Effects of Anatolian Propolis and Hypertonic Saline Combination Nasal Spray on Allergic Rhinitis Symptoms: A Prospective, Multicenter Study

Objectives: This study aimed to evaluate how Rhinapi nasal spray affects symptoms of allergic rhinitis. Methods: In this prospective, multicenter, observational study, 10,000 patients (comprising 5028 males and 4972 females) exhibiting symptoms of allergic rhinitis (namely, nasal discharge, sneezing, nasal itching, and nasal obstruction) from different centers in different regions of Turkey were enrolled in the study between March 2022 and March 2023. All the patients wanted to participate in the study and were administered Rhinapi one puff to each nostril three times a day, for a period of 3 weeks. Total symptom scores, quality of life (QoL) scores, and otolaryngological examination scores were evaluated before and 3 weeks after treatment. Results: The scores for discharge from the nose, sneezing, nasal pruritus, and blockage of the nose all indicated improvement when compared to pre-medication and post-medication. This difference achieved statistical significance (P < .001). The mean total symptom score fell following treatment (P < .001): whilst the score was 11.09 ± 3.41 before administering Rhinapi; after administration, the average score was 6.23 ± 2.41. The mean QoL scores also altered after medication (P < .001), improving from a mean value of 6.44 ± 1.55 to a mean of 7.31 ± 1.24. Significant improvement was also noted in the scores for conchal color and degree of edema after the treatment had been administered (P < .001). Conclusion: The study demonstrates that Rhinapi nasal spray decreases total symptom scores, and results in improved QoL and otolaryngological examination scores. Propolis spray may be recommended for patients with allergic rhinitis alongside other treatments.

Examination of the Relation Between Audiometric Configuration and Hematological Parameters in Idiopathic Sudden Sensorineural Hearing Loss

Among the hematological parameters, neutrophil/lymphocyte ratio (NLR) and platelet/ lymphocyte ratio (PLR) have been associated with inflammatory state, microvascular damage and ischemia. It is well-known that these ratios increase in idiopathic sudden sensorineural hearing loss (ISSHL). In ISSHL, different audiographic features may reflect different disease mechanisms. This study aimed to investigate whether there were differences in NLR and PLR among patient groups with different audiometric configurations. Patients meeting the study inclusion criteria were divided into four groups according to their audiogram configurations. Mean NLR and PLR values of the patient groups were compared among themselves and versus control group. The study was conducted with 166 participants. Mean NLR values were 3.07 ± 2.48, 3.30 ± 2.70, 5.24 ± 3.71, 3.57 ± 3.19 and 1.51 ± 0.68 for ascending, flat, descending and total/subtotal audiometric configuration groups and control group, respectively. Mean PLR values were 145.2 ± 126.7, 130.9 ± 57.8, 192.2 ± 94.4, 143.7 ± 70.8 and 94.1 ± 24.7 for ascending, flat, descending, total/subtotal audiometric configuration groups and control group, respectively. Both NLR and PLR were significantly greater in patients from all configuration groups than in control group (p < 0.05). In addition, the group with descending audiometric configuration showed significantly higher mean NLR and PLR compared to other audiometric configuration groups (p < 0.05). The highest level of inflammation was detected in the ISSHL patient group with high frequency hearing loss and descending audiographic configuration.

The effect of anatomic variations and maxillary sinus volume in antrochoanal polyp formation

PURPOSE

The antrochoanal polyp (ACP), otherwise known as the Killain polyp, is a benign lesion that originates from maxillary sinus mucosa, extending from the accessory ostium towards the middle meatus, and later tends to protrude posteriorly towards the choana and nasopharynx. Many studies have emphasized that its etiopathogenesis is unclear. Research suggests that chronic sinusitis and allergic rhinitis are factors that play an important role in the formation of ACP, as well as anatomical variations. In this study, we aimed to evaluate the effect of anatomical variations and maxillary sinus volume in patients diagnosed with anthrochoanal polyp.

METHODS

Paranasal sinus computed tomography (PNS CT) images of patients with unilateral ACP patients were examined. The non-ACP sides of the patients comprised the control group. Nasal septal deviation, agger nasi cells, concha bullosa, paradoxical middle turbinate, hyperpneumotized ethmoid bulla, uncinate pathology (medialized or pneumatized uncinate), haller cell, accessory ostium, maxillary sinus retention cyst and maxillary sinus volumes were evaluated.

RESULTS

The study included a total of 54 patients (33 females, 21 males). Mean patient age was 22.92 ± 13.95 (range 6-56) years. Mean maxillary sinus volume was 17.88 ± 5.16 mm³ for the ACP sides and 16.37 ± 4.55 mm³ for the non-ACP sides. Maxillary sinus volume was significantly larger in the ACP side (p = 0.000). Concha bullosa was observed on the ACP side in 23 patients (42.6%) and in the non-ACP side in 21 patients (38.9%). Agger nasi cells were observed in the ACP side in 47 patients (87.0%) and in the non-ACP side in 42 patients (77.7%). Hyperpneumatized ethmoid bulla was observed in the ACP side in 14 patients (25.9%) and in the non-ACP side in 12 patients (22.2%). Haller cells were observed in the ACP side in seven patients (12.96%) and in the non-ACP side in ten patients (18.51%).

CONCLUSION

Disrupted airflow of the well-developed maxillary sinus cavity due to anatomical variations seems to be an effective factor in the formation of ACP.

The Effect of Extranodal Extension on Survival in Laryngeal Carcinoma

It is known that lymph node metastasis lowers the survival rates in laryngeal carcinoma. This study aimed to investigate the effect of extranodal extension in lymph node metastasis on survival. The demographic characteristics and histopathologic results of 81 patients who underwent total laryngectomy and neck dissection due to advanced larynx squamous cell carcinoma between 2011 and 2018 were reviewed retrospectively. The patients were divided into 3 groups by lymph node metastasis status as reactive lymph node (group 1), lymph node metastasis without detected extranodal extension (group 2), and lymph node metastasis with detected extranodal extension (group 3). Survival analysis was performed between these 3 groups. In the patient population with a mean age of 61.56 years consisting of 6 females and 75 males, demographic characteristics between groups were comparable. Overall survival (OS) rates were detected to be 81% in group 1, 69.2% in group 2, and 61.5% in group 3. Two-year OS rates were detected to be 66.7% in group 1, 46.2% in group 2, and 38.5% in group 3. Statistical difference was detected between group 1 and group 3 both for OS and 2-year OS (P = .014, P = .008, respectively). No statistical difference was detected between group 2 and group 1, and between group 2 and group 3. In this study, we found a negative effect of detecting neck lymphadenopathy metastasis and extranodal extension on survival in patients who underwent total laryngectomy and neck dissection due to advanced laryngeal carcinoma.

Curettage adenoidectomy versus endoscopic microdebrider adenoidectomy in children: A randomized controlled trial

INTRODUCTION

Adenoidectomy is one of the most frequently performed surgical procedures with different techniques and technologies. Although curettage adenoidectomy (CA) has been practiced conventionally for many years, endoscopic microdebrider adenoidectomy (EMA) has emerged as an innovative surgical method. Comparing physiological effects, efficacy and safety of the endoscopic microdebrider adenoidectomy (EMA) and curettage adenoidectomy (CA) in pediatric population is aimed with this prospective, single-blind, randomized, controlled trial.

METHODS

Sixty pediatric patients with type-A tympanogram according to Jerger classification in both ears before surgery were randomly assigned to receive the CA (n = 30) and the EMA (n = 30). Tympanometry evaluation for each ear was performed the day before surgery firstly and was repeated on days 1, 7 and 14 after surgery. Intraoperative time, complications during and after the operation were recorded. Postoperative pain was also evaluated for 10 days postoperatively.

RESULTS

Tympanometric evaluation revealed significantly reduced middle ear peak pressure levels with the EMA than with the CA for each ear on day 1 after surgery and for only left ear on day 7 after surgery (P < 0.05). In addition, statistically significant reduced pain scores in postoperative first 3 days were related to the EMA (P < 0.05). There was no significant difference between the methods in terms of duration of surgery and complications.

CONCLUSION

According to findings from this study, the EMA procedure may be as safe and rapid as the CA. Furthermore, the EMA may be more controlled and less invasive to the surrounding tissues. Further studies are advised to support these data.

The anatomic analysis of the vidian canal and the surrounding structures concerning vidian neurectomy using computed tomography scans

INTRODUCTION

The type of endoscopic approach chosen for vidian neurectomy can be specified by evaluating the vidian canal and the surrounding sphenoid sinus structures.

OBJECTIVE

The variations and morphometry of the vidian canal were investigated, focusing on the functional correlations between them which are crucial anatomical landmarks for preoperative planning.

METHODS

This study was performed using paranasal multidetector computed tomography images that were obtained with a section thickening of 0.625mm of 250 adults.

RESULTS

The distributions of 500 vidian canal variants were categorized as follows; Type 1, within the sphenoid corpus (55.6%); Type 2, partially protruding into the sphenoid sinus (34.8%); Type 3, within the sphenoid sinus (9.6%). The pneumatization of the pterygoid process is mostly seen in vidian canal Type 2 (72.4%) and Type 3 (95.8%) (p<0.001). The mean distances from the vidian canal to the foramen rotundum and the palatovaginal canal were greater in the vidian canal Type 2 and 3 with the pterygoid process pneumatization (p<0.001). The prevalence of the intrasphenoid septum between the vidian canal and the vomerine crest and lateral attachment which ending on carotid prominence were much higher in vidian canal Type 3 than other types (p<0.001). The mean angle between the posterior end of the middle turbinate and the lateral margin of the anterior opening of the vidian canal was measured as 33.05±7.71°.

CONCLUSIONS

Preoperative radiologic analysis of the vidian canal and the surrounding structures will allow surgeons to choose an appropriate endoscopic approach to ensure predictable postoperative outcomes.

Comparison of Early Versus Delayed Oral Feeding After Total Laryngectomy in Terms of Pharyngocutaneous Fistula Development

Objective

There is still no consensus on the effect of early oral feeding and nasogastric tube feeding on the development of pharyngocutaneous fistula (PCF) after total laryngectomy. The aim of the present study was to compare the effects of early oral feeding and nasogastric tube (NGT) feeding after total laryngectomy on the incidence of PCF.

Methods

A total of 59 male and three female patients with a mean age of 61.65 (range 44-77) years who underwent total laryngectomy and bilateral neck dissection between May 2010 and June 2016 were evaluated retrospectively. Thirty-two patients started oral feeding on postoperative day three, and 30 patients started NGT feeding on postoperative day one following oral feeding on 7th day. Besides the investigation of the factors which can affect PCF formation, the incidence of PCF was also determined between the two groups of patients.

Results

Only preoperative albumin value was different between the groups in the determination of factors which can affect development of PCF. No statistical difference was found between the two groups in terms of the development of PCF and the length of hospital stay (p>0.05).

Conclusion

To start oral feeding on postoperative day three or with a NGT feeding on postoperative day one following oral feeding on day seven did not affect the development of PCF and the length of hospital stay in patients who underwent total laryngectomy.

Paranasal Sinus Anatomic Variations Accompanying Maxillary Sinus Retention Cysts: A Radiological Analysis

Objective

The risk factors for the development of retention cysts of the maxillary sinuses (RCMs) are not clear, although RCMs are common findings on radiographic images. This study was conducted to evaluate the correlation between RCMs and other nasal-paranasal anomalies and to demonstrate the possible effects of these anomalies on the development of RCMs.

Methods

In the study, paranasal sinus computerized tomography (PNsCT) images from 5166 patients were retrospectively reviewed. Correlations between RCMs and osteomeatal complex obstruction, accessory ostium presence, abnormalities of the middle turbinate, and nasal septal deviation were analyzed in the PNsCT images. The paranasal sinus anomalies on the side of the RCMs were compared to the contralateral side.

Results

A total of 1880 RCMs were detected in 1429 (27.6%) of 5166 patients. At least one nasal-paranasal sinus anomaly was associated with 88.7% of the RCMs. In the descending order, accessory ostium presence, accessory ostium, middle turbinate anomalies, and nasal septal deviation are pathologies that accompany RCMs. When unilateral RCMs were compared with the normal side, significant correlations were observed between RCMs and osteomeatal complex obstruction, accessory ostium, and middle turbinate anomalies (p=0.001, p=0.016, and p=0.03, respectively). RCMs were commonly found on the same side as osteomeatal complex obstruction (p=0.001), middle turbinate anomalies (p=0.001), and accessory ostium (p=0.052).

Conclusions

In this study, the coexistence of osteomeatal complex obstruction, accessory ostium, middle turbinate anomalies, and nasal septum deviation with RCMs was analyzed by investigating PNsCT findings in 5166 patients. The results show that RCMs are associated with pathologies that increase paranasal inflammation, such as osteomeatal complex obstruction, and are good markers for nasal-paranasal sinus anomalies. The presence of incidental RCMs should be a warning sign of nasal-paranasal sinus anomalies.

Comparison of Hydroxyapatite Prosthesis and Incus Interposition in Incus Defects

Objective

Chronic otitis media most commonly causes an ossicular chain defect in incus. Different materials can be used for repair of this defect. In this study, the hydroxyapatite prosthesis, used for repair of the incus defect, was compared with the incus interposition.

Methods

Between 2010 and 2016, 27 female and 16 male patients who underwent ossiculoplasty due to an incus defect were studied retrospectively. Patients' hearing results at the sixth month were compared. The hydroxyapatite prosthesis was used in 24 patients (group 1) and incus interposition was used in 19 patients (group 2) for the ossicular chain repair. Hearing gain at 500, 1000, 2000, and 4000 Hz between the two groups and the success rates in the two groups were compared.

Results

Successful hearing reconstruction was performed on 10 patients in each group (group 1, 41.6% and group 2, 52.9%). There was no statistically significant difference between groups both in terms of successful hearing and hearing gain at 500, 1000, 2000, and 4000 Hz. There was no extrusion of the materials used in both groups.

Conclusion

As it does not have any additional cost and is easily shaped and biocompatibility problem is not encountered; we recommend using incus interposition primarily in incus defects.

The Effects of Prognostic Factors in Idiopathic Sudden Hearing Loss

Introduction  Sudden hearing loss is one of the otologic emergencies. The treatment of this disease is affected negatively by some prognostic factors. Objective  In this study, the effects of early treatment initiation in patients with idiopathic sudden hearing loss and of prognostic factors in early treated patients were investigated. Methods  Out of the 216 patients admitted between September 2007 and September 2015, 154 were identified as having idiopathic sudden hearing loss; they were followed-up for a mean time of 7.4 months, and evaluated retrospectively. The effects of several parameters on the success of the treatment were statistically evaluated, such as the time the treatment was initiated, being of the female gender, the severity of the hearing loss, having descending type audiogram patterns, being older than 60 years old, and the co-presence of vertigo. Results  Success rates were found to be significantly higher in idiopathic hearing loss patients that were admitted within the first week ( p  < 0.05) of the onset of the hearing loss. However, the outcomes were found to be similar when patients admitted within the first 3 days and 4-7 days after the occurrence of the hearing loss were compared ( p  > 0.05). Parameters such as female gender, severe hearing loss, descending type audiogram, being older than 60 years old, and co-presence of vertigo didn't reveal statistically significant effects on the outcome ( p >0.05). Conclusion  The aforementioned prognostic factors, which are well-known in the literature, did not have significant effects when the idiopathic sudden hearing loss treatment was initiated within the first 7 days of the onset of the hearing loss.

An Unusual Neck Mass: Ingested Chicken Bone

BACKGROUND

Foreign bodies in the upper aerodigestive tract are frequently seen in otolaryngological practice, but migration of an ingested foreign body to the neck is a very rare condition.

CASE REPORT

We present a 66-year-old woman admitted to our outpatient department with a painful neck mass. She had a history of emergency department admission 4 months prior with odynophagia after eating chicken meal. A physical examination revealed a painful and hyperemic mass on the left neck. Antibiotherapy did not relieve the patient's symptoms and signs. A 3-cm linear foreign body was observed in X-ray and computed tomography scans. The symptoms of the patient were relieved after excision of the foreign body.

CONCLUSION

Although it is a rare situation, migration of a foreign body ingested through the aerodigestive tract to the neck should be kept in mind in the differential diagnosis of patients who present with neck masses.

Apparent diffusion coefficient for discriminating metastatic lymph nodes in patients with squamous cell carcinoma of the head and neck

PURPOSE

We aimed to evaluate the apparent diffusion coefficient (ADC) values of metastatic lymph nodes in patients with squamous cell carcinoma (SCC) of the head and neck.

METHODS

Patients with metastatic lymph nodes underwent 1.5 Tesla diffusion-weighted magnetic resonance imaging (MRI). The ADC values of the histologically proven metastases were evaluated retrospectively and mean ADC values were compared using one-way analysis of variance test. Receiver operating characteristic analysis was performed to identify ADC threshold values.

RESULTS

We included 33 patients (27 males, 6 females; mean age, 60.7 years) with 53 metastatic lymph nodes in the study. Mean ADC values for nodal metastases of nasopharyngeal carcinoma (NPC) (n=7), oropharyngeal (n=12), laryngeal (n=27), and hypopharyngeal (n=7) carcinoma were (0.810±0.158)×10-3 mm2/s, (0.985±0.099)×10-3 mm2/s, (1.037±0.150)×10-3 mm2/s, and (0.948±0.081)×10-3 mm2/s, respectively. The mean ADC values of nodal metastases of NPC were significantly lower than ADC values of laryngeal carcinoma (LSCC) (P = 0.002). An ADC value less than 0.890×10-3 mm2/s was found to facilitate differentiation of NPC from LSCC with a sensitivity of 71% and specificity of 85% (area under the curve, 0.852).

CONCLUSION

The mean ADC values showed significant differences between nodal metastases of NPC and LSCC. Considering SCCs as a single group may affect the accuracy of ADC-based differentiation. Location of the primary tumor should be taken into account and cutoff values should be determined separately for each anatomical location.

Relation between Ossicular Erosion and Destruction of Facial and Lateral Semicircular Canals in Chronic Otitis Media

Introduction  Chronic otitis media can cause multiple middle ear pathogeneses. The surgeon should be aware of relation between ossicular chain erosion and other destructions because of the possibility of complications. Objective  This study aimed to investigate the rates of ossicular erosion in cases of patients with and without facial nerve canal destruction, who had undergone mastoidectomy due to chronic otitis media with or without cholesteatoma. Methods  We retrospectively analyzed three hundred twenty-seven patients who had undergone tympanomastoidectomy between April 2008 and February 2014. We documented the types of mastoidectomy (canal wall up, canal wall down, and radical mastoidectomy), erosion of the malleus, incus and stapes, and the destruction of facial and lateral semi-circular canal. Results  Out of the 327 patients, 147 were women (44.95%) and 180 were men (55.04%) with a mean age 50.8 ± 13 years (range 8-72 years). 245 of the 327 patients (75.22%) had been operated with the diagnosis of chronic otitis media with cholesteatoma. FNCD was present in 62 of the 327 patients (18.96%) and 49 of these 62 (79.03%) patients had chronic otitis media with cholesteatoma. The correlation between the presence of FNCD with LSCC destruction and stapes erosion in chronic otitis media with cholesteatoma is statistically significant ( p  < 0.05). Conclusion  Although incus is the most common of destructed ossicles in chronic otitis media, facial canal destruction is more closely related to stapes erosion.

Quantum molecular resonance-assisted phonomicrosurgery: preliminary experience

The objective of this study was to evaluate the use of quantum molecular resonance (QMR) energy in phonomicrosurgery. Quantum molecular resonance energy (QMRE) is an innovative technology that provides low temperature cutting and coagulation of tissues and causes minimal tissue damage during the procedure. Because of these features, this technology may offer new possibilities in phonomicrosurgery. Twelve patients with vocal fold polyps underwent QMR-assisted phonomicrosurgery. The patients were evaluated before and after surgery at 1 and 3 months postoperatively by using the voice handicap index, laryngeal stroboscopy rating, acoustic voice analysis, and perceptual voice evaluation. The subjects were also evaluated by a patient self-assessment questionnaire at 3 months postoperatively. All parameters significantly improved after QMR-assisted phonomicrosurgery (P < .05). All of the patients also subjectively improved by self-rating. These results suggest that QMRE is a safe and potentially promising treatment in phonomicrosurgery. Yet, further studies should be conducted to confirm these results.