Hearing Gain Research Articles

Clinical features and prognosis of pediatric idiopathic sudden sensorineural hearing loss: A bi-center retrospective study.

Limited research has focused on the clinical features of sudden sensorineural hearing loss (SSNHL) in pediatric patients. This study is aimed to investigate the relationship between clinical features and the baseline hearing severity and outcomes of SSNHL in the pediatric population. We conducted a bi-center retrospective observational study in 145 SSNHL patients aged no more than 18 years who were recruited between November 2013 and October 2022. Data extracted from medical records, audiograms, complete blood count (CBC) and coagulation tests have been assessed for the relationship with the severity (the thresholds of the initial hearing) and outcomes (recovery rate, hearing gain and the thresholds of the final hearing). A lower lymphocyte count (P = 0.004) and a higher platelet-to-lymphocyte ratio (PLR) (P = 0.041) were found in the patient group with profound initial hearing than in the less severe group. Vertigo (β = 13.932, 95%CI: 4.082-23.782, P = 0.007) and lymphocyte count (β = -6.686, 95%CI: -10.919 to -2.454, P = 0.003) showed significant associations with the threshold of the initial hearing. In the multivariate logistic model, the probability of recovery was higher for patients with ascending and flat audiograms compared to those with descending audiograms (ascending: OR 8.168, 95% CI 1.450-70.143, P = 0.029; flat: OR 3.966, 95% CI 1.341-12.651, P = 0.015). Patients with tinnitus had a 3.2-fold increase in the probability of recovery (OR 3.222, 95% CI 1.241-8.907, P = 0.019), while the baseline hearing threshold (OR 0.968, 95% CI 0.936-0.998, P = 0.047) and duration to the onset of therapy (OR 0.942, 95% CI 0.890-0.977, P = 0.010) were negatively associated with the odds of recovery. The present study showed that accompanying tinnitus, the severity of initial hearing loss, the time elapse and the audiogram configuration might be related to the prognosis of pediatric SSNHL. Meanwhile, the presence of vertigo, lower lymphocytes and higher PLR were associated with worse severity.

Is There an Association between Concurrent Epstein–Barr Virus Infection and Sudden Hearing Loss?—A Case—Control Study in an East Asian Population

Viral infection serves as the crucial etiology for the development of sudden sensorineural hearing loss (SSNHL). We aimed to investigate whether there is an association between concurrent Epstein-Barr virus (EBV) infection and SSNHL in an East Asian population. Patients who were older than 18 years of age and met the criteria of sudden hearing loss without an identifiable etiology were enrolled from July 2021 until June 2022, followed by the serological testing of IgA antibody responses against EBV-specific early antigen (EA) and viral capsid antigen (VCA) with an indirect hemagglutination assay (IHA) and real-time quantitative polymerase chain reaction (qPCR) of EBV DNA in serum before the treatment was initiated. After the treatment for SSNHL, post-treatment audiometry was performed to record the treatment response and degree of recovery. Among the 29 patients included during enrollment, 3 (10.3%) had a positive qPCR result for EBV. In addition, a trend of poor recovery of hearing thresholds was noted for those patients with a higher viral PCR titer. This is the first study to use real-time PCR to detect possible concurrent EBV infection in SSNHL. Our study demonstrated that approximately one-tenth of the enrolled SSNHL patients had evidence of concurrent EBV infection, as reflected by the positive qPCR test results, and a negative trend between hearing gain and the viral DNA PCR level was found within the affected cohort after steroid therapy. These findings indicate a possible role for EBV infection in East Asian patients with SSNHL. Further larger-scale research is needed to better understand the potential role and underlying mechanism of viral infection in the etiology of SSNHL.

Endoscopic Push-Through Cartilage Myringoplasty for Anterior Perforations.

The study aims to evaluate the anatomical and functional success rates of endoscopic push-through cartilage myringoplasty for anterior tympanic membrane (TM) perforations. Thirty patients with TM perforations in the anterior quadrant underwent endoscopic push-through cartilage tympanoplasty and underwent prospective evaluation. The graft uptake rate and hearing gain were the outcomes evaluated. Out of the 30 patients, 15 were male, and 15 were female. The mean age was 32.60 ± 13.66 years (from 18-60 years). The overall graft uptake rate was 90%, with failure observed in three cases. The mean preoperative air conduction threshold was 37.9 ± 5.83 dB which improved to 27.66 ± 4.88 dB at 16 weeks post-operation. The mean postoperative ABG closure was 7.28 dB with a p-value of 0.001 which was statistically significant. Endoscopic push-through cartilage myringoplasty is the least invasive, safe, simple, and advantageous for healing TM perforation and hearing restoration.

Outcome of classical and reversal stapedotomy in otosclerosis

Classical and reversal stapedotomy both are exclusively done in otosclerosis but definite information regarding surgical advances, postoperative results, complications and information about how and in which patients these surgical techniques should exclusively be used are a source of continuous discussions. This prospective observational study was conducted in the Department of Otolaryngology-Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka from July 2019 to December 2020 o compare the outcomes of classical and reversal stapedotomy in patients with otosclerosis. Total 28 cases of otosclerosis who underwent stapedotomy were divided in to two groups i.e. Group A (classical stapedotomy) & Group B (reversal stapedotomy) with 14 patients in each group. All patients were followed up post-operatively up to 3 months with Pure-tone audiometry (PTA). There is no significant difference between classical and reversal stapedotomy approach in terms of hearing improvement and complications. Chorda tympani injury was the main complication in both the groups. Regarding hearing gain and complications there was no significant difference between classical and reversal stapedotomy approach. BSMMU J 2022; 15(2): 121-126

Transcanal endoscopic myringoplasty with butterfly dermal allograft

ObjectiveTympanic membrane perforation (TMP) is a common cause of visits to the otolaryngology clinic. For decades, various surgical methods and various grafts have been used to treat TMP. This study aimed to compare the efficacy of butterfly dermal allograft (BDA) and fat myringoplasty for the treatment of TMP. Study designA retrospective case-control study. SettingTertiary referral center. MethodsWe retrospectively analyzed 40 patients who underwent BDA (n = 20) and fat myringoplasty (n = 20) for TMP performed by a single surgeon between January 2019 and December 2021. The hearing outcomes, graft success rate, complications, operation time, and hospital stay were recorded and compared between the two groups. Hearing outcomes were determined by pure-tone audiometry. ResultsThere was no significant difference between the BDA and fat groups regarding demographic characteristics. There was no significant difference in the pre and postoperative air conduction and bone conduction thresholds, or air-bone gap values between the two groups. A significant audiologic improvement was observed in both groups (p < 0.05), but there was no significant difference in the degree of hearing gain between the two groups. In terms of recurrence of tympanic membrane perforation, postoperative otorrhea, and discomfort symptoms; however, there was no significant difference between the groups (p > 0.05). The operation time and hospital stay were shorter in the BDA group than in the fat group (p < 0.05). ConclusionBDA myringoplasty is as safe and medically efficacious as fat myringoplasty and shortens the operation time and hospital stay.

Long-Term Results of Tragal Cartilage Type 1 Tympanoplasty

Aim: Tympanoplasty is one of the most frequently performed operations by ear, nose, and throat specialists. Surgical treatment of tympanoplasty aims to obtain a healthy ear membrane and minimise hearing loss. The purpose of this study was to evaluate the success of the graft and functional hearing outcomes of patients applied with tragal cartilage type 1 tympanoplasty operation in our clinic. Materials and Methods: This study included 43 patients who underwent tragal cartilage type 1 tympanoplasty operation between January 2016 and November 2020. A retrospective evaluation was made of the preoperative pure tone audiometry (PTA) values and the operative findings. In the follow-up examination, the graft status and PTA results were recorded. The graft success and improvements in hearing were evaluated in all the patients. Results: A total of 43 patients were evaluated, comprising 24 males and 19 females with a mean age of 31.2 years (range, 13-58 years). The operation was performed on the right ear of 22 patients and the left ear of 21. The tympanoplasty operation was performed with an endaural approach in 6 cases and a postauricular approach in 37. The mean follow-up period was 20.8 months (range, 12-39 months). The rate of graft success of all the patients was 88.4%. The mean air conduction threshold, air-bone gap, and bone conduction threshold values at 500, 1000, 2000, and 4000 Hz were determined to have statistically significantly decreased postoperatively in comparison with the preoperative values (p&amp;lt;0.05). Conclusion: In tragal cartilage type 1 tympanoplasty operations, high rates of graft success were obtained and a dramatic gain in hearing postoperatively.

Stapes Bar-Normal Stapedial Superstructure with a Mobile Footplate Fixed to the Promontory.

This report describes a case of stapedial superstructure fixation with a mobile footplate, which is a rare occurrence among the ossicular malformations that cause conductive hearing impairment. A 44-year-old man with symptoms of left-sided hearing impairment since childhood presented to our department. The eardrum was normal, and pure tone audiometry showed conductive hearing impairment with a three-frequency (500, 1000, and 2000 Hz) mean of 53.3 dB and a normal tympanogram result. An abnormal shadow was observed on the internal side of the left stapes during the three-dimensional reconstruction of computed tomography. We suspected a stapes malformation and performed an exploratory tympanotomy with transcanal endoscopic ear surgery. We found a bony bar between the superstructure of the stapes and the promontory. The mobility of the stapes was significantly improved by removing the bony bar. Findings of postoperative audiometry were normal after surgery. The treatment of such cases of stapedial fixation is simple, and the prognosis of hearing gain after surgery is quite good. Thus, regarding the treatment of patients with conductive hearing impairment, clinicians and surgeons should be aware of the possibility of single stapedial superstructure fixation.

Efficacy of Oral versus Intratympanic Steroids in the Treatment of Idiopathic Sudden Sensorineural Hearing Loss: A 1-year Randomized Control Trial

Background: Sudden sensorineural hearing loss (SSNHL) is a common otologic emergency, with hearing loss of 30 dB or greater at three contiguous frequencies, and an abrupt onset within 3 days or fewer, with no recognizable cause. Aims and Objectives: In this study, the efficacy of intratympanic (IT) injections of dexamethasone are compared with oral prednisolone and the behaviour of the different audiometric curves in response to both the steroid therapies in studied. Materials and Methods: Patients presenting with SSNHL to the Department of ENT, Head and Neck Surgery at Government Multi Speciality Hospital, Chandigarh, were subjected to routine tests. Informed written consent was taken from each patient, and cases meeting the selection criteria were included in the study. Pure-tone audiometry was done before starting treatment. Patients were randomly assigned into two groups based on their enrollment number. Those in Group 1 were treated with three doses of 0.3–0.6 mL IT injections of dexamethasone (4 mg/mL) on alternate days and those in Group 2 received OP 1 mg/kg/day with tapering doses. Pure-tone audiogram (PTA) will be repeated after 2 weeks, 4 weeks, and 8 weeks from the first dose. Results: In the IT dexamethasone group, the pretreatment PTA was 61.05 dB while the posttreatment PTA was 37.45 dB. The hearing gain was 23.6 dB. In the oral steroid group, pretreatment PTA was 66.79 while posttreatment PTA was 47.36 dB. The hearing gain was 19.43 dB. The hearing gain in both the groups was statistically significant; however, there was no statistical difference between the two in terms of superiority of efficacy (P &gt; 0.05). Conclusion: The treatment of SSNHL still remains a challenge among the otologists. The present study establishes that the efficacy of IT steroids was as good as the oral steroid therapy for the management of SSNHL as both the modalities showed significant hearing improvement. Hence, IT steroid can be used as a first-line therapy in patients with. Our study also uncovered the fact that patients who come with shorter duration of onset recover quickly compared to those patients who delay their treatment. Hence, IT steroid can be used as a primary modality of treatment instead of a salvage therapy in the selected group of patients.

Double-layer fascial grafts in Type I tympanoplasty for subtotal perforation: A case–control study

Objective: The objective of this study was to assess the double-layer temporalis fascia grafting for myringoplasty for subtotal tympanic membrane (TM) perforation regarding graft uptake and hearing gain. Patients and Methods: The study included 60 patients with subtotal TM perforation attributed to tubotympanic suppurative otitis media. Myringoplasty was done through a postauricular approach using the underlay technique by two layers of the temporalis fascia grafts in the study group and one layer of the temporalis fascia graft in the control group. The procedure was considered successful if there was no residual TM perforation within the follow-up period. Results: Within included 60 patients, 30 patients in the study included 60 patients, 30 patients in the study group (11 males and 19 females) and 30 patients in the control group (9 males and 21 females). The success rate of TM healing was 100% in the case group and 87.7% in the control group with significant difference (P = 0.038). The hearing gains (>10 dB) were reported in 96.7% in the case group while it was 70% in the control group which is significantly better (P = 0.00558). Conclusion: The double-layer temporalis fascia graft is effective for both postoperative graft taking and hearing improvement for subtotal (Grade 4) TM perforation.

The outcome of a single-stage endoscopic tympanoplasty with septoplasty using autologous septal cartilage graft in patients with mucosal chronic otitis media and deviated nasal septum

Background: Single-stage endoscopic tympanoplasty with septoplasty using autologous septal cartilage graft in patients with mucosal chronic otitis media and deviated nasal septum had resulted in successful repair of the tympanic membrane perforation and correction of the deviated nasal septum with improved eustachian tube dysfunction at the same time. Aims and Objectives: To study the structural and functional outcome of single-stage endoscopic Type 1 tympanoplasty using autologous septal cartilage graft after septoplasty in patients having mucosal chronic otitis media and deviated nasal septum. Material and Methods: We prospectively analysed 102 patients with chronic mucosal otitis media and central perforation of the tympanic membrane and deviated nasal septum with Eustachian tube dysfunction. The patients underwent endoscopic Type I tympanoplasty using an autologous septal cartilage graft with a thickness of approximately 0.5 mm that was harvested during endoscopic septoplasty. Morphological and functional results were recorded at 1, 6 and 12 month follow ups. Result: All patients were between years of age 31 to 40 years (31%). The average age of the study subject was 33.38 ± 12.63 years, with the male to female ratio of 1.31. Postoperatively the patients were looked for the acceptance of the cartilage graft and hearing gain. Of the total 102 patients, in 90 patients, eardrums perforations were closed satisfactorily, and 12 patients suffered from residual perforation (12%). On the functional front the mean pre-operative hearing loss of 40.98 ± 8.71 dB, improved significantly to 32 ± 9.06 dB postoperatively (P-value < 0.001). with a mean gain of 8.98 dB. Also, the mean pre-operative Air-Bone gap (27 ± 9.13 dB) was reduced postoperatively (13.82 ± 8.45 dB) (P-value < 0.001). Thus, improvement was noted to be 13.18 dB. Conclusion: Endoscopic cartilage tympanoplasty with autologous septal cartilage graft of the nose is a safe and effective way for Type I tympanoplasty with good structural and functional results and added benefits of reduced operating time, optimal graft uptake rate, minimal morbidity and pain and more importantly, ear surgery without a postauricular scar.

A comparative study of endoscopic versus microscopic tympanoplasty in chronic otitis media

Background: To compare the results between tympanoplasty performed with transcanal endoscopic ear surgery and microscopic ear surgery for the treatment of chronic otitis media. Materials and Methods: A double-blind randomized prospective study was performed on inactive chronic otitis media patients that underwent tympanoplasty and later follow-up for at least 6 months in terms of graft uptake and hearing gain. Seventy patients were selected and randomized in Group A-endoscopic tympanoplasty and Group B-microscopic tympanoplasty. Results: In our study, we found that the graft take up rate was 94.3% (33/35) in Group A and 91.4% (32/35) in Group B. The improvements in the air-conduction levels and the air-bone gaps were not significantly different between the two groups (P > 0.05). The average hearing gains in the endoscopic group postsurgery were 10.51 ± 4.71 dB and in the microscopic group were 12.23 ± 4.72 dB (P = 0.132). The average operating time was 37.77 ± 5.33 min in the endoscopic group which was better than the microscopic group which was 45.77 ± 5.29 min, (P < 0.001). Conclusion: Endoscopic tympanoplasty technique is a feasible alternative to the conventional microscopic technique owing to the findings in terms of duration of surgery and graft uptake. In addition, the endoscopic approach provides better postoperative cosmesis, patient satisfaction, and early mobilization.

Comparative study of minimally invasive endoscopic tympanoplasty with microscopic tympanoplasty

Background: Chronic suppurative otitis media (CSOM) is a disease of a low-socioeconomic group with high prevalence in India. Tympanoplasty is a common procedure done for CSOM. Hopkins endoscopes are now more popular for various ear surgeries due to better optics, portability, and cost-effectiveness. The objective was to compare the surgical outcome of minimally invasive endoscopic tympanoplasty and microscopic tympanoplasty. Materials and Methods: A prospective follow-up comparative study was performed on 60 patients who underwent tympanoplasty from January 2021 to December 2021. The subjects were divided equally and randomly into two groups (endoscopic group and microscopic group). Demographic data, perforation size of the tympanic membrane, pure-tone audiometry results preoperatively, and at the 8th week postoperatively, type of anesthesia used, average surgical time, postoperative morbidity, and graft uptake rate in both the groups were compared. Results: Graft uptake was 93% in the endoscopic group and 96% in the microscopic group. Postoperative morbidity was more in the microscopic group as compared to the endoscopic group. Average surgical time was less in the endoscopic group as compared to the microscopic group. Endoscopic tympanoplasty was done under local anesthesia and is economically more acceptable to the patient as compared to the microscopic group. The mean air–bone gap gain was 16.44 dB in the endoscopic group and 16.07 dB in the microscopic group. Conclusion: With minimally invasive endoscopic procedure, it is possible to get a similar graft uptake rate and hearing gain as compared with conventional microscopic procedure with the advantage of having less postoperative morbidity and lesser consumption of medical resources. Thereby making it a more cost-effective technique and can be easily performed in remote places.

Comparative study between anterior tucking and tunneling of graft in Type-1 tympanoplasty

Background: Tympanoplasty is the surgical procedure performed to repair a perforated tympanic membrane, with or without reconstruction of the ossicles, with the aim of preventing reinfection and restoring hearing ability. There are various techniques to perform Type 1 tympanoplasty. Aims and Objectives: · To compare anterior tucking and tunneling of temporalis fascia graft in Type 1 tympanoplasty based on the clinical and audiological outcome. · To study the hearing outcome and graft uptake in anterior tucking technique and anterior tunneling technique in Type 1 tympanoplasty. · To compare the hearing outcome and graft uptake in anterior tucking versus anterior tunneling technique in Type 1 tympanoplasty. Materials and Methods: The study was carried out in the Department of Otorhinolaryngology (ENT), Maharishi Markandeshwar Institute of Medical Sciences and Research Hospital, Mullana over 2 years from September 2020 to September 2022. One hundred cases of inactive, chronic otitis media (COM) were included in this study and subjected to Type 1 tympanoplasty with 50 belonging to the anterior tucking technique (Group A) and 50 to the anterior tunneling technique (Group B). Results: The graft uptake rate was 96% in Group A (anterior tucking technique) and 98% in Group B (anterior tunneling technique). The average hearing gain in Group A was 9.94 dB and in Group B was 9.36. Chances of complications like residual perforation were found to be low (4% in Group A and 2% in Group B) in both techniques. Conclusion: In our study, we concluded that both the techniques of anterior tucking and anterior tunneling of temporalis fascia graft in Type 1 tympanoplasty surgery are equally effective to achieve intactness of graft and hearing improvement in patients of inactive, mucosal COM.

Comparative Study of Temporalis Fascia Graft versus Cartilage Shield Tympanoplasty in Chronic Otitis Media - Mucosal Type

Introduction: Tympanoplasty is the procedure of choice for surgical correction of tympanic membrane perforation triggered by either chronic otitis media or trauma. Various types of autologous grafts have been used to close tympanic membrane perforations among which temporalis fascia and tragal cartilage are preferred, due to their anatomic proximity, ease of harvesting and suppleness.&#x0D; Aims: To compare clinical and audiological outcomes of type 1 tympanoplasty where temporalis fascia and tragal cartilage were used as the graft material.&#x0D; Methods: A prospective study was conducted on 50 patients of ages ranging from 10 to 50 years with Chronic Otitis Media - Mucosal. All the patients underwent type 1 tympanoplasty and were categorized into Group-A (Temporalis fascia graft) and Group-B (Cartilage graft), each group comprising of 25 patients. Graft uptake rate, hearing gain and air bone gap closure were compared between the groups in 4 and 8 weeks after surgery.&#x0D; Results: Out of total 50 patients, 20 were male and 30 were female. The average age of the patients was 28.20 years. The total hearing gain in the whole series was 14.94 dB while the total air bone gap closure was 14.78 dB respectively. The difference between pre and post-operative hearing was statistically significant for both air bone gap and air conduction, (P&lt;0.05) in the whole series. There was 15.56 dB improvement in mean hearing threshold and 15.64 dB mean air bone gap closure in the fascia group, compared to 14.32 dB improvement in mean hearing and 13.92 dB mean air bone gap closure in the cartilage group. Graft uptake rate in the temporalis fascia group was 84% and the cartilage group was 92 % with significant difference in the graft uptake rate between the groups.&#x0D; Conclusion: The graft uptake rate and hearing results of tragal cartilage are comparable to those of temporalis fascia. Cartilage tympanoplasty has a higher graft uptake rate with low failure rate and also shows a high degree of reliability in high risk cases. Both cartilage and fascia tympanoplasty provided similar improvements in the hearing outcome post-operatively. Thus, cartilage tympanoplasty is recommended as an alternative option.

OSSICULOPLASTY: AUTOGRAFT VS ALLOGRAFT

Background: Chronic otitis media (COM) is defined as a perforation of the tympanic membrane with persistent drainage of pus from the middle ear lasting at least two weeks. Tympanoplasty is a surgical procedure in ENT practice which aims at removal of diseased pathology from middle ear along with reconstruction of sound conducting mechanism by reconstructing the ossicular chain with various materials. Methods:All the cases of CSOM with ossicular chain deformity were included. Ear examination was done in detail, Preoperative hearing assessment was done and Hearing loss was calculated by average air bone gap on PTA.For Auto graftstragal cartilage or incus was used andfor allograft Teflon TORP/PORP with cartilage cap was used. Results: Comparison forossiculoplasty was done by comparing its advantages and disadvantages in the terms of extrusion rate and hearing restoration in postoperative period. Overall failure rate for autologous material was 8% and for alloplastic material was 12%. Conclusion: the use of autologous graft is more advantageous in terms of surgical outcome, extrusion rate, and postoperative hearing gain.

Study On The Outcome Of Endoscopic Tympanoplasty Versus The Conventional Method.

BACKGROUND : Endoscopic tympanoplasty is an minimally invasive surgery for the repair of tympanic membrane with complete graft survival and hearing outcomes to the conventional microscopic surgery. This study was aimed to evaluate the success rate of endoscopic trans-canal closure of tympanic membrane perforation compared to the conventional post auricular approach using temporalis fascia and tragal cartilage as a graft. METHODS: Our study consisted of 50 patientswith chronic otitis media,with dry ear for last 2 months and all patients were between 18-50yrs of age.All selected patients were subjected to pre operative oto endoscopicand audiological assessment and underwent endoscopic trans canal tympanoplasty using temporalis fascia in some and tragal cartilage in some. RESULTS: Trans canal endoscopic surgery resulted in the successful healing of 97% whereas in conventional method successful healing was only up-to 92%. The average hearing gain was also significantly improved in endoscopic surgery compared to that of conventional method. When the operative time was considered the mean time in endoscopic method was lesser. All patients were followed up for a period of 3 months. CONCLUSION: Comparisons between these 2 groups focused on the surgical outcomes and restoration of hearing, including the duration of surgery. All patients were followed up for a period of 3 months. Using this method not only improves the cosmetic outcome but also reduces the post operative morbidity with shorter operative time. KEYWORDS: Endoscopic Tympanoplasty, Conventional Tympanoplasty, Tympanoplasty

The Effect of Hormone Replacement Treatment on Hearing Function in Hypothyroid Patients.

Fifty hypothyroid patients were included in this study. Levothyroxine (0.05-0.2mg/dl) was used for HRT and its dosage was gradually increased until the patients became euthyroid. Otoscopy and microscope was used to evaluate tympanic membrane and hearing thresholds and pure tone avarages (PTA) were estimated by using pure tone audiometry before and after treatment. Patients with lower baseline free T4 (FT4) had significantly higher air conduction PTA (p < 0.05). Negative correlation between the severity of hypothyroidism and hearing gain were found (p < 0.05). Hearing improvements were at 250 and 8000Hz after HRT. Due to the correlation between baseline FT4 and hearing impairment in a negative direction, disease severity may have an effect on hearing impairment. In addition, patients with lower FT4 and higher thyroid-stimulating hormone levels had lower PTA improvement after HRT. HRT may not significantly improve hearing disorders in severe hypothyroidism.

Outcome of Tympanoplasty with Cortical Mastoidectomy in Tubotympanic Type of CSOM

Background: Chronic suppurative otitis media (CSOM) is one of the most common ear diseases in under developing countries. Otolaryngologists debate whether to perform tympanoplasty with or without cortical mastoidectomy when treating CSOM. Objective: To see the outcome of tympanoplasty with cortical mastoidectomy for hearing gain and grafting success. Methods: This observational study was carried out in the Department of Otolaryngology - Head and Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2018 to June 2020. A total of 30 patients who underwent type 1 tympanoplasty with cortical mastoidectomy were enrolled in this study. Following enrollment, the condition of the pinna, preauricular region, postauricular region, and external auditory canal were examined. The location and extent of the tympanic membrane perforation, the state of the remaining tympanic membrane, the health of the middle ear mucosa, and the ossicles were all examined during the otoscopy. Tuning fork tests, tests for facial nerve integrity, and fistula tests were also carried out. The hearing level was assessed by pure-tone audiometry with masking. Results: Among 30 patients’ females were 53.3% and males were 46.7%. All of the patients ranged in age from 16 to 60, with the majority of them falling between the ages of 21 and 30. Most of the patients came from middle-class families, and the majority of patients were from rural areas. The majority of patients showed unilateral ear involvement. Most often, the central malleolar region was perforated, then the anterior central region and the posterior central region. The most frequent perforation size was medium, followed by small, large, and subtotal. The pre- treatment bone conduction threshold was 11.74± 4.42 dB, which was reduced to 10.14 ±3.70 dB after treatment (p&lt;0.05). The pre-treatment air conduction threshold was 39.78± 8.76 dB, which was reduced to 26.45 ±9.19 dB after treatment (p&lt;0.05). The pre-treatment air-bone ..

Modified Radical Mastoidectomy: Open Mastoid Cavity versus Cavity Obliteration Using Periosteal Temporofascial Flap - A Comparative Study

Introduction The surgical treatment of Chronic Otitis Media by modified radical mastoidectomy usually results in an open cavity, with chronic discharge, hearing loss of 30 to 40 dB, frequent visits to OPD for debris removal and none the less dizziness on cold air exposure. One way to deal with these issues effectively is to obliterate the mastoid cavity. In our study we used vascularised periosteo-temporofascial swing flap with medicated bone dust to obliterate the mastoid cavity. Material and Methods In this prospective study, 50 patients who suffered from chronic otitis media, active squamous (cholesteatoma) disease, and underwent modified radical mastoidectomy with tympanoplasty procedure were and split between two equally sized groups. Group 1 had patients with open mastoid cavity and Group 2 had obliteration of mastoid cavity using vascularised periosteo-temporofascial swing flap with medicated bone dust. Patients were followed at 3rd week, 6th week, 3rd month and 6th month. Results Patients with cavity obliteration had better and statistically significant outcomes in term of discharge status of cavity and epithelization at 3 weeks. Patients with obliteration also had positive and statistically significant results in hearing levels and hearing gain at 6 months follow up. Conclusion Mastoid cavity obliteration with vascularised periosteo-temporofascial swing flap with medicated bone dust is a good and effective method for better post-operative outcomes and curtailing dependency on doctors for cavity care.

Modulation of Asymmetry in Auditory Perception through a Bilateral Auditory Intervention

The objective of this work was to analyze the modulating effect of an auditory intervention (AI) on the threshold and symmetry of auditory perception in people with different emotional states. The effects of AI were compared 3 months after using threshold audiometry (air conduction). The studied groups were emotional well-being (EWB) (n = 50, 14 with AI, 36 without AI); anxiety (ANX) (n = 31, 10 with AI, 21 without AI); and mixed group (MIX) (n = 45, 19 with AI, 26 without AI). The EWB group with AI lost the advantage of the left ear due to the hearing gain of the right ear, whereas in EWB without AI, no changes were observed. The ANX group with AI showed a non-significant improvement in both ears, maintaining the left interaural advantage. Interestingly, in the group without AI, the interaural difference was lost. The MIX group did not show interaural differences either with or without AI. However, the AI group showed a lower left ear threshold than that of the right ear, in contrast to the non-AI group. In conclusion, the application of this AI manages to decrease the prioritization of high frequencies, in addition to balance hearing between ears, which could decrease activation in states of anxiety.