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

The protective role of S-allylmercaptocysteine, diallyl disulfide and high dose of vitamin B12 on noise induced hearing loss

"S-allylmercaptocysteine, Diallyl disulfide ve yüksek doz B12 vitamininin ratlarda oluşturulan gürültüye bağlı işitme kaybında koruyucu etkinliği" Bu çalışma S-allylmercaptocysteine, Diallyl disulfide ve yüksek doz B12 vitamininin ratlarda oluşturulan gürültüye bağlı işitme kaybında koruyucu etkinliğini ortaya koymak amacıyla yapılmıştır. Ratlar rastlantısal olarak 6'şarlı 4 gruba ayrıldı. Tüm ratların ilaç verilmeden önce sağ kulaklarındaki işitme eşikleri "Audıotory Brain Responce" (ABR) testi ile belirlendi. İlk gruba 100 mg/kg serum fizyolojik intragastrik, ikinci gruba 1 mg/kg dozda B12 vitamini intraperitoneal, üçüncü gruba 100 mg/kg S-allylmercaptocysteine (SAMC) intragastrik, dördüncü gruba da 50 mg/kg Diallyl disulfide (DADS) intragastrik olarak 2 hafta süre ile verildi. 2 haftanın sonunda tüm gruplar 8 saat süreyle 110 dB geniş band gürültüye (White noise) maruz bırakıldı. Gürültü sonrasında gruplara, ilaçlar aynı doz ve şekillerde 2 hafta daha verilmeye devam edildi. Gürültü sonrası hemen (0. saat), 48. saat ve 2. haftada ABR testi ile işitme eşikleri tekrar değerlendirildi. Son ABR ölçümlerinin ardından derin anestezi altında intrakardiyak kan alımını takiben ratların sağ (ölçüm yapılan) temporal kemikleri çıkarıldı. Kohleaları ışık ve transmisyon elektron mikroskobik incelemeler için ayrıldı. ABR testlerinde, tüm ilaç gruplarının, 14. gün 8 kHz'deki işitme eşiklerinin, kontrol grubuna göre anlamlı olarak korunduğu gözlendi. Ayrıca SAMC verilen grupta, yine 8 kHz'de 48.saat eşiklerinin kontrol grubuna göre anlamlı olarak korunduğu gözlendi. DADS verilen grupta da 6 kHz'de 14. gün eşiklerinin kontrol grubuna göre anlamlı olarak korunduğu gözlendi. Işık mikroskopisinde kohleanın 7 farklı alanı incelenerek dejenerasyon kriterleri oluşturuldu. SAMC ve DADS verilen grupların hem kontrol hem de B12 verilen gruba göre kohlea bütünlüğünü anlamlı düzeyde daha iyi koruduğu gözlendi. B12 ile kontrol grubu arasında anlamlı bir fark izlenmedi. SAMC ve DADS kendi aralarında değerlendirildiğinde, SAMC'nin daha iyi koruduğu gözlendi. Elektron mikroskopide de ışık mikroskpisine benzer bulgular elde edildi. B12 ve kontrol gruplarındaki hasar benzer izlendi. SAMC ve DADS moleküllerinin kontrol ve B12 gruplarına göre daha iyi koruduğu gözlendi. En iyi korumanın SAMC grubunda olduğu izlendi. Sonuç olarak B12, SAMC ve DADS moleküllerinin ABR testlerinde gürültüden koruyucu etkinliği gösterildi. SAMC ve DADS moleküllerinin koruyucu etkinliği ışık ve elektron mikroskopi ile de desteklendi. Hem ABR hem de histolojik değerlendirmeler neticesimde, tüm gruplar içerisinde en iyi koruyucu molekülün SAMC olduğu gözlendi."The protective role of S-allylmercaptocysteine, Diallyl disulfide and high dose of vitamin B12 on noise induced hearing loss" The aim of this study was to demonstrate the protective effect of S-allylmercaptocysteine, Diallyl disulfide and high dose of vitamin B12 in rats exposed to noise. Rats were divided randomly into four groups. Auditory brainstem response (ABR) thresholds of all subjects were detected (right ear) before any drug administration. Drugs were applied to each group once a day for four weeks. First group (group A, n=6) was chosen as the control group and subjects in this group received 100 mg/kg of saline intragastrically. The second group (group B, n=6) were treated with intraperitoneal injection of 1mg/kg vitamin B12. The third group (group C, n=6) were treated with intragastric application of 100 mg/kg SAMC. The fourth group (group D, n=6) received 50 mg/kg of intragastric DADS. After the end of the second week of application, each group was exposed to white noise at 110 dB, for 8 hours. First measurement was performed immediately after noise exposure. The second measurement was performed 48 hours after exposure, and the third measurement was assessed two weeks after exposure. Following the last assesment of ABR thresholds, intracardiac blood was collected under deep anesthesia, and right temporal bones of the rats were sacrificed. Cochleas were spared for transmission and electromicroscopic investigation. In conclusion, statistically significiant lower ABR thresholds were observed in the treatment groups with vitamine B12, SAMC and DADS on the tone burst 8 kHz stimuli at the 14th day of noise exposure. Cochleas were histologically examined, in groups C and D cochleas were found to be better preserved than the cochleas of groups A and B

Atipik prezentasyonlu Bir pediatrik renal hücreli karsinom vakası: Boyunda kitle

The most common malignant diseases of the head and neck in the adolescent period are acute leukemia, Hodgkin's disease, non-Hodgkin's lymphoma, nasopharyngeal carcinoma, and thyroid carcinoma. Although renal cell carcinoma (RCC) may metastasize in the cervical lymph nodes, both occurrence and presentation as a neck mass are rare in the childhood period. In this report, we present a sixteen-year-old girl who was admitted with a left neck mass at presentation. The primary tumor was found to be located in the left kidney and both masses were surgically removed, revealing a diagnosis of a translocation renal cell carcinoma with metastases. Distant metastases of abdominal and thoracic malignancies may present with metastatic lymph nodes, and should be included in the differential diagnosis of the neck masses in children.Adölesan dönemde baş boyun bölgesinde en sık rastlanılan malign hastalıklar; akut lösemi, Hodgkin lenfoma, non-Hodgkin lenfoma, nazofarenks kanseri ve tiroid kanseridir. Renal hücreli karsinom (RHK) servikal lenf nodlarına metastaz yapabilmekle beraber, çocukluk döneminde görülmesi ve boyun kitlesi ile başvurusu çok nadirdir. Bu yazıda ilk başvuru şikayeti sol boyunda kitle olan on altı yaşında bir kız çocuğunu sunuyoruz. Hastanın sol böbreğinde yerleşik olduğu tespit edilen primer tümör ve boyun metastazı eksize edildi ve patolojik tanı translokasyonal renal hücreli karsinom olarak rapor edildi. Abdominal ve torasik malignensiler metastatik lenf nodları ile prezente olabileceğinden çocuklarda boyun kitlelerine yaklaşımda ayırıcı tanıda bulundurulmalıdır

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

Temporal bone paragangliomas: 15 years experience

Abstract Introduction 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. Objective In this paper we aim to present our clinical experience with TBPs and to review literature data. Methods The patients who were operated for tympanomastoid paraganglioma (TMP) or tympanojugular paraganglioma (TJP) in our clinic in the last 15 years were enrolled in the study. A detailed patient's charts review was performed retrospectively. Results There were 18 (52.9%) cases with TMPs and 16 (47.1%) cases with TJPs, a total of 34 patients operated for TBPs in this time period. The mean age was 50.3 ± 11.7 (range 25-71 years). The most common presenting symptoms were tinnitus and hearing loss for both TMPs and TJPs. Gross total tumor resection was achieved in 17 (94.4%) and 10 (62.5%) cases for TMPs and TJPs, respectively. Five patients (31.2%) with TJP experienced facial palsy following the operation. For all the patients the mean follow-up period was 25.8 months (range 4-108 months). Conclusion In conclusion, based on our findings and literature review, total surgical excision alone or with preoperative embolization is the main treatment modality for TBPs. However radiotherapy, observation protocol and subtotal resection must be considered in cases of preoperative functioning cranial nerves, large tumors and advanced age