Improvement In Average Air-bone Gap Research Articles

Long-term outcomes following pediatric endoscopic titanium ossiculoplasty: A single-institution experience

IntroductionEndoscopic ossicular chain reconstruction (OCR) in adults has demonstrated equivalent outcomes to the traditional microscopic approach. Less data exist on endoscopic OCR outcomes in children, who have unique considerations including a smaller transcanal corridor and variable pathology. The purpose of this study was to investigate surgical and audiometric outcomes in children undergoing fully endoscopic and endoscopic-assisted OCR in both the short and long-term. MethodsRetrospective review of all children (<17 years) who underwent endoscopic OCR at one tertiary care center between 2017 and 2021. Children undergoing primary and revision endoscopic OCR with either partial (PORP) and total ossicular reconstruction prostheses (TORP) were included. Children undergoing surgery for juvenile otosclerosis or congenital stapes fixation, or any child receiving a stapes prosthesis were excluded. Primary outcome measures were post-operative change in 4 frequency (500 Hz, 1, 2, 4 KHz) air conduction pure tone average (AC PTA) and change in air-bone gap (ABG). Secondary measures included need for readmission and/or revision surgery, complication rate, and surgery duration. ResultsSeventeen patients met inclusion criteria. Average age was 11.3 years (range, 5–17 years); 14 were male. A variety of fixed length, titanium total and partial prostheses were used. The most common prosthesis length was 2 mm (range 2–5 mm), and there were no intra- or perioperative complications. Mean long-term follow-up was 2.6 years. Most common pathology was congenital cholesteatoma (11/17, 64%), followed by chronic otitis media with tympanic membrane perforation (5/17, 29.4%), and extruded prosthesis (1/17, 5.9%). Intraoperatively, the most common finding was incus erosion (10/17, 58.8%), followed by malleus erosion (6/17, 35.3%), stapes erosion (4/17, 23.5%), and stapes absence (4/17, 23.5%). Eight children (47%) were reconstructed with PORPs, and 9 children (52.9%) were reconstructed with TORPs. Average ABG improved from 36.8 dB preoperatively to 19.9 dB postoperatively in the short-term and remained stable at 19.5 dB in the long-term. Average short-term ABG improvement was 4.2 dB for PORPs and 18 dB for TORPs. In the long-term, average ABG improved by 2.3 dB in PORPs and 13.4 dB in TORPs. PORPs had higher rates of ABG closure and lower AC PTAs than TORPs in the long-term. DiscussionEndoscopic ossiculoplasty is a viable option in children presenting with ossicular erosion from various causes. Audiometric improvement following endoscopic partial and total ossicular reconstruction remains stable over time, with a preference towards partial in the long-term, and mirrors published outcomes for microscopic surgery.

English

BACKGROUND Otologists always yearn to improve the hearing outcome of their patients with chronic suppurative otitis media. There are different options for ossiculoplasty to choose from, depending on the extent of disease, condition of ossicular chain and availability of implant material and there has always been a quest to make appropriate decision with a predictable outcome. In this study, we have tried to analyse various factors which can affect hearing outcome after Ossiculoplasty. METHODS A retrospective study was done to study the effect of implant material, condition of ossicular chain and disease in the mastoid on post-operative hearing improvement on 200 patients, who underwent tympanoplasty or tympanomastoidectomy from January 2018 to January 2020, in Department of Otorhinolaryngology and Head and Neck Surgery, K.D. Medical College, Mathura. Decision of ossiculoplasty was made based on intra-operative findings. Autograft incus, Teflon TORP (total ossicular replacement prosthesis) and cartilage columella were used based on availability and feasibility. RESULTS Mean improvement in average air-bone gap of 200 patients was found to be 18.57 dB, with autograft incus, it was 19.99 dB, with Teflon TORP (total ossicular replacement prosthesis), 19.53 dB and with cartilage columella 16.73 dB (P = 0.023). Mean hearing improvement was 18.98 dB when handle of malleus was present and 15.59 dB when it was absent (P = 0.023). Mean hearing improvement was 19.42 dB when stapes superstructure was present and 16.92 dB when it was absent (P = 0.016). Even though the hearing outcome was better when mastoid was disease free (19.57 dB) compared to when it was diseased (18.30 dB), the difference was not statistically significant. (P = 0.177) CONCLUSIONS In our study, we found autograft incus to be the best material for ossiculoplasty and presence of handle of malleus and stapes superstructure improved postoperative hearing outcome significantly but involvement of mastoid by disease did not significantly affect the hearing outcome post-operatively. KEYWORDS Chronic Suppurative Otitis Media, Ossiculoplasty, Tympanoplasty, Ossicular Prosthesis, Autograft

Tympanoplasty With or Without Balloon Eustachian Tuboplasty for Chronic Suppurative Otitis Media With Obstructive Eustachian Tube Dysfunction.

To further elucidate the role of balloon Eustachian tuboplasty (BET) in tympanoplasty, we conducted a study to compare the outcomes of tympanoplasty with and without BET for the treatment of chronic suppurative otitis media (CSOM) with obstructive Eustachian tube dysfunction (OETD). Case control study. Tertiary referral center. A total of 70 ears diagnosed with CSOM (tubotympanic type) and OETD were included in this study. Thirty-five patients were prospectively enrolled for BET and tympanomastoidectomy between February 2018 and June 2019. Thirty-five control subjects were matched by sex and age and retrospectively enrolled for tympanomastoidectomy between July 2016 and January 2018. BET, tympanomastoidectomy. The graft take rate, hearing levels, and Eustachian tube function test results. The graft take success rate was higher in the BET group (80.0%; 28/35) than in the control group (68.6%; 24/35). However, the difference was not statistically significant. The average air-bone gap (ABG) improvement was 10.93 ± 7.70 dB in the BET group and 7.11 ± 8.08 dB in the control group, with a statistically significant between-group difference (p = 0.033). Our findings suggest that BET can objectively and subjectively improve the Eustachian tube function, with a slight but significant improvement in ABG despite the lack of a clinically significant improvement overall. However, it does not affect the graft take rate. In summary, BET could be used as an adjunctive procedure in the treatment of CSOM with OETD.

Comparative study of outcomes of type-1 tympanoplasty with temporalis fascia only and with cartilage slice reinforcement

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tympanoplasty is a surgical procedure performed to eradicate infection and restore the function of middle ear. Cartilage slice support offers an extremely reliable method for reconstruction of tympanic membrane in cases of high-risk perforation. The purpose of this study was to evaluate the graft uptake and auditory outcomes of type I tympanoplasty using temporalis muscle fascia only and with cartilage slice reinforcement.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study was conducted at the Department of Otorhinolaryngology, Government Medical College, Jalaun, Uttar Pradesh, India from November 2016 to November 2019. There were total of 100 patients, divided in two groups, 50 patients in each group, tympanoplasty type-1 using only temporalis fascia (group-A) and tympanoplasty type-1 using temporalis fascia with cartilage slice reinforcement (group-B). The result was measured on graft uptake and hearing outcome at 6 months postoperatively. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Overall graft uptake rate in group-A was 94%, whereas that in group-B was 100%. The age and sex had no significant effect on the success rate of surgery (p&amp;gt;0.05) in group-A. The average air bone gap (ABG) decreased from 28.3 dB to 10 dB, in group-B, the average ABG was 28.3 dB preoperatively and reached 16.6 dB after surgery. The difference between the rates of ABG improvement in the two groups was significant (p&amp;lt;0.01).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Hearing improvements is better in tympanoplasty type-1 with a temporalis graft only then with cartilage slice reinforcement. However, the graft uptake rate is higher in cartilage reinforcement compare with temporalis muscle fascia only.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Impact of tympanoplasty on tinnitus using tinnitogram

Introduction: Chronic Suppurative otitis Media (CSOM) and tympanic membrane perforation are leading causes of mild to moderate conductive acquired hearing loss worldwide that may lead to tinnitus. Aim: This study is designed to evaluate the postoperative various potential effects of tympanoplasty on tinnitus in patients with central tympanic membrane perforation using different methods of testing including tinnitogram. Methods: This study was carried out in: Oto-rhinolaryngology department – El Azhar University Hospitals and Oto-rhinolaryngology department Hearing and Speech institute in Giza (from March 2016 to March 2018). One hundred ears with central tympanic membrane perforation of one hundred patients were included in this study and it was designed as a prospective randomized study. Typmpanoplasty was done for all the ears with preoperative and postoperative audiological assessment and tinnitogram and Tinnitus Handicap Inventory. Results: Overall improvement by comparing pre-operative and post-operative results revealed that Tinnitus Handicap Inventory score improvement mean was (67.25), loudness threshold decrease mean was (35.71) and average Air Bone Gap improvement mean was (44.13). Conclusion: Patients with tinnitus and hearing loss are excellent candidates to undergo tympanoplasty in order to control tinnitus by hearing improvement. Our study results proved that Repair of tympanic membrane perforation will improve hearing outcome and decrease burden of tinnitus complaint on patient's life.

Superiority of Nitinol Piston Over Conventional Prostheses in Stapes Surgery: First Comparative Results in the Chinese Population in Taiwan

A growing number of studies conducted on stapes surgery have suggested that firm and adequate attachment of the prosthesis onto the long process of the incus plays a key role in surgical success. For this reason, a new prosthesis made of Nitinol characterized by "self-crimping" has been developed. Although better postoperative outcomes achieved with a Nitinol piston have been previously confirmed, the superiority of the Nitinol piston over the conventional manual-crimping prostheses remains controversial. The aim of this study was to determine the advantages of the Nitinol piston with regard to hearing improvement. We retrospectively compared postoperative hearing in otosclerosis surgeries with the Nitinol piston versus the manual-crimping prostheses. Sixteen surgeries with Nitinol pistons (carried out between April 2007 and August 2009) and 21 surgeries with conventional prostheses (carried out between January 2004 and January 2009) were evaluated. All patients received pure-tone audiograms preoperatively and postoperatively. In the Nitinol piston group, the air-bone gap (ABG) average (7.92 + or - 6.75 dBHL) was significantly smaller postoperatively than preoperatively (26.79 + or - 8.33 dBHL, p < 0.001). Similarly, the ABG average for the conventional piston group (13.09 + or - 6.99 dBHL) was significantly smaller postoperatively than preoperatively (26.19 + or - 6.76 dBHL, p < 0.001). Although both groups demonstrated an improvement in average ABG postoperatively, the Nitinol piston group showed a greater improvement than the conventional piston group (p = 0.018). Additionally, ABG closure within 10 dB was attained in significantly more patients (75%) in the Nitinol piston group compared with the conventional piston group (33.3%, p = 0.012). The Nitinol piston has a distinct advantage over conventional prostheses, providing an easier, safer and more effective treatment option in otosclerosis surgery. To our knowledge, this is the first comparative analysis of hearing results of the Nitinol piston with conventional prostheses in the Chinese population in Taiwan. In this population, there is a much lower prevalence of otosclerosis, leading to a lack of surgical experience in otosclerosis surgery, even at large medical centers. This may explain, in part, the relative lack of studies conducted on stapes prostheses in Asian patients. Therefore, our preliminary research may provide a reference for future investigations on stapes surgery in Asian patients with otosclerosis based on ethnic differences.

To POP or Not: Ossiculoplasty in Congenital Aural Atresia Surgery

To examine indications for ossiculoplasty (OP) in aural atresia surgery and to compare audiometric results and surgical revision rates between patients undergoing OP and those undergoing intact native chain reconstruction (INCR). Retrospective chart review. Charts of patients undergoing surgery for congenital aural atresia were reviewed for demographic data, preoperative Jahrsdoerfer score, ossicular chain status, and audiometric data. Patients undergoing OP were compared with an equal number of age and Jahrsdoerfer grade-matched patients who had an INCR. The preoperative and postoperative average air-bone gap (ABG), speech reception thresholds (SRT), and rates of revision surgery were compared between the two groups. Nineteen patients (20 ears) underwent OP during aural atresia repair and were compared with 20 matched patients who had INCR. Mean age, Jahrsdoerfer score, preoperative ABG, and SRT were similar for both groups. Mean postoperative audiometric follow-up was 33.1 months for the OP group and 20.4 months for the INC group (P = .24). Mean postoperative ABG was 33.8 dB HL for OP and 23.8 dB HL for INCR (P < .05). Mean improvement in ABG was 16.8 dB HL for OP and 29.9 dB HL for INCR (P < .001). Mean improvement in SRT was 24.6 dB HL for OP and 34.8 dB HL for INCR (P < .05). Nine ears (45%) in the OP group and four ears (20%) in the INCR group underwent revision surgery (P = .09). Patients reconstructed with their own intact native chain during aural atresia surgery have better audiometric outcomes than those undergoing OP and are less likely to undergo revision surgery.

Titanium middle ear prostheses in staged ossiculoplasty: does mass really matter?

Objectives Several articles have demonstrated the efficacy of titanium middle ear prostheses. Our study compares the results of 2 brands of titanium implants that differ in design and weight to assess potential benefit of one over the other. The purpose of this study was to investigate the relationship of prostheses mass based on the stiffness vs mass curve of acoustic transfer between 2 different brands of titanium implants. Study design A retrospective study was done for this article. Methods A chart review was conducted including the postoperative results, complications, and audiometric data for 34 patients with titanium middle ear implants (21 Tuebingen VARIO prostheses [Kurz Co, DuBlingen, Germany] and 13 Micron Monolithic prostheses [Gyrus ENT, Bartlett, TN]) with an average follow-up of 19 months. Both total and partial prostheses were included. Average postoperative air-bone gap (ABG) and average improvement in ABG was compared between the groups. Results There was a considerable variability in the postoperative results with both implants. Both the Kurz prostheses (group A) and the Gyrus prostheses (group B) demonstrated an average postoperative ABG of less than 25 dB (23.2 and 21.3 dB). There was no significant difference between the groups. Both groups also demonstrated an improvement in average ABG (preoperative minus postoperative ABG), 9.6 and 11.2 dB. There was no significant difference between the 2 prosthesis types in the frequency-specific ABG (500, 1000, 2000, and 4000 Hz). Both groups demonstrated maximal resonant frequency at 2000 Hz. The extrusion rates (5% and 8%) were comparable between the groups. Conclusion Factors other than the prosthesis design (eg, surgical technique, fibrosis, retraction, and cholesteatoma) primarily determine hearing results after staged ossiculoplasty. The differences we noted in frequency-specific hearing improvement do not demonstrate that the mass of the prostheses plays a significant role in outcome.