Improvement In Bone Conduction Threshold Research Articles

Efficacy of Oral Steroids for Acute Acoustic Trauma

Objective: This study aimed to study the effect of steroid treatment on new-onset sensorineural hearing loss (SNHL) in subjects presenting shortly after an audiometry-confirmed acute acoustic trauma (AAT) injury. Study Design: This is a case-control study. Methods: We identified healthy military personnel who presented with AAT injury to the Israeli Defense Forces Medical Corps Otolaryngology/Audiology Services during 2016–2020. Patients were nonrandomly allocated to a treatment arm, where they received steroids (prednisone, 1 mg/kg, 60 mg maximal daily dose), administered for either ≥7 days or <7 days, or to a control arm, in which no treatment was offered besides loud noise avoidance. Audiometries were conducted within 7 days following the AAT and within 1 month later. We compared changes in bone conduction (BC) and air conduction (AC) thresholds at 2–8 kHz. Results: Of the 263 enrolled subjects, 137 (52%) received steroids and 126 (48%) received no treatment. Subjects who were treated early (<24 h) with high-dose steroids and for ≥7 days demonstrated significantly better hearing outcomes, compared with the nontreatment group. Subjects in the steroids group demonstrated 13–14 dB average improvement in BC thresholds at 3 and 4 kHz (p = 0.001) and additional 7–8 dB average improvement in AC thresholds at 6 and 8 kHz, compared with the nontreatment group (p < 0.0001). These observations were more compelling in patients who initially presented with worse hearing losses (>35 dB). No statistically significant differences were observed in AC/BC pure tone average between the two groups. Conclusions: Early oral steroids are recommended in AAT injuries and were shown to improve hearing outcomes within 1 month.

Association Between Postoperative Vertigo and Hearing Outcomes After Stapes Surgery for Otosclerosis

During the postoperative period, most patients with otosclerosis report vertigo and/or nausea caused by interventions within the inner ear. The aim of this study was to evaluate both early and late vertigo associated with hearing improvement after stapes surgery for otosclerosis. The analysis included 170 patients admitted to the hospital undergoing their first surgery for otosclerosis. Audiological diagnostics, surgical techniques, and symptoms reported by the patients were all analyzed. A statistical correlation and an unfavorable influence of late, undesired symptoms, such as vertigo, nausea/vomiting, and nystagmus, on final hearing improvement after surgical treatment of otosclerosis were found. Prostheses that were too long or placed too deep within the inner ear space were the most frequent cause of both vertigo and lack of hearing improvement observed after stapedotomy. A significant negative influence on bone conduction thresholds, particularly at 2000 Hz, was associated with vestibular symptoms persisting for 7 days after the surgery. Symptoms of impaired bony labyrinth function after stapedotomy, persisting for more than 1 year, were associated with insufficient reduction of the air-bone gap and worse improvement in bone conduction thresholds at 1000 and 2000 Hz. The cause of both problems was related to a prosthesis that was too long or placed too deep in the inner ear during stapedotomy.

Audiological outcomes utilizing a transcutaneous ossseointegrated implant system in pediatric patients

Background: Percutaneous bone conduction hearing aids have proven to be audiometrically successful, but too often result in soft tissue issues at the abutment site. To counter this possibility, a magnetized, transcutaneous bone conduction hearing aid has been developed, the Baha Attract®. However, only limited research exists to demonstrate efficacy and verification measures of the Baha Attract® System. Purpose: The purpose of this study was to evaluate audiologic outcomes when using the Baha Attract® magnetic osseointegrated system in pediatric patients by measuring functional gain and post-implant user satisfaction with the Children’s Home Inventory for Listening Difficulties (CHILD) scale. Research design: The authors used a retrospective chart review of pediatric patients implanted with the Attract® System from 2014 to 2017 at Cook Children's Medical Center located in Fort Worth, Texas. Study sample: One ear of fourteen pediatric patients aged 5 to 18 years with bilateral or unilateral conductive hearing loss implanted unilaterally (13 children) or bilaterally (1 child, 1 ear randomly chosen for inclusion) with the Cochlear Baha Attract® System. Data collection and analysis: Aided and unaided thresholds were collected for 14 patients. Effective gain testing occurred approximately three months after the initial fitting appointment. Additionally, results of the CHILD survey were collected from seven of these children. A 2-factor analysis of variance test was used to examine the audiometric data, descriptive statistics were employed for the CHILD scores and correlations were run between CHILD scores and 1) overall functional gain, 2) frequency-specific functional gain and 3) age. Results: Participants in this study showed a statistically significant improvement in bone conduction thresholds at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz when using the Baha Attract® System compared to the unaided condition. CHILD survey results showed a mean score of 6.5 and median score of 7 on a scale of 8. Correlation R values ranged from 0.14 to 0.79. Conclusion: For these children with conductive losses, a transcutaneous, magnetic osseointegrated hearing implant is a viable treatment option that provides significant audiometric functional gain. The CHILD results suggest that the children positively benefit from the implant, and that the perceived benefit may increase with age.

Stapes surgery in patients with a small air-bone gap.

The objective of this study was to determine hearing outcomes in patients undergoing stapes surgery with a preoperative air-bone gap (ABG) <21.25 dB. Patients with a unilateral or bilateral preoperative ABG <21.25 dB undergoing primary stapes surgery were identified from a database of all stapes surgeries performed in a tertiary center over 15 years. A total of 254 ears met the inclusion criteria. The primary outcome measure was the degree of closure of the preoperative ABG. A secondary outcome measure was improvement in bone-conduction thresholds at 4 kHz. All patients underwent stapes surgery under local anesthesia. Ossicular reconstruction was achieved using a SMart 360 nitinol fluoroplastic piston (Gyrus ACMI, Inc.; Southborough, Mass.), and complete posterior crurotomy was performed with a KTP laser. Hearing was assessed with clinical voice testing immediately postoperatively and with pure-tone audiometry at 6 weeks postoperatively. A total of 248 ears (97.6%) demonstrated ABG closure to <10 dB. Bone-conduction thresholds showed an increase in 114 (44.9%), no change 74 (29.1%), and a decrease in 66 (26.0%). There is a slight increase in the risk of stapes mobilization in ears with a small ABG when compared to those with larger ABGs; however, this can be overcome by using a laser-assisted technique in combination with good surgical experience. The benefit in terms of hearing aid avoidance and the restoration of symmetrical hearing is both achievable and significant for the patient.

Study of the Improvement in Bone Conduction Threshold After Stapedectomy

Introduction and objectivesBone conduction threshold depression is not always a result of inner ear and cochlear nerve pathology. In fact, middle ear pathologies may be responsible for such threshold depression, as occurs in otosclerosis. The aims of this study were to evaluate the improvement of bone conduction threshold in patients with otosclerosis that underwent stapedectomy and to study the postoperative audiological results. Materials and methodsThis was a retrospective study on 95 patients (116 ears) diagnosed with otosclerosis having conductive or mixed hearing loss that received surgery (stapedectomy and complete removal of the footplate) consecutively. Audiometry was performed on all patients pre- and postoperatively (one month and one year after surgery). Bone and air conduction thresholds were measured at 4 frequencies (500, 1000, 2000 and 4000Hz). ResultsThe air-bone gap was closed, with a residual air-bone gap below 10dB in 92.2% of the patients and below 5dB in 79.3% of the cases. The air conduction threshold improved an average of 25dB. The patients that had an affected bone conduction threshold preoperatively improved bone conduction postoperatively at the frequencies of 1000 and 2000Hz (6 and 12dB, respectively). Consequently, the Carhart notch disappeared on the audiogram. These results were maintained at one year of follow up. ConclusionsWe found a significant improvement in the bone conduction threshold at the frequencies of 1000 and 2000Hz and a disappearance of the Carhart notch in the audiogram after stapedectomy and total footplate removal in patients diagnosed with otosclerosis having mixed hearing loss.

Zmiana odpowiedzi ucha wewnętrznego obserwowana po operacjach na uchu środkowym

BackgroundRelationship beetwen middle ear surgery and function of the inner ear is known. This problem is often discussed in determination of hearing improvement after otosurgery. AimUsefulness of the click evoked otoacoustic emissions (CEOAE) in evaluation of the inner ear function and effectiveness of tympanoplasties is discussed. Material and methodsProspective analysis of 70 individuals operated on middle ear problems was performed. Patients were divided into four groups of otosurgeries: stapedoplasty, myringoplasty, type II tympanoplasty, type III tympanoplasty. Otoacoustic emissions and pure tones audiometry were performed before middle ear surgery and 3 months after ear operation. ResultsIn all established groups improvement in ABG (air bone gap) was observed. Improvement of bone conduction thresholds in the ranges of 5dB was observed in individuals with otosclerosis and type I and type III tympanoplasty. Patients with type II tympanoplasty developed no changes of bone conduction threashold after otosurgery. ConclusionsBehind routine audiometric diagnostics otoacoustic emissions can be useful in postoperative evaluation of effectiveness of middle ear surgery (especially in patients operated on otosclerosis and in individuals with chronic otitis media with intact ossicular chain).

Conductive hearing loss caused by third-window lesions of the inner ear.

Various authors have described conductive hearing loss (CHL), defined as an air-bone gap on audiometry, in patients without obvious middle ear pathologic findings. Recent investigations have suggested that many of these cases are due to disorders of the inner ear, resulting in pathologic third windows. To provide an overview of lesions of the inner ear resulting in a CHL due to a third-window mechanism. The mechanism of the CHL is explained along with a classification scheme for these disorders. We also discuss methods for diagnosis of these disorders. The data were compiled from a review of the literature and recent published research on middle and inner ear mechanics from our laboratory. A number of disparate disorders affecting the labyrinth can produce CHL by acting as a pathologic third window in the inner ear. The common denominator is that these conditions result in a mobile window on the scala vestibuli side of the cochlear partition. The CHL results by the dual mechanism of worsening of air conduction thresholds and improvement of bone conduction thresholds. Such lesions may be anatomically discrete or diffuse. Anatomically discrete lesions may be classified by location: semicircular canals (superior, lateral, or posterior canal dehiscence), bony vestibule (large vestibular aqueduct syndrome, other inner ear malformations), or the cochlea (carotid-cochlear dehiscence, X-linked deafness with stapes gusher, etc.). An example of an anatomically diffuse lesion is Paget disease, which may behave as a distributed or diffuse third window. Third-window lesions should be considered in the differential diagnosis of CHL in patients with an intact tympanic membrane and an aerated, otherwise healthy, middle ear. Clues to suspect such a lesion include a low-frequency air-bone gap with supranormal thresholds for bone conduction, and presence of acoustic reflexes, vestibular evoked myogenic responses, or otoacoustic emission responses despite the CHL. Imaging studies can help confirm the diagnosis.

Cochleaprotektion und chirurgische Präzision bei der Er:YAG-laserchirurgischen Stapedotomie

Using laser in stapedotomy has attracted a lot of attention since the nineties. It aims at minimizing complications due to hand-operated equipment, especially inner ear lesions, and achieving higher precision. We analyzed the clinical effect of Er:YAG laser with the question whether the postulated cochlea protection and foot plate perforation, optimized for better sound conduction, are achieved, compared to conventional stapedotomy. We evaluated retrospectively audiometrical data including pre- and postoperative bone and air conduction thresholds of 114 consecutive patients, on whom we had performed stapedotomy and had inserted platinum-teflon prostheses. The intervention was done conventionally in 72 cases and in 42 cases with Er:YAG laser. In the lower and middle frequencies, laser technique resulted in a more pronounced improvement of bone conduction thresholds compared to conventional stapedotomy. The improvement of air conduction was more distinct in ears after laser surgery; also, the difference between air and bone conduction was reduced at a higher degree. Er:YAG laser in stapedotomy is coupled with cochlea protection, as demonstrated under clinical conditions, and allows higher hearing benefit of air conduction compared to conventional stapedotomy. Our results emphasize the impact of innovative laser technique on stapedotomy.

Treatment of Sensorineural Hearing Loss in Acute Viral Otitis Media with Intratympanic Dexamethasone and Hyaluronic Acid in Comparison with Intravenous Therapy

Intratympanic dexamethasone with hyaluronic acid has shown to be an effective treatment of the inner ear damage in sudden hearing loss and Menière's disease. It is not known yet if the same applies to the toxic inner ear damage in acute viral otitis media. Retrospectively, 26 patients who suffered from acute viral otitis media with sensorineural hearing loss were examined with regard to the improvement of their inner ear hearing loss. Twelve patients were treated with intravenous therapy only, consisting of hydroxyethyl starch, pentoxifylline and prednisolone. Fourteen patients additionally received intratympanic injections, consisting of dexamethasone and hyaluronic acid once acute inflammatory changes subsided. The inner ear hearing loss was evaluated by means of standard bone-conduction audiometry. Neither local nor systemic side effects of the intratympanic injections occurred. During treatment no significant difference in the improvement of bone-conduction thresholds in any frequency was seen between the two groups. Intratympanic injections of dexamethasone with hyaluronic acid do not result in any additional benefit on the sensorineural hearing loss in acute viral otitis media compared to intravenous therapy alone. A reason might be the post inflammatory changes of the round window membrane or the toxic nature of the acute viral infection affecting the inner ear.

Improvement in bone conduction threshold after tympanoplasty

Objective: To investigate the causes of bone conduction threshold impairment associated with middle ear pathoses and the factors influencing improvement in bone conduction threshold after tympanoplasty. Study Design And Setting: The records of 98 consecutive patients with unilateral chronic otitis media who underwent tympanoplasty were reviewed. Pre-operatively, 15 dB or more depression of bone conduction threshold at least in 2 frequencies between 500 and 6000 Hz was considered to be significant. Similarly in the postoperative period, 15 dB or more improvement of bone conduction threshold at least in 2 frequencies between 500 and 6000 Hz was regarded as significant. Results: Twelve (12.5%) of 98 cases were found to have depressed bone conduction threshold; 6 of 12 cases had improved bone conduction threshold after tympanoplasty. Conclusion: In cases with cholesteatoma and extensive middle ear disease, successful results could be achieved after tympanoplasty disregarding the air-bone gap and deteriorated bone conduction threshold. Significance: Bone conduction threshold may improve after tympanoplasty. (Otolaryngol Head Neck Surg 2000;123:775-8.)

Influence of the thickness of the skin and subcutaneous tissue covering the mastoid on bone-conduction thresholds obtained transcutaneously versus percutaneously.

Percutaneous and transcutaneous bone-conduction thresholds were obtained at 0.25, 0.5, 1, 2, and 4 kHz in 57 patients who were fitted with the Bone Anchored Hearing Aid (BAHA). Additionally, the thickness of the skin and subcutaneous tissue covering the mastoid was determined. No relation was found between the thickness of the skin and subcutaneous tissue, and the improvement in bone-conduction thresholds at any of the frequencies, i.e. thresholds obtained percutaneously minus transcutaneously. The improvement (or deterioration) in speech recognition with the BAHA in a subgroup of patients who had previously used a (conventional) transcutaneous bone-conduction hearing aid was not related to the thickness of the skin and subcutaneous tissue layers. Therefore, the thickness of the skin and subcutaneous tissue layers measured pre-operatively cannot be used as a predictor of successful fitting with a BAHA.

The influence of age on the results of stapedectomy.

In a retrospective study, we investigated the results of 384 stapedectomies performed between 1962 and 1989. The purpose was to determine the possible influence of age on the postoperative functional result. The operative technique uniformly consisted of a total stapedectomy, seal of the oval window with perichondrium and replacement of the stapes by a free tragal cartilage graft. The audiometric data at 0.5, 1, 2, and 4 kHz were compared. The patients were divided into five groups based upon chronological age: under 30, 30-40, 41-50, 51-60, over 60 years. Although the preoperative airbone gap (ABG) increased with age at all frequencies, and thus the chance for surgery to improve the ABG, the youngest group showed the best improvement in ABG (P less than 0.05). Using a technique with total removal of the footplate, bone conduction thresholds improved in the frequencies up to 2 kHz. At 4 kHz, they deteriorated in the four oldest groups. The greatest improvement in bone conduction thresholds occurred in the youngest group of patients (P less than 0.05), with a parallel decline in age and postoperative results occurring. The causes of these differences are not yet clear, although spontaneous recovery and greater resistance to operative trauma in the younger age groups might be of influence.