OBJECTIVES:Adenoid tissue is important in local immune response and epithelial barrier dysfunction of this tissue may contribute to allergies. The aim of this study was to evaluate the relationship between the status of cross-epithelial barrier elements in adenoid tissue lymphoepithelium and inhalant allergen sensitization.MATERIALS AND METHODS:Children aged 5-15 years, who underwent adenotonsillectomy, participated in this study. All subjects underwent skin prick testing with environmental inhalant allergens. Occludin, ZO1, e-cadherin, β-catenin, desmoglein, desmoplakin, and connexon-43 were stained immunohistochemically in the adenoid tissues obtained and scored by H-score.RESULTS:We enrolled 76 children, 14 among whom were sensitized to environmental allergens. Among the zonula occludens proteins, median H-scores for occludin, claudin, and ZO-1 were significantly lower in the atopic compared to the nonatopic group respectively (p<0.001). Similarly, median H-scores for e-cadherin and β catenin proteins of the zonula adherens were significantly lower in the atopic group (p<0.001). Both desmoglein and desmoplakin H-scores were significantly lower in the atopic group [60 (50-100) vs 280 (260-300), p<0.001 and 105 (87.5-120) vs 280 (67.25-300), p<0.001 respectively]. Moreover, connexin-43 protein of the gap junction was significantly lower in the atopic group (p<0.001).CONCLUSION:Adenoid tissue, which is the initial point of contact of inhalant allergens demonstrates epithelial barrier junctional protein, changes in children with inhalant allergen sensitization without clinical allergic disease symptoms. Therefore, it may be concluded that epithelial barrier function plays an important role in the development of allergen sensitization versus tolerance.

The goals of this study were to determine and evaluate the bioaccessibility of total anthocyanin and procyanidin in apple (Amasya, Malus communis), red grape (Papazkarası, Vitis vinifera) and cinnamon (Cassia, Cinnamomum) using an in vitro static digestion system based on human gastrointestinal physiologically relevant conditions. Also, in vitro inhibitory effects of these foods on lipid (lipase) and carbohydrate digestive enzymes (α-amylase and α-glucosidase) were performed with before and after digested samples using acarbose and methylumbelliferyl oleate (4MUO) as the positive control. While the highest total anthocyanin content was found in red grape (164 ± 2.51 mg/100 g), the highest procyanidin content was found in cinnamon (6432 ± 177.31 mg/100 g) (p < 0.05). The anthocyanin bioaccessibilities were found as 10.2 ± 1%, 8.23 ± 0.64%, and 8.73 ± 0.70% in apple, red grape, and cinnamon, respectively. The procyanidin bioaccessibilities of apple, red grape, and cinnamon were found as 17.57 ± 0.71%, 14.08 ± 0.74% and 18.75 ± 1.49%, respectively. The analyzed apple, red grape and cinnamon showed the inhibitory activity against α-glucosidase (IC50 544 ± 21.94, 445 ± 15.67, 1592 ± 17.58 μg/mL, respectively), α-amylase (IC50 38.4 ± 7.26, 56.1 ± 3.60, 3.54 ± 0.86 μg/mL, respectively), and lipase (IC50 52.7 ± 2.05, 581 ± 54.14, 49.6 ± 2.72 μg/mL), respectively. According to our results apple, red grape and cinnamon have potential to inhibit of lipase, α-amylase and α-glucosidase digestive enzymes.

The aim of this study was to determine the most important risk factors in the development of otitis media with effusion (OME) in children with adenoid hypertrophy. A total of 539 patients undergoing surgery for adenoid hypertrophy (AH Group) (n = 429) or adenoid hypertrophy and otitis media with effusion (AH + OME Group) (n = 110) between February 2012 and February 2018 constituted the study group. Data were obtained on neonatal history (breastfeeding, bottle feeding), past health and medical history (presence of atopy or allergic rhinitis, snoring at night, cough, tonsillitis in the past 12 months), environmental factors (presence of pets, attending to daycare centers, district of school), family history (passive smoking at home, number of siblings, family size, parental education), and family income. The groups did not differ from each other for age (p = 0.684) and gender (p = 0.728). Our data support the presence of atopy or allergic rhinitis (p < 0.001), frequent (> 5) tonsillitis (p < 0.001), attending to daycare centers (p < 0.001), exposure to smoke (p < 0.001), having 3 or more siblings (p < 0.001), and 4 or more people in the household (p < 0.001) as the main risk factors for OME. Comprehensive knowledge of modifiable risk factors found in this study could help to minimise the complications of OME in children.

Bu çalışmanın amacı, uzamsal yeteneğin “uzamsal görselleştirme, uzamsal yönelim, zihinde döndürme ve zihinde kesme” bileşenleri bağlamında incelenen Eğitim Bilişim Ağı (EBA) etkinlikleri hakkında farklı okullarda görev yapan ortaokul matematik öğretmenlerinin görüşlerinin belirlenmesidir. Bu amaç doğrultusunda EBA eğitim platformunda yer alan uzamsal beceriler ile ilgili etkinlikler analiz edilmiş ve bu etkinliklere yönelik nicel bir çalışma yapılmıştır. Veriler araştırmacılar tarafından geliştirilen bir anket ile toplanmıştır. Verilerin analizinde betimsel analiz yöntemi kullanılmıştır. Araştırmacılar tarafından hazırlanan ve daha sonra uzman görüşü alınarak bazı maddelerin birleştirilmesi ve düzenlenmesiyle son hali verilen 8 soruluk anket, Sinop ve Kastamonu illerinde görev yapmakta olan 20 ortaokul matematik öğretmenine uygulanmıştır. Araştırmadan elde edilen bulgular ankette yer alan maddeler ve sınıflar (5., 6., 7. ve 8. Sınıf) bazında karşılaştırılmıştır. Araştırma sonucunda EBA’da uzamsal becerilerle ilgili tespit edilen 35 etkinlik hakkında ortaokul matematik öğretmenlerinin sundukları görüşlerin sınıf bazında genel ortalamalarının 5 tam puan üzerinden 4,16 ile 4,57 arasında değiştiği saptanmıştır. Elde edilen ortalamalar doğrultusunda matematik öğretmenlerinin uzamsal becerilerle ilgili EBA etkinliklerini ders kazanımlarının öğrenimine ve öğrenci hedef kitlesine uygun, , kazanımların öğrenimini ve 3 boyutlu düşünmeyi kolaylaştırıcı, dikkat çekici ve öğretici buldukları ifade edilebilir.

Introduction 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters such as; maximum standardized uptake values, standard metabolic tumor volume and otal lesion glycosis are important prognostic biomarkers in cancers. Objective To investigate the prognostic value of these parameters in patients with head and neck cancers. Methods We performed a retrospective study including 47 patients with head and neck cancer who underwent18F-fluorodeoxyglucose positron emission tomography/computed tomography prior to treatment. Standard metabolic tumor volume, otal lesion glycosis and standardized uptake were measured for each patient. The prognostic value of quantitative 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters and clinicopathologic variables on disease free survival and overall survival were analyzed. Results The median (range) standard metabolic tumor volume and otal lesion glycosis and standardized uptake were 7.63 cm3 (0.6-34.3), 68.9 g (2.58-524.5 g), 13.89 (4.89-33.03 g/mL), respectively. Lymph node metastases and tumour differentiation were significant variables for disease free survival and overall survival, however, all 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters were not associated with disease- free survival and overall survival. Conclusion Pretreatment quantities positron emission tomography parameters did not predict survival in head and neck cancer.

Address for Correspondence: Mustafa Yazır E-mail: muyazir66@gmail.com Received: 13.02.2019 Accepted: 06.03.2019 DOI: 10.5152/ejra.2019.118 ©Copyright 2018 by Turkish Rhinologic Society Available online at www.eurjrhinol.org Abstract Objective: The aim of this study was to evaluate clinical characteristics and surgical outcomes of paranasal sinus fungus ball. Material and Methods: We retrospectively examined clinical records including clinical presentations, radiologic findings, management, and outcomes of fungus ball who underwent functional endoscopic surgery for treatment between 2008-2019. The patients demographic data, clinical presentations, radiological findings and surgical outcomes were analysed. Results: The patients ages ranged between 30 and 76 years, mean age was 55.2. Most common symptoms were headache and facial pain.On computed tomography, the most common finding was sclerosis in bony walls of the sinus (78.3%). Magnetic resonance imaging revealed a marked low intensity on T2 weighted images in all cases (100%). All patients were treated with functional endoscopic sinus surgery. Conclusion: Fungus ball should be considered in patients with unilateral nasal symptoms and unexplained headache and facial pain. Endoscopic sinus surgery is the treatment of choice in all cases.

Various surgical techniques and approaches for addressing nasal valve collapse have been described in the literature. Still, new techniques continue to be developed and old techniques continue to be improved upon. The aim of the present study was to validate the use of the internal nasal valve expanding graft for middle vault reconstruction and to review the authors' experience using this technique. A total of 32 patients who underwent middle vault reconstruction were retrospective reviewed. Analysis using Visual Analogue Scale (VAS) and Nasal Obstruction Symptom Evaluation (NOSE)-scale was performed pre-and postoperatively. Visual Analogue Scale scores for nasal airflow per side were collected on a 10-point scale, with 1 indicating total obstruction and 10 indicating a perfect nasal airway. Nasal Obstruction Symptom Evaluation scale was used to assess nasal obstruction. Minimum follow-up period was 6 months after the operation. Pre- and postoperative VAS scores were used to assess degree of nasal valve collapse according to examination findings. It was significant that there was improvement in nasal valve collapse after surgery (P<0.05). Based upon pre-and postoperative calculations made using NOSE scores, there was significant improvement regarding nasal blockage or congestion, troubled breathing and sleeping, and air through nose during exercise, respectively (P<0.05). No complications in terms of septal perforation, hematoma, synechiae, or infection that required further intervention were noted at postoperative follow-ups. In conclusion, internal nasal valve expanding graft has now been shown to be successful for middle vault reconstruction in a group of appropriately selected patient.

PURPOSE:The type and extent of surgery for benign parotid tumors are a subject of debate. We aimed to measure and compare hospital stay, operative time, and complication rates associated with superficial parotidectomy (SP) and partial superficial parotidectomy (PSP). MATERIALS AND METHODS:This retrospective cohort study included all patients who underwent surgery for benign parotid gland tumors in our tertiary center between January 2006 and March 2014 and were followed up for at least 3 years. The predictor variable was the type of parotidectomy, and the main outcome parameters were operative time, hospital stay, and postoperative complications. The demographic characteristics (age and gender), clinical history, and preoperative findings were obtained from patient records. The Kolmogorov-Smirnov test, Mann-Whitney U test, and χ2 test were used to analyze the data. P < .05 was considered statistically significant. RESULTS:The sample was composed of 321 patients (184 men and 137 women) with a mean age of 54.0 ± 14.7 years (range, 18 to 87 years). Of these, 190 underwent SP and 131 underwent PSP. Pleomorphic adenoma was the most common tumor (83 patients, 53%), followed by Warthin tumor (50 patients, 32%). The mean hospital stay was 6.7 ± 2.3 days in the SP group and 4.8 ± 2.4 days in the PSP group (P < .001). The mean operative times in the SP and PSP groups were 134.0 ± 24.6 and 92.1 ± 21.9 minutes, respectively (P < .001). The overall complication rates were 21.6% and 12.2% in the SP and PSP groups, respectively (P = .031). No tumor recurrence was observed in either group. CONCLUSIONS:Compared with the SP group, the PSP group had shorter operative and hospital stay durations and fewer postoperative complications with a comparable recurrence rate. Therefore, PSP should be considered in suitable cases.

In this article, a novel endoscopic technique used to close oro-antral fistulas will be described. In the technique described here, 24 cases were surgically treated between May 2011, and November 2014. Under endonasal endoscopic examination following partial inferior uncinectomy, the natural ostium of the maxillary sinus was identified; through this tract, a curved aspirator was advanced into the sinus. If present, we extracted endoscopically tissues causing obliteration of the ostium through the Caldwell-Luc antrostomy, taking care to preserve the integrity of the natural ostium. In the technique described here, endoscopic examination using the Caldwell-Luc approach, the inside of the maxillary sinus is explored fully, existing infection and polyps are eliminated locally, and natural patency of the maxillary sinus ostium can be achieved. The graft used to obliterate the oroantral fistula can be easily harvested from the bone of the anterior wall of the maxillary sinus by accessing the surgical entry tract.

In this study, the aim was to determine the bioaccessibilities of carnosic acid in sage and rosemary and in vitro inhibitory effects of these samples on lipid and starch digestive enzymes by evaluating the lipase, α-amylase and α-glucosidase enzyme inhibition activities. The content of carnosic acid in rosemary (18.72 ± 0.33 mg/g) was found to be higher than that content of that in sage (3.76 ± 0.13 mg/g) (p < 0.05). The carnosic acid bioaccessibilities were found as 45.10 ± 1.88% and 38.32 ± 0.21% in sage and rosemary, respectively. The tested sage and rosemary showed inhibitory activity against α-glucosidase (Concentration of inhibitor required to produce a 50% inhibition of the initial rate of reaction - IC50 88.49 ± 2.35, 76.80 ± 1.68 μg/mL, respectively), α-amylase (IC50 107.65 ± 12.64, 95.65 ± 2.73 μg/mL, respectively) and lipase (IC50 6.20 ± 0.63, 4.31 ± 0.62 μg/mL, respectively). Furthermore, to the best of our knowledge, this is the first work that carnosic acid standard equivalent inhibition capacities (CAEIC50) for these food samples were determined and these values were in agreement with the IC50 values. These results show that sage and rosemary are potent inhibitors of lipase, α-amylase and α-glucosidase digestive enzymes.

Background: The accuracy of fine-needle aspiration biopsy (FNAB) is controversial in parotid tumors. We aimed to compare FNAB results with the final histopathological diagnosis and to apply the ''Sal classification'' to our data and discuss its results and its place in parotid gland cytology. Methods: The FNAB cytological findings and final histological diagnosis were assessed retrospectively in 2 different scenarios based on the distribution of nondefinitive cytology, and we applied the Sal classification and determined malignancy rate, sensitivity, and specificity for each category. Results: In 2 different scenarios FNAB sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were found to be 81%, 87%, 54.7%, and 96.1%; and 65.3%, 100%, 100%, and 96.1%, respectively. The malignancy rates and sensitivity and specificity were also calculated and discussed for each Sal category. Conclusion: We believe that the Sal classification has a great potential to be a useful tool in classification of parotid gland cytology.

Objective: The aim of this study was to evaluate the efficacy of hyperbaric oxygen (HBO) therapy as salvage therapy in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) after failure of systemic therapy. Methods: Forty-eight consecutive patients with refractory ISSNHL were enrolled retrospectively. All patients were given systemic steroid therapy by tapered doses. In addition, forty-one patients received intratympanic dexamethasone injection. Hearing outcomes were determined by recovery rate according to Siegel's criteria and hearing gains in pure-tone average (PTA) measured by audiometry before and after HBO therapy. The effects of prognostic factors on hearing recovery were also evaluated. Results: Thirteen (27%) patients responded to HBO therapy. The remaining 35 (73%) patients did not show any improvement. After HBO therapy, significant improvement was found in mean hearing thresholds at all frequencies. Only the level of initial PTA level and gender were significantly associated with recovery. Patients with severe hearing loss (≥70 dB) had significantly better results. Conclusion: Salvage HBO therapy may be beneficial in patients with ISSNHL who failed to recover by primary combined steroid therapy. Further hearing recovery with salvage HBO therapy can be expected, particularly in patients with PTA greater than 70 dB.

Objectives: To investigate the presenting symptoms, intra-operative findings and long-term facial nerve function in patients treated for cholesteatoma with associated facial paralysis.Methods: Fifteen patients with facial paralysis due to middle-ear cholesteatoma who underwent tympanomastoidectomy surgery from February 2000 to February 2015 were retrospectively reviewed. After removal of the cholesteatoma, a limited area of the fallopian canal, in which facial nerve oedema or redness was evident, was opened. Incision of the epineural sheath for nerve decompression was not performed.Results: Pre-operativeHouse-Brackmann grade was grade II in two patients, grade III in four, grade IV in seven, grade V in one and grade VI in one. Facial nerve perineurium damage was observed in two patients with poor prognoses. All patients treated within the first 15 days after paralysis onset showed normal facial function at long-term follow up. Post-operative House-Brackmann grade was grade I in 11 patients, grade II in 1, grade III in 2 and grade VI in 1.Conclusion: Early surgical treatment is more likely to give good results, and poor outcomes are observed in patients with facial nerve perineurium damage.

Objective: To determine the frequency of p16 positivity in oral cavity and oropharyngeal squamous cell carcinoma (OC/OP-SCC) and to reveal whether there is a difference between p16-positive and -negative cases according to clinicopathological parameters.Methods: p16 antibody was retrospectively analyzed immunohistochemically in biopsies of 60 patients with OC/OP-SCC operated between 2007 to 2015. Comparison was performed for age, sex, smoking habit, alcohol consumption, site of the tumor, the level of keratinization, T stage, lymphovascular invasion, perineural invasion, recurrence of the tumor, and survival.Results: Of the 60 patients (18 females, 42 males), the median was 58 (range: 27 to 75) years. Seventeen patients were p16-positive, and 43 patients were p16-negative. Comparison of p16-positive and p16negative groups according to age, sex, T-stage, tumor subsite, tumor profundity, lymphovascular invasion, perineural invasion and survival was not statistically significant (p> 0.05). We found statistical difference between two groups according to tumor recurrence, smoking habit, and the degree of keratinization.Conclusion: In patients who underwent surgical treatment after the diagnosis of zOC/OP-SCC, p16 positivity may have a predictive role in terms of tumor recurrence.

Objective: To determine the frequency of p16 positivity in oral cavity and oropharyngeal squamous cell carcinoma (OC/OP-SCC) and to reveal whether there is a difference between p16-positive and -negative cases according to clinicopathological parameters. Methods: p16 antibody was retrospectively analyzed immunohistochemically in biopsies of 60 patients with OC/OP-SCC operated between 2007 to 2015. Comparison was performed for age, sex, smoking habit, alcohol consumption, site of the tumor, the level of keratinization, T stage, lymphovascular invasion, perineural invasion, recurrence of the tumor, and survival. Results: Of the 60 patients (18 females, 42 males), the median was 58 (range: 27 to 75) years. Seventeen patients were p16-positive, and 43 patients were p16-negative. Comparison of p16-positive and p16-negative groups according to age, sex, T-stage, tumor subsite, tumor profundity, lymphovascular invasion, perineural invasion and survival was not statistically significant (p>0.05). We found statistical difference between two groups according to tumor recurrence, smoking habit, and the degree of keratinization. Conclusion: In patients who underwent surgical treatment after the diagnosis of zOC/OP-SCC, p16 positivity may have a predictive role in terms of tumor recurrence.

A 24-year-old man referred to our clinic with complaint of intermittent right-sided watery rhinorrhea. Patient underwent nasal septoplasty one year ago and rhinorrhea occurred two weeks after the surgery. Rhinorrhea was ignored and then patient developed meningitis two months after the surgery. Subsequently, meningoencephalocele formation developed. In this case report, we present a case of meningoencephalocele associated with cerebrospinal fluid leak diagnosed one year after the septoplasty. Septoplasty is usually regarded as a relatively safe operation. However, forceful maneuvers to perpendicular lamina of the ethmoid bone may cause breakdown of the skull base structures, particularly the horizontal lamella of the cribriform plate. When this occur, immediate management is necessary to prevent intracranial complications including meningitis, intracranial abscess, and pneumocephalus. Delay in the diagnosis of such injury may cause erosion of the bone and gradual herniation of the intracranial contents through the skull base defect.