The Effects of Nasal Septum Deviation on Ocular Examination Findings: Does Deviated Nasal Septum Cause Impaired Vision?

Aim: Nasal obstruction due to nasal septum deviation is associated with systemic diseases such as cardiopulmonary disease, neurological and vascular problems. But the effect of pure nasal deviation on the ocular system has not been precisely investigated. The aim of this study was to analyze the association of nasal septal deviation with ocular examination findings. Material and Methods: Twenty-seven adult patients underwent septoplasty and 31 controls were included in the study. The study group was conducted on patients with pure nasal septum deviation which is significantly obstructing the nasal airway (>50%). In ophthalmological examination; peripapillary retinal nerve fiber layer, macular and choroidal thickness measurements were obtained. The examination findings were compared between the study and control groups. Results: The mean macular thicknesses at nasal-500μm were 305.89±32.79 and 287.87±25.00 in the study and control groups, respectively (p=0.021). The mean macular thicknesses at nasal-1000μm were 353.04±21.28 and 341.16±17.97 in the study and control groups, respectively (p=0.025). The mean thickness of choroid was statistically significantly different at central (p=0.036) and peripheral measurements; nasal-500μm (p=0.020); nasal-1000μm (p=0.001); nasal-1500μm (p<0.001); temporal-500μm (p=0.023) and temporal-1000μm (p=0.045). No statistically significant difference was found between the two groups according to ocular tension, thickness of cornea, keratometry, anterior chamber depth, axial length of cornea, and retinal nerve fiber layer thickness. Conclusion: This is one of the pioneer studies evaluating the ocular examination findings in patients with nasal septum deviation. Our results indicate the increased thickness of both macula and choroid in patients with nasal septum deviation

Vertigo in Children; Differential Diagnosis

Çocuklarda baş dönmesi nadir görülen bir şikayet olmasına rağmen gerek hastada gerekse ailede ortaya çıkardığı anksiyete nedeniyle önemli bir sorundur. Çocuklarda ifade zorluğuna bağlı tanı ve tedavide ciddi sorunlar yaşanmaktadır. Baş dönmesi şikayeti ile gelen çocuk hastada ayrıntılı bir anamnez ve fizik muayene hâlâ tanı koymada en etkili yöntemler olarak durmaktadır. Baş dönmesi şikayetinin en sık nedenleri arasında benign paroksismal vertigo, migren ve kafa travması izlenmektedir. Diğer nedenler ise; vestibüler nörinit, meniere hastalığı, benign pozisyonel paroksismal vertigo, psikojenik, otitis media, santral sinir sistem patolojileri ve ortostatik hipotansiyondur. Baş dönmesi sorunu yaşayan çocuklardaki en önemli problemlerden bir tanesi de kognitif ve motor gelişimin etkilenmesidir ve bu çocuklar mutlaka pediatrist, nörolog, oftalmolog ve gerek halinde ortopedist ve fizyoterapist ile birlikte değerlendirilmelidir.Although vertigo is a rare complaint in children, it is an important problem for both the patient and the family because of the anxiety that it creates. Difficulty of expression in children leads to serious problems in the diagnosis and treatment of vertigo. A detailed anamnesis and physical examination is still the most effective method of diagnosis in children with vertigo. Benign paroxysmal vertigo, migraine and head trauma are the most common causes of a vertigo complaint. Other common reasons are vestibular neuronitis, meningitis, benign positional paroxysmal vertigo, psychogenic, otitis media, central nervous system pathologies and orthostatic hypotension. One of the most important problems in children with vertigo is the effect on cognitive and motor development, and these children should be evaluated together with the pediatrician, neurologist, ophthalmologist and, if necessary, orthopedist and physiotherapist

Posterior pillar mucosal suspension technique for posttonsillectomy pain and wound healing: a prospective, randomized, controlled trial

WOS: 000447934800034PubMed: 30255204Objectives/hypothesisTo investigate the efficacy of a simple and feasible suturing technique on posttonsillectomy pain control and wound healing.MethodsA prospective, randomized, controlled trial was conducted on a sample of 121 children between 3 and 10years of age. Group A comprised children undergoing surgery with bipolar cautery and the posterior pillar mucosal suspension technique. Bipolar alone (Group B) and cold dissection tonsillectomy (Group C) were used as control groups. Pain was assessed at 1, 3, 5, 7, and 10days postoperatively via visual analog scale scores. Peritonsillar edema, erythema, and granulation tissue in the tonsillar fossa were evaluated by direct visual examination for wound healing on days 1, 3, 5, 7, and 10.ResultsThere were consecutive 121 patients which were included, with mean ages being 6.22.5, 6.1 +/- 2.4, and 6.1 +/- 2.6 in groups A, B, and C, respectively. Postoperative pain scores on days 1 and 3 were significantly lower in Group A than Group B and C (P<.001) and scores were 0.87 +/- 1.1, 3.83 +/- 2.29, and 4.29 +/- 2.48 on day 1 and 0.38 +/- 0.88, 2.25 +/- 2.13, and 2.76 +/- 2.12 on day 3 respectively. The wound-healing scores on postoperative 1st, 3rd, 5th, and 7th days were significantly lower in Group A than control groups (P<.001). The wound-healing score on postoperative day 10 was only different than Group C (P=.020).Conclusions p id=Par4 The posterior pillar mucosal suspension technique is an effective and comparable method in terms of wound healing, maintains the preoperative anatomical structures, and enables a better pain control with reduced analgesic/opioid usage

Lateral Suspension Technique in Treatment of Lateral Crus Malposition Belada Technique

Lateral crus malposition can cause health problems from both functional and esthetic perspectives. Recently many techniques are developed to solve this problem. One of the failures that can be seen in these surgical techniques is that the lateral crus placed in its new position is shifted to the cephalic and is dislocated. Our aim in this study is to introduce the technique authors developed to prevent complications. 16 patients (10 female and 6 male) with a lateral crus malposition during rhinoplasty surgery were included in the study to have a reposition. The suture placed on the caudal end of the lateral crural strut graft attached to the lateral crus, which authors freed from the vestibule skin for repositioning in our patients operated with an open technique, is fixed by taking it out from the skin through the newly created pocket. The lateral crus, which was fixed with a suture in its new pocket, did not dislocate, did not shift to cephalic and no infection developed in any of our patients. In 1 of our patients, a second surgery was planned because the inserted lateral crural strut graft caused a narrowing in the nasal cavity

Investigation of Risk Factors for Otitis Media With Effusion in Patients with Adenotonsillar Hypertrophy (Risk Assessment in Otitis Media with Effusion)

Objective: Sleep Disordered Breathing (USB) is one of the most common childhood disorders ranging from simple snoring to obstructive sleep apnea (OSA), and most common cause of it is the adenotonsillar hypertrophy (ATH). Otitis Media with Effusion (OME) is another important problem in children with USB due to ATH. The aim of this study was to evaluate the possible risk factors for the development of EOM in children with USB due to ATH. Methods: 171 pediatric patients with ATH-related snoring and sleep apnea complaints were included in the study. The patients were divided into two groups. Group 1: patients with ATH + OME and Group 2: patients with ATH alone. A pre-operative standard questionnaire was used to assess USB severity. Twenty-one different parameters were evaluated for both groups. Results: Age, sex, exposure to tobacco smoke, cow milk exposure before 12 months, breast milk only for at least 6 months, duration of symptoms, USB symptom scores, history of recurrent tonsillitis, adenoid / nasopharynx (AN) ratio, tonsil size, body mass index (BMI), hemoglobin (Hb) level, hematocrit (Hct) ratio, mean platelet volume (MPV), eosinophil ratio, neutrophil-lymphocyte ratio (NLR), thyroid function tests (TSH, fT4), folate and vitamin B12 levels were evaluated. There was no statistically significant difference between these parameters except BMI. BMI values were 16.08 +/- 1.96 in Group 1 and 17.11 +/- 2.81 in Group 2, respectively (p: 0.006). Conclusions: Many different parameters were evaluated for EOM, a multifactorial disease. Among the groups, only BMI was different. Further study is required to identify risk factors for the development of EOM in patients with ATH.WOS:00068972950000

Cerrahi Teknik Post Tonsillektomi Hemoraji Oranını Anlamlı Olarak Değiştirir mi?

Amaç: Tonsillektomi pediatrik populasyonda en sık uygulanan cerrahi girişimlerden biridir ve KBB eğitiminde ilk öğrenilen işlemlerdendir. Bu çalışma, tonsillektomi sonrası kanamada cerrahi tekniğin etkili olup olmadığını değerlendirmeyi amaçlamıştır.Gereç ve Yöntemler: Bu prospektif planlı klinik çalışma, Mayıs 2012 ile Nisan 2015 arasında bir üçüncü basamak sağlık merkezinde gerçekleştirildi. Çalışma süresince, aynı cerrah tarafından 3 farklı teknikle toplam 608 hasta ameliyat edildi. Grup 1'de soğuk diseksiyon ile ameliyat edilen çocuklar, Grup 2'de bipolar koter ile opere edilen çocuklar, Grup 3’de ise posterior pillar mukozal sütür tekniği ile opere edilen çocuklar yer aldı.Bulgular: Soğuk diseksiyon (n=165), bipolar koter (n=274) ve posterior pillar mukozal sütür (n=169) tekniklerine toplam 608 hasta dahil edildi. Yaş ortancası 5 (2-14) idi. Beş hastada (%0,82) ameliyat sonrası kanama oldu. Bu hastalardan sadece birinde primer hemoraji gözlenmiş olup, hasta soğuk diseksiyon grubunda yer almaktaydı. Beş hastanın dördünde sekonder kanama gözlendi ve bu hastalar bipolar koter grubu ve posterior pillar mukozal sütür gruplarındaydı. Postoperatif hemoraji oranları gruplar için sırasıyla %0.61, %0,73 ve %1,18 olarak tespit edildi (p=0,861). Kanamayı kontrol etmek için ameliyat odasına sadece beş hastadan biri transfer edildi.Sonuç: Çalışmamızın bulguları, cerrahi tekniğin tonsillektomi sonrası kanama oranını etkilemediğini desteklemektedir. Farklı cerrahi teknikler arasında primer ve sekonder kanamada oranları açısından anlamlı fark olmadığı görüldü

Cervical necrotizing fasciitis

Servikal nekrotizan fasiit (NF) nadir ve ölümcül bir bakteriyelenfeksiyondur. Fasya planları ve subkütan dokularda ilerleyendoku nekrozu ile karakterizedir. Bu yazıda, yaygın boyunağrısı ve hareket kısıtlılığı nedeni ile değerlendirilen iki NFhastası sunuldu. Boyun bilgisayarlı tomografide subkütanözdokuda yaygın ödem izlendi. Nekrotizan fasiit tanısı konulanhastalar yoğun bakıma nakledildi ve geniş spektrumluantibiyoterapi başlandı. Acil şartlarda boyun eksplorasyonuyapıldı ve tüm nekrotik fasya planları rezeke edildi. Birincihasta boyun enfeksiyonunun giderilmesine rağmen hastaneyeyatışının 45. gününde ikincil bir hastane enfeksiyonu nedeniile kaybedildi. İkinci hasta takiplerinde komplikasyonolmaksızın ameliyat sonrası 10. günde taburcu edildi.Nekrotizan fasiit tanısı klinik şüphe ve fizik muayene ilekonulur. Erken tanı, uygun geniş spektrumlu antibiyoterapive cerrahi debridman mortalitenin önüne geçebilmek için enönemli faktörlerdir.Cervical necrotizing fasciitis (NF) is a rare and fatal bacterialinfection. It is characterized with tissue necrosis advancing onfascial planes and subcutaneous tissues. In this article, we presenttwo NF patients who were evaluated for prevalent neck pain andmotion limitation. We observed prevalent edema on subcutaneoustissue on neck computed tomography. We transferred the patients,who were diagnosed as NF, to intensive care and started widespectrum antibiotherapy. We performed neck exploration inemergency conditions and resected all necrotic fascial planes.First patient died due to a secondary hospital infection on 45 thday of hospitalization despite the elimination of the infectionin the neck. Second patient was discharged from hospital atpostoperative 10 th day without any follow-up complication.The diagnosis of NF is established with clinical suspicion andphysical examination. Early diagnosis, appropriate wide spectrumantibiotherapy, and surgical debridement are the most importantfactors to avoid mortality

The Histopathological Findings of Adenoid Tissue After Topical Mometasone Furoate Implementation

WOS: 000441304600013Objective: Pediatric sleep disordered breathing (SDB) is a common childhood disease with a potential risk of several comorbidities. The most common cause of SDB in childhood is upper airway obstruction due to adenotonsillar hypertrophy and the classical treatment is adenotonsillectomy. However, it carries a risk of many complications and persistent apnea. Topical nasal steroid treatment may be an alternative to surgery in the treatment of pediatric SDB. However, histopathological effects of topical nasal steroids are mostly understudied. Methods: A retrospective controlled clinical study in an academic tertiary referral center. A total of 110 children were involved in the study who underwent adenoidectomy for the treatment of SDB. The study group (51-children) was treated with topical nasal mometasone furoate monohydrate 100 mcg/day. The control group (59-children) was selected randomly and all had no history of topical nasal steroid pre-operatively. Post-operative adenoidectomy specimens were reviewed according to acute/chronic inflammation findings, follicular hyperplasia, goblet cell hyperplasia, squamous metaplasia, fibrosis, atrophy, ulcer and hemorrhage. The findings were scored semiquantitatively for statistical analysis. Results: Chronic inflammation findings, follicular hyperplasia and goblet cell hyperplasia were significantly decreased in the study group in addition fibrosis, atrophy and ulcer findings were significantly increased in the study group. However, there was no statistical difference between the groups according to acute inflammation and hemorrhage. Conclusions: Topical nasal corticosteroids significantly suppress the nasopharyngeal inflammatory process in SDB. This treatment may be an alternative to surgery at least in patients with mild and moderate disease

Tonsillektomi Sonrası Boy ve Kilo Değişimi Üzerine Etkili Faktörlerin Araştırılması

Amaç: Bu çalışmanın amacı tonsillektomi hastalarında yaş, cinsiyet, endikasyon, tonsiller grade, tonsil hacmi ve tonsil ağırlığı gibi değişkenlerin boy ve kilo gelişimi üzerine etkisinin araştırılmasıdır.Gereç ve Yöntemler: Tüm hastaların anamnez ve muayene bulguları kaydedildikten sonra, ameliyat öncesi boy ve kilolarına bakıldı. Postoperatif 6. ayda hastaların tekrar boy ve kiloları ölçülerek kaydedildi. Hastaların boy ve kilo gelişimleri persentil artışına göre hesaplandı. Hastaya bağlı değişkenlerin boy ve kilo gelişimine etkisi karşılaştırıldı.Bulgular: Çalışmaya katılan toplam 45 hastanın 25’i erkek olup 20’si ise kızdır. Hastalar yaşa göre 7 yaş altı ve 7 yaş üstü olmak üzere iki gruba ayrıldı. Cerrahi endikasyona göre hastalar uykuda solunum bozukluğu (USB), rekürren tonsillit ve USB+rekürren tonsillit olmak üzere 3 grupta değerlendirildi. Hastalar tonsil büyüklüğüne göre Grade 1-2, Grade 3 ve Grade 4 olmak üzere üç grupta değerlendirildi. Hastalar tonsil hacmine göre 7 cc altı ve üstü olacak şekilde iki gruba ayrıldı. Hastalar tonsil ağırlığına göre 7 gr altı ve üstü olacak şekilde iki gruba ayrıldı. Bakılan hastaya bağlı değişkenlerin boy ve kilo persentil değişimi üzerine anlamlı etkisinin olmadığı görüldü.Sonuç: Tonsillektomi sonrası gelişmeyi etkileyen hastaya bağlı faktörler açısından yapılan değerlendirmede istatistiksel olarak anlamlı sonuçlar çıkmamıştır. Bu konuda daha ayrıntılı bilgi edinebilmek için geniş hasta katılımının ve daha uzun takip sürelerinin olduğu çalışmalara ihtiyaç vardır