Audiological and Vestibular Measurements in Chronic Renal Failure Patients Receiving Hemodialysis Treatment.

BACKGROUND: The aim was to evaluate the changes in the audiovestibular system in adult patients with the diagnosis of chronic renal failure who were treated with hemodialysis. METHODS: Thirty-five patients diagnosed with chronic renal failure and receiving hemodialysis treatment 3 days a week and 35 healthy individuals were tested with pure tone audiometry, video head impulse test, and post-head shake nystagmus test. Dizziness Handicap Inventory was applied to all participants. RESULTS: The Dizziness Handicap Inventory scores of the patient groups are higher than the control groups (P=.001). In the video head impulse test, there is no statistically significant difference between the patient and control groups in terms of gain asymmetry. 17.1% of the patients had both left and right lateral saccades (P=.03). A statistically significant difference was also found after the post-head shake test (P=.025). In the patient group, an inverse relationship between the presence of left anterior right posterior saccades and blood urea nitrogen-creatinine ratio and a direct relationship between the presence of right anterior left posterior saccades and creatinine elevation were determined. The presence of saccades in the video head impulse test increased significantly as the disease duration of hemodialysis patients increased. CONCLUSION: It was determined that the overt and covert saccades in the video head impulse test increased significantly as the creatinine increased and the duration of the disease increased in the patients with chronic renal failure. The common clinical usage of video head impulse test in monitoring the vestibular side effects of creatinine elevation and disease duration in chronic renal failure patients may be possible with future studies.

Simultaneous Sudden Hearing Loss and Peripheral Facial Paralysis in a Patient With Covid-19.

Although peripheral facial paralysis and sudden sensorineural hearing loss are not as common as anosmia, they are reported neurological manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We present a 62-year-old, serologically COVID-19 positive woman with seventh and eighth nerve involvement showed electrophysiologically with Auditory Brainstem Response and electroneurography and radiologically with internal acoustic canal magnetic resonance imaging. This single case report suggests a possible association between the SARS-CoV-2 infection with simultaneous sudden sensorineural hearing loss and isolated facial paralysis. However, further studies are needed to determine whether this relationship is coincidental or occasional.

Evaluation of the Relationship Between Facial Nerve and Lateral Semicircular Canal in the Posterior Tympanotomy Approach.

BACKGROUND: To clinically and radiologically evaluate the relationship between the facial nerve and the lateral semicircular canal during posterior tympanotomy. METHODS: Patients who received cochlear implants between 2010 and 2020 were included in the study. The relationship between the facial nerve and the lateral semicircular canal was classified into 3 types by evaluating the axial section computed tomography images. If the facial nerve passed medially without contacting the lateral semicircular canal dome, it was classified as type 1; if the facial nerve passed by contacting the medial border of the lateral semicircular canal dome, it was classified as type 2; and if the facial nerve contacted the lateral border of the lateral semicircular canal dome or passed more laterally, it was classified as type 3. RESULTS: In total, 309 ears of 257 patients [139 males (54.1%) and 118 females (45.9%)] were included in the study. Ninety-three (30.1%) of the ears were classified as type 1, 179 (57.9%) were type 2, and 37 (12%) were type 3. It was found that the combined posterior tympanotomy/endomeatal approach was used in 6 ears (1.9%), of which 4 were type 3, and 2 were type 2 (P=.006). CONCLUSION: Systematic evaluation of the relationship between facial nerve and lateral semicircular canal in computed tomography axial sections might help prevent facial nerve damage that can occur during posterior tympanotomy. It was concluded that type 3 ears should be evaluated in this respect, as a combined posterior tympanotomy/endomeatal approach may be required.

[Two Case of Rhino-Orbito-Cerebral Mucormicosis Developed After COVID-19 Infection]. / COVID-19 Enfeksiyonu Sonrasi Gelisen Iki Rino-Orbito-Serebral Mukormikoz Olgusu.

Coronavirus 2019 (COVID-19) infection causes excessive cytokine response and a decrease in cellular immune response and this increases susceptibility to fungal co-infections. Mucormycosis is a rare, lifethreatening invasive fungal infection. In this report, two cases who developed rhino-orbito-cerebral mucormycosis shortly after having COVID-19 infection were presented. The first case was a 68-year old woman who admitted to our clinic with orbital cellulitis in her left eye and had a known diagnosis of asthma and rheumatoid arthritis. She was diagnosed with COVID-19 pneumonia 40 days ago, stayed in the intensive care unit for a long time, and received pulse steroid (1000 mg methylprednisolone), interleukin-1 (IL-1) inhibitor (anakinra) and broad-spectrum antibiotic treatments together with antiviral therapy during this period. The second case was a 63-year-old male patient with known diabetes mellitus, hypertension and retinitis pigmentosa, with a history of hospitalization in the intensive care unit due to COVID-19 pneumonia 20 days ago and received pulse steroid therapy during this period. He admitted to our clinic with the complaints of droopy right eyelid, swelling, nausea and vomiting. In both cases, paranasal sinus tomography findings were consistent with invasive sinusitis. Functional endoscopic sinus surgery was performed immediately in less than 16 hours from the first admission in both cases. Histopathological examination of the both cases revealed results consistent with mucormycosis. Mucorales spp. was isolated in sinus tissue culture of the second case taken during the operation. Both of the patients received liposomal amphotericin B. First case died on the 19th day of the treatment. Second case was discharged with full recovery after nine weeks of treatment. The suppression of cellular immunity during the COVID-19 infection, and the use of steroids and interleukin inhibitors in the treatment of severe cases may increase secondary invasive fungal infections. Therefore, clinicians should more frequently consider possible fungal infections in patients with COVID-19.

Cochlear Implant Failure in the Pediatric Population.

BACKGROUND AND OBJECTIVES: In cochlear implant (CI) surgery, the results and causes of revision and reimplantation may guide surgeons in establishing surgical protocols for revision surgery with safe audiological outcomes. The aim of this study was to review our experience in terms of etiology, surgical strategy, and hearing outcomes in pediatric patients who underwent CI removal and reimplantation. SUBJECTS AND PURPOSE: All patients received implants of the same brand. Pre and postoperative Categories of Auditory Performance score and aided free-field pure tone audiometry thresholds were noted. In vivo integrity tests were performed for each patient and the results of ex vivo tests of each implant were obtained from manufacturer. RESULTS: A total of 149 CIs were placed in 121 patients aged <18 years. The revision rate in children was 6.7% (10/121 children). Six patients had a history of head injury leading to a hard failure. The causes of reimplantation in others were soft failure (n=1), electrode migration (n=1), infection (n=1), and other (n=1). All patients showed better or similar postreimplantation audiological performance compared with pre-reimplantation results. CONCLUSIONS: It is very important to provide a safe school and home environment and educate the family for reducing reimplantation due to trauma. Especially for active children, psychiatric consultation should be continued postoperatively.

Middle-Ear Resonance Frequency and Eustachian Tube Function in Players of Wind Instruments.

INTRODUCTION: The effect of the continuous forced expiration action of players of wind instruments to produce sound, on the eustachian tube functions and the middle-ear resonance frequency (RF), has not been investigated in the literature to date. The aim of this study is to evaluate eustachian tube functions and the middle-ear RF of players of wind instruments. METHODS: In this prospective case-control clinical study, a study group of 28 players of wind instruments in the orchestra (28 participants, 56 ears) and a control group of 34 volunteers (34 participants, 68 ears) were included. The eustachian function of wind instrument players in a symphony orchestra was measured using an automatic eustachian tube function test in acoustic tympanometry and the RF of the middle ear was determined in multifrequency tympanometry. RESULTS: There was a statistically significant difference among the musicians, especially in players of woodwind instruments, in terms of dysfunction of the eustachian tubes (p = 0.048). In the musicians, the pre- and postperformance RF mean values for all ears were 925 and 1,020 Hz, respectively, and these were significantly different (p = 0.004). CONCLUSION: This is the first study to uses multifrequency tympanometry to examine the middle-ear RF and eustachian tube function of wind instrument musicians in an orchestra. Eustachian tube dysfunction was found to be more prominent and a higher RF of the middle ear was seen after a performance, especially in players of wood wind instruments. However, the effect of these on the professional performance of players of wind instruments should be investigated in future work.

Evaluation of the possible effect of magnetic resonance imaging noise on peripheral hearing organ with the otoacoustic emission.

PURPOSE: The aim of this study is to evaluate the effect of noise produced by magnetic resonance imaging (MRI) device on hearing by using objective and subjective audiological assessments. METHODS: A total of 38 patients between the ages of 18 and 50 without hearing loss, and had performed MRI for brain, head, neck or cervical imaging were included in this prospective clinical study. Pure tone audiometry, speech audiometry, high frequency audiometry, transient evoked otoacoustic emissions (TEOAE) and distortion product otoacoustic emission (DPOAE) were performed before and after MRI. RESULTS: There was no statistically significant difference in TEOAE, pure tone audiogram, high frequency audiogram and speech audiogram thresholds. In DPOAE, the median value before and after MRI at the frequency of the left ear at 4.0 kHz was 13.6 (8.5-19.9) and 15.7 (8.9-20.7) SNR respectively (p > .05). The median value before MRI at the right ear 4.0 kHz frequency was 14.1 (9.1-20.5) SNR, whereas the median value after MRI was 13.2 (8.8-19.8 SNR (p = 0,03). There was no statistically significant difference in other frequencies in DPOAE. CONCLUSIONS: This is the first objective study that examines the MRI noise on speech audiometry and otoacoustic emission together. However, the effect of MRI noise on hearing pathway is still doubt. Based on the difference at 4 kHz frequency on DPOAE; on-earphones may not sufficiently protect the patients from the MRI noise and this issue should deserve further research.

A Rare Diagnosis in the Neck During Childhood: Congenital Chondrolipoma.

Chondrolipomas are mesenchymal tumors that found as mature cartilage tissue in a fat tissue. A 2-year-old boy was seen with a complaint of a mass of the neck. On physical examination of the child, there was a one-centimeter mass above the sternocleidomastoid muscle on the lateral neck. Pathological examination of this mass after excision was reported as chondrolipoma. Chondrolipomas are seen mostly in the breast and in the adult. They are rare tumors of the head and neck area and seen mostly the in oral cavity here. This is the first case of chondrolipoma with this age and localization combination in the literature. Chondrolipoma should therefore also be considered in the differential diagnosis of congenital masses located at lateral cervical area.

[Cochlear implantation in far advanced otosclerosis: series of four cases]. / Asiri ilerlemis otosklerozda koklear implantasyon: Dört olguluk seri.

In this article, we present four patients who underwent cochlear implantation due to far advanced otosclerosis. Preoperative evaluations, intraoperative findings, complications, and postoperative benefits were analyzed. Cochlear implantation is a treatment option providing excellent audiological results for rehabilitation of patients with far advanced otosclerosis. However, facial nerve stimulation after cochlear implantation is observed more frequently in patients with otosclerosis. Also, caution should be paid in patients with otosclerosis in terms of cochlear ossification and inconsistent results.

Surgical treatment of carotid body tumors.

OBJECTIVES: In this study, we report our clinical experience in a series of patients with carotid body tumors along with diagnosis, treatment and follow-up procedures in the light of related literature data. PATIENTS AND METHODS: Between November 2001 and May 2012, 10 patients (5 males, 5 females; mean age 53.2 years; range 27 to 80 years) who underwent surgery due to a carotid body tumor in our clinic were included. Diagnosis was based on ultrasonography, computed tomography, magnetic resonance imaging, magnetic resonance angiography, selective carotid angiography, balloon occlusion test, biochemical tests and preoperative embolization. Complications were also recorded. RESULTS: Balloon occlusion test was performed in all patients preoperatively, while embolization was implemented in seven patients. All masses were dissected by carotid artery subadventitial approach. Carotid integrity was maintained in nine patients, while a vein graft was used in one patient. Neurological disorder was observed in one patient, whereas transient hypoglossal paresis was in one patient who underwent saphenous vein grafting. CONCLUSION: Our study results suggest that (i) carotid body tumors should be handled with multidisciplinary approach; (ii) balloon occlusion test should be performed in all patients undergoing surgery; (iii) a particular attention should be paid to cranial and phrenic nerves, if it is necessary to extend the surgical field while removing the tumor; and (iv) pathological examination should be carried out by an experienced team and in a multi-centered fashion, if necessary.

[The therapeutic role and effectiveness of selective neck dissection in the management of N0 neck]. / N0 boyun tedavisinde selektif boyun diseksiyonunun tedavideki rolü ve etkinligi.

OBJECTIVES: To assess the therapeutic role and the effectiveness of the selective neck dissection in the management of the clinically node negative neck in the head and neck squamous cell carcinomas. PATIENTS AND METHODS: The charts of 177 patients with squamous cell carcinoma, who underwent neck dissection between January 2000 and January 2007, were reviewed retrospectively. Seventy neck dissections in 58 patients (51 males, 7 females; mean age 63 years; range 21 to 85 years) in whom the primary site of the lesion was the larynx, oral cavity, oropharynx and hypopharynx, and who were considered to have N0 neck and to comply with the study criteria were included in the study. Details were collected on tumor site and stage, type of surgery, pathologic N stage, number and size of pathologic nodes, extracapsular spread of nodes, postoperative radiotherapy, local recurrence, follow up time and survival status in all patients. RESULTS: It was found out that selective neck dissection operations were performed on 99 of 102 N0 patients. The follow up time was approximately 23 months in 58 patients who were found to comply with the inclusion criteria. The most frequent site for primary tumor was larynx and most patients were at T2 stage. Nine patients had pathologically positive lymph node with occult metastasis rate of 13%. The overall recurrence rate was 19%. Postoperative radiotherapy was used as adjuvant therapy in 15 patients. Regional control rate was lower in patients with pathologically positive lymph nodes. However, it was not statistically significant. CONCLUSION: Selective neck dissection is an effective and safe method for controlling and staging of the patients with clinically N0 neck.

Appropriate interslice gap for screening coronal paranasal sinus tomography for mucosal thickening.

The objective of this study was to establish the appropriate interslice gap for screening coronal paranasal sinus tomography to identify sinus mucosal thickening. We reviewed 100 coronal paranasal sinus tomographic scans (interslice gap, 2 mm) that had been performed at our institution between January 2004 and November 2004 to evaluate rhinosinusitis. Digital photographs of all slices from each tomographic scan were taken. The intervening slices were eliminated to form six different sets of interslice gaps of 4, 6, 8, 10, 16, and 20 mm. The remaining slices for each set were moved to corresponding folders created on a computer to catalog each interslice gap. The same specialist evaluated each folder of interslice gap. The paranasal sinuses, the ethmoid infundibulum, and the frontal recess were evaluated for mucosal thickening. The sensitivity, specificity, and accuracy of each interslice gap in detecting mucosal thickening were calculated by accepting the results of 2-mm-thick slices as the gold standard. The interslice gap of 2 mm was compared with that of other interslice gaps using the chi-square test for dependent groups (the McNemar test). The value of 20 mm interslice gap in detecting sinus mucosal thickening was found to be significantly low when compared with the interslice gap of 2 mm (P = 0.022). Using coronal paranasal sinus tomography, an interslice gap up to 16 mm may be used to detect sinus mucosal thickening.

Evaluation of the effect of dexamethasone in experimentally induced endolymphatic hydrops in guinea pigs.

PURPOSE: The aim of this study was to investigate the audiological and histopathologic effects of dexamethasone in the treatment of experimentally induced endolymphatic hydrops. MATERIALS AND METHODS: Thirty mature, male guinea pigs weighing 400 +/- 50 g were operated on to induce experimental endolymphatic hydrops in their right ear. Left ear served as control. Subjects were separated into control and dexamethasone groups, with the latter receiving dexamethasone 5 mg/(kg d) intraperitoneally for 10 days. Electrocochleography and auditory brainstem response were applied to all subjects at preoperation, on the second postoperative day and also on the 15th postoperative day in animals that lived for a long time. The histopathologic examination of the inner ear in all animals was done at the end of the study. RESULTS: The summating potential and the ratio of the summating potential to the action potential measured on the second postoperative day were found to be increased in both groups, but more significantly in the control one. When the left and right ears were compared, significant difference was found in the control group; however, no significant difference was found between the ears in the dexamethasone group. Histopathologic examination revealed varying degrees of hydrops in the control group, but showed only normal findings or minor changes in the dexamethasone group. CONCLUSIONS: Dexamethasone can prevent the audiological and histopathologic findings of experimentally induced endolymphatic hydrops. However, these results must be supported by clinical and experimental studies designed with a large number of subjects.

Reliability of microdrill stapedotomy: comparison with pick stapedotomy.

OBJECTIVE: To assess the hearing outcomes and complications of the microdrill and pick stapedotomy techniques. PATIENTS: We assessed 123 primary otosclerosis operation in 103 patients who had more than 1 year follow-up (71 microdrill; 52 pick stapedotomies). There were 87 women and 36 men in the study group (mean age, 44 +/- 11.2 years) at surgery. INTERVENTION: Stapedotomy for otosclerosis. MAIN OUTCOME MEASURES: Pure tone hearing thresholds and clinical evaluation for complications. RESULTS: In the microdrill group, preoperative mean air conduction was 61 dB, and mean bone conduction was 27 dB, postoperatively, these values improved to 31 dB and 16 dB, respectively. In the pick group, mean air conduction was 61 dB, and mean bone conduction was 27 dB, which improved postoperatively to 33 dB and 18 dB, respectively. Postoperative hearing gains were similar in both groups (p > 0.005). The mean postoperative gain in bone conduction was significant (p < 0.001) in each group: 11 dB in the microdrill group and 9 dB in the pick group, with no significant difference between the two groups. The preoperative air-bone gap was 34 dB in both groups, and improved to 15 dB in both. Complication rates were similar. CONCLUSION: The microdrill and pick stapedotomy techniques produced similar hearing results and complication rates. Within the limitations of the present study, we found no evidence of microdrill-induced acoustic trauma. The microdrill can be a useful technique in performing a stapedotomy and seems to produce similar results to those associated with pick stapedotomy.

A forgotten gauze pack in the nasopharynx: an unfortunate complication of adenotonsillectomy.

A case of a foreign body lodged in the nasopharynx for a long time as a complication of adenotonsillectomy is presented. The patient was an 11-year-old boy admitted with nasal obstruction and bilateral foul-smelling purulent rhinorrhea. The diagnosis was confirmed with nasal endoscopy. Immediate removal of foreign body in the nasopharynx was performed under general anesthesia. Although foreign bodies lodged into the nasopharynx are rare, they may cause serious and even fatal complications. A high index of suspicion, particularly for persistent symptoms, is essential and necessitates further investigation before diagnosis of a case of rhinosinusitis or empirically prescribing antibiotics.

Hyperaeration of the frontal sinus.

The nasal cavity and paranasal sinuses constitute an anatomical and functional unit. Paranasal sinuses communicate with the nasal cavities, which are covered by the same mucosa, via small openings and narrow ducts that allow both aeration and sinus drainage. Anatomical variations of the paranasal sinuses and nasal cavity are important in sinus diseases. Computerized tomography (CT) plays a critical role in evaluation of the patients with paranasal sinus pathology and variations. A 38-year-old man admitted to our clinic with headache and postnasal dripping for 1 year. His paranasal CT scanning revealed that there is hyperaeration of the frontal sinus which is in continuity with the sphenoid sinus. Hyperaeration of the sinuses may be kept in mind in a patient complaining of headache.

Epithelial cyst of the soft palate.

Epithelial cysts are benign epithelium-lined lesions that contain fluid or semisolid material. This type of cyst is rare in the oral cavity. Most epithelial cysts in this location are situated in the anterior floor of the mouth; the soft palate is seldom affected. Oral examination in a 6-year-old boy revealed a cyst in the soft palate. The lesion was excised under general anesthesia, and histopathological examination identified it as an epithelial cyst. The report discusses this rare location for an epithelial cyst and reviews the pertinent literature.