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Laryngopharyngeal reflux (LPR) is a type of reflux, seen with complaints of hoarseness, chronic cough, and globus sensation, different from gastroesophageal reflux disease (GERD). The aim of this study was to evaluate the awareness, knowledge, and practices of family physicians and trainees who were being trained in medical branches other than ENT and to determine the effective factors on decision making for diagnosis of this disorder. The study was designed as a two-stage study. At the first stage, a data collection tool, involving 29 questions by which the knowledge, awareness, and applications of the physicians about LPR would be determined, was developed with 12 specialists, using Delphi method. At the second stage, 101 family physicians replied the questionnaire online. For 45 trainees other than ENT, the questionnaire was filled face-to-face by one of the investigators. In patients admitted with complaints of hoarseness, lasting longer than 2 weeks, cough, lasting longer than 3 weeks, and globus sensation, the physicians considered LPR as the preliminary diagnosis with rates of 88.4, 82.2, and 62.8 %, respectively. 87.0 % of physicians, participating in the study, started treatment for reflux empirically in patients having complaints of hoarseness, chronic cough, and globus sensation; however, only 29.0 % of physicians prescribed this treatment for periods of 3 or 6 months. 69.9 % of physicians, participating in the study, made a diagnosis of reflux in general during their daily practices; only 6.9 % made the discrimination between LPR and GERD. Of all physicians, 27.9 % prescribed double-dose PPI or H2.

Context: Pycnogenol ® , which is French maritime pine bark extract, is a potent antioxidant. It is used in medical conditions caused by oxidative stress. Cisplatin (cis-diamminedichloroplatinum II) is an antineoplastic agent. However, its serious side effects such as ototoxicity limit its usage., Objective: Antioxidants can be used to prevent ototoxicity. We investigated the effect of Pycnogenol ® on cisplatin-induced ototoxicity., Materials and Methods: Rats were randomly assigned to four groups of five. Distortion product-evoked otoacoustic emissions (DPOAE) test was performed for each rat. The experimental groups were as follows: Control Group, Pycnogenol ® Group: 10 mg/kg Pycnogenol ® intraperitoneally for 7 days, Cisplatin Group: intraperitoneally 15 mg/kg single injection of cisplatin on the fifth day, Cisplatin + Pycnogenol ® Group: intraperitoneally 10 mg/kg Pycnogenol ® treatment for 7 days, additionally on the fifth day, 15 mg/kg single injection of cisplatin was given. On the eighth day, DPOAE was re-performed and rats were sacrificed. Apoptosis was evaluated histopathologically., Results: Mean percentage of apoptotic cells was 1.5, 3, 30 and 11% in organ of Corti and 2, 2, 40, 15% in spiral ganglion neurons in Control Group, Pycnogenol ® Group, Cisplatin Group and Cisplatin + Pycnogenol ® Group, respectively. Cisplatin Group and Cisplatin + Pycnogenol ® Group were significantly different when compared to Control Group histopathologically both in organ of Corti and spiral ganglion neuron (p <0.001, p = 0.019, p = 0.001, p = 0.015). DPOAE results showed that Cisplatin + Pycnogenol ® Group was significantly different when compared to Cisplatin Group at 3, 6 and 8 kHz (p < 0.05)., Conclusion: Pycnogenol protected against cisplatin ototoxicity. Also, pycnogenol is not ototoxic.

Objective: One of the frequently encountered disorders of wound healing following laryngectomy is pharyngocutaneous fistula. However, although studies have been performed with the aim of prevention of pharyngocutaneous fistulae, there are very few studies with tissue adhesives and platelet-rich plasma. In this study, our aim was to investigate the histopathologic changes in wound healing caused by various tissue adhesives and platelet-rich plasma, together with their effects on prevention of pharyngocutaneous fistula., Methods: 40 male rats were randomly divided into five groups: control, platelet-rich plasma, fibrin tissue adhesive, protein-based albumin glutaraldehyde and synthetic tissue adhesive groups. The pharyngotomy procedure was performed and was sutured. Except the control group, tissue adhesives and platelet-rich plasma were applied. Then, the skin was sutured. On the seventh day, the rats were sacrificed. The skin was opened and pharyngotomy site was assessed in terms of fistulae. The pharyngeal suture line was evaluated histopathologically by using Ehrlich Hunt scale., Results: Inflammatory infiltration was found to be higher in "platelet-rich plasma" group than "fibrin tissue adhesive" and "synthetic tissue adhesive" groups. The fibroblastic activity of "platelet-rich plasma", "fibrin tissue adhesive" and "protein-based albumin glutaraldehyde" groups was higher than the control group. The positive changes created by platelet-rich plasma and fibrin tissue adhesive at the histopathologic level were found together with no detected fistula. Among the study groups, there was no statistical difference for pharyngeal fistula development. This result may be obtained by the small number of animal experiments., Conclusion: These results shed light on the suggestion that platelet-rich plasma and fibrin tissue adhesive can be used in clinical studies to prevent pharyngocutaneous fistula., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: Neutrophil to Lymphocyte Ratio (NLR) is considered to be a reliable indicator in etiological investigation and identification of the disease severity in inflammatory disorders. There are numerous observations or evidences suggesting that Bell's palsy is an inflammatory disorder., Objectives: Our aim was to investigate the presence of any clue which might suggest inflammatory etiology and also the presence of compliance between NLR elevation and inflammation severity in children., Methods: Patients younger than 18 years with Bell's palsy and who had not another inflammatory disorder in addition to Bell's palsy were included. A total of 25 patients and 25 healthy individuals were taken. The patient group and the control group were compared in terms of NLR, neutrophil and lymphocytes. The relationship of NLR with pre-treatment House-Brackmann classification was evaluated., Results: The mean age was 9.86±5.07 in the patient group and 9.14±5.94 in the control group. In all members of the patient group, oral prednisolone (1 mg/kg/d) was administered for 7 days. The post-treatment House-Brackmann classification of all patients was determined as grade 1. The average neutrophil values were significantly higher in the patient group. In terms of average lymphocyte values, no statistically significant difference was found. The average NLR value was 1.78 (0.93-4.58) in the pediatric patient group and 1.1 (0.6-2.05) in the control group. NLR was significantly higher in the patient group. NLR and pre-treatment House-Brackmann classification showed no statistically significant correlation (r=0.173, p>0.05). When cut-off value was taken as 3 for NLR, no statistically significant difference was found between groups., Conclusions: High NLR values determined in pediatric patients with Bell's palsy support the inflammatory feature of this disease. NLR is recommended as a supportive parameter in the diagnosis of pediatric patients with Bell's palsy., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: Hypothyroidism is accepted as one of the hormonal factors leading to non-allergic rhinitis. Nasal obstruction and runny nose due to an increase in submucosal connective tissue and mucous gland hypertrophy are the prominent symptoms in hypothyroidism-induced rhinitis at humans. The aim of this study was to analyze the biochemical and histopathological changes in the nasal mucosa of the rats with thyroidectomy-induced hypothyroidism and to compare them with those of a control group., Methods: A total of 60 adult male Wistar Albino rats were included in the study. The rats constituting the test and the control groups were randomly divided into 3 subgroups (T1-3 and C 1-3). While the rats in the test group underwent thyroidectomy, in the control group the incision was sutured without any interventions after exposure of thyroid tissues of the rats. The nasal and paranasal sinus regions of all the rats were carefully dissected and tissue samples were obtained for pathological examinations., Results: In the rats in T1, T2, and T3, the decrease in serum glucuronic acid levels before and after thyroidectomy was statistically significant (p = 0.001, p = 0.003, and p = 0.002, respectively). The difference between the test and the control groups was statistically significant in terms of inflammation at the end of 12 weeks (p = 0.002)., Conclusions: An increase in acid mucopolysaccharidase production due to TSH has been suggested to cause congestion in tissues. Although our study supports the data in the literature up to date, we consider that further clinical and experimental studies are necessary for this verification.

Background: Inverted papilloma (IP), oncocytic papilloma (OP), respiratory epithelial adenomatoid hamartoma (REAH) and capillary hemangioma (CH) are benign and rare tumours. OP and IP are associated with squamous cell carcinoma (SCC). Human papillomavirus (HPV) may play a role in malignant transformation., Aim: We aimed to investigate the presence of HPV, inflammation, epithelial dysplasia, and prognostic markers including proliferative cell nuclear antigen (PCNA), epidermal growth fac- tor receptor (EGFR) and p53 in tissue specimens from rare unilateral intranasal benign tumours., Methods: Presence of HPV DNA was detected by PCR. Proliferative cell nuclear antigen, EGFR, p53 expression and the presence of HPV type 16 in tissues were determined by immuno-histochemical analysis., Results: We determined the presence of HPV DNA in 2 of 6 IP cases, in one CH patient and one OP patient, but the REAH patient was negative. Histologically, only one specimen with IP was positive for HPV type 16 being the high risk type. The remaining cases were considered as low risk type HPV., Conclusion: Although our patient numbers are limited, there is a significant association between IP and HPV. This is the first study showing the cooccurrence of CH and OP with HPV.

The role of fungi in chronic rhinosinusitis (CRS) remains unknown. Fungi were also determined as one of the responsible agents in the etio-pathogenesis, while several studies found fungi in 6-93% of the cases. The aim of this study is to test the presence of fungi in samples taken from the middle meatus of patients with CRS, using traditional culture methods and polymerase chain reaction (PCR), and to compare the efficacy of these methods. Thirty patients diagnosed with CRS, with or without nasal polyposis, undergoing an operation in the Otorhinolaryngology Clinic, were prospectively included in the study. Nasal mucosa samples from ten patients, who were operated for pathologic evaluation, and without CRS, were used as controls. Nasal samples were taken from each patient by swabbing with a cytology brush. Middle meatus culture samples were taken by using nasal cotton swab, and the polyp and/or sinus mucosa samples were taken during endoscopic sinus surgery. Fungal specific PCR, using 18S rRNA primers and standard cultures, were performed on every sample. All amplicons were sequenced. There was no fungal growth in the Sabouraud dextrose agar (SDA) medium from middle meatus samples and tissue parts. Of 30 tissue and brush samples, 3 and 2 were positive for fungal DNA, respectively. Sequence analysis showed that four amplicons were homologus to Cladosporium herbarum and one to Aspergillus amstelodami. We concluded that fungal etiology is overestimated and fungi rarely play a role in patients with CRS. Large-scale studies should be done using molecular methods.

Purpose: Discovery of the role of the neurogenic inflammation in the formation of otitis media with effusion has led to the investigation of the place of some neuropeptide antagonists in the treatment. In the current study, we investigated the effect of capsaicin (CP) pretreatment on the inflammation and proliferation in the middle ear mucosa and on the nerve fibers containing substance P, vasoactive intestinal polypeptide, and calcitonin gene-related peptide., Methods: Seventeen Wistar rats were used in the study. Ten rats were given CP on 3 consecutive days, and seven rats were given isotonic saline solution. Seven days after the third injection, animals were operated on, and their eustachian tubes were occluded. On the seventh day after the operation, five rats from the test group and three from the control group were killed. The others were killed 21 days after the operation. In the histopathologic examination of the sections, acute inflammation and proliferation scores were determined. Gland degeneration, goblet cell hyperplasia, and the density of mast cells were evaluated. Neural elements were stained immunohistochemically., Results: The acute inflammation score in the test group was lower, but the difference was insignificant (p > 0.05). The proliferation score in the test group was lower, and the difference was significant (p = 0.02). In the control group, gland degeneration was significantly higher (p = 0.044). Goblet cell hyperplasia demonstrated no difference between two groups (p > 0.05). Mast cell density was higher in the control group, but the difference was not significant (p > 0.05). Substance P immunoreactivity (IR) was significantly higher in the control group (p = 0.015). calcitonin gene-related peptide-IR and vasoactive intestinal polypeptide-IR were limited in both groups., Conclusions: That CP pretreatment reduces inflammatory proliferative findings, and gland degeneration leads us to consider that it could be effective in both treatment of experimental otitis media with effusion and prevention of its complications.