Browsing by Author "Unlu, HH"
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Item Neural Control of Eustachian Tube FunctionSongu, M; Aslan, A; Unlu, HH; Celik, OObjectives/Hypothesis: It has been hypothesized that middle ear pressure can be controlled by the Eustachian tube through a neuronal reflex arc in animal models. We aimed to define the role of the neuronal control mechanisms in regulating middle ear pressure in humans. Study Design: Prospective study. Methods: The study population consisted of 95 ears of 95 volunteers. The mechanoreceptors on the tympanic membrane and the baroreceptors in the middle ear, which are assumed to form the afferent plexus of the neuronal reflex arc, were blocked by topical administration of lidocaine hydrochloride, in various patient groups. The Eustachian tube functions forming the efferent plexus of the neuronal reflex arc were evaluated by manometric tests both before and after blocking the possible afferent plexus in each study group. Results: The baroreceptors established in the tympanic plexus might possibly have an effective role in this mechanism where the mechanoreceptors on the tympanic membrane seem to have a minor effect. Conclusions: Neuronal control mechanism could play an important role in regulating Eustachian tube function in humans.Item Orbital exenteration: A dilemma in mucormycosis presented with orbital apex syndromeSongu, M; Unlu, HH; Gunhan, K; Rker, SS; Nese, NBackground: Mucormycosis is an uncommon, rapidly progressive, commonly fatal, opportunistic, fungal paranasal sinus infection. The most critical decision in the management of rhino-orbital mucormycosis is whether the orbit should be exenterated. The literature fails to provide a broad base of information of how physicians determine the need for exenteration in daily practice. The decision for exenteration often depends on the judgment of the treating otolaryngologist. The authors report their experience and outline that orbital exenteration may not be mandatory in all cases of rhino-orbital mucormycosis. Methods: The medical records from Celal Bayar University Medical Faculty Department of Otorhinolaryngology/Head and Neck Surgery were retrospectively searched from 1995 to 2007 for three cases with rhino-orbital mucormycosis, treated without orbital exenteration. Results: All patients with rhino-orbital mucormycosis who were treated without exenteration survived. Conclusion: The favorable outcome was attributable to rapid correction of the underlying medical condition; wide local excision and debridement of all involved and devitalized sinonasal and periorbital tissue, while establishing adequate sinus and orbital drainage; daily endoscopic assessment with multiple sinus debridement when necessary; daily irrigation of the involved areas; and high-dose i.v. amphotericin B.Item Organized hematoma of the maxillary sinus mimicking tumorUnlu, HH; Mutlu, C; Ayhan, S; Tarhan, SThe authors present two cases of organized hematoma of the maxillary sinus. Both patients showed no bleeding abnormalities. Clinical symptoms, signs and radiologic appearance of the mass mimicked tumor during the initial diagnosis of the disease. To our knowledge, this is the first article describing organized hematoma in the maxillary sinus mimicking tumor without bleeding history and disorders. A provisional diagnosis of organized hematoma should be considered when a patient with history of epistaxis develops a slow-growing mass of the cheek and/or nasal obstruction. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.Item Comparison of surgical outcomes in primary endoscopic dacryocystorhinostomy with and without silicone intubationUnlu, HH; Aslan, A; Toprak, B; Guler, CThe surgical outcome of endoscopic endonasal dacryocystorhinostomy was analyzed in 30 cases of post saccal stenosis. Intubation with silicone tubing was used in 14 cases (46.7%) and not used in 16 cases (53.3%). Surgical success was evaluated subjectively and objectively. The patients' complaints were improved in 85.7% of cases in the intubation group, and in 81.3% of the group in which no stent was used. Postoperative endoscopic examinations revealed that the rhinostomy opening was visible in 11 cases without intubation (68.8%) and 9 cases with intubation (64.3%). Six patients in the intubation group (42.9%) had granulation tissue at the rhinostomy site. Four patients (28.6%) had complaints regarding the intubation. Considering the similar surgical success rates, and the granulation formation, patient discomfort, and cost related to intubation, we recommend endoscopic dacryocystorhinostomy without intubation as the treatment of choice in cases of chronic epiphora due to postsaccal stenosis of the lacrimal canal.Item Radiologic anatomy of the sphenoid sinus for intranasal surgeryMutlu, C; Unlu, HH; Goktan, C; Tarhan, S; Egrilmez, MEndoscopic surgery of the sphenoid sinus can present the operator with a considerable challenge. The relationship of the sphenoid sinuses, in particular on the lateral wall, to the carotid artery, optic nerve, as well as the other anatomic structures, is of utmost importance. Surgical complications can occur because of a lack of orientation during dissection. To avoid the complications or lessen, somehow, the rate of complications, some described the technique consisting of the opening of the sphenoid sinus ostium medially. Me studied 69 axial high resolution computed tomography (HRCT) of temporal bones to reveal the relationship of sphenoid sinus to the vital structures and to get some measurements in the sphenoid sinus. The lateral distance from the sphenoid ostium revealed that the lateral distance was about the distance between both ostea. We consider that in selected cases the dissection might be carried out laterally from the sphenoid ostium for safe enlargement of the ostium and approaching the sinus.Item Osteochondroma of the posterior nasal septum managed by endoscopic transnasal transseptal approachUnlu, HH; Unlu, Z; Ayhan, S; Egrilmez, MA case of osteochondroma of the posterior nasal septum is presented. A 57-year-old female patient presented with a history of bilateral nasal obstruction for 20 years. To the best of our knowledge, this is the second reported case of an osteochondroma of the nasal septum. It was treated by endoscopic transnasal transseptal surgery.Item Facial growth after middle turbinate resection: An experimental study in the rabbitEgrilmez, M; Mutlu, C; Unlu, HH; Celik, OBackground: The aim of this study was to determine the effects of total middle turbinate resection on midfacial growth through a morphometric analysis on an animal model. Methods: Twenty eight male New Zealand white rabbits were used. The animals were divided into three groups: group 1, elevation and relocation Of the nasal bone was performed; group 2, concha resection was performed: group 3, control group with no surgical procedure. The surgery was done at 8-10 weeks of age and the skull of each subject was sampled as they reached maturity. The determined distances then were measured by using landmarks identified oil skull. The supplied data were evaluated by using the Mann-Whitney U test. Results: Deviation of the nasal axis to the opposite side of the resected concha and an increase in the width of nasal bone were observed only in group 2. In group 1, all increase nasal bone length and zygomaticonasal distances was determined ill both the operated and the unoperated sides of nasal bones. Conclusion: This animal experiment showed that operations on the nasal bone or concha resection affected the midfacial growth ill rabbits. The effects of middle turbinate resection to midfacial development should be evaluated by additional studies. Vile recommend only limited, conservative surgical procedures 017 the middle turbinate. saving all the vital mucosa, periosteum. and bone.Item Inferior concha bullosaUnlu, HH; Altuntas, A; Aslan, A; Eskiizmir, G; Yucel, AItem Injury to the lacrimal apparatus after endoscopic sinus surgery: Surgical implications from active transport dacryocystographyUnlu, HH; Goktan, C; Aslan, A; Tarhan, SIn order to evaluate the lacrimal drainage system injury after functional endoscopic sinus surgery, surgical records and postoperative active transport dacryocystography imaging of 31 patients were analyzed. Presence of the lacrimal bone dehiscence and no passage of the contrast material into the inferior meatus were noted as the signs of injury to the lacrimal canal on active transport dacryocystography. Bony dehiscence was detected in 53.2% of the operated sides but 20% of the nonoperated sides. No passage of the contrast material into the inferior meatus was observed in 14.9% of the operated sides. There were no cases of epiphora postoperatively. The lacrimal drainage system injury was more frequently observed on the left sides operated. We conclude that lacrimal drainage system injury might occur in various extents during functional endoscopic sinus surgery. However, it does not necessarily result in postoperative epiphora. Performing the middle meatal antrostomy in posteroinferior direction, and uncinectomy with backbiting forceps or a shave! might help in reducing the lacrimal injury. Active transport dacryocystography can be adopted as an alternative diagnostic tool in detection of the lacrimal injury.Item The evaluation of eustachian tube function in patients with chronic otitis mediaYuceturk, AV; Unlu, HH; Okumus, M; Yildiz, T; Filiz, UIn this study we evaluated eustachian tube function in patients with chronic otitis media and compared the results with normal subjects. Two different eustachian tube function tests were applied to 60 ears of the chronic otitis media group and 146 ears of the control group. While eustachian tube dysfunction was observed in 71.7% of the chronic suppurative otitis media group, it was only seen in 34.9% of the control group.Item Pleomorphic adenoma originated from the inferior nasal turbinateUnlu, HH; Celik, O; Demir, MA; Eskiizmir, GAlthough pleomorphic adenoma is the most common benign neoplasm of the salivary glands, it has also been reported to be present in the neck, ear, mediastinum, external nose and nasal cavity. Intranasal localization of this lesion is very rare and mainly originates from the nasal septum. From wherever the lesion originates, the main treatment modality should be surgical. We presented a very rare case of intranasal pleomorphic adenoma originated from the inferior nasal turbinate. Due to the expansile nature of the lesion, a midfacial degloving approach was preferred. (C) 2003 Elsevier Ireland Ltd. All rights reserved.Item Inverted papilloma with new bone formation: Report of three casesUnlu, HH; Songu, M; Ovali, GY; Nese, NBackground: An inverted papilloma (IP) is a benign sinonasal tumor of ectodermal origin, which is locally aggressive and destructive, tends to recur if incompletely removed, and has significant malignant potential. On CT scan, the appearance of an IP is variable and nonspecific but most commonly it appears to have soft tissue density, The association of IPs and new bone formation is extremely rare; to the best Of our knowledge, only one case has been reported in the literature to date. Methods: We report three cases with existence of bony mass surrounded by polypoid soft tissue diagnosed as IP histopathologically. Results: The nature, shape, and location of the bony mass were not in concordance with trapped bone, with tumoral calcifications, or with osteoma. Conclusion: We propose that with regard to the three cases presented here, new bone formation may be associated with IP pathologically. We also believe that additional investigations are required to characterize the pathophysiological mechanisms involved in neoplasm-induced osteogenesis.Item Fluorescein dye disappearance test in patients with different degrees of epiphoraToprak, AB; Erkin, EF; Kayikçioglu, Ö; Seymenoglu, G; Güler, C; Unlu, HHPURPOSE. To assess the diagnostic efficacy of a modification of the fluorescein dye disappearance test (DDT) in patients with different degrees of epiphora. METHODS. DDT was performed by instilling a drop of 2% fluorescein in the eye. Schirmer tear test strips were placed in the lower conjunctival fornix, after 3 and 10 minutes. The colour dilution on the strips was compared to a scale with known standards and the most closely comparable colour dilution was chosen and recorded as the visual scale test (VST) grade of the strip. The grey-scale value (GV) of each strip was calculated by computer image analysis. The control group comprised 44 patients, mean age 44.8 years (SD 7.5, range 30-60). There were 13 patients in group 1 with moderate epiphora; mean age was 44.2 years (SD 9.5, range 30-60). There were 17 patients in group 2 with severe epiphora; mean age was 48.3 years (SD 7.7, range 37-60). RESULTS. VST and GV differed significantly between controls and group 1 patients at 3 minutes (p=0.002, p=0.001), and between controls and group 2 patients at 3 minutes (p<0.001, p<0.001). There was no difference between groups 1 and 2 patients in VST and GV at 3 minutes. The differences were highly significant between controls and group 1 at 10 minutes (p=0.001, p=0.007), and between controls and group 2 at 10 minutes (p<0.001, p<0.001). The differences in GV and VST between groups 1 and 2 were significant at 10 minutes (p=0.026, p=0.018). CONCLUSIONS. This modified DDT permits identification of different degrees of epiphora in a non-invasive manner, it can therefore be used to evaluate the outcome of different treatment strategies.Item Assessment of symptomatic patients after endoscopic sinus surgery with special reference to the frontal sinus: Comparative radiologic analysisUnlu, HH; Eskiizmir, G; Tarhan, S; Ovali, GYPurpose: To reveal the role of potential risk factors in frontal recess dissection (FRD), middle turbinate resection (MTR), sinonasal polyposis, and extension of disease in postoperative frontal sinus opacification by determining radiologic changes after endoscopic sinus surgery (ESS) in symptomatic cases using computed tomography (CT). Study Design: Retrospective analysis of prospectively collected data from symptomatic patients after ESS. Methods: Postoperative CT scans were taken in all symptomatic patients during their least symptomatic period or after maximal medical therapy. The radiologic findings of each sinus were compared, and the outcome of ESS was statistically evaluated. Furthermore, FRD, MTR, sinonasal polyposis, and extension of disease were analyzed for postoperative frontal sinus opacification. Results: In our study, 101 sinuses of 61 symptomatic patients were examined. A significant improvement in opacification in all sinuses was detected postoperatively. Multivariate analysis of all potential risk factors revealed that postoperative frontal sinus opacification was affected only by sinonasal polyposis (odds ratio [OR] 3.32; 95% confidence interval [CI] 1.04-10.58) and extension of disease (OR 16.93; 95% CI 4.33-66.23). Conclusions: Our study revealed that surgical procedures such as FRD and/or MTR may not directly affect postoperative frontal sinus opacification. On the contrary, sinonasal polyposis and extension of disease seemed to be the main risk factors of this issue.Item The intracranial complication of acute isolated sphenoid sinusitisUnlu, HH; Aslan, A; Goktan, C; Egrilmez, MAcute isolated sphenoid sinusitis is a rare, potentially destructive entity, which has indistinct clinical findings and non-specific symptoms. Hence, it can be easily be misdiagnosed. We present and discuss a case of an isolated sphenoiditis with intracranial complication. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.Item Long-term results in endoscopic dacryocystorhinostomy: Is intubation really required?Unlu, HH; Gunhan, K; Baser, EF; Songu, MOBJECTIVE: The long-term (median follow-up eight years) results of endoscopic dacryocystorhinostomy approach and silicone intubation were evaluated by various aspects. STUDY DESIGN: Case series with planned data collection of 38 procedures for postsaccal stenosis were analyzed. SUBJECTS AND METHODS: Silicone intubation was not used in 19 of the randomly selected procedures. Anatomical and functional surgical success was evaluated subjectively and objectively. RESULTS: The patients' complaints improved in 84.2 percent of eyes in the intubation group, and in 94.7 percent of the group without intubation, with a mean follow-up of 112 and 96 months after surgery. respectively. Postoperative endoscopic examinations revealed that the rhinostomy opening was visible in 17 sides with intubation (89.5%) and IS sides without intubation (94.7%). CONCLUSIONS: Considering the similar surgical success rates. and disadvantageous factors such as granulation formation, patient discomfort. and cost related to intubation, we recommend endoscopic dacryocystorhinostomy without intubation as the treatment of choice in cases of chronic epiphora due to postsaccal stenosis of the lacrimal drainage system.Item The variational anatomy of the external aperture of the human vestibular aqueductMutlu, C; Govsa, F; Unlu, HH; Senyilmaz, YA study was undertaken to demonstrate the variational anatomy of the external aperture of the vestibular aqueduct in 90 human temporal bones obtained from 58 cadavers, Topographic landmarks of the posterior surface of the petrous bone are useful for general orientation and include the external aperture of the vestibular aqueduct, internal auditory meatus, sigmoid sinus, subarcuate fossa, superior petrosal sinus and cochlear canaliculus. We determined the mean distances from the external aperture of vestibular aqueduct to the above structures to be 10.98, 11.21, 9.42, 10.27 and 13.90 mm, respectively. Furthermore, the length of the external aperture of the vestibular aqueduct revealed significant differences between the right and left sides. The distances between the EAVA and certain anatomical structures on the posterior surface of the temporal bone should be taken into consideration during surgery. Knowing the variability of the position of the external aperture of the vestibular aqueduct may help surgeons avoid traumatizing, and thus producing inadvertent lesions to the hearing mechanism.