Bone Conduction Hearing Thresholds Research Articles

Evaluation of inner ear damage by mastoid drilling with measurement of serum prestin (SLC26A5) levels

ObjectiveThe objective of this study is to demonstrate any inner ear injury caused by drilling in mastoid surgery with prestin, outer hair cell motor protein specific to the cochlea. MethodsThe patients with chronic otitis media requiring mastoidectomy (n = 21) and myringoplasty (n = 21) were included. Serum prestin level obtained from blood samples was measured before surgery and on postoperative days 0, 3, and 7 using Human Prestin (SLC26A5) ELISA Kit. All patients underwent the Pure Tone Audiometry (PTA) test before surgery and on the postoperative 7th day. The drilling time was also recorded for all patients who underwent mastoidectomy. ResultsIn both mastoidectomy and myringoplasty groups, the postoperative serum prestin levels increased on days 0 and 7 (pday-0 = 0.002, pday-7 = 0.001 and pday-0 = 0.005, pday-7 = 0.001, respectively). There was no significant difference in the serum prestin levels between the two groups, postoperatively. The PTA thresholds at day 7 did not change in either group. A significant decline at 2000 Hz of bone conduction hearing threshold in both groups and a decline at 4000 Hz in the myringoplasty group were found. There was no correlation between the drilling time and the increase of prestin levels in the postoperative day 0, 3, and 7. ConclusionOur results showed that mastoid drilling is not related to a significant inner ear injury. Although the myringoplasty group was not exposed to drill trauma, there was a similar increase in serum prestin levels as the mastoidectomy group. Also, a significant decline at 2000 Hz of bone conduction hearing threshold in both groups and a decline at 4000 Hz in the myringoplasty group were found. These findings suggest that suction and ossicular manipulation trauma can lead to an increase in serum prestin levels and postoperative temporary or permanent SNHL at 2000 and 4000 Hz. Level of evidenceLevel-4.

Effects of noise on the hearing of intensive care unit nurses

This study aims to investigate the hearing problems experienced by nurses working in the intensive care units (ICUs) and gastroenterology departments of a hospital in China. A total of 93 participants who are currently employed in these settings were recruited for the study. The research methodology involved several components. Firstly, the pure tone audiometry (PTA) hearing threshold measurements were conducted in a closed audiometry room. The air conduction hearing and bone conduction hearing thresholds were recorded using calibrated equipment. Secondly, the participants underwent the Digits In Noise (DIN) test to assess their speech reception threshold in a noisy environment. They were instructed to wear headphones and adjust the volume to be a comfortable level while Chinese digit triplets were presented with a background masking noise. Thirdly, a questionnaire with previously validated and subjective components was also administered after the PTA and DIN tests. The survey aimed to assess self-reported auditory dysesthesia, including symptoms such as tinnitus, aural fullness, and otalgia. It was observed that ICU nurses exhibited more hearing loss at high frequencies above 4 kHz compared to non-ICU nurses. Additionally, nurses who worked more hours per week demonstrated worse hearing thresholds. Furthermore, ICU nurses reported more severe self-reported hearing problems compared with non-ICU nurses.

Prediction of postoperative speech comprehension with the transcutaneous partially implantable bone conduction hearing system Osia®.

The active transcutaneous, partially implantable osseointegrated bone conduction system Cochlear™ Osia® (Cochlear, Sydney, Australia) has been approved for use in German-speaking countries since April 2021. The Osia is indicated for patients either having conductive (CHL) or mixed hearing loss (MHL) with an average bone conduction (BC) hearing loss of 55 dB HL or less, or having single-sided deafness (SSD). The aim of this retrospective study was to investigate the prediction of postoperative speech recognition with Osia® and to evaluate the speech recognition of patients with MHL and in particular an aided dynamic range of less than 30 dB with Osia®. Between 2017 and 2022, 29adult patients were fitted with the Osia®, 10patients (11ears) with CHL and 19patients (25ears) with MHL. MHL was subdivided into two groups: MHL‑I with four-frequency pure-tone average in BC (BC-4PTA) ≥ 20 dB HL and < 40 dB HL (n = 15patients; 20ears) vs. MHL-II with BC-4PTA ≥ 40 dB HL (n = 4patients; 5ears). All patients tested abone conduction hearing device on asoftband preoperatively. Speech intelligibility in quiet was assessed preoperatively using the Freiburg monosyllabic test in unaided condition, with the trial BCHD preoperatively and with Osia® postoperatively with Osia®. The maximum word recognition score (mWRS) unaided and the word recognition score (WRS) with the test system at 65 dB SPL were correlated with the postoperative WRS with Osia® at 65 dB SPL. Preoperative prediction of postoperative outcome with Osia® was better using the mWRS than by the WRS at 65 dB SPL with the test device on the softband. Postoperative WRS was most predictive for patients with CHL and less predictable for patients with mixed hearing loss with BC-4PTA ≥ 40 dB HL. For the test device on a softband, the achievable outcome tended to a minimum, with the mWRS tending to predict the realistically achievable outcome. Osia® can be used for the treatment of CHL and MHL within the indication limits. The average preoperative bone conduction hearing threshold also provides an approximate estimate of the postoperative WRS with Osia®, for which the most accurate prediction is obtained using the preoperative mWRS. Prediction accuracy decreases from aBC-4PTA of ≥ 40 dB HL.

Clinical application of retrosigmoid approach for BONEBRIDGE implantation after auricle reconstruction using expanded postauricular flap

Objective: To explore the safety and reliability of retrosigmoid approach BONEBRIDGE implantation in patients with auricle reconstruction using skin expansion flap. Methods: A retrospective analysis was conducted on 43 congenital aural atresia cases (43 ears) who underwent BONEBRIDGE implantation from September 2019 to January 2023 in Beijing Tongren Hospital. 30 males and 13 females were included in this work. The implantation age was 9-36 years old (median age=10 y/o). All cases underwent auricle reconstruction surgery using the posterior ear flap expansion method, with 36 cases using the single expanded postauricular flap method and 7 cases using two-flap method. BONEBRIDGE implant surgery was performed during the third stage of auricle reconstruction or after all stages. The hearing improvements were evaluated by comparing the changes in pure tone hearing threshold and speech recognition rate of patients before and after BONEBRIDGE implantation. Routine follow-up was conducted to observe the hearing results and complications. SPSS 14.0 software was applied for data statistical analysis. Results: All 43 patients healed well and had no surgical complications when discharge. The average bone conduction hearing threshold after surgery was (8.2±6.6) dBHL, and there was no statistically significant difference compared to the preoperative [(8.1±5.7) dBHL] (P=0.95). After surgery, the threshold of hearing assistance with power on was significantly lower than that without hearing assistance [(32.8±4.6) dBHL vs (60.5±5.5) dBHL], and the difference was statistically significant (P<0.001). The speech recognition rate of monosyllable words, disyllabic words and short sentences in quiet environment increased to 72%, 84%, and 98% respectively. The differences were statistically significant (P<0.001). The speech recognition rate of monosyllabic words, disyllabic words, and short sentences in noise environment was significantly increased by 70%, 80%, and 92% respectively (P<0.001). After a follow-up of 4 to 47 months (median=24 months), the hearing results were stable and the aesthetic outcomes were satisfying. One patient had delayed hematoma around coil of the implant. After aspiration and compressed dressing for one week, hematoma was not recurrent. Conclusion: For patients after auricle reconstruction using expanded postauricular flap, the preference of retrosigmoid approach is a good choice in terms of safety and reliability of operation, as well as aesthetic appearance.

Prediction of speech understanding with the transcutaneous partially implantable bone conduction hearing system Osia®. German Version

The active transcutaneous, partially implantable osseointegrated bone conduction system Cochlear™ Osia® (Cochlear, Sydney, Australia) has been approved for use in German-speaking countries since April 2021. The Osia is indicated for patients with conductive (CHL) or mixed hearing loss (MHL) with an average bone conduction (BC) hearing loss of 55 dB or less, or with single-sided deafness (SSD). The aim of this retrospective study was to investigate the prediction of postoperative speech recognition with Osia and to evaluate the speech recognition of patients with MHL and an aided dynamic range of less than 30 dB with Osia. Between 2017 and 2022, 29adult patients were fitted with the Osia, 10patients (11ears) with CHL and 19patients (21ears) with MHL. MHL was subdivided into two groups: MHL‑I with four-frequency pure-tone average in BC (BC-4PTA) ≥ 20 dB HL and < 40 dB HL (n = 15patients; 20ears) vs. MHL-II with BC-4PTA ≥ 40 dB HL (n = 4patients; 5ears). All patients tested abone conduction hearing device on asoftband preoperatively. Speech intelligibility in quiet was assessed preoperatively using the Freiburg monosyllabic test unaided and with the test system and postoperatively with Osia. The maximum monosyllabic score (mEV) unaided and the monosyllabic score with the test system at 65 dB SPL were correlated with the postoperative monosyllabic score with Osia at 65 dB SPL. Preoperative prediction of postoperative outcome with Osia was better using the mEV than the EV at 65 dB SPL with the test device on the softband. Postoperative EV was most predictive for patients with CHL and least predictive for patients with mixed hearing loss with 4PTA BC ≥ 40 dB HL. For the test device at softband, results tended to show the minimum achievable outcome and the mEV tended to predict the realistically achievable outcome. Osia can be used for the treatment of CHL and MHL within the indication limits. The average preoperative bone conduction hearing threshold also provides an approximate estimate of the postoperative EV with Osia, for which the most accurate prediction is obtained using the preoperative mEV. Prediction accuracy decreases from aBC-4PTA of ≥ 40 dB.

Hearing loss related outcomes post-lateral temporal bone resection and other oncologic treatment.

e18069 Background: Lateral temporal bone resection (LTBR) is used to treat malignancies originating from the auricle, periauricular skin, external auditory canal, parotid gland, or temporal bone. LTBR is the workhorse of otologic cancer surgery; however, few studies have described audiologic outcomes in a large sample of patients. The current literature focuses on overall survival rates post-surgery; however, hearing loss-related outcomes after surgery and adjuvant therapy are lacking in the literature. Following surgery, patients are expected to have maximal conductive hearing loss in the affected ear which can be augmented by ototoxic effects of adjuvant treatment such as radiation and systemic therapy. This type of hearing loss significantly impacts quality of life, making it difficult to understand speech directed to the surgically closed ear, localize sounds, and understand conversational speech in noisy environments. Less is known about the rate and severity of sensorineural hearing loss (SNHL) following LTBR. Methods: A retrospective chart review was conducted among 252 patients who underwent LTBR at single tertiary care center from 2010 to 2020. We evaluated changes in ipsilateral bone conduction (BC) hearing thresholds after LTBR ± adjuvant therapy, including head and neck radiation, chemotherapy, and immunotherapy. Patients who completed at least 1 preoperative and 1 postoperative audiogram within 2 years of surgery were included. Patients who had preoperative chemotherapy, immunotherapy, or temporal bone radiation were excluded. Of 252 patients reviewed, 94 met the eligibility criteria. Audiometric data included pure tone average (PTA) for BC thresholds. A significant decline in hearing was defined as an increase in PTA ≥ 10 decibels (American Academy of Otolaryngology-Head and Neck Surgery). Three treatment subgroups were analyzed, including LTBR only, LTBR and radiation therapy, and LTBR with radiation and systemic therapy. Results: Among all patients, BC PTA increased on average by 7dB after treatment (p&lt;0.001); 30% of patients had ≥ 10dB shift. Patients undergoing LTBR with adjuvant therapy had a higher rate of hearing loss compared to patients undergoing LTBR alone (22/69, 32% vs. 5/25, 20%, respectively). Conclusions: LTBR can cause significant long-term decline in BC hearing that is worsened with the addition of adjuvant therapy. Therefore, it is critical to systematically obtain preoperative and post-treatment audiologic testing to monitor and rehabilitate hearing loss over time. The findings of this study may help patients understand realistic expectations of long-term treatment outcomes related to hearing loss, as an initial step to help improve quality of life with hearing rehabilitation such as osseointegrated bone conduction devices.

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

Evaluation of Auditory Functions in Patients with Psoriasis.

Our study aims to evaluate the functions of the middle and inner ear and the efferent auditory system in psoriasis. Hearing thresholds, resonance frequency, otoacoustic emission amplitudes with and without contralateral acoustic stimulation, contralateral suppression levels were evaluated in 35 psoriasis patients and 40 controls. The air-conduction hearing thresholds of the patients were significantly higher than the controls at 125, 250, 500, 1000, 2000, 4000, and 12,000Hz frequencies in the left ear, and 125, 250, 500, 1000, 2000, and 4000Hz frequencies in the right ear, and the bone-conduction hearing thresholds of the patients were found to be significantly higher than the controls at all frequencies in the left ear, and 250, 500, 1000 and 2000Hz in the right ear (p < 0.05). The resonance frequencies of patients were found to be significantly lower than the controls (p < 0.001). The emission amplitudes obtained with contralateral acoustic stimulation were significantly lower than without contralateral acoustic stimulation at 1kHz frequency in both groups (p < 0.01). There was no significant difference in contralateral suppression levels of the two groups (p > 0.05). Our findings indicate that middle ear mechanics can be affected by psoriasis. There was no significant difference between psoriasis patients and healthy controls in terms of efferent auditory functions. There was a significant difference at limited frequency in hearing thresholds and emission amplitudes between the groups.

Analysis of therapeutic effect of tympanoplasty type Ⅰ in elderly patients with chronic suppurative otitis media

Objective:To summarize the clinical characteristics of elderly patients with chronic suppurative otitis media who underwent type Ⅰ tympanoplasty, and to analyze for the first time the efficacy of type Ⅰtympanoplasty in elderly patients from multiple perspectives of medical data and patient evaluation, so as to provide reference for doctors and patients to make rational decisions on treatment methods. Methods:Forty-four elderly patients（45 ears） who underwent type Ⅰtympanoplasty from May 2016 to February 2022 were retrospectively analyzed, and were followed up for 6 months to 3 years. To analyze the clinical characteristics of patients, summarize the success rate of graft, and compare the hearing level of patients before and after surgery. The patients' quality of life before and after operation was evaluated by Chronic Ear Survey, and the scores obtained were statistically analyzed. Results:Of the 44 patients（45 ears）, 22.22%（10/45） of the ears had predisposing factors. The percentage of hearing loss, ear pus and tinnitus were 91.11%（41/45）, 88.89%（40/45） and 42.22%（19/45）, respectively. Mixed deafness accounted for 55.56%（25/45）. 66.67%（30/45） patients were diagnosed as tympanosclerosis by operation. The graft success rate was 97.78%. There was no significant difference in bone conduction hearing threshold before and after surgery, but there was significant difference in air conduction hearing threshold and air bone conduction difference. The scores of "activity restriction", "symptom", "medical resource utilization" and their total scores of the preoperative and postoperative were statistically different. Hypertension or diabetes had no significant effect on the efficacy of type Ⅰ tympanoplasty in elderly patients. Conclusion:Type Ⅰtympanoplasty is safe and effective in elderly patients, and the quality of life of patients after surgery is significantly improved. It is necessary to increase the awareness of elderly patients to seek medical advice and use surgical methods reasonably to treat chronic suppurative otitis media.

Bone Auditory Thresholds Variations in Cholesteatoma Middle Ear Surgery

Objective: To investigate the changes of bone auditory thresholds variations in cholesteatoma middle ear surgery and its related factors and its related factors. Methods: 122 cases (122 ears) of unilateral cholesteatoma otitis media were treated by mastoidectomy and/or tympanoplasty plus stage I tympanoplasty, and tragus cartilage ring-cartilage membrane (Referred to as cartilage group, 62 ears) and temporalis muscle fascia (Referred to as fascia group, 60 ears) were used as tympanic membrane grafts respectively. The changes of bone conduction hearing threshold were compared between the two groups before and 1, 3, 6 months and 1, 3 years after operation. And compare the difference in the incidence of ossicular chain fixation or necrosis, vestibular window or cochlear window dysfunction between the two groups of patients with increased (positive) and decreased (negative) bone conduction threshold before operation. Results: Compared with the healthy side, 95 ears of 122 ears in the two groups had higher bone conduction hearing threshold before operation. Among them, 48 ears were in cartilage group and 47 ears were in fascia group; In 72 ears (76.34%) of these cases, the bone conduction hearing threshold decreased after operation, and the difference between the two groups was statistically significant (P < 0.01). During operation, 57 ears (79.17%, 57/72) were found to have ossicular chain or two windows dysfunction, including 30 ears in cartilage group and 27 ears in fascia group. Of the 27 patients with normal hearing threshold, 5 had the above-mentioned lesions, including 3 in cartilage group and 2 in fascia group. Conclusion: The improvement of bone conduction hearing threshold in patients with cholesteatoma otitis media is mainly related to the fixation or necrosis of ossicular chain and the dysfunction of two windows. The tragus cartilage ring-perichondrium tympanoplasty can not only reduce the air-bone conduction difference, but also reduce the bone conduction hearing threshold, which has the advantage of stable and lasting hearing improvement.

The Effect of Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio on the Severity of Diabetes Mellitus Type II and Air and Bone Conduction Hearing Threshold at Speech Frequency

Background: Diabetes Mellitus Type II (DMT II) is a metabolic disorder characterized by chronic hyperglycemia resulting from relative or absolute insulin deficiency. It can cause various complications, including hearing loss (HL). NLR and PLR can determine the severity of DMT II but are not yet known for HL. Methods: This research was quantitative, analytically observational, and cross-sectional, using medical record data from July-November 2022. The variables were age, NLR, PLR, FBG, the duration and severity of DMT II, the air and bone conduction thresholds at speech frequencies (500, 1000, 2000, and 4000 Hz). Results: 43 respondents (86 ears) met the inclusion and exclusion criteria. The mean age was 61.63 + 8.64 years, with more women (60.5%, 26/43) than men (39.5%, 17/43). The mean duration of DM was 10.45 + 8.77 years. The average severity level was 2.63 + 1.77, which means that respondents in this study had more than two complications on average. DM in the elderly &gt; 60 years old has a risk of HL 9.839 times compared to those &lt; 60. DM with a high NLR can increase the risk of HL by increasing the incidence of HL, bilateral sides, type and degree of HL, and air and bone conduction threshold. DM with NLR &gt; 2.76 is more at risk of experiencing HL as much as 6.83 times compared to DM with NLR &lt; 2.76. Factors that predict HL in DM are age, NLR, and FBG, which are 33.1%, while other factors determine 66.7%. The age, FBG, and NLR variables can predict hearing loss in DM with moderate accuracy (AUC 76.7%). Conclusion: Hearing loss needs to be added to the screening program for complications of diabetes mellitus. A hearing screening program is needed for DM aged &gt; 60 years, FGB &gt; 126 mg/dl and NLR &gt; 2,76. NLR could be used to predict hearing loss incidents in DMT II.

Characterization and Clinical Use of Bone Conduction Transducers at Extended High Frequencies

Measurement of bone conduction (BC) hearing thresholds at extended high frequencies (EHF; above 8 kHz) is of clinical interest but is technically complicated by limitations in standard BC transducer output, a lack of calibration standards and sparse clinical data from human subjects. A recently described calibration scheme using an artificial mastoid and interposed accelerometer is applied in this study to characterize and compare acceleration and computed force outputs over the 4–20 kHz range of two standard BC transducers: the RadioEar® B71 and B81, as well as two non-standard, commercially available BC transducers: the Tascam® HP-F200 and the Aftershokz® AS400. Measures of linear output growth, harmonic distortion and acoustic radiation are assessed and compared across devices. A maximum linear input voltage is established for each BC transducer using measurements of linear output growth and total harmonic distortion. At maximum linear input level, the Tascam shows superior force output by 25 to 40 dB above 8 kHz and the widest dynamic EHF range. Acoustic radiation per output force was lowest for the Tascam, whereas the AS400 behaved more like an air conduction earphone than a force generator. In a cohort of 15 normal hearing volunteers, BC thresholds, measured with the Tascam and reported in dB re 1 rms μN, were consistent with historical measures of EHF BC thresholds in similar subjects using an alternative BC transducer.

Improved Prediction of Hearing Loss after Temporal Bone Fracture by Applying a Detailed Classification for Otic Capsule-Violating Fracture: A Wide Scope Analysis with Large Case Series.

This study aimed to analyze the predictability of temporal bone (TB) fracture-associated hearing loss by applying a detailed classification separating individual injury of the cochlea, vestibule, and semicircular canals (SCC). In this retrospective study, patients with otic capsule-violating (OCV) fractures were further classified as OCV-C(VS) when the cochlea was involved regardless of vestibule or SCC involvement, OCV-V(S) when the vestibule was involved regardless of SCC involvement, and OCV-S when the fracture only involved SCC. Hearing changes were compared by applying the above-mentioned classification, and TB fracture-induced facial palsy was also analyzed. A total of 119 patients were included. Patients with OCV fractures had significantly worse bone conduction (BC) and air conduction (AC) thresholds (59.1 ± 25.3 and 87.0 ± 29.5 dB) than those with otic capsule-sparing (OCS) fractures (20.1 ± 17.9 and 36.5 ± 21.9 dB; p < 0.001 for each comparison). The BC and the AC thresholds of OCV-C(VS) (77.5 ± 11.0 and 114.2 ± 14.3 dB) and OCV-V(S) (69.3 ± 27.7 and 98.0 ± 22.2 dB) were significantly higher than OCV-S (40.1 ± 22.9 and 62.1 ± 25.6 dB; p < 0.001 for each comparison). The BC hearing thresholds were not significantly improved in the last pure tone audiometry when compared for total, OCV, or OCS cases. The AC threshold significantly improved in OCS cases. In a considerable number of cases with facial palsy, causative fracture lines involved the geniculate ganglion or tympanic segment without the involvement of the otic capsule. Most cases showed significant improvement; however, recovery was limited in cases with obvious fallopian canal disruption. The cases with sole involvement of SCC had significantly better hearing thresholds than those with cochlear or vestibule involvement, even in OCV fracture cases.

An objective bone conduction verification tool using a piezoelectric thin-film force transducer.

All hearing aid fittings should be validated with appropriate outcome measurements, whereas there is a lack of well-designed objective verification methods for bone conduction (BC) hearing aids, compared to the real-ear measurement for air conduction hearing aids. This study aims to develop a new objective verification method for BC hearing aids by placing a piezoelectric thin-film force transducer between the BC transducer and the stimulation position. The newly proposed method was compared with the ear canal method and the artificial mastoid method through audibility estimation. The audibility estimation adopted the responses from the transducers that correspond to the individual BC hearing thresholds and three different input levels of pink noise. Twenty hearing-impaired (HI) subjects without prior experience with hearing aids were recruited for this study. The measurement and analysis results showed that the force transducer and ear canal methods almost yielded consistent results, while the artificial mastoid method exhibited significant differences from these two methods. The proposed force transducer method showed a lower noise level and was less affected by the sound field signal when compared with other methods. This indicates that it is promising to utilize a piezoelectric thin-film force transducer as an in-situ objective measurement method of BC stimulation.

The Relationship between Bone Conduction Hearing Threshold Shifts after Surgery for Chronic Otitis Media with Cholesteatoma According to STAM, EAONO/JOS, and SAMEO-ATO Classifications.

Background: This study focuses on the hearing threshold for bone conduction (BC) after middle-ear surgery. Methods: A total of 92 patients (120 ears) were treated for newly diagnosed chronic otitis media with cholesteatoma (2013–2018). BC was examined at frequencies of 0.5, 1, 2, and 4 kHz prior to and 1 year after surgery. STAM classification for cholesteatoma location, EAONO/JOS for stage, and surgery according to SAMEO-ATO classification were applied. The bone conduction threshold was compared for individual frequencies in patients with occurrence/absence of cholesteatoma in different locations. Results: For the occurrence of cholesteatoma in the attic (A), a statistically significant difference was found at 4 kHz (p < 0.001), in the supratubal recess (S1) at 4 kHz (p = 0.003), and for the mastoid (M) at 0.5 kHz (p = 0.024), at 1 kHz (p = 0.032), and at 2 kHz (p = 0.039). Conclusions: Cholesteatoma location can influence the post-operative hearing threshold for bone conduction.

Influence of the Coupling on the Hearing Outcome After Implantation of an Active Middle Ear Implant: Comparison of the Transmission Behavior in Temporal Bone Experiments With Clinical Data.

The active middle ear implant, Vibrant Soundbridge (VSB), can be implanted with a variety of couplers. Hearing outcome after implantation has been investigated in both temporal bone (TB) experiments and patient studies, but the relationship between experimental and clinical data is still weak in the literature. Therefore, experimental data from TB experiments should be compared with patient data in a retrospective study, in which the floating mass transducer is used with couplers of the third generation. Actuator coupling structures included the long (LP coupler) and short (SP coupler) incus process, the stapes head (Clip coupler), and the round window membrane (RW soft coupler). In the TB experiments, the sound transmission after vibroplasty on the above-mentioned actuator coupling structures was determined in 32 specimens by means of laser Doppler vibrometry on the stapes footplate. Data of 69 patients were analyzed. The main target audiometric parameters were the postoperative aided word recognition score (WRS) in the free field at 65 dB SPL (WRS 65 dB in %), the preoperative and postoperative pure-tone average (PTA4, including the frequencies 0.5, 1, 2, and 4 kHz) of the bone conduction hearing threshold (PTA4BC), the aided postoperative air conduction hearing threshold in the free field (PTA4FF) and the direct threshold (Vibrogram) at least 6 months postoperatively. The coupling efficiency of the actuator (Vibrogram-PTA4BC) as well as the effective hearing gain (PTA4FF-PTA4BC) was compared between the couplers. The analysis in the main speech range (0.5-4 kHz) indicated that in the TB experiments, the LP coupler tends to have the best coupling quality at low frequencies (500-1000 Hz). This was up to 15 dB above the worst actuator (RW soft coupler). However, the results missed the significance level ( p > 0.05). In the high frequencies (2000-4000 Hz), the Clip coupler showed the best coupling quality. This was 15 dB above the worst actuator (SP coupler). However, the results missed the significance level ( p > 0.05), too. The postoperative WRS at 65 dB SPL and the postoperative PTA4FF were independent of the actuator coupling structure. The PTA4BC was stable at 6 months postoperatively. For the PTA4 of the coupling efficiency, there were no significant differences between the actuator coupling structures (LP 8.9 dB ± 12.9; SP 9.5 ± 6.5 dB; Clip 5.2 ± 10.5 dB; RW 12.7 ± 11.0 dB). However, the tendential inferiority of the RW soft coupler with regard to transmission in the low-frequency range and the tendential superiority of the Clip coupler in the high-frequency range that have already been displayed experimentally could be confirmed in the clinical results. However, the clinical results missed the significance level, too ( p > 0.05). In vivo, there are no significant differences in the postoperative outcome stratified according to coupling the target structure. The differences known from the experimental setting were repressed by individual biasing factors. However, to ensure sufficient postoperative speech intelligibility, the frequency-specific transmission behavior of the couplers should be taken into account when setting the indication for VSB implantation.

Transcanal endoscopic treatment for congenital middle ear cholesteatoma in children.

To investigate the feasibility and efficacy of transcanal endoscopic treatment for congenital middle ear cholesteatoma in children.Eleven children diagnosed with congenital middle ear cholesteatoma, who underwent total ear endoscopic surgery under general anesthesia, were included from the Huazhong University of Science and Technology Union Shenzhen Hospital between January 2016 and December 2020. We retrospectively analyzed their operation process and surgical complications through the surgical video; moreover, we compared the pre- and postoperative hearing outcomes.One child underwent a planned second operation to reconstruct the ossicular chain. At 6 postoperative months, all 11 children underwent reexamination. There was no significant change and a significant decrease in the mean bone and air conduction hearing thresholds, respectively (P > .05 and P < .05); moreover, there was a significant reduction in the air–bone conduction difference (P < .05). Further, the air–bone conduction difference was reduced to >20 dB and >10 dB in 11 and 7 children, respectively. Follow-up of the children did not reveal sensorineural deafness, facial paralysis, and other serious complications; further, there were no cases of recurrence.Transcanal endoscopic treatment for congenital middle ear cholesteatoma in children is feasible, minimally invasive, and functional.

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

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

Evaluation of Carhart’s Notch in Patients with Serous Otitis Media

Objective: To investigate the changes in bone-conduction and air-bone gap in patients with serous otitis media and to evaluate the presence of Carhart’s notch. Material and Methods: Patients with unilateral serous otitis media were included in the study. Audiometric evaluation comprised air-conduction and bone-conduction hearing thresholds, and air-bone gap values. The preoperative and postoperative pure tone audiometry results of 45 patients were compared in terms of the air-bone gap and bone-conduction thresholds. Results: Carhart’s notch was present in 17 (37.8%) patients preoperatively. For pure tone audiometry, there was a statistically significant decrease in air-bone gap at all frequencies postoperatively. The postoperative decrease in the bone-conduction thresholds was statistically significant only at 2 kHz. In the postoperative period, a 4.7 dB improvement was observed in the bone-conduction threshold at 2 kHz for patients with Carhart’s notch. Conclusion: Carhart’s notch may be present in patients with serous otitis media. It is not specific to otosclerosis.

Stapedotomy using skeeter drill and self-retaining ear canal retractor: a single surgeon's 1000-plus surgical procedure experience.

This study aimed to evaluate the long-term hearing outcomes in stapedotomy surgery using skeeter oto-drill and to assess safety in difficult situations. A retrospective study was conducted with 944 patients who underwent 1007 stapedotomy procedures over 16 years, performed by a single surgeon using a trans-canal approach and a self-retaining ear canal retractor. Hearing thresholds were calculated over four frequencies. Air-bone conduction hearing thresholds were obtained at 1, 5 and 10 years post-operatively and compared to the pre-operative records. Out of 1007 operated ears with one year follow up, 98.61 per cent of cases showed a negligible air-bone gap of equal to or less than 5 dB, 1.19 per cent of cases showed an air-bone gap equal to or more than 5 dB but less than 10 dB, and only 0.2 per cent of cases showed an air-bone gap of more than 10 dB. In this study, using skeeter drill with a 0.6 mm diamond burr to make the fenestra was constant in all the cases and one of the safest techniques, showing persistent long-term hearing results.