Peripheral Vestibular System Involvement in Multiple Sclerosis and Associations with the Disease Severity.

INTRODUCTION: Multiple sclerosis (MS) is an autoimmune disease that can affect balance, gait, and improve fall risk. The aim of this study was to investigate peripheral vestibular system involvement in MS and associations with the disease severity. METHODS: Thirty-five adult patients with MS and 14 age- and gender-matched healthy controls were evaluated using video head impulse test (v-HIT), cervical vestibular evoked myogenic potential (c-VEMP), ocular vestibular evoked myogenic potentials (o-VEMPs), and sensory organization test (SOT) of computerized dynamic posturography (CDP). The results of both groups were compared, and association with EDSS scores was evaluated. RESULTS: There was no significant difference between the groups regarding v-HIT and c-VEMP results (p > 0.05). There was no association of the v-HIT, c-VEMP, and o-VEMP results with EDSS scores (p > 0.05). There was no significant difference between the o-VEMP results of the groups (p > 0.05) except for N1-P1 amplitudes (p = 0.01). The amplitudes of N1-P1 were significantly lower in the patients compared to controls (p = 0.01). There was no significant difference between the SOT results of the groups (p > 0.05). However, significant differences were found within and between groups when the patients were categorized according to their EDSS scores with a cutoff point of 3 (p < 0.05). There were negative correlations between the EDSS scores and composite (r = -396, p = 0.02) and somatosensory (SOM) scores (r = -487, p = 0.04) of CDP in the MS group. CONCLUSION: Although central and peripheral balance-related systems are affected in MS, the impact of disease on the peripheral vestibular end organ is subtle. In particular, the v-HIT, which was mentioned previously as a detector of brainstem dysfunction could not be a reliable tool in the detection of brainstem pathologies in MS patients. The o-VEMP amplitudes may be affected in the early stages of the disease, possibly due to the crossed ventral tegmental tract, oculomotor nuclei, or interstitial nucleus of Cajal involvements. An EDSS score >3 seems a cutoff level indicating abnormalities in balance integration.

A Non-invasive Method to Assess Tensor Tympani Muscle Contraction in Response to Tactile Stimulation.

BACKGROUND: The function of the tensor tympani muscle and its effects, as well as a universal testing procedure, is not yet known. The purpose of this study is to investigate the effect of tactile stimulation on the tensor tympani muscle activity in an attempt to evaluate the functional status of the muscle. METHODS: In this study, 20 healthy adults aged between 18 and 30 years were included. All participants had their history taken, as well as the evaluation of otoscopy, audiometry, and tympanometry. A modified reflex decay paradigm was used to evaluate the tensor tympani muscle activity, in both humans and a fresh-frozen cadaver. The tactile stimulation was applied by thumb tappings on different forehead areas. RESULTS: Reflex decay responses were in the form of the absence of a response or either a positive or negative waveform. Tactile stimulation had no impact on reflex decay recordings obtained from the cadaver. There was no significant difference between the waveforms obtained from both ears, at different stimulation frequencies, tactile stimulation areas, or the 3 successive stimuli for 1 individual in 1 ear (P > .05). Changes observed in the reflex decay test upon tactile stimulation seem to be due to tensor tympani muscle activity as supported by the previous findings in the literature. CONCLUSION: The application of a tactile stimulus on the forehead is a non-invasive test method to assess tensor tympani muscle contraction. Understanding the function of the tensor tympani muscle using a non-invasive method will be helpful during the decision-making process in the practice of otology.

Three-Corridors Procedure to Operate in the Infralabyrinthine Cervico-Jugulo-Carotico-Tympanic Area.

INTRODUCTION: The aim of the study was to present the results of our experience in three-corridors procedures applied for the tumors and inflammatory lesions of the infralabyrinthine cervico-jugulo-carotico-tympanic area. METHODS: The lesions located in the infralabyrinthine cervico-jugulo-carotico-tympanic area were operated in 13 patients using the 3-corridors technique. The anatomical and functional integrity of the external and middle ears and the facial nerve (FN) could be preserved. RESULTS: The diagnoses were glomus jugulare, infralabyrinthine petrous bone cholesteatoma, jugular foramen schwannoma, and giant-cell tumor. The follow-up duration ranged from 2 to 24 months. No tumor recurrence or growth was encountered in the follow-up. The operations were uneventful. Total surgical excision could be achieved in 10 patients. A second-stage retrosigmoid approach was performed for the total removal of the intracranial tumor remnant in two patients. A wait-and-scan policy has been considered in one patient who had partial resection for a glomus jugulare tumor. CONCLUSION: Three-corridors procedure seems to be a useful technique to operate in the infralabyrinthine, cervico-jugulo-carotico-tympanic area as it takes the advantage of hearing preservation, preservation of the anatomic and functional integrity of the external and middle ear structures as well as the FN.

Cochlear Implantation in Inner Ear Malformations: Considerations Related to Surgical Complications and Communication Skills.

INTRODUCTION: There are particular challenges in the implantation of malformed cochleae, such as in cases of facial nerve anomalies, cerebrospinal fluid (CSF) leaks, erroneous electrode insertion, or facial stimulation, and the outcomes may differ depending on the severity of the malformation. The aim of this study was to assess the impact of inner ear malformations (IEMs) on surgical complications and outcomes of cochlear implantation. METHODS: In order to assess the impact of IEMs on cochlear implant (CI) outcomes, 2 groups of patients with similar epidemiological parameters were selected from among 863 patients. Both the study group (patients with an IEM) and control group (patients with a normal inner ear) included 25 patients who received a CI and completed at least 1 year of follow-up. Auditory performance, receptive and expressive language skills, and production and use of speech were evaluated preoperatively and at least 1 year after implantation. Types of surgical complications and rates of revision surgeries were determined in each group. RESULTS: In the study group, the most common malformation was an isolated enlarged vestibular aqueduct (EVA) (44.8%). Overall, the patients with IEMs showed significant improvement in auditory-verbal skills. In general, the patients who had normal cochleae scored significantly better compared to patients with IEMs (p < 0.05). The complication rate was significantly lower in the control group compared to the study group (p = 0.001), but the rate of revision surgeries did not differ significantly (p = 0.637). CONCLUSION: It is possible to improve communication skills with CIs in patients with IEMs despite the variations in postoperative performances. Patients with EVA, incomplete partition type 2, and cochlear hypoplasia type 2 were the best performers in terms of auditory-verbal skills. Patients with IEMs scored poorly compared to patients with normal cochleae. CSF leak (gusher or oozing) was the most common complication during surgery, which is highly likely in cases of incomplete partition type 3.

Assessment of balance after recovery from Covid-19 disease.

OBJECTIVE: To answer the question whether balance related systems have been affected in adults who recovered from Covid-19 disease. This is the first case-control study to assess balance objectively and quantitatively in Covid-19 disease. METHODS: Thirty-seven patients who recovered from Covid-19 disease and 30 healthy controls were compared using Dizziness Handicap Inventory (DHI), Computerized Dynamic Posturography (CDP), Vestibular Evoked Myogenic Potentials(VEMP) and Video Head Impulse Test (v-HIT). RESULTS: On CDP, the composite and visual general scores of the patients were significantly lower than controls (p<0.01). The v-HIT gains of the patients significantly decreased in the vertical semicircular canals compared to controls (p<0.01).There was a significant difference between the patients and controls regarding the absence of o-VEMPs (p<0.01) while the amplitudes and latencies were similar between the groups (p>0.05). Decreased P1/N1 amplitudes and elongated N1 latencies were found on c-VEMP testing (p<0.05). Anosmia, taste disorder and gender were not associated with subjective and objective test results (p>0.05). CONCLUSION: The Covid-19 disease can cause dizziness rather that incapacitating vertigo. Dizziness can be seen in almost one-fifth of the adult covid19 out-patients, which may be due to involvement of vestibular and visual systems,ortheir central connections. The squeals created in the balance related systems may be irreversible as they have persisted after the recovery of the patients. It is also plausible to anticipate more severe condition in the older patients who were treated in the intensive care units. In the long term follow up of the survivors, the need for balance rehabilitation programs should be remembered in order to minimize risks of falling down.

Cochlear Implantation in Chronic Otitis Media with and without Cholesteatoma: Surgical Considerations and Auditory Outcomes.

INTRODUCTION: Cochlear implant (CI) surgery is a safe and standardized procedure in the presence of normal temporal bone anatomy. However, in the surgery of patients with chronic otitis media (COM), the surgeon may encounter several problems. The aim of this study was to evaluate the impact of COM with and without cholesteatoma on surgical and auditory outcomes of CIs. METHODS: The study group consisted of 39 patients with COM who received CIs. Age- and gender-matched 38 standard CI patients served as controls. The surgical techniques and complications, pure tone audiometry (PTA) scores, speech discrimination scores (SDS), and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire results of the groups were compared. RESULTS: The presence of COM was associated with a higher rate of complication than controls. Staging the surgeries, presence or absence of cholesteatoma, and type of surgical technique were not associated with surgical outcomes and complications (p > 0.05). There was no significant difference between the groups in terms of postoperative PTA scores, SDS, and IOI-HA scores (p > 0.05). CONCLUSION: Postoperative complications like device failure and skin breakdown are increased in cases of COM compared to standard CI surgeries. However, that increase is not associated with staging the surgeries, presence or absence of cholesteatoma, and type of ear surgery performed. It is advocated to close the external ear canal and eustachian tube without mastoid obliteration in the presence of a radical mastoidectomy cavity, which will decrease the postoperative complication rates and allow for radiological follow-up with computed tomography for the possibility of cholesteatoma recurrence. The auditory benefits of CI in patients with and without COM are comparable.

Association of Conductive Hearing Loss with the Structural Changes in the Organ of Corti.

OBJECTIVE: The aim of the study was to evaluate the association of conductive hearing loss (CHL) with the structural changes in the organ of Corti. METHODS: Twenty ears of 10 healthy adult Wistar albino rats were included in the study. The right ears (n = 10) of the animals served as controls (group 1), and no surgical intervention was performed in these ears. A tympanic membrane perforation without annulus removal was performed under operative microscope on the left ears (n = 5) in 5 of 10 animals (group 2). A tympanic membrane perforation with annulus removal was performed under operative microscope on the left ears (n = 5) of the remaining 5 animals (group 3). Auditory brainstem response testing was performed in the animals before the interventions. After 3 months, the animals were sacrificed, their temporal bones were removed, and inner ears were investigated using scanning electron microscopy (SEM). The organ of Corti was evaluated from the cochlear base to apex in the modiolar axis, and the parameters were scored semiquantitatively. RESULTS: In group 1, the pre- and post-intervention hearing thresholds were similar (p > 0.05). In group 2, a hearing decrease of at least 5 dB was encountered in all test frequencies (p > 0.05). In group 3, at the frequency range of 2-32 kHz, there was a significant hearing loss after 3 months (p < 0.01). After 3 months, the hearing thresholds in group 2 and 3 were higher than group 1 (p < 0.01). The hearing threshold in group 3 was higher than group 2 (p < 0.01). On SEM evaluation, the general cell morphology and stereocilia of the outer hair cells were preserved in all segments of the cochlea in group 1 with a mean SEM score of 0.2. There was segmental degeneration in the general cell morphology and outer hair cells in group 2 with a mean SEM score of 2.2. There was widespread degeneration in the general cell morphology and outer hair cells in group 3 with a mean SEM score of 3.2. The SEM scores of group 2 and 3 were significantly higher than group 1 (p < 0.05). The SEM scores of group 3 were significantly higher than group 2 (p < 0.05). CONCLUSION: CHL may be associated with an inner ear damage. The severity of damage appears to be associated with severity and duration of CHL. Early correction of CHL is advocated in order to reverse or prevent progression of the inner ear damage, which will enhance the success rates of hearing restoration surgeries. Subjective differences and compliance of the hearing aid users may be due to the impact of CHL on inner ear structures.

Individualized Treatment of Tinnitus during Sleep Using Combined Tinnitus Signal and Music.

INTRODUCTION: Tinnitus is a widely seen otological symptom that interferes with daily activities and causes discomfort. Tinnitus treatments can be classified into 4 main groups: pharmacological treatments, cognitive and behavioral therapy, psychological treatments, and combined treatment approaches made up of at least 2 of these 3 treatment methods. OBJECTIVE: The aim of this study was to assess whether it would be possible to develop an individualized treatment method of tinnitus by application of a combined tinnitus signal and music during sleep. METHODS: Forty-three ears of 30 patients who had subjective tinnitus were included. The patients were evaluated using Tinnitus Handicap Inventory, Visual Analogue Scale, and Beck Depression Inventory. The psychoacoustic parameters of tinnitus, such as tinnitus frequency and loudness, and minimal masking levels, were determined. The patients were asked to select musical melodies that they liked. The tinnitus frequency of each patient was taken as the central frequency according to ANSI 2004. All sound files were prepared as stereo channels, with 16-bit resolution and 44,100 Hz sampling rate. The root mean square power value of the music and the band noise's average root mean square power value were equalized with the "Amplification" command, and 70% of the music and 30% of wide/narrow-band noise were mixed as a stereo channel by the "Mix Paste" command. The patients were instructed to listen to that individualized music/narrow-band noise (tinnitus signal) for 2 h during sleep for a duration of 6 months. RESULTS: Tinnitus frequencies of the patients measured prior to treatment and at the second, fourth, and sixth months of follow-up were not significantly different. A statistically significant decrease was seen in tinnitus loudness, minimal masking levels, and residual inhibition during the follow-up. Tinnitus Handicap Inventory scores decreased significantly during follow-up, and the number of patients who complained of tinnitus decreased (p < 0.05). The Visual Analogue Scale scores significantly decreased during follow-up (p < 0.05). Beck Depression Inventory scores decreased significantly during follow-up (p < 0.05). CONCLUSION: Stimulation of the auditory and limbic systems during sleep by the tinnitus signal combined with individualized musical melodies seems an alternative, effective, and cheap method in the treatment of tinnitus.

Impact of the demographic and aetiological factors and intraoperative findings on postoperative outcomes in chronic otitis media surgery

Background/aim: Surgical success is related with many factors belonging to both the patient and the disease. This study aims to analyse the preoperative and intraoperative characteristics, the postoperative results, and the factors affecting the surgical success in different types of chronic otitis media (COM). Materials and methods: A total of 1510 ears of 1398 patients who underwent COM surgery were included in the study. Postoperative results were obtained from 376 ears of 356 patients who had been followed after surgery. The demographic characteristics of the patients, such as age and sex, operative findings, preoperative audiological examination results, and final audiometric and otoscopic examination findings, were retrospectively obtained from the archives of the department. Results: The most frequent diagnosis was simple COM (39.9%), and the most frequently performed surgery was tympanoplasty without mastoidectomy (46.6%). The overall hearing success rate was found to be 75.8%. Postoperative hearing success was significantly associated with the chronic otitis subgroup, ossicular pathologies, and the condition of the middle ear mucosa. Postoperative graft take rate was found to be 78.6%. Graft success was statistically significantly higher in patients with normal middle ear mucosa. Performing mastoidectomy, the presence of patency in aditus ad antrum, and being a paediatric case had no impact on graft success. Conclusion: Factors affecting the success of COM surgery include age, chronic otitis subgroup, location and size of perforation, the condition of the middle ear mucosa, and the level of the ossicular disease. These factors should be known and an appropriate treatment plan should be prepared.

Canal wall down versus canal wall up surgeries in the treatment of middle ear cholesteatoma

Background/aim: To compare outcomes of canal wall up (CWU) and canal wall down (CWD) techniques in the treatment of middle ear cholesteatoma. Materials and methods: Medical records of 76 patients who had a primary surgery due to middle ear cholesteatoma between July 2015 and November 2017 were reviewed retrospectively. Hearing thresholds, speech discrimination scores (SDS), recurrences, and revision surgeries of CWU and CWD surgeries were compared. Results: Of 76 cholesteatoma cases, 40 (52.6%) had a CWU and 36 (47.4%) had a CWD operation. Postoperatively, the mean air conduction thresholds were significantly better in CWU compared to CWD surgeries (P = 0.016). The presence of the stapes and the type of reconstruction material used did not have a significant effect on auditory success rates (P = 0.342 and P = 0.905, respectively). Auditory success was affected by the status of the middle ear mucosa as well. The recurrence and revision rates did not differ between the surgical techniques (P > 0.05). Conclusion: Status of the middle ear mucosa and external auditory canal are important factors affecting the outcomes in cholesteatoma. Instead of a CWD surgery, a CWU surgery seems applicable in cases of cholesteatoma when the bone in the external auditory canal is not eroded by the disease.

Assessment of Cochlear Implant Revision Surgeries in a Cohort of 802 Patients.

OBJECTIVE: To assess the etiology, demographics, rates and outcomes of revision surgeries, and device survival rates after cochlear implantation. STUDY DESIGN: Retrospective case review. SETTING: Tertiary Otology & Neurotology center. PATIENTS: Cochlear implantees who received revision surgeries after implantation INTERVENTIONS:: Any surgical intervention, performed due to device failure or the major complications of cochlear implantation. MAIN OUTCOME MEASURE: Medical records of the patients who received cochlear implants (CIs) between July 2002 and March 2018 were reviewed retrospectively regarding postoperative complications. Demographic data, device survival rates, and causes of revisions were recorded. RESULTS: Totally, 924 implantations were performed in 802 patients. Eighty one (8.7%) of them underwent 102 revision surgeries. The most common causes of revision surgeries were device failures and flap related problems which were seen in 28 and 18 patients, respectively.Overall CI survival rate was 91.9% in a 10 years period, which remained almost stable after 10 years. Although age was not found to be related with device failure (p = 0.693), device loss rates were significantly higher in adult implantees than children (p = 0.006). CONCLUSION: Device failure seems the most common cause of revision. The revision surgeries are usually safe and help to resolve the problem although flap problems are the most difficult to treat and may necessitate multiple revision surgeries. The device failure rate may reach to a plateau after 6 years. Overall CI survival rate exceeds 90% in 10 years period, and then remains stable.

Effects of Rhinoplasty on Labyrinthine Function.

BACKGROUND: Rhinoplasty is a common surgical procedure that is requested and accepted by patients for cosmetic and functional reasons. Osteotomies are performed on nasal bone, maxillary crest, or vomer to fix the deviations of the nasal dorsum or septum. During the percussion of the osteotomes with the surgical mallet, the vibration energy diffuses to the cranium. Auditory and vestibular systems may be affected by these vibrations. OBJECTIVES: To assess the effects of rhinoplasty, in which osteotomies were performed using a hammer, on the audiovestibular system. METHODS: Thirty adults who underwent rhinoplasty were included in the study group. Ten age and gender matched adults who had nasal surgery without surgical mallet or osteotome served as the control group. The patients in both groups were assessed using pure tone audiometry, tympanometry, distortion product otoacoustic emission testing, and vestibular-evoked myogenic potential, as well as video head impulse tests (vHIT) before the operation and 1 week after the operation. RESULTS: On auditory assessment, there was no significant difference between the study and control groups regarding pure tone thresholds at frequencies of 250 Hz to 8 kHz (P > 0.05) as well as otoacoustic emissions. The vestibular assessment performed by using vestibular-evoked myogenic potential and vHIT did not reveal a statistically significant difference between the groups, before surgery or after surgery (P > 0.05). CONCLUSIONS: Rhinoplasty appears to be a safe operation in terms of audiovestibular functions, and osteotomy, in which a hammer is usually used, does not have an impact on hearing or balance functions of the ear.

Dorsal Augmentation of Saddle Nose Deformity With Toothpick-Shaped Costal Cartilage Grafts in the Secondary Septorhinoplasty.

Saddle nose deformity is a challenging complication of septoplasty or septorhinoplasty, characterized by underprojected cartilaginous dorsum. Nasal dorsal augmentation is a significant part of reconstructive surgery of saddle nose deformities. In this study, the authors aimed to discuss the results of using toothpick-shaped costal cartilage grafts in nasal dorsal augmentation of saddle nose deformity. Twelve patients who underwent nasal dorsal augmentation due to moderate to severe saddle nose deformity secondary to the previous septoplasty or septorhinoplasty were retrospectively reviewed. Costal cartilage grafts prepared in the shape of toothpicks were used in all patients. Costal cartilage was used as toothpick-shaped free grafts in 12 patients (female: 7, male: 5) with a mean age of 42 (range: 24-56) for dorsal augmentation in the secondary septorhinoplasty. All patients had a history of previous surgery (septoplasty, n = 9; and septorhinoplasty, n = 3). All patients were operated under general anesthesia with open technique septorhinoplasty. The mean follow-up was 18 (range: 9-48) months. In only 1 of the 12 patients, a postoperative complication was observed including an infection of the tip area in the second postoperative week. None of the patients experienced donor site complications or major graft resorption. All patients were satisfied with functional and esthetic outcomes. No revision surgery was needed in any patient. Toothpick-shaped costal cartilage grafts are useful in nasal dorsal augmentation of moderate to severe saddle nose deformity. This technique offers smooth camouflage, satisfactory accordance with the recipient region, and shorter operation time. In addition, it avoids the side effects from wrapping techniques such as foreign body reaction or additional donor site morbidities.

Association of Helicobacter pylori infection with olfactory function using smell identification screening test.

The aim of the present study is to investigate the role of Helicobacter pylori in olfactory function. Thirty-six patients (mean age 38.5) aged between 18 and 55 years who were diagnosed with H. pylori by gastric biopsies and age- and sex-matched 30 healthy adults (mean age 33.6) were included in the study. All participants underwent a detailed ear-nose-throat examination including endoscopic examination of the nasal cavity and laryngeal area, and olfactory tests were performed using the Sniffin' Sticks, a 12-item screening test (Sniffin'Sticks; Burghart, Wedel, Germany) and odor scores were recorded. The mean odor score was 7.9 ± 1.7 (range 2-10) in the patient group and 10.3 ± 1.4 (range 6-12) in the control group. There were significant lower scores in the patient group compared to the control group (p < 0.05). In conclusion, it is apparent that there is an association of H. pylori infection with olfactory dysfunction. H. pylori infection should be considered as possible etiological factors in patients with olfactory dysfunction.

Treatment of seborrheic keratosis in bilateral external auditory canal using fiber CO2 laser.

In this article, we report a 33-year-old female patient with lesions of bilateral external auditory canals who was treated using fiber CO2 laser without canaloplasty. Histopathological examination confirmed the diagnosis of irritated type seborrheic keratosis, which is rare in external auditory canal. Twelve months after the treatment, the patient showed no signs of recurrence.

Histopathological Effects of Parylene C (poly-chloro-p-xylylene) in the Inner Ear.

OBJECTIVE: To assess the histopathological effects of parylene C (PC) (poly-chloro-p-xylylene) in the inner ear. METHODS: Nine adult Dunkin Hartley guinea pigs (500-600 g) were included in the study. PC pieces were inserted into the cochlea in the right ear of the animals (study group). The round windows were punctured in the left ears comprised the control group. After three months, the animals were sacrificed, and the dissected temporal bones were examined under a light microscope. RESULTS: No significant difference was revealed between the study and control groups regarding histopathological findings such as perineural congestion, perineural inflammation, neural fibrosis, number of ganglion cells, edema, and degeneration of ganglion cells (p>0.05). CONCLUSION: PC did not cause any additional histopathologic damage in the cochlea. This finding may be promising regarding the use of PC in cochlear implant electrodes as an alternative to silicon materials in the future.

Cochlear Implantation in Extraordinary Cases.

BACKGROUND: Although cochlear implantation has been almost a standard otological procedure worldwide, it may still create a dilemma for the surgeon in some unusual instances such as Seckel syndrome, aural atresia and posterior fossa arachnoid cyst. CASE REPORT: Three extraordinary cases of cochlear implantation were reported. The first case was a case of Seckel syndrome with a cardiac pacemaker due to complete atrioventricular block. The second case had posterior fossa arachnoid cyst that had retrosigmoid cyst removal and cochlear implantation simultaneously. The last case had cochlear implantation in the ear with congenital aural atresia. All cases could be implanted successfully with full electrode insertion and good audiological outcome. Delayed facial paralysis that occurred in the patient with arachnoid cyst resolved spontaneously. CONCLUSION: This study addressed the efficiency of cochlear implantation in cases of Seckel syndrome, complete atrioventricular block managed with cardiac pacemaker, congenital aural atresia and posterior fossa arachnoid cyst. In addition, the retrosigmoid approach and cochlear implantation can be performed simultaneously.

Delayed prelingual cochlear implantation in childhood and puberty.

OBJECTIVE: To evaluate the results of delayed cochlear impantion performed in childhood and puberty in the light of speech language pathology assessments. METHODS: Totally 49 children with prelingual profound hearing loss were included in the study. All children received a cochlear implant between the ages of 5 and 19 years (Group 1 aged between 5 and 9 years, group 2 aged between 10 and 14 years, group 3 aged between and 15 and 19 years). The MAIS, MUSS and PLS-4 scores of children were evaluated one month before, and one year and two years after the operation. The descriptive statistics included several independent variables; age of implantation; gender; trade name of the implant; preoperative duration of hearing aid use; preoperative special education, family support and additional handicap. These variables were categorical variables. We used repeated measures analysis of variance to test improvements in MAIS, MUSS and PLS scores, and whether this improvement depend on the independent variables. In addition, we also tested the interaction between time and the independent variables. RESULTS: The preoperative MAIS, MUSS and language scores were significantly higher in older children compared to younger children (p<0.01). After two years these scores were similar between the all age groups (p>0.4). There was a significant age and time interaction (p=0.005). That is, improvement continued in all age groups in a parallel way and group 2 reached to the level of group 1 after two years. However, group 3 almost reached to a plateau level after two years. The family support was associated with the MAIS, MUSS and language scores of the patients (p=0.01), and there was a family support-time interaction (p<0.0001). In group 1 and 2, the way of communication shifted from total communication (lip reading, sign language, auditory) to auditory-verbal communication in a significant number of the patients (p<0.01). However, that change in the way of communication was not statistically significant in group 3 (p>0.05). CONCLUSION: The decision of delayed cochlear implantation in children can be made in the light of following parameters. A good family support is most important. The patients must be wearing hearing aids regularly since early childhood, and preferably use the auditory verbal communication. Evaluation of the patient with MAIS, MUSS and PLS is important to understand the level of receptive and expressive communication level.

[Vascular compression syndromes: our 24 year endoscope-assisted microvascular decompression experiences]. / Vasküler kompresyon sendromlari: 24 yillik endoskop yardimli mikrovasküler dekompresyon deneyimlerimiz.

OBJECTIVES: This study aims to report our experience on endoscope-assisted microvascular decompression experiences performed due to vascular compression syndromes such as hemifacial spasm, trigeminal neuralgia, and cochleovestibular nerve compression. PATIENTS AND METHODS: Between March 1999 and June 2013, 55 patients (34 females, 21 males; mean age 44 years; range 24 to 77 years) underwent endoscope-assisted microvascular decompression surgery through a retrosigmoid approach due to vascular compression syndromes in our clinic. The diagnosis was based on history, neurological examination, magnetic resonance imaging findings and audio-vestibular tests. RESULTS: A total of 49 patients (89.1%) had complete relief of the symptoms and two had (3.6%) a partial relief, while four had (7.3%) no relief of the symptoms. Only two patients had (3.6%) cerebrospinal fluid leakages as a perioperative complication. The major offending vessels were anterior and inferior cerebellar arteries in 14 patients. Four patients with essential hypertension became normotensive after decompression of the left medulla oblongata as well. CONCLUSION: Microvascular decompression surgery provides a significant relief of the symptoms in patients with vascular compression syndromes. An angled endoscope as an adjunct to microscope contributes to the diagnosis of the offending vessel in the root entry zone of the cranial nerve.

Evaluation of outer hair cell function and medial olivocochlear efferent system in patients with type II diabetes mellitus.

AIM: This study was designed to investigate the function of outer hair cells and medial olivocochlear efferents in type II diabetes mellitus (DM). MATERIALS AND METHODS: There were 50 patients with type II DM and 51 age- and sex-matched healthy controls included in the study. Both groups were compared in terms of transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), and contralateral suppression of TEOAE. RESULTS: Pure tone thresholds of the patients with type II DM were significantly higher than in the controls (P < 0.05). The TEOAE amplitudes at 1 kHz and at 1.5, 2, 3, 4, and 6 kHz signal-to-noise ratio amplitudes on DPOAE testing were significantly lower in the patients than controls (P < 0.05). There was no significant difference between the type II DM and control groups regarding contralateral suppression test results of TEOAEs. CONCLUSION: Type II DM seems to impact the auditory system at the cochlear level by affecting the functions of outer hair cells, and it results in elevation of the thresholds on audiometry and a decrease in the amplitudes of otoacoustic emissions.