Cognitive function in Meniere's disease.

Meniere's disease is an otological disease characterized by various symptoms that include episodic peripheral vertigo, sensorineural hearing loss, tinnitus, and aural fullness, all of which deteriorate the maintenance of daily activities. We aimed to investigate cognitive function in Meniere's disease patients and compare their results to those of healthy controls. Eighteen patients diagnosed with definite Meniere's disease without any psychiatric, neurological or otological comorbidity, and 30 healthy controls with normal cognitive functions were included in the study. General cognitive status, attention, verbal memory, visual memory, executive and visuospatial function were measured by detailed neuropsychological tests in both groups. In the patients with Meniere's disease, pure-tone hearing thresholds, and speech discrimination scores were also measured. Patients with Meniere's disease showed lower levels of performance in the trail making test, Oktem verbal memory processes, Rey Complex Figure Test, Wisconsin Card Sorting Test, semantic and phonemic fluency than did healthy controls. In other words, there were deficits in attention, recognition and recall in verbal memory, recall in visual memory, visual spatial construction, and planning skills in patients with Meniere's disease. Education years and depression scores of participants had a significant effect on cognitive function in all groups. This study is an update and confirmation of the findings of studies showing cognitive impairment in patients with Meniere's disease. In addition to previous findings, this study found a decrease in executive function performance in patients with Meniere's disease compared to healthy controls. Unlike previous studies, this study comprehensively addressed all cognitive functions and included a control group. Our results emphasize that executive functions, which are high-level cognitive processes, may affect the compliance of patients with Meniere's disease treatment and follow-up processes.

Changes in P1 latencies of children with normal hearing and those with cochlear implants

Background/aim: The aim of this study was to determine the age-related latency interval of P1 latencies of children with normal hearing, and to evaluate the P1 latency changes after surgery in children who underwent cochlear implantation. Materials and methods: We evaluated 60 children with normal hearing and 16 children with cochlear implants aged 0­6 years using cortical auditory evoked potentials. P1 latencies were measured only once in the children with normal hearing, and on the postoperative first day, and the first, third, and sixth postoperative months in the children with cochlear implants. Results: There was a statistically significant decrease in the P1 latencies as the age increased in children with normal hearing (P < 0.001). It was determined that when the external partof the cochlear implant was applied, the P1 latencies of children with cochlear implants were significantly longer than those of age-matched children with normal hearing (P < 0.001). This difference disappeared in 10 children with implants at the third and sixth months, but significant differences remained in 6 children. Conclusion: P1 latency could be used as an objective tool to evaluate the normal development of auditory pathways, and may be helpful in the effective programming of children undergoing cochlear implantation.

Wide-Band Tympanometry Results during an Acute Episode of Ménière's Disease.

BACKGROUND: Wide-band tympanometry (WBT) was introduced as a beneficial diagnostic test for Ménière's disease (MD) almost 15 years ago. However, an acute episode of MD has not been evaluated by using WBT yet. OBJECTIVE: To investigate WBT findings in patients with MD during acute attacks. METHOD: Thirty definite MD patients with unilateral acute low-tone sensorineural hearing loss and aural fullness, and thirty age- and sex-matched control subjects were enrolled prospectively in a tertiary referral center. Ears were divided into three groups as follows: (1) affected ears of MD patients, (2) contralateral ears of MD patients, (3) control ears. Individuals underwent WBT. The resonance frequency (RF), mean absorbance value, mean low- and high-frequency absorbance values (LF-A and HF-A), and double peak width at 2 kHz of conductance tympanometry (2-kHz PW) were assessed. RESULTS: Seventy percent in group 1, 66.7% in group 2, and 78.3% in group 3 demonstrated double peaks at 2 kHz. The mean 2-kHz PW values were 157.52 ± 79.19, 177.40 ± 79.14, and 139.64 ± 87.501 daPa for groups 1, 2, and 3, respectively. There were no significant differences between groups with respect to 2-kHz PW, RF, absorbance, LF-A, and HF-A. CONCLUSION: This was the first study that evaluated the effects of acute Ménière attacks on WBT findings. An acute Ménière attack was found to have no significant effect on the 2-kHz PW and other variables measured using WBT.

The Impact of Oleuropein on Cisplatin-Induced Toxicity in Cochlear Cells in Relation to the Expression of Deoxyribonucleic Acid Damage-Associated Genes.

Different organs respond differently to cisplatin (CDDP)-induced toxicity. Oleuropein (OLE) is a natural phenolic antioxidant. The purpose of this study was to determine the potential protective effect of OLE against CDDP-induced ototoxicity by evaluating expression of genes associated with deoxyribonucleic acid (DNA) damage and repair in cochlear cells. House Ear Institute-Organ of Corti 1 (HEI-OC1) cells were treated using CDDP, OLE, and OLE-CDDP. The water-soluble tetrazolium salt assay was used for monitoring cell viability. Deoxyribonucleic acid damage in cells due to the CDDP, OLE, and combination treatments was determined using a flow-cytometric kit. The change in the expression of 84 genes associated with CCDP, OLE, and OLE-CDDP treatments that induced DNA damage was tested using the reverse transcription polymerase chain reaction array. Changes ≥3-fold were considered significant. House Ear Institute-Organ of Corti 1 cell viability was significantly reduced by CDDP. The OLE-CDDP combination restored the cell viability. Cisplatin increased the H2AX ratio, while OLE-CDDP combination decreased it. Some of the DNA damage-associated genes whose expression was upregulated with CDDP were downregulated with OLE-CDDP, while the expression of genes such as Gadd45g and Rev1 was further downregulated. The expression of DNA repair-related Abl1, Dbd2, Rad52, and Trp53 genes was downregulated with CDDP, whereas their expression was upregulated with OLE-CDDP treatment. In cochlear cells, the OLE-CDDP combination downregulated DNA damage-associated gene expression relative to that upregulated mainly by CDDP. The results revealed that OLE has a potential protective effect on CDDP-induced ototoxicity in cochlear cells by altering the expression of DNA damage-related genes.

Evaluation of the Impact of Cochlear Implantation on Patients' Working Life: A Cross-Sectional Study.

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.

The effect of percutaneous and transcutaneous BAHA on hearing and subjective auditory abilities: A comparative study.

Hearing loss significantly affects communication, social interactions, and the overall quality of life. The bone-anchored hearing aid (BAHA) is an implantable system that bypasses the outer and middle ear to directly stimulate the cochlea through bone conduction. This study aimed to compare hearing performance and subjective auditory ability improvements between transcutaneous and percutaneous BAHA devices using audiological assessments and Speech, Spatial and Qualities of Hearing Scale. This cross-sectional prospective study included 29 participants aged 14 to 69 years who had used BAHA for at least 6 months. Both Cochlear Baha System's percutaneous (connect) and transcutaneous (attract) implants were evaluated. Audiological assessments involved pure-tone audiometry, speech recognition threshold, and free-field (FF) audiometry, while subjective auditory ability was measured using the Turkish Speech, Spatial and Qualities of Hearing scale (Tr-SSQ). Significant improvements in FF audiometry averages and speech recognition thresholds were observed with BAHA compared to without BAHA (P < .001). Both implant types provided similar FF averages, speech audiometry results, and Tr-SSQ outcomes, with no significant differences between them. Tr-SSQ scores showed substantial satisfaction, indicating significant improvements in speech perception, spatial perception, and hearing quality with BAHA (P < .001). The findings align with previous research, demonstrating that BAHA is a reliable and effective solution for hearing rehabilitation. The study also emphasized the importance of using both audiological test results and daily hearing function scales to comprehensively evaluate the benefits of hearing rehabilitation in real-world environments. In conclusion, BAHA, regardless of the implant type, can provide predictable and lasting improvements in hearing thresholds and daily hearing abilities, making it a valuable option for patients with conductive hearing loss.

[Quantitative and qualitative analysis of four national otorhinolaryngology journals between 2002 and 2010]. / Dört ulusal KBB dergisinin 2002/2010 yillari arasindaki niceliksel ve niteliksel analizi.

OBJECTIVES: This study aims to perform a quantitative and qualitative analysis of four national peer-reviewed otorhinolaryngology journals between 2002 and 2010 and compare various parameters in 1990-1994 period. MATERIALS AND METHODS: The number of authors and female authors, gender of first author, city and the institution where the article was submitted, number of references and national references were noted separately for each article in all issues of four national peer-reviewed journals in years 2002, 2005 and 2010. Language of articles was noted and they were grouped under six main headings based on their subjects. Quantitative analysis was performed considering evidence-based medicine principle and evidence levels of articles were noted between 1 and 5. Statistical analysis was performed using Pearson chi-square and one-way ANOVA tests. RESULTS: A total of 424 articles including 143 in 2002, 147 in 2005 and 134 in 2010 in four national otorhinolaryngology journals were evaluated. The number of authors per article was found to be 4.49, indicating no statistically significant difference between the years (p>0.05). The mean number of female authors per article was 0.85. When the institutions submitted articles were assessed, number of publications from university hospitals was higher than the education hospitals and other health care services; however, this difference was reduced in 2010. In the evaluation of cited references, the mean number of references and national references per article increased from 16.90 to 18.12 and from 1.54 to 1.68 in 2002 and 2010, respectively. According to the articles categorized to their main subjects, it was found that most of the publications were related to upper respiratory/digestive tract and neck and the least was related to facial plastic surgery. The qualitative analysis in terms of evidence-based medicine revealed no articles with level 1 evidence through three years studied. CONCLUSION: It will be useful to make similar periodical studies to improve the quality of otorhinolaryngology journals and related articles in Turkey.

The Effect of Noise Exposure on Hearing Function and Vestibular Evoked Myogenic Potentials.

Purpose: Exposure to noise can cause damage to both auditory and vestibular systems. The objective of this study is to evaluate how noise exposure affects the hearing and vestibular systems in individuals with noise-induced hearing loss (NIHL). Methods: This study included 80 subjects (40 subjects with NIHL, and 40 controls), between 26 and 59 years old. For hearing assessment, pure-tone audiometry, extended high-frequency audiometry, tympanometry, acoustic reflex threshold, and distortion product otoacoustic emission tests were used; for vestibular assessment, the cervical and ocular vestibular evoked myogenic potentials tests were used. Results: Statistically significant differences were found between the two groups in 3 to 6 kHz frequency thresholds; in extended high-frequency audiometry tests, there were also significant differences between groups at all frequencies from 9.5 to 16 kHz. The cervical and ocular vestibular evoked myogenic potentials thresholds were significantly higher and N1-P1 amplitudes were significantly lower in the NIHL group. Conclusion: Noise can lead to damage to both auditory and vestibular functions. Therefore, audiological assessments and vestibular evoked myogenic potentials could be clinically useful for examining patients with NIHL.

Effects of Cross-linked Hyaluronic Acid in a Rat Model of Vestibular and Cochlear Toxicity.

Objective: To investigate the effects of cross-linked hyaluronic acid (CLHA) in an experimental model of vestibulotoxicity and cochleotoxicity. Methods: Twenty-eight female Wistar albino rats (200-250 g) were divided into four groups. Group A received 0.06 mL of 13.33 mg/mL gentamicin, Group B received 0.06 mL of CLHA, Group C received 0.03 mL of 26.66 mg/mL gentamicin and 0.03 mL CLHA, and Group D received 0.06 mL of 0.09% saline. All groups underwent auditory brainstem response testing at 4-32 kHz, signal-to-noise ratio of distortion product otoacoustic emission measurements at 1.5-8 kHz and vestibular tests on days 0,1,7,10. The rats were sacrificed, and their labyrinths were histologically assessed and scored. Results: The hearing thresholds of Groups A and C were similar and significantly higher than those of the other groups at all frequencies, beginning from day 1. The vestibular and histological scores of Groups A and C were similar and significantly higher than those of the other groups from day 1. The audiological results, vestibular scores, and histological scores of Groups B and D were similar, except for a temporary middle ear effusion and hearing threshold shift in Group B. No significant deterioration was observed in the audiological, vestibular, and histological analyses of Groups B and D. Conclusion: That both Group A and Group C similarly showed worsening audiological, vestibular, and histological tests suggests that CLHA did not alter the pharmacokinetics and histologic results of gentamicin.

Comparison of clinical and pathological staging in oral cavity cancers.

OBJECTIVES: This study aims to compare the clinical and pathological TN stages of patients with oral cavity cancer and to identify the factors leading to staging discrepancies. PATIENTS AND METHODS: The medical records of 125 patients (77 males, 48 females; mean age 57 years; range 19 to 82 years) who underwent primary tumor resection and neck dissection simultaneously for oral cavity cancer were retrospectively analyzed. Clinical and pathological TN stages of all patients were compared. Sensitivity, specificity and predictive values of clinical staging were calculated. RESULTS: Computed tomography (CT) with contrast which was used to examine the cervical lymph node metastasis showed a sensitivity of 71.9%, a specificity of 75%, a positive predictive value of 70.6%, and a negative predictive value of 76.1%. The diagnostic accuracy of CT for detecting mandibular invasion was as follows: sensitivity, 92.6%; specificity, 97%; positive predictive value, 96.1%; and negative predictive value, 94.3%. CONCLUSION: High correlation between clinical and pathological stages for assessment of mandibular invasion and neck metastasis supports the reliability of CT in our study. Diagnostic contribution of magnetic resonance imaging is necessary for assessment of extrinsic tongue muscle involvement; in cases of tongue cancer which are surrounded by induration on palpation and extending to the floor of the mouth.

3D Model to Understand the Diagnosis and Treatment of Horizontal Canal BPPV.

Objective: Our primary objective was to develop a three-dimensional (3D) model of the vestibular labyrinth to understand the pathophysiological mechanisms of benign paroxysmal positional vertigo (BPPV) observed during common diagnostic positional tests. We secondarily aimed to monitor the effects of the repositioning maneuvers and use this tool in teaching. Methods: A 3D model of a human semicircular canals (SSCs) system was created by 3D printing the core and assembling it with silicone tubing filled with lubricant oil containing colored small stones in the lumen mimicking otoconia. We used the model in horizontal canal BPPV diagnostic tests and therapeutic maneuvers. The working mechanism of the model we designed was recorded with video. Results: The model allowed for a clear display of the anatomy and the respective orientations of the SSCs. Otolith movement in the horizontal canals could be imitated during diagnostic positional tests (Dix-Hallpike and Pagnini-McClure) and therapeutic maneuvers (Epley, Semont, Lempert and Gufoni). Conclusion: As well as helping to understand the anatomy and physiology of the SSCs, this simple 3D model also provides a teaching tool for the diagnosis and treatment of BPPV. The mechanism of horizontal canal canalithiasis and the effect of therapeutic repositioning maneuvers could be clearly observed by watching the markers in the lumen demonstrating the progress of otolith movements with changes in head position relative to gravity.

Evaluation of the effect of acetyl L-carnitine on experimental cisplatin ototoxicity and neurotoxicity.

INTRODUCTION: Cisplatin (CDDP) is an effective and widely used chemotherapeutic agent for pediatric tumors, and ototoxicity is one of the dose-limiting side effects. OBJECTIVE: It was the aim of our study to investigate the effect of acetyl L-carnitine (ALCAR) on experimental CDDP ototoxicity by audiologic tests, histomorphologic, immunohistochemical and ultrastructural examinations and to investigate the apoptotic pathways. MATERIALS AND METHODS: Wistar albino rats (n = 28) were studied. Baseline audiological tests were performed in 4 groups: group 1, control; group 2, ALCAR; group 3, CDDP; group 4, CDDP + ALCAR-administered rats. Control audiological tests were performed on the 3rd day, and then the rats were sacrificed. Ear and brain specimens were examined by transmission electron microscopy, and caspase 3, 8 and 9 activities were investigated. RESULTS: The CDDP-administered rats showed significant auditory brainstem response threshold shifts using all stimuli (clicks, 6-kHz and 8-kHz tone burst) compared with the control groups. The CDDP + ALCAR-administered rats showed significant auditory brainstem response threshold shifts by only click stimuli compared with the control groups. In the brain, spiral ganglion and organ of Corti, ultrastructural damage was prominent in group 3; the number of TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling)-positive cells and caspase 3, 8 and 9 immunostaining cells was significantly high in group 3. CONCLUSION: ALCAR improves CDDP-induced auditory impairment, and also antioxidative and antiapoptotic properties of ALCAR on CDDP ototoxicity were supported by the findings.

Metastatic adenocarcinomas of the temporal bone: a report of three cases.

We reported three cases with adenocarcinomas of the lung, prostate and stomach, which metastasized to the temporal bone. Two of them had proven adenocarcinoma of the lung and stomach, respectively at the time of the diagnosis of the temporal bone tumor. But the other patient had no known primary malignancy when the tumor in the petrous apex was demonstrated radiologically. First he underwent biopsy of the petrous apex lesion and the pathology was reported as malignant; then a probable distant malignancy spreading to the temporal bone was suspected and searched for. Subsequently, his prostate adenocarcinoma was proved with prostate biopsy.

The Relationship Between the Third Window Abnormalities and Inner Ear Malformations in Children with Hearing Loss.

OBJECTIVE: To evaluate the relationship between the third window abnormalities and congenital inner ear malformations in pediatric patients with different types of hearing loss. If such a relationship should exist, it would be important to take it into account, in order to diagnose and treat pediatric hearing loss cases more accurately. METHODS: Two hundred twenty-one children with hearing loss who had temporal bone computed tomography (CT) examination and were identified from 2013 to 2018 were retrospectively evaluated. The types of hearing loss were grouped as sensorineural hearing loss (SNHL), conductive hearing loss (CHL), and mixed hearing loss (MHL). Third window abnormalities included superior semicircular canal (SC) dehiscence, posterior SC dehiscence, enlarged vestibular aqueduct (EVA), X-linked stapes gusher, perilymph fistula, and bone dyscrasias. Congenital inner ear malformations included cochleovestibular, SC, and internal acoustic canal malformations. The relationships were analyzed with chi-square and Fisher's exact tests. RESULTS: In the study, 40 patients had unilateral hearing loss and 181 had bilateral hearing loss. In 402 ears, the rates of SNHL, CHL, and MHL were 88.5%, 6.9%, and 4.4%, respectively. EVA was the most common third window abnormality (41/402; 9.7%), and SC malformations were the most common inner ear malformations (53/402; 13.2%). In the SNHL group, superior and posterior SC dehiscence were associated with cochleovestibular malformations (P = .035 and.020, respectively). In the CHL group, there was a relationship between EVA and SC malformations (P = .041). No relationships were found in the MHL group. CONCLUSION: Third window abnormalities and congenital inner ear malformations may be encountered simultaneously in children with SNHL and CHL.

Our Experience in the Management of CSF Otorrhea: A Transmastoid Approach with Middle Ear Cavity Obliteration and a Middle Cranial Fossa Approach.

In this report, we present two cases of patients with cerebrospinal fluid (CSF) otorrhea who underwent surgical repair through either a transmastoid or middle cranial fossa approach. In our first case, a 34-year-old male after head trauma with conductive hearing loss and a House-Brackmann grade 2 facial palsy was found to have a soft tissue mass protruding through his right tympanic membrane. Radiological examination revealed a wide tegmen tympani defect. He underwent surgery via a transmastoid approach with repair of the defect and blind sac closure of the external auditory canal after middle ear cavity obliteration. Our second case involved a 50-year-old female who had developed chronic clear otorrhea following tympanostomy tube placement. Radiological evaluation revealed a tegmen tympani defect and CSF fistula. She underwent a middle cranial fossa approach in which a multilayer closure technique was performed. These two cases illustrate that the type of surgical approach for the CSF otorrhea repair depends on the location and size of the defect and hearing status. We recommend a multilayer closure to ensure proper resolution of the defect.

Alexander Crum Brown: A Forgotten Pioneer in Vestibular Sciences.

Although vestibular anatomy was described in the Renaissance period, research in vestibular physiology began in the 1820s and was spearheaded by Purkinje and Flourens. This was subsequently expanded by Ménière, Helmholtz, Goltz, Mach, Breuer, Ewald, and Hogyes, who are regarded as the early pioneers in research on vestibular physiology in the 19th century. The relationship of endolymphatic flow and semicircular canal function is termed the Mach-Breuer hypothesis. What is less well known is that a Scottish chemist, Alexander Crum Brown, arrived at similar conclusions as Mach and Breuer at the same time quite independently. In fact, he pioneered several concepts in vestibular physiology that included pairing of semicircular canals for function, the vestibular pathway, optic fixation elimination in vestibular experimentation, the theory of motion intolerance, and study in deaf mutes for insights into vestibular pathology and vestibular compensation. This article is a tribute to this forgotten pioneer in vestibular research.

The Diagnostic Efficacy of MRI in the Evaluation of the Enlarged Vestibular Aqueduct in Children with Hearing Loss.

OBJECTIVE: The aim of our study is to evaluate the diagnostic effectiveness of magnetic resonance imaging (MRI) compared to computed tomography (CT) in the detection of enlarged vestibular aqueduct (EVA) in childhood. METHODS: One hundred twenty-three children who underwent temporal bone CT and MRI examinations for hearing loss between 2013 and 2020 were evaluated retrospectively. All CT and MRI images were examined by two pediatric radiologists, according to the Valvassori and Cincinnati criteria for EVA. Imaging findings on CT and MRI of the vestibular aqueduct were recorded. Two pediatric radiologists performed the measurements for EVA on CT and MRI. In addition, an otolaryngologist performed the measurements independently. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI compared to CT were calculated to detect EVA. The difference between the measurements on CT and MRI was investigated. The inter-observer agreement was evaluated for measurements. RESULTS: The mean age of 123 children (65 boys and 58 girls) was 50.18±50.40 months. Two hundred forty-six ears were evaluated in 123 children. On CT images, EVA was present in 28 (11.3%) of 246 ears according to Cincinnati criteria and 27 (10.9%) of 246 ears according to Valvassori criteria, respectively. While sensitivity, specificity, PPD, and NPD rates of MRI were 100%, 99%, 92.8%, and 100%, respectively, for Cincinnati criteria, for Valvassori criteria, they were 100%, 97.3%, 77.7%, and 100%, respectively. According to the visual evaluation performed without using measurement, the enlarged appearance of the vestibular aqueduct was significant for the diagnosis of EVA (p<0.001), while the absence of this appearance was significant for the exclusion of EVA (p<0.001). There was no significant difference between the measurements on CT and MRI. There was a perfect correlation between the observers for measurements. CONCLUSION: MRI can be used as an initial imaging technique in children with suspicion of EVA to reduce radiation exposure.

The influence of age and language on developmental trajectory of theory of mind in children with cochlear implants.

OBJECTIVE: The present study investigates if children with cochlear implants (CI) are associated with delayed development of Theory of Mind (ToM) and the differences in gain of ToM ability with respect to age, language and other aspects of CI. METHODS: One-hundred-eleven children with participation of their hearing parents, aged between 36 months and 132 months, who had congenital profound bilateral deafness and were unilateral CI users; plus 99 healthy children underwent 'Peabody Picture Vocabulary' and 'Sally-Anne' tests. A total of 77 children with CI (mean age: 76.51 months, 31 girls and 46 boys) and 82 healthy children (mean age: 72.41 months, 47 girls and 35 boys) were included in the analyses. Analytic comparisons were created between the controls and children with CI and between subgroups of CI users by univariate and multivariate analysis. The effects of age of hearing aid use, age of CI surgery, duration of CI use, language scores and the presence of risk factors, early rehabilitation with hearing aid and CI on the ToM development were analyzed. RESULTS: The Sally-Anne test success rates of 67.1% were significantly higher in controls than that of children with CI (49.4%) (p < 0.05). The mean age difference of the children, who were successful in Sally-Anne test was 5.33 months in favor of healthy controls. The ToM task success rates were 57.1% (24/42) and 40% (14/35) in children with early CI and late CI respectively. The children, who were good at language, were also better in Sally-Anne tests, but the mean Peabody Picture Vocabulary test scores were indifferent in the same age group with respect to the presence of CI use (p > 0.05). However, multivariate analysis presented the higher language scores as the only significant independent variable that has impact on the success in Sally-Anne test (p < 0.05). CONCLUSION: The results revealed that among all children, who did better in ToM were older in age and better in language skills. Children with CI also performed better in false-belief test depending on their language scores. Early CI surgery, older age, and hence longer CI use can provide a well-developed ToM for children with CI.

Ophthalmic Abnormalities among Children Treated with Cochlear Implants.

OBJECTIVES: To review the ocular abnormalities in children treated with cochlear implant. MATERIALS AND METHODS: A total of 51 children (29 boys, 22 girls) who were under 18 years old, presented previously with severe to profound hearing loss, and underwent cochlear implantation surgery were included in this study prospectively. A detailed ophthalmic examination, including refraction, best corrected visual acuity, ocular motility, slit-lamp biomicroscopy, and dilated fundus examination, was performed for each patient. RESULTS: Mean age of the patients was 80.10±38.64 (range, 18-168) months. A total of 13 (25.4%) children had at least 1 ophthalmic abnormality. The majority of the detected ophthalmic abnormalities were hyperopia and astigmatism (6 patients had hyperopia, 5 had astigmatism, and 2 had hyperopia plus astigmatism). Strabismus (esotropia) was found in 2 patients, 2 patients had refractive amblyopia, and 2 patients had nystagmus. Moreover, 3 patients had microcornea, 2 patients had cataract, and 1 patient had epiblepharon. Optic disc coloboma (3 patients), choroidal coloboma (1 patient), and pigmentary abnormality (1 patient) were noticed on fundus examination. Congenital rubella syndrome (2 patients), Waardenburg's syndrome (1 patient), and CHARGE syndrome (coloboma, heart defects, choanal atresia, growth retardation, genital abnormalities, ear abnormalities) (1 patient) were also present. CONCLUSION: Children treated with cochlear implant should be consulted with an ophthalmologist to identify any treatable ocular abnormality.

Evaluation of the effect of acetyl L-carnitine on experimental cisplatin nephrotoxicity.

BACKGROUND/AIMS: To evaluate the protective effects of acetyl L-carnitine (ALCAR) on cisplatin-induced nephrotoxicity in rats, and to gain insights into the possible protective mechanisms of ALCAR against nephrotoxicity. METHODS: Twenty-eight Wistar rats were divided into four groups. Group 1 was administered saline only, group 2 was administered ALCAR, group 3 was administered cisplatin, and group 4 was administered ALCAR prior to cisplatin. Rats were sacrificed after 72 h of cisplatin/saline infusion. Serum creatinine and glomerular filtration rate values were obtained, and kidney samples were examined by light and electron microscopy. Apoptotic cell death and caspase-3, 8 and 9 activities were studied immunohistochemically. RESULTS: In group 4, ALCAR administration resulted in an improvement in kidney function tests. Histopathological findings confirmed the biochemical data. Whilst the fusion of the foot processes of podocytes was observed in group 3, they were intact in group 4 on electron-microscopic examination. Apoptotic cell death and caspase-3, 8 and 9 activities were also decreased in group 4 compared to group 3. CONCLUSIONS: Antioxidative, antiapoptotic and anti-inflammatory properties of ALCAR were supported by the findings that this agent improves kidney function tests and has the effects of tissue protection and inhibition of apoptosis in cisplatin-induced nephrotoxicity.