Surgical Methods and Auditory Outcomes of Cochlear Implantation in Cochlear Ossification.

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

The Relationship Between Degree of Nasal Septum Deviation With Sinonasal Structures and Variations.

ABSTRACT: We aimed to evaluate whether the nasal septum deviation affects the development of sinonasal structures. Patients who had undergone paranasal sinus computed tomography (PNS-CT) imaging due to nasal obstruction were divided into 3 groups according to the septal deviation angle; group I: 0° to 9°, group II: 10° to 15°, and group III: >15°. The features of sinonasal structures were recorded when evaluating PNS-CT. There were totally 234 patients, 119 patients in group I, 68 in group II, and 47 in group III. On the opposite side of the deviation, keros 3 was significantly more in group III ( P < 0.001). Although the incidence of concha bullosa and agger nasi cell were not affected by the degree of deviation ( P > 0.05), the incidence of Haller and Onodi cells were significantly higher in group III ( P < 0.001). In addition, all cells were observed more in the opposite side of the deviation in each group ( P < 0.001). Maxillary sinus retention cysts and hypoplasia of maxillary and frontal sinuses, as an indicator of the low pneumatization of the sinuses, are seen more on the same side of nasal septum deviation, increasing with the degree of deviation increases ( P < 0.001). Nasal septum deviation affects the development of sinonasal structures by affecting the pneumatization. Preoperative PNS-CT evaluation is important in order to be aware of the situations that we may encounter during surgery and to provide adequate treatment.

Surgical considerations and audiological results of cochlear implantation in patients with otosclerosis

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

Can MRI-induced silastic casing tear be repaired without the need for cochlear implant replacement?

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

Anatomical and frequencies-specific hearing results of retrograde mastoidectomy.

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

Role of N-acetyl cysteine and acetyl-l-carnitine combination treatment on DNA-damage-related genes induced by radiation in HEI-OC1 cells.

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

Auditory and Histopathological Effects of Topical Mercurochrome Treatment in Rats with Tympanic Membrane Perforation.

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

Audiological Results of Total Ossicular Replacement Prosthesis with Cartilage Shoe Technique.

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

Cochlear Implantation in Postmeningitic Deafness.

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

Waardenburg Syndrome: An Unusual Indication of Cochlear Implantation Experienced in 11 Patients.

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

Speech and language development after cochlear implantation in children with bony labyrinth malformations: long-term results.

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

Pediatric cochlear implant revision surgery and reimplantation: an analysis of 957 cases.

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

Revision stapes surgery.

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

Management of lingual tonsillar hypertrophy using microdebrider.

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

[Evaluation of dysphonia in partial laryngectomy patients]. / Parsiyel larenjektomili hastalarda disfoni degerlendirilmesi.

OBJECTIVES: The purpose of this study was to research and compare the affects of cordectomy, frontolateral laryngectomy or cricohyoidopexy techniques over voice parameters prospectively. PATIENTS AND METHODS: Fifty-six larynx cancer patients (56 males; mean age 59; range 48 to 71 years) whom cordectomy, frontolateral laryngectomy or cricohyoidopexy was applied in S.B. Izmir Training Hospital were included in this study. In the subjective evaluation of the patients voices and RBH scoring, in the aerodynamic evaluation, MPT measurements and in the objective evaluation computerized voice analysis was used. In calculating the dysphonia severity index (DSI), this formula (DSI=0.13xMPT+0.0053xF0 (high)-0.26xI (low)-1.18x jitter (%)+12.4) was used. RESULTS: In the subjective (RBH) evaluation of voices of these three group of patients and their DSI scores, there wasn't any statistically differences among them. When arytenoidectomized patients were evaluated as a separate group, this procedure was found not to have a significant impact over DSI. CONCLUSION: From phoniatric point of view, there wasn't any difference of cordectomy, frontolateral laryngectomy or cricohyoidopexy techniques over voice.

[Long-term results of functional surgery for attic cholesteatoma]. / Attik kolesteatomlu olgularda fonksiyonel cerrahinin uzun dönem sonuçlari.

OBJECTIVES: We evaluated the long-term results of functional surgery for attic cholesteatoma. PATIENTS AND METHODS: In this study, we presented the results of 81 patients (42 males 39 females; mean age 34 years; range 8 to 59 years) who underwent functional surgical techniques for attic cholesteatomas between January 1992 and January 1998. All the patients were followed-up for at least five years. RESULTS: For eradication of attic cholesteatoma, canal wall-down technique tympanoplasty was required in the majority of the patients. After surgery there was a statistically significant hearing improvement in all but four cases. In the postoperative period, residual cholesteatoma and graft perforation were found in five and six patients, respectively. Two patients required revision meatoplasty for problems related with cavity clearance. CONCLUSION: Apart from satisfactory hearing improvement with functional surgery, a successful self-clearance was obtained in mastoid cavities with saucerization and meatoplasty. Canal wall-down tympanoplasty is associated with very low incidences of residual or recurrent cholesteatoma in the majority of patients.

Local anesthesia for middle ear surgery.

The adequacy of anesthesia and comfort during surgery was assessed for 100 consecutive patients undergoing middle ear surgery using local anesthesia, both by the patients themselves and by the surgeon. The possibility of inducing an iatrogenic facial weakness was also evaluated. Both the surgeon and the majority of patients were pleased with the quality of anesthesia and little adverse effects occurred as a consequence of local anesthesia itself.

Non-Hodgkin's lymphoma of the nose and paranasal sinuses: a case report.

Primary non-Hodgkin lymphoma (NHL) of the nasal cavity is a rare neoplasm. They account for about 0.17-2% of all cases of NHL and 5.8% of all malignant neoplasms of the sinonasal region in adults. A 37-year-old male patient presented with left-sided nasal obstruction and headache which appeared a couple of weeks before the admission. Nasal examination revealed a massive polyposis. After medical therapy with corticosteroids, neither the polyposis nor his complaints showed regression; thus, he underwent a nasal polypectomy operation. Biopsy results indicated an inflammatory nasal polyp. Two weeks later, a rapidly progressive facial swelling, especially in the left periorbital area and blurred vision occurred. Second biopsy, which was also taken from the left nasal cavity suggested again an inflammatory nasal polyp. To rule out any possible malignancy, a third biopsy was conducted in the left maxillary sinus which indicated T/NK cell lymphoma of the sinonasal tract.

Causes of dysphonia in patients above 60 years of age.

OBJECTIVES: We evaluated the causes of hoarseness in patients above 60 years of age. PATIENTS AND METHODS: The study included 98 patients (40 females, 58 males; mean age 64 years; range 60 to 77 years) who presented with hoarseness. All the patients were examined by videolaryngoscopy. Temporary hoarseness secondary to respiratory tract infections was excluded. RESULTS: The most common cause of hoarseness was benign vocal fold lesions (28.6%) followed by malignant lesions (27.6%), vocal fold paralysis (25.5%), functional dysphonia (10.2%), and presbyphonia (8.2%). Laryngopharyngeal reflux was found in 13 patients (13.3%). Fourteen male and 11 female patients had paralysis of the recurrent laryngeal nerve. Malignancies that caused hoarseness without paralyzing the vocal folds were larynx carcinoma (n=18), hypopharynx carcinoma (n=8), and multiple malignancy (n=1). CONCLUSION: Our data show that dysphonia develops due to disease processes associated with aging rather than to physiologic aging alone. Considering adverse influences of dysphonia on the quality of life of elderly population, efforts should be directed to elucidation of the cause and to performing appropriate treatment.