Murat Topak

How can periorbital oedema and ecchymose be reduced in rhinoplasty

Oedema and ecchymose are frequent morbidities of septorhinoplasty, a facial surgical procedure for reforming the shape and functions of the nose. Periorbital oedema (PO) and periorbital ecchymose (PE) are normal occurrences, but are undesirable for patients undergoing the procedure for aesthetic purposes. The present study examined 65 patients who underwent open technique septorhinoplasty for aesthetic and functional complaints. Patients were divided into two groups: Group 1 patients underwent lateral osteotomy following tip plasty, at the end of the surgical operation; Group 2 patients underwent lateral osteotomy before tip plasty, at the beginning of the surgical operation. Patients were followed on the postoperative first, third and seventh days. PO and PE values of patients were scored from 0 to 4. The plastering time (Pt) was significantly shorter for Group I than Group II (pxa0<xa00.05). The total surgical time (T) showed no significant difference (pxa0>xa00.05). The PO value at the first, third and seventh days was significantly smaller for Group I than Group II (pxa0<xa00.05). The PE value at the first, third and seventh days was also significantly smaller for Group I than Group II (pxa0<xa00.05). The obtained data indicate that performing a lateral osteotomy in the final stages of surgery, and subsequently applying a nasal plaster and splint as rapidly as possible, decreases PO and PE in the postoperative period.

Peak nasal inspiratory flowmetry for selection of patients for radiofrequency ablation of turbinates.

Objectives: Our goals were to investigate (1) the effectiveness of the topical vasoconstrictor test (TVT) and peak nasal inspiratory flow (PNIF) measurement for the selection of patients with inferior turbinate hypertrophy (ITH) who will benefit from radiofrequency ablation (RFA) of the turbinates and (2) the efficacy of the TVT and PNIF in follow-up of treatment outcomes. Methods: Patients with bilateral chronic nasal obstruction due to ITH underwent assessment with a visual analog scale (VAS) and PNIF before and after the TVT. Twenty patients with symptom improvement according to VAS and PNIF results were enrolled in the study. These patients underwent RFA, and PNIF and VAS scores were determined before and 1 and 6 months after the TVT. These results were compared to evaluate the preoperative prediction of RFA treatment success. Results: Radiofrequency ablation of the turbinates resulted in significant changes in objective and subjective scores. Preoperative (baseline) subjective and objective responses to decongestant were positively correlated (P = .024 and P < .05, respectively). Preoperative (baseline) objective responses to decongestant were significantly correlated with the objective outcomes of surgery (P = .006 and P < .05, respectively). Conclusion: The combined use of PNIF and the TVT allows for the preoperative prediction of the success of RFA and the selection of patients who will benefit most from RFA.

Does iron deficiency anemia affect olfactory function

Abstract Conclusion This study found a negative effect of IDA on olfactory function. IDA leads to a reduction in olfactory function, and decreases in hemoglobin levels result in further reduction in olfactory function. Objective This study examined the effects of iron-deficiency anemia (IDA) on olfactory function. Method The study enrolled 50 IDA patients and 50 healthy subjects. Olfactory function was evaluated using the Sniffin’ Sticks olfactory test. The diagnosis of IDA was made according to World Health Organization (WHO) criteria. Results Patients with IDA had a significantly lower threshold, discrimination, and identification (TDI) value, and a lower threshold compared with the control group. However, there were no significant differences between the groups in terms of smell selectivity values.

Are people who have a better smell sense, more affected from satiation?

INTRODUCTIONnThe olfactory system is affected by the nutritional balance and chemical state of the body, serving as an internal sensor. All bodily functions are affected by energy loss, including olfaction; hunger can alter odour perception.nnnOBJECTIVEnIn this study, we investigated the effect of fasting on olfactory perception in humans, and also assessed perceptual changes during satiation.nnnMETHODSnThe Sniffin Sticks olfactory test was applied after 16h of fasting, and again at least 1h after Ramadan supper during periods of satiation. All participants were informed about the study procedure and provided informed consent. The study protocol was approved by the local Ethics Committee of Gaziosmanpaşa Taksim Education and Research Hospital (09/07/2014 no: 60). The study was conducted in accordance with the basic principles of the Declaration of Helsinki.nnnRESULTSnThis prospective study included 48 subjects (20 males, 28 females) with a mean age of 33.6±9.7 (range 20-72) years; their mean height was 169.1±7.6 (range 150.0-185.0)cm, mean weight was 71.2±17.6 (range 50.0-85.0)kg, and average BMI was 24.8±5.3 (range 19.5-55.9). Scores were higher on all items pertaining to olfactory identification, thresholds and discrimination during fasting vs. satiation (p<0.05). Identification (I) results: Identification scores were significantly higher during the fasting (median=14.0) vs. satiation period (median=13.0). Threshold (T) results: Threshold scores were significantly higher during the fasting (median=7.3) vs. satiation period (median=6.2). Discrimination (D) results: Discrimination scores were significantly higher during the fasting (median=14.0) vs. satiation period (median=13.0). The total TDI scores were 35.2 (fasting) vs. 32.6 (satiation). When we compared fasting threshold value of >9 and ≤9, the gap between the fasting and satiety thresholds was significantly greater in >9 (p<0.05).nnnCONCLUSIONnOlfactory function improved during fasting and declined during satiation. The olfactory system is more sensitive, and more reactive to odours, under starvation conditions, and is characterised by reduced activity during satiation. This situation was more pronounced in patients with a better sense of smell. Olfaction-related neurotransmitters should be the target of further study.

Halitosis associated volatile sulphur compound levels in patients with laryngopharyngeal reflux

Previous reports have suggested that laryngopharyngeal reflux (LPR) may cause halitosis. However, it remains unclear if LPR is a risk factor for halitosis. The aim of this study was to investigate if patients diagnosed with LPR have an increased probability of halitosis compared to a normal population. Fifty-eight patients complaining of LPR symptoms and 35 healthy subjects were included in the study. A LPR diagnosis was made using an ambulatory 24-h double pH-probe monitor, which is the gold standard diagnostic tool for LPR. Additionally, halitosis was evaluated by measuring the levels of volatile sulphur compounds using OralChroma™ and an organoleptic test score. The result of the final diagnosis of the 58 patients after the 24xa0h ambulatory pH monitoring was that 42 patients had LPR. Significant correlations were observed between the organoleptic test score and hydrogen sulfide (H2S) and methyl mercaptan (CH3SH) levels. These were also significantly correlated with LPR. We found a strong positive association between LPR and volatile sulphur compound levels. The H2S and CH3SH levels differed significantly between the LPR and control groups (pxa0<xa00.0001 and pxa0<xa00.0001, respectively). Halitosis was significantly associated with the occurrence and severity of LPR. The present study provides clear evidence for an association between halitosis and LPR. Halitosis has a high frequency in patients with LPR and reflux characteristics are directly related to their severity and therefore could be considered as a manifestation of LPR.

Differences in Mucociliary activity of volunteers undergoing Ramadan versus Nineveh fasting

This study, aimed to evaluate the difference in mucociliary clearance among volunteers who underwent Ramadan versus Nineveh fasting regimens as well as the difference between the fasting period and 4xa0weeks following the fasting period in both groups. In this study, two different fasting groups were established: Ramadan (fasting for an average of 15xa0h for 29 consecutive days, nxa0=xa040) and Nineveh (60xa0h of nonstop fasting, nxa0=xa026). Subjects in each group underwent saccharin testing twice: at the end of the fasting period prior to resumption of eating and at 4xa0weeks after the end of Ramadan or Nineveh fasting. Statistical analysis was performed using the Mann–Whitney U-test, Wilcoxon, Chi-square, and paired t test. A p value less than 0.05 was considered statistically significant. Forty subjects who underwent Ramadan fasting and 26 subjects who underwent Nineveh fasting were included in this study. Of the 66 study participants, 34 (51.5xa0%) were men and 32 (48.5xa0%) were women. Their median age was 31xa0years (range 17–70xa0years) for Nineveh fasting subjects and 40xa0years (range 17–70xa0years) for Ramadan fasting subjects. Chi-square tests revealed no significant difference between the Ramadan and Nineveh fasting groups in gender (pxa0=xa00.418), and the Mann-Whitney U-test showed no difference in age. A statistically significant difference was found in the mucociliary clearance time between the Nineveh fasting and non-fasting periods (pxa0=xa00.013). Using Wilcoxon signed-rank tests, we found no significant difference in the mucociliary clearance time between the Ramadan fasting and control (4xa0weeks after the fasting period) periods (pxa0=xa00.121). The percentage difference between the fasting and control periods was similar between groups and was not statistically significant for the Ramadan and Nineveh fasting groups (pxa0=xa00.086). The results of the present study indicated that long-term fasting with hypohydration contributed to the deterioration of nasal mucociliary clearance. Our data indicate that optimal hydration, sleep patterns, and fasting times contribute to proper mucociliary clearance.

Does Rhinoplasty Reduce Nasal Patency

Objective: This study aimed to evaluate the effect of rhinoplasty on subjective and objective assessment of nasal patency in patients who underwent rhinoplasty for cosmetic reasons only. Setting: Tertiary referral center. Design: Prospective, clinical study. Subject and Methods: A total of 50 adult patients who underwent rhinoplasty were included in the study. Preoperative and postoperative photographs of the nasal profile (frontal, lateral, and oblique) were obtained. The visual analog scale (VAS) was used for the subjective evaluation of nasal obstruction (0 being the minimum, 10 being the maximum amount of nasal patency). Objective evaluation of nasal obstruction was performed with a peak nasal inspiratory flowmeter (PNIF). Results: Preoperative mean VAS scores and PNIF values of the patients were 7.36 ± 0.83 and 115.10 ± 17.45, respectively. Postoperative mean VAS scores and PNIF values of the patients were 7.42 ± 0.73 and 115.30 ± 16.7, respectively. There was no statistically significant difference between any of the pre- and postoperative subjective and objective parameters (P > .05). Conclusion: Reduction rhinoplasty has been shown not to reduce nasal patency.

The effect of the duration of merocel in a glove finger on postoperative morbidity.

AbstractWe examined the effects of the duration of keeping a Merocel nasal packing in the nose and the application technique (packing applied either directly or inside a glove finger) on postoperative morbidity and complications. The study included 129 patients (67 males and 62 females; age range 18 to 56 years) undergoing nasal septoplasty without turbinate intervention. The patients were randomly assigned into 4 groups. In group 1 and group 2, Merocel was directly applied in the nasal cavity for 24 hours and 48 hours, respectively; in group 3 and group 4, Merocel was kept in the nasal cavity in a powder-free glove finger for 24 hours and for 48 hours, respectively. Pain and discomfort scores were evaluated by a visual analog scale. The time taken between removal of the tampon and when the patients began to breathe comfortably was called the nasal obstruction time. The differences in mean discomfort score between the groups were not statistically significant (P > 0.05), while the mean pain scores were statistically higher in groups 1 and 2 than in groups 3 and 4 (P < 0.05). The nasal obstruction time was statistically shorter in groups 2 and 4 than in groups 1 and 3 (P < 0.05). Therefore, keeping Merocel inside a glove finger in place for 48 hours notably reduces the pain occurring during the removal of the nasal tampon. It also reduces nasal obstruction time and prevents synechia, leakage, bleeding, and septal hematoma, without compromising patient comfort.

A rare tumor of the parapharyngeal space: angiomyxolipoma.

Abstract Parapharyngeal space tumors are uncommon, most are salivary gland tumors (50%), and they are often pleomorphic adenomas. Neurogenic tumors are the second most common primary tumors of all neoplasms in the parapharyngeal space (30%). Angiomyxolipoma is a very rare form of lipoma. Up until now, only 12 cases located on different sides of the body were reported. Presented here is a case report of a patient with an angiomyxolipoma of the parapharyngeal space. A 17-year-old boy had a slowly growing, painless mass on the left side of the neck. During the oropharyngeal examination, medial displacement of the left tonsilla palatina was observed. Magnetic resonance imaging findings were of a 6 × 5.5 × 3-cm “dumbbell”-shaped parapharyngeal mass. A fine needle aspiration of the mass showed no specific histopathology. The patient underwent a transparotid-transcervical approach for the excision of the tumoral mass under general anesthesia. Although an angiomyxolipoma is a rare form of lipoma, it is a pathology that should be kept in mind for the differential diagnosis of parapharyngeal tumors.

Was the rapid resolution of a laryngeal granuloma due to high dose double proton pump inhibitor treatment

A laryngeal granuloma (LG) is a benign tumor that usually develops on the cartilaginous vocal process of the vocal cords. Gastroesophageal reflux (GER), hyperfunctional use of the voice, and intubation injury are etiological factors. Patients usually complain of dysphagia, and dysphonia. A 53-year-old male consulted the Taksim Educational and Research Hospital ENT Department, complaining of a 6-month history of hoarseness, dysphagia, and globus sensation. On laryngoscopic examination, a granuloma was found on his left vocal process He was given an anti reflux treatments and advised on vocal hygiene. At the 1-month follow-up, the granuloma had disappeared. A thorough history was taken and disclosed that at time of his first visit, he saw a gastroenterologist for his heartburn and regurgitation and was administered pantoprazole 40 mg once daily. Consequently, the rapid resolution of the granuloma was thought have resulted from the high-dose double PPI treatment.