Which imaging modality in cochlear implant candidates?

PURPOSE: There is no guideline or consensus on preoperative radiologic imaging modality despite the fact that it has a vital importance in appropriate candidacy selection of cochlear implantation. We aimed to find out the role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) on surgical planning, intraoperative technique in cochlear implant candidates. METHODS: The clinical charts, imagings, and operative reports of patients who underwent cochlear implant surgery at a tertiary institution were retrospectively examined. RESULTS: 611 patients (503 children and 108 adult) were enrolled into the study. We found 11 different pathologies in MRI which could not be seen in HRCT. However, we decided the side of surgery according to MRI in only three of them in which the pathology was cochlear nerve hypoplasia. Two patients with cochlear nerve hypoplasia were children with prelingual deafness and one was adult with perilingual deafness. Moreover, we changed the surgical planning of side according to both imaging modalities in nine patients. Seven of them were children and two were adult. One of these adults had cochlear anomaly, and another had bilateral temporal bone fracture. CONCLUSIONS: We suggest both imaging modalities in pediatric candidates. However, in adults, we think that superiority of either imaging modalities is still contradictive. We had only three adult patients and the decision of the side of surgery was made according to MRI in one of them and to both imaging modalities in the other two adults.

Computed tomography analysis of intranasal distance of frontal and sphenoid sinus ostiums in children.

PURPOSE: Pediatric population may be more prone to complications in comparison to adults because of the variability of developmental changes of paranasal sinuses and skull base. Knowledge of standard columellar distances regarding age in addition to anatomical landmarks is an important guide during functional endoscopic sinus surgery. We aimed to identify standard distances from columella and anterior nasal spine to the anterior and posterior border of frontal and sphenoid sinus ostiums and provide an objective reference graph in regard to age in children. METHODS: Subjects who are older than 1 year and younger than 18 years who had undergone a head-and-neck, maxillofacial or temporal bone region high resolution computed tomography scan during the last 3 years were obtained from radiological database. The distances from columella and anterior nasal spine to the anterior and posterior border of frontal and sphenoid sinus ostiums were measured and nasofrontal and nasosphenoid angles were calculated. RESULTS: A total number of 119 children (73 boys, 46 girls) were reviewed. The average age was 7.7 ± 5.0 years. All subjects had normal sinonasal anatomy. We found statistically significantly positive correlation between age and all distances (p < 0.001). Although all measured distances of boys were greater than girls, this difference did not reach statistical significance. Additionally, nasosphenoidal angles were significantly obtuse in boys (p < 0.05). CONCLUSIONS: Our columellar distance graphic can provide further improvement of surgeon confidence while performing endoscopic sinus surgery or skull base surgery.

Relations Between Hyoid-Related Cephalometric Measurements and Severity of Obstructive Sleep Apnea.

OBJECTIVE: To evaluate the relationship between the hyoid-related cephalometric measurements and the apnea-hypopnea index (AHI) in patients diagnosed with obstructive sleep apnea (OSA). METHODS: A total of 56 subjects were evaluated by lateral cephalometric radiography and polysomnography (PSG). The OSA diagnosis was made according to the patients' AHI. Included were 13 primary snoring, 16 mild OSA, 10 moderate OSA, and 17 severe OSA. C3-hyoid distance and mentum-hyoid distance were measured on lateral cephalogram. Cephalometric measurements and PSG parameters were compared among the different OSA groups. RESULTS: The distance between the mentum and hyoid was significantly longer in the severe OSA group than in the primary snoring, mild OSA, and moderate OSA groups (P = 0.029). There was a significant positive correlation between the AHI value and the distance of the mentum hyoid (r = 0.368, P = 0.005). The C3-hyoid distance among the groups was not statistically significant different (P = 0.889). CONCLUSION: The mentum-hyoid distance of patients with severe OSA was longer compared to the other OSA groups. These patients might have more benefit from the surgeries that have an impact on the position of the hyoid bone compared to other patients with OSA.

Relationship between vertebral artery blood flow in different head positions and vertigo.

OBJECTIVE: To identify the vertebral artery blood flow in different head positions in patients with positional vertigo with no specific diagnosis. METHODS: Patients with history of vestibular symptoms associated with changes in head position were enrolled into the study. Healthy volunteers were evaluated as control group. Doppler ultrasonography examination of the cervical segment of the vertebral arteries was performed under three different head positions: (i) supine position, (ii) head hyperextended and rotated to the right side and (iii) head hyperextended and rotated to the left side. RESULTS: In the study group, right and left vertebral artery blood flow was significantly lower in the ipsilateral hyperextended position compared to standard supine position (respectively p = .014; p = .001), but did not differ significantly when compared between the standard supine and contralateral hyperextended positions (respectively = .959; p = .669). In the control group, left and right vertebral artery blood flow did not differ significantly when the head was hyperextended to the right or left sides compared to standard supine position (p > .05). CONCLUSIONS: Our data demonstrated that the etiology of vestibular complaints in patients with undiagnosed positional vertigo might be related to impairment in vertebral artery blood flow according to head positions.

The effectiveness of platelet-rich plasma in an anosmia-induced mice model.

OBJECTIVE: In this study, we aimed to functionally and morphologically demonstrate the effectiveness of platelet-rich plasma (PRP) on anosmia in a mouse model of anosmia. STUDY DESIGN: Animal study. METHODS: A total of 16 male mice were included. When selecting the mice, the food-finding test (FFT) was used to make sure that the animals could smell, and anosmia was induced by administration of intraperitoneal 3-methylindole. The mice were randomly divided into two groups of eight (groups A and B). After 1 week, topical PRP was administered to the mice in group A and topical saline was administered to the mice in group B. The FFT was again administered at 7, 14, and 21 days. The mice were sacrificed on day 21, the olfactory neuroepithelium was histopathologically examined, and the epithelial damage scores and epithelial thickness were measured. RESULTS: After topical administration of PRP and saline, the difference in the average FFT values of the groups was statistically significant at 7, 14, and 21 days (P < 0,005). During the histopathological examination, the epithelial damage score was statistically significantly lower in the PRP group (P = 0.001) than in the saline group, and epithelial thickness was statistically significantly greater in the PRP group compared to the saline group (P = 0.003). CONCLUSION: We showed that PRP administration has a curative effect on olfactory functions in an anosmia-induced mice model. However, there is a need for further research before PRP can be considered for use in patients with anosmia in clinical practice. LEVEL OF EVIDENCE: NA. Laryngoscope, 128:E157-E162, 2018.

Long-term results of pillar implant procedure.

OBJECTIVES: This study aims to investigate the long-term efficiency and reliability of the Pillar Implant (PI) procedure. PATIENTS AND METHODS: Between January 2008 and January 2010, a total of 27 patients (16 males, 11 females; mean age 45.8±7.2 years; range 31 to 58 years) who were diagnosed with low obstructive sleep apnea syndrome and simple snoring underwent the PI procedure in this retrospective, nonrandomized study. The patients were evaluated preoperatively with visual analog scale (VAS) scores in terms of snoring, dysphagia, mouth dryness, foreign body sensation, and pain at the first month, third month, and sixth year intervals. RESULTS: Based on the snoring scale, VAS scores were statistically significantly lower in the first month, third month and sixth year compared to preoperative scores (p=0.001, p=0.008, p=0.017, respectively). There was no pain in any patients beyond the third day. The VAS score averages in all evaluations were higher by statistical significance relative to the preoperative averages (p=0.018, p=0.027, p=0.025, respectively). Mouth dryness was encountered in seven patients. It persisted in seven patients at the third month and in five patients at the sixth year interval. The VAS score averages were statistically significantly higher in all evaluations compared to the preoperative scores (p=0.017, p=0.018, p=0.042, respectively). CONCLUSION: Pillar implant is an efficient, reliable method in the long-term; however, it should be considered that it could cause complaints such as dysphagia, foreign body sensation, and mouth dryness.