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Öğe Audio-vestibular evaluation in patients with Behcet's syndrome(Headley Brothers Ltd, 2001) Evereklioglu, C; Cokkeser, Y; Doganay, S; Er, H; Kizilay, AA prospective controlled clinical study was carried out at the Department of Ophthalmology and ENT, Inonu University Medical Faculty, Turgut Ozal Medical Center, Research Hospital, to evaluate the audiovestibular involvement in patients with Behcet's syndrome compared with controls. Twenty-five consecutive patients with Behcet's syndrome (mean age :+/- SD, 34.96 +/- 8.50) and 20 ageand sex-matched healthy volunteers (hospital staff) as control subjects (mean age +/- SD, 34.45 +/- 9.16) were included in this study. Behcet's patients were divided into two groups according to the number of criteria, complete (all four major criteria) and incomplete (three major criteria without ocular involvement). The groups were compared with each other or controls regarding inner ear involvement. Audiometric pure-tone thresholds at 125 to 8000 Hz were obtained in all subjects in both groups, and pure tone average (PTA) hearing thresholds were calculated for the middle, high and low frequencies. In addition, short increment sensitivity index (SISI), tone decay and BERA examinations were performed in all Behcet's patients. Sensorineural hearing loss (SNHL) was present in six of 25 patients with Behcet's syndrome. Two Behcet's patients had unilateral total SNHL, two had bilateral moderate level SNHL, one had bilateral low-frequency SNHL and one bilateral high frequency SNHL. In two, BERA, and in five SISI, examination disclosed inner ear involvement. In control subjects, the past medical history was normal and there was no consistent audio-vestibular complaint. Their PTA thresholds were all in the normal range. Otoscopic examination findings were normal, with intact, mobile tympanic membranes in both groups. The present study showed that audio-vestibular involvement is not infrequent in Behcet's syndrome compared with age-and sex-matched healthy controls, and it is under-estimated. All Behcet's patients should regularly be followed by an otolaryngologists and be given information about the possibility of inner ear involvement. According to our results, hearing loss occurs more often in older patients and also in the complete form of Behcet's syndrome.Öğe Comparative external versus endoscopic dacryocystorhinostomy: Results in 115 patients (130 eyes)(Mosby, Inc, 2000) Cokkeser, Y; Everelkioglu, C; Er, HBACKGROUND: Epiphora is an annoying symptom, embarrassing the patient both socially and functionally. The two widely accepted treatment modalities of epiphora resulting from obstruction of the nasolacrimal ductus are external and endoscopic dacryocystorhinostomy (DCR). OBJECTIVE: The aim was to compare the results, operative time, and complications of external and videoendoscopic endonasal DCR performed between December 1994 and December 1998, METHODS: In group 1, conventional primary external DCR with or without silicone tube intubation was performed in 79 patients (66 women and 13 men) with unilateral dacryocystitis, In group 2, endoscopic primary endonasal DCR with hammer-chisel removal of bone located over the lacrimal sac was performed in 51 eyes of 36 patients, 33 women and 3 men (15 bilateral procedures). RESULTS: The follow-up period was 6 to 48 months (mean 25 months) after surgery. The age range was from 4 to 76 years (mean 38.5 years). The success rates of external and endoscopic hammer-chisel DCR were found to be 89.8% and 88.2%, respectively. A lower complication rate was observed in the endoscopic group, with minimal morbidity and shorter operative time compared with the external approach. CONCLUSIONS: Hammer-chisel endoscopic DCR is practical, less traumatic, less time-consuming, and cosmetically more convenient than the external approach. The success rate of the endoscopic DCR procedure is comparable with that of traditional external DCR, and it also allows simultaneous correction of any intranasal pathology.Öğe Concentrations of trace elements in larynx and skin tissues with epidermoid cancer(Dustri-Verlag Dr Karl Feistle, 2004) Kizilay, A; Kalcioglu, MT; Ozyurt, H; Vural, H; Sogut, S; Cokkeser, Y; Akyol, OBackground and objectives: Playing a crucial role in a number of biological processes, trace elements are an essential part of the body. Up to now, trace elements-cancer relationships have not had a definitive explanation. This study was scheduled to investigate the trace element content of squamous cell carcinoma of the larynx and skin. Methods: The study was designed as a prospective controlled study. Tissue concentrations of iron, selenium, copper and zinc were studied in 30 patients with squamous cell carcinoma (19 larynx and 11 skin), while 20 tissues (12 larynx and 8 neck) of non-cancerous patients served as control. All samples were taken during surgical operations. Tissue element concentrations were measured by atomic absorption spectrophotometer after tissues were digested in an acid mixture. Results: No meaningful differences were interpreted in copper and zinc in epidermoid cancer and non-cancerous tissues. However, iron and selenium concentrations were found to be decreased significantly in cancer tissues than in control values. Conclusion: Decreased selenium and iron concentrations in the cancerous tissue from the patients with epidermoid cancer may result in increased oxidative stress because of the requirements of these elements for activities of some antioxidant enzymes.Öğe An easy method to control the rats in experimental studies(Lippincott Williams & Wilkins, 2000) Tercan, M; Cokkeser, Y[Abstract Not Available]Öğe Effects of partial neuromuscular blockade on facial nerve monitorization in otologic surgery(Taylor & Francis As, 2003) Kizilay, A; Aladag, I; Cokkeser, Y; Miman, MC; Ozturan, O; Gulhas, NObjective-Neuromuscular blockade (NMB) is administered as part of a general anesthetic in order to keep the Patient immobilized during surgery and has been known to hinder intraoperative neuromonitorization. The aim of this study was to determine the effects of different levels of NMB on electrical stimulation thresholds of the facial nerve during otologic surgery. Material and Methods-Intraoperative facial nerve monitorization was performed in 29 patients with advanced middle ear disease. Electromyographic (EMG) responses were recorded by insertion of needle electrodes into the orbicularis oris and orbicularis oculi muscles. Minimal facial nerve stimulations causing EMG responses in the facial musculature were measured during full recovery from the effects of muscular relaxants and with 25%, 50%, 75% and 100% levels of NMB. These defined NMB levels were maintained by the administration of a drip infusion of atracurium and were assessed objectively by recording the hypothenar muscle action. Results-All of the patients had detectable EMG responses of the facial musculature at the 50% and 75% levels of NMB in response to the electrical stimulation of the facial nerve. The corresponding mean stimulation thresholds were 0.10 +/- 0.08 and 0.11 +/- 0.09 mA, respectively. No responses were measured in 31% of the patients when the level of peripheral NMB was 100%. Conclusion-This study suggests that a regulated 50% level of peripheral NMB provides reliable intraoperative EMG monitoring of the facial musculature in response to electrical stimulation and adequate anesthesia, with full immobilization of the patient.Öğe Follow-up of 366 ears after tympanostomy tube insertion: Why is it draining?(Sage Publications Ltd, 2003) Kalcioglu, MT; Cokkeser, Y; Kizilay, A; Ozturan, OOBJECTIVE: Tympanostomy tube insertion is one of the most frequently performed procedures in otolaryngology. Complications, such as otorrhea, tympanosclerosis, and cholesteatoma, have been reported in the literature after its application. STUDY DESIGN: This study reports the complications encountered with 239 children (439 ears) with a follow-up of 7 to 73 months (median, 29 months) after tympanostomy tube insertion. Hearing results and middle ear pressures were compared and complications were noted in 366 ears that were available for the study. RESULTS: Otorrhea developed in 3 (0.8%) cases. Tympanosclerosis was seen in 74 (20.2%) cases. Tympanic membrane perforation, retraction pocket, granulation tissue, and atelectasis were seen in 4.6%, 5.2%, 1.1%, and 6%, respectively. No patients developed cholesteatoma after tube insertion. Hearing results were improved postoperatively in 93.4% of patients (median, 14.2 dB) and worse in 6.6% of patients (median, 8.3 dB). The average extrusion time was 7.3 months for grommet and 16.3 months for T-tubes. CONCLUSION: Multifactor etiologies show some unsolved or misunderstood underlying pathology, or unmentioned environmental factor such as atopy due to rich flora and humidity might exist to consider in the pathophysiology of the otorrhea.Öğe Hammer-chisel technique in endoscopic dacryocystorhinostomy(Annals Publ Co, 2003) Cokkeser, Y; Tercan, M; Evereklioglu, C; Hepsen, IFWe performed a prospective evaluation of endoscopic hammer-chisel dacryocystorhinostomy (DCR) procedures on 62 eyes of 44 patients (40 female and 4 male) with chronic epiphora or dacryocystitis (26 unilateral and 18 bilateral). The technique included chisel removal of bone over the lacrimal sac. The follow-up period was 12 to 54 months (mean, 28 months), and the patients' ages ranged from 17 to 67 years (mean, 35.5 years). The success rate of the consecutive endoscopic: hammer-chisel DCR procedures was 87%. During operation, 8 patients had mild mucosal hemorrhage, which did not prevent the successful completion of the operation. Excellent patient tolerance was observed, with minimal morbidity and no major complications. As compared to the external approach, endoscopic hammer-chisel DCR is less traumatic, is less time-consuming, and is practical and cosmetically convenient, with minimal perioperative and postoperative complications. It also allows the simultaneous correction of any intranasal disease. It requires minimal instrumentation and is a relatively easy and fast technique.Öğe Identification of internal acoustic canal in the middle cranial fossa approach: A safe technique(Mosby, Inc, 2001) Cokkeser, Y; Aristegui, M; Naguib, MB; Saleh, E; Taibah, AK; Sanna, MBACKGROUND: The middle cranial fossa approach (MCFA) is a very valuable functional approach in the armamentarium of the neuro-otologic surgeon. Identification of the internal acoustic canal (IAC) in MCFA is one of the most tedious steps. Many techniques have been described to locate the IAC safely when using the MCFA. OBJECTIVE: We sought to describe a safe technique for identification of the IAC and to demonstrate its feasibility in temporal bone dissections, as well as to discuss our clinical experience with this technique. METHODS: The surgical anatomy of the 20 temporal bones were evaluated and measured, especially by defining the medial and lateral ends of the IAC and relations to the nearby located structures, Measurements were obtained at 3 levels: the width of the IAC at the level of the fundus, the width of the IAC at the level of the porus, and the safe distance around the IAC at the meatal level. The medial and lateral IAC end widths were compared with each other and with the safe area at the meatal level. RESULTS: The smallest, the largest, and the mean values were recorded. The mean width of the IAC at the level of the porus was found to be more than 3-fold that of the width of the IAC at the level of the Bill's bar, and the ratio between the width of the medial safe area around the IAC and the lateral end of the IAC was found to be more than 7-fold as wide. CONCLUSION: This technique offers direct quick exposure of the IAC, without handling the facial nerve and the inner ear structures, Forty-five cases of operations with the same technique showed excellent ease and safety of identifying the IAC medially in the MCFA.Öğe Management of acoustic neuroma in the only hearing ear(Springer, 2005) Naguib, MB; Cokkeser, Y; Sanna, MPatients with acoustic neuroma in their only hearing ear are not frequently seen in clinical practice. Managing this group of patients is a challenge to both the patient and surgeon. In this study we report on five cases of acoustic neuroma in an only hearing ear. Our decision for conservative management of those patients with regular follow-up using auditory brain stem response and magnetic resonance imaging is discussed. Other management options currently available are reviewed as well.
