Mustafa Acar

The effects of mometasone furoate and desloratadine in obstructive sleep apnea syndrome patients with allergic rhinitis

Background Allergic rhinitis (AR) and obstructive sleep apnea syndrome (OSAS) are worldwide prevalent diseases. These diseases impair patient quality of life. The aim of this study was to investigate and compare the efficacy of treatment of AR on OSAS by objective and subjective methods. Methods The study group was composed of 80 OSAS patients with AR between the ages of 30 and 50 years. The patients were admitted with the complaint of snoring, and they were asked about AR-related symptoms (nasal discharge, nasal itching, sneeze, and nasal obstruction). Daytime somnolence was measured by the Epworth sleepiness scale (ESS). Sleep parameters on polysomnography tests before and after treatment were compared, and the effects of different AR treatment protocols on sleep quality were evaluated. Results When pretreatment and posttreatment apnea–hypopnea index (AHI) values of the groups were compared, the most significant difference was observed in the nasal steroid (Ns) + antihistamine (Ah) group (p < 0.05). The ESS results were significantly decreased in the Ns and Ns + Ah groups after treatment (p < 0.05). AHI oxygen saturation <90% were significantly decreased in the Ns and Ns + Ah groups after treatment (p < 0.05). Conclusion Nasal obstruction due to nasal congestion causes increases in airway resistance and can lead to development of OSAS. We concluded that treating AR with Ns has both positive effects on OSAS and daily activity. However, adding Ah to this treatment did not show improved effects compared with placebo treatment.

Investigation of the Presence of Biofilms in Chronic Suppurative Otitis Media, Nonsuppurative Otitis Media, and Chronic Otitis Media with Cholesteatoma by Scanning Electron Microscopy

Objective. Biofilms have been shown to play a major role in the pathogenesis of otolaryngologic infections. However, very limited studies have been undertaken to demonstrate the presence of biofilms in tissues from patients with chronic otitis media (COM) with or without cholesteatoma. Our objective is to study the presence of biofilms in humans with chronic suppurative and nonsuppurative otitis media and cholesteatoma. Study Design. In all, 102 tissue specimens (middle ear, mastoid tissue, and ossicle samples) were collected during surgery from 34 patients. Methods. The samples were processed for the investigation of biofilms by scanning electron microscopy (SEM). Results. Our research supports the hypothesis in which biofilms are involved in chronic suppurative otitis media, cholesteatoma, and, to a lesser degree, chronic nonsuppurative otitis media. There were higher rates in hypertrophic and granulated tissue samples than in normal mucosa. In addition, the presence of biofilms was significantly higher in the middle ear mucosa compared with the mastoid and ossicle samples. Conclusion. In the clinic, the careful use of topical or systemic antimicrobials is essential, and, during surgery, hypertrophic tissue must be carefully removed from normal tissue.

International study of the incidence of particular types of septal deformities in chronic rhinosinusitis patients: the outcomes from five countries

Background Chronic rhinosinusitis (CRS) may be more frequent in patients with particular types of septal deformities. The aim of this article was to investigate the incidence of particular types of septal deformities in adult CRS patients and healthy volunteers in various countries to determine whether some of them are more frequent in those groups. Methods This international multicentric study involved 505 subjects from five countries: Croatia, Romania, Italy, Russia, and Turkey. The types of septal deformities were observed and grouped according to the Mladina classification. Subjects were examined by means of native anterior rhinoscopy, anterior rhinoscopy after decongestion, and fiber endoscopy with topical anesthesia. CRS patients have been diagnostically proved by computed tomography scanning of the paranasal sinuses. Results Considering the CRS patients, the prevalence of so-called vertical deformities (types 2, 3, and 4) was seen. Among them, type 3 deformity was found most frequently in Turkey, Croatia, Italy, and Romania. Conclusion Type 3 deformity has been found frequently in CRS patients in all five of the countries. Russian subjects exhibited a high frequency of type 4 deformity. Because this type consists of types 2 and 3, the later, again, has been proven to be prevalent in CRS patients also in this group of patients.

Is There a Relationship Between Snoring Sound Intensity and Frequency and OSAS Severity

Objectives: We investigated the relationship between snoring sounds and severity of obstructive sleep apnea syndrome (OSAS). Methods: A total number of 103 snoring patients (60 males and 43 females) were evaluated by means of polysomnographic findings and snoring sound recordings. Snoring sound intensity was assessed using fast Fourier transform (FFT) method by measuring maximal frequency (Fmax) and average snoring sound intensity level (SSIL). Results: Maximal frequency and SSIL are correlated with apnea-hypopnea index (AHI), REM AHI, and severity of the OSAS. So, as the severity of the OSAS increased, so did the Fmax and SSIL of the snoring recordings, meaning patients started snoring louder with more frequency. In older patients, in females, in severe OSAS group, and in patients with higher body mass index (BMI), AHI and AHI REM values and SSIL and Fmax values increased. As mean oxygen (O2) saturation and lowest O2 saturation decreased, SSIL and Fmax values increased. Conclusion: Maximal frequency and SSIL analysis of the snoring sound increased in severe OSAS patients. People should be aware of the importance of snoring sounds. In particular, patients with snoring sounds increasing in intensity and of higher frequency should discuss with their physicians the possibility of OSAS.

Association of Interleukin-10 gene promoter polymorphisms with obstructive sleep apnea

BackgroundInterleukin-10 (IL) is an anti-inflammatory cytokine that regulates normal sleep patterns, and recent studies have reported that it is a potential useful biomarker to identify presence and severity of sleep apnea syndrome (OSAS). Promoter polymorphisms of IL-10 gene have been associated with altered expression levels, which contributes to OSAS.ObjectiveThe aim of this study was to determine the prevalence of −1082 G/A, −819 C/T, and −592 C/A promoter polymorphisms of IL-10 gene in individuals with OSAS and controls.Subjects and methodsAn open-label study was performed in the Otorhinolaryngology and Sleep Disorders Outpatient Clinics. One hundred four cases with OSAS were included as the study group, and 78 individuals without OSAS were included as the controls. DNAs were extracted from peripheral blood leukocytes, and the sites that encompassed those polymorphisms were identified by DNA sequencing analyses. Data were analyzed with SNPStats and multifactor dimensionality reduction (MDR) software.ResultsThe prevalence of OSAS was higher in males in the study group when compared to controls (P = 0.0003). The IL-10-1082 G/A, −819 C/T, and −592 C/A SNPs, and their minor alleles were associated with a significantly increased risk for OSAS compared to the controls (P ˂ 0.05 for all). Furthermore, ATA haplotype frequency was significantly higher in the study group compared to the control group, but the GCC haplotype frequency was lower (P = 0.0001 and P = 0.0001). As indicated in MDR analysis, combinations of IL-10 gene were associated with OSAS in single-, double-, and triple-locus analyses.ConclusionThe prevalences of the IL-10 gene promoter polymorphisms were different in OSAS patients and the controls in Turkish population. IL-10 gene polymorphisms may lead to altered inflammatory cascade, which might contribute to OSAS. Further studies on larger cohorts are needed to validate our findings.

Reply to the letter to the editor concerning: ‘Fat-plug myringoplasty of ear lobule vs abdominal donor sites’

for testing ETD had been described in the literature. Contralateral middle ear index, instillation of ear drops, auscultation tube test, Toynbee test, modified pressure equilibration inflation-deflation test, sonotubometry, dye test and the saccharin test are all diverse methods for testing ETD [7–12]. Although saccharin test is the most recommended method for testing eustachian tube function, these tests are not widely used and more prospective studies are needed for the association of these tests with surgical outcomes [12, 13]. The etiology of tympanic membrane perforation (TMP) was unidentified in many cases and would not necessarily affect the outcomes of our research. TMP lasting for 6 months was sufficient and acceptable for the timing of the myringoplasty. There is no consensus on the timing of the myringoplasty in the literature. The studies of Dursun et al., Ozgursoy and Yorulmaz, Koc et al. and Kwong et al. included patients with perforations present for at least 6 months, so we do not think it is a remissness of our research [3–5, 14]. In the study of Park et al., the patients with chronic perforations presenting for more than 3 months regardless of the causes were included in the study [15]. Alain et al.’s study compromised patients that did not have active inflammation during the 3 months prior to surgery [16]. Carr et al. did not mention about the duration of the perforation in their retrospective study, included patients in all age groups and tympanic membrane perforations of the pars tensa [7]. We also stated in our inclusion criteria that we performed this study on patients with “absence of ossicular or mastoid pathology, a normal tympanic cavity mucosa, no otorrhea or retraction pocket formation” [1]. Pınar et al. in their study did not mention about the TMP duration or eustachian tube function. They classified perforation size as ≤50 and ≥50%; and they did not clarify the Dear Editor,

Can curcumin modulate allergic rhinitis in rats

OBJECTIVES This study aimed to explore the effects of curcumin on experimental allergic rhinitis in rats. METHODS Twenty-eight male Wistar albino rats were randomly divided into four groups: a control group; a group in which allergic rhinitis was induced and no treatment given; a group in which allergic rhinitis was induced followed by treatment with azelastine hydrochloride on days 21-28; and a group in which allergic rhinitis was induced followed by treatment with curcumin on days 21-28. Allergy symptoms and histopathological features of the nasal mucosa were examined. RESULTS The sneezing and nasal congestion scores were higher in the azelastine and curcumin treatment groups than in the control group. Histopathological examination showed focal goblet cell metaplasia on the epithelial surface in the azelastine group. In the curcumin group, there was a decrease in goblet cell metaplasia in the epithelium, decreased inflammatory cell infiltration and vascular proliferation in the lamina propria. CONCLUSION Curcumin is an effective treatment for experimentally induced allergic rhinitis in rats.

Maxillary Sinus Aeration in Allergic Rhinitis.

Objective:We aimed to investigate the relationship between allergic rhinitis, which is an important reason of nasal obstruction, and maxillary sinus aeration. Patients and Methods:Three hundred fifteen patients who have a complaint of nasal obstruction and scheduled to undergo skin prick test (SPT) with a suspicion of allergic rhinitis (AR) were enrolled for this study. Thirty-two patients with positive SPT result and 30 patients with a negative SPT result were determined as group 1 and 2 (control group), respectively. A 3-dimensional reconstruction of computed tomography images of the 62 patients was used to assess and calculate maxillary sinus volumes (MSVs). Results:Total maxillary sinus volumes were measured as 21.87 cm3 and 30.15 cm3 in group 1 and group 2, respectively. A statistically significant difference was observed between the MSVs of the groups (P < 0.001). Conclusion:Total maxillary sinus volumes were found to be significantly smaller for patients with a positive SPT compared to patients with a negative SPT. Thus, we may conclude that AR has a negative impact on maxillary sinus aeration.

Nazolakrimal kanal obstrüksiyonunun tedavisinde endonazal dakriyosistorinostomi (DSR) ve endokanaliküler diyot lazer DSR'nin karşılaştırması

Objective: Dacryocystorhinostomy (DCR), the treatment for nasolacrimal duct obstruction, is generally performed endonasally. In this retrospective study, we compared the anatomical and functional success rate of endonasal DCR with endocanalicular diode laser DCR. Methods: Medical records of 53 patients in endonasal DCR group (Group 1) and 47 in endocanalicular diode laser DCR group (Group 2) were analyzed for preoperative syringing and probing evaluations as well as surgical details, outcomes and complications. Results: Recurrence was observed in eight patients in Group 1 and six in Group 2. Although the recurrence rates differed between the two groups, this difference was not statistically significant (p>0.05). The complications in Group 1 included eight cases of synechia and one tube protrusion, whereas the complications in Group 2 included two cases of synechia, two tube protrusions and two punctum atrophies. The presence of allergy, concha hypertrophy and septum deviation did not significantly increase the rates of recurrence or complications (p>0.05). Bleeding and pain were observed significantly more frequently in Group 1 and the patient comfort was significantly better in Group 2 (p<0.05). Conclusion: Endocanalicular diode laser DCR was found to be a good alternative to endonasal DCR surgery thanks to better postoperative comfort, shorter healing time and less postoperative pain.

Effects of lateral osteotomy on nasal sound intensity levels in patients who underwent rhinoplasty.

Abstract We investigated the effects of lateral osteotomy on nasal sound intensity levels in 34 patients who underwent rhinoplasty. Four groups were evaluated: group 1, preoperative rhinoplasty with lateral osteotomy (Preop-RPwithLO); group 2, postoperative rhinoplasty with lateral osteotomy (Postop-RPwithLO); group 3, preoperative rhinoplasty without lateral osteotomy (Preop-RPwithoutLO); and group 4, postoperative rhinoplasty without lateral osteotomy (Postop-RPwithoutLO). By sound analysis, low-frequency (Lf; 500–1000 Hz), medium-frequency (Mf; 1–2 kHz), and high-frequency (Hf; 2–4 and 4–6 kHz) nasal sound intensities were defined. Mf-left values of Postop-RPwithLO were significantly lower than those of Preop-RPwithLO, and Mf-left values of Postop-RPwithoutLO were significantly higher than those of Postop-RPwithLO and Preop-RPwithoutLO. Hf-right values of Preop-RPwithoutLO were significantly higher than those of Postop-RPwithLO and Postop-RPwithoutLO. Hf-total values of Postop-RPwithoutLO were significantly lower than those of Preop-RPwithoutLO. Nasal airway width decreased and nasal sounds, especially Mf sound intensities, increased in the nonlateral osteotomy group (group 4). When lateral osteotomy is performed, the nasal air passage may be adjusted as required by the surgeon, the air passage in the nasal valve region may not be narrowed, and nasal sound intensities may decrease. During postoperative follow-ups, increased Mf and Lf nasal sound intensities should be considered for the narrowness of the nasal passage and lower patency of the nasal cavities. Nasal sound analysis is a noninvasive technique and can also be used to evaluate nasal patency in septoplasty and rhinoplasty patients and children and for cases in which official reports are needed in addition to acoustic rhinometry measurements.