Air Conduction Pure-tone Averages Research Articles

Unilateral congenital malformations of middle ear with intact external ear: a review of 64 cases

To describe the operative findings and surgical results of unilateral congenital middle ear malformations with intact external ear. A retrospective review was performed on 64 patients with unilateral congenital middle ear malformations and intact external ear who underwent exploratory tympanotomy from 2011 to 2016. Demographic data, clinical data, high-resolution computed tomography findings, audiometric data and intraoperative findings were collected. Audiological evaluations before and 6months after surgery were analyzed in 47 patients. The most common malformation were mobile stapes with missing incus long process and stapes suprastructure. The air conduction pure tone average was 58.9 ± 10.5dB HL (range 34.4-78.1dB HL) preoperatively and 28.8 ± 10.6dB HL (range 9.4-55.6dB HL) postoperatively (P = 0.000). Twenty-five cases (53.2%) acquired an air conduction hearing gain exceeding 30dB. Mean air-bone gap (ABG) was 44.5 ± 9.4dB (range 22.5-66.4dB HL) before surgery and 15.6 ± 9.3dB (range 0-35.6dB) after surgery (P = 0.000) for an average gain of 28.8 ± 11.5dB. Thirty-four cases (72.3%) showed a postoperative ABG of less than 20dB, 15 had an ABG within 10dB, and 4 had 0dB ABG after operation. No significant difference was observed for air conduction hearing gain regarding age (P = 0.261) or types of malformations (mobile stapes footplate with or without a suprastructure anomaly, P = 0.058). Unilateral congenital middle ear malformations with intact external ear can be complex and diverse. Functional ossiculoplasty for patients with unilateral congenital middle ear malformations can achieve good hearing outcomes.

Clinical Characteristics and Treatment Outcomes for Patients With External Auditory Canal Cholesteatoma.

We aimed to evaluate the clinical features and treatment outcomes for patients with idiopathic and secondary external auditory canal cholesteatoma (EACC), and to validate the treatment strategy from the perspective of hearing as well as etiology and staging. Retrospective case series. Tertiary referral center and affiliated hospitals. Fifty-eight patients with idiopathic EACC and 14 patients with secondary EACC. Conservative management and surgery. Air conduction (AC) pure-tone averages (PTAs) and mean air-bone gaps (ABGs). There were no significant differences between hearing values before and after conservative management for idiopathic EACC patients with stages I-III, indicating that hearing abilities were preserved. For idiopathic EACC patients with stage IV disease treated with surgery, the AC PTA threshold and mean ABG significantly improved from a preoperative value of 60.3 dB HL to a postoperative value of 32.4 dB HL (p = 0.013), and from 34.3 to 9.5 dB HL (p < 0.001), respectively. For secondary EACC, the AC PTA threshold and mean ABG significantly improved from a preoperative value of 49.5 dB HL to a postoperative value of 23.2 dB HL (p < 0.001), and from 31.4 to 6.7 dB HL (p < 0.001), respectively. The treatment modalities should be selected based on the perspective of hearing as well as the extent of disease and etiology. The early lesions can be treated conservatively, whereas the advanced lesions or cases refractory to conservative management require complete surgical removal of EACC.

Audiologic Assessment in Adults With Down Syndrome.

Increased life expectancy in persons with Down syndrome (DS) is associated with premature age-related changes. The aim of this study was to assess auditory function in adults with DS and to evaluate the prevalence of hearing loss in this population. Audiometric tests were performed in 72 adults with DS (mean age 37.3±10.1 years, 51.4% females). Air conduction pure tone average (PTA) thresholds at frequencies 0.5-1-2-4 kHz were calculated to assess hearing function. Hearing loss was present if the PTA threshold was > 20 dB hearing level. Higher frequencies of 4 and 8 kHz were also assessed. Hearing loss was shown in 47 (65.3%) participants. The prevalence of hearing loss increased with age, ranging from 42.86% in the 20-29 years group to 90.91% in the 50-59 years group. High frequencies (4 and 8 kHz) were more often impaired than other frequencies used to measure PTA. Thus, the study concluded hearing loss is common in adults with DS and shows a pattern compatible with precocious aging of the hearing system. Auditory evaluation is strongly recommended in adults with DS.

Visual and hearing impairment and retirement in older adults: A population-based cohort study

ObjectiveImpaired vision and hearing are common among older adults and have been shown to reduce functional independence and to reduce quality of life. This cohort study investigated the cross-sectional and temporal associations between objectively measured dual sensory impairment (DSI) and retirement from employment. Study design2409 Blue Mountains Eye Study participants aged 55+ years at baseline were included for analyses. Main outcome measuresVisual impairment was defined as visual acuity less than 20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold >25dB HL (500–4000Hz, better ear). Employment status was questioned at each examination over 10 years. ResultsAt baseline, 650 (27.0%) were employed and 1759 (73.0%) were retired. Cross-sectional analysis showed that participants with moderate to severe hearing loss, compared with those with normal hearing, had greater odds of being retired (multivariable-adjusted OR 1.96; 95% CI 1.05–3.66). Participants presenting with concurrent visual impairment and moderate to severe hearing loss versus participants with no sensory loss had a significantly lower mean retirement age, 57.1 versus 58.7 years (multivariable-adjusted p-value=0.04). Participants with any hearing loss at baseline had significantly higher odds of being retired by the 10-year follow-up (age-sex adjusted OR 1.82; 95% CI 1.00–3.30); this became marginally non-significant after adjusting for all other covariates (multivariable-adjusted OR 1.74; 95% CI 0.95–3.17). No associations were observed between DSI and the incidence of retirement. ConclusionsSensory impairment in older adults was independently associated with the decision to retire.

Long-term Results of Troublesome CWD Cavity Reconstruction by Mastoid and Epitympanic Bony Obliteration (CWR-BOT) in Adults.

To present the long-term surgical outcome of the bony mastoid and epitympanic obliteration technique with canal wall reconstruction (CWR-BOT) in adults with an unstable cavity after previous canal wall-down surgery for extensive cholesteatoma. Retrospective study. Therapeutic. Tertiary referral center. Fifty consecutive adult patients undergoing a CWR-BOT between 1998 and 2009. (A) Recurrence and residual rates of cholesteatoma, (B) postoperative hygienic status of the ear, including postoperative aspect of the tympanic membrane and external ear canal integrity (EAC), (C) functional outcome, and (D) long-term safety issues. (A) The percentage of ears remaining safe without recurrent or residual disease after CWR-BOT was 96% after a mean follow-up time of 101.8 months. Recurrent cholesteatoma occurred in 2% (n = 1) and a residual cholesteatoma was detected in 2% (n = 1) of the patients. (B) A safe dry, and trouble-free graft and selfcleaning EAC was achieved in 94%. (C) The postoperative hearing results showed a gain of 1.7 dB on pure-tone average air-conduction. (D) Nonecho planar diffusion-weighted imaging (non-EP DW magnetic resonance imaging) documented the residual (n = 1) and recurrent cholesteatoma (n = 1). The 1- and 5-year imaging follow-up revealed no other recurrent or residual disease. The CWR-BOT is a safe and very effective option for treatment of problematic unstable canal wall-down mastoid cavities, resulting in dry trouble-free ears.

Gender Differences in Mathematics Achievement of Deaf Students in Ashanti School for the Deaf, Ghana

Anchored on the socio-cultural theory of learning, this intact group comparison posttest-only research analyzed gender differences in Mathematics achievement of Deaf students in Ashanti School for the Deaf on the Ghana National Education Assessment Test for Primary Six (NEA-P6) in order to provide empirical information for educational practice in that school. One research question and one hypothesis were formulated to guide the study. Out of a population of 29 Primary Six students, a sample of 16 matched students (8 males and 8 females) aged 14 to 19 years with an average pure tone air conduction hearing loss of 101dB, participated in the study. A t-test for dependent samples was used to determine the mean differences between the two group means because the study involved matched participants chosen from a single population. Findings of the study indicated slightly higher mean achievement levels for female participants than that of their male counterparts. Implications for practice and further studies were discussed.

Hearing and vision impairment and the 5-year incidence of falls in older adults.

concurrent vision and hearing loss are common in older adults; however, epidemiological data on their relationship with the incidence of falls are lacking. we assessed the association between dual sensory impairment (DSI) and incidence of falls. We examined the influence of self-perceived hearing handicap and hearing aid use and risk of falls. a population-based, cohort study of participants followed over 5 years. Blue Mountains, west of Sydney, Australia. one thousand four hundred and seventy-eight participants aged 55 and older at baseline were included in longitudinal analyses. visual impairment was defined as presenting or best-corrected visual acuity less than 20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold >25 dB HL (500-4,000 Hz, better ear). The shortened version of the hearing handicap inventory for the elderly was administered. Incident falls were assessed over the 12 months before each visit. Cognitive impairment was determined using the Mini-Mental State Examination. five-year incidence of falls was 10.4%. Participants with severe self-perceived hearing handicap versus no hearing handicap had increased risk of incident falls, multivariable-adjusted OR 1.93 (95% confidence intervals, CI, 1.02-3.64). Hearing aid users versus non-users had 75% increased likelihood of incident falls. Participants with co-existing best-corrected visual impairment and mild hearing loss (>25 to ≤40 dB HL) had higher odds of incident falls, OR 2.19 (95% CI 1.03-4.67). After excluding persons with cognitive impairment, this association did not persist. these epidemiological data show that DSI in older adults could significantly increase their risk of falling.

Long-term Outcomes of Titanium Ossiculoplasty in Chronic Otitis Media.

The primary objective is to report long-term hearing outcomes (>2 years) after titanium ossiculoplasty in patients with chronic otitis media. Case series with chart review. Tertiary care hospital. In total, 156 patients with chronic otitis media undergoing titanium ossiculoplasty were included. The primary outcome measure was the long-term postoperative ABG. The stability of hearing over time was determined by comparing short-term and long-term postoperative air-bone gap (ABG). Secondary outcome measures included ΔABG, postoperative speech reception thresholds, air-conduction pure-tone average (AC PTA), word recognition scores, and percentage of patients achieving ABG ≤20 dB. Revision and extrusion rates were examined. At short-term follow-up (<6 months), mean postoperative ABG was 18.4 ± 10.6 dB and AC PTA was 31.7 ± 15.2 dB; 67% of patients achieved ABG ≤20 dB. At long-term follow-up (>2 years), mean ABG was 20.0 dB ± 15.4 and AC PTA was 35.3 ± 16.1 dB; 60% of patients achieved ABG ≤20. At both short- and long-term follow-up, ABG and AC PTA were significantly improved compared with preoperative values. No difference in hearing outcomes was observed when comparing partial titanium ossicular prostheses (PORPs) to total titanium ossicular prostheses (TORPs) at either short- or long-term follow-ups. In patients with both short- and long-term follow-up (n = 50), deterioration in hearing was noted (3.4 dB, P = .04). When analyzed by type of prosthesis, PORPs demonstrated statistically significant deterioration in ABG over time (4.9 dB, P = .02), while TORPs did not (2.5 dB, P = .50). The long-term extrusion rate was 3.2%. With a minimum follow-up of 2 years, titanium ossiculoplasty provides good long-term hearing results. Modest deterioration in hearing is noted over time.

Round window application of an active middle ear implant (AMEI) system in congenital oval window atresia

Conclusion: Application of the Vibrant Soundbridge to the round window (RW) membrane can be utilized as an efficient therapy for congenital oval window (OW) atresia. Objective: To report the surgical technique and auditory outcome of an active middle ear implant (AMEI) system used in patients with congenital OW atresia. Methods: Nine subjects with congenital OW atresia (six males and three females, ranging in age from 5.5 to 25 years, average 12.5 years) were implanted with an AMEI (Vibrant Soundbridge) at the round window (RW-Vibroplasty). Five cases were diagnosed as having isolated congenital OW atresia while four patients presented with combined external/middle ear malformation. Results: An improvement of 30 dB in average pure-tone air conduction thresholds (0.5–4 kHz) was achieved, with the high frequencies showing greater results. The subjects achieved postoperative speech recognition scores of 80–100% on the Computerized Mandarin Speech Test System (CMSTS) sentence test. Bone conduction thresholds were confirmed as stable in all subjects postoperatively. Decline in auditory benefit was noticed in two subjects, who then underwent revision surgery. One of these revision surgery patients then experienced stable hearing recovery, while the other patient’s hearing declined.

Cochlear implantation as a long-term treatment for ipsilateral incapacitating tinnitus in subjects with unilateral hearing loss up to 10 years

IntroductionThe authors previously demonstrated that tinnitus resulting from unilateral hearing loss (UHL) can be treated with electrical stimulation via a Cochlear Implant (CI). The study aimed to do a long-term (LT) evaluation of CI in subjects suffering from UHL and accompanied incapacitating tinnitus up to 10 years. The primary focus of the study is on LT tinnitus reduction. SubjectsLT evaluation was derived from 23 subjects suffering from UHL and accompanied incapacitating tinnitus (Pre-operative Tinnitus Loudness Visual Analogue Scale (VAS) score >6/10). They were cochlear implanted at a median age of 55 years (22–71 yr) and had 8 years (3–10 yr) experience with their CI at the LT testing. The subjects were categorized into two groups: a Single-Sided Deaf Group (SSD) and an Asymmetric Hearing Loss Group (AHL). The SSD group comprises subjects with contralateral normal hearing (i.e. air conduction pure tone average (PTA0.5, 1, 2 and 4 kHz) ≤ 30 dB HL) and the AHL group subjects with contralateral mild to moderate hearing loss (i.e. air conduction PTA0.5, 1, 2 and 4 kHz > 30 dB HL). MethodsIn order to obtain a LT structural overview of the CI use in UHL subjects, a structured interview was conducted including questions about daily amount of CI use, residual inhibition of the tinnitus after switch off, tinnitus type, etc. The VAStinnitus loudness and the Tinnitus Questionnaire were obtained pre-operatively, one, three, six, 12, and 36-months post-operatively and at the long-term test interval (8 (3–10 years) post-operative). The Hyperacusis Questionnaire was administered in the CION and the CIOFF condition. ResultsThe structural interview revealed that all patients (23/23) still wear their CI seven days a week, eight (3–10) years after cochlear implantation. It appeared that in all subjects but one CI switch-on is the first act when rising and CI switch-off is the last act before bedtime. In the SSD group, tinnitus suppression is still the primary benefit reported (83%), whereas in the AHL the majority of the subjects (55%) report that the primary benefit shifted to improved hearing. In the majority of the subjects the tinnitus reduction starts within 1 min (in 70% of the cases) and the residual inhibition after CI switch-off is less than a minute (in 65% of the cases). The VAS and TQ scores significantly improved up to three months after the first-fitting and remain stable up to the LT test interval. The median score on the Hyperacusis Questionnaire was 17 (7–36) in the CIOFF condition and improved to 23,5 (12–39) in the CION condition in the SSD group. ConclusionThis is the first study to report on LT results in a large number of UHL CI users, up to 10 years. Structured interviews shows that 100% of the subjects wears their CI seven days a week. The tinnitus reduces significantly up to three months after the first-fitting and the tinnitus reduction remain stable up to the LT test interval. The SSD group report tinnitus reduction as the primary benefit, whereas the majority of the AHL group report improved hearing as the primary benefit, eight (3–10) years after implantation. In addition to the tinnitus reduction, the CI provides also a benefit regarding reported.

Revision surgery for canal wall down mastoidectomy: intra-operative findings and results

Conclusion: Canal wall down mastoid surgery following multiple earlier surgical failures can be revised by a well-trained experienced surgeon. A dry and safe ear is obtainable in most patients, and hearing preservation is also possible. Objectives: To analyze the intra-operative findings in revision surgery for canal wall down (CWD) mastoidectomy and to ascertain the prognosis.Methods: A total of 76 revision mastoidectomies with tympanoplasties performed from March 2008 to May 2014 at the First Affiliated Hospital of Zhengzhou University in China were reviewed. The pre-operative, intra-operative, and post-operative data was recorded and analyzed. Results: The possible reason of previous surgical failures were confirmed by the operative findings, which included inadequate mastoidectomy or persistent air-cell disease (66/76 [86.8%]), recurrent or persistent cholesteatoma (44/76 [57.9%]), excessive opened cavity combined with complications (9/76 [11.8%]), and infected cavities (68/76 [89.5%]). In this study, disease control was achieved in 70 (92.1%) patients. Complications following previous surgery were modified by revision surgery. Hearing was significantly improved in the 54 cases with ossicular replacement prosthesis. After a mean follow-up of 22 months, the group of revision surgery with ossiculoplasty as a whole experienced a statistically significant hearing gain of 16.57 ± 11.96 dB (p < 0.05) at air conduction pure tone average (PTA).

Hearing Outcomes after Revision Stapedectomy Managed with Total Ossicular Prostheses.

(1) To describe the use of total ossicular prostheses (TOPs) in the setting of stapedectomy requiring an incus bypass procedure. (2) To analyze the short- and long-term audiometric results of TOP utilization in the setting of stapedectomy for an incus bypass procedure. Case series with chart review. Tertiary neurotologic referral center. Seventeen cases of TOP reconstruction after stapedectomy were performed due to advanced incus erosion. The cases were assessed for pre- and postoperative bone conduction and air conduction pure-tone averages (PTAs; 0.5, 1, 2, 3 kHz), including high-tone bone conduction (1, 2, 4 kHz), air-bone gap, and speech discrimination scores. Hearing outcomes were measured: short-term (3 weeks) and long-term (average, 22 months). Among 17 ears undergoing revision stapedectomy managed with TOP reconstruction, the average number of previous revision attempts was 1.0 (SD, 1; range, 1-5). The preoperative bone conduction PTA was 30.7 dB preoperatively, while the preoperative air conduction PTA was 64.3 dB. The mean postoperative air-bone gap significantly decreased to 18.9 dB (SD, 12.7; range, 5-46.25; P < .003) with a mean follow-up of 22.2 months (SD, 25.0; range, 0.75-78). No significant decrement in high-tone bone conduction PTA was observed (mean, 0 dB; SD, 12.8; range, -36.7 to 20; P = .427); however, 1 ear revealed a severe decrease in PTA and speech discrimination score postoperatively. No further revisions were noted in follow-up. TOP reconstruction in the setting of previous revision stapedectomy with limited incudovestibular reconstructive options may lead to favorable hearing outcomes, but it carries an increased risk of sensorineural hearing loss.

Hearing function after intratympanic application of gadolinium-based contrast agent: A long-term evaluation.

The aim of this study was to evaluate the long-term influence of intratympanic gadolinium-based contrast agent on hearing function in patients with possible Ménière's disease and normal auditory thresholds who were undergoing locally enhanced magnetic resonance imaging scans. Prospective observational cohort study in a tertiary referral university hospital ear, nose, and throat department. Between 2009 and 2012, 17 patients with possible or probable Ménière's disease and a four-tone pure-tone average baseline of <25 dB were recruited for our study. Before undergoing intratympanic injection of gadolinium-based contrast agent, all patients underwent a complete audiological evaluation. The study population was then invited back after at least 6 months postinjection for a follow-up auditory evaluation. This consisted of comprehensive clinical and audiological tests on both sides and were evaluated according to the ototoxicity guidelines. A long-term evaluation of our study group revealed no significant difference in the air-conduction pure-tone average. Furthermore, no statistical difference at individual frequencies compared to baseline was found. There was no evidence of ototoxicity in the injected ear. Long-term hearing function assessment after intratympanic application of gadolinium-based agent showed no evidence of ototoxicity. The use of intratympanic gadolinium-based agent in the diagnosis of Ménièrés disease is currently a helpful tool, and seems to be a safe method, especially with regard to auditory function. 4.

Decisive criteria between stapedotomy and cochlear implantation in patients with far advanced otosclerosis.

To describe the hearing outcomes in patients with far-advanced otosclerosis and to identify the best initial approach based on preoperative word recognition scores (WRS), pure tone averages (PTA), and radiological classification. Retrospective case review. Academic neurotology tertiary referral center. All patients (n = 58) with preoperative air conduction PTA less than 85 dB (HL), disyllabic WRS less than or equal to 50% at 60 dB (HL) with well-fitted hearing aids, and evidence of otosclerosis on CT scan, treated in our department over the past 20 years. Stapedotomy, cochlear implantation, or both. Postoperative WRS after a minimum of 12 months' follow-up, percentage of patients with WRS greater than 50%. Reliability of air and bone conduction PTAs and WRS in predicting failure of stapedotomy. Fifty-eight patients were divided into three groups: group I, primary stapedotomy (n = 32); group II, primary cochlear implantation (n = 9); and group III, secondary cochlear implantation (with a previous history of stapedotomy) (n = 25). The mean postoperative WRS were 50.6% (± 34), 75% (± 17), and 72% (± 20), respectively. Sixty percent of patients in the stapedotomy group had a postoperative WRS greater than 50% requiring no further treatment, compared to 85% for cochlear implant recipients. No specific predictive factors for stapedotomy outcome could be identified. Surgical difficulties during cochlear implantation were significantly higher in patients with advanced radiological stage. Although cochlear implantation gives better overall results, stapedotomy with hearing aids can still be very effective in the management of patients with far-advanced otosclerosis. It should therefore be proposed as a first-line treatment.

Hearing rehabilitation with the closed skin bone-anchored implant Sophono Alpha1: Results of a prospective study in 15 children with ear atresia

ObjectiveTo study gain and cutaneous tolerance of the Sophono Alpha1 implant, used for unilateral hearing rehabilitation in children with ear atresia, and to demonstrate non-inferiority compared to the referral closed skin device, BAHA® on a test-band. Methods and materialsFifteen children included in a prospective clinical trial from September 2010 to November 2012. Tertiary care center. Main outcomes: Pure tone and speech audiometry before surgery and at M6 and 12; Speech-in-noise tests with and without Alpha1 at M6. Quality of life questionnaire completed before surgery and at M6; children and parent's satisfaction assessed at M6. Cutaneous appearance assessed at M6, M12 and during the last clinical assessment. ResultsPatients’ ages ranged from 61 to 129 months. They had a pure conductive deafness with a mean air conduction pure-tone average (ACPTA) of 69.02±9.31dB, and a mean SRT of 71.73±9.20dB. Follow-up was 12–32 months. At M6, the mean aided ACPTA was 33.49±4.89dB, the mean aided SRT 38.27±4.54dB and the mean aided SRT in noise was statistically improved (−7.80dB). Sophono Alpha1 demonstrated non-inferiority compared to BAHA® on a test-band. At M12, mean aided ACPTA was 2.94dB higher (p<0.001) but the mean SRT variation (+0.73dB) was not significantly different (p=0.35).At M12, all children used the implant 5 to 12h daily (mean: 10) without cutaneous complications. Both children and parents reported being satisfied or very satisfied. The score for 7/10 questions in silence or noisy environment was statistically improved when wearing the device. ConclusionsThis prospective study demonstrate non inferiority, good cutaneous tolerance, satisfaction of children and parents and improvement of the quality of life with the Sophono Alpha1 compared to BAHA® on a test-band. In the light of this study and of the previously published series, the aided threshold is between that obtained with BAHA on a softband and percutaneous BAHA. The Sophono Alpha1 device needs to be part of the hearing solutions proposed for the hearing rehabilitation in children with ear atresia.

Autologous total ossicular replacement prosthesis.

To develop an autologous total ossicular replacement prosthesis with sustainable hearing results. The ears of 40 patients, who had chronic otitis media with absent suprastructure of the stapes and long process of the incus, were repaired using the autologous total ossicular replacement technique. Post-operative results were evaluated after 6 and 12 months on the basis of average pure tone air conduction and average air-bone gap measured at 0.5, 1, 2 and 3kHz. Successful rehabilitation of pure tone average to 30dB or less was achieved in 75 per cent of patients, and air-bone gap to 20dB or less was attained in 82.5 per cent of patients. Overall mean improvement in air-bone gap was 23.9±8.5dB (p<0.001). Mean improvements in air-bone gap were significantly greater (p<0.05) in the tympanoplasty only group (27.3±6.6dB) and the intact canal wall tympanoplasty group (25.9±6.3dB) than in the canal wall down tympanoplasty group (16.3±8.9dB). This paper describes an autologous total ossicular replacement prosthesis that is biocompatible, stable, magnetic resonance imaging compatible and, above all, results in sustainable hearing improvement.

Audiological results after total ossicular reconstruction for stapes fixation.

The objective was to assess audiological results after total ossicular reconstruction for stapes fixation. The study is a retrospective evaluation conducted in a tertiary referral centre. The patients were 16 adults with conductive or mixed hearing loss and stapes fixation due to tympanosclerosis or otosclerosis. A total or partial stapedectomy with perichondrium interposition on the oval window and ossicular reconstruction with titanium total prosthesis were done. To assess pre- and post-operative (1 and 4 years) air and bone-conduction thresholds (frequencies 0.5, 1, 2, 3 kHz), pure-tone average air and bone conduction, and air-bone gaps were measured and the number of decibels of closure of the air-bone gap at 1 year and at 4 years were compared. One year after surgery, air conduction thresholds and pure-tone average air conduction were improved for all frequencies, and there were no significant differences in bone conduction thresholds or in pure-tone average bone conduction. There were no differences in air and bone conduction thresholds, pure-tone average air or bone conduction between 1 and 4 years. The air-bone gap was significantly reduced 1 year after surgery and remained so at 4 years. (Preoperative air-bone gap, 34.04 dB; at 1 year, 16.40 dB; at 4 years, 17.3 dB. Decibels of closure of the air-bone gap at 1 year, 17.64 dB; at 4 years, 16.74 dB.) No differences were found between otosclerosis subjects and all other cases combined. Total ossicular reconstruction in stapes fixation due to tympanosclerosis or otosclerosis produces satisfactory short- and long-term auditory results.

Audiological Evaluation of the Contralateral Ear in Patients with Cholesteatoma

Objectives: Evaluate the contralateral ear (CLE) audiometric findings in patients with middle ear cholesteatoma. (2) Correlate the audiometric thresholds to videotoscopic findings. Methods: Cross-sectional study. Videotoscopies and audiometries of 300 patients with cholesteatoma at a tertiary hospital were analyzed. The CLE videotoscopy, bone conduction, air conduction, and air-bone gap pure tone average (PTA) were analyzed. Results: The mean patient age was 32.35 ± 19.26 years, and 52.2% were female. The CLE was abnormal in 60.8% of cases: 5.6% had perforation, 39.9% had moderate or severe retraction, and 15.6% had cholesteatoma. The CLE bone conduction PTA was 16.75 ± 16.1 dB, the air conduction PTA was 47.1 ± 22.8 dB, and the air-bone gap PTA was 32.2 ± 18.7 dB. The CLE prevalence of severe and profound sensorineural hearing loss was 1.7%. Severe hearing impairment did not occur in patients with a normal CLE, whereas it did occur in 2.7% of patients with an abnormal CLE ( P = .02). Bone conduction PTA was similar between normal and abnormal CLE ( P = .82), but the air conduction and air-bone gap PTA were higher in abnormal CLE ( P &lt; .001 and P &lt; .001, respectively). Conclusions: In patients with cholesteatoma, the CLE had a high prevalence of abnormalities and hearing impairment. Severe and profound sensorineural hearing loss was only observed in abnormal CLE. The air bone gap and air conduction PTA were also higher in the abnormal CLE.

Management of incus necrosis in revision stapedectomy using hydroxyapatite bone cement.

Review audiological outcomes after revision stapedectomy using hydroxyapatite cement. Retrospective case review. Tertiary neurotological referral center. Thirty-seven cases of previously treated otosclerosis where incus erosion was observed during revision stapedectomy. Hydroxyapatite cement was used to rebuild the eroded incus and stabilize the prosthesis during revision stapedectomy. Pre- and postoperative bone conduction (BC) and air conduction (AC) pure-tone averages (PTA) (0.5, 1, 2, 3 kHz) including high tone BC (1, 2, 4 kHz), air-bone gap (ABG), and speech discrimination scores were measured. Short-term (3 wk) and longer-term (average 12 mo) hearing outcomes were measured. Data are reported according to the most recent guidelines of the AAO-HNS Committee on Hearing and Equilibrium. Among 37 ears undergoing revision stapedectomy with hydroxyapatite cement, the AC PTA was 59.8 dB preoperatively and 34.6 dB postoperatively (p < 0.0001) at latest follow-up. The mean postoperative ABG was 8.8 dB (SD = 8.6, range -1.3-36.3 dB) while a mean improvement of 2.1 dB (SD = 6.5, range -8.33-15.0 dB) of the high tone BC PTA was observed. One revision case was noted during the follow-up period. Hydroxyapatite cement is useful to reconstruct and stabilize the prosthesis in revision stapedectomy when erosion of the long process is encountered. Short- and longer-term hearing results are favorable when compared to previously reported results of revision stapedectomy.

Outcomes following Semicircular Canal Plugging.

To examine audiometric outcomes, symptom control rates, and complication rates following semicircular canal plugging for superior semicircular canal dehiscence syndrome. Retrospective chart review. Private, neurotologic tertiary referral center. Patients undergoing semicircular canal plugging for superior semicircular canal dehiscence syndrome from January 1, 2007, to December 31, 2012. Pre- and postoperative audiometry, vestibular testing, operative findings, and clinical symptoms were assessed through chart review. A total of 24 ears underwent a canal plugging procedure during the study period for superior canal dehiscence syndrome. Pre- and postoperative air conduction pure-tone averages were 21.1 and 22.5 dB (P = .42, not significant [NS]). The average pre- and postoperative word recognition scores were 95.8% and 95.1% (P = .48, NS). Vestibular evoked myogenic potential data showed reduced thresholds in 7 patients with canal dehiscence. Complications were limited to a single, temporary facial weakness. Complete symptom improvement was noted in 35.7% of all patients, while at least partial symptom improvement was found in over 80% of patients. Semicircular canal plugging procedures are associated with excellent hearing outcomes and may reduce preoperative symptoms in patients with superior semicircular canal dehiscence.