An approach to orbital complications in rhinosinusitis

Objective: Whilst orbital complications arising from acute rhinosinusitis are infrequent in contemporary practice, the spread of infection orbitally or intracranially can result in severe complications and a high mortality. This study aims to review cases of orbital complications arising from rhinosinusitis in the light of the published literature on the topic. Methods: Eight cases of individuals presenting to a particular clinic with the development of orbital complications following sinusitis within the previous four years were included in the study. The characteristic features of these cases in terms of diagnosis, treatment and follow-up were investigated. Results: The mean age of all cases was 29.5 years. In three cases, orbital abscess, and in five cases, preseptal cellulitis, were observed as complications. Both surgical and medical treatment was administered in three cases, while medical treatment alone was used for five cases. Conclusion: The region where the complications of rhinosinusitis are most commonly observed is the orbit, due to its proximity to the paranasal sinuses, especially the ethmoid cells. Where limitation of eye movements, proptosis, and a decrease in vision exists alongside an orbital abscess which itself has developed as a complication of sinusitis, surgical treatment is the most important option to consider to prevent complications

Type 1 tympanoplasty in pediatric patients: Comparison of fascia and perichondrium grafts

Objective:The timing of tympanoplasty in the pediatric age group is an ongoing debate. The purpose of thisstudy was to analyze and compare the success of grafts in type 1 tympanoplasty in pediatric patients, and toevaluate the prognostic factors that may affect its success.Materials and methods:A retrospective study of 42 pediatric patients who were younger than 18 years andunderwent a primary type 1 tympanoplasty using tragal cartilage perichondrium and temporalis fascia fromJanuary 2013 to December 2018, were evaluated. A total of 42 medical records of children aged between 8 and18 years (20 female, 22 male) were reviewed. Age, gender, co-morbidities, perforation size and location, type(central, marginal), pre- and post-operative hearing levels, mean air-bone gap (ABG), graft material (fascia,perichondrium), length of follow up and surgical outcomes were collected.Results:The overall graft success rate was 83.3% (out of 35 patients). The graft success rate was significantlyhigher 95.2% (20/21) for the perichondrium group compared with 71.4% (15/21) for the temporal fascia group(p = 0.023). The functional success rate (postoperative air–bone gap 0.05).Conclusion:Both temporalis fascia and tragal cartilage perichondrium are suitable graft materials for pediatrictympanoplasty with 83.3% of graft success rate. Tragal cartilage perichondrium may be thefirst choice of graftmaterial due to its high success rates. There were no significant differences between the fascia and perichon-drium groups in terms of functional results. Reperforation is more likely to occur in bilateral perforations andcontralateral OME, and should be treated with perichondrium or cartilage graft...

Histopathologiıcal correlation of fıne needle aspiration biopsy ın salivary gland pathologies

Amaç: Tükürük bezi kitlelerinde ameliyat öncesi tedavi planlamasında sık kullanılan bir yöntem olan ince iğne aspirasyon biyopsisi (İİAB) işleminin güvenilirliğini araştırmak ve tanısal değerini değerlendirmektir. Yöntem: 2015-2020 yılları arasında kliniğimizde tükürük bezi kitlesi nedeniyle opere edilmiş olan 88 hastanın dosyası retrospektif olarak incelendi. Vakaların ameliyat öncesi ultrason (USG) eşliğinde yapılmış olan İİAB sonuçları ile ameliyat sonrası histopatolojik sonuçları karşılaştırılarak analiz edildi. Bu analiz sonucunda İİAB işlemin sensitivitesi, spesifitesi, pozitif prediktif değeri, negatif prediktif değeri ve doğruluk oranı saptandı. Bulgular: Hastaların ortalama yaşı 53,8 yıl idi ve 43 kadın ve 45 erkek hastanın tükürük bezi kitlesi nedeniyle opere edildiği saptandı. Kitlelerin 51'i parotis bezinde, 32'si submandibuler bezde ve 5'i ise minör tükürük bezlerinde idi. İİAB sonuçları incelendiğinde malign olarak en sık skuamöz hücreli karsinom görülürken ve benign olarak ise en sık pleomorfik adenom saptandı. Tükürük bezi kitlelerinde İİAB'nin sensitivitesi %80, spesifitesi %93,2, pozitif prediktif değeri %81,8, negatif prediktif değeri %96,3 ve doğruluk oranı %89,8 idi. İİAB sonucu şüpheli olarak bildirilen vakaların %40'ının histopatolojik olarak malignite ile ilişkili olduğu görüldü. Sonuç: Tükürük bezi kitlelerinde İİAB yüksek sensitivite ve spesifiteye sahip, güvenilir bir yöntemdir. İİAB sonucu şüpheli olarak raporlanan kitlelerin malign olma olasılığı yüksek olup bu vakalarda klinisyenlerin tedavi planlamasında daha dikkatli olmalarıgerekmektedir.Objective: The aim of this study is to investigate the reliability and diagnostic value of fine needle aspiration biopsy (FNAB), which is a common method in preoperative treatment planning in salivary gland masses. Material and Methods: Medical records of 88 patients who were operated for salivary gland masses in our clinic between 2015-2020 were retrospectively examined. The cases were analyzed by comparing the results of the preoperative ultrasound (USG) guided FNAB and the histopathological results after the surgery. As a result of this analysis, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate of the FNAB procedure were determined. Results: The mean age of the patients was 53.8 years and 43 female and 45 male patients were operated due to salivary gland masses. 51 of the masses were in the parotid gland, 32 in the submandibular gland and 5 in the minor salivary glands. When the results of FNAB were examined, squamous cell carcinoma was most common as malignant and pleomorphic adenoma was most common as benign. In salivary gland masses, the sensitivity of FNAB was 80%, specificity 93.2%, positive predictive value 81.8%, negative predictive value 96.3% and accuracy rate 89.8%. It was observed that 40% of the cases whose FNAB results were reported as suspicious were histopathologically associated with malignancy. Conclusion: In salivary gland masses, FNAB is a reliable method with high sensitivity and specificity. Masses reported as suspicious as a result of FNAB are highly likely to be malignant, and in these cases, clinicians need to be more careful in treatment planning

Is C-reactive protein to albumin ratio an indicator of poor prognosis in Bell's palsy?

*Çayır, Serkan ( Aksaray, Yazar ) *Kayabaşı, Serkan ( Aksaray, Yazar )Purpose The aim of this study was to determine whether the C-reactive protein to albumin ratio was associated with the prognosis in patients with Bell's palsy. Methods Reviewing records of 79 patients diagnosed with Bell's palsy, 3 groups were constituted: recovered group (with a House Brackman grade of 1 or 2 after treatment, 56 patients), unrecovered group (23 patients) and control group (60 healthy individuals). Age, hemoglobin, C-reactive protein to albumin ratio, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, white blood cell and hemoglobin values were compared among the groups. Results Age, hemoglobin and platelet to lymphocyte ratio were not significantly different between the groups (p = 0.12, p = 0.31, p = 0.86 and p = 0.87, respectively). Median C-reactive protein to albumin ratio, neutrophil to lymphocyte ratio and white blood cell were significantly greater both in non-recovery group (p < 0.001) and recovery group (p = 0.001 and p < 0.001, respectively) compared to the control group. Additionally, median C-reactive protein to albumin ratio and neutrophil to lymphocyte ratio were significantly greater in the non-recovery group, compared to the recovery group (p = 0.002, and p < 0.001, respectively). However, median white blood cell did not significantly differ between the non-recovery and the recovery groups (p = 0.89). Conclusion Higher C-reactive protein to albumin ratio and neutrophil to lymphocyte ratio were associated with poor prognosis in patients with Bell's palsy. C-reactive protein to albumin ratio might be the most significant indicator of poor prognosis in patients with Bell's palsy...

Long-term efficacy of expansion sphincter pharyngoplasty in obstructive sleep apnea syndrome

*Çayır, Serkan ( Aksaray, Yazar ) *Kayabaşı, Serkan ( Aksaray, Yazar )Purpose The aim of this study was to analyze both short-term and long-term results of the expansion sphincter pharyngoplasty surgery, which is commonly used in obstructive sleep apnea syndrome (OSAS) and to compare it with objective and subjective methods. Methods Patients who underwent expansion sphincter pharyngoplasty were included in the study. Polysomnography at postoperative sixth-month, Epworth Sleepiness Scale, and visual analog score of snoring (VAS) were used to assess short-term results. Epworth Sleepiness Scale (ESS) and visual analog score of snoring (VAS) at postoperative third-year were used for long-term results. Sixth-month and third-year data before and after the surgery were compared. Possible complications and morbidity rates related to surgery were evaluated. Results Of 39 patients, OSAS was assessed as mild in 16 (41%), moderate in 14 (36%), and severe in 9 (23%). Mean age of patients was 43.2 +/- 7.5, and 21 were men (54%). According to postoperative six-month PSG data, the apnea hypopnea index (AHI) values decreased significantly from 25.2 +/- 8.3 to 11.6 +/- 6.9/h, p=0.012. There were decreases in ESS from baseline to 6-month and 3-years from 10.4, to 4.4, and 4.4, and VAS scores changed from 8.6 to 1.6 and 1.9, pConclusion The expansion sphincter pharyngoplasty procedure is an important option for OSAS surgery with long-term effective results and low morbidity and complication rates

A novel predictor parameter for active recurrent aphthous stomatitis: C-Reactive protein to albumin ratio

*Kayabaşı, Serkan ( Aksaray, Yazar ) *Çayır, Serkan ( Aksaray, Yazar )Objective Laboratory analysis results may provide an opportunity to predict the activity process of recurrent aphthous stomatitis. The goal of this study was to investigate whether there is a correlation between C-reactive protein to albumin ratio (CAR) and oral ulcer activity in patients with recurrent aphthous stomatitis. Materials and methods We included 72 patients (39 with active and 33 with inactive lesion) with recurrent aphthous stomatitis and 60 healthy controls. We compared blood test parameters including CAR, white blood cell count (WBC) and neutrophil to lymphocyte ratio (NLR) among the groups. Additionally, we investigated the most significant parameter for the activity of oral ulcers. Results NLR was significantly higher both in the active (p<0.001) and inactive lesion groups (p<0.001), compared to the control group but did not significantly differ between active and inactive lesion groups (pm3.17). A significant difference in median CAR (p<0.001) and WBC (p<0.001) was evident among the three groups. Median WBC was significantly higher in the active lesion group compared to the control group (p<0.001) but did not significantly differ between active and inactive lesion groups (p=0.095). Median CAR was significantly higher in the active lesion group, compared both to the inactive lesion group (p=0.002) and the control group (p<0.001). Median CAR was also significantly higher in the inactive lesion group compared to the control group (p<0.001). Median hemoglobin, platelet to lymphocyte ratio and mean platelet volume did not significantly differ among three groups (p=0.16, p=0.85, p=0.19, respectively). Conclusion CAR could be used as a predictive parameter for inflammation and activity of oral ulcers in patients with recurrent aphthous stomatitis...

Parâmetros preditores de mau prognóstico em pacientes com perda auditiva neurossensorial súbita: relação fibrinogênio/albumina vs. relação proteina C-reativa/albumina

*Çayır, Serkan ( Aksaray, Yazar ) *Kayabaşı, Serkan ( Aksaray, Yazar )Introduction: Prognosis of sudden sensorineural hearing loss may be predicted using several parameters of laboratory blood analysis. Objective: To identify and investigate the most significant indicator parameters related to the poor prognosis of sudden sensorineural hearing loss. Methods: Eighty-eight patients were included, and three groups were constituted: non-recovery group with14 patients, recovery group with 33 patients and control group with 41 individuals. We compared fibrinogen-to-albumin ratio, C-reactive protein-to-albumin ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, white blood cell and hemoglobin of the groups. Then, we investigated the most significant indicator parameters related to the poor prognosis of sudden hearing loss. Results: The mean hemoglobin, mean platelet-lymphocyte ratio and median white blood cell values did not significantly differ among three groups (p = 0.36, p = 0.86 and p = 0.79, respectively). A significant difference of median fibrinogen-albumin ratio, C-reactive protein-albumin ratio, neutrophil-to-lymphocyte ratio was evident among three groups (p < 0.001, p = 0.003 and p = 0.002, respectively). Median fibrinogen-albumin ratio, C-reactive protein-albumin ratio and neutrophil-to-lymphocyte ratio values were significantly greater in the non-recovery group, compared with the controls (p < 0.001, p = 0.003 and p = 0.005, respectively). Median fibrinogen-to-albumin ratio, C-reactive protein-to-albumin ratio and neutrophil-to-lymphocyte ratio were significantly greater in the recovery group, compared with the controls (p < 0.001, p = 0.013 and p = 0.005, respectively). Moreover, the median fibrinogen-albumin ratio was significantly greater in the non-recovery group compared with the recovery group (p = 0.017). However, no statistically significant difference of median C-reactive protein-albumin ratio, neutrophil-to-lymphocyte was evident between the non-recovery and recovery groups (p = 0.15). Conclusion: Increased levels of fibrinogen-albumin ratio may be predictive for poor prognosis in patients with sudden sensorineural hearing loss

Traumatic tympanic membrane perforation in children in the emergency department: comparison of spontaneous closure and paper patch

Objective There are different clinical approaches for traumatic tympanic membrane perforation in the pediatric age group. The purpose of this study was to compare spontaneous recovery and the paper patch procedure and to analyze the factors that play a role in recovery. Materials and methods Pediatric patients who were admitted to the Emergency Department between January 2014 and June 2019 due to traumatic tympanic membrane perforation were investigated. Among these patients, medical records of cases followed by the otorhinolaryngology clinic for spontaneous closure or paper patch procedure were retrospectively examined. Medical records of a total number of 71 patients aged 2-16 years (33 females, 38 males) were analyzed. Results The overall closure rate was 89.75% (64/71). Although there was no difference between the groups of small- and medium-size perforations in terms of closure rates, the closure rate in large perforations was 90.9% in the paper patch group and 63.6% in the spontaneous closure group, and the difference between these two groups was statistically significant (p 0.05). Conclusion Both procedures can be employed in pediatric cases of traumatic tympanic membrane perforation with high success rates. However, in case of a large perforation or a perforation contacting the malleus that is detected in the Emergency Department, it is necessary to refer the patients to the otorhinolaryngology clinic immediately for paper patch procedure instead of following up the patients for spontaneous closure

Os efeitos do tempo de cirurgia intradia na dor e ansiedade de pacientes submetidos à septoplastia

Kayabaşı, Serkan ( Aksaray, Yazar ) Çayır, Serkan ( Aksaray, Yazar )Introduction: Anxiety and pain levels of septoplasty patients may vary according to intraday operation time. Objective: To investigate the effects of septoplasty operation and intraday operation time on anxiety and postoperative pain. Methods: Ninety- eight voluntary patients filled out the hospital anxiety and depression scale to measure the anxiety level three weeks before, one hour before and one week after surgery. Forty-nine patients were operated at 8:00 am (morning group); other 49 were operated at 03:00 pm (afternoon group). We used a visual analogue scale to measure postoperative pain. Preoperative and postoperative scores were compared, as were the scores of the groups. Results: Median hospital anxiety and depression scale scores one hour before the operation [6 (2–10)] were significantly higher compared to the median scores three weeks before the operation [3 (1–6)] (p < 0.001), and one week after the operation [2 (1–6)] were significantly lower compared to the median scores three weeks before the operation [3 (1–6)] (p < 0.001). Hospital anxiety and depression scale scores one hour before the operation were significantly greater in the afternoon group [8 (7–10)], compared to the morning group [4 (2–6)] (p < 0.001). Postoperative first, sixth, twelfth and twenty-fourth-hour pain visual analogue scale scores were significantly higher in the afternoon group compared to the morning group (p < 0.001). Conclusion: Septoplasty might have an increasing effect on short-term anxiety and postoperative pain. Performing this operation at a late hour in the day might further increase anxiety and pain. However, the latter has no long-term effect on anxiety

Hematologic parameters as predictive markers in pediatric Bell's palsy

Purpose To analyze various hematological parameters in pediatric population with Bell's palsy (BP) and to determine the most valuable parameter as a prognostic marker. Methods Fifty-nine patients with BP under 18 years were enrolled, and patients were divided into three groups: recovery group (49 cases), non-recovery group (10 cases) and controls (65 healthy children). Age, white blood cell (WBC), hemoglobin (Hbg), mean platelet volume (MPV), red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and C-reactive protein-to-albumin ratio (CAR) were determined and compared between groups. Additionally, the receiver operating characteristics (ROC) analysis was carried out, and the most valuable marker to demonstrate the prognosis among these parameters was investigated. Results While mean age was found as 10.69 +/- 5.76 years, 28 (47.5%) female and 31 (52.5%) male pediatric patients were determined to be followed up due to BP in our hospital. When such parameters age, mean Hbg, MPV and RDW were examined, no significant difference was detected between groups. However, compared controls with recovery and non-recovery groups, WBC, NLR, PLR and CAR were found to be significantly higher, respectively (p 0.05). Conclusion High NLR and CAR values in pediatric BP may be related to poor prognosis in such patients. CAR, however, is a more valuable parameter than NLR in terms of indicating poor prognosis