The stria vascularis, which is located in the cochlea of the inner ear, and the renal tubules contain similar anatomical, physiological, immunological, and pathological properties. Therefore, nephrotoxic drugs; electrolyte imbalances; and biochemical, immunological, osmotic, and vascular differences may affect the middle and inner ear and the central pathways. We evaluated the middle ear mechanisms, inner ear functions, and hearing thresholds of 30 renal transplant (RT) recipients (60 ears); 30 healthy volunteers (60 ears) served as the control group. All patients underwent an audiological assessment by means of pure-tone audiometry, otoacoustic emission (OAE), and contralateral suppression of transient-evoked OAE measurements. The mean follow-up after transplant was 6.8 ± 6.1 years (range: 1-20 years). Hearing for the four frequency averages between the two groups was significantly different (P = 0.002). When the cochlea's outer hair cells were evaluated, the signal-to-noise ratio was significantly lower at frequencies of 1000 and 1400 Hz in the RT group versus the control group (P <0.001 and P = 0.008, respectively). When frequency-specific suppressions were assessed, there was no significant suppression at any frequencies in the RT group, but significantly lower suppression was found at all frequencies in the control group (P <0.001 for all frequencies). These results support the presence of auditory dysfunction in RT recipients. Low levels of OAE support our conclusion that RT recipients are prone to cochlear dysfunction. Therefore, audiometric evaluations should be conducted before and after RT, and the recipients should be informed about possible otological involvement.

BACKGROUND:The aim was to evaluate the changes in the audiovestibular system in adult patients with the diagnosis of chronic renal failure who were treated with hemodialysis.METHODS:Thirty-five patients diagnosed with chronic renal failure and receiving hemodialysis treatment 3 days a week and 35 healthy individuals were tested with pure tone audiometry, video head impulse test, and post-head shake nystagmus test. Dizziness Handicap Inventory was applied to all participants.RESULTS:The Dizziness Handicap Inventory scores of the patient groups are higher than the control groups (P=.001). In the video head impulse test, there is no statistically significant difference between the patient and control groups in terms of gain asymmetry. 17.1% of the patients had both left and right lateral saccades (P=.03). A statistically significant difference was also found after the post-head shake test (P=.025). In the patient group, an inverse relationship between the presence of left anterior right posterior saccades and blood urea nitrogen-creatinine ratio and a direct relationship between the presence of right anterior left posterior saccades and creatinine elevation were determined. The presence of saccades in the video head impulse test increased significantly as the disease duration of hemodialysis patients increased.CONCLUSION:It was determined that the overt and covert saccades in the video head impulse test increased significantly as the creatinine increased and the duration of the disease increased in the patients with chronic renal failure. The common clinical usage of video head impulse test in monitoring the vestibular side effects of creatinine elevation and disease duration in chronic renal failure patients may be possible with future studies.

ABS TRACT Objective:The aim of this study is to retrospectively evaluate the effects of bone cement stabilization of the stapedotomy prosthesis with respect to audiological results and incidence of prosthesis dislocation.Material and Methods: A retrospective analysis of 32 cases that were operated using the same surgical technique.Surgeries were done by the same surgeon under general anesthesia.Preoperative and postoperative audiograms between Group 1 and Group 2 were compared.Demographic data, the surgical status of the contralateral ear, surgical technique, bone cement fixation status, length of the prosthesis, and intraoperative complications were analysed.Pure tone average (PTA) gains, air-bone gap (ABG) improvements, and 8 kHz hearing level changes were calculated.Results: Out of 32 stapedotomies, 13 cases had bone cement stabilization.There was no age (p=0.388) or sex (p=0.704)difference between the groups.Both groups had significantly improved PTAs (p<0.001) and decreased ABG (p<0.001) values.But there was no difference between the groups (p=0.701).Also, there was no difference of 8 kHz hearing levels (p: 0.656).Three prosthesis dislocations were seen in the "no bone cement" Group 1 versus no dislocations in the "bone cement" Group 2. This difference was not significant (p=0.253).Conclusion: Bone cement stabilization of the stapedotomy prosthesis is a safe technique.Bone cement stabilization did not affect audiological outcomes and may offer a reduction in the incidence of prosthesis dislocation.However, studies with larger patient series and longer follow-up periods are needed.

Background: To compare the reporting of high-resolution computed tomography of temporal bones for otosclerosis by general radiologists and a neurotologist within a tertiary-care hospital. Methods: A retrospective review of temporal bone high-resolution computed tomography reports of surgically confrmed otosclerosis patients obtained between 2011 and 2020 was performed at a single tertiary-care center. For comparison, the high-resolution computed tomography reports of all patients performed by the general radiologists and the preoperative patient image evaluation notes of the senior neurotologist were reviewed from the medical records. The main outcome measure was the correct identifcation of otosclerosis on HRCT. Results: A total of 42 patients (47 ears) were included in the study. The neurotologist correctly diagnosed otosclerosis in 31 of 47 images (66.0%) and the general radiologists correctly diagnosed otosclerosis in only 3 of 47 images (6.4%). The number of correct diagnoses were signifcantly different when made by the neurotologist and the general radiologist (X-2 = 25.14, P < .001, McNemar test). Conclusion: The results of this study show that a radiologist without suffcient experience in the feld of neurotology may have a low detection rate of otosclerosis in high-resolution computed tomography of the temporal bone, as is consistent with the literature. In the light of this study, it can be concluded that more experienced eyes (neuroradiologist, neorotologist) are required to diagnose otosclerosis in HRCT than a general radiologist.

Background and Aim: Word Recognition Test (WRT) is a widely used component of routine audiology battery. Several studies were conducted on the effect of words in word recognition lists and whether word difficulty level had an effect in word recalling process of patients. This study aims to compare the scores of patients to the designed Başkent WRT and commonly used Hacettepe WRT by focusing on the lexical neighbourhood. Methods: Study carried out in an Ear Nose and Throat Department of a private university hospital between June and August 2021. 34 persons with sensorineural hearing loss and 34 persons without hearing loss was participated in the study. Designed WRT and widely used common WRT were presented to the participants. Results: Results showed that common WRT included words with more lexical neighbours and sensorineural hearing loss group scores were significantly lower compared to designed WRT. Conclusion: Persons with sensorineural hearing loss have a tendency to misunderstand presented words in WRT as they may trigger other words and misguide the patient. Keywords: Speech audiometry; speech discrimination tests; hearing tests; psychoacoustics

BACKGROUND:Both the Dix-Hallpike test and the supine head-roll test can provoke positional nystagmus in a group of benign paroxysmal positional vertigo patients, including but not limited to those with multiple canal involvement. This study aimed to determine the incidence and interpret the clinical significance of positional nystagmus provoked by both the Dix-Hallpike and the supine head-roll tests.METHODS:The results of video-nystagmography sessions recorded in the computer database that included both the Dix-Hallpike and the supine head-roll tests were examined.RESULTS:The records belonging to 2880 video-nystagmography sessions of 2387 patients were examined. Nystagmus was detected in both the Dix-Hallpike and the supine head-roll tests of 131 (5.5%) patients. The video images belonging to 142 session records of 122 patients were accessed and further analyzed. The diagnosis was posterior canal BPPV in 9.0%, and lateral canal BPPV in 62.3%. More than one canal was involved in 3.3%, one rehabilitation maneuver was performed in 75.0%, and recurrence was observed in 7.4% of those patients.CONCLUSION:In both geotropic and apogeotropic variants of lateral canal BPPV, nystagmus can be observed during the Dix-Hallpike test in addition to the supine head-roll test. In patients with posterior canal benign paroxysmal positional vertigo, nystagmus can also be observed in the head-roll test. To reach a correct and comprehensive diagnosis and apply appropriate treatment in benign paroxysmal positional vertigo, the Dix-Hallpike test and the head-roll test should be completely performed on both sides, and the results of those tests must be interpreted concomitantly.

oluşması sonucu gelişen sensörinöral işitme kaybıdır (SNİK). 4Bir diğeri ise otoimmün hasarın inflamatuar süreçleri nedeniyle

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.

Amaç: Orkestra sanatçılarında afferent işitme sistemini saf ses odyometri, yüksek frekans odyometri, geçici uyarılmış otoakustik emisyon ile; efferent işitme sistemini ise medial olivokoklear kompleks supresyon testi ile incelemektir. Gereç ve Yöntem: Aynı orkestrada çalan en az 5 yıl deneyimi olan 30 sanatçı ve kontrol grubu olarak müzik icra etmeyen 30 gönüllü alınmıştır. Saf Ses Odyometri (SSO) ve yüksek frekans odyometri ile işitme eşikleri değerlendirilmiştir. Transient uyarılmış otoakustik emisyon (TEOAE) testiyle ilk olarak kontralateral akustik stimülasyon (KAS) verilmeden önce ölçümler alınmış, daha sonra 70 dB dar band gürültü ile KAS verilerek aynı anda TEOAE testiyle medial olivokoklear kompleks refleksi (MOCR) ölçülmüştür. Ortalama prova süreleri günlük 4 saat; ortam gürültüsüne maruz kalma süreleri haftada 20-35 saat arasında değişmektedir. Bulgular: SSO eşiklerine göre; orkestra çalışanlarında 16 kHz’de özellikle sol kulakta anlamlı bir eşik yükselmesi tespit edilmiştir (orkestra grubu 42,17 dB; kontrol grubu 31,83 dB). TEOAE amplitüdleri, orkestra sanatçılarında tüm frekanslarda anlamlı derecede azdır (p<0.001). Orkestra sanatçılarında kontralateral akustik stimulasyon verildiğinde; 1, 2,4 ve 8 kHz frekanslarında anlamlı olarak TEOAE emisyon değerlerinde belirgin bir azalma tespit edilmiştir (p<0,05). Orkestra sanatçılarında prova süresi arttıkça TEOAE değerlerinde azalma gözlenirken; kontralateral supresyon değerlerinde anlamlı bir farklılık olmamıştır. Sonuç: Orkestrada çalan sanatçıların işitme sistemi değerlendirilmesinde, saf ses odyometri tek başına yeterli değildir. İşitme takibinde yüksek frekans odyometri ve otoakustik emisyonun beraber kullanımının gerekli olduğu bu çalışmada vurgulanmaktadır. Orkestra sanatçılarında medial olivary kompleks refleks aktivitesinin değerlendirilmesi önemli olmakla beraber müzisyenlerin işitme takibinde medial olivary kompleks refleks aktivitesinin tek başına kullanımı ile ilgili prospektif uzun dönem çalışmalara ihtiyaç vardır.

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 Methods: 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.

Acute unilateral vestibulopathy, known as vestibular neuritis (VN), accounts for 10-15% of all vertigo cases. 1 Its annual incidence is 3-5/100,000.Incidence increases with age and is most commonly seen between the ages of 40-50. 2 Patients present with sudden onset nausea, vomiting, dizziness, and bal-

Introduction: The effect of the continuous forced expiration action of players of wind instruments to produce sound, on the eustachian tube functions and the middle-ear resonance frequency (RF), has not been investigated in the literature to date. The aim of this study is to evaluate eustachian tube functions and the middle-ear RF of players of wind instruments. Methods: In this prospective case-control clinical study, a study group of 28 players of wind instruments in the orchestra (28 participants, 56 ears) and a control group of 34 volunteers (34 participants, 68 ears) were included. The eustachian function of wind instrument players in a symphony orchestra was measured using an automatic eustachian tube function test in acoustic tympanometry and the RF of the middle ear was determined in multifrequency tympanometry. Results: There was a statistically significant difference among the musicians, especially in players of woodwind instruments, in terms of dysfunction of the eustachian tubes (p = 0.048). In the musicians, the pre- and postperformance RF mean values for all ears were 925 and 1,020 Hz, respectively, and these were significantly different (p = 0.004). Conclusion: This is the first study to uses multifrequency tympanometry to examine the middle-ear RF and eustachian tube function of wind instrument musicians in an orchestra. Eustachian tube dysfunction was found to be more prominent and a higher RF of the middle ear was seen after a performance, especially in players of wood wind instruments. However, the effect of these on the professional performance of players of wind instruments should be investigated in future work.

BACKGROUND: Positional nystagmus elicited by the Dix-Hallpike maneuver often reverses its direction as the patient is re-seated from the provoking head hanging position. The incidence of reverse nystagmus and its association with prognosis in posterior canal benign paroxysmal positional vertigo (pcBPPV) is not clear. OBJECTIVE: To determine the incidence of upright positioning-related reverse nystagmus and its association with the success of canalith repositioning (Epley) maneuver (CRM) treatment in pcBPPV. METHODS: The records of patients that had been tested with video-nystagmography in a tertiary care center, between October 2016 and March 2019, were reviewed. Data were obtained from detailed analysis of video recordings of 321 patients with typical pcBPPV. RESULTS: Reverse nystagmus was determined in 85% of the patients with pcBPPV. The number of CRMs required for treatment was lower in patients with reverse nystagmus (1.32 +/- 0.68) compared to patients without reverse nystagmus (1.81 +/- 0.98) (p < 0.001). There was not a statistically significant relationship between reverse nystagmus and recurrence (p = 0.623). CONCLUSIONS: The absence of reverse nystagmus on upright positioning during the Dix-Hallpike test predicts poor success for the CRM, as repetitive repositioning maneuvers might be required to achieve successful treatment in pcBPPV.

Video head impulse test (vHIT) is commonly used for the evaluation of vestibular system disorders because it can be performed easily in a short period of time.However, there is no diagnostic value to vHIT alone.Patient history and examination findings con-tribute the most important information in the diagnosis of vestibular disorders and in some pathologies such as benign paroxysmal positional vertigo (BPPV) and Meniere's disease, a correct diagnosis can generally be made with a limited number of laboratory

Elongation of the stylohyoid process or calcification of the stylohyoid ligament is known as the Eagle syndrome. Mostly, it is seen incidentally on imaging or with extreme suspicion and usually patients are asymptomatic. Surgery is the preferred method in symptomatic patients. Transcervical or transoral methods may be preferred as surgical route. A 28-year-old female patient who had formerly underwent tonsillectomy presented with throat and ear pain. A neck computed tomography was performed, and the patient was diagnosed as Eagle Syndrome. Surgery was recommended. Patient developed transient velopharyngeal insufficiency on postoperative day 4. Ventilation exercise and follow-up was recommended. Complaints of the patient decreased on the 15th day. It should be kept in mind that stylohyoid ligament may be calcified in young age group and middle age group patients with dysphagia or odynophagia, and differential diagnosis should be performed. Another issue is the condition of velofaringeal insufficiency which may occur due to the damage of the pharynx muscles by deep dissection during surgery.

Introduction: The cochlear cells in kidney and inner ear have similar anatomic, physiologic, immunologic and pathologic properties in microscopic view. Renal glomerule is similar to stria vascularis as compared with the tubules. For this reason nephrotoxic drugs, electrolyte imbalances, biochemical, immunological, osmotic and vascular differences may influence on middle- inner ear and central pathway. Here, we aimed to evaluate the middle ear mechanism, outer hairy cell function in inner ear and hearing threshold in renal transplant (RT) patients. Methods: From November 1975 to December 2019, we performed 3071 renal transplant procedures in Başkent University. In this prospective study; 30 RT recipients (60 ears; study group) and 30 healthy volunteers (60 ears; control group) were included. All patients underwent audiologic assessment by means of pure-tone audiometry, otoacoustic emission (OAEs) and contralateral suppression TEOAEs (CS-TEOAEs) measurements. Results: Mean follow-up time after RT was 6.8 ± 6.1years (1-20 years). Hearing performance for the four frequency averages between groups was significantly different (p=0.002). When the cochlea outer hairy cells were evaluated, the signal-to-noise ratio was significantly lower at frequencies of 1000 and 1400 Hz between the patient and the control group (p=0.000, p=0.008). When the frequency-specific suppressions were assessed, there was no significantly lower suppression in all frequency in the RT group, but significantly lower suppression was found in all frequencies (for all frequency, p=0000). Conclusion: Our results support the presence of auditory dysfunction in RT recipients. Low levels of OAEs support that RT recipients are prone to cochlear dysfunction. Therefore, audiometric evaluation of patients should be done before and after RT.