Nonoperated Ear Research Articles

Risk of hearing loss in non-operated ear due to mastoid drilling

Background: The study purpose is to evaluate the effect of drill-generated high intensity noise on hearing sensitivity in contralateral ear. Methods: Sixty patients who underwent mastoidectomy were studied to see the effect of mastoid drilling on hearing sensitivity in normal ear using pure tone audiometry (PTA) and distortion product otoacoustic emission (OAE) values recorded preoperatively and postoperatively. Results: For PTA, there is no significant hearing loss for 0.25 kHz and 0.50 kHz for all PODs. For 1 kHz, 2 kHz and average PTA there is significant temporary hearing loss from POD 1 to POD 7 which normalizes around POD 30. However, there is significant temporary threshold shift for 4 kHz and 8 kHz from POD 1 to POD 5 and the hearing sensitivity improves to preoperative levels at POD 7. For OAE, 1 kHz, 4 kHz and average OAE there is significant temporary hearing loss from POD 1 to POD 7 which normalizes around POD 30. However, there is significant temporary threshold shift for 2 kHz and 6 kHz from POD 1 to POD 5 and hearing sensitivity improves to preoperative levels at POD 7. There is a significant correlation between drilling duration and PTA averages and OAE averages. Conclusions: Sensorineural hearing loss is more prevalent following modified radical and radical mastoidectomy as compared to canal wall up mastoidectomy. The factors influencing postoperative contralateral ear sensorineural hearing loss are type and size of burr and the duration of burr use.

Vestibular Loss in Children Affected by LVAS and IP2 Malformation and Operated with Cochlear Implant.

This is a single center cohort study regarding the prevalence of vestibular loss in hearing impaired children affected by large vestibular aqueduct syndrome (LVAS) with incomplete cochlear partition malformation type II (IP2), fitted with cochlear implant (CI). Twenty-seven children received CI operations at 0.4-13 years on one or both ears and tested for vestibular loss with head impulse test, video head impulse test, mini ice-water test and cervical VEMP. Vestibular loss was found in 19% of operated ears and in 13.9% of non-operated ears. The difference was not statistically significant and was not significantly modified by age at implantation, age at testing, sex, presence of SLC26A4 gene mutation or bilaterality. However, the presence of anatomic anomalies at the level of the vestibulum or semicircular canals was significantly associated with a higher incidence of vestibular loss in CI operated children but not in those non-operated. No other factors, such as the surgical access, the electrode type, the presence of Gusher perioperatively, or post-operative vertigo modified significantly the prevalence of vestibular loss. In conclusion, LVAS/IP2 appears to be the major determinant of vestibular loss in these children, with a less obvious impact of CI, excluding the cases with vestibulum/canal anomalies: this group might have a higher risk for vestibular loss after CI surgery.

Does drilling affect the hearing of contralateral normal ear after mastoid surgery?

<p><strong>Background:</strong> Chronic otitis media (COM) is a recurrent infection of the middle ear and/or mastoid air cells affecting 2-3% of global population. Mastoidectomy is the mainstay of the treatment of COM. Bone drilling during mastoidectomy procedure exposes both the ears to acoustic trauma leading to sensorineural hearing loss. The present study was conducted to assess the possible deleterious effect of drilling on hearing of contralateral normal ear by monitoring pre-operative and post-operative pure tone audibility (PTA) and otoacoustic emissions (OAE). Aims and objectives were to evaluate the effect of drill- generated noise on hearing in non-operated ear during mastoidectomy in terms of hearing loss, its nature and duration and recovery of hearing loss.</p><p><strong>Methods:</strong> An observational study was carried out in ENT department at SMS medical college and hospital, Jaipur. Total 40 patients were studied. Pre-operative and post-operative PTA and OAE were studied and compared. Mean drilling time during mastoid surgery was also studied.</p><p><strong>Results:</strong> Out of 40 subjects, maximum patients were 11-20 years of age group (37.5%) with female preponderance (57.5%). All had undergone mastiodectomy. Only 6 (15%) subjects had transient sensorineural hearing loss of contralateral normal ear as determined by comparing pre-operative and post-operative PTA and OAE. The mean recovery time was 2-3 days. The study had shown significant effect of drill generated noise on hearing of contralateral healthy ear following mastoidectomy.</p><p><strong>Conclusions</strong>: Drill-generated noise can’t be lowered to a great extent therefore drilling time should be minimized during mastoid surgeries.</p>

The Clinical Effect of Steroids for Hearing Preservation in Cochlear Implantation: Conclusions Based on Three Cochlear Implant Systems and Two Administration Regimes.

The main aim of this study was to assess the clinical effect of steroids (dexamethasone and prednisone) on hearing preservation in patients who underwent cochlear implantation with different cochlear implant systems (Oticon®, Advanced Bionics®, Med-El®). 147 adult patients met the inclusion criteria and were enrolled to the study and divided into three groups depending on the brand of cochlear implant they received and participated in all follow-up visits regularly. They were also randomly divided into three subgroups depending on the steroid administration regime: (1) intravenous dexamethasone (0.1 mg/kg body weight twice a day for three days); (2) combined intravenous and oral steroids (dexamethasone 0.1 mg/kg body weight twice a day plus prednisone 1 mg/kg weight once a day); and (3) no steroids (control group). The results were measured by pure tone audiometry (PTA) at three time points: (i) before implantation, (ii) at processor activation, and (iii) 12 months after activation. A hearing preservation (HP) figure was also calculated by comparing the preoperative results and the results after 12 months. Further measures collected were electrode impedance and hearing threshold in the non-operated ear. The highest HP measures (partial and complete) were obtained in the subgroups who were given steroids. Of the 102 patients given steroids, HP was partial or complete in 63 of them (62%). In comparison, partial or complete HP was achieved in only 15 patients out of 45 (33%) who were not given steroids. There were differences between the three cochlear implant groups, with the Med-El and Advanced Bionics groups performing better than the Oticon group (45% and 43% of the former two groups achieved partial or complete HP compared to 20% in the latter). Hearing thresholds in the non-operated ear were stable over 12 months. Generally, impedance was slightly lower in the 12 month follow-up in comparison with the activation period, with the exception of the Oticon group. (4) Conclusions: Pharmacological treatment with steroids in patients undergoing cochlear implantation helps to preserve residual hearing.

Sound Pressure Distribution in the Ear After Radical Mastoidectomy With Meatoplasty.

We aimed to identify the sound pressure distribution along the external auditory canal after radical mastoidectomy with meatoplasty by combining real ear measurements and measurements obtained using a finite-element model. Case series with chart review. Tertiary care university hospital. We evaluated 16 patients who had undergone radical mastoidectomy with meatoplasty in one ear and had intact nonoperated contralateral ears, which served as the control group. Real ear measurements testing at specific frequencies were performed postoperatively. Sound pressure gains were measured at five different depths along the external auditory canal, and a validated finite-element model was used to simulate the sound pressure distributions along the external auditory canals of the operated and nonoperated ears. The average peak resonant frequency near the tympanic membrane in operated ears was significantly lesser than that in nonoperated ears (2434.4 ± 616.4 versus 2935.9 ± 602.2 Hz; Wilcoxon signed-rank test, p < 0.05). The average peak resonant amplitude near the tympanic membrane showed no significant intergroup difference (paired-sample t test, p > 0.05). The peak resonant frequencies at different depths of the external auditory canal varied in the nonoperated ears (Kruskal-Wallis rank-sum test, 2880.9 ± 581.7 Hz, p = 0.02) but did not differ significantly in the operated ears (Kruskal-Wallis rank-sum test, 2464.4 ± 670.3 Hz, p = 0.75). In the finite-element model, the peak resonant frequencies along the depth of the external auditory canal varied in the normal ear and were homogeneous in the operated ear. Radical mastoidectomy with meatoplasty altered the sound distribution in the external auditory canal. Our finite-element model successfully simulated the postoperative sound distribution in the external auditory canal and will facilitate development of wearable equipment for these patients.

PREDICTING THE SUBJECTIVE HEARING OUTCOME IN TYPE I TYMPANOPLASTY USING BELFAST 15/30DB RULE OF THUMB.

OBJECTIVE: Both Otologists and patients mutually hope for an improvement in hearing and a functional benet from an ear surgery to correct unilateral conductive hearing loss that has been reported as the closure of air-bone gap or reduction in air conduction thresholds. While these provide a measure of technical success of the operation, they may not always translate into real life benet for the patient. This is because listening is a binaural task and benet to the patient is determined by numerous factors, of paramount importance is hearing in the non-operated ear. With the aim, to estimate patient benet in terms of subjective hearing gain after type I tympanoplasty, we reviewed the Belfast 15/30 dB rule of thumb. METHOD: A 100 cases of chronic otitis media with inactive mucosal disease having conductive hearing loss, who had undergone type I tympanoplasty were included. Hearing was assessed using pure tone audiogram with average of, .5, 1, 2 &amp; 4Hz and a detailed questionnaire regarding the subjective perception of hearing was obtained pre and 6 month post-operatively which was correlated with Belfast 15/30 dB rule of thumb. RESULT: The predictive value as per pure tone audiometry with Belfast 15/30 dB rule of thumb is 89% with a conclusion that the objective hearing improvement (88.1%) does not necessarily transform into patients' perception of hearing improvement (78.4%) CONCLUSION: Hearing is a binaural function and this should always be kept in mind while operating on unilateral/ asymmetric hearing loss patients as mere closure of air-bone gap or reduction in air conduction threshold might not conclude patients' perception of hearing gain. Belfast 15/30 dB rule of thumb has proved to be a valuable tool in predicting the subjective improvement of hearing

Associations between condylar fractures and external auditory canal fracture: A 7-year retrospective study

The study aimed to investigate whether the incidence rate of external auditory canal (EAC) fracture varies among different clinical types of condylar fracture. A retrospective cohort study was conducted in single hospital of China. Eligible patients diagnosed with mandibular condylar fractures were retrospectively reviewed. Among all patients with condylar fractures (318 cases and 437 sides), 45 cases and 59 sides (59/437 sides, 13.5%) were found with EAC fracture, including 17(17/38, 44.7%) sides of sagittal fracture of condyle (Type I), 21(21/59, 35.6%) sides of intracapsular condylar fracture (Type II), 8 (8/306, 2.6%) sides of condylar neck fracture (Type III), and 6 (6/34, 17.7%) sides of condylar base fracture (Type IV). Type III condylar fracture had a significant lower rate of EAC fracture than all other three types (all p<0.001). Type I condylar fracture had a higher rate of EAC fracture compared to Type IV (p=0.014). The incidence rates of EAC fracture in combined Type I+Type II group (38/97, 39.2%) was significantly higher than Type III (8/306,2.6%, p<0.001) and Type IV (6/34,17.7%, p=0.002). A total of 35 sides (27 patients) with combined fractures were followed up for 6 months after treatment, among whom 11 sides (7 patients) were operated for both fractures simultaneously. Neither EAC stenosis nor hearing loss was observed. Meanwhile, for 24 non-operated ears from 20 patients, all EACs showed different degrees of stenosis. In conclusion, oral and maxillofacial surgeons should pay more attention to EAC fracture combined with condylar fracture, especially for patients diagnosed with condylar head fracture. Maxillofacial fractures should be accompanied by early treatment of EAC fractures, in order to prevent EAC stenosis, hearing loss, and other complications.

Binaural squelch effect in unilateral otosclerosis surgery: comparison of speech intelligibility in noise before-after surgery.

We aimed to evaluate the speech intelligibility benefit in noise provided by stapedotomy in the treatment of unilateral otosclerosis. We enrolled adults suffering from unilateral conductive hearing loss and followed them up until 9months after surgery. The patients underwent a free field speech hearing evaluation using the French Matrix test before and after stapedotomy. Speech material was sent to the front of the patients (S0) and noise was presented either at the front (N0), or at the operated ear (N-90) or at the non-operated ear (N + 90). The speech intelligibility benefit in noise was assessed by comparing Squelch effect (SE), Head shadow effect (HS) and Binaural redundancy (BR) before and after surgery. SE was measured as the difference in speech reception thresholds (SRT) between S0N + 90 situations before and after surgery, HS as the difference in SRT between S0N + 90 and S0N-90 situations, and BR as the difference in SRT between S0N0 situations before and after surgery. In addition, two quality of life's questionnaires were completed by patients to evaluate their discomfort. Among 25 patients, 19 were followed up during 9months, 4 were excluded and 2 were lost for the following-up. Stapedotomy provided a restoration of SE of 3.7dB SNR (p < 0.001) and a BR gain of 1.8dB SNR (p < 0.001). HS did not show any statistical variation after surgery (p = 0.077). Finally, the questionnaires showed a residual hearing discomfort. Stapedotomy provided a binaural benefit with the restoration of the SE and BR but which remained lower than in the normal-hearing population. The 07/02/2018 on Clinical.Trial.Gouv: NCT03587792.

Impact of surgery in otosclerosis on the non-operated ear.

Backgrounds Otosclerosis is an underlying disease of the bony labyrinth. The hearing loss is most often of conductive nature, in some cases the involvement of the bony part of the cochlea results in mixed hearing loss. Aims: The aim of the analysis was to answer the question whether a surgery on one of the ears affects the state of the other ear in the course of otosclerosis. Methods The analysis included 140 patients hospitalized and operated on between 2010 - 2016. Only patients who had not had a surgical operation within the middle ear due to otosclerosis prior to the study were included in it. An audiological assessment was performed with the use of pure tone threshold audiometry taking into account. Results In the group of patients with no Carhart&apos;s notch, the mean threshold of bone conduction was statistically lower than before the procedure for the frequencies of 500, 1000 Hz and statistically equal for the frequency of 2000 Hz. The same analysis in the group of patients with Carhart&apos;s notch present in the pre-surgical tonal audiogram of the non-operated ear showed a statistically significant lower value of the post-surgical threshold bone conduction value. Conclusion It was confirmed the possibility of improving the hearing of the non-operated ear after the stapedotomy of the opposite ear, in the author&apos;s own studies by an average of 5 dB in the low-frequency range.

Managing NF2-associated vestibular schwannomas in children and young adults: review of an institutional series regarding effects of surgery and bevacizumab on growth rates, tumor volume, and hearing quality

We reviewed our experience in managing of NF2-associated vestibular schwannoma (VS) in children and young adults regarding the effect of surgery and postoperative bevacizumab treatment. A total of 579 volumetric and hearing data sets were analyzed. The effect of surgery on tumor volume and growth rate was investigated in 46 tumors and on hearing function in 39 tumors. Long-term hearing follow-up behavior was compared with 20 non-operated ears in additional 15 patients. Sixteen operated VS were treated with bevacizumab. Mutation analysis of the NF2 gene was performed in 25 patients. Surgery significantly slowed down VS growth rate. Factors associated with a higher growth rate were increasing patient age, tumor volume, and constitutional truncating mutations. Immediately after surgery, functional hearing was maintained in 82% of ears. Deterioration of hearing was associated with initial hearing quality, larger tumor volumes, and larger resection amounts. Average hearing scores were initially better in the group of non-operated VS. Over time, hearing scores in both groups worsened with a similar dynamic. During bevacizumab treatment of residual tumors, four different patterns of growth were observed. Decompression of the internal auditory canal with various degrees of tumor resection decreases the postoperative tumor growth rates. Carefully tailored BAEP-guided surgery does not cause additional hearing deterioration. Secondary bevacizumab treatment showed heterogenous effects both regarding tumor size and hearing preservation. It seems that postoperative tumor residuals, that grow slower, behave differently to bevacizumab than reported for not-operated faster growing VS.

Effect of drill-induced noise on hearing of nonoperated ear after mastoidectomy

Background Chronic suppurative otitis media is an inflammation of middle ear of more than 2 weeks with treatment without improvement. Aim The aim was to evaluate the effect of drill-generated noise after mastoidectomy on hearing status of the nonoperated ear. Patients and methods This is a prospective study of 40 patients with unilateral chronic suppurative otitis media attending ENT Departments of Al-Zahraa University Hospital, Faculty of Medicine (Girls), Al-Azhar University, and El-Maadi Armed Forces Medical Complex during the period from August 2018 till September 2019. Patients were divided into two equal groups: group A included 20 patients who underwent mastoidectomy operations with the usage of mastoid drilling and group B underwent myringoplasty without the usage of drilling. Pure tone audiometry (PTA) and otoacoustic emissions (OAEs) were done for nonoperated ear of all patients preoperatively and at days 1, 2, and 7 postoperatively. Results Result showed that postoperative nonoperated ear hearing was affected in group A. This effect is not significant enough to cause hearing loss as detected by PTA but can be detected by OAE in which their amplitude deteriorated at first day postoperatively and improved after that back to the normal preoperative values within 1 week. However, hearing in nonoperated ear of group B was not affected by observation of PTA or OAE. Conclusion Drill-induced noise during mastoidectomy affects hearing of contralateral nonoperated ear temporarily through some outer hair cells (OHC) damage.

Early Assessment of Vestibular Function after Unilateral Cochlear Implant Surgery

Introduction: Cochlear implantation (CI) has been reported to negatively affect vestibular function. The study of vestibular function has variably been conducted using different types of diagnostic tools. The combined use of modern, rapidly performing diagnostic tools could prove useful for standardization of the evaluation protocol. Methods: In a group of 28 subjects undergoing CI, the video head impulse test (vHIT), the cervical vestibular evoked myogenic potentials (cVEMP) and the short form of the Dizziness Handicap Inventory (DHI) questionnaire were investigated preoperatively and postoperatively (implant on and off) in both the implanted and the contralateral, nonimplanted ear. All surgeries were performed with a round window approach (RWA), except for 3 otosclerosis cases in which the extended RWA (eRWA) was used. Results: The vHIT of the lateral semicircular canal showed preoperative vestibular involvement in nearly 50% of the cases, while the 3 canals were contemporarily affected in only 14% of the cases. In all the hypofunctional subjects, cVEMP were absent. A low VOR gain in all of the investigated superior semicircular canals was found in 4 subjects (14%). In those subjects (21.7%) in whom cVEMP were preoperatively present and normal on the operated side, the absence of a response was postoperatively recorded. Discussion/Conclusion: The vestibular protocol applied in this study was found to be appropriate for distinguishing between the CI-operated ear and the nonoperated ear. In this regard, cVEMP was found to be more sensitive than vHIT for revealing a vestibular sufferance after CI, though without statistical significance. Finally, the use of RWA surgery apparently did not reduce the occurrence of signs of vestibular impairment.

Evaluation of outer hair cells function of non-operated ear after mastoid drilling using distortion-product otoacoustic emissions

Aim: To analyze the effect of acoustic and mechanical trauma of drilling on the outer hair cell function of the non operated ear using distortion-product otoacoustic emissions (DPOAE’s) after mastoidectomy and its relation with the duration of drilling, age, and gender of the patient along with duration and permanency of the effects. Study Design: Observational study. Materials and Methods: Screening DPOAE’s were recorded preoperatively, immediate postoperative period, one hour postoperatively, 1st and 7th postoperative days in the normal ear in 94 patients who underwent tympanomastoidectomy for unilateral chronic suppurative otitis media (CSOM). DPOAE’s were measured using Neuro-audio-screener (Neurosoft Inc.) at 1.5 KHz, 2.1 KHz, 3.3 KHz, and 4.2 KHz. If DPOAE’s were absent preoperatively, the patients were not evaluated further and patients who had absent DPOAE’s post-operatively were successively followed till DPOAE’s were regained. Results: Of the 94 patients included, in 62 patients DPOAE’s were present preoperatively. Out of these 62, in 30 patients DPOAE’s were absent immediate postoperatively. On repeat testing, DPOAE’s were absent in 20 patients after 1 hour and in 8 patients after 1 day. On re-evaluation of these 8 patients after 1 week all of them had regained the DPOAE’s. In terms of duration of drilling, 66.6% patients in immediate post operative period, 90% patients in 1-hour post operative and 100 % patients on post operative day 1, having absent DPOAE’s had drilling time more than 60 minutes. Patients more than 30 years of age are affected more, but there is no preponderance for any gender. Conclusion: Nonoperated ear does have the effect of acoustic and mechanical trauma by vibration transmitted from another side during drilling of the operative ear mastoid bone. This effect is temporary and depends on the duration of drilling also.

The Early Postoperative Effects of Cochlear Implantation on Horizontal Semicircular Canal Function.

To use video head impulse testing to examine the effect of cochlear implantation (CI) on horizontal SCC vestibulo-ocular reflex (VOR) gain early after surgery, and to relate outcomes to subjective imbalance. Prospective cohort study. Academic tertiary referral center. Thirty-seven (23F:14M) adult cochlear implant recipients (mean age, 55; age range, 20-80). Cochlear implantation. The VOR of the horizontal semicircular canal of both the operated and non-operated ears was examined using video head impulse testing before surgery and at days 1, 7, and 28 following surgery. VOR gain, VOR gain asymmetry, and the change in VOR gain from preoperative baseline where the primary outcome measures. Subjective imbalance was assessed using a structured questionnaire. VOR gain value for the operated ear was 0.88 ± 0.21. Mean VOR gain on day 1 postoperatively was 0.86 ± 0.19; on day 7, 0.87 ± 0.17, and on day 30, 0.91 ± 0.21. Before surgery median asymmery was -5.50%, on day 1 it was -5.30%, at day 7, -6.44%, and at day 30 it was -2.61%. There was no significant difference between these measures for the cohort across the four time points. Thirteen of 37 (35%) of patients experienced imbalance in the follow-up period, but this was not correlated to changes in VOR gain. Horizontal semicircular canal function is preserved in the immediate and early postoperative period. This suggests that horizontal semicircular canal impairment is not likely to be responsible for postoperative imbalance.

Ultra Long-Term Audiometric Outcomes in the Treatment of Vestibular Schwannoma With the Middle Cranial Fossa Approach.

Define the long-term audiometric outcomes of vestibular schwannomas treated using the middle cranial fossa (MCF) approach. Retrospective records review. University-based tertiary referral center. Patients undergoing treatment of small vestibular schwannomas using the MCF approach. MCF exposure and treatment of small vestibular schwannomas. Demographic and audiometric variables were assessed. Thirteen subjects demonstrated audiometric data for review. The average time between surgery and the most recent audiometric testing was 14 years (range 10-18 yr). The mean baseline pure-tone average (PTA) was 36 dB HL and the most recent PTA was 59 dB HL in the operated ear. The mean baseline PTA was 16 dB HL and the most recent PTA was 37 dB HL in the nonoperated ear. The mean change from baseline to most recent follow-up was a threshold elevation of 22 and 19 dB HL in the operated and nonoperated ears, respectively. The mean baseline speech discrimination score (SDS) was 83% and the most recent SDS was 73% in the operated ear. The mean baseline SDS was 98% and the most recent SDS was 94% in the nonoperated ear. The mean changes from baseline to most recent follow-up were 10 and 0% SDS depression in the operated and nonoperated ears, respectively. The rates of changes in PTA and SDS were not statistically different between the operated and nonoperated ears. Surgically preserved hearing is maintained in the majority of patients more than 10 years following surgery. PTA and SDS changes were similar between the ipsilateral and contralateral ears.

Influence of mastoid drilling on otoacoustic emissions of the nonoperated ear

Introduction: Drilling in mastoid surgeries can affect the nonoperated normal ear by transcranial transmission. This transient hearing loss can be assessed using distortion-product otoacoustic emissions (DPOAE). Objectives: To determine the effect of drilling on the DPOAE in the contralateral normal ear following mastoid surgeries and its relation with the duration of drilling. Study Design: This was a comparative, prospective, and case–control study. Materials and Methods: DPOAE was obtained for 20 patients who underwent mastoid surgery. DPOAE was measured at frequencies of 2, 3, 4, and 5 kHz with frequency ratio maintained at 1.22. DPOAE was recorded during the preoperative, immediate postoperative, 1st and 7th postoperative days. Twenty controls that underwent tympanoplasty were also analyzed pre- and post-operatively. Results: Significant deterioration in the DPOAE amplitudes was noticed during immediate postoperative period in all the four frequencies studied. No correlation was obtained between the duration of drilling and the change in amplitudes. Conclusion: A transient hearing loss is seen in the nonoperated ear following mastoid surgeries due to a drill-induced noise exposure.

Evaluation of Sensorineural Hearing Loss Caused by Drill Burr (Types, Size and Speed of Drilling) In Ipsilateral and Contra Lateral Ear after Middle Ear Surgery

Background and Objective- It has been observed that drilling during ear surgery can lead to noise induced sensorineural hearing loss in diseased and non-operated ear both. Hearing loss is caused by drill noise conducted to the non-operated ear by vibrations of the intact skull. This noise exposure results in dysfunction of the outer hair cells, which may produce hearing loss. Aim of our study is to evaluate the sensorineural hearing loss caused by various types of drill bit, various size of drill bit, speed of in diseased and non-operated ear during ear surgery. Method- Study design was prospective. Hearing assessment of all patients was done by tuning fork test and pure tone audiometry and patients with only mild, moderate and moderately severe conductive hearing loss were selected for study. Patients underwent middle ear surgeries like cortical mastoidectomy, radical mastoidectomy, modified radical mastoidectomy combined approached tympanoplasty and plain tympanoplasty after taking detailed informed consent. All patients underwent post-operative hearing assessment on 10 th post-operative day and after 2 months of operation. Result and Conclusions- Drilling at high speed (rpm) cause more sensorineural hearing loss thus according to our study best speed of drilling is 15000 rpm-25000 rpm. Larger sized burr produces more sensorineural hearing loss.always avoid the use of burrs of more than 7 mm size. We recommend use of <3 mm burr. Cutting burr produces more sensorineural hearing loss than diamond burr.

Effect of drill-induced noise on hearing in non-operated ear.

Background:The aim of this study was to evaluate the effect of drill-generated noise on hearing loss in non-operated ear and if any, was temporary or persistent.Materials and Methods:In this prospective clinical study, 23 patients who had undergone mastoidectomy and normal contralateral hearing were enrolled. Patients were evaluated preoperatively and postoperatively (1 and 7 days) following surgery using low and high-frequency pure tone audiometry (PTA) and low and high-frequency transient evoked and distortion product otoacoustic emission (DPOAE) testing.Results:Comparing preoperative and 1-day after surgery, PTA averages were significantly different at low frequencies, but no statistical significant differences were observed at 0.25 KHz and high-frequencies. Comparing 1-day after surgery and 7 days after surgery showed that, PTA averages at 0.5, 2 and 2 KHz were significantly different with no significant differences at the other average of thresholds in low and high frequencies; PTA average at 1 KHz was significantly different with, no significant differences at the other averages of thresholds in low and high frequencies. DPOAEs showed a significant difference preoperative and 1-day after surgery, 1-day and 7 days after, but DPOAEs were not significantly different. Transiently evoked otoacoustic emissions (TEOAEs) had a significant difference preoperative and 1-day after surgery, 1-day and 7 days after but when comparing preoperative and 7 days after surgery, TEOAEs were not significantly different.Conclusions:Drill-induced noise during ear surgery (mastoidectomy) can cause reversible changes in PTA, DPOAEs and TEOAEs in the non-operated ear.

Smoking and its influence on success of tympanoplasty: A prospective study

Objective: To compare the surgical outcome of tympanoplasty in smokers and nonsmokers. Design: Prospective cohort study. Setting: Tertiary Care Center in Central India. Patients: The study included 245 male patients who underwent type 1 tympanoplasty and were subsequently divided into 2 groups. Group A: Nonsmokers (115 patients). Group B: Smokers (130 patients). All the cases were operated by postaural route and underlay technique. Revision cases and patients with systemic disease were excluded from the study. Main Outcome Measures: The success rate and hearing gain at the last follow-up i.e., 6 months from the day of surgery. Results: The overall success rate of tympanoplasty in our study is 91.3% in nonsmokers and 73% in smokers. Most of the patients were in the age group 15–30 years. Smokers had significantly longer duration of complaints associated with chronic suppurative otitis media. Preoperatively, eustachian tube dysfunction was assessed by tympanometry and it showed a significant difference in both the operated and the nonoperated ears of smokers. Sclerosis in X-ray mastoid Schuller's view was seen more in smokers than in nonsmokers (P = 0.001). There was a significant difference in otomicroscopic findings of smokers and nonsmokers i.e. more patients with grade 3 and 4 pars tensa retractions in the contralateral ear (P = 0.0001). Mean gain in the postoperative air-bone gap was significantly more in nonsmokers as compared to smokers (P = 0.013). Conclusion: Smoking is a definitive risk factor in the success of tympanoplasty in terms of graft take up and hearing gain.

Evaluation of cholesteatoma: our experience with DW Propeller imaging.

Cholesteatoma management includes early detection and surgical exploration. Due to its tendency to recur, it can be potentially locally aggressive. Magnetic resonance imaging (MRI), and in particular diffusion weighted imaging (DWI), plays an important role in management of these lesions. To assess the accuracy of Propeller (Periodically Rotated Overlapping ParallEL Lines with Enhanced Reconstruction) DW sequence in detecting middle ear and mastoid cholesteatomas in non-operated ears by surgical correlation. A retrospective review of 15 patients was done who underwent Propeller DWI with either clinically confirmed or suspected cholesteatomas. Surgical correlation was done in all cases. All patients had hyperintense foci on Propeller DWI. Surgical correlation performed revealed that 13 patients had cholesteatomas while two patients had mastoid abscesses. The location, extent, and size of cholesteatomas on Propeller DWI matched with the operative findings. Of the 13 patients with cholesteatomas, three patients had multiple foci of hyperintensity on Propeller DWI, which corroborated with the surgical finding of multiple cholesteatomas. The average apparent diffusion coefficient value of cholesteatoma was 0.868 × 10(-3) mm(2)/s, found to be higher than that of abscess, which was 0.425 × 10(-3) mm(2)/s. Propeller DWI was accurate in assessing the location, extent, and size of cholesteatomas as corroborated with surgical findings. Propeller DWI is useful in detecting number of cholesteatoma foci, a vital finding as it may impact the choice of surgery.