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Öğe A Case with Thyroid Cartilage Fracture after Sneezing(2020) Ateş, Murat Samet; Durusoy, Duygu; Aysel, Aldulhalim; Öztürk, Kerem; Turhal, GökselNon-traumatic laryngeal injuries are unusual occasions. In the medical literature we found only six reports of cases that had laryngeal injury after sneezing. We report a case of a 34-year-old man diagnosed with thyroid cartilage fracture after a strong sneeze. In physical examination, edema and hematoma were seen in the right vocal cord and the right band. Computed tomography scan revealed an anterior thyroid cartilage fracture without separation. Antibiotics and steroids were administered. This is a very rare entity and the seventh case reported in the literature. Ear Nose Throat specialist should be aware of this situation.Öğe The Comparative Analysis of Suture versus Linear Stapler Pharyngeal Closure in Total Laryngectomy: A Prospective Randomized Study(2019) Öztürk, Kerem; Turhal, Göksel; Öztürk, Arın; Kaya, İsa; Akyıldız, Nurullah Serdar; Uluöz, ÜmitObjective: the aim of this study was to prospectively evaluate and compare the outcomes in patients undergoing pharyngeal closure with the linear stapler and suture techniques after total laryngectomy. Methods: Forty-one patients who needed total laryngectomy for laryngeal cancer were enrolled in the study. Patients were randomized into two groups according to the pharyngeal closure technique: the linear stapler group (Group A) and the suture closure group (Group B). Rate of pharyngocutaneous fistula (PCF), nasogastric tube (NGT) removal time and pharyngeal closure time were analyzed and compared between the two groups. Results: PCF developed in three patients in Group A (14.3%) and in seven patients in Group B (35%). Although the rate of PCF was lower in Group A, this did not represent a statistical difference (p:0.129). Median NGT removal time was 12 days (IQR=3) and 19.5 days (IQR=1) in Groups A and B, respectively. Median NGT removal time was not statistically different between the two groups (p:0.642). All patients were able to swallow liquids and solids without difficulty. Median pharyngeal closure time was 3 minutes (IQR=1) and 37.5 minutes (IQR=9) in Groups A and B, respectively. Median pharyngeal closure time was significantly lower in Group A (p:0.00). Conclusion: the linear stapler technique in total laryngectomy is a reliable, safe, easy-to-apply and time-saving method. Closure with linear stapler significantly reduces pharyngeal closure time without adverse effect on NGT removal times and PCF rates.Öğe Ege Üniversitesi Hastanesi veri tabanında kayıtlı larinks kanserli olguların epidemiyolojik ve genel sağkalım özellikleri(2020) Turhal, Göksel; Şahin, Fetih Furkan; Öztürk, Kerem; Akagündüz, Özlem; Akyıldız, Serdar; Esassolak, Mustafa; Caner, AyşeAmaç: Bu çalışmada Ege Üniversitesi Kanserle Savaş Uygulama ve Araştırma Merkezi (EÜKAM) sisteminde kayıtlı olan larinks kanseri tanısı alan hastaların demografik özellikleri ile birlikte malignite kliniğine göre genel sağkalımlarının araştırılması amaçlanmıştır. Gereç ve Yöntem: EÜKAM’da görevli kanser kayıt teknik ekibi tarafından kaydedilen 1992-2016 yılları arasında Ege Üniversitesi’nde tanı, tedavi ve takip sürecinde yer alan 3144 olgunun yaşı,cinsiyeti, histopatolojisi, tümör evresi, uygulanan tedavi şekli, takip süresi ve sağkalım durumu retrospektif olarak analiz edilmiştir. Bulgular: 3144 olgunun ortalama yaşı 59.4±10.5 saptanmıştır. En sık histopatolojik tip %97.4 ile karsinom olarak, en sık gözlenen evre durumu %47.1 ile lokal sınırlı evre olarak saptanmıştır. Tüm olgu serisinin 5, 10, 15 ve 20 yıllık genel sağkalımları ise sırasıyla %67, %48.6, %33.8 ve %23.5 olarak bulunmuştur. Sonuç: Larinks kanserleri genel sağkalımında tümör evresi, yaş gibi faktörlerin anlamlı olarak etkili olduğu saptanırken cinsiyetin sağkalım üzerinde anlamlı etkisinin olmadığı görülmüştür. Ayrıca son yıllarda organ koruyucu tedavi modellerindeki alternatif seçenek ve başarı oranlarında artış olduğu, bunun yanında larinks kanseri insidansında artışın günümüze kadar devam ettiği saptanmıştır.Öğe Evaluation of Inferior Turbinate Stroma with Ultrasound Elastography in Allergic Rhinitis Patients(2017) Turhal, Göksel; Göde, Sercan; Dalgıç, Ceyda Tunakan; Sin, Aytül Zerrin; Kısmalı, Erkan; Kaya, İsa; Göksel, ÖzlemBackground: 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.Öğe Nadir paranazal sinüs kanserlerinde yeni tanımlanan reseptör tirozin kinaz mutasyonları ve potansiyel fonksiyonel etkileri(2023) Bağca, Bakiye Göker; Göde, Sercan; Turhal, Göksel; Özateş, Neslihan Pınar; Veral, Ali; Gündüz, Cumhur; Avcı, Çığır BirayAmaç: Paranazal sinüs kanserleri oldukça nadir görülen heterojen bir hastalık grubudur. Maksiler sinüs skuamoz hücreli karsinomu, paranazal sinüs kanserlerinin anatomik ve histolojik olarak en yaygın alt tipidir. Bu kanserin genetik profiline dair bilginin sınırlı olması, hastaların hedefli tedavi seçeneklerinden yararlanamamasına neden olmaktadır. Çalışmamızda bu nadir kanserdeki reseptör tirozin kinaz mutasyonlarının tanımlanması ve mutasyonların olası fonksiyonel etkilerinin tahmin edilmesi amaçlanmıştır. Gereç ve Yöntem: Bu amaçla 30 olgunun tümörüne ait FFPE dokulardan DNA izolasyonu gerçekleştirildi, olguların mutasyon profili yeni nesil sekanslama yöntemi ve biyoinformatik değerlendirme ile belirlendi. Belirlenen patojenik/ olası patojenik varyantların fonksiyonel etkileri farklı in silico araçlar yardımıyla tahminlendi. Bulgular: Olgularının tamamında en az bir adet patojenik/olası patojenik KIT, PDFGRA ve RET mutasyonu belirlendi. KIT geninin katalitik bölgesindeki mutasyonların kinaz aktivitesini arttıracağı tahmin edildi. PDFGRA genindeki p.P567P ve p.D1074D mutasyonları, 30 olgunun tamamında ve SRA veritabanından elde edilen normal dokulara ait okumaların tümünde belirlendi. Sonuç: Reseptör tirozin kinaz mutasyonlarının paranazal sinüs kanserlerinde de önemli rol oynayabileceğinin belirlenmiş olması özellikle artmış kinaz aktivitesini hedefleyen tedavi yaklaşımlarını bu olguların erişimine sunma potansiyeli taşıması bakımından oldukça önemlidir.Öğe Oral cavity cancers: A single-center study(2019) Turhal, Göksel; Şahin, Fetih Furkan; Kaya, İsa; Öztürk, Kerem; Akyıldız, Nurullah Serdar; Uluöz, ÜmitObjectives: This study aims to evaluate demographic characteristics, tumor characteristics, and survival outcomes of surgically treated patients with oral cavity cancer (OCC). Patients and Methods: A total of 459 OCC patients (269 males, 190 females; mean age 61.4±15.0 years; range, 18 to 90 years) who were treated with surgery between January 2000 and December 2015 were retrospectively analyzed. Demographic data, diagnosis, histopathological type, tumor origin, tumor stage, neck status, type of surgery, reconstruction technique, complications, follow-up duration, recurrence, and survival status were recorded. Results: the tumor originated from the lip in 134 (29.2%) of the patients. the histopathological diagnosis was a squamous cell carcinoma in 403 patients (87.8%). the five-year overall survival and disease-free survival rates were 69.5% and 60.8%, respectively. the five-year overall survival rate was significantly lower in patients with neck metastasis (p<0.05). Conclusion: Our study results suggest that regional lymph node metastasis, age, and surgical margin are the main factors affecting survival and prognosis in OCCÖğe Orbital complications of pediatric rhinosinusitis: A single institution report(2020) Kaya, İsa; Sezgin, Baha; Göde, Sercan; Midilli, Raşit; Karcı, Bülent; Turhal, Göksel; Bozan, AykutBackground and objectives. Rhinosinusitis is one of the most common infections of childhood. Rhinosinusitis usually limits itself in the pediatric age group, however orbital and intracranial complications may arise in some of the patients. The purpose of the study was to retrospectively analyse the previous treatments and outcomes in pediatric rhinosinusitis patients with orbital complications. Methods. The effect and prognosis of medical treatment and endoscopic sinus surgery are reported in this study. Twenty-five pediatric patients diagnosed with complicated rhinosinusitis between January 2008 - February 2016 were included in the study. Orbital complications, examination findings, radiological imaging and blood counts were retrospectively collected from patient files. The duration of hospitalization, source of the infection, complications, previous medical and surgical treatments were also retrospectively assessed. Results. Average age of the patients were 8.84 ± 4.02 years (range: 1-16 years). The mean length of stay in hospital was 6.72 ± 3.28 days. Hospitalization in surgically treated group was higher than primarily medically treated group. However this difference could not reach to a statistically significant level (p >0.05). Mean hospitalization time was found 5.21 ± 2.51 and 8.43 ± 2.87 days in patients diagnosed with preseptal cellulitis and subperiosteal abscess respectively. Hospitalization in patients with subperiosteal abscess was higher than preseptal cellulitis and a statistically significant difference was detected (p <0.05). Conclusion. Morbidity and mortality of orbital complications which are the most common complications of pediatric rhinosinusitis, could significantly be reduced by using appropriate treatment methods and an early diagnosis. Conservative therapy is an effective method for patients with preseptal cellulitis and most cases of orbital cellulitis in children.Öğe Outcomes of masking and habituation therapy with the implementation of a new sound therapy protocol(2020) Kaya, İsa; Öğüt, Mehmet; Göde, Sercan; Turhal, GökselObjectives: This study aims to evaluate the outcomes of masking, counseling, and a new sound therapy protocol in subjectivetinnitus patients.Patients and Methods: This prospective study, conducted between November 2014 and November 2015, included 60 subjectivetinnitus patients (33 males, 27 females; mean age 51.6±11.0 years; range, 29 to 76 years) randomly assigned to five groups. Totalmasking was implemented in four groups (groups 1, 2, 3, and 4), while combined habituation therapy and sound therapy wereimplemented in one group (group 5). Patients that did not benefit from masking therapy were offered habituation therapy. Directivecounseling was applied during each session in group 5 and patients were started on a new sound protocol. Patients were evaluatedwith the tinnitus handicap questionnaire (THQ) in the beginning of the study (THQ1) and in the second (THQ2) and fourth months(THQ3). Patients were evaluated in the second month and regrouped: Patients that benefited from masking therapy were regroupedas group A, patients that did not benefit from masking therapy and continued with habituation therapy were group B, and patientsthat were only treated with habituation formed group C.Results: Median THQ2-THQ1 and THQ3-THQ1 scores were significantly lower in group A (p=0.00063 and p=0.00109, respectively).Median THQ2-THQ1 and THQ3-THQ1 scores were significantly lower in group B (p=0.02421 and p=0.00503, respectively). MedianTHQ3-THQ1 and THQ3-THQ2 scores were significantly lower in group C (p=0.04685 and p=0.00506, respectively).Conclusion: Masking with tinnitus masker could be beneficial in a limited group of patients. Further studies with longer follow-upduration for patients receiving only habituation and habituation after masking failure are warranted.Öğe Primary Sinonasal Malignant Melanoma: Effect of Clinical and Histopathologic Prognostic Factors on Survival(2017) Göde, Sercan; Turhal, Göksel; Tarhan, Ceyda; Yaman, Banu; Kandiloğlu, Gülşen; Öztürk, Kerem; Midilli, RaşitBackground: Mucosal melanoma is a rare malignancy arising from melanocytes of the mucosal surfaces. the pattern and frequency of oncogenic mutations and histopathological biomarkers have a role on distinct tumour behaviour and survival. Aims: To assess the rate of C-KIT positivity and its effect on survival of surgically treated sinonasal malignant melanoma patients with other histopathological biomarkers and clinical features. Study Design: Retrospective cross-sectional study. Methods: Seventeen sinonasal malignant melanoma patients with a mean age of 65.41 (39-86) years were included. Overall survival and disease-specific survival rates were calculated. the impact of age, gender, stage and extent of the disease, type of surgery, and adjuvant therapies were also taken into consideration. the effect of mitotic index, pigmentation, S100, HMB-45, Melan-A and C-KIT on survival were evaluated. Results: Median tumour size was 20 mm (interquartile range=27.5 mm). Pigmentation was present in 7 (41.2%) cases. Median number of mitoses per millimetre squared was 11 (interquartile range=13). Melan A was positive in 7 (41.2%) patients, ulceration was present in 6 cases (35.3%), and necrosis was present in (47.1%) 8 cases. Six patients (35.3%) were positive for S100, 14 (82.4%) specimens stained positive for HMB-45 and C-KIT (CD117) was positive in 9 cases (52.9%). Three patients (16.7%) developed distant metastasis. Five year overall and disease free survival rates were 61.4% and 43.8%, respectively. Conclusion: Although C-KIT positive sinonasal malignant melanoma patients (52.9%) can be candidates for targeted tumour therapies, the studied clinical or histopathological features along with C-KIT seem to have no significant effect on survival in a small group of patients with sinonasal malignant melanoma.Öğe Procalcitonin Levels in Chronic Rhinosinusitis(2019) Turhal, Göksel; Eraslan, Sevinç; Kaya, İsa; Midilli, Raşit; Karcı, Halil Bülent; Göde, SercanObjective: the aim of this study was to evaluate and compare procalcitonin levels of patients diagnosed with chronic rhinosinusitis (CRS) with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP) along with healthy controls. Methods: A total of 67 subjects were included. Twenty-two CRSwNP patients were included in group A, 25 CRSsNP patients in group B, and the control group (group C) consisted of 20 healthy subjects. Procalcitonin level was assessed after CRSwNP or CRSsNP diagnosis. Healthy individuals scheduled for septorhinoplasty constituted the control group. Nasal polyposis was graded according to the Meltzer Clinical Scoring System. Results: the mean procalcitonin levels of patients of groups A, B and C were 0.042±0.020 µg/L, 0.031±0.016 µg/L and 0.031±0.010 µg/L, respectively. Mean procalcitonin levels were significantly higher in group A compared to groups B and C (p=0.05 and p=0.032). However, mean procalcitonin levels were not significantly different between group B and group C (p=0.962). Four patients (18%) had grade 1, three had (13.6%) grade 2, eight had (36.4%) grade 3, and seven had (31.8%) grade 4 polyposis. Mean procalcitonin levels for grades 1, 2, 3 and 4 polyposis were 0.045±0.030 µg/L, 0.037±0.006 µg/L, 0.041±0.021 µg/L and 0.043±0.019 µg/L, respectively. No statistical significance was present regarding the mean procalcitonin levels of polyposis grades (p>0.05). Conclusion: Procalcitonin, which is an important inflammatory marker especially in sepsis and systemic inflammation, was significantly elevated in CRSwNP patients compared to CRSsNP patients and healthy controls. This may support the presence of chronic mucosal inflammation in CRSwNP patients. However, procalcitonin is an indirect marker of inflammation and further studies with larger patient groups are warranted.Öğe Subjektif tinnitus tedavisinde Ege Üniversitesi yaklaşımı(Ege Üniversitesi, Tıp Fakültesi, 2016) Turhal, Göksel; Öğüt, Mehmet FatihAmaç Çalışmamızda toplumda oldukça sık görülen ve hayat kalitesinde anlamlı negatif etkilere neden olan subjektif tinnituslu hastalarında danışmanlık, maskeleme, ses zengileştirmesi ve alıştırma tedavisini içeren bir tinnitus tedavisi algoritmasının oluşturulması ve bunun etkinliğinin belirlenmesi amaçlanmıştır. Yöntem Çalışmaya Kasım 2014 ✹ Kasım 2015 tarihleri arasında Ege Üniversitesi Kulak Burun Boğaz Hastalıkları Kliniği'ne kronik subjektif tinnitus şikayetiyle başvuran ve daha önceki tedavilerden fayda görmemiş 60 hasta alındı. Hastalar toplam 5 grupta incelendi. Dört grupta (Grup 1, 2, 3, 4) farklı maskeleme cihazlarıyla total maskeleme, bir gruba ise habituasyon (Grup 5) tedavisi uygulandı. Maskeleme cihazından fayda görmeyen hastalara ise habituasyon tedavisi başlandı. Hastalar çalışmanın başında, 2.ayda ve 4.ayda tinnitus handikap anketi (THQ) ve görsel analog skala (VAS) sonuçlarıyla değerlendirildi. Maskeleme cihazından fayda gören hastalar grup A (18 hasta, %36), fayda görmeyip habituasyona geçilen hastalar grup B (32 hasta, %64), habituasyona devam eden hastalar ise grup C (10 hasta) olarak tekrar değerlendirildi. Bulgular Hastaların ortalama yaşı 51.62 yıl (29-76) olarak bulundu. Grup 1, 2 ve 4'te THQ skorları 2.ayda anlamlı olarak azaldı (p<0.05). VAS'ta tinnitus şiddeti (VASŞiddet) grup 1, 2 ve 3'te (p<0.05), tinnitusa bağlı rahatsızlık (VASRahatsızlık) grup 4'te ve tinnitusun yaşama olan etkisi (VASEtki) grup 2'de (p<0.05) anlamlı olarak azaldı. Grup A'nın 0.ay-2.ay ve 0.ay-4.ay THQ skorlarınında anlamlı azalma saptandı (p<0.05). Grup B'nin 0.ay-2.ay ve 0.ay-4.ay THQ skorlarınında anlamlı azalma saptandı (p<0.05). Grup C'nin 2.ay-4.ay ve 0.ay-4.ay THQ skorlarından anlamlı azalma saptandı (p<0.05). Sonuç Maskeleme cihazı ile total maskeleme uygulanması uygun hasta seçimi ve iyi hasta takibi ile etkili bir tedavi seçeneği olabilir ancak bu hasta grubu küçük bir popülasyonu oluşturmakta ve bu veriler uzun süreli takiple desteklenmelidir. İlk iki ayda maskeleme cihazı tedavisinden fayda görmeyen hastalarda habituasyon tedavisinin ve sadece habituasyon uygulanan hastalarda habituasyon tedavisinin etkinliğinin değerlendirilmesi için daha uzun süreli takip süreleri olan çalışmalara ihtiyaç vardır.Öğe Surgery for Submandibular Gland Diseases: 14-years of Experience of a Single Tertiary Center(2021) Ceylan, Hakan; Öztürk, Kerem; Turhal, Göksel; Akyıldız, Nurullah Serdar; Öztürk, ArınObjective: Surgical removal is a valid option in the treatment of submandibular gland diseases but there are still operative and diagnostic pitfalls. We aimed to review and investigate the long-term clinical, surgical, and pathologic outcomes of our cases that had undergone submandibular gland removal. Materials and Methods: Retrospective analysis was conducted on patients who underwent submandibular gland excision via the transcervical approach with minimal skin incision between January 2007 and April 2020. Demographic data, preoperative FNA cytology results, clinical findings, surgical procedure, postoperative histopathological diagnosis, and postoperative morbidity were reviewed and analyzed. Results: 66 patients (41.7%) had sialolithiasis, 47 patients (29.7%) had chronic sialadenitis. Pleomorphic adenoma was found in 30 of the 44 patients that been operated on for submandibular mass. Gland derived carcinoma was found in 9 patients. The sensitivity of FNA biopsy in our case series was 83.3% (10/12), specificity was 78.1% (25/32), positive predictive value was 71.4% (10/14), and the negative predictive value was 96.1% (25/26). Permanent facial nerve marginal mandibular branch palsy was found in two patients (1.2%). Conclusion: The transcervical approach to the submandibular gland offers safe and reliable removal of the submandibular gland with a minimal risk of complications. FNA cytology was found to be useful in the preoperative evaluation of the submandibular masses.
