BACKGROUND AND OBJECTIVES: Septoplasty with or without turbinate surgery is performed by many otorhinolaryngologists. However, the surgical methods largely rely on clinical judgement alone. The purpose of this study is to investigate the correlation between deviated nasal septum and inferior turbinate with compensatory hypertrophy on paranasal sinus computed tomography (CT) and to suggest a guideline for septal and turbinate surgery. SUBJECTS AND METHOD: Paranasal sinus CT scans of twenty patients with nasal septal deviation and compensatory hypertrophy of inferior turbinate were taken and reviewed. Measurements of thickness of mucosa and medial conchal bone, projection angle of inferior turbinate, distance between medial conchal bone and lateral nasal line, and interval between median line and conchal bone were obtained. Each measurement was compared with that of opposite side of nasal cavity and normal control subjects. RESULTS: The thickness of medial mucosa and conchal bone of inferior turbinate of concave side were more increased than those of the other side (p<0.05). The projection angles of conchal bone from lateral nasal wall in each side were different and the distances between medial conchal bone and lateral nasal line were more increased in concave side (p<0.05). CONCLUSION: Septoplasty and concomitant inferior turbinate surgery that manipulates conchal bone and soft tissue is necessary for the patients with a complaint of nasal obstruction. Reduction of medial mucosa and out-fracture of hypertrophied inferior turbinate are proper for the concomitant inferior turbinate surgery. The data gathered using CT images are important in making a decision regarding turbinate surgery in septoplasty.
Humans ; Hypertrophy* ; Mucous Membrane ; Nasal Cavity ; Nasal Obstruction ; Nasal Septum ; Tomography, X-Ray Computed ; Turbinates*

BACKGROUND AND OBJECTIVES: Various surgical approach has been used for the removal of pituitary tumor. Recently, endoscopic transnasal transsphenoidal approach has been technically upgraded and the morbidity associated with surgical treatment of the pituitary tumor has been decreased. The objectives of our study was to describe surgical techniques and materials used in sellar repair after endoscopic transnasal transsphenoidal approach. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 18 patients who had received endoscopic transnasal transsphenoidal pituitary surgery between November 2002 and January 2004. We evaluated effectiveness of this technique by analyzing surgical techniques, symptom improvement and complications after surgery. RESULTS: In most of the case, tumor was found to be macroadenoma and 8 of the cases had suprasellar extension. Tumor was totally removed in 13 cases and partially removed in 5 cases. In all cases we used endoscopic unilateral transnasal transsphenoidal approach with anterior sphenoidotomy. CONCLUSION: We may consider that this approach is more safe and effective and a better treatment method for pituitary tumor surgery than the transcranial approach.
Endoscopy ; Humans ; Hypophysectomy* ; Medical Records ; Pituitary Neoplasms* ; Retrospective Studies

BACKGROUND AND OBJECTIVES: As a result of increasing the use of hematopoietic stem cell transplantation (HSCT) for hematologic malignancies and certain solid tumors, more patients have become susceptible to infection. Sinonasal infections in patients with HSCT frequently cause problems which are sometimes fatal. The purpose of this study is to determine the clinical features of sinonasal infections in the immunocompromised patients who received HSCT and to suggest a proper evaluation of these patients. MATERIALS AND METHOD: We reviewed retrospectively 1814 patients who had received HSCT in St. Mary's hospital from August 1995 to May 2003 to determine the clinical features of sinonasal infections in these patients and to analyze the correlation between sinonasal infection of pre- and post-HSCT. RESULTS: 403 patients (22.2%) had sinonasal infections. The infection occurred before HSCT in 206 patients (11.3%), whereas it occurred after HSCT in 197 patients (10.8%). Of 197 patients (27.4%) 54 had previously sinonasal infections. CONCLUSION: Sinonasal infection in the patients of pre-HSCT increased incidence of post-HSCT sinonasal infection. Early detection using endoscopic examination and sinus computed tomography scan as well as employing an aggressive combined treatment of medical and surgical modalities are essential for the treatment of sinonasal infections in the HSCT patients.
Hematologic Neoplasms ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Immunocompromised Host ; Incidence ; Retrospective Studies ; Sinusitis

BACKGROUND AND OBJECTIVES: Septoplasty with turbinate reductive surgery is a frequently performed operation for the treatment of nasal obstruction. However, the effect of septoplasty on olfactory function has not been systematically evaluated. The purpose of this study is to investigate changes of olfactory function following septoplasty with turbinate reductive surgery and to evaluate correlations between the change of minimal cross sectional area (MCA) of nasal cavity and nasal volume and olfactory function after nasal surgery. SUBJECTS AND METHOD: Olfactory threshold and identification test of 25 patients with nasal septal deviation and compensated hypertrophy of inferior turbinate were taken pre- and postoperatively. Nasal volume and MCA were measured using acoustic rhinometry before and after the nasal surgery. RESULTS: Septoplasty with turbinate reductive surgery increased the volume and MCA of the nasal cavity and scores of the olfactory identification test were increased after the septal surgery (p<0.05). However, some patients have decreased scores in the olfactory function test after surgery. There were no correlation between the changes of olfactory threshold and acoustic rhinometric parameters of nasal cavity. CONCLUSION: Septoplasty with turbinate reductive surgery has some beneficial effect on olfactory function. However, there are no correlation between changes of olfactory function and changes of parameters in acoustic rhinometry. Preoperative olfactory test is advisable and informed consent for postoperative change of olfaction is necessary in assessing patients for nasal surgery.
Acoustics ; Humans ; Hypertrophy ; Informed Consent ; Nasal Cavity ; Nasal Obstruction ; Nasal Septum ; Nasal Surgical Procedures ; Rhinometry, Acoustic ; Smell ; Turbinates*

BACKGROUND AND OBJECTIVES: The effect of electrical stimulation (ES) on vestibular compensation was investigated for 28 days after unilateral labyrinthectomy (Lx) in 24 rats. MATERIALS AND METHOD: The rats were divided into 4 groups and were treated as follows: A) Lx only, B) Lx with ES (0.6 mA) for 2 days, C) Lx with ES (0.6 mA) for 7 days, D) Lx with ES (1.2 mA) for 2 days. ES with pulse wave (10 Hz) was applied to temporal portion bilaterally (8 hr/day). Cathodal currents were transmitted to the electrode on the destructive side, anodal to that on the intact side. Postoperatively, spontaneous nystagmus (SN) was recorded with the video camera and yaw and roll head tilt (YHT, RHT) were measured using photo images. Horizontal vestibulo-ocular reflex (VOR) was evaluated at various frequencies (0.05, 0.1, 0.5, 1, 2, 3 Hz with peak angular velocity of 40degrees/sec) with the magnetic search coil system. Locomotor movement was monitored with a video camera. RESULTS: The ES groups showed faster compensation in SN, YHT, and RHT than the Lx group. At 3 days after Lx, the ES groups showed significant improvement in the gain over the whole frequency and asymmetry at low frequency compared to that of the Lx group. But the ES group had no effect on compensation of gain and asymmetry on and after 7 days of post-labyrinthectomy. There was no significant difference in vestibular compensation with respect to duration and intensity of ES. ES had no significant effect on the mean velocity and mean deviation of locomotor movements. CONCLUSION: These results suggest that ES has a favorable effect on the suppression of early static symptoms but has no effect on the compensation of dynamic symptoms after the recovery of resting discharge of the vestibular nuclei neurons.
Animals ; Compensation and Redress* ; Ear, Inner ; Electric Stimulation* ; Electrodes ; Head ; Neurons ; Rats* ; Reflex, Vestibulo-Ocular ; Vestibular Nuclei

BACKGROUND AND OBJECTIVES: Anatomic variations of the sphenoid sinus and the related neurovascular structures are common. Because it is a rule that may complicate surgery in such a place, these variations should be known preoperatively. The aim of this study was to delineate the relationship between the pneumatization of the sphenoid sinus and the related neurovascular structure variations including carotid artery and optic nerve. SUBJECTS AND METHOD: A review of 100 paranasal sinus tomographic scans was made to investigate the anatomic variations of the sphenoid sinus and the related structures. The analyzed items were the pneumatization of the sphenoid bone including anterior clinoid process (ACP) and pterygoid process (PP), the relationship between the pneumatization of the sphenoid sinus and the incidence of bulging of the internal carotid artery (ICA), optic nerve (ON), maxillary nerve and pterygoid nerve. The patterns of intersinus septum and accessory septum were also assessed. RESULTS: The most prevalent type of the pneumatization of the sphenoid sinus was the sellar type (90%). Midline location of the septum was found in 32 patients. Accessory septum was found in 52 patients. The bulging of ICA into the sphenoid sinus was found in 52 patients (retrosellar segment) and 67 patients (presellar segment). ON bulging was found in 52 patients. Patients showing pneumatization of ACP and PP were 20 and 34, respectively. There was a statistically significant relationship between the pneumatization of ACP, PP and the bulging in ICA and ON. Number of patients showing bulging of the maxillary nerve and pterygoid nerve was 36 and 49, respectively. CONCLUSION: Accurate evaluation of the pneumatization of the sphenoid sinus and the variations of the related neurovascular structures is possible with preoperative CT scans of the sinus. Numerous variations of the related neurovascular structures are related with degrees of pneumatization of the sphenoid sinus. For safe sphenoid sinus surgery, a thorough analysis of the preoperative CT scans as well as the precise anatomic knowledge is required.
Carotid Arteries ; Carotid Artery, Internal ; Humans ; Incidence ; Maxillary Nerve ; Optic Nerve ; Sphenoid Bone ; Sphenoid Sinus* ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: For patients with sudden hearing loss or retina arterial spasm, stellate ganglion block (SGB) has been used as a treatment method to increase the blood flow to the interested area. The aim of this study is to prospectively investigate the efficacy of SGB in patients with olfactory dysfunction following upper respiratory tract infection (URI). MATERIALS AND METHOD: Fifty one patients with anosmia or hyposmia following URI were included. The average duration of olfactory dysfunction was 3.5+/-8.4 years. Thirty eight patients were treated with SGB and compared with the untreated 13 patients. Buthanol threshold test and odor identification test with 16 natural fragrances were used to determine anosmia/hyposmia in these patients and to quantify the improvement of olfactory perception after SGB treatment or follow-up without treatment. RESULTS: Olfactory perception was improved significantly in the treated patients as shown by the buthanol threshold test (p<0.001) and by odor identification test (p<0.001). Subjective olfactory perception was improved in 27 of the 38 treated patients (p<0.001). No complications were observed after SGB and no one reported any worsening in olfactory perception during or after treatment. On the other hand, none of the untreated patients showed any improvement in neither of the tests or the subjective assessment. CONCLUSION: These results suggest that SGB may be a new treatment modality for olfactory dysfunction following URI.
Follow-Up Studies ; Hand ; Hearing Loss, Sudden ; Humans ; Odors ; Olfaction Disorders ; Olfactory Perception ; Prospective Studies ; Respiratory System* ; Respiratory Tract Infections* ; Retina ; Smell ; Spasm ; Stellate Ganglion*

BACKGROUND AND OBJECTIVES: The etiology and the pathophysiology of nasal polyps are still not definitely known and recently, it is suggested that inflammatory responses involving eosinophils may play a major role. The process of the infiltration of eosinophils in tissues is explained by the increase of the movement of eosinophils to the inflammatory area and the delay of apoptosis which results in the longer survival of eosinophils. Recently, there have been studies showing how eosinophils extracted from blood expressed their anti-apoptotic Bcl-xL genes and pro-apoptotic Bax genes when put in a delayed apoptotic condition. The purpose of this study is to investigate Bcl-xL and Bax expressions of eosinophils in nasal polyps and how allergic rhinitis affect their expressions. MATERIALS AND METHOD: Nasal polyps were obtained from patients with chronic paranasal sinusitis (30 cases) and nasal polyps were divided into two groups, one obtained from the patient with allergic rhinitis (15 cases) and the other obtained from the patient without allergic rhinitis (15 cases). The normal control group consisted of 5 cases of normal nasal mucosa in the inferior turbinate. The immunohistochemical stain was used to detect eosinophils and the cells expressing Bcl-xL and Bax. RESULTS: In nasal polyps, a significant statistical correlation between eosinophil numbers and Bcl-xL positive cell numbers was detected. But there was no correlation between them in the normal control. The Bax positive cell numbers had a correlation to eosinophil numbers in both the normal control and nasal polyps. And allergic rhinitis did not affect the expression of Bcl-xL and Bax of eosinophils in nasal polyps. CONCLUSION: The authors propose that in eosinophils of nasal polyps, Bcl-xL plays an important role in delayed apoptosis and allergic rhinitis has no effect on the expression of Bcl-xL and Bax.
Apoptosis ; Cell Count ; Eosinophils ; Humans ; Nasal Mucosa ; Nasal Polyps* ; Rhinitis ; Sinusitis ; Turbinates

BACKGROUND AND OBJECTIVES: Measurement of the peak nasal inspiratory flow rate (PNIFR) is a useful technique for obtaining a quick measure of nasal obstruction and changes in PNIFR, reflecting changes in symptoms. The aim of the present study was to correlate changes in nasal obstruction symptoms with changes in several parameters of acoustic rhinometry (AR) and peak nasal inspiratory flow metry (PNIFM) before and after decongestion and to examine whether changes in PNIFR correlate with changes in nasal cross-sectional areas and volume. MATERIALS AND METHODS: The subjects of the current study were 30 patients with nasal obstruction symptoms and 20 normal subjects. Subjective nasal patency was assessed by visual analogue scale (VAS). We measured PNIFR and minimal cross-sectional area (MCA), cross-sectional area at distances of 3.3 (CA3.3), 4.0 (CA4.0), and 6.4 (CA6.4) cm from the nostril and volume from the nostril 6.4 cm (V6.4) towards the choanae, in each nasal cavity before and after decongestion. RESULTS: The VAS had no significant correlation with PNIFR, each cross-sectional area and volume in bilateral nasal cavities before decongestion. There was a significant correlation between the changes in VAS and PNIFR and MCA before and after decongestion. There was a significant correlation between changes in PNIFR and MCA and CA3.3 in one side and both sides of nasal cavity before and after decongestion. CONCLUSIONS: These results suggest that PNIFM and AR may have no sensitive diagnostic values in estimating the severity of nasal obstruction symptoms in the nondecongested state of the bilateral nasal cavities, but PNIFM and AR can be recommended especially in provocation studies because PNIFR and MCA reflect changes in subjective symptoms by mucosal changes.
Acoustics* ; Humans ; Nasal Cavity ; Nasal Obstruction* ; Nasopharynx ; Rhinometry, Acoustic*

BACKGROUND AND OBJECTIVES: Measurement of the peak nasal inspiratory flow rate (PNIFR) is a useful technique for obtaining a quick measure of nasal obstruction and changes in PNIFR, reflecting changes in symptoms. The aim of the present study was to correlate changes in nasal obstruction symptoms with changes in several parameters of acoustic rhinometry (AR) and peak nasal inspiratory flow metry (PNIFM) before and after decongestion and to examine whether changes in PNIFR correlate with changes in nasal cross-sectional areas and volume. MATERIALS AND METHODS: The subjects of the current study were 30 patients with nasal obstruction symptoms and 20 normal subjects. Subjective nasal patency was assessed by visual analogue scale (VAS). We measured PNIFR and minimal cross-sectional area (MCA), cross-sectional area at distances of 3.3 (CA3.3), 4.0 (CA4.0), and 6.4 (CA6.4) cm from the nostril and volume from the nostril 6.4 cm (V6.4) towards the choanae, in each nasal cavity before and after decongestion. RESULTS: The VAS had no significant correlation with PNIFR, each cross-sectional area and volume in bilateral nasal cavities before decongestion. There was a significant correlation between the changes in VAS and PNIFR and MCA before and after decongestion. There was a significant correlation between changes in PNIFR and MCA and CA3.3 in one side and both sides of nasal cavity before and after decongestion. CONCLUSIONS: These results suggest that PNIFM and AR may have no sensitive diagnostic values in estimating the severity of nasal obstruction symptoms in the nondecongested state of the bilateral nasal cavities, but PNIFM and AR can be recommended especially in provocation studies because PNIFR and MCA reflect changes in subjective symptoms by mucosal changes.
Acoustics* ; Humans ; Nasal Cavity ; Nasal Obstruction* ; Nasopharynx ; Rhinometry, Acoustic*