Isil Cakmak Karaer

Cholesterol granulomas (CG) are benign, expansile lesions that arise from a foreign body giant cell reaction to cholesterol crystals, surrounded by chronic inflammation and fibrous tissue. In this case report, a patient reported a sudden onset of symptoms, presented with twice positive beta-trace protein (BTP) samples from his middle ear fluid, and due to watery otorrhea, a cerebrospinal fluid (CSF) leak was initially suspected. Even though the intrathecal contrast-enhanced myelography turned out negative, 2 unsuccessful surgical attempts to localize the leak finally led to the correct diagnosis of a BTP-positive cholesterol granuloma with cyst formations. As cases with CG do not produce beta-2 transferrin, both markers should be tested to confirm CSF leakage before proceeding to surgical intervention in case of doubt.

Background/Objectives: Pregnancy involves significant hormonal, cardiovascular, and physiological shifts that may potentially affect the vestibular system. The utricle and saccule, the two primary otolith organs, are responsible for detecting linear acceleration and maintaining equilibrium. This study aims to objectively evaluate the functional status of these organs throughout the three trimesters of pregnancy using Vestibular Evoked Myogenic Potentials (VEMPs). Methods: A prospective cross-sectional study was conducted with 64 healthy primigravida women (mean age 29.4 ± 2.3 years). Cervical VEMP (cVEMP) and ocular VEMP (oVEMP) tests were performed at three distinct time points: the first (8–9 weeks), second (20–21 weeks), and third (33–34 weeks) trimesters. Latencies (p13 and n23 for cVEMP; n10 and p15 for oVEMP) and peak-to-peak amplitudes were recorded and statistically compared across trimesters. Results: No statistically significant differences were found in cVEMP p13 and n23 latencies or amplitudes across the three trimesters (p > 0.05). Similarly, oVEMP p15 latencies and amplitudes remained stable throughout the pregnancy (p = 0.43 and p = 0.95, respectively). While a slight numerical increase in certain latencies was observed in the third trimester, and the oVEMP n10 latency was found to be consistently prolonged compared to non-pregnant norms, these values remained stable between trimesters. The inter-aural asymmetry showed no significant deviations, indicating a balanced vestibular adaptation. Conclusions: The functional integrity of the saccule and utricle is preserved during a healthy pregnancy. Despite the dramatic increase in gestational hormones such as estrogen and progesterone, the otolith-dependent reflex pathways (vestibulocollic and vestibulo-ocular) remain resilient. These results provide a clinical baseline for evaluating vestibular symptoms in pregnant populations, suggesting that significant VEMP abnormalities should prompt investigation into underlying vestibular pathologies rather than being attributed to normal pregnancy changes.

Background/Objectives: To determine the effect of single-dose hemodialysis treatment on the inner ear in patients with normal hearing functions using the Distortion product otoacoustic emissions (DPOAE) test. Methods: A total of twenty-four (24) patients with end-stage renal disease were included in the study. For all patients, the DPOAE test was performed immediately before hemodialysis and 3 h after hemodialysis. Both amplitude and signal-to-noise ratio (SNR) values were compared. Results: Compared to pre-dialysis values, the DPOAE test showed a statistically significant decrease in both amplitude and SNR values at all frequencies (1000, 2000, 4000 and 6000 Hz) in patients’ post-dialysis measurements. Conclusions: A single hemodialysis treatment has been found to have an adverse effect on cochlear function at both low and high frequencies.

Background: Post-earthquake dizziness syndrome (PEDS) is increasingly recognized as a condition marked by persistent dizziness and imbalance after major earthquakes, often without clear peripheral vestibular pathology. Despite proposed roles of visuo-vestibular dysfunction and sensory conflict, longitudinal objective evidence remains limited. Objective: To examine the longitudinal effects of virtual reality–based vestibular rehabilitation (VR), cognitive behavioral therapy (CBT), and their integration (VR + CBT) on objective visuo-vestibular processing and symptom burden in adults with PEDS. Methods: In a four-arm longitudinal study, 48 earthquake-exposed adults with PEDS were evaluated at baseline, post-intervention, and 3-month follow-up following an 8-week intervention. Objective visuo-vestibular outcomes were assessed using an immersive virtual reality–based system, including static and dynamic subjective visual vertical (SVV/DSVV), rod-and-frame test (RFT), and visual motion sensitivity (VMS) tests. Subjective outcomes included dizziness-related handicap (DHI) and post-traumatic stress symptoms (PCL-5). Results: Dizziness-related disability and trauma-related symptoms improved over time across groups, indicating clinical modifiability of PEDS. Objective measures demonstrated a domain-specific response profile: SVV and DSVV remained largely stable, whereas RFT showed improvement in active treatment arms, suggesting reduced visual frame dependence. VMS outcomes exhibited differential trajectories, with the integrated VR + CBT group showing the most consistent and durable modulation under visually provocative conditions. Conclusions: Recovery in PEDS appears to involve selective modulation of context-dependent visuo-vestibular processing rather than uniform changes across all spatial orientation measures. Integrated VR + CBT yields the most coherent and durable benefits in visually demanding domains, supporting multidisciplinary models that jointly address sensory conflict and cognitive–emotional mechanisms after major earthquakes.

The aim of this study is to examine the association between low serum vitamin B₁₂ levels and low serum vitamin D levels and cochlear health in women. A prospective case–control study was carried out in the Department of Otolaryngology, Malatya Training and Research Hospital between 2017–2018. Thirty (30) patients with vitamin B₁₂ deficiency (a mean age of 32.5 ± 1.7 years(y) women); 30 patients with vitamin D deficiency (a mean age of 32.3 ± 1.58 y women) and 30 controls (a mean age of 27.8 ± 1.48 y women) were recruited. The study participants have no evidence of symptomatic hearing loss. Transiently evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) of the study participants were recorded. A comparative analysis of the parameters revealed that results at TEOAE 1,2,3,4 kHz (p = 0.013, p = 0.002, p = 0.001, p = 0.001, respectively) and at DPOAE 1, 2, 6 kHz ( p < 0.001, p < 0.001, p = 0.002, respectively) were somewhat lower in patients with vitamin B₁₂ deficient group when compared with the controls. Moreover, TEOAE 3,4 kHz (p = 0.005, p = 0.013 respectively) and DPOAE 1,2,6 kHz (p = 0.005, p = 0.01, p = 0.031, respectively) were lower in the vitamin D deficiency group compared with the controls. There was a significant association between both vitamin B₁₂ deficiency and vitamin D deficiency and cochlear health. Patients with vitamin B₁₂ and vitamin D deficiency should be evaluated for cochlear function.

The aim of this study was to test whether hearing function is impaired in women with premature ovarian failure. Thirty (30) women with premature ovarian failure (POF), 30 women in menopause and 30 healthy controls were recruited in this study. Pure tone audiometric (PTA), transiently evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) of the study participants were analysed. At PTA, 6 and 8 kHz were lower in menopause group compared with both women with POF and controls. At TEOAE 3 and 4 kHz and at DPOAE 1, 2, 4 and 6 kHz were lower in menopause group compared with the controls. At DPOAE 6 kHz was lower in the POF group compared with the controls. Women with POF comparing to menopause group at TEOAE 3, 4 kHz and at DPOAE 4 and 6 kHz were lower in the menopause group. Inner ear function of both women in menopause and women with POF was declined compared to the healthy controls. Clinically, evaluation of hearing status may be considered in women with POF.

Premature ovarian insufficiency (POI) is a global health concern for women and affects several systems, such as cardiovascular system, autoimmune disease, and psychological status. The aim of this study was to investigate the effect of POI on nasal mucociliary clearance time via saccharin test by comparing postmenopausal women and healthy controls. Thirty-five (35) patients with POI, 35 healthy postmenopausal women and 35 healthy controls were recruited in this study. All study participants underwent measurements of nasal mucociliary clearance time via saccharine test. When women with POI and postmenopausal women compared with the controls, nasal mucociliary clearance time was longer in both women with POI and postmenopausal women. When women with POI were compared with postmenopausal women, the nasal mucociliary clearance time was not difference between two groups. There was a significant prolonged nasal mucociliary clearance time in the women with POI and postmenopausal women. Lower serum estradiol levels in women with POI as well as postmenopausal women had an adverse effect of nasal mucociliary clearance time.

Objectives: The aim of this study was to examine the effects of melatonin on ionized radiation‐induced salivary gland damage using an experimental model.Materials and Methods: Thirty‐two rats were randomized into four groups: (i) the control group (C, n = 8) that received intraperitoneal (i.p.) 0.9% NaCl; (ii) the melatonin group (M, n = 8) that received i.p. 5 mg/kg melatonin; (iii) the radiotherapy group (RT, n = 8) that underwent irradiation; (iv) the melatonin plus radiotherapy group (M+RT, n = 8) that received i.p. 5 mg/kg of melatonin, followed by irradiation 30 min later; and (v) the radiotherapy plus melatonin group (RT+M, n = 8) that received irradiation followed by i.p. 5 mg/kg of melatonin 30 min later. The medications and irradiation were administered for 5 days and the salivary glands of the rats were excised 10 days later; the histopathological changes in the salivary glands were assessed and biochemical analyses were conducted (tissue levels of malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), reduced glutathione (GSH), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI)).Results: Regardless of whether melatonin was administered before or after radiotherapy, melatonin decreased the radiation‐induced parotid and submandibular histological damage. In addition, regardless of whether administration occurred before or after radiotherapy, melatonin decreased oxidative stress markers, such as MDA, TOS, and OSI. On the contrary, levels of antioxidative markers, such as CAT and GPx, were increased by melatonin.Conclusions: Melatonin may have a significant protective effect on salivary gland damage secondary to ionizing radiation.

Objectives/Hypothesis: To examine the effects of N‐acetyl‐5‐methoxytryptamine (melatonin) on radiation‐induced inner ear damage.Study Design: An experimental animal model.Methods: Forty rats were randomized into five groups, as follows: 1) melatonin and then radiotherapy group (n = 8), which received intraperitoneal (i.p.) melatonin (5 mg/kg) followed by irradiation 30 minutes later; 2) radiotherapy and then melatonin group (n = 8), which received irradiation with i.p. melatonin (5 mg/kg) 30 minutes later; 3) melatonin group (n = 8), which received i.p. melatonin (5 mg/kg); 4) radiotherapy group (n = 8), which underwent only irradiation; 5) and the control group (n = 8), which received i.p. 0.9% NaCl. The medications and irradiation were administered for 5 days. All rats underwent the distortion product otoacoustic emission (DPOAE) test before and 10 days after the experiment. The middle ears of the rats were excised, and assessment of tissue alterations in the organs of Corti, spiral ganglions, and stria vascularis were compared among the groups.Results: In the radiotherapy group, the DPOAE amplitudes at frequencies of 4000 to 6000 Hz were significantly decreased when compared with the controls. The DPOAE amplitudes both in the melatonin and then radiotherapy group and the radiotherapy and then melatonin group exhibited better values than they did in the radiotherapy group. Histopathological evidence of damage to the organs of Corti, spiral ganglions, and stria vascularis damage was markedly reduced in both these two groups when compared to the radiotherapy group.Conclusion: These results indicate that melatonin may have significant ameliorative effects on cochlear damage secondary to ionizing radiation. Laryngoscope, 125:E345–E349, 2015