Otology Updates

Preface
Contents
Part I: Anatomy, Embryology and Physiology of Auditory System
	1: Outer–Middle–Inner Ear and Central Hearing System Anatomy
		1.1	 Introduction
		1.2	 The External Ear
			1.2.1	 The Auricle
			1.2.2	 Innervation of the External Auditory Canal
			1.2.3	 The Eternal Auditory Canal/External Acoustic Meatus
		1.3	 The Middle Ear (Tympanic Cavity)
			1.3.1	 The Tympanic Membrane
			1.3.2	 The Middle Ear or the Tympanic Cavity
			1.3.3	 Ossicles
			1.3.4	 The Eustachian Tube
			1.3.5	 Muscles
			1.3.6	 Innervation
			1.3.7	 Vascular Supply
		1.4	 The Inner Ear (Labyrinthine Cavity)
			1.4.1	 The Vestibule
			1.4.2	 Semicircular Canals
			1.4.3	 The Saccule and the Utricle
			1.4.4	 The Cochlea
			1.4.5	 Innervation
			1.4.6	 Cochlea Nerve Anatomy
			1.4.7	 Vestibular Nerves
			1.4.8	 The Vestibulocochlear Nerve
		1.5	 The Central Hearing System
			1.5.1	 First-Order Neurons of the Auditory System
			1.5.2	 Hearing Neurons of Different Orders
			1.5.3	 Auditory Input
			1.5.4	 The Auditory Nerve’s Descending Routes
		References
	2: Outer–Middle–Inner Ear Embryology
		2.1	 Introduction
		2.2	 Embryology
		2.3	 Embryologic Development of the Head and Neck and the Ear
			2.3.1	 First Week
			2.3.2	 Second Week
			2.3.3	 Third Week
			2.3.4	 Fourth Week
			2.3.5	 Sixth Week
		2.4	 Embryology of the Cochlear Nerve and Central Auditory Pathways
		References
	3: Physiology of the Peripheral and Central Hearing System
		3.1	 Introduction
		3.2	 The Peripheral Auditory System: A Perspective
		3.3	 The Outer Ear
			3.3.1	 Anatomy
			3.3.2	 Resonance and Amplification
			3.3.3	 Localization
		3.4	 The Middle Ear
			3.4.1	 Structural Elements and Their Functions
			3.4.2	 The Tympanic Membrane and the Ossicular Chain
			3.4.3	 Middle Ear Muscles
			3.4.4	 The Eustachian Tube
			3.4.5	 Impedance Matching
		3.5	 The Inner Ear
			3.5.1	 General Organization of the Cochlea
				3.5.1.1	 Lateral Wall
				3.5.1.2	 Reissner’s Membrane
				3.5.1.3	 The Basilar Membrane
			3.5.2	 Organ of Corti
				3.5.2.1	 Hair Cells
					Inner Hair Cells
					Outer Hair Cells
			3.5.3	 The Tectorial Membrane
			3.5.4	 The Osseous Spiral Lamina
			3.5.5	 Cochlear Mechanics
				3.5.5.1	 Passive Mechanics
				3.5.5.2	 Active Mechanics
			3.5.6	 Frequency Analysis of the Cochlea
		3.6	 The Central Auditory System: A Perspective
			3.6.1	 Auditory Nerve Fibers
			3.6.2	 The Subcortical Auditory Nuclei
				3.6.2.1	 The Cochlear Nucleus
				3.6.2.2	 The Superior Olivary Complex
				3.6.2.3	 The Lateral Lemniscus
				3.6.2.4	 Inferior Colliculus
				3.6.2.5	 The Medial Geniculate Body
			3.6.3	 The Auditory Cortex
		3.7	 Conclusion
		References
	4: Eustachian Tube: An Overview
		4.1	 Introduction
		4.2	 Eustachian Tube Anatomy
		4.3	 Eustachian Tube Function and Physiology
			4.3.1	 Control of Airflow or Pressure
		4.4	 Eustachian Tube Dysfunction
		4.5	 Epidemiology of Eustachian Tube Dysfunction
		4.6	 Etiology of Eustachian Tube Dysfunction
		4.7	 Evaluation of the Eustachian Tube
		4.8	 How to Approach Eustachian Tube Malfunction
		References
	5: Temporal Bone Radiology
		5.1	 Imaging Modalities and Techniques for Temporal Bone Evaluation
			5.1.1	 Introduction
			5.1.2	 Computed Tomography (CT)
			5.1.3	 Temporal Bone CT Angiography
			5.1.4	 Magnetic Resonance Imaging (MRI)
			5.1.5	 Diffusion-Weighted Imaging (DWI)
			5.1.6	 Conclusion
		5.2	 Radiologic Anatomy and Fractures of the Temporal Bone
			5.2.1	 Introduction
			5.2.2	 Parts of the Temporal Bone
				5.2.2.1	 The External Auditory Canal (EAC)
				5.2.2.2	 The Middle Ear (ME) and the Ossicular Chain
				5.2.2.3	 The Cochlea and the Vestibular System
				5.2.2.4	 The Internal Auditory Canal and Cranial Nerves
			5.2.3	 Temporal Bone Fractures
			5.2.4	 Conclusion
		5.3	 Radiologic Findings of Infectious and Inflammatory Pathologies of the Temporal Bone
			5.3.1	 Introduction
			5.3.2	 Necrotizing Otitis Externa
			5.3.3	 Middle Ear
				5.3.3.1	 Acute Otitis Media and Mastoiditis
				5.3.3.2	 Chronic Otitis Media
				5.3.3.3	 Cholesteatomas
				5.3.3.4	 Cholesterol Granulomas
			5.3.4	 Inner Ear
				5.3.4.1	 Labyrinthitis
				5.3.4.2	 Petrous Apicitis
				5.3.4.3	 Facial and Vestibular Nerves
			5.3.5	 Conclusion
		5.4	 Temporal Bone Tumors: Radiologic Evaluation and Diagnosis
			5.4.1	 Introduction
			5.4.2	 Classification of Temporal Bone Tumors
				5.4.2.1	 Cerebellopontine Angle Tumors
					Vestibular Schwannomas
					Arachnoid Cysts
					Meningiomas
					Epidermoids
				5.4.2.2	 The Middle Ear
				5.4.2.3	 External Ear and Mastoid
				5.4.2.4	 Petrous Bone
				5.4.2.5	 Metastatic Tumors
			5.4.3	 Conclusion
		5.5	 Radiologic Assessment of Congenital Malformations of the Temporal Bone
			5.5.1	 Introduction
			5.5.2	 External Auditory Canal Aplasia
			5.5.3	 Tympanic Cavity and Ossicular Chain
			5.5.4	 Inner Ear Malformations
				5.5.4.1	 Complete Labyrinthine Aplasia/Michel Anomaly
				5.5.4.2	 Rudimentary Otocysts
				5.5.4.3	 Common Cavity Malformation
				5.5.4.4	 Incomplete Partition (IP) Type I
				5.5.4.5	 Incomplete Partition Type II/Mondini Malformation
				5.5.4.6	 Incomplete Partition Type III
				5.5.4.7	 Cochlear Anomalies
				5.5.4.8	 Semicircular Canal Anomalies
			5.5.5	 Radiologic Evaluation and Therapeutic Implications
			5.5.6	 Conclusion
		5.6	 Imaging of Otospongiosis/Otosclerosis and Pathologic Third Window
			5.6.1	 Introduction
			5.6.2	 Otospongiosis/Otosclerosis
			5.6.3	 Third Window Lesions
			5.6.4	 Conclusion
		References
Part II: Hearing and Management of Hearing Loss
	6: Sound and Acoustics: An Overview
		6.1	 Introduction
		6.2	 Hearing and Acoustic Noise
		6.3	 Acoustic Properties of Sound
			6.3.1	 What Is Sound?
			6.3.2	 Sound Intensity
		6.4	 Psychoacoustics
			6.4.1	 Signal Detection Theory
			6.4.2	 Level of Distress from Various Pitches
			6.4.3	 Spectra and Volume
			6.4.4	 Time and Volume
			6.4.5	 Determinants of Ambient Noise Level
		References
	7: Acoustics, Psychoacoustics, and Properties of Sound
		7.1	 Introduction
			7.1.1	 What Is Sound?
			7.1.2	 What Is a Wave?
			7.1.3	 What Is the Sound Wave We Hear?
		7.2	 Fundamental Acoustic Concepts
			7.2.1	 Speed of Sound
			7.2.2	 Amplitude of Sound Waves
			7.2.3	 Period
			7.2.4	 Frequency
			7.2.5	 Wavelength
			7.2.6	 Power and Intensity
			7.2.7	 Levels and Decibels
		7.3	 Psychoacoustics
			7.3.1	 Loudness
				7.3.1.1	 Critical Bands and Loudness
				7.3.1.2	 Measurement: Phons and Sones
			7.3.2	 Auditory Masking
				7.3.2.1	 Simultaneous Masking
				7.3.2.2	 Temporal Masking
		7.4	 Fundamentals of Binaural Hearing
			7.4.1	 Temporal Aspects: Envelope and Fine Structure of Sound
			7.4.2	 Spatial Hearing
		References
	8: Behavioral and Electrophysiological Tests in Audiology
		8.1	 Introduction
		8.2	 Case History
		8.3	 The Audiology Test Room
		8.4	 Behavioral Evaluation of Hearing
			8.4.1	 Pure-Tone Audiometry
				8.4.1.1	 Masking
			8.4.2	 Speech Audiometry
			8.4.3	 Pediatric Assessment
		8.5	 Objective Evaluation of Hearing
			8.5.1	 Acoustic Immittance Audiometry
				8.5.1.1	 Tympanometry
					Tympanogram Interpretation
				8.5.1.2	 Multifrequency Tympanometry
				8.5.1.3	 Wideband Tympanometry
				8.5.1.4	 Acoustic Reflex Test
				8.5.1.5	 The Reflex Decay Test
				8.5.1.6	 Eustachian Tube Evaluation
			8.5.2	 Otoacoustic Emissions
				8.5.2.1	 Classification of Otoacoustic Emissions
				8.5.2.2	 Performing Otoacoustic Emission Tests
				8.5.2.3	 Analysis and Interpretation of Otoacoustic Emissions
			8.5.3	 Auditory Evoked Potentials
				8.5.3.1	 Auditory Evoked Response Measurement Principles and Techniques
				8.5.3.2	 Auditory Evoked Brainstem Response
					Stimulus Types
					Stimulus Polarity
					Stimulus Presentation Rate
					Stimulus Intensity
					Analysis Time (Recording Epoch)
					Filters
					Artifact Rejection Level
					Number of Sweeps
					Electrodes
					Neural Generators of ABRs
					Auditory Brainstem Response Analysis and Interpretation
					Clinical Use of ABRs for Children
				8.5.3.3	 Auditory Steady-State Responses
					Effect of the Stimulus Rate
				8.5.3.4	 Electrocochleography
					Electrocochleography Analysis
				8.5.3.5	 Cortical Auditory Evoked Potentials
				8.5.3.6	 Event-Related Auditory Potentials
					P300
					Mismatch Negativity
					Acoustic Change Complex
		8.6	 Conclusion
		References
	9: Basic Definition, Classification, and Characteristics of Hearing Loss
		9.1	 Introduction
		9.2	 Definition and Classification of Hearing Loss
			9.2.1	 Degree of Hearing Loss
			9.2.2	 Types of Hearing Loss
			9.2.3	 Conductive Hearing Loss
			9.2.4	 Sensorineural Hearing Loss
				9.2.4.1	 Internal Acoustic Canal Tumors
				9.2.4.2	 Auditory Neuropathy Spectrum Disorder
				9.2.4.3	 Third Window Syndrome
				9.2.4.4	 Dead Region
			9.2.5	 Mixed Hearing Loss
		9.3	 Hearing Loss Configuration
			9.3.1	 Pattern of Audiogram
			9.3.2	 Progressive or Sudden Onset of Hearing Loss
			9.3.3	 Unilateral or Bilateral Hearing Loss
			9.3.4	 Symmetric or Asymmetric Hearing Loss
			9.3.5	 Fluctuating or Stable Hearing Loss
		9.4	 Diagnostic Tests
			9.4.1	 Pure Tone Threshold Testing
			9.4.2	 Speech Recognition Tests
			9.4.3	 Tympanometric Tests
			9.4.4	 Stapedial Reflex
			9.4.5	 Otoacoustic Emission Test
			9.4.6	 Auditory Brainstem Responses
		9.5	 Audiological Test Battery for Pathologies
		9.6	 Reporting Audiological Findings
		9.7	 Conclusion
		References
	10: Otologic History Taking and Basic Examination Techniques
		10.1	 Introduction
		10.2	 Purposes of Otologic Examination
			10.2.1	 Anamnesis
			10.2.2	 Hearing Loss
			10.2.3	 Ear Pain (Otalgia)
			10.2.4	 Ear Discharge (Otorrhea)
			10.2.5	 Itchy Ear
			10.2.6	 Dizziness and Vertigo
			10.2.7	 Ringing in Ears (Tinnitus)
			10.2.8	 Physical Examination
				10.2.8.1	 Inspection
				10.2.8.2	 Palpation
				10.2.8.3	 Otoscopy
			10.2.9	 Examination Technique with an Otoscope
			10.2.10	 Examination with an Otomicroscope
			10.2.11	 Examination with a Video Endoscope
			10.2.12	 Hearing Examination
			10.2.13	 Hearing Assessment
				10.2.13.1	 Whisper Test
				10.2.13.2	 Tuning Fork Tests
					Rinne Test
					Weber Test
					Schwabach Test
					Gelle Test
		10.3	 Conclusion
		References
	11: Selection and Application Principles of Hearing Aids in Pediatric and Adult Population
		11.1	 Introduction
		11.2	 Basic Components of the Hearing Aids
			11.2.1	 Microphone
			11.2.2	 Amplifier
			11.2.3	 Receiver
			11.2.4	 Batteries
			11.2.5	 Earmolds/Domes
		11.3	 The Working Principles of the Hearing Aids: Digital Signal Processing and Compression System
		11.4	 Hearing Aid Types
		11.5	 Most Popular Technologies Used in Hearing Aids
			11.5.1	 Directional Microphone Technologies
			11.5.2	 Digital Noise Reduction
			11.5.3	 Frequency Lowering
			11.5.4	 Feedback Canceller
			11.5.5	 Bluetooth
		11.6	 Other Hearing Aid Technologies
		11.7	 Pediatric Hearing Aid Application
			11.7.1	 Negative Effects of Hearing Loss in Pediatric Populations
			11.7.2	 Learning Process and Participation in Life
			11.7.3	 Hearing Aid Fitting Process in the Pediatric Population
				11.7.3.1	 Welcoming the Family for Hearing Aid Application
				11.7.3.2	 Anamnesis and Audiological Examination of the Baby
				11.7.3.3	 Deciding on the Amplification Method
				11.7.3.4	 Informing the Family About Hearing Loss and Hearing Aid Application Process
				11.7.3.5	 Taking the Ear Impressions for Earmolds
				11.7.3.6	 The Hearing Aid Fitting Software and Connection to Hearing Aids
				11.7.3.7	 Hearing Aid Fitting
					Prescription Formula Preference
					Verification of Hearing Aids: Objective and Subjective Tools
						Objective Verification Tools
						Subjective Verification Tools
					Fine-Tuning
				11.7.3.8	 Hearing Aid Accessories and Assistive Listening Technologies
				11.7.3.9	 Informing Parents About the Use of Hearing Aids and How to Approach a Hearing-Impaired Baby
				11.7.3.10	 The Importance of Auditory-Verbal Therapy
			11.7.4	 Conclusion to Pediatric Hearing Aid Application
		11.8	 Adult Hearing Aid Application
			11.8.1	 Assessment of Hearing Aid Candidate
				11.8.1.1	 Medical Evaluation
				11.8.1.2	 Audiological Evaluation
				11.8.1.3	 Physical Evaluation
				11.8.1.4	 Psychological Evaluation
			11.8.2	 Hearing Aid Application Process
				11.8.2.1	 Anamnesis
				11.8.2.2	 Informing Candidates and Their Companions About Hearing Loss and Hearing Aids
				11.8.2.3	 Determining the Appropriate Hearing Aid Model and Application Style
				11.8.2.4	 Connecting the Hearing Aid to the Fitting Software
				11.8.2.5	 Determining the “Safe” Hearing Aid Gain Range: Acoustic Feedback Control
				11.8.2.6	 Hearing Aid Fitting
					Selection of Prescription Formula
					Objective Verification of Calculated Auditory Gain
					Fine-Tuning
					Subjective Verification of Fine-Tuned Auditory Gain
				11.8.2.7	 Accessories and Assistive Technologies
		11.9	 Conclusion
		11.10	 Case Studies
			11.10.1	 Case 1
			11.10.2	 Case 2
			11.10.3	 Case 3
			11.10.4	 Case 4
		References
Part III: Outer Ear Pathologies and Management
	12: Auricula Anomalies and Auricula Atresia
		12.1	 Introduction
		12.2	 Embryology of the Ear
		12.3	 Congenital Abnormalities of the Ear
			12.3.1	 Pathophysiology
			12.3.2	 Management
			12.3.3	 Etiology
			12.3.4	 Epidemiology
			12.3.5	 Assessing
			12.3.6	 Treatment
		References
	13: Otoplasty
		13.1	 Introduction
		13.2	 General Information
			13.2.1	 Auricular Anthropometry
		13.3	 History
		13.4	 Anatomical Basis of Prominent Ears
		13.5	 Objectives in Correcting Prominent Ears
		13.6	 Preoperative Evaluation of Prominent Ear Patients
		13.7	 Timing of the Repair
		13.8	 Treatment Methods for Prominent Ears
			13.8.1	 Conservative Treatment
			13.8.2	 Surgical Treatment
		13.9	 Preparation and Incision for Surgery
		13.10	 Closure, Dressing, and Postoperative Care
		13.11	 Patient Follow-Up
		13.12	 Case Examples
		13.13	 Complications
			13.13.1	 Early Complications
			13.13.2	 Late Complications
			13.13.3	 Specific Complications Related to Technique
				13.13.3.1	 Telephone Ear Deformity
				13.13.3.2	 Reverse Telephone Ear Deformity
				13.13.3.3	 Overcorrection and Hidden Helix Deformity
				13.13.3.4	 Antihelical Folding and Crinkling
				13.13.3.5	 Antihelical Malposition
				13.13.3.6	 Tragal Prominence
				13.13.3.7	 Auricular Lines
		13.14	 Revision Otoplasty
		References
	14: External Ear Tract Diseases
		14.1	 Introduction
		14.2	 Immunologic and Inflammatory Disorders
			14.2.1	 Atopic Dermatitis
			14.2.2	 Allergic Contact Dermatitis
			14.2.3	 Photoallergic Dermatitis
			14.2.4	 Psoriasis
			14.2.5	 Relapsing Polychondritis
			14.2.6	 Gout
		14.3	 Traumatic Disorders
			14.3.1	 Irritant Contact Dermatitis
			14.3.2	 Phototoxic Dermatitis
			14.3.3	 Phototrauma
		14.4	 Infectious Diseases
			14.4.1	 Otitis Externa
				14.4.1.1	 Background
				14.4.1.2	 Anatomy
				14.4.1.3	 Classification
				14.4.1.4	 Signs and Symptoms
				14.4.1.5	 Diagnosis
				14.4.1.6	 Management
		References
	15: Auricula Tumors
		15.1	 Introduction
		15.2	 Benign Tumors
			15.2.1	 Chondrodermatitis Nodularis Chronica Helicis
			15.2.2	 Cystic Chondromalacia
			15.2.3	 Ceruminous Gland Adenoma
		15.3	 Malign Tumors
			15.3.1	 Basal Cell Carcinoma (BCC)
			15.3.2	 Squamous Cell Carcinoma
			15.3.3	 Ceruminous Gland Adenocarcinoma
		15.4	 Conclusion
		References
Part IV: Middle Ear Pathologies and Management
	16: Acute Suppurative Otitis Media
		16.1	 Introduction
		16.2	 Pathophysiology
		16.3	 Etiology
			16.3.1	 Host Factors
				16.3.1.1	 Immune System
				16.3.1.2	 Hereditary Susceptibility
				16.3.1.3	 Mucins
				16.3.1.4	 Anatomic Abnormalities
				16.3.1.5	 Physiologic Dysfunction
			16.3.2	 Infectious Factors
				16.3.2.1	 Bacterial Pathogens
				16.3.2.2	 Viral Pathogens
				16.3.2.3	 Factors Related to Allergies
			16.3.3	 Environmental Factors
				16.3.3.1	 Infant Feeding Methods
				16.3.3.2	 Involuntary Exposure to Smoke
				16.3.3.3	 Attendance at a Group Daycare
		16.4	 Classification
		16.5	 Signs and Symptoms
		16.6	 Diagnosis
		16.7	 Treatment
			16.7.1	 Antibiotic Therapy Versus Observation
			16.7.2	 Initial Antibiotic Therapy
			16.7.3	 Supplemental Programs
		References
	17: Otitis Media with Effusion
		17.1	 Introduction
		17.2	 Definition
		17.3	 Epidemiology and Risk Factors
		17.4	 Pathophysiology
		17.5	 Diagnosis
			17.5.1	 Clinical Evaluation
			17.5.2	 Audiological Workup and Hearing Evaluation
		17.6	 Treatment
			17.6.1	 Medical Treatment
			17.6.2	 Surgical Treatment
		17.7	 Conclusion
		References
	18: Chronic Suppurative Otitis Media
		18.1	 Introduction
		18.2	 Epidemiology
		18.3	 Pathophysiology
		18.4	 Microbiology
		18.5	 Histopathology
		18.6	 Clinical Manifestations
			18.6.1	 Tubotympanic Type
			18.6.2	 Atticoantral Type
		18.7	 Diagnosis
			18.7.1	 Anamnesis
			18.7.2	 Otoscopic Examination
			18.7.3	 Audiological Evaluation
			18.7.4	 Imaging
		18.8	 Treatment
			18.8.1	 Medical Treatment
			18.8.2	 Surgical Treatment
		18.9	 Complications
		18.10	 Future Directions
		18.11	 Conclusion
		References
	19: Cholesteatoma
		19.1	 Introduction
		19.2	 Definition
		19.3	 Epidemiology
		19.4	 Histopathology
		19.5	 Biology of Cholesteatoma
		19.6	 Etiopathogenesis and Classification
		19.7	 Cholesteatoma Types
			19.7.1	 Congenital Cholesteatoma
			19.7.2	 Acquired Cholesteatoma
				19.7.2.1	 Epithelial Metaplasia of the Middle Ear Mucosa
				19.7.2.2	 Epithelial Migration Theory
				19.7.2.3	 Basal Cell Hyperplasia Theory
				19.7.2.4	 Epithelial Invagination that Develops in Retraction Pockets
					Tos Staging
					Sade Staging
				19.7.2.5	 Cholesteatoma Development from a Retraction Pocket
			19.7.3	 Unclassified Cholesteatomas
			19.7.4	 Petrous Bone Cholesteatomas
		19.8	 Practical Classification
			19.8.1	 Attic Cholesteatomas
			19.8.2	 Sinus Cholesteatomas
			19.8.3	 Pars Tensa Cholesteatomas
		19.9	 Clinical Presentations
			19.9.1	 Cholesteatoma Microbiology
			19.9.2	 Dizziness in Cholesteatomas
			19.9.3	 Facial Paralysis in Cholesteatomas
			19.9.4	 Complications in Cholesteatomas
		19.10	 Diagnosis
			19.10.1	 Otoscopic and Endoscopic Examination
			19.10.2	 Computed Tomography
			19.10.3	 Magnetic Resonance Imaging
			19.10.4	 Audiometric Evaluation
		19.11	 Treatment of Cholesteatomas
			19.11.1	 Closed Techniques
			19.11.2	 Open Techniques
		19.12	 Conclusion
		References
	20: Retraction Pockets and Adhesive Otitis Media
		20.1	 Introduction
		20.2	 Physiology
			20.2.1	 Role of the Mucosa
			20.2.2	 The Role of the Eustachian Tube
			20.2.3	 Role of Mastoid Air Cells
			20.2.4	 Tympanic Isthmus
		20.3	 Retraction Pockets of the Tympanic Membrane
		20.4	 Pathophysiology
		20.5	 Clinical Picture
		20.6	 Management
			20.6.1	 Surgical Management
				20.6.1.1	 Myringotomy with Tubes
				20.6.1.2	 Tympanoplasty
				20.6.1.3	 Mastoid Surgery
		20.7	 Adhesive Otitis Media
			20.7.1	 Pathogenesis
			20.7.2	 Clinical Findings
			20.7.3	 Imaging
			20.7.4	 Treatment
		20.8	 Conclusion
		References
	21: Complications of Otitis Media
		21.1	 Introduction
		21.2	 Intratemporal Complications
			21.2.1	 Acute Mastoiditis
			21.2.2	 Facial Nerve Paralysis
			21.2.3	 Labyrinthitis
			21.2.4	 Labyrinthine Fistula
			21.2.5	 Petrositis
		21.3	 Intracranial Complications
			21.3.1	 Meningitis
			21.3.2	 Lateral Sinus Thrombosis
			21.3.3	 Brain Abscess
			21.3.4	 Otitic Hydrocephalus
			21.3.5	 Epidural Abscess
			21.3.6	 Subdural Empyema
		21.4	 Conclusion
		References
	22: Basic Otological Surgical Techniques
		22.1	 Introduction
		22.2	 Tympanoplasty, Ossiculoplasty, and Myringoplasty
			22.2.1	 Transcanal, Endaural, and Retroauricular Approaches
			22.2.2	 Canalplasty and Meatoplasty
			22.2.3	 Graft Selection and Grafting Technique
		22.3	 Atticotomy
		22.4	 Mastoidectomy
			22.4.1	 Simple (Cortical) Mastoidectomy
			22.4.2	 Canal Wall-Up Mastoidectomy
			22.4.3	 Canal Wall-Down Mastoidectomy
			22.4.4	 Retrograde Mastoidectomy
			22.4.5	 Modified Radical Mastoidectomy
			22.4.6	 Radical Mastoidectomy
			22.4.7	 Mastoid Obliteration
		22.5	 Petrosectomy
		22.6	 Conclusion
		References
	23: Tympanoplasty
		23.1	 Introduction
		23.2	 Etiology of TM Perforations
			23.2.1	 Chronic Otitis Media
			23.2.2	 Traumatic Perforations
		23.3	 History of Tympanoplasty
		23.4	 Anatomy and Physiology
		23.5	 Tympanoplasty Types
		23.6	 Perforation Size and Location
		23.7	 Graft Materials
		23.8	 Graft Techniques
			23.8.1	 The Perichondrium/Cartilage Island Graft
			23.8.2	 The Palisade Graft
			23.8.3	 The Temporalis Fascia Graft
			23.8.4	 Cubism Graft as a Novel Graft Technique
		23.9	 Surgical Approaches
			23.9.1	 Microscopic Approach
			23.9.2	 Endoscopic Approach
		23.10	 Incisions in Tympanoplasty
			23.10.1	 Transmeatal Incisions
				23.10.1.1	 The Rosen Incision
				23.10.1.2	 Incisions Used for Onlay Technique
				23.10.1.3	 Anterior Tympanomeatal Flap
			23.10.2	 Endaural Incision
			23.10.3	 Postauricular Incision
		23.11	 Pediatric Tympanoplasty
		23.12	 Prognostic Factors
		23.13	 Contraindications for Tympanoplasty
		23.14	 Conclusion
		References
	24: Ossiculoplasty
		24.1	 Introduction
		24.2	 History of Ossiculoplasty
		24.3	 Anatomy and Physiology
		24.4	 Indications/Contraindications
		24.5	 Reconstruction Materials
		24.6	 Evaluation of the Patients
		24.7	 Surgical Preparation
		24.8	 Surgical Technique
		24.9	 Ossiculoplasty Results
		24.10	 Complications
		24.11	 Postoperative Care
		24.12	 Follow-Up
		24.13	 Conclusion
		References
	25: Tympanomastoidectomy
		25.1	 Introduction
		25.2	 Surgical Anatomy
		25.3	 Definitions and Classification
		25.4	 Indications
		25.5	 Technique
			25.5.1	 Patient’s Preparation
			25.5.2	 Incision and Soft Tissue Flap
			25.5.3	 Simple Mastoidectomy
			25.5.4	 Posterior Tympanostomy or Facial Recess Approach
			25.5.5	 Epitympanectomy
			25.5.6	 Endolymphatic Sac Procedures
			25.5.7	 Tympanomastoidectomy with Removal of External Canal Wall
			25.5.8	 Atticotomy-Atticoantrotomy
			25.5.9	 Mastoidectomy with Whole Canal Removed
			25.5.10	 Retrograde (Inside-Out) Mastoidectomy
			25.5.11	 Radical Mastoidectomy
		25.6	 General Considerations
		25.7	 Prevention and Management of Complications of Tympanomastoidectomy
		25.8	 Conclusion
		References
	26: Otosclerosis
		26.1	 Introduction
		26.2	 Etiology
			26.2.1	 Genetic Factors
			26.2.2	 Viral Etiology
			26.2.3	 Autoimmunity and Inflammation
			26.2.4	 Connective Tissue Pathologies
			26.2.5	 Hormonal and Metabolic Factors
		26.3	 Clinical Features
		26.4	 Audiological Features
		26.5	 Radiological Features
		26.6	 Treatment
		26.7	 Conclusion
		References
	27: Tympanosclerosis
		27.1	 Introduction
		27.2	 Epidemiology
		27.3	 Etiopathogenesis
			27.3.1	 Inflammation
			27.3.2	 Tissue Trauma
			27.3.3	 Autoimmune and Allergic Factors
			27.3.4	 Free Oxygen Radicals
		27.4	 Histopathology
		27.5	 Classification
			27.5.1	 Tympanic Membrane Tympanosclerosis
			27.5.2	 Middle Ear Tympanosclerosis
				27.5.2.1	 Closed Type
				27.5.2.2	 Open Type
		27.6	 Clinical Findings and Diagnosis
		27.7	 Treatment
			27.7.1	 Preventive Treatment
			27.7.2	 Medical Treatment
			27.7.3	 Surgical Treatment
				27.7.3.1	 Tympanic Membrane Surgery
				27.7.3.2	 Ossicular Chain Surgery
					Attic Fixation
					Stapes Fixation
			27.7.4	 Rehabilitation
		27.8	 Conclusion
		References
	28: Postoperative Care and Follow-Up After Otologic Surgery
		28.1	 Introduction
		28.2	 Postoperative Care and Follow-Up Times
			28.2.1	 Early Postoperative Care
				28.2.1.1	 Postoperative First Visit
			28.2.2	 Intermediate Postoperative Care for a Period of 2–8 Weeks
				28.2.2.1	 Second Postoperative Visit
				28.2.2.2	 Third Postoperative Visit
			28.2.3	 Short-Term Postoperative Care for a Period of 6–12 Months
			28.2.4	 Long-Term Post-Operative Care for a Period of 1–5 Years
		28.3	 Postoperative Care and Follow-Up by Type of Otologic Surgery
			28.3.1	 Ventilation Tube Insertion
			28.3.2	 Myringoplasty/Tympanoplasty
			28.3.3	 Ossiculoplasty
			28.3.4	 Mastoidectomy
			28.3.5	 Stapes Surgery
			28.3.6	 Otoplasty
		28.4	 Conclusion
		References
	29: Eustachian Tube Dysfunction
		29.1	 Introduction
		29.2	 Eustachian Tube Dysfunction
			29.2.1	 Dilatory Eustachian Tube Dysfunction
			29.2.2	 Baro-Challenge-Induced Eustachian Tube Dysfunction
			29.2.3	 Patulous Eustachian Tube
		29.3	 Conclusion
		References
	30: Auto Inflation in Otitis Media with Effusion
		30.1	 Introduction
		30.2	 Treatment of OME
			30.2.1	 Tympanostomy Tubes
			30.2.2	 Adenoidectomy
			30.2.3	 Balloon Dilation of the Eustachian Tube
			30.2.4	 Hearing Aids
			30.2.5	 Autoinflation
			30.2.6	 Rhinitis Treatments
		References
	31: Granulomatous Diseases of Temporal Bone
		31.1	 Introduction
		31.2	 Epidemiology
		31.3	 Types of Granulomatous Diseases
		31.4	 Clinical Features
		31.5	 Diagnosis
			31.5.1	 Laboratory Findings
			31.5.2	 Radiological Imaging
			31.5.3	 Diagnosis and Treatment
		31.6	 Conclusion
		References
Part V: Inner Ear Diseases and Management
	32: Tinnitus
		32.1	 Introduction
		32.2	 Definition and Classification
		32.3	 Prevalence
		32.4	 Mechanisms and Neurophysiological Approach
		32.5	 The Triple Network Model
		32.6	 Central Gain Model
		32.7	 Increased Spontaneous Activity and Enhanced Neural Synchrony
		32.8	 Tonotopic Reorganization
		32.9	 Evaluation
		32.10	 Treatment and Management
			32.10.1	 Methods That Directly Target Tinnitus
			32.10.2	 Methods Targeting Tinnitus and its Reactions
		32.11	 Conclusion
		References
	33: Hyperacusis
		33.1	 Introduction
		33.2	 Definition and Subtypes
		33.3	 Prevalence
		33.4	 Causes of Hyperacusis
		33.5	 Mechanisms and Neurophysiological Approach
		33.6	 Hyperacusis and Loudness Recruitment
		33.7	 Evaluation
		33.8	 Treatment and Coping Strategies
		33.9	 Conclusion
		References
	34: Presbycusis
		34.1	 Introduction
		34.2	 Types of Presbycusis
			34.2.1	 Sensorial Presbycusis
			34.2.2	 Neural Presbycusis
			34.2.3	 Metabolic (Strial) Presbycusis
			34.2.4	 Mechanical (Cochlear Conductive) Presbycusis
			34.2.5	 Mixed Presbycusis
			34.2.6	 Intermediate Presbycusis
		34.3	 Pathophysiology
			34.3.1	 Stria Vascularis/Spiral Ligament
			34.3.2	 Sensory Hair Cells
			34.3.3	 Auditory Neurons/Spiral Ganglion Cells
		34.4	 Causative Factors
			34.4.1	 Genetics
				34.4.1.1	 Genome-Wide Association Studies
				34.4.1.2	 Linkage Studies
				34.4.1.3	 Histopathological and Genetic Studies
			34.4.2	 Hormonal Factors
				34.4.2.1	 Insulin-Like Growth Factor 1
				34.4.2.2	 Estrogen
			34.4.3	 Environmental Factors
				34.4.3.1	 Noise
				34.4.3.2	 Inflammation
				34.4.3.3	 Ototoxic Drugs
		34.5	 Diagnosis
		34.6	 Management and Treatment
		34.7	 Conclusion
		References
	35: Otological Manifestations of Systemic Diseases
		35.1	 Introduction
		35.2	 Granulomatous Diseases
			35.2.1	 Langerhans Cell Histiocytosis
			35.2.2	 Granulomatosis with Polyangiitis
			35.2.3	 Sarcoidosis
			35.2.4	 Rheumatoid Arthritis
			35.2.5	 Polyarteritis Nodosa
		35.3	 Infectious Diseases
			35.3.1	 Tuberculosis
			35.3.2	 Syphilis
			35.3.3	 Lyme Disease
			35.3.4	 Mycotic Diseases
			35.3.5	 Cytomegalic Inclusion Disease
			35.3.6	 Congenital Toxoplasmosis
			35.3.7	 Congenital Rubella
		35.4	 Neoplastıc Dıseases
			35.4.1	 Multiple Myeloma
			35.4.2	 Leukemia
			35.4.3	 Lymphoma
			35.4.4	 Neurofibromatosis Type 1 (von Recklinghausen)
			35.4.5	 Neurofibromatosis Type 2
		35.5	 Bone Diseases
			35.5.1	 Paget’s Disease
			35.5.2	 Osteogenesis Imperfecta
			35.5.3	 Fibrous Dysplasia
			35.5.4	 Osteopetrosis
		35.6	 Metabolic Diseases
			35.6.1	 Mucopolysaccharidoses
			35.6.2	 Gout
			35.6.3	 Ochronosis (Alkaptonuria)
			35.6.4	 Glutaric Aciduria Type 1
		35.7	 Autoimmune Diseases
		35.8	 Immunodeficiency and Immune-Mediated Disorders
			35.8.1	 Primary or Congenital Immunodeficiency and Immune-Mediated Disorders
			35.8.2	 Acquired Immunodeficiency Syndrome
		References
	36: Sudden Sensorineural Hearing Loss
		36.1	 Introduction
		36.2	 Pathophysiology
			36.2.1	 Vascular Causes
			36.2.2	 Membrane Rupture
			36.2.3	 Infection
			36.2.4	 Autoimmunity
		36.3	 Etiology
			36.3.1	 Trauma
			36.3.2	 Ototoxicity
			36.3.3	 Infection
				36.3.3.1	 Viral Origins
				36.3.3.2	 Bacterial Origins
			36.3.4	 Neoplasia
			36.3.5	 Vascular
			36.3.6	 Immunology
		36.4	 Evaluation
			36.4.1	 Imaging
			36.4.2	 Laboratory Examinations
		36.5	 Treatment
			36.5.1	 Steroids
			36.5.2	 Hyperbaric Oxygen Treatment
			36.5.3	 Other Treatments
		36.6	 Rehabilitation
		36.7	 Prognosis
		36.8	 Conclusion
		References
	37: Autoimmune Inner Ear Disease
		37.1	 Introduction
		37.2	 Pathophysiology
		37.3	 Clinical Findings
		37.4	 Physical Examination
		37.5	 Audiologic Findings
		37.6	 Laboratory Findings
		37.7	 Human Leukocyte Antigens (HLA)
		37.8	 Radiological Findings
		37.9	 Treatment
			37.9.1	 Systemic Steroids
			37.9.2	 Intratympanic Steroids
			37.9.3	 Cyclophosphamide
			37.9.4	 Methotrexate
			37.9.5	 Tumor Necrosis Factor-Alpha (TNF-α) Inhibitors
			37.9.6	 Golimumab
			37.9.7	 Infliximab
			37.9.8	 Etanercept
			37.9.9	 Anakinra
			37.9.10	 Rituximab
			37.9.11	 Sodium Enoxaparin
			37.9.12	 Azathioprine
			37.9.13	 Plasmapheresis
			37.9.14	 Hearing Aids
			37.9.15	 Cochlear Implants
		37.10	 Conclusion
		References
	38: Perilymphatic Fistula
		38.1	 Introduction
		38.2	 Etiopathogenesis
		38.3	 Diagnosis
			38.3.1	 Biochemical Examination
			38.3.2	 Audiovestibular Examination
			38.3.3	 Radiological Examination
		38.4	 Clinical Findings
			38.4.1	 Differential Diagnosis
		38.5	 Treatment
			38.5.1	 Medical Treatment
			38.5.2	 Surgical Treatment
		38.6	 Conclusion
		References
Part VI: Audiology
	39: Newborn Hearing Screening
		39.1	 Introduction
		39.2	 Brief History of the Development of Newborn Hearing Screening Programs
		39.3	 The Risk Factors Related to Congenital Hearing Impairments
		39.4	 The Staff, Tools, and Protocols in Newborn Hearing Screening Programs
			39.4.1	 The Staff in the NHS Program
			39.4.2	 Health Staff in Screening Units
			39.4.3	 Health Staff in Reference Centers
			39.4.4	 Physicians Working in Health Centers with Screening Units and Reference Centers
			39.4.5	 Regional and National Authorities
		39.5	 Tools
			39.5.1	 Auditory Brainstem Response (ABR) Devices
			39.5.2	 Evoked Otoacoustic Emission (EOAE) Devices
		39.6	 Protocols
		39.7	 Newborn Hearing Screening Program in Case of Major Challenges
			39.7.1	 COVID-19 Pandemic
			39.7.2	 Major Disasters, Such as Earthquake
		39.8	 Conclusions
		References
	40: Functional Hearing Loss
		40.1	 Introduction
		40.2	 Terminology
		40.3	 Prevalence
		40.4	 Functional Hearing Loss in Children and Adults
		40.5	 History and Preclinical Indicators
		40.6	 Audiological Evaluation
			40.6.1	 Subjective Audiological Evaluation
				40.6.1.1	 Pure-Tone Audiometry
				40.6.1.2	 Speech Audiometry
			40.6.2	 Objective Audiological Evaluation
				40.6.2.1	 Acoustic Immittance Measurements
				40.6.2.2	 Otoacoustic Emission Test
				40.6.2.3	 Auditory Evoked Potentials Test
			40.6.3	 Functional Hearing Loss Specific Tests
				40.6.3.1	 Stenger Test
				40.6.3.2	 Speech Stenger Test
				40.6.3.3	 Doerfler–Stewart Test
				40.6.3.4	 Lombard Test
				40.6.3.5	 The Pure Tone Delayed Auditory Feedback and Delayed Speech Feedback Test
				40.6.3.6	 Switching Speech (Variable Story) Test
			40.6.4	 Other Audiological Tests
		40.7	 Management of the FHL
		40.8	 Conclusion
		References
	41: Hidden Hearing Loss
		41.1	 Inroduction
		41.2	 Factors Causing Hidden Hearing Loss
			41.2.1	 Noise
			41.2.2	 Aging
			41.2.3	 Neuropathy
			41.2.4	 Ototoxicity
		41.3	 Cochlear Synaptopathy
		41.4	 Gene Factors
			41.4.1	 Presynaptic
			41.4.2	 Postsynaptic
		41.5	 Diagnostic Tests
			41.5.1	 Auditory Brainstem Response and Electrocochleography
			41.5.2	 Envelope Following Responses and Frequency Following Responses
			41.5.3	 Middle Ear Muscle Reflex Bottom of Form
		41.6	 Treatment/Intervention
			41.6.1	 Hearing Aids and Cochlear Implants
			41.6.2	 Neuroprotective Agents
			41.6.3	 Subcortical Adaptation
		41.7	 Conclusion
		References
	42: Auditory Neuropathy Spectrum Disorder
		42.1	 Introduction
		42.2	 An Overview of Auditory Neuropathy Spectrum Disorder
		42.3	 Differential Diagnosis of ANSD
		42.4	 Etiology
			42.4.1	 Prenatal Factors
				42.4.1.1	 Genetic Causes
					Syndromic Genetic Causes Associated with Auditory Neuropathy Spectrum Disorder
					Non-Syndromic Genetic Causes Associated with Auditory Neuropathy Spectrum Disorder
					Mitochondrial Causes
				42.4.1.2	 Acquired Causes
					Prenatal Causes
					Perinatal Causes
					Postnatal Causes
					Late-Onset ANSD
		42.5	 Assessment of ANSD
			42.5.1	 Psychophysical Evaluation
			42.5.2	 ANSD and Electrophysiological Assessment
		42.6	 Therapies
			42.6.1	 Amplification: Hearing Aids and Cochlear Implant
		42.7	 Case Presentation
		42.8	 Conclusion
		References
	43: Noise-Induced Hearing Loss
		43.1	 Introduction
		43.2	 Sound and Noise
		43.3	 Noise Induced Hearing Loss
		43.4	 Pathophysiology
			43.4.1	 Mechanical Trauma
			43.4.2	 Free Radicals
			43.4.3	 Calcium Mechanism
			43.4.4	 Inflammation and the Immune System
			43.4.5	 Genetic Causes
		43.5	 Findings and Clinical Picture
		43.6	 Prevention
		43.7	 Treatment
		43.8	 Conclusion
		References
	44: Central Auditory Processing Disorders
		44.1	 Introduction
		44.2	 Definition
		44.3	 Etiology
		44.4	 Pathophysiology
		44.5	 Diagnosis
		44.6	 Treatment
		References
	45: Motion Sickness
		45.1	 Introduction
		45.2	 Etiology
		45.3	 Epidemiology
		45.4	 Pathophysiology
		45.5	 History
		45.6	 The Physical Evaluation
		45.7	 Diagnosis
		45.8	 Assessment
		45.9	 Treatment
			45.9.1	 Behavioral Management
			45.9.2	 Treatment
				45.9.2.1	 Ginkgo Biloba
				45.9.2.2	 Nasal Sprays
		References
	46: Audiology and Otology in Geriatric Patients
		46.1	 Introduction
		46.2	 Pathophysiology
			46.2.1	 Sensory Presbycusis
			46.2.2	 Neural Presbycusis
			46.2.3	 Metabolic Presbycusis
			46.2.4	 Mechanical Presbycusis
		46.3	 History
		46.4	 Causes
			46.4.1	 Arteriosclerosis
			46.4.2	 Diet and Metabolism
		46.5	 Treatment
		46.6	 Prognosis
		46.7	 Complications
		46.8	 Healthcare Team Outcomes
		References
	47: Occupational Health from an Otologic and Audiological Perspective
		47.1	 Introduction
		47.2	 Epidemiology
		47.3	 Pathophysiology
		47.4	 Diagnosis
			47.4.1	 History
			47.4.2	 Tests
		47.5	 Treatment
		References
	48: Experimental Studies in Otology and Audiology
		48.1	 Introduction
		48.2	 The Importance of Experimental Research
		48.3	 Experimental Research in Otology and Audiology
			48.3.1	 In Vitro Cell Analyses and Culture
			48.3.2	 Ex Vivo/In Vitro Experimental Models
			48.3.3	 Inner Ear Organoids
			48.3.4	 In Vivo Experimental Animal Models
		48.4	 Categories of Experimental Animal Models
			48.4.1	 Induced Animal Models
			48.4.2	 Spontaneous Animal Models
			48.4.3	 Genetically Modified Animal Models
			48.4.4	 Negative Animal Models
			48.4.5	 Orphan Animal Models
		48.5	 The Selection of an Animal Model for Research in Otology and Audiology
		48.6	 Ear Anatomy and Interspecies Comparison in Experimental Animals Used in Otology and Audiology
			48.6.1	 Mouse (Mus musculus)
			48.6.2	 Rat (Rattus sp.)
			48.6.3	 Guinea Pig (Cavia porcellus)
			48.6.4	 Rabbit (Oryctolagus cuniculus)
			48.6.5	 Chinchilla (Chinchilla laniger)
			48.6.6	 Domestic Pig (Sus domesticus)
			48.6.7	 Gerbil (Meriones unguiculatus)
		48.7	 Experimental Models in Otology and Audiology Research
			48.7.1	 Noise-Induced Hearing Loss (NIHL) Model
			48.7.2	 Presbycusis Model
			48.7.3	 Ototoxicity Model
			48.7.4	 Tinnitus Model
			48.7.5	 Endolymphatic Hydrops Model
			48.7.6	 Otitis Media Model
		48.8	 Evaluation of Auditory Functions in Experimental Animals
		48.9	 Ethical Principles in Experimental Research
		48.10	 Conclusion
		References