Air Conduction Gain Research Articles

Evaluating the benefits and outcomes of second ear surgeries in bilateral stapedectomies: a comprehensive analysis

Background: Objectives of the study were to evaluate the anatomical abnormalities and benefits of second ear surgery in patients with bilateral otosclerosis undergoing stapedectomy. Methods: A descriptive retrospective study was done in 43 patients undergoing bilateral stapedotomy in a tertiary care centre. Anatomical abnormalties presenting intraoperative were recorded in both operated ears. Hearing outcomes after the first and second ear surgeries were recorded. Chi square and paired t test was used to find the association between categorical and continuous variables between both groups. We correlated the post-operative air conduction (AC) averages, air bone gap (ABG) gain, AC gain between first and second operated ears. Results: Obliterative FP was the most common abnormality seen 7%, followed by facial nerve anamolies 5%. Bilateral variations were seen in 66% and 60% respectively. 66% required bilateral drill outs. After 1st ear and 2nd ear surgery 81% and 76% gained normal hearing. Average postop AC threshold was significantly higher after first ear surgery (p<0.001). ABG and AC gain had no significant difference in both ears. Binaural symmetrical hearing with inter aural difference AB<10 dB was achieved in 90% of patients. Conclusions: It is worthwhile to recommend the patients to undergo contralateral ear surgery if the first ear had achieved normal or socially acceptable hearing, as the chances of achieving a comparable hearing outcome as that of 1st ear is high. Following 2nd ear surgery an effective binaural symmetric hearing can be achieved.

The effect of piston diameter in primary stapes surgery on surgical success

PurposeTo evaluate the effect of piston diameter in patients undergoing primary stapes surgery on audiometric results and postoperative complications.MethodsA retrospective single-center cohort study was performed. Adult patients who underwent primary stapes surgery between January 2013 and April 2022 and received a 0.4-mm-diameter piston or a 0.6-mm-diameter piston were included. The primary and secondary outcomes were pre- and postoperative pure-tone audiometry, pre- and postoperative speech audiometry, postoperative complications, intraoperative anatomical difficulties, and the need for revision stapes surgery. The pure-tone audiometry included air conduction, bone conduction, and air–bone gap averaged over 0.5, 1, 2 and 3 kHz.ResultsIn total, 280 otosclerosis patients who underwent 321 primary stapes surgeries were included. The audiometric outcomes were significantly better in the 0.6 mm group compared to the 0.4 mm group in terms of gain in air conduction (median = 24 and 20 dB, respectively), postoperative air–bone gap (median = 7.5 and 9.4 dB, respectively), gain in air–bone gap (median = 20.0 and 18.1 dB, respectively), air–bone gap closure to 10 dB or less (75% and 59%, respectively) and 100% speech reception (median = 75 and 80 dB, respectively). We found no statistically significant difference in postoperative dizziness, postoperative complications and the need for revision stapes surgery between the 0.4 and 0.6 mm group. The incidence of anatomical difficulties was higher in the 0.4 mm group.ConclusionThe use of a 0.6-mm-diameter piston during stapes surgery seems to provide better audiometric results compared to a 0.4-mm-diameter piston, and should be the preferred piston size in otosclerosis surgery. We found no statistically significant difference in postoperative complications between the 0.4- and 0.6-mm-diameter piston. Based on the results, we recommend always using a 0.6-mm-diameter piston during primary stapes surgery unless anatomical difficulties do not allow it.

Which is Better for Ossiculoplasty Following Tympanomastoidectomy: Polycel® or Titanium?

The purpose of this study was to compare the surgical outcomes of Polycel® and titanium in ossiculoplasty following tympanomastoidectomy (TM). A total of 221 patients underwent ossiculoplasty following TM by a single surgeon using either Polycel® or titanium as prosthesis. Hearing was tested preoperatively and postoperatively at 6 months by pure-tone audiometry. Successful surgery was defined if postoperative air-bone gap (ABG) was <20 dB, the gain in air conduction (AC) hearing was >15 dB HL, or postoperative AC was <30 dB HL. Multiple linear regression was conducted to identify the factors associated with the surgical outcomes. In canal wall up mastoidectomy (CWUM), both Polycel® and titanium showed favorable successful rates if partial ossicular replacement prosthesis (PORP) was used (64.3% of Polycel® and 67.6% in titanium). If total ossicular replacement prosthesis (TORP) was used, both represented similar outcomes (54.5% of Polycel® and 75.0% in titanium). In canal wall down mastoidectomy (CWDM), significant ABG reductions were observed only in the titanium group (5.2 ± 14.7 dB of Polycel® [P = .083] and 7.0 ± 14.2 dB of titanium [P = .002] in PORP; 4.6 ± 13.5 dB of Polycel® [P = .097] and 9.5 ± 11.2 dB of titanium [P < .001] in TORP). In multivariate analysis, titanium had a positive effect on the reduction of postoperative AC thresholds (B: -4.772; 95% CI: -8.706--0.838). Both Polycel® and titanium showed favorable surgical outcomes for ossiculoplasty following CWUM. Titanium prosthesis is recommended for surgery after CWDM.

Cartilage palisades versus temporalis fascia: a randomised control trial

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tympanic membrane perforation is a common cause of hearing loss. Various surgical techniques with different graft materials have been described for the treatment of perforations. The most widely used graft materials are the cartilage and temporalis fascia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We conducted a prospective randomised control longitudinal study to document the post operative hearing outcomes of type 1 tympanoplasty in patients with inactive mucosal chronic otitis media (n=120) using the cartilage palisades tympanoplasty technique (n=60) and temporalis fascia (n=60).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; It was found that the mean AB (air-bone) gap at 5 months post operatively was 12.35±7.17 dB with temporalis fascia and 11.39±7.907 dB in cartilage palisades tympanoplasty. At 12 months the AB gap was 14.98±9.915 dB in temporalis fascia group as compared 11.41±8.288 dB for cartilage palisades group. Thus, hearing improvement was better in cartilage palisades group, but interestingly the comparison of the air conduction gain and subjective improvement at the end of 5 and 12 months between the two techniques was not statistically significant and parallels the above findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Hence we conclude that both temporalis fascia and cartilage palisades were acceptable graft material for successful closure of tympanic membrane perforation.&lt;/p&gt;

Robot-Assisted Middle Ear Endoscopic Surgery: Preliminary Results on 37 Patients.

Background: Endoscopy during middle ear surgery is advantageous for better exploration of middle ear structures. However, using an endoscope has some weaknesses as surgical gestures are performed with one hand. This may trouble surgeons accustomed to using two-handed surgery, and may affect accuracy. A robot-based holder may combine the benefits from endoscopic exposure with a two-handed technique. The purpose of this study was to assess the safety and value of an endoscope held by a teleoperated system.Patients and Methods: A case series of 37 consecutive patients operated using endoscopic exposure with robot-based assistance was analyzed retrospectively. The RobOtol® system (Collin, France) was teleoperated as an endoscope holder in combination with a microscope. The following data were collected: patient characteristics, etiology, procedure type, complications, mean air and bone conduction thresholds, and speech performance at 3 months postoperatively. Patients had type I (myringoplasty), II (partial ossiculoplasty), and III (total ossiculoplasty) tympanoplasties in 15, 14, and 4 cases, respectively. Three patients had partial petrosectomies for cholesteatomas extending to the petrous apex. Finally, one case underwent resection of a tympanic paraganglioma. Ambulatory procedures were performed in 25 of the 37 patients (68%).Results: Complete healing with no perforation of the tympanic membrane was noted postoperatively in all patients. No complications relating to robotic manipulation occurred during surgery or postoperatively. The mean air conduction gain was 3.8 ± 12.6 dB for type I (n = 15), 7.9 ± 11.4 dB for type II (n = 14), and −0.9 ± 10.8 for type III tympanoplasties (n = 4), and the postoperative air-bone conduction gap was 13.8 ± 13.3 dB for type I, 19.7 ± 11.7 dB for type II and 31.6 ± 13.0 dB for type III tympanoplasty. They was no relapse of cholesteatoma or paraganglioma during the short follow-up period (<1 year).Conclusion: This study indicates that robot-assisted endoscopy is a safe and trustworthy tool for several categories of middle ear procedures. It combines the benefits of endoscopic exposure with a two-handed technique in middle ear surgery. It can be used as a standalone tool for pathology limited to the middle ear cleft or in combination with a microscope in lesions extending to the mastoid or petrous apex.

Experience in endoscopic stapedotomy technique and its audiological outcome: a case series

BackgroundStapedotomy is being performed endoscopically for otosclerosis in Sudan since 2011 with increasing number of patients. This prospective hospital-based study from Nov 2016 to Nov 2020 states the clinic-demographic features of otosclerosis; it describes this surgical technique and hearing outcome following endoscopic stapedotomy.ResultsTotal number included in the study was 91 patients. Females were 48, and males were 43 with a female to male ratio of 1.1:1. Age ranged from 19 years to 52 with a mean age of 30.6± 7 SD years. The main symptom was decreased hearing in all patients (100%); in 82 patients (90%), it was bilateral, followed by tinnitus in 80 patients (88%) while two patients (2.2%) had vertigo. Family history was stated by 2 patients (2.2%) only. Audiological assessment by pure tone audiogram (PTA) for each ear (total of 182) revealed that conductive hearing loss (CHL) is the commonest type of hearing loss in 148 ears (81.3%), mixed type in 30 ears (16.5%), while 4 ears (2.2%) were normal.Endoscopic stapedotomy was performed for 74 patients; this technique was safe; few complications were managed successfully: one gusher and one revision, with no facial nerve injury. Majority of complications happened during the first year. Mean air bone gap (ABG) gain was 23.3± 7.2 dB, air conduction (AC) gain was 18.3 ± 8 dB, and Carhart notch disappeared in 79.5%.ConclusionsEndoscopic stapedotomy is a safe and effective procedure with a steep learning curve and a satisfactory hearing outcome. The air bone gap (ABG) gain was comparable to international studies.

To compare the efficacy of Titanium versus Teflon piston on hearing outcome in terms of Air conduction gain and Air Bone Gap closure in LASER Stapedotomy – A retrospective study

Aim: To determine the efficacy of Titanium versus Teflon piston on hearing outcome in terms of Air Conduction Threshold (ACT) gain and Air Bone Gap (ABG) closure in patients undergoing LASER Stapedotomy. Methods: This retrospective study was conducted at the department of ENT and Head and Neck Surgery, AIIMS Patna. 40 patients underwent LASER stapedotomy. Both Teflon (0.4mm and 0.6mm D, Grace Medical Devices) and Titanium (0.4mm D, Kurz Medical Devices) pistons were inserted randomly. Crimping of titanium Kurz piston was not required due to its unique design which fits on to the incus long process like a clip whereas all the Teflon pistons required crimping.Titanium (Kurz Medical Devices) pistons are costlier in comparison to Teflon (Grace Medical Devices) pistons. Preoperative and 3 monthly postoperative Pure Tone Audiograms (PTA) wereobtained. ACT (Air conduction threshold) gain and ABG (Air Bone Gap) closure were measured.Data was analyzed with IBM SPSS Statistics software Version 20. Descriptive analysis,paired and unpaired t-tests were applied. P-value of &lt;0.05 at 95% confidence levels was considered statistically significant. Results: 40 patients (M: F: 3:7) underwent LASER stapedotomy.Titanium piston was utilized in 11and Teflon in 29 patients. Patients with titanium piston experienced a mean ACT gain of 21.51±05.42dBand mean ABG closure of 12.27±05.18 dB. Those with Teflon piston gained a meanACT gain of 18.54±04.43 dB and mean ABG closure of11.96±06.12 dB.Both groups experienced statistically significant hearing gain (p &lt;0.05).Both groups were however comparable and the difference between these parameters was statistically insignificant (p&gt;0.05).Conclusion: Both titanium and Teflon pistons are equally efficacious in improving postoperative hearing gain in LASER stapedotomy patients in terms of ACT gain and ABG closure. Titanium Kurz pistons do not require crimping making it easier to use in comparison to the Teflon pistons which needs to be crimped every time though cost may be a limiting factor in the usage of Titanium pistons.Both types of pistons can be satisfactorily employed in this surgical procedure if we consider the hearing gain post operatively. Study design: A retrospective observational study Keywords: Otosclerosis, Teflon, Titanium, Air Conduction Threshold (ACT), Air Bone Gap (ABG) closure

Does stapedotomy improve high frequency conductive hearing?

ObjectivesStapedotomy is performed to address conductive hearing deficits. While hearing thresholds reliably improve at low frequencies (LF), conductive outcomes at high frequencies (HF) are less reliable and have not been well described. Herein, we evaluate post‐operative HF air‐bone gap (ABG) changes and measure HF air conduction (AC) thresholds changes as a function of frequency.MethodsRetrospective review of patients who underwent primary stapedotomy with incus wire piston prosthesis between January 2016 and May 2020. Pre‐ and postoperative audiograms were evaluated. LF ABG was calculated as the mean ABG of thresholds at 250, 500, and 1000 Hz. HF ABG was calculated at 4 kHz.ResultsForty‐six cases met criteria. Mean age at surgery was 54.0 ± 11.7 years. The LF mean preoperative ABG was 36.9 ± 11.0 dB and postoperatively this significantly reduced to 9.35 ± 6.76 dB, (P < .001). The HF mean preoperative ABG was 31.1 ± 14.4 dB and postoperatively, this also significantly reduced to 14.5 ± 12.3 dB, (P < .001). The magnitude of LF ABG closure was over 1.5 times the magnitude of HF ABG closure (P < .001). The gain in AC decreased with increasing frequency (P < .001).ConclusionHearing improvement following stapedotomy is greater at low than high frequencies. Postoperative air bone gaps persist at 4 kHz. Further biomechanical and histopathologic work is necessary to localize postoperative high frequency conductive hearing deficits and improve stapedotomy hearing outcomes.Level of Evidence4, retrospective study.

Evaluation of Audiological Results and Cochleo-Vestibular Subclinical Injury After CO2 Laser Stapedotomy.

Evaluation of the effectiveness and safety of CO2 laser stapedotomy, focusing on the audiological results, and on the surgical cochleo-vestibular trauma. Retrospective clinical trial on 38 patients with the diagnosis of otosclerosis, who underwent CO2 laser stapedotomy between January 2015 and October 2019. Postoperative air-bone gap (ABG), mean air conduction gain, and postoperative changes of high frequency threshold were evaluated 1, 3, 6, and 12 months after surgery. Videoculography (VOG) was performed to assess the vestibular impairment preoperatively and 1 day, 1 week, and 1 month after surgery. Postoperative ABG closure within 10 dB was obtained in 35 cases (92.1%), with a mean postoperative ABG of 4.4 dB and a mean air conduction improvement of 32.3 dB. No significant worsening of high frequency threshold was observed. Spontaneous nystagmus was found preoperatively in 5/38 patients (13.2%), 1 day after surgery in 13/38 patients (34.2%), 1 week after surgery in 12/38 patients (31.6%), and 1 month after surgery in 4/38 patients (10.5%). Positional nystagmus was found preoperatively in 12/38 patients (31.6%), 1 day after surgery in 25/38 patients (65.8%), 1 week after surgery in 22/38 patients (57.9%), and 1 month after surgery in 10/38 patients (26.3%). The occurrence of nystagmus did not always correlate with vestibular symptoms: after surgery, 10 patients (26.3%) experienced vertigo associated with dizziness, 8 patients (21.1%) suffered from dizziness without vertigo, and 14 patients (36.8%) showed nystagmus without any symptomatology. At 1 month after surgerynone of the patients complained about vestibular symptoms. CO2 laser stapedotomy is a safe and effective technique, which allows to obtain good functional results with minimal perioperative cochleo-vestibular trauma.© 2021 Wiley Periodicals LLC.

Stapes surgery in osteogenesis imperfecta: retrospective analysis of 18 operated ears.

To evaluate short and long term results of stapes surgery in patients with osteogenesis imperfecta (OI), METHODS: Retrospective case series of 18 primary stapes surgeries performed on 11 hearing-impaired OI patients with evidence of stapes fixation, in a Tertiary referral center. We analysed pre-operative and post-operative hearing results at 1month and at least 1year RESULTS: The main operative findings were stapes fixation, thickened footplate and fragile or fractured stapes crura. No revision surgery was necessary. Hearing improvement was achieved in 94% of the cases. We obtained an air-bone gap closure to within 10dB in 46% of the cases and to within 15dB in 92% of the cases at 1-year follow-up. The mean hearing gain in air conduction (at 0.5, 1, 2 and 4kHz) was 18.4dB at 1month and 22.4dB at 1year. Stapes surgery in OI gives good results with few complications in our series. A hearing gain is often obtained in spite of the sensorineural hearing loss caused by the natural progression of the disease.

Comparison of Ossiculoplasty Outcomes Using Different Materials in the Treatment of Chronic Otitis Media.

This study aimed to evaluate success rates after ossicular chain reconstruction using different materials. Retrospective cohort study. Tertiary referral center. Four hundred forty-three participants who underwent ossiculoplasty at a tertiary medical center were included. Ossicular chain reconstruction using five materials: autologous malleus, incus, and cortical bone, as well as Hydroxyapatite (HA) and titanium. Hearing data were measured 1 day preoperatively and 6 months postoperatively. Successful hearing outcomes were defined by the fulfillment of more than one of the following criteria: postoperative air-bone gap of 20 dB or less, hearing air conduction (AC) gain of 15 dB or more, or postoperative AC hearing less than 30 dB. Preoperative median AC values (95% confidence interval) among participants with malleus, incus, cortical bone, HA, and titanium transplants or prostheses were 50 (39.6-54.6) dB, 51.3 (48.1-51.8) dB, 50 (45.2-52.2) dB, 56.3 (50.9-57.6) dB, and 54.3 (48.5-56.0) dB, respectively (p = 0.092). The success rates in malleus, incus, cortical bone, HA, and titanium were 53.3%, 60.3%, 51.7%, 61.6%, and 69.7%, respectively. Titanium had the highest success rate among the five materials, but the differences between the materials were not statistically significant (p = 0.283). Titanium had highest success rate among the participants with erosive stapes suprastructure or obstructed Eustachian tubes (p = 0.042 for erosive stapes suprastructure and p = 0.010 for obstructed Eustachian tubes). Our study demonstrated that titanium prostheses would be a good alternative for ossiculoplasty in cases wherein autologous material is unavailable, especially in association with unfavorable conditions, such as with the presence of cholesteatoma, erosive stapes suprastructure, edematous middle ear mucosa, and obstructed Eustachian tube.

Comparison between Fluoroplastic and Platinum/Titanium Piston in Stapedotomy: A Prospective, Randomized Clinical Study.

The objective of this study was to compare hearing results of fluoroplastic (Teflon) Causse Loop Piston with platinum/titanium (Big Easy) Piston in patients who underwent stapedotomy due to otosclerosis. In this prospective randomized clinical trial study, Causse Loop Piston prosthesis was used in 76 ears and the Big Easy Piston prosthesis in 72 ears. The main outcomes were preoperative and postoperative pure tone audiometry and air-bone gap (ABG). Postoperative ABG closure was not significantly different between both groups. However, the Causse Loop Piston resulted in a significant improvement of the air conduction (AC) in frequencies of 250, 500, and 1,000 Hz. In addition, the improvement of speech reception threshold (SRT) was significantly higher in Causse Loop Piston group. We achieved similar postoperative ABG closure in short-term with both prostheses. However, at low frequencies, AC gain was higher in Causse Loop Piston group. In addition, patients in this group yielded better SRT.

Hearing outcome following ossicular reconstruction for incus defects using partial ossicular replacement prosthesis

Background: Situation of incus erosion is common while performing tympanoplasties for cases of chronic otitis media. As none of the available techniques is said to be gold standard, a cost effective and easily available partial ossicular replacement prosthesis is employed and the postoperative hearing outcome is presented.&#x0D; Objectives: To assess the hearing results of ossiculoplasty using partial ossicular replacement prosthesis (PORP) during tympanoplasty.&#x0D; Methodology: A descriptive cross-sectional study was carried out in a tertiary referral hospital of Nepal from June 2018 to September 2019. Thirty consecutive patients who underwent tympanoplasty for chronic otitis media (inactive/mucosal) with incudostapedial discontinuity were operated using polytetrafluroethylene partial ossicular replacement prosthesis without removing the incus. Pure tone averages, air-bone gap (ABG) and air conduction gain were calculated pre and post-operatively.&#x0D; Results: There was no extrusion of prosthesis. The post-operative air-bone gap less than 20 dB was achieved in 23 (77%) cases. All the patients had post-operative air-bone gap of ≤25 dB. There were no major complications.&#x0D; Conclusion: Polytetrafluroethylene partial ossicular replacement prosthesis is safe, reliable and efficient alternative for ossiculoplasty when the incus is found to have eroded during tympanoplasty surgery.

Endoscopic type 1 cartilage tympanoplasty in children

ObjectivesEndoscopic type 1 tympanoplasty using cartilage grafts for repair of chronic tympanic membrane perforation is increasing. The aim of this study was to evaluate the results of endoscopic type 1 cartilage tympanoplasty in children. Materials and methodsPatients under 18 years of age who underwent type 1 cartilage tympanoplasty between January 2013 and February 2019 were retrospectively evaluated. Anatomic success rate was calculated according to the intact status of the graft. Air conduction (AC), bone conduction (BC), air-bone gap (ABG) and hearing gain were calculated using pure tone audiometry tests at pre-operative, and 6th month postoperative period. Patients with postoperative ABG ≤20 dB were considered as functionally successful. ResultsThe study included 56 patients (6 bilateral) and 62 ears. The anatomic success rate of our study was 91.9% (57/62). Preoperative AC was 36.4 ± 6.5 (21–50) dB, BC was 7.8 ± 3.7 (5–25) dB, and ABG was 28.6 ± 6.9 (10–41) dB. Postoperative AC was 24.5 ± 8.8 (7–45) dB, BC was 7.6 ± 3.4 (5–19) dB, and ABG was 16.9 ± 7.4 (2–32) dB. There was no change in postoperative BC (p: 0.683), whereas AC, and ABG significantly decreased (p < 0.001). Mean hearing gain was 12.1 ± 6.2 (3–26) dB and the functional success rate was 72.5% (45/62). ConclusionEndoscopic type 1 cartilage tympanoplasty, a minimally invasive surgical procedure, provided successful functional and anatomical results at the pediatric population.

Revision Stapes Surgery in a Tertiary Referral Center: Surgical and Audiometric Outcomes.

Objectives:To evaluate pure-tone audiometric results in otosclerosis patients undergoing revision stapes surgery following previous middle ear interventions.Methods:A retrospective cohort study was performed in a tertiary referral center. Consecutive otosclerosis patients who underwent revision stapes surgeries, following previous middle ear interventions, for persistent conductive hearing loss, recurrent conductive hearing loss, or vertigo and had available postoperative pure-tone audiometry were included. Mean pre- and postoperative air conduction, bone conduction, and air-bone gap averaged over 0.5, 1, 2, and 3 kHz were obtained. Audiometric outcomes were obtained at 7 weeks postoperatively.Results:In total, 63 consecutive otosclerosis patients who underwent 66 revision stapes surgeries were included. Air-bone gap improved significantly with a mean gain of 19 dB (95% CI, 15-22). Air conduction improved significantly with a mean gain of 18 dB (95% CI, 14-23). Bone conduction did not change significantly, with a mean deterioration of 0 dB (95% CI, –2 to 1). Air-bone gap closure to 10 dB or less was achieved in 38% of cases and to 20 dB or less in 80% of cases. Indication for surgery, previous type of procedure, primary cause of failure, and current surgical technique were not significantly associated with air-bone gap closure to 10 dB or less. Indication for surgery and primary cause of failure were associated with one another.Conclusions:Compared to the available literature, a slightly larger gain in air conduction and air-bone gap was achieved in our study. Air-bone gap closure to 10 dB or less was achieved less often in our study.

Evaluating Success of Surgery in Mucosal and Squamosal Chronic Otitis Media: A Retrospective Study

This study attempted to document success of surgery postoperatively, be it type I tympanoplasty or type III tympanoplasty with or without modified radical mastoidectomy.&#x0D; Materials and Methods&#x0D; This retrospective study involved 90 patients of Chronic Otitis Media who underwent surgery in the Department of Otorhinolaryngology in a tertiary care centre in the state of Uttar Pradesh. &#x0D; Results &#x0D; At 3 week postoperatively, 83 patients (92.22%) had successful uptake of graft. Overall successful graft uptake was reduced to 87.78% (79 patients) after 3 months. Postoperatively, after 3 months, 90% of the patients (n=81) reported improvement in hearing. Preoperatively, 89.71 % patients of mucosal disease and 63.64% of squamosal disease had 21-40 dB hearing loss. Postoperatively, 88.24% patients with mucosal disease and 63.64% of squamosal disease had no conductive hearing loss. There was statistically significant gain in air conduction postoperatively. Average improvement in AB gap was also notably significant postoperatively in both subgroups.&#x0D; Conclusion&#x0D; Both type I and type III tympanoplasty give excellent response in term of graft uptake and postoperative hearing.&#x0D; Abbreviations: COM-Chronic Otitis Media, AC-Air Conduction, AB-Air Bone, TP-Tympanoplasty, MRM-Modified Radical Mastoidectomy

A comparison of autograft incus and titanium prostheses in primary ossiculoplasty in modified radical mastoidectomy

Background: Numerous graft materials are available for ossicular reconstruction yet, no single option is considered ideal. This study aims to analyze and compare the outcome of primary ossiculoplasty in terms of hearing gain using autograft incus and titanium (Ti) prostheses in patients with active squamosal chronic otitis media (COM) undergoing modified radical mastoidectomy (MRM). Study Design: Randomized study. Materials and Methods: Sixty patients with active squamosal COM with ossicular chain erosion undergoing MRM were divided into two equal groups. First group underwent ossiculoplasty with autograft incus and the second group received Ti prostheses. Follow-up was done over a period of 6 months and hearing thresholds were evaluated postoperatively at 3rd and 6th month at the four frequency average of 0.5/1/2/4 KHz. Results: There was no significant difference in air conduction (AC) gain when the inter-group comparison is made (P > 0.05 at 3rd and 6th month), however, intra-group AC gain was significant in both groups, at the end of the 3rd month and 6th month (P < 0.05). Conclusion: Autograft incus and Ti prostheses both give a comparable hearing gain in ossicular reconstruction. Ti prostheses are a good alternative in longstanding cases of active squamous COM without any available ossicular autograft for hearing reconstruction.

Modified Radical Mastoidectomy with Type III Tympanoplasty: Revisited.

Chronic suppurative otitis media with cholesteatoma is a fairly common condition presenting in any ENT clinic and its surgery remains one of the most challenging surgeries in otology. The primary goal of cholesteatoma surgery is to clear the disease and produce a safe and stable ear but there is still debate on whether these goals are best achieved by canal wall down or canal wall up procedures. A retrospective study was done to access benefits of modified radical mastoidectomy (MRM) with type III tympanoplasty in terms of eradication of disease and hearing improvement. It consisted of 140 patients of chronic otitis media (attico-antral) who underwent MRM with type III tympanoplasty in 156 ears in a tertiary care centre. Temporalis fascia graft was used for tympanoplasty. Results were analyzed in terms of condition of cavity, condition of graft and gain in hearing. The study showed significant improvement in gain in air conduction (21.24dB) and closure of AB gap (15.62dB). In the Indian population with low socio-economic status and poor follow up, single stage canal wall down procedure (MRM) provides maximum benefit to patients in terms of eradication of disease and hearing improvement.

Footplate reconstruction: preliminary results.

A partially or fully absent or largely perforated footplate is a challenging condition that may be encountered during middle ear surgery, especially in patients with a history of chronic ear problems or with previous tympanoplasties. Retrospective study on a limited number of cases undergoing revision tympanoplasty in which a new footplate was created from the cartilage, and the ossicular chain was reconstructed with a titanium prosthesis in 1 stage. Minimum follow-up was 24 months. Outcome measurements included the preoperative and postoperative bone conduction to assess the function of the inner ear, and the preoperative and postoperative threshold levels of air and bone conduction in 4 frequencies to assess the possible hearing improvement. Six patients could be included. The audiologic results showed the average air conduction gain of 11 dB. We did not observe any significant deterioration in the bone conduction which, in some cases, even improved (average change of +3 dB). The symptoms related to a perilymphatic fistula were resolved. The technique described herein has proven to be safe and reliable. Reconstruction of the footplate with autologous cartilage and simultaneous type III tympanoplasty seems to be a promising solution for those rare but challenging cases in which the footplate is partially of fully absent.

Pediatric ossiculoplasty with titanium total ossicular replacement prosthesis.

To assess the medium-term efficacy of total ossicular reconstruction with a titanium total ossicular replacement prosthesis (TORP) in children. Case series. A consecutive series of children receiving an adjustable-length titanium TORP was identified from a prospective surgical and audiological database. Audiometric testing was obtained preoperatively, 2 months postoperatively, and subsequently at 6- to 12-month intervals. Four-frequency pure-tone averages (PTA) were determined for air conduction (AC) and bone conduction thresholds, as well as air-bone gap (ABG). Pre- and postoperative measures were compared to determine degree of improvement. The proportion with successful outcome (defined as ≤ 30 dB hearing level [HL] AC) was determined over time with Kaplan-Meier analysis. Seventy-five TORPs were inserted in 71 children aged 7 to 18 years, with a median follow-up of 2.7 years (0.6-5.5 years). The mean postoperative PTA AC threshold and ABG at 1 year were 35 dB HL and 29 dB, respectively, with ABG closure of 14 dB. The maximum gain in AC was 40 dB, achieved in eight (11%) cases. Successful outcome was seen in 50% of children at first follow-up. Over the following 1 to 3 years, hearing levels deteriorated to AC > 30 dB HL in an additional 10% of patients. Four patients had revision surgery, one for prosthesis extrusion and three for a lack of improvement in hearing. Titanium TORPs offer children an effective method of ossicular reconstruction, with infrequent extrusion at least in the short term. The hearing improvement achieved in the early postoperative period appears to be maintained over the first year but may not be sustained over longer time periods.