Onur Celik

Pleomorphic adenoma originated from the inferior nasal turbinate

Although pleomorphic adenoma is the most common benign neoplasm of the salivary glands, it has also been reported to be present in the neck, ear, mediastinum, external nose and nasal cavity. Intranasal localization of this lesion is very rare and mainly originates from the nasal septum. From wherever the lesion originates, the main treatment modality should be surgical. We presented a very rare case of intranasal pleomorphic adenoma originated from the inferior nasal turbinate. Due to the expansile nature of the lesion, a midfacial degloving approach was preferred.

Regulatory-T, T-helper 1, and T-helper 2 cell differentiation in nasal mucosa of allergic rhinitis with olive pollen sensitivity.

Background: Allergic rhinitis (AR) is a disease in which T-helper (Th)2 response is predominant and its pathogenic mechanism is still poorly understood. Aim: To evaluate the possible role of Th1, Th2 and regulatory-T (Treg) cells in the pathogenesis of AR. Methods: This case-control study enrolled 41 patients with seasonal AR (10–62 years old), sensitive to olive pollens, and 15 healthy controls (18–60 years old). Nasal biopsy was performed and specimens of nasal lavage fluid were obtained from all participants. The levels of interleukin (IL)-4, IL-10, interferon (IFN)-γ and transforming growth factor-β (TGF-β) were measured in nasal lavage fluid specimens. The expression of FOXP3, GATA-3 and T-bet was measured by immunohistochemical methods in the nasal biopsy specimens. Results: The levels of IFN-γ in the group with AR were significantly lower than those in the control group (p = 0.008). The levels of IL-4, IL-10 and TGF-β did not differ between the two groups. The expression of FOXP3 and T-bet in patients with AR was significantly lower than that in the control group (both p = 0.001). Expression of GATA-3 in the nasal mucosa was similar between the groups (p = 0.2). The ratios of T-bet/GATA-3 and FOXP3/GATA-3 in the AR group were significantly lower than those in the control group (p = 0.001). Conclusion: Insufficient Treg and Th1 cells may be associated with the allergic inflammation that may be attributed to the Th2 immune response in patients suffering from AR who are sensitive to olive pollen.

Neural control of eustachian tube function

It has been hypothesized that middle ear pressure can be controlled by the Eustachian tube through a neuronal reflex arc in animal models. We aimed to define the role of the neuronal control mechanisms in regulating middle ear pressure in humans.

Effects of allergen-specific immunotherapy on functions of helper and regulatory T cells in patients with seasonal allergic rhinitis.

BACKGROUND Seasonal allergic rhinitis (SAR) is characterized by a helper T (Th)2 cell-mediated immune response at the target site. There is a relative Th1 and/or regulatory T (Treg) cell insufficiency in patients with SAR. It has been demonstrated that there is a change in the balance between these cells after allergen-specific immunotherapy (SIT), which is a curative treatment modality for this disease. However, there are few studies that evaluate the number and function of these cells in the inflammatory area after SIT treatment. OBJECTIVE We aimed to investigate the distribution of Th1, Th2 and Treg cells in nasal biopsies and lavage fluid (NLF) specimens from patients with SAR, before and after SIT. METHODS Twenty-four, symptomatic SAR patients sensitized to Olea europeae, were enrolled in the study prior to treatment. Fifteen, non-allergic subjects with nasal septum deviation, who needed surgical treatment, served as the control group. NLF and inferior turbinate biopsies were obtained from both groups during the pollen season. Conventional, subcutaneous SIT with Olea europeae extract was initiated in patients with SAR. One year after the first biopsy, biopsies and NLF specimens were again obtained for reevaluation. All biopsies were evaluated for Th1, Th2 and Treg cell counts by means of their transcription factors (T-bet, GATA-3 and FoxP3) using an immunohistochemical analysis method. Additionally, all NLF specimens were evaluated for the functions of these cells, by means of their specific cytokines, using an ELISA method. RESULTS When the basal status of those patients with SAR was evaluated based on transcription factors, prior to treatment, Th1 and Treg cells were found to be fewer than in non-allergic controls (p=0.001 for both T-bet and FoxP3). It was demonstrated that numbers of GATA-3-carrying cells, which are a marker for Th2, were not significantly different between the groups (p=0.276), but evaluation of the Th1/Th2 ratio revealed a relative Th2 dominance in patients with SAR prior to treatment. When evaluated on the basis of cytokine levels, it was observed that Th1-originated IFN-γ was lower in patients with SAR compared to the control group, both before and after treatment (p=0.012 for both comparisons), Th2-originated IL-4 levels were not significantly different between the groups either before or after treatment (p=0.649, p=0.855; respectively). Th2- and Treg cell-originated IL-10 levels were higher in patients with SAR before treatment (p=0.033), but this difference was not statistically signifant following treatment compared with controls (p=0.174). Treg cell-originated TGF-β levels were slightly lower in patients with SAR compared to the controls, although the difference was not statistically significant (p=0.178, p=0.296; respectively). None of the above mentioned cytokine levels changed significantly as a result of SIT. CONCLUSION The results of our study indicate that although clinical findings improve after one year of SIT, this duration may not be sufficient to detect changes in cytokine patterns and transcription factors. Further studies that evaluate outcome over a longer duration of treatment would provide valuable information.

The effectiveness of different neuroprotective agents in facial nerve injury: An experimental study.

To examine and compare the neuroprotective effects of dexamethasone, oxytocin, and resveratrol administration on regeneration after facial nerve crush injury in a rat model.

Facial growth after middle turbinate resection: an experimental study in the rabbit.

Background The aim of this study was to determine the effects of total middle turbinate resection on midfacial growth through a morphometric analysis on an animal model. Methods Twenty-eight male New Zealand white rabbits were used. The animals were divided into three groups: group 1, elevation and relocation of the nasal bone was performed; group 2, concha resection was performed; group 3, control group with no surgical procedure. The surgery was done at 8–10 weeks of age and the skull of each subject was sampled as they reached maturity. The determined distances then were measured by using landmarks identified on skull. The supplied data were evaluated by using the Mann-Whitney U test. Results Deviation of the nasal axis to the opposite side of the resected concha and an increase in the width of nasal bone were observed only in group 2. In group 1, an increase of nasal bone length and zygomaticonasal distances was determined in both the operated and the unoperated sides of nasal bones. Conclusion This animal experiment showed that operations on the nasal bone or concha resection affected the midfacial growth in rabbits. The effects of middle turbinate resection to midfacial development should be evaluated by additional studies. We recommend only limited, conservative surgical procedures on the middle turbinate, saving all the vital mucosa, periosteum, and bone.

Pregnancy rhinitis in Turkish women: Do gestational week, BMI and parity affect nasal congestion?

Objective: To determine the cumulative incidence of pregnancy rhinitis along with prevalence in different trimesters and to find out whether gestational age, BMI and parity have any effect on pregnancy related nasal congestion. Methods: In the prospective protocol at the obstetrics outpatient clinic, 167 pregnant women were enrolled consecutively. According to exclusion criteria, 67 of them were excluded. Visual-Analogue-Scale (VAS), Nasal-Obstructive-Symptom-Evaluation (NOSE) scale and Discharge-Inflammation-Polyps/Oedema (DIP) scoring were utilized for diagnosis of pregnancy rhinitis. Besides, weight, length, age, parity and week of pregnancy were recorded. Results: Total prevalence of pregnancy rhinitis was 17.17% and cumulative incidence was 38.89%. Our study revealed significant relation of NOSE score with both gestational week (r=0.474, p=0.001) and BMI (r=0.301, p=0.003). VAS score was significantly related with gestational week (r=0.409, p=0.001) and BMI (r=0.270, p=0.007). DIP score was found to be correlated only with gestational week (r=0.375, p=0.001). Conclusion: Cumulative incidence of pregnancy rhinitis was 38.89%. Nasal congestion was significantly associated with BMI and gestational week. Patients should be informed about unfavorable fetal and maternal outcomes of pregnancy related nasal congestion which is triggered by obesity and excessive weight gain in pregnancy.

The evaluation of pretreatment neutrophil–lymphocyte ratio and derived neutrophil–lymphocyte ratio in patients with laryngeal neoplasms

INTRODUCTION Systemic inflammatory biomarkers are promising predictive and prognostic factors for solid cancers. The neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio are used to predict inflammation and used as biomarker in several malignancies. OBJECTIVE The purpose of this study was to demonstrate the diagnostic, predictive and prognostic role of neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio in patients with laryngeal neoplasms. METHODS A retrospective study was conducted on medical records involving 229 patients with benign, premalignant and malignant laryngeal neoplasms between 2002 and 2015. The diagnostic, predictive and prognostic role of neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio were evaluated using uni- and multivariate analysis. RESULTS The neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio were not statistically different between patients with benign, premalignant and malignant laryngeal neoplasms. Both neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio were predictive factors for stage, lymph node metastasis, and distant metastasis. Patients with high neutrophil-lymphocyte ratio value (≥4) had a poor prognosis when compared with patients with low neutrophil-lymphocyte ratio value (5 year, Overall Survival: 69.0% vs. 31.1%, p<0.001; 5 year, disease free survival: 70.0% vs. 32.7%, p˂0.001; 5 year, locoregional recurrence free survival: 69.7% vs. 32.0%, p<0.001). Furthermore, neutrophil-lymphocyte ratio was an independent prognostic factor for 5 year: Overall survival (HR=2.396; 95% CI 1.408-4.077; p=0.001), Disease free survival (HR=2.246; 95% CI 1.322-3.816; p=0.006) and locoregional recurrence free survival (HR=2.210; 95% CI 1.301-3.753; p=0.003). CONCLUSION Pretreatment neutrophil-lymphocyte ratio is a useful and reliable predictive and prognostic biomarker for patients with laryngeal carcinoma.

The Safety of Open Surgical Tracheotomy Performed by Otorhinolaryngology Residents

Objective: We aimed to clarify the safety of open surgical tracheotomy performed by supervised residents, and the impact of “reason for hospitalization” on complication rates in open surgical tracheotomy technique. Methods: In this retrospective cohort study, the medical files and documents of 277 patients who underwent open surgical tracheotomy (OST) over a period of 12 years from October 2005 to July 2017 were analyzed. Forty four patients were excluded due to emergent tracheotomy and presence of malignancy. Remaining 223 cases were divided into two groups as “OSTs done by supervised residents” and “OSTs done by attending surgeons”. Age, gender, reason for hospitalization, observation time and complications were noted. The overall minor and major complication rates and each complication rate were compared with regard to the operating surgeons. Results: No statistically significant difference between two groups was demonstrated in terms of observation time (p=0.127). Minor complication rate for residents and attending surgeons was 14.7% and 17.5%, whereas major complication rate was 6.3% and 5.0%, respectively. No significant difference was found between two groups both in terms of minor (p=0.58) and major (p=0.43) complication rates. No risk of “reason for hospitalization” on minor and major complications was found (p=0.06, p=0.15). Conclusion: Open surgical tracheotomy performed by supervised residents is as safer as the ones performed by the attending surgeons. The study also showed that “reason for hospitalization” does not potentiate the occurrence of tracheotomy related complications.

The role of facial canal diameter in the pathogenesis and grade of Bell's palsy: a study by high resolution computed tomography

INTRODUCTION The exact etiology of Bells palsy still remains obscure. The only authenticated finding is inflammation and edema of the facial nerve leading to entrapment inside the facial canal. OBJECTIVE To identify if there is any relationship between the grade of Bells palsy and diameter of the facial canal, and also to study any possible anatomic predisposition of facial canal for Bells palsy including parts which have not been studied before. METHODS Medical records and temporal computed tomography scans of 34 patients with Bells palsy were utilized in this retrospective clinical study. Diameters of both facial canals (affected and unaffected) of each patient were measured at labyrinthine segment, geniculate ganglion, tympanic segment, second genu, mastoid segment and stylomastoid foramen. The House-Brackmann (HB) scale of each patient at presentation and 3 months after the treatment was evaluated from their medical records. The paired samples t-test and Wilcoxon signed-rank test were used for comparison of width between the affected side and unaffected side. The Wilcoxon signed-rank test was also used for evaluation of relationship between the diameter of facial canal and the grade of the Bells palsy. Significant differences were established at a level of p=0.05 (IBM SPSS Statistics for Windows, Version 21.0.; Armonk, NY, IBM Corp). RESULTS Thirty-four patients - 16 females, 18 males; mean age±Standard Deviation, 40.3±21.3 - with Bells palsy were included in the study. According to the HB facial nerve grading system; 8 patients were grade V, 6 were grade IV, 11 were grade III, 8 were grade II and 1 patient was grade I. The mean width at the labyrinthine segment of the facial canal in the affected temporal bone was significantly smaller than the equivalent in the unaffected temporal bone (p=0.00). There was no significant difference between the affected and unaffected temporal bones at the geniculate ganglion (p=0.87), tympanic segment (p=0.66), second genu (p=0.62), mastoid segment (p=0.67) and stylomastoid foramen (p=0.16). We did not find any relationship between the HB grade and the facial canal diameter at the level of labyrinthine segment (p=0.41), tympanic segment (p=0.12), mastoid segment (p=0.14), geniculate ganglion (p=0.13) and stylomastoid foramen (p=0.44), while we found significant relationship at the level of second genu (p=0.02). CONCLUSION We found the diameter of labyrinthine segment of facial canal as an anatomic risk factor for Bells palsy. We also found significant relationship between the HB grade and FC diameter at the level of second genu. Future studies (MRI-CT combined or 3D modeling) are needed to promote this possible relevance especially at second genu. Thus, in the future it may be possible to selectively decompress particular segments in high grade BP patients.