Volume 9 Issue 2 (2019)

Objective: Inter-retrotransposon polymorphism Polymerase Chain Reaction (IRAP-PCR) technique allows for detecting insertional polymorphisms via amplification of the DNA fragment between two retrotransposons in plant genomes. However, this method has not been reported to be used for analyzing human samples to date. Recently, Human Endogenous Retrovirus (HERV) polymorphisms gained interest due to their potential effect on pathophysiology of certain diseases. Nevertheless, the association between HERV polymorphisms and the risk for developing nasal polyposis (NP) has not been studied. In this study, we aimed to investigate whether or not IRAP-PCR could be performed in nasal swab samples for comparing HERV polymorphisms in different nasal mucosal samples.

Methods: Nasal swab samples from 16 patients were used for DNA isolation. These DNA samples were used as templates for IRAP PCR of HERV-K6, HERV-K11, HERV-L1 and HERV-L2 and PCR products were analyzed by agarose gel electrophoresis.

Results: Nasal swab samples yielded enough DNA material for successfully performing IRAP-PCR. We obtained specific banding patterns the three out of four HERV sequences tested in this study. No polymorphisms was detected between samples from different patients. Similarly, polymorphic bands was not detected between the polyps or nasal mucosal swab samples obtained from the same patient.

Conclusion: We have, for the first time, shown that IRAPPCR can be performed in nasal swabs. Our findings suggest that this technique can serve as an inexpensive and effective screening tool for investigating links between nasal mucosal diseases and HERV polymorphisms such as nasal polyposis.

Objective: The aim of this study was to determine the factors affecting the success of vestibular rehabilitation therapy (VRT) in patients with idiopathic unilateral vestibular hypofunction (UVH) and idiopathic bilateral vestibular hypofunction (BVH).

Methods: 30 patients with idiopathic UVH and 30 patients with idiopathic BVH were included in this prospective study. Visual analog scale (VAS) was used to evaluate the severity of the patients’ complaints of dizziness. The duration of the complaint of dizziness was recorded. All patients underwent the Dizziness Handicap Inventory (DHI) before and after VRT. The severity, duration, and localization (unilateral/bilateral) of the vestibular hypofunction were compared with the efficacy of VRT.

Results: A significant decrease in DHI scores was observed after VRT for both, UVH and BVH patients, as compared to their pre-VRT scores (p<0.001). There was no significant difference in the efficacy of vestibular rehabilitation therapy in patients with UVH and BVH (p=0.09). As the VAS scores increased and the duration of the complaint lengthened, the efficacy of VRT decreased significantly (p<0.001/r=5.6, p=0.016/r=3.1, respectively).

Conclusion: VRT is an effective treatment for the relief of symptoms in both UVH and BVH patients. Unilateral or bilateral vestibular hypofunction does not affect the efficacy of VRT, whereas prolonged or severe symptoms of dizziness affect the effectiveness of VRT negatively. In idiopathic vestibular hypofunction patients with long-standing and/or severe dizziness complaints, VRT should be initiated immediately and continued longer.

Since the introduction of endoscopic ear surgery (EES) in the 1990s, endoscopic systems have been utilized in a number of ear surgeries including myringoplasty and tympanoplasty. Endoscopic tympanoplasty (ET) is described as a minimally invasive surgery for surgical repair of the tympanic membrane (TM) with comparable graft survival and hearing outcomes to conventional microscopic surgery (CMT). In the present review, we aimed to outline the surgical benefits and potential drawbacks of ET with clinical outcomes in order to determine whether ET constitutes a proper alternative to CMT.

Objective: Drug induced sleep endoscopy (DISE) is a valuable tool which is used in the diagnosis of obstructive sleep apnea (OUA). The aim of this study is to evaluate inter-rater and intra-rater consistency of DISE.

Methods: 36 OSA patients with Apnea-hypopne index>5 included in this study. DISE was performed and recorded digitally for all patients, by the first author (OA1). VOTE scores were noted to procedure report in patients’ charts. Video records of DISE were blindly evaluated six months after the last procedure, by observer 1 for the second time (OA2) and by observer 2 (OB) for the first time. DISE was evaluated by using VOTE classification. OA1 and OA2 scores were compared to determine intra-rater reliability and OA2 and OB scores were compared to determine inter-rater reliability.

Results: Inter-rater consistency of DISE was poor to good. Highest consistency rate was found in velum at anteroposterior configuration, while the lowest was found in the same level at lateral configuration. Intra-rater consistency of DISE was moderate to excellent. Highest consistency rate was found in epiglottis at lateral configuration, while the lowest was found in oropharynx level.

Conclusion: OSA is condition with possible serious complications. DISE is a tool that could change the course of treatment in OSA. The validity of DISE is quite acceptable although a golden standard classification tool could enable us to “speak the exact same language” and will surely increase the diagnostic success of DISE.

Objective: Objective: Chronic rhinosinusitis (CRS) is inflammation of the nasal mucosa and paranasal sinuses. Subjective complaint of dizziness can be observed in patients with CRS. However, a review of the literature did not reveal any prospective studies that have used videonystagmography (VNG) to examine the vestibular system of patients with CRS. The goal of this study is the evaluation of the vestibular system of CRS patients.

Methods: The study comprised 30 patients with CRS and 30 control subjects. The vestibular system was evaluated through VNG. The association with vestibular function was evaluated according to the Lund-Mackay score, the Sino-Nasal Outcome Test-22 (SNOT-22) score, and the existence of nasal polyps.

Results: Abnormal caloric test results were observed in eight (26.6%) of the 30 CRS patients. The caloric test results were normal for the control group. The oculomotor test results with VNG were normal for the CRS and control groups. The abnormal caloric results were higher for the CRS with nasal polyp patients than for the CRS without nasal polyp patients. The VNG showed no correlation among the SNOT-22 scores and the Lund-Mackay scores in patients with CRS.

Conclusion: Abnormal caloric responses can be observed in patients with CRS with nasal polyps.

Objective: The aim of this study is to assess neutrophil-lymphocyte ratio (NLR), mean platelet volume (MPV), platelet-lymphocyte ratio (PLR) and eosinophil-lymphocyte ratio (ELR) of allergic rhinitis patients and compare our findings with healthy controls. We also analyzed the effect of severity of allergic rhinitis on hematological parameters and total IgE levels of the patients.

Methods: A total of forty-six patients diagnosed having allergic rhinitis according to Allergic Rhinitis and its Impact on Asthma (ARIA) criteria and forty-six healthy, age and sex-matched subjects were included in this study. The clinical records of the patients were retrospectively analyzed and age, gender, skin prick test results, complete blood counts, total IgE levels and Sino-Nasal Outcome Test (SNOT) 22 scores were recorded for assessment of neutrophil-lymphocyte ratio (NLR), mean platelet volume (MPV), platelet-lymphocyte ratio (PLR) and eosinophil-lymphocyte ratio (ELR) of the patients.

Results: Eosinophil count, eosinophil percentage and ELR value of the study group were significantly higher than the control group (p=0.001, p=0.001, p=0.001, respectively). The cut-off value for ELR was ≥0.105 (sensitivity=0.61, specificity=0.76, AUC=0.703). Total IgE levels of patients with positive skin prick test were significantly higher than patients with negative skin prick test (p=0.019). The cutoff value for total IgE was ≥63 IU/mL (sensitivity=0.59, specificity=0.74, AUC=0.706).

Conclusion: ELR is a valuable marker for predicting allergic rhinitis. However, it does not correlate with the severity of the disease. Total IgE levels increase in patients with positive skin prick tests. Also, total IgE level does not correlate with the severity of allergic rhinitis.

Objective: To demonstrate the effects of rheumatoid arthritis (RA) on hearing with audiometric and tympanometric measurements, and to reveal its relationship with the disease in comparison with healthy volunteers.

Methods: The study included 30 RA patients and 30 healthy controls. Demographic findings such as age, height, weight, onset of complaint (year), time elapsed since diagnosis, previous surgery, accompanying systemic disease, drugs used, family history, habits of smoking and alcohol use were questioned for both groups. Tympanometry, pure voice audiometry and otoacoustic Emission tests were performed.

Results: The hearing thresholds in the airway conduction in RA group were significantly higher in all frequencies (0.25-6 kHz) than in the control group. When bone conduction hearing thresholds were compared, RA group was more affected at only 4 kHz and left ear (p=0.006). When air-bone conduction differences (AB-gap) were examined, the differences in the RA group at 0.5, 1 and 4 kHz were statistically significant. When tympanometry and acoustic reflex measurement results were evaluated, there was no statistically significant difference between groups. In the transient OAE test, 3 (10%) patients were in the RA and 2 (6.6%) patients in the control group (p=0.064).

Conclusion: Conductive hearing loss was significantly more frequent in patients with RA than in healthy individuals, whereas bone conduction was affected partially at high frequencies; whereas stapes reflex, compliance and pressure values were not significantly affected.

Objective: This study aims to examine what ear pathologies may occur in law-enforcement officials exposed to the effects of improvised explosive devices in regions where high levels of terrorist activity are expected. The issues faced by ENT and head and neck surgeons in treating such injuries are also examined.

Methods: A retrospective review of examination findings and initial treatment offered was performed on clinical records written by specialists in Emergency Medicine, General Surgery, ENT and Head and Neck Surgery during a particular period (14/3/2016 to 25/7/2016) when a curfew was in operation. The records were taken from Nusaybin State Hospital. Some 260 individuals were included in the review, all of whom had ear problems related to exposure to an explosion. The particulars of the trauma incurred, the presenting complaint, examination findings, and initial surgical and medical treatment offered were determined for each case.

Results: In 224 out of 260 cases, a primary explosion injury was recorded. The most frequently documented symptoms were tinnitus and loss of hearing. On physical examination, 25 individuals had traumatic perforation of the tympanic membrane. 12 cases featured nystagmus and dizziness and fistula testing was positive in 2 cases, possibly as a result of a perilymph fistula. In case where abrupt hearing loss was apparent on audiological testing, intravenous methylprednisolone was administered at a dosage of 1mg/kg. Cases of multiple trauma were referred onto more specialised clinical units. For cases where hearing loss was mild and the only symptom, the treatment was a reducing dose of oral methylprednisolone over twelve days. Thirty-six individuals were diagnosed with secondary trauma from the explosion. Such trauma included soft tissue and bony injury in the auricular, pre- and post-auricular regions, and was treated by surgery.

Conclusion: Ear trauma secondary to improvised explosive devices is a common injury in law-enforcement officials. In individuals exposed to such hazards, symptoms of hearing problems should be sought, otoscopic and vestibular examination and audiological testing should be carried out at an early stage, and the patient should be referred to an ENT or Head and Neck Surgeon.

Objective: Allergic rhinitis (AR) is one of the most frequently encountered allergic disorders and has a typical prevalence of between 18 and 40%. The factors which underlie allergic disorders may vary since they are linked to climate, geography, different social conditions and genetic makeup. The objective of our research was to investigate any connections between polymorphism in the serotonin transporter gene and allergic rhinitis.

Methods: This study involved the participation of two groups aged between 15 and 60 years of age who attended the ENT clinic of the Medical Faculty at Erzincan University: 100 individuals with allergic rhinitis plus a control group of 200 individuals who lacked the condition. The AR cases were established on the basis of history, physical examination and skin prick testing. Peripheral blood samples were taken from both groups and subjected to genetic analyses. The analysis utilised a 5-HTT Taqman® primer as genetic probe. The Chi-squared method was utilised for statistical analysis.

Results: 129 of the participants were female (64.5%) and 71 (35.5%) male. The average age of those participating was 34.5 ± 14.6 (range: 20-65) years. In reference to the sex distribution of the patients, 79% of the patients were female. There was a significant difference between the groups according to sex (p <0.01). No significant differences were noted between the patient and control groups when compared according to genetic polymorphism or place of residence. In 61% of the allergic rhinitis sufferers, their symptoms were seasonal. The incidence of AR was higher in both females and in those living in an urban rather than rural setting. When the polymorphism is examined in both the patient and control groups, the most common type is the mutant type. In both the cases and controls, when the polymorphism was investigated, the most frequently seen type was the Mutant variety and no signi0cant difference in frequency was noted according to sex or place of residence.

Conclusion: In this study, when the cases and controls were compared in terms of the polymorphism in the rs35521 serotonin transporter gene, there was no difference at the level of statistical significance between the frequency of occurrence of the mutant or heterozygote form of the gene.

Objective: Comorbidities accompanying to cardiac disorders might be as detrimental as the diseases themselves. While it is not common, comorbidities associated with inner ear functions may also be seen. This study was planned to investigate evaluation of hearing which also includes high frequencies, and the presence of vestibular and tinnitus symptoms in children with acute rheumatic fever (ARF), Kawasaki disease (KD) or who underwent open heart surgery (due to atrial septal defect and/or ventricular septal defect, Tetralogy of Fallot).

Methods: This study included a patient group including 214 children patients diagnosed with cardiac disorders (116 males, 98 females; mean age 9.70 [range 6-16]) and a control group including 44 healthy children who do not have any kind of chronic disease (21 males, 23 females; mean age 9.38 [range 6-16]). The subjects underwent hearing test with frequencies between 250-20000 Hz, vestibular and tinnitus symptoms were evaluated by Symptom Questionnaire Forms.

Results: Out of 214 patients in the patient group, 6 (2.8%) had hearing loss in pure tones, 25 (11.7%) had in high frequencies, 35 (16.4%) had tinnitus symptoms, and 21 (9.8%) had vertigo symptoms. Hearing loss in high frequencies was detected in 11.7% of patients with ARF, in 22.7% of patients with KD, and in 7.8% of patients who underwent open heart surgery. The difference between KD patients and the control group in terms of hearing loss was statistically significant (p=0.014). Out of 214 patients in the patient group, 4 (1.9%) had hearing loss in pure tones and high frequencies, vertigo and tinnitus symptoms.

Conclusions: Our results suggest that some childhood cardiac disorders can cause some changes in the inner ear, although the exact cause is unknown. Perhaps, a detailed hearing and balance examination should be a routine in a child diagnosed with a cardiac disorders. We think it is necessary to work on more comprehensive patient groups and tests in the future.

Introduction: Hearing aids are electronic devices used by individuals with hearing loss to improve their quality of life. It is more useful to use bilateral hearing aids. Thus, the localization of the sound is better determined and an additional 6-10 dB increase in sound intensity can be achieved. In our study, we compared the satisfaction level of patients with hearing loss who used unilateral or bilateral devices.

Methods: Patients with bilateral sensorineural hearing loss and using unilateral or bilateral hearing aids for at least 3 months and whose hearing loss cannot be treated with medical or surgical treatments were included. International Outcome Inventory for Hearing Aids Turkish Version (IOIHA-TR) was administered to them.

Results: Matched data were used to standardize age and gender between the groups. In high school bilateral fitting increased. There was no difference between the groups in terms of hearing pure tone thresholds and speech discriminations. There was a significant difference between the groups in terms of the mean score of question 5 (p=0.047), question 7 (p=0.022) and mean total scale (p=0.028) in IOI-HA-TR.

Conclusion: As a result, we found that the satisfaction level of bilateral hearing aid users was higher. Bilateral hearing aid use has a positive effect on the

Objective: The purpose of this research was to examine how attachment of the uncinate process superiorly (SAUP) relates to possession of an agger nasi cell, pneumatisation of the middle turbinate and the measurements of the base of the skull anteriorly. The study was carried out using computerised tomography (CT).

Methods: The study involved CT imaging captured from 727 individuals with persistent sinusitis- 1454 images in total, featuring coronal section of the paranasal sinus. The frequency of SAUP, existence of an agger nasi cell, pneumatisation of the middle turbinate and how high the lamella measured laterally, were all noted. Landsberg and Friedman’s classification scheme for SAUP was utilised. Statistical analysis used the chisquared test.

Results: In 1.65% of cases, SAUP was not identifiable. With regard to class of SAUP, the most frequent was type 2, then, in descending order of frequency, types 1, 4, 3, 5 and 6. The frequencies noted were 27.6%, 19.8%, 15.4%, 14.5%, 12.0% and 9.0%, respectively. An agger nasi cell was visualised in 894 images (61.07%). There was pneumatisation of the middle turbinate in 395 images (27.17%). The lamina cribrosa measured 5.58mm on average.

Conclusion: There were significant correlations between the type of SAUP and the existence of agger nasi cells or of concha bullosa. However, the type of SAUP was not statistically significant in predicting the height of the lamina cribrosa.

Objective: The aim of this study was to investigate the incidence and severity of Frey’s syndrome (FS) among parotidectomy patients and to assess the impact of parotidectomy sequelae on quality of life (QoL).

Methods: In total, 43 patients (21 males, 22 females) who underwent parotidectomy were included in this study. Iodine-starch test was applied to identify the presence and the severity of FS. The results were evaluated using a previously described grading system. Patients’ perceptions of parotidectomy sequelae were graded to identify their impact on QoL and also if there is an association between the extent of parotidectomy, the time elapsed after surgery and the severity of symptoms.

Results: FS was diagnosed in 18 (41.8%) patients, 10 of which (23.3%) reported having FS symptoms. Of all patients who were diagnosed with FS, 11 (61.2%) patients’ symptoms were classified as mild, whereas 7 (38.8%) were classified as severe. There was no significant correlation between the incidence of FS and the time between surgery and diagnosis, or the extent of parotidectomy. Among all symptoms reported by patients, FS was the sequelae that caused the most discomfort after parotidectomy.

Conclusion: The negative impact of FS on QoL is restricted to cases with severe symptoms, the incidence of which is rare and independent of the extent of surgery. To avoid overtreatment, true incidence of FS remains to be identified in study samples from different centers. By this means, clinicians can make more accurate definitions for indications of preventive procedures as well as treatment approaches.

Objective: To assess the effects of Metformin, Dichloroacetate (DCA) and their combination on cell viability in oral squamous cell carcinoma, UPCI-SCC-131 cell line.

Methods: UPCI-SCC-131 cells were plated in 96 E-plate (1x104 cells/well) and were treated with Metformin (1-16mM) and/or DCA (15-120mM) for 24-48-72h. xCELLigence SP system was used to monitor real time cell viability. In addition, drug combination index was analyzed with CompuSyn software according to Chou-Talalay method.

Results: Half-maximal inhibitory concentrations (IC50) of Metformin and DCA were found to be 3mM and 23mM, respectively, for 72 hours. CI values (0.76-0.80) in all combination groups below 1 indicated that Metformin/DCA combination had a moderate synergistic effect on cell viability in UPCI-SCC-131 cells.

Discussion: Metformin/DCA combination synergistically decreased the cell viability of UPCI-SCC-131 cells. Therefore, a combined application of Metformin and DCA may be considered as a candidate therapy for the “drug repositioning” of the treatment of oral cavity cancer.