Patients with Mondini deformty: is standard electrode necessary?

PURPOSE: The aim of this study is to compare the results of auditory perception tests and speech sound evaluations with electrode array length in patients with Mondini deformity. METHODS: The study included 14 patients who underwent cochlear implantation and radiologically confirmed Mondini deformity between 2007 and 2021 in our clinic. While 7 patients received standard electrode arrays from the MED-EL brand, the remaining 7 received shortened electrode arrays from the MED-EL brand. Differences in auditory perception, articulation, and speech intelligibility between the two groups were examined. Auditory perception tests were administered to these patients preoperatively and at least 2 years after cochlear implant surgery. The patients' auditory perception performance was evaluated using single, double, and triple closed-set word tests (MTP-3, MTP-6, MTP-12), two-syllable open-set word test, Glendonald Auditory Screening Procedure (GASP) tests for articulation, Phonemic Synthesis Test (SST) for phonemic knowledge, and Speech Intelligibility Rating (SIR) test for speech intelligibility. RESULTS: Both groups did not show statistically significant differences in auditory perception tests (MTP-3, MTP-6, MTP-12, two-syllable open-set word test), speech sound tests (SST), and speech intelligibility test (SIR). Significant improvement was observed in all tests in both groups when compared preoperatively and postoperatively. CONCLUSION: No significant difference was observed in auditory perception and speech sound tests between groups with short and standard electrode arrays in patients with Mondini deformity. The option of using short electrode arrays during implantation in patients with Mondini deformity can be preferred without doubt in terms of outcomes.

Middle Ear Adenomatous Neuroendocrine Tumor: A Case Report and Review of Literature.

Middle ear adenomatous neuroendocrine tumor (MEANT) is a rare entity and accounts for approximately 2% of all middle ear tumors. Histologically, the presence of neuroendocrine and glandular structures has led to the use of a wide variety of terminologies such as adenoma, carcinoid tumor, and neuroendocrine tumor. The patients usually have nonspecific symptoms such as unilateral hearing loss, auditory fullness, tinnitus, and otalgia. There is no specific radiological finding. A definitive diagnosis is based on complete removal of the tumor and combined histopathology and immunohistochemical examination. In this case-report, we describe a patient with MEANT who complained of hearing loss and auditory fullness in her left ear. Otomicroscopy revealed a mass of polypoid tissue filling the left external auditory canal. In the pure tone audiometry test, the pure-tone average was reported as L45/5 R10/0, and the tympanogram was type B on the left ear. In temporal bone computed tomography, the soft-tissue mass located in the middle ear was found to extend to the antrum and the external auditory canal. Biopsy taken under local anesthesia from the visible mass in the external auditory canal was reported as MEANT and the diagnosis was confirmed by histopathology and immunochemistry after surgery.

Use of Neutrophil-To-Lymphocyte and Platelet-To-Lymphocyte Ratio to Predict Early Postoperative Periorbital Edema and Ecchymosis After Primary Septorhinoplasty.

PURPOSE: To investigate the benefit of preoperative neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in predicting early postoperative periorbital edema and ecchymosis in patients undergoing primary septorhinoplasty. METHODS: Sixty patients in ASA-I (American Society of Anesthesiologists) who were scheduled for elective primary septorhinoplasty were prospectively included in the study. Periorbital edema and ecchymosis levels of the patients were scored on the postoperative second day. The relationship between early postoperative periorbital edema and ecchymosis levels and preoperative neutrophil, lymphocyte, platelet, NLR, and PLR values were investigated. RESULTS: The mean age of the 60 patients was 24.05 ± 6.83 years. The patients were divided into 2 groups according to the total periorbital edema scores in both eyes on the second day after surgery. There was no significant difference between the two groups in terms of neutrophil, platelet, and NLR ( P > 0.05). In addition, the lymphocyte count was found to be statistically significantly lower and PLR significantly higher in the group with high edema scores ( P < 0.05). When the patients were divided into groups according to their periorbital ecchymosis scores, no significant correlation was found between any blood values and periorbital ecchymosis ( P > 0.05). CONCLUSION: Preoperative PLR may be used to predict early postoperative periorbital edema in patients undergoing primary rhinoplasty. However, a blood value that can predict periorbital ecchymosis has not been determined yet.

How useful is electrocardiography in children with cochlear implantation?

OBJECTIVES: Hearing loss is an important health problem in children and cochlear implantation is used in its treatment. In addition, in children with hearing loss, accompanying renal, neurological, structural and cardiac conductive pathologies can often accompany. In this study, it was aimed to evaluate the electrocardiographic findings, especially QT duration in children who underwent cochlear implantation. METHODS: The data were obtained from the medical records of our hospital, which is a tertiary referral cochlear implant center. All children who had cochlear implantation surgery due to sensorineural hearing loss and admitted to our hospital for speech therapy between 2019 and 2020 were evaluated with 12-channel ECG. RESULTS: Sixty children (15 girls and 45 boys) with a mean age of 6.5 years were analyzed. Children with a history of heart disease were excluded. In cardiac examinations, five (8.3%) had systolic murmur, four (6.6%) had mid systolic click, and two (3.3%) had stiffening in the first heart sound. Abnormalities were detected in 25% (n = 15) of the electrocardiograms. The most common ECG abnormalities were prolonged QT in 4 cases, left ventricular hypertrophy in 3 cases, left axis deviation in 2 cases, and T wave changes in 2 cases. Long QT syndrome (3.3%) was diagnosed in 2 of the cases with long QT. CONCLUSION: This study demonstrates the need for electrocardiography and cardiac examinations in children undergoing cochlear implantation for hearing loss. These cases should be evaluated especially in terms of the presence of cardiac arrhythmias and potential for fatal ion channelopathy.

Do the Age of Implantation, the Widths of Internal Acoustic Canal and Bony Cochlear Nerve Canal Affect the Auditory Performance of Primary School Children with Bilateral Cochlear Implants?

Objective: To reveal the correlation between implantation age, the internal acoustic canal (IAC) width, bony cochlear nerve canal (BCNC) width, and auditory performance in primary school children with bilateral cochlear implantation (CI). Methods: Preoperative IAC and BCNC widths of 57 pre-lingually deaf children aged 7-11 years who had previously undergone bilateral CI in our institution were reviewed and cut-off values were calculated. Twenty-four patients who had additional problems and could not attend school and those who refused to participate in the study were excluded. The remaining 33 were invited to the hospital, and their speech perception tests, and language development scores were analyzed (16 of 33 patients had been operated on before the age of 24 months). Results: The cut-off values calculated from the 114 ears of 57 patients were 3.86 mm for IAC width and 1.56 mm for BCNC width. The auditory performances of the 33 patients after CI were not significantly different in the narrow and normal width groups. However, speech perception test results, and language development scores of patients implanted before the age of 24 months were significantly higher. Conclusion: There are some studies showing that children with bilateral sensorineural hearing loss have narrower IAC and BCNC widths. However, we concluded that the widths of the IAC and the bone cochlear nerve canal did not affect auditory performance. We found that implantation age is the single most important determinant of speech-language development after CI.

Long-Term Effects of Metal-on-Metal Cobalt-Chromium-Containing Prostheses Used in Total Knee Arthroplasty on Hearing and Tinnitus.

Objectives: We aimed to determine the long-term effects of metal-on-metal (MoM) cobalt (Co)-chromium-containing prostheses used in total knee arthroplasty (TKA) on hearing and tinnitus. Methods: A total of 88 patients with the normal otoscopic examination and normal blood B12 levels, consisting of 44 patients who had been using MoM Co-chromium-containing total knee prosthesis for more than 5 years, and 44 non-implanted patients with similar demographic characteristics, were randomly selected and included in the study. Patients with previous ear surgery, chronic middle ear disease, or conductive hearing loss were excluded from the study. All participants were evaluated with pure-tone audiometry (PTA), distortion product otoacoustic emission (DPOAE), tinnitus handicap inventory (THI), and tinnitus reaction questionnaire (TRQ). Results: The mean age of the 88 patients was 67.22±10.4 years. The mean age of 44 patients who underwent TKA at least 5 years ago was 72.89±7.18 years, 75% of these patients had bilateral prostheses, and the mean prosthesis duration was 11.00±5.08 years (range 5-25). The two groups were compared statistically using PTA, DPOAE, THI, and TRQ scores. When the patient groups with and without prostheses were compared in terms of hearing and tinnitus, we did not find a significant difference between the two groups (p>0.05). Conclusion: In our study, we observed that the long-term use of MoM Co-chromium total knee prostheses did not have an ototoxic effect, contrary to what was believed. We also found that prolonged prosthesis duration or undergoing bilateral surgery did not worsen hearing and tinnitus.

Cochlear Implant Complications in a Tertiary Referral Center in Istanbul.

OBJECTIVE: All surgeons should inform the patients about complications and also their clinic's complication rates of cochlear implantation (CI). We aimed to review the complications of CI in 1,148 pediatric and adult patients. METHODS: It is a retrospective case review study enrolled in a tertiary referral center in Istanbul where CI was mostly performed. A total of 1,148 pediatric and adult CIs (unilateral or bilateral CI and revision surgery) performed by the same experienced surgeon in our institution were examined. Complications were noted as major and minor. RESULTS: The mean age of first CI of 702 children and 157 adult patients was 10.2 years (1-75 years). The overall complication rate was 13.68%, comprising 8.28% of minor and 5.4% of major complications. Swelling (wound seroma or hematoma) was the most common minor complication. The most common cause of major complications was related to implanted devices. Despite the high rates of minor complications in children, there was no statistically significant difference between children and adults (p = 0,194). CONCLUSIONS: Our clinic has a low major complication rate. Surgeons should be aware of postoperative complications, apply appropriate procedures, and inform patients about their surgical complication rates.