Publications by authors named "Levent N Ozluoglu"

47 Publications

Upright positioning-related reverse nystagmus in posterior canal benign paroxysmal positional vertigo and its effect on prognosis.

J Vestib Res 2020 ;30(3):195-201

Baskent University, Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey.

Background: Positional nystagmus elicited by the Dix-Hallpike maneuver often reverses its direction as the patient is re-seated from the provoking head hanging position. The incidence of reverse nystagmus and its association with prognosis in posterior canal benign paroxysmal positional vertigo (pcBPPV) is not clear.

Objective: To determine the incidence of upright positioning-related reverse nystagmus and its association with the success of canalith repositioning (Epley) maneuver (CRM) treatment in pcBPPV.

Methods: The records of patients that had been tested with video-nystagmography in a tertiary care center, between October 2016 and March 2019, were reviewed. Data were obtained from detailed analysis of video recordings of 321 patients with typical pcBPPV.

Results: Reverse nystagmus was determined in 85% of the patients with pcBPPV. The number of CRMs required for treatment was lower in patients with reverse nystagmus (1.32±0.68) compared to patients without reverse nystagmus (1.81±0.98) (p < 0.001). There was not a statistically significant relationship between reverse nystagmus and recurrence (p = 0.623).

Conclusions: The absence of reverse nystagmus on upright positioning during the Dix-Hallpike test predicts poor success for the CRM, as repetitive repositioning maneuvers might be required to achieve successful treatment in pcBPPV.
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http://dx.doi.org/10.3233/VES-200700DOI Listing
January 2020

Transient Velopharyngeal Insufficiency After Calcified Stylohyoid Ligament Resection.

J Craniofac Surg 2020 Sep;31(6):e540-e541

Ear, Nose, and Throat Department, Başkent University, Ankara Hospital, Ankara, Turkey.

Elongation of the stylohyoid process or calcification of the stylohyoid ligament is known as the Eagle syndrome. Mostly, it is seen incidentally on imaging or with extreme suspicion and usually patients are asymptomatic.Surgery is the preferred method in symptomatic patients. Transcervical or transoral methods may be preferred as surgical route.A 28-year-old female patient who had formerly underwent tonsillectomy presented with throat and ear pain. A neck computed tomography was performed, and the patient was diagnosed as Eagle Syndrome. Surgery was recommended.Patient developed transient velopharyngeal insufficiency on postoperative day 4. Ventilation exercise and follow-up was recommended. Complaints of the patient decreased on the 15th day.It should be kept in mind that stylohyoid ligament may be calcified in young age group and middle age group patients with dysphagia or odynophagia, and differential diagnosis should be performed. Another issue is the condition of velofaringeal insufficiency which may occur due to the damage of the pharynx muscles by deep dissection during surgery.
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http://dx.doi.org/10.1097/SCS.0000000000006467DOI Listing
September 2020

[Cochlear implantation in far advanced otosclerosis: series of four cases].

Kulak Burun Bogaz Ihtis Derg 2016 Nov-Dec;26(6):360-5

Department of Otolaryngology, Medical Faculty of Başkent University, 06490 Bahçelievler, Ankara, Turkey.

In this article, we present four patients who underwent cochlear implantation due to far advanced otosclerosis. Preoperative evaluations, intraoperative findings, complications, and postoperative benefits were analyzed. Cochlear implantation is a treatment option providing excellent audiological results for rehabilitation of patients with far advanced otosclerosis. However, facial nerve stimulation after cochlear implantation is observed more frequently in patients with otosclerosis. Also, caution should be paid in patients with otosclerosis in terms of cochlear ossification and inconsistent results.
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http://dx.doi.org/10.5606/kbbihtisas.2016.37541DOI Listing
March 2017

Congenital cholesteatoma together with ossicular chain anomaly.

Eur Arch Otorhinolaryngol 2017 Feb 8;274(2):1179-1182. Epub 2016 Jun 8.

Department of Otolaryngology-Head and Neck Surgery, Baskent University, Ankara, Turkey.

Cholesteatomas that occur under an intact tympanic membrane in the absence of prior surgical procedures or perforation are defined as congenital cholesteatomas. These entities are rarely seen, because they do not cause any major symptoms unless they touch the ossicular chain. Likewise, isolated congenital ossicular anomalies that occur independently of external ear anomalies and craniofacial dysplasia are also rarely seen. Here, we report a patient who presented with congenital cholesteatoma associated with anomalies of the ossicular chain and discuss its pathogenesis.
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http://dx.doi.org/10.1007/s00405-016-4132-0DOI Listing
February 2017

Facial palsy following embolization of a dural arteriovenous fistula.

Eur Arch Otorhinolaryngol 2016 Sep 2;273(9):2843-6. Epub 2015 Sep 2.

Department of Interventional Radiology, Baskent University School of Medicine, Ankara, Turkey.

Intracranial arteriovenous malformations are infrequent. Advances in endovascular treatment techniques have promoted the use of endovascular embolization in management of intracranial arteriovenous malformations. Transvenous or transarterial embolization procedures are effective options in the treatment of the arteriovenous fistulas. However, complications such as cranial nerve palsies may occur. Here, we present a case of right-sided lower motor neuron facial paralysis due to embolization of an intracranial dural arteriovenous fistula that have presented with clinical findings on the left eye. Facial functions of the patient improved from total weakness to House-Brackmann grade II, following facial nerve decompression surgery.
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http://dx.doi.org/10.1007/s00405-015-3772-9DOI Listing
September 2016

[Our surgical treatment results in pediatric cholesteatoma].

Kulak Burun Bogaz Ihtis Derg 2015 ;25(4):224-8

Department of Otolaryngology, Medical Faculty of Başkent University, 06490 Bahçelievler, Ankara, Turkey.

Objectives: This study aims to evaluate surgical techniques and obtained outcomes in pediatric cholesteatoma.

Patients And Methods: A total of 62 patients (41 males, 21 females; mean age 13 years; range 3 to 17 years) diagnosed as pediatric cholesteatoma between January 1998 and December 2014 were enrolled into the study. Of the patients, canal wall down (CWD) mastoidectomy was performed in 31, canal wall up (CWU) mastoidectomy in 13, inside-out (ISO) mastoidectomy in eight, and tympanoplasty in 10. Surgical approaches, staging, hearing outcomes, relapse status, and surgical data were retrospectively analyzed.

Results: Cholesteatoma recurred in seven patients (11%). Recurrence rates for CWU and CWD mastoidectomies were 31% and 6%, respectively. While the number of patients with good serviceable hearing (pure-tone average ≥25 dB) was 10 preoperatively, it became 16 postoperatively. Ossicular erosion was higher in CWD group. Twenty-nine patients (47%) had extensive disease and CWD mastoidectomy was performed in 86% of these. Number of patients not requiring care was 45 (72.6%).

Conclusion: In this study, we observed no differences in terms of good serviceable hearing between CWU and CWD mastoidectomies. The preferred method was mainly CWD in patients with extensive disease and ossicular erosion. Recurrence rates were higher in CWU group. Therefore, ISO or CWD mastoidectomy come to the forefront as appropriate treatment options in the treatment of pediatric cholesteatomas according to the extensiveness of disease.
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http://dx.doi.org/10.5606/kbbihtisas.2015.98123DOI Listing
June 2016

Positron emission tomography evaluation of sinonasal inverted papilloma and related conditions: a prospective clinical study.

Kulak Burun Bogaz Ihtis Derg 2015 ;25(1):9-15

Department of Otolaryngology, Medical Faculty of Başkent University, Adana Seyhan Hospital, 01110 Seyhan, Adana, Turkey.

Objectives: This study aims to determine whether there is a difference between inverted papilloma (IP) and nasal polyp, and squamous cell carcinoma (SCC) with regard to fluorodeoxyglucose uptake.

Patients And Methods: Between September 2007 and May 2014, positron emission tomography computed tomography (PET/CT) images of 27 patients (20 males, 7 females; mean age 53.4 years; range 18 to 74 years), with unilateral polyposis diagnosed on examination and tomographic scans of paranasal sinus were obtained. Nasal polyps in eight of the patients (group 1), IP in 10 patients (group 2), and SCC in nine patients (group 3) were found. The data were compared with Kruskal-Wallis and Mann-Whitney U tests.

Results: The mean maximum standardized uptake (SUVmax) values were found to be 2.9 in the group 1; 7.8 in the group 2, and 17.8 in the group 3. There was significant difference in the SUVmax values between the group 1 and the group 2 (p=0.016), the group 1 and the group 3 (p=0.001), and the group 2 and the group 3 (p=0.01).

Conclusion: According to the results of this study, PET/CT scan in the patients with unilateral polyposis is invaluable to distinguish nasal polyp from IP and SCC. It is also useful to recognize the distinctions between IP and SCC. In our study of 27 patients, a SUVmax of 6 or higher ruled out the presence of nasal polyp [95% CI (5.93 to 13.39), specificity 100%] might also be clinically useful.
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http://dx.doi.org/10.5606/kbbihtisas.2015.45212DOI Listing
June 2016

Ocular vestibular evoked myogenic potentials in response to air conducted stimuli: clinical application in healthy adults.

Kulak Burun Bogaz Ihtis Derg 2014 Nov-Dec;24(6):311-5

Department of Otolaryngology, Medical Faculty of Başkent University, 06490 Bahçelievler, Ankara, Turkey.

Objectives: This study aims to determine the normal values for ocular vestibular evoked myogenic potentials in response to air conducted stimuli in healthy adults.

Patients And Methods: Thirty-six healthy adult participants with no ear complaints were enrolled. Ocular vestibular evoked myogenic potential tests were performed to all participants. Latency and amplitude values of the waves were recorded.

Results: The mean N1 latency was 9.62±2.02 (4.30-16.00) msec and the mean P1 latency was 14.90±2.33 (9.0-21.00) msec. The mean amplitude was 3.36±1.36 (1.06-8.48) µV. There was a positive correlation between N1 and P1 latencies and age (r=242, p=0.0359 for N1; r=250, p=0.030 for P1).

Conclusion: Ocular vestibular evoked myogenic potentials can be obtained easily and can be used in the evaluation of vestibular disorders. However, the effect of age should be considered when interpreting results.
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http://dx.doi.org/10.5606/kbbihtisas.2014.42027DOI Listing
October 2015

Effectiveness of the combined hearing and masking devices on the severity and perception of tinnitus: a randomized, controlled, double-blind study.

ORL J Otorhinolaryngol Relat Spec 2013 26;75(4):211-20. Epub 2013 Jul 26.

Department of ENT Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey.

Objective: The aim of this study was to evaluate the effect of combined hearing and tinnitus masking devices that are appropriately programmed for acoustic stimulations using wide-band noise over the specific frequency range of tinnitus.

Material And Methods: A total of 21 patients were randomly divided into 2 groups. Group I (12 patients) was managed with betahistine dihydrochloride (2HCl) and fitted either with a combined hearing aid or a sound generator, and group II (9 patients) was treated with betahistine 2HCl for 3 months. Audiological tests, pitch matching to determine the frequency of tinnitus, an assessment of tinnitus severity, and subjective scores (visual analog scale, VAS; Mini-Tinnitus Questionnaire) were used to assess the patients in both groups, and a loudness scale was also analyzed in group I. The results were evaluated in a double-blinded manner.

Results: Significant decreases in the severity of tinnitus, Mini-Tinnitus Questionnaire score and VAS were observed in both groups. No significant differences were obtained in pitch-matched frequency of tinnitus in the two groups.

Conclusion: The findings obtained using either the combined devices or the masking devices with wide-band masking demonstrate that these devices are an effective tinnitus treatment alternative.
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http://dx.doi.org/10.1159/000349979DOI Listing
April 2014

Benign paroxysmal positional vertigo following septorhinoplasty.

J Craniofac Surg 2013 Jan;24(1):e89-90

Department of Otorhinolaryngology, Baskent University, Istanbul Hospital, Cevre Hospital, Istanbul, Turkey.

We present 2 cases of benign paroxysmal positional vertigo (BPPV) following septorhinoplasty. Benign paroxysmal positional vertigo following septorhinoplasty is an unusual entity. Two young women who had difficulty in breathing and nasal deformity underwent septorhinoplasty. On the second and the third postoperative days, the patients experienced vertigo that was induced by position changes. Both patients had neither preexisting ear disease nor vertigo before the surgery. All the examinations were normal. With Dix-Hallpike maneuver, which is the criterion-standard test, the characteristic nystagmus was observed. Right posterior canal BPPV was diagnosed, and they were both treated with Epley canalith repositioning maneuver. Publications related to postsurgical vertigo are available in literature, but it is still an underdiagnosed disorder. We would like to mention about this rare entity and inform the surgeons that they must keep in mind that a patient who is complaining about vertigo or dizziness after the surgery should be observed and investigated for BPPV.
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http://dx.doi.org/10.1097/SCS.0b013e318272d9e0DOI Listing
January 2013

Clinical significance of TRAIL and TRAIL receptors in patients with head and neck cancer.

Head Neck 2011 Sep 10;33(9):1278-84. Epub 2010 Nov 10.

Human Gene Therapy Division of the Department of Medical Genetics, Akdeniz University Faculty of Medicine, Antalya, Turkey.

Background: Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) is a death ligand currently under clinical trials for cancer. The molecular profile of TRAIL and TRAIL receptors has not yet been mapped for patients with laryngeal squamous cell carcinoma (SCC) or patients with oral cavity squamous cell carcinoma (OCSCC).

Methods: Paraffin-embedded tissues from 60 patients with laryngeal SCC and 14 patients with OCSCC were retrospectively analyzed using immunohistochemistry.

Results: An increase in decoy-R1 (DcR1) but a decrease in decoy-R2 (DcR2) expression were observed in patients with laryngeal SCC and in patients with OCSCC compared with control individuals with benign lesions. Clinical and pathologic grading revealed distinctive TRAIL and TRAIL receptor profiles in patients with squamous cell carcinoma of the head and neck (SCCHN).

Conclusions: TRAIL and a TRAIL receptor expression profile might be useful to follow-up disease progression by virtue of its connection with clinical staging and pathologic grading in patients with laryngeal SCC.
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http://dx.doi.org/10.1002/hed.21598DOI Listing
September 2011

Long-term follow-up of patients with posterior canal benign paroxysmal positional vertigo.

Acta Otolaryngol 2010 Sep;130(9):1009-12

Department of Otolaryngology-Head and Neck Surgery, Baskent University, Ankara, Turkey.

Conclusions: Recurrence of posterior canal benign paroxysmal positional vertigo (PC-BPPV) developed in one-third of patients when followed for an average of 5 years from diagnosis. History of head trauma and Ménière's disease contributed significantly to recurrence (p < 0.05). History of head trauma as an etiologic cause was more frequent in patients with recurrence of PC-BPPV.

Objectives: To estimate recurrence in the long-term follow-up of patients with PC-BPPV after successful canalith repositioning maneuvers, and to determine which factors contribute to recurrence.

Methods: The charts of 118 patients with PC-BPPV were reviewed. Data of patients were recorded from the initial evaluation and treatment. Follow-up was performed at mean of 64 +/- 7.7 months after the initial phase. The Dix-Hallpike maneuver was performed for diagnosis, and all patients were treated by the canalith repositioning maneuver, which was repeated every 3 days until the patients were symptom-free or results of the Dix-Hallpike maneuver were negative.

Results: At diagnosis, the most common etiology was idiopathic in 55 patients (46.6%). Recurrence occurred in 39 of 118 patients (33.1%). Recurrence occurred within the first 2 years in 21 of the 39 patients (53.8%). History of head trauma was a more frequent finding in patients who developed recurrence (12 of 39, 30.8%).
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http://dx.doi.org/10.3109/00016481003629333DOI Listing
September 2010

[Function of outer hair cells in patients with pseudoexfoliation].

Kulak Burun Bogaz Ihtis Derg 2009 May-Jun;19(3):130-3

Department of Otolaryngology, Medicine Faculty of Başkent University Ankara, Turkey.

Objectives: In this study, we aimed to assess whether outer hair cell function in patients with pseudoexfoliation syndrome (PES) was affected or not.

Patients And Methods: Thirty-two patients (21 males, 11 females; mean age 69.8+/-9.3 years; range 49 to 86 years) with the diagnosis of PES and 23 healthy subjects (12 males, 11 females; mean age 65.3+/-9.1 year; range 51 to 79 years) as control group were included in the study. All of the subjects were evaluated with pure tone audiometry, tympanometry, and transient otoacoustic emission tests.

Results: Sensorineural hearing loss was present in 28 patients with PES and in 13 healthy subjects (p<0.05). Transient otoacoustic emissions were present in 42 ears of patients with PES and in 32 ears of healthy subjects and there was no statistically significant difference between these two groups (p>0.05). Signal to noise ratios for PES and control groups were 5.1+/-4.4 dB and 5.2+/-4.2 dB, respectively (p>0.05).

Conclusion: Our results confirmed the presence of sensorineural hearing loss in PES patients. However, we failed to show a difference in outer hair cell functions of this group. Further postmortem histopathologic studies are needed to delineate the causes of sensorineural hearing loss in patients with PES.
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November 2010

Effect of preoperative hearing level on success of stapes surgery.

Otolaryngol Head Neck Surg 2009 Jul 28;141(1):12-5. Epub 2009 Mar 28.

Baskent University Faculty of Medicine, Adana Teaching and Medical Research Center, Department of Otorhinolaryngology-Head and Neck Surgery, Ankara, Turkey.

Objective: We evaluated functional results after stapedotomy in terms of the influence of preoperative hearing threshold.

Study Design: Case series and chart review.

Subjects And Methods: We classified 141 patients according to preoperative mean air-conduction threshold: 40 to 54 dB, group 1; 55 to 69 dB, group 2; and 70 to 89 dB, group 3. Speech discrimination scores also were noted.

Results: All groups showed significant improvement. The greatest increase in postoperative speech discrimination score was seen in group 3. Group 1 improved from moderate hearing loss (mean, 49 dB) to normal (mean, 24 dB); group 2, from moderately severe loss (mean, 61.2 dB) to mild (mean, 28 dB); and group 3, from severe loss (mean, 76.4 dB) to moderate (mean, 41.1 dB).

Conclusion: Success in treating otosclerosis does not depend on extent of preoperative hearing loss. Patients with severe loss improved to moderate, increasing the benefit from use of a hearing aid. The patients attained good auditory function, improving their quality of life.
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http://dx.doi.org/10.1016/j.otohns.2009.02.023DOI Listing
July 2009

[Utility of fine-needle aspiration biopsy in head and neck masses].

Kulak Burun Bogaz Ihtis Derg 2008 Jul-Aug;18(4):211-5

Department of Otolaryngology, Medicine Faculty of Başkent University, Ankara, Turkey.

Objectives: We investigated the utility of fine-needle aspiration biopsy (FNAB) for head and neck masses, and compared FNAB results with histopathologic diagnoses.

Patients And Methods: In a group of 352 patients (168 males, 184 females; mean age 44+/-19 years; range 2 to 94 years) who were operated on for head and neck masses, FNAB was performed in 167 patients (47.4%). The results of FNAB were compared with histopathologic diagnoses in four groups of localization: parotid, thyroid, submandibular gland, and cervical levels. Sensitivity, specificity, positive predictive and negative predictive rates of FNAB were calculated for each group.

Results: There were 64 parotid (38.3%), 29 thyroid (17.4%), 19 level V (11.4%), 18 level II (10.8%), 14 level III (8.4%), 9 level I (5.4%), and 7 submandibular gland (4.2%) masses. The overall correlation of FNAB with histopathologic diagnoses was 71.9%, being 76.6% in parotid, 75.9% in thyroid, 57.1% in submandibular gland, and 67.2% in neck (levels I-VI) masses. The highest sensitivity, specificity, positive predictive and negative predictive rates were determined for parotid masses (98%, 93.3%, 98%, 93.3%, respectively), whereas the lowest rates were obtained in submandibular gland masses (50%, 66.7%, 66.7%, 50%, respectively).

Conclusion: The use of FNAB for head and neck masses, in particular parotid masses, provides considerable contribution to treatment planning.
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August 2010

Vestibular evoked myogenic potentials in preterm infants.

Audiol Neurootol 2009 29;14(1):1-6. Epub 2008 Jul 29.

Department of Otorhinolaryngology, Baskent University Faculty of Medicine, Ankara, Turkey.

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.
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http://dx.doi.org/10.1159/000148204DOI Listing
March 2009

Correlation of diagnostic systems with adenoidal tissue volume: a blind prospective study.

Int J Pediatr Otorhinolaryngol 2008 Aug 24;72(8):1235-40. Epub 2008 Jun 24.

Department of Otolaryngology, Baskent University School of Medicine, Ankara, Turkey.

Objectives: To determine the correlation between adenoid tissue volume and three diagnostic methods of deciding whether to perform an adenoidectomy.

Methods: The study used 152 patients (mean age, 5.8+/-2.5 years; age range, 2-12 years) who underwent an adenoidectomy at our clinic between April 2005 and April 2007. Patients requiring a revision operation and those with a cleft palate were excluded. To estimate the extent to which the adenoid narrowed the choana, an evaluation was made using nasal endoscopy (%), a mirror (%), and palpation (rated from 1 to 5) with the patient in Rose's position just before surgery. Postadenoidectomy tissue volume was measured (in cm(3)). The Spearman rank correlation and stepwise linear regression analyses were used to statistically evaluate the data.

Results: Nasal endoscopy revealed that the choana was narrowed by the adenoid at an average of 86.6+/-13.1% (range, 50-99%). When viewing upward by a mirror, the choana was observed as being narrowed at an average of 44.2+/-30.2% (range, 5-100%). The mean palpation value was 3.2+/-1.4 (range, 1-5). The mean volume of adenoidal tissue measured was 1.8+/-0.8 cm(3) (range, 0.7-4.5 cm(3)). Nasal endoscopy was determined to be the best means of checking by the Spearman rank correlation. Mirror (R=0.64, P<.0001), palpation (R=0.62, P<.0001), and volume (R=0.62, P<.0001) were correlated with the nasal endoscopy; however, regression analysis found that only palpation (P=.003) and volume (P<.001) were independent variables affecting the image of nasal endoscopy, mirror inspection (P=.260) was not.

Conclusions: Nasal endoscopy is considered the most important tool to indicate adenoidectomy. This study showed that nasal endoscopy and palpation provide the most accurate determination of the volume of adenoidal tissues dissected by adenoidectomy.
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http://dx.doi.org/10.1016/j.ijporl.2008.05.002DOI Listing
August 2008

Angulation of the styloid process in Eagle's syndrome.

Eur Arch Otorhinolaryngol 2008 Nov 22;265(11):1393-6. Epub 2008 Apr 22.

Department of Otorhinolaryngology Head and Neck Surgery, Baskent University Faculty of Medicine, Ankara, Turkey.

In a retrospective study, we investigated and compared the angulation and the length of the styloid process between patients operated for Eagle's syndrome and a control group by means of lateral skull and Towne's radiographs. Thirty patients with 51 symptomatic elongated styloid processes underwent surgery. As a control group, patients with chronic otitis media and trauma were included in the study and none of them had symptoms characteristic of an elongated styloid process. The length, medial and anterior angulation of the styloid processes of the patient and the control groups were measured on lateral skull and Towne's radiographs. The mean length of the styloid process was 5 cm on the right and 5.2 cm on the left in the patient group, whereas they were 2.8 and 2.6 cm, respectively, in the control group. The mean degree of anterior angulation in the patient group was 33.6 degrees on the right, 36.7 degrees on the left, whereas these were 21.4 degrees and 18.5 degrees , respectively, in the control group. There was a significant difference between the two groups for length and anterior angulation (P = 0.001). The mean medial angulation was 14 degrees on the right and 18.1 degrees on the left in the patient group, whereas these were 15 degrees and 16.3 degrees in the control group, respectively, and there were no significant differences between the two groups. The anterior angulation and the length of the styloid process are responsible for the symptoms of Eagle's syndrome.
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http://dx.doi.org/10.1007/s00405-008-0686-9DOI Listing
November 2008

Benign paroxysmal positional vertigo after radiologic scanning: a case series.

J Med Case Rep 2008 Mar 27;2:92. Epub 2008 Mar 27.

Baskent University Zubeyde Hanim Practice and Research Center, Department of Radiology, Izmir, Turkey.

Introduction: Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo. It is frequently seen in elderly patients, and the course of the attack may easily mimic cerebrovascular disease. A BPPV attack after a radiologic examination has not been reported previously. We report the cases of two patients who had BPPV attacks after radiologic imaging.

Case Presentation: The first patient with headache and tremor was admitted to the radiology department for cranial computed tomography (CT) imaging. During scanning, she was asked to lie in the supine position with no other head movements for approximately 10 minutes. After the cranial CT imaging, she stood up rapidly, and suddenly experienced a vertigo attack and nausea. The second patient was admitted to the radiology department for evaluation of his renal arteries. During the renal magnetic resonance angiography, he was in the supine position for 20 minutes and asked not to move. After the examination, he stood up rapidly with the help of the technician and suddenly experienced a vertigo attack with nausea and vomiting. The results of standard laboratory analyses and their neurologic examinations were within normal limits and Dix-Hallpike tests showed rotatory nystagmus in both cases. An Epley maneuver was performed to the patients. The results of a control Dix-Hallpike tests after 1 Epley maneuver were negative in both patients.

Conclusion: Radiologists and clinicians must keep in mind that after radiologic imaging in which the patient is still for some time in the supine position and then helped to stand up rapidly, a BPPV attack may occur.
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http://dx.doi.org/10.1186/1752-1947-2-92DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2324108PMC
March 2008

Reliability of the vestibular evoked myogenic potential test in assessing intratympanic gentamicin therapy in Meniere's disease.

Acta Otolaryngol 2008 Apr;128(4):422-6

Department of Otolaryngology, Baskent University, Ankara, Turkey.

Conclusions: The results of this preliminary study demonstrate that with regard to determining the efficacy of intratympanic (IT) gentamicin treatment in patients with Meniere's disease, the reliability of testing for vestibular evoked myogenic potentials (VEMPs) is comparable to that of caloric tests. Compared with caloric tests, VEMP measurements are more comfortable and take less time. The results of VEMP and caloric testing do not correlate with the results of hearing tests.

Objective: To test the reliability of VEMP testing to monitor the results of IT gentamicin therapy in patients with Meniere's disease.

Subjects And Methods: Twelve patients with unilateral Meniere's disease were evaluated with pure tone audiometry (PTA), bithermal caloric tests, and VEMP tests. Patients with measurable caloric and VEMP results before IT gentamicin treatment were included in the study. IT gentamicin (0.5 ml) at a concentration of 40 mg/ml was administered to the patients. Reinjection was performed 10 days later depending on patients' complaints. Patients were re-evaluated with short- and long-term VEMP, hearing, and caloric test results.

Results: Caloric responses and VEMPs changed following gentamicin therapy in 9 patients and 12 patients, respectively. Long-term results of caloric and VEMP tests in patients receiving IT gentamicin treatment changed in 7 patients and 10 patients, respectively.
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http://dx.doi.org/10.1080/00016480701808988DOI Listing
April 2008

Vestibular evoked myogenic potentials in Behcet's disease.

Eur Arch Otorhinolaryngol 2008 Nov 26;265(11):1315-20. Epub 2008 Mar 26.

Department of Otolaryngology, Baskent University Faculty of Medicine, 06640, Bahcelievler, Ankara, Turkey.

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.
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http://dx.doi.org/10.1007/s00405-008-0650-8DOI Listing
November 2008

Reliability of microdrill stapedotomy: comparison with pick stapedotomy.

Otol Neurotol 2007 Dec;28(8):998-1001

Otorhinolaryngology Department, Baskent University Faculty of Medicine, Ankara, Turkey.

Objective: To assess the hearing outcomes and complications of the microdrill and pick stapedotomy techniques.

Patients: We assessed 123 primary otosclerosis operation in 103 patients who had more than 1 year follow-up (71 microdrill; 52 pick stapedotomies). There were 87 women and 36 men in the study group (mean age, 44 +/- 11.2 years) at surgery.

Intervention: Stapedotomy for otosclerosis.

Main Outcome Measures: Pure tone hearing thresholds and clinical evaluation for complications.

Results: In the microdrill group, preoperative mean air conduction was 61 dB, and mean bone conduction was 27 dB, postoperatively, these values improved to 31 dB and 16 dB, respectively. In the pick group, mean air conduction was 61 dB, and mean bone conduction was 27 dB, which improved postoperatively to 33 dB and 18 dB, respectively. Postoperative hearing gains were similar in both groups (p > 0.005). The mean postoperative gain in bone conduction was significant (p < 0.001) in each group: 11 dB in the microdrill group and 9 dB in the pick group, with no significant difference between the two groups. The preoperative air-bone gap was 34 dB in both groups, and improved to 15 dB in both. Complication rates were similar.

Conclusion: The microdrill and pick stapedotomy techniques produced similar hearing results and complication rates. Within the limitations of the present study, we found no evidence of microdrill-induced acoustic trauma. The microdrill can be a useful technique in performing a stapedotomy and seems to produce similar results to those associated with pick stapedotomy.
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http://dx.doi.org/10.1097/MAO.0b013e31815a3548DOI Listing
December 2007

Endoscopic endonasal-transantral surgery for an isolated orbital floor blow-out fracture in a pediatric patient.

Kulak Burun Bogaz Ihtis Derg 2007 ;17(3):179-82

Department of Otolaryngology, Medicine Faculty of Başkent University, Ankara, Turkey.

Orbital floor blow-out fractures occur due to blunt trauma causing displacement of orbital contents to the maxillary sinus while the orbital rim is intact. Surgical repair of these fractures includes transantral, transorbital, or endoscopic endonasal approaches with or without implant use. We report a 12-year-old boy who presented with diplopia after blunt trauma to the head while playing football. Computed tomography revealed a left isolated orbital blow-out fracture. The patient was treated by a combined endoscopic endonasal-transantral approach and stability was restored with a urethral balloon catheter following endoscopic reduction of the fracture. Healing of the orbital floor was confirmed by an early computed tomography scan. This technique restores eye volume and function without the use of external incisions or implants.
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October 2007

Endolymphatic sac papillary tumor: a case report and review.

Auris Nasus Larynx 2008 Jun 14;35(2):276-81. Epub 2007 Sep 14.

The Baskent University School of Medicine, Department of Otolaryngology, Ankara, Turkey.

Endolymphatic sac papillary tumor (endolymphatic sac adenoma, temporal-mastoid bone adenoma or adenocarcinoma, low-grade adenocarcinoma of potential endolymphatic sac origin, aggressive papillary tumor of the temporal bone, Heffner's tumor) is a rare lesion that involves the temporal bone. This tumor usually appears alone, but in 11-30% of afflicted individuals, it is accompanied by von Hippel-Lindau disease. Endolymphatic sac papillary tumors are destructive tumors that exhibit locally aggressive behavior. They slowly grow into the posteromedial section of petrous temporal bone. The main symptoms produced by these lesions include hearing loss and cranial nerve deficits. Endolymphatic sac papillary tumors develop in two principal patterns that histopathologically form follicular and papillary or solid structures. Those two patterns are usually manifested in the same tumor. Immunochemical analysis of these tumors usually reveals cytokeratin, vimentin, epithelial membrane antigen, and (less frequently) S-100 protein and neuron-specific enolase. Local excision is curative for endolymphatic sac papillary tumors. The currently favored method of treatment consists of excision and long-term follow-up. The role of adjuvant radiotherapy as treatment is controversial. This case report describes an endolymphatic sac tumor in a 22-year-old woman without von Hippel-Lindau disease who had a number of complaints, including deafness in her left ear, complete left-sided facial paralysis, and hoarseness of approximately 8 years' duration.
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http://dx.doi.org/10.1016/j.anl.2007.06.009DOI Listing
June 2008

Subjective pulsatile tinnitus associated with extensive pneumatization of temporal bone.

Eur Arch Otorhinolaryngol 2008 Jan 24;265(1):123-5. Epub 2007 Jul 24.

Department of Otorhinolaryngology, Baskent University Faculty of Medicine, 06640, Bahcelievler, Ankara, Turkey.

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.
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http://dx.doi.org/10.1007/s00405-007-0400-3DOI Listing
January 2008

Clinical application of vestibular evoked myogenic potentials in healthy newborns.

Int J Pediatr Otorhinolaryngol 2007 Aug 29;71(8):1181-5. Epub 2007 May 29.

Department of Otorhinolaryngology, Baskent University, 06640 Bahcelievler, Ankara, Turkey.

Objective: Auditory and vestibular functions have critical importance in infancy because they may affect motor and mental development. We aimed to determine the normal values of the vestibular evoked myogenic potential (VEMP) parameters to provide a reference for further research regarding the early diagnosis of vestibular dysfunction in newborns.

Methods: Twenty-four term newborns (12 girls, 12 boys), with birth weights greater than 2500 g and Apgar scores higher than 7 at 1 min, were studied. Tympanometry, auditory-evoked brainstem responses, transient-evoked otoacoustic emissions, and VEMP recordings were assessed in all subjects during fourth week after birth.

Results: All newborns passed the audiologic evaluation, and biphasic waveforms of the VEMP were obtained in all 48 tested ears. Mean latencies of p13, n23, and p13-n23 intervals were 13.7+/-1.1, 20.5+/-1.6, and 7.1+/-2.1 ms, respectively. The mean amplitude value was 22.6+/-18.4 microV. There were no significant differences in latency values or amplitudes with regard to sex or side of ear tested in newborns.

Conclusions: VEMP may easily be used for early evaluation of vestibular dysfunction in newborns. Because results may differ owing to test techniques and age, every laboratory should have its own normal values.
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http://dx.doi.org/10.1016/j.ijporl.2007.04.007DOI Listing
August 2007

[Classic Kaposi's sarcoma of the tongue: a case report].

Kulak Burun Bogaz Ihtis Derg 2007 ;17(2):116-9

Department of Otolaryngology, Medicine Faculty of Başkent University, Ankara, Turkey.

An 81-year-old male patient presented with a painful mass in the tongue that showed a progressive growth within the past two months. Examination revealed a polypoid mass in the midline of the tongue, purple in color, and 1.5x1.5 cm in size. There was no palpable lymph node on neck examination. An excisional biopsy was performed with adequate surgical margins. The histopathological diagnosis was Kaposi's sarcoma. Clinical and radiological evaluations did not show any systemic involvement. An HIV test was negative. He was referred to the medical oncology department. No recurrence was detected during a year follow-up.
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October 2007

Dynamic multislice computed tomography findings for parotid gland tumors.

J Comput Assist Tomogr 2007 Mar-Apr;31(2):309-16

Department of Radiology, Baskent University Medical School, Ankara, Turkey.

Objective: Our aim was to research the enhancement features of parotid gland masses in detail and characterize if the masses were Warthin tumors, adenomas, or malignant tumors.

Methods: The prospective study included 25 parotid tumors in 21 patients. Neck computed tomography (CT) was performed using a multislice CT unit. A full-neck CT examination was done at 30 seconds after completion of contrast injection, and then tumor-level images were obtained at 90 seconds and at 5 and 25 minutes. Computed tomography number (lesion density in Hounsfield units) was determined at each phase, and differences within and among tumor groups were statistically analyzed. Diagnoses were confirmed by histopathology.

Results: There were 11 Warthin tumors, 8 pleomorphic adenomas, 5 malignant tumors, and 1 basal cell adenoma. Ten Warthin tumors showed rapid contrast enhancement at 30 seconds and rapid reduction of enhancement from the first to the fourth phase. The basal cell adenoma showed also a peak enhancement at 30 seconds. Seven pleomorphic adenomas showed increased enhancement through the first 3 phases. Four malignant tumors showed peak enhancement at 90 seconds. Statistically significant differences within and among tumor groups were determined.

Conclusions: The data suggest that peak tumor enhancement at 30 and 90 seconds, respectively, might identify Warthin and malignant tumors. Increased enhancement through all phases might be an indicator for diagnosing pleomorphic adenomas.
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http://dx.doi.org/10.1097/01.rct.0000236418.82395.b3DOI Listing
May 2007

Investigation of Helicobacter pylori in tonsillary tissue with Pronto Dry test and pathologic examination.

Auris Nasus Larynx 2007 Sep 29;34(3):339-42. Epub 2006 Dec 29.

Department of Otolaryngology Head and Neck Surgery, Baskent University School of Medicine, Ankara, Turkey.

Objective: The objectives of this clinical study were to identify, by means of the Pronto Dry test and pathologic examination, Helicobacter pylori (HP) in tonsillary tissue and to establish the role of HP in tonsillary microbiology by identifying that bacterium in the tonsillary mucosa or within the tonsil core.

Methods: The subjects consisted of 52 patients (25 men and 27 women; age range, 3-65 years; mean age, 15.1+/-14.5 years) who were scheduled to undergo tonsillectomy for the treatment of chronic tonsillitis and who had not been treated with an antibiotic or a bismuth-containing compound for 6 months before the initiation of the study. In each patient, two specimens (one 4 mm x 4 mm tissue sample from the nonmucosal tonsil core and one 4 mm x 4 mm sample of mucosal tissue) were excised from both tonsils immediately after tonsillectomy. The specimens were placed in the Pronto Dry test kit, and the test results were obtained 1 h later. The remaining tonsillary tissues were submitted for pathologic analysis via hematoxylin-eosin stain, Giemsa stain, Warthin-Starry silver stain, and staining for inducible nitric oxide synthase (iNOS).

Results: The results of the Pronto Dry test were positive for HP in 42% (n=22) of the excised mucosal tissue and in 47% (n=24) of the excised core tissue. In 27% (n=14) of the patients, both the core and the mucosal tissues tested positive for HP. There was no significant difference between the positive Pronto Dry test ratios of the biopsies obtained from the mucosa and those obtained from the core (P=0.693). iNOS staining showed that macrophage iNOS activity was significantly higher (P=0.025) in biopsied mucosal tissues with a positive Pronto Dry test result than in those with a negative result. Light microscopy revealed no HP in samples stained with hematoxylin-eosin stain, Giemsa stain, or Warthin-Starry silver stain.

Conclusion: Positive Pronto Dry test results and the results of iNOS staining showed that HP contributes to chronic tonsillitis, especially at the mucosal layer. Although HP does not colonize, it contributes to the chronic tonsillary inflammatory process as a triggering agent by affecting macrophages in the tonsil and thus increasing iNOS expression.
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http://dx.doi.org/10.1016/j.anl.2006.10.004DOI Listing
September 2007

[Intratympanic treatment in Meniere's disease: the effect of gentamicin and dexamethasone on vertigo control and hearing].

Kulak Burun Bogaz Ihtis Derg 2006 ;16(5):193-9

Department of Otolaryngology, Medicine Faculty of Başkent University, Ankara, Turkey.

Objectives: We investigated the effect of intratympanic gentamicin and dexamethasone treatments on the control of vertigo and hearing loss in patients with Meniere's disease.

Patients And Methods: Forty-five patients with a diagnosis of Meniere's disease according to the 1995 criteria of American Academy of Otorhinolaryngology Head and Neck Surgery were assigned to receive intratympanic gentamicin (40 mg/ml, 0.7 ml; n=24; 11 males, 13 females; mean age 46 years) or dexamethasone (4 mg/ml, 0.7 ml; n=21; 8 males, 13 females; mean age 50.4 years). The results were evaluated with respect to changes in vertigo and hearing symptoms.

Results: In the gentamicin group, vertigo symptoms were controlled in 22 patients (92%), deterioration in hearing was seen in only two patients (8%). In the dexamethasone group, nine patients had complete follow-up. Of these, vertigo control was achieved in six patients (67%), none had worsened hearing, and one patient (5%) had improved hearing. When improvement in hearing was defined as at least a 5 dB change, then five patients (24%) benefited from treatment.

Conclusion: Intratympanic treatment modalities in Meniere's disease are easy to perform, cheap, and effective. They are expected to have a more extensive use with higher success rates in the future.
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January 2007