Volume 6 Issue 2 (2016)

Objective: To determine the relation between hypoxia and physical parameters in patients who had different levels of severity of obstructive sleep apnea (OSA).

Methods: This was a retrospective, cross-sectional study of 259 men who were evaluated with overnight polysomnography. Severity of OSA was graded based on the apnea-hypopnea index (AHI): normal/simple snoring (n=31); mild OSA (n=70); moderate OSA (n=63); severe OSA (n=95). Patients with different severity were divided into subgroups, based on having the lowest or highest values of the total sleep time with oxygen saturation <90% (ST90) or minimum oxygen saturation (min SaO2).

Results: Median AHI was 20.4 events/hour. Univariate analysis showed that ST90 was correlated with AHI (r=0.772; p≤0.001) and Epworth sleepiness scale (ESS) (r=0.344; p≤0.001), and min SaO2 was inversely correlated with AHI (r=-0.748; p≤0.001) and ESS (r=-0.319; p≤0.001). Multivariate linear regression showed that ST90 was independently associated with AHI, ESS, and neck circumference, and min SaO2 was independently inversely associated with AHI, ESS, and body mass index (BMI). In patients who had severe OSA, the subgroups which had lowest and highest min SaO2 differed significantly in BMI, modified Mallampati score, neck and waist circumferences, and retroglossal Müller grade. In patients with percentage of sleep time with oxygen saturation below 90% (CT90) <10%, the upper limit of ST90 was 36 minutes and corresponded to 70% lower limit of min SaO2.

Conclusion: Hypoxia parameters show significant variation in OSA severity categories. None of the physical parameters had clinically useful relations with hypoxia parameters in OSA patients except patients who had severe OSA.

Objective: The aim of this study was to investigate the effects of different physical activities on nasal response.

Methods: Young non-professional university teams (male, 20 to 24 years old) were enrolled in this study. Nasal functions were measured with an active anterior rhinomanometry and the saccharine transport method (nasal transport times, NTT) before and immediately after the exercise. After the initial measurements, the first group swam 30 minutes in the swimming pool. The second group (outdoor runners) ran 10 kilometers in approximately 30 minutes. The third group played handball for 30 minutes. The initial findings were compared statistically with the data obtained after exercise.

Results: When the reductions in nasal resistance were compared before and after exercise, the inspiration and expiration values of all groups were statistically significant. These three groups were similar regarding the comparison of nasal resistance change percentages. When the NTTs were compared before and after exercise, the decreases in the amount of time were statistically significant in all these three groups after exercise. When the change percentages of the decrease in nasal transport time were compared, the decrease in handball players was statistically significant compared to runners.

Conclusion: Nasal resistance reductions and the decreases in NTT were not affected by the type of sports being played or the air quality of the environment.

Objective: The purpose of the present study was to investigate the relationship of sinonasal anatomic variations (SAVs) with maxillary sinus retention cysts (RCs) on paranasal sinus tomography.

Methods: Our study included 202 patients who applied to the ENT outpatient clinic with fascial pain, nasal obstruction and postnasal drip complaints between September 2014 and February 2016 and underwent CT of paranasal sinus on coronal plane. The patients who had maxillary RCs in their CT scan comprised the study group while the patients who did not have RCs in their CT scan comprised the control group. The CT scans of these two groups were examined and recorded for the SAVs. The statistical analysis of the SAVs for these two groups was conducted using the Mann-Whitney U test.

Results: The presence of septal deviation from SAVs and pneumatized uncinate in patients found to have maxillary sinus retention cyst was considered statistically significant (p<0.05). The sex in patients with right maxillary sinus RCs was considered statistically significant (p<0.05). The presence of pneumatized uncinate in patients with left maxillary sinus RCs was considered statistically significant (p<0.05).

Conclusion: In our study, the statistical relationship between SAV and maxillary sinus retention cysts may show that SAVs may be effective in the etiology of maxillary sinus retention cysts. This result has to be verified by more detailed studies.

Objective: The aim of the present study was to analyze patients who underwent facial nerve decompression.

Methods: A retrospective data analysis was performed on 15 patients operated between January 2005 and January 2015. All patients were evaluated with high-resolution temporal computed tomography, House-Brackmann grading system, and electrodiagnostic tools (electromyography or electroneurography).

Results: There were 8 female and 7 male patients with a mean age of 20.56 (range: 2 to 59) years. All of the patients underwent facial decompression surgery via a transmastoid approach.

Conclusion: Transmastoid approach in patients with facial nerve injuries within the first genu and the digastric ridge is appropriate, and the increase in the amplitude observed in the postoperative EMG records obtained from musculus orbicularis oculi may be considered as significant indicator of nerve recovery that occurs before clinical improvement.

Objective: To investigate the effects of hyaluronic acid (HA) (Sepragel® Hylan B; Genzyme Co., Cambridge, MA, USA) on the mucosal healing of patients who undergone functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis and/or nasal polyposis.

Methods: A total of thirty-six patients were included in the study. Patients had received topical administration of HA soaked sponges to the middle meatus on one side of their nasal cavities intra-operatively at the end of the procedures. Other side of the middle meatus was free of any treatment or packing to create a control group. Postoperative endoscopic examination was performed at the 1st, 4th and 12th weeks in order to score mucosal findings regarding synechiae, mucosal hypertrophy and polyp formation on both sides. Mucosal findings were scored from 0 to 3 points (0: lesion free, 1: mild, 2: moderate, 3: severe).

Results: Average scores of the mucosal cavities were compared and it was found to be significantly low for the HA administered mucosa (p<0.05). Synechia formation and mucosal hypertrophy at the 1st, 4th and 12th weeks were significantly low for the Hylan B group compared to the control group (p<0.05 for both findings).

Conclusion: Topical HA has preventive effects on synechia formation and mucosal hypertrophy.

Objective: Recurrent aphthous stomatitis (RAS) is a chronic inflammatory disease of oral mucosa characterized by recurrent painful ulcers. Despite it is a condition seen frequently, its etiology and pathogenesis are not known fully. Its etiology is reportedly idiopathic or multifactorial. Mean platelet volume (MPV) indicates thrombocytic activation, while neutrophil/lymphocyte rate (NLR) is an indicator of chronic inflammation, and both of them can be measured during routine whole blood analysis. The aim of this study is to investigate MPV and NLR values in patients with RAS and the control group.

Methods: A total of 39 patients with RAS and 34 control subjects were included in the study.

Results: When the patient and the control groups were compared, MPV, ESR, CRP and vitamin B12 values were significantly higher in the patient group while NLR, WBC, hemoglobin, neutrophil and lymphocyte values were not significantly different between both groups.

Conclusion: It was shown that MPV can be used as a diagnostic indicator in patients with RAS.

Objective: To determine the incidence, clinical and histopathological presentations of the paranasal sinus tumors in Komfo Anokye Teaching Hospital, Kumasi, Ghana.

Methods: All cases of sinonasal cancers diagnosed between January 2007 and December 2012 were retrospectively reviewed.

Results: Of the 68 patients (38 males, 30 females) whose charts were reviewed, the median age was 49 (range: 14 to 84) years. The common clinical presentations were epistaxis (23%), nasal mass (20%), headache (12%), nasal blockage (12%), nasal discharge (11%), proptosis (9%), cheek swelling (8%), and epiphora (5%). The most common histopathological subtypes were squamous cell carcinoma (39.6%) and adenocarcinoma (25%).

Conclusion: Sinonasal tumors are frequent in male adults and present with epistaxis, nasal mass, blocked nose and nasal discharge, while squamous cell carcinoma remains the common histopathological type.

Objective: To evaluate the clinical and pathologic parameters associated with level IIb metastasis in transglottic laryngeal carcinoma.

Methods: A total of 238 laryngeal squamous cell carcinoma patients admitted to our tertiary center and surgically treated between January 2006 and January 2014. Of these 238 patients, 134 patients with transglottic laryngeal SCC were enrolled in the study. The type of neck dissection, the location of histopathologically proven metastatic lymph nodes, clinical N and T stages were reviewed. Palpable lymph nodes were accepted clinically cN(+) and the opposite as cN(-).

Results: Of the 134 patients, 116 were diagnosed as cN(-), and 18 were as cN(+). Level IIb metastasis was diagnosed in 12 patients in the cN(+) group, and in two patients in the cN(-) group. Histopathological level IIb metastasis was shown in 14 of 134 patients, representing 16 of 268 neck dissection specimens. Level IIb metastasis was shown in the ipsilateral specimens in 12 patients and contralateral specimens in two patients. Forty-one of 134 patients presented cartilage invasion, and nine of them were diagnosed with level IIb metastasis.

Conclusion: Thyroid cartilage invasion, the presence of level IIa invasion and advanced stage disease are the risk factors for level IIb metastasis. Therefore, level IIb should not be neglected during neck dissection in transglotticlaryngeal carcinoma.

Objective: To compare the severity of anxiety and depression symptoms in idiopathic sudden sensorineural hearing loss (ISSHL) patients with (n=33) and without (n=17) recovery, and healthy control group.

Methods: This study was conducted on ISSHL inpatients (n=50) and a healthy control group (n=52). Severity of the anxiety and depression symptoms was assessed using the State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI) during admission. Hearing data of all 50 cases obtained at baseline and after the treatment (at the end of the 4th week) were gathered from the audiological evaluation form of each patient.

Results: The rates of ISSHL patients with and without recovery were 66% and 34%, respectively. The mean BDI and STAI-II scores of the patients with ISSHL were significantly higher than those of the control group (11.4±8.6 vs. 6.8±4.3 and 41.6±7.3 vs. 36.7±8.4, respectively; p0.05).

Conclusion: ISSHL patients had a more depressive and anxious mood compared to the healthy controls. However, anxiety and depressive mood had no effect on the recovery status of the ISSHL patients. Physicians also need to pay attention to the status of anxiety and depressive symptoms in patients with ISSHL.

Ultrasonography technique is generally used for head and neck lumps. As pharyngoesophageal diverticula reach large sizes, it might project toward the thyroid gland which can be confused with thyroid nodule during thyroid ultrasonography, leading to unnecessary fine needle aspiration biopsy. In this report, we present a case of pharyngoesophageal diverticulum that mimicked thyroid nodule in ultrasonography together with literature knowledge and ultrasonographic signs.