Süleyman Emre Karakurt

Objective: Endoscopic dacryocystorhinostomy (EDCR) is a widely accepted surgical technique for the management of nasolacrimal duct obstruction. Various factors may influence the success of this procedure; therefore, identifying these determinants is crucial for optimizing surgical outcomes. The aim of the present study was to investigate factors potentially affecting the success of EDCR. Methods: A total of 287 sides from 261 adult patients diagnosed with chronic dacryocystitis who underwent EDCR were included in the study. Surgical success was defined as the absence of epiphora based on history and physical examination, confirmation of patent lacrimal system through irrigation, and presence of patent rhinostomy as determined by endoscopic examination. The impact of factors including sex, age, the type of anesthesia (general or local), preservation of nasal mucosal flap (with or without flap), surgical instrument used [mechanical (rongeur and chisel), powered (microdebrider)], presence of pus, and stent placement (with or without stenting) on surgical success was investigated based on the patients’ medical records. Results: Out of the cases, 259 were successful, resulting in a success rate of 90.2%. Univariate analysis identified 3 variables with the potential to affect success. These variables were sex, surgical instrument used, and stent placement. Through multivariate analysis, the use of surgical instruments and stenting were identified as factors influencing success. The use of powered instruments and stent placement were found to be factors that increase success (odds ratios 3.621 and 5.316, respectively). Conclusion: The use of powered instruments and stent placement emerged as factors that increase success in this study.

Introduction Functional endoscopic sinus surgery and endoscopic skull base surgery are frequently performed surgeries today. Nasal septal deviation is a common finding and can affect the surgical area. Therefore, it is important to examine the effect of this deviation on other anatomical structures. Objectıve The aim of the present study was to determine whether there is a relationship between the degree of nasal septal deviation and anterior skull base structures using computed tomography (CT). Methods A total of 312 patients (aged 18 to 65 years old) whose paranasal sinus CT images were available were included in the study. Measurements were obtained on images retrieved from Picture Archiving and Communication System (PACS) and Horos image archive systems in the bone window in the coronal and axial plane. Results The mean age of 312 patients was 33.00 years old (standard deviation [SD] 11.22 years). The presence of septal deviation was not associated with changes in olfactory fossa (OF) depths, Keros degrees, and the angle between the lateral lamella and the cribriform lamella. However, OF depths and Keros degrees on the deviated side of the septum were found to change at a significant level (p < 0.05). No significant association was observed between the degree of septal deviation and cribriform lamella-lateral lamella angle. Conclusion The study showed significantly increased OF depth and Keros degree on the deviated side of the nasal septum. Performing CT scans before endoscopic sinus surgery and endoscopic skull base surgery is important to increase the chances of a successful surgical outcome and to reduce complications.

Epworth Sleepiness Scale,excessive daytime sleepiness,obstructive sleep apnea,polysomnography

To investigate the acoustic parameter changes after weight loss in bariatric surgery patients. This prospective, longitudinal study was conducted with 15 patients with planned bariatric surgery, who were evaluated pre-operatively and at 6 months post-operatively. Fundamental frequency (F0), Formant frequency (F1, F2, F3, and F4), Frequency perturbation (Jitter), Amplitude perturbation (Shimmer) and Noise-to-Harmonics Ratio (NHR) parameters were evaluated for /a/, /e/, /i/, /o/, and /u/ vowels. Changes in the acoustic analysis parameters for each vowel were compared. The study group was separated into two groups according to whether the Mallampati score had not changed (Group 1) or had decreased (Group 2) and changes in the formant frequencies were compared between these groups. A total of 15 patients with a median age of 40 ± 11 years completed the study. The median weight of the patients was 122 ± 14 kg pre-operatively and 80 ± 15 kg, post-operatively. BMI declined from 46 ± 4 to 31 ± 5 kg/m². The Mallampati score decreased by one point in six patients and remained stable in nine. Of the acoustic voice analysis parameters of vowels, in general, fundamental frequency tended to decrease, and shimmer and jitter values tended to increase. Some of the formant frequencies were specifically affected by the weight loss and this showed statistical significance between Group 1 and Group 2. The present study reveals that some specific voice characteristics might be affected by successful weight loss after bariatric surgery.

Aim: In this study, we aimed to investigate the relationship between sphenoid sinus pneuma¬tization and the angle of the Eustachian tube. Methods: The study included a total of 158 patients. The Eustachian tube angle (ETA) was measured and sphenoid pneumatization was classified in the coronal plane. Results: According to the coronal classification of sphenoid pneumatization, 52 (16%) hemi-sphenoids were type 1, 177 (56%) hemi-sphenoids were type 2, and 87 (27.5%) hemi-sphe¬noids were type 3. According to the sagittal classification, 24 (7.6%) hemi-sphenoids were pre-sellar, 101 (32%) hemi-sphenoids were sellar, and 191 (60.4%) hemi-sphenoids were post-sellar. The mean ETA in coronal classification was 24.71±3.35, 25.03±3.24, and 25.90±3.10 de¬grees for the type 1, type 2, and type 3 classes, respectively. The angle showed a gradual increase from type 1 to type 3, and it was found that ETA was statistically significantly wider in cases with lateral recess pneumatization (type 3, post-rotundum) than in type 2 and type 1 pneumatizations (p=0.039, p=0.035, respectively). Conclusion: ETA is increased in patients with lateral recess pneumatization.

Among the hematological parameters, neutrophil/lymphocyte ratio (NLR) and platelet/ lymphocyte ratio (PLR) have been associated with inflammatory state, microvascular damage and ischemia. It is well-known that these ratios increase in idiopathic sudden sensorineural hearing loss (ISSHL). In ISSHL, different audiographic features may reflect different disease mechanisms. This study aimed to investigate whether there were differences in NLR and PLR among patient groups with different audiometric configurations. Patients meeting the study inclusion criteria were divided into four groups according to their audiogram configurations. Mean NLR and PLR values of the patient groups were compared among themselves and versus control group. The study was conducted with 166 participants. Mean NLR values were 3.07 ± 2.48, 3.30 ± 2.70, 5.24 ± 3.71, 3.57 ± 3.19 and 1.51 ± 0.68 for ascending, flat, descending and total/subtotal audiometric configuration groups and control group, respectively. Mean PLR values were 145.2 ± 126.7, 130.9 ± 57.8, 192.2 ± 94.4, 143.7 ± 70.8 and 94.1 ± 24.7 for ascending, flat, descending, total/subtotal audiometric configuration groups and control group, respectively. Both NLR and PLR were significantly greater in patients from all configuration groups than in control group (p < 0.05). In addition, the group with descending audiometric configuration showed significantly higher mean NLR and PLR compared to other audiometric configuration groups (p < 0.05). The highest level of inflammation was detected in the ISSHL patient group with high frequency hearing loss and descending audiographic configuration.

Purpose To compare retinal capillary plexus vessel densities, choroidal thickness, optic disc vessel densities and foveal avascular zone measurements between normal subjects and subjects with obstructive sleep apnea syndrome (OSAS) using spectral-domain OCT angiography (OCTA). Methods Forty eyes of patients with overall OSAS, 20 eyes of patients with mild-moderate OSAS, 20 eyes of patients with severe OSAS on polysomnography and 21 controls were evaluated with the RTVue-XR Avanti OCTA (Optovue, Inc., Fremont, CA). Superficial and deep retinal capillary plexus vessel densities, choroidal thickness and foveal avascular zone (FAZ) parameters (area, diameter, acircularity index of the FAZ, foveal density-300) were measured for all subjects. Results Superficial capillary plexus vessel densities of the groups were similar. Deep capillary plexus (DCP) vessel densities of all three OSAS groups decreased in the parafoveal region (< 0.001). In the perifoveal region, DCP vessel densities were decreased in the Overall OSAS group (p = 0.023) and in the Severe OSAS group (p = 0.021), whereas it was similar in the Mild-moderate OSAS group. Choroidal thickness decreased in all three OSAS groups (p < 0.001). All FAZ measurements and foveal density-300 measurements were similar compared to the control group. Conclusion Our findings indicate that in severe OSAS patients, deep parafoveal, perifoveal vascular densities decrease and the choroid layer becomes thinner. When evaluating a patient with OSAS, it should be kept in mind that there may be eye involvement due to the disease.

Purpose To evaluate, both subjectively and objectively, whether turbinate outfracture provides any additional benefit in the treatment of inferior turbinate hypertrophy when combined with radiofrequency ablation. Methods The study was conducted on 58 patients diagnosed with inferior turbinate hypertrophy. The patients were randomly divided into two groups according to the treatment they receive. Group A consisted of patients undergoing radiofrequency ablation and Group B included patients undergoing turbinate outfracture in combination with radiofrequency ablation. For the purposes of objective evaluation, all patients underwent acoustic rhinometry and anterior rhinomanometry preoperatively and at 6 months postoperatively. In addition, for subjective evaluation, the patients completed the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire. Postoperative changes in objective and subjective parameters in both groups versus the preoperative period and their differences were compared statistically. Results In Group A, mean postoperative minimal cross-sectional area (MCA) and nasal volume (NV) values and NOSE scores were significantly greater compared to those obtained in the preoperative period. Similarly, Group B showed significantly greater mean postoperative MCA, NV and NOSE score values compared to the preoperative period. In Group A and B, mean postoperative total nasal resistance (TNR) value was significantly lower in comparison to the preoperative period. The differences in mean preoperative and postoperative MCA, NV, TNR and NOSE scores were significantly greater in Group B versus Group A. Conclusion The addition of turbinate outfracture to inferior turbinate radiofrequency ablation treatment provides both objective and subjective benefits in the resolution of nasal obstruction.