Search

Objective: To examine the complication rate in adult patients during and after cochlear implantation. Methods: A retrospective chart review was conducted of patients who had undergone cochlear implantation at a tertiary referral centre between 2009 and 2018. All complications and their treatments were categorised as either minor or major, as well as intra- or post-operative. Results: The records of 392 patients with 395 implants were reviewed. The mean follow-up period was 89 ± 65.5 months (range, 6–408 months). The mean age of patients was 46 ± 15.2 years (range, 19–84 years). Sixty-two patients (16 per cent) had minor complications and 31 (8 per cent) had major complications. Conclusion: Although cochlear implantation has the potential for significant intra- and post-operative complications, the actual complication rate is relatively low, and it can therefore be considered a safe procedure. [ABSTRACT FROM AUTHOR]

Hearing loss that arises from various causes at different stages of life has a direct impact on individuals' physical and mental well-being. This paper aimed to evaluate the employment, workplace adaptation, productivity, and professional success of individuals who have hearing loss and whose hearing loss is corrected with a cochlear implant. In this cross-sectional study, data were collected between November 2022 and March 2023 with the participation of individuals with cochlear implants living in several settlements in all regions of Türkiye. A total of 142 participants with severe hearing loss who were corrected with a cochlear implant were included in this study. The survey method was used to collect data for the study. The questionnaire consisted of 32 questions and was distributed to the participants online. In the first part of the questionnaire (questions 1-10), the general characteristics of implant patients were investigated. In the second part (questions 11-32), the positive or negative effects of implantation on the work lives of the participants were evaluated. Almost half of the research group (49.3%, n = 70) consisted of women, and the mean age of the participants was determined to be 35.8 ± 14.8 years. There was no significant difference between gender, educational status, implanted side, working time, working style (physical, desk), and factors affecting work life ( p > 0.05). Professional satisfaction and success at work increased significantly more in those with acquired hearing loss ( p = 0.010). Post-implantation workplace compliance, success, and productivity were found to be higher in those with acquired hearing loss ( p = 0.013). Hearing loss had a significantly less negative impact on work performance in those implanted in childhood than in those implanted in adulthood ( p = 0.043). It was observed that hearing loss had a greater negative impact on the work life of married people ( p = 0.006). Cochlear implantation greatly enhances workplace satisfaction, increases self-confidence, and has a positive impact on the future of profoundly deaf individuals.

Background: It is aimed to investigate the incidence of cerebrospinal fluid gusher in cochlear implantation and the association between cerebrospinal fluid gusher and inner-ear malformations in adult and pediatric patients., Methods: A retrospective case review of 1025 primary cochlear implantation procedures was performed. Patients with inner-ear malformation or cerebrospinal fluid gusher during primary cochlear implantation were included and divided into 2 groups according to age: pediatric and adult groups., Results: The incidence of inner-ear malformation was 4.19% (17/405) and 7.6% (47/620) in the adult and pediatric groups, respectively. There was a significant difference in the incidence of inner-ear malformation in the pediatric group. The incidence of cerebrospinal fluid gusher was 0.9% (4/405) and 4.1% (26/620) in the adult and pediatric groups, respectively. There was a significant difference in the incidence of gusher between the adult and pediatric groups., Conclusion: The incidence of a cerebrospinal fluid gusher is higher in the pediatric group, compared to adults due to a higher rate of inner-ear malformation. Inner-ear malformation poses a risk factor for cerebrospinal fluid gusher.

Abstract: We aimed to evaluate whether the nasal septum deviation affects the development of sinonasal structures. Patients who had undergone paranasal sinus computed tomography (PNS-CT) imaging due to nasal obstruction were divided into 3 groups according to the septal deviation angle; group I: 0° to 9°, group II: 10° to 15°, and group III: >15°. The features of sinonasal structures were recorded when evaluating PNS-CT. There were totally 234 patients, 119 patients in group I, 68 in group II, and 47 in group III. On the opposite side of the deviation, keros 3 was significantly more in group III ( P < 0.001). Although the incidence of concha bullosa and agger nasi cell were not affected by the degree of deviation ( P > 0.05), the incidence of Haller and Onodi cells were significantly higher in group III ( P < 0.001). In addition, all cells were observed more in the opposite side of the deviation in each group ( P < 0.001). Maxillary sinus retention cysts and hypoplasia of maxillary and frontal sinuses, as an indicator of the low pneumatization of the sinuses, are seen more on the same side of nasal septum deviation, increasing with the degree of deviation increases ( P < 0.001). Nasal septum deviation affects the development of sinonasal structures by affecting the pneumatization. Preoperative PNS-CT evaluation is important in order to be aware of the situations that we may encounter during surgery and to provide adequate treatment., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by Mutaz B. Habal, MD.)

Background: The aim of this study was to evaluate the surgical and auditory outcomes of cochlear implantation in patients with cochlear ossification., Methods: This study comprised 54 patients with cochlear ossification who underwent cochlear implantation in the cochlear implant center of a tertiary care hospital between January 1998 and May 2019. Clinical data were evaluated including surgical findings and audiological performances. The auditory outcomes of the implanted patients were assessed through the Categories of Auditory Performance-II test and Speech Intelligibility Rating test, respectively. The outcomes of patients with cochlear ossification were compared with those of 54 patients selected for the control group who underwent implantation with no cochlear ossification., Results: Auditory outcomes were comparable between the study group and the control group. The control group obtained significantly higher scores than those of the study group when compared using the Categories of Auditory Performance-II test and Speech Intelligibility Rating test batteries. Patients with meningitis produced poorer outcomes within the group comparisons of the study group. None of the patients experienced surgical complications. The extent of ossification was analyzed in terms of its effectiveness on audiological performance. Patients with complete ossification had significantly lower Categories of Auditory Performance-II and Speech Intelligibility Rating test scores., Conclusion: Cochlear implantation is a safe and beneficial procedure, even in patients with cochlear ossification. The ossified cochlea may require varied drill techniques beyond traditional implantation surgery for the insertion of the electrode array. It is, however, still difficult to predict audiological outcomes in patients with cochlear ossification.

Background: Patients' satisfaction with the device is as important as the audiological gains in patients using these devices., Objective: In this study, we aimed to evaluate the hearing aid satisfaction of individuals using The Vibrant Sound Bridge (VSB) (Vibrant Med-El, Innsbruck, Austria) and to compare this result with audiologic results ​​with and without devices., Material and Methods: Patients who were using VSB were included in the study. Preoperative and postoperative pure tone averages and demographic datas of the patients to be included in the study were recorded. A shortened version of Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, was used to evaluate patients' device satisfaction., Results: Fifteen patients with VSB were included in the study. The mean follow-up was 9.13 years. The preoperative air conduction threshold and the air-bone gap in all frequencies were significantly higher than postoperative values ( p  < .05). The functional gain was found as 28 dB. In the APHAB questionnaire, there was a significant difference between total score results and EC, BN, RV subscales in the patients using the device ( p  < .01)., Conclusion and Significance: Patients with VSB give satisfactory results in auditory gains. In particular, good indication and long-term use of the device increases the suitability and satisfaction of the patients.

Background/aim: To emphasize the role of cochlear implantation (CI) in the auditory rehabilitation of patients with otosclerosis (OS) and share our surgical experiences on this rare group of patients., Materials and Methods: Retrospective analysis of the patients who have a diagnosis of otosclerosis and implanted between January 1998–May 2019 was performed. Preoperative and postoperative clinical, radiological, audiological and surgical findings are presented., Results: Among 2195 patients who have been implanted in our institution, 12 (0.54%) met the diagnostic criteria of OS according to their preoperative (clinical, radiological, audiological) and peroperative (surgical) findings. Electrode insertion was performed via “round window membrane and cochleostomy” in 8 and 4 patients, respectively. No major complications occured. All patients showed satisfactory performances by means of audiometric scores postoperatively. Nonauditory stimulation (NAS) which manifested as “facial twitching” was a challenging problem in one patient during the surgery and subsided after the operation., Conclusion: Our experience on CI in patients with OS revealed that the implantation was a relatively safe procedure and had satisfactory impact on audiological performances., Competing Interests: The authors declare no conflict of interest., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Objectives: The aim of this study is to evaluate the quality of life in pediatric patients with auditory neuropathy according to the perspective of their parents after cochlear implantation., Materials and Methods: The pediatric patients, who underwent cochlear implantation with the diagnosis of auditory neuropathy at İzmir Bozyaka Training and Research Hospital ENT Clinic between January 1997 and May 2017, were included to the study. "Parents' Perspective Questionnaire" developed by Nottingham Pediatric Cochlear Implant Programme was used in the study. The questionnaire was composed of 11 subscales and 58 questions in total., Results: The study included 26 pediatric patients (14 female, 12 male) who used cochlear implant for at least 1 year. The mean age of patients was 10.91±3.85 ( 4.3-17.3 years old) and implantation age varied between 14 months and 80 months. (median; 35.65±20.03 months). Patients who attended school had more self-confidence, and also those having implant use over 6 years had a better self confidence and social relationship., Conclusion: Cochlear implantation not only improves the ability of hearing but also provides development of speech and language skills and therefore enhancing the patient's quality of life. From the perspective of parents, the use of cochlear implant in the children with auditory neuropathy improves the quality of life in many different ways. The perspective of parents can provide a multidimensional evaluation about the child's progress, therefore, ıt should be taken into consideration by the staff in implant centers.

Silastic magnet casing tear of cochlear implant (CI) due to magnetic resonance imaging (MRI) is an uncommon complication. We report repair of a case with magnet dislocation due to MRI-induced silastic casing tear without re-implantation. We believe that this repair method, which has not been previously defined in the literature, will be interesting and guiding., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose: The aim of this study was to evaluate the long-term anatomical and frequency-specific hearing results of canal wall down (CWD) and canal wall up (CWU) mastoidectomy by retrograde mastoidectomy (RM) surgical method., Materials and Methods: Patients underwent CWU and CWD procedures with method of RM, 53 and 59 patients between January 2010 and June 2015 were evaluated retrospectively. The pre- and post-operative pure tone average air-bone gap (ABG) values of these patients were recorded in detail at 0.5, 1, 2 and 4 kHz. Pre and post-operative ABG were evaluated in detail in each group in each frequency. In addition, at least two years follow-up recurrence rates were evaluated., Results: In the CWU method, post-operative ABG decreased significantly at low-frequencies compared to pre-operative ABG (p < 0.05), especially at 2 kHz (p < 0.001). But, auditory improvement was not achieved at 4 kHz. In the CWD procedure, auditory improvement was not achieved both 1 kHz and 4 kHz. CWU and CWD recurrence rates were respectively 9.4% and 10.1%., Conclusion: Postoperative hearing results of both surgical methods provide good auditory outcome at low-frequencies. This improvement is evident in CWU especially at 2 kHz. This may be related to the protection of the external ear canal. In both surgical methods of RM, a satisfactory anatomical success was achieved with recurrence rates of around 10%. RM is a good surgical technique alternative to classical canal wall down procedure with both auditory results and low recurrence rates., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: Topical treatment is first choice in the treatment of uncomplicated chronic otitis media. It was intended to assess auditory and histopathological safety of ototopical use of mercurochrome solution in rats with induced tympanic membrane perforation., Materials and Methods: The study was conducted on 21 female Wistar-Albino rats which were randomly assigned into 3 groups. In all rats, perforation was performed at right tympanic membrane. Distortion product otoacoustic emissions (DPOAEs) measurements were performed at frequencies of 2000, 3000 and 4000 Hz (with L1/L2: 70 /70 dB at 2f1-f2 frequency; f2/f1 ratio: 1:22) before recovery from anesthesia and signal-to-noise ratio (SNR) were recorded. Normal saline, 2% mercurochrome and gentamicin were given to group 1, 2 and 3 twice daily over a week, respectively. Rats were sacrificed after DPOAE measurements on day 14. Right temporal bone specimens were examined under light microscope after processing., Results: Based on DPOAE results, there was no significant difference among groups before treatment. On day 14, significant differences were found in DPOAE measurements at 3000 and 4000 Hz, and in mean SNR values in 2% mercurochrome and gentamicin groups when compared to normal saline group while no significant difference was detected at 2000 Hz among groups. In addition, significant degeneration was detected in Corti organs, spiral ganglions and stria vascularis in groups 2 and 3., Conclusion: In this study, it was observed that mercurochrome use in external otitis and otitis media with tympanic membrane perforation could cause ototoxicity and concluded that the solution should be used cautiously.

Purpose: The aim of the present study was to evaluate the effect of acetyl-l-carnitine (ALC) and N-acetyl cysteine (NAC) on ionizing radiation (IR)-induced cytotoxicity and change in DNA damage-related genes in House Ear Institute-Organ of Corti 1 (HEI-OC1) cells., Methods: HEI-OC1 cells were irradiated with 5 Gy radiation and treated by eight combinations of NAC and/or ALC: control, NAC, ALC, IR, NAC + IR, ALC + NAC, ALC + IR, and ALC + NAC + IR. Cell viability, apoptotic cell death, and DNA damage were measured at the 72nd hour. Eighty-four IR-induced DNA-damage-related genes were determined by RT-PCR gene array and >10-fold changes were considered significant., Results: IR decreased cell viability by about 50% at 72 hours of incubation. In particular, the ALC and/or NAC combination before IR protected the HEI-OC1 cells (p < .05). Single and combination treatment prior to IR led to lower apoptotic cell death (p < .05). There was a significant lower DNA damage in ALC + NAC + IR group compared to IR group (p < .05). Expressions of Brca2, Xpc, Mlh3, Rad51, Xrcc2, Hus1, Rad9a, Cdkn1a, Gadd45a which are the DNA-repair genes were found to be significantly higher in NAC + ALC + IR group than those in individual treatment of ALC or NAC., Conclusions: ALC and/or NAC treatment prior to IR led to higher cell viability and lower apoptotic cell damage compared to the IR group. The results of the study show that the ALC + NAC combination treatment inhibits DNA damage and induces DNA-repair genes to repair radiation damage, and this combination treatment is more effective against radiation-induced DNA damage than NAC or ALC therapy individually.

Objectives: The purpose of our study was to evaluate whether hydrogen peroxide and silver composition (H202-Ag) used in pool water disinfectant is ototoxic to individuals with tympanic membrane perforation., Materials and Methods: The tympanic membranes of both ears of 14 Wistar-type albino female rats were perforated. Since topical application was performed, the right and left ears were categorized as two subgroups (a: right ear, b: left ear). Baseline auditory brainstem response (ABR) was measured. The groups were classified according to topical applications performed as Ia (30 mg/L H202-Ag), Ib (saline), IIa (70 mg/L H202-Ag), and IIb (saline). The topical applications were performed for 30 min/day for 10 days. The ABR was measured 24 hours after the last application, and the animals were sacrificed. Bilateral temporal bones were examined using light microscopy., Results: An apparent rise in the hearing thresholds of the groups Ia and Ib was not observed. However, there was an apparent rise in the hearing thresholds of the group IIa, which supports ototoxicity. According to histopathology results, there weren't any pathological findings in groups Ia and Ib and did not display special features, but a neurotoxic effect was observed in group II., Conclusion: Our study shows that the H202-Ag used in pool water disinfection can have ototoxic and neurotoxic effects, particularly at high concentrations.

Objective: The aim of this study was to investigate functional results of total ossicular replacement prosthesis (TORP) shaft stabilization with a cartilage shoe in chronic otitis media patients with cholesteatoma who had undergone canal wall down tympanomastoidectomy (CWDT). In addition, it was determined whether the presence of granular and edematous mucosa in middle ear altered functional outcomes., Methods: Sixty patients, who had undergone CWDT with the use of TORP for the reconstruction of ossicular chain, were divided into two groups. Patients with cartilage shoe were classified as Group 1 (n=30) and those without the shoe were classified as Group 2 (n=30). Patients in both groups were classified into "A" and "B" subgroups according to the middle ear risk index (MERI). Air conduction (AC) and bone conduction thresholds were evaluated preoperatively and postoperatively., Results: There was no statistically significant change between preoperative AC thresholds of the groups and subgroups (p>0.05). There were statistically significant differences regarding AC thresholds and air-bone gap (ABG) values between Groups 1 and 2 at the postoperative 12th month (p<0.05). Postoperative AC thresholds and ABG values of Group 1B patients with a high MERI score were statistically significant at all frequencies than those of Group 2B patients (p<0.05). When ABG values were compared, it was observed that functional results were better in Group 1B, but a statistically significant difference was observed only at 2000 Hz (p<0.01)., Conclusion: The cartilage shoe method for titanium TORP stabilization that is used for ossicular reconstruction during CWDT has been found to have a beneficial effect on auditory outcomes. Cartilage shoe application increases positive effects on hearing outcomes, particularly if the middle ear mucosa is granular and edematous., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare.

Purpose: The aim of this study is to evaluate long-term outcomes of cochlear implantation (CI) in patients with postmeningitic deafness., Methods: Twenty-seven patients with severe to profound hearing loss due to bacterial meningitis and received CI were the subjects of this study. Surgical findings and long-term audiological performances were evaluated. Speech perception and speech intelligibility of the implanted patients were evaluated with the categories of auditory performance-II (CAP-II) test and speech intelligibility rating (SIR) test, respectively., Results: Eighteen of the 27 patients had received full electrode insertion through the patent cochlear lumen. Remaining 9 patients had varying degrees of ossification throughout the cochlea and needed to be drilled to achieve partial electrode insertion. None of the patients exhibited surgical complication. Scores in both test batteries (CAP-II and SIR) were comparable between patients who received full or partial electrode insertion (P > 0.05)., Conclusion: Cochlear implantation after postmeningitic deafness has favorable outcomes especially in long term. Although this type of inner ear pathology may require special considerations during surgery, it is a relatively safe procedure.

Objectives: The aim of this study is to investigate the efficacy of locally applied insulin-like growth factor 1 (IGF-1) on the recovery of facial nerve functions after crush injury in a rabbit model., Methods: The rabbits were randomly assigned into three groups. Group 1 consisted of the rabbits with crush injury alone; group 2, the animals applied saline solution onto the crushed facial nerve and group 3, IGF-1 implemented to the nerve in the same manner. Facial nerve injury was first electrophysiologically studied on 10th and 42nd days of the procedure. The damage to the facial nerves was then investigated histopathologically, after sacrification of the animals., Results: In the electrophysiological study, compound muscle action potential amplitudes of the crushed nerves in the second group were decreased. In pathological specimens of the first and second groups, the orders of axons were distorted; demyelination and proliferation of Schwann cells were observed. However, in IGF-1 treated group axonal order and myelin were preserved, and Schwann cell proliferation was close to normal (P<0.05)., Conclusion: Local application of IGF-1 in a slow releasing gel was found efficacious in the recovery of the facial nerve crush injury in rabbits. IGF-1 was considered worthy of being tried in clinical studies in facial nerve injury cases.

Objectives: The genetics of sensorineural hearing loss is characterized by a high degree of heterogeneity. Despite this heterogeneity, DNA variants found within SLC26A4 have been reported to be the second most common contributor after those of GJB2 in many populations., Methods: Whole exome sequencing and/or Sanger sequencing of SLC26A4 in 117 individuals with sensorineural hearing loss with or without inner ear anomalies but not with goiter from Turkey, Iran, and Mexico were performed., Results: We identified 27 unique SLC26A4 variants in 31 probands. The variants c.1673A > G (p.N558S), c.1708-1G > A, c.1952C > T (p.P651L), and c.2090-1G > A have not been previously reported. The p.N558S variant was detected in two unrelated Mexican families., Conclusion: A range of SLC26A4 variants without a common recurrent mutation underlies SLC26A4-related hearing loss in Turkey, Iran, and Mexico., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: The aim of this study was to present the surgical findings of children with Waardenburg syndrome (WS) and investigate speech development after cochlear implantation in this unique group of patients., Materials and Methods: A retrospective chart review of the patients diagnosed with WS and implanted between 1998 and 2015 was performed. Categories of auditory performance (CAP) test were used to assess the auditory skills of these patients. CAP is a nonlinear hierarchical scale used to rate a child's developing auditory abilities. Preoperative test results and intraoperative surgical findings of these patients have been presented., Results: In total, 1835 cases were implanted a tour institution, and 1210 of these were children. Among these implantees, 11 were diagnosed with WS (0.59% of all implantees). Four of the 11 patients showed incomplete partition type 2bony labyrinth abnormality (Mondini deformity) and all patients showed intraoperative gusher during cochleostomy, which was subsided through routine interventions. No other complications occurred during surgery, and all patients showed satisfactory CAP results in the late postoperative period., Conclusion: Our experiences with cochlear implantation in patients with WS showed that the procedure is safe and effective in this group of patients. Surgeons should be aware of possible labyrinth malformations and intraoperative problems such as gusher in these patients. In long term, auditory performances may exhibit satisfactory results with optimal postoperative educational and supportive measures.

Conclusions: The proposed INCAV system standardizes reporting of inner ear malformations; gives adequate information about the structures of inner ear; defines the ears which could not be classified before; and helps in the selection of the ear as the cochlear implant candidate. Also it is easy-to-use for radiologists, and useful to the referring otolaryngologists., Objective: This study was conducted to explore a more specific, definitive classification system which was based on radiological criteria for inner ear malformations., Method: This study found 43 patients who had inner ear malformations, magnetic resonance (MR), and computed tomography (CT) imaging, together with the retrospective evaluation of the medical records between August 2010 and February 2015. It analyzed inner ear structures by dividing five sub-groups and each sub-group was given a letter: internal acoustic canal (I), cochlear nerve (N), cochlea (C), vestibular aqueduct (A) and vestibule (V). Based on their malformations, these anatomical structures have been assigned grades and have been classified by using increasing numbers which were dependent to increasing order of severity of the malformation., Results: Among these 43 patients, there were six normal (I 0 N 0 C 0 A 0 V 0 ) and 80 inner ear malformations. All of the ears were defined successfully by the INCAV system.

The aim of this study was to investigate speech and language development after long-term cochlear implantation in children with bony labyrinth malformations (BLMs) and to present the surgical findings in this group of patients. The auditory and linguistic skills of 21 children who had BLM were assessed in this study. They were implanted between 1998 and 2009. Twenty-two sex-matched and age-matched implantees without BLM were evaluated as the control group. To compare speech perception and speech intelligibility between the groups, the categories of auditory performance (CAP) test and speech intelligibility rating (SIR) test, respectively, were administered. The Turkish version of the Test of Early Language Development (TELD-3-T) was administered to evaluate and compare the linguistic skills of the groups. Surgical findings and complications were also analyzed. Implanted anomalies were common cavity in five patients, incomplete partition type 1 in 5 patients, and incomplete partition type 2 in 11 patients. The CAP and SIR scores were significantly higher in the control group (p < 0.05), but the TELD-3-T test scores were comparable among the groups (p > 0.05). Based on the specific type of malformation, the CAP and SIR scores were comparable between the subgroups (p > 0.05). No perioperative complications occurred in the control group. However, various perioperative complications (gusher, etc.) and surgical difficulty occurred in the anomaly group. The malformation group had unsatisfactory results with regard to speech perception skills; however, this group and the non-anomalous group exhibited comparable long-term results on linguistic development.

Objective: In this retrospective review, we aimed to determine the most appropriate management of the complication of late swelling around the implant body following cochlear implantation., Methods: The medical records of 516 patients who underwent cochlear implantation between January 2008 and June 2013 were reviewed for a history of swelling around the implant body. RESULTS; Of the 516 patients, 16 (8 males and 8 females) had a history of swelling around the implant body following implantation. The onset of swelling was from 1 to 60 months (median 21.2 months) after implantation. Three of the 16 patients had a history of manifest trauma to the head, and the remaining 13 had experienced an upper respiratory tract infection just before the swelling arose. Discussion In the light of our clinical experiences, we may suggest that late swelling around the implant body seems associated with a manifest or hidden head trauma or upper respiratory tract infections., Conclusion: After the initial assessment of swelling, surgeons should be aware of the possibility of abscess formation. As a general rule, any kind of pus collection should be drained surgically. However, in the case of pus collection without abscess formation, conservative measurements can often achieve satisfactory results.

Objectives: This study aims to investigate the prevalence of myringosclerosis in tragal perichondrium (TP) and temporalis fascia (TF) grafts after myringo-/tympanoplasty., Patients and Methods: Thirty patients, who were diagnosed with non-suppurative chronic otitis media and administered myringo-/tympanoplasty under general anesthesia using TP or TF as grafting material in our clinic between January 2012 and May 2013, were recruited in this retrospective case-control study. Patients were divided into two groups according to used graft material as group 1 (TP) (9 males, 6 females; median age 35.4 years; range 20 to 62 years) and group 2 (TF) (7 males, 8 females; median age 39.8 years; range 19 to 63 years). Occurrence of myringosclerosis on the intact tympanic membrane grafts was evaluated postoperatively by the same surgeon under surgical microscope., Results: Postoperative myringosclerosis was detected in six patients (40%) in TP group and 13 patients (86.7%) in TF group., Conclusion: Prevalence of myringosclerosis on graft materials used in myringo-/tympanoplasty was lower in TP group compared to TF group. We believe that this may be due to different vascular structures of different graft tissues and that the low predisposition of perichondrium towards development of myringosclerosis can be considered as an advantage for this graft. We hope that this study adds a new dimension to etiopathogenesis of myringosclerosis and assists otologists in the prevention and treatment of this lesion.

Objective: In this study causes, risk factors, prevention strategies, diffuculties encountered during revision cochlear implant surgery, reimplantation in pediatric age group were evaluated., Methods: Charts of 957 CI patients younger than 18 years of age implanted at Izmir Bozyaka Teaching and Research Hospital between 1998 and July 2012 and 18 referred CI complications at same age group were retrospectively evaluated. Revision and reimplantation surgeries were systematically reviewed., Results: We encountered 26 surgical complications in 24 patients and 36 device related problems in 36 patients. Eighteen referred cases including 7 surgical complications and 11 device related problems were also evaluated. A total number of 80 complications were evaluated. In 11 cases conservative management was successful, 19 revision surgery was performed but we failed in 4 cases. We reimplanted 48 cases and 4 additional cases were implanted after failed revision surgery. Implant was extracted in one case. In one case we could implant the other side. Forty-six of reimplantations were done in one stage surgery, 5 cases required second stage surgery., Conclusions: Surgical complications and device related problems of cochlear implantation may be different in children and majority of them require revision surgery or reimplantation. Although surgical problems leading to revision surgery and reimplantation are expected to diminish by experience every center has to deal with device failures. Both revision surgery and reimplantation require extra care and it should be better carried out by experienced surgeons. Implant performances are expected to be comparable with primary implantations., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: This study aims to assess the usefulness of the LittlEARS(®) Auditory Questionnaire (LEAQ) in determining the audiological development of Turkish children who have received a cochlear implant., Methods: 20 children received a cochlear implant before their 3rd birthday. Each child's progress was evaluated with the LittlEARS(®) Auditory Questionnaire at first device fitting and then at 3-month intervals for 2 years. Scores were compared with the age-related norms established by hearing children., Results: All children showed a significant increase in LittlEARS(®) Auditory Questionnaire scores over time. Nearly all children showed a growth in auditory skills similar to that of hearing children. Children without additional needs showed more development than did children with additional needs., Conclusions: The LittlEARS(®) Auditory Questionnaire is useful for monitoring the audiological development of young children with a cochlear implant. Confirmation that a cochlear implant user is achieving typical auditory milestones serves to boost parental morale during a child's pre-verbal stage when parents may be anxious about their child's ability to talk. The questionnaire could also be useful as an early warning system. Poor scores likely indicate that something is impeding the child's development. This should prompt professionals to try to identify the impediment, whether technical, medical, social or educational and, possibly, eliminate/mitigate its effects while the child is still in his/her critical development stages., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objectives: The aims of this study were to collect data on electrically evoked compound action potential (eCAP) and electrically evoked stapedius reflex thresholds (eSRT) in HiResolution(TM) cochlear implant (CI) users, and to explore the relationships between these objective measures and behavioural measures of comfort levels (M-levels)., Methods: A prospective study on newly implanted subjects was designed. The eCAP was measured intra-operatively and at first fitting through neural response imaging (NRI), using the SoundWave(TM) fitting software. The eSRT was measured intra-operatively by visual monitoring of the stapes, using both single-electrode stimulation and speech bursts (four electrodes stimulated at the same time). Measures of M-levels were performed according to standard clinical practice and collected at first fitting, 3 and 6 months of CI use., Results: One hundred seventeen subjects from 14 centres, all implanted unilaterally with a HiResolution CII Bionic Ear(®) or HiRes 90K(®), were included in the study. Speech burst stimulation elicited a significantly higher eSRT success rate than single-electrode stimulation, 84 vs. 64% respectively. The NRI success rate was 81% intra-operatively, significantly increasing to 96% after 6 months. Fitting guidelines were defined on the basis of a single NRI measurement. Correlations, analysis of variance, and multiple regression analysis were applied to generate a predictive model for the M-levels., Discussion: Useful insights were produced into the behaviour of objective measures according to time, electrode location, and fitting parameters. They may usefully assist in programming the CI when no reliable feedback is obtained through standard behavioural procedures.

Objectives: Surgery for otosclerosis has a highly satisfactory hearing outcome, for both the patient and the otologic surgeon. However, subsequent conductive hearing loss, dizziness/vertigo, or sound distortion could necessitate revision surgery. The aim of the present study is to evaluate the surgical findings and hearing outcomes of 84 revision stapes surgeries., Study Design: Case series with chart review., Setting: Tertiary referral center., Subjects and Methods: At our institution, 84 revision cases were performed between 1998 and 2009. Conductive hearing loss was the revision indication in 69 cases, severe dizziness/vertigo in 8 patients, sound distortion in 5 cases, and progressive hearing loss with dizziness in 2 patients. Operative findings were noted in every case and evaluated separately., Results: Surgical intervention revealed problems related to prosthesis in 51 cases, fibrotic bands in 26 cases, adhesions in 13 cases, incus necrosis in 15 cases, perilymphatic fistula in 3 cases, intact footplate in 5 cases, incus-malleus fixation in 2 cases, and reobliteration in 2 cases. Mean follow-up period was 19 months (range, 12-53 months). Successful hearing results (air-bone gap <10 dB) were reached in 58% of the cases, and satisfactory hearing results (air-bone gap <20 dB) were reached in 71% of the cases., Conclusions: The ideal patient for revision stapes surgery is one who benefits from the initial surgery but complained of conductive hearing loss. In the present study, improvement in pure-tone average was 13.2 dB, and the mean air-bone gap was 9.6 dB.

A female patient presented with globus sensation, chronic cough, and choking attacks. Endoscopic examination showed lingual tonsillar hypertrophy. Partial lingual tonsillectomy was planned. Surgery was performed under local anesthesia in the sitting position, with the use of the microdebrider under the guidance of an endoscope. The operation was accomplished with minimal bleeding. Surgery was very comfortable and easy for both the patient and the surgeon. The microdebrider was found to be effective and useful in the management of lingual tonsillar hypertrophy.

Objective: To study over time correlations between Compound Action Potential measured through Neural Response Imaging (NRI) and electrically Evoked Stapedius Reflex Thresholds (eSRT) and psychophysical measurements to develop guidelines for using those objective measures to optimize HiRes programs in patients implanted with Advanced Bionics CII-Bionic Ear or a HiRes90K cochlear implants., Patients: Fifteen pediatric subjects, all implanted with a CII-Bionic Ear or a HiRes90K., Interventions: NRI was measured on 4 electrodes intraoperatively at first fitting and after 3, 6, and 12 months of use. eSRT recordings were performed intraoperatively with SoundWave speech bursts. Subjects were fitted using the SoundWave defaults. Relationships between NRI thresholds (tNRI), eSRT, and most comfortable levels (M) are presented., Main Outcome Measures: Intraoperative eSRT, and intraoperative and postoperative tNRI at each fitting session. Auditory performance measured by Categories of Auditory Performance and Meaningful Auditory Integration Scale., Results: First fitting Ms are 97% of intraoperative tNRI; stable Ms (12 months of implant use) are equal to 115% of 12 months' tNRI and to 76% of intraoperative eSRT on average across the electrode array with great intersubject variability., Conclusion: The results show that single-channel tNRI and eSRT values can be clinically useful for programming cochlear implants in children, although this should be done with caution as there is considerable interpatient variability.

Objectives: The effect of cochlear implantation on voice development in prelingually deaf children was investigated., Patients and Methods: The study included 60 prelingually deaf children (28 girls, 32 boys; mean age 68 months; range 37 to 128 months) who underwent cochlear implantation. Voice analyses were made between 6 to 21 months after the first fitting and six months after the baseline. The patients were divided into two groups (i) according to age (younger or older than 48 months) and (ii) to the duration of implant use (more or less than 18 months) to observe the changes in fundamental frequency (F(0)), and two formant frequencies (F(1) and F(2)). Forty-seven children (22 girls, 25 boys; mean age 62 months; range 38 to 118 months) with normal speech and language development comprised the control group. In all the cases, F(0), F(1), and F(2) values of the vowel /a/ were studied., Results: In the patient group, F(0) and F(2) values significantly differed between the first and second voice analyses, whereas the change in F(1) values was insignificant. No significant differences were found in terms of F(0), F(1) and F(2) values between the patients younger than 48 months and age-matched controls; however, F(0) and F(1) values significantly differed in those older than 48 months while F(2) values remained insignificant. Albeit statistically insignificant, F(0), F(1), and F(2) values approximated normal levels in children in whom the duration of implant use exceeded 18 months., Conclusion: Our study confirms that early cochlear implantation and longer implant use result in improved development of voice, speech, and language.