Ertap Akoglu

Evaluation of the turbinate hypertrophy by computed tomography in patients with deviated nasal septum

Objectives/Hypothesis To determine the dimensions of the compensatory hypertrophic inferior turbinate and investigate the radiological changes in the morphology of the conchal bone in patients with septal deviation. Study Design A retrospective chart review. Methods The mucosal and bone compartments of the hypertrophic turbinate were measured using computed tomography (CT) in patients with septal deviation, and the conchal bones were classified radiologically as lamellar, compact, and combined types. The results were compared with those of controls. Results The dimensions of the bony and mucosal components of the inferior turbinate were significantly greater than those of controls in the anterior and middle segments, while the morphological changes in the conchal bone were not different. Conclusion The significant bony and mucosal enlargement in the anterior and middle segments of the inferior turbinate supports turbinate reduction at the time of septoplasty and the CT findings should be considered when making a decision about the reduction type.

Effect of phosphodiesterase-5 inhibitor on hearing.

OBJECTIVE Following a report of sudden hearing loss in a patient taking phosphodiesterase type 5 inhibitor, and a Food and Drug Administration announcement concerning this class of drugs, a study was planned to investigate if ototoxicity occurs in patients using phosphodiesterase 5 inhibitor for erectile dysfunction. METHODS Eighteen patients with erectile dysfunction who had been using phosphodiesterase 5 inhibitor were included in the study. Audiometric tests were performed on all patients, between the frequencies 250 and 16,000 Hz, before and 1, 5 and 72 hours after drug ingestion. RESULTS Four patients showed a unilateral threshold decrease compatible with ototoxicity criteria; this change was reversible. A statistically significant difference in pre- versus post-drug hearing thresholds was observed in the right ear at 10,000 Hz (p = 0.008). There were no statistically significant hearing threshold differences at any other frequencies (p > 0.05). CONCLUSION Although temporary ototoxicity was noted in four patients, we could not find any permanent, deleterious effect of phosphodiesterase type 5 inhibitor on hearing thresholds.

Concha bullosa pyocele

An aerated middle turbinate is called a concha bullosa (CB), and given the importance of the middle turbinate in nasal physiology, variations that alter the airflow and mucous drainage can cause sinonasal symptoms. A pyocele of the middle turbinate differs from an infected CB because it has the potential to expand and destroy neighbouring tissues like a tumour. We present a concha bullosa pyocele (CBP) that expanded against the lamina papyracea without causing orbital displacement. As pus was discharged whilst performing an endoscopic biopsy to determine whether it was neoplastic, the lateral aspect of the turbinate was excised to complete the procedure.

Endoscopic dacryocystorhinostomy with silicone, polypropylene, and T-tube stents; randomized controlled trial of efficacy and safety.

Objective To compare the efficacy and safety of endoscopic dacryocystorhinostomy (En-DCR) with different stent materials for lacrimal sac intubation in primary nasolacrimal ductal obstructions. Study Design Randomized controlled study with three parallel groups. Level of evidence is 1b. Methods A total of 91 patients (five bilateral) with primary nasolacrimal duct obstruction (NLDO) at a tertiary referral center scheduled for En-DCR were to allocated into three stent groups with a sealed envelope and were randomized into three treatments: silicone, Prolene (polypropylene), and otologic T-tube. Ophthalmology and otolaryngology clinics evaluated the patients preoperatively and postoperatively with endoscopes, lacrimal system syringing, and dacryocystography. The success of the stents was evaluated 12 months after surgery with symptom relief and ostial patency. Complications were also noted. Results The overall success rate of the En-DCR in the stent groups was 78.1% (75/96); specifically, 87.5% (28/32) with silicone, 84.4% (27/32) with Prolene, and 62.5% (20/32) with T-tube. The efficacy of the procedures with the T-tube was significantly lower than that of the Prolene and silicone (p = .031, χ2 test). There were no significant differences between the silicone and Prolene (p = .718, χ2 test). Prolene was found to be related with orbital complications. Spontaneous loss is a particular complication of otologic T-tube and highly portends to failure. Conclusions The results of our study suggest that efficacy, defined as anatomic and functional success, is equally high for silicone and Prolene stents and lower for otologic T-tube in En-DCR.

The Score For Allergic Rhinitis study in Turkey.

Background The clinical definition of allergic rhinitis (AR) is difficult to use in epidemiological settings of large populations where it is impossible to obtain the laboratory evidence of each immune response. However, the standardization of the definition of AR in epidemiological studies is of crucial importance. This study was designed to estimate the prevalence of AR in an adult general population with respect to seven distinct geographical regions in Turkey. Methods Individuals were evaluated with the Score for Allergic Rhinitis (SFAR) questionnaire for a national cross-sectional study. The Turkish version of the SFAR questionnaire was tested for clarity and sensitivity in a small sample of the general population. Results Among the 3967 interviewed subjects, the overall prevalence of AR was 29.6%, with regional variations (from 21.0% in the southeastern Anatolia region to 36.1% in the Marmara region). The prevalence was higher in women and in urban area of residence. Conclusion This national survey confirmed the elevated prevalence of AR in Turkey. Our findings may contribute to the formulation of the public health policy and development of preventive and therapeutic strategies for AR in eastern Europe.

Prolene: a novel, cheap, and effective material in dacryocystorhinostomy.

Conclusion. Prolene® is cheap, effective, and readily available in almost all operating theaters. It might be used successfully in endoscopic dacryocystorhinostomy and is promising as an alternative to silicone stent intubations, especially in settings with limited resources. Objective. To evaluate the clinical efficacy and results of stenting with polypropylene (Prolene®; Ethicon, Inc.) suture material instead of silicone tube in endoscopic dacryocystorhinostomy. Patients and methods. Forty-two endoscopic dacryocystorhinostomy operations were performed in 36 patients (11 men and 25 women; mean age 34.7±9.5 years, range 16–60 years) between 2007 and 2008. After creating an aperture in the medial wall of the lacrimal sac, 2/0 Prolene was inserted through the canaliculi into the sac. The Prolene was left in the lacrimal sac for 3 months. The patients were followed up for between 6 and 18 months (mean 8.1±3.6 months). The improvement in the complaint of epiphora was grouped as very good, good, or no change. Results. The improvement in 34 eyes (81%) was reported as very good, whereas improvement was noted as good in 5 eyes (11.9%), and there was no change in 3 eyes (7.1%). We observed granulation tissue formation around the Prolene in two patients.

Determination of hearing levels in patients with Familial Mediterranean Fever

OBJECTIVE Familial Mediterranean Fever is the most common congenital, periodic fever condition that affects over 100,000 people worldwide. In the literature, there is limited number of studies about hearing levels in children with Familial Mediterranean Fever. In the present study, we aimed to investigate hearing levels and cochlear functions by using Distortion product Otoacoustic Emission and High Frequency Audiometry (250-20,000 Hz) in pediatric patients with Familial Mediterranean Fever. METHODS The study included 62 children with Familial Mediterranean Fever and 27 healthy children with similar age and gender. After otoscopic examination, both groups underwent audiological evaluation including High Frequency Audiometry (250-20,000 Hz) and Distortion product Otoacoustic Emissions. The results obtained were assessed among groups. In addition, these results were compared regarding colchicine use, age at the onset of disease and duration of the diseases in the Familial Mediterranean Fever group. RESULTS Of the Familial Mediterranean Fever patients, 93.5% were on colchicine therapy and mean duration of colchicine use was 19.9 ± 13.9 months. The mean age at diagnosis was 6.57 ± 2.86 years (min-max: 2-14) and mean duration of disease was 23 ± 17 months (min-max: 6-84). Pure tone audiometry values, and hearing levels between 9000 and 20,000 Hz were similar and within normal range in both groups. The Distortion product Otoacoustic Emissions responses at the frequencies of 1020, 2040, 3000, 4080 and 5040 Hz were similar for both groups. CONCLUSION To the best of our knowledge, this is the first study evaluating hearing levels at the frequencies of 18k Hz and 20k Hz in children with Familial Mediterranean Fever in the literature. In children with Familial Mediterranean Fever, Pure tone audiometry values, hearing values obtained at all frequencies from 250 to 20,000 Hz, and Distortion product Otoacoustic Emissions levels were within normal range. Furthermore, hearing levels were found to be similar to those in healthy children.

The prevalence and significance of incidental middle ear and mastoid cavity abnormalities on MRI in a pediatric population

OBJECTIVE The purposes of this study were to determine the prevalence of abnormalities in the middle ear and mastoid cavity on the magnetic resonance imaging (MRI) in children and correlate the results with clinical data, tympanometric findings and paranasal sinus changes. MATERIALS AND METHODS A total of 85 consecutive pediatric patients for suspected non-inflammatory intracranial pathologies were prospectively examined. MRI was conducted for the suspected intracranial pathology. All patients were also examined by an otolaryngologist for otologic pathologies. A tympanometry examination was performed in patients prior to MRI scan. RESULTS In 23 (27.1%) of 85 (39 males, 46 females) children, MRI demonstrated middle ear and/or mastoid cavity abnormalities. MRI abnormalities of the middle ear and/or mastoid cavity were correlated with clinical data and tympanometric findings. CONCLUSIONS Incidental abnormal signal intensities in the middle ear and/or mastoid cavity are frequent in children, especially in first years of life. MRI will demonstrate incidental middle ear and mastoid cavity abnormalities seems to have clinical significance.

The Efficacy of Sucralfate and Chlorhexidine as an Oral Rinse in Patients with Recurrent Aphthous Stomatitis

Aim. In this study, we compared the efficacy of sucralfate suspension with chlorhexidine as an oral rinse in patients with recurrent aphthous stomatitis (RAS) in terms of pain relief and healing time. Materials and Methods. The subjects with a complaint of recurrent oral aphthous ulcers less than 1 cm in diameter on the first day of the occurrence of the ulcer and between 20 and 40 years were included in the study. Seventy patients completed the study. The patients were randomized into two groups as SCH group and CHX group. Changes in pain scores, healing time, and side effects of the treatments were evaluated. Results. The mean value of pain scores on the days after the treatment from the first day to the seventh day was significantly higher in CHX group than SCH group (P ≤ 0.05). On the seventh day after the treatment, the ulcers were completely reepithelialized in 23 patients in SCH group and in 19 patients in CHX group. The difference was statistically significant (P ≤ 0.05). In SCH group, the mean healing time of ulcers was 1.97 ± 1.56 days whereas it was 2.80 ± 3.00 days in CHX group. The difference was statistically significant (P ≤ 0.05). No side effects were recorded in either of the groups. Conclusion. Topical sucralfate suspension is an easy, safe, inexpensive, and effective treatment option for RAS to obtain pain relief and shorten the healing time of oral ulcers.

The effect of anesthetic agents on perioperative bleeding during tonsillectomy: Propofol-based versus desflurane-based anesthesia

OBJECTIVE: Hemorrhage during tonsillectomy is related to the surgical technique, management of bleeding, and choice of anesthetic agent. This study evaluated the effects of anesthetic agents on hemorrhage during tonsillectomy with standardized surgical techniques and management of bleeding. STUDY DESIGN: Double-blind, randomized controlled trial. SUBJECTS AND METHODS: Sixty patients, aged 3 to 12 years, who were scheduled for elective tonsillectomy were enrolled in the study. Propofol-based anesthesia was administered to the first group; desflurane-based anesthesia, to the second. The amount of blood loss due to hemorrhage was measured. RESULTS: Propofol-based anesthesia significantly decreased bleeding during tonsillectomy. CONCLUSION: Propofol-based anesthesia is a reliable method for use in children who undergo tonsillectomy.