Murat Damar

Do the angle and length of the eustachian tube influence the development of chronic otitis media

To compare the eustachian tube (ET) angle (ETa) and length (ETl) of ears with and without chronic otitis media (COM), and to determine the relationship between ET anatomy and the development of COM.

The neutrophil-to-lymphocyte ratio in patients with obstructive sleep apnoea syndrome and its relationship with cardiovascular disease

OBJECTIVE To investigate the association between the neutrophil-to-lymphocyte ratio (NLR) and obstructive sleep apnoea syndrome (OSAS) severity and whether the NLR predicts cardiovascular disease (CVD) in patients with OSAS. BACKGROUND OSAS is known as a risk factor for CVD. An increased NLR was strongly correlated with cardiovascular outcomes in several studies. METHODS We retrospectively examined the laboratory data for 289 patients with suspected OSAS evaluated using polysomnography. RESULTS The study included 171 OSAS patients and 118 controls. The NLR was higher in OSAS group than control group. The NLR was significantly higher in patients with CVD than in those without (3.31 ± 1.1 vs. 1.93 ± 0.8, p = 0.002). There were also significant correlations between the NLR and apnoea-hypopnoea index, mean SaO2, and oxygen desaturation index. CONCLUSIONS There was a significant correlation between the NLR and OSAS severity and the NLR was independently associated with CVD in patients with OSAS.

The Impact of Obstructive Sleep Apnoea and Nasal Continuous Positive Airway Pressure on Circulating Ischaemia-Modified Albumin Concentrations

The aim of the present study was to evaluate the impact of obstructive sleep apnoea syndrome (OSAS) and the effects of nasal continuous positive airway pressure (CPAP) on circulating ischaemia-modified albumin (IMA) concentrations. The study included 97 newly diagnosed OSAS patients and 30 nonapnoeic controls. Blood samples were obtained in the morning after polysomnography. After 3 months of CPAP treatment, 31 patients with moderate-severe OSAS were reassessed for serum IMA concentrations. Significantly higher serum IMA concentrations were measured in the OSAS group than in the control group [0.518 ± 0.091 absorbance units (ABSU), 0.415 ± 0.068 ABSU, P < 0.001]. Serum IMA concentrations correlated significantly with the apnoea-hypopnoea index, mean SaO2, desaturation index, and C-reactive protein concentrations. Multiple logistic regression analyses showed that OSAS increased the serum IMA concentration independent of age, sex, body mass index, smoking habit, and cardiovascular disease. After 3 months of treatment with CPAP, OSAS patients had significantly lower serum IMA concentrations (0.555 ± 0.062 ABSU to 0.431 ± 0.063 ABSU, P < 0.001). The results showed that OSAS is associated with elevated concentrations of IMA, which can be reversed by effective CPAP treatment.

Does the Degree of Septal Deviation Affect Cribriform Plate Dimensions and Middle Turbinate Length

Objective:To investigate the effect of septal deviation severity on the dimensions of the lateral lamina of the cribriform plate (LLCP), middle turbinate length (MTL), and the angle of the lateral lamella of the cribriform plate (ALLCP). Methods:Paranasal computed tomography (CT) scans of 148 patients with septum deviation (102 males, 46 females; age range 18–63 years) were retrospectively evaluated. The patients were divided into 3 groups according to the measured angle of nasal septal deviation as mild (<9°), moderate (9–15°), or severe (>15°). Height and width of LLCP, MTL, and ALLCP on both sides were measured and these parameters were compared between the groups according to the septal deviation side. Results:The nasal septum was deviated to the right in 73 patients (49.3%) and to the left in 75 patients (50.7%). The LLCP dimensions, MTL, and ALLCP between the groups at the contralateral side were not statistically different (P > 0.05). The LLCP height, ALLCP between the groups at the ipsilateral side were not statistically different (P > 0.05). There was a significant difference in the LLCP width at the ipsilateral side between the groups (P = 0.039). The MTL at the ipsilateral side was significantly different between the groups (P = 0.003). Conclusion:The severity of nasal septum deviation in patients with nasal septum deviation affects the ipsilateral LLCP width and the ipsilateral MTL. These findings suggest that the increase in the severity of septum deviation in patients undergoing endoscopic sinus surgery does not increase the risk of possible damages that may occur in LLCP.

Efficacy of Intraoperative Single Dose Methylprednisolone on Recurrent Laryngeal Nerve Function After Thyroidectomy

OBJECTIVE Primary endpoint is to determine whether intraoperative steroid affect post-thyroidectomy recurrent laryngeal palsy or not Background: Recurrent laryngeal nerve (RLN) palsy is an important complication of thyroid surgery. Injuries can either be permanent or temporary. Prevention or shortening the recovery period of temporary palsies is an area of interest. Some surgeons prefer to use corticosteroids for this purpose as is used for facial nerve palsies although there are conflicting data in the literature. We aimed to investigate the efficacy of perioperative single dose methylprednisolone on RLN function. METHOD 438 nerves under risk in 237 surgeries are investigated in two groups. Group 1, patients are administered a single intraoperative dose of methylprednisolone (1mg/kg) intravenously for 220 nerves under risk. 218 nerves under risk in Group 2 were operated and followed without methylprednisolone. The demographic data of the patients, operation time, the final pathology reports, incidence of RLNP and recovery time are documented and compared. RESULTS No statistically significant difference was determined in terms of age, sex distribution, number of nerves under risk and the operation time between groups. There were 3 unilateral RLNP in each group and the mean recovery time for Group 1 and 2 palsies were 20.4 and 19.8 days respectively, without statistical significance. CONCLUSION The presented data indicates that a single intraoperative dose of steroid does not seem to effect the rate and recovery period of RLNP in thyroid surgery.

Pretreatment Neutrophil-Lymphocyte Ratio in Salivary Gland Tumors Is Associated with Malignancy

Objective To assess pretreatment levels in the counts and percentages of leukocytes and the neutrophil-lymphocyte ratio (NLR) in benign and malignant salivary gland tumors (SGTs) while investigating whether NLR is an inflammatory marker for distinguishing low- from high-grade parotid gland tumors. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods This study was performed on 182 patients with SGTs (age range: 16-87 years; 93 male and 89 female) who were treated between January 2010 and May 2015. Pretreatment counts and percentages of leukocytes and NLR were measured preoperatively in benign and malignant tumors. Results Mean neutrophil percentage (63.50% ± 12.11% vs 58.76% ± 8.20%, P = .008) and NLR (3.29 ± 3.13 vs 2.13 ± 1.26, P = .008) were significantly higher in patients with malignant SGTs than in patients with benign SGTs. Mean lymphocyte count (2.42 ± 0.72 103/mm3 vs 1.97 ± 0.87 103/mm3, P < .001) and percentage (30.67% ± 7.68% vs 26.86% ± 10.15%, P = .011) were lower in patients with malignant SGTs than in patients with benign SGTs. Mean lymphocyte percentage and NLR were significantly different between low- and high-grade malignant parotid gland tumors (P = .026 and P = .030, respectively). Conclusion Elevated NLR could be an inflammatory marker to distinguish low- from high-grade malignant parotid gland tumors.

Audiometric correlations with pathologies of ossicular chain in 159 ears with chronic otitis media

disorders. • Abnormal lateral canal function for high-frequency stimuli tested by vHIT was rare (8%) in vestibular migraine (VM), suggesting that there is a substantial remaining high-frequency canal function in VM. • In vestibular neuritis (VN), caloric and vHIT responses are more frequently affected than VM, with a significant positive correlation between both tests. • Caloric and vHIT probe different frequencies of head movement and provide complementary information regarding the lateral canal function.

Bilateral Facial Paralysis Caused by Bilateral Temporal Bone Fracture: A Case Report and a Literature Review

Bilateral facial paralysis caused by bilateral temporal bone fracture is a rare clinical entity, with seven cases reported in the literature to date. In this paper, we describe a 40-year-old male patient with bilateral facial paralysis and hearing loss that developed after an occupational accident. On physical examination, House-Brackmann (HB) facial paralysis of grade 6 was observed on the right side and HB grade 5 paralysis on the left. Upon temporal bone computed tomography (CT) examination, a fracture line exhibiting transverse progression was observed in both petrous temporal bones. Our patient underwent transmastoid facial decompression surgery of the right ear. The patient refused a left-side operation. Such patients require extensive monitoring in intensive care units because the presence of multiple injuries means that facial functions are often very difficult to evaluate. Therefore, delays may ensue in both diagnosis and treatment of bilateral facial paralysis.

The role of the nasal and paranasal sinus pathologies on the development of chronic otitis media and its subtypes: A computed tomography study

Objective: This objective of this study is to evaluate the presence and the coincidence of common nasal and paranasal sinus pathologies in adults suffering from chronic otitis media (COM) and its subtypes. Materials and Methods: The study group comprised 354 ears of 177 patients who underwent tympanoplasty with or without mastoidectomy from January 2013 to February 2015 due to uni/bilateral COM. Chronic suppurative otitis media, intratympanic tympanosclerosis (ITTS), cholesteatoma, and tympanic membrane with retraction pockets constituted subtypes of COM. The control group consisted of 100 ears of 50 adult patients with aural diseases other than middle ear problems. All patients were evaluated for the evidence of mucosal disease on paranasal sinuses, the presence of concha bullosa (CB), and the angle of nasal septal deviation (NSD) and thickness of the medial mucosa of the inferior turbinate were measured by coronal computed tomography images. Results: The incidence and the angle of NSD were found significantly higher in patients with COM (P = 0.028, P = 0.018; respectively). When ears with unilateral and bilateral COM compared in term of sinonasal pathologies, CB was found higher in patients with unilateral COM (P = 0.040). The presence of CB was significantly higher in ITTS when compared to other subtypes (P = 0.028). Conclusions: Our study suggests that obstructive nasal pathologies such as NSD and CB may play a role in the pathogenesis of especially unilateral COM. However, there was no correlation between COM and inflammatory pathologies such as sinusitis.

Histopathological Effects of Fibrin Glue and Cyanoacrylate on the Maxillary Sinus

Objective To compare the histopathological effects of fibrin glue (FbGl) and cyanoacrylate (CyAc) on the maxillary sinus mucosa. Methods Twenty rabbits were divided into two groups of 10, and surgical defects were created in the maxillary sinuses. The right maxillary sinus was treated with FbGl in one group and with CyAc in the other group. As a control, the left maxillary sinuses of all rabbits were treated with sterile saline solution. One rabbit treated with CyAc died during the study and was excluded. On postoperative day 21, all animals were sacrificed. Maxillary sinus mucosa samples were studied to determine the extent of inflammation and fibrosis, foreign body reaction, cilia loss, increased osteogenesis in bony structures under the mucosa, and loss of serous glands. Results The FbGl group differed significantly from the CyAc and control groups in terms of a high degree of inflammation (p<0.001), fibrosis (p<0.001), foreign body reaction (p<0.001), cilia loss (p<0.001), and serous gland loss (p<0.001). In terms of osteogenesis, there were no significant differences between the FbGl and CyAc groups (p=0.650), while there was a significant (p=0.002) difference between these two groups and the control group. Conclusion Histopathologically, CyAc had fewer side effects than FbGl. Further clinical studies are needed to demonstrate the validity of these results in humans.