Browsing by Author "Katilmis, H"

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    Factors confusing the diagnosis of laryngopharyngeal reflux: the role of allergic rhinitis and inter-rater variability of laryngeal findings
    Eren, E; Arslanoglu, S; Aktas, A; Kopar, A; Ciger, E; Önal, K; Katilmis, H
    The objective of the study was to determine the inter-rater variability in assessment of laryngeal findings and whether diagnosing laryngopharyngeal reflux based on the laryngeal findings and history alone without considering allergic rhinitis leads to the overdiagnosis and overtreatment of laryngopharyngeal reflux. Patients with positive and negative skin prick tests were recruited from an allergy clinic in a tertiary teaching university hospital. All subjects completed the Reflux Symptom Index (RSI) and underwent laryngeal examinations by three physicians blinded to the skin prick test results and the Reflux Finding Score (RFS) was determined. RFS > 7 or RSI > 13 was considered reflux positive. Fleiss' kappa (kappa) was used to measure inter-rater agreement. The inter-rater agreement was low for pseudosulcus vocalis (kappa = 0.078), ventricular obliteration (kappa = 0.206), diffuse laryngeal edema (kappa = 0.204), and posterior laryngeal hypertrophy (kappa = 0.27), intermediate for laryngeal erythema/hyperemia (kappa = 0.42) and vocal fold edema (kappa = 0.42), and high for thick endolaryngeal mucus (kappa = 0.61). Although the frequency of allergy was high, there was no significant difference between allergy-positive and laryngopharyngeal reflux-positive patients. On logistic regression analysis, thick endolaryngeal mucus was a significant predictor of allergy (p = 0.012, odds ratio 0.264, 95 % confidence interval 0.093-0.74). The laryngeal examination for reflux is subject to marked inter-rater variability and allergic laryngitis was not misdiagnosed as laryngopharyngeal reflux. The presence of thick endolaryngeal mucus should alert physicians to the possibility of allergic rhinitis/laryngitis.
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    Increased expression of VEGF, iNOS, IL-1β, and IL-17 in a rabbit model of gastric content-induced middle ear inflammation
    Basoglu, MS; Eren, E; Aslan, H; Kolatan, HE; Özbay, C; Inan, S; Karaca, F; Öztürkcan, S; Katilmis, H
    Objective: To investigate the histopathological changes and the expression of vascular endothelial growth factor (VEGF), inducible NO-synthase (iNOS), endothelial NO-synthase (eNOS), interleukin (IL)-1 beta, and IL-17 in the rabbit middle ear mucosa after direct gastric content exposure. Methods: Exploratory controlled study in which histological and immunochemical features were studied after gastric content-induced inflammation was established in rabbits. Sixteen healthy rabbits were divided into two equal groups. Gastric contents of an animal were injected into the middle ear of the same animal for 20 days. Saline was injected into the middle ear of the animals in the control group. The rabbits were humanely killed on day 27. Inflammation was assayed by light microscopy. Immunochemical staining was performed for VEGF, iNOS, eNOS, IL-1 beta, and IL-17 expression. Experimental and control animals were examined using the same protocol. Results: The expression levels of VEGF, INOS, IL-1 beta, and IL-17 differed significantly between the experimental and control groups (p = 0.018, p = 0.010, p = 0.002, and p = 0.002, respectively). The expression level of eNOS was not significantly different between the two groups (p = 0.132). Conclusion: This study demonstrates that gastroesophagial reflux induced middle ear inflammation is associated with increased expression of VEGF, IL-1 beta, IL-17, and iNOS. (C) 2011 Elsevier Ireland Ltd. All rights reserved.
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    Diagnosis of allergic rhinitis: inter-rater reliability and predictive value of nasal endoscopic examination: a prospective observational study
    Eren, E; Aktas, A; Arslanoglu, S; Kopar, A; Ciger, E; Özkul, Y; Önal, K; Katilmis, H
    ObjectiveTo determine the inter-rater reliability of nasal endoscopic findings and the feasibility of diagnosis of allergic rhinitis based solely on symptoms and nasal endoscopy. DesignProspective observational study. SettingUniversity Teaching hospital. ParticipantsOne hundred and eight patients were referred from the allergy clinic included in the study. Main outcome measuresPredictive value of symptoms and nasal endoscopic examination to diagnose allergic rhinitis and inter-rater reliability of the examination were evaluated. ResultsLogistic regression analysis of patient symptoms and nasal examination findings revealed no significant predictive power for any of the symptoms or examination findings. The Fleiss coefficient of the three raters was calculated. Inter-rater variability among the three physicians demonstrated that mucosal oedema (=0,48, P<0.001), polypoid degeneration of the inferior turbinate tail (=0.48, P=0.01), nasal polyps (=0.96, P<0.001) and nasal septal deviation (=0.65, P=0.01) showed significant inter-rater agreement. A low coefficient (0.29) was found, and the inter-rater variability among physicians in interpreting the characteristics of nasal secretions was significant (P=0.04). The inter-rater variability among the three physicians suggested that turbinate hypertrophy (=0.31) and turbinate colour (=0.38) showed no significant inter-rater agreement. ConclusionsPatient symptoms and nasal endoscopy findings do not provide reliable diagnosis of allergic rhinitis. Turbinate colour and hypertrophy are believed to be related to allergic rhinitis; however, these were subject to marked inter-rater variability in this study.
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    Inhibitory effect of N-acetyl cysteine and ascorbic acid on the development of myringosclerosis: An experimental study
    Dündar, R; Inan, S; Muluk, NB; Cingi, C; Ilknur, AE; Katilmis, H
    Objectives: This study investigated the effects of ascorbic acid and N-acetyl cysteine (NAC) antioxidants on the development of myringosclerosis (MS) in an experimental model. Methods: Myringotomies were performed in the ears of 15 guinea pigs, and Spongostan (R) pieces were placed on the perforated regions of the tympanic membrane. The subjects were divided randomly into three groups and treated with three different solutions on the Spongostan-group 1: (control, 0.9% saline), group 2 (ascorbic acid), and group 3 (NAC). On day 15 after treatment, specimens from the tympanic membranes were obtained and examined via light microscopy. Sclerosis and inflammation scores and the tympanic membrane thicknesses were evaluated. Immunohistochemical methods were used to evaluate the expression of VEGF, TGF-beta, iNOS, and IL1-beta in all groups. Results: Lower sclerosis and inflammation scores and reduced tympanic membrane thicknesses were observed in groups treated with NAC or ascorbic acid compared with the control group. Immunohistochemical studies revealed significantly less expression of VEGF, TGF-beta, and iNOS in groups 2 and 3 compared with group 1. Additionally, IL1-beta expression was significantly less in group 3 than in group 1. Compared with group 1, group 2 animals exhibited reduced inflammation in the lamina propria, fewer active fibroblasts, less leukocyte infiltration, and decreased thickness of the vessels; group 3 animals exhibited decreased numbers of active fibroblasts and collagen fibers in the lamina propria. Conclusions: Inflammation scores, cellular infiltration, and expression of VEGF, TGF-beta, and iNOS were reduced by ascorbic acid and/or NAC treatments, thereby decreasing MS development. Decreased expression of IL1-beta was observed only in animals treated with NAC. (C) 2014 Elsevier Ireland Ltd. All rights reserved.
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    Efficiency of Bioflavonoids in the Prevention of Experimental Myringosclerosis
    Ilknur, AE; Dundar, R; Basoglu, S; Inan, S; Aktas, S; Aslan, H; Ozkul, Y; Ozturkcan, S; Katilmis, H
    Objectives/Hypothesis: It has been noted that some materials with anti-inflammatory and antioxidant effects decrease sclerotic lesions in experimental myringosclerosis. Our purpose in this study is to investigate the effect of micronized purified flavonoid fraction (MPFF), an antioxidant with anti-inflammatory effects, in experimental myringosclerosis in guinea pigs. Materials and Methods: Two study groups were formed. The first group was administered 100mg/kg/day MPFF by catheter for five days before myringotomy and 10 days after myringotomy, while the second group was administered distilled water by the same method, before and after myringotomy. On the 15th day of the study, after the tympanic membranes were examined otomicroscopically for myringosclerosis, they were removed by dissection together with the bone annulus, for histochemical and immunohistochemical examinations. Results: In the MPFF group, the otomicroscopical sclerosis score, inflammation score and tympanic membrane thickness were significantly less than those in the untreated group (p<0.05). It was also determined that the immunoactivity of the anti-VEGF, anti-TGF-beta, anti-eNOS, anti-iNOS, and anti-IL1-beta primary antibodies, which are known to have an important role in angiogenesis and inflammation, significantly decreased in the MPFF group (p<0.05). Conclusion: In conclusion, this study shows that orally administered MPFF can be efficient in the prevention of experimental myringosclerosis in guinea pigs.