Hüseyin Dere

Anatomical variations of nasal turbinates.

After the widespread use of endoscopic sinus surgery and paranasal sinus computed tomography, many variations of nasal turbinates have been described. In addition to the most common one-middle turbinate pneumatization (concha bullosa)-superior and inferior turbinate pneumatizations have also been described. Secondary and accessory middle turbinates that can mimic real middle turbinate are anomalies described in recent years. Paradoxical middle turbinate and bifid inferior turbinate are very rarely encountered anomalies and can be easily recognized in paranasal tomography but can be overlooked by endoscopical examination. In the present study, the computed tomography images of 384 patients were evaluated for nasal turbinate variations, as well as their relations to mucosal pathologies. The most frequent variation was found to be concha bullosa; the least frequent one was found to be bifid inferior turbinate. In 1 of our patients, 5 of the 6 turbinates were found to have pneumatization, which is extremely rarely encountered in the literature. In this study, the prevalence of the variations of the turbinates and their association with chronic rhinosinusitis were investigated.

Variations of maxillary sinus and accompanying anatomical and pathological structures.

Hypoplasia and aplasia of maxillary sinus, maxillary sinus septae, ethmomaxillary sinus, superior meatus-draining maxillary sinus, and over-pneumatization are the variations of maxillary sinuses. Findings such as uncinate process abnormality, orbital enlargement, sphenomaxillary plate, canine fossa elevation, infraorbital fissure enlargement, thickening of the sinus wall and mucosal pathologies can be seen together with these variations. The aim of this study is to determine the incidence and morphology of the anatomical variations of maxillary sinus and accompanying structures. A total of 330 consecutive paranasal sinus computed tomography scans of the patients presenting with sinonasal complaints at our ENT department were assessed for maxillary sinus anatomical variations and related structures. There were 134 (20.3%) anteriorly and 17 (2.5%) posteriorly localized maxillary sinus bony septa. The position of antral septa was frequently vertical at anterior, and horizontal at posterior. We found significant correlation between the anteriorly localized maxillary sinus septa and infraorbital fissure enlargement. Maxillary sinus hypoplasia was found in 31 (4.6%) maxillary sinuses. Seven (1.0%) ethmomaxillary sinuses were assessed. Significant correlation was found between maxillary sinus hypoplasia and orbital enlargement. Presence of mucosal pathology was significant in patients with maxillary sinus septa, but there was no difference when it was compared with the mucosal pathology in the nonseptated group. There was no significant correlation between other anatomical variations and mucosal pathologies. Determining the anatomical variations of maxillary sinus and accompanying structures in patients planning endoscopic sinus surgery will significantly help with providing surgical orientation and preventing possible complications.

Shoulder function in various types of neck dissection. Role of spinal accessory nerve and cervical plexus preservation

Aims and background The aim of this study is to determine the effects of two different types of nerve-sparing neck dissection on shoulder function. Even if the spinal accessory nerve is spared in functional neck dissection, some degree of shoulder syndrome may occur. The role of the cervical plexus in shoulder function and the effects of dissection of level 5 are emphasized. Methods Twenty-six patients with laryngeal carcinoma were studied prospectively. Seventeen anterolateral and 15 functional neck dissections were performed. Electromyographic evaluation was carried out in all patients to assess spinal accessory nerve function preoperatively and at the sixth week and sixth month postoperatively. Shoulder disability was evaluated by a questionnaire (shoulder pain disability index) and goniometric measurements were done preoperatively and at the sixth postoperative month. Results In patients who underwent anterolateral neck dissection, the goniometric results were better than in the functional neck dissection group. The questionnaire results also showed better quality of life of patients who underwent anterolateral neck dissection. Electrophysiological evaluation of the trapezius muscles of both groups at the sixth week showed significant differences. The distal motor latency values of the anterolateral neck dissection group were shorter than those of the other group. Electrophysiological evaluation at the sixth postoperative month showed shorter distal latency values in the anterolateral dissection group, without statistical significance. Conclusions Preservation of the cervical plexus and less disturbance of the spinal accessory nerve are important to diminish postoperative shoulder disability. The type of neck dissection has an important influence on shoulder function.

Bifid inferior turbinate: a case report

OBJECTIVES A bifid inferior turbinate is an extremely rare anatomical variation and has been reported in only two cases to date. Including the present report, the uncinate processes were missing in all three patients reported. It is suggested that, in the reported patient, bifid inferior turbinate coexisted with a developmental anomaly of the uncinate process, and that the bifid inferior turbinate represented two separate turbinates originating from the same site. CASE REPORT We present the first reported case of bilateral bifid inferior turbinates, with a secondary middle turbinate, in a patient complaining of nasal obstruction. CONCLUSION We suggest that the superior part of the bifid inferior turbinate may have been formed by severe medial displacement and inferior rotation of the uncinate process, and that the bifid inferior turbinate is an anatomical abnormality of the uncinate process.

Continuous or intermittent noise exposure, does it cause vestibular damage?: An experimental study

OBJECTIVE Aim of this study was to compare vestibular changes in guinea pigs exposed to same level of continuous and intermittent noise by electron microscopy. METHODS The study included 10 adult albino guinea pigs. In a silent room, a 4-kHz octave band noise at an intensity of 120 dB SPL was presented. Six animals were exposed to continuous noise for 6h, and four animals were exposed to 12h intermittent noise. One day after noise exposure eight guinea pigs were decapitated and temporal bones of one side were removed. Ten days after continuous noise exposure two guinea pigs were decapitated. They were examined with an electron microscope. RESULTS The most characteristic changes in the macula of the continuous noise exposure group were degeneration of the epithelial cells and separation in their layers. Marked crystolysis and stromal cell apoptosis were also noted in this group compared to the intermittent noise exposure group. Effect of noise was more obvious in the group that continuous noise was applied. The histological changes in group which examined after 10 days were similar to the group that examined after 1 day. CONCLUSION Continuous noise can cause more damage to the vestibular system compared with intermittent noise and histological changes after continuous noise are permanent.

The Effect of Topical Doxycycline in the Prevention of Experimental Tympanosclerosis

Objectives: The aim of this study is to determine the effectiveness of topical doxycycline used in the process of experimental myringosclerosis and tympanosclerosis.

Tinnitus after cochlear implantation

OBJECTIVE The purpose of this study was to investigate properties of tinnitus which starts after cochlear implantation. Of the 17 adult patients in our cochlear implant group, four (23.5%) who had no pre-implantation tinnitus were eligible for the study. METHODS Each patient was requested to complete a short questionnaire regarding his or her experience with tinnitus. Tinnitus match test was performed for each patient by using an Interacoustic Clinical Audiometer (model AC40; Assens, Denmark). RESULTS Tinnitus match test revealed a tinnitus frequency of a 4KHz for three and of a 6KHz for one patient. Mean value of the loudness score was calculated as 17.5dB SL. CONCLUSIONS The results of this study emphasize the importance of counseling patients regarding risks of tinnitus after cochlear implantation.

Topical Application of Calcium Channel Blockers to Reduce the Progression of Experimentally Induced Myringosclerosis and Tympanosclerosis

Objectives: This study aimed to evaluate the ability of topically applied calcium channel blockers (diltiazem) to reduce the progression of experimentally induced myringosclerosis and tympanosclerosis.

New Predictive Parameters of Bell's Palsy: Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio

BACKGROUND Bells palsy is the most frequent cause of unilateral facial paralysis. Inflammation is thought to play an important role in the pathogenesis of Bells palsy. AIMS Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are simple and inexpensive tests which are indicative of inflammation and can be calculated by all physicians. The aim of this study was to reveal correlations of Bells palsy and degree of paralysis with NLR and PLR. STUDY DESIGN Case-control study. METHODS The retrospective study was performed January 2010 and December 2013. Ninety-nine patients diagnosed as Bells palsy were included in the Bells palsy group and ninety-nine healthy individuals with the same demographic characteristics as the Bells palsy group were included in the control group. As a result of analyses, NLR and PLR were calculated. RESULTS The mean NLR was 4.37 in the Bells palsy group and 1.89 in the control group with a statistically significant difference (p<0.001). The mean PLR was 137.5 in the Bells palsy group and 113.75 in the control group with a statistically significant difference (p=0.008). No statistically significant relation was detected between the degree of facial paralysis and NLR and PLR. CONCLUSION The NLR and the PLR were significantly higher in patients with Bells palsy. This is the first study to reveal a relation between Bells palsy and PLR. NLR and PLR can be used as auxiliary parameters in the diagnosis of Bells palsy.

Investigation of the cochlear effects of intratympanic steroids administered following acoustic trauma

To electrophysiologically and histomorphologically demonstrate the effects of intratympanic corticosteroids administered following an acoustic trauma on cochlear hair cells.