Mehmet Karataş

Retinal Nerve Fiber Layer Thickness Alteration in Apneic Children.

Purpose We examined retinal nerve fiber layer (RNFL) thickness alterations in children with chronic upper airway obstructions (UAOs) and obstructive sleep apnea syndrome (OSAS). We also investigated whether it was affected by an adenotonsillectomy operation. Methods Forty-two children aged 3 to 8 years with chronic UAO resulting from adenotonsillar enlargement and 34 age-matched controls were included in the study. Patients underwent a Brouillette scoring questionnaire to be divided into mild (N = 10), moderate (N = 22), severe (N = 10), and total (N = 42) UAO groups. According to the scoring, the severe UAO group was defined as the severe OSAS group, the moderate group was suspicious for OSAS, and the mild UAO group was defined as the non-OSAS group. The patients’ demographic data for age, sex, and body mass index were obtained. Ophthalmologic evaluations were performed with optical coherence tomography. Central corneal thickness, macular thickness, intraocular pressure (IOP), and RNFL thickness were measured. An adenotonsillectomy was performed on all patients, and eye examinations and scoring were repeated after the surgery. Results Higher IOP levels were obtained between the total UAO group and the control group (p > 0.05). There were significant differences between UAO groups and the control group except for the moderate UAO group. There was no significant difference in RNFL thickness (p > 0.05) between preoperative UAO groups and the control group. However, after surgery, some significant differences emerged in the superior, inferior, and average RNFL thickness (p < 0.05). Also, IOP levels were significantly lower in the mild, moderate, and total UAO groups after the operation (p < 0.05). Conclusions Upper airway obstruction and OSAS seem to worsen some RNFL and IOP parameters in children, and eye examinations may be useful in these patients.

Reply to the letter to the editor by Beyan concerning: Increased mean platelet volume in patients with idiopathic subjective tinnitus

We appreciated the comment of Beyan on our paper which investigating the relationship between mean platelet volume (MPV) and idiopathic subjective tinnitus [1]. At first, there is a comment about platelet function and MPV, and claim that MPV is linked with platelet production, not function. In our study, we did not focus on platelet function and we did not use MPV as a platelet function indicator. On the other hand, there are numerous studies in literature which stated that MPV values were related with platelet function [2–6]. We think that this relation can be explained in an indirect way. Larger platelets have more granules and aggregate more rapidly. In addition, increased MPV was found associated with shortened bleeding time [6]. Second, there is a comment about MPV measurement method. As we mentioned in our study, MPV can be affected by several parameters such as age, hyperlipidemia, and smoking. Because of this reason, we created homogenous groups. In addition, some other factors can be responsible for wrong measurement such as used anticoagulant, storage temperature, analysis time and counters [7]. When used ethylenediamine tetraacetic acid (EDTA) as an anticoagulant, there are different statements about time interval for optimal MPV measurement. Dastjerdi et al. reported that if the measurements were performed within 1 h time, accurate measurements could be performed with using EDTA anticoagulant [2]. Lancé et al. propose measurements 120 min after sampling to perform appropriate measurements when using EDTA [8]. We were not standardized time interval in our study but MPV measurements were performed in all individuals in the same way. All the subjects and controls’ MPV values were measured similarly in both groups, and we found statistically significant alterations. Therefore, we think that our findings are very important and we believe that MPV can be qualified as a useful marker in tinnitus patients.

Ocular blood flow alterations during inferior turbinate radiofrequency reduction under local anesthesia.

Background Ocular blood flow alterations and blindness are uncommon and less-known adverse effects of nasal local anesthetic infiltrations. Our aim was to investigate ocular blood flow alterations during radiofrequency (RF) tissue reduction of inferior turbinates with the patient under local anesthesia by using a noninvasive method with optical coherence tomography. Methods A total of 120 patients with inferior turbinate hypertrophy were prospectively randomized into two groups. In group 1, a total of 61 patients underwent RF tissue reduction while under local anesthesia with epinephrine. In group 2, a total of 59 patients underwent RF tissue reduction of inferior turbinates while under local anesthesia without epinephrine. Optical coherence tomography measurements were performed before surgery and at 5, 15, 30, 45, and 60 minutes after local anesthetic infiltration. Results Choroid thickness measurements decreased gradually after local anesthetic infiltration until 30 minutes and increased to the same plane with the baseline at 60 minutes in group 1 (p < 0.05). In group 2, the choroid thickness measurement was significantly decreased after local anesthetic infiltration at 15 and 45 minutes (p < 0.05). When the choroid thickness measurements were compared between the groups, in group 1 blood flow was significantly lower than in group 2 at 30 minutes (p < 0.05). Conclusion We observed a statistically significant reduction in choroid circulation after local anesthetic with epinephrine infiltration into inferior turbinates. Otolaryngologists should be careful after local anesthetic infiltration, and monitor the vision. Further studies with larger series would be needed to discuss safety of local anesthetics.

Simultaneous bilateral butterfly tympanoplasty using tragal cartilage from one ear

OBJECTIVE To evaluate the outcomes of simultaneous bilateral inlay butterfly cartilage tympanoplasties (BIBCT) using tragal cartilage from one ear in patients with bilateral chronic otitis media (BCOM). METHODS 33 patients (66 ears) who underwent bilateral inlay butterfly cartilage tympanoplasties between June 2013 and September 2016 in Department of Otolaryngology-Head and Neck Surgery of Adiyaman University Education and Research Hospital, Adiyaman, Turkey - a tertiary care university teaching hospital. Anatomical success and functional success were assessed postoperatively. Air-bone gap (ABG), air-conduction thresholds, and bone-conduction thresholds were all assessed. The preoperative and postoperative averages of 0.5, 1, 2, and 3kHz of pure-tone thresholds were used for the mean air- and bone-conduction thresholds according to the guidelines of the Committee on Hearing and Equilibrium. RESULTS Anatomical success could be demonstrated in 57 of 66 ears (86.3%). The overall mean of ABG improved from 23.97±8.63dB preoperatively to 10.42±4.82dB postoperatively (p<0.05). The ABG gain was 13.55±8.17dB. Postoperative percentages of patients with ABG less than 20dB and 10dB were excellently achieved to 98% (41% preoperatively) and 56% (10.6% preoperatively), respectively. The average length of operation time for both ears was 57.42±9.39min. CONCLUSION When compared with conventional two-staged tympanoplasty in patients with BCOM, simultaneous BIBCT using tragal cartilage from one ear is an advantageous approach for multiple reasons which include single hospital stay with resultant decreased risk of complications associated with anesthesia and surgery, less morbidity like cosmetic and hearing discomfort, time-savingness and cost-effectiveness.

Atypical Feeding and Drainage of Dural AV Fistula

Dural arteriovenous fistulas (DAVF) are frequent causes of pulsatile tinnitus. Color Doppler sonography may play a useful, complementary role to CTA/MRA and digital subtraction angiography (DSA) in the assessment of these anomalies’ characteristics, such as an ipsilateral increased flow volume and a low resistive index. In this article, we report a case of DAVF first detected with Color Doppler sonography that displayed an uncharacteristic venous drainage pattern.

The effect of long-term use of intranasal steroids on intraocular pressure

Long-term use of topical nasal steroids (especially older generation steroids) has been shown to elevate intraocular pressure (IOP), but newer intranasal steroids are thought to have a minimal effect on IOP because of their low bioavailability. This study aimed to investigate alterations in IOP with two commonly used intranasal steroids for a 6-month period of time. One-hundred allergic rhinitis patients, divided equally into two groups, used mometasone furoate and fluticasone furoate intranasal steroids for 6 months. IOPs were measured before treatment and repeated at the 3rd, 6th, 12th, and 24th weeks of treatment. The IOPs of the groups were then compared. No statistically significant alteration was observed between the groups during the treatment time period. It was found that new generation intranasal steroids can be used safely, and there may not be an increased risk of IOP elevation in prolonged use in normal healthy people.

Evaluation of subclinical atherosclerosis in chronic sinusitis patients

OBJECTIVE This study aimed to assess the impact of chronic sinusitis (CS) on carotid-intima-media thickness (CIMT), a marker of early atherosclerotic changes in the arterial bed. METHODS The study included 50 patients with CS (25 male, 25 female, mean age 26.6 ± 5.34 years), and 50 healthy subjects (25 male, 25 female, mean age 25.8 ± 4.76 years), aged 18 to 35 years without atherosclerotic risk factors, normal body mass index and normal metabolic parameters. CIMT was measured in all patients by ultrasonography. CS was confirmed by medical history and computed tomography scan of the paranasal cavities. RESULTS No significant difference existed between the groups in terms of age, sex, body mass index (BMI), waist circumference, plasma creatinine, glucose, low-density lipoprotein (LDL), high-density lipoprotein (HDL) cholesterol values (p>0.05). However, mean values of CIMT (mm) were significantly greater in CS patients than in healthy subjects (0.51 ± 0.09 vs. 0.40 ± 0.07, p<0.001). Duration of CS disease was 6.0 (3.0-13.0) years. Significant correlation was found between CIMT mean values and age, BMI, waist circumference, HDL and LDL-cholesterol values and duration of CS (r=0.413; p<0.001, r=0.353; p<0.001, r=0.355; p<0.001, r=-0.266; p=0.007, r=0.327; p<0.001 and r=0.425; p=0.002 respectively). Multiple linear regression analysis revealed that waist circumference, HDL and LDL-cholesterol and duration disease of CS were independent predictors of CIMT (ß=0.523; p=0.001, ß=-0.176; p=0.045, ß=0.297; p=0.002, and ß=0.436; p<0.001, respectively). CONCLUSION Our cross-sectional study revealed the presence of a negative effect of CS on the atherosclerotic process. Therefore, it is believed that effective treatment of CS may be beneficial in slowing the process of atherosclerosis.