The Evaluation of Hematologic and Platelet Function in Total Septum Reconstruction Patients

Nasal obstruction is one of the most common complaints within the otolaryngology clinics and it is mainly caused by septum deviation [1,2]. Septum deviation has a close relationship with hypoxia and with hypoxia average platelet counts increase [3,4]. Platelets have an important role in damage repair in both endothelial and haemostasis. Platelets produce proinfl ammatory mediators such as cytokines and chemokine’s during vascular infl ammation. Furthermore, they also lead to release of mediators from the cells in the vascular wall. Activate platelets lead to formation of thrombi by either repairing the endothelial cell erosion or forming an atherosclerotic plaque. This triggers the start of atherothrombotic diseases [5,6].


Introduction
Nasal obstruction is one of the most common complaints within the otolaryngology clinics and it is mainly caused by septum deviation [1,2]. Septum deviation has a close relationship with hypoxia and with hypoxia average platelet counts increase [3,4]. Platelets have an important role in damage repair in both endothelial and haemostasis. Platelets produce proinfl ammatory mediators such as cytokines and chemokine's during vascular infl ammation. Furthermore, they also lead to release of mediators from the cells in the vascular wall. Activate platelets lead to formation of thrombi by either repairing the endothelial cell erosion or forming an atherosclerotic plaque.
Snoring and hypoxia caused by nasal obstruction is usually caused by septal and external deviation, which is treated surgically. Rhinoplasty is technique applied in two ways as closed and open (external), and it allows visibility into the nose cartilage and bone structure, also allows bimanual surgery manipulations and grafting [7]. The fi rst explanation of rhinoplasty is from Indian Sushutra and Samhita from MO 600. Open rhinoplasty was introduced by Rheti in 1934 [8,9].

Materials and Methods
This is a retrospective study consisting of patients with nasal congestion, snoring and misshaped nose symptoms,

Statistics
In the patient group n=100 and control n=101 cases were evaluated. The male and female were done separately the statistical analysis. The statistical analysis was completed using SPSS 20 programme. Unpaired two-sample t-test is used to analyse results. For results showing normal distribution parametric tests were used. Non-parametric tests were used for the analysis of results that did not fi t normal distribution.
For results that fi t normal distribution, the control group and the patient groups values were compared using unpaired twosample t-test, for the age comparisons one-way analysis of  (Chart 1,2). The incidence of the male patient in PLR and NLR was also studied but the observation was statistically not signifi cant. According to the analysis, PLR and NLR parameters between the female patients

Discussion
Nasal obstruction is one of the most common symptoms in nasal septum deviation [1,2,10]. Septum deviation accompanied by the nasal roof, is less commonly seen than insulating septum deviations. Due to nasal obstruction, patients are exposed to intermittent hypoxia. One of the consequences of hypoxia is the difference in platelet function. As shown by previous studies, chronic hypoxia could lead to many cardiovascular diseases by the activation of platelets leading to hypercoagulation (7,11,12).
Similar platelet activation mechanisms are seen in nasal obstruction, which is one of the causes of intermittent hypoxia.
MPV is a parameter that is used in evaluating the size of platelets, as well as being a marker for platelet reactivation potential [3,13]. MPV is a routine hemogram parameter and it gives information on platelet function. Larger platelets are more adhesive and are inclined to be more aggressive [5,6,14].
MPV increases with age, while platelet count decreases [14].   PLR is a new biomarker, which allows detecting infl ammation in both patients with cardiac or noncardiac diseases [11,16]. Song et al. [11], have claimed that PLR and PDW values are infl ammatory markers that can show platelet activation and infl ammation. Several studies have also shown that PLR and NLR values are markers that detect infl ammation [7,12,17,18]. In our study we have found that the PLR and NLR values were not signifi cant in male patients. We have found that PLR and NLR values were signifi cantly in female patients group. Koseoglu et al. [5], have studied MPV and PLR values in OSAS patients and have shown that as the severity of OSAS increased, the PLR values also increased. They also suggested that PLR could be used as a biomarker in OSAS patients with cardiovascular diseases. In patients suffering from septum deviation, it was seen that as age increased, MPV and PDW values increased, which also increased the risk of cardiopulmonary diseases [3]. The male patient group showed signifi cantly higher PDW. Therefore, we can say that the fi rst changes in platelets due to hypoxia start with PDW and that PDW may be a good criterion.
This study showed that, within the young male patient population, septum deviation accompanied by the nasal roof results, the fi rst change in PDW value being an increase. We detected that PLR and NLR values is a signifi cantly in young female patient. As nasal obstruction period is elongated, also increase the risk of cardiopulmonary complication risk in patients. Concerning the mechanisms that are responsible for the age-related changes, this may be effect a variation in hematopoietic stem cell reserve during aging. However, the time that cardiopulmonary complication will occur is not known; patients with apparent septum deviation should be subject to surgery as soon as possible. To conclude, studies have shown that markers, which show the evaluation of hematologic, are also markers that lead in the mortality and morbidity of diseases, which develop due to snoring in patients with septum and external deviations. We believe that further retrospective and prospective studies are required for the markers, which show hematologic functions and platelet activation.

Ethics Committee Approval
The study was approved by the Local Ethic Committee of Kahramanmaras Sutcu Imam University, 70-03/2016.