Air-bone Gap Research Articles

An endoscopic approach to stapes surgery needs less external auditory canal wall removal than a microscopic approach

Background Although many advantages of endoscopic stapes surgery have been reported, there is little objective data on whether it provides better visualization than the microscopic approach. Objectives To evaluate and compare audiological results, external auditory canal wall removal area, and adverse event rates between endoscopic and microscopic stapes surgery. Material and methods Data from patients who received stapedotomy were collected. Pre and postoperative audiometry, procedure-related parameters, and adverse events were analyzed in conventional microscopic and endoscopic groups. Results There were no differences in procedure time or postoperative hearing between the endoscopic and microscopic surgery groups. The mean procedure times were 87.3 ± 18.9 min in the endoscopic group and 79.9 ± 23.5 min in the microscopic group. The mean postoperative air-bone gaps were 10.9 ± 8.3 dB in the endoscopic group and 10.5 ± 7.8 dB in the microscopic group. There were no differences in the rate of sensorineural hearing loss, postoperative pain, facial palsy, vertigo, or dysgeusia between the two groups. The bony removal area of the posterosuperior external auditory canal wall measured by two observers was significantly less in the endoscopic group than in the microscopic group. Conclusions Endoscopic stapedotomy needed less external auditory canal wall removal and showed similar audiological outcomes to microscopic stapedotomy.

Analysis of Causative Disorders and Hearing Improvement in 100 Consecutive Stapes Surgeries

Background and Objectives Stapes surgery has been widely used to improve the conductive hearing loss caused by stapedial fixation. The purpose of this study is to evaluate the causes of stapedial fixation using audiological results of 100 stapes surgeries.Subjects and Method We reviewed the medical records of 100 consecutive stapes surgeries between June 2011 and December 2022. A total of 100 ears from 86 patients were included and the patient age ranged from 6 to 80 years. Hearing improvements of pure-tone thresholds were defined as successful when air-bone gap (ABG) was reduced to 20 dB or less, and as excellent when ABG was reduced to within 10 dB.Results The causative diseases of stapedial fixation were otosclerosis (n=74, 74%), ossicular anomaly (n=19, 19%) and chronic otitis media (n=7, 7%). Overall, the pre-operative bone-conduction thresholds/air-conduction thresholds (BC/AC) thresholds were 32±14/58±18 dB HL and ABG were 26±11 dB while the postoperative BC/AC thresholds were 29±15/36±18 dB HL and ABG were 7±8 dB. The postoperative ABG was excellent in 77% and successful in 93%. The postoperative ABG was excellent in 82.4% and successful in 97.3% of otosclerosis, excellent in 78.9% and successful in 89.5% of ossicular anomaly, and excellent in 14.3% and successful in 57.2% for chronic otitis media. ABG significantly improved less in revision cases than in primary otosclerosis cases (<i>p</i>=0.006).Conclusion Stapes surgery is an effective method to improve hearing for various types of stapedial fixation. There was a difference in the degree of hearing improvement according to causative disorders.

Perichondrium-Cartilage Inlay Butterfly Myringoplasty: An Office-Based Procedure for Closing Small- to Medium-Sized Tympanic Membrane Perforations.

Objective: The objective of this study was to assess the graft and functional outcomes of inlay butterfly cartilage-perichondrium graft myringoplasty in an office setting. Material and Methods: Adult patients with chronic perforations underwent inlay butterfly cartilage-perichondrium graft myringoplasty under local and topical anesthesia. The graft and functional outcomes, intraoperative pain score, and complications were evaluated at 6 months postoperatively. Results: A total of 39 patients (39 ears) were included in this study. All patients completed 6 months of follow-up. The mean operation time was 26.5 ± 3.2 (ranged from 21 to 32) minutes. The intraoperative mean pain score was 0.61 ± 0.28. The graft success rate was 97.4% (38/39) at 6 months postoperatively. The mean preoperative air-bone gap (ABG) was 19.18 ± 4.01 dB, while the mean postoperative ABG at 6 months was 10.56 ± 2.27 dB (P < .05; Paired-Samples T Test). The functional success rate was 100.0% (38/38). Endoscopic examination showed that the transplanted perichondrium graft gradually atrophied, flattened, and became indistinguishable from the surrounding tympanic membrane 2 to 3 months following surgery, the superficial layer of perichondrium graft formed the crust and migrated into the external auditory canal at 3 to 6 months postoperatively. Conclusions: Perichondrium-cartilage inlay butterfly myringoplasty is a highly successful and minimally invasive procedure well tolerated by adults for closure of small- and medium-sized perforations in an office setting.

Audiometric Outcomes After the Middle Cranial Fossa Repair of Superior Semicircular Canal Dehiscence.

To evaluate the audiometric outcomes after the middle cranial fossa approach (MCF) for superior canal dehiscence (SCD) repair. Retrospective review. Tertiary referral center. SCD cases presented to a single institution between 2012 and 2022. The MCF repair of SCD. Air conduction (AC) threshold (250-8,000 Hz), bone conduction threshold (BC) (250-4,000 Hz), and air bone gap (ABG) (250-4,000 Hz) at each frequency, pure tone average (PTA) (500, 1,000, 2,000, 3,000 Hz). Among 202 repairs, 57% were bilateral SCD disease and 9% had previous surgery on the affected ear. The approach significantly narrowed ABG at 250, 500, and 1,000 Hz. The narrowing of ABG was achieved by both decreased AC and increased BC at 250 Hz, but mediated primarily by increased BC at 500 Hz and 1,000 Hz. Among cases without previous ear surgery, mean PTA remained in the normal hearing range (mean: preop, 21 dB; postop, 24 dB) and clinically important hearing loss (PTA increased by ≥10 dB) after the approach was noted in 15% of cases. Among cases with previous ear surgery, mean PTA remained in the mild hearing loss range (mean: preop, 33 dB; postop, 35 dB) and clinically important hearing loss after the approach was noted in 5% of cases. This is the largest study to date examining the audiometric outcomes after the middle cranial fossa approach for SCD repair. Findings of this investigation support that the approach is effective and safe with long-term hearing preservation for most.

Effect of Packing Versus No Packing in Transperforation Myringoplasty for Chronic Tympanic Membrane Perforations.

To compare the operation times, graft survival and success rates, audiometric outcomes, and complications of patients who underwent transperforation myringoplasty with and without packing but without perforation rimming. A prospective, randomized controlled trial. A university-affiliated teaching hospital. We conducted a randomized controlled trial that enrolled patients who underwent underlay myringoplasty. No patient underwent perforation rimming. Patients underwent myringoplasty with or without graft lateral packing. The operation times, graft survival and success rates, audiometric outcomes, and complications were compared between the 2groups. Sixty patients with unilateral perforations were included. The mean neovascularization score at postoperative week 2 was significantly higher in the no-packing group than in the packing group (p < .01) but did not differ significantly at postoperative weeks 3 and 4, or postoperative month 3. Neither the graft healing rate (p = .313) nor the perforation closure rate (p = .640) significantly differed between the 2groups. The mean air-bone gap improved by 8.91 ± 5.45 dB in the packing group and 8.17 ± 1.19 dB in the no-packing group (p = .758). The long-term graft success and hearing improvements in transperforation myringoplasty with no rimming of the perforation and no-graft lateral packing were comparable to those in the graft lateral packing group with no rimming of the perforation, with a low incidence of complications. These results may change the traditional practice of packing the external auditory canal and rimming the perforation in underlay myringoplasty, even for all myringoplasty surgery.

EAONO/JOS classification for acquired cholesteatoma: evaluating the impact of the number of affected sites on treatment and outcomes

PurposeThe European and Japanese system for cholesteatoma classification proposed an anatomical differentiation in five sites. In stage I disease, one site would be affected and in stage II, two to five. We tested the significance of this differentiation by analyzing the influence of the number of affected sites on residual disease, hearing ability and surgical complexity.MethodsCases of acquired cholesteatoma treated at a single tertiary referral center between 2010-01-01 and 2019-07-31 were retrospectively analyzed. Residual disease was determined according to the system. The air–bone gap mean of 0.5, 1, 2, 3 kHz (ABG) and its change with surgery served as hearing outcome. The surgical complexity was estimated regarding the Wullstein’s tympanoplasty classification and the procedure approach (transcanal, canal up/down).Results513 ears (431 patients) were followed-up during 21.6 ± 21.5 months. 107 (20.9%) ears had one site affected, 130 (25.3%) two, 157 (30.6%) three, 72 (14.0%) four and 47 (9.2%) five. An increasing number of affected sites resulted in higher residual rates (9.4–21.3%, p = 0.008) and surgical complexity, as well poorer ABG (preoperative 14.1 to 25.3 dB, postoperative 11.3–16.8 dB, p < 0.001). These differences existed between the means of cases of stage I and II, but also when only considering ears with stage II classification.ConclusionThe data showed statistically significant differences when comparing the averages of ears with two to five affected sites, questioning the pertinence of the differentiation between stages I and II.

Comparison of subcutaneous soft tissue versus temporalis fascia as a tympanoplasty graft material: a retrospective cohort study.

This research compares the efficacy of subcutaneous soft tissue and temporalis fascia in tympanic membrane grafting for large tympanic membrane perforations. A retrospective cohort study compared tympanic membrane graft success rate and hearing outcomes in 248 patients who underwent tympanoplasty using subcutaneous soft tissue (n = 118) or temporalis fascia (n = 130) via the post-auricular approach. Comparable results were observed in both groups. Tympanic membrane graft success rate was 98.3 per cent (116 ears) in the subcutaneous soft tissue group and 98.5 per cent (128 ears) in the temporalis fascia group. The rate of air-bone gap closure within 20 dB was 54.2 per cent (64 ears) and 60.0 per cent (78 ears) in the soft tissue and temporalis fascia groups, respectively (p = 0.360). Subcutaneous soft tissue is a reliable and readily available tympanic membrane graft material in both revision and primary tympanoplasty for large tympanic membrane perforations.

Is pre-operative audiometry a reliable predictor of ossicular chain condition?

ObjectiveInvestigation of ossicular chain (OC) status before surgery is important for preoperative patient consultation. This research aimed to investigate the relationship between pre-operative audiometric values and intra-operative OC condition in a relatively large population of chronic otitis media (COM) surgeries. MethodsIn this descriptive-analytic cross-sectional study, we evaluated 694 patients who underwent COM surgeries. We analyzed pre-operative audiometric data and intraoperative findings including ossicular anatomy, ossicular mobility, and the condition of middle ear mucosa. ResultsThe optimal cut-off values of pre-operative speech reception threshold (SRT), mean air-conduction (AC), and mean air-bone gap (ABG) for predicting OC discontinuity were 37.5 dB, 37.2 dB, and 28.4 dB, respectively. For the prediction of OC fixation, the optimal cut-off points of SRT, mean AC, and mean ABG were 37.5 dB, 40.3 dB, and 32.8 dB, respectively.The computing of Cohen's d (95 % confidence interval) demonstrated the greater mean ABG in ears with OC discontinuity in comparison with ears with normal ossicles in all types of pathologies. There was a descending trend of Cohen's d from cholesteatoma to tympanosclerosis and then to granulation tissue and hypertrophic mucosa.There was a substantial relation between the type of pathology and OC status (P < 0.001). Ears with tympanosclerosis plaque had the most fixed OC among all types of pathologies (40 ears, 30.8 %), and ears with no pathology had the most normal OC (135 ears, 83.3 %). ConclusionsThe results supported the view that pre-operative hearing is a key determining factor for the prediction of OC status.

Comparison of tragal perichondrium and COOK artificial material in endoscopic type 1 tympanoplasty

ObjectiveVarious materials have been used for tympanic membrane reconstruction in middle ear surgery. This study aimed to evaluate the difference between the tragal perichondrium and COOK artificial material in patients who underwent endoscopic type 1 tympanoplasty. MethodThis retrospective study included patients who underwent endoscopic type 1 tympanoplasty from June 2021 to June 2022 at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. Patients were divided into group A (tragal perichondrium) and group B (COOK artificial material) according to the material used in the operation. All patients were followed up for 6 months. The differences in age, gender, operation site, disease course, preoperative air-bone gap (ABG), operation time, blood loss, hearing gain, and wound healing rate were compared between the two groups. ResultsThis study enrolled 197 patients, with 120 patients in group A and 77 patients in group B. There were no significant differences in age, gender, operation site, disease course, or preoperative ABG between groups A and B (p > 0.05). Both groups had significant postoperative improvement in hearing (group A: 30.98 ± 9.58 dB vs. 17.07 ± 9.92 dB, p < 0.001; group B: 29.75 ± 7.52 dB vs. 14.25 ± 9.07 dB, p < 0.001). The mean hearing gain in group A and group B was comparable (14.02 ± 11.91 dB vs. 15.50 ± 7.05 dB, p = 0.609). The wound healing rates of groups A and B were no differences (93.33% vs. 87.01%, p = 0.133). The patients in group B had a shorter operation duration (72.57 ± 11.32 min vs. 61.86 ± 9.27 min, p = 0.045) and less blood loss (12.38 ± 3.7 mL vs. 8.10 ± 2.43 mL, p = 0.004). ConclusionsTragal perichondrium and COOK artificial material are reliable for functional and anatomical outcomes in endoscopic type 1 tympanoplasty, and COOK artificial material can save operation time and blood loss in surgery compared to the tragal perichondrium.

Management of attic retraction pockets.

Attic retraction pockets, classified by degree of invasion and erosion, are reconstructed here as outlined by attic retraction pocket grade. Attic retraction pocket grade, surgical management, subsequent conditions of tympanic membrane and middle ear, and improvement of air-bone gap pure tone average were recorded. Our management strategy, based on attic retraction pocket grade, was applied to 200 ears: 44 grade I ears had non-surgical management and 156 grade II-V ears had surgical management. All 200 ears were followed up for 36-240 months, showing only 1 attic retraction pocket reformation and 1 adhesive otitis media (complication rate of 1 per cent), and improved air-bone gaps (p < 0.05). An earlier series of 50 grade IV attic retraction pockets used atticotomy with epitympanic reconstruction. These showed attic retraction pocket recurrence or cholesteatoma onset in 34 ears (68 per cent). When these ears were revised per protocol, there was no evidence of cholesteatoma thereafter. Reconstruction of the ossicles and scutal defect according to attic retraction pocket grade shows long-term stability of the tympanic membrane, middle ear and hearing.

Comparative Analysis of the Hearing Effects of Partial Ossicular Replacement Prosthesis Versus Conchal Cartilage in Canal Wall Down Mastoidectomy with Type II Tympanoplasty: A Retrospective Case Review Study.

To investigate the effects of titanium partial ossicular replacement prosthesis (PORP) and conchal cartilage for ossiculoplasty on hearing results in single-stage canal wall down (CWD) mastoidectomy surgery with type II tympanoplasty in patients with cholesteatoma. The patients were performed surgeries for the first time by a senior otosurgeon from 2009 to 2022 and were performed CWD mastoidectomy with type II tympanoplasty in one stage were enrolled. Patients who could not be followed up were excluded. Titanium PORP or conchal cartilage was used for ossiculoplasty. When the stapes head was intact, a cartilage 1.2-1.5mm thick was attached directly to the stapes; when the head of the stapes was eroded, a 1mm high PORP and cartilage of .2-.5mm thick were placed on the stapes simultaneously. 148 patients were included in the study in total. The titanium PORP and conchal cartilage groups showed no statistically significant differences at 500, 1000, 2000, and 4000Hz considering the number of decibels of closure of the air-bone gap (ABG) (P > .05) and pure-tone average ABG (PTA-ABG) (P > .05). Meanwhile, the closure of PTA-ABG between the 2 groups showed no statistically significant differences in the overall distribution (P > .05). For patients with cholesteatoma and mobile stapes who underwent CWD mastoidectomy with type II tympanoplasty in one stage, either PORP or conchal cartilage is a satisfactory material for ossiculoplasty.

Exclusive endoscopic ossiculoplasty with autologous material: step-by-step procedure and functional results.

To describe the surgical procedure of exclusive endoscopic ossiculoplasty (EEO) with autologous grafts and evaluate audiological results, focusing on the advantages or drawbacks compared to the corresponding microscopic technique. A retrospective review of consecutive adult and pediatric patients affected by chronic otitis media (COM) with or without cholesteatoma who underwent EEO was conducted. Only autologous ossiculoplasty was included in the study. The procedure was performed by experienced surgeons of our institution between November 2014 and September 2019. Hearing outcomes were evaluated using postoperative air-bone gap (ABG) and success rates in different subgroups of patients and different types of ossiculoplasty (OPL) were analyzed. Our results were finally compared with the existing literature regarding both microscopic and endoscopic ossicular chain reconstruction. In total, 74 endoscopic ossicular chain repair procedures performed within the study period met the inclusion criteria. Of these, 21 were pediatric patients (28%) and 53 were adults (72%). Surgical reconstruction procedures included 43 partial ossicular reconstructions (POR) and 31 total ossicular reconstructions (TOR). The postoperative ABG improved significantly compared to preoperative measurements, and the mean ABG closure was 7.85dB HL (p = 0.00064). No statistically significant differences in audiological outcomes between TOR/POR techniques and pediatric/adult groups were found in our study cohort, with p values of 0.10 and 0.88, respectively. At present, EEO can be considered a valid surgical option for re-establishing a functioning ossicular chain with acceptable hearing restoration in children and adults. Further reports in wider case series are required to confirm these results.

Self-assessment of bone conduction hearing threshold using mobile audiometry: comparison with pure tone audiometry

Objective The aim of the research was to evaluate the feasibility of measuring the bone conduction hearing threshold using self-administered mobile audiometry. Design A single-centre, closed, cross-over trial was carried out on patients from the ENT Department. A mobile-based, self-administered, audiologist-assisted assessment of the bone conduction hearing threshold was carried out by means of the open-access, freeware app Hearing Test using two types of bone conduction headphones: professional B71 bone transducer and commercially available AfterShokz Openmove open-ear headphones. Study sample Seventy-seven ears. Results A test-retest examination revealed the lowest standard deviation for open-ear headphones at 3.33 dB (95% CI 2.92–3.79). When compared with pure tone audiometry, the intraclass correlations of 0.95 (95% CI 0.94–0.96) and 0.90 (95% CI 0.88–0.92) were obtained for the bone transducer and for the open-ear headphones, indicating excellent and good reliability, respectively. However, the regression slope of 0.67 was found for the air-bone gap when using open ear headphones, which was significantly different from 1 (p < 0.001). Conclusions Open-ear headphones provide an alternative for estimating bone conduction once the air-bone gap has been adjusted by a factor of 1/0.6 7 ≅1.5. They demonstrate improved reproducibility over the bone transducer and are much easier to use with a mobile device. Trial Registration: Wroclaw Medical University, Science Support Centre, BW60/2020

Impact of Intraoperative Findings on Hearing in Revision Ear Surgery.

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

A study of outcome of ossiculoplasty using autologous cartilage, refashioned incus, and polytetrafluoroethylene (Teflon) prosthesis in patients of chronic suppurative otitis media

AimTo find out the mean air conduction thresholds (ACT) and air–bone gap (ABG) closure across the treatment groups at the end of 3 and 6 months of follow-up.Material and methodsSixty patients diagnosed with COM with conductive hearing loss were included in the study. Air conduction threshold (ACT) and air–bone gap were calculated and recorded pre-operatively. Surgery was done with clearance of disease followed by reconstruction of hearing in single-stage operation using autologous conchal cartilage, refashioned incus, and polytetrafluoroethylene (Teflon) prosthesis (PORP, TORP) depending upon the intraoperative findings during surgery. Patients were followed for up to 6 months for assessing the hearing outcome in terms of the mean air conduction threshold and mean air–bone gap closure for each group separately.ResultsThe outcome of each ossiculoplasty material was calculated in terms of mean air conduction threshold and mean AB gap closure. Preoperative and postoperative air conduction threshold (ACT) at 3 months and 6 months follow-up of each group was as follows: for the autologous conchal cartilage group, 41.3 (± SD 6.69), 29.2 (± SD 5.39), and 21 (± SD 4.66); for autologous refashioned incus group, 40.4 (± SD 5.43), 28.4 (± SD 6.73), and 20.8 (± SD 4.33); for the Teflon PORP group, 42.9 (± SD 5.68), 31.4 (± SD 6.86), and 34.9 (± SD 6.37); and for the Teflon TORP group, 43.1 (± SD 5.40), 32.5 (± SD 5.91), and 36.2 (± SD 5.31). The mean air–bone gap preoperatively and postoperatively at 3 months and 6 months respectively were as follows: for autologous conchal cartilage, 40.6 (± SD 4.57), 23.7 (± SD 4.48), and 20 (± SD 5.28); for autologous refashioned incus, 39.3(± SD 4.92), 21.9 (± SD 5.61), and 19.4 (± SD 5.82); for Teflon PORP 43.0 (± SD 4.48), 32.8 (± SD 4.84), and 36.3 (± SD 5.56); and for Teflon TORP, 44.5 (± SD 5.56), 33.2 (± SD 5.53), and 35.2 (± SD 5.10).ConclusionThe hearing outcome of ossiculoplasty varies with the type of ossiculoplasty material used. Most favorable results were obtained with refashioned autologous incus followed by autologous conchal cartilage. Teflon prosthesis has a significant improvement in hearing outcomes although the results are less favorable.

Evaluation of hearing limits post tympanoplasty in patients with chronic suppurative otitis media

Link of Video Abstract: https://youtu.be/Nr9MKgu2v2E Background: Chronic suppurative otitis media (CSOM) causes partial or complete damage to the tympanic membrane and ossicles, causing hearing loss in the form of conductive and mixed hearing loss with a decrease of up to 60 dB. This study aimed to evaluate the hearing threshold before and after tympanoplasty surgery in CSOM patients. Methods: This type of research was carried out in a retrospective descriptive manner. The materials in this study were the medical records of CSOM patients who underwent canal wall up (CWU) tympanoplasty and canal wall down (CWD) tympanoplasty at the outpatients of ear, nose, and throat – head and neck surgery (ENT-HNS) Otology Division Dr. Soetomo Hospital Surabaya for the period January 1, 2018 to December 31, 2018 with a total of 51 patients. This study analyzed with the Wilcoxon test. Results: The mean age was 30.96 years (51% female and 49% male). Postoperatively 40 (78.5%) patients experienced an increase in hearing threshold, 10 (19.6%) patients experienced a decrease and 1 (1.9%) patient remained. The average increase in air-bone gap (ABG) pre and post tympanoplasty surgery was 9.78 dB, from 38.92 dB to 29.14 dB. Conclusion: There was an increase in hearing threshold after tympanoplasty.

Effect of the size of tympanic membrane perforation on hearing

Tympanic membrane (TM) perforation is one of the most common causes of hearing impairment. Apart from conduction of sound waves across the middle ear, the tympanic membrane, also sub-serves a protective function to the middle ear cleft and round window niche. It has been established that the larger the perforation on the tympanic membrane, the greater the decibel loss. The aim of this study is to determine the effect of the size of the tympanic membrane perforation on hearing. The study was conducted at Al-Jumhoori teaching hospital during march 2011 to march 2012. Seventy-eight patients with perforated tympanic membranes were included in the study.They all have TM perforation due to recurrent or chronic otitis media. Patients with traumatic TM perforation were excluded from the study. There were 47 males (46.5%) and 54 females (53.5%). Twenty patients had left ear perforation, 35 patients had right ear perforation, and 23 patients had bilateral perforations. Each ear was taken as a case, so the total number of the perforated ear drums were 101. The age ranged from 13- 56 with the mean of (31.64 ± 13.249) years. The TM perforation was examined and photo image was taken with the aid of the endoscope, and the percentage of the perforation was measured from the whole area by using a special Microsoft (infomap). Controls were 55 patients with a mean age 30.73 ±12.09( range 14-53) years. Male controls were 34 (61.8%), and 21 female controls(38.2%). There was a highly significant correlation between size of TM perforation with the hearing level, air bone gap, high frequency hearing loss and low frequency hearing loss. As a conclusion, there is strong relationship between the size of TM perforation and the hearing level, air-bone gap and both the low frequency and the high frequency hearing level and air-bone gaps.

The Effect of site of tympanic membrane perforation on hearing

Tympanic membrane(TM) perforation is one of the most common causes of hearing impairment. Apart from conduction of sound waves across the middle ear, the tympanic membrane, also sub-serves a protective function to the middle ear cleft and round window niche. The aim of the study is to determine the effect of the site of the tympanic membrane perforation on hearing. Seventy-eight patients with perforated tympanic membranes were included in the study.They all have TM perforation due to recurrent or chronic otitis media. Patients with traumatic TM perforation were excluded from the study. There were 47 males (46.5%) and 54 females (53.5%). Twenty patients had left ear perforation, 35 patients had right ear perforation, and 23 patients had bilateral perforations. Each ear was taken as a case, so the total number of the perforated ear drums was 101. The age ranged from 13- 56 with the mean of age was (31.64 ± 13.249) years. The TM perforation was examined and photo image was taken with the aid of the endoscope. Controls were 55 patients with a mean age 30.73 ±12.09 (range 14-53) years. Male controls were 34 (61.8%), and 21 female controls (38.2%). There is a positive correlation between site of TM perforation and hearing level, air bone gap, low frequency hearing level and high frequency hearing level. As a conclusion, there is a positive relationship between the site of TM perforation and hearing level being more in the posterior-superior and inferior parts.

Molecular Genetic Etiology and Revisiting the Middle Ear Surgery Outcomes of Branchio-Oto-Renal Syndrome: Experience in a Tertiary Referral Center.

To explore the phenotypes and genotypes of patients with branchio-oto-renal (BOR) and branchio-otic (BO) syndrome, and to analyze the middle ear surgery outcomes qualitatively and quantitatively, proposing a factor usefully prognostic of surgical outcomes. Retrospective cohort study. Tertiary referral center. Eighteen patients with BOR/BO syndrome in 12 unrelated Korean families. Middle ear surgery, including either stapes surgery or ossicular reconstruction. Clinical phenotypes, genotypes, and middle ear surgery outcomes. Eight probands (66.7%) were confirmed genetically; the condition segregated as a dominant or de novo trait. Six EYA1 heterozygous variants were identified by exome sequencing and multiplex ligation-dependent probe amplification. All variants were pathogenic or likely pathogenic based on the ACMG/AMP guidelines. Two novel EYA1 frameshift variants (p.His373Phefs*4 and p.Gln543Asnfs*90) truncating a highly conserved C-terminal Eya domain were identified, expanding the genotypic spectrum of EYA1 in BOR/BO syndrome. Remarkably, middle ear surgery was individualized to ensure optimal audiological outcomes and afforded significant audiological improvements, especially in BOR/BO patients without enlarged vestibular aqueducts (EVAs). A significant difference in air-bone gap closure after middle ear surgery was noted between the two groups even after adjusting for confounders: -20.5 dB in ears without EVAs (improvement) but 0.8 dB in ears with EVAs (no change or deterioration). Furthermore, the success rate was significantly associated with the absence of EVA. The results of this study were against the notion that middle ear surgery is always contraindicated in patients with BOR/BO syndrome, and an EVA could be a negative prognostic indicator of middle ear surgery in BOR/BO patients. This may aid to determine the strategy of audiological rehabilitation in patients with BOR/BO syndrome.

Correlation Between Air-Bone Gap and Vestibular Aqueduct Size in Enlarged Vestibular Aqueduct Syndrome: A Systematic Review.

The purpose of this review was to evaluate the air-bone gap with vestibular aqueduct size in enlarged vestibular aqueduct syndrome. According to the PRISMA guidelines we conducted a systematic review of the literature. Published international articles in English from 2000 to 2022 were screened, checking for studies that evaluated the air-bone gap of patients affected by enlarged vestibular aqueduct syndrome and the size of vestibular aqueduct. Data related to the hearing assessment and imaging investigation of enrolled participants were extracted. The chosen primary outcome measure was the correlation between air-bone-gap and vestibular aqueduct size. The database search allowed us to screen 485 articles and to select 5 articles discussing this topic for a total of 349 patients. Two studies showed a positive correlation between air-bone gap and vestibular aqueduct size, one only a trend and two no correlation. To date, it is not possible to draw conclusions whether or not there is a positive correlation between air-bone gap and vestibular aqueduct size in enlarged vestibular aqueduct syndrome. Higher quality studies would be conducted with standardized outcome measures to clarify the specific research question.