Background/Objectives: We investigated whether cervical sensitive nerves (CSN) provide motor input to the trapezius muscle and how this relates to short-term functional outcomes after neck dissection. Methods: A total of 22 neck dissections were performed in 17 patients; the SAN was preserved. CSN roots (C2–C4) were stimulated intraoperatively using IONM. Shoulder and neck function were evaluated preoperatively and at 3 months in 15 operated necks using goniometry, an IMU-based motion analysis system (iSen), trapezius isometric strength, the Modified Constant–Murley Score (MCMS), and the Shoulder Pain and Disability Index (SPADI). Results: CSN-evoked trapezius responses were detected in 10/22 (45.5%) dissections (C2: 6/22, 27.2%; C3: 4/22, 18.2%; C4: 0/22). Postoperatively, neck extension/rotation and shoulder abduction/external rotation decreased significantly within groups; upper and middle trapezius strength and MCMS also declined. Shoulder flexion loss was smaller when CSN motor participation was present. Median shoulder flexion (goniometry) changed from 162°→140° in CSN(+) vs. 170°→131° in CSN(−) (between-group p = 0.024). With iSen, shoulder flexion changed 120°→116° in CSN(+) vs. 122°→97° in CSN(−) (p = 0.033). Conclusions: Approximately half of the neck dissections exhibited CSN-related motor responses. Short-term shoulder flexion was better preserved when CSN motor participation was present, suggesting that documenting CSN motor input intraoperatively may inform early rehabilitation planning.

Background: This study aims to present our experiences regarding otitis media (OM) complications in a tertiary hospital and discuss them in light of the literature. Methods: In our study, the demographic information, findings at admission, radiological examinations, treatment approaches, and follow-up periods of the patients treated for OM complications at Dokuz Eylül University Hospital Ear Nose and Throat Clinic between January 2010 and January 2024 were retrospectively analyzed. Complications were grouped as acute otitis media (AOM), chronic otitis media (COM), and extracranial and intracranial complications. Results: In the study, 74 complications were observed in 67 patients, 44 of which were due to AOM and 30 due to COM. Thirty-nine patients were male (58.2%) and 28 were female (41.8%). The mean age was 28.7 years (2 months-78 years). Twenty-eight of the COM complications were extracranial, and 2 were intracranial. Extracranial complications consisted of 14 perilymphatic fistula (PLF), 11 cases of peripheral facial paralysis (PFP), 2 subperiosteal abscesses, and 1 Citelli abscess. There was a temporal lobe abscess and a sigmoid sinus thrombosis as intracranial complications. More than 1 complication was observed in 3 patients. A patient treated for temporal lobe abscess underwent radical mastoidectomy along with neurosurgery and intracranial abscess drainage. In 14 patients with PLF, the fistula was repaired with bone pates and soft tissues after the appropriate removal of the cholesteatoma. We managed to preserve hearing in all of these patients. While complete recovery was observed in 6 of the 11 PFP patients who underwent surgery, 3 patients had grade 2 PFP and 1 patient had grade 3 PFP according to the House–Brackmann staging system at the last follow-up. One patient voluntarily lost follow-up after the first month of the operation. Modi!ed radical mastoidectomy and medical treatment were applied to the patient who was diagnosed with sigmoid sinus thrombosis. At the second-month follow-up, it was observed that the thrombosed segment in the sinus was recanalized. Forty-four AOM complications were treated in 40 patients. Extracranial complications were listed as 14 subperiosteal abscesses, 10 cases of mastoiditis, 6 cases of labyrinthitis, and 4 PFP. Among the intracranial complications, sigmoid sinus thrombosis was observed in 6 patients, epidural abscess was observed in 3 patients, and otitic hydrocephalus was observed in 1 patient. All patients with subperiosteal abscesses underwent abscess drainage and a ventilation tube in addition to intravenous antibiotic therapy. Patients with PFP and labyrinthitis were treated with a ventilation tube, and patients were also given antibiotics and oral steroids. Intravenous antibiotics, abscess drainage, mastoidectomy, and anticoagulant treatment were applied to patients presenting with epidural abscess and sigmoid sinus thrombosis. Another remarkable situation is that after the emergence of the COVID-19 pandemic, AOM was the increase in complications. Eleven cases of AOM complications in 10 years before the pandemic. Thirty-three cases of AOM complications were observed after the emergence of the pandemic. Three of these 33 cases were diagnosed during the period when pandemic measures were implemented, including curfew, personal hygiene, wearing masks, and closing schools, while 30 were diagnosed after September 2021, when schools reopened after the pandemic and the measures were reduced. It is attractive. Conclusion: Otitis media complications are pathologies in which signi!cant morbidity and mortality can be prevented thanks to early diagnosis and treatment. In addition, these complications increased after the COVID-19 pandemic. For this reason, early diagnosis and treatment are important, as they are lifesaving. Cite this article as: Öncül EC, Olgun Y, Savaş Ö, Çakır Çetin A, Güneri EA. Our 14 years of clinical experience in otitis media complications. Balkan ORL-HNS 2025;2(1):15-21.

Background/Objectives: This study aimed to evaluate factors necessitating alternative techniques during cochlear implant (CI) surgery and to compare outcomes with standard procedures. Methods: Patients of all ages who underwent CI at our center between January 2003 and January 2024 were included. Alternative methods were defined as removal of external auditory canal/posterior canal wall, removal of ossicles to enhance surgical view, use of an endoscope for round window visualization, or similar approaches. Results: A total of 404 patients (mean age 13 ± 19.7 years) were analyzed. Preoperative imaging revealed inner ear anomalies in 44 patients (10.9%). Alternative methods were used in 41 patients (10.1%), including incus removal (n = 16), endoscopic assistance (n = 14), posterior canal wall removal (n = 4), incus buttress removal (n = 3), combined ossicle removal (n = 3), and one canal wall down mastoidectomy with fat graft obliteration and blind pouch closure. Alternative methods were significantly more frequent in patients with inner ear anomalies or additional otologic disease (p = 0.01 and p < 0.01, respectively), but not across age groups (p = 0.65). Partial electrode insertion occurred in 17 cases. Electrode insertion and complication rates were comparable between groups (p = 0.08 and p = 0.99, respectively). Bony cochleostomy was significantly more common in the alternative methods group (p = 0.01). Conclusions: Inner ear anomalies and additional otologic diseases may necessitate alternative CI techniques. These methods achieve electrode insertion and complication rates comparable to standard approaches, supporting their effectiveness in selected cases.

Background: Pilomatrixoma is a superficial, benign skin tumor differentiating from the hair follicle matrix. More than half of these tumors occur in the head and neck region. This study aims to share the clinical experience with patients diagnosed with pilomatrixoma in the head and neck region through surgical excision, to raise awareness of differential diagnosis, and to contribute to the literature. Methods: The data of patients diagnosed with pilomatrixoma through surgical excision in the Otorhinolaryngology Clinic of Dokuz Eylül University Hospital between January 2009 and July 2021 were retrospectively analyzed. The demographic data of the patients, presenting complaints, tumor location and pathological size, imaging methods used, surgical procedures performed, and postoperative follow-up characteristics were evaluated. Results: Between January 2009 and July 2021, twelve patients underwent surgery in the clinic and were diagnosed with pilomatrixoma. Seven of these patients were male (58.3%), and 5 were female (41.7%), with a mean age of 23.75 years, and a median age of 15 years. Seven of the twelve patients (58.3%) were under 20. Nine patients presented with a firm, painless mass covered by normal skin in the preauricular region, 2 in the auricle, and 1 in the postauricular region. Conclusion: Pilomatrixoma is a rare condition that should be considered in the differential diagnosis of head and neck masses. The treatment is complete excision of the lesion, as failure to excise it may result in a very low risk of malignant transformation. The importance of complete excision in preventing recurrences should not be overlooked.Cite this article as: Hancı S, İkiz AÖ, Doğan E, et al. A 12-year clinical experience with pilomatrixomas in the head and neck region. Balkan ORL-HNS 2025;2(2):50-53.

Labyrinthine fistulas are a common complication of cholesteatomatous chronic otitis media (COM), with the lateral semicircular canal (LSCC) being the most frequently affected site. This retrospective cohort study aims to evaluate the clinical management of cases with LSSC fistula secondary to cholesteatomatous COM in a tertiary care hospital and analyze the obtained results along with the literature. Between January 2009 and June 2024, patients who developed LSSC fistula due to cholesteatomatous COM and underwent surgical treatment at our center were retrospectively analyzed. The study evaluated patients’ demographic data, presenting symptoms, radiological findings, preoperative and postoperative audiological assessments, surgical approaches applied, and postoperative follow-up processes. A total of 36 patients were included in the study. Of these, 21 (58.3%) were male and 15 (41.7%) were female, with a mean age of 49.2 years. Postoperatively, patients were followed up for a minimum of 4 weeks and a maximum of 1 year. LSCC fistulas were classified based on Durko labyrinthine fistula classification, revealing Type I in 31 cases (86%), Type II in 3 cases (8%), and Type III in 2 cases (6%). Canal wall-down mastoidectomy was performed in all patients, transtemporal in 33 (92%) and inside-out mastoidectomy in 3 patients (8%). In 11 patients (31%), the fistula was covered with a temporalis muscle fascia graft, whereas in 25 patients (69%), a combination of bone dust and temporalis fascia was used for repair. No cases of recurrent cholesteatoma were detected during postoperative follow-up. The bone conduction thresholds were preserved in all patients, highlighting the positive postoperative hearing outcomes and the potential for a successful recovery. LSCC fistula is a common complication in COM with cholesteatoma patients. Early diagnosis and complete, atraumatic removal of the cholesteatoma matrix with closure using temporalis fascia and/or bone dust is a safe and effective treatment approach.