Murat Doğan

The contribution of computed tomography to nasal septoplasty.

Purpose The aim of this study was to determine the contribution of computed tomography (CT) scanning to nasal septoplasty. Methods The study included 76 patients, on whom septoplasty was planned to be performed because of deviated nasal septum. The patients were divided into 2 groups: those who had a CT scan (group 1, study group) and those who did not have a CT scan (group 2, control group) before septoplasty. Pathologic anatomic structures accompanying deviated septum and surgical interventions performed in addition to septoplasty were determined. The patients were asked the degree of improvement in nasal air passage obstruction, and 2 groups were compared with each other. Results Group 1 included 40 patients, and group 2 had 36 patients. In group 1, the pathologic findings determined along with deviated septum were concha bullosa in 14 patients, retention cyst of the maxillary sinus in 2 patients, paradox middle nasal concha in 2 patients, inferior concha hypertrophy in 18 patients, frontal osteoma in 1 patient, antrochoanal polyp in 1 patient, and chronic sinusitis (maxillary, ethmoidal, frontal) in 7 patients. Lateral resection was performed for concha bullosa; out-fracture with submucosal cauterization was performed on the patients with inferior concha hypertrophy, and endoscopic sinus surgery was performed for the patients with chronic sinusitis and antrochoanal polyp. Conclusions Computed tomography is able to recognize some pathologic findings that cannot be found on physical examination and is helpful to decide the location and the type of the surgery. Additional surgical interventions owing to CT performed before the septoplasty are much more helpful to relieve the patient’s nasal air passage obstruction.

The Effect of Nasal Septal Deviation on Frontal and Maxillary Sinus Volumes and Development of Sinusitis.

AbstractThe purpose of this study was to determine the possible role of nasal septal deviation on volume of maxillary and frontal sinuses. Between February 2011 and October 2013, paranasal sinus computed tomography (CT) findings of 732 patients (410 males, 322 females) who were admitted to Ear Nose and Throat Department of Kayseri Research and Training Hospital were retrospectively analyzed. By excluding the other coexistent sinonasal pathologies, 83 consecutive patients with nasal septal deviations were included in the study. The volume of each maxillary and frontal sinus (ipsi- and contralateral to the deviation side) was also calculated using the computer program. There was no statistically significant difference between ipsilateral and contralateral maxillary sinus volumes in group 1 and group 3 (P > 0.05). There was a statistically significant difference between ipsilateral and contralateral maxillary sinus volumes in group 2 (P < 0.05). There was no statistically significant difference between ipsilateral and contralateral frontal sinus volumes in group 1, group 2, and group 3 (P > 0.05). Moderate septal deviation significantly affects the volume of maxillary sinus. Mild and severe septal deviation does not significantly affect the volume of maxillary sinus. Effect of septal deviation on frontal sinus volume was not detected. The probability to encounter maxillary and frontal sinusitis ipsilateral to the all septum deviation groups was significantly increased in both right- and left-sided subjects.

Protective role of misoprostol against cisplatin-induced ototoxicity.

Cis-diammineedichloroplatinum (cisplatin) is a chemotherapeutic agent that is widely used in the treatment of many cancers. Nephrotoxicity, ototoxicity and neurotoxicity are dose-limiting adverse effects for cisplatin. The cellular and molecular mechanisms underlying cisplatin-induced ototoxicity aren’t fully understood. It has been proposed that cisplatin primarily cause damage at the cochlea, outer hair cells in particular, leading to excessive production of free oxygen radicals in the organ of Corti, stria vascularis, spiral ligament, and spiral ganglionic cells. The cytotoxicity is associated with the generation of reactive oxygen species (ROS); thus, there is an increasing interest on antioxidants with an effort to discover the established protection against cisplatin-induced ototoxicity over time. Misoprostol (MP) has gained considerable interest as a reactive oxygen species scavenger in recent years. To best of our knowledge, there is no study about protective effect of MP, a prostaglandin E1 (PGE1) analogue, on cisplatin-induced ototoxicity. In our study, we show that protective effects of misoprostol on cisplatin-induced ototoxcity on rats.

Cervical and ocular vestibular evoked myogenic potentials in Behcet’s disease

OBJECTIVE To investigate vestibular evoked myogenic potentials combined with audiologic status in Behcets disease (BD) and to compare the results with normal healthy subjects. METHODS Cervical vestibular evoked myogenic potential (cVEMP) test, ocular vestibular evoked myogenic potential (oVEMP) test, Dix-Hallpike test, conventional pure tone audiometry (cPTA) and high frequency audiometry (HFA), and 226 and 1000Hz tympanometry were performed to each subject of the study. Cranial magnetic resonance imaging (MRI) with contrast enhancement was also performed to evaluate the central nervous system (CNS) in patients with BD. RESULTS VEMP parameters including the mean peak latencies of p13-n23 and n10-p15, AR values and thresholds were not statistically different both in cVEMP and oVEMP between the BD and control groups. Except for 250Hz, mean audiological thresholds were significantly higher in the BD group. Five of the 20 patients had pathological cranial MRI findings that may be compatible with central nervous system involvement. CONCLUSION To our knowledge, the present study is the first report investigating oVEMP and cVEMP responses combined with MRI findings in patients with BD. The presence of high frequency hearing loss is a common finding in BD and HFA may help early detection of hearing loss in patients with BD when combined with cPTA.

Another advantage of the transseptal suture: shortens the duration of waking up after anesthesia.

AimThe aim of this study was to investigate the effects of transseptal suturing against 3 different types of nasal packings with respect to pain, operating time, and postoperative complications after nasal septal surgery. Patients and MethodsTwo hundred twenty-eight patients (aged between 18 and 58 y) undergoing nasal septal surgery were included in the study. After surgery, 4 types of nasal packing were used: (1) transseptal suturing (group A: 57 patients), (2) internal nasal splint (group B: 57 patients), (3) Merocel standard 8-cm packing without airway (group C: 57 patients), and (4) soft paraffin gauze dressing (group D: 57 patients). ResultsRegarding the mean operating time, there was no statistically significant difference among groups B, C, and D (P > 0.05). However, when the operating times observed in the said 3 groups were compared with those observed in group A, the difference was statistically significant (P < 0.05). The mean (SD) postoperative pain score within 1 to 48 hours was 2.9 (1.3; median, 2) in group A, 6.3 (1.4; median, 6) in group B, 7.5 (1.1; median, 7) in group C, and 7.7 (1.8; median, 7) in group D. Starting from the postoperative 48th hour, internal nasal splint, Merocel packing, and soft paraffin gauze dressing were significantly more painful compared with transseptal suturing (P < 0.05). When compared with the other groups, extubation period and postoperative care unit stay were shorter in the transseptal suturing group (P < 0.05). Regarding infection, hematoma, synechia, or perforation, there was no statistically significant difference among the groups (P > 0.05). ConclusionsTransseptal suturing technique is a useful alternative to packing, with only a minor increase in operating time. Particularly, transseptal suturing shortens extubation time and postoperative care unit stay.

Utilizing prestin as a predictive marker for the early detection of outer hair cell damage

PURPOSE To evaluate prestin as a biomarker for the identification of early ototoxicity. MATERIALS AND METHODS Rats (n = 47) were randomly assigned to five groups: low-dose (LAG) or high-dose (HAG) amikacin (200 and 600 mg/kg/day, respectively, for 10 days), low-dose (LCIS)or high-dose (HCIS) cisplatin (single doses of 5 and 15 mg/kg, respectively, for 3 days), and control (n = 8). At the end of the experiment, measurement of distortion product-evoked otoacoustic emissions (DPOAE) were performed to evaluate hearing, then blood samples and both ear tissues were collected under anesthesia. Prestin levels were determined by ELISA. Cochlear damage was evaluated histologically using a 4-point scoring system. RESULTS The mean serum prestin levels were 377.0 ± 135.3, 411.3 ± 73.1, 512.6 ± 106.0, 455.0 ± 74.2 and 555.3 ± 47.9 pg/ml for control, LCIS, HCIS, LAG and HAG groups, respectively. There was significant difference between prestin levels of Control-LCIS-HCIS groups (p = 0.031) and prestin levels of Control-LAG-HAG groups (p = 0.003). There were also significant differences in prestin levels between the low- and high-dose cisplatin and amikacin groups (p = 0.028 and p = 0.011, respectively). Each group had significantly lower DPOAE results at 4, 6 and 8 kHz than control groups (p < 0.001). The LAG, HAG, LCIS and HCIS groups had significantly higher cochlear damage scores than the control group (p < 0.05). CONCLUSIONS Higher doses of cisplatin and amikacin were associated with the greatest increases in serum prestin level and cochlear damage score. The results of this study suggest that prestin is a promising early indicator of cochlear damage.

Do diabetic patients with Bell's palsy benefit from corticosteroids?

Objective: To evaluate the beneficial effect of steroid therapy in the treatment of diabetic patients with Bells palsy (BP). Methods: There were three patient groups in the present retrospective study. Group I consisted of diabetic patients with BP who were hospitalized for corticosteroid treatment, whereas Group II was composed of diabetic patients with BP who refused to receive steroid therapy after being informed about the adverse effects of the regimen. Thirty age- and sex-matched non-diabetic BP patients treated with steroid therapy on an outpatient basis constituted Group III. House-Brackmann (H-B) grades at onset and 12 months after facial paralysis, mean complete recovery time and the number of patients who demonstrated satisfactory recovery were compared between the groups. Results: There was no statistically significant difference with regard to H-B grades, mean recovery time or number of patients with satisfactory recovery at onset and 12 months after facial paralysis among the study groups. Conclusion: In diabetic patients with BP, the recovery of facial functions may be satisfactory without steroid therapy as long as the regulation of blood sugar and blood pressure levels are ensured with regular medical follow-up.

Retrospective Analysis of Surgically Managed Maxillofacial Fractures in Kayseri Training and Research Hospital

Objective To retrospectively evaluate the clinical and surgical data of patients with maxillofacial fracture (MFF) who were surgically treated at the Department of ENT and Head Neck Surgery in the Kayseri Training and Research Hospital and to compare and discuss the results with relevant literature, including that from Turkey. Methods Data concerning the age, gender, etiology, type and site of injury, treatment modality, and postoperative complications were collected and analyzed from medical records of patients who underwent maxillofacial surgery for MFF at the Department of ENT and Head Neck Surgery in the Kayseri Training and Research Hospital between January 2013 and March 2015. Results A total of 35 patients were surgically treated because of MFF between January 2013 and March 2015. Of the 35 patients, 28 (80%) were male, whereas seven (20%) were female. Traffic accidents (40%) were the most frequent cause of MFFs. Mandibular fractures (49.1%) were the most common fractures, followed by zygomatic fractures (31.6%). Surgical management of MFFs was performed via closed reduction (17.5%) and/or open reduction with internal fixation by miniplates (82.5%). A total of five complications were observed in the present study: malunion (n=2), removal of fixation plate because of infection (n=2), and permanent infraorbital nerve injury (n=1). Conclusion Based on the experience from the close proximity of the area, we think that surgeries for MFFs should be in the surgical repertoire of ENT surgeons.

The Efficacy of Levobupivacaine Hydrochloride-Dexamethasone Infiltration for Post-Tonsillectomy Pain in Adults.

Objective:The aim of the study is to evaluate the efficacy of peritonsillar infiltration of a levobupivacaine hydrochloride and dexamethasone combination for post-tonsillectomy pain in adult patients. Methods:A total of 40 patients were included in this double-blind, randomized, and placebo-controlled study. The patients were equally randomized into 2 groups by means of sealed envelopes. The study group (SG) received peritonsillar levobupivacaine hydrochloride and dexamethasone infiltration and the control group (CG) received peritonsillar saline infiltration. Pain scores at the second, fourth, eighth, 12th, 16th, and 24th hours and the second to seventh days after operation were recorded by the patients in each group using a visual analog scale. Duration of surgery and the total amount of blood loss during the surgery were also recorded for each patient. Results:All pain scores in the SG were lower than those in the CG; however, the difference was significant at the second, 12th, and 16th hours, and the second and third day (P < 0.05). Postoperative morbidity parameters, including otalgia, nausea, vomiting, fever, halitosis, and bleeding were similar between the 2 groups. Total amount of analgesic consumption in the SG was significantly lower than in the CG on each day of the week after tonsillectomy. Conclusions:Peritonsillar infiltration of a levobupivacaine hydrochloride and dexamethasone combination may provide pain reduction and decrease analgesic consumption in the postoperative period after adult tonsillectomy.