Researcher: Ünsaler, Selin
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Ünsaler, Selin
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Publication Metadata only Virtual reality simulation-based training in otolaryngology(Springer London Ltd, 2023) N/A; Ünsaler, Selin; Hafız, Ayşenur Meriç; Gökler, Ozan; Özkaya, Yasemin Sıla; School of Medicine; Koç University HospitalVR simulators will gain wider place in medical education in order to ensure high quality surgical training. The integration of VR simulators into residency programs is actually required more than ever in the era after the pandemic. In this review, the literature is reviewed for articles that reported validation results of different VR simulators designed for the field of otolaryngology. A total of 213 articles searched from Pubmed and Web of Science databases with the key words "virtual reality simulation" and "otolaryngology" on January 2022 are retrieved. After removal of duplicates, 190 articles were reviewed by two independent authors. All the accessible articles in english and which report on validation studies of virtual reality systems are included in this review. There were 33 articles reporting validation studies of otolaryngology simulators. Twenty one articles reported on otology simulator validation studies, eight articles reported rhinology simulator validation studies and four articles reported on pharyngeal and laryngeal surgery simulators. Otology simulators are shown to increase the performance of the trainees. In some studies, efficacy of simulators has been found comparable to cadaveric bone dissections and trainees reported that VR simulators was very useful in facilitating the learning process and improved the learning curves. Rhinology simulators designed for endoscopic sinus surgery are shown to have the construct validity to differentiate the surgeons of different level of expertise. Simulators in temporal bone surgery and endoscopic sinus surgery can mimic the surgical environment and anatomy along with different surgical scenarios, thus can be more implemented in surgical training and evaluation of the trainees in the future. Currently there are no validated surgical simulators for pharyngeal and laryngeal surgery.Publication Metadata only Subglottic cysts in preterm infants: superficially located cysts versus deeply buried cysts in the mucosa(Springer, 2022) Ünsaler, Selin; Gökler, Ozan; Altuntaş, Muzaffer Ozan; Hafız, Ayşenur Meriç; Ünal, Ömer Faruk; Teaching Faculty; Teaching Faculty; Teaching Faculty; Faculty Member; Other; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 167909; 311179; 169795; 53676; 199800Purpose: To analyze the reason for the diversity of the clinical course of subglottic cysts and discuss their pre- and coexistence with subglottic stenosis. Methods: The medical records of patients who were treated for subglottic cysts between 2003 and 2020 were retrospectively reviewed and direct laryngoscopy videos were analyzed to assess the healing patterns of their disease. Results: Of the 15 patients, 10 had a history of intubation in the neonatal period. In 11 patients, the cysts were transparent and well defined, and no recurrence of subglottic cysts occurred after the initial surgery. In four patients, the cysts were located deep in the mucosa and did not have the typical appearance of a cyst, but rather of a stenotic segment; all of them had a history of intubation and three of them required laryngotracheal reconstruction. Conclusion: Transparent, thin-walled superficial subglottic cysts with healthy surrounding mucosa can easily be treated with endoscopic marsupialization; however, the treatment of deep subglottic cysts can be challenging. The coexistence of subglottic cysts and subglottic stenosis is not rare. We point out the need for considering the possibility of a missed deep submucosal cyst in a seemingly refractory case of pediatric subglottic stenosis with atypical endoscopic findings and with a background history of prior intubation.Publication Open Access Free flap reconstruction of the head and neck region: a series of 127 flaps performed by otolaryngologists(Galenos Yayınevi, 2021) Başaran, Bora; Kesimli, Mustafa Caner; Aslan, İsmet; Ünsaler, Selin; Teaching Faculty; School of Medicine; 167909Objective: to determine flap success rate and complications in patients who underwent microvascular free tissue reconstruction after major head and neck ablative surgery and to report the improvement in the results. Methods: medical records of 124 patients who were operated on in 2012 to 2019 were retrospectively reviewed. Indications for different free flap types, success rates and re-exploration rates, donor site morbidities, and reasons for flap loss were analyzed. Patients were divided into two groups to identify the effects of the anticoagulant and the antiaggregant treatments on postoperative results. Results: there were 127 flaps in 124 patients, including two different free flaps each in three patients that were harvested and used in the same surgical session. Of the total 127 flaps, 82 (64.6%) were radial forearm flaps, 39 (30.7%) were fibula flaps, and 6 (4.7) were rectus abdominis flaps. Four patients were re-explored for flap perfusion problems, and 18 patients were re-explored for hematoma drainage (n=22/124, %17.3). The rate of hematoma and re-exploration was higher in patients who received anticoagulant and antiaggregant treatments synchronously (p=0.02). Three flaps were lost, and the overall success rate was 97.6%. Two patients died from perioperative complications. No major complications were observed at the donor site; minor complications were observed in 30 patients. Conclusion: the success rate for the 127 flaps in 124 patients were found comparable to those reported in the literature. These results show that successful outcomes can be achieved with experience and a head and neck team dedicated to improving the results in microsurgical reconstruction, and flap failure rarely occurs if perioperative care of the patients is given meticulously.Publication Open Access An overview of vagal paraganglioma surgery: evaluation of operative morbidities and quality of life after surgery(Aves, 2021) Kılıç, Halime; Şen, Cömert; Başaran, Bora; Ünsaler, Selin; Teaching Faculty; School of Medicine; 167909Objective: to analyze postoperative morbidity and quality of life of surgically treated patients for vagal paraganglioma. Methods: preoperative symptoms and findings, presence of cranial nerve paralysis, radiological findings, surgical techniques, perioperative, and postoperative complications were analyzed retrospectively. Washington University Quality of Life Questionnaire (UW-QOL) was used to evaluate the quality of life of the patients. Results: of the 11 patients, 8 were women and 3 were men with an age distribution of 22-70 (mean age, 49.9 years). Two patients had vocal cord paralysis and 1 patient had hypoglossal nerve paresis preoperatively. In 5 patients, the vagus nerve was partially resected; vocal cord movements recovered within 6 months in 2 out of 5 (40%). The continuity of the nerve could not be preserved in the remaining 6 patients, Ishiki type 1 medialization thyroplasty was performed in 4 (44.4%). In 3 patients, the hypoglossal nerve was invaded by the tumor and was sacrificed. Temporary facial paresis occurred in 3 patients who were operated on with transcervical-transparotid approach. Complete recovery was achieved in all within 3 months. In a patient with an extensively large tumor, carotid bypass surgery was performed with the saphenous vein. Except for one patient, the mean scores of all patients were above 90 with UW-QOL. Conclusion: surgery, which is the only curative treatment method, may not cause a significant change in the postoperative quality of life in well-selected cases. Trying to protect the vagus nerve by dissecting it as much as possible and rehabilitation with Isshiki type 1 thyroplasty in case of aspiration are key points.Publication Open Access Carcinoma of the posterior wall of the hypopharynx: surgical treatment with larynx preservation(Elsevier, 2020) Başaran, Bora; Ünsaler, Selin; Teaching Faculty; School of Medicine; 167909Introduction: posterior pharyngeal wall is the most rare subsite for hypopharyngeal carcinomas. Because of its rarity, there are few studies published in the literature specifically concerning posterior pharyngeal wall carcinoma. Objectives: to report our functional results in patients with the carcinoma of the posterior wall of the hypopharynx after surgical treatment by resection via a lateral or infrahyoid pharyngotomy approach, with the preservation of the larynx and reconstruction with a radial forearm free flap. Methods: the study included 10 patients who underwent surgery for a carcinoma of the posterior wall of the hypopharynx over a 6 year period. The associated postoperative morbidity was investigated and functional results were analyzed. Results: nine patients had T3 lesions and one patient had a T2 lesion. The preferred approach to access the hypopharynx was a lateral pharyngotomy in 5 patients and lateral pharyngotomy combined with infrahyoid pharyngotomy in 5 patients with superior extension to oropharynx. The pharyngeal defects were reconstructed successfully with radial forearm free flaps. Four patients received adjuvant radiotherapy only, and 4 patients with N2b and N2c neck diseases received adjuvant chemoradiotherapy. The mean duration of hospitalization was 15.6 days (range, 10–21 days). All patients achieved oral intake in a median time of 74 days (range, 15–180). Decannulation was achieved in all patients and the median time for decannulation was 90 (range, 21–300 days). The mean followup duration was 38.3 months (range, 10–71 months) and 8 patients survived. One patient died due to regional recurrence in the retropharyngeal lymph nodes and 1 patient died due to systemic metastasis. Conclusion: primary surgery is still a very effective treatment modality for the carcinoma of the posterior wall of the hypopharynx and does not permanently compromise the swallowing and laryngeal functions if pharyngeal reconstruction is performed with a free flap. / Introdução: a parede posterior da faringe é o sub-sítio mais raro para carcinomas hipofaríngeos. Devido à sua raridade, há poucos estudos publicados na literatura especificamente sobre o carcinoma da parede posterior da faringe. Objetivos: relatar nossos resultados funcionais em pacientes com carcinoma da parede posterior da hipofaringe após tratamento cirúrgico por ressecção via faringotomia lateral ou infra-hióidea, com preservação da laringe e reconstrução com retalho livre radial do antebraço. Método: o estudo incluiu 10 pacientes submetidos à cirurgia para carcinoma da parede posterior da hipofaringe por um período de 6 anos. A morbidade pós-operatória associada foi investigada e os resultados funcionais foram analisados. Resultados: nove pacientes apresentaram lesões T3 e um paciente apresentou lesão T2. A via preferida para acessar a hipofaringe foi a faringotomia lateral em 5 pacientes e a faringotomia lateral combinada com a faringotomia infra-hióidea em 5 pacientes com extensão superior até a orofaringe. Os defeitos faríngeos foram reconstruídos com sucesso com retalhos livres radiais do antebraço. Quatro pacientes receberam apenas radioterapia djuvante e 4 pacientes com doença cervical N2b e N2c receberam quimiorradioterapia adjuvante. A duração média da hospitalização foi de 15,6 dias (variação de 10 a 21 dias). Todos os pacientes retornaram à ingestão oral em um tempo médio de 74 dias (variação de 15 a 180). A decanulação foi possível para todos os pacientes e o tempo médio foi de 90 dias (variação de 21 a 300 dias). A duração média do seguimento foi de 38,3 meses (10 a 71 meses) e 8 pacientes sobreviveram. Um paciente foi a óbito devido a recorrência regional nos linfonodos retrofaríngeos e outro devido a metástase sistêmica. Conclusão: a cirurgia primária ainda é uma modalidade de tratamento muito eficaz para o carcinoma da parede posterior da hipofaringe e não compromete de forma permanente as funções de deglutição e da laringe se a reconstrução faríngea for realizada com retalho livre.Publication Open Access Comparison of nasopharyngeal swab and nasopharyngeal aspiration in adults for SARS-COV-2 identification using reverse transcription-polymerase chain reaction(Wiley, 2021) Altuntaş, Muzaffer Ozan; Gökler, Ozan; Hafız, Ayşenur Meriç; Ünsaler, Selin; Okan, Ayşe; Tekin, Süda; Teaching Faculty; Teaching Faculty; Faculty Member; Teaching Faculty; School of Medicine; Koç University Hospital; 169795; 311179; 53676; 167909; N/A; 42146We aimed to compare reverse transcription-polymerase chain reaction (RT-PCR) results of nasopharyngeal aspiration (NA) and nasopharyngeal swab (NS) samples in the diagnosis of coronavirus disease 2019. NS was obtained with a dacron swab and NA was performed by aspiration cannula. The sampling was performed by an otolaryngologist to ensure standardized correct sampling from the nasopharynx. RT-PCR was performed for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The level of agreement between the result of NA and NS samples for each patient was analyzed. The Ct values were compared. Thirty-three patients were enrolled in the study with a mean age of 56.3 years. Thirteen subjects resulted negative with both NS and NA; 20 subjects resulted positive with NA and 18 subjects resulted positive with NS. The mean values of Ct for NA samples and NS samples were 24.6 +/- 5.9 and 24 +/- 6.7, respectively. There was no statistical difference between Ct values of NA and NS samples (p = 0.48). RT-PCR for SARS-Cov2 performed with NA sample and NS sample showed a strong correlation regarding the positivity/negativity and the Ct values.Publication Open Access Publishing outcomes of abstracts presented at the European Society of Pediatric Otorhinolaryngology Congress in 2018: a web-based analysis(Aves, 2022) Gökler, Ozan; Coşkuntürk, Ali; Bayram, Yavuz; Ünsaler, Selin; Altuntaş, Muzaffer Ozan; Çetin, Feyza; Teaching Faculty; Teaching Faculty; School of Medicine; 311179; N/A; N/A; 167909; 169795; N/ABackground: clinicians and researchers share their projects in congresses, which are collaborative meetings that enhance the dissemination of information among scientists. Furthermore, critical evaluations of their colleagues help the progress of their research. However, the mainfocus of any research is publication. In thisstudy, we assess the effect of the European Society of Pediatric Otorhinolaryngology 2018 meeting on the publication rate of abstracts submitted. The aim of this study was to determine whether attending the ESPO 2018 congress had an impact on the publication rate of oral and poster presentations. Methods: all abstracts submitted to the European Society of Pediatric Otorhinolaryngology 2018 Congress catalog were searched in Google Scholar via corresponding title and author to identify the ones that were published. The date of publication, name, and impactfactor of the journals of published articles was recorded. Results: a total of 785 abstracts (217 oral, 568 posters) were accepted. Of all abstracts, 21.3% (n=167) were published. Out of all publications, 32% (n=53) were oral presentations and 68% (n=114) were poster presentations. There were 62 different journals with an average weighted 3-year impact factor of 2.06 (+/- 1.09 standard deviation). The 3 most common journals were Mt) Pediatr Otorhinolaryngol (n = 49, impact factor: 1.64 ), Laryngoscope (n=12, impact factor: 2.81 ), and Eur Arch Otorhinolaryngol (n=10, impactfactor: 2.16). Conclusion: our publication rate of 21.27% is low when compared to oral-only meetings but is similar to others having both oral and poster presentations. We found out that poster presentations reduced the overall publication rate and were published in journals having lower impactfactors when compared to oral presentations.Publication Open Access The effect of COVID-19 pandemic on sudden idiopathic sensorineural hearing loss: a cross-sectional study in a single institution(Bayçınar Tıbbi Yayıncılık ve Reklam Hizmetleri, 2022) Ünsaler, Selin; Hafız, Ayşenur Meriç; Şahin, Selin Merve; Aydoğan, Esra; Gökler, Ozan; Altuntaş, Muzaffer Ozan; Faculty Member; Undergraduate Student; Teaching Faculty; Teaching Faculty; School of Medicine; Koç University Hospital; 167909; N/A; N/A; N/A; 311179; 169795Objectives: this study aimed to evaluate the effects of the coronavirus disease 2019 (COVID-19) pandemic on the incidence, course, and prognosis of sudden idiopathic sensorineural hearing loss (SISNHL). Patients and methods: this retrospective study was conducted with 55 patients (31 males, 24 females; mean age: 44.4±18.5 years; range, 11 to 83 years) treated for SISNHL. The patients were analyzed in two groups: Group 1, which included 35 patients (24 males, 11 females; mean age: 42.5±18.8 years; range, 11 to 72 years) admitted after the onset of the pandemic between March 2020 and March 2021, and Group 2, which consisted of 20 patients (7 males, 13 females; mean age: 47.5±19.0 years; range, 20 to 83 years) admitted before the pandemic between March 2019 and February 2020. Age, the timing of referral to the otolaryngology clinic after the perception of the first otologic symptom, the severity of the hearing loss, and the status of recovery were investigated. The COVID-19 status of Group 1 was investigated. Results: the incidence of SISNHL among all patients admitted to our clinic in the same time duration was found to have increased after the COVID-19 pandemic, and this increase was statistically significant (p=0.04). One patient had SISNHL during acute COVID-19. Three patients had COVID-19 three weeks before SISNHL, six patients had COVID-19 three months before SISNHL, and one patient was diagnosed with COVID-19 six months before SISNHL. Fourteen patients were tested for severe acute respiratory syndrome coronavirus 2 with real-time polymerase chain reaction at the time of admission, which resulted in negative. Conclusion: as the incidence of SISNHL has increased following the COVID-19 pandemic, a possible relation between hearing loss, presenting as SISNHL, and COVID-19 disease should be investigated. / Amaç: bu çalışmada, koronavirüs hastalığı 2019 (COVID-19) pandemisinin ani idiyopatik sensörinöral işitme kaybının (AİSİK) insidansı, seyri ve prognozu üzerindeki etkileri değerlendirildi. Hastalar ve yöntemler: bu retrospektif çalışma, AİSİK için tedavi edilen 55 hasta (31 erkek, 24 kadın; ort. yaş: 44.4±18.5 yıl; dağılım, 11-83 yıl) ile yürütüldü. Hastalar iki grupta analiz edildi: Mart 2020 ile Mart 2021 arasında pandemi başlangıcından sonra başvuran 35 hastadan (24 erkek, 11 kadın; ort. yaş: 42.5±8.8 yıl; dağılım, 11-72 yıl) oluşan Grup 1 ve Mart 2019 ile Şubat 2020 arasında pandemi öncesi başvuran 20 hastadan (7 erkek, 13 kadın; ort. yaş: 47.5±19.0 yıl; dağılım, 20-83 yıl) oluşan Grup 2. Yaş, ilk otolojik semptomun algılanmasından sonra kulak burun boğaz polikliniğine başvuru zamanlaması, işitme kaybının şiddeti ve iyileşme durumu araştırıldı. Grup 1’in COVID-19 durumu araştırıldı. Bulgular: kliniğimize aynı süre içinde başvuran tüm hastalarda AİSİK insidansının COVID-19 pandemisi sonrası arttığı saptandı ve bu artış istatistiksel olarak anlamlıydı (p=0.04). Bir hastada akut COVID-19 sırasında AİSİK gelişti. Üç hastada AİSİK’den üç hafta önce COVID-19 vardı, altı hastada AİSİK’den üç ay önce COVID-19 vardı ve bir hastada AİSİK’den altı ay önce COVID-19 tanısı konulmuştu. On dört hasta başvuru sırasında şiddetli akut solunum yolu sendromu koronavirüsü 2 için gerçek zamanlı polimeraz zincir reaksiyonu ile test edildi ve sonuç negatif çıktı. Sonuç: COVID-19 pandemisini takiben AİSİK insidansı arttığı için AİSİK olarak ortaya çıkan işitme kaybı ile COVID-19 hastalığı arasındaki olası ilişki araştırılmalıdır.Publication Open Access Pediatric laryngeal measurements based on computed tomography images(Aves, 2022) Ünsaler, Selin; Gökler, Ozan; Aygün, Murat Serhat; Şahin, Selin Merve; Yaycıoğlu, Arda; Altuntaş, Muzaffer Ozan; Ünal, Ömer Faruk; Hafız, Ayşenur Meriç; Teaching Faculty; Teaching Faculty; Undergraduate Student; Other; Faculty Member; School of Medicine; Koç University Hospital; 167909; N/A; N/A; N/A; N/A; N/A; N/A; N/ABackground: this study aimed to establish average laryngeal measurements in the Turkish pediatric population and measure the narrowest portion of the pediatric airway. Methods: the laryngeal measurements of 88 pediatric patients between the ages 0 and 17 were retrospectively obtained from neck computed tomography scans performed between January 2018 and May 2021. Subjects were divided into 6 age groups. Four following measurements were made: cricoid anteroposterior, cricoid transverse, subglottic anteroposterior, and subglottic transverse. Cross-sectional areas were calculated using these dimensions. Subglottic cross-sectional area/cricoid crosssectional area ratio for each subject was calculated and patients were divided into 2 groups: group 1, subjects with ratio < 1; group 2, subjects with ratio ? 1. Results: mean age was 8.97 ± 5.7. Mean anteroposterior diameters at subglottis and cricoid ring levels were 13.74 ± 4.45 mm and 13.26 ± 4.39 mm; mean transverse diameters were 7.88 ± 2.62 mm and 9.06 ± 3.12 mm, respectively. The subglottic anteroposterior diameter was greater than cricoid (P < .001), but the transverse diameter was smaller than cricoid (P < .001). Subglottic cross-sectional area was 93.24 ± 59.20 mm2 and cricoid cross-sectional area was 103.61 ± 69.15 mm2 . Subglottic cross-sectional area/cricoid cross-sectional area ratio was smaller than 1 in 69 subjects (group 1; mean=0.85) and equal to or greater than 1 in 19 subjects (group 2; mean=1.33). Conclusion: the narrowest portion of the airway was subglottis immediately below the vocal cords, in contrast to the common belief as to the cricoid ring. Subglottic cross-sectional area/cricoid cross-sectional area ratios showed that the pediatric airway was larger at cricoid (69 subjects, 78.4%), and this ratio does not differ based on age.Publication Open Access A diagnostic challenge: risk factors and surgical treatment of laryngeal chondroradionecrosis(Aves, 2022) Başaran, Bora; Doruk, Can; Çaytemel, Berkay; Şen, Cömert; Aslan, İsmet; Ünsaler, Selin; School of Medicine; 167909Objectives: thirteen cases of laryngeal chondroradionecrosis unresponsiveto conservative treatment and treated with laryngectomy were presented with an analysis of possible risk factors. Methods: retrospective analysis of 13 patients operated on for chondroradionecrosis was made. Characteristics of the primarytumor, chondroradionecrosis grade, number of biopsies needed to rule out recurrence, and laryngectomy indications were analyzed. The possible predisposing factors such as alcohol and tobacco use and other major chronic diseases were investigated. Results: all of the patients had a history of smoking. The most common comorbidity was hypertension (46.2%), followed by chronic obstructive pulmonary disease (23.1%). The onset of symptoms was documented within the 10 monthsfollowing the radiation therapy in 12 of the patients (93.3%) and 12 years after the primary radiation therapy in 1 patient. Asthe most common symptom, fetor oris was observed in all of the patients, followed by dysphagia (69.2%), hoarseness (61.5%), pain (53.8%), dyspnea (46.2%), and necrotic fistula formation in the anterior neck (15.4%) consecutively. Tumor suspicion (84.6%) was the most common indication for laryngectomy followed by chronic aspiration or feeding disorder (61.5%). Twelve patients were treated with total and 1 with supraglottic laryngectomy. Pectoralis major muscle flap was used in all of the patients for pharyngeal reconstruction or protection against salivary fistula. Conclusion: diagnosis of chondroradionecrosis is challenging, and tumor recurrence should always be kept in mind. Patients must be informed about the possibility of chondroradionecrosis complications including laryngectomy. Introduction: chondroradionecrosis is a rare and the most severe complication of radiation therapy for laryngeal carcinoma.