Vefa Kinis

Effect of upper airway obstruction on pulmonary arterial pressure in children

OBJECTIVEnOur aim was to examine the elevation of pulmonary arterial pressure in children with upper airway obstruction caused by adenotonsillar hypertrophy according to their disease severity assessed with symptom scoring and to demonstrate the profit for echocardiographic monitorization of the children with adenotonsillar hypertrophy regardless of their clinical status.nnnMETHODSnThirty-nine children with a diagnosis of upper airway obstruction caused by adenotonsillar hypertrophy were included for the study. There were 16 female and 23 male patients. Ages of the children were between 3 and 10 years with a mean age of 5.78+/-1.98. Twenty children composed the control group with a similar age and sex distribution but without any sign and symptom of upper airway obstruction. Mean pulmonary arterial pressures were measured by Doppler echocardiography preoperatively and 6 months postoperatively. Symptom scores were calculated for each patient in the study group to assess their disease severity. The significances of changes and relations between pressure levels and symptom scores were calculated by statistical package for social sciences (SSPS) computer program in terms of Students test, chi(2)-test and Mc Nemars test.nnnRESULTSnMean pulmonary arterial pressure were 26.26+/-5.40 (14-36) preoperatively, 16,61+/-2.68 (10.15-22.3) postoperatively and 16.54+/-2.63 (10.5-21.7) in the control group. There were a statistically significant decrease at pressure levels postoperatively and a significant difference from the levels in the control group (Students t-test, p<0.01). We found no correlation between the pressure levels and disease severity assessed in terms of symptom scoring.nnnCONCLUSIONnThis study showed that upper airway obstruction caused by adenotonsillar hypertrophy causes significant elevation of pulmonary arterial pressures and adenotonsilectomy is an absolute therapeutic method in these children. Every child with adenotonsillar hypertrophy has some probability of having pulmonary hypertension regardless of his or her disease severity. Therefore, performing echocardiographic examination to all children with adenotonsillar hypertrophy is beneficial for assessing the cardiopulmonary status of the patient and may be useful at decision making for adenotonsilectomy.

Investigation of gastric pepsinogen in middle ear fluid of children with glue ear

Abstract Conclusion: The presence of pepsinogen in middle ear effusion (MEE) supports the relationship between gastroesophageal reflux (GER) and otitis media with effusion (OME). Measurement of pepsin/pepsinogen can be considered as a simple and reliable method for assesment of reflux in children. However, further research is needed to establish a definite association between GER and OME before beginning antireflux treatment in the management of MEE. Objective: The aim of this study was to investigate the relationship between GER and chronic OME, and to confirm the presence of gastric enzyme in the MEE of children with OME. Methods: This was a prospective study. MEE and blood samples were obtained from 42 children undergoing tympanostomy tube placement. Total pepsinogen concentrations of effusions and serum samples were measured with a commercial ELISA using a human pepsinogen I specific antibody. Albumin levels of effusions and serum samples were also measured with ELISA for comparison with pepsinogen levels. Results: Measurable pepsinogen was present in all MEEs from patients, with levels higher than the serum values. The difference between the levels of pepsinogen measured in MEE and serum was statistically significant (p < 0.01), but albumin levels were higher in serum than in MEE and the difference was statistically significant (p < 0.01).

Mental health and quality of life in patients with chronic otitis media

The present study focused on the comparison of mental health and quality of life (QoL) between chronic otitis media (COM) patients and the hearing population. The patients with chronic otitis media and healthy control group were enrolled in the study. The duration and severity of the auditory impairment were recorded. In addition to hearing loss (HL), the findings of each patient’s other ear disorders (ear discharge and tinnitus) were also recorded. In both the groups, psychological symptom profile and health-related QoL were evaluated and compared using a sociodemographic questionnaire, the Symptom Check List 90-Revised Form (SCL-90-R), and the Short Form-36 (SF-36). According to SCL-90-R, somatization (pxa0<xa00.001), interpersonal sensitivity (pxa0<xa00.001), depression (pxa0<xa00.001), phobic anxiety (pxa0<xa00.001), and other subscores, and also global severity index score (pxa0<xa00.001) were significantly high in patient group when compared to the control group. The patients with COM reported significantly lower levels of QoL in terms of physical role difficulty (pxa0<xa00.001), general health perception (pxa0<xa00.004), social functioning (pxa0<xa00.001), and mental health (pxa0<xa00.017) than those of control subjects. Our results indicated that COM patients with mild or moderate HL have poorer life quality and higher psychological problems. Psychological well being should be also considered in assessment of COM patients in addition to the clinical evaluation and audiological tests.

The protective role of caffeic acid phenethyl ester against streptomycin ototoxicity.

OBJECTIVEnThe aim of this experimental study was to investigate the efficacy of caffeic acid phenethyl ester (CAPE) in the prevention of streptomycin-induced ototoxicity.nnnMATERIALS AND METHODSnThirty-two adult Wistar albino rats were divided into 4 groups: control (n = 8), streptomycin (n = 8), CAPE (n = 8), and streptomycin + CAPE (n = 8). Rats were tested with distortion product otoacoustic emissions (DPOAEs) before drug administration. The animals in all groups were killed under general anesthesia on the 45th day following last DPOAE measurements. Hearing results were analyzed statistically to determine differences in amplitudes of DPOAE. Also, the cochleas of each rat were evaluated by histopathological and immunohistochemical examination.nnnRESULTSnSignificant difference was not observed in cochlear hair cells in the control and CAPE groups. In the streptomycin group, severe degeneration of hair cells and increased apoptotic cells were observed. In the streptomycin + CAPE group, although some deteriorations were observed, hair cells were mostly preserved. The DPgram of the streptomycin and streptomycin + CAPE groups was significantly deteriorated (P < .05). The analysis of the DPgram results revealed statistically significant differences between the groups of streptomycin and streptomycin + CAPE (P < .05).nnnCONCLUSIONSnCaffeic acid phenethyl ester treatment attenuated hair cells injury in the inner ear, possibly via its antioxidant effect. Prophylactic administration of CAPE for streptomycin ototoxicity ameliorated hearing deterioration in rats.

Effect of caffeic acid phenethyl ester on myringosclerosis development in the tympanic membrane of rat

Myringosclerosis is hyalinization and calcification of certain areas of the tympanic membrane, especially the fibrous lamina propria layer and appears as white sclerotic lesions. Ventilation tube insertion is one of the most performed operations in the pediatric otorhinolaryngology practice to treat chronic otitis media with effusion. Myringosclerosis is a very common sequela of ventilation tube insertion. In this experimental study, our aim was to show the histopathological effects of caffeic acid phenethyl ester on myringosclerosis development in rat tympanic membrane after myringotomy. The rats were randomly categorized into four experimental groups including the comparison group (nxa0=xa04), non-treated group (nxa0=xa07), the saline (control) group (nxa0=xa07), the caffeic acid phenethyl ester group (nxa0=xa07). Non-treated group did not receive any treatment for 15xa0days. Saline (2.5xa0mL/kg, intraperitoneal) was administered to the third group once a day for 15xa0days. Fourth group received caffeic acid phenethyl ester intraperitoneally once a day at a dose of 10xa0μmol/kg for 15xa0days. Myringotomy was performed on the right tympanic membrane of all rats except comparison group using a sterile pick with the help of an operating microscope. Histopathological examination of myringosclerosis formation was done by a pathologist under light microscope. In histopathological analysis of groups, the severity of inflammation was milder in caffeic acid phenethyl ester group compared to non-treated and saline groups (pxa0<xa00.05). There was less myringosclerotic plaques in caffeic acid phenethyl ester group than in non-treated and saline groups (pxa0<xa00.05). TM thickness measurements were very close to each other in non-treated and saline groups. The tympanic membrane thickness of caffeic acid phenethyl ester group was much thinner than the other two groups (pxa0<xa00.05). Caffeic acid phenethyl ester decreases inflammation severity and the formation of myringosclerotic plaques. These two effects resulted in thinner tympanic membranes of rats which were treated with caffeic acid phenethyl ester. As a result, caffeic acid phenethyl ester has potential preventive effects on myringosclerosis development after myringotomy and ventilation tube insertion.

Management of orbital complications of sinusitis in pediatric patients.

Abstract The most common reason of orbital infections is sinusitis. Orbital complications of sinusitis are mostly seen in children. Loss of vision and intracranial infections are among the complications of sinusitis. Prompt diagnosis and treatment is very important in the management of orbital complications. The orbital complication can be in the form of cellulitis or abscess. A retrospective review of 26 pediatric patients with orbital complications due to sinusitis was presented in this study. Of 26 patients, there were 13 cases of preseptal cellulitis, 2 cases of orbital cellulitis, and 11 cases of subperiosteal abscess. We grouped the preseptal and orbital cellulites in one category and the subperiosteal abscess in the other. All patients in the cellulitis group recovered by medical treatment. All the patients were treated by surgical drainage. Early diagnosis and appropriate treatment method are vital for the treatment of orbital complications secondary to sinusitis.

Evaluation of hyperactivity, attention deficit, and impulsivity before and after adenoidectomy/adenotonsillectomy surgery.

ObjectiveThe objective of this study was to determine the severity of attention deficit, hyperactivity, and impulsivity symptoms in patients with obstructive airway problems scheduled to undergo adenoidectomy or adenotonsillectomy operation. The effects of the surgical treatment on these symptoms will also be investigated in a case-control design. MethodsThis prospective study included 63 patients (29 girls, 34 boys) who were operated on at the Department of Otorhinolaryngology, Dicle University Medical School, between January 2010 and May 2011 because of obstructive symptoms caused by adenoid or adenotonsillar hypertrophy. The age range of the patients was between 4 and 13 years. The control group consisted of 33 (17 girls, 16 boys) healthy children. ResultsAmong the patients, 15 children underwent adenoidectomy because of adenoid hypertrophy; 13 patients had adenotonsillectomy because of adenotonsillar hypertrophy, and the remaining patients underwent adenotonsillectomy related with chronic or recurrent tonsillitis with adenoid hypertrophy. Based on the preoperative data, statistically significant difference was observed between the patient and control groups. The patients’ attention deficit, hyperactivity, and impulsivity symptoms preoperatively and postoperatively have shown statistically significant differences. ConclusionsAttention deficit, hyperactivity, and impulsivity symptoms were common among the children who show signs of airway obstruction due to adenotonsillar hypertrophy. Adenoidectomy or adenotonsillectomy operations were both observed to be associated with improvement in these symptoms.

The reconstruction of full-thickness ear defects including the helix using the superior pedicle postauricular chondrocutaneous flap.

AbstractThe ear is a complex structure with specific anatomical landmarks and different surface contour properties. In this article, we present the results that we obtained after reconstruction of full-thickness defects of the upper and middle third of the ear including the helix using a superior auricular artery (SAA) pedicled chondrocutaneous flap.In this study, 8 patients underwent reconstructions with postauricular SAA pedicled chondrocutaneous flaps between March 2009 and May 2011. Seven patients were male (88%), and 1 patient was female (12%). The age range was between 27 and 78 years, with a mean age of 57 years. The causes of the defects were tumor excisions in 6 patients and trauma in 2 patients. No serious postoperative complications such as wound infection, wound dehiscence, or partial or total flap loss were observed in any of the patients. A good cosmetic result was obtained with this technique with maximum preservation of the anatomical landmarks and without an effect on the vertical height or projection of the ear.In our experience, the postauricular SAA pedicled chondrocutaneous flap can be used as an appropriate alternative for the treatment of full-thickness defects of the upper and middle thirds of the ear including the helix.

Effects of caffeic acid phenethyl ester on wound healing of nasal mucosa in the rat: an experimental study

PURPOSEnWound healing of the nasal mucosa is a highly complex process that restores the anatomical and functional integrity of tissue that has been exposed to trauma. In this experimental study, our aim was to use histopathological examination to investigate the effects of caffeic acid phenethyl ester on the wound healing of rat nasal mucosa after mechanical trauma.nnnMATERIALS AND METHODSnThe rats were randomly divided into 3 experimental groups: a non-treated group (n=7), a control saline group (n=7) and a caffeic acid phenethyl ester group (n=7). The non-treated group received no treatment for 15 days. The second group was administered saline (2.5 mL/kg, intraperitoneal) once a day for 15 days. The third group received caffeic acid phenethyl ester intraperitoneally at a dose of 10 μmol/kg once a day for 15 days. At the beginning of the study, unilateral mechanical nasal trauma was induced on the right nasal mucosa of all rats in the three groups using a brushing technique. Samples were stained using hematoxylin and eosin solution and were examined by a pathologist using a light microscope.nnnRESULTSnThe severity of inflammation was milder in the caffeic acid phenethyl ester group compared with that in the non-treated and saline groups (P<0.05). The subepithelial thickness index was lower in the experimental group (P<0.05). Goblet cell and ciliated cell loss was substantially reduced in the experimental group compared with the non-treated and saline groups (P<0.05).nnnCONCLUSIONSnCaffeic acid phenethyl ester decreases inflammation and the loss of goblet cells and ciliated cells. Therefore, caffeic acid phenethyl ester has potential beneficial effects on the wound healing of nasal mucosa in the rat.

How does reflux affect laryngeal tissue quality? An experimental and histopathologic animal study

OBJECTIVE: To investigate the histopathologic changes in intact laryngeal epithelium and mucosa exposed to endogenous gastric acid and pepsin in an experimental model of reflux. STUDY DESIGN: Randomized trial. SETTING: The study was conducted at the animal care facility of Haydarpasa Numune Education and Research Hospital. SUBJECTS AND METHODS: Eighteen healthy 200- to 220-g, 20-week-old Sprague-Dawley rats were used. The animals were divided into three groups according to exposure time (1-, 4-, and 12-week exposures), and four rats were examined as controls who underwent sham operation. An experimental model of gastroesophageal reflux was induced. After exposure, the animals were euthanized, and their larynges were removed. The histopathologic changes in the larynx were observed under a light microscope. RESULTS: The mean scores for inflammation in the control, one-, four-, and 12-week groups were 0.75 ± 0.50, 1.75 ± 0.50, 2.20 ± 0.45, and 1.94 ± 0.87, respectively. However, mean scores for vascular engorgement in the control, one-, and four-week groups were 0, and in the 12-week group was 2.0 ± 0.70. The mean scores for subepithelial edema in the control, one-, four-, and 12-week groups were 1.00 ± 0, 1.75 ± 0.95, 1.80 ± 0.45, and 2.20 ± 0.84, respectively. However, mean scores for keratinization for the control, one-, and four-week groups were 0, and for the 12-week group was 1.60 ± 0.55. When we compared inflammation, vascular engorgement, subepithelial edema, and keratinization mean scores between the control and study groups, there were statistically significant increases (P = 0.005, P = 0.001, P = 0.043, P = 0.002, respectively). CONCLUSION: Our findings suggest that reflux induces significant histopathologic changes in larynx mucosa.