Volume 14 Issue 3 (2024)

The paranasal sinuses are air-filled spaces which begin developing prenatally. The sphenoid sinus is a paired paranasal sinus located within the sphenoid bone’s body. It represents one of four pairs of paranasal sinuses. A sphenoid sinus septum separates the pair of sphenoid sinuses in the middle. Each sphenoid sinus connects with the nasal cavity via the sphenoidal sinus aperture. The size and shape of the two sphenoid sinuses vary and are frequently asymmetrical. The paranasal sinuses start to develop as evaginations of mucosa during the 3rd and 4th fetal months; however, they expand after birth to reach their normal size. The underdevelopment or agenesis of the paranasal sinuses is an infrequent occurrence; if found, it is more frequently in the frontal sinus and seldom concerns the sphenoid sinus. The authors thus present a case of sphenoid sinus aplasia detected incidentally on cone-beam computed tomography (CBCT) and believe it will be a valuable addition to the literature.

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Chondroblastoma, a rare tumor, can affect the temporomandibular joint (TMJ) and cause symptoms similar to those of other TMJ problems. Although benign, it has aggressive traits such as bone invasion. A 45-year-old man reported swelling in the left preauricular region for two years. On examination, it was bony hard, not tender, and did not move when the mouth was opened. We diagnosed the patient with pigmented villonodular synovitis based on the radiographic findings. After excision, the histopathological report suggested an uncommon chondroblastoma pathology. Osteolytic tumors of the bone are difficult to diagnose preoperatively owing to their nonspecific clinical and radiographic characteristics. When an osteolytic bony lesion of the temporal bone is present, chondroblastoma should be considered a differential diagnosis.

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The possibility of biofilms on otitis media with effusion was reviewed. A systematic literature review was conducted using PubMed, Medline, Google, and Google Scholar search engines between 1975 and 2024. Articles dealing with “otitis media with effusion”, “children”, “treatment”, “pathophysiology”, “ventilation tube”, or “biofilms” were located through a search engine and retrieved through a query. A middle ear effusion, which can be either mucoid or serous and is not purulent, is a hallmark of OME. The eustachian tube disruption, age, and environmental factors have all been linked to OME. Inflammation, infection, effusion, and tissue hyperplasia are common pathways that might lead to OME, suggesting that it is a complex disorder. Whether attached to living or nonliving surfaces, biofilms comprise a collection of microbial cells surrounded by a matrix formed by the cells. This matrix accounts for about 90% of the dry mass of the biofilm. Microbiological biofilms evade both the host immune system and antibiotics. The fact that 70% of OME cultures are sterile has been known for a long time. Numerous data point to the ineffectiveness of antibiotic treatment in OME, suggesting that biofilm is responsible for the disease’s chronic nature. The present high rate of further surgery can be reduced by exploring new therapeutic options made possible by comprehending the function of biofilms in the genesis of OME. The most effective way to eliminate biofilms in the middle ear is to provide antibiotics locally.

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Pediatric submandibular pleomorphic adenomas are very rare benign tumors. Fine needle aspiration biopsy is a useful preoperative diagnosis to avoid tumor rupture and seeding. We present three cases of pediatric submandibular pleomorphic adenoma.

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This study aimed to investigate the utility of the Systemic Immune Inflammatory Index (SIII) as a diagnostic biomarker for distinguishing between acute tonsillitis and peritonsillar abscess. Conducted retrospectively at Trakya University, the study analyzed 122 cases of acute tonsillitis and 124 cases of peritonsillar abscess, using data from patients treated at the university's Otorhinolaryngology Department between 2013 and 2023. Ethical approval was obtained from the institution's Ethics Committee. Blood samples were evaluated to assess three key parameters: neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and SIII. Results demonstrated a significant difference in SIII values, with patients suffering from peritonsillar abscess showing significantly higher SIII levels compared to those with acute tonsillitis. Similarly, PLR values were significantly different between the groups, reinforcing the clinical relevance of these markers. In contrast, NLR did not show a statistically significant difference. These findings highlight the potential of SIII as a valuable biomarker for distinguishing between acute tonsillitis and peritonsillar abscess, offering promising applications in otolaryngology to enhance diagnostic accuracy and inform treatment decisions.

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Objective: To explore the relationship between the “white line” of the posterior pharyngeal wall and laryngopharyngeal reflux disease (LPRD). Methods: The subjects were examined by fiberlaryngoscopy, and RSI and RFS scores were performed. The posterior pharyngeal wall was observed to determine the “white line”, the mucosal boundary between the nasopharynx and oropharynx. Results: There was a significant difference in RFS values of the three types of white lines (P = 0.017), and the significant difference was between type I and III (P = 0.006). Age, gender, RSI, and RFS were included to construct the ordered multi-classification logistics regression equation. The effect of RFS on the white line was statistically significant (OR = 0.8, 95%CI −0.326～−0.053, P = 0.008). Conclusions: The “white line”—the mucosal boundary between nasopharynx and oropharynx—has a correlation with laryngopharyngeal reflux.

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To compare the results of the Oculomotor Random Saccade test, Positional test and Video Head Impulse Test (vHIT) patients with Vestibular Migraine (VM) and in healthy volunteers and to determine the sensitivity of these tests in revealing peripheral vestibular hypofunction. A retrospective examination was made of the data of 33 patients (mean age:44.72±13.73 years) diagnosed with VM in a tertiary level neuro-otological clinic between June 2020 and December 2022. The oculomotor random saccade test, positional tests, vHIT gain and asymmetry results were compared with those of 33 healthy volunteers and statistically analysed. Gaze nystagmus was observed in 18.18% of VM patients. The positional tests were abnormal in 15.1% of the VM patients. The mean velocity was seen to be increased 18.2% patients in VM. The right-side accuracy values were determined to be <80% in 4 (12.2%) patients in VM. The two groups were similar in terms of vHIT vestibulo-ocular reflex (VOR) gain values. Vestibular deficit of VOR gain <0.7 was determined in 30.3% of the VM patients. VOR gain asymmetry of >20% was observed in 11 (33.3%) VM patients (p>0.05). Abnormalities in the oculomotor saccade test results and differentiated asymmetry values with reduced VOR gain values may be observed in patients with VM. It should be kept in mind that vHIT results may be affected in patients with VM.

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Lund Mackay Score (LMS), modified Lund Kennedy (MLK) scores quantify degree of opacification for each sinus by numerical scoring systems. Correlations between LMS on paranasal sinus CT scans, MLK nasoendoscopic scores and associated tools like SNOT-22, RSDI, EPOS, PROMIS-29, etc. showed contrasting empirical results. The paper discusses methodological limitations of numerical scoring systems and provides a method of transforming ordinal discrete scores of a multi-point item to normally distributed proposed scores). Scale scores -scores) as sum of s also follow normal distribution and can include all indicators irrespective of scale formats. Normality of monotonically increasing P-scores and -scores of LMS/MLK satisfy desired properties, provide unique ranks to the individuals,  facilitate parametric analysis for diagnosis (ROC analysis), classification  and comparisons of different aspects of chronic rhinosinusitis measured by LMS/MLK and subjective measures of symptom scores reflecting disease severity. The method also facilitates statistical tests of equality of mean and variance of LMS/MLK for two groups or a single group at different time periods, significance of disease progression and better computation of reliability, factorial validity. Proposed method can better assess severity/disability of CRS and include all tools (pathological, clinical, patient-reported- outcomes and HRQoL instruments) irrespective of scale formats without any bias for advantaged or disadvantaged groups

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Allergic rhinitis (AR) is a common inflammatory condition of the nasal mucosa, affecting 10–30% of adults and 40% of children globally. This systematic review assessed the efficacy and safety of fexofenadine and montelukast, individually and combined, for AR treatment. A literature search using PubMed, Scopus, and Web of Science identified 162 studies, with eight meeting the inclusion criteria. The combination of fexofenadine and montelukast showed superior efficacy over monotherapy in reducing nasal and non-nasal AR symptoms. Patients experienced significant relief from sneezing, itching, and nasal congestion, with rapid onset of action, indicating a synergistic effect on the histamine and leukotriene pathways. Quality of life also improved, reflecting the efficacy of the combination treatment. The safety profile of the combination therapy was similar to that of monotherapy, with the common adverse events being mild headaches and gastrointestinal distress. No new safety concerns have emerged, suggesting the viability of combination therapy for long-term AR management. However, the potential neuropsychiatric effects of montelukast require further monitoring. Despite some methodological limitations, evidence supports the incorporation of fexofenadine and montelukast combination therapy into the clinical guidelines for AR management, providing an effective, well-tolerated, and flexible treatment option to reduce symptoms and improve patient outcomes.

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Chronic rhinosinusitis (CRS) is a prevalent inflammatory disorder of the nasal and paranasal sinus mucosa, affecting 5–15% of the global population. This systematic review evaluated the efficacy and safety of systemic, injectable, and intranasal corticosteroids (CS) for the treatment of CRS and its subtypes. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science, focusing on studies published between 2010 and 2023. Six studies were finally included in the analysis. Systemic CS, particularly oral CS, significantly improved nasal congestion, reduced nasal polyp size, and enhanced the quality of life in the short term. However, their long-term use is discouraged because of side effects, such as insomnia and gastrointestinal issues. Injectable CS offer longer symptom relief and potentially lower adrenal suppression risk than oral forms, but data are limited. Intranasal CS are preferred because of their safety and efficacy in long-term maintenance therapy, with newer formulations offering increased potency and reduced systemic absorption This review highlights the importance of tailoring CS treatment based on CRS subtype, severity, and patient-specific factors. Future research should focus on optimizing CS delivery methods and exploring novel therapies to enhance the long-term management of CRS, while minimizing adverse effects.

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