Zafer Ciftci

The evaluation of auditory system in obstructive sleep apnea syndrome (OSAS) patients

OBJECTIVE The authors of the present study aimed to investigate the impact of hypoxemia on the auditory functions of OSAS patients and discussed their findings under the scope of the existing literature. MATERIALS AND METHODS 160 patients who underwent a polysomnographic analysis for the diagnosis of possible sleep disordered breathing between January 2015 and December 2015 were enrolled in this study. Polysomnography tests were conducted at the sleep laboratory of the department of neurology at the same institute. Comprehensive otorhinolaryngological examinations of all participants were conducted by the same senior otorhinolaryngologist. Three study groups and a control group were designated in the study. Each study group was designated according to the severity of the apnea hypopnea index (AHI) and blood oxygen saturation values of the participants. All participants underwent pure tone auditometry and otoacoustic emission testing (OAE). Statistical data analysis was performed using SPSS for Windows, version 17 (SPSS Inc., Chicago, IL, USA). RESULTS Audiological assessment of the patients revealed that all patients in the control group and in mild OSAS group had normal hearing thresholds (lower than 26dB). However, the patients who had moderate and severe OSAS had varying degrees of sensorineural hearing losses. As far as body mass indexes are concerned, statistically significant differences were observed among the groups (p=0.038). CONCLUSION There is convincing evidence that the risk of progressive dysfunction in vascular and neural structures of the body is inevitable for the patients who suffer from a chronic hypoxemic condition secondary to OSAS. The findings of the present study indicated auditory transduction and transmission mechanisms may also be affected in moderate and severe OSAS patients. Therefore, via taking necessary steps in preventing hypoxemia at the outset, OSAS patients may be protected from the long term detrimental effects of chronic hypoxemia on the auditory system.

Rhinorrhoea in the elderly

The ageing population has various medical problems, ranging from relatively minor to truly severe. The ageing process includes physiological changes that can also aggravate sinonasal problems such as rhinorrhoea. As one of the most troublesome condition of this population, the causes of rhinorrhea can be classified as “age related, medication induced, secondary to rhinitis and other causes (tumour, cerebrospinal fluid (CSF) leakage, etc.)”. The underlying aetiology should be meticulously investigated. Although common conditions such as “allergic or infectious rhinitis” are relatively easy to diagnose and threat, more serious causes such as “primary spontaneous CSF rhinorrhea” are hard to manage. The treatment options should be individualised to the patient according to his or her metabolic, cardiac and central nervous system status. Rapid and accurate diagnosis and treatment of the pathology would not only increase the quality of life but also decrease morbidity and mortality of this population. As a conclusion, rhinorrhoea in the elderly is an important condition that should not be overlooked.

Pharyngoesophageal Suturing Technique May Decrease the Incidence of Pharyngocutaneous Fistula following Total Laryngectomy

Objectives. A pharyngocutaneous fistula (PCF) following total laryngectomy is associated with increased morbidity and severe life threatening complications. We aimed to review our experience with the PCF following total laryngectomy and determine the impact of previously reported risk factors on the development of PCF in our patients. Methods. The medical records of 20 patients who had a total laryngectomy operation were retrospectively analyzed. The association between the proposed risk factors and the incidence of the PCF was investigated. Results. Comparison of the suture techniques used for the closure of the pharynx (either continuous Cushing type or interrupted) yielded that primary interrupted sutures had a significantly higher incidence of PCF formation (p < 0.05). Although it was not statistically significant, diabetes mellitus was also associated with increased PCF formation (p > 0.05). No significant difference was observed between the PCF and non-PCF groups in terms of other proposed risk factors (p > 0.05).  Conclusions. The main risk factor associated with PCF was found to be the type of pharyngeal closure technique. A vertical closure with a Cushing type continuous suture may be more successful than interrupted sutures in preventing a PCF.

In vitro analysis of a novel controlled release system designed for intratympanic administration of N-acetylcysteine: a preliminary report.

The aim of this in-vitro experimental study was to design a novel drug delivery system that may permit controlled release of N-acetylcysteine (NAC) following intratympanic administration. The system was composed of two different solutions that attained a hydrogel form within seconds after getting into contact with each other. The authors performed swelling, pH and temperature tests and analysis of controlled release of NAC from this novel controlled release system. For the structure and porosity analysis of the hydrogel, an environmental scanning electron microscope (SEM) was used. The diameter of designed hydrogel showed an increase when pH was increased. In addition, in comparison to acidic values, the pore diameter of the hydrogel increased significantly especially in physiological level. The increase in the pore diameter was also directly proportional to the increase in temperature. Spectrophotometric analysis showed that the amount of NAC released into the medium was statistically significant (p=0.038, t=-2.18, 95% CI; DF: 27). SEM analysis of the samples revealed a smooth surface topography and numerous porous structures. The authors are of the opinion that the designed hydrogel may be used as an alternative method for intratympanic delivery of NAC for otoprotective purposes. The disadvantages of intratympanic injection of the drug in its liquid form, including leakage through eustachian tube, restraining the patient in an uncomfortable position, necessity for repetitive injections and dose dependent inflammation of the middle ear epithelium, may also be avoided. Further in vivo studies should be conducted to assess its tolerability and effectivity.

A new horizon in the treatment of biofilm-associated tonsillitis.

Objective: To demonstrate the efficacy of tonsil brushing in patients with chronic tonsillitis to remove the microbial biofilm on the tonsil surface using an in vitro model. Design: Specimens from patients undergoing tonsillectomy were evaluated prior to and following surface cleaning methods, including rinsing and brushing, using scanning electron microscopy (SEM). Patients: The study population consisted of 25 randomly selected patients with chronic tonsillitis. Interventions: Specimens were collected and divided into four portions. Each portion received distinct surface cleaning methods and was immediately fixed for SEM examination. Outcome measures: The biofilm layer on the surface of the tonsils was examined using SEM. The density of the biofilm layer and the degree of persistence of the biofilm after rinsing and brushing were measured. Results: The surface biofilm of the tonsils in the first group, which were neither brushed nor rinsed, revealed a thick layer of biofilm on the mucosal surface. The second group of tonsils, which were only rinsed, also showed a thick layer of biofilm. The third group of tonsils, which were rinsed following gentle brushing using a soft toothbrush, showed a reduction in the thickness of the biofilm layer. The fourth group of tonsils, which were brushed with a hard brush, was almost devoid of a biofilm layer. Conclusion: Our results demonstrate that rinsing does not effectively remove the biofilm layer on the tonsil surface. The use of a harder brush was identified as a more powerful means of removing biofilm compared with a soft brush.

Nasal mucociliary clearance in obstructive sleep apnea syndrome patients.

Background The main objective of this study was to investigate the correlation between the level of mucociliary dysfunction and severity of obstructive sleep apnea syndrome (OSAS). The effect of smoking in OSAS patients on mucociliary dysfunction was also assessed. Methods It is a descriptive study that compares variables between groups (univariate analysis). In this clinical trial 122 patients with varying degrees of OSAS and 49 healthy volunteers were included (n = 171). Patients were divided into three groups as having mild, moderate, and severe OSAS, according to their apnea hypopnea index (AHI) values. (AHI values are typically categorized as 5–15/hr, mild OSAS; 15–30/hr, moderate OSAS; and >30/hr, severe OSAS.) The control group was comprised of healthy subjects. Each group was divided into smoking and nonsmoking subgroups. The mucociliary rates of the subjects were measured using the saccharin test. Statistical analysis was performed with the GraphPad Prism Version 3 pocket program. Results Mild and moderate OSAS groups showed similar results with control group (p = 0.869), but severe OSAS patients showed a statistically significant difference with control group (Kruskal–Wallis [KW] = 32.28; p = 0.0032 and p < 0.05). Although in the moderate OSAS group the mucociliary clearance rates showed a tendency to decrease, this decrease was not significant (p = 0.453). A statistically significant difference was observed between smokers and nonsmokers in terms of mucociliary clearance times in all groups (KW = 18.24; p = 0.001). Conclusion The nasal mucociliary system is significantly deteriorated in severe OSAS patients and they should be meticulously observed to prevent sinonasal infections. Measures to enhance mucociliary activity in these patients should be taken. Smoking, a well-known inhibitor of mucociliary activity, also has a negative impact on the mucociliary function of OSAS patients and quitting smoking would be of benefit for these patients.

Do we really need to coat the novel silicone intranasal splints with antibiotics

PURPOSE The novel silicone intranasal splints are suggested to resist biofilm formation due to their surface characteristics. We aimed to ascertain the necessity of coating these splints with antibiotics to prevent splint associated infections, in vitro. MATERIALS AND METHODS Pieces of Doyle II airway nasal splints made of medical grade silicone were divided into two test groups, treated with either (i) 0.2% nitrofurazone solution or (ii) 0.2% nitrofurazone containing ointment, and a control group, treated with (iii) 0.9% saline. Splint pieces were then incubated with Staphylococcus aureus solutions at 37°C for 48 and 96h. Following this, the splint pieces were incubated in 20ml Mueller Hinton agar and appearing colonies were counted. RESULTS Following 48and 96h of incubation, the colonization rates in the saline group were significantly higher than the nitrofurazone ointment group (p<0.001). The colonization rates in the liquid nitrofurazone group were significantly lower in comparison to the nitrofurazone ointment group (p<0.001 and p=0.019 respectively). CONCLUSIONS The method of coating the splints with antibiotic was superior to using uncoated splints in terms of preventing S. aureus colonization. The rather smooth surfaces of the splints were insufficient to block bacterial colonization and coating them with antibiotics seems to be beneficial for the prevention of infections.

Evaluation of Serum Endocan Levels in Sensorineural Hearing Loss

OBJECTIVES The aim of this study was to reveal the possible role of endothelial dysfunction in sensorineural hearing loss (SNHL) by determining the serum endocan levels of patients with varying degrees of SNHL. MATERIALS AND METHODS Patients with documented SNHL and healthy controls were included in the study, whereas those with a known history of chronic inflammatory condition were excluded. In addition, a recent history of use of glucocorticoids, nonsteroid anti-inflammatory drugs, or any ototoxic medications was also considered as an exclusion criterion due to its potential impact on endocan synthesis and metabolism. Following overnight fasting, blood samples were collected, and serum endocan levels were measured. For statistical analysis of the data, PASW Statistics for Windows version 18 was used. RESULTS The comparison of the subgroups yielded no statistically significant difference between the control and mild-to-moderate SNHL groups. Despite the increase in hearing loss, the difference between the endocan levels in these patients did not increase proportionately and was not statistically significant (p>0.05). The patients in the severe SNHL group had a higher level of serum endocan than those in other groups, and the difference was statistically significant (p<0.05). CONCLUSION The serum endocan levels failed to show a proportionate increase with increasing degree of SNHL, indicating that there is no precise association between SNHL and serum endocan levels. The serum endocan levels of patients with SNHL did not significantly differ from those of the healthy controls.