Bone Conduction Pure-tone Averages Research Articles

Comparing Approaches for Repair of Superior Semicircular Canal Dehiscence.

Compare outcomes for subjects who underwent middle cranial fossa (MCF) or transmastoid (TM) repair of superior semicircular canal dehiscence (SSCD). Retrospective cohort study. Quaternary-care, academic neurotology practice. Subjects who underwent MCF or TM repair of SSCD between December 1999 and April 2023 were identified. Main outcome measures included demographic data, length of surgery and hospital stay, clinical presentation, and audiometric testing. Ninety-three subjects (97 ears) who underwent surgery for SSCD met inclusion criteria: 58.8% (57) via MCF, 39.2% (38) via TM, and 2.0% (2) via TM + MCF. Median operative time was shorter for the TM (35) compared to the MCF (29) approach (118 vs 151 minutes, P < .001). Additionally, median hospital stays were shorter for TM (36) compared to the MCF (56) approach (15.3 vs 67.7 hours, P < .001). Overall, 92% (49/53) of MCF and 92% (33/36) of TM surgeries resulted in an improvement or resolution of one or more symptoms (P = .84). There was no significant preoperative to postoperative change in the median air conduction pure-tone average (PTA), air-bone gap, or word recognition score in both the MCF and TM groups (P > .05). Improvements of >10 dB in the pre- to postoperative absolute change in bone conduction PTA were noted in 3 subjects in the MCF group and 4 subjects in the TM group (P = .49). The TM approach for SSCD demonstrates shorter operative times and length of hospital stay. The TM and MCF approaches have comparable audiometric and clinical outcomes.

Additional cartilage reinforcement of the annulus in myringoplasty for subtotal perforation

ObjectiveIn this study, graft success, hearing outcome, and complications were compared following the repair of subtotal perforation using a cartilage reinforcement underlay technique (CRUT) versus the traditional cartilage underlay technique (TCUT). Study designRandomized controlled trial. Materials and methodsSeventy-six patients with subtotal perforations were prospectively randomized to the CRUT (n = 38) or TCUT (n = 38) group. The graft success rate, hearing outcome, and complications were compared at 12 months. ResultsThe mean operation time was 32.9 ± 4.2 (range: 26–47) min in the CRUT group and 51.8 ± 6.3 (range: 48–73) min in the TCUT group (P < 0.001). At 12 months postoperatively, no residual perforation was seen in either group. The graft success rate was 94.7 % (36/38) in the CRUT group and 92.1 % (35/38) in the TCUT group; the difference was not significant (P = 0.643). The postoperative air bone gap (ABG) was significantly improved compared to the preoperative value in both groups, without significant between-group differences in either the preoperative (P = 0.741) or postoperative (P = 0.865) ABG or the mean ABG gain (P = 0.812). Additionally, there were no significant between-group differences in the preoperative (P = 0.887) or postoperative (P = 0.753) mean bone-conduction pure tone average. In the TCUT group, seven (18.4 %) patients developed temporary hypogeusia and two (5.3 %) had external auditory canal scarring. Graft cholesteatoma was not observed in either group. ConclusionIn the treatment of subtotal perforations, lateral reinforcement of the annulus with additional cartilage is simpler than traditional cartilage underlay for achieving graft and hearing success. The technique also does not involve raising the tympanomeatal flap or removing perforation margins.

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.

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.

Audiological assessment with Matrix sentence test of percutaneous vs transcutaneous bone-anchored hearing aids: a pilot study.

The study evaluated if there were differences between two types of bone-anchored hearing aids (BAHA), percutaneous vs transcutaneous implants in terms of audiological and psychosocial outcomes. Eleven patients were enrolled. Inclusion criteria were: patients with conductive or mixed hearing loss in the implanted ear with a bone conduction pure-tone average (BC PTA) of the hearing threshold at 500, 1000, 2000, and 3000Hz ≤ 55dB HL, aged > 5years. Patients were assigned to two groups: percutaneous implant (BAHA Connect) and transcutaneous implant (BAHA Attract). Pure-tone audiometry, speech audiometry, free-field pure-tone and speech audiometry with the hearing aid, and Matrix sentence test were performed. The Satisfaction with Amplification in Daily Life (SADL) questionnaire, the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, and the Glasgow Benefit Inventory (GBI) were used to assess the psychosocial and audiological benefits provided by the implant, and the variation in the quality of life after the surgery. No differences were found comparing the data of Matrix SRT. APHAB and GBI questionnaires did not show a statistically significant difference comparing each subscale and the global score. The comparison of scores obtained from the SADL questionnaire demonstrated a difference in the "Personal Image" subscale with a better score for the transcutaneous implant. Furthermore, the Global Score of the SADL questionnaire was statistically different between groups. Other subscales did not show any significant difference. A Spearman's ρ correlation test was used to evaluate if the age could influence the SRT results; no correlation was found between age and SRT. Furthermore, the same test was used to confirm a negative correlation between SRT and the global benefit of the APHAB questionnaire. The current research confirms the absence of statistically significant differences comparing percutaneous and transcutaneous implants. The Matrix sentence test has shown the comparability of the two implants in the speech-in-noise intelligibility. Actually, the choice of the implant type can be done according to the patient's personal needs, the surgeon's experience, and the patient anatomy.

Salivary Gland Choristoma of the Middle Ear: Case Report

Choristoma, a salivary gland tumor, may localize at unforeseen locations. Since 1961 when it was first described, roughly 50 cases of choristoma have been accounted for, including 30 cases among pediatric–adolescents. The patient in this current study is a girl of 14 years of age. She was admitted to a tertiary otolaryngology polyclinic with right-sided hearing problems and aural fullness complaint. Her average airway hearing level measured using the pure tone audiometry hearing test was 70 dB, whereas the bone conduction pure tone average was 6 dB. A high-resolution computerized tomography of the temporal bone demonstrated a mass behind the intact tympanic membrane. The tumor was excised entirely over the facial nerves tympanic part of the facial nerve with careful dissection. Histopathological examination revealed the tumor to be a salivary gland choristoma. In this article, we present the case of a 14-year-old girl with unilateral conductive hearing loss caused by salivary gland choristoma.

Audiometric Outcomes After Surgical Repair of Congenital Aural Atresia: Does Age Matter?

To determine if there is an age-based difference in audiometric outcomes for patients undergoing primary congenital aural atresia (CAA) repair. Retrospective chart review. Single academic, high-volume, tertiary care hospital. Individuals undergoing primary CAA repair by a single surgeon between 2004 and 2020. CAA repair. Preoperative and postoperative four tone (500, 1,000, 2,000, 4,000 Hz) air-conduction pure-tone average (PTA), bone-conduction PTA, air-bone gap and speech reception threshold, and preoperative to postoperative change in values. We identified 247 patients (262 ears) who underwent repair. The mean and median ages were approximately 12 and 8.5 years, respectively, both of which served as cutoff ages to compare younger versus older patients. The average preoperative to postoperative improvement values in air-conduction PTA, air-bone gap, and speech reception threshold for individuals younger than 12 years were 26.6 ± 10.2, 23.8 ± 12.6, and 30.1 ± 12.1 dB hearing level (HL), respectively, and those for individuals 12 years or older were 25.9 ± 15.7, 26.2 ± 10.3, and 31.3 ± 12.8 dB HL, respectively. For individuals younger than 8.5 years, the values were 25.8 ± 9.5, 24.9 ± 9.4, and 30.0 ± 10.6 dB HL, respectively, and those for individuals 8.5 years or older were 27.1 ± 13.5, 25.7 ± 11.0, and 30.0 ± 14.6 dB HL, respectively. The improvement did not differ significantly between the younger and older groups, using both cutoff ages. There was no difference in revision surgery rates or complications between groups. An individual at any age can enjoy audiometric improvement from atresia repair.

Labyrinthine fistulas: Surgical outcomes and an additional diagnostic strategy

PurposeTo evaluate perioperative findings and audiological and vestibular outcomes in patients operated for cholesteatoma with labyrinthine fistulas. Also to assess radiological fistula size. Materials and methodsPatients who underwent surgery for a labyrinthine fistula caused by a cholesteatoma between 2015 and 2020 in a tertiary referral center were retrospectively investigated. Fistula size was determined on preoperative CT scan. Bone and air conduction pure tone average thresholds were obtained pre- and postoperatively. Clinical outcomes, such as vertigo and otorrea were also evaluated. Main purpose was to determine whether there is a correlation between fistula size and postoperative hearing. Furthermore, perioperative findings and vestibular outcomes are evaluated. Results21 patients (22 cases) with a labyrinthine fistula were included. There was no significant change after surgery in bone conduction pure tone average (preoperatively 27.6 dB ± 26.7; postoperatively 30.3 dB ± 34.3; p = 0.628) or air conduction pure tone average (preoperatively 58.7 dB ± 24.3; postoperatively 60.2 dB ± 28.3; p = 0.816). Fistula size was not correlated to postoperative hearing outcome. There were two patients with membranous labyrinth invasion: one patient was deaf preoperatively, the other acquired total sensorineural hearing loss after surgery. ConclusionsSensorineural hearing loss after cholesteatoma surgery with labyrinthine fistula is rare. Fistula size and postoperative hearing loss are not correlated, however, membranous labyrinthine invasion seems to be related to poor postoperative hearing outcomes. Therefore, additional preoperative radiological work up, by MRI scan, in selected cases is advocated to guide the surgeon to optimize preoperative counselling.

Outcomes of Stapedotomy in Patients With Concomitant Otosclerosis and Superior Semicircular Canal Dehiscence: Should a Radiographic Third-Window Be a Contraindication to Stapes Surgery?

Review surgical outcomes of stapedotomy in patients with concomitant otosclerosis and superior semicircular canal dehiscence. Retrospective case review. Tertiary referral center. Patients with otosclerosis and radiographic superior semicircular canal dehiscence undergoing stapedotomy between 2008 and 2020. Stapedotomy. Pre- and postoperative hearing and unmasking of third-window symptoms. Hearing was measured by air conduction (AC) and bone conduction (BC) pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). Third-window symptoms included hyperacusis, autophony, sound- or pressure-induced vertigo, imbalance, or oscillopsia. Twenty patients with otosclerosis and radiographic superior semicircular canal dehiscence underwent stapedotomy, 13 primary and 7 revision. Mean AC PTA was 49.3 dB preoperatively and 35.6 dB postoperatively (p = 0.0077), while the ABG improved on average from 23.9 to 9.68 dB (p < 0.0001). The ABG improved to ≤10 dB in 12/20 patients (60%), and ≤20 dB in 18/20 patients (90%). There was no significant difference in BC PTA or WRS postoperatively. Two patients (10%) experienced potential transient unmasking of third-window symptoms-hyperacusis and prolonged imbalance-which both resolved. There were no other complications. There was no significant difference in audiologic outcomes or unmasking of third window symptoms between primary or revision cases. Persistent conductive hearing loss is common following stapedotomy for otosclerosis in patients with concomitant superior semicircular canal dehiscence. However, a majority of patients can achieve excellent hearing outcomes, while unmasking of third window symptoms appears to be rare. Radiographic superior semicircular canal dehiscence may not be an absolute contraindication to stapes surgery for otosclerosis.

Radiological parameters and audiometric findings in otosclerosis: is there any relationship?

The role of high-resolution computed tomography scans in otosclerosis remains uncertain. There is a debate over the relationship between radiological and audiometric findings among patients. Pre-operative audiometry and high-resolution computed tomography findings from 40 ears with surgically confirmed otosclerosis were compared. High-resolution computed tomography scan data regarding the characteristics of the disease foci, the endosteal extension and the occurrence of internal auditory canal diverticula were obtained. The influence of each radiological variable on the simple pure tone average, the high-frequency pure tone average and the bone-conduction pure tone average were investigated. Cases with endosteal extension (p = 0.047) and a higher number of affected sites within the otic capsule had a worse bone-conduction pure tone average, although it was only significant for the latter (p = 0.006). Those without concomitant retrofenestral disease (p = 0.019) had better simple pure tone average. The number of sites of involvement and concomitant retrofenestral disease seem to significantly impact audiometric findings in otosclerosis.

Auditory Outcomes Following Transmastoid and Middle Cranial Fossa Approaches for Superior Semicircular Canal Dehiscence Repair.

To describe postoperative hearing outcomes following transmastoid (TM) and middle cranial fossa (MCF) approaches for semicircular canal dehiscence (SSCD) repair. Retrospective review. Academic, tertiary referral center. Adults with SSCD who underwent repair between 2005 and 2019. Pure tone audiometry pre- and postoperatively after SSCD repair. Change in air-bone gap (ABG) at 250 and 500 Hz, pure tone average (PTA), bone conduction (BC), and air conduction (AC) thresholds at 500, 1000, 2000, and 4000 Hz for patients undergoing TM and MCF approaches for SSCD repair. The average change in BC PTA for patients undergoing TM (n = 26) and MCF (n = 24) SSCD repair was not significantly different between the two groups. The first and final postoperative PTAs were recorded an average of 1.7 (range 0.30-3.0) and 29.1 (range 3.5-154) months postoperatively. For patients who underwent MCF repair, the average BC PTAs increased (+) by 2.2 dB HL (p 0.43) and 0.57 dB HL (p 0.88) at the first and final audiograms respectively compared to +1.27 dB HL (p 0.53) and a decrease (-) of 0.57 dB HL (p 0.63) for the TM group. The average changes in low frequency ABG for patients undergoing MCF repair were -4.7 dB (p 0.08) and -6.9 dB (p 0.15) at first and final audiograms respectively compared to -4.9 dB (p 0.06) and -4.1 dB (p 0.36) for patients who underwent TM repair. There was a high frequency hearing loss noted at 8000 Hz for the MCF (30.0 dB ± 18.7 preop; 41.7 dB ± 21.7 postop; p 0.01) and TM (32.1 dB ± 23.2 preop; 44.3 dB ± 29.6 postop; p 0.001) groups which persisted on long term follow up. Both TM and MCF approaches to SSCD repair can be performed with long-term preservation of hearing. ABGs were reduced in each treatment group but did not reach significance. A high frequency hearing loss (8000 Hz) may be expected with either approach.

Results of Active Middle Ear Implantation in Patients With Mixed Hearing Loss After Middle Ear Surgery: A Prospective Multicenter Study (the ROMEO Study).

ObjectivesThis study was conducted to evaluate the user satisfaction, efficacy, and safety of round window (RW) vibroplasty using the Vibrant Soundbridge (VSB) in patients with persistent mixed hearing loss after mastoidectomy.Methods The study included 27 patients (mean age, 58.7 years; age range, 28–76 years; 11 men and 16 women) with mixed hearing loss after mastoidectomy from 15 tertiary referral centers in Korea. The VSB was implanted at the RW. The Korean translation of the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire and the Korean version of the International Outcome Inventory for Hearing Aids (K-IOI-HA) questionnaire were used to evaluate user satisfaction as the primary outcome. The secondary outcome measures were audiological test results and complication rates.ResultsThe mean scores for ease of communication (61.3% to 29.7% to 30.2%), reverberation (62.1% to 43.1% to 37.4%), and background noise (63.3% to 37.7% to 34.3%) subscales of the APHAB questionnaire significantly decreased after VSB surgery. The mean K-IOI-HA scores at 3 and 6 months after surgery were significantly higher than the mean preoperative score (18.6 to 27.2 to 28.1). The postoperative VSB-aided thresholds were significantly lower than the preoperative unaided and hearing aid (HA)-aided thresholds. There was no significant difference between preoperative unaided, preoperative HA-aided, and postoperative VSB-aided maximum phonetically balanced word-recognition scores. None of the 27 patients experienced a change in postoperative bone conduction pure tone average. One patient developed temporary facial palsy and two developed surgical wound infections.ConclusionRW vibroplasty resulted in improved satisfaction and audiological test results in patients with mixed hearing loss after mastoidectomy, and the complication rate was tolerable.

Outcomes After Tympanic Membrane Perforation During Primary Stapes Surgery for Otosclerosis.

Stapes surgery is occasionally complicated by an intraoperative tympanic membrane perforation (ITMP), traditionally indicating abortion of the procedure due to concerns for postoperative infection and sensorineural hearing loss (SNHL). This work examines outcomes and complications in completed primary stapes surgeries with and without ITMP. Retrospective review. All patients diagnosed with otosclerosis between February 2008 and September 2017 at a tertiary otology referral center were reviewed retrospectively. Primary outcome measures were post-operative air-bone gap (ABG), air conduction and bone conduction pure tone averages, and post-operative complications. Review revealed 652 primary stapes operations meeting inclusion criteria, of which ITMP occurred in 10. There were no significant differences in pre-operative hearing metrics or demographic characteristics between ears with and without ITMP. There were also no significant differences in post-operative ABG (6.4 vs. 8.0 dB HL, P = .43) or change in ABG after surgery (-21.6 vs. -18.2 dB, P = .34) between these two groups. Patients with ITMP were more likely to complain of post-operative dysgeusia (30.0% vs. 5.3%, P = .015) but were no more likely to develop reparative granuloma, otitis media, or SNHL (P > .05). The first review of ITMP and hearing outcomes after stapes surgery is presented. Our findings suggest that it is likely safe and appropriate to proceed with primary stapes surgery and concurrent tympanoplasty in the presence of a small ITMP with minimal risk of infection, SNHL, or worsened hearing outcomes. 4 Laryngoscope, 131:E2026-E2030, 2021.

Expanding the indications for the bone anchored hearing system (BAHS) in patients with single sided deafness

PurposeProvide data to support expansion of FDA indications for the Bone anchored hearing system (BAHS). Materials and methodsThis retrospective study in a tertiary otologic referral center included106 consecutive subjects who were implanted with a Bone Anchored Hearing System (BAHS) between January 2009 and January 2015 for single sided deafness. Subjects were divided into three groups by bone conduction pure tone average (PTA) of the better hearing ear: 0–20 dB (group 1), 21–40 dB (group 2) and 41–55 dB (group 3). All patients underwent BAHS implantation. Speech perception data (Hearing In Noise Test and Consonant-Nucleus-Consonant testing) was collected before and after surgical intervention. Patient-reported quality of life measures were obtained at least 6 months after activation. These included the Abbreviated Profile of Hearing Aid Benefit and Glasgow Benefit Inventory. ResultsAll three groups of subjects demonstrated statistically significant improvement in outcome measures following BAHS. Subject reported quality of life outcome measures demonstrated significant improvement in disability from hearing loss and in quality of life. ConclusionsPatients with single sided deafness who have bone conduction thresholds worse than 20 dB in their contralateral ear are still able to benefit significantly from BAHS.

Is Menière's Disease a Contraindication to Stapedectomy?

Review surgical outcomes of stapedectomy for otosclerosis in patients with Menierè's disease. Retrospective case review. Tertiary referral center. Patients with otosclerosis and Menière's disease undergoing stapedectomy between 2010 and 2017. Stapedectomy. Pre- and postoperative hearing and complications. Hearing was measured by air conduction (AC) and bone conduction (BC) pure-tone frequency, pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). Among 1,499 patients with otosclerosis, the incidence of concomitant Menière's disease was 1.7%. Fifteen patients with otosclerosis and Menière's disease underwent stapedectomy, 12 primary and three revisions. Mean AC PTA was 43 dB preoperatively, and 25 dB postoperatively (p = 0.0007), while the ABG improved on average from 20 to 5 dB (p = 0.0001). There was no significant difference in BC PTA or WRS postoperatively. Two patients experienced fluctuation of hearing in the postoperative period, one of which resolved with a course of steroids. The mean follow-up time was 41 months. In patients with otosclerosis and Menière's disease, stapedectomy provides excellent hearing outcomes in a majority of patients. As is characteristic of Menière's disease, some patients will continue to experience fluctuating hearing postoperatively, which may progress to severe sensorineural hearing loss. Menière's disease may not be an absolute contraindication to stapes surgery.

Hearing Outcomes With a Novel Total Ossicular Replacement Prosthesis.

A total ossicular replacement prosthesis (TORP) is used to reconstruct the ossicular chain in the absence of the stapes suprastructure. The Wildcat prosthesis is a novel TORP that eliminates the need for a separate footplate shoe prosthesis and aims to improve ease-of-use and stability. This study evaluates hearing outcomes using the Wildcat prosthesis. Case series with chart review. Tertiary neurotology referral center. Retrospective chart review of 64 patients undergoing ossicular chain reconstruction using the Wildcat TORP. Hearing outcomes after surgery were assessed with air conduction pure-tone average, bone conduction pure-tone average, air-bone gap (ABG), speech recognition threshold , and word recognition score as primary outcome measures. The stability of hearing outcomes was evaluated on subsequent long-term follow-up. At mean short-term follow-up of 4.4 ± 2.7 months, ABG improved from 31.0 ± 13.0 dB preoperatively to 22.5 ± 10.0 dB (p < 0.001) with 51.6% achieving ABG less than 20 dB. No significant difference in any primary outcome measures was found when analyzing outcomes by initial versus revision surgery, use of cartilage graft, or type of mastoidectomy. The only exception was a smaller reduction in ABG of 4.2 dB for patients with canal wall down mastoidectomy compared with a 13.7 dB ABG closure in patients with canal wall up mastoidectomy (p = 0.039). Total ossicular chain reconstruction using the Wildcat demonstrates versatility in challenging cases to provide hearing outcomes that are comparable to published data using TORPs.

Bone Cement Fixation of Stapedotomy Prostheses: Long-term Outcomes in Primary and Revision Stapes Surgery.

To describe audiologic outcomes following hydroxyapatite bone cement fixation of stapedotomy prostheses. A retrospective case review at a tertiary neurotology referral center was performed of patients undergoing primary or revision stapedotomy between 2010 and 2017. Patients with hydroxyapatite bone cement fixation of stapes prostheses were assessed. Pre- and postoperative hearing was compared, consisting of air conduction (AC) and bone conduction (BC) pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). Short and long-term outcomes were assessed. Forty-six patients with otosclerosis underwent stapedotomy with bone cement fixation: 21 primary cases and 25 revision cases, with an average follow-up time of 17 months. Mean AC PTA was 56 dB preoperatively, and 34 dB postoperatively (P < .0001), while the ABG improved on average from 27 dB to 9 dB (P < .0001). There was no significant difference in postoperative ABG between primary and revision stapes surgery (6 dB vs 10 dB, P = .07). These results persisted through long-term follow-up in a subgroup of patients with significantly longer follow-up time (mean 44 months). There was no significant change in BC PTA or word recognition scores. Three patients underwent subsequent revisions, one patient developed sensorineural hearing loss. Stapedotomy with bone cement fixation of the prosthesis provides excellent hearing outcomes in both primary and revision treatment of otosclerosis. Results are consistent and stable through long-term follow-up. The use of bone cement should be incorporated into the surgical armamentarium of the otologist for the prevention and treatment of loose-wire syndrome and incus necrosis.

Simultaneous bilateral stapes surgery after follow-up of 13 years

Background Eighteen patients underwent simultaneous bilateral stapes surgery in 2003–2006. Objectives We evaluated the long-term outcomes in this patient group, and assessed their hearing in noise and binaural hearing. Material and Methods Fifteen patients returned questionnaires concerning their hearing, taste function, and balance. Thirteen patients underwent pure-tone and speech audiogram, Finnish matrix sentence test, video head impulse test, and clinical examination on average 13 years after surgery. Results We found no significant difference in air- and bone conduction pure-tone average, speech audiometry, and the air-bone gap between the 1-year and the late postoperative visits. One patient had bilaterally a partial loss of the vestibulo-ocular reflex of unknown cause. Conclusions and Significance The hearing results 13 years after simultaneous bilateral stapes surgery remained good without any significant delayed complications. Simultaneous bilateral stapes surgery is a viable treatment option in selected patients with otosclerosis.

Evaluating hearing outcome, recidivism and complications in cholesteatoma surgery using the ChOLE classification system

PurposeTo establish a standardized reporting system of cholesteatoma, the ChOLE classification has recently been introduced. We here aimed to systematically investigate the association between the ChOLE classification and (i) hearing, (ii) recidivism rate, and (iii) postoperative complications. These data may increase the utility of the ChOLE classification in clinical practice and research by stratifying patients according to expected outcomes or risks for complications.MethodsIn this prospective multicentric study, we included adult patients undergoing tympanomastoid surgery due to cholesteatoma. Main outcome measures included the association of the ChOLE classification system with (i) audiometric data including air conduction (AC) and bone conduction (BC) pure-tone average (PTA), and the air–bone gap (ABG), (ii) recidivism and complication.ResultsA total of 160 patients suffering from cholesteatoma were included. ChOLE stage distribution was stage I in 23 (14%), stage II in 128 (80%), and stage III in 9 (6%) patients. The ChOLE stage was associated with the postoperative AC PTA (p = 0.05) and the postoperative BC PTA (p = 0.02). Further, the status of the ossicular chain after surgery (ChOLE subdivision “O”) was associated with both the postoperative ABG (p = 0.0001) and the postoperative AC PTA (p = 0.003). Moreover, we found an association between complications (ChOLE subdivision “L) and both the postoperative BC PTA (p = 0.04) and the postoperative ABG (p = 0.04). No association between the ChOLE stage was found to both cholesteatoma recidivism and surgical complications.ConclusionThe ChOLE classification is a new system to classify cholesteatomas. We provide evidence that hearing outcomes vary among different ChOLE stages. In particular, hearing outcomes are associated with the ChOLE subdivision “O” and “L”. Thus, the ChOLE classification system has a predictive value regarding hearing outcomes.

The effectiveness of repairment of traumatic tympanic membrane perforations with cigarette paper.

The aim of this study was to evaluate the effects of repairment of traumatic tympanic membrane perforation (TTMP) with cigarette paper patch (CPP) on perforation closure and hearing functions. A retrospective evaluation was made of 67 ears of 61 patients diagnosed with TTMP and treated with CPP in our clinic between January 2015 and 2019. In the classification of TTMP size, the entire tympanic membrane was evaluated as 100%, perforation of <25% was considered small, perforation of between 25% and 50% was considered medium and perforation of ≥50% was considered large. Audiological examination was performed before and at 3 months after the CPP procedure. Air conduction (AC) and bone conduction (BC) pure tone averages (PTAs) and air-bone gap (ABG) at 0.5, 1, 2, and 4 khz frequencies were compared. Perforations were small in 20 (29.9%) of 67 ears, medium in 27 (40.2%), and large in 20 ears (29.9%). AC PTA before CPP was found to be 28.26±5.63 dB hearing level (HL), BC PTA was 8.80±4.35 dB HL and ABG was 19.26±5.80 dB HL. After CPP, the AC PTA was found to be 11.90±6.59 dB HL, BC PTA was 8.29±4.05 dB HL, and ABG was 14.10±4.66 dB HL. TTMP was determined to have improved in 61 ears (91%) in the 1st month after CPP application. There was no statistically significant difference between perforation size and improvement rates (p>0.05). AC PTA values after CPP application were determined to be significantly lower than AC PTA values before CPP application at 0.5, 1, 2, and 4 khz (p<0.001). The ABG values measured at 0.5 khz after CPP were significantly higher than the values measured at 2 khz. and 4 khz. (p<0.001, p<0.001, respectively). The amount of decrease in PTA value after CPP was found to be significantly greater at 0.5 khz than at 2 khz and 4 khz (p<0.001, p<0.001, respectively). In the treatment of TTMP, early application of CPP is an effective treatment method in terms of both perforation closure and hearing gain.