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

Analysis of preoperative and peroperative features and postoperative outcomes and affecting factors, in chronic otitis surgery

Kronik Otit Cerrahisinde; Preoperatif, Peroperatif Özellikler ve Postoperatif Sonuçların Analizi ve Bunları Etkileyen Faktörler Çalışmamız, KOM cerrahisi yapılan hastaların preoperatif ve intraoperatif bulgularının ve postoperatif sonuçlarının incelenmesini ve cerrahi başarısını etkileyen faktörlerin gözden geçirilmesini amaçlayan retrospektif özellikte bir arşiv çalışmasıdır. Gazi Üniversitesi Tıp Fakültesi Kulak Burun Boğaz Hastalıkları Anabilim Dalı'nda, Ocak 2007 - Haziran 2012 tarihleri arasında kronik otitis media tanısı ile opere edilen 1398 hastanın 1510 kulağı preoperatif ve intraoperatif özellikler açısından, postoperatif sonuçlarına ulaşılan 356 hastanın 376 kulağı da postoperatif sonuçlar açısından analiz edilmiştir. Çalışmamızda, vakalar otomikroskopik muayene ve operasyon bulgularına göre tanı açısından altı alt guruba ayrılmıştır. En sık tanı %39,9 oranında kronik basit otitis media olarak bulunmuştur. Vakaların büyük çoğunluğuna mastoidektomisiz timpanoplasti uygulanmıştır. Kolesteatom hastalarında sıklıkla açık teknik operasyon tercih edilmiştir. Hastaların otomikroskopik muayenelerinde en sık santral perforasyonlarla karşılaşılmıştır. Takipli vakalarda, işitme ve greft başarısını etkileyen faktörler incelenmiştir. Postoperatif tüm hastalarda %75,8 işitme başarısı elde edilmiştir. İşitme başarısı en yüksek kronik basit otit vakalarında olurken, en kötü kolesteatoma ve timpanoskleroz vakalarında görülmüştür. Ameliyat öncesi işitme düzeyi ve kemikçiklerin ve özellikle de stapesin durumu, orta kulak mukozasının durumu işitme başarısı açısından etkili bulunmuştur. Çalışmamızda, tüm hastalık guruplarında greft tutma başarısı %78,6 olarak bulunmuştur. Greft başarısı en yüksek santral perforasyonlarda olurken, önde ve total perforasyonlarda daha düşük olarak bulunmuştur. Orta kulak mukozasının durumu da greft başarısını etkileyen önemli bir faktör olarak bulunmuştur. Mastoidektominin ve aditus ve antrum geçişinin greft başarısı üzerine anlamlı bir etkisi olmadığı bulunmuştur. Pediatrik hastalarda da greft başarısı açısından erişkinlerle fark saptanmazken, ileri yaşlarda greft başarısının düştüğü belirlenmiştir. Sonuç olarak, kronik otitis mediada cerrahi başarıyı etkileyen pek çok faktör bulunmaktadır. Bu faktörler dikkatlice incelenerek, her vaka için uygun bir tedavi planı yapılmalıdır.Analysis of Preoperative and Peroperative Features and Postoperative Outcomes and Affecting Factors, in Chronic Otitis Surgery Our study aims to retrospectively review preoperative and intraoperative findings and postoperative results and check the factors affecting the success of surgery in patients with chronic otitis media surgery. Between January 2007 and June 2012 in Gazi University Faculty of Medicine department of ENT , 1510 ears of 1398 patients which operated on with diagnosis of chronic otitis media were analyzed about preoperative and intraoperative characteristics. Postoperative resuts in terms of postoperative outcome in 376 ears of 376 patient were analyzed. In this study, cases divided six subgroups in terms of diagnosis, according to the findings of operation and otomicroscopic examinations. The most common diagnosis is simple chronic otitis media with rate of 39,9% recpectively. The majority of cases were underwent tympanoplasty without mastoidectomy. In cholesteatoma patients, the open technique is preferred commonly. In otomicroscopic examination of cases, central perforations were the most common finding. The cases were followed-up, factors affecting the success of hearing and graft take were investigated. Hearing success was found as 75,8% in all cases. While, hearing results was the highest in simple chronic otitis media, in cases of cholesteatoma and tympanosclerosis were observed worst. Preoperative hearing level, state of ossicles, especially stapes, state of middle ear mucosa were found to be effective for the success of hearing. In our study, the graft-take-rate was found to be 78,6% in all groups of chronic otitis. While, the graft take rate was the highest in central perforations, subtotal and anterior perforations were found to be worse. Status of the middle ear mucosa was found to be an important factor affecting the success of the graft. There was no difference in the graft take rate in pediatric patients and adults, but in elderly patients were decreased. As a conclusion, in chronic otitis media surgery there were many factors which can effect the success rate of operation. These factors should evaluate carefully and suitable treatment strategy was performed for every patient individually

First report of Bursaphelenchus hellenicus Skarmoutsos, Braasch, Michalopoulou 1998 (Nematoda: Aphelenchoididae) from Turkey

Cebeci, H.Huseyin/0000-0002-4569-9527;WOS: 000325500300007A survey was conducted in forest sites of the Mula Regional Forest Directorates for the presence of the pinewood nematode, Bursaphelenchus xylophilus. Wood samples were collected from declining pine and cedar trees. A total of 207 samples were taken, and nematodes were extracted, observed and identified. The pinewood nematode was not detected, but another Bursaphelenchus species was recovered from the wood of a Pinus brutia tree in Een-Karadere location in Fethiye, which strongly resembled the original description of B.hellenicus. It was identified as this species by morphology and ITS-RFLP. Measurements and diagnostic features are presented. This is the first report of B.hellenicus from Turkey.Scientific and Technological Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [TOVAG-107O088]This project (TOVAG-107O088) was supported by the Scientific and Technological Council of Turkey (TUBITAK). The authors kindly thank Dr. T. Schroeder, Germany for the confirmation of Bursaphelenchus hellenicus by using the ITS-RFLP technique. We also thank Dr. Besir Yuksel, Ismail Baysal, Metin Serin and Mahir Erdem for their help during the project and the General Directorate of Forestry for their field support. The authors kindly thank Dr. Marc J. Linit for his critical reading of the manuscript. Finally, we would like to thank two anonymous reviewers for their helpful comments on this manuscript

Impact of the demographic and aetiological factors and intraoperative findings on postoperative outcomes in chronic otitis media surgery

Background/aim: Surgical success is related with many factors belonging to both the patient and the disease. This study aims to analyse the preoperative and intraoperative characteristics, the postoperative results, and the factors affecting the surgical success in different types of chronic otitis media (COM).Materials and methods: A total of 1510 ears of 1398 patients who underwent COM surgery were included in the study. Postoperative results were obtained from 376 ears of 356 patients who had been followed after surgery. The demographic characteristics of the patients, such as age and sex, operative findings, preoperative audiological examination results, and final audiometric and otoscopic examination findings, were retrospectively obtained from the archives of the department.Results: The most frequent diagnosis was simple COM (39.9%), and the most frequently performed surgery was tympanoplasty without mastoidectomy (46.6%). The overall hearing success rate was found to be 75.8%. Postoperative hearing success was significantly associated with the chronic otitis subgroup, ossicular pathologies, and the condition of the middle ear mucosa. Postoperative graft take rate was found to be 78.6%. Graft success was statistically significantly higher in patients with normal middle ear mucosa. Performing mastoidectomy, the presence of patency in aditus ad antrum, and being a paediatric case had no impact on graft success.Conclusion: Factors affecting the success of COM surgery include age, chronic otitis subgroup, location and size of perforation, the condition of the middle ear mucosa, and the level of the ossicular disease. These factors should be known and an appropriate treatment plan should be prepared

Canal wall down versus canal wall up surgeries in the treatment of middle ear cholesteatoma

Background/aim: To compare outcomes of canal wall up (CWU) and canal wall down (CWD) techniques in the treatment of middle ear cholesteatoma. Materials and methods: Medical records of 76 patients who had a primary surgery due to middle ear cholesteatoma between July 2015 and November 2017 were reviewed retrospectively. Hearing thresholds, speech discrimination scores (SDS), recurrences, and revision surgeries of CWU and CWD surgeries were compared. Results: Of 76 cholesteatoma cases, 40 (52.6%) had a CWU and 36 (47.4%) had a CWD operation. Postoperatively, the mean air conduction thresholds were significantly better in CWU compared to CWD surgeries (P = 0.016). The presence of the stapes and the type of reconstruction material used did not have a significant effect on auditory success rates (P = 0.342 and P = 0.905, respectively). Auditory success was affected by the status of the middle ear mucosa as well. The recurrence and revision rates did not differ between the surgical techniques (P > 0.05). Conclusion: Status of the middle ear mucosa and external auditory canal are important factors affecting the outcomes in cholesteatoma. Instead of a CWD surgery, a CWU surgery seems applicable in cases of cholesteatoma when the bone in the external auditory canal is not eroded by the disease

Assessment of cochlear implant revision surgeries in a cohort of 802 patients

Objective: To assess the etiology, demographics, rates and outcomes of revision surgeries, and device survival rates after cochlear implantation. Study Design: Retrospective case review. Setting: Tertiary Otology & Neurotology center. Patients: Cochlear implantees who received revision surgeries after implantation Interventions: Any surgical intervention, performed due to device failure or the major complications of cochlear implantation. Main Outcome Measure: Medical records of the patients who received cochlear implants (CIs) between July 2002 and March 2018 were reviewed retrospectively regarding postoperative complications. Demographic data, device survival rates, and causes of revisions were recorded. Results: Totally, 924 implantations were performed in 802 patients. Eighty one (8.7%) of them underwent 102 revision surgeries. The most common causes of revision surgeries were device failures and flap related problems which were seen in 28 and 18 patients, respectively. Overall CI survival rate was 91.9% in a 10 years period, which remained almost stable after 10 years. Although age was not found to be related with device failure (p = 0.693), device loss rates were significantly higher in adult implantees than children (p = 0.006). Conclusion: Device failure seems the most common cause of revision. The revision surgeries are usually safe and help to resolve the problem although flap problems are the most difficult to treat and may necessitate multiple revision surgeries. The device failure rate may reach to a plateau after 6 years. Overall CI survival rate exceeds 90% in 10 years period, and then remains stable

Impact of the demographic and aetiological factors and intraoperative findings on postoperative outcomes in chronic otitis media surgery

Background/aim: Surgical success is related with many factors belonging to both the patient and the disease. This study aims to analyse the preoperative and intraoperative characteristics, the postoperative results, and the factors affecting the surgical success in different types of chronic otitis media (COM). Materials and methods: A total of 1510 ears of 1398 patients who underwent COM surgery were included in the study. Postoperative results were obtained from 376 ears of 356 patients who had been followed after surgery. The demographic characteristics of the patients, such as age and sex, operative findings, preoperative audiological examination results, and final audiometric and otoscopic examination findings, were retrospectively obtained from the archives of the department. Results: The most frequent diagnosis was simple COM (39.9\%), and the most frequently performed surgery was tympanoplasty without mastoidectomy (46.6\%). The overall hearing success rate was found to be 75.8\%. Postoperative hearing success was significantly associated with the chronic otitis subgroup, ossicular pathologies, and the condition of the middle ear mucosa. Postoperative graft take rate was found to be 78.6\%. Graft success was statistically significantly higher in patients with normal middle ear mucosa. Performing mastoidectomy, the presence of patency in aditus ad antrum, and being a paediatric case had no impact on graft success. Conclusion: Factors affecting the success of COM surgery include age, chronic otitis subgroup, location and size of perforation, the condition of the middle ear mucosa, and the level of the ossicular disease. These factors should be known and an appropriate treatment plan should be prepared