Mean Pre-operative Pure Tone Average Research Articles

Validating an Evoked Potential Platform for Electrocochleography During Cochlear Implantation.

To validate electrocochleography (ECochG) between an auditory evoked potential (AEP) machine and an established cochlear implant (CI) manufacturer ECochG system. Intraoperative validation study at a tertiary referral center. Patients included adults and children undergoing cochlear implantation. Intraoperative ECochG was measured with both the Intelligent Hearing Systems (IHS) Duet AEP machine and Cochlear Corporation (CC) ECochG platform. Recording electrodes captured extracochlear measurements through a standard facial recess. Tone-bursts were presented from 250 Hz to 2 kHz (~110 dB SPL). A fast Fourier transform (FFT) of ECochG waveforms at key frequencies was summed into a total response (ECochG-TR). Pearson's correlation was utilized to evaluate the relationship between IHS-ECochG-TR and CC-ECochG-TR after confirming normality. Thirty patients were enrolled with an average age of 67 years (SD 18.8). In the ear that was implanted, mean preoperative pure-tone average (PTA; 0.5, 1, 2, and 4 kHz) was 87.4 dB HL (SD 19.3) and mean preoperative word-recognition scores (WRS) was 17.0% correct (SD 19.1). There was strong correlation (r = 0.905, 95% confidence interval: 0.809 to 0.954) between IHS-ECochG-TR (median 2.30 μV, range 0.1-148.26) and CC-ECochG-TR (median 3.00 μV, range 0.1-239.63). Four patients underwent transtympanic ECochG with the IHS system for feasibility evaluation and achieved similar responses. Extracochlear ECochG has been predictive of CI speech perception performance. The IHS duet system is a valid measure of extracochlear ECochG for the CI population. Future work will utilize this system for measuring transtympanic ECochG to improve preoperative estimation of CI performance. 3 Laryngoscope, 2024.

Further Evidence for Individual Ear Consideration in Cochlear Implant Candidacy Evaluation.

To report speech outcomes after cochlear implantation (CI) for asymmetric hearing loss (AHL) and assess the influence of contralateral hearing. Retrospective review. Tertiary referral center. One hundred eighty-eight adults (mean age, 70 yr) undergoing CI for AHL from 2015 to 2020. Candidacy included pure-tone average (PTA) at least 70 dB hearing level and AzBio in quiet 60% or less in the implanted ear and AzBio in quiet greater than 40% in the contralateral ear. PTA; Consonant-Nucleus-Consonant (CNC) word, AzBio sentences scores; Speech, Spatial, and Qualities of Hearing Scale (SSQ). Mean preoperative PTA and AzBio in the implanted and contralateral ears were 85.2 and 68.1 dB hearing level and 24.7% and 69.2%, respectively. Mean CNC in the implanted ear increased from 18.3% preoperatively to 44.4% ( p < 0.0001) at 6 months and 49.3% ( p < 0.0001) at 12 months. Mean AzBio in the implanted ear improved from 24.7% preoperatively to 60.3% ( p < 0.0001) at 6 months and 64.3% ( p < 0.0001) at 12 months. Patients demonstrated significant improvement in all SSQ domains at 6 and 12 months. When comparing patients with preoperative contralateral AzBio greater than 60% versus 41% to 60%, no significant differences existed in postoperative CNC scores (6-mo: 47% versus 41%, p = 0.276; 12-mo: 51% versus 47%, p = 0.543). There were no significant differences in 6-month ( p = 0.936) or 12-month ( p = 0.792) CNC scores between patients with AHL (contralateral ear AzBio >40%) and 169 unilateral CI patients meeting the traditional Medicare criteria (contralateral ear AzBio ≤40%). CI recipients with AHL derive significant speech improvements, supporting individual ear consideration for CI candidacy and patient benefit outside of current Medicare criteria.

National study of hearing preservation rates and outcomes after cochlear implantation in Ireland

Objective To study the rate of hearing preservation and outcomes of hearing preservation candidates in a national cochlear implant centre. The HEARRING criteria was used. Methods All cochlear implant candidates with preserved low frequency pure tone average (PTA) were included. All patients underwent cochlear implantation using a standard ‘soft-surgery’ technique. PTA was assessed at switch-on, 3, 6, 9 and 12 months postoperatively. The primary outcome was hearing preservation at 12 months. Results Sixty six patients were included in the study between 2015 and 2020. Seventy one ears were implanted including 33 adults and 33 children with 5 bilateral implantations. Mean preoperative PTA was 74.8 dB (range 52.3–92 dB), mean postoperative PTA was 95.3 dB corresponding to a mean shift of 20.5 dB. In the adult population, HP rates were as follows: complete HP in 13%, partial HP in 39.1%, minimal HP in 30.4%, loss of hearing in 17.4%. In the paediatric population: complete HP in 20.7%, partial HP in 51.7%, minimal HP in 13.8% and loss of hearing in 13.8%. After the initial postoperative shift, there was no significant worsening of residual hearing during follow-up between 3 and 12 months. There were no significant prognostic factors for hearing preservation. Conclusion Hearing preservation rates using the HEARRING criteria are described. This study will help counselling and decision making in patients eligible for cochlear implantation with hearing preservation. Further studies are required to assess the performances and outcomes of electronatural and electroacoustic stimulation.

Chronic Otitis Media (Squamous Disease): Clinical Predictors for Hearing Outcome

Introduction Postoperative hearing outcome after tympanomastoid surgery may sometimes be disappointing. This study aims to identify the factors influencing hearing outcome in squamous type of chronic otitis media (COM). Materials and Methods Prospective descriptive study on consecutive patients undergoing tympano-mastoidectomy for squamous COM. Results Analysis of 40 ears revealed that 10% had discharge less than one year with majority (75%) having more than three years. Pars flaccida and postero-superior pars tensa retraction pockets were most common findings with frank cholesteatoma only in 10%. Though mean preoperative pure tone average was significantly better (p=0.004) in those with ear discharge less than one year, 50% required type IV tympanoplasty, irrespective of duration of discharge. Type IV tympanoplasty revealed significant worsening of hearing (p=0.05), unlike type I-III where intact stapes suprastructure showed a significant postoperative improvement (p = 0.036). Successful graft uptake with discharge free ear was noted in 97.5% by 12 weeks. Conclusion Majority of our patients availed otolaryngologist opinion after more than three years of onset of discharge. Significant ossicular erosion occurs early in the disease. Preoperative better audiogram is not a predictor of ossicular status. Lack of significant symptoms and subtle clinical finding in the tympanic membrane, overlooked by the patient as well as the primary health care provider are confounding factors for early referral and surgical intervention by otolaryngologist. There appears to be a considerable delay for the common person in reaching the services of otolaryngologist; a relevant issue which need to be addressed at a national level to reduce the burden of the disease.

Predictors of hearing functional outcome following surgery for cerebellopontine angle meningioma.

Cerebellopontine angle (CPA) meningiomas can affect hearing function and require expeditious treatment to prevent permanent hearing loss. The authors sought to determine the factors associated with functional hearing outcome in CPA meningioma patients treated with surgery and/or radiation therapy in the form of either stereotactic radiosurgery or stereotactic radiation therapy. Consecutive patients with CPA meningiomas who had presented at our hospital from 2008 to 2018 were identified through retrospective chart review. Hearing function (as defined by pure tone average (PTA) and speech discrimination score (SDS) on Audiogram) was assessed before and after surgery for CPA meningioma. Audiograms with PTA > 50dB and SDS < 69% were defined as poor hearing functional outcome. Multivariable Cox Proportional Hazards Regression Model was used to assess the associations between pre-operative hearing functional assessment and post-operative hearing functional outcomes. The study cohort included 31 patients (80.6% females, with a mean age of 61.3 ± 15.2years) with a median clinical follow-up of 5months (range: 1week-98months). The mean pre-operative PTA and SDS were 23.8 ± 11.2dB and 64.4 ± 22.2% respectively. At the last visit, there was significant hearing recovery, with an improvement of 29.7 ± 18.0dB (p < 0.001) and 87.6 ± 17.8% (p < 0.001) in PTA and SDS respectively. After adjusting for age, gender, tumor volume, location, and tumor classification, Multivariable Cox Proportional Hazards Regression Model was conducted which revealed that patients undergoing surgery through retro sigmoid approach [Hazards Ratio (HR): 32.1, 95% Confidence Interval (CI): 2.11-491.0, p = 0.01] and gross total resection (GTR) (HR: 2.99, 95% CI: 1.09-9.32, p = 0.05) had significantly higher risk of poor hearing functional outcome compared to petrosal approach and near/subtotal resection. Moreover, patients with poor preoperative hearing had 85% higher chance of poor hearing functional outcome postoperatively (HR: 0.15, 95%CI: 0.03-0.59, p = 0.007). Postoperative improvement in hearing is a reasonable expectation following surgery for CPA meningioma. Preoperative hearing, surgical approach and extent of surgical resection are predictive factors of postoperative hearing function outcome and can therefore aid in identification of patients at higher risk of hearing loss.

Hearing recovery after surgical resection of non-vestibular schwannoma cerebellopontine angle tumors.

Post-operative outcomes for hearing after resection surgery to remove cerebellopontine angle (CPA) tumors other than vestibular schwannomas (VS) are not well understood. This study presents a series of patients with significant post-operative hearing recovery, trying to define the incidence among all patients operated on for removal of non-VS CPA tumors. This is a retrospective observational case series of 8 patients among 69 operated on for removal of non-VS CPA tumors between 2012 and 2020. All patients had pre- and post-operative hearing measurement with pure-tone average (PTA) and speech discrimination score (SDS), according to the American Academy of Otolaryngology-Head and Neck Surgery recommendations, auditory brainstem response (ABR) measurements and imaging. Six meningiomas and two lower cranial nerve schwannomas operated on with a retrosigmoid approach were included for analysis. The mean pre-operative PTA and SDS were 58 ± 20.7dB and 13 ± 17.5%, respectively. All patients had pre-operative class D hearing and asynchronous ABRs. They all showed significant hearing recovery, with an improvement of 36 ± 22.2dB (p = 0.0025) and 85 ± 16.9% (p = 0.0001) in PTA and SDS, respectively, with mean follow-up of 21 ± 23.5months. Seven patients recovered to a class A hearing level and one patient to class B. The ABRs became synchronous for three patients. The incidence of auditory recovery was 13% for patients operated on with a conservative approach (n = 60). A significant post-operative improvement in hearing could be a reasonable expectation in non-VS tumors extending into the CPA and a retrosigmoid approach should always be considered regardless of pre-operative hearing status.

TORP ossiculoplasty in the presence of an intact stapes superstructure

IntroductionIn this series, we describe ossicular reconstruction using routine TORP in the presence of the stapes superstructure using a tympanic-membrane-to-footplate configuration. Materials and methodsThis is a case series of 12 patients who underwent TORP ossiculoplasties from 1st January 2010 to 31st October 2017. Data collected included demographics, indication for surgery, status of the middle ear and pre-operative and post-operative audiometric data (including pure tone average (PTA) and air-bone gap (ABG)). ResultsThe mean pre-operative PTA was 56.5 dB and ABG was 39.8 dB. Surgical success (ABG ≤ 20 dB) was achieved in 83.3%, with an average improvement in PTA of 24.3 dB and closure of ABG of 27.1 dB. The mean post-operative ABG was 12.7 dB. ConclusionTORP ossiculoplasty with tympanic-membrane-to-footplate configuration is a feasible means of ossicular reconstruction, independent of the status or spatial arrangement of the remnant ossicles. Using this technique, it is possible to achieve a consistently good outcome for improvement in hearing and closure of ABG.

An overview of endoscopic stapedotomy in a tertiary care centre

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Stapedotomy is now one of the most popular and common surgeries done worldwide. Otosclerosis remains the most common single cause of conducting hearing loss in adult population. Females are more frequently affected than males with an approximate 2:1 ratio.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study consists of 30 patients who underwent stapedotomy for otosclerosis. This study was conducted at Dr Shankarrao Chavan Government Medical College, Nanded, during the period of 2 years (2017-2019). Patients were evaluated and operated. The various anatomical variations, diagnostic dilemmas, intraoperative complications, its management and follow-up were done systematically. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Age of patients included in this study ranged from 15 to 50 years. Youngest patient was a 17-year-old male. Age of presentation was most commonly seen in third decade of life. Male to female ratio was 1:2. The most common symptom was hard of hearing followed by tinnitus. In this study, 76.67% of the patient’s had bilateral disease. 66.66% of patients had hearing loss between 41-55 dB with mean pre-operative pure tone average was 51.16 dB. About 80% of patients had successful air bone closure between 0-10 dB after the surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Endoscopic stapedotomy seems a feasible and relatively safe surgical technique in limited case series. Cosmetically this procedure was more compliant by the patients however endoscopic stapedotomy requires a significant learning curve and an extreme expertise.&lt;/p&gt;

Graft uptake and post-operative hearing outcome with type-I tympanoplasty in dry versus wet ear: a comparative study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The discharging ear presents the otologist with the dilemma of operating on it or not. This study is being undertaken to study and compare the results of type I tympanoplasty in dry ear (no ear discharge at the time of surgery) and wet ear (culture negative consistent ear discharge at the time of surgery).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 50 patients of either sex aged between 18 to 50 years undergoing type-I tympanoplasty were included in the study on the basis of pre-determined clinical criteria. Type I tympanoplasty was performed using temporalis fascia graft by underlay technique. Post-operative data regarding graft uptake and hearing improvement was recorded in the follow up period of three months. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The complete graft uptake was there in 88% of the patients in group 1 and 84% patients in group 2. The difference in the two groups was statistically insignificant (p&amp;gt;0.05). The mean pre-operative pure tone average in group 1 was 30.57±7.80 dB while post-operative pure tone average was 20.68±8.22 dB with a mean hearing gain of 9.89 dB. The mean pre-operative pure tone average in group 2 was 35.21±5.98 dB while the post-operative pure tone average was 27.07±9.25 dB with a mean hearing gain of 8.12 dB. There was marked hearing improvement in both the groups post operatively (p&amp;lt;0.001 i.e., highly significant). When hearing improvement was compared between two groups there was no significant statistical difference (p&amp;gt;0.05).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The outcome is equally good for type 1 tympanoplasty in dry and wet ear in safe (mucosal) type of chronic suppurative otitis media with respect to graft uptake and hearing improvement.&lt;/p&gt;

Long-term results of atresiaplasty in patients with congenital aural atresia

Objectives: To evaluate long-term benefits of atresiaplasty on hearing and the impact of surgery on quality of life (QoL) in congenital aural atresia (CAA) patients.Methods: We evaluated the long-term hearing results, the impact of atresiaplasty on QoL, the meatal diameter of the operated ear canal, and the cumulative number of post-operative hospital visits in 14 CAA patients, on average, 12 years (range: 4–17 years) post-operatively.Results: The mean preoperative pure tone average (PTA) was 61 dB HL. The postoperative short-term PTA was 36 dB HL and the long-term PTA was 51 dB HL. The mean total Glasgow Benefit Inventory (GBI) score was 16 (range: −11–39), showing the positive benefit of atresiaplasty on QoL. The mean postoperative diameter of the auditory meatus was 6 mm. The average number of hospital outpatient visits during the first postoperative year was 10.Conclusion: Surgery for CAA is a demanding operation with variable anatomical and hearing outcomes. Atresiaplasty operations should be centralized to hospitals with large numbers of such patients to ensure sufficient levels of surgical experience. Bone-anchored hearing devices or middle-ear implants should be considered as a first-line option because they offer good hearing predictability.

Endoscopic exclusive transcanal approach to the tympanic cavity cholesteatoma in pediatric patients: Our experience

ObjectivesThe aim of the present study is to describe our experience in the management of tympanic cavity cholesteatoma in pediatric patients, treated with endoscopic exclusive transcanal approach. MethodsA chart review of clinical data and videos from the operations of 54 pediatric patients, undergoing surgery between January 2007 and December 2013, was made. Patients presenting with cholesteatoma involving the tympanic cavity (mesotympanum, epitympanum, protympanum and/or hypotympanum), with no mastoid involvement, were included in the first group and underwent an exclusive transcanalar endoscopic approach (TEA). In case of mastoid extension of the pathology, patients were included in the control group and underwent a canal wall up microscopic technique (CWU). ResultsIn this study, 34 males and 20 females, including 5 bilateral cases, giving a total of 59 ears, were reviewed. Median age was 9.6 years (range 4–16 years). 31 cholesteatomas underwent a TEA approach, while 28 underwent a CWU approach, based on inclusion criteria. No differences from congenital vs acquired form was made, due to the difficult to correctly distinguish always the two forms. The ossicular chain was preserved in 26.6% of patients (16 ears): 42% of patients (13 ears) undergoing a transcanal endoscopic approach and 10% of patients undergoing a canal wall up microscopic approach (3 ears) (P=0.006). Second look surgery was executed in 41.6% of patients (25 ears). In partial ossicular prosthesis reconstructions, the mean preoperative pure-tone average was 29.4dB, while the mean postoperative pure-tone average was 27.1dB, with a mean increase of 2.3dB. In total ossicular prosthesis reconstructions, the mean preoperative pure-tone average was 47.8dB, while the mean postoperative pure-tone average was 26.5dB, with a mean increase of 21.3dB. Recurrence rate was 12.9% (4 ears) for the transcanal endoscopic approach group and 17.2% (5 ears) for the canal wall up microscopic approach. Residual disease was present in 26.6%: 19.3% (6 ears) for the transcanal endoscopic approach group and 34.4% (10 ears) for the canal wall up microscopic approach. The mean follow up was 36 months (range 8–88). Kaplan–Meier analysis at 36 months showed a lower recurrence risk for the transcanal endoscopic approach compared with the canal wall up microscopic approach, but this data was not statistically significant (P=0.58). ConclusionThe transcanal endoscopic approach represents a feasible, minimally invasive and conservative technique for the management of pediatric middle ear cholesteatoma.

The Envoy Esteem Hearing System: Single Surgeon Experience

Objectives: (1) Review the results of patients undergoing Envoy Esteem implantation from December 2010 through December 2013. All procedures were performed by the same senior surgeon (S.J.M.). (2) Analyze results following implantation of the Envoy Esteem System to determine if patients achieved statistically significant improvement in pure tone average (PTA). Methods: Patients undergoing implantation at Loyola University Medical Center were analyzed regarding preoperative, postimplantation audiometric data, complications, infections, and revision surgery. Study design: Institutional review board approved, retrospective study. Results: A total of 109 Esteem related procedures were performed. Seventy-one primary implants were performed. A total of 51 were male and 20 were female. A total of 29 revision cases were performed. Additionally, 9 patients were explanted and 9 cases were aborted prior to implantation. The average age of the implant population was 62.8 years old. The average length of follow-up was 20 months. A total of 43 primary implant patients had sufficient data available for analysis. The mean preoperative PTA was 63.4 dB and the mean postoperative PTA was 50.7 dB. Patients demonstrated a 9.90 dB average increase in PTA. A paired t test was used to determine if the difference was statistically significant. The difference proved to be statistically significant with a t-stat of 5.87, which was statistically significant at the .05 level of confidence. Conclusions: Initial results of The Envoy Esteem system demonstrated a significant hearing benefit in our study population. The revision surgery rate of 26.6% is concerning and patients need to be aware of this potential issue.

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.

Inferior Flap Tympanoplasty: A Novel Technique for Anterior Perforation Closure

Objective. To report a novel tympanoplasty modification for anterior tympanic membrane perforation closure. Materials and Methods. A prospective study on 13 patients who underwent inferior tympanoplasty between December 2008 and May 2011 was carried out. In our technique, an inferior rather than a posterior flap is raised and the graft is laid from the inferior direction to obtain better access to the anterior part of the tympanic membrane perforation and provide better support. Results. A total of 13 patients underwent the novel inferior tympanoplasty technique with a mean age of 33 years. Six patients had undergone tympanoplasties and/or mastoidectomies in the past, 3 in the contralateral ear. A marginal perforation was observed in 3 cases, total perforation in 2 and subtotal in 1 case. The mean preoperative pure-tone average was 40.4 dB (10 to 90 dB), compared to 26.5 dB (10 to 55 dB) postoperatively. All perforations were found to be closed but one (92.3% success rate). Conclusions. The inferior tympanoplasty technique provides a favorable outcome in terms of tympanic membrane closure and hearing improvement for anterior perforations, even in difficult and complex cases. It is based on a well-known technique and is easy to implement.

Hearing Results Post Tympanoplasty: Our Experience with Adults at the KKR ENT Hospital, India.

Chronic suppurative otitis media is often associated with some degree of hearing loss. Tympanomastoid surgery is considered effective in controlling infection and preventing recurrence. However, opinions differ with regards the post-operative hearing results. This study aims to assess the hearing results, and also ascertain the effects of some variables on hearing in adult patients with chronic suppurative otitis media after primary tympanoplasty. This was a retrospective review of the clinical records of adult patients with chronic suppurative otitis media, who had primary tympanoplasty at the KKR ENT Hospital and Research Institute in Chennai (India), between 1st June and 30th September, 2011. A total of 26 adult patients with a mean age of 35.85years (SD 14.775) were studied. There were 16 males (61.54%) and 10 females (38.46%). The commonest presenting symptoms were ear discharge (80.8%) and hearing loss (76.9%); and the mean duration of symptom was 8.52years (SD 8.599). The overall mean pre-operative pure tone average was 49.58dB (SD 18.608), while the overall mean post-operative pure tone average was 37.38dB (SD 17.837). The difference between the overall mean pre- and post-operative pure tone average (hearing gain) was 12.192dB (SD 12.924); and this was found to be statistically significant (p<0.05). Multiple linear regression model showed that only increasing age was significantly associated with increasing mean post-operative pure tone average. This study found primary tympanoplasty effective in improving hearing results in adults with chronic suppurative otitis media even in those with advanced ossicular lesions.

Relevance of Pure Tone Average (PTA) as a Predictor for Incus Erosion

Between 40 and 90% of tympanoplasty require middle ear ossicular chain reconstruction. Ossicular discontinuity usually cannot be determined unless an operation is performed. The main objective was to determine the predictive value of pre-operative audiological factors in diagnosing incudal necrosis in patients with tubotympanic chronic suppurative otitis media. A retrospective clinical study of 20 patients who underwent ossicular reconstruction with autologous incus over a period of two years was performed. The mean pre-operative pure tone average was 49.18dBHL.The minimum value being 45dBHL and the maximum value being 64dBHL.

Retrograde mastoidectomy on demand with soft-wall reconstruction in pediatric cholesteatoma

Conclusion: Retrograde mastoidectomy with soft-wall reconstruction is an effective technique that can be used to lower the recurrence rate of cholesteatoma in the pediatric population. Objective: To evaluate surgical outcomes of retrograde mastoidectomy when using soft-wall reconstruction in pediatric cholesteatoma. Methods: A total of 25 children underwent cholesteatoma removal surgery employing soft-wall reconstruction. The cases were retrospectively reviewed. Average follow-up time was 48.7 months. In order to fully expose and extirpate the disease, the bony canal wall was removed in association with a retrograde-type mastoidectomy in all cases. The posterior ear canal defect was then reconstructed using soft tissue; i.e. temporal fascia and canal wall skin. The incidence and localization of residual and recurrent cholesteatoma, preoperative and postoperative audiogram results, pure-tone average (PTA), and air–bone gap (ABG) were assessed. Results: Residual cholesteatoma was detected in 5 (20%) of 25 ears while recurrent cholesteatoma occurred in 1 (4%) of 25 ears. The mean preoperative PTA of air conduction (AC) was 39.1 dB, while the preoperative PTA of the ABGs was 28.8 dB. The mean postoperative PTA-AC and PTA-ABG were 20.9 dB and 11.7 dB, respectively. The mean hearing gain was 18.2 dB. The differences between the pre- and postoperative values were statistically significant (p < 0.05).

Staging and management of primary cerebellopontine cholesteatoma.

Primary cerebellopontine angle (CPA) cholesteatoma grows slowly and silently in the subarachnoidal spaces. The diagnosis is often late, when the lesion has reached large dimensions. Surgical removal is the only available therapy. Fifteen consecutive cases of CPA cholesteatoma managed at a tertiary otoneurosurgical referral unit between September 1985 and April 1999 were reviewed. The study population, consisting of seven males and eight females, had a mean age of 44 years of age (range 21-69) at the time of surgery. The clinical, audiological and radiological presentations were examined. The tumours were classified according to the Moffat classification of CPA cholesteatomas. In 67 per cent of cases the presenting symptom was related to the vestibulo-cochlear nerve. The average duration of symptoms was 23 months (ranging from one month-10 years). The hearing preservation approaches were utilized the most (11 cases), while the translabyrinthine approach alone, or in association with a middle fossa craniotomy, was performed in four cases. Tumour removal was total in 12 cases and subtotal in three cases. In cases undergoing hearing preservation surgery the mean pre-operative pure tone average (PTA) for the frequencies 0.5, 1, 2, and 3 kHz was 19.3 dB HL (SD 13.84) and the mean pre-operative speech discrimination score (SDS) was 89.8 per cent (SD 5.97). In 44.4 per cent of patients the hearing was preserved and the mean post-operative PTA was 20.29 dB HL (SD 15.84). In five patients post-operative complications occurred. No peri- or post-operative death occurred in this series, one patient developed a recurrence 15 years after the initial surgery.

Modification of auditory pathway functions in patients with hearing improvement after middle ear surgery

We recorded auditory-evoked magnetic responses with a whole-scalp 122-channel neuromagnetometer from seven adult patients with unilateral conductive hearing loss before and after middle ear surgery. The stimuli were 50-msec 1-kHz tone bursts, delivered to the healthy, nonoperated ear at interstimulus intervals of 1, 2, and 4 seconds. The mean preoperative pure-tone average in the affected ear was 57 dB hearing level; the mean postoperative pure-tone average was 17 dB. The 100-msec auditory-evoked response originating in the auditory cortex peaked, on average, 7 msecs earlier after than before surgery over the hemisphere contralateral to the stimulated ear and 2 msecs earlier over the ipsilateral hemisphere. The contralateral response strengths increased by 5% after surgery; ipsilateral strengths increased by 11%. The variation of the response latency and amplitude in the patients who underwent surgery was similar to that of seven control subjects. The postoperative source locations did not differ noticeably from preoperative ones. These findings suggest that temporary unilateral conductive hearing loss in adult patients modifies the function of the auditory neural pathway. (Otolaryngol Head Neck Surg 1998;119:125-30.)