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Objective: To evaluate vestibular evoked myogenic potentials (VEMP) results of unilateral cochlear implant users with inner ear malformations. Method: VEMP is a short latency myogenic response recorded with surface electrodes placed over muscles. VEMP response could be recorded even in subjects with severe to profound hearing loss and this reveals intact vestibular organs. However, it is complicated that what happens in case of inner ear malformations. In the current study, 10 unilateral cochlear implant users with inner ear malformations were included. These subjects were selected randomly from institutional ear malformations database. Both cervical VEMP (cVEMP) and ocular VEMP (oVEMP) was applied for all subjects. Results: Age range was in between 7 years and 6 months and 40 years with 20,7 mean. All subjects had different cochleaovestibular malformations and in same subject both ear also had different malformations. 9 subjects had right CI and 1 subject left CI. All subjects had bilateral normal middle ear function. They were tested with cVEMP and oVEMP in a random order. In implanted ear, cVEMP response got in 4 subject, but oVEMP response got in 2 subjects. However in non-implanted ear, cVEMP and oVEMP responses got in 5 subjects. VEMP wave forms revealed some difference in both latency and amplitude form CI user with normal inner ear structure and normal subject's reports from literature. Conclusion: Cochlear implant could change vestibular functions and this could be evaluated with VEMP especially to see saccul and utricul functions. It was known that dizziness and balance problems commonly accompany with inner ear malformations also after CI their complaint may increase. Different cochleovestibular malformations result in different VEMP recordings. But it is not clear that absence of VEMP result from cochleaovestibular malformation or from CI. Therefore, further studies need. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate otorhinolaryngologic findings and the relationship between aminoglycoside (AG) exposure and hearing loss in paediatric patients with cystic fibrosis (cwCF). We also aimed to investigate the genetic predisposition to AG ototoxicity by screening for m.1555A>G mutations., Methods: CwCF who underwent otorhinolaryngologic and audiologic examinations were retrospectively included. Clinical characteristics, ear-nose-throat related symptoms, and a history of ototoxic drug exposure were recorded. m.1555A>G mutations were retrospectively screened among patients with audiologic evaluations., Results: Two hundred thirty-four cwCF were included in this study with a median age of 10.7 (range, 6.8-14.2) years. Nasal obstruction (14.1%) was the most common symptom. Fifty-two (22.2%) patients had chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP). There was a positive correlation between CRSwNP and the symptom of nasal obstruction (r:.234, p < .001), snoring (r:.179, p = .006), and sleeping with mouth open (r:.138, p = .034). One hundred forty-nine (63.6%) patients had audiologic evaluations; 14 (9.4%) had hearing impairment. No statistical significance existed between ototoxicity and IV AG exposure (p = .90). Six (42.8%) of 14 patients did not receive ototoxic drugs. One hundred nineteen (50.8%) patients were screened for m.1555A>G mutations, and none were detected., Conclusions: Almost a quarter of the study population had CRSwNP. Neither the relationship between AGs exposure and hearing loss nor the genetic predisposition to AG ototoxicity could be shown in cwCF., (© 2024 Wiley Periodicals LLC.)

Conductive hearing loss caused by external or middle ear problems prevents the transmission of sound waves from the external auditory canal to the cochlea, and it is a common condition, especially in pediatric patients aged 1-5 years. The most common etiological factors are otitis media and cerumen during childhood. In some patients, external and middle ear functions and structures may be normal bilaterally despite the air-bone gap on the audiogram. This condition, which is often a missed diagnosis in children, is defined as a pseudo-conductive hearing loss (PCHL) caused by third window syndromes (TWSs) such as semicircular canal dehiscence, inner ear malformations with third window effect, and perilymphatic fistula. In this review of the literature, the authors emphasize the pitfalls of pediatric audio-vestibular evaluation on TWSs as well as the key aspects of this evaluation for the differential diagnosis of PCHL brought on by TWSs. This literature review will provide audiologists and otologists with early diagnostic guidance for TWSs in pediatric patients.

Purpose: New perspectives on rehabilitation options for inner ear malformations have still been studied in the literature. This study investigated the cognitive, language, and motor skills of auditory brainstem implant (ABI) users in unimodal and bimodal groups., Methods: The motor competency of the participants was assessed with Bruininks-Oseretsky Motor Proficiency Test-2 Short Form (BOT2 SF). Language performance was evaluated by the test of Early Language Development-3 and Speech Intelligibility Rating. Word identification, sentence recognition tests, and Categories of Auditory Performance were used to assess auditory perception skills. To examine the cognitive performance, Cancellation Test and Gesell Copy Form were administered. All the tests were conducted in a quiet environment without any distractions., Results: The participants were divided into two groups: (1) 17 children in the unimodal group and (2) 11 children in the bimodal (who used a cochlear implant on one side and ABI on the other side) group. There were significant correlations between the chronological age of participants and BOT2 SF total score, cancellation tests, auditory perception tests, and language performance. Similarly, there were significant correlations between the duration of ABI use and auditory perception tests, language performance, cancellation test, and some BOT2 SF subtests ( r  = -0.47 to -0.60, p  < .001). There was no significant difference between the unimodal and bimodal groups in any task ( p  > .05). However, there were moderate-to-strong correlations among the auditory perception tests, cancellation test, language test, and BOT2 SF total score and subtests ( r  = 0.40 to 0.55, p  < .05)., Conclusion: Although there were no significant differences between bimodal and unimodal groups, a holistic approach, which indicates that hearing and balance issues can have broader impacts on a person's physical, emotional, social, and psychological aspects, should be used in the assessment process., Level of Evidence: Level 4., Competing Interests: The authors declare no conflicts of interest., (© 2023 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Background: Levels of zonulin, a surrogate marker of intestinal permeability, are elevated in various disorders including insulin resistance, obesity, celiac disease, and inflammatory bowel disease. We aimed to elucidate the association of zonulin levels and metabolic syndrome (MS) in renal transplant recipients., Methods: Seventy-nine renal transplant recipients were enrolled. Diagnosis of MS was established employing the Adult Treatment Panel III (ATP III) criteria. Serum zonulin level was determined using the double antibody sandwich ELISA method., Results: MS was encountered in 37 (41.6%) of the 79 patients. Serum zonulin level was significantly higher in patients with MS compared to those without MS (p < 0.001). Serum zonulin level correlated with presence of MS (r: 739, p < 0.001), abdominal obesity (r: 514, p < 0.001), fasting glucose level (r: 361, p: 0.001), presence of fasting glucose/diabetes criterion of MS (r: 316, p: 0.005), presence of low HDL criterion of MS (r: 266, p: 0.018), and BMI (r: 527, p < 0.001)., Conclusions: A Zonulin-mediated increase in intestinal permeability may play a role in the pathogenesis of metabolic syndrome. We propose that zonulin may be a suitable surrogate marker of MS in renal transplant recipients.

Scabies is a contagious, parasitic skin disease that adversely affects the quality of life and, can cause systemic complications if it is not properly treated. Sulfur ointment and permethrin cream are among the most used topical agents in the treatment of scabies. In this study, we aimed to compare the efficacy of sulfur ointment and permethrin cream in the treatment of scabies. In this single-center study, patients who were diagnosed with scabies in the dermatology outpatient clinics of Karabuk University Training and Research Hospital between April, 2021 and September, 2021 were investigated retrospectively. Age, gender, date of diagnosis, topical agent used for scabies treatment, and response to the treatment at the control examination in the second week were recorded. The patients were divided into two groups those receiving 5% permethrin cream or 10% sulfur ointment, and the treatment efficacy of both agents was compared. This study showed that 10% sulfur ointment was significantly more effective in treating scabies than 5% permethrin cream (p < 0.001). Moreover, younger patients with scabies responded better to both treatments. 10% Sulfur ointment can be considered a safe and effective topical option in the treatment of scabies. The resistance to 5% permethrin cream, which is the most commonly used agent for scabies, can be a concern as an unexpected low success rate was obtained in this study., (© 2022 Wiley Periodicals LLC.)

Introduction: Liver transplantation (LT) is the most effective treatment modality in patients with end-stage liver disease (ESLD). With the increased prevalence of diabetes and non-alcoholic fatty liver disease (NAFLD), coupled with a steady increase in the age of transplant population, liver transplant candidates are at increased risk for coronary artery disease (CAD). Improvements in anesthesia, surgical experiences, and increased effectiveness of drugs have facilitated concurrent surgical interventions in transplantation, allowing for orthotopic LT to be performed in elderly patients with a high incidence of coexisting diseases, especially those of the cardiovascular system. In this study, we present two cases of combined off-pump coronary artery bypass surgery and living donor liver transplantation., Case Presentation: A 68-year-old male patient with ESLD due to chronic hepatitis C infection and multi-vessel CAD, and a 65-year-old female patient with NAFLD cirrhosis and multi-vessel CAD were referred to our institution for an LT evaluation. We performed combined living donor LT and off-pump coronary artery bypass surgery in both patients. Both the first and second patients were alive with good liver and cardiac function at the 25 and 15 months after surgery, respectively., Conclusion: Combined off-pump coronary artery bypass surgery and living donor LT are an alternative treatment for patients with severe CAD and ESLD. We consider that combined coronary artery bypass graft surgery and LT can be safely performed by experienced anesthesia and surgical teams in selected patients.

Objective: To investigate the high-frequency vestibular functions using a child-friendly video head impulse test and to classify vestibular symptoms using a standard nomenclature guideline in dizzy children., Materials and Methods: The video head impulse test with a remote camera was used in this study. The data of 40 dizzy children (7.30 ± 4.75 years) were analyzed retrospectively., Results: The high-frequency vestibulo-ocular reflex gains of 14 (35%) dizzy children in the study group were reduced, whereas the vestibulo-ocular reflex gains of 26 (65%) dizzy children were normal. Two of them had a dramatic reduction in vestibulo-ocular reflex gains on their affected SCCs, but no corrective saccades as their gazes had not been fixated on the target at the onset of head impulses. In dizzy children, the most common cause was inner ear malformation (15%) and the most common vestibular symptom was unsteadiness (25%)., Conclusion: The high-frequency vestibular function of the VOR in dizzy children, especially those suffering from IEM and unsteadiness, can be quickly screened using the vHIT device with the remote camera. However, clinicians should be careful during the interpretation of traces in the pediatric group., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: Children with inner ear malformation (IEM) are at risk of vestibular loss as well as hearing loss. Incomplete partition (IP) anomalies constitute about 41% of all IEMs. This study aimed to investigate the postural control in subjects with the same type of IP on both sides and to compare their results with cochlear implant (CI) users without IEM and healthy peers., Methods: The study group consists of 17 subjects with the same IP types on both sides and using auditory implants on at least one side, with the following 3 groups: 6 IP-I subjects (mean age 12.28 ± 6.25), 6 IP-II subjects (mean age 12.90 ± 3.23), and 5 IP-III subjects (mean age 6.98 ± 3.10). Six unilateral CI users (mean age 11.38 ± 3.57) with normal inner ear structures were included in the CI control group, and 6 healthy peers (10.20 ± 4.79) were included in the healthy control group. The postural control was measured using the Bruininks-Oseretsky Test of Motor Proficiency Second Edition (BOT-2) balance subtest. All devices were turned off during the balance test., Results: The BOT-2 balance scale scores were observed to be significantly different between the IP-I and healthy control group (medians of balance scores being 3.00 and 16.00, respectively, p < 0.001) and the IP-III and healthy control group (medians of balance scores being 6.60 and 16.00, respectively, p = 0.04). The IP-II group had better balance scores (median = 8.00) than those of the other IP groups, although there were no significant differences between the IP-II and other groups (p > 0.05)., Conclusion: This study demonstrated that subjects with the same IP type on both sides and with early implantation may differ in terms of their postural control abilities depending on their IP type. Subjects with IP should be regularly followed up by the vestibular assessment and supported by their postural control ability by vestibular rehabilitation., (© 2021 S. Karger AG, Basel.)

Objective: To determine the frequency of granulomatous inflammation within hepatocellular carcinoma (HCC) and its clinicopathologic associations., Material and Method: Fifty-eight HCCs (51 explants, 3 lobectomies, and 4 segmentectomies) were reviewed., Results: Five (8.6%) cases (F/M=1/4, mean age: 63.6) were identified with granulomas.1/5 had history of neoadjuvant therapy. 4/5 patients presented with early stage (pT1/2). All were well-differentiated (Grade1-2/4). The mean number of tumor foci was 3.6, with a median size of 2.2 cm. All of them had advanced fibrosis. No difference was identified from cases without granulomas (n=53) in terms of prognosis and aforementioned parameters (p > 0.05). Granulomas were mainly concentrated in peripheral parts of the tumors. One case with nodule-in-nodule formation had granulomas lined along the border of the inner nodule. In 2 cases, granulomas were identified in steatohepatitic areas, while another had clear cell change. Only 1 had necrotizing granulomas, none with acid resistant bacilli. Two cases revealed concomitant granulomas in the adjacent liver parenchyma in addition to the tumor stroma. Except for one with a history of tuberculosis, none of the cases had a granulomatous disease., Conclusion: This is the largest case series of HCCs with granulomas by far. Our data revealed neither clinicopathologic and prognostic difference nor definite etiology related to granulomas. Yet, association with steatotic and clear tumor cells suggests the role of cytoplasmic content, while distribution of granulomas points to host immune response.

Objectives: This study aimed to examine the vestibulo-collic reflex (VCR) and linear vestibulo-ocular reflex (lVOR) and their correlation with brain lesions in pediatric-onset multiple sclerosis (POMS)., Methods: The study group consisted of 17 patients (34 ears) with POMS (mean age 18.73 ± 2.02, mean age at disease onset 14.64 ± 1.36 years), and the control group included 11 age-matched healthy subjects (22 ears). Ocular and cervical Vestibular Evoked Myogenic Potentials (oVEMP and cVEMP) were performed to assess IVOR and VCR pathways. Magnetic Resonance Imaging was evaluated in the study group., Results: In the POMS group, 47.05 % of oVEMPs and 17.64 % of the cVEMPs were abnormal, while all VEMPs were normal in the control group. The oVEMP amplitude was associated with infratentorial lesion volume (r = -0.459, p = 0.01) and total lesion volume of the brainstem and cerebellum (r = -0.450, p = 0.01). The cVEMP asymmetry ratio was correlated with the deep white matter lesion volume (r = 0.683, p < 0.001). The MVEMP scores were found to correlate only with lesion volumes in the cerebellum (r = 0.488, p = 0.04) and infratentorial region (r = 0.573, p = 0.01)., Conclusions: Ocular and cervical VEMP abnormalities confirm that lVOR and VCR pathways may be affected in early POMS., Significance: Routine use of the VEMP test, especially the oVEMP test is recommended as a useful tool in the follow-up of POMS patients., (Copyright © 2021 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Purpose: Follicular melanocytes are known to be damaged in alopecia areata (AA). However, it is not clear whether melanocytes are the primary target of autoimmunity and whether melanocytes in the inner ear are affected. This study aimed to detect possible cochlear and/or vestibular melanocyte damage in AA patients., Methods: Thirty-two AA patients and 35 sex- and age-matched healthy volunteers were evaluated between November 2018 and March 2020 at the Karabük University Training and Research Hospital. The conventional pure tone audiometry test and distortion product otoacoustic emission test were performed to evaluate hearing. To evaluate the vestibular function, the following tests were performed: the vestibulospinal reflex tests (Romberg test, tandem stance test and tandem walking test); positional balance tests (Dix-Hallpike test, supine roll test and head hanging test); vestibulo-ocular reflex tests (caloric test, head shake test) and oculomotor tests (saccade, smooth pursuit and optokinetic)., Results: The mean age of AA patients was 31.94 ± 11.86 years (range, 15-67 years). There were no significant differences in the results of the hearing and balance tests between the groups. Furthermore, disease parameters (duration of the last attack, recurrence, positive family history, positive pull test, the severity of the disease, etc) were not associated with hearing loss and vestibular damage., Conclusion: AA patients did not exhibit hearing loss or balance abnormalities that would indicate cochlear and vestibular melanocyte damage. The lack of damage to the inner ear melanocytes in AA patients may indicate that follicular melanocytes are affected secondary to autoimmune damage in the hair bulb, and melanocytes are not the primary target in the pathogenesis of AA., (© 2021 John Wiley & Sons Ltd.)

Objective: To investigate the postural instability and vestibular functions in children with severe inner ear malformations (IEMs)., Design: A prospective case-control study., Study Sample: The study group consisted of 10 children using unilateral auditory brainstem implant (ABI) with labyrinthine aplasia or rudimentary otocyst. The age-matched control groups consisted of 10 unilateral cochlear implant (CI) users with normal inner ear structures and 10 healthy peers. All tests were performed to implant users when the implants were off., Results: All median VOR gains in the ABI group (median anterior, lateral, and posterior canal 0.15, 0.05, and 0.05, respectively, for the non-implanted sides) were significantly lower than those of the control groups (median VOR gains ≥ 0.90 in both control groups). There were no oVEMP and cVEMP responses in the study group. The mean BOT-2 balance scores of the ABI (3.70 ± 1.34) group was dramatically lower than those of the CI (9.40 ± 2.88) and healthy control (16.20 ± 4.16, p  < 0.001)., Conclusions: The postural instability in children with severe IEMs was higher than those in CI users with normal inner ear structures and healthy peers. The level of deficiency in the labyrinthine was more important for postural stability in children.

Background: Young children are able to explore new objects and practice language through the acquisition of motor skills that lead to their overall development. Congenital hearing loss and total vestibular loss may contribute to the delay in speech and motor skill development., Objectives: To investigate the relationship between motor development performance, speech perception, and language performance in children with auditory brainstem implant (ABI)., Method: Ten children, aged 4-17 years (mean age 9.76 ± 4.03), fitted with unilateral ABI for at least 2 years due to the presence of labyrinthine aplasia and rudimentary otocyst at least 1 side were included in the study. Several standardized tests, such as Bruininks-Oseretsky Motor Proficiency Test-2 (BOT-2), Children's Auditory Perception Test Battery, Meaningful Auditory Integration Scale (MAIS), and Test of Early Language Development-3, were performed to evaluate their skills of fine motor control, balance, manual dexterity, language, and auditory perception., Results: A significant correlation was established between the BOT-2 manual dexterity and MAIS scores (r = 0.827, p < 0.05) and between the manual dexterity and language skills (for expressive language, r = 0.762, p < 0.05; for receptive language, r = 0.650, p < 0.05). Some of the BOT-2 balance tasks, such as standing on 1 leg on a line with eyes closed, standing on 1 leg on a balance beam with eyes open, standing heel-to-toe on a balance beam, and walking forward heel-to-toe on a line, showed a strong correlation with their receptive and expressive language performance (p < 0.05)., Conclusion: The current study has indicated that significantly poor manual and balance performances are associated with poor speech perception and language skills in children with ABI. The authors recommend performing a vestibular assessment before and after ABI surgery and the use of a holistic rehabilitation approach, including auditory and vestibular rehabilitation, to support development of the children with ABI., (© 2021 S. Karger AG, Basel.)

Background: Multiple Sclerosis (MS), an autoimmune demyelinating disease of the central nervous system, is an important cause of disability in young adults. The purpose of this cross-sectional study was to evaluate the vestibular system with video Head Impulse Test (vHIT) and determine the impairment of the Vestibulo-ocular Reflex (VOR) in childhood-onset MS., Methods: The study group, 20 persons with MS (pwMS) with onset before 18 years of age (6 M, 14 F; mean age 19.06 ± 1.66) and the control group, 20 healthy, age- and sex-matched individuals were retrieved from vHIT recordings. The mean age of MS onset in the study group was 14.60 ± 1.53 years. The VOR pathway was evaluated using vHIT., Results: The median VOR gains of right anterior (1.00), left lateral (0.96) and left posterior (0.91) semicircular canals were significantly lower in the pwMS group than those of the healthy control group (1.05, 1.00, 0.98 respectively, p < 0.05). Four of pwMS (20%) had abnormal VOR gains. The pwMS with dizziness had significantly lower VOR gains (median 0.91) compared with pwMS without dizziness (median 1.01, p < 0.05)., Conclusion: This study demonstrates vestibulo-ocular system can be affected in patients with childhood-onset MS and suggests using vHIT especially in the follow-up of pwMS with dizziness., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Vitiligo is a systemic disease that affects not only the skin but also other areas that contain melanocytes, such as the inner ear. Studies of the effect of vitiligo on hearing loss have shown inconsistent results, and it is not clear which parameters related to the disease affect hearing. The aim of this study was to determine which disease-related parameters trigger damage to cochlear melanocytes in vitiligo patients and the effect of vitiligo on the outer hair cells and hearing. Thirty-one vitiligo patients and 40 sex- and age-matched healthy volunteers were evaluated. The conventional pure tone audiometry (C-PTA) test and the distortion product otoacoustic emission (DPOAE) test were performed. There was no significant difference between vitiligo patients and controls in C-PTA test results, but the DPOAE test results were abnormal in vitiligo patients. The duration of the disease was significantly related to hypoacusis. As the duration of the disease increases, cochlear dysfunction may increase. Especially in patients with longer disease duration, otoacoustic emission tests should be performed in addition to conventional audiometry tests for early detection of damage to the outer hair cells., (© 2020 Wiley Periodicals LLC.)

Inner ear involvement may occur in systemic autoimmune diseases. Although there are studies evaluating hearing in psoriasis patients, its effect on the balance system is not clear. The aim of the present study was to evaluate the audiovestibular system in psoriasis patients without joint involvement. In this prospective study, the audiovestibular system of 32 psoriasis patients without joint involvement and 35 healthy volunteers were evaluated. The severity of the disease was determined by the psoriasis area severity index (PASI). There was no significant difference between the groups in terms of hearing test results, while the abnormal caloric test response was significantly higher in the psoriatic patients. PASI scores of psoriasis patients with abnormal caloric test results were higher than those with normal caloric test response. In psoriasis patients without joint involvement, the hearing was not affected, but the vestibular system was. The severity of the disease was associated with vestibular involvement. Particularly in patients with severe psoriasis, it must be considered that the vestibular system might be affected, and vestibular evaluations should be performed., (© 2020 Wiley Periodicals LLC.)

Nicolau syndrome is a skin and underlying tissue necrosis resulting from vascular occlusion after various injections of certain drugs. Intramuscular injections are the most common cause but it may occur after other types of parenteral interventions. There are many medications reported as causative factors inducing Nicolau syndrome including penicillin, nonsteroidal anti-inflammatory drugs, corticosteroids, local anesthetics, and several others. We present an observational study of diclofenac induced Nicolau syndrome., (© 2020 Wiley Periodicals LLC.)