Selim S. Erbek

Efficacy of olopatadine HCI 0.1%, ketotifen fumarate 0.025%, epinastine HCI 0.05%, emedastine 0.05% and fluorometholone acetate 0.1% ophthalmic solutions for seasonal allergic conjunctivitis: a placebo-controlled environmental trial.

Purpose:  We aimed to compare the clinical efficacy and ocular surface variables of olopatadine, ketotifen fumarate, epinastine, emedastine and fluorometholone acetate ophthalmic solutions in preventing the signs and symptoms of seasonal allergic conjunctivitis (SAC).

Cochleovestibular dysfunction in ankylosing spondylitis.

Ankylosing spondylitis (AS) is a rheumatic disease characterized by chronic inflammation. The aim of this study was to evaluate the functions of the cochlea and the vestibular system in patients with AS. The study group consisted of 32 patients with AS and 30 healthy volunteers as a control group. Otorhinolaryngologic examinations were performed in all patients together with pure-tone audiometry, speech tests, impedancemetry, transient evoked otoacoustic emission (TEOAE) and electronystagmography (ENG). A significant difference was found between the 2 groups with regard to pure-tone averages at high frequencies in each ear (p < 0.05). The rates of reproducibility in TEOAE testing were significantly lower in patients with AS (p = 0.03). The signal-to-noise rates of the response values were lower at all frequencies in patients with AS, but a statistically significant difference was only observed at 2, 3 and 4 Hz (p < 0.05). ENG revealed pathologies in 11 patients with AS (34%), 8 of which were central (25%) and 3 of which were peripheral (9%). No correlation was found between cochleovestibular dysfunction and age, sex, disease duration, activity and medication taken. This study demonstrated that there is an association between AS and cochleovestibular dysfunction.

The role of allergy in the severity of nasal polyposis.

Background Although patients with nasal polyposis frequently exhibit concomitant allergy, there is limited information about the impact of allergy on the severity of nasal polyposis. The goal of this study was to evaluate the role of allergy in the severity of nasal polyposis. Methods Polyp sizes, computed tomography (CT) scores, skin-prick test results, blood total eosinophil count, serum levels of total immunoglobulin E, symptom scores, and recurrences were analyzed in 83 patients with nasal polyposis. The results were compared between allergic and nonallergic patients with nasal polyposis. Results No association was found between the presence of allergy per skin-prick testing and polyp size, CT opacification, symptom scores, or recurrences (p > 0.05). In allergic patients, only the serum total eosinophil count correlated strongly with the results of CT (p = 0.005) but not with other parameters (p > 0.05). Conclusions The results of this study show that, although patients with nasal polyposis frequently have allergies, the presence of allergy does not correlate with polyp size, symptom scores or rate of recurrence.

Expression of a disintegrin and metalloproteinase 33 protein in nasal polyposis: an immunohistochemical study.

Background A disintegrin and metalloproteinase (ADAM)-33 is a member of matrix metalloproteinases. This protein takes a role in angiogenesis and airway remodeling in asthma. Because histopathological findings of airway remodeling in asthma and nasal polyposis (NP) are similar, the aim of this study was to evaluate the ADAM-33 expression in NP. Methods Immunohistochemical staining of specimens of 47 patients with NP and 8 patients with concha bullosa was performed to detect the expression of ADAM-33. Paraffin blocks were used to identify the expression of ADAM-33 polyclonal antibodies. Immunostaining of epithelial cells, stroma, mesenchymal cells of vessels, and inflammatory cells were analyzed by using light microscopy. Results Immunopositivity scores in epithelial cells in NP (median, 2; range, 1–3) were significantly higher than those of controls (median, 1.5; range, 1–2; p < 0.001). ADAM–33 staining was increased in the mesenchymal cells of vessels of nasal polyps (median, 2; range, 1–3) compared with control tissues (median, 1.5; range, 1–2; p = 0.006). Although the staining scores of fibroblasts in nasal polyp specimens were also high (median, 3; range 1–3), there was no statistical significance when compared with controls (median 2; range, 1–3; p = 0.228). ADAM–33 immunostaining was not related with the presence of allergies, asthma, and aspirin intolerance (p > 0.05). Moreover, no relationship was found between increased expression of ADAM–33 and the stages of polyp or computerized tomography scores (p > 0.05). Conclusion This study suggests that the increased expression of ADAM-33 protein may have a role in the pathogenesis of NP.

Matrix metalloproteinase-9 promoter gene polymorphism (-1562C>T) in nasal polyposis.

Background Expression of matrix metalloproteinase (MMP)-9 increases in nasal polyp tissues. However, the impact of MMP-9 genotypes on the development of nasal polyposis (NP) is unknown. The aim of this study was to examine a potential association of MMP-9 promoter gene polymorphism with the development of NP. Methods A prospective and case–control study was performed on 93 patients with NP and 115 controls without sinonasal disease. Genotypes of MMP-9 (–1562C>T) were identified by restriction fragment length polymorphism analyses after polymerase chain reaction. Results The frequency of – 1562CT genotype of MMP-9 was significantly high in NP patients with aspirin-induced asthma (p = 0.014). Distribution of T allele was significantly high in NP patients with aspirin-induced asthma (p = 0.013). MMP-9 genotypes were not associated with gender or the presence of atopy. Conclusion In this study, MMP-9 – 1562CT genotype was associated with susceptibility to NP in aspirin-induced asthmatic patients. Because this report is a population-based study, further research should be performed on larger study subjects to reveal the precise role of MMP-9 promoter gene polymorphism in the development of NP.

Expression of metalloproteinases MMP-2 and MMP-9 in antrochoanal polyps.

Background Matrix metalloproteinase (MMP) 2 and MMP-9 are known to cleave specifically type 4 collagen, which is a major structural component of basement membrane. This is an early step of inflammation. Because of this property they have been studied in chronic sinonasal disorders. The aim of this study was to determine the MMP-2 and MMP-9 expressions in an antrochoanal polyp (ACP). Methods We examined tissue samples from 10 ACPs, 10 diffuse nasal polyps, and 10 control nasal mucosa (CM) by immunohisto-chemistry for MMP-2 and MMP-9 expression. Results Most of epithelial and endothelial cells showed positive immunostaining for MMP-2 and MMP-9 in all tissue samples. MMP-2 staining of inflammatory cells showed no difference among the groups (p > 0.05). On the other hand, MMP-9+ inflammatory cells were found to be significantly increased in ACP and diffuse nasal polyps when compared with CM (p < 0.05). Conclusion MMP-9–expressing inflammatory cells could play a role in the pathophysiology of ACP as well as nasal polyps.

Vestibular evoked myogenic potentials in Behcet's disease.

The aim of this study was to investigate vestibular evoked myogenic potentials (VEMPs) and their clinical significance in Behcet’s disease. Twenty-six patients with Behcet’s disease and 25 healthy volunteers were evaluated for pure tone audiometry, caloric response, and VEMPs. Sensorineural hearing loss was found in 53.8% of patients with Behcet’s disease, which was significantly higher than controls. Four patients had canal paresis, but no controls; this difference was not significant. Although VEMP recordings were elicited in all study subjects, mean p13 and n23 latencies were prolonged in Behcet’s patients compared with controls. Seven patients had delayed VEMP responses. There were no correlations regarding p13 values and age, duration or activity of disease, vertigo, or sensorineural hearing loss. The results of this preliminary study suggest an association between delayed VEMP responses and Behcet’s disease. Further research with large samples is needed to confirm that VEMP testing is useful to diagnose and follow vestibular dysfunction in Behcet’s disease.

Subjective pulsatile tinnitus associated with extensive pneumatization of temporal bone

Pulsatile tinnitus (PT), a rare otologic symptom, is frequently associated with identifiable and treatable causes. We report two cases of subjective PT due to extensive pneumatization of temporal bone around the internal carotid artery.

Oxidative stress and nasal polyposis: does it affect the severity of the disease?

Background Nasal polyposis (NP) is a chronic inflammatory disease and the waste products of this inflammation are reactive oxygen species composed of free radicals. Changes in oxidative status have already been revealed in NP. The aim of this study was to investigate the effect of oxidative status to the severity of the disease and the quality of life. Methods The study group included 24 patients with NP and 20 controls. The Turkish version of the Rhinosinusitis Disability Index, visual analog scale (VAS), polyp stage, computed tomography (CT) score, and the eosinophilic cationic protein (ECP) levels in nasal lavage (NAL) fluid were used to assess the severity of the disease. Malondialdehyde, nitric oxide (NO), and the total antioxidant status (TAS) levels in NAL fluids were measured representing the oxidative stress. Results NO values were correlated with nasal congestion (p = 0.031). TAS values were correlated with nasal obstruction (p = 0.039). ECP values showed correlation with all the nasal obstruction (p = 0.003), congestion (p = 0.009), rhinorrhea (p = 0.009), and VAS scores (p = 0.039). Conclusion In NP, ECP levels detected in NAL fluid were significantly high and were correlated with the severity of the disease. Moreover, the severity of oxidative stress, in the forms of TAS and NO, is significantly correlated with the severity of the nasal obstruction and congestion, respectively.

Vestibular evoked myogenic potentials in preterm infants.

The goal of this study was to determine whether there was an association between perinatal risk factors of prematurity and vestibular evoked myogenic potentials (VEMPs). A prospective case-control trial was designed. Fifty preterm newborns (100 ears) with a gestational age <37 weeks were included. The control group consisted of 20 healthy term infants (40 ears). VEMP recordings were performed, and mean latencies of p13 were calculated in all study subjects. Multivariable logistic regression was used to investigate the influence of perinatal variables on abnormal VEMP responses. VEMPs were elicited in all term infants (40 ears). In preterm infants, the responses were normal in 71 ears, delayed in 24 and absent in 5. There was a significant difference between abnormal VEMP rates for preterm and term infants (p < 0.001). Asphyxia (OR = 13.985, p = 0.048) and time of VEMP test (OR = 0.865, p = 0.038) were related to abnormal VEMP responses. There was no association between delayed VEMPs and gestational age, birth weight, hemoglobin and bilirubin levels, phototherapy, intracranial hemorrhage, convulsions, sepsis, ototoxic drugs, transfusion, mechanical ventilation, retinopathy of prematurity, bronchopulmonary dysplasia and respiratory distress syndrome. These results suggest a delay in the maturation of VEMPs in premature infants. Asphyxia was the most important risk factor for abnormal VEMP responses in preterm infants.