Elif Baysal

GJB2 and mitochondrial A1555G gene mutations in nonsyndromic profound hearing loss and carrier frequencies in healthy individuals

This study aimed to assess mutations in GJB2 gene (connexin 26), as well as A1555G mitochondrial mutation in both the patients with profound genetic nonsyndromic hearing loss and healthy controls. Ninety-five patients with profound hearing loss (>90 dB) and 67 healthy controls were included. All patients had genetic nonsyndromic hearing loss. Molecular analyses were performed for connexin 26 (35delG, M34T, L90P, R184P, delE120, 167delT, 235delC and IVS1+1 A → G) mutations, and for mitochondrial A1555G mutation. Twenty-two connexin 26 mutations were found in 14.7% of the patients, which were 35delG, R184P, del120E and IVS1+1 A → G. Mitochondrial A1555G mutation was not encountered. The most common GJB2 gene mutation was 35delG, which was followed by del120E, IVS1+1 A → G and R184P, and 14.3% of the patients segregated with DFNB1. In consanguineous marriages, the most common mutation was 35delG. The carrier frequency for 35delG mutation was 1.4% in the controls. 35delG and del120E populations, seems the most common connexin 26 mutations that cause genetic nonsyndromic hearing loss in this country. Nonsyndromic hearing loss mostly shows DFNB1 form of segregation.

Radiofrequency for inferior turbinate hypertrophy : Could its long-term effect be predicted with a preoperative topical vasoconstrictor drop test?

Background Our purpose was to evaluate whether postoperative improvement by radiofrequency (RF) volumetric tissue reduction (RFVTR) correlated with a preoperative topical vasoconstrictor drop test (TVDT) in subjects with chronic nasal obstruction secondary to inferior turbinate hypertrophy (ITH). Methods This study was a prospective and unblinded clinical trial. We included 22 subjects suffering from chronic nasal obstruction secondary to ITH. TVDT was performed on all subjects before the operation, and RF energy was delivered to three different sites of each turbinate. Nasal obstruction was evaluated by visual analog score (VAS) preoperatively, after TVDT, and 1, 2, 4, 6, 8,12, and 24tweeks after surgery. Success rates of RFVTR and gain ratios of RFVTR and TVDT were calculated. Results Significant improvements were observed in success ratios by RFVTR between the 2nd and 12th weeks. Postoperative VAS values reached to VAS value achieved by TVDT at the 8th week. Correlation analysis revealed that postoperative VAS values found at the 2nd to 24th weeks correlated positively with VAS values achieved by TVDT (r = 0.47 and p < 0.03 at the 2nd week; r = 0.65 and p = 0.001 at the 24th week) but not with preoperative VAS values. Similar positive correlations also were found between gain ratios of TVDT and RFVTR from the 4th to 24th weeks. Conclusion This study showed that success by RFVTR in ITH could be predicted by preoperative TVDT. Improvement by RFVTR depends on how much the patients turbinates respond to TVDT, but not how much he/she complains of nasal obstruction.

Systemic steroid versus combined systemic and intratympanic steroid treatment for sudden sensorineural hearing loss.

ObjectiveThe aim of this study was to evaluate the effectiveness of oral steroid treatment versus combined oral and intratympanic dexamethasone injection for idiopathic sudden sensorineural hearing loss. MethodsThis was a retrospective case review in which 30 patients in the oral steroid group and 39 patients in the combined oral and intratympanic steroid injection group were compared. ResultsThe comparison of the initial pure tone audiometry (PTA) threshold results revealed a significant difference between the systemic steroid (SS) group and the systemic and intratympanic steroid group. The initial PTA was 74.33 ± 22.64 dB (mean ± SD) in the SS group and 87.49 ± 26.22 dB (mean ± SD) in the intratympanic steroid group. The difference in the initial PTA results was statistically significant between the SS group and intratympanic steroid group (P < 0.05, P = 0.032). The pure-tone gain in the SS group was 20.97 ± 27.47 dB (mean ± SD), and that of the group treated with both systemic and intratympanic steroids was 19.36 ± 22.16 dB (mean ± SD) (P = 0.49). ConclusionsThe results of this study indicate that, in sudden sensorineural hearing loss, the administration of intratympanic steroids in conjunction with SS therapy appears to have the same effect on the restoration of hearing “as the effect obtained using SS therapy alone.”

Complications and treatment of chronic otitis media.

ObjectiveThe aim of this study was to investigate the etiologic factors and treatment types for chronic otitis media (COM) complications. MethodsIn this study, the data from 82 patients who had been diagnosed and treated at the Departments of Otolaryngology and Neurosurgery of Gaziantep University between 1999 and 2011 for complications from COM were retrospectively reviewed. The chosen surgical procedure was based on the type of complication and the ear pathology. ResultsThe study included 55 male and 27 female patients. Ten patients (12.2%) had intracranial complications, and 72 patients (87.80%) had extracranial complications. There were 47 patients with cholesteatoma. Radical mastoidectomy was performed on 46 patients, canal-wall-down mastoidectomy was performed on 30 patients, and canal-wall-up mastoidectomy was performed on 6 patients. Five patients underwent neurosurgical operations because of COM complications. ConclusionsAlthough the rate of COM complications has recently declined, it remains important to diagnose COM without delay and to use appropriate treatments for the patients because COM complications are associated with poor outcomes.

Effectiveness and Safety of Selective Neck Dissection in Lymph Node-Positive Squamous Cell Carcinoma of the Head and Neck.

AbstractThe aim of this study was to investigate the effectiveness and safety of selective neck dissection in patients with lymph node-positive head and neck squamous cell carcinoma to determine regional control and survival rates. Eighty patients with lymph node-positive head and neck squamous cell carcinoma who underwent selective dissection were included in the study. Regional control, survival rates, and factors affecting survival were analyzed. Regional control was 90%, disease-specific survival was 93.4%, and the overall survival rate was 87.25%. T stage, N stage, age, and extracapsular spread were included in hazard regression models. None of the factors were statistically significant. Selective neck dissection is an effective and oncologically safe treatment option in selected cases. T stage, N stage, and extracapsular spread had no significant impact on disease-specific survival.

Management of upper aerodigestive tract amyloidosis.

Objectives: The aim of this study was to discuss the treatment options for upper aerodigestive tract amyloidosis. Methods: Four patients with histologically confirmed amyloidosis were included in the study. All patients underwent surgical treatment. Three patients had laryngeal amyloidosis, and 1 patient had tonsillar amyloidosis. Results: Two of the cases of laryngeal amyloidosis were successfully treated with a combination of surgery and radiation therapy. One case of laryngeal amyloidosis was treated with surgery alone. The tonsillar amyloidosis was removed by tonsillectomy. None of the cases showed systemic involvement. Long-term follow-up of the patients showed no recurrence or evidence of systemic disease. Conclusions: Surgical resection is the primary treatment for patients with upper aerodigestive tract amyloidosis. Radiation therapy is especially effective in cases of recurrent amyloidosis with submucosal involvement. Pedunculated polypoid lesions may be treated with surgery alone, and in cases of recurrence, irradiation following the surgical removal should be considered. Tonsillectomy is usually sufficient for treating tonsillar amyloidosis.

Treatment of Congenital Choanal Atresia via Transnasal Endoscopic Method

Objectives: Congenital choanal atresia (CCA) is a very rare abnormality of the nose, but in the case of bilateral presence, it becomes a life-threatening malformation. Various surgical treatment options, such as transpalatal, transseptal, and open rhinoplasty techniques, as well as the transnasal approach, have been defined for the repair of CCA. In this study, the authors intended to evaluate the outcomes of transnasal endoscopic surgery for CCA, and stent implementations impact on surgical success. Methods: Patients who were admitted to the Otorhinolaryngology Department of Gaziantep University and patients who had not undergone CCA surgery before were included in the study. Patients who underwent transnasal endoscopic choanal atresia surgery (TECAS) were advised to have regular nasal endoscopic examinations performed at check-ups; after a 6-month follow-up period, surgical results were evaluated concerning whether stenosis had occurred or not. Results: Of the 48 patients who underwent TECAS after a minimum 6-month follow-up period, 34 of patients revealed no stenosis, so the overall surgical success rate was 70.8%. Fourteen (29.2%) patients who underwent TECAS developed stenosis and required revision surgery. Conclusions: Transnasal endoscopic choanal atresia surgery is the most preferred approach for CCA repair and has many advantages, such as excellent vision, shorter operative time, minimal bleeding, and minimum complication. Despite advances in endovision systems and surgical instruments, stenosis is the most challenging problem after TECAS, so new treatment strategies should be developed to prevent stenosis.

Anesthesia Management in Patients With Choanal Atresia

BACKGROUND In this study, the anaesthetic management of newborn and infant patients who underwent surgery for choanal atresia between 2009 and 2016 is discussed in the light of recently published literature. METHODS The diagnoses, demographic data, anaesthetic risk and duration, additional anomalies, airway management, and complications that arose in 41 patients with choanal atresia who were operated on between 2009 and 2016 were evaluated retrospectively by examining their medical and anaesthesia records. RESULTS The patients were divided into 2 groups: Group I-bilateral choanal atresia and Group II-unilateral choanal atresia. Of the 41 patients included in the study, 24 (58.53%) were in the bilateral group, and 17 (41.46%) were in the unilateral group. Fifteen (34.1%) of the patients were male, and 26 (59.1%) of the patients were female. The mean age of the 24 patients in Group I was 25.86 days (3-72), and the mean age of the 17 patients in Group II was 171.08 days (81-365). Additional congenital anomalies were present in 13 of the patients in the bilateral choanal atresia group and 3 of the patients in the unilateral choanal atresia group.Seven patients from Groups I and 2 patients from Group II were determined to have difficult airways. The laryngoscopic images from these patients were classified as grades 3 and 4 according to the Cormack-Lehane classification system. When the durations of anesthesia in the groups were compared, the duration of anesthesia in Group I was found to be significantly longer (Table 3). Anesthesia-related complications were observed in 9 patients (37.5%) from the bilateral choanal atresia group and in 4 patients (2.3%) from the unilateral atresia group. Steroids were used as prophylactics in these patients. CONCLUSIONS Congenital anomalies and their associated risks, as well as intubation and ventilation problems and the complications that might arise, must be considered in addition to anesthetic management when repairing choanal atresia in newborn and infant patients.Background:In this study, the anaesthetic management of newborn and infant patients who underwent surgery for choanal atresia between 2009 and 2016 is discussed in the light of recently published literature. Methods:The diagnoses, demographic data, anaesthetic risk and duration, additional anomalies, airway management, and complications that arose in 41 patients with choanal atresia who were operated on between 2009 and 2016 were evaluated retrospectively by examining their medical and anaesthesia records. Results:The patients were divided into 2 groups: Group I—bilateral choanal atresia and Group II—unilateral choanal atresia. Of the 41 patients included in the study, 24 (58.53%) were in the bilateral group, and 17 (41.46%) were in the unilateral group. Fifteen (34.1%) of the patients were male, and 26 (59.1%) of the patients were female. The mean age of the 24 patients in Group I was 25.86 days (3–72), and the mean age of the 17 patients in Group II was 171.08 days (81–365). Additional congenital anomalies were present in 13 of the patients in the bilateral choanal atresia group and 3 of the patients in the unilateral choanal atresia group.Seven patients from Groups I and 2 patients from Group II were determined to have difficult airways. The laryngoscopic images from these patients were classified as grades 3 and 4 according to the Cormack–Lehane classification system. When the durations of anesthesia in the groups were compared, the duration of anesthesia in Group I was found to be significantly longer (Table 3). Anesthesia-related complications were observed in 9 patients (37.5%) from the bilateral choanal atresia group and in 4 patients (2.3%) from the unilateral atresia group. Steroids were used as prophylactics in these patients. Conclusions:Congenital anomalies and their associated risks, as well as intubation and ventilation problems and the complications that might arise, must be considered in addition to anesthetic management when repairing choanal atresia in newborn and infant patients.

Masking Treatment and its Effect on Tinnitus Parameters

OBJECTIVE Tinnitus is described as the perception of sound without any external acoustic stimulation. Any pathology of auditory pathways or any system of the human body may result with tinnitus. The pathophysiology of tinnitus accompanying the disorders of auditory system is not fully understood and there is not any particular effective treatment method has been specified. Tinnitus masking therapy has been reported as an effective treatment modality in the treatment of tinnitus. In this study, the results of tinnitus masking treatment on the parameters were evaluated prospectively. PATIENTS AND METHODS Patients with normal physical examination was enrolled in the study. Blood tests (complete blood count, biochemical analysis of lipid profile, and thyroid hormones), pure tone audiometry, tympanometric measurement of the middle ear pressure and stapedial reflexes were performed, Sixty six patients with normal results of blood tests and normal hearing thresholds with type A tympanogram were included. Tinnitus sufferers questionnaires (socio-demographics, clinical information, Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI) was filled, audiological tests were performed, tinnitus parameters (frequency, intensity, minimal masking levels, residual inhibition) were measured. After four weeks of the treatment the questionnaires were repeated. RESULTS Masking treatment for tinnitus patients resulted with significant decrease in Tinnitus Handicap Inventory and VAS scores. After four weeks of the masking treatment the questionnaire was repeated. Twenty patients did not respond to treatment. CONCLUSION Masking therapy is one of the most effective methods of treatment for tinnitus patients. Masking therapy, that is not invasive and cost-effective has an important place in the treatment of tinnitus. Especially in a short time provides a significant reduction in tinnitus parameters.