Browsing by Author "Günhan, K"

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    Agents of Otomycosis in Manisa Region, Turkey, 1995-2011
    Degerli, K; Ecemis, T; Günhan, K; Baskesen, T; Kal, E
    Otomycosis, which is otitis externa caused by fungi, is common throughout the world especially in tropical and subtropical countries. However, the epidemiologic data about the etiologic agents of otomycosis in Turkey is limited. The aim of this retrospective study was to evaluate the agents of otomycosis in patients living at Manisa region (located at western Anatolia of Turkey). A total of 2279 cases [1465 male, 813 female; age range 1-87 (mean: 41.7) years] who were clinically prediagnosed as otomycosis at Celal Bayar University Hospital, between February 1995 and July 2011, were included in the study. External ear swab samples from patients with suspicion of otomycosis have been evaluated by routine mycological methods. Identification of mold-like fungi was based on colony morphology and microscopic examination of fungal structure, whereas germ tube test, growth characteristics on cornmeal-Tween 80 agar and API 20C AUX (bio-Merieux, France) system were used for the identification of yeast-like fungi. Of the samples, 28% (638/2279) were found positive by direct microscopy and 24% (544/2279) by culture methods. Among culture-positive cases the isolation rates of mold-like and yeast-like fungi were 66% (359/544) and 34% (185/544), respectively. The number of distribution of the molds were as follows; Aspergillus niger (180), Aspergillus fumigatus (95), Aspergillus terreus (32), Aspergillus flavus (23), Aspergillus spp. (14), Penicillium spp. (13), Trichophyton spp. (T.rubrum 1, T.mentagrophytes 1); while this distribution was as follows for the yeasts; Candida tropicalis (97), Candida albicans (39), Candida parapsilosis (21), Candida glabrata (19), Candida kefyr (4), C.guilliermondii (2), Candida krusei (1), Geotrichum candidum (1) and Trichosporon capitatum (1). It was notable that 96% (344/359) of mold-like fungi were Aspergillus spp., and 99% (183/185) of yeast-like fungi were Candida spp. The results of this study indicated that the most frequent agents of otomycosis were non-dermatophyte species such as Aspergillus, followed by Candida. Dermatophytes were isolated in a small number of otomycosis cases. These data will provide support to the establishment of antifungal therapy guidelines for otomycosis.
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    Multidimensional assessment of voice and speech after supracricoid laryngectomy with cricohyoidopexy
    Yücetürk, AV; Günhan, K
    This study was designed: to evaluate the vocal function in the patients with supracricoid laryngectomy (SCL) compared with normal subjects; to determine the factors affecting voice (such as number of arytenoid(s) preserved and movement of larynx and tongue base); and to determine the correlations between videolaryngostroboscopy, acoustic and perceptual parameters. Ten patients who underwent SCL with cricohyoidopexy for primary laryngeal squamous cell carcinoma were included into the study. Vocal function was investigated by means or videolaryngostroboscopy. Voice quality was assessed by means of objective acoustic analysis and subjective perceptual ratings by trained raters. Aberrant, incompetent, and rough mucosal wave was observed in the anterior and superior surfaces of arytenoids(s), the inferior part of tongue base and the lateral walls of the hypopharynx. The acoustic parameters were found to be significantly different from those of normal subjects. The values of perceptual scores were approximately within 50 per cent of normal range. The number of arytenoids spared did not affect acoustic or perceptual measurements. A rough, breathy, unpleasant but intelligible and acceptable voice could be obtained after SCL with cricohyoidopexy.
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    Lower Airway Inflammation in Nonasthmatic Allergic Rhinitis Patients
    Alpaydin, AÖ; Bora, M; Günhan, K; Isisag, A; Çelik, O; Çelik, P; Taneli, F; Yorgancioglu, A
    Objective: Allergic rhinitis and asthma have been considered as a single airway disease sharing a common pathophysiological mechanism of airway inflammation. We aimed to investigate the lower airway inflammation in allergic rhinitis patients without asthma. Material and Methods: Forty patients who referred to our tertiary care hospital's otorhinolaryngology clinic and diagnosed as moderate/severe persistent allergic rhinitis according to ARIA criteria were included in the study. After evaluation for the eligibility for the study, a nasal smear was taken, and rhinomanometry was performed to measure the nasal obstruction on visit 1. Twenty-four hours later from the visit 1, pulmonary functions including bronchial hyperactivity (BHR) were measured on visit 2. Twenty-four hours later from the visit 2, sputum induction was performed, and cell distribution of the sputums was evaluated. Results: Mean age of the 17 male and 23 female patients was 37 +/- 11. Nasal smear eosinophilia was studied in 36 of the patients and found positive in 36%. Nasal obstruction was demonstrated in 68% of the patients by rhinomanometry. BHR was positive in 30% of the participants. There was not any statistical significant relationship between nasal eosinophilia and nasal obstruction severity, BHR and induced sputum eosinophilia (p> 0.05). Among the induced sputums which were of good quality to be evaluated, 7.5% had an eosinophil ratio of 2%. Any relationship between induced sputum eosinophil percentages and FEV1, FEV1/FVC, nasal obstruction severity was not observed (p> 0.05). However, BHR was found to be significantly related with FEV1/FVC ratio which was >70% through the whole study population (r= 0.392 p= 0.012). Condusion: We could not demonstrate the expected relationship between nasal and lower airway inflammation markers in our study group of allergic rhinitis patients. This may be due to the small number of study population and strict exclusion of asthmatic patients as well as particularly the difficulties in standardization of the induced sputum technique.
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    Videofluoroscopic evaluation of the swallowing function after supracricoid laryngectomy
    Yücetürk, A; Tarhan, S; Günhan, K; Pabusçu, Y
    This study was designed to evaluate the swallowing function in patients with supracricoid laryngectomy (SCL) compared to normal subjects and to search for the factors affecting postoperative aspiration. Ten patients who underwent SCL with cricohyoidopexy (CHP) for primary laryngeal squamous cell carcinoma were included in the study. The control group consisted of 13 normal adult volunteer men with similar ages. The swallowing act of the subjects was evaluated by using videofluoroscopy (VFS) and videolaryngostroboscopy (VLS). The movements of the larynx were measured with regard to the hyoid bone, mandible and vertebral spine. The patients with SCL-CHP, except for two who had slight aspiration, had effective and near normal swallowing regarding the measurements of the movements of the hyoid bone. They could tolerate a near-normal oral diet. We have observed that the preventive precautions for aspiration are preserving the superior laryngeal nerves, suturing and positioning the cricoarytenoid unit as anterosuperiorly as possible, early decannulation and early onset of swallowing rehabilitation; the risk factors for aspiration are advanced stage of cancer, postoperative radiation and shortening of bolus transit time. VFS is useful for the patients with postoperative aspiration, because it is the definitive technique for anatomical and physiological evaluation of swallowing. We consider that the parameters of VLS and VFS, such as tongue base-arytenoid contact, presence of bolus splitting, pseudoepiglottis function, maximal opening of the pharyngoeosophageal sphincter and total movement of hyoid bone are important criteria to evaluate swallowing.
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    Candida Infection During Successful Treatment of Mucor Infection Through Antifungal and Minimal Invasive Surgery in a Child with Acute Lymphoblastic Leukemia
    Yildirim, AT; Gülen, H; Günhan, K; Nese, N; Özkol, M; Degerli, K
    Invasive mucormycosis is a fungal infection that is rare but has a high mortality rate. It is often seen in immune supressed patients with diabetic ketoacidosis, hematologic malignancy, or those that have undergone stem cell transplantation. Febrile neutropenia, swelling of the right cheek, and a necrotic area in the palate developed during the induction chemotherapy of a three year-old male patient with acute lymphoblastic leukemia. Minor debridements and antifungal treatment was applied, and in the sixth month of the treatment, softening of the right maxillary bone was detected in the same area. From the biopsy sample, Candida tropicalis grew in the culture, and was treated with combined antifungal medicines. This case is presented to emphasize the feasibility of mucor infection treatment via minor debridements and antifungal medicines without any need for major surgery, and also to emphasize that breaktrough fungal infections should not be ignored, in spite of the antifungal medicines that are highly effective and have broad-spectrum.
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    Transformation of the maxillary bone in adults with nasal polyposis: a CT morphometric study
    Serter, S; Günhan, K; Can, F; Pabusçu, Y
    PURPOSE Nasal polyposis (NP) in adult population is a common problem in otorhinolaryngology outpatient practice. Computed tomography (CT) is the ideal imaging method to investigate paranasal sinus diseases. There is yet no study in the literature measuring the morphometry of maxillary bone in NP. The objectives of this study are to correlate the airway variables obtained by CT findings of both chronic nasal airway obstruction and control group in an adult population, and to investigate whether the bony structure of the airway is affected or not. MATERIALS AND METHODS Forty NP cases that were followed up for 1-5 years by an otorhinolaryngologist were included in this retrospective study. Forty subjects who had normal findings reported on paranasal CT scans were randomly selected from our CT database as the control group. Maxillary and palatine bones (PB) were evaluated: the plane angle between the maxillary alveolar processes (MAP) and PB, and depth of the maxillary arch of both groups were compared. RESULTS The mean angle between MAP and PB plane was wider in the NP group (right 128.1 +/- 8.5 degrees and left 126.2 +/- degrees 8.5) than control group (right 106.6 +/- 8.1 degrees and left 105.5 +/- 7.3 degrees). The mean depth of maxillary arch was significantly smaller in the NP group (1.2 +/- 0.2 cm) than in the control group (1.4 +/- 0.2 cm). CONCLUSION There could be a relationship between nasal polyposis in adults and maxillary shape. The flattening and shallowing of the maxillary arch detected in patients with NP may indicate that the bony structural changes continue in adulthood.
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    The evaluation of pattern and quality of sleep in patients with chronic rhinosinusitis with nasal polyps
    Uz, U; Günhan, K; Yilmaz, H; Ünlü, H
    Objective: The goal of this study is to evaluate the impact of chronic rhinosinusitis with nasal polyps (CRSwNP) on sleep pattern and sleep quality before and after functional endoscopic sinus surgery using subjective and objective parameters. Methods: Twenty-two patients with CRSwNP were evaluated. All subjects underwent assessment by nasal endoscopy, rhinomanometry and computed tomography. Sleep pattern and sleep quality were evaluated by Pittsburgh sleep quality index (PSQI) and polysomnography (PSG). All patients were reassessed 6 months after surgery. Results: Nasal resistance decreased after the surgery (p < 0.001). Postoperative PSQI scores were significantly lower than preoperative scores (p < 0.001). The preoperative mean values of total apnea index and apnea-hypopnea index were 25.4 and 13.3, respectively. After surgery, the total apnea and apnea-hypopnea index had decreased significantly to 7.8 and 11.2, respectively (p = 0.009 and 0.019, respectively). Conclusion: In patients with CRSwNP, functional endoscopic sinus surgery significantly ameliorates sleep pattern and sleep quality. CRSwNP may be a predisposing factor for sleep related respiratory disorders. (C) 2017 Elsevier B.V. All rights reserved.