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Öğe An atypical presentation of renal cell carcinoma in a child: A neck mass(Gazi University, 2015) Cevizci, Raşit; Düzlü, Mehmet; Aydil, Utku; Karamert, Recep; Onur Özen, İbrahim; Pınarlı Güçlü , Faruk; Işık Gönül, İpek; Okur, Arzu; Şahin, Muammer Melih; Yılmaz, MetinThe most common malignant diseases of the head and neck in the adolescent period are acute leukemia, Hodgkin's disease, non-Hodgkin's lymphoma, nasopharyngeal carcinoma, and thyroid carcinoma. Although renal cell carcinoma (RCC) may metastasize in the cervical lymph nodes, both occurrence and presentation as a neck mass are rare in the childhood period. In this report, we present a sixteen-year-old girl who was admitted with a left neck mass at presentation. The primary tumor was found to be located in the left kidney and both masses were surgically removed, revealing a diagnosis of a translocation renal cell carcinoma with metastases. Distant metastases of abdominal and thoracic malignancies may present with metastatic lymph nodes, and should be included in the differential diagnosis of the neck masses in children.Öğe Assessment of cochlear implant revision surgeries in a cohort of 802 patients(NLM (Medline), 2019) Karamert, Recep; Düzlü, Mehmet; Tutar, Hakan; Eravcı, Fakih Cihat; Türkcan, Alper Kutalmış; Zorlu, Mehmet Ekrem; Uğur, Mehmet Birol; Cebeci, Süleyman; Bezgin, Selin Üstün; Cevizci, Raşit; Bayazıt, Yıldırım AhmetObjective: To assess the etiology, demographics, rates and outcomes of revision surgeries, and device survival rates after cochlear implantation. Study Design: Retrospective case review. Setting: Tertiary Otology & Neurotology center. Patients: Cochlear implantees who received revision surgeries after implantation Interventions: Any surgical intervention, performed due to device failure or the major complications of cochlear implantation. Main Outcome Measure: Medical records of the patients who received cochlear implants (CIs) between July 2002 and March 2018 were reviewed retrospectively regarding postoperative complications. Demographic data, device survival rates, and causes of revisions were recorded. Results: Totally, 924 implantations were performed in 802 patients. Eighty one (8.7%) of them underwent 102 revision surgeries. The most common causes of revision surgeries were device failures and flap related problems which were seen in 28 and 18 patients, respectively. Overall CI survival rate was 91.9% in a 10 years period, which remained almost stable after 10 years. Although age was not found to be related with device failure (p = 0.693), device loss rates were significantly higher in adult implantees than children (p = 0.006). Conclusion: Device failure seems the most common cause of revision. The revision surgeries are usually safe and help to resolve the problem although flap problems are the most difficult to treat and may necessitate multiple revision surgeries. The device failure rate may reach to a plateau after 6 years. Overall CI survival rate exceeds 90% in 10 years period, and then remains stable.Öğe Atipik yerleşimli bir Warthin tümörü olgusu(Gazi Üniversitesi, 2014) Düzlü, Mehmet; Gümüş, Sami; Tutar, Hakan; Karamert, Recep; Cevizci, Raşit; Oltulu, PembePapiller kistadenoma lenfomatozum (Warthin tümörü) parotis bezi kaynaklı benign bir tükrük bezi neoplazisidir. Genellikle parotis bezi kuyruğunda yerleşik olan ve yavaş büyüme şekli gösteren bu tümör nadiren parotis bezi dışında; servikal lenf nodlarında ve minör tükrük bezlerinde de görülebilir. Biz de bu yazıda atipik yerleşimli bir warthin tümörü olgusunu sunduk. Kırk yaşında herhangi başka bir sağlık problemi bulunmayan erkek hasta sağ çene köşesinin altında yerleşik kitle nedeniyle kliniğimize başvurdu. Yapılan fizik muayene ve görüntüleme sonrası servikal lenfadenopati ön tanısı ile eksizyonel biyopsi yapıldı. Histopatolojik görünümü warthin tümörü olarak yorumlandı. Postoperatif takiplerinde nüks ya da komplikasyon izlenmedi. Bu vakayı sunarak warthin tümörünün parotis bezi dışında boyunda herhangi başka bir lokalizasyonda da karşımıza çıkabileceği ve servikal bölgeye yerleşik kitlelere yaklaşımda akılda tutulması gerektiğini vurgulamak istedik.Öğe Canal wall down versus canal wall up surgeries in the treatment of middle ear cholesteatoma(The Scientific and Technological Research Council of Turkey (TÜBİTAK), 2019) Karamert, Recep; Eravcı, Fakih Cihat; Cebeci, Süleyman; Düzlü, Mehmet; Zorlu, Mehmet Ekrem; Gülhan, Nagihan; Tutar, Hakan; Uğur, Mehmet Birol; İriz, Ayşe; Bayazıt, Yıldırım AhmetBackground/aim: To compare outcomes of canal wall up (CWU) and canal wall down (CWD) techniques in the treatment of middle ear cholesteatoma. Materials and methods: Medical records of 76 patients who had a primary surgery due to middle ear cholesteatoma between July 2015 and November 2017 were reviewed retrospectively. Hearing thresholds, speech discrimination scores (SDS), recurrences, and revision surgeries of CWU and CWD surgeries were compared. Results: Of 76 cholesteatoma cases, 40 (52.6%) had a CWU and 36 (47.4%) had a CWD operation. Postoperatively, the mean air conduction thresholds were significantly better in CWU compared to CWD surgeries (P = 0.016). The presence of the stapes and the type of reconstruction material used did not have a significant effect on auditory success rates (P = 0.342 and P = 0.905, respectively). Auditory success was affected by the status of the middle ear mucosa as well. The recurrence and revision rates did not differ between the surgical techniques (P > 0.05). Conclusion: Status of the middle ear mucosa and external auditory canal are important factors affecting the outcomes in cholesteatoma. Instead of a CWD surgery, a CWU surgery seems applicable in cases of cholesteatoma when the bone in the external auditory canal is not eroded by the disease.Öğe Cochlear implantation in chronic otitis media with and without cholesteatoma: Surgical considerations and auditory outcomes(Karger, 2021) Gülhan Yaşar, Nagihan; Karamert, Recep; Tutar, Hakan; Uğur, Mehmet Birol; Hazır, Burak; Bayazıt, Yıldırım AhmetIntroduction: Cochlear implant (CI) surgery is a safe and standardized procedure in the presence of normal temporal bone anatomy. However, in the surgery of patients with chronic otitis media (COM), the surgeon may encounter several problems. The aim of this study was to evaluate the impact of COM with and without cholesteatoma on surgical and auditory outcomes of CIs. Methods: The study group consisted of 39 patients with COM who received CIs. Age- and gender-matched 38 standard CI patients served as controls. The surgical techniques and complications, pure tone audiometry (PTA) scores, speech discrimination scores (SDS), and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire results of the groups were compared. Results: The presence of COM was associated with a higher rate of complication than controls. Staging the surgeries, presence or absence of cholesteatoma, and type of surgical technique were not associated with surgical outcomes and complications (p > 0.05). There was no significant difference between the groups in terms of postoperative PTA scores, SDS, and IOI-HA scores (p > 0.05). Conclusion: Postoperative complications like device failure and skin breakdown are increased in cases of COM compared to standard CI surgeries. However, that increase is not associated with staging the surgeries, presence or absence of cholesteatoma, and type of ear surgery performed. It is advocated to close the external ear canal and eustachian tube without mastoid obliteration in the presence of a radical mastoidectomy cavity, which will decrease the postoperative complication rates and allow for radiological follow-up with computed tomography for the possibility of cholesteatoma recurrence. The auditory benefits of CI in patients with and without COM are comparable.Öğe Cochlear implantation in inner ear malformations: Considerations related to surgical complications and communication skills(S. Karger AG, 2022) Karamert, Recep; Tutar, Hakan; Altınyay, Şenay; Düzlü, Mehmet; Yıldız, Merve; Akdulum, İsmail; U?ur, Mehmet Birol; Çolak, Mustafa; Cebeci, Süleyman; Şahin, Muammer Melih; Orçan, Elçin; Bayazıt, Yıldırım AhmetIntroduction: There are particular challenges in the implantation of malformed cochleae, such as in cases of facial nerve anomalies, cerebrospinal fluid (CSF) leaks, erroneous electrode insertion, or facial stimulation, and the outcomes may differ depending on the severity of the malformation. The aim of this study was to assess the impact of inner ear malformations (IEMs) on surgical complications and outcomes of cochlear implantation. Methods: In order to assess the impact of IEMs on cochlear implant (CI) outcomes, 2 groups of patients with similar epidemiological parameters were selected from among 863 patients. Both the study group (patients with an IEM) and control group (patients with a normal inner ear) included 25 patients who received a CI and completed at least 1 year of follow-up. Auditory performance, receptive and expressive language skills, and production and use of speech were evaluated preoperatively and at least 1 year after implantation. Types of surgical complications and rates of revision surgeries were determined in each group. Results: In the study group, the most common malformation was an isolated enlarged vestibular aqueduct (EVA) (44.8%). Overall, the patients with IEMs showed significant improvement in auditory-verbal skills. In general, the patients who had normal cochleae scored significantly better compared to patients with IEMs (p < 0.05). The complication rate was significantly lower in the control group compared to the study group (p = 0.001), but the rate of revision surgeries did not differ significantly (p = 0.637). Conclusion: It is possible to improve communication skills with CIs in patients with IEMs despite the variations in postoperative performances. Patients with EVA, incomplete partition type 2, and cochlear hypoplasia type 2 were the best performers in terms of auditory-verbal skills. Patients with IEMs scored poorly compared to patients with normal cochleae. CSF leak (gusher or oozing) was the most common complication during surgery, which is highly likely in cases of incomplete partition type 3.Öğe Comparison of Carina active middle-ear implant with conventional hearing aids for mixed hearing loss(Cambridge Univ Press, 2016) Savaş, Veysel; Gündüz, Bülent; Karamert, Recep; Cevizci, Raşit; Düzlü, Mehmet; Tutar, Hakan; Bayazit, Yıldırım AhmetObjective: To compare the auditory outcomes of Carina middle-ear implants with those of conventional hearing aids in patients with moderate-to-severe mixed hearing loss. Methods: The study comprised nine patients (six males, three females) who underwent middle-ear implantation with Carina fully implantable active middle-ear implants to treat bilateral moderate-to-severe mixed hearing loss. The patients initially used conventional hearing aids and subsequently received the Carina implants. The hearing thresholds with implants and hearing aids were compared. Results: There were no significant differences between: the pre-operative and post-operative air and bone conduction thresholds (p > 0.05), the thresholds with hearing aids and Carina implants (p > 0.05), or the pre-operative (mean, 72.8 +/- 19 per cent) and post-operative (mean, 69.9 +/- 24 per cent) speech discrimination scores (p > 0.05). One of the patients suffered total sensorineural hearing loss three months following implantation despite an initial 38 dB functional gain. All except one patient showed clinical improvements after implantation according to quality of life questionnaire (Glasgow Benefit Inventory) scores. Conclusion: Acceptance of Carina implants is better than with conventional hearing aids in patients with mixed hearing loss, although both yield similar hearing amplification. Cosmetic reasons appear to be critical for patient acceptance.Öğe Histopathological effects of parylene C (poly-chloro-p-xylylene) in the inner ear(Aves, 2016) Cevizci, Raşit; Düzlü, Mehmet; Göçün Uyar, Pınar; Karamert, Recep; Üstün Bezgin, Selin; Tutar, Hakan; Göksu, Nebil; Bayazıt, Yıldırım AhmetObjective: To assess the histopathological effects of parylene C (PC) (poly-chloro-p-xylylene) in the inner ear. Methods: Nine adult Dunkin Hartley guinea pigs (500–600 g) were included in the study. PC pieces were inserted into the cochlea in the right ear of the animals (study group). The round windows were punctured in the left ears comprised the control group. After three months, the animals were sacrificed, and the dissected temporal bones were examined under a light microscope. Results: No significant difference was revealed between the study and control groups regarding histopathological findings such as perineural congestion, perineural inflammation, neural fibrosis, number of ganglion cells, edema, and degeneration of ganglion cells (p>0.05). Conclusion: PC did not cause any additional histopathologic damage in the cochlea. This finding may be promising regarding the use of PC in cochlear implant electrodes as an alternative to silicon materials in the future.Öğe Impact of the demographic and aetiological factors and intraoperative findings on postoperative outcomes in chronic otitis media surgery(TUBITAK Scientific & Technical Research Council Turkey, 2020) Cebeci, Süleyman; Özbilen, Mehmet Suat; Bayramo?lu, İsmet; Kemalo?lu, Yusuf Kemal; Uygur, Kemal; Bayazıt, Yıldırım Ahmet; Karamert, RecepBackground/aim: Surgical success is related with many factors belonging to both the patient and the disease. This study aims to analyse the preoperative and intraoperative characteristics, the postoperative results, and the factors affecting the surgical success in different types of chronic otitis media (COM).Materials and methods: A total of 1510 ears of 1398 patients who underwent COM surgery were included in the study. Postoperative results were obtained from 376 ears of 356 patients who had been followed after surgery. The demographic characteristics of the patients, such as age and sex, operative findings, preoperative audiological examination results, and final audiometric and otoscopic examination findings, were retrospectively obtained from the archives of the department.Results: The most frequent diagnosis was simple COM (39.9%), and the most frequently performed surgery was tympanoplasty without mastoidectomy (46.6%). The overall hearing success rate was found to be 75.8%. Postoperative hearing success was significantly associated with the chronic otitis subgroup, ossicular pathologies, and the condition of the middle ear mucosa. Postoperative graft take rate was found to be 78.6%. Graft success was statistically significantly higher in patients with normal middle ear mucosa. Performing mastoidectomy, the presence of patency in aditus ad antrum, and being a paediatric case had no impact on graft success.Conclusion: Factors affecting the success of COM surgery include age, chronic otitis subgroup, location and size of perforation, the condition of the middle ear mucosa, and the level of the ossicular disease. These factors should be known and an appropriate treatment plan should be prepared.Öğe Neutrophil-lymphocyte ratio findings and larynx carcinoma: A preliminary study in Turkey(Asian Pacific Organization for Cancer Prevention, 2015) Düzlü, Mehmet; Karamert, Recep; Tutar, Hakan; Karalo?lu, Furkan; Şahin, Melih; Cevizci, RaşitBackground: To identify the potential prognostic role of the neutrophil/lymphocyte (N/L) ratio in larynx carcinoma. Materials and Methods: Oncologic archive charts of patients with a larynx carcinoma diagnosis between the years 2010 and 2013 were retrospectively reviewed. The inclusion criterion was to be available with hemogram test prior to diagnostic procedure. Patients undergoing septorinoplasty comprised the control group. Results: There were 65 cases in the study and 42 cases in control group meeting inclusion criteria. In general a non-significant increase in N/L ratio was observed with increasing tumor size and stage (p>0.05) in larynx carcinoma. The N/L ratio was found to be significantly higher in larynx carcinoma compared to control group (p=0.004). Conclusions: In conclusion, the N/L ratio was shown to be significantly increased in larynx carcinomas compared to control group. Further studies are needed to assess any prognostic role.Öğe Role of nasal problems on positional and nonpositional obstructive sleep apnea(2016) Cevizci, Raşit; Kemaloğlu, Yusuf Kemal; Yılmaz, Metin; Düzlü, Mehmet; Karamert, RecepOBJECTIVES: This study aims to examine the relationship between nasal pathologies and positional (PP) obstructive sleep apnea (OSA) or nonpositional (NPP) OSA.PATIENTS AND METHODS: A total of 44 male OSA patients (mean age 48.0±6.8 years; range 31 to 60 years) suffering from nasal obstruction were retrospectively evaluated for nasal obstruction scores, overall apnea hypopnea index (AHI) and AHI in supine and nonsupine positions, daytime sleepiness scores, and body mass index (BMI). Patients were divided into two equal groups as PP group and NPP group. Output parameters were snoring severity index, clinical nasal obstruction score, septal deviation score, conchal hypertrophy score, and allergic rhinitis (AR) score. These parameters were correlated with the type of OSA.RESULTS: Apnea hypopnea index was significantly lower in PP group than in NPP group (p<0.03). Spearman correlation analysis revealed significant negative correlation between AR score and PP (r=-0.40, p<0.0001). Pearson correlation test revealed significant correlation between AHI and BMI (r=0.32, p<0.05).CONCLUSION: We suggest that AR is not only an important risk factor for OSA, but also patients with AR tend to be NPP OSA patients because of the serious nasal obstruction which already causes an increase in nasal resistance or pharyngeal collapsibility.Öğe Surgical considerations and safety of cochlear implantation in otitis media with effusion(Elsevier Science Ltd, 2018) Cevizci, Raşit; Dilci, Alper; Çelenk, Fatih; Karamert, Recep; Bayazıt, YıldırımObjective: To evaluate the effects of otitis media with effusion on surgical parameters, patient safety, perioperative and postoperative complications. Methods: Total 890 children who underwent cochlear implantation between 2006 and 2015 were included. The ages ranged from 12 months to 63 months (mean: 32 months). The patients were divided into two groups according to the presence or absence of otitis media with effusion; otitis media with effusion group and non-otitis media group. Results: Of 890 children, 105 had otitis media with effusion prior to surgery. In non-otitis media with group, there were 785 children. The average duration of surgery was 60 min (ranged from 28 to 75 min) in non-otitis media group, and 90 min (ranged from 50 to 135 min) in otitis media with effusion group (p <0.05). Granulation tissue and edematous middle ear and mastoid mucosa were observed in all cases of otitis media with effusion during the surgery. There was no significant difference between the complications of groups with or without otitis media with effusion (p> 0.05). In 5 of 105 patients, there was a ventilation tube inserted before cochlear implantation, which did not change the outcome of implantation. Conclusion: There is no need for surgical treatment for otitis media with effusion before implantation since otitis media with effusion does not increase the risks associated with cochlear implantation. Operation duration is longer in the presence of otitis media with effusion. However, otitis media with effusion leads to intraoperative difficulties like longer operation duration, bleeding, visualization of the round window membrane, cleansing the middle ear granulations as well as mastoid and petrous air cells.Öğe The demographics and histopathological features of oral cavity cancers in Turkey(2016) Düzlü, Mehmet; Karamert, Recep; Bakkal, Faruk Kadri; Cevizci, Raşit; Tutar, Hakan; Zorlu, Mehmet Ekrem; Dilci, Alper; Eravcı, Fakih CihatBackground/aim: This study aimed to examine the demographics and histopathological features of oral cavity cancers (OCCs) managed in our clinic. Materials and methods: Patients who were diagnosed with OCCs in the Gazi University Otorhinolaryngology Department between the years 1993 and 2013 were retrospectively enrolled in the study. Surgical archive charts and pathology records were reviewed in detail regarding the anatomical and histopathological profiles of the tumors, as well as the demographic data of the patients. Results: Out of 230 patients with OCCs, the most common anatomic location and histopathological diagnosis were found to be the oral tongue (41.4%) and squamous cell carcinoma (SCC) (84.3%), respectively. A marked predominance of SCC was observed in all subsites of the oral cavity except the hard palate location. The mean age at presentation was 55.5 ± 13.4 years (±SD). The male:female ratio was found to be 2.2:1. A male predominance was also present in all subsites except the retromolar trigon. Conclusion: OCCs particularly concern the elderly population with a male predominance. The most common location and histopathological type are the oral tongue and SCC, respectively
