Early Results from a Pressureless Middle Ear Diagnostic and Its Relation to the Types of Tympanometry Results.

To describe and quantify computed tomography (CT) findings of auto-evacuated (spontaneously drained) secondary acquired cholesteatoma (SAC). This multicenter retrospective study included 69 patients with intermittent ear discharge diagnosed with SAC by autoscopy or automicroscopy who were surgically treated. Three independent radiologists measured the medial and lateral attic distance on coronal and axial planes using multidetector computed tomography (MDCT) in 75 ear CTs from 69 patients with intraoperatively verified diagnoses of pars flaccida cholesteatoma (n=36), pars tensa cholesteatoma (n=24), and auto-atticotomy or automastoidectomy (n=15) and compared them with contralateral healthy ears. A circular or elliptical air-filled cavity surrounded by granulation tissue was morphologically detected on MDCT in these patients. The lateral attic distance was significantly higher in pars flaccida cholesteatoma cases than in contralateral healthy ears on both coronal and axial planes (p<0.05). The medial attic distance was significantly higher in pars tensa cholesteatoma cases than in contralateral healthy ears in the axial pane, but with no difference in the coronal plane. In patients with chronic intermittent aural discharge, nonopacified areas surrounded by granulation tissue, which expands the medial or lateral attic in a CT scan, suggest an auto-evacuated cholesteatoma.

BackgroundTemporal bone osteomyelitis in necrotizing otitis externa is a threatening condition, especially in immune-deficient people, with a relatively high morbidity and mortality rate. The bone densitometry by computerized tomography scan is one of the best methods in the diagnosis of temporal bone osteomyelitis.MethodsIn this case–control study, 103 patients who suffered from unilateral temporal bone osteomyelitis were referred to two specialist referral hospitals in Tehran. The bone densities of different parts of the temporal bone and adjacent structures were compared with the contralateral healthy ear. The correlation between bone densitometry and the temporal osteomyelitis diagnosis was assessed.ResultsSeventy-five patients were male (72.8%), the mean age was 68 ± 10.2 years, and the right ear was affected in 53 patients (51.5%). Twenty-seven patients (26.2%) had facial palsy. There was a significant difference in bone densities of four parts (mastoid cortex, external ear canal, mandibular condyle, and root of zygoma (paired t-test, p-value < 0.05)) of eight regions in the temporal bone in the infected ear compared with the contralateral healthy ear. There was a significant correlation between mastoid cortex density decreasing and facial palsy. The linear regression test predicted a model for mastoid involvement based on the mastoid cortex density and facial palsy.ConclusionBone density changes in temporal bone tomography can be an important predictive factor of disease and facial nerve involvement following temporal bone osteomyelitis.

In mastoid surgeries, contralateral ear noise exposure is a known, identified factor leading to high-frequency hearing loss due to the wide variety of surgical devices that may be used during the surgery. However, the hearing threshold recovery time after this trauma was uncertain. The present study aimed to assess this time. In this prospective survival analysis study, 28 consecutive patients with chronic otitis media who were undergoing tympanomastoidectomy were assessed. Standard pure-tone audiometry (PTA) and distortion-product otoacoustic emission (DPOAE) were measured in all contralateral ears before and 6 h, 24 h, 48 h, 72 h, and 96 h after the surgery. Based on the PTA postoperative hearing loss, survival rates at frequencies of 3000 Hz, 4000 Hz, 6000 Hz, and 8000 Hz were 44.4%, 36.4%, 51.7%, and 47.4%, 24 h after surgery; 11.1%, 9.1%, 10.3%, and 13.2%, 48 h after surgery; and 0%, 0%, 3.4%, and 2.6%, 72 h after surgery, respectively. Based on the PTA and DPOAE, survival rates at all frequencies were 0%, 96 h after the surgery. According to the PTA, mean hearing recovery times were 61.98 ± 26.76 h (3000 Hz), 62.73 ± 26.50 h (4000 Hz), 67.08 ± 25.90 h (6000 Hz), 70.70 ± 24.13 h (8000 Hz), and with regard to DPOAE the recovery times were 58.58 ± 28.39 h (2000 Hz), 63.32 ± 28.83 h (4000 Hz), 65.22 ± 29.13 h (6000 Hz), and 75.14 ± 22.70 h (8000 Hz), respectively. To conclude, high-frequency hearing loss usually occurs following mastoid surgeries that is mainly temporary and reversible after 72 h.

To evaluate vestibular evoked myogenic potentials (VEMPs) in cases of sudden deafness, and to confirm the noncochlear origin of the VEMPs. Prospective study. VEMPs, which were evoked by short tone burst (95 dB nHL) stimulation, were recorded in 20 patients with unilateral, idiopathic sudden deafness. The results of the deaf ears were compared with those of the contralateral healthy ears and the normal control ears. The relations between VEMPs and the hearing level or caloric response were then investigated. All 20 of the deaf ears displayed normal biphasic VEMPs. The mean latencies of p13 and n23, as well as mean amplitude p13-n23, were 15.1 +/- 2.8 msec, 20.7 +/- 3.3 msec and 25.2 +/- 12.6 microV, respectively, not significantly different to either the contralateral healthy ears (p > 0.05) or the normal control ears (p > 0.05). Five deaf ears displayed canal paresis or absent caloric response, whereas the remaining 15 ears revealed normal caloric response. All the lesioned ears of patients with idiopathic sudden deafness exhibit normal biphasic VEMPs. Neither the hearing level nor the caloric response correlated to the VEMPs.

Risk factors for sensorineural hearing loss in pediatric chronic otitis media

Most patients with suspicion of hydrops do not have access to MRI with 3D reconstruction of the endolymphatic space. Our main objective was to show that measurements of the saccule on a non-enhanced 3D-T2 MRI could show hydrops and help diagnose Menière disease. We conducted a prospective study from 2015 to 2016 to compare consecutive patients consulting for Menière's disease to a control group (patients with unilateral non-hydrops disorders and contralateral healthy ears). They all received full auditory and vestibular testing. They also underwent a 3-Tesla 3D-T2 MRI using CISS sequence (0.4mm thick slices), which were blindly evaluated by two independent neuroradiologists. The saccular height and width were measured in a coronal plane and Menière's disease patients' symptomatic ears were compared to asymptomatic and control ears. 36 patients with definite Menière's disease and 36 control patients were studied, including 42 symptomatic Menière, 30 asymptomatic Menière and 72 control ears. Saccular measurements were significantly different between symptomatic Menière ears compared to healthy ears (1.59 vs 1.32mm, p<0.001 for height; 1.13 vs 0.90mm, p<0.001 for width). Symptomatic and asymptomatic Menière ears' measurements were not significantly different (p=0.307 and p=0.109). Using ROC curve, we found cut-off values for saccular height 1.51mm, Se=63%, Sp=95% and width 1.05mm, Se=41%, Sp=95%. Routine 3D-T2 MRI, which patients must undergo for differential diagnosis, could help diagnose hydrops with high specificity using saccular measurements.

Objectives: 1. To find out which among dynamic slow motion video endoscopy (DSVE) and impedance audiometry is a better investigation for diagnosis of Eustachian tube dysfunction in the cases of middle ear disorders. 2. To correlate the Eustachian dysfunction with nasal pathology.Material and methods:  A case control study done on a total of 84 patients (168 ears) where ear complaints either unilateral or bilateral (total 95 ears) having middle ear disease were taken as cases. Patients without any ear and nasal complaints and normal ears of the case group were taken as controls (total 73 ears). DSVE was performed in cases and controls to compare the incidence of Eustachian dysfunction in the two groups. Impedance audiometry was performed in all cases by William’s or Toynbee’s test, depending on the presence of perforation. Nasal pathologies were identified by endoscopy or CT-scan.Results: On comparing DSVE findings with impedance audiometry, a strong association was found by applying Mc Nemar Chi square test. However, no significant correlation was found between results obtained on impedance audiometry with middle ear disease. In the mechanical type of dysfunction, we found nasal, paranasal or nasopharyngeal pathology in all the cases. In unilateral otitis media, the contralateral healthy ear was also associated with Eustachian dysfunction.Conclusion: DSVE is a better investigation than impedance audiometry for diagnosing Eustachian dysfunction in cases of chronic otitis media, especially the functional type. Nasal, paranasal or nasopharyngeal pathologies should be looked for in all cases of mechanical type of dysfunction and adequately addressed.

ObjectivesTo assess the hearing thresholds in acute otitis media, otitis media with effusion and chronic otitis media (non-suppurative, non-cholesteatomatous suppurative and cholesteatomatous) and to compare the hearing outcomes with non-diseased ears (in bilateral cases) or contralateral healthy ears (in unilateral cases), since hearing loss is the most frequent sequel of otitis media and there is no previous study comparing the audiometric thresholds among the different forms of otitis media. MethodsCross sectional, controlled study. We performed conventional audiometry (500–8000Hz) and tympanometry in patients with otitis media and healthy individuals (control group). Hearing loss was considered when the hearing thresholds were > 25 dBHL. ResultsOf the 112 patients diagnosed with otitis media (151 ears), 48 were men (42.86%) and 64 were women (57.14%). The average age was 42.72 years. Of those, 25 (22.32%) were diagnosed as AOM, 15 (13.39%) were diagnosed with OME and the remaining 72 (63.28%) were diagnosed with COM (non-suppurative COM, n=31; suppurative COM, n=18; cholesteatomatous COM, n=23). As compared with controls, all forms of otitis media had significantly higher bone-conduction thresholds (500–4000Hz). Conductive hearing loss was the most frequent type of hearing loss (58.94%). However, the number of patients with mixed hearing loss was also relevant (39.07%). We noted that the presence of sensorioneural component occurred more frequently in 1) Higher frequencies; and 2) In groups of otitis media that were more active or severe in the inflammatory/infective standpoint (AOM, suppurative COM and cholesteatomatous COM). ConclusionAll types of otitis media, even those with infrequent episodes of inflammation and otorrhea, had worse bone conduction thresholds as compared with nondiseased ears (p<0.01). We observed worse hearing outcomes in ears with recurrent episodes of otorrhea and in ears with AOM, especially in high frequencies.

Introduction: Vertigo, a multisensory symptom, is one of the most common presentations to otolaryngology clinic and may occur in a multitude of ENT-related diseases, thus making a correct diagnosis challenging. In the last few decades, there has been a paradigm shift in the diagnostics of vertigo due to the availability of better objective modalities that allow assessment of different components of the complex vestibular labyrinth with relative ease. With the advent of vestibular evoked myogenic potentials (VEMP) since the last few decades, it is possible to test otolith organs in isolation and objectively. Aim: The aim of this study is to study the effectiveness of cervical VEMP (cVEMP) in the evaluation of saccular function in patients suffering from peripheral vertigo. Study Design: Analytical cross-sectional study. Setting: Tertiary care hospital. Materials and Methods: The study was conducted over a period of 2 years, from December 2016 to October 2018 at the ENT department of a tertiary care hospital. A sample size of 40 patients of peripheral vertigo and 40 age-matched healthy controls was selected. Air conduction cVEMP was performed in cases of posterior canal benign paroxysmal positional vertigo (pBPPV), vestibular neuritis (VN), superior semicircular canal dehiscence syndrome (SCD), and Meniere's disease (MD) and their values were compared with contralateral healthy ears and controls. Results: cVEMP parameters in VN, SCD, and MD were found to be abnormal, and the difference from normal was statistically significant. However, in the case of pBPPV patients, they did not show any difference from the normal. Conclusion: cVEMP is found to be a useful screening tool for conditions such as VN, SCD, and MD.

Otitis media has been associated with several auditory and developmental sequelae. Here, the results of auditory tests were evaluated in patients who had a first episode of unilateral otitis media and compared with the contralateral healthy ear. Cohort study. This study was undertaken from 2015 to 2016, with a follow-up period of 6 months. A total of 41 patients who had been diagnosed with unilateral acute otitis media were selected. Standard (250 Hz-8 kHz) and extended high-frequency (8 kHz-16 kHz) audiometry was performed within 5 days of the beginning of the clinical symptoms, and then in defined time frames for a period of 6 months. The results of the contralateral healthy ears were used as individual controls. After closure of the initial air-bone gap, the results of the standard audiometry did not demonstrate significant differences in the thresholds of diseased ears compared with controls. A significant elevation of the mean extended high-frequency thresholds in the ears affected by otitis media was observed at the first and subsequent appointments within the 6-month follow-up period. Diseased ears from patients who experienced tinnitus during the 6-month follow-up period had significantly higher thresholds in the extended high frequencies than diseased ears from patients without residual tinnitus. These results suggest that the first episode of otitis media may lead to persistent elevation of the mean thresholds of extended high-frequencies, whereas persistent tinnitus after 6 months of the acute infection is associated with more severe hearing loss. 2b Laryngoscope, 128:2879-2884, 2018.

To analyze the sectional anatomical features of auricular and middle ear malformation in patients with microtia so as to improve the clinical classification and the instruction of surgery. From Jun. to Dec. 2009, 36 cases with microtia were selected in the center of auricular reconstruction in Plastic Surgery Hospital, including 22 cases of unilateral microtia and 14 cases of bilateral microtia. 22 patients with unilateral microtia were studied with the contralateral healthy ears as controls. Spiral CT was performed for high-resolution scan of the temporal bone. The coronal, sagittal and 3D reconstruction images were created with Mimic software. Several distances and degrees were measured. The patients were classified by Max classification. The anteroposterior diameter and the vertical diameter of tympanic cavity were (7.75 +/- 1.92) mm and (14.66 +/- 4.75) mm for type I; (6.17 +/- 2.56) mm and(14.35 +/- 5.12) mm for type II; (6.31 +/- 3.40) mm and (9.97 +/- 4.36) mm for type III (P = 0.001). The mastoid pneumatization degree for type I, II, III were 13.33%, 13.64%, 30.77% in sclerotic type, 13.33%, 18.18%, 7.69% in diploe type, 0, 9.09%, 38.46% in composite type, 73.33%, 59.09%, 23.08% in pneumatic type (chi2 = 24.11, P = 0.002). The cover of fenestra vestibuli by facial nerve was 21.43%, 47.62%, 54.55% (chi2 = 23.44, P = 0.002) for type I, II, III. There was a statistical difference between the microtia group and the control group. According to the Max classification, the middle ear malformation changed along the auricular malformation. The anatomical variations was complicated in type II microtia, which should be sub-classified.

Objectives: 1. To find out which among dynamic slow motion video endoscopy (DSVE) and impedance audiometry is a better investigation for diagnosis of Eustachian tube dysfunction in the cases of middle ear disorders. 2. To correlate the Eustachian dysfunction with nasal pathology.Material and methods:  A case control study done on a total of 84 patients (168 ears) where ear complaints either unilateral or bilateral (total 95 ears) having middle ear disease were taken as cases. Patients without any ear and nasal complaints and normal ears of the case group were taken as controls (total 73 ears). DSVE was performed in cases and controls to compare the incidence of Eustachian dysfunction in the two groups. Impedance audiometry was performed in all cases by William’s or Toynbee’s test, depending on the presence of perforation. Nasal pathologies were identified by endoscopy or CT-scan.Results: On comparing DSVE findings with impedance audiometry, a strong association was found by applying Mc Nemar Chi square test. However, no significant correlation was found between results obtained on impedance audiometry with middle ear disease. In the mechanical type of dysfunction, we found nasal, paranasal or nasopharyngeal pathology in all the cases. In unilateral otitis media, the contralateral healthy ear was also associated with Eustachian dysfunction.Conclusion: DSVE is a better investigation than impedance audiometry for diagnosing Eustachian dysfunction in cases of chronic otitis media, especially the functional type. Nasal, paranasal or nasopharyngeal pathologies should be looked for in all cases of mechanical type of dysfunction and adequately addressed.

In advanced otological surgeries, powered instruments form an indispensable part. The risk of deterioration to hearing in the operated ear is a commonly discussed issue, however, there remains a possibility of affecting the hearing in the contralateral ear due to transcranial vibration. So in this study we aimed to assess the possibility of the non-operated ear being affected by the noise generated during ear surgeries and whether it is temporary or permanent in nature. Methodology: This study included 63 patients diagnosed with unilateral disease who underwent mastoid surgery. Preoperatively all the patients were subjected to Pure tone audiometry (PTA), Transient evoked otoacoustic emission (TEOAE) and Distortion product otoacoustic emission (DPOAE). Patients were operated using both cutting and diamond burrs of ranging from sizes 1 - 6 mm. Total drilling time was recorded. Results: Post-operative hearing evaluation was done at 1 week, 4 weeks and 12 weeks. The sound emitted by various burrs was recorded by Sound Level Meter. Out of the total 58 patients that followed up, 46 showed change in at least one of the hearing parameters. Patients showing changes had a higher drilling time as compared to those with no changes. Of these, the changes associated with the total drilling time and with cutting burr time were found to be significant. The hearing changes seen on PTA, TEOAE and DPOAE were transient in nature with only one patient having a persistent decreased high frequency threshold at the end of 12 weeks. It was also found that cutting burrs produce more sound as compared to diamond burrs and a larger size burr of a type produces more sound than a smaller one of its type. Conclusion: The drilling of mastoid bone during ear surgeries can transiently impair the hearing in the contralateral ear which is of great significance in patients with only one hearing ear.

Objective: To study the shift of oVEMP frequency tuning of unilateral Meniere's disease, by analyzing oVEMP of air-conducted tone bursts in various frequencies. Methods: From May 2016 to October 2017, 33 patients with unilateral Meniere's from Aerospace Center Hospital were tested for oVEMP in 500 Hz and 1 000 Hz air-conducted tone bursts respectively, and 20 healthy subjects(40 ears), matched for age and sex, were used as healthy control. The amplitudes of the N1-P1 wave and the frequency amplitude ratios of 500/1 000 Hz in affected ears, unaffected ears and normal ears were compared; and receiver operating characteristic curve was analyzed for frequency amplitude ratios of 500/1 000 Hz. Results: By the 500 Hz tone-burst stimulus, the provocation rates of the oVEMP were 84.9%(28/33), 93.9%(31/33) and 97.5%(39/40) in affected ears, contralateral ears and the ears of normal controls, respectively. By the stimulus of 1 000 Hz tone-burst, the provocation rates of the oVEMP were 81.8%(27/33), 87.9%(29/33) and 82.5% (33/40) in affected ears, contralateral ears and normal control ears, respectively. Amplitudes of N1-P1 waveforms in 500 Hz air-conducted tone bursts in affected ears were under normal control ears and contralateral ears. There was significant difference between affected ears and healthy control ears (P<0.05). Amplitudes of N1-P1 waveforms in contralateral ears were also significantly smaller than those in normal control ears (P<0.05). There were no significant differences in amplitudes of N1-P1 waveforms between affected ears, contralateral ears and normal control ears in 1 000 Hz tone bursts stimulus(P>0.05). Frequency amplitude ratios of 500/1 000 Hz in affected ears were significantly under contralateral and normal control ears (P<0.05). According to ROC, the frequency amplitude ratio critical value of frequency tuning was set as 1.17, the positive rate of frequency tuning shift in affected ears was 54.5%(18/33) and significantly higher than in contralateral ears(18.2%, 6/33, χ(2)=9.429, P=0.002) and normal control ears (7.5%, 3/40, χ(2)=19.530, P=0.000). In contrast, there was no significant difference in the incidence of frequency tuning shift between contralateral ears and normal ears(χ(2)=1.909, P=0.167). Conclusions: Frequency tuning oVEMP with Meniere's disease will be changed.Frequency tuning of oVEMP with Meniere's disease shifts from low frequency region to high frequency region in comparison with healthy people. Frequency amplitude ratio is helpful for diagnosis of Meniere's disease.

Introduction: Chronic otitis media is one of the most common ear diseases in developing countries like Nepal and is important cause of the hearing loss. Chronic otitis media is rarely an isolated entity, because the responsible factors for its development in one ear in similar way will impact the contralateral ear, since both ears have a common “nasopharyngeal” drainage. Contralateral ear is defined as asymptomatic ear in cases of unilateral chronic otitis media. Aims: To evaluate the audiological profile of Contralateral ear in post-operative subjects of unilateral otorrhoea. Methods: Patients fulfilling criteria underwent Otoscopic examination, tuning fork test and pure tone audiometry. The findings of contralateral ear like retraction, tympanosclerotic patch (TS patch), thin, dull and atrophied tympanic membrane were noted. The final diagnosis with the type of surgery of diseased ear, as well as status of contralateral ear were entered into the proforma. All the patients were followed till three months in relation to anatomy of Tympanic membrane onotomicroscopy and pure tone audiometry respectively. Results: In postoperative cases of mucosal disease, the cases with abnormality in the contralateral ear reduced from 17 to 10 patients (30.3%) and the normal patients increased from 16 to 23 cases (69.7%). Likewise, in postoperative squamous disease, the cases with abnormality in the contralateral ear reduced from 14 to 11 patients (64.7%) and the normal patients increased from 3 to 6 cases (35.3%). Out of 50 cases, 14 cases (28%) had defective hearing while 36 cases (72%) had normal hearing in the contralateral ear respectively. Conclusion: The high incidence of occurrence of abnormality in contralateral ear indicate that both ears should be regarded as a pair. Unilateral Chronic otitis media should not be taken as a static phenomenon but as a continuous process in the other ear too.