of the affected side. Saccharin time was not correlated with the acoustic rhinometric values of the affected side (p > 0.05). Conclusions: These findings do not support the hypothesis that unilateral COM is correlated with the side of nasal obstruction.