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The aim of this study was to translated, validate, and culturally adapt the original English version of the Expectations of Aesthetic Rhinoplasty Scale (EARS) into Turkish for use in Turkish-speaking communities. Fifty-one patients who wanted to undergo primary rhinoplasty and were literate in Turkish were included in the study. The control group consisted of 81 healthy volunteers who did not require rhinoplasty. A Turkish version of the EARS (EARS-T) was created. The participants completed the EARS-T questionnaire twice, four weeks apart. The internal consistency of the scale (Cronbach's α), the test-retest reliability (intraclass correlation coefficient [ICC]), and differences between the patient and control groups (Pearson's chi-square test) were analyzed. A statistically significant difference was found between the age and gender of the patient and control groups (p = 0.001 and p = 0.001, respectively). Univariate analysis showed that this significant difference did not affect the study results (age: p = 0.2; gender: p = 0.12). In addition, a statistically significant difference was found between the scale scores of the control and rhinoplasty groups (all p < 0.05). The EARS-T had good internal consistency, with high Cronbach's α scores ranging between 0.74 and 0.87. Test-retest reliability was demonstrated by high ICC scores ranging from 0.71 to 0.87. Our study revealed that the EARS-T has good internal consistency, reliability, and validity. Therefore, it can be used to assess the expectations of aesthetic rhinoplasty patients in preoperative consultation practice and in clinical studies related to rhinoplasty., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Purpose: There is still no widely-accepted local agent proven to be effective in nerve regeneration. We aimed to investigate the effects of chitosan gel and platelet-rich plasma MATERIALS AND METHODS: Electrophysiological measurements were performed before and immediately after injury. The injured nerves were covered with spongostan impregnated with the following agents: Group 1 (Control Group): Saline at a dose of 50 µl; Group 2: Chitosan (CHT) at a dose of 50 µl; Group 3: PRP at a dose of 50 ml; and Group 4: a solution of CHT with PRP (1:1). The final measurements were performed after 3 weeks and the injured nerve of each rat was removed., Results: There were statistically-significant differences between the groups regarding the measurements of the after-treatment values of stimulus threshold (p < 0.05). The best improvement in electrophysiological measurement and histopathological evaluation was found in Group 4 (CHT-PRP)., Conclusion: Chitosan gel has a positive effect on nerve healing and applying it along with PRP can enhance the effect of chitosan., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: This study aimed to investigate the differences in olfactory cleft (OC) morphology in coronavirus disease 2019 (COVID-19) anosmia compared to control subjects and postviral anosmia related to infection other than severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)., Study Design: Prospective., Setting: This study comprises 91 cases, including 24 cases with anosmia due to SARS-CoV-2, 38 patients with olfactory dysfunction (OD) due to viral infection other than SARS-CoV-2, and a control group of 29 normosmic cases., Methods: All cases had paranasal sinus computed tomography (CT), and cases with OD had magnetic resonance imaging (MRI) dedicated to the olfactory nerve. The OC width and volumes were measured on CT, and T2-weighted signal intensity (SI), olfactory bulb volumes, and olfactory sulcus depths were assessed on MRI., Results: This study showed 3 major findings: the right and left OC widths were significantly wider in anosmic patients due to SARS-CoV-2 (group 1) or OD due to non-SARS-CoV-2 viral infection (group 2) when compared to healthy controls. OC volumes were significantly higher in group 1 or 2 than in healthy controls, and T2 SI of OC area was higher in groups 1 and 2 than in healthy controls. There was no significant difference in olfactory bulb volumes and olfactory sulcus depths on MRI among groups 1 and 2., Conclusion: In this study, patients with COVID-19 anosmia had higher OC widths and volumes compared to control subjects. In addition, there was higher T2 SI of the olfactory bulb in COVID-19 anosmia compared to control subjects, suggesting underlying inflammatory changes. There was a significant negative correlation between these morphological findings and threshold discrimination identification scores., Level of Evidence: Level 4.

Objectives/hypothesis: Upper respiratory tract infections are a common cause of temporary and permanent olfactory dysfunction in the general population. Postviral or postinfectious olfactory loss (PIOL) develops only in rare cases. The aim of this study was to investigate the anatomical features of olfactory cleft (OC) in patients with PIOL to shed light on possible predisposing factors for PIOL., Study Design: Retrospective study., Methods: We retrospectively evaluated paranasal sinus computed tomography (CT) scan results of patients diagnosed with PIOL. A control group consisted of normosmic individuals who underwent paranasal sinus CT scans before septoplasty surgery. We compared the olfactory fossa depth, OC width, and volume on the CT scans of the PIOL and control groups., Results: In total, 71 individuals fulfilled the study criteria (PIOL group, n = 32; control group, n = 39). There was no statistically significant difference in the olfactory fossa depth in the two groups. The OC width and volume in the PIOL group was found to be significantly increased than that in the control group (P < .001 for both)., Conclusions: Patients with PIOL had increased OC width and volume than the healthy controls. An extra-wide olfactory cleft may be a predisposing factor in the pathogenesis of PIOL., Level of Evidence: 4 Laryngoscope, 131:5-9, 2021., (© 2020 The American Laryngological, Rhinological and Otological Society, Inc.)

Our aim was to investigate the relationship between facial canal dehiscence (FCD) and surgical findings and procedures in patients with cholesteatoma. A total of 186 patients (118 males, 39.2 ± 15 years) who underwent surgery for advanced cholesteatoma between 2013 and 2018 were included in the study. The relationship between FCD and surgical findings was investigated via the surgical registries. The prevalence of FCD was 36.6% (68/186). The prevalence of FCD was 44%, and 13.2% for the patients who underwent canal wall down mastoidectomy (62/141) and canal wall up mastoidectomy (6/45), respectively ( P < .001). Facial canal dehiscence was detected in 73.9% of the 23 patients who had a lateral semicircular canal (LSCC) defect ( P < .001), in 61.9% of 21 patients who had a tegmen tympani defect, and in 58.1% of the 31 patients who had erosion on the posterior wall of the external auditory canal (EAC; P < .05). The prevalence of FCD was 3.1% in patients with isolated incus erosion, 59.1% in patients with erosion of malleus and incus, 60.7% in patients with erosion of stapes suprastructure and incus, and 43.2% in patients with whole ossicular chain deformation ( P < .001). The defects on LSCC, EAC, tegmen tympani, and malleus and incus might be cautionary findings for the presence of FCD during cholesteatoma surgery.

Purpose: The aim of this study was to compare olfactory functions pre- and post-CPAP treatment in patients with moderate to severe OSA, and to evaluate the factors that cause changes in olfactory functions., Methods: Twenty-two patients who had completed regular usage of CPAP treatment for 2 months were included in this prospective study. Olfactory tests using Sniffin' Sticks were performed pre- and post-treatment., Results: The mean age of the subjects was 47.6 ± 9.5 years. We did not find a significant change in olfactory functions after 2 months of CPAP treatment in our study group. When the patients were divided into two groups-those whose olfactory functions showed improvement and those whose functions did not-it was found that the mean age of the patients whose olfactory functions did not improve was significantly higher statistically. A significant adverse correlation was found between age and post-treatment olfactory functions, specifically in odour threshold and odour identification scores., Conclusions: Increased age adversely affects the therapeutic effect of CPAP treatment for olfactory functions.

Objectives: The aim of this study was to investigate changes in olfactory function after smoking cessation., Methods: We conducted a cross-sectional study involving 28 volunteers who were admitted to the smoking cessation section of our hospital. Olfactory tests were performed immediately before smoking cessation and 45 days after smoking cessation. The duration of smoking and the number of cigarettes smoked per day were noted., Results: The mean duration of smoking was 25.5 ± 12 years, and the participants smoked 21.6 ± 6.6 cigarettes per day. There was a significant improvement in odor discrimination, odor identification, and TDI scores (i.e., the total score of odor threshold, odor discrimination, and odor identification tests) 45 days after smoking cessation (P = .003, P = .002, and P < .001, respectively). Furthermore, a statistically significant negative correlation was found between the duration of cigarette smoking and the Sniffin' Sticks olfactory tests performed after smoking cessation, namely odor discrimination, odor identification, and TDI (P = .008, P = .002, P = .001, respectively)., Conclusion: A significant improvement was observed in odor discrimination, odor identification, and TDI scores after smoking cessation. However, this improvement was inversely associated with the duration of smoking, indicating that a longer duration of smoking may result in an insufficient improvement after smoking cessation., Level of Evidence: 4 Laryngoscope, 130:E35-E38, 2020., (© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)

Smoking is known to increase laryngeal inflammation and laryngopharyngeal reflux (LPR), which cause laryngeal irritation. Thus, the aim of this study is to evaluate the changes in the symptoms and the findings of laryngeal irritation in smokers after a smoking cessation period. The reflux symptom index (RSI) and the reflux finding score (RFS) were used for evaluating the symptoms and findings of laryngeal irritation in smokers. Endoscopic examination of the laryngeal structures for RFS and symptom inquiry for RSI were performed at the beginning of the study and after a 2 months of cigarette cessation period. This study was carried out in 24 volunteers (14 female and 10 male), between the ages of 24 and 62 years. When we compared the results of RSI and RFS that were performed before and after the cigarette cession period, we found that there was a significant improvement both in RSI and in RFS ( P < .001 and P < .001, respectively). Also, there was significant correlation between the cigarette smoking period and RFS score that was determined at the beginning of the study ( P = .006, r = .54). A significant improvement was found both in RSI and in RFS after smoking cessation period, which might be the evidence of improvement in laryngeal irritation possibly caused by inflammation due to smoking and LPR. A significant positive correlation was found between smoking period and RFS, especially with vocal fold edema and posterior commissure hypertrophy.

Objective: To compare the graft success and hearing results in patients who underwent cartilage island graft (CIG) myringoplasty and temporal muscle fascia graft (TFG) myringoplasty., Study Design: Retrospective clinical study., Place and Duration of Study: Ankara Numune Training and Research Hospital, Otolaryngology Clinic, Ankara, from January 2013 to January 2018., Methodology: Patients who underwent cartilage island graft myringoplasty and temporal muscle graft myringoplasty for chronic non-suppurative otitis media were inducted. Age, gender, preoperative audiologic examination results, postoperative audiologic examination, perforation site, graft material, preoperative microscopic examination and graft success were documented., Results: A total of 116 patients were included in the study. The mean age of the patients was 35 ±15.3 years. Fifty-four patients were females and 62 were males. Temporal muscle fascia graft was applied to 68 (58.6%) patients, while cartilage graft was applied to 48 (41.4%) patients. The success rate of graft was found to be 80.2% (55 cases with graft success) in TFG; whereas, this rate was found to be 93.8% (45 cases with graft success) in CIG group. Cartilage island graft material had a better graft success in terms of graft endurance (p = 0.048). There was no statistically significant difference between the two graft materials in terms of postoperative hearing success (p = 0.29)., Conclusion: Cartilage island grafts can be preferable for myringoplasty operations.

Objective: The aim of this study was to investigate the effect of the medical and the surgical treatment on the olfactory functions, clinical scoring systems and inflammation markers in patients with nasal polyposis. In addition, the secondary aim was to investigate the correlation between those investigated parameters., Subjects and Methods: A total of 30 patients, who completed the standardized medical and surgical treatment and also came to 3 months of follow-ups regularly after the surgery, were included in the study. The Sniffin' Sticks olfactory tests, radiological and the endoscopic stagings, liver-expressed chemokine (CCL16) and endothelin (ET) levels and sino-nasal outcome test-22 (SNOT-22) were performed at the initial and at the end of the study., Results: The current study had four major findings: (1) significant improvement in odor functions after treatment was determined; however, the majority of the patients had been already hyposmic. (2) In addition, significant improvement was found in ET and CCL16 levels, SNOT-22 results, and radiologic and endoscopic stagings at the end of the study. (3) However, there was no correlation between the olfactory functions and the investigated parameters. (4) There was a positive correlation between polyp recurrence and ET levels., Conclusion: The standardized medical and surgical treatment provided a significant improvement in the olfactory functions. However, only one patient (3.3%) had become normosmic at the end of the study.

Objective: The authors aimed to determine the changes in the odor threshold and sinonasal outcome test-22 scores of the patients after septoplasty surgery in terms of nasal septum deviation classifications., Methods: Forty-nine patients with nasal septum deviation, aged between 17 and 65, were included in our study. The sinonasal outcome test-22 scores questionnaire and the N-Butanol Threshold test were administered to the patients, 2 days before and 2 months after the septoplasty., Results: The authors' study had 4 major findings: Odor threshold scores improved after septoplasty operation both for the narrower and the wider side of the nasal airway passage. The Vidigal classification for nasal septum deviation was best for predicting the changes for odor threshold scores after septoplasty operation. The nasal septum deviation in which the nasal septum was pushing the inferior turbinate to lateral nasal wall caused the most smell dysfunction according to the Vidigal classification. Unilateral vertical crest affecting the nasal valv area or the posterior part of the septum had the most negative effect on olfactory functions according to the Mladina classification., Conclusion: Septoplasty operation leads to improvement in odor threshold scores, and the Vidigal nasal septum deviation classification was best in predicting postoperative odor threshold changes.

Purpose: To determine the minimum lymph node yield (LNY) in patients with laryngeal squamous cell carcinoma (LSCCs)., Methods: This retrospective study was performed in a tertiary care hospital setting and included 42 LSCC patients aged 39-81 years (females, n = 2; males, n = 40) who underwent a total or partial laryngectomy and elective bilateral level II-IV neck dissections (unilateral neck dissections: n = 84)., Results: The average LNY in the unilateral level II-IV lymph node dissections was 25.9 ± 10, and the average metastatic LNY was 0.9 ± 1.9. The unilateral neck dissections were grouped according to the number of lymph nodes. There was no significant difference between the groups in terms of the metastatic LNY (p = 0.5). The metastatic lymph node density (LND) (metastatic lymph node yield/LNY) was 0.043 for unilateral neck level II-IV neck dissections. A Cox regression analysis revealed no significant relationship between survival and the LNY and LND in bilateral neck dissections (p = 0.4 and p = 0.8, respectively)., Conclusions: The results revealed no minimum number of lymph nodes that could reliably detect metastatic lymph nodes in LSCC patients.

Aim: The aim of this retrospective study was to investigate possible factors affecting the survival in patients who were operated due to laryngeal squamous cell carcinoma (SCC) MATERIAL AND METHOD: The study included patients who underwent surgery in our clinic due to laryngeal SCC between May 2010 and June 2018. It was learned whether the patients were alive or not by hospital records, death notification system records and patient / family interviews. Surgical reports, pathology reports, tumor clinical council notes and preoperative hematological examinations were retrospectively evaluated and recorded from the hospital registry system., Results: The mean age of the 63 patients included in the study was 59.3 (age range; 38 to 83 years). The mean postoperative follow-up period was 56.8 months (minimum 6 months to maximum 102 months). We found that surgical margin positivity had a statistically significant negative negative effect on survival (p = 0.049, r = -0.26). Perineural invasion, perivascular invasion, the presence of neck metastasis and the effect of tumor differentiation on survival were not found to be statistically significant (p values; 0.9, 0.1, 0.9 and 0.4, respectively)., Conclusion: The absence of a tumor at the surgical margin is one of the most basic rules in oncologic surgery., Key Words: Laryngeal carcinoma, Oncologic surgery, Survival, Surgical Margin.

The aim of this study was to describe a novel surgical suture technique for achieving ideal nasal tip rotation and projection with nasal supratip angle. The figure-of-eight suspension suture (FOESS) technique was used in 68 patients who underwent open technique septorhinoplasty operation between the years 2013 and 2015. Fifty-four of the patients were female and 14 were male. The mean age of the patients was 28.2. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to the FOESS technique. Satisfactory results were obtained in the postoperative period after surgery. The FOESS technique generated power against the anterior-inferior tensile strength of the alar cartilages. Thus, it can be possible to shape the nasal tip rotation and projection in the desired dimensions. In addition, this technique helps us to create supratip break point and angle.

Objective: We evaluated the halimetric, olfactory, and taste functions of patients with laryngopharyngeal reflux (LPR)., Study Design: Prospective clinical study., Setting: Multicenter tertiary care hospital., Methods: Patients who were diagnosed with LPR for the first time on the basis of a Reflux Finding Score (RFS) >11 and a Reflux Symptom Index (RSI) >13 were enrolled in this study. A control group was selected from patients without a complaint of LPR. OralChroma was used for the halimetric measurement; Sniffin' Sticks were used for the smelling test; Taste Strips were used for the taste test; and monosodium L-glutamate was used for the umami test., Results: A total of 110 subjects were included, with a mean age of 36.8 ± 10 years (range, 19-57 years). The differences in odor threshold scores were significant between the groups (P < .001), but no change was detected for the odor identification or discrimination scores between the groups. Bitter taste scores were significantly diminished in the reflux group compared with those in the control group (P = .001), whereas no impairments were found in the other taste scores (sweet, salty, and sour). The reflux group had significantly higher umami taste scores than those of the control group for the posterior tongue and soft palate anatomic sites (P < .001 and P < .001, respectively). Dimethyl sulfite levels were significantly higher in the reflux group than in the control (P = .001)., Conclusion: Questioning patients who present with halitosis, taste, or smelling disorders is important to diagnose LPR., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.)

Objective: In this study, we investigated the chemical senses (namely, olfaction), the 4 basic tastes, and umami taste in patients who underwent anterior palatoplasty (AP) for primary snoring., Study Design: Prospective clinical study., Setting: Multicenter, tertiary care hospitals., Subjects and Methods: The age range of the 28 participants was 22 to 47 years, and all had been diagnosed with primary snoring by polysomnography. Orthonasal and retronasal olfactory testing was performed using the respective "Sniffin' Sticks." Tests for the 4 basic tastes (sweet, sour, salty, and bitter) and umami were performed before and 6 months after AP., Results: The changes between the preoperative and postoperative results for the 4 basic tastes, which were applied to the anterior tongue region, were not significant. Retronasal olfactory function improved significantly 6 months after AP (P = .007). After AP, umami scores for the soft palate but not those of the anterior and posterior tongue decreased significantly (P = .001)., Conclusion: Patients scheduled for AP should be properly informed about potential postoperative taste and flavor changes. They should also be warned of a possible loss of appetite due to a postoperative decrease in the umami taste sensation of the soft palate., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.)

BACKGROUND Nasal septal perforation (NSP) may alter nasal airflow patterns and physiology. To the best of our knowledge, no studies in the English literature have investigated the effect of NSP and its treatment on polysomnographic parameters. In this study, we aimed to investigate polysomnographic parameters in patients with NSP as well as changes in those parameters after treatment of NSP. MATERIAL AND METHODS Nineteen patients diagnosed with NSP were included in the study. All patients had baseline and post-procedure polysomnographies (PSG) after insertion of silicone septal button for closure of NSP. RESULTS Both median AHI [5.30 (14.40) vs. 2.40 (14.50)] and median supine AHI [10.00 (42.10) vs. 6.60 (37.00)] decreased after correction of the perforation. There was a large reduction in median supine AHI in patients with a perforation size >66 mm2 [10.10 (34.15) vs. 1.60 (28.30)]. CONCLUSIONS We conclude that NSP did not cause any deterioration in objective sleep parameters as determined by PSG, other than a decrease in REM sleep duration and an increase in supine AHI. Correction of NSP did not affect REM duration and supine AHI decreased after treatment.

Background: Cancer and its treatment therapies, such as chemotherapy and radiotherapy, have negative effects on taste and smell functions. It is easy to explain smell and taste dysfunctions when a cancer involves the peripheric end organs or neurologic pathways of smell and taste. However, it is difficult to understand how distortion in sensory perception develops as cancer progresses and cancer therapies are applied, because few studies on this subject have described heterogeneous oncological patient populations who are receiving different treatment regimens., Methods: A literature review was performed about the chemical senses of the patients with various cancer types, and also about the possible mechanisms of taste and smell dysfunctions in cancer patients., Results: Chemotherapy and radiotherapy may cause taste and smell alterations by destroying taste and olfactory receptor cells, creating alterations on the surfaces of cells and receptors as well as interrupting neural coding. The prevalence of taste dysfunctions in cancer patients has been reported to be up to 77%. Unlike taste dysfunction, diminished sensitivity of smell in cancer patients is described infrequently and the available literature contains some conflicting results for smell dysfunction in cancer patients., Conclusion: Further studies are needed on the loss of appetite in cancer patients, and specific treatments should be identified according to the pathologic mechanism responsible for anorexia and particularly for taste and smell dysfunctions. Because sufficient nutrition and energy intake can help patients overcome the cancer and its treatment-related complications.

Objective: Myasthenia gravis (MG) is commonly viewed as a muscle disorder. Less is known about neurosensory function and dysfunction in MG. We aim to evaluate olfactory and gustatory behavior in Turkish patients with MG, and compare these results with age and sex-matched healthy controls., Material/methods: 30 individuals with MG, and 30 healthy volunteers were studied. Olfactory function was studied with the Sniffin' sticks test. Taste strip test was used for studying taste function. The t-test was used for analyzing continuous variables, and the chi-square test for categorical data. Clinical staging and medication status were included in a model analyzed using analysis of variances., Results: MG patients showed significantly lower olfactory (p<0.001) and gustatory scores (p<0.001) than the healthy controls. In addition, olfactory loss correlated with the severity of the disease. Medications for MG did not influence these results., Conclusion: This study replicates the olfactory dysfunction found elsewhere in MG. Further, gustatory dysfunction, an activity unrelated to muscle strength, was also unveiled. Medications used for treating MG must not be blamed for the chemosensory dysfunction found in this neurological disorder., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: The University of Pennsylvania Smell Identification Test (UPSIT) is a well-developed and popular olfactory test, which has been validated in various populations. However, there was only one study in a Turkish population, and this study indicated that the North American version of the UPSIT was not enough to evaluate the olfactory functions of Turkish population. So, we developed a cross-cultural adaptation of the UPSIT, the UPSIT-Turkish (UPSIT-T). Thus, the goal of this study was to investigate the applicability of the UPSIT-T in healthy Turkish subjects., Material and Methods: The study included 51 healthy individuals who reported having normal olfactory function. The participants were administered the North American version of the UPSIT firstly, and then, after a day UPSIT-T was applied to the participants. The results of two smell tests were compared, and the applicability of UPSIT-T was evaluated., Results: The mean (standard deviation) value for correctly identified odors was 27.2 ± 5.7 (range, 14-38) with the UPSIT application, whereas the mean (standard deviation) value for correctly identified odors was 35.9 ± 3.1 for UPSIT-T. There was a statistically significant increase in the scores of the participants when UPSIT-T was performed (p < 0.001). The identification rates of 10 test odorants were <80% for our study group, and 2 of 10 were <70% for the UPSIT-T., Conclusion: The UPSIT-T modification is an adequate olfactory test for clinical use in a Turkish population.

Objectives/hypothesis: Patients with olfactory dysfunction benefit from repeated exposure to odors, so-called olfactory training (OT). This does not mean occasional smelling but the structured sniffing of a defined set of odors, twice daily, for a period of 4 months or longer. In this prospective study, we investigated whether the effect of OT might increase through the use of more odors and extension of the training period., Study Design and Methods: This study shows OT results when performed with four or 12 odors for 36 weeks in patients with postinfectious olfactory dysfunction. A total of 85 subjects participated (mean age 45.6 ± 10.5 years, range 24-68 years). Three groups were formed: 1) In the modified olfactory training (MOT) group, patients used three sets of four different odors sequentially. 2) Participants in the classical odor training (COT) group used four odors. 3) Participants in the control group did not perform OT. All groups were matched for age and sex distribution of participants., Results: Both participants in the COT and MOT groups reached better scores than controls in terms of odor discrimination and odor identification. Continuing OT with four different odors after the 12th and 24th weeks produced better results in terms of odor discrimination and odor identification scores as compared to using the same four odors throughout the entire study., Conclusion: This study confirmed the effectiveness of OT. Increasing the duration of OT and changing the odors enhances the success rate of this therapy., Level of Evidence: 2b. Laryngoscope, 125:1763-1766, 2015., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives/hypothesis: Obstructive sleep apnea (OSA) and balance disorders are common chronic diseases seen in the general population. The aim of this study was to evaluate vestibular functions in individuals with OSA., Study Design: Cross-sectional clinical study., Methods: Patients who were referred to the sleep clinic in our hospital were classified into two groups according to a polysomnographic test: a moderate-to-severe OSA group and a mild OSA group. A vestibular system assessment of all patients was performed subjectively with the Dizziness Handicap Inventory (DHI) survey and objectively with videonystagmography., Results: The current investigation produced four major findings: 1) Apnea-hypopnea index was significantly correlated with age and body mass index, whereas it was not correlated with Epworth Sleepiness Scale scores. 2) There was a significant difference in study groups in terms DHI scores, particularly in the physical subgroup. Moderate-to-severe OSA patients had higher scores in the physical subgroup of DHI. 3) Nystagmus and canal paresis rates were significantly higher in the moderate-to-severe OSA group when compared to the mild OSA group. 4) Results of the Romberg test, tandem Romberg test, cerebellar examinations, and positional tests were normal in both., Conclusions: Abnormal vestibular responses are common in individuals suffering from severe OSA, and dizziness has negative effects on the quality of life in these individuals., Level of Evidence: 4, (© 2014 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: In this study, we aimed to present a novel application and use of Kirschner wire-guided suturing that is less invasive and allows permanent fixation for nasal dorsal reconstruction., Methods: A total of 23 patients, who underwent surgery between 2009 and 2013, were included in this study: 19 with saddle nose deformity and 4 patients with keystone area damage, or collapse of the dorsal nasal support during primary septoplasty or rhinoplasty. The patients were asked to fill out a nasal obstruction symptom evaluation (NOSE) scale preoperatively and at the postoperative sixth month to assess breathing quality. The patients were followed up for complications such as nasal dorsal contour irregularity, dorsal collapse, as well as graft malposition and infections. The results of the surgeries were assessed on the basis of preoperative and postoperative examinations, septal support test, NOSE scale results, and photographic comparison., Results: The mean (SD) NOSE scales were 78.91 (10.09) and 30.48 (10.71) in the preoperative and postoperative periods, respectively. The difference of mean NOSE scale was statistically significant (P < 0.001). None of the patients experienced nasal dorsal collapse or graft malposition. Two patients had nasal dorsal irregularity complaints owing to inadequate costal cartilage edge beveling. None of the patients had complications of suture reaction, suture visibility, or suture extrusion. All of the patients stated that they were happy with the cosmetic outcome., Conclusions: Permanent sutures introduced through channels made with the Kirschner wire provide a less invasive, cosmetically pleasing, and functional solution, promising more reliable results in the long term.

Purpose: Transcanalicular diode laser dacryocystorhinostomy (TCL-DCR) is used much in recent years for the surgery of nasolacrimal duct obstruction (NLDO). Although TCL-DCR is accepted to be minimally invasive, safe, and effective, there is no report focusing on postoperative changes in olfactory function after this procedure. Hence, the aim of this current study was to investigate the changes in olfactory function after TCL-DCR procedure., Materials and Methods: This study was carried out in 42 volunteers (16 men and 26 women) between the ages of 20 and 81 years. All participants received detailed lateralized olfactory tests preoperatively and at the postoperative first week, first month, third month, and sixth month. After lateralized olfactory tests were performed, the results were grouped according to the side of the nasal passage where the operation was performed for NLDO: the nonoperated side served as the control., Results: The current investigation produced 2 major findings: (1) olfactory function decreased significantly after TCL-DCR procedure at the operated side of the nose compared with the nonoperated side; (2) olfactory abilities of the patients returned to normal within 3 months., Conclusion: The results of this study showed that transcanalicular diode laser could be used safely in terms of olfactory function for dacryocystorhinostomy. Temporary decrease of olfactory function on the side having TCL-DCR should be taken into account when obtaining informed patient consent.

The aim of this study was to evaluate the effect of olfactory dysfunction on quality of life (QOL), and to investigate olfactory dysfunction related self-reported clinical features in Turkish population. The participants were questioned about the presence of any olfactory dysfunction. Participants with a complaint of olfactory dysfunction were asked to fill out a survey and then a validated olfactory test was performed. We asked 2,824 volunteers whether they had olfactory dysfunctions or not. A total of 199 (6.7 %) people mentioned that they had, and filled out the questions in our survey. The mean age of the surveyed population was 44 ± 15 years. The current investigation produced four major findings (1) the feeling of inadequacy due to olfactory dysfunction was more common among females than males (2) there was a significant correlation between subjective olfactory complaints and objective olfactory testing (3) problems in QOL issues are typically reported primarily in the areas of safety and nutrition (4) the possible reasons for the olfactory dysfunction according to the volunteers were upper respiratory infections including rhinosinusitis (46 %), allergic rhinitis (27 %), severe face and head trauma (6.5 %). The effect of subjective olfactory dysfunctions on QOL among the Turkish population was investigated for the first time. Problems in daily life issues are typically reported primarily in the areas of safety and nutrition.

Objective: To evaluate long-term results of septal bone grafting and to show sustainable viability of bone grafts with objective parameters such as computed tomography., Methods: Nasal septal bones were used as splinting grafts during septo/rhinoplasty operations in 27 patients (Male=16; Female=11) between 2009 and 2013. Of these, only the 21 patients who were monitored long-term and who had computed tomography (CT) records were included in this investigation. The average duration of monitoring for the patients reported here was 17 (12-37 months) months. Patients were excluded for the following reasons: pregnancy; morbid obesity; uncontrolled diabetes; long-term oral steroid or chemotherapeutic agent use; inflammatory, systemic or immunodeficiency disease or acute local infections at the operative site. Bone graft positions, lengths and respective resorption were evaluated and compared pre-postoperatively for each patient., Results: Bone grafts retained 90% of their lengths in 14 of the 21 (66.6%) patients. In other cases, control computed sinus tomography showed four bone grafts at 80%, two grafts with 70%, and one graft retained 60% of the original lengths. None of the grafts showed resorption less than 50%., Conclusion: Bone grafts are reliable grafts and can be used as an alternative to cartilage grafts., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Halitosis and olfactory dysfunction may disrupt an individual's quality of life remarkably. One may ask whether halitosis has effects on olfactory functions or not? Thus, the aim of this study was to evaluate the olfactory abilities of subjects with chronic halitosis evaluated using the measurements of volatile sulfur compounds. This study was carried out in 77 subjects, with a mean age of 40.1±13.3 years, ranging from 18 to 65 years. Forty-three participants were diagnosed as halitosis according to the gas chromatography results and constituted the halitosis group. Also, a control group was created from individuals without a complaint of halitosis and also who had normal values for volatile sulfur compounds. Each subject's orthonasal olfactory and retronasal olfactory functions were assessed using "Sniffin' Sticks" and retronasal olfactory testing. The results showed that odor threshold scores were lower in participants with halitosis compared with controls. Also, hyposmia was seen more common in the halitosis group than in controls. Moreover, a significant negative correlation was found between odor threshold scores and volatile sulfur compounds levels, particularly with hydrogen sulfide and dimethyl sulfide levels. The results suggest that the chronic presence of volatile sulfur compounds may have a negative effect on olfactory function., (© The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Olfactory dysfunction is a common symptom of many neurodegenerative diseases, and age-related macular degeneration (AMD) is a late-onset neurodegenerative disease., Objective: Thus, the aim of this study was to investigate olfactory functions in patients with AMD., Methods: A total of 69 subjects with AMD and 69 age- and sex-matched healthy controls were enrolled. After a complete ophthalmic evaluation, the AMD patients were subclassified as early- and late-stage AMD. Psychophysical testing of olfactory function was performed using the validated Sniffin' Sticks test., Results: This study was carried out in 138 subjects, with a mean age of 74.3 ± 8.9 years (range 51-89). The current investigation showed the following two major findings: (1) patients with AMD had decreased olfactory abilities, especially in odor discrimination and odor identification, even at early stages compared to controls, whereas patients had decreased olfactory abilities in all subtasks of olfactory testings in advanced stages of AMD disease, and (2) as the visual acuity of AMD patients decreased, the olfactory abilities of these patients worsened., Conclusion: This study demonstrated that AMD had significant negative effects on all orthonasal olfactory tasks, particularly in advanced stages. Similar to other neurodegenerative diseases, odor discrimination and identification seemed to be more affected than odor detection threshold tasks., (© 2015 S. Karger AG, Basel.)

Introduction: Dental implants have been associated with the occurrence of postoperative rhinosinusitis. In some patients, preoperative sinus lifting must be performed to increase the chances of successful implant placement. This retrospective study examines the relationship of dental implants after sinus lifting with the occurrence of postoperative rhinosinusitis., Methods: A total of 268 dental implants were inserted in 94 patients (62 Males, 32 Females) between 2011-2013. The ages ranged from 29-71 (in males) and 33-64 (in females). Additionally, bilateral sinus lifing was performed in 51 patients, and unilateral sinus lifting was performed in 43 of the patients. Patients were evaluated for sinus pathology for a period of 5-47 months postoperatively using a satisfaction questionnaire, conventional radiographic examination, and nasal endoscopic examination., Results: Four of the patients (4.2%) had a complication of postoperative sinusitis and were treated medically. In one patient, the implant was unsuccessful (even after treatment) and was removed. None of the patients needed surgery due to the sinusitis or any associated complications., Conclusion: The risk for postoperative rhinosinusitis was found to be higher in patients who suffer from chronic sinusitis and in cases in which a large amount of graft was utilized for sinus lifting. These predisposing factors need to be considered when evaluating patients for dental implants and sinus lift procedures.

Our aim was to evaluate acoustic voice analysis of patients diagnosed with nasal polyps before and after endoscopic sinus surgery. Forty-three patients diagnosed with nasal polyposis who had undergone endoscopic sinus surgery were included in this prospective study. Patients were divided into three groups according to the stage of nasal obstruction before the surgery. Acoustic voice analyses were performed on each patient before the endoscopic sinus surgery and six weeks following the surgery with the multi-dimensional voice program. Jitter, shimmer, F0 frequency, and noise to harmonic ratio (NHR) parameters were obtained for acoustic analysis. Our investigation showed that Jitter, shimmer and NHR values decreased, and F0 value increased in the postoperative period in patients that had a partial nasal obstruction before the surgery. Non-significant increases were also observed in these four parameters after the surgery in cases with total or near-total nasal obstruction. We also found that the postoperative changes in shimmer values between the Stage III patients and the patients in other stages were statistically significant (P = 0.027). Voice changes that became more marked with increasing stages of the nasal polyposis. According to our results, patients should be informed of the possible alterations in speech following major surgical interventions on the paranasal sinuses.

Revision surgery of the central neck compartment is still a controversial subject, and data are scarce in the literature regarding surgical approaches and outcomes. This might be a result of the small number of patients in need of revision of the central neck compartment. Therefore, the purpose of this study was to document the approach and outcomes for revision surgery of the central neck compartment performed in our clinic. The files of patients who had undergone revision surgery of the central neck compartment in the Clinic of Otorhinolaryngology, Ankara Numune Training and Research Hospital, between 2007 and 2013, were evaluated. The subjects included 61 patients who had previously undergone surgical intervention in the central neck compartment and had then undergone bilateral lymph node dissection covering at least levels 6 and 7 in our clinic. Patient ages ranged between 36 and 63 years (mean, 47.2 y; SD = 8.3 y). The complications seen after revision surgery were temporary recurrent laryngeal nerve palsy in 4 patients (6.6%), temporary hypocalcemia in 8 patients (13.1%), and permanent hypocalcemia in 3 patients (4.9%). No permanent recurrent laryngeal nerve damage, wound infection, or hematoma was encountered. Meticulous surgical dissection with identification of the recurrent laryngeal nerve and the implantation site of the parathyroid glands may safeguard against complications. Reoperative surgery in the central compartment of the neck allows the removal of recurrent/persistent disease and has acceptable morbidity.

The aim of the present study was to investigate whether nasal nitric oxide (nNO) levels change in relation to high altitude in a natural setting where the weather conditions were favorable. The present study included 41 healthy volunteers without a history of acute rhinosinusitis within 3 weeks and nasal polyposis. The study group consisted of 31 males (76 %) and 10 females (24 %) and the mean age of the study population was 38 ± 10 years. The volunteers encamped for 2 days in a mountain village at an altitude of 1,500 m above sea level (masl) and proceeded to highlands at an altitude of 2,200 masl throughout the day. The measurements of nNO were done randomly, either first at the mountain village or at sea level. Each participant had nNO values both at sea level and at high altitude at the end of the study. The nNO values of sea level and high altitude were compared to investigate the effect of high altitude on nNO levels. The mean of average nNO measurements at the high altitude was 74.2 ± 41 parts-per-billion (ppb) and the mean of the measurements at sea level was 93.4 ± 45 ppb. The change in nNO depending on the altitude level was statistically significant (p < 0.001). The current investigation showed that nNO levels were decreased at high altitude even if the weather conditions were favorable, such as temperature, humidity, and wind.

Tonsillar hypertrophy is common in children, but it can also be present in adults. Enlarged tonsils, a significant anatomical barrier, may affect the flow of odor molecules from the oral cavity to the nasal passages, which has not yet been studied. Thus, we aimed to investigate the mass effect of palatine tonsillar hypertrophy on retronasal olfaction. This study was carried out in 146 subjects, with a mean age of 22.1 ± 2.2 years, ranging 20-29 years. An oropharyngeal examination of the participants was completed, and tonsillar hypertrophy was graded according to the subjective tonsil size scale. The participants were divided into four groups according to their tonsil size grading; then, each subject's orthonasal olfactory and retronasal olfactory functions were assessed using "Sniffin' Sticks" and retronasal olfactory testing. There were no differences observed between the groups in terms of age, gender, cigarette smoking, or alcohol consumption. In addition, there was no difference between the groups in terms of "Sniffin' Sticks" subtests and TDI scores. It was determined that the retronasal olfactory scores of the participants with grade 4 tonsil size were significantly lower than the retronasal olfactory scores of the participants with grade 1 tonsil size. The current investigation demonstrates that grade 4 tonsillar hypertrophy has significant negative effects on the retronasal route of olfactory sensing, when compared with grade 1 tonsillar hypertrophy.

Purpose: The purpose of this study was to investigate the relationship between the volume of the olfactory bulb (OB), the depth of the olfactory sulcus (OS), the depth of the fossa olfactoria (FO), and the height of the OB., Methods: A total of 54 patients participated (9 women and 45 men; mean [SD] age, 27 [38] y; range, 20-45 y). Magnetic resonance imaging was performed with a 1.5-T system (slice thickness, 1 mm). Measurements of the right and left OB volumes were performed through manual segmentation of the coronal slices. We measured the depth of the FO on the basis of Keros classification on coronal magnetic resonance images. The depth of the OS was measured on the coronal plane at the posterior tangent through the orbital globes. The height of the OB was measured on the coronal plane of the cribriform plate at the highest portion of the OB., Results: The mean (SD) right OB volume was measured to be 52.21 (13.73) mm3 with a range between 33.90 and 95.70 mm3. The mean (SD) left OB volume was measured to be 53.98 (13.31) mm3 with a range between 31.20 and 94.10 mm3. Type 1, type 2, and type 3 Keros ratios of the FO bilaterally were 12.9% (7/54), 68.5% (37/54), and 3.7% (2/54), respectively. There was no significant relationship between the OB volume and ipsilateral Keros type of FO (right side: P = 0.208; left side: P = 0.164). Similarly, there was no significant relationship between the OB volume and depth of OS on both sides (right side: P = 0.073; left side: P = 0.065). There was no significant association between the Keros type of the right FO and depth of the OS (right side: P = 0.812; left side P = 0.863)., Conclusions: We conclude that there is no statistical correlation between the OB volume and depth of the FO (Keros type). From the current study, it may be concluded that the depth of the FO may develop largely independent from OB volumes. The individuals without smell disorder have a wide range in OB volume. The method of OB volume measurement that we described is a valid measure of real OB volumes with high reproducibility.

Objective: The aim of this study was to investigate the changes of both ortho- and retronasal olfactory function in children who underwent adenotonsillectomy (AT) operation due to infectious and/or obstructive adenotonsillar disease., Material and Methods: A total of 25 children with adenotonsillar disease are included in the study; the children were followed for 6 months in the conducted clinics and underwent AT operation. An age- and sex-matched control group was constituted with 25 healthy children free of adenotonsillar disease. Adenoid and tonsillar hypertrophy was graded according to the subjective size scales. Each subject's orthonasal and retronasal olfactory functions were assessed using odor identification test and retronasal olfactory testing. These tests were performed once, at the beginning of the study, for the control group and performed twice, at the beginning of the study and the third month follow-up, for the disease group. Parents of children in the adenotonsillar disease group filled out a visual analog scale to evaluate the children's appetite at the same time with olfactory testing., Results: The current investigation produced four major findings: (1) both ortho- and retronasal olfactory abilities of participants were improving following AT operation, (2) adenoid hypertrophy had a significant negative effect on both ortho- and retronasal olfaction, whereas tonsil hypertrophy had significant negative effect only on the retronasal olfactory score, (3) retronasal olfaction was found to be more affected by the adenoid size than the orthonasal, as shown with correlation analysis, and (4) the increase in appetite of children after AT operation had been specified by parents., Conclusions: Children with adenotonsillar disease have increased olfaction abilities, namely ortho- and retronasal olfactory function following AT operation. In addition, retronasal olfactory function, an important component of flavor, seems to be more affected than orthonasal function. These results also explain the increased appetite of operated children., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: The aim of this study was to investigate the effect of increased atmospheric pressure (AP) on olfactory function., Subjects and Methods: The present study included 40 healthy volunteers with no history of chronic rhinosinusitis and nasal polyposis. The experimental procedure consisted of two episodes: (a) baseline episode, with normal AP; 1 absolute atmosphere (atm abs) in a test room at sea level; (b) experimental episode, increased level of AP; 2.4 atm abs in the hyperbaric chamber. Sino-nasal outcome test-20, Trail Making Test A and olfactory testing were performed in each episodes., Results: The study group consisted of 23 men (57.5%) and 17 women (42.5%); the mean age of the study population was 38.7 +/- 9 years (range 23-58 years). The current investigation produced two major findings: (1) the mean of odor threshold scores was significantly increased in the hyperbaric condition when compared to the normobaric condition; (2) rather, there was no significant change in odor discrimination and identification scores in the hyperbaric condition., Conclusion: Based on two measurements taken at two different barometric pressures and the same temperature and relative humidity, this study suggests that odor threshold scores increase under hyperbaric conditions.

Background: The aim of this study was: (1) to perform a preliminary study for the validation of ''retronasal olfactory testing'' in the Turkish population to find the best way to evaluate smell and taste disorders in Turkey; (2) to determine if cultural differences make application of the test more difficult; and (3) to determine the flavors that participants had not yet tasted by using the survey method., Material and Methods: The study included 330 volunteers. Orthonasal olfactory function was assessed psycho-physically using the "Sniffin' Sticks" olfactory test. Retronasal olfaction was assessed using a collection of 20 available food powders applied to the oral cavity. Also, all participants filled in a questionnaire of 50 items about the flavors they had not tasted before., Results: The mean age of the participants was 26 ± 7.3 years. Participants were divided into 3 groups according to the "Sniffin' Sticks" test results: anosmia, hyposmia, and normosmia groups. Differences in retronasal olfaction scores were significant among the 3 groups., Conclusions: The retronasal olfactory test appeared to perform well, but modifications of odorized powders or granules and distracters used in the retronasal olfactory test, taking into account Turkish cultural differences, is likely to improve its performance.

Conclusion: The patients who underwent septoplasty with bilateral totally occlusive nasal packing had an increased risk of experiencing respiratory distress (RD)., Objective: To compare the immediate RD rates during recovery from anesthesia and surgical complications of totally occlusive nasal pack, internal nasal splint, and transseptal suture technique., Methods: A total of 150 patients were assigned to one of three groups according to the technique utilized following septoplasty: transseptal suturing, internal nasal splint, or Merocel (nasal dressing without airway). To determine RD related to anesthesia in the operating theatre, the criterion was defined as any unanticipated hypoxemia, hypoventilation or upper airway obstruction (stridor or laryngospasm) requiring an active and specific intervention. Postoperative hemorrhage, infection, synechia formation, and septal perforation were evaluated., Results: Patients in the Merocel group were 3.6 times more likely to have RD than patients in the transseptal suture and internal nasal splint groups. Also, patients who smoked had an increased risk of RD during the recovery phase of anesthesia after the septoplasty. In addition, all three techniques resulted in similar complication rates after septoplasty, with the exception of minor hemorrhage, which had a significantly higher rate in the transseptal suture group.

One of the most common reasons for partial nasal obstruction is nasal septal deviation (NSD). The effect of a partial lateralized nasal obstruction on olfactory bulb (OB) volume remains unclear. Thus, the aim of this study was to investigate the side differences in olfactory function and OB in patients with serious NSD. Sixty-five volunteers were included: 22 patients with serious right NSD and 43 patients with left NSD. The patients' mean age was 22 years. All participants received volumetric magnetic resonance imaging scans of the entire brain and detailed lateralized olfactory tests. The majority of the patients exhibited an overall decreased olfactory function (as judged for the better nostril: functional anosmia in 3%, hyposmia in 72%, normosmia in 25%), which seems to be mostly due to the overall severe changes in nasal anatomy. As expected, olfactory function was significantly lower at the narrower side as indicated for odor thresholds, odor discrimination, and odor identification (P ≤ 0.005). When correlating relative scores and volumes (wider minus narrower side), a significantly positive correlation between the relative measures emerged for OB volume and odor identification, odor discrimination, and odor thresholds. Our study clearly highlights that septal deviation results in decreased olfactory function at the narrower side.