Hearing Gain Research Articles

COMPARATIVE EFFICACY OF SLICED TRAGAL CARTILAGE VERSUS TEMPORALIS FASCIA IN TYMPANOPLASTY: A STUDY ON HEARING IMPROVEMENT AND GRAFT UPTAKE

Objective: Chronic suppurative otitis media (CSOM) often necessitates surgical intervention, with tympanoplasty being a key procedure to restore hearing. The choice of graft material-sliced tragal cartilage versus temporalis fascia remains controversial due to potential differences in acoustic transmission and graft resilience. Methods: This prospective cohort study included 48 patients with CSOM, randomly assigned to receive either tragal cartilage or temporalis fascia grafts. Outcomes measured were hearing improvement and graft uptake, assessed through audiometric testing and otoscopic evaluations. Results: Both groups showed significant improvements in hearing postoperatively, with no statistically significant difference in hearing gain (P=0.3064). Graft uptake rates were comparable, with a non-significant lower reperforation rate in the cartilage group (P=0.551). Conclusion: The study supports the use of either sliced tragal cartilage or temporalis fascia as effective materials for tympanoplasty, offering substantial hearing improvement and reliable graft uptake.

Endoscopic Surgery for a Case of Congenital Cholesteatoma with Ossicular Chain Anomaly.

The simultaneous occurrence of congenital ossicular anomalies and congenital cholesteatoma (CC) is exceedingly rare. This report describes the case of an 11-year-old boy who presented with conductive hearing loss, characterized by an average air conduction threshold of 50 dB in the left ear, without any prior otologic history. Preoperative assessments suggested the presence of CC, with suspicion of ossicular chain malformation. The patient underwent ear endoscopic surgery, during which the lesion was excised, and the ossicular chain was reconstructed using a titanium ossicular prosthesis. Postoperative follow-up indicated successful healing, with a significant improvement in hearing, as demonstrated by a reduction in the air conduction threshold to 15 and a hearing gain of 35 dB.

Endoscopic Cartilage Myringoplasty with Anterior Margin Preservation for Repairing Large Anterior Perforations.

Objective: This study compared the graft outcomes and complications of endoscopic cartilage inlay myringoplasty with preservation of anterior margins (IPAM) and the cartilage underlay technique with raising the tympanomeatal flap (CUTF) for repairing large anterior perforations. Materials and Methods: In total, 55 patients with large anterior perforations were recruited and allocated to the IPAM (n = 28) or the CUTF (n = 27) group. The graft success rate, hearing gain, operation time, and postoperative complications were compared between the groups at 12 months. Results: The mean operation times were 29.3 ± 2.7 minutes and 46.4 ± 3.9 minutes in the IPAM and CUTF groups, respectively (P < .001). The residual perforation rate was 0.0% in the IPAM group and 11.1% in the CUTF group (P = .222). All patients completed the 12-month follow-up. The overall graft success rate was 96.4% in the IPAM group and 88.9% in the CUTF group (P = .577). No significant differences were observed between the groups in terms of postoperative pure-tone averages for air conduction and bone conduction, air-bone gaps (ABGs), or ABG changes. In the CUTF group, 22.2% of the patients reported altered taste perception, 3.7% experienced bony external auditory canal (EAC) stenosis, and 3.7% developed EAC cholesteatoma. By contrast, the IPAM group did not have any cases of altered taste perception, EAC stenosis, or cholesteatoma. Conclusions: Endoscopic cartilage myringoplasty with IPAM and anterior perichondrium folding is a simple, effective, and minimally invasive technique for repairing large anterior perforations. It offers a high graft success rate and better hearing improvement compared to CUTF.

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

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

A cost-utility analysis of cochlear implants for single sided deafness in adults and children in the Netherlands.

Cochlear Implant (CI) has been shown to improve speech comprehension, sound localization and tinnitus in adults with Single-Sided-Deafness (SSD) compared to standard treatment currently available in the Dutch setting such as a CROS (Contralateral Routing of Signals) hearing device or a BCD (Bone Conduction Device). Also, for the pediatric population with SSD, CI has shown to be clinically meaningful. Because currently no information is available on the health economic effects of CI in adults and children with SSD in the Netherlands, a cost-utility analysis was conducted. We developed a Markov cohort model, for both the adult and pediatric SSD population, with three states: implant, no implant, and dead. CI was compared with the Bone Conduction Device (BCD) treatment, requiring surgery and no specific treatment. The time horizon of the model was lifelong, costs were discounted with 3% and effects with 1.5%. A societal perspective was taken, including productivity costs in the analysis, with costing data based on publicly available prices for the Netherlands. Values for clinical outcome parameters, i.e. hearing gain, and event probabilities were based on existing literature. Deterministic and probabilistic sensitivity analyses as well as scenario analyses were performed to outline uncertainty of individual and combined parameters. Mean per patient costs for CI in the adult population were €194,051 (95%-CrI €177,274 to €211,108) compared to the total costs of €185,310 (95%-CrI €182,367 to €194,142) for BCD resulting in a cost difference of €8,826 (95%-CrI -€5,020 to €18,252). Compared to no treatment, the cost difference was -€25,089 (95%-CrI -€31,678 to -€6,003). Adults who were treated with CI gained 18.41 (95%-CrI 18.07 to 18.75) quality adjusted life years (QALY) whereas BCD patients gained 15.81 QALYs (95%-CrI 15.53 to 16.10), a difference of 2.60 QALYs (95%-CrI 2.15 to 3.05). The Incremental Cost Effectiveness Ratio (ICER) for adults with CI was determined to be €3,494/QALY gained. Patient without treatment gained 13.46 QALY (95%-CrI 13.20 to 13.73), a difference of 4.95 (95%-CrI 4.87 to 5.01) resulting in CI dominating no treatment. The ICER remained below the Dutch threshold of €20,000/QALY. The probabilistic sensitivity analyses confirmed the results. For children, CI dominated when compared to BCD and when compared to no treatment. Compared to BCD, CI led to a cost saving of €29,611 (95%-CrI -€126,800 to €54,375) and compared to no treatment, CI resulted in a cost saving of €57,658 (95%-CrI -€146,687 to €5,919). The incremental QALY gain compared to BCD was 7.22 (95%-CrI 4.19 to 8.55) and 26.03 (95%-CrI 20.82 to 31.06) compared to no treatment. Based on the results of this health economic evaluation with a Markov cohort model, it is very likely that CI is cost-effective compared to BCD and to no treatment in the Dutch adult and pediatric population with SSD. In both populations the ICER was below the Dutch cost-effectiveness threshold of €20,000/QALY.

Comparison of endoscopic tympanoplasty, cartilage vs. temporalis fascia in chronic suppurative otitis media with inactive mucosal disease: A prospective randomised study.

The introduction of endoscopy into middle ear has open up new opportunities for minimal invasive temporal bone surgery. The present study was planned to compare anatomical and functional outcome in patients who underwent endoscope assisted tympanoplasty using cartilage and temporalis fascia graft. The present prospective observational randomized study was carried out in the Department of Otorhinolaryngology of a tertiary care teaching hospital of Rajasthan, India from September 2020 to July 2021. Fifty patients of age group 18-60 years, with diagnosis of chronic otitis media having inactive mucosal disease were enrolled in the study and divided into two groups viz. cartilage (group I) and temporalis fascia group (group II). Each patient postoperatively underwent otoscopic examination of ear and pure tone audiometery at 8 weeks and 3rd month. Local wound condition, graft uptake and healing and hearing were assessed and compared. Graft uptake was 92% in cartilage group and 84% in temporalis fascia group. Air conduction and air-bone gap of patients in both the groups showed significant improvement after 3 months of surgery. (p˂0.05) Regarding bone conduction, both groups had shown non-significant changes. (p > 0.05) Hearing gain was comparable on both groups which was 6.71dB in cartilage group vs. 5.9 dB in other group. The present study showed that graft placement time for temporalis fascia graft was less than cartilage graft, but the difference was insignificant. Hearing improvement, graft uptake and clinical improvement were found to be statistically insignificant between both groups.

Comparative Study of Endoscopic Transcanal Tympanoplasty and Tympanoplasty by Conventional Postaural Approach in a Tertiary Care Hospital in Central India.

Background Chronic otitis media (COM) often necessitates tympanoplasty to repair the tympanic membrane. While conventional postaural tympanoplasty (PA) is well-established, endoscopic transcanal tympanoplasty (ET) is gaining traction for its minimally invasive benefits. This study aims to compare these two surgical techniques regarding their anatomical and functional outcomes and assess the role of platelet-rich plasma (PRP) in improving these outcomes. Material and methods This prospective comparative study was conducted at Acharya Vinoba Bhave Rural Hospital, involving 60 patients with COM. Participants were randomly assigned to receive either ET or PA, with each group further subdivided based on PRP use. Preoperative evaluations included auditory function tests and diagnostic endoscopy. Postoperative assessments were performed at seven days, one month, and three months to evaluate graft acceptance and hearing improvement using pure tone audiometry (PTA). Statistical analyses included the chi-square test, t-test, ANOVA, and paired t-test. Results The study included patients with a mean age of 38.1 years, predominantly female (71.67%). ET demonstrated superior anatomical outcomes compared to PA, with higher graft acceptance rates and better hearing improvements. The average hearing gain was 10.4 dB in the ET group versus 8.1 dB in the PA group. PRP uses enhanced graft acceptance and hearing restoration across both surgical approaches, contributing to better overall outcomes. Conclusion ET offers significant advantages over conventional postaural tympanoplasty in terms of anatomical and functional results. PRP further improves surgical outcomes, making ET a preferable option for tympanoplasty in COM patients. These findings support the broader adoption of ET and PRP to enhance patient outcomes in tympanoplasty procedures.

Endoscopic and Microscopic Tympanoplasty for Adhesive Otitis Media: A Comparative Prospective Analysis.

BACKGROUND This prospective study aimed to compare outcomes and hearing improvement in 51 patients with adhesive otitis media following endoscopic and microscopic tympanoplasty. MATERIAL AND METHODS Between April 2021 and April 2022, 51 patients diagnosed with pars tensa retraction and hearing loss who underwent endoscopic and microscopic cartilage tympanoplasty were included in the study (endoscopic tympanoplasty group: 26 patients, microscopic tympanoplasty group: 25 patients). Pure-tone audiometric data (0.5, 1, 2, and 4 kHz), air-bone gap (ABG), and postoperative graft intake were compared. RESULTS Hearing gain in the ABG was significant in both groups (p<0.05). When the groups were compared for mean hearing gain in the ABG, the difference was significant (p<0.05). The postoperative ABG in the endoscopic group was significantly smaller than that in the microscopic group. When the postoperative air conduction threshold was evaluated, there was no significant difference between the 2 groups at 4 kHz, whereas a significant difference was observed in the endoscopic tympanoplasty group at 0.5, 1, and 2 kHz. Postoperative graft failure and otorrhea were not observed in any of the patients. CONCLUSIONS Pars tensa retractions and adhesive otitis media show comparable outcomes with both endoscopic and microscopic techniques. In endoscopic tympanoplasty, better visualization allows for better hearing outcomes. The endoscopic method, characterized by a wide field of view and a less invasive approach, enhances access to retraction limits.

Endoscopic Double Flap Tympanoplasty.

This study is aimed to compare the outcomes of the two techniques (endoscopic single flap tympanoplasty- ESFT versus endoscopic double flap tympanoplasty - EDFT) of endoscopic tympanoplasty for repairing large tympanic membrane (TM)perforations with limited anterior remnant. In this randomised controlled trial, forty patients with large sized TM perforations were included and randomised in the ESFT and EDFT arms with twenty patients in each group. Both the groups underwent endoscopic tympanoplasty using temporalis fascia graft. The graft uptake rates and hearing results were compared. Graft success rate was 85% (17/20 cases) in the ESFT group and 90%(18/20 cases) in the EDFT group. The ABG (air-bone gap) improvement median with interquartile range(IQR) was 5 dB (3.12 dB-10 dB) in the ESFT group and 8.75 dB (5dB-11.87 dB) in the EDFT group. The difference was not statistically significant. In our study, there was no statistically significant difference in the graft success rate or hearing gain in ESFT or EDFT group. Moreover, there was longer operative time and need for an extra incision while raising the anterior flap. This lack of statistically significant results in our study may be since the study has a very small sample size. Whether the same conclusion is reproducible needs to be further explored by a larger sized randomised controlled trial.

Outcomes of Minimally Invasive Tympanoplasty: Fat Graft Myringoplasty.

Fat tympanoplasty is repair of small dry tympanic membrane perforations using fat as graft material. It is a simple office procedure with minimal morbidity and manipulation of the middle ear. The present study was a prospective review of 60 patients who underwent fat tympanoplasty over the period of 15 months. In all the patients fat was harvested from ear lobule. Patients were kept on follow up for 3 months and evaluated for graft uptake and hearing gain. 86.66% closure rate of tympanic membrane defect was achieved. Postoperative air conduction was 29.6 ± 5.3 while air bone gap was 13.2 ± 6.1. The study concludes that fat plug myringoplasty is a simple, quick, less invasive method to repair small tympanic membrane defects.

The Effect of Using Ofloxacin Ear Drops in Traumatic Tympanic Membrane Healing: A Systematic Review and Meta-Analysis.

Objectives: To evaluate the effectiveness of ofloxacin ear drops versus no intervention in the repair of traumatic tympanic membrane (TM) perforations from randomized controlled trials (RCTs). Data Sources: Medline/PubMed, CENTRAL, Clinical Trials.Gov, and Google Scholar. Study Selection: Inclusion criteria: (1) English language; (2) RCT studies; (3) reported the outcomes on the application of ofloxacin and outcomes of spontaneous healing. Exclusion criteria: (1) studies without a control group; (2) patient with severe otologic disease such as chronic suppurative otitis media or ossicular disruption or patients with craniocerebral injury; (3) studies with no pretreatment values or single-arm clinical studies. Data Extraction: Country, year of publication, number of participants in each arm, patient characteristics such as age, sex, intervention details, laterality, cause of TM perforation, position of perforation, follow-up time, hearing gain, rate of TM closure, and closure time. Results: A total of 6 RCTs studies were analyzed. A total of 502 participants were included; the relative risk for closure rate of ofloxacin treatment was 1.18 [95% confidence interval (CI), 1.08 to 1.28, P < .001] and the mean difference (MD) for healing time was -18.4 (95% CI, -19.96 to -16.82, P < .001), suggesting ofloxacin has a significant effect on closure of TM perforations. However, no clinically significant effect in hearing (SMD: 0.21, 95% CI, 0.02 to 0.40, P = .03) was seen in ofloxacin group. Also, patients in the ofloxacin group were associated with a 13% reduction in the risk of infections compared to their observation-assigned counterparts, but this estimate was not statistically significant. Conclusion: Ofloxacin use in patients with traumatic TM perforation is effective in reducing healing time and increasing rate of TM perforation closure. No evidence of increased risk of hearing loss or infection rates are encountered when ofloxacin is prescribed to patients with traumatic TM perforation.

Nationwide Prevalence of Video Head Impulse Test Abnormality and its Risk Factors in South Korea.

To identify the prevalence of and relevant information for video head impulse test (vHIT) abnormality in a large population. A cross-sectional design. Korean National Health and Nutrition Examination Survey, 2021. The sample was representative of the Korean population, with 2237 participants aged ≥40 years. A vHIT was performed to evaluate vestibular function. The vestibulo-ocular reflex (VOR) gain and the presence of reproducible catch-up saccades was assessed in a vHIT. Participants also completed questionnaires for demographics, socioeconomic status, and basic information regarding systemic diseases and dizziness and underwent hearing tests with automated pure-tone audiometry. The prevalence of vHIT abnormality was 22.5%, with unilateral (14.3%) being more common than bilateral (8.2%). The prevalence of vHIT abnormality increased significantly with age, with the highest rate observed in individuals aged >70 years (42.5%). Both hearing and VOR gain deteriorated with age, but the patterns of age-related progression were different. While hearing loss (HL) deteriorated gradually and progressively throughout adulthood, VOR gain deterioration was markedly evident after 70 years of age. Considering the high prevalence of vHIT abnormality, appropriate social and medical policies are needed to prevent associated injuries and improve patients' quality of life. The distinct age-related changes in HL and objective findings of vestibular dysfunction indicate the need for different approaches to address these social problems in aging countries.

Natural History of Untreated Idiopathic Sudden Sensorineural Hearing Loss.

Although corticosteroids and other treatments for idiopathic sudden sensorineural hearing loss (ISSNHL) have been described, understanding its prognosis without intervention provides valuable information for patient management. The objective of this study is to provide a comprehensive, quantitative statistical analysis of the natural history of untreated idiopathic sudden sensorineural hearing loss (ISSNHL). A systematic review and meta-analyses. Two independent searches of PubMed, Scopus, Web of Science, and Cochrane Library databases up to June 30, 2022, were performed. Adults with idiopathic sudden sensorineural hearing loss who received placebo or were untreated and had audiometric outcome measures in all study types were reviewed. These data indicative of the natural history of ISSNHL were analyzed, as were study characteristics related to risk of bias. Heterogeneity as assessed via I2 and random effects analyses were performed. Six studies meeting the inclusion criteria yielded 319 untreated patients whose natural history could be assessed. Heterogeneity among studies was moderate, with a variety of reported outcomes. A hearing improvement of at least 30 dB HL was observed in 36% (95% CI 0.28-0.44) of untreated patients, and of at least 10 dB HL was observed in 70% (95% CI 0.57-0.82) of untreated patients at 3 months. The mean hearing gain among untreated patients was 24.0 dB HL (95% CI 2.65-45.37) at 2-3 months. The observed natural history of ISSNHL suggests that patients can regain some hearing without active treatment. In the absence of future studies collecting prospective natural history data from untreated or placebo-treated ISSNHL patients, the data presented here provide the best available historical control data for reconsideration of results in past ISSNHL studies, as well as a roadmap for design and interpretation of future ISSNHL treatment clinical trials. Furthermore, knowing there is a statistically significant mean hearing gain of 24.0 dB HL in the untreated/placebo group provides an ethical basis for future placebo study of ISSNHL. The current status on ISSNHL management calls for a multi-institutional, randomized, double-blind placebo-controlled trial with validated outcome measures to provide science-based treatment guidance. Laryngoscope, 134:S1-S15, 2024.

Endoscopic Cartilage Modified Inlay Technique With Preserving External Auditory Canal Skin for Repairing Posterior Marginal Perforation.

Objective: To evaluate the graft success rate and hearing gain of endoscopic cartilage myringoplasty with preserving external auditory canal (EAC) skin for posterior marginal perforation. Materials and Methods: We performed a prospective study in 36 patients with posterior marginal perforation who underwent endoscopic cartilage modified inlay technique with preserving EAC skin. Patients were followed up for 12 months. Results: All the 36 patients with unilateral posterior marginal perforation were included in this study. Clinical inosculation of the perichondrium graft and remnant tympanic membrane (TM) occurred at 2 to 3 weeks postoperatively. Simultaneously, neovascularization was initiated at the perichondrium graft. The perichondrium graft had been clinically incorporated to the EAC skin at 2 to 3 weeks postoperatively, which could not be distinguished. At 12 months, residual perforation was seen in inferior margin in one but reperforation was not. The graft success rate was 97.2% (35/36). The mean preoperative air bone gap (ABG) was 29.7 ± 3.8 dB, and the mean postoperative ABG at 12 months was 15.2 ± 3.1 dB; the difference between these values was significant (P < .05; paired-samples t test). The successful surgery rate (postoperative ABG ≤ 20 dB) was 91.7% (33/36). No any intratympanic or EAC cholesteatoma was noted during the follow-up period. Conclusions: Endoscopic cartilage modified inlay technique with preserving EAC skin for repairing posterior marginal perforation is simple and minimally invasive technique, which had shorter operative time, similar graft success rate compared with raising a tympanomeatal flap techniques.

Traditional and non-traditional lipid parameters as risk factors for sudden sensorineural hearing loss

ObjectiveThe purpose was to explore the effects of traditional and non-traditional lipid parameters on Sudden Sensorineural Hearing Loss (SSNHL). MethodsThe study included 452 patients diagnosed with SSNHL, among whom 206 patients had a level of hearing improvement ≥10 dB after one month of follow-up. A propensity score-matched (2:1) control group was used. Conditional and unconditional logistic regression were used to analyze the risk factors for SSNHL. ResultsPatients with SSNHL had a higher risk of concomitant hypertension and elevated atherosclerogenic lipid levels, with apolipoprotein B and apolipoprotein E identified as independent risk factors for the onset of SSNHL. Additionally, the Lipid Comprehensive Index (LCI) was an independent risk factor for the degree of hearing loss. A positive linear correlation was revealed between triglyceride, non-high-density lipoprotein cholesterol, atherogenic index, Castelli risk index, atherogenic index of plasma, LCI and hearing loss. However, no linear relationship was observed between hearing gain and any lipid parameters. When Total Cholesterol (TC) was in the range of borderline high, the treatment effect was the best. However, the statistical significance disappeared upon adjusting for confounding factors. ConclusionPatients with SSNHL exhibited markedly dysregulated lipid metabolism. Elevated serum lipid levels may be a causative factor in auditory impairment and can influence the extent of hearing loss. Promptly improving cochlear microcirculation may benefit patients with borderline elevated TC. Level of evidence4.

Platelet Rich Fibrin Graft in Myringoplasty: Pitfalls and Challenges.

Autologous Platelet-rich fibrin (PRF) is an amalgam of fibrin mesh, platelets and growth factors that favour wound healing. It can be easily used as a graft material in myringoplasty, making it a promising, easy to harvest and cost effective alternative compared to cartilage or fascia graft used in conventional myringoplasty. 50 patients of small to medium, dry central perforation underwent myringoplasty using PRF graft (Group 1). Results were compared to 50 patients with similar small to medium perforations who underwent conventional transcanal myringoplasty using temporalis fascia graft (Group 2): Outcome of surgery was measured by closure of perforation and improvement in hearing at 3 months. In group 1, overall closure rate was 70% while in group 2 it was 96%. For both small and medium perforations healing was significantly higher in group 2 compared to group 1, (100% vs 87.5%) for small perforations and (95.45% vs 66.67%) for medium perforations. Hearing gain was comparable in both groups in patients in whom healing of perforation occurred. PRF stands as a suitable graft material for closure of small perforations, but, lack of rigidity and early disintegration of the graft makes it less suitable for larger perforations compared to other conventional grafts such as temporalis fascia.

Active TriCROS: A Simultaneous Stimulation With a (Bi)CROS System and a Hearing Aid in the Worst Ear for Severely Asymmetrical Hearing Loss.

Severely asymmetrical hearing loss (SAHL) is characterized by a moderately severe or severe hearing loss in one side and normal or mildly impaired controlateral hearing in the other. The Active tri-CROS combines the Contralateral Routing-of-Signal System (CROS, or BiCROS if the best ear is stimulated) and the stimulation of the worst ear by an in-the-canal hearing aid. This study aims to evaluate the benefit of the Active tri-CROS for SAHL patients. This retrospective study was conducted from September 2019 to December 2020. Ambulatory, tertiary care. Patients were retrospectively included if they had received the Active tri-CROS system after having used a CROS or BiCROS system for SAHL for at least 3 years. Audiometric gain, signal-to-noise ratio, spatial localization, and the Abbreviated Profile of Hearing Aid Benefit and Tinnitus Handicap Inventory questionnaires were performed before equipment and after a month with the system. Twenty patients (mean, 62 yr old) with a mean of 74.3 ± 8.7 dB HL on the worst ear were included. The mean tonal hearing gain on the worst ear was 20 ± 6 dB. Signal-to-noise ratio significantly rose from 1.43 ± 3.9 to 0.16 ± 3.4 dB ( p = 0.0001). Spatial localization was not significantly improved. The mean Tinnitus Handicap Inventory test score of the eight patients suffering from tinnitus rose from 45.5 ± 18.5 to 31 ± 25.2 ( p = 0.016). The Active tri-CROS system is a promising new therapeutically solution for SAHL.

Bone Conduction Implants: Comparative of Audiometric Results and Quality-of-Life Bonebridge® versus Osia®

Introduction: Bone conduction implants have been indicated for patients with conductive hearing loss, mixed hearing loss, and even profound unilateral sensorineural hearing loss. With the introduction of Bonebridge®, new transcutaneous implant options emerged. The latest is Osia®, a direct-drive variant or active systems, where the implant directly generates and applies vibration to the bone. Materials and Methods: Retrospective study of two cohorts of patients treated with active bone conduction implants at a single center, one with the Bonebridge® device and the other with Osia®. Outcomes: Fourteen patients were included, seven in each group (n = 14). The Bonebridge® group showed an average hearing gain in tonal intelligibility thresholds of 32.43 ± 21.39 dB and a gain in the average intelligibility threshold (with 50% discrimination) of 26.29 ± 19.10 dB. In the Osia® group, there was a gain in average tonal thresholds of 41.49 ± 14.16 dB and 23.72 ± 6.98 dB in average intelligibility thresholds. Both devices contributed to improvements in patients’ quality of life, as assessed with APHAB in all the variables studied in the test. Both devices offer rehabilitation for hearing loss as an alternative to hearing aids. The Osia® system shows statistically significant (p < 0.05) improvements in mid and high frequencies, but Bonebridge® slightly outperforms in speech understanding at 50%. Differences in average tonal thresholds and quality of life are not statistically significant. Conclusions: While auditory improvement is observed postimplantation, other aspects, such as intelligibility thresholds and quality of life, lack statistical significance. Given the limited experience with Osia® and the small sample size, the choice of the device should be personalized. Although the literature is inconsistent due to small sample sizes and variable approaches, some studies suggest potential advantages of the Osia® system, especially in speech comprehension in different environments and greater hearing gain compared to Bonebridge®.

The TORP-PORP: A Tympanoplasty Technique for Isolated Defects of the Stapes Suprastructure.

Investigating the outcomes of a surgical approach to treat isolated defects of the stapes suprastructure, using a modified total ossicular replacement prosthesis (TORP) prosthesis as a PORP between the footplate and the incus, effectively creating a TORP-PORP configuration. Eleven patients (mean age, 37.2 years; 36% male and 64% female) between the years 2007 and 2022. Therapeutic (ossiculoplasty). Hearing gain (in dB) in air conduction thresholds at 0.5, 1, 2, 3, and 4 kHz, stability of bone conduction, revision rate. Significant improvement in air conduction between the preoperative and the postoperative cohorts (p = 0.002) with a mean postoperative hearing level of 30.00 ± 5.25 dB. The bone conduction remained stable. We encountered no perioperative complications, and there were no revisions surgery. The described ossiculoplasty procedure is a safe and effective approach to treat isolated defects of the stapes suprastructure.

Linear transmission between malleus and stapes in cases with incus necrosis.

The outcome of cartilage interposition ossiculoplasty was assessed in cases of incus necrosis after posterior malleus repositioning in the plane of the stapes, in terms of hearing gain after ossicular reconstruction. A retrospective observational study was conducted of 30 patients admitted to an Ain Shams University hospital from March 2021 to September 2021. All patients with ossicular disruption due to chronic suppurative otitis media and hearing loss of more than 40 dB were included in the study. Pure tone audiometry was conducted for each patient after three months, six months and one year post operation. The audiogram showed a post-operative air-bone gap of 20 dB or less in 83.33 per cent of patients (n = 25) at three months post-operatively and in 80 per cent of patients after six months; after one year, the results remained the same. The use of cartilage interposition after malleus posterior mobilisation represents an excellent partial ossicular replacement technique.