Objective: Laryngopharyngeal reflux (LPR) is defined as a retrograde flow of gastric contents into the larynx and hypopharynx. However, a possible pathophysiological contribution from nasal resistance has been proposed, according to which increased nasal resistance associated with septal deviation may cause increased respiratory effort, resulting in a more negative intrathoracic pressure, which may, in turn, overcome the upper esophageal sphincter and lead to the retrograde passage of gastric contents. The aim of this study was to investigate whether septal deviation of adequate severity necessitating septoplasty is associated with an increased use of proton pump inhibitors (PPIs) in comparison with the general population.
Material and Methods: This retrospective single-center cohort study investigated the usage of PPIs in patients undergoing septoplasty. Hospital databases were searched to identify patients aged 18-85 years who underwent septoplasty from January 2012 to December 2016. Electronic medical records were reviewed to collect details pertaining to demographic variables, usage of PPIs, smoking and drinking status, and other comorbidities. A control group of subjects who underwent an unrelated procedure (arthroscopy) was also sampled.
Results: The data of 200 patients (29% females, mean age 40.8±14.8 years) who underwent septoplasties were compared with those of 200 control subjects (39.5% females, mean age 45.3±15.0 years) who underwent arthroscopies. The incidence of PPI usage in patients undergoing septoplasty was found to be significantly greater than that in the control group (Pearson’s chi-square 4.7, Odds Ratio [OR] 1.97, p=0.03).
Conclusion: Patients who undergo septoplasty have a significantly increased rate of PPI usage, which suggests that nasal obstruction is associated with LPR and gastroesophageal reflux disease. Further studies are required to explore this association and develop potential therapeutic strategies.
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Objective: The aim of this study is to investigate the effects of septal deviation on the aeration of the middle turbinate.
Material and Methods: In this retrospective study, computed tomography (CT) scans of 100 individuals (50 males and 50 females) with nasal septal deviation were analyzed. The direction, angle, and grading of the septal deviation angle (SDA) and middle turbinate aeration and the presence of concha bullosa (CB) were evaluated in these paranasal sinus CTs.
Results: Of the 100 patients, nasal septum was deviated to the right in 49 (49%) and to the left in 51 (51%). Generally, the incidence of CB was 24%. It was seen more on the nondeviated side, which was 33%, compared to the deviated side, which was 15%. The incidence of CB increased with the SDA grade: 21.5% in Grade 1, 25.6% in Grade 2, and 29.1% in Grade 3
Conclusion: The incidence of CB was higher in patients with nasal septal deviation, being more frequent on the nondeviated side. The incidence increased as the SDA grade increased.
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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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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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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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Nasal dermoid cysts constitute 3.7%-12.6% of all head and neck dermoid cysts and 1%-3% of all dermoid cysts on the whole body. The majority are diagnosed early in life, before 3 years of age. Total 5%-41% of nasal dermoid cysts may extend to the central nervous system. At this point, high-resolution computed tomography (HRCT) and/or magnetic resonance imaging plays a critical role in determining the appropriate surgical approach. In this study, we present the case of a 41-year-old female patient with a dermoid cyst originating from the right middle turbinate. The case is worth discussing owing to the unusual age at occurrence and anatomical location of the nasal dermoid cyst. HRCT revealed smooth soft tissue mass in the right nasal cavity. The mass reportedly did not show an intracranial connection and was completely excised using an endoscopic surgical approach.
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Objective: Osteomas represent the most common benign tumors of the paranasal sinuses. In spite of being slow-growing and usually asymptomatic, osteomas can cause symptoms depending on their size, location, and extension to the adjacent anatomical structures. The aim of this study was to investigate and discuss the clinical features and surgical management of patients with paranasal sinus osteomas who were treated in one center.
Material and Methods: A retrospective chart review of 40 patients undergoing surgical treatment for paranasal sinus osteoma between January, 2005 and December, 2019 was carried out. Patients’ demographic characteristics, presenting symptoms, osteoma size and location, imaging findings, and surgical outcomes were analyzed.
Results: The mean duration of follow-up was 31 months (range, 6-122 months). The most frequently affected site was the frontal sinus (55%), followed by the frontoethmoid region (27.5%) and the ethmoid sinus (7.5%). Headache was found to be associated with frontal sinus osteomas (p=0.014). Besides, extra-sinusal extension was observed in 10 (25%) patients. While 20 (50%) patients were treated with a purely endonasal endoscopic technique, an external technique was most commonly used for frontal sinus osteomas (p=0.035). There were no major surgical complications in 33 patients (85%); complete resection, however, could not be successfully achieved in 6 patients (15% residual tumor rate), 2 of whom subsequently underwent revision surgery (5% revision rate).
Conclusion: Paranasal sinus oteomas are benign, slow-growing, and usually asymptomatic lesions with potentially important complications. That being said, surgical removal remains the treatment of choice for symptomatic or rapidly growing osteomas of the paranasal sinuses.
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Objective: This study aimed to elucidate the effect of Staphylococcus aureus and budesonide on the mRNA expression and the biologic role (caspase-1 activation and IL-1β secretion) of NLRP3 inflammasome in primary nasal epithelial cells (NECs) in patients with chronic rhinosinusitis (CRS) and healthy controls.
Material and Methods: Brush biopsies isolated from both patients and healthy controls were denoted respectively for our experiments. These were treated with S. aureus strains (four strains) only and in combination with budesonide (0, 10, 100, 1000 nM). NECs treated with only budesonide (0, 10, 100, 1000 nM) and untreated NECs were used as controls. Expression of NLRP3, caspase-1, IL-1β along with NLRC1/2 was analyzed by qPCR. Caspase-1 activity was measured by fluorogenic substrates Ac-YVAD-AMC. Enzyme-linked immunosorbent (ELISA) assay was performed to measure IL-1β production.
Results: The mRNA levels of NLRC1, NLRC2, caspase-1, and IL-1β significantly increased, while NLRP3 demonstrated a trend toward elevation in the CRS group compared to the healthy controls. Infection with S. aureus increased caspase-1 activity and IL-1β secretion. However, treatment with budesonide decreased mRNA expression of NLRC2 and IL-1β secretion.
Conclusion: Increase in the caspase-1 activity and IL-1β levels, due to possible activation of NLRP3 inflammasomes, upon S. aureus infection, may have an important role in the pathogenesis of CRS.
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It is important to carefully use sodium hypochloride(NaOCI) in its clinical applications. Non-careful use of cytotoxic agents(NaOCI,etg) may cause serious complications. In this case report, a treatment approach to paresthesia and tissue necrosis after inadvertent injection of 1% NaOCl solution into oral mucosa is presented.. Pain, edema, loss of sensation, redness on the cheek, and difficulty in swallowing was seemed during the patient’s clinical examination. The patient was experiencing severe pain and a burning sensation during injection. The patient was administered intraoral drugs,such as antibiotics (amoxicillin 1000 mg two times per a day for two week),alpha lipoic acid (300 mg one times per a day for one mounth), and debridement of oral mucousa .Consequently, re-epithelialization of necrotic tissue was observed in the 3rd month. All symptoms disappeared completely in the 6th month.
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