Bone-Anchored Hearing Implants: Surgical and Audiological Comparison of Different Surgical Techniques

Abstract Introduction The bone-anchored hearing implant system (BAHS) is an effective amplification system that transmits the sounds received by an external operating system to the inner ear by bypassing the middle ear placed in the temporal bone. Objective This study compares the results of patients who underwent bone-anchored hearing implant system (BAHS) surgery using two different surgical methods in terms of preoperative and postoperative complications, surgical time, audiological findings, and patient satisfaction. Methods The results of 22 patients who underwent BAHS were evaluated retrospectively from video records and audiological results, The Turkish Version of the Glasgow Benefit Inventory (GBI) questionnaire were evaluated. Two different surgical approaches were used for implantation: the linear incision technique (n = 9) and the punch technique (n = 13). Results Mean surgical durations were 9.67 ± 2.85 and 47.65 ± 6.13 minutes for Groups A and B, respectively, and these were significantly different (p < 0.001). There were no significant differences between the groups' speech recognition scores for a signal-to-noise ratio (SNR) of +5 (p = 0.173), SNR of 0 (p = 0.315), or SNR of -5 (p = 0.360) and results of the GBI scores. Conclusion The punch technique has a significant advantage due to a shorter surgery duration without increased surgical complications. Additionally, the punch technique showed no significant difference in hearing performance or satisfaction compared with linear incision.

Bone-Anchored Hearing Implants: Surgical and Audiological Comparison of Different Surgical Techniques.

Introduction The bone-anchored hearing implant system (BAHS) is an effective amplification system that transmits the sounds received by an external operating system to the inner ear by bypassing the middle ear placed in the temporal bone. Objective This study compares the results of patients who underwent bone-anchored hearing implant system (BAHS) surgery using two different surgical methods in terms of preoperative and postoperative complications, surgical time, audiological findings, and patient satisfaction. Methods The results of 22 patients who underwent BAHS were evaluated retrospectively from video records and audiological results, The Turkish Version of the Glasgow Benefit Inventory (GBI) questionnaire were evaluated. Two different surgical approaches were used for implantation: the linear incision technique ( n = 9) and the punch technique ( n = 13). Results Mean surgical durations were 9.67 ± 2.85 and 47.65 ± 6.13 minutes for Groups A and B, respectively, and these were significantly different ( p < 0.001). There were no significant differences between the groups' speech recognition scores for a signal-to-noise ratio (SNR) of +5 ( p = 0.173), SNR of 0 ( p = 0.315), or SNR of -5 ( p = 0.360) and results of the GBI scores. Conclusion The punch technique has a significant advantage due to a shorter surgery duration without increased surgical complications. Additionally, the punch technique showed no significant difference in hearing performance or satisfaction compared with linear incision.

Evaluation of Effects of the Human Immunodeficiency Virus on the Vestibular System by Using the Video Head Impulse Test.

OBJECTIVE: Some studies have suggested that the human immunodeficiency virus causes dizziness and other balance problems; however, the exact effects on the vestibular system in acute and chronic phases of the disease are not clear. In this study, we aimed to evaluate the effect of the human immunodeficiency virus on semicircular canals using a video head impulse test. MATERIALS AND METHODS: Seventy-two cases were included in the study. Twenty-six of the cases had positive human immunodeficiency virus RNA (group A) and 22 had negative human immunodeficiency virus RNA with positive anti-human immunodeficiency virus (group B) laboratory results. Twenty-four of the cases were healthy individuals (group C). The vestibular system was evaluated with a video head impulse test in all cases. RESULTS: In the evaluation of overt/covert saccades, a statistically significant difference was detected for the left posterior semicircular canal between group B and the other 2 groups. However, this was considered an incidental finding and not a clinically significant result. There was no other significant difference in the catch- up saccades for other canals. In addition, there was no statistically significant difference between the groups for the vestibulo-ocular reflex gain. CONCLUSION: Although the human immunodeficiency virus has been reported to be vestibulotoxic in previ- ous studies, we found that the video head impulse test findings were not affected in our patient groups. Because the video head impulse test is considered a high-frequency test of vestibulo-ocular reflex, it is pos- sible that vestibular effects of the human immunodeficiency virus can be confined to low frequencies. It is also possible that HIV affects the central structures while sparing the peripheral vestibular pathways.

The Effect of Platelet-Rich Fibrin and Hyaluronic Acid on Perforation of Nasal Septum.

BACKGROUND: Conservative approaches and surgical methods have been tried for the treatment of nasal septum perforations (NSPs), but a satisfactory method has not yet been determined. OBJECTIVE: Our study aimed to investigate the effect of platelet-rich fibrin (PRF) and hyaluronic acid (HA) in repairing NSPs, which were experimentally created in rabbit septum. METHODS: A total of 36 white New Zealand rabbits were included in the study. Perforations measuring 0.7 × 0.7 cm were created in their nasal septa. No additional intervention was made to the control group, which was the first group. For the second, third, and fourth groups, respectively, HA, PRF, and HA + PRF were used in the NSP region. Macroscopic and histopathological evaluations were performed after 40 days. RESULTS: In the first group, closure was observed in none of the rabbits' NSPs. In the second group, 6 rabbits (66.7%) had full closure in their NSPs. In the third group, the NSP of 6 rabbits (66.7%) was completely closed. In the fourth group, the NSP of 7 rabbits (77.8%) had full closure. CONCLUSION: Statistically significant closure was achieved with PRF and/or HA in rabbits in which NSP was established. These materials can be used to increase the likelihood of perforations closing.

Primary T-Cell Lymphoma of the Parotid Gland.

Primary malignant lymphomas of parotid gland are very rare. Most are B-cell lymphomas, and T-cell lymphomas are very rare. Unfortunately, fine needle aspiration biopsy is non-diagnostic. We, herein, present a case of a 51-year male, who presented with a large mass in the left parotid gland that had rapidly grown over a few months. As fine needle aspiration biopsy was non-diagnostic, we decided to take an incisional biopsy to disclose the pathology. The lesion was diagnosed as T-cell lymphoma after immunohistochemical examination of the specimens. Following 2-[18F] fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT), the disease was staged as 'Stage I'. The patient received six sessions of cyclophosphamide, doxorubicin, vincristine and prednisone protocol as chemotherapy management. After the completion of chemotherapy, complete remission was achieved. In suspected cases, an incisional open parotid core biopsy should be considered for a definite diagnosis. As the treatment of lymphomas is not surgical, this approach avoids a parotidectomy, which in turn, avoids facial nerve complications. Key Words: T-cell lymphoma, Parotid gland, Malignant lymphoma, Incisional biopsy, Fine needle aspiration biopsy.

Does COVID-19 have an impact on hearing?

BACKGROUNDS: SARS-CoV-2 is known to be a neurotrophic virus. However, the effect of this virus on the hearing system is still uncertain. OBJECTIVES: We aimed to investigate the possible effect of COVID-19 on hearing. MATERIALS AND METHODS: Thirty healthcare workers who had COVID-19 after hearing evaluation with pure tone audiometry (PTA) for any reason in the last 1 year were included in the study. PTA and transient evoked otoacoustic emissions (TEOAE) tests were performed in 15 of 30 patients during the active infection period. For all 30 patients, otoscopic examination plus PTA and TEOAE tests were performed at the end of the first month after their treatment. RESULTS: When the PTA results of 30 patients (60 ears) before and after COVID-19 were compared, a significant decrease in hearing level was found only at 1000 Hz (p < .05). There were no significant differences at other frequencies. When the PTA and TEAOE test results of 15 patients (30 ears) that were performed during and after COVID-19 were compared, no significant differences were found. CONCLUSION AND SIGNIFICANCE: We conclude that COVID-19 may cause hearing loss. However, this result needs to be confirmed with comprehensive studies to be conducted in larger patient groups.

Prevalence of and factors affecting otitis media with effusion in children in the region from Balkans to Caspian basin; A multicentric cross-sectional study.

OBJECTIVE: The aim of our study was to contribute to the literature about the prevalence of OME by conducting a research in a wide geography examining most of the associating factors together with a questionnaire. Additionally, possible effects of altitudes and latitudes, concordance between the otoscopic examination findings and tympanometric and acoustic reflex test results were evaluated in 4-7 years old children in the same season in different countries. METHODS: In the randomly sampled schools from different regions of different cities where people of different scoioecomonic statuses live, 4-7 year-old children were included in the study. The results of the questionnaire covering the potential factors in OME etiology were evaluated together with the results of the otoscopic examination and tympanometry findings, and also the acoustic reflex findings to direct the interpretation in cases of low amplitude - blunted peak tympanograms which can be interpreted as a "Type B" or "Type As". All the results were gathered in the same season. RESULTS: Ten centers from nine countries participated in the study. A total of 4768 children were evaluated. The frequency of OME diagnosed by otosopic examination was 22.48% (n=1072) and the diagnosis rate when otoscopic examination plus type B tympanometry were taken into account was found as 11.3% (n=539) in general population. Factors increasing the prevalence of OME were found as; mother's educational level (p=0.02), child's age (p=0.006), history of upper respiratory tract infection (p=0.001), smoking father (p=0.01), mother being a housewife or laborer (p=0.01), history of allergy (p=0.001), asthma (p=0.04), or allergy symptoms (p=0.02). No direct relationship was found between altitudes or latitudes and prevalence of OME. CONCLUSION: The important affecting factors found after analyzing all of the potential risk factors in the same model are secondhand smoke exposure, low level of mother's education, mother's occupation, positive history of URTI, and age of the child being less than 7. By paying attention to the factors that increase the prevalence of OME, putting particular emphasis on the preventable ones such as smoking, education, and fighting with allergies could decrease the prevalence of this public health issue.

SARS-CoV-2 Presence in Cerumen.

The emergence of a new coronavirus strain (SARS-CoV-2) in December 2019 from China led to a global pandemic. The lack of herd immunity against this virus and the possibility of viral spread from asymptomatic individuals is still a major challenge for the prevention of viral transmission. The studies of Islamoglu and Hanege evaluated the presence of the virus in different bodily secretions (Cerumen) as a potential source of viral spread among patients infected with SARS-CoV-2. We would like to comment on these 2 studies.

Are long-term auditory results following ossiculoplasty with bone cement as successful as early-middle period results?

PURPOSE: Bone-cement (BC) ossiculoplasty is one of the options to solve ossicular chain problems. Many authors reported successful results in the early or mid-follow-up period; however, there is no long-term result in the literature. We aim to evaluate long term results of BC ossiculoplasty. MATERIALS AND METHODS: Forty-eight patients who underwent BC ossiculoplasty as incudostapedial re-bridging by the same surgeon were invited to evaluation. Postoperative otomicroscopic examination was performed. Pre-operative and post-operative audiological results after longer follow up and graft success rate were noted. RESULTS: Fourteen patients came for control examination. The follow-up period was between 87 and 135 months (mean 102 months). None of the patients had graft failure. Ten patients had early postoperative follow-up results (between 10 and 52; mean 24 months). In the comparison of preoperative and early postoperative air-bone gap, there were significant differences in all frequencies while the comparison of preoperative and long-term postoperative results showed a significant difference only in 250 and 500 Hz. Early postoperative results were better than late with significant difference only in the 2000 and 4000 Hz. CONCLUSIONS: As reported by many studies, bone cement application provides a significant auditory improvement in the early postoperative period. The results of the present study showed that this early auditory success may decrease over time with a long-term follow-up. Further studies should be conducted with larger patient groups to clarify the long-term benefits of this treatment and possible causes for its deterioration.

Detection of human immunodeficiency virus (HIV) RNA in the sweat of HIV-infected patients.

OBJECTIVE: Human immunodeficiency virus (HIV) infection is a significant health problem. Many studies reported that HIV was mainly transmitted through parenteral exposure, sexual activity, and body secretions, such as saliva and semen. Many people, including health-care providers and patient relatives, may easily contact with the sweat of HIV-infected patients. Although reference books assert that HIV does not transmit through sweat, to our knowledge, there is no systemic study which this statement is based upon. This study aims to investigate the potential of sweat to transmit HIV infection. METHODS: This study included 31 treatment-naive HIV RNA-positive patients who were in the acute phase of the infection and 26 subjects with a negative HIV RNA test who had received antiviral treatment. A total of 57 sweat samples collected from intact skin areas were prospectively evaluated by polymerase chain reaction (PCR) for the presence of HIV RNA. HIV RNA levels in the blood samples were also noted. RESULTS: HIV RNA was not detected by PCR in any sweat sample taken from HIV-infected HIV RNA-negative and -positive subjects. CONCLUSION: The findings obtained in this study suggest that sweat by itself has no potential for transmitting HIV infection.

In Vitro Investigation of the Antibacterial Activity of Nigella sativa Oil on Some of the Most Commonly Isolated Bacteria in Otitis Media and Externa.

OBJECTIVE: This study aimed to evaluate the antibacterial efficacy of Nigella sativa (NS) seed oil against the most frequently isolated infectious bacteria of the middle and external ear. MATERIALS AND METHODS: The in vitro antibacterial activity of NS oil was evaluated against 34 clinical isolates of Streptococcus pneumoniae, 32 clinical isolates of Moraxella catarrhalis, 32 clinical isolates of Haemophilus influenzae, and 32 clinical isolates of Pseudomonas aeruginosa. Staphylococcus aureus, Escherichia coli, and P. aeruginosa were also evaluated for their sensitivity to the NS oil. The minimum inhibitory concentration (MIC) of the NS oil was determined via a broth dilution technique. Serial solutions were prepared in a Mueller Hinton-F broth to achieve an ultimate concentration of NS oil within the microplate wells ranging from 256 µg/mL to 0.25 µg/mL. The growth control wells and medium were used for each bacterial strain, and the microplates were incubated at 35°C for 24 h. Those wells having no visible growth and the lowest concentration of NS oil were accepted as showing the MIC. RESULTS: In this study, a comparison was made between NS oil and the various antibiotics known to be effective against the bacterial strains mentioned above. The NS was shown to have bactericidal activity against H. influenzae, M. catarrhalis, and S. pneumoniae. However, the NS was not found to be effective against P. aeruginosa at any concentration. CONCLUSION: The results of this laboratory-based study support the use of NS oil as an alternative treatment for ear infections. However, it is necessary to conduct clinical studies to evaluate the antibacterial efficacy of NS oil on patients with ear infections.

The bacteriome of otitis media with effusion: Does it originate from the adenoid?

OBJECTIVE: The aim of this study was to evaluate the composition and the diversity of bacteriome in middle ear effusion (MEE) and adenoid specimens of pediatric patients having otitis media with effusion (OME). MATERIALS AND METHODS: Sample collection from children with OME followed by next generation sequencing. Seventeen adenoid and 43 middle ear effusion specimens from 25 children having OME were evaluated. Microbiome analysis was performed via Ion 16S rRNA metagenomics kit. RESULTS: Twenty-two different bacterial species were identified from all of the samples analyzed. There were variations in the prevalence and relative abundance of the bacteriome observed between adenoid and MEE samples. MEE microbiome was significantly dominated by Alloicoccus otitis (44%), Turicella otitidis (6%), and Staphylococcus auricularis (3%). Whereas, Rothia mucilaginosa (39%), R. dentocariosa (11%), S. aureus (5%), Veillonella rogosae (2%), Granulicatella elegans (2%), Granulicatella adiacens (2%), Eikenella corrodens (1%), and Prevotella nanceiensis (1%) had significantly higher relative abundance in adenoid samples. Overall, there was no statistically significant difference in alpha diversity of MEE and adenoid samples, whereas adenoid samples constituted a cluster in the beta diversity graph. CONCLUSION: Bacteriome of MEE is mostly dominated by A. otitis yet accompanied by other bacteria with lower relative abundances suggests that OME is likely to be a polymicrobial process. Despite similarities, significant differences in relative abundances of several predominant species between bacteriome in the MEE and adenoid put the theory that OME in children is originated from the adenoids under question.

Ossicular chain erosion in chronic otitis media patients with cholesteatoma or granulation tissue or without those: analysis of 915 cases.

PURPOSE: The aim of this study was to evaluate the ossicular chain erosions (OCE) in chronic otitis media patients with cholesteatoma (COM-C) or without cholesteatoma (COM). MATERIALS AND METHODS: The OCE and preoperative hearing levels of a total of 915 patients were evaluated retrospectively. Patients were divided into three groups. Of the 915 patients, 615 (67.2%) had COM, 234 (25.6%) had COM-C, and 66 (7.2%) had chronic otitis media with granulation tissue (COM-G). RESULTS: OCE was found in 291 (31.8%) of 915 patients. OCE was found in 192 (82%) of 234 patients with COM-C, 21 (31.8%) of 66 patients with COM-G, and 78 (12.7%) of 615 patients with COM. CONCLUSION: The most commonly seen OCE was incus erosion, followed by stapes and malleus erosions. The results of this study show that there are more OCE in the COM-C group than in the COM-G and COM groups. To our knowledge, this study has the widest patient population in the literature focused on the OCE relation with COM, COM-C, and COM-G and its effect on the preoperative hearing level.

Antimicrobial Activity of Garlic Derivatives on Common Causative Microorganisms of the External Ear Canal and Chronic Middle Ear Infections.

OBJECTIVE: Today, antibiotic resistance is increasing and evolving into an important health problem. Therefore, it is important to research on alternative therapies to antibiotics. This study aimed to investigate the inhibitory effect of four garlic derivatives on microorganisms commonly isolated in ear infections. METHODS: The antimicrobial activities of allicin, s-allyl cysteine (SAC), diallyl disulfide (DADS), and s-allyl mercaptocysteine (SAMC) were investigated on standard strains of commonly isolated microorganisms using the broth microdilution method. The test strains were selected among the microorganisms responsible for chronic suppurative otitis media and otitis externa. These microorganisms were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Enterococcus faecium, Candida albicans, and Candida tropicalis. RESULTS: Minimum inhibitory concentration (MIC) values of allicin and SAC ranged from 0.125 to 20 µg/mL for fermentative bacteria (E. coli and K. pneumoniae), 20 to 80 µg/mL for non-fermentative bacteria (P. aeruginosa and A. baumannii), 5 to 10 µg/mL for gram-positive cocci (S. aureus and E. faecium), and 40 to 80 µg/mL for yeasts (C. albicans and C. tropicalis). MIC values of DADS ranged from 40 to 80 µg/mL for fermentative bacteria, 40 to 160 µg/mL for non-fermentative bacteria, 40 to 80 µg/mL for gram-positive cocci, and 20 to 40 µg/mL for yeasts. The MICs of SAMC were >640 µg/mL for the tested bacteria and yeasts. CONCLUSION: Both allicin and SAC showed antimicrobial activity against the tested microorganisms, even at low concentrations. These two derivatives may be used to treat infections in the future.