Hearing Outcomes In Patients Research Articles

A Study on the Effectiveness of Treatment of Acoustic Trauma Caused by Gunshot Noise

Background and Objectives : The effectiveness of many treatment regimens on acoustic trauma has been debated, but there is no established treatment yet. The purpose of this study was to evaluate the efficacy of steroid treatment in acoustic trauma caused by rifles and to find a critical time limit for the treatment to be effective. Subjects and Method : A retrospective review was conducted for 86 conscripted policemen (97 ears) who suffered acoustic trauma after rifle exercise. Pure tone audiograms were compared before and after treatment at 0.5, 1 and 2 kHz (speech-frequency pure tone average, speech-PTA) and at 4, 6 and 8 kHz (high tone pure tone average, high-PTA). Treatment consisted of drugs (steroid, ascorbic acid, gingko biloba, dextran) and carbogen therapy. The patients who came to the hospital after the first 14 days following injury were grouped as control. Hearing outcomes of patients treated within 3 days and within 7 days were compared to the control. Pre-and post-treatment hearing was compared according to the elapsed time before treatment. Results : Hearing outcomes of patients who received treatment within 3 days of acoustic trauma was better than the control group. Speech-frequency did not show any difference. Treatment within 7 days showed no statistical difference compared to the control. Hearing gain was better when treated within 7 days, especially if it was within 3 days. Speech-frequency showed significant spontaneous recovery within 3days. Conclusion : Our data showed a possible effectiveness of treatment of acoustic trauma on the recovery of high frequency hearing when started within 3 days. Speech-frequency seems to recover spontaneously within 3 days.

Hearing outcomes in patients with vestibular schwannomas

Hearing outcomes in patients with vestibular schwannomas

Partial Ossicular Replacement Versus Type II Tympanoplasty in Congenital Aural Atresia Surgery

To compare partial ossicular replacement (POR) with type II tympanoplasty (T2) with regard to the postoperative hearing outcomes in patients with congenital aural atresia. A retrospective review of medical records. Tertiary referral center. Thirty-four ears undergoing POR were compared with matched 34 ears by age at operation, grade of microtia, and the Jahrsdoerfer grading scale score that underwent T2. The medical records of the patients that underwent surgery for congenital aural atresia were reviewed. The preoperative and postoperative air-conduction threshold, air-bone gap, and air-bone gap closure were compared between the 2 groups. Thirty-four ears in each group were compared. PORs were performed in cases of a incudostapedial joint problem, ossicular anomaly, or ossicular fixation. The preoperative and 6-month postoperative mean air-conduction thresholds and air-bone gaps were not significantly different in the comparisons between the 2 groups. The mean values for the postoperative air-bone gap closure were not significantly different in the 2 groups. The hearing results 3 years after surgery were available in 13 patients in each group. In these patients, the mean values of the preoperative and the 3-year postoperative air-conduction threshold and air-bone gap were not statistically different in the 2 groups. However, the mean air-bone gap closure in the POR group was 28.6 +/- 10.2 dB hearing level compared with 19.0 +/- 12.9 dB hearing loss in the T2 group, which was statistically significant (p = 0.034). POR can be a good surgical option in cases of a poor incudostapedial joint connection, ossicular anomaly, or ossicular fixation.

Postoperative Aeration in the Middle Ear and Hearing Outcome After Canal Wall Down Tympanoplasty With Soft-Wall Reconstruction for Cholesteatoma

Canal wall down (CWD) tympanoplasty with soft-wall reconstruction (SWR) is a unique technique for cholesteatoma surgery. The external auditory canal shape after surgery-retracted like a radical mastoid cavity or preserved intact-depends on postoperative aeration in the mastoid cavity. However, the relationship between postoperative middle ear aeration and hearing outcome with this procedure is unknown. We characterized this relationship and propose an ideal state of middle ear aeration to obtain satisfactory postoperative hearing after CWD tympanoplasty with SWR. Retrospective case series. Seventy-eight patients (78 ears) with fresh cholesteatomas treated surgically at our hospital by planned 2-stage CWD tympanoplasty and SWR were included. Postoperative middle ear aeration was scored 1 year after second-stage surgery by computed tomography. The patients were divided into 4 bins according to postoperative audiometric air-bone (A-B) gaps: 0-10, 11-20, 21-30, and greater than 30 dB. Postoperative middle ear aeration was significantly greater in the smaller gap bins (0-10 and 11-20 dB) compared with the larger A-B gap bins (21-30 and >30 dB). In contrast to the larger A-B gap bins, those with smaller A-B gaps showed reaeration of the antrum and mastoid cavity. No significant differences were observed in postoperative middle ear aeration or hearing outcome between the 2 cholesteatoma types. Promoting postoperative aeration of the entire middle ear is necessary to achieve better hearing outcome in patients undergoing CWD tympanoplasty and SWR for cholesteatoma.

Can Intratympanic Dexamethasone Added to Systemic Steroids Improve Hearing Outcome in Patients With Sudden Deafness?

Can Intratympanic Dexamethasone Added to Systemic Steroids Improve Hearing Outcome in Patients With Sudden Deafness?

Myringostapediopexy and myringolenticulopexy in mastoid surgery

To compare hearing results in patients undergoing myringostapediopexy or myringolenticulopexy in canal wall down mastoidectomy. Case series of one surgeon. A retrospective review of 83 consecutive mastoid cavity operations for primary cholesteatoma. Only those patients who had undergone either myringostapediopexy or myringolenticulopexy were included. District general hospital. Forty-two procedures were performed in 40 patients. The mean age was 42 years old. The average follow up was 5.9 years. Seventeen patients underwent myringolenticulopexy (the incus head was excised, leaving the lenticular process attached to the stapes prior to graft placement) and 25 underwent myringostapediopexy (type III tympanoplasty). Audiometry three to six months after surgery, and status of mastoid cavity after a minimum follow up of one year. Comparison of post-operative hearing results for the two groups showed a statistically significant hearing advantage for myringolenticulopexy (p = 0.029). In the myringolenticulopexy group, 92 per cent achieved a post-operative air-bone gap of less than 30 dB, compared with 62 per cent in the myringostapediopexy group. The mean post-operative air-bone gaps in the two groups were 17.5 and 24.7 dB, respectively. When surgically feasible, the technique of myringolenticulopexy is a useful method of preserving serviceable hearing in single-stage mastoid cavity surgery.

Can Intratympanic Dexamethasone Added to Systemic Steroids Improve Hearing Outcome in Patients With Sudden Deafness?

To evaluate the therapeutic efficacy of intratympanic dexamethasone (ITD) injections added to systemic steroids in patients with idiopathic sudden sensorineural hearing loss (HL). A total of 120 patients diagnosed with sudden HL were treated with ITD injections (0.3 mL on days 1, 3, and 5) plus 48 mg methylprednisolone (ITD group) or methylprednisolone alone (control group). The total recovery rate after the treatment was 73.3% in the ITD group and 70.0% in the control group. Although improvements in pure-tone average were the same in the two groups, the ITD group showed significantly better hearing improvement at 250 Hz than the control group. The addition of ITD to systemic steroids did not result in significant improvements in the treatment of idiopathic sudden HL.

突発性難聴における歪成分耳音響放射出力と聴力予後

We investigated the clinical usefulness of distortion product otoacoustic emissions (DPOAEs) for the prediction of hearing outcomes in idiopathic sudden sensorineural hearing loss (ISSNHL).Thirty-two patients with ISSNHL (time from the onset to the start of treatment≤14 days) were enrolled in the study. They received steroid administration (400mg/day of hydrocortisone sodium succinate followed by tapered doses) combined with hyperbaric oxygen therapy. DPOAEs (f2/f1=1.2, L1=80dBSPL, L2=70dBSPL, geometric mean (GM) of f1 and f2=531-5, 500Hz, every one-third octave) were measured before and after treatment. The degree of hearing recovery was classified into four categories (complete recovery, good recovery, satisfactory recovery, no change) according to the criteria of the Ad Hoc Committee of the Japanese Ministry of Health, Labour and Welfare.The DPOAE output in the high-frequency range (GM of f1 and f2≥2, 781Hz) before treatment was higher in the complete recovery group than in the other three groups. The DPOAE output at 2, 781Hz and 4, 375Hz was significantly higher in the complete recovery than in the satisfactory recovery and no change groups (Student's t-test, p<0.05). However, the improvement of the DPOAE output after treatment did not statistically differ at any frequency among the four groups.These results indicate that the DPOAE output in the high-frequency range before treatment can be a prognostic indicator of hearing outcomes in patients with ISSNHL.

Influence of nerve branch of origin and extracanalicular extension of the tumor on hearing after middle fossa removal of vestibular schwannoma

Conclusion. Neither nerve branch of origin nor extracanalicular (up to 1 cm) extension of a vestibular schwannoma (VS) influence the postoperative hearing outcome in patients operated via a middle cranial fossa (MCF) approach. Objective. To test whether the nerve branch of tumor origin and an extracanalicular, up to 1 cm, tumor extension influences hearing outcome after MCF VS surgery. Patients and methods. This was a retrospective case review of 50 patients with postoperative pure-tone audiogram (PTA) performed later than 90 days after surgery. Twenty patients had a superior vestibular nerve (SVN) tumor and 27 patients had an inferior vestibular nerve (IVN) tumor. In three patients the nerve branch of origin of the VS could not be unequivocally determined. Thirty-four patients had a purely intracanalicular (IC) tumor and 16 patients had an extracanalicular extension in the cerebello-pontine angle. The differences between preoperative and postoperative air-conduction pure-tone hearing thresholds at 500, 1000, 2000, 3000, and 4000 Hz were compared between groups using the Mann–Whitney–Wilcoxon test. Results. Neither vestibular nerve branch of origin nor extracanalicular tumor extension (up to 1 cm) caused any significant difference in the degree of postoperative hearing change at any of the tested PTA frequencies.

Steroid and Vasoactive Treatment for Acute Deafness after Attempted Hearing Preservation Acoustic Neuroma Surgery

Objective: To investigate whether intravenous steroid and vasoactive therapy in the acute postoperative period improves hearing outcome in patients who develop acute deafness after attempted hearing preservation surgery for acoustic neuroma (AN) through a retrosigmoid or a middle cranial fossa approach. Study Design and Setting: Retrospective controlled study in a tertiary care center. Thirty-six patients who had developed acute deafness after hearing preservation surgery for treatment of an AN were reviewed. Preoperative AAOHNS hearing class was A in 2, B in 2 and D in 32 patients. Twenty-seven patients were treated with prednisolone, hydroxyethyl starch 3% and pentoxifylline intravenously for a period of at least 5 days. Nine patients (controls) did not receive any specific steroid or vasoactive therapy. Results: All patients in both groups remained deaf. Conclusions: Intravenous therapy with prednisolone, hydroxyethyl starch 3% and pentoxifylline in the acute postoperative period does not improve hearing in patients who develop acute deafness after attempted hearing preservation surgery for AN.

Unilateral Acoustic Neuromas: Long-Term Hearing Results in Patients Managed with Fractionated Stereotactic Radiotherapy, Hearing Preservation Surgery, and Expectantly

Hearing preservation is invariably a consideration when exploring treatment options for acoustic neuromas. We reviewed the long-term hearing results of patients who were treated using 1) hyperfractionated stereotactic radiotherapy (HSR), 2) hearing preservation tumor excision surgery (HPTES), and 3) expectantly (no treatment). Single institution retrospective chart review of 42 patients managed with HSR (1993-2003), 113 patients in whom HPTES was carried out, and 86 patients who were untreated (1974-2003). Hearing levels were graded according to the Gardner-Robertson classification. The percent of patients managed with HSR initially who had serviceable hearing (class 1-2) was 68.8%. This fell to 6.7% in the follow-up interval. Of the group treated with HPTES, 100% had preoperative serviceable hearing. This dropped to 15.9% in the follow-up interval. The percent of patients managed expectantly who initially had serviceable hearing was 77.3%. This dropped to 33.3% during the follow-up interval. Mean follow-up periods were 4.0, 9.5, and 6.8 years in the HSR, HPTES, and expectant groups, respectively. Hearing acuity statistically worsened over the long term (P < .01) in all three groups. There was a significant proportion of patients in whom hearing deteriorated from serviceable to nonserviceable hearing (P < .01) during the follow-up interval. The decline was most significant in the groups treated with HPTES and HSR compared with the group treated expectantly (P < .05). Hearing outcomes, in our experience, continue to be poor, but this is especially so in patients treated with HPTES or HSR.

Intratympanic dexamethasone with hyaluronic acid in the treatment of idiopathic sudden sensorineural hearing loss after failure of intravenous steroid and vasoactive therapy

The purpose of this prospective study was to test whether intratympanic application of dexamethasone/hyaluronic acid improves hearing outcome in patients with pantonal idiopathic sudden sensorineural hearing loss (ISSHL), in patients with sudden deafness or sudden profound SHL and in patients with predominant high-frequency ISSHL who are refractory to intravenous steroid and vasoactive therapy. The study took place in an academic tertiary referral hospital involving 21 patients with pantonal ISSHL, 10 patients with sudden deafness or sudden profound SHL and 9 patients with a high-frequency ISSHL. Intratympanic dexamethasone/hyaluronic acid was administered in the affected ear. Hearing was evaluated by means of standard pure-tone audiometry. The differences between pure-tone hearing thresholds by air conduction before intravenous therapy and before the beginning of the intratympanic therapy, as well as before and after intratympanic therapy, were calculated. Statistical analysis was performed by means of the Wilcoxon's test for paired samples. Intratympanic injection of dexamethasone/hyaluronic acid results in a significant global (pantonal) improvement in hearing in patients with pantonal ISSHL. It also effects improvement in hearing at selected frequencies (namely at 1.5 and 3 kHz) in patients with a predominant high-frequency ISSHL and at selected frequencies (namely at 0.5, 0.75 and 1 kHz) in patients with sudden deafness or sudden profound SHL. Neither systemic nor local side effects were observed. Intratympanic administration of dexamethasone/hyaluronic acid provides a safe and efficacious therapeutic option for the treatment of patients with pantonal and high-frequency ISSHL who don't respond to intravenous steroid and vasoactive therapy.

真珠腫性中耳炎に対する外耳道再建型鼓室形成術の聴力成績

While the hearing outcome of patients undergoing a tympanoplasty with canal reconstruction is generally thought to be inferior to that of patients undergoing a canal-up tympanoplasty, a direct comparison of these two procedures, performed by the same operator, has not been reported. Consequently, we compared the hearing outcomes of these two techniques and discussed the postoperative complications that could accompany the procedures. Hearing was evaluated in 52 ears with middle ear cholesteatoma. Using the postsurgical hearing result assessment criteria published by the Japanese Society of Otology in 2000, hearing was then evaluated again at least 6 months after surgery. When the data was analyzed according to the type of operation, the success rates (as determined using the above assessment criteria) were 78.6% for type I, 88.5% for modified type III, and 50.0% for modified type IV. The success rate for the modified type III operations was superior to that of the modified type IV operations, and the incidence of a postoperative air-bone gap in the type IV tympanoplasties was significantly larger than that in other groups. Procedures involving external auditory canal surgery can be particularly problematic for the treatment of cholesteatoma. In this series, the same author (KH) performed all the canal-up tympanoplasty procedures that took place during 1990-1996, and all other tympanoplasties, mainly canal reconstruction procedures, that took place during 1998-2001. The success rate was 68.4% (13/19) for the canal-up tympanoplasties, 100% (8/8) for the atticotomies and 76% (19/25) for the canal wall reconstructions. The postoperative success rate in the atticotomy group was significantly higher than the rates of the other groups. Among the canal reconstructive tympanoplasty procedures, a second exploratory surgery was performed in 15/24 cases, and residual cholesteatoma was observed in 3 cases. The major postoperative complications were epitympanic pocket formation (12/24) and taste disturbances, caused by chordal damage (2/24). These findings indicate that tympanoplasties with canal reconstruction improve the hearing outcome, compared with the outcome of canal-up tympanoplasties. However, epitympanic retraction pocket formation, resulting in recurrent cholesteatoma, is a possible complication of both surgical procedures, and new approaches or techniques should be sought to minimize such postoperative changes.

Long-term hearing outcome in patients receiving intratympanic gentamicin for Ménière's disease.

To determine the long-term hearing outcome in patients with intractable vertigo caused by unilateral Ménière's disease who were treated with intratympanic injection of gentamicin. The study was a longitudinal analysis of hearing and control of vertigo in patients with unilateral Ménière's disease who received intratympanic gentamicin. Pure-tone thresholds and speech discrimination scores on audiometry were analyzed, along with the control of vertigo. Criteria described in 1995 by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) were used. Patients treated with intratympanic gentamicin had "definite" Ménière's disease and had intractable vertigo despite optimal medical therapy, no symptoms suggestive of Ménière's disease in the contralateral ear, and serviceable hearing in the contralateral ear. The study analyzed the outcomes of 34 patients for whom follow-up data were available for periods greater than 24 months after intratympanic gentamicin. Complete control of vertigo (AAOHNS Class A) was obtained in 90% of the patients. Profound sensorineural hearing loss occurred as a result of gentamicin injection in 1 of the 34 patients (3%). When data from all patients were grouped together, hearing was improved in 5 (15%), unchanged in 23 (68%), and worse in 6 (17%) patients. This distribution of hearing outcome is similar to that in patients whose symptoms of Ménière's disease were managed with medical measures. Recurrent vertigo developed in 10 patients (29%) at an interval of 4 to 15 months after initially complete control. Treatment with additional intratympanic injection(s) of gentamicin did not result in a change in hearing. The risk of hearing loss in patients treated with infrequent intratympanic injection(s) of gentamicin is low.

Hearing preservation in patients with vestibular schwannomas with sudden sensorineural hearing loss

Objective: We evaluated hearing outcomes in patients with sudden hearing loss and vestibular schwannoma who underwent a hearing preservation operation for tumor resection in an effort to determine whether a history of sudden sensorineural hearing loss has an impact on subsequent hearing preservation surgery. Methods: Retrospective chart review of 45 patients operated between 1990 and 1998. Patients were divided into “Recovery” (n = 22) and “No Recovery” (n = 23) groups based on preoperative hearing recovery. Hearing preservation was assessed using the AAO-HNS hearing classification system. Results: Measurable hearing was preserved in 73% of patients, with 47% having good postoperative hearing (AAO-HNS Classes A-B). There was no significant difference in hearing outcome from patients presenting with progressive hearing loss (45% Classes A-B). There was also no difference in postoperative hearing between the “Recovery” and “No Recovery” groups. Conclusions: Patients with sudden hearing loss and vestibular schwannoma have the same chance of hearing preservation after tumor removal as those with progressive loss. Preoperative recovery of hearing is not predictive of hearing preservation. Available data support the nerve compression theory as the mechanism of sudden hearing loss in patients with vestibular schwannoma. (Otolaryngol Head Neck Surg 2001;125:544-51.)

Hearing results of ossiculoplasty in Austin-Kartush group A patients.

To compare hearing results in patients who underwent ossiculoplasty for Austin-Kartush group A impairments (incus erosion, malleus handle present, stapes superstructure present) with the results in patients with an intact ossicular chain who required only myringoplasty. The literature on hearing results of ossiculoplasty with different types of prostheses and different techniques is reviewed. This study retrospectively reviews a series of 181 consecutive ossiculoplasties and 204 consecutive myringoplasties. The study was carried out partly at a private practice and partly in an academic tertiary referral center. This study complies with levels 1 and 2 of the guidelines recommended by the American Academy of Otolaryngology--Head and Neck Surgery (1995). When success was defined as a postoperative air-bone gap within 10 dB, the success rate was higher for myringoplasty (81%) than for ossiculoplasty (55%). When success was defined as a postoperative air-bone gap within 20 dB, the success rate was 97% in myringoplasties and 85% in ossiculoplasties. There was no significant deterioration over time of the mean postoperative air-bone gap for any frequency. Cumulative data from several authors show that -50% of patients undergoing partial ossiculoplasty have a postoperative air-bone gap of 0 to 10 dB, and 80% have a postoperative air-bone gap of 0 to 20 dB. Equally good results may be achieved with autograft (no difference was found between interposition of the incus or the head of the malleus), homograft, or alloplastic partial prostheses. With alloplastic total prostheses, 36% of patients have a postoperative air-bone gap of 0 to 10 dB, and 74% have a postoperative air-bone gap of 0 to 20 dB.

Third Place — Resident Clinical Science Award 1994: Recovery of Eustachian Tube Function and Hearing Outcome in Patients with Cleft Palate

Eustachian tube dysfunction is a nearly universal complication of cleft palate, resulting in chronic ear disease and conductive hearing loss. Cleft palate repair is thought to result in recovery of eustachian tube function, but the length of time between repair and recovery of eustachian tube function is not known. Furthermore, the efficacy of tympanostomy tubes in the treatment of eustachian tube dysfunction and hearing sequelae has not been examined in a systematic way. To answer these questions, we performed a retrospective study that used serial audiometric data and tympanometry on 81 patients with cleft palates (162 ears), with follow-up ranging from 1 to 17.3 years. Average time to recovery of eustachian tube function was 6.0 years (range, 1.0 to 10.3 years) after cleft palate surgery. For children followed up for at least 6 years (longest follow-up, 17.3 years), 70% (67 of 85) had normal eustachian tube function at their last follow-up visit. Ears treated with Armstrong tympanostomy tubes required an average of 3.1 tubes per ear until recovery of eustachian tube function, whereas ears treated with Goode T tubes required only 1.1 tubes per ear (p < 0.05). Hearing evaluation revealed that 67% of ears had abnormal hearing thresholds (> 20 dB) before tympanostomy tube placement, whereas only 7.5% of ears demonstrated this loss after tube placement. Furthermore, more than 90% of ears maintained normal thresholds after recovery of eustachian tube function. These data indicate that most children with cleft palates eventually recover normal eustachian tube function after palatoplasty, but for the majority of children, this does not occur for many years.(ABSTRACT TRUNCATED AT 250 WORDS)

Results of surgery for chronic otitis media in patients with a cleft palate.

The long-term results of surgical treatment of 19 chronic ears in 16 patients with a cleft palate were analysed. The mean follow-up period was 6.5 years. The patients were found to be significantly younger than other patients with chronic otitis media. Granulating otitis media was the indication for surgery in 11 ears and cholesteatoma in 7 ears. A successful outcome after the primary operation was found in 68% of the patients. Four patients required a revision operation which was successful in all of them. Hearing results of patients with cleft palate did not differ significantly from those obtained in other patients. It is concluded that middle ear surgery should be offered to patients with a cleft palate with the same indications as in other patients with chronic otitis media.