Air-bone Gap Values Research Articles

Exclusive endoscopic management of incus long process major defects: conventional incus interposition versus malleostapediopexy.

The aim of the current study is to compare the surgical and audiometric results of conventional incus interposition (IP) versus malleostapediopexy (MS) in incus long process large defects. A total of 71 patients (incus IP group n = 37, MS group n = 34) were enrolled in this study. All patients enrolled in the current study underwent ossiculoplasty via an exclusive endoscopic transcanal approach. Pre- and postoperative audiometric measurements and air-bone gap (ABG) values were compared, and if the postoperative ABG value was less than 20dB, ossiculoplasty was considered successful. Graft success rates and complications were also compared. The average auditory gain was 14.7 ± 4.2dB in the incus IP group and 18.3 ± 5.1dB in the MS group. The auditory gain was significantly greater in the MS group relative to the incus IP group (p = 0.012). Ossiculoplasty success (postoperative ABG value < 20dB) rate was 70.3% in the incus IP group patients and 88.2% in the MS group patients (p < 0.001). There was no significant difference in terms of graft success rate between groups (p > 0.05) and the overall graft uptake rate was 91.5% (65/71). Malleostapediopexy-bridging of malleus and stapes using bone cement-is an effective, reasonable, and more efficient technique in terms of auditory outcomes relative to the conventional incus interposition in endoscopic transcanal management of incus long process major defects.

Using bone cement in re-bridging incudostapedial joint

Objective: to evaluate the hearing outcomes of using ionomeric bone cement in re-bridging incudostapedial joint discontinuity. Methods: This study included 50 patients who had ossiculoplasty using ionomeric bone cement for re-bridging of incudostapedial joint. There pre and post-operative audiologic outcomes were evaluated and reviewed by using pure tone audiometry averages and the air bone gap values with a follow up period of one year. Results: 42 patients (84%) had a post-operative air bone gap less than 20 dB following one year of surgery. The pre and post-operative mean of pure tune averages were 50.04±7.28 and 32.74±7.07 respectively (P value&lt;0.01). The pre and post-operative mean of air bone gap were 36.56±6.41 and 17.60±5.77 respectively which was statistically significant (P value&lt;0.01). Conclusion: using of ionomeric bone cement is a good grafting material in incudostapedial re-bridging ossiculoplasty being cost effective, easy applicable and biocompatible and give a satisfactory hearing outcome in selected patients.

The Impact of Middle Ear Packing Material Containing Antibiotic Ointment on Postoperative Infection After Myringoplasty.

The objective of this study was to compare the postoperative infection and graft success rates, and the hearing improvement, after endoscopic cartilage underlay myringoplasty with versus without antibiotic ointment coating. This was a retrospective case-control study. The clinical records of patients who underwent endoscopic cartilage underlay myringoplasty and who met the selection criteria were retrieved and divided based on middle ear packing status into groups with antibiotic ointment packing (AOP group) and with no antibiotic ointment packing (no-AOP group). The operation time, postoperative infection, graft success status, and hearing improvement were compared between the 2 groups. Patients with 166 perforations constituted the AOP group, and patients with 141 perforations comprised the no-AOP group. At 3 months postoperatively, middle ear infections had occurred in 24 (14.5%) ears in the AOP group and 4 (2.8%) ears in the no-AOP group (P < .01). At 12 months postoperatively, the graft success rate was 81.3% in the AOP group and 97.9% in the no-AOP group (P < .01). No significant group differences were observed, preoperatively (P = .657) or postoperatively (P = .578), in the air-bone gap (ABG) values or mean ABG gains (P = .758). Middle ear packing without antibiotic ointment coating does not increase the postoperative infection rate or reduce the graft success rate after endoscopic cartilage underlay myringoplasty compared to antibiotic ointment coating. On the contrary, coating with antibiotic ointment increases the risk of postoperative infection given the complexity of middle ear manipulation.

Push-Through Myringoplasty Versus External Auditory Canal Flap Tympanoplasty for Chronic Marginal Perforations.

We compared the operation times, graft success rates, and hearing gains between push-through (PT) myringoplasty and external auditory canal (EAC) flap tympanoplasty in patients with chronic marginal perforations. A total of 77 patients with chronic marginal perforations were randomly allocated to endoscopic perichondrium-cartilage myringoplasty with raising of the EAC flaps (n = 39) and PT technique (n = 38) groups. The graft outcomes, mean operation times, and postoperative complications were compared 6 months after operation. The graft success rate was 97.4% (38/39) in the EAC group and 81.6% (31/38) in the PT group; the difference was significant (P = .056). The mean operation time was 40.7 ± 10.4 min in the EAC group and 42.4 ± 8.3 min in the PT group (P = .741). In the EAC group, the mean pre- and postoperative air-bone gap (ABG)s were 29.3 (range: 28.4 ± 8.6) and 12.1 (range: 11.8 ± 2.4) dB (P < .01), respectively; the respective values were 29.5 (range: 29.1 ± 5.4) and 12.6 (range: 12.0 ± 1.3) dB (P < .01) in the PT group. No significant group difference was observed in the pre- (P = .794) or postoperative (P = .689) ABG values or mean ABG gain (16.7 ± 5.3 vs 17.1 ± 7.7 dB; P = .526). In addition, graft medialization occurred in 7.9% patients in the PT group. However, graft lateralization, significant blunting, deteriorative sensorineural hearing loss, vertigo, or tinnitus were not encountered in either group. No taste change was reported and no inclusion cholesteatoma was seen in the EAC group. Endoscopic perichondrium-cartilage myringoplasty with raising of an EAC flap is useful and minimally invasive to repair chronic marginal perforations; the technique is simple, has a high graft success rate in comparison to the PT technique.

Impaired Vestibulo-Ocular Reflex on Video Head Impulse Test in Superior Canal Dehiscence: "Spontaneous Plugging" or Endolymphatic Flow Dissipation?

Surgical plugging of the superior semicircular canal (SSC) represents an effective procedure to treat disabling symptoms in superior canal dehiscence (SCD), despite resulting in an impaired vestibulo-ocular reflex (VOR) gain for the SSC. On the other hand, SSC hypofunction on video head impulse test (vHIT) represents a common finding in patients with SCD exhibiting sound/pressure-induced vertigo, a low-frequency air-bone gap (ABG), and enhanced vestibular-evoked myogenic potentials (VEMPs). "Spontaneous canal plugging" has been assumed as the underlying process. Nevertheless, missing/mitigated symptoms and/or near-normal instrumental findings would be expected. An endolymphatic flow dissipation has been recently proposed as an alternative pathomechanism for SSC VOR gain reduction in SCD. We aimed to shed light on this debate by comparing instrumental findings from 46 ears of 44 patients with SCD exhibiting SSC hypofunction with post-operative data from 10 ears of 10 patients with SCD who underwent surgical plugging. While no difference in SSC VOR gain values was found between the two groups (p = 0.199), operated ears developed a posterior canal hypofunction (p = 0.002). Moreover, both ABG values (p = 0.012) and cervical/ocular VEMP amplitudes (p < 0.001) were significantly higher and VEMP thresholds were significantly lower (p < 0.001) in ears with SCD compared to operated ears. According to our data, canal VOR gain reduction in SCD should be considered as an additional sign of a third window mechanism, likely due to an endolymphatic flow dissipation.

Effect of type 1 tympanoplasty on health-related Quality of Life assessed by Chronic Otitis Media Questionnaire 12.

The aim of the study was to evaluate the changes in the quality of life of patients who underwent Type 1 tympanoplasty using the Chronic Otitis Media Questionnaire 12 (COMQ-12). Prospectively collected data of patients aged between 18-65 years, who had undergone type 1 tympanoplasty between January 2018 to January 2019 were included in the study. The Turkish version of COMQ-12 was completed by all of the patients preoperatively as well as 12 months postoperatively. Preoperative and postoperative graft uptake outcomes, hearing assessment results, and scores of COMQ-12 were evaluated. Shapiro-Wilk test, Mann-Whitney U test, and Wilcoxon test were used. A total of 98 patients were included. Noticeable improvement in the severity of symptoms, negative effect on daily life and work routine, health care, and general well-being was detected by subjective scores of the questionnaire. The COMQ-12 preoperative and postoperative overall average score was 25 and 7, respectively (p<0.001). Graft uptake success was found to be 85%. Hearing assessment evaluation showed a mean change in air conduction values of 8.78 (SD 1.17), and a mean change in air-bone gap values of 7 (SD 0.8), both showing statistical significance (p<0.001). According to the COMQ-12 questionnaire data after surgery, symptom severity, lifestyle and work impact, health service impact, and general discomfort were significantly reduced.

Plasma-Rich Fibrin-Regenerative Material in Tympanic Membrane Surgery.

Background and Objectives: Platelet-rich fibrin (PRF) membrane plays an important role in cell proliferation and aids in healing. This study aimed to assess the safety and efficacy of the addition of PRF to the graft in tympanoplasty. Materials and Methods: A retrospective study was conducted involving 47 patients with chronic dry eardrum perforation, who were candidates for different types of tympanoplasty (type I-IV). The study took place in the ENT department, County Emergency Clinical Hospital of Cluj-Napoca. In group 1 (27 patients) tympanoplasty was performed with a cartilage graft, while in group 2 (20 patients) a cartilage graft was used with the addition of a PRF membrane. The PRF clot was extracted and transformed into a thin membrane. Postoperative evaluation included otoendoscopy and otomicroscopy at 1, 3, 6, and 12 months after surgery, as well as pure-tone audiometry at 12 months. Results: Postoperative follow-up at 1, 3, 6, and 12 months showed a higher rate of graft survival in the PRF group than in the non-PRF group. At the 12-month mark, a successful outcome was observed in 95.0% of patients in the PRF group, while the success rate in group 1 was 70.4% (p < 0.05). The postoperative hearing threshold value was statistically significantly lower in the group with PRF, compared to the non-PRF group, being 18.4 ± 10.4 dB and 27.6 ± 16.2 dB (p < 0.001), respectively. Although the postoperative air-bone gap value did not differ significantly between groups, there was a greater improvement in the PRF group (p < 0.7). The PRF was well tolerated, and the incisions healed perfectly. Conclusions: The PRF membrane increases the rate of autograft survival and is therefore an effective material for patients with chronic perforations of the tympanic membrane.

Impact of Intraoperative Findings on Hearing in Revision Ear Surgery.

Hearing results after chronic ear surgery encompass recurrence, localization and extent of cholesteatoma, type of surgery, ossiculoplasty methods, but rarely interpret intraoperative findings. This study aimed to analyze the impact of intraoperative findings in revision tympanomastoidectomy in predicting postoperative hearing. This was a retrospective non-randomized cohort of 101 patients treated for recurrent chronic otitis media by tympanomastoidectomy. The patients' demographics, localizations of disease recurrence and perioperative hearing results were analyzed. Logistic regression showed that presence of tympanic perforation (p=0.036), ossicular chain damage (p=0.006), were negatively associated with improved hearing postoperatively. Attic cholesteatoma was associated with better postoperative hearing (p=0.045). Presence of tympanic perforation (p=0.050), alongside perifacial localization of imflammation (p=0.021) and ossicle destruction (p=0.013) were associated with worse postoperative hearing results. Multivariate analysis confirmed that tympanic perforation (p=0.040, F=4.401), and ossicular chain involvement (p=0.025, F=5.249), were consistent negative predictors of hearing improvement, while postoperative deterioration of hearing was associated with tympanic perforation (p=0.038, F=4.465) and facial nerve dehiscence (p=0.045, F=4.160). Comparison of postoperative revision tympanomastoidectomy hearing outcomes revealed significant positive reductions in air-bone gap values, primarily at low and mid frequencies. Postoperative hearing results at high frequencies are not affected by revision surgery.

A novel technique in treatment of advanced tympanosclerosis: results of malleus replacement and loop prostheses combination; pure endoscopic transcanal approach.

The objectives of the present clinical trial are to describe our surgical technique for advanced tympanosclerosis (TS) and to present the comparison of pre-and postoperative audiometric results. 21 patients suffering from advanced TS (Only type III and IV patients according to Wielinga-Kerr classification) were enrolled in this prospective study. A pure transcanal endoscopic approach was preferred for all patients included in the study. Titanium malleus replacement prosthesis (MRP) and polytetrafluoroethylene (PTFE) loop prosthesis combination were used to bypass fixed ossicles to achieve sound transmission to the inner ear. Pre-and postoperative pure tone audiometry (PTA) measurements and air-bone gap (ABG) results compared, and surgical technique was considered successful if postoperative ABG was less than 20dB. Six of the 21 patients had been operated on before and the tympanic membrane (TM) was intact. The remaining 15 of the 21 patients were the primary cases, and TM perforation repair and ossiculoplasty using combination of the MRP and PTFE loop prosthesis were performed at single-staged operation. The average preoperative ABG values significantly improved from 37.1 ± 6.2 to 14.5 ± 1.2dB postoperatively (p < 0.001). The mean preoperative air conduction threshold (ACT) significantly decreased from 51.7 ± 11.4 to 28.5 ± 9.1dB (p < 0.001). TS surgery is still a controversial issue particularly in stapes footplate fixation. However, our surgical and audiological results in this study are quite promising. The combination of titanium MRP and PTFE loop prosthesis for restoring sound transmission in advanced TS cases is reliable, effective and novel treatment option via endoscopic transcanal approach.

Transcanal endoscopic myringoplasty with butterfly dermal allograft

ObjectiveTympanic membrane perforation (TMP) is a common cause of visits to the otolaryngology clinic. For decades, various surgical methods and various grafts have been used to treat TMP. This study aimed to compare the efficacy of butterfly dermal allograft (BDA) and fat myringoplasty for the treatment of TMP. Study designA retrospective case-control study. SettingTertiary referral center. MethodsWe retrospectively analyzed 40 patients who underwent BDA (n = 20) and fat myringoplasty (n = 20) for TMP performed by a single surgeon between January 2019 and December 2021. The hearing outcomes, graft success rate, complications, operation time, and hospital stay were recorded and compared between the two groups. Hearing outcomes were determined by pure-tone audiometry. ResultsThere was no significant difference between the BDA and fat groups regarding demographic characteristics. There was no significant difference in the pre and postoperative air conduction and bone conduction thresholds, or air-bone gap values between the two groups. A significant audiologic improvement was observed in both groups (p < 0.05), but there was no significant difference in the degree of hearing gain between the two groups. In terms of recurrence of tympanic membrane perforation, postoperative otorrhea, and discomfort symptoms; however, there was no significant difference between the groups (p > 0.05). The operation time and hospital stay were shorter in the BDA group than in the fat group (p < 0.05). ConclusionBDA myringoplasty is as safe and medically efficacious as fat myringoplasty and shortens the operation time and hospital stay.

Prognostic factors of hearing outcome in patients with chronic suppurative otitis media following tympanoplasty: a retrospective cohort study.

Research on the factors affecting the functional outcome of tympanoplasty in chronic suppurative otitis media (CSOM) is limited. This study aimed to investigate the prognostic factors of hearing outcome in CSOM patients following tympanoplasty. The multivariate logistic regression analysis is used to evaluate the influence of demographic, audiological, clinical and disease factors on the postoperative prognosis of CSOM. A total of 179 CSOM patients who received surgery between January 2016 and December 2019 were retrospectively included. The inclusion criteria are mainly based on clinical classification of otitis media and surgical classification guidelines [2012]. These patients were divided into an effective group (n=132) and a non-effective group (n=47) according to their postoperative air-bone gap (ABG) value. Multivariate analysis was performed according to the pure tone hearing results 1 week before operation and 4 weeks after operation. The type of preoperative hearing impairment, middle ear cholesteatoma, ossicular chain status, tympanic perforation site, repair material, tympanum sclerosis, and surgical methods were significantly different between the effective and non-effective groups (all P<0.01). The speech reception threshold (SRT) (36.88±15.54 vs. 27.68±13.75, P<0.001) and ABG (18.53±9.30 vs. 10.89±5.07, P<0.001) values were markedly reduced after surgery in the effective group but not in the non-effective group. Furthermore, the postoperative decreases in the SRT (9.20±9.69 vs. 2.021±7.34, P<0.001) and ABG (7.64±8.57 vs. 0.45±7.322, P<0.001) values were considerably higher in the effective group than the non-effective group. After multivariate logistic regression analysis, we found that the type of preoperative hearing impairment [P=0.031; odds ratio (OR) =2.378], ossicular chain status (P=0.002; OR =4.430). Our research shows that the curative effect of conductive deafness before operation is 2.378 times better than that of mixed deafness, the curative effect of complete and unfixed ossicular chain before operation is 1.080 times better than that of interrupted ossicular chain, and the curative effect of complete ossicular chain but fixed ossicular chain is 4.430 times better than that of interrupted ossicular chain. Our findings may help to predict the postoperative prognosis of patients, thus facilitating the development of corresponding treatment strategies.

Assessment of hearing outcomes in pre-adolescent cases of otitis media with effusion treated with adenoidectomy

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Otitis media with effusion is one of the most common presenting features in children coming to the otorhinolaryngology outpatient with a variety of medical and surgical treatment modalities being offered. This study aims to evaluate post-adenoidectomy hearing outcomes in cases of otitis media with effusion in an attempt to provide long term benefits.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;It is a prospective study of 50 pre-adolescent cases in a tertiary care hospital. Pure tone audiometry and tympanometry was performed pre-operatively as well as at regular follow up intervals after adenoidectomy (along with tonsillectomy when indicated). The mean improvement in hearing outcomes was evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean hearing improvement when compared to baseline pre-op air-bone gap values were 8.4±6.35, 8.6±6.39, 8.1±6.99 at 15&lt;sup&gt;th&lt;/sup&gt; day, 1 month and 2 months post op respectively. There was also a significant shift of tympanometry curves from types B and C pre-op to types A and B 6 months post-op.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Adenoidectomy, along with tonsillectomy when indicated, in children with hypertrophied adenoids as well as otitis media with effusion offers very good, long-standing hearing improvement and should always be considered in such patients so as to improve eustachian tube function and eradicate possible source of infection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;

Comparison of endoscopic and microscopic methods in stapedotomy: a retrospective analysis.

The goal of the present study was to compare the audiologic results, complications, and advantages/disadvantages of endoscopic and microscopic stapedotomy. Patients who experienced stapedotomy surgery in the Ear Nose Throat Clinic (ENT) of Selcuk University Faculty of Medicine between September 2011 and January 2018 were included in the study. The data of all patients were analyzed and divided into two groups. Those who underwent endoscopic stapedotomy were included in group I, and patients who underwent microscopic stapedotomy formed group II. Surgical findings, complications, and operation times were compared for the two groups. Air and bone conduction thresholds were evaluated at the frequencies of 500, 1000, 2000, and 4000Hz pre- and postoperatively at 1, 3, and 6months, and the mean (± SD) air-bone gap value was recorded. While the mean pre- and postoperative air-bone gaps were 34.38 ± 7.47dB (23-53dB) and 9.69 ± 4.43dB (0-19dB), respectively, in group I, 34.32 ± 7.57dB (23-6dB) and 9.62 ± 4.25dB (2-23dB) were the respective means calculated in group II (p < 0.05). When the mean postoperative air-bone gap was compared, there was no statistically significant difference between the two groups (p = 0.774). The mean operative times for groups I and II were 57.22 ± 4.37min and 63.70 ± 7.34min, respectively (p < 0.001). The requirement for chorda tympani nerve manipulation and scutum curettage was significantly less in group I compared to group II (p = 0.003). Postoperative dysgeusia and postoperative pain were found to be higher in group II than group I, but they were not statistically significant (p > 0.05). Endoscopic stapedotomy displayed similar audiological results, shorter operation times, and similar complication rates, as well as being a less invasive surgery, compared to the microscopic approach.

Transtympanic soft tissue tympanoplasty can replace conventional techniques elevating tympanic membranes.

Most traditional tympanoplasties require elevating the tympanic membrane (TM). These techniques are rather complicated and success rates are not perfect. Therefore, the authors developed a novel technique, transtympanic soft tissue (TST) tympanoplasty, which does not require raising eardrums, and evaluated its surgical efficiency compared to perichondrium underlay (PU) tympanoplasty. A retrospective study was conducted in a single center. 152 cases who underwent TST tympanoplasty (n = 70) or PU tympanoplasty (n = 82) between 2011 and 2020 were included in the study. Perforation location, pure tone audiometry, complications, and closure rates were analyzed according to the size of the TM perforations: moderate perforation (25-40%, n = 100) and large perforation (≥ 40%, n = 52). For the moderate perforations, the closure rates of the TST (n = 45) and PU (n = 55) groups were 93.3% and 89.1%, respectively (p = 0.461), and even for the large perforations, the success rates were 88.0% in the TST group (n = 25) and 81.5% in the PU group (n = 27) (p = 0.515). The mean postoperative air-bone gap (ABG) values of the TST group for moderate and large perforations were 5.3 ± 5.8dB and 6.6 ± 5.7dB, respectively. There was no significant difference in postoperative ABG between the two surgical procedures (p > 0.05). The total operation time for TST tympanoplasty was significantly shorter than that for PU tympanoplasty (p = 0.002). TST tympanoplasty is considered a novel, simple technique to replace traditional tympanoplasty techniques involving raising eardrums, even for large-sized perforations.

A Retrospective comparative Study of Endoscopic and Microscopic Tympanoplasty

Aim: To investigate the outcomes of endoscopic vs. microscopic technique to tympanoplasty among patients. Methods: It was a retrospective study in which outcomes of sixty one ears of sixty patients (thirty three male and twenty seven female) who experienced type-1 tympanoplasty were assessed. Patients age range was between 20-50 years. Patients in Group-1 experienced tympanoplasty together with endoscopic procedure (n=32) while patients in Group-2 experienced tympanoplasty along with conservative microscopic approach (n=29). Among both groups patients, a rebound-shaped temporalis fascia was utilized. The results were studied regarding surgery time, success rate of graft and hearing gain. Results: Among both groups patients, postop ABG (air-bone gap) was considerably less than preop air-bone gap. Insignificant differences were found between pre- and post-op air-bone gap values (in decibel) in either cohort. Among Group-1 patients, mean surgery time was considerably less than Group-2 patients (51.37 versus 67.03 minutes)2. Among patients, this procedure was more frequently performed during current years3,4. Conclusion: Among patients experiencing type-1 tympanoplasty, particularly if external acoustic meatus is narrow and anterior canal wall is protuberant, endoscopic technique seems to offer results equivalent to microscopic technique for TM entire visualization while lack of additional interventions needed to assess the ossicular system. Keywords: Tympanoplasty, endoscopy, micsoscopy

Evaluation of Carhart’s Notch in Patients with Serous Otitis Media

Objective: To investigate the changes in bone-conduction and air-bone gap in patients with serous otitis media and to evaluate the presence of Carhart’s notch. Material and Methods: Patients with unilateral serous otitis media were included in the study. Audiometric evaluation comprised air-conduction and bone-conduction hearing thresholds, and air-bone gap values. The preoperative and postoperative pure tone audiometry results of 45 patients were compared in terms of the air-bone gap and bone-conduction thresholds. Results: Carhart’s notch was present in 17 (37.8%) patients preoperatively. For pure tone audiometry, there was a statistically significant decrease in air-bone gap at all frequencies postoperatively. The postoperative decrease in the bone-conduction thresholds was statistically significant only at 2 kHz. In the postoperative period, a 4.7 dB improvement was observed in the bone-conduction threshold at 2 kHz for patients with Carhart’s notch. Conclusion: Carhart’s notch may be present in patients with serous otitis media. It is not specific to otosclerosis.

DIAGNOSTIC IMPORTANCE OF THE CARHART NOTCH IN PATIENTS WITH CHRONIC OTITIS MEDIA

Objective&#x0D; The false sensorineural loss caused by otosclerosis&#x0D; due to stapes fixation is known as the Carhart notch.&#x0D; To examine the changes in air-bone gap (ABG)&#x0D; and bone-conduction (BC) hearing thresholds by&#x0D; comparing the preoperative and postoperative&#x0D; audiometry results in patients with chronic otitis media&#x0D; (COM), to investigate the effects of air conduction&#x0D; (AC) on BC, to determine the effects of postoperative&#x0D; improvement in AC on BC, to detect the presence&#x0D; of the Carhart notch in COM, and to determine the&#x0D; effects of surgery on the Carhart notch.&#x0D; Material and Methods&#x0D; A total of 104 patients who underwent type 1&#x0D; tympnoplasty between January 2012 - March 2017&#x0D; in our clinic were included in this retrospective study.&#x0D; Parameters measured during the preoperative and&#x0D; postoperative sixth month audiometric evaluation&#x0D; comprised AC hearing thresholds at the frequencies&#x0D; of 250-8,000 Hz, BC hearing thresholds at 500-4,000&#x0D; Hz, and ABG values at 500-4,000 Hz intervals.&#x0D; Results&#x0D; Before surgery, the Carhart notch was present in&#x0D; 46 (44.2%) of the 104 patients. Postoperatively, the&#x0D; Carhart notch was observed to have been corrected&#x0D; in 25 (54.3%) of these patients (p=0.029).&#x0D; Conclusion&#x0D; After tympanoplasty, significant improvement in ABG&#x0D; may lead to improvement in BC at 2,000 Hz in COM&#x0D; cases with an intact and mobile ossicular chain. The&#x0D; Carhart notch may also be present in COM.

Correlation between Intraoperative Ossicular Status and Conductive Hearing Loss Degree among Chronic Suppurative Otitis Media Patients in Dr Mohammad Hoesin General Hospital Palembang

Background: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the mucosa and periosteum of the middle ear and mastoid cavity that defined as a perforated tympanic membrane with persistent drainage for more than 2 months. Preoperative hearing threshold and air bone gap (ABG) assessment are expected to predict the ossicular status which can only be ascertained intraoperatively. This study aimed to determine the correlation between intra-operative ossicular status and the degree of conductive hearing loss assessed based on the hearing threshold and average ABG among CSOM patients in RSUP Dr. Mohammad Hoesin Palembang.&#x0D; Methods: Observational research using a cross sectional design. The data were collected using medical record on 64 subjects with a diagnosis of CSOM who underwent mastoidectomy surgery at Dr. Mohammad Hoesin Hospital Palembang for the period of March 2019 to June 2021.&#x0D; Results: From 64 samples conducted in the study, the average ossicular status score in CSOM patients was 1.84 ± 1.48, with the highest group scoring 0 being the malleus incus and intact stapes as many as 21 patients (31.3%). There was a strong positive correlation between hearing threshold scores and intra-operative ossicular status scores (p&lt;0.005, R=0.5) and there was a strong positive correlation between ABG scores and intra-operative ossicular status scores (p &lt;0.005, R=0.6). From the linear regression test, the most influential in predicting intra-operative ossicular status scores were gender, hearing threshold value, ABG value, and the presence of cholesteatoma&#x0D; Conclusions: There is a significant relationship between intra-operative ossicular status and the degree of conductive hearing loss in CSOM patients.

Different approach for surgery of stapes: Comparison microscopic and endoscopic approach

ObjectiveThis study aimed to discuss the different surgical approach, functional hearing results, which are applied to patients operated with a diagnosis of otosclerosis in our clinic. MethodsThis study includes 92 ears of 84 patients who were operated with the diagnosis of otosclerosis. Air bone gap was calculated before and after the operation in all patients. In addition, endoscopic and microscopic methods can be compared and statistically tested whether there is a difference in air bone gap averages and surgical success. Of the 92 ears operated, 56 were right (61%) and 36 were left (39%). Otosclerosis was detected bilaterally in 61 patients (73%) and unilaterally (27%) in 23 patients. The duration of follow-up ranges from 6 month to ten years, on average 28 months. ResultsIn the microscopic operation group, the air pathway measurement was mean 55.58 dB preoperatively and mean 38.42 dB postoperatively, with a mean decrease of 17.16 dB determined. The decrease between the preoperative and postoperative air pathway values was determined to be statistically significant (t:7.20, p < 0.001). In the microscopic operation group, the air-bone gap value was mean 30.50 dB preoperatively and fell by 15.90 dB to 14.60 dB postoperatively. In the endoscopic group, the air-bone gap value was mean 32.32 dB preoperatively and fell by 13.51 dB to 18.81 dB postoperatively. ConclusionsStapes surgery is a successful method with high success rate and low complication rates in the treatment of otosclerosis. The success rate of endoscopic and microscopic stapes surgery is similar. However, endoscopic stapes surgery is specific and difficult otological surgery that must be performed by surgeons specialised on this subject.

Surgical Outcomes of Transmastoid Facial Nerve Decompression for Patients With Traumatic Facial Nerve Paralysis

Objective:To evaluate the facial nerve function and audiological results of delayed (by at least one month after the insult) transmastoid facial nerve decompression (FND) in traumatic facial nerve paralysis (FNP). Methods: Medical records of 57 patients with traumatic FNP were reviewed and surgical results of 13 patients (mean age 28.0 ± 17.67, range 3-67) undergoing transmastoid FND were analyzed. Preoperative and postoperative mean hearing thresholds were compared using 0.5, 1, 2, and 3 kHz. Facial nerve function was graded according to the House–Brackmann scale (HB) before and after surgery. HB scale results of grade III or better were accepted as good results postoperatively. Results: Preoperative HB grades were V in 5 and VI in 8 patients. Twelve of 13 patients had good recovery of facial nerve function regardless of the operation timing. When mean preoperative and postoperative air–bone gap (ABG) values were compared (except the patients with total sensorineural hearing loss), the mean preoperative ABG was 33 ± 15.9 dB, and mean postoperative ABG was 17.2 ± 8.68 dB. There was a mean hearing gain of 15.8 dB after transmastoid facial nerve decompression surgery. Surgery and anesthesia-related complications were not seen in any patients. Conclusion: The transmastoid route can be used safely and effectively with elimination of the risks of craniotomy and middle fossa surgery for patients with traumatic FNP. Hearing improvement can be achieved by performing ossicular chain reconstruction during decompression surgery for patients with conductive or mixed hearing loss (HL).KEYWORDS: Facial nerve, decompression, facial paralysis