Conduction Pure-tone Averages Research Articles

The Effect of Different Adaptation Formulas on Mid-Latency Auditory Evoked Potentials in Adults with Hearing Aids.

We were conducting this study to evaluate the effects of different hearing aid adaptation formulas on middle latency responses (MLR) in adult hearing aid users. The study included 72 participants: those with moderate hearing loss using hearing aids with two different formulas for the last year, those with moderate hearing loss not using hearing aids, and those without hearing loss. Sixteen participants using NAL-NL1 and NAL-RP formulas were Group 1; twenty using NAL-NL2 and DSL formulas were Group 2; fifteen with hearing loss not using devices were Group 3; and twenty-one without hearing loss were Group 4. We obtained and compared MLR responses, including Na latency, Pa latency, and Na-Pa amplitude. Group 1 mean Na-Pa amplitude value was found to be higher than Group 2 (p = 0.001). No significant difference was observed between Group 1 and Group 2 in terms of Na latency and Pa latency values (p = 0.001; p = 0.035). It was observed that the mean Na-Pa amplitude values in Group 1 and Group 2 were higher than Group 3 (p = 0.001), but this elevation reached the level of statistical significance only in Group 1. No difference was observed between Group 1, Group 2, and Group 3 in terms of Na latency and Pa latency values (p = 0.001; p = 0.035). Compared with those without hearing loss (Group 4), participants with hearing loss (Group 1, Group 2, and Group 3) had longer Na latency and Pa latency values (p = 0.001; p = 0.035), and Na-Pa amplitudes were lower (p = 0.001). The effect of current (tested) hearing aid usage time on Na latency, Pa latency, and Na-Pa amplitude values of Group 1 and Group 2 was not observed. In all groups, there was a positive correlation between audiometric airway/bone conduction pure tone averages and speech acquisition threshold values, Na latency and Pa latency values, and a negative correlation between Na-Pa amplitude values. In all groups, there was a negative correlation between speech discrimination scores and Na and Pa latency values, as well as a positive correlation between Na and Pa amplitude values. There was a positive correlation between age and Pa latency values in all groups, as well as a negative correlation between Na and Pa amplitude values. Middle latency responses are affected by the presence of hearing loss, the use of hearing aids, and different hearing aid adaptation formulas. MLR measurements with a hearing aid can be used as an objective test to evaluate the benefit of hearing aid use.

Long-term follow-up of Bonebridge BCI 601 implantation for microtia patients with aural atresia: acoustic and subjective benefits.

This study evaluated the long-term acoustic and subjective outcomes of Bonebridge bone conduction implant (BCI) 601 implantation in Taiwanese microtia patients with aural atresia (AA). A total of 41 microtia patients (26 with bilateral AA and 15 with unilateral AA) who received Bonebridge BCI 601 implantation between December 2014 and March 2021 at Chang Gung Memorial Hospital, Linkou, Taiwan, were included in this retrospective study. Acoustic outcomes, including the functional hearing gain (FHG), speech reception threshold (SRT), and word recognition score (WRS), were assessed. Subjective outcomes were assessed using the Chinese versions of four questionnaires: the Abbreviated Profile of Hearing Aid Benefit (APHAB); the Speech, Spatial and Qualities of Hearing Scale; the International Outcome Inventory for Hearing Aids; and the Satisfaction with Amplification in Daily Living. The mean follow-up duration was 6.3 years (range, 2.8-9.1). The mean unaided air conduction pure tone average (PTA4) was 65.3 ± 8.8 decibels (dB) hearing level (HL) and the mean aided sound field PTA4 was 31.1 ± 9.1 dB HL, resulting in a FHG of 34.2 ± 11.7 dB HL (p < 0.05). After Bonebridge implantation, the mean SRT in quiet, SRT in noise, WRS in quiet, and WRS in noise improved from 58.3 ± 7.4 dB HL to 29.4 ± 7.0 dB HL, from -1.4 ± 7.3 dB signal-to-noise ratio (SNR) to -9.6 ± 5.4 dB SNR, from 46.4 ± 26.9% to 93.8 ± 3.1%, and from 46.7 ± 21.8% to 72.7 ± 19.3%, respectively (p < 0.05). Additionally, the bilateral AA group exhibited greater SRT and WRS improvements compared to the unilateral AA group (p < 0.05). All mean subscale scores in the four questionnaires showed improvement after Bonebridge implantation, except for the mean aversiveness to sounds subscale score in the APHAB questionnaire. Bonebridge BCI 601 implantation provided long-term acoustic and subjective benefits to microtia patients with AA, particularly those with bilateral AA.

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.

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

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

Primary Stapedectomy: A Retrospective Review of Surgical Results Using a Cold Steel Technique and Pre-Operative CT Correlates.

Stapedectomy is an effective treatment option for patients with symptomatic otosclerosis. A common surgical technique today is laser stapedotomy, although the equipment required adds a significant cost to the procedure and may not be available in certain, particularly remote, centers. This study aimed to evaluate cold steel stapedectomy in a modern otology practice as a cost-effective and versatile alternative. The primary objective was to evaluate the efficacy and safety of cold steel stapedectomy. The secondary objectives included characterizing the prevalence of relevant computed tomography (CT) findings and evaluating other factors such as piston size. A retrospective case series from April 2006 to November 2021. A single tertiary care hospital in Montreal, QC, Canada. Patients with suspected otosclerosis and no prior stapes surgery. Cold steel primary stapedectomy. In primary analysis, change in pure tone thresholds, pure tone average (PTA), and complication rates were obtained. Secondary analysis measures included rates of relevant CT findings and change in PTA with piston size. A total of 302 cases were included in the analysis. The average change in air conduction PTA was a decrease of 27 dB, with 91% (276/302) having over 10 dB of improvement. The air-bone gap was closed to within 10 dB in 82% (248/302) of cases and within 20 dB in 96% (290/302) of cases. Overclosure occurred in 19% of cases, while only 4% resulted in worsened PTA bone conduction thresholds. In secondary analysis, 74% of CT scans demonstrated radiologic otosclerosis. Other findings included suspected superior semicircular canal dehiscence in 1.8%. Cold steel stapedectomy was demonstrated to be a safe and effective technique, with audiometric results comparable to laser and drill studies in recent literature. It should be considered as a cost-effective and global health accessible alternative. Additionally, CT scans can provide valuable information in the pre-operative workup.

The impact of waiting time on hearing outcome and patients’ satisfaction after cholesteatoma surgery

Background Cholesteatoma is a formation of epithelium mass in the middle ear. Surgery aims to prevent complications while maintain or improve hearing. Aims/Objectives To determine if waiting time until cholesteatoma surgery affects hearing outcome and patients’ satisfaction. Material and Methods A retrospective cohort study performed at the only Ear Nose Throat clinic in one county in Sweden. Sixty concomitant surgeries, both first time and revisions, were included. Results Of the 60 surgeries, 33 (55%) were performed within a 3-month period. The mean waiting time was 1.4 months. In the remaining 27 cases, the mean waiting time was 8.6 months. Both groups had preoperatively similar air conduction pure tone average (AC PTA4), 47.3 dB and 47.0 dB respectively. The mean AC PTA4 gain was greater in the group with waiting time ≤3 months (8.6 dB) compared to the >3 months group (1.2 dB, p = 0.040). The patients’ satisfaction was lower in the latter group, but the difference was not statistically significant. Conclusions This study indicates that longer waiting time to cholesteatoma surgery has a negative impact on postoperative hearing results but not on patients’ satisfaction. Significance The outcome of this study suggests that waiting time to surgery can be a factor determining postoperative hearing results.

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.

Does young otologists’ method of initiation to tympanoplasty make a difference?

Objectives: The study aimed to identify which surgical method will provide an easier initiation to tympanoplasty for young otolaryngology residents and which method will achieve more successful results. Patients and Methods: The files of 58 patients who underwent type 1 tympanoplasty were retrospectively reviewed between September 2020 and September 2021. Patients were divided into two groups according to the surgical procedure as the microscopic (MT) and the endoscopic (ET) group. The ET group included 30 patients (16 females, 14 males; median age: 36.5 years range, 18 to 56 years), and the MT group included 28 patients (15 males, 13 females; median age: 29.5 years; range, 18 to 52 years). The two groups were compared in terms of pre- and postoperative audiometry results and graft success rates. Results: There was no significant difference between the two groups in terms of pre- and postoperative air-bone conduction pure tone averages and air-bone gap (p&gt;0.05). Air-bone gap gain was 13 dB in the ET group and 9.42 dB in the MT group, and this difference was statistically significant (p&lt;0.05). The graft success rate was 86.7% in the ET group and 75% in the MT group, but there was no significant difference between the two groups (p&gt;0.05). Conclusion: Although the air-bone gap gain was better in the ET group in our study, it can be said that this difference was clinically negligible. We believe that conducting such a study with more surgeons and surgical cases may guide the otolaryngology residents to start type 1 tympanoplasty surgery.

Transcanal endoscopic management of isolated congenital middle ear malformations

Background A few studies have reported transcanal endoscopic management of isolated congenital middle ear malformations (CMEMs). Objective The purpose of this study is to describe our surgical experience in endoscopic ear surgery for isolated CMEMs and evaluate the surgical effect of hearing reconstruction. Methods From January 2017 to January 2022, a retrospective study was performed on 36 patients (37 ears) with isolated CMEMs who all underwent endoscopic surgery. Demographic data, high-resolution computed tomography (HRCT) findings, intraoperative findings, surgical management and audiometric data were recorded. Results Anomalies were categorized according to the Teunissen and Cremers classification system: 8 ears were categorized as class I, 8 ears as class II, 19 ears as class III and 2 ears as class IV. The air conduction pure tone average (AC-PTA) of 37 cases was 61.5 ± 8.6 dB preoperatively and 29.6 ± 6.9 dB postoperatively (p < 0.001). The mean preoperative air-bone gap (ABG) significantly decreased from 43.1 ± 8.7 dB to 12.8 ± 5.5 dB postoperatively. 36 of 37 cases (97%) met the criteria for successful operation. Conclusion Isolated CMEMs are mainly manifested as aplasia of the stapes’ superstructure and dysplasia of the long process of the incus. Transcanal endoscopic surgery seems a safe technique for the management of isolated CMEMs.

Frequency-dependent hearing outcomes with or without preservation of intact ossicular articulations.

To determine the frequency-specific benefits of ossicular chain preservation compared to performing disarticulations and reconstructions in transmastoid facial nerve decompression surgery in patients with an intact ossicular chain. A retrospective chart review (January 2007 and June 2018) of patients undergoing transmastoid facial nerve decompression on the intact middle ear for severe facial palsy at a tertiary referral center. Surgery was performed with ossicular chain disarticulation on an as-needed basis using either ossicular chain preservation (without ossicular disarticulation), incudostapedial separation, or incus disarticulation technique. Hearing outcomes were assessed. The 108 patients were included in this study. Among these, 89 patients underwent ossicular chain preservation, 5 underwent incudostapedial separation and 14 underwent incus repositioning. The proportion of patients with a change in the 4-frequency air conduction pure-tone average of less than 10dB was 91%, 60%, and 50%, respectively, for the three surgical techniques; these were significantly different (Fisher's exact test, p < .001). Frequency-specific analysis showed that air conduction was significantly better following the ossicular chain preservation technique compared with the incus repositioning technique at stimulation frequencies lower than 250 Hz and higher than 2000 Hz, and compared with the incudostapedial separation technique at 4000 Hz. Analysis of biometric measures determined on CT images suggested that the feasibility of the ossicular chain preservation technique correlates with incus body thickness on coronal CT images. Ossicular chain preservation is an effective approach for hearing preservation in transmastoid facial nerve decompression or similar surgical procedures.

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.

Long-term outcomes of retrospective case series of middle ear implantation with Vibrant Soundbridge in children with congenital aural atresia.

to assess audiological performance in quiet and noise, quality of life and side effects of Vibrant Soundbridge (VSB) in children with congenital aural atresia (CAA). A retrospective study including consecutive patients with unilateral or bilateral CAA implanted with VSB from 2009 to 2020 in a tertiary referral centre. 18 patients with CAA and a present stapes were included (3 simultaneous bilateral VSB implants) and 21 ears: 17 VSB were attached to the short incus process, and four to the stapes. Age at implantation ranged from 4.7 to 15.8years. Average follow-up was 6.5years (± 3.7years). In unilateral VSB, air conduction pure tone average (ACPTA) thresholds increased from 75.3 ± 15.2 to 32.6 ± 8.3dB post-operatively (VSB activated) (n = 15; p < 0.01). The speech reception threshold (SRT) and the word recognition score (WRS) were significantly improved from 81.5 ± 10.4 to 43.9 ± 7.6dB and 0% to 84.8 ± 8.5% postoperatively (n = 15; p < 0.01). The signal to noise ratio (SNR) was significantly improved from 2.1 ± 2.9dB VSB inactivated to 0.3 ± 2.7dB VSB activated (n = 15; p < 0.01). There was no significant difference in performance according to floating mass transducer (FMT) placement. 5/15 children were non-users at last follow-up in unilateral VSB and 0/3 in bilateral. CAA ears with VSB activated had a significant improvement of ACPTA, WRS, SRT and SNR. A third of patients with unilateral CAA became non-users at last follow-up. The main challenge is to target the indications for the implantation of the VSB to avoid its discontinuation.

Audiometric and Surgical Outcomes of a Novel Bone-Conduction Hearing Aid.

To report the audiometric and surgical outcomes of a series of patients having undergone implantation of a novel transcutaneous bone conduction implant (t-BCI). Retrospective case series. Single academic tertiary referral center. Adults (≥18 yr) implanted between December 1, 2019, and August 1, 2021, with audiometric data available before and after device implantation and a minimum of 4 weeks follow-up. Surgical t-BCI. Change in aided pure tone average (PTA) after implantation. Secondary outcomes include average operative time, and adverse events. Twenty-three patients underwent implantation of the t-BCI via either a conventional or minimally invasive surgical approach. The most common indication for implantation was unilateral conductive hearing loss with a history of chronic otitis media. The mean operative time was 59 minutes. The mean preimplantation unaided air conduction PTA was 65 dB, and mean postimplantation was 27.2 dB. The mean change in PTA was 37.8 dB, which was significant ( p < 0.0001). There were 30.4% of the patients that suffered from adverse events, the most common of which were pain (8.7%) and device-related complications (13%). One major adverse event occurred, involving magnet displacement that impaired device activation and required reoperation for replacement. Forming the largest series of patients implanted with this t-BCI in the published literature, our data demonstrate that implantation of the device is feasible via either a traditional or minimally invasive surgical approach, with good audiometric benefit and a favorable safety profile.

Differing Bilateral Benefits for Spatial Release From Masking and Sound Localization Accuracy Using Bone Conduction Devices.

Objectives:Normal binaural hearing facilitates spatial hearing and therefore many everyday listening tasks, such as understanding speech against a backdrop of competing sounds originating from various locations, and localization of sounds. For stimulation with bone conduction hearing devices (BCD), used to alleviate conductive hearing losses, limited transcranial attenuation results in cross-stimulation so that both cochleae are stimulated from the position of the bone conduction transducer. As such, interaural time and level differences, hallmarks of binaural hearing, are unpredictable at the level of the inner ears. The aim of this study was to compare spatial hearing by unilateral and bilateral BCD stimulation in normal-hearing listeners with simulated bilateral conductive hearing loss.Design:Bilateral conductive hearing loss was reversibly induced in 25 subjects (mean age = 28.5 years) with air conduction and bone conduction (BC) pure-tone averages across 0.5, 1, 2, and 4 kHz (PTA4) <5 dB HL. The mean (SD) PTA4 for the simulated conductive hearing loss was 48.2 dB (3.8 dB). Subjects participated in a speech-in-speech task and a horizontal sound localization task in a within-subject repeated measures design (unilateral and bilateral bone conduction stimulation) using Baha 5 clinical sound processors on a softband. For the speech-in-speech task, the main outcome measure was the threshold for 40% correct speech recognition when masking speech and target speech were both colocated (0°) and spatially and symmetrically separated (target 0°, maskers ±30° and ±150°). Spatial release from masking was quantified as the difference between colocated and separated masking and target speech thresholds. For the localization task, the main outcome measure was the overall variance in localization accuracy quantified as an error index (0.0 = perfect performance; 1.0 = random performance). Four stimuli providing various spatial cues were used in the sound localization task.Results:The bilateral BCD benefit for recognition thresholds of speech in competing speech was statistically significant but small regardless if the masking speech signals were colocated with, or spatially and symmetrically separated from, the target speech. Spatial release from masking was identical for unilateral and bilateral conditions, and significantly different from zero. A distinct bilateral BCD sound localization benefit existed but varied in magnitude across stimuli. The smallest benefit occurred for a low-frequency stimulus (octave-filtered noise, CF = 0.5 kHz), and the largest benefit occurred for unmodulated broadband and narrowband (octave-filtered noise, CF = 4.0 kHz) stimuli. Sound localization by unilateral BCD was poor across stimuli.Conclusions:Results suggest that the well-known transcranial transmission of BC sound affects bilateral BCD benefits for spatial processing of sound in differing ways. Results further suggest that patients with bilateral conductive hearing loss and BC thresholds within the normal range may benefit from a bilateral fitting of BCD, particularly for horizontal localization of sounds.

Osseointegrated device placement with minimally invasive surgery: Experience and audiological outcome.

Objectives:To evaluate the clinical and audiological outcomes of percutaneous bone conduction device placement by minimally invasive Ponto surgery (MIPS).Methods:This was a retrospective descriptive study of patients who underwent MIPS from March-November 2019 at King Abdullah Ear Specialist Center, Collage of Medicine, King Saud University, Riyadh, Saudi Arabia. We reviewed all the clinical data of patients, including preoperative data, postoperative surgical results, and audiological performance (aided and unaided pure tone audiometry and aided and unaided speech tests).Results:A total of 9 patients with 10 implants were enrolled in this study. One patient underwent revision surgery because of infection and loss of the abutment. We followed the patients from 1-2 years, with a mean of 16.8 months. A significant difference was found between the unaided air conduction pure tone average, with a mean of 72.6±28.4 decibel (dB), and the postoperative aided threshold, with a mean of 20.8±12.2 dB/hectoliter (p=0.008), indicating a functional gain of 51.8 dB. The mean unaided speech discrimination at 65 dB sound pressure level was 34.7±24.8, which was significantly improved to 88.4±11.7 after implantation (p=0.007).Conclusion:minimally invasive Ponto surgery is a suitable minimally invasive surgical method for bone-anchored implant placement. This technique has an advantage in terms of skin sensitivity, cosmetic outcomes, and operative duration.

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.

Special Considerations for Tympanoplasty Type I in the Oncological Pediatric Population: A Case-Control Study.

IntroductionAlthough cutting-edges antineoplastic therapies increase survival in children with malignancies, the optimal surgical strategy to address associated comorbidities such as chronic tympanic membrane perforation is still poorly documented. The aim of this study is to evaluate the outcomes of type I tympanoplasty in pediatric cancer survivors who received chemo and/or radiotherapy to the skull and to identify potential associated risk factors.MethodsThis case-control study included medical records review of oncologic patients (age <21) treated at the same Academic medical oncologic center between March 2015 and July 2021 and referred for conductive hearing loss and chronic tympanic membrane perforation. Patients and middle ear status-related variables were analyzed, and outcomes were compared with matched peers without any history of malignancies.ResultsA total of seven pediatric cancer survivors and seven paired children without any history of malignancies were included in this report. The mean age at tympanoplasty type I surgery was 10.2 years (range = 4.3–19.9; median = 7.9 years) for the pediatric cancer survivors' group and 10.1 years (range = 5.5–19.2; median = 7.9 years) in the control group. Three pediatric cancer patients had received chemotherapy alone, one patient had radiotherapy to the skull base, and three patients had received chemoradiotherapy. On average, surgery was performed 3.9 years after chemo and/or radiotherapy termination, except for 1 patient for whom the tympanoplasty was performed during chemotherapy treatment. A retroauricular approach was used for one of the pediatric cancer patients, a transcanal approach was performed in one other and five patients benefited from an otoendoscopic approach. Tragal perichondrium with cartilage was used in most of the pediatric cancer survivor cases (four out seven cases) while xenograft (Biodesign) and Temporalis fascia without cartilage graft were used in five out of the seven control cases. Rate of tympanic membrane perforation recurrence was similar between groups (28.6%). Mean functional gain for air conduction Pure Tone Average (AC PTA) was 2.6 and 7.7 dB HL for the oncologic and control group, respectively. Mean postoperative air-bone gap (ABG) was 10.7 dB HL [median = 8.7; inter-quartile range (IQR) = 13.8] for the oncologic cohort and 10.1 dB HL (median = 10.7; IQR = 9.6) for the control group.DiscussionChemo- and chemoradiotherapy to the skull are associated with damages to the inner and middle ear structures with secondary eustachian tube dysfunction and chronic middle ear effusion. Although healing abilities and immunological defenses are compromised as part of the expected effects of antineoplastic therapies, type I tympanoplasty can be safe and effective in this population. While different approaches may be considered, otoendoscopy showed excellent results with less morbidity in this vulnerable population.

Tympanic membrane perforations: the importance of etiology, size and location.

The ability to predict the degree of a conductive hearing loss caused by a tympanic membrane perforation is important for every otologist, as it may require additional diagnostic tests and prevent unexpected intraoperative findings. The aim of this study was to correlate the various characteristics of a perforation (etiology, size, location, involvement of the manubrium or umbo) with the degree and frequency predominance of the consequent hearing loss. A transversal study in a tertiary hospital center was conducted between July 2019 and December 2020. Fifty-eight patients with 65 tympanic perforations underwent a comprehensive medical and audiological evaluation, which included an otoendoscopy. An image processing software (ImageJ®) was used to measure the perforated area. The qualitative variables were etiology, affected quadrants, presence of myringosclerosis and involvement of umbo or manubrium of the malleus. The air-bone gap was measured at 250, 500, 1000, 2000 and 4000Hz. Primary outcomes (mean air-bone gap and pure-tone average) were evaluated to find clinical factors associated with worse hearing. Data collected from 50 ears was included. Perforation size showed a positive statistically significant correlation with the air-bone gap (r = .508; p < .001) and pure-tone average (r = .375; p < .001). Higher air-bone gaps were found in perforations involving the posterior quadrants and the manubrium (p < .001 and p = .031, respectively). Inflammatory causes showed higher bone and air conduction pure-tone averages (p = .031 and p = .084, respectively) compared to traumatic or iatrogenic. An "inverted V" pattern of the air-bone gap, with the 2kHz frequency being the least affected, was a consistent finding. However, it was not due to the Carhart's notch in bone conduction. The conductive hearing loss resulting from a tympanic membrane perforation is etiology, size and location-dependent, with higher losses occurring for inflammatory backgrounds, large perforations and when the posterior quadrants or the manubrium are involved. If the "inverted V" is absent, additional middle ear pathology should be investigated.

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.

Endoscopic Over Under Cartilage Tympanoplasty Is Not Inferior to Underlay Cartilage Tympanoplasty.

Evaluate whether elevating the tympanic membrane from the malleus during endoscopic tympanoplasty may negatively affect postoperative hearing outcomes or perforation rates by comparing 2 similar endoscopic tympanoplasty techniques. Retrospective cohort. Tertiary care center. Endoscopic over-under cartilage tympanoplasties age and gender matched to endoscopic underlay cartilage tympanoplasties between January 2015 and January 2019. Exclusion criteria included preoperative or intraoperative cholesteatoma, performance of mastoidectomy or ossicular chain reconstruction, and lack of postoperative audiogram. Endoscopic cartilage tympanoplasty via over-under or underlay technique. Pre- and postoperative pure-tone average and word recognition score, graft success. A total of 52 patients were evaluated: 26 endoscopic over-under cartilage tympanoplasties were matched to endoscopic underlay cartilage tympanoplasties. Both groups demonstrated a statistically significant improvement in air conduction hearing (9 dB [P < 0.001] and 6 dB [P < 0.01], respectively), and bone pure-tone average did not worsen in either group (P < 0.001 and P < 0.05, respectively). Postoperative air conduction pure-tone average was statistically noninferior in the over-under group compared with the underlay group (P < 0.05). Reperforation was present in 3 patients (12%) in the underlay group and none in the over-under group, but this difference was not statistically significant (P = 0.24). Endoscopic over-under cartilage tympanoplasty effectively closes tympanic membrane perforations and improves hearing, without greater risk than underlay tympanoplasty. Elevating the tympanic membrane from the malleus does not confer worsen hearing outcomes.