Assessment of early language development in Turkish children with a cochlear implant using the TEDIL test.

OBJECTIVES: To analyse language development of children with a cochlear implant (CI) in relation to length of CI use and age at implantation and to examine the suitability of the TEDIL as an assessment tool for measuring early language development in Turkish children. METHODS: A total of 119 children implanted with a CI before 5 years of age were assessed acutely on sound field thresholds, speech recognition thresholds, open-set and closed-set monosyllabic word tests, the TEDIL, categories of auditory performance (CAP), and speech intelligibility rating (SIR). The outcome scores were analysed in relation to length of CI use (3, 4, and 5 years) and age at implantation (<24 months vs. >24 months). The TEDIL scores were compared to all other outcome measures. RESULTS: Scores significantly increased with CI experience. CAP and SIR were significantly higher in the younger implanted group. No significant difference was observed between the younger and older implanted group on the closed-set and open-set monosyllabic tests and the TEDIL. The TEDIL scores significantly correlated with CAP, SIR, and the closed-set and open-set word scores. The mean TEDIL standard score was close to average. CONCLUSIONS: Performance of CI users improves with increased CI experience. CI users implanted <24 months tend to have better auditory skills and clearer speech than CI users implanted >24 months. CI users implanted between 24 months and 60 months tend to develop language similarly to CI users implanted <24 months. The TEDIL is a suitable tool for assessing early receptive and expressive language development in Turkish children.

An effective antioxidant drug on prevention of the necrosis of zone of stasis: N-acetylcysteine.

The zone of stasis, the encircling area of the zone of coagulation, is a critical area which determines the depth and width of the necrosis in burns. Many agents were proposed to salvage the zone of stasis. Due to the known preventive and therapeutic effects of N-acetylcysteine on hepatotoxicity, nephrotoxicity, pulmonary injury, and multiple organ failure in humans, the effect of N-acetylcysteine on saving the zone of stasis was investigated in this experimental study. The effects of N-acetylcysteine administration via oral or intraperitoneal route was compared in a rat comb-burn model. The extent of burn wounds was evaluated by photography and planimetry in the groups. Additionally, skin samples were obtained to analyze malondialdehyde levels to see the antioxidant effect of N-acetylcysteine. In control group (no treatment), the burn areas went to near total necrosis. In intraperitoneal and oral treatment groups, skin survival occurred in the interspace area of the comb. There was no difference between the groups in terms of MDA concentrations. In conclusion, this study showed us the possible saving effect of N-acetylcysteine on the zone of stasis. N-acetylcysteine may be used in the cases of severe burns, not only for its effects on wound healing but also the systemic effects of the drug.

The polymorphisms of the MBL2 and MIF genes associated with Pediatric Cochlear Implant Patients.

OBJECTIVES: Mannose-binding lectin and macrophage migration inhibitory factor gene polymorphisms are associated with several acute/chronic autoimmune or inflammatory diseases. The aim of this study was to investigate if there was any association between mannose-binding lectin 2 (MBL2) and macrophage migration inhibitory factor (MIF) gene polymorphisms and profound congenital sensorineural hearing loss in children who underwent cochlear implantation. METHODS: A total of 62 patients with congenital hearing loss and 80 age- and sex-matched healthy controls were evaluated for codon 54 A/B polymorphisms in MBL2 and the-173 G/C polymorphism in MIF by using the polymerase chain reaction and restriction fragment length polymorphism method. RESULTS: The frequency of the BB genotype of MBL2 and MIF -173 GC genotype were statistically significantly higher in the patient group than in the controls (p=0.0127, p=0.0408, respectively). CONCLUSION: In this study, we found that a subject who is homozygous for the variant allele B of codon 54 of the MBL2and heterozygous for variant allele C of -173 MIF has a risk factor for sensorineural hearing loss.

Intra- and postoperative electrically evoked stapedius reflex thresholds in children with cochlear implants.

OBJECTIVES: The aim of this study was to investigate whether there is a significant correlation between intra- and postoperative electrically evoked stapedius reflex thresholds (eSRTs) in children with cochlear implants. METHODS: Sixty-five pediatric cochlear implant users were included in this study. All patients had congenital prelingual hearing loss. The round window approach was used in all patients. The eSRTs were intraoperatively measured using the 1st, 3rd, 6th and 12th electrodes of the cochlear implant. The measurements taken during the first fitting of the device were taken again one month after surgery. We used paired-sample t-tests to determine the correlation between intra- and postoperative eSRTs. RESULTS: The eSRT analysis revealed a statistically significant difference between the intra- and postoperative thresholds. A correlation analysis did not reveal any correlation between intra- and postoperative eSRTs. CONCLUSION: Intraoperative eSRT measurements were unable to predict early postoperative eSRTs.

Developing a music programme for preschool children with cochlear implants.

UNLABELLED: Although music perception is especially challenging for cochlear implant (CI) users, young CI users' musical perception abilities are improved by participation in structured musical activities. OBJECTIVES: To design, implement, evaluate, and publish a music training programme with a monitoring tool for preschool CI users, for use in family-centred habilitation programmes. METHODS: We devised a programme of musical activities, Musical EARS®, and a curriculum-related hierarchical Evaluation Form to represent performance. The programme included sections on singing; recognizing songs, tunes, and timbre; and responding appropriately to music and rhythm. It was implemented over 18 months at Ilkses Rehabilitation Centre, with 25 paediatric MED-EL CI users split into three groups of varying age, duration of CI use, and ability. RESULTS: Mean total scores increased significantly for all groups. Scores increased unevenly across subscales. Participation in and enjoyment of musical activities increased for both children and parents. Significant correlations were found between scores and length of CI use. DISCUSSION: The training programme effectively enriches child CI users' musical experience. To varying degrees, children learned to perform the Musical EARS® activities. The study allowed us to validate the lesson content and the hierarchical nature of the Evaluation Form. We conclude that prelingually deafened CI users should be systematically involved in musical activities to help them acquire skills acquired more easily by hearing peers.

The comparison of acoustic and psychic parameters of subjective tinnitus.

We aim to assess the correlation between audiometric data, and psychotic and acoustic measures associated with subjective tinnitus (ST) and to clarify the importance of the psychological process in determining the degree of subjective annoyance and disability due to tinnitus. Fifty-four patients experiencing unilateral ST were allocated for the study. Acoustic assessment of patients including LDL (loudness discomfort levels), MML (minimum masking level) and RI (residual inhibition) was performed. Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI) and Visual Analog Scale (VAS) tests were performed for the psychological aspects of subjective annoyance. RI was positive in 23 patients with 13 frequency-matched stimuli at 8,000 Hz. Masking treatment response was successful in 16 RI-positive patients. Mean and standard deviation (SD) of THI scores were 38.77 ± 23.63. Ten patients (%18.51) with tinnitus had ≥ 17 points score, which was significant for BDI. Mean and SD were 5.01 ± 2.31 for VAS-1 scores (severity of tinnitus), 7.98 ± 2.79 for VAS-2 (frequency and duration of tinnitus), 5.77 ± 2.72 for VAS-3 (discomfort level), 3.56 ± 3.30 for VAS-4 (attention deficit) and 3.31 ± 3.31 for VAS-5 (sleep disorders). A significant correlation was found between the tinnitus duration time, age, gender and THI scores (P < 0.05). There were statistically significant correlations between VAS 1, 2, 3 scores and LDL, MML and RI (P > 0.05). RI might be largely frequency dependent and was found as an indicator for the masking treatment response. We did not notice statistically significant correlations between audiometric data and THI and BDI. There were correlations between with VAS and LDL and with MML and RI. VAS was simpler and easier for the assessment of ST. We should consider the psychological aspects of ST and assess it as a symptom separately with acoustic and psychotic tests.

Significance of serotonin transporter gene polymorphism in tinnitus.

OBJECTIVES: To assess the role of serotonin transporter gene (SLC6A4) polymorphism in tinnitus. MATERIALS AND METHODS: Fifty-four consecutive patients experiencing subjective tinnitus and 174 healthy controls were allocated for the study. Psychoacoustic parameters of tinnitus were measured. Beck Depression Inventory was used to assess the depression level of the patients. Tinnitus Handicap Inventory was used to assess the severity of tinnitus. A visual analog scale was designed to measure the impact of tinnitus on quality of life of the patients. The 44-bp insertion-deletion in the promoter region (5-HTTLPR) and 17-bp variable number tandem repeats in the second intron of the serotonin transporter gene were assessed. RESULTS: No difference was found between the genotypes and allele frequencies of the patients and controls regarding variable number tandem repeats and 5-HTTLPR polymorphisms (p > 0.05). There was no association between the psychoacoustic parameters of tinnitus and SLC6A4 polymorphism (p > 0.05). There was a significant association between the 5-HTTLPR polymorphism and scores from the visual analog scale of the patients (p < 0.05). CONCLUSION: Generation of tinnitus signal is not associated with SLC6A4 polymorphism and possibly with serotonergic mechanisms. However, the "ll" genotype variant of the SLC6A4 polymorphic promoter region seems associated with the limbic and autonomic nervous system symptoms of the patients with tinnitus. Therefore, serotonergic mechanisms may help explain the neurophysiological model of tinnitus, and serotonin replacement or serotonin reuptake inhibitors may increase the success rate of tinnitus treatment modalities based on the neurophysiologic model of tinnitus.

Comparison of two different vascular delay methods in a rat cranial epigastric perforator flap model.

The effectiveness of vascular delay in transverse rectus abdominis muscle flaps has been demonstrated in many studies. In deep inferior epigastric perforator flaps, however, the effectiveness of ligation of deep versus superficial epigastric vessels in producing delay is unclear. Using a rat model, we compared ligation of deep and superficial vessels with each other and with a (nondelayed) control group (n = 10). One vascular delay group (n = 10) had ligation of the contralateral cranial epigastric vessels (homolog to the human deep inferior epigastric vessels); the other (n = 10) had ligation of contralateral superficial inferior epigastric vessels. One week later, cranial epigastric perforator flap elevation was performed. Both vascular techniques were effective in producing delay, and there was no statistically significant difference between the 2 groups. Ligation of superficial inferior epigastric vessels, deep inferior epigastric vessels, or both, at least 1 week prior to the deep inferior epigastric perforator flap elevation may increase the usable skin paddle area in humans.

An alternative method of using an interpositional silicone sheet in tissue expansion.

To reduce the rate of complications in tissue expansion, we placed a silicone sheet between the expander and the tissue above it in a rat model. In the rats in group 1 (n = 10), the expanders were placed under the dorsal skin. The expanders were inflated with up to 45 mL of saline solution. In group 2 (n = 10), a silicone sheet was inserted between the tissue expander and the skin, after which the procedure used in group 1 was performed. The blood flow was reduced at the dome (center [C]) of the expanders in groups 1C and 2C to a degree greater than that in the expanded skin in groups 1 and 2 far periphery. However, the flow was significantly better in group 2C than in group 1C. Histologic analysis showed that the dermal and capsular tissues were significantly thicker in group 2C than in group 1C. In our opinion, placing a silicone sheet between the expander and the tissue above it seems to be beneficial. This may reduce the incidence of complications, especially the expander extrusion in this model.

Intranasal porous polyethylene implant extrusion 7 years after insertion in a patient with Hashimoto disease.

We report a case of intranasal porous polyethylene implant extrusion 7 years after insertion in a patient with Hashimoto disease. We also discuss the possible causes of the extrusion and convey the histopathologic examination and microbiological investigation results of the samples taken from the removed implant.

7-plasty technique for the surgical treatment of congenital longitudinal ear lobe cleft.

The ear lobe plays an important part in the aesthetic appearance of the auricle. The clefts of the ear lobe may vary in a wide range of severity from a simple notching to extensive tissue deficiency. We have operated on a congenital longitudinal ear lobe cleft using an alternative surgical method and obtained a favorable result. This method consists of a 7-plasty (or inverted L-plasty) that was performed to correct the deformity. The inner edges of the lobes were excised, and a medial extension incision was added. This helped to drop the medial part inferiorly like a back-cut so that the length of that lobe was increased. Eversion of the lateral lobe was also done, and the edges were approximated so that the angle between the extension incision and the excision line was increased to produce an obtuse angle between the 2 lines. We report an alternative method of reconstruction that can be used in longitudinal ear lobe clefts that offers a favorable result.

Double opposing rectangular advancement elongates tension line as much as Z-plasty: an experimental study in the rat inguinal skin.

PURPOSE: Z-plasty is a well-known and commonly used local flap technique in the treatment of contracture bands. Double opposing rectangular advancement is a new and alternate local flap design which can be used in the treatment of wide and linear postburn scar contractures. The technique consists of opposition of two adjacent rectangular flaps by advancement. This experimental study compares lengthening provided by Z-plasty and double opposing rectangular advancement. MATERIALS AND METHOD: Lower extremities of 10 male Sprague-Dawley rats were strained by hanging 400 g of weight to provide tension lines over both inguinal areas. We planned Z-plasty with 2 cm central limb and with 60 degrees angles to the inguinal tension line on one side. On the other side, we sketched double adjacent rectangular flaps with 2 cm long axis and 1cm short axis over the tension line. Triangular flaps were elevated over the muscle, transposed and sutured in Z-plasty. Rectangular flaps were incised down to the muscle, advanced and opposed to each other before suturing. The final lengthening provided by both techniques were measured and the results were statistically analysed. RESULTS: Both Z-plasty and double opposing rectangular advancement techniques were effective in relief of tension over both inguinal areas and in lengthening the tension lines. Z-plasties provided lengthening ranging between 4 and 4.6 cm. The difference between pre- and post-operative (Delta) measurements in Z-plasty ranged between 2-2.6 cm (mean+/-standard deviation=2.26+/-0.24 cm). The lengthening provided by double opposing rectangular advancement were between 3.9 and 4.5 cm and the Delta measurements ranged between 1.9 and 2.5 cm (mean+/-S.D.=2.22+/-0.22 cm). Statistical analysis revealed that the elongation provided by both techniques are not significantly different from each other (p>0.05). CONCLUSION: Double opposing rectangular advancement technique elongates a tension line as much as Z-plasty in the rat inguinal skin.

Effects of different preservation solutions on skin graft epidermal cell viability and graft performance in a rat model.

This study sought to evaluate the viable epidermal cell count of skin stored at 4 degrees C in different media, and to determine the longest time that grafts could be stored and still be used for clinical application of skin grafts. Harvested rat skin grafts were divided into four groups: saline (group 1), Roswell Park Memorial Institute-1,640 solution (RPMI) (group 2), University of Wisconsin solution (UW) (group 3), and Histidine-tryptophan-ketoglutarate solution (HTK) (group 4). After the designated storage time (7, 14, 21, 28, or 35 days), grafts were divided into two parts. Skin grafts (3 cm x 3 cm) were then autotransplanted onto full-thickness circular wound beds. Percentages of viable keratinocytes (PVK) declined significantly for skin grafts stored in UW, HTK, and saline solutions (Kruskal-Wallis, P<0.05), while there was an insignificant decline in the PVK of skin grafts stored in RPMI until the 28th day of storage (Kruskal-Wallis, P>0.05). Compared with UW, HTK, and saline, grafts stored in RPMI had significantly higher percentages of PCNA at the 14th and 21st days of storage (Mann-Whitney U-test, P<0.05). Grafts stored in RPMI had significantly lower apoptosis rates than did grafts stored in UW or HTK (P<0.05). Based on these results, we conclude that RPMI-1640 provides a better environment for skin grafts by increased quality and survival time of skin grafts, as assessed by both microscopic and macroscopic investigations.