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Background: Congenital midnasal stenosis has previously been described as a cause of nasal obstruction in infants, and conservative and interventional treatments have been suggested. However, midnasal stenosis in adults has not been reported and related normative measurements have not been studied. Methods: Three adult patients presented with nasal obstruction and, based on examination and radiological findings, were diagnosed with midnasal stenosis. Anatomical measurements were studied in axial and coronal computed tomography scans, and compared with findings for 161 healthy individuals. Results: Anatomical measurements showed that the endonasal cavity was larger in males than females. The midnasal region was found to be constricted in patients compared to healthy controls. Conclusion: This is the first study to report on midnasal stenosis in adults and to define normative anatomical measurements in adults. In patients presenting with nasal obstruction, midnasal stenosis should be suspected during endoscopic visualisation of medially located middle turbinates and uncinate processes in nasal cavities. A definitive diagnosis of midnasal stenosis can be made by examining paranasal sinus computed tomography scans. Endoscopic middle turbinectomy, complete uncinectomy, mega maxillary antrostomy and partial anterior ethmoidectomy have been suggested to relieve midnasal stenosis. [ABSTRACT FROM AUTHOR]

Objective:This study aimed to examine the relationship of the accessory sphenoidal septum with surrounding vital structures and their variations.Methods:This cross-sectional retrospective study investigated the prevalence of accessory sphenoidal septa and their relationship with variations in surrounding vital structures in coronal and axial paranasal computed tomography images.Results:Coronal and axial computed tomography images of 347 patients were assessed to evaluate the presence of accessory sphenoidal septa. Accessory sphenoidal septa originated from the internal carotid artery in 47.7 per cent of patients and from the optic nerve in 17.5 per cent. These structures were significantly associated with protrusion of the optic nerve, internal carotid canal or Vidian nerve canal.Conclusion:Accessory sphenoidal septa can originate from the internal carotid artery or the optic nerve. Therefore, the presence of an accessory sphenoidal septum indicates an increased risk of surgical complications including internal carotid artery injury and loss of vision due to optic nerve injury. [ABSTRACT FROM PUBLISHER]

Objective:Azelastine nasal spray is a topical antihistaminic drug for the symptomatic treatment of allergic rhinitis. This study aimed to investigate the effects of azelastine on nasal and nasopharyngeal microflora.Methods:Swab samples from 25 patients prescribed azelastine nasal spray monotherapy were collected just before treatment and after 1 month of treatment. After incubation of inoculates, the number of bacteria present in cultures was measured (in colony-forming units per millilitre).Results:Evaluation of the number of microflora revealed increased bacterial reproduction after treatment, but this difference was not statistically significant. The use of azelastine nasal spray decreased the reproduction of three potentially pathogenic bacteria; however, it did not affect the reproduction of other potentially pathogenic bacteria.Conclusion:The use of azelastine nasal spray for one month did not have a statistically significant effect on the numbers of nasal and nasopharyngeal microflora; it is therefore safe from a microbiological viewpoint. [ABSTRACT FROM PUBLISHER]

Objectives: To compare the efficacy and safety of radiofrequency and monopolar electrocautery tonsillectomy, regarding operation duration and tonsillectomy morbidity, including post-operative pain and haemorrhage and tonsillar fossa healing, in patients with recurrent chronic tonsillitis. Study design: A prospective, randomised, double-blind, controlled clinical study. Methods: Fifty patients aged over 10 years who required tonsillectomy were randomly assigned to have one tonsil removed by radiofrequency and the other by monopolar electrocautery. Operation duration, post-operative haemorrhage, post-operative pain and tonsillar fossa wound healing were compared. Results: The mean ± standard deviation of the operation duration required for the radiofrequency method was significantly longer than that for monopolar electrocautery: 8.1 ± 1.6 minutes vs 7.3 ± 1.5 minutes, respectively (p = 0.034). Post-operative haemorrhage was observed in only three patients (13.6 per cent). Inter-group analysis showed no significant differences in post-operative pain scores for the radiofrequency vs monopolar electrocautery methods (3.7 ± 1.6 vs 3.3 ± 1.4, respectively; p < 0.126). Inter-group analysis showed that tonsillar fossa wound healing scores evaluated on the fifth, 10th and 14th post-operative days were significantly higher in the radiofrequency group compared with the monopolar electrocautery group (p < 0.001). Conclusion: The present study results indicated that monopolar electrocautery tonsillectomy was superior to radiofrequency tonsillectomy in terms of post-operative tonsillar fossa wound healing; however, both techniques were comparable in terms of post-operative pain. [ABSTRACT FROM AUTHOR]

BACKGROUND: The aim of this study was to evaluate the effect of nasal septal deviation (NSD) on ethmoid cell volume and to determine whether there was any correlation between NSD grade and ethmoid cell volume. METHODS: Forty computerized tomography (CT) scans from patients with rhinosinusitis symptoms with NSD were evaluated. Septal deviations were classified into three groups according to the degree of deviation on CT. Ethmoid cell volumes were measured and the relationship between NSD and ethmoid cell volume was investigated. RESULTS: There was a moderate but significant negative correlation between the septal deviation angle and the percentage of the ethmoid cell volumes (p = 0.001, r = -0.5152, r2 = 0.2654). Total ethmoid cell volume on the ipsilateral side compared with the contralateral side was found to decrease as the degree of NSD increased. CONCLUSIONS: Nasal septal deviation affects the total ethmoid cell volume of the nasal cavity. The results of our study underline the role of ethmoid cell volume in the compensation mechanism equalizing the nasal cavity airflow changes due to NSD. [ABSTRACT FROM AUTHOR]

Objective: Tympanostomy tube insertion is one of the most frequently performed procedures in otolaryngology. Complications, such as otorrhea, tympanosclerosis, and cholesteatoma, have been reported in the literature after its application.Study Design: This study reports the complications encountered with 239 children (439 ears) with a follow-up of 7 to 73 months (median, 29 months) after tympanostomy tube insertion. Hearing results and middle ear pressures were compared and complications were noted in 366 ears that were available for the study.Results: Otorrhea developed in 3 (0.8%) cases. Tympanosclerosis was seen in 74 (20.2%) cases. Tympanic membrane perforation, retraction pocket, granulation tissue, and atelectasis were seen in 4.6%, 5.2%, 1.1%, and 6%, respectively. No patients developed cholesteatoma after tube insertion. Hearing results were improved postoperatively in 93.4% of patients (median, 14.2 dB) and worse in 6.6% of patients (median, 8.3 dB). The average extrusion time was 7.3 months for grommet and 16.3 months for T-tubes.Conclusion: Multifactor etiologies show some unsolved or misunderstood underlying pathology, or unmentioned environmental factor such as atopy due to rich flora and humidity might exist to consider in the pathophysiology of the otorrhea. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: This study aims to evaluate white matter microstructure integrity in patients diagnosed with presbycusis (age-related hearing loss) using diffusion tensor imaging (DTI) and to investigate the relationship between DTI parameters and hearing loss severity., Materials and Methods: Patients aged 50 and above with presbycusis (pure-tone average [PTA] ≥20dB) were categorized as mild (PTA 20-34dB), moderate (PTA 35-49dB), or severe (PTA ≥50dB). Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were measured in 16 white matter regions. The relationship between DTI parameters and speech discrimination scores was assessed using multiple linear regression, adjusting for age, sex, and vascular risk profile., Results: The study included 148 patients (mild=32, moderate=84, severe=32). DTI analysis showed significantly lower FA in the left cingulum (p = 0.001) and right IFOF (p = 0.003) in the severe group compared to the mild and moderate groups, while RD in the left cingulum was higher in the severe group (p = 0.006). The mild group exhibited significantly lower left IFOF RD (p < 0.001) compared to the moderate and severe groups, and significantly lower left cingulum body MD (p = 0.004) compared to the severe group. Significant associations were found between speech discrimination scores and DTI parameters, including right hippocampal cingulum MD (p = 0.030), left IFOF RD (p = 0.033), right Heschl's gyrus MD (p = 0.018), and AD (p = 0.008)., Conclusion: This study demonstrated significant alterations in white matter microstructure across different severities of presbycusis. Further research is needed to fully understand the cognitive and central auditory dysfunctions associated with presbycusis., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Objectives: Insulin resistance is associated with increased levels of IGF-1. IGF-1 has been shown to increase the risk of laryngeal squamous cell carcinoma. The Triglyceride-glucose index (TyG index) is a marker of insulin resistance. Our study aimed to investigate the relationship between the TyG index and laryngeal squamous cell carcinoma., Design: Retrospective cohort study., Setting: Two tertiary care academic hospitals., Methods: The study included 53 patients with laryngeal squamous cell carcinoma (Group 1) and 48 healthy volunteers (Group 2). Laryngeal cancer patients were divided into two groups according to their stage. Stages I and II were named Group 1A, and Stages III and IV were called Group 1B. The TyG index was calculated as ln [fasting Triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. The effect of the TyG index on laryngeal cancer was investigated on the parameters of sex, age, body mass index, and stage of the disease., Results: There were no significant differences in age, sex, and BMI between the groups. The TyG index of group 1 (4.75 ± 0.33) was significantly higher than that of group 2 (4.59 ± 0.15). The TyG index value of group 1B (4.84 ± 0.31) was significantly higher than both group 1A (4.61 ± 0.32) and group 2 (4.59 ± 0.15). There was no significant difference between the TyG index values of group 1A (4.61 ± 0.32) and group 2 (4.59 ± 0.15)., Conclusion: The TyG index may be a promising laryngeal squamous cell carcinoma biomarker. People with a higher TyG index may have a higher incidence of laryngeal squamous cell carcinoma and a higher risk of progression., (© 2024 John Wiley & Sons Ltd.)

Objective: The aim of our study is to reduce the complications of pain and chest wall deformity by modifying conventional costal cartilage graft harvesting., Method: In this method while the superior part of the costal cartilage is removed completely, medial, lateral, and inferior parts are excised incompletely and used as a graft. Hence, continuity of the costal cartilage is maintained inferiorly., Results: Nineteen primary and 28 revision rhinoplasty patients were included in the study. There were no donor site complications in the early postoperative period or during one-year follow-up., Conclusion: The modified costal cartilage graft harvesting technique we described is a safe conservative surgical method., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: The aim of this study is to demonstrate a novel surgical technique of total lower lateral cartilage reconstruction using costal cartilage grafts in multiple revision rhinoplasty cases., Method: Total lower lateral cartilage reconstruction technique was utilized in 24 patients who underwent open technique septorhinoplasty between 2019 and 2023. Fourteen of the patients were female, and 10 were male. In this technique, we performed total lower lateral cartilage reconstruction in multiple revision cases where the support of both medial and lateral crura was poor. In cases where only the medial crus or only the lateral crus support was inadequate, we performed reconstruction only for the poorly supported portion. A new lower lateral cartilage was created with grafts obtained from the costal cartilage., Results: The mean age of the patients was 23. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to this technique. Satisfactory results were obtained in the postoperative period after surgery., Conclusion: Multiple revision rhinoplasties present significant difficulties due to complicated nasal anatomy and weakened lower lateral cartilages. We have shown that successful results can be achieved in these complex cases with total lower lateral cartilage reconstruction using costal cartilage grafts., 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., Competing Interests: Declarations. Conflict of interest: None. Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed Consent: For this type of study, informed consent is not required., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Objectives: This study aimed to assess the effectiveness of four-duct ligation following Botulinum toxin-A injections into the parotid and submandibular glands in pediatric patients with sialorrhea resistant to nonsurgical treatments. Prior research has individually explored either surgical or Botulinum toxin interventions; however, the safety and efficacy of the combined approach to these treatments have yet to be documented., Methods: Patients were assessed before surgery and 6, 12, and 24 months post-operatively. Evaluations involved interviews with parents and caregivers, conducted face-to-face or by telephone, using the Drooling Severity and Frequency Scales. Additionally, metrics such as the daily count of bib changes and the hourly frequency of saliva wiping were recorded. Quality-of-life assessments were performed before and after the surgical procedures. All complications associated with the interventions were carefully recorded., Results: The study group consisted of 25 participants, with a median age of 6 years (range 2-17 years). Each participant was diagnosed with a neurological, metabolic, or genetic disorder. Evaluations were conducted periodically, culminating in a final follow-up at 24 months. The treatment demonstrated a 100% success rate at six months post-operation (25/25 patients), which slightly decreased to 96% at the 12-month mark (24/25 patients) and further to 84% by the 24-month follow-up (21/25 patients). Major complications were not observed. However, minor complications were reported in six patients (24%): three exhibited temporary facial swelling (12%), two encountered minor bleeding (8%), and one experienced excessive dryness (4%)., Conclusions: The combination of Botulinum toxin-A injection 3 weeks prior to the four-duct ligation procedure demonstrated high success rates and substantially reduced the incidence of infectious and cosmetic complications. Consequently, this staggered approach to combination treatment is recommended for managing pediatric sialorrhea cases that are resistant to non-surgical interventions., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Adequate nasal tip support is crucial for achieving both aesthetic and functional outcomes in rhinoplasty. This study introduces a wide-based columellar strut graft (WB-columellar strut graft) as a new modification to provide enhanced support for the nasal tip, especially in challenging ethnic and revision rhinoplasty cases., Objective: To present and evaluate the effectiveness of the WB-columellar strut graft in providing sufficient nasal tip support and achieving satisfactory aesthetic outcomes in patients with ethnic noses, Asian noses, and revision rhinoplasty cases presenting with weak caudal septum or anterior nasal spine., Materials and Methods: A total of 32 patients, aged between 17 and 48, were included in this study. Of these, 11 were revision cases, 12 had ethnic noses, and nine had Asian noses. The technique involved preparing a WB-columellar strut graft in two different ways according to the need of particular case. WB-columellar strut graft-1: Constructed from either costal or septal cartilage, with a widened columellar base using bilateral grafts and a columellar strut graft. WB-columellar strut graft-2: Exclusively from costal cartilage, featuring a groove on the anterior surface for insertion of a columellar strut graft to form a wide-based structure. The grafts were applied to provide robust support in cases, where the caudal septum and spine were excessively resected., Results: In 25 patients, the graft was prepared from costal cartilage, while in seven patients it was from septal cartilage. The WB-columellar strut graft-1 modification was used in 22 patients, and the WB-columellar strut graft-2 in 10 patients. Follow-up ranged from 12 to 24 months, with only one case requiring a mini-revision due to visible tip graft. No significant complications were reported in other patients., Conclusion: The WB-columellar strut graft is an effective boost for enhancing nasal tip support in ethnic and revision rhinoplasty cases. It provides a more robust structural foundation, leading to long-lasting and satisfactory aesthetic results. This technique is particularly beneficial for patients with retracted caudal septum and weak anterior nasal spine, providing improved nasal tip projection and rotation., 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Objective: Intranasal analgesic sprays represent a safe, efficacious method for pain relief, with a shorter working time compared to oral painkillers. This study aimed to develop nasal sprays using commonly available over-the-counter analgesics, providing an alternative treatment option that is more convenient and potentially more effective in managing pain, particularly in pediatric patients., Methods: Three different nasal spray formulations with the contents of diclofenac sodium, ibuprofen, and paracetamol were created, and characterization studies were completed. The possible cytotoxic, genotoxic, and apoptotic effects of nasal sprays were studied on human normal skin fibroblastic cells (CCD-1079Sk) using WST cell viability test, alkaline single-cell gel electrophoresis analysis, and acridine orange/ethidium bromide staining, respectively., Results: The formulations' physical appearance and drug content were assessed, yielding nonsignificant results ( p  > 0.05). All formulations were determined at pH 5.5-6.2 so that the pH values of the prepared formulations were compatible with the pH value of the nasal mucosa. Selected nasal spray formulations were stable for 90 days, and the safe doses were chosen as 0.0625, 0.375, and 1.25 mg/mL for diclofenac, ibuprofen, and paracetamol, respectively, by not showing toxicity even at 24 h., Conclusion: This study demonstrated that nasal sprays containing paracetamol, ibuprofen, and diclofenac sodium can be successfully formulated. These new formulations may provide alternative treatment and easier application for patients unable to swallow or refuse to take oral analgesics., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: In rhinoplasty, it is very important to adjust the rotation and projection of the tip together harmoniously with the nasal dorsum and face to achieve pleasing results., Objective: In this study, our aim is to describe a new modification of the vertical alar resection technique that can effectively regulate nasal tip projection and rotation., Materials and Methods: Versatile vertical alar resection (V-VAR) technique was applied to 14 primary and 9 revision rhinoplasty cases with highly projected nasal tip. V-VAR technique consists of three steps. In the first step, the original dome point was marked. In patients with high tip projection and caudal rotation, resection was performed from the lateral crus of the original dome. In patients with high tip projection and cephalic rotation, resection was performed from the medial crus of the original dome. In patients with high nasal tip projection but adequate rotation, an equal amount of resections were performed from both the medial crus and lateral crus of the original dome. The patients were followed in average 18 months (between 12 and 24 months)., Results: The desired type of rotation and projection was achieved utilizing V-VAR technique in all patients. All patients had satisfactory esthetic results., Conclusions: In highly projected nasal tips, the height can be reduced using the proposed V-VAR technique. Rotation in the nasal tip region was maintained, increased or decreased in accordance with the esthetic aims., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Ozone is often used as an additive therapy for skin conditions like infectious diseases, wound healing, diabetic foot, and pressure ulcers. The viability of the nasal skin has crucial importance in revision rhinoplasty cases. The study investigates the potential benefits of medical ozone therapy in healing the nasal skin in multiple-operated cases., Methods: The study retrospectively examined 523 revision rhinoplasty patients operated by the first author from January 2017 to January 2024. Patients consenting to ozone therapy received 3 major autohemotherapy sessions post-surgery. Patients were divided into 2 groups: those with compromised nasal skin (infection, poor vascular supply) and those with normal healing. Age, gender, smoking, diabetes, previous surgeries, grafting materials, and techniques were considered., Results: Of the 523 patients, 12 (2.3%) experienced major skin complications like infection and necrosis, while 511 (97.7%) had no or minor issues, such as discoloration. In total, 301 patients accepted and received ozone therapy. Of the patients without major complications, 299 (58.3%) received ozone therapy, while 212 (41.7%) did not. Among the 12 with major complications, two (16.7%) received ozone therapy, and the remaining 10 (83.3%) did not. Ozone therapy recipients showed statistically fewer skin problems (p<0.05). Costal cartilage as tip and septal extension graft was linked to skin issues (p<0.05). No major adverse effects from ozone therapy were noted., Conclusions: Our findings indicate that ozone therapy may be a safe and potentially effective option for patients undergoing revision rhinoplasty, especially those with compromised nasal skin. It appears to aid in skin healing and regeneration, possibly through enhancing oxygen delivery and modulation of the immune response. Ozone therapy is a promising adjunct treatment for managing skin complications in revision rhinoplasty patients., 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Objective: The aim of this study is to demonstrate use of Lateral Alar Caudal Graft to increase nasal tip definition in primary or revision rhinoplasty cases., Method: Lateral Alar Caudal Graft was used in 24 patients who underwent open technique septorhinoplasty between 2019 and 2023 years. Fourteen of the patients were female and 10 were male. This technique was applied in revision or primary cases where the caudal part of the lateral alar crura of the lower lateral cartilage was lower in the vertical plane than the cephalic part. The Lateral Alar Caudal Graft was sutured over the caudal edge of the lateral alar crura of the lower lateral cartilage., Result: The mean age of the patients was 23. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to this technique. Satisfactory results were obtained in the postoperative period after surgery., Conclusion: We have successfully demonstrated that in primary or revision rhinoplasty cases, nasal tip definition will be enhanced by positioning the caudal level of the lateral alar crura of the lower lateral cartilage higher than the cephalic level using an onlay lateral alar crural graft and eliminated the need for alar rim graft., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: This study examined the potential of ChatGPT as an accurate and readable source of information for parents seeking guidance on adenoidectomy, tonsillectomy, and ventilation tube insertion surgeries (ATVtis)., Methods: ChatGPT was tasked with identifying the top 15 most frequently asked questions by parents on internet search engines for each of the three specific surgical procedures. We removed repeated questions from the initial set of 45. Subsequently, we asked ChatGPT to generate answers to the remaining 33 questions. Seven highly experienced otolaryngologists individually assessed the accuracy of the responses using a four-level grading scale, from completely incorrect to comprehensive. The readability of responses was determined using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) scores. The questions were categorized into four groups: Diagnosis and Preparation Process, Surgical Information, Risks and Complications, and Postoperative Process. Responses were then compared based on accuracy grade, FRE, and FKGL scores., Results: Seven evaluators each assessed 33 AI-generated responses, providing a total of 231 evaluations. Among the evaluated responses, 167 (72.3 %) were classified as 'comprehensive.' Sixty-two responses (26.8 %) were categorized as 'correct but inadequate,' and two responses (0.9 %) were assessed as 'some correct, some incorrect.' None of the responses were adjudged 'completely incorrect' by any assessors. The average FRE and FGKL scores were 57.15(±10.73) and 9.95(±1.91), respectively. Upon analyzing the responses from ChatGPT, 3 (9.1 %) were at or below the sixth-grade reading level recommended by the American Medical Association (AMA). No significant differences were found between the groups regarding readability and accuracy scores (p > 0.05)., Conclusions: ChatGPT can provide accurate answers to questions on various topics related to ATVtis. However, ChatGPT's answers may be too complex for some readers, as they are generally written at a high school level. This is above the sixth-grade reading level recommended for patient information by the AMA. According to our study, more than three-quarters of the AI-generated responses were at or above the 10th-grade reading level, raising concerns about the ChatGPT text's readability., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)