Cem Bayraktar

Relationship between increased carotid artery stiffness and idiopathic subjective tinnitus.

Tinnitus is defined as perception of sound with no external stimulus, and can separate into pulsatile and non-pulsatile types. Arterial stiffness is a parameter that can predict the cardiovascular event and associated with incidence of stroke. It has been shown that increased arterial stiffness may lead to microvascular damage in brain. Our aim was to assess the arterial stiffness of the carotid system in the development and severity of idiopathic subjective tinnitus. Forty subjective tinnitus patients and 40 age- and sex-matched controls were enrolled in the study. The parameters obtained from the participants included pure tone hearing (dB), serum lipid profile (mg/dl), fasting glucose (mg/dl), blood pressure (mmHg), and body mass index (BMI, kg/m2). The common carotid artery (CCA) stiffness index, Young’s elastic modulus (YEM), common carotid intima–media thickness (CIMT), peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), pulsatility index (PI), vessel diameter, mean velocity (MV), and volume flow (VF) were measured in both the right and left common carotid arteries in both groups. The CCA stiffness index, YEM measurements, right CIMT, and left PI were found to be significantly higher in the patients than those in the control group (p < 0.05). With regard to the severity of the tinnitus and the patient characteristics, there was a significant positive correlation with the CCA stiffness index, YEM measurements, left CIMT, and neutrophil-to-lymphocyte ratio (NLR). However, only the right and left CCA stiffness parameters were found to be statistically significant in the multivariate analysis as independent predictors of a moderate to high degree of tinnitus. The increased stiffness index of the common carotid arteries was significantly associated with the formation and severity of tinnitus. Therefore, an assessment of the carotideal system may be helpful in these patients.

Bilateral parotitis in a patient under continuous positive airway pressure treatment

BACKGROUND AND OBJECTIVES Many conditions such as bacterial and viral infectious diseases, mechanical obstruction due to air and calculi and drugs can cause parotitis. We present a case of unusual bilateral parotitis in a patient under non-invasive continuous positive airway pressure (CPAP) therapy for chronic obstructive pulmonary disease exacerbation in intensive care unit. CASE REPORT A 36-year-old patient was admitted to intensive care unit with the diagnosis of chronic obstructive pulmonary disease exacerbation. Antibiotherapy, bronchodilator therapy and non-invasive positive pressure ventilation were applied as treatment regimen. Painless swellings developed on the 3rd day of admission on the right and a day after this on the left parotid glands. Amylase levels were increased and ultrasonographic evaluation revealed bilateral parotitis. No intervention was made and the therapy was continued. The patient was discharged on the 6th day with clinical improvement and regression of parotid swellings without any complications. CONCLUSIONS Parotitis may have occurred after retrograde air flow in the Stensen duct during CPAP application. After the exclusion of possible viral and bacteriological etiologies and possible drug reactions we can focus on this diagnosis.

Retinal Nerve Fiber Layer Thickness Alteration in Apneic Children.

Purpose We examined retinal nerve fiber layer (RNFL) thickness alterations in children with chronic upper airway obstructions (UAOs) and obstructive sleep apnea syndrome (OSAS). We also investigated whether it was affected by an adenotonsillectomy operation. Methods Forty-two children aged 3 to 8 years with chronic UAO resulting from adenotonsillar enlargement and 34 age-matched controls were included in the study. Patients underwent a Brouillette scoring questionnaire to be divided into mild (N = 10), moderate (N = 22), severe (N = 10), and total (N = 42) UAO groups. According to the scoring, the severe UAO group was defined as the severe OSAS group, the moderate group was suspicious for OSAS, and the mild UAO group was defined as the non-OSAS group. The patients’ demographic data for age, sex, and body mass index were obtained. Ophthalmologic evaluations were performed with optical coherence tomography. Central corneal thickness, macular thickness, intraocular pressure (IOP), and RNFL thickness were measured. An adenotonsillectomy was performed on all patients, and eye examinations and scoring were repeated after the surgery. Results Higher IOP levels were obtained between the total UAO group and the control group (p > 0.05). There were significant differences between UAO groups and the control group except for the moderate UAO group. There was no significant difference in RNFL thickness (p > 0.05) between preoperative UAO groups and the control group. However, after surgery, some significant differences emerged in the superior, inferior, and average RNFL thickness (p < 0.05). Also, IOP levels were significantly lower in the mild, moderate, and total UAO groups after the operation (p < 0.05). Conclusions Upper airway obstruction and OSAS seem to worsen some RNFL and IOP parameters in children, and eye examinations may be useful in these patients.

Increased Concomitant Nasal Procedure Frequency in Bilateral Endoscopic Dacryocystorhinostomy

Abstract The etiology of primary nasolacrimal duct obstruction (NLDO) is unknown, and the disease may exist bilaterally in a small number of patients. Dacryocystorhinostomy (DCR) surgery is the recommended treatment for these patients, but concomitant nasal pathologies are believed to be related to decreased surgical success. The authors aim to assess the concomitant required nasal surgical procedure frequency for endoscopic surgical access retrospectively in bilateral and unilateral NLDO patients. Twenty-eight patients who underwent bilateral endoscopic DCR simultaneously and 30 patients who underwent unilateral endoscopic DCR were enrolled in this retrospective study. Required concomitant nasal procedure frequency was recorded. In the bilaterally applied DCR group, septoplasty, partial midline turbinectomy, and inferior nasal concha submucosal resection rates were 16 (57.1%), 5 (17.8%), and 3 (10.7%) patients, respectively. Septoplasty and concha bullosa resection were performed simultaneously in 2 patients. Also, uncinectomy was performed with septoplasty in 1 patient. The concomitant nasal surgery rate was 22 of 28 patients (78.6%). On the other hand, in the unilaterally applied DCR group, septoplasty, partial midline turbinectomy, and inferior nasal concha submucosal resection rates were 5 (16.7%), 1 (3.3%), and 2 (6.7%) patients, respectively. Both septoplasty and concha bullosa resection were done in 1 patient. Uncinectomy was performed on 1 (3.3%) patient. A concomitant surgery rate was observed in 8 of 30 patients (26.7%). Nasal pathology, which requires surgical intervention, is seen much more frequently in bilateral than in unilateral NLDO patients.

Simultaneous Bilateral Endonasal Endoscopic Dacryocystorhinostomy: A Low Cost, Fast, and Successful Method.

AbstractThe etiology of primary nasolacrimal duct obstruction is largely unknown, and this disease may occur bilaterally in a small percentage of patients. In this retrospective study, the authors aimed to discuss the cost, operation time, complications, and success rate of simultaneous bilateral endonasal endoscopic surgery. Twenty-eight patients (16 female, 12 male) were enrolled in this study, with a mean age of 55 years old (range: 43–76). The success rate was 91% (51/56), and the mean operation time was 44 minutes. Only minor and transient complications were observed in 2 of the patients. Overall, the authors believe that a bilateral endoscopic dacryocystorhinostomy would be useful in a single session, based on its advantages of low morbidity, low cost, and high success.

Reply to the letter to the editor by Beyan concerning: Increased mean platelet volume in patients with idiopathic subjective tinnitus

We appreciated the comment of Beyan on our paper which investigating the relationship between mean platelet volume (MPV) and idiopathic subjective tinnitus [1]. At first, there is a comment about platelet function and MPV, and claim that MPV is linked with platelet production, not function. In our study, we did not focus on platelet function and we did not use MPV as a platelet function indicator. On the other hand, there are numerous studies in literature which stated that MPV values were related with platelet function [2–6]. We think that this relation can be explained in an indirect way. Larger platelets have more granules and aggregate more rapidly. In addition, increased MPV was found associated with shortened bleeding time [6]. Second, there is a comment about MPV measurement method. As we mentioned in our study, MPV can be affected by several parameters such as age, hyperlipidemia, and smoking. Because of this reason, we created homogenous groups. In addition, some other factors can be responsible for wrong measurement such as used anticoagulant, storage temperature, analysis time and counters [7]. When used ethylenediamine tetraacetic acid (EDTA) as an anticoagulant, there are different statements about time interval for optimal MPV measurement. Dastjerdi et al. reported that if the measurements were performed within 1 h time, accurate measurements could be performed with using EDTA anticoagulant [2]. Lancé et al. propose measurements 120 min after sampling to perform appropriate measurements when using EDTA [8]. We were not standardized time interval in our study but MPV measurements were performed in all individuals in the same way. All the subjects and controls’ MPV values were measured similarly in both groups, and we found statistically significant alterations. Therefore, we think that our findings are very important and we believe that MPV can be qualified as a useful marker in tinnitus patients.

Ocular blood flow alterations during inferior turbinate radiofrequency reduction under local anesthesia.

Background Ocular blood flow alterations and blindness are uncommon and less-known adverse effects of nasal local anesthetic infiltrations. Our aim was to investigate ocular blood flow alterations during radiofrequency (RF) tissue reduction of inferior turbinates with the patient under local anesthesia by using a noninvasive method with optical coherence tomography. Methods A total of 120 patients with inferior turbinate hypertrophy were prospectively randomized into two groups. In group 1, a total of 61 patients underwent RF tissue reduction while under local anesthesia with epinephrine. In group 2, a total of 59 patients underwent RF tissue reduction of inferior turbinates while under local anesthesia without epinephrine. Optical coherence tomography measurements were performed before surgery and at 5, 15, 30, 45, and 60 minutes after local anesthetic infiltration. Results Choroid thickness measurements decreased gradually after local anesthetic infiltration until 30 minutes and increased to the same plane with the baseline at 60 minutes in group 1 (p < 0.05). In group 2, the choroid thickness measurement was significantly decreased after local anesthetic infiltration at 15 and 45 minutes (p < 0.05). When the choroid thickness measurements were compared between the groups, in group 1 blood flow was significantly lower than in group 2 at 30 minutes (p < 0.05). Conclusion We observed a statistically significant reduction in choroid circulation after local anesthetic with epinephrine infiltration into inferior turbinates. Otolaryngologists should be careful after local anesthetic infiltration, and monitor the vision. Further studies with larger series would be needed to discuss safety of local anesthetics.

Evaluation of hearing results in Behçet's disease

Objectives: Behcets disease is an inflammatory rheumatic disease with recurrent scarring in the oral and genital area, as well as skin, eye, joint, vein, and nerve involvement. The aim of the study was to investigate the level of hearing in Behcet’s disease and whether there is a change in hearing levels as the level of the disease increases. Methods: In this study we examined 32 patients with Behcet’s disease and 50 healthy volunteers. All patients were evaluated with audiometry, tympanometry and acoustic reflex tests, as well as detailed ear, nose, and throat examinations. Results: Sensorineural hearing loss was observed in 9.3% of the patients with Behcets disease, according to the audiological data, and all patients were bilateral. We also observed sensorineural hearing loss to be the fifth most common symptom in our study. Especially in high frequencies, there was positive correlation between hearing levels and disease exposure time ( p < 0.05). Conclusions: We think that the audiological examinations should be included in the routine check-ups of Behcets patients. In addition, a follow-up assessment of the hearing level of these patients with high frequency audiometry may be more meaningful.

Reply to the letter to the editor concerning: ‘Relationship between increased carotid artery stiffness and idiopathic subjective tinnitus’

from the analysis. When we perform a correlation analysis (Spearman or Kendall tau) between the relevant variables, the coefficient of r is lower than 0.7 for all variables. According to these results, there is no multicollinearity in our study; for this reason we did not need to perform any regression modelling to find the association between the variables with moderate to high degree of tinnitus. Second, we stated in the method section that the systolic and diastolic blood pressures were recorded after 5 min of rest. Since our study design was cross-sectional, we performed these measurements before the Doppler ultrasonographic examinations to exclude the individual fluctuations for the blood pressure. Even though we have not specified this deficiency in the text, we have done these measurements at least three times from each arm and have received the highest average of three measurements. So, we did not think any regression dilution bias to our manuscript.

Reply to the letter to the editor concerning “Endoscopic tympanoplasty: learning curve for a surgeon already trained in microscopic tympanoplasty”

We thank the authors for their valuable evaluation of our article entitled ‘‘Endoscopic tympanoplasty: learning curve for a surgeon already trained in microscopic tympanoplasty’’ published in European Archives of OtoRhinoLaryngology in 2017 [1]. First of all, the authors pointed out the disadvantages of endoscopic technique, and they listed six disadvantages of using an endoscope for tympanoplasty. However, our study was not intended to investigate the superiority of microscopic or endoscopic techniques, and we mentioned the advantages and disadvantages of using an endoscope for tympanoplasty in the introduction. The authors also criticized the fact that the external auditory canal (EAC) diameters of the patients in each group were not stated. They claim that EAC diameters may affect operation success and operation time. However, none of our patients had excessively narrow EACs. In fact, we think that problems, such as narrow EACs, may require more time to address with microscopic tympanoplasty due to the canalplasty requirement. In particular, microscopes may fail to show the anterior edges of anterior perforations, but endoscopes can easily show the whole perforation area [2]. The authors are correct that we failed to describe the anesthesia type. All surgeries were performed under general anesthesia. Local anesthetics were administered to reduce bleeding in the operation areas. The authors did not agree with us regarding the necessity of tympanomeatal flap elevation in the endoscopic approach; they thought that flap elevation was a timeconsuming procedure. However, we prefer to use the same technique used in microscopic surgery, and many surgeons choose to create a flap with the endoscopic approach [3, 4]. Our purpose was to encourage otologic surgeons to perform endoscopic tympanoplasties, because we think that most surgeons try this technique but give up after a few cases, because they are not accustomed to working with one hand and addressing the difficulties of tympanomeatal flap elevation. However, our opinion is that surgeons will become very comfortable after 60 operations if they continue performing endoscopic surgeries.