Postoperative Air-bone Gap Closure Research Articles

Audit on the safety and effectiveness of the use of KTP laser in stapedotomy: One year experience in an Otorhinolaryngology Center at a Tertiary Care Hospital in Sri Lanka

Introduction: This retrospective descriptive study was conducted to assess the effectiveness and safety of using KTP laser in surgically diagnosed patients with otosclerosis who underwent Endoscopic Laser Stapedotomy at the Teaching Hospital Anuradhapura from October 2020 to September 2021. Endoscopic Laser Stapedotomy is used as a minimally invasive technique and it is considered superior to conventional stapedectomy.Methods: Nine patients who underwent laser stapedotomy were incorporated in the study. Data was collected via a pre-formed paper-based operator filled questionnaire. The results of pre-operative pure tone audiogram (PTA) were compared with a three-month post-operative audiogram in addition to demographic and clinical variables and post-operative complications.Results: Mean post-operative air bone gap closure within 10dB was achieved in 55.5% patients. Mean four frequency air bone gap improvement was 25.3dB. Statistically significant post-operative impairment in bone conduction was not demonstrated.Conclusion: Use of KTP laser in endoscopic stapedotomy has produced improvement in air bone gap closure resulting in improvement of hearing with less side effects as a minimally invasive surgical modality in patients with otosclerosis.

Do Decreased Mastoid Pneumatization, Bilateral Involvement and Eustachian Tube Function Affect the Success of Type 1 Tympanoplasty?

The surgical success rate of tympanoplasty appears to be influenced by a number of variables. Eustachian tube dysfunction has been shown as one of the factors causing failure in tympanoplasty. It is known that bilateral disease and decreased in mastoid pneumatization are associated with Eustachian tube (ET) dysfunction. In this study, the relationship between the success of type 1 tympanoplasty and mastoid pneumatization, bilateral disease and ET function was investigated. A total of 44 patients who were operated for chronic otitis media in our clinic were included. The information of the patients was obtained retrospectively, the direction of the disease (bilateral/unilateral), the status of the graft (intact/perforated), mastoid pneumatization status, and hearing levels (preoperative/postoperative 6th month) were noted. Automatic Williams test was used to tympanometrically evaluate ET functions (ETF) in postoperative period. The relationship between tympanoplasty success and mastoid pneumatization, bilateral disease and ETF was investigated by statistical analysis. The disease aspect was found bilateral in 34.1% (n = 15) of the cases, and unilateral in 65.9% (n = 29) of the cases. Mastoid pneumatization was decreased in 52.2% (n = 23) of the cases, and normal in 45.4% (n = 20). The preoperative air-bone mean difference (gap) of the cases with decreased mastoid pneumatization was found to be statistically significantly higher than the cases with normal mastoid pneumatization (p < 0.05). The closure of the postoperative air-bone gap in patients with unilateral disease direction was found to be statistically significantly higher than in patients with bilateral disease direction (p < 0.05). Also we found significantly worse ET functions both in unilateral and bilateral disease. Preoperative air-bone gap average is higher in ears with decreased mastoid pneumatization, and postoperative air-bone gap closure is higher in unilateral patients. Mastoid ventilation does not make a significant difference in the success of type 1 tympanoplasty. On the other hand, our results support that ET dysfunction can be effective in the occurrence of chronic otitis media (COM).

Comparison of temporalis muscle fascia and cartilage grafts for primary type 1 tympanoplasty: a meta-analysis of randomized controlled trials.

To compare the efficacy and safety of temporalis fascia (TF) with cartilage grafts for primary type 1 tympanoplasty in chronic otitis media (COM) patients. Computerized search was performed in MEDLINE, Embase, and CENTRAL. Eligible for inclusion were randomized controlled trials (RCTs) comparing TF and cartilage grafts in individuals with non-cholesteatoma COM and intact ossicles requiring type 1 tympanoplasty. Primary outcomes were graft success and hearing improvement, measured by the air-bone gap (ABG) closure. The secondary outcome was the occurrence of complications. Standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals were calculated. Eighteen RCTs that enrolled 1273 participants were found eligible. Data were reported at follow-up periods ranging from 6weeks to 24months. The pooled effect estimate revealed a higher and statistically significant graft success favoring cartilage grafts at 12months (OR = 2.24, 95% CI 1.33-3.78) and 24months (OR = 2.96, 95% CI 1.18-7.43). There was no significant difference between both grafts in post-operative ABG closure across all follow-up periods (6weeks to 12months). Compared to TF, primary type 1 cartilage tympanoplasty offers better graft uptake rates and comparable postoperative hearing outcomes for COM patients.

The utility and safety of diode laser in endoscopic stapes surgery.

The advantages of laser stapedotomy are less trauma and more precise and minimally invasive techniques; however, the potential risk of overheating from the laser combined with the endoscope tip must be considered. This study aimed to assess the efficacy and safety of diode lasers for endoscopic stapes surgery. A retrospective review of 56 patients with otosclerosis who underwent primary endoscopic stapedotomy with a diode laser from 2017 to 2020 was conducted. Demographic data, intraoperative findings, preoperative and postoperative audiological assessments, and postoperative complications were analyzed. There was no statistically significant difference between the preoperative and postoperative bone conduction thresholds. The mean postoperative air-bone gap (ABG) improved significantly compared to the preoperative ABG (4.07 vs. 35.43 dB, p < .001). The postoperative ABG closure within 10 dB at 6 and 12 months was achieved in 87.50% and 91.07% of patients, respectively. The postoperative pain scores at 4 and 24 h were 2.55 and 0.39, respectively. Immediate postoperative vertigo was reported in 12.50% of patients, with 100% complete recovery 2 months after surgery. The chorda tympani nerve was preserved in all the cases. Postoperative taste disturbances at 2 and 12 months were observed in 17.86% and 1.79% of patients, respectively. The diode laser in endoscopic stapedotomy is a safe and effective technique that provides satisfactory hearing outcomes. Temporary taste disturbances during the early postoperative period are a concern. The handheld diode laser delivery system is suitable for an endoscopic approach and is an alternative armamentarium for the treatment of otosclerosis. Level of evidence: IV.

Endoscopic vs microscopic facial nerve decompression for traumatic facial nerve palsy: a randomized controlled trial.

To explore a minimally invasive trans-canal endoscopic facial nerve decompression for traumatic facial nerve palsy and compare it with microscopic facial nerve decompression. 35 and 38 patients underwent endoscopic and microscopic facial nerve decompression, respectively, for traumatic facial nerve palsy. Onset of symptoms, type of temporal bone fracture, day of surgical intervention following trauma, ossicular chain status and nature of insult to facial nerve were observed. Time period for recovery (House Brackmann grade ≤ 3), long term recovery rates, pre- and post-operative hearing status, surgical time and post-operative pain were compared between groups. Maximum patients in endoscopic and microscopic groups (77.1% and 76.3%, respectively) had acute onset of symptoms. 57.1% (20/35) had longitudinal, 17.1% (6/35) had transverse and 25.7% (9/35) had mixed fractures in endoscopic group. In the microscopic group, 57.9% (22/38) had longitudinal, 18.4% (7/38) had transverse and 23.7% (9/38) had mixed fractures. The mean (± S.D.) post-operative air-bone gap in endoscopic and microscopic group were 16.47 ± 4.5dB and 19.4 ± 5.2dB, respectively, which was statistically significant. The mean (± S.D.) time period for recovery of endoscopic and microscopic groups were 14.4 ± 5days and 22.5 ± 7days, respectively (p value < 0.05). The difference in post-operative pain between the two groups was also statistically significant. The difference in long term recovery rates was not statistically significant (p > 0.05). Endoscopic facial nerve decompression results in early recovery, less post-operative pain and better post-operative air-bone gap closure when compared to conventional microscopic technique.

Exploratory tympanotomy in conductive hearing loss with normal pre-operative investigations

To investigate whether patients with conductive hearing loss (CHL) and normal preoperative investigations may benefit from exploratory tympanotomy (ET) and tailored treatment performed according to intraoperative findings. Patients treated with ET for CHL with normal pre-operative otoscopy, tympanometry and CT scan from 2011 to 2019 were reviewed. Data regarding demographics, audiometry, intraoperative findings and surgery were collected and analysed to assess if they can predict post-operative air bone gap (ABG) closure and patient satisfaction. Forty-eight cases were included. Mean ABG significantly reduced (p < 0.001) from preoperative (38.4 dB) to postoperative (14.8 dB). Post-operative ABG closure within 10 dB was observed in 20 cases (41.7%). Overall satisfaction was reported in 60% of cases. Stapes fixation was the most common diagnosis (47.9%) and significantly associated with lower post-operative ABG and higher satisfaction. In CHL with normal pre-operative investigations, ET represents the mainstay of treatment, even if audiological outcomes may widely vary. Intraoperative finding of stapes fixation (thus stapedotomy) ensures the best audiological and satisfaction outcomes.

Is Endoscopic Tympanoplasty an Alternative to Microscopic Tympanoplasty for Small Central Perforations? A Study

Introduction: Traditional approaches to tympanoplasty involve the use of a microscope. However, with the advent of endoscopes and HD cameras, endoscopic tympanoplasty has appeared as an alternative to microscopic tympanoplasty. Our study was aimed at assessing the success rates of endoscopic tympanoplasty in small dry central perforations of pars tensa. Materials and Methods: 49 patients were enrolled in this study for undergoing endoscopic tympanoplasty and the surgical outcome was analyzed in terms of graft uptake and postoperative air-bone gap closure for 6 months. Results: Among the study population, 45 participants (91.84%) had an intact neotympanum at the end of 6 months, two participants (4.08%) had residual perforation, and two (4.08%) had recurrent perforations due to upper respiratory tract infection. The mean preoperative air-bone gap (AB gap) was 23.63 dB ± 3.9 dB in the study population with a minimum of 16 dB and a maximum of 31 dB (95% confidence interval [CI] 22.43–24.83), whereas the mean postoperative AB gap was 13.84 dB ± 2.79 dB, minimum being 8 dB and maximum being 20 dB (95% CI 12.98–14.69). The difference between the preoperative and postoperative air-bone gap was statistically significant (P &lt; 0.001). Conclusions: We conclude that the endoscopic myringoplasty is an attractive alternative to conventional microscopic myringoplasty in terms of surgical outcomes, graft uptake, and air-bone gap closure.

Endoscopic transcanal management of incus long process defects: rebridging with bone cement versus incus interposition

Objectivesto compare hearing outcomes between endoscopic transcanal rebridging with bone cement and endoscopic transcanal incus interposition in patients with incus long process defects secondary to chronic suppurative otitis media (inactive mucosal type).MethodsThis retrospective study was performed on 83 ears of 83 consecutive patients with incus long process defects secondary to chronic suppurative otitis media (inactive mucosal type). According to the extent of incus long process erosion and subsequent ossiculoplasty technique, patients were divided into 2 groups. Patients in group 1 had erosion involving up to two thirds of the length of the incus long process and underwent endoscopic transcanal rebridging with bone cement. Patients in group 2 had erosion involving more than two thirds of the length of the incus long process and underwent endoscopic transcanal incus interposition.ResultsHearing gain (mean ± standard deviation) was 21.39 ± 2.15 dB in group 1 and 19.71 ± 6.12 dB in group 2. A significantly greater hearing gain was achieved in bone cement group than in incus interposition group (P value < 0.001). Successful hearing outcome (post-operative air bone gap closure within 20 dB) was achieved in 81.6% and 71.1% of patients of group 1 and group 2 respectively.ConclusionEndoscopic transcanal rebridging with bone cement offers greater hearing gain than endoscopic transcanal incus interposition. The two techniques remain reliable and cost-effective techniques in management of patients with incus long process defects. The main limitation of this study was the short follow-up period. Further studies with relatively long-term follow-up are strongly recommended.

Functional Results and Learning Curve of Endoscopic Ossiculoplasty

Background and Objectives Endoscopes are recently being used to manage various middle ear surgeries including ossiculoplasty. Here, we investigated hearing results of endoscopic ossiculoplasty and surgeon’ learning curve in gaining endoscopic ossiculoplasty proficiency. We compared the results with those of microscopic ossiculoplasty.Subjects and Method We analyzed 48 patients of ossiculoplasties performed from 2010 to 2020. Patients were divided into three groups: microscopic technique group (n=16); endoscopic early phase group (n=16); endoscopic late phase group (n=16). Operation time and hearing results including postoperative air-bone gap (ABG) and ABG closure were analyzed. Hearing outcomes were considered “successful” when the postoperative ABG was less than 20 dB and considered “excellent” when ABG was less than 10 dB. The learning curve of the outcomes were analyzed.Results Both operation time and postoperative ABG showed decreasing tendency, but only operation time showed statistical significance. The ratio of successful and excellent operations improved, but did not show statistical significance. Improvement in learning curve was not statistically significant presumably due to the lack of patient numbers.Conclusion Surgeon’s proficiency of endoscopic ossiculoplasty was correlated with the improved clinical outcomes, and proficiently conducted endoscopic ossiculoplasty could be used as a surgical technique comparable to microscopic ossiculoplasty.

Audiological characteristics and effect of endoscopic surgery for simple congenital malformation of ossicular chain

ObjectiveTo analyze the audiological characteristics and surgical results in patients undergoing surgery for simple congenital ossicular chain malformation, and the effect of endoscopic surgery. MethodsA retrospective review was performed on 86 patients who underwent surgery for the congenital malformation of the ossicular chain. Clinical characteristics and audiometric data were analyzed. Fifty-eight patients had detailed postoperative data, and the preoperative and postoperative audiometric results were compared. The subjects were further divided into endoscopic and microscopic groups, and their surgical effects were examined. ResultsThe preoperative audiometry results in the low-frequency group were worse than those in the high-frequency group (P < 0.05). A postoperative air-bone gap closure to 20 dB or less was achieved in 73.33% of the 60 ears of patients postoperatively. The postoperative air conduction and air-bone gap were significantly better than the preoperative ones (P < 0.05), and the improvement effect was the best in class III patients (P < 0.05). Postoperative hearing had no significant differences between the endoscopic and microscopic groups. However, endoscopic surgery also was more advantageous in terms of operating time (P < 0.05). ConclusionsPreoperative pure tone audiometric results showed moderate or moderate–severe hearing loss, especially in the low-frequency area. The reconstruction of the auditory ossicle chain can achieve satisfactory results, especially in class III patients. Endoscopic and microscopic surgery in the treatment of simple congenital ossicular chain malformations can effectively improve postoperative hearing.

ASSESSMENT OF HEARING OUTCOME IN ENDOSCOPIC TYMPANOPLASTY BY UNDERLAY TECHNIQUE

AIM: To study the hearing outcome of “Endoscopic Tympanoplasty” by underlay technique. METHODS: This study includes 30 patients presenting with Chronic Suppurative Otitis MediaTubotympanic type. Preoperative assessment includes complete clinical history, thorough ENT examination, X-ray mastoids, Pure Tone Audiogram and routine investigations. Informed and written consent was obtained from all the patients. All the patients were subjected to endoscopic transcanal tympanoplasty by underlay technique using temporalis fascia. Patients were regularly followed up for a period of 3 months and at the end of 3 months pure tone audiogram was done to assess hearing. RESULTS: In our study of 30 patients postoperatively, 80% of the patients had successful graft uptake. In our study, postoperative air-bone gap closure was in the range of 0-10 dB in 55% of patients, 11-20 dB in 20% of patients, 21-30 dB in 5% of patients and 31-40 dB in 20% of patients. CONCLUSION: Transcanal Endoscopic Tympanoplasty is a minimally invasive surgical approach as the endoscope usage provides good exposure of tympanic membrane and improves the visualisation of middle ear structures without canaloplasty

Outcomes in primary and revision surgery for pediatric onset stapedial pathology

ObjectivesTo analyze audiometric outcomes of surgery for pediatric onset stapedial pathology (POSP). Study designRetrospective cohort study. SettingSingle-institution database. MethodsRetrospective analysis of 809 stapes procedures performed at a single high-volume tertiary referral otology practice, 75 of which were POSP cases. ResultsOval window drillout for thick footplate and aborting the procedure were more common in POSP cases compared to the rest of the cohort (28.0% versus 9.8% [p < .001] and 5.3% versus 1.2% [p = .007], respectively). Postoperative complications were rare. Postoperative Air-Bone Gap (pABG) closure to ≤20 dB was significantly lower in the POSP group (80.0% versus 89.0%, p = .021). Rates of sensorineural hearing loss (SNHL) were not different between the two groups. Poor audiometric outcomes in the POSP group were largely driven by revision cases; pABG≤10 dB was 60.3% in primary cases but only 11.8% in revisions (p < .001), and postoperative SNHL was significantly higher in revisions (29.4% versus 0.0%, p < .001). In multivariate analysis, POSP was not a predictor of successful closure of the pABG at either level, nor did it predict significant postoperative SNHL. ConclusionsSurgery for pediatric onset stapedial pathology had significantly worse audiometric outcomes, particularly in revision cases, as compared to the rest of the cohort.

Hearing Results in 151 Primary Stapedotomies for Otosclerosis: The Effects of Using Different Audiologic Parameters and Criteria on Success Rates.

Objective:To describe the 151 hearing results of primary stapedotomy for otosclerosis using different criteria of success rates.Design:Retrospective case series of 151 patients with a diagnosis of otosclerosis and operated on by the same surgeon with the same technique, using a CO2 laser. Patients with revision surgery were excluded. The audiometric data were extracted from the patient files and divided into three groups: early postoperative follow-up (<1 mo after surgery), mid-term follow up (between 1 mo and 1 yr), and late postoperative follow-up (>1 yr).Results:The postoperative air-bone gap (ABG) was 10 dB or less in 45.2% in the mid-term follow up. For this same follow-up, ABG closure less or equal than 20 dB was achieved in 95.6% of cases. The lower percentage of patients with a postoperative ABG closure of less than or equal to 10 dB can be due to the high rate of bone conduction (BC) overclosure of 15.65%. The functional success described as an air conduction (AC) threshold less than or equal to 30 dB was achieved in 52.2% of patients. The mean speech reception threshold (SRT) in the mid-term follow up was 27.4 dB. The analysis of the data according to the Amsterdam Hearing Evaluation Plots (AHEPs) shows a success rate of 87% at early follow-up.Conclusions:The success rate is mainly dependent on the definition and criteria as a measure of success. An analysis of the evolution of the BC is mandatory to avoid a false positive success rate when the ABG closure is used. Therefore, the use of the AHEPs would acquire additional information. The hearing outcome has also been based on the speech audiometry and the number of patients achieving an AC less than or equal to 30 dB as a more realistic measure of success. Our series confirms good long term hearing results achieved in stapedotomy surgery with the CO2 laser.

A retrospective study on middle ear risk indices in analysing the post-operative outcome following tympanoplasty

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media is a highly prevalent disease of middle ear. As tympanoplasty plays an important role in management of otitis media it is important to predict the outcome of surgery and give proper counselling to the patient. The objective of this study was to evaluate the effectiveness of Middle ear risk index (MERI) in determining postoperative graft uptake and postoperative air bone gap closure following tympanoplasty.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a retrospective study conducted to find the correlation between MERI and the result of tympanoplasty outcome and post-operative hearing gain. Ninety-six subjects who underwent tympanoplasty for chronic otitis media were included in the study. MERI score was calculated and was compared with postoperative graft uptake and audiogram. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In this study there was no statistical difference in graft uptake between the MERI categories. There was statistically significant decrease in postoperative air bone gap closure in both mild and moderate categories. Other prognostic factors associated with a favourable outcome were healthy middle ear mucosa and absence of smoking.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; MERI did not have a direct impact on the outcome of surgery in terms of graft uptake and hearing results. However certain factors like Belluci’s criteria and smoking had an impact on the outcome. Hence MERI can be used for pre-operative counselling of the patients.&lt;/p&gt;

Evaluation of Audiological Results and Cochleo-Vestibular Subclinical Injury After CO2 Laser Stapedotomy.

Evaluation of the effectiveness and safety of CO2 laser stapedotomy, focusing on the audiological results, and on the surgical cochleo-vestibular trauma. Retrospective clinical trial on 38 patients with the diagnosis of otosclerosis, who underwent CO2 laser stapedotomy between January 2015 and October 2019. Postoperative air-bone gap (ABG), mean air conduction gain, and postoperative changes of high frequency threshold were evaluated 1, 3, 6, and 12 months after surgery. Videoculography (VOG) was performed to assess the vestibular impairment preoperatively and 1 day, 1 week, and 1 month after surgery. Postoperative ABG closure within 10 dB was obtained in 35 cases (92.1%), with a mean postoperative ABG of 4.4 dB and a mean air conduction improvement of 32.3 dB. No significant worsening of high frequency threshold was observed. Spontaneous nystagmus was found preoperatively in 5/38 patients (13.2%), 1 day after surgery in 13/38 patients (34.2%), 1 week after surgery in 12/38 patients (31.6%), and 1 month after surgery in 4/38 patients (10.5%). Positional nystagmus was found preoperatively in 12/38 patients (31.6%), 1 day after surgery in 25/38 patients (65.8%), 1 week after surgery in 22/38 patients (57.9%), and 1 month after surgery in 10/38 patients (26.3%). The occurrence of nystagmus did not always correlate with vestibular symptoms: after surgery, 10 patients (26.3%) experienced vertigo associated with dizziness, 8 patients (21.1%) suffered from dizziness without vertigo, and 14 patients (36.8%) showed nystagmus without any symptomatology. At 1 month after surgerynone of the patients complained about vestibular symptoms. CO2 laser stapedotomy is a safe and effective technique, which allows to obtain good functional results with minimal perioperative cochleo-vestibular trauma.© 2021 Wiley Periodicals LLC.

Outcomes in Revision Stapes Surgery

To compare audiometric outcomes and complication rates between primary and revision stapes surgical cases. Retrospective cohort study. Large single-institution database. Data on 809 patients (including 170 revisions) undergoing primary and revision stapes surgery were reviewed, with Pearson chi-square and multivariable logistic regression analysis performed. Rates of postoperative air-bone gap (ABG) closure to ≤10 dB were significantly worse in the revision group (40.2% vs 61.8%, P < .001), as were those to ≤20 dB (78.1% vs 90.9%, P < .001). The bone conduction pure tone average worsened by >10 dB in 7.1% of primary cases and 13.1% of revisions (P = .016). The mean postoperative ABG for revision cases was significantly higher at 15.5 dB as compared with 11.0 dB for primaries (P < .001), despite a slightly higher preoperative ABG for primary cases (30.6 vs 28.24 dB, P = .010). In multivariate analysis, revision surgery had an odds ratio 0.41 (P < .001) in closing the ABG to ≤10 dB. Postoperative reparative granuloma (2.4% vs 0.2%, P = .001) and hydrops (1.8% vs 0.2%, P = .008) were higher in revision cases. Revision stapes surgery was found to have less predictable and inferior results as compared with primary cases. 4 (retrospective observational research).

Endoscopic ear surgery in middle ear cholesteatoma

ObjectiveEndoscope has been used as diagnostic tool for recidivism and as an adjunct to microscopic technique in the management of cholesteatoma. At present transcanal endoscopic ear surgery (TEES) is being used as a minimally invasive alternative for microscopic approach. We aim to evaluate the feasibility, structural, functional and quality of life outcomes of endoscopic technique in middle ear cholesteatoma. MethodThis prospective study was conducted at a tertiary care hospital from January 2017 to January 2018 including 32 adult patients who were treated by TEES for middle ear cholesteatoma. Feasibility of endoscopic technique was assessed by the conversion rates, visualization of middle ear structures and complications. Structural outcomes were evaluated in terms of graft uptake at the third month follow-up and presence of residual or recurrent disease. Functional outcomes were evaluated in terms of post-operative air-bone gap closure at third month follow-up. Patient outcomes in terms of post-operative pain, cosmetic score, day of return to daily activities and patient comfort scores were evaluated. The quality of life outcomes were evaluated using chronic ear survey (CES) and short form questionnaire −12 version 2 (SF-12V2) which are disease specific and general quality of life assessment tools respectively. ResultOut of 32 patients, endoscopic intact canal wall mastoidectomy was done for 28 and endoscopic canal wall down mastoidectomy in 4 patients. One (3.1%) patient had to be converted to microscopic technique. Median follow-up period was 32.8 months (9–46 months). There were no post-operative complications in any of our patients. The mean middle ear structural visibility index score was 8.4 ± 1.4 with the use of zero-degree endoscope. Graft uptake rate at third month follow-up was 100%. Two (6.3%) patients had recurrent disease at 6 months follow-up and were treated by revision endoscopic surgery. The air conduction (51.3 ± 20.2 dB vs. 34.5 ± 20.4 dB, p < 0.001), and air-bone gap (33.5 ± 11.1 dB vs. 16.9 ± 11.8 dB, p < 0.001) has been significantly improved. The mean pain score at 0 hours, 6 hours and 24 hours after surgery were 2.5/10, 1.6/10 and 0.75/10 respectively. At the discharge, the mean patient comfort score was 9.3 ± 0.6 out of 10. Mean cosmetic score was 9.3 ± 0.5 at the third month follow-up. There was significant post-operative improvement in the sub-scale and total scores of CES and SF-12V2. ConclusionEndoscopic approach to middle ear cholesteatoma is feasible and confers excellent structural, functional as well as patient related quality of life outcomes.

Traumatic incudostapedial joint disarticulation: anatomical reconstruction versus stapes bypass

Objectives: To outline two surgical strategies for managing traumatic incudostapedial joint disarticulation (ISJD) with intact tympanic membrane (TM), aiming for improving the stability and the functional outcomes of the procedure.Patients and Methods: This randomized controlled clinical trial was performed on 27 ears of 27 patients with isolated traumatic ISJD with intact tympanic membrane. The study was conducted in the Otorhinolaryngology Department, Mansoura University Hospitals, Egypt. Patients were randomly assigned into two groups: anatomical reconstruction group (n=14), and stapes bypass group (using a Teflon piston) (n=13). Air and bone conduction thresholds at frequencies 500–4000 Hz, were determined pre- and postoperatively.Results: The postoperative pure-tone average and mean air-bone gap (ABG) were statistically significantly different (p < 0.001). The mean postoperative gain of air conduction (AC) threshold and consequently the mean postoperative ABG closure were significantly better with the stapes bypass group compared to the bone cement one. ABG closure to within 10 dB in the stapes bypass group was found in 11ears (84.6%), while in bone cement group, closure to within 10 dB was found in 10 (71.4%) and to within 20 dB in 14.2%. The cochlear function remained stable postoperatively in both groups (p=0.422). No complications were reported, and no patient had a postoperative ABG greater than 30 dB.Conclusion: When the ISJ is dislocated, two options exist for ossicular reconstruction: bypassing the stapes using Teflon piston (stapedotomy) and anatomical reconstruction using ionomeric bone cement. Both techniques are successful with no statistically significant difference regarding hearing outcomes.

Comparison between Fluoroplastic and Platinum/Titanium Piston in Stapedotomy: A Prospective, Randomized Clinical Study.

The objective of this study was to compare hearing results of fluoroplastic (Teflon) Causse Loop Piston with platinum/titanium (Big Easy) Piston in patients who underwent stapedotomy due to otosclerosis. In this prospective randomized clinical trial study, Causse Loop Piston prosthesis was used in 76 ears and the Big Easy Piston prosthesis in 72 ears. The main outcomes were preoperative and postoperative pure tone audiometry and air-bone gap (ABG). Postoperative ABG closure was not significantly different between both groups. However, the Causse Loop Piston resulted in a significant improvement of the air conduction (AC) in frequencies of 250, 500, and 1,000 Hz. In addition, the improvement of speech reception threshold (SRT) was significantly higher in Causse Loop Piston group. We achieved similar postoperative ABG closure in short-term with both prostheses. However, at low frequencies, AC gain was higher in Causse Loop Piston group. In addition, patients in this group yielded better SRT.

Comparative Study of Hearing Results in Various Types of Tympanoplasties.

This study mainly focus on hearing loss pattern in CSOM patients undergoing tympanoplasty surgery or tympanomastoidectomy pre-operatively and analysis of the outcome of the surgery in terms of improvement in hearing (air-bone gap) after 3months of the surgery. All patients of age 15-65years reporting to ENT OPD with ear discharge and decreased hearing were screened with detailed history, clinical examination and microscopic examination.110 cases of tympanic membrane perforation who were fit for surgery were advised tympanoplasty or tympanoplasty with mastoidectomy. Our study shows that postoperative air-bone gap closure is maximum for cortical mastoidectomy type I tympanoplasty (14.03dB), followed with cortical mastoidectomy with type II (12.2dB), Type I tympanoplasty (11dB), cortical mastoidectomy with type III (7.72dB). Procedures combined with modified radical mastoidectomy showed a very poor mean improvement in our study. It is very difficult to predict the results preoperatively because outcome will depend on extent of involvement of middle ear cleft by the disease process which can only be assessed intraoperatively.