Improvement In Postoperative Air-bone Gap Research Articles

Ossicular Reconstruction With Various Degrees of Malleus Preservation in Patients With Chronic Otitis Media.

Objective: We examined the relationship between factors of middle ear conditions and the outcome of ossiculoplasty in chronic otitis media (COM) by measuring the improvement in the air-bone gap (ABG) and air conduction threshold (TAC). Methods: This retrospective study analyzed 76 patients (77 ears) who underwent ossiculoplasty from among 520 COM patients who underwent tympanoplasty based on the maximum preservation of the original ossicles. The reconstructed ossicular chain was performed by preserving or utilizing the remaining malleus in all cases with the presence of the malleus manubrium. Patients with eardrum adhesion, cholesteatoma, and cholesterol granuloma were defined as having a compromised middle ear condition (Group A), and those without as having an uncompromised middle ear condition (Group B). In each group, pure-tone audiometry was performed preoperatively and postoperatively, and improvements in the ABG and TAC were compared. The effects of the types of tympanoplasty and the method of ossiculoplasty (columella versus incus interposition) on postoperative ABG and TAC were also compared. Results: The postoperative ABG improvement in Group B was significantly higher than that in Group A [β = 7.31, 95% confidence interval (CI) = 1.93-12.69, P < .05]. Type III minor columella tympanoplasty yielded significantly better results than type III major and type Vb tympanoplasty (β = 11.42, 95% CI = 5.16-17.68, P < .01). There were no significant differences in the postoperative ABG or TAC between the reconstruction groups with and without preservation of malleus. Conclusions: Our results indicate that complex cases compromised by adhesions, cholesteatoma, and cholesterol granuloma have worse outcomes regarding hearing improvement and success rates, while those with intact stapes suprastructure have better outcomes. Malleus was maximally preserved in the patients of this study; however, this showed no significant prognostic benefit in hearing.

Stapes prosthesis length and hearing outcomes

First, to determine if prosthesis length plays a role in optimizing successful hearing outcomes in stapedotomy surgery; and second, to determine if patient factors such as height are correlated with prosthesis length. Retrospective chart review. Retrospective chart review of patients undergoing stapedotomy surgeries with adequate follow up. Length of prosthesis, pre-/postoperative audiograms, and follow-up data were obtained. The primary group consisted of 227 cases. The prosthesis length ranged from 3.75 mm to 4.75 mm (median 4.25 mm). The greatest improvement in postoperative air-bone gap (ABG) occurred in the 4.25 mm group, and the least in the 3.75 mm group. Patient height showed a positive, although weak, correlation with prosthesis length. No findings reached statistical significance. Accurate measurement of prosthesis length is important for successful postoperative hearing outcomes. There is a positive but not significant correlation between patient height and prosthesis length. 4. Laryngoscope, 128:722-726, 2018.

Titanium Ossicular Chain Reconstruction Revision Success and Preoperative Factors Predicting Success.

Objective Determine rates of success after revision titanium ossicular chain reconstruction with either partial or total ossicular replacement prosthesis and assess preoperative factors predicting positive outcomes. Study Design Case series with planned data collection. Setting Tertiary hospital. Subjects and Methods The charts of 76 surgical patients who underwent revision titanium ossicular chain reconstruction from 2003 to 2014 were abstracted from a prospectively maintained database at the Medical University of South Carolina. Postoperative air-bone gap (ABG) after revision surgery at short-term (<6 months) and intermediate to long-term (>1 year) follow-up and preoperative factors associated with postoperative ABG ≤20 dB were recorded. A paired t test or Wilcoxon signed-rank sum test was utilized to compare preoperative, short-term, or intermediate to long-term results. Results Seventy-six patients underwent revision ossiculoplasty and met inclusion criteria. Mean postoperative ABG was 22.5 at short-term follow-up ( P < .0001) and 24.4 at intermediate to long-term follow-up ( P = .003). Postoperative ABG ≤20 dB was achieved in 51.5% of patients. The only preoperative factor associated with postoperative ABG ≤20 dB was location of original primary ossiculoplasty ( P = .01). Conclusions This is one of the larger studies involving revision titanium ossiculoplasty. Revision surgery showed a significant improvement in postoperative ABG. The location of the original ossiculoplasty correlated with success of revision surgery (defined as postoperative ABG ≤20 dB). Patients who had the primary ossiculoplasty at an outside hospital may have better audiometric outcomes than patients who had it at a tertiary hospital.

Comparison of Fluoroplastic Causse Loop Piston and Titanium Soft-Clip in Stapedotomy.

Different types of prosthesis are available for stapes replacement. Because there has been no published report on the efficacy of the titanium soft-clip vs the fluoroplastic Causse loop Teflon piston, we compared short-term hearing results of both types of prosthesis in patients who underwent stapedotomy due to otosclerosis. A total of 57 ears were included in the soft-clip group and 63 ears were included in the Teflon-piston group. Pre-operative and post-operative air conduction, bone conduction, air-bone gaps, speech discrimination score, and speech reception thresholds were analyzed. Post-operative speech reception threshold gains did not differ significantly between the two groups (P=0.919). However, better post-operative air-bone gap improvement at low frequencies was observed in the Teflon-piston group over the short-term follow-up (at frequencies of 0.25 and 0.50 kHz; P=0.007 and P=0.001, respectively). Similar post-operative hearing results were observed in the two groups in the short-term.

Butterfly cartilage tympanoplasty: An alternative approach for management of small- and medium-sized perforations

Objective: To evaluate the efficacy of butterfly cartilage tympanoplasty for small- and medium-sized central perforations and compare it with temporalis fascia tympanoplasty. Materials and Methods: A prospective, comparative study was conducted on 110 patients, divided into two groups. Patients of tubotympanic type of chronic suppurative otitis media with 2–6 mm size perforation were included in the study. Fifty-five patients were operated by temporalis fascia Type I tympanoplasty and rest 55 by butterfly cartilage tympanoplasty (transcanal technique) under local anesthesia. Results were compared in terms of pre- and post-operative air-bone gap improvement and success rates. Results: In our study, in terms of outcomes, both techniques had similar results. The success rate was 93.7% in butterfly cartilage tympanoplasty and 96.3% in temporalis fascia group. However, in terms of time taken, butterfly cartilage tympanoplasty took less time (about 30 min) than temporalis fascia (about 55 min). Conclusion: Transcanal butterfly cartilage tympanoplasty is a very good alternative in small- and medium-sized perforations for conventional temporalis fascia tympanoplasty as it is simple, takes less time, day care procedure, on table hearing improvement, cosmetically no postoperative scar, no need of post aural preparation, and patient can go home within hours.

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

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

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

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

Comparison of Pre and Post-Operative Hearing Results in Patients Undergone Modified Inlay Butterfly Cartilage Perichondrium Myringoplasty

Objective: The perichondrium cartilage graft has its advantage not only on hearing outcome but also in graft uptake rate. So, the main aims are to compare the pre and post-operative hearing results and to observe the graft uptake rate. Materials and methodology: This is a prospective, longitudinal and analytical study conducted in the department of otorhinolaryngology in Kathmandu university hospital from 1st January 2011 to 1st June 2012. There were 34 patients who underwent modified inlay butterfly cartilage perichondrium myringoplasty using tragal cartilage perichondrium in ≥13 years patients and with the diagnosis of Chronic otitis media (mucosal- inactive) with central perforation of >50% and those requiring revision surgeries for failed myringoplasties were included. The pre and post-operative PTA (pure tone audiogram) was performed and evaluated. The post-operative hearing was assessed in terms of average ABG (air bone gap) and size of ABG closure. Results: Among 34 patients, the 30 (88.2%) patients had graft uptaken. Other 4 patients had residual perforation because of infection. The post operative ABG was smaller than the pre operative ABG. (36.57+/-12.13dB and 26.41+/-8.47dB respectively) The mean ABG closure was 10.15+/-10.23dB. The ABG closure was smaller than 10dB in 15 (50%) patients. Conclusion: There was statistically significant improvement in postoperative ABG with ABG closure within 10dB in 50% of patients. So, it is useful to perform the procedure in subtotal to total perforation with good outcome. Keywords: Air bone gap, cartilage, chronic otitis media, Myringoplasty. Read more →