Browsing by Author "Günhan K."
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Item Supracricoid laryngectomy: oncological and functional outcome.(2004) Yücetürk A.V.; Günhan K.OBJECTIVES: The aim of this study was to evaluate the oncological outcome and postoperative course, mortality, morbidity, and functional results of supracricoid laryngectomy (SCL). PATIENTS AND METHODS: The study included 15 consecutive patients who underwent SCL for primary laryngeal squamous cell carcinoma and had a follow-up period of more than two years. Unilateral arytenoidectomy was required in seven of the SCLs. All of the patients with supraglottic tumors and the patients with glottic T2-3 tumors underwent neck dissection in the same session with SCL. Adjuvant radiotherapy was applied in two patients with pN2 and pN3, respectively. RESULTS: The mean time for starting oral feeding was 6 days (range 3-10 days) and the time for adequate oral taking was 12.5 days (range 7-25 days). Nasogastric tube was removed between the seventh and 49th postoperative days (mean 15.7 days). All the patients were decannulated successfully in 10 to 38 days (mean 18 days) and had a satisfactory swallowing, a well-understood speech, and an intelligible voice quality. The hospitalization period was 12 to 46 days (mean 23.4 days). The durations of adequate oral feeding, nasogastric tube removal, decannulation, and hospitalization were longer in patients with one arytenoid preserved than those with bilateral arytenoids preserved, but the difference was not statistically significant. Postoperative complications were observed in three patients. Wound infection was found in two patients in the early postoperative period. One patient with a T3 supraglottic tumor that involved the medial wall of the pyriform sinus developed aspiration pneumonia twice in six months after the first operation. This patient underwent total laryngectomy seven months after the first operation. Recurrences and mortality did not occur in the follow-up period. The mean follow-up of the patients was 50.3 months (range 26-80 months). CONCLUSION: Supracricoid laryngectomy has obvious functional advantages over total laryngectomy with similar local control rates.Item Multidimensional assessment of voice and speech after supracricoid laryngectomy with cricohyoidopexy(2004) Yücetürk A.V.; 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.Item Videofluoroscopic evaluation of the swallowing function after supracricoid laryngectomy(2005) Yücetürk A.V.; Tarhan S.; Günhan K.; Pabuşçu 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. © Springer-Verlag 2004.Item Transformation of the maxillary bone in adults with nasal polyposis: A CT morphometric study(2010) Serter S.; Günhan K.; Can F.; Pabuşçu 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° and left 126.2 ± 8.5°) than control group (right 106.6 ± 8.1° and left 105.5 ± 7.3°). 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. © Turkish Society of Radiology 2010.Item Agents of otomycosis in manisa region, Turkey, 1995-2011; [Manisa bölgesinde otomikoz etkenleri, 1995-2011](2012) Deǧerli K.; Ecemiş T.; Günhan K.; Başkesen 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-Mérieux, 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), Ceotrichum 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.Item The evaluation of pattern and quality of sleep in patients with chronic rhinosinusitis with nasal polyps(Elsevier Ireland Ltd, 2017) Uz U.; Günhan K.; Yılmaz 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. © 2017 Elsevier B.V.Item Regenerative Medicine in Rhinology(Springer International Publishing, 2019) Günhan K.; Uz U.Regenerative medicine, using stem cells with or without scaffolds, allows surgeons to treat congenital or acquired defects with normal structure and functions. Although stem cell and regenerative medicine are nowadays used quite often in some areas of medicine, it is obvious that they are in their crawling stage in reconstructive surgery and in rhinology. However, it is not difficult to predict that it will become popular in the next few decades and will be among the treatment regimens in the guidelines. The various developments in isolation, duplication, and differentiation of stem cells and three-dimensional scaffolds suggest that some of the more frequently applied therapies may be shelved in the close future. Stem cells are categorized as embryonic stem cells, induced pluripotent stem cells and adult stem cells. Adult stem cells are generally preferred in practice nowadays due to ease of isolation and differentiation stages. The purpose of this section is to provide information on stem cell applications and regenerative medicine in rhinology at present and in close future. © Springer Nature Switzerland AG 2020.Item Clinical Assessment of Mucociliary Disorders(Springer International Publishing, 2019) Uz U.; Günhan K.; Cohen N.There has been growing appreciation of the significant role played by the mucociliary transport system in the body. Mucociliary clearance is a critical host defense mechanism of the airways. Effective mucociliary clearance requires appropriate mucus production and coordinated ciliary activity. Mucociliary transport is responsible for primary innate immunity in the respiratory tract. In order to assess mucociliary transport and diseases resulting from mucociliary transport dysfunction, it is first necessary to understand the cellular anatomy and physiology that drive mucociliary function. The primary function of this epithelium is as a protective barrier. There are two different liquid layers coating the epithelial surface: the viscous outer gel layer and the thin inner periciliary layer. The gel layer of the mucus consists of mucin glycoproteins, secreted by goblet cells and submucosal glands. The mucin traps the bacterial compounds, pathogens, and inhaled debris, and coordinated ciliary activity propels the debris-laden mucus toward the glottis for elimination. This action is called mucociliary clearance. Ciliary disorders are divided into two categories: primary (inherited) and secondary (acquired). Primary ciliary dyskinesia (PCD) is a collection of genetic defects in cilia structure resulting in defective ciliary activity. Secondary ciliary dyskinesia (SCD) or acquired ciliary dyskinesia is a transient defect immunociliary clearance that occurs after viral or bacterial infection, tobacco smoke, pollutant exposure, as well as during allergic inflammation. In this chapter, clinical assessment of mucociliary disorders are discussed. © Springer Nature Switzerland AG 2020.Item Correlation of Disease Severity and Systemic Inflammatory Markers in Patients with Chronic Rhinosinusitis with Nasal Polyps(AVES, 2023) Uz U.; Günhan K.; Eskiizmir G.Objective: The aim of this study is to evaluate the relationship between Lund-Mackay scores, osteitis severity, and neutrophil lymphocyte ratio, platelet lymphocyte ratio, basophil lymphocyte ratio, eosinophil lymphocyte ratio, and systemic immune inflammation index in patients with chronic rhinosinusitis with nasal polyps. Methods: Patients who were diagnosed with chronic rhinosinusitis with nasal polyps and underwent endoscopic sinus surgery between 2014 and 2020 were evaluated retrospectively. Lund-Mackay scores and osteitis severity (Hounsfield Unit) were determined separately for each nasal cavity by examining preoperative computed tomog-raphy images. Lund-Mackay and Hounsfield Unit scores were compared with the preoperative neutrophil lympho-cyte ratio, platelet lymphocyte ratio, basophil lymphocyte ratio, eosinophil lymphocyte ratio, and systemic immune inflammation index. Results: A total of 39 patients (24 males, 15 females) (78 sides) enrolled in the study. There was a positive correlation between right-sided Lund-Mackay scores and ipsilateral Hounsfield Unit (r = 0.343, P =.033). Similarly, there was a positive correlation between left nasal cavity Lund-Mackay scores and ipsilateral Hounsfield Unit (r = 0.376; P =.018). No statistically significant correlation between Lund-Mackay scores and Hounsfield Unit values, and neutrophil lympho-cyte ratio, platelet lymphocyte ratio, basophil lymphocyte ratio, eosinophil lymphocyte ratio, and systemic immune inflammation index values were detected. Conclusion: In the present study, no correlation between chronic rhinosinusitis with nasal polyps severity and systematic inflammatory markers was demonstrated. © Author(s).Item Extraordinary Complication of COVID-19 Swab Testing: CSF Rhinorrhea(Lippincott Williams and Wilkins, 2023) Uz U.; Günhan K.; Pabuşcu Y.; Mutlu S.; Kamiloǧlu U.Coronavirus disease 2019 (COVID-19) is a highly contagious disease that has reached pandemic status. The diagnosis of COVID-19 is made using the polymerase chain reaction test to evaluate a swab taken from the naso/oro-pharyngeal area. Since COVID-19 is still a pandemic, it is thought that the use of this diagnostic test will be on the agenda for a while. A patient with COVID-19 symptoms presented with unilateral cerebrospinal fluid rhinorrhea after a nasopharyngeal swab test. Although nasopharyngeal swabs are taken very frequently, the complication rate is very low. However, life-threatening complications can be observed on rare occasions, and care should be taken. © 2023 Lippincott Williams and Wilkins. All rights reserved.