Mean Preoperative Air-bone Gap Research Articles

Manubrio-stapedioplasty: new surgical technique for malleus and incus fixation due to tympanosclerosis.

This paper reports the authors' technique of manubrio-stapedioplasty using glass ionomer cement for malleus and incus fixation due to tympanosclerosis. A retrospective case review was conducted of five patients with conductive hearing loss (mean pre-operative air-bone gap of 42.75 dB) treated in a tertiary referral centre. The hearing results of a manubrio-stapedial bone cement ossiculoplasty technique, utilised on the five patients, were analysed. All cases were Wielinga and Kerr tympanosclerosis classification type 2 (attic fixation of the malleus-incus complex with a mobile stapes). The incus and head of the malleus were removed in all patients, and the manubrium was directly connected to the head of the mobile stapes using glass ionomer cement. Patients were evaluated in terms of pre- and post-operative audiometric results; hearing gain and post-operative air-bone gap were the main outcome measures. Mean post-operative air-bone gap was 5.25 dB. Four patients had an air-bone gap of less than 10 dB; the remaining patient had an air-bone of 12.50 dB. Manubrio-stapedioplasty is an effective method for ossicular reconstruction in cases of malleus and incus fixation due to tympanosclerosis.

Transcanal endoscopic tympanoplasty in the treatment of chronic otitis media

This study aims to report early postoperative complications and hearing results in patients with chronic otitis media undergoing endoscopic transcanal tympanoplasty. Twenty-four patients (6 males, 18 females; mean age 25.9 years; range 9 to 46 years) who were operated with endoscopic transcanal tympanoplasty in the Department of Otorhinolaryngology, Faculty of Medicine, Çukurova University between December 2012 and January 2014 were included. Postoperative complication rates, graft success, and hearing outcomes (mean air-bone gap) were evaluated. The mean preoperative air bone gap was found 25.1 dB and the mean postoperative air bone gap was found 20.3 dB. Postoperative duration of hospital was 24 hours. Reperforation was seen in one patient and medialization of the anterior quadrant of the graft was seen in one patient. The mean follow-up time was 7.3 months. Endoscopic transcanal tympanoplasty can be easily applied, cheap and safe method and can be given successful results in challenging cases.

Recurrence rate of cholesteatoma with autoclaved incus autograft.

To study the long-term recurrence rate of cholesteatoma with autoclaved incus autograft. Prospective observational study between 1994 and 2009. The incus remnants were autoclaved at 134°C for 24 minutes at 205 kPa. The mean follow-up duration was 65.5 months, with a minimum follow-up duration of 31 months and a maximum follow-up duration of 186 months. Secondary referral center in a district general hospital. Thirty-seven cases of cholesteatoma treated with canal wall down mastoidectomy with primary ossicular reconstruction with autoclaved incus autograft were included. The age range of the patients was from 11 years to 67 years. The mean age was 38 years. Fifty-four percent was male, and 46% was female. Therapeutic and rehabilitative--to treat and improve the patients' hearing loss secondary to cholesteatoma by using autoclaved autologous incus. Primary end point is the recurrence rate of cholesteatoma with a mean follow-up period of more than 5 years. Secondary end point is the audiometric outcome with air-bone gap (ABG) and air conduction improvement. No recurrence of cholesteatoma was observed. No graft extrusion was seen. Preoperative mean ABG was 29.8 dB. Postoperative mean ABG was 25.6 dB at the final review, with the air conduction improvement at final review at 4.2 dB. Autoclaving the incus remnant harvested from cholesteatomatous middle ear cleft is a safe and effective method to prepare an incus autograft for primary ossicular reconstruction.

Long-term outcome of ossiculoplasty using autogenous mastoid cortical bone.

To observe the long-term outcome of ossiculoplasty using autogenous mastoid cortical bone in chronic otitis media in-patients. Sixty-one ears of 57 in-patients with chronic otitis media, with or without cholesteatoma, underwent type III tympanoplasty using autogenous mastoid cortical bone as the prosthetic material. Twenty-one ears were treated by canal wall down mastoidectomy and 40 ears by canal wall up mastoidectomy. The follow-up period was 3 to 6 years (average 4.2 years). Pure tone averages for thresholds at 0.5, 1, 2 and 3 kHz were calculated using standard conventional audiometry. The pre-operative mean air-bone gap of 31.6 dB, for all ears, was reduced to 20.3 dB post-operatively. For the 40 canal wall up ears, this value decreased from 30.8 dB to 19.9 dB, and for the 21 canal wall down ears it decreased from 33.0 dB to 21.0 dB. The differences between the pre- and post-operative mean air-bone gap values were significant. No cases of extrusion, necrosis or resorption were exhibited for the autogenous mastoid cortical bone prosthesis. A significant hearing improvement was obtained in the majority of cases and this remained stable over time.

Outcome of Interlay Grafting in Type 1 Tympanoplasty for Large Central Perforation.

A prospective, cohort, clinical study was conducted at Dr. D. Y. Patil Hospital, Kolhapur from August 2010 to August 2013. The aim was to evaluate the results of type 1 interlay tympanoplasty with respect to graft uptake, hearing improvement and complications. Total of 100 cases with a mucosal type of chronic suppurative otitis media and a large central perforation (involving more than 50% of tympanic membrane) were operated for type 1 tympanoplasty where the graft was placed by interlay method (below the fibro-squamous layer and above the mucosal or endothelial layer). Patients were followed up with ear microscopy at each follow up visit and an audiometry at the end of 3rd month. Statistical analysis was done by statcal software using paired t test and two sample t test for proportion. 96 (96%) cases had a successful graft uptake. The mean pre-operative air-bone gap was 36.42±12.0dB; whereas the mean post-operative air-bone gap was 9.7±6.71dB. Except for residual perforation in four patients and partial tympanomeatal flap necrosis in two patients no other complications were encountered. Thus, we conclude that, the interlay tympanoplasty is a safe and effective method of graft placement for large central perforation.

Long-Term, High-Frequency Tympanometry and Audiometry Results after Cartilage and Fascia Tympanoplasty

Long-Term, High-Frequency Tympanometry and Audiometry Results after Cartilage and Fascia Tympanoplasty

Delaying partial stapedectomy for otosclerosis: effects on long-term hearing outcomes following surgery

The purpose of this study is to evaluate hearing outcomes following partial stapedectomy according to age at the time of surgery and evaluate functional hearing at ≥ 10 years' follow-up, and to assess the effect of delay in surgery on overall functional hearing outcomes. Data were collected from patients operated upon for otosclerosis by a single surgeon from 1990 to 1999. Pure-tone air (PTA), pure-tone bone (PTB), air-bone gap (ABG), air-conduction at 8 kHz (AC 8), bone-conduction at 4 kHz (BC4) and speech discrimination score (SDS) were compared between patients <45 and ≥ 45 years old, as well as correlated with overall age preoperatively, short term (4 months) and long term (>10 years), postoperatively. Forty-five patients were included with a mean follow-up of 12.6 years. Mean preoperative ABG and AC 8 values were significantly different between the two age groups (p = 0.002; p = 0.010, respectively). No values remained significantly different between the two age groups at the long-term follow-up. ABG values correlated with age preoperatively (p = 0.001), although no correlation was seen short- and long-term postoperatively (p = 0.980; p = 0.495, respectively). Mean PTA, PTB, and ABG values showed a significant improvement in both groups preoperatively to short-term postoperatively (p < 0.001). Although mean PTA values decreased significantly from short- to long-term follow-ups in both groups (p = 0.033; p = 0.020), the improvement from the preoperative state remained significant (p < 0.001). Regardless of age at the time of surgery, long-term hearing levels will evolve similarly in patients <45 and ≥ 45 years old. Furthermore, no difference will be seen in hearing measurements between the two age groups at ≥ 10 years postoperatively. Delaying a surgery would thus not affect overall long-term hearing outcomes.

Oval window atresia: A novel surgical approach and pathognomonic radiological finding

ObjectivesThe facial nerve usually occupies the oval window area in patients with oval window atresia. During exploration, if the facial nerve is discovered to lie in the oval window area, this is usually regarded as a contraindication for further surgical intervention. The aim of the present paper is to demonstrate the preoperative pathognomonic radiological sign and describe a new surgical approach for this difficult situation. Methods3 patients and 4 ears were operated due to conductive hearing loss by the same surgeon in a tertiary referral center. Their clinical presentation, radiological findings, surgical findings and final outcomes were evaluated and correlated. ResultsSurgical findings were identical in all 4 ears: facial nerve was running over the oval window and tympanic portion was completely dehiscent. Incus long arm was medially displaced due to abnormal development of the stapes suprastructure. In each ear a successful vestibulotomy and teflon piston placement was achieved. Preoperative mean air-bone gap of 47.5dB was improved to 21.5dB. There were no complications. ConclusionOval window atresia is a rare middle ear anomaly usually regarded as a contraindication for surgical intervention. In this study we present a novel surgical approach with succesful results. However the best approach is to inform the family by showing the nerve on tomography, showing the operation video, informing the family about the sensorineural hearing loss and letting the family choose the treatment option.

Transmastoid Approach to Spontaneous Temporal Bone Cerebrospinal Fluid Leaks: Hearing Improvement and Success of Repair

To determine whether the transmastoid approach to repair of spontaneous temporal bone cerebrospinal fluid (CSF) leak is safe and effective and if improvement in conductive hearing loss is an achievable goal with this approach. Case series with chart review. Tertiary academic medical center. Fifteen consecutive patients (16 ears) presented with spontaneous temporal bone CSF leaks over a 6-year period. Clinical data, imaging, audiometry, operative reports, and postoperative course were reviewed. Median age was 59.5 years. Mean body mass index was 40.7 kg/m2. All presented with chronic otorrhea after tympanostomy tube placement and conductive/mixed hearing loss. The mean preoperative air-bone gap was 19 dB. A transmastoid approach alone was used in 15 cases; 1 underwent middle fossa craniotomy. Most defects were located in the tegmen mastoideum and tympani. All repairs were multilayered, typically using autologous mastoid bone, temporalis fascia, and tissue sealant. Primary repair was successful in 15 cases; 1 patient with persistent postoperative otorrhea subsequently underwent middle fossa craniotomy, but no frank leakage was found. No serious complications were encountered. Following transmastoid repair, postoperative audiograms were available for 14 patients. The mean improvement in air-bone gap was 12 dB. Closure of the air-bone gap to ≤12 dB occurred in 100% of cases. The transmastoid approach to repair of spontaneous temporal bone CSF leak is highly successful. Furthermore, patients in this series had excellent hearing results with closure of their air-bone gap to ≤12 dB, which has not been previously described.

Fat graft myringoplasty in small central perforations

Background: Perforations of the tympanic membrane (TM) are treated with various surgical techniques and materials. Although autologous temporalis fascia is the most common material used for the closure of TM perforations, however for a dry, small central perforation the fat graft myringoplasty (FM) is a good alternative as it is a simple and cost-effective technique. Objectives: The aim of this study was to determine the efficacy of FM for repair of small central perforations. Suggestions for optimizing the outcome of FM are presented. Material and Methods: Twenty patients (10 males and 10 females) who had uncomplicated dry small central perforation, which was confined to one quadrant of the pars tensa underwent FM. The outcome was evaluated after 1-week, 1-month, and 3 months. Results: After 3 months of follow-up, a closure rate of 80% was achieved. Mean preoperative air-bone (AB) gap was 22.90 ± 6.54 dB and mean postoperative AB gap was 21.80 ± 6.28 dB. Mean improvement in AB gap postoperatively was 1.1 ± 2.63 dB. Conclusion: Fat graft myringoplasty, with its ease of technique and good graft uptake rate justifies its use in the closure of small dry central TM perforations.

A new grafting technique for tympanoplasty: tympanoplasty with a boomerang-shaped chondroperichondrial graft (TwBSCPG)

The aim of this study was to introduce a new grafting technique in tympanoplasty that involves use of a boomerang-shaped chondroperichondrial graft (BSCPG). The anatomical and functional results were evaluated. A new tympanoplasty with boomerang-shaped chondroperichondrial graft (TwBSCPG) technique was used in 99 chronic otitis media patients with central or marginal perforation of the tympanic membrane and a normal middle ear mucosa. All 99 patients received chondroperichondrial cartilage grafts with a boomerang-shaped cartilage island left at the anterior and inferior parts. Postoperative follow-ups were conducted at months 1, 6, and 12. Preoperative and postoperative audiological examinations were performed and air-bone gaps were calculated according to the pure-tone averages (PTAs) of the patients. In the preoperative period, most (83.8%) air-bone gaps were ≥ 16 dB; after operating using the TwBSCPG technique, the air-bone gaps decreased to 0-10 dB in most patients (77.8%). In the TwBSCPG patients, the mean preoperative air-bone gap was 22.02 ± 6.74 dB SPL. Postoperatively, the mean postoperative air-bone gap was 8.70 ± 5.74 dB SPL. The TwBSCPG technique therefore decreased the postoperative air-bone gap compared to that preoperatively (p = 0.000, z = -8.645). At the 1-month follow-up, there were six graft perforations and one graft retraction. At the 6-month follow-up, there were nine graft perforations and three graft retractions. At 12 months, there were seven graft perforations and four graft retractions. During the first year after the boomerang tympanoplasty surgery, graft lateralization was not detected in any patient. Retractions were grade 1 according to the Sade classification and were localized to the postero-superior quadrant of the tympanic membrane. The TwBSCPG technique has benefits with respect to postoperative anatomical and audiological results. It prevents perforation of the tympanic membrane at the anterior quadrant and avoids graft lateralization due to placement of the graft under the manubrium mallei. Given these benefits, the TwBSCPG technique seems to be a good alternative for grafting in tympanoplasties.

Performing Transcanal Tympanoplasty with Human Amniotic Membrane Allograft

Objectives: Determine if dehydrated human amniotic membrane (dHAM) can be successfully used in tympanoplasty. Methods: A prospective observational study was conducted on 14 patients in one year with a tympanic membrane perforation of &gt;6 months’ duration who underwent type I tympanoplasty with a dHAM allograft. The subjects did not have active infection, mastoiditis, or previous attempted repair. All patients underwent pre-operative audiologic testing and transcanal repair with an overlay technique. Operative time was recorded in each patient, as well as pre-operative and post-operative photographs. Patients were examined at 1-, 3- and 6-weeks post-operatively, at which point audiograms were repeated. Success was measured using photomicrographs. Study outcomes included operative time, post-operative pain assessment, graft success and audiologic improvement. Patients were also surveyed post-operatively on their satisfaction of undergoing transcanal tympanoplasty with dHAM. Results: The mean operative time was 13.3 ± 0.10 minutes. Only one patient (7%) in the group reported having post-operative pain one week after surgery. About 70% of patients had complete or partial success. The pre-operative mean air-bone gap was 23.0dB and the post-operative mean air-bone gap was 16.7dB. All patients (100%) were satisfied in undergoing transcanal tympanoplasty with dHAM. Conclusions: Transcanal tympanoplasty with dHAM is a time efficient alternative to traditional tympanoplasty with a high rate of surgical success and high patient satisfaction.

Transmastoid Approach to Spontaneous Temporal Bone CSF Leaks: Hearing Improvement and Success of Repair

Objectives: 1) Recognize that transmastoid repair of spontaneous CSF leaks is safe and effective. 2) Recognize that improvement in conductive hearing loss is an achievable goal with this approach. Methods: This is a retrospective case review at a tertiary academic medical center of 17 consecutive patients (18 ears) who presented with spontaneous temporal bone CSF leaks over an 8-year period. Clinical data, imaging, audiometry, operative reports, and postoperative course were reviewed. The primary outcome was success of the repair. The secondary outcome was hearing preservation. Results: Median age was 57.5 years. Mean body mass index was 39.27mg/kg2. All presented with chronic otorrhea after tympanostomy tube placement and conductive/mixed hearing loss. The mean preoperative air-bone gap was 19dB. A transmastoid approach alone was used in 17 cases; 1 underwent middle fossa craniotomy approach. Defects were located over the tegmen mastoideum and tegmen tympani. Most repairs used autologous mastoid bone, temporalis fascia, and tissue sealant. Primary surgical repair was successful in 17 cases; 1 patient with persistent postoperative otorrhea subsequently underwent middle fossa craniotomy, but no frank leakage was found. No complications were encountered. The average improvement in postoperative air-bone gap was 12dB. Closure of the air-bone gap to &lt;10dB occurred in over 80% of the cases. Conclusions: The transmastoid approach for repair of temporal bone CSF leak is safe and highly successful. Furthermore, the majority of patients in this series had excellent hearing results with closure of their air-bone gap to &lt;10dB, which has not been previously described.

Pediatric stapedectomy: Does cause of fixation affect outcomes?

ObjectiveTo compare outcomes of stapedectomy in patients with congenital stapes fixation versus juvenile otosclerosis. MethodsA retrospective chart review was performed from January 1, 1999 until January 1, 2011 to identify patients under 18 years old who underwent a stapedectomy. Age, gender, pre- and postoperative audiograms, intraoperative findings including etiology of stapes fixation, prosthesis type, and complications were recorded. ResultsTwenty-two children were identified who had undergone a stapedectomy (two patients underwent sequential bilateral surgery) resulting in a total of 24 ears. The cause of fixation included juvenile otosclerosis (n=7) and congenital stapes fixation (n=17). The overall mean pre-operative air-bone gap (ABG) was 34.7dB (SD: 13.5) compared to a postoperative mean ABG of 9.0 (SD: 9.3) (p<0.001). The mean postoperative ABG of 9.6 (SD: 10.5) in the congenital stapes fixation group was similar to the mean postoperative ABG of 7.2dB (SD: 5.4) in children with juvenile otosclerosis (p=0.6). Two patients developed delayed profound sensorineural hearing loss approximately two weeks after surgery. One patient with profound sensorineural hearing loss recovered to a profound mixed hearing loss with a speech discrimination score of 80%. ConclusionsPediatric stapedectomy has comparable results to stapedectomy in adults regardless of the cause of stapes fixation; however, delayed sensorineural hearing loss may be higher in the pediatric population.

Wyniki operacyjnego leczenia otosklerozy u chorych po wykonanej stapedotomii

IntroductionThere are many ways of presenting the treatment's results for otosclerosis. Because of loss of the uniform standard, it is impossible to compare these results between various health centres. But the most important is, which way of presenting seems to be the best. AimThe aim of the study was to propose a scheme of presenting the treatment's results for otosclerosis. Material and methodsIn order to devise method, medical documentation of 81 patients, treated for otosclerosis in Otolaryngological and Oncological Laryngology Clinic with Audiology and Phoniatrics Department, was analysed retrospectively. ResultsThe received results were analysed for each patient and divided into 3 groups: first – changes of the air conduction, second – changes of the air-bone gap, third – changes of the bone conduction. The value of the air-bone gap is a measure of surgeon's effectiveness interpreting as the reconstruction of the conductive chain in the middle ear. The loss of bone conduction before and after the operation can evaluate the improving hearing after the operation of otosklerosis due to overclosure and also can take under consideration the sensoneurinal hearing loss induced by moving of the stapes. Only comparison these three parameters is correct to evaluate the operation's results, especially the air conduction. So that de Bruijn et al. proposed a diagram, called Amsterdam Evaluation Hearing Plots – AEHPs. That diagram compares the pre-operative mean air-bone gap to post-operative change of loss of air – conduction. Thanks to that, the overclosure and post-operative sensorineurinal hearing loss were taken under consideration. ConclusionsThe presentation of the treatment's results for otosclerosis should include, besides the air-bone gap, the air conduction and bone conduction too. The AEHPs meet the requirements.

The use of bone cement for ossicular chain defects

Bone cement is a good and cheap option for some ossicular chain problems such as incudostapedial re-bridging. The purpose of this retrospective study is to evaluate the audiologic results after reconstruction of three different types of ossicular chain defects, using bone cement. Group 1 consists of 42 patients who underwent an ossiculoplasty using bone cement between the damaged long process of the incus and an intact stapes superstructure. Group 2 consists of 46 patients in which incus interposition between malleus and stapes superstructure was performed, using bone cement to fix the interposed incus. For group 3, consisting of 32 patients who had a present malleus, a defective long process of the incus and a missing stapes superstructure, a re-shaped incus was placed between the stapes footplate and the malleus and bone cement was again used as a fixator. Preoperative and postoperative pure-tone audiometric findings were obtained and hearing differences were assessed. The mean preoperative and postoperative air-bone gaps were 34.8 and 15.6, 35 and 18.4, and 43.4 and 19.8 for groups 1, 2, and 3, respectively. There was a significant improvement in hearing outcomes in all the groups when comparing preoperative and postoperative mean air-bone gaps (p<0.001). The postoperative air-bone gap was ≤20dB in 76% of patients in group 1, 64% of patients in group 2, and 46% of patients in group 3. Bone cement is an effective and cheap option for some ossicular chain problems such as incudostapedial re-bridging. It may also be used to fix the interposed incus to the stapes superstructure and/or malleus to avert displacement.

Hearing results in adults after stapedotomy

Background:Although clinical otosclerosis is considered a rare disease, it is the common cause of hearing loss in patients with an intact tympanic membrane. Also, the hearing loss is amenable to other non-surgical remedies. However, stapes surgery is currently the preferred treatment modality. This study aimed to assess the short-term hearing results in adults after primary stapedotomy, and find, if any, the effects of some variables on post operative hearing.Materials and Methods:This was a retrospective review of the clinical records of all consecutive patients who had primary stapedotomy for otosclerosis at the K. K. Ramalingam Ear, Nose and Throat Hospital and Research institute, Chennai, India between October 2011 and December 2011.Results:A total of 31 adults were studied; 19 (61.3%) were males and 12 (38.7%) were females. Their ages were between 21 years and 69 years; the mean age was 43.67 years, standard deviation (SD) 11.859 (95% CI; 39.24-48.10). The mean duration of symptom was 5.96 years; SD 6.188 (95% CI; 3.65-8.27). The commonest presenting symptoms were hearing loss (96.5%) and tinnitus (48.4%). The overall mean pre-operative pure tone average was 56.54 dB, SD 10.866 (95% CI; 52.55-60.52), while the overall mean post operative pure tone average was 33.75 dB, SD 15.577 (95% CI; 28.03-39.46). This difference was found to be statistically significant (Z = −4.454; P = 0.000). The overall mean pre-operative air bone gap was 43.14 dB; SD 6.824 (95% CI; 40.64-45.64) and the overall mean post operative air bone gap was 19.17 dB; SD 12.368 (95% CI; 14.63-23.70). This difference was found to be statistically significant (Z = −4.701). Nineteen patients (61.3%) had post operative air bone closure within 15 dB. The patient's age significantly correlated with the post operative pure tone average (r = 0.443; P = 0.023). There was no significant correlation between the duration of disease and the post operative pure tone average (r = −0.034; P = 0.870).Conclusions:Primary stapedotomy was effective in improving short term hearing outcome in adults with clinical otosclerosis. In addition, the post operative hearing outcomes were not affected by the duration of the disease; but by an increase in the patient's age.

Middle ear risk index as a prognostic factor in pediatric ossicular reconstruction

Objectives: To study the hearing results in children following ossicular reconstruction and to determine if the middle ear risk index (MERI) is a useful tool for predicting the outcome of surgery. Design: A retrospective case series. Setting: A tertiary academic center. Patients: Forty-four children underwent ossicular reconstruction using autologous or alloplastic prostheses from January 1995 to January 2005. Materials and Methods: Patients' audiograms were evaluated preoperatively and postoperatively for pure-tone average (PTA) and air-bone gap (ABG). Each ear was scored using the MERI and a total index was calculated. Results: 23 boys and 21 girls were included in the study. The mean preoperative ABG was 38 dB, and the mean postoperative ABG was 25.3 dB. The mean MERI was 3.40 for excellent results (0-10 dB postoperative ABG), 4.42 for good results (11-20 dB postoperative ABG), 4.45 for fair results (21-30 dB postoperative ABG), and 4.06 for poor results (ABG > 30 dB). The complications included perforation of tympanic membrane (13.6%), worsening of the conductive hearing loss (6.8%), retraction pockets (9.1%), recurrent or residual cholesteatoma (6.8%), high-frequency sensorineural hearing loss (4.45%), and prosthesis extrusion (2.3%). The mean follow-up period was 14 months. Conclusion: Children have poorer hearing outcome following ossicular reconstruction in comparison to the published adults' results. The MERI was not a reliable tool for predicting the hearing results of ossicular reconstruction in children.

Congenital Ossicular Chain Anomalies Associated with a Mobile Stapes Footplate: Surgical Results for 23 Ears

We describe the audiometric results following surgery in a consecutive series of patients with a congenital ossicular middle ear disorder that was associated with a mobile stapes footplate. We performed a retrospective analysis of patient charts from a tertiary referral center. A total of 23 patients (23 ears) underwent exploratory tympanotomy and ossicular reconstruction between 1986 and 2001. The main outcome measure was the audiometric results. Overall, we observed a mean gain in air conduction pure tone average of 17 dB (from 47 dB to 30 dB), a sensorineural deterioration of 3 dB, and a mean postoperative air-bone gap of 19 dB (mean preoperative air-bone gap of 38 dB). The air-bone gap closure was 20 dB or less in 15 of the 23 cases (65%), in agreement with the few results reported in the literature. Moreover, the audiometric results remained stable. In the syndromic group, the mean gain in air conduction was only 13 dB, which was worse than that observed for the nonsyndromic ears. Surgery for congenital ossicular chain anomalies with a concomitant mobile stapes footplate provides positive audiometric outcomes. Most ears had some sensorineural impairment (10 to 20 dB), which influenced the final hearing level attained after surgery. Preoperative assessment is mandatory to search for syndromal diagnoses, which might be important for patient counseling and prognosis.

Congenital Stapes Ankylosis Associated With Another Ossicular Chain Anomaly&lt;subtitle&gt;Surgical Results in 30 Ears&lt;/subtitle&gt;

To describe the audiometric results after stapes surgery in a consecutive series of patients with stapes footplate ankylosis combined with another ossicular middle ear anomaly. A retrospective analysis of charts collected between 1986 and 2001. A tertiary referral center. A total of 25 patients (30 ears) underwent exploratory tympanotomies and ossicular reconstruction. Audiometric results. Overall, a mean gain in air conduction of 18 dB (from 49 dB to 31 dB) and a mean postoperative air-bone gap (ABG) of 20 dB (mean preoperative ABG, 40 dB) were observed. The ABG closure was 20 dB or less in 70% of cases, which is in agreement with the few results reported in the literature. Moreover, the audiometric results remained stable. In the group of ears with a syndrome, the mean gain of air conduction was only 19 dB, which was comparable to that observed among nonsyndromic ears. Surgery for congenital stapes footplate ankylosis with a concomitant ossicular chain anomaly can provide worthwhile hearing improvement. The ABG closure was 20 dB or less in 21 of 30 ears (70%). Most ears had some sensorineural impairment (10-20 dB), which influenced the final hearing level after surgery. Over recent decades, the technique of the malleostapedotomy procedure has been improved. Preoperative assessment is mandatory for syndromal diagnoses, which might be important for patient counseling and prognosis.