Cengiz Arli

Calcium Homeostasis During Attack and Remission in Patients With Idiopathic Benign Paroxysmal Positional Vertigo.

Objective: To evaluate changes in calcium metabolism in patients with idiopathic benign paroxysmal positional vertigo (BPPV) on initial presentation and at the follow-up visit. Subjects and Methods: The study comprised a total of 31 patients aged greater than 18 years who presented at the otorhinolaryngology outpatient clinic of our hospital, newly diagnosed as idiopathic BPPV based on the history compatible with BPPV and positive provocative maneuver (either Dix-Hallpike or Roll test). The first blood sample was obtained on the day of initial presentation when the patient was found to have active unilateral BPPV. After 6 months, a blood sample was again drawn in accordance with the procedure. Blood samples were analyzed for data on 25-hydroxyvitamin D (25(OH)-D), total calcium, parathormone and ionized calcium on initial presentation, and at the follow-up visit. Results: The patients comprised 20 (64.5%) women and 11 (35.5%) men with a mean age of 49.78 years (range, 23–75 years). During an attack a higher prevalence of decreased serum Vitamin D is less than 20 ng/ml, was determined (93.5% versus 38.7%). There were statistical differences between the Vitamin D values, parathormone, and corrected by pH ionized calcium in both periods (p < 0.05). Conclusion: A statistically significant association was determined between Vitamin D and calcium metabolism in patients with idiopathic BPPV. It can be considered that Vitamin D deficiency and decreased ionized Ca level may be a risk for BPPV, not only in patients with osteoporosis but also in all patients. Very low levels of 25(OH)-D seem to be associated with recurrence of BPPV. The recurrences might possibly be prevented with supplementary Vitamin D especially in those with recurrent idiopathic BPPV but further studies would be necessary to determine this.

Perioperative difficulties and early postoperative complications of transoral approach in mouth base surgery.

ObjectiveThe aim of this study was to discuss perioperative difficulties and temporary or permanent complications that can be seen at early postoperative period in cases undergoing transoral surgical approach for disorders of mouth base. Study DesignThe study included 19 patients undergoing transoral surgical approach between September 2011 and January 2013 who were retrospectively evaluated. Exclusion criteria were patients with malign submandibular gland tumor or other suspected tumors at mouth base, those with a benign solid mass larger than 10 × 10 cm, and those who did not accept the transoral approach. ResultsMean age was 28.47 ± 17.89 years (range, 8–76 years) in 19 patients included (9 male and 10 female subjects). Of these, submandibular gland excision was performed in 9 cases, whereas thyroglossal duct cyst excision was performed in 3 (2 transfrenulum approach and 1 lateral lingual approach), lymphangioma excision in 1, diagnostic lymph node excision at the posterior of submandibular gland in 3 cases, and dermoid cyst excision (2 with midline and 1 with left submandibular localization) in 3 cases. Perioperative difficulties included dissection problems due to adhesion, partial adhesion between Wharton canal and lingual nerve, fragmented dissection of the gland, capsule rupture of submandibular adenoma, and facial artery rupture. While visualization of surgical field and retraction of mouth base muscles are an important issue in midline approaches, resection of hyoid bone corpus is challenging in lateral approaches. Early postoperative complications included edema at mouth base, lingual ecchymosis, and postoperative temporary abnormal tongue sensation. ConclusionsTransoral mouth base surgery is a safe approach in selected patients. Permanent injuries of neural structures are rarely encountered, which is considered as a concern by head and neck surgeons. Temporary complications are at a level that can be tolerated by patients.

The evaluation of anxiety and panic agarophobia scores in patients with benign paroxysmal positional vertigo on initial presentation and at the follow-up visit

Abstract Conclusion: Patients with BPPV experienced short but intense anxiety and/or panic disorder, especially at the initial visit, but most patients recovered without medication with successful treatment. Objective: Recent studies have shown that people with dizziness report some psychological problems such as panic and agoraphobia and anxiety. The aim of this study was to evaluate anxiety and panic agorophobia levels in patients with benign paroxysmal positional vertigo on initial presentation and at the follow-up visit and compare the scores with the control group. Methods: All the 32 patients in the study had a diagnosis of BPPV confirmed by their history, typical subjective symptom reports, and characteristic positional nystagmus during the Dix–Hallpike test and/or Roll test. The patients were instructed to complete the standard forms of Beck anxiety inventory and panic agoraphobia scale questionnaire before and at 7 and 14 days after the canalith repositioning treatment. Results: The validity scores of panic agoraphobia were statistically significantly higher in patients with BPPV than in the control group in each period (p < .001) and the validity scores of the Beck anxiety inventory were statistically significantly higher in patients with BPPV than in the control group at the first and second evaluation (p < .001).

Electron microscopic examination of effects of bogma raki and walnut on cochlea An experimental study

Illegal alcohol beverages known as bogma raki in our country are consumed widely in our region. The studies investigating the relationship between alcohol consumption and hearing ability report different results. In this study, we aimed to investigate the toxic effects of bogma raki that contains neurotoxic substances on cochlea by electron microscopy. To the best of our knowledge, this study is the first in the literature. A total of 48 Wistar male albino rats (aged 12–16 weeks and weighing 200–240 g) were used in the study. The rats were divided into 4 groups with 12 animals in each group. The groups include control, bogma raki, walnut, and walnut + bogma raki groups. Bogma raki (30% v/v, 9.2 ml kg−1 day−1) is added to drinking water of rats in bogma raki group (n = 12) for 4 weeks. Walnut group rats (n = 12) are fed with standard rat food and walnut without limitation (10 g kg−1 day−1). Bogma raki + walnut group rats (n = 12) are fed with standard rat food and walnut and bogma raki is added to drinking water. The cochleas were dissected and removed en bloc and examined by electron microscopy. Perineuronal oedema around neurons of spiral ganglion and hairy cells of organ of Corti were present in the bogma raki group, walnut group and bogma raki + walnut group under electron microscopic examination. Comparing these three groups, there were no differences in the ultrastructural pathological changes. In the ultrastructural examination of the myelinated axons forming cochlear nerve, no ultrastructural pathology was detected in all the groups.

Thyroid gland papillary microcarcinomas diagnosed by extraglandular mass findings

Thyroid papillary microcarcinomas not only present with neck lympathic metastasis but also may occur in thyroglossal cysts or ectopic thyroid glands. The aim of this case report is to discuss two cases of thyroid papillary carcinomas with no mass detectable by thyroid gland ultrasonography but diagnosed with the biopsy of cervical lymphatic metastasis and occurred in ground of lateral sided thyroglossal cyst. It must be kept in mind that, in cervical metastasis and even laterally sided cystic masses, these symptoms may be associated with thyroid papillary carcinoma.

The Role of Topical Thymoquinone in the Treatment of Acute Otitis Externa; an Experimental Study in Rats

OBJECTIVE The aim of this experimental study was to compare the dose-related effect of topical thymoquinone (TQ) with other topical agents used in the management of acute otitis externa (AOE) in a rat model. MATERIALS AND METHODS Forty-eight male Wistar albino rats were divided into six groups each with eight rats per group. Group I was the control group with no external otitis, whereas external otitis were created in the other five groups (study groups). Dexamethasone, 0.1% TQ, 0.4% TQ, ciprofloxacin, and 0.9% saline (NaCl) drops was applied once daily in Groups II-VI, respectively. The treatment was administered regularly for 10 days. Pathologic and microbiologic evaluation were performed. Pathologically, the thicknesses of the stroma and the epithelium in the external auditory canal (EAC) were measured using an occulometer. Edema in the stroma, density of inflammatory cells and blood vessels, presence of fibroblasts, and changes in collagen fibers in the EAC were evaluated in five different areas to obtain the area of highest concentration and classified into four grades (0=no change, 1=mild, 2=moderate, 3=severe). RESULTS The higher concentration of TQ (0.4%) was more effective than dexamethasone and 0.1% TQ with respect to antibacterial and the anti-inflammatory properties. CONCLUSION TQ, particularly at a concentration of 0.4%, may be considered for topical application alone in the treatment of AOE, without any requirement for a combined treatment.

Radiological Imaging of Rare Intracranial Complications Secondary to Otitis Media and Mastoiditis

Acute otitis media used to cause fatal results because of its intracranial complications before the introduction of potent and effective antibiotics. After the introduction of antibiotics, complications have started to be observed more frequently as a result of chronic otitis media and especially in children. Because clinical findings changed and became indistinct, the diagnosis of otitis and mastoiditis has been made occasionally with imaging findings only after complications occurred. Multidetector computed tomography and magnetic resonance imaging are efficient and sufficient methods in the rapid diagnosis and should be immediately referred methods.Abstract Acute otitis media used to cause fatal results because of its intracranial complications before the introduction of potent and effective antibiotics. After the introduction of antibiotics, complications have started to be observed more frequently as a result of chronic otitis media and especially in children. Because clinical findings changed and became indistinct, the diagnosis of otitis and mastoiditis has been made occasionally with imaging findings only after complications occurred. Multidetector computed tomography and magnetic resonance imaging are efficient and sufficient methods in the rapid diagnosis and should be immediately referred methods.

Re: "Symptom Resolution Rates of Posttraumatic versus Nontraumatic Benign Paroxysmal Positional Vertigo: A Systematic Review".

We read with great interest the recent article by Aron et al. In most patients with benign paroxysmal positional vertigo (BPPV), there is no identifiable cause. Possible causes of BPPV include viral neurolabyrinthitis, Meniere’s disease, migraine, and head trauma. Occasionally BPPV can occur after middle ear surgery and stapedectomy. In this article, the authors profoundly have emphasized the relationship between BPPV and head trauma. But it is not clear whether there were other possible causes of head trauma in the group. Vestibular neuritis and Meniere’s disease have a tendency for recurrence as well as head trauma. Since BPPV occurred after tympanoplasty, stapedectomy, and other ear surgery, these surgical procedures had each better be considered a trauma. We are of the opinion that it would have been useful to emphasize these situations in the article. As such, we think that the patients should be asked about a history of ear surgery and ear disease. Thus, we can provide more detailed information about recurrence.

Determination of oxidative stress and effect of erdosteine on rhinitis medicamentosa in a rat model

We aimed to determine the presence of oxidative stress in rhinitis medicamentosa (RM) and to evaluate the effect of erdosteine (ED) on mucosal changes in a rat model. Twenty-four male rats were used in this experimental study. Three groups were created. Group 1 (n=8) was the control group. Two puffs of 0.05% oxymetazolin were sprayed into the nasal cavities of the remaining rats (n=16) three times daily for eight weeks. One of these 16 rats was scarified at the end of the eight weeks and examined to confirm the presence of RM. Seven of the remaining 16 rats were killed, and venous blood samples were taken (Group 2). Group 3 (n=8) received 10mg/kg of an ED suspension orally for seven days. All rats were put on formalin for light microscopy. The total antioxidant status (TAS) was similar in all groups (p=0.073). The total oxidative status (TOS) of the RM group was significantly higher than that of the control group and RM+ED group (Group 3) (p=0.003 and p=0.011, respectively). The pathological recovery of the nasal mucosa of the rats was similar in the RM+ED and control groups. The TOS was high in this RM rat model, and oxidative stress was associated with RM. ED significantly ameliorated nasal mucosal changes induced by RM, suggesting that oxidative stress may play an important role in the pathophysiology of this condition.

Maksillofasiyal ateşli silah yaralanmalarında atış yönünün belirlenmesinde radyografik görüntülemenin önemi

Objective: The aim of this study is to investigate the importance of the initial radiographies of patients whose first medical intervention was made outside the country borders and recovered after treatment in our hospital. Methods: The patients with maxillofacial trauma due to gunshot and shrapnel injuries who were treated by Department of Otolaryngology in the last year were examined retrospectively. Twenty two patients were included to the study, who had injuries in another country and who were received initial medical treatments there. The maxillofacial computed tomographies of patients which were performed before the treatment were evaluated according to the direction of movement of bone fracture fragments. Results: The youngest patient was 17 years old and the oldest one was 43 years old. All the patients were male. It was observed that all of the patients were referred to our hospital after the first intervention had been made in other medical centers. There was no reliable information about the event of injury and type of used weapon. According to the findings of the radiological images, the directions of shootings were determined by the evaluation of the directions of bone fragments in 19 (86.4%) patients. Conclusion: The initial radiographic images of dead or medically treated patients with bone fractures due to gunshot injuries, in cases with unidentified origins and injury mechanisms, play an important role in the determination of the direction of shooting. The wounds have been identified whether they are entry or exit wounds when the direc tions of fire are determined.