Postoperative Pure-tone Average Research Articles

Review of a single surgeon’s stapedotomy cases performed with a nickel titanium prosthesis over a 14-year period

Conclusion: Stapes surgery with a nickel titanium prosthesis is a safe and well-tolerated procedure that leads to a significant improvement in hearing outcomes.Objective: To identify the efficacy and safety of stapedotomy procedures performed with a nickel titanium prosthesis for patients with otosclerosis.Methods: A review of 431 unique stapedotomies performed over 14 years by a single surgeon at an academic tertiary care center yielded 312 cases with nickel titanium prosthesis that met inclusion criteria of otosclerosis diagnosis, initial surgery in operative ear, and presence of pre-operative and post-operative audiograms. Pure-tone averages (PTA) at baseline and 8 weeks after surgery were calculated over four frequencies; 0.5, 1, 2, and 4 kHz. Average air–bone gaps (ABG) were calculated from pre-operative and post-operative audiograms.Results: Average pre-operative baseline PTA was 56.7 dB in the affected ear. Post-operative PTA was 30.1 dB, a 26.6 dB improvement. Initial average ABG was 29.7 dB, while post-operative ABG averaged 5.4 dB, a 24.2 dB improvement. Surgical success (closure of ABG within 10 dB) was achieved in 263 (84%) patients. Rate of surgical success was not correlated with age, gender, race, or affected ear. Complications included recurrent conductive hearing loss (14), progressive SNHL (4), and post-operative BPPV (3).

Hearing Gain with Tailor-made Polyethylene Strut in Total Stapedectomy

Objective: To study audiometric changes after total stapedectomy with tailor-made polyethylene strut. Methods: A retrospective analysis of preoperative and postoperative hearing results. One hundred and ninety-eight patients underwent total stapedectomy during 2009-2014. Stapedectomy was performed with tailor-made polyethylene strut prosthesis on vein or perichondrium graft over oval window. Changes of preoperative and postoperative pure tone average (PTA) were calculated from 4 frequencies after stapedectomy. Results: Ninety percent success rate in the air-bone gap closure within 10 dB after stapedectomy. Conclusion: Tailor-made polyethylene strut prosthesis is a cheap and cost-effective prosthesis, which is an alternative option for surgeons instead of the commercial prosthesis.

Comparative study of type I tympanoplasty with or without mastoidectomy in tubotympanic type of chronic suppurative otitis media patients

Objectives: The aim is to compare the results of type I tympanoplasty alone and tympanoplasty with cortical mastoidectomy in safe chronic suppurative otitis media (CSOM) patients in terms of graft uptake, improvement in hearing and clinical improvement. Study Design: This was prospective study. Materials and Methods: Sixty cases of safe type of CSOM were included in the study. Type I tympanoplasty was done in thirty cases and tympanoplasty with cortical mastoidectomy was done in another thirty cases. Patients were followed up postoperatively at 3, 6, and 12 weeks for graft uptake and any complication. Pure-tone audiometry was done at 6th and 12th week postoperatively to note the hearing improvement. Results: Graft uptake was 76.67% in tympanoplasty alone group and 83.33% in tympanoplasty with cortical mastoidectomy group. In the present study, pre- and post-operative pure-tone average was compared and the statistical difference between tympanoplasty group and tympanoplasty combined with cortical mastoidectomy group was not statistically significant. Recurrence of discharge was seen in 6 cases of tympanoplasty alone group. Although tympanoplasty combined with cortical mastoidectomy is better in hearing yield, graft acceptance rate, and clinical benefit, but the difference in two groups is statistically insignificant. Conclusion: Hearing outcome, graft acceptance rate, and clinical benefit were statistically unequalled in two groups. Tympanoplasty combined with cortical mastoidectomy will not give an additional advantage in terms of hearing gain, disease clearance, and graft uptake.

Hearing Preservation After Cochlear Implantation May Improve Long-term Word Perception in the Electric-only Condition.

To correlate hearing preservation with word perception in the electric-only condition in recipients of full length cochlear implant (CI) electrode arrays. Retrospective chart review. Tertiary academic referral center. CI recipients between January 2003 and December 2013 who had measurable residual acoustic hearing before surgery and serial postoperative word perception tests. Demographic data, pre- and postoperative pure-tone average, and postoperative monosyllabic word perception scores were evaluated. Hearing preservation was correlated with postoperative monosyllabic word perception scores. Data from 96 ears in 91 subjects were included. Complete or partial hearing preservation was achieved in 48%. After 6 and 12 months, no significant difference in word perception was found between subjects with and without hearing preservation. However, after 18 or more months, subjects with hearing preservation had significantly better word perception scores (83% versus 72%, p <0.05). Preservation of residual hearing leads to better word perception in the electric-only condition over the long term. CI recipients with hearing preservation continue to make progress after more than 12 months of CI experience whereas those without plateau at 12 months.

Cochlear Implants in Adults: Effects of Age and Duration of Deafness on Speech Recognition.

Unexplained outcome variability exists among adults with cochlear implants (CIs). Two significant predictors are age and duration of deafness, with older patients and those with longer durations of deafness generally demonstrating poorer speech recognition. However, these factors are often highly correlated. Thus, it is unclear whether poorer outcomes should be attributed primarily to age-related declines or to the experience of auditory deprivation. Our aim was to examine the effects of aging and duration of hearing loss on outcomes for postlingually deaf adults with CIs. Retrospective review of adults who received CIs from 1983 to 2014. Tertiary adult CI program. Sixty-four adult patients with postlingual hearing loss beginning after age 12 years, full electrode insertion, normal cochlear anatomy, and availability of postoperative outcome measures. Cochlear implantation with 12 months or greater of device use. Postoperative pure-tone averages (0.5, 1, 2, and 3 kHz) and recognition of words in sentences (Hearing in Noise Test and AzBio). Age at postoperative testing had a negative partial correlation with AzBio scores, when controlling for duration of deafness, whereas duration of deafness had a positive partial correlation with AzBio scores, when controlling for age. No other effects were identified. Older age at testing was associated with poorer recognition of words in difficult sentences, suggesting that cognitive aging may negatively impact CI outcomes. Further studies are needed to examine how a long duration of auditory deprivation affects CI outcomes.

Impact of cartilage graft size on success of tympanoplasty

IntroductionIn the last decade, there has been an increasing use of cartilage grafts in the primary repair of tympanic membrane perforations. The major advantages of cartilage are its stiffness and its very low metabolic requirements, which make it particularly suitable for difficult conditions, such as subtotal perforations, adhesive otitis and reoperation. ObjectiveTo analyze the impact of different perforation sizes requiring different sizes of cartilage on the anatomical and functional outcome after tympanoplasty. MethodsThrough this prospective non-controlled, non-randomized study, 50 patients underwent cartilage type 1 tympanoplasty (20 females and 30 males), with a mean age of 19.3±9.8 years. According to size of perforation, patients were subdivided into three groups, Group I had perforation >50% of tympanic membrane area, in Group II patients the perforations were 25–50% of tympanic membrane area, and in Group III the perforations were ≤25% of tympanic membrane. All patients had pre and postoperative Pure Tone Average and Air Bone Gap frequencies (0.5, 1, 2, 4kHz). All patients were followed up at least 12 months after operation. ResultsThe anatomical success rate among all patients was 92%, all groups showed statistical significant improvement between pre and postoperative air bone gap, no significant correlation between size of cartilage graft and degree of air bone gap improvement was noticed among the three groups. ConclusionSize of a cartilage graft has no impact on degree of hearing improvement or anatomical success rate after tympanoplasty.

Audiological Outcomes of Type 1 Tympanoplasty done with Fibrin Glue

Introduction: The aim of this study was to assess the audiological outcomes of type 1tympanoplasty done with fibrin glue by comparing the pre and post-operative pure tone average. Materials and Methods: Thirty three patients who were diagnosed to have chronic otitis media mucosal type and underwent type 1tympanoplasty with fibrin glue in the department of ENT of a tertiary care hospital between August 2014 and September 2015 were followed up for six months. Pre and post-operative pure tone averages were noted. Post operatively pure tone averages were noted at the third and sixth month follow-up. Results: A total of thirty three patients underwent the procedure. The pre op mean pure tone average was 34.45dB which improved to 24.55dB three months after the surgery and to 21.73dB six months after the surgery. Pre operatively 66.7% of the patients had a hearing loss of more than 31dB and only 3% had a hearing loss of less than 20dB, where as post operatively only 15.1% had a loss of more than 31dB and 48.5% had a loss of less than 20dB. One case of graft displacement was seen. Conclusion: The learning curve in using fibrin glue in tympanoplasty is not very steep and can be easily mastered. Through our study we have observed that using fibrin glue provides good hearing outcomes post-operatively and can be used especially in patients with large perforations to assure good hearing outcomes with graft uptake rates comparable to conventional methods.

Assessment of hearing in patients undergoing tympanoplasty with and without cortical mastoidectomy for chronic otitis media: A hospital-based, randomized controlled trial

Aims: To assess hearing in patients undergoing tympanoplasty with and without cortical mastoidectomy for chronic otitis media. Settings and Design: A hospital-based, randomized controlled study. Subjects and Methods: The study included sixty patients. Patients were randomly allocated into two groups of thirty each. In Group 1, patients underwent tympanoplasty alone. In Group 2, patients underwent tympanoplasty with cortical mastoidectomy. Hearing assessment was done by pure tone audiometry. Follow-up period was 3 months. Statistical Analysis Used: Paired and unpaired t-tests were used for quantitative variables and Chi-square test was used for qualitative ones. P Results: The mean pre- and post-operative pure-tone average was 42.4 ± 10.53 dB and 32.8 ± 13.02 dB in Group 1, with a mean hearing gain of 9.5 ± 11.33 dB. The mean pre- and post-operative pure-tone average was 42 ± 10.43 dB and 34.9 ± 9.94 dB in Group 2, with a mean hearing gain of 7.1 ± 8.85 dB. The mean pre- and post-operative air-bone gap was 37.27 ± 9.51 dB and 24.21 ± 11.64 dB in Group 1, with improvement in air-bone gap of 13.07 ± 12.93 dB. The mean pre- and post-operative air-bone gap was 32.27 ± 11.53 dB and 23.75 ± 9.91 dB in Group 2, with improvement in air-bone gap of 8.52 ± 9.13 dB. No statistically significant difference was seen between the two groups. Conclusions: Combining cortical mastoidectomy with tympanoplasty in the patients of chronic otitis media, mucosal disease, offers no additional benefit in terms of hearing improvement compared to tympanoplasty alone.

Surgical and Audiometric Outcomes for Repair of Congenital Aural Atresia and Hypoplasia.

Surgical repair of congenital aural atresia and hypoplasia (CAAH) is technically challenging. Long-term surgical and audiologic outcomes of atresiaplasty are incompletely understood. To review the surgical outcomes for CAAH and analyze the hearing results. A retrospective medical record review of CAAH outcomes was performed during an 11-year period from January 1, 2004, through December 31, 2014. The data analysis was undertaken from December 1, 2014, through January 31, 2015. The mean clinic follow-up time was 3.9 years, and the mean audiologic follow-time was 2.8 years. The study included 98 patients aged 5 to 66 years (mean age, 16.6 years) with CAAH who underwent a total of 104 operations. Surgical repair of CAAH. Preoperative and postoperative pure-tone averages (PTAs), speech reception thresholds (SRTs), air-bone gaps (ABGs), and interaural PTA and SRT differences were compared. Factors that affect hearing outcomes were analyzed. The complication rates were reviewed and compared with results from similar studies. In the 98 patients with CAAH, the mean improvement in ABGs and SRTs was 26.7 and 25.9 dB, respectively, resulting in a postoperative ABG of 30 dB or less in 4 of 5 cases. The mean postoperative PTAs and SRTs were 36.9 and 34.3 dB, respectively. Patients with a functional native ossicular chain (36 of 104 [34.6%]) had significantly superior audiometric outcomes when compared with patients in whom a reconstruction prosthesis was required during primary or revision operations. Audiometric results from hypoplasia surgery were not significantly different from those of atresia surgery; results in patients with craniofacial syndromes were similarly not significantly different from those in patients with sporadic CAAH. We report a low incidence of meatal stenosis. The mean hearing outcomes for this group compared favorably with other series. The need for ossicular chain reconstruction was associated with poorer audiometric outcomes. The safety profile and the demonstrated hearing improvement of CAAH surgery suggest that it remains a favorable option for patients.

Hearing results of tympanoplasty with attic reconstruction vs. obliteration in attic cholesteatoma

INTRODUCTION: The aim of the study was to compare hearing results between tympanoplasty with attic wall reconstruction and attic obliteration. MATERIAL AND METHODS: A prospective study included 88 patients who were operated for chronic suppurative otitis media (CSOM) and cholesteatoma in the ENT Department University Clinic Center Banja Luka from 2006 to 2011. Analysis of variance (ANOVA) was conducted to assess the impact of two different techniques of tympanoplasty: attic wall reconstruction and attic wall obliteration on patients` hearing. Hearing outcome was measured comparing preoperative to postoperative pure-tone average (PTA) and postoperative air-bone gap (ABG). RESULTS: Cholesteatoma was found in 54 (61.4%) patients: 31 (35.2%) sinus cholesteatoma, 20 (22.7%) attic cholesteatoma, 3 (3.4%) tensa tympanic cholesteatoma, and 34 cases (38.6%) of CSOM. Lateral attic wall and ossicular chain reconstruction was performed in 33 cases with subsequent attic reconstruction if the long process of the incus and the incudo-stapedial joint were missing. A mixed between-within-subjects analysis of variance showed significant improvement of PTA postoperatively in comparison to preoperative levels: Wilk`s Lambda=0.33, F(1,86)=172.1, p<0.001. ANOVA showed significant improvement of ABG postoperatively in comparison to preoperative levels: Wilk`s Lambda=0.23, F(1,86)=286.3, p<0.001. Hearing improvement was measured in both cases, the ABG closure and mean PTA improvement was larger in the attic reconstruction compared to attic obliteration technique. CONCLUSION: Attic wall reconstruction with cartilage provides better postoperative hearing compared to attic obliteration. Attic reconstruction in revision cases for cholesteatoma recurrence is not recommended.

Pediatric Modified Radical Mastoidectomy: Open Cavity versus Periosteal-Temporofascial Flap Obliteration: An Analysis

Obliteration of the mastoid cavity leaves a smaller cavity with quicker as well as better healing. Chances of developing cavity granulations or infection are also reduced. Protection of the lateral semicircular canal by soft tissue obliteration also prevents vertigo episodes on exposure to cold air. This prospective study was to compare the results of pediatric modified radical mastoidectomy (MRM) in open mastoid cavities and cavities obliterated with periosteal-temporofascial swing flap at Manipal Teaching Hospital, Pokhara; a tertiary referral centre. The cohort comprised of 40 pediatric patients who underwent MRM between January 2012 and December 2014. They were divided into group 1 where mastoid cavity was kept open and group 2 where mastoid cavity was obliterated with periosteal-temporofascial swing flap plus medicated bone dust. Results in the 2 groups were assessed by comparing the time taken for mastoid cavity to become dry, incidence of vertigo on exposure to cold air, tympanic membrane graft status, mastoid cavity status and change in the pre-operative to post-operative pure tone average after 6 months. Statistical analysis was done with Statistical Package for Social Sciences (SPSS) version 16.0. Statistical significance was set at p<0.05. Group 1 vs. Group 2 results were as follows: Mean time taken for mastoid cavity to dry was 81.8 days vs. 30.1 days. Vertigo on exposure to cold air was present in 77.3% vs. 0%. Tympanic membrane graft status was intact in 72.7% vs. 100%. Mastoid cavity epithelialization was complete in 68.2% vs. 94.4%. Mastoid cavity granulations were present in 36.4% vs. 5.6%. Mastoid cavity healing rates were 63.6% vs. 94.4%. Residual cholesteatoma was seen in 4.5% vs. 0%. Excessive wax & keratin debris was present in 36.4% vs. 5.6%. External auditory canal opening was adequate in 86.4% vs. 94.4%. The mean post-operative pure tone average was 37.61 dB vs. 25.97 dB. Mean gain in pure tone average was 8.94 dB vs. 19.84 dB. None of the patients developed intra-cranial complications. Periosteal-temporofascial swing flap plus medicated bone dust obliteration of pediatric MRM cavity provides a dry and healed cavity in less time with better hearing when compared to an open MRM cavity.

The "One Shot" Diode Laser Stapedotomy.

The purpose of this study was to evaluate the effectiveness and the safety of diode laser stapedotomy, through the functional results analysis. A total of 179 primary cases of otosclerosis that had been operated on with a diode laser technique from 2004 to 2012 were retrospectively reviewed. Preoperative, 1 month postoperative, and late annual follow-up audiograms (up to 8 years) were obtained in all the cases. Mean preoperative and 1 month postoperative pure-tone average (500-1000-2000-4000 Hz) bone conduction thresholds (PTA-BCs), air conduction (AC) hearing outcomes for 8 kHz and mean postoperative air-bone gap (PTA-ABG) closure were analyzed. The mean preoperative (pre) PTA-BC was 24.22 dB (±8.7 SD) whereas the mean postoperative (post) PTA-BC was 21.11 dB (±9.1 SD). The mean preoperative 8 kHz AC was 56.41 dB (±22.86 SD) and the postoperative 8 kHz AC was 52.56 dB (±24.35 SD). A statistically significant improvement of the PTA-BC post and of the postoperative 8 kHz AC was observed. The 1 month ABG closure within 10 dB in 89.02% of the patients and within 20 dB in 97.69% of the patients was obtained with statistically significant stability over long-term follow-up. No major complications occurred in the series. The use of diode laser with high power and short time exposure as setup can be considered a safe, precise, and useful tool in stapes surgery.

Facial Nerve Outcomes After Middle Fossa Decompression for Bell’s Palsy

Evaluate the long-term outcomes of facial nerve decompression via the middle fossa approach for Bell's palsy patients with poor prognosis based on clinical and electrodiagnostic testing. Retrospective case series. Tertiary-care, academic medical center. Fourteen patients underwent surgical decompression for Bell's palsy within 14 days of symptom onset from 2000 to 2012. Surgical criteria included greater than 90% degeneration on ENoG testing and no voluntary EMG potentials. Middle cranial fossa (MCF) bony decompression of the facial nerve, including the meatal foramen, labyrinthine segment, and geniculate ganglion. Long-term facial function, hearing results, and surgical complications. After MCF decompression, 10 patients (71.4%) regained normal or near-normal facial function (House-Brackmann [HB] I or II) within 1 year after surgery, and 5 of those patients (35.7%) improved to HB I. The remaining 4 patients (28.6%) improved to HB III. Patients older than 60 years (n = 3) had an HB III outcome and did significantly worse than the younger-than-60-years group (p = 0.002). The difference in preoperative and postoperative pure tone average and word recognition score was 2.1 dB and 0.9%, respectively. There were no major complications. Minor, transient complications occurred in 22.2% of patients. In patients with severe Bell's palsy at risk for a poor facial nerve outcome, MCF decompression of the facial nerve within 14 days of symptom onset provides good facial nerve outcomes with minimal morbidity.

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

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

Obliteration of Radical Cavities and Total Reconstruction Procedure Without Staging After Canal Wall Down Mastoidectomy: Long-term Results.

ObjectivesWe evaluate the long-term surgical and hearing results using a canal wall down mastoidectomy technique followed by cavities obliteration, canal wall reconstruction and ossiculoplasty without staging.MethodsA total of 44 patients between January 2002 and October 2009 were selected and 27 of them were revision cases. Preoperative and postoperative pure tone average (PTA) and air-bone gap (ABG) were assessed and compared 1 and 4 years after surgery.ResultsThe middle ear was well healed and aerated in 40 patients (90.9%) and the tympanic membrane was intact in 42 patients (95.5%). Recurrent cholesteatoma was found on postoperative follow-up in two of the revision patients (7.4%) but none in the primary patients. Seven patients were found to have partial canal bone absorption, but revision surgery was not required. Over 86.4% of all cases were water resistant. Long-lasting improvement and/or preservation of hearing, with maintenance of PTA-ABG closure in 63.7% of all cases within 20 dB, were obtained.ConclusionThe efficacy of our technique after a canal wall down mastoidectomy is satisfactory, and the rate of complication is acceptably low. We believe that our technique could be a convenient method in disease control and providing an excellent basis for hearing restoration simultaneously.

Surgery of isolated malleus fixation due to tympanosclerosis.

The aim of the present study was to describe our surgical approach for isolated malleus fixation in patients with tympanosclerosis and to analyze the postoperative results. A total of 30 patients presented with isolated malleus fixation were operated. The fixation was reached via canalplasty. Fixated areas were cleaned without damaging the ossicle. Pre- and postoperative audiometric results were evaluated for each patient. Improvement of the pure-tone average (PTA) by at least 10 dB and an air-bone gap (ABG) of less than 20 dB after 12 months of follow-up was accepted to indicate success. The recovery of the postoperative PTA and ABG measurements was significant. Pre- and postoperative PTA was 48.00 ± 11.86 and 24.90 ± 12.45 dB, respectively (p < 0.001). According to PTA measurements, 40-50 dB recovery was achieved in four (13.3 %) patients, 31-40 dB in six (20 %) patients, 21-30 dB in ten (33.3 %) patients, and 11-20 dB in five (16.6 %) patients, with a total success rate of 25/30 (83.2 %). Pre- and postoperative ABG levels were 38.95 ± 9.92 and 16.10 ± 7.79 dB (p < 0.001), respectively. The ABG level was between 0 and 10 dB for 8 (26.6 %) patients, and 11-20 dB for 16 (53.3 %), with a total success rate of 24/30 (80 %). In cases of isolated malleus fixation with tympanosclerosis, performing a canalplasty to clean the sclerotic plaques without damaging the normal anatomy of the ossicle system using a diamond burr is a safe surgical option that provides significant recovery in hearing levels.

The effect of stapes fixation on hearing results in tympanosclerosis treated by mobilization.

We aimed to investigate the effect of stapes fixation on hearing results in patients who underwent mobilization surgery due to tympanosclerosis (TS). Seventy-nine patients were retrospectively analyzed and divided into two groups. Forty-four (55.7%) patients with mobile stapes were classified as group 1, and 35 (44.3%) patients with fixed stapes were classified as group 2. Improvement of the air-bone gap (ABG) to become less than 20 dB and the pure-tone average (PTA) by at least 10 dB postoperatively were accepted as success criteria. The PTA and ABG levels were significantly improved in both groups. The pre- and post-operative PTAs were 46.57 ± 15.55 and 25.84 ± 15.47 dB, respectively, in group 1 (p = 0.001). The pre- and post-operative PTAs were 55.64 ± 12.69 and 36.20 ± 14.47 dB, respectively, in group 2 (p = 0.001). The pre- and post-operative ABG levels were 35.36 ± 10.53 and 16.91 ± 8.54 dB, respectively, in group 1 (p = 0.001). The pre- and post-operative ABG levels were 41.68 ± 8.78 and 22.20 ± 10.03 dB, respectively, in group 2 (p = 0.001). A gain ≥10-dB in the PTA in groups 1 and 2 was found in 34 (77.2 %) and 23 (65.7%) patients, respectively, and the difference between the groups was not significant (p = 0.684). The post-operative AGB in groups 1 and 2 was less than 20 dB in 32 (72.7%) and 21 (60%) patients, respectively, and the difference between the groups was not significant (p = 0.733). No significant negative effect of stapes fixation on post-operative hearing results in TS was detected. Successful results can be obtained with a mobilization procedure, even if the stapes is fixed.

Stapedotomy in cochlear implant candidates with far advanced otosclerosis: a systematic review of the literature and meta-analysis.

To evaluate the effect of stapedotomy in cochlear implant candidates with far-advanced otosclerosis (FAO). Systematic review of literature and meta-analysis. PubMed, EMBASE, and Cochrane databases were searched for "stapedotomy" and "far-advanced otosclerosis" and their synonyms. The search was carried out on November 28, 2013; no language restrictions were applied. The initial search yielded 243 articles; a total of nine articles met our inclusion criteria (i.e., patients with FAO and aided speech recognition scores of ≤50%) and were included in this review. In addition, a group of five patients (seven stapedotomies) of our own center was also included in this meta-analysis. The methodologic quality of included studies was assessed by examining the study design, level of evidence, method of measurement, and adequacy of outcome reporting. The speech recognition scores before and after stapedotomy as well as the pure-tone average before and after stapedotomy were extracted. A random-effects model was fitted for calculating weighted means. The mean preoperative speech recognition score was 11%; stapedotomy resulted in a mean postoperative speech recognition score of 59%. The mean preoperative and postoperative pure-tone averages were 112 dB HL and 80 dB HL, respectively. Seventy-two percent of the patients no longer met the criterion for cochlear implantation (CI) (i.e., <50% speech recognition), and 35% of the patients reached a postoperative aided speech recognition of more than 80%. Stapedotomy combined with hearing aid fitting results in a good outcome in a substantial amount of CI candidates with FAO. We feel that a stapedotomy should be attempted before considering CI in all patients with FAO. In patients with bilateral otosclerosis, a contralateral stapedotomy may offer patients the benefits of binaural processing. If bilateral stapedotomy yields an unsatisfactory outcome, the option for CI is still open.

Prognostic factors for long-term hearing preservation after canal-tympanoplasty for congenital aural atresia.

The present study aimed to determine favorable prognostic factors for long-term postoperative hearing outcome after canal-tympanoplasty for congenital aural atresia (CAA). We retrospectively reviewed pre and postoperative hearing results and image findings of 51 ears with CAA performed by canal-tympanoplasty for primary repair. Averages of the postoperative air and bone-conduction thresholds, and the air-bone gap (ABG) were calculated from the last pure-tone audiometry. Follow-up duration ranged from 16 to 139 months. A successful hearing result was defined as a postoperative ABG of ≤15 dB, or a postoperative pure-tone average of ≤30 dB. The influence of the following factors on the success of surgery was assessed by multivariate logistic regression analysis: total Jahrsdoerfer grading system score, age at surgery, and dimensions of middle ear including incudostapedial joint angulation, mesotympanic height, mesotympanic width, mesotympanic depth, mesotympanic area, mesotympanic volume, reconstructable external auditory canal (EAC) diameter, and reconstructable EAC height. Successful hearing outcomes were achieved in 24 of 51 ears (47.1%). A multivariate logistic regression analysis showed that an EAC area >72.3 mm(2) was the most significant favorable predictive factor (P = 0.006), followed by mesotympanic depth >5.5 mm (P = 0.013), mesotympanic height >4.6 mm (P = 0.016), and EAC diameter >9.5 mm (P = 0.029). In conclusion, the size of the reconstructable EAC and mesotympanum is important for predicting long-term favorable hearing outcome following canal-tympanoplasty for CAA.

The Envoy Esteem Hearing System: Single Surgeon Experience

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