Bülent Topuz

Eficacy of vestibular rehabilitation on chronic unilateral vestibular dysfunction

Objective: To assess the efficacy of vestibular rehabilitation exercises on patients with chronic unilateral vestibular dysfunction. Design: Prospective study. Setting: Physical Medicine and Rehabilitation Clinic and Otolaryngology Clinic of a tertiary referral hospital. Subjects: One-hundred and twenty-five patients with unilateral chronic vestibular dysfunction were included in the study. Interventions: Eight-week, two-staged (clinic and home) vestibular rehabilitation programme with components of Cawthorne-Cooksey and Norre exercises was applied. Main outcome measures: Dizziness Handicap Inventory (DHI) and visual analogue scale (VAS) were completed three times (at the beginning, end of the second week and end of the treatment). Results: Data for 112 patients in the first stage and 93 patients in the second stage were evaluated because of insufficient compliance of the other patients. The mean DHI score was decreased from 50.42 ± 24.12 points to 21.21 ± 15.97 points (p < 0.001) at the end of first two weeks, and to 19.93 ± 19.33 points at the end of the whole treatment. The mean VAS score was decreased from 5.87 ± 2.27 to 2.02 ± 1.75 (p < 0.001) at the end of second week, and to 1.51 ± 1.29 at the end of eighth week. In respect to both VAS and DHI scores, improvement was noted in 67 patients (77.4%). Age, gender and disability level had no predictive value about therapy outcome. Conclusions: There was a fast recovery in the supervised exercise session, whereas there was no significant difference in the home exercise session. These findings suggest that either supervised exercise is better than home exercise or that 10 supervised sessions are sufficient to get the end result.

Importance of mastoid pneumatization on secretory otitis media.

Secretory otitis media is the most common middle ear disease of childhood. It heals spontaneously, by medical therapy or by minor surgical procedures in most of the cases. Sequelae such as retraction pockets and adhesive otitis that lead to cholesteatoma rarely occur, but initially it is hard to diagnose which patient will acquire a sequela. It is well known that mastoid pneumatization is poor in the patients who had complications like retraction pocket, adhesive otitis and cholesterol granuloma. The aim of this study was to determine if any relationship exists between mastoid pneumatization and secretory otitis media. Lateral mastoid X-rays of 47 children with secretory otitis media were evaluated. After 2 months of follow-up with medical therapy, 30 of the 47 patients needed ventilation tube insertion. The remaining 17 patients showed total recovery with medicines only. Control X-rays of the operated patients were taken 6 months after the operation. Mastoid pneumatizations of patients healed with medicine were compared with the operated patients. There were statistically significant differences between the mastoid pneumatizations of surgically and medically treated groups. In addition we observed a statistically significant difference between the mastoid areas of the preoperative and the postoperative X-rays. We concluded that mastoid pneumatization might be considered as a prognostic indicator in secretory otitis media. The estimated prognosis is poor when the mastoid pneumatization is poor.

Prevalence of allergic rhinitis among the adult population in Turkey

Conclusion: The prevalence of self-reported and physician-diagnosed allergic rhinitis (AR) exhibits significant variability across the seven geographical regions in Turkey. Our findings may contribute to the formulation of public health policy and development of preventive and therapeutic strategies for AR in Turkey. Objective: The purpose of this study was to assess the prevalence of AR in the Turkish adult population, with emphasis on descriptive parameters in seven distinct geographical regions in Turkey. Methods: The volunteers were evaluated with a custom-designed questionnaire for AR. Sample size for the study was calculated by allowing for 2% error in prevalence along with a 95% confidence interval (CI). At the end of the study, we reached 4125 volunteers. The data were analyzed with χ2, ANOVA, and Tukey (post hoc) tests. Results: A total of 4125 volunteers participated in the study; 2200 were female and 1925 were male. On the basis of self-reporting, 23.1% of the study population was considered to have AR (males 22.3%, females 23.8%). On the other hand, the prevalence of physician-diagnosed AR was 20.1% (males 19.7%, females 20.4%). The prevalence of self-reported AR was 23.8% in the urban and 18.4% in the rural areas.

Horner's syndrome after excision of cervical sympathetic chain schwannoma.

A 20-year-old girl presented with an asymptomatic left neck mass. It was an approximately 2 2 cm, mobile, nontender, nonpulsatile mass that was laying under the upper portion of the sternocleidomastoid muscle. Using a transcervical approach, we explored the mass. It originated from a very thin nerve branch of cervical sympathetic chain, and the nerve coursed directly into the mass. Although the dissection was meticulously performed, the mass could not be separated from the nerve and the tumor was excised with part of the nerve. A schwannoma was confirmed by pathologic examination. On postoperative day 2, left miosis and ptosis were exhibited. After a 20-month follow-up, the patient had additional clinical findings of Horner’s syndrome, enophthalmos, anhidrosis, and vasodilatation of the ipsilateral face (Fig 1). Surprisingly, she had no complaint about these symptoms.

Experimental Sinusitis in a Rhinogenic Model

Objectives/Hypothesis: The objectives were to determine the optimal sinusitis induction period and to examine microbiological and histopathological changes of sinusitis recovery stage in a rhinogenic sinusitis model.

Does corticosteroid usage in rhinoplasty cause mood changes

In this study, the psychological effects of single-dose corticosteroids administered to patients who had undergone rhinoplasty were assessed. A total of 30 rhinoplasty patients were included in the study and were randomly assigned to 1 of 2 groups. Preoperatively, patients completed the Bech Rafaelsen Mania Scale and the Beck Depression Inventory. Dexamethasone 10 mg was given intravenously just before surgery to the first group, but no medication was administered to the second group. On the first postoperative day, patients were seen again, and the Bech Rafaelsen Mania Scale and the Beck Depression Inventory were again completed. Periorbital edema and ecchymosis were graded, and psychological well-being was measured on a standard visual analog scale. All patients and physicians were blinded to treatment until the end of the study. Results show that administration of a single-dose of dexamethasone 10 mg caused neither euphoria nor depression. No significant differences were observed between steroid and control groups in terms of patients’ psychological well-being. With single-dose dexamethasone, periorbital edema was significantly reduced on the first 2 postoperative days, and upper eyelid ecchymosis was significantly decreased only on the first postoperative day. However, preoperative steroid administration had no influence on ecchymosis of the lower eyelid. The authors conclude that single-dose dexamethasone 10 mg can be used safely to reduce periorbital edema and ecchymosis in rhinoplasty patients.

Does tonsillectomy reduce the risk of being a habitual or severe snorer

We assessed the relationship between tonsillectomy and being a habitual or severe snorer. Volunteers were asked to provide their age and sex, a detailed snoring history covering the frequency and intensity of snoring, and their smoking and alcohol intake habits. After oral and nasal examinations, the tonsil size scores, Mallampati index scores, and nasal obstructions of the volunteers were recorded. Body heights and weights were measured, and body mass indexes were calculated. Being male, aging, an increase in body mass index and tonsillectomy were identified as independent risk factors for being a habitual and severe snorer. Although a nasal obstruction was found to be an independent risk factor for being a habitual snorer, an obstructive tongue base was identified as an independent risk factor for being a severe snorer. Tonsillectomy reduces the risk of being both a habitual and severe snorer. This reduced incidence and intensity of snoring following tonsillectomy could be accepted as a long-term beneficial side effect of the operation.

Provocation of endolymphatic hydrops with a prick test in Meniere's disease.

This study was conducted to test the hypothesis that antigenic challenge is an important stimulative factor for an episode of endolymphatic hydrops. The study was held in a tertiary care center for patients with probable or definite Meniere’s disease. The prick test, which included dietary and inhalant allergens, was applied to all patients with a Multi-Test Applicator (Lincoln Diagnostics, Decatur, Ill). Patients were tested with electrocochleography before and after the prick test. The positive allergen was diluted in 1/10 of a prick test dose, and patients were provoked and tested again. A negative summating potential/action potential (SP/AP) amplitude ratio greater than 0.5 was used as the main outcome measure. Pretest, posttest, and postprovocation SP/AP amplitude ratios were compared. A total of 80 diseased and 16 normal ears of 48 patients with Meniere’s disease were assessed. All patients were found to be atopic, but none had allergic symptoms. No symptom like vertigo or fullness was seen after the prick test was performed. In all, 30 patients had tinnitus and fullness in the diseased ear, and 6 patients had vertigo after the provocation. The SP/AP ratio was greater than 0.50 in 23 diseased (29%) and 3 normal (19%) ears before the prick test. After the prick test, 62 diseased (78%) and 13 normal (81%) ears had endolymphatic hydrops. These numbers did not change much after the provocation. Results reported here support the role of antigenic stimulation for episodes of Meniere’s disease. Endolymphatic hydrops was the atopic reaction that occurred in most study patients

Subjective visual vertical and subjective visual horizontal measures in patients with chronic dizziness

OBJECTIVES We aimed to find the frequency of otolith organ pathologies in the clinical picture of common dizziness etiologies in the chronic stage. METHOD Subjective visual vertical and subjective visual horizontal measures were assessed in patients who had persistent or recurrent dizziness at least 2 months after the acute period. Every patient was tested in three head positions: neutral, right, or left deviation in the roll plane. Test results were compared with those of the control group. RESULTS Seventy-three patients and 18 controls were examined. Fifty-eight of the patients had peripheral vestibular disease; 15 of them had central vestibular disease. Left subjective visual horizontal (SVH) and right SVH measures of the peripheral group were significantly different from those of the control group (p < .01). There was no difference in any test between the peripheral and central groups. When we put a cut off point for abnormality (0, 1) according to mean +/- 2 SD of the control group, the peripheral and central groups had very high significant differences from the control group. Approximately 25 to 50% of our patients had pathologic subjective visual vertical or SVH measures according to test type. CONCLUSION These results showed that the otolith system must be evaluated in the chronic period of dizziness, especially in patients who frequently visit their physician, and modifications in treatment programs must be conducted.

FREQUENCIES OF ADH1C ALLELES AND GENOTYPES IN A TURKISH HEAD AND NECK CANCER POPULATION

Squamous cell carcinoma of the head and neck (SCCHN) have been reported to be related to both genetic and environmental factors, including alcohol consumption and alcohol-metabolizing enzymes such as alcohol dehydrogenase (ADH). We conducted a hospital-based, case-control study including 50 cases with diagnosed SCCHN and 100 controls with non-neoplastic conditions such as upper respiratory tract infection. The genomic DNA was isolated from peripheral blood leukocytes. The ADH1C*1 wild-type and ADH1C*2 variant alleles were analyzed with an RFLP method by using SspI as restriction enzyme. The ADH1C*1 allele frequencies were 0.89 (CI95% = 0.84-0.91) in controls and 0.77 (CI95% = 0.71-0.83) in cases, and respective frequencies of the ADH1C*2 allele were 0.11 (CI95% = 0.07-0.14) and 0.23 (CI95% = 0.17-0.29) among controls and cases (P = 0.01). The ADH1C*1/*1 genotype frequency was significantly higher in the control group (77%) compared to that of the cases (58%) (P = 0.02).These findings suggest that a lower presence of ADH1C*1 allele is associated with SCCHN, but larger numbers are needed to more precisely estimate the interaction, if any, with ADH1C. Interestingly, the ADH1C allele and genotype frequencies in our control group living in Denizli were significantly different compared to a previously published report from healthy volunteers living in Ankara (P < 0.0001).