Kadriye Serife Ugur

Comparison of Scores of Application Methods of the Epworth Sleepiness Scale: Self Administered or Nurse Administered

Purpose of the Study: The aim of this study was to investigate the impact of two different application methods (self or nurse administered) on Epworth Sleepiness Scale (ESS) scores and compare the scores according to their correlations between polysomnographic findings. Procedures: 114 patients agreed to participate by completing the Turkish version of the ESS with 2 different methods of application, but the complete results of polysomnography (PSG) were available for 101 patients. Results: The scores of the nurse-administered ESS were clinically significantly correlated with the apnea-hypoapnea index. Scores of the self-administered ESS were not correlated with any of the demographic and PSG parameters. In the reliability analysis, the scores of the self-administered and the nurse-administered ESS were quite consistent. Conclusion and Message: We considered that to complete the ESS with the method of nurse administration could change the reliability and sensitivity. In conclusion, the ESS may be a more reliable tool for measuring the severity of excessive daytime sleepiness or obstructive sleep apnea by a change in the administration method.

Association of Oral Antireflux Medication With Laryngopharyngeal Reflux and Nasal Resistance

Importance Laryngopharyngeal reflux (LPR) is thought to be a potential exacerbating factor in upper airway diseases. Objective To describe the effect of pharmacologic therapy of laryngopharyngeal reflux on nasal resistance. Design, Setting, and Participants Prospective observational study performed between August 30, 2014, and October 1, 2015, at a tertiary care academic center including 50 patients with Reflux Symptom Index higher than 13 and Reflux Finding Score higher than 7 and 50 controls with no history of LPR and nasal disease. Interventions Oral antireflux medication was given to the LPR group for 12 weeks. Main Outcomes and Measures The measurements of total nasal resistance (TNR) were performed by means of active anterior rhinomanometry technique and Nasal Obstruction Symptom Evaluation (NOSE) was assessed. Results The LPR group had 29 (58%) women and a median age of 41.5 years (range, 18-64 years). The control group had 27 (54%) women and a median age of 38.5 years (range, 19-63 years). After treatment, a significant decrease was observed in all parameters. The median (range) TNR scores of the LPR group before and after treatment were 0.29 (0.12-0.36) and 0.19 (0.10-0.31), respectively. The median TNR score of the control group was 0.20 (range, 0.11-0.32). Whereas the TNR scores of the LPR group were higher than those of the control group before treatment (difference, −0.77; 95% CI, −0.10 to 0.05), they were almost the same after treatment (difference, 0.01; 95% CI, −0.01 to 0.03). The median (range) NOSE scores of the LPR group before and after treatment were 0.29 (0.12-0.36) and 0.19 (0.10-0.31), respectively. The median NOSE score of the control group was 0.20 (range, 0.11-0.32). Conclusions and Relevance In this study, laryngopharyngeal reflux had a negative effect on nasal resistance and nasal congestion. Treatment was associated with improved subjective and objective nasal findings.

Subcutaneous Fat Tissue Thickness of the Anterior Neck and Umbilicus in Patients with Obstructive Sleep Apnea

Objective. To investigate the differences in thickness of subcutaneous fat tissue of the anterior neck and umbilicus of patients with and without obstructive sleep apnea (OSA), the relationship between thickness of subcutaneous fat tissue of the anterior neck and umbilicus and polysomnographic findings, and the influence of body mass index (BMI), anthropometric findings, and gender. Study Design. Cross-sectional study. Setting. Tertiary care university hospital. Subject and Methods. Seventy-three patients with OSA and 24 non-OSA patients were evaluated with polysomnography for 1 night. Anthropometric parameters and BMI were also investigated. Subcutaneous fat tissue thickness of anterior neck and umbilicus was assessed using ultrasound. The thickness of subcutaneous fat tissue adjacent to the submandibular gland, isthmus, hyoid, suprasternal notch, and umbilicus was measured with ultrasound. Data analysis was performed using SPSS. Results. Apnea–hypopnea index (AHI) was significantly and positively correlated with age (P = .016, r2 = 0.244), BMI (P < .001, r2 = 0.416), and anthropometric findings (waist circumference P < .001, r2 = 0.337; hip circumference P = .008, r2 = 0.269; neck circumference P = .002, r2 = 0.309). Minimum oxygen saturation was significantly, negatively correlated with age (P = .002, r2 = −0.310), BMI (P < .001, r2 = −0.404), and anthropometric findings (waist circumference P = .005, r2 = −0.281, hip circumference P < .001, r2 = −0.353, neck circumference P = .010, r2 = −0.261). There were no significant differences between the OSA and non-OSA groups with respect to age (P = .178), gender (P = .189), or ultrasonographic findings for subcutaneous fat tissue thickness adjacent to the submandibular gland (P = .480), thyroid isthmus (P = .311), suprasternal notch (P = .950), umbilicus (P = .691), or hyoid (P = .159). Neck circumference (P = .039) and BMI (P = .014) were significantly higher in the OSA group. Conclusion. These indicate that anterior neck and umbilical subcutaneous fat tissue thickness may not contribute to the severity of OSA.

Letter to the Editor on “Comparative Effectiveness of the Different Treatment Modalities for Snoring”

1. Uranagase A, Katsunuma S, Doi K, Nibu K. BDNF expression in olfactory bulb and epithelium during regeneration of olfactory epithelium. Neurosci Lett. 2012;516:45-49. 2. Lim LS, Mitchell P, Seddon JM, Holz FG, Wong TY. Age-related macular degeneration. Lancet. 2012;379:1728-1738. 3. Kar T, Yildirim Y, Altundağ A, et al. The relationship between age-related macular degeneration and olfactory function. Neurodegener Dis. 2015;15:219-224.

Effects of Surgery on Quality of Life in Obstructive Sleep Apnea Syndrome

Objective: To understand the influence of surgical treatment on quality of life and depression score in simple snorers and in mild, moderate, severe obstructive sleep apnea syndrome (OSAS) patients. Method: This prospective cohort study involved 65 patients who underwent surgery with the diagnosis of simple snoring and OSAS between years 2007-2011. Short-form health survey (SF-36) and Beck Depression Inventory were used before and 18 months following surgery together with nocturnal polysomnography. Kruskal-Wallis test was used for statistical analysis. Results: There was a statistically significant difference in apnea-hypopnea indexes (AHI) of moderate and severe apnea groups following surgery (P < .001). There was an increase in general health level of SF36 in mild apnea group (P = .009). There were increases in general health level and vitality level of SF36 in the moderate apnea group (P < .001). There was no difference among groups in Beck Depression Inventory scores postoperatively (P > .0125). Conclusion: Despite the favorable differences in apnea-hypopnea index scores, there is a limited favorable effect of surgical treatment on quality of life scores and no influence on depression scores in simple snorers and OSAS patients.

H2O2 Irrigation in Children undergoing Adenoidectomy

Objective: To evaluate the effectiveness of 0.5% hydrogen peroxide (H2O2) irrigation in hemostasis after adenoidectomy. Method: A cross-sectional study was conducted on 80 children undergoing adenoidectomy. Children were randomized into either 0.5% H2O2 or control (25 0C serum physiologic) irrigation groups after adenoidectomy. Adenoid volume, size, location were recorded. Hemostasis and operation times were measured. Bleeding and hemostasis visual analog scale (VAS) values were scored. Results: The ages ranged from 3 to 9 years (mean ± SD, 4.9 ± 1.8 years). There were 29 boys and 8 girls in the control group and 22 boys and 21 girls in the H2O2 group. The average hemostasis time for H2O2 group (4 minutes) was shorter than control group (5 minutes), but there was no correlation between control and H2O2 groups with respect to operation (P = .854) or hemostasis time (P = .065), or VAS values of subjective bleeding (P = .961) and hemostasis (P = .346). Significant positive correlation was found between adenoid volume and operation time (r = 0.269; P = .016). But correlation between adenoid volume and hemostasis was not significant (r = 0.213; P = .058). Conclusion: We may recommend to surgeons a higher concentration than 0.5% H2O2 in the hemostasis of post- adenoidectomy, especially for those confronted with significant bleeding following adenoidectomy.

Leech in the Nasopharynx: An Uncommon Cause of Epistaxis.

A 61-year-old man presented with a 1-week history of intermittent epistaxis. No other symptoms and signs were reported. On physical examination, nasal endoscopy revealed a dark-colored moving foreign body in the nasopharynx (Figure 1). The foreign body in the nasopharynx was removed using forceps and was found to be an engorged and deformed leech (Figure 2). Upon further questioning with regard to leech infestation, the patient reported that he had been swimming in a lake in his village. After removal of the leech, he remained asymptomatic, and complete blood count did not reveal anemia. He was discharged from the hospital on the same day. The institutional review board of Fatih University Medical School approved this article.

Unexpected cerebrospinal fluid rhinorrhea after a spinal anesthesia.

A 47-year-old woman presented with a left-sided watery nasal discharge persisting for 3 weeks after an orthopedic operation using spinal anesthesia. The testing of the nasal fluid for &bgr;-2 transferrin confirmed that the leakage was cerebrospinal fluid (CSF). The computed tomographic cisternography revealed a left-sided bone defect in the cribriform plate. Endonasal approach was performed for closing the defect. At 3-month follow-up, CSF rhinorrhea had not recurred. In this report, we present an unexpected CSF rhinorrhea after a spinal anesthesia and discuss the reason of spontaneous leak after spinal anesthesia, as well as discuss current diagnosis and management of CSF rhinorrhea with the composite graft.