Hamdi Cakli

Phototherapy for allergic rhinitis: a prospective, randomized, single-blind, placebo-controlled study

Background: Phototherapy has a profound immunosuppressive effect, and phototherapeutic methods using both ultraviolet (UV) and visible light are therefore widely used for the therapy of various inflammatory skin diseases. It is also proposed that phototherapy, using a combination of UV-A (25%), UV-B (5%) and visible light (70%), may represent a therapeutic alternative in patients with allergic rhinitis. Method: Seventy-nine patients were randomly assigned to receive either a combination of UV-A (25%), UV-B (5%) and visible light (70%), in the phototherapy group, or low-intensity visible light, in the control group. The efficacy of treatment was assessed by means of total nasal symptom score before treatment and 1 month after the end of treatment. Results: Total nasal scores decreased in both groups but the decrease was highly significant in the active treatment group when compared with the placebo (p < 0.001). Conclusions: This study demonstrates that phototherapy may be an effective modality in the treatment of allergic rhinitis especially in cases of which commonly used drugs either are contraindicated and/or have insufficient efficacy.

Scintigraphic evaluation of nasal mucociliary activity in unilateral chronic otitis media

Mucociliary clearance is a key defence mechanism in human upper and lower airways. Although mucociliary activity is present in both ears of the patients, most cases of chronic otitis media are unilateral. In this study, we aim to evaluate the difference between nasal mucociliary activity of the affected and non-affected sides in patients with unilateral chronic otitis media. Both nasal transport times of 36 patients with unilateral chronic otitis media were compared statistically with each other and with the control group by independent samples t-test. The nasal mucociliary transport times of the nasal cavity at the same side as the affected ear and as the non-affected ear are significantly different, in the same patients. Our study shows that impaired or decreased nasal mucociliary activity may result in dysfunction of the eustachian tube and middle-ear ciliary activity, which plays an important role in the aetiopathogenesis of chronic otitis media.

Prognostic significance of Ki-67 expression for patients with laryngeal squamous cell carcinoma primarily treated by total laryngectomy

The aim of this study was to determine the prognostic value of Ki-67 immunostaining in laryngeal squamous cell carcinomas. Ki-67 labeling was quantified in 63 laryngeal squamous cell carcinomas by counting at least 1,000 tumor cells in the most immunoreactive area in each sample, and the Ki-67 labeling index was calculated as a percentage. The antigen expression was compared with clinical factors, histopathological grading and prognosis. The Ki-67 mean proliferation index for all patients was 25.44% ( range, 2–75%). A significant correlation was found between Ki-67 mean proliferation index and patient age (P<0.05), T-stage (P<0.05), nodal metastasis (P=0.001) and recurrence (P<0.001). There was no significant association between the Ki-67 mean proliferation index and tumor site or histologic grade. A univariate analysis showed that the Ki-67 labeling index >21% (P<0.001), T-stage (P<0.001) and nodal metastasis (P=0.001) are determinants of recurrence. In the multivariate analysis, the Ki-67 labeling index >21% (P<0.001), T-stage (P<0.001) and nodal metastasis (P<0.05) were independent predictors of recurrence. Kaplan-Meier plots of survival in patients with Ki-67 values above and below the median (21%) of the general study population showed that a high Ki-67 labeling index correlated with a shorter disease-free survival (P<0.0001). The analysis of the Ki-67 labeling index at the time of initial surgery may be a powerful prognostic marker for patients with laryngeal squamous cell carcinoma and may be useful for selecting subgroups of patients who should be treated with more aggressive therapies.

Seawater gel in allergic rhinitis: entrapment effect and mucociliary clearance compared with saline:

Objective: We performed a prospective study to investigate the the efficacy of seawater gel in reducing symptoms in patients with mild allergic rhinitis. We also aimed to investigate the impact of nasal irrigation on mucociliary clearance with seawater gel compared with saline in this patient group. Methods: The study was performed in 100 consecutive adult individuals with a history of allergic rhinitis that was not controlled by anti-allergic drugs. Patients were assigned to receive seawater gel nasal spray for 10 days. The efficacy of treatment was assessed by means of total nasal symptom score and clinical findings. Results: A statistically significant difference was found between scores of ‘nasal discharge, nasal obstruction, sneezing, nasal itching’before and after treatment (p < 0.001). Clinical findings evaluation revealed a statistically significant decrease in lower turbinate colour rating and turbinate congestion at the end of treatment (p< 0.001). Saccharin transit time decreased from baseline in the seawater trials by 12% compared with a 4% decrease for saline. The difference between the percent changes was statistically significant (t = 2.177; p < 0.05). Conclusions: The present study provides evidence that a four times daily regimen of seawater gel can be an adjunctive therapy in the patient with allergic rhinitis.

Comparative analysis of primary and secondary rhinoplasties according to surgeon's perspective, patient satisfaction, and quality of life.

Objectives: We sought to analyze and compare the problems and technical difficulties related to surgical intervention, patient satisfaction, and quality of life after primary and secondary rhinoplasties. Methods: A total of 168 cases of rhinoplasty were grouped as primary or secondary according to the patients history of rhinoplasty. The type of nasal deformity, the surgical approach, and the difficulty of the surgery were recorded. The levels of patient satisfaction and the quality of life were assessed before and after the operation with the Rhinoplasty Outcomes Evaluation (ROE) and European Quality of Life–5 Dimension (EQ-5D) questionnaires. A quantitative and statistical analysis was performed. Results: Thirty-three patients had secondary rhinoplasty, and 135 patients had primary rhinoplasty. Relatively high rates of saddle nose deformity, crooked nose, and tip asymmetry were observed in the secondary rhinoplasty group. The preoperative and postoperative scores on the ROE and EQ-5D questionnaires demonstrated statistically significant differences in both the primary and secondary rhinoplasty groups. The comparison of postoperative change between the primary and secondary rhinoplasty groups did not demonstrate a statistically significant difference. Conclusions: The surgical difficulty of secondary rhinoplasty is approximately twice that of primary rhinoplasty because of the high rate of major deformities. However, the levels of patient satisfaction and improvements in quality of life are similar after primary and secondary rhinoplasties.

Evaluation of nasal airway alterations associated with septorhinoplasty by both objective and subjective methods

The aim of functional septorhinoplasty is to create an esthetically elegant nose and harmony in the face by preserving nasal function as well as maintaining or restoring adequate airway. Since nasal complaints are usually subjective, it may be difficult to evaluate the functions objectively. In the present study, we aimed to investigate the alterations in nasal function associated with septorhinoplasty by using both objective and subjective methods. The study population consisted of 40 patients who underwent septorhinoplasty and 40 healthy controls. Before and after the operation, visual analog scale, acoustic rhinometry, rhinomanometry, and Odiosoft-Rhino test were applied to all patients and controls. There were significant differences in all parameters both before and after the operation. While a significant difference was obtained between the patient and control groups in terms of preoperative values, no significant difference was found between postoperative values of these groups. Both objective and subjective methods are important in evaluations.

Use of cone beam computed tomography in otolaryngologic treatments

Cone beam computed tomography (CBCT) allows us to evaluate 3-dimensional (3D) morphology of the maxillofacial skeleton and also used in dentomaxillofacial imaging to solve complex diagnostic and treatment planning problems such as craniofacial fractures, temporamandibular dysfunctions or sinus imaging. CBCT uses a rectangular or round 2D detector, which allows a single rotation of the gantry to generate a scan of the entire region of interest. Technological and application-specific factors such as development of compact, relatively low-cost, high-quality, large, flat-panel detector arrays; the availability of low-cost computers with processing power sufficient for cone beam image reconstruction; the fabrication of highly efficient radiograph tubes capable of multiple exposures necessary for cone beam scanning at prices lower than those currently used for fan beam CT; and limited volume scanning (e.g., head and neck) eliminating the need for subsecond gantry rotation speeds make this possible. The objective of this study is to review published evidence for CBCT having an important role in ORL treatments. We aimed to review all the available literature about the CBCT imagination in ORL treatments. Systematic literature search was performed using PubMed and Ovid. Additional literature was retrieved from reference lists in the articles. Systematic analysis of the literature from 1998 to 2010 was performed. A total of 40 abstracts were evaluated independently by two members of the project group, and 38 articles were included in the review.

Use of rhinomanometry in common rhinologic disorders.

Rhinomanometry is a functional test of nasal aerodynamics that measures transnasal airflow and the pressure gradient allowing nasal resistance to be calculated from these data. Three methods of rhinomanometry that are currently in use are anterior rhinomanometry, posterior (peroral) rhinomanometry and postnasal (pernasal) rhinomanometry. The usefulness of this method has increased owing to the development of technology and use of microcomputers connected to the measuring devices. Rhinomanometry can be used for: clinical evaluation of the symptom of nasal obstruction; research in nasal physiology; allergy challenge testing; pre- and post-treatment assessments of surgical or medical therapy; and evaluation of patients with sleep apnea.

What is the role of partial middle turbinectomy in endocanalicular laser-assisted endonasal dacryocystorhinostomy?

Background This study was designed to compare outcomes of endocanalicular laser-assisted endonasal dacryocystorhinostomy (DCR) with and without partial anterior middle turbinectomy. Methods A prospective randomized comparative study was conducted on 91 subjects with primary acquired nasolacrimal duct obstruction, undergoing endocanalicular (ECL) procedures. Group 1 was composed of 44 (7 bilateral) patients undergoing ECL diode laser-assisted endonasal DCR without partial anterior middle turbinectomy and group 2 was composed of 47 (7 bilateral) patients undergoing partial anterior middle turbinectomy and ECL diode laser-assisted endonasal DCR. Follow-up period was 11.0 (6.0–14.5 months) months for group 1 and 9.2 (5.0–14.2 months) months for group 2. Functional success was defined as absence of epiphora and anatomic success was defined as ability to irrigate the lacrimal system. Anatomic and functional success at the 1st week, 3rd month, and final postoperative examinations of two groups were compared using chi-square tests. Results Final anatomic successes were 39/51 (76%) cases for group 1 and 51/54 (94%) cases for group 2. Final functional successes were 36/51 (%71) patients in group 1 and 48/54 (88%) patients in group 2. Group 2 had higher success at the final examination and the difference was statistically significant. Conclusion We recommend partial anterior middle turbinectomy in all laser ECL laser-assisted endonasal DCR, but further studies with larger sample sizes are needed to strengthen our hypothesis.

Malignant myoepithelioma of the palate: a case report with review of the clinicopathological characteristics.

A malignant myoepithelioma is one of the rarest salivary gland neoplasms which may either arise de novo or develop within a preexisting pleomorphic adenoma or benign myoepithelioma. The parotid gland is the most common primary site and the palate the most common intra-oral site of occurrence. Herein is present a case of a malignant myoepithelioma arising in the hard palate of a 79-year-old woman. The lesion had been examined by biopsy at another hospital, and diagnosed as a poorly differentiated squamous cell carcinoma. The patient underwent a wide local tumor resection. Examination of the resection specimen showed the characteristic histopathological and immunohistochemical features of a malignant myoepithelioma. Five months after the operation, the patient was well without evidence of recurrence or metastasis.