Air Conduction Thresholds Research Articles

Validation of app-based hearing assessment (H3 hearing test) through smart phone: preliminary trends

Objective To promote tele-audiology, the smartphone online applications (APP) for assessment of hearing function need to be validated. We present our preliminary report of one such APP that we adapted during the active COVID phase of 2021. Methodology A total of 44 patients underwent both pure tone audiometry (PTA) and APP-based hearing assessment. The air conduction thresholds at 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz, 6000 Hz and 8000 Hz were noted. Results A significant correlation was seen between the thresholds and paired differences. However, air-conduction (AC) thresholds of either PTA or APP were shown to overshoot each other and right side values were more consistent. Conclusions While suggestions have been made to overcome these inconsistencies, the APP-based hearing assessment is likely to improve tele-audiology as relevant modifications by the manufacturer are incorporated to improve its efficacy.

The study of otoendoscopic tympanoplasty (type I)

Background With the development of otoendoscopic surgery technology and the update of equipment, more and more otoendoscopic tympanoplasty are carried out. Objectives To investigate application of otoendoscopic tympanoplasty. Methods Seventy-six patients with tympanic membrane perforation were randomly enrolled into otoendoscopic group (OP, n = 38) and microscope group (MP, n = 38). We compared two-group patients using operative time, intraoperative blood loss, healing of postoperative perforations, and degree of postoperative hearing improvement. Results Average operation time was statistically significant shorter in the OP than the MP (p < .05); the intraoperative blood loss in the OP was significant less than MP (p < .05); after postoperative follow-up, the healing rate of tympanic membrane perforation was 92.11% in the OP compared to 89.47% in the MP. However, there was no statistically significant difference in the two groups (p > .05). There were no statistically significant differences between the preoperative and postoperative air and bone conduction thresholds in the two groups (p > .05). Conclusions Otoendoscopic tympanoplasty is a minimally invasive operation but with similar effects as compared to microscopic one. But the operation time and intraoperative blood loss in the OP were significantly better than those in the MP, thus it is a safe, effective and easy to be operated in clinical practice.

Surgical Outcome in Patients Undergoing Tympanoplasty Alone for Active Chronic Otitis Media Mucosal Type in Hilly Area

Abstract Introduction Chronic otitis media (COM) is a common problem affecting 65 to 330 million population worldwide with 50% patients suffering from hearing impairment. In active COM, the usual clinical practice is to wait for the ear to become dry and to consider tympanoplasty with/without cortical mastoidectomy. If cortical mastoidectomy can be avoided without compromising the outcomes, it is desirable. Various prognostic factors have been studied; however, the effect of altitude on the outcome of tympanoplasty has not been commonly studied. High-altitude areas can have poor connectivity and can result in middle ear pressure changes when the patients commute from low-altitude areas. Aim The aim of this article was to assess the surgical outcome in patients undergoing tympanoplasty for active COM mucosal type in comparison to inactive COM mucosal type in a hilly area located at an altitude of 4,757 ft (1,450 m). Objective This article compared the success rate and audiometric improvement in patients undergoing tympanoplasty for active COM mucosal type and inactive COM mucosal type. Materials and Methods This prospective cohort study included 24 patients with 12 patients each in active and inactive groups. At 3 months follow-up, there was significant improvement in all the air conduction threshold frequencies and air bone gap in both the groups. Conclusion The success rate for our tympanoplasties for active and inactive COM performed in a hilly area was 92% and it was comparable to those reported from other centers. Altitude may not negatively affect the outcome of tympanoplasty and that the active ear COM can have similar success rate as inactive COM tympanoplasty.

Prognostic factors influencing postoperative air-bone gap in stapes surgery.

SUMMARYObjectiveOtosclerosis is an osteodystrophic disease of the otic capsule, determining conductive or mixed hearing loss, which can be successfully treated with stapedotomy. The aim of the present multicentric retrospective study was to identify prognostic factors related to better auditory outcomes in stapes surgery.Methods581 patients affected by otosclerosis were submitted to stapedotomy under local anaesthesia in two different hospitals. Both Teflon and titanium prostheses were adopted.ResultsA statistically significant decrease of postoperative air-conduction thresholds and air–bone gap (ABG) values was seen, whereas the mean bone-conduction threshold did not differ from the preoperative condition. Among the various parameters investigated, the prosthetic material, duration of surgery and intraoperative detection of unexpected anatomical anomalies of the middle ear were found to be related to lower postoperative ABG values.ConclusionsAll the previously mentioned parameters played a significant role in determining the postoperative auditory outcomes and can therefore be considered prognostic factors for the success of the stapedotomy.

Cancer survivors and neurotoxic chemotherapy: hearing loss and tinnitus

ObjectivesLittle is known about hearing loss and tinnitus associated with neurotoxic chemotherapy. Study evaluated for differences in occurrence rates and effects of hearing loss and tinnitus in survivors who received...

A comparative study between audiological and speech outcomes of non-implantable wearing options for BAHA in the pediatric population

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of the study was to determine the audiological benefit of the current BAHAs sound processor worn on a SoundArc and to compare it to the known Softband in terms of soundField hearing thresholds and speech understanding in patients who have purely conductive, mixed, or SSD hearing loss.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A cross-sectional study looking at children with conductive, mixed, or SSD hearing loss who are not candidates for middle ear surgery, canalplasty, or standard hearing aids. At the baseline visit, pure-tone audiograms were obtained, including masked/unmasked air- and bone conduction thresholds with speech recognition scores. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; After two weeks of using programmed processors with Softband and SoundArc, all children were examined. The threshold for aided pure-tone audiometry was tested twice through each of the two transmission paths. The aided pure-tone audiometry threshold demonstrated a statistically significant improvement in PTA. The mean air-conduction thresholds for frequencies (0.5 to 4 kHz) were 63 dB, while the aided mean thresholds with the device (with Softband and SoundArc) was 35 dB. When compared to the unaided scenario, a statistically significant improvement of 98 percent (SoundArc) to 96 percent (Softband) was found at 65 dBSPL. There were no statistically significant differences between any of the ensembles (p=0.261).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The results of our study suggest that subjects with conductive, mixed, or single-sided deafness hearing loss aided with BAHA sound processor worn on SoundArc or on a Softband can cause a significant improvement in terms of soundfield hearing threshold and speech understanding when compared to unaided conditions.&lt;/p&gt;

Outcome of Limited Attic Cholesteatoma Surgery: Endoscopic vs Microscopic

Background: Endoscope and microscope are exclusively used in different middle ear pathologies as well as patients with attic cholesteatoma. However, straightforward information regarding surgical advances, postoperative results, and information about in which patients and how this surgical technique should be exclusively used is debatable.&#x0D; Aim: To compare the outcome of primary exclusive endoscopic ear surgery with those of the microscopic ear surgery in two groups of patients with cholesteatoma limited to the attic region.&#x0D; Methods: This prospective observational study was conducted in the Department of Otolaryngology-Head and Neck Surgery, BSMMU, Dhaka, from July 2018 to December 2019, with 26 patients having cholesteatoma limited to the attic region. Patients were divided into two groups. One group of patients were submitted to atticotomy with tympanoplasty via microscopic ear surgery (MES) and a second group to exclusive trans-canal endoscopic ear surgery (EES). All the patients were followed up post-operatively up to 3 months with PTA.&#x0D; Results: Mean bone conduction threshold, air conduction threshold, and ABG has been reduced considerably in both groups (endoscopic and microscopic) at the end of three months postoperatively.There was no significant statistical difference between the two groups in terms of graft uptake success rate and the audiological success rate (p-value &gt;0.05).Postoperatively, pain requiring analgesics wassignificantly lower (p&lt;0.033) in theendoscopic group (23.1%) than in the microscopic group (69.2%).&#x0D; Conclusion: Audiological outcome and graft uptake success rates achieved by the endoscopic ear surgery were similar to the results obtained by the microscopic ear surgery in limited attic cholesteatoma.&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(1): 103-111

Hearing and Disease-Specific Health-Related Quality of Life in Patients with Otosclerosis after Stapedotomy - a Trial of the SPOT-25 Questionnaire.

Background:The study aims to investigate the effect of stapedotomy on audiology measurements and the disease-specific health-related quality of life for patients with otosclerosis using the Danish Stapesplasty Outcome Test-25 as a quality of life measuring tool.Methods:In this study, 50 patients who had undergone stapedotomy at our department between September 2017 and December 2020 were included. Data collection was performed by audiometric testing (pure tone and speech audiometry) in the pre- and postoperative settings. Health-related quality of life was assessed pre- and postoperatively in 30 patients using the validated Danish Stapesplasty Outcome Test-25.Results:The mean improvement in air conduction thresholds was 27.7 dB and the mean improvement in air-bone gap was 21.8 dB. Health-related quality of life improved significantly after stapes surgery in all subscores of the Stapesplasty Outcome Test-25 (hearing, mental condition, social restriction, and general), except for “tinnitus.” The improvement in the audiometric data correlated significantly with the improvement in “total score” and “hearing function” but not with “tinnitus,” “social restrictions,” and “mental condition.”Conclusion:Stapedotomy leads to significant improvement in hearing and health-related quality of life. The Stapesplasty Outcome Test-25 can be used as a valuable supplement to the hearing test by assessing health-related quality of life.

The prevalence of Post-Ebola Syndrome hearing loss, Sierra Leone

BackgroundGlobally, hearing loss is the second leading cause of disability, affecting approximately 18.7% of the world’s population. However, the burden of hearing loss is unequally distributed, with the majority of affected individuals located in Asia or Sub-Saharan Africa. Following the 2014 West African Ebola Outbreak, disease survivors began to describe hearing loss as part of the constellation of symptoms known as Post-Ebola Syndrome. The goal of this study was to more fully characterize hearing loss among Ebola Virus Disease (EVD) survivors.Methodology and principal findingsEVD survivors and their household contacts were recruited (n = 1,12) from Eastern Sierra Leone. Each individual completed a symptom questionnaire, physical exam, and a two-step audiometry process measuring both air and bone conduction thresholds. In comparison to contacts, EVD survivors were more likely to have complaints or abnormal findings affecting every organ system. A significantly greater percentage of EVD survivors were found to have hearing loss in comparison to contacts (23% vs. 9%, p < 0.001). Additionally, survivors were more likely to have bilateral hearing loss of a mixed etiology. Logistic regression revealed that the presence of any symptoms of middle or inner ear (p < 0.001), eye (p = 0.005), psychiatric (p = 0.019), and nervous system (p = 0.037) increased the odds of developing hearing loss.Conclusions and significanceThis study is the first to use an objective and standardized measurement to report hearing loss among EVD survivors in a clinically meaningful manner. In this study it was found that greater than 1/5th of EVD survivors develop hearing loss. The association between hearing impairment and symptoms affecting the eye and nervous system may indicate a similar mechanism of pathogenesis, which should be investigated further. Due to the quality of life and socioeconomic detriments associated with untreated hearing loss, a greater emphasis must be placed on understanding and mitigating hearing loss following survival to aid in economic recovery following infectious disease epidemics.

Comparison of Disease-Specific, Generic, and Hearing-Specific Instruments Assessing Health-Related Quality of Life in Patients Undergoing Middle Ear Surgery for Chronic Otitis Media: A Prospective Correlational Study

This study aimed to determine the responsiveness of three instruments (disease-specific, generic, and hearing-specific) assessing health-related quality of life (HRQoL) in adult patients undergoing surgery for chronic otitis media (COM). Prospective correlational study. Two otology referral centers in England, United Kingdom. Consecutive adult patients undergoing middle ear surgery for COM. HRQoL assessment and audiometry were performed preoperatively and 12 months after surgery. HRQoL was assessed using disease-specific (Chronic Otitis Media Questionnaire-12 [COMQ-12]), generic (Euro-Qol-5D-5L), and hearing-specific (Hearing Handicap Inventory for Adults [HHIA]) instruments. A total of 52 patients (mean [standard deviation {SD}] age, 47.3 [18.3] yr) were included, with 42 patients completing both preoperative and postoperative COMQ-12 forms. COMQ-12 and HHIA total scores significantly improved after surgery (COMQ-12: mean [SD], 28.3 [11.6] versus 14.8 [10.6]; p < 0.001; HHIA: 42.9 (28.4) versus 32.6 (27.5); p = 0.012). General HRQoL measured with the Euro-Qol-5D-5L was unaffected by surgery ( p > 0.05). The standardized response means for the COMQ-12 and HHIA total scores were 1.21 and 0.44, respectively. Postoperative air conduction thresholds were moderately correlated with the postoperative COMQ-12 ( r = 0.46, p = 0.005) and HHIA ( r = 0.41, p = 0.012) total scores. Middle ear surgery significantly improved both disease-specific and hearing-specific HRQoL, whereas general HRQoL did not change. Only the COMQ-12 is highly responsive to surgical intervention. This study supports the use of the COMQ-12 to monitor patient-reported outcomes in both research and routine clinical settings.

High-resolution computed tomography and pure-tone audiometry in patients with otosclerosis in the spongiotic phase.

There is no consensus in the literature regarding the relationship between high-resolution computed tomography findings and hearing thresholds in pure-tone audiometry in otosclerosis. This study evaluated the association between high-resolution computed tomography findings and pure-tone audiometry in otosclerosis in the spongiotic phase. A cross-sectional study was conducted of 57 ears with surgically confirmed stapes fixation and tomographic findings. Air conduction and bone conduction thresholds on audiometry, and air-bone gap, were analysed. There were no correlations between sites affected by otospongiosis and air conduction threshold, bone conduction threshold or air-bone gap in the analysed tomographic images, but the diameter of the otospongiotic focus was greater in the presence of extension of the otospongiotic foci to the cochlear endosteum. There were no relevant associations between high-resolution computed tomography findings and pure-tone audiometric measurements. However, the diameter of the otospongiotic focus was greater in the presence of extension of the otospongiotic foci to the cochlear endosteum.

The protective effect of aspirin-induced temporary threshold shift in an animal model of cisplatin-related ototoxicity.

The purpose of this study was to evaluate whether induction of temporary threshold shift (TTS) with aspirin prior to cisplatin exposure can prevent or minimize cisplatin detrimental effects on hearing. We randomly divided BALB mice into three groups: (1) cisplatin only, (2) aspirin only, and (3) combined aspirin/cisplatin. Cisplatin was administered as a single intraperitoneal injection of 14mg/kg. Aspirin was administered for three weeks via intraperitoneal injection of 200mg/kg sodium salicylate, twice daily. Air conduction thresholds were recorded using Auditory Brainstem Responses (ABR). Cochleae were harvested and cochlear hair cells were counted using a scanning electron microscope (SEM). Aspirin-induced TTS have reached an average of 30.05±16.9dB after 2weeks. At 60days, cisplatin-only treated mice experienced an average threshold shifts of 50.7dB at 4kHz, 35.16dB at 8kHz, 70dB at 16kHz, 53.1dB at 32kHz. All threshold shifts were significantly worse than for cisplatin/aspirin treated mice with TTS of 11.85dB at 4kHz, 3.58dB at 8kHz, 16.58 dB at 16kHz, 20.41dB at 32kHz (p < 0.01). Cochlear cell count with SEM has shown reduction in the number of both inner and outer hair cells in the mid-turn in cisplatin treated mice. Aspirin induced TTS can protect from cisplatin-induced ototoxicity. This beneficial effect was demonstrated by auditory thresholds as well as SEM. Larger pre-clinical and clinical studies are still needed to confirm these findings.

Validation of a Low-Cost, Portable Pure-Tone Audiometer

Introduction: Around the world, there is an increasing demand for better hearing services. Access to hearing care involves the availability of accurate and calibrated audiometric apparatus. As audiometers are task-specific and expensive equipment, their portability is a common constraint. Hence, there is a need for developing low-cost, portable audiometers, so that the instrument can be quickly transported to remote regions and is conveniently accessible to multiple centers. Aim: The aim was to compare the air conduction (AC) and bone conduction (BC) thresholds obtained using newly developed Nautilus “KiVi” and a commercial, nonportable audiometer in both normal hearing and hearing-impaired individuals. Methods: The study included a total of 73 people, 52 having normal hearing sensitivity and 21 with hearing impairment. Results: It was found that among individuals with normal hearing except at 125 Hz, there was no significant difference in AC thresholds obtained using the Nautilus “KiVi” audiometer and a commercial, nonportable audiometer across frequencies. However, the BC thresholds obtained using the Nautilus “KiVi” audiometer was significantly better than that of a commercial, nonportable audiometer across frequencies. Among the individuals with hearing impairment, except at 8k Hz, there was no significant difference in AC thresholds obtained using the Nautilus “KiVi” audiometer and a commercial, nonportable audiometer. Conclusion: The Nautilus “KiVi”audiometers provide consistent results throughout a wide frequency range in those with normal hearing as well as with hearing impairment. The equipment is portable and easy to use. Hence, it can be used for diagnostic testing in schools, hospitals, remote villages, and industries.

Comparing of anteroinferior and posteroinferior tympanostomy tube insertion: a cohort study.

BackgroundTympanostomy tube insertion (TTI) is one of the primary treatments for Otitis media with effusion (OME) in children, a common condition in children. However, there is still no conclusion on the better choice of tube position, and no relevant research has been found in the literature. This study analyzed the results of the two commonly selected tube insert positions, anteroinferior quadrant (AQ) and posteroinferior quadrant (PQ), in order to determine which is the better choice.MethodsChildren with bilateral OME who received TTI in Beijing Tongren Hospital from May 2020 to January 2021 were selected as subjects. one side on AQ and the other side on PQ randomly. Follow-up visits were arranged at 1 week, 1 month, 6 months and 12 months after surgery. The results of audiology and the tube status of the two positions were recorded and compared statistically.ResultsA total of 90 patients with bilateral OME were selected. There was no difference in preoperative hearing between the 2 groups. The AQ group’s average air conduction threshold was significantly higher than that of the PQ group 1 week after surgery. Although there was no significant difference in tube fall-off rate between the two groups within 6 months, it was significantly higher in AQ group than that in PQ group at 12 months after surgery.ConclusionsCompared to TTI on AQ, TTI on PQ is more stable and better improves hearing, and the operation is also more convenient for surgeons. This study provides reference for a better position of TTI in OME therapy.

A prospective observational study of ototoxicity in head and neck cancers treated with chemoradiotherapy

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Head and neck cancer is a major global health problem. Cisplatin has been widely used in the treatment of head and neck malignancies. Ototoxicity is considered as the primary outcome of interest and the type of hearing loss is the secondary variable of interest. The Chi-square test/Fisher’s exact test is used to test statistical significance. P value&amp;lt;0.05 is considered statistically significant. IBM statistical package for the social sciences (SPSS) version 22 is used for statistical analysis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this prospective observational study, 62 patients with head and neck cancers were evaluated for chemoradiotherapy-induced ototoxicity. The hearing assessment included air and bone conduction thresholds, frequency, and pattern of hearing loss. The assessment was done at baseline, at the end of treatment, and after 8 weeks of completion of chemoradiotherapy. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Results showed the mean age group to be, between 61 to 70 years. Gender distribution showed that 80.65% are males and 19.35% are females. The most common site of malignancy is the larynx (20.97%). Cisplatin is used in 51 patients (82.26%) and carboplatin in 7 patients (11.29%). Radiotherapy was given to 82.26% of the patients. Results showed an increased incidence of sensorineural hearing loss (SNHL) after 8 weeks of treatment. There was a statistically significant difference between pure tone average (PTA) values before treatment, at the end of treatment, and after 8 weeks of chemoradiotherapy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Pure-tone hearing threshold was most affected at 8 kHz and sensorineural hearing loss at higher frequencies is the most common finding.&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.

Assessment of hearing loss in patients with rosacea.

Rosacea is not only a skin condition but a systemic inflammatory disease that includes chronic inflammation, vascular alterations, and autoimmunity in pathogenesis. We aimed to evaluate the presence of a sensorineural hearing loss in the patients with rosacea in comparison with the healthy control group and, also to compare the audiometric results according to the severity of disease among the patient group. Fifty-three patients with erythematelangiectatic or papulopustular type of rosacea and 105 age- and sex-matched healthy controls were included. Each participant had audiometric measurements after a complete ear-nose-throat examination by the same otorhinolaryngologist. The results of air and bone conduction thresholds showed statistically significant differences in particularly high frequencies between the groups in both the right and left ear (for all p < 0.05), but there was no correlation between audiometric measurements and the severity or the type of rosacea (p > 0.05). Regardless of disease severity or type, rosacea patients are likely to have sensorineural hearing loss, and it is important to refer these patients in the early period.

Evaluation of audiological profile and graft uptake by endoscopic composite cartilage graft tympanoplasty in chronic otitis media patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Transcanal endoscopic ear surgery (TEES) permits wide-angle vision, high resolution, and magnification as well as the direct visualization of hidden areas of the middle ear cavity. The aim of the study was to determine the anatomic and functional results of endoscopic composite cartilage tympanoplasty in chronic otitis media cases with safe central perforation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study was conducted on 50 chronic otitis media cases with safe central perforation (small/medium) between February 2020 to July 2021 in a tertiary care center. All the patients were selected as per the described inclusion and exclusion criteria. All cases underwent endoscopic composite cartilage graft tympanoplasty (type-I) under general anesthesia. Audiological outcomes were assessed by comparing mean pure tone average pre-and post-operatively and morphological results (successful graft uptake) were evaluated at 6 months. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The result of this study showed that out of 50 cases 47 had successful graft uptake (94%) while 3 cases were found to have a residual perforation. The pre-operative air conduction threshold (ACT) was 42.82±7.33 dB whereas postoperative ACT was 31.26±7.48 dB, and the difference between the preoperative and postoperative values was found to be statistically significant. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study concluded that endoscopic composite cartilage tympanoplasty in chronic otitis media cases with dry central perforations is an effective surgical modality with good audiological and morphological outcomes and negligible post-operative complications.&lt;/p&gt;

Low Frequency Air-Bone Gap in Meniere's Disease: Relationship With Magnetic Resonance Imaging Features of Endolymphatic Hydrops.

Objectives:The appearance of low-frequency air-bone gaps (LFABGs) in Meniere’s disease (MD) is a recognized but relatively unexplored phenomenon. Two theories have been proposed to explain their etiology: increased perilymphatic pressure resulting in either reduced stapedial mobility or dampened transmission of acoustic energy, and direct contact between the dilated saccule and the stapes footplate. The aim of this study was to evaluate these two hypotheses by comparing delayed postgadolinium magnetic resonance imaging (MRI) features of two groups of patients with unilateral definite MD, those with and without LFABGs.Design:This retrospective case-control study was conducted at a tertiary otolaryngology unit in the United Kingdom. The study included 35 patients who satisfied the 2015 Barany criteria for unilateral definite MD. The cohort was divided into two groups, those with LFABGs (LFABG+ group) and those without (LFABG− group), according to the pure-tone audiometry performed within 6 months of MRI. Alternative potential causes for the LFABGs were excluded on the basis of otologic history, otoscopy, tympanometry, and/or imaging. Using a 4-hr delayed postgadolinium 3-dimensional fluid-attenuated inversion recovery sequence, two observers evaluated the severity of cochlear and vestibular endolymphatic hydrops (EH) and the presence of vestibular endolymphatic space contacting the oval window (VESCO). The air and bone conduction thresholds, ABGs and MRI features were compared between the LFABG+ and LFABG− groups. Where any of the variables were found to be significantly associated with the presence of ABGs, further analysis was performed to determine whether or not they were independent predictors. Continuous variables were compared using the independent t test if normally distributed, and the Mann–Whitney U test or Kruskall–Wallis test if not normally distributed. Categorical variables were compared with Pearson’s Chi-squared test or Fishers/Fisher-Freeman-Halton exact tests.Results:There were 10 patients in the LFABG+ group (28.6%) and 25 patients in the LFABG− group (71.4%). The mean ABGs in the symptomatic ear at 500 Hz, 1 kHz, and 2 kHz were 15.1 dB ± 6.4, 10.5 dB ± 9.0, and 4.0 dB ± 7.7, respectively, in the LFABG+ group and 2.0 ± 5.8, 2.4 ± 4.4, and −0.8 ± 4.7 dB in the LFABG− group. The differences in ABGs between the two groups were statistically significant at all three test frequencies (p < 0.001 at 500 Hz, p = 0.007 at 1 kHz, and p = 0.041 at 2 kHz). The presence of ABGs was significantly associated with both the grade of vestibular EH (p = 0.049) and VESCO (p = 0.009). Further analysis showed a statistically significant association between the grade of vestibular EH and VESCO (p = 0.007), and only VESCO was an independent variable associated with the presence of LFABGs (p = 0.045).Conclusions:The study findings add to the existing body of evidence that LFABGs are a true audiological finding in MD and allow us to propose a mechanism. Analysis of delayed gadolinium-enhanced MRI suggests that direct contact between the distended saccule and the inner surface of the stapes footplate is the more likely underlying pathophysiological mechanism for this audiometric phenomenon.

Eustachian tube insufflation with thermal water: Effectiveness in the treatment of pediatric otitis media with effusion

PurposeOtitis media with effusion (OME) is the most common ear disease in childhood. The hearing loss associated with OME impacts on children's language development and behavior. Eustachian tube insufflation are among possible treatments for OME, but data regarding their effectiveness are scarce. The aim of this investigation was to analyze the effect of inhalatory thermal therapy and Eustachian tube insufflation in a consecutive cohort of pediatric patients with OME. Materials and methodsSeventy-four pediatric patients referred for OME to the thermal medical center “La Contea” (Battaglia Terme, Padova, Italy) were considered. Data from tympanometry and pure tone audiometry performed immediately before (T0), at the end of treatment (T1) and at a follow-up control (T2) were analyzed. ResultsData from 148 ears were available. The pressure values of tympanometry significantly improved from T0 to T1 (p = 0.0001), and further improvement was recorded at T2, when 60.8% of patients had normal tympanograms. A significant gain of the air-conduction threshold in the T0-T2 interval was observed (p = 0.0001). At otoscopy, a significant reduction of tympanic membranes with fluid or air-fluid levels presence (p < 0.00001) and a significant increase of normal tympanic membranes (p = 0.0001) were found. ConclusionEustachian tube insufflation represented a well-tolerated and effective treatment in children with OME. Further investigations should deepen these results in randomized, double-blind settings, possibly with long-term follow-up periods. A quality-of-life and cost-effectiveness evaluation of this treatment approach for pediatric OME could be helpful for public health decision-making.