Abdullah Dalgic

Background and Objectives: Noise-induced hearing loss (NIHL) is a major cause of sensorineural hearing loss. However, effective pharmacological treatments remain limited. The aim of this study was to investigate the therapeutic effects of allicin on NIHL in a rat model. Materials and Methods: Forty-two female Wistar albino rats were randomly divided into six groups (n= 7 per group): saline (SF), allicin, dimethyl sulfoxide (DMSO), noise+SF, noise+allicin+DMSO, and noise+DMSO. Noise exposure was performed using 4 kHz octave-band noise at a sound pressure level (SPL) of 120 dB for 4 hours. Allicin (20 mg/kg/day, intraperitoneally) was administered for 7 days following noise exposure. Auditory brainstem response (ABR) thresholds (dB SPL) were measured at 8, 12, 16, 20, and 32 kHz at baseline, 24 hours, and day 7. Histopathological evaluation of the cochlea was performed after euthanasia. Results: Noise exposure significantly increased ABR thresholds in all noise-exposed groups. On day 7, the noise+allicin+ DMSO group demonstrated significantly lower ABR thresholds at 16, 20, and 32 kHz compared with the noise+SF group and at 20 and 32 kHz compared with the noise+DMSO group (p<0.05). No significant differences were observed at lower frequencies. Histopathological analysis showed a trend toward reduced cochlear damage in the allicin-treated group; however, the differences were not statistically significant. Conclusions: Allicin treatment improved high-frequency hearing thresholds in rats with NIHL. However, the absence of significant histopathological and mechanistic findings indicates that further molecular and region-specific studies are required.

BACKGROUND: Facial nerve transection leads to significant functional and aesthetic deficits. Although microsurgical repair is the standard of care, complete functional recovery remains rare. Biological scaffolds and corticosteroids have been explored as adjuncts to enhance nerve regeneration. To evaluate the effects of human amniotic membrane (AM) wrapping and intraperitoneal dexamethasone, used alone or in combination, on facial nerve regeneration in a murine model. METHODS: Twenty-eight male albino mice underwent right facial nerve transection followed by epineural repair and were randomized into 4 groups (n= 7 each): (1) control (repair only), (2) dexamethasone (1 mg/kg IP for 7 days), (3) AM wrapping, and (4) combination therapy (AM + dexamethasone). Functional recovery was assessed using compound muscle action potential (CMAP) recordings on postoperative day 21. Histological analysis included axon count, myelin density, axon diameter, and CD44/Ki-67 immunohistochemistry. RESULTS: Group 4 (combination therapy) demonstrated the highest CMAP amplitude (5.5 ± 2.7 mV), axon count (median: 92.0), and myelin density (median: 50.5). Significant intergroup differences were observed in axon count (P < .001), myelin density (P < .001), and nuclear vacuole reduction (P=.04). Group 4 (combination therapy) demonstrated the highest CMAP amplitude (5.5 ± 2.7 mV); however, this increase did not reach statistical significance when compared with other groups (P=.299). Significant intergroup differences were observed in axon count (P < .001), myelin density (P < .001), and nuclear vacuole reduction (P=.04). Thus, while histopathological outcomes clearly favored Group 4, functional superiority should be interpreted with caution. CONCLUSION: Combined use of AM and dexamethasone synergistically enhanced facial nerve regeneration in this model. This dual approach may serve as an effective adjunct to microsurgical repair in peripheral nerve injuries. Further studies are needed to confirm its translational potential.

Clinical Outcomes Following Revision Cochlear Implantation: A Single-Center Experience - Turkish Archives of Otorhinolaryngology

Background: Hearing loss reduces quality of life, particularly prevalent in the geriatric population (≥ 65 years). This study aims to evaluate the efficacy of incus interposition in the geriatric population and to compare functional outcomes with those of the adults. Methods: Patients who underwent incus interposition in the clinic were retrospectively reviewed and divided into 2 groups according to age. Cases with ossicular problems other than incus problems, cholesteatoma, and revision surgeries were excluded from the study. The results of pure tone audiometry preoperatively and postoperatively (sixth month) were compared within each group and between the groups. The differences in air conduction, bone conduction, and air-bone gap were analyzed. Results: The study included a total of 76 patients, 44 (57.9%) under 65 years of age and 32 (42.1%) over 65 years of age. The distribution of sex and type of graft was homogeneous between the groups. The preoperative air and bone conduction thresholds were significantly higher in the geriatric group compared to the adult group (P < .001). In the sixth postoperative month, a significant reduction in air conduction thresholds and air-bone gap was observed in both groups (P < .001). When the changes in the air-bone gap between the preoperative and postoperative periods were compared, the adult group showed a significantly greater improvement than the geriatric group (P = .006). Conclusion: Incus interposition is a safe and effective surgical procedure in the geriatric population. The comparatively lower hearing gains observed in the geriatric group may be attributed to age-related pathological changes in the middle ear. Cite this article as: Akı ES, Dalgı. A, Aksoy-Yıldırım G, Kertmen C, Kubilay U. Evaluation of the effectiveness of incus interposition in the geriatric population. B-ENT. 2025;21(2):86-90.

Objective: This observational, cross-sectional simulation study evaluated ChatGPT-4 as a postoperative information tool for rhinoplasty using standardized questions and blinded ENT specialist ratings. Study Design: This study is an observational, cross-sectional simulation study using blinded expert evaluation. Setting: We used an online Artificial Intelligence (AI) platform accessed under standardized conditions. Methods: Ten typical recovery questions were posed to ChatGPT-4, and the responses were independently rated by ENT specialists for accuracy, clarity, relevance, response time, and patient-centered communication. Responses were also assessed with a structured performance instrument and supported by linguistic and statistical analyses. Results: ChatGPT-4 achieved high scores for accuracy (90%, 95% CI: 84.9–95.1) and clarity (87%, 95% CI: 82.8–91.2), but lower performance in patient-centered communication (77%, 95% CI: 74.0–80.0). Specialist scoring confirmed structured medical reasoning, while machine learning analyses highlighted clarity, diagnostic depth, and empathy as key contributors to higher ratings. Conclusions: ChatGPT-4 demonstrated high clinician-rated accuracy and clarity when answering standardized postoperative rhinoplasty questions, while patient-centered communication remained comparatively lower. These findings suggest that LLM-based tools may complement clinician-delivered postoperative counseling under appropriate oversight, but they are not a substitute for individualized medical advice or surgical follow-up.

Background: This study was designed to assess if thiol-disulfide homeostasis could be used as diagnostic biomarker in noise-induced hearing loss (NIHL) in a laboratory animal model. Methods: The study was carried out with a total of 28 female albino rats in 4 groups: group 1 (control group) included rats that were not exposed to noise or any study treatment; in group 2, following noise exposure, rats received 2 mg of dexamethasone per kilogram of body weight via the intramuscular route for 5 days; in Group 3, rats were exposed to noise and received a saline solution for 5 days, in a volume (0.15 cc) matched to that of dexamethasone administered in group 2; and in group 4, rats were exposed to noise, and blood samples were collected during the early phase to assess thiol-disulfide homeostasis without administering any treatment. Rats in groups 2, 3, and 4 were exposed to 120 dB noise in the 4 kHz octave band for 4 hours. The auditory brainstem response (ABR) test was performed in all groups on day 1 after noise exposure and was repeated in groups 1, 2, and 3 on day 5. Auditory brainstem response thresholds were recorded at 8, 12, 16, 20, and 32 kHz frequencies. Groups 1, 2, and 3 rats were sacrificed on day 5, and group 4 rats were sacrificed by exsanguination on day 1 after noise exposure. Venous blood samples collected from the caudal vena cava were centrifuged and sent to the corresponding laboratory for thiol-disulfide homeostasis studies. After sacrificing the rats, the right and left temporal bones of each rat were removed and stained with hematoxylin eosin for histological studies to explore any pyknotic changes in spiral ganglion cells. Results: Intergroup comparisons by frequency on day 5 of noise exposure showed statistically significantly lower responses in ABR measurements at 8 kHz, 12 kHz, and 16 kHz in group 2 compared to group 3 (P = .003, P=.006, and P=.002). Improvements were observed with dexamethasone administered for therapeutic purposes, particularly if the hearing loss was induced by low-frequency noise. In the assessment of the parameters of thiol-disulfide homeostasis, disulfide/native thiol and disulfide/total thiol ratios and ischemia-modified albumin (IMA) levels were higher in group 4 than in other groups, although only the differences between group 1 and group 4 reached statistical significance. Conclusion: According to this study, thiol-disulfide homeostasis and IMA can be shown as diagnostic biomarkers in NIHL, especially in the early period. The results from our study suggest that these markers may be used as adjunctive diagnostic tools in NIHL, in addition to audiological studies. However, this issue can be clarified with further clinical studies. Cite this article as: Aydın E, Mungan Durankaya S, Yilmaz O, et al. Thiol-disulfide homeostasis in noise-induced hearing loss in rats. J Int Adv Otol. 2024;20(6):466-471.

Background: This study aimed to compare total endoscopic ear surgery (TEES) and microscopic postauricular canal-wall-down tympanomastoidectomy (CWD) in cholesteatoma surgery in our clinic. Methods: This study included 59 patients, of whom 30 and 29 were operated on with CWD in 2016-2018 and TEES in 2019-2021, respectively and compared regarding intraoperative findings, hearing outcomes, long-term outcomes, and recidivism rates between groups. This study excluded patients in stage IV according to the European Academy of Otology and Neurotology/Japan Otological Society Staging System on Middle Ear Cholesteatoma, aged < 18, with congenital cholesteatoma, who underwent revision surgery. Results: Two patients in the TEES group had recidivism (6.9%), with recurrent disease observed in both patients and residual disease in none, whereas 3 patients in the CWD group had recidivism (10%), including recurrent disease in 2 and residual disease in 1 patient. Tympanic membrane perforation occurred in 2 (6.9%) and 1 (3.3%) patients in the TEES and CWD groups, respectively. The 2 groups revealed no significant difference in terms of recidivism and perforation rates (P=1.000, P = .612). The CWD group had a longer mean operation time (225.54 ± 47.86 minutes) than the TEES group (160.55 ± 24.98 minutes) (P < .001). The 2 groups demonstrated no significant difference regarding pre- and postoperative air–bone gap (ABG) and ABG gain (P = .105, P=.329, P=.82, respectively). Conclusion: Total endoscopic ear surgery provides similar results in terms of hearing, recidivism, and long-term outcomes with the microscopic CWD approach. However, the CWD approach is still important, especially in patients in advanced stages. Cite this article as: Ekrem Zorlu M, Yaramis B, Emrah Ceylan M, Dalgic A. Comparison of total endoscopic ear surgery and microscopic postauricular canal-wall-down approach on primary acquired cholesteatoma. J Int Adv Otol. 2024;20(4):325-330.

Background: Several fixation methods have been described to secure the cochlear implant’s receiver/stimulator, but the optimal stabilization technique is still being debated. The aim of this study was to compare the conventional technique with suture fixation to the subperiosteal tight pocket technique in terms of revision cochlear implantation rate. Methods: A retrospective review was conducted on the medical records of 649 patients who underwent cochlear implantation. The study participants were divided into different groups regarding the applied surgery technique. The relationship between the fixation technique, revision rates, and the cause of revisions related to techniques was investigated. Results: The overall revision rate was 2.9% (19 out of 649). There were 14 (3.5%) and 5 (2%) revision implantations in the subperiosteal tight pocket and conventional technique groups, respectively. The incidence of device failure was 2.5%, and it constituted the primary cause for revision surgery in both groups. Even though patients who had the subperiosteal tight pocket technique had a much higher rate of device failure, the results indicate that there was no significant difference between the groups, as evidenced by a P-value of .12. Conclusion: The conventional and subperiosteal tight pocket techniques can both be safely preferred with low revision rates in patients undergoing cochlear implantation. Cite this article as: Ceylan ME, Zorlu ME, Çorakçı O, Akı ES, Aksoy Yıldırım G, Dalgic A. Comparison of conventional technique with suture fixation and subperiosteal tight pocket technique on revision cochlear implantation rate. J Int Adv Otol. 2024;20(4):301-305.

Objective: This study aimed to compare the pharyngocutaneous fistula (PCF) between patients who underwent reconstruction using cervical fascia after total laryngectomy and those who did not and to investigate the factors affecting PCF rates.Methods: We retrospectively compared 22 patients operated between February 2021 and March 2023 who received cervical fascia flap as the study group and 21 patients operated between January 2018 and March 2023 who did not receive fascia flap as the control group. The study included patients who underwent total laryngectomy for Stage 3 and 4 squamous cell laryngeal cancer.Results: We included 43 patients, with 22 (51.2%) and 21 patients (48.8%) in the study and control groups, respectively. The age and sex were not different between the two groups (p = 0.471, p = 0.176, respectively). The distribution of patients as per sex, smoking, alcohol use, chronic obstructive pulmonary disease, diabetes mellitus, coronary artery disease, and multiple comorbidities was similar in both groups (p > 0.05). PCF was observed in one patient (4.5%) and seven patients (33.3%) in the study and control groups, respectively. The PCF rate was significantly lower in the study group (p = 0.021). When the relationship between flap use and risk factors was compared by correlation analysis, a moderate negative relationship was found between flap use and PCF (p = 0.015, r = −0.370).Conclusion: The use of a cervical fascia flap is effective in reducing fistula rates after total laryngectomy. Its main advantages include being technically simpler than alternative techniques, locally available, cost‐effective.Level of Evidence: 3 Laryngoscope, 134:4964–4970, 2024