Volume 5 Issue 2 (2015)

Objective: In this prospective case-control study, we aimed to perform translation, cross-cultural adaptation, and validation of the SinoNasal Outcome Test (SNOT)-22 in the Turkish language.

Methods: Validation of the Turkish questionnaire included translation of original SNOT-22 items from English to Turkish by two independent native Turkish translators, and retranslation back from Turkish to English by two other native English translators. The testretest reliability was carried out in patients with chronic rhinosinusitis (CRS). SNOT-22 questionnaire was applied twice by two different physicians.

Results: Cronbach’s alpha was 0.88 and 0.90 at test and retest examinations, respectively, suggesting good internal consistency within the SNOT-22 questionnaire. Pearson’s correlation coefficient was 0.97, revealing excellent correlation in repeated examinations. Mean of kappa values evaluated for individual items was 0.83, indicating a high level of reproducibility. The comparison of mean SNOT-22 scores of healthy individuals with those of patient group indicated statistically significant difference between the two groups, proving the validity of SNOT-22 in Turkish in differentiating between healthy individuals and patients with CRS. The statistically significant reduction in the postoperative and preoperative mean SNOT-22 scores demonstrated the responsiveness of the instrument.

Conclusion: The results indicated that the Turkish version of the SNOT-22 is a valid instrument with good internal consistency, excellent reproducibility, validity, and responsiveness for assessing patients with CRS.

Objective: To evaluate laryngeal irritation before and after treatment using the reflux symptom index (RSI) in patients diagnosed with laryngopharyngeal reflux (LFR).

Methods: A total of 30 patients who were diagnosed with LFR after 24 hours of dual-probe pH monitoring were included in the study. RSI was applied to the patients before and after treatment. In evaluating the patients’ symptoms, throat clearing need and post-nasal drainage, which are frequently observed in LFR, were evaluated post-treatment. The patients were followed for 3 months during proton pump inhibitor treatment. Data regarding the patients’ LFR symptoms were obtained after 3 months, and the responses to treatment based on reflux symptom scale scores, post-nasal drainage, and throat clearing need were evaluated and compared with those pre-treatment.

Results: The decrease in the RSI for postnasal drainage value was statistically significant after treatment. The decrease in the throat clearing RSI value was statistically significant after treatment.

Conclusion: In patients with persistent postnasal drainage and throat clearing need complaints, if no infection source is identified, the patients should be evaluated by 24-hour pH monitorization in terms of LFR, irrespective of the presence or absence of laryngoscopic findings. 

Objective: The aim of this prospective study was to compare the duration and the postoperative complaints of the patients who had tonsillectomies with cold knife vs thermal welding.

Methods: Thirty-one adults undergoing tonsillectomy were included. Traditional tonsillectomy was implemented in one tonsil, and thermal welding tonsillectomy (TWT) was implemented in other tonsil of the same patient. Duration of the operation, amounts of blood loss and morbidity (postoperative pain) were recorded.

Results: Degree of pain, as assessed by Visual Analogue Scale, within the 1st postoperative day was not different between the two groups. Sensation of pain in 2nd–14th days were significantly lower in TWT group than in traditional tonsillectomy group. Although sensation of throat swelling and difficulty in eating tended to be lower in TWT group than in traditional tonsillectomy group, difference was not statistically significant. Although degree of ear ache on TWT side tended to be lower than traditional tonsillectomy side, difference was not statistically significant. In terms of postoperative hemorrhage, there was no difference between two tonsillectomy techniques. Duration of operation was significantly lower in TWT group than in traditional tonsillectomy group.

Conclusion: TWT results in decreased postoperative pain and significantly shortened operation time compared to the traditional tonsillectomy. Therefore, we suggest that TWT is a quite effective in tonsillectomy procedure.

Objective: In this study, the role of lateral nasal wall and sinus pathologies in the etiology of distal lacrimal duct disease has been investigated.

Methods: Seventeen female and 11 male patients who were scheduled for endoscopic endonasal dacryocystorhinostomy and silicon tube intubation between April 1999 and September 2003 were included in the study. The patients underwent general ophthalmologic examinations such as Schirmer test, fluorescein dye disappearance test, Jones I-II tests, canalicular irrigation, canalicular probing, dacryocystography, dacryoscintigraphy for the diagnosis of lacrimal duct obstruction. In the clinics of ENT, for the detection of nasal cavity pathologies, anterior rhinoscopy and diagnostic nasal endoscopic examinations were performed. All patients were evaluated during paranasal computed tomographic examinations regarding osteomeatal complex disease, ethmoid cell opacification, concha bullosa and presence of agger nasi cells and data obtained were compared with findings of 50 control subjects using Fisher’s chi-square tests.

Results: On the side where lacrimal duct obstruction exists, agger nasi cells were detected in 17 (60.7%) patients, concha bullosa in 10 (35.7%) patients, ethmoid cell opacification in 6 (21.4%) patients, osteomeatal complex disease in 4 (14.2%) patients, and one or more than one symptom were detected in 21 (75%) patients. Despite higher number of lateral nasal wall and sinus pathologies in the study group when compared with the control group, intergroup difference was not statistically significant (p>0.05).

Conclusion: We have concluded that despite the higher rates of lateral nasal wall and sinus pathologies in patients with distal nasolacrimal system obstruction, its etiology has not been adequately expounded and paranasal computed tomographies will have increasing importance in the evaluation of these patients.

Objective: The aim of this study was to evaluate the different factors that may affect graft success in tympanoplasty with mastoidectomy.

Methods: Patients who underwent tympanoplasty with mastoidectomy between September 2004 and July 2010 were included in this study. Patient data were collected retrospectively. The effects of the epitympanic patency, duration of the dry period of the ear, presence of preoperative otorrhea, location of the perforation, status of the middle ear mucosa, and status of the tympanic membrane on the rate of postoperative graft success in patients who underwent tympanoplasty with mastoidectomy were investigated. The chi-square test and Fisher’s exact test were used for statistical analysis.

Results: A total of 130 patients, 74 male and 56 female, with an average age of 35.7 (range: 11 to 56) years were included. The overall success rate for full postoperative graft success was 75%. A >3-month dry period of the ear, absence of preoperative otorrhea, preoperative normal middle ear mucosa, and presence of epitympanic patency significantly increased the postoperative success rate of graft (p<0.001). The presence of preoperative otorrhea and granulation tissue in the middle ear mucosa, presence of preoperative myringosclerosis, and lack of epitympanic patency were significantly associated with graft failure after tympanoplasty with mastoidectomy (p<0.001).

Conclusion: Epitympanic patency, middle ear infection, and the morphology of the tympanic membrane and middle ear mucosa should be considered prognostic factors in patients who undergo tympanoplasty with mastoidectomy.

Objective: The aim of this study was to assess the impact of odor exposure time on odor threshold, odor identification and discrimination.

Methods: Ninety healthy volunteers were randomly divided into three groups: Group 1 underwent an olfactory test with the standard odor exposure time (3–4 sec), Group 2 had an odor exposure time of 8–10 seconds, and Group 3 had 30 seconds. Odor parameters of three groups were compared.

Results: Groups 2 and 3 had significantly better odor identification scores than Group 1. There were no statistically significant differences between the three groups in terms of mean odor threshold and discrimination scores. Males of Group 3 had significantly better odor identification scores than males of Groups 1 and 2 and females of Groups 2 and 3 had significantly better odor identification scores than females of Group 1.

Conclusion: The results of the present study showed that longer odor stimulation led to higher odor identification scores. However, odor threshold and odor discrimination were independent from the odor exposure time. The odor exposure time of olfactory screening tests may be revised according to the gender in accordance with our findings.

Objective: To identify the effects of clinical and histopathological parameters on neck metastasis in early-stage oral cavity cancers.

Methods: The medical records of 92 patients who underwent primary surgical resection and concurrent neck dissection due to early-stage oral cavity squamous cell cancer at ‹zmir Atatürk Training and Research Hospital between June 2001 and June 2010 were retrospectively reviewed. The associations of clinical and histological parameters with neck metastasis were assessed. Based on the histological data, the histological sections of the operative tissue were obtained via the measurement of tumor width and tumor depth. Using an optical micrometer, the maximum width at the horizontal plane and the maximum depth at the vertical plane were measured and the maximum depth was recorded as tumor thickness.

Results: The association between neck metastasis and tumor localization, T stage, degree of differentiation, tumor thickness, perineural invasion, vascular invasion and perilymphatic invasion in early-stage oral cavity cancers was found statistically significant (p<0.05). The value of critical tumor thickness for the neck metastasis was found to be 5.6 mm.

Conclusion: On the basis of our results, a tumor thickness of 5.6 mm is the critical value for the development of neck metastasis in oral cavity cancers. The neck metastasis risk showed a significant increase in cases where the tumor thickness exceeded this threshold value. In oral cavity cancers with a high risk of occult metastasis, the tumor thickness may be identified pre-operatively or intra-operatively and, a decision can be taken to perform neck dissection when they exceed critical values.