Postoperative Air-bone Gap Research Articles

Outcome Variation of CO 2 Laser and MicrodrillAssisted Stapedotomy in Otosclerosis

Background: CO2 laser and microdrill-assisted stapedotomy are widely performed procedures in otolaryngology practice. However, definite information regarding surgical advances, postoperative results, complications and how and in which patients these surgical techniques should be exclusively used is a source of continuous discussion. Aim: To compare the outcome of CO2 laser and microdrill-assisted stapedotomy in patients with otosclerosis. Methodology: We enrolled 26 cases as study sample on the basis of selection criteria. All these patients were evaluated by a complete clinical head and neck examination, preoperative oto-microscopic evaluation,pure tone audiometry (PTA) and a high-resolution CT scan.One group of patientswere treated by CO2 laser stapedotomy, and another group by microdrill-assisted stapedotomy. Fisher’s Exact test and Student’s t-test were done as appropriate, and a p-value <0.05 was considered as the level of significance. Results: Maximum patients 9(69.2%) and 7(53.8%) were in the age group of 20-30 years in Group A (CO2 laser stapedotomy) and Group B (Microdrill assisted stapedotomy), respectively. The difference in the mean postoperative air–bone gap was not statistically significant (p=0.679) between the groups. All surgical procedures compared in our study showed the surgical success of > 90%. In present study, 8(61.5%) and 9(69.2%) of the study subjects presented with tinnitus in the CO2 and Microdrill groups, respectively. 1(7.7%) and 1(7.7%) of the study subjects presented with dizziness in both groups, respectively. At 3 months postoperative follow-up, only 1(7.7%) case in the CO 2 laser group and 4(30.8%) cases in the Microdrill group developed complications. Among them, 1 (7.7%) and 2(15.4%) cases developed permanent vertigo in CO2 and Microdrill groups, respectively. 1(7.7%) case developed chorda tympani injury, and 1(7.7%) case developed worsened tinnitus in the Microdrill group. No significant (p>0.05) difference was observed between the groups regarding postoperative complications at 3 months. Conclusion: After analyzing the results of the present study, it can be concluded that there is no significant difference between CO2 laser and microdrill-assisted stapedotomy in terms of hearing outcome and complication. Bangladesh J Otorhinolaryngology 2024; 30(1): 15-23

Endoscopic Fat Graft Myringoplasty Augmented With Hyaluronic Acid for Managing Large-Sized Eardrum Perforations; A Prospective Comparative Randomised Study.

We aimed to assess the outcomes of fat graft myringoplasty augmented with hyaluronic acid in closing large-sized eardrum perforations compared to the traditional underlay cartilage-perichondrium composite myringoplasty (CPCM). It was a prospective randomised comparative study. It was held in tertiary referral institutions between May 2020 and April 2022. We included 100 patients with a large-sized eardrum perforation (50%-75% of the eardrum surface area). Using the endoscopic transcanal approach, 50 patients were managed by fat graft myringoplasty augmented with hyaluronic acid, while CPCM managed the other 50 patients. We evaluated the closure rates 1, 6 months and 1 year after surgery. Also, we assessed the audiological performance of the patients with a successful closure before and 1 year after the operation. Fat graft myringoplasty operation was statistically shorter than the CPCM. The closure rate 1 year after surgery was 92% in the first group and 86% in the second group, without a statistically significant difference between both groups. Successful air-bone gap closure to less than 10 dB occurred in 93.5% of group A and 81.4% of group B without a statistically significant difference. The mean postoperative air-bone gap was 5.3 ± 3.95 dB in the first group and 7.95 ± 5.17 dB in the second group, with a statistically significant difference. Fat graft myringoplasty augmented with hyaluronic acid was a reliable, safe, simple, and effective manoeuvre to close large-sized eardrum perforations compared to the conventional CPCM.

Endoscopic Cartilage Slice Reinforcement Technique for Anterior Perforation Repair with Anterior Canal Wall Protrusion.

Objective: To evaluate the outcomes and complications of the endoscopic cartilage slice reinforcement technique used on anterior margins for anterior perforation repair with anterior canal wall protrusion. Material and Methods: We conducted a prospective study on 38 cases of anterior perforation with anterior canal wall protrusion, treated using the endoscopic cartilage slice reinforcement technique from February 1, 2017 to August 29, 2023. The follow-up period was 6 months. Results: Of the 38 patients, medium perforations were present in 28.9%, large in 65.8%, and subtotal in 5.3%. The cause was mucosal chronic otitis media in 92.1%, traumatic perforation in 5.3%, and ventilation tube removal in 2.6%. The average operation time was 27.2 ± 4.6 minutes. The graft success rate was 94.7% (36/38) at 6 months postoperative. The average preoperative air-bone gap (ABG) was 19.8 ± 4.2 dB, and postoperative ABG was 8.6 ± 2.9 dB; this improvement was statistically significant (P < .001; paired-sample t-test). The ABG gain was 11.8 ± 5.1 dB, and the rate of successful surgery (postoperative ABG ≤ 20 dB) was 97.4% (37/38). No complications such as altered taste, vertigo, or tinnitus were reported, and no cases involved graft lateralization, significant blunting, graft atelectasis, graft adhesions, or effusion. However, myringitis was observed in 4 (10.5%) patients. Conclusion: The endoscopic cartilage slice reinforcement technique for anterior margins is a simple and effective method for repairing anterior perforations with anterior canal wall protrusion, achieving a high graft success rate, improved hearing, and minimal complications.

Conventional one-handed compared to two-handed endoscopic ear surgery using an endoscope holder: a single center study.

One-handedness is a challenge in conventional endoscopic ear surgery (EES). We present results on the first-ever application of the passive endoscope holder 'Endofix exo' (Co. AKTORmed GmbH, Neutraubling, Germany) in EES, which enables two-handed surgery. This two-sided study compares cut-suture time, operating time, postoperative complications, graft take rates, hearing results and quality of life in patients who underwent first stage tympanoplasty due to tympanic membrane perforation with intact ossicular chain conditions. 25 patients received classic EES (EES-, mean age: 28 ± 21 years) and 15 received EES with the passive holder (EES+, mean age: 48 ± 21 years). Mean operating times (EES-: 96 ± 38 (SD) min; EES+: 107 ± 33min), cut-suture times (EES-: 68 ± 30min; EES+: 73 ± 31min), complications, graft take rates and hearing results (preoperative air bone gap (ABG) (PTA4): 15 dB ± SD 8 dB (EES-); 16 dB ± SD 8 dB (EES+); postoperative ABG (PTA4): 11.25dB ± SD 11.3dB (EES-); 14 dB ± SD 10 dB (EES+)) did not differ significantly (p > 0.05) between the two groups. Postoperative hearing results and quality of life tended to improve in both groups (p > 0.05). The passive endoscope holder has been successfully applied during the course of the study. However, modifications of the endoscope holder and further studies are recommended focusing on positioning of grafts and prostheses to obtain conclusive results regarding the superiority of two-handed EES over one-handed conventional EES.

Unilateral versus bilateral stapes surgery: A comparative study on auditory outcome and quality of life

Otosclerosis is a well-known disease which mainly affects middle-aged female patients, causing conductive or mixed hearing loss. Diagnosis is essentially made through a complete audiometric battery testing, while treatment substantially relies on stapes surgery.In this study, we analyzed audiometric and Quality-of-Life data from 33 patients in order to refine the surgical indications (unilateral versus bilateral stapes surgery) and assess the best technique (stapedotomy versus partial stapedectomy) and timing of treatment. The original questionnaire OTOS, in the Italian language, was administered to all patients.In this study, most of the patients were female (18/33), with a mean age of 53 years old. Both surgical techniques appear to be effective with no significant difference in post-operative Air Bone Gap. OTOS questionnaire appeared to be effective in assessing quality of life in patients treated by stapes surgery. Post-operative QoL appeared to be similar in bilaterally and unilaterally operated patients, suggesting that a contralateral intervention after effective surgery should be undertaken only if expressly requested by the patient.

A comparison of surgical outcomes of endoscopic versus microscopic myringoplasty

BackgroundThere is a gradual transition from open to minimal access surgeries in Otorhinolaryngology. Myringoplasty can be done with either microscope or endoscope. Use of both the techniques has been reported in literature. However, there is no clear consensus over which is better than the other. The current study was done with the aim of comparing the hearing outcomes post myringoplasty by endoscopic versus microscopic technique. MethodsHundred patients of chronic otitis media mucosal inactive were recruited and divided into two groups, A and B. The patients in group A underwent endoscopic myringoplasty while those in group B underwent conventional microscopic myringoplasty. All patients underwent pure tone audiometry (PTA) and oto-endoscopy prior to and six months post-surgery. The study outcomes in the form of air-bone (AB) gap on PTA, successful closure of tympanic membrane perforation, pain scores, duration of hospital stay and occurrence of complications were compared. ResultsThe post-operative AB gap on PTA and pain score was lesser in the endoscopic technique as compared to microscopic technique. The reduction in AB gap post-surgery, duration of hospital stay, proportion of patients with closure of AB gap to ≤10 dB, successful closure of tympanic membrane perforation, and taste alteration were similar in both groups. ConclusionEndoscopic technique for myringoplasty can be recommended in view of similar or slightly better surgical and functional outcomes, wider field of view and better visualisation of middle ear by the endoscopes.

Endoscopic Push-Through Technique Myringoplasty in Tympanic Membrane Perforations; An Institutional Experience in Kathmandu, Nepal

Background Push-through technique cartilage perichondrium composite graft myringoplasty involves placing the graft beneath the freshened perforation by endoscopic approach without elevating tympanomeatal flap. The aim of this study is to assess the graft uptake and hearing after push-through myringoplasty at our institution. MethodsThis prospective study was conducted in Otorhinolarynology Department of Nepal Medical College Teaching Hospital from November 2022 to October 2023 after obtaining ethical clearance from Research and Ethical Sub Committee (RESC). All patients aged 20 years and above with inactive type of chronic otitis media mucosal disease with conductive hearing loss underwent myringoplasty by push-through technique using cartilage perichondrium composite graft. Pure tone audiograms of the patients were done before and after surgery. Graft uptake and hearing results were evaluated at 12 weeks using SPSS. Paired t test was used to assess hearing improvement.ResultsThe success rate among the participants who underwent endoscopic push through myringoplasty regarding graft uptake was 84.8% (78 of 92). The mean preoperative bone conduction threshold was 13.6±4.1 dB as compared to 13.1±4.0 dB postoperatively. Similarly, the mean preoperative air conduction threshold was 45.2±7.3 dB, with the postoperative value being 30.9±7.6 dB. The mean preoperative air-bone gap was 30.6±7.5 dB, while the air-bone gap postoperatively was 17.8±6.7 dB. Paired t-test comparing the means of the preoperative to postoperative air-bone gap showed a significant difference post-surgery with a p value of less than 0.001. Conclusions Push through technique myringoplasty can be used to repair perforations with good results in terms of graft uptake and improved hearing.

Indications, Surgical Strategies And Hearing Outcomes of Revision Stapes Surgery for Otosclerosis: A Systematic Review and Meta‐analysis on 2602 Patients

AbstractObjectiveTo summarize current knowledge on the indications, surgical strategies, and auditory outcomes of revision stapes surgery (RSS) for otosclerosis.Data SourcesThe search was conducted in PubMed, Scopus, and Web of Science online databases, including papers published since 2000.Review MethodsThe study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines. We considered original series describing RSS for otosclerosis, reporting postoperative hearing outcomes according to the American Academy of Otolaryngology–Head and Neck Surgery guidelines for conductive hearing loss (CHL) for at least 30 consecutive cases. The quality of included studies was assessed with the Joanna Briggs Institute checklist. Pooled proportion and odds ratio (OR) meta‐analysis were conducted using random effect models.ResultsNineteen studies were included, for a total of 2602 patients (2735 ears) and 2359 postoperative hearing results. RSS was mostly performed for recurrent CHL with air‐bone gap (ABG)&gt;20 dB. Multiple concomitant causes were often present, with prosthesis placement defect and incus necrosis as the most common causes. The pooled proportion of postoperative ABG&lt;10 dB and ABG&lt;20 dB was 57.2% (95% confidence interval [CI]: 52.8%‐61.4%) and 79% (95% CI: 76.0%‐81.8%), respectively. Dead ears were 1.2% (95% CI: 0.7%‐2.1%). Compared to primary surgery, RSS had a significantly lower rate of ABG&lt;10 dB (OR = 0.36, 95% CI: 0.24%‐0.54%; P &lt; .001). Both revision incudostapedotomy with/without incus reconstruction and malleovestibulopexy are viable options with nonsignificant differences in ABG closure rates (P = .182).ConclusionRSS is challenging and requires the surgeon to carefully evaluate all potential causes of previous failure and tailor the intervention according to intraoperative findings. In most cases, ABG closure within 20 dB can be achieved with a relatively low risk of dead ears.

Comparison of Outcomes with the Use of Different Heat-Activated Crimping Prostheses in Stapedotomy.

To determine differences in failure rate and hearing outcomes of a completely encircling heat-activated crimping prosthesis (SMart 360°) compared to partially encircling prosthesis (SMart). Retrospective chart review. Private neurotology tertiary referral center. Patients who underwent stapedotomies performed by the senior authors from 2008 to 2019 using the SMart prosthesis and SMart 360° prothesis. Stapedotomy operations with placement of a SMart or SMart 360° prosthesis. Incidence of early failure requiring revision surgery. Differences in preoperative air-bone gap (ABG) compared to postoperative ABG at 3 months, 1 year, and 2 years after surgery. A total of 228 stapedotomies were performed (SMart n = 48 and SMart 360° n = 180). Mean preoperative ABG for SMart and SMart 360° were 26.15 and 29 dB, respectively. The mean difference in ABG for the SMart at 3 months, 1 year, and 2 years were 17, 18, and 11 dB, respectively. The mean difference in ABG for the SMart 360° at 3 months, 1 year, and 2 years were 20, 20, and 19 dB. ABG differences at 3 months (p = 0.10) and 1 year (p = 0.36) were not statistically different. The failure rate for the SMart prosthesis was 12.5% and for the SMart 360° 2.2% (p = 0.002). There were no statistically significant differences in ABG changes for SMart compared to SMart 360°. The Smart 360 corrects the problem with early failure seen with the Smart prosthesis. Determination of most efficacious stapes prosthesis. Which stapes prosthesis produces better hearing results with fewer failures. To disseminate information necessary to choose the best stapes prosthesis for patients. Level III. 2022-029-agh.

Comparison of Total Endoscopic Ear Surgery and Microscopic Postauricular Canal-Wall-Down Approach on Primary Acquired Cholesteatoma.

This study aimed to compare total endoscopic ear surgery (TEES) and microscopic postauricular canal-wall-down tympanomastoidectomy (CWD) in cholesteatoma surgery in our clinic. This study included 59 patients, of whom 30 and 29 were operated on with CWD in 2016-2018 and TEES in 2019-2021, respectively and compared regarding intraoperative findings, hearing outcomes, long-term outcomes, and recidivism rates between groups. This study excluded patients in stage IV according to the European Academy of Otology and Neurotology/Japan Otological Society Staging System on Middle Ear Cholesteatoma, aged < 18, with congenital cholesteatoma, who underwent revision surgery. Two patients in the TEES group had recidivism (6.9%), with recurrent disease observed in both patients and residual disease in none, whereas 3 patients in the CWD group had recidivism (10%), including recurrent disease in 2 and residual disease in 1 patient. Tympanic membrane perforation occurred in 2 (6.9%) and 1 (3.3%) patients in the TEES and CWD groups, respectively. The 2 groups revealed no significant difference in terms of recidivism and perforation rates (P=1.000, P = .612). The CWD group had a longer mean operation time (225.54 ± 47.86 minutes) than the TEES group (160.55 ± 24.98 minutes) (P < .001). The 2 groups demonstrated no significant difference regarding pre- and postoperative air-bone gap (ABG) and ABG gain (P = .105, P=.329, P=.82, respectively). Total endoscopic ear surgery provides similar results in terms of hearing, recidivism, and long-term outcomes with the microscopic CWD approach. However, the CWD approach is still important, especially in patients in advanced stages.

Outcome of Primary Stapedotomy in 21 Consecutive Cases of Juvenile Otosclerosis.

Otosclerosis is a relatively uncommon condition that causes conductive hearing loss in children. The preferred treatment for adults is stapedotomy, while for individuals under 18 years old, there is an ongoing discussion about the best treatment approach. Thus, the surgical procedure for the stapes in pediatric patients continues to be a subject of debate. This study aimed to evaluate the results of stapes surgery in children, trying to understand, based on our results, whether this is actually the most suitable option. The study included 18 patients who underwent surgery between January 2013 and December 2023. The patients' ages ranged from 11 to 18 years, with an average age of 14.7. Out of the total 21 surgeries, three patients opted for bilateral surgery. Pre- and post-operative data were compared, focusing on the mean air conduction (AC) and bone conduction (BC) thresholds at frequencies of 0.5, 1, 2, and 4 kHz. Additionally, pre-operative thresholds and the post-operative air-bone gap (ABG) were examined. After a year, the air-bone gap was effectively reduced to 10 dB or less in 94% of the 21 cases, and to 20 dB or less in 98% of all cases. Our results and research in the field have consistently shown that stapedotomy, when conducted by skilled otosurgeons, is a reliable and successful procedure for a considerable number of patients. The outcomes it generates are similar to those achieved through the procedure conducted during adulthood.

Comparative study of endoscopic underlay myringoplasty with or without tucking of the attached perichondrium graft when repairing large central dry perforations

ObjectiveTo compare the graft success rates and hearing outcomes of underlay myringoplasty with or without perichondrium tucking of the attached perichondrium, graft perforation margins when repairing chronic large central dry perforations. Study designRandomized controlled trial. Material and methodsChronic large central dry perforations were prospectively randomized to tucking perichondrium graft underlay (TPGU) and no-tucking perichondrium graft underlay (NTPG) groups. The graft outcomes and complications were compared between the two groups at 12 months postoperatively. ResultsIn total, 61 patients with large central dry perforations were included. All patients completed 12-month follow-ups. Residual perforations occurred in 0.0 % of the TPGU group and in 12.9 % of the NTPG group (P = 0.129), and re-perforations occurred within 6 months in 0.0 % and 3.2 % of the two groups, respectively (P = 0.987). The graft success rates were 100.0 % (30/30) and 83.9 % (26/31) (P = 0.067). No significant between-group differences were observed in terms of preoperative (P = 0.547) or postoperative (P = 0.612) air bone gaps (ABGs) or mean ABG gains (P = 0.597). No graft-related complications were observed in either group during follow-up. No patients exhibited significant graft blunting or medialization; graft lateralization was noted in one patient of the NTPG group. ConclusionsEndoscopic cartilage with tucking of the attached perichondrium perforation margins during underlay myringoplasty may improve the graft success rate compared to that of the cartilage push-through technique when repairing large central dry perforations; however, the hearing improvements were comparable in the two groups.

Endoscopic and Microscopic Tympanoplasty for Adhesive Otitis Media: A Comparative Prospective Analysis.

BACKGROUND This prospective study aimed to compare outcomes and hearing improvement in 51 patients with adhesive otitis media following endoscopic and microscopic tympanoplasty. MATERIAL AND METHODS Between April 2021 and April 2022, 51 patients diagnosed with pars tensa retraction and hearing loss who underwent endoscopic and microscopic cartilage tympanoplasty were included in the study (endoscopic tympanoplasty group: 26 patients, microscopic tympanoplasty group: 25 patients). Pure-tone audiometric data (0.5, 1, 2, and 4 kHz), air-bone gap (ABG), and postoperative graft intake were compared. RESULTS Hearing gain in the ABG was significant in both groups (p<0.05). When the groups were compared for mean hearing gain in the ABG, the difference was significant (p<0.05). The postoperative ABG in the endoscopic group was significantly smaller than that in the microscopic group. When the postoperative air conduction threshold was evaluated, there was no significant difference between the 2 groups at 4 kHz, whereas a significant difference was observed in the endoscopic tympanoplasty group at 0.5, 1, and 2 kHz. Postoperative graft failure and otorrhea were not observed in any of the patients. CONCLUSIONS Pars tensa retractions and adhesive otitis media show comparable outcomes with both endoscopic and microscopic techniques. In endoscopic tympanoplasty, better visualization allows for better hearing outcomes. The endoscopic method, characterized by a wide field of view and a less invasive approach, enhances access to retraction limits.

Safety and performance of the new med-el total ossicular replacement prostheses.

This multicentric, retrospective study provides safety and performance data of the MED-EL total ossicular replacement prostheses (TORP). Patients underwent tympanoplasty with mXACT Total Prosthesis Center, mXACT Total Prosthesis Offcenter or mXACT PRO Total Prosthesis. The clinical data were retrospectively analyzed. Follow-up examination included access to the medical record (for adverse events) of the patients, ear microscopy and pure-tone audiometry to determine the post-operative pure tone average of the frequencies 0.5, 1, 2 and 3kHz (PTA4). The post-operative PTA4 air bone gap (ABG) was used to evaluate the audiological outcome. A post-operative minimum and maximum follow-up period was not defined. 103 patients were implanted with a TORP. 102 (88 adults, 14 children; 37 CHL, 64 MHL, 1 not specified) patients were analyzed for safety and 92 (79 adults, 13 children) patients for performance of the prostheses. ADVERSE EVENTS RESULTS (N = 102): In 1 patient (child, mXACT Total Prosthesis Offcenter) a prosthesis dislocation was reported, which lead to a revision surgery. No prosthesis extrusion or migration was reported. AUDIOLOGICAL RESULTS (N = 92): 49 (53.3%) of the 92 patients had a PTA4 ABG of ≤ 20dB and therefore a successful rehabilitation. The mean post-operative PTA4 ABG of all 92 patients was 21.0 ± 9.7dB. The first endpoint, improvement in post-operative PTA4 ABG of ≤ 20dB by ≥ 25% of the patients was achieved. The individual Δ BC PTA4 (post-operative minus pre-operative BC PTA4) thresholds were stable (within ± 5dBHL) in 91 (98.9%) patients. 1 patient had a BC PTA4 deterioration of 11.3dBHL. The MED-EL TORPs are safe and effective for middle ear reconstruction. Trial registration number NCT05565339, September 09, 2022, retrospectively registered.

Microscopic versus Endoscopic Stapes Surgery – A Meta-Analysis

Abstract Background The microscope is the conventional method used by ear surgeons to view the middle ear structures, allowing for binocular vision and the freedom of both hands. Its main disadvantage is the need for an unobstructed, direct view of the operating area. The end-aural incision, drilling of the bony auditory canal, and regular repositioning of the patient and the surgeon are a few examples of how the operation has to adapt to the microscope. Nevertheless, the microscope has proven itself as the tool of choice in stapes surgery with reliable outcomes. Objective to compare endoscopic and microscopic interventions in stapes surgery regarding intraoperative and post-operative outcomes. Patients and Methods The review was a meta analytic &amp; systematic review that included randomized controlled trials (RCT), case series and retrospective studies which studied the comparison of microscopic and endoscopic stapes surgery, 15 articles published between 2014 and 2020 were included in our study. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2020. Results Our results showed that the injury to the chorda tympani nerve was significantly higher in microscopic vs endoscopic groups. And also as regard the operative times, it was significant longer in microscopic vs. endoscopic groups. But there is no significant difference as regarde pain, dizziness, perforation of tympanic membrane, delayed conductive hearing &amp; post-operative Air- bone gap improvement and taste disturbance between both groups. Conclusion Endoscopic stapes surgeries are technically feasible, safe and promising. Overall, our study indicates endoscopic and microscopic stapes surgery has similar audiological success, with some data suggesting a lower risk of chorda tympani injury and postoperative taste disturbance with the endoscope. Endoscopic stapes surgery appears to be a reasonable alternative to microscopic stapes surgery, with similar complications (chorda tympani nerve injury, pain, Perforation of tympanic membrane, taste disturbance, Dizziness, and delayed conductive hearing). Shorter operative times shorter and lower postoperative air-bone gap were found in endoscopic stapes surgery. Superior visibility with the endoscope was consistently reported in all the studies. This meta-analysis of the current evidence supports the use of endoscopic techniques for stapes surgery.

Outcomes After Exoscopic Versus Microscopic Type 1 Tympanoplasty.

To analyze the outcomes of exoscopic versus microscopic type 1 tympanoplasty. Retrospective chart review. Tertiary care otology-neurotology practice. Adult subjects with a diagnosis of tympanic membrane perforation from 2018 to 2022. Exoscopic or microscopic tympanoplasty with cartilage + perichondrium or perichondrium/fascia graft. Primary outcomes were graft success rate (1 wk, 3 wk, 3 mo, and 6 mo postoperatively) and operative time. Secondary outcomes included audiometric outcomes of postoperative air-bone gap (ABG), change in ABG, pure tone average (PTA), speech reception threshold (SRT), and word recognition score (WRS) at 6-month follow-up and complication rates of cerebrospinal fluid leak, facial nerve injury, persistent tinnitus, and persistent vertigo. Seventy-one patients underwent type 1 tympanoplasty by a single surgeon. Thirty-six patients underwent exoscopic tympanoplasty, and 35 patients underwent microscopic tympanoplasty. Cartilage and perichondrium were utilized in 27 subjects (75.0%) in the exoscopic group and in 25 subjects (71.4%) in the microscopic group (p = 0.7, Cramer's V = 0.04). Graft success rate was as follows (exoscope versus microscope): 100% (36/36) versus 100% (35/35) at 1 week (p = 1.0, Cramer's V = 0.0), 97.2% (35/36) versus 100% (35/35) at 3 weeks (p = 1.0, Cramer's V = 0.1), 97.2% (35/36) versus 94.3% (33/35) at 3 months (p = 1.0, Cramer's V = 0.07), and 91.7% (33/36) versus 91.4% (32/35) at 6 months (p = 0.7, Cramer's V = 0.0). Operative time was 57.7 minutes for the exoscopic group and 65.4 minutes for the microscopic group (p = 0.08, 95% CI [-16.4, 0.9], Cohen's d = 0.4). There were no serious complications. All preoperative and postoperative audiometric outcomes were comparable. The outcomes after exoscopic versus microscopic type 1 tympanoplasty are comparable.

Stapedotomy Utilizing a Fixed-Size Prosthesis in a Tertiary Care Center: A Retrospective Study.

Background Stapes surgery success depends on several factors, including the length of the prosthesis used. Whether to use a standard-size prosthesis or measure the length of the stapes prosthesis has been debated in the literature. This study aims to assess the surgical outcomes of a stapedotomy using the standard 4.5 mm prosthesis without custom measurements. Methodology This retrospective study involved patients with otosclerosis who underwent primary stapedotomy using a standardized 4.5 mm fixed-length prosthesis between January 2017 and February 2023 at a tertiary care center. Results Out of 111 charts reviewed, 99 ears (56 males and 43 females) were studied. The mean air-bone gap (ABG) significantly improved from 27.9 ± 9.12 dB preoperatively to 3.95 ± 3.54 dB post-operatively (p-value < 0.05). Hearing results showed that out of 99 ears, 96.96% had a postoperative ABG of ≤10 dB and 98.98% ≤20 dB. Only three patients showed postoperative mild transient dizziness that lasted a few days. None of the patients had persistent dizziness for more than one week. One patient developed postoperative reparative granuloma with tinnitus and sensory-neural hearing loss. None had a recurrence of the conductive hearing loss during the study period. Conclusion Our retrospective study on stapes surgery utilizing a standardized 4.5 mm prosthesis without custom measurements showed notable surgical success and safety. Using a standard-size prosthesis shortens the surgical time and eliminates the complexities associated with intraoperative measurements, potentially reducing the risk of complications.

COMPARATIVE STUDY OF SURGICAL OUT COME OF INTERLAY TYMPANOPLASTY AND UNDERLAY TYMPANOPLASTY IN TERMS OF HEARING IMPROVEMENT AND GRAFT UPTAKE

Introduction: Perforation of the tympanic membrane primarily results from middle ear infections, trauma or iatrogenic causes. Up to 80% of these perforations heal spontaneously; for the remaining, surgical repair, known as myringoplasty, is usually proposed. The principal indications are recurrent otorrhea, the desire to swim without having to waterproof the ear and to improve conductive hearing loss. Several factors may affect surgical outcome such as the surgical approach (endaural, postaural) and technique (underlay vs. overlay), site of perforation and type of graft utilized. Material &amp;Methods: This study was carried out from January 2018 to October 2019. Detailed history and examination were carried out the patient of Chronic Otitis Media with Inactive mucosal disease in large central perforation. Out of 50 patients, 25 patients were operated by underlay technique and rest 25 patients were operated by interlay tympanoplasty. In both the techniques of myringoplasty post auricular approach and temporalis fascia was used as a graft material and operated under general or local anesthesia. Conclusion: Thus in present study as far as resolution of air bone gap is concerned, Interlay technique showed a statistically better outcome as compared to the underlay group. The findings in present study showed a better graft up take in Interlay method which coupled with a better postoperative air bone gap provided a better overall outcome. Key words: Tympanoplasty , Interlay Tympanoplasty, Underlay Tympanoplasty, CSOM,

The New Semisynthetic TORP: A Prosthesis for Ossicular Reconstruction Both With the Absence and the Presence of the Stapes Superstructure.

To describe the new semisynthetic total ossicular replacement prosthesis (New-SSTORP) and to evaluate the New-SSTORP ossiculoplasty results both with the presence and absence of the stapes superstructure. Prospective study. Tertiary referral center. From April 2023 to May 2023, 18 New-SSTORP ossiculoplasties were performed by the first author. In all patients, the New-SSTORP was interposed between the footplate and the eardrum. The study group was divided into two groups (group A and group B). Group A included 13 patients with the absence of stapes superstructure. Group B included five patients with the presence of stapes superstructure. A successful reconstruction was defined as a postoperative air-bone gap ABG ≤20 dB. For all patients of groups A and B, the last audiometric control considered was performed in January 2024. The mean follow-up was 8½ months. The χ2 test was used to compare results. p < 0.05 was considered significant. Mean postoperative ABG ≤20 dB. At the end of follow-up, the overall success rate (ABG ≤20 dB) of New-SSTORP ossiculoplasty was obtained in 88.8% (n = 16 of 18) of cases. In group A, the success rate of New-SSTORP ossiculoplasty occurred in 84.6% (n = 11 of 13) of cases, and in group B, the success rate of New-SSTORP ossiculoplasty occurred in 100% (n = 5 of 5) of cases. There was no audiological statistically significant difference between groups A and B (Fisher value is 1; p < 0.05). In all cases, the time for positioning of New-SSTORP was about 5 minutes. The New-SSTORP has a minimal technical challenge for building and placement. The New-SSTORP ossiculoplasty results are very good both with the presence and absence of SS.

Hearing Outcomes After Ossiculoplasty With Bone or Titanium Prostheses-A Nationwide Register-Based Study.

This study compares hearing outcomes of two prosthesis materials, bone and titanium, used in ossiculoplasty. This retrospective nationwide registry-based study uses data systematically collected by the Swedish Quality Registry for Ear Surgery (SwedEar). The data were obtained from clinics in Sweden that perform ossiculoplasty. Patients who underwent ossiculoplasty using either bone or titanium prostheses were registered in SwedEar between 2013 and 2019. Hearing outcome expressed as air-bone gap (ABG) gain. The study found no differences between bone and titanium for ABG or air conduction (AC) for either partial ossicular replacement prostheses (PORP) or total ossicular replacement prostheses (TORP). In a comparison between PORP and TORP for ABG and AC outcomes, regardless of the material used, PORP showed a small advantage, with an additional improvement of 3.3 dB (95% CI [confidence interval], 0.1-4.4) in ABG and 2.2 dB (95% CI, 1.7-4.8) in AC. In secondary surgery using TORP, titanium produced slightly better results for high-frequency pure tone average. The success rate, a postoperative ABG ≤20 dB, was achieved in 62% of the operations for the whole group. Both bone and titanium used to reconstruct the ossicular chain produce similar hearing outcomes for both PORP and TORP procedures. However, titanium may be a preferable option for secondary surgeries involving TORP. The success rate, a postoperative ABG ≤20 dB, is consistent with other studies, but there is room for improvement in patient selection criteria and surgical techniques.