Conductive Type Of Hearing Loss Research Articles

Evaluation of oVEMP and cVEMP in Superior Semicircular Canal Dehiscence Cases

Superior semisircular canal dehiscence (SSCD) is a disease of the audiovestibular system, which occurs as a result of the lack of bone layer covering the superior semisircular canal. The disease forms a third window in the inner ear due to the lack of bone layer. The third window that occurs forms a pseudo conductive type of hearing loss, which has decreased bone thresholds in the audiometry test. Vestibular evoked myogenic potentials are an electrophysiological measurement method in which the responses of the neck or eye muscles to an acoustic stimulus are recorded by means of electrodes. The purpose of use is to evaluate the functions of the urticle and saccule, which are the vestibular end organs. Therefore its primary purpose is to diagnose semicircular canal dehiscence. This review is based on research from the last decade; diagnostic results of ocular vestibular evoked myogenic potentials (oVEMP) and cervical vestibular evoked myogenic potentials (cVEMP) tests were evaluated in cases of superior semicircular canal dehiscence (SSCD). Studies indicate abnormal decreases in cVEMP test thresholds on the affected side in SSCD cases. Additionally, a significant increase in oVEMP amplitude on the affected side has been reported. Results; It shows that evaluating these two tests together will contribute to the diagnosis of semicircular canal dehiscence cases.

Prevalence of Chronic Middle Ear Effusion in Cases of Cleft Palate.

Chronic middle ear effusion is generally present in children with cleft palate (CP) associated with or without cleft lips. The aim of our study was to assessment of how common middle ear effusion is in patients with cleft palates and to evaluate the presence of these symptoms by performing a Basic Audiological Evaluation (BAE). A retrospective randomized study was conducted on 50 children (29 male and 21 female) aged 2 to 16 years who had CPs (associated with or without cleft lips) with symptoms of middle ear effusion. The study was conducted from March 2021 to February 2022. Data review included the results of otoscopic findings and BAE. The Fundamentals of BAE comprise the testing of middle ear function with tympanometry and a pure tone audiometry to determine the kind and degree of hearing impairment. Regarding the BAE, we found that 70% of the children with normal hearing, 24% with conductive type of hearing loss, and 6% with mixed type of hearing loss. The tympanometric results revealed that 66% of the children with type A tympanogram, 24% with type C tympanogram, and 10% with type B tympanogram. The contralateral stapedial reflex was present in 60% of the patients while in 40% of cases not present. The results confirmed the great prevalence of chronic middle ear effusion in children with CPs. Furthermore, the hearing impairment associated with middle ear effusion was visible, demonstrating that middle ear effusion was linked with the prevalence of moderate conductive type of hearing loss. The OME in cases of CP necessitates early prediction and in turn early treatment.

A rare case of temporal bone chondrosarcoma

A rare case of lateral skullbase lesion, in a 24-year female, presented with moderately severe conductive type hearing loss, and facial paralysis. Audiological and radiological investigations were done which could not provide a reasonably certain diagnosis. So the patient was taken up for surgery. A subtotal pertrosectomy with blind sac closure was done. The histopathological analysis showed the lesion to be moderately differentiated chondrosracoma, an osseocartilagenous malignancy of the temporal bone. Due to rare nature, difficult location near vital structures, local invasiveness and potential for complications, diagnosis and treatment is difficult.

An Unusual Cause of Hearing Loss: Incudal Osteoma.

Osteoma is common in the temporal bone but extremely rare in the middle ear cavity and incus. Computed tomography plays an important role in the diagnosis of this slow growing benign osseous mass. The treatment of this lesion, which usually causes conductive type hearing loss, includes follow-up and surgery according to the patient's condition.

Computed tomography evaluation of temporal bone fracture and hearing loss: A narrative review with systematic analysis

In the modern world, the most common cause of head trauma causing temporal bone fracture in adults is road traffic accidents with high impact force. Hearing loss is one of the most common complaints after head trauma involving temporal bone fracture. Because of other life-threatening conditions associated with road traffic accidents, fractures of temporal bone is often overlooked. If these fractures are detected early, there complications can be avoided with conservative or surgical intervention. In this research following databases were used to search for published as well as unpublished studies over the period 2000–2021 in the English language: PubMed, EMBASE, and Web of Science. The terms used to generate a search were as follows: Temporal bone fracture and hearing loss. Those studies which did not fulfil the inclusion criteria were removed. Case reports, documentaries, and duplicate data were excluded. Most common cause of injury leading to temporal bone fracture was road traffic accident. Majority of cases were males belonging to the age group of 31–40 years and average age was 36 years. According to traditional classification, majority had longitudinal fracture followed by transverse fracture. According to newer classification, otic capsule sparing was more common in comparison to otic capsule involvement. The conductive type of hearing loss was more common and it was found associated with longitudinal fracture while sensorineural type of hearing loss was associated with transverse type of fracture. The conductive type of hearing loss was usually common in otic capsule sparing while sensorineural type of hearing loss is associated with otic capsule involvement. Otic capsule sparing is mostly seen in longitudinal fracture and transverse fracture involves otic capsule involvement. Head trauma due to fast moving vehicles is the most common cause of injury leading to temporal bone fracture. Because of complex structure of temporal bone identification of line of fracture is necessary which requires high-resolution computed tomography (CT) of the head. High-resolution CT not only helps in knowing anatomy and types of fracture but also it helps in knowing sequelae of various types of fractures which helps in treating physician weather to go for conservative or surgical intervention.

Otological Manifestations in Oral Submucous Fibrosis

Oral submucous fibrosis (OSMF) is a chronic and progressive disease where fibrous bands formed in the oral mucosa, resulting in severe restriction of movements of the jaw and also tongue. OSMF is one of the commonly seen potentially malignant disorders which can cause severe morbidity. It is prevalent in the Indian subcontinent. The exact etiology of OSMF is not known. Chronic irritation of the oral mucosa is thought to be the underlying etiology for OSMF. The common irritants are betel nut, tobacco, and chilies. The pathological changes not only affect mucosa and submucosa of the oral cavity and pharynx but also affect deeper parts with the involvement of underlying muscles. Atrophic and degenerative changes in the tubal and paratubal muscles of the eustachian tube, leading to eustachian tube dysfunctions. The eustachian tube dysfunction in OSMF results in different otological symptoms such as hearing impairment, otalgia, and fullness in the ear. Dysfunction of the eustachian tube in OSMF may be due to fibrosis in the palatal muscles, resulting in a conductive type of hearing loss. While treating OSMF, otological manifestations such as eustachian tube dysfunctions and hearing impairment have to be kept in mind and vice versa because managing hearing disability without taking care of OSMF will not be successful. All literature related to otological manifestations in OSMF were identified through Scopus, Google Scholar, Medline, and Pub Med and analyzed individually. This review article discusses the etiopathology, epidemiology, clinical manifestations, and management of the OSMF with otological manifestations.

Assessment of hearing loss in temporal bone fractures

Introduction: Thirty percent to seventy percent of skull fractures in adult head trauma patients is due to temporal bone fractures and is caused due to road traffic accidents (RTAs). Temporal bone fractures are more commonly associated with hearing loss. Objective: The objective of this study is to assess the type and the amount of hearing loss in temporal bone fractures. Methodology: A 3-month retrospective study was conducted at the department of ear, nose, and throat in a tertiary care center. Fifty patients, diagnosed as cases of temporal bone fractures with hearing loss were included in the study. The patients with temporal bone fractures were categorized into two groups-otic-capsule sparing (OCS) and otic-capsule violating (OCV) fractures, and hearing loss was evaluated with Pure tone audiogram (PTA). Results: OCS fractures were more common (64%) than OCV. Conductive type of hearing loss was commonly associated with OCS, whereas sensorineural hearing loss was more common in OCV fractures. The average degree of hearing loss ranged from 20 to 68 db. The correlation was statistically significant for temporal bone fractures (OCS and OCV) with respect to hearing loss (P < 0.00001). Other complications such as external auditory canal filled with blood, perforation of tympanic membrane, and hemotympanum were also observed in our study. Conclusion: Temporal bone fractures are most commonly due to RTAs and are frequently associated with severe brain injury. Classifying temporal bone fractures as OCS and OCV fractures correlates well with the severity of hearing loss, and conductive hearing loss was the most common type hearing loss.

Acoustic and Speech Perceptual Evaluation of health related Quality of Life among adults with Chronic Suppurative Otitis Media

Background: Chronic Suppurative Otitis Media, patients suffer from hearing loss causing communication problems and social withdrawal. Objective: To assess the acoustic iand speech perceptual evaluation iof health related quality of life among adults iwith Chronic Suppurative Otitis Media. Methodology: This cross sectional study was performed in ENT/Audiology Departments of District Headquarter Hospital, Hafizabad and Saqib Bashir General Hospital, Hafizabad, from March, 2015 to September, 2018, after the approval of synopsis. Covenient sampling method was used to induct 101 patients with Chronic Suppurative Otitis Media meeting inclusion criteria. Pure itone audiometry and speech audiometry were performed. A statement based questionnaire COMOT-15 was used to measure the scoring difference in cases. Results: The mean age of patients was 33±10 years and 53 (52.47%) were male. Out of 101 patients,the speech deficit was moderate in 7 (6.93%) patients, moderately severe in 19 (18.81%), severe in 42 (41.58%) and speech deficit was profound in 33 (32.67%) patients. There were 10 (9.90%) patients with conductive type of hearing loss, 91 (90.09%) with mixed type of hearing loss. Chronic Otitis Media Outcome Test-15 (COMOT-15), overall score was between 41-50 in 11 (10.89%) patients, 51-60 in 62 (61.38%) patients and Chronic Otitis Media Outcome Test-15 (COMOT-15) overall score was between 61-70 in 28 (27.72%) patients. Conclusion: This study showed that speech deficit was severe to profound in majority of patients with Chronic Suppurative Otitis Media. Mixed type of hearing loss is commonest type of deafness and very high scores were observed on COMOT-15 scale, which reflects a significant impairment in quality of life.

Hemifacial Microsomia Review: Recent Advancements in Understanding the Disease.

Hemifacial microsomia (HFM) is the second most common congenital disability of the face, with a prevalence of 1 in 3000 to 5600 live births. Although etiology is still not fully understood, including both genetics and environmental factors, the latest reports indicate the prominence of premature loss of the neural crest cells. What is more, a deficit of muscles of mastication, except the masseter, correlates in the pathomechanism of mandibular underdevelopment. Due to the significant phenotypic diversification, the typical picture of HFM cannot be determined. It may present as an esthetic concern-minor asymmetry with deformed auricle, and on the contrary, as microtia/anotia with conductive type hearing loss, hypoplastic mandible, and microphthalmia, impairing patient's daily activities. Referring to psychosocial problems, it has been proved that in population with HFM, there is a modestly elevated risk for behavior problems, social competence, and less acceptance. Over the years, more comprehensive methods of assessing the extent and severity of the HFM as the OMENS (+) classification have emerged. The authors like to summarize and present for plastic surgery resident and plastic surgeons the critical features of HFM, including the epidemiology, clinical presentation, pathogenesis, and innovative management reported in the current literature.

Hearing Loss In Chronic Suppurative Otitis Media (CSOM)

Objectives: To evaluate the type and degree of hearing loss in CSOM and also to find out any relationship between the hearing loss and disease duration.
 Methods: This was a cross sectional study which was carried out in the departments of Otolaryngology and Head-Neck Surgery of BSMMU and Dhaka Medical College Hospital during the period of July’2011 to December’2011. A total 80 cases of CSOM were collected. Patient below the age of 5 years and patients above the age of 50 years were excluded from this study. The diagnosis of CSOM was established on the basis of clinical examination- otoscopy and tunning fork test. Pure tone audiogram (PTA) was done for hearing assessment. Thus, 80 cases of CSOM were collected with their PTA reports of 117 ears.
 Results: The study included 80 patients of CSOM, of them 60 were with tubo-tympanic type and 20 were with attico-antral disease. Highest number of patients was in 2nd decade in both type of disease. 44.79% of ears of tubo-tympanic type were associated with mild (26-40 dB) hearing loss and 42.85% attico-antral variety was with moderate (41-55 dB) hearing loss. Conductive type of hearing loss was common in both types of disease. 98% of ears in tubotympanic and 81% of ears in attico-antral disease had conductive hearing loss. Mixed type (2.08%) of hearing loss was found in tubo-tympanic disease. Attico-antral disease was also associated with mixed (14.28%) and SNHL (4.76%).
 Conclusion: The above study revealed that hearing loss in CSOM is mostly conductive in nature rarely sensorineural in type.
 Bangladesh J Otorhinolaryngol; April 2017; 23(1): 59-66

Hearing status before and after Stapes surgery in otosclerotic patients

Background: Otosclerosis is a disease of the otic capsule that is characterized by resorption and redeposition of bony tissue. Stapes surgery has established its position as the primary treament of conductive hearing loss in otosclerosis. It is anticipated that the hearing level of approximately 90% of patients should improve after surgery.
 Objective: To evaluate the hearing status of an otosclerotic patient and compare their preoperative and postoperative hearing status.
 Methods: In this prospective study, 34 patients with otosclerosis from head-Neck Surgery department of Sir Salimullah Medical College & Mitford Hospital, Bangladesh ENT Hospital, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Period from January 2008 to December 2008. The patients were examined and hearing assessment after admission into the hospital pre-operatively and in the post-operative period.
 Results: In this study most of the cases were age group 21-30 years (50%), male (64-71%), middle socio economic condition (67-71%), rural (58-82%), primary educated (35-29%). It was observed that most common symptom was progressive deafness; duration of hearing loss was 2-5 years, pre-operative conductive type of hearing loss (50-55 dB). It was also observed that after surgery, hearing status were improved in 82.35% cases, the most of the patients were within 21-30 years age group.
 Conclusion: Stapedotomy obtaining closure of the air-bone gap to within 10dB of the preoperative bone conduction level in 90% of their patients. So, it is supperior to other procedures
 Bangladesh J of Otorhinolaryngology; October 2018; 24(2): 137-142

Do eyeglasses and palatal prostheses affect the results of the Weber test?

<p class="abstract"><strong>Background:</strong> The aim of the study was to analyze the possible effects of eyeglasses and palatal prostheses on the results of the Weber tuning fork test.</p><p class="abstract"><strong>Methods:</strong> We enrolled 96 patients diagnosed with unilateral conductive-type hearing loss. All were aged between 18 and 65 years. Group 1 was composed of 48 patients with eyeglasses and group 2 included 48 patients with palatal prostheses. All patients underwent the weber tuning fork test with and without their eyeglasses and prostheses, and the results were compared. Weber tests were performed using 256 Hz and 512 Hz tuning forks. </p><p class="abstract"><strong>Results:</strong> No significant between-group difference was apparent (both p>0.05).</p><p class="abstract"><strong>Conclusions</strong> Neither eyeglasses nor palatal prostheses significantly affected the results of the Weber test.</p>

To study the effect of site and size of tympanic membrane perforation on graft uptake rates and hearing improvement in type I tympanoplasty using sliced conchal cartilage reinforced with temporalis muscle fascia and temporalis muscle fascia alone

Aim: To study the effect of site and size of tympanic membrane perforation on graft uptake rates and hearing improvement in Type I tympanoplasty using sliced conchal cartilage reinforced with temporalis muscle fascia and temporalis muscle fascia alone. Materials and Methods: In this retrospective study, a total of forty patients presenting with dry central perforation with intact and mobile ossicular chain and conductive type of hearing loss, visiting the ENT outpatient department of Government Medical College, Amritsar, were included. They were randomly divided into two groups of twenty patients each, with Group I patients undergoing Type I tympanoplasty with temporalis muscle fascia and Group II patients with sliced conchal cartilage as graft reinforced with temporalis fascia. A pure-tone audiometry (PTA) was done within 1 week prior to the surgery and at 3 months postoperatively to evaluate the hearing status. Results: Overall graft uptake rate in Group I was 85%, whereas that in Group II was 95% (P 0.05). The hearing improvement was statistically insignificant between anterior and posterior perforations. Conclusion: From this study, we observed that size of the perforation is a major factor that influences graft uptake and hearing improvement results in Type I tympanoplasty using reinforced sliced conchal cartilage. Site of perforation failed to be a statistically significant influencing factor in this study.

Analysis of hearing loss by pure tone audiometry in patients with chronic suppurative otitis media

Background: Chronic suppurative otitis media (CSOM) are an infection of the middle ear and mastoid cavity. Hearing loss is a consequence of CSOM; the degree of hearing loss can be analyzed by audiometry. Aims and Objectives: The objective of the study is to analyze hearing loss by pure tone audiometry in patients with CSOM. Materials and Methods: A total of 32 patients between the age group of 10–40 years, with discharging ears of >12 weeks duration were examined in outpatient clinics of ENT Department of Al Azhar Medical College and super specialty hospital. Patients were subjected for audiometric examination to assess the hearing loss. Patients were categorized based on the degree of hearing loss into five group’s mild (26–40 dB), moderate (41–55 dB), moderately severe (56–70 dB), severe (71–90 dB), and profound (>90 dB), respectively. Results: Most of the ears (85.9%) had mild-to-moderate hearing loss. Conductive hearing loss was 87.5% and mixed hearing loss was 12.5%. Average air-bone gap (ABG) was found to be 30.7 dB and 30.65 and maximum ABG was 50 and 45 dB in the right ear and left ear, respectively. Conclusion: Patients had mild-to-moderate conductive type of hearing loss. If these patients are left untreated may progress in developing mixed hearing loss. Audiometry is an important screening and diagnostic tool for assessing the degree of hearing loss. It also gives an idea for proper planning for surgery in these patients and to prevent hearing disability.

The Effect Of Perioperative I.V. Corticosteroids On Hearing Outcome Following Stapedotomy

Objective: The purpose of this study is to investigate the effect of steroids on postoperative hearing outcome in patients with a clinical diagnosis of otosclerosis, who received intraoperative steroid treat ment during surgery for conductive-type hearing loss. Methods: Between January 2014 and January 2017, 106 patients, comprising 43 men (40.6%) and 63 women (59.4%) between the ages of 18-64 (mean age: 44.1 ± 11.5 years), who had been diag nosed with otosclerosis resulting in conductive-type hearing loss, were included in the study. The audiometric values obtained for patients who had received intraoperative intravenous steroids were analysed on a retrospective basis by comparing the pre- and post-operative sit uation. The group of all patients was then subdivided into two groups on the basis of whether or not they had received intraoperative ster oids. These groups were then evaluated in terms of pre- and post-op erative bone and air conduction levels and the differences investigated statistically. Results: Postoperative bone conduction averages for all the patients in both Group 1 and Group 2 were significantly improved at all fre quencies, except at 4000 Hz, compared to the preoperative mean val ue. However, there was no statistically significant difference observed between patients who did receive intra-operative single-dose IV corti costeroid injections and patients who did not receive IV corticosteroid injections group in terms of preoperative and postoperative air-bone conduction levels. Conclusion: It is not necessary routinely to administer systemic corti costeroids in order to prevent perioperative sensorineural hearing loss during surgery for otosclerosis. However, perioperative corticosteroids may be helpful in preventing sensorineural hearing loss when there are conditions present that can lead to inner ear damage during the operation.

Incidence and characteristics of Traumatic Tympanic Membrane perforation.

Objective:To determine incidence and characteristics of traumatic Tympanic Membrane perforation in a tertiary care hospital.Methods:This descriptive cross sectional study was conducted at the Department of ENT, MTI/LRH, Peshawar from August to December 2017. After well informed consent a detailed history was taken; thorough examination of ENT was carried out. Pure Tone Audiometry (PTA) of all included patients was performed by same senior audiometrician. The data were collected on predesigned proforma and were analyzed using SPSS (16 versionResults:This study included 48 patients; Male 34, Female 14 with Male: Female ratio of 2.24:1. The mean age was 26.75 ± SD 9.88 Years. Majority of the patients (24, 50%) were in 3rd decade of life. The commonest cause of perforation of tympanic membrane was slap (35, 72.9%). Perforation of the Tympanic membrane was found more on left side (24, 50%), involving anterio-inferior site (18, 37.5%), while medium sized perforation was frequent finding (27, 56.2%). Single perforation was commonest observation (45, 93.8%), conductive hearing loss was the most common finding (38, 79.2%), and mild degree hearing loss was commonest (24, 50%).Conclusion:Traumatic tympanic membrane perforation is common in young male. Slap was the commonest cause of traumatic perforation affecting left ear more than right ear. Inferior quadrant of the tympanic membrane was commonly involved and mild degree and conductive type of hearing loss was common.

Assessment of Hearing and Language Development in Individuals with Cleft Lip Palate

Objectives : Most children with cleft palate±lip have conductive-type hearing loss due to otitis media in the early years of life. Due to not presenting required interventions can affect language development negatively. In this study, we aimed to evaluate the hearing thresholds and determine the type of hearing loss and to evaluate the linguistic skills of children with cleft palate and lips without hearing loss. Materıals and Methods : The study was conducted in ENT, Audiology and Speech Disorders Department at Gazi University between April 2014 and June 2017. 30 patients who were between 2 to 20 years old, with cleft lip±palate were included in the study. First, hearing assessments were performed; if individuals had hearing loss, type of hearing loss were identified. Then, language assessments were made on 2-7 year old children who have no hearing loss. Results : Among individuals who had hearing loss (%30), 88% of cases had conductive type and 12% of them had sensorineural hearing loss. Receptive and expressive language assesment were conducted with 11 cases between the ages of 2 to 7. It was observed that 3 (%27) participants had receptive language delay and 7 (%63) had delays in expressive language skills. Conclusion : Regular otological and audiologic follow-up is important for children with cleft lip±palate. The high rate of language impairment in children with cleft palate ± lip without hearing loss indicated that the language development of these children needs to be assessed. The study reveals that these children must be monitored by a multidisciplinary team.

Hearing impairment in rural area of Himalaya: prevalence and etiology

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Hearing impairment is most frequent sensory deficit in human population. The disease burden estimations based on sound epidemiological research provide the foundation for appropriate public policy focus and measures for effective management of disease conditions. Data regarding the magnitude of hearing impairment in our country is limited and the literature search revealed that no such studies have been conducted in this region. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A community based cross sectional observational study was carried out among the 306 individuals in rural area of Shimla district, Himachal Pradesh. Information was obtained by a structured questionnaire, clinical ENT examination and audiological tests after obtaining informed consent. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The study group had 52.6% males and 47.4% females. Maximum 26.5% of individuals were in the age group of 31-45 years. Mean age was 36.56±18.83. The prevalence of hearing impairment was 16.7%. Among individuals with hearing loss, maximum 52.9% were in the age group of ≥60 years. Sensorineural hearing loss was found in 68.6%, maximum 56.9% had mild hearing loss. Among majority of individuals with hearing loss cause was presbyacusis 52.9% followed by infectious ear disease 33.3%.</span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">In the present study, prevalence of hearing loss was found to be 16.7% and predominantly mild sensorineural or conductive type of hearing loss. An early intervention and quality patient education is necessary for prevention of hearing impairment in majority of cases.</span></p>

Assessment of Patch Test in Predicting Ossicular Status in Chronic Otitis Media

Objectives: To assess the reliability of paper-patch test in predicting the intra-operative ossicular status of patients with tympanic th membrane perforation from small to medium size.
 Methods: This is a hospital based prospective study conducted from 30 April, st 2016 to 1 May, 2017 in the Department of Otorhinolaryngology of Nepalgunj Medical College Teaching Hospital. The patients of chronic otitis media with small to medium sized central perforation were subjected to complete history taking and thorough examination. Audiological evaluation was done before patching, then after patching the perforation with cigarette paper. The result was recorded to predict the ossicular status.
 Result: The most common age group affected by the disease was 20-30 years with 21(42%) patients. Most of them were females 28(56%). Left ear was affected more 19(38%) than right ear 16(32%) and bilateral 15(30%). All the patients had conductive type of hearing loss out of which moderate degree of hearing loss was present in 36(72%) and mild degree of hearing was present in 14(28%). Following patch test, the hearing improved and in 7(14%) of patients the hearing came to normalcy. Majority of patients had mild degree of hearing loss, i.e., 36(72%) and moderate degree of hearing loss was seen in 7(14%). It was found that in those patients in whom there was less improvement in hearing that i.e. less than 10 dB, the mobility of the ossicles was restricted intra-operatively.
 Conclusion: The type of hearing loss was conductive hearing loss out of which most common was moderate degree of hearing loss in 36(72%) followed by mild degree of hearing present in 14(28%). Following patch test, it was found that in those patients in whom there was less improvement in hearing i.e., less than 10 dB,ossicular discontinuity was noted intra-operatively and thus ossicular reconstruction by tympanoplasty procedures had to be undertaken.

Auditory changes in acromegaly.

The aim of this study is to determine the changes involving auditory system in cases with acromegaly. Otological examinations of 41 cases with acromegaly (uncontrolled n=22, controlled n=19) were compared with those of age and gender-matched 24 healthy subjects. Whereas the cases with acromegaly underwent examination with pure tone audiometry (PTA), speech audiometry for speech discrimination (SD), tympanometry, stapedius reflex evaluation and otoacoustic emission tests, the control group did only have otological examination and PTA. Additionally, previously performed paranasal sinus-computed tomography of all cases with acromegaly and control subjects were obtained to measure the length of internal acoustic canal (IAC). PTA values were higher (p<0.001 for right ears and p=0.001 for left ears), and SD scores were (p=0.002 for right ears and p=0.002 for left ears) lower in acromegalic patients. IAC width in acromegaly group was narrower compared to that in control group (p=0.03 for right ears and p=0.02 for left ears). When only cases with acromegaly were taken into consideration, PTA values in left ears had positive correlation with growth hormone and insulin-like growth factor-1 levels (r=0.4, p=0.02 and r=0.3, p=0.03). Of all cases with acromegaly 13 (32%) had hearing loss in at least one ear, 7 (54%) had sensorineural type and 6 (46%) had conductive type hearing loss. Acromegaly may cause certain changes in the auditory system in cases with acromegaly. The changes in the auditory system may be multifactorial causing both conductive and sensorioneural defects.