Publications by authors named "Levent Ozlüoğlu"

101 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

Effects of Glycerol Test on Resonance Frequency in Patients with Ménière's Disease.

Audiol Neurootol 2019 12;24(6):285-292. Epub 2019 Nov 12.

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

Objective: To evaluate resonance frequency (RF) values via dehydration effects in the inner ear caused by the glycerol test, which is used as a diagnostic method for Ménière's disease (MD).

Methods: Twenty adult patients with unilateral MD were included in the study. Before, and then at 1, 2, and 3 h after administration of glycerol (1 g/kg), pure-tone hearing levels (125-8,000 kHz) and multifrequency tympanometry tests were performed. As a control, the RF values of the ears of 25 healthy subjects (i.e., 50 ears) were compared to the affected and unaffected ears in the 20 MD patients.

Results: There was a significant difference between the RF values of affected and healthy ears before glycerol administration (p = 0.047). The RF values before and after glycerol administration into affected ears were compared. The average RF values decreased significantly from 748.0 ± 402.1 to 808.0 ± 410.1 Hz at 1 h after glycerol intake, and this value increased during the subsequent hours. There were no statistically significant differences between the pure-tone levels before and 1 h after glycerol administration, but a significant decrease was observed at 3 h.

Conclusion: We suggest that MD has different inner-ear dynamics and normal RF values when compared to healthy ears. Furthermore, decreased inner ear pressure causes reduction of the mass effect and a stiffening of the annular ligament. We conclude that pre- and post-RF tests should be added to the test battery for diagnosis of MD.
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http://dx.doi.org/10.1159/000503845DOI Listing
June 2020

Correlation between Vestibular Evoked Myogenic Potentials and Disease Progression in Ménière's Disease.

ORL J Otorhinolaryngol Relat Spec 2019;81(4):193-201. Epub 2019 Aug 7.

Baskent University School of Medicine, Ankara, Turkey.

Objective: To assess the relationship between ocular (oVEMPs) and cervical (cVEMPs) vestibular evoked myogenic potentials and audiometrically determined clinical stage in Ménière's disease (MD).

Methods: Thirty-four unilateral MD patients and 30 healthy volunteers were included in the study. Pure-tone hearing levels, oVEMPs, cVEMPs, and videonystagmography results were analyzed and compared between the groups.

Results: Both oVEMPs and cVEMPs were highly reproducible in the control group. At the early stages of MD, cVEMPs were particularly disturbed, while at the advanced stages both oVEMPs and cVEMPs were altered pathologically. In the study group, oVEMP and cVEMP amplitudes and interaural amplitude difference (IAD) statistically differed from those in the control sample. oVEMPs were absent in 7.7% of stage III and in 44.5% of stage IV MD patients, while cVEMPs were absent in 15.4% of stage III and in 54.5% of stage IV MD patients, respectively. In stage III and IV MD patients in whom oVEMPs and cVEMPs were obtained, IADs were increased. Caloric asymmetry was found in 64.7% of MD patients. Caloric weakness was more prominent in cases with advanced MD.

Conclusion: VEMPs can be used for objective validation of the stage of MD.
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http://dx.doi.org/10.1159/000496088DOI Listing
May 2020

Audiological and vestibular measurements in Behçet's disease.

Eur Arch Otorhinolaryngol 2019 Jun 30;276(6):1625-1632. Epub 2019 Mar 30.

Otorhinolaryngology Department, Medical Faculty, Baskent University, Ankara, Turkey.

Introduction: Behçet's disease (BD) is a vasculitis that involves all small vessels and influences the multiple systems of the human body. This study aimed to evaluate the audio-vestibular system involvement of patients with BD and healthy individuals.

Materials And Methods: This study was designed as a prospective case-control blinded study. Thirty-one patients with BD and 31 healthy individuals were included. All the subjects were evaluated via pure tone audiometry (PTA), video head impulse test (vHIT), post head shake nystagmus test (PHSNT) and dizziness handicap inventory (DHI) to check for audio-vestibular system involvement.

Results: Patients with BD showed higher PTA scores in both speech and high frequencies. The vHIT revealed pathological saccades, particularly in horizontal canals (right ear: p = 0.002, left ear: p = 0.039). The gain values of the patients were slightly lower than those of the control group; however, gain and gain asymmetry differed significantly in a few canals. In the spontaneous nystagmus test and PHSNT, pathological nystagmus was detected to be significantly higher in the patient group than control group (p = 0.001); but the saccade presence in vHIT and nystagmus in PHNT did not differ among the patients (p = 0.106). In addition, the DHI scores of the patients group were higher than those of the control group (p < 0.001). No correlation was found between disease duration and saccade presence.

Conclusion: The vHIT was used preliminary for evaluating the vestibular system in BD. This study showed the influence of BD on the audio-vestibular system, in particular isolated horizontal canal involvement was discovered in patients with BD.

Level Of Evidence: Level III b.
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http://dx.doi.org/10.1007/s00405-019-05403-xDOI Listing
June 2019

The protective effect of metformin against the noise-induced hearing loss.

Eur Arch Otorhinolaryngol 2018 Dec 10;275(12):2957-2966. Epub 2018 Oct 10.

Department of ENT, Başkent University, 06500, Ankara, Turkey.

Objective: To test the protective effect of metformin against noise-induced hearing loss.

Methods: 24 rats were included in the study. The first group was exposed to noise only, the second group took metformin, the third group was exposed to noise and took metformin, and the fourth group was neither exposed to noise nor took metformin as control group. After measurement of baseline DPOAE and ABR of rats, the metformin group and the metformin + noise group received 300 mg/kg/day metformin via gavage for 10 days. On the 11th day, group 1 and group 3 were exposured to white noise at 105 dB SPL for 15 h. After noise exposure, DPOAE and ABR measurements of all rats were repeated on days 1st, 7th, and 21st. At the end of the study, all animals were sacrificed and cochlear tissues were separated for immunohistochemical assessments.

Results: ABR threshold values and DPAOE measurements of groups 1 and 3 were deteriorated on the 1st day after noise, while deterioration in group 1 continued on 7th and 21st days, but normalized on 7th day in group 3. After immune staining, a significant immunoreaction was observed in the noise group, while the reaction in the noise + metformin group was close to the control group.

Conclusion: Metformin has a protective effect on noise-induced hearing loss in rats. As a conclusion, it is determined that metformin protects from permanent threshold shift in rats. It can be considered a good alternative for protecting noise-induced hearing loss.
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http://dx.doi.org/10.1007/s00405-018-5161-7DOI Listing
December 2018

Otorhinolaryngologic Problems in Liver and Kidney Transplant Recipients.

Exp Clin Transplant 2018 Sep 4. Epub 2018 Sep 4.

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

Objectives: The aim of this study was to define the otorhinolaryngologic manifestations and clinical characteristics of patients who received kidney or liver transplants at a university hospital.

Materials And Methods: Medical records of patients who received a kidney or liver transplant between 2000 and 2013 and who were referred or applied to the ear, nose, and throat clinic were retrospectively reviewed. Otorhinolaryngologic complaints, signs, examination findings, and diagnoses of patients were noted.

Results: Our analyses included 540 visits to the ear, nose, and throat clinic by 101 liver and 191 kidney transplant recipients. Mean duration between date of transplant and otorhinolaryngologic examination was 747.9 ± 37.1 days. The most common complaint was rhinorrhea (n = 112), whereas the most common diagnosis was acute rhinosinusitis (n = 85). Acute upper respiratory tract infections, including rhinosinusitis, were diagnosed more frequently during the late postoperative period (ie, > 180 days after transplant). Epistaxis was more frequent during the first 30 days after transplant.

Conclusions: A diverse variety of otorhinolaryngologic conditions, including emergencies and potentially life-threatening infections, were seen in our kidney and liver transplant recipients, both during the early and the late follow-up period. All transplant team members should be familiar with the clinical presentation of frequently seen otorhinolaryngologic diseases.
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http://dx.doi.org/10.6002/ect.2018.0173DOI Listing
September 2018

The protective effect of adrenocorticotropic hormone treatment against noise-induced hearing loss.

Auris Nasus Larynx 2018 Oct 7;45(5):929-935. Epub 2018 May 7.

Baskent University Medical Faculty, Otorhinolaryngology Department, Ankara, Turkey.

Objective: NIHL is a common problem, and steroids are the most effective treatment option. In this study, we aimed to evaluate the protective effects of the synthetic adrenocorticotropic hormone (ACTH) analogues, which induce endogenous steroid secretion, against noise-induced hearing loss (NIHL) and to compare their effectiveness with that of steroid treatment.

Methods: Twenty-four male Sprague-Dawley albino rats were divided into four subgroups as follows: group 1 (n=6) control, group 2 (n=6) saline, group 3 (n=6) dexamethasone (2mg/kg/day intramuscularly [IM]), group 4 (n=6) ACTH analogue (0,4mg/kg/day IM), respectively. Three groups (groups 2-4) were exposed to white noise (105dB SPL, 12h). All the rats were evaluated for hearing thresholds of 10kHz, 20kHz, and 32kHz via acoustic brainstem responses (ABR) measurement. After the basal threshold measurements, measurements were repeated immediately after the noise and on day 7 and day 21.

Results: Both steroid and ACTH analogue groups showed significantly better hearing outcomes than the saline group on day 7 (p<0.001) and day 21 (p<0.001) after the noise exposure. No superior treatment effect was demonstrated in either the steroid or ACTH analogue group. None of the related intervention groups reached the basal hearing thresholds.

Conclusion: Steroids were effective drugs for the treatment of NIHL. ACTH analogues also demonstrated promising therapeutic effects for NIHL. Further studies to establish ACTH analogues as an alternative NIHL treatment option to steroids are needed.
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http://dx.doi.org/10.1016/j.anl.2017.12.006DOI Listing
October 2018

Audio-Vestibular Findings in Increased Intracranial Hypertension Syndrome.

J Int Adv Otol 2017 Apr 13;13(1):100-104. Epub 2017 Jan 13.

Department of Otorhinolaryngology, Başkent University Alanya Hospital, Antalya, Turkey.

Objective: Idiopathic intracranial hypertension (IIH) can be manifested by audiological and vestibular complaints. The aim of the present study is to determine the audio-vestibular pathologies and their pathophysiologies in this syndrome by performing current audio-vestibular tests.

Materials And Methods: The study was performed prospectively on 40 individuals (20 IIH patients, 20 healthy volunteers). Pure tone audiometry, tympanometry, vestibular evoked myogenic potentials, and electronystagmography tests were performed in both groups and the results were compared.

Results: The mean age of both groups was found to be 30.2±18.7. There were 11 females and 9 males in each group. The study group patients had significantly worse hearing levels. Pure tone averages were significantly higher in both ears of the study group (p<0.05). Ten patients (50%) in the study group and one healthy volunteer (5%) had pathologic ENG, possibly related to central pathologies (p=0.008). Eight patients (40%) and one (5%) control had variable abnormal VEMP records (p=0008).

Conclusion: Many IIH patients initially visit otolaryngology clinics since cochlear and vestibular systems are frequently affected in this condition. Our test results suggest inner ear pathologies in these patients. Higher incidence of inferior vestibular nerve and/or saccule dysfunction is detected as a novelty. Increased intracranial pressure may affect the inner ear with similar mechanisms as in hydrops.
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http://dx.doi.org/10.5152/iao.2016.2626DOI Listing
April 2017

[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

Submandibular Gland Surgery: Our Clinical Experience.

Turk Arch Otorhinolaryngol 2016 Mar 1;54(1):16-20. Epub 2016 Mar 1.

Department of Otorhinolaryngology, Başkent University Ankara Hospital, Ankara, Turkey.

Objective: The aim of this study was to assess the demographic findings and surgical results of patients who underwent submandibular gland excision at a tertiary care center.

Methods: The clinical characteristics and histopathological results of 45 patients who had undergone submandibular gland excision between 1997 and 2014 were evaluated in detail.

Results: Twenty-eight (62.2%) and 17 (37.8%) patients presented with a complaint of a painful mass and painless mass, respectively. Histopathologic investigation of the surgical specimens revealed sialolithiasis in 14 patients (31.1%), chronic sialadenitis in 16 (35.6%), benign tumor in 12 (26.7%), malignant tumor in two (4.4%), and mucocele extravasation in one. As complications, permanent paralysis of the marginal mandibular branch of the facial nerve was seen in one patient (2.2%), temporary paralysis of the marginal mandibular branch of the facial nerve was seen in seven (15.6%), orocutaneous fistula was seen in one (2.2%), and temporary paralysis of the hypoglossal nerve was seen in one (2.2%).

Conclusion: This study revealed that in patients presenting with complaints of a submandibular gland mass, sialolithiasis, sialadenitis, and benign masses were the mostly diagnosed disorders. Transcervical submandibular gland excision is a satisfactory procedure with low complication and recurrence rates when it is performed on selected patients and obeyed to surgical techniques.
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http://dx.doi.org/10.5152/tao.2016.1467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5782970PMC
March 2016

Auditory brainstem implant in postlingual postmeningitic patients.

Laryngoscope 2016 08 20;126(8):1889-92. Epub 2015 Oct 20.

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

Objectives/hypothesis: The aim of this study was to evaluate outcomes of postlingual postmeningitic patients who received an auditory brainstem implant (ABI).

Study Design: Retrospective analysis was performed on postlingual postmeningitic patients with bilateral profound sensorineural hearing loss who underwent ABI between the years 2007 and 2014 METHODS: All patients were postlingually deaf due to cochlear ossification as a consequence of bacterial meningitis. The patients received a MED-EL or Neurelec ABI. All patients were operated on at different hospitals by the same primary surgeon. The patients were tested using Ling 5 sound detection, sound field implant thresholds between 250 Hz and 6 kHz, and 6 to 12 choice closed-set word and sentence tests.

Results: Nine patients with postmeningitic cochlear ossification received an ABI. Five of nine ABI users (55.5%) wear their audio processors (AP) most of the time. Four (44.5%) with no perceivable benefit have become nonusers. Three of the five consistent ABI users reported good benefit. The other two ABI users who do wear their APs do not respond to sound in daily living but reported benefits such as "feeling sound" in a good way.

Conclusions: In this study, five of nine patients (55.5%) with bilateral ossified cochlea had some degree of benefit from their ABI. An ABI may be useful in hearing restoration in postlingual patients with bilateral ossified cochlea due to meningitis. However, poor results may be related to side effects, which may necessitate deactivation of electrodes, long duration of auditory deprivation, or impairments in the auditory neural structures as a result of meningitis.

Level Of Evidence: 4. Laryngoscope, 126:1889-1892, 2016.
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http://dx.doi.org/10.1002/lary.25731DOI Listing
August 2016

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

Glycerol affects vestibular-evoked myogenic potentials and pure-tone hearing in patients with Ménière's disease.

Acta Otolaryngol 2015 Feb 27;135(2):111-8. Epub 2014 Nov 27.

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

Conclusion: The pure-tone audiometry results following glycerol administration indicated a positive effect on cochlear endolymphatic hydrops. Glycerol cervical vestibular-evoked myogenic potential (cVEMP) tests are a useful means of diagnosing saccular hydrops. There was no correlation between cVEMP and audiological results.

Objective: To document the changes in pure-tone hearing outcomes and cVEMPs in patients with Ménière's disease (MD) and 10 healthy volunteers before and after oral administration of glycerol.

Methods: Twenty-nine study group subjects were chosen with complaints of vertigo. cVEMP testing and pure-tone hearing level testing were performed before and at 1, 2, and 3 h after administration of glycerol.

Results: The means of the latencies, amplitudes, and difference ratio in 20 normal subject ears were determined. Based on these values, 9/29 MD-affected (MDA) ears (31%) had a unilaterally absent cVEMP. Compared with difference ratio values of the control groups there were significant differences in both latencies and amplitudes in MDA ears after glycerol administration. Before glycerol administration, there were significant differences between control and MDA ears on mean values of pure-tone hearing outcomes. Twenty patients in the MDA group showed significant pure-tone hearing outcomes after glycerol administration.
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http://dx.doi.org/10.3109/00016489.2014.952045DOI Listing
February 2015

Hearing Status in Pediatric Renal Transplant Recipients.

Exp Clin Transplant 2015 Aug 31;13(4):324-8. Epub 2014 Oct 31.

Pediatric Nephrology Department, Baskent University, Ankara, Turkey.

Objectives: Renal transplant provides a long-term survival. Hearing impairment is a major factor in subjective health status. Status of hearing and the cause of hearing impairment in the pediatric renal transplant group have not been evaluated. Here, we studied to evaluate hearing status in pediatric renal transplant patients and to determine the factors that cause hearing impairment.

Materials And Methods: Twenty-seven pediatric renal transplant recipients were investigated. All patients underwent audiologic assessment by means of pure-tone audiometry. The factors on hearing impairment were performed.

Results: Sensorineural hearing impairment was found in 17 patients. There was marked hearing impairment for the higher frequencies between 4000 and 8000 Hz. Sudden hearing loss developed in 2 patients, 1 of them had tinnitus. Decrease of speech understanding was found in 8 patients. The cyclosporine level was significantly high in patients with hearing impairment compared with group without hearing impairment. Cyclosporine levels also were found to be statistically significantly high when compared with the group with decrease of speech understanding and the group without decrease of speech understanding. Similar relations cannot be found between tacrolimus levels and hearing impairment and speech understanding.

Conclusions: Sensorineural hearing impairment prevalence was high in pediatric renal transplant recipients when compared with the general population of children. Cyclosporine may be responsible for causing hearing impairment after renal transplant. We suggest that this effect is a dose-dependent toxicity.
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http://dx.doi.org/10.6002/ect.2014.0158DOI Listing
August 2015

Sudden hearing loss associated with tacrolimus after pediatric renal transplant.

Exp Clin Transplant 2013 Dec;11(6):562-4

Department of Pediatric Nephrology, Baskent University, Ankara, Turkey.

Objectives: Hearing impairment is a frequent problem that can easily influence the quality of life for the individual. It may affect one's social and academic life. Knowledge regarding hearing impairment after renal transplant is sparse. It has been suggested that renal transplant improves hearing function. Potential ototoxic side effects may be related to immunosuppression with calcineurin inhibitors. In pediatric renal transplanted patients, we do not have enough information about this subject. We report 2 cases that developed sudden hearing loss after a renal transplant that was associated with high serum levels of tacrolimus.

Case Reports: Two renal transplanted children (a 15-year-old boy and a 17-year-old girl), in the fourth year of their follow-up after transplant, developed symptomatic bilateral sudden hearing loss. There was a marked hearing impairment for the higher frequencies between 4000 and 8000 Hz in pure-tone audiometry evaluation. Also, a decrease of speech understanding was found, but the patients were not conscious of this problem. Hearing loss in these patients was not associated with any known risk factors such as chronic renal disease, ototoxic drugs, or acoustic trauma. Sudden hearing loss occurred under high serum levels of tacrolimus, and after dosage correction of tacrolimus pure-tone audiometry ruled out hearing loss progression for each patient.

Conclusions: Awareness of this potential complication of tacrolimus may be helpful for early recognition and treatment.
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http://dx.doi.org/10.6002/ect.2012.0241DOI Listing
December 2013

Surgical treatment of carotid body tumors.

Kulak Burun Bogaz Ihtis Derg 2013 Nov-Dec;23(6):336-40

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

Objectives: In this study, we report our clinical experience in a series of patients with carotid body tumors along with diagnosis, treatment and follow-up procedures in the light of related literature data.

Patients And Methods: Between November 2001 and May 2012, 10 patients (5 males, 5 females; mean age 53.2 years; range 27 to 80 years) who underwent surgery due to a carotid body tumor in our clinic were included. Diagnosis was based on ultrasonography, computed tomography, magnetic resonance imaging, magnetic resonance angiography, selective carotid angiography, balloon occlusion test, biochemical tests and preoperative embolization. Complications were also recorded.

Results: Balloon occlusion test was performed in all patients preoperatively, while embolization was implemented in seven patients. All masses were dissected by carotid artery subadventitial approach. Carotid integrity was maintained in nine patients, while a vein graft was used in one patient. Neurological disorder was observed in one patient, whereas transient hypoglossal paresis was in one patient who underwent saphenous vein grafting.

Conclusion: Our study results suggest that (i) carotid body tumors should be handled with multidisciplinary approach; (ii) balloon occlusion test should be performed in all patients undergoing surgery; (iii) a particular attention should be paid to cranial and phrenic nerves, if it is necessary to extend the surgical field while removing the tumor; and (iv) pathological examination should be carried out by an experienced team and in a multi-centered fashion, if necessary.
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http://dx.doi.org/10.5606/kbbihtisas.2013.28159DOI Listing
May 2015

[Normative values of middle ear resonance frequency in normal hearing adults].

Kulak Burun Bogaz Ihtis Derg 2013 Nov-Dec;23(6):331-5

Health and Counseling Center, Middle East Technical University, 06800 Çankaya, Ankara, Turkey.

Objectives: This study aims to determine the normative values of middle ear resonance frequency in healthy adults.

Patients And Methods: Sixty adult volunteers (32 females, 28 males; mean age 31.8±7.1 years; range 21 to 46 years) with normal otoscopic examination, audiometry and electroacoustic immitancemetry findings were enrolled in the study. The middle ear resonance frequencies were calculated by multifrequency tympanometry.

Results: The mean resonance frequency for all volunteers was 999.6±134.9 Hz. The mean resonance frequency was 1020.8±140.6 Hz for the right ear, and 978.3±180.5 Hz for the left ear. The mean resonance frequencies for the right- and left-side were 1023.2±146.9 Hz and 912.5±177.8 Hz in males, and 1018.8±137.2 Hz and 1035.9±164.7 Hz in females, respectively. There was no statistically significant difference in the mean resonance frequency of the right ears between the males and females (p=0.9), whereas the mean resonance frequency of the left ears was statistically significantly higher in females (p=0.007).

Conclusion: The middle ear resonance frequency values may vary according to the side of the ear or gender.
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http://dx.doi.org/10.5606/kbbihtisas.2013.32391DOI Listing
May 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

Short-term results of Neurelec Digisonic SP cochlear implantation in prelingually deafened children.

Eur Arch Otorhinolaryngol 2014 Jun 9;271(6):1415-22. Epub 2013 Jun 9.

Department of Otolaryngology, Faculty of Medicine, Baskent University, Adana, Turkey,

This paper examines the reports on the selection criteria and the post-operative performance of 25 children implanted with the Neurelec Digisonic SP. This study reported benefits from Neurelec Digisonic SP cochlear implant in auditory and speech perception outcomes. There has been a lack of studies into the additional factors such as level of the mothers' education and bilingualism, which is a factor that may have a significant effect on the success of cochlear implantation. This paper examines the reports on the reasons for the differences in performance and the post-operative performance of 25 children implanted with the Neurelec Digisonic SP. Meaningful Auditory Integration Scale and Meaningful Use of Speech Scale questionnaires were used just before 3, 6, 12, and 18 months following implantation. Electrode array was inserted without difficulty in all cases, with no complications to date. This is a retrospective and cross-sectional study and all the data were collected between March 2010 and December 2012. Auditory performance improved over time for up to 12 months after implantation. Our experience indicates that the Neurelec Digisonic SP cochlear implant system in children under the age of two is relatively safe and reliable. The Neurelec Digisonic SP device surgery can be performed without complications. Auditory performance results support the effectiveness of early implantation. These important findings further support the importance of professionals working very closely with parents or especially mothers and enhancing their involvement in achieving therapy goals to develop auditory skills and speech in young children following cochlear implantation.
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http://dx.doi.org/10.1007/s00405-013-2576-zDOI Listing
June 2014

Extensive cholesterol granuloma of the petrous apex presenting with facial paralysis and sensorineural hearing loss: a case report.

Kulak Burun Bogaz Ihtis Derg 2013 Jan-Feb;23(1):60-4

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

A cholesterol granuloma of the petrous bone is an expanding mass which contains fluids, lipids, chronic inflammatory cells, and cholesterol crystals surrounded by a fibrous lining. The goal of surgery is to provide drainage and ventilation of the affected area to prevent recurrences. In this article, we report a case of a 27-year-old man who was operated using the transmastoid infralabyrinthine approach to drain a cholesterol granuloma cyst.
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http://dx.doi.org/10.5606/kbbihtisas.2013.70037DOI Listing
June 2015

Idiopathic incus necrosis: Analysis of 4 cases.

Ear Nose Throat J 2013 Feb;92(2):E10-3

Department of Otolaryngology-Head and Neck Surgery, Alanya Medical and Research Center, Baskent University, Alanya, Antalya, Turkey.

We evaluated ossicular chain reconstruction in patients with idiopathic incus necrosis who have conductive hearing loss and an intact ear drum. The study included four patients (3 women and 1 man; the ages of the patients were 22, 31, 35, and 56 years, respectively) with unilateral conductive hearing loss, no history of chronic serous otitis media, an intact ear drum, normal middle ear mucosa, and necrosis of the long processes of the incus. On preoperative pure tone audiometry, air-bone gaps were 24, 25, 38, and 33 dB. Bilateral tympanometry and temporal bone computed tomography results were normal. All 4 patients underwent an exploratory tympanotomy. During the operation, the mucosa of the middle ear was normal, with a mobile stapes foot plate and malleus. No evidence of any granulation tissue was found; however, necrosis of the incus long processes was seen. For ossicular reconstruction, we used tragal cartilage between the incus and the stapes in 1 patient; in the other 3 patients, glass ionomer bone cement was used (an interposition cartilage graft also was used in the patients who received the glass ionomer bone cement). In all patients, air-bone gaps under 20 dB were established in the first year after surgery. In the ossicular disorders within the middle ear, the incus is the most commonly affected ossicle. While, the most common cause of these disorders is chronic otitis media, it may be idiopathic rarely. Several ossicular reconstruction techniques have been used to repair incudostapedial discontinuity.
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February 2013

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

Are thiazides effective on hypertensive vertigo? A preliminary study.

Kulak Burun Bogaz Ihtis Derg 2012 Jul-Aug;22(4):219-24

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

Objectives: In this study, we aimed to investigate whether the symptoms of vertigo related to hypertension resulted from endolymphatic hydrops and the efficacy of the thiazides in the treatment.

Patients And Methods: A total of 24 vertigo patients without peripheric or central vestibular pathologies or hyperlipidemia were included. The study group comprised 15 patients with hypertension, including nine with regulated non-insulin-dependent diabetes mellitus (DM). The control group comprised nine patients without hypertension or DM. The patients in the study group received hydrochlorothiazide treatment. The European Evaluation of Vertigo Scale (EEVS) and Vertigo Handicap Questionnaire (VHQ), puretone audiometry, tympanometry, electronystagmography (ENG) for nystagmus tests, oculomotor tests, and caloric test were carried out initially and at three weeks for both groups. The results of the study group were compared to those of the control group.

Results: There was a statistically significant decrease in the scores of EEVS and VHQ at three weeks in the study group, compared to the baseline scores (for both groups p≤0.01).

Conclusion: Our study results showed that thiazides alleviated vertigo symptoms in hypertensive patients, as measured by qualitative methods (i.e. EEVS, VHQ), but not with quantitative measurements (i.e. ENG).
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http://dx.doi.org/10.5606/kbbihtisas.2012.042DOI Listing
March 2014

The relationship of homocysteine, vitamin B12, folic acid levels with vertigo.

Kulak Burun Bogaz Ihtis Derg 2012 Jul-Aug;22(4):214-8

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

Objectives: In this study the relationship of serum homocysteine, vitamin B12, folic acid levels and peripheral vestibular dysfunction (PVD) was investigated.

Patients And Methods: Forty-one patients (31 females, 10 males; mean age 57.34±14.3 years; range 12 to 80 years) who admitted to Baskent University Hospital Ear Nose and Throat Department between the dates of April 2005 - December 2007 with complaint of vertigo were prospectively analyzed and diagnosed using audio-vestibular test, at the same time serum homocysteine, vitamin B12, folic acid measurements was done from the blood samples of patients. The patients were divided into three groups as Meniere's disease, vestibular neurinitis, and benign paroxismal positional vertigo (BPPV) according to the diagnoses and serum homocysteine, vitamin B12, folic acid levels of patients were compared to normal values in and between groups.

Results: Of the patients, 29.3% (n=12) were diagnosed with Meniere's disease, 36.6% (n=15) with vestibular neurinitis, and 34.1% (n=14) with BPPV. Serum homocysteine leves of patients were 12.42±3.56 umol/L, 11.32±4.14 umol/L and 10.72±2.95 umol/L (p>0.05) in Meniere's disease, vestibular neurinitis, and BPPV respectively; vitamin B12 levels were 371.58±141.35 pg/ml, 288.13±139.51 pg/ml, 352.14±150.41 pg/ml (p>0.05) respectively and folic acid levels were 8.76±3.2 umol/L, 10.63±6.59 umol/L, 8.8±3.18 umol/L (p>0.05) respectively. The values were similar in all patients. No statistically significant difference was found in and between groups comparing with normal values.

Conclusion: This is the first prospective study investigating the relationship of serum homocystein, vitamin B12 and folic acid levels with PVD. We found that there is no relationship of homocysteine, vitamin B12, folic acid levels with PVD.
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http://dx.doi.org/10.5606/kbbihtisas.2012.041DOI Listing
March 2014

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