Objective: This prospective study investigated the risk of respiratory distress in the patients who were applied nasal packing at the end of nasal surgery; and effects of nasal packing on consciousness level while the patients were awake or asleep, measured by Bispectral Index (BIS).Methods: The study group consisted of 15 adult patients (10 male, 5 female), who were applied nasal packing at the end of nasal surgery. The control group consisted of 15 adult patients 10 male, 5 female), who received general anesthesia for various reasons. In the study and control groups, BIS index, respiratory rate, peripheral oxygen saturation, pulse per minute and blood pressure were measured at seven different times.Results: There was no statistically significant difference between BIS indexes of the study and control groups. In the fourth hour after sleep (AS-4 h), respiratory rate of the study group was significantly lower than that of the control group. In the fourth hour after the anesthesia (AA-4 h), oxygen saturation value of the study group was lower than that of the control group.Conclusion: We conclude that in patients who are applied nasal packing at the end of nasal surgery; at AA-4 h and AS-4 h times, there may be risk of decrease in the oxygen saturation and respiratory rate parameters, respectively. Therefore, it is necessary to monitor non-invasive respiratory, parameters and to give enriched oxygen by an oral catheter. (C) 2008 Published by Elsevier Ireland Ltd.

Purpose: We treated allergic rhinitis with trichloroacetic acid (TCA) applied to the inferior turbinates. Further clinical evaluations were made to determine the effect of TCA application on symptoms of allergic rhinitis. We also report the results of measurement of the mucociliary transit time (saccharin time) and nasal airway resistance.Materials and methods: A group of 54 patients with perennial allergic rhinitis was treated with 80% TCA applied to the inferior turbinate. Further clinical evaluations were made to determine the effect of TCA application on symptom scores of allergic rhinitis. We also report the results of measurement of the mucociliary transit time (saccharin time) and nasal airway resistance in those cases.Results: The most common complaint, nasal obstruction, improved effectively in 82% of cases, watery rhinorrhea in 86%, and sneezing in 86%, 1 year after treatment. A significant decrease in scoring was noted for subjective nasal obstruction, watery rhinorrhea, and sneezing. Nasal airway resistance was effectively reduced 1 year after treatment, and the difference was statically significant. In our Study, saccharin time appeared to be shortened in the early and late periods after the TCA application. There was a statistical difference between the before- and after-treatment groups.Conclusions: We concluded that TCA treatment was quite effective for controlling nasal allergic symptoms and that it does not damage the mucociliary function. (C) 2008 Elsevier Inc. All rights reserved.

OBJECTIVE:This study was aimed at determining the expression of vascular endothelial growth factor (VEGF) in nasal polyps by immunohistochemical technique.METHODS:The study group consisted of 25 adult patients with nasal polyps who underwent functional endoscopic sinus surgery. Polyp tissues were taken from the maxillary and ethmoid sinuseses and the nasal cavity. The control group consisted of three adult patients without nasal polyps who underwent septoplasty operation. Their inferior turbinate biopsies were taken with written approval. VEGF positivity was scored by the Vascular Endothelial Growth Factor Positivity Index (VEGF-PI) in the subepithelial (VEGF-PI-SE) and deep (VEGF-PI-Deep) layers of the mucosa on a 0 to 3 scale, and the percentage of inflammatory cells per 100 cells was found.RESULTS:VEGF expression was identified as cytoplasmic staining in the vascular endothelium and inflammatory cells. In each of four groups (maxillary and ethmoid sinuses, nasal cavity, and control), no significant difference was present between VEGF-PI-SE and VEGF-PI-Deep scores. For the VEGF-PI-SE and VEGF-PI-Deep groups, nasal cavity scores were significantly higher. For plasma cell count, the nasal cavity value was significantly higher. As the plasma cell count increased, VEGF-PI-SE and VEGF-PI-Deep scores were also increased in all four groups.CONCLUSION:In the nasal cavity, VEGF expression is observed more, causing angiogenesis and an increase in the vascular permeability. In the paranasal sinuses, lower VEGF-PI results may show that contact inhibition reduces VEGF expression and thus the polyp growth rate.

Conclusion. Fluticasone propionate ( FP) aqueous nasal spray was objectively found to be effective and safe for the treatment of lower turbinate enlargement in patients with vasomotor rhinitis. Objective. To assess the efficacy of FP aqueous nasal spray treatment in lower turbinate hypertrophy due to vasomotor rhinitis using CT. Material and methods. Of 35 patients with hypertrophic lower turbinates due to vasomotor rhinitis, 20 were treated twice daily with FP aqueous nasal spray ( 200 mu g/day) for 3 months continuously and 15 were treated with placebo vehicle as a control group. The local effect of the nasal spray was studied using CT and visual analog scales. Results. Treatment with FP provided significantly greater relief from the symptom of nasal obstruction compared with placebo over the entire 3-month treatment period ( p< 0.001). When the change from baseline was compared between the two groups, FP produced statistically significant reductions in the mucosal area of the lower turbinates and in the thickness of the nasal mucosa after 3 months (p< 0.05).

OBJECTIVESThis is a preliminary report of a relatively new method, Phadiatop, in screening atopic adult patients with recurrent secretory otitis media (SOM). The sensitivity and specificity, and its use in atopic adult patients with recurrent SOM were evaluated.PATIENTS AND METHODSEighty-four patients (54 females, 30 males; mean age 36.7; range 19 to 62 years) who were diagnosed as recurrent SOM were included in the study. The patients were evaluated with respect to history, laboratory tests, skin-prick test, and total IgE. Patients with at least one positive skin-prick test result and/or a high total IgE level with a positive history were considered to be in atopic status.RESULTSAccording to certain criteria, atopy was detected in 31 of 84 patients. Negative Phadiatop values were found in all non-atopic patients as well as in one atopic patient. Among 31 patients having atopy, 30 patients showed positive Phadiatop values (specificity 1.00, sensitivity 0.97, positive predictive value 1.00, negative predictive value 0.98).CONCLUSIONThese results indicate that Phadiatop is an effective test to detect atopy in patients with recurrent SOM.

OBJECTIVE:To determine whether pre-emptive ropivacaine has an influence on postoperative pain in adult patients undergoing tonsillectomy.DESIGN:A prospective, randomized, double-blind, placebo-controlled clinical trial.SETTING:University hospital.PATIENTS:The study included 20 adult patients undergoing elective tonsillectomy. Anesthetic induction and maintenance, dissection tonsillectomy, hemostasis techniques, and postoperative analgesic treatment were standardized for all patients. Before the onset of incision, one tonsillar fossa was administered 5 mL of 2% ropivacaine hydrochloride with epinephrine, whereas the other side received 5 mL of 0.9% saline with epinephrine and was designated as the control side.MAIN OUTCOMES MEASURES:For each side, postoperative pain, otalgia, operating time, amount of intraoperative blood loss, and postoperative hemorrhage were assessed. The intensity of postoperative pain was measured at rest and when the patient was drinking and was scored on a visual analogue scale. The patients were followed up for 10 days after surgery.RESULTS:There was no statistically significant difference in the amount of intraoperative hemorrhage and operation time between sides (p > .05). The constant postoperative pain in the ropivacaine side at rest was significantly less than in the placebo side on days 1, 2, 5, and 6 (p < .05). The post-tonsillectomy pain experienced in the ropivacaine side when swallowing was significantly less than that in the placebo side throughout the study period except on day 10 (p < .05).CONCLUSION:Based on the present findings, preincisional infiltration of ropivacaine 2% appears to be effective against both early and late postoperative pain, especially on swallowing, following tonsillectomy in adults.

The aim of this study was to investigate the effect of ropivacaine, a newer amide local anesthetic, on the ears of rabbits by using transient-evoked otoacoustic emissions (TEOAEs). Thirty rabbits were studied in a random block design of six groups of five animals each. There received intra-tympanically instilled single doses of 0.5 mg/kg, 1.0 mg/kg of ropivacaine, 0.5 ml of isotonic saline (control for intratympanic application), or intravenously administered single doses of 1.0 mg/kg, 2.0 mg/kg of ropivacaine and 1.0 ml of isotonic saline (control for intravenous application). Cochlear function was serially monitored using TEOAEs before administration and on the 1st and 15th days after administrations of ropivacaine or isotonic saline. The responses of TEOAEs were analyzed in terms of mean stimulus, stability, wave reproducibility and emission amplitudes at 1.0-4.0 kHz. We found no significant changes in the TEOAE responses of the baseline measurements in each group before administration and the responses at each interval in the same group after administration throughout the experiment (P > 0.05). Also, no significant difference was found between the group receiving ropivacaine administered intravenously or intratympanicly and the control group at each interval (P > 0.05). The data from the present study showed that ropivacaine, whether administered intravenously or intratympanically and even at a low or high dose, has no effects on the responses of TEOAEs in the early period. These findings encourage the use of ropivacaine as a safe agent without ototoxic effects in peripheral nerve blocks, epidural and intravenous regional anesthesia or even tinnitus therapy in the future.

Pediatric cholesteatoma can be classified as congenital or acquired based on clinical criteria. We studied the expression patterns of five distinctive cytokeratins in both types of cholesteatoma in order to improve understanding of their pathogenesis and origin. A comparable expression pattern for CK10, CK14, CK18, CK19 and 34βE12 antigens was found in the matrix of congenital and acquired pediatric cholesteatoma. Our results demonstrate that congenital and acquired pediatric cholesteatoma exhibit an identical cytokeratin distribution pattern, suggesting that they share a common origin. Therefore, it seems possible that a portion of the so-called “acquired” cholesteatoma may actually originate from advanced congenital cholesteatoma with secondary destruction of the tympanic membrane in the pediatric patient population.

Objective: To determine total inner ear fluid volume and cochlear and semicircular canal/vestibule volumes of a normal population to form a base for dimensional abnormalities of inner ear structures. Study Design: Cross-sectional.Setting: Academic otology and radiology practices.Patients: Twenty-nine healthy volunteers (13 male patients and 16 female patients with an average age of 31 yr) without any known history of intrauterine infection or any exposure to ototoxic agents and no abnormality at physical examination from the standpoint of hearing loss were included.Interventions: Twenty-nine volunteers underwent magnetic resonance imaging of the temporal region by means of thin-section T2-weighted sequences. The images were evaluated by the radiologist for the presence of any gross configurational abnormality. Fluid volume of each inner ear and components of labyrinth (cochlea, semicircular canals/vestibule) were calculated with the help of an online work station.Main Outcome Measure: To determine the volume of components of the labyrinth and total inner ear fluid, which may form a base for future studies about sensorineural hearing loss.Results: The volumes of total inner ear fluid, cochlea, and semicircular canals/vestibule were calculated. The mean and standard deviation of total inner ear fluid volume, cochlear volume, and semicircular canal/vestibule volume were obtained for each volunteer. Results were assessed with the help of statistical tests.Conclusion: There was no statistically significant difference between right and left inner ear fluid volumes of male and female subjects. There was also no statistical difference between right and left inner ear volumes when age and sex were not concerned. During evaluation of volumes according to sex, the difference between right and left inner ear fluid volumes was also assessed. Left semicircular canal/vestibule volume of female subjects were found to be higher than that of male subjects. The difference between right and left semicircular canal/vestibule volumes of female subjects was higher than the difference between right and left semicircular canal/vestibule volumes of male subjects.

The aim of this study was to test the validity of the Hospital Anxiety and Depression (HAD) Scale in patients who underwent nasal surgery as a method of screening for emotional disorders during their hospital stay. The study group consisted of 50 adult patients (29 male, 21 female) who underwent nasal surgery for different reasons, such as chronic sinusitis, nasal polyposis, and nasal septal deviation. Functional endoscopic sinus surgery and/or septoplasty were managed in these patients, and all of the patients had nasal packing applied bilaterally for 2 days. The HAD Scale was given to all of the patients 1 day before surgery and 1 day after surgery, with anterior nasal packing bilaterally during the hospital stay. The anxiety and depression levels of the male group were under the cutoff points. For the female group, the depression levels were under the cutoff points, and the anxiety levels were high in the preoperative period and decreased after the operation. Anxiety and depression levels in the pre- and postoperative periods for the male and female groups were analyzed by Paired t-test. No statistically significant result was found (p >.05). It was concluded that, for patients well informed about nasal packing and hospital conditions, nasal packing may be used safely, without any psychological disturbance. The HAD Scale should be a more useful screening method to diagnose emotional disorders, especially in patients who are hospitalized for a long time.

BACKGROUND:Tissue cooling has long been used in the management of both acute and chronic pain.OBJECTIVE:To determine whether the application of cryotherapy can reduce the pain of patients with minor form of recurrent aphthous stomatitis.STUDY DESIGN:Twenty adult patients who had 2 discrete aphthous stomatitides in the labial mucosa at the same time were included in this prospective, randomized, and placebo-controlled study. One of the 2 aphthous stomatitides was treated with cryotherapy, the other serving as a control. The pain of aphthous stomatitis was scored by the patient on a 6-point scale (from 0 to 5). The size of the aphthous stomatitis was also measured.RESULTS:At any interval, no statistical difference was found between the cryotherapy-treated aphthous stomatitis and the control in the change in the value of pain severity, nor was any statistical difference found in the change in the size of the aphthous stomatitis. However, a trend toward less pain in the aphthous stomatitis receiving cryotherapy was noted.CONCLUSION:These results suggest that application of cryotherapy on minor form of recurrent oral aphthous stomatitis has no beneficial analgesic effect compared to placebo.

Chondroid syringoma (mixed tumor of the skin) is a rare benign neoplasm of the sweat glands which often occurs in the head and neck region. We present a 73-year-old white farmer man with a mass in the anterior surface of the upper lip that was histologically diagnosed as a chondroid syringoma after surgical wide excision. There were no signs of recurrence during a follow-up of 14 months.

In this report, we describe a 57-year-old woman with oropharyngeal tularemia who presented with tonsillopharyngitis and cervical lymphadenitis. Clinical and radiological manifestations and histopathological characteristics of this disease are discussed with a review of the world literature. The oropharyngeal form of tularemia should be considered in the differential diagnosis of cases involving tonsillopharyngitis and cervical lymphadenitis, particularly in those not responding to penicillin treatment.

Before the antibiotic era, lateral sinus thrombosis (LST) was the most frequent complication of otitis media. With the widespread usage of antibiotics, its occurrence is rare. Nevertheless, it is still a major complication of middle ear disease. LST mortality fluctuates between 5 and 35%. The major clinical symptoms of patients with LST are pain in the mastoid region, spiking fever, anemia and general health disorders. Computed tomography, magnetic resonance imaging and angiography are the most helpful in diagnosis, but the final diagnosis is made by surgical exploration. Three cases with LST are presented, and signs, diagnosis and treatment of disease are discussed.

Objectives:To compare the haemodynamic and adverse effects of different intravenous sedation techniques during sinonasal surgery with local anaesthesia.Materials and Methods:Eighty patients undergoing septoplasty or functional endoscopic sinus surgery were studied. Patients were randomly assigned into one of four groups (n=20/group). Group I received midazolam (0.07 mg/kg) and fentanyl (1 μg/kg), group II received fentanyl (1 μg/kg) and propofol (2 mg/kg/h), group III received midazolam (0.07 mg/kg) and remifentanil (0.05 μg/kg/min), and group IV received propofol (2mg/kg/h) and remifentanil (0.05 μg/kg/min). Cardiovascular monitoring including electrocardiography, mean arterial pressure and oxygen saturation was applied to all patients. The readings; baseline (1), after intravenous medication (2), after local anesthesia (3), at the beginning of the operation (4), during the operation (5, 6, 7) and at the end of the operation (8), were analyzed.Results:There were statistically significant differences among the groups in saturation after sedation (p<0.01). Haemodynamic parameters remained more stable in group-I. In group-IV, no side effect occurred, except a decrease in saturation, at the second part of the operation.Conclusion:The combination of midazolam and remifentanil provided more stable haemodynamic parameters during sinonasal surgery. Propofol and remifentanil may be an alternative technique in respect to less side effects except hypoventilation.