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Altuntaş OM, Özer F, Kuşçu O, Süslü N. Does Submandibular Gland Sacrificing Neck Dissection Decrease Salivary Output and Quality of Life? ORL J Otorhinolaryngol Relat Spec 2021; 83:341-346. [PMID: 33756490 DOI: 10.1159/000514134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/24/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Our study aimed to quantify the impact of submandibular gland (SMG) resection during Level I neck dissection (ND) on stimulated salivary output (SSO) and xerostomia-related quality of life in patients with head and neck cancer (HNC). METHODS A retrospective cohort was formed from 32 patients that underwent unilateral or bilateral Level I ND and a control group of 23 patients that had level II-IV ND. SSO (Saxon test) and University of Washington Quality of Life survey results for both groups were compared. RESULTS Mean SSO was 3.41 g in the SMG resection group and 3.86 g in the control group, with no significant statistical difference. There was no difference in mean SSO between patients with 2 SMGs, a single remaining SMG, or no glands. The mean SSO of SMG resection cases with a history of adjuvant RT was 2.61 g which was below the xerostomia threshold for the Saxon test (2.75 g) and control group patients with RT had a significantly higher mean SSO (4.07 g). The lowest UW-QoL saliva domain score average (53.8) was in the SMG-resected, RT-positive group. CONCLUSION Results indicate unilateral or bilateral resection of SMG does not reduce SSO to a significant extent. Adjuvant radiotherapy and SMG resection are additive risk factors for xerostomia and the related loss in quality of life. SMG sparing may be necessary in HNC patients with higher risk for the need of adjuvant radiation.
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Affiliation(s)
- Ozan Muzaffer Altuntaş
- Instructor, Department of Otorhinolaryngology, Koç University Faculty of Medicine, İstanbul, Turkey,
| | - Furkan Özer
- Attending Surgeon, Department of Otorhinolaryngology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Oğuz Kuşçu
- Associate Professor, Department of Otorhinolaryngology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nilda Süslü
- Professor, Department of Otorhinolaryngology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Altuntaş OM, Süslü N, Güler Tezel YG, Tatlı Doğan H, Yılmaz T. Lysyl Oxidase Like-4 (LOXL4) as a tumor marker and prognosticator in advanced stage laryngeal cancer. Braz J Otorhinolaryngol 2021; 88:968-974. [PMID: 33757755 PMCID: PMC9615536 DOI: 10.1016/j.bjorl.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/06/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Lysyl oxidase-like 4 is an amine oxidase from the lysyl oxidase family that was previously shown to be overexpressed in head and neck cancer and upregulated in response to hypoxia. The possible role of lysyl oxidase-like 4 as a tumor marker in advanced stage larynx cancer was investigated. Objective To investigate the expression of lysyl Oxidase-Like 4 protein in advanced stage laryngeal cancer and elucidate its possible role as a tumor marker, predictor of treatment response and prognosticator. Methods Diagnostic specimens of 72 patients treated for stage III–IV laryngeal squamous cell carcinoma were evaluated for lysyl oxidase-like 4 expression by immunohistochemistry. Results Lysyl oxidase-like 4 expression was correlated with advanced tumor stage (p = 0.041) and better differentiation (p = 0.025) but was independent of tumor diameter (p = 0.456). Response to induction chemotherapy or the need for salvage laryngectomy were not affected by lysyl oxidase-like 4 expression (p = 0.999, p = 0.070 respectively). Increased lysyl oxidase-like 4 expression was associated with better 2 year overall survival in both univariate (p = 0.036) and multivariate analyses (p = 0.014). Conclusion Lysyl oxidase-like 4 expression emerges with advancing stages, is lost with worsening differentiation, and may have tumor suppressive properties in larynx cancer.
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Affiliation(s)
- Ozan Muzaffer Altuntaş
- Koç University, Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey.
| | - Nilda Süslü
- Hacettepe University, Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey
| | | | | | - Taner Yılmaz
- Hacettepe University, Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey
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Tuncel M, Kılıçkap S, Süslü N. Clinical impact of 68Ga-DOTATATE PET-CT imaging in patients with medullary thyroid cancer. Ann Nucl Med 2020; 34:663-674. [PMID: 32602032 DOI: 10.1007/s12149-020-01494-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/17/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Medullary thyroid cancer (MTC) arises from neuroendocrine C cells of the thyroid. There is no single diagnostic imaging method that can reveal all MTC recurrences or metastases. 68Ga-DOTATATE is an alternative PET radiotracer that showed acceptable efficacy in the detection of MTC. In this study, we aimed to reveal the clinical efficacy and impact of this radiotracer on the management of patients with MTC. METHODS The 68Ga-DOTATATE PET-CT records of 38 patients with confirmed MTC were included in the study. The demographic data, clinical indication for the scan, previous therapies, and tumor marker levels were recorded. The site and SUVmax of the lesions were also noted. A consensus was reached on the additional value of 68Ga-DOTATATE PET-CT, and sites with discordant results on conventional imaging (CI). Finally, changes in management after the scan were evaluated. RESULTS 68Ga-DOTATATE PET-CT outperformed CI in 14/38 (37%) patients. In these 14 patients, metastatic lymph nodes were detected in 8, bone metastases in 4, and both bone and lymph nodes metastases in 2 patients. In 16/38 (42%) patients, 68Ga-DOTATATE PET-CT performed equally well as CI. In 5/38 (13%) patients, CI outperformed PET-CT. Most of the patients (4/5) in this group had hepatic metastases. 68Ga-DOTATATE PET-CT positivity was also correlated with tumor marker expression [median calcitonin; PET-positive: 743 ± 5439 vs PET-negative: 45 ± 17 (p:0.012), median CEA; PET-positive: 41 ± 162 vs PET-negative: 2.6 ± 1.4 (p:0.015)]. 68Ga-DOTATATE PET-CT changed the clinical management of 13/38 (34%) patients. The information provided by PET-CT resulted in neck surgery in 5/13 patients, external radiotherapy in 3/13 and both in one patient. Four of these thirteen patients were found to be eligible for peptide receptor radionuclide therapy. CONCLUSION 68 Ga-DOTATATE is an essential part of the work-up for patients with MTC. This modality outperformed CI in 14/38 (37%) patients and changed the clinical management in 13/38 (34%) patients. Prospective randomized studies with image-guided therapy decisions are needed to further reveal the impact of PET imaging in patients with MTC.
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Affiliation(s)
- Murat Tuncel
- Department of Nuclear Medicine, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey.
| | - Saadettin Kılıçkap
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nilda Süslü
- Department of Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Aydınlı FE, Kulak Kayıkcı ME, Süslü N. Temporal and Frequency Characteristics of Turkish Vowels in Laryngectomized Speakers: Preliminary Study. Medeni Med J 2019. [DOI: 10.5222/mmj.2019.42744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Tahir E, Süslü N, Günaydın RÖ, Kuşçu O, Ergün O, Akyol U. Pediatric deep neck infections: efficacy of conservative treatment versus immediate surgical intervention. ENT Updates 2017. [DOI: 10.2399/jmu.2017002006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ermutlu G, Süslü N, Yılmaz T, Saraç S. Sudden hearing loss: an effectivity comparison of intratympanic and systemic steroid treatments. Eur Arch Otorhinolaryngol 2017; 274:3585-3591. [PMID: 28756569 DOI: 10.1007/s00405-017-4691-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/25/2017] [Indexed: 12/01/2022]
Abstract
Corticosteroid treatment has been considered the most effective treatment modality for sudden sensorineural hearing loss so far. Application route of corticosteroids may vary. We have designed a prospective randomized case-controlled clinical trial to evaluate the effectivenesses of the different application routes of steroids in the treatment of SSHL. Thirty-five patients were distributed randomly to two groups which were treated with either 'oral' or 'intratympanic' corticosteroids. Intratympanic steroid administration was performed three times every other day transtympanically. At the end of third month, recovery rate in the 'intratympanic' group was 84.2%, whereas in the 'oral' group, it was 87.5%. The difference between the recovery rates was not statistically significant. There were no major complications related to transtympanic steroid administration. These findings support that intratympanic steroid therapy is an alternative to systemic steroid therapy in the initial treatment of sudden hearing loss. In addition, transtympanic technique is an easy to perform and safe method for delivering steroids into the inner ear.
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Affiliation(s)
- Gülce Ermutlu
- Department of Otorhinolaryngology and Head and Neck Surgery, Hacettepe University, Ankara, Turkey. .,Kağıthane Devlet Hastanesi, Sanayi Mahallesi Sultan Selim Caddesi, Şahinler Sokak No:23 Kağıthane, İstanbul, Turkey.
| | - Nilda Süslü
- Department of Otorhinolaryngology and Head and Neck Surgery, Hacettepe University, Ankara, Turkey
| | - Taner Yılmaz
- Department of Otorhinolaryngology and Head and Neck Surgery, Hacettepe University, Ankara, Turkey
| | - Sarp Saraç
- Department of Otorhinolaryngology and Head and Neck Surgery, Koc University Hospital, İstanbul, Turkey
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Hapa A, Süslü N, Karaduman A, Budak B, Ersoy Evans S, Sennaroğlu L. Evaluation of hearing in patients with psoriasis considering the disease severity. ENT Updates 2016. [DOI: 10.2399/jmu.2016003006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Yılmaz T, Süslü N, Günaydın RÖ, Kuşçu O, Sözen T, Atay G, Bajin MD. Microtrapdoor Flap Technique for Treatment of Glottic Laryngeal Stenosis: Experience With 34 Cases. J Voice 2016; 30:751-754. [DOI: 10.1016/j.jvoice.2015.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/04/2015] [Indexed: 10/23/2022]
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Süslü N, Şefik Hoşal A. Early oral feeding after total laryngectomy: Outcome of 602 patients in one cancer center. Auris Nasus Larynx 2016; 43:546-50. [DOI: 10.1016/j.anl.2016.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/17/2015] [Accepted: 01/11/2016] [Indexed: 11/26/2022]
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Kuşcu O, Önay Ö, Kayahan B, Süslü N, Yılmaz T. The rising incidence of papillary thyroid microcarcinoma and is completion surgery necessary or not? Otolaryngol Pol 2016; 70:14-18. [PMID: 27383733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Papillary thyroid microcarcinoma (PTMC) is defined as a papillary cancer that is 1 cm or less in its maximal diameter. The incidence of thyroid cancer has increased during the past 30 years. The aim of this study is to evaluate the rising incidence of PTMC (papillary thyroid microcarcinoma) and whether is lobectomy enough or not. The data of 462 consecutive patients who underwent thyroidectomy (hemithyroidectomy and total thyroidectomy) at the Hacettepe University Hospitals Department of ENT from 2000 to 2015 were analyzed. Surgical procedure, histopathologic examinations, postoperative complications, follow-up time and mortality were recorded. USG and FNAC were performed on all cases. Of the 344 patients with thyroid malignancy and 118 patients underwent total laryngectomy with thyroidectomy. 364 patients with TT and 98 patients with HT. The first group included 204 patients (Surgery time 2000-2007), 91 of them ( 44.6%) had PTMC. The second group included 258 patients, 192of them (74,4%) had PTMC (p<0.001). 22 Patients with PTMC underwent completion surgery and 40 of them just followed by hemithyroidectomy. There was no recurrence. PTMC has been rising incidence because of ,pathological and radiological, increased awareness and completion surgery is not necessary for all PTMC cases especially incidental PTMC.
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Affiliation(s)
- Oğuz Kuşcu
- Hacettepe University Faculty of Medicine Department of Otorhinolaryngology
| | - Övsen Önay
- Hacettepe University Deparment of Otorinolaryngology, Head and Neck Surgery
| | - Bahar Kayahan
- Hacettepe University Deparment of Otorinolaryngology, Head and Neck Surgery
| | - Nilda Süslü
- Hacettepe University Deparment of Otorinolaryngology, Head and Neck Surgery
| | - Taner Yılmaz
- Hacettepe University Deparment of Otorinolaryngology, Head and Neck Surgery
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Kuşcu O, Önay Ö, Kayahan B, Süslü N, Yılmaz T. The rising incidence of papillary thyroid microcarcinoma and is completion surgery necessary or not? Otolaryngol Pol 2016; 70:15-9. [PMID: 27386928 DOI: 10.5604/00306657.1199990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Papillary thyroid microcarcinoma (PTMC) is defined as a papillary cancer that is 1 cm or less in its maximal diameter. The incidence of thyroid cancer has increased during the past 30 years. The aim of this study is to evaluate the rising incidence of PTMC (papillary thyroid microcarcinoma) and whether is lobectomy enough or not. The data of 462 consecutive patients who underwent thyroidectomy (hemithyroidectomy and total thyroidectomy) at the Hacettepe University Hospitals Department of ENT from 2000 to 2015 were analyzed. Surgical procedure, histopathologic examinations, postoperative complications, follow-up time and mortality were recorded. USG and FNAC were performed on all cases. Of the 344 patients with thyroid malignancy and 118 patients underwent total laryngectomy with thyroidectomy. 364 patients with TT and 98 patients with HT. The first group included 204 patients (Surgery time 2000-2007), 91 of them ( 44.6%) had PTMC. The second group included 258 patients, 192of them (74,4%) had PTMC (p<0.001). 22 Patients with PTMC underwent completion surgery and 40 of them just followed by hemithyroidectomy. There was no recurrence. PTMC has been rising incidence because of ,pathological and radiological, increased awareness and completion surgery is not necessary for all PTMC cases especially incidental PTMC.
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Affiliation(s)
- Oğuz Kuşcu
- Hacettepe University Faculty of Medicine Department of Otorhinolaryngology
| | - Övsen Önay
- Hacettepe University Deparment of Otorinolaryngology, Head and Neck Surgery
| | - Bahar Kayahan
- Hacettepe University Deparment of Otorinolaryngology, Head and Neck Surgery
| | - Nilda Süslü
- Hacettepe University Deparment of Otorinolaryngology, Head and Neck Surgery
| | - Taner Yılmaz
- Hacettepe University Deparment of Otorinolaryngology, Head and Neck Surgery
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Kuscu O, Bajin MD, Süslü N, Hoşal AŞ. The role of suprahyoid neck dissection in the treatment of squamous cell carcinoma of the lower lip: 20 years' experience at a Tertiary Center. J Craniomaxillofac Surg 2016; 44:1404-7. [PMID: 27427340 DOI: 10.1016/j.jcms.2016.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 04/19/2016] [Accepted: 06/02/2016] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the efficacy of L1-2ND in the management of the lower lip squamous cell carcinoma and to achieve the highest cure rates with adequate neck dissection. METHODS A retrospective review was completed on patients treated between 1994 and 2014. The case histories of 184 patients who were treated with surgical excision of the primary tumor along with neck dissection, and 24 patients who were treated only with surgical excision without neck dissection at another center, were studied. All patients were followed up for evidence of recurrent disease. RESULTS In 208 patients (193 men, 15 women) with a mean age of 51 years, 12 were N1, 3 were N2, and 169 were N0; 24 patients had undergone operation at another center without neck dissection. Lymph node metastases were present in 34 patients (18.4%) with dissected necks and occult metastases were detected in 19 patients with clinically N0 necks (11.2%). The median follow-up of each patient was 28 months. Only 1 patient developed neck recurrence, and there was no local recurrence. The overall survival rate (OAS) of patients with clinical N0 disease who underwent neck dissection was 94.7%; the OAS of the patients who were not treated with neck dissection was 29.1%. CONCLUSION Level 1-2 neck dissection (L1-2ND) is the treatment of choice for controlling neck disease in patients with lower lip carcinoma, and serves as a staging procedure to detect patients who require adjuvant therapy.
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Affiliation(s)
- Oguz Kuscu
- Hacettepe University, Department of Otorhinolaryngology, Head and, Neck Surgery, Turkey.
| | - Munir Demir Bajin
- Hacettepe University, Department of Otorhinolaryngology, Head and, Neck Surgery, Turkey.
| | - Nilda Süslü
- Hacettepe University, Department of Otorhinolaryngology, Head and, Neck Surgery, Turkey.
| | - Ali Şefik Hoşal
- Liv Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Turkey.
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Salimov A, Süslü N, Kuşçu O, Süslü AE, Akyol MU, Gököz Ö, Özoğul E. Parapharyngeal giant ganglioneuroma with multifocal bone involvement in a pediatric female patient. Turk J Pediatr 2016; 58:669-674. [PMID: 29090884 DOI: 10.24953/turkjped.2016.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ganglioneuroma is a rare benign tumor that originates from neural crest. Tumor tends to be slow growing, asymptomatic but can cause symptoms because of pressure to neighboring structures. In the head and neck region they are relatively rarely seen. We hereby present a rare case of multiple ganglioneuromas that were located in parapharyngeal space, iliac bone and other bones in a 13-year-old girl. Patient underwent surgery for the excision of a large mass, extending from parapharyngeal space to neck, with transparotid and transcervical combined approach. After operation, MIBG (iodine-123-meta-iodobenzylguanidine) scintigraphy was performed and involvement of parietooccipital bone, lumbal vertebra, right iliac wing medial cortex and left humerus were detected. No adjuvant therapy was given to the patient. There is no evidence of recurrence in the head and neck region in the following 12 months. In conclusion, complete surgical excision of the tumor, if possible, is the treatment of choice with high success rate. Close clinical and radiological follow-up for these tumors after surgery should be made.
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Affiliation(s)
- Asif Salimov
- Department of Otolaryngology Head and Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nilda Süslü
- Department of Otolaryngology Head and Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Oğuz Kuşçu
- Department of Otolaryngology Head and Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Emre Süslü
- Department of Otolaryngology Head and Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Umut Akyol
- Department of Otolaryngology Head and Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Özay Gököz
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ece Özoğul
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Altuntaş O, Petekkaya İ, Süslü N, Güllü İ. Renal Cell Carcinoma Metastatic to the Tongue: A Case Report and Review of the Literature. J Oral Maxillofac Surg 2015; 73:1227-30. [DOI: 10.1016/j.joms.2014.12.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/15/2014] [Accepted: 12/23/2014] [Indexed: 11/16/2022]
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Abstract
CONCLUSION Preoperative chemoradiotherapy (CRT) was associated with a significantly higher rate of pharyngocutaneous fistula (PCF). OBJECTIVE PCF is the most frequent complication following total laryngectomy. Although organ-preserving radiotherapy (RT) or CRT offer good locoregional control, many patients still require salvage laryngectomy. The aim of this study was to evaluate the factors that predispose patients to PCF, with a focus on preoperative RT, induction chemotherapy (ICT), and CRT. METHODS This was a retrospective case series; 151 patients who underwent TL were reviewed. Preoperative RT, ICT, CRT, and some surgical parameters were analyzed as potential risk factors. RESULTS The overall PCF rate was 13%. CRT was the only preoperative treatment that had a significant effect on PCF (35.3%, p = 0.004, odds ratio (OR) = 10.75). Surgery extended to the pharynx (p = 0.005, OR = 8.34) and vacuum drain duration (p = 0.012, OR = 5.16) were observed to be associated with PCF.
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Affiliation(s)
- Nilda Süslü
- Department of Otorhinolaryngology-Head and Neck Surgery
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Yılmaz T, Süslü N, Atay G, Günaydın RÖ, Bajin MD, Özer S. The effect of midline crossing of lateral supraglottic cancer on contralateral cervical lymph node metastasis. Acta Otolaryngol 2015; 135:484-8. [PMID: 25677524 DOI: 10.3109/00016489.2014.986759] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The degree of midline crossing of lateral supraglottic cancer does not significantly change its rate of contralateral cervical metastasis. The rate of occult metastasis is too high to take the risk of contralateral regional recurrence. We support routine bilateral neck dissection even in lateral supraglottic cancers with no or minimal midline crossing. OBJECTIVES Data on the rate of contralateral cervical metastasis of laterally located supraglottic cancer, the effect of its degree of midline crossing on contralateral cervical metastasis, and its treatment are still controversial. METHODS This was a retrospective cohort, chart review involving 305 surgically treated patients with T1-3 squamous cell carcinoma of the supraglottic larynx. In all, 184 patients had bilateral neck dissection; 86 N0 contralateral necks were followed up. Thirty-five patients who needed postoperative radiation therapy because of the primary tumor or ipsilateral neck dissection specimen also received radiation therapy to the contralateral neck. The degree of midline crossing at the epiglottis was measured on a laryngectomy specimen with a ruler and expressed as 'no,' '<5 mm' or '≥5 mm.' RESULTS The rates of occult and overall contralateral metastasis in our series were 16% and 28%, respectively. There was no statistically significant difference between contralateral neck metastasis and recurrence rates in the neck dissection, follow-up, and irradiation groups according to the degree of midline crossing.
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Affiliation(s)
- Taner Yılmaz
- Department of Otolaryngology-Head & Neck Surgery, Hacettepe University Faculty of Medicine , Ankara , Turkey
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Günaydın RÖ, Süslü N, Bajin MD, Kuscu O, Yılmaz T, Ünal ÖF, Akyol U. Endolaryngeal dilatation versus laryngotracheal reconstruction in the primary management of subglottic stenosis. Int J Pediatr Otorhinolaryngol 2014; 78:1332-6. [PMID: 24961989 DOI: 10.1016/j.ijporl.2014.05.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/18/2014] [Accepted: 05/20/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The scope of the study is to compare endolaryngeal dilatations (ED) with laryngotracheal reconstruction with cartilage grafting (LTRCG) in terms of restenosis. METHODS Pediatric subglottic stenosis patients treated in Hacettepe University, between 2002 and 2012 were retrospectively evaluated. Patients who had ED or LTRCG as primary management were included in the study. EDs were grouped into bronchoscopic dilatation (BD), laser incision and balloon dilatation (LBD) and cold knife incision and balloon dilatation (CKBD). The groups were evaluated in terms of restenosis and decannulation rates. RESULTS There were 35 patients (9 females, 26 males; mean age 4.42). LTRCG was performed in 16 patients (9 anterior and 7 anterior and posterior grafts). EDs were performed in 19 patients with 6 CKBDs, 7 LBDs and 6 BDs. There were 3 grade II, 13 grade III cases in the LTRCG group while 4 grade I, 6 grade II, 8 grade 3 and 1 grade 4 in the ED group. Overall decannulation rate was 97% (34/35) in all patients. Restenosis was higher in the ED group (63.2%) than the LTRCG group (31.3%) with rates of CKBD 16.7% (1/6), LBD 71.4% (5/7) and BD 100% (6/6). Restenosis rates were found to be increasing with higher grades (grade I-25%, grade II-66%, grade III-85%). CONCLUSION ED may need more repetitive interventions than LTRCG due to restenosis. Less restenosis might be observed when balloon is used for dilatation and cold knife for mucosal incisions.
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Affiliation(s)
- Rıza Önder Günaydın
- Hacettepe University, Faculty of Medicine, Otolaryngology Department, Ankara, Turkey.
| | - Nilda Süslü
- Hacettepe University, Faculty of Medicine, Otolaryngology Department, Ankara, Turkey.
| | - Münir Demir Bajin
- Hacettepe University, Faculty of Medicine, Otolaryngology Department, Ankara, Turkey.
| | - Oguz Kuscu
- Hacettepe University, Faculty of Medicine, Otolaryngology Department, Ankara, Turkey.
| | - Taner Yılmaz
- Hacettepe University, Faculty of Medicine, Otolaryngology Department, Ankara, Turkey.
| | - Ömer Faruk Ünal
- Acıbadem University, Faculty of Medicine, Otolaryngology Department, Ankara, Turkey.
| | - Umut Akyol
- Hacettepe University, Faculty of Medicine, Otolaryngology Department, Ankara, Turkey.
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Cabbarzade C, Sennaroglu L, Süslü N. CSF gusher in cochlear implantation: The risk of missing CT evidence of a cochlear base defect in the presence of otherwise normal cochlear anatomy. Cochlear Implants Int 2014; 16:233-6. [DOI: 10.1179/1754762813y.0000000048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Yılmaz T, Cabbarzade C, Süslü N, Bajin MD, Günaydın RÖ, Özer S, Atay G. Novel endoscopic treatment of pharyngocele: endoscopic suture pharyngoplasty. Head Neck 2014; 36:E78-80. [PMID: 24170686 DOI: 10.1002/hed.23531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/13/2013] [Accepted: 10/22/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pharyngocele or a lateral pharyngeal diverticulum (LPD) are rare lesions, which are bulgings of the pharyngeal mucosal surface through one of the weak areas of the pharynx. METHODS The external approach has been the primary surgical treatment of pharyngoceles. The purpose of this article was for us to report an endoscopic successful treatment of pharyngocele by suture pharyngoplasty. RESULTS Endoscopic suture pharyngoplasty does not require an external incision and hospitalization. After 3 months of abstinence from trumpet playing, the patient is back to his musical career. CONCLUSION Because of the minimally invasive procedure, endoscopic suture pharyngoplasty can be performed in case of symptomatic pharyngoceles with a good result.
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Affiliation(s)
- Taner Yılmaz
- Department of Otolaryngology - Head and Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Pamuk AE, Süslü N, Günaydın RO, Atay G, Akyol U. Laryngomalacia: patient outcomes following aryepiglottoplasty at a tertiary care center. Turk J Pediatr 2013; 55:524-528. [PMID: 24382534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Laryngomalacia is the most common cause of stridor in neonates and infants. Most cases are mild and resolve spontaneously without treatment. Only severe cases with intolerable symptoms require surgical intervention; in such cases, supraglottoplasty is considered the treatment of choice. The aim of this study was to review and present the outcomes in patients with laryngomalacia who underwent aryepiglottoplasty-a type of supraglottoplasty. The medical records of children diagnosed as laryngomalacia who were followed up at Hacettepe University Hospital, Department of Otorhinolaryngology, between 2007 and 2012 were reviewed retrospectively. The study included 16 children who required surgical intervention. The mean age of the 16 children included in the study was 133 days (range: 7 days-48 months). Among the patients, 9 (56%) were male and 7 (44%) were female. In all, 7 patients (44%) had a comorbid condition. Laryngomalacia diagnoses were as follows: type I: n = 2, 13%; type II: n = 13, 81%; type III: n= 1, 6%. Stridor completely resolved in 10 of the children who underwent aryepiglottoplasty. Three patients required tracheotomy and 3 required revision supraglottoplasty; these six cases were considered as failed surgical treatment. The aryepiglottoplasty success rate was 63%. None of the patients had any intraoperative or postoperative complications. Despite the primarily benign nature of laryngomalacia, comorbid conditions can exacerbate symptoms and negatively affect the prognosis. Aryepiglottoplasty can be performed with high success and low complication rates in properly selected patients.
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Affiliation(s)
- A Erim Pamuk
- Department of Otorhinolaryngology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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21
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Süslü N, Süslü AE, Akyol U, Yılmaz T. Minimally invasive endoscope-assisted surgery for bilateral branchial cleft fistula. Laryngoscope 2013; 123:2296-9. [DOI: 10.1002/lary.23826] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Nilda Süslü
- Department of Otorhinolaryngology; Hacettepe University School of Medicine; Ankara; Turkey
| | - Ahmet E. Süslü
- Department of Otolaryngology; TDV 29 Mayıs Hospital; Ankara; Turkey
| | - Umut Akyol
- Department of Otorhinolaryngology; Hacettepe University School of Medicine; Ankara; Turkey
| | - Taner Yılmaz
- Department of Otorhinolaryngology; Hacettepe University School of Medicine; Ankara; Turkey
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22
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Yilmaz T, Süslü N, Atay G, Özer S, Günaydin RÖ, Bajin MD. Comparison of Voice and Swallowing Parameters After Endoscopic Total and Partial Arytenoidectomy for Bilateral Abductor Vocal Fold Paralysis. JAMA Otolaryngol Head Neck Surg 2013; 139:712-8. [DOI: 10.1001/jamaoto.2013.3395] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Taner Yilmaz
- Department of Otolaryngology, Head & Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nilda Süslü
- Department of Otolaryngology, Head & Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gamze Atay
- Department of Otolaryngology, Head & Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serdar Özer
- Department of Otolaryngology, Head & Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Riza Önder Günaydin
- Department of Otolaryngology, Head & Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Münir Demir Bajin
- Department of Otolaryngology, Head & Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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23
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Süslü N, Hoşal AŞ, Aslan T, Sözeri B, Dolgun A. Carcinoma of the Oral Tongue: A Case Series Analysis of Prognostic Factors and Surgical Outcomes. J Oral Maxillofac Surg 2013; 71:1283-90. [DOI: 10.1016/j.joms.2013.01.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 01/15/2013] [Accepted: 01/17/2013] [Indexed: 11/29/2022]
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Aksoy HT, Süslü N, Demirel G, Çelik İ, Canpolat FE, Erdeve Ö, Akyol U, Dilmen U. Congenital laryngeal cyst: a rare cause of polyhydramnios. APSP J Case Rep 2013; 4:12. [PMID: 24040590 PMCID: PMC3754397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 03/25/2013] [Indexed: 11/03/2022] Open
Abstract
Congenital laryngeal cyst is a rare cause of airway obstruction that may require urgent diagnosis and treatment. We report a case of a neonate having history of polyhydramnios and severe respiratory distress at birth. A laryngeal cyst detected during intubation. The outcome of laryngoscopic treatment of the cyst was favorable.
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Affiliation(s)
- Hatice Tatar Aksoy
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Nilda Süslü
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine Children’s Hospital, Ankara, Turkey
| | - Gamze Demirel
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - İstemihan Çelik
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Fuat Emre Canpolat
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Ömer Erdeve
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine Children’s Hospital, Ankara, Turkey
| | - Umut Akyol
- Department of Otorhinolaryngology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Dilmen
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey, and Department of Pediatrics, Yildirim Beyazit University School of Medicine, Ankara, Turkey
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Süslü N, Ermutlu G, Akyol U. Pediatric tracheotomy: comparison of indications and complications between children and adults. Turk J Pediatr 2012; 54:497-501. [PMID: 23427513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The aim of this study was to demonstrate the differences between adult and pediatric tracheotomies in terms of indications, early and late complications and decannulation time. A total of 136 (53 children, 83 adult) patients who underwent tracheotomy between 2006 and 2011 were studied. Prolonged intubation was the most common indication in children (84.9%), whereas in the adult group, upper airway obstruction (45.8%) was the main indication. Early and late complication rates in children were 22.6% and 5.7%, respectively. Complication rates (early 19.3%, late 4.8%) in adults did not differ statistically from those in children. Similar decannulation success was observed in children (34.6%) and adults (40.2%). Mean decannulation times after tracheotomy were 317 and 69 days in children and adults, respectively, and the difference was statistically significant (p = 0.040). Pediatric and adult tracheotomies differ in terms of indication and decannulation time, but complications are similar.
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Affiliation(s)
- Nilda Süslü
- Department of Otorhinolaryngology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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26
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Ozdemir R, Erdeve O, Süslü N, Akyol U, Yurttutan S, Uras N, Oguz SS, Dilmen U. Treatment of congenital nasal cavity stenosis by balloon dilatation in a newborn: a case report. Int J Pediatr Otorhinolaryngol 2011; 75:960-2. [PMID: 21524805 DOI: 10.1016/j.ijporl.2011.03.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 03/28/2011] [Accepted: 03/29/2011] [Indexed: 11/29/2022]
Abstract
Neonates are obligate nasal breathers, and any form of neonatal nasal obstruction may have serious consequences. Prompt diagnosis and appropriate treatment are essential to avoid severe hypoxia. Congenital bony nasal stenosis (CBNS) is an extremely rare cause of neonatal nasal airway obstruction and can easily be confused with choanal atresia or stenosis. This is a paper to describe a balloon dilatation technique that can be an effective alternative to surgery for the treatment of congenital nasal cavity stenosis, with minimal stress to the patient.
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Affiliation(s)
- R Ozdemir
- Neonatal Intensive Care Unit, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey.
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Süslü N, Hoşal AŞ, Sözeri B. Prognostic value of metastatic lymph node ratio in node-positive head and neck carcinomas. Am J Otolaryngol 2010; 31:315-9. [PMID: 20015770 DOI: 10.1016/j.amjoto.2009.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 03/02/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of the study was to determine the prognostic significance of the ratio between metastatic and examined lymph nodes to the survival rate of patients with squamous cell carcinoma of the head and neck. MATERIALS AND METHODS The study included 142 patients in whom metastatic lymph nodes were observed in neck dissection specimens. The number of metastatic lymph nodes and the ratio of metastatic lymph nodes (RMLN) were compared as prognostic factors affecting overall survival (OS) and disease-free survival (DFS) rates. Survival curves were made using Kaplan-Meier analysis and were assessed by the log-rank test and Cox regression method. RESULTS The median number of metastatic lymph nodes and RMLN for the entire study population were 2 and 4%, respectively. The OS and DFS rates were analyzed in the groups according to such stratification. The result of analysis of OS and DFS showed a statistically significant difference between patients with RMLN of at least 4% and those with RMLN less than 4% (hazard ratio, 3.4 and 2.7; P = .015 and P = .001, respectively). CONCLUSIONS The ratio of metastatic lymph nodes has a significant impact on the survival period.
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Abstract
CONCLUSION Because of the lack of association between a positive test and response to corticosteroid treatment, at present, detection of anti-HSP 70 antibody, tumor necrosis factor (TNF)-alpha, erythrocyte sedimentation rate (ESR), or antinuclear antibody (ANA), does not offer clinically useful information in the treatment of Meniere's disease (MD). OBJECTIVES The study was designed to investigate the performance of various laboratory tests, including anti-HSP 70, TNF-alpha, ESR, ANA, and anti-phospholipid antibodies, in the diagnosis and treatment response of patients with MD. PATIENTS AND METHODS Thirty patients who presented with MD and 30 healthy people were selected as study and control groups, respectively. The laboratory panel included the following tests: anti-HSP 70 antibody immunoassay, TNF-alpha, ESR, ANA, and anti-phospholipid antibodies. The study group was given corticosteroid therapy and separated into two groups: the corticosteroid responders and the corticosteroid non-responders. In the follow-up, repeat audiograms were evaluated to determine the response to treatment. RESULTS TNF-alpha was found at significantly lower titers in the study group when compared with the control group (p<0.05). Anti-HSP 70 was not found in high titers in the study group. ANA positivity in patients with MD was not statistically different from the control group. There was no significant difference in the treatment response for any of the parameters tested.
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Affiliation(s)
- Nilda Süslü
- Department of Otolaryngology-Head and Neck Surgery, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey.
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Süslü N, Yilmaz T, Gürsel B. Utility of anti-HSP 70, TNF-alpha, ESR, antinuclear antibody, and antiphospholipid antibodies in the diagnosis and treatment of sudden sensorineural hearing loss. Laryngoscope 2009; 119:341-6. [PMID: 19160386 DOI: 10.1002/lary.20050] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To investigate the performance of various laboratory tests used for patients with sudden sensorineural hearing loss (SSNHL). STUDY DESIGN Prospective clinical trial. METHODS Thirty patients who presented with SSNHL and 30 healthy people with no cochleovestibular disorders were selected as study and control groups. The laboratory panel includes the following tests: anti-HSP 70 antibody immunoassay, tumor necrosis factor-alpha (TNF-alpha), erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), and antiphospholipid antibodies. The study group was given corticosteroid therapy and separated into two groups: the corticosteroid responders and the corticosteroid nonresponders. In the follow-up, repeat audiograms were evaluated to determine the response to treatment. RESULTS TNF-alpha was found at lower titers in the study group when compared with the control group in contrast to other studies. Also, anti-HSP 70 was not found in high titers in the study group. ANA and ESR were the two parameters that were significantly more positive in the study group compared with the control group. CONCLUSIONS Because of the lack of association between a positive test and response to corticosteroid treatment, detection of the anti-HSP 70 antibody, TNF-alpha, ESR, and ANA, at present, do not offer clinically useful information in the treatment of SSNHL. Also, because of the lower titers of TNF-alpha documented in patients with SSNHL, we do not recommend the use of specific TNF-alpha inhibitors in SSNHL.
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Affiliation(s)
- Nilda Süslü
- Department of Otolaryngology, Head & Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Süslü N, Bajin MD, Süslü AE, Oğretmenoğlu O. Effects of buffered 2.3%, buffered 0.9%, and non-buffered 0.9% irrigation solutions on nasal mucosa after septoplasty. Eur Arch Otorhinolaryngol 2008; 266:685-9. [PMID: 18802718 DOI: 10.1007/s00405-008-0807-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022]
Abstract
A prospective randomized study was designed to compare the effect of different irrigation solutions on mucociliary clearance and nasal patency and to compare the limitations of the used solutions, such as nasal burning by a visual analog scale. Forty-five patients who underwent septoplasty were divided into three groups postoperatively. Each group was administered with 2.3% buffered hypertonic seawater, buffered isotonic saline solution and non-buffered isotonic saline, respectively, as irrigation fluid. Saccharine test and acoustic rhinometer were used to determine mucociliary activity and nasal patency. Patients were asked about the burning sensation using a 10-cm visual analog scale. There was no significant difference in saccharine clearance time (SCT) on the 5th postoperative day between the three groups (P = 0.07). On the 20th day, there was a significant difference in SCT between the hypertonic buffered seawater group and non-buffered isotonic saline (P = 0.003). Buffered hypertonic seawater improved nasal airway patency more than the buffered isotonic saline (P = 0.004). Buffered hypertonic solutions used after endonasal surgery have been advantageous for both mucociliary clearance and postoperative decongestion.
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Affiliation(s)
- Nilda Süslü
- Department of Otorhinolaryngology, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey.
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Süslü AE, Öğretmenoğlu O, Süslü N, Yücel ÖT, Önerci TM. Acute invasive fungal rhinosinusitis: our experience with 19 patients. Eur Arch Otorhinolaryngol 2008; 266:77-82. [DOI: 10.1007/s00405-008-0694-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Accepted: 04/24/2008] [Indexed: 11/29/2022]
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