Average Postoperative Air-bone Gap Research Articles

Primary Endoscopic Stapedotomy

Background: Otosclerosis is a progressive disease of the otic capsule which presents with conductive hearing loss with an intact tympanic membrane. The description of the disease was first given by Valsalva in 1704. Since then, several techniques are described for otosclerosis. All these procedures have traditionally been performed with microscope. New modifications of surgical techniques have been introduced time to time. The concept of minimally invasive surgical techniques has sprung up lately. Recent advances in optics such as high-definition endoscopes have revolutionized the surgeries in otology. Aim: The study aimed to study the feasibility of primary endoscopic stapedotomy. Objectives: (1) The objectives of the study were to evaluate Air-bone gap (ABG) closure in primary endoscopic stapedotomy and (2) to study intra- and post-operative complications in primary endoscopic stapedotomy. Methodology: Thirty patients with otosclerosis underwent stapedotomy using the standard 0.4 mm 18 cm endoscope and high-definition camera system. Results: Of the 30 cases, 17 were males and 13 were females, with a mean age of 39.84 years. A minimal removal of posterosuperior bony canal wall was required in 21 (70%) cases. The average operative time was 65 min. Among intraoperative complications, chorda tympani injury was seen in 2 (6%) cases, and incus subluxation and stapes footplate subluxation in 1 (3%) case each. Pure-tone audiograms done at an interval of 4 months demonstrated improvement across the three speech frequencies (500–2000 Hz) (50.2 dB vs. 23.7 dB). The average postoperative ABG was within 10 dB in twenty (66%) ears and between 10 and 25 dB in the rest ten (33%) ears. Conclusion: Endoscopic stapedotomy is a good alternative tool to conventional operating microscope. It offers better visualization, less trauma while elevating tympanomeatal flap flap, lesser bone curettage, and provides equivalent results.

Endoscopic versus microscopic ossiculoplasty: Does the functional outcome vary according to the type of osciculoplasty?

To compare functional outcome of microscopic and endoscopic approach regarding type of ossiculoplasty. In this retrospective study, cases who had undergone type-II and type-III tympanoplasty between February 2007 to September 2019 were divided into two groups according to the type of approach as microscopic and endoscopic. In cases with type-II reconstruction; Partial Ossicular chain Replacement Prosthesis (PORP), incus interposition and bone cement were used in order of frequency. Whereas in cases with type-III reconstruction, only Total Ossicular chain Replacement Prosthesis (TORP) was used. The average Air Bone Gap (ABG) was determined pre- and post-operatively for the calculation of Air Conductance Gain (ACG). The ACG, pre- and post-operative ABG values of each group were compared with regard to the type of ossiculoplasty. A total of 79 cases consisting of 32 females and 47 males who had undergone type-II and type-III tympanoplasty were enrolled. No statistically significant difference between microscopic and endoscopic approach was found in terms of ACG (p = 0.42), pre-(p = 0.23) and postoperative ABG (p = 0.99). We did not find any significant difference in terms of ACG, pre- and postoperative ABG between two approaches for type-II and type-III reconstructions (p > 0.05). According to the current study, endoscopic approach in type-II and type-III reconstruction is at least reliable as microscopic approach regarding functional outcome. Since both techniques have similar functional results, other factors (anatomic characteristics, habitude of the surgeon and duration of the surgery) should be considered when choosing the technique. In the current paper we present a retrospective comparative study of two different approaches of a particular type of otologic surgery. Level of evidence corresponds to level III.

Using the external auditory canal skin graft of the healthy side to treat unilateral congenital aural atresia: preliminary results of clinical research

Objective: To investigate whether the contralateral normal external auditory canal (EAC) skin graft can maintain the ear canal health after EAC reconstruction in unilateral congenital aural atresia (CAA) cases. Methods: A Zelen design randomized controlled study was used to collect unilateral CAA patients for EAC reconstruction prospectively (clinical trial registration number: ChiCTR2000032103). The patients were randomly divided into the control group and the trial group. The trial group used the contralateral normal EAC skin graft group (transplant part of the contralateral normal EAC skin to repair the atresia side for unilateral CAA patients), the control group all used scalp blade thick skin. We observed the EAC health and hearing results of the two groups after EAC reconstruction. Results: A total of 13 cases were enrolled from July 2020 to August 2021. There were eight patients in the trial group, including six males and two females, with an average age of 22.3 years (14-36 years). There were two patients with CAA on the left and six patients on the right. The average follow-up time was 8.8 months (4-14 months). There were five patients in the control group, all cases were male with an average age of 16.2 years (12-20 years). There were four patients with CAA on the left and one patient on the right. The average follow-up time was 7.0 months (2-14 months). In the trial group, eight cases of reconstructed EAC epithelium were healthy, one patient had cicatricial stenosis of EAC opening and lateralization of the tympanic membrane. The other patient had cicatricial stenosis of reconstructed EAC, this case also had scar hyperplasia of the contralateral EAC opening but recovered after soft packing and triamcinolone acetonide injection treatment. The healthy side EAC of the rest trial group had no scarring stenosis or local bone hyperplasia during long-term follow-up. In the control group, one patient was lost to follow-up and the other four patients had dry ears of reconstructed EAC, but easily to form crusts and needed to be cleaned repeatedly, one patient had lateralization of the tympanic membrane, the EAC epithelium was not healthy for long-term follow-up. The incidence of complications related to EAC reconstruction was lower than previous studies (χ²=5.55, P=0.018), and the average postoperative Air-Bone Gap increased (18.8±10.0)dB. Conclusion: By optimizing the EAC reconstruction technology, the health of the reconstructed EAC is improved compared with the previous study. After active intervention and treatment, there should be no scarring stenosis or local bone hyperplasia on the contralateral side EAC.

Is gelfoam sealing necessary in stapes surgery?

Background Sealing the oval window around the piston after fenestration with Gelfoam® is a common practice in stapes surgery for otosclerosis. Objectives To analyse the effect of using or not using Gelfoam® as a sealing material. Methods A retrospective study was performed on 418 patients who underwent stapes surgery from 2013 until 2019. Data were collected from medical records in a tertiary centre. 215 cases in the Gelfoam group and 203 cases in the control group without sealing were included. The main comparisons were made between these two groups in terms of vestibular (primary outcome) and audiological outcomes and complications. Results The patients’ mean age was 47 years with a mean follow up of 50 months and a female predominance (65.6%, p = .049). There was no significant difference in terms of postoperative vertigo (11.6% vs 8.4%) or audiological outcomes in between Gelfoam and control group respectively. The average postoperative air-bone gap in the Gelfoam group was 4.6 dB vs. 5.3 dB in the control group (p = .634). Conclusion and significance No difference were identified in vestibular or audiological outcomes during stapes surgery when using or not using Gelfoam® in the middle ear.

Outcomes of ossicular disruption in traumatic facial paralysis: a case series

Background As tympanotomy using the transcanal approach was a routine surgical technique for traumatic ossicular disruption, the efficacy of the posterior tympanum approach was rarely explored. Aim This study aimed to investigate whether the hearing outcomes improved after simultaneous ossiculoplasty and facial nerve decompression using the posterior tympanum approach compared with the transcanal approach. Material and methods The data of 11 patients who underwent ossiculoplasty and facial nerve decompression using the posterior tympanum approach and 21 patients who underwent ossiculoplasty via transcannal approach were analyzed. Results The average air–bone gap (ABG) of patients undergoing posterior tympanotomy showed a statistically significant improvement. Postoperative ABG within 20 dB was observed in 81.8% of patients in the posterior tympanum group and 76.2% of patients in the transcanal group. However, the ABG closure in the two groups was not statistically different. Conclusions and significance Simultaneous ossiculoplasty using the posterior tympanum approach was practical, and the hearing outcomes were promising for the patients with traumatic facial nerve paralysis and ossicular disruption.

Analysis of surgical effect on middle ear cholesterol granuloma

Objective:To evaluate surgical effects on middle ear cholesterol granuloma（CG）. Method:The patients receiving surgery due to middle ear CG were retrospectively analyzed. The choice of operative methods was made according to medical history, endotoscope, pure-tone audiometry and temporal bone CT. Tympanostomy tube（TT） insertion was performed on 12 patients; canal wall up（CWU） tympanoplasty combined with tympanostomy tube was performed on 40 patients, and canal wall down（CWD） tympanoplasty combined with TT on 14 cases. The pre-and postoperative audiometric results（500, 1000, 2000 and 4000 Hz） were evaluated for each patient. Then the average air-bone gap（ABG） was analyzed. Result:One patient had postoperative tube obstruction. One patient who performed only TT insertion recurred. Secretory otitis media occurred in one case undergoing CWU tympanoplasty after removal of the ventilation tube. For TT insertion group, pre-and postoperative ABG levels were （21.25±5.96） dB and （8.85±6.49） dB, respectively（P<0.01）. For CWU+TT group, pre-and postoperative ABG levels were （34.19±10.43） dB and （23.55±12.48） dB, respectively（P<0.01）. For CWD+TT group, pre-and postoperative ABG levels were （36.43±12.11） dB and （25.71±13.50） dB, respectively（P<0.01）. Conclusion:The aim of surgical treatment for middle ear CG includes thorough removal of lesions, improvement of ventilation and drainage of middle ear. Individualized surgical strategy should be adopted according to the patients' conditions. And long-term follow-up should be done after operation.

Effect of tympanoplasty on wet ear with different mucosal status of tympanic cavity

Objective:A retrospective analysis of audiologic outcome and graft take rate on post-tympanoplasty with different middle ear mucosal conditions in wet ear. Method:According to the characteristics of middle ear mucosal condition and residual eardrum, 80 cases with wet ear of chronic suppurative otitis media were divided into the hydrocele group, the swelling group and the granulation group. The factors in different groups, including gender, age, disease course, sides, size and location of perforations, destruction of ossicular chain and reconstruction methods were analyzed. Moreover, postoperative hearing improvement and graft take rate were compared among the three groups. Result:There was no significant difference in gender, age, disease course, sides, size and location of perforations among the hydrocele group, the swelling group and the granulation group （P>0.05）. Overall, the postoperative average Air-Bone Gaps（ABG） were reduced in all wet ear patients after surgery （P<0.01）. The ABG was decreased from （25.5 ± 10.8） dB to（15.4 ± 9.4） dB in the hydrocele group, and decreased from （27.6 ± 8.7） dB to （15.2 ± 9.6） dB in the swelling group, and from （29.5 ± 7.7） dB to （17.2 ± 17.2） dB in the granulation group. The graft take rates were 90.0% in totally. There were no significant difference in graft take rates among the three groups, and 84.6% in the hydrocele group, 93.3% in the swelling group and 100.0% in the swelling group（P>0.05）. Conclusion:Wet ear is not an absolute contraindication of tympanoplasty for chronic suppurative otitis media. Whether there was effusion, swelling or granulomatous hyperplasia in the tympanoplasty, the patients'hearing improved significantly after tympanoplasty, and the healing rate of the tympanoplasty did not decrease. Further basic and clinical studies are needed to standardize the timing of wet ear surgery, clarify the operative contraindication and elucidate the pathophysiological mechanism of eardrum healing.

Anatomical and frequencies-specific hearing results of retrograde mastoidectomy.

The aim of this study was to evaluate the long-term anatomical and frequency-specific hearing results of canal wall down (CWD) and canal wall up (CWU) mastoidectomy by retrograde mastoidectomy (RM) surgical method. Patients underwent CWU and CWD procedures with method of RM, 53 and 59 patients between January 2010 and June 2015 were evaluated retrospectively. The pre- and post-operative pure tone average air-bone gap (ABG) values of these patients were recorded in detail at 0.5, 1, 2 and 4 kHz. Pre and post-operative ABG were evaluated in detail in each group in each frequency. In addition, at least two years follow-up recurrence rates were evaluated. In the CWU method, post-operative ABG decreased significantly at low-frequencies compared to pre-operative ABG (p < 0.05), especially at 2 kHz (p < 0.001). But, auditory improvement was not achieved at 4 kHz. In the CWD procedure, auditory improvement was not achieved both 1 kHz and 4 kHz. CWU and CWD recurrence rates were respectively 9.4% and 10.1%. Postoperative hearing results of both surgical methods provide good auditory outcome at low-frequencies. This improvement is evident in CWU especially at 2 kHz. This may be related to the protection of the external ear canal. In both surgical methods of RM, a satisfactory anatomical success was achieved with recurrence rates of around 10%. RM is a good surgical technique alternative to classical canal wall down procedure with both auditory results and low recurrence rates.

The benefit of trans-attic endoscopic control of ossicular prosthesis after cholesteatoma surgery.

To show the efficiency of using transmastoid atticotomy (TMA) endoscopy on the outcome of ossiculoplasty in patients with cholesteatoma. TMA is often performed as part of the surgical management of patients with middle ear cholesteatoma extending to the epitympanum. TMA can also be used as an access for endoscopic view to confirm the right alignment and stability of the ossicular prosthesis because the reconstruction of the tympanic membrane will obscure the visualization of the prosthesis. A retrospective study was done at a tertiary referral institute, including 133 ears with cholesteatoma that underwent canal wall-up tympanomastoidectomy (CWU) with ossicular reconstruction using titanium prosthesis between August 2013 and August 2015. Post packing of the ear canal and position, stability, and axis of the prosthesis were checked using endoscope positioned in the attic through TMA. A postoperative pure-tone average air-bone gap (ABG) of 20 dB or less was considered as a successful hearing result. Results are compared with historical control groups. Of the 133 ears, 88 patients underwent reconstruction with partial ossicular replacement prosthesis (PORP), whereas the rest (45 patients) had total ossicular replacement prosthesis (TORP). A postoperative ABG ≤ 20 dB was obtained in 77.4% of all the patients (79.5% for PORP; 73.3% for TORP). Endoscopic assessment of the ossicular prosthesis via the attic, after repositioning of the tympanomeatal flap and packing the ear canal, decreases the risk of immediate ossiculoplasty failure and improves the functional outcome after ossicular chain reconstruction in cholesteatoma surgery. 4 Laryngoscope, 129:2754-2759, 2019.

Comparison of surgical and audiological outcomes of endoscopic and microscopic approach in stapes surgery.

Objective:The main objectives of the present study were to compare the surgical and audiological outcomes of endoscopic and microscopic approach in stapes surgery.Methods:Sixty-one patients who underwent the stapes surgery with the endoscopic and microscopic approach between January 2012-November 2018 were included in the study. Patients were divided into two groups as a Group-I (endoscopic) and Group-II (microscopic). The audiometric measurements, duration of surgery, intraoperative findings and complications were recorded and evaluated retrospectively.Results:Mean operative time for the Group-I and II was 45.1±8.4 minutes and 48.7±5.6 minutes, respectively (p>0.05). The preoperative and postoperative average air-bone gap in the Group-I was 27.8±7.2 dB and 8.7±3.4 dB and these values in Group-II were 30.2±5.1 dB and 7.4±4.8 dB, respectively (p<0.001). The requirement of chorda tympani nerve manipulation and scutum curettage were significantly less in Group-I as compared Group-II (p<0.05). Dysgeusia and postoperative pain were observed significantly higher ratios in Group-II relative to Group-I (p<0.05). There was no significant difference between endoscopic and microscopic approach in stapes surgery in terms of difficulty of prosthesis insertion (p>0.05).Conclusion:Endoscopic stapes surgery provides comparable audiological outcomes, shorter operative times, fewer complications rates, and more minimally invasive surgery, relative to the microscopic approach.

Erosion of the long process of the incus with incomplete ossicular discontinuity in simple chronic otitis media: Should we reconstruct or leave it be?

To determine whether patients with simple chronic otitis media and incomplete ossicular discontinuity should undergo ossicular reconstruction. Prospective, randomised surgical trial comparing no intervention with incus interposition over a 5-year period. Tertiary referral hospital. Seventy-six participants with simple chronic otitis media and erosion of the long process of the incus but apparent good transmission throughout the ossicular chain as tested intra-operatively. Forty-four patients had partial erosion of the incus but still bony contact with the stapes head (Group A-Type I), and 32 had mainly connective tissue binding the incus and stapes (Group B-Type II). Each of these groups was randomised to either leaving the ossicular chain as it was (A1 and B1) or performing an incus interposition (A2 and B2). Average postoperative air-bone gap and the degree of ABG closure. A postoperative air-bone gap under 20 dB was considered a successful result. In group A, there was no significant difference between no intervention and incus interposition. In group B, patients in the no reconstruction subgroup had a significantly worse hearing result than the incus interposition subgroup (postoperative air-bone gap of 27.5 dB and 31% closure within 20 dB vs 15 dB and 75% closure). For Type I patients, the postoperative hearing results were similar for the reconstruction and no reconstruction groups. For Type II patients, the results clearly favour reconstruction.

A retrospective study of 54 cases with chronic otitis media prepared for staging tympanoplasty

Objective:To analyze the clinical effect of 54 cases with chronic otitis media prepared for staging tympanoplasty and 19 cases finished staging ossicular reconstruction surgery, evaluate the advantages of different surgery technique.Method:Fifty-four cases with chronic otitis media were planned for staging tympanoplasty surgery and had been received the first stage surgery. Silicagel plates were placed in the tympanic cavity in order to prevent adhesions. Among them, 19 cases had received the second stage ossicular reconstruction, including 10 cases with TORPs and 9 cases with PORPs. The average air bone gaps (ABG) were measured at four frequencies: 500, 1 000, 2 000 and 4 000 Hz.Result:Among the 54 cases, 45 cases had swollen mucosa in the tympanic cavity and eustachian tube, 18 cases had tympanic fibrous adhesions, and 12 cases had fixed or sclerotic stapes. The preoperative ABG of the 54 cases were (38.26±7.88)dB. As for the 19 cases finished the second stage surgery, their preoperative ABG in the first stage were (39.21±7.05)dB, the preoperative ABG in the second stage were (38.82±11.43)dB, and the postoperative ABG after the second stage were (21.77±11.92)dB. The hearing function after staging tympanoplasty was significantly improved compared with the preoperative hearing in the first and the second stage operation (P< 0.01). In addition, the second stage surgery of three cases was postponed because of a good postoperative hearing with (10.42±10.63)dB ABG after the first stage surgery. Up to now, none of the 54 cases suffered from facial palsy, infection and other complications after surgery.Conclusion:Staging tympanoplasty is an important technique to improving hearing and reducing the complications, especially for the cases with chronic otitis media unsuitable for one stage reconstruction of ossicular chain.

Ossiculoplasty: study of hearing results in 50 patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Ossiculoplasty improves conductive hearing loss. Various reconstruction methods and techniques are developed with use of different graft materials over period of time. Results of ossiculoplasty can be predetermined with consideration of prognostic factors&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present study is retrospective study of 50 patients who underwent ossiculoplasty in the medical college hospital over the period of 3 years i.e. from January 2013 to December 2016. The pre-operative and post-operative audiometric findings were documented and analyzed to study the hearing improvement with the use of auto graft malleus and incus for ossiculoplasty. The results of ossiculoplasty were also compared with other studies done for ossiculoplasty. Predictors of ossiculoplasty results such as ossicular status and middle ear mucosa were also studied&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The average post-operative air bone gap was 12.92 dB. The mean post-operative ABG was within 20 dB in both primary and revision cases. Average air-bone closure in patients with normal mucosa was 32.1 dB and that of adhesive mucosa was 18 dB. Significant improvement in post-operative air-bone closure (p &amp;lt;0.01) was observed in patients with auto graft incus than malleus head as ossiculoplast&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; 84% ossiculopasty patients were having post-operative air bone gap within 20 dB. The ossiculoplasty using auto graft ossicle is physiological, biocompatible, stable and has low complication rate&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Review of a single surgeon’s stapedotomy cases performed with a nickel titanium prosthesis over a 14-year period

Conclusion: Stapes surgery with a nickel titanium prosthesis is a safe and well-tolerated procedure that leads to a significant improvement in hearing outcomes.Objective: To identify the efficacy and safety of stapedotomy procedures performed with a nickel titanium prosthesis for patients with otosclerosis.Methods: A review of 431 unique stapedotomies performed over 14 years by a single surgeon at an academic tertiary care center yielded 312 cases with nickel titanium prosthesis that met inclusion criteria of otosclerosis diagnosis, initial surgery in operative ear, and presence of pre-operative and post-operative audiograms. Pure-tone averages (PTA) at baseline and 8 weeks after surgery were calculated over four frequencies; 0.5, 1, 2, and 4 kHz. Average air–bone gaps (ABG) were calculated from pre-operative and post-operative audiograms.Results: Average pre-operative baseline PTA was 56.7 dB in the affected ear. Post-operative PTA was 30.1 dB, a 26.6 dB improvement. Initial average ABG was 29.7 dB, while post-operative ABG averaged 5.4 dB, a 24.2 dB improvement. Surgical success (closure of ABG within 10 dB) was achieved in 263 (84%) patients. Rate of surgical success was not correlated with age, gender, race, or affected ear. Complications included recurrent conductive hearing loss (14), progressive SNHL (4), and post-operative BPPV (3).

The effects of surgery type and different ossiculoplasty materials on the hearing results in cholesteatoma surgery.

To investigate the effects of surgery type [intact canal wall (ICW) or canal wall down (CWD) mastoidectomy] and different ossiculoplasty materials on hearing outcome in single-staged cholesteatoma surgery. A retrospective case-control study. A total of 116 cases (97 adults, 29 children) underwent surgery, including ossiculoplasty, between 2012 and 2015 for cholesteatoma. Patients who had undergone surgery for the first time, and whose grafts were successful, were included in the study. Patients with adhesive otitis media, unsuccessful grafts, revision and recurrent cases, radical mastoidectomy, and craniofacial anomalies were excluded. Audiogram examinations of the enrolled patients were performed 3-6months after surgery, and the audiometric results were analyzed according to the criteria of the American Academy of Otolaryngology, Head and Neck Surgery. All ossiculoplasties were performed during the first operation. The preoperative average air-bone gap (ABG) of the patients was decreased from 31.37±10.1 to 27.42±10.4dB; this decrease was found to be highly significant (p=0.0001). Concerning the ICW technique, statistical evaluation of the hearing gain at frequencies of 500, 1000, and 2000Hz, as well as the mean frequency, showed a high level of significance. Improvement at 4000Hz was not found to be statistically significant. When the ABGs at 500, 1000, 2000, and 4000Hz, and the mean frequency in patients with an hydroxyapatite-partial ossicular replacement prosthesis (HA-PORP) or autograft-partial ossicular replacement prosthesis (APORP), were evaluated, it was found that, at 4000Hz, the APORP significantly reduced the ABG (p=0.02). No significant difference was determined between patients with the hydroxyapatite-total ossicular replacement prosthesis (HA-TORP) and those with the autograft-total ossicular replacement prosthesis (ATORP) (p=0.565). Although the use of the malleus as an APORP was found to be less effective than other autografts, the degree of advantage of using the incus, malleus, cortical bone, and cartilage did not significantly differ between materials (p=0.152). Despite the effects of the incus, malleus, and cortical bone not differing in terms of the postoperative ABG (p=0.160), incus usage was highly beneficial for hearing gain (p=0.009). Despite CWD tympanoplasty affecting all frequencies, it has a particularly negative effect on the hearing threshold at 1000Hz. In patients with partial ossicular replacement, autogenous grafts are more successful in restoring hearing at high frequencies, particularly at 4000Hz. Although autogenous materials do not differ in terms of partial replacement effectiveness, the incus has been shown to be most effective for total replacement.

A new graft material for myringoplasty: bacterial cellulose.

We aimed to determine the success rate of bacterial cellulose (BC) myringoplasty in tympanic membrane (TM) perforation. We reviewed the clinical records of 12 patients (16 ears) who underwent BC myringoplasty for long-standing TM perforations (>6months) between March 2012 and January 2015. The mean duration of postoperative follow-up was 12.8 (range 6-24) months. In all patients, the perforation involved less than 50% of the tympanic membrane, and the air-bone gap was ≤30dB on the operative side. The age, gender, preoperative air average, bone average, air-bone gap, perforation size and location, and postoperative TM microscopic examinations of the patients were recorded. Following the BC myringoplasty, complete coverage of the perforation occurred in the first 6months in 13 of 16 ears (81.3%), although retraction occurred in two of these ears within 6months. In three ears (18.8%), the perforation persisted during the first postoperative month. The pre- and postoperative average air threshold was 19.56 (range 7-75) and 15.69 (range 5-75) dB, respectively. The pre- and postoperative average air-bone gap was 9.25 (range 0-25) and 5.63 (0-25) dB, respectively. Both the air threshold and air-bone gap improved postoperatively (both p=0.008). No complications such as infection and granulation tissue formation were detected in any patient. BC is a safe graft material that is inexpensive, easy-to-use, and provides a high success rate in small tympanic membrane perforations. However, further studies of large tympanic membrane perforations with more samples and long-term follow-up are required.

Audiological Outcome of Classical Adenoidectomy versus Endoscopically-Assisted Adenoidectomy using a Microdebrider.

The aim of this study was to evaluate audiological outcomes following adenoidectomy by the classical method and by endoscopically-assisted adenoidectomy using a powered instrument (microdebrider). This study was conducted in a tertiary care center. It included 40 patients divided into two equal groups of 20 each. Group-A patients underwent classical adenoidectomy, while Group-B patients were subjected to endoscopically-assisted adenoidectomy using a microdebrider. Hearing outcome was measured by post-operative pure-tone audiometry and tympanometry. The post-operative average air-bone gap (ABG) was reduced from 19.6 dB to 11.8 dB in Group A and from 17.6 dB to 8.7 dB in Group B (P=0.010). There was reversal of tympanometric curves from type-B and type-C to type-A in 55% of the patients in Group A, while type-A curve was seen in 90% cases in Group B in the post-operative period. Audiological outcomes of endoscopically-assisted adenoidectomy using a microdebrider were superior compared with classical adenoidectomy.

Does Malleolus non-Lifting Tympanoplasty have any Advantage Over Malleus Lifting Techniques?

In order to achieve a higher success rate for tympanoplasty, different techniques have been developed, and a wide variety of grafting materials have been developed. One of the techniques currently receiving considerable attention involves not lifting the remaining of eardrum from the malleus and embedding the graft underneath in order to repair the eardrum correctly in its original position, as well as minimizing graft lateralization leading to progression of hearing rehabilitation. We compared the effects of tympanoplasty with and without malleus lifting on hearing loss in patients with chronic otitis media. In this study, 30 consecutive patients diagnosed as having chronic otitis media without cholesteatoma were randomly assigned to two tympanoplasty groups; with or without malleus lifting. Air and bone conduction thresholds were recorded before and 45 days after the intervention. In groups, except for 8000 Hz, the air conduction was significantly improved following surgery. According to air conduction there was no difference between the groups before surgery at different frequencies, although it was improved to a greater degree in the group without lifting at 250 Hz postoperatively. The average post-operative air-bone gap (ABG) gain was significantly higher in all study frequencies in the target group. One of the effects of this technique is inner-ear protection from physical trauma to the ossicular chain, and prevention of damage to bone conduction. A higher hearing threshold and also higher ABG gain can be achieved by not lifting the remaining eardrum from the malleus and embedding the graft undereath it, especially at lower frequencies.

Cartilage ossiculoplasty in cholesteatoma surgery: hearing results and prognostic factors.

SUMMARYCartilage tympanoplasty is an established procedure for tympanic membrane and attic reconstruction. Cartilage has been used as an ossiculoplasty material for many years. The aim of this study was to evaluate hearing results of costal cartilage prostheses in ossicular chain reconstruction procedures in subjects operated on for middle ear cholesteatoma and to determine the presence of prognostic factors. Candidates for this study were patients affected by middle ear cholesteatoma whose ossicular chain was reconstructed with a chondroprosthesis. 67 cases of ossiculoplasty with total (TORP) or partial (PORP) chondroprosthesis were performed between January 2011 and December 2013. Follow-up examination included micro-otoscopy and pure tone audiometry. The guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology Head and Neck Surgery were followed and pure-tone average (PTA) was calculated as the mean of 0.5, 1, 2 and 4 kHz thresholds. Statistical analysis was performed with ANOVA tests and regression models. Average air-bone gap (ABG) significantly improved from 39.2 dB HL (SD 9.1 dB HL) to 25.4 dB HL (SD 11 dB HL) (p < 0.001). Linear regression analysis showed that the only prognostic factor was the type of operation (p = 0.02). In fact, patients submitted to ICWT presented better post-operative ABG compared to CWDT. None of the other variables influenced the results. The present study proposes costal cartilage as material of choice when autologous ossicles are not available. The maintenance of the posterior canal wall was the only prognostic factor identified.

Ossiculoplasty with hydroxyapatite bone cement: our reconstruction philosophy

The main objective of this study is to analyze results obtained with hydroxyapatite bone cement (HABC) ossiculoplasties. This is a retrospective study of a case series. This study was conducted in an academic hospital and tertiary referral center. A total of 127 ossiculoplasties using HABC were evaluated. Ears were divided into three groups according to procedure: group 1 involved reinforcement of the incudostapedial joint with cement and reconstruction of an incus long process defect with cement. Group 2 involved partial ossicular reconstruction between the stapes and malleus handle with HABC. Group 3 was divided into two subgroups. Group 3B entailed reconstruction of the stapes with a mobile footplate (Austin-Kartush type B = group 3B) and group 3F with a fixed footplate (Austin-Kartush type F = group 3F) using a K-Helix piston (Grace Medical, Memphis, TN, USA) or a classical titanium piston (Kurz, Fuerth, Germany) glued to the incus remnant or malleus handle with cement. Anatomical and pre- and postoperative audiological results were assessed. The mean follow-up was 26 ± 14 months. Percentages of average postoperative air-bone gap ≤ 20 dB were 95, 82.5, 50 and 83.3%, and for air-bone gap ≤ 1 0 dB, 80, 50.9, 16.6 and 50% for groups 1, 2, 3B and 3F, respectively. No complications related to the cement or extrusion occurred. Hearing outcomes also remained stable over time. In our experience, ossiculoplasty with cement provides good and stable functional results, is safe, cost effective, and easy to use. HABC with or without biocompatible ossicular prostheses allows repair of different types of ossicular defects with preservation of the anatomical and physiological ossicular chain, as well as improved stability. Reconstruction of the incus long process or incudostapedial joint defect with cement is preferred over partial ossicular reconstruction.