Objectives/Hypothesis Facial nerve stimulation (FNS) can occur after cochlear implantation for a small number of recipients. This study aimed to investigate if a correlation exists between the variables involved in FNS. Study Design Retrospective cohort review. Methods There were 32 out of 1,100 cochlear implant recipients who experienced FNS in our clinic between 2010 and 2019. The following variables were recorded from a retrospective chart review: grade of FNS, onset of FNS, the number of channels stimulating FNS, and radiological findings of abnormalities in the inner ear. Statistical analyses were performed to identify a correlation between any of the variables involved. The techniques used to reduce FNS were analyzed. Results Eleven adult ears had progressive hearing loss, three had idiopathic sudden sensorineural hearing loss (SNHL), and one congenital SNHL. All pediatric ears were diagnosed with congenital SNHL, except for one ear with idiopathic sudden SNHL. The grade of FNS ranged from mild stimulation or slight motion in the eye, mouth, nasolabial, or forehead regions (n = 8) to total severe stimulation of the facial musculature and/or severe pain (n = 3). The onset of FNS occurred immediately after activation for nine ears, and up to 16 months later for the other subjects. A significant correlation was observed between the number of channels stimulating FNS, the grade of FNS, and the radiological findings of the inner ear. FNS was completely resolved for 30 ears and partially resolved for two ears. Conclusions FNS can occur any time after cochlear implantation and can affect both adult and pediatric. However, it can be effectively resolved using specific fitting techniques. Level of Evidence 2c Laryngoscope, 131:374–379, 2021

Objectives: To determine if Electrode Voltage (EV) measurements are potentially suitable as a test for detecting extra-cochlear electrodes in cochlear implants (CIs) and to analyse voltages developed in different stimulation modes. Methods: EV measurements were made using surface electrodes in live mode without averaging in 17 adult cochlear implant (CI) users (18 ears). The effect of stimulation level, the position of the active recording electrode, repeatability and the position of the implant's active electrode were investigated. For Nucleus recipients, measurements were made in different stimulation modes. Results/Discussion: Recordings made in monopolar mode showed good repeatability when the active recording electrode was placed on the ipsilateral earlobe; voltages increased linearly with stimulation level as expected. Basal electrode measurements differed greatly between fully inserted devices with all electrodes activated, partially inserted/migrated devices and fully inserted devices with deactivated basal electrodes [χ 2 (2)=10.2, p<0.05 for the most basal electrode]. Analysis of voltages measured in different stimulation modes found that EVs could be separated into two components, associated with the CI's active and return electrodes respectively. EVs for electrodes on the array were much smaller than those for monopolar return electrodes for fully inserted devices, but were abnormally large for one participant with extra-cochlear electrodes. We argue that fibrosis around the electrode array facilitated current flow across the round window in this case. Conclusion: The test appears to be a viable approach to detect electrode migration and extracochlear electrodes in adult CI users and may also be sensitive to discomfort caused by current leakage from the basal end of the cochlea.

Objective: Our aim was to estimate prevalence rates of different headache forms among tinnitus patients in Arabia, to investigate whether there is a relationship between tinnitus laterality and headache laterality in patients with unilateral tinnitus and unilateral headache, to explore the relationship between tinnitus and headache over time, and to know the effect of headache pain medications in tinnitus in Riyadh, Saudi Arabia. Method: The study is a quantitative observational cross-sectional study with a convenient sample by data from patients with tinnitus. The participants received a self-administrated electronic questionnaire measuring demographics, prevalence of an associated headache, and the relationship between tinnitus and headache. Results: A total of 226 patients enrolled themselves into the study, and all of them came from the capital city Riyadh of Saudi Arabia. 58% were females, and the remainder of them were males. Females reported significantly more ear tinnitus than males, and patients aged 51 years or older were significantly less inclined to report ear tinnitus compared to those younger; however, those aged 20–31 years were found to be significantly more inclined to report ear tinnitus. There was a statistically significant association between patients experiencing headaches and those experiencing ear tinnitus. Surprisingly, patients who take medications of any type to alleviate their headaches were significantly less inclined to report ear tinnitus than those who do not take medications. However, patients with ear tinnitus experienced longer headache duration in years than those who had no history of tinnitus. Moreover, those people who experienced right-sided tinnitus tended to report significantly more right-sided headaches, and the same goes for left-sided headaches. Conclusion: Our results showed that there is a relationship between headaches and tinnitus. Painkillers also showed a protective effect against tinnitus. High awareness about the relationship between headaches and tinnitus among physicians and patients may lead to early recognition and lead to early implementation of primary prevention, which is the cornerstone of family medicine practice, and treatment without referring to other specialties. However, the pathophysiology is still not clear. Further studies should be performed to know the pathophysiology.