The Journal of Craniofacial Surgery  Volume 30, Number 1, January 2019
scientific literature approaching the field of nerve transfers in
patients with long-term facial paralysis.
Masseteric nerve transfer has been encouraged as one of the
main options for reanimation in short-term facial paralysis. Some of
the advantages provided by the use of this nerve include: a relatively
easy surgical technique, low impact of donor site morbidity caused
by masseter nerve disruption, achievement of a strong commissural
pull, and absence of nerve grafting.2
In the present study, ENG and EMG studies showed a residual
minimal innervation that might have prevented complete degra-
dation of the motor end plate.6 Therefore, potential for facial
reanimation existed. Scientific literature reports an average mus-
cular contraction recovery time of 3 to 5 months after masseter-to-
facial nerve transfer.12 Notwithstanding, in the present study, time
required for contraction recovery was longer, probably, due to the
existent partial muscular atrophy.
The performance of nerve transfers in patients suffering from
long-term denervation in facial paralysis has not been approached
sufficiently in scientific literature, and no recommendations exist
about which patients could benefit from this intervention. As this
report is an isolated study, more studies should be performed to
clear possible indications for facial reanimation with nerve transfers
in this type of patients, when there is minimal residual innervation.
CONCLUSION
In certain patients with long-term facial paralysis with minimal
response in ENG and EMG studies, nerve transfers can achieve
complete recovery of facial movement. Notwithstanding, more
studies are required to support the performance of nerve transfers
in patients with long-term facial paralysis with minimal residual
innervation; and also to find which patients would benefit most
from these procedures.
REFERENCES
1. Melvin TA, Limb CJ. Overview of facial paralysis: current concepts.
Facial Plast Surg 2008;24:155–163
2. Fattah A, Borschel GH, Manktelow RT, et al. Facial palsy and
reconstruction. Plast Reconstr Surg 2012;129:340e–352e
3. Mersa B, Tiangco DA, Terzis JK. Efficacy of the ‘‘baby sitter’’
procedure after prolonged denervation. J Reconstr Microsurg
2000;16:27–35
4. Terzis JK, Olivares FS. Long-term outcomes of free-muscle transfer for
smile restoration in adults. Plast Reconstr Surg 2009;123:877–888
5. Ronald MZ, Eyal G, Gazi H, et al. Facial paralysis. In: Nelligan PC, ed.
Plastic Surgery Vol 3 - Craniofacial, Head and Neck Surgery and
Pediatric Plastic Surgery. 4th ed. New York, NY: Elsevier; 2015:
279–306
6. Gordin E, Thomas SL, Ducic Y, et al. Facial nerve trauma: evaluation
and considerations in management. Craniomaxillofac Trauma Reconstr
2015;8:1–13
7. House JW, Brackmann DE. Facial nerve grading system. Laryngoscope
1983;93:1056–1069
8. Terzis JK, Tzafetta K. Facial reanimation. In: Guyuron B, Eriksson E,
Persing JA, eds. Plastic Surgery Indications and Practice. et al, eds.
Plastic Surgery Indications and Practice. Philadelphia, PA: Saunders;
2009:907–926
9. Hua J, Kumar VP, Tay SS, et al. Microscopic changes at the
neuromuscular junction in free muscle transfer. Clin Orthop Relat
Res 2003;411:325–333
10. Hontanilla B, Marre D. Retrospective study of the functional recovery of
men compared with that of women with long-term facial paralysis. Br J
Oral Maxillofac Surg 2013;51:684–688
11. Forootan SK, Fatemi MJ, Pooli AH, et al. Cross-facial nerve graft: a
report of chronically paralyzed facial muscle neurotization by a nerve
graft. Aesthetic Plast Surg 2008;32:150–152
12. Henstrom DK. Masseteric nerve use in facial reanimation. Curr Opin
Otolaryngol Head Neck Surg 2014;22:284–290
# 2018 Mutaz B. Habal, MD
Copyright © 2018 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Brief Clinical Studies
Comparison of the Clinical
Outcomes of Buccal
Advancement Flap Versus
Platelet-Rich Fibrin Application
for the Immediate Closure
of Acute Oroantral
Communications
Kani Bilginaylar, DDS, PhD
Abstract: The aim of this study was to compare the clinical
outcomes of buccal advancement flap surgery to platelet-rich fibrin
(PRF) application for the closure of acute oroantral communi-
cations (AOACs). In 36 patients, following the extractions of
posterior maxillary teeth, AOACs which were larger than 3 mm
diameter were detected. In group A, PRF clots were used in 21
patients and group B, classic buccal advancement flap was used in
15 patients. Baseline variables such as pain, the analgesic doses are
taken, and swelling was assessed preoperatively. These were also
examined on postoperative days 1, 2, 3, and 7, and patients were
seen again in the 3rd week. In group A, statistically significant
reduction was examined (P < 0.05) in pain and the analgesic doses
are taken (sum of 1st, 2nd, 3rd, and 7th days on days 1 and 2) (PRF).
The swelling was also significantly less in group A (P < 0.05). The
mean duration did not differ between the groups (P > 0.05). In
conclusion, both methods were successful for the immediate closure
of AOACs. However, a lesser amount of pain and no swelling
observed with the use of PRF clots for the immediate closure of
AOACs compared to buccal advancement flap surgery.
Key Words: Acute oroantral communication, buccal flap surgery,
pain, platelet-rich fibrin, swelling
O roantral communication (OAC) is described as a pathologic
communication between the maxillary sinus and the oral
cavity. There are many causes of OAC, such as removal of
maxillary cysts/tumors, trauma, implant surgery, orthognathic
surgeries, pathologic entities, and mainly the extraction of posterior
maxillary teeth, because of the close anatomical relation between the
sinus floor and the root apices of posterior teeth in that region.1–3
If the perforation is up to 3 mm and there is no sinus infection,
acute oroantral communications (AOACs) can close spontaneously
without any surgery, whereas those larger than 3 mm require
surgical intervention.3,4 It is not simple to establish the size of
From the Department of Oral and Maxillofacial Surgery, Near East
University, Boulevard, Nicosia, Turkey.
Received March 7, 2018.
Accepted for publication July 19, 2018.
Address correspondence and reprint requests to Kani Bilginaylar, DDS
PhD, Department of Oral and Maxillofacial Surgery, Near East
University, Near East Boulevard, Nicosia, Mersin 10, Turkey;
E-mail: kani_blgnylr@hotmail.com
The authors report no conflicts of interest.
Copyright # 2018 by Mutaz B. Habal, MD
ISSN: 1049-2275
DOI: 10.1097/SCS.0000000000004958
e45
Brief Clinical Studies The Journal of Craniofacial Surgery  Volume 30, Number 1, January 2019

the OAC. For this reason, it is hard to estimate whether the defect
will heal uneventfully without any surgical procedure. Immediate
approach to an OAC, within 24 to 48 hours, is recommended to
prevent the development of oroantral fistulas (OAFs) and the risk of
chronic sinusitis.4,5 In addition, literature revealed high success
ratio for the immediate closure of AOACs, approaching 95%,
whereas the proportion of success for the secondary closure of
oroantral fistulas has been shown to be as low as 67%.3,6
Various flap designs and techniques have been reported in the
literature to close large OACs. These techniques can be defined as
buccal fad pad, the palatal flap, distant soft tissue flaps (tongue and
temporalis flaps), double layer techniques, suture, dental transplan-
tation, titanium mesh, biodegradable polyurethane foam, and most
frequently the buccal advancement flap.1–9 In addition, recent
researches showed that platelet-rich fibrin (PRF) is also a useful
approach for the management of acute oroantral perforations.10–13
The present study aimed to compare the clinical outcomes (pain,
analgesics, swelling, and duration) of the buccal advancement flap
surgery versus the use of PRF for the closure of AOAC following
extraction of posterior maxillary teeth.

METHODS
The AOACs of larger than 3 mm detected following the extraction
of maxillary molar teeth in 36 patients at the Near East University,
Faculty of Dentistry, Cyprus, between November 2011 and
July 2017. The volunteers had neither systemic diseases nor signs
of sinus disease. Furthermore, patients had no smoking or drinking
habits. Teeth were extracted under the buccal and palatal local
infiltration anesthesia, which contained 0.012 mg/mL epinephrine
HCl and 40 mg/mL articaine HCl (2 mL Ultracaine D-S Forte
Ampul; Sanofi Aventis, Paris, France). Following tooth extraction,
Valsalva’s maneuver test was used for the diagnosis of AOAC
(pressing of nostrils and exhalation of the air from the nose). After
the observation of air leak, to decide whether the size of perforation
was >3 mm, modification of ball burnisher instrument (Fig. 1)
which was 3 mm in diameter was used. For this aim, the tool was
used to define if it could pass into the sinus cavity through the
bottom of the extraction socket. The highest size of the AOAC could
not be specified because of the clinical measurement difficulty.
However, the highest size of the defect was measured about
8  4 mm with the help of periodontal probe (after checking which
roots caused perforation, diameter of roots was measured mesio-
distally and buccopalatinally). Likewise, preoperative panoramic
FIGURE 2. (A) One of the pre-extraction panoramic view from group A
(maxillary left first molar). (B) View of perforation. (C) View of sutured
platelet-rich fibrin clots. (D) View of healthy granulation tissue on the 7th day of
follow-up. (E) View of epithelialized oral mucosa on the 3rd week of monitoring.
radiographs revealed a close relationship between the apices of
tooth and floor of the sinus in all cases before extractions (Figs. 2A-
3A). After completing an informed consent agreement, the patients
randomly separated into 2 groups. In group A (n ¼ 21), PRF clots
were used for the treatment of acute OACs. Blood samples of each
patient were taken directly into 2  10 mL glass-coated plastic tubes
(excluding anticoagulant, Fig. 4A) and immediately centrifuged at
3000 rpm for 10 minutes (Elektro-mag, M415P, Istanbul, Turkey;
Fig. 4B). For each tube, the platelet-poor plasma was separated from
middle part (PRF) that accumulated at the top of the tube (Fig. 4C)
and PRF clot was separated 2 mm below from its’ contact point with
the red corpuscles (Fig. 4D). Two PRF clots were gently placed into
the extraction cavity and sutured to avoid them from escaping to the
sinus and for stabilization (Fig. 2B-C). In group B (n ¼ 15), buccal
advancement flap was used to close acute OACs. The extraction

FIGURE 3. (A) One of the pre-extraction panoramic view from group B

(maxillary left first molar). (B) View of the sutured buccal flap. (C) View of
FIGURE 1. The instrument (3 mm in diameter) which was used to determine extraction region on the 7th day of follow-up. (D) View of epithelialized oral
whether the size of perforation is >3 mm. mucosa on the 3rd week of follow-up.

e46 # 2018 Mutaz B. Habal, MD

Copyright © 2018 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery  Volume 30, Number 1, January 2019 Brief Clinical Studies

TABLE 1. Comparison of VAS Pain Scores (Sum of 1st, 2nd, 3rd, and 7th Days)
(mm)

VAS
Groups (G) n Min–Max Mean  SD t P

PRF (A) 21 8.0–81.50 31.24  15.89


Buccal flap (B) 15 25.0–90.0 59.0  19.53 4.698 0.0001

PRF, platelet-rich fibrin; SD, standard deviation; VAS, visual analog scale.

P < 0.5.

again on the 3rd week to check wound healing. Another doctor

recorded all measurements.
Statistical analyses were performed using independent samples
t-test (t), to compare the mean values of 2 independent groups.
Whenever the data were not normally distributed, Mann-Whitney
test (z) applied. Besides, the Chi-squared test (x2) was used to
compare categorical variables. R statistical software package was
used to perform statistical analysis (ver 2.14.0). Statistical signifi-
cance was defined at P < 0.05.
Ethical approval obtained for the study by the Near East Univer-
sity IRB, Nicosia, Cyprus, and all participants signed an informed
consent agreement. The project number was YDU/41-340.
FIGURE 4. (A) Drawing the blood samples into 2  10 mL glass-coated plastic
tubes. (B) Centrifuge device which was set to 3000 rpm for 10 minutes. (C) The RESULTS
composition of a structured fibrin clot in the middle of the tube, just between
the red corpuscles at the bottom and acellular plasma at the top. (D) The view of In group A (PRF), 11 males and 10 females and in group B (buccal
2 platelet-rich fibrin clots which were ready to use. flap), 9 males and 6 females were treated uneventfully without any
serious complications, such as alveolitis, infection, side effects, or
formation of OAF. Both groups had similar gender distributions
socket was closed by sliding the buccal flap over the socket and (x2 ¼ 0.206, P ¼ 0.650, df ¼ 1). The mean ages between the groups
suturing the flap to the undermined palatal mucosa (Fig. 3B). In all were insignificant among the groups (z ¼ 0.562, P ¼ 0.590)
cases, before any intervention, the sterile physiologic saline solution (P > 0.5).
was used to clean the postextraction socket of the tooth. The 3-0 silk In group A, OAC detected after the extractions of 11 right
sutures were used and removed after 7 days. In group A, healthy maxillary first molar, 7 left maxillary first molar, 1 right maxillary
granulation tissue (Fig. 2D) and in group B, primary closure was second molar, and 2 left maxillary second molar. In group B, OAC
observed on the 7th day of follow-up (Fig. 3C). Additionally, the observed after the 8 right maxillary first molar, 3 left maxillary first
epithelialized oral mucosa was detected in all cases on the 3rd week of molar, 2 right maxillary second molar, and 2 left maxillary second
monitoring (Figs. 2E-3D). Postoperative care was the same in both molar extractions. Statistical analysis revealed that similar number
groups, and all the patients were instructed not to eat hard foods and of sides were operated (x2 ¼ 1.447, P ¼ 0.695, df ¼ 3) (P > 0.05).
not to blow from the nose during for 1 week. Acetaminophen The mean duration of PRF application was 17.31  1.36 minutes
(paracetamol 500 mg, advised to take as required) and mouthwash in the group A, which was not significantly different from the mean
(isotonic saline, 2–3 times daily 24 hours after the intervention) were duration (17.02  1.51 minutes) in the group B (t ¼ 0.598,
prescribed. Antibiotics and decongestants were not used. Pain, the P ¼ 0.554) (P > 0.05).
number of analgesic doses taken, and swelling were evaluated Total VAS pain scores (sum of values on days 1, 2, 3, and 7)
preoperatively and postoperatively on days 1, 2, 3, and 7. were significantly higher (P < 0.5) in the group B (buccal flap)
A visual analog scale (VAS) (0 mm: no pain to 100 mm: severe compared to group A (PRF) (t ¼ 4.698, P ¼ 0.0001) (Table 1).
pain) was used to assess pain and the number of analgesics taken There was also significant difference between the groups on the
were recorded.14 The swelling evaluated by using the modified postoperative day 1 (t ¼ 4.966, P ¼ 0.0001) and 2 (t ¼ 3.491,
method by Gabka and Matsamura.15 Three preoperative measure- P ¼ 0.001), but there was no significant difference (P > 0.5) on
ments taken with soft tape measure between 5 reference points: the days 3 and 7 (z ¼ 2.399, P ¼ 0.058) (Table 2). Statistical
tragus to the outer corner of the nose, tragus to the outer corner of
the mouth, and lateral corner of the eye to the angle of the mandible TABLE 2. Comparison of VAS Scores at 1st, 2nd, 3rd, and 7th Days (mm)
were repeated on the 1st, 2nd, 3rd, and 7th postoperative days. The
sum of the 3 preoperative measurements was taken as the baseline VAS PRF (A) Buccal Flap (B)
for that side. The difference between the maximum postoperative
measurement and the baseline gave the value of facial swelling for Day n Mean  SD n Mean  SD t z P
each patient. The swelling values of each patient recorded as a 
1st 20 24.33  9.30 15 42.33  12.47 4.966 0.0001
percentage by using the following formula: ([Maximum postopera- 
2nd 20 6.31  7.01 15 14.20  6.19 3.491 0.001
tive value – Preoperative value]/Preoperative value)  100 ¼ % of
3rd 20 0.5  1.38 15 2.67  3.07 2.399 0.058
facial swelling. In group A, the operating time was recorded from
7th 20 0.00  0.00 15 0.00  0.00
taking blood samples to the last stitch. However, in group B,
operating time was the period between the beginnings of incision
PRF, platelet-rich fibrin; SD, standard deviation; VAS, visual analog scale.
to the final suture. Patients were examined on each of the 4 
P < 0.5.
postoperative days, at approximately the same time of day and

# 2018 Mutaz B. Habal, MD e47

Copyright © 2018 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Brief Clinical Studies The Journal of Craniofacial Surgery  Volume 30, Number 1, January 2019

TABLE 3. Total Number of Analgesic Doses for Groups (Sum of 1st, 2nd, 3rd, Also, the depth of the sulcus was protected in PRF group, as the
and 7th Days) raising of the flap is not necessary (primary closure). As a result, no
Analgesics
swelling and the lesser amount of pain were observed because
Groups (G) n Min–Max Mean  SD t P capillaries and nerves protected in PRF group which was one of the
leading advantages of this technique. Once getting the knowledge
PRF (A) 21 1.0–8.0 3.67  1.80 about the PRF application and materials, such as centrifuge device

Buccal flap (B) 15 3.0–9.0 5.53  1.67 3.151 0.003 and disposables, it is easily applicable and inexpensive. Never-
theless, the necessity to particular devices/disposables and the idea
PRF, platelet-rich fibrin; SD, standard deviation. of giving blood samples for the treatment may create fear in

P < 0.5. patients, which are the primary limits of this method. Additionally,
the success of this technique directly depends on the speed of blood
collection and transfer to the centrifuge.19 Patients also should not
have any systemic diseases or signs of sinus disease because these
analyses showed that in PRF group less pain was experienced situations may disrupt the behavior and structure of PRF.
compared to buccal flap group. Joseph Choukroun first defined PRF as a natural matrix which
The total number of analgesic doses taken from the 1st to 7th day consists of different types of healing cells. Therefore, it can
was significantly lower (P < 0.5) in PRF group than buccal flap simultaneously support the epithelial coverage, immunity, and
group (t ¼ 3.151, P ¼ 0.003) (Table 3). When the daily analgesic development of angiogenesis. Consequently, it can speed
doses are taken were compared between the groups, on the 1st revascularization and enhance tissue/wound healing. Fibrin
(t ¼ 2.424, P ¼ 0.021) and 2nd (t ¼ 3.300, P ¼ 0.02) days, there was has been shown to act as the natural scaffold guiding angiogenesis
a significant difference. However, there was no significant differ- that contains the creation of new blood vessels inside the wound.
ence (P > 0.5) on the days 3 and 7 (z ¼ 1.398, P ¼ 0.058) (Table 4). Thus, the requirement of an extracellular matrix scaffold
According to these results, the patients who treated with PRF (group which permits the migration, division, and phenotypic change of
A) used significantly fewer analgesics compared to the group B endothelial cells has been demonstrated to cause faster
(buccal flap). angiogenesis.12,19,20
In group A (PRF), There was no swelling in all cases, but in In the literature, there are only a few articles that showed PRF
group B, mean% 0.94  0.26 swelling observed and the swelling application for the treatment of OACs. Agarwal et al indicated an
difference between the groups was statistically significant alternative method for the management of OAFs with use of PRF
(z ¼ 5.501, P ¼ 0.0001) (P < 0.5). clots. Four PRF clots obtained and squeezed to form a membrane: 3
of them rolled together to create cylinder-shaped fibrin plug to
obturate the fistula and the last one was sutured below the buccal
DISCUSSION and palatal flap to seal the oral cavity from the underlying fistula
The primary factor for the treatment of acute OAC is closing the and the fibrin plug.10 Gülşen et al reported that 20 patients with
communication because it is essential to prevent food and saliva acute OACs with perforations more than 5 mm in diameter
contamination that could cause bacterial infection, chronic sinusitis, received treatment with the use of PRF clots. Extraction cavity
and impaired healing. Management of acute OAC could be recom- was filled with 6 PRF clots.11 Bilginaylar reported that 21 acute
mended within 24 to 48 hours, without any intervention large acute OACs were treated with the application of 2 PRF clots which the
OAC (>3 mm) may turn into an OAF which is meant to indicate a perforation was more than 3 mm in diameter.12 Assad et al also
canal lined by epithelium that may be filled by granulation tissue or used PRF for the closure of OACs. According to their technique,
by polyposis of the sinus membrane.3,4,7,12,16 one-third of a PRF clot was cutoff and inserted into the extraction
According to the literature, the most common technique for the socket, and the remaining two-third of the clot was pressed gently
closure of an acute OAC is buccal flap which was first described by with sterile dry gauze forming the membrane. The extraction site
Rehrmann.1,17,18 The present study also showed that buccal flap was covered with the membrane and was sutured to the gingiva.13
technique is still an effective technique for the treatment of acute Although there are some differences between these approaches
OACs. However, there are some disadvantages when compared to such as amount/number of PRF clots or material differences (the
PRF application. The results of present study displayed that the use use of PRF either a clot or membrane or both together), briefly, all
of PRF in acute OACs statistically decreased the pain and the use of approaches revealed that PRF could be used as a useful treatment
analgesics after the interventions when compared to buccal material of OACs.
advancement flap procedure. In addition to all, clinically, there are also some uncountable
advantageous for PRF application for the immediate closure of
AOACs. Although there is no statistical difference in mean duration
(P > 0.5) between the techniques, during the centrifugation process
TABLE 4. Comparison of Number of Analgesics Taken at 1st, 2nd, 3rd, and 7th after taking the blood samples, the surgeon has free 10 minutes to
Days
prepare and talk with the patient about the process. However, in
Analgesics PRF (A) Buccal Flap (B) buccal advancement flap surgery, surgeon raises a flap, slides, and
sutures it to the palatal mucosa during that period.
Day n Mean  SD n Mean  SD T z P

1st 21 2.67  0.91 15 3.47  1.07 2.424 0.021

CONCLUSION
2nd 21 0.86  0.85 15 1.67  0.49 3.300 0.02 The present study showed that buccal advancement flap and PRF
3rd 21 0.14  0.36 15 0.4  0.63 1.398 0.058 techniques are both useful for the closure of acute OACs. Although
7th 21 0.00  0.00 15 0.00  0.00 both methods were successful for the immediate closure of acute
OAC, PRF application decreased pain and swelling compared to
PRF, platelet-rich fibrin; SD, standard deviation.
 buccal advancement flap surgery. Moreover, PRF procedure was
P < 0.5.
less traumatic (bleeding was also lesser because of no need for

e48 # 2018 Mutaz B. Habal, MD

Copyright © 2018 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery  Volume 30, Number 1, January 2019
raising a flap so that no necessity to aspiration), readily applicable
and less stressfully when compared to buccal advancement
flap surgery.
ACKNOWLEDGMENTS
The authors thank the associate professor Dr Ilker Etikan (Near East
University, Faculty of Medicine, Department of Biostatistics) for the
statistical analysis of this study and assistant professor Dr Aysa Ayali
(Near East University, Faculty of Dentistry Department of Oral and
Maxillofacial Surgery) for the measurements of patients.
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2. Abuabara A, Cortez AL, Passeri LA, et al. Evaluation of different
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# 2018 Mutaz B. Habal, MD
Copyright © 2018 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Brief Clinical Studies
Tympanogram Findings in
Hemodialysis Patients
Ates Mehmet Aksit, MD, Emel Pektas, MD,y
Mahmut Tayyar Kalcioglu, MD,z Abdullah Ozkok, MD,§
Ozan Tuysuz, MD,z and Muhammet Tekin, MDz
Background: The aim of this study is to investigate whether changes
in cerebrospinal fluid (CSF) pressure during the hemodialysis (HD)
treatment are reflected on tympanometric measurements.
Methods: The study was performed on 24 HD patients. The static
compliance and absorbance values of the patients before and after
HD were measured using a wideband tympanometry. The tympa-
nogram tests were performed immediately before and at the end of
the HD session.
Results: The static compliance values of the patients after HD were
significantly lower than those before HD. This decrease signifi-
cantly correlated with the adequacy of dialysis determined by urea
reduction rate and Kt/V. The absorbance values showed a decrease
in the band 343 and 727 Hz, but no significant difference was found
in other frequencies. The static admittance and absorbance values
were influenced by the HD process.
Discussion: This influence might be due to the increase in CSF pressure
as a result of the removal of urea from blood during HD session.
Key Words: Absorbance, compliance, hemodialysis,
tympanometry
earing loss is common in chronic kidney patients.1 The effect
H of hemodialysis (HD) on hearing loss in chronic kidney
patients has been the subject of many researches. While no sig-
nificant hearing loss was found in pure threshold tests performed
immediately before and after HD,2– 5 Gatland et al determined
hearing loss at low frequency in 38% of patients during HD
session.6 In general, it has been accepted that HD does not cause
hearing loss. However, studies cannot explain why hearing loss is
commonly seen in HD patients. Therefore, similar studies were
repeated using different auditory tests such as auditory brainstem
response and otoacoustic emission. However, in these studies, the
From the Department of Audiology, Near East University, Nicosia, North
Cyprus; yDepartment of Audiology; zDepartment of Otorhinolaryngol-
ogy - Head and Neck Surgery, Istanbul Medeniyet University, Goztepe
Training and Research Hospital; and §Department of Nephrology,
University of Health Sciences, Umraniye Training and Research Hospi-
tal, Istanbul, Turkey.
Received June 6, 2018.
Accepted for publication July 20, 2018.
Address correspondence and reprint requests to Mahmut Tayyar Kalcioglu,
MD, Department of Otorhinolaryngology, Istanbul Medeniyet Univer-
sity, Department of Otorhinolaryngology, Goztepe Training and
Research Hospital, Dr. Erkin Street, 34730, Goztepe, Kadikoy, Istanbul,
Turkey; E-mail: mtkalcioglu@hotmail.com
This work was supported by unit of Scientific Investigation Projects of
Istanbul Medeniyet University (project no: T-BAG-2016-811).
The study presented in the 6th National Otology & Neurotology Congress,
April 28 to May 1, 2018, Antalya, Turkey and 11th Balkan Congress of
Otorhinolaryngology, June 1 to 3, 2018, Varna, Bulgaria (International).
The authors report no conflicts of interest.
Copyright # 2018 by Mutaz B. Habal, MD
ISSN: 1049-2275
DOI: 10.1097/SCS.0000000000004960
e49