Redefinition of naval missions in the post cold war environment

Ankara : Institute of Economics and Social Sciences, Bilkent Univ., 1995.Thesis (Master's) -- Bilkent University, 1995.Includes bibliographical references leaves 126-132.The world is again experiencing a new period of change today. The cold war has ended and the strategic environment is changing to reflect those developments. The objective of this study is to describe the changes in naval mission types after the end of the cold war. An analytical method has been used in the study; the developments in the naval strategic environnment will be described in a detailed way. Then the study will try to analyse those developments and try to explain how the naval power missions will be redefined according the new factors. The naval strategic environment is becoming littoral and also more prone to conflictual situations as more states try to seek their national interests, once they are free from the binding conditions of the old bi-polar strategic environment. Some naval missions that were the needs of the global scale confrontation of the cold war will not be of the same importance in this new period. Instead the mission types that can be described as regional and coastal will be more used by the navies of the world reflecting the rise of littorality in the new period.Altınyay, ÖzgürM.S

Cochlear implantation in inner ear malformations: Considerations related to surgical complications and communication skills

Introduction: There are particular challenges in the implantation of malformed cochleae, such as in cases of facial nerve anomalies, cerebrospinal fluid (CSF) leaks, erroneous electrode insertion, or facial stimulation, and the outcomes may differ depending on the severity of the malformation. The aim of this study was to assess the impact of inner ear malformations (IEMs) on surgical complications and outcomes of cochlear implantation. Methods: In order to assess the impact of IEMs on cochlear implant (CI) outcomes, 2 groups of patients with similar epidemiological parameters were selected from among 863 patients. Both the study group (patients with an IEM) and control group (patients with a normal inner ear) included 25 patients who received a CI and completed at least 1 year of follow-up. Auditory performance, receptive and expressive language skills, and production and use of speech were evaluated preoperatively and at least 1 year after implantation. Types of surgical complications and rates of revision surgeries were determined in each group. Results: In the study group, the most common malformation was an isolated enlarged vestibular aqueduct (EVA) (44.8%). Overall, the patients with IEMs showed significant improvement in auditory-verbal skills. In general, the patients who had normal cochleae scored significantly better compared to patients with IEMs (p < 0.05). The complication rate was significantly lower in the control group compared to the study group (p = 0.001), but the rate of revision surgeries did not differ significantly (p = 0.637). Conclusion: It is possible to improve communication skills with CIs in patients with IEMs despite the variations in postoperative performances. Patients with EVA, incomplete partition type 2, and cochlear hypoplasia type 2 were the best performers in terms of auditory-verbal skills. Patients with IEMs scored poorly compared to patients with normal cochleae. CSF leak (gusher or oozing) was the most common complication during surgery, which is highly likely in cases of incomplete partition type 3

Effectiveness of Auditory-Verbal Therapy Training on Mothers Usage of Auditory-Verbal Therapy Techniques

Bu araştırmada İşitsel-Sözel Terapi (İST) eğitimine katılan annelerin, İST tekniklerini uygulamalarındaki etkililiğinin belirlenmesi ve annelerin İST tekniklerini uygulamasının işitme engelli çocuklarındaki anlamsız ses üretimlerinin azalmasında, sözcük üretimlerinin artmasında ve sözcük dağarcığı becerilerinin gelişimine etkisinin belirlenmesi amaçlanmıştır. Araştırmanın bağımsız değişkeni İST eğitimidir. Araştırmada hem annelerden hem de çocuklardan veri toplanmıştır. Annelere yönelik bağımlı değişken; annelerin işitme engelli çocukları ile etkileşiminde İST tekniklerini (önce işitsel sonra görsel uyarıcıyı sunma, bekleme, ara verme, akustik vurgulama, melodik ses tonu kullanma, genişletme, sırayla konuşma, tekrarlama ve çocuğun dikkatini dinlemeye yöneltme) kullanma sayılarıdır. Çocuklara yönelik bağımlı değişkenleri ise, çocukların anlamsız ses üretimlerindeki azalma, kelime sayıları ve sözcük dağarcıklarındaki gelişimleridir. Bu araştırma 2-4 yaş arasında üç işitme engelli çocuk ve annesi ile yürütülmüştür. İşitme engelli çocukların seçiminde bazı önkoşul ölçütler belirlenmiştir. Bu ölçütler; a) çift taraflı ileri/çok ileri derecede duyu-sinir işitme kaybı bulunan, b) doğuştan işitme kaybı meydana gelmiş olan, c) cihazı ya da koklear implantı ile serbest saha işitme eşik düzeyi 500-4000 frekans aralığında ortalama 30-40 dB düzeyinde bulunan, d) işitme kaybı dışında başka bir yetersizliği bulunmayan, e) daha önce İST eğitimi almamış çocuklar olarak belirlenmiştir. Anneler için belirlenen önkoşul ölçütler ise; a) normal işiten, b) ailesinde bir işitme engelli çocuğu bulunan, c) eğitime katılmaya istekli olan, d) Ankara'da yaşayan anneler olarak belirlenmiştir. Araştırmada annelerin verilerinin toplanması amacıyla gözleme yer verilmiştir. Çocukların verilerin toplanması amacıyla video üzerinden ses üretim analizi yapılmış ve Türkçe İletişim Davranışları Gelişimi Envanteri I kullanılmıştır. İST uygulama basamakları çocuk performansının belirlenmesi, uzun dönemli amaçların oluşturulması ve İST eğitiminin uygulanması olmak üzere üç aşamada gerçekleştirilmiştir. İST eğitimi dört aşamada gerçekleştirilmiştir. Bunlar giriş, bilgi alış-verişi, uygulama ve ev programının oluşturulması - aileye öneriler bölümleridir (Estabrooks, 1998; 2001; 2006). Araştırma tek denekli desenlerden deneklerarası çoklu yoklama deseni ile gerçekleştirilmiştir. Deney süreci çocuklardan ön test verilerinin toplanması, annelerin başlama düzeyinin belirlenmesi, İST eğitimi, İST oturumları sırasında değerlendirme, çocukların son testlerinin uygulanması ve annelerin izleme verilerinin toplanması aşamalarında uygulanmıştır. Araştırma sonunda elde edilen bulgular şu şekildedir; İST uygulaması sonucunda, çalışma grubunda yer alan üç annede, başlama düzeyine göre İST tekniklerini uygulamalarında artış belirlenmiştir. Anneler öğretim sırasında kazandıkları İST tekniklerini kullanım becerilerini öğretimden 3, 5 ve 8 hafta sonra yapılan izleme oturumlarında korumuşlar ve teknik kullanımlarını arttırarak devam ettirmişlerdir. Araştırmaya katılan üç anne de öğretim sonunda hedeflenen dokuz tekniği de kullanmış izleme oturumlarında bu dokuz çeşit tekniği kullanmaya devam etmiştir. Bu sonuç İST uygulaması ile annelerin hedeflenen tüm teknikleri kullandıkları ve sürdürebildiklerini göstermektedir. Araştırma kapsamında yer alan üç çocuğun ön test değerlendirmelerine göre, son testte anlamsız ses üretim sayılarında azalma ve sözcük üretimleri ile sözcük dağarcık gelişimlerinde artış görülmüştür. Sosyal geçerlilik verilerinde de anneler İST eğitimine katıldıkları için memnun olduklarını, katıldıkları eğitimin çocuklarının dinleme, konuşma, anlama ve ifade etme, iletişim becerilerini geliştirmelerine yardımcı olduğu görüşlerini bildirmişlerdir.The purpose of this study is to assess the effectiveness of the Auditory-Verbal Therapy (AVT) training, participated by the mothers of hearing impaired children, in their application of auditory-verbal therapy techniques; and to identify the effects of the AVT techniques in decreasing the children's nonsense vocal production and increase in word production skills and vocabulary. The independent variable of study is AVT training program. In this study, both mothers' and children data were collected. The dependent variable for mothers is usage frequency of AVT techniques (initially using auditorial stimulus and then visual one; waiting, pausing, using melodic intonation, expansion, talking in turn, repetition and directing child's attention to listening) during interactions with their children with hearing impairment. The dependent variable for children is nonsense vocal production, number of production words and vocabulary development. The participants of the study are 2-4 years old three children with hearing impairment and their mothers. Some prerequisite criteria were established for eligibility of children with hearing impairment. These are as follow: a) bilateral severe/profound sensorineural hearing loss, b) congenitally hearing loss, c) free field hearing threshold level is average of 30-40 dB at 500-4000 frequency range via hearing aids or cochlear implants, d) no additional disability, e) not previously received AVT training. The prerequisite criteria that established for mothers are as follow: a) typically hearing, b) have a child with hearing impairment in her family, c) enthusiasm to participate with study and d) live in Ankara. In the study, observation method was used to collect mothers' data. On the other hand, for collecting children data, vocal production analysis through video and The Development Inventory of Turkish Communicative Behaviors I were used. The implementation steps of AVT were conducted at three stages - determining of child performance, setting long-term goals and implementation of AVT training. The AVT training was completed at four stages - introduction, information exchange, implementation and generating home-based program-suggestions for family (Estabrooks, 1998; 2001; 2006). The research design is multiple-probe design across subject. The experimental procedure was implemented at four stages; baseline, AVT training, assessment during AVT sessions, posttreatment assessment and maintanance. After implementation of AVT, all of the mothers' usage of AVT techniques increased in comparison with baseline levels. In the maintanance sessions, conducted three, five and eight weeks later, mothers maintained their AVT techniques and inreasingly went on. All of three participant mothers used nine targeted techniques in the post asessment sessions and they maintained to use these techniques. This result indicates that after implementation of AVT, participant mothers gained and maintained all the targeted techniques. In addition, it was explored that frequency levels of nonsense vocal production on posttreatment assesment all three children decreased in comparison with their baseline levels and increase in word production and vocabulary development. With regard to social validity data, mothers reported that they satisfied with participation of AVT program, and they believed that AVT is very helpful in enhancing their child's listening, speaking, comprehending and expressing, and communication skills

Delayed prelingual cochlear implantation in childhood and puberty

WOS: 000348888700013PubMed ID: 25560805Objective: To evaluate the results of delayed cochlear impantion performed in childhood and puberty in the light of speech language pathology assessments. Methods: Totally 49 children with prelingual profound hearing loss were included in the study. All children received a cochlear implant between the ages of 5 and 19 years (Group 1 aged between 5 and 9 years, group 2 aged between 10 and 14 years, group 3 aged between and 15 and 19 years). The MAIS, MUSS and PLS-4 scores of children were evaluated one month before, and one year and two years after the operation. The descriptive statistics included several independent variables; age of implantation; gender; trade name of the implant; preoperative duration of hearing aid use; preoperative special education, family support and additional handicap. These variables were categorical variables. We used repeated measures analysis of variance to test improvements in MAIS, MUSS and PLS scores, and whether this improvement depend on the independent variables. In addition, we also tested the interaction between time and the independent variables. Results: The preoperative MAIS, MUSS and language scores were significantly higher in older children compared to younger children (p 0.4). There was a significant age and time interaction (p = 0.005). That is, improvement continued in all age groups in a parallel way and group 2 reached to the level of group 1 after two years. However, group 3 almost reached to a plateau level after two years. The family support was associated with the MAIS, MUSS and language scores of the patients (p = 0.01), and there was a family support-time interaction (p 0.05). Conclusion: The decision of delayed cochlear implantation in children can be made in the light of following parameters. A good family support is most important. The patients must be wearing hearing aids regularly since early childhood, and preferably use the auditory verbal communication. Evaluation of the patient with MAIS, MUSS and PLS is important to understand the level of receptive and expressive communication level

Cochlear implantation in extraordinary cases

Background: Although cochlear implantation has been almost a standard otological procedure worldwide, it may still create a dilemma for the surgeon in some unusual instances such as Seckel syndrome, aural atresia and posterior fossa arachnoid cyst. Case Report: Three extraordinary cases of cochlear implantation were reported. The first case was a case of Seckel syndrome with a cardiac pacemaker due to complete atrioventricular block. The second case had posterior fossa arachnoid cyst that had retrosigmoid cyst removal and cochlear implantation simultaneously. The last case had cochlear implantation in the ear with congenital aural atresia. All cases could be implanted successfully with full electrode insertion and good audiological outcome. Delayed facial paralysis that occurred in the patient with arachnoid cyst resolved spontaneously. Conclusion: This study addressed the efficiency of cochlear implantation in cases of Seckel syndrome, complete atrioventricular block managed with cardiac pacemaker, congenital aural atresia and posterior fossa arachnoid cyst. In addition, the retrosigmoid approach and cochlear implantation can be performed simultaneously

Management of children with auditory neuropathy spectrum disorder (ANSD)

AbstractIntroductionANSD is a challenging problem.ObjectiveTo present our experience on management of the children with ANSD with respect to clinical data.MethodsThis retrospective study included all children younger than 16 years of age who applied to the department between 2005 and 2013 (with the exception of newborn hearing screening NHS referrals). The data were derived from pure tone, OAEs and ABR tests, and further medical risk factors of the subjects were evaluated.ResultsANSD was recognized in 74 ears of 40 children (B/U: 34/6) among 1952 children with SNHL (2.04%) detected among 9520 applicants to the department (0.42%). The clinical tests revealed that hearing loss greater than 15dB was present in both ears of 38 cases. The degree of hearing loss was profound in 48% children, severe in 12% children, moderate in 28% children, mild in 10% children and normal in 5% children. ABRs were absent/abnormal in 37/3 ears and CMs were detected in all. Acoustic reflexes were absent in all ears. Rehabilitation was managed by CI and hearing aids in 15 and 23 cases, respectively. FM system was given to two cases displaying normal hearing but poor speech discrimination in noisy environments.ConclusionANSD is a relatively challenging problem for the audiology departments because of its various clinical features and difficulties in management. Our patients with ANSD most commonly displayed profound hearing loss. The number of overlooked cases may be minimized by performing ABR and OAE in every case referred with the suspicion of hearing loss

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