Based on these findings, cochlear implantation is surgically feasible in patients with common cavity, IP types I and II, and LVA. The surgeon should be ready to make modifications in the surgical approach because of the abnormal course of the facial nerve and be ready to produce special precautions to cerebrospinal fluid gusher.

Our preliminary results show that there is adequate contribution of brainstem implants in the development of auditory-verbal skills. Additional handicaps slow the progress of the prelingually deaf children.

On the 18th of September 2009, a group of health care professionals and scientists involved in implantation of the auditory system attended a meeting convened by the Hacettepe Cochlear Implant Group. The aim of the meeting was to have a detailed discussion on the pressing and pertinent issues around auditory brainstem implantation (ABI) in children and in non-neurofibromatosis Type 2 (NF2) cases and to reach a consensus based on these discussions. surgery, experience of individual ABI centers, intraoperative issues, and rehabilitation with the final session devoted to discussion of the issues raised. The centers presented their experience of ABI in children who had hearing impairment because of congenital abnormalities or pathology where cochlear implantation (CI) was either contraindicated or the possibility of successful placement of the electrode was unlikely. Altogether, 61 children with various types of inner ear malformations, cochleovestibular nerve (CVN) anomalies, cochlear ossification, and bilateral cochlear fractures with cochlear nerve avulsion were presented by different groups. The following topics were discussed, and a consensus was obtained at the end of the meeting on the following issues. IN WHICH CHILDREN AND NON-NF2 PATIENTS IS THE ABI A VIABLE INTERVENTION?Two patient categories were identified: 1) Prelingual patients with inner ear malformations and cochlear nerve hypoplasia/aplasia. ABI provides auditory perception in most patients. The potential for speech and language acquisition in the longer term will depend on the age of implantation, the presence or absence of additional disabilities, and the other established factors seen in CI. It also was concluded that open set speech discrimination is possible in selected cases. In addition, prelingually deafened children because of meningitis with total ossification of both cochleas also should be included in this group. 2) Individuals deafened postlingually because of meningitis, temporal bone fractures with cochlear nerve avulsion, otosclerosis with gross cochlear destruction, or unmanageable facial nerve stimulation with CI. As with CI, the duration of severe or profound deafness is a prognostic indicator, and with short

Corticosteroid treatment has been considered the most effective treatment modality for sudden sensorineural hearing loss so far. Application route of corticosteroids may vary. We have designed a prospective randomized case-controlled clinical trial to evaluate the effectivenesses of the different application routes of steroids in the treatment of SSHL. Thirty-five patients were distributed randomly to two groups which were treated with either 'oral' or 'intratympanic' corticosteroids. Intratympanic steroid administration was performed three times every other day transtympanically. At the end of third month, recovery rate in the 'intratympanic' group was 84.2%, whereas in the 'oral' group, it was 87.5%. The difference between the recovery rates was not statistically significant. There were no major complications related to transtympanic steroid administration. These findings support that intratympanic steroid therapy is an alternative to systemic steroid therapy in the initial treatment of sudden hearing loss. In addition, transtympanic technique is an easy to perform and safe method for delivering steroids into the inner ear.

No abstract

No abstract

Background: Sudden sensorineural hearing loss (SSNHL) is still a complex and challenging process which requires clinical evidence regarding its etiology, treatment and prognostic factors. Therefore, determination of prognostic factors might aid in the selection of proper treatment modality. Aims: The aim of this study is to analyze whether there is correlation between SSNHL outcomes and (1) systemic steroid therapy, (2) time gap between onset of symptoms and initiation of therapy and (3) audiological pattern of hearing loss. Study Design: Retrospective chart review. Methods: Patients diagnosed at our clinic with SSNHL between May 2005 and December 2011were reviewed. A detailed history of demographic features, side of hearing loss, previous SSNHL and/or ear surgery, recent upper respiratory tract infection, season of admission, duration of symptoms before admission and the presence of co-morbid diseases was obtained. Radiological and audiological evaluations were recorded and treatment protocol was assessed to determine whether systemic steroids were administered or not. Treatment started ≤5 days was regarded as "early" and >5 days as "delayed". Initial audiological configurations were grouped as "upward sloping", "downward sloping", "flat" and "profound" hearing loss. Significant recovery was defined as thresholds improved to the same level with the unaffected ear or improved ≥30 dB on average. Slight recovery was hearing improvement between 10-30dB on average. Hearing recovery less than 10 dB was accepted as unchanged. Results: Among the 181 patients who met the inclusion criteria, systemic steroid was administered to 122 patients (67.4%), whereas 59 (32.6%) patients did not have steroids. It was found that steroid administration did not have any statistically significant effect in either recovered or unchanged hearing groups. Early treatment was achieved in 105 patients (58%) and 76 patients (42%) had delayed treatment. Recovery rates were no different in these two groups; however, when unchanged hearing rates were compared, it was statistically significantly lower in the early treatment group (p<0.05). When hearing outcomes were compared according to initial audiological pattern, significant recovery and unchanged hearing rates did not differ between groups; however, slight recovery rate was highest in the "flat" type audiological configuration (p<0.05). Conclusion: According to this patient series, oral steroid therapy does not have any influence on the outcomes of SSNHL. However, mid-frequency hearing loss of flat type and initiation of treatment earlier than 5 days from the onset of symptoms, seem to have positive prognostic effects. Further randomized controlled subject groups might contribute to determine prognostic factors of SSNHL.

ABI is an acceptable and effective treatment modality for pediatric population with severe inner ear malformations. Bilateral stimulation together with CI and contralateral ABI should be utilized in suitable cases.