Archives of Otolaryngology-head & Neck Surgery, 2007
To investigate the association between nasal polyposis (NP) and single nucleotide polymorphisms o... more To investigate the association between nasal polyposis (NP) and single nucleotide polymorphisms of the proinflammatory cytokines IL (interleukin) 1alpha (the IL1A gene), IL-1beta (the IL1B gene), and tumor necrosis factor alpha (the TNFA gene). Prospective case-control trial. Tertiary referral center. Eighty-two patients with NP and 106 healthy volunteers without sinonasal disease. Genotypes of IL1A (4845G, 4845T), IL1B (-511C, -511T) and TNFA (-238G, -238A and -308G, -308A) were identified by restriction fragment length polymorphism analyses after polymerase chain reaction. The 4845 GT and 4845 TT genotypes of the IL1A gene were associated with NP (P<.05). The frequency of the -511 CC genotype of the IL1B gene was significantly higher in patients with NP than in controls (P=.01). The frequency of the -511 CT genotype of IL1B was significantly higher (P=.01) in the controls than in the patients with NP. The -238 AA genotype of the TNFA gene was higher in the patients with NP than in the controls (P=.05). There was a significantly high risk of susceptibility to NP in patients with the -308 GA genotype of TNFA (P=.001). None of the genotypes of the proinflammatory cytokines were related to sex, the presence of atopy, asthma, or aspirin intolerance (P>.05). The IL1A (4845 GT and 4845 TT), IL1B (-511 CC), and TNFA (-238 AA and -308 GA) genotypes were associated with susceptibility to NP in our study population.
Expression of matrix metalloproteinase (MMP)-9 increases in nasal polyp tissues. However, the imp... more 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. 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. 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. 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.
The goal of this study was to determine whether there was an association between perinatal risk f... more 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.
Although sensorineural hearing loss has been widely investigated in those with rheumatoid arthrit... more Although sensorineural hearing loss has been widely investigated in those with rheumatoid arthritis, studies assessing the vestibular system in patients with rheumatoid arthritis are limited. The aim of this study was to assess the vestibular system in patients with rheumatoid arthritis.The study consisted of 43 patients with rheumatoid arthritis and 30 healthy controls. Otorhinolaryngologic and neurotologic examinations, pure-tone audiometry, impedancemetry, electronystagmography including smooth pursuit, saccade, positional, and caloric tests were performed in all patients with rheumatoid arthritis and in controls. The erythrocyte sedimentation rate, C-reactive protein level, and rheumatoid factor level were evaluated in all patients with rheumatoid arthritis.Audiograms revealed sensorineural hearing loss in 12 patients (27.9%) with rheumatoid arthritis and in two controls (6.6%); the difference was statistically significant (P = .033). In those with rheumatoid arthritis, the results of electronystagmography revealed central abnormalities in nine patients (20.9%), peripheral abnormalities in three (6.9%), and mixed abnormalities in three (6.9%). Smooth pursuit and saccade tracing impairments were significantly higher in patients with rheumatoid arthritis (P > .05). Canal paresis in patients with rheumatoid arthritis were significantly higher than those in the control group (P = .039). No association was found between electronystagmographic abnormalities in patients with rheumatoid arthritis and age, sex, duration of disease, the results of laboratory testing, sensorineural hearing loss, or medication use.Our results suggest an association of rheumatoid arthritis with vestibular system dysfunction as well as auditory impairment.
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2007
Sudden sensorineural hearing loss (SNHL) accounts for 1% of all SNHL cases. It has been reported ... more Sudden sensorineural hearing loss (SNHL) accounts for 1% of all SNHL cases. It has been reported that acoustic neuroma may be present up to 47.5% of patients with sudden SNHL. A 55-year-old man presented with sudden hearing loss in his left ear of 45-day history. Audiologic and transient evoked otoacoustic emission tests showed near-total hearing loss and absence of emissions in the left ear, respectively. Electronystagmography showed left canal paralysis and lack of response to the Kobrak test. The interpeak interval I-V latency and interaural amplitude differences in wave V latency were prolonged in auditory brainstem response. Computed tomography showed an increase in the diameter of the left internal acoustic canal, and magnetic resonance imaging (MRI) revealed an intracanalicular mass, 3 mm in size, originating from the left cochlear nerve. Another mass (18x17 mm) was detected that filled the right pontocerebellar cistern, suggesting a meningioma, but this was not thought to exert an obvious shift effect contributing to the development of left-sided hearing loss. Despite treatment with a tapered course of fluocortolone for 18 days the patient's hearing level did not change. He was included in a follow-up with MRI at six-month intervals.
International journal of pediatric otorhinolaryngology, 2015
Defensins are antimicrobial peptides expressed on mucosal surfaces. They function as part of the ... more Defensins are antimicrobial peptides expressed on mucosal surfaces. They function as part of the innate immune system. Palatine tonsils play important roles in innate immune system. However, our knowledge on the pathophysiology of chronic tonsils is limited. The aim of this study was to investigate the association between beta defensin 1 gene single nucleotide polymorphisms and chronic tonsillitis. Prospective, non-randomized, controlled clinical study. Tertiary referral center. Eighty six patients with chronic tonsillitis and eighty controls without history of chronic tonsillitis were enrolled in this study. Genotypes were determined by restriction fragment length polymorphism analyses after polymerase chain reaction. Genotype and allele frequencies of the -20G/A (rs11362), -44C/G (rs1800972) and -52G/A (rs1799946) single nucleotide polymorphisms were not statistically different between patients and control groups (p>0.05). In this study, we found that DEFB1 gene -20G/A, -44C/G and -52G/A single nucleotide polymorphisms were not associated with chronic tonsillitis. Studies, which analyse other polymorphism of the beta defensin 1 gene in large case series, should be conducted to understand the role of DEFB1 gene on chronic tonsillitis.
To investigate the association between nasal polyposis (NP) and single nucleotide polymorphisms o... more To investigate the association between nasal polyposis (NP) and single nucleotide polymorphisms of the proinflammatory cytokines IL (interleukin) 1alpha (the IL1A gene), IL-1beta (the IL1B gene), and tumor necrosis factor alpha (the TNFA gene). Prospective case-control trial. Tertiary referral center. Eighty-two patients with NP and 106 healthy volunteers without sinonasal disease. Genotypes of IL1A (4845G, 4845T), IL1B (-511C, -511T) and TNFA (-238G, -238A and -308G, -308A) were identified by restriction fragment length polymorphism analyses after polymerase chain reaction. The 4845 GT and 4845 TT genotypes of the IL1A gene were associated with NP (P<.05). The frequency of the -511 CC genotype of the IL1B gene was significantly higher in patients with NP than in controls (P=.01). The frequency of the -511 CT genotype of IL1B was significantly higher (P=.01) in the controls than in the patients with NP. The -238 AA genotype of the TNFA gene was higher in the patients with NP than in the controls (P=.05). There was a significantly high risk of susceptibility to NP in patients with the -308 GA genotype of TNFA (P=.001). None of the genotypes of the proinflammatory cytokines were related to sex, the presence of atopy, asthma, or aspirin intolerance (P>.05). The IL1A (4845 GT and 4845 TT), IL1B (-511 CC), and TNFA (-238 AA and -308 GA) genotypes were associated with susceptibility to NP in our study population.
The aim of this study was to investigate vestibular evoked myogenic potentials (VEMPs) and their ... more 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.
Although sensorineural hearing loss has been widely investigated in those with rheumatoid arthrit... more Although sensorineural hearing loss has been widely investigated in those with rheumatoid arthritis, studies assessing the vestibular system in patients with rheumatoid arthritis are limited. The aim of this study was to assess the vestibular system in patients with rheumatoid arthritis.The study consisted of 43 patients with rheumatoid arthritis and 30 healthy controls. Otorhinolaryngologic and neurotologic examinations, pure-tone audiometry, impedancemetry, electronystagmography including smooth pursuit, saccade, positional, and caloric tests were performed in all patients with rheumatoid arthritis and in controls. The erythrocyte sedimentation rate, C-reactive protein level, and rheumatoid factor level were evaluated in all patients with rheumatoid arthritis.Audiograms revealed sensorineural hearing loss in 12 patients (27.9%) with rheumatoid arthritis and in two controls (6.6%); the difference was statistically significant (P = .033). In those with rheumatoid arthritis, the results of electronystagmography revealed central abnormalities in nine patients (20.9%), peripheral abnormalities in three (6.9%), and mixed abnormalities in three (6.9%). Smooth pursuit and saccade tracing impairments were significantly higher in patients with rheumatoid arthritis (P > .05). Canal paresis in patients with rheumatoid arthritis were significantly higher than those in the control group (P = .039). No association was found between electronystagmographic abnormalities in patients with rheumatoid arthritis and age, sex, duration of disease, the results of laboratory testing, sensorineural hearing loss, or medication use.Our results suggest an association of rheumatoid arthritis with vestibular system dysfunction as well as auditory impairment.
Purpose: We aimed to compare the clinical efficacy and ocular surface variables of olopatadine, ... more 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).Methods: This was a prospective, randomized, double-blinded and placebo-controlled study. A total of 100 patients with SAC were randomly assigned to one of five groups, in which they were administered olopatadine, ketotifen fumarate, epinastine, emedastine or fluorometholone acetate, instilled twice daily for 2 weeks. One eye of each patient was treated with the study drug and the other was treated with a placebo. Signs and symptoms of allergic conjunctivitis (itching, redness, tearing, chemosis and eyelid swelling) were scored on a 4-point scale. Each symptom was assessed at baseline and then again after 1 and 2 weeks of treatment. Ocular surface variables were assessed by conjunctival impression cytology.Results: At weeks 1 and 2, all antiallergic agents were significantly more effective than placebo in alleviating itching, redness, tearing, chemosis and eyelid swelling. Fluorometholone acetate was significantly less effective than the other agents in reducing itching and redness at all control visits. Ocular surface findings by impression cytology improved significantly after all treatments compared with placebo.Conclusions: In patients with SAC, olopatadine, ketotifen, epinastine and emedastine are more efficacious than fluorometholone acetate in preventing itching and redness. All the antiallergic agents gave similar results in terms of reducing tearing, chemosis and eyelid swelling. Our data showed that impression cytology parameters improved after treatment with antiallergic agents in patients with SAC.
Paranasal mucoceles are regarded as slow-growing and benign lesions. They are usually recognized ... more Paranasal mucoceles are regarded as slow-growing and benign lesions. They are usually recognized by otorhinolaryngologists, but a clinically relevant mucocele with orbital complications may present to an ophthalmologist. We report a 15-year-old's case with unilateral reduced ocular motility due to bilateral frontal mucocele associated with grade II nasal polyposis.
Background: Schwannomas are uncommon benign tumors of the external auditory canal. The clinical f... more Background: Schwannomas are uncommon benign tumors of the external auditory canal. The clinical features, the differential diagnosis, and the surgical treatment of these lesions are discussed.
Although patients with nasal polyposis frequently exhibit concomitant allergy, there is limited i... more 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. 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. 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). 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.
Pulsatile tinnitus (PT), a rare otologic symptom, is frequently associated with identifiable and ... more 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.
Matrix metalloproteinase (MMP) 2 and MMP-9 are known to cleave specifically type 4 collagen, whic... more 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). We examined tissue samples from 10 ACPs, 10 diffuse nasal polyps, and 10 control nasal mucosa (CM) by immunohistochemistry for MMP-2 and MMP-9 expression. 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). MMP-9-expressing inflammatory cells could play a role in the pathophysiology of ACP as well as nasal polyps.
Ankylosing spondylitis (AS) is a rheumatic disease characterized by chronic inflammation. The aim... more 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.
International Journal of Pediatric Otorhinolaryngology, 2006
Vertigo in childhood is a complaint consisting of a wide spectrum of diagnoses. The aim of this s... more Vertigo in childhood is a complaint consisting of a wide spectrum of diagnoses. The aim of this study was to evaluate pediatric patients with vertigo with normal eardrum and middle ear findings and discuss the differential diagnoses.Patient records of 50 children under 18 years of age with vertigo as the chief complaint, examined at the Baskent University, Research and Application Centers at Konya and Adana otorhinolaryngology clinics between May 2003 and October 2005 were retrospectively reviewed. The questionnaires, laboratory tests including blood samples, audiological and vestibular tests, and final diagnoses were analyzed. Patients with perforated eardrums, otitis media with effusion, and acute upper respiratory tract infections were not included in the study.The study group consisted of 50 patients (33 females, 66%; 17 males, 34%), between 4 and 17 years of age (mean age, 11.5 ± 3.9 years). Severe sensorineural hearing loss was present in one patient unilaterally (2%) and one patient bilaterally (2%). Bilateral low-frequency sensorineural hearing loss was present in one patient (2%). Electronystagmography revealed central vestibular abnormalities in three patients (6%). Canal paresis was established in six patients (12%). The Dix–Hallpike test was positive in six patients (12%). The most frequent cause of vertigo was migraine, occurring in 34% of patients (n = 17). Other less-frequent etiologies of vertigo were benign paroxysmal vertigo (n = 6; 12%), benign paroxysmal positional vertigo (n = 6; 12%), psychogenic vertigo (n = 5; 10%), epilepsy (n = 3; 6%), metabolic disorders (n = 3; 6%), vestibular neuritis (n = 2; 4%), Meniere's disease (n = 1; 2%), perilymphatic fistula (n = 1; 2%), amblyopia (n = 1; 2%), and unclassifiable (n = 5; 10%).Migraine was found to be the most frequent presenting diagnosis in childhood vertigo, although several peripheral vestibular disorders also were diagnosed. Evaluation of vertigo in childhood should begin with a thorough neuro-otologic evaluation and include other relevant multidisciplinary team members as needed to avoid unnecessary effort and cost.
To compare general anaesthesia and local anaesthesia with dexmedetomidine on the basis of postope... more To compare general anaesthesia and local anaesthesia with dexmedetomidine on the basis of postoperative pain and surgical bleeding after septoplasties. Sixty patients with ASA 1 or 2 were divided into the local anaesthesia with dexmedetomidine (LAD) group (n = 30) and the general anaesthesia group (n = 30). Heart rate (HR), SBP and DBP were monitored. The amount of surgical bleeding, duration of surgery and recovery, postoperative pain evaluations [by visual analogue scale (VAS)] and nausea-vomiting were also recorded. Patients' satisfaction with anaesthesia and quality of breathing was questioned 1 week after discharge. HR values were significantly higher in the general anaesthesia group than in the LAD group at the 15th min and at the end of surgery. The SBP value at the 30th min was significantly higher in the LAD group than in the general anaesthesia group. No difference was observed between the groups with respect to the DBP value. Surgical bleeding and the duration of recovery were significantly less in the LAD group. The postoperative VAS scores were significantly higher in the general anaesthesia group than in the LAD group. Postoperative nausea-vomiting was also significantly greater in the general anaesthesia group. Although more patients in the LAD group preferred this anaesthetic procedure to general anaesthesia, the quality of breathing was better in both groups after surgery. Septoplasty performed under local anaesthesia with dexmedetomidine sedation resulted in less surgical bleeding, less postoperative pain, a more stable haemodynamic state, less nausea-vomiting, a shorter recovery period and a higher level of anaesthesia satisfaction.
The goal of this study was to investigate clinical characteristics of chronic rhinosinusitis (CRS... more The goal of this study was to investigate clinical characteristics of chronic rhinosinusitis (CRS) in patients with positive fungal cultures. Fungal cultures were taken from 55 CRS patients and 20 healthy volunteers. Susceptibilities of isolated fungi to Xuconazole, amphotericin B, itraconazole, voriconazole, and caspofungin were determined in CRS patients. Fungi grew in the cultures from 44 (80%) CRS patients and 17 (85%) healthy volunteers. Of the patients with positive fungal cultures, 5 (11.3%) had fungal hypersensitivity (FH), and 21 (47.7%) had eosinophilic mucin (EM). Fungal culture-positive patients with EM were more likely to be associated with presence of polyps and higher CT scores than those without EM (P < 0.05). All the patients with FH had EM and polyps, and CT scores of those patients were highest. The sensitivity rates of fungal isolates were 97.8% for amphotericin B, caspofungin, and voriconazole; 74.4% for itraconazole; and 6.4% for Xuconazole. The presence of EM with or without FH leaded to more extended CRS, but a part of positive fungal cultures were together with EM in patients with CRS. Sensitivity to antifungal agents, except Xuconazole, was high. Because many factors can contribute to the pathogenesis of CRS, medical treatment should be considered on a case-by-case basis.
Archives of Otolaryngology-head & Neck Surgery, 2007
To investigate the association between nasal polyposis (NP) and single nucleotide polymorphisms o... more To investigate the association between nasal polyposis (NP) and single nucleotide polymorphisms of the proinflammatory cytokines IL (interleukin) 1alpha (the IL1A gene), IL-1beta (the IL1B gene), and tumor necrosis factor alpha (the TNFA gene). Prospective case-control trial. Tertiary referral center. Eighty-two patients with NP and 106 healthy volunteers without sinonasal disease. Genotypes of IL1A (4845G, 4845T), IL1B (-511C, -511T) and TNFA (-238G, -238A and -308G, -308A) were identified by restriction fragment length polymorphism analyses after polymerase chain reaction. The 4845 GT and 4845 TT genotypes of the IL1A gene were associated with NP (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05). The frequency of the -511 CC genotype of the IL1B gene was significantly higher in patients with NP than in controls (P=.01). The frequency of the -511 CT genotype of IL1B was significantly higher (P=.01) in the controls than in the patients with NP. The -238 AA genotype of the TNFA gene was higher in the patients with NP than in the controls (P=.05). There was a significantly high risk of susceptibility to NP in patients with the -308 GA genotype of TNFA (P=.001). None of the genotypes of the proinflammatory cytokines were related to sex, the presence of atopy, asthma, or aspirin intolerance (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;.05). The IL1A (4845 GT and 4845 TT), IL1B (-511 CC), and TNFA (-238 AA and -308 GA) genotypes were associated with susceptibility to NP in our study population.
Expression of matrix metalloproteinase (MMP)-9 increases in nasal polyp tissues. However, the imp... more 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. A prospective and case-control study was performed on 93 patients with NP and 115 controls without sinonasal disease. Genotypes of MMP-9 (-1562C&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;T) were identified by restriction fragment length polymorphism analyses after polymerase chain reaction. 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. 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.
The goal of this study was to determine whether there was an association between perinatal risk f... more 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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 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.
Although sensorineural hearing loss has been widely investigated in those with rheumatoid arthrit... more Although sensorineural hearing loss has been widely investigated in those with rheumatoid arthritis, studies assessing the vestibular system in patients with rheumatoid arthritis are limited. The aim of this study was to assess the vestibular system in patients with rheumatoid arthritis.The study consisted of 43 patients with rheumatoid arthritis and 30 healthy controls. Otorhinolaryngologic and neurotologic examinations, pure-tone audiometry, impedancemetry, electronystagmography including smooth pursuit, saccade, positional, and caloric tests were performed in all patients with rheumatoid arthritis and in controls. The erythrocyte sedimentation rate, C-reactive protein level, and rheumatoid factor level were evaluated in all patients with rheumatoid arthritis.Audiograms revealed sensorineural hearing loss in 12 patients (27.9%) with rheumatoid arthritis and in two controls (6.6%); the difference was statistically significant (P = .033). In those with rheumatoid arthritis, the results of electronystagmography revealed central abnormalities in nine patients (20.9%), peripheral abnormalities in three (6.9%), and mixed abnormalities in three (6.9%). Smooth pursuit and saccade tracing impairments were significantly higher in patients with rheumatoid arthritis (P > .05). Canal paresis in patients with rheumatoid arthritis were significantly higher than those in the control group (P = .039). No association was found between electronystagmographic abnormalities in patients with rheumatoid arthritis and age, sex, duration of disease, the results of laboratory testing, sensorineural hearing loss, or medication use.Our results suggest an association of rheumatoid arthritis with vestibular system dysfunction as well as auditory impairment.
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2007
Sudden sensorineural hearing loss (SNHL) accounts for 1% of all SNHL cases. It has been reported ... more Sudden sensorineural hearing loss (SNHL) accounts for 1% of all SNHL cases. It has been reported that acoustic neuroma may be present up to 47.5% of patients with sudden SNHL. A 55-year-old man presented with sudden hearing loss in his left ear of 45-day history. Audiologic and transient evoked otoacoustic emission tests showed near-total hearing loss and absence of emissions in the left ear, respectively. Electronystagmography showed left canal paralysis and lack of response to the Kobrak test. The interpeak interval I-V latency and interaural amplitude differences in wave V latency were prolonged in auditory brainstem response. Computed tomography showed an increase in the diameter of the left internal acoustic canal, and magnetic resonance imaging (MRI) revealed an intracanalicular mass, 3 mm in size, originating from the left cochlear nerve. Another mass (18x17 mm) was detected that filled the right pontocerebellar cistern, suggesting a meningioma, but this was not thought to exert an obvious shift effect contributing to the development of left-sided hearing loss. Despite treatment with a tapered course of fluocortolone for 18 days the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s hearing level did not change. He was included in a follow-up with MRI at six-month intervals.
International journal of pediatric otorhinolaryngology, 2015
Defensins are antimicrobial peptides expressed on mucosal surfaces. They function as part of the ... more Defensins are antimicrobial peptides expressed on mucosal surfaces. They function as part of the innate immune system. Palatine tonsils play important roles in innate immune system. However, our knowledge on the pathophysiology of chronic tonsils is limited. The aim of this study was to investigate the association between beta defensin 1 gene single nucleotide polymorphisms and chronic tonsillitis. Prospective, non-randomized, controlled clinical study. Tertiary referral center. Eighty six patients with chronic tonsillitis and eighty controls without history of chronic tonsillitis were enrolled in this study. Genotypes were determined by restriction fragment length polymorphism analyses after polymerase chain reaction. Genotype and allele frequencies of the -20G/A (rs11362), -44C/G (rs1800972) and -52G/A (rs1799946) single nucleotide polymorphisms were not statistically different between patients and control groups (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). In this study, we found that DEFB1 gene -20G/A, -44C/G and -52G/A single nucleotide polymorphisms were not associated with chronic tonsillitis. Studies, which analyse other polymorphism of the beta defensin 1 gene in large case series, should be conducted to understand the role of DEFB1 gene on chronic tonsillitis.
To investigate the association between nasal polyposis (NP) and single nucleotide polymorphisms o... more To investigate the association between nasal polyposis (NP) and single nucleotide polymorphisms of the proinflammatory cytokines IL (interleukin) 1alpha (the IL1A gene), IL-1beta (the IL1B gene), and tumor necrosis factor alpha (the TNFA gene). Prospective case-control trial. Tertiary referral center. Eighty-two patients with NP and 106 healthy volunteers without sinonasal disease. Genotypes of IL1A (4845G, 4845T), IL1B (-511C, -511T) and TNFA (-238G, -238A and -308G, -308A) were identified by restriction fragment length polymorphism analyses after polymerase chain reaction. The 4845 GT and 4845 TT genotypes of the IL1A gene were associated with NP (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05). The frequency of the -511 CC genotype of the IL1B gene was significantly higher in patients with NP than in controls (P=.01). The frequency of the -511 CT genotype of IL1B was significantly higher (P=.01) in the controls than in the patients with NP. The -238 AA genotype of the TNFA gene was higher in the patients with NP than in the controls (P=.05). There was a significantly high risk of susceptibility to NP in patients with the -308 GA genotype of TNFA (P=.001). None of the genotypes of the proinflammatory cytokines were related to sex, the presence of atopy, asthma, or aspirin intolerance (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;.05). The IL1A (4845 GT and 4845 TT), IL1B (-511 CC), and TNFA (-238 AA and -308 GA) genotypes were associated with susceptibility to NP in our study population.
The aim of this study was to investigate vestibular evoked myogenic potentials (VEMPs) and their ... more 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.
Although sensorineural hearing loss has been widely investigated in those with rheumatoid arthrit... more Although sensorineural hearing loss has been widely investigated in those with rheumatoid arthritis, studies assessing the vestibular system in patients with rheumatoid arthritis are limited. The aim of this study was to assess the vestibular system in patients with rheumatoid arthritis.The study consisted of 43 patients with rheumatoid arthritis and 30 healthy controls. Otorhinolaryngologic and neurotologic examinations, pure-tone audiometry, impedancemetry, electronystagmography including smooth pursuit, saccade, positional, and caloric tests were performed in all patients with rheumatoid arthritis and in controls. The erythrocyte sedimentation rate, C-reactive protein level, and rheumatoid factor level were evaluated in all patients with rheumatoid arthritis.Audiograms revealed sensorineural hearing loss in 12 patients (27.9%) with rheumatoid arthritis and in two controls (6.6%); the difference was statistically significant (P = .033). In those with rheumatoid arthritis, the results of electronystagmography revealed central abnormalities in nine patients (20.9%), peripheral abnormalities in three (6.9%), and mixed abnormalities in three (6.9%). Smooth pursuit and saccade tracing impairments were significantly higher in patients with rheumatoid arthritis (P > .05). Canal paresis in patients with rheumatoid arthritis were significantly higher than those in the control group (P = .039). No association was found between electronystagmographic abnormalities in patients with rheumatoid arthritis and age, sex, duration of disease, the results of laboratory testing, sensorineural hearing loss, or medication use.Our results suggest an association of rheumatoid arthritis with vestibular system dysfunction as well as auditory impairment.
Purpose: We aimed to compare the clinical efficacy and ocular surface variables of olopatadine, ... more 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).Methods: This was a prospective, randomized, double-blinded and placebo-controlled study. A total of 100 patients with SAC were randomly assigned to one of five groups, in which they were administered olopatadine, ketotifen fumarate, epinastine, emedastine or fluorometholone acetate, instilled twice daily for 2 weeks. One eye of each patient was treated with the study drug and the other was treated with a placebo. Signs and symptoms of allergic conjunctivitis (itching, redness, tearing, chemosis and eyelid swelling) were scored on a 4-point scale. Each symptom was assessed at baseline and then again after 1 and 2 weeks of treatment. Ocular surface variables were assessed by conjunctival impression cytology.Results: At weeks 1 and 2, all antiallergic agents were significantly more effective than placebo in alleviating itching, redness, tearing, chemosis and eyelid swelling. Fluorometholone acetate was significantly less effective than the other agents in reducing itching and redness at all control visits. Ocular surface findings by impression cytology improved significantly after all treatments compared with placebo.Conclusions: In patients with SAC, olopatadine, ketotifen, epinastine and emedastine are more efficacious than fluorometholone acetate in preventing itching and redness. All the antiallergic agents gave similar results in terms of reducing tearing, chemosis and eyelid swelling. Our data showed that impression cytology parameters improved after treatment with antiallergic agents in patients with SAC.
Paranasal mucoceles are regarded as slow-growing and benign lesions. They are usually recognized ... more Paranasal mucoceles are regarded as slow-growing and benign lesions. They are usually recognized by otorhinolaryngologists, but a clinically relevant mucocele with orbital complications may present to an ophthalmologist. We report a 15-year-old&amp;amp;amp;amp;amp;amp;amp;amp;#39;s case with unilateral reduced ocular motility due to bilateral frontal mucocele associated with grade II nasal polyposis.
Background: Schwannomas are uncommon benign tumors of the external auditory canal. The clinical f... more Background: Schwannomas are uncommon benign tumors of the external auditory canal. The clinical features, the differential diagnosis, and the surgical treatment of these lesions are discussed.
Although patients with nasal polyposis frequently exhibit concomitant allergy, there is limited i... more 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. 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. No association was found between the presence of allergy per skin-prick testing and polyp size, CT opacification, symptom scores, or recurrences (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). 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.
Pulsatile tinnitus (PT), a rare otologic symptom, is frequently associated with identifiable and ... more 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.
Matrix metalloproteinase (MMP) 2 and MMP-9 are known to cleave specifically type 4 collagen, whic... more 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). We examined tissue samples from 10 ACPs, 10 diffuse nasal polyps, and 10 control nasal mucosa (CM) by immunohistochemistry for MMP-2 and MMP-9 expression. 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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). MMP-9-expressing inflammatory cells could play a role in the pathophysiology of ACP as well as nasal polyps.
Ankylosing spondylitis (AS) is a rheumatic disease characterized by chronic inflammation. The aim... more 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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 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.
International Journal of Pediatric Otorhinolaryngology, 2006
Vertigo in childhood is a complaint consisting of a wide spectrum of diagnoses. The aim of this s... more Vertigo in childhood is a complaint consisting of a wide spectrum of diagnoses. The aim of this study was to evaluate pediatric patients with vertigo with normal eardrum and middle ear findings and discuss the differential diagnoses.Patient records of 50 children under 18 years of age with vertigo as the chief complaint, examined at the Baskent University, Research and Application Centers at Konya and Adana otorhinolaryngology clinics between May 2003 and October 2005 were retrospectively reviewed. The questionnaires, laboratory tests including blood samples, audiological and vestibular tests, and final diagnoses were analyzed. Patients with perforated eardrums, otitis media with effusion, and acute upper respiratory tract infections were not included in the study.The study group consisted of 50 patients (33 females, 66%; 17 males, 34%), between 4 and 17 years of age (mean age, 11.5 ± 3.9 years). Severe sensorineural hearing loss was present in one patient unilaterally (2%) and one patient bilaterally (2%). Bilateral low-frequency sensorineural hearing loss was present in one patient (2%). Electronystagmography revealed central vestibular abnormalities in three patients (6%). Canal paresis was established in six patients (12%). The Dix–Hallpike test was positive in six patients (12%). The most frequent cause of vertigo was migraine, occurring in 34% of patients (n = 17). Other less-frequent etiologies of vertigo were benign paroxysmal vertigo (n = 6; 12%), benign paroxysmal positional vertigo (n = 6; 12%), psychogenic vertigo (n = 5; 10%), epilepsy (n = 3; 6%), metabolic disorders (n = 3; 6%), vestibular neuritis (n = 2; 4%), Meniere's disease (n = 1; 2%), perilymphatic fistula (n = 1; 2%), amblyopia (n = 1; 2%), and unclassifiable (n = 5; 10%).Migraine was found to be the most frequent presenting diagnosis in childhood vertigo, although several peripheral vestibular disorders also were diagnosed. Evaluation of vertigo in childhood should begin with a thorough neuro-otologic evaluation and include other relevant multidisciplinary team members as needed to avoid unnecessary effort and cost.
To compare general anaesthesia and local anaesthesia with dexmedetomidine on the basis of postope... more To compare general anaesthesia and local anaesthesia with dexmedetomidine on the basis of postoperative pain and surgical bleeding after septoplasties. Sixty patients with ASA 1 or 2 were divided into the local anaesthesia with dexmedetomidine (LAD) group (n = 30) and the general anaesthesia group (n = 30). Heart rate (HR), SBP and DBP were monitored. The amount of surgical bleeding, duration of surgery and recovery, postoperative pain evaluations [by visual analogue scale (VAS)] and nausea-vomiting were also recorded. Patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; satisfaction with anaesthesia and quality of breathing was questioned 1 week after discharge. HR values were significantly higher in the general anaesthesia group than in the LAD group at the 15th min and at the end of surgery. The SBP value at the 30th min was significantly higher in the LAD group than in the general anaesthesia group. No difference was observed between the groups with respect to the DBP value. Surgical bleeding and the duration of recovery were significantly less in the LAD group. The postoperative VAS scores were significantly higher in the general anaesthesia group than in the LAD group. Postoperative nausea-vomiting was also significantly greater in the general anaesthesia group. Although more patients in the LAD group preferred this anaesthetic procedure to general anaesthesia, the quality of breathing was better in both groups after surgery. Septoplasty performed under local anaesthesia with dexmedetomidine sedation resulted in less surgical bleeding, less postoperative pain, a more stable haemodynamic state, less nausea-vomiting, a shorter recovery period and a higher level of anaesthesia satisfaction.
The goal of this study was to investigate clinical characteristics of chronic rhinosinusitis (CRS... more The goal of this study was to investigate clinical characteristics of chronic rhinosinusitis (CRS) in patients with positive fungal cultures. Fungal cultures were taken from 55 CRS patients and 20 healthy volunteers. Susceptibilities of isolated fungi to Xuconazole, amphotericin B, itraconazole, voriconazole, and caspofungin were determined in CRS patients. Fungi grew in the cultures from 44 (80%) CRS patients and 17 (85%) healthy volunteers. Of the patients with positive fungal cultures, 5 (11.3%) had fungal hypersensitivity (FH), and 21 (47.7%) had eosinophilic mucin (EM). Fungal culture-positive patients with EM were more likely to be associated with presence of polyps and higher CT scores than those without EM (P < 0.05). All the patients with FH had EM and polyps, and CT scores of those patients were highest. The sensitivity rates of fungal isolates were 97.8% for amphotericin B, caspofungin, and voriconazole; 74.4% for itraconazole; and 6.4% for Xuconazole. The presence of EM with or without FH leaded to more extended CRS, but a part of positive fungal cultures were together with EM in patients with CRS. Sensitivity to antifungal agents, except Xuconazole, was high. Because many factors can contribute to the pathogenesis of CRS, medical treatment should be considered on a case-by-case basis.
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