Publications by authors named "Selmin Karatayli-Ozgursoy"

29 Publications

  • Page 1 of 1

Effect of Partial Uncinectomy After Balloon Sinuplasty on Maxillary Sinus Irrigant Penetration: A Cadaveric Study.

OTO Open 2021 Jan-Mar;5(1):2473974X21989583. Epub 2021 Jan 27.

Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic in Florida, Jacksonville, Florida, USA.

Objective: The uncinate process may play a role in the amount of irrigation penetrance. In this cadaver study, we aimed to investigate if the addition of partial uncinectomy provides better maxillary sinus irrigation penetrance than balloon sinuplasty (BSP) alone.

Study Design: Cadaveric study.

Setting: Simulation laboratory at the Mayo Clinic in Florida.

Methods: Five fresh-frozen human cadaveric heads (10 sides) were used to assess maxillary sinus irrigation penetration after 3 interventions performed sequentially: irrigation penetrance with no intervention, irrigation after BSP, and irrigation after BSP and partial removal of the uncinate. Penetrance was recorded with intrasinus endoscopy and scored by 4 blinded observers using a scale from 0 (no irrigation) to 5 (fully irrigated). The diameter of the maxillary ostium was measured before and after BSP. Internal consistency was evaluated with Cronbach's alpha.

Results: Mean ostium size increased from 4.1 to 6.8 mm after BSP ( = .013). Cronbach's alpha was 0.93. The median scores of irrigation penetration after no intervention, BSP, and BSP and partial uncinectomy were 2.5, 3, and 4, respectively. We found a significantly higher penetrance following partial uncinectomy plus BSP versus BSP alone ( = .008). Both interventions had a statistically significant difference in irrigation penetrance as compared with no intervention ( = .0001).

Conclusion: Maxillary sinus irrigation penetration increased from baseline after BSP. The addition of a partial uncinectomy to the balloon dilation of the maxillary sinus was associated with a statistically significant increase in irrigation penetrance scores as compared with BSP alone.
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http://dx.doi.org/10.1177/2473974X21989583DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863165PMC
January 2021

Laryngoscopic Examination During the COVID-19 Pandemic: Turkish Voice Speech and Swallowing Disorders Society and Turkish Professional Voice Society Recommendations.

Turk Arch Otorhinolaryngol 2020 Dec 23;58(4):274-278. Epub 2020 Oct 23.

Department of Otolaryngology, Head and Neck Surgery, Bakırköy Acıbadem Hospital, İstanbul, Turkey.

COVID-19 is highly transmissible and spreads rapidly in the population. This increases the occupational risk for health care workers. In otolaryngology clinic practice, patients with upper respiratory tract infection symptoms are common. Also, routine head and neck examinations such as oral cavity examination, nasal/nasopharyngeal examination, or video laryngostroboscopic evaluation are highly risky because of the aerosol formation. To emphasize this issue, two leading otolaryngology organizations in Turkey; 'Voice Speech and Swallowing Disorders Society', and 'Professional Voice Society' gathered a task force. This task force aimed to prepare a consensus report that would provide practical recommendations of the safety measurements during routine clinical care of laryngology patients. To fulfill this, universal aim, on the 2 and 9 of May 2020, two web-based meetings were conducted by 20 expert physicians. This eighteen items list was prepared as an output.
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http://dx.doi.org/10.5152/tao.2020.5719DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846307PMC
December 2020

Laryngeal Venous Malformation.

Ear Nose Throat J 2020 Jul 15;99(6):367-368. Epub 2019 May 15.

Department of Diagnostic Radiology, Interventional Radiology Unit, Mayo Clinic Jacksonville, Jacksonville, FL, USA.

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http://dx.doi.org/10.1177/0145561319840136DOI Listing
July 2020

Robotic-Assisted Removal of Wire Bristle in Tongue Base.

Ear Nose Throat J 2020 Jul 9;99(6):382-383. Epub 2019 May 9.

Baptist ENT Specialists, Jacksonville, FL, USA.

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http://dx.doi.org/10.1177/0145561319840539DOI Listing
July 2020

Molecular and immunologic analysis of laryngeal squamous cell carcinoma in smokers and non-smokers.

Am J Otolaryngol 2019 Mar - Apr;40(2):213-217. Epub 2018 Nov 22.

Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.

Background: Laryngeal squamous cell carcinoma (LSCC) is strongly associated with tobacco use, but recent reports suggest an increasing incidence of LSCC in patients without traditional risk factors, suggesting an alternative etiology of tumorigenesis. The purpose of this study is to characterize this non-smoking population and to compare immunohistochemical markers in tumor specimens from non-smokers and smokers with LSCC.

Methods: A retrospective chart review of patients with LSCC at Johns Hopkins Hospital (JHH) was performed. A tissue microarray (TMA) was constructed with tumor specimen from non-smokers with stage and age-matched smokers and stained for a variety of immunologic and molecular targets.

Results: In the JHH cohort of 521 patients, 12% (n = 63) were non-smokers. Non-smokers were more likely to be <45 years old at time of diagnosis (OR 4.13, p = 0.001) and to have glottic tumors (OR 2.46, p = 0.003). The TMA was comprised of tumors from 34 patients (14 non-smokers, 20 smokers). Only 2 patients (6%) were human-papillomavirus (HPV) positive by high-risk RNA in situ hybridization (ISH). There was no correlation between smoking status and p16 (p = 0.36), HPV-ISH positivity (p = 0.79), phosphatase and tensin homolog (PTEN, p = 0.91), p53 (p = 0.14), or programmed death-ligand 1 (PD-L1, p = 0.27) expression.

Conclusions: Non-smokers with LSCC are more likely to be younger at the time of diagnosis and have glottic tumors than smokers with LSCC. In TMA analysis of stage and age-matched specimens from smoker and non-smokers with LSCC, the pattern of expression for common molecular and immunologic markers is similar. Further, HPV does not appear to be a major causative etiology of LSCC in either smokers or non-smokers in our cohort of patients.
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http://dx.doi.org/10.1016/j.amjoto.2018.11.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485418PMC
June 2019

Intratympanic Dexamethasone via Saturated Gelfoam for Idiopathic Sudden Sensorineural Hearing Loss.

Otolaryngol Head Neck Surg 2019 02 4;160(2):361-363. Epub 2018 Dec 4.

3 Norton Sound Health, Nome, Alaska, USA.

The duration of contact time of intratympanic steroids at the round window is a variable that can potentially affect the ultimate concentration within the cochlea. By placing Gelfoam saturated with dexamethasone directly over the round window, contact time is prolonged and potentially increases the dexamethasone concentration within the cochlea. This technique is simple, readily available with standard instruments and ingredients, and easily done in the office.
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http://dx.doi.org/10.1177/0194599818816306DOI Listing
February 2019

Botox Injection for Laryngeal Dysfunction in Alexander Disease.

J Voice 2019 09 13;33(5):728-729. Epub 2018 Jul 13.

Department of Otolaryngology, Mayo Clinic, Jacksonville, Florida. Electronic address:

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http://dx.doi.org/10.1016/j.jvoice.2018.02.002DOI Listing
September 2019

Histopathologic Evaluation of Hyaluronic Acid and Plasma-Rich Platelet Injection into Rabbit Vocal Cords: An Experimental Study.

Turk Arch Otorhinolaryngol 2018 Mar 1;56(1):30-35. Epub 2018 Mar 1.

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

Objective: Various materials are used by otolaryngologists for vocal cord injections in the management of vocal cord paralysis. An ideal injection material should be long-term effective, readily available, cheap, easy to prepare, have no donor morbidity, easy to use, biocompatible, resistant to resorption or migration, and easy to extract during revision. In this study, we aimed to see the histopathological effects of hyaluronic acid (HYA) and platelet-rich plasma (PRP) injections into the vocal cords of New Zealand rabbits.

Methods: PRP was injected into the right vocal cords of twelve rabbits, which was prepared from their serum (PRP group). HYA was injected into the left vocal cords of first six rabbits (numbered 1-6) (HYA group), and the left vocal cords of the other six rabbits (numbered 7-12) were followed with no intervention (control group). Two months later, histomorphological findings in the vocal cords were assessed by two experienced pathologists in seven parameters: chronic inflammation, mucosal atrophy, necrosis, neovascularization, fibrosis, foreign body reaction, and muscular atrophy. They were scored double-blinded as negative (0), mild (+1), moderate (+2), and severe (+3). Fisher's chi-square test was used to evaluate any statistical significance among the three groups.

Results: Chronic inflammation, mucosal atrophy, necrosis, foreign body reaction, and muscular atrophy parameters were scored as "0" for each preparate by both pathologists. For neovascularization and fibrosis, a stasistically significant difference was seen among the three groups (p<0.05). Neovascularization was increased in the PRP and HYA groups compared with the control group. No significant difference was observed in fibrosis when the groups were compared separately. After two months, two of the six vocal cords injected with HYA revealed HYA; however, none of the PRP-injected vocal cords showed PRP.

Conclusion: HYA and PRP can be safely injected into vocal cords. Our findings show that HYA is a biocompatible and safe injection material for clinical use. Only two of the six vocal cords showed HYA at the end of two months, suggesting that HYA is a short-term effective material. Similarly, PRP was also shown to be a short-term effective material and can be used in patients for testing purpose before using a long-term effective material. The advantages of PRP are that it is inexpensive, readily available, and completely inert as it is prepared from the subject itself.
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http://dx.doi.org/10.5152/tao.2018.2942DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6017207PMC
March 2018

Platelet-Rich Plasma Application for Acute Tympanic Membrane Perforations.

J Int Adv Otol 2017 Aug 13;13(2):195-199. Epub 2017 Jan 13.

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

Objective: To assess the efficacy of the application of platelet-rich plasma (PRP) in the healing process of acute tympanic membrane perforations (TMPs).

Materials And Methods: Acute TMPs were made in both the ears of 12 New Zealand rabbits. Plasma gel was applied at the right tympanic membrane (TM) of the same animal until the perforations were closed. The left TM was left untreated. On days 1, 4, 7, 10, 13, 16, 21, 28, and 35, the TMs were monitored to check the closure of perforations. The days of perforation closure for the 2 groups were compared using the paired t-test. The animals were sacrificed 2 months after making the perforations. Seven histopathological parameters were reviewed by 2 blinded pathologists: acute inflammation, chronic inflammation, edema in the lamina propria, congestion in the lamina propria, sclerosis, fibroblastic reaction, and an increase in the thickness of the squamous epithelial layer. The presence or absence of each histological parameter in both groups was compared using the Pearson Chi-square test.

Results: The average number of days for closure in the plasma gel group was 12 (range 8-18 days) and that in the control group was 17.7 (range 8-31 days). The difference was statistically significant (p=0.0145). There was no sclerosis or fibroblastic reaction in any of the specimens. No statistically significant difference was seen between the 2 groups with respect to acute inflammation, chronic inflammation, edema in the lamina propria, congestion in the lamina propria, and an increase in thickness of the squamous epithelial layer (p>0.05).

Conclusion: Platelet-rich plasma fastens TMP closure; in long term, the eventual outcome is both microscopically and macroscopically same for the control as well as study groups in a rabbit traumatic TMP model. We believe that this study will encourage the clinical use of PRP for acute TMPs and trigger clinical studies in this field.
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http://dx.doi.org/10.5152/iao.2016.2533DOI Listing
August 2017

Ocular Disorders in Turkish Children with Sensorineural Hearıng Loss: A Cross-Sectional Study and Literature Review.

Semin Ophthalmol 2018 14;33(2):155-160. Epub 2016 Sep 14.

a Ministry of Health, Dr. Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey.

Purpose: To investigate types and frequencies of ocular disorders in children with sensorineural hearing loss (SNHL), and to emphasize the importance of ophthalmological examination in these children.

Methods: A retrospective analysis of the examination records of children examined in our instutititon between January 2011 and September 2014 was performed. Ocular disorders of children with SHNL were selectively reviewed.

Results: Among 55340 patients, SNHL was present in 110 (0.2%). SNHL was bilateral in 104 patients (94.5%) and unilateral in 6 (5.5%). Ninety-one cases had congenital hearing loss (83%), and 19 (17%) had acquired SNHL. Forty cases (36%) had an ocular disorder, either refractive or non-refractive or both. Seventy cases (64%) had normal ocular examination. No difference was found between congenital or acquired SNHL cases in terms of possessing an ocular disorder (p=0.0962). The most common ocular abnormality was refractive error, mainly hypermetropia (21%). There was no significant difference between the prevalences of ocular abnormalities among cases with different lateralites or severities of SNHL (p=0.051, p=0.874, respectively). Twenty-six cases (23.6%) had SNHL as a component of a genetically defined syndrome. All of them had coexisting refractive or non-refractive ocular abnormalities. Some genetic, non-syndromic abnormalities, including Achondroplasia, Celiac disease, and focal segmental glomerulosclerosis, were diagnosed in four cases, among whom refractive errors and/or strabismus were detected.

Conclusions: Due to the common coexistence of ocular problems and SNHL in children, ophthalmological screening is crucial. Families and healthcare providers should be informed about the critical role of ophthalmic assesment in these children for their future quality of life.
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http://dx.doi.org/10.1080/08820538.2016.1182560DOI Listing
April 2018

Life-Threatening Respiratory Distress in a Total Laryngectomy Patient: Aspirated Voice Prosthesis or Lung Tumor?

Turk Arch Otorhinolaryngol 2016 Sep 1;54(3):131-133. Epub 2016 Sep 1.

Department of Otorhinolaryngology, Ankara University School of Medicine, Ankara, Turkey.

Laryngectomy patients usually have poor pulmonary functions due to long-term smoking. Their lungs can easily be decompensated. Hence, meticulous evaluation and timely management of severe respiratory distress in laryngectomy patients can be life savers. Here we present an interesting case of a laryngectomy patient with two different clinical presentations of life-threatening respiratory distress at the same time (aspiration of voice prosthesis and a second primary lung cancer). Marked or persistent respiratory distress in a laryngectomy patient deserves thorough clinical evaluation and may require urgent intervention. We consider that the presentation and course of respiratory distress in our laryngectomy patient will provide an additional aspect for emergency room doctors and airway specialists dealing with such a patient.
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http://dx.doi.org/10.5152/tao.2016.1592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5782963PMC
September 2016

Evaluation of Dyspnea Outcomes After Endoscopic Airway Surgery for Laryngotracheal Stenosis.

JAMA Otolaryngol Head Neck Surg 2016 11;142(11):1075-1081

Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Importance: Endoscopic airway surgery is a frequently used procedure in the management of laryngotracheal stenosis (LTS); however, no established outcome measures are available to assess treatment response.

Objective: To assess acoustics and aerodynamic measures and voice- and dyspnea-related quality of life (QOL) in adult patients with LTS who undergo endoscopic airway surgery.

Design, Setting, And Participants: This case series compared preoperative measures and postoperative outcomes among adult patients who underwent endoscopic airway surgery for LTS from September 1, 2013, to September 30, 2015, at the tertiary care Johns Hopkins Voice Center. Patients were excluded if they did not undergo balloon dilation or if they had multilevel or glottic stenosis. The Phonatory Aerodynamic System was used to quantify laryngotracheal aerodynamic changes after surgery. Final follow-up was completed 2 to 6 weeks after surgery.

Main Outcomes And Measures: The voice-related QOL instrument (V-RQOL), Dyspnea Index, and Clinical Chronic Obstructive Pulmonary Disease Questionnaire were completed before and after endoscopic surgery. Consensus auditory perceptual evaluation of voice, acoustic measurements, and aerodynamic outcomes were also assessed.

Results: Fourteen patients (1 man and 13 women; mean [SD] age, 45.4 [4.3] years) were enrolled. The mean postoperative V-RQOL scores (n = 14) increased from 74.3 to 85.5 (mean of difference, 11.3; 95% CI, 2.2 to 20.3). The mean postoperative Dyspnea Index (n = 14) decreased from 26.9 to 6.6 (mean of difference, -20.3; 95% CI, -27.9 to -12.7); the mean postoperative Clinical Chronic Obstructive Pulmonary Disease Questionnaire scores (n = 9) decreased from 3.2 to 1.0 (mean of difference, -2.2; 95% CI, -3.4 to -0.9). Postoperative mean vital capacity (n = 14) increased from 2.5 to 3.1 L (mean of difference, 0.6 L; 95% CI, 0.3-1.0 L), whereas mean laryngeal resistance (n = 14) decreased from 73.9 to 46.4 cm H2O/L/s (mean of difference, -27.5 cm H2O/L/s; 95% CI, -44.8 to -10.3 cm H2O/L/s) postoperatively.

Conclusions And Relevance: Patients demonstrate statistically and clinically significant improvement in dyspnea-related QOL, whereas a few patients showed a clinically significant improvement in V-RQOL. Dyspnea-related QOL outcomes should be added to airway surgeons' regular assessment of patients with LTS to measure treatment response and inform the decision to perform a second operation, whereas V-RQOL outcomes need additional prospective study with a larger sample size. The Phonatory Aerodynamic System is not an optimal method to quantify changes in laryngotracheal aerodynamics after intervention in LTS.
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http://dx.doi.org/10.1001/jamaoto.2016.2029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5516931PMC
November 2016

Predictors of Posterior Glottic Stenosis: A Multi-Institutional Case-Control Study.

Ann Otol Rhinol Laryngol 2016 Mar 14;125(3):257-63. Epub 2015 Oct 14.

Emory University School of Medicine, Department of Otolaryngology, Head & Neck Surgery, Atlanta, Georgia, USA.

Objective: To assess intrinsic and extrinsic risk factors in the development of posterior glottic stenosis (PGS) in intubated patients.

Methods: Patients diagnosed with PGS between September 2012 and May 2014 at 3 tertiary care university hospitals were included. Patient demographics, comorbidities, duration of intubation, endotracheal tube (ETT) size, and indication for intubation were recorded. Patients with PGS were compared to control patients represented by patients intubated in intensive care units (ICU).

Results: Thirty-six PGS patients were identified. After exclusion, 28 PGS patients (14 male, 14 female) and 112 (65 male, 47 female) controls were studied. Multivariate analysis demonstrated ischemia (P < .05), diabetes (P < .01), and length of intubation (P < .01) were significant risk factors for the development of PGS. Fourteen of 14 (100%) males were intubated with a size 8 or larger ETT compared to 47 of 65 (72.3%) male controls (P < .05). Posterior glottic stenosis (P < .01), length of intubation (P < .001), and obstructive sleep apnea (P < .05) were significant risk factors for tracheostomy.

Conclusion: Duration of intubation, ischemia, diabetes mellitus, and large ETT size (8 or greater) in males were significant risk factors for the development of PGS. Reducing the use of size 8 ETTs and earlier planned tracheostomy in high-risk patients may reduce the incidence of PGS and improve ICU safety.
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http://dx.doi.org/10.1177/0003489415608867DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4742396PMC
March 2016

Risk Factors for Dysplasia in Recurrent Respiratory Papillomatosis in an Adult and Pediatric Population.

Ann Otol Rhinol Laryngol 2016 Mar 8;125(3):235-41. Epub 2015 Oct 8.

Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA

Aim: Recurrent respiratory papillomatosis (RRP) is classically described as a benign neoplasm of the larynx caused by the low-risk human papillomavirus (HPV) viral subtypes. Nevertheless, transformation to dysplasia and invasive carcinoma can occur. We aimed to assess the prevalence of dysplasia and carcinoma-ex-papilloma in both adult-onset and juvenile-onset RRP and identify patient risk factors for this dysplastic transformation.

Material And Methods: Ten-year retrospective chart review of a tertiary otolaryngology referral center. Patients with papilloma were identified from a review of a pathology database and clinical records. Patient demographics, pathologic data, and treatment history, including use of cidofovir as an adjunctive therapy for papilloma, were extracted from electronic medical records.

Results: One hundred fifty-nine RRP patients were identified, 96 adult-onset (AORRP) and 63 juvenile-onset (JORRP) cases. Of this cohort, 139 (87%) had only benign papilloma as a pathologic diagnosis. In the AORRP cohort, 10 patients (10%) were diagnosed with dysplasia or carcinoma in situ in addition to papilloma, and 5 patients (5%) had malignant transformation to invasive carcinoma-ex-papilloma. There was a significantly higher age of disease onset for those with dysplasia or carcinoma versus those without dysplasia or carcinoma (56 vs 45 years old; P = .0005). Of the 63 JORRP patients, there were no cases of dysplasia but 3 (5%) cases of invasive carcinoma-ex-papilloma, all involving pulmonary disease. The JORRP patients with carcinoma-ex-papilloma had a younger average disease onset (2 vs 6 years old; P = .009) and a higher rate of tracheal involvement than those without carcinoma. Gender, smoking history, number of operations, or use of cidofovir showed no association with the development of dysplasia or carcinoma-ex-papillomatosis in either the AORRP or JORRP population.

Conclusion: In a large series of RRP, age of disease onset is the strongest predictor of dysplastic transformation in the adult and pediatric population. Carcinoma-ex-papillomatosis was uniformly associated with pulmonary disease in the JORRP population in this series. No other demographic or behavioral factors, including adjunctive therapy with cidofovir, were statistically associated with dysplasia or carcinoma-ex-papilloma.
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http://dx.doi.org/10.1177/0003489415608196DOI Listing
March 2016

Laryngeal dysplasia, demographics, and treatment: a single-institution, 20-year review.

JAMA Otolaryngol Head Neck Surg 2015 Apr;141(4):313-8

Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland2Milton J. Dance Jr Head and Neck Center, Johns Hopkins Voice Center, Baltimore, Maryland.

Importance: Laryngeal dysplasia is a common disease entity that remains clinically frustrating because functional outcomes are balanced against oncologic results. Understanding evolution in dysplasia demographics, treatment, and progression rates may inform better therapy in the future.

Objectives: To review laryngeal dysplasia cases at a single institution during the last 20 years and identify changes in patient demographics, categorize treatment approaches, and review rates of progression to cancer.

Design, Setting, And Participants: In this retrospective medical record review, patients with laryngeal dysplasia treated at an academic medical center were identified on review of pathology records.

Interventions: Patients were organized by date of dysplasia diagnosis, divided into 2 groups (group 1, January 1, 1993, through December 31, 2002; group 2, January 1, 2003, through December 31, 2012), and compared against one another.

Main Outcomes And Measures: Age at diagnosis, sex, type of treatment, and progression to malignant disease were analyzed from one period to the next.

Results: A total of 107 patients were identified through review of pathology databases. Progression of dysplasia to cancer remained roughly stable across periods, at 8.8% and 8.0%, respectively. Mean age at diagnosis decreased from 68.7 to 61.7 years over time, with a statistically significant trend toward presentation at younger ages. The male to female ratio was 3.75 in group 1 and 3.17 in group 2, with a trend toward a greater proportion of females over time that did not reach statistical significance. Use of radiotherapy remained stable across groups, with increased use of microflap excision techniques and laser treatment (especially photoangiolytic lasers) in group 2.

Conclusions And Relevance: Overall, progression of laryngeal dysplasia to cancer has remained stable during the past 20 years at a rate of approximately 8%. Although laryngeal dysplasia remains a disease predominantly found in males, there is a demographic trend toward diagnosis at earlier ages. Treatment choices may slowly be changing over time, although multi-institutional studies may be required to better categorize this shift.
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http://dx.doi.org/10.1001/jamaoto.2014.3736DOI Listing
April 2015

Voice quality in laryngotracheal stenosis: impact of dilation and level of stenosis.

Ann Otol Rhinol Laryngol 2015 May 17;124(5):413-8. Epub 2014 Dec 17.

Department of Otolaryngology and Head-Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA

Objective: To assess the impact of suspension microlaryngoscopy with balloon dilation on voice-related quality of life (V-RQOL) in laryngotracheal stenosis (LTS).

Methods: Retrospective chart review of LTS patients dilated at a tertiary-care academic hospital from 2010 to 2013. Data were obtained and then analyzed. LTS was stratified by (1) subglottic or tracheal stenosis and (2) multilevel stenosis (MLS; glottic and subglottic/tracheal). Pre- and postoperative V-RQOL and grade, roughness, breathiness, asthenia, strain (GRBAS) scores were compared. The number and frequency of balloon dilation procedures over the lifetime were secondary outcome variables.

Results: Thirty-eight patients were identified: 26 subglottic/tracheal and 12 multilevel. Of these, 71.4% required multiple dilations, with greatest dilations/patient for multilevel stenosis (4.8). V-RQOL improved in the 27 patients with completed pre- and postoperative scores from a mean of 70.4 to 80 (P=.025). Pre/postoperative V-RQOLs for tracheal/subglottic (mean, 82.8/93.8) were significantly higher (P=.0001/.0001) than multilevel stenosis (48/55.3). Voice quality-of-life improvement was significant for the subglottic/tracheal cohort (P=.036) but not for the MLS group. GRBAS was performed pre- and postoperatively in 10 patients with improvement in all domains except breathiness.

Conclusion: Laryngotracheal stenosis is associated with dysphonia. Patients with glottic involvement have significantly worse voice quality of life than those with tracheal/subglottic stenosis. Endoscopic balloon dilation improves V-RQOL in patients with subglottic/tracheal stenosis.
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http://dx.doi.org/10.1177/0003489414564249DOI Listing
May 2015

Hyoid suspension surgery with UPPP for the treatment of hypopharyngeal airway obstruction in obstructive sleep apnea.

Ear Nose Throat J 2012 Aug;91(8):358-64

Department of Otolaryngology, Dr. Sami Ulus Children's Hospital, Merkez-Altındağ, Ankara, Turkey.

We report our experience with hyoid suspension surgery in patients with obstructive sleep apnea (OSA) diagnosed on the basis of polysomnographic criteria. We conducted a prospective, observational study of 20 patients--18 males and 2 females, aged 15 to 52 years (mean: 42.1)--who were treated at our tertiary care center. All patients underwent hyoid suspension surgery and uvulopalatopharyngoplasty (UPPP) in a single session. Postoperative success was defined as either (1) a reduction in the apnea-hypopnea index (AHI) from 20 or higher to less than 20 or (2) a reduction in AHI of at least 50%. Postoperative follow-up polysomnography indicated that surgery was successful in 18 of 20 patients (90%). No important complications were observed. We conclude that hyoid suspension surgery is an effective procedure with low morbidity for the treatment of OSA in selected patients with hypopharyngeal obstruction. We believe it is a good option for those patients who will not or cannot tolerate therapy with continuous positive airway pressure.
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August 2012

Cochlear implant fixation using resorbable mesh.

Ear Nose Throat J 2011 Jul;90(7):306-12

Department of Otolaryngology, Mayo Clinic Florida, Jacksonville, FL 32224, USA.

In this article we describe a new method of cochlear implant receiver-stimulator fixation using a resorbable poly (D,L) lactic acid mesh. We conducted a retrospective case review at a tertiary referral center; 10 pediatric and 4 adult patients had undergone cochlear implantation during the period from February to October 2008. Resorbable poly (D,L) lactic acid mesh and pins were used for fixation of the cochlear implant receiver stimulator. The receiver stimulator was assessed for stability/migration, and the scalp flap/incision were evaluated for allergic reactions, infections, and healing problems. With an average follow-up of 17.2 months, no patients had migration of the receiver stimulator, and there was no evidence of infection, wound dehiscence, or allergic reaction. Early results indicate that fixation of a cochlear implant receiver stimulator using resorbable mesh is well tolerated and provides good stability without device migration. Resorbable mesh fixation of the receiver stimulator is a reasonable alternative technique for cochlear implantation.
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http://dx.doi.org/10.1177/014556131109000707DOI Listing
July 2011

Bilateral multicanal benign paroxysmal positional vertigo coexisting with a vestibular schwannoma: case report.

Ear Nose Throat J 2011 Jan;90(1):E10-5

Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.

We describe a rarely encountered case of coexisting bilateral multicanal benign paroxysmal positional vertigo (BPPV) and vestibular schwannoma in a 56-year-old woman. The patient had presented with a 10-year history of dizziness and imbalance, and her vestibular findings were perplexing. We decided on a working diagnosis of BPPV and began treatment. After several months of canalith repositioning maneuvers had failed to resolve her symptoms, we obtained magnetic resonance imaging, which revealed the presence of the vestibular schwannoma. This case serves as a reminder of the importance of differentiating between central and peripheral vestibular disorders, as well as central and anterior canal BPPV-induced down-beating nystagmus in order to establish the correct diagnosis and initiate appropriate treatment.
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http://dx.doi.org/10.1177/014556131109000114DOI Listing
January 2011

Chronic cough as the presenting symptom of hydrocephalus.

South Med J 2010 Jun;103(6):574-7

Department of Otolaryngology and Neurology, and Allergy Division, Mayo Clinic Florida, Jacksonville, FL 32224, USA.

Chronic cough is defined as a daily cough lasting for more than eight weeks. We report an unusual case of chronic cough as the primary manifestation of obstructive hydrocephalus. Chronic cough in our case was determined to be of neurogenic origin only after exhaustive investigations failed to reveal a systemic cause, and, in particular, after a positive response to treatment of the hydrocephalus was observed. To the best of our knowledge, this is the first report of hydrocephalus presenting as chronic cough. We believe this case will remind physicians of the importance of considering neurological disease as a cause of chronic cough after common causes are excluded.
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http://dx.doi.org/10.1097/SMJ.0b013e3181de2ddfDOI Listing
June 2010

Safety of audiology direct access for medicare patients complaining of impaired hearing.

J Am Acad Audiol 2010 Jun;21(6):365-79

Audiology Section, Otorhinolaryngology/Head and Neck Surgery, Mayo Clinic Florida, Jacksonville, FL 32224, USA.

Background: Allowing Medicare beneficiaries to self-refer to audiologists for evaluation of hearing loss has been advocated as a cost-effective service delivery model. Resistance to audiology direct access is based, in part, on the concern that audiologists might miss significant otologic conditions.

Purpose: To evaluate the relative safety of audiology direct access by comparing the treatment plans of audiologists and otolaryngologists in a large group of Medicare-eligible patients seeking hearing evaluation.

Research Design: Retrospective chart review study comparing assessment and treatment plans developed by audiologists and otolaryngologists.

Study Sample: 1550 records comprising all Medicare eligible patients referred to the Audiology Section of the Mayo Clinic Florida in 2007 with a primary complaint of hearing impairment.

Data Collection And Analysis: Assessment and treatment plans were compiled from the electronic medical record and placed in a secured database. Records of patients seen jointly by audiology and otolaryngology practitioners (Group 1: 352 cases) were reviewed by four blinded reviewers, two otolaryngologists and two audiologists, who judged whether the audiologist treatment plan, if followed, would have missed conditions identified and addressed in the otolaryngologist's treatment plan. Records of patients seen by audiology but not otolaryngology (Group 2: 1198 cases) were evaluated by a neurotologist who judged whether the patient should have seen an otolaryngologist based on the audiologist's documentation and test results. Additionally, the audiologist and reviewing neurotologist judgments about hearing asymmetry were compared to two mathematical measures of hearing asymmetry (Charing Cross and AAO-HNS [American Academy of Otolaryngology-Head and Neck Surgery] calculations).

Results: In the analysis of Group 1 records, the jury of four judges found no audiology discrepant treatment plans in over 95% of cases. In no case where a judge identified a discrepancy in treatment plans did the audiologist plan risk missing conditions associated with significant mortality or morbidity that were subsequently identified by the otolaryngologist. In the analysis of Group 2 records, the neurotologist judged that audiology services alone were all that was required in 78% of cases. An additional 9% of cases were referred for subsequent medical evaluation. The majority of remaining patients had hearing asymmetries. Some were evaluated by otolaryngology for hearing asymmetry in the past with no interval changes, and others were consistent with noise exposure history. In 0.33% of cases, unexplained hearing asymmetry was potentially missed by the audiologist. Audiologists and the neurotologist demonstrated comparable accuracy in identifying Charing Cross and AAO-HNS pure-tone asymmetries.

Conclusions: Of study patients evaluated for hearing problems in the one-year period of this study, the majority (95%) ultimately required audiological services, and in most of these cases, audiological services were the only hearing health-care services that were needed. Audiologist treatment plans did not differ substantially from otolaryngologist plans for the same condition; there was no convincing evidence that audiologists missed significant symptoms of otologic disease; and there was strong evidence that audiologists referred to otolaryngology when appropriate. These findings are consistent with the premise that audiology direct access would not pose a safety risk to Medicare beneficiaries complaining of hearing impairment.
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http://dx.doi.org/10.3766/jaaa.21.6.2DOI Listing
June 2010

Influence of the macroscopic features of vocal fold polyps on the quality of voice: a retrospective review of 101 cases.

Ear Nose Throat J 2010 Mar;89(3):E12-7

Department of Otorhinolaryngology-Head and Neck Surgery, Ankara University Faculty of Medicine, Ibni Sina Hastanesi, KBB AbD, Ankara 06100, Turkey.

We conducted a study to examine six macroscopic features of vocal fold polyps and to investigate their influence on quality of voice. We retrospectively reviewed the records of 101 consecutive patients with vocal fold polyps who had undergone microlaryngeal surgery for polyp removal after conservative measures had failed. All patients had undergone videolaryngostroboscopy and perceptual and acoustic voice analyses. The six macroscopic features of these vocal fold polyps were morphologic type, location, position, shape, size, and the presence or absence of a reactive lesion on the contralateral vocal fold. Among our statistically significant findings were that gelatinous polyps tended to be broad-based; polyps located on the superior surface tended to be hemorrhagic; small polyps were mostly located on the middle one-third of the vocal fold, and most of them were broad-based; and all of the polyps that were accompanied by reactive lesions on the contralateral vocal fold were located on the free edge. Moreover, jitter was found to be low in small polyps. Finally, noise-to-harmonics ratios were significantly higher in patients with anterior polyps and in those with pedunculated polyps. We conclude that each of the six macroscopic features of vocal fold polyps affected vocal function to a certain degree. We believe that our study provides additional information to otolaryngologists and speech language pathologists who deal with vocal fold polyps.
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March 2010

Takotsubo cardiomyopathy and canalith repositioning procedure for benign paroxysmal positional vertigo.

J Am Acad Audiol 2010 Feb;21(2):73-7; quiz 139-40

Department of Otolaryngology, Mayo Clinic Florida, Jacksonville, FL 32224, USA.

Background: Takotsubo cardiomyopathy, also known as left ventricular apical ballooning syndrome, ampulla cardiomyopathy, or transient left ventricular dysfunction is characterized by chest pain, electrocardiographic changes, transient left ventricular apical aneurysm, and normal coronary arteries. Takotsubo is a round-bottomed, narrow-necked Japanese octopus trap and lends its name to takotsubo cardiomyopathy because of its resemblance to echocardiographic and ventricular angiographic images of the left ventricle in this condition. This appearance takes its source from peculiar, transient regional systolic dysfunction involving the left ventricular apex and mid-ventricle with hyperkinesis of the basal left ventricular segments. Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo caused by peripheral vestibular dysfunction. The symptoms of BPPV are attributed to intralabyrinthine particles, presumed displaced otoconia. Thus, the treatment recommended for BPPV is head repositioning maneuvers.

Purpose: To present the first takotsubo cardiomyopathy case in the English literature related to BPPV undergoing canalith repositioning procedure.

Conclusion: This report will provide additional information for physicians encountering acute-onset chest pain and vertigo. It will also expand the spectrum of clinical correlates of the increasingly well recognized but poorly understood syndrome, takotsubo cardiomyopathy.
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http://dx.doi.org/10.3766/jaaa.21.2.2DOI Listing
February 2010

Changes after voice therapy in objective and subjective voice measurements of pediatric patients with vocal nodules.

Eur Arch Otorhinolaryngol 2009 Dec 21;266(12):1923-7. Epub 2009 Jun 21.

Department of Otorhinolaryngology, Ankara University School of Medicine, Ankara, Turkey.

The aim of this study was to analyze the efficiency of the voice therapy in children with vocal nodules by using the acoustic analysis and subjective assessment. Thirty-nine patients with vocal fold nodules, aged between 7 and 14, were included in the study. Each subject had voice therapy led by an experienced voice therapist once a week. All diagnostic and follow-up workouts were performed before the voice therapy and after the third or the sixth month. Transoral and/or transnasal videostroboscopic examination and acoustic analysis were achieved using multi-dimensional voice program (MDVP) and subjective analysis with GRBAS scale. As for the perceptual assessment, the difference was significant for four parameters out of five. A significant improvement was found in the acoustic analysis parameters of jitter, shimmer, and noise-to-harmonic ratio. The voice therapy which was planned according to patients' needs, age, compliance and response to therapy had positive effects on pediatric patients with vocal nodules. Acoustic analysis and GRBAS may be used successfully in the follow-up of pediatric vocal nodule treatment.
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http://dx.doi.org/10.1007/s00405-009-1008-6DOI Listing
December 2009

Melkersson-Rosenthal syndrome revisited as a misdiagnosed disease.

Am J Otolaryngol 2009 Jan-Feb;30(1):33-7. Epub 2008 Jul 22.

Ankara University Faculty of Medicine, Ankara, Turkey.

Purpose: We aimed to attract our college's attention to the Melkersson-Rosenthal syndrome (MRS), which has been an infrequently encountered subject in otolaryngology journals during the last 10 years.

Materials And Methods: A retrospective review of the last 10 years' patient database was performed to find patients with MRS. The medical files, treatment charts, and radiological and histopathological records of these patients were reviewed.

Results: The study group consisted of 3 MRS patients who had been misdiagnosed for 9, 10, and 16 years. Two of them have had the symptoms since adolescence. All of them presented orofacial edema and fissured tongue, whereas first two also had recurrent facial paralysis. Characteristic histopathological features were noted in 1 patient. Electromyography (EMG) was done in 1 patient who underwent facial decompressiom. All patients responded to either systemic or intralesional corticosteroid treatment.

Conclusions: In the daily practice of an otolaryngologist, it is not usual to diagnose a patient as having MRS. We consider that this is partly because of misdiagnosis. We therefore believe that this study will supply an additional aspect to otolaryngologists, in the scope of recurrent facial paralysis and orofacial edema in both children and adults.
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http://dx.doi.org/10.1016/j.amjoto.2008.02.004DOI Listing
January 2009

Evaluation of taste after underlay technique myringoplasty using whole-mouth gustatory test: smokers versus non-smokers.

Eur Arch Otorhinolaryngol 2009 Jul 11;266(7):1025-30. Epub 2008 Nov 11.

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

The aim of this prospective non-randomized study was to evaluate the alterations in taste sensation after myringoplasty and to investigate the influence of smoking on taste. Ninety-six patients who underwent myringoplasty and 43 healthy controls were examined. Whole-mouth gustatory test solutions were sucrose (sweet); sodium chloride (salty taste); citrate (sour) taste; and quinine hydrochloride (bitter). Sucrose, citric acid, and sodium chloride recognition thresholds were high in the early postoperative period; however, they were regressed to the preoperative status in course of time. No difference was found between preoperative, early/late postoperative taste recognition thresholds of smoker and non-smoker patients. Underlay myringoplasty has little but transient effect on taste recognition in the early postoperative period. This impairment is completely recovered within 6 months. Furthermore, smoking has no effect on the taste recognition of patients with permanent tympanic membrane perforation and has no influence on the alterations in taste recognition thresholds after myringoplasty. We believe that this study will supply some additional aspects in the scope of taste disturbances due to ear surgery and smoking.
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http://dx.doi.org/10.1007/s00405-008-0856-9DOI Listing
July 2009

Three-dimensional computed tomography and surgical treatment for Eagle's syndrome.

Ear Nose Throat J 2006 Jul;85(7):443-5

Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Ankara, Turkey.

Eagle's syndrome represents a group of symptoms that includes recurrent throat pain, globus pharyngeus, dysphagia, referred otalgia, and neck pain possibly caused by elongation of the styloid process or ossification of the stylohyoid or stylomandibular ligaments. The medical history and physical and radiologic examinations are the main guides to the precise diagnosis. The radiologic diagnostic modality of choice is three-dimensional computed tomography (3-D CT). We describe a case of bilaterally symptomatic Eagle's syndrome that was diagnosed by 3-D CT of the styloid processes and successfully treated with surgery via a transoral approach.
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July 2006

Current diagnosis and transoral surgical treatment of Eagle's syndrome.

J Oral Maxillofac Surg 2005 Dec;63(12):1742-5

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

Purpose: The purpose of this study was to discuss the current diagnosis of Eagle's syndrome and to present our experience in transoral surgical treatment of the syndrome.

Materials And Methods: Nineteen patients with Eagle's syndrome due to elongated styloid process were included in this clinical trial. Diagnostic work-up also consists of 3-dimensional computed tomography scanning in recent cases. Elongated styloid processes were resected via transoral approach under general anesthesia.

Results: Three-dimensional computed tomography scanning depicted how the preoperative estimation of the styloid length correlated with the true styloid length measure intraoperatively. No postoperative complications were encountered, while the chief symptoms of all patients regressed after surgery.

Conclusions: Three-dimensional computed tomography scanning is an advanced technique that can measure the definitive length of styloid process and takes the physician straightforward to the exact diagnosis. The transoral approach is a safe surgical alternative that achieves adequate treatment of Eagle's syndrome.
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http://dx.doi.org/10.1016/j.joms.2005.08.017DOI Listing
December 2005