Fevzi Solmaz

BackgroundThe aim of this study was to investigate the relationship between specific sinonasal anatomical parameters and primary acquired nasolacrimal duct obstruction (PANDO) using paranasal sinus computed tomography (PSCT).MethodsThis retrospective case-control study included 42 patients with PANDO and 42 controls. Axial and coronal PSCT images were analyzed to measure the anterior medial lacrimal crest-uncinate process angle (AMLC-UP), nasal bone-lacrimal crest angle (NB-LC), and orbital-maxillary wall distance (OMD). Independent samples t-tests and Mann-Whitney U tests were applied based on data distribution. Variables were entered into stepwise binary logistic regression to identify independent predictors of PANDO.ResultsAMLC-UP angle was significantly higher in the PANDO group compared with controls (mean difference 4.04°, 95% CI: 0.34-7.74, P = .033), while NB-LC angle and OMD did not differ significantly. Multivariate analysis identified both AMLC-UP (OR = 0.916, P = .007) and NB-LC (OR = 1.061, P = .030 (Control:1, PANDO:0)) angles as independent predictors of PANDO. An increasing AMLC-UP angle and a decreasing NB-LC angle were independently associated with higher odds of PANDO. OMD was not retained in the final model. The logistic regression explained 14.6% of variance (Nagelkerke R²) with an overall classification accuracy of 61.9%.ConclusionSubtle angular variations between the lacrimal crest, uncinate process, and nasal bone are independently associated with PANDO, suggesting that lateral nasal wall anatomy contributes to nasolacrimal duct patency. These findings may inform preoperative planning for endoscopic dacryocystorhinostomy.

Background: Frey syndrome is a frequent long-term complication following superficial parotidectomy, with reported prevalence varying widely according to diagnostic methods and follow-up duration. Although most studies focus on the presence of Frey syndrome, limited data are available regarding the influence of surgical technique on the extent or severity of gustatory sweating. Methods: This single-center, prospective observational study included adult patients who underwent superficial parotidectomy for benign parotid gland lesions between March 2021 and March 2023. Frey syndrome was evaluated using the starch–iodine test performed at a median of 12 months postoperatively. Test positivity, clinical symptoms, and the area of starch–iodine test positivity (cm²) were recorded. Patients were grouped according to skin flap elevation technique (cold scalpel vs. monopolar cautery). Tumor size and postoperative outcomes were analyzed, and effect size estimates were calculated to complement statistical significance testing. Results: Thirty patients were included (median age: 59 years; 70% male). The starch–iodine test was positive in 13 patients (43.3%), whereas clinical Frey syndrome was observed in only 2 patients (6.7%). Test positivity rates did not differ significantly between the cold scalpel and monopolar cautery groups (35.7% vs. 50.0%, p = 0.484). Among patients with a positive test, the monopolar cautery group demonstrated a larger median area of gustatory sweating compared with the cold scalpel group (15.85 vs. 8.00 cm²), although this difference did not reach statistical significance ( p = 0.284); a moderate effect size was observed. Conclusion: While the incidence of Frey syndrome was similar between surgical techniques, monopolar cautery was associated with a trend toward a greater extent of gustatory sweating. Among patients with a positive starch–iodine test, differences were observed in the extent of gustatory sweating according to the skin flap elevation technique; however, these findings should be interpreted descriptively and do not imply a causal effect on disease severity. These findings suggest that the skin flap elevation technique may influence the extent of subclinical gustatory sweating, rather than the clinical incidence or severity of Frey syndrome.

Objective The aim of our study is to investigate the predictive and prognostic value of inflammatory cells in blood and tissues in laryngeal lesions. Methods The data of a total of 112 patients, of whom 36 had benign, 38 had premalignant and 38 had malignant laryngeal lesions, were analyzed retrospectively. Along with the demographic characteristics of the patients, hemogram parameters were also captured by hematoxylin-eosin staining performed on pathology preparation lymphocytes and neutrophils, and Langerhans cells count was carried out by immunohistochemical staining. The correlation between blood and tissue inflammatory cells, development of malignancy, disease-free survival time and relationship thereof with survival were analyzed. Results Langerhans cell count and stain volume were found to be significantly higher in malignant group than the premalignant and the benign groups, and they were determined to be higher in premalignant group as compared to the benign group. Early and advanced stages of the illness were compared through the volume of Langerhans cell stain but no difference was found. In the malignant group, it was observed that survival of the group with the higher Langerhans cell count was significantly higher. Considering lymphocyte count in tissues, they were found significantly higher in malignant and premalignant group than the benign group. And eosinophil and neutrophil count in tissues were found to be significantly higher in malignant group than the premalignant and the benign group. In premalignant group, no correlation was found between development of malignancy and inflammatory cells. In comparison of venous blood samples among the subgroups, no difference was found about lymphocyte and eosinophil count. Conclusion In this study, among inflammatory cells, increase of Langerhans cells comes forward as a good prognostic factor. Furthermore, compared with benign and premalignant groups, in malignant group inflammatory cell count was found increased depending on the more significant immune response.

Purpose The definitive treatment for chronic suppurative otitis media is surgery. Surgical technique and procedure varies according to individual case findings and pathology and may require mastoidectomies in which the canal wall is preserved or lowered to eradicate disease from mastoid air cells. Surgical treatment of chronic middle ear disease carries a risk of damage to the inner ear. The aim of this study was to investigate whether the noise produced by the tour system following chronic ear surgery causes sensorineural hearing loss, a condition for which not many studies have been published in the literature. Methods The study consisted of a total of 49 patients with type I, type II and type III canal wall preservation and 62 patients with tympanoplasty with canal wall preservation and lowering. Bone and air thresholds were compared before and after middle ear surgery. Changes in bone and air thresholds were compared according to the type of tympanoplasty. Results In the ICW-I, ICW-II and ICW-III tympanoplasties, and in the ICW and CWD tympanoplasties, the preoperative and postoperative values of the opposite ear hearing measurements were performed, and did not differ according to the type of surgery. There is no correlation drilling duration and hearing for the opposite ear. Conclusion The prevention of postoperative sensorineural hearing loss depends on multiple factors, and assessing the magnitude of hearing loss in relation to these factors is important in determining the success of the surgery.

Summary: There have been studies in the literature regarding the effect of obstructive sleep apnea syndrome on hearing function, but studies on the effect of obstructive sleep apnea syndrome on the peripheral vestibular system are limited. The aim of the present study was to determine whether obstructive sleep apnea syndrome causes functional neurological changes, particularly in the peripheral vestibular system, using the video head impulse test. Overall, 57 patients with obstructive sleep apnea syndrome were included; the ‘Snorers’ group comprised 20 volunteers diagnosed with simple snoring in the polysomnography test. The severity of apnea was assessed by monitoring cardiac and respiratory functions during sleep in both groups. The video head impulse test and audiological evaluations were performed in both groups. Statistically significant differences were found in the cochlea and semicircular canals of our patients in the video head impulse test and audiological battery tests. It may be assumed that decreased blood oxygen concentrations and chronic hypoxaemia have negative effects on the vestibule, cochlear sensory epithelium, and the auditory pathways. We think that inner ear structures and pathways may be affected due to hypoxia in obstructive sleep apnea syndrome. Therefore, screening patients with obstructive sleep apnea syndrome with an audiometry battery may help to detect inner ear pathologies early.

Introduction: The aim of this study was to investigate the relationship between nasal mucociliary clearance time (NMCT), degree of smoking dependence, cumulative smoking burden and OSAS severity in smokers. Material and methods: 123 patients (Group 1) with OSAS and 92 healthy controls (Group 2) were included in the study. Group 1 was divided into smokers (Group 1a) and non-smokers (Group 1b). In Group 1a, cumulative smoking burden and Fagerström nicotine dependence test (FNDT) were questioned. Saccharin test was applied to Groups 1 and 2. Student-t, Mann-Whitney-U, Anova, Kruskal-Wallis tests were used to compare the means. Results: NMCT was higher in Group 1 than Group 2 (p = 0.005). The duration of NMCT was higher in Group 1A than Group 1B (p = 0.002). In Group 1a, NMCT values of mild and moderate OSAS patients were longer than in Group 1b (p = 0.02, p = 0.01, respectively). NMCT values of patients with mild dependence were shorter than those with moderate or severe dependence (p = 0.032, p < 0.001, respectively). Conclusion: Mucociliary clearance time was higher in smokers with OSAS than non-smokers. While OSAS has a negative effect on mucociliary clearance, smoking also exacerbates the condition.

The eradication of the middle ear disease is mentioned as the fundamental principle of tympanoplasty. The presence of some factors related to patient or disease itself forces the physician to classify the chronic ear disease as high-risk perforations. The aim of this study was to present a tri-layer tympanoplasty technique and its otological and audiological outcomes in the ears with high-risk perforations. This retrospective study was carried out on a total of 46 eligible ears that had chronic otitis media with high-risk perforations. Preoperatively, 17, 15, and 14 ears were reported with Sade classification grade 4 pars tensa retraction (Group 1), total or near-total tympanic membrane perforation (Group 2), and a history of ear surgery (Group 3), respectively. All the cases had tympanoplasty using the tri-layer technique at a tertiary center during 2008 and 2014. A review of the patients’ chart showed that 46 patients underwent tri-layer tympanoplasty. Regarding the audiological outcomes, the comparison of pre- and post-operative results revealed mean air conduction level and mean air-bone gap (ABG) of 4 different frequencies in dB according to a new standardized format for reporting hearing outcome in clinical trials. The mean value of the follow-up period was reported as 29.22±3.23 months. Graft take rate was 93.4 % in all the cases, as well as 94.1%, 100%, and 85.7% in Group 1, Group 2, and Group 3, respectively. The mean values of ABG were improved from 35.17±6.64 to 23.52±10.4, 30.46±5.89 to 17.20±8.04, and 29.14±8.37 to 16.14±5.02 dB in Group 1, Group 2, and Group 3, respectively (P<0.05). Tri-layer tympanoplasty is a reliable procedure in the surgical treatment of the chronic otitis media with high-risk re-perforations.

Objectives: Chronic nasal obstruction is a common disease of childhood. Adenotonsillar hypertrophy plays an important role in obstructive sleep apnea. The topical use of the aerosolized forms of corticosteroids therefore seems the most appropriate route to decrease systemic side effects. The aim of our study is to demonstrate the effect of topical mometasone furoate especially on the adenoid volume in patients without any allergic story.Methods: The study group consisting of 30 males and 25 females was administered topical nasal mometasone furoate steroid treatment. The 20 patients were in the control group where saline solution (0.9% NaCl) treatment was administered consisted of 12 males and 8 females. Nasopharyngeal X-rays before treatment revealed that 25 patients were Grade 2 and 30 patients were Grade 3 according to the Fujioka method. Results: Flexible endoscopy performed before the treatment revealed that 20 patients were Grade 2, 11 patients were Grade 3 and 24 patients were Grade 4. Nasal endoscopies performed after 6 weeks of intranasal topical steroid therapy revealed that 45 patients were Grade 1 and 10 patients were Grade 2. A statistically significant difference was present between endoscopic grades before and after treatment (p < 0.0001). Nasal endoscopies performed after 6 weeks in control group receiving saline solution treatment revealed Grade 2 in 7 patients, Grade 3 in 10 patients and Grade 4 in 3 patients. There was no statistically significant difference between in the prior and later grades of the control group (p = 0.3125). Conclusions: We believe that the use of intranasal steroids (mometasone furoate) for 6 weeks in patients with pediatric chronic nasal obstruction due to adenoid hypertrophy may be an effective treatment modality in alleviating symptoms and decreasing adenoid volume without causing systemic side effects.

Objective: Elevated levels of serum IgE and eosinophilia are the indicators of atopy and intestinal parasitic infections. We evaluated the effect of Enterobius vermicularis infection (enterobiasis) on blood eosinophil count and IgE levels in allergic rhinitis. Methods: A total of 110 patients diagnosed with allergic rhinitis (with symptoms of rhinorrhea, itchy nose and nasal congestion) consisting of 41 (37.27%) males and 69 (62.73%) females were examined. Forty-one (37.27%) patients with enterobiasis were selected as the study group. The remaining 69 (62.73%) patients accepted as the control group.Results: In the study group the mean serum total IgE level and mean serum eosinophil count were 393.10 ± 159.83 IU/mL and 0.56 ± 0.04 103/mL, respectively. In the control group the mean serum total IgE level and mean serum eosinophil count were 236.91 ± 63.55 IU/mL and 0.37 ± 0.12 103/mL, respectively. The difference between the two groups was statistically significant for serum total IgE levels (p < 0.05) but not for serum eosinophil count (p > 0.05). The correlation coefficients between serum total IgE level and eosinophil count were statistically insignificant (p > 0.05).Conclusions: More comprehensive and long-term placebo-controlled studies should be performed in order to find the answer to the question of whether helminth infections play a role in allergic disease.