Evaluation of the Relationship Between Facial Nerve and Lateral Semicircular Canal in the Posterior Tympanotomy Approach.

BACKGROUND: To clinically and radiologically evaluate the relationship between the facial nerve and the lateral semicircular canal during posterior tympanotomy. METHODS: Patients who received cochlear implants between 2010 and 2020 were included in the study. The relationship between the facial nerve and the lateral semicircular canal was classified into 3 types by evaluating the axial section computed tomography images. If the facial nerve passed medially without contacting the lateral semicircular canal dome, it was classified as type 1; if the facial nerve passed by contacting the medial border of the lateral semicircular canal dome, it was classified as type 2; and if the facial nerve contacted the lateral border of the lateral semicircular canal dome or passed more laterally, it was classified as type 3. RESULTS: In total, 309 ears of 257 patients [139 males (54.1%) and 118 females (45.9%)] were included in the study. Ninety-three (30.1%) of the ears were classified as type 1, 179 (57.9%) were type 2, and 37 (12%) were type 3. It was found that the combined posterior tympanotomy/endomeatal approach was used in 6 ears (1.9%), of which 4 were type 3, and 2 were type 2 (P=.006). CONCLUSION: Systematic evaluation of the relationship between facial nerve and lateral semicircular canal in computed tomography axial sections might help prevent facial nerve damage that can occur during posterior tympanotomy. It was concluded that type 3 ears should be evaluated in this respect, as a combined posterior tympanotomy/endomeatal approach may be required.

Cochlear Implant Failure in the Pediatric Population.

BACKGROUND AND OBJECTIVES: In cochlear implant (CI) surgery, the results and causes of revision and reimplantation may guide surgeons in establishing surgical protocols for revision surgery with safe audiological outcomes. The aim of this study was to review our experience in terms of etiology, surgical strategy, and hearing outcomes in pediatric patients who underwent CI removal and reimplantation. SUBJECTS AND PURPOSE: All patients received implants of the same brand. Pre and postoperative Categories of Auditory Performance score and aided free-field pure tone audiometry thresholds were noted. In vivo integrity tests were performed for each patient and the results of ex vivo tests of each implant were obtained from manufacturer. RESULTS: A total of 149 CIs were placed in 121 patients aged <18 years. The revision rate in children was 6.7% (10/121 children). Six patients had a history of head injury leading to a hard failure. The causes of reimplantation in others were soft failure (n=1), electrode migration (n=1), infection (n=1), and other (n=1). All patients showed better or similar postreimplantation audiological performance compared with pre-reimplantation results. CONCLUSIONS: It is very important to provide a safe school and home environment and educate the family for reducing reimplantation due to trauma. Especially for active children, psychiatric consultation should be continued postoperatively.

Tracheoesophageal puncture closure with annular mucosal flap.

BACKGROUND: To present an effective and easily applicable method for tracheoesophageal puncture (TEP) closure by using a localized annular flap instead of bulky and distant flaps. METHODS: The medical records of patients who underwent TEP closure surgery with the annular mucosal flap technique between July 2012 and August 2018 were retrospectively reviewed. Fistula size, indication for closure, duration of surgery, radiotherapy status, and surgery results were analyzed. RESULTS: We have used our technique in nine patients. No postoperative bleeding, wound infection, esophageal stenosis, and tracheostoma stenosis occurred. In all these patients except one, successful closure was achieved. None of the patients had a recurrence of the TEP. CONCLUSION: The annular mucosal flap technique for TEP closure is easy and quick to apply. The patient's oral feeding at the sixth hour after procedure without using a nasogastric tube makes the technique preferable as a priority.

Transoral Approach to the Giant Deep Lobe Parotid Gland Pleomorphic Adenoma.

ABSTRACT: Parapharyngeal space tumors are rare tumors that make up about 0.5% to 1% of all head and neck neoplasms. The majority of parapharyngeal space tumors, which are usually benign, consist of salivary gland tumors and neurogenic tumors. Although the transcervical, transparotid or transmandibular approach is generally preferred for the excision of these tumors, the transoral approach, which is more advantageous in terms of cosmetics and function, can be applied in selected cases. This article presents a case in which the giant pleomorphic adenoma originating from the deep lobe of the parotid gland is removed by transoral approach.

[Cochlear implantation in far advanced otosclerosis: series of four cases]. / Asiri ilerlemis otosklerozda koklear implantasyon: Dört olguluk seri.

In this article, we present four patients who underwent cochlear implantation due to far advanced otosclerosis. Preoperative evaluations, intraoperative findings, complications, and postoperative benefits were analyzed. Cochlear implantation is a treatment option providing excellent audiological results for rehabilitation of patients with far advanced otosclerosis. However, facial nerve stimulation after cochlear implantation is observed more frequently in patients with otosclerosis. Also, caution should be paid in patients with otosclerosis in terms of cochlear ossification and inconsistent results.

Auditory brainstem implant in postlingual postmeningitic patients.

OBJECTIVES/HYPOTHESIS: The aim of this study was to evaluate outcomes of postlingual postmeningitic patients who received an auditory brainstem implant (ABI). STUDY DESIGN: Retrospective analysis was performed on postlingual postmeningitic patients with bilateral profound sensorineural hearing loss who underwent ABI between the years 2007 and 2014 METHODS: All patients were postlingually deaf due to cochlear ossification as a consequence of bacterial meningitis. The patients received a MED-EL or Neurelec ABI. All patients were operated on at different hospitals by the same primary surgeon. The patients were tested using Ling 5 sound detection, sound field implant thresholds between 250 Hz and 6 kHz, and 6 to 12 choice closed-set word and sentence tests. RESULTS: Nine patients with postmeningitic cochlear ossification received an ABI. Five of nine ABI users (55.5%) wear their audio processors (AP) most of the time. Four (44.5%) with no perceivable benefit have become nonusers. Three of the five consistent ABI users reported good benefit. The other two ABI users who do wear their APs do not respond to sound in daily living but reported benefits such as "feeling sound" in a good way. CONCLUSIONS: In this study, five of nine patients (55.5%) with bilateral ossified cochlea had some degree of benefit from their ABI. An ABI may be useful in hearing restoration in postlingual patients with bilateral ossified cochlea due to meningitis. However, poor results may be related to side effects, which may necessitate deactivation of electrodes, long duration of auditory deprivation, or impairments in the auditory neural structures as a result of meningitis. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1889-1892, 2016.

[Our surgical treatment results in pediatric cholesteatoma]. / Pediatrik kolesteatomda cerrahi tedavi sonuçlarimiz.

OBJECTIVES: This study aims to evaluate surgical techniques and obtained outcomes in pediatric cholesteatoma. PATIENTS AND METHODS: A total of 62 patients (41 males, 21 females; mean age 13 years; range 3 to 17 years) diagnosed as pediatric cholesteatoma between January 1998 and December 2014 were enrolled into the study. Of the patients, canal wall down (CWD) mastoidectomy was performed in 31, canal wall up (CWU) mastoidectomy in 13, inside-out (ISO) mastoidectomy in eight, and tympanoplasty in 10. Surgical approaches, staging, hearing outcomes, relapse status, and surgical data were retrospectively analyzed. RESULTS: Cholesteatoma recurred in seven patients (11%). Recurrence rates for CWU and CWD mastoidectomies were 31% and 6%, respectively. While the number of patients with good serviceable hearing (pure-tone average ≥25 dB) was 10 preoperatively, it became 16 postoperatively. Ossicular erosion was higher in CWD group. Twenty-nine patients (47%) had extensive disease and CWD mastoidectomy was performed in 86% of these. Number of patients not requiring care was 45 (72.6%). CONCLUSION: In this study, we observed no differences in terms of good serviceable hearing between CWU and CWD mastoidectomies. The preferred method was mainly CWD in patients with extensive disease and ossicular erosion. Recurrence rates were higher in CWU group. Therefore, ISO or CWD mastoidectomy come to the forefront as appropriate treatment options in the treatment of pediatric cholesteatomas according to the extensiveness of disease.

Toxic epidermal necrolysis treated with N-acetylcysteine.

Adverse drug reactions are the major cause of morbidity and mortality worldwide. Cutaneous drug reaction is the most common type of adverse reaction. Toxic epidermal necrolysis (TEN) is a rare, life-threatening mucocutaneous disease, usually attributable to drugs. There is no proven therapy for TEN. The mainstay of therapy is immediate withdrawal of the culprit drug, using disease-modifying agents, and meticulous supportive care. Several disease-modifying agents have been used such as steroid, i.v. human immunoglobulin (IVIg), plasmapheresis. A 10-year-old epileptic girl was admitted with lamotrigine-induced TEN. She was unresponsive to steroid. Her condition deteriorated despite IVIg treatment. She was treated with N-acetylcysteine (NAC). To our knowledge this is the first report of a child with TEN, a potentially lethal disorder, treated with NAC. NAC may be effective for children with TEN.

Short-term results of Neurelec Digisonic SP cochlear implantation in prelingually deafened children.

This paper examines the reports on the selection criteria and the post-operative performance of 25 children implanted with the Neurelec Digisonic SP. This study reported benefits from Neurelec Digisonic SP cochlear implant in auditory and speech perception outcomes. There has been a lack of studies into the additional factors such as level of the mothers' education and bilingualism, which is a factor that may have a significant effect on the success of cochlear implantation. This paper examines the reports on the reasons for the differences in performance and the post-operative performance of 25 children implanted with the Neurelec Digisonic SP. Meaningful Auditory Integration Scale and Meaningful Use of Speech Scale questionnaires were used just before 3, 6, 12, and 18 months following implantation. Electrode array was inserted without difficulty in all cases, with no complications to date. This is a retrospective and cross-sectional study and all the data were collected between March 2010 and December 2012. Auditory performance improved over time for up to 12 months after implantation. Our experience indicates that the Neurelec Digisonic SP cochlear implant system in children under the age of two is relatively safe and reliable. The Neurelec Digisonic SP device surgery can be performed without complications. Auditory performance results support the effectiveness of early implantation. These important findings further support the importance of professionals working very closely with parents or especially mothers and enhancing their involvement in achieving therapy goals to develop auditory skills and speech in young children following cochlear implantation.

Vitamin B12 levels of subjects aged 0-24 year(s) in Konya, Turkey.

Research reports indicate that vitamin B12 levels show racial differences, which suggests that using the reference ranges of varied populations may lead to inaccurate results. This study aimed to determine normal serum levels of vitamin B12 among children and young people in the Konya region of Turkey. It evaluated 1,109 samples; 54 were from cord-blood and 1,055 were from healthy subjects aged 0-24 year(s), who were admitted to primary healthcare centres. The normal reference levels obtained for vitamin B12 at 2.5-97.5 percentile (P2.5-P97.5) range were 127-606 pg/mL for girls, 127-576 pg/mL for boys, and 127-590 pg/mL for the entire study group. The reported reference values for vitamin B12 in other studies were higher than the current results. Vitamin B12 levels vary from country to country; comparisons between countries may not be valid, and normal levels for each population should be obtained.

Surgical treatment of carotid body tumors.

OBJECTIVES: In this study, we report our clinical experience in a series of patients with carotid body tumors along with diagnosis, treatment and follow-up procedures in the light of related literature data. PATIENTS AND METHODS: Between November 2001 and May 2012, 10 patients (5 males, 5 females; mean age 53.2 years; range 27 to 80 years) who underwent surgery due to a carotid body tumor in our clinic were included. Diagnosis was based on ultrasonography, computed tomography, magnetic resonance imaging, magnetic resonance angiography, selective carotid angiography, balloon occlusion test, biochemical tests and preoperative embolization. Complications were also recorded. RESULTS: Balloon occlusion test was performed in all patients preoperatively, while embolization was implemented in seven patients. All masses were dissected by carotid artery subadventitial approach. Carotid integrity was maintained in nine patients, while a vein graft was used in one patient. Neurological disorder was observed in one patient, whereas transient hypoglossal paresis was in one patient who underwent saphenous vein grafting. CONCLUSION: Our study results suggest that (i) carotid body tumors should be handled with multidisciplinary approach; (ii) balloon occlusion test should be performed in all patients undergoing surgery; (iii) a particular attention should be paid to cranial and phrenic nerves, if it is necessary to extend the surgical field while removing the tumor; and (iv) pathological examination should be carried out by an experienced team and in a multi-centered fashion, if necessary.

Extensive cholesterol granuloma of the petrous apex presenting with facial paralysis and sensorineural hearing loss: a case report.

A cholesterol granuloma of the petrous bone is an expanding mass which contains fluids, lipids, chronic inflammatory cells, and cholesterol crystals surrounded by a fibrous lining. The goal of surgery is to provide drainage and ventilation of the affected area to prevent recurrences. In this article, we report a case of a 27-year-old man who was operated using the transmastoid infralabyrinthine approach to drain a cholesterol granuloma cyst.

Unusual manifestations of pediatric neuromyelitis optica.

Neuromyelitis optica is a rare, severe idiopathic disease that predominantly involves optic nerves and spinal cord. Main clinical features of neuromyelitis optica are visual loss, paraparesis or tetraparesis, sensory loss, and sphincter dysfunction. A 13-year-old girl with vision loss and behavioral change was admitted. Her behavioral changes concerned demanding everything, eating cacik (a kind of meal prepared by yogurt) continuously, calling everyone "father," and self-throttling during the last 1 month, and blurred vision started 15 days ago. On cranial magnetic resonance imaging (MRI), multiple lesions were seen. The patient was admitted 40 days later with walking difficulty. There were lesions in the medulla and cervical spinal cord on MRI. Neuromyelitis optica was diagnosed. Vomiting was the beginning complaint in 2 of 5 hospitalizations later. We conclude that neuromyelitis optica may involve atypical symptoms such as behavioral change and vomiting. Atypical presentations may delay diagnosis. Vomiting may be a recurrence messenger.

Modified intraoral approach for removal of an elongated styloid process.

OBJECTIVE: To decrease the postoperative pain and the probability of intraoperative complications during intraoral removal of an elongated styloid process. STUDY DESIGN: A prospective, clinical trial. METHODS: Twenty-seven patients with 45 elongated styloid processes underwent surgery. There were 24 females and 3 males, with a mean age of 47.1 years. A simple visual analogue scale was used to assess pre- and postoperative pain. The length and medial and anterior angulation of each process were measured on lateral skull and Towne projection. During the surgery, after tonsillectomy was performed, the styloid process was identified and the process was stripped off proximally using a ring curette. The muscles and ligaments were in continuity with the periosteum, and attachments to the periostem were not disrupted. RESULTS: No intraoperative complications were seen. Only 2 of 45 procedures did not result in a decrease in pain, and a success rate of 95.6% was achieved by this modified surgical method. CONCLUSIONS: Excision of the styloid process without disturbing the attachments of the muscles and ligaments to the periosteum of the process is an important factor in relieving postoperative pain and complications.

Intestinal involvement in metachromatic leukodystrophy.

Metachromatic leukodystrophy is a lysosomal storage disease caused by the deficiency of the enzyme arylsulfatase A. If arylsulfatase A is deficient, sulfatide accumulates. Functionally, this accumulation results in progressive neurological deterioration. The reports about the extra nervous system manifestations of metachromatic leukodystrophy are related to the gallbladder involvement such as polyposis. Unexplained vomiting began in a 5½-year-old girl with late infantile metachromatic leukodystrophy. Endoscopy showed multiple polypoid masses in the pylor of the stomach and duodenum. Severe gastrointestinal bleedings occurred during nasogastric feeding. Intestinal intussusception developed later. To the authors' knowledge, intestinal polypoid masses and obstruction with metachromatic leukodystrophy have not previously been reported. The persistent vomiting may be a symptom of intestinal obstruction due to intestinal polypoid masses with metachromatic leukodystrophy. There may be a trend for the development of polypoid masses in intestine as well as in the gallbladder in metachromatic leukodystrophy.