Air Conduction Thresholds Research Articles

CT scan findings impact on hearing thresholds in otosclerosis: A study of 108 patients

BackgroundThe relationship between the location of otosclerotic zones and hearing thresholds has been evaluated in several studies and has generated different conflicting reports. This study was carried out in order to evaluate the relationship between otosclerotic zones extension on CT scan and pure tone audiometry (PTA) thresholds, before and after stapedotomy. Materials and Methods: 108 patients with a positive surgical diagnosis of otosclerosis, operated by the same surgeon, were enrolled in this retrospective study, performed in a tertiary referral hospital between 2015 and 2018. ResultsPTA thresholds were significantly poorer in cases of extensive otosclerosis (peri cochlear, peri vestibular, or internal auditory canal hypodensities, p = 0,001). However, for cases with hypodensity extending to the endosteum of cochlea (Type III), we have noted a significant improvement in postoperative PTA thresholds (Mean AC (air conduction) = 32,8 ± 8,16/62,97 ± 12,28 dB), Mean BC (bone conduction) = 18,3 ± 8,56/26,25 ± 15,93 dB). Conclusions: In our study, extensive and multifocal otosclerosis lesions had a statistically significant negative impact on postoperative AC and BC threshold; however, type III lesions tend to be associated with a very good prognosis.

Results of Hearing Screening in School-Age Children from Rural Areas of the Kujawsko- Pomorskie Region in Poland.

Objective: There is a need for regular surveillance of the hearing of children, no matter what their age. Screening of the hearing of school children can be done quickly and cheaply using teleaudiology. The primary aim of this study was to identify children who showed a suspected hearing impairment from rural areas of the Kujawsko–Pomorskie region and refer them for further audiological testing. A secondary aim was to estimate the prevalence of hearing loss in those children.Methods: There were 4754 children, made up of 1840 children aged 6–7 years old and 2914 children aged 12–13 years old. Pure-tone air conduction thresholds were obtained at 0.5–8 kHz. Audiometric test was supplemented by results of a brief questionnaire filled in by parents.Results: Of the 4754 children, 618 (13%) failed screening and were referred for detailed audiological diagnostics. The prevalence of hearing loss was estimated to be 7% and was significantly higher (OR = 2.12) in the group aged 6–7 y/o (10.1%) than in the group aged 12–13 y/o (5.0%). In our study the estimated prevalence of HL was twice as high in children aged 6–7 y/o (10.1%) than in children 12–13 y/o (5.0%). This difference was also evident in another study of Polish children from rural areas, where the prevalence of HL was 11.4% in younger children (6–9 y/o) and 5.5% in older children (12–13 y/o).Conclusion: Large numbers of school-age children in rural areas have hearing problems. It is recommended that a hearing screening program in primary schools based on e-health solutions should be adopted.

Hearing disorders in lupus patients: correlation with duration and severity of the disease

BackgroundHearing loss can greatly affect the overall quality of life. Several studies have reported that patients with SLE may suffer from audio-vestibular manifestations. The aim of this study is to evaluate the influence of systemic lupus erythematosus (SLE) on hearing and association of hearing impairment with severity and duration of SLE.ResultsPure-tone audiometry (PTA) (air conduction and bone conduction) thresholds showed significant elevation in SLE group than controls (P ≤ 0.05). It was observed also that there is a significant association between SLE severity and duration with sensorineural hearing loss (SNHL) and its degree.ConclusionSLE can lead to hearing loss, and there is a positive association of SLE severity and duration with degree of hearing loss.

PREDICTING THE SUBJECTIVE HEARING OUTCOME IN TYPE I TYMPANOPLASTY USING BELFAST 15/30DB RULE OF THUMB.

OBJECTIVE: Both Otologists and patients mutually hope for an improvement in hearing and a functional benet from an ear surgery to correct unilateral conductive hearing loss that has been reported as the closure of air-bone gap or reduction in air conduction thresholds. While these provide a measure of technical success of the operation, they may not always translate into real life benet for the patient. This is because listening is a binaural task and benet to the patient is determined by numerous factors, of paramount importance is hearing in the non-operated ear. With the aim, to estimate patient benet in terms of subjective hearing gain after type I tympanoplasty, we reviewed the Belfast 15/30 dB rule of thumb. METHOD: A 100 cases of chronic otitis media with inactive mucosal disease having conductive hearing loss, who had undergone type I tympanoplasty were included. Hearing was assessed using pure tone audiogram with average of, .5, 1, 2 & 4Hz and a detailed questionnaire regarding the subjective perception of hearing was obtained pre and 6 month post-operatively which was correlated with Belfast 15/30 dB rule of thumb. RESULT: The predictive value as per pure tone audiometry with Belfast 15/30 dB rule of thumb is 89% with a conclusion that the objective hearing improvement (88.1%) does not necessarily transform into patients' perception of hearing improvement (78.4%) CONCLUSION: Hearing is a binaural function and this should always be kept in mind while operating on unilateral/ asymmetric hearing loss patients as mere closure of air-bone gap or reduction in air conduction threshold might not conclude patients' perception of hearing gain. Belfast 15/30 dB rule of thumb has proved to be a valuable tool in predicting the subjective improvement of hearing

The Importance of Considering the Minimum Interaural Attenuation Value in the Masking Procedure of Pure-Tone Audiometry

In pure-tone audiometry (PTA) testing, air conduction (AC) and bone conduction (BC) thresholds are documented accordingly to obtain complete information on the hearing status. Nevertheless, due to the cross-hearing phenomenon, a masking procedure is typically implemented in PTA as an effort to obtain the exact (masked) AC and BC thresholds. As indicated by the respective masking rules, the decision to carry out the masking procedure is based on the “suggested” minimum interaural attenuation (IAA), which is 40 dB (for headphones), regardless of frequency. In this case report, the importance of considering the minimum IAA value based on research findings is highlighted. In particular, to produce more reliable PTA results, the masking procedure can be conducted by considering a lower IAA value (<40 dB).

Effect of Hydrogen Inhalation Therapy on Hearing Loss of Patients With Nasopharyngeal Carcinoma After Radiotherapy.

ObjectiveTo evaluate the clinical efficacy and safety of hydrogen inhalation in improving hearing loss in patients with long-term survival of nasopharyngeal carcinoma after radiotherapy.MethodsThe eustachian tube dysfunction score, pure tone air conduction threshold, bone conduction threshold, the score of tympanogram and otoscope were prospectively observed in patients with deafness after radiotherapy only or combined radiotherapy and chemotherapy for nasopharyngeal carcinoma. Paired t test and one-way analysis of variance were used to analyze the data before and after treatment.ResultsA total of 17 patients were observed. The median time from radiotherapy to now was 228 months, and the median time from the diagnose of deafness to now was 92 months. After 4 weeks of hydrogen inhalation, the score of eustachian tube dysfunction, air conduction and bone conduction hearing thresholds were significantly reduced, P values were 0.0293, 0.0027, 0.0404, respectively. The mean air-bone gap, the score of otoendoscopy and tympanogram were also decreased, but the differences were not significant (P = 0.2079, P = 0.0536, P = 0.1056). Patients with radiotherapy alone and concurrent chemo-radiotherapy had significantly lower air conduction hearing threshold after hydrogen absorption (P = 0.0142, P = 0.0495). The results of air and bone hearing thresholds before, 4 and 12 weeks after hydrogen inhalation showed a descending trend. The air and bone hearing thresholds before hydrogen inhalation were 74.69 ± 27.03 dB and 45.70 ± 21.58 dB, respectively. At the 12th week, the mean values of air and bone hearing thresholds were the lowest, which were 66.88 ± 20.88 dB and 40.94 ± 18.93 dB, respectively, but there was no significant difference in air and bone hearing thresholds among all groups (P = 0.6755, P = 0.7712). After hydrogen inhalation treatment, no adverse reactions such as nosebleed, chest pain, dyspnea, nausea, vomiting, dizziness, earache and allergic reaction were observed.ConclusionThis is the first prospective study on the effect of hydrogen inhalation on hearing improvement in patients with deafness after radiotherapy/chemotherapy for nasopharyngeal carcinoma, suggesting that continuous hydrogen inhalation may be an alternative rehabilitation therapy for these patients.

Subjective Sound Quality Detection (HISQUI) over Time after Vibrant Soundbridge Implantation.

Background: To evaluate the long-term audiological outcomes combined with the Hearing Implant Sound Quality Index (HISQUI) after Vibrant Soundbridge (VSB) implantation. Methods: Prospective recall cohort study of patients who received a VSB in a tertiary academic medical center between 1996 and 2017. Air conduction (AC) and bone conduction (BC), sound field thresholds in aided and unaided conditions, and speech discrimination in noise (Oldenburger sentence test) were measured. Postoperative results were compared with preoperative audiograms. Furthermore, the HISQUI was evaluated. Results: Ten patients (eleven implants) were included, the mean follow up period was nine years. The mean AC threshold preoperatively was between 63 and 70 dB, and the BC was between 38 and 49 dB from 500 to 4000 Hz. In the free-field audiogram, the mean threshold was between 61 and 77 dB unaided vs. between 28 and 52 dB in the aided condition. The average signal to noise ratio (SNR) in the Oldenburger sentence test in the unaided condition was 10 dB ± 6.7 dB vs. 2 dB ± 5.4 dB in the aided condition. Three patients reported a good to very good hearing result, four patients a moderate, and three patients a poor hearing result. There was a significant association between the years of implantation and the HISQUI (p = 0.013), as well as a significant decrease by 14 HISQUI points per 10 dB SPL decline (SE 5.2, p = 0.023). There was a significant difference between the change of BC over the years and the HISQUI, as well as the number of years after implantation and the HISQUI. On average, per dB decrease in BC, the HISQUI decreases by 1.4 points, and every year after implantation the HISQUI decreases by 2.7 points. Conclusions: The aided threshold in free field and speech understanding in noise improved significantly with VSB. An increase over time of BC thresholds was observed as well as a decrease in HISQUI score. This decrease in BC thresholds over time may be due to presbycusis. Therefore, monitoring of these patients over time should be considered to discuss alternative hearing rehabilitation measures in a timely manner.

Preoperative Significance of Ipsilateral Manual Neck Compression in Patients With Pulsatile Tinnitus Secondary to Sigmoid Sinus Dehiscences and Diverticula.

Venous pulsatile tinnitus (PT) is characterized by an auditory perception of pulse-synchronous sound, suppressed by compression of the ipsilateral internal jugular vein. We sought to determine the preoperative prognostic significance of the effect of ipsilateral neck manual compression on the PT loudness and audiometric changes in patients with sigmoid sinus dehiscences (SS-Deh) and diverticula (SS-Div) by comparing postoperative improvements in ipsilateral low-frequency hearing loss (LFHL) in pure-tone audiogram (PTA) and PT symptoms. Twenty-two subjects with PT originating from SS-Deh/Div were recruited. Air-conduction hearing thresholds were measured using PTA at three time points: twice preoperatively (with neutral neck position and with ipsilateral manual compression of internal jugular vein) and once at 3-months postoperatively with neutral neck position. We defined a positive neck compression effect as a threshold improvement of ≥ 10 dB HL at 250 or 500 Hz after manual neck compression. All but two subjects presented with ipsilateral LFHL in the neutral position. The average hearing threshold in the neutral position markedly improved after manual neck compression, indicating that LFHL originated from the masking effect of venous PT. All subjects had subjective improvements in PT and LFHL after sigmoid sinus surgeries, confirming that LFHL resulted from the masking effect of PT. Additionally, improvement of LFHL after neck compression could be regarded as a positive prognostic indicator after surgery. Collectively, elimination of PT loudness and improvement of LFHL with manual compression over the ipsilateral neck may suggest the venous origin of the PT and predict a favorable outcome following repair of SS-Deh/SS-Div.

Efficacy of Oral Steroids for Acute Acoustic Trauma

Objective: This study aimed to study the effect of steroid treatment on new-onset sensorineural hearing loss (SNHL) in subjects presenting shortly after an audiometry-confirmed acute acoustic trauma (AAT) injury. Study Design: This is a case-control study. Methods: We identified healthy military personnel who presented with AAT injury to the Israeli Defense Forces Medical Corps Otolaryngology/Audiology Services during 2016–2020. Patients were nonrandomly allocated to a treatment arm, where they received steroids (prednisone, 1 mg/kg, 60 mg maximal daily dose), administered for either ≥7 days or <7 days, or to a control arm, in which no treatment was offered besides loud noise avoidance. Audiometries were conducted within 7 days following the AAT and within 1 month later. We compared changes in bone conduction (BC) and air conduction (AC) thresholds at 2–8 kHz. Results: Of the 263 enrolled subjects, 137 (52%) received steroids and 126 (48%) received no treatment. Subjects who were treated early (<24 h) with high-dose steroids and for ≥7 days demonstrated significantly better hearing outcomes, compared with the nontreatment group. Subjects in the steroids group demonstrated 13–14 dB average improvement in BC thresholds at 3 and 4 kHz (p = 0.001) and additional 7–8 dB average improvement in AC thresholds at 6 and 8 kHz, compared with the nontreatment group (p < 0.0001). These observations were more compelling in patients who initially presented with worse hearing losses (>35 dB). No statistically significant differences were observed in AC/BC pure tone average between the two groups. Conclusions: Early oral steroids are recommended in AAT injuries and were shown to improve hearing outcomes within 1 month.

Circumferential subannular tympanoplasty: surgical and hearing outcome in 224 ears with subtotal perforation

Background Subannular tympanoplasty is a newer technique with limited research articles in the literature. These articles have limitation in terms of sample data. We reviewed outcome of subannular tympanoplasty performed during last five years in our center. Objective To determine the surgical and hearing outcome of circumferential subannular tympanoplasty. Methods A retrospective observational study was performed in a tertiary care academic center involving 224 subjects with mucosal chronic otitis media who underwent circumferential subannular type 1 tympanoplasty. Results Complete neo-tympanum was found in 213 cases (95.1%) at the end final follow period of 12 months after surgery. Eleven tympanic membranes did not take up the graft and considered failure at the end of 6 months after surgery. All of them were subjected for revision surgery and showed intact neo-tympanum after 12 months of surgery. The hearing outcome showed significant improvement in air conduction thresholds from 42.54 ± 13.04 dB to 30.48 ± 10.61 dB at the end of one year. No surgical complication was observed in the study group. Conclusion The circumferential subannular tympanoplasty carries good surgical success and should be preferred in large and subtotal perforations. Randomized controlled trials are warranted to overcome the limitations in the present study. Significance This is the first study showing outcome of subannular tympanoplasty in large sample size of more than 200.

The effect of female hormone in otosclerosis. A comparative study and speculation about their effect on the ossicular chain based on the clinical results

PurposeThis study aimed at identifying gender differences in the hearing thresholds in a sample of patients with otosclerosis before and after surgery to understand the impact of female hormones on auditory thresholds.MethodsThis retrospective study analyzed 184 patients (123 women and 61 men) affected by otosclerosis. All the patients were affected by conductive hearing loss and treated by stapedoplasty. Auditory thresholds at the baseline (T0) and one month after surgery (T30) were collected. Air and bone thresholds and Air Bone Gap (ABG) were compared between females and males using one-way ANOVA.ResultsStatistically significant differences were observed comparing the air threshold at T0 vs T30 both in women and men (p < 0.0001). No statistically significant differences were observed in the bone conduction thresholds before and after surgery. The comparison between females and males showed statistically significant differences both at T0 (p < 0.01) and T30 (p < 0.05) for air conduction thresholds and ABG at 4000 Hz.ConclusionAlthough stapedoplasty reduced the difference between females and males in the air conduction thresholds and ABG, women showed better recovery of their middle ear function with better auditory thresholds and ABG. The female hormones might positively impact the ligaments of the incudostapedial joint improving chain flexibility. This benefit might explain the statistically significant difference observed in women at 4000 Hz before and after surgery.

Ossicular Chain Status in Adults with Chronic Otitis Media Mucosal at a Tertiary Referral Hospital in Nepal

Introduction&#x0D; Chronic Otitis Media (COM) is a common condition characterized by perforation of the tympanic membrane and inflammation of middle ear cleft mucosal lining for at least 2-6 weeks. This study was carried out to find out the status of the middle ear ossicles in patients with COM mucosal and to correlate with clinical parameters.&#x0D; Materials and Methods&#x0D; This retrospective clinical study comprises 106 myringoplasty patients at the department of ENT, Shree Birendra Hospital. Their preoperative PTA, four frequencies (500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz) Air Conduction Thresholds (ACT), and Air Bone Gap (ABG) were recorded. Ossicular chain integrity and mobility evaluated intraoperatively were noted. Ossicular chain status was analyzed with ACT and ABG.&#x0D; Results&#x0D; The ossicles were intact and mobile in 91.5%, either fixed/ restricted or disrupted in 8.5%. Mean ACT and ABG comparisons in intact and ossicular chain defect groups were statistically significant. Frequency-specific ACT at all four frequencies and ABG except at 4000 Hz in the two groups were also statistically significant to predict the ossicular involvement. The group with ossicular defect had moderate to severe Conductive Hearing Loss (CHL).&#x0D; Conclusion&#x0D; Mean as well as frequency-specific ACT and ABG can be considered as a potential preoperative predictor for ossicular chain status in COM mucosal.

Hearing loss in fabry disease: A 16 year follow-up study of the Danish nationwide cohort

BackgroundFabry disease (FD) is a lysosomal storage disorder resulting in systemic accumulation of globotriaosylceramide (Gb3) causing multi-organ dysfunction. The audiologic involvement in FD has been neglected in previous studies; while not a lethal aspect of the disease, hearing loss can have a significantly negative impact on quality of life. ObjectiveTo investigate hearing loss from baseline through 16 years follow-up of the Danish FD cohort and to compare audiometric data to other clinical variables. MethodsData was collected prospectively and assessed retrospectively during a period of 16 years from 83 patients (age: 9–72 years; sex: 29 males and 54 females). 55 patients underwent treatment. Air conduction thresholds was assessed at six frequencies between 0.25 and 8 kHz bilaterally. Data was analyzed using multilinear models. ResultsMean follow-up period for patients undergoing a FD specific treatment was 7.8 years (0–12.8 years, SD 3.8 years, n = 55). Hearing thresholds for FD patients deviated from healthy individuals at all frequencies for both sexes (p < 0.001). Males had more profound hearing loss than females at high frequencies (4,8 kHz) (p = 0.025). There was no improvement in hearing with treatment (p = 0.343♂, p = 0.256♀). No associations between hearing loss and measured glomerular filtration rate, left ventricular wall thickness or cerebral white matter lesions were found. Lower plasma Gb3 concentration correlated with better hearing (p = 0.046) in males. ConclusionOur findings demonstrated significant hearing loss in FD patients compared to audiologically healthy individuals at all frequencies, and no change in hearing during treatment. Lower plasma Gb3 concentrations correlated with better hearing in males.

Comparison of the clinical outcome of endoscopic push-through myringoplasty and microscopic overlay myringoplasty: matching co-variated designs

BackgroundThe conventional microscopic overlayer myringoplasty is preferred because it allows a both hands technique, not reducing middle ear space, increasing the blood supply in the repaired area, and providing graft support; however, this technique may be troublesome for the novice surgeon during tympanomeatal flap elevation. Recently, the endoscopic push-through myringoplasty technique has developed. It provides better visualization of the hidden areas and does not require raising tympanomeatal flap. Therefore, the comparison of clinical outcomes between endoscopic push-through myringoplasty and conventional microscopic overlay myringoplasty technique was investigated.MethodsA retrospective case–control hospital-based study was conducted using archival data from the patients who underwent myringoplasty between January 2015 and May 2021 at Srinagarind Hospital and Khon Kaen Hospital, Thailand. The medical records of patients who underwent endoscopic push-through technique or microscopic overlayer technique were chosen by simple randomization and matched 1:1 based on the air conduction threshold, air-bone gap, size of perforation, and experience of the surgeon. The two techniques were compared for clinical outcome success, including tympanic membrane closure, improved air conduction threshold, air-bone gap closure, and operation time duration.ResultsMedical records of 70 patients were retrieved and classified into 35 patients who underwent endoscopic push-through and 35 patients who underwent microscopic overlayer myringoplasty. The size of tympanic membrane perforation and preoperative audiometry were not significantly different between both groups (p > 0.05). The postoperative outcome in endoscopic technique revealed that the air-bone gap and the success rate of tympanic membrane closure were comparable with microscopic techniques (p = 0.420 and p = 0.156, respectively). The operation time was significantly shorter in the endoscopic technique (p < 0.05). Complications were found in one patient with otitis externa in the endoscopic technique group and one patient with graft lateralization in the microscopic technique group.ConclusionsEndoscopic push-through myringoplasty is an alternative minimally invasive technique that may allow the potential outcomes comparable with the microscopic overlayer myringoplasty and with a significantly shorter operation time.

Progressive Sensorineural Hearing Loss in Vibrant Soundbridge Users Requiring Cochlear Implantation.

Less than 20% of patients with sensorineural hearing loss (HL) provided with the Vibrant Soundbridge (VSB) experience a progressive HL and warrant cochlear implantation (CI). The aim of this study was to identify possible predictors of progressive HL prior to VSB implantation. This retrospective study included all consecutive ears with sensorineural HL provided with the VSB between 1998 and 2016. The patient cohort was divided in a study group comprising patients who underwent CI (CI group) after years of VSB usage and those who did not require VSB replacement during the observational time (control group). Pre- and postoperative pure-tone audiometry thresholds were compared among the two groups. Fifteen out of 81 VSB devices (18.5%) required a CI. The CI group had higher preoperative air-conduction (AC) thresholds than the control group (64.3 ± 8.9 dB vs. 56.3 ± 12.9 dB; p = 0.007) at the time of the VSB implantation. On average, the CI group was significantly younger (39.1 ± 12.3 years vs. 52.6 ± 16.2 years; p = 0.003). In conclusion, VSB users with higher preoperative AC thresholds and younger age at the time of VSB implantation might be at risk for progressive HL within the upcoming eight years and need a further CI surgery. Preoperative counseling is particularly advisable in this patient group.

An Exposition on Endoscopic Broad Palisade Cartilage Tympanoplasty: Procedural Illustrations and Connotations in Context of Audiological and Morphological Outcomes.

The objective of this study was to evaluate graft take up rate and hearing improvement in type I and type III endoscopic tympanoplasty using broad palisade cartilage graft and to compare the results with other studies who have used single piece cartilage as graft. This retrospective observational descriptive study was done in a tertiary care hospital. This study included 64 cases, who met the inclusion criteria, which were operated over 2years and were followed for 3years. The results were evaluated using graft uptake rates and hearing improvement comparing the preoperative and postoperative air conduction threshold (ACT) and air bone gap closure (ABG). The graft take rate was 92.1% and 87.5% at the end of 1year and 3years respectively. The preoperative and post-operative air conduction threshold were 35 ± 6.0dB HL and 17.5 ± 2.7dB HL in type I tympanoplasty respectively (p value <0.0001) while in type III tympanoplasty, preoperative and post-operative air conduction threshold (ACT) were 43.3 ± 8.6dB HL and 23.1 ± 4.2dB HL respectively (p value <0.0001). The preoperative and postoperative air bone gap (ABG) were 29.0 ± 5.6dB HL and 14.4 ± 4.20dB HL in type I tympanoplasty respectively (p value <0.0001). In type III preoperative and post-operative air bone gap were 36. 1 ± 7.5dB HL and 16.4 ± 3.3dB HL respectively (p value < 0.0001). Endoscopic broad palisade cartilage tympanoplasty has similar outcomes in morphological and audio logical perspectives as single piece cartilage tympanoplasty. Further studies with long term follow up period are required to corroborate the result of this study.

The Emerging Surgical Concepts and Principles of Attic and Postero-Superior Wall Reconstruction by Auricular Cartilage and Free Fibro-Periosteal Tissue in Middle Ear Surgery. An Exposition on Surgical Experiences, Observations and Mistakes.

In middle ear surgeries, addressing the pathologies (cholesteatoma, retractions or tympanosclerosis) in attic or postero-superior area, are associated with difficulties like reconstruction of attic and postero-superior canal wall after clearing the disease. There are various graft materials available for such attic reconstruction in intact canal -wall surgeries. We describe our experience of attic and postero-superior canal wall reconstruction in combined approach tympanoplasty (CAT) using free auricular cartilage and free fibro-periosteal tissue and to present our results in anatomical and functional perspectives. This retrospective observational study was conducted in a tertiary care center which comprised 25 cases of combined approach tympanoplasty (with attic wall reconstruction) which were operated for attic cholesteatoma, tympanosclerosis or adhesive otitis media from January 2017 to December 2019 in our otolaryngology department. Outcomes were evaluated in audiological and morphological dimensions and paired "t" test (significant p value <0.05) was used to analyse the audiological data. A total of 25 cases (22 primary and 3 revision cases) were included in the study. Defect in attic and posterosuperior canal wall was caused by pathology (disease itself) in 2 cases, surgically created (intraoperatively to clear the disease) in 11 cases and both by pathology and surgically in 12 cases. 22 cases had successful graft uptake, with a morphological success rate of 88%, whereas graft failure was encountered in 3 cases. Complications observed were post-operative otorrhea (2 cases), recurrence (3 cases), no hearing improvement despite intact graft (1 case) and worsening of hearing post operatively in 1 case. Pre-operative ACT (Air conduction threshold) was 45.96 ± 12.47dB and the post-operative ACT was 38.61 ± 9.76dB (p value = 0.0246). Pre-operative ABG (Air-bone gap) was reduced from 30.58 ± 11.06dB to the post-operative ABG of 21.89 ± 6.24dB (p value = 0.0013). Reconstruction of postero-superior canal wall and attic defects in CAT using auricular cartilage and fibro-periosteal tissue (over mastoid cortex) is a novel method and associated with satisfactory morphological and audiological results. It is also effective in preventing postoperative retractions.

Is there any difference in hearing function between surgical and natural menopause?

ABSTRACT This study was designed to examine cochlear function in surgical postmenopausal women and natural menopause. Three groups, each including 20 patients, were formed: surgical menopause (SM), natural menopause (NM), and healthy controls who had not yet gone through menopause. Conventional audiometry (0.125–8 kHz), ultra-high frequency audiometry (10–16 kHz), and otoacoustic emission (OAE) tests were used in the evaluation of the patients. Almost all the hearing thresholds were significantly poorer in the menopause groups than in the control group (p < .05). However, the amplitudes of the healthy controls were higher in transient evoked otoacoustic emissions (TEOAEs), especially in many frequencies of distortion product otoacoustic emissions (DPOAEs) (p < .05). In the SM group, all the frequencies between 0.125 and 10 kHz for the right ear, and 1, 2, 6 and 8 kHz air-conduction hearing thresholds for the left ear were significantly poorer compared to the NM group (p < .05). There was also a significant decrease in the 4, 6, and 8 kHz DPOAE amplitudes of the SM group compared to the NM group (p < .05). This study showed that postmenopausal women, in particular those with SM had significantly poorer hearing thresholds and lower OAE amplitudes. Menopause may be a potential risk factor for the development of hearing loss in women.

FLUCTUATING HEARING LOSS AS A SYMPTOM OF ACQUIRED PERILYMPHATIC FISTULA (PLF) UNDER EXTERNAL INJURIES FACTOR.

The aim: To evaluate the effectiveness of treatment patients with spontaneous PLF and labyrinthine window ruptures by studying the clinical and audiological results. Materials and methods: 52 patients after exposure to traumatic factors in the anamnesis were evaluated. The perilymphatic fistula was diagnosed in 18 patients after the complex examination. All patients with PLF underwent surgical treatment. Results: Vestibular disorders and hearing loss were the predominant symptoms. The fistula test was positive in 11 (61%) patients. Fluctuating hearing loss was determined in 9 (50%) patients. Labyrinthine window ruptures were detected in 16 (88%) patients: oval window membrane rupture was identified in 6 patients, and in another 10 patients round window membrane rupture was found and was detected on CT scan. The surgical treatment included minimally invasive tympanotomy with combined microscopic and endoscopic visualization and sealing techniques. Results were evaluated in 6 months after surgical treatment, patients had a decrease in bone and air conduction thresholds at all evaluated frequencies and a significant decrease in the level of the air-bone interval. Conclusions: Fluctuating hearing loss is considered one of the key symptoms, which suggests the presence of PLF. Determination of PLF and its surgical treatment, by using minimally invasive tympanotomy with sealing technique using optimal combined visualization, allows obtaining a stable functional result, with hearing improvement and vestibular symptoms reducing.

Effect of Consanguinity on the Audio Profile Section of Non Syndromic Sensorineural Hearing Impaired Children: A Cross-sectional Study

Introduction: The incidence of bilateral sensorineural hearing loss is quite notable in live births worldwide. Among the etiologies, the primary aetiology is thought to be genetic, followed by non heritable, and unknown. Aim: To study the effect of consanguinity on audiological profile in children presented with non syndromic sensorineural hearing loss. Materials And Methods: This cross-sectional study was conducted in the Department of Ear Nose Throat, McGANN Teaching District Hospital (Shimoga Institute of Medical Sciences), Shivamogga, Karnataka, India, from January 2019 to December 2020, among 95 children with non syndromic sensorineural hearing loss. A Pure Tone Audiometry (PTA) test was done for each patient both air conduction and bone conduction thresholds were tested using different transducers. An audiogram was collected and the degree of hearing loss of each patient was analysed. Statistical tests were performed using Statistical Package for Social Sciences (SPSS) version 34.0, Kruskal-Wallis test, oneway Analysis of Variance (ANOVA) was used for comparing the difference in PTA followed by the Mann-Whitney U test. Results: The mean age of the study population was 9.7 years; 39 subjects were female, and 56 were male. The PTA among the study population showed asymmetric audiograms in 17 (17.9%) children. A majority (60, 63%) of the participants were born out of consanguineous marriage. Total 80 (84.2%) children had bilateral hearing loss, among which 58 (72.5%) were cases of bilateral profound. One-way ANOVA showed that there was an overall significant difference between the consanguinity and non consanguinity groups and post-hoc analysis with the Mann-Whitney U test revealed a significant difference between the different degrees of consanguineous marriage. Conclusion: Consanguinity affects the audio profile (PTA) among the non syndromic hearing-impaired children.