Ozgul Topal

Cochleovestibular dysfunction in ankylosing spondylitis.

Ankylosing spondylitis (AS) is a rheumatic disease characterized by chronic inflammation. The aim of this study was to evaluate the functions of the cochlea and the vestibular system in patients with AS. The study group consisted of 32 patients with AS and 30 healthy volunteers as a control group. Otorhinolaryngologic examinations were performed in all patients together with pure-tone audiometry, speech tests, impedancemetry, transient evoked otoacoustic emission (TEOAE) and electronystagmography (ENG). A significant difference was found between the 2 groups with regard to pure-tone averages at high frequencies in each ear (p < 0.05). The rates of reproducibility in TEOAE testing were significantly lower in patients with AS (p = 0.03). The signal-to-noise rates of the response values were lower at all frequencies in patients with AS, but a statistically significant difference was only observed at 2, 3 and 4 Hz (p < 0.05). ENG revealed pathologies in 11 patients with AS (34%), 8 of which were central (25%) and 3 of which were peripheral (9%). No correlation was found between cochleovestibular dysfunction and age, sex, disease duration, activity and medication taken. This study demonstrated that there is an association between AS and cochleovestibular dysfunction.

The role of allergy in the severity of nasal polyposis.

Background Although patients with nasal polyposis frequently exhibit concomitant allergy, there is limited information about the impact of allergy on the severity of nasal polyposis. The goal of this study was to evaluate the role of allergy in the severity of nasal polyposis. Methods Polyp sizes, computed tomography (CT) scores, skin-prick test results, blood total eosinophil count, serum levels of total immunoglobulin E, symptom scores, and recurrences were analyzed in 83 patients with nasal polyposis. The results were compared between allergic and nonallergic patients with nasal polyposis. Results No association was found between the presence of allergy per skin-prick testing and polyp size, CT opacification, symptom scores, or recurrences (p > 0.05). In allergic patients, only the serum total eosinophil count correlated strongly with the results of CT (p = 0.005) but not with other parameters (p > 0.05). Conclusions The results of this study show that, although patients with nasal polyposis frequently have allergies, the presence of allergy does not correlate with polyp size, symptom scores or rate of recurrence.

Expression of a disintegrin and metalloproteinase 33 protein in nasal polyposis: an immunohistochemical study.

Background A disintegrin and metalloproteinase (ADAM)-33 is a member of matrix metalloproteinases. This protein takes a role in angiogenesis and airway remodeling in asthma. Because histopathological findings of airway remodeling in asthma and nasal polyposis (NP) are similar, the aim of this study was to evaluate the ADAM-33 expression in NP. Methods Immunohistochemical staining of specimens of 47 patients with NP and 8 patients with concha bullosa was performed to detect the expression of ADAM-33. Paraffin blocks were used to identify the expression of ADAM-33 polyclonal antibodies. Immunostaining of epithelial cells, stroma, mesenchymal cells of vessels, and inflammatory cells were analyzed by using light microscopy. Results Immunopositivity scores in epithelial cells in NP (median, 2; range, 1–3) were significantly higher than those of controls (median, 1.5; range, 1–2; p < 0.001). ADAM–33 staining was increased in the mesenchymal cells of vessels of nasal polyps (median, 2; range, 1–3) compared with control tissues (median, 1.5; range, 1–2; p = 0.006). Although the staining scores of fibroblasts in nasal polyp specimens were also high (median, 3; range 1–3), there was no statistical significance when compared with controls (median 2; range, 1–3; p = 0.228). ADAM–33 immunostaining was not related with the presence of allergies, asthma, and aspirin intolerance (p > 0.05). Moreover, no relationship was found between increased expression of ADAM–33 and the stages of polyp or computerized tomography scores (p > 0.05). Conclusion This study suggests that the increased expression of ADAM-33 protein may have a role in the pathogenesis of NP.

Expression of metalloproteinases MMP-2 and MMP-9 in antrochoanal polyps.

Background Matrix metalloproteinase (MMP) 2 and MMP-9 are known to cleave specifically type 4 collagen, which is a major structural component of basement membrane. This is an early step of inflammation. Because of this property they have been studied in chronic sinonasal disorders. The aim of this study was to determine the MMP-2 and MMP-9 expressions in an antrochoanal polyp (ACP). Methods We examined tissue samples from 10 ACPs, 10 diffuse nasal polyps, and 10 control nasal mucosa (CM) by immunohisto-chemistry for MMP-2 and MMP-9 expression. Results Most of epithelial and endothelial cells showed positive immunostaining for MMP-2 and MMP-9 in all tissue samples. MMP-2 staining of inflammatory cells showed no difference among the groups (p > 0.05). On the other hand, MMP-9+ inflammatory cells were found to be significantly increased in ACP and diffuse nasal polyps when compared with CM (p < 0.05). Conclusion MMP-9–expressing inflammatory cells could play a role in the pathophysiology of ACP as well as nasal polyps.

Subjective pulsatile tinnitus associated with extensive pneumatization of temporal bone

Pulsatile tinnitus (PT), a rare otologic symptom, is frequently associated with identifiable and treatable causes. We report two cases of subjective PT due to extensive pneumatization of temporal bone around the internal carotid artery.

Oxidative stress and nasal polyposis: does it affect the severity of the disease?

Background Nasal polyposis (NP) is a chronic inflammatory disease and the waste products of this inflammation are reactive oxygen species composed of free radicals. Changes in oxidative status have already been revealed in NP. The aim of this study was to investigate the effect of oxidative status to the severity of the disease and the quality of life. Methods The study group included 24 patients with NP and 20 controls. The Turkish version of the Rhinosinusitis Disability Index, visual analog scale (VAS), polyp stage, computed tomography (CT) score, and the eosinophilic cationic protein (ECP) levels in nasal lavage (NAL) fluid were used to assess the severity of the disease. Malondialdehyde, nitric oxide (NO), and the total antioxidant status (TAS) levels in NAL fluids were measured representing the oxidative stress. Results NO values were correlated with nasal congestion (p = 0.031). TAS values were correlated with nasal obstruction (p = 0.039). ECP values showed correlation with all the nasal obstruction (p = 0.003), congestion (p = 0.009), rhinorrhea (p = 0.009), and VAS scores (p = 0.039). Conclusion In NP, ECP levels detected in NAL fluid were significantly high and were correlated with the severity of the disease. Moreover, the severity of oxidative stress, in the forms of TAS and NO, is significantly correlated with the severity of the nasal obstruction and congestion, respectively.

Schwannoma of the external auditory canal: a case report.

BackgroundSchwannomas are uncommon benign tumors of the external auditory canal. The clinical features, the differential diagnosis, and the surgical treatment of these lesions are discussed.Case presentationA 51-year-old patient presented with a mass obliterating the external auditory meatus. Excisional biopsy was performed. Diagnosis was reported to be schwannoma by histopathologic examination.ConclusionSchwannoma, rarely seen in the external auditory canal, can be managed by a precise excision of the tumor via transmeatal approach.

Haloperidol: A possible medication for the treatment of exacerbation of intractable psychogenic sneezing

Sneezing is one of the physiological defense mechanisms that develops generally due to nasal irritation. But intractable sneezing episodes are uncommon and generally detected among the adolescents. It is difficult to distinguish physiologic sneezing from psychogenic sneezing. Herein, we report a 12-year-old girl who was complaint with intractable sneezing. She was diagnosed as intractable psychogenic sneezing and haloperidol treatment was started. All symptoms had resolved completely within 2 weeks. As a result, haloperidol can be considered as a different treatment modality for intractable psychogenic sneezing.

Therapeutic effect of Castellani's paint in patients with an itchy ear canal

OBJECTIVE To examine the effects of Castellanis paint on symptomatic relief and skin flora in patients with an itchy external ear canal. METHODS Subjective pruritus scores, and erythema and desquamation scores, were noted in 61 patients with an itchy external ear canal. External ear canal skin swabs were taken for bacterial and fungal cultures. Patients were then randomly divided into three groups: either Castellanis paint (group one) or steroid ear drops (group two) were instilled, or non-impacted cerumen was removed (group three). Patients were re-assessed at one month after the initial visit. RESULTS After treatment, subjective pruritus scores were significantly lower in all groups, erythema scores were significantly decreased in group one, and desquamation scores were significantly reduced in groups one and two, when compared with pre-treatment scores. Reproduction density of bacteria including normal flora was decreased in group one. However, the types of bacteria that constitute the normal flora of the external ear canal were unchanged. CONCLUSION Castellanis paint can be administered safely, effectively and easily, without affecting the type of external ear canal skin bacteria, in patients with an itchy external ear canal.

Strabismus secondary to frontal sinus mucocele associated with nasal polyposis.

Paranasal mucoceles are regarded as slow-growing and benign lesions. They are usually recognized by otorhinolaryngologists, but a clinically relevant mucocele with orbital complications may present to an ophthalmologist. We report a 15-year-olds case with unilateral reduced ocular motility due to bilateral frontal mucocele associated with grade II nasal polyposis.