Air-bone Gap Values Research Articles

Retrospective air bone gap evaluation of patients with tympanic membrane central perforation

The purpose of this study was to evaluate hearing recovery and air-bone gap (ABG) before and after tympanoplasty surgery in patients with tympanic membrane central perforation. Histories and audiological assessments of 160 cases (total of 26 ears from 22 patients; 11 men and 11 women) from patients who had undergone tympanoplasty surgery and hearing reconstruction due to tympanic membrane central perforation were evaluated. Pre-postoperative audiograms and the pure tone, air-bone hearing thresholds and ABG gains were evaluated. The mean age of the patients was 38.6 years (± 16.04). The mean postoperative follow-up period was 13.4 months (± 15.5). The mean preoperative ABG was 25.36 dB (± 9.9) and postoperative ABG was 17.36 dB (± 11.68) (p = 0.001). When four groups were compared before surgery and after surgery period as 0-6 months, 6-12 months, 1-2 years and 2 years in terms of pre- and postoperative ABG values, no statistically significant difference was observed (p>0.05). All patients were divided into three groups: < 20 years of age; between the ages of 21-40; and, >41 years of age, and no statistically significant difference were found between the groups (p> 0.05). Surgeries of the patients 21-40 years of age were more successful (ABG gain) than other age groups. No statistically significant gender differences were found in ABG averages (p = 0.33), but clinical results were significantly better in women as compared with men. In patients with central tympanic membrane perforation, tympanoplasty surgery with temporal fascia is beneficial in terms of hearing recovery.

Evaluation of the anatomical and auditory outcomes of minimally invasive cartilage myringoplasty: Our technique and experience

The purpose of this study was to assess closure rates in tympanic membrane perforations of various dimensions using the tragal cartilage-perichondrium composite graft and its effect on hearing values and also to present our own experiences. Materials and methodsSixty-one patients presenting to our clinic in 2014–2015 and diagnosed with tympanic membrane perforation were included in the study. Otomicroscopic and otoendoscopic examinations were performed preoperatively and at the 12th month postoperatively. Patients were divided into three groups depending on perforation diameter. Pure tone audiometry was performed at 500, 1000, 2000, and 4000Hz (Hz) preoperatively and at the 12th month postoperatively, air-bone values were recorded, and air-bone gap (ABG) was calculated. Surgery was performed under local anesthesia usıng the transcanal, push-through (transperforation) technique. Perichondrium supported by thinned cartilage graft obtained from the tragal cartilage was used for tympanic membrane repair. ResultsGraft acceptance levels after 12months in small, medium, and large perforations were 100%, 93.5%, and 93.75%, respectively, and 95% on average. Preoperative air-bone gap values were 18.64±9.63 decibel (dB), 22.51±9.66dB, and 28.43±11.36dB, respectively, and 23.18±11.36dB on average, while 12th month postoperative air-bone gap values were 9.14±8.27dB, 11.25±6.73dB, and 17.37±9.22dB, respectively, and 12.37±8.28dB on average. The difference between pre- and postoperative 12th month air-bone gap values was statistically significant (p<0.005). ConclusionThe use of thinned cartilage-supported perichondrial grafts in patients with all sizes of tympanic membrane perforation is safe and effective in terms of both anatomical healing and restoration of hearing and can represent a first-choice technique that is easy to perform and involves minimal morbidity.

Does stapes surgery improve tinnitus in patients with otosclerosis?

IntroductionOtosclerosis (OS) is the primary disease of the human temporal bone characterized by conductive hearing loss and tinnitus. The exact pathogenesis of tinnitus in otosclerosis patients is not known and factors affecting the tinnitus outcome in otosclerosis patients are still controversial. ObjectivesTo find the effect of stapedotomy on tinnitus for otosclerosis patients. MethodsFifty-six otosclerosis patients with preoperative tinnitus were enrolled to the study. Pure tone average Air-Bone Gap values, preoperative tinnitus pitch, Air-Bone Gap closure at tinnitus frequencies were evaluated for their effect on the postoperative outcome. ResultsLow pitch tinnitus had more favorable outcome compared to high pitch tinnitus (p=0.002). Postoperative average pure tone thresholds Air-Bone Gap values were not related to the postoperative tinnitus (p=0.213). There was no statistically significant difference between postoperative Air-Bone Gap closure at tinnitus frequency and improvement of high pitch tinnitus (p=0.427). There was a statistically significant difference between Air-Bone Gap improvement in tinnitus frequency and low pitch tinnitus recovery (p=0.026). ConclusionLow pitch tinnitus is more likely to be resolved after stapedotomy for patients with otosclerosis. High pitch tinnitus may not resolve even after closure of the Air-Bone Gap at tinnitus frequencies.

Audiologic Patterns of Otic Capsule Preserving Temporal Bone Fracture: Effects of the Affected Subsites.

Objectives.This study was aimed to assess the relationship between the type of temporal bone area involved and conductive hearing loss.Methods.We enrolled 97 patients who visited the otolaryngology clinics of Seoul National University Hospital or Boramae Medical Center, Seoul Metropolitan Government-Seoul National University with temporal bone fracture between January 2004 and January 2014. Audiometric parameters, including initial and improved air-bone (AB) conduction gap values, were reviewed in accordance with the temporal bone computed tomography (external auditory canal [EAC], middle ear [ME], mastoid [M], and ossicle [O]).Results.Patients with ossicular chain involvement exhibited a larger AB gap compared to those with no ossicular chain involvement at 250, 1,000, 2,000, and 4,000 Hz. Among the groups without ossicular chain involvement, the initial AB gap was largest in patients with EAC+ME+M involvement, followed by the ME+M and M-only involvement groups. The greatest improvement in the AB gap was observed in the EAC+ME+M group followed by the ME+M and M-only groups, irrespective of ossicular chain involvement. Improvements in AB gap values were smallest at 2,000 Hz.Conclusion.Conductive hearing loss pattern differed according to the temporal bone area involved. Therefore, areas such as the hematoma and hemotympanum, as well as the fracture line of the temporal bone area, must be evaluated to predict audiologic patterns with otic capsule preserving temporal bone fracture.

Comparative Study of Endoscope Assisted Myringoplasty and Microscopic Myringoplasty.

To study and compare the outcomes of the endoscopic versus microscopic approach to Myringoplasty in 60 patients. In this prospective study, the outcomes of 60 ears of 60 patients (40 male and 20 female) who underwent Myringoplasty were evaluated. The age range of the patients was 15-55years. Group 1 underwent Myringoplasty with an endoscopic technique (n=30), and Group 2 underwent Myringoplasty with the conventional microscopic technique (n=30). A temporalis fascia graft was used in both groups. The outcomes were analyzed in terms of the hearing gain, duration of surgery, graft success rate and advantages and disadvantages of endoscopic versus microscopic approach to Myringoplasty. In both groups, the postoperative air-bone gap (ABG) was significantly lower than the preoperative ABG. There were no significant differences between the preoperative and postoperative ABG values (in dB) in either group. The mean operative duration in Group 1 (96.32min) was significantly lower than that in Group 2 (136.09min). In the preoperative evaluation of patients in Group 1 had small, medium, large perforations are 16 (53%), 12 (40%), and 02 (7%), respectively. In Group 2, had small, medium, large perforations are 12 (40%), 15 (50%), and 03 (10%), respectively. Perforations (wet ear) were detected in 10 (33%), 06 (20%), and 04 (12%) of the patients in Group 1 at postoperative months 1, 3, and 6, respectively. Perforations (wet ear) were detected 09 (30%), 06 (20%) and 03 (10%) patients in Group 2 at postoperative months 1, 3, and 6. At 6months postoperatively, there were smaller perforations and reduced rate of perforations as compared to 1st and 3rdmonth in Group 1 and Group 2. The difference between the perforation conditions (larger vs. smaller) was not significant in either group. The preoperative and postoperative increases in the ABG were associated. At the end of 6months all (100%) patients in the Group 1 rated their cosmetic result as excellent as compared in the Group 2. Unlike the microscope, the endoscope is easily transportable and hence is ideal for use in ear surgery camps conducted in remote places. In patients undergoing Myringoplasty, especially if the external ear canal is narrow and the anterior canal wall is prominent, the endoscopic and microscopic approaches appear to give equal results in terms of easy visualization of the entire tympanic membrane and no requirement for extra intervention to evaluate the ossicular system. A shorter operative duration and excellent cosmetic result is an advantage of the endoscopic Myringoplasty technique.

The effect of early routine grommet insertion on management of otitis media with effusion in children with cleft palate.

The aim of the study is to compare long term otoscopic and audiological findings of cleft palate patients with or without early grommet insertion. Cleft palate patients followed-up in Hacettepe University between 2008 and 2013 were included in the study. Age, gender, cleft types and palate surgery data, grommet tube insertion history and otological - audiological evaluations of the patients were recorded. Patients were evaluated in three groups according to grommet insertion history: A-early routine grommet insertion, B-grommet insertion during follow-up, C-no grommet insertion. Otological and audiological findings were compared. There were 154 patients in the study, with a median age of 7.7 years. There were 67 patients in group A (43.5%), 22 patients in group B (14.3%) and 65 patients in group C (42.2%). OME was identified significantly higher in group A and normal otoscopic examination findings were higher in group C. Complications showed a higher rate than other otoscopic findings in group B patients. There was no significant difference for any frequencies in between the groups in terms of mean air-bone gap (ABG) values. There were 20 grade I, 25 grade II, 77 grade III and 32 grade IV patients in the study according to the Veau classification. Prophylactic grommet insertion may not be applied as some cleft palate patients with no OME. Wait and see protocol can be recommended for these patients, and they should be followed-up up closely to avoid complications. If the effusion does not recover or tympanic membrane changes occur in follow-up, grommet insertion should be considered.

Hearing outcomes after suppurative chronic otitis media surgery.

This study aims to compare the hearing outcomes after canal wall up mastoidectomy (CWUM) and canal wall down mastoidectomy (CWDM). Ninety-two patients (74 males, 18 females; mean age 30.1 years; range 9 to 67 years) who were diagnosed with chronic suppurative otitis media (CSOM) between January 2009 and May 2011 were enrolled in this retrospective study. Based on hospital data, patients were separated into two groups as having mucosal or squamous disease. Patients were also categorized into two groups based on the type of mastoidectomy: CWUM (n=51) and CWDM (n=41). Hearing results between the groups were evaluated using the air-bone gap (ABG) recorded by audiogram before surgery and at three months after ossiculoplasty. Relationship between obtained hearing results and performed ossiculoplasty techniques were also discussed. We were able to perform ossiculoplasty in 42.3% (n=39) of patients diagnosed with CSOM. Presurgical ABG in CWUM and CWDM groups were 35.38±10.82 dB and 37.92±5.80 dB, respectively. Postsurgical ABG value was ≤20 dB in 27% of CWUM patients and 7.7% of CWDM patients. Mean hearing gain of patients with active squamous disease was 3.8 dB in CWUM group and 11.9 dB in CWDM group (p<0.5). The pathology affecting the middle ear had influence on the hearing results of the two groups. Canal wall down mastoidectomy may be a beneficial procedure to improve hearing in patients with CSOM.

Surgical success of boomerang-shaped chondroperichondrial graft in pediatric chronic otitis media cases

ObjectivesTo reveal the success of boomerang-shaped chondroperichondrial graft (BSCPG) in pediatric chronic otitis media cases. MethodsA total of 43 pediatric patients (age 7–16 years) who had undergone type 1 tympanoplasty with the diagnosis of chronic otitis media between March 2010 and March 2013 were included in this retrospective study. The main outcome measures were the graft success rate and level of hearing improvement. ResultsGraft intake success rate was 90.7%. Mean preoperative and postoperative air-bone gap values were 20.51±4.34dB SPL and 9.32±5.64dB SPL, respectively (p<0.001). Mean preoperative and postoperative pure tone average values were 28.6±3.52 and 12.24±5.22 respectively (p<0.001). Air-bone gap was improved to ≤10dB in 38 (88.37%) patients during the postoperative period. ConclusionsBoomerang-shaped chondroperichondrial grafting technique seems to be a successful alternative in the management of pediatric chronic otitis media cases. It has relatively higher grade graft success rate.

Boomerang-Shaped Chondro-Perichondral Graft Versus Temporalis Muscle Fascia Graft: Which One is to be Trusted?

The aim of this study was to compare anatomical and audiological results of boomerang-shaped chondroperichondrial graft (BSCPG) with temporal muscle fascia in type 1 tympanoplasties. Sixty-eight patients in BSCPG group and 54 patients in fascia group were evaluated. Otomicroscopic examination was done periodically till 24months as for graft perforation, lateralization and retraction and mean air conduction threshold and airbone gap values were measured. At long term controls, in BSCPG group, rates of neomembrane, perforation, retraction and lateralization were 91.17% (n=62), 8.82% (n=6), 4.41% (n=3) and 0% (n=0), respectively. In fascia group, the corresponding rates were 79.62% (n=43), 20.37% (n=11), 12.96% (n=7) and 3.7% (n=2), respectively. In both groups, mean postoperative PTA and ABG values were significantly better while postoperative same values were significantly different between groups (p=0.044 and 0.032, respectively). Compared to fascia, BSCPG is an ideal grafting technique in the repair of tympanic membrane perforations.

Sklerotik mastoid kemiğe sahip kronik otitis medialı hastalarda tip 1 timpanoplasti: Anatomik ve fonksiyonel sonuçlar

Objective: To evaluate success of tympanoplasty type 1 in the treatment of patients with sclerotic mastoid bone. Methods: A retrospective study where 92 patients with non-cholesteatomatous chronic suppurative otitis media were recruited during the period of 2010 to 2012. Patients were managed medically and after dryness of their perforations they were operated upon. Ninety-two patients underwent type 1 tympanoplasty alone without cortical mastoidectomy. Underlay technique with chondroperichondrial graft was performed for all patients. Results: Mean air-bone gap values were estimated and compared. In pre- and postoperative audiograms, air-bone gap values at 500, 1000, 2000 and 4000 Hz frequencies were determined. Pre- and postoperative mean air-bone gap values of the patients were 23.47±4.95 and 11.58±4.77 dB, respectively. Conclusion: Our study emphasizes the fact that overall satisfactory hearing outcome with adequate air-bone closure can be achieved irrespective of cortical mastoidectomy in the surgical treatment of noncomplicated chronic ear diseases.

Long-term outcome of ossiculoplasty using autogenous mastoid cortical bone.

To observe the long-term outcome of ossiculoplasty using autogenous mastoid cortical bone in chronic otitis media in-patients. Sixty-one ears of 57 in-patients with chronic otitis media, with or without cholesteatoma, underwent type III tympanoplasty using autogenous mastoid cortical bone as the prosthetic material. Twenty-one ears were treated by canal wall down mastoidectomy and 40 ears by canal wall up mastoidectomy. The follow-up period was 3 to 6 years (average 4.2 years). Pure tone averages for thresholds at 0.5, 1, 2 and 3 kHz were calculated using standard conventional audiometry. The pre-operative mean air-bone gap of 31.6 dB, for all ears, was reduced to 20.3 dB post-operatively. For the 40 canal wall up ears, this value decreased from 30.8 dB to 19.9 dB, and for the 21 canal wall down ears it decreased from 33.0 dB to 21.0 dB. The differences between the pre- and post-operative mean air-bone gap values were significant. No cases of extrusion, necrosis or resorption were exhibited for the autogenous mastoid cortical bone prosthesis. A significant hearing improvement was obtained in the majority of cases and this remained stable over time.

Influence of size and site of perforation on fat graft myringoplasty.

In this retrospective study, we investigated the outcomes of fat graft myringoplasty (FGM) in different perforation sizes and locations. The outcomes were evaluated in terms of closure rates and audiological test results. The study population included 172 patients who were operated between 2007 and 2012. 161 had unilateral and 11 had bilateral chronic otitis media; and 183 ears were operated by FGM. The patients were divided into two groups based on size as small and larger (size of ≤30 of TM was defined as small perforations, and size of >30% TM was defined as a medium-large perforations); and two groups based on location of perforation [anterior and other (non-anteriorly located)]. Patients' follow-ups were performed between 1 and 5 years; and follow-up examinations were performed with otoendoscopy. Air conduction (AC) thresholds and air-bone gap (ABG) were evaluated both preoperative year and postoperative 1st year. The total perforation closure rate was 84.7%. In this study, we found out that FGM is effective closing medium-large perforations just as small perforations with the success rate of 79.1% and 86.4% respectively (p>0.05). When audiological outcomes were evaluated in both groups, AC values got lower and ABG values improved postoperatively, whereas regarding AC thresholds and ABG improvement among the size groups, patients with small perforations had significantly better postoperative results (p<0.05). In terms of perforation location, closure rates were 85.2% in anteriorly perforations and 84.5% in the other located perforations. Audiological outcomes demonstrated that in both groups, AC values got lower and ABG values improved postoperatively; and hearing results were not different in anteriorly located perforations and other locations. Fat graft myringoplasty (FGM) may be used in all small and medium-large, and anteriorly and other located perforations. Although hearing improvement was detected in each of the small; and medium-large perforations; patients with small perforations had more satisfied audiological outcome than medium-large perforations.

Endoscopic versus microscopic approach to type 1 tympanoplasty in children

ObjectivesWe investigated the outcomes of the endoscopic versus microscopic approach to type 1 tympanoplasty in pediatric patients. MethodsIn this retrospective study, the outcomes of 61 ears of 60 pediatric patients (33 male and 27 female) who underwent type 1 tympanoplasty were evaluated. One patient underwent a bilateral operation. The age range of the patients was 7–16 years. Group 1 underwent tympanoplasty with an endoscopic technique (n=32), and Group 2 underwent tympanoplasty with the conventional microscopic technique (n=29). A boomerang-shaped chondroperichondrial graft was used in both groups. The outcomes were analyzed in terms of the hearing gain, duration of surgery, and graft success rate. ResultsIn both groups, the postoperative air–bone gap (ABG) was significantly lower than the preoperative ABG. There were no significant differences between the preoperative and postoperative ABG values (in dB) in either group. The mean operative duration in Group 1 was significantly lower than that in Group 2 (51.37 vs. 67.03min, respectively). In the preoperative evaluation, 65.6% of patients in Group 1 had larger perforations and 34.4% had smaller perforations. In Group 2, 58.6% and 41.3% of patients had larger and smaller perforations, respectively. Perforations were detected in two (6.25%), four (12.50%), and four (12.50%) of the patients in Group 1 at postoperative months 1, 6, and 12, respectively. Perforations were detected in two (5.71%) patients in Group 2 at postoperative months 1, 6, and 12. At 12 months postoperatively, there were smaller perforations in four (12.5%) of the children in Group 1 and in two (5.71%) of the children in Group 2. The difference between the perforation conditions (larger vs. smaller) was not significant in either group. The preoperative and postoperative increases in the ABG were associated. The operative duration was shorter in Group 1 than in Group 2. ConclusionIn pediatric patients undergoing type 1 tympanoplasty, especially if the external ear canal is narrow and the anterior canal wall is prominent, the endoscopic and microscopic approaches appear to give equal results in terms of easy visualization of the entire tympanic membrane and no requirement for extra intervention to evaluate the ossicular system. A shorter operative duration is an advantage of the endoscopic tympanoplasty technique.

Delaying partial stapedectomy for otosclerosis: effects on long-term hearing outcomes following surgery

The purpose of this study is to evaluate hearing outcomes following partial stapedectomy according to age at the time of surgery and evaluate functional hearing at ≥ 10 years' follow-up, and to assess the effect of delay in surgery on overall functional hearing outcomes. Data were collected from patients operated upon for otosclerosis by a single surgeon from 1990 to 1999. Pure-tone air (PTA), pure-tone bone (PTB), air-bone gap (ABG), air-conduction at 8 kHz (AC 8), bone-conduction at 4 kHz (BC4) and speech discrimination score (SDS) were compared between patients <45 and ≥ 45 years old, as well as correlated with overall age preoperatively, short term (4 months) and long term (>10 years), postoperatively. Forty-five patients were included with a mean follow-up of 12.6 years. Mean preoperative ABG and AC 8 values were significantly different between the two age groups (p = 0.002; p = 0.010, respectively). No values remained significantly different between the two age groups at the long-term follow-up. ABG values correlated with age preoperatively (p = 0.001), although no correlation was seen short- and long-term postoperatively (p = 0.980; p = 0.495, respectively). Mean PTA, PTB, and ABG values showed a significant improvement in both groups preoperatively to short-term postoperatively (p < 0.001). Although mean PTA values decreased significantly from short- to long-term follow-ups in both groups (p = 0.033; p = 0.020), the improvement from the preoperative state remained significant (p < 0.001). Regardless of age at the time of surgery, long-term hearing levels will evolve similarly in patients <45 and ≥ 45 years old. Furthermore, no difference will be seen in hearing measurements between the two age groups at ≥ 10 years postoperatively. Delaying a surgery would thus not affect overall long-term hearing outcomes.

A novel technique for micro-reconstruction of posterior wall of external auditory canal and tympanum in patients with chronic supprative otitis media using pedicled temporalis myofascia

Objective To explore a novel surgical treatment for chronic suppurative otitis media (CSOM) and evaluate its treatment effect.Methods All 97 patients with chronic suppurative otitis media were chosen to be treated using this new surgical method.The skin of the external auditory canal was maintained intact.Open radical mastoidectomy was used to complete clean-up lesions ; the fascia of pedicled temporalis myofascia (PTM) was used to repair the tympanic membrane.The pedicled temporalis fascia,pedicled postauricular periosteal flap and intact skin of the external auditory canal were used in reconstruction of the posterior wall of external auditory canal.Pure tone audiometry (PTA) was performed before and after surgery,recording the air conduction and bone conduction thresholds at 0.5 kHz,1.0 kHz,2.0 kHz,4.0 kHz.The average of the patient's air and bone conduction hearing thresholds was recorded at the 4 frequencies.External auditory canal gauze was removed 3 weeks after surgery.All subjects were followed up for over 2 years.Comparison of hearing thresholds (PTA) was made ① Before and 4 weeks after surgery.② Before and 2 years after surgery.Hearing function comparison include air conduction (AC),bone conduction (BC) and air-bone gap (ABG) analysis.SPSS 16.0 was used in statistical analysis.Pre-and postoperated AC,BC and ABG were compared using T-test.P ＜ 0.05 was considered statistically significant.Results The healing rate of post-operated tympanic membrane was 95.88％ (93/97).Ninty-six ears had 2-year follow-up,and 1 patient was lost in follow-up.There were 2 patients presented with eardrum perforation during the follow-up,and the 2-year healing rate of tympanic membrane perforation was also 93.85％ (92/97).In 96 ears with 2-year followed-up,the average of pre-AC was (52.10 ±3.96) dB,the average of post-AC was (35.67 ±2.52) dB; the average of preABG was (36.6 ± 5.2) dB,and the average of post-ABG (± SD) was (12.14 ± 6.20) dB.Statistical analysis showed significant difference between preoperative and postoperative AC or ABG values (P ＜ 0.05).Conclusion The present surgical procedure broke through the existing conventional mastoidectomy of making a surgical incision in the posterior wall of the external auditory canal.This procedure cleared the lesion completely and preserved the physiological function of the external auditory canal.The acoustic systems and state of gasification to the mastoid tymnpanum were reconstructed,rehabilitated and maintained.The healing rate of hearing and tympanic membrane perforation was improved. Key words: Chronic suppurative otitis media; Tympanoplasty; External acoustic meatus; Tissue flaps

Long-term results of the Er-Yag laser used in stapes surgery

Stapes surgery is performed using both conventional techniques and a variety of laser systems. The Er-Yag laser is a type of pulsation laser deemed by many to be the safest for ear surgery. The aim of this study was to assess the long-term effects of using the Er-Yag laser in stapes surgery and its impact on inner ear function. The study was conducted on 95 ears (48 right and 47 left) that had undergone Er-Yag laser-assisted stapedotomy. The follow-up time was at least 3 years. Pure tone audiometry was performed on all patients. The frequency ranged from 125 to 8,000 Hz. Air conduction and bone conduction were both assessed. Moreover, all patients had their stapedius reflex assessed and were given a Rinne test. The results were evaluated according to the Committee on Hearing and Equilibrium guidelines and then statistically analyzed using the Wilcoxon sequence pair test with a p value of <0.05. A decrease in the hearing threshold of 0.5, 1, and 3 kHz, for both bone and air conduction was observed for all patients (p < 0.0001). The Wilcoxon sequence pair test revealed a statistically significant correlation between the pre- and postoperative treatment mean air-bone gap values (p < 0.0001). No facial nerve paralysis was observed. No Er-Yag laser side effects were observed on inner ear function. The patients also had lower hearing thresholds. These observations demonstrate the usefulness of Er-Yag lasers in stapes surgery.

A novel technique for reconstruction of the posterior wall of the external auditory canal and tympanum using pedicled temporalis myofascia

Conclusions: The procedure cleared the lesion completely and preserved the physiological function of the external auditory canal. Objective: To develop a novel surgical procedure to treat chronic suppurative otitis media (CSOM). To explore the merit of using pedicled temporalis myofascia (PTM) and reconstruction of the posterior wall of the external auditory canal with pedicled postauricular periosteal flap and intact skin of the external auditory canal. Methods: Forty-seven patients with CSOM were chosen. Open radical mastoidectomy was used to complete clean-up lesions; the fascia of PTM was used to repair the tympanic membrane. The PTM, pedicled postauricular periosteal flap, and intact skin of the external auditory canal were used in the reconstruction of the posterior wall of the external auditory canal. All subjects were followed up for over 2 years. Hearing thresholds, including air conduction (AC), bone conduction (BC), and air–bone gap (ABG) before and after surgery, and after follow-up, were compared. Results: The healing rate of postoperated tympanic membrane was 95.74% and the 2-year healing rate of tympanic membrane perforation was 95.65%. The 46 ears included in the 2-year follow-up showed significant improvement between preoperative and postoperative AC and ABG values.

Anatomical and functional results of open cavity tympanomastoidectomy

In this study, we aimed to evaluate the anatomical and functional results of open cavity tympanomastoidectomy due to chronic otitis media with cholesteatoma. Between January 2003 and October 2009, 166 patients who underwent open cavity tympanomastoidectomy due to chronic otitis media with cholesteatoma in our clinic were retrospectively analyzed. Seventy-two ears of 69 patients (40 males, 29 females; mean age 36.7±17.7 years; range 9 to 64 years) who visited on a regular basis due to acquired middle ear cholesteatoma were included. Cholesteatoma was classified as attic, sinus and tensa retraction cholesteatoma, according to its localization. Audiological findings were compared based on the localization of cholesteatoma and intraoperative ossicular status. The mean follow-up was 36.3±27.0 months (range 6 to 88 months). There were six (8.4%) greft failures, four (5.6%) graft retractions, and one (1.4%) recurrent cholesteatomas in the ears of the patients. There were also five (7%) pearly residual cholesteatomas. At the last visit following surgery, 97.2% of cavities were dry and self-cleaning. The mean preoperative pure tone air threshold was 53.5±22 dB, while it reduced to 52.2±23.3 dB at the last visit in 48 ears operated open cavity tympanomastoidectomy type 1, 2, 3, and 4 in combination with hearing reconstruction (p=0.454). There was a statistically significant reduction in the mean air-bone gap of the attic cholesteatomas, decreasing from 27.2±14.6 dB to 21.6±12.2 dB (p=0.007). Air-bone gap values were lower than 20 dB in 23 (47.9%) of the cases and the gain was more than 10 dB in 17 (35.5%). No statistically significant correlation was found between the localization of cholesteatoma and intraoperative ossicular status (p>0.05). Open cavity tympanomastoidectomy, which allows total removal of the pathology, is an applicable surgical approach with satisfactory outcomes for hearing reconstruction.

The impact of chronic suppurative otitis media on children's and teenagers’ hearing

Objective Otitis media is the most common otological condition during childhood which compromises sound conduction in the middle ear. In chronic cases, it is estimated that the degree to which hearing is compromised is directly proportional to the damage caused to the middle ear's structures. It means that hearing thresholds may be influenced by factors such as the size and location of the tympanic perforation, the presence of ossicular chain erosion or disarticulation as well as the presence of cholesteatoma and its growth patterns. The goals of this study were to compare air conduction, bone conduction thresholds and air-bone gaps of children and teenagers between those with chronic suppurative otitis media with cholesteatoma and those without cholesteatoma. To compare air-bone gap values for different cholesteatoma growth patterns. To verify the relationship between the number of perforated quadrants and the size of the air-bone gap. To compare air-bone gap values between tympanic perforations in posterior quadrants with those in anterior quadrants. Methods A transversal study involving 202 children and teenagers (287 ears), aged between 6 and 18, with chronic suppurative otitis media with and without cholesteatoma, submitted to digital videotoscopy and pure tone audiometry (PTA) was conducted. Results and conclusions Air conduction, bone conduction thresholds and air-bone gaps in children and teenagers with CCOM are significantly greater. There were no significative differences between air-bone gaps in epitympanic and posterior mesotympanic cholesteatomas. In NCCOM, the gap value is positively correlated with the number of quadrants with tympanic perforation. There was no significative difference between the air-bone gaps in tympanic perforations affecting the posterior and anterior quadrants.

Canal wall reconstruction and mastoid obliteration in canal wall down tympanomastoidectomized patients

Conclusion: Posterior canal reconstruction using autogenous bone pate and mastoid obliteration with allogenous cancellous bone chips (ACBCs) is a useful method to eliminate cavity problems after canal wall down tympanomastoidectomy (CWDT). It is also an appropriate method to obtain adequate middle ear space for hearing gain and to apply hearing aids for patients with poor eustachian tube function after surgery. Objective: This study was performed to suggest a new technique for posterior canal reconstruction and mastoid obliteration and to evaluate the outcome of the surgery. Patients and methods: The entire posterior canal was reconstructed with autogenous bone pate, and the new isolated mastoid cavity was obliterated with ACBCs in patients who had undergone CWDT and suffered from cavity problems. Outcomes were measured by external auditory canal shape, condition of the neotympanum, hearing outcome, improvement of cavity problems, and surgical complications. Results: In 90.9%, the reconstructed canal wall maintained a cylindrical shape. The drum healed without perforation/retraction in 90.9%. The average air–bone gap value was 34.5 dB hearing level (HL) before the staged operation and 17.8 dB HL after the staged operation; 95.5% had no more cavity problems. Minor postauricular wound infection was the most common complication (13.6%).