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Yazıcı, Haşmet (Balikesir Author), Object: To prepare a national guideline for Oto-rhinolaryngologist who treat allergic rhinitis patients Methods: The study was conducted by three authors, namely the writing support team. The support team made the study plan, determined the writing instructions, chose the subgroups including the advisory committee, the advisors for authors and the authors. A workshop was organized at the very beginning to explain the details of the study to the team. Advisors took the chance to meet their coworkers in their subgroups and determined the main headings and subheadings of the guideline, together with the authors. After key words were determined by the authors, literature search was done in various databases. The authors keep in touch with the advisors and the advisors with the advisory committee and the support group at every stage of the study. National and International published articles as well as the abstracts of unpublished studies, imperatively presented in National Congresses, were included in this guideline. Only Guideline and meta-analyses published in last seven years (2013- 2017) and randomized controlled studies published in last two years (2015- 2017) were included. After all work was completed by the subgroups, support team brought all work together and edited the article. Results: A detailed guideline about all aspects of allergic rhinitis was created. Conclusion: The authors believe that this guideline will enable a compact and up-to-date information on allergic rhinitis to healthcare professionals. This guideline is the first in the field of Otolaryngology in Turkey. It should be updated at regular intervals.

Chronic rhinosinusitis (CRS) is a multifactorial disease due to chronic inflammation of sino-nasal mucosa that persists for more than 12 weeks. Since the first edition of EPOS guidelines, CRS has been divided into two main phenotypes: CRS with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP). In recent years, several authors agreed that CRS is not a uniform disease process but rather includes different phenotypes and endotypes. Differences may be observed in terms of risk factors, co-morbid conditions associated with CRS and disease control by medical treatment and surgery. The role of allergy in chronic rhinosinusitis (CRS) has been largely discussed in the literature, but nevertheless it remains controversial. Allergy and CRS are very prevalent diseases and frequently co-occur; however, direct causality has never been clearly demonstrated. Because the association between the two diseases has not been clear for years, making an evidence-based decision of whether to evaluate or treat allergies in CRS patients was difficult. Recently, it is clear that the prevalence of allergy is variable between the different subtypes of CRSwNP and the association seems to be very strong particularly with allergic fungal rhinosinusitis (AFRS) and central compartment atopic disease (CCAD).

OBJECTIVE: The purpose of this study was to examine the anti-ototoxic impact of Ginkgo biloba extract and lycopene on the model of cisplatin-induced ototoxicity in rats. MATERIALS and METHODS: Thirty-two Wistar albino rats were examined with the distortion product otoacoustic emission (DPOAE) test (MADSEN Capella2; GN Otometrics, ICS Medical, Chicago USA), and they were randomly divided into four groups. Group 1 (n=8) was defined as the healthy control group. Cisplatin was given intraperitoneally as single dose of 12 mg/kg to group 2 (n=8), group 3 (n=8), and group 4 (n=8). Group 2 was determined as ototoxic control group. G. biloba extract (100 mg/kg) was given to group 3, and 20 mg/kg lycopene was given to group 4 with oro-gastric feeding tube daily for 10 days. DPOAE test was repeated on day 10 on all the groups. Finally, histopathological examination was performed. The study has been lead in agreement with the principles by the Institutional Animal Care and Use Committee Review Board at Kocaeli University Medical Center (KOÜ HADYEK- 1/9-14). The animals were treated in accordance with protocols approved by this committee. RESULTS: When DPOAE tests were compared, there was no significant difference in the four groups before the application (p>0.05). At the end of day 10, in groups 2 to 4, statistically significant changes were observed (p

We present Shewanella algea infection in a chronic suppurative otitis media (CSOM) patient with cholesteatoma in terms of clinical course and treatment. This is the first time S. algea is found as solely pathogen in a CSOM patient without history of contact with seawater in Turkey. The patient admitted to the hospital several times with complaints of otorrhoea, was diagnosed as otitis media and treated. He was hospitalized to the otorhinolaryngology department for further evaluation of recurrent infections. The patient was diagnosed as cholesteatoma according to computed tomography scan findings and was operated for cholesteatoma. As a result of surgical and medical treatment he was discharged with full recovery. Physicians must be aware of rarely seen pathogens and their unexpected ways of transmission and underlying causes such as cholesteatoma when treating patients for CSOM.

Nasal polyps (NP) are benign, edematous masses growing into nasal cavity that could have multiple etiological factors. Basic etiological factor for polyp formation is chronic inflammatory change and thus stromal nasal and paranasal mucosa edema. All theories about NP formation try to explain the edema formation. Edema and mucosal inflammation may originate from trauma, bacterial, viral, or fungal infections, environmental irritants, or allergens. The prevalence of NP in the general population is unclear. It varies from 0.2% to 5.6%. Different diagnostic measurements and criteria may be responsible for this wide range. Additionally, age, gender, and such demographical factors affect the variability. Ethnic and genetic factors should also be taken into consideration. The prevalence of NP shows a wide range according to etiology. The most important data on the epidemiology of NP are obtained from NP etiology studies. For these reasons, in this chapter, epidemiological data are presented parallel to the etiological reasons and hypotheses of NP. There may be hereditary factors for NP but there is limited knowledge in this area. However, we have some evidence for genetic inheritance. Studies reported that up to 14% of patients with NP have a family history. A link has been indicated that NP and asthma have an association with HLA-A1B8 and HLA-A74 genes. The main hypotheses that lead to the development of NP will be discussed below with the current incidence and prevalence rates.

Objective:This study aimed to compare the efficacies of intratympanic dexamethasone and methylprednisolone in preventing in cisplatin-induced ototoxicity in rats.Methods:Experimental groups of rats (n = 8 each) received intratympanic isotonic saline, intraperitoneal cisplatin and intratympanic isotonic saline, intraperitoneal cisplatin and intratympanic dexamethasone, or intraperitoneal cisplatin and intratympanic methylprednisolone. Distortion product otoacoustic emission thresholds were compared on days 0 and 10 in all rats, and correlations between drug effects and changes in cochlear histology were evaluated.Results:Distortion product otoacoustic emission thresholds were comparable in groups III and IV (p > 0.05). Significant protection against cisplatin-induced ototoxicity was seen in groups III and IV compared with group II (p < 0.05). Dexamethasone and, to a lesser extent, methylprednisolone protected against cellular apoptosis in cisplatin-induced ototoxicity.Conclusion:Dexamethasone (and possibly methylprednisolone) may be clinically useful as an intratympanic chemopreventive agent to treat cisplatin ototoxicity. Future clinical studies should investigate the use of dexamethasone for this purpose in adult patients.

To investigate the effect of transtympanic betamethasone administration on hearing function with histologic correlation, rats were divided into three transtympanic treatment groups: isotonic saline (group I, n = 10), gentamicin (group II, n = 10) and betamethasone (group III, n = 10). Distortion product otoacoustic emission thresholds were compared on day 10. Also histological effects on cellular apoptosis in both the inner and outer hair cells in organ of Corti and spiral ganglion neurons were evaluated. Distortion product otoacoustic emission thresholds were comparable (p > 0.05) between group I and group III in all measurements. Distortion product otoacoustic emission thresholds of group II were significantly elevated in all measurements when compared with group I (p

The nasolabial cyst also known as Klestadt’s cyst is a rare non-odontogenic soft tissue lesion of the nasal alar region. Aetiopathogenesis of the nasolabial cysts is controversial. Embryonic and developmental theories were considered at pathogenesis of the nasolabial cyst. In addition, surgical or non-surgical trauma is one of the possible theories. This paper reports a case of a 33-year-old male patient that presented with bilateral nasolabial cysts after rhinoplasty and alar base reduction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background The etiology and the effects of the maxillary accessory ostium (MAO) are not well understood. The aim of this study is to investigate the association between septal deviation (SD) and the presence of an MAO. Methods Paranasal computed tomography (CT) scans of 1104 adult patients were studied retrospectively. Patients with chronic sinusitis, acute sinusitis, nasal polyposis, allergic rhinitis, paranasal sinus tumors, septal perforation, and unilateral or bilateral maxillary sinus hypoplasia/aplasia, as well as patients who had previously had nasal surgery or a history of nasal trauma, were not included in the study. Eight-hundred and seven patients were found to meet the criteria and were included in the study. CT scans were examined to note the presence of SD and MAO and the side of both diseases. Results A total of 807 patients were evaluated. SD and MAO were detected in 572 (70.9%) and 299 (37.1%) patients, respectively. A statistically significant relationship was found between the presence of SD and MAO, regardless of side of the disease (p = 0.002). The side of MAO showed a significant correlation with the direction of SD (p < 0.001). Conclusion Our results revealed a link between SD and MAO. This relationship was correlated with the side of occurrence of the disease.

OBJECTIVES This study aims to show the effects of nasal continuous positive airway pressure (CPAP) treatment on platelet activation in patients with severe obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS Forty-six patients (29 males, 17 females; mean age 48.2±7.6 years; range 40 to 56 years) with severe OSAS with apnea/hypopnea index (AHI) ≥30 were included in this study. Complete blood counts were analyzed and mean platelet volume (MPV) values were compared in patients before and after CPAP treatment at six months. RESULTS The mean MPV values before CPAP were 8.9±1.3 (p

To investigate changes in upper airway volume parameters measured by computerized tomography scans in patients with surgically treated by anterior palatoplasty of whom having pure snoring and mild-moderate obstructive sleep apnea. A prospective study on consecutively anterior palatoplasty performed pure snoring and obstructive sleep apnea patients. Computerized tomography scans were obtained preoperatively and following anterior palatoplasty procedure to measure changes in upper airway volume. Patients underwent diagnostic drug induced sleep endoscopy to assess the site of obstruction. Preoperative and postoperative measurements were compared using student’s t test and Chi-square test. Twenty-two patients (16 men and 6 women, age 48.22 ± 9.23, body mass index 25.85 ± 2.57) completed the trial. Anterior palatoplasty was associated with an increase in total upper airway volume from 4.81 ± 1.73 cm3 before treatment to 6.57 ± 2.03 cm3 after treatment (p

Objectives To evaluate the effect of the surgical and percutaneous tracheotomy on the thyroid hormones and their comparisons. Materials and methods Between January and May 2010, the surgical and percutaneous tracheotomy had been performed on 40 patients with respiration problems. The thyroid hormone levels were measured just before, after one and three hour of the operation and than these measurements were compared statistically. Results The effect of the surgical and percutaneous tracheotomy on serum thyroglobulin (TG), free thyroxine (fT4), free triiodothyronine (fT3) and thyroid stimulating hormone (TSH) levels was found statistically significant. Conclusions The surgeons should not forget the possible increase of the serum thyroid hormone levels after the surgical and percutaneous tracheotomy because of the systemic effects of thyroid hormones. The patients, especially who have cardiac rhythm problems, should be monitored for a while after these processes because the increase of serum thyroid hormones may cause undesired cardiovascular effects.

Paranasal sinus agenesis is unusual clinical condition. The frontal sinus agenesis is more frequently seen, whereas agenesis of sphenoid sinus is extremely rare. Agenesis of both frontal and sphenoid sinus is very unique. This case presents a 13-year-old child with combined sphenoid and frontal sinus agenesis accompanied by bilateral maxillary sinus hypoplasia with scoliosis and coccyx abnormality.

Objective. This study aimed to evaluate the influence of ade- notonsillectomy on the plasma concentration of endothelin- 1 (ET-1) and C-reactive protein (CRP) in children with sleep-disordered breathing (SDB). The relationship between quality of life and ET-1 levels was also evaluated. Setting. Tertiary referral center. Study Design. Before-and-after case series. Methods. Fasting blood samples for ET-1 and high-sensitivity CRP were drawn preoperatively in all patients and at 3 to 4 months postoperatively. The Obstructive Sleep Apnea-18 (OSA-18) survey and Brouilette symptom score were com- pleted by each child's parents during the same time periods. Results. The mean ET-1 level decreased from 3.51 6 0.93 fmol/mL to 2.67 6 0.69 fmol/mL postoperatively (P \ .01). OSA-18 survey scores and Brouilette symptom scores also decreased in the postoperative period (P \.01). When com- paring moderate and severe cases to mild cases according to Brouilette scores, ET-1 levels were significantly higher in mod- erate and severe cases (P \.01). There was a significant cor- relation between ET-1 and the OSA-18 survey scale (r = 0.442; P = .001). Although CRP levels decreased from 0.63 6 1.19 mg/dL to 0.31 6 0.23 mg/dL postoperatively, this was not statistically significant. Conclusion. Adenotonsillectomy effectively lowered plasma ET-1 levels in children with SDB and thus may have reduced their related risk for cardiovascular disease. In addition, ade- notonsillectomy improved quality of life in this group.

OBJECTIVE: The objective of this study was to investigate the association between upper airway morphology and apnea vs hypopnea predominance in patients with obstructive sleep apnea (OSA) syndrome. METHODS: A retrospective study on consecutively CT scans obtained from 54 OSA patients and 53 non-snoring controls. CT scans were measured to evaluate upper airway and surrounding structures' morphologic characteristics. OSA patients (matched for age, gender and body mass index) compared as two groups; apneic group: apnea ratio >50% and hypopneic group: hypopnea ratio >50%. Morphologic characteristics were analyzed using Kruskal–Wallis test and Pearson’s correlation test. RESULTS: Apneic group (17 patients) showed 76.56% apnea rate and hypopneic group (37 patients) showed 78.46% hypopnea rate. Minimal lateral and anteroposterior dimensions of velopharynx in the apneic group (0.86 ± 0.73 and 0.21 ± 0.13 cm, respectively) was statistically lesser from that of the hypopneic group (1.2 ± 0.42 and 0.54 ± 0.22 cm, respectively). Minimum cross-sectional area of the velopharynx was also lesser in apneic group (0.21 ± 0.16 cm(2)) than that in hypopneic group (0.65 ± 0.38 cm(2)). Almost all upper airway parameters in both apneic and hypopneic groups were tended to be smaller than in controls. CONCLUSION: Decrease in airway volume does not signify the type of respiratory event, but significant narrowing of velopharynx in both dimensions; thus having the narrowest value below a certain level causes more apnea. ADVANCES IN KNOWLEDGE: We did not find a similar study when we did a literature search, showing the relationship of apnea vs hypopnea predominance and upper airway parameters in CT in patients with OSA.

To investigate the effect of intranasal splint removal time on patient comfort and possible complications after septoplasty. One hundred and nine patients who had septoplasty operations were included in this study. The patients were divided into three groups. In the 1st group (n = 36), splints were removed on the 3rd day after septoplasty; in the 2nd group (n = 36), splints were removed on the 5th day; and in the 3rd group (n = 37), splints were removed on the 7th day. Pain and nasal fullness were evaluated with visual analog scale. Synechia, perforation, hematoma, infection and hemorrhage were recorded after the removal of the splints (postoperative 1, 8 and 24 weeks). For the 1st, 2nd, and 3rd groups, respectively, pain score was 1.96, 2.67, and 2.67; and nasal fullness score was 6.23, 6.04, and 5.48. Nasal synechia was detected in two patients in the 1st group and in one patient in the 2nd group. Early hemorrhage was detected in two patients in the 1st group and one patient in the 3rd group. Infection, septal perforation and hematoma were detected in three patients in the 1st group. There was no difference in hemorrhage, hematoma, synechia and perforation rates between the three groups. There are various opinions in the literature about the ideal removal time of intranasal tampons after septoplasty, but there is no consensus on this topic. Our study shows that removal time of intranasal splints has no effect on patient comfort or possible complications.

The etiology and the effects of the maxillary accessory ostium (MAO) are not well understood. The aim of this study is to investigate the association between septal deviation (SD) and the presence of an MAO.Paranasal computed tomography (CT) scans of 1104 adult patients were studied retrospectively. Patients with chronic sinusitis, acute sinusitis, nasal polyposis, allergic rhinitis, paranasal sinus tumors, septal perforation, and unilateral or bilateral maxillary sinus hypoplasia/aplasia, as well as patients who had previously had nasal surgery or a history of nasal trauma, were not included in the study. Eight-hundred and seven patients were found to meet the criteria and were included in the study. CT scans were examined to note the presence of SD and MAO and the side of both diseases.A total of 807 patients were evaluated. SD and MAO were detected in 572 (70.9%) and 299 (37.1%) patients, respectively. A statistically significant relationship was found between the presence of SD and MAO, regardless of side of the disease (p = 0.002). The side of MAO showed a significant correlation with the direction of SD (p0.001).Our results revealed a link between SD and MAO. This relationship was correlated with the side of occurrence of the disease.

Im Rahmen dieser Masterarbeit wurden die wichtigsten Punkte rund um das Thema Einsatz von Personalcontrolling im Konzern und mögliche Auswirkungen auf Klein- und Mittelunternehmen behandelt. Da die wichtigste Ressource eines Unternehmens die eigenen Mitarbeiter sind, übernehmen immer mehr Unternehmen die Aufgabe, diese Mitarbeiter strategisch, zielgerichtet zu steuern um dadurch eine hohe Wertschöpfung zu schaffen. Der theoretische Teil dieser Arbeit befasst sich mit der Definition der Begrifflichkeiten, Unterscheidung des Controllings mit dem Personalcontrolling und mit den Personalcontrolling-Instrumenten. Im empirischen Teil werden qualitative Interviews mit fünf Experten durchgeführt. Das Ergebnis dieser Arbeit zeigt, dass in den letzten Jahren immer mehr Tendenz zum Personalcontrolling vor allem in Konzernen entstanden ist und vermehrt KPIs mit den Instrumenten eingesetzt werden. Dennoch hat die empirische Erhebung gezeigt, dass neben den zahlreichen vorhandenen Vorteilen aus der Implementierung des Personalcontrollings, auch die Thematik mit dem hiermit verbunden Aufwand, vor allem in Klein- und Mittelunternehmen gegeben ist. *****This master thesis examines the main points around the subject The use of the human resources controlling-tools in group of affiliated companies and its possible impact on small and medium sized businesses. The main resource of a company is their own employees. In fact more and more companies assume the task to navigate these strategic with an active human resource controlling, to provide a high value added in the company. The theoretical part of this thesis deals with the definition of the main terms, differentiating controlling vs. human resource controlling, and the tools of the human resource controlling. In the empirical part qualitative interviews will be conducted with five experts. The result of this work show that in recent years there is an increasing tendency to human resource-controlling, especially in groups originated a

OBJECTIVES This study aims to analyze the treatment outcomes of benign parotid tumors operated through auriculomastoid incision (the authors defined incision as "ariculomastoid incision" in this study). PATIENTS AND METHODS Between April 2008 and March 2012, 23 patients (15 females, 8 males; mean age 48.8 years; range 28 to 67 years) who underwent parotidectomy first at Bolu State Hospital, Ear, Nose and Throat Clinic due to benign and mobile mass lesions in superficial lobe of parotid gland were retrospectively analyzed. Approximately a 5 cm incision starting at anterior to the tragus, extending along the ear lobule and ending at the mastoid apex was performed. Facial nerve traces were identified according to the anatomical landmarks. Pathological diagnoses, complications and follow-up results were recorded. RESULTS Pathological diagnoses were pleomorphic adenoma in 15, Warthin tumor in six, branchial cleft cyst in one, and extrapulmonary lymph node tuberculosis in one patient. The main truncus and bifurcation of the facial nerve was identified at the lower level of the incision and in the direction of mandibular angle. Facial nerve was identified by following high calibration stylomastoid artery a few millimeters inferomedialy in 16 patients. Incision was extended in three patients due to an inferior mass located. No local recurrence occurred during at a mean follow-up of 28 months (range; 6-48 months). Three patients developed transient, partial facial paralysis, which recovered completely within two months. Two patients had salivary fistulas, which recovered by compression dressing within three weeks. CONCLUSION Auriculomastoid incision can be applied safely in the treatment of mobile, benign parotid tumors localized in the superficial lobe with a low rate of postoperative complication.

OBJECTIVES This study aims to investigate whether postoperative follow-up period, clinical signs or Minor test is effective to determine the incidence of Frey's syndrome following superficial parotidectomy. PATIENTS AND METHODS Between January 2005 and December 2008, 30 patients, (16 males, 14 females; mean age 47.7±15.3 years, range 17 to 76 years) who underwent superficial parotidectomy in the Ear, Nose, Throat Clinic, were retrospectively analyzed. All patients were administered a questionnaire on clinical signs of Frey's syndrome and disease period, and Minor's test. RESULTS The postoperative pathological examination showed pleomorphic adenoma, Whartin's tumor, basal cell adenoma and oncocytoma. The Minor's test result was positive in 50% of the patients. While 10% of the patients complained about excessive sweating requiring no treatment, none of them complained about the bad body odor. The disease was considered moderate based on the severity of the disease in all patients. CONCLUSION The incidence of Frey's syndrome may vary according to the postoperative follow-up period and the diagnostic method applied, including assessment of clinical signs and Minor's test.

Objectives Obstructive adenoid and tonsillar hyperplasia may present with retardation of growth. An adenoid–nasopharynx (A/N) ratio determined by means of lateral cephalometric radiographs has long been used as a diagnostic tool in the assessment of adenoid size. This study was designed to investigate the effect of adenotonsillectomy on insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) levels and correlation between A/N ratio and IGF-I and IGFBP-3 levels. Methods Patients ( n = 48) that had been operated on our clinic with a diagnosis of adenotonsillar hypertrophy between July 2009 and January 2010 were included in the study. The routine ear–nose and throat examination was done in all patients. Blood samples were taken, and lateral cephalometric radiographs were obtained preoperatively and repeated at 6–9 months (mean 7.2 ± 1.0 mo) following tonsillectomy and adenoidectomy. The chemiluminescent enzyme-linked immunosorbent method was used to IGF-I and IGFBP-3 levels. Each cephalometric radiograph was evaluated by a blinded radiologist. The A/N ratio was calculated using the Fujioka method. Results When the preoperative and postoperative results were compared, a statistically significant increase in serum IGF-I and IGFBP-3 and a decreased A/N ratio were found. However, although correlation between the Δ(preoperative − postoperative difference) IGFBP-3 and ΔA/N ratio was 40%, it was not statistically significant. Additionally, no statistically significant correlation between the ΔIGF-I and ΔA/N ratio was found. Conclusions The results of the present study indicate that adenotonsillectomy could result in the relief of nasopharyngeal obstruction and have a positive effect on growth in children by decreasing the A/N ratio and increasing IGF-I and IGFBP-3. There was no correlation between the ΔA/N ratio and ΔIGF-I and ΔIGFBP-3 levels.