Mean Bone Conduction Thresholds Research Articles

Outcome of Primary Stapedotomy in 21 Consecutive Cases of Juvenile Otosclerosis.

Otosclerosis is a relatively uncommon condition that causes conductive hearing loss in children. The preferred treatment for adults is stapedotomy, while for individuals under 18 years old, there is an ongoing discussion about the best treatment approach. Thus, the surgical procedure for the stapes in pediatric patients continues to be a subject of debate. This study aimed to evaluate the results of stapes surgery in children, trying to understand, based on our results, whether this is actually the most suitable option. The study included 18 patients who underwent surgery between January 2013 and December 2023. The patients' ages ranged from 11 to 18 years, with an average age of 14.7. Out of the total 21 surgeries, three patients opted for bilateral surgery. Pre- and post-operative data were compared, focusing on the mean air conduction (AC) and bone conduction (BC) thresholds at frequencies of 0.5, 1, 2, and 4 kHz. Additionally, pre-operative thresholds and the post-operative air-bone gap (ABG) were examined. After a year, the air-bone gap was effectively reduced to 10 dB or less in 94% of the 21 cases, and to 20 dB or less in 98% of all cases. Our results and research in the field have consistently shown that stapedotomy, when conducted by skilled otosurgeons, is a reliable and successful procedure for a considerable number of patients. The outcomes it generates are similar to those achieved through the procedure conducted during adulthood.

Exoscope-Assisted Stapedotomy: Evaluation of Safety and Efficacy.

Evaluate the safety and efficacy of exoscope-assisted stapedotomy. Retrospective chart review. Tertiary care neurotology clinic. Adult patients with otosclerosis undergoing stapedotomy. Primary stapedotomy. Evaluation of audiologic outcomes, including pure-tone average, bone-conduction thresholds, word recognition score, and air-bone gap. Complications, need for scutum removal, and length of surgery were also evaluated. A total of 47 patients were identified, and 24 patients underwent surgery with the microscope and 22 with the exoscope. There were significant improvements in pure-tone average, mean bone-conduction thresholds, and air-bone gap for both groups. There was no difference in preoperative or postoperative audiologic status for either group. There was no difference in rates of dysgeusia, chorda tympani nerve damage, dizziness, or facial paresis in either group. This study indicates similar audiologic outcomes, complication profiles, and visualization when comparing exoscopic and microscopic stapedotomy. Demonstrated here, exoscopic stapedotomy can be safely performed in a transcanal manner.

Effects of radiotherapy for tumors of the larynx and hypopharynx in hearing levels

The head and neck oncological patients are susceptible, either because of tumor location or the treatments performed, to changes of their ear structures. Due to close proximity of radiation field to the ear, radiotherapy induces short and long-term toxicities to the external, middle and internal ear. The aim of this study was to evaluate the impact of radiotherapy on the inner ear. We conducted a cross-sectional retrospective study of patients with cancer of the larynx and hypopharynx undergoing radiotherapy alone or adjuvant to surgery. The follow-up period was 1 year. Relevant clinical and audiological variables were analyzed. We included 15 patients, mostly males, with a median age of 66 years. Average hearing threshold (AHT) deterioration was found in 13 ears, with a median of 8.1dB. Mean bone conduction threshold at 4000 Hz, air conduction threshold at 8000 Hz at 12 months and the median of the final air conduction threshold at 10,000 Hz was significantly higher than the pre-treatment. A correlation was observed between final AHT and dosage of radiation per fraction. Thus, for each increase of 1 Gy per fraction there was an increase of 22.13 dB in the final AHT. About half of the patients had deterioration of the final AHT, proving, on the one hand, the sensorineural hearing loss associated with radiotherapy, while emphasizing the need to perform long-term follow-up protocols for early auditory rehabilitation of these patients.

Hearing Results after Transmastoid Superior Semicircular Canal Plugging for Superior Semicircular Canal Dehiscence: A Meta-Analysis.

The transmastoid plugging of a superior semicircular canal is considered a safe and effective technique for the management of superior semicircular canal dehiscence (SSCD). The aim of this meta-analysis is to assess the postoperative hearing outcomes after the transmastoid plugging of the superior semicircular canal. Search method and data sources: A systematic database search was performed on the following databases until 30 January 2023: MEDLINE, Embase, Cochrane Library, Web of Science, CINAHL, ICTRP, and clinicaltrials.gov. A systematic literature review and meta-analysis of the pooled data were conducted. We also included a consecutive case series with SCDS for those who underwent transmastoid plugging treatment at our clinic. We identified 643 citations and examined 358 full abstracts and 88 full manuscripts. A total of 16 studies were eligible for the systematic review and 11 studies for the meta-analysis. Furthermore, 159 ears (152 patients) were included. The postoperative mean air conduction threshold remained unchanged (mean difference, 2.89 dB; 95% CI: -0.05, 5.84 dB, p = 0.58), while the mean bone conduction threshold was significantly worse (mean difference, -3.53 dB; 95% CI, -6.1, -0.95 dB, p = 0.9). The transmastoid plugging technique for superior semicircular canal dehiscence syndrome, although minimally worsening the inner ear threshold, is a safe procedure in terms of hearing preservation and satisfactory symptom relief.

Conservative Otosclerosis Treatment With Sodium Fluoride and Other Modern Formulations: A Systematic Review.

Otosclerosis, also known as otospongiosis, is a primary osteodystrophy of the otic capsule of the inner ear and one of the leading causes of deafness in adults. The rationale for medical therapy for otospongiosis is to slow down and eventually stop the phase of bone resorption. Conservative treatments includesodium fluoride (NaF), bisphosphonates, and other modern medicines. A systematic review of the existing and published articles and books until April 2021 has been conducted in Medscape, Google Scholar, PubMed, and other databasesusing appropriate terms.According to the results of the research, the administration of NaF for a period of at least six months stabilizes hearing thresholds (HTs), improves vestibular symptoms, and delays the worsening of tinnitus. The administration of bisphosphonates for a period of at least six months showed significant percentage differences in the improvement of hearing loss, dizziness, and tinnitus remission.In the already existing double-blind studies that were evaluated, groups of patients treated with bisphosphonates for at least 24 months showed greater stabilization of the mean air and bone conduction thresholds than groups of patients treated with a placebo. The new modern medications have not yet been widely administered clinically to draw useful conclusions, although the test results of some of their use are quite encouraging.

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<0.05). Conclusion: In tragal cartilage type 1 tympanoplasty operations, high rates of graft success were obtained and a dramatic gain in hearing postoperatively.

Prognostic factors influencing postoperative air-bone gap in stapes surgery.

SUMMARYObjectiveOtosclerosis is an osteodystrophic disease of the otic capsule, determining conductive or mixed hearing loss, which can be successfully treated with stapedotomy. The aim of the present multicentric retrospective study was to identify prognostic factors related to better auditory outcomes in stapes surgery.Methods581 patients affected by otosclerosis were submitted to stapedotomy under local anaesthesia in two different hospitals. Both Teflon and titanium prostheses were adopted.ResultsA statistically significant decrease of postoperative air-conduction thresholds and air–bone gap (ABG) values was seen, whereas the mean bone-conduction threshold did not differ from the preoperative condition. Among the various parameters investigated, the prosthetic material, duration of surgery and intraoperative detection of unexpected anatomical anomalies of the middle ear were found to be related to lower postoperative ABG values.ConclusionsAll the previously mentioned parameters played a significant role in determining the postoperative auditory outcomes and can therefore be considered prognostic factors for the success of the stapedotomy.

Outcome of Limited Attic Cholesteatoma Surgery: Endoscopic vs Microscopic

Background: Endoscope and microscope are exclusively used in different middle ear pathologies as well as patients with attic cholesteatoma. However, straightforward information regarding surgical advances, postoperative results, and information about in which patients and how this surgical technique should be exclusively used is debatable.
 Aim: To compare the outcome of primary exclusive endoscopic ear surgery with those of the microscopic ear surgery in two groups of patients with cholesteatoma limited to the attic region.
 Methods: This prospective observational study was conducted in the Department of Otolaryngology-Head and Neck Surgery, BSMMU, Dhaka, from July 2018 to December 2019, with 26 patients having cholesteatoma limited to the attic region. Patients were divided into two groups. One group of patients were submitted to atticotomy with tympanoplasty via microscopic ear surgery (MES) and a second group to exclusive trans-canal endoscopic ear surgery (EES). All the patients were followed up post-operatively up to 3 months with PTA.
 Results: Mean bone conduction threshold, air conduction threshold, and ABG has been reduced considerably in both groups (endoscopic and microscopic) at the end of three months postoperatively.There was no significant statistical difference between the two groups in terms of graft uptake success rate and the audiological success rate (p-value >0.05).Postoperatively, pain requiring analgesics wassignificantly lower (p<0.033) in theendoscopic group (23.1%) than in the microscopic group (69.2%).
 Conclusion: Audiological outcome and graft uptake success rates achieved by the endoscopic ear surgery were similar to the results obtained by the microscopic ear surgery in limited attic cholesteatoma.
 Bangladesh J Otorhinolaryngol 2022; 28(1): 103-111

Vestibular and cochlear dysfunction in aging: Two sides of the same coin?

Nonspecific complaints of hearing loss, vertigo, imbalance, and instability, without a defined etiology, are very prevalent in the elderly population, with a great impact on morbidity and mortality in this age group. The objectives of this study were to verify whether there is age-related vestibular dysfunction and to test the association of vestibular dysfunction with presbycusis in the elderly population. Original retrospective analytical cross-sectional study, carried out with 80 patients who underwent a videonystagmography and complete audiometric evaluation due to nonspecific vestibular complaints, without a specific vestibular disorder diagnosis. Patients were selected and divided into two distinct age groups (group A: >60 years; group B: 18-50 years) and, in both groups, we analyzed the caloric tests and the pure-tone audiometry. In the vestibular evaluation, we found that there was a statistically significant difference (P < 0.05) between groups in the prevalence of bilateral vestibular weakness (group A: 22.5%; group B: 5%), and that the increase in age, above 60 years, is negatively correlated with the mean total caloric response. Additionally, we obtained a reasonable negative and statistically significant correlation (r = -0.320, P < 0.05) between the mean bone conduction thresholds at high frequencies and total caloric responses in group A. In patients with hearing loss, it is essential to perform a complete vestibular study to diagnose vestibular disorders and, consequently, prevent adverse outcomes that may result from these alterations.

The Effect of Postmenopausal Osteoporosis on Middle Ear Resonance Frequency.

Background: The effect of postmenopausal osteoporosis on the middle ear mechano-acoustic system is unknown. The aim of this study is to investigate whether or not middle ear resonance frequency is affected in females with postmenopausal osteoporosis.Methods:The study included postmenopausal women aged 45-60 years, separated into 2 groups as females with postmenopausal osteoporosis and healthy postmenopausal females (control group). A detailed anamnesis was taken from all subjects and then the ear, nose, and throat examinations were done followed by pure tone audiometry, tympanometry, and multifrequency tympanometry tests. The groups were compared in respect of pure tone average, bone conduction threshold, RF, static admittance, and tympanometric peak pressure values.Results: The mean age of the patients was 59.2 ± 4.53 years (range, 48-65 years) in the postmenopausal osteoporosis group and 57.11 ± 4.27 years (range, 48-65 years) in the control group (P > .05). The mean resonance frequency values for the postmenopausal osteoporosis and control group were 954.41 ± 127.47 and 935.29 ± 126.39 Hz (P > .05 ). The mean static admittance values for the postmenopausal osteoporosis and control group were 0.82 ± 0.33 and 0.85 ± 0.3 mmho, and mean tympanometric peak pressure values were −7.35 ± 18.52 and −6.94 ± 19.52 daPa (P > .05 for both static admittance and tympanometric peak pressure). The mean pure tone averagevalues for the postmenopausal osteoporosis and control group were 20.96 ± 6.82 and 15.60 ± 7.81 dB, and mean bone conduction threshold values were 17.57 ± 6.03 and 12.10 ± 6.52 dB (P < .05 for both pure tone average and bone conduction threshold).Conclusions: The results showed that the middle ear resonance frequency values were not affected in postmenopausal osteoporosis patients, but there was seen to be greater sensorineural hearing loss in females with postmenopausal osteoporosis compared to healthy postmenopausal females.

Audiologic Outcomes of Footplate Drillout for Obliterative Otosclerosis.

To evaluate the audiologic outcomes of microdrill fenestration for obliterative otosclerosis compared to traditional stapedotomy technique. Retrospective chart review. Tertiary referral center. Adult patients undergoing stapedotomy for otosclerosis. Patients were separated into groups that underwent either microdrill or laser fenestration based on intraoperative severity of disease. Audiologic outcomes and complications were compared between the two groups. There were 588 ears in 519 patients that were evaluated. There was a significant postoperative improvement in pure tone average, air-bone gap, and mean bone conduction thresholds for both the obliterative and nonobliterative group (p < 0.001). There was no significant difference in the pre- or postoperative hearing status between the two groups. There was no significant difference in complications between the two groups, including no cases of postoperative profound hearing loss in the drill fenestration group. Audiologic outcomes are similar between microdrill fenestration and laser fenestration for otosclerosis. Pure tone average, air-bone gap, and mean bone conduction thresholds all improved postoperatively and were similar between groups.

Hearing Outcomes of Stapes Surgery in Children With Stapes Fixation and Ossicular Anomalies.

To investigate hearing outcomes after stapes surgery in children with stapes fixation. Retrospective study. Tertiary referral center. Forty-nine patients (66 ears) aged less than 15 years who received stapes surgery. Stapes surgery. Preoperative symptoms, bilateral involvement, pure-tone hearing levels, and perioperative complications were analyzed using paired t test and Mann-Whitney U test. The chief complaint of all patients was hearing disturbance. Sixteen ears were diagnosed with stapes fixation and an additional congenital ossicular anomaly and 50 ears had only stapes fixation. Preoperative mean bone conduction and air conduction thresholds were 12.0 ± 5.8 dB and 60.9 ± 10.9 dB, respectively. The mean air-bone gap (ABG) was 48.9 ± 12.0 dB in patients with stapes fixation and an ossicular anomaly. The postoperative mean ABG was 23.6 ± 14.5 dB, and the ABG closure was 25.3 ± 18.2 dB. In patients with stapes fixation only, the preoperative mean bone conduction and air conduction thresholds were 14.3 ± 7.5 dB and 49.6 ± 9.5 dB, respectively, and the mean ABG was 35.5 ± 9.6 dB. The postoperative mean ABG was 14.4 ± 10.3 dB, and the ABG closure was 16.2 ± 16.1 dB. The successful results (ABG <20 dB) were 75.8% overall, 56.3% for fixation and an ossicular anomaly, and 82.0% for fixation only. In children with stapes fixation, hearing loss was worse when the fixation was combined with an ossicular anomaly. Ossicular continuity, especially of the incus, is the most important factor for successful stapes surgery. Appropriate diagnosis and surgical intervention can lead to good results for children with stapes fixation.

Is Septal Cartilage Graft via Transmastoid Approach Safe Enough in the Repair of Large Tegmen Defects?

Introduction: Tegmen defect (TD) has a potential of intracranial spread of middle ear infection, meningoencephalic herniation (MEH), and cerebrospinal fluid leakage (CSFL). Especially the defects >1 cm with MEH or CSFL are generally repaired via the classical middle fossa or minicraniotomy technique. The aim of this study was to show the efficiency of the intracranial, extradural placement of the septal cartilage graft in the closure of the TD larger than 1 cm via the transmastoid (TM) approach. Methods: The demographic, preoperative, intraoperative, and postoperative data of 11 patients with chronic otitis media (COM) who had TD larger than 1 cm were reviewed retrospectively. Hospitalization time and hearing preservation with respect to MEH or CSFL were analyzed. Results: The most common etiology of TD was cholesteatoma (82%), and 91% of the patients had multiple COM surgery history. The mean TD size was 15.4 (10–25) mm. Fifty-five percent of the patients presented with either MEH or CSFL. The mean follow-up of the patients was 22.5 (8–42) months. There was no significant difference between preoperative and postoperative mean bone conduction thresholds. Mean hospitalization time was 5.2 (3–10) days. There was no significant difference in the hospitalization time between patients with MEH or CSFL and without MEH or CSFL. Neither recurrence nor graft infection was encountered. Conclusion: Extradural grafting with the septal cartilage in the large TD up to 25 mm can be repaired efficiently via the TM approach without application of a lumbar drainage.

Comparison of Thresholds Obtained With the Radioear B-71 and B-81 Bone-Conduction Transducers.

A new bone conduction transducer, the Radioear B-81, has been designed to be an improvement over the commonly used transducer, the Radioear B-71. Reference Equivalent Threshold Force Levels (RETFLs) were obtained with the new Radioear B-81. Thresholds were obtained in accordance with ANSI-S3.6-2018 (Annex D) and participants were selected as prescribed in ISO 389.9-2009. Thresholds were obtained with automatic audiometry using circumaural earphones (Radioear DD450) and forehead placement of the bone vibrators. Mean bone conduction thresholds obtained using the B-81 and B-71 bone oscillators for frequencies from 250 to 4000 Hz were not statistically different. RETFLs for the B-81 are identical to the values in ANSI S3.6-2018 for the B-71 bone vibrator. Air-bone gaps were observed for both transducers at low frequencies (250 and 500 Hz) due to occlusion effects produced by the circumaural earphone and at high frequencies (3000 and 4000 Hz), previously reported in several studies that used standard RETFLs. Test-retest differences for air conduction thresholds were analyzed and the results are presented in the Appendix A (Supplemental Digital Content 1, http://links.lww.com/EANDH/A639). RETFLs in ANSI S3.6-2018 and ISO 389.3-2016 are appropriate for use with the B-81 bone vibrator.

Influence of Changes in Bone-Conduction Thresholds on Speech Audiometry in Patients Who Underwent Surgery for Otosclerosis.

Otosclerosis is an underlying disease of the bony labyrinth that results in hearing loss. In some cases, the involvement of the bony part of the cochlea results in mixed hearing loss. The aim of this analysis was to seek a correlation between the results of speech audiometry tests and the changes in bone-conduction thresholds observed after surgical treatment. The analysis included 140 patients who were hospitalized and surgically treated for otosclerosis. The patients who were treated with stapedotomy were divided into subgroups based on the value of the bone-conduction threshold before the surgery. An audiological assessment was performed, with pure-tone threshold audiometry and speech audiometry tests taken into account. The effectiveness of the surgery was judged by the change in the speech audiometry test results after 12 months of observation. After the surgery, it was found that a significant improvement, characterized as achieving 100% understanding of speech, occurred in 61.90% of the patients. There is a correlation between the improvement in speech audiometry tests and bone-conduction curve after stapedotomy. The changes achieved in the bone-conduction curve at the frequency range up to 3,000 Hz (hertz) had a significant impact on the improvements in speech audiometry test results. Higher frequencies provide more data for improving the hearing process. A mean bone-conduction threshold between 21 and 40 dB (decibels) in the pure-tone audiometry examination performed before surgery is a favorable prognostic factor in the improvement of the bone-conduction threshold after surgery.

Mucosal Type of Chronic Suppurative Otitis Media and the Long-Term Impact on Hearing Loss

IntroductionWorldwide the chronic suppurative otitis media (CSOM) is one of the most common infectious diseases in childhood and is a common cause of impaired hearing. The disease remains a challenging entity for the healthcare system of resource-limited nations despite the advances in modern medicine. The nature of hearing loss in CSOM is mainly conductive, the sensorineural hearing loss (SNHL) is also reported in such patients. The purpose of the study was to identify SNHL in patients with the mucosal type of CSOM and to find the impact of long-term discharging ears on bone conduction (BC) thresholds.MethodsPatients with a diagnosis of the mucosal type of CSOM were identified from the record of ENT, Head and Neck Surgery clinic between January 2019 and January 2020. The patients were divided into three groups based on the duration of the disease: groups I, II, and III for 1-5 years, 5-10 years, and 10-15 years, respectively. Pure tone audiogram was reviewed, and data of BC was recorded for 500, 1000, and 2000 Hz. The descriptive frequency was calculated for SNHL in each group and group I was compared with other groups using a chi-square test. The mean BC threshold of group I was compared with other groups using a t-test. SPSS version 26 (IBM Corp., Armonk, New York) was used for statistical analysis.ResultsA total of 154 patients were included in the study. There were 73 males and 81 females. The mean age was 26 years. The minimum age was 12 years and the maximum age was 58 years. Active ear discharge was the presenting complaint in 84 patients. The right ear was involved in 88 patients, and the left ear was involved in 66 patients. SNHL was present in 30 out of 154 patients, i.e., 19.5%. The number of patients in each of the groups I, II, and III was 95, 28, and 31, respectively. The group I was compared with group II using the chi-square test, the p-value was found not significant, i.e., >0.05. The group I was then compared with group III using the same statistical test, and the p-value was found significant, i.e., <0.05.The mean BC threshold for an average of three speech frequencies for each of the three groups was 16.9, 18.7, and 22.9, respectively. The mean BC threshold of group I was compared with that of group II using a t-test, and the p-value was found not significant, i.e., >0.05. The mean BC threshold of group I was then compared with that of group III using a t-test, and the p-value was found significant, i.e., <0.05.ConclusionsThe findings of our study reproduce the presence of SNHL in a sizable proportion of the patients with a mucosal type of CSOM. Furthermore, the elevation of the BC threshold also appears statistically significant on analysis in association with the protracted duration of CSOM, highlighting the adverse impact of delaying the surgical repair. However, the clinical importance remains unclear because the maximum losses in the BC threshold seen in the patients are not severe enough to necessarily make them hard of hearing. Nevertheless, these statistically significant results influence clinical thought process and measures for an early remedy, including surgery, and need to be considered in time to prevent progressively worsening hearing loss in such cases.

Sound-localisation performance in patients with congenital unilateral microtia and atresia fitted with an active middle ear implant.

This study assessed the safety and sound-localisation ability of the Vibrant Soundbridge (VSB) (Med-EL, Innsbruck, Austria) in patients with unilateral microtia and atresia (MA). This was a single-centre retrospective research study. Twelve subjects with unilateral conductive hearing loss (UCHL) caused by ipsilateral MA were recruited, each of whom underwent VSB implantation and auricular reconstruction. The bone-conduction (BC) threshold was measured postoperatively, and the accuracy of sound localisation was evaluated at least 6months after surgery. Horizontal sound-localisation performance was investigated with the VSB activated and inactivated, at varying sound stimuli levels (65, 70 and 75dB SPL). Localisation benefit was analysed via the mean absolute error (MAE). There was no statistical difference in mean BC threshold of impaired ears measured preoperatively and postoperatively. When compared with VSB-inactivated condition, the MAE increased significantly in unilateral MA patients in the VSB-activated condition. Besides, sound-localisation performance worsened remarkably when sound was presented at 70dB SPL and 75dB SPL. Regarding the side of signal location, the average MAE with the VSB device was much higher than that without the VSB when sound was from the normal-hearing ear. However, no significant difference was observed when sound was located from the impaired ear. This study demonstrates that in patients with unilateral MA, the VSB device does not affect inner-ear function. Sound-localisation ability is not improved, but deteriorated at follow-up. Our results suggest that the VSB-aided localisation abilities may be related to the thresholds between the ears, plasticity of auditory system and duration of use of VSB.

Hearing gain after myringoplasty in relation to the size of tympanic membrane perforation

Objectives: To assess hearing gain after successful myringoplasty in relation to the size of tympanic membrane perforation.&#x0D; Methods: This cross-sectional study was done in the department of otolaryngology and head neck surgery, BSMMU, Sahbag, Dhaka during the period of January 2009 to December 2010.A total of 60 patients were under went myringoplasty operation after taking detailed history, clinical examination and investigation. Preoperative and postoperative hearing assessment was done. Analysed data presented by various tables, graphics and figures.&#x0D; Results: In case of small size perforation preoperative mean bone conduction threshold was 7.66 dB, mean air conduction threshold was 34.14 dB and mean air bone gap was 26.48 dB. In case of medium size perforation preoperative mean bone conduction threshold was 9.61 dB, mean air conduction threshold was 44.48 dB. Mean air bone gap was 34.87 dB. In case of large size perforation preoperative mean bone conduction threshold was 13.12 dB, mean air conduction threshold was 59 dB, and mean air bone gap was 45.88 dB. Hearing loss increases with increasing size of perforation. Ahmed and Rahim (1979) showed in the study that hearing loss increases with increasing the size of the perforation which was relevant in the study. After myringoplasty post-operative mean air bone gap was 21.24 dB in small size, 21.74 dB in medium sized and 24 dB in large size. From the record improvement of mean air bone gap or hearing gain was 5.24 dB in small size perforation respectively. The different of air bone gap closure between small and medium size perforation was statistically significant by unpaired’ test.&#x0D; Conclusion: Hearing gain after myringoplasty is better in large size perforation.&#x0D; Bangladesh J Otorhinolaryngol; April 2019; 25(1): 54-59

Possible Effect of Chronic Otitis Media with and without Cholesteatoma on Bone Conduction Thresholds: Evaluation of the 112 Cases

Objective: The aim of this study is to evaluate any possible effects of chronic otitis media (COM), with or without accompanying cholesteatoma, on bone conduction thresholds (BCT). Methods : A total of 112 cases who underwent surgery for unilateral COM between 2006 and 2014 were enrolled in the study. Eighty cases had no cholesteatoma (Group 1). Thirty-two cases did have cholesteatoma (Group 2). Prior to surgery, the temporal bone was evaluated radiologically by use of high resolution computed tomography. The presence of a clinically and radiologically normal contralateral ear was the principal selection criterion for the cases. BCT at 0.5, 1, 2, 4 kHz and their averages were evaluated with pure tone audiogram (PTA) and the normal and diseased ears in each group were compared. This comparison was also made between the diseased ears in Groups 1 and 2. Results: There was a statistically significant difference observed between the mean BCT scores obtained by PTA for the normal/diseased ears in Group 1 (9.78±0.98/17.34±1.71 dB) and in Group 2 (9.10±0.99/17.58±2.59 dB). This statistically significant difference was observed for each of the four different frequencies (p<0.0001). However, there was no statistically significant difference observed between the mean BCT scores obtained by PTA for the diseased ears in Groups 1 and 2 (17.34±1.71/17.58±2.59 dB). Similarly, in the comparison between the diseased ears, the differences of BCT at all four different frequencies (0.5, 1, 2, 4 kHz) lacked statistical significance (p>0.05). Conclusion: As a result of this study, we can say that COM may lead to sensorineural hearing loss. However, we observed that the presence of cholesteatoma does not exert an additional negative effect on cochlear function.

Factors affecting the treatment outcomes of myringoplasty in patients with small tympanic membrane perforations.

Factors affecting the outcomes of myringoplasty have been widely discussed but remain controversial. In this study, we retrospectively analyzed the factors associated with the outcomes of myringoplasty treating small tympanic membrane perforations (defined as those involving less than 30% of the whole eardrum area) in patients with a history of chronic otitis media. The clinical demographic data, preoperative pure tone audiometry, surgical procedures, and surgical outcomes of patients with small tympanic perforations were analyzed statistically. Overlay myringoplasty was performed in 24 ears (45.27%); Gelfoam® plugs were placed in 29 ears (54.73%). Univariate and multivariate tests among demographic, surgical procedure-related, hearing test-related factors were performed. A total of 53 patients (22 males and 31 females) were enrolled (mean age 54.84 ± 15.51years). Fourteen patients (26.41%) had the habit of cigarette smoking, 8 (15.09%) had diabetes mellitus, 20 (37.73%) had a past history of chronic otitis media, 5 (9.43%) had a history of grommet insertion, 5 (9.43%) had received radiotherapy in the head and neck region, and 1 (1.88%) had microtia. The success rate for overlay myringoplasty using Silastic® sheets was 54.16%; the success rate for Gelfoam® plugs was 54.16%. On univariate analysis, smoking, older age, and the mean air conduction and bone conduction hearing levels significantly affected the surgical outcomes. Cigarette smoking was the only independent (negative) prognostic factor of surgical success on multivariate analysis (OR =0.1614, 95% CI: 0.0336-0.7762, p = 0.0228). As for surgical repair for the small tympanic membrane perforations with a history of chronic otitis media, age, cigarette smoking, mean air conduction threshold, and mean bone conduction threshold were associated with surgical outcomes; cigarette smoking was the independent predictive prognostic factor for the surgical outcomes.