Discussion and expostulations on postoperative worsening of hearing following middle ear surgeries

Apoorva Kumar Pandey,Sahil Deep Singh,Sonal Kala,Aparna Bhardwaj,Arvind Varma,Mudit Gupta,Chetan Bansal

doi:10.1186/s43163-022-00202-4

Apoorva Kumar Pandey, Sahil Deep Singh + Show 5 more

Open Access

https://doi.org/10.1186/s43163-022-00202-4

Copy DOI

Abstract

BackgroundHearing assessment after middle ear surgery has always been of interest to otologists for one of its major unavoidable and unpredictable complication is hearing loss. As the initial indication for operation is to treat precisely this problem, this complication poses a major dilemma for surgeons. We, thus, aimed to detect the proportion of postoperative worsening of hearing, causes, and risk factors in patients undergoing middle ear surgery.MethodThis retrospective descriptive study was conducted in the department of otolaryngology of a tertiary care center and data of medical records were retrieved from January 2016 until December 2020. This study included middle ear surgery patients with pre- and postoperative audiometric results. Those patients whose hearing worsened post-operatively (where bone conduction deteriorated > 10 dB) were noted and assessed accordingly.ResultsThe medical records regarding morphological and audiological outcomes of 178 patients were available. We observed auditory degradation after surgery in eight patients (five primary cases and three revision cases), with an overall incidence rate of 4.49%. The mastoidectomy was performed in seven cases, either cortical (n = 5) and modified radical (n = 2). Modified radical mastoidectomy showed the greatest incidence of hearing loss (40%) among all surgical procedures. Except in one case, where sudden, profound loss occurred following otorrhoea on third day, hearing loss was progressive in rest of cases.ConclusionA patient with deteriorating hearing after middle ear surgery must be evaluated properly. There is an increased chance of hearing loss following surgery that involves more ossicular manipulation, drilling, extensive disease clearance, and revision. Utmost care must be taken while operating around ossicles and during disease clearance in key areas. Proper consent should be taken from such patients to avoid future litigations.

Highlights

Hearing assessment after middle ear surgery has always been of interest to otologists for one of its major unavoidable and unpredictable complication is hearing loss
The mastoidectomy was performed in seven cases, either cortical (n = 5) and modified radical (n = 2)
Modified radical mastoidectomy showed the greatest incidence of hearing loss (40%) among all surgical procedures

Summary

Introduction

Hearing assessment after middle ear surgery has always been of interest to otologists for one of its major unavoidable and unpredictable complication is hearing loss. Aimed to detect the proportion of postoperative worsening of hearing, causes, and risk factors in patients undergoing middle ear surgery. The intricate anatomy of the middle ear makes otologist’s work challenging and difficult, as he must bal‐ ance preservation of functionality with eradication of disease [1]. An inherent risk of surgery for chronic mid‐ dle ear disease is that it may cause permanent damage of auditory structure resulting in permanent sensorineu‐ ral hearing loss (SNHL) in 1.2‐4.5% [2, 3]. Worsening of hearing resulting into SNHL after middle ear surgery has been described in the medical literature as early as 1960 [4]. Ipsilateral cochlea is potentially sub‐ jected to higher, damaging acoustic levels of 90 dB and above, whereas contralateral cochlea is exposed to 80‐85 dB noise levels during drilling [6]

Methods

Results

Discussion

Conclusion