Glasgow Benefit Plot Research Articles

Technical and functional hearing results after unilateral stapes surgery for otosclerosis at Cluj-Napoca University Hospital

The aim of this study was to assess the hearing results after unilateral stapes surgery for otosclerosis at Cluj-Napoca University Hospital, and to evaluate surgical trauma to the inner ear in these patients. The medical records of 387 consecutive patients who underwent unilateral stapes surgery were reviewed. Hearing results were evaluated according to the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium guidelines and the Glasgow benefit plot. In addition we used Amsterdam plot to give an overview on air conduction gain and bone-conduction differences on an individual level. Results were analyzed separately for patients with preoperative unilateral, bilateral asymmetrical, and bilateral symmetrical hearing loss. Despite good technical hearing results after surgery (closure of the air-bone gap to ≤20 dB in 92% of patients, air conduction gain of 24 ± 10.00 dB), only 37% of patients achieved functionally normal, symmetrical hearing. Our results indicated that the pattern of preoperative hearing impairment in patients with otosclerosis can predict postoperative functional hearing results. The type of preoperative hearing impairment had.

Bilateral hearing results of 751 unilateral stapedotomies evaluated with the Glasgow benefit plot

We aimed to evaluate bilateral hearing function in patients undergoing primary unilateral stapedotomy, according to the 1995 American Academy of Otolaryngology, Head and Neck Surgery guidelines and the Glasgow benefit plot. We also aimed to analyse the effect of pre-operative hearing impairment type on post-stapedotomy hearing. Retrospective chart review. Medical records relating to 1369 stapedotomies performed by the senior author (JJH) from 1991 to 2006 were reviewed. Seven hundred and fifty-one patients undergoing primary unilateral stapedotomy were included. Hearing results for these patients were evaluated according to the criteria of the 1995 American Academy of Otolaryngology, Head and Neck Surgery Committee on Hearing and Equilibrium guidelines, and the Glasgow benefit plot. Subgroups of patients with pre-operative unilateral, bilateral symmetrical and bilateral asymmetrical hearing loss were separately analysed. The most successful results, as regards the achievement of bilateral, socially serviceable hearing, were demonstrated in patients with unilateral hearing loss; 78 per cent of these patients had normal hearing post-operatively. Overall, patients' achievement of bilateral, socially serviceable hearing correlated highly with their type of pre-operative hearing impairment (r = 0.74). Normal post-operative hearing levels also correlated with pre-operative bone conduction (r = 0.61). This study represents the largest reported series of primary stapedotomy cases evaluated with the Glasgow benefit plot. Patients' bilateral post-operative hearing function depended on their type of pre-operative hearing impairment. Pre-operative bone conduction thresholds, corrected for Carhart's effect, were useful in predicting achievable post-operative air conduction.

Functional results of 394 bilateral stapedotomies evaluated with the Glasgow Benefit Plot

This study aimed to evaluate the results of 394 bilateral stapedotomies according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines and with the Glasgow Benefit Plot (GBP) and also analyze the benefit of a second-ear stapedotomy in achievement of normal and symmetrical hearing using retrospective chart review. The charts of 1,369 stapedotomies performed by senior author (J.H.) from 1991 to 2006 were reviewed. Results of 394 bilateral stapedotomies were included. The hearing results were evaluated according to the 1995 AAO-HNS Committee on Hearing and Equilibrium (CHE) guidelines and the GBP criteria. Success rates after the first and second ear surgeries were separately analysed. ABG closure < or =20 dB was demonstrated in 98% of cases after both first and second procedures. Postoperative AC gain was higher in the first ear surgery compared with the second ear surgery in all groups of preoperative hearing impairment. As a result of first ear surgery, 142 (72%) patients changed into the category of unilateral hearing loss. As a result of second ear surgery, 125 (64%) patients changed into the category of normal and symmetric hearing. In this study the largest group of 394 primary bilateral stapedotomies was simultaneously evaluated according to AAO-HNS guidelines and GBP criteria. The results showed that the first ear surgery was more successful in achievement of normal hearing in the operated ear. Second ear surgery was more beneficial in providing symmetric hearing.

The assessment of hearing test results following surgery for otitis media with effusion in adults using the Glasgow Benefit Plot: how we do it

The assessment of hearing test results following surgery for otitis media with effusion in adults using the Glasgow Benefit Plot: how we do it

Ossiculoplastie par prothèse partielle en titane Spiggle & Theis ® dans l’otite cholestéatomateuse : résultats fonctionnels

Objectives To report the functional results of ossicular reconstruction achieved with a specific partial prosthesis in tympanoplasty for cholesteatoma. Materials and methods Forty-four patients presenting cholesteatoma of the middle ear were involved in a retrospective study. Tympanoplasties were performed by the same surgeon over a 30-month period. The patients underwent ossiculoplasty with the shortest nondivisible partial titanium Spiggle & Theis ® prosthesis. Twenty-eight procedures were canal wall-up tympanoplasties and 17 were canal wall-down procedures; 27 were primary tympanoplasties and 18 were revisions. Audiometric data were evaluated before and after surgery, with a mean follow-up of 13.4 months. Results Improvement of the air–bone gap was 6 ± 12.2 dB. The overall success rate was 56% and 67% using the Glasgow Benefit Plot and a postoperative air–bone gap lower than 20 dB, respectively. There was no significant functional difference between canal wall-up and canal wall-down procedures. Hearing results were better in primary tympanoplasties than in revisions ( p = 0.004). The extrusion rate was 2.2%. Conclusion The functional results observed in this study confirm that this partial titanium Spiggle & Theis ® prosthesis is a valuable biomaterial for ossicular reconstruction in primary tympanoplasty for cholesteatoma.

The Quartile Benefit Plot: A Middle Ear Surgery Benefit Assessment Scheme

The purpose of this study is to present a new method for the assessment of hearing improvement following stapes surgery, taking into account additional, previously omitted evaluation criteria. Retrospective. A quartile plot, based on the currently used Glasgow benefit plot, is structured to include two additional criteria of hearing assessment, namely the absence of postoperative sensorineural hearing loss and the closure of the air-bone gap to <10 dB. Pre- and postoperative hearing results of 132 patients diagnosed with bilateral otosclerosis and treated with bilateral stapes surgery were plotted on both the classical Glasgow benefit plot and the new quartile benefit plot. The difference in success assessment due to stricter assessment criteria is demonstrated. Functional success rate following bilateral stapes surgery as plotted on the traditional Glasgow benefit plot was 51.5%. Success rate for bilateral stapes surgery assessed on the new quartile plot with the addition of the two new criteria was 38.64%. The difference in success rates was found to be statistically significant. The basis of benefit assessment in stapes surgery solely on the mean deficit in air conduction results in overestimation of success rate. This study demonstrates that results that appear satisfactory when judged by the Glasgow benefit plot are of modest success when assessed by the new quartile plot. The quartile benefit plot presented in this paper provides a strict measure of presentation and evaluation of stapes surgery results.

Using the Glasgow Benefit Plot as a Prognostic Instrument and for Preoperative Counseling in Patients With Otosclerosis

The Glasgow Benefit Plot (GBP) is a graph showing the pure-tone thresholds preoperatively and postoperatively, and is meant to visualize the possible outcome of binaural hearing for individual patients. We used our database comprising a large number of patient data to test the usefulness of the GBP. Evaluation based on retrospective clinical data. Tertiary referral center, University clinic. Audiometric assessment included bilateral preoperative and postoperative evaluation using conventional audiometry. Three preoperative groups (unilateral, asymmetric, and symmetric hearing impairment) were split into 6 postoperative categories in the GBP diagram. Considering the 509 operations, including 34 bilateral operations, the total outcome was distributed as follows: 34% resulted in bilateral normal hearing, 24% unilateral normal hearing (in operated ear), 14% still unilateral hearing impairment (in operated ear), 13% symmetric hearing impairment, 10% asymmetric hearing impairment (operated ear best), 5% still asymmetric hearing impairment (nonoperated ear best). The distribution of outcomes depended in part on the bone conduction level in the operated ear and in part on the hearing status in the contralateral ear. The GBP is a useful instrument that provides a means for judging the binaural hearing status. However, the outcome of stapes surgery for individual persons and for a group depends critically on the preoperative audiometric criteria for patients who are chosen for surgery. In cases of depressed bone conductions, the method does not indicate the upper limit for possible hearing improvement. A number of patients with combined hearing impairments were included in the present study population. In preoperative counseling, the GBP must be complemented with information with regard to the limitation of possible hearing improvement owing to the individual bone conduction level.

Comparison between the conventional methods and Glasgow Benefit Plot in evaluating subjective hearing results after myringoplasty

Comparison between the conventional methods and Glasgow Benefit Plot in evaluating subjective hearing results after myringoplasty

Patient's quality of life and hearing outcomes after stapes surgery

To determine the quality of life (QOL) after stapes surgery and whether audiological parameters for hearing correlate with specific QOL factors. A retrospective cross-sectional study. A tertiary referral centre. A series of 35 patients who underwent stapes surgery of which three were excluded because they were <18 years of age, chronically or mentally ill, or in a dependant relationship. Response rate was 93% (30/32). Nine were further excluded because they had revision or bilateral surgery, or missing data. Twenty-one patients were included in this study. The Glasgow Benefit Inventory (GBI) was used to evaluate general QOL and the Hearing Disability and Handicap Scale (HDHS) was used as a disease-specific measure. The Belfast Rule of Thumb and Glasgow Benefit Plot assessed hearing outcomes. Operative success was 86% using the Belfast Rule of Thumb and 95% had closure of the air-bone gap to within 20 dB. 81.8% of patients reported a better overall QOL as surgery. Glasgow Benefit Inventory Social and GBI Physical scores correlated positively with the HDHS speech component (P < 0.05). The duration of hearing loss correlated inversely with the average HDHS score (P < 0.05). The majority of patients report a better QOL as undergoing stapes surgery. Speech impacts on people's physical and social QOL of patients. Quality of life tools, in addition to objective audiologic measurements can provide clinicians with patients' subjective perspective that helps guide clinical decision-making and counselling.

Hearing benefit in middle ear reconstructive surgery: A comparative study of the current methods

The objective of this prospective study was to compare two methods of predicting the level of hearing benefit following reconstructive middle ear surgery, namely Glasgow benefit plot and Belfast rule of thumb. The correlation of hearing benefit as measured by using these methods was also compared with patient's self-assessment of his/her hearing status. Sixty patients undergoing middle ear reconstructive surgery were studied. Hearing status was assessed pre and post operatively by pure tone audiometry and self-assessment by patient with a questionnaire. The accuracy of predictability of hearing benefit by the two methods was compared with the patient's own assessment. Relevant literature on the subject is reviewed.

Effects of varying unilateral conductive hearing losses on speech-in-noise discrimination: an experimental study with implications for surgical correction.

Unilateral conductive hearing loss (HL) causes measurable disability in realistic hearing environments. The benefits of improving this loss depend both on the absolute level of final hearing and on hearing asymmetry. Surgical success is often measured by the degree of change in the air-bone gap or in the air thresholds. The Glasgow Benefit Plot and the Belfast Rule of Thumb suggest that a given hearing gain will be of greater benefit if the postoperative thresholds in the worse ear are a <30-dB HL or within 15 dB of the contralateral ear. This assertion has important surgical implications, but few audiometric data supporting it currently exist. Speech-in-noise sound-field scores were measured in 16 normal volunteers at three presentation levels at two signal-to-noise ratios (SNRs). Two levels of unilateral conductive HL were simulated with earplugs, averaging 25-and 43-dB HL, respectively, and the effect on speech-in-noise scores was measured and analyzed. Unilateral conductive HL is a disadvantage at lower sound intensities and low SNRs, but it can be compensated for by increasing volume or SNR. The benefits of improving unilateral conductive HL are greater if the final asymmetry is <25 dB and the final hearing threshold is <25 dB. Unilateral conductive HL is a significant disadvantage at low SNRs or presentation volumes. The benefits of surgery to improve HL depend not only on the degree of hearing improvement but also on the final hearing threshold in both ears.

Evaluation of Second-Ear Stapedotomy with the Glasgow Benefit Plot

This study reports the evaluation of the results after 72 stapedotomies in patients with bilateral otosclerosis. All pre- and postoperative audiological data, together with all relevant information of the operations, were stored in a data base and analyzed retrospectively. The Glasgow benefit plot (GBP) is a useful method to evaluate the hearing results of each individual ear after stapes surgery in a more functional way rather than from a technical standpoint. Therefore, it has been used to assess the benefit obtained after second-ear stapedotomy. From the results it appears that a second operation on the contralateral side increases the chances of achieving at least one ‘normal’-hearing ear, and it makes symmetrical ‘normal’ hearing possible in the majority of the cases.

Surgery of tympanosclerosis.

Eighty-five cases with tympanosclerosis of the middle ear were treated surgically in this series from 1984 to 1995. Twelve of them were associated with cholesteatoma and had radical surgery performed. An attempt is made here to classify the tympanosclerosis on a patho-physiological basis. A planned two-stage procedure was performed in 36 cases after an interval of 18 months. The majority of patients had stapes surgery carried out by a two-stage procedure. One of the patients who did not have stapes surgery developed anacusis after 18 months post-operatively and in another patient recurrence was observed. Post-operative hearing improvement was found to be satisfactory in the short-term follow-up period of two to five years. The hearing improvement was analysed by using Chi-square value (chi 2) and also plotted in the Glasgow Benefit Plot.

The Glasgow benefit plot used to assess the effect of bilateral stapedectomy

The Glasgow benefit plot has encouraged surgeons to look at the results of their surgery from a more functional standpoint rather than in purely technical terms. Our aim was to use the plot to examine the efficacy of second side stapedectomy. A retrospective study of 17 second side stapedectomies showed that the addition of the second operation significantly increased the chances of achieving at least one 'normal' hearing ear and made 'normal' and symmetrical hearing possible.

The assessment of hearing results following surgery for otitis media with effusion using the Glasgow Benefit Plot.

The hearing data from a sample of 73 children undergoing surgical treatment for chronic otitis media with effusion (OME) were analysed using a modification of the Glasgow Benefit Plot. All the patients had bilateral middle ear effusions confirmed at surgery. Using 20 dB average hearing level as the 'cutoff' point between normal and abnormal hearing, 65 (89 per cent) patients had binaural normal hearing, five (7 per cent) had monaural normal hearing and three (4 per cent) had bilateral hearing loss after surgery. However, 70 patients (96 per cent) were found to benefit from surgery. The cases with persistent hearing loss were re-examined to determine the cause of failure.

Long-term results of total ossicular chain reconstruction using autografts.

The long-term results of 63 total ossicular chain reconstructions using autografts is presented. The follow-up period ranged from 18 months to 18 years with an average of 8.5 years. The primary aims of the study were firstly to assess the long-term success rate and to find out if there were any hitherto unknown causes of bone graft failure. In the event, it was found that the recently described anatomical variation of the oval window viz., the deep oval window, was the prime cause of failure in 32 per cent of unsuccessful cases. Some measures to help to mitigate this problem, are suggested. The result were assessed on the basis of: 1. A minimum gain of 20 dB HL in air conduction (Technical success). The success rate was 55.5 per cent. 2. Patients benefited using Smyth and Patterson's criteria in conjunction with the Glasgow Benefit Plot; 54 per cent of the patients benefited significantly.

The glasgow benefit plot: A new method for reporting benefits from middle ear surgery

Conventionally, the results of middle ear surgery are reported in terms of postoperative closure of the air-bone gap or the improvement in air-conduction thresholds. While these are relevant in that they assess the technical success of the procedure and the lessening of monaural disability, they do not necessarily assess whether the patient has benefited. This is determined by many factors, not least of which is the hearing in the nonoperated ear. In this paper, we suggest that preoperative and postoperative plots of the air-conduction thresholds in both ears be used as an additional method of presenting the results. First, the proportion of patients that fall into each of three main preoperative impairment groups are identified. This is important, as the potential benefits from surgery are not the same in each group. Thereafter, the percentages of patients that achieve various postoperative hearing categories can be calculated, allowing surgeons to audit their results and make comparisons between series.