Endoscopic transcanal management of tympanosclerosis.

OBJECTIVES: The objectives of this study are to describe our experiences in endoscopic transcanal management of tympanosclerosis, to explain our surgical approaches to reconstruct the sound conduction system and to analyze the hearing results obtained with our surgical approaches. STUDY DESIGN: A retrospective cohort study, using medical records of 28 cases that underwent endoscopic transcanal tympanoplasty surgery due to tympanosclerosis from January 2016 to January 2020. SETTINGS: Private otology clinic PATIENTS: Twenty-eight ears of 26 patients were enrolled into study. Patients were grouped according to Wielinga-Kerr classification and only type II, III and IV patients were included in the study. INTERVENTIONS: Exclusively transcanal endoscopic surgery was performed in all cases. Primary goal was to mobilize the affected ossicles by removing the offending TS and reconstruct the ossicular chain. Malleostapediopexy was preferred when attic by-pass procedures were needed. Glass ionemer bone cement was used to reconstruct the ossicular defects. OUTCOME MEASURES: Preoperative and postoperative pure tone average of air conduction and bone conduction and air-bone gap results were evaluated. Operation was considered successful if postoperative ABG < 20 dB was achieved. Complications and graft take rate were also evaluated. RESULTS: Single-staged surgery was performed in 23 of 28 cases (82.1%). Graft take rate was 93%. The mean preoperative ABG significantly decreased from 33.9 ± 5.19 to 12.55 ± 5.52 dB postoperatively for 23 cases who had single-staged surgeries (p < 0.001, Wilcoxon signed rank test) at the end of the mean follow-up period of 23 months. For this group, the mean preoperative AC-PTA significantly improved from 48.64 ± 9.30 to 22.93 ± 7.45 dB (p < 0.001, Wilcoxon signed rank test) postoperatively with a mean PTA improvement of 25.71 ± 6.02 dB. Success criterion was achieved in 22 of 23 cases (95.7%). There was no sensorineural hearing loss, facial nerve paralysis and postoperative vertigo after the surgical procedures. All patients had been discharged within the first 24 h. CONCLUSIONS: Surgical treatment of tympanosclerosis is still a controversial issue. Endoscopic surgery seems a safe technique for the management of tympanosclerosis. Single-stage surgery is possible in most of the cases with a satisfactory hearing result. We speculate that addition of endoscopic view may increase the single-stage surgery ratio.

Comparison of cervical and ocular vestibular-evoked myogenic potential responses between tone burst versus chirp stimulation.

PURPOSE: To compare the effectiveness of chirp and tone burst stimuli in oVEMP and cVEMP testing for healthy adults METHODS: This study was conducted in 56 healthy volunteers (112 ears). Ocular and cervical VEMP (oVEMP, cVEMP) tests were performed for each participant using tone burst and chirp stimuli. VEMP response rates, latency of each peak (p1-n1, n1-p1), peak to peak amplitude (p1-n1 amplitude and n1-p1 amplitude), and rectified amplitudes were measured and compared between these two different stimuli. RESULTS: VEMP response rates with chirp stimuli are higher than the tone burst stimuli for both cVEMP and oVEMP tests (The difference was statistically significant for oVEMP, p = 0.001). Chirp stimuli have higher p1n1 amplitude and rectified amplitude and shorter p1and n1 latency then tone burst stimuli for cVEMP (p = 0.015, p = 0.007, p < 0.001, p < 0.001, respectively). Chirp stimuli also have higher n1p1 amplitude and shorter n1and p1 latency then tone burst stimuli for oVEMP (p = 0.006, p < 0.001, p < 0.001, respectively). CONCLUSION: The present findings show that the chirp stimulus triggers earlier VEMP responses with higher amplitudes than the tone burst stimulus during cVEMP and oVEMP testing. VEMP response rate with chirp stimulus is also higher than the tone burst. Therefore chirp stimulus can be used in VEMP testing as effectively as, if not more than, tone burst stimulus in clinical practice.

Prognostic role of homeostasis model assessment and oral glucose tolerance test in nondiabetic patients with Bell's palsy

Background/aim: We aimed to revealthe incidence and predictive role of insulin resistance and distorted oral glucose tolerance test in nondiabetic patients withBell's Palsy (BP). Materials and methods: Eighty-sixpatients with BP and 28 control subjects; all with normal blood glucose levels and no history of diabetes, were enrolled in the study. We investigated insulin resistance (IR) in all subjects, in terms of HOMA-IR greater than 2.7. Sixty-two of the patients also underwent an oral glucose tolerance test (OGTT). Results: The mean HOMA-IR value was significantly increased in patients, compared to the control group (3.2 vs 1.6; P < 0.01). IR was detected more in BP patients than in controls (P < 0.05). The patients with higher HOMA-IR values had more severe facial dysfunction at the initial presentation and complete recovery time took longer than the patients with normal HOMA-IR value (75 days vs 42 days; P < 0.05). Following a 2h-OGTT, impaired glucose tolerance and newly diagnosed DM were found in 60% of the patients. Recovery time was significantly longer in prediabetics and newly diagnosed diabetic patients than in patients with normal glycemia (68 days, 52 days, and 32 days, respectively; P < 0.01). Conclusion: There is a strong linkage between HOMA-IR value and BP prognosis so HOMA-IR value may have a significant role of predicting BP prognosis at presentation.

Addition of intratympanic steroid or hyperbaric oxygen treatment to systemic steroid treatment in sudden idiopathic sensorineural hearing loss treatment, and long-term results of salvage treatment

Background/aim: This study aims to determine the therapeutic superiority of the addition of intratympanic steroid or hyperbaric oxygen therapy to systemic steroid treatment in idiopathic sudden sensorineural hearing loss as initial treatment, and evaluate the long- term results of salvage treatment. Materials and methods: This study was a retrospective clinical trial with a total of 96 patients with idiopathic sudden sensorineural hearing loss. Patients were divided into 3 groups. Group 1 (n: 32) received systemic steroid treatment. Group 2 (n: 32) received the Group 1 protocol plus intratympanic steroid treatment. Group 3 (n: 32) received the Group 1 protocol plus hyperbaric oxygen treatment. Pretreatment and postinitial audiologic evaluations were performed, and the hearing outcome was analyzed with Furuhashi criteria. All patients, except those who experienced total recovery after initial treatment, were directed to salvage treatment. Audiologic assessment was performed again after salvage treatment and a mean follow-up period of 36.5 months. Results: Each group was homogenous according to demographics, audiologic data, and prognostic factors. There was no statistically significant difference in recovery and success rate within the 3 groups after initial treatment. (P: 0.66, P: 0.248, respectively). Successful results were obtained after salvage treatment in only 3 patients (5%). These patients received follow-up treatment at a mean of 36.5 months, but there was no spontaneous recovery after the end of salvage treatment. Conclusion: The addition of intratympanic steroids or hyperbaric oxygen to systemic steroids caused no significant hearing improvement as the initial treatment of idiopathic sudden sensorineural hearing loss. The efficacy of salvage treatment was limited, and there was no spontaneous hearing improvement after the long-term follow-up.

Evaluation of vestibular system with vHIT in industrial workers with noise-induced hearing loss.

PURPOSE: Industrial workers are frequently exposed to noise and the noise can cause hearing loss. The relationship between vestibular abnormalities and long-term exposure to occupational noise has been reported. The aim of this study was to use vHIT (video head impulse test) to evaluate the semicircular canal's function in industrial workers with noise-induced hearing loss. METHODS: In the present study, we included 36 male patients (aged 28-55 years, mean 44.4 ± 6.1 years) with hearing loss due to noise exposure from working in the steel and metal industry for at least 4 years, and a control group of 30 healthy men (aged 34-50 years, mean 41.1 ± 4.5 years) without hearing loss. The gain of the vestibulo-ocular reflex for all 6 semicircular canals was examined by vHIT in 66 patients. RESULTS: Canal deficit was detected in 20 (55.5%) of 36 patients in the noise exposure hearing loss group and was detected in 2 (6.6%) of 30 participants in the control group. There was significant loss of capacity for VOR gain in patients with noise exposure hearing loss. CONCLUSIONS: In the present study we found that exposure to noise can cause vestibular dysfunction. And the vHIT is easily applicable, quick and practical and can individually evaluate all semicircular channels. Therefore, to evaluate vestibular function with vHIT is quick and practical.

Stentless endoscopic repair of congenital choanal atresia: is it enough for maintaining choanal patency?

The aim of choanal atresia (CA) surgery is to achieve bilateral nasal patency. Among the different methods of CA repair, the endoscopic transnasal approach has gained recent popularity with the advent of endoscopic instruments and techniques. This article describes our experience regarding CA repair that was done either using or not using a stent in different periods of time in our department. Between February 2006 and February 2016, a total of 29 patients aged 2 days-53 years underwent endoscopic transnasal CA repair. While in early years stents were used to maintain nasal patency, since 2010, all cases were repaired endoscopically without stenting. Of the 29 patients, 8 were excluded because of inadequate follow-up data. The mean follow-up time for the remaining 21 patients after surgery averaged 53 months (range 12-111 months). Intranasal stents were used in 5 of 21 patients for 8 out of 32 operative sides. Of the 8 stented neochoanae, 6 (75%), restenosed at a mean time of 15.2 weeks (5-24). The restenosis rate was 25% (6/24 nasal sides) in 16 patients who underwent stentless repair. In unilateral CA, 2 of 10 (20%) patients underwent atresia repair using stents and only these cases restenosed after surgery in this group. Of the 11 patients with bilateral disease, 5 (45.4%) underwent revision surgeries. In the bilateral group, 2 of 3 (66.6%) stented patients required revision surgeries, whereas 3 of 8 (37.5%) patients who underwent stentless repair relapsed. In one patient, we have experienced an alar cartilage injury intraoperatively caused by drilling. The transnasal endoscopic repair has proved to be effective and yielded long-term satisfactory results. The use of stent seems to have no advantage over a stentless repair regarding maintenance of a patent nasal airway. Patients experienced restenosis more frequently with stenting.

Laryngeal electromyographic changes in postthyroidectomy patients with normal vocal cord mobility.

Thyroidectomy has been used for the treatment of thyroid disease for more than 100 years. In spite of the advancement of surgical techniques, there is still a risk of laryngeal nerve injury. The risk of partial or complete injury still depends on some surgical and disease-related factors. The aim of this study is to show the partial injury and to establish these risk factors via laryngeal electromyographic analysis (LEMG) in postthyroidectomy patients with normal vocal cord motion and mucosal anatomy. Patients who had undergone thyroid surgery were enrolled in this prospective study. LEMG analysis was performed to all patients with normal vocal cord mobility preoperatively and was repeated after the first and the third months of surgery. Thyroarytenoid (TA) and cricothyroid (CT) muscles were used to evaluate recurrent and external branch of superior laryngeal nerves, respectively. Four of the 32 patients had mild-to-moderate degrees of partial LEMG changes during preoperative LEMG analysis of TA and CT muscles on each side. After 3 months of surgery, there was a statistically significant worsening of LEMG findings in the right and left external branches of superior and left recurrent laryngeal nerves. Disease and surgery-related risk factors were analyzed. However, there was no significant relationship on the progression of LEMG findings according to these parameters. This is the first prospective study which supports the risk of progression of LEMG changes in patients with normal laryngoscopic examination after thyroid surgery. No reliable significant risk factor was found influencing the LEMG progression.

Satisfaction and compliance of adult patients using hearing aid and evaluation of factors affecting them.

The aims of this study are to reveal patient compliance and satisfaction in hearing aid-prescribed adult population and to determine the relevant clinical factors. The study was designed retrospectively, and those patients who have been using hearing aid for at least 6 months were invited for evaluation. Demographical data, hearing aid type (digital vs analog), general satisfaction, and daily usage time were asked. Then, the Hearing Aid Satisfaction Questionnaire (HASQ) was applied to all patients which included visual analog scale (VAS)-based 10 questions about the effects of hearing aid on social communication, efficiency, cosmetics, life quality and cost. Totally 400 patients were included in the study. The HASQ was confirmed to be highly reliable by "Kaiser Meyer Olkin and Bartlett Sphericity" tests after exclusion of aid-cost question. There was a negative correlation between age and satisfaction, and a positive correlation between hearing aid usage time (years) and satisfaction (p < 0.05). There was no significant difference between mean HASQ scores regarding gender, employment status, hearing aid type and the site of hearing aid wearing. HASQ scores were significantly worse in pure sensorineural loss type, lower educational status, shorter daily usage time, but better in higher pure tone threshold levels (p < 0.05). Age, time of hearing aid usage daily, type of hearing impairment, the threshold of hearing and education were the factors affecting satisfaction. Regular daily usage of hearing aid should be encouraged in patients, since by this way aid usage and satisfaction may be improved.

Vestibular evoked myogenic potential responses in obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) provokes oxidative stress and ischemia, which affects the central nervous system. The degeneration of neurons in the brainstem due to periodic hypoxia can be evaluated by vestibular and audiologic tests. The objective of this study is to determine brainstem damage in severe OSAS patients with the help of vestibular evoked myogenic potential (VEMP) responses. Prospective, randomize, double-blind. Research-training hospital. We compared cervical vestibular evoked myogenic potential (cVEMP) responses between severe OSAS patients and a control group. 54 patients were included and divided into the OSAS group, with severe OSAS (apnea-hypopnea index, AHI >70), and a control group with snoring without OSAS (AHI <5). Both groups underwent cVEMP. Bilateral recordings with simultaneous binaural logon stimulations were used during VEMP recordings. The existing p1n1 and n2p2 responses, p1, n1, n2, and p2 latencies and amplitudes, and p1n1 and n2p2 intervals were measured. Statistically significant differences were revealed between patients and controls for the response rate of the p1n1, n2p2 and p1n1, n2p2 amplitudes. There were no significant differences between the two groups with respect to the latencies of p1, n1, n2 and p2, or the p1n1 and n2p2 intervals. The VEMP response rate was lower in severe OSAS patients, and all amplitudes were shorter than in healthy subjects. VEMP recordings in severe OSAS subjects demonstrates abnormalities in brainstem pathways. It appears that brainstem damage in severe OSAS can be detected by cVEMP recordings.

Vestibular-evoked myogenic potentials, clinical evaluation, and imaging findings in multiple sclerosis.

Vestibular-evoked myogenic potentials (VEMP), short-latency electromyographic responses elicited by acoustic stimuli, evaluate the function of vestibulocollic reflex and may give information about brainstem function. The aim of the present study is to evaluate the potential contribution of VEMP to the diagnosis of multiple sclerosis (MS). Fifty patients with MS and 30 healthy control subjects were included in this study. The frequency of VEMP p1-n1 and n2-p2 waves; mean p1, n1, n2, and p2 latency; and mean p1-n1 and n2-p2 amplitude were determined. The relation between clinical and imaging findings and VEMP parameters was evaluated. The p1-n1 and n2-p2 waves were more frequently absent in MS than in control subjects [p1-n1 wave absent: MS, 25 (25 %) ears; control, 6 (10 %) ears; P ≤ 0.02] [n2-p2 wave absent: MS, 44 (44 %) ears; control, 7 (12 %) ears; P ≤ 0.001]. The mean p1-n1 amplitude was lower in MS than in control subjects (MS, 19.1 ± 7.2 µV; control, 23.3 ± 7.4 µV; P ≤ 0.002). A total of 24/50 (48 %) MS patients had VEMP abnormalities (absent responses and/or prolonged latencies). VEMP abnormalities were more frequent in patients with than without vestibular symptoms (P ≤ 0.02) and with brainstem functional system score (FSS) ≥ 1 than FSS = 0 (P ≤ 0.02). In patients with MS, absence of p1-n1 wave was more frequent in patients with than without vestibular symptoms [absence of p1-n1 wave: vestibular symptoms, 9 (45 %) ears; no vestibular symptoms, 16 (20 %) ears; P ≤ 0.03] and patients with Expanded Disability Status Scale (EDSS) score ≥ 5.5 [absence of p1-n1 wave: EDSS ≥ 5.5, 7 (70 %) ears; EDSS <5.5, 18 (20 %) ears; P ≤ 0.001]. Abnormal VEMP may be noted in MS patients, especially those with vestibular symptoms and greater disability. The VEMP test may complement other studies for diagnosis and follow-up of patients with MS.

Methods and preliminary outcomes of pediatric auditory brainstem implantation.

OBJECTIVE: The objective was to provide information about methods used and preliminary outcomes for pediatric ABI (auditory brainstem implant). STUDY DESIGN: An analysis of outcome was performed in children who received an ABI. METHODS: Twelve children received a MED-EL ABI system. Progress in audition and language was monitored through parental reports, questionnaires, profiles, and closed-set tests. RESULTS: The median number of active electrodes was 9 of 12. Seven of 12 users consistently respond to sound, and 5 of 12 do not. Highest performers can recognize words in small sets and have begun to use some words. CONCLUSION: Auditory brainstem implants appear to be beneficial for some pediatric patients who cannot benefit from traditional cochlear implant surgery. Benefits in the short-term can be recognition of environmental sounds, recognition of some words and very commonly used phrases, and the beginning use of words. Although some of our ABI users demonstrate no response to sound, they do want to wear their sound processors all waking hours. The cause of lack of response may be related to the second intervention, which might have led to displacement of the electrode array, or presence of additional handicaps or syndromes. However, the results are less than optimal. The relatively short postoperative follow-up duration is a considered weakness of this study.

Permanent central diabetes insipidus as a complication of sphenoid sinus mucocele.

Although mucocele is a benign lesion, its unavoidable expansions may result in irreversible damages in adjacent organs. In spheno-ethmoid mucoceles which are extremely rare, this condition may cause more severe problems. Central diabetes insipidus, developed secondary to sphenoid sinus mucocele, was detected in a 54-year-old male patient, who underwent endoscopic sinus surgery 2 times due to nasal polyposis. Endoscopic sphenoid mucocele marsupialization was performed to the patient, but despite partial regression in the 1-year follow up, complete recovery was not observed.

Hearing restoration in NF2 patients and patients with vestibular schwannoma in the only hearing ear: report of two cases.

OBJECTIVE: To explore audiologic outcome of auditory brain stem implantation (ABI) and cochlear implantation (CI) in NF2 patients and patients with vestibular schwannoma (VS) in the only hearing ear. PATIENTS AND METHODS: Study includes retrospective analysis of 2 cases. One is totally deaf patient due to NF2, and the other one is totally deaf due to VS development in only hearing ear. Tumor was removed by retrosigmoid approach in NF2 patient and ABI was performed simultaneously. For the VS in only hearing ear case, tumor was removed by translabyrinthine approach and CI was performed simultaneously. RESULTS: ABI patient showed quite well outcome during the 15 months of follow-up. She has 25 dB hearing threshold at speaking frequencies. She developed open set speech discrimination with 87.5% word discrimination score, and 70% sentence discrimination score. She uses device daily manner, she can use telephone. For CI patient, outcome is not perfect but satisfactory. She couldn't develop open set speech discrimination during the 18 months of follow-up. She has 67% the disyllabic words recognition score (close set). She is daily user of device. CI improves quite well lip reading. CONCLUSION: ABI and CI are the two options to restore hearing in VS caused deafness. We advocate giving every effort to preserve cochlear nerve during the VS resection and place CI simultaneously. However if it is not possible to preserve cochlear nerve during surgery, ABI is also a good alternative for hearing restoration.

Biofilms in chronic rhinosinusitis with polyps: is eradication possible?

The objective of the study was to reveal if mometasone furoate nasal spray as monotherapy or combined with long-term oral clarithromycin have influence on biofilms in chronic rhinosinusitis with polyps. The study is a randomized controlled trial in a tertiary referral hospital. Thirty-four patients with chronic rhinosinusitis completed the study. In the first group, 19 patients received mometasone furoate nasal spray 200 µg once daily for 8 weeks. In the second group, 15 patients received oral clarithromycin 500 mg twice daily for 2 weeks and continued once daily 250 mg tablet for subsequent 6 weeks, plus mometasone furoate. Scanning electron microscopy was the primary outcome measure. Secondary outcome measures included computerized tomography and sinonasal outcome test-20 items. Mucosal biofilms were detected in 23 of 34 (68%) patients on pretreatment polyp samples. After the treatment, biofilms disappeared in 1 of 11 patients in the first group, whereas the eradication of biofilms was evident in 6 of 12 (50%) patients in the second group. Tomography scores improved in eight patients of each group (42.1 and 53.4%, respectively). The comparison of improvements did not reveal significant difference between the groups. The overall symptom scores improved compared to the baseline levels. The mean changes of -8.8421 and -11.4000 in the first and second group, respectively, were not statistically different. Adding long-term low-dose oral macrolides to nasal steroids was effective in the eradication of biofilm. However, we were not able to demonstrate that combined therapy was superior in terms of the improvement in tomography and symptom scores.

Closure of nasal septal perforations using bilateral intranasal advancement/rotation flaps.

OBJECTIVES: This study aims to report our experience on surgical repair of nasal septal perforations (NSP) using bilateral intranasal advancement/rotation flaps with open septoplasty technique. PATIENTS AND METHODS: Medical records of 28 consecutive patients who were operated for NSP in our clinic between January 2009 and February 2013 were retrospectively analyzed. Demographic features of the patients and surgical results were evaluated. RESULTS: The most common cause of NSP was previous septal surgery in 18 (64%) of the patients. Nasal crusting was the most common symptom in 21 patients (75%). Perforation size ranged from 10 to 30 mm in diameter. Septoplasty was performed in five patients, while septorhinoplasty was performed in three patients simultaneously to the NSP repair. Nasal septal cartilage and auricular chonchal cartilage were used to support the nasoseptal skeleton, if required. There were no major intra- or postoperative complications. The mean postoperative follow-up period was 23 months. During follow-up, there was mild columellar retraction in five patients (18%). Nasal septal perforation was closed successfully in 24 patients (86%). Pinpoint perforation remained in two patients and perforation size was smaller than 5 mm in two patients. CONCLUSION: Closing the NSP with bilateral intranasal advancement/rotation flaps has a comparable high success rate. Therefore, this technique can be easily applied to small-medium sized septal perforations.

Transcanal Endoscopic Management of Middle Ear Paragangliomas.

OBJECTIVE: To evaluate the clinical and audiological outcomes of transcanal endoscopic resection of middle ear paragangliomas. STUDY DESIGN: Retrospective multicenter study. SETTING: Tertiary referral center and private otology clinic. PATIENTS: Patients who underwent transcanal endoscopic surgery between January 2015 and September 2020. INTERVENTIONS: Transcanal endocope-assisted resection of middle ear paragangliomas. MAIN OUTCOME MEASURES: Demographic data. RESULTS: Twenty-three patients (2 men, 21 women) with a mean (standard deviation [SD]) age of 50.5 (11.8) years and stage 1 or 2 disease were included in the study. The mean follow-up time was 2.7 years (range, 1-5 yr). Preoperatively, the mean (SD) air-conduction threshold was 33.8 (17.9) dB, and the mean (SD) air-bone gap was 13.1 (13.9) dB. Postoperatively, the mean (SD) air-conduction threshold was 25.7 (10.2) dB, the mean (SD) air-bone gap was 6.3 (6.1) dB. The mean (SD) hospital stay was 27.7 (9.9) hours. No tumor regrowth was detected on magnetic resonance imaging during postoperative follow-up. CONCLUSIONS: Endoscopic transcanal tumor resection is effective and feasible in the treatment of stage 1 and 2 tumors and is associated with short operative time, low risk of perioperative and postoperative complications, and rapid discharge.

Effectiveness of pandemic influenza A/H1N1 vaccine for prevention of otitis media in children.

UNLABELLED: Our aim was to evaluate effectiveness of pandemic influenza A/H1N1 vaccine in preventing acute otitis media (AOM) and/or otitis media with effusion (OME), in a randomized, prospective and single-blind study conducted in the children aged of 6-60 months. This study was done between December 1, 2009 and April 30, 2010 during the pandemia between June 2009 and May 2010. On the healthy children, vaccinated against pandemic influenza A/H1N1 and age-matched unvaccinated controls, the rate of AOM, OME, and any otitis media (OM) attack (sum of AOM and OME attacks) confirmed by otoscopic and tympanometric examination, and their associations with risk factors were looked for. Otoscopic and tympanometric evaluation was done twice within the follow-up period of 4-8 weeks. Totally 46 vaccinated and 46 unvaccinated healthy children were enrolled. No difference in rates of AOM, OME, or OM was found between vaccinated and unvaccinated children. But logistic regression analysis revealed that unvaccinated children had 2.9-folds more risk for OME and OM, but not for AOM. Further, male gender and bottle feeding and/or using pacifier revealed significant relationships with AOM. CONCLUSION: We conclude that pandemic influenza A/H1N1 vaccine prevented OME rather than AOM attacks in children with 6-60 months of age.

Comparison of tone burst versus logon stimulation for vestibular evoked myogenic potentials.

The following study has been carried out to compare the effectiveness of logon and tone burst acoustic stimulation to elicit vestibular evoked myogenic potential (VEMP) responses. The methods and the subjects include 31 healthy adult volunteers (62 ears) who were enrolled in this study. Two different acoustic stimuli, logon (L-VEMP) and tone burst (T-VEMP), were used to elicit VEMP responses in each subject. Bilateral recordings with simultaneous binaural acoustic stimulations were used during VEMP recordings. During the recording period, the subjects were in supine position with their head elevated. The results observed were that the response rate of p1n1 wave was 91.9% for L-VEMP and 88.7% for T-VEMP. The response rate of n2p2 wave was 80.6% for L-VEMP, and 75.8% for T-VEMP. There were no significant differences between the two groups with respect to the latencies of p1, n1, n2 and p2, p1n1 and n2p2 interval, and p1n1 and n2p2 amplitude. The conclusion was that there was no difference between logon and tone burst stimulation with respect to VEMP response rates and VEMP parameters. Therefore, they are not superior to each other.

Nasal dorsal mucous cyst formation: a rare and preventable complication of rhinoplasty.

Nasal dorsal mucous cyst formation after rhinoplasty is a rare and preventable complication in otorhinolaryngology literature. To prevent this complication bony, cartilage, and mucous remnants should be removed meticulously. Maintaining mucosal integrity during cartilage incisions and osteotomy and completing all osteotomies are very important in preventing mucous cyst formation. The treatment of this complication is the complete excision of the cyst with its capsule. In this article, we report a case of nasal dorsal cyst that developed within six months after rhinoplasty with a brief review of the literature.

Comparison of pure tone audiometry and auditory steady-state responses in subjects with normal hearing and hearing loss.

The objective of this study is to compare pure tone audiometry and auditory steady-state response (ASSR) thresholds in normal hearing (NH) subjects and subjects with hearing loss. This study involved 23 NH adults and 38 adults with hearing loss (HI). After detection of behavioral thresholds (BHT) with pure tone audiometry, each subject was tested for ASSR responses in the same day. Only one ear was tested for each subject. The mean pure tone average was 9 ± 4 dB for NH group and 57 ± 14 for HI group. There was a very strong correlation between BHT and ASSR measurements in HI group. However, the correlation was weaker in the NH group. The mean differences of pure tone average of four frequencies (0.5, 1, 2, and 4 kHz) and ASSR threshold average of same frequencies were 13 ± 6 dB in NH group and 7 ± 5 dB in HI group and the difference was significant (P = 0.01). It was found that 86% of threshold difference values were less than 20 dB in NH group and 92% of threshold difference values were less than 20 dB in HI group. In conclusion, ASSR thresholds can be used to predict the configuration of pure tone audiometry. Results are more accurate in HI group than NH group. Although ASSR can be used in cochlear implant decision-making process, findings do not permit the utilization of the test for medico-legal reasons.