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    Evaluation of utricular and saccular function in BPPV patients: The role of VEMP in diagnosis
    (2020) CENGİZ, Deniz Uğur; TAN, Mehmet; BAYINDIR, Tuba; CAN ÇOLAK, Sanem; EMEKCİ, Tuğba; DEMİREL, Sümeyye
    Aim: The pathological cause of Benign Paroxysmal Positional Vertigo (BPPV) is the degeneration of the otolith organs (utricle and sacculus). Vestibular Evoked Myogenic Potentials (VEMP) assess the functions of the otolith organs. The objective of this research was to evaluate the otolith organ functions of patients with unilateral idiopathic BPPV (canalolithiasis of the posterior and lateral semicircular canals) by cVEMP and oVEMP tests. Material and Methods: The study prospectively included 35 patients with BPPV (canalolithiasis of the posterior and lateral semicircular canals) and 30 healthy individuals. Bilateral cVEMP and oVEMP tests were administered to all participants. Participants were divided into three groups: control, BPPV-affected ear, and unaffected ear.Results: In our study, cVEMP and oVEMP abnormalities were statistically significantly different both between the affected and unaffected ear groups and between the affected ear and control groups. There were statistically significant differences in the cVEMP and oVEMP amplitude values both between the affected and unaffected ear groups and between the affected ear and control groups. Also, the asymmetry ratios of the cVEMP and oVEMP tests were statistically significantly different between the case group and the control group. The cVEMP and oVEMP wave latencies (p1, n1, p1-n1) were not statistically significantly different among the BPPV-affected ear, unaffected ear, and control groups. The results of measurements were not statistically significantly different between the posterior and lateral canal involvement subgroups of BPPV patients.Conclusion: Abnormal cVEMP and oVEMP test results, which are observed more frequently in patients with BPPV compared to the control group, indicate utricular and saccular degeneration. Higher oVEMP abnormality ratios compared to those of cVEMP in BPPV patients suggest that utricular dysfunction may be more common than saccular dysfunction.
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    Is diffusion-weighted magnetic resonance imaging (DW-MRI) a requirement for suspected cholesteatoma in patients to undergo primary surgery?
    (2020) ERBAY, Mehmet Fatih; TAN, Mehmet; BAYINDIR, Tuba; ÇİÇEK, Mehmet Turan; ÖZER, Ebru
    Öz: Aim: In this study, the aim was to investigate the correlation of preoperative diffusion-weighted magnetic resonance imaging (DWMRI) with postoperative pathology findings in patients undergoing tympanomastoidectomy with suspicion of primary cholesteatoma.Materials and Methods: The study consisted of the retrospective evaluation of preoperative MRIs, surgical findings and pathologyresults of patients who underwent tympanomastoidectomy and had preoperative DW-MRI at the Department of Otorhinolaryngologybetween the years 2017 and 2019.Results: The study was conducted with 199 patients who underwent tympanomastoidectomy surgery. A retrospective examinationof patient files revealed that 80 (40.2%) of the patients underwent echoplanar diffusion-weighted magnetic resonance imaging(DW-MRI) because of suspected cholesteatoma in the preoperative period. Of these 80 patients, cholesteatoma was detected in 22(27.5%) as a result of pathological analysis and/or surgery, but no diffusion restriction was found in MRI interpretation; in 44 (55%)of them, both cholesteatoma in pathological analysis and/or surgery and diffusion restriction in MRI interpretation were detected.In 10 (12.5%) of these 80 patients, cholesteatoma was not detected either in the MRI interpretation or in the pathological analysisand/or surgery. In the remaining 4 (5%) patients, there was a cholesteatoma suspicion in MRI, but it was not detected as a result ofpathological analysis or surgery. In this study, the sensitivity of MRI for the diagnosis of cholesteatoma was 66.6%, and its specificitywas 71.4%.Conclusion: MRI provides moderately (66.6%) reliable information in the diagnosis of cholesteatoma patients. However, it is morereliable (71.4%) when it comes to exclusion of the disease. Therefore, it should not be used as the sole determining factor in patientswho will undergo primary surgery with suspected cholesteatoma. As much as our study results provide guidance for a more accurateuse of imaging methods, series with higher numbers of patients are needed.