Kemal Deger

Evaluation of the Effect of Passive Smoking on Otitis Media in Children by an Objective Method: Urinary Cotinine Analysis

Objectives We aimed to determine objectively the effect of the passive smoking on otitis media with effusion (OME) and recurrent otitis media (ROM) by using the method of cotinine urinalysis.

Spinal accessory nerve function after neck dissections.

The aim of this study was to evaluate spinal accessory nerve function after functional neck dissection (FND) and radical neck dissection (RND) by monitoring the nerve with electromyographic (EMG) examinations. A prospective, double-blind, clinical study was undertaken in 21 patients (42 neck side dissections) operated on for head and neck malignant diseases, separated into two groups: 10 neck sides in the RND group and 32 neck sides in the FND group. Electromyographic examinations were performed pre-operatively and post-operatively in the third week and third and ninth months. Additionally, a questionnaire, modified from the neck dissection impairment index, was applied to all the patients in order to assess shoulder function in the ninth post-operative month. All patients had maximum EMG scores pre-operatively. Following the operation, motor amplitudes decreased in both groups. At the third post-operative month, amplitudes decreased to their lowest values. As expected, the decreases in amplitude and EMG score were more prominent in the RND group. Following reinnervation, the amplitudes of the trapezius motor response increased in the FND group but never reached pre-operative values (during the time of follow up). The FND group scores for pain, neck and shoulder stiffness, and disability in heavy object lifting, light object lifting and reaching overhead were significantly lower than those of the RND group. In FND, one aims to preserve anatomically the spinal accessory nerve, and it is presumed to be intact after the procedure. However, using EMG nerve function monitoring, our study revealed that profound spinal nerve injury was detected immediately after FND surgery, which tended to improve over subsequent months but had not regained its original function by the end of the ninth post-operative month.

Auditory rehabilitation in neurofibromatosis type 2 : A case for cochlear implantation

Cochlear implantation has a limited but definite role in the rehabilitation of certain neurofibromatosis type 2 (NF2) patients. The presence of a dead ear either before, or after, tumour removal does not necessarily imply loss of function in the eighth nerve; in some instances the hearing loss will be cochlear. Promontory or round window electrical stimulation may help to identify those individuals with surviving eighth nerve function. In such patients multichannel cochlear implantation promises a better level of audition than the auditory brain stem implant. This paper highlights such a case and the management problems are discussed.

Subperiosteal temporal pocket versus standard technique in cochlear implantation: a comparative clinical study.

Objective: In the standard technique of cochlear implantation, the internal receiver-stimulator (IRS) is fixed into a socket drilled on the calvarial bone. In the subperiosteal technique, the IRS is fixed under the subperiosteal plane, and drilling is not necessary. The purpose of this study was to compare the subperiosteal and the standard techniques. Study Design: Retrospective clinical study. Setting: Tertiary referral center; cochlear implant program. Patients: One hundred forty-eight patients who underwent cochlear implantation. Intervention: The researcher who evaluated the patients was not informed which of the 2 techniques was used on the patients and administered a visual analog scale (VAS) analysis. The duration of the operation, intraoperative and postoperative complications, and migration of the IRS were assessed. Main Outcome Measures: A VAS survey was administered to the patients or to their parents to evaluate the practicability of the implant. Results: The duration of the operation was 73.4 ± 17.8 minutes in the subperiosteal group and 105.5 ± 17.8 minutes in the standard technique group. The difference was statistically significant. Intracranial complications or migration of the IRS was also not observed in any patient. The VAS score was 4.2 ± 2.1 in the standard group and 4.3 ± 1.9 in the subperiosteal group. The difference was not statistically significant. Conclusion: The subperiosteal technique can be safely and effectively used in cochlear implantation. Not only are there no intracranial complications and no migration of IRS was observed but also the mean operation time is reduced up to 30% and none of the patients have reported difficulty with fixing of the external device.

Vitamin D levels in children with recurrent tonsillitis

AIM Although recurrent tonsillitis can be the consequence of defects in immune system, the exact etiology of recurrent tonsillitis is not clear. In this study, our aim was to determine the serum vitamin D levels and vitamin D receptor polymorphism among children undergone tonsillectomy due to the recurrent tonsillitis. METHODS A 106 children undergone tonsillectomy due to recurrent tonsillitis and a 127 healthy children aging between 2 and 12 years were enrolled in this study, to determine serum 25-hydroxyvitamin D level and vitamin D receptor gene polymorphisms (Apa1, Taq 1, fok1). Serum vitamin D level was measured with ELISA (nmol/L) and receptor gene polymorphism was determined by PCR. Vitamin D serum level below 80nmol/L was accepted as insufficient. RESULTS The average serum vitamin D level was 176±79nmol/L in recurrent tonsillitis group and 193±56nmol/L in control group. There was no significant difference between the groups (p=0.13). In recurrent tonsillitis group, 18% (n=15) of children had their serum vitamin D levels below 80nmol/L. The vitamin D receptor gene polymorphism (APA1, TAQ 1, FOK 1) in each group was compared (AA, Aa, aa, TT, Tt, tt, FF, Ff, ff). There was no significant difference between the two groups. The vitamin D serum levels and receptor sub-genotypes are also compared, and there was no significant difference between the groups. CONCLUSION There is no difference between the serum vitamin D level and receptor gene polymorphism among children with recurrent tonsillitis and healthy children. But vitamin D insufficiency is more prevalent in children with recurrent tonsillitis group (18%).

Evaluation of Factors Concerning the Olfaction Using the Sniffin’ Sticks Test:

Objective. This study aimed to research the normative values of olfactory function in the Turkish population using the Sniffin’ Sticks test and to relate olfactory performance to age, sex, smoking, educational level, and the side examined. It also aimed to compare the results with other countries’ normative values, especially Europe, using the same test and procedure. Study Design. Prospective clinical study. Setting. Tertiary referral center. Subjects and Methods. This study was a prospective clinical trial conducted in a tertiary clinic. A total of 100 healthy subjects were included in the study. Of these, 50 were men and 50 were women. The mean (SD) age of the subjects was 37.7 (14.8) years (range, 18-77 years). Results. Odor scores were lower than the scores of other countries, and the scores decreased significantly with age. There was no relationship between olfaction and sex or smoking. Subjects with a lower educational status had lower scores compared with the scores of median and highly educated subjects. Conclusion. This is the first study that evaluated the relationship between education level and olfaction. According to the results, the cultural differences, education level, and age seemed to influence odor scores. The Sniffin’ Sticks test can be used to assess olfactory performance in a Turkish population, but identification of odors in this test battery may show variability because of local and cultural factors.

The effects of different levels of air pollution on atopy and symptoms of allergic rhinitis.

We evaluated the prevalence of symptoms of allergic rhinitis and atopy among two groups living in areas with different pollution levels. The study was conducted among high school students living in Bayrampa§a (polluted by SO2 and TSP) and Beykoz (unpolluted, residental area) in Istanbul (n = 386). Each subject filled out a standardized self-administered questionnaire. Atopic status was evaluated by skin-prick testing using eight different allergens. Also, anterior active rhinomanometry was performed to evaluate the symptoms objectively. Significantly higher prevalence rates for symptoms of allergic rhinitis were found in Bayrampaşa (22.8%) compared to Beykoz (6%). However, no significant difference was found for atopic status among the two groups. When we evaluated the atopic status of subjects with symptoms of allergic rhinitis between the two areas, the prevalence of atopic students was found to be relatively higher in the unpolluted area (BZ). This difference was not statistically significant. Within the atopic population, subjects complaining of symptoms of allergic rhinitis were significantly more frequent in the polluted area (BP), suggesting that air pollution causes an increase in symptoms of allergic rhinitis in the atopic population, but this is not significantly higher than the increase in symptoms of allergic rhinitis of the total study group. Our results suggest that pollutants exert irritant effects on mucous membranes of the population in general rather than aggrevating symptoms in predisposed individuals. Smoking was more frequent in the unpolluted area. Exposure to parental smoking in childhood and heating systems in houses were evenly distributed. Household crowding was lower in Beykoz. Rhinomanometric measurements among the two groups did not show significant difference. Multiple logistic regression models estimating the role of each risk factor independently showed significant odds ratio associated with residence in Bayrampaşa for symptoms of allergic rhinitis (OR = 4.6, 95% CI = 9.0–2.3). In conclusion, this study suggests that outdoor pollution has adverse effects on the symptoms of allergic rhinitis, while it has no effect on the prevalence of atopy in Istanbul in the 1990s.

P21, p53, and p27 kip1 alterations in benign and malignant tumors of sinonasal epithelium ☆

OBJECTIVE The goal of this study was to investigate alterations of cell cycle-related molecules, including p27, p21, and p53, in inverted papillomas (IPs) and squamous cell carcinomas (SCCs) of the sinonasal epithelium. Study design Sixteen IPs and 6 SCCs of the sinonasal epithelium, surgically resected at Istanbul Faculty of Medicine, Department of Otorhinolaryngology, from 1992 to 2000 were immunohistochemically investigated (p27, p21, and p53). RESULTS A significant decrease in p27 nuclear staining was observed for SCCs of paranasal sinus compared with inverted papillomas (P = 0.0072). In SCCs there was no association between p27 expression and the presence of keratinization and tumor grade. p21 and p53 expressions were not associated with IPs (dysplastic and nondysplastic) and SCCs. CONCLUSION Reduced levels of p27 expression correlate with increased cell proliferation in tumors of sinonasal region. Our findings indicate that p27 immunohistochemistry can be recommended to analyze the dysregulation of cell kinetics in these tumors.

An unusual metastatic site of laryngeal carcinoma: scapular muscles

It is well known that in advanced cervical metastatic disease of head and neck squamous cell carcinoma, the incidence of distant metastasis is high. A case of distant metastasis to the scapular muscles from an uncontrolled cervical metastasis of laryngeal carcinoma is presented. Other unusual metastatic sites are reviewed and the possible mechanism of the spread is discussed.

Olfactory Function Assessment of Blind Subjects Using the Sniffin’ Sticks Test

Objective In recent years, a growing number of studies have focused on the olfactory abilities of blind individuals as well as their tactile and auditory senses. In this study, we aimed to investigate possible alterations in the sense of smell in early- and late-blind subjects as compared with sighted controls, using a Sniffin’ Sticks test battery. Study Design Prospective clinical study. Setting Tertiary referral center. Subjects and Methods A total of 66 subjects were included in the study. The subjects were divided into 2 groups: blind subjects—who were then subgrouped as subjects with congenital blindness (n = 17) and those with acquired blindness (n = 16)—and sighted subjects (n = 33). We compared both congenitally and acquired blind subjects with sighted counterparts using the Sniffin’ Sticks test for odor threshold, odor discrimination, odor identification, and total odor scores. Results The blind subjects were more successful than their sighted counterparts in odor discrimination and odor threshold tasks. There was no statistically significant difference between the blind participants and the sighted individuals in terms of odor identification value. Another important finding was that the difference between individuals with congenital blindness and those with acquired blindness was not significant in any of the parameters. Conclusion This finding may suggest that odor discrimination and odor threshold in blind people were superior to those of controls. There was no difference in any of the results of tasks among congenital and acquired blind subjects.