Fine needle aspiration cytology (FNAC) is the gold standard for detecting thyroid nodules. It is a cost-efficient approach that affords prompt and accurate evaluation. It is crucial in deciding to treat patients with suspected malignancy of thyroid nodules that might have thyroid surgery. According to findings in cytology, patients may be observed when the cytology is benign, and surgery can be performed if the cytology is malignant, which leads to a reduction in the incidence of unneeded surgery. The current study aims to assess the concordance between FNAC of thyroid nodules with final histopathology and identify the different types of detected thyroid lesions. A retrospective record-based study reviewed the medical files of all patients presenting to the Armed Forces Hospital, Southern region, with suspected thyroid nodules from April 2018 to January 2020. Data were extracted using pre-structured data extraction sheet to avoid inconsistency. Data extracted included patients' demographic data, swelling laterality, size, ultrasound, and histopathological findings. The baseline characteristics of studied samples in the present study: Forty-seven samples had a mean age of 44.27 (SD=±13.5) years, and 85.1% were female gender. The study showed that 12.5% of benign samples were lymphocytic in histopathology, 25% suspicious for follicular neoplasm samples were benign multi-nodular goiter in histopathology, and all 100% of samples suspicious for malignancy were malignant in final histopathology. The current study showed that the malignancy rate of the examined nodules was not uncommon in FNAC and histopathology. Where papillary carcinoma was the most detected malignancy, the diagnosis of malignancy using FNAC is a cost-efficient approach that affords prompt and accurate evaluation. Once diagnosed, these cases should be subjected to surgery.

Background: Cochlear implantation, the primary treatment for severe to profound hearing loss, relies critically on proper electrode array design and insertion. Objectives: This systematic review and meta-analysis examined the complications and hearing outcomes of cochlear implantation in ossified cochleae, compared with non-ossified cases, and explored management strategies to enhance surgical success and patient outcomes. Methods: A comprehensive literature search was conducted using the PubMed, Scopus, Web of Science, and Cochrane Library databases, following the PRISMA guidelines. We used the following broad search strategy: Ossified OR ossification and cochlear AND implantation or implant. Two independent investigators screened titles, abstracts, and full texts and extracted data. A total of 20 studies and 971 patients were included. Results: Post implantation and intraoperative complications had pooled incidence rates of 13.48% and 7.2%, respectively. Complete electrode insertion was successful in 82.2% of cases, while partial insertion occurred in 22.6%. Hearing performance outcomes [Speech Perception Categories (SPCs), Categories of Audiological Performance Scores (CAPS), Speech reception threshold (SRT), and Speech Intelligibility Rating (SIR)] were significantly better for patients without ossification (SMD=0.35, P =0.005), although word and sentence scores showed no significant differences. Conclusions: Despite adaptations such as modified drilling and electrode arrays, hearing outcomes were inferior compared with non-ossified cochleae in addition to the risk of complications associated with the procedure. These findings underscore the need for continued research to improve outcomes in this patient population and have important implications for surgical planning and patient counseling.

Background: The aim of this study is to compare patients who develop facial nerve stimulation (FNS) after cochlear implantation (CI) and aremanaged with a triphasic stimulation pulse pattern (TPP) to those who do not develop FNS regarding the behavioral mapping parameters including the most comfortable loudness level (MCL) charge and amplitude, and the threshold level (THR), as well as the electrophysiological mappingparameters including phase duration (PD) and impedance level.Methods: A retrospective chart review of the patients who developed FNS at any point after device activation and were managed with TPP wascarried out. Electrophysiological and behavioral mapping parameters were retrieved from the programming software database at 3 time points:the time of implantation, the time of shift to TPP, and the last programming session. A control group with no FNS was matched randomly to evaluate any difference in the mapping parameters that could be attributed to FNS.Results: Sixteen ears with FNS were found to be eligible for inclusion in this study. These cases were matched to 16 ears in the control group.The programming was changed from biphasic pulse pattern (BPP) to TPP (time point -1) after a period of 22.37± 14.62 months. Resolution of FNSwas achieved in 14 ears (87.5%) by using TPP alone.Conclusion: The TPP mapping strategy, in addition to decreased phase duration, showed successful results in managing facial nerve stimulation while allowing an increase in the hearing level in the form of increased MCL amplitude.Cite this article as: Algazlan AJ, Aljazeeri I, Yousef M, et al. Electrophysiological and behavioral programming parameters in patients with facialnerve stimulation post-cochlear implantation. J Int Adv Otol. 2025, 21(2), 1704, doi: 10.5152/iao.2025.241704.

Objectives: The triphasic pulse pattern (TPP) is one of the successful strategies for managing facial nerve stimulation (FNS) after cochlear implantation (CI). This study evaluates the electrode impedance (EI) changes for patients who were shifted from the biphasic pulse pattern (BPP) to TPP.Materials and Methods: This retrospective study was conducted on the patients who experienced FNS post‐CI and were managed with a TPP strategy. The fitting parameters with TPP were compared to those with BPP, including electrode impedance, maximum comfortable levels (MCL), threshold levels (THR), and phase duration. .Results: This study included 25 implanted ears. The impedances of the electrode contacts significantly decreased when shifted to TPP at the first two apical contacts compared to the BPP (7.0 ± 2.7 vs. 7.8 ± 3.4 kΩ at the first contact and 6.5 ± 2.4 vs. 7.1 ± 2.9 kΩ at the second contact, respectively). The MCL showed a statistically significant increase with TPP compared to the BPP at the first 10 electrode contacts.Conclusion: The TPP of stimulation appears to be a successful strategy for managing FNS. Among the patients with FNS, there is a decrease in the most apical impedance values and an increase in MCL when using TPP. These findings suggest that TPP might be considered a routine and successful pattern for FNS patients. Future studies should investigate the impact of different stimulation patterns on CI outcomes.Level of Evidence: 3.

BACKGROUND: Cochlear ossification, otherwise known as labyrinthitis ossificans, is not an uncommon encounter in candidates for cochlear implantation (CI) that may necessitate alternative surgical approaches due to the insertion difficulties. We aimed to review the literature for the documented approaches for CI in cases with cochlear ossification. METHODS: This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines on articles that described their surgical approach for CI in cases with cochlear ossification. A comprehensive search of the electronic medical databases was conducted through Feb 2025. RESULTS: A total of 31 reports on 492 patients were included. The following approaches were documented: the facial recess approach, facial recess approach with removal of the incus buttress, combined facial recess and transcanal approach, subtotal petrosectomy/or radical mastoidectomy approach. The insertion was carried out through round window (RW), extended RW, scala tympani (ST) cochleostomy, scala vestibuli (SV) cochleostomy, double cochleostomy (basal turn with apical or middle turn cochleostomies), retrograde array insertion (through middle or apical turn cochleostomy) and partial or complete drill-out procedure. Alternative electrode designs used were short, double/split, triple, and stiff electrode arrays. In some instances, there was a need for alternative techniques to enable CI, including partial insertion technique, retrograde insertion, and robotic-assisted cochlear implant surgery. CONCLUSIONS: This review suggests numerous approaches and techniques for CI in an ossified cochlea, providing alternative approaches when the RW is inaccessible through the standard facial recess approach.