Decrease In Air-bone Gap Research Articles

Audiometric outcomes following surgery for spontaneous temporal bone cerebrospinal fluid leaks – A single institution study

PurposeTo assess the audiometric outcomes following surgical repair of spontaneous temporal bone cerebrospinal fluid otorrhea and compare different surgical approaches. Materials and methodsRetrospective review of adults (≥18 years old) who underwent repair of spontaneous CSF leak between 2011 and 2022. Audiometric outcomes were compared across the three surgical groups: transmastoid, middle cranial fossa and combined. ResultsThirty-nine patients (40 ears) met the inclusion criteria (71.8 % females; mean age 59.77 +/− 12.4). Forty-two percent underwent transmastoid, 12.5 % middle cranial fossa and 45 % transmastoid-middle cranial fossa. Four patients (10 %) had recurrence, 3 in the transmastoid group and 1 in the combined approach. The mean change in air-bone gap (ABG) for all patients (postoperative-preoperative) was −7.4 (paired t-test, p-value = 0.0003). The postoperative ABG was closed in 28 (70 %) ears (postoperative ABG ≤ 15). The mean change in pure tone average (PTA) for all patients (postoperative-preoperative) was −4.1 (paired t-test, p-value = 0.13). The mean change in word recognition scores (WRS) for all patients (postoperative-preoperative) was −3 (paired t-test, p-value = 0.35). On multivariable analysis (controlling for site and reconstruction material), there was no significant difference in ABG, PTA and WRS change between surgical groups. ConclusionsTransmastoid, middle cranial fossa and combined approaches are all effective in treatment of spontaneous CSF leaks and all showed mean decrease in post-operative ABG. Transmastoid approach showed the greatest decrease in ABG and PTA (although middle cranial fossa approach shows the greatest decrease, when excluding profound hearing loss in a patient with superior canal dehiscence). Further studies comparing audiometric outcomes are needed.

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

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

Outcome of Interlay Type 1 Tympanoplasty for Large Central Perforation

Background: Perforation of the tympanic membrane may occur from various reasons. Most of these perforations heal spontaneously, whereas the remaining long-standing perforations that lead to recurrent ear discharge need tympanoplasty. Interlay Type 1 Tympanoplasty,a newer technique has shown promising results with higher success ratein terms of hearing gain and graft uptake.
 Objective: To analyze the results of interlay Type 1 Tympanoplasty in terms of graft uptake and hearing improvement in cases of inactive mucosal chronic otitis media (COM) with large central perforation.
 Methods: This is a prospective study of 24 months (January 2018 to December 2019) duration conducted in department of E.N.T, Khulna medical college, Khulna and data was collected from the 60 patients admitted for tympanoplasty. Results were calculated in terms of graft accepted or rejected and decrease in air bone gap.
 Result: The graft uptake rate in the present study was found to be 91.67% and the patients reported an improvement in terms of hearing. Pre operatively mean air bone gap was 26.5dBand post operatively after 12 weeks mean air bone gap improved to 17.58dB.
 Conclusion: Interlay Type 1 Tympanoplasty is an effective technique over conventional methods in terms of both graft uptake as well as hearing improvement in large central perforation.
 Bangladesh J Otorhinolaryngol; April 2021; 27(1): 86-91

A study to assess hearing improvement after fat graft myringoplasty

<p class="abstract"><strong>Background:</strong> Tympanic membrane perforations result mainly from infectious and traumatic etiologies. Postoperative outcomes of reconstructive surgeries of hearing mechanism have routinely been assessed by take up rates and air bone gap closure on pure tone testing. The present study was conducted to assess hearing improvement after fat graft myringoplasty.</p><p class="abstract"><strong>Methods:</strong> The present prospective study was conducted from 1<sup>st</sup> January 2017 to 30<sup>th</sup> June 2018. The study population consists of patients of age 18 to 60 years. The subjects with safe or tubotympanic type of chronic suppurative otitis media with small dry central perforation or perforation of the pars tensa less than 3 mm were included in the study. Pure tone audiometry (PTA) was consigned to an audiologist who was blind to the study. Air conduction threshold level was measured at frequencies 0.25 to 8 kHz and bone conduction threshold level was measured at frequencies 0.5 to 4 kHz; average air bone gap of each patient was calculated preoperatively and postoperatively at one and three months at the frequencies 500 Hz, 1000 Hz and 2000 Hz. </p><p class="abstract"><strong>Results:</strong> Among 30 patients, 15 (50.00%) had pre-operative bone conduction threshold in the range of 0-10 dB HL and rest 15 (50.00%) had between 11-20 dB HL. Majority of them i.e. 20 had post-operative air bone gap in the range of 0-10 dB HL whereas 02 had pre op air bone gap in this range, followed by 07 with air bone gap in the range of 11-20 dB HL as compared to 18 in the pre op and 03 in the range of 21-30 dB HL as compared to 10 in the pre op. Paired t test reveals results are significant.</p><p class="abstract"><strong>Conclusions:</strong> Postoperative audiometry at the end of 1 month revealed majority i.e. 14 had air bone gap in range of 0-10 dB HL thus showing improvement in hearing. Postoperative audiometry at the end of 3 months revealed maximum number of patients i.e. 20 in the range of 0-10 dB HL which showed further improvement in hearing in the form of decrease in air bone gap.</p><p class="Default"> </p>

Factors Affecting Success and Results of Cartilage-Perichondrium Island Graft in Revision Tympanoplasty

RESULTS: Thirty-three cases, 14 females and 19 males with mean age 37.5±12.7, were included in the study. Ossiculoplasty was performed in 8 cases, and mastoidectomy was added to tympanoplasty in 12 cases. Tympanic membrane was intact in 29 cases (87.4%) in the 12th postoperative month. Large perforation, adhesive tympanic membrane, and especially hypertrophic middle ear mucosa were found to have negative impact on success of graft (p<0.01). The success of graft in patients with mastoidectomy was lower than without mastoidectomy (p<0.001). Age (p=0.491), gender (p=0.567), surgical approach (p=0.378), and the number of operations (p=0.283) did not contribute to the success of the graft. Average improvement of postoperative air conduction hearing threshold was 13.2±5.5 dB, and average decrease in air bone gap was 11.7±5.5 dB. CONCLUSION: Postoperative closure rate of the tympanic membrane was high and audiologic improvement was satisfactory with cartilage-perichondrium island graft in revision tympanoplasty. Cartilage-perichondrium island graft may be preferred for reconstruction of the tympanic membrane because of its resistance to inflammation and poor feeding in revision tympanoplasty.

A Comparative study of the techniques of Myringoplasty - Overlay Underlay &amp; Interlay

Background: Myringoplasty is a surgical technique used to restore the integrity of tympanic membrane and to improve hearing level. Objective: To compare the three surgical modalities for Myringoplasty - Overlay, Underlay and Interlay in cases of Chronic Suppurative Otitis Media with Inactive Mucosal Disease in large central perforation. Material and Methods: This is a prospective study of 18 months (January 2013 to June 2014) duration conducted in department of E.N.T, Era’s Lucknow Medical College, Lucknow and data was collected from the 90 patients admitted for Myringoplasty. 30 in each group. Results were calculated in terms of graft accepted or rejected and decrease in air bone gap. Result: Maximum number of graft rejection were observed in Overlay 5/30 and minimum in Interlay 2/30. Post operatively after 16 weeks mean air bone gap was maximum reduced in Interlay and minimum in Overlay Myringoplasty. Conclusion: The present study showed that Interlay technique had a better graft take and hearing improvement in large central perforation of Chronic Suppurative Otitis Media.

KTP laser stapedotomy with a self-crimping, thermal shape memory Nitinol piston: follow-up study reporting intermediate-term hearing

The aim of this study was an evaluation of the mid-term hearing results after the implantation of a self-crimping heat memory Nitinol piston in stapes surgery. The 12-month postoperative results were compared with those at a minimum of 3 years (maximum 6.7, average 4.4 years). The medical records of all 44 patients who underwent surgery with a Nitinol piston for stapes fixation between November 2005 and January 2007 were evaluated retrospectively. The prostheses used in all cases measured either 4.5 or 4.75 × 0.6 mm. We hypothesized that the 12-month postoperative hearing results would be permanent after an average follow-up of 4.4 years. Thirty-two of the 44 consecutive patients were females and 12 were males. Their mean age was 40.4 years (range 27-69). All underwent a 12-month postoperative audiometric evaluation. 38 (30 females, 8 males, average age 45, range 28-77 years) of the 44 were available for mid-term 4.4-year (minimum 3 years, maximum 6.7 years) postoperative audiometric evaluation. The mean air-bone gap (ABG) for the frequencies 0.5, 1, 2 and 3 kHz at the 12-month postoperative follow-up was 11 dB (SD 4.1) and that after an average 4.4-year postoperative evaluation was 6.4 dB (SD 3.6). The mean decrease in ABG after 12 months was 19.5 dB, and that after the average 4.4 years was 21.3 dB. ABG closure within 10 dB was achieved in 77.2 % after 12 months and in 89.5 % after the average 4.4 years. No patient with an ABG > 20 dB was recorded after the average 4.4 years. The mean air conduction threshold at 4 kHz was examined pre and postoperatively so as to indicate any possible inner ear damage. At the 12-month follow-up, the difference between the pre and postoperative values was -2.5 dB, whereas after the average 4.4 years the difference was surprisingly +13 dB. The individual AC improvements were also demonstrated with the use of Amsterdam Hearing Evaluation Plots (AHEPs). The Nitinol prosthesis allowed excellent intraoperative handling and no postoperative complication was reported. As compared with conventional stapes prostheses, the Nitinol-based SMart prosthesis is a safe and reliable stapes prosthesis. Our mid-term audiometric evaluations revealed that the audiometric parameters demonstrated a hearing improvement between the postoperative 12-month and average 4.4-year examinations. We consider the elimination of manual crimping and the use of a "non-touch" hand-held laser technique has a positive impact on the mid-term audiometric results. Most of the previous studies presented only relatively short-term (from 6 weeks up to 6-12 months) audiometric evaluations. Complications are rare, but a longer follow-up is needed to establish the long-term stability.

Ossiculoplasty for Monocrural Stapes Anomaly

Congenital anomalies of ossicle in the middle ear are rare and could appear in various forms. The most common congenital isolated ossicular anomalies are stapes fixation and incudostape dial discontinuity, with isolated congenital stapes fixation representing about one third of ossic ular malformations. We present a rare case of monocrural anomaly of unilateral stapes in a 36-year-old woman with nonprogressive conductive hearing loss. During explotympanotomy, the lateral half of the suprastructure of anomalous stapes was removed and sculptured total ossicular replacement prosthesis was fitted between the long process of incus and remained sta pes. Postoperative pure tone audiogram showed a significant decrease in air-bone gap. We report this case with a review of literature. � Korean J Otorhinolaryngol-Head Neck Surg 2013;56:448-51 Key WordsZZConductive hearing loss ㆍCongenital abnormalities ㆍStapes ㆍSurgical procedures.

Postoperative Results of Tympanoplasty with Mastoidectomy in Elderly Patients with Chronic Otitis Media

We evaluated the long-term results of tympanoplasty with mastoidectomy in elderly patients with chronic otitis media (COM). We included 192 patients with intractable COM who underwent both tympanoplasty and mastoidectomy from the same surgeon between January 2003 and December 2006 and were followed up for more than 3 years. The patients were divided into two groups: an "old COM group" of 83 patients (more than 65 years of age) and a "young COM group" of 109 patients (between 21 and 40 years of age). We compared the preoperative and postoperative levels of hearing, the types of tympanoplasty and mastoidectomy, and the postoperative complications of the two groups. Among the old COM group, 11 patients (13.3%) showed temporary postoperative complaints without serious sequelae. Between the old and young COM groups, there were no significant differences in the rates of associated cholesteatoma, middle ear swab culture results, or type of tympanoplasty, ossiculoplasty, and mastoidectomy. In the comparison of postoperative hearing improvement, both the old and young COM groups showed a significant decrease in airbone gap, although the old COM group showed a significantly worse preoperative air-bone gap. There were no significant differences in the rates of re-perforation of the tympanic membrane or of reoperation between the two groups. From this study, we conclude that there is no reason to withhold surgery for COM on the assumption that older patients do not have good results or that the procedure is too risky.

High-pass masking in the classification of low-frequency hearing loss.

Invalid BC determinations may be responsible for many diagnostic misinterpretations in the classification of low-frequency hearing losses. To reduce the influence from harmonic distortion, BC thresholds are determined during simultaneous, ipsilateral HP masking and composed with the conventionally obtained BC thresholds. Based on normative data a change of greater than or equal to 10 dB HL caused by HP masking is used as the criterion for judging the validity of the conventional BC testing. In 55% (11/20) of ears with low-frequency hearing loss, a decrease in air-bone gap was obtained with HP masking, and it is concluded that HP masking is of clinical significance for the diagnosis in these patients.