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    Butterfly cartilage tympanoplasty: an alternative new technique instead of conventional surgery method
    (Springer, 2017) Kaya, Isa; Benzer, Murat; Gode, Sercan; Bilgen, Cem; Kirazli, Tayfun
    Butterfly graft inlay tympanoplasty is a well-established technique for the repair of small- and medium-sized perforations. There are some difficulties with application of conventional butterfly technique and it affects our success rate of graft healing. With some modifications of graft preparation we can make better success rates. The aim of this study was to present the new renovation of conventional method, describe about what kind of changes we made and its technical facilities about the procedure. The study design is a prospective case series. This study was carried out on 18 patients who underwent inlay butterfly cartilage tympanoplasty with the new technique for anterior and inferior perforations at an otolaryngology department of a tertiary medical center between November 2015 and August 2016. Patients were followed with otoscopy and audiometry, and graft healing's success. Anatomic closure at 6th month after tympanoplasty was found in all 18 patients. There was no incidence of cartilage graft rejection or displacement. Preoperative mean PTA was 27.7 dB, which improved 6 months after surgery to 10.5 dB (the average value of hearing thresholds at 0.5, 1, 2 and 4 kHz). Butterfly cartilage tympanoplasty technique is safe and efficient in terms of both anatomical closure of the defect and improvement in hearing. We believe with this new technique, we facilitate this procedure in addition to the improvement of patients' comfort and decrease the morbidity of the procedure.
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    Can verapamil be effective in controlling vertigo and headache attacks in vestibular migraine accompanied with Meniere's disease? A preliminary study
    (Springer Heidelberg, 2019) Kaya, Isa; Eraslan, Sevinc; Tarhan, Ceyda; Bilgen, Cem; Kirazli, Tayfun; Gokcay, Figen; Karapolat, Hale; Celebisoy, Nese
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    Cavernous Sinus and Parasellar Region: An Endoscopic Endonasal Anatomic Cadaver Dissection
    (Lippincott Williams & Wilkins, 2018) Erdogan, Umut; Turhal, Goksel; Kaya, Isa; Biceroglu, Huseyin; Midilli, Rasit; Gode, Sercan; Karci, Bulent
    The aim of this study was to investigate the neurovascular structures of the cavernous sinus with the endonasal endoscopic transpterygoid approach on fresh human cadavers. Additionally, the course of internal carotid artery (ICA) and relevant anatomy was thoroughly investigated to refine the anatomical landmarks, exposure difficulties, potential complications, and limitations using the endonasal endoscopic technique. This study was carried out at an otolaryngology department of a tertiary medical center between June 2014 and June 2015. The surgical dissection was performed on 10 fresh human cadaver specimens using paranasal sinus and skull base endoscopic instruments. Cavernous sinuses and parasellar area were explored via an endoscopic endonasal transpterygoid approach. Dehiscence was present in 5 (25%) cavernous ICAs. Projection of the cavernous ICA on the whole lateral sphenoid wall was prominent in 6 (%30) sphenoid sinuses. Anterior curve was prominent in 12 (60%) cavernous ICAs, whereas posterior was prominent in 7 (35%). Mean distance between the lateral wall of eustachian tube orifice and petrous ICA was 19.50 +/- 1.05 mm (range 18-22 mm). Cranial nerves of the cavernous sinus showed no variation. Control of the ICA is critical during the endonasal endoscopic approach to the cavernous sinus and skull base. The vidian nerve is a reliable and important landmark to the petrous ICA in the transpterygoid approach. Dissection of the eustachian tube and its relation to the ICA has to be kept in mind during nasopharyngeal surgery.
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    Comparative outcomes of extracapsular dissection and superficial parotidectomy
    (Taylor & Francis Ltd, 2019) Ozturk, Kerem; Ozturk, Arin; Turhal, Goksel; Kaya, Isa; Akyildiz, Serdar; Uluoz, Umit
    Background: Retrospective analysis of extracapsular dissection (ECD) and superficial parotidectomy (SP). Aims/objectives: Comparing the outcomes of ECD and SP in surgery of benign parotid masses. Material and methods: Total of 136 patients included in the study. The inclusion criteria were pathologically proven benign FNA biopsy, lack of deep lobe invasion and single tumour diameter lower than 4 cm, absence of radiologically and clinically malignant lesion and facial paralysis at the time of diagnosis. Objectives: Drain volumes and seroma presence, clinical evaluation of face nerve function; signs of infective complications were collected from patients' clinic chart. Complications and recurrence rates were obtained from follow-up forms. Results: The mean follow-up period was 42.53 +/- 14.88 months. In SP group, three patients with disease recurrence were found, 8 (10.2%) had early facial nerve paralysis (grade 2 and 3) and 11 (14.1%) had Frey's syndrome. No postoperative complication, early facial paralysis and recurrence were observed in ECD group.
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    A Comparative Study: Platelet-Rich Fibrin Packing as an Alternative to the Absorbable Gelatine in Tympanoplasty
    (Aves, 2022) Turhal, Goksel; Ozturk, Arin; Kirazli, Tayfun; Kaya, Isa
    BACKGROUND: We aimed to investigate platelet-rich fibrin's potential role as packing material in both the middle ear and external auditory canal. METHODS: Twenty-nine patients undergoing transcanal endoscopic type 1 cartilage tympanoplasty were included in this controlled prospective clinical study. Patients were randomly assigned to platelet-rich fibrin (n = 14) or absorbable gelatine (n = 15) groups. Preoperative and postoperative pure-tone audiometry results, graft healing rates, tympanometry values, and Glasgow Benefit Inventory scores were compared. RESULTS: No significant postoperative complications were observed and the graft intake rate was 100% in both groups. Mean aft-bone gap gain was 9.82 +/- 4 dB HL in the postoperative first month and 10.08 +/- 491 dB HL in the sixth postoperative month in the platelet-rich fibrin group. There was no statistically significant difference between the postoperative air-bone gap gains of the groups in the first (P= .537) and sixth month (P= .723) controls. There was no statistically significant difference in compliance (P = .453) between groups. The physical benefit scores of the Glasgow Benefit Inventory were significantly higher in the platelet-rich fibrin group (P= .01).There was no difference in general and sodas benefit scores (P> .05). CONCLUSION: As a middle and external auditory canal packing agent, platelet-rich fibrin was as successful as absorbable gelatine in transcanal endoscopic cartilage tympanoplasty with similar functional results and graft healing rate.
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    Comparison between Rescue Flap and Double Flap Technique
    (Thieme Medical Publ Inc, 2019) Benzer, Murat; Biceroglu, Huseyin; Ates, Murat Samet; Kaya, Isa; Ozgiray, Erkin; Midilli, Rasit; Karci, Bulent; Gode, Sercan
    Objectives Endoscopic techniques in pituitary surgery lead to inevitable mucosal loss of the sphenoethmoidal recess and posterior nasal septum in the nasal cavity. There is no other comparative study between primary reconstruction of septal perforation and secondary healing in the literature. The aim of this study is to evaluate postoperative patient morbidity with or without posterior septal perforation in endonasal pituitary surgery by comparing two commonly used techniques: rescue and double nasoseptal flaps. Design Prospectively randomized study. Setting Tertiary academic center. Participants Sixty patients underwent endoscopic endonasal pituitary surgery. Main Outcomes and Measures Functional results (breathing) using visual analog scale (VAS), sphenoid sinusitis, presence of synechia, perforation in the posterior septum, and crusting in the sphenoethmoidal recess were assessed. Results Pre- and postoperative mean VAS scores were 71.67 +/- 11.47 and 67.67 +/- 9.71 mm in the intact septum group and 77.67 +/- 14.06 and 62.67 +/- 10.48 mm in the posterior septal perforation group. There was a significant difference between pre- and postoperative VAS values in all groups. There was significant worsening in both groups; worsening in VAS values was much higher in the posterior septal perforation group. In the posterior septal perforation group, much more crusting was seen. Conclusions This is the first study to compare the postoperative patient morbidity in endoscopic endonasal pituitary surgery with and without a posterior septal perforation. Reconstruction of the posterior septum along with less mucosal loss yields better postoperative nasal symptom score.
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    Comparison of anterior and posterior tympanomeatal flap elevations in endoscopic transcanal tympanoplasty
    (Taylor & Francis Ltd, 2019) Ozturk, Arin; Benzer, Murat; Kaya, Isa; Gode, Sercan; Bilgen, Cem; Kirazli, Tayfun
    Background: There is not an ideal tympanomeatal flap incision type for transcanal procedures. Aims/Objectives: Comparing the outcomes and feasibility of posteriorly and anteriorly based tympanomeatal flap incisions for anterior perforations in endoscopic transcanal cartilage tympanoplasty. Material and methods: Twenty-six patients who had anterior TM perforation were included. Patients were divided into two groups with randomization. All of the data were prospectively collected. These included demographic data, date of the surgery, mean surgery time, preoperative and postoperative sixth-month pure-tone audiometry (PTA), type of tympanomeatal flap incision and graft healing success. Results: Mean follow up time was 20.69 +/- 5.03 months. Graft healing rate was 100% in both groups. There was no major complication in both of groups. Mean air bone gap level improvement of (dB HL) at all frequencies was 7.69 +/- 2.83 dB HL in group 1 and 7.98 +/- 3.08 dB HL in group 2 respectively. Regarding pre-and postoperative mean air bone gap levels and mean surgery times, there was no significant difference between groups (p>.05). Conclusions and significance: For non-complicated anterior perforations that are less than 50% of TM, endoscopic transcanal cartilage tympanoplasty using anterior tympanomeatal flap elevation procedure was seemed minimally invasive and feasible to perform with successful audiologic and postoperative outcomes.
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    A comparison of electrothermal bipolar vessel sealing system and electrocautery in selective neck dissection
    (Springer, 2016) Ozturk, Kerem; Kaya, Isa; Turhal, Goksel; Ozturk, Arin; Gursan, Gulce; Akyildiz, Serdar
    The use of LigaSure (TM) vessel sealing system in head and neck surgery was reported to be reliable and safe, providing sufficient hemostasis and reducing operating time. The aim of this study was to evaluate efficacy of this technique in patients undergoing selective neck dissections. This study was carried out as a prospective controlled study at an otolaryngology department of a tertiary medical center between July 2013 and July 2015. Twenty-five patients older than 18 years who underwent unilateral selective neck dissection for head and neck cancer were included in the study. In the control group (group 2, 10 patients) only monopolar and bipolar diathermy was used; in the Ligasure group (group 1, 15 patients) Ligasure was used for hemostasis and dissection in addition to the conventional techniques. Cervical lymphadenectomy time, operation time, preoperative hemoglobin levels, preoperative hematocrit levels, postoperative hemoglobin levels, postoperative hematocrit levels, total neck drainage and drain removal time were analyzed and compared between the groups. Median operation time in group 1 and 2 were 95 min (IQR = 35) and 142.5 min (IQR = 63), respectively. Median cervical lymphadenectomy time in group 1 and 2 were 55 min (IQR = 23) and 102.5 min (IQR = 49), respectively. Median operation time and cervical operation time were significantly lower in group 1 (p < 0.05). In conclusion, LigaSure (TM) vessel sealing system is a safe, efficacious technique and significantly lowers cervical lymphadenectomy and operation time in selective neck dissections compared to controls. Given the superb hemostatic properties, this technique should be in the surgeon's armamentarium when possible.
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    Comparison of endoscopic and microscopic stapedotomy in the same patients: a prospective randomized controlled trial
    (Springer, 2024) Kaya, Isa; Sahin, Fetih Furkan; Tanriverdi, Hasan; Eroglu, Suleyman; Kirazli, Tayfun
    Purpose This study aimed to conduct a comparative analysis of audiological and postoperative clinical outcomes between the endoscopic and microscopic stapedotomy approaches. Methods This study employed a randomized, controlled design. Twenty-seven patients with bilateral otosclerosis underwent stapedotomy in both ears, with randomized allocation of the surgical technique (endoscopic vs. microscopic) for the first operated ear. Air-bone gap (ABG) and ABG gain were measured at least 12 months postoperatively. Postoperative outcomes including pain (Visual Analog Scale-VAS), dizziness, early-term (day 1) and late-term (6 months) dysgeusia were evaluated. The Glasgow Benefit Inventory (GBI) assessed health-related quality of life at one month postoperatively, and operative time was measured. Results This study compared endoscopic (n = 27 ears) and microscopic (n = 27 ears) stapedotomy for otosclerosis. Both groups achieved similar hearing improvement with no significant differences in pre-operative and post-operative bone/air conduction thresholds, ABG, and ABG gain (all p > 0.05). The endoscopic stapedotomy group demonstrated reduced postoperative pain (lower VAS scores, p < 0.001), lower early dysgeusia (3.7% vs. 33.3%, p = 0.005), shorter operative time (47.3 vs. 75.4 min, p < 0.001) and improved patient-reported outcomes (higher GBI score, p = 0.014) when compared to microscopic stapedotomy group. No significant differences were observed in postoperative dizziness or late-term dysgeusia between groups. Conclusion This study found similar hearing improvement with both endoscopic and microscopic stapedotomy for otosclerosis. However, the endoscopic approach showed advantages in reduced postoperative pain, early dysgeusia, and operative time, with improved patient-reported quality of life. These findings suggest endoscopic stapedotomy as a valuable alternative to the conventional microscopic approach.
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    Defect Reconstruction of the Nose After Surgery for Nonmelanoma Skin Cancer: Our Clinical Experience
    (Aves, 2017) Kaya, Isa; Uslu, Mustafa; Apaydin, Fazil
    Objective: This study aimed to investigate reconstruction methods according to nasal subunits in patients who were surgically treated with diagnosis of non-melanoma skin cancer of the nose. Methods: All patients were retrospectively investigated. This study was conducted between April 2004 and December 2010; 180 patients who were surgically treated with diagnoses of skin basal cell carcinoma, squamous cell carcinoma, cancer of skin appendages, and precancerous lesions and 194 lesions were included. The types of repair performed were divided into seven main groups: Secondary healing, primary closure, skin graft, local flap, auricular composite graft, subtotal reconstruction and prosthesis application. Results: Among the 180 patients, 110 (61.1%) were males and 70 (38.9%) were females. The mean duration of follow-up was 39.8 (range, 32-81) months. Repair was by a local flap, a primary suture, a skin graft, and an auricular composite graft in 133, 16, 38, and 2 defects, respectively. Four defects were left for secondary healing. A prosthesis was applied to one patient. Totally, 194 defects were treated by surgery. Conclusion: Although nonsurgical treatment options such as radiotherapy or cryotherapy may be effectively used, surgery is the main treatment option for cancer of the nasal skin. Nasal subunits have distinct characteristics; thus, optimal reconstruction should be preferred for each subunit. The objective of the reconstruction is not only closing the defect. Closing the defect appropriately with the optimal flap and in proper with the aesthetic subunits is the most important point in reconstruction of the nose.
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    Delayed Reconstruction with Full-Thickness Skin Grafts Following Defect Size Reduction in Head and Neck Nonmelanoma Skin Cancer
    (Thieme Medical Publ Inc, 2020) Sezgin, Baha; Kaya, Isa; Turhal, Goksel; Apaydin, Fazil
    Different treatment modalities have been applied for nonmelanoma skin cancers (NMSCs) of the head and neck area. One of the most important points after surgical treatment is the selection of appropriate reconstruction methods. the aim of this study is to investigate the efficacy and feasibility of the use of both defect size reduction with sutures and secondary healing with delayed reconstruction with full-thickness skin grafts in NMSC patients. in total, 18 (42.8%) male and 24 (57.2%) female patients with NMSC were operated. Defect size was measured both after excision and just before repair, and the approximate defect area was calculated with ImageJ software. Reconstruction was performed after 14 days in all patients in the second session, using free skin grafts. There were 18 (42.8%) male and 24 (57.2%) female patients. the mean age was 70.5 (45-82) years. the mean follow-up period was 40.3 (16-68) months. the mean defect area measured after excision was 8.44 +/- 1.91cm (2) . After 14 days of delay, the mean defect area was 5.51 +/- 1.28cm (2) (34.8% reduction) ( p <0.05). Defect-reduction methods applied during the first session, together with proper interval prior to placement of graft, have been shown to be beneficial and acceptable methods, providing an advantage in reconstruction with free skin graft.
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    Double nasoseptal flap technique for endonasal pituitary surgery
    (Springer, 2017) Gode, Sercan; Biceroglu, Huseyin; Turhal, Goksel; Erdogan, Umut; Ates, Murat S.; Kaya, Isa; Ozgiray, Erkin; Midilli, Rasit; Karci, Bulent
    Endoscopic endonasal approach has been successfully used for the management of pituitary tumors; however, the loss of septal mucosa especially around sphenoethmoidal recess and posterior nasal septum might be a disadvantage of this technique. The aim of this study is to describe a variation of the endonasal approach, "double nasoseptal flap'' technique in endoscopic transsphenoidal pituitary surgery, and to evaluate its outcomes. The technique depends on fully harvested bigger nasoseptal flap on one side and smaller on the other. Thirty patients were included. Functional results were assessed by preoperative and postoperative first month visual analogue scale (VAS), and morphology was evaluated by achieving intact septum from the sphenoid ostium to the columella. Sphenoid sinusitis, the presence of synechia and crusting in the sphenoethmoidal recess was also assessed. Mean VAS was 71 and 67 mm preoperatively and postoperatively, respectively (p > 0.01). There were no septal perforations, synechia, and sphenoid sinusitis postoperatively. Three patients had (10 %) crusts on sphenoethmoidal recess on first month postoperatively. Double nasoseptal flap technique has advantages, such as wider exposure during surgery; prepared flaps could be used if needed, better morphological and functional outcomes postoperatively. The technique is safe without any perforations and minimal crusting.
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    The effect of "xanthan gum-based fluid thickener" on hydration, swallowing functions and nutritional status in total maxillectomy patients
    (Springer, 2018) Sezgin, Baha; Durusoy, Duygu; Demirci, Meltem Sezis; Ozturk, Kerem; Kaya, Isa; Eyigor, Sibel; Gode, Sercan
    PurposeSwallowing functions are affected after total maxillectomy operations and adjuvant chemoradiotherapy. The purpose of our study is to assess the role of xanthan gum based thickening agents on swallowing and hydration of maxillectomy patients on a randomized controlled fashion.Methods12 of the 22 patients diagnosed with maxillary carcinoma and planned to undergo total maxillectomy was identified as study group and 10 of them were identified as control group. The study group used xantham based liquid thickener for liquid foods up to 3 months postoperatively and the control group did not use. Dysphagia-related quality of life, bioimpedance analysis, EAT-10 scores, swallowing functions were evaluated both preoperative and postoperative period.ResultsThe mean age of the study group was 569.87, and 41.6% were women. The mean age of control group was 60 +/- 15.63, and 50% were women. Postoperative EAT-10 scores were statistically significant higher than preoperative scores in both groups (p<0.05). In both of the study and control groups, a statistically significant reduction in dysphagia related quality of life was detected postoperatively (p<0.05). Intracellular water, extracellular water and total body water detected statistically significant higher in study group at postoperative month three.Conclusion Swallowing functions are affected due to total maxillectomy and radiotherapy. With this study, it has been shown that, total maxillectomy and radiotherapy reduce dysphagia-related quality of life. Swallowing dysfunction and dehydration has been shown to affect total maxillectomy patients. Using of xanthan gum-based fluid thickener' helps to maintain intracellular water, extracellular water, and total body water.
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    The Effect of Endoscopic Endonasal Transsphenoidal Skull Base Surgery on Cochlear Function
    (Thieme Medical Publ Inc, 2019) Ates, Murat Samet; Benzer, Murat; Kaya, Isa; Biceroglu, Huseyin; Ozgiray, Erkin; Midilli, Rasit; Gode, Sercan
    Endoscopic transsphenoidal skull base surgery (ETSS) has become a standard approach in the treatment of sellar and clival lesions, such as pituitary adenoma and chordoma. Due to the close proximity of the clivus and the sella turcica to the inner ear, it is thought that bone drilling in the surgery may have effects on hearing. the aim of this study was to assess the effect of bone drilling in ETSS procedure on cochlear function. This study was performed on 18 patients who underwent ETSS procedure between December 2016 and May 2017. the study was designed as a prospective study. All of the data were prospectively collected. These included demographic data, date of surgery, type of surgery, preoperative pure-tone audiometry, and preoperative and postoperative distortion product otoacoustic emission (DPOAE) measurements. of the DPOAE measurements of the patients who were operated for pituitary adenoma, there was a statistically significant difference between the signal-to-noise ratio (SNR) measurements at 0.5, 1, 2 and 4 kHz ( p < 0.05). Additionally, there were no significant differences in preoperative and postoperative SNR measurements of six patients who were selected for clivus chordoma. When the preoperative and postoperative tonal audiometric tests of the patients were compared, no statistically significant difference was found ( p > 0.05). in conclusion, it is found that bone drilling in ETSS procedure has a negative effect on cochlear function in the early period. This is the first study to evaluate the degree of noise-induced cochlear damage in patients who were gone under ETSS procedure.
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    The Effect of Endoscopic Tympanoplasty on Cochlear Function
    (Korean Soc Otorhinolaryngol, 2018) Kaya, Isa; Turhal, Goksel; Ozturk, Arin; Gode, Sercan; Bilgen, Cem; Kirazli, Tayfun
    Objectives. The aim of this prospective clinical study was to measure the audiologic outcomes of the patients that underwent endoscopic transcanal cartilage tympanoplasty, and to investigate the effects on cochlear function. Methods. Thirty-three patients (33 ears) who were diagnosed with noncomplicated chronic otitis media and underwent endoscopic transcanal cartilage tympanoplasty technique were included. Pre- and postoperative first month distortion product otoacoustic emission (DPOAE) signal-to-noise ratio (SNR), bone conduction hearing levels and air bone gap (ABG) values were measured and total endoscope usage time was noted. Results. Preoperative median SNR measurements at 0.5, 1, 2, and 4 kHz were 6 dB (1-11; interquartile range [IQR], 1), 6 dB (4-20; IQR, 1), 7 dB (3-26; IQR, 5) and 5.50 dB (0-9; IQR, 3), respectively. Postoperative median SNR measurements at 0.5, 1, 2, and 4 kHz were 6 dB (3-9; IQR, 1), 6 dB (2-21; IQR, 3), 7 dB (2-20; IQR, 3), and 6 dB (0-10; IQR, 7), respectively. Regarding the DPOAE measurements, there was no statistically significant difference between the SNR values of all given frequencies (P>0.05). Regarding the pure tone audiometry (PTA) measurements, bone conduction was significantly better at 0.5 and 1 kHz, postoperatively (P<0.05) and there was statistically significant difference at 2 and 4 kHz (P>0.05). Additionally, no statistically significant correlation was found between the SNR and PTA measurements and the endoscope usage time (P>0.05). Conclusion. We suggested that cochlear functions and sensorineural hearing remained stable after endoscopic transcanal cartilage tympanoplasty and cold light source doesn't cause significant adverse effects cochlear functions.
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    The Effect of Mandibulectomy and Mandibulotomy on Cochlear Function
    (Lippincott Williams & Wilkins, 2016) Gode, Sercan; Kaya, Isa; Turhal, Goksel; Kirazli, Tayfun; Bilgen, Cem; Ogut, Mehmet Fatih; Ozturk, Kerem
    Mandibulectomy and mandibulotomy procedures are performed with the oscillating saw and the acoustic energy generated during the osteotomies is transferred to the cochlea via temporomandibular joint and air conduction. The aim of this study was to assess the effect of mandibulectomy and mandibulotomy on cochlear function. This study was carried out on 15 patients who underwent at an otolaryngology department of a tertiary medical center between January 2013 and August 2015. The study was designed as a prospective study. All of the data were prospectively collected. These included demographic data, date of the surgery, type of surgery, preoperative pure-tone audiometry, preoperative and postoperative distortion product otoacoustic emission (DPOAE) measurements. Of the DPOAE measurements, there was a statistically significant difference between the signal-to-noise ratio measurement on the right ear measurement at 4kHz (P<0.05). Additionally, there was a statistically significant correlation between the signal-to-noise ratio measurements and the side of the osteotomy (P<0.05). In conclusion, it is found that mandibulectomy and mandibulotomy procedure has a negative effect on cochlear function in the early period. The DPOAEs were diminished on the osteotomy site in day one postoperatively. Results with a longer follow-up time can yield more information on the prognosis of the cochlear damage.
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    Endoscopic versus microscopic type 1 tympanoplasty in the same patients: a prospective randomized controlled trial
    (Springer, 2017) Kaya, Isa; Sezgin, Baha; Sergin, Demet; Ozturk, Arin; Eraslan, Sevinc; Gode, Sercan; Bilgen, Cem; Kirazli, Tayfun
    The aim of this study was to compare the audiologic outcomes of the patients who underwent endoscopy on one ear and microscopic tympanoplasty on the other, and to investigate the operative time, graft success, postoperative pain and health status. This prospective randomized controlled study was carried out in Ege University ENT Department between February 2015 and September 2016. The patients who had bilateral chronic otitis media, normal middle ear mucosa and a hearing loss difference of 10 dB or less between the two ears randomly underwent microscopic tympanoplasty in one ear and endoscopic tympanoplasty in the contralateral ear, with 6-month intervals. 13 patients were included in the study with a mean age of 36.17 +/- 3.61 years (range 17-53 years, 7 female, 6 male). The improvement in air-bone gap for groups 1 (endoscopic) and 2 (microscopic) was 9.48 +/- 5.23 and 9.89 +/- 2.79 dB, respectively. The duration of the surgery in group 1 was significantly lower than that in group 2 (p < 0.01). VAS scores were 2.15 +/- 0.37 and 3.76 +/- 1.64 cm for groups 1 and 2, respectively (p = 0.006). The endoscopic approach for type 1 tympanoplasty offers shorter surgery time, better health status and lower postoperative pain than microscopic surgery. In addition, endoscopic surgery offers comparable improvement in air-bone gap and similar graft success. The endoscopic approach has comparable audiological and morphological graft outcomes with the microscopic one. The endoscopic approach yielded better health and pain status for the same patients. Level of evidence This is an individual randomized controlled trial. The level of evidence is 1b.
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    Evaluation of Inferior Turbinate Stroma with Ultrasound Elastography in Allergic Rhinitis Patients
    (Galenos Yayincilik, 2017) Turhal, Goksel; Gode, Sercan; Dalgic, Ceyda Tunakan; Sin, Aytul Zerrin; Kismali, Erkan; Kaya, Isa; Ozturk, Arin; Goksel, Ozlem; Midilli, Rasit; Ozturk, Kerem; Karci, Bulent
    Background: Diagnosis of allergic rhinitis is primarily based on history, physical examination and allergy testing. A technique that noninvasively evaluates the soft tissue changes in the nasal mucosa of allergic rhinitis patients has not been defined. Aims: To assess nasal mucosal changes and measure the submucosal fibrosis in allergic rhinitis patients with sonoelastography. Study Design: Case control study. Methods: Eighty-eight turbinates of 44 patients were included in the study. There were 23 prick test positive allergic rhinitis patients. The control group constituted 21 patients. The rhinitis quality of life questionnaire and the visual analogue scale were applied to the allergic rhinitis patients. A higher visual analogue scale score indicated more severe allergic rhinitis symptoms. Sonoelastographic measurements were made from the lateral nasal wall. The propagation speed of sound waves was recorded in m/s. The presence of asthma and the type of allergic rhinitis (seasonal or perennial) was noted. Results: Ten patients had seasonal allergic rhinitis and thirteen patients had perennial allergic rhinitis. Six patients (26.1%) had accompanying asthma along with allergic rhinitis. The median visual analogue scale score was 7 (3-9) in allergic rhinitis patients. The median symptom duration was 7 (1-24) months. The median quality of life questionnaire score was 3.39 (1.68-5.43) points. The median sonoelastography scores of allergic rhinitis patients and healthy subjects were 2.38 m/s (0.9-4.47) and 2.42 m/s (1.62-3.50), respectively. Sonoelastographic measurements of seasonal and perennial allergic rhinitis patients did not differ significantly (p>0.05). The presence of asthma did not have a significant impact on the elastography measurements (p>0.05). However, regression analysis revealed a significant inverse correlation (coefficients: B=0.005, standard error=0.097, beta 0=0.008) between the visual analogue scale and sonoelastography scores (p<0.05). Conclusion: Sonoelastography was not suitable as a diagnostic tool in allergic rhinitis. Reduced sonoelastography scores were measured in more symptomatic patients. Higher visual analogue scale scores could be an indicator of disease severity.
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    Evaluation of Procalcitonin and hs-CRP Levels in Sudden Sensorineural Hearing Loss
    (Aves, 2018) Gode, Sercan; Turhal, Goksel; Kaya, Isa; Mavili, Halil Ibrahim; Kirazli, Tayfun
    OBJECTIVE: The aim of this study was to evaluate procalcitonin and high sensitive c-reactive protein (hs-CRP) levels in idiopathic sudden sensorineural hearing loss (ISSNHL) patients and assess their correlations with the clinical prognosis. MATERIALS and METHODS: Twenty-three ISSNHL patients were included in the study (group A). The control group was consisted of 19 patients (group B). Procalcitonin and hs-CRP levels were compared between the groups. The relationship between procalcitonin and hs-CRP levels and the configuration of the audiogram, degree of hearing loss [partial or total (>90 dB)], and status of improvement (improvement of >15 dB in the first month PTA) were evaluated. RESULTS: The mean age was 47.91 +/- 15.73 years (range 21-73 years) and 35.16 +/- 15.67 years (range 19-79 years) in groups A and B, respectively. Seven patients (30.4%) had underlying cardiovascular risk factors. Mean procalcitonin levels were 0.057 +/- 0.025 mu g/L and 0.041 +/- 0.016 mu g/L in groups A and B, respectively. Mean hs-CRP levels were 0.461 +/- 1.335 mg/dL and 0.129 +/- 0.125 mg/dL in groups A and B, respectively. Procalcitonin levels were significantly higher in group A than in group B (p=0.018). Procalcitonin levels were significantly lower (0.035 +/- 0.013 mu g/L vs. 0.061 +/- 0.025 mu g/L) in patients with low-frequency hearing loss (p=0.04). ROC analysis of procalcitonin values revealed that area under the curve was 0.80 (p=0.005). A cut-off procalcitonin level of 0.45 mu g/L yielded a sensitivity of 90% and specificity of 56.2%. CONCLUSION: In conclusion, as a proinflammatory marker, procalcitonin levels were higher in ISSNHL patients than in healthy controls. The procalcitonin level was significantly lower in upsloping-type hearing loss patients. This finding could be regarded as an indirect indicator of pathogenesis.
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    Evaluation of significant gene expression changes in congenital and acquired cholesteatoma
    (Springer, 2020) Kaya, Isa; Avci, Cigir Biray; Sahin, Fetih Furkan; Ozates, Neslihan Pinar; Sezgin, Baha; Kurt, Cansu Caliskan; Kirazli, Tayfun
    Etiopathogenesis of acquired and congenital cholesteatoma is still unclear. the clinical behavior of adult acquired, pediatric acquired and congenital cholesteatomas show differences. the scope of the this study was to detect thematrix metalloproteinase(MMP),tissue inhibitors of metalloproteinase(TIMP) andepidermal growth factor receptor(EGFR) gene expression changes in cholesteatoma perimatrix and to compare these changes among congenital cholesteatoma, adult acquired cholesteatoma and pediatric acquired cholesteatoma. A total of 16 genes includingMMPs,TIMPs andEGFRwere analyzed in the samples of 32 cholesteatoma tissues. Real-time PCR was used for detection of the gene expression levels. Data analyses were achieved by Delta Delta CT method (Light Cycler 480 Quantification Software) and Statistical Package for Social Sciences (SPSS) version 22.0. the expression levels ofMMP-2,-9,-10,-11,-13,-14,-15,-16andEGFRgenes were significantly higher in acquired cholesteatoma than healthy tissue (p < 0.05). There was a statistically significant decrease (3.34 times more) in the meanTIMP-2gene expression level in acquired cholesteatoma compared to healthy tissue (p < 0.05). There was a significant increase in the mean expression level ofMMP-7gene and a decrease in the mean expression level ofTIMP-1gene (3.12 times more) in congenital cholesteatoma compared to healthy tissue (p < 0.05). This study indicates that increased expression levels of some particularMMPgenes andEGFRgene and decreased expression levels ofTIMPgenes may play an important role in the development of cholesteatoma. Further,MMP-9,MMP-13andMMP-14genes may have a remarkable role in the development of more aggressive cholesteatoma forms. the authors concluded that overexpression ofMMP-9,MMP-13andMMP-14may cause stronger inflammation associated with cholesteatoma.