Background and Aim: It have been shown that changes in organization of high stimulation related to tinnitus in special areas in brain can be eliminated using protocols based on transcranial magnetic stimulation (TMS). The current study aims to assess the pattern of brain perfusion and effects of TMS on brain activity in tinnitus participants as measured by single-photon emission computed tomography (SPECT) as well as evaluate the efficacy of TMS on severity of tinnitus. Methods: This was a cross-sectional randomized clinical trial, which was performed in 15 patients that referred to tinnitus clinic of Rasoul Akram Hospital during March 2017 to April 2018. These participant were randomly divided into two groups of active treatment with TMS and placebo. In each studied group, the variables of the brain perfusion, tinnitus handicap index (THI), pitch-matching test, loudness match of tinnitus, minimum masking level, and residual inhibition were investigated for all included tinnitus participants before and after TMS. Results: In all tinnitus participants, we had increased uptake in temporal lobes (unilateral or bilateral). In active treatment group, SPECT variables in hotspots were significantly decreased in comparison with placebo group (P < 0.05). Visual analog scale of tinnitus was significantly decreased in active group rather than placebo group (P = 0.023). Conclusion: Our findings showed that tinnitus patients have abnormal brain perfusion increased uptake in temporal lobes that decreased with treatment with TMS and therefore this modality could be an appropriate therapeutic option for the improvement of tinnitus in these patients and efficacy of therapy could assessed by brain perfusion scan as well.

Aims: The aim of our study was to determine the efficacy of this treatment by evaluating the results of pure-tone audiometry, tinnitus rating scale, and tinnitus handicap questionnaire performed before and after intratympanic (IT) steroid treatment in patients with chronic subjective tinnitus who were not treated despite receiving medical treatment. Settings and Design: Twenty-three patients between 27 and 79 years of age who had normal physical examination had tinnitus complaints at least 3-month duration and who had been treated with IT steroid treatment were enrolled to the current study. Patients smaller than 18 years of age, patients with mental, neurological and psychological pathology, patients who had used any kind of medical treatment for tinnitus in the past 3 months, were excluded from the study. Subjects and Methods: The study included patients who were admitted to Mersin University Medicine Faculty Otorhinolaryngology Department, Department with tinnitus and were treated with IT steroid treatment. Written informed consent was obtained from all patients participating in the study. Statistical Analysis Used: All analyses were performed using IBM SPSS 22 package software trial version. The normal distribution of the data was examined with Shapiro–Wilk test. Frequency and percentage were calculated for categorical values. Results: In the tinnitus grading scale, a significant decrease in before and after treatment was determined for 17 patients with tinnitus complaints and was found statistically significant (P < 0.001). The results of tinnitus handicap questionnaires were rated between 21.4 and 69.6 for before treatment and between 11.4 and 63.6 for after treatment and were found statistically significant (P < 0.001). Conclusion: In this study, we found that IT steroid treatment decreased both tinnitus rating scale and tinnitus handicap scores for patients with chronic idiopathic tinnitus without hearing loss.

Aims: To evaluate the prognostic value of Ossiculoplasty Outcome Parameter Staging (OOPS) index with reference to the audiological outcome in the patients undergoing ossiculoplasty. Study Design: A prospective study. Setting: A tertiary referral hospital. Subjects: The study comprised 118 patients suffering from chronic otitis media with or without cholesteatoma. Materials and Methods: Ossiculoplasty was done by autologous incus interposition, partial ossicular prosthesis, and total ossicular prosthesis. Temporalis fascia graft was used for myringoplasty in all the patients. When partial ossicular replacement prosthesis or total ossicular replacement prosthesis was used a thin slice of cartilage was interposed between graft and prosthesis. The mastoidectomy was performed when needed, and whenever possible, a canal wall-up procedure was performed. Results: The short-term (measured after 3 and 6 months of surgery) and long-term (measured at 1 and 2 years after surgery) outcome of ossiculoplasty measured as a relationship between mean audiological gain and OOPS index score had a statically significant difference. Conclusion: The OOPS index is an appropriate prognostication index to predict accurately both the short- and long-term outcome of ossiculoplasty.

Purpose: The purpose of this study was to determine the prevalence of hearing loss (HL) in children with hydrocephalus (HCP) and to assess the impact of the ventriculoperitoneal (VP) shunt on their hearing threshold and speech discrimination percentage. Methodology: This was a case–control study. A total of 20 children who experienced HCP and 20 healthy controls were recruited. All participants in the study were subjected to a systematic clinical examination including otomicroscopic, audiometric (Pure-tone audiometry and speech audiometry), and tympanometric examination before and after VP shunt. Results: The mean age ± standard deviation for the HCP children and the control group was 5.4 ± 0.994 and 5.8 ± 1.196 years, respectively. The prevalence of HL in hydrocephalic children was 40%, and they had raising mild-to-moderate sensorineural HL. Children with HCP (preoperative) had a statistically significantly higher pure-tone threshold at 250, 500, 1000, 2000, and 4000 Hz than the control group. They also had a statistically significantly lower speech discrimination percentage than the control group. There was a statistically significant difference between the preoperative and the postoperative groups in pure-tone thresholds at 250, 500, 1000, and 2000 Hz. There is also a statistically significant difference between the preoperative and the postoperative groups in speech discrimination percentage. Conclusion: Early diagnosis in children with HCP is important. The results of the current study add further evidence of hearing impairment in hydrocephalic children and improvement in hearing after shunt operation. Auditory assessment is highly recommended for all hydrocephalic children as a routine examination.

Purpose: Among many central and peripheral causes of vertigo, one of the factors whose pathophysiology is not yet understood is cervicogenic dizziness (CD). There are studies reporting that CD may benefit from facet joint medial bundle branch block (MBB). The purpose of our study was to share our experiences of MBB application using ultrasonography (USG) in patients diagnosed with CD. Materials and Methods: After physical examination and necessary cervical imaging, C1, C2 and C3 cervical facet joint MBB and ozone injection were performed using USG for patients who had vertigo and accompanying cervical pathology and neck pain. In order to evaluate the effectiveness of the treatment, pain levels with the Visual Analog Scale (VAS) and the effect of vertigo on the quality of life with the “Dizziness Handicap Inventory (DHI)” Turkish validation questionnaire were documented. Results: Thirty-five patients who met the criteria were included in the study. The mean age of the patients was 50.8 ± 10.7. Of the 35 patients, 10 (28.6%) were male and 25 (71.4%) were female. There was a significant difference between the preoperative period and the postoperative 1^st, 2^nd, and 6^th week VAS scores. A significant difference was found between the preoperative and the postoperative 2^nd and 6^th week DHI questionnaire survey results as well. Conclusions: In the follow-up after the procedures, it was observed that vertigo complaints of the patients decreased significantly.

Objective: To predict risks for complications and determine the type of operation, several studies developed the grading system based on clinical assessment. However, there is no evidence regarding the score for tomographic opacification and bone erosion of temporal bone on computed tomography (CT) scan. Therefore, the aim of this study was primarily to design a new computerized tomography staging system for the evaluation of chronic otitis media (COM) and mastoiditis. Materials and Methods: Between August 1, 2020, and December 30, 2021, 40 patients with the clinical diagnosis of COM (males and females) have received temporal bone CT scans at medical institutions. The patients were retrospectively evaluated and verified the correlation of the score of CT imaging in preoperative evaluation with the clinical picture and surgical planning. Descriptive statistics, one-way ANOVA analysis, and Spearman's correlation test were employed to evaluate the accumulated data. The P values were calculated for all tests and its outcome <0.05 was considered statistically significant. Results: There are significant correlations between the total score and the size of perforation, the type of surgical intervention, and low-frequency air-bone gap (ABG) (P < 0.05) while no correlation between the total score and high-frequency ABG was revealed. Conclusion: The abnormal landmarks of the temporal bone are presented, and scored systematically and there is an excellent way to analyze and make a decision not only in diagnosis but also in the choice of surgical intervention.

Introduction: Chronic otitis media (COM) is now synonymous with chronic suppurative otitis media, which is not actively used since COM is seldom associated with “the collection of pus.” Acute suppuration of the ear which transcends 6 weeks is considered to be COM which suggests an abnormality of the ear drum. With a prevalence incidence of 1%, Eustachian tube (ET) dysfunction is among the most important factors in the development of COM. Recently, mastoid air cells have been acknowledged as an essential compounding factor for the pathogenesis of middle ear disease. Since ET, mastoid air cell system, and nasopharyngeal mass like adenoids can play a pivotal role in the causation and persistence of COM, the current study will be taken to observe the status of ET, mastoid air cells system, nasopharynx in general, and adenoids in particular in patients of COM. Aim: This study aims to study the status of the mastoid antrum on surgical exploration, the status of ET, and nasopharynx for adenoids in patients of large, subtotal perforation, and posterosuperior retraction pockets (PSRPs). Study Design: This study was an observational, cross-sectional study. Study Setting: All the patients with large, subtotal perforation, and PSRPs visiting the Outpatient Department and Inpatient Department of ENT in Acharya Vinoba Bhave Rural Hospital (AVBRH) between 2022 and 2023 will be studied. Methods: All the selected patients of large, subtotal perforation, and posterosuperior retraction pocket (PSRP) in the age bracket of 15–65 years and satisfying the inclusion criteria will be considered and accrued in this study. We plan to look at a sample size of 50 patients (50 ears). Diagnostic nasal video endoscopy to get insight into ET function, size, and grade of adenoids by grading system given by Cassano et al. and pure-tone audiometry by ALPS AD2000 to know the type and amount of hearing loss will be carried out. Status of the mastoid antrum, the extent of the disease, status of ossicles, and associated abnormalities of temporal bone along with any other incidental findings will be noted intraoperatively. Expected Results: The data will be tabulated, analyzed statistically, and will be discussed in the context of existing research. Conclusion: The purpose of the present study is to help the surgeon have a better insight into the status of the mastoid antrum, ET in cases of large and subtotal perforation, and PSRP and nasopharynx in general with significance to adenoids in patients of COM in rural area.

Objective: We assessed preoperative parental expectations on communication abilities, social skills, and academic achievements of children with cochlear implant (CI). Materials and Methods: A total of 18 questions from the “Parent Expectations Questionnaire for Cochlear Implants” related to communication abilities, social skills, and academic achievements were administered on a total of 80 parents who were in the process of cochlear implantation for their children. Results: The results revealed that parents expressed high expectations (expectation score between 81% and 100%) on communication abilities (82.5%), social skills (90.8%), and academic achievements (84.1%) of their children from cochlear implantation. With respect to questions related to communication abilities, social skills, and academic achievements, 87.28%, 97.17%, and 91.80% of parents, respectively, agreed that their children show improvements in the above domains. Conclusions: Overall, parents expressed high expectations on the outcomes of children with CI. Hence, CI team must judge the actualism in the preoperative parental expectations and disseminate accurate prognostic information that is expected from cochlear implantation before surgery in order to make the whole procedure effective.

Diagnosis of temporomandibular disorder (TMD) in patients with otalgia is based on the medical history and physical examination, which is based on deep palpation of the joint area, however, palpation will often cause discomfort in healthy patients. Ninety-nine patients with otological symptoms in relationship with TMD were studied. We palpated with a blunt curette, the skin lining the anterior wall of the bony auditory canal located above the temporomandibular joint. We only consider a positive sign if palpation unequivocally evokes pain or discomfort identical to what the patient feels or has felt before. The positivity of the anterior wall sign was 99% in the TMD group. We found a significant difference between the control and TMD groups regarding the sign of the anterior wall (P < 0.005). The anterior wall sign could be an effective tool to detect temporomandibular dysfunction.

Trichilemmal carcinoma is a rare malignancy of hair follicles affecting sun-exposed and hair-bearing skin; occurrence over pinna is unusual. This case report describes one such uncommon presentation in a 71-year-old man who came with a pinna swelling clinically mimicking basal cell carcinoma. Diagnosis is an arduous task due to its close resemblance with more common cutaneous tumors. Misdiagnosis or delay in intervention may lead to recurrence and local metastasis.

Ever since Langerhans cell histiocytosis (LCH) was first described in 1865, mystery revolving around its cause and pathogenesis remains, although most agree that LCH is either a reactive or neoplastic process. We aim to highlight the importance of careful investigations of common presentation, which may lead to the diagnosis and treatment in a toddler. We report a case of LCH of the temporal bone with an atypical presentation in a toddler, which led to delayed diagnosis. The patient presented with a vague preauricular swelling and aural polyp. Imaging and histopathological examination of the biopsy revealed temporal bone LCH, and the child was referred to the pediatric oncology unit and successfully treated. This case clearly demonstrates the highly diversified clinical manifestation of LCH and the high level of suspicion required to diagnose it. We describe the challenge faced in managing this rare entity.

Paragangliomas (PGLs) are benign tumors of neuroectodermal origin. In the ear, they are commonly found in the middle ear or jugular bulb. PGL of external auditory canal (EAC) is extremely rare. To date, only a few cases of PGL of EAC have been reported. Here, we present a case of a 52-year-old female, who presented with complaints of decreased hearing and painful left ear discharge. On evaluation, she was found to have a soft-tissue mass arising from the posterosuperior wall of the left EAC, which was excised under general anesthesia and histopathologically confirmed to be EAC PGL. At 1 year of follow-up, the patient has a patent EAC and is disease-free. Although rare, PGL should be considered in the differential diagnosis of soft-tissue mass in EAC.

Cerebellar dizziness is a common clinical sign in patients with cerebellar dysfunction with several multifaceted consequences in the life of an individual. The clinical diagnosis of this type of dizziness is delayed or overlooked as its frequency is underestimated. Inaccurate examination of the vestibular or ocular motor systems contributes to this effect. However, with expansion of use of ocular vestibular evoked myogenic potentials (oVEMPs) in the diagnosis of central disorders, makes it an important tool used in routine practice. The present study shows that oVEMP is majorly affected in various cerebellar disorders, making it a sensitive test to be used in suspected patients. Based on the vestibular evoked myogenic potential results and complete audiological profile in the patients with cerebellar demyelination and cerebellar atrophy, medical team was able to arrive at a diagnosis when the radiological findings were inconclusive. This study shows that oVEMPs are neurological responses, sensitive to cerebellar dysfunction.

Schneiderian papillomas commonly occur in the nasal sinuses and septal mucosa. This type of papilloma rarely develops in the middle ear, with only 51 previously reported cases. The oncocytic papilloma (OP) subtype is even rarer, with only seven cases. We present a case of primary OP in the middle ear that recurred during long-term postoperative follow-up. The patient was a 31-year-old man who experienced papilloma recurrence after three surgeries. These recurrences appeared as a shadow on computed tomography. No recurrence has been observed since his fourth surgery. Our review showed increased recurrence and malignant transformation rates in inverted papillomas that occur in the middle ear. In contrast, OPs occurring in the middle ear were reported to have a high recurrence rate and no malignant transformation. Close and careful follow-up is necessary for any type of papilloma.

Foreign bodies in the ear are a common occurrence in medical practice. This is true for both adults and children. It is one of the most common causes of trauma to the external auditory canal, tympanic membrane, and middle ear. However, an impacted foreign body in the eustachian tube (ET) has been reported very rarely. Due to the anatomical orientation of the ET, entry of a foreign body in it is very improbable. After an extensive research, we found only 14 reported cases of foreign body in the ET. A high degree of suspicion, incisive clinical evaluation, appropriate radiological evaluation, and diligent preoperative planning are imperative to extract an artifact from the ET. Herein, we present a case of a forgotten, impacted foreign body in the ET of a 52-year-old woman presenting with recurrent, intermittent foul-smelling discharge, and decreased hearing on the left ear for 2 years. To our knowledge, our case is the first, presenting with a foreign body in the ET after an inadvertent self-inflicted trauma.

Introduction: The preauricular sinus is a congenital abnormality which was initially identified by Van Heusinger in 1864. Preauricular sinus development is strongly related to the development of auricle in the sixth week of pregnancy. Preauricular sinus can be inherited or are sporadic. Most cases are sporadic and over half of all cases are unilateral. Bilateral cases are more frequent in inherited cases. Case Report: A 10 year old boy was brought with complaints of discharge from left pre auricular region on and off since birth. History of frequent episodes of discharge from left pre auricular region about 2-3 episodes per year. Local examination showed preauricular sinus tract at the root of helix on both sides. There was no discharge,no warmth, no tenderness. The child underwent necessary investigations and pre aneasthetic fitness was obtained. Pre auricular sinus tract excision on left side under general anasthesia was done. Multiple sinus tracts were excised and sent for histopathological examination which showed evidence of pilonidal sinus. There was presence of sinus tract line by epidermis, lumen filled with keratin and hair shafts. The child was brought for follow up on postoperative day 10, the sutured site was found to be healthy. Suture removal was done and the wound was healing well. The child is on regular follow up and has shown no signs of any recurrence. Discussion: The only definite treatment of recurrent infective sinuses is complete excision of the sinus tract. In our case, supra aural elliptical incision was placed and all visible sinus tracts were cleared and sent for histopathological analysis. When these sinuses get infected, most frequent cause being with gram-positive bacteria, the exudates should be sent for culture, and the appropriate antibiotics should be administered. The temporalis fascia, the cartilage of the helix, and the auditory canal are identified using the supra-auricular approach. An en bloc excision of the sinus is then carried out. Pilonidal sinus is a difficult condition that causes suffering and embarrassment to its victims. Despite it being rare and atypical, pilonidal sinus could also occur in the auricular region. Although pilonidal sinus has been reported in a number of uncommon areas of the body besides the sacrococcygeal region, this is the second case of pilonidal sinus that we are aware of in the preauricular region that is reported in literature. Conclusion: Thus we present a very rare case of pilonidal sinus in pre auricular region. Only two cases have been reported till date in literature and our case is the second one to be reported in the pre auricular region.

Subperiosteal abscess (SPA) is a known sequel of acute mastoiditis typically afflicting children and less often the elderly, caused by Streptococcus, Staphylococcus, and anaerobes. Atrophic rhinitis is a progressive disease with nasal mucosal and turbinate atrophy, thick dried crusts, and foul odor called ozaena, caused by Klebsiella ozaenae. We present an interesting case of SPA in the mastoid in a patient with atrophic rhinitis, astonishingly caused by a common pathogen, K. ozaenae, and a review of literature. The presence of coexistent atrophic rhinitis and mastoiditis should always compel otolaryngologists to consider K. ozaenae as the common etiology.