Browsing by Author "Unlu H."
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Item Morphometric analysis of anatomical relationships of the facial nerve for mastoid surgery(2001) Aslan A.; Goktan C.; Okumus M.; Tarhan S.; Unlu H.Surgical anatomical relationships of the facial nerve (FN) with several landmarks used in mastoid surgery were studied in temporal bone axial high resolution CT scans of 90 patients (180 ears). The shortest distances between the FN and external auditory canal (EAC), sigmoid sinus (SS), posterior fossa dural plate (PFD), and joint of the bony EAC with the lateral surface of the mastoid (M) were measured. These measurements were also analysed in respect of pneumatization and side differences. On average, it was found that FN-EAC was 2.9 mm, FN-SS was 10.5 mm, FN-PFD was 7.3 mm and FN-M was 15.3 mm. FN-EAC was found to be longer in poorly pneumatized bones whereas other distances were longer in pneumatized bones. FN-M was found to be longer on the right side.Item Increased expression of angiogenic markers in patients with seasonal allergic rhinitis(2004) Kirmaz C.; Ozbilgin K.; Yuksel H.; Bayrak P.; Unlu H.; Giray G.; Kiliccioglu B.Background. Increased vascularity due to neo-angiogenesis is an essential part of airway remodelling. Vascular endothelial growth factor (VEGF), CD34 and von Willebrand's factor (FvW) are known angiogenic markers. Angiogenesis and airway remodelling has been documented in asthma but not in allergic rhinitis.Objective: We aimed to investigate the presence of increased angiogenesis and its relation to angiogenic molecules, namely VEGF, CD34 and FvW, in endothelial cells of nasal mucosa in patients with seasonal allergic rhinitis (SAR), using three different immunohistochemical analysis methods, namely HSCORE, microvessel density (MVD) and vascular surface density (VSD). The findings in allergic rhinitis were compared with the findings in nasal septal deviation (NSD), which is not associated with increased angiogenesis. Methods. Twenty patients with symptomatic SAR, who were not under treatment, were enrolled in the study. Ten patients with NSD, who needed surgical therapy, served as the control group. Demographic characteristics did not differ between the two groups. Inferior turbinate biopsy was obtained from SAR patients and control patients, under local anaesthesia and during surgery respectively. All biopsies were evaluated for angiogenesis on the basis of VEGF, CD34 and FvW by two blinded histologists using three immunohistochemical analysis methods (HSCORE, MVD and VSD). Results. HSCORE, estimated on the basis of each staining technique, showed statistically significant differences among the two groups (p=0.002; p=0.045; p=0.016, respectively). Anti-CD34 and anti-VEGF showed higher MVD values in SAR when compared to the controls (p=0.038; p=0,009, respectively). No statistically significant difference was found in Anti-FvW-based MVD between SAR patients and controls (p=0.071). The measurements of VSD for FvW and VEGF from nasal biopsy specimens displayed a statistically significant difference between the two groups (p=0.004; p=0.0001, respectively). However, measurement of VSD for CD-34 was not significantly different between the groups (p=0.086). On the other hand, morphometric data obtained by all three methods did not correlated. Conclusion. There are a few studies that have investigated the essential role of angiogenesis in the pathogenesis of allergic rhinitis. We conclude that, increased angiogenesis may be as prominent in patients with allergic rhinitis as in patients with non-allergic nasal pathologies and may play an important role in the remodelling of nasal mucosa of subjects with SAR.Item Comparison of propofol and sevoflurane anesthesia by means of blood loss during endoscopic sinus surgery(2004) Sivaci R.; Yilmaz M.D.; Balci C.; Erincler T.; Unlu H.Objective: The purpose of the present investigation is to examine whether induced hypotension with propofol or sevoflurane anesthesia improves the dryness of surgical field in endoscopic sinus surgery (ESS). Methods: The study was performed between 1999 and 2002 in Celal Bayar University and Afyon Kocatepe University Hospitals, Turkey. Thirty-two patients (American Society of Anesthesiologists physical status I and III) with chronic sinusitis undergoing outpatient endoscopic sinus surgery under general anesthesia were studied to determine if anesthetic technique had an impact on estimated blood loss. The patients were allocated randomly into 2 groups. None of the patients were premedicated. Anesthesia was induced with propofol in both groups and maintained with propofol/fentanyl in the first group and sevoflurane/fentanyl in the second group. In both groups, controlled hypotension was used to improve surgical condition. Results: There were no differences between the duration of surgery and intraoperative mean arterial blood pressure when comparing the 2 groups. The average estimated blood loss in the propofol group was 128.1 ± 37.3 ml compared with an average estimated blood loss of 296.9 ± 97.8 ml in the sevoflurane group (p<0.01). Conclusion: General anesthesia based on propofol infusion may have the advantage of decreased bleeding compared with conventional inhalation agents. Therefore, making endoscopic surgery technically easier and safer by improving endoscopic visualization of the surgical field.Item Efficacy of leukotriene antagonists as concomitant stherapy in allergic rhinitis(2010) Cingi C.; Gunhan K.; Gage-White L.; Unlu H.Objectives/Hypothesis: The symptoms of allergic rhinitis result from an immunoglobulin E-dependent mast cell activation cascade, marked by the release of inflammatory mediators, including histamine. Patients with perennial allergic rhinitis also have elevated levels of cysteinyl leukotrienes (CysLTs) in nasal lavage fluid. Histamine and CysLTs produce different responses in the pathogenesis of allergic rhinitis, and this study tested the hypothesis that the effects of combined antihistamine and leukotriene antagonist therapy would be more effective than antihistamine alone. Study Design: Multicentered, prospective, randomized, placebo-controlled, parallel-group. Methods: Three groups totaling 275 patients using: 1) fexofenadine alone, 2) fexofenadine with montelukast, or 3) fexofenadine with placebo, participated in a 21-day trial conducted during the spring pollen season. Objective analysis included pre- and poststudy physical examination findings and nasal resistance measurements. Subjective data gathered included a daily patient diary and pre- and poststudy patient satisfaction measurements. Results: The group using both fexofenadine and montelukast showed significantly better control of nasal congestion both subjectively, using patient diary and visual analog scale evaluations, and objectively, using rhinomanometry and physical examination, compared to groups using antihistamine alone or with placebo. Conclusions: Our data provided both objective and subjective evidence that leukotriene receptor antagonist- antihistamine combination therapy is more effective than antihistamine alone in the control of allergic rhinitis symptoms. © 2010 The American Laryngological, Rhinological and Otological Society, Inc.Item Does maxillary arch remodeling exist in nasal polyposis?(2010) Gunhan K.; Can F.; Uz D.; Serter S.; Unlu H.Background: The potential transformation in the maxillary complex morphology is mostly complete during childhood. Recent studies suggest a nasal tissue remodeling both in the overlying mucosa and in the underlying sinus bone in nasal polyposis (NP). Our evaluation of computed tomography (CT) revealed that the maxillary arch is more flat and shallow in patients with chronic rhinosinusitis with NP. The purpose of this study was to determine the possible effects of NP to the maxillary arch morphology in adulthood and to investigate a possible remodeling of the maxillary bone during the course of NP. Methods: A prospective study was performed on 25 patients. Grading of the polyps, acoustic rhinometry and rhinomanometry assessments, and CT scans were documented initially, 1 year after diagnosis, and 2 years postoperatively. Twenty-five subjects' CT scans randomly selected from our CT database formed the comparison group. The plane angle between the maxillary alveolar processes (MAP) and the palatine process of the maxillary bone (MPP), and the depth of the maxillary arch of both groups were compared. Results: The results pointed out that the maxillary arch was shallower and the bilateral angles between MAP and MPP were significantly greater than those of the comparison group in all evaluation periods. This difference was less at the end of the postoperative follow-up period. Conclusion: Although it is a common belief that maxillofacial formation expires in childhood, this may not be the case under some special conditions such as NP in adulthood. NP might cause maxillary arch remodeling in adults. Copyright © 2010, OceanSide Publications, Inc.Item Impact of nasal polyposis on erectile dysfunction(2011) Gunhan K.; Zeren F.; Uz U.; Gumus B.; Unlu H.Background: Our male patients with chronic rhinosinusitis with nasal polyposis (NP) declare a better sexual function after functional endoscopic sinus surgery (FESS) with polypectomy. This study was planned to conduct the first prospective, controlled trial evaluating the possible relation between erectile dysfunction (ED) and NP by subjective and objective parameters. Methods: Thirty-three male patients with NP and thirty randomly selected male control subjects were evaluated. All subjects underwent assessments of nasal endoscopy, rhinomanometry, body mass index (BMI), Epworth Sleepiness Scale, full in-laboratory polysomnograpy and serum levels of glucose, thyroid hormones, lipid profile, and testosterone. ED was evaluated by the erectile function domain of the International Index of Erectile Function (IIEF-EF) subjectively and nocturnal penile tumescence (NPT) objectively. The NP group was reassessed 6 months after FESS. Results: The mean age, BMI, and laboratory tests of the patients and the control subjects had no significant difference. The well-recognized risk factors for ED were eliminated. Preoperative evaluation of the patients revealed that ED was present in 34 and 24% of the patients by IIEF-EF and NPT, respectively, which was significantly higher than the control group (p = 0.009 and p = 0.018, respectively). There was a significant improvement of ED in the assessment of IIEF-EF and NPT postoperatively (p = 0.014 and p = 0.037, respectively). Conclusion: ED was determined in a high percentage of patients with NP and significantly ameliorated after FESS. NP might present a risk factor in the development of ED. Copyright © 2011, OceanSide Publications, Inc.Item Intranasal steroids or radiofrequency turbinoplasty in persistent allergic rhinitis: Effects on quality of life and objective parameters(2011) Gunhan K.; Unlu H.; Yuceturk A.V.; Songu M.Nasal congestion is a cardinal symptom of allergic rhinitis (AR). It is associated with decreased quality of life and difficult to treat as perceived by the patients. The purpose of this study is to evaluate the mid-term objective and subjective outcomes of management of nasal congestion using intranasal steroid (INS) therapy or radiofrequency turbinoplasty (RFT) in patients with persistent AR who have mucosal hypertrophy of the inferior turbinate. Fifty-five adult patients with AR, who claimed nasal congestion refractory to oral antihistamine (desloratadine) therapy, were randomized to INS (mometasone furoate) or temperature-controlled RFT treatment groups. Outcomes were determined by active anterior rhinomanometry, visual analog scale (VAS), and rhinoconjunctivitis quality of life questionnaire (RQLQ) at least 12 months after treatment. The median total nasal resistance decreased from 0.49 ± 0.17 to 0.39 ± 0.12 Pa/cm3/s (p = 0.42), and from 0.51 ± 0.18 to 0.29 ± 0.07 Pa/cm3/s (p = 0.003) with INS and RFT, respectively. RFT provided a better reduction in the perception of congestion in VAS scores. RQLQ scores improved significantly in both groups 1 year after treatment (mean follow-up 14.2 months) (p < 0.05). No adverse reactions were encountered in either group. Nasal congestion refractory to antihistamine appears to be improved by INS at some point, while reduced significantly by RFT in objective and subjective parameters. Both options are also effective in increasing the quality of life in patients with AR. RFT might be a safe and effective treatment of option in AR compared with INS. © 2010 Springer-Verlag.Item Nonmelanoma Skin Cancer of the Head and Neck: Prevention(2012) Oghan F.; Eskiizmir G.; Unlu H.; Cingi C.The importance and effectiveness of prevention efforts and strategies for skin cancers are reviewed. Topical sunscreens and their proper use are presented. Topical and ingested forms of natural, synthetic, or biologic chemical agents that are potentially efficacious for chemoprevention are listtdldted and discussed. © 2012 Elsevier Inc.Item The "physician on call patient engagement trial" (POPET): Measuring the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis and asthma patients(John Wiley and Sons Inc, 2015) Cingi C.; Yorgancioglu A.; Cingi C.C.; Oguzulgen K.; Muluk N.B.; Ulusoy S.; Orhon N.; Yumru C.; Gokdag D.; Karakaya G.; Çelebi S.; Çobanoglu H.B.; Unlu H.; Aksoy M.A.Background: In this prospective, multicenter, randomized, controlled, double-blind study, we investigated the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis (AR) and asthma patients. Methods: In total, 327 patients with diagnoses of persistent AR or mild-to-severe persistent asthma were randomized into 2 intervention groups and 2 control groups upon their admission at outpatient clinics. The intervention groups (POPET-AR and POPET-Asthma) received a mobile phone application ("physician on call patient engagement trial" [POPET]), enabling them to communicate with their physician, and record their health status and medication compliance. The AR groups completed the Rhinitis Quality of Life Questionnaire (RQLQ) at initiation and at the first month of the study. The asthma groups completed the Asthma Control Test (ACT) at initiation and at the third month of the study. Results: The POPET-AR group showed better clinical improvement than the control group in terms of the overall RQLQ score as well in measures of general problems, activity, symptoms other than nose/eye, and emotion domains (p < 0.05). In the POPET-Asthma group, more patients (49%) achieved a well-controlled asthma score (ACT > 19) compared with the control group (27%); this was statistically significant (p < 0.05). Conclusion: Use of a mobile engagement platform, such as POPET, can have a significant impact on health outcomes and quality of life in both AR and asthma, potentially decreasing the number of hospital admissions, repeat doctor visits, and losses in productivity. Improvements were seen in domains related to activity, productivity, perception of disease, and emotion. © 2015 ARS-AAOA, LLC.