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    Chronic Rhinosinusitis—Could Phenotyping or Endotyping Aid Therapy?
    (SAGE Publications Inc., 2019) Bayar Muluk N.; Cingi C.; Scadding G.K.; Scadding G.
    Objectives: We reviewed the phenotyping and endotyping of chronic rhinosinusitis (CRS) and treatment options. Methods: We searched PubMed, Google, Google Scholar, and the Proquest Central Database of the Kırıkkale University Library. Results: Phenotypes are observable properties of an organism produced by the environment acting upon the genotype, that is, patients with a particular disorder are subgrouped according to common characteristics. Currently, CRS is usually phenotyped as being with (CRSwNP) or without (CRSsNP) nasal polyps. However, this is not immutable as some individuals progress from nonpolyp to polypoid CRS over time. Phenotypes of CRS are also based on inflammatory patterns, generally CRSwNP is eosinophilic, CRSsNP neutrophilic; but there is a spectrum, rather than a clear-cut division into 2 types. An endotype is a subtype of a condition defined by a distinct functional or pathobiological mechanism. Endotypes of CRS can be (1) nontype Th2, (2) moderate type Th2, and (3) severe type Th2 immune reactions, based on cytokines and mediators such as IL4, 5, 13. CRS endotyping can also include a (1) type 2 cytokine-based approach, (2) eosinophil-mediated approach, (3) immunoglobulin E-based approach, and (4) cysteinyl leukotriene-based approach. Subdivisions of CRSwNP can be made into nonsteroidal anti-inflammatory drug-exacerbated respiratory disease, allergic fungal sinusitis, and eosinophil pauci-granulomatous arteritis by testing. General treatment for all CRS is nasal douching. The place of surgery needs careful reconsideration. Endotype-directed therapies include glucocorticosteroids, antibiotics, aspirin, antifungals, anticytokines, and immunoglobulin replacement. The recognition of united airways and the co-occurrence of CRSwNPs and severe asthma should lead to common endotyping of both upper and lower airways in order to better direct therapy. Conclusion: Endotyping can allow for the identification of groups of patients with CRS with a high likelihood of successful treatment, such as patients with a moderate type 2 immune reaction or those with acquired immune deficiency. © The Author(s) 2018.
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    Is there a relationship between mastoid pneumatisation and facial canal dimensions?
    (Cambridge University Press, 2019) Inal M.; Bayar Muluk N.; Asal N.; Şahan M.H.; Şimşek G.; Arikan O.K.
    Objective To evaluate mastoid pneumatisation and facial canal dimensions.Method In this retrospective study, 169 multidetector computed tomography scans of temporal bone were reviewed. Facial canal dimensions were evaluated at the labyrinthine, tympanic and mastoid segments using axial and coronal multidetector computed tomography scans of temporal bone. Mastoid pneumatisation and facial canal dehiscence were evaluated. Facial canal dehiscence was measured if it was found to be present.Results This study showed that facial canal dimensions decreased in pneumatised mastoids. Facial canal dimensions in females were smaller than in males. Facial canal dehiscence was detected in 5.9 per cent and 6.5 per cent of the patients on the right and left sides, respectively. No correlations were found between facial canal dehiscence and mastoid pneumatisation. The length of dehiscence was 1.92 ± 0.44 mm (range, 0.86-2.51 mm) on the left side. In older subjects, left facial canal dehiscence was detected more, and the length of the dehiscence increased.Conclusion This study concluded that during surgery, facial canal dehiscence should be kept in mind in order to avoid complications. © 2019 JLO (1984) Limited.
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    Olfactory Bulb Volume and Olfactory Sulcus Depth in Patients With OSA: An MRI Evaluation
    (SAGE Publications Ltd, 2019) Doğan A.; Bayar Muluk N.; Şahin H.
    Objectives: We evaluated olfactory functions in patients with obstructive sleep apnea (OSA). Methods: The cranial magnetic resonance images of 58 adult patients (36 males and 22 females) aged 27 to 79 years were retrieved from the hospital picture archiving and communication system (PACS) system. There were 29 patients with OSA (17 males and 12 females), diagnosed according to the polysomnography results. A control group consisted of 29 healthy patients without OSA. Olfactory bulb (OB) volume and olfactory sulcus (OS) depth measurements were performed. Nasal septal deviation (SD) was also evaluated and recorded as no SD, deviation to the right, and deviation to the left in all groups. Results: Olfactory bulb volumes of the OSA group were significantly lower than those of the control group (P <.05), whereas OS depth values were not different (P >.05). There was a positive correlation between the right and left OB volumes and right and left OS depth values (P <.05). In older patients with OSA and in female patients with OSA, OB volumes decreased bilaterally (P <.05). Olfactory sulcus depth of the right side was lower in the female patients with OSA compared to the male patients with OSA (P <.05). There were no significant correlations between apnea–hypopnea index and OB volumes and OS depth values in the OSA group (P >.05) Conclusion: In patients with OSA, OB volumes decreased bilaterally. It may be related to intermittent nocturnal hypoxia/reoxygenation episodes, which may be a trigger for upper airway inflammation; and proinflammatory mediators maybe harmful on olfactory neuroepithelium and olfactory impairment may occur. © The Author(s) 2019.