Omer Afsin Ozmen

Nasal Pepsin Assay and pH Monitoring in Chronic Rhinosinusitis

Objectives/Hypothesis: The primary objective of this study was to determine the relationship between chronic rhinosinusitis (CRS) and laryngopharyngeal reflux (LPR). We also investigated the diagnostic value of pepsin in nasal lavage by means of fluorometric assay as compared with 24‐hour dual‐probe pH monitoring.

Effects of levobupivacaine versus bupivacaine infiltration on postoperative analgesia in pediatric tonsillectomy patients: a randomized, double-blind, placebo-controlled study.

Objectives: We compared the effects of levobupivacaine hydrochloride, bupivacaine hydrochloride, and saline injections in alleviating posttonsillectomy pain. Methods: Between November 2009 and April 2010, we recruited 60 patients (36 male and 24 female) between 2 and 12 years of age into the study. After informed consent was obtained from the parents, patients admitted for tonsillectomy were randomized into 3 groups by means of sealed envelopes. Group 1 (20 patients; mean age, 6.45 ± 2.78 years) received 0.9% sodium chloride (saline solution), group 2 (20 patients; mean age, 5.60 ± 2.70 years) received 0.25% levobupivacaine hydrochloride, and group 3 (20 patients; mean age, 5.85 ± 2.43 years) received 0.5% bupivacaine hydrochloride infiltrated around each tonsil. Pain was evaluated with McGraths face scale. Results: The postoperative pain scores at 1 and 5 hours were similar among the groups (p > 0.05). The pain scores in the levobupivacaine group were lower than those in the saline group at 13 hours (p < 0.017). The pain scores in the bupivacaine and levobupivacaine groups were significantly lower than those in the saline group from 17 to 21 hours until day 6 (p > 0.017). There was no difference between the levobupivacaine and bupivacaine groups (p > 0.017). Conclusions: Local infiltration of levobupivacaine is a relatively safe and effective method and is equivalent to use of bupivacaine for posttonsillectomy pain.

Comparison of Clinical Results in Nasal Tip Augmentation Either Via Face to Face or Back to Back Technique With Autogenous Auricular Conchal Cartilage.

Objective:To compare the objective and subjective findings between patients who underwent nasal tip augmentation surgery via two different methods using autogenous auricular conchal cartilage. Materials and Methods:This study included the data of 21 patients who underwent nasal tip augmentation surgery. The patients were randomly divided in two groups according to the technique used to form a double layer columellar strut graft; either face to face (group 1) and back to back (group 2). All patients were assessed via nasal obstruction symptom evaluation scale (NOSE) and via acoustic rhinometry and rhinomanometry at preoperative and postoperative 1st and 6th months. Results:There was statistically significant improvement in symptom score in both patient groups with no difference inbetween. Total nasal resistance decreased nonsignificantly at the end of 6th month in both groups; 13.1 Pa/cm3 to 8.6 Pa/cm3 and 10.3 Pa/cm3 to 9.5 Pa/cm3 respectively. There was no significant increment in MCA values for both groups except left MCA1. Conclusions:We achieved good results in tip augmentation via both techniques. An autogenous conchal cartilage is a good alternative to replace lacking caudal septal cartilage. It provides safe and stable support to the nasal tip. However, further comprehensive studies with larger sample size and long follow-up are required to elucidate any difference between these two techniques.

Does Septoplasty Improve Heart Functions of Patients With Septum Deviation in Terms of Echocardiography Findings

Objective: The authors aimed to determine pulmonary artery pressure and right heart functions in patients with nasal septum deviation (NSD) with echocardiography (EchoCG) and compare the postoperative changes of EchoCG parameters with preoperative findings. Methods: Seventy-six patients who underwent septoplasty composed the study group. Average age of patients was 23.50 ranging between 18 and 48 years of age. There were 53 males (69.7%) and 23 females (30.3%). Mean pulmonary artery pressure, tricuspid annular-plane systolic excursion, right ventricular diameter, and e/a ratio were measured by EchoCG preoperatively and same parameters were reobtained 3 months after surgery. Results: Mean pulmonary artery pressure reduced from 23.88 ± 6.36 to 19.80 ±3.95 mm Hg and tricuspid annular-plane systolic excursion increased from 22.36 ±3.85 to 23.57±3.00 3 months after surgery. It represented statistically significant improvement at right heart functions postoperatively (P < 0.001). Although they were not statistically significant, there was also some improvement in right ventricular diameter and e/a ratio values postoperatively. Conclusion: Nasal septum deviation was associated with higher PAP values, which were improved after surgery. Although at a lower extent, a negative effect of NSD on right heart functions was also suspected. Thus, treatment of NSD without delay was proposed, not only to treat the nasal symptoms but possible future cardiovascular complications as well.

Early Results and Description of a New Modification of Spreader Graft to Enlarge Nasal Valve Area: Modified Triangular Spreader Graft.

Objective:Nasal valve area is an important, functional part of nose and there are several different methods that have been used to enlarge that area for a better breathing function. In this study, the authors aimed to study the efficacy of a new spreader graft modification that was crafted in a triangular shape to enlarge nasal valve area. Methods:Twenty-two patients who underwent rhinoplasty operation with this new technique composed the study group. Average age of patients was 21.4 ± 2.1, 13 of them were men (59%) and 9 of them were women (41%). Same surgeon operated all 22 patients with the same technique that included usage of modified triangular spreader graft. Surgical outcomes were assessed by visual analog scale and nasal obstruction symptom evaluation scale preoperatively and 3 months postoperatively. Results:None of the patients had complications or aesthetic deformities according to surgeon after surgery. Average of nasal obstruction symptom evaluation scale score was 64.3 before surgery which reduced to 17.9 at postoperative third month. Also average visual analog scale score was 2.6 before surgery and it was 8.1 3 months after surgery indicating a better breathing sensation (P < 0.001). Conclusions:Modified triangular spreader graft usage is a safe and effective method to enlarge nasal valve area with satisfactory aesthetic outcomes and good functional results because of its compatibility with anatomic position of nasal valve area.

Comparison of the effectiveness of Brandt-Daroff Vestibular training and Epley Canalith repositioning maneuver in benign Paroxysmal positional vertigo long term result: A randomized prospective clinical trial

Objective: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral cause of vertigo. It can be defined as transient vertigo induced by rapid change in head position, associated with a characteristic paroxysmal positional nystagmus. Posterior canal benign paroxysmal positional vertigo is the most frequent form of BPPV. The aim of our study was to investigate and compare the effectiveness of Epley maneuver and Brand-Daroff home exercises for the treatment of posterior canal BPPV. Methods: A total of 50 patients between 27 and 76 years of age who were diagnosed with unilateral posterior canal into BPPV were randomized prospectively into two groups. In Group-1, modified particle repositioning maneuver and in Group-2 Brandt-Daroff exercises were utilized as treatment. Patients were followed weekly. Cure weeks were recorded. The patients were followed for 12 to 24 months for recurrence. Results: The recovery rates at the first, second and third week controls were 76%, 96% and 100% for Group-1 (modified Epley maneuver) and 64%, 88% and 100% for Group-2 (Brandt-Daroff exercises) respectively. The recovery rates were similar for both groups. The average follow-up duration was 18 months. In Group 1, 7 patients (28%) and in Group 2, 5 patients (20%) had recurrence, which was also similar with no statistical difference. Conclusion: It was concluded that both Brandt-Daroff Exercises and Modified Epley maneuvers were almost equally effective in the treatment of BPPV.

Should Nasal Function be Considered Prior to Tympanoplasty

OBJECTIVE To evaluate the association between nasal airway function and Eustachian tube (ET) functions and their impact on tympanoplasty in patients with chronic suppurative otitis media (CSOM). MATERIALS AND METHODS The study group (CSOM group) consisted of 33 patients scheduled to undergo tympanoplasty for CSOM. Two control groups were formed: a nasal septal deviation (NSD) group of 25 patients scheduled to undergo nasal surgery for NSD, and a control group of 25 healthy individuals with no otologic or rhinologic symptoms. ET functions were assessed tympanometrically with automatic Williams test (ETF1) and modified pressure equalization inflation-deflation test (ETF2) and nasal functions were analyzed using acoustic rhinometry and rhinomanometry. The patients in the CSOM group underwent tympanoplasty, and tests were repeated at the end of the 3rd postoperative month. RESULTS Both acoustic rhinometry and rhinomanometry revealed similar nasal function in the CSOM and NSD groups, which was inferior to that of the control group. The CSOM group had the worst ET function. Dysfunctional ETs in the CSOM group improved at 3 months postsurgery, and all groups had a similar outcome regarding ET functions. The outcome of ear surgery was not affected by nasal function, and the graft take rate was 90%. CONCLUSION Patients with NSD had generally poor ET function; however, this did not affect the outcomes of tympanoplasty. The preoperative ET function results were inconsistent with the results following tympanoplasty; therefore, they were not predictive of need for septoplasty. Thus, we do not universally recommend surgical correction of NSD prior to ear surgery; however, this decision should be made on an individual basis.

Can We Improve Pressure Feedback Methods in Vestibular Evoked Myogenic Potentials by Applying Custom Pressures

OBJECTIVE The aim of the present study was to use constant and customized pressure levels to improve the feedback method of the blood pressure cuff technique in order to decrease intra-subject and inter-subject variability. MATERIALS AND METHODS The study was conducted in two stages. In the first stage, the relationship between the pressure level generated in the blood pressure cuff and electromyographic response in the sternocleidomastoid (SCM) muscle was investigated. In the second stage, vestibular evoked myogenic potential (VEMP) measurements were made using a custom-built VEMP chair at a constant pressure level of 40 mmHg (P40) or at 50% of the maximum pressure (Pmax50%) that could be generated by the SCM muscle. RESULTS VEMP measurements were performed on 100 volunteers consisting of 48 males and 52 females whose ages were between 20 and 68 years. The response rate was 41% on a subject basis and 53% on an ear basis. Response rates were similar in males and females, and they decreased with age. The response rate was significantly lower in 11% of the volunteers who could not generate the stipulated 80 mmHg pressure level. Response rates obtained with P40 and Pmax50% were similar, and p13 and n23 latencies and p13-n23 amplitudes obtained from both sides were also similar. Amplitudes were higher in Pmax50% measurements compared to P40, and amplitudes obtained with P40 levels showed greater variance compared to Pmax50%. CONCLUSION The use of Pmax50% provided reduced variation compared to P40; however, it did not have significant clinical implications. Further studies are needed for the control of many factors that are related to amplitude variability.

Impact of Septoplasty on Eustachian Tube Functions

Objective: To evaluate the impact of nasal septum deviation (NSD) and septoplasty on eustachian tube (ET) functions. Material and Methods: The study was designed as a prospective controlled study and conducted in a tertiary referral center. A study group of 25 patients who were scheduled for septoplasty for NSD; and a control group of 25 healthy individuals having no ear or nose symptoms were formed. Tympanometric analysis of ET function, subjective and objective analysis of nasal functions with acoustic rhinometry and rhinomanometry were performed. Patients in study group underwent nasal surgery and tests were repeated at postoperative 1st and 3rd months. Results: Eustachian tube functions of study group were significantly worse than the control group (P = 0.032). ET functions were found to be poorer as the nasal airway resistances increase which was found to be close to significance (P = 0.056). One and 3 months after corrective surgery, both nasal airway functions and ET functions improved significantly reaching to the level of control group. Conclusions: Nasal septum deviation was associated with higher rates of ET dysfunction, which could be improved by the nasal surgery. However, in some patients, nasal surgery itself caused ET dysfunction in the early postoperative period.

Comparison of Videonystagmography and Audiological Findings after Stapedotomy; CO2 Laser vs Perforator.

OBJECTIVE Various types of laser, microdrill, and perforator are effectively used in the surgical treatment of otosclerosis. However, they have certain disadvantages along with advantages. The aim of this study was to evaluate the effects of carbon dioxide (CO2) laser and perforator stapedotomy techniques on audiological outcomes and postoperative vestibular functions via videonystagmography (VNG). MATERIALS AND METHODS This prospective and randomized clinical study was conducted in an academic tertiary medical center. Sixty-nine patients diagnosed with otosclerosis who underwent stapedotomy were enrolled in this study. Patients were divided into two groups based on the technique used in stapedotomy: CO2 laser and perforator. Postoperative hearing gain and VNG findings were the main outcome measures. Subsequently, the two study groups were compared for analysis. RESULTS The preoperative air-bone gap was 32.7±8.9 decibel (dB) in the study population and it was improved to 12.9±8.4 dB after operation. There were no differences in VNG findings and vertigo symptoms between the laser and perforator groups at postoperative day 2. There was no significant gain difference regarding the air conduction, bone conduction, and air-bone gap between the two groups (p=0.294, p=0.57, and p=0.37, respectively). CONCLUSION Both CO2 laser and perforator stapedotomy have successful audiological outcomes with no difference in postoperative vestibular disturbance.