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Introduction Open rhinoplasty involving columellar incision has gained popularity since the 1930s. Many surgical incision techniques have been employed to obtain better results in terms of postoperative scarring. This study evaluated and compared the results of absorbable and non-absorbable sutures used in open technique rhinoplasty, assessed scar properties regardless of the techniques used, from the perspectives of patients and surgeons. Objective This study evaluated and compared the results of absorbable and nonabsorbable sutures used in open technique rhinoplasty from the perspectives of patients and surgeons. Material and methods Study population included 70 patients who underwent primary open rhinoplasty between 2013 and 2018. Rhinoplasty Operations were performed in 2 different centers by a total of 2 rhinoplasty surgeons. Both surgeons used suture materials, which can be used for columellar closure, regardless of patients' skin characteristics. Columellar scars were assessed at an outpatient clinic at least 6 months postoperatively. Patients who could not come to the clinic were excluded from the study. Columellar Scars were assessed using the Turkish Patient Observer Scar Assessment Questionnaire. Patients were also asked to complete a Scar Assessment Analysis Questionnaire at the outpatient clinic, and were photographed from the front, basal, and right and left oblique sides. Three surgeons, who were not part of the research team but routinely performed rhinoplasty, completed the Observer Scar Assessment Questionnaire by examining patients in person at the clinic as well as their photographs. Results Observer Scar Assessment Questionnaire results; for the Vicryl group, surgeons ranked pigmentation of the scar as the best criterion (3.34 ± 0.97) and irregularity of the scar as the worst (3.82 ± 1.01). For the Prolene group, surgeons ranked irregularity as the best criterion (3.30 ± 0.97) and stiffness as the worst (3.54 ± 0.94). Although there was no statistically significant result between the two groups in the criteria, the mean scores of the Prolene group were less than the Vicryl group. (3.36 ± 0.46, 3.50 ± 0.65 respectively).Scar Assessment Analysis Questionnaire Results; patients in both the Vicryl and Prolene groups ranked pain as the least important factor (mean 2.9 ± 1.11 and 3.33 ± 1.35, respectively). The Prolene group scored lower than the Vcryl group in terms of overall scarring (3.49 ± 0.72, 3.66 ± 1.37, respectively, P > 0,05). Conclusions Absorbable sutures are a convenient alternative to nonabsorbable sutures. Level iv Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

View references (16) Introduction: Rhinoplasty surgeons often find that despite their best efforts to straighten the nose, patients often continue to perceive their nose as deviated, and this perception is particularly prevalent in patients with concurrent facial asymmetry. The aims of this study were to determine whether facial asymmetry influences the satisfaction of rhinoplasty patients and whether there is a difference in postoperative happiness between patients with and without facial asymmetry. Materials and Methods: In this retrospective study, we reviewed the charts and photographs of patients who underwent rhinoplasty between 2016 and 2018. Patient photographs were analysed; 30 patients with facial asymmetry and 30 patients with symmetric faces were randomly selected for the study. The preoperative and postoperative rhinoplasty outcome evaluation (ROE) and standardized cosmesis and health nasal outcomes survey (SCHNOS) scores were compared between the two groups. Results: The mean preoperative symmetry scores of the group with facial asymmetry were significantly higher than those of the group with symmetric faces. The magnitude of increase in the average ROE score from pre- to postoperatively was significantly larger in the group with symmetric faces than in the group with facial asymmetry. The magnitude of decrease in the mean SCHNOS score from pre- to postoperatively was significantly larger in the group with symmetric faces than in the group with facial asymmetry (p: 0.006). Conclusion: It is important to clearly evaluate patients with facial asymmetries before surgery to increase their postoperative satisfaction and outcomes and make their expectations more realistic. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. WOS:000572592900002 32974739 Q3

DIZDAR, DENIZHAN/0000-0002-0991-2706 Objectives: Bell palsy (BP), also known as idiopathic facial paralysis, is a unilateral, acute-onset, isolated lower motor neuron weakness. It accounts for 60% to 75% of all cases of unilateral facial paralysis. The estimated annual incidence ranges between 11 and 40 per 100.000 people, with 40.000 new cases each year in different parts of the world. The neutrophil/lymphocyte ratio (NLR), calculated as the ratio of absolute neutrophil count to absolute lymphocyte count, is an easily measurable and inexpensive systemic inflammation marker. This study investigated the association between the NLR and BP by comparing clinical characteristics and functional outcomes of patients with BP and healthy controls. Methods: Thirty patients (24 women, 6 men) who presented to our clinic with BP between 2014 and 2016 were included in the study. The subjects underwent a general physical examination and an assessment of laboratory blood parameters. All patients were treated with prednisone, 1 mg/kg per day with a progressive dose reduction. The NLR was calculated as the simple ratio between absolute neutrophil and absolute lymphocyte counts. Results: The mean (SD) NLR values were 2.141 (0.80) in patients with BP and 1.41 (0.46) in the control group. The difference between groups was significant (p=0.0001). There was a positive correlation between grade of facial paralysis and NLR values (r=0.663, p=0.0001). There was a positive correlation between prognosis of facial paralysis and NLR values (r=0.239, p=0.0251). Conclusion: The NLR was a valuable marker in BP patients in this study. Moreover, this study demonstrated a linear relationship between the NLR and BP severity and prognosis. WOS:000493730200008

Introduction: The most difficult aspect of radix lowering is determining the maximum amount of bone that can be removed with osteotomes; here, we describe use of a radix saw, which is a new tool for determining this amount. Objective: In this study, we describe use of a radix saw, which is a new tool to reduce the radix. Methods: The medical charts of 96 patients undergoing surgery to lower a high radix between 2016 and 2017 were assessed retrospectively. All operations were performed by the senior surgeon. Outcomes were assessed by comparing preoperative photographs with the most recent follow-up photographs (minimum of 6 months postoperatively). The photographs were all taken using the same imaging settings, and with consistent subject distance and angulation. The photographs were subsequently analysed by authors. Results: The study population consisted of 96 patients (70 women, 26 men) who underwent rhinoplasty between 2016 and 2017. The mean age of the patients was 28.8 years (range: 18-50 years) and the mean clinical follow-up period was 1.8 years. No patient required revision surgery due to radix problems, and there were no cases with unwanted bone fragments or radix asymmetry. The swelling and oedema seen immediately after surgery subsided after an average of 7-10 days. Conclusion: In conclusion, a radix saw can be used for rhinoplasty requiring delicate bone removal in patients with a high radix. Level IV: Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. Resumo Introdução: O aspecto mais difícil do rebaixamento do radix nasal é determinar a quantidade máxima de osso que pode ser removida com o osteótomo; aqui, descrevemos o uso de uma serra para radix nasal, uma nova ferramenta para redução dessa estrutura. Método: Prontuários médicos de 96 pacientes submetidos a cirurgia para redução do radix entre 2016 e 2017 foram avaliados retrospectivamente. Todas as cirurgias foram realizadas pelo cirurgião sênior. Os resultados foram avaliados comparando-se fotografias pré-operatórias com as fotografias de acompanhamento mais recentes (mínimo de 6 meses de pós-operatório). Todas as fotografias foram tiradas utilizando as mesmas configurações de imagem e com distância e ângulo consistentes do indivíduo. As fotografias foram posteriormente analisadas pelos autores. Resultados: A população do estudo foi composta por 96 pacientes (70 mulheres, 26 homens) que realizaram rinoplastia entre 2016 e 2017. A média de idade dos pacientes foi de 28,8 anos (18 a 50 anos) e o tempo médio de acompanhamento clínico foi de 1,8 anos. Nenhum paciente necessitou de cirurgia de revisão por problemas relacionados ao radix nasal e não houve casos com fragmentos ósseos indesejados ou assimetria do radix. O inchaço e o edema observados imediatamente após a cirurgia diminuíram após uma média de 7 a 10 dias. Conclusão: Uma serra para radix nasal pode ser utilizada para rinoplastia, exige manipulação óssea delicada em pacientes com radix alto, com nível de evidência IV. Evidência IV é obtida de várias séries temporais com ou sem intervenção, como estudos de caso. Resultados significativos em ensaios não controlados também podem apresentar esse tipo de evidência.

DIZDAR, DENIZHAN/0000-0002-0991-2706; DIZDAR, DENIZHAN/0000-0002-0991-2706 WOS:000417392200006 PubMed: 27658749 Introduction: The olfactory system is affected by the nutritional balance and chemical state of the body, serving as an internal sensor. All bodily functions are affected by energy loss, including olfaction; hunger can alter odour perception. Objective: In this study, we investigated the effect of fasting on olfactory perception in humans, and also assessed perceptual changes during satiation. Methods: The "Sniffin' Sticks'' olfactory test was applied after 16 h of fasting, and again at least 1 h after Ramadan supper during periods of satiation. All participants were informed about the study procedure and provided informed consent. The study protocol was approved by the local Ethics Committee of Gaziosmanpas, a Taksim Education and Research Hospital (09/07/2014 no: 60). The study was conducted in accordance with the basic principles of the Declaration of Helsinki. Results: This prospective study included 48 subjects (20 males, 28 females) with a mean age of 33.6 +/- 9.7 (range 20-72) years; their mean height was 169.1 +/- 7.6 (range 150.0-185.0) cm, mean weight was 71.2 +/- 17.6 (range 50.0-85.0) kg, and average BMI was 24.8 +/- 5.3 (range 19.5-55.9). Scores were higher on all items pertaining to olfactory identification, thresholds and discrimination during fasting vs. satiation (p < 0.05). Identification (I) results: Identification scores were significantly higher during the fasting (median = 14.0) vs. satiation period (median = 13.0). Threshold (T) results: Threshold scores were significantly higher during the fasting (median = 7.3) vs. satiation period (median = 6.2). Discrimination (D) results: Discrimination scores were significantly higher during the fasting (median = 14.0) vs. satiation period (median = 13.0). The total TDI scores were 35.2 (fasting) vs. 32.6 (satiation). When we compared fasting threshold value of > 9 and 9 (p < 0.05). Conclusion: Olfactory function improved during fasting and declined during satiation. The olfactory system is more sensitive, and more reactive to odours, under starvation conditions, and is characterised by reduced activity during satiation. This situation was more pronounced in patients with a better sense of smell. Olfaction-related neurotransmitters should be the target of further study. (C) 2016 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.

Dome division or vertical dome division (VDD) is a tip plasty technique that is effective when applied appropriately to suitable patients. For 15 years, we have used VDD and made modifications as needed. In classical VDD, the dome area is cut and left to heal, but experience shows that additional components are needed to complement dome division, such as sutures or grafts. In this study, we retrospectively analysed our rhinoplasty patients in whom we used vertical alar resection (VAR) to assess the advantages and disadvantages of this technique. To our knowledge, this is one of the most exhaustive studies of VDD, including over 3000 patients. This retrospective case series reviewed the charts of 3965 patients who underwent VAR between 2000 and 2015. All patients were operated on by the senior surgeon. Dome division was used for various reasons, including a deformed tip area in revision rhinoplasties, droopy nose, wide tip, pinched nose, tip asymmetry, and overprojected nasal tip. Patients were excluded if they had septal deviation that enabled tip rotation, or a dorsum problem that caused tip asymmetry. The study included 3965 patients (3172 women and 793 men) who underwent open rhinoplasty from 2000 to 2015. The mean patient age was 28.3 years (range 18–50 years). The mean clinical follow-up duration was 11.2 years. In conclusion, this technique is capable of modifying all parameters of the nasal tip (projection, rotation, and volume), as required, at the same time, addressing many tip problems. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Olfactory dysfunction is one of the comorbidities associated with allergic rhinitis (AR) and AR is one of the common causes of olfactory problems. We aimed to evaluate by the Sniffin' Sticks test the effects on olfactory functions of nasal steroids and leukotriene antagonists used for allergic rhinitis.Thirty patients with seasonal rhinitis were included in this study. Patients were randomly divided into three groups of 10 patients; group 1 received montelukast sodium and mometasone furoate (MF) therapy, group 2 received only montelukast, and group 3 only MF. Patients' olfactory functions were determined using the Sniffin' Sticks olfactory test before and after a month treatment.Threshold, discrimination, identification, and the sum of threshold, discrimination, and identification (TDI) values were not significantly different among the groups before treatment. For Group 1 and Group 3 patients, there were statistically significant differences in threshold, discrimination, identification, and TDI values before and after treatment (P0.05) (Wilcoxon signed ranks analysis). For Group 2 patients, the before and after treatment values of threshold, discrimination, identification, and TDI showed no significant difference (P0.05).According to the findings of our study, MF is superior to montelukast in improving olfactory function. Although montelukast has been shown to be effective against AR symptoms, its effect on olfactory function was not demonstrated in this study.

Objective: Allergic rhinitis (AR) is a globally common inflammatory disease that has a considerable effect on an individual's quality of life. It is estimated that AR affects 10% to 25% of the general population. Both gustatory and olfactory disorders affect the social activities and job performance resulting in impaired quality of life in patients suffering from AR. We think that these problems have not been sufficiently investigated in the past. We, therefore, decided to evaluate the smell-taste disorders in patients suffering from AR. Our objective is to evaluate the chemosensory perception in patients suffering from allergic AR. Methods: Fifty-four patients with AR and 34 healthy controls were enrolled for the current study. "Sniffin' sticks" test and taste strips were used for chemosensory assessment. Results: According to the "Sniffin' sticks" test results, patients with AR had significantly lower scores for odor threshold and identification subtasks, whereas there was no difference between the two groups regarding odor discrimination scores (p

DIZDAR, DENIZHAN/0000-0002-0991-2706; Tasdelen, Bahar/0000-0001-8146-4912; DIZDAR, DENIZHAN/0000-0002-0991-2706; bozan, aykut/0000-0002-3455-4955, WOS: 000489065400005, PubMed: 29891422, Introduction: the most common cause of septoplasty failure is inferior turbinate that is not treated properly. Several techniques have been described to date: total or partial turbinectomy, submucosal resection (surgical or with a microdebrider), with turbinate outfracture being some of those. Objective: in this study, we compared the pre- and postoperative lower turbinate volumes using computed tomography in patients who had undergone septoplasty and compensatory lower turbinate turbinoplasty with those treated with outfracture and bipolar cauterization. Methods: This retrospective study enrolled 66 patients (37 men, 29 women) who were admitted to our otorhinolaryngotogy clinic between 2010 and 2017 because of nasal obstruction and who were operated on for nasal septum deviation. the patients who underwent turbinoplasty due to compensatory lower turbinate hypertrophy were the turbinoplasty group; Outfracture and bipolar cauterization were separated as the out fracture group. Compensatory lower turbinate volumes of all patients participating in the study (mean age 34.0 +/- 12.4 years, range 17-61 years) were assessed by preoperative and postoperative 2 month coronal and axial plane paranasal computed tomography. Results: the transverse and longitudinal dimensions of the postoperative turbinoplasty group were significantly lower than those of the out-fracture group (p = 0.004). in both groups the lower turbinate volumes were significantly decreased (p = 0.002, p < 0.001 in order). the postoperative volume of the turbinate on the deviated side of the patients was significantly increased: tubinoplasty group (p = 0.033). Conclusion: Both turbinoplasty and outfracture are effective volume-reduction techniques. However, the turbinoplasty method results in more reduction of the lower turbinate volume than outfracture and bipolar cauterization. (C) 2018 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.

The practice in rhinoplasty tends to go toward reduction rhinoplasty, except Asian noses. The more resection is done, the more complications arise. The poor durability of aesthetic outcomes and the progressive functional impairment associated with reductive surgery have provided a major drive for the development of grafting approaches in rhinoplasty. Dorsal and middle vault depression is the frequently seen outcome that yields tip over-rotation, loss of tip projection, retraction of the columella, and unnatural contours. Disfiguring and functionally crippling are the final results of these noses. The best choice for graft material is the patient’s own cartilage, but in some primary cases with severe deformities (trauma etc.) or secondary cases, there may be a lack of appropriate material for reconstruction. In these situations, there are other choices such as using an allograft or an alloplastic material. Allograft, meaning a tissue from other individuals of the same species, may be the next best alternative to an autograft. Allogeneic cartilage seems an attractive alternative to autogenous cartilage grafts, mainly because of its apparent similarity. Allografts are not limited in quantity, and there is no donor-site morbidity. The allograft matrix is invaded and replaced by adjacent connective tissue and may show reduction in volume over time. Because of the long-term unpredictability in resorption, relatively high infection rate, and the possibility of warping, homografts must be used carefully.

DIZDAR, DENIZHAN/0000-0002-0991-2706; DIZDAR, DENIZHAN/0000-0002-0991-2706, WOS: 000489652700005, PubMed: 31097827, The aim of our study is to evaluate the nasal symptoms of patients with indications for septoplasty using the SNOT-22 questionnaire and to investigate the effects of variables such as concha surgery, age, obstructive sleep apnoea (OSA), smoking and asthma on these symptoms. A total of 100 patients were included in the study. Pre-operative and at postoperative month 3, patients were administered the Sinus Nasal Conduct Test (SNOT-22). Septoplasty operations were performed by two centres and two otolaryngologists and head and neck surgeons. the patients were divided into two groups according to the surgical procedure of the lower concha, concha shaver group and concha out fractures. the difference in total score between preop and postop was significant in both the shaver and outfracture groups with a difference in total score of 17.85 (46%). Improvement in symptoms of nasal obstruction was observed with a mean improvement of 0.81 points (2.79 points). in our study, there was no significant difference in preop and postop symptom scores in patients who had subcuneal shaved submucous resection with outfracture (p = 0.861). There was no significant difference between preop and postop total scores between asthma, smoking, OSA and non-asthmatics (p > 0.05). There was no correlation between scores and age in either group (p > 0.05). Before septoplasty, the most important symptom was nasal obstruction. Intervention at the inferior turbinate during surgery increases the benefits of septoplasty independently of the surgical technique. Factors such as asthma, OSA, smoking are significantly relevant to symptoms. in those with asthma and OSA, the scores were found to be high both before and after intervention.

Following rhinoplasty, the cross-sectional parts of the nose may be significantly reduced, and nasal air movement and olfaction may be altered. Studies on olfactory function after surgical procedures are quite limited and have largely focused on sinus surgery or septoplasty.The objective of this study is to assess the consequences of spreader grafts on olfactory function.This prospective study was conducted at the Gaziosmanpaşa Taksim Education and Research Hospital, Department of Otolaryngology, from January 2014 to June 2015. In total, 68 patients who had undergone an open-technique septorhinoplasty were included. In 35 patients, bilateral spreader grafts were included with the open septorhinoplasty (group 1), and 33 patients underwent open septorhinoplasties without spreader grafts (group 2).The age and gender distributions of the patients in the two groups did not differ (p0.05). Preoperative threshold, discrimination, and identification values in both groups did not differ (p0.05). In groups 1 and 2, postoperative threshold values were significantly higher than preoperative values (p0.05). The change in threshold, discrimination, and identification level was significantly higher postoperatively versus preoperatively in group 1 (p0.05); however, the changes in discrimination and identification values did not significantly differ between in group 2 (p0.05).Our study demonstrates the superior widening effect of spreader grafts over the nasal valve and favorable results in olfactory function in primary septorhinoplasty patients.This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Snoring is caused by the vibration of structures of the oral cavity, such as the soft palate, uvula, tonsils, base of the tongue, epiglottis, and lateral pharyngeal walls. When these structures collapse and obstruct the airway, apnea occurs. Obstructive sleep apnea syndrome (OSAS) is characterized by repeated periods of upper airway obstruction, a decrease in arterial oxygen saturation, and interrupted sleep. The prevalence of OSAS is 1% to 5% in men and 1.2% to 2.5% in women. Crucial factors in deciding the surgical approach include a detailed ear-nose-throat examination, Muller maneuver, sleep endoscopy, and apnea hypopnea index scores. Accepted treatments include continuous positive airway pressure (CPAP), surgeries of the base of the tongue and/or palate, and multi-level surgeries. It, however, is important to continue to evaluate the efficacies of such procedures. The authors evaluated the outcomes of 23 patients who underwent surgery for OSAS, using preoperative and postoperative polysomnography (PSG) and the Epworth sleepiness scale (ESS). The results were compared before and after surgery. In all, 14 patients had lateral pharyngoplasty and 9 had uvulopalatopharyngoplasty (UPPP). The PSG and Epworth scale values were significantly lower in both groups, postoperatively. Patients indicated that their quality of life had improved. In conclusion, the surgeries were successful. In line with the literature, our results indicate that lateral pharyngoplasty and UPPP can be used in appropriate patients. Longer-term studies on more patients will provide more detailed information in the future.

Objective: Monitorization of patients in intensive care units requires a multidisciplinary approach. As cooperation with unconscious or intubated patients is often not possible, some conditions may be overlooked. The aim of this study is to reveal the incidence and factors affecting otitis media with effusion in ICU patients intubated longer than 7 days. Methods: Twenty patients hospitalized in the intensive care unit of the Gaziosmanpasa Taksim Training and Research Hospital from March to December 2014 were included in the study. The Gaziosmanpasa Taksim Training and Research Hospital Ethics Committee approved the study according to the Declaration of Helsinki and Good Clinical Practices guidelines. All of the patients included in the study were aged ≥18 years. Patients intubated because of traffic accidents or trauma, patients with a history of chronic otitis media or ear, nose, and throat operations, patients with head and neck tumors, and patients with tympanic membrane perforation, external auditory canal pathology, nasopharyngeal mass, and chronic sinusitis as well as patients with a pathology leading to nasal obstruction, such as nasal polyposis or severe septal deviation, were excluded. After a detailed history by patients’ relatives, an otoscopic examination, nasal examination, tympanometry, and acoustic reflex measurements were performed. Ear examination was performed using a conventional portable otoscope. Results: Among 20 patients, 12 had bilateral effusion (24 out of 40 ears, 60%). In two patients, a type C tympanogram was obtained (four out of 40 ears, 10%), and the remaining 12 ears of six patients were normal (30%). When intubation time is evaluated, among 13 patients intubated longer than 14 days, 11 had effusion (84%). A significant correlation was found between the duration of intubation and effusion development. Assessing the state of consciousness, 11 of 12 unconscious patients (91%) were found to have effusion. There was a significant correlation between effusion development and state of consciousness. Conclusion: In unconscious patients intubated longer than 14 days, the risk of having middle ear effusion is demonstrated to be higher. Consequently, in the periodic follow-up of intensive care patients with prolonged intubation, a routine otoscopic examination has to be considered. (JAREM 2015; 5: 64-7)

Objective: To evaluate laryngeal irritation before and after treatment using the reflux symptom index (RSI) in patients diagnosed with laryngopharyngeal reflux (LFR). Methods: A total of 30 patients who were diagnosed with LFR after 24 hours of dual-probe pH monitoring were included in the study. RSI was applied to the patients before and after treatment. In evaluating the patients’ symptoms, throat clearing need and post-nasal drainage, which are frequently observed in LFR, were evaluated post-treatment. The patients were followed for 3 months during proton pump inhibitor treatment. Data regarding the patients’ LFR symptoms were obtained after 3 months, and the responses to treatment based on reflux symptom scale scores, post-nasal drainage, and throat clearing need were evaluated and compared with those pre-treatment. Results: The decrease in the RSI for postnasal drainage value was statistically significant after treatment. The decrease in the throat clearing RSI value was statistically significant after treatment. Conclusion: In patients with persistent postnasal drainage and throat clearing need complaints, if no infection source is identified, the patients should be evaluated by 24-hour pH monitorization in terms of LFR, irrespective of the presence or absence of laryngoscopic findings.

PALTURA, CEKI/0000-0002-0971-3643; Uysal, Omer/0000-0002-8833-697X; DIZDAR, DENIZHAN/0000-0002-0991-2706; DIZDAR, DENIZHAN/0000-0002-0991-2706 WOS:000427514100008 PubMed: 28975239 IMPORTANCE Postoperative pain at the donor site is a common morbidity following autologous costal cartilage grafting. OBJECTIVE To evaluate postoperative pain at the donor site after the use of a muscle-sparing costal cartilage harvesting technique compared with a muscle-cutting technique using electrocautery. DESIGN, SETTING, AND PARTICIPANTS Designed as a controlled trial without randomization, this prospective, comparative cohort study was conducted between January 1, 2016, and March 31, 2017. Participants included 20 patients who underwent rhinoplasty for various cosmetic and functional complaints from January 1, 2016, to February 28, 2017. Of the 20 patients, 1 was excluded owing to an infection that developed on postoperative day (POD) 7. Patients were grouped by the rib harvesting technique used that was either a muscle-sparing technique (n = 11) or a muscle-cutting technique (n = 8). Skin incisions for both groups were carried out with a blade. Transection of muscle fascia and muscle fibers was performed with monopolar electrocautery in the muscle-cutting technique group. Blunt dissection with a hemostat was performed in the muscle-sparing technique group. All other surgical techniques were identical. MAIN OUTCOMES AND MEASURES Postoperative pain was assessed with visual analog scale scores for resting pain and movement pain. Eight pain measurements were noted at the sixth postoperative hour and on PODs 1, 2, 3, 7, 15, 30, and 45. During the hospital stay, the postoperative need for analgesics was recorded daily as the number of analgesic infusion vials used. RESULTS The 19 patients in the study included 11 women and 8 men whose mean age (SD) was 33.2 (10.3) years The mean (SD) visual pain analog scale scores for resting pain and movement pain were consistently higher in the muscle-cutting technique group than in the muscle-sparing technique group. This difference was statistically significant on PODs 2, 3, and 15 for resting pain and on PODs 2, 3, 7, 15, 30, and 45 for movement pain. The mean postoperative need for analgesic infusion vials during hospital stay was higher in the muscle-cutting technique group, and the difference was statistically significant on POD 2 (1.9 [0.6] vials vs 1.0 [0.9] vials; P = .02). CONCLUSIONS AND RELEVANCE Both resting and movement pain at the donor site was significantly reduced in the muscle-sparing technique group during the postoperative period, findings that align with anecdotal reports in the literature. Routine use of the muscle-sparing technique in autologous costal cartilage harvesting is recommended to reduce postoperative pain.

DIZDAR, DENIZHAN/0000-0002-0991-2706; DIZDAR, DENIZHAN/0000-0002-0991-2706; Sahin, Mehmet I/0000-0002-9576-1448; Vural, Alperen/0000-0003-1969-7760 WOS:000402429700021 PubMed: 27819649 OBJECTIVE: In patients with a perforated tympanic membrane, topically administered medication reaches the middle ear and thus creates a risk of ototoxicity. The aim of the present study was to evaluate the possible ototoxic effect of the antifungal medication nystatin when administered to the rat middle ear cavity. MATERIALS and METHODS: Three groups (negative control, positive control, and study groups), each containing eight rats, were formed. Before the drug administration, distortion product otoacoustic emissions were recorded in both ears of each rat. Saline (0.09% NaCl), gentamycin, and nystatin solutions were transtympanically injected into the middle ear cavities of the negative control, positive control, and study groups, respectively, for five consecutive days. Seven days after the last infiltration, the control otoacoustic emission was measured, and the data of the 2, 3, 4, 6, 8 kHz frequencies were statistically analyzed. RESULTS: There were no significant changes between the 1st and 2nd measures in the negative control group (0.09% NaCl) (p>0.05), whereas there were significant changes between the 1st and 2nd measures in the positive control group (gentamycin) and study group (nystatin) (p

DIZDAR, DENIZHAN/0000-0002-0991-2706; DIZDAR, DENIZHAN/0000-0002-0991-2706; WOS:000394351800029 PubMed: 27577041 Olfactory dysfunction and migraine has been associated for a long time. In this study, we planned to compare olfactory functions in patients with migraine and osmophobia with patients having migraine but no osmophobia, in addition with a normal control group using "Sniffin' Sticks'' test. The main distinction of this study is that all qualitative and quantitative properties of olfactory functions; threshold, discrimination and identification, are evaluated separately and jointly. Thirty healthy person aged between 16 and 56 (18 women, 12 men) and 60 migraine patients aged between 15 and 54 (39 women, 21 man) were included in the study. All patients have been inquired about osmophobia and have been assessed with Hedonic tone assessment. Osmophobia has been tested for perfume, cigarette smoke, leather, stale food, soy sauce, fish, spices and coffee smells. Olfactory functions has been assessed with "Sniffin' Sticks'' smell test. Thresholds, discrimination and identification have been determined for each patient. In migraine patients with osmophobia, threshold was 7.75 +/- 2.3, in migraine patients without osmophobia threshold was 8.25 +/- 1.5 and threshold was 10.75 +/- 1.3 for the control group. Discrimination score was 6 +/- 1.2 in migraine patients with osmophobia, 9 +/- 0.8 in patients without osmophobia and was 12 +/- 1.4 in the control group. In migraine patient with or without osmophobia Threshold/Discrimination/Identification (TDI) scores were lower than the control group. The most important parameter in our study is that discrimination scores were especially lower in patients with osmophobia. We believe that this decrease in discrimination in migraine patients with osmophobia; who claim that they smell everything and they are sensitive to all smells, is significant. Further studies about smell discrimination will help better understand some conditions; especially anosmia and hyposmia after upper respiratory tract infections and parosmia.

Background:Allergic rhinitis is strongly associated with the presence of house dust mites. This study investigated the long-term effects of allergen-specific immunotherapy. Allergen-specific immunotherapy was applied over three years. The study was based on a 10-year follow up of patients with allergic rhinitis.Methods:The study was conducted between 2001 and 2015. Skin prick test results and symptom scores were evaluated before (26 patients) and after 3 years (20 patients) of allergen-specific immunotherapy (using data from a previously published study), and 10 years after allergen-specific immunotherapy had ended (20 of 26 patients).Results:The symptom scores before allergen-specific immunotherapy were significantly higher than those obtained after 3 years of allergen-specific immunotherapy and 10 years after allergen-specific immunotherapy (p < 0.0175). There were no significant differences between the scores obtained at 3 years and 10 years after allergen-specific immunotherapy (p > 0.0175).Conclusion:Subcutaneous immunotherapy is an effective treatment for house dust mite induced allergic rhinitis.

DIZDAR, DENIZHAN/0000-0002-0991-2706; DIZDAR, DENIZHAN/0000-0002-0991-2706 WOS:000415085100099 PubMed: 28953161 In rhinoplasty patients radix position profoundly impacts the appearance of the nasal profile by influencing dorsal length, contour, angulation, and height. The authors wanted to introduce a new perspective to radix, and decided to focus on subcutaneous tissues, especially procerus muscle. Actually resection of procerus and corrugator supercilii is a part of browlift and endoscopic facelift techniques, with which the authors are already familiar. In this short report and video, the authors wanted to present a new technique to lower radix area. This technique is based on face anatomy, and muscles under radix area, and takes its roots from facelift techniques. Before introducing the authors' technique the authors wanted to show the effect of soft tissues on radix with lateral nasal x-rays. With this maneuver the soft tissue thickness of radix area is thinned.

1Department of Otolaryngology-Head and Neck Surgery, Van Training and Research Hopsital, Van, Turkey 2Clinic of Otolaryngology-Head and Neck Surgery, Ercis State Hospital, Van, Turkey 3Clinic of Eye, Van Training and Research Hopsital, Van, Turkey 4Clinic of Eye, Ercis State Hospital, Van, Turkey 5Department of Otolaryngology-Head and Neck Surgery, Igdir State Hospital, Igdir, Turkey 6Department of Otolaryngology-Head and Neck Surgery, G.O.P Taksim Training and Research Hopsital, Istanbul, Turkey Original Investigation Ozgun Arastirmalar

Currently, clinicians better understand the functional and aesthetic consequences of a cephalic malpositioned lateral crus of the lower lateral cartilage, which was identified 30 years ago. Functionally, cephalic malpositioning causes alar support deficiency, which results in external valve insufficiency. Cosmetically, it causes alae nasi retraction, alar bracket deformity, boxiness, and underprojection of the nasal tip. The stair-step technique, defined by Boccieri and Raimondi, is an effective repositioning technique for the repair of this deformity. The strengthened stair-step technique, a combination of the lateral crural-rim graft and the stair-step technique, is described in this article. In this study, designed as a prospective case series, the strengthened stair-step technique was performed for 62 patients (43 women and 19 men; mean age, 27.3 years) between November 2009 and December 2012. Because 12 patients did not attend follow-up visits regularly, their outcomes could not be evaluated. These patients were excluded from the study. Pre- and postoperative photos of all the patients were taken. Aesthetic evaluations showed that six patients were not satisfied with their results, four patients had complaints about the nasal tip (1 had asymmetry and 3 had alar stiffness and/or thickness), and two patients had nasal dorsum complaints. Functional evaluation showed that four patients had slight dissatisfaction with their breathing. They reported continuing collapse in the valve area with inspiration. The remaining patients were satisfied with their results. The strengthened stair-step technique is a safe and effective technique for correcting not only lateral crus cephalic malpositioning but also alar rim retraction and external valve collapse. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PALTURA, CEKI/0000-0002-0971-3643; DIZDAR, DENIZHAN/0000-0002-0991-2706; DIZDAR, DENIZHAN/0000-0002-0991-2706; avincsal, mehmet ozgur/0000-0002-3896-5807 WOS:000381842000011 PubMed: 27497386 Objectives: Although most specialists in otorhinolaryngology and pediatrics find halitosis to be a common problem in children with adenoid hypertrophy, there are no objective data on this topic in the literature. Whether adenoid hypertrophy is a risk factor for halitosis or whether halitosis is a sign of adenoid hypertrophy remains unclear. Thus, the aim of this study was to investigate whether children diagnosed with adenoid hypertrophy have a higher probability of halitosis than do children in the normal population and whether adenoidectomy can decrease oral malodor. Methods: Forty children with adenoid hypertrophy and 40 healthy subjects aged 5-15 years were included in the study. The children with adenoid hypertrophy underwent adenoidectomy operations and were followed for 3 months. We measured volatile sulfur compounds (VSCs), hydrogen sulfide (H2S), methyl mercaptan (CH3SH), and dimethyl sulfide (CH3)(2)S using an objective method, a portable gas chromatograph (OralChroma; AbiMedical, Osaka, Japan). Results: The mean CH3SH and (CH3)(2)S levels were significantly different (p < 0.05) between the adenoid hypertrophy group and the controls. The H2S, CH3SH, and (CH3)(2)S levels in the third postoperative month were significantly lower (p < 0.05) than those in the preoperative period, and there was no significant difference postoperatively between the patients with adenoid hypertrophy and controls. There was a positive correlation between age and VSC levels, and CH3SH levels were significantly higher in patients with ventilation tube insertion, rather than just adenoidectomy. Conclusions: There was a statistically significant association between halitosis and adenoid hypertrophy, and a significant improvement in halitosis was obtained following adenoidectomy. The present study provides an association between halitosis and adenoid hypertrophy. If there is no other oral pathology causing halitosis, halitosis can be a sign of adenoid hypertrophy in children. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Conclusion This study found a negative effect of IDA on olfactory function. IDA leads to a reduction in olfactory function, and decreases in hemoglobin levels result in further reduction in olfactory function. Objective This study examined the effects of iron-deficiency anemia (IDA) on olfactory function. Method The study enrolled 50 IDA patients and 50 healthy subjects. Olfactory function was evaluated using the Sniffin' Sticks olfactory test. The diagnosis of IDA was made according to World Health Organization (WHO) criteria. Results Patients with IDA had a significantly lower threshold, discrimination, and identification (TDI) value, and a lower threshold compared with the control group. However, there were no significant differences between the groups in terms of smell selectivity values.

Objectives/Hypothesis: To evaluate the effect and obtain a pressure value of continuous positive airway pressure (CPAP) under direct visualization using drug-induced sleep endoscopy (DISE) and compare the pressure values with values obtained using conventional CPAP. Study Design: Prospective, double-blinded, cohort study. Methods: Sixteen patients with obstructive sleep apnea syndrome (OSAS) were included in the study. Each patient underwent polysomnographic evaluation. After diagnosis of OSAS, patients underwent conventional CPAP titration. Patients were then taken to the operating theatre and put under sedation, where CPAP titration with nasendoscopy was performed (DISE CPAP). Results: There were no statistically significant differences between the two techniques regarding pressure levels that decreased apneas in conventional CPAP and provided sufficient opening during DISE CPAP. Conclusions: Results with conventional CPAP titration and endoscopy-assisted CPAP titration showed no statistically significant difference. Endoscopy-assisted CPAP is a cheaper and less time consuming alternative to conventional CPAP and has similar results.

Oxaliplatin is used to treat advanced colorectal cancer. Platinum-containing chemotherapeutic agents are known to be ototoxic. However, ototoxicity is rare with newer generation platinum-derived agents, such as oxaliplatin. This case report presents a rare case of sudden unilateral sensorineural hearing loss following intravenous (IV) infusion of oxaliplatin in a 64-year-old woman with advanced colon cancer. The hearing loss was severe and did not respond to treatment. To the best of our knowledge, this is the fifth reported case of oxaliplatin ototoxicity. Although oxaliplatin ototoxicity is rare, physicians must be aware of this important adverse effect, and an audiometric evaluation must be performed when necessary. Patients treated with oxaliplatin should be followed closely for early signs and symptoms of hearing loss, and if hearing loss is detected, treatment should be stopped immediately.

The most common reason for failure in dacryocystorhinostomy has been proven to be the granuloma or membranous obstruction of scar tissue formation on lacrimal opening in the nasal cavity during the healing process. In this article, the authors suggest an easy maneuver to avoid the risk of scarring and collapsing of the knot in bony window by using a piece of an aspiration catheter. Using this easy maneuver, the authors can manage to reduce the risk of scarring and stenosis, and when the authors take out the tubes after 2 months, removing the silicone tube was easier with our technique. Moreover with the present technique the authors observed there was no embedding of the knot in the scar.

Introduction: Open rhinoplasty involving columellar incision has gained popularity since the 1930s. Many surgical incision techniques have been employed to obtain better results in terms of postoperative scarring. This study evaluated and compared the results of absorbable and non-absorbable sutures used in open technique rhinoplasty, assessed scar properties regardless of the techniques used, from the perspectives of patients and surgeons. Objective: This study evaluated and compared the results of absorbable and nonabsorbable sutures used in open technique rhinoplasty from the perspectives of patients and surgeons. Material and methods: Study population included 70 patients who underwent primary open rhinoplasty between 2013 and 2018. Rhinoplasty Operations were performed in 2 different centers by a total of 2 rhinoplasty surgeons. Both surgeons used suture materials, which can be used for columellar closure, regardless of patients' skin characteristics. Columellar scars were assessed at an outpatient clinic at least 6 months postoperatively. Patients who could not come to the clinic were excluded from the study. Columellar Scars were assessed using the Turkish Patient Observer Scar Assessment Questionnaire. Patients were also asked to complete a Scar Assessment Analysis Questionnaire at the outpatient clinic, and were photographed from the front, basal, and right and left oblique sides. Three surgeons, who were not part of the research team but routinely performed rhinoplasty, completed the Observer Scar Assessment Questionnaire by examining patients in person at the clinic as well as their photographs. Results: Observer Scar Assessment Questionnaire results; for the Vicryl group, surgeons ranked pigmentation of the scar as the best criterion (3.34 ± 0.97) and irregularity of the scar as the worst (3.82 ± 1.01). For the Prolene group, surgeons ranked irregularity as the best criterion (3.30 ± 0.97) and stiffness as the worst (3.54 ± 0.94). Although there was no statistically significant result between the two groups in the criteria, the mean scores of the Prolene group were less than the Vicryl group. (3.36 ± 0.46, 3.50 ± 0.65 respectively).Scar Assessment Analysis Questionnaire Results; patients in both the Vicryl and Prolene groups ranked pain as the least important factor (mean 2.9 ± 1.11 and 3.33 ± 1.35, respectively). The Prolene group scored lower than the Vcryl group in terms of overall scarring (3.49 ± 0.72, 3.66 ± 1.37, respectively, P > 0,05). WOS:000662282900103 33405440 Q4