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Objective: Tonsillectomy is one of the most common surgical procedures performed in Ear Nose Throat (ENT) practice. The tongue depressor, which is routinely used during tonsillectomy surgeries, may cause various complications by applying high pressure to the patient›s tongue. In this study, we aimed to investigate the tongue edema caused by the pressure applied by the tongue depressor using ultrasonography (USG) in adult patients who underwent tonsillectomy. Material and Methods: Our study consisted of two groups, including patients between the ages of 18-40. The patients in the study group (n = 31) were composed of patients who underwent tonsillectomy surgeries in the ENT clinic. The patients in the control group (n = 30) were composed of patients who were operated on for a reason other than tonsillectomy under general anesthesia, no pressure was applied on the tongue during surgery, and the duration of general anesthesia was close to the duration of tonsillectomy surgeries. Submental coronal plane USG examination of the tongue area (TA) was performed twice for each patient. The first tongue area examination (TA1) was performed immediately after intubation but before inserting the tongue depressor in the tonsillectomy group. The second tongue area examination (TA2) was performed at the end of the tonsillectomy surgery, after removal of the tongue depressor just before extubation. In the control group, the first tongue area examination (TA1) was performed immediately after intubation, and the second tongue area examination (TA2) was performed at the end of the operation just before extubation. Tongue edema, which is thought to occur due to the high pressure applied by the tongue depressor during tonsillectomy surgeries, was calculated by the difference in tongue areas (i.e., TA2 - TA1). Results: The groups were similar in terms of demographic data and general anesthesia duration. When the mean TA1 values were taken into account between the tonsillectomy (3.93 ± 1.29 cm2) and control (3.80 ± 1.20 cm2) groups, no significant difference was found (p = 0.212). The mean TA2 value of the tonsillectomy group (4.63 ± 0.28 cm2) was greater than the control group’s TA2 value (3.91 ± 0.23 cm2) and was significantly different (p = 0.000). In addition, the mean tongue edema value of the tonsillectomy group (0.90 ± 0.26 cm2) was greater than the control group (0.11 ± 0.07 cm2) and was significantly different (p = 0.000). Conclusion: The tongue depressor used caused tongue edema in tonsillectomy surgeries in adult patients. This tongue edema appears to be the result of the pressure exerted by the tongue depressor. This study is the first to show the possible role of USG in determining tongue edema due to tongue depressor in adult patients undergoing tonsillectomy. [ABSTRACT FROM AUTHOR]

Abstract Objectives Seasonal allergic rhinitis (SAR) is common in children and hyposmia is a major symptom affecting the quality of life. The aim of the present study is to assess olfactory dysfunction in pediatric patients with SAR and correlate the results with acoustic rhinometry measurements. Methods Forty children, diagnosed as moderate and severe SAR based on clinical findings, ARIA (Allergic rhinitis and it's impact on asthma) classification and prick test results were enrolled in the study. Endoscopic nasal examination, acoustic rhinometry, total nasal symptom score (TNSS) and Connecticut Chemosensory Clinical Research Center (CCCRC) tests were performed 'in season' (May–August) and 'out season' (November–February). Three patients who did not show up in 'out season' examinations were excluded from the study. Results The ages of the children ranged between 8 and 18 years with a hyposmia increased and odor identification decreased (p < 0.005, p = 0.003, respectively), whereas no differences were found between odor thresholds and the discrimination values (p > 0.05). Mean CCCRC value was obstruction score (r =−0.340, p = 0.04), subjective hyposmia (r = −0.44, p = 0.007) and TNSS (r = −0.494, p = 0.02). Although some of the acustic rhinometry parameters were lower during allergy season, there were no correlations between acoustic rhinometry parameters and CCCRS values. Conclusion Nearly half of the children with AR reported a mild to moderate hyposmia during pollen season and there was a decrease in odor identification, which can be easily shown using a CCCRC test. [ABSTRACT FROM AUTHOR]

Laryngocele is an air-filled, abnormal dilation of the laryngeal saccule that extends upward within the false vocal fold, in communication with the laryngeal lumen. A case of 43-year-old male with bilateral internal laryngoceles, who has been treated as asthma for 4 years, is presented. The patient had dyspnea, cough, and excessive phlegm for a month and a late onset stridor. Flexible nasopharyngolaryngoscopy showed bilateral cystic enlargements of the false vocal folds and true vocal folds could not be visualized. Laryngeal CT without contrast enhancement showed bilateral internal laryngoceles. Submucosal total excision of bilateral cystic masses including parts of false vocal folds was performed. The symptoms resolved immediately after surgery. Although the incidence of internal laryngocele is rare, it should be remembered in the differential diagnosis of upper airway problems and diagnostic flexible nasopharnygolaryngoscopy is routinely indicated for airway evaluation in at-risk patients. [ABSTRACT FROM AUTHOR]

Squamous cell carcinoma (SCC) of the external auditory canal (EAC) is an extremely rare malignant tumor with a prevalance between 1 and 6 cases per 1 million population. The incidence is higher in patients presenting with otological diseases (1 in 5,000 to 15,000). Certain associating factors have been described in the literature. This malignancy frequently presents with symptoms similar to a case of otitis externa or a chronic suppurative otitis media. In this paper, we present a patient who had bilateral SCC of EAC caused by radiotherapy for nasopharyngeal carcinoma. To our knowledge, our case is the fifth bilateral SCC of the EAC and the first bilateral radiotherapy related SCC of the EAC reported in the literature so far. [ABSTRACT FROM AUTHOR]

Purpose: Our study aimed to evaluate the effects of chronic hypoxic state in Obstructive Sleep Apnea Syndrome (OSAS) on brainstem pathways using Vestibular Evoked Myogenic Potential (VEMP) test and to investigate the presence of new markers likely to be correlated with the severity of the disease. Methods: The study was planned as prospective and double blind. A total of 60 patients (120 ears) diagnosed with mild, moderate and severe OSAS were included in the study and the patients are grouped as 20 patients in each group. Twenty volunteer healthy individuals (40 ears) shown to be without OSAS were included in the study. VEMP measurements were made in 60 study group patients (120 ears) and in 20 healthy controls (40 ears). The groups were compared in terms of variables such as the acquisition rate of oVEMP and cVEMP waves, interval between the waves, latency and amplitude of the waves. p < 0.05 values were considered as significant. Results: The results of cVEMP test showed that the rate of wave acquisition in the moderate and severe OSAS groups was significantly lower than the control group and mild OSAS groups (p = 0.008). There was no difference between the control group and the mild OSAS group in terms of the rate of obtaining the wave (p > 0.05). In the moderate and severe OSAS groups, P1N1 amplitude and N1P2 amplitude values were found to be significantly lower than the mild OSAS group (p = 0.007 and p = 0.017, respectively). In the oVEMP test, there was no significant difference between the mild OSAS group and the control group in terms of the wave yield (p > 0.05); however, it was found that the rate of wave acquisition in the moderate and severe OSAS groups was significantly lower than the mild OSAS group (p = 0.041). There was inverse correlation between the N1P2 interval and P1N1 amplitude value and AHI in simple regression analysis and multiple regression analysis (p = 0.012 and p = 0.021; p = 0.009 and p = 0.040, respectively). Conclusion: The negative effects of chronic intermittent hypoxia related with OSAS on the brainstem and vestibular system can be demonstrated by VEMP tests. Especially, the inability to obtain the wave is the most important finding showing this situation. Also, we think that N1P2 interval and P1N1 amplitude markers can be used to detect the subclinical negative effect of chronic hypoxia on vestibular nuclei in the brainstem. [ABSTRACT FROM AUTHOR]

Object: To prepare a national guideline for Otorhinolaryngologist who treat allergic rhinitis patients who treat allergic rhinitis patients. Methods: The study was conducted by three authors, namely the writing support team. The support team made the study plan, determined the writing instructions, chose the subgroups including the advisory committee, the advisors for authors and the authors. A workshop was organized at the very beginning to explain the details of the study to the team. Advisors took the chance to meet their coworkers in their subgroups and determined the main headings and subheadings of the guideline, together with the authors. After key words were determined by the authors, literature search was done in various databases. The authors keep in touch with the advisors and the advisors with the advisory committee and the support group at every stage of the study. National and International published articles as well as the abstracts of unpublished studies, imperatively presented in National Congresses, were included in this guideline. Only Guideline and meta-analyses published in last seven years (2013-2017) and randomized controlled studies published in last two years (2015-2017) were included. After all work was completed by the subgroups, support team brought all work together and edited the article. Results: A detailed guideline about all aspects of allergic rhinitis was created. Conclusion: The authors believe that this guideline will enable a compact and up-to-date information on allergic rhinitis to healthcare professionals. This guideline is the first in the field of Otolaryngology in Turkey. It should be updated at regular intervals. [ABSTRACT FROM AUTHOR]

Purpose: Allergic rhinitis (AR), is an IgE-mediated inflammation of the nose. Regulatory T cells (Tregs) and inflammatory cytokines have been shown to play a critical role in allergic airway inflammation. The aim of the study was to compare the levels of blood T lymphocyte subsets and IL-10, IL-17 and neopterin concentrations in serum and nasal lavage of patients with AR compared to healthy subjects. Methods: The study included 38 subjects with moderate-severe AR and 36 sex- and age-matched controls. Peripheral blood CD3+, CD3+CD4+ and CD4+CD25+Foxp3 percentages were evaluated using flow cytometry. Levels of IL-10, IL-17 and neopterin were measured both in serum and nasal lavage fluid with ELISA and HPLC, respectively. Results: No difference was found in the percentages of T lymphocyte subsets between the two groups (p > 0.05). Serum IL-10 levels were similar (p > 0.05), whereas nasal IL-10 was lower in AR subjects compared to control group (2.22 ± 0.91 and 3.12 ± 1.45 pg/ml, respectively) (p < 0.05). Mean serum and nasal IL-17 were higher in AR (107.7 ± 79.61 and 527.36 ± 738.7 pg/ml) than the control group (76.29 ± 28.94 and 328.9 ± 430.8 pg/ml) (p < 0.05 and p > 0.05). There were no significant differences in serum and nasal neopterin levels (p > 0.05). Conclusions: Although there were no differences in the distribution of lymphocyte subsets between the AR and control groups, the finding of higher levels of serum and nasal IL-17 and lower levels of nasal IL-10 support the cytokine imbalance in the pathogenesis of AR. [ABSTRACT FROM AUTHOR]

Objective: Tinnitus is a common neuro-otological disease for which exact information about its cause and treatment has not been reached yet. In this study, making morphometric measurements of os temporale in patients and healthy ears of patients with unilateral tinnitus; It was aimed to compare these measurements according to gender, side, patient-health status, and bulbus jugularis levels. Methods: In the study, 30 (18 females, 12 males) patients with unilateral subjective non-pulsatile tinnitus had meatus acusticus internus (MAI) diameter, length, n. cochlearis bone canal diameter (NCKC), bulbus jugularis (BJ) diameter and level, fenestra vestibuli niche height (FVNY) os temporale computed tomography (CT) images were measured. The data obtained were compared according to gender, side, health status and bulbus jugularis levels. Results: hi the results obtained, the diameter of MAI in the sick ears was found to be statistically significantly smaller on the right side from the left side. When the ears with left and right tinnitus were compared with same person's other ear, a statistically significant difference was observed. BJ diameter was significantly different only in healthy ears with hypotympanic and mesotym-panic BJ ears. When bulbus jugularis levels were investigated, 43 hypotympanicand 17 mesotympanic BJs were seen, while no epitympanic located BJ was observed. FVNY was found to be significandy smaller in the left ears tinnitus than in the right ears tinnitus ears. When individuals with left tinnitus were compared with their healthy right ears, it was observed that the left side was significantly smaller than the right. Conclusion: Significant differences between the right and left sides of the ears with tinnitus suggest that the right and left sides may affect tinnitus in different degrees. The results obtained from the study will help to interpret the CT images of patients with tinnitus, determine the etiology, and create a treatment plan. [ABSTRACT FROM AUTHOR]