Following residency he worked for several hospitals (1982-1984 Sivas, 1984-1986 Gelibolu, and 1986-1990 Ankara). Among them he was one of the few in Otolaryngology when he was in Sivas which had the population of several hundred thousands and he received a lot of experience at that time. Gelibolu (Gallipoli) was the city where he made his military service. But the professional academic life began in Ankara Numune Hospital during 1986 and 1990. He has been Associate Professor in 1988 and following that he has been in Barcelona “Instituto Otologia Garcia Ibanez” for six months. Emilio Garcia Ibanez is still one of the leading surgeons on otology and neurotology well known with his middle cranial fossa surgical techniques. This was the opportunity where Prof. Ozgirgin found possibility to have contacts with other otologists in the world. Additionally this period allowed him to develop skills on otology and neurotology.

He attended to Gazi University ORL Dept. as an associate professor during the years 1990-1992. During this period there have been visits realized to University of Texas in Houston for aural atresia surgery as well as House Ear Institute in Los Angeles, CA for the rest of Otologic and neurotologic surgery.

He moved to Bayindir Hospital and worked there for ten years (1992-2002). During his Professional life in Bayindir Hospital he has been the member of the Politzer Society and had also the opportunity of organizing the biannual meeting in 1998 which is among the most prestigious events in the otology world. This meeting had a great success and with this opportunity he was invited to the Board of Directors of Politzer Society as a member.

Late in 1990’s The European Academy of Otology and Neurotology (EAONO) was founded. He was involved in this process as a founder member.

Additionally he was elected of Vice President of the Mediterranean Society of Otology and Audiology and later he became the President during the years 2004 and 2008.

One of the most contributing activities to Academic and Professional life was the initiation of the International Journal called “Mediterranean Journal of Otology” as the editor in chief which became popular in a short time in otology world, soon accepted to Science Citation Index and changed the title as “The Journal of International Advanced Otology”
In 2002 he moved to Baskent University where he worked for more than five years and became a full Professor early in 2003.

In 2005 he while waiting for his term as a member of the Board of Directors in Politzer Society he was nominated to be the President Elect by Mirko Tos during the meeting in Seoul. This meant that another 12 years should be added to his contributions to the Society also as being the President for four years. This moment was one of the turning points in professional life.
In the meantime he was also elected as Steering Committee Member of EAONO.

Professor Ozgirgin moved back to Bayindir Hospital in 2007 and he is still working there.

He was invited to be the Corresponding Member of the German ORL Society. Also following his term as the member of Steering Committee he continued on working for EAONO as the president of Standing Committee for Meetings and Congresses of EAONO that is still active.

Recently in 2011 he was awarded with prize on “Service to Deaf” by the Middle East Countries.

He has 34 articles published in international journals. Additionally he has one chapter and he made the editorial of a book in international press. He has written 9 chapters for the books published in Turkish language and 40 articles for national journals.

He is still the editor in chief of “The Journal of International Advanced Otology” that has been indexed and tracked by SSCI and AHCI and also involved within the reviewer panel of Otology and Neurotology journal.

Has been in charge of chairing four international meetings and involved in the scientific program as guest speaker, in 105 international and in 85 national meetings.

He worked for the Curriculum Development program on advanced Neurotology training of EAONO. He is also chairing the committee on honorary and ethics of the Turkish ORL Society.

What is bionic ear (cochlear implant)?

What are the components of a cochlear implant? How does it function?
Cochlear implant consists of two components. These are internal and external components. The inner implant (also known as receiver or stimulator) is placed surgically under the skin behind the ear. It is made up of receiver and magnet components. In addition, a group of tiny cables (electrodes) are available. The external part consists of sound processor, cable and microphone. Sound processor analyzes the outside sound signals (ie. Speech, music etc.) and converts them into electrical current format. This electrical current is transferred by cable and transferred to implant which is placed under the skin via the radio waves. Receiver (internal part) carries these waves through the electrodes to the inner ear. Auditory nerve fibers are therefore stimulated and thereby providing hearing.

What are the differences between hearing devices and bionic ear?
Bionic ear is quite different from a hearing device. Hearing device increases the volume of sound to the ear like a loudspeaker. On the other hand, a bionic ear penetrates from the damaged cells in inner ear and directly stimulates the auditory nerve.

Bionic ear provides the social communication in the adults presenting with severe hearing loss or deafness by enabling the hearing. In addition to this, different from hearing devices, accurate hearing via bionic ear requires for a healing process.

Is bionic ear an experiment tool?
Bionic ear has been used since the 1970’s. Approximately 200.000 persons have been implanted bionic ear throughout the world so far. Nearly 3000 persons have bionic ears in both ears. Of these persons 1600 are babies. It was reported in 1984 that the bionic ear implantation threshold age was 18 months for children, and this threshold was decreased to 12 months in the year 2002.

Who uses bionic ear?
Bionic ear is placed in those with severe hearing loss and who may not sufficiently benefit from hearing devices. Bionic ear implantation may be planned to be inserted in persons between 3 months and 100 years. Bionic ear provides the maximum contribution to those who have recently lost their hearing sensation. However, bionic ears for those who are congenitally deaf should be planned to be implanted during the early stage. Therefore, such children are stimulated by the sound and initiate to speak when they are 2 – 3 years old.

Compared to those children who are implanted bionic ear in later stages, operations in congenitally deaf children and to whom bionic ear is surgically implanted before they are 2 years old are more successful. Those children who are implanted bionic ear when they are between 2 – 4 years old present with speech disorder. If the bionic ear is implanted after 9 years old, the possibility of speech of the child is almost not available. Therefore, it is of great importance that the bionic ear be implanted in the early age.

What are the hearing losses that may be treated with bionic ear?
Bionic ear is employed in the inner ear hearing loss cases, not sufficiently treated with standard hearing devices. Normally sound waves are perceived by the tympanic membrane when they reach to the ear, and directed to the inner ear via the ossicles of the middle ear. Sound waves are affect liquids in the cochlea and sensorial cells in the inner ear respond to this move of liquids. This converts the sound waves to the electrical signal. This electrical signal is directed to brain by auditory nerve. In many cases vitality of these sensorial cells in the inner ear lead to hearing loss. However, some of these cells may often survive. Because the bionic ear directly stimulates the auditory nerve, it penetrates from the damaged site and delivers sound signals to the brain.

May all the patients with severe hearing loss benefit from bionic ear?
Unfortunately, not all the patients may use bionic ear. Some of hearing losses arise from the disease of the auditory cell. If there are not any auditory nerves, no structures through which bionic ear transfer electrical signals to the brain are available. In some persons, inner ear physical condition is abnormal. In such cases, there may not be appropriate space to place the cables of bionic ear.

Just after the operation, what should I expect?
A large ear dressing (bandage) should be expected. This bandage may be tight. Slight imbalance may be felt. Sensation of dryness and burning in throat may be seen (due to anesthesia). Do not expect to hear thanks to implant just after the operation. Many patients have reported that bionic ear operations are easier than they assumed.

When may I use my implant?
3 – 4 weeks after operation, external component of the implant is placed. Implant programming is carried out by an audiologist. First programming may last for hours. During this process, patient and audiologist make their decisions for a mapping. This mapping method enables the most appropriate settings that the patient may hear. Signal levels in the electrodes improve with visits of the patient to the audiologist in the next months. The most appropriate settings are applied. Sounds initially are more different than those before hearing loss. Firstly, the patient should adapt at the surrounding sounds. With trials and errors, adaptation at sounds is available.

What are the risks associated with bionic ear?
The risks of bionic ear solely include those related to surgery. These risks may be bleeding, infection, damage of facial nerve, delay of recovery from anesthesia, and imbalance. Direct risks of implant on the other hand may be mechanical or electrical, and extrusion of implant.

Will my scull be perforated during the operation?
No, not any holes are formed, nevertheless; a slot for the placement of the implant is done. This site is covered by scalp. Possible slight swelling recovers within a short time. Later on, it is possible to feel the implant under the scalp. Still, no components or cables are on the surface of the scull.

May surgery scar be seen outside?
Surgical scars after the recovery may hardly never be seen. Implant associated bulge that may be hidden by hairs is seen.

May more operations be required with developing technology?
The implant has been designed to function for life long. The sound processor which is on the surface may be changed with developing technology.

Will another implant be needed to be placed to my child when s/he grows?
No, in the time of birth inner ear is full and never needs to grow. Scull is complete as from 2 years. Electrodes are designed by considering the growth of the child.

Should I expect the improvement of cochlear implant technology?
No, the part of implant which is placed with surgical procedure has slightly been improved and evolved during the development of the bionic ear. Yet, sound coding systems are always improved. The part that employs these technologies are on the surface.

Is there a battery in the surgically placed part of the implant? Does this part need to be altered?
No, there is not any battery in the surgically implanted part of the implant. Energy is delivered to the part on the surface. Rechargeable batteries are used.

How long is the life of batteries?
BTE (behind – the – ear) batteries show performances for days. In noisy environments device functions frequently and life of battery shortens.

What kinds of batteries are used?
BTE devices use high energy zinc alloy batteries.

After the placement of bionic ear, may I undergo MRI?
Magnetic fields in the MRI devices apply pressure to the magnet of the device. In the recent implants, the lower effective MRI devices do not demonstrate any effects. If the high tesla devices are preferred for scanning, battery of the implant may be removed with a minor operation.

May I have normal x – rays?
Yes, it is possible to undergo normal x – rays and CT with cochlear implant

May I keep myself away from magnetic fields?
No problems occur in the low magnetic fields.

May I use mobile phone?
Yes, many persons with bionic ears use mobile phones together.

May bionic ear users swim, have shower? Do sports?
Bionic ear users may swim, have shower and do many sports. During these activities, the part on the surface should not be used. Helmet for head should be used during sports.

May I do diving?
The part on the surface should be removed when swimming. Inner part is not affected by water. Sports like boxing may not be done. Some implants are pressure resistant against 25 mt.

If I undergo implant operation today, and if the implants of the new technology are produced within two years, may I need to undergo operation again?
Most of the developments in the bionic ear technology are associated with the part on the surface.

If I had underwent operation 15 years ago and would like to use the new technology, would I need to undergo a new operation?
The first introduced implants were dependent upon analog technology, more operations could be needed. For example, if a single channel device were used in advance, and poly channel device is demanded, then new operation is required.

If I do not want to use the implant, may the implant be removed?
The part on the surface is always removed at nights. In order for removing the part implanted, a new surgical procedure is required.

If operation is demanded for recent technology, is this possible?
A little damage is developed in the inner ear due to trauma during the first placement, however recent implant may be placed. Therefore, it is determined that hearing in the persons with implants is as well as the first implant and even more than this.

Is our child not too young to undergo bionic ear operation?
It has been determined that those children undergoing implant surgery during early ages tend to hear and speak normally. Such children learn to speak faster.

I am 75 years old. Am I too old for cochlear implant?
No age limitation is available for bionic ear application. If you concern participating in the recovering programs, bionic ear operation may be done in every age.

I have lost my hearing in both ears. Should I have one or two implants placed?
One implant has mostly been placed so far. Two implants have advantages such as determination of the sound direction and well comprehension in noisy environments. Children with two implants may concentrate upon their classes well.

Is my implant affected by the detectors in airports and shopping malls?
Your implant is not affected in such environments. However, due to the fact that your device will lead to signals by the detectors, it is good for you to carry a special document for this.

First introduce of the device after implantation – Fitting

THE EARLY YEARS: Research during the late 18th and 19th centuries

Interest in the electrical methods of stimulating hearing had its beginnings in the late 18th century when Alessandro Volta discovered the electrolytic cell. Volta was the first to stimulate the auditory system electrically, by connecting a battery of 30 or 40 ‘couples’ (approximately 50V) to two metal rods that were inserted into his ears. When the circuits were completed, he received the sensation of ‘une recousse dans la tate’ (“a boom within the head”), followed by a sound similar to that of boiling of thick soup. Volta’s observation sparked sporadic attempts to investigate the phenomenon over the next 50 years, but the sensation the patients described was always momentary and lacked tonal quality.

Crude applications of electrical stimulation were described through the 18th and 19th century in Paris, Amsterdam, London, and Berlin. (Clark and niparko). Since sound is an alternating, disturbance in an elastic medium, it was soon realized that stimulating the auditory system with a direct current could not reproduce a satisfactory hearing sensation. The next step was taken by Duchenne of Boulogne who, in 1855, stimulated the ear with an alternating current that he produced by inserting a vibrator into a circuit containing a condenser and induction coil. What resulted was a sound that resembled, ‘the beating of a fly’s wings between a pane of glass and a curtain’. (Clark) This was better, but still not satisfactory.

In 1868, Brenner published a more extensive investigation of these effects that studied the effects of altering the polarity, rate and intensity of the stimulus, and placement of the electrodes, on the hearing sensation produced (cited by Simmons 1966). He found that hearing was better with an electrical stimulus that created a negative polarity in the ear, and that correct placement of the electrodes could reduce the unpleasant side effects. Brenner used bipolar stimulation, meaning that one electrode was placed in saline in the external auditory meatus, and the other was placed on a more distant part of the body. This electrode is now referred to as the Brenner electrode (Clark et al).

INTEREST RENEWED: Breaking ground during the early 1900’s

The initial optimism surrounding the bioelectrical approaches to cure deafness was followed by a period of skepticism as the applications appeared to be invasive and required ongoing critical evaluation. However, in the 1930’s, interest was renewed in the problem of reproducing hearing artificially. This coincided with the introduction of the thermionic valve, which allowed for the auditory system to be stimulated electrically with significantly greater precision.

The work of Wever and Bray (1930) demonstrated that the electrical response recorded form the vicinity of the auditory nerve of a cat was similar in frequency and amplitude to the sounds to which the ear had been exposed. Meanwhile, the Russian investigators Gersuni and Volokhov in 1936 examined the effects of an alternating electrical stimulus on hearing. They found that hearing could persist following the surgical removal of the tympanic membrane and ossicles, and thus hypothesized that the cochlea was the site of stimulation.

Another set of researchers, Stevens and Jones (1939), thought that electrical could be transduced into sound vibrations before it reached the inner year. Hearing induced in this way has been called the electrophonic effect. They were able to determine whether a linear or non-linear transducer was involved by the presence and strength of the overtones, which were detected when the subject heard beats. The studies by Stevens and Jones (1939), as well as Jones et al (1940) indicated that when the cochlea was stimulated electrically, there were three mechanisms, which produced hearing:

1. The middle ear could act as a transducer, which obeys the ‘square law’ and convert alternations in the strength of an electrical field into the mechanical vibrations that produce sound.

2. Electrical energy could be converted into sound by a direct effect on the basilar membrane, which would then vibrate maximally at a point determined by the frequency and these vibrations would stimulate the hair cells

3. Direct stimulation of the auditory nerve produced a crude hearing sensation.

Their conclusions were basically correct, although now other body tissues have been shown to act as transducers (Clark).

A wealth of research in the 1940’s and 1950’s into the mechanisms involved in electrophonic hearing indicated that hearing is produced by transducing electrical energy into sound vibrations and that residual cochlear function is also required. It became apparent that total perception deafness could not be corrected by inducing a widespread electrical filed in the region of cochlea. Instead, a more localized stimulation of the auditory nerve fibers is required.

MAJOR BREAKTHROUGHS!

In 1950, Lundberg performed one of the first recorded attempts to stimulate the auditory nerve with a sinusoidal current during a neurosurgical operation. His patient could only hear noise. However, a more detail study followed in 1957 by Djourno and Eyries, provided the first detailed description of the effects of directly stimulating the auditory nerve in deafness. In their study, the stimulus appears to have been well controlled. Djourno and Eyries placed a wire on the auditory nerves that were exposed during an operation for cholesteatoma. When the current was applied to the wire, the patient described generally high-frequency sounds that resembled a “roulette wheel of the casino” and a “cricket”. The signal generator provided up to 1,000-Hz and the patient gradually developed limited recognition of common words and improved speech-reading capabilities. The patient was found able to discern differences in pitch at increments of 100 pulses and was found able to distinguish words such as “pap’, mamn”and “allo”.

In 1964, Doyle et al., reported inserting an array of electrodes into the cochlea of a patient with total perceptive deafness. The electrodes were designed to limit the spread of the electrical field and were stimulated in sequence with threshold square waves that were superimposed with speech signals. The four electrodes were not especially implanted to take advantage of the spatial distribution of the auditory nerve fibers responding to different frequencies, and the result obtained was only satisfactory. However, it was significant that the patient was able to repeat phrases.

Yet another researcher, Simmons (1966) provided a more extensive study in which electrodes were placed through the promontory and vestibule directly into the modiolar segment of the auditory nerves. The nerve fibers representing different frequencies could be stimulated. The patient was tested to assess the effect of alterations in the frequency and intensity of the signal. The subject demonstrated that in addition to being able to discern the length of signal duration, some degree of tonality could be achieved.

The clinical applications of electrical stimulation of the auditory nerve were refined by House (1976) and Michelson (1971) through scala tympani implantation of electrodes driven by implantable receiver-stimulators. Dr. William House observed the percepts of patients when small electric currents were introduced to the promontory during middle ear procedures under local anesthesia. But technical barriers proved frustrating. During the early sixties, House implanted several devices in totally deaf volunteer patients. Although these were rejected due to lack of biocompatibility of the insulating material, that they worked for a short time provided optimism towards a solution for sensorineural deafness. (House testimonial). House teamed up with Jack Urban, a very innovative engineer, to ultimately make cochlear implants a clinical reality. The new devices benefited from the increasing capabilities for microcircuit fabrication derived form space exploration and computer development.

RAPID PROGRESS: The commercial marketing of Cochlear Implants

In 1972, a speech processor was developed to interface with the House 3M single-electrode implant and was the first to be commercially marketed. More than 1,000 of these devices were implanted between 1972 to the mid 1980s. In 1980, the age criteria for use of this device was lowered from 18 to 2 years. ). During the 1980’s, several hundred children had been implanted with the House 3M single channel device. The FDA formally approved the marketing of the 3M/ House cochlear implant in November 1984. By the late eighties, virtually all of the major concerns about the long-term success and safety of cochlear implants were largely resolved.

During this same period, work outside the United States was progressing, most notably in Australia where Clark and colleagues were developing a multi-channel cochlear implant that, in the last half of the eighties, was to become the single-most used implant in the world under the name “Nucleus Multi-channel Cochlear Implant”. Multiple channel devices were introduced in 1984, and enhanced the spectral perception and speech recognition capabilities compared to the single-channel device, as reported in large adult clinical trials.

THE LAST DECADE TO PRESENT

Through the 1990’s, clinical and basic science studies have resulted in progress in implant technology and in clinical approaches to cochlear implants. Electrode and speech processor now produce coding strategies that are associated with successively higher performance levels. The commercial success of the Nucleus device has triggered the acceptance of implants as assistive devices. Over the years, implant patients have become more numerous and risks have been minimized. More people have accepted that implants are here to stay, and are increasingly being recommended. Currently, there are two major corporations manufacturing cochlear implants for use in the United States. Cochlear Corporation and Advanced Bionics Corporation.

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The International Patient Program at Bayındır HealthCare Group provides a single point of access, service and coordination for international patients and their families.

Our International Patient Program assists patients with administrative details such as appointment settings, transportation services from airport to hospital and/or hotel, accomodation arrangements with your choice of exclusive or medium standard hotels, and financial arrangements as a VIP patient. We also provie discounted flight tickets from Turkish Airlines who wish to come for a treatment to Bayındır HealthCare Group:

- Travel from USA to Bayındır Hospitals: 20% discount on Business and First Class fares, 15% discount on Comfort Class fares and 10% discount on Economy Class fares.
- Travel from other countries to Bayındır Hospitals: 15% discount on Business, Economy and Comfort Class fares.
- 10 kg excess luggage allowance.
- Up to 2 companions travelling with the patient are entitled for the same discounts.

Our International Patients Program also includes free interpreters within the hospital. Specialized customer service ensures that your needs are throughly met during communication.

International patient service begins before your arrival at Bayındır HealthCare Group and lasts throughout your stay.

For more information please call, write or e-mail the International Patient Program at:

International Patient Program
Bayındır HealthCare Group
Kızılırmak Mahallesi, 53. Cad. No: 17,
Söğütözü-ANKARA/TURKEY 06520
Telephone: 0090 312 289 7085
Cell Phone: 0090 555 991 4564
E-mail: moral@bayindirhastanesi.com.tr

The Fatih mosque complex was a religious and social building of unprecedented size and complexity built in Istanbul between 1463-1470 by the order of Fatih Sultan Mehmed, on the site of the former Byzantine Church of the Holy Apostles, which had been a ruin since the Fourth Crusade. It was built by the royal architect Atik Sinan.[1] The Fatih mosque was the first monumental project in the Ottoman imperial architectural tradition.

The original complex included a set of well-planned buildings constructed around the mosque. They include eight medrese, library, hospital, hospice, caravanserai, market, hamam, primary school and public kitchen (imaret) which served food to the poor. Various türbe were added at a later dates. The original complex covered an almost square area 325 meters on a side, extending along the Golden Horn side of Fevzipasa Street..

The original mosque was badly damaged in the 1509 earthquake, after that it was repaired, but was then damaged again by earthquakes in 1557 and 1754 and repaired yet again. It was then completely destroyed by an earthquake on 22 May 1766 when the main dome was collapsed and the walls were irreparably damaged. The current mosque (designed on a completely different plan) was completed in 1771 under Sultan Mustafa III by the architect, Mimar Mehmet Tahir.

The first Fatih mosque had one central dome supported by a single semi-dome of the same diameter on the qibla side and suspended on four arches, its dome was 26 meter in diameter. The second mosque which was built (1771) by Sultan Mustafa III after the 1766 earthquake, was built on a square plan. It has one central dome supported by four semi-domes. The courtyard, main entrance portal and lower portions of the minarets remain from the original construction, with the remainder consisting of the 1771 Baroque reconstruction.

The present interior of the Fatih Mosque is essentially a copy of earlier designs invented by Sinan re-used repeatedly by himself and his successors throughout Istanbul (this technique is emulative of the Hagia Sophia). The 26 meter diameter center dome is supported by four semi-domes on each axis supported by four large marble columns. There are two minarets each with twin galleries. The calligraphy within the mosque and the mimbar exhibit a Baroque influence, but the white tiles of inferior quality are a poor comparison with the İznik tiled splendor of mosques such as the Rüstem Pasha Mosque. The mihrab dates from the original construction.

As with other imperial mosques in Istanbul, the Fatih Mosque was designed as a kulliye, or complex with adjacent structures to service both religious and cultural needs.

To the north and south of the mosque are eight great medrese, four to each side. These buildings are symmetrical, and each contains 18 cells for students (each housing four youths) and a dershane. Behind each was an annex, about half as large as the medrese itself, all of which have been destroyed as a result of road construction. The medreses provided for about a thousand students, making it a large university for its time.

The Hospice (taphane) is outside the southeast corner of the mosque precincts. The building has a beautiful courtyard supported by 16 exceptional columns of verd antique and granite, which were probably salvaged from the Church of the Holy Apostles. Opposite the hospice is the large turbe of Sultan Mahmud II’s mother, Naksh-i Dil Sultana.

In the graveyard on the kiblah side behind the mosque are the turbe of Sultan Mehmet II and his wife Gulbahar Hatun. Both were reconstructed after the earthquake. The turbe of the Conqueror is very baroque with a lavishly decorated interior. The turbe of Gulbahar is simple, with classic lines, and may closely resemble the original. In addition, the graveyard has a large number of graves belonging to leading state officials, including Osman Nuri Pasha.

On the kiblah side of the mosque, connected to it, is a domed library which was built in 1724. One of its doors opens onto the street, while the two other open onto the inner courtyard of the mosque. The library is presently undergoing repairs, and the books are under protection at the Suleymaniye Library.

The caravanserai in the complex was repaired in the 1980s and combined with new shops to begin functioning as a workplace. The hospital, market, kitchens and hammam belonging to the original complex no longer exist.

The mosque rises next to the place where Abu Ayyub al-Ansari (Turkish: Eyüp Sultan), the standard-bearer of the Islamic prophet Muhammad, is said to have been buried during the Arab assault on Constantinople in 670. His tomb is greatly venerated by Muslims, attracting many pilgrims. Some of the personal belongings of Muhammad are preserved in the tomb.