Nebil Ark

Lobular capillary haemangioma of the middle turbinate

Lobular capillary haemangioma (LCH) is a benign, vascular lesion of unknown origin. It usually affects skin and mucous membranes of the oral cavity. It rarely occurs in the nose. Microtrauma and hormonal factors are considered in the aetiology. The most frequently seen symptoms of nasal LCH are epistaxis and nasal obstruction. LCH can be pedinculated or wide based. Its size ranges from several millimetres to centimetres. LCH cases secondary to postoperative use of nasal packs have been reported. Here we present an LCH which was located on the middle turbinate and occurred after the usage of nasal packing. It is known that the nose is a rare location for LCH but middle turbinate location has not been described so far in the literature. LCH should be considered in the differential diagnosis of all endonasal masses with bleeding.

Comparison of adenoidectomy methods: Examining with digital palpation vs. visualizing the placement of the curette

OBJECTIVE To evaluate the effectiveness of adenoidectomy by defining the remnant volume and localization in nasopharynx, following being satisfied with completeness of removal of the adenoid tissue with digital palpation. METHODS A prospective study conducted on 99 patients undergoing adenoidectomy+/-tonsillectomy. The main mass of the patients adenoid tissue was removed with a sharp adenoid curette without visualization and the surgeon was allowed to palpate the adenoid bed and repeat the curettage until satisfied with completeness of removal. Then nasopharynx was visualized with a laryngeal mirror for defining the anatomical localization of the residual adenoid tissue and curettage completed under indirect mirror visualization. The volumes of the adenoid tissue excised at both stages were measured. RESULTS By blunt curettage and digital palpation, only 20.2% of the patients (20) had no residual adenoid tissue. In patients who had residual adenoid tissue, the proportion of the median percentage of residual adenoid tissue to total adenoid tissue was 19.98% (range 3.22-50%). The anatomical localization of the residual adenoid tissue were, along the torus tubarius on either side of the nasopharynx in 9 (11.4%), on the pharyngeal roof near choanal openings in 64 (81%), along the torus tubarius on either side of the nasopharynx+on the pharyngeal roof near choanal openings in 5 (6.3%), and on the pharyngeal roof near choanal openings+on the posterior wall of nasopharynx in 1 (1.3%) patients. There was no difference found among surgeons in the percentage and the location of the residue left (p>0.05). CONCLUSION Digital palpation is not a dependable technique and visualization of the nasopharynx is crucial for a complete adenoidectomy.

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.

Effects of a topical hemostatic agent on an epistaxis model in rabbits.

BACKGROUND Ankaferd BloodStopper (ABS) is a standardized herbal compound consisting of 5 different plant extracts. ABS, as a topical medicinal product, has been approved by the Turkish Ministry of Health for the management of dermal, external postsurgical and postdental surgery bleedings. OBJECTIVE The aim of this study was to assess the hemostatic effect of ABS in an experimental epistaxis model. METHODS Adult female New Zealand rabbits were used in this study. Standardized full-thickness mucosal wounds were created to provide bleeding on the right and left side of the nasal septum of rabbits with a 3-mm surgical punch. To stop bleeding, the wounds were treated with topical ABS on one side and with topical isotonic saline solution as a control on the other side of the nasal septum. Investigators were blinded to treatment. The duration of bleeding was measured in order to compare the hemo-static effect with ABS or topical isotonic saline solution. The wounds were observed for the duration of bleeding in order to compare the hemostatic effect of ABS with isotonic saline solution and acute adverse effects (AEs) for 30 minutes by a researcher blinded to treatment groups. RESULTS Six rabbits (mean weight, 2.6 kg [range, 2.3-3.1 kg]) were used in this study. Mean (SD) bleeding time in the wounds administered ABS (98 [17] sec) was significantly less than that of the controls (266 [36] sec; P = 0.004). No AEs were observed up to 30 minutes after study initiation. CONCLUSION This study suggests that ABS may be more effective in reducing time to hemostasis when compared with isotonic saline solution in this epistaxis model in rabbits.

Tongue abscess with actinomycosis.

Actinomycosis of the tongue is uncommon, but without proper treatment, it causes extensive tissue destruction. A mass that may mimic both benign and malignant neoplasms can be seen at clinical presentation and may mislead the diagnosis. Early diagnosis is critical but usually difficult with cultures or imaging. We report a patient who presented with a tumor-like deeply localized primary actinomycosis of the tongue with its magnetic resonance imaging 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.

Changes in growth pattern, leptin ghrelin and neuropeptide Y levels after adenotonsillectomy in prepubertal children.

Abstract Aim: The purpose of this prospective study was to evaluate whether surgical treatment of adenotonsillar hypertrophy has an effect on growth patterns and circulating concentrations of leptin, ghrelin and neuropeptide Y, which are all significant in energy balance. Materials and methods: The study group consisted of 20 children who underwent tonsillectomy with or without adenoidectomy due to chronic adenotonsillar hypertrophy. The ages ranged from 4.3 to 9.2 years with normal weight. The healthy control subjects consisted of 30 age- and sex-matched children (control group) with ages between 3.2 and 8.1 years. Serum levels of leptin ghrelin and neuropeptide Y were measured in the preoperative period and at the end of the postoperative period, which was 6 months in the study group, serum levels were only measured during the first examination in the control group. Results: When the study group (preoperative) is compared with the control group, it is observed that the leptin and ghrelin levels were higher in the study group and that the neuropeptide Y levels were similar (p=0.01, p=0.005, p=0.19, respectively). When the preoperative and postoperative anthropometric data were compared, it was observed that weight, height, body mass index (BMI) and BMI-standard deviation score (SDS) values increased in the 6th month postoperatively (p<0.001, p<0.001, p=0.01, p=0.03, respectively). However, the leptin, ghrelin and neuropeptide Y levels were similar (p=0.70, p=0.12, p=0.60, respectively). Conclusion: Following adenotonsillectomy, an increase in weight and height occurred in the children. In the postoperative period, dietary and lifestyle suggestions as well as growth monitoring might be useful.

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.