Objective: This study aimed to discuss perspectives of the 2016-2018 Turkish Otorhinolaryngology Head and Neck Surgery Society Rhinology-Rhinoplasty-Allergy and Sleep School (RS) postgraduate training and education.
Material and Methods: This was a retrospective analysis of aspects related to the postgraduate rhinology training and education of students admitted to the RS for the 2016-2018 education periods. The following data was collected and reviewed: criteria for student admission to the school, student age and gender, institution of practice, qualification document status, training course content, pre-test, and post-test results, place of training activities in the total time, sites for clinic visitations and their durations, educational activities carried out during the visitations and student feedback.
Results: Fifteen students were accepted in the two consecutive semesters. The academic program of the RS comprised four days of lectures, a day of cadaver dissection, and five days of clinic visitations. The average scores of the feedback received for lectures were 3.95/5 and 4.05/5 for each semester, respectively. Regarding the correct result ratio for pre- and post-test students presented was a statistically positive change in the level of knowledge (p=0.001).
Conclusion: The training program of the RS, conducted by Otorhinolaryngology Schools (ORL-S), has contributed to the process of obtaining information on the day of training and was evaluated positively by the participants. The student presented positive feedback about the full curriculum, however revealed some organizational drawbacks. The main outcome, the impact on behavioral change, has not been evaluated and it has been observed that rhinology school education is not sufficiently structured to evaluate this. The sustainability of the training appears to be an important concern that needs to be addressed.
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Objective: In recent years, a different subtype, characterized by eosinophilia infiltration that is associated with T-helper cell type 2 (Th2) inflammation is known to worsen disease prognosis in patients with a nasal polyp. We aimed to assess the correlation of serum and tissue eosinophil levels and the radiological severity of the disease in our own patient group.
Material and Methods: Total 201 patients, including 131 men and 70 women who had undergone endoscopic sinus surgery for nasal polyp from 2013 to 2017 at the Aydın Adnan Menderes University Hospital were enrolled in our study. The eosinophil rates in the preoperative whole blood hemogram examinations and the rates of eosinophils in surgical pathologies were compared; the paranasal sinus computed tomography (CT) sections were evaluated as per the Lund-Mackey score and Kennedy osteitis score (KOS). Osteitis was scored radiologically as per the KOS systems. As per the tissue eosinophil count, more patients had an eosinophil count >10 eosinophil count/HPF (large magnification; 400×) and fewer had eosinophil count ≤10 eosinophil/HPF count.
Results: The Lund-Mackey scores were significantly higher in those with high eosinophil levels in the pathological specimens. The KOS were also found to be high in patients with high Lund-Mackey scores. In patients with higher eosinophil levels in the blood sample, the tissue eosinophil value in pathology samples was also high.
Conclusion: In patients with eosinophilia in the tissue or blood, the radiological prevalence and the osteitis scores of chronic sinusitis are expected to be high.
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Objective: The present study was performed to investigate the association of antrochoanal polyps (ACP) with contralateral sinus obliteration and their effect on recurrence.
Material and Methods: This retrospective study was performed by searching the records of 106 patients who underwent surgery with a diagnosis of ACP between January 2010 and January 2018. Determination of the presence of sinus obliteration in patients and scoring were performed by analyzing the preoperative paranasal sinus tomography. The Lund–MacKay (LMK) system was used for scoring. Patients were followed up for an average of 25 months (range, 12 to 47 months).
Results: Sinus obliteration was determined by examination of tomography results and the mean preoperative LMK score of 106 patients was 7.49±3.76. The mean LMK score for the side with the polyp(s) (5.49±2.56) was significantly higher than that of the contralateral side (2. 00±2.31) (p = 0.0001). Recurrence was detected in eleven patients (10.4%). The mean preoperative LMK score for the side with the polyp(s) of recurrence (+) patients was significantly higher than that of recurrence (–) patients (p = 0.039). There was no significant difference between mean LMK scores of the sides without ACP in recurrence (–) and recurrence (+) patients (p= 0.367). The total mean preoperative LMK score of recurrence (+) patients was significantly higher than that of recurrence (–) patients (p = 0.049)
Conclusion: In our study, it was observed that recurrencies increased in patients with ACP where sinus opacity was more intense, but contralateral sinus opacity had no effect on recurrence.
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Foreign body in the nose is relatively uncommon in adults. The occurrence of a foreign body in the paranasal sinuses is even rarer, and majority of the cases are associated with maxillofacial trauma. In contrast to the common presentation of foul-smelling nasal discharge, a foreign body in the paranasal sinuses may only produce vague symptoms. Their presence is frequently overlooked. Clinical suspicion and radiological investigations are essential for establishing a diagnosis. It is important to rule out the presence of foreign bodies in patients with maxillofacial trauma. We present a rare case of foreign body in the frontal sinus of a patient that was discovered after 25 years.
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Chronic maxillary atelectasis (CMA) is an underdiagnosed condition that can occur bilaterally and may lead to significant complications. An accessory maxillary ostium (AMO) is a defect in the posterior fontanelle that is associated with maxillary sinus pathology. We present a case of a 47-year-old man with sinonasal symptoms. Nasendoscopy demonstrated bilateral lateralized uncinate processes. Radiological findings were consistent with a diagnosis of bilateral stage II CMA, with the left side less atelectatic than the right and only partially opacified. The patient was treated surgically with bilateral uncinectomy and maxillary antrostomy. Intraoperatively, an AMO was visualized on the left. The main theory regarding the etiology of CMA is sustained obstruction of the ostiomeatal complex resulting in negative intra-sinus pressures and subsequent atelectatic remodeling of the antral walls. Our patient had an AMO on the left side, which was also the side of reduced severity of both symptoms and radiographic findings. We propose that the patient initially had bilateral CMA, with subsequent development of a left AMO, which halted further progression of the disease on this side. This case suggests that an AMO can develop or enlarge and supports the notion that CMA is caused by negative intra-sinus pressures. Further research is required to establish the detailed etiology of CMA.
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Posterior choanal atresia is rare but is the most common congenital malformation of the nasal cavity. It is characterized by a completely closed choana. Generally, this malformation is observed in newborns as increased respiratory distress during feeding, cyanotic attacks, and relaxation with crying. In contrast to unilateral atresia, bilateral disease is a life threatening condition and is extremely rare in adults. Herein, we presented a case of bilateral membranous choanal atresia detected in an 18-year-old patient. An 18-year-old female patient was admitted to our clinic after complaining of nasal obstruction, nasal discharge, snoring, anosmia, and mouth breathing since she was a child. On endoscopic examination, a right-deviated nasal septum and bilaterally closed choanae were observed. Membranous bilateral choanal atresia was observed on computed tomography (CT). The patient underwent transnasal endoscopic surgery under general anesthesia. Both septoplasty and bilateral coanoplasty surgeries were performed. No complications were observed postoperatively or at one year of follow up. Bilateral choanal atresia is a rare anomaly in adults. The diagnosis can easily be made by endoscopic examination or CT. The transnasal endoscopic surgical technique is an easy, reliable, and effective treatment method.
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Objective: Benign vascular lesions are common in the head and neck area, but sinonasal involvement is rare. This study aimed to present the features and surgical outcomes of patients with benign sinonasal vascular lesions in a single institution.
Material and Methods: Medical records of 20 patients who underwent surgery for benign sinonasal vascular lesions at the Department of Otolaryngology, Hacettepe University between 2005 and 2020, were retrospectively reviewed. Patients’ demographic characteristics, lesion size and localization, surgical outcomes, and recurrence status were noted.
Results: The study group comprised 8 male (40%) and 12 female (60%) patients. Mean age was 41.3±22 years. The main presenting symptoms were epistaxis (60%) and nasal obstruction (30%). The most common sites of origin were the inferior turbinate (35%) and nasal septum (30%), followed by the maxillary sinus (15%). Mean lesion size was 27.1±13.2 mm. Histopathologically, 12 specimens were classified as vascular malformations and 8 as vascular tumors. Mean age was higher among the vascular malformations compared to the vascular tumors (49.9 y vs 28.5 y, p=0.031). All the lesions at the inferior turbinate were vascular malformations (p=0.014). The endoscopic endonasal technique was used in 16 patients (80%) whereas, combined techniques were used in 4 patients (20%). Residue/recurrence rate was 25%. The mean lesion size was larger in patients with residue/recurrence (42 mm vs 22 mm, p=0.001).
Conclusion: The endonasal endoscopic technique could be successfully used for the treatment of benign sinonasal vascular lesions. Lesion size was important with regard to residue/recurrence; thus, patients with larger lesions should be followed-up closely in the postoperative period.
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Objective: This study aimed to compare the serum oxidative stress levels of patients with adenotonsillar hypertrophy (ATH) with those of controls and to investigate the effects of adenotonsillectomy on the oxidative stress levels.
Material and Methods: Thirty healthy children (mean age, 6 years) and 30 patients with ATH (mean age, 7 years) aged 2-12 years were included in the study. Serum total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and paraoxonase (PON) levels were compared between the patient and control groups. The preoperative and postoperative levels were also compared within the patient group.
Results: The TOS and OSI levels were significantly higher in the patient group than in the control group (p=0.007 and p=0.027, respectively). There was no significant difference between the patient and control groups in terms of the TAS and PON levels (p=0.399 and p=0.237, respectively). The TOS and OSI levels in the patient group were significantly higher in the preoperative than in the postoperative period (p=0.005 and p=0.023, respectively), whereas there were no significant differences in the TAS and PON levels between the preoperative and postoperative period (p=0.192 and p=0.262, respectively).
Conclusion: These findings demonstrate that patients with ATH are exposed to high levels of oxidative stress and that adenotonsillectomy normalizes the oxidative stress.
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Nasolabial cysts are rare lesions of the maxillofacial region that exhibit slow growth and can remain asymptomatic for a long time. Common symptoms include swelling in the nasolabial region and nasal obstruction. These cysts have a female predilection and are usually diagnosed in the 4th-5th decades of life. Surgical excision via a sublabial approach and transnasal marsupialization are the preferred treatment modalities. In this study, we retrospectively examined 10 patients who were operated for nasolabial cysts at our clinic between 2009 and 2019. We aimed to present our clinical experience with nasolabial cysts.
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