BACKGROUND: The aim is to quantify the electrode insertion trauma-induced hearing loss (EITHL), its risk factors, and its impact on speech outcomes in prelingually deafened children undergoing cochlear implantation. METHODS: This was a prospective, observational study conducted at a single center between 2021 and 2024. Forty children aged 1-5 years with severe-to-profound sensorineural hearing loss underwent cochlear implantation using either the cochleostomy or round-window (RW) techniques. Auditory steady-state response (ASSR) thresholds were utilized to assess hearing preservation levels. Speech outcomes were evaluated by measuring word recognition scores (WRS) at 6, 12, and 24 months. The correlation between electrode insertion depth, hearing preservation, and speech outcomes was analyzed. RESULTS: All participants achieved Grade 1 hearing preservation (>75%). The mean hearing preservation rates at 3, 6, 9, and 12 months were 93.2%, 92.3%, 92.9%, and 92.1%, respectively. Although the RWT demonstrated better hearing preservation than the CS technique, the difference was not statistically significant. A significant increase in low-frequency hearing thresholds was observed over time, with 12-month values of 84.9 ± 3.5 dB (250 Hz), 90.2 ± 3.7 dB (500 Hz), and 92.4 ± 4.0 dB (1000 Hz). A negative correlation was found between the depth of electrode insertion and hearing preservation (r=-0.45, P=.03). Word recognition scores improved over time, with bilateral implant recipients showing significantly higher scores (P < .00). CONCLUSION: Cochlear implantation via both CS and RW approaches preserves residual hearing in prelingually deafened children, with RW insertion demonstrating superior preservation. Deeper electrode insertion is associated with poorer hearing preservation, while better hearing preservation correlates with improved speech outcomes.

BACKGROUND: There is a general idea that the external auditory canal (EAC) is wide in patients with otosclerosis. However, as far as we know, there is no objective measurement of the EAC of patients with otosclerosis. In this study, we aimed to measure objectively the dimensions of the osseous EAC (OEAC) in otosclerosis, using high-resolution computed tomography (HRCT). METHODS: High-resolution CT images of cranial bones were obtained from 66 patients with otosclerosis and 48 control individuals using a 256- slice CT scanner with a thickness of 0.67 mm. The dimensions and shape of the OEAC from the end of the cartilaginous portion of the EAC to the annulus of the middle ear were then measured. RESULTS: A total of 228 ears were analyzed using CT images. The osseous external ear canal was most commonly conical in both groups. The width of OEAC was not significantly different in the otosclerosis group. The length of the osseous external ear canal was 6.69 ± 1.49 mm in the control group, and 5.96 ± 1.07 mm in the otosclerosis group. It was significantly shorter in the otosclerosis group (P=.001). CONCLUSION: We measured the OEAC in otosclerosis using an objective method. Contrary to what is known, the OEAC tends to be short bilaterally in the ears of patients with otosclerosis, rather than wider.

BACKGROUND: To characterize alterations in white matter microstructure in cases with idiopathic sudden sensorineural hearing loss (SSNHL) through tract-based spatial statistics applied to diffusion tensor imaging (DTI), elucidating both early-stage and chronic neuroanatomical alterations. METHODS: All cases underwent high-resolution conventional magnetic resonance imaging and DTI. Diffusion data preprocessing was performed using the FMRIB Software Library, including corrections for eddy currents and head motion, brain extraction, and normalization to standard space. Tract-based spatial statistics was employed to undertake voxel-wise whole-brain analysis of fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity across 3 groups: left-sided idiopathic SSNHL, chronic left-sided sensorineural hearing loss (SNHL), and healthy control (HC). Additionally, in the SNHL group, correlation analysis of regional DTI metrics with clinical variables was implemented, involving disease duration, interaural latency difference, and auditory brainstem response thresholds. RESULTS: Relative to the HC group, the left SNHL group exhibited remarkably diminished FA values in the bilateral internal capsules, superior corona radiata, and left external capsule. Concurrently, elevated MD values were noteworthy in the body of the corpus callosum, left external capsule, bilateral internal capsules, and corona radiata. Radial diffusivity values were escalated in the corpus callosum body, bilateral superior corona radiata, and left external capsule, suggesting compromised microstructural integrity. CONCLUSION: Both idiopathic SSNHL and chronic SNHL cases demonstrated discernible white matter abnormalities, implicating a disruption in major commissural and projection fiber tracts. Notably, cases with prolonged auditory deprivation exceeding 2 years exhibited microstructural signatures consistent with axonal degeneration and progressive demyelination.

BACKGROUND: Inside attendant personnel (IAP) working in hyperbaric oxygen therapy (HBO2) chambers face unique risks due to their exposure to pressurized environments, similar to those encountered by divers. During sessions, IAP breathe only compressed air, making them susceptible to potential adverse effects on hearing function. Previous studies have almost exclusively focused on divers, leaving a gap in understanding how these conditions might affect the hearing function of IAP. METHODS: A retrospective analysis was conducted on the audiometry results of 15 IAP who worked at the Akyurt HBO2 Center between 2012 and 2023. Hearing function was assessed through pure tone audiometry at frequencies ranging from 0.5 to 6 kHz. The data were analyzed by comparing baseline and final audiometry results, with subgroup analyses based on age, number of sessions, and working duration. RESULTS: The study comprised a sample of 15 IAP, corresponding to 30 ears, who participated in a total of 2446 HBO2 sessions. The analysis revealed no significant changes in hearing function, and no clinically significant hearing loss was detected. Three participants experienced mild middle ear barotrauma, and no cases of decompression sickness (DCS) were reported. Percent change values were computed to show the change more clearly; however, no clinically significant or consistent changes were identified in any subgroup analyses. CONCLUSION: The findings suggest that with proper precautions, the risks associated with barotrauma and DCS do not pose significant threats to the hearing function of IAP. In this occupational setting, ongoing health screenings and preventive strategies appear to be beneficial for main-taining auditory health.

BACKGROUND: Electrocochleography (EcochG) is a valuable method for determining frequency-specific objective hearing thresholds. While pure tone audiometry (PTA) is the gold standard, it can be inconclusive in certain populations, such as infants and non-responders. Auditory brainstem response is the primary electrophysiological test for threshold estimation in these groups. However, EcochG offers the advantage of closer field measurements, making it a promising alternative. This study compares PTA-based subjective thresholds with EcochG-derived objective thresholds in patients with varying degrees of hearing loss. METHODS: Participants consisted of individuals with both normal hearing and varying degrees of hearing loss. 0.5, 1, 2, and 4 kHz tone-burst stimuli and click stimuli were used to measure the latency and amplitude of action potentials (APs) using extra-tympanic electrodes. The AP component of the EcochG response was used as the primary measure for estimating hearing thresholds and was compared with PTA data. RESULTS: There is a strong correlation between 0.5, 1, 2, and 4 kHz pure tone thresholds (PTTs) and EcochG thresholds of the same frequencies (P < .001). Also, there is a strong correlation between click stimulus and the 4-frequency pure tone average (P < .001). The results of the linear regression analysis showed that the 0.5, 1, 2, and 4 kHz PTTs can be predicted using EcochG. Electrocochleography with click stimuli can also predict PTA of 4 frequencies. CONCLUSION: Using the EcochG test, hearing thresholds can be estimated without the need for a correction factor according to our results.

BACKGROUND: Clinicians recommend that parents use noise-making toys for hearing conditioning, but these differ from formal testing stimuli, resulting in longer test times and more sessions to complete the hearing evaluation. The app-based (AB) conditioning method, having similar stimuli used in actual hearing evaluation with structured parental guidance, could reduce the clinician's task load and the number of sessions needed for pure tone audiometry (PTA) testing among children compared to the conventional conditioning method. METHODS: A comparative research design assessed the effectiveness of 2 conditioning methods for hearing in 30 participants aged 2 to 3.6 years, randomly assigned to conventional (n=15) or AB methods (n=15). The clinician was blinded to the method used. The clinician's workload during PTA testing was evaluated using the National Aeronautics and Space Administration (NASA) task load tool, and the number of sessions needed to complete PTA testing was recorded for each method. RESULTS: Children conditioned using the AB method required significantly less clinician task load and fewer PTA testing sessions than the conventional method (CM). Additionally, clinician task load decreased after conditioning, regardless of the method, with no correlation between task load before and after. CONCLUSION: App-based conditioning creates a strong stimulus-response link in children and reduces clinician task load compared to the CM.

BACKGROUND: Tinnitus is a common symptom in patients with vestibular schwannoma (VS). The impact of Gamma Knife radiosurgery (GKRS) on tinnitus and the health-related quality of life (HRQoL) of patients with VS remains unclear. This study evaluated the effect of GKRS on HRQoL affected by tinnitus. METHODS: From December 2020 to April 2022, spontaneous VS patients who had no prior history of treatment and underwent their first GKRS in this period were analyzed. Subjective distress from tinnitus was measured by the Tinnitus Handicap Inventory (THI) and their HRQoL by 36-Item Short Form Survey Version 2 (SF-36v2). Pre-GKRS THI and SF-36v2 were obtained, and after GKRS, consecutive THI and SF-36v2 were obtained during the follow-up period. Bowker's test, paired Student's t-test, and Spearman's correlation were used to analyze the changes in THI grade, SF-36v2 score, and the correlation between THI grade and SF-36v2 score. Factors affecting the THI grade change and SF-36v2 score were evaluated through univariate and multivariate models. RESULTS: Twenty of 34 patients showed serviceable hearing before GKRS. The median radiation dose of GKRS was 12.75 Gy (range, 12-21 Gy). Twenty-two of 33 patients demonstrated no change or worse THI grade after GKRS, but the change was not statistically significant (P =.34). However, with age, the odds ratio of THI improvement is 0.905 (95% CI 0.83-0.98, P=.02). Patients with serviceable hearing before GKRS displayed THI grade improvement (OR = 6.721; P = .03). Compared to those with pre-GKRS THI grade 1, grades 3 and 4 exhibited lower odds of THI improvement (OR =0.095; P=.0449). No significant change was noted in SF-36v2 scores after GKRS. A high THI grade was correlated with a low physical component score (P =.03) and mental component score (P=.0002) of SF-36v2. CONCLUSION: Although THI grade and SF-36v2 change before and after GKRS did not show statistical significance, several factors affected THI grade change. Moreover, the THI grade and SF-36v2 score had a significant negative correlation. Factors that may aggravate tinnitus and further impact HRQoL of VS patients should be taken into account when planning treatment and providing counseling to VS patients.

BACKGROUND: Musical hallucinations have a great impact on a patient's life, but because of the rare frequency of occurrence and multiple causes, not enough research has been conducted on this topic yet, especially in Korea. Many patients with musical hallucinations have audiological and otologic problems. This study investigated the clinical manifestations of musical hallucinations in patients. METHODS: The authors retrospectively analyzed clinical data from patients with musical hallucinations who visited the outpatient clinic of the Department of Otorhinolaryngology at Severance Hospital, Seoul, Republic of Korea, for 7 years, from January 1, 2015, to December 31, 2021. RESULTS: Seven of 9 patients were female, the average age was 67.1 (52-89) years, and post-lingual hearing loss was diagnosed in all patients. They listened to songs 1-3 over and over again for 5.4 (±6.1) years. Four patients had chronic otitis media or underwent tympanomastoidectomy surgery because of chronic otitis media. Audiological rehabilitation was performed, including cochlear implantation surgery, in one patient. CONCLUSION: In most cases, patients with musical hallucinations had audiological and otologic symptoms. Therefore, when patients complaining of musical hallucinations visit the hospital, it is essential to perform an audiological and otologic evaluation, and treatment for their symptoms should be considered.

BACKGROUND: Successful cochlear implantation depends on many factors, one of which is the electrode type. The aim of this study was to evaluate it in terms of the preservation of residual hearing, as well as to investigate the effects of patient age and preoperative low-frequency hearing loss. METHODS: Twenty-three patients were implanted unilaterally with the HiFocus™ SlimJ electrode array. Pure tone audiometry (0.125-8 kHz) was performed preoperatively and at 1, 3, and 6 months postoperatively. Hearing preservation was established using the HEARRING group formula. RESULTS: Residual hearing was preserved in all patients. For hearing to be preserved, it was found that preoperative low-frequency hearing levels were more important than age. CONCLUSION: Residual hearing was preserved in all the patients who received the HiFocus™ SlimJ electrode array. Hearing preservation depended more on a patient's preoperative low-frequency hearing threshold than their age.

BACKGROUND: The aim of this study is to investigate factors associated with computed tomography (CT) scan prescription and surgical intervention in pediatric patients with acute mastoiditis (AM). METHODS: Children with AM admitted to Modena University Hospital over a 10-year period were retrospectively divided into 3 groups: those who did not undergo a CT scan nor surgery (Group A); those who underwent a CT scan but not surgery (Group B); and those who underwent CT scan and surgery (Group C). A multivariate analysis was performed to determine possible differences among groups in terms of clinical and laboratory variables. RESULTS: In total, 80 patients were included (57 Group A, 22 Group B, 13 Group C). Factors independently associated with CT scan prescription and surgical intervention were WBC count (P = .015 and .041, respectively), CRP (P = .001 and .003, respectively), and at-home antibiotic adminis-tration (P= .008 and .039, respectively). CONCLUSION: Laboratory parameters may be helpful in guiding pediatric AM management. Antibiotic treatment prior to admission is associated with a worse clinical picture.

Chronic inflammation has been proposed as a contributing factor in the pathogenesis of sudden sensorineural hearing loss (SSNHL). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) are well-established indices of inflammation, but their roles in SSNHL pathogenesis and prognosis remain controversial. This meta-analysis aimed to explore these associations. A systematic review was performed by 2 independent investigators across PubMed, Web of Science, Cochrane Library, and Embase databases. The quality of included studies was assessed using the Newcastle-Ottawa Scale. Twenty-six studies including 2392 SSNHL patients and 1865 controls were included. Recovery data were available for 1343 patients, of whom 785 recovered and 558 did not. Meta-analysis revealed that both NLR (standardized mean difference [SMD]=1.082, 95% CI=0.949, 1.216, P < .001) and PLR (SMD=0.516, 95% CI=0.333, 0.700, P < .001) were significantly elevated in SSNHL patients compared to controls. MPV (SMD=1.103, 95% CI=0.820, 1.483, P=.516) showed no significant difference. Additionally, higher NLR (SMD=-0.472, 95% CI=-0.784, -0.160, P=.003) and PLR (SMD=-0.327, 95% CI=-0.630, -0.023, P=.035) were associated with non-recovery in SSNHL, whereas differences in MPV (SMD=-0.352, 95% CI=-0.881, 0.177, P=.192) were not statistically significant. NLR and PLR may be involved in the pathogenesis of SSNHL and may serve as cost-effective and accessible prognostic markers.

We present the case of a 42-year-old female who experienced gradually worsening pain in the left ear, accompanied by hearing impairment and occasional ear discharge. These lesions rarely occur in the temporal bone. Computed tomography and magnetic resonance scans identified a mass of soft tissue located in the left mastoid, with intracranial invasion and mastoid erosion. Initial treatment involved surgery followed by histo- pathology, which confirmed the diagnosis of a plasma cell granuloma, also known as an inflammatory pseudotumor. After surgery, the pseudo- tumor invaded the ipsilateral parapharyngeal space and became surgically inaccessible. Steroid therapy and radiotherapy were proceeded with. When feasible, aggressive surgical intervention is advised as the primary treatment, supplemented by steroids and radiation therapy for persis- tent or recurrent conditions. At the last follow-up, the patient was not completely free of disease but symptom-free and in good general health.

Ludwig's angina is a cellulitis involving multiple spaces in the floor of the mouth. It is mainly associated with odontogenic infections and head or facial trauma, which may result in death by asphyxiation due to sudden airway obstruction. By presenting a case of Ludwig's pharyngitis second- ary to middle ear cholesteatoma, it was aimed to alert otolaryngologists to the potential risks and management of this disorder. The patient was a 49-year-old woman with a 40-year history of middle ear cholesteatoma. Ten days prior to her admission, she sustained an ipsilateral punch injury to the tempo-lateral region, which was followed by postauricular erythematous swelling, pain, and postauricular subperiosteal abscess forma- tion. Sudden mandibular swelling was found during postoperative extubation from middle ear cholesteatoma surgery. In order to prevent the occurrence of sudden acute asphyxia in the postoperative period, an immediate prophylactic tracheotomy was carried out to establish an artifi- cial airway. The patient was subsequently treated with antibiotics and had an uneventful recovery. Prompt diagnosis and aggressive therapeutic interventions are essential for successfully managing Ludwig's angina.

BACKGROUND: The aim of this study was to determine whether there are differences in the balance system between individuals with vision loss and a healthy control group using the video head impulse test (vHIT), cervical vestibular evoked myogenic potentials (cVEMP) and ocular vestibular evoked myogenic potentials (oVEMP) tests. METHODS: The study included 23 individuals diagnosed with bilateral low vision, 20 individuals diagnosed with bilateral blindness, and 50 healthy control subjects. vHIT, cVEMP, and oVEMP tests were applied to all participants to evaluate the vestibular system. In addition to the standard vHIT, 2-condition vHIT (in the dark and in daylight without a target) was performed on the control group to evaluate the effect of visual input. RESULTS: In vHIT responses, a significant difference in vestibulo-ocular reflex (VOR) gains was detected in the comparison between the bilateral low vision, bilateral blind, and control groups in all semicircular canals (SSC) (P < .001). When the vHIT responses in the 3 conditional groups of the control group (untargeted daylight, darkness, and standard) were examined, a significant difference in VOR gains was detected in the comparison of all 3 groups in the entire SSC (P < .001). CONCLUSION: The findings of statistically significantly low VOR gains obtained in individuals with low vision and the blind group showed the great effect of visual input on the vestibular system. This hypothesis was also supported by the results of vHIT, which was applied in 3 stages (dark, untargeted daylight, and standard) in healthy individuals.

BACKGROUND: This study examines low-dose botulinum toxin at acupuncture points for its effects on vestibular symptoms, headaches, depression, anxiety, and stress in vestibular migraine patients. METHODS: This prospective study included patients with vestibular migraine per Barany Society criteria. Fifty units of Onabotulinum toxin were injected using a 31-gauge needle at 5 units/0.1 mL, diluted from 100 units with 2 mL of 0.9% sodium chloride. The injections were given at predetermined acupuncture points: Yintang (EX-HN3), Taiyang (EX-HN5), Baihui (GV20), Shuaigu (GB8), Fengchi (GB20), and Tianzhu (BL10). Six-month follow-up assessments included assessments using the Migraine Disability Assessment Scale (MIDAS), Dizziness Handicap Inventory-Screening Form (DHI-S), Vertigo Symptom Scale-Short Form (VSS-SF), Depression Anxiety Stress Scale (DASS-21), and Allodynia Symptom Checklist (ASC-12). RESULTS: Statistically significant improvements were observed in MIDAS, VSS-SF, DHI-S, and DASS-21 scores at both 3 and 6 months (P < .05). CONCLUSION: Application of Onabotulinum toxin A (BoNT-A) to acupuncture points alleviated headache, vestibular symptoms, and anxiety, with benefits persisting for up to 6 months.

Pulsatile tinnitus (PT) is a symptom consisting of the perception of sound without an external stimulus, synchronized with the patient's heartbeat.It accounts for 4% of all tinnitus cases. The most common etiologies are vascular, including carotid stenosis, idiopathic intracranial hypertension, sinus stenosis, aneurysms, and arteriovenous malformations. The diagnostic approach involves a complete history and clinical examination to determine if PT is of arterial or venous origin and to guide imaging studies. Treatment ranges from lifestyle modifications and pharmacological therapy to minimally invasive procedures like endovascular interventions and surgery. Minimally invasive endovascular procedures offer promising outcomes. This narrative review analyzes the etiologies, diagnostic approaches, and management strategies of PT, providing updated information to guide its approach. Most patients with PT have a treatable cause; however, despite a thorough diagnostic approach, a specific etiology is not found in approximately 30% of cases. Although most etiologies of PT are not life-threatening, it affects the patient's quality of life as it provokes psychological disturbances.

BACKGROUND: To compare the quality of life scores of children with monoaural cochlear implants (CIs) aged 4-16 with those of normally hearing (NH) children and parents' reports. METHODS: The KINDL-R questionnaire that measures health-related quality of life (HRQoL) was delivered to 72 children aged 4-16 years and their parents. The children were divided into 3 subgroups of 4-7, 8-11, and 12-16 years and asked to report their quality of life from their own perspectives. The parents were divided into 2 subgroups for 4-7 aged and 8-16 aged children and were asked to report their child's quality of life status from their perspectives. The QoL scores of children with CI in the 3 subgroups were compared with the scores of their parents and NH peers. RESULTS: The total scores of children with CIs in all subgroups were significantly worse than NH peers. The total scores of parents and children with CIs in all subgroups revealed no statistically significant differences. In the correlation analysis, the age of implantation was negatively correlated with the total score both in 8-11 (ρ: -0.777) and 12-16 year subgroups (ρ: -0.591). Similarly, the implant usage duration was positively correlated with the total score in all age groups. CONCLUSION: Children with CI experience worse QoL status than their NH peers. The possible causes of the lower QoL scores following cochlear implantation must be investigated. Reports from parents on their children's QoL status are reliable.

The study aimed to evaluate the impact of manufacturer first-fit (FF) vs. optimized-fit (OF) hearing aid conditions on the real-ear aided response (REAR), aided thresholds, speech identification scores (SIS) in quiet, and signal-to-noise ratio at 50% speech intelligibility (SNR-50) among adults with bilateral sensorineural hearing loss.

Surgery of the thoracic and lumbar spine must employ monopolar electrical coagulation due to the necessity of bleeding control because alternative methods have too many limitations. The use of such electrocoagulation in cochlear implant (CI) users carries a high risk of damaging the assistive listening device. The objective of this paper is to present the management of 2 CI system users with advanced spinal curvature who required surgical treatment for scoliosis. A review of the literature was conducted on the use of medical procedures based on the conduction of electrical potentials within CI users. This paper presents 2 cases of surgery for spinal deformity in children who use CI. The precautions employed with regard to the utilization of monopolar coagulation are delineated. In neither case was damage to the CIs identified, despite the utilization of monopolar coagulation. A review of the literature revealed 415 documented instances of CIs being exposed to electrical current flow, of which 2 resulted in damage to the device. One case involved a patient who was defibrillated during cardiac arrest, while the other was related to dental pulp measurements on cadaveric teeth. Although monopolar electrocoagulation is considered a high-risk procedure for patients with CIs, this paper demonstrates that such procedures can be performed safely with appropriate precautions. It seems reasonable to conduct further experimental studies aimed at developing safe protocols to minimize the risk of damage to CI, ensuring that patients can undergo necessary medical procedures.

Retinoic acid (RA), the active metabolite of vitamin A, is essential for the embryonic development of the inner ear, involving processes such as cell proliferation, differentiation, and morphogenesis. It also plays a crucial role in the protection and maintenance of the inner ear during the postnatal period. This study investigated the electrophysiological effects of early intratympanic RA administration following acoustic trauma.