Endoscope-Assisted Cochlear Implantation

Objectives Our aim was to present our endoscope-assisted cochlear implantation (CI) technique, in which the middle ear landmarks were identified through the facial recess exposure by using an endoscopic view without elevating the tympanic annulus. The secondary goal was to assess whether the situation of difficult surgical exposure could be predicted by evaluating preoperative axial computed tomography (CT) examinations. Methods CT examinations and surgical outcomes of endoscope-assisted CI surgeries were analyzed. Results A total of 179 CI operations performed in 27 adults (15.1%) and 152 children (84.9%) were retrospectively evaluated. It was found that in 14 cases (7.8%), endoscopic examination contributed substantially in identifying the round window (RW) membrane correctly. Endoscopic identification of the RW through the posterior tympanotomy enabled us to perform a straightforward surgery in all these cases, without the need for switching to a bony cochleostomy or alternative surgical techniques. The difficulty in the surgical exposure was predicted preoperatively by examining the axial CT scans in six of the 14 cases (42.8%) for which endoscopic assistance was necessary in order to identify the RW correctly. Conclusion The main benefit of endoscope-assisted CI is the improved visibility leading to a panoramic view of the RW region. The implementation of transfacial recess endoscopic examination into the conventional CI technique is helpful to avoid problems during surgical orientation. However, the difficulty in the surgical exposure of the RW cannot be reliably predicted by the subjective evaluation of preoperative CT scans and more studies are needed to obtain reliable criteria

Laryngomalacia: Our Clinical Experience

Objective:The aim of this study is to analyse the clinical symptoms, follow-up and treatment properties of the laryngomalacia patients that we encountered between 2009 and 2014.Methods:Records of 81 laryngomalacia patients who were followed up in our clinic between 2009 and 2014 were retrospectively analysed. Patients’ gender, age, time of onset of the symptoms, chief complaints, other co-existing congenital laryngeal anomalies and treatment and follow-up properties were evaluated.Results:Of the 81 patients, 48 were male and 33 were female, and the mean age was 4.9 months. The average period of follow-up was 12.1 months. The chief complaints at the time of admission were stridor (100%) and episodic cyanosis with feeding (27.16%). Symptoms of 75 patients were resolved at an average of 8.2 months with conservative treatment. Three patients underwent supraglottoplasty. Tracheotomy and posterior cordotomy was performed for a patient with co-existing vocal cord paralysis. Additional tracheotomy was necessary for a patient with pulmonary co-morbidities and for another with co-existing subglottic stenosis.Conclusion:Laryngomalacia is the most common cause of stridor in infants. The majority of laryngomalacia patients can be managed conservatively by close follow- up. For patients in whom respiratory and feeding problems persist or growth retardation develops, surgical treatment is performed. Tracheotomy may be necessary for a small group of patients with additional diseases

Effect of Ecklonia Cava Polyphenol Extract in House Ear Institute-Organ of Corti 1 Cells Against Cisplatin Ototoxicity: A Preliminary Study

Objective:Cisplatin is a widely used agent for the treatment of adult and childhood malignancies. Side effects such as nephrotoxicity, neurotoxicity, and ototoxicity lead to dose limitations. Ecklonia cava polyphenol extract (ECP) is a molecule obtained from algae that live in seawater in the Far East. ECP has recently been shown to have protective effects against oxidative stress. The aim of this study was to evaluate the possible protective effects of ECP on cisplatin ototoxicity.Methods:In this study, we investigated the protective effects of ECP against cisplatin-induced cell death in mouse-derived House Ear Institute Organ of Corti (HEI-OC1) cochlear cells. Cisplatin (100 μM) and 1, 10, and 25 μM doses of ECP were administered to the cells, and the protective effects of ECP at 24 and 72 hours were investigated. Cell viability was evaluated by the WST-1 (water soluble tetrazolium salt).Results:Cisplatin (100 μM) reduced cell viability in both the 24th and 72nd hour evaluation. Although the 25 μM dose of ECP showed otoprotective effects in the 24th hour, in the 72nd hour this effect disappeared. Other doses of ECP showed no otoprotective effects in the 24th and 72nd hours.Conclusion:Although ECP showed some protective effects in the 24th hour against cisplatin ototoxicity, these effects disappeared by the 72nd hour. Further studies using recurrent and higher doses of ECP are required

A New Trend in the Management of Pediatric Deep Neck Abscess: Achievement of the Medical Treatment Alone

Objective: Albeit the traditional opinion that advocates a routine surgical drainage for the treatment of an abscess, the case series presenting high success rates of the medical therapy alone is increasing in deep neck abscesses of childhood. This research focuses on children whose deep neck abscess fully disappeared after only medical treatment.Methods: In a retrospective study, we evaluated medical records of 12 pediatric (<18 years old) cases diagnosed with deep neck abscess or abscess containing suppurative lymphadenitis and treated with only medical therapy between 2010 and 2015 for age, gender, treatment modality, parameters related to antimicrobial agents, location of the infection, etiology, symptoms, duration of hospital stay, characteristics of the radiological and biochemical examination findings, and complications.Results: The mean age of 10 male and two female children was 5.9 years (range, 1-17 years). Baseline and the last control’s mean values of white blood cell (WBC), C-reactive protein, and erythrocyte sedimentation rate were 18,050/ µL, 99.8 mg/L, 73.1 mm/h, and 8,166/µL, 34.1 mg/L, 35.3 mm/h, respectively. Contrast-enhanced neck computed tomography demonstrated an abscess in seven cases and an abscess containing suppurative lymphadenitis in five cases. The largest diameter of the abscess was 41 mm. All cases were given broad-spectrum empirical antibiotherapy (penicillin+ metronidazole, ceftriaxone+metronidazole, or clindamycin). No medical treatment failure was experienced.Conclusion: Independent of age and abscess size, if the baseline WBC is ≤25.200/µL, if only two or less than two cervical compartments are involved, if there are no complications in the admission, and if the etiological reason is not a previous history of trauma, surgery, foreign body, and malignancy, pediatric deep neck abscess can be treated successfully with parenteral empirical wide-spectrum antibiotherapy

3D Model to Understand the Diagnosis and Treatment of Horizontal Canal BPPV

Objective:Our primary objective was to develop a three-dimensional (3D) model of the vestibular labyrinth to understand the pathophysiological mechanisms of benign paroxysmal positional vertigo (BPPV) observed during common diagnostic positional tests. We secondarily aimed to monitor the effects of the repositioning maneuvers and use this tool in teaching.Methods:A 3D model of a human semicircular canals (SSCs) system was created by 3D printing the core and assembling it with silicone tubing filled with lubricant oil containing colored small stones in the lumen mimicking otoconia. We used the model in horizontal canal BPPV diagnostic tests and therapeutic maneuvers. The working mechanism of the model we designed was recorded with video.Results:The model allowed for a clear display of the anatomy and the respective orientations of the SSCs. Otolith movement in the horizontal canals could be imitated during diagnostic positional tests (Dix-Hallpike and Pagnini-McClure) and therapeutic maneuvers (Epley, Semont, Lempert and Gufoni).Conclusion:As well as helping to understand the anatomy and physiology of the SSCs, this simple 3D model also provides a teaching tool for the diagnosis and treatment of BPPV. The mechanism of horizontal canal canalithiasis and the effect of therapeutic repositioning maneuvers could be clearly observed by watching the markers in the lumen demonstrating the progress of otolith movements with changes in head position relative to gravity

Myxoma of the Middle Ear Mimicking Chronic Otitis Media

Myxoma is a benign connective tissue tumor that arises mostly from the heart. Temporal bone myxomas are extremely rare and these patients should be evaluated for the Carney complex association. Herein, our aim was to present a middle ear myxoma case operated with an initial diagnosis of chronic otitis media (COM) and to underline the fact that myxomas should be kept in mind in the differential diagnosis of aural polyps

Role of Elective Neck Dissection in Early Stage Lip Cancers

Objective:To date, the management of the neck in early stage lower lip cancers remains controversial. The aim of this study is to investigate if prophylactic neck dissection is necessary in early stage lower lip cancers.Methods:Charts of 11 patients who underwent surgery of the primary site and neck because of T1–2N0 lower lip cancer between 1997 and 2011 were retrospectively examined. Clinical stages, surgeries, histopatological examination results, and loco-regional recurrences were evaluated.Results:Of the 11 patients, 10 were male (90.9%) and 1 was female (9.09%). The follow-up time of these patients was between 24-168 months (mean, 56.6 months). There were 5 patients with clinically diagnosed T1N0 tumors and 6 patients with clinically diagnosed T2N0 tumors. Suprahyoid neck dissection was performed in 4/5 T1N0 patients and supraomohyoid neck dissection was performed in the remaining 1 patient. For T2N0 tumors, 4 suprahyoid, 1 supraomohyoid, and 1 comprehensive neck dissection was performed. Histopathological examination revealed no occult metastasis in any of the patients. In 1 patient who had lower lip resection and suprahyoid neck dissection for T1N0 lower lip cancer, a contralateral neck metastasis was detected 22 months postsurgery, and a comprehensive neck dissection was performed.Conclusion:Our results show that in patients with T1N0 lower lip tumors, neck dissection may not be necessary; however, close follow-up is mandatory. Further researches with larger series dividing T2N0 tumors into subgroups for tumor size and thickness are necessary to determine neck treatment in these tumors

TuRaN: True Random Number Generation Using Supply Voltage Underscaling in SRAMs

Prior works propose SRAM-based TRNGs that extract entropy from SRAM arrays. SRAM arrays are widely used in a majority of specialized or general-purpose chips that perform the computation to store data inside the chip. Thus, SRAM-based TRNGs present a low-cost alternative to dedicated hardware TRNGs. However, existing SRAM-based TRNGs suffer from 1) low TRNG throughput, 2) high energy consumption, 3) high TRNG latency, and 4) the inability to generate true random numbers continuously, which limits the application space of SRAM-based TRNGs. Our goal in this paper is to design an SRAM-based TRNG that overcomes these four key limitations and thus, extends the application space of SRAM-based TRNGs. To this end, we propose TuRaN, a new high-throughput, energy-efficient, and low-latency SRAM-based TRNG that can sustain continuous operation. TuRaN leverages the key observation that accessing SRAM cells results in random access failures when the supply voltage is reduced below the manufacturer-recommended supply voltage. TuRaN generates random numbers at high throughput by repeatedly accessing SRAM cells with reduced supply voltage and post-processing the resulting random faults using the SHA-256 hash function. To demonstrate the feasibility of TuRaN, we conduct SPICE simulations on different process nodes and analyze the potential of access failure for use as an entropy source. We verify and support our simulation results by conducting real-world experiments on two commercial off-the-shelf FPGA boards. We evaluate the quality of the random numbers generated by TuRaN using the widely-adopted NIST standard randomness tests and observe that TuRaN passes all tests. TuRaN generates true random numbers with (i) an average (maximum) throughput of 1.6Gbps (1.812Gbps), (ii) 0.11nJ/bit energy consumption, and (iii) 278.46us latency

Comparison of Audiological Findings in Patients with Vestibular Migraine and Migraine

Objective:The aim of this study was to investigate and compare the auditory findings in vestibular migraine (VM) and migraine patients without a history of vertigo.Methods:This study was conducted on 44 patients diagnosed with definite VM and 31 patients diagnosed with migraine who were followed and treated between January 2011 and February 2015. Also, 52 healthy subjects were included in this study as a control group. All participants underwent a detailed otorhinolaryngological examination followed by audiological evaluation, including pure tone audiometry, speech reception threshold, speech recognition score, and acoustic immitancemetry.Results:In the VM group, there were 16 patients (36.4%) with tinnitus, while in the other groups we did not observe any patients with tinnitus. The rate of tinnitus in the VM group was significantly higher in comparison to other groups (p<0.05). None of the groups had any patients with permanent or fluctuating sensorineural hearing loss.Conclusion:We conclude that patients with VM should be closely and longitudinally followed up for the early detection of other otological symptoms and possible occurrence of sensorineural hearing loss in the long term

Effect of Korean Red Ginseng on Noise-Induced Hearing Loss

Objective:Noise-induced hearing loss (NIHL) is one of the most important problems affecting both social and professional life of patients. There is no treatment method considered to be successful on the hearing loss that has become a permanent nature. Aim of this study is to evaluate protective effect of Korean Red Ginseng (KRG) against NIHL in an animal model.Methods:Twenty-eight rats were separated into four groups [control saline (group I), control KRG (group II), saline + noise (group III), KRG + noise (group IV)]. Rats in the saline and KRG groups were fed via oral gavage with a dose of 200 mg/kg/day throughout for 10 days. Fourteen rats (group III and IV) were exposed to 4 kHz octave band noise at 120 dB SPL for 5 hours. Hearing levels of rats were evaluated by distortion product otoacoustic emissions (DPOAE) and auditory brainstem responses (ABR) at 4, 8, 12, 16 and 32 kHz frequencies prior to and on days 1, 7 and 10 after the noise exposure. Rats were sacrificed on 10th day, after the last audiological test. Cochlea and spiral ganglion tissues were evaluated by light microscopy.Results:Audiological and histological results demonstrated that after noise the group IV showed better results than group III. In the noise exposed groups, the most prominent damage was seen at the 8 kHz frequency region than other regions. After the noise exposure, DPOAE responses were lost in 1st, 7th and 10th measurements in both group III and IV. Thus, we were not able to perform any statistical analyses for DPOAE results.Conclusion:Our findings suggest that KRG seems to be an efficient agent against NIHL. There is need for additional research to find out about the mechanisms of KRG’s protective effect