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Öğe Effects of Neck Dissection and Radiotherapy on Short-Term Speech Success in Voice Prosthesis Restoration Patients(Mosby-Elsevier, 2011) Gültekin, Erdoğan; Yelken, Kursat; Garça, Mehmet Fatih; Develioğlu, Ömer Necati; Külekçi, MehmetObjective. To compare the short-term speech success of voice prosthesis (VP) among patients who underwent total laryngectomy or total laryngectomy in combination with neck dissection and those who received postoperative radiotherapy. Materials and Methods. Thirty-two male patients treated for laryngeal squamous cell carcinoma were included. Nine patients underwent total laryngectomy and 23 underwent total laryngectomy combined with neck dissection, and 17 of the 23 with neck dissection were managed with postoperative radiotherapy (45-75 Gy). All of the patients had indwelling intraoperative placement of the Provox VP (Atos Medical AB, Horby, Sweden; and Entermed BV, Woerden, The Netherlands) at the time of the primary tracheoesophageal puncture (TEP) completed in conjunction with total laryngectomy. Patients with pharyngoesophageal myotomy and pharyngeal plexus neurectomy were excluded. Patients' speech success was perceptually evaluated 3-4 weeks after the surgery and 3-4 weeks after the cessation of radiotherapy, using a 1-3 scale (1 = failure to develop speech (aphonia); 2 = communicate with short phrases only; and 3 = communicate with fluency and long sentences). Results. No complications were noted with intraoperative prosthesis placement. No prostheses were dislodged in the postoperative period. Eighteen of 32 patients (56%) demonstrated successful speech (rating of 3). Nine patients (28%) demonstrated less successful speech (rating of 2). Five patients (16%) were found to be aphonic (P > 0.05). Of the nine patients who underwent total laryngectomy only, six were found to have successful speech (66.6%), one (11.1%) was found to have less successful speech quality, and two (22.2%) patients were aphonic (P > 0.05). Of the six patients who underwent total laryngectomy in combination with neck dissection, three had successful speech (50%), one (16.6%) had less successful speech, and two (33.3%) were aphonic (P > 0.05). Of the 17 patients who received postoperative radiotherapy, nine (52.9%) had successful speech, three (17.6%) had less successful speech, and five (29.4%) were aphonic (P > 0.05). Conclusion. Neck dissection and postoperative radiotherapy have no significant influence on short-term speech success in VP restoration patients. Primary TEP should be preferred in patients who have laryngectomy in combination with neck dissection and/or will have postoperative radiation therapy, as it provides early and successful voice restoration without interfering with radiation treatment and avoids a second surgical intervention.Öğe Fonksiyonel endoskopik sinüs cerrahisi sonuçlarımız(2010) Garça, Mehmet Fatih; Çelik, Öner; Gültekin, Erdoğan; Külekçi, MehmetAmaç: Kliniğimizde kronik rinosinüzal hastalık tanısı konmuş 100 hastaya, uygulanan fonksiyonel endoskopik sinüs cerrahisi sonuçlarımızı literatür sonuçları ile kıyaslamak. Gereç ve yöntem: Kronik rekürren sünizit (n=36 ), alerjik-non alerjik nazal polipozis (n=24), orta konka pnömatizasyonu (n=32), maksiller retansiyon kisti (n=8) tanıları alan 56’sı erkek (%56), 44’ü kadın (%44) 100 hasta, çalışmaya dâhil edildi. Hastaların % 65’ine çift taraflı %35’ine tek taraflı fonksiyonel endoskopik sinüs cerrahisi uygulandı. Yaş ortalaması 39 ve postoperatif takip 3 -21 ay ortalama (ortalama 12 ay) idi. Hastaların yaşı, preoperatif subjektif şikâyetleri, hastanın alerjik- nonalerjik grupta bulunması, anestezi şekli, preoperatif bilgisayarlı tomografi bulguları, uygulanan endoskopik cerrahi şekli, operasyonun komplikasyonları, postoperatif subjektif şikâyetleri ve postoperatif endoskopik bulgular parametre olarak kullanıldı. Bulgular: Başarı oranları kontrol endoskopik muayene ve şikâyetlere göre değerlendirildi. Yüz hastanın 68’inde (%68) tam iyileşme, 24’ünde kısmi iyileşme, 8’inde ise sonuçların başarısız olduğu görüldü. Sonuç: Fonksiyonel endoskopik sinüs cerrahisi, kronik ya da tekrarlayan sinüzitlerin tedavisinde doğru tanı sağlanması, klasik cerrahiye göre cerrahi esnasında görüntü üstünlüğü, yüksek başarı oranı, daha az travmatik olması, postoperatif takibin daha güvenilir yapılabilmesi sebebiyle tercih edilmesi gereken cerrahi yöntemdir.Öğe Noise Pollution in Biochemistry Laboratories of Different Hospitals in Istanbul/Turkey(Galenos Yayincilik, 2013) Gültekin, Erdoğan; Yener, Murat; Develioğlu, Ömer Necati; Koleli, Hakan; Külekçi, MehmetObjective: To measure and analyse noise levels generated by different biochemistry analysers in public hospitals. Methods: Noise levels generated from different analysers were measured in biochemistry laboratories by using a sound level meter. Each device was operated separately and noise levels were measured for 15 minutes; the lowest and highest sound pressure levels were recorded and compared with the World Health Organisation (WHO) guidelines for community noise. Also, 20 laboratory workers were chosen randomly and their hearing levels were screened. Results: The highest noise level recorded from biochemical analysers was 81 dB with an average of 77.7 +/- 2.11 dB; the lowest noise level was 64 dB with an average of 66.9 +/- 1.66 dB. The average highest noise level of total blood count devices was 78.5 +/- 5.94 dB and the average lowest noise level was 66.3 +/- 7.05 dB. The average highest measurement of hormone analysers was 78.5 +/- 1.95 dB and the average lowest measurement was 66.1 +/- 4.53 dB. The average highest measurement of urine analysers was 75.3 +/- 5.39 dB and the average lowest measurement was 64.3 +/- 4.62 dB. The average highest noise level of centrifuge devices was 80.6 +/- 5.68 dB and the average lowest noise level was 69.2 +/- 5.75 dB. In the audiometric screening, the hearing thresholds were within normal levels. Conclusion: The WHO guidelines state that noise levels in hospital areas should be 35-40 dB in the daytime and 30-40 dB in the evening. Our results exceed these guidelines at all times.Öğe Noise Pollution in Different Hospital Policlinics of İstanbul/Turkey(Galenos Yayincilik, 2013) Gültekin, Erdoğan; Develioğlu, Ömer Necati; Yener, Murat; Senay, Necmi; Külekçi, MehmetObjective: This study was performed to measure and analyse noise levels measured in different public hospital policlinics. Methods: Noise levels in general policlinics of five different public hospitals were measured by using a RadioShack digital sound level meter. The measurements were made from 8: 15 to 16: 00 hours. They were recorded and were compared with World Health Organisation (WHO) guidelines for community noise. Results: The average LminA level in Centre 1 was 61 +/- 1.73 dB and LmaxA level was 80.14 +/- 1.34 dB. The measurements in Centre 2 noted an average LminA level of 62.7 +/- 1.7 dB, LmaxA level of 82.42 +/- 1.39. The average LminA level in Centre 3 was 63.14 +/- 2.41 dB, LmaxA level was 83.57 +/- 2.93 dB. The measurements in Centre 4 noted an average LminA level of 59.85 +/- 1.06 dB, LmaxA level of 74.85 +/- 1.34. The average measurements in Centre 5 were 59.57 +/- 3.5 dB for LminA, 75.28 +/- 2.92 dB for LmaxA. The highest noise levels were recorded in Centre 3, but the difference was not statistically significant (p>0.05). Conclusion: The WHO guidelines state that noise levels in hospital areas should be 35-40 dB in the daytime and 30-40 dB in the evening. Turkish Noise Control Regulations also restrict the noise levels to maximum 40 dB. Our results exceed these guidelines at all times.Öğe Prevalence and risk factors for persistent otitis media with effusion in primary school children in Istanbul, Turkey(Elsevier Sci Ltd, 2010) Gültekin, Erdoğan; Develioğlu, Ömer Necati; Yener, Murat; Özdemir, İsmail; Külekçi, MehmetObjective: To determine the impact of environmental, epidemiologic and familial factors in the development of persistent otitis media with effusion (OME-OME treated with antibiotics and followed additional 12 weeks) in primary school children in Istanbul. Materials and methods: A total of 1800 children who were attending 4 ifferent primary schools in Sisli and Beyoglu districts of Istanbul were screened and 1740 children who met the inclusion criteria were enrolled into this Study. Questionnaires prepared in the Otorhinolaryngology Clinics of Taksirn Research and Training Hospital and the forms were delivered to the parents to be filled the day before examination of each child. The Forms were collected during the otoscopic examinations. Pure tone audiometry and tympanometry tests and pneumatic otoscopy were performed on the children who were diagnosed as OME by otoscopic examination. The association between the children diagnosed as OME and the answers to the questionnaires was evaluated. Results: The prevalence of persistent OME in this paper was 8.7% (152/1740). Frequency of smoking in both parents (p < 0.01) and mothers alone (p < 0.0001), the frequency of acute otitis media (AOM) and upper respiratory tract infection (URTI) in past 1 year (p < 0.0001), incidence of attending day care centers and creches (p < 0.0001), allergy history (p < 0.05), the number of siblings (p < 0.0001) and poor educational status of the parents (p < 0001) were statistically significant factors among children with OME compared to normal children. Sex factors (p > 0.05), mothers smoke history during pregnancy (p > 0.05), relative marriage (p > 0.05), smoking history of the fathers > 0.05) and duration of breastfeeding (p > 0.05) were not statistically significant. Conclusion: Environmental, epidemiologic and familial factors in the etiology of OME are important. The parents must be informed about the risk factors and symptoms of OME and by this way, the development or delayed diagnosis of the disease that may lead to permanent hearing loss may be prevented. (C) 2009 Elsevier Ireland Ltd. All rights reserved.Öğe Primer provox ses protezinin uygulanmasındaki başarı oranları, komplikasyonlar ve değiştirme nedenleri(2011) Garça, Mehmet Fatih; Yelken, Kürşat; Gültekin, Erdoğan; Külekçi, MehmetAmaç: Provox ses protezinin konuşmadaki başarı oranını, insitu ömrünü, oluşan komplikasyonları ve protezin değiştirilme nedenlerini araştırmaktır. Ek olarak başarı oranıyla cerrahi uygulama ve radyoterapi arasındaki ilişkiyi saptamaktır. Yöntem: 32 hastaya total larenjektomi ile eş seanslı trakeoesofageal fistül işlemi ile Provox ses protezi uygulandı. Bu hastaların 9’una yalnızca total larenjektomi, 23’üne total larenjektomi ile beraber boyun diseksiyonu ve bu 23 hastadan 17’sine de boyun diseksiyonu sonrasında bir ay süre ile radyoterapi uygulandı. Hiçbir hastaya krikofarengeal myotomi uygulanmadı. Bulgular: Protez uygulanan 32 hastanın 19’u (% 59) başarılı konuşmakta, 8’i (%25) konuşamıyor ve 5’i (% 16) kalitesiz konuşmaktaydı. Konuşma protezinin ömrü en kısa 20 gün ve en uzun 20 ay olup ortalama 8.5 ay olarak bulundu. Protez değişiminin en sık iki nedeni, protez içinden sıvı gelmesi ve/veya protez çevresinden saliva gelmesi idi. Majör komplikasyon gözlenmedi. En sık gözlenen minör komplikasyon protezde mantar kolonizasyonu idi. Uygulanan cerrahi protokolün (total larenjektomi, total larenjektomi ile beraber boyun diseksiyonu ve radyoterapi) ses protezi ile konuşabilme başarısını etkilemediği saptandı. Radyoterapinin uzun dönemde konuşmanın üzerine olumsuz etkisi görülmemekle beraber trakeoesofageal fistülde genişleme (%18.8) ve migrasyon (%4) komplikasyonunu arttırdığı gözlendi. Boyun diseksiyonu uygulanan hastalarda konuşma becerisi olumsuz etkilenmemekle beraber konuşma egzersizlerine başlama 20. güne uzamakta idi. Sonuç: Trakeoesofageal fistül ile primer provox ses protezi tatbiki başarı oranı yüksek ve komplikasyon oranı düşük, basit ve kısa sürede uygulanabilen yararlı bir ses rehabilitasyonu yöntemidir. Radyoterapinin ve boyun diseksiyonunun uzun dönemde provox ses protezi ile konuşma üzerine olumsuz etkisi bulunmamaktadır.
