International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Assessment of sociodemographic clinical findings in cases of rheumatic subclinical carditis and comparison the effect of different treatment protocols on prognosis

Subklinik kardit, izole artrit, kore veya poliartraljisi olan akut romatizmal ateş olgularında Doppler ekokardiyografi ile tanımlanmıştır. Akut romatizmal ateşte kalıcı sekel kalp tutulumuna bağlıdır, bu nedenle karditin erken teşhisi önemlidir. Subklinik karditte tedavi etkinliği ve prognoz belirsizdir. Bu çalışma ile, ekokardiyografinin erken tanıdaki önemini vurgulamak ve sessiz karditte tedavi ve prognoz arasındaki ilişkiyi retrospektif olarak değerlendirmeyi amaçladık. Ocak 1998 ile Ağustos 2010 tarihleri arasında, Gazi Üniversitesi Tıp Fakültesi pediatrik kardiyoloji bilim dalına başvuran hastaların dosyaları retrospektif yöntemle taranarak 40 sessiz kardit hastası bulundu. Kore, artrit veya poliartralji ile başvuran 6-16 yaş arası 22 erkek, 18 kız hasta saptandı. Hastaların 19&#8217;unda mitral yetmezlik, 18 hastada mitral ve aort yetersizliği ve üç hastada aort yetmezliği vardı. Hastaların 21&#8217;ine prednizolon, dokuz hastaya asetilsalisilik asit verilmiş olduğu ve 10 hastaya antienflamatuvar tedavi uygulanmamış olduğu görüldü. Hastalar, ortalama 46,81 ± 32,66 ay takip edildi ve kapak yetmezliklerinin 15&#8217;inin tamamen düzelmiş olduğu, 11&#8217;inin kısmen düzelmiş olduğu görüldü.Hastaların almış oldukları tedavi protokollerini ve buna göre hastalığın seyrini karşılaştırdık. Prednizolon tedavisi almış olan grupta, prednizolon almamış gruba göre kapak yetmezliklerinde istatistiksel olarak iyileşmenin daha fazla ve iyileşme süresinin daha kısa olduğu saptandı (p <0,05). Bulgularımıza göre, prednizolon ile tedavinin tam iyileşmede yararlı olduğunu ve erken bir kardit bulgusu olarak sessiz karditte kapakta proliferatif lezyonlar oluşmadan erken başlanan prednizolon tedavisinin sekel gelişiminin önlenmesinde önemli olduğunu düşünüyoruz.Subclinical carditis has been identified using Doppler echocardiography in cases of acute rheumatic fever with isolated arthritis, chorea or poliartralgia. Permanent sequelae of acute rheumatic fever depends on the involvement of the heart, so early diagnosis of carditis is important. The efficiency of the treatment and prognosis of subclinical carditis is not clear. We aimed to explain the importance of echocardiography for early detection and to determine retrospectively the relationship between the medication and prognosis. We scanned the patients files at the Department of Pediatric Cardiology, Gazi University School of Medicine, between January 1998 and August 2010 retrospectively and found 40 patients with subclinical carditis. 22 males and 18 females aged 6-16 years presenting with either chorea, arthritis or poliartralgia. Nineteen patients had mitral regurgitation, 18 patients had combined mitral and aortic regurgitation, and three patients had aortic regurgitation. Of the patients, 21 received prednisolone, nine patients received acetylsalicylic acid and 10 received no treatment. The patients were followed over a mean period of 46,81 ± 32,66 months, 15 of the valvar regurgitation disappeared. We compared the treatment protocols of the patients and compare the prognosis of subclinical carditis, we found more patients from the group who received prednisolone recovered fully and recovered earlier than the grup who have not received prednisolone (p<0,05). Based on our study, treatment with prednisolone seems to have a role in fully recovery and we consider starting prednisolone treatment for rheumatic subclinical carditis which can be the early sign of rheumatic carditis, is important to prevent sequelae

A Rare Cause of Headache: Superior Concha Over Pneumatization

Pnömatize süperior konka nadir bir başağrısı sebebidir. Nazal endoskopi, tanı için yetersiz kalabilir ve tanının doğrulanması için koronal bilgisayarlı tomografi gerekir. Medikal tedaviye rağmen 6 aydır baş ağrısı yakınması olan 52 yaşında bayan hasta kliniğimize başvurdu. Muayene ve görüntüleme yöntemleri sonucunda süperior konkada aşırı pnömatizasyon saptanan hastaya endoskopik sinüs cerrahisi uygulandı. Postoperatif dönemde hastanın şikayetlerinin gerilediği izlendiPneumatized superior concha is a rare cause of headache. Nasal endoscopy may not give sufficient information for diagnosis and coronal computerized tomography might be needed to confirm the exact diagnosis. A 52-year-old female patient with a complaint of chronic headache unresponsive to medical treatment for 6 months was admitted to our clinic. Endoscopic sinus surgery was commenced after the diagnosis of over pneumatized superior concha by physical examination and imaging techniques. Patient's complaints were relieved after the operatio

Is Hyperbaric Oxygen Therapy Effective in Cisplatin-Induced Ototoxicity in Rats?

Objectives. Cisplatin is an antineoplastic agent, used in the treatment of different types of malignant neoplasms. Side effects such as ototoxicity, nephrotoxicity, and bone marrow toxicity are the main limitations of its clinical use. The aim of the present study was to evaluate the possible effects of hyperbaric oxygen (HBO) therapy as a protective agent in cisplatin-induced ototoxicity in rats

Does melatonin alleviate ototoxic effect caused by administration of cisplatin?

Aim: In this study, it was aimed to experimentally investigate the protective effects of melatonin in the cisplatin-induced ototoxicity. Material and Methods: Ten Wistar-albino rats were included in the study. Two equal groups were generated randomly as cisplatin and melatonin groups. Rats’ underwent Auditory Brainstem Response (ABR) and Distortion Product Otoacoustic Emission (DPOAE) testing before the drug administration and the results were recorded. Both tests were repeated 72 hours after the cisplatin administration in all rats. Results: Significant difference was found between the I-IV interval values before the treatment and after the treatment both in cisplatin and melatonin group. As well as the significant difference in hearing threshold value changes, statistically, significant differences in ABR-I and ABR-IV interval variations were also seen between the cisplatin and melatonin groups. A statistically significant decrease was found between the initial and final control SNR (signal-to-noise ratio) levels within the cisplatin group in the evaluations at 2000Hz, 3000Hz and 4000Hz. Statistically, significant differences were observed between SNR levels when the melatonin group was compared with the cisplatin group. Conclusion: Melatonin appears to reduce cisplatin-induced ototoxicity in rats. Although, the use of supplementary therapies targeting to reduce the toxic effects in clinical studies is still a controversial point

Effects of methotrexate in a toluene diisocyanate-induced allergic rhinitis rat model

Objectives: This study aims to investigate the therapeutic effect of low-dose topical administration of methotrexate (MTX) in a toluene diisocyanate (TDI)-induced allergic rhinitis rat model. Materials and Methods: The experiments were performed on 18 healthy male Wistar albino rats weighing between 250-270 g. Rats were divided into four study groups: control group (n=5), sham group (n=3), steroid group (n=5), and MTX group (n=5). After the drugs were administered, multiple biopsies were taken bilaterally from the nasal mucosal areas and evaluated histologically for fibrosis, loss of cilia and goblet cells, edema, squamous cell metaplasia, and vascular proliferation. Results: Fibrosis, loss of cilia cells, edema, and vascular proliferation were significantly lower in both MTX and steroid groups than in the control group (p0.05). There were no statistically significant differences with respect to loss of goblet cells and squamous cell metaplasia among the studied groups (p>0.05). Conclusion: Methotrexate may be an alternative or adjuvant therapeutic agent in allergic rhinitis

Effects of topical nasal steroids and diclofenac on the nasal mucosa during hyperbaric oxygen therapy: a double-blind experimental study

We aimed to evaluate nasal mucosal changes and efficiency of nasal steroids and diclofenac on nasal mucosa during hyperbaric oxygen (HBO) treatment. Forty adult Albino-Wistar rats were randomized into four groups. Group 1 (control group) (n = 10) not exposed to hyperbaric or enhanced oxygen concentrations; group 2 (HBO group) (n = 10) underwent only HBO treatment; group 3 (n = 10) received HBO and intranasal mometasone furoate (10 mu l/day); group 4 (n = 10) treated with HBO and diclofenac sodium (10 mg/kg/day ip). Specimens of nasal mucosa were collected after sacrificing and dissection of animals. The specimens were processed for light microscopic evaluation, and then evaluated histopathologically for fibroblastic proliferation and inflammation. Regarding the scores of inflammation, the level of inflammation in the control group was significantly less severe than the other groups (p 0.05). Chronic HBO treatment induced mild inflammation of the nasal mucosa. These effects cannot be prevented adequately by administration of nasal steroids and diclofenac

Comparison of montelukast and mometasone furoate in the prevention of recurrent nasal polyps

Background: The aim of our study was to compare the effects of montelukast and mometasone furoate nasal spray on the postoperative course of patients with nasal polyposis. Patients and methods: Fifty patients diagnosed with nasal polyposis between March 2006 and August 2007 were included in the study. All patients underwent bilateral endoscopic sphenoethmoidectomy and were randomized postoperatively into two groups. Group A ( n = 25) received 10 mg montelukast per day and group B ( n = 25) received 400 µg mometasone furoate nasal spray twice daily. All patients were followed up for 6 months. Sino-Nasal Outcome Test (SNOT)-22 scores, polyp grades, computerized tomography (CT) scores (Lund–Mackay), eosinophils in peripheral blood and polyp tissue were evaluated before and after surgery. Results: There was a significant reduction in SNOT-22 scores in both groups throughout the study period. There was a significant difference in the recurrence rate between both groups with a marginal advantage of mometasone furoate nasal spray. Eosinophils in peripheral blood were found to be effective on the recurrence rate ( p < 0.05). Conclusions: In conclusion, both drugs seem to have a complementary action and further studies are needed to determine which patients should receive which treatment