Evren Hizal

Correlation between adenoid-nasopharynx ratio and endoscopic examination of adenoid hypertrophy: a blind, prospective clinical study.

OBJECTIVE To determine the reliability of adenoid-nasopharynx (A/N) ratio that is calculated on lateral cephalometric graphies for measuring the adenoid tissue size. METHODS 85 patients that had been examined in our clinic with a prediagnosis of adenoid hypertrophy between June 2007 and March 2008 were included in the study. Local ethics committee approved the study protocol. Patients who had a previous adenoidectomy history and anatomic anomaly or acute infection in nose, palate or nasopharynx were excluded. Endoscopic nasal examination was done in all patients in addition to the routine ear nose throat examination. Lateral cephalometric graphs were obtained from all patients. Digital images obtained during endoscopic examination were evaluated on computer and obstruction ratios of adenoid tissue to choanal opening were calculated. Each cephalometric graph was evaluated by a blinded author. A/N ratio was calculated by dividing the distance from the outermost point of convexity of adenoid shadow to basiocciput to the distance between sphenobasiocciput and posterior end of hard palate (Fujioka Method). A/N ratio of each patient was then compared with the obstruction ratio obtained in nasal endoscopy. Pearson correlation test was used for statistical analysis and a p-value of <0.05 was accepted as significant. RESULTS There were 52 male and 33 female patients between the ages of 2 and 12 years (mean age, 5.0+/-2.2; median, 4.5). In nasal endoscopy, adenoid tissue was determined to obstruct the choanal opening as 88.5+/-12.0% (range, 51-99%) in an average. Mean adenoid nasopharynx ratio was found to be 0.87+/-0.1. There was a statistical significant correlation between A/N ratio and nasal endoscopic examination findings (r=0.511; p<0.0001). CONCLUSIONS A/N ratio is an easily applicable, noninvasive method that can correctly measure the size of the adenoid tissue in patients who are suspected to have adenoid hypertrophy.

Acoustic Rhinometry in Healthy Humans: Accuracy of Area Estimates and Ability to Quantify Certain Anatomic Structures in the Nasal Cavity

Objectives: We evaluated the accuracy of acoustic rhinometry (AR) measurements in healthy humans and assessed the ability of AR in quantifying the dimensions of the paranasal sinuses and certain anatomic structures in the nasal cavity. Methods: Twenty nasal passages of 10 healthy adults were examined by AR and computed tomography (CT) before and after decongestion. Actual cross-sectional areas of the nasal cavity and actual locations of the nasal valve, the head of the inferior turbinate, the head of the middle turbinate, the ostia of the frontal and maxillary sinuses, and the choana were determined from CT sections perpendicular to the curved acoustic axis of the nasal passage. Results: The AR-measured cross-sectional areas in the anterior nasal cavity were in reasonable agreement with the corresponding areas determined from CT, whereas AR consistently overestimated the passage areas at locations posterior to the paranasal sinus ostia. The nasal valve was identified as a pronounced minimum on the AR area-distance curve. However, AR did not discretely identify the head of the inferior turbinate, the head of the middle turbinate, or the choana. Conclusions: The local minima on the AR area-distance curve beyond the nasal valve are caused by acoustic resonances in the nasal cavity, and do not correspond to any anatomic structure. The AR area overestimation beyond the paranasal sinus ostia is due to the interaction between the nasal cavity and the paranasal sinuses, rather than to sound loss into the sinuses. Acoustic rhinometry provides no quantitative information on ostium size or sinus volume in either non-decongested or decongested nasal cavities.

Outfracture of the Inferior Turbinate: A Computed Tomography Study.

Background: Various surgical treatment modalities are available for inferior turbinate hypertrophy. Each is related to well-established complications, but still there is a lack of consensus on the optimal technique. Outfracture of the inferior turbinate is thought to be a minimally destructive procedure among all other reductive turbinate interventions. The authors’ aim was to assess the long-term effects of inferior turbinate outfracture technique in patients with mild or moderate inferior turbinate hypertrophies. Methods: Twenty inferior turbinates in 10 patients were outfractured during a septoplasty procedure. The distance of the inferior turbinate bone to the lateral nasal wall was compared at three different levels of the nasal passage before and after (at 9 months) surgery with computed tomography scans of each patient at (1) the first section in which the inferior turbinate bone could be seen entirely (anterior portion), (2) the level of the maxillary sinus ostium (middle portion), and (3) the last section in which the inferior turbinate bone could be seen entirely (posterior portion). Results: A statistically significant degree of lateralization was observed at all levels in all patients. The mean lateralization rates were 15, 26, and 23 percent for the right side, and 26, 29, and 25 percent for the left side at the first, second, and third levels, respectively. There was no bleeding, edema, or crusting due to the outfracture procedure in any patient. Conclusion: The authors’ results suggest that outfracture of the inferior turbinate is an effective and durable technique, which can be performed easily to enlarge the nasal airway in mild and moderate inferior turbinate hypertrophies with minimal morbidity.

Effects of different levels of crushing on the viability of rabbit costal and nasal septal cartilages.

Background: Cartilage grafts are frequently used in nasal surgery for structural and/or aesthetic purposes. The literature holds contradictory reports concerning the effect of crushing on the viability of cartilage grafts. Methods: Nasal septal and costal cartilage grafts were harvested from 12 New Zealand rabbits. Each nasal septal and costal cartilage was divided into five equal pieces. One of the pieces was left intact and the remaining four were prepared as slightly, moderately, severely, or significantly crushed. The cartilage pieces were then autoimplanted into the paravertebral skin of the rabbits. The animals were euthanized 4 months later and the effect of crushing on cartilage grafts was assessed pathologically. Results: The viability of the chondrocytes was found to be decreased as the level of crushing increased. The mean chondrocyte viability rates for the intact, slightly crushed, moderately crushed, severely crushed, and significantly crushed cartilages were 88, 75, 51, 41, and 13 percent for the septal cartilages and 94, 83, 62, 32, and 26 percent for the costal cartilages, respectively. The differences between the mean viability rates of septal and costal cartilage groups were statistically not significant. Conclusions: The level of crushing determines the rate of viability for the crushed cartilage. Viability rates and the clinical properties of the slightly crushed cartilage grafts at long-term follow-up may be similar to those of the intact cartilage grafts. However, severe or significant crushing leads to a decrement in the viability of the chondrocytes and may cause unpredictable degrees of volume loss at long-term follow-up.

Glycerol affects vestibular-evoked myogenic potentials and pure-tone hearing in patients with Ménière's disease.

Abstract Conclusion: The pure-tone audiometry results following glycerol administration indicated a positive effect on cochlear endolymphatic hydrops. Glycerol cervical vestibular-evoked myogenic potential (cVEMP) tests are a useful means of diagnosing saccular hydrops. There was no correlation between cVEMP and audiological results. Objective: To document the changes in pure-tone hearing outcomes and cVEMPs in patients with Ménière’s disease (MD) and 10 healthy volunteers before and after oral administration of glycerol. Methods: Twenty-nine study group subjects were chosen with complaints of vertigo. cVEMP testing and pure-tone hearing level testing were performed before and at 1, 2, and 3 h after administration of glycerol. Results: The means of the latencies, amplitudes, and difference ratio in 20 normal subject ears were determined. Based on these values, 9/29 MD-affected (MDA) ears (31%) had a unilaterally absent cVEMP. Compared with difference ratio values of the control groups there were significant differences in both latencies and amplitudes in MDA ears after glycerol administration. Before glycerol administration, there were significant differences between control and MDA ears on mean values of pure-tone hearing outcomes. Twenty patients in the MDA group showed significant pure-tone hearing outcomes after glycerol administration.

Effectiveness of the Combined Hearing and Masking Devices on the Severity and Perception of Tinnitus: A Randomized, Controlled, Double-Blind Study

Objective: The aim of this study was to evaluate the effect of combined hearing and tinnitus masking devices that are appropriately programmed for acoustic stimulations using wide-band noise over the specific frequency range of tinnitus. Material and Methods: A total of 21 patients were randomly divided into 2 groups. Group I (12 patients) was managed with betahistine dihydrochloride (2HCl) and fitted either with a combined hearing aid or a sound generator, and group II (9 patients) was treated with betahistine 2HCl for 3 months. Audiological tests, pitch matching to determine the frequency of tinnitus, an assessment of tinnitus severity, and subjective scores (visual analog scale, VAS; Mini-Tinnitus Questionnaire) were used to assess the patients in both groups, and a loudness scale was also analyzed in group I. The results were evaluated in a double-blinded manner. Results: Significant decreases in the severity of tinnitus, Mini-Tinnitus Questionnaire score and VAS were observed in both groups. No significant differences were obtained in pitch-matched frequency of tinnitus in the two groups. Conclusion: The findings obtained using either the combined devices or the masking devices with wide-band masking demonstrate that these devices are an effective tinnitus treatment alternative.

Long-term inflammatory response to liquid injectable silicone, cartilage, and silicone sheet

To show and compare the long‐term inflammatory responses to subdermal microdroplet injections of 1,000 centistoke (cS) and 5,000 cS liquid injectable silicone (LIS), and to assess the applicability of insulin pen as an alternative LIS delivery device in an animal model.

A double-blind, placebo-controlled, randomized clinical study of the effects of vardenafil on human nasal patency.

Background Vardenafil, a selective phosphodiesterase 5 (PDE5) inhibitor, may affect nasal patency because of its adverse-effect profile. This double-blind, placebo-controlled, randomized clinical study sought to assess the effect of vardenafil on nasal patency in patients at a university hospital. Methods Nasal patency was assessed using a visual analog score and by measuring the minimum cross-sectional areas (MCAs) and nasal cavity volumes with acoustic rhinometry in 14 subjects before and after administration of vardenafil. Measurements were repeated after administration of a local decongestant spray. Results There was no statistically significant difference between the nasal cavity volumes, MCA, and visual analog scale (VAS) scores before and after the administration of placebo. However, there was a significant increase in the nasal cavity volumes, MCAs, and VAS scores after application of the local decongestant. A significant correlation was found between MCAs and VAS scores (r = 0.96; p < 0.001). After administration of vardenafil, there was a significant increase in the degree of subjective sense of nasal obstruction as measured by VAS scores. Total nasal volumes showed a significant decrease (p < 0.05). The congestion effect induced by the vardenafil was reversed after application of the local decongestant spray, and a significant increase in cross-sectional areas was noted. In the vardenafil group, a significant increase in MCA, total volume, and VAS scores was observed after application of the local decongestant (p < 0.05). Conclusion Objective and subjective nasal obstruction after administration of vardenafil was significantly higher in this study than in previously reported studies. The effect of congestion can be reversed by local decongestants. The role of PDE5 inhibitors in nasal physiology merits additional investigation.

Risk of contamination of nasal sprays in otolaryngologic practice

BackgroundReusable nasal-spray devices are frequently used in otolaryngologic examinations, and there is an increasing concern about the risk of cross-contamination from these devices. The aim of our study was to determine, by means of microbiologic analysis, the safety of a positive-displacement or pump-type atomizer after multiple uses.MethodsA reusable nasal spray bottle, pump, and tips were used in the nasal physical examination of 282 patients admitted to a tertiary otolaryngology clinic. The effectiveness of 2 different methods of prophylaxis against microbiologic contamination (the use of protective punched caps or rinsing the bottle tip with alcohol) was compared with that of a control procedure.ResultsAlthough there was no statistically significant difference in positive culture rates among the types of nasal spray bottles tested, methicillin-resistant coagulase-negative staphylococci were isolated in 4 of 198 cultures.ConclusionGiven these findings, we concluded that additional precautions (such as the use of an autoclave between sprays, disposable tips, or disposable devices) are warranted to avoid interpatient cross-contamination from a reusable nasal spray device.

Expression of a disintegrin and metalloproteinase 8 by inflammatory cells in nasal polyps.

We have read the article of Park et al.1 entitled “Increased Expression of a Disintegrin and Metalloprotease 8 in Allergic Rhinitis” with great interest. These authors have studied the relationship between a disintegrin and metalloproteinase (ADAM) 8 protein and allergic rhinitis and showed ADAM-8 expression in the nasal mucosa of both allergic rhinitis patients and normal controls. Several studies have also focused on and presented the link between different members of ADAMs and asthma.2,3 Asthma and nasal polyposis have similar histopathological features. Inflammatory cell infiltration and remodelling are the factors that are interrelated with the clinical course in both diseases. However, data regarding the relation of ADAMs with nasal polyposis is limited. In a previous study, we had found increased expression of ADAM-33 protein in vessels and stroma of the nasal polyp (NP) tissues.4 Those results encouraged us to search for a link with ADAM-8, another asthma-related protein,5 and NP. We then looked for the expression of ADAM-8 in the specimens of the same patient group that had been used for our ADAM-33 study. Paraffin blocks were used to identify the expression of ADAM-8 polyclonal antibodies (dilution 1:100; Santa Cruz Biotechnology, Santa Cruz, CA) as described in the previous study.4 The number of ADAM-8 subepithelial inflammatory cells were semiquantitatively counted in 10 randomly selected fields (magnification, 400) of each slide. Immunostaining ratios of inflammatory cells in NP tissues and nasal mucosa were compared with each other. Data were collected in SPSS software (Statistical Package for the Social Sciences, Version 17.0; SSPS, Inc., Chicago, IL). The Mann-Whitney U test and Spearman analysis were used to analyze the data. A value of p 0.05 was considered statistically significant. Epithelial and stromal layers in both NP and control groups showed a weak immunopositive staining pattern, and ADAM-8 immunoreactivity was marked in subepithelial layers. Immunostaining ratios of inflammatory cells in NPs (median, 70%; interquartile range, 30–80%) and control mucosa (median, 70%; interquartile range, 50– 80%) were statistically not different from each other (p 0.948). In the NP group, immunostaining was more prominent as the total inflammatory cell count increased, i.e., the number of the immunopositive inflammatory cells correlated with the total number of inflammatory cells ( 0.316; p 0.031). On the other hand, there was no correlation between the number of ADAM-8 cells and total number of inflammatory cells in control mucosa ( 0; p 1.0). The number of ADAM-8 inflammatory cells in asthmatic and nonasthmatic patient groups did not show a statistically significant difference (p 0.139). Similarly, the presence of allergies had no impact on the amount of immunopositive ADAM-8 cells in polyp tissues (p 0.171). Consistent with the findings of Park et al.,1 we found ADAM-8 immunopositivity in normal nasal mucosa. This may be caused by the inherent nature of the nasal mucosa because it is the first line of defense in human respiratory tract. Still, the finding of positive correlation between the strength of ADAM-8 immunostaining and the level of inflammation in NP tissues warrant further research on the role of ADAM-8 protein in NP pathogenesis.