Hakan Korkmaz

The Prevalence of Aspirin Hypersensitivity in Patients with Nasal Polyposis and Contributing Factors

Background Aspirin (acetylsalicylic acid [ASA]) hypersensitivity is frequent in patients with nasal polyps (NPs) and is called aspirin exacerbated respiratory disease, previously known as Samters syndrome. However, studies evaluating the prevalence of ASA hypersensitivity in patients with NPs using the oral aspirin provocation test (APT) are quite limited. This study was designed to determine the prevalence of ASA hypersensitivity and factors associated with ASA hypersensitivity in patients with NPs. Methods Sixty-eight patients with NPs with or without asthma were recruited. Extension of NPs was evaluated by endoscopic examination/paranasal CT. A 2-day, single-blind placebo-controlled APT was used to detect ASA hypersensitivity. Results APT was performed in 53 (21 women/ 32 men) patients (mean age, 39.34 ± 1.76 years). APT resulted positive in 12 patients (22.6%) of whom 3 (25%) had no history of ASA hypersensitivity. Of the positive APTs, three were isolated rhinitis and nine had classic responses. APT was negative in 41 patients (77.4%) although three (7.3%) had a history of ASA hypersensitivity. History of ASA hypersensitivity and prolonged duration of NPs were associated with positive APT (p < 0.05). Advanced NP with multiple operations was also correlated with APT positivity but was not statistically significant. Presence of asthma was associated with age, female gender, NP duration, and ASA hypersensitivity history (p < 0.05), but not with smoking, atopy, NP extension, and positive APT. Conclusion ASA hypersensitivity is quite common in patients with NP. Patients with extensive and long-term NP with multiple polyp operations require evaluation for the presence of ASA hypersensitivity in terms of chronic management and future risks of the disease.

Is there any correlation between the results of skin-prick test and the severity of symptoms in allergic rhinitis?

Background This study was designed to determine whether there is any correlation between results of the skin-prick test and the severity of symptoms in allergic rhinitis. Methods We retrospectively evaluated 150 patients with persistent or intermittent allergic rhinitis confirmed by positive skin tests and scaled from 1 to 4 according to the size of the wheal. The symptoms including sneezing, nasal obstruction, rhinorrhea, and nasal itching were ranked according to their severity (0 for no symptoms, 1 for mild, 2 for moderate, and 3 for severe). We investigated the correlation between the skin tests’ positivity and symptoms score, rhinoconjunctivitis quality-of-life questionnaire (RQLQ), and visual analog scale (VAS) scores. Results Of the 150 patients, 98 had persistent and 52 had intermittent allergic rhinitis. Some patient d multiple al en senitivity. Each skin test group was compared with respect to symptom scores, RQLQ, or VAS scores. There was no statistically significant correlation between the size of the wheal and symptoms score, RQLQ, or VAS scores. There was also no correlation between the type of allergen and symptoms score. Conclusion The skin-prick test can be applied to support the diagnosis of allergic rhinitis, but one can not predict the severity of illness by stratifying the size of the skin-prick test result.

Biofilms in chronic rhinosinusitis with polyps: is eradication possible?

The objective of the study was to reveal if mometasone furoate nasal spray as monotherapy or combined with long-term oral clarithromycin have influence on biofilms in chronic rhinosinusitis with polyps. The study is a randomized controlled trial in a tertiary referral hospital. Thirty-four patients with chronic rhinosinusitis completed the study. In the first group, 19 patients received mometasone furoate nasal spray 200xa0μg once daily for 8xa0weeks. In the second group, 15 patients received oral clarithromycin 500xa0mg twice daily for 2xa0weeks and continued once daily 250xa0mg tablet for subsequent 6xa0weeks, plus mometasone furoate. Scanning electron microscopy was the primary outcome measure. Secondary outcome measures included computerized tomography and sinonasal outcome test-20 items. Mucosal biofilms were detected in 23 of 34 (68xa0%) patients on pretreatment polyp samples. After the treatment, biofilms disappeared in 1 of 11 patients in the first group, whereas the eradication of biofilms was evident in 6 of 12 (50xa0%) patients in the second group. Tomography scores improved in eight patients of each group (42.1 and 53.4xa0%, respectively). The comparison of improvements did not reveal significant difference between the groups. The overall symptom scores improved compared to the baseline levels. The mean changes of −8.8421 and −11.4000 in the first and second group, respectively, were not statistically different. Adding long-term low-dose oral macrolides to nasal steroids was effective in the eradication of biofilm. However, we were not able to demonstrate that combined therapy was superior in terms of the improvement in tomography and symptom scores.

Bilateral congenital choanal atresia encountered in late adulthood

OBJECTIVEnWe describe a case of bilateral congenital choanal atresia in the oldest patient reported with this condition in the recent English language literature.nnnMETHODnCase report and a review of the relevant English language literature, presenting the embryopathogenesis, diagnostic methods and treatment options for this condition.nnnRESULTSnA 53-year-old woman having difficulty with nasal breathing, and with a continuous nasal discharge, was admitted to our clinic. Bilateral congenital choanal atresia was diagnosed by endoscopic examination and paranasal sinus computed tomography. Surgical treatment used an endoscopic transnasal approach. The follow-up examination a year later revealed adequate choanal openings bilaterally.nnnCONCLUSIONnTo our knowledge, this is the oldest patient with bilateral congenital choanal atresia to be reported in the recent literature. This condition is rarely encountered in adulthood but should be considered as a possible differential diagnosis of persistent nasal obstruction.

Vestibular-evoked myogenic potentials, clinical evaluation, and imaging findings in multiple sclerosis

Vestibular-evoked myogenic potentials (VEMP), short-latency electromyographic responses elicited by acoustic stimuli, evaluate the function of vestibulocollic reflex and may give information about brainstem function. The aim of the present study is to evaluate the potential contribution of VEMP to the diagnosis of multiple sclerosis (MS). Fifty patients with MS and 30 healthy control subjects were included in this study. The frequency of VEMP p1–n1 and n2–p2 waves; mean p1, n1, n2, and p2 latency; and mean p1–n1 and n2–p2 amplitude were determined. The relation between clinical and imaging findings and VEMP parameters was evaluated. The p1–n1 and n2–p2 waves were more frequently absent in MS than in control subjects [p1–n1 wave absent: MS, 25 (25xa0%) ears; control, 6 (10xa0%) ears; Pxa0≤xa00.02] [n2–p2 wave absent: MS, 44 (44xa0%) ears; control, 7 (12xa0%) ears; Pxa0≤xa00.001]. The mean p1–n1 amplitude was lower in MS than in control subjects (MS, 19.1xa0±xa07.2xa0μV; control, 23.3xa0±xa07.4xa0μV; Pxa0≤xa00.002). A total of 24/50 (48xa0%) MS patients had VEMP abnormalities (absent responses and/or prolonged latencies). VEMP abnormalities were more frequent in patients with than without vestibular symptoms (Pxa0≤xa00.02) and with brainstem functional system score (FSS) ≥1 than FSSxa0=xa00 (Pxa0≤xa00.02). In patients with MS, absence of p1–n1 wave was more frequent in patients with than without vestibular symptoms [absence of p1–n1 wave: vestibular symptoms, 9 (45xa0%) ears; no vestibular symptoms, 16 (20xa0%) ears; Pxa0≤xa00.03] and patients with Expanded Disability Status Scale (EDSS) score ≥5.5 [absence of p1–n1 wave: EDSS ≥5.5, 7 (70xa0%) ears; EDSS <5.5, 18 (20xa0%) ears; Pxa0≤xa00.001]. Abnormal VEMP may be noted in MS patients, especially those with vestibular symptoms and greater disability. The VEMP test may complement other studies for diagnosis and follow-up of patients with MS.

Anesthesia mumps resulting in temporary facial nerve paralysis after the auditory brainstem implantation in a 3-year-old child

An acute transient sialadenitis of the major salivary glands in the early postoperative period is called anesthesia mumps. It has been reported in different surgical procedures especially in neurosurgical procedures. Anesthesia mumps develops very fast after the extubation period but it usually regresses with no sequelae within a few hours. However, sometimes serious complication can occur such as respiratory distress. In this report, we present a 3-year-old girl with an anesthesia mumps and facial palsy occurring after successful auditory brainstem implantation and we discuss the cause and the management of this rare complication in this report.

Postviral Vagal Neuropathy: What Is the Role of Laryngeal Electromyography in Improving Diagnostic Accuracy?

OBJECTIVESnTo investigate the convenience of laryngeal electromyography (EMG) findings in patients with chronic cough thought to be postviral vagal neuropathy (PVVN) with the clinical symptoms.nnnSTUDY DESIGNnProspective cohort study.nnnMETHODSnWe applied PVVN questionnaire and chronic cough quality of life (QoL) questionnaire, which is for determining the effect of chronic cough on the QoL, to 20 chronic cough applicants who has no explanatory cause in differential diagnosis. We also carried out videolaryngostroboscopy (VLS) and laryngeal needle EMG in these patients.nnnRESULTSnThe mean duration of persisting cough was 1.875 months (SD ±0.825). The overall mean symptom score of chronic cough questionnaire was 58.80 (SD ±9.89). There was a significant positive correlation between total EMG score and chronic cough score (Spearman r, 0.489, P < 0.05). The correlation between VLS findings and either chronic cough scores or EMG scores did not reach statistical significance.nnnCONCLUSIONSnCranial nerves might be affected by inflammatory processes as occur in the PVVN, which must be considered in the etiology of chronic cough. We showed that the laryngeal EMG can be used as an appropriate diagnostic tool for these patients.

Association between XRCC3 Thr241Met polymorphism and laryngeal cancer susceptibility in Turkish population

DNA repair systems are essential for normal cell function. Genetic alterations in the DNA repair genes such as X-ray repair cross-complementing group 3 (XRCC3), can cause a change in protein activity which results in cancer susceptibility. The aim of this study was to investigate the association of XRCC3 Thr241Met single nucleotide polymorphism (SNP), smoking and alcohol consumption with the risk of laryngeal cancer in Turkish population. The frequencies of Thr241Met SNP were studied in 58 laryngeal cancer cases (SSC) and 67 healthy individuals. Genomic DNA was isolated from peripheral blood samples of both controls and laryngeal cancer cases. Thr241Met SNP was genotyped by polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) method. The genotype and allele frequencies of Thr241Met polymorphism were not statistically significant between the laryngeal cancer and control groups. Carrying mutant allele was not associated with the risk of laryngeal cancer. On the other hand, smoking and chronic alcohol consumption were associated with the risk of laryngeal cancer but there is no association between Thr241Met, smoking and alcohol consumption in laryngeal cancer cases. These results indicate that Thr241Met polymorphism was not associated with the development of laryngeal cancer in Turkish population. However, it should be kept in mind that the association of a polymorphism with cancer susceptibility can differ due to several factors such as cancer type, selection criteria, ethnic differences and size of the studied population.

The Effect of Combined Medical Treatment on Quality of Life in Persistent Allergic Rhinitis

Allergic rhinitis may significantly affect the patients’ quality of life. The aim of this study was to compare the effects of nasal steroids alone, to nasal steroids plus Levocetirizine or Montelukast, on quality of life in persistent allergic rhinitis. This is a prospective, randomized study and included 56 patients with moderate to severe persistent allergic rhinitis. All patients had house dust mite allergy on skin prick test and we divided the patients into three groups. 1xa0month long medical treatment was; topical Mometasone furoate 200xa0mcg/day in the first group (n:14), Mometasone furoate 200xa0mcg/day plus oral Levocetirizine 5xa0mg/day in the second group (n:21), and Mometasone furoate 200xa0mcg/day plus oral Montelukast 10xa0mg/day in the third group (n:21). We evaluated the patients before treatment and at the firstxa0month after treatment with mini rhinoconjunctivitis quality of life questionnaire (miniRQLQ) and nasal symptom scores. In the first group nasal symptom and mini RQLQ scores were not improved but in second and third group, both scores were improved significantly (pxa0<xa00.05). Nasal obstruction symptom score was better in the third group after treatment (pxa0<xa00.01), but other nasal symptom scores (rhinorrhea, sneezing and nasal itching) were better in the second group (For each symptom pxa0<xa00.05). Improvement of quality of life scores in the second group were better than the third group (pxa0<xa00.05). In persistent allergic rhinitis, combination of levocetirizine or montelukast to nasal steroids was better than the topical mometasone furoate alone in terms of quality of life.

Effects of Rhinophototherapy on Quality of Life in Persistant Allergic Rhinitis

Objectives To investigate the effect of rhinophototherapy with medical therapy on quality of life in persistent allergic rhinitis. Methods A prospective, randomized study was being performed between December 2009 and March 2010. The study included 65 patients with persistent allergic rhinitis. The diagnosis was confirmed with positive skin tests. All of the patients had house dust mite allergies. We divided the patients into two groups. First group (n=33) was given topical mometasone furoate 200 mcg/day and levocetirizine 5 mg/day for a month. Rhinophototherapy was applied with the same medical therapy to the second group (n=32), twice a week for three weeks continuously. Rhinophototherapy included visible light, ultraviolet A and ultraviolet B. We evaluated patients before the treatment, at the first month and at the third month after treatment with rhinoconjunctivitis quality of life questionnaire, nasal symptom scores and visual analogue scale (VAS) scores. Results Improvements of all variables of the quality of life questionnaire, nasal symptom scores and VAS were statistically significant in the second group both on the first and the third months when compared with the first group. Conclusion Allergic rhinitis is a social problem and impairs quality of life. Rhinophototherapy with medical therapy improves the quality of life in allergic rhinitis.