The effect of radiofrequency thermal ablation method on nasal mucociliary activity in patients with inferior turbinate hypertrophy

OBJECTIVES

This study aims to investigate the effect of radiofrequency thermal ablation (RFTA) treatment on nasal mucociliary activity before and after treatment in inferior turbinate hypertrophy.

PATIENTS AND METHODS

Thirty-nine patients (21 males, 18 females; mean age 36.3±13.9 years; range 16 to 67 years) admitted to our clinic with complaint of nasal obstruction and diagnosed with stromal inferior turbinate hypertrophy were included in this study. Effect of RFTA treatment on nasal mucociliary activity was investigated by saccharine test before treatment and two months after treatment. Grade of nasal obstruction was evaluated by visual analog scale (VAS) before treatment and two months after treatment. Results were compared with paired t-test.

RESULTS

Mean mucociliary activity times were 9.8±4.4 minutes before treatment and 9.6±4.1 minutes two months after treatment, and the difference between two tests was not statistically significant (p=0.3). Mean VAS scores for nasal obstruction were 6.5±1.2 before treatment and 3.8±1.0 two months after treatment, and the difference between two results was statistically significant (p=0.001). Difference between sexes in terms of saccharine transit time and VAS values before and after treatment was not statistically significant (p>0.05).

CONCLUSION

It was detected that RFTA has no adverse effect on mucociliary activity in the treatment of inferior turbinate hypertrophy, and this method is notably effective in relieving the nasal obstruction caused by inferior turbinate hypertrophy.

A Hemophagocytic Lymphohistiocytosis Case with Newly Defined UNC13D (c.175G>C; p.Ala59Pro) Mutation and a Rare Complication

Hemophagocytic lymphohistiocytosis (HLH) represents a severe hyperinflammatory condition with cardinal symptoms of prolonged fever, cytopenias, hepatosplenomegaly, and hemophagocytosis by activated, morphologically benign macrophages with impaired function of natural killer cells and cytotoxic T lymphocytes. A 2-month-old girl, who was admitted with fever, was diagnosed with HLH and her genetic examination revealed a newly defined mutation in the UNC13D (c.175G>C; p.Ala59Pro) gene. She was treated with dexamethasone, etoposide, and intrathecal methotrexate. During the second week of treatment, after three doses of etoposide, it was noticed that there was a necrotic plaque lesion on the soft palate. Pathologic examination of debrided material in PAS and Grocott staining revealed lots of septated hyphae, which was consistent with aspergillosis infection. Etoposide was stopped and amphotericin B treatment was given for six weeks. HLH 2004 protocol was completed to eight weeks with cyclosporine A orally. There was no patient with invasive aspergillosis infection as severe as causing palate and nasal septum perforation during HLH therapy. In immuncompromised patients, fungal infections may cause nasal septum perforation and treatment could be achieved by antifungal therapy and debridement of necrotic tissue.

The effects of caspofungin and voriconazole in an experimental fungal infection of the ear due to Aspergillus

The purpose of the study was to evaluate the effectiveness of caspofungin and voriconazole in the treatment of experimental Aspergillus otitis media in an experimental rabbit model. A total of 30 New Zealand white rabbits were divided into four treatment groups and one control group. The rabbits were immunosuppressed by cyclophosphamide and triamcinolone acetonide. The right ear of each rabbit was infected by an injection of the inoculum of 0.1 ml (8.6 x 103 CFU/0.1 ml) of Aspergillus fumigatus into the middle ear cavity. At 72 h after the inoculation, amphotericin B 1 mg/kg per day (n = 6), itraconazole 10 mg/kg per day (n = 6), voriconazole 10 mg/kg per day (n = 6) and caspofungin 5 mg/kg per day (n = 6) were injected to each treatment group. No antifungal drug was administered to the control group (n = 6). Clinical and histopathological examination scores and microbiological analysis of middle ear mucosa were compared.There was statistically significant difference in the clinical scores, histopathological scores, and mean CFU/g between the treatment and control groups (P < 0.05). There was no statistically significant difference among the treatment groups in the clinical and histopathological scores, whereas there was statistically significant difference in the mean CFU/g (P < 0.05). The mean CFU/g of amphotericin B and caspofungin groups were similar and both were lower than the itraconazole and voriconazole groups. Also, the mean CFU/g of voriconazole group was lower than the itraconazole group (P < 0.05). Caspofungin and voriconazole were demonstrated at least as effective as amphotericin B and itraconazole. We suggest that caspofungin and voriconazole may be considered for the treatment of fungal infection of the ear.

Incidence of auditory neuropathy among the deaf school students

OBJECTIVE

We aimed to determine the incidence of auditory neuropathy (AN) among the deaf school students that have severe hearing loss.

METHOD

All students having severe hearing loss constituting a total of 75 at Deafness school in Afyon Province of Turkey were enrolled in the study. The etiological factors about the hearing loss were determined by performing an individual file survey and by interviewing the teachers and parents. First, all the children were subjected to an otolaryngologic examination. Then, auditory brainstem response (ABR) and transient evoked otoacoustic emissions (TEOAE) tests were done to all students enrolled in the study.

RESULTS

The ages of the children were between 6 and 17 (mean age 11.9) and 32 (42.9%) of them were girls and 43 (57.1%) were boys. Three cases (4%) were diagnosed as AN in our study, however, no risk factors were determined in two of them. A history of hearing loss following a vaccination was found in only one patient.

CONCLUSION

Our data show that the incidence of AN in the children with severe hearing loss is not negligible. Therefore, our results suggest that automatic ABR should be also used with OAE as a routine application in the neonatal screening programmes, since the solely use of OAE in the neonatal screening programmes may result in the delay of the diagnosis of the children with AN.

Can Rh antigens be a risk factor in noise-induced hearing loss?

Noise-induced hearing loss (NIHL) is one of the most common occupational problems and is one of the main causes of deafness. Many factors cause NIHL. Individual susceptibility is one of them. Rhesus (Rh) antigens and ABO blood groups can be factors in determining individual susceptibility. We aim to investigate the relationship between the Rh antigens and NIHL. The study was conducted in 438 factory workers who had been exposed to a noise level more than 85 dB for 8 h a day for a period of >/=15 years. The audiologic results and blood groups were obtained from the individual health records of the factory workers. We determined NIHL in 236 (53.9%) workers. Two hundred and nineteen (55.4%) of Rh-positive workers and seventeen (39.5%) of Rh-negative workers have NIHL, and the difference between the two groups was statistically significant (P < 0.05), whereas no statistically significant difference was determined between the NIHL and ABO blood groups. In conclusion, we suggest that the people with Rh-positive blood group are more prone to develop NIHL.