AC Threshold Research Articles

Comparison Between the Veillon and the Symons-Fanning CT Classification Systems for Otosclerosis.

To analyze the correlation between outcomes of stapes surgery and preoperative and postoperative audiometric results with different radiological staging classifications such as the Veillon classification (VC) and the Symons-Fanning classification (SFC). Retrospective observational study. One tertiary hospital center. Adult patients submitted to stapes surgery due to otosclerosis from January 2017 to December 2022. Evaluation of different radiological classifications such as the VC and SFC. Preoperative and postoperative pure-tone audiometric data, outcomes of stapes surgery success (closure of the ABG, rates of AC threshold less than or equal to 30 dB), and postoperative sensorineural hearing loss. A total of 87 patients and 97 operated ears were included. The SFC was associated with preoperative BC (p = 0.041) and AC (p = 0.018) and postoperative BC (p = 0.026) with an increase in thresholds with higher radiological stages. The VC was associated with postoperative AC (p = 0.045) with an increase in AC thresholds with increasing radiological stages. Lastly, both the VC (p = 0.032) and the SFC (p = 0.023) were associated with a decrease in rates of postoperative AC thresholds ≤30 dB with higher radiological stages. The SFC seems to be more useful to predict preoperative AC and BC and postoperative BC. On the contrary, the VC was more useful to predict postoperative AC. Both scales were similarly associated with the rate of AC thresholds ≤30 dB.

“Hot” vs “Cold” endoscopic stapes surgery: a matched case–control study

PurposeTo compare hearing results and complication rates between two groups of patients operated on by endoscopic stapes surgery (ESS) for otosclerosis, either with CO2 fiber laser or microdrill.MethodsA case–control study was performed. All consecutive cases of CO2 fiber laser ESS operated at a single center during the period 2017–2020 (case group) were matched to a control group of patients operated by traditional technique, according to year of surgery, preoperative mean air–bone gap, sex and age. Audiological data from preoperative and postoperative examinations and complication rates were compared.Results46 cases were included. Mean operative time was significantly longer in the laser cohort (65 min) than in the drill one (45 min) (p = 0.003). Similar results were found in the two groups regarding the mean postoperative BC-PTA. The high-frequency bone conduction resulted significantly higher in the laser group (p = 0.002), suggesting an overclosure effect in the laser group. Consistently, a significant improvement of the BC-PTA threshold at 2000 Hz postoperatively was found in the laser group (p = 0.034). The postoperative AC-PTA significantly improved in both groups at all frequencies (p < 0.05), except for the AC threshold at 8 kHz. Similar rates of complications were found in the two groups.ConclusionThis study is the first to compare hearing results and complications between CO2 fiber laser and microdrill in ESS. Our results demonstrated similar functional outcomes between the two groups, confirming ESS as safe and effective, regardless of the technique used.

Assessment of orthodontic borderline treatment need: A comparison of two aesthetic indices

ObjectiveTo compare a new “guide for borderline orthodontic need” (GBON) with the “aesthetic component” (AC) of the IOTN in assessing borderline cases (dental health component DHC 3), and to compare reliability and opinions of orthodontists on the use of each index.Materials and methodsCross-sectional population descriptive study. Ninety-four qualified orthodontists assessed 30 borderline malocclusions according to the GBON and AC indices and completed a questionnaire.ResultsKappa analysis showed GBON and AC to have similar intra-examiner reliability (K = 0.64 and 0.60 ,respectively). Cronbach’s alpha inter-examiner reliability analysis showed GBON and AC to have similar, acceptable reliability (α = 0.7 and 0.9 ,respectively). There was only fair agreement between GBON and AC in terms of the number of malocclusions deemed as needing treatment (AC threshold 6). Analysis of specific occlusal traits revealed that reverse overjets were deemed as needing treatment according to AC but not anterior open bites. Both traits were assessed as needing treatment according GBON. Despite a lack of familiarity with GBON, assessors found GBON easier to use and more appropriate in assessing borderline malocclusions.ConclusionsBoth GBON and AC had good and similar inter- and intra-examiner reliability. There was substantial agreement on treatment need between GBON and AC but only when the AC threshold is reduced to 4. GBON was more able to identify malocclusal traits in need of treatment than AC. GBON was found to be easier to use and considered more appropriate than AC in judging DHC 3 malocclusions.

Transcanal Endoscopic Tympanoplasty: Our Experience at a Tertiary Care Centre.

Transcanal Myringoplasty can be performed with both microscope and endoscopes. Advancement in endoscopes has started the new era of minimal invasive surgery in otology practice. Endoscopic approach offers improved visualization with wider field of view, easy access to the hidden recesses of the middle ear, avoidance of a postauricular incision and less bony drilling. To report our experience with transcanal endoscopic tympanoplasty for tubotympanic type of COM and to evaluate its outcome in terms of morphological and functional success. Prospective study, conducted during September 2017 to August 2019, including 60 patients of tubotympanic type of COM. All patients underwent transcanal endoscopic type 1 tympanoplasty. Postoperative results i.e. graft uptake (morphological success) and hearing improvement (functional success) were evaluated at 6months. The graft take up rate was 93.33%. Preoperatively mean AB gap was 23.15 ± 7.23dB which was reduced to 11.68 ± 4.65dB at 6month postoperative follow up. The mean gain in AC threshold and AB gap was 15.43 ± 4.37dB and 11.46 ± 1.13dB respectively. Improvement in both AC threshold and AB gap was statistically significant (p < 0.0001). No major surgical or thermal injury related complications were observed. Although both microscopic and endoscopic techniques have their advantages and disadvantages, endoscopic technique can effectively replace traditional microscopic techniques in management of COM with satisfactory outcomes. We infer that EES offers less operative time, less postoperative pain, least complications and less hospital stay thus helping to reduce the physical and psychological burden placed on patients.

Ossicular reconstruction of incudo-stapedial joint by glass ionomer\u2014a study of 24 cases

BackgroundChronic otitis media is one of the major health issues worldwide resulting in partial or complete loss of conductive hearing mechanism including the tympanic membrane and ossicular assembly. The aim of the study is to assess hearing improvement after reconstructing the incudo-stapedial joint with glass ionomer cement. Here, a prospective observational study was done in a tertiary care hospital. Patients of chronic mucosal otitis media were operated, and intraoperatively incudo-stapedial joint discontinuity was restored using glass ionomer cement. Post-operative follow-up was done at 1-month, 3-month, 6-month, and 1-year intervals, and hearing was evaluated by doing pure tone audiometry with air conduction at 0.5, 1, 2, 3, 4, 6, and 8 kHz and bone conduction at 0.5, 1, 2, 3, and 4 kHz. Tabulation was done by calculating the air-bone gap in each patient.ResultsIn our study, the patients showed statistically significant improvement in air conduction thresholds and near closure of air-bone gap post-operatively. The mean AC threshold is 15 dB with 91.67% patients having closure of ABG < 20 dB at the end of the 3rd month. Hearing was also evaluated at 6-month and 1-year intervals, which showed good improvement in hearing levels.ConclusionsGlass ionomer is a simple, physiological, and cost-effective method of tympano-ossicular reconstruction with certain significant post-operative hearing improvement.

Study on impact of duration of tympanic membrane perforation on hearing loss and audiological outcome after surgery

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of the study was to assess impact of duration of tympanic membrane perforation on hearing loss and postoperative audiological outcome using pure tone audiogram.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present study was conducted on 100 patients in department of ENT and HNS, SMGS Hospital, Government Medical College Jammu during a time period of November 2018 to October 2019. All the patients with age 15 to 60 years who presented with tympanic membrane (pars tensa) perforation were included in the study. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study, mean preoperative hearing loss (AC threshold) of group A was 36.23±1.07 dB and of group B was 25.67±6.38 dB. Group C had mean preoperative hearing loss (AC threshold) of 28.78±6.50 dB. Mean preoperative air-bone gap (AB gap) of group A was 12.9±8.05dB and of group B was 13.86±4.19 dB. Group C had mean preoperative air-bone gap (AB gap) of 16.47±5.51 dB. Postoperatively, pure tone threshold at three months was least in group B (15.09±5.80 dB), followed by group C (15.68±4.66 dB) and group A (19.33±2.81 dB). Whereas, postoperative AB gap at 3 months was least in group C (10±3 dB), followed by group C (8.44±3.59 dB). Group B had maximum postoperative AB gap of 8.49±4.34 dB.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study did not show any correlation between duration of disease and degree of hearing loss.&lt;/p&gt;

Endoscopic transtympanic cartilage push-through myringoplasty without tympanomeatal flap elevation for tympanic membrane perforation

Background The elevation of the tympanomeatal flap in endoscopic myringoplasty will cause considerable tissue damage. Objective To analyze anatomic and audiological results of tympanic membrane perforation underwent endoscopic transtympanic cartilage push-through myringoplasty without tympanomeatal flap elevation (EPM) and their relationship with the size of perforation. Methods A clinical retrospective study was performed on 75 cases of tympanic membrane perforation that underwent EPM from January 2019 to March 2021. Graft success and hearing outcomes were evaluated 3 months after surgery. Results The overall graft success rate for EPM was 94.7% (71/75). The total rate of hearing success, postoperative ABG ≤ 20 dB was achieved in 96.0% (72/75). The overall mean AC threshold of 35.1 ± 5.6 dB was lowered to 25.0 ± 4.8 dB postoperatively (p < .01). The mean pre- and postoperative ABG of all patients were 20.5 ± 4.6 dB and 10.4 ± 3.9 dB (p < .01), respectively. The graft success rates for the small, middle and large perforations groups were 100% (11/11), 100% (34/34) and 86.7% (26/30), respectively. Conclusion It is revealed that EPM is an effective method to repair perforation of tympanic membrane. The size of the tympanic membrane perforation may be a risk factor for perforation healing and hearing recovery, although EPM is available for large perforations.

Treatment Outcome of the Bony Obliteration Tympanoplasty Versus Nonobliterative Techniques in Cholesteatoma Surgery: A Retrospective Analysis.

In cholesteatoma surgery, obliteration of the mastoid and epitympanic space (bony obliteration tympanoplasty, BOT) is an increasingly used technique with low recurrent and residual cholesteatoma rates. While factors as the postoperative hearing level and infection rate are important for the patient as well, these outcome parameters are not frequently reported on in current literature. The objective of this study is to evaluate the recurrent and residual cholesteatoma rates of the BOT technique and nonobliterative canal wall up (CWU) and canal wall down (CWD) mastoidectomy in a large patient cohort. Secondary objectives were to evaluate the infection rate and hearing outcome for all three techniques. Retrospective cohort study. Single-center study. All 337 adult patients (≥18 yrs) who underwent primary or revision cholesteatoma surgery between January 2013 and March 2019 were included. Recurrent cholesteatoma rates, residual cholesteatoma rates, postoperative infections and other complications, hearing outcome. The estimated combined rate of recurrent and residual cholesteatoma at 5 years follow-up was 7.6% in the BOT group, 34.9% in the CWU group, and 17.9% in the CWD group. The postoperative infection rate in the different groups ranged from 4.3% to 4.9%. The median gain in AC threshold level varied from 0.0 dB in the BOT and CWD group to 3.8 dB in the CWU group. We show that cholesteatoma recurrence rates after the BOT technique in our clinic are significantly lower compared to CWU surgery. There were no differences in infection rate and no clinically relevant differences in postoperative hearing between the BOT, CWU, and CWD technique.

Single centre experience of ossiculoplasty using different materials: a subjective and objective evaluation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media has serious impact over the ossicular integrity in middle ear resulting in ossicular necrosis and various grades of hearing loss along with other associated symptoms. Tympanomastoidectomy with ossicular reconstruction using various materials can improve the symptoms.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective study of 50 patients underwent tympanomastoidectomy with ossiculoplasty in Department of ENT and Head and Neck Surgery at AIIMS Patna from April 2017 to 2018. Patients with chronic otitis media having ossicular necrosis with ABG (air bone gap) more than 25 dB were included in this study. PORP (partial ossicular reconstruction prosthesis) and TORP (total ossicular reconstruction prosthesis) were used as ossicular reconstruction after clearance of disease. This study was expressed as subjective and objective evaluation following ossiculoplasty. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Fifty patients having chronic otitis media with decreased hearing and other associating symptoms were included in this study. Preoperative air conduction threshold was 55.32 dB with preoperative ABG was 44.24 dB. Postoperative result was summarised as postoperative AC threshold was 32.72 dB with gain of 22.60 dB with ABG 25.45 dB.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Chronic otitis media may lead to ossicular necrosis and various grade of hearing loss. A proper technique and skilled tympanomastoidectomy with ossiculoplasty can improve the symptoms of chronic otitis media.&lt;/p&gt;

Graft uptake and hearing assessment in revision myringoplasty in a tertiary centre

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The revision myringoplasty surgery is done for the graft failure after myringoplasty. The surgeons’ make use of the temporalis fascia or cartilage as the graft material. Some surgeons opt for the revision myringoplasty with cortical mastoidectomy as well.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study is a retrospective, observational study done in the Department of ENT and Head and Neck Surgery, Tribhuvan University Teaching Hospital from December 2015 to 2019. Data of all the patients undergoing revision myringoplasty with or without cortical mastoidectomy were collected from the record section and included in the study. Post-operatively, the patients were assessed for graft uptake and hearing assessment after six weeks of surgery. Total uptake of the graft was taken as the successful graft uptake. The hearing was assessed by air conduction threshold (AC threshold) and air-bone gap status postoperatively. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Total of 42 patients were analysed with the graft uptake of 86%. There was no significant difference in the graft uptake on using the temporalis fascia or tragal cartilage. Regarding the hearing assessment, the average pre-operative and post-operative AC threshold was 37.95±5.68 dB and 29.36±6.28 dB. The average pre and postoperative AB gap was 29.97±8.16 dB and 21.85±6.68 dB. The improvement in the hearing threshold was significant (p value &amp;lt;0.05).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The graft uptake rate for revision surgery in our centre was comparable to other studies in the literature. There was significant hearing improvement pre and postoperatively after revision myringoplasty.&lt;/p&gt;

Power-Law Distributions of Dynamic Cascade Failures in Power-Grid Models.

Power-law distributed cascade failures are well known in power-grid systems. Understanding this phenomena has been done by various DC threshold models, self-tuned at their critical point. Here, we attempt to describe it using an AC threshold model, with a second-order Kuramoto type equation of motion of the power-flow. We have focused on the exploration of network heterogeneity effects, starting from homogeneous two-dimensional (2D) square lattices to the US power-grid, possessing identical nodes and links, to a realistic electric power-grid obtained from the Hungarian electrical database. The last one exhibits node dependent parameters, topologically marginally on the verge of robust networks. We show that too weak quenched heterogeneity, coming solely from the probabilistic self-frequencies of nodes (2D square lattice), is not sufficient for finding power-law distributed cascades. On the other hand, too strong heterogeneity destroys the synchronization of the system. We found agreement with the empirically observed power-law failure size distributions on the US grid, as well as on the Hungarian networks near the synchronization transition point. We have also investigated the consequence of replacing the usual Gaussian self-frequencies to exponential distributed ones, describing renewable energy sources. We found a drop in the steady state synchronization averages, but the cascade size distribution, both for the US and Hungarian systems, remained insensitive and have kept the universal tails, being characterized by the exponent . We have also investigated the effect of an instantaneous feedback mechanism in case of the Hungarian power-grid.

Silver nanoparticles dispersed in nematic liquid crystal: an impact on dielectric and electro-optical parameters

In the present study, nematic liquid crystal (NLC) 4′-(Octyloxy)-4-biphenylcarbonitrile dispersed with three different concentrations of silver nanoparticles (Ag NPs) is characterized by electro-optical and dielectric spectroscopy method. The dispersion of Ag NPs into NLC material leads to the change in physical parameters such as dielectric permittivity, photoluminescence, threshold voltage, response time and splay elastic constant. The AC conductivity and threshold voltage of Ag NPs-dispersed composite system have increased significantly. The increase in the AC conductivity for the composite system is attributed to the Ag NPs-assisted induced charge transfer mechanism in the system. Moreover, the increase in AC conductivity value for Ag NPs/NLC composite system discloses its importance in photovoltaic solar cell.

A Retrospective Analysis and Comparison of the STAM and STAMCO Classification and EAONO/JOS Cholesteatoma Staging System in Predicting Surgical Treatment Outcomes of Middle Ear Cholesteatoma.

To evaluate and compare the STAM classification, STAMCO classification and the EAONO/JOS staging system as predictors for cholesteatoma recidivism and postoperative hearing, using a large patient cohort in our tertiary referral center. Two hundred thirty-one patients who underwent surgery for primary cholesteatoma between 2003 and December 2012 were included and retrospectively classified and staged according to the STAM classification, STAMCO classification, and EAONO/JOS staging system. Data on cholesteatoma recidivism rates and postoperative hearing were collected. The predictive value of the three instruments for recurrent and residual cholesteatoma was compared by using receiver operating characteristic curves. For predicting recurrent cholesteatoma, the STAMCO classification was significantly superior compared to the other two instruments. For predicting residual cholesteatoma, the STAMCO classification was superior to the EANO/JOS Staging system. The postoperative hearing shows a significant increase in ABG with increasing extension of cholesteatoma in the CWU group and a significant decrease in AC threshold level with increasing stage and a significant increase in AC with increasing ossicular chain status in the CWD group. Based on our study, the STAMCO classification represents the best available predictor for recurrent cholesteatoma and holds most promise for predicting residual cholesteatoma. Extension of cholesteatoma seems to be linked to postoperative hearing and thus the classifications and staging systems may be able to predict postoperative hearing. More studies are needed to assess the validation of these classifications.

Relation between the duration of disease and audiogram findings in tubotympanic type of chronic suppurative otitis media after myringoplasty

Introduction: Chronic Suppurative Otitis Media (CSOM) has been an important cause of hearing loss and ear discharge in people affected by it for a significant time now. Its prevalence is more in developing countries where the socioeconomic status is low. Poor and overcrowded living conditions, poor hygiene and nutrition have been suggested as a basis for the widespread prevalence of CSOM in developing countries. Pure Tone Audiometry is the easiest and the most basic procedure which needs to be performed on any patient who has history of hearing loss irrespective of the nature of the disease and the cause surrounding it. Every initial evaluation for CSOM should include audiometric testing via air and bone along with pure tone thresholds. Aims & Objectives: To co-relate the hearing loss to the duration of the disease in the ear in patients with CSOM and to also associate the same to the corresponding hearing changes after Myringoplasty. Materials & Methods: Sixty patients were taken to be part of the study after following a strict inclusion and exclusion criteria. With proper consent, they underwent Pure Tone Audiogram and Myringoplasty. Their Air Bone Gap and Air Conduction Threshold results were tabulated with the duration of the disease and a consensus was reached at. Observations & Results: It was observed that the hearing loss was much lesser if the duration of the disease was lesser than one year. As the diagnosis was delayed, both the AB gap and the mean AC threshold went up. The early closure of the perforation can significantly bridge the AB gap but the same cannot be said about the AC threshold as it seemed to be lesser affected by the duration. Conclusion: It can thus be concluded that AC threshold is quietly independent of the changes in the diseased middle ear as compared to the AB gap. This makes it a stronger tool in the assessment of hearing. The early diagnosis and management of Tubotympanic type of CSOM can not only help in preventing complications but also aid in better hearing protection which in-turn helps in better social survival.

Hearing results in modified radical mastoidectomy with type III tympanoplasty

&lt;p class="abstract" style="display: inline !important;"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The objective of the study was to hear the results in patients with atticoantral-chronic otitis media who undergone canal wall down mastoidectomy with different types of tympanoplasty.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 86 cases of CSOM-AA were included. Patients were divided in 3 groups according to intra-operative ossicular chain status and reconstruction. Group A were patients having intact stapes superstructure and the graft kept over the stapes head covering middle ear and mastoid cavity. Group B patients were with intact superstructure of stapes and graft kept over cartilage graft kept on mobile stapes head. Group C patients were with absent superstructure of stapes with intact, mobile footplate and graft kept over autologous or homologous cartilage kept on footplate of stapes. On 10&lt;sup&gt;th&lt;/sup&gt; week and 24&lt;sup&gt;th&lt;/sup&gt; week after surgery, PTA was carried out to compare pre and post-operative hearing status. The study was conducted at SMIMER Hospital, Surat (a tertiary health care hospital) fromSeptember 2016 to September 2017. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In 86 patients, average mean preoperative AC threshold was 48.16 (±15.15) dB, mean pre-operative BC was 8.96 (±7.85) dB and mean pre-operative air bone gap was 40.11 (±12.92) dB. The mean post-operative AC threshold was 43.17 (±13.72) dB, mean post-operative BC was 11.34 (±9.44) dB and postoperative air bone gap was 32.06 (±11.62) dB. The mean air bone gap closure was 8.76 (±11.86). This hearing gain was statistically highly significant (p&amp;lt;0.001). Among 86 patients, cartilage was used in total 60 patients. Mean ABG was 8.6 dB, 11.05 dB and 8.43 dB respectively for tragal, conchal and homologous septal cartilage. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Hearing improvement can be achieved with appropriate reconstruction in CWD mastoidectomy.&lt;/p&gt;

Perichondrium - An Autologous Substitute for Temporalis Fascia in Type I Tympanoplasty: A Comparative Study

Introduction &#x0D; Temporalis fascia is the commonly used graft material for tympanic membrane reconstruction. Tragal perichondrium share with the fascia the quality of being mesenchymal tissue. In our study we compared perichondrium and temporalis fascia in terms of graft uptake and hearing improvement.&#x0D; Materials and Methods&#x0D; All patients presenting with discharge from ear and decreased hearing were subjected to clinical examination and investigation. Patients satisfying inclusion criteria were included in study with total of 40 patients. Twenty underwent type1 tympanoplasty with temporalis fascia (TF) and another 20 patients with tragal perichondrium (TP). To evaluate success patients are evaluated at end of 6 months for graft uptake and 3 months for hearing results in audiological gain of 10 dB in two consecutive frequencies.&#x0D; Results&#x0D; Mean Pre-op AC Threshold in TF group was 30.75 dB±5.16 and Post-op AC Threshold was 14.15 dB±8.05. Mean Pre-op AC Threshold in TP group was 32.2 dB±4.81 and Post-op AC Threshold was 20.95 dB±7.14. Mean post-op AC Threshold, Mean Post-Op AB Gap and Mean Audiological Gain was statistically significant among 2 groups p=0.0075, p=0.0013, p=0.0294 respectively. Temporalis fascia was better than Tragal Perichondrium. Graft uptake in 2 groups was not significant (p=0.6325).&#x0D; Conclusion&#x0D; From the present study we may conclude that temporalis fascia, tragal perichondrium free grafts provide viable autograft material for tympanoplasty. Both achieve good hearing restoration but the improvement in hearing or audiological gain is better in temporalis fascia graft than in tragal perichondrium graft.

Titanium ossicular chain reconstruction in single stage canal wall down tympanoplasty for chronic otitis media with mucosa defect.

To evaluate surgical outcomes for chronic otitis media with mucosa defect underwent titanium ossicular chain reconstruction (OCR) in single stage canal wall down tympanoplasty (CWD). A clinical retrospective study was performed on 83 cases of the chronic otitis media with mucosa defect and 123 ears with mucosa integrity according to intraoperative findings that underwent synchronous titanium OCR in single stage CWD form January 2012 to January 2018. Pre- and postoperative air conduction threshold (AC), air-bone gap (ABG) and ABG closure at 0.5, 1, 2, and 4 kHz were investigated. The overall mean AC threshold of 53.4 ± 16.5 dB was lowered to 41.2 ± 15.9 dB postoperatively (p < 0.01). The mean pre- and postoperative ABG of all patients were 27.9 ± 9.9 dB and 17.2 ± 9.3 dB (p < 0.01), respectively, with a mean ABG closure of 10.7 ± 8.4 dB. The total rate of success, postoperative ABG ≤ 20 dB was achieved in 71.4%. In the mucosa defect group underwent TORP, the mean pre- and postoperative ABG were 28.1 ± 9.8 dB and 20.1 ± 9.0 dB (p < 0.01), respectively, with the ABG closure was 8.0 ± 7.9 dB. In the mucosa defect group underwent PORP, the mean pre- and postoperative ABG were 27.9 ± 10.1 dB and 16.5 ± 9.1 dB (p < 0.01), respectively, with the ABG closure was 11.4 ± 8.6 dB. Furthermore, in the mucosa defect group, there was significant difference in success rate of achieved postoperative ABG ≤ 20 dB between the TORP (48.9%) and PORP (77.5%) (p < 0.05). It is revealed PORP in single stage CWD tympanoplasty for the patients suffered from chronic otitis media with mucosa defect is favored.

PD07-02: Docetaxel Is Superior to Paclitaxel Given Every Three Weeks in Post Operative Patients with Node-Positive Breast Cancer: Results of the Final Analyses of the NSAS-BC (National Surgical Adjuvant Study of Breast Cancer) 02 Trial from Japan.

Abstract Background: Four cycles of doxorubicin plus cyclophosphamide (4-AC) followed by four cycles of a taxane is widely used for postoperative chemotherapy in breast cancer (BC). Concern about relatively rare, but life-threatening toxicity of anthracyclines such as heart failure and secondary leukemia has promoted research to seek anthracycline-free regimens. Since 1990's when taxanes were introduced, docetaxel (DTX) is used interchangeably with paclitaxel (PTX) for the treatment of BC, but they may differ more than initially anticipated. We conducted this trial to test two hypotheses: (1) Eight cycles of a taxane is not inferior to 4-AC followed by four cycles of a taxane; (2) one taxane is superior to the other. Methods: Eligibility included a diagnosis of clinical stage I-IIIA and axillary node-positive BC, an age younger than 71 years and with performance status of 0 to 1. Patients were randomly assigned to receive either one of the following regimens;ACP: 4-AC (doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2 q3w x 4) followed by 4-PTX (175 mg/m2 q3w x 4)ACD: 4-AC followed by 4-DTX (75 mg/m2 q3w x 4)8-PTX: PTX (175 mg/m2 q3w x 8)8-DTX: DTX (75 mg/m2 q3w x 8) Comparisons included PTX vs. DTX (ACP + 8-PTX vs. ACD + 8-DTX) and +AC vs. -AC (ACP + ACD vs. 8-PTX + 8-DTX). The primary endpoint was disease-free survival (DFS), and the secondary endpoints include overall survival (OS). The trial was powered to prove the non-inferiority of +AC to -AC (threshold hazard ratio 1.32) in terms of DFS. DFS was also compared between PTX and DTX to determine any superiority. Results: A total of 1,060 eligible patients were accrued at 84 centers between December 2001 and April 2006. There were 348 DFS events and 166 deaths after a median followup of 72.2 months. DTX was superior to PTX in terms of both DFS (Hazard ratio(HR) 0.76; 95% Confidence Interval(CI) 0.62−0.95, p=0.012) and OS (HR 0.72;95%CI 0.53−0.97, p=0.033). -AC was not inferior to +AC with respect to DFS (HR: 1.21, 90% CI 1.01−1.44). Among the four arms, 8-PTX alone resulted in poorer DFS (compared with ACP, HR 1.42 95%CI 1.07−1.89). Nausea and vomiting were more frequent with +AC than -AC. Edema and febrile neutropenia were more frequent with DTX than PTX. The incidence of sensory neuropathy was higher with PTX than DTX and it lasted for more than one year of the end of PTX treatment. Conclusions: When AC, PTX and DTX were given every three weeks, both DFS and OS were better in the arms including DTX than in those including PTX. AC followed by a taxane can be replaced by 8-DTX. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD07-02.

Pure-tone auditory thresholds are decreased in depressed people with post-traumatic stress disorder

Background Depression has been related to sensory modulation and notably to auditory modifications such as alterations in auditory event-related potentials, abnormal patterns of auditory habituation, increased activation of primary and secondary auditory cortex, and higher bilateral auditory thresholds. However, few experiments have considered the exploration of the auditory system in depression. The aim of the experiment is to further explore auditory thresholds across a higher number of frequencies than has previously been undertaken in depressed subjects, to determine whether thresholds are modified as compared to controls, and if so, at which frequencies. Methods 25 pure-tones covering a large range of frequencies from 125 Hz to 8 kHz were used to measure both air and bone conduction (AC and BC respectively) hearing thresholds. 13 patients with depression and post-traumatic disorder matched for age, sex and education level with 13 healthy subjects, were tested. Results Hearing thresholds were found to be significantly poorer in depressed participants than in controls for frequencies from 2.75 Hz to 8 kHz in BC, and for 0.5, 0.75, 0.875 and 2.0–8.0 kHz pure-tone frequencies in AC. Limitations Given that the depressed patients also had comorbid post-traumatic disorder, it should be verified whether their modified pure-tone audiometry is only related to depression. Conclusions The AC and BC pure-tone auditory threshold measurement may provide new and different insights into the aetiology and evolution of depression.

Phase III two by two factorial comparison of doxorubicin and cyclophosphamide followed by a taxan vs. a taxan alone, and paclitaxel vs. docetaxel in operable node positive breast cancer – results of the first interim analysis of NSASBC02 trial.

Abstract Abstract #4103 Background: Evidence suggests that anthracycline-containing regimens can be excluded in some patients(pts) with operable breast cancer. It is also suggested that docetaxel (D) is more effective than paclitaxel (P) in metastatic breast cancer (BC) pts.&amp;#x2028; Methods: Eligibility included axillary lymph node positive BC age less than 70 years old. Pts were randomized to receive either AC(doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2) every(q) 3 weeks(wks) x 4 followed by P 175 mg/m2 q3 wks x 4 (ACP), same AC followed by D 75 mg/m2 q3 wks x 4(ACD), P 175 mg/m2 q3 wks x 8 (PTX) or D 75 mg/m2 q3 wks x 8(DTX). Comparison included taxane (ACP+PTX vs. ACD+DTX) and with AC or without AC (ACP+ACD vs. PTX+DTX). The primary endpoint was disease free survival (DFS) and the secondary endpoints included overall survival, adverse events(AE) and quality of life (QOL). The trial was powered to prove the non-inferiority of regimens without AC to those with AC(threshold hazard ratio 1.321) in terms of DFS.&amp;#x2028; Results: A total of 1,060 eligible pts were accrued from 84 centers between Dec. 2000 and Mar.2006. 270 DFS events and 106 deaths after a median follow-up of 46.5 months were observed. The hazard ratio (HR) of DFS between ACD+DTX and ACP+PTX was 0.81(95% Confidence Interval (CI); 0.64-1.03) (p=0.08). The HR of DFS between PTX+DTX and ACP+ACD was 1.26 (95% CI; 0.99-1.60) ( p=0.67) in all eligible pts but was 1.85 (95% CI; 1.11-3.07)(p=0.017) in pts with HER2 overexpressing BC and 1.11(95% CI; 0.85-1.46)( p=0.44) in pts with HER2 non-overexpressing BC. AEs of grade 3 or 4 were observed in the lowest incidence in PTX arm and edema was observed in 11% of pts in DTX arm(p=0.01), neutropenic fever was more frequent in D cotaining arms(Table1). Conclusions: DFS was better in the arms containing D than in the arnms with P. AC improved DFS in the subset of pts with HER2 overexpressing BC but not in non-selected population. Higher incidence of severe AEs was observed in the arms containing D than in arms with P.&amp;#x2028; &amp;#x2028; Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4103.