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The current study aimed to investigate if there is a difference in the use of intratympanic steroid therapy (IST), compared to systemic steroid treatment (SST), as an initial treatment for patients with sudden sensorineural hearing loss (SSNHL) by a meta-analysis design performed on the mean pure-tone average (PTA) improvement and the complete recovery rate.A systematic literature review was performed on randomized controlled trials published from 1990 to August 2020 in some databases including PubMed/MEDLINE, Scopus, Embase, Web of Science, Cochrane library/CENTRAL, Ovid, ProQuest, Google Scholar, and clinical trials.gov. The primary outcomes of interest were pure-tone average improvement and complete recovery rates.Six eligible studies with 496 patients (250 patients in the IST group and 246 subjects in the SST group) were included in this study. The pooled standardized mean difference of the PTAs was estimated as 0.07 (95% CI = -0.10 to 0.25; IThe current study demonstrated that the effect of intratympanic injection of corticosteroid, as a first-line treatment, is not statistically different from the systemic route in improving the hearing outcomes among patients with SSNHL.

The present study investigated if and how the smell training scheme affects resting‑state effective connectivity. We focused on connectivity among brain regions that participate in olfactory‑related processes, including the piriform cortex, amygdala, orbitofrontal cortex (OFC), insula, and cingulate cortex. Sixteen patients with posttraumatic olfactory dysfunctions between the ages of 18 and 36 years participated in this study. Olfactory performance of subjects was evaluated using the Sniffin' Sticks test kit and then, resting‑state functional magnetic resonance imaging (fMRI) was performed. Of the 16 participants, 8 underwent olfactory training for 16 weeks and the remaining 8 did not receive the treatment (the control group). After 16 weeks, participants in both groups underwent the same procedure (smell testing and the MRI examination). Olfactory performance scores were compared between groups using an independent samples t‑test. Spectral dynamic causal modeling was applied to resting‑state fMRI data to identify alterations in effective connectivity due to the smell training. We found that patients in the treatment group improved in the odor discrimination task and overall olfactory function as compared to the control group. Compared to the control group, patients in the treatment group had increased self‑inhibitory connectivity of the OFC and increased excitatory connectivity from the cingulate cortex to the insula. Moreover, the excitatory connectivity from the OFC to the cingulate cortex was found to be weaker following the olfactory training scheme. This study shows that a smell training scheme can cause changes in resting‑state effective connectivity parameters that can be attributed to improvements in the odor discrimination task.

Hybrid electrospun scaffolds based on poly (L-lactic acid) (PLLA)/poly (amidoamine) (PAMAM-G2) dendrimer/gemini surfactant were fabricated for the enhancement of synergistic antibacterial activities. The second generation of poly (amidoamine) (PAMAM-G2) and cationic gemini surfactant were utilized to functionalize the optimum electrospun scaffolds. The gelatination process was utilized to improve the wettability of PLLA scaffolds to extend cell attachment and cell proliferation. PLLA nanofibrous scaffolds were characterized by energy dispersion x-ray, scanning electron microscopy images, mechanical properties, water contact angle, Fourier transform infrared spectroscopy, zeta potential and antibacterial assessment. In vitro cell biocompatibility was evaluated by 3-(4, 5- dimethylthiazoyl-2-yl)-2, 5-diphenyltetrazolium bromide assay and morphology of PC-12 cells cultured on hybrid nanofibrous scaffolds and gelatinized ones. The results indicated that the optimum scaffolds could successfully modify the characteristics of PLLA scaffolds leading to much more appropriate physical and chemical properties. In addition, gelatinized nanofibrous scaffolds reveal more wettability enhancing cell attachment and proliferation. Furthermore, using poly (amidoamine) (PAMAM-G2) and gemini surfactant reveals synergetic antibacterial activity due to the competition between both cationic groups of PAMAM and gemini surfactant. Finally, improved cell adhesion and cell viability on modified scaffolds were confirmed. These favorable properties give a chance for these scaffolds to be used in a wide variety of biomedical applications.

Objectives: Tinnitus is a common and distressing otologic symptom, with various probable pathophysiologic mechanisms, such as an imbalance between excitatory and inhibitory mechanisms. Acamprosate, generally used to treat alcoholism, is a glutaminergic antagonist and GABA agonist suggested for treating tinnitus. Thus, we aimed to evaluate the efficacy and safety of acamprosate in the treatment of tinnitus. Methods: The current randomized-controlled trial study included 20 subjects with chronic tinnitus. After performing psycho-acoustic, psychometric and electrophysiological evaluations, all studied tinnitus subjects were randomly divided into two groups of acamprosate and placebo. The first group received oral acamprosate (two tablets of 333 mg/d, three times a day), whereas the second group was given placebo treatment (two tablets, three times a day). After the first 30 days, all evaluations were repeated for the studied groups just in the same manner before the study. Subsequently, the final results of each evaluation were compared together with the baseline values. Results: Nine studied subjects randomly received acamprosate, whereas eleven others received a placebo. There was no significant improvement in the psycho-acoustic tests, except a decrease was observed in the pitch match of tinnitus ( P = .039). For those subjects who were receiving acamprosate, a significant reduction was observed in tinnitus handicap inventory ( P = .006), tinnitus questionnaire scores ( P = .007), and the visual analog scores ( P = .007) compared to the placebo group. There was a significant reduction in Action Potential latency ( P = .048) as well as an increase in the amplitude of distortion product otoacoustic emissions at 4 kHz ( P = .048). Conclusions: The study results indicated a subjective relief of tinnitus as well as some degree of the electrophysiological improvement at the level of the cochlear and the distal portion of the auditory nerve among the subjects who received the acamprosate. Clinical trial registration code: IRCT2013121115751N1

To evaluate the auditory performance and speech production outcome in children with auditory neuropathy spectrum disorder (ANSD). The effect of age on the outcomes of the surgery at the time of implantation was also evaluated.Cochlear implantation was performed in 136 children with bilateral severe-to- profound hearing loss due to ANSD, at four tertiary academic centers. The patients were divided into two groups based on the age at the time of implantation; Group I: Children ≤24 months, and Group II: subjects24 months. The categories of auditory performance (CAP) and speech intelligibility rating (SIR) scores were evaluated after the first and second years of implantation. The differences between the CAP and SIR scores in the two groups were assessed.The median CAP scores improved significantly after the cochlear implantation in all the patients (p value 0.001). The improvement in the CAP scores during the first year in Group II was greater than Group I (p value: 0.007), but the improvement in CAP scores tended to be significantly higher in patients who were implanted at ≤24 months (p value 0.001). There was no significant difference between two groups in SIR scores at first-year and second-year follow-ups. The evaluation of the SIR improvement revealed significantly higher values for Group I during the second-year follow-up (p value: 0.003).The auditory performance and speech production skills of the children with ANSD improved significantly after cochlear implantation, and this improvement was affected by age at the time of implantation.

Diffuse glioma is a primary brain tumor that originates from glial supportive cells and is the most common type of intra-axial brain tumor. Open tumor resection is the first step in the treatment of diffuse gliomas. The extent of resection (EOR) directly influences clinical outcomes in glioma surgery. However, resection of diffuse glioma is encountered with the problem of macroscopic and even microscopic similarity of normal brain and tumor. Furthermore, maximizing EOR requires attention because a mistake in identifying and preserving normal brain regions in complete resection can lead to catastrophic complications.

This multicenter study evaluated the auditory performance and speech production outcomes of cochlear implantation in children with inner ear anomaly and compared the outcomes of patients with different kinds of malformation.Cochlear implantation was performed in 107 children with inner ear malformation at four tertiary academic centers. The categories of auditory performance (CAP) and speech intelligibility rating (SIR) scores were evaluated preoperatively and one year and two years postoperatively.Types of inner ear malformation and their frequencies were: incomplete partition type-I, 19 (17.8%) patients; incomplete partition type-II, 31 (29%), common cavity, 17 (15.9%), cochlear hypoplasia, 17 (15.9%), and isolated enlarged vestibular aqueduct (isolated EVA), 23 (21.5%) patients. EVA was the coexisting anomaly in 27(25.2%) subjects. The median CAP and SIR scores improved significantly during the first two years after cochlear implantation in all groups (p-values0.001 and 0.001, respectively). No significant difference was seen in CAP and SIR scores of children with different inner ear malformations (p-value = 0.147 and 0.570, respectively) or in patients with isolated EVA compared to coexisting EVA (p-value = 0.538 and 0.075, respectively).The median CAP and SIR scores two years after surgery were 5 (Understanding of common phrases without lip-reading) IQR: 4-6, and 3 (Connected speech is intelligible to a listener who concentrates and lip-reads within a known context) IQR: 3-4, respectively. Auditory performance and speech production were significantly improved in all inner ear malformation patient groups, and no significant difference was observed between the scores of patients with different types of anomaly.

Background: Introduction of the novel imaging modalities such as optical coherence tomography and scanning laser optical tomography allow the morphological and functional evaluation of the intracochlear structures up to the histological details. The prerequisite of these modalities is the preparation of the membranous labyrinth by removing the dense otic capsule to enhance the optical penetration depth. In the present study, a combination of the chemical decalcification and bone drilling method was explained for the preparation of the human inner ear structures for further studies. Methods: In this study, nine human temporal bones were used and trimmed in cubes containing middle and inner ear structures. The samples were immersed in 5% nitric acid, 20% EDTA, and 10% EDTA solutions, respectively. The samples were brought out and rinsed every 90 minutes, and mechanical removal of the softened bone was performed with surgical drill system until the complete decalcification of the samples was confirmed by X-ray imaging. The prepared samples were evaluated by microcomputed tomography imaging for anatomical distortions caused by the preparation process. Results: Complete decalcification and preparation of the samples were obtained in average of 10.5 ± 0.5 hours. No obvious morphological changes were observed in microcomputed tomography images, except for fracture of the remnant bony shell at the apex of cochlea in one sample. Conclusions: The combination of the chemical decalcification and mechanical removal of the softened bone can accelerate the sample preparation for high resolution imaging studies without significant morphological changes.

This study was conducted to evaluate the effect of the round window membrane accessibility on the residual hearing after cochlear implantation surgery in adults. Moreover, the effects of the other demographics and intra-operative factors on the residual hearing loss have been evaluated. The hearing preservation cochlear implantation surgery was performed on 64 adults with residual hearing thresholds ≤80 dB at 250 and 500 Hz, who had referred to our tertiary academic center. All the patients underwent a standardized surgical approach with the same straight electrode inserted through the round window membrane. The hearing thresholds at 250, 500, and 1000 Hz were compared in pre-operative and 1 month postoperative pure-tone audiograms. The average hearing threshold shifts at these frequencies was used to evaluate the hearing preservation. The effects of the round window accessibility and other factors (including gender, age, side of the surgery, necessity of anterior-inferior drilling of the round window margin and average insertion speed) on hearing threshold shifts were analyzed. The mean low-frequency hearing threshold shift was found to be 17.5 dB for all the patients. The hearing preservation goal (threshold shifts ≤30 dB) was achieved in 58 patients. Among the evaluated parameters, only accessibility of the round window membrane could change the hearing threshold shifts significantly (p = 0.026), and was a predictor for the hearing loss (B coefficient = 7.5, p = 0.006). Incomplete accessibility of the round window membrane may be a predictor for increased hearing threshold shifts in short-term evaluations after cochlear implantation.

The aim of the study was to evaluate insertion forces during manual insertion of a straight atraumatic electrode in human temporal bones, and post-implantation histologic evaluation of the samples to determine whether violation of intracochlear structures is related to insertion forces. In order to minimize intracochlear trauma and preserve residual hearing during cochlear implantation, knowledge of the insertion forces is necessary. Ten fresh frozen human temporal bones were prepared with canal wall down mastoidectomy. All samples were mounted on a one-axis force sensor. Insertion of a 16-mm straight atraumatic electrode was performed from different angles to induce “traumatic” insertion. Histologic evaluation was performed in order to evaluate intracochlear trauma. In 4 of 10 samples, dislocation of the electrode into scala vestibuli was observed. The mean insertion force for all 10 procedures was 0.003 ± 0.005 N. Insertion forces measured around the site of dislocation to scala vestibuli in 3 of 4 samples were significantly higher than insertion forces at the same location of the cochleae measured in samples without trauma (p

Incomplete repair of the dura mater may result in numerous complications such as cerebrospinal fluid leakage and meningitis. For this reason, accurate repair of the dura mater is essential. In this study, the effect of systemic and local supplementation of l-arginine on dural healing was evaluated.Thirty male Wistar rats were used and divided into control, local, and systemic l-arginine groups, with 10 rats in each. In each group, a 5-mm experimental incision was made at the lumbar segment of the dura mater and cerebrospinal fluid leakage was induced. Each group was divided into 2 subgroups and at the end of the first and sixth weeks, the rats were killed and the damaged segments of the dura were separated, histologically evaluated and the dural healing indicators including cell types, granulation tissue formation, collagen deposit, and vascularization were compared between groups.The systematic supplementation of l-arginine showed a significant effect in dural healing compared with the control group. After the first week, granulation formation increased considerably (P0.031), and after 6 weeks, collagen deposition and neovascularization were significantly different compared with the control group (P 0.030; P0.009). In comparison between different groups at the end of the first and sixth weeks, maximum changes in healing indicators were observed in the systemic group and the least variations were related to the control group.The systemic supplementation of l-arginine may accelerate dural healing by increasing the level of granulation tissue formation, collagen deposition, and vascularization.