Yalcin Alimoglu

Evaluation of nasal cytology in subjects with chronic rhinitis: a 7-year study

BACKGROUND No diagnostic test had been specifically developed to diagnose nonallergic rhinitis (NAR). Also a negative nasal smear for eosinophils does not rule out the diagnosis. There is a significant diagnostic problem in patients with NAR. How can we solve this problem? OBJECTIVES Assessment of other cells than eosinophils present in the cytogram such as basophils, neutrophils, and goblet cells may help us to classify and management of diagnostic problem of rhinitis. We sought to characterize the cellular pattern of patients with allergic rhinitis (AR) and compare them with those of NAR. METHODS According to the skin prick test positivity or negativity, individuals were divided into AR and NAR groups, respectively. Allergic rhinitis group was further divided into seasonal, perennial, and mixed subgroups. Nonallergic rhinitis group was also divided into the following 5 subgroups according to the nasal smear cytologic result: basophilic, neutrophilic, eosinophilic, mixed, and nonallergic noninfectious type. So the frequency rates of the subgroups were calculated and also smear cytologic results were compared. RESULTS Frequency of AR was approximately equal to NAR in subjects with chronic rhinitis. Neutrophilic, eosinophilic, mixed, and nonallergic noninfectious types were the common types of NAR. An evident nasal eosinophilia was found in AR and eosinophilic NAR, whereas a higher percentage of goblet cells were determined in nonallergic noninfectious rhinitis. There is no significant difference between cytologic results from NAR and AR patients. CONCLUSION In the patient with positive skin test result, the presence of nasal eosinophilia strongly supports the diagnosis of AR. No diagnostic test had been specifically developed to diagnose chronic NAR. Also, a negative nasal smear for eosinophils does not rule out the diagnosis. Assessment of other cells present in the cytogram such as basophils, neutrophils, and goblet cells may also provide valuable information for differential diagnosis and management of these conditions.

Primary Tuberculosis Involving Epiglottis: A Rare Case Report

The case of a 29-year-old patient with active laryngeal tuberculosis predominantly involving the epiglottis, without pulmonary disease, is presented. The predominant symptoms are dysphagia, odynophagia, and hoarseness. Laryngeal carcinoma, which shares almost the same symptoms and signs, should be ruled out immediately. Laryngeal tuberculosis is discussed with a brief literature review.

Comparison of Odiosoft-Rhino and rhinomanometry in evaluation of nasal patency.

OBJECTIVE To conduct a preliminary study testing the validity of the Odiosoft-Rhino (OR) in the evaluation of nasal patency in patients with nasal septal deviation and compare the results with visual analogue score (VAS) of nasal obstruction and rhinomanometry (RMM). METHODS OR and RMM were performed on 68 patients with nasal septal deviation and 61 healthy controls. VAS, nasal resistance values and nasal sound analysis were noted for the left and right nasal cavities. RESULTS There are statistically significant differences between VAS, RMM and nasal endoscopic findings between the patient and the control group. The OR results at expiratory and inspiratory 2000 - 4000 Hz and 4000 - 6000 Hz intervals for both nasal cavities show a statistically significant difference between the patient and control groups. Nasal endoscopic findings, RMM, OR results of the deviated sides in the 2000 - 4000 Hz interval correlate well with VAS. CONCLUSIONS OR may be a practical test in assessment of nasal patency. OR at the 2000 - 4000 Hz interval shows a correlation with VAS. However, showing a correlation between a test and a variable is not the same as proving that it is a useful diagnostic test. Therefore, more studies with larger series are needed.

Paradoxical vocal cord motion--haloperidol usage in acute attack treatment.

Paradoxical vocal cord motion (PVCM) is an uncommon disease characterized by vocal cord adduction during inspiration and/or expiration. It can create shortness of breath, wheezing, respiratory stridor, or breathy dysphonia. Possible etiological factors include asthma, underlying psychologic condition, gastroesophageal acid reflux disease, respiratory irritants exposure, central neurologic diseases, viral upper airway infections, and postsurgical procedures. Many treatment modalities were performed for acute attack of PVCM, including reassurance and onsite maneuvers, benzodiazepines, heliox, and so forth. We report a patient with PVCM who had stridor and dyspnea for 10 days and responded to intravenous haloperidol treatment.

Huge arteriovenous malformation in masseter muscle.

Arteriovenous malformation is a tumor characterized by direct connection between an artery and vein without capillaries in-between, and it is commonly located intracranially. Intramuscular arteriovenous malformations are rare in the head and neck region. Less than 1% of the vascular tumors are localized in a muscle, 15% of them are in the head and neck muscles. Among the head and neck muscles, masseter muscle is the most common location, with the rate of 4.9%. The condition of a 36-year-old patient who applied to our clinic with the complaints of progressively increasing pain and progressively growing mass in the right cheek that appeared 1.5 years ago was diagnosed as arteriovenous malformation located in the masseter muscle. After preoperative embolization, the mass was successfully treated with total excision. In this case report, diagnostic and therapeutic tools addressing arteriovenous malformation located in the masseter muscle are discussed in the light of current literature.

Nasal patency by rhinomanometry in patients with sensation of nasal obstruction.

Background The objective assessment of nasal patency is a common challenge in clinical practice. This study was designed to show and compare the values of active anterior rhinomanometry (RMM) in patients with sensation of nasal obstruction. Methods According to the physical examination, 7283 individuals with sensation of nasal obstruction were divided into the nasal septal deviation (NSD) group and normal nasal anatomy group. The NSD group and normal nasal anatomy group were further divided into subgroups according to skin-prick test positivity or negativity, respectively. Nasal airway resistances (NARs) of the subgroups were evaluated and compared. Results The mean value of total inspiratory NAR was 0.51 and 0.34 Pa/cm3 per second at 150-Pa pressure point in allergic rhinitis subjects with and without NSD, respectively; 0.48 and 0.32 Pa/cm3 per second were the mean values of total inspiratory NAR in nonallergic rhinitis subjects with and without NSD, respectively. The total inspiratory resistances in groups with NSD were significantly higher than the others. Conclusion We believe that the results of so large a number of participants in this test will make an obvious contribution to the medical literature.

Comparison of Frey Syndrome Rates Following Superficial Parotidectomy and Partial Superficial Parotidectomy for Pleomorphic Adenoma.

Purpose:Comparison of Frey syndrome rates following superficial parotidectomy and partial superficial parotidectomy for pleomorphic adenoma. Methods:Fifty patients diagnosed with pleomorphic adenoma and received surgical treatment at the Otolaryngology Department of Bagcilar Training and Research Hospital between January 2009 and October 2015 were reviewed retrospectively. The patients were specifically queried for Frey syndrome symptoms. The syndrome was investigated with Minor starch iodine test. The patients who underwent superficial parotidectomy were compared to those who underwent partial superficial parotidectomy in terms of Frey syndrome development and recurrence. Results:In the partial superficial parotidectomy group, Frey syndrome symptoms were edema and increased sweating and burning sensation on the face in 7 patients (21.9%, P = 0.735). In the superficial parotidectomy group, 5 patients exhibited edema (27.8%), 3 exhibited increased sweating (16.7%), and 5 exhibited burning sensation (27.8%). Minor test results were positive for 7 patients in the partial superficial parotidectomy group (21.8%) and 5 patients were positive (27.8%) in the superficial parotidectomy group. No recurrence was found in either group during the 5-year follow-up. No significant difference was found between 2 groups in terms of postoperative complications and recurrence. Conclusion:In terms of their effect on Frey syndrome development, there is no significant difference between partial superficial parotidectomy and superficial parotidectomy.

Epidermal inclusion cyst of external auditory canal.

Epidermal inclusion cyst is a benign cyst filled with keratin fibers, and its wall has nearly the same characteristics as the epidermis. It is commonly seen in the skin and has the tendency to slowly grow toward deeper epidermis parts and to cause cystic expansion. We report a 23-year-old woman who presented with right external otitis lasting for 2 months. The patients complaints did not respond to treatment even after parenteral antibiotic therapy. Surgical exploration revealed epidermal inclusion cyst of the ear canal. This pathologic entity is discussed in the light of current literature.

Oropharyngeal flora changes after tonsillectomy

Objective: We aimed to investigate the effect of tonsillectomy on oropharyngeal flora in children who underwent tonsillectomy for chronic recurrent tonsillitis. Study Design and Setting: A prospective study was performed comprising patients with chronic recurrent tonsillitis who underwent tonsillectomy at the Department of Otolaryngology, Cerrahpasa Medical School. Incisional core biopsies of excised tonsils were also performed. Swabs and core biopsy specimens were transferred and maintained in Stuarts medium and sent to the Department of Microbiology and Clinical Microbiology at Cerrahpasa Medical School for microbiologic evaluation. Subjects and Methods: Oropharyngeal swabs and tonsillar core biopsy specimens from 31 patients operated on for recurrent tonsillitis were cultured. Follow-up oropharyngeal swabs were cultured one month after tonsillectomy. Results: There was no significant difference between the preoperative and postoperative isolation rate of the potentially pathogenic bacteria. Normal aerobic flora did not change significantly. However, the isolation rate of the Neisseria species dropped (P = 0.097) but did not reach statistical significance. Among anaerobes, Bacteroides fragilis, one of the major anaerobic bacteria, dropped significantly (P = 0.007). The Propionibacterium acnes isolation rate increased significantly (P = 0.009). Conclusion: Oropharyngeal anaerobic bacterial flora decreases after tonsillectomy in recurrent tonsillitis patients. The isolation rate for bacteria of the normal flora and potentially pathogenic bacteria does not change. Tonsils with recurrent infections may become a nidus for anaerobic bacteria. In patients with chronic recurrent tonsillitis, tonsillectomy may help change anaerobic bacterial oropharyngeal flora to the normal flora found in healthy individuals.

High-grade mucoepidermoid carcinoma of the larynx.

Laryngeal mucoepidermoid carcinoma is rare. Approximately 85 cases have been reported in the literature. There is no standardized treatment because of the rarity of the disease. A case of a 55-year-old man with laryngeal mucoepidermoid carcinoma, who was treated with total laryngectomy and postoperative radiotherapy, is presented, and current literature is reviewed.