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    Chronic Rhinosinusitis—Could Phenotyping or Endotyping Aid Therapy?
    (SAGE Publications Inc., 2019) Bayar Muluk N.; Cingi C.; Scadding G.K.; Scadding G.
    Objectives: We reviewed the phenotyping and endotyping of chronic rhinosinusitis (CRS) and treatment options. Methods: We searched PubMed, Google, Google Scholar, and the Proquest Central Database of the Kırıkkale University Library. Results: Phenotypes are observable properties of an organism produced by the environment acting upon the genotype, that is, patients with a particular disorder are subgrouped according to common characteristics. Currently, CRS is usually phenotyped as being with (CRSwNP) or without (CRSsNP) nasal polyps. However, this is not immutable as some individuals progress from nonpolyp to polypoid CRS over time. Phenotypes of CRS are also based on inflammatory patterns, generally CRSwNP is eosinophilic, CRSsNP neutrophilic; but there is a spectrum, rather than a clear-cut division into 2 types. An endotype is a subtype of a condition defined by a distinct functional or pathobiological mechanism. Endotypes of CRS can be (1) nontype Th2, (2) moderate type Th2, and (3) severe type Th2 immune reactions, based on cytokines and mediators such as IL4, 5, 13. CRS endotyping can also include a (1) type 2 cytokine-based approach, (2) eosinophil-mediated approach, (3) immunoglobulin E-based approach, and (4) cysteinyl leukotriene-based approach. Subdivisions of CRSwNP can be made into nonsteroidal anti-inflammatory drug-exacerbated respiratory disease, allergic fungal sinusitis, and eosinophil pauci-granulomatous arteritis by testing. General treatment for all CRS is nasal douching. The place of surgery needs careful reconsideration. Endotype-directed therapies include glucocorticosteroids, antibiotics, aspirin, antifungals, anticytokines, and immunoglobulin replacement. The recognition of united airways and the co-occurrence of CRSwNPs and severe asthma should lead to common endotyping of both upper and lower airways in order to better direct therapy. Conclusion: Endotyping can allow for the identification of groups of patients with CRS with a high likelihood of successful treatment, such as patients with a moderate type 2 immune reaction or those with acquired immune deficiency. © The Author(s) 2018.
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    Cognitive evaluation and quality of life assessment in patients with subjective tinnitus (2)
    (Neurological Society R.O.C (Taiwan), 2016) Dağ E.; Bayar Muluk N.; Karabiçak H.; Arikan O.K.; Türkel Y.
    Purpose: To investigate the effects of subjective tinnitus on cognitive functions. Methods: There were 15 patients (10 bilateral, 5 unilateral) with tinnitus who were non-psychiatric in the study group. There were 14 controls (28 ears of them) that were healthy, non-psychiatric and did not have tinnitus. We used questionnaire form; Hospital Anxiety and Depression Scale (HAD); The SF-36 Health Survey; and the Montreal Cognitive Assessment (MoCA) test to evaluate cognitive functions of the subjects. Results: In tinnitus patients, all HAD results (HAD-depression, HAD-anxiety and HAD-total) were insignificantly higher; and all SF-36 items were lower than the control group. In tinnitus group, MoCA scores (mean: 22.28 ± 3.90) were significantly lower then the control group (mean = 26.07 ± 1.74). In tinnitus group, higher MoCA scores were related to increased role limitations due to emotional problems (RE) and physical functioning (PF) values. As subjective tinnitus loudness level (STLL) values increased, HAD-Anxiety values increased and social functioning (SF) values were decreased. In well educated tinnitus patients, MoCA scores found significantly increased. Better Quality of life (QoL) results were found with better MoCA scores. The most important SF-36 items were PF, RE and social functioning (SF). Conclusion: Subjective tinnitus had negative impact not only in quality of life, but also in cognitive function of the patients. © 2016, Neurological Society R.O.C (Taiwan). All rights reserved.
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    Is there a relationship between mastoid pneumatisation and facial canal dimensions?
    (Cambridge University Press, 2019) Inal M.; Bayar Muluk N.; Asal N.; Şahan M.H.; Şimşek G.; Arikan O.K.
    Objective To evaluate mastoid pneumatisation and facial canal dimensions.Method In this retrospective study, 169 multidetector computed tomography scans of temporal bone were reviewed. Facial canal dimensions were evaluated at the labyrinthine, tympanic and mastoid segments using axial and coronal multidetector computed tomography scans of temporal bone. Mastoid pneumatisation and facial canal dehiscence were evaluated. Facial canal dehiscence was measured if it was found to be present.Results This study showed that facial canal dimensions decreased in pneumatised mastoids. Facial canal dimensions in females were smaller than in males. Facial canal dehiscence was detected in 5.9 per cent and 6.5 per cent of the patients on the right and left sides, respectively. No correlations were found between facial canal dehiscence and mastoid pneumatisation. The length of dehiscence was 1.92 ± 0.44 mm (range, 0.86-2.51 mm) on the left side. In older subjects, left facial canal dehiscence was detected more, and the length of the dehiscence increased.Conclusion This study concluded that during surgery, facial canal dehiscence should be kept in mind in order to avoid complications. © 2019 JLO (1984) Limited.
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    Olfactory Bulb Volume and Olfactory Sulcus Depth in Patients With OSA: An MRI Evaluation
    (SAGE Publications Ltd, 2019) Doğan A.; Bayar Muluk N.; Şahin H.
    Objectives: We evaluated olfactory functions in patients with obstructive sleep apnea (OSA). Methods: The cranial magnetic resonance images of 58 adult patients (36 males and 22 females) aged 27 to 79 years were retrieved from the hospital picture archiving and communication system (PACS) system. There were 29 patients with OSA (17 males and 12 females), diagnosed according to the polysomnography results. A control group consisted of 29 healthy patients without OSA. Olfactory bulb (OB) volume and olfactory sulcus (OS) depth measurements were performed. Nasal septal deviation (SD) was also evaluated and recorded as no SD, deviation to the right, and deviation to the left in all groups. Results: Olfactory bulb volumes of the OSA group were significantly lower than those of the control group (P <.05), whereas OS depth values were not different (P >.05). There was a positive correlation between the right and left OB volumes and right and left OS depth values (P <.05). In older patients with OSA and in female patients with OSA, OB volumes decreased bilaterally (P <.05). Olfactory sulcus depth of the right side was lower in the female patients with OSA compared to the male patients with OSA (P <.05). There were no significant correlations between apnea–hypopnea index and OB volumes and OS depth values in the OSA group (P >.05) Conclusion: In patients with OSA, OB volumes decreased bilaterally. It may be related to intermittent nocturnal hypoxia/reoxygenation episodes, which may be a trigger for upper airway inflammation; and proinflammatory mediators maybe harmful on olfactory neuroepithelium and olfactory impairment may occur. © The Author(s) 2019.
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    Time-dependent middle ear pressure changes under general anaesthesia in children: N2O-O2 mixture versus air-oxygen mixture
    (2013) Apan A.; Bayar Muluk N.; Güler S.; Budak B.
    Time-dependent middle ear pressure changes under general anaesthesia in children: N2O-O2mixture versus air-oxygen mixture. Objectives: The aim of this study was to investigate the effects of N 2O-O2 mixture (Inspired O230%) on middle ear pressure (MEP) in children compared with the effects of an air-oxygen mixture (Inspired O250%). Method: The study included thirty child patients who underwent general anaesthesia for different reasons, with the exception of ENT problems and ear interventions. They were randomly divided into two groups. Group 1(15 children: 10 male and 5 female) received a N2O-O 2 mixture (Inspired O2 30%); and group 2(15 children: 10 male and 5 female) were given an air-oxygen mixture (Inspired O2 50%). MEP was measured using a portable impedance analyser before the operation (PreO),10 minutes after intubation (10AEn), 30 minutes after intubation (30AEn), 10 minutes before extubation (10BEx), 15 minutes after the operation (PO15), 30 minutes after the operation (PO30), 1 hour after the operation (POlh) and 6 hours after the operation (PO6h). Results: The pressure and compliance values were the same in groups 1 and 2. The pressure-time graphs for the two groups were different: in Group 2, MEP rose quickly at l0AEn and positive pressure values were seen in the middle ear. MEP then fell rapidly until the end of the surgery and lower and negative pressures (Mean-50 daPa) were observed at PO6h. In Group 1, MEP was elevated at l0AEn and positive pressure was found (but not as high as in Group 2). MEP then fell more slowly. In other words, positive pressure in the middle ear persisted longer and the middle ear was subjected to positive pressure and nitrogen over a longer period. Separate analyses were made in Groups 1 and 2 of pressure differences and of compliance values at eight measurement points using the Friedman test. Differences in pressure values were found to be statistically significant in both Group 1 (p = 0.000) and Group 2 (p = 0.000). In Group 1, all the lOAEn and 30AEn values were significantly higher than the PreO, PO30, POlh and P06h values. The lOBEx value was significantly higher than the PreO and POlh values. The PO15 value was significantly higher than the PreO value. In Group 2, the PO6h value was significantly lower than the lOBEx, l00AEn and 30AEn values. The POlh value was significantly lower than the 30AEn values. The MEP values increased in Group 1 in younger and taller children and in children receiving anaesthesia for shorter periods. MEP values increased in Group 2 in younger and taller children, and in heavier children. MEP values fell with the length of anaesthesia. Conclusion: In brief anaesthesia, nitrogen was not removed from the middle ear quickly in Group 1: middle ear pressure values were higher. The nitrous oxide remained in the middle ear longer and so the possibility of ear toxicity may increase. In Group 2,50% O2was rapidly absorbed and removed from the middle ear and so middle ear pressure was not as high. It may be concluded that air-oxygen mixture (Inspired O2 50%) anaesthesia should be recommended as being more reliable in tympanoplasties and other middle ear interventions than a N 2O-O2mixture (Inspired O2 30%).