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Öğe Cartilage tympanoplasty with island technique: A comparison with the temporalis muscle fascia technique(2009) Tayyar Kalcioglu M.; Firat Y.; Selimoglu E.Objective; To evaluate hearing results and failures of tympanoplasty techniques with either island cartilage or temporaiis muscle fascia. Materials & Methods; Retrospective evaluation of selected cases operated by the same surgery team between 2000 and 2008. A total of 307 patients with a tympanic membrane perforation or retraction due to chronic otitis media were treated surgically with tympanoplasty with or without mastoidectomy. From these 96 cases who had primary repair of tympanic membrane perforation or retraction with intact ossicular chain and normal middle ear were included into the study. Tympanic membrane perforation was reconstructed by using fascia in 36 while cartilage island graft was used in 60 patients. Temporalis muscle fascia was preferred for simple perforations while cartilage was used in more difficult cases such as retractions or total or subtotal perforations. Preoperative and postoperative pure-tone average air-bone gaps were compared at 250, 500, 1000, 2000 and 4000 Hz frequencies. Postoperative failures were compared. Results; Main outcomes of both techniques were similar for hearing results and prevalence of failures. Closure of air-bone gaps after surgery were 14.98, 12.5, 9.67. 8.67, and 7.01 dB for cartilage group and 15.42, 11.67, 8.34, 7.36, and 8.61 dB for fascia group respectively. The differences were not statistically significant. Graft survival rates were 86.1% in the fascia group and 95% in the cartilage group. Conclusion; Both techniques show similar functional and hearing results. Cartilage tympanoplasty with island technique may be chosen according to patient's condition like atelectatic ear, adhesive otitis and retraction pockets, totally or sub totally perforation of tympanic membrane or revision tympanoplasty. Copyright 2005 © The Mediterranean Society of Otology and Audiology.Öğe Chondroradionecrosis in two patients with laryngeal carcinoma(2007) Firat Y.; Kizilay A.; Firat A.K.; Serin M.; Erkal H.S.Postradiotherapy necrosis in the larynx is a rare but serious complication. It must be differentiated from tumor recurrence with radiological and histopathological studies. Herein, we presented two patients with stage II and stage IV larynx carcinoma who developed chondroradionecrosis following radiotherapy. The first patient did not accept surgical treatment and was treated with curative radiotherapy at a dose of 70 Gy. The other one received adjuvant radiotherapy at a dose of 46 Gy following total laryngectomy and bilateral functional neck dissection. The two patients were evaluated with computed tomography and magnetic resonance imaging, respectively. Pathologic examination of multiple biopsies taken from both cases showed coagulation necrosis without malignancy. The first patient had grade IV radionecrosis according to the Chandler classification and underwent total laryngectomy because of non-functional larynx. Histopathologically, there were no malignant cells, but widespread fibrosis and coagulation necrosis. The other patient was treated with conservative treatment and local debridement.Öğe Dexmedetomidine: A novel anesthetic agent for middle ear surgery(2007) Firat Y.; Selimoglu E.Proper selection of anesthetic technique is important in otologic surgical procedures. In the middle ear microsurgery an anesthetic agent must provide bloodless, good surgical field visibility for safe tympanic membrane reconstruction, safe ossicular reconstruction with respect to the basic anatomic structure of the middle ear. Additionally, no alteration of intratympanic pressure is acceptable during the anesthetic act and after its discontinuation. Consequently, postoperative nausea and vomiting should be minimal after tympanoplasty operations for the stability of tympanic graft and ossicles. Therefore, the anesthesiologist must use a technique that provides a sufficiently deep level of anesthesia with minimal intraoperative movement, rapid emergence, good hemodynamic control and tympanometric stability. Currently, many inhaler and intravenous (IV) anesthesia could be preferred for otologic surgical procedures and they offer ideal intraoperative conditions. Dexmedetomidine is a novel analgesic agent that helps this inhaler or IV anesthesia at preoperative state, postoperative period and during surgery especially for hemodynamic stability. In this article, pharmacocinetic properties of dexmedetomidine were described, its advantages for patients undergoing surgery,related patents and its role in otologic surgery were discussed. © 2007 Bentham Science Publishers Ltd.Öğe Dynamic contrast-enhanced magnetic resonance imaging findings of mass lesions of the pontocerebellar angle(2007) Firat A.K.; Karakaş H.M.; Kahraman B.; Firat Y.; Altinok T.; Kizilay A.OBJECTIVES: The differential diagnosis of mass lesions of the pontocerebellar angle is not always possible by conventional magnetic resonance imaging (MRI). In this study, we investigated the role of dynamic contrast-enhanced MRI in the differential diagnosis of acoustic neurinoma, meningioma, and paraganglioma. PATIENTS AND METHODS: Twelve patients (8 females, 4 males; mean age 47.5 years; range 8 to 71 years) whose diagnoses were acoustic neurinoma (n=3), paraganglioma (n=5), and meningioma (n=4) were evaluated by simultaneous conventional and dynamic contrast-enhanced MRI. Prior to postcontrast T1-weighted images, dynamic MRI was obtained. On these images, maximum contrast enhancement (Cmax) and time to peak enhancement (Tmax) were calculated at 15 different time points. Time-signal intensity curve patterns of the lesions were compared. RESULTS: According to the four main time-signal intensity curve patterns described in the literature, acoustic neurinomas, meningiomas, and paragangliomas exhibited type C, type A-B, and type A curve patterns, respectively. CONCLUSION: Our results suggest that dynamic contrast MRI may have an additional but limited role in the differential diagnosis of extra-axial intracranial tumors such as those of the pontocerebellar angle.Öğe [Efficacy of local heparinoids on preventing edema and ecchymosis after rhinoplasty].(2010) Kelleş M.; Erdem T.; Firat Y.; Kalcio?lu M.T.; Akarçay M.; Selimo?lu E.; Yolo?lu S.In this study, the effect of local heparinoids on prevention of periorbital edema and ecchymosis due to rhinoplasty was investigated. Twenty patients (12 males, 8 females, mean age 23.3 years; range 19 to 34 years) who had bilateral osteotomy were randomly administered postoperative local heparinoid on one periorbital region, without performing any care in the other one. One and a half centimeter of heparinoid was applied once a day for nine days. The other periorbital region was used as control group. The heparinoid was applied additionally, 8 mg dexamethasone i.v was administered to all patients 30 minutes before the surgery and 24 hours after the surgery. Photographs of each patient which were taken on postoperative days 1, 3, 5 and 9 were evaluated as double-blind by two observers. Scoring was performed according to edema and ecchymosis scales. There was no statistical difference with respect to edema and ecchymosis between local heparinoid treated and control eyes. No hypersensitivity to drugs occurred in any patients. After analysing the scores, we observed that heparanoids administered locally was not effective in preventing periorbital edema and ecchymosis after rhinoplasty (p>0.05).Öğe Silent sinus syndrome.(2009) Miman M.C.; Akarcay M.; Doganay S.; Erdem T.; Firat Y.We present a case of silent sinus syndrome (SSS) who underwent unilateral surgical endoscopic maxillary meatotomy. Orbital floor reconstruction is delayed after follow up. Enophthalmos recovered 8 months after the surgery and radiologic findings improved. SSS is a clinical entity that should be kept in mind in the differential diagnosis of enophthalmos and can be treated successfully via endoscopic approach.Öğe Spontaneous bilateral intrasphenoidal lateral encephaloceles: CT and MRI findings(Medquest Communications LLC, 2004) Firat A.K.; Firat Y.Lateral intrasphenoidal encephaloceles are rare anomalies. We describe a unique case in which spontaneous bilateral intrasphenoidal lateral encephaloceles were discovered in a 53-year-old man during a work-up for cerebrospinal fluid leak. We discuss our clinical findings and the results of preoperative computed tomography and magnetic resonance imaging.Öğe The tinnitus handicap inventory: A study of validity and reliability(2007) Aksoy S.; Firat Y.; Alpar R.Our aim was to compose a Turkish version of the Tinnitus Handicap Inventory (THI). Each of two individuals independently translated and retranslated the English version of the THI, and it was adapted by an expert team. The Turkish version of the THI was completed by 110 tinnitus patients. We assessed the internal consistency and reliability of the Turkish version by Cronbach's alpha. We assessed test-retest reliability with a second investigation in 21 patients. We assessed construct validity by analyzing the patients according to their age and to tinnitus duration. Internal validity was tested by multi-item analysis, to assess item convergence and discriminant validity. We obtained high internal consistency and reliability with the Cronbach's alpha coefficient (0.88) and high intraclass correlation coefficient (ICC, 0.78-0.90). Test-retest correlation coefficient scores were highly significant. The Turkish version of the THI is a highly consistent and reliable measure that can be used in evaluating symptoms in tinnitus patients.Öğe Treatment algorithm for patients with puberphonia(2008) Kizilay A.; Firat Y.OBJECTIVES: We evaluated the results of treatment for puberphonia and aimed to develop a treatment algorithm for patients with puberphonia. PATIENTS AND METHODS: Sixteen male patients (mean age 21.5 years; range 16 to 34 years) with puberphonia underwent voice therapy (3-10 sessions). Perceptual and acoustic analyses of vocal quality were performed in 12 patients. Perceptual analysis included the Voice Handicap Index (VHI) and videolaryngostroboscopy (VLS) and acoustic evaluations included F0 (fundamental frequency), jitter, shimmer, and NNE (normalized noise energy). RESULTS: Following voice therapy, all scores of the VHI showed significant improvements (p=0.001). There was a significant improvement in vibratory pattern and mucosal wave of vocal cords in VLS evaluation (p=0.004 and p=0.002, respectively). Among acoustic parameters, only the mean F0 showed a significant change from 246 Hz to 134 Hz after treatment (p=0.001). Stabilization of F0 could not be achieved in two patients, one of whom underwent type III thyroplasty. CONCLUSION: The main difficulties encountered in the treatment of puberphonia include stabilization of the attained F0 and widening the frequency range. Implementation of the treatment algorithm through a step-by-step approach provides an objective way of assessing the disease and its management.
