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Öğe The Association between Iron Deficiency and Otitis Media with Effusion(Aves, 2019) Akcan, Fatih Alper; Dündar, Yusuf; Akcan, Hümeyra Bayram; Cebeci, Derya; Sungur, Mehmet Ali; Ünlü, İlhanOBJECTIVES: The purpose of this trial is to examine the clinical role of iron metabolism on development of Otitis media with effusion. MATERIALS and METHODS: This prospective study was conducted in a tertiary referral center. The study group made up of children who had surgery for Otitis media with effusion (OME). Control group was comprised of children who had surgery by a pediatric surgeon for inguinal hernia repair or circumcision operations with normal ear nose throat examination. Each group was evaluated depending on the serum iron metabolism parameters. RESULTS: One-hundred-thirteen children with OME and 117 control patients were included to the study. Iron deficiency anemia was detected in 18 out of 113 patients (15.9%) in study group while there were 4 out of the 117 patients (3.4%) in control group (p:0.001). The mean hemoglobin level was 12.16 +/- 1.16 in OME group and 12.93 +/- 1.08 in control group (p<0.001). CONCLUSION: The current study shows the rate of iron deficiency anemia is higher in patients with OME than controls. Iron-deficiency anemia might be considered a potential risk factor for development of otitis media with effusion, and iron parameters should be evaluated in these children.Öğe Clinical role of vitamin D in prognosis of otitis media with effusion(Elsevier Ireland Ltd, 2018) Akcan, Fatih Alper; Dündar, Yusuf; Akcan, Hümeyra Bayram; Uluat, Ahmet; Cebeci, Derya; Sungur, Mehmet Ali; Ünlü, İlhanObjective: To investigate the clinical role of Vitamin D in prognosis of Otitis media with effusion. Methods: This prospective-controlled study was conducted at otolaryngology department in Duzce University, Turkey. The study group comprised children who were diagnosed with Otitis media with effusion between September 2016 and February 2017. Control group was conducted with children underwent circumcision or inguinal hernia repair operations that confirmed with ENT examination they do not have any sign of otitis media. After 3 months of follow-up without any treatment, unresolved cases who were accepted as chronic otitis media with effusion were operated under general anesthesia for ventilation tube application. Study and control groups were assessed depending on the serum 25(OH)Vitamin D levels at the end of 3 months; <15 ng/mL was accepted as vitamin D deficiency. The results were compared with the control group in terms of vitamin D levels. Also, subgroup analysis was performed addressing to the complete recovery otitis media with effusion and chronic otitis media with effusion. Results: One-hundred-seventy-four children with otitis media with effusion and 80 control patients were included to the study. One-hundred-eight (62%) out of 174 patients with otitis media with effusion was completely recovered after a 3-months follow up. Of those 66 out of 174 children, they had persistent diseases, underwent ventilation tube insertion after a 3-months follow-up. The mean 25(OH)Vitamin D level was 18.98 +/- 10.60 in otitis media with effusion group and 28.07 +/- 14.10 in control group and the difference was statistically significant between the study and control group (p < 0.001). Vitamin D deficiency was observed in 33 out of 66 patients (50.0%) in chronic otitis media with effusion group whilst 35 out of 108 patients (32.4%) in complete recovery otitis media with effusion group (p = 0.021). The rate of 25(OH)Vitamin D deficiency was 25% in control group which was statistically different from chronic otitis media with effusion and recovery chronic otitis media with effusion groups (p = 0.006). Conclusions: This study not only shows the relationship between Vitamin D and otitis media with effusion development, but also demonstrates the effects of Vitamin D on otitis media with effusion prognosis. There is a significant association between 25(OH)Vitamin D deficiency and follow-up outcomes of otitis media with effusion.Öğe Does surgical technique significantly change the rate of post-tonsillectomy hemorrhage?(Duzce University Medical School, 2018) Dündar, Yusuf; Akcan, Hümeyra Bayram; Cebeci, Derya; Uluat, Ahmet; Akcan, Fatih AlperAim: Tonsillectomy is one of the most common surgical procedures in the pediatric population, as well as one of the first operations learned during otolaryngology residency. This study aims to evaluate the effect of surgical technique on the occurrence of post-tonsillectomy hemorrhage. Material and Methods: This prospectively-designed clinical trial was conducted in a tertiary referral center between May 2012 and April 2015. A total of 608 patients had tonsillectomies performed by a single surgeon with three different surgical techniques used during the study period. Patients in group one were operated on using cold dissection; group two comprised patients who underwent bipolar cautery; group three had the posterior pillar mucosal suturing technique performed. Results: 608 patients met inclusion criteria; 165 of them in group one, 274 in group two, and 169 in group three. The median age was 5 (2-14) years old. A total of five patients (0.82%) experienced post-operative bleeding. One of these patients (from group one) experienced primary hemorrhage. The four others were considered secondary hemorrhage; two from each the bipolar cautery and posterior pillar mucosal suturing groups. The rates of post-operative hemorrhage in each group were 0.61%, 0.73% and 1.18%, respectively (p=0.861). Only one of the five patients necessitated a return to the operating room to control the bleeding. Conclusion: Our study findings suggest that the choice of surgical technique does not affect the post-tonsillectomy bleeding rate. There were no significant differences in bleeding rates between subgroups. © 2018, Duzce University Medical School. All rights reserved.Öğe Evaluating the effect of nasal septoplasty on atrial electromechanical features(W B Saunders Co-Elsevier Inc, 2019) Kayapınar, Osman; Kaya, Adnan; Özde, Cem; Cebeci, Derya; Ünlü, İlhanBackground: Recent studies have demonstrated that right ventricular (RV) dysfunction and increased pulmonary artery pressure may be frequent in patients with upper airway obstruction. In this study, we evaluated atrial conduction delays in patients with upper airway obstruction secondary to nasal septum deviation (NSD). Methods: A total of 32 patients with upper airway obstruction secondary to NSD undergoing a septoplasty procedure were enrolled in this study. Preoperative electrocardiography and transthoracic echocardiography were performed in all patients who underwent surgery. The mean pulmonary artery pressure (mPAP) and atrial conduction time (ACT) were recorded before and 6 months after the surgical procedures. Results: The PAP was significantly lower postoperatively than preoperatively (20.75 +/- 4.83 vs. 24.68 +/- 5.26; P < 0.001). The postoperative Electromechanical Delay of Mitral septal wall (EMD-MS) value was significantly lower than that preoperatively (46.20 +/- 8.5 vs. 40.5 +/- 9.9; P < 0.001). The postoperative Electromechanical Delay of Mitral lateral wall (EMD-ML) value decreased significantly compared to the preoperative period (46.3 +/- 7.4 vs. 40.6 +/- 9.3; P < 0.001). The postoperative Electromechanical Delay of Tricuspit lateral wall (EMD-TL) value was significantly lower than that preoperatively (43.8 +/- 7.0 vs. 38.1 +/- 9.1; P < 0.001). There was no significant change in pre- or postoperative measurements of inter- and intra-atrial conduction delays. Conclusions: We demonstrated that upper airway obstruction secondary to NSD causes a significant increase in mPAP and a significant delay in ACT, which improved after nasal septoplasty. According to these results, we conclude that upper airway obstruction may be an important risk factor for pulmonary arterial hypertension, RV dysfunction, and atrial arrhythmias, especially in unoperated cases.Öğe Evaluation of nasal mucociliary clearance time in patients with Vitamin-D deficiency(Springer, 2019) Akcan, Fatih Alper; Dündar, Yusuf; Akcan, Hümeyra Bayram; Uluat, Ahmet; Cebeci, Derya; Ünlü, İlhanObjectivesThe main purpose of the current study was to investigate nasal mucociliary clearance time (NMC) in patients with Vitamin-D deficiency.MethodsA total of 55 patients with Vitamin-D deficiency and 32 controls were evaluated. NMC time was measured with subjective saccharine test and compared between study and control groups. In addition, NMC time was re-evaluated after Vitamin-D replacement protocol in patients with Vitamin-D deficiency.ResultsThe mean 25(HO)Vitamin-D levels were 14.324.23ng/mL (7-24.6) and 29.38 +/- 7.05ng/mL (25-53.8) in study and control groups, respectively (p<0.001). The mean NMC time was 11.15 +/- 3.05 (6.3-17.6) and 8.40 +/- 2.33 (6-13.2) in study and control groups, respectively (p<0.001). The mean 25(HO)Vitamin-D level after the replacement protocol was 33.38 +/- 10.03 and the mean NMC time was 9.56 +/- 2.54 (p<0.001).Conclusion The mean NMC time was significantly increased in patients with Vitamin-D deficiency which can be corrected after Vitamin-D replacement protocols. The prolonged mucociliary clearance might be one of the pathophysiologic pathways at increased upper respiratory tract infections, and sinonasal and ear infections in patients with Vitamin-D deficiency.Öğe Gebe kadınlarda birinci, ikinci ve üçüncü trimesterde kulak burun boğaz değişikliklerinin araştırılması(Düzce Üniversitesi, 2018) Cebeci, Derya; Akcan, Fatih AlperGebelikle ilişkili metabolik, endokrinolojik ve fizyolojik değişiklikler her organ sistemini bir dereceye kadar etkilemektedir. Bu değişikliklerin çoğu baş ve boyun bölgesinde semptomlara yol açmaktadır ve kulak burun boğaz hekimleri tarafından takibi ve tedavisi gereken bozukluklar yaygın görülmektedir. Kulak burun boğaz hekiminin hamilelikle ilgili fizyolojik değişiklikleri ve bu değişikliklerin baş ve boyunda nasıl ortaya çıktığını bilmesi önemlidir. Gebelikle beraber ortaya çıkan ya da önceden var olup gebelikle beraber şiddetini arttıran bu bozuklukların tanı ve yönetimi hala karmaşıklığını sürdürmektedir. Özellikle tedavi verilirken, anne ve fetüs için oluşabilecek tehlikeli yan etkilere dikkat edilmelidir. Bu çalışma Eylül 2017 – Eylül 2018 tarihleri arasında Düzce Üniversitesi Tıp Fakültesi Kulak Burun Boğaz kliniğinde, Kadın Hastalıkları ve Doğum kliniğinden tarafımıza yönlendirilen 18 ile 40 yaş aralığındaki yeni tanı gebeler ile yapıldı. Çalışma süresince 22 hastanın üç trimester boyunca kulak burun boğaz ile ilgili muayeneleri yapıldı. Kontrol grubu da doğurganlık döneminde olup, gebelik tanısı bulunmayan sağlıklı 22 bayandan oluşturuldu. Gebelere üç trimester boyunca periyodik olarak kulak burun boğaz muayeneleri, saf ses odyometrisi, timpanometri, nazal mukosilier klirens süresi ölçümü yapıldı ve Tinnitusun subjektif algı seviyesi için Görsel Analog Ölçeği (GAÖ), Alerjik Rinokonjuktivit Yaşam Kalitesi Anketi, Gebelikte kusma-bulantı değerlendirme skalası uygulandı. Kontrol grubuna ise bir kez olmak üzere kulak burun boğaz muayeneleri, saf ses odyometrisi, timpanometri, nazal mukosilier klirens süresi ölçümü yapıldı. Gebelerin üç trimesterde elde edilen değerleri kendi aralarında kıyaslanırken, kontrol grubu ile birinci trimester verileri karşılaştırıldı.Öğe Is anemia in children with sleep disordered breathing actually a consequence of chronic disease?(2018) Akcan, Fatih Alper; Dündar, Yusuf; Akcan, Hümeyra Bayram; Uluat, Ahmet; Cebeci, Derya; Sungur, Mehmet AliObjectives. We aimed to investigate iron metabolism and laboratory findings of anemia in children undergoing adenotonsillectomy for sleep disordered breathing. Methods. Consecutive children undergoing adenoidectomy/adenotonsillectomy for sleep disordered breathing between January 2013 and January 2015 were investigated. Routine preoperative blood tests including blood count and iron studies were analyzed. Subgroup analyses were performed addressing to the severity of sleep disordered breathing, age and duration of symptoms. Results were compared between subgroups and normal values. Results. The study included 171 children. The mean age was 5.44 2.62 years. The mean hemoglobin level was 11.87 1.125 gr/dL and 24 (14%) out of 171 patients had anemia ( 11 gr/dL). The mean ferritin levels were 23.23 17.27 µg/L and 21.27 15.44 µg/L in patients with anemia and non-anemic patients, respectively (p 0.572). Ferritin levels decreased in only 8 (33%) out of 24 patients with anemia. The mean age, body mass index, hematocrit, mean corpuscular volume, unsaturated iron binding capacity and serum iron levels decreased in patients with anemia. The rate of anemia significantly increased in children less than or equal to 3 years of age (p 0.020). There was no significant association between hemoglobin levels and sleep disordered breathing clinical score or duration of symptoms. Conclusion. The association between low iron status and sleep disordered breathing has previously published. Unfortunately, the type of anemia is still unclear. Our results supposed that the anemia of chronic disease secondary to chronic inflammatory process might play a role in pathogenesis of anemia in patients with sleep disordered breathing.Öğe Pediatric Tracheotomies: A 5-Year Experience In 152 Children(Deomed Publ, Istanbul, 2018) Akcan, Fatih Alper; Dündar, Yusuf; Uluat, Ahmet; Cebeci, Derya; Sungur, Mehmet Ali; Salman, Nergis; Ünlü, İlhanObjective: To analyze the indications, complications, and outcomes of pediatric tracheotomies. Material and methods: All tracheotomies performed in a tertiary referral center between January 2011 and December 2015 were reviewed retrospectively. Demographic characteristics of patients, types of referral to hospital, tracheotomy indications, preoperative evaluation findings, surgical technique, postoperative care and complications, discharge and follow-up results were analyzed. Results: A total of 152 pediatric patients underwent tracheotomy at our hospital during this five year period. The median age of patients at the time of tracheotomy was 15.8 months, ranging from 24 days to 17 years. Of the 152 patients, 91 had neurological diseases, 38 had cardiopulmonary diseases, 14 had craniofacial abnormalities, seven had upper airway obstruction, and two underwent tracheostomy for trauma. Eleven (7.2%) patients experienced early complications, and 15 (9.8%) experienced late complications. Twenty (13.1%) patients were decannulated during the follow-up period. Unfortunately, 9 patients (5.9%) died of primary disease and 3 patients (1.9%) died of tracheostomy-related complications Conclusions: The majority of procedures were performed for diseases leading to prolonged mechanical ventilator support such as neurological and cardiopulmonary diseases. This study demostrates the importance of tracheotomy indications, which are the main predictors of decannulation rates. The other significant predictor is pulmonary complications that may cause permanent dependence of mechanical ventilator support as a result of pulmonary failure.Öğe Servikal nekrotizan fasiit(2018) Akcan, Fatih Alper; Cebeci, Derya; Dündar, Yusuf; Ünlü, İlhanServikal nekrotizan fasiit (NF) nadir ve ölümcül bir bakteriyelenfeksiyondur. Fasya planları ve subkütan dokularda ilerleyendoku nekrozu ile karakterizedir. Bu yazıda, yaygın boyunağrısı ve hareket kısıtlılığı nedeni ile değerlendirilen iki NFhastası sunuldu. Boyun bilgisayarlı tomografide subkütanözdokuda yaygın ödem izlendi. Nekrotizan fasiit tanısı konulanhastalar yoğun bakıma nakledildi ve geniş spektrumluantibiyoterapi başlandı. Acil şartlarda boyun eksplorasyonuyapıldı ve tüm nekrotik fasya planları rezeke edildi. Birincihasta boyun enfeksiyonunun giderilmesine rağmen hastaneyeyatışının 45. gününde ikincil bir hastane enfeksiyonu nedeniile kaybedildi. İkinci hasta takiplerinde komplikasyonolmaksızın ameliyat sonrası 10. günde taburcu edildi.Nekrotizan fasiit tanısı klinik şüphe ve fizik muayene ilekonulur. Erken tanı, uygun geniş spektrumlu antibiyoterapive cerrahi debridman mortalitenin önüne geçebilmek için enönemli faktörlerdir.
