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Öğe 2014 Yılında Larengeal Transplantasyonun Geldiği Nokta(Namık Kemal Üniversitesi, Tıp Fakültesi, 2014) Çifti, Zafer; Deniz, Mahmut; Çifti, Halide Güneş; Gültekin, Erdoğanİşlev görmeyen insan larenksinin yerine başka bir larenksin konulabilmesi düşüncesi son 50 yıldan beri bu konuda yapılan birçok çalışmaya ilham konusu olmuştur. Kanser ameliyatları sonrasında hastaların sağ kalımlarının artmasının yanı sıra, yaşam kalitelerinin de artması gittikçe ön plana çıkmaktadır. Bu durum özellikle cerrahi ve medikal tedavilerdeki gelişmelere paralel olarak yaşam sürelerinde artış sağlanmış olan total larenjektomili hastalar için çok önemlidir. Sonuç olarak, yaşam kalitesini artırmak amacıyla larenks tranplantasyonu yapılması düşüncesi önemli hale gelmektedir. Bu derlemede bu konu ile ilgili tarihsel gelişim sürecinin yanı sıra, endikasyonlara ve etikomediko-legal konulara değinilmesi ve larengeal transplantasyonun geleceği ile ilgili görüşlerin detaylı bir şekilde ele alınması amaçlanmıştır.Öğe Can Curcumin Prevent the Formation of Pseudomonas aeruginosa Biofilm on the Surface of Tympanostomy Tubes?(Ankara Microbiology Soc, 2015) Çiftçi, Zafer; Deniz, Mahmut; Güneş, Hayati; Gümüş, Abdullah; Gültekin, Erdoğan; Eren Topkaya, AynurFormation of bacterial biofilm on the surface of tympanostomy tubes are held responsible in the pathogenesis of post-tympanostomy tube otorrhea. To prevent the formation of biofilm, various methods were employed and varying degrees of success have been achieved. In some recent studies curcumin, which is the fenolic form of Curcuma longa (turmeric), has been pointed out to have inhibitory effects on virulence factors of Pseudomonas aeruginosa. The aim of this study was to investigate whether the administration of curcumin is able to prevent the formation of P.aeruginosa biofilm on the surface of silicone tympanostomy tubes in vitro conditions. For this purpose, qualitative and quantitative analysis of P.aeruginosa biofilm created on the surface of the tympanostomy tubes were performed following a period of 48 hours incubation in microplate wells that contained decreasing concentrations of curcumin. For qualitative analysis, specimens were evaluated with an environmental scanning electron microscope for the existence of biofilm. For the quantitative analysis, bacteria attached to the tube surface was detached using a combination of vortexing and sonication. Following serial dilutions, the obtained solution was then inoculated on the sheep blood agar plates using calibrated loop, incubated for 24 hours and the colony forming unit (CFU) per mL were recorded. Environmental scanning electron microscope analysis revealed that 100 mu g/mL of curcumin could prevent formation of the biofilm. Lower concentrations of curcumin could not prevent the biofilm formation. Qualitative analysis also revealed that when the concentrations of curcumin in the wells were decreased, the number of CFU/mL was increased significantly. Mean number of CFU in 100 mu g/mL and 12.5 mu g/mL groups were 35 +/- 7.07 and 650 +/- 494, respectively. Curcumin could prevent formation of P.aeruginosa biofilm on the surface of tympanostomy tubes in vitro with concentrations lower than the MIC value. The results of the present study show that local administration of curcumin may prevent suppurative otitis media following tympanostomy tube insertion, keep the patency of the tube and decrease the rate of treatment failure. In vivo studies are needed to support the in vitro anti-biofilm action of curcumin on tympanostomy tubes.Öğe Do we really need to coat the novel silicone intranasal splints with antibiotics?(W B Saunders Co-Elsevier Inc, 2016) Çiftçi, Zafer; Kurc, Mine Aydin; Kaya, Ayşe Demet; Saraçoğlu Varol, Gamze; Deniz, Mahmut; Gültekin, ErdoğanPurpose: The novel silicone intranasal splints are suggested to resist biofilm formation due to their surface characteristics. We aimed to ascertain the necessity of coating these splints with antibiotics to prevent splint associated infections, in vitro. Materials and methods: Pieces of Doyle II airway nasal splints made of medical grade silicone were divided into two test groups, treated with either (i) 0.2% nitrofurazone solution or (ii) 0.2% nitrofurazone containing ointment, and a control group, treated with (iii) 0.9% saline. Splint pieces were then incubated with Staphylococcus aureus solutions at 37 degrees C for 48 and 96 h. Following this, the splint pieces were incubated in 20 ml Mueller Hinton agar and appearing colonies were counted. Results: Following 48 and 96 h of incubation, the colonization rates in the saline group were significantly higher than the nitrofurazone ointment group (p < 0.001). The colonization rates in the liquid nitrofurazone group were significantly lower in comparison to the nitrofurazone ointment group (p < 0.001 and p = 0.019 respectively). Conclusions: The method of coating the splints with antibiotic was superior to using uncoated splints in terms of preventing S. aureus colonization. The rather smooth surfaces of the splints were insufficient to block bacterial colonization and coating them with antibiotics seems to be beneficial for the prevention of infections. (C) 2016 Elsevier Inc. All rights reserved.Öğe Evaluation of the changes in the hearing system over the years among patients with OSAS using a CPAP device(Taylor & Francis Ltd, 2020) Deniz, Mahmut; Ersözlü, TolgaObjective To evaluate whether patients using a continuous positive airway pressure (CPAP) device for obstructive sleep apnea syndrome (OSAS) have improvement or deterioration in their auditory systems. Methods Charts of OSAS patients who were followed up at the ENT clinic were retrospectively reviewed starting from 2018. The hearing tests performed at least 2 years before and after CPAP use in patients were compared with themselves and with the test results of patients with no CPAP use. Results No improvement in the hearing system on the patients using a CPAP device was detected. Deterioration in hearing was detected in 13.63% and 9.09% of the patients with and without CPAP use, respectively. No statistically significant difference was found between the two groups. Conclusion The use of a CPAP device does not affect hearing positively or negatively.Öğe Evaluation of the Hearing System in Chronic Obstructive Pulmonary Disease Patients(2021) Demirel, Oral Burak; Ersözlü, Tolga; Deniz, MahmutAim: This study aimed to examine the effect of chronic hypoxemia on auditory functions in chronic obstructive pulmonary disease (COPD) patients.Materials and Methods: Sixty patients who had pulmonary function test (PFT) and diagnosed with COPD were included in the study. Four studygroups and a control group were created in the study. Each study group was determined based on forced expiratory volume (FEV1) and FEV1/forcedvital capacity (FVC) ratio. Groups consisted of mild, moderate, severe and very severe COPD patients. Each group included 15 patients. The controlgroup consisted of 30 patients with an FEV1/FVC ratio of >70%. All patients underwent pure tone audiometry and otoacoustic emission (OAE) test.Results: According to the audiological evaluation, a statistically significant difference was found between the severe and very severe group andthe control group (p<0.01).Conclusion: The results of the present study showed that auditory mechanisms may also be affected in patients with severe and very severe COPD.The authors of this study argue that necessary measures should be taken in the early stages of the disease for COPD patients to prevent the negativeeffects of chronic hypoxemia on the auditory system.Öğe In vitro analysis of a novel controlled release system designed for intratympanic administration of N-acetylcysteine: a preliminary report(W B Saunders Co-Elsevier Inc, 2015) Çiftçi, Zafer; Deniz, Mahmut; Yılmaz, İbrahim; Çiftçi, Halide Güneş; Şirin, Duygu Yaşar; Gültekin, ErdoğanThe aim of this in-vitro experimental study was to design a novel drug delivery system that may permit controlled release of N-acetylcysteine (NAC) following intratympanic administration. The system was composed of two different solutions that attained a hydrogel form within seconds after getting into contact with each other. The authors performed swelling, pH and temperature tests and analysis of. controlled release of NAC from this novel controlled release system. For the structure and porosity analysis of the hydrogel, an environmental scanning electron microscope (SEM) was used. The diameter of designed hydrogel showed an increase when pH was increased. In addition, in comparison to acidic values, the pore diameter of the hydrogel increased significantly especially in physiological level. The increase in the pore diameter was also directly proportional to the increase in temperature. Spectrophotometric analysis showed that the amount of NAC released into the medium was statistically significant (p = 0.038, t = 2.18, 95% CI; DF: 27). SEM analysis of the samples revealed a smooth surface topography and numerous porous structures. The authors are of the opinion that the designed hydrogel may be used as an alternative method for invatympanic delivery of NAC for otoprotective purposes. The disadvantages of intratympanic injection of the drug in its liquid form, including leakage through eustachian tube, restraining the patient in an uncomfortable position, necessity for repetitive injections and dose dependent inflammation of the middle ear epithelium, may also be avoided. Further in vivo studies should be conducted to assess its tolerability and effectivity. (C) 2015 Elsevier Inc. All rights reserved.Öğe Kurkumin, Timpanostomi Tüpleri Yüzeyinde Pseudomonas aeruginosa Biyofi lminin Oluşmasına Engel Olabilir mi?(2015) Çiftçi, Zafer; Deniz, Mahmut; Güneş, Hayati; Gümüş, Abdullah; Gültekin, Erdoğan; Topkaya, Aynur ErenTimpanostomi tüpü konulduktan sonra gelişen otorelerden, en çok tüp yüzeyinde oluşan bakteriyel biyofi lm sorumlu tutulmaktadır. Bu durumun önlenebilmesi için çok değişik yöntemler denenmiş ve bu yöntemlerin bazılarıyla da değişen oranlarda başarı elde edilebilmiştir. Ancak yöntemlerin hiçbiri biyofi lm oluşumunu tamamen önleyememiştir. Son zamanlarda yapılan bazı çalışmalarda, Curcuma longa (zerdeçal)'nın fenolik formu olan kurkuminin Pseudomonas aeruginosa'nın virülans faktörlerini etkilediğine dikkat çekilmiştir. Bu çalışmanın amacı, kurkuminin, in vitro ortamda, silikon timpanostomi tüplerinin yüzeyinde P.aeruginosa biyofi lminin oluşumuna engel olup olmadığının araştırılmasıdır. Bu amaçla, azalan konsantrasyonlarda kurkumin içeren kuyucuklar içerisinde 48 saatlik bir inkübasyonu takiben, timpanostomi tüpleri yüzeyinde oluşan P.aeruginosa biyofi lminin kalitatif ve kantitatif analizleri yapılmıştır. Kalitatif analiz için, tüpler çevresel taramalı elektron mikroskobu ile incelenerek biyofi lm varlığı açısından değerlendirilmiştir. Kantitatif analiz için, öncelikle tüp yüzeyinde tutunmuş olan bakteriler vorteksleme ve sonikasyon işlemleri kullanılarak tüp yüzeylerinden ayrıştırılmış; elde edilen bakteri solüsyonlarının seri (10'un katları olacak şekilde) dilüsyonları yapılmıştır. Seri dilüsyonlardan kalibre özeler kullanılarak koyun kanlı agarlara sayım plağı şeklinde ekim yapılmış ve 24 saatlik inkübasyon sonrasında kültürler değerlendirilerek sayım sonuçları koloni oluşturan birim (CFU)/mL olarak kaydedilmiştir. Çevresel taramalı elektron mikroskobu görüntüleri 100 ?g/mL'lik kurkumin konsantrasyonun biyofi lm oluşumunu önleyebildiğini ortaya koymuştur. Daha düşük konsantrasyonlarda, kurkuminin biyofi lm oluşumunu azalttığı, ancak tamamen önleyemediği görülmüştür. Kantitatif analiz sonuçları da, kuyucuklardaki kurkumin konsantrasyonu azaldıkça, CFU/mL değerlerinde anlamlı bir artış olduğunu göstermiştir. 100 ?g/mL ve 12.5 ?g/mL gruplarındaki CFU/mL değerleri sırasıyla, 35 ± 7.07 ve 650 ± 494 olarak tespit edilmiştir. Kurkuminin in vitro ortamda, minimum inhibitör konsantrasyon (MİK) değerlerinden daha düşük konsantrasyonlarda timpanostomi tüplerinin yüzeyinde P.aeruginosa biyofi lminin oluşumunu engellediği saptanmıştır. Çalışmamızın bulguları, kurkuminin lokal olarak uygulanmasının, timpanostomi tüpü konulması sonrası süpüratif otitis media gelişimine engel olabileceğini, tüpün lümeninin açık kalmasını sağlayabileceğini ve tedavi başarısızlık oranlarını azaltabileceğini düşündürmektedir. Sonuç olarak, kurkuminin in vitro koşullarda saptadığımız P.aeruginosa'nın biyofi lm oluşumunu önleyici etkisinin in vivo çalışmalarla da desteklenmesi gerektiği kanısına varılmıştırÖğe Magnetic Control of the Glottic Opening in an Ex Vivo Sheep Larynx Model: A Preliminary Study(Mosby-Elsevier, 2016) Çiftçi, Zafer; Deniz, Mahmut; Çiftçi, Halide Güneş; Özdemir, Damla Nihan; Işık, Aklime; Gültekin, ErdoğanObjective/Hypothesis. So far, a number of techniques have been described for the treatment of bilateral vocal fold paralysis. These techniques were reported to be successful in maintaining an adequate airway but also found to be associated with an increased risk of aspiration, dysphonia, and granulation tissue formation at the operation site. We aimed to investigate the effectiveness of a novel mucosa-sparing technique based on the generation of a magnetic field within the larynx for the tailored lateralization of the ipsilateral vocal fold. Study design. This is an ex vivo experimental study. Methods. Twenty sheep larynges that were procured from the local slaughterhouse were used as a model. For each specimen, two neodymium (Nd) disc magnets with marked poles were used to create a unilateral attractive magnetic force at the glottic level. Following insertion of the magnets, the level of vocal fold lateralization was assessed under an operating microscope. The results were analyzed for their statistical significance. Results. Before the procedure, the mean value of the glottic openings of all the specimens was 4.985 mm. The post-procedure mean value was 5.640 mm. The mean amount of increase in the glottic openings after the procedure was 0.655 mm. This change was found to be statistically significant (P < 0.05). Conclusions. A statistically significant increase in the cross-sectional area of the glottic region could be achieved. The mucosal integrity of the laryngeal airway was also preserved. The idea of magnetic control of the glottic airway'' is a novel concept but seems to be a promising option.Öğe Nasal mucociliary clearance in obstructive sleep apnea syndrome patients(Ocean Side Publications Inc, 2014) Deniz, Mahmut; Gültekin, Erdoğan; Çiftçi, Zafer; Alp, Recep; Özdemir, Damla Nihan; Işık, Aklime; Demirel, Oral BurakBackground: The main objective of this study was to investigate the correlation between the level of mucociliary dysfunction and severity of obstructive sleep apnea syndrome (OSAS). The effect of smoking in OSAS patients on mucociliary dysfunction was also assessed. Methods: It is a descriptive study that compares variables between groups (univariate analysis). In this clinical trial 122 patients with varying degrees of OSAS and 49 healthy volunteers were included (n = 171). Patients were divided into three groups as having mild, moderate, and severe OSAS, according to their apnea hypopnea index (AHI) values. (AHI values are typically categorized as 5-15/hr, mild OSAS; 15-30/hr, moderate OSAS; and >30/hr, severe OSAS.) The control group was comprised of healthy subjects. Each group was divided into smoking and nonsmoking subgroups. The mucociliary rates of the subjects were measured using the saccharin test. Statistical analysis was performed with the GraphPad Prism Version 3 pocket program. Results: Mild and moderate OSAS groups showed similar results with control group (p = 0.869), but severe OSAS patients showed a statistically significant difference with control group (Kruskal-Wallis [KW] = 32.28; p = 0.0032 and p < 0.05). Although in the moderate OSAS group the mucociliary clearance rates showed a tendency to decrease, this decrease was not significant (p = 0.453). A statistically significant difference was observed between smokers and nonsmokers in terms of mucociliary clearance times in all groups (KW = 18.24; p = 0.001). Conclusion: The nasal mucociliary system is significantly deteriorated in severe OSAS patients and they should be meticulously observed to prevent sinonasal infections. Measures to enhance mucociliary activity in these patients should be taken. Smoking, a well-known inhibitor of mucociliary activity, also has a negative impact on the mucociliary function of OSAS patients and quitting smoking would be of benefit for these patients.Öğe Otorhinolaryngology practices during the COVID-19 pandemic(Aves, 2021) Deniz, Mahmut; Ersözlü, TolgaThe COVID-19 epidemic, caused by SARS-CoV-2, broke out in December 2019 in the province of Wuhan, China. On March 12, 2020, the World Health Organization declared the COVID-19 outbreak as a pandemic. Although typical symptoms of the disease include fever, dry cough, and shortness of breath, complaints such as anosmia and dysgeusia also occur. The swab polymerase chain reaction tests, which were taken from the nasopharynx, became negative among asymptomatic individuals from the third day onward, whereas virus positivity was still detected among symptomatic individuals from the 12th to 20th days. Risk factors such as chronic diseases increase the rate of acute respiratory distress syndrome during COVID-19. It has been reported that the virus is transmitted more commonly through the contact of respiratory secretions. Thus, it has been reported that there is an increased risk of virus transmission particularly to physicians who are frequently exposed to aerodigestive secretions, such as otorhinolaryngologists, gastroenterologists, pneumologists, dentists, speech therapists, ophthalmologists, and infectious diseases physicians. Promising results have been reported from vaccine development studies currently in process. Although in some countries, vaccinations have been almost completed, there are a few countries where it has not started yet. Therefore, it is believed that it will take months or years for vaccines to be produced, distributed, and reach all people worldwide. During this period, it is our aim to protect our patients. hospital teams, and ourselves by examining and assessing the experiences of our international colleagues.Öğe The evaluation of auditory system in obstructive sleep apnea syndrome (OSAS) patients(W B Saunders Co-Elsevier Inc, 2016) Deniz, Mahmut; Çiftçi, Zafer; Ersözlü, Tolga; Gültekin, Erdoğan; Alp, RecepObjective: The authors of the present study aimed to investigate the impact of hypoxemia on the auditory functions of OSAS patients and discussed their findings under the scope of the existing literature. Materials and methods: 160 patients who underwent a polysomnographic analysis for the diagnosis of possible sleep disordered breathing between January 2015 and December 2015 were enrolled in this study. Polysomnography tests were conducted at the sleep laboratory of the department of neurology at the same institute. Comprehensive otorhinolaryngological examinations of all participants were conducted by the same senior otorhinolaryngologist. Three study groups and a control group were designated in the study. Each study group was designated according to the severity of the apnea hypopnea index (AHI) and blood oxygen saturation values of the participants. All participants underwent pure tone auditometry and otoacoustic emission testing (OAE). Statistical data analysis was performed using SPSS for Windows, version 17 (SPSS Inc., Chicago, IL, USA). Results: Audiological assessment of the patients revealed that all patients in the control group and in mild OSAS group had normal hearing thresholds (lower than 26 dB). However, the patients who had moderate and severe OSAS had varying degrees of sensorineural hearing losses. As far as body mass indexes are concerned, statistically significant differences were observed among the groups (p = 0.038). Conclusion: There is convincing evidence that the risk of progressive dysfunction in vascular and neural structures of the body is inevitable for the Patients who suffer from a chronic hypoxemic condition secondary to OSAS. The findings of the present study indicated auditory transduction and transmission mechanisms may also be affected in moderate and severe OSAS patients. Therefore, via taking necessary steps in preventing hypoxemia at the outset, OSAS patients may be protected from the long term detrimental effects of chronic hypoxemia on the auditory system. (C) 2016 Elsevier Inc. All rights reserved.Öğe The impact of different nasal packings on postoperative complications(W B Saunders Co-Elsevier Inc, 2014) Deniz, Mahmut; Çiftçi, Zafer; Işık, Aklime; Demirel, Oral Burak; Gültekin, ErdoğanObjective: The objective of this study was to find out if there is any association between the use of nasal packings and nasal synechia formation, septal perforation, postoperative infection and epistaxis in patients who underwent septoplasty and concha reduction operations. Methods: This retrospective study was conducted at a tertiary referral center. One hundred thirty patients were randomly selected among patients who underwent endonasal surgery in Narmik Kemal University Hospital between January 1st 2012 and August 1st 2013. Retrospective analysis of these patients' files, including operative reports and follow-up notes, was done. The postoperative findings of patients who had septal splints and Merocel nasal packings were compared and analyzed for statistical significance. Results: The results of the study showed a statistically significant difference in the frequency of synechia formation between two groups (p < 0.05). The frequency of synechia formation was found to be higher in the Merocel packing group. However, no statistically significant difference was found between groups in terms of postoperative infection, septal perforation, and epistaxis (p > 0.05). Conclusion: Our findings suggest that intranasal splints are superior to Merocel nasal packings in terms of preventing nasal synechia formation. Insertion of a septal splint after nasal surgery should be preferred to avoid this complication. On the other hand, other factors should be sought in the etiology of postoperative infection, septal perforation, and epistaxis. (C) 2014 Elsevier Inc. All rights reserved.Öğe Understanding potential associations between anatomic and other factors in OSA severity(Springer Heidelberg, 2021) Ersözlü, Tolga; Deniz, Mahmut; Fazlıoğlu, Nevin; Gültekin, Erdoğan; Altıntaş, NejatPurpose The aim of this prospective study was to investigate associations between nasal/oropharyngeal structures and a range of factors including age, gender, daytime sleepiness, and body mass index (BMI). Methods Patients with OSA were prospectively selected as research participants in rhinomanometric analysis as well as for otolaryngological evaluation. Participants were grouped as follows according to their apnea/hypopnea index (AHI) scores: no OSA (AHI < 5), mild OSA (5 <= AHI <= 15), moderate OSA (15 <= AHI < 30), and severe OSA (AHI >= 30). One-way analysis of variance (ANOVA), Kruskal-Wallis H, and Mann-Whitney U tests were performed to assess OSA severity in terms of the relationships between nasal resistance (NR) and anthropometric indices (body mass index (BMI), Friedman tongue position (FTP)), age, and gender. Results The study cohort of 177 men and 81 women ranged in age between 21 and 76 years, with BMI ranging from 23 to 45. In total, 37 patients were simple snorers (AHI < 5), and 221 patients were diagnosed with OSA. There was no significant difference among the AHI groups in terms of nasal volume (Vol05) (p = 0.952), mean flow (p = 0.778), and mean NR total (p = 0.723). A statistically significant difference was found between the AHI groups in terms of mean BMI and median FTP scores (p < 0.001). Conclusion This study provides evidence that that the oropharyngeal region (oropharynx, tongue, and vallecula) is a more important determinant of OSA severity than the nasal region.Öğe Which technique is better for cholesteatoma surgery?(Royal Belgian Soc Ear, Nose, Throat, Head & Neck Surgery, 2015) Deniz, Mahmut; Uslu, C.; Koldas, C.; Deniz, B.Objective: The objective of this study was to evaluate the long-term surgical outcomes and recurrence rates of three surgical techniques that are commonly used for cholesteatoma. Patients and methods: The hospital records of 132 patients with primary cholesteatoma who underwent surgery between January 1996 and December 2006 were evaluated retrospectively. Twelve cases had bilateral disease, and a total of 144 ears were treated. The patients were divided into three groups according to surgical technique: modified radical mastoidectomy (MRM) (n = 48 ears), radical mastoidectomy (RM) (n = 42 ears), and intact canal wall mastoidectomy (ICWM) (n = 54 ears). MRM and RM procedures are canal wall down (CWD) techniques, whereas the ICWM procedure is a canal wall up (CWU) technique. Postoperatively, all patients were followed up yearly for at least 6 years. The otomicroscopic features, cholesteatoma extension, surgical findings, and recurrence rates were compared in the groups. Results: Preoperative otomicroscopic examination showed attic retraction or perforation in 32% of the cases and central perforation in 11%. There was a higher cholesteatoma recurrence rate in the ICWM group than in the MRM and RM groups (p < 0.05), but there was also better hearing gain in the ICWM group (p < 0.05). Conclusion: There are several surgical techniques for eradicating cholesteatoma. Our study found that CWD procedures (RM, MRM) were more effective for the eradication of cholesteatoma, but hearing gain was better when a CWU technique was used. The choice of surgical technique should be individually tailored based on the pre-operative imaging and hearing examination findings.
