Objective: Epistaxis is one of the common complications after septoplasty. The type of packs more effective in preventing bleeding after the surgery is still a matter of debate. The aim of this study is to compare the effects of airway Doyle Silicone pack, Merocel pack, and the combination of Merocel and silicone packs on pain, bleeding, and mucociliary clearance after septoplasty.Material and Methods: This study is a prospective cohort study. A total of 75 patients who underwent septoplasty were divided into 3 groups: silicone pack was applied to the first group (termed group S), Merocel pack was applied to the second group (termed group M), and a combination of Merocel and silicone packs was applied to the third group (termed group M+S). The amount of bleeding, the intensity of pain, and mucociliary clearance duration were compared.Results: The amount of bleeding in group M+Swas significantly lower than that in group S (p<.001). The amount of bleeding in group M+Swas significantly lower than that in group M (P=.003). Pain was significantly lower in group S than in groups M and M+S (p<.001 and p=.024).Conclusion: It was determined that combined use of silicone and Merocel packs after septoplasty caused less bleeding than the useof silicone pack or Merocel pack alone. The combined use of Merocel and silicone packs can be a good alternative packing method because it reduces nasal bleeding after septoplasty.
|
Objective: This study aimed to determine the age groups at risk of nasal cavity foreign bodies, investigate the types of materials that might pose a danger and the measures that can be taken to avoid them, as well as to evaluate these measures in the light of the literature.Material and Methods: The files of patients diagnosed with foreign body in the nose who were admitted to the Emergency Service or Ear-Nose-Throat Clinic in our hospital between January and December 2018 were retrospectively reviewed. Various parameters such as the variety and frequency of foreign bodies, the nostril in which they were placed, the foreign body observed as per the age group, and gender were recorded. Patients who were admitted and completed their treatment in the pediatric clinic were excluded from the study. Clinical symptoms and treatment protocols were investigated and these cases were discussed in the light of the literature.Results: A total of 120 patients applied to our hospital during the study period. Seventy-nine of them (65.8%) were male and 41 (34.2%) were female patients. The average age was 4.25 years (13 months to 74 years). Endoscopic nasal examination was performed in the outpatient clinic. Foreign bodies were removed from the right nasal passage in 70 (58.3%), left nasal passage in 47 (39.2%), and both nasal passages in three (2.5%) cases. Treatment of 113 patients (94.2%) was successfully completed in the outpatient clinic. In the remaining seven patients (5.8%), foreign bodies were removed under sedation in the operating room. Five of the patients who underwent sedation were children and two were adult patients. Smelly rhinolith fragments could be removed from adult patients by breaking them. The limestone plaques formed around it caused bleeding. After the procedure, merocele tampon was placed. Most of the patients were between 0–5 years old in the pre-school group (n=94, 78.3%). This was followed by the school age group of children aged 6-15 years (n=17, 14.2%). The lowest proportion was the group consisting of adults aged 16 years and above (n=9, 7.5). The most common foreign bodies were small pieces of plastic toys (n=37, 30.8%). The most common age group in which the plastic toy parts were encountered was the 0–5 years age group (n=29, 78.4%). The second most common foreign bodies (n=23, 19.2%) were granular foods such as roasted chickpeas, hazelnuts, corn, and pomegranate seeds. The most common age group in which the granular foods were encountered was the pre-school age group with children aged 0–5 years (n=19, 82.6%).Conclusion: The presence of foreign bodies in the nasal cavity is a common problem in otolaryngology, especially in the pediatric age group. It can cause serious side effects such as aspiration and obstruction; therefore, immediate intervention is required. Parents should be informed about this issue. Warning notices should be written especially on plastic toys that they may be dangerous for younger age groups.
|
Objective: The variations of the nasal turbinates have been implicated in the pathogenesis of rhinosinusitis. Accordingly, this study aimed at elucidating the variations of the nasal turbinates in adults.Methods: This retrospective study was conducted in the Radiology Department of a teaching hospital. Following ethical approval, brain CT scan images of 336 patients aged 20-99 years were used to study the nasal turbinates. Datawere analyzed using Statistical Package for the Social Sciences (SPSS) version 23.0 (IBM SPSS Corp.; Armonk, NY, USA)and summarized in frequencies. Chi-square test was used to evaluate for gender and side differences in the frequencies of the variants. A P-value of <.05 was considered statistically significant.Results: Concha bullosa (CB) was the commonest variant (28.6%) followed by the paradoxically curved middle turbinate (PMT) (14.3%) and inferior turbinate hypertrophy (14.3%). The least prevalent variants were pneumatized superiorturbinate (6.5%) and hypoplastic inferior turbinate (4.5%). None of the variants showed a statistically significant genderdifference (P > .05). Both CB and PMT showed a statistically significant side difference (P ¼ .001).Conclusion: The presence of the variants of the nasal turbinates in this study emphasizes on the need for preoperative imaging prior to functional endoscopic sinus surgery, which is becoming popular among otolaryngologists. Thiswill ensure the successful restoration of sinus ventilation and drainage and minimize complications.
|
Background and Aim: There are various studies on the inflammatory pathogenesis of nasal polyposis (NP). It hasbeen suggested that discoidin domain receptor-1 (DDR1) and collagen type 4A (COL4A) have a role in formation ofinflammatory responses in the tissue microenvironment. The aim of the study was to study the expressions of DDR1and COL4A in NP, and nasal mucosa.Materials and Methods: This randomized, prospective, controlled clinical study was conducted on 17 patients’ NPtissue and 24 subjects’ inferior nasal turbinate. DDR1 and COL4A expressions were determined by quantitative realtime PCR. Histopathologic examinations were also carried out. Protein levels of the samples were determined usingELISA. The associations between the parameters were explored.Results: DDR1 and COL4A transcripts were found at similar levels in all of the samples. There were correlationsbetween DDR1 and COL4A mRNA levels in both the NP and control groups. There was also a negative correlationbetween extracellular edema and COL4A protein levels in NP.Conclusion: To our knowledge, this is the first study to report DDR1 expression in NP tissue. We did not find any significant differences between NP and inferior nasal turbinate in terms of expressions of DDR1 and COL4A. Prospectivestudies with large populations should be planned for understanding DDR1 role in NP.
|
Objective: This study aimed to determine the allergen distribution by sex and age in patients diagnosed with allergic rhinitis living in Edirne and to evaluate the patients presenting with allergic rhinitis symptoms considering climatic and geographic factors.Material and Methods: Between March 2013 and March 2018, in an Otorhinolaryngology clinic in Edirne, a total of 334 (226 female, 108 male) patients with allergic rhinitis diagnosis underwent an allergic skin test (prick test). The data were evaluated on the basis of age, sex, and sensitive allergen.Results: A total of 226 female (66.7%) and 108 male (33.3%) patients were included in the study. The mean age of the participants was 27±18.1 years. In 326 patients (97.6%), a reaction to at least 1 allergen was detected. A total of 130 patients (38.9%) with the most common allergy were seen against Dermatophagoides farinae from the house dust allergen group. The second most common allergen susceptibility was detected from the weed pollen allergen group in a total of 107 individuals (32%). The first and second most common allergens (D. farinae and Plantago lanceolata) were found to be similar in males and females.Conclusion: A high rate of positivity was detected in patients diagnosed with allergic rhinitis. In accordance with regional characteristics, the second allergen was determined as P. lanceolata. Determining the differences in regional allergen sensitivity in patients with allergic rhinitis may contribute to preventive measures.
|
Objective: The nasal symptoms of non-specific rhinitis affect a large proportion of older adults, and can significantly impact the quality of life. Our study aimed to determine the incidence of non-specific nasal hyperreactivity (NHR)-related exposure and the characteristics of rhinitis among elderly individuals in our country.Material and Methods: Individuals aged over 65 years who applied to our outpatient clinic were asked whether they had nasal symptoms for more than 20 minutes a day and for more than 2 months in a year. Those who met these criteria were accepted as NHR and included the study group. The incidence, triggering factors, relationship with examination findings, and severity of symptoms were evaluated and recorded.Results: Overall, the mean age was 74.56±7.21 (65-89) years. The most common symptom was nasal discharge and most common trigerring was temperature changes. Inferior turbinate hypertrophy was detected in most individuals who reported of irritant triggering. The mean rhinorrhea score was significantly higher in partipiciants of the study group with turbinate hypertrophy. The highest mean of Visual analog score (VAS) score was in the nasal discharge group.Conclusion: There are important gaps in our knowledge about the frequency and characteristics of rhinitis in elderly adults in our country. In our study on this issue among older people in our country will provide important data on nasal hypersensitivity, which will be the guiding terms of other studies.
|
Objective: Rhinology procedures are increasingly performed as day cases worldwide as well as in our department.Our aim was to identify if our rhinology patients fulfill the day case criteria and to audit our postoperativecomplications.Material and Methods: A retrospective review of all septo/rhinoplasties and septal perforation repair for the last 3years was performed. Overnight admission rate, medical and surgical complications were recorded.Results: Out of the 103 patients, only one (0.97%) needed overnight admission. The reason was medical, sinus tachycardia in a young anxious patient. Two immediate postoperative complications were recorded, self-limited epistaxisand light headedness. A self-limited epistaxis occurred day 5 post-operatively. No action was required in any of thesecases. Late post-operative complications were three septal perforations (2.9%).Conclusions: Day case septo/rhinoplasties can be safely performed with a <1% overnight admission rate in wellselected patients. Increasing numbers of day procedures should be the goal in all otorhinolaryngology areas.
|
Objective: We aimed to correlate post-operative endoscopic disease status and reduction in serum total IgE levels inpatients with allergic fungal rhinosinusitis (AFRS) and to ascertain whether this reduction has prognostic significance.Material and Methods: A prospective cohort of 50 patients with biopsy-proven AFRS underwent preoperativeendoscopy and serum total IgE assessment. Following endoscopic excision of polyps and allergic mucin and postoperative steroid therapy, patients were re-evaluated at 3-6 months with nasal endoscopy with Kupferberg stagingand serum total IgE levels.Results: There were 27 (54%) male and 23 (46%) female patients. Preoperative endoscopy showed grade 3 polyps in33 (66%) patients and grade 2 polyps in 17 (34%) patients. Post-operatively, 37 (74%) patients had Stage 0, 11 (22%)had Stage 1, and two (4%) had Stage 2 diseases. Preoperative IgE levels ranged from 153.2 to 6,548.2 IU mL1. Postoperative IgE levels were reduced in 42 of 50 (84%) patients and ranged from 79.9 to 3,900 IU mL1. There was a negative correlation between percentage change in IgE and post-operative endoscopic score, which was significant (r ¼0.25; P ¼ .032). Based on receiver operating characteristic analysis, a percentage reduction in IgE of 32% had a sensitivity of 69.2% (95% CI: 38.6-90.9) and specificity of 67.6% (95% CI: 50.2-82.0) in predicting endoscopic stage.Conclusion: Post-operative reduction in serum total IgE levels negatively correlates with endoscopic stage in AFRSpatients who undergo surgery and post-operative steroid therapy. A cutoff of 32% in change in IgE levels is predictive of endoscopic Stage 0 disease.
|
Objectives: To analyze the initial investigation and management of allergic rhinitis (AR) patients in general practiceand determine if it could be expanded further.Methods: Clinical letters of patients with a diagnosis of AR seen in our outpatient’s department for the past 5 yearswere retrospectively reviewed. We have confirmed the diagnosis when possible, with allergy tests.Results: From 555 patients included in our study, 90.6% were referred by their general practitioner (GP). Male tofemale ratio was 1.7. Almost half of the patients presented with nasal congestion had typical AR symptoms. A positivepersonal history of atopy was present in 19% of cases. Only 4% of GPs performed nasal examination on their patients.One hundred and five patients (19%) were prescribed nasal sprays, but they neither received instructions on the technique nor were told to use them long term. Twelve percent of the cases had allergy testing done prior to our clinicassessment, which confirmed allergen sensitization in 82% of these cases.Conclusions: More efficient triaging and initial management of GP and otolaryngology referrals for rhinitis couldresult in fewer patients needing hospital management. We propose an instruction manual for GP suggesting initialappropriate and consistent topical therapy for at least 3 months, particularly in patients with a positive personal orfamily history of atopy, who have also been instructed in allergy avoidance. Those who fail should have allergy testingdone or an alternative diagnosis considered.
|
Dorsal cyst, one of the long-term complications of rhinoplasty, is rare, and very few cases have been reported in the literature. These cysts are mostly mucous cysts and are caused by the transplantation of the mucosa into the ectopicsubcutaneous structures or by different materials that cause a foreign body reaction. Here, we present a case of a 28-year-old female patient with a nasal dorsal cyst that developed 10 years after a primary rhinoplasty. Since the cyst,which grew progressively over time, caused deformity and deformity in the nasal roof, it was totally excised and revision rhinoplasty was performed. No complications were seen during and after the surgery.
|
