Difference In Hearing Improvement Research Articles

Piston diameter in stapes surgery. Does it have a bearing?

Aims and Objectives: This prospective randomized controlled trial was done to study the effect of piston diameter on hearing outcomes after stapedotomy. Materials and Methods: All the patients diagnosed to have otosclerosis were included in the study. A total of 52 patients were studied ranging in age from 18 to 50 years. The subjects were randomized into two groups, that is, 0.4 mm piston (group A) and 0.6 mm piston (group B). The subjects were taken up for small fenestra stapedotomy using either a 0.4 or 0.6 mm piston. The main outcome measures were hearing improvement, air-bone gap closure, and overclosure of air-bone gap. Results: There was no statistical difference in hearing improvement in two different piston diameters, 0.4 and 0.6 mm at speech frequencies. In group A, the air-bone gap improvement in the third follow-up was not significant ( P > 0.05), whereas group B showed a statistically significant improvement ( P = 0.003). The mean overclosure of air-bone gap was better in patients with 0.4 mm piston at speech frequencies and also at 250 Hz. Significantly, overclosure of air-bone gap at higher frequencies (4 and 8 KHz) was seen only with a smaller sized piston. (0.4 mm). Discussion: We analyzed the effect of piston diameter on the hearing results after small fenestra stapedotomy by using similar surgical procedure and similar prosthesis in all patients. Conclusion: There is evidence to suggest that 0.4 mm piston may be better suited for providing optimum hearing results.

Outcomes of Cartilage Tympanoplasty in Pediatric Patients

Objective: To determine whether a relationship exists between successful outcomes of cartilage tympanoplasty and age at repair. Method: A retrospective chart review of patients between ages 4 and 13 who underwent cartilage tympanoplasty for tympanic membrane perforations from August 2005 to November 2011 was preformed. Demographics, complication data, and auditory outcomes were collected. Results: Patients were subdivided into 3 age groups. Group 1 consisted of patients less than 7 years of age (n = 43), group 2 ages 7 to 10 (n = 40), and group 3 ages 10 to 13 (n = 36). Mean follow-up was 595 days (range = 48-1742). Complication rates respective to the 3 groups were as follows: Eustachian tube dysfunction (ETD) or fluid causing a conductive hearing loss (9.3%, 10%, 5.6%), need for tympanostomy tubes (4.7%, 2.5%, 0%), remnant perforation (7%, 5%, 2.8%), and revision tympanoplasty (2.3%, 2.5%, 0%). Resolution of ETD or fluid on subsequent visits precluded tube placement. A 1-way analysis of variance (ANOVA) was performed to evaluate complication rates between groups. No significant differences were found (remnant perforation, P = .70, repeat tympanoplasty, P = .64, tympanostomy tubes, P = .42, and ETD or fluid, P = .76). Improvement in pure tone average was 10.23, 12.5, and 3.95, respectively. Conclusion: A trend for slight increase in complications in children under the age of 10 was found but was not statistically significant. There were significant group differences in hearing improvement with younger patients demonstrating better outcomes. The implications for these findings will be discussed. These data suggest cartilage tympanoplasty can be performed effectively in young children when appropriate conditions exist.

Effect of the use of dry (rigid) or wet (soft) temporal fascia graft on tympanoplasty.

The aim of this study was to research the advantages and disadvantages of using a wet or dry temporalis fascia graft in myringoplasty surgery. Randomized prospective study. Teaching and research hospital. Dry graft was used in 210 cases, and wet graft was used in 174 cases in 384 patients who underwent tympanoplasty. (1) Rate of primary closure of perforation, (2) rate of recurrent and residual perforation, (3) difference in hearing improvement between the two groups, (4) total operation time and graft placement time, and (5) histologic properties of wet and dry fascia grafts. The success rate was 91.4% (159 of 174) in the wet graft group and 88.6% (186 of 210) in the dry graft group. There were no differences between groups regarding recurrent disease, residual disease, and postoperative hearing results (p > .05). The mean operation time and graft placement time were shorter in group 2 (wet graft), and this difference was found to be statistically significant (p < .01). Histologically, the number of fibroblast nuclei was higher in group 2 (wet graft), and this was statistically significant (p < .01). The temporal fascia graft has a high success rate regardless of its use, either wet or dry. Using wet grafts can shorten the operation time and result in a high number of fibroblast nuclei histologically.

Randomized, double blind, placebo controlled trial on the safety and efficacy of continuous intratympanic dexamethasone delivered via a round window catheter for severe to profound sudden idiopathic sensorineural hearing loss after failure of systemic therapy

To study the safety and efficacy of continuous intratympanic dexamethasone-phosphate (Dex-P) for severe to profound sudden idiopathic sensorineural hearing (ISSHL) or sudden idiopathic anacusis after failure of systemic therapy. Randomized, double-blind, placebo controlled multicenter trial. Patients with ISSHL and insufficient recovery (mean 4PTA = 97 dB HL) after systemic high dose glucocorticoid therapy received either Dex-P (4 mg/ml) or placebo (NaCl 0.9%) continuously applied for 14 days into the round window niche via a temporarily implanted catheter. For ethical reasons, intratympanic treatment was continued with Dex-P in all patients for another 14 days after the placebo-controlled study period. According to a two-step adaptive study design an interim analysis was performed after inclusion of 23 patients. Intention-to-treat analysis for the primary outcome criterion (4PTA: 0.5-3 kHz) during the placebo controlled study period (14 days) showed an average hearing improvement in the treatment group of 13.9 dB (SD: 21.3) and in the placebo group of 5.4 dB (SD: 10.4). This difference in hearing improvement between the two groups (mean: 8.4 dB, SD: 17.0, 95% CI: -7.1-24.1) was statistically not significant (p = .26). Of the secondary outcome parameters, the largest benefit of local salvage therapy was found for maximum speech discrimination with an improvement of 24.4% (SD: 32.0) in the treatment and 4.5% (SD: 7.6) in the placebo group (p = 0.07). After a 3 month follow-up period (i.e. after all patients received intratympanic Dex-P) hearing improvement in the two groups was very similar. No serious adverse events were observed. Sample size calculation after the interim analysis resulted in stopping of the trial. The tendency toward better hearing improvement in the treatment group, the rather conservative inclusion criteria, the limited placebo-controlled observation period and the absence of serious adverse events supports further investigation local inner ear drug delivery as a first or second line treatment option for ISSHL.

Cortical mastoidectomy in quiescent, tubotympanic, chronic otitis media: is it routinely necessary?

This study aimed to compare outcomes for mastoidotympanoplasty and for tympanoplasty alone in cases of quiescent, tubotympanic, chronic, suppurative otitis media. Single-blinded, randomised, controlled study within a tertiary referral hospital. Sixty-eight cases were randomly allocated into two groups. In group one, 35 ears underwent type one tympanoplasty along with cortical mastoidectomy. In group two, 33 ears underwent type one tympanoplasty alone. Outcome measures were as follows: perforation closure and graft uptake, hearing improvement, disease eradication, and post-operative complications. There were no statistically significant differences in hearing improvement, tympanic perforation closure, graft uptake or disease eradication, comparing the two groups at three and six months post-operatively. Mastoidotympanoplasty was not found to be superior to tympanoplasty alone over a short term follow-up period. Hence, it may not be necessary to undertake routine mastoid exploration at this stage of disease.

Urografin in the Treatment of Sudden Sensorineural Hearing Loss

The present study was conducted to find out whether combined treatment of intravenous urografin and corticosteroid has a therapeutic advantage over oral corticosteroid therapy in the treatment of Sudden Sensorineural Hearing Loss (SSNHL). The design of the study was an interventional and controlled clinical trial. Between 2003 and 2005, patients with SSNHL were treated in our center in Tabriz, Iran. Patients were selected if they had a hearing loss of at least 30 dB in at least 3 frequencies on audiometric testing. Audiograms were performed before admission, 1 and 2 weeks and 1 and 2 months after treatment. Patients who were put on bed rest and received intravenous urografin and hydrocortisone were compared with outpatients treated with oral steroid alone. Various descriptive analytical calculations and both Chi-square and t-test were used to analyze the data. Sixty patients were included in this study. Fifty-one patients referred to the otological clinics for the appropriate treatment within the first two weeks after the onset of hearing loss. The overall improvement of both groups was 53.3%. Seventeen (56.6%) of 30 patients treated in the inpatient group who received intravenous urografin and intravenous corticosteroid had hearing improvement, while half of the outpatient group received oral corticosteroid responded positively to the treatment (p > 0.05). This study revealed no significant difference in hearing improvement between the hospitalized patients who received intravenous urografin and corticosteroid and the patients who received oral corticosteroid alone.

Myringoplasty: surgical outcomes and hearing improvement: is it worth performing to improve hearing?

The purpose of our study was to determine the success rate of myringoplasty in adults and children and to examine whether the hearing improvement is a potential indication for surgery. We performed a 6-year prospective audit study in a cohort of patients undergoing myringoplasty at the University Teaching Hospital, Department of Otolaryngology and Head and Neck Surgery. Two hundred and eleven patients who underwent myringoplasties were included in the study. All were performed by a postaural approach using autologous temporalis fascia and underlay technique. The total success rate, in terms of graft uptake at 3-6 months, was 91.5% and an overall hearing improvement was achieved in 91.5% of cases. This was statistically significant (P < 0.001). Only weak correlation was found between hearing improvement and age (Pearson's r = 0.175, P = 0.024), and there was no significant difference in hearing improvement across gender (P = 0.164), size (P = 0.198) or site (P = 0.447) of the perforation. Myringoplasty is an operation that can improve hearing in many cases independently of age, gender and the size and site of the perforation. Patients who undergo myringoplasty should be advised whilst been consented that there is a good chance of hearing improvement.

Modified stapes prosthesis to limit postoperative vertigo

To investigate the anatomic relationship between utricle, saccule, and stapes footplate, and adapt the stapes prosthesis tip to reduce postoperative vertigo. Five temporal bones were serially sectioned and stained, and the distance from the inner lining of stapes footplate to saccule and utricle, respectively, were measured. The Fisch prosthesis was modified with a slope of 45 degrees at its tip to adapt to the anatomic configuration of the vestibule. Fisch's original piston or the modified piston was used in 174 ears (Group I) and 108 ears (Group II), randomly. There was no statistically significant difference in hearing improvement between the 2 groups (P > 0.5). However, postoperative vertigo was significantly reduced when the modified prosthesis was inserted (P < 0.005). The modified piston improved the hearing to the level of the original piston, and the incidence of postoperative vertigo was significantly decreased. A modified prosthesis is presented for a patient undergoing stapedotomy.

糖尿病をともなった突発性難聴

212 patients diagnosed with sudden deafness between October, 1978 and April, 1998 were reported in our department. In order to clarify the relationship between sudden deafness and diabetes mellitus, the treatment course of 18 patients with sudden deafness, who were affected by diabetes, was analyzed retrospectively. The patients with sudden deafness were divided into two groups (diabetic and non-diabetic) and were analyzed. The following results were obtained:1) The mean age of patients in the diabetic group was 51.8 years, approximately 8 years older than the non-diabetic group. The number of patients with diabetes mellitus increased markedly in the last 10 years.2) There was no significant difference in hearing improvement after treatment as well as in hearing levels between the two groups.3) The rate of patients with dizziness or vertigo in the diabetic group was significantly higher than in the non-diabetic group. The patients with dizziness or vertigo showed a poorer prognosis in their hearing loss.4) There was no relationship between the duration of diabetes and the prognosis of hearing loss. The patients with retinopathy due to diabetes tended to show less hearing improvement.5) Steroid therapy for sudden deafness patients with diabetes was executed without worsening the diabetic condition if insulin was administered adequately.

Infusionstherapie bei Hörsturz - Reduktion des Juckreizrisikos nach Hydroxyethylstärke (HES) unter Erhalt des Therapieerfolges - eine prospektive randomisierte Studie*

A Prospective Randomized Study: The aim of the study was to demonstrate the effectiveness of two different treatment schemes with hydroxyethyl starch (HES) and the incidence of pruritus as a side effect in a population of patients with sudden sensorineural hearing loss and hematocrit values above 44% and/or hemoglobin values above 14 g/dl. Under these circumstances we found a significant hearing improvement with infusions of 500 ml 10% HES 200/0.5 compared to saline infusions in a previous double-blind placebo-controlled study. Two groups are compared in a prospective randomized study. Group 1 was treated with infusions of 250 ml 10% HES 200/0.5 and group 2 with 500 ml of the same substance (n = 200). No difference in hearing improvement was detected between the two groups. The results were significantly better than with saline infusions. Eleven percent of the patients in group 1 developed pruritus and 38% in group 2. The incidence of pruritus correlated with the cumulative dosage of HES given. A correlation between allergic disposition and pruritus could not be found. Therefore, we suggest infusions with 250 ml 10% HES 200/0.5 per day for patients with sudden sensorineural hearing loss and hematocrit values above 44% and/or hemoglobin values above 14 g/dl. Indications for a long lasting HES-therapy should be restrictive. The effectiveness of HES has not been yet demonstrated in patients with lower hemoglobin and hematocrit values.

グリセロール・テスト陽性率の時間的変動

To determine the adequate evaluation time of the glycerol test, the time course of the pure-tone threshold was investigated before and after (1, 2 and 3 hours) glycerol intake in 54 patients who showed a positive reaction to the glycerol test.The incidence of positive reaction was 74% at 3 hours after glycerol intake and this value was the highest during the 3 hour observation. There were, however, 14 patients who exhibited positive results only at 1 or 2 hours after glycerol intake. The results of the glycerol test in these patients would be evaluated as negative if evaluated only at 3 hours as is usually done. Thus, the hearing test should be performed every hour for 3 hours after glycerol intake.Analysis of the hearing threshold at each frequency tested (0.125 to 8kHz), revealed that threshold improvement was greatest in the middle frequency range and smallest at high frequencies. The cause of these differences in hearing improvement was unclear. Further study is necessary to clarify it.