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

Yetişkinde kendiliğinden edinilen tek taraflı makrotia: Olgu sunumu

Macrotia is one of the rare congenital external ear deformities. This deformity occurs when the measurements of the ear exceeds the standard values. However, enlargement of the ear may occur secondary to other causes and have clinical implications similar to true macrotia. In this report, we present an adult who had previously unilateral, slight auricular asymmetry on his left ear. His left ear enlarged spontaneously within the last four years without genetic, dermatological and rheumatological pathologies. We recommend considering other possibilities in the differential diagnosis and making comprehensive research before surgical intervention to the deformity.Makrotia ender görülen konjenital dış kulak deformitelerinden biridir. Bu deformite dış kulağın standart boyutlarının artması ile oluşur. Ancak dış kulakta başka nedenlerle de büyüme olabilir ve gerçek makrotia gibi klinik olabilir. Bu raporda, daha önce sol kulağında tek taraflı, hafif dış kulak asimetrisi olan, son dört yıl içinde spontane olarak sol kulağı büyüyen, genetik dermatolojik ve romatolojik patolojisi bulunmayan yetişkin hasta sunulmaktadır. Deformiteye cerrahi müdahale öncesi ayırıcı tanıdaki diğer olasılıkların düşünülmesi ve kapsamlı bir araştırma yapılmasını önermekteyiz

Burun problemlerinin pozisyonel ve pozisyonel olmayan tıkayıcı uyku apnesiüzerindeki rolü

OBJECTIVES: This study aims to examine the relationship between nasal pathologies and positional (PP) obstructive sleep apnea (OSA) or nonpositional (NPP) OSA.PATIENTS AND METHODS: A total of 44 male OSA patients (mean age 48.0±6.8 years; range 31 to 60 years) suffering from nasal obstruction were retrospectively evaluated for nasal obstruction scores, overall apnea hypopnea index (AHI) and AHI in supine and nonsupine positions, daytime sleepiness scores, and body mass index (BMI). Patients were divided into two equal groups as PP group and NPP group. Output parameters were snoring severity index, clinical nasal obstruction score, septal deviation score, conchal hypertrophy score, and allergic rhinitis (AR) score. These parameters were correlated with the type of OSA.RESULTS: Apnea hypopnea index was significantly lower in PP group than in NPP group (p<0.03). Spearman correlation analysis revealed significant negative correlation between AR score and PP (r=-0.40, p<0.0001). Pearson correlation test revealed significant correlation between AHI and BMI (r=0.32, p<0.05).CONCLUSION: We suggest that AR is not only an important risk factor for OSA, but also patients with AR tend to be NPP OSA patients because of the serious nasal obstruction which already causes an increase in nasal resistance or pharyngeal collapsibility.Amaç: Bu çalışmada burun patolojileri ve pozisyonel (PP) tıkayıcı uyku apnesi (TUA) veya pozisyonel olmayan (PO) TUA arasındakiilişki incelendi.Hastalar ve Yöntemler: Burun tıkanıklığı olan toplam 44 erkek TUA hastası (ort. yaş 48.0±6.8 yıl; dağılım 31-60 yıl) burun tıkanıklığıskorları, genel apne hipopne indeksi (AHİ) ve sırtüstü ve sırtüstü olmayan pozisyonlarda AHİ, gündüz uykululuk skorları ve vücut kütleindeksi (VKİ) açısından retrospektif olarak değerlendirildi. Hastalar PP grubu ve PO grubu olmak üzere iki eşit gruba ayrıldı. Çıktıparametreleri horlama şiddeti indeksi, klinik burun tıkanıklığı skoru, septum deviasyonu skoru, konka hipertrofisi skoru ve alerjik rinit (AR)skoru idi. Bu parametreler TUA tipi ile ilişkiliydi.Bulgular: Apne hipopne indeksi PP grubunda PO grubundan anlamlı olarak daha düşüktü (p<0.03). Spearman korelasyon analizi ARskoru ve PP arasında anlamlı negatif ilişki gösterdi (r=-0.40, p<0.0001). Pearson korelasyon testi AHİ ve VKİ arasında anlamlı ilişkigösterdi (r=0.32, p<0.05).Sonuç: Alerjik rinitin sadece TUA için önemli bir risk faktörü olduğunu değil, AR’li hastaların nazal direnç veya farengeal çökebilirliktehalihazırda artışa yol açan ciddi burun tıkanıklığı nedeniyle PO TUA hastaları olma eğilimi gösterdiğini ileri sürmekteyiz

Neutrophil-lymphocyte ratio findings and larynx carcinoma: A preliminary study in Turkey

Background: To identify the potential prognostic role of the neutrophil/lymphocyte (N/L) ratio in larynx carcinoma. Materials and Methods: Oncologic archive charts of patients with a larynx carcinoma diagnosis between the years 2010 and 2013 were retrospectively reviewed. The inclusion criterion was to be available with hemogram test prior to diagnostic procedure. Patients undergoing septorinoplasty comprised the control group. Results: There were 65 cases in the study and 42 cases in control group meeting inclusion criteria. In general a non-significant increase in N/L ratio was observed with increasing tumor size and stage (p>0.05) in larynx carcinoma. The N/L ratio was found to be significantly higher in larynx carcinoma compared to control group (p=0.004). Conclusions: In conclusion, the N/L ratio was shown to be significantly increased in larynx carcinomas compared to control group. Further studies are needed to assess any prognostic role

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

Comparison of Carina active middle-ear implant with conventional hearing aids for mixed hearing loss

WOS: 000373127800005PubMed ID: 26991874Objective: To compare the auditory outcomes of Carina middle-ear implants with those of conventional hearing aids in patients with moderate-to-severe mixed hearing loss. Methods: The study comprised nine patients (six males, three females) who underwent middle-ear implantation with Carina fully implantable active middle-ear implants to treat bilateral moderate-to-severe mixed hearing loss. The patients initially used conventional hearing aids and subsequently received the Carina implants. The hearing thresholds with implants and hearing aids were compared. Results: There were no significant differences between: the pre-operative and post-operative air and bone conduction thresholds (p > 0.05), the thresholds with hearing aids and Carina implants (p > 0.05), or the pre-operative (mean, 72.8 +/- 19 per cent) and post-operative (mean, 69.9 +/- 24 per cent) speech discrimination scores (p > 0.05). One of the patients suffered total sensorineural hearing loss three months following implantation despite an initial 38 dB functional gain. All except one patient showed clinical improvements after implantation according to quality of life questionnaire (Glasgow Benefit Inventory) scores. Conclusion: Acceptance of Carina implants is better than with conventional hearing aids in patients with mixed hearing loss, although both yield similar hearing amplification. Cosmetic reasons appear to be critical for patient acceptance

Temporal bone paragangliomas: 15 years experience.

Temporal bone paragangliomas (TBPs) are benign tumors arising from neural crest cells located along the jugular bulbus and the tympanic plexus. In general surgical excision, radiotherapy and wait-and-scan protocols are the main management modalities for TBPs