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    Imaging features to predict response to olfactory training in post-traumatic olfactory dysfunction
    (John Wiley and Sons Inc, 2021) Altundağ, Aytuğ; Saatçi, Özlem; Kandemirli, Sedat Giray; Tekcan Şanlı, Deniz Esin; Arıcı Düz, Özge; Şanlı, Ahmet Necati; Yıldırım, Düzgün
    Objectives/Hypothesis: Prognosis of post-traumatic olfactory dysfunction is poor, with medical treatment options showing limited success rates. Olfactory training (OT) has been introduced as a potential therapeutic option in olfactory dysfunction. We aimed to identify the imaging features that would predict a better response to OT and create an imaging-based prognostic scale. Methods: We retrospectively reviewed 52 patients that underwent OT at our center for post-traumatic olfactory dysfunction. Olfactory functions at the time of initial presentation and at completion of OT were evaluated using Sniffin’ Sticks test and threshold discrimination identification (TDI) scores were calculated. Patients were divided into responders (ROT group: 16 cases) and non-responders (n-ROT group: 36 cases) to OT based on TDI score change (cut-off 5.5 point). Morphological measurements of olfactory fossa, olfactory bulb volume and signal abnormalities, olfactory nerve filia integrity, siderosis, encephalomalacic changes in olfactory cortex, and other cortical regions were reviewed. Results: There was no significant difference between the two groups in terms of age, gender distribution, olfactory dysfunction duration, head-trauma severity, and initial TDI scores. A model incorporating five variables: cribriform plate fracture, olfactory fossa depth (cut-off: 4.9 mm), olfactory bulb encephalomalacia, olfactory bulb volume (cut-off: 27.1 mm3), and siderosis was developed. This model had an area under the curve (AUC) of 0.950, and a cut-off value of 1 had 76.5% sensitivity and 97.1% specificity in prediction of response to OT. Conclusions: We developed an imaging-based scoring system with good specificity that can be used as an adjunctive tool for patient counseling, and optimal selection of management options. Level of Evidence: 4 Laryngoscope, 131:E2243–E2250, 2021.
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    Olfactory cleft measurements and COVID-19-related anosmia
    (Sage Publications Ltd, 2021) Altundağ, Aytuğ; Yıldırım, Düzgün; Tekcan Şanlı, Deniz Esin; Çayönü, Melih; Kandemirli, Sedat Giray; Şanlı, Ahmet Necati; Arıcı Düz, Özge; Saatçi, Özlem
    Objective. This study aimed to investigate the differences in olfactory cleft (OC) morphology in coronavirus disease 2019 (COVID-19) anosmia compared to control subjects and postviral anosmia related to infection other than severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Study Design. Prospective. Setting. This study comprises 91 cases, including 24 cases with anosmia due to SARS-CoV-2, 38 patients with olfactory dysfunction (OD) due to viral infection other than SARS-CoV-2, and a control group of 29 normosmic cases. Methods. All cases had paranasal sinus computed tomography (CT), and cases with OD had magnetic resonance imaging (MRI) dedicated to the olfactory nerve. The OC width and volumes were measured on CT, and T2-weighted signal intensity (SI), olfactory bulb volumes, and olfactory sulcus depths were assessed on MRI. Results. This study showed 3 major findings: the right and left OC widths were significantly wider in anosmic patients due to SARS-CoV-2 (group 1) or OD due to non-SARS-CoV-2 viral infection (group 2) when compared to healthy controls. OC volumes were significantly higher in group 1 or 2 than in healthy controls, and T2 SI of OC area was higher in groups 1 and 2 than in healthy controls. There was no significant difference in olfactory bulb volumes and olfactory sulcus depths on MRI among groups 1 and 2. Conclusion. In this study, patients with COVID-19 anosmia had higher OC widths and volumes compared to control subjects. In addition, there was higher T2 SI of the olfactory bulb in COVID-19 anosmia compared to control subjects, suggesting underlying inflammatory changes. There was a significant negative correlation between these morphological findings and threshold discrimination identification scores.
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    The temporal course of COVID-19 anosmia and relation to other clinical symptoms
    (Springer, 2021) Altundağ, Aytuğ; Saatçi, Özlem; Tekcan Şanlı, Deniz Esin; Arıcı Düz, Özge; Şanlı, Ahmet Necati; Olmuşçelik, Oktay; Temirbekov, Dastan; Kandemirli, Sedat Giray; Batıoğlu Karaaltın, Ayşegül
    Objective This study aimed to define the clinical course of anosmia in relation to other clinical symptoms. Methods 135 patients with COVID-19 were reached by phone and subsequently included in the study. Olfactory functions were evaluated using a questionnaire for assessment of self-reported olfactory function. Patients were divided into four subgroups according to the presence of olfactory symptoms and temporal relationship with the other symptoms: group1 had only olfactory complaints (isolated, sudden-onset loss of smell); group2 had sudden-onset loss of smell, followed by COVID-19 related complaints; group3 initially had COVID-19 related complaints, then gradually developed olfactory complaints; and group4 had no olfactory complaints. Results In total, 59.3% of the patients interviewed had olfactory complaints during the disease course. The olfactory dysfunction severity during COVID-19 infection was significantly higher in group1 compared to groups 2 and 3. In groups1-3, the odor scores after recovery from COVID-19 disease were significantly lower compared to the status prior to disease onset. The residual olfactory dysfunction was similar between groups1 and 2, but was more evident than group3. Mean duration for loss of smell was 7.8 +/- 3.1 (2-15) days. Duration of loss of smell was longer in groups1 and 2 than in group3. Odor scores completely returned back to the pre-disease values in 41 (51.2%) patients with olfactory dysfunction. Rate of complete olfactory dysfunction recovery was higher in group3 compared to groups1 and 2. Conclusion In isolated anosmia cases, anosmia is more severe, and complete recovery rates are lower compared to the patients who have other clinical symptoms.