Air-bone Gap Research Articles

Outcomes of Endoscopic Stapedectomy: Systematic Review.

Introduction Stapes surgery was traditionally performed with the use of microscopy either through postauricular, endaural or transcanal approaches. Endoscopic stapedectomy ushered a revolution as a new technique with less complications. Objective To review the outcomes of endoscopic stapes surgery with an emphasis on intraoperative and postoperative clinical and audiological results. Data Synthesis A literature review on the PubMed, Web of Science, Scopus, the Cochrane Library, and Embase databases was conducted. Endoscopic stapes surgery or stapedotomy were the main keywords used, and we searched for studies and research published from January 2015 to October 2021. Articles on endoscopic stapes surgery were included, and qualitative and descriptive analyses of the studies and outcomes data regarding audiometric changes and postoperative complications were conducted. Articles including patients with cholesteatoma were excluded. A total of 122 studies were retrieved for qualitative and descriptive analyses and to measure the outcomes of endoscopic stapedotomy; only 12 studies met the inclusion criteria, and the rest was excluded. The meta-analysis revealed a statistically significant difference in hearing improvement. The gain in air-bone gap ranged from 9 dB to 16 dB. A low rate of operative and postoperative complications was reported. Conclusions Endoscopic stapes surgery appears to be a reasonable alternative to microscopic stapes surgery, with shorter operative times, low complication rate, and significant hearing improvement. The endoscopic technique enabled a better visualization and less scutum drilling, which was confirmed by all included studies.

The outcome of type I tympanoplasty in patients with chronic otitis media

Background. Tympanoplasty type 1 is a reconstruction of tympanic membrane perforation with an examination of the middle ear to ensure normality. Aim. Assess the effect of the age of the patient, site, and size of tympanic membrane perforation on hearing gain and graft uptake in patients with chronic otitis media. Patients and method. Thirty patients with type 1 tympanoplasty aged between 10 years and 50 years. Patients had been submitted for audiological tests and examination pre-operatively and at 1, 3 and 6-month intervals postoperatively. Results. Improvement was 57% in 10-25 years, 59% in 25-40 years, and 56% in 40-50 years. While graft uptake was 90% in the three groups. Hearing improvement in anterior perforation was (60%), ost. perforation (41.5%), inferior perforation (43%). While the take rate is 100% in the post, perforation, 80% in anterior perforation and 83.3% in inferior perforation, hearing gain was 40% in large perforation, 66% in medium size and 77% in small size. While the take rate in small perforation was 100%, in medium perforation 90% and large perforation 80%. About 70% of patients had closure of the air-bone gap to within 15 dB and 83 % to within 20 dB. Conclusion. Age had no impact on hearing gain and graft uptake. Size of perforation affects hearing gain and graft uptake where they are better in small and medium size perforation than large perforation. The site of perforation affects hearing gain and graft uptake where hearing gain was better in anterior perforation, while graft up was better in posterior perforation.

Endoscopic Transcanal Stapes Surgery: Our Audiological and Surgical Results

Endoscopic Transcanal Stapes Surgery: Our Audiological and Surgical Results
 Adem Bora, Tuğberk Salık
 Sivas Republic University Health Services Application and Research Hospital, Ear Nose Throat Clinic, Sivas, Turkey
 
 ABSTRACT
 Aim: The aim of this study is to investigate the intraoperative and postoperative results of endoscopic stapes surgery performed at our institution.
 
 Methods: A total of 25 patients with 28 ears (14 right, 14 left ears) who underwent endoscopic stapes surgery between 2018 and 2022 were analyzed for postoperative hearing outcomes and surgical complications at the 6-month follow-up.
 
 Results: The average age of the patients was 43.16 years (range, 24-63 years), and 64.0% of the patients were female. The median preoperative air-bone gap decreased from 30.36 dB hearing level (HL) to 18.95 dB HL after surgery (P < 0.001). The postoperative air-bone gap was 10 dB or lower in 8 patients (28.6%), 11-20 dB in 10 patients (35.7%), and more than 20 dB in 6 patients (21.4%). Intraoperative complications included only tympanic membrane ruptures in one patient, which resolved during the initial follow-up. Postoperatively, 10.7% of the subjects complained of changes in taste sensation. One patient developed facial paralysis responsive to steroid treatment one week after surgery.
 
 Conclusion: Endoscopic surgery is particularly suitable for stapedial disorders. Endoscopic stapes surgery is minimally invasive and suitable for surgical training, as surgical anatomy can be easily understood, and both the surgeon and assistant can observe the procedure from the same monitor. The operation should only be performed by experienced surgeons due to the need for single-handed operation and the lack of stereoscopic vision.
 
 Keywords: Stapes; Stapedectomy; Outcomes; Endoscopic ear surgery

Narrowing of Low-Frequency Air-Bone Gap and Its Association with Symptom Resolution Following Superior Canal Dehiscence Repair.

Low-frequency air-bone gap (LABG) on pure tone audiometry is an expected clinical finding of superior canal dehiscence (SCD) syndrome. We investigate how narrowing of LABG following SCD repairs translates to symptom resolution. Cohort study. Tertiary Care Center. We analyzed consecutive SCD repairs at an institution between 2012 and 2022. Pure tone audiometry and symptom questionnaires were administered pre- and post-operatively. The independent variable assessed whether the LABG narrowed (≥5 dB) following surgery. Outcome measures were rates of Overall Symptom Improvement (OSI, net resolution of ≥1 symptom) and Symptom Resolution Score (SRS, % symptoms resolved). We conducted multivariable regression analyses with LABG narrowing as the primary predictor. All models controlled for demographics, bilateral disease, prior ear surgery, and follow-up. Among total of 217 repairs analyzed, 161 (74%) reached OSI, and mean SRS was 39 (out of 100). LABG narrowing at 250 Hz (65%), 500 Hz (52%), and 1000 Hz (47%) was associated with a 41-point (β 95% confidence interval [CI]5-77) increase in auditory, 15-point (β 95% CI1-30) increase in auditory, and 23-point (β 95% CI2-45) increase in vestibular SRS, respectively. However, LABG narrowing was not significantly associated with the rates of auditory and vestibular OSI at all frequencies assessed. Lack of LABG narrowing following repair was associated with the persistence of a greater proportion of preoperative symptoms but similar likelihood of OSI. This relationship was more prominent for auditory symptoms at 250 to 500 Hz and for vestibular symptoms at 1000 Hz. Additional research is warranted to elucidate the mechanism through which symptoms resolve despite LABG persistence.

Endoscopic Versus Microscopic Type I Tympanoplasty: An Updated Systematic Review and Meta-analysis.

Our objective was to perform a systematic review and meta-analysis comparing the clinical outcomes after endoscopic and microscopic type I tympanoplasty. Randomized controlled trials, two-arm prospective studies, and retrospective studies were included. Medline, Cochrane, EMBASE, and Google Scholar databases were searched until March 1, 2022 using the combinations of search terms: "endoscopic," "microscopic," and "tympanoplasty." Two independent reviewers utilized the abovementioned search strategy to identify eligible studies. If any uncertainty existed regarding eligibility, a third reviewer was consulted. Primary outcome measures were graft success rate, air-bone gap (ABG) improvement, and operative time. Secondary outcomes were the rate of need for canalplasty, the proportion of self-rated excellent cosmetic results, and pain visual analog scale (VAS). Forty-three studies enrolled a total of 3712 patients who were undergoing type I tympanoplasty and were finally included. The pooled result showed endoscopic approach was significantly associated with shorter operative time (difference in means: -20.021, 95% confidence interval [CI]: -31.431 to -8.611), less need for canalplasty (odds ratio [OR]: 0.065, 95% CI: 0.026-0.164), more self-rated excellent cosmetic results (OR: 87.323, 95% CI: 26.750-285.063), and lower pain VAS (difference in means: -2.513, 95% CI: -4.737 to -0.228). No significant differences in graft success rate or ABG were observed between the two procedures. Endoscopic type I tympanoplasty provides a similar graft success rate, improvement in ABG, and reperforation rate to microscopic tympanoplasty with a shorter operative time, better self-rated cosmetic results, and less pain. Unless contraindicated, the endoscopic approach should be the procedure of choice in type I tympanoplasty.

Short-term safety and effectiveness of the mCLIP partial prosthesis

PurposeThis multicentric, retrospective study aimed to analyze the short-term safety and effectiveness of the mCLIP Partial Prosthesis.MethodsPatients underwent tympanoplasty with implantation of a mCLIP Partial Prosthesis. Follow-up examination included ear microscopy and pure-tone audiometry to determine the post-operative pure tone average of the frequencies 0.5, 1, 2 and 3 kHz (PTA4). The post-operative PTA4 air bone gap (ABG) was used to evaluate the audiological outcome. A post-operative minimum and maximum follow-up period was not defined. Thus, the follow-up times of each study center were different, which resulted in different follow-up times for the audiological analysis and for adverse events (AE).Results72 (66 adults, 6 children) patients were implanted with the mCLIP Partial Prosthesis. 68 (62 adults, 6 children) patients underwent audiological examination; all 72 patients were examined for adverse events. All patients (N = 68): 72.1% of the patients showed a PTA4 ABG of ≤ 20 dB. Individual post-operative bone conduction (BC) PTA4 thresholds were stable in 67 patients. The mean post-operative follow-up time was 78 ± 46 days. Children (N = 6): 5 out of 6 children showed a PTA4 ABG of ≤ 20 dB. None of the children reported a BC PTA4 deterioration of > 10 dB HL after the implantation. The mean post-operative follow-up time was 101 ± 45 days. Adverse events (all patients, N = 72): 15 (14 adults, 1 child) patients had AEs (27 AEs and 2 Follow-Ups). The mean post-operative follow-up time was 375 days.ConclusionClinical data show satisfactory audiological parameters after implantation of the mCLIP Partial Prosthesis. The prosthesis is safe and effective for implantation in children and adults.Trial registration numberNCT05565339, 09 September 2022, retrospectively registered.

A comparative study of endoscopic myringoplasty versus microscopic myringoplasty at tertiary care center

Background and objectivesMyringoplasty is a surgical procedure performed to repair tympanic membrane perforation which can be performed either using a microscope or an endoscope. The aim of this study is to compare the graft uptake, hearing outcome and operative time of endoscopic myringoplasty (EM) versus microscopic myringoplasty (MM) by underlay cartilage island graft technique. Subjects and methodsIn this prospective comparative study of sixty patients divided into two equal groups with small to medium sized tympanic membrane perforation were included. Tragal cartilage was used as graft material. Both the groups underwent myringoplasty by underlay cartilage island graft using endoscope (n = 30) and microscope (n = 30). The study was conducted between February 2022 to May 2023 after taking ethical approval from IRC of Nepalese Army Institute of Health Sciences. All patients were followed up on 7th postoperative day (POD), 1 and 3 months after surgery. ResultsGraft uptake in was 90 % (27/30) in MM group and 93.33 % (28/30) in EM group. Mean operating time was more in MM group (66.46 ± 6.78min) than EM group (64.53 ± 6.6 min). The improvement in Air Bone Gap (ABG) was better in EM group (12.46 ± 6.58 dB) compared to MM group (10.9 ± 9.01 dB). The differences in graft uptake, operating time and improvement in ABG were not statistically significant. ConclusionThe study concludes that it does not matter which approach is used, good results are predictable and choice of the tool used is up to the individual surgeon.

To detach or not to detach the umbo in type I tympanoplasty: functional results.

To compare the audiological outcomes, tympanic membrane (TM) healing rates and complication rates in patients undergoing endoscopic underlay and over-under tympanoplasty type I (TTI). The study includes 95 patients who underwent endoscopic TTI in the period between 2018 and 2023: 56% of the patients had the underlay technique and 41% had the over-under technique. Data regarding pre- and postoperative hearing, perforation characteristics, surgical procedures, graft types and complications were retrospectively analyzed. Audiometrical assessment included air conduction (AC) and bone conduction (BC) pure tone averages (PTA) and air-bone gap (ABG), pre- and postoperatively. Both underlay and over-under techniques significant improved AC PTA, with a mean ABG improvements of 5.9 dB and 7.2 dB, respectively. There was no significant difference in BC PTA between pre- and post-operative, indicating no inner ear damage in both techniques. The over-under technique showed a significantly higher TM closure rate (94.4%) compared to the underlay technique (80.6%). Complications were rare, with only one case of TM lateralization requiring revision surgery. Endoscopic TTI is an effective treatment in improving auditory function in chronic middle ear diseases. In our cohort, the detachment of the umbo does not negatively influence the postoperative hearing results and does not increase rate of complications. Moreover, the over-under technique demonstrates superior TM closure rates, making it a valuable option for specific cases. However, future prospective studies with larger sample sizes and longer term follow-up are needed to validate these findings and provide more comprehensive insights.

Inside-out raising mucosal-tympanomeatal flap approach for the repair of large marginal perforations

ObjectiveThis study evaluated the graft success rate and hearing outcomes of the inside-out raising mucosal-tympanomeatal flap technique for the repair of large marginal perforations.Study designProspective case series.Materials and methodsThe study enrolled patients with large marginal perforations who underwent endoscopic cartilage myringoplasty with the inside-out raising mucosal-tympanomeatal flap technique. The graft success rate, hearing outcomes, and complications were evaluated at 12 months postoperatively.ResultsIn total, 48 patients with large marginal perforations were included. 81% of the population had large perforation, 14.6 had subtotal and total perforation was seen in 4.2%. The mean operation time was 38.6 ± 7.1 min. At 12 months postoperatively, the graft success rate was 89.6% (43/48). The mean air-bone gap was 25.6 ± 5.2 dB preoperatively and 16.5 ± 4.1 dB at 12 months postoperatively, with significant differences between these values (p = 0.001). The functional success rate was 85.4% (41/48). None of the patients experienced worsened sensorineural hearing loss or graft-related complications, such as graft lateralization, significant blunting, and graft medialization, during follow-up.ConclusionsEndoscopic cartilage-perichondrium myringoplasty for the repair of large marginal perforations using the inside-out raising mucosal-tympanomeatal flap technique was associated with satisfactory graft outcomes and minimal complications.

Wideband Absorbance Predicts the Severity of Conductive Hearing Loss in Children With Otitis Media With Effusion.

The objectives of the present study were to investigate the relationship between wideband absorbance (WBA) and air-bone gap (ABG) in children with a conductive hearing loss (CHL) due to otitis media with effusion (OME) and determine the accuracy of WBA to predict the magnitude of ABGs. This was a prospective, cross-sectional study involving a control group of 170 healthy ears from 130 children (mean age 7.7 years) and a CHL cohort of 181 ears from 176 children (mean age 5.9 years) with OME. The CHL cohort was divided into three groups: CHL1, CHL2, and CHL3 defined by mean ABG (averaged across 0.5 to 4 kHz) of 16 to 25 dB, 26 to 35 dB, and 36 to 45 dB, respectively. WBA was measured at frequencies from 0.25 to 8 kHz at ambient pressure. WBA was significantly reduced between 0.25 and 5 kHz for all CHL groups. The difference in WBA at 1 to 4 kHz between the control and CHL groups increased with increasing ABG. The predictive accuracy, as indicated by area under the receiver operating characteristic curve (AUROC) of WBA, increased with increasing ABG. The AUROC for WBA at 1.5 kHz was 0.86 for the CHL1, 0.91 for the CHL2, and 0.93 for the CHL3 group. The AUROCs for WBA averaged across 0.5 to 4 kHz were 0.88, 0.93, and 0.94 for the CHL1, CHL2, and CHL3 groups, respectively. Linear regression analyses showed significant negative correlations between WBA 0.5-4 k and ABG 0.5-4 k . The regression model (ABG 0.5-4 k = 31.83 - 24.08 × WBA 0.5-4 k ) showed that WBA 0.5-4 k predicted ABG 0.5-4 k with high accuracy. Comparison of predicted and actual WBA on a different group of subjects revealed that at an individual level, the model predicted ABG between 16 and 35 with greater precision. There were significant strong correlations between WBA and ABG such that WBA decreased with increasing ABG. WBA demonstrated good discrimination accuracy with AUROC exceeding 0.88 for the 0.5 to 4 kHz and 1 to 4 kHz frequency bands. The WBA test holds promise for determining the severity of CHL in children with OME.

Exoscope-Assisted Stapedotomy: Evaluation of Safety and Efficacy.

Evaluate the safety and efficacy of exoscope-assisted stapedotomy. Retrospective chart review. Tertiary care neurotology clinic. Adult patients with otosclerosis undergoing stapedotomy. Primary stapedotomy. Evaluation of audiologic outcomes, including pure-tone average, bone-conduction thresholds, word recognition score, and air-bone gap. Complications, need for scutum removal, and length of surgery were also evaluated. A total of 47 patients were identified, and 24 patients underwent surgery with the microscope and 22 with the exoscope. There were significant improvements in pure-tone average, mean bone-conduction thresholds, and air-bone gap for both groups. There was no difference in preoperative or postoperative audiologic status for either group. There was no difference in rates of dysgeusia, chorda tympani nerve damage, dizziness, or facial paresis in either group. This study indicates similar audiologic outcomes, complication profiles, and visualization when comparing exoscopic and microscopic stapedotomy. Demonstrated here, exoscopic stapedotomy can be safely performed in a transcanal manner.

Endoscopic Findings on Facial Nerve Anatomy During Exclusive Endoscopic Stapedotomy: Clinical Considerations and Impact on Surgical Results.

Variations along the facial nerve (FN) course present considerable challenges in the surgical treatment of otosclerosis, often complicating the procedure. Existing knowledge of its tympanic tract and its implications primarily comes from microscopical procedures. This study aims to assess endoscopic findings of FN anatomy in a healthy tympanic cavity and its impact on the stapedotomy procedure, focusing on the risk of complications and functional hearing outcomes. A retrospective study on exclusive endoscopic stapedotoplasties between October 2014 and October 2021 at our Otorhinolaryngology University Department was carried out. An evaluation of intraoperative endoscopic findings reviewed in surgical descriptive and/or video records was conducted to assess their potential negative impact on the surgery. Demographic data, preoperative and postoperative hearing thresholds, as well as intraoperative and postoperative complications were analyzed. One hundred fifty-seven subjects were included. A FN partially overhanging the oval window was observed in 7.3% (n=12): 10 prolapsing with bony canal dehiscence and 2 without any detected dehiscence. Each procedure was successfully completed without any issues related to the anomalous anatomy, and in no case, switching to the microscope for the handling of the prosthesis near the dehiscent nerve was required. No facial paralysis occurred, with an early- or long-term postoperative House-Brackman grade of 1 (n=157, 100%). Only 3/157 patients (1.9%) showed a sensorineural threshold reduction of ≥20 dB HL, but a significant air-bone gap improvement was observed (mean closure of 18.36 dB HL, P -lt; .0001). The endoscope promotes a concrete description of tympanic FN anatomy, and endoscopic stapes surgery appears to be a safe and viable option when dehiscent or prolapsed FNs reduce the footplate's exposure.

Comparative study of anatomical and functional results of butterfly myringoplasty versus temporalis fascia underlay myringoplasty

Background: Myringoplasty is traditionally been done by using temporalis fascia graft material. But in recent years understanding of physiology and pathology of middle ear cleft is drastically improved with technical advancement in surgical methods. Various grafts have been tried for myringoplasty time to time with varying results. Methods: A case control study was conducted; where 52 patients underwent myringoplasty with butterfly graft and second group of 52 patients underwent myringoplasty with temporalis fascia graft under general anesthesia in major OT. All the patients were followed up for 3 months. The results of the procedure were assessed, with respect to closure of tympanic membrane perforations and improvement in the air bone gap post operatively. Results: Butterfly group had statistically significant number of healed patients and hearing improvement compared to temporalis fascia group at the end of one month and with no statistical significance at the end of three months. The age group less than 18 years showed better uptake with butterfly graft. The difference of mean pre-operative, 1 month and 3 months post-operative air bone gaps in butterfly graft were 35.57±2.87 dB, 27.86±2.53 dB, 24.65±2.66dB and in temporalis fascia were 35.97±2.6dB, 29.36±1.54dB, 25.12±1.73 dB respectively. Conclusions: Butterfly group had statistically significant hearing improvement in patients compared to temporalis fascia group at one month and with no statistical significance at three months post procedure. The age group less than 18 years showed better uptake with butterfly graft.

Surgical outcome of type I tympanoplasty in different types of mucosal chronic otitis media: a prospective study

Background: Chronic otitis media (COM) is a long-standing infection of middle ear cleft, causes severe destruction and leading to irreversible sequelae. The interval to convert discharging ear into dry is variable. Extensive counselling is required to keep these patients motivated for prolonged treatment duration. Hence, the study was conducted. Methods: A prospective study was carried out at NKP Salve and Lata Mangeshkar Hospital Nagpur, Maharashtra, between the age group of 16-60 years, who underwent type 1 tympanoplasty. Results were statistically analysed with respect to graft uptake, hearing improvement and size of perforation over a period of 2 years. Temporalis fascia was taken as a graft material. Results: Out of 70 cases, 38 cases had inactive ears and 32 cases had minimal, mucoid ear discharge (Active ear), which bacteriologically showed no organism. M:F ratio was 1.12:1. Graft uptake was successful in 92.11% of the cases in inactive group and 93.75% of the cases in active group. Graft uptake was 100% in small and moderate perforation. Hearing improvement was achieved in 71.05% of cases in the inactive group and 78.12% of cases in the active group, as measured by closure of the air-bone gap (ABG) and improvement in conductive hearing (significant >10 dB). We found no difference in the success rates. Conclusions: Presence of minimal discharge will not affect the surgical outcome of type 1 tympanoplasty in terms of graft uptake, hearing improvement and size of perforation.

Do Decreased Mastoid Pneumatization, Bilateral Involvement and Eustachian Tube Function Affect the Success of Type 1 Tympanoplasty?

The surgical success rate of tympanoplasty appears to be influenced by a number of variables. Eustachian tube dysfunction has been shown as one of the factors causing failure in tympanoplasty. It is known that bilateral disease and decreased in mastoid pneumatization are associated with Eustachian tube (ET) dysfunction. In this study, the relationship between the success of type 1 tympanoplasty and mastoid pneumatization, bilateral disease and ET function was investigated. A total of 44 patients who were operated for chronic otitis media in our clinic were included. The information of the patients was obtained retrospectively, the direction of the disease (bilateral/unilateral), the status of the graft (intact/perforated), mastoid pneumatization status, and hearing levels (preoperative/postoperative 6th month) were noted. Automatic Williams test was used to tympanometrically evaluate ET functions (ETF) in postoperative period. The relationship between tympanoplasty success and mastoid pneumatization, bilateral disease and ETF was investigated by statistical analysis. The disease aspect was found bilateral in 34.1% (n = 15) of the cases, and unilateral in 65.9% (n = 29) of the cases. Mastoid pneumatization was decreased in 52.2% (n = 23) of the cases, and normal in 45.4% (n = 20). The preoperative air-bone mean difference (gap) of the cases with decreased mastoid pneumatization was found to be statistically significantly higher than the cases with normal mastoid pneumatization (p < 0.05). The closure of the postoperative air-bone gap in patients with unilateral disease direction was found to be statistically significantly higher than in patients with bilateral disease direction (p < 0.05). Also we found significantly worse ET functions both in unilateral and bilateral disease. Preoperative air-bone gap average is higher in ears with decreased mastoid pneumatization, and postoperative air-bone gap closure is higher in unilateral patients. Mastoid ventilation does not make a significant difference in the success of type 1 tympanoplasty. On the other hand, our results support that ET dysfunction can be effective in the occurrence of chronic otitis media (COM).

Otosclerosis Surgery: Predictive Factors of Functional Results: 21 Cases

Introduction: Otosclerosis is an osteodystrophy of the otic capsula which is anatomically expressed by a stapedo-vestibular ankylosis. The objective of this work is to evaluate the audiometric result and to determine the predictive factors of functional failure. Materials and methods: we conducted a retrospective study about 21 ears operated for otosclerosis, within the department of otolaryngology and cervicofacial surgery CHU Mohammed VI Oujda over a period of 3 years (2016-2020). Epidemiological, clinical of patients and preoperative and postoperative audiometry at 12 months were analyzed. Surgical success was defined by a postoperative Rinne (RPO) ≤ 10db. Results: The mean age of the patients was 37,76 years. Female gender was predominant with a sex ratio of 2. The mean time to consultation was 4.2 years. The clinical picture was dominated by deafness which was constant in all patients. Tinnitus was present in 62% of cases. We retained 2 independent factors significantly predictive of functional failure: an age at surgery over 40 years and an audiometric stage III or IV of Aubry. Conclusion: Early post-operative air-bone gap is useful to detect early failure of stapes surgery. Although advanced otosclerosis was considered a negative factor for hearing gain, thanks to stapes surgery patients with advanced otoscle- rosis can better benefit from appropriate hearing aids.

Outcomes of regenerative treatment for over 200 patients with tympanic membrane perforation

ObjectiveTo evaluate outcomes of a regenerative treatment (RT) for over 200 patients with tympanic membrane perforation (TMP). The RT-TMP method involves a gelatin sponge, basic fibroblast growth factor (bFGF) and fibrin glue. MethodsThe study population included 216 patients and 234 ears (male: female =100:116; age 1–93 years). All enrolled patients were treated with RT-TMP in which TMP edges were disrupted mechanically and a gelatin sponge immersed in bFGF was inserted into the perforation. Fibrin glue was then dripped over the sponge. Patient outcomes including TMP closure rates, change in hearing level, and complications were obtained from retrospective medical chart reviews. The TMP was examined three or more weeks after surgery. The treatment was repeated up to 4 times until complete TMP closure was achieved. ResultsAfter mechanical disruption, the perforation size was Grade I, ≤1/3 of entire TM area in 22 ears (9.4 %), Grade II, 1/3–2/3 of entire TM in 77 ears (32.9 %) and Grade III, ≥2/3 of entire TM area in 135 ears (57.7 %). The overall TMP closure rates were 97.0 % (227/234). Complete TMP closure was achieved in 68.8 % (161/234), 22.6 % (53/234), 4.7 % (11/234) and 0.9 % (2/234) of ears after 1, 2, 3 and 4 treatments, respectively. In 7 of 234 ears (3.0 %), the TMPs were not closed completely after 4 treatments. There was no correlation between TMP size after mechanical disruption and number of treatments required to achieve complete closure (Fisher's exact test p = 0.70). The mean air-conduction hearing threshold at low frequency improved from 57.3 ± 16.7 dB before treatment to 37.3 ± 16.0 dB (p < 0.0001) after closure of TMPs. For middle and high frequencies, the improvement was 49.0 ± 19.3 dB to 36.9 ± 17.9 dB (p < 0.0001) and 57.7 ± 22.9 dB to 49.2 ± 23.3 dB (p < 0.0001), respectively. The mean air-bone gaps also improved significantly, and were within 10 dB at 250 Hz, 500 Hz and 1 kHz, and 11 dB at 2 kHz. One or more complications occurred in 32 patients (32/216; 14.8 %). The most common complication was formation of an epithelial pearl (16 ears; 6.8 %), followed by severe TM retraction (9 ears; 3.8 %) and otitis media with effusion (6 ears; 2.6 %). There were no serious complications that caused deterioration of the patient's general condition. ConclusionOur results showed that RT-TMP had high success rates for TMP closure and good hearing improvement and produced no severe complications that could affect general health status. This novel therapy is simple, safe and minimally invasive, and could help improve the quality of life in patients with TMP.

Antibiotics for otitis media with effusion (OME) in children.

Antibiotics for otitis media with effusion (OME) in children.

Impaired Vestibulo-Ocular Reflex on Video Head Impulse Test in Superior Canal Dehiscence: "Spontaneous Plugging" or Endolymphatic Flow Dissipation?

Surgical plugging of the superior semicircular canal (SSC) represents an effective procedure to treat disabling symptoms in superior canal dehiscence (SCD), despite resulting in an impaired vestibulo-ocular reflex (VOR) gain for the SSC. On the other hand, SSC hypofunction on video head impulse test (vHIT) represents a common finding in patients with SCD exhibiting sound/pressure-induced vertigo, a low-frequency air-bone gap (ABG), and enhanced vestibular-evoked myogenic potentials (VEMPs). "Spontaneous canal plugging" has been assumed as the underlying process. Nevertheless, missing/mitigated symptoms and/or near-normal instrumental findings would be expected. An endolymphatic flow dissipation has been recently proposed as an alternative pathomechanism for SSC VOR gain reduction in SCD. We aimed to shed light on this debate by comparing instrumental findings from 46 ears of 44 patients with SCD exhibiting SSC hypofunction with post-operative data from 10 ears of 10 patients with SCD who underwent surgical plugging. While no difference in SSC VOR gain values was found between the two groups (p = 0.199), operated ears developed a posterior canal hypofunction (p = 0.002). Moreover, both ABG values (p = 0.012) and cervical/ocular VEMP amplitudes (p < 0.001) were significantly higher and VEMP thresholds were significantly lower (p < 0.001) in ears with SCD compared to operated ears. According to our data, canal VOR gain reduction in SCD should be considered as an additional sign of a third window mechanism, likely due to an endolymphatic flow dissipation.

Extrusion and Dislocation in Titanium Middle Ear Prostheses: A Literature Review.

Titanium middle ear (ME) prostheses are widely used in surgical practice due to their acoustic properties. However, they present a significant drawback shared by all synthetic materials currently in use for ME reconstruction: they can be rejected by the organism of the host. In this study, we aim to review the current literature on titanium partial ossicular replacement prostheses (PORPs) and total ossicular replacement prostheses (TORPs) extrusion and dislocation. Eighty articles were analysed after a full article review based on the inclusion and exclusion criteria. The most common indication for reconstruction was chronic otitis media with cholesteatoma. The average extrusion or dislocation rate was 5.2%, ranging from 0 to 35%. The average improvements in the air-bone gap were 12.1 dB (1.6 dB to 25.1 dB) and 13.8 (-0.5 dB to 22.7 dB) for the PORP and TORP groups, respectively. The data reported on this topic are highly variable, demonstrating that functional outcomes are difficult to predict in clinical practice. We believe that the current limitations could be overcome with technological developments, including bioengineering research focused on promoting prosthesis adaptation to the ME environment.