Volume 11 Issue 1 (2021)

Objective: This study aimed to determine how prevalent allergic rhinitis (AR) is in Turkey and to compare the current prevalence with the figures obtained 10 years earlier.

Methods: This study included 9,017 participants. The minimum number of participants required from each center was determined via a stratified sampling technique according to regional demographic characteristics as ascertained from the last census. For each region, both men and women were administered the score for allergic rhinitis (SFAR) questionnaire and a score for each participant was calculated based on the responses supplied.

Results: A total of 9,017 individuals (55.3% men and 44.7% women) took part in this study. Of these, 94.4% were urban residents and 5.6% lived in a rural setting. Of the men, 38.5% self-reported as suffering from AR. The corresponding figure in women was 40.5%. The overall prevalence of AR, as deduced on the basis of the SFAR, was found to be 36.7%. Comparing the prevalence in different regions, we found that AR was the least prevalent in the Black Sea region with a frequency of 35.8%. The highest prevalence was in the Mediterranean region, where the prevalence was 37.7%. There was no statistical significance in the apparent differences in prevalence between different geographical regions. Despite this, however, there was a clear increase in the frequency of AR over the preceding decade. This increase was most pronounced in the South-Eastern Anatolian region, where the frequency rose from 21.0% to 36.9%.

Conclusion: Our results indicate that there has been a marked increase in the prevalence of AR in every region in Turkey over the last 10 years. This could be related to living conditions in urban environments. Alterations in lifestyle, urban living, air pollution causing impairments in immune defense mechanisms, and other aspects of modern lifestyles may account for the increase in AR in Turkey.

Objective: Gentamicin is a broad-spectrum aminoglycoside antibiotic administered parenterally for moderate to severe gram-negative infections. Ototoxicity is an important side effect that limits gentamicin use. The aim of this study is to investigate the effect of rutin on gentamicin-induced ototoxicity in rats biochemically and histopathologically.

Methods: Distilled water was administered by oral gavage to healthy controls (HG) and cobalt administered group (GC). 50 mg/kg rutin was administered by oral gavage to rutin + gentamicin (RGG) group. After one hour, 100 mg/kg gentamicin was injected intraperitoneally (i.p) to the RGG and GC animal groups. This procedure was repeated once a day for 14 days.

Results: Malondialdehyde (MDA), nuclear factor-κB(NF-κB), tumor necrosis factor alpha (TNF-α) and interleukin-1 beta(IL-1β) levels in the cochlear nerve tissue of gentamicin-treated animals were significantly higher compared to healthy controls and rutin + gentamicin treated rats. On the other hand, the amount of total Glutathione (tGSH) was significantly lower compared to the control and rutin group. Histopathological examination revealed degenerated myelinated nerve fibers in the gentamicin group and Schwann cell nuclei were generally not seen. There was a high accumulation of collagen fiber in the tissue and dilated blood capillaries. In the rutin group, myelinated nerve fibers mostly exhibited normal morphology, Schwann cell nuclei were evident and the vessels were normal. 

Conclusion: Our experimental results suggest that rutin may be effective in the treatment of gentamicin-associated ototoxicity.

Objective: The retrograde flow of gastric contents to the upper aerodigestive tract is known as laryngopharyngeal reflux disease (LPRD). It is also known as extraesophageal reflux disease and is a common condition seen in otolaryngology practice. Diagnosis of LPRD is difficult as the patients present with vague and indistinct symptoms. Reflux symptom index (RSI) is a 9-item questionnaire for evaluating symptoms of LPR, whereas the reflux finding score (RFS) is an 8-item clinical severity scale used to interpret the most common larynxgoscopic findings related to LPR. In this study, we aimed to correlate RSI with RFS in symptomatic patients to investigate the reliability of RSI in the diagnosis of LPRD.

Methods: In this study, we included100 patients attending the Otorhinolaryngology OPD at Santosh Hospital, Ghaziabad, India, with symptoms suggestive of reflux disease. The patients were asked to fill the RSI scoresheet in the first stage and patients with RSI >13 were chosen for the study. A total of 81 patients were chosen and examined by video-assisted 70° direct laryngoscopy to determine the RFS. The correlation between RSI and RFS were investigated.

Result: The study group included 81 patients presented with various symptoms of LPR. Upon investigating further with RFS and RSI we observed that only 7 patients of 81 had a positive score on RSI with a negative score on RFS.

Conclusion: According to the results of our study, RSI scoring alone is a fast and reliable method for the evaluation and diagnosis of LPR. Our study shows a high correlation between RSI scoring and RFS.

Objective: To determine the imaging features of extranodal head and neck lymphoma (EHNL) and their influence on prognosis. 

Methods: We retrospectively analyzed the clinical and imaging findings of patients who received a diagnosis of EHNL from January 2010 to September 2018. We documented their demographic characteristics and clinical, biochemical, and imaging features. We evaluated the number, location, size, margin, shape, enhancement degree and pattern, local tumor invasiveness, regional lymph node, and presence of necrosis using computed tomography or magnetic resonance imaging. The influence of imaging features on prognosis was assessed using univariate and multivariate logistic regression analyses. 

Results: Sixty-nine patients with EHNL (male/female: 39/30; mean age ± SD: 59.3±17 years; age range: 18-87 years) were included. The most frequent histological type was non-Hodgkin’s lymphoma (97.1%) with diffuse large B-cell lymphoma (47.8%) as subtype. Solitary involvement was more frequent (58%). The most commonly involved locations were the Waldeyer’s ring (60.9%) and sinonasal region (13%). Univariate analysis revealed that tumor size of 5 cm or larger, ill-defined margin, irregular shape, presence of local invasion, presence of necrosis, and heterogeneous irregular enhancement were more frequent in patients with a poor prognosis (P < .05). In contrast, multivariate analysis revealed that all these factors independently had no significant influence on prognosis. 

Conclusion: Radiological characteristics of tumor including size, margin, shape, contrast enhancement pattern, local tumor invasiveness, and presence of necrosis impacted prognosis in univariate analysis but not in multivariate analysis. However, further studies are needed to firmly establish the imaging features of EHNL in predicting prognosis. 

Objective: Contrast-enhanced temporal magnetic resonance imaging (MRI) is the gold standard for differential diagnosis of retrocochlear pathologies. Nowadays, with the improvement of MRI devices and new imaging modalities, we have very detailed images of the cerebellopontine angle. In this study, we calculated the additional cost of contrast-enhanced MRI and questioned that if contrast-enhanced imaging is still necessary for diagnosis. 

Methods: Temporal bone MRIs of 1145 patients admitted to our clinic with unilateral asymmetric sensorineural hearing loss were evaluated retrospectively. The factors that affect the cost of the imaging, including serum creatinine test, establishing vascular access, and contrast material were analyzed, both for the cost and the time consumed. 

Results: Of the 1145 patients, 31 were diagnosed with vestibular schwannoma (VS). Re-examination of the images of the patients with VS revealed that the tumor could be seen on the images with and without contrast in 30 cases. Only one patient had a tiny VS that was difficult to identify on noncontrast imaging. The total additional time and cost for contrast-enhanced imaging were calculated as 18,320 minutes and 37,888 USD. The sensitivity and specificity of the noncontrast 3D FIESTA technique have been determined as 96.8% and 99.9%, respectively. 

Conclusion: We recommend the noncontrast MRI 3D FIESTA modality for screening because of its high sensitivity and specificity when the cost and time spent for contrast enhancement are taken into account. It will also reduce the expenses of the health system, increase hospital income, and shorten waiting lists of patients. 

Objective: Aspirin intolerance (AI) is one of the endotypes of chronic rhinosinusitis (CRS) that can be effectively treated if detected early. Considering the limitations of the available tests for AI, there is still a need for an affordable, cost-effective, and safe marker that can enhance AI’s early detection. In the past years, the association between AI and eosinophilic inflammation has been well documented. Eosinophil cationic protein (ECP) is a specific marker for eosinophil activation. In this study, we aimed to assess the value of assaying serum ECP in detecting AI in patients with CRS.

Methods: Eighty-four patients with CRS were enrolled in this study, and they underwent an intravenous or oral aspirin (ASA) challenge test. Receiver operating characteristic curves were used to evaluate the diagnostic value of serum ECP level for the AI in patients with CRS and calculate the best diagnostic cut-off value.

Results: Using systemic ASA provocation, the prevalence of AI among patients with CRS was relatively high (43%). There was a significant difference in the mean serum ECP level in the two groups (positive group 19.3, negative group 8.6 µg/L, and P < .0125). Serum ECP level showed an acceptable discrimination value for predicting AI in patients with CRS (area under the curve = 0.622). The best diagnostic cut-off value and corresponding sensitivity and specificity were >13.9 µg/L (38.89%, 85.42%).

Conclusion: Assaying serum ECP in patients with CRS could help detect AI, especially when other more accurate tests are not available. 

Objective: The aim of this study was to investigate the relationship between septum deviation and sleeping position in patients with nasal septum deviation. 

Methods: The study included 25 patients with nasal septum deviation on the right side, 25 patients with septum deviation on the left side, and 25 patients without septum deviation as the control group. The polysomnography reports of these patients were assessed retrospectively, and the spans of rest in the right, left, and supine positions were evaluated. 

Results: The right side-lying time was significantly longer than the left side-lying time in the group with right side deviation (P < .01). In the group with left sided septal deviation, the left side-lying time was significantly longer than the right side-lying time 
(P < .01). There was no significant difference between the 2 side-lying periods (P = .118). Moreover, the ratio of sleep duration in the supine/non-supine position in the groups with deviation was significantly higher than that in the control group. 

Conclusion: The results of our study showed that patients with nasal septum deviation slept more in the supine position than those without deviation and slept more on the deviated side when sleeping in the non-supine position. 

Objective: The Covid-19 pandemic continues to threaten the whole world. Early diagnosis of patients is very important to prevent the spread of the virus. Sudden loss of taste and smell is a common early symptom in patients. Therefore, it is thought that revealing the pathogenesis of the symptom will help both in early diagnosis and in predicting the prognosis.

Materials and Methods: The age, gender, predominant symptoms during Covid, length of stay at home/hospital, and smoking status of patients who had Covid and had loss of taste and smell between July 2020 and December 2020 were evaluated retrospectively. 

Results: Patients with loss of taste and smell were significantly younger than those who did not. The majority were female patients, non-smokers, and patients needing significantly less hospitalization and receiving treatment at home. Among the accompanying symptoms, GIS symptoms were also significantly more common in this group.

Conclusion: Loss of taste and smell is an important symptom in Covid-19 infection. Revealing the demographic and clinical characteristics associated with this symptom is valuable in terms of early diagnosis of the disease, predicting the prognosis and reducing the contagiousness.

Objective: Investigations show that nasal septum deviation changes the paranasal sinus volume on the deviation side and affects the middle ear pressure. In this study, we investigated the relationship between the degree of nasal septum deviation and the pneumatization degree of the mastoid bone air cell system.

Methods: This retrospective study evaluated data collected from February 2018 to January 2020 at Amasya University Sabuncuoglu Serefeddin Training and Research Hospital The nasal deviation direction and the angle of septal deviation in coronal sections were recorded, and the mastoid bone pneumatization was classified. Then, the relationship between the nasal septum deviation and the mastoid pneumatization was evaluated.

Results: There was a statistically significant difference between the rate of the right mastoid pneumatization level in relation to the direction of nasal septum deviation. Otherwise, no statistically significant differences were found in the left mastoid pneumatization between the areas to the right and left of the nasal septum deviation.

Conclusion: The results showed that mastoid pneumatization significantly affected those with a deviation of the nasal septum to the right, resulting in a significant reduction in volume on the ipsilateral side. However, on the opposite side of the deviation, the mastoid pneumatization was reduced, although not as much as on the deviation side. These results suggest that nasal septum deviation may also affect mastoid pneumatization. 

Objective: Systemic inflammatory markers are investigated in many solid cancers, including laryngeal squamous cell carcinoma. Neutrophils, lymphocytes, platelet counts, and red cell distribution width (RDW) are thought to predict survival in patients with cancer.

Methods: Patients included in the study had a diagnosis of laryngeal squamous cell carcinoma and were treated at our hospital. Patients with a metastatic disease, positive margin, insufficient follow-up, treatment before surgery, and hematologic disorders were excluded. This retrospective cohort study included 82 patients. The relationship between inflammatory markers with overall survival (OS) and disease-free survival (DFS) was investigated using Kaplan–Meyer, univariate, and multivariate analyses.

Results: Although pathologic N (pN) status, derived neutrophil to lymphocyte ratio (dNLR), and lymphovascular invasion showed significant correlation with OS in the univariate analysis, dNLR and pN showed significant correlation in the multivariate analysis. DFS was related to perineural invasion, grade, and pN status in the univariate analysis, and perineural invasion and pN were also significantly related in the multivariate analysis.

Conclusion: Platelet to lymphocyte ratio, systemic-immune-inflammation index, RDW, and dNLR correlate to grade, pathologic T, and OS, but not to the neutrophil to lymphocyte ratio.

Ranula is defined as a swelling on the floor of the mouth, and its etiology is unclear. Aspects of etiopathogenesis, origin, and management remain debatable. The rationale of our study was to eliminate the discrepancies pertaining to the etiopathogenesis and management of ranula. Our objective was to determine the etiopathogenesis of ranula by systematically reviewing the available literature and to establish the best treatment protocol for ranula (intraoral and plunging). Case series, case reports, and observational and longitudinal studies referring to the etiology, pathogenesis, and management of ranula were included, and the previously published review articles were excluded from our study. We performed an electronic search from the year of inception of the database to December 2019. PubMed, Science direct, and Google Scholar databases were explored without restrictions of language or publication date. The search algorithm was Ranula {Mesh Major topic} and {Etiopathogenesis}, Ranula {Mesh Major topic} and {Management}. A total of 64 full-text articles were assessed. We concluded that the presence of the Bartholin duct might be a possible cause of intraoral ranula development, indicating that it originates from greater sublingual gland. Intraoral and plunging ranula are traumatic extravasation pseudocysts. Congenital ranula are histopathologically classified retention cysts lined with stratified squamous epithelium. The mylohyoid muscle exhibits dehiscence, which is commonly present in the anterior two-third part from which a part of the sublingual gland can be herniated or mucus can extravasate, leading to the formation of plunging ranula. Transoral excision with complete excision of ipsilateral sublingual gland remains the gold standard treatment of intraoral ranula and gold standard surgical treatment for plunging ranula. For mixed ranula, the treatment includes transoral excision of the sublingual gland along with the drainage of cyst.

Foreign body ingestion is not an uncommon encounter in adults, especially denture ingestion in the elderly. Dentures usually studded with wires can be categorized among sharp, irregularly shaped, and impacted foreign bodies, which necessitates their urgent removal considering their capability of triggering fatal complications if left unattended. Aerosolization procedures, especially in patients who are positive for coronavirus disease 2019 (COVID-19), is a high-risk procedure that may cause infections in healthcare professionals. We hereby present the challenges faced and the protocol followed for managing the case of a 60-year-old patient with COVID-19 infection who presented with accidental denture ingestion, which manifested as a foreign body in the upper end of the esophagus.