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    An investigation of tinnitus, noise sensitivity and anxiety levels in liver transplantation patients in the early and late periods: A cross-sectional study
    (2023) Yilmaz, Sezai; Cengiz, Deniz; Çolak, Sanem Can; Çiçek, Mehmet Turan; Aslan, Mehmet; Korkmaz, Hanifi; Kurtcu, Büşra
    This study aims to evaluate the perception of anxiety, tinnitus, and noise sensitivity in liver transplant patients according to early and late periods following transplantation. The study included 76 patients with liver transplantation. They were divided into two groups according to the duration of time after transplantation: early (1-3 years) and late (5 years or more). A demographic data form, the Tinnitus Handicap Inventory (THI), Weinstein's Noise Sensitivity Scale (WNSS), and the Beck Anxiety Inventory (BAI) were administered and used for data collection. There was a statistically significant difference between the early and late-period groups in terms of WNSS and THI scores (p<0.05), whereas there was no statistically significant difference in BAI scores (p>0.05). Noise sensitivity and tinnitus perception of the late-period group were statistically higher than those of the early-period group (p<0.05). Correlations between BAI, WNSS, and THI scores of late-stage patients were significant (p<0.05). A multivariate regression model was performed with the WNSS and the THI as dependent variables. According to this analysis, the THI had a statistically significant positive effect on the BAI in the early period (p2=0.003) and WNSS had a statistically significant positive effect on the BAI score in the late period (p2=0.002). Both otologic and psychological effects are observed in patients with liver transplantation. The post-transplant period triggered otologic symptoms more. It is also noteworthy that psychological and otologic symptoms are in correlation. Psychological and otologic evaluations with a multidisciplinary approach should gain importance in the post-transplant period.
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    Circadian rhythm disruption as a potential contributor to BPPV: Evidence from a young rat model vestibular effects of circadian disruption
    (Public Library Science, 2025) Otlu, Husniye Gul; Korkmaz, Hanifi; Bulut, Nilufer Diller; Gokturk, Nurcan
    Circadian rhythm disturbances, increasingly common due to artificial lighting and modern lifestyle factors, may underlie vestibular dysfunction such as benign paroxysmal positional vertigo (BPPV), even in younger populations. This study aimed to investigate the effects of circadian rhythm disruption on balance performance and vestibular biomarkers in a young rat model. Young male Wistar rats were exposed to constant light (CL) for 4 weeks to induce circadian disruption, while control rats were maintained under a standard 12:12-hour light-dark cycle. Following the exposure, serum and cochlear tissues were analyzed for otolin-1, vitamin D3, melatonin, and electrolytes (Ca-2 (+) , Na (+) , K (+) , Cl-). Balance was evaluated using the rotarod performance test. Constant light exposed rats showed significantly elevated otolin-1 levels in both serum and cochlear tissues, along with reduced melatonin levels and impaired rotarod performance. Vitamin D3 levels were lower in the CL group, while serum electrolytes remained unchanged. Circadian rhythm disruption may impair vestibular function in young rats via melatonin related pathways or otolin-1 modulation, independent of serum electrolytes. Our results imply that circadian rhythm disruption may contribute to BPPV through pathways unrelated to aging or bone metabolism.
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    Role of the functional head impulse test in evaluating vestibulo-ocular reflex abnormalities in individuals with Parkinson's disease
    (Wiley, 2023) Karababa, Ercan; Sonkaya, Ali Riza; Satar, Bulent; Korkmaz, Hanifi
    PurposeTo assess vestibular-ocular reflex (VOR) function in patients with Parkinson's disease (PD) using a new method called functional head impulse test (fHIT).Study DesignCase-control study.SettingTertiary medical center.ParticipantsTwenty individuals with PD were recruited for PD group, and twenty healthy individuals for the control group. Ages of both groups ranged from 47 to 76 years.Main Outcome MeasuresAccording to the modified Hoehn-Yahr score, PD group was classified as an early stage with a range of 1-2.5 and a mid-late stage with a range of 3-5. Percentage of correct answers (%CA) was calculated using fHIT for lateral, anterior and posterior semicircular canal (SCC) planes.ResultsPD group had statistically lower fHIT %CA in the right lateral, left lateral, and left posterior SCC planes compared to control group (p < .05). There was no statistical difference between two PD severity groups and functional VOR abnormality.ConclusionIt was concluded that the functional VOR in the right lateral and left lateral and left posterior SCC plane was affected in individuals with PD. Our results show that impaired VOR and reduced dynamic visual acuity should be considered in individuals with PD for vestibular rehabilitation exercises.
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    The Effect of Different Auditory Stimuli and Optokinetic Stimuli on Vestibulo-Ocular Reflex Function
    (Wiley, 2026) Korkmaz, Hanifi; Cicek, Ipek Balikci
    This study investigated how auditory stimuli and optokinetic stimulation modulate functional Head Impulse Test (fHIT) correct response rate (CR%) across semicircular canals (SCCs) and the associated cognitive load in healthy adults. Fifty participants (20-57 years) completed repeated-measures fHIT under four conditions: silence, music, white noise, and optokinetic stimulation. The CR% from all SCCs were recorded and workload was assessed with the NASA Task Load Index (NASA-TLX). Optokinetic stimulation produced the most significant CR% decrement (e.g., right lateral 90 vs. 100 in silence; p<0.001) and the highest workload (median NASA-TLX = 50). Auditory conditions produced minimal CR% changes. Across conditions, lateral SCCs were less affected than vertical SCCs by sensory and cognitive interference. Visual-vestibular conflict markedly reduced CR%, whereas auditory effects appeared indirect and attention mediated. These findings provide normative benchmarks for multisensory fHIT assessment.
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    Treatment-related modulation of visuo-vestibular integration in post-earthquake dizziness syndrome: a longitudinal virtual reality-based study
    (Springer Heidelberg, 2026) Korkmaz, Hanifi; Karaer, Isil Cakmak; Orman, Kubra; Talu, Burcu; Inceoglu, Feyza
    BackgroundPost-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.ObjectiveTo 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.MethodsIn 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).ResultsDizziness-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.ConclusionsRecovery 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.