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Öğe Carotico-vertebral Doppler Ultrasonography in Patients with Idiopathic Vertigo(Bentham Science Publ Ltd, 2019) Erkan, Sanem Oksan; Muluk, Nuray Bayar; Tuhanioglu, Birgul; Ozdas, Talih; Arslan, Muhammet; Arikan, Osman Kursat; Gorgulu, OrhanBackground: In the present study, we investigated the relationship between carotico-vertebral Doppler USG measurement results and Vertigo Symptom Scale-Short Form (VSS-SF) in patients with idiopathic vertigo. Methods: Fifty patients with idiopathic vertigo and 30 healthy subjects were included into the study. Ear, Nose & Throat (ENT) examination, audiological examination, routine hemogram, bio-chemichal tests and temporal magnetic resonance imaging were performed to diagnose "idiopathic vertigo". By carotico-vertebral Doppler ultrasonography (USG), common carotid artery (CCA) area, intima media thickness; and vertebral artery dimension were measured on the right and left side of the study and control groups. Results: CCA area values were not different between the study and control groups; and between the right and left sides of the each group. On the left side, intima media thickness and vertebral artery dimension values of the vertigo group were significantly higher than those of the control group. Correlation tests showed that CCA area and intima media thickness values on the right and left side were positively correlated with each other. Moreover, in patients with higher right; or left intima media thickness values, left vertebral artery dimensions decreased. Older age was associated with higher intima media thickness in right and left sides. When CCA values decreased on the right side, VSS-SF values increased; and patients' complaints for vertigo got higher. Linear regression analysis (Backward LID) results also showed that the significant compounding factor on VSS-SF was right CCA area. As right CCA area decreased, VSS-SF increased with more vertigo complaints. Whereas, vertigo complaints and VSS-SF decreased when right CCA increased. Conclusion: We concluded that a decrease in the right CCA were linked with higher VSS-SF scores and increasing vertigo symptoms. Whereas, a decrease in the left CCA area and left crabial blood supply are more important related to the left hemispheric dominance in right-handed people. Moreover, an increase in the intima media thickness was also detected in the vertigo patients and it probably causes a decrease in the central blood flow.Öğe Comparison of anterior palatoplasty and uvulopalatal flap placement for treating mild and moderate obstructive sleep apnea(Sage Publications Inc, 2018) Haytoglu, Suheyl; Arikan, Osman Kursat; Muluk, Nuray Bayar; Tuhanioglu, Birgul; Cortuk, MustafaWe prospectively compared the efficacy of anterior palatoplasty and the uvulopalatal flap procedure for the treatment of patients with mild and moderate obstructive sleep apnea syndrome (OSAS). Our study group was made up of 45 patients who had been randomly assigned to undergo one of the two procedures. Palatoplasty was performed on 22 patients-12 men and 10 women, aged 28 to 49 years (mean: 39.2)-and the flap procedure was performed on 23 patients-14 men and 9 women, aged 28 to 56 years (mean: 41.3). Our primary outcomes measure was the difference in pre- and postoperative apnea-hypopnea index (AHI) as determined by polysomnography at 6 months after surgery. Surgical success was observed in 18 of the 22 palatoplasty patients (81.8%) and in 19 of the 23 flap patients (82.6%). Compared with the preoperative values, mean AHIs declined from 17.5 to 8.1 in the former group and from 18.5 to 8.6 in the latter; the improvement in both groups was statistically significant (p < 0.001). In addition, significant postoperative improvements in both groups were seen in mean visual analog scale (VAS) scores for snoring, in Pittsburgh Sleep Quality Index values, and in Epworth Sleepiness Scale scores (p < 0.001 for all). VAS scores for pain at rest were significantly lower in the palatoplasty group than in the flap group at 2, 4, and 8 hours post-operatively and on postoperative days 4 through 7 (p < 0.002). Likewise, VAS scores for pain during swallowing were significantly lower in the palatoplasty group at 2, 4, 8, and 16 hours and on days 4 through 7 (p < 0.009). We conclude that both anterior palatoplasty and uvulopalatal flap procedures are effective for the treatment of mild and moderate OSAS in patients with retropalatal obstruction. However, our comparison of postoperative pain scores revealed that anterior palatoplasty was associated with significantly less morbidity.Öğe Comparison of two incisionless otoplasty techniques for prominent ears in children(Elsevier Ireland Ltd, 2015) Haytoglu, Suheyl; Haytoglu, Tahir Gokhan; Muluk, Nuray Bayar; Kuran, Gokhan; Arikan, Osman KursatObjectives: In the present study, we applied two incisionless suture techniques for otoplasty: Haytoglu et al.'s modification of incisionless otoplasty technique and Fritsch's incisionless otoplasty technique for correction of prominent ears. Methods: In this prospective study, 60 patients with prominent ears were included in the study. In Group 1, 55 ears of 30 patients (25 bilateral and 5 unilateral) were operated with Haytoglu et al.'s modification of incisionless otoplasty technique. In Group 2,57 ears of 30 patients (27 bilateral and 3 unilateral) were operated with Fritsch's incisionless otoplasty technique. For comparison of two methods, auriculocephalic distances were measured at three levels which were level 1 (the most superior point of the auricle), level 2 (the midpoint of the auricle) and level 3 (level of the lobule) pre-operatively (preop); and measurements were repeated at the end of the surgery (PO0-day, 1st month (PO1-Mo) and 6th month (PO6-Mo) after the surgery, in both groups. Patient satisfaction was evaluated using a visual analog scale (VAS). Moreover, Global Aesthetic Improvement Scale (GAIS) was rated by an independent, non-participating plastic surgeon at 6 months after the surgery. Results: Operation time was 15.9 +/- 5.6 min in Group 1 (Haytoglu et al.'s) and 19 +/- 4.7 min in Group 2 (Fritsch). Hematoma, infection, bleeding, keloid scar formation, sharp edges or irregularities of the cartilage were not observed in any group. Suture extrusion was detected in 14.03% of Group 1 and 16.1% of Group 2. No statistically significant difference was observed between auriculocephalic distances at levels 1-3 of groups at. pO(0-day) preop, PO1-Mo and PO6-Mo separately. Similarly, difference in auriculocephalic distances (preop values-PO6-mo values) was not detected as statistically significant in Groups 1 and 2 at three levels. In both techniques, No statistically significant difference was observed in patient satisfaction at 6th months after the operation which was measured using Visual Analogue Scale (VAS) on 0 to 100 scales. According to GALS, the patients were rated as 92.9% "improved" and 7.1% "no change" in Group 1; as 94.6% "improved" and 5.4% "no change" in Group 2. Conclusions: Due to the similar results, Haytoglu et al.'s and Fritsch's incisionless otoplasty techniques are good options in the treatment of prominent ears, especially in pediatric patients with isolated inadequate development of antihelical ridge, and with soft auricular cartilage. (C) 2015 Elsevier Ireland Ltd. All rights reserved.Öğe Different anesthetic agents-soaked sinus packings on pain management after functional endoscopic sinus surgery: which is the most effective?(Springer, 2016) Haytoglu, Suheyl; Kuran, Gokhan; Muluk, Nuray Bayar; Arikan, Osman KursatIn the present study, we investigated the efficacy of local anesthetics soaked non-absorbable sinus packs on pain management after functional endoscopic surgery (FESS). One hundred and fifty patients with the diagnosis of bilateral chronic sinusitis with or without nasal polyps who underwent FESS were included into the study. Their pre-operative Lund-Mackay computerized tomography (CT) Scores were similar. We applied anesthetic agents of 2 % lidocaine HCl, 0.25 % Bupivacaine HCl, 0.2 % Ropivacaine, 2 % Prilocaine and 0.9 % NaCl (Saline) in groups 1-5 onto the sinus packs after FESS. At postoperative period, acetaminophen (250 mg/5 ml) was used in 10-15 mg/kg per dose (4 times a day). Bleeding grade, operation duration, postoperative number of gauze/24 h, additional painkiller need, pain values at 1, 2, 4, 8, 12 and 24 h were noted. Lund-Kennedy endoscopic scores were also evaluated at 1st, 2nd and 4th weeks postoperatively. In saline group, 93.3 % of the patients needed additional painkiller. Whereas, in Bupivacaine group, additional painkiller use (20.0 %) is less than the other groups. In Bupivacaine group, number of gauze/24 h use was lower than lidocaine, ropivacaine and prilocaine groups. In our study, except 1st and 24th hours, pain values of groups can be written in ascending order (from less to higher) as Bupivacaine, Lidocaine, Prilocaine, Ropivacaine and Saline. In the first hour, pain values of groups can be written in ascending order (from less to higher) as Lidocaine, Prilocaine, Bupivacaine, Ropivacaine and Saline. In the 2nd week, in the Bupivacaine and Lidocaine Groups separately, postoperative Lund-Kennedy scores were lower than the Prilocaine and Saline Groups. In the 1st month, Lidocaine Group's Lund-Kennedy scores were significantly lower than the Saline Group. Synechia values were not different between groups. Bupivacaine help the lower pain values and less additional painkiller need after FESS. Therefore, we recommend to use Bupivacaine soaked sinus packs after FESS for achieve less pain values and to improve patient satisfaction.Öğe Does Mastoid Pneumatization Affect Facial Canal Dimensions and Distances of Facial Tympanic Segment-Scutum and Lateral Semicircular Canal-Scutum?(LIPPINCOTT WILLIAMS & WILKINS, 2020) Inal, Mikail; Muluk, Nuray Bayar; Asal, Nese; Sahan, Mehmet Hamdi; Simsek, Gokce; Arikan, Osman KursatObjectives In the present study, we investigated whether mastoid pneumatization affects facial canal dimensions and distances of facial tympanic segment and scutum, and lateral semicircular (LSS) canal and scutum. Methods One hundred sixty-one temporal multidetector computed tomography scans were reviewed. Patients with unilateral sclerotic mastoid pneumatization (no aeration) (group 1, n = 81) and unilateral total mastoid pneumatization (100.0% aeration) (group 2, n = 80) were included. Facial canal dimensions at the labrythine, tympanic, and mastoid segments; facial canal dehiscence and length; and facial tympanic segment-scutum and LSS canal-scutum distances were evaluated. Results In the present study, facial canal dimensions of labyrinthine, tympanic, and mastoid segments in total pneumatized mastoid group were significantly lower than sclerotic mastoids on axial and coronal images (P < 0.05). Facial tympanic segment and scutum distance of the sclerotic mastoid group was significantly lower than those of the total pneumatized mastoid group (P < 0.05). However, LSS canal-scutum distance was not different between both groups (P > 0.05). The LSS canal-scutum distance of the females was lower than those of the males (P < 0.05). Facial canal dehiscence ratio was 11.3% and 11.1% in sclerotic and total pneumatized mastoids, respectively. The mean +/- SD length of the dehiscence was 2.46 +/- 1.29 mm in pneumatized mastoids and 1.92 +/- 0.68 mm in sclerotic mastoids. Conclusions In cholesteatoma cases, scutum erosion may occur. Because facial tympanic segment and scutum distance decreased in sclerotic mastoids compared with completely pneumatized ones, maximum care must be taken in the operations for avoiding to damage facial canal and nerve. Revision cases may be more difficult because of distorted anatomy. However, in pneumatized mastoids, the mean length of the facial canal was more than 2 mm, which must be kept in mind during operations.Öğe Effect of Continuous Positive Airway Pressure Treatment on Mean Platelet Volume and Platelet Distribution Width in Patients with Sleep Apnea Syndrome(Aves, 2016) Cortuk, Mustafa; Simsek, Gokce; Kiraz, Kemal; Haytoglu, Suheyl; Zitouni, Burcak; Muluk, Nuray Bayar; Arikan, Osman KursatObjective: Obstructive sleep apnea (OSA) syndrome is a common disorder that can cause hypercoagulation. Mean platelet volume (MPV) and platelet distribution width (PDW) are associated with hypercoagulability. This study aimed to investigate whether MPV and PDW values change in patients with OSA who were treated with continuous positive airway pressure (CPAP) device. Methods: A total of 43 adult patients with OSA who were treated with CPAP were included in this retrospective study. Patients who underwent CPAP treatment for <5 days/week and <4 h/day were excluded. Blood parameters, including MPV and PDW, were recorded before CPAP treatment and at the third month of CPAP treatment. All patients underwent polysomnographic evaluation with full night polysomnography and in the second night CPAP titration was performed together with full night polysomnography and MPV and PDW values were statistically compared before and after CPAP treatment. Results: Apnea hypopnea index was significantly reduced, whereas oxygen saturation was significantly increased at CPAP titration night (p<0.001). The third month of CPAP treatment resulted in significantly low PDW (p=0.004) values, but MPV values did not change. Conclusion: PDW value at the third month of CPAP treatment revealed a significant improvement compared with the values before treatment; moreover, no change was observed in MPV values. It was concluded that in patients with OSA who were treated with CPAP, activation of platelets may result in recovery.Öğe Effects of septoplasty on olfactory function evaluated by the Brief Smell Identification Test: A study of 116 patients(Vendome Group Llc, 2017) Haytoglu, Suheyl; Dengiz, Ramazan; Muluk, Nuray Bayar; Kuran, Gokhan; Arikan, Osman KursatWe conducted a prospective study of 116 patients-61 men and 55 women, aged 17 to 64 years (mean: 26.4)- to investigate the effects of septoplasty on olfactory function in patients with septal deviation (SD). The Mladina classification system was used to define SD types, and olfactory function was assessed with the Brief Smell Identification test (BSIT). The BSIT, which includes 12 odorants, was administered preoperatively and at postoperative months I and 3. The most common SD types were types 2 (20.7% of patients) and 1 (19.0%), followed by types 3 and 5 (both 16.4%). At postoperative month 1, the mean BSIT score was significantly higher in men than in the women. For patients with types 1 and 2 SD, BSIT scores at 1 month were significantly lower than the scores preoperatively and 3 months postoperatively. For types 3 and 4, BSIT values were significantly higher at 3 months than preoperatively or at 1 month. For type 3 SD, the preoperative mean score was significantly lower than those for types 1, 4, 5, 6, and 7; for type 2 SD, the BSIT score was significantly lower than those of types 5 and 6 only. At 1 month, the scores for types 2 and 3 were significantly lower than those for types 4, 5, 6, and 7. At 3 months, the BSIT score for type 2 was significantly lower than those of types I, 3, 4, 5, and 6; the type 3 SD score at 3 months was significantly higher than those for types I, 2, 5, 6, and 7. We conclude that septoplasty surgery for patients with a type 3 SD may improve olfactory function. In contrast, we found that olfactory function in patients with a type 2 SD did not improve to a satisfactory degree, even when good nasal patency was achieved with a corrected septum and an enlarged intranasal volume. Our findings should be investigated further in future studies.Öğe Endoscopic Management Of Subperiosteal Orbital Abscess As Sinusitis Complication; A Case Report(Turkish Ophthalmological Soc, 2009) Onaran, Zafer; Yilmazbas, Pelin; Arikan, Osman Kursat; Ergin, AhmetPurpose: We aimed to emphasize the diagnosis and treatment of subperiosteal orbital abscess secondary to acute sinusitis. Method: A 9-year-old patient referred to our clinic complaining pain and swelling in his left eye for three days. There were proptosis, chemosis, eyelid edema and ocular motility restriction on examination, therefore magnetic resonance imaging was performed with the diagnosis of orbital cellulites and left paranasal sinusitis and subperiosteal orbital abscess were reported. Result: As the medical management failed the patient was successfully treated with endoscopic sinus surgery and abscess drainage. Conclusion: Endoscopic approach should be considered as the first choice when surgery is indicated in the subperiosteal orbital abscess cases.Öğe High-Dose Ropivacaine versus Bupivacaine for Posttonsillectomy Pain Relief in Adults(Bmc, 2008) Arikan, Osman Kursat; Şahin, Saziye; Kazkayasi, Mustafa; Muluk, Nuray Bayar; Akpinar, Serpil; Kilic, RahmiObjective: To compare the efficacy and safety of preincisional high-dose ropivacaine with bupivacaine in relieving posttonsillectomy pain. Design: A prospective, randomized, double blind, placebo-controlled clinical trial. Setting: University hospital. Patients: Before the incision, 58 subjects were randomly assigned to receive 10 mL of 10 mg/mL ropivacaine hydrochloride with epinephrine (n = 19, group 1), 10 mL of 2.5 mg/mL bupivacaine with epinephrine (n = 20, group 2), or saline with epinephrine (n = 19, group 3) as a placebo. Main Outcomes Measures: Postoperative pain, additional analgesic drug consumption, otalgia, operating time, amount of intraoperative blood loss, and possible complications were assessed. The intensity of pain was scored on a visual analogue scale. The patients were followed up for 10 days after surgery. Results: There were no statistically significant differences between the demographic and operational characteristics of the patient groups. Statistically significant differences were determined between in the mean intensity of constant and swallowing pain values of group 1 and group 2 or 3, at 4, 8, and 12 hours, and on days 1, 2, 3, and 4, postoperatively. However, no statistical differences were determined between the groups on days 5, 7, and 10. A lower amount of additional analgesic drug was consumed by the ropivacaine group than by the bupivacaine group, and by the bupivacaine group than by the control group, and the differences were statistically significant. Conclusion: Preincisional infiltration of the tonsils with high-dose ropivacaine markedly decreased the intensity of pain after tonsillectomy when compared with bupivacaine or placebo, especially until postoperative day 4 in adults.Öğe Is there a Relationship Between Keros Classification of Olfactory Fossae Depth, Septal Deviation Angle and the Distance Between Infraorbital Foramens?(Bentham Science Publ Ltd, 2018) Inal, Mikail; Muluk, Nuray Bayar; Arikan, Osman Kursat; Sahin, SafaObjectives: We retrospectively investigated the relationship between olfactory fossae depth, septal deviation angle, paranasal sinuses and the distance between infraorbital foramens (IOFs). Methods: Computerized Tomography (CT) images of 315 adult subjects were used. Paranasal sinus dimensions; Keros classification of olfactory fossae, length of Crista Galli (CG), the distance between IOFs (ZP), The distance between inferior part of crista galli and basal-inferior part of the nasal septum at the midline (CG-Sbasal) (XY), ZP/XY ratio, septal deviation side and angle were measured. Results: Keros type I was detected in males (50.3%) and Keros type II was detected in females (59.5%) mainly. In females, Keros type was highly related to the males. Both right-deviated and left deviated subjects, Keros type II (49.7% and 54.3% respectively) was the most detected Keros-type for olfactory fossae. Higher ethmoid sinus-height, maxillary sinus-width; and lower maxillary sinus-height values were related to higher Keros types. As IOFs (ZP) distance increased, Keros type also increased. Conclusion: When Endoscopic Sinus Surgery (ESS) is performed in patients having nasal septal deviation, surgeons should be careful for Keros type II olfactory fossae to avoid intracranial penetration. If possible, navigation systems should be used in these patients.Öğe Is There a Relationship Between Optic Canal, Foramen Rotundum, and Vidian Canal?(Lippincott Williams & Wilkins, 2015) Inal, Mikail; Muluk, Nuray Bayar; Arikan, Osman Kursat; Sahin, SafaObjectives: In this retrospective study, we investigated the relationship between paranasal sinus, optic canal, foramen rotundum, and vidian canal measurements. Methods: Computed tomographic (CT) images of 320 adult subjects and 640 sides (right and left) were used. Paranasal sinus dimensions, optic canal (OC), foramen rotundum (FR), vidian canal (VC), bilateral FR (FRFR), bilateral vidian canal (VCVC), VC-foramen rotundum (VCFR), and VC-optic canal (VCOC) distances were measured. Results: Right VCFR (6.06 mm), and right and left VCOC values (20.34 and 20.31 mm) of the males were significantly higher than those of the females (5.50, 18.91, and 18.80 mm, respectively). Foramen rotundum, OC, and VC values were positively correlated with each other. There was also positive correlation between FR width and maxillary sinus height. Increase of OC width was related to increase in FR width and area, VCVC distance; and decrease in maxillary sinus width. There was positive correlation between FRFR, VCVC, VCFR, and VCOC distance values. There was negative correlation between VC width and area; VCVC, VCFR, and VCOC distance; and maxillary sinus, ethmoid sinus, and sphenoid sinus measurement values. As these sinuses pneumatized more, VC width and area values decreased. Conclusion: As a conclusion, the paranasal sinus, OC, VC, and FR values showed relationship with each other. Before performing craniofacial and/or skull base surgeries, CT view should be taken to evaluate the localization and the course and dimensions of the OC and vidian nerve. It should be kept in mind that in the presence of more pneumatized paranasal sinuses in CT views, VC dimensions decreased.Öğe Marked changes in olfactory perception during early pregnancy: a prospective case-control study(Springer, 2015) Simsek, Gokce; Muluk, Nuray Bayar; Arikan, Osman Kursat; Dag, Zeynep Ozcan; Simsek, Yavuz; Dag, ErselPregnancy seems to be related with a significant change in olfaction. Here, we investigate this theory by testing the odor identification abilities of uncomplicated pregnant women and compare the results with non-pregnant controls. The study included 31 healthy pregnant women in the first trimester (Group 1), 30 in the second trimester (Group 2), 31 in the third trimester, and 30 non-pregnant healthy controls (Group 4). In order to measure odor identification abilities, each subject completed the 12-item Brief Smell Identification Test (BSIT). Next, the demographic characteristics and BSIT scores of the groups were compared. The total BSIT scores of the subjects in Group 1 were found to be significantly lower than those of the other groups (p < 0.001). This reduction in odor identification abilities was particularly noticeable for leather, pine, and soot. Pregnant women in the second and third trimesters had similar odor identification abilities to the healthy controls (p > 0.05). Early pregnancy might be related to significant changes in olfactory performance. The distortion of odor identification in the first trimester might be a causative factor for the development of pregnancy-specific conditions, such as morning sickness and hyperemesis gravidarum, which are both common complaints during the early phase of parturition.Öğe Mean Platelet Volume Decreases in Adult Patients With Obstructive Sleep Apnea After Uvulopalatal Flap Surgery(Lippincott Williams & Wilkins, 2015) Simsek, Gokce; Haytoglu, Suheyl; Muluk, Nuray Bayar; Arikan, Osman Kursat; Cortuk, Mustafa; Kiraz, KemalAim:The main purpose of the study was to investigate changes in mean platelet volume (MPV) values in patients with obstructive sleep apnea syndrome (OSAS) who had undergone uvulopalatal flap (UPF) surgery.Method:The study included a review of the medical records of 37 adult patients who had undergone UPF surgery after being diagnosed with OSAS. The baseline blood parameters of patients, including the MPV and platelet distribution width (PDW) values, were measured and repeated 3 months after treatment. Polysomnographic evaluations of the patients were also performed during admission and the 3rd month control. Comparisons of MPV values and their correlation with polysomnographic parameters were the main outcomes measured.Results:The blood parameters of all patients were similar except for MPV values, which were significantly lower after treatment (P<0.001). Patients' apnea hypopnea index (AHI) and apnea episodes were significantly reduced after the UPF surgery, whereas their oxygen saturation significantly increased (P<0.001). The MPV values were not correlated with polysomnographic parameters (P>0.05).Conclusion:The UPF surgery, which is a relatively simple surgical intervention to treat OSAS, alleviates nocturnal hypoxic episodes and lowers platelet volume. These may both be important predictors of adverse cardiovascular outcomes related to OSAS.Öğe Olfactory dysfunction and oxidative stress in pregnant women with hyperemesis gravidarum(Springer Heidelberg, 2021) Simsek, Yavuz; Simsek, Gokce; Muluk, Nuray Bayar; Arikan, Osman KursatPurpose This study aimed to compare the first-trimester pregnancy serum total oxidative status (TOS), total antioxidant status (TAS), and serum estradiol levels as well as the olfactory functions assessed using the brief smell identification test (BSIT) of women with healthy pregnancies and those with hyperemesis gravidarum (HG). Methods In this prospective study, 60 pregnant women in the first trimester of their pregnancies were divided into two groups: 30 pregnant women with HG (study group) and 30 healthy pregnant women (control group). The following parameters were compared in the HG group and the healthy controls: TOS, TAS, serum levels of estradiol (E2), and olfactory function, which was measured using BSIT. Results Both groups were similar in terms of age, gravida, and parity. The mean total smell score was lower in the HG group than the healthy control group (p < 0.05). TOS was significantly higher in the HG group than the control group. TAS was significantly higher in the control group than the HG group (p < 0.05). Conclusion The removal of sharp odors that will trigger the perception of odor in pregnant women with HG can contribute to the effective control of this disease; moreover, adding fetal-safe antioxidants to the treatment can contribute to the effective control of this disease.Öğe Relief of Pain at Rest and During Swallowing After Modified Cautery-Assisted Uvulopalatopharyngoplasty: Bupivacaine Versus Lidocaine(Lippincott Williams & Wilkins, 2015) Haytoglu, Suheyl; Arikan, Osman Kursat; Muluk, Nuray Bayar; Kuran, GokhanObjectives: We investigated the efficacy of bupivacaine, lidocaine, and saline infiltrations to peritonsillar region and uvula and soft palate regions for pain relief after tonsillectomy and modified cautery-assisted uvulopalatopharyngoplasty (MCAUP) in patients with obstructive sleep apnea. Methods: In this prospective study, 91 patients (32-65 years old) with obstructive sleep apnea underwent tonsillectomy and MCAUP and were divided into 3 groups. In group 1 patients (n = 31), 0.25% bupivacaine HCl + 1/200,000 epinephrine (10 mL); in group 2 patients (n = 31), 1% lidocaine HCl+1/200,000 epinephrine (10 mL); and in group 3 patients (n = 29), 0.9% saline (10 mL) were injected to peritonsillar region and uvula and soft palate regions. Operation duration, amount of bleeding, and analgesic requirement and visual analog scale for pain at rest and at swallowing were evaluated in all groups. Results: Mean body mass index values were between 27.0 and 27.3 kg/m(2) in all groups. Their apnea-hypopnea index values were between 15.3 and 16.9 per hour, and there were no significant differences between their body mass index and apnea-hypopnea index values. Duration of operation of patients in the bupivacaine group was significantly lower than that of patients in the lidocaine and saline groups. In addition, in the lidocaine group, operation duration was significantly lower than that in the saline group. Bleeding amount and postoperative analgesic requirement of the saline group were significantly higher than those of the bupivacaine and lidocaine groups. Although both these measures (operation duration and amount of bleeding) were statistically significant, a mean operating time of 44.3 versus 46.0 minutes and 64.4-mL versus 68.4-mL blood loss for the bupivacaine and lidocaine groups were clinically irrelevant and not too important. In terms of visual analog scale for pain at rest and/or swallowing, Bupivacaine provided more relief than lidocaine and saline injections. The lidocaine provides pain relief less than bupivacaine and more than saline at rest and/or swallowing. Conclusion: We recommend the use of bupivacaine injections in peritonsillar, uvular, and soft palate regions during tonsillectomy + MCAUP operations. It reduces operation duration and provides more pain relief postoperatively. When patients had cardiac problems, lidocaine may also be recommended because of its cardiac depressant and antiarrhythmic effects and positive effects for pain relief compared with saline injections.Öğe The Role of CD68 (+) Histiocytic Macrophages in Nasal Polyp Development(THIEME MEDICAL PUBL INC, 2020) Bayar Muluk, Nuray; Arikan, Osman Kursat; Atasoy, Pinar; Kilic, Rahmi; Tuna Yalcinozan, EdaObjectives The aim of this study was to investigate the role of CD68 (+) histiocytic macrophages (H-M) in the nasal polyp pathogenesis. Materials and Methods The study group consisted of 24 adult patients with nasal polyposis. The control group consisted of 11 adult patients without nasal polyps. A total of 36 nasal polyp samples (10-nasal cavity, 10-maxillary sinus, and 16-ethmoid sinus) from the study group and 11 inferior turbinate samples from the control group were analyzed by immunohistochemical staining, with monoclonal antibodies against CD68 (+) H-M. Results CD68 positivity was significantly higher than the control group in the subepithelial (SE) layer of the ethmoid sinus, and deep layers of nasal cavity, maxillary, and ethmoid sinuses. In SE and deep layers of ethmoid and maxillary sinuses, CD68 positivity was significantly higher than that of the epithelial layer. In the deep layer, histiocytic macrophages tended to gather around eosinophils. Conclusion The high numbers of CD68 (+) histiocytic macrophages mainly located in deep layer of lamina propria may be responsible for the phagocytosis of eosinophils within the polyp tissue. Therefore, it may be concluded that increased macrophages in nasal polyps do not trigger the growth of nasal polyps. Instead, they may serve to reduce the number of eosinophils in already-developed nasal polyps.Öğe The Role of Platelet-Derived Growth Factor in the Pathogenesis of Sinonasal Polyps: Immunohistochemical Assessment in Epithelial, Subepithelial and Deep Layers of the Mucosa(Korean Soc Otorhinolaryngol, 2013) Muluk, Nuray Bayar; Arikan, Osman Kursat; Atasoy, Pinar; Kilic, Rahmi; Yalcinozan, Eda TunaObjectives:The aim of this study is to investigate the role of platelet-derived growth factor (PDGF) in the pathogenesis of sinonasal polyps. Methods. Study group (groups 1-3) consisted of nasal polyp samples of patients with sinonasal polyps and the control group consisted of inferior turbinate samples of patients without nasal polyp. In group 1, 14 specimens from ethmoid sinus; in group 2,10 specimens from nasal cavity; in group 3,10 specimens from maxillary sinus; and in group 4 (control), 9 specimens from inferior turbinate were included. By immunohistochemical staining technique, the PDGF positivity index (PI) in mucosal layers and in the inflammatory cells were assessed at the epithelium (EP), subepithelial layer of lamina propria (SE), and deep paraglandular layer of the mucosa (D). Results. Polymorphonudear cell (PMNC)-percentage (%) values of ethmoid and maxillary sinus, and the PDGF PI from all cells of ethmoid sinus and nasal cavity were significantly higher than those of the control group. As mononuclear cell-% (MNC-%) increased, the PDGF_EP_basal PI, PDGF_SE_endothelial PI, and PDGF_D_endothelial PI decreased. As PMNC-PDGF PI increased, the PDGF_D_perivascular PI decreased and PDGF_D_endothelial PI increased. As PDGF-MNC PI increased, the PDGF_EP_apical PI, PDGF_SE_endothelial PI, and PDGF_D_endothelial PI decreased. As PDGF-all cells (PMNCs, MNCs, and fibroblasts) PI increased, the PDGF_EP_basal PI and PDGF_D_endothelial PI decreased, and the PDGF_D_perivascular PI increased. Conclusion. We concluded that the PDGF systems play important roles in polyp pathogenesis. Fibroblast-derived PDGF may be more important than MNC-derived PDGF in polyp developing process. Increased perivascular-PDGF-PI in deep layers of the mucosa may result in sinonasal polyp formation by causing an increase in vascular permeability and extracellular edema, and thus promoting migration of inflammatory cells to extracellular area. Tissue oxygenization may be important for the initiation of PDGF release system. Because of this reason, nasal obstruction should be medically treated earlier, and, if necessary, by surgical approaches.Öğe Sonoelastographic Evaluation of the Lower Lateral Nasal Cartilage Lateral Crus, Auricular Conchal Cartilage, and Costal Cartilage(Thieme Medical Publ Inc, 2019) Sahan, Mehmet Hamdi; Muluk, Nuray Bayar; Inal, Mikail; Asal, Nese; Simsek, Gokce; Arikan, Osman KursatWe investigated the sonoelastographic features of the lower lateral nasal cartilage lateral crus (LLNC-LC), auricular conchal cartilage (ACC), and costal cartilage (CC). In this prospective study, group 1 consisted of 60 participants (30 males and 30 females) between 18 and 35 years of age. Group 2 consisted of 60 participants (30 males and 30 females) between 35 and 50 years of age. Strain elastography (SE) and shear wave elastography (SWE) were performed. For all LLNC-LCs and ACCs, type I SE was detected more in group 2, type II SE was detected more in group 1, and type III SE was detected more in group 1 ( p < 0.05). For CC, type I SE was detected more in both groups ( p < 0.05). For LLNC-LC, type I SE was detected more in males compared with females in both groups ( p < 0.05). For all LLNC-LC, ACC and CC, the SWE modulus of group 2 was significantly higher than that of group 1 ( p < 0.05). In older participants, the SWE modulus increased. We recommend using ACC mainly in rhinoplasty operations for primary and revision cases as its SWE modulus is similar to that of the LLNC-LC. However, due to the higher SWE modulus of CC, CC grafts should not be used as the first choice in rhinoplasties, especially in the reconstruction of the nasal tip contour, but may be used in nasal dorsum augmentation.
