Kürşat Murat Özcan

Anatomical variations of nasal turbinates.

After the widespread use of endoscopic sinus surgery and paranasal sinus computed tomography, many variations of nasal turbinates have been described. In addition to the most common one-middle turbinate pneumatization (concha bullosa)-superior and inferior turbinate pneumatizations have also been described. Secondary and accessory middle turbinates that can mimic real middle turbinate are anomalies described in recent years. Paradoxical middle turbinate and bifid inferior turbinate are very rarely encountered anomalies and can be easily recognized in paranasal tomography but can be overlooked by endoscopical examination. In the present study, the computed tomography images of 384 patients were evaluated for nasal turbinate variations, as well as their relations to mucosal pathologies. The most frequent variation was found to be concha bullosa; the least frequent one was found to be bifid inferior turbinate. In 1 of our patients, 5 of the 6 turbinates were found to have pneumatization, which is extremely rarely encountered in the literature. In this study, the prevalence of the variations of the turbinates and their association with chronic rhinosinusitis were investigated.

Variations of maxillary sinus and accompanying anatomical and pathological structures.

Hypoplasia and aplasia of maxillary sinus, maxillary sinus septae, ethmomaxillary sinus, superior meatus-draining maxillary sinus, and over-pneumatization are the variations of maxillary sinuses. Findings such as uncinate process abnormality, orbital enlargement, sphenomaxillary plate, canine fossa elevation, infraorbital fissure enlargement, thickening of the sinus wall and mucosal pathologies can be seen together with these variations. The aim of this study is to determine the incidence and morphology of the anatomical variations of maxillary sinus and accompanying structures. A total of 330 consecutive paranasal sinus computed tomography scans of the patients presenting with sinonasal complaints at our ENT department were assessed for maxillary sinus anatomical variations and related structures. There were 134 (20.3%) anteriorly and 17 (2.5%) posteriorly localized maxillary sinus bony septa. The position of antral septa was frequently vertical at anterior, and horizontal at posterior. We found significant correlation between the anteriorly localized maxillary sinus septa and infraorbital fissure enlargement. Maxillary sinus hypoplasia was found in 31 (4.6%) maxillary sinuses. Seven (1.0%) ethmomaxillary sinuses were assessed. Significant correlation was found between maxillary sinus hypoplasia and orbital enlargement. Presence of mucosal pathology was significant in patients with maxillary sinus septa, but there was no difference when it was compared with the mucosal pathology in the nonseptated group. There was no significant correlation between other anatomical variations and mucosal pathologies. Determining the anatomical variations of maxillary sinus and accompanying structures in patients planning endoscopic sinus surgery will significantly help with providing surgical orientation and preventing possible complications.

New Predictive Parameters of Bell's Palsy: Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio

BACKGROUND Bells palsy is the most frequent cause of unilateral facial paralysis. Inflammation is thought to play an important role in the pathogenesis of Bells palsy. AIMS Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are simple and inexpensive tests which are indicative of inflammation and can be calculated by all physicians. The aim of this study was to reveal correlations of Bells palsy and degree of paralysis with NLR and PLR. STUDY DESIGN Case-control study. METHODS The retrospective study was performed January 2010 and December 2013. Ninety-nine patients diagnosed as Bells palsy were included in the Bells palsy group and ninety-nine healthy individuals with the same demographic characteristics as the Bells palsy group were included in the control group. As a result of analyses, NLR and PLR were calculated. RESULTS The mean NLR was 4.37 in the Bells palsy group and 1.89 in the control group with a statistically significant difference (p<0.001). The mean PLR was 137.5 in the Bells palsy group and 113.75 in the control group with a statistically significant difference (p=0.008). No statistically significant relation was detected between the degree of facial paralysis and NLR and PLR. CONCLUSION The NLR and the PLR were significantly higher in patients with Bells palsy. This is the first study to reveal a relation between Bells palsy and PLR. NLR and PLR can be used as auxiliary parameters in the diagnosis of Bells palsy.

Investigation of the cochlear effects of intratympanic steroids administered following acoustic trauma

To electrophysiologically and histomorphologically demonstrate the effects of intratympanic corticosteroids administered following an acoustic trauma on cochlear hair cells.

Activation of vocal fold healing with topical vitamin A in rabbits

Conclusion. The results suggest that vitamin A can prevent scar formation in the vocal fold after surgery. Objectives. This study aimed to evaluate the effects of topically applied vitamin A on healing after vocal fold trauma. Materials and methods. Vocal folds of 20 adult rabbits were traumatized unilaterally. Ten of them were treated with topical application of vitamin A and the others served as controls. All animals were sacrificed after 10 days. Vocal folds were resected for analysis by light microscopy. Results. The untreated vocal folds showed extensive deposition of collagen and fibroblast on light microscopy and vocal folds treated with vitamin A showed less deposition. There was a significant difference between the two groups according to the percentage of collagen and fibroblasts in the lamina propria (p<0.01).

Relationship Between Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Obstructive Sleep Apnea Syndrome

BACKGROUND Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) give information about many diseases. An increase in inflammation markers occurs in patients with obstructive sleep apnea syndrome (OSAS). OBJECTIVES The aim of this study is to determine the relationship between OSAS and NLR and PLR values. MATERIAL AND METHODS Two hundred eighty four patients with complaints of snoring and excessive daytime sleepiness were included in the study. Polysomnography had been performed on all patients and the control group. Fourty eight of these patients with apnea-hypopnea index (AHI) less than 5 (pure snoring) were included in the control group, 67 patients with AHI between 5 and 14.9 in the mild OSAS group, 61 patients with AHI between 15 and 29.9 in the moderate OSAS group and 108 patients with AHI more than 30 in the severe OSAS group. NLR and PLR values were calculated from the complete blood count (CBC) analysis of the patients and control group. The OSAS and control groups were compared by age, gender, body mass index (BMI) and PSG parameters as well as NLR and PLR values. RESULTS The PLR value in the OSAS group was found to be less than in the control group (p=0.006). As the non-REM AHI increased, the value of PLR decreased. As the nocturnal time spent with arterial oxygen saturation<90% increased, the value of NLR was determined to increase. CONCLUSIONS NLR and PLR values can give valuable information in OSAS.

Does Tonsillectomy Affect Voice in Early or Late Postoperative Periods in Adults

OBJECTIVE The aim of our study was to investigate the short- and long-term effects of tonsillectomy on voice performance in adults. STUDY DESIGN Prospective cohort study. MATERIALS AND METHODS This study was conducted between January 2013 and June 2015. A total of 26 adults who had tonsillectomy due to chronic tonsillitis or recurrent acute tonsillitis were included in the study. The voice performances of the participants were analyzed with objective and subjective methods before surgery, and 1 and 3 months after surgery. An acoustic voice analysis (fundamental frequency [F0], jitter %, shimmer %) was performed for objective analysis, and Voice Handicap Index survey was used for subjective analysis of the voice. Preoperative F0, jitter %, shimmer %, and Voice Handicap Index values were compared with the values obtained 1 and 3 months after surgery. RESULTS Impairment of voice performance was determined when preoperative and postoperative first month F0, jitter %, and shimmer % values were compared. Three months after surgery, those values were found similar to the preoperative values. CONCLUSION Tonsillectomy affects voice performance negatively in adults in short term; however, it does not affect voice performance in long term after surgery.

Auditory brainstem response and otoacoustic emissions in Duane retraction syndrome

OBJECTIVE We aimed to investigate the origin of hearing loss with relevance to auditory brainstem responses and otoacoustic emissions in patients with Duanes retraction syndrome (DRS). MATERIALS AND METHODS 17 patients with DRS were included in the study. 14 patients were diagnosed as DRS type 1 and the remaining three as type 3. The control group consisted of nine healthy subjects. Pure tone audiogram, auditory brainstem response, as well as distortion product otoacoustic emissions were recorded in all the patients and the controls. RESULTS Among the 17 patients with DRS, 15 demonstrated normal hearing according to pure tone audiogram. One patient with DRS had profound sensorineural hearing loss with a pure tone average of 110 dB, and one patient had moderate sensorineural hearing loss with a pure tone average of 60 dB. Auditory brainstem response latencies of the waves I, III and V, and interwave latencies were calculated in 15 patients with DRS and were compared with the control group. There was statistically significant increase in wave I latency of left ear in the DRS group compared to the controls (P<0.05). Amplitudes of distortion product otoacoustic emissions were also recorded at frequencies of 2, 3, 4, 6, and 8 kHz in both groups and the comparison of the DRS patients and controls revealed no statistically significant difference. CONCLUSIONS We recommend auditory examinations be undertaken in patients with DRS by auditory brainstem response tests, as well as distortion product otoacoustic emissions, whereas all patients with normal results should be followed-up for future hearing loss.

Results of ossicular chain reconstruction with glass ionomer cement in pediatric patients

OBJECTIVE The aim of our study was to analyze the hearing results of ossicular chain reconstruction in incus long process defects in pediatric patients. METHODS This retrospective study included 15 pediatric patients that had incus long process defect due to chronic otitis media or adhesive otitis, and repaired with glass ionomer cement between 2009 and 2015. The audiological tests (air conduction thresholds, bone conduction thresholds, air bone gap) obtained preoperatively and one year after surgery were compared. In addition, preoperative and postoperative air bone gap differences were estimated to determine hearing gain. RESULTS Mean air conduction and air bone gaps decreased significantly one year after surgery when compared to the preoperative values (p< 0.001 for both). Mean hearing gain was 20.33±6.36dB one year after surgery. CONCLUSION Use of glass ionomer cement to repair incus long process defects is a suitable method that improves hearing in pediatric patients. Further large studies that compare glass ionomer cement ossiculoplasty with other ossicular reconstruction methods are needed.

Pediatric Vocal Fold Nodule Etiology: What Are Its Usual Causes in Children?

OBJECTIVES In this study, the relation between phonotrauma and presence of siblings and social activities was investigated, and the incidence of voice disorders in the mothers of children with vocal fold nodules was studied with objective (clinical voice analysis) and subjective (laryngostroboscopy, Voice Handicap Index) methods. METHODS Twenty-nine children with vocal fold nodules (age range 5-14 years), 45 age-matched children without any voice disorders as a control group, and their mothers were included in the study. All patients had laryngostroboscopy and clinical voice analysis, and their mothers filled out the Pediatric Voice Handicap Index. We noted the most common place or situation where children used their voice in excessively high volume according to their mothers, including home, school, sportive activities, and singing or reciting poem activities, to recognize the major cause of phonotrauma. In addition, presence of siblings was recorded. RESULTS It was found that 15 patients (51.7%) had younger siblings, seven patients (24.1%) had older siblings, five patients (17.2%) had both younger and older siblings, and two patients (6.8%) did not have any siblings. It was seen that excessive usage of high-volume voice at home had a correlation with presence of only younger siblings, and both younger and older siblings tended to cause phonotrauma at home (86.7%). Additionally, eight boys (44.4%) reported presence of sportive activities, whereas none of the girls had such an activity (P = 0.012). CONCLUSION Presence of siblings seems to be an important factor for vocal nodule formation. Maternal relationship does not seem to be a major factor for vocal misuse.