Mean Preoperative Air-bone Gap Research Articles

Endoscopic Cartilage Modified Inlay Technique With Preserving External Auditory Canal Skin for Repairing Posterior Marginal Perforation.

Objective: To evaluate the graft success rate and hearing gain of endoscopic cartilage myringoplasty with preserving external auditory canal (EAC) skin for posterior marginal perforation. Materials and Methods: We performed a prospective study in 36 patients with posterior marginal perforation who underwent endoscopic cartilage modified inlay technique with preserving EAC skin. Patients were followed up for 12 months. Results: All the 36 patients with unilateral posterior marginal perforation were included in this study. Clinical inosculation of the perichondrium graft and remnant tympanic membrane (TM) occurred at 2 to 3 weeks postoperatively. Simultaneously, neovascularization was initiated at the perichondrium graft. The perichondrium graft had been clinically incorporated to the EAC skin at 2 to 3 weeks postoperatively, which could not be distinguished. At 12 months, residual perforation was seen in inferior margin in one but reperforation was not. The graft success rate was 97.2% (35/36). The mean preoperative air bone gap (ABG) was 29.7 ± 3.8 dB, and the mean postoperative ABG at 12 months was 15.2 ± 3.1 dB; the difference between these values was significant (P < .05; paired-samples t test). The successful surgery rate (postoperative ABG ≤ 20 dB) was 91.7% (33/36). No any intratympanic or EAC cholesteatoma was noted during the follow-up period. Conclusions: Endoscopic cartilage modified inlay technique with preserving EAC skin for repairing posterior marginal perforation is simple and minimally invasive technique, which had shorter operative time, similar graft success rate compared with raising a tympanomeatal flap techniques.

Endoscopic Broad Palisade Cartilage Graft Without Raising a Tympanomeatal Flap in the Repair of Subtotal Perforation.

Objective: This study evaluated the outcome of a broad palisade cartilage graft in the repair of subtotal perforation. Study Design: Prospective case series. Materials and Methods: This was a prospective study of 43 patients with subtotal perforations who underwent an endoscopic broad palisade cartilage graft procedure that did not include raising a tympanomeatal flap. The patients were followed up for 6 months. Results: The 43 patients (43 ears) included in this study had a mean operation time of 38.6 ± 7.4 minutes. Five (11.6%) patients were lost to follow-up; 38 (88.4%) completed the 6 month follow-up. The graft success rate in the latter was 92.1% (35/38). Audiological testing showed no sensorineural threshold shift. The mean preoperative air-bone gap (ABG) was 28.4 ± 5.1 dB, while the mean ABG at 6 months postoperatively was 13.6 ± 3.1 dB; the difference between these values was significant (P < .05; paired samples t test). According to the audiometry assessment, the successful surgery rate (postoperative ABG ≤ 20 dB) was 89.5% (34/38). No graft-related complications (eg, graft lateralization, significant blunting, graft medialization) were encountered during the follow-up period. However, granular myringitis with minimal moistness but without infection was noted in 5.3% (2/38) of the patients. Conclusions: In the repair of subtotal perforation, an endoscopic broad palisade cartilage graft, performed without raising a tympanomeatal flap, is simple and feasible, resulting in a high graft success rate and good hearing restoration.

Local Anesthesia-Based Modified Cartilage "Inlay" Graft Myringoplasty for Repairing Large Perforation.

The objective of this study was to evaluate the graft success rate and hearing outcome of modified cartilage inlay graft technique for repairing large perforations under local anesthesia. Prospective case series. We performed a prospective study in 31 patients with large perforations who underwent endoscopic local anesthesia-based modified cartilage inlay graft technique with no raising of the squamous epithelium and no rimming of the perforation margins. The graft outcomes and complications were evaluated at 6 and 24 months postoperatively. Thirty-one patients (31 ears) were included in this study. The mean operation time was 42.3 ± 2.6 (ranged 36-51) minutes. The visual analog scale pain scores at intraoperative and 2 and 48 hours postoperatively were, respectively, 2.6 ± 0.6, 1.4 ± 0.2, and 0.6 ± 0.1. The graft success rate was 100.0% (31/31) at 6 months after surgery. However, only 25 (80.6%, 25/31) patients completed a 2-year follow-up and performed a temporal bone CT examination; re-perforation was seen in 2 patients, the graft success rate was 92.0% (23/25). CT revealed the well-developed pneumatization of the mastoids and middle ear in all the patients. Nevertheless, 1 (1/25, 8.0%) patient developed a graft epithelial inclusion cyst, which was removed by endoscope in the outpatient setting. The mean preoperative air bone gap (ABG) was 23.1 ± 4.3 dB, while the mean postoperative ABG after 6 months was 14.9 ± 2.6 dB; the difference between these values was significant (P < .05; Wilcoxon's signed-rank test), and the functional success rate was 93.5% (29/31). Endoscopic modified cartilage "inlay" graft technique with no raising the squamous epithelium and no rimming the perforation is a minimally invasive technique with a short operative time and satisfying success rate for closure of large perforations under local anesthesia.

Perichondrium-Cartilage Inlay Butterfly Myringoplasty: An Office-Based Procedure for Closing Small- to Medium-Sized Tympanic Membrane Perforations.

Objective: The objective of this study was to assess the graft and functional outcomes of inlay butterfly cartilage-perichondrium graft myringoplasty in an office setting. Material and Methods: Adult patients with chronic perforations underwent inlay butterfly cartilage-perichondrium graft myringoplasty under local and topical anesthesia. The graft and functional outcomes, intraoperative pain score, and complications were evaluated at 6 months postoperatively. Results: A total of 39 patients (39 ears) were included in this study. All patients completed 6 months of follow-up. The mean operation time was 26.5 ± 3.2 (ranged from 21 to 32) minutes. The intraoperative mean pain score was 0.61 ± 0.28. The graft success rate was 97.4% (38/39) at 6 months postoperatively. The mean preoperative air-bone gap (ABG) was 19.18 ± 4.01 dB, while the mean postoperative ABG at 6 months was 10.56 ± 2.27 dB (P < .05; Paired-Samples T Test). The functional success rate was 100.0% (38/38). Endoscopic examination showed that the transplanted perichondrium graft gradually atrophied, flattened, and became indistinguishable from the surrounding tympanic membrane 2 to 3 months following surgery, the superficial layer of perichondrium graft formed the crust and migrated into the external auditory canal at 3 to 6 months postoperatively. Conclusions: Perichondrium-cartilage inlay butterfly myringoplasty is a highly successful and minimally invasive procedure well tolerated by adults for closure of small- and medium-sized perforations in an office setting.

Transcanal endoscopic management of isolated congenital middle ear malformations

Background A few studies have reported transcanal endoscopic management of isolated congenital middle ear malformations (CMEMs). Objective The purpose of this study is to describe our surgical experience in endoscopic ear surgery for isolated CMEMs and evaluate the surgical effect of hearing reconstruction. Methods From January 2017 to January 2022, a retrospective study was performed on 36 patients (37 ears) with isolated CMEMs who all underwent endoscopic surgery. Demographic data, high-resolution computed tomography (HRCT) findings, intraoperative findings, surgical management and audiometric data were recorded. Results Anomalies were categorized according to the Teunissen and Cremers classification system: 8 ears were categorized as class I, 8 ears as class II, 19 ears as class III and 2 ears as class IV. The air conduction pure tone average (AC-PTA) of 37 cases was 61.5 ± 8.6 dB preoperatively and 29.6 ± 6.9 dB postoperatively (p < 0.001). The mean preoperative air-bone gap (ABG) significantly decreased from 43.1 ± 8.7 dB to 12.8 ± 5.5 dB postoperatively. 36 of 37 cases (97%) met the criteria for successful operation. Conclusion Isolated CMEMs are mainly manifested as aplasia of the stapes’ superstructure and dysplasia of the long process of the incus. Transcanal endoscopic surgery seems a safe technique for the management of isolated CMEMs.

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

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

“Hot” vs “Cold” endoscopic stapes surgery: a matched case–control study

PurposeTo compare hearing results and complication rates between two groups of patients operated on by endoscopic stapes surgery (ESS) for otosclerosis, either with CO2 fiber laser or microdrill.MethodsA case–control study was performed. All consecutive cases of CO2 fiber laser ESS operated at a single center during the period 2017–2020 (case group) were matched to a control group of patients operated by traditional technique, according to year of surgery, preoperative mean air–bone gap, sex and age. Audiological data from preoperative and postoperative examinations and complication rates were compared.Results46 cases were included. Mean operative time was significantly longer in the laser cohort (65 min) than in the drill one (45 min) (p = 0.003). Similar results were found in the two groups regarding the mean postoperative BC-PTA. The high-frequency bone conduction resulted significantly higher in the laser group (p = 0.002), suggesting an overclosure effect in the laser group. Consistently, a significant improvement of the BC-PTA threshold at 2000 Hz postoperatively was found in the laser group (p = 0.034). The postoperative AC-PTA significantly improved in both groups at all frequencies (p < 0.05), except for the AC threshold at 8 kHz. Similar rates of complications were found in the two groups.ConclusionThis study is the first to compare hearing results and complications between CO2 fiber laser and microdrill in ESS. Our results demonstrated similar functional outcomes between the two groups, confirming ESS as safe and effective, regardless of the technique used.

Endoscopic Fascia-Cartilage Composite Grafting in Chronic Suppurative Otitis Media

Objective: To evaluate perforation of an air-bone gap closure success using fascia-cartilage composite graft in endoscopic Trans canal tympanoplasty.&#x0D; Study Design: Randomized Control Trial (Clinical Trials.gov Identifier: NCT04945811)&#x0D; Place and Duration of Study: ENT Department Combined Military Hospital, Quetta Pakistan, from Apr 2020 to May 2021&#x0D; Methodology: One hundred and thirty-three cases of chronic Suppurative otitis media fulfilling the selection criteria were operated upon, and an endoscopic fascia-cartilage composite graft was used. A successful outcome in terms of perforation closure and air-bone gap closure was evaluated in all patients.&#x0D; Results: In the 138 patients operated, complete fascia-cartilage composite graft uptake was achieved in 129 (93.5%) patients. Nine (6.5%) patients had graft failure. The pre-operative mean air-bone gap was 36.49 ± 4.61 decibels, and the postoperative mean air-bone gap was 12.57 ± 5.09 decibels. This improvement was found to be significant, with the p-value &lt; 0.001.&#x0D; Conclusion: Endoscopic per-meatal fascia-cartilage composite grafting has a high graft uptake and air-bone gap closure percentage in chronic Suppurative otitis media cases.

ENDOSCOPIC EAR SURGERY IN CROATIA - INITIAL RESULTS OF TOTAL ENDOSCOPIC TRANSCANAL MYRINGOPLASTY.

The aim of this study was to show clinical outcome in 56 patients with tympanic membrane perforation operated on by total endoscopic transcanal myringoplasty. Out of the total of 74 patients operated on exclusively endoscopically, we identified 56 patients in whom tympanoplasty type I (myringoplasty) was performed. In 43 patients (45 ears), myringoplasty was performed in a standard transcanal fashion with lifting of the tympanomeatal flap, and in 13 patient butterfly myringoplasty was performed. The size and position of perforation, surgery duration, hearing status and closure of the perforation were evaluated. Perforation closure was obtained in 50 of 58 ears (86.21%). The mean surgery duration was 62.69±22.56 minutes in both groups. Hearing improved significantly, with the preoperative mean air-bone gap of 20.41±9.29 dB improving to the postoperative mean air-bone gap of 9.05±7.77 dB. No major complications were recorded. Our results of graft success rate and hearing outcomes are comparable with those of microscopic myringoplasties but without the need for external incisions and with reduced surgical morbidity. Hence, we recommend total endoscopic transcanal myringoplasty as the method of choice for tympanic membrane perforation regardless of its size and location.

Outcome of Endoscopic Transcanal Cartilage Myringoplasty performed in Janaki Medical College Teaching Hospital

Background and Objectives: Myringoplasty is a commonly performed surgical procedure usually with a microscope. Transcanal endoscopic myringoplasty is being widely used procedures nowadays and has the advantages of demanding lower operative time and minimal external incisions. The main objective of our study was to see the graft uptake rate and hearing results after endoscopic cartilage myringoplasty.&#x0D; Material and Methods: This prospective study was carried out on 50 patients from March 01, 2020 till April 30, 2021. All patients presented with central perforation of tympanic membrane which was dry for at least 3 months were subjected to preoperative clinical, endoscopic, audiological assessment. These patients were followed through a period of 6 months and assessed using pure tone audiometry and graft uptake was seen.&#x0D; Results: Out of 50 patients, male: female ratio was 1.9:1 with mean age group of 34 years. In our study the graft uptake rates is 85% (42) and 6 patient has pin hole perforation and 2 has small central re-perforation on 6 month followup. Mean preoperative air bone gap was 28.95 dB whereas mean postoperative air bone gap was 10.63 dB. The maximum number of patient i.e 20 had pre-operative air bone gap in the range of 31 – 40 and 20 has post operative air bone gap in the range of 0-10 which is normal.&#x0D; Conclusions: The endoscopic approach for myringoplasty offers excellent visualization; avoids postaural approach, enables a faster recovery, requires less hospital stay, with excellent graft closure rate and improved functional outcomes.

Predictive Effect of Bone Conduction Pattern on Hearing Outcomes of Stapes Surgery.

Examine the effect of preoperative bone conduction pattern on outcomes of stapedotomy/stapedectomy. Retrospective case series. Tertiary-care academic medical center. Patients who underwent stapedotomy or stapedectomy from 2013 to 2019. Primary small-fenestra stapedotomy or partial stapedectomy. Association between preoperative bone conduction patterns and hearing after stapes surgery. Complete audiometric data were available for 137 patients who had surgery. The mean preoperative air-bone gap (ABG) was 26.8 dBHL. The ABG was closed to less than 20 and 10 dBHL in 88.7 and 65.2% of patients, respectively. A notch at 2000 Hz was present in 32.1% of operated ears and was rarely found at other frequencies. There was no statistically significant association between the presence of a notch and hearing outcomes. The slope of the bone conduction line had no association with hearing outcomes, though an increased bone conduction PTA compared with the contralateral ear was associated with ABG closure less than 10 dBHL and overclosure (odds ratio: 2.14, p = 0.027 and odds ratio: 2.20, p = 0.04). In properly selected otosclerosis patients, depressions in bone conduction other than near 2000 Hz are rare and hearing outcomes are generally favorable regardless of the preoperative bone conduction pattern. Despite the association with otosclerosis, the presence of a notch at 2000 Hz is not associated with better hearing outcomes with surgery.

Comparison of Surgical Outcome of Endoscopic with Microscopic Type I Tympanoplasty in Chronic Otitis Media: A Randomized Controlled Trial.

Aim of the study was to compare the surgical outcome of endoscopic with microscopic Type 1 tympanoplasty in dry, mucosal type of chronic otitis media with respect to graft uptake rate, hearing gain and duration of surgery. This randomized controlled trial of 3 years was carried out at Tertiary Care Hospital of Central India. Total 80 cases of mucosal type of chronic otitis media posted for Type I tympanoplasty were included in the study. They were randomly divided into two groups viz. Endoscopic tympanoplasty and microscopic tympanoplasty with 40 patients in each group. Chi-square test was used to compare the qualitative results and student's t-test was used to compare quantitative results with a level of significance of p ≤ 0.05. Intraoperatively, widening of external auditory canal and auxiliary incision were required in 45% and 47.5% patients of microscopic group respectively. Mean operative time for endoscopic tympanoplasty (62.5 ±14.94mins) was less as compared to microscopic tympanoplasty (74.88 ± 15.83mins). Graft uptake rate was 95% and 92.5% in endoscopic and microscopic tympanoplasty groups respectively with statistically insignificant difference (p=0.32). The preoperative mean air bone gap in both the groups was improved significantly 6 months postoperatively. Air bone gap closure was of 13.21± 4.37dB in endoscopic group and 12.54± 4.14dB in microscopic group with statistically insignificant difference. Endoscope provides superior visualization of hidden areas of middle ear cavity and has shorter operative time than microscopic tympanoplasty with comparable surgical and functional outcomes. hence endoscopic tympanoplasty can be a good option to microscopic surgery.

Long Term Versus Short Term Hearing Results in Endoscopic Sandwich Myringoplasty.

Introduction:The use of the endoscope in otological surgeries has both diagnostic and therapeutic values. It provides an excellent view in difficult nooks and corners. The use of endoscopic sandwich myringoplasty using cartilage and perichondrium has its benefit in hearing outcome and graft uptake in long-term follow-up. The main objective was to compare the long-term with short- term hearing outcomes in those who have undergone endoscopic sandwich myringoplasty with Dhulikhel hospital (D‑HOS) technique.Materials and Methods:Forty-two patients who underwent endoscopic sandwich myringoplasty with D-HOS technique using tragal cartilage perichondrium were enrolled in the study. The hearing outcome was analyzed by comparing the pre-operative findings with post-operative findings and amongst post-operative patients, long-term with short-term air bone gap (ABG) and ABG closure in speech frequencies (0.5kHz, 1kHz, 2kHz, 4kHz) were compared. Results:Amongst forty-two patients, 40 (95.2%) had graft uptake in both short-term (6.08 months) and in long-term (20 months) follow-up. The mean pre-operative ABG was 28.1±9.3dB whereas the mean short-term post-operative ABG was 14.5±7.2dB, it showed statistical significance (P=0.001). Likewise, while comparing pre-operative with long-term post-operative ABG (13.4±4.8 dB), it showed statistical significance of P=0.000. While comparing short-term with long-term post-operative ABG, it did not show any statistical significance (P=0.065).The mean closure in ABG in both short-term and long-term hearing assessment was not statistically significant (P=0.077).Conclusion:Endoscopic sandwich myringoplasty with D-HOS technique is a reliable procedure with good hearing outcome and graft uptake in both short and long-term follow-up.

Study on impact of duration of tympanic membrane perforation on hearing loss and audiological outcome after surgery

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of the study was to assess impact of duration of tympanic membrane perforation on hearing loss and postoperative audiological outcome using pure tone audiogram.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present study was conducted on 100 patients in department of ENT and HNS, SMGS Hospital, Government Medical College Jammu during a time period of November 2018 to October 2019. All the patients with age 15 to 60 years who presented with tympanic membrane (pars tensa) perforation were included in the study. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study, mean preoperative hearing loss (AC threshold) of group A was 36.23±1.07 dB and of group B was 25.67±6.38 dB. Group C had mean preoperative hearing loss (AC threshold) of 28.78±6.50 dB. Mean preoperative air-bone gap (AB gap) of group A was 12.9±8.05dB and of group B was 13.86±4.19 dB. Group C had mean preoperative air-bone gap (AB gap) of 16.47±5.51 dB. Postoperatively, pure tone threshold at three months was least in group B (15.09±5.80 dB), followed by group C (15.68±4.66 dB) and group A (19.33±2.81 dB). Whereas, postoperative AB gap at 3 months was least in group C (10±3 dB), followed by group C (8.44±3.59 dB). Group B had maximum postoperative AB gap of 8.49±4.34 dB.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study did not show any correlation between duration of disease and degree of hearing loss.&lt;/p&gt;

Correlation between functional outcome and the SAMEO-ATO framework.

PurposeTo evaluate the recently proposed SAMEO-ATO framework for middle ear and mastoid surgery, by correlating it with the functional outcome in a large cohort of patients operated for middle ear and mastoid cholesteatoma in a tertiary referral center.MethodsWe retrospectively included all surgeries for middle ear and mastoid cholesteatoma undergone in our Department between January 2009 and December 2014, by excluding revision surgeries, congenital and petrous bone cholesteatoma. All surgeries were classified according to the SAMEO-ATO framework. The post-operative air bone gap (ABG) was calculated and chosen as benchmark parameter for the correlation analysis.Results282 consecutive surgeries for middle ear and mastoid cholesteatoma were released in the study period on a total of 273 patients, with a mean age of 41.2 years. All patients were followed for an average period of 55.3 months. 54% of patients underwent M2c mastoidectomy (Canal Wall Down, CWD), while the remaining underwent Canal Wall Up (CWU) procedures, being M1b2a mastoidectomy the most common one (33%). Mean pre-operative and post-operative ABGs were 29.2 and 23.5 dB, with a significant improvement (p < 0.0001). ‘Mastoidectomy’ and ‘Ossicular reconstruction’ parameters of SAMEO-ATO showed significant association with postoperative ABG, with smaller residual gaps for the classes Mx and On, and worse hearing results for M3a and Ox.ConclusionOur results show the utility of SAMEO-ATO framework, and in particular of ‘M’ (Mastoidectomy) and ‘O’ (Ossicular reconstruction) parameters, in predicting the hearing outcome.

Surgical Outcomes of Transmastoid Facial Nerve Decompression for Patients With Traumatic Facial Nerve Paralysis

Objective:To evaluate the facial nerve function and audiological results of delayed (by at least one month after the insult) transmastoid facial nerve decompression (FND) in traumatic facial nerve paralysis (FNP). Methods: Medical records of 57 patients with traumatic FNP were reviewed and surgical results of 13 patients (mean age 28.0 ± 17.67, range 3-67) undergoing transmastoid FND were analyzed. Preoperative and postoperative mean hearing thresholds were compared using 0.5, 1, 2, and 3 kHz. Facial nerve function was graded according to the House–Brackmann scale (HB) before and after surgery. HB scale results of grade III or better were accepted as good results postoperatively. Results: Preoperative HB grades were V in 5 and VI in 8 patients. Twelve of 13 patients had good recovery of facial nerve function regardless of the operation timing. When mean preoperative and postoperative air–bone gap (ABG) values were compared (except the patients with total sensorineural hearing loss), the mean preoperative ABG was 33 ± 15.9 dB, and mean postoperative ABG was 17.2 ± 8.68 dB. There was a mean hearing gain of 15.8 dB after transmastoid facial nerve decompression surgery. Surgery and anesthesia-related complications were not seen in any patients. Conclusion: The transmastoid route can be used safely and effectively with elimination of the risks of craniotomy and middle fossa surgery for patients with traumatic FNP. Hearing improvement can be achieved by performing ossicular chain reconstruction during decompression surgery for patients with conductive or mixed hearing loss (HL).KEYWORDS: Facial nerve, decompression, facial paralysis

Does stapedotomy improve high frequency conductive hearing?

ObjectivesStapedotomy is performed to address conductive hearing deficits. While hearing thresholds reliably improve at low frequencies (LF), conductive outcomes at high frequencies (HF) are less reliable and have not been well described. Herein, we evaluate post‐operative HF air‐bone gap (ABG) changes and measure HF air conduction (AC) thresholds changes as a function of frequency.MethodsRetrospective review of patients who underwent primary stapedotomy with incus wire piston prosthesis between January 2016 and May 2020. Pre‐ and postoperative audiograms were evaluated. LF ABG was calculated as the mean ABG of thresholds at 250, 500, and 1000 Hz. HF ABG was calculated at 4 kHz.ResultsForty‐six cases met criteria. Mean age at surgery was 54.0 ± 11.7 years. The LF mean preoperative ABG was 36.9 ± 11.0 dB and postoperatively this significantly reduced to 9.35 ± 6.76 dB, (P < .001). The HF mean preoperative ABG was 31.1 ± 14.4 dB and postoperatively, this also significantly reduced to 14.5 ± 12.3 dB, (P < .001). The magnitude of LF ABG closure was over 1.5 times the magnitude of HF ABG closure (P < .001). The gain in AC decreased with increasing frequency (P < .001).ConclusionHearing improvement following stapedotomy is greater at low than high frequencies. Postoperative air bone gaps persist at 4 kHz. Further biomechanical and histopathologic work is necessary to localize postoperative high frequency conductive hearing deficits and improve stapedotomy hearing outcomes.Level of Evidence4, retrospective study.

Success rates in restoring hearing loss in patients with chronic otitis media: A systematic review.

ObjectiveTo assess the effectiveness of tympanoplasty in treating chronic otitis media‐related hearing loss, published literature was systematically reviewed to determine the clinical success rate of tympanoplasty at restoring hearing in chronic otitis media patients at a minimum follow‐up period of 12‐months.Data SourcesPubMed, Embase and the Cochrane Library.MethodsTwo independent reviewers performed literature searches. Publications reporting long‐term (≥12‐month) hearing outcomes and complications data on adult and pediatric patients with chronic otitis media were included and assessed for risk of bias and strength of evidence. To assess how tympanoplasty influences long‐term hearing outcomes, data on pure tone audiometry (air‐bone gap) and complications were extracted and synthesized.ResultsThirty‐nine studies met the inclusion criteria. Data from 3162 patients indicated that 14.0% of patients encountered postoperative complications. In adult patients, mean weighted air‐bone gap data show closure from 26.5 dB hearing level (HL) (preoperatively) to 16.1 dB HL (postoperatively). In studies that presented combined adult and pediatric data, the mean preoperative air‐bone gap of 26.7 dB HL was closed to 15.4 dB HL. In 1370 patients with synthesizable data, 70.7% of patients had a postoperative air‐bone gap ˂ 20 dB HL at long‐term follow‐up. Finally, subgroup analysis identified that mean improvement in ABG closure for patients with and without cholesteatoma was 10.0 dB HL and 12.4 dB HL, respectively.ConclusionIn patients with chronic otitis media, tympanoplasty successfully closed the air‐bone gap to within 20 dB HL in 7/10 cases and had an overall complication rate of 14.0%.Level of Evidence2a.

Comparative analysis of titanium clip prostheses for partial ossiculoplasty

ObjectivesThe aim of our study was to perform a comparative analysis in our cases with titanium partial clip ossiculoplasty in terms of audiometric outcome and extrusion rates as well as to review the literature for relevant information on this surgical issue. Materials and methodsThe records of all patients who had undergone primary partial ossiculoplasty with the implantation of a CliP® Partial Prosthesis Dresden Type (CPPDT, group A) or a CliP Partial FlexiBAL® (CPF, Group B, both Heinz Kurz GmbH, Dusslingen, Germany) between 2012 and 2020 were studied retrospectively. Results274 patients made up our study sample (148 men, 126 women, male to female ratio: 1.17). Their mean age at the time of first surgery was 39.6 years (range: 4–79 years). The mean preoperative air-bone gap (ABG) was 22.7dΒ ± 10.5 dB. Mean follow-up was approximately 4 months (1–12 months). The mean postoperative ABG was 15.7 ± 8.1 dB. In total, the postoperative ABG was significantly improved compared to preoperative values (P < 0.001). Surgical success, defined as an ABG ≤ 20 dB, was achieved in the majority of our study patients (210/274, 76.6%). Extrusion of the prosthesis was detected in 3/216 CPF and 5/58 CPPDT cases (p = 0.012). Comparison of both prosthesis groups revealed a significantly better audiological outcome for the patients with ossicular reconstruction using CPF. A significantly better audiological outcome was detected in the cases with a normal aeration of the middle ear. DiscussionTitanium clip partial ossiculoplasty is a reliable component of modern tympanoplasty, allowing a satisfying audiologic outcome. The higher adaptability of the CPF to the changing postoperative circumstances and the frequently defective aeration of the middle ear is reflected in the better audiologic outcome for this prosthesis.

Postinflammatory Medial Meatal Fibrosis: Histopathologic Features and Outcomes of Surgical Management.

The aims of our study were to investigate the clinical and audiometric outcome of the surgical treatment of postinflammatory medial meatal fibrosis (PIMMF) and to review the histopathologic changes in the specimens of the fibrotic plug, in order to try to shed light on the pathogenesis of the disease. The clinical records and the histopathologic specimens of all patients who underwent tympanomeatoplasty for PIMMF at the ENT Clinic of the University of Erlangen between 2006 and 2020 were evaluated retrospectively. Thirty-four patients (41 primary surgical procedures) made up our study cohort. Of this, 28 cases were managed by means of meatoplasty and 13 cases with tympanomeatoplasty. The mean preoperative air-bone gap (ABG) was 27.8 dB (10-44 dB). Postoperative ABG was significantly improved compared to preoperative values at both short- and long-term follow-ups (P < .001 for both). No significant difference was noted between short-term and long-term ABG (P = .240). An ABG ≤20 dB was achieved in 65.8% of patients (short term) and 50% (long term). The overall rate of revision surgery for restenosis was 29.3% (12/41). Histopathologic reevaluation of the fibrotic plugs revealed a mosaic of patterns with frequent occurrence of secondary cholesteatoma-like lesions and keloid-like tissue changes. Lichenoid submucosal inflammation and increased ectopic ceruminous gland lobules were seen less frequently. The moderate long-term outcome of surgical management and the identification of histologic changes with therapeutic implications might pave the way for alternative nonsurgical treatment options.