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Schwannoma is a benign, asymptomatic, solitary, and encapsulated tumor that grows slowly from peripheral, autonomic, or cranial nerve sheaths. The origin of the schwannomas in the facial nerve is rare and they tend to occur in the intratemporal part of the nerve. An intraparotid facial nerve schwannoma is usually a painless, slow-growing mass like the other benign parotid tumors. In this case report, we will discuss the clinical presentation, management, and outcome of two patients with intraparotid facial nerve schwannoma. How to cite this article: Topuz MF, Genç O, Kadioglu N, et al. Intraparotid Facial Nerve Schwannoma: A Report of Two Cases. Int J Otorhinolaryngol Clin 2020;12(1):4–7.

Amaç: Bu çalışmanın amacı, retrospektif olarak hastanemizde nazofaringeal patoloji nedeniyle biyopsi yapılan hastaların klinikopatolojik özelliklerini analiz etmektir.Materyal ve metod: Ocak 2009-Temmuz 2018 tarihleri arkasında nazofaringeal lezyonu tanımlamak amacıyla 535 hastaya biyopsi yapıldı. Klinik ve patolojik verileri retrospektif olarak kayıt edildi. İstatistiksel olarak analize edildi.Bulgular: Çalışmaya dahil edilen 535 olgunun 311’ü erkek ve 224’ü kadın İdi. Yaş ortalaması 37.7±17’di. En sık izlenen benign lezyon reaktif lenfoid hiperplazi ve en sık malign lezyon nazofarinks karsinomu idi. Yaş arttıkça malignite saptanma oranının arttığı tespit edildi. Sonuç: İleri yaşlarda nazofarinkste tanımlanan lezyonların malign olma olasılığı yüksektir. Bu yüzden, semptomatik olgularda doğru tanı için öncelikle klinikopatolojik korelasyon gereklidir.

To evaluate extraocular orbital vessels with color Doppler ultrasound (CDU) and investigate the effects of severe obstructive sleep apnea (OSA) on retrobulbar blood flow. Between February 2014 and September 2015, 30 patients with severe OSA (apnea–hypopnea index (AHI) > 30) and 28 controls were prospectively included in this study. Intraocular pressure (IOP) was measured with a Goldmann applanation tonometer, and CDU was used to evaluate the retrobulbar vessels. The mean AHI score for the OSA group was 63.2 ± 21.5 per hour. The IOP values were significantly higher in the severe OSA group (p

Platelet-rich fibrin (PRF) membrane could be used successfully in the repair of tympanic membrane perforation and wound healing.To evaluate the effect of platelet-rich fibrin membrane in the repair of perforated tympanic membrane.After otoscopic examination, a 3-mm perforation was made in the posterior quadrant of both tympanic membranes of 50 adult male Sprague-Dawley rats. Venous blood was withdrawn from the rats, then centrifuged. PRF was obtained in membrane form. The membrane was placed on the right tympanic membrane perforation. The perforations on the left side were left to spontaneously heal and, thus, formed the control group. Daily examinations were made of 20 rats and the time to healing of the tympanic membrane was recorded. The remaining 30 rats were separated into five groups of six, and histopathological examination was made. Evaluation was made in respect of the presence of oedema in the lamina propria, neovascularization, fibroblastic reaction, and inflammatory cells.The healing time of the tympanic membrane perforation was determined as mean 10.3 ± 2.18 days in the study group applied with PRF and 17 ± 2.40 days in the control group. Higher values in respect of fibrosis and neovascularization were obtained in the study group.

The role of IL-25 and IL-33 in the aetiology and pathogenesis of nasal polyps has been controversial in the literature. The objective of the study is to detect serum and tissue levels of IL-25 and IL-33 in patients with (CRSwNP) or without (CRSsNP) nasal polyps using enzyme-linked immunosorbent assay (ELISA). Study group consisted of 20 CRSwNP and 20 CRSsNP patients. Control group comprised of 20 volunteers who had been operated with septum deviation without any additional sinonasal pathology, allergy, systemic disease, or medication use. All groups preoperatively underwent paranasal CT examinations and sinonasal pathologies were recorded based on Lund–Mackay radiological staging system. IL-25 and IL-33 levels in serum and tissue samples were analyzed using the ELISA method. Serum IL-25 and IL-33 levels in CRSsNP, CRSwNP, and control groups did not differ statistically significantly (p = 0.345 and p = 0.338). Any statistically significant difference was not detected in mean tissue IL-25 levels among CRSsNP, CRSwNP, and control groups (p = 0.698). Mean tissue IL-33 level in the CRSwNP group was statistically significantly lower when compared with those of CRSsNP and control groups (p

Objective To determine the hearing levels of participants of a randomized group using a smartphone hearing application and to compare these results with the results from a pure-tone audiogram. Materials and methods A heterogenous group consisting of both normal-hearing and hearing-impaired participants were included in this study. Pure-tone audiogram thresholds were measured from 250 Hz to 8000 Hz, while smartphone measurements were obtained with a Samsung Galaxy GT-19500 S4 with a bundled headphone running the Hearing Test™ software (e-audiologia.pl), which was downloaded from the Google Play Store as a free application. We compared these results with those obtained from pure-tone audiograms performed by an audiologist as a reference. Results Validity analysis indicated that the results for each ear and each frequency were excellent (>0.75). We assessed the mean difference between the pure-tone audiogram and the smartphone hearing test results and found the absolute difference to be less than 8.8 dB. Conclusion Smartphone hearing test applications are providing alternative tests that present low-cost solutions. Using the hearing application test may decrease the demand for audiological services in underserved areas. The study suggests that smartphone hearing test results are comparable to pure-tone audiometry results.

BACKGROUND Fine-needle aspiration cytology (FNAC) is a noninvasive, safe, cost-effective, diagnostic procedure for the evaluation of salivary gland lesions and the selection of patients for surgery. The aim of this study was to analyze the risk of malignancy (ROM) according to the Milan reporting system of salivary gland FNA specimens using a liquid-based cytology (LBC) technique. METHODS The cytological diagnosis of 459 cases between 2014 and 2017 was revised according to the Milan reporting system. The FNAC results of 129 cases with a histological diagnosis were compared with respect to the final diagnosis. The ROM for each category calculated. RESULTS The ROM was high in the indeterminate and malignant categories, while the ROM in the benign neoplasm category was low. Sensitivity and specificity analyzed in two different ways were 95.1% and 88.8%, 81%, and 77.7%, respectively. CONCLUSIONS When salivary gland lesions are evaluated together with clinical and radiological data, the LBC technique can be applied to salivary gland specimens based on the high diagnostic sensitivity and specificity in liquid-based samples reported according to the Milan system.

Introduction Mucosal contact headache is a referred pain that arises from contact between the nasal septum and the lateral nasal wall. Evidence supports the role of substance P in a contact headache such that release of substance P from sensory nerve endings causes inflammation and allergy. Objectives This study aimed to determine possible differences in substance P levels in inferior turbinate hypertrophy creating a contact headache. Methods 28 patients who had contact headaches (study group) and 16 volunteers with no complaints were included in the study. Substance P levels in the inferior turbinate tissue samples were quantified using a commercially available substance P EIA kit. Results In the study group average substance P levels were 2.65 ± 0.27 pg/mg tissue (range: 0.61–5.44) and in the control group it was 1.77 ± 0.27 pg/mg tissue (range: 0.11–4.35). The difference was statistically significant between the two groups (p = 0.0215). Average preoperative headache group visual analog scale scores was 5.93 ± 0.38 (2–9) and the turbinate volume was 6.56 ± 0.35 cm3 (3.50–10.30). The control group turbinate volume was 4.71 ± 0.39 cm3 (2.50–7.70). We found a correlation between the visual analog scale scores and substance P levels such that substance P levels were higher in visual analog scale scores above 5 (p = 0.001). Conclusion This study demonstrates the relationship between intranasal contact headaches and increased mucosal substance P levels. We also found that there is no correlation with substance P levels and volume of the inferior turbinate. Resumo Introdução A cefaleia por ponto de contato da mucosa é uma dor direcionada que surge do contato entre o septo nasal e a parede nasal lateral. Evidências corroboram o papel da substância P na cefaleia de contato, de tal forma que a liberação da mesma a partir de terminações nervosas sensoriais possa causar inflamação e alergia. Objetivo Determinar possíveis diferenças nos níveis da substância P na hipertrofia de conchas inferiores em relação à cefaleia de contato. Método Foram incluídos no estudo 28 pacientes que apresentaram cefaleia por ponto de contato (Grupo Estudo) e 16 voluntários sem queixas. Os níveis de substância P nas amostras de tecido da concha inferior foram quantificados com um kit substância P EIA, comercialmente disponível. Resultados No grupo do estudo, os níveis médios de substância P foram 2,65 ± 0,27 pg/mg de tecido (variação: 0,61-5,44) e no grupo controle foram de 1,77 ± 0,27 pg/mg de tecido (variação: 0,11-4,35) e a diferença foi estatisticamente significante entre os dois grupos (p = 0,0215). O escore médio da escala visual analógica do grupo de cefaleia pré-operatória foi de 5,93 ± 0,38 (2-9) e o volume das conchas foi de 6,56 ± 0,35 cm3 (3,50-10,30). O volume da concha do grupo controle foi de 4,71 ± 0,39 cm3 (2,50 ± 7,70). Encontramos uma correlação entre o escore da escala visual analógica e os níveis de substância P, de modo que os níveis de substância P foram maiores nos escores da escala visual analógica acima de 5 (p = 0,001). Conclusão Este estudo demonstra a relação entre cefaleias por contato intranasais e níveis aumentados de substância P nas mucosas. Também observamos que não há correlação com os níveis de substância P e o volume da concha inferior.

Auditory system abnormalities commonly occur in patients with chronic renal disease and end-stage renal disease undergoing hemodialysis. The aim of this study was to determine the relationship between cochlear sensitivity and hemodialysis in dialytic and non-dialytic chronic kidney disease patients.The study included children aged 6-18 years that were divided into 3 groups: 36 non-dialytic patients with chronic kidney disease, 16 end-stage renal disease patients undergoing hemodialysis, and 30 healthy controls. Blood urea nitrogen, serum cystatin C levels, duration of chronic kidney disease, and the duration of hemodialysis were compared between the chronic kidney disease patients and end-stage renal disease patients undergoing hemodialysis. Hearing health was measured via tympanometry, pure-tone audiometry and distortion product otoacoustic emissions testing.Distortion product otoacoustic emission amplitudes and signal-to-noise ratios were significantly lower at all frequencies tested in the non-dialytic and dialytic groups than in the control group (p0.05). Patients with normal hearing had significantly lower distortion product otoacoustic emission amplitudes and signal-to-noise ratios than the healthy controls (p0.05). The duration of CKD, the cystatin C level, and the blood urea level were not associated with hearing loss. The present findings suggest that there was a significant association between the duration of HD and hearing loss.The present findings show that there was impaired cochlear function in the dialytic and non-dialytic patient groups, regardless of hearing loss, as compared to the control group. Patients with chronic renal disease-both dialytic and non-dialytic-should be monitored to prevent any further deterioration by avoiding potential ototoxic agents, even if their hearing thresholds are within normal limits.

Hashimoto's thyroiditis (HT) is the most common autoimmune thyroid disease in children. HT is a multifaceted disease with a variable clinicopathological presentation, including hearing impairment. It is known that hearing function is negatively affected in patients with thyroid disorders. The literature includes a very limited number of studies on hearing function in euthyroid pediatric patients with HT. The aim of this study was to determine the relationship between cochlear function and HT, independent of thyroid function.The study included 48 children and adolescents (42 females and 6 males) aged 9-18 years that were diagnosed as HT, and 30 gender- and age-matched healthy controls. Hearing was assessed via otoscopy, tympanometry, pure-tone audiometry, and measurement of distortion product otoacoustic emissions.There weren't any significant differences in pure tone thresholds between the 2 groups based on pure-tone audiometry, except in the right ear at 6kHz and 8kHz. Distortion product otoacoustic emissions signal to noise ratios were significantly lower in the HT group than in the control group at 4 different frequencies (6kHz [left ear], 8kHz [left ear], 1.5kHz [right ear], and 6kHz [right ear]) (P0.05). The signal to noise ratios at all frequencies were6dB in 3% of left ears and 2.5% of right ears in the control group, versus 12.5% of left ears and 9.6% of right ears in the HT group. Distortion product amplitudes were significantly lower in the HT group than in the control group for both left and right ears at 1kHz, 1.5kHz, 3kHz, and 8kHz, and at 2kHz for left ears only (P0.05).The present findings show that cochlear function was lower in the HT group than in the control group. Accordingly, we think that hearing in patients with HT should be monitored periodically, even if their hearing thresholds are within normal limits. Thyroid autoimmunity appears to play an important role in a decrease in cochlear activity in pediatric HT patients.

Introduction One of the most common otological complaints is tinnitus in adults. When there is a complaint of unilateral tinnitus and retrocochlear pathology is suspected, imaging methods are applied. However, the imaging findings obtained may not always be compatible with the severity and localization of the tinnitus. Aim The aim of the present study was to determine whether or not there was a significant correlation between the findings on magnetic resonance imaging (MRI) and the presence and severity of tinnitus in patients with the complaint of unilateral tinnitus. Method The study included 44 patients with no loss of hearing who presented with the complaint of unilateral tinnitus. The relationship between tinnitus severity and vascular loop presence was investigated. Results Various types of vascular loop were determined in 14 patients. No statistically significant relationship was determined between the presence of vascular loop and the Tinnitus Handicap Inventory scores. Conclusion The results of this study showed no significant difference in respect of the presence of vascular loop on the MRI findings of symptomatic and healthy ears. The presence of vascular loop on MRI is not always a pathological event and should be considered only as an examination finding that could be an anatomic variation.

OBJECTIVES This study aims to evaluate the effect of septal deviation causing nasal obstruction and septal surgery on middle ear ventilation. PATIENTS AND METHODS Twenty-five patients over 18 years of age (6 females, 19 males; mean age 24.7±6.1 years; range 18 to 38 years) who underwent septoplasty due to septal deviation with a normal baseline ear function were included in the study. Nasal obstruction was evaluated preoperatively and at three months postoperatively using visual analog scale and nasal obstruction symptom evaluation (NOSE) scale. Tympanometric tests were performed preoperatively and on seventh day, in the first month and third month postoperatively. RESULTS There was a statistically significant difference in the mean NOSE score (p=0.00). The mean preoperative NOSE score was 55.5±16.4, while the mean postoperative (at 3 months) NOSE score was 19.0±7.7. The difference in preoperative and postoperative (at 3 months) NOSE scores was statistically significant (p=0.00). In the comparison of the preoperative and postoperative tympanometry results, no statistically significant difference was observed in middle ear pressures (p=0.375). There was no statistically significant relationship between postoperative NOSE scores and middle ear pressures (r=-0.10; p=0.943). CONCLUSION Our study results showed that the success of septoplasty operation and operation success does not affect the ventilation and pressure of the middle ear significantly.

Radicular cysts are inflammatory in character and the most frequently seen of odontogenic cysts. As they are generally seen to grow painlessly, the first finding may be facial asymmetry. Although seen in every age group, they are most often seen in males aged 20-60 years. The patient reported here presented with complaints of swelling in the right cheek. On the paranasal sinus computed tomography, a cyst appeared to be completely filling the maxillary sinus and this was totally excised with a Caldwell-Luc approach. In the differential diagnosis of cystic masses of the maxillary sinus, there may be confusion with odontogenic cysts. Imaging methods can clearly define the localisation of cystic lesions within the sinus cavity, growth direction, bone tissue loss associated with lysis and osteocondensation. To prevent recurrence, it is necessary to completely remove regenerated mucosa and the residual cyst epithelium. [Med-Science 2016; 5(4.000): 1011-12]

Background Allergic rhinitis (AR) is a disease that reduces athletic performance. Environmental allergen exposure is higher in outdoor sports (such as orienteering) than indoor sports. The main purpose of this study was to investigate the AR frequency in orienteers comparing with indoor athletes. Methods Sixty adolescent athletes (33 orienteers, 27 basketball players) enrolled this prospective study. AR diagnosis was made by both history (ISAAC questionnaire) and physical examination. Nasal endoscopy was performed to observe objective findings (concha hypertrophy, mucosal paleness, serosity, septum deviation, adenoid hypertrophy). Epidermal prick test, pulmonary function test, total IgE and serum eosinophil levels were also assessed. Results AR was diagnosed in 21 (35%) athletes. 14 (42.4%) were orienteers and 7 (25.9%) were basketball players (P=0.144). Endoscopic findings and skin test positivity were also seen at higher percentages in orienteers with no significance. Training age (sport duration), total IgE levels and skin test positivity were significantly higher in rhinitic orieenters than non-rhinitic orieenters (P=0.046, P=0.0001, and P=0.004, respectively). Conclusions Although adolescent orieenters had some higher allergic parameters than indoor athletes, they were not found more susceptible to AR. It seems that the frequency of AR increases with longer training age in orieentering sport. This study is the first report about AR in adolescent orienteers. Future researchs should more focus on comparing allergic conditions between outdoor and indoor sports.

Leiomyosarcoma (LMS) of the larynx is a very rare malignancy that originates from blood vessel, smooth muscle or from the heterotopic mesenchymal tissue in the larynx. The histological diagnosis of LMS depends on the immunohistochemical investigation. The case is here presented of an 82-year-old man with shortness of breath and hoarseness. Indirect laryngoscopy showed a pedunculated large glottic lesion causing airway obstruction. Direct laryngoscopy was performed and biopsies were taken. From the pathological examination, the diagnosis of LMS was made. This case is presented of laryngeal LMS with the clinical, radiological, and histological findings.

Necrotizing fasciitis is a rare but life-threatening soft-tissue infection primarily involving the superficial fascia and subcutaneous tissue. Only early diagnosis and aggressive therapy including broad-spectrum antibiotics and surgical intervention can avoid systemic toxicity associated with a high mortality rate. Necrotizing fasciitis is rarely seen in the head and neck region. In this article, we report a fatal case of necrotizing fasciitis in the neck of 75-years-old female patient and reviewed the microbiology, diagnosis, treatment and prognosis of this rare infection together with literature data.

The predictive value of pure-tone audiometry (PTA) in the early detection of ototoxicity has been questioned, particularly in the higher frequencies. Otoacoustic emissions testing appears to be more sensitive to cochlear insult than conventional PTA. We conducted a cross-sectional descriptive study to compare the efficacy of distortion-product otoacoustic emissions (DPOAE) testing with that of PTA as a method of audiologic monitoring. Our study group was made up of 159 patients (318 ears)-69 males (43.4%) and 90 females (56.6%), aged 5 to 61 years (mean: 23.59 ± 12.55). All patients had been diagnosed with either β-thalassemia major (BTM) or β-thalassemia intermedia (BTI), and all had received at least 1 year of treatment within the previous year with an iron chelator-either deferasirox, desferrioxamine (deferoxamine in the United States), deferiprone, or a combination of desferrioxamine and deferiprone. PTA and DPOAE evaluations were performed by the same audiologist using the same audiometer for all patients. In the right ears, the overall incidence of ototoxicity as manifested by sensorineural hearing loss was 39.0% on PTA and 22.0% on DPOAE testing; in the left ears, the corresponding figures were 27.7 and 19.5%, respectively. There were no statistically significant differences in the incidence of ototoxicity between the BTM and BTI groups with any of the four different drug regimens on PTA (p = 0.765, p = 0.378, p = 0.265, and p = 0.579, respectively) or on DPOAE testing (p = 0.890, p = 0.263, p = 0.390, and p = 0.340, respectively). Based on these data, we found no significant difference between PTA and DPOAE testing in their ability to detect ototoxicity. We conclude that periodic testing with both PTA and DPOAE is necessary for patients with suspected β-thalassemia in order arrive at a prompt diagnosis and initiate timely management.

Background:Nasal polyposis is one of the most common inflammatory pathologies of the nasal cavity. Eosinophilic inflammation plays an important role in the pathogenesis. This study aimed to investigate soluble tumour necrosis factor related apoptosis-inducing ligand levels and eosinophil count in nasal polyposis patients.Methods:The study was performed on 24 adult nasal polyposis patients and 24 age-matched healthy individuals. The patients had not received any medical or surgical treatment. Pre-operative computed tomography scans were assessed using the Lund–MacKay grading system, and soluble tumour necrosis factor related apoptosis-inducing ligand levels were measured with a sandwich enzyme-linked immunosorbent assay.Results:Compared with controls, eosinophil levels in nasal polyposis patients were increased (p = 0.024), but there was no significant difference in soluble tumour necrosis factor related apoptosis-inducing ligand levels (p = 0.529). The Lund–Mackay mean grading was 12.43 ± 6.9. There was no correlation between soluble tumour necrosis factor related apoptosis-inducing ligand level and Lund–Mackay grading and eosinophil count.Conclusion:There was no relationship between soluble tumour necrosis factor related apoptosis-inducing ligand level and blood eosinophil or clinical markers; however, soluble tumour necrosis factor related apoptosis-inducing ligand level remains of interest for future studies.

Uncertain etiology of cervical osteophytes, in particular emerging in geriatric population, is a rare skeletal system disease. Often, the cases are asymptomatic and may lead to symptoms such as dysphagia, cough, dyspnea, and dysphonia. We present a patient who had anterior osteophytes causing symptoms of severe obstructive sleep apnea (OSA), and literature on etiology of OSA has been reviewed. A 57-year-old male patient with complaints of snoring and cessation of breathing during sleep was referred to the ear nose throat clinic. Cervical radiograph and computed tomography showed the osteophytes in the anterior of the vertebral corpus at the level C1-2. In addition, bridging osteophyte was observed between C6 and C7 vertebrae. The patient's neck circumference was 41 cm, body mass index was 29 kg/m2, Epworth Sleepiness Scale score was 11, and apnea hypopnea index was 62. Surgery was recommended, but the patient refused. Continuous positive airway pressure titration was applied with 12.6 cm H2O pressure; apnea control was attained with an AHI of 2.7. One of the rare causes of OSA, a case of cervical vertebral osteophyte, was presented, and we would like to draw attention to the importance of ear nose throat examination in the diagnosis of OSA.

Background: Sialolithiasis is a common disease of the major salivary glands, but it is rarely seen in the sublingual gland. Patients commonly experience pain and/or swelling, but dysphagia is presented in extended lesions.

Objective: To determine the characteristics of Brainstem auditory evoked response (BAER) findings in children with tuberculous meningitis (TBM) at admission. Methods: Twenty-seven children with highly probable TBM were admitted to the University Hospital. The control group was 23 healthy, age and sex matched subjects. Brainstem response audiometry recording was performed in all patients and controls. Ninety dB sound pressure level (SPL) was used for comparisons. The main BAER measurements analysed were the I–III, III–V, I–V interpeak intervals. In statistical analysis, t-test for independent groups were performed. At the same time, for interpeak intervals, values exceeding 2.5 standard deviations (S.D.) above the means of the normal controls were considered abnormal. To the result of BAER findings, HL was classified as mild (until 40 dBHL), severe (until 80 dBHL) and total HL (no hearing was detected). Results: The latencies of interpeak intervals (except III–V latency at 10 per s) have significantly prolonged in comparison with controls. Mild HL was detected in four ears. In eight ears, any wave form could not be obtained at 110 dBSPL. Abnormal BAER result was seen in 13 of 54 ears (24%) at the click of 10 per s and five ears (12%) at the click of 50 per s. Conclusion: Abnormal BAER result was seen in 24% of patients with TBM before treatment. Depending on these findings, it can be inferred that hearing impairments must be lower than those values which was detected by BAER during the acute phase of TBM, since the abnormal BAER may be reversible following the illness, returning to normal with recovery.

Angiomyolipoma is a rare benign mesenchymal tumor, which is mostly renal in origin. A sixty-year-old male patient with the diagnosis of angiomyolipoma located in the larynx has been presented here, and the literature is reviewed.

Objective The aim of this study was to compare serum copeptin levels in patients with obstructive sleep apnea syndrome (OSA) and simple snorers without sleep apnea; and to investigate relationships between copeptin levels and polysomnographic parameters. Methods Serum copeptin levels were determined using enzyme-linked immunosorbent assay in 47 patients with OSA and 12 patients without OSA (control group). Full-night polysomnography was performed in each patient. Patients with OSA were divided into three groups according to their Apnea Hypopnea Index (AHI) scores: mild OSA (5 30). Results A total of 59 patients were included in the study. There were 23 female (39.0 %) and 36 male (61.0 %) subjects. The range of ages of study subjects was between 27 and 63 (mean 44.75 ± 9.64) years. According to the AHI values, patients were classified into four groups: simple snoring (n = 13), mild OSA (n = 10), moderate OSA (n = 15), and severe OSA (n = 21). Statistically significant differences between AHI groups in terms of age, Epworth score, and neck circumference. According to multiple comparison results for age, the difference between simple snoring and moderate OSA was statistically significant. According to multiple comparison results for Epworth score, the difference between simple snoring and severe OSA was statistically significant. According to multiple comparison results for neck circumference, a similar result was found like Epworth Sleepiness Scale score. The difference between AHI groups by gender was tested by a Pearson χ 2 test and was found to be statistically significant. There was no statistically significant difference among AHI groups in terms of copeptin. There was a statistically significant correlation of copeptin with AHI during rapid eye movement (REM) sleep; however, the correlation coefficient was not sufficiently large. Conclusions Increased serum copeptin concentration may reflect a response to stress in some diseases. This is well documented especially in cardiovascular diseases; however, we could not find any difference in OSA groups in terms of copeptin levels.

The aim of this study was to investigate the incidence, mortality and morbidity of complications due to chronic otitis media (COM). During the nine-year period 1990–1999, 2890 cases of COM were reviewed, 93 (3.22 per cent) having 57 (1.97 per cent) intracranial complications (IC) and 39 (1.35 per cent) extracranial complications (EC). In three patients more than one complication was observed. Meningitis and brain abscess were common in the IC group. Subperiosteal abscess (mastoid and Bezold’s abscess) was a common complication in the EC group. Cholesteatoma and granulation/polyp in the middle ear/mastoid were the major findings in both groups. Fifteen patients died from IC. Overall, the mortality rate was 16.1 per cent in all patients having complications, and in patients with IC it was 26.3 per cent. In all of the patients with complications, the morbidity rate was 11.8 per cent. Our study supports the finding that meningitis and brain abscess are the common complications of COM and the main reason for mortality.

Benign paroxysmal positional vertigo (BPPV) is characterized by mechanical dysfunction of the vestibular system in the inner ear. Displacement of otoconia from utricle to semicircular canals is held responsible for the development of BPPV. Etiologic factors are mostly classified as idiopathic. Head trauma, viral labyrinthitis and otologic surgery are also included [1, 2]. A 58 year old, female patient was admitted to Ear Nose Throat Clinic with sudden onset of vertigo and nausea. In her detailed history, she had had a long-term swimming activity just before the onset of symptoms. She reported that her house is on the seaside in Antalya, and she swims as a recreational activity for 3-5 days/week every summer. She had been using the freestyle swimming technique (front crawl) and rotating her head to the left for breathing. Different from previous swimming sessions, she had swam faster at the last session. She did not have a history of head injury, upper respiratory tract infection or drug usage that affect the vestibular system in the last 2-3 weeks. Otoscopic examination was normal. Head shake, head thrust and Romberg tests were positive. Dix-Hallpike test was positive on the right side. During the test, horizonto-rotatuar nystagmus with latency period was observed. Other neurological examination findings were normal. Pure tone audiometry and tympanometry tests showed normal values. There was no limited range of motion of the neck. The patient was diagnosed as BPPV. There was no need for imaging of central nervous system because the Dix-Hallpike test was positive (peripheral vertigo) and neurological examination was greatly normal. Right Epley maneuver was performed for therapeutic approach (1 session). The patient's symptoms dramatically declined after the particle repositioning maneuver. In addition, the patient was referred to Sports Medicine Clinic for recommendations about the swimming sport. In order to prevent the possible recurrence, it was recommended to mainly use the backstroke style in which the head is in a more fixed position. It was also told to her that she should avoid rapid head movements during stroke, and should breathe on both sides while swimming in freestyle. Additionally, “ear band” was advised to use. After two weeks, she was able to return to swimming. After 12 months, the patient was called by phone. There was no symptomatic recurrence in 1 year. She could continue swimming activity without any problem in the subsequent summer. There are various studies in the literature showing the relationship between water sports and inner ear disorders. However, the majority of these studies are focused on diving related (inner ear decompression sickness) and water skiing related (traumatic audiovestibular injury) problems [3–6]. There is limited information in the literature about vestibulopathies due to surface swimming. Among the surface swimming styles (freestyle, breaststroke, backstroke, butterfly etc.); the freestyle swimming requires the fast rotational movements of the head. Aksoy and Sennaroglu [7] showed that the freestyle swimming takes a place in the etiology of BPPV. They also reported that there is no correlation between BPPV with duration and frequency of swimming. However, in our case, the patient had increased the speed of swimming at the last swimming session. Her head movements had accelerated toward the left for breathing. For this reason, swimming speed may play a greater role in development of BPPV than swimming duration and frequency. In another study, Giacomini et al. described two cases of BPPV due to intense swimming activity [2]. Conditions different from BPPV can cause vertigo in swimmers. It has been reported that asymmetric thermal inputs following water exposure may cause vertigo in swimmers who had undergone mastoidectomy [8]. A swimmer was reported as a case of vertigo that had been induced by compression of the vertebral artery [9]. This vertigo was a part of the complex clinical picture due to cerebellar stroke. Therefore, treatment had become intensive. Heidenreich et al [10] described the abnormal afferent activity in the neck due to recurrent head movements while swimming as “cervicogenic dizziness“. Their patient had neck pain which was effectively treated with physiotherapy. We concluded that a detailed history will help to reduce the cases which are classified as idiopathic BPPV. Freestyle swimming should be noted in the etiology of BPPV because it contains repetitive rotational movements of the head. Increased swimming speed seems to trigger the development of BPPV in our case. However, extensive studies are needed to reveal the effects of speed, duration and frequency of swimming on the vestibular system. After diagnosis of BPPV, the Epley maneuver should be preferred in treatment because it is simple, safe, non-invasive and has a high success rate.

Background The aim of this study was to investigate whether in children with middle ear effusions (MEE), adenoid and tonsil tissues are associated with human bocavirus (HBoV). Materials and methods A total of 124 patients (56 females (45.2%) and 68 males (54.8%)) with chronic adenotonsillitis and serous otitis media under the age of 15 were recruited. Two hundered four samples (113 adenoid (55.4%), 68 tonsil (33.3%), and 23 middle ear effusion (11.3%)) were analyzed for the presence of HBoV using polymerase chain reaction (PCR). Results HBoV was detected in only 6 (4.8%) adenoid tissue samples each belonging to a different patient. Conclusions Our findings are consistent with the results of other studies, reporting approximately 5 - 10% of the samples being positive for HBoV. To understand the detailed role of HBoV in the etiology of RTI in children, further studies would be needed.

Pleomorphic adenoma is the most common benign tumor of the salivary glands. A 62-year-old female patient presented with epiphora and was suffering from breathing difficulties. With the diagnostic nasal endoscopy, a mass, originating from right inferior nasal turbinate and filling the entire nasal cavity, was seen. Originating from the inferior nasal turbinate is a very rare entity. Paranasal sinus computed tomography and magnetic resonance images revealed a mass that fills and expands the right nasal cavity. Mass was hypoechoic in B-mode ultrasonography and hypovascular in color Doppler ultrasonography, and rate of tissue stiffness was high in sonoelastography. These were helpful for the diagnosis.

This is the first report demonstrating high levels of substance P (SP) that inversely correlate with vasoactive intestinal peptide (VIP) levels in middle ear effusions (MEEs) of patients with otitis media with effusion (OME). Increased SP and decreased VIP levels might play a role in the pathogenesis of chronic OME.The etiology of OME is multifactorial, and neurogenic inflammation may play a significant role. SP and VIP levels were not evaluated previously in MEEs of children with OME.Fifty patients aged 2-12 years (mean age 5.24 ± 2.64) were included in the study. MEEs were classified as mucoid or serous based on the gross appearance. SP and VIP levels were determined using ELISA.High levels of SP were detected in MEEs. In addition SP levels were significantly higher in serous samples (2910.55 ± 307.96 vs 2218.55 ± 262.30 pg/ml). There were also age-dependent changes, such that SP levels were significantly higher in children aged 2-3 years compared with those who were 4-5 and 6-12 years old. VIP levels were undetectable in 30% of patients and the mean level of VIP was 50.91 ± 16.01 pg/ml in serous middle ear effusions and 54.86 ± 15.91 pg/ml in mucoid MEEs.

The nasal hamartoma is a rare non-neoplastic malformation or inborn error of tissue development, characterized by a mix of several tissue types. Folliculosebaceous cystic hamartoma is a distinct type of cutaneous hamartoma. We present a 3-month-old male infant who had nasal obstruction and who had a diagnosis of nasal folliculosebaceous cystic hamartoma after surgery.

Background Allergic inflammation commonly affects the upper and lower airways concurrently. Although allergic nasal and pulmonary effects have been well described, laryngeal effects are not well understood. In this study we investigated the incidence of allergy in patients with benign lesions of the vocal cords and types of allergens causing these reactions. Methods The study was approved by the local ethics committee, and written consent was obtained from all patients. A questionnaire made by the investigators taking the latest literature data into consideration were used during the study. Laryngeal examination was done with videolaryngostroboscopy and the lesions of each patients was recorded. Serum IgE levels and eosinophil levels were evaluated in all patients. All assays were carried out in duplicate. Skin prick tests on the forearm were performed in all patients using standardized latex extract containing high ammonia natural rubber latex, and a full set of 35 common. In addition, venom SPT was performed on one patient based on the subject's clinical history. Positive tests were counted as wheals of 3 mm in diameter after 20 minutes. Commercial extracts used were manufactured by Alyostal ST-IR. None of intradermal tests were performed. Results The group of 30 patients included 10 male and 20 female subjects with vocal cord pathology, having a mean age of 39.87 years. Sixteen (53.3%) patients had vocal polyp, 10 (33.3%) had nodule, 4 (13.3%) had Reinke edema. The mean IgE levels was 133.73 IU/mL, and mean eosinophil levels was 10,728.3. Dermal prick tests were found to be positive in 66.7% of the patients): The most common allergen was mite (53.3%) and grass pollen (52.3%). Conclusions In conclusion skin Prick tests were found to be highy positive in patients with bening lesions of vocal cords compared to normal population. Thus we can speculate that allergy may play a role in pathopysiology of these lesions. Further research is needed to identify the underlying pathways mediating the laryngeal response to allergy so that improved diagnostic and therapeutic techniques can be developed.

Hydatid disease is an important medical problem in countries of the temperate zones. A 21-year-old female patient was admitted to our outpatient clinics with a complaint of a progressive swelling in the left preauricular region. The case of the patient with hydatid disease that developed in the left preauricular region is presented in detail. Hydatid cyst in this location is rare.

Castleman's disease (giant lymph node hyperplasia) is an uncommon cause of neck mass. Its cause and pathogenesis are still unknown. Giant lymph node hyperplasia (GLH) usually presents as an asymptomatic solitary mass and can occur anywhere in the head and neck. Diagnostic test results are always inconclusive. Excision and histopathological evaluation are the only ways to make a definitive diagnosis. The disease is curable by surgical excision. A case of GLH presenting as a solitary neck mass in a 68-year-old man is reported. There has been no recurrence during about 7 months.

Congenital cholesteatoma may arise in the petrous apex, mastoid, middle ear, or external auditory canal. The least common site being the mastoid process. We present one case of primary mastoid cholesteatoma confirmed by clinical examination, surgical findings and radiological evaluation.

In this study we investigated the histopathological changes of nasal mucosa after the use of topical benzalkonium-chloride solution. In the study, 28 male New Zealand white rabbits were used. The animals were divided into two groups. In the first group, 50 micro l of 0.001% benzalkonium-chloride solution was sprayed into the right nostril and 50 micro l of 0.9% saline into the left twice daily for 14 days. In the second group, the same solutions were applied twice daily for 28 days. All of the biopsies from each nasal cavity were processed for electron microscopy. In the nostrils treated with 0.001% benzalkonium chloride, there were areas with obvious squamous cell metaplasia. Some cells showed broken cristae of the mitochondria. Degenerative changes in the supportive and olfactory cells, deformation of nuclei and the increase of heterochromatin were observed. The present investigation has shown that the application of topical benzalkonium chloride does induce degenerative morphologic changes in the nasal mucosa in rabbits in vivo.

Nasal septal perforation may present with various symptoms. Perforations may be surgically closed or managed by obturation, inserting a prosthesis. We used a silicon septal button in the management of nasal septal perforation. In the follow-up period, although the insertion of the nasal septal button alleviated epistaxis, whistling during inspiration, and nasal obstruction, it could not control the production of crusting around the margin of the button.

The purpose of this study was to evaluate the normal width of the anterior commissure of the glottis by measuring its dimensions in patients who had no laryngeal disease on magnetic resonance imaging (MRI), but had unrelated cervical pathology. In all, 27 patients were studied. Axial images through the arytenoid commissure at the level of the vocalis muscle and/or vocal process of the arytenoid cartilage were magnified on MRI. The anteroposterior width of the anterior commissure was measured by using an electronic ruler having 1-mm marks. The average width of the anterior commissure was 1.59 +/- 0.6 mm, varying from a minimum width of 1 mm to a maximum width of 3 mm. The width was less than or equal to 2 mm in 25 patients (92.5%). Our results showed that all of the patients studied had measurable mucosal thicknesses at the level of anterior commissureor = 1.0 mm.

Introduction Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm, which is traditionally seen as a pleural mass, but can also occur in other locations. Although SFTs are very rare in the head and neck region, they have been reported in the orbit, nasal cavity, paranasal sinus, nasopharynx, parapharyngeal space, thyroid gland, and larynx. Laryngeal involvement has been previously reported in only 11 cases. Case report The case is here presented of a 57-year-old male with complaints of progressive hoarseness and difficulty in breathing which had been ongoing for 1 year. By direct laryngoscopy the mass which was oriented from the right vocal cord was totally excised. Discussion The clinical, radiological and histopathological findings are reported here, with a review of literature, to comprise the twelfth case of laryngeal solitary fibrous tumor.

Objectives: This study aims to investigate whether vestibular evoked myogenic potentials VEMPs and distortion product otoacoustic emissions DPOAEs have prognostic values in the follow-up of patients diagnosed with idiopathic sudden sensorineural hearing loss ISSNHL with audiological tests. Patients and Methods: Between June 2013 and January 2014, a total of 27 patients 11 males, 16 females; mean age: 44.9±13.8 years; range, 18 to 60 years diagnosed with ISSNHL at their first admissions and underwent VEMP and DPOAE tests were included. As the treatment protocol, steroid treatment combined with hyperbaric oxygen therapy was initiated in all patients. At the second month of the treatment, all patients underwent VEMP and DPOAE tests once again. Hearing recovery was evaluated based on the hearing improvement, compared to the unaffected contralateral ear. Results: The median recovery rate was statistically significantly higher in the patients with normal pre-treatment VEMP test results than those with abnormal VEMP test results p=0.023 . The median recovery rate was statistically significantly higher in the patients with normal post-treatment VEMP test results compared to those with abnormal post-treatment VEMP test results p=0.031 . The median recovery rate was also statistically significantly higher in the post-treatment DPOAE test positivity than the post-treatment DPOAE test negativity p

Objectives: The aim of this study was to evaluate serum copeptin levels in patients with obstructive sleep apnea OSA before and after the positive airway pressure PAP treatment. Patients and Methods: A total of 16 patients 14 males, 2 females; median age 48 years; range, 38 to 60 years with severe sleep apnea based on the Apnea Hypopnea Index AHI >30 and 20 healthy controls 10 males, 10 females; median age 35.5 years; range, 22 to 47 years were included in this study between October 2014 and December 2015. Full-night polysomnography was applied to each patient. Serum copeptin levels were determined using the enzyme-linked immunosorbent assay in both groups. Serum copeptin level measurement was repeated in the patient group after one year of PAP treatment. Results: After one year of PAP treatment, serum copeptin levels of the patients with OSA decreased, although there was no statistically significant difference before and after treatment. Conclusion: Increased serum copeptin concentration may reflect a response to moderate stress in many diseases, particularly cardiovascular diseases. Based on our study results, there was no significant difference between the severe OSA group and healthy volunteers and before and after treatment among the patients with severe OSA.