Ozgur Yigit

Recovery of Idiopathic Sudden Sensorineural Hearing Loss.

OBJECTIVE The objective was to identify and evaluate factors that may influence the recovery rate in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). MATERIALS AND METHODS A retrospective analysis was performed for patients with sudden sensorineural hearing loss between 2009 and 2013. Those with an identified etiology were excluded. The patients were divided into four treatment groups: (i) systemic corticosteroids (SC) only, (ii) SC+low-molecular-weight heparin (LMWH), (iii) SC+hyperbaric oxygen (HBO), and (iv) SC+LMWH+HBO. Recovery was evaluated according to Siegels criteria. Age, initial hearing level, onset, treatment and audiogram types, comorbidities, and associated tinnitus and vestibular symptoms were investigated for their impact on prognosis. RESULTS Two hundred five patients with ISSNHL were included. Recovery was seen in 59% of the patients. The complete recovery rate was significantly lower in patients older than 60 years and in patients presenting with profound hearing loss. Different audiogram curves had no significant effect on recovery. Sudden hearing loss was accompanied by tinnitus in 107 (52.1%) patients and vestibular symptoms in 55 (26.8%); however, neither was noted to affect prognosis. Different treatment combinations did not significantly affect prognosis. However, hypertension and a delay in treatment by more than 10 days from the onset of hearing loss were associated with a worse prognosis. CONCLUSION Profound hearing loss, older than 60 years, a delay in treatment by more than 10 days, and hypertension were negative prognostic factors in this study, whereas, the type of audiogram curve and addition of HBO to SC did not affect prognosis.

Efficacy of the Combination of Intraoperative Cold Saline-Soaked Gauze Compression and Corticosteroids on Rhinoplasty Morbidity

Objective. The basic aim of this study was to minimize intraoperative bleeding, postoperative eyelid edema, and periorbital ecchymosis and to reduce morbidity with a combination of cold saline-soaked gauze compression and intraoperative single-dose corticosteroids. Study Design. The study was designed as a prospective, double-blind, randomized controlled study. Three hundred patients who underwent septorhinoplasty were included. Setting. A tertiary referral hospital in Turkey. Subjects and Methods. Three hundred patients undergoing septorhinoplasty were divided into 2 groups. A single dose of 10 mg dexamethasone was intravenously administered in all cases at the beginning of the operation. In the study group, the nasal dorsum was continuously compressed with cold saline-soaked gauze during the operation. In the control group, the nasal dorsum was compressed with dry gauze continuously during surgery. The operation time and amount of bleeding were recorded during surgery. Degree of eyelid edema and periorbital soft tissue ecchymosis was recorded at 24 hours and on postoperative days 2, 3, 5, and 7 by 2 investigators. Results. The operation time was significantly shorter in the study group than in the control group. Eyelid edema and periorbital ecchymosis were significantly decreased in the study group at the following postoperative days 1, 3, 5, and 7 (P < .05). Conclusion. Bleeding, edema, and ecchymosis are the main morbidities of rhinoplasty. It is highly probable that cold compression and intraoperative corticosteroids have synergistic effects on these morbidities, especially by the intraoperative control of bleeding.

The effect of corticosteroid on metalloproteinase levels of nasal polyposis.

The aim of this study was to investigate the effect of corticosteroid treatment on topical and systemic metalloproteinase levels of patients with nasal polyposis (NP).

Histopathological Characteristics of Sulcus Vocalis

Objective. To describe the frequency of sulcus vocalis in a population and to establish its histopathological properties. Study Design. A cadaver study. Setting. Istanbul Training and Research Hospital and Ministry of Justice National Forensic Institute. Subjects and Methods. One hundred (21 women, 79 men) fresh cadaver larynges were examined. Two hundred vocal folds were coronally sectioned and examined by light microscopy. Sulcus types, depths, degree of fibrosis in Reinke space, basement membrane thickness, and perisulcus degeneration were determined. Results. Sulcus vocalis was found in 39 of 100 cases (39%), with a male preponderance of 41.8% compared with women at 28.6%. Twenty-one (54%) cases had unilateral and 18 (46%) cases had bilateral sulcus. Among 200 vocal folds, 57 had sulcus (28%). A total of 21 sulcus cases were type 1 (37%), 18 were type 2 (31.5%), and the remaining 18 cases were type 3 (31.5%). Of the 39 (30.7%) sulcus cases, 12 were confirmed by histopathological examination, although they looked morphologically normal following macroscopic evaluation. Vocal ligament involvement was found in 14 cases with type 2 (78%) and in 15 cases with type 3 sulcus (83%). Conclusion. Sulcus vocalis is a common pathology in the population and can be observed at all ages. The accuracy of diagnosis seems to depend on the measurement of the sulcus depth and the histological characteristics. For this reason, tools and strategies should be established in living subjects for effective management of this challenging disorder.

Watch peripheral arterial tonometry in the diagnosis of obstructive sleep apnea: Influence of aging

To investigate the consequences of aging and associated peripheral vascular tone impairment on peripheral arterial tonometry (Watch PAT)‐based sleep and respiratory disturbance analysis in obstructive sleep apnea (OSA) diagnosis.

Surfactant protein A and D in chronic rhinosinusitis with nasal polyposis and corticosteroid response.

Background Corticosteroids are a mainstay of treatment for chronic rhinosinusitis with nasal polyposis (CRSwNP). Data related to the effect of systemic methylprednisolone on surfactant protein (SP) expression in CRSwNP is limited. This study aimed to reveal the consequences of systemic methylprednisolone treatment on levels of SP-A and SP-D, which play a role in innate immunity, in patients with CRSwNP. Methods Twenty-one patients with CRSwNP were included in the study, along with 15 control patients scheduled for dacryocystorhinostomy. A polypoid tissue biopsy was taken under local anesthesia, and 15 CRSwNP patients were scheduled for endoscopic sinus surgery after 3 weeks of oral methylprednisolone. Posttreatment biopsies were performed perioperatively. Pre- and posttreatment endoscopic polyp grades were determined, as were symptom scores regarding nasal obstruction, headache, and nasal discharge using a visual analog scale (VAS). SP-A and SP-D levels were measured using enzyme-linked immunosorbent assay and the results were compared. Results All patients reported relief from clinical symptoms through VAS after methylprednisolone treatment. The posttreatment polyp grade was reduced (p < 0.0001). SP-A and SP-D levels did not yield a significant difference between CRSwNP patients and controls (p = 0.25 and p = 0.13, respectively). Statistically significant up-regulation was detected in SP-A and SP-D levels after oral methylprednisolone (p = 0.0002 and p = 0.0004, respectively). Conclusion In this study, significant up-regulation of SP-A and SP-D was revealed in patients with CRSwNP after systemic steroid treatment. The role of SP-A and SP-D up-regulation in CRSwNP pathogenesis and therapeutic outcomes of corticosteroids have potential importance for the introduction of new therapeutic modalities that are more effective and produce fewer adverse effects.

The role of matrix metalloproteinases in recurrent tonsillitis

OBJECTIVE The aim of this study was to investigate the status of matrix metalloproteinases (MMP-2, MMP-7, MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) due to dysregulated turnover of connective tissue matrices in children with recurrent tonsillitis (RT). METHODS Forty-four patients with RT were enrolled in the study. All patients with RT were graded according to the hypertrophy degree of the tonsillar tissue from grade I to grade IV. Patients with grade I tonsillar hypertrophy and grade II tonsillar hypertrophy were accepted as group A, patients with grade III tonsillar hypertrophy and grade IV tonsillar hypertrophy were accepted as group B Tonsillectomy was performed via the usual dissection-snare method. Tonsillar specimens of superficial and core region were evaluated for MMP-2, MMP-7, MMP-9 and TIMP-1 analysis. RESULTS There was no statistical significance according to the MMP-2, MMP-7, MMP-9 and TIMP-1 activity of superficial part and core regions in both groups individually, MMP-9 level of both the superficial and core regions in group B had statistical significant higher results than group A (p=0.026, p=0.06 respectively). MMP-7 level of the superficial part in group B patients also had statistical significant higher results than group A (p=0.025). However, there was no statistical difference found between superficial and core region MMP-2 and TIMP-1 levels of group A and group B. Related to this, balance between MMP-7-9 and TIMP-1 activities tended to slip MMP-7 and MMP-9 sides with increased tonsillar grade. CONCLUSIONS Results from this study suggest that the presence of MMPs in tonsil tissue consolidates the involvement of degraded extracellular matrix proteins in the pathophysiology of chronic tonsillitis. MMPs activity showed diffuse dissemination in the tonsillar tissue and especially MMP-9 and MMP-7 are the main promoters of the extracellular matrix that responded to inflammatory changes in the tonsillar tissue. Further studies are needed concerning the possible efficiency of selective MMP inhibitors on tonsillar tissue.

Septal Perforation Repairing with Combination of Mucosal Flaps and Auricular Interpositional Grafts in Revision Patients

Objectives. To examine the closure of nasal septal perforations with bilateral nasal floor flaps combined with auricular cartilage grafts and a normally functioning nose in revision patients. Study Design. Case series with chart review. Setting. A tertiary referral hospital in Turkey. Subjects and Methods. Seventeen patients (11 men, 6 women) with nasal septal reperforation were treated surgically using combined bilateral nasal floor mucosal flaps with bilateral auricular cartilage interpositional grafts. Results. The mean follow-up was 15.2 (range, 9-28) months. The average anteroposterior diameter of perforation was 28 ± 3 (range, 20-38) mm, and the average vertical diameter was 23 ± 8 (range, 20-27) mm at the widest site. The nasal septal perforations were closed completely in 16 cases; in 1 case, the perforation was not repaired completely. Conclusions. A successful multilayer closure technique with good exposure was applied in patients with reperforation.

Tensile Characteristics of Costal and Septal Cartilages Used as Graft Materials

OBJECTIVES To determine the biomechanical characteristics of septal cartilage (SC) and costal cartilage (CC) taken from fresh cadavers using tensile testing and to establish CC graft material of a suitable thickness (ie, with tensile characteristics closest to those of SC). METHODS Grafts of varying thickness were harvested from the central part of the seventh-rib CC and SC of 18 fresh cadavers. Tensile testing was performed with a 0.5-kilonewton load calibrated at 7 mm/min. The results were shown as a force-elongation curve. RESULTS No significant difference according to tensile force was observed between the SC group and the 1.0-mm and 1.5-mm CC groups (P = .09 and P = .32, respectively). However, a significant difference was observed between the SC group and the 2.0-mm CC group (P = .04). Although the strength value of the CC group was 5.03 MPa, the modulus of elasticity was 1.33 MPa. In the SC group, the strength value was 12.42, but the modulus of elasticity was 1.39 MPa. The strength value of the SC group was higher than that of the CC group (P = .001), but the modulus of elasticity value of the CC group was higher than that of the SC group (P = .001). CONCLUSIONS From the standpoint of tensile testing for preparing columellar struts, 1.0-mm and 1.5-mm CC have similar characteristics to SC and thus can be used instead of it. However, it is important to determine the thickness of CC by considering the expected characteristics of the established material and the forces that affect the area in the nose where the graft will be placed.

Evaluation of life quality, self-confidence and sexual functions in patients with total and partial laryngectomy ☆

OBJECTIVE In this study patients who have undergone partial (PL) or total laryngectomy (TL) were evaluated for life quality, self-esteem and sexual dysfunctions. METHODS 108 patients who received TL or PL without tracheostoma were included in this study. During patient interview, sociodemographical data form, European Organization for Research and Treatment of Cancer, Life Questionnaire Core 30 Items, Cancer and Head and Neck module-35 Items (EORTC QLQ-C30 and H&N35) were filled and patients were also asked to fill in Arizona Sexual Experiences Scale (ASEX), Becks Depression Inventory (BDI), Becks Anxiety Inventory (BAI) and Rosenberg Self-Esteem Scale (RSES) forms. RESULTS Depression and anxiety scores and points taken from RSES were significantly different between TL and PL patients (p=0.045, p=0.041 and p=0.006 respectively). Although the difference was not significant in ASEX (p=0.174), the average scores of sexuality subunit (QL-35 59-60) of EORTC QLQ-H&N35 module were significantly different in these patients (p<0.001). Besides, it was shown that 90.3% of TL patients and 63.9% of PL patients have experienced negative effects in sexual functions. CONCLUSION TL patients were more often observed to have problems regarding depression, anxiety, self-esteem and sexual functions and it is concluded that they may need psychosocial support more than PL patients.