Postoperative Hearing Thresholds Research Articles

Artificial neural network modelling of the results of tympanoplasty in chronic suppurative otitis media patients

The application of computer modelling for medical purposes, although challenging, is a promising pathway for further development in the medical sciences. We present predictive neural and k-nearest neighbour (k-NN) models for hearing improvements after middle ear surgery for chronic otitis media. The studied data set comprised 150 patients characterised by the set of input variables: age, gender, preoperative audiometric results, ear pathology and details of the surgical procedure. The predicted (output) variable was the postoperative hearing threshold. The best neural models developed in this study achieved 84% correct predictions for the test data set while the k-NN model produced only 75.8% correct predictions.

Clinical Characteristics and Surgical Benefits and Problems of Chronic Otitis Media and Middle Ear Cholesteatoma in Elderly Patients Older Than 70 Years

To investigate the benefits and problems of tympanoplasty in elderly patients older than 70 years. Retrospective case review. Referral hospital otolaryngology department. Among 1,014 patients who underwent tympanoplasty for chronic otitis media from 2006 to 2011, those aged over 70 years were eligible for inclusion. Clinical characteristics including tympanosclerosis and preoperative severe complications were investigated. In chronic otitis media group, hearing outcomes (air-bone gap at 500-Hz and 1- and 2-kHz frequency) and postoperative ear condition were investigated. In chronic otitis media with cholesteatoma, clinical characteristics including postoperative bone conduction hearing threshold (at 500-Hz and 1- and 2-kHz frequency) were investigated. Ninety-seven ears of 83 patients were included. Eighteen ears had obvious findings of tympanosclerosis (18/97 = 18.6%). In chronic otitis media without cholesteatoma (52 ears/47 patients), no preoperative complications were noted. The mean air-bone was 30.8 and 16.1 dB before and after the operation, respectively (p < 0.001). Otorrhea disappeared in 51 ears (98.1%). In chronic otitis media with cholesteatoma (42 ears/33 patients), we noted preoperative severe complications including labyrinthine fistula (7/97 = 7.22%), widely exposed dura (1/97 = 1.03%), and facial palsy 1 (1/97 =1.03%). The mean bone conduction hearing threshold was 39.6 dB and 40.89 dB, respectively (p = 0.7). Three ears of 3 patients had operated ears with open mastoid and underwent canal wall reconstruction tympanoplasty. Tympanoplasty in elderly patients older than 70 years seems to be as safe as when performed in younger patients.

Comparison of incus interpositioning technique versus glass ionomer cement application in type 2 tympanoplasty

Objective of this study is to compare glass ionomer cement application and incus interpositioning techniques in patients who have chronic otitis media, conductive hearing loss with intact tympanic membrane and who undergo hearing reconstruction of staged surgery using a retrospective chart review in the setting of Ministry of Health Ankara Training and Research Hospital ENT Clinic, Turkey. We retrospectively evaluated patients who underwent otological surgery and hearing reconstruction with auto graft incus during 2005-2008 or glass ionomer cement during 2008-2010. Patients who had cholesteatoma, stapes fixation and tympanosclerosis were excluded. Postoperative mean follow-up time of 107 patients was 9.8 months (6-38 months, 83.2 % of them was ≤ 9 months). Postoperative pure tone hearing thresholds, graft status, gain scores and air bone gaps were recorded. Intact graft, dry ear on the operated side and ABG scores less than 20 dB were accepted as surgical success. Preoperative ABG score was 30.6 ± 7.93 dB in glass ionomer (group I) and 33.6 ± 11.99 dB in incus interpositioning (group II). Postoperative ABG scores were 13.6 ± 10.40 and 22.6 ± 12.39 dB, respectively, in group I and II. Success of closure in ABG scores was obtained in both groups (p < 0.001). Gain scores in group I were better (p = 0.035). Graft success (p = 0.020) correlated with gain score. Results showed that the glass ionomer cement application is a good, cost-effective technique, easy to perform and yields better hearing scores and lower complication rates compared to incus interpositioning technique.

Hearing Preservation Via a Cochleostomy Approach and Deep Insertion of a Standard Length Cochlear Implant Electrode

The suggestion that the depth of insertion of the electrode into the cochlea is critical to hearing preservation has led to the development of a generation of short electrodes designed to minimize intracochlear trauma and avoid contact with the apical region of the cochlea. This study aims to describe our experience of hearing preservation surgery using a deeply inserted standard length electrode array covering the region of residual hearing. A retrospective case note review was performed identifying cases of attempted hearing preservation using standard length electrodes. Study based at Manchester Royal Infirmary, a tertiary referral center. Fourteen cochlear implants in 13 patients were identified for further analysis from the Manchester Cochlear Implant Programme database. Each patient received the same design of implant using a "soft" surgical technique. Preoperative and postoperative air conduction thresholds were compared to assess the degree of hearing preservation. Successful hearing preservation was demonstrated in 12 of 14 cases, and the postoperative residual hearing thresholds in 3 adolescents receiving a standard length electrode array were found to have improved. Preservation of speech recognition was not measured in this study, rather hearing was tested by pure tone audiogram. Follow-up at the time of this study ranged from 1 week to 23 months. This study demonstrates that deep insertion of the electrode into the cochlea does not preclude successful hearing preservation. It also highlights that residual hearing can be consistently preserved using a "cochleostomy" approach.

Synchronous ossiculoplasty with titanium prosthesis during canal wall down surgery for advanced cholesteatoma: anatomical and hearing outcomes

To analyse patients with cholesteatoma undergoing canal wall down mastoidectomy together with ossicular reconstruction with a titanium prosthesis, in order to identify factors associated with hearing outcomes. Retrospective review of 97 cases undergoing single-stage surgical management. All patients underwent canal wall down mastoidectomy. Kurz titanium ossicular prostheses were used for ossicular chain reconstruction. Pre-operative and post-operative air conduction and bone conduction hearing thresholds were obtained at 500, 1000, 2000 and 3000 Hz. The mean pure tone average improved from 46.02 ± 14.54 dB pre-operatively to 29.32 ± 14.64 dB post-operatively, for both total and partial ossicular replacement prosthesis groups combined. The mean air-bone gap improved from 30.38 ± 11.12 dB pre-operatively to 15.62 ± 9.65 dB post-operatively, for both groups combined. Reconstruction with a titanium prosthesis offers good functional results when performed during canal wall down surgery for advanced cholesteatoma, as a single-stage procedure.

Type of Electrode Insertion and Hearing Preservation Outcomes

Objective: Assess the levels of hearing preservation during cochlear implant surgery by comparing different electrode insertion techniques (standard cochleostomy, soft surgery, round window). Method: Retrospective chart review looking at levels of hearing preservation after cochlear implantation in children and adults, using different electrode insertion techniques (N = 144 ears from 32 patients). Pre- and postoperative pure tone thresholds at 250, 500, and 1000 Hz frequencies were measured. Statistical analysis was performed using nonparametric method (Kruskal Wallis test). Results: One hundred and four (72%) procedures were performed using standard cochleostomy, 25 (17 %) procedures were performed using soft surgery, and 15 (11 %) procedures were performed using round window insertion. Postoperative hearing thresholds were used as the main outcome measure. In all groups, residual hearing was preserved in different degrees (total: 30 %, moderate: 27 %, marginal: 37 %, none: 6 %). Statistically significant differences were encountered between the 3 groups. Soft surgery technique and round window insertion had better hearing preservation results compared to standard cochleostomy ( P &lt; .008 and P &lt; .009, respectively). No difference between round window and soft surgery techniques was encountered ( P = .07). Conclusion: Although cochlear implants are a revolutionary technology, they carry the risk of destroying residual hearing. Our study demonstrates that the use of soft surgery or round window techniques warrants better residual hearing when compared to standard cochleostomy.

An evaluation of preservation of residual hearing using the suprameatal approach for cochlear implantation

The preservation of residual hearing has become a high priority in cochlear implant surgery. This study was designed to substantiate whether conservation of residual hearing can be preserved after cochlear implantation using the suprameatal approach. Retrospective chart review. Retrospective chart review was performed in 109 severely to profoundly hearing impaired cochlear recipients who had some measurable hearing preoperatively. Subsequently, the pre- and postoperative pure-tone thresholds were analyzed by three different analyses to observe the degree of hearing preservation. Single-subject results showed a complete conservation of residual hearing (change in pure-tone average [ΔPTA] ≤ 10 dB) in 27 of 109 patients (24.7%). Partial conservation of residual hearing (ΔPTA > 10 dB) was observed in 77 patients (70.6%), but these percentages have been affected severely by ceiling effects. Furthermore, group-subject results demonstrated that the median postoperative PTA was 11.7 dB worse than the preoperative PTA. For individual frequencies, the median deteriorations were 15, 20, 10, and 5 dB at 250, 500, 1,000, and 2,000 Hz, respectively. Stratification for the absence of postoperative hearing thresholds showed a conservation of measurable postoperative hearing levels in 17.4% of all study patients. The results of this study demonstrate that complete preservation of residual hearing is possible in a limited number of patients using the suprameatal approach technique for cochlear implantation. For a reliable analysis of the audiometric effects of cochlear implant surgery, it is important to take into account the ceiling effects, therefore using different calculation methods to estimate the accurate deterioration of hearing thresholds.

Transmastoid extradural–intracranial approach for repair of transtemporal meningoencephalocele: A review of 31 consecutive cases

To review the clinical presentation, surgical techniques, and outcomes of the transmastoid extradural-intracranial (TMEDIC) approach for the treatment of transtemporal meningoencephalocele. The TMEDIC is a safe and effective approach to repair meningoencephalocele originating from the middle or posterior cranial fossa. Retrospective chart review. Academic neurotologic tertiary referral center. Thirty-one consecutive patients diagnosed with transpetrous meningo(encephalo)cele, with or without cerebrospinal fluid leak, between January of 2003 and October of 2010. TMEDIC approach for repairing herniated neural tissue through the tegmen or posterior fossa plate using the combination of autologous cartilage, fascia, and tissue sealant. Anatomic location, size, and number of defects, presence of herniated brain tissue, pre- and postoperative hearing thresholds, and failure rate. Mean age was 62 ± 26 years. The etiology was spontaneous in 25/31 (80%), congenital in 3/31 (10%), chronic otitis media in 2/31 (6%), and posttraumatic in 1/31 (4%). Posttympanostomy tube clear otorrhea was the presenting sign in 21/31 (68%) of patients. The mean duration of symptoms was 26 months (range: 1-240). The defect involved the middle fossa (MF) floor in 25/31 (90%). Both the tegmen tympani and mastoideum were involved in 12/31 (39%) of patients and multiple dehiscences were seen in 7/31 (22%). In 17/31 (55%) of cases the size exceeded 1 cm. No recurrences were seen. The TMEDIC is a safe and effective method to repair transtemporal meningoencephalocele obviating the need for a middle fossa craniotomy in certain cases.

Atraumatic round window deep insertion of cochlear electrodes

Conclusion: This study shows that by using the round window approach and deep insertion, it is possible to reduce electrode insertion trauma (EIT), as indicated by the results of the hearing preservation marker. Objectives: In this prospective study EIT was evaluated in 42 subjects with low frequency hearing before surgery with 28 mm round window deep insertion. Methods: The degree of hearing preservation was a marker of EIT. Pure tone audiometry, monosyllable testing was conducted preoperatively and then at 3, 6, and 13 months after surgery. Results: Immediate hearing preservation (3 months postoperatively) was 92.9% (39/42). The surgery-related hearing preservation 13 months after surgery varied from 85% (34/40) to 90% (36/40). The ipsilateral implanted ear showed significant differences between preoperative and postoperative hearing thresholds (p < 0.005). Comparisons of thresholds for the control ear showed a significant difference between preoperative and postoperative thresholds tested 13 months after surgery (p < 0.05). When the subtraction factor of the mean contralateral hearing loss for each tested frequency for the same time interval was applied to the implanted ear, no significant hearing loss was found, showing that postoperative ipsilateral progressive hearing loss was caused by etiology rather than surgery.

Vibrant Soundbridge Surgery in Patients With Severe External Otitis

To evaluate the transcanal surgical implantation of the semi-implantable Vibrant Soundbridge (VSB) device in patients with severe external otitis. Retrospective analysis. Long-term postoperative complications and postoperative hearing thresholds were evaluated in 13 adults with bilateral sensorineural hearing loss (average of between 40 and 55 dB HL) and therapy-resistant external otitis after implantation of the VSB by a transcanal surgical method. Postoperative audiometry findings were comparable with those reported after the transmastoidal posterior tympanotomy approach. In 2 patients, the chorda tympani was intentionally sacrificed to maximize the size of the facial recess. Seven postoperative complications occurred in 6 patients (46%) during a mean follow-up period of 51 months: extrusion of the conducting wire into the ear canal (n=5), collapse of the cartilaginous part of the ear canal (n=1), and tympanic membrane perforation (n=1). In the revision operations that added additional layers of fascia for the patients with wire extrusions, repeated extrusion occurred in 3 of 4 cases. The transcanal approach for the implantation of the VSB has led to postoperative complications different from those reported after the transmastoidal posterior tympanotomy approach. External otitis should be considered as a contraindication for VSB surgery by the transcanal approach.

Correlations between CT scan findings and hearing thresholds in otosclerosis

Conclusion: High-resolution computed tomography (CT) scan may reveal an isolated fenestral form of otosclerosis, and an extensive form, which involves multiple foci around the otic capsule. Pre- and postoperative hearing thresholds are poorer in patients with extensive otosclerosis and their chance of overclosure is reduced by 90%. Objectives: To evaluate the relationship between CT scan extension of otosclerotic foci and hearing thresholds in the operated ear, before and after stapedotomy. Methods: A preoperative CT scan was performed in 200 patients suspected of having otosclerosis. CT scan findings were categorized as negative, isolated fenestral otosclerosis, and extensive otosclerosis. Preoperative and 2 months postoperative air-conduction (AC) and bone-conduction (BC) thresholds were collected. Results: In the operated ear, 150 CT scans (75%) revealed an isolated fenestral otosclerosis; 35 (17.5%) were classified as extensive otosclerosis. Mean preoperative BC was significantly poorer in extensive otosclerosis (30.3 dB) than in isolated fenestral otosclerosis (24.6 dB). Mean postoperative BC remained lower in extensive otosclerosis (30.3 dB) than in isolated fenestral otosclerosis (21.2 dB). An overclosure greater than 10 dB was found in 20% of isolated fenestral otoscleroses and in 2.85% of extensive otoscleroses (chi-square: 5.5; p = 0.02).

35 cases clinical observation of open mastoidectomy with tympanoplasty

Objective To study the dry ear curative effect and hearing enhancement of openmastoidectomy with tympanoplast(OMT).Methods 35 patients with chronic suppurative otitis media from 2008.6-2009.6 received OMT,35 patients received Ⅰ stage auditory bone chain reconstruction,22 examples were implanted the titanium artificial auditory bone,13 examples used autogenous bone followed up at one year.Results Tympanic membrane perforation was healed in 33 cases(94.3%),dry ear in 35 cases( 100%).At 12 months post operative time,The post operative hearing threshold level improved over 30 dBHL( air conducted threshold)in 1 case,20 ～30 dBHL in 5 cases,10 ～20 dBHL in 20 cases,0 ～ 10 dBHL in 8 cases,1 case was worse,the hearing enhances above 10 dBHL for effective,the hearing raises effectiveness was 74.3%(26/35).Conclusion Adequate OMT could get a better result of dry ear and hearing enhancement in patients with chronic suppurative otitis media. Key words: Open mastoidectomy with tympanoplasty; Auditory rehabilitation; Air conduction

Cochlear Implantation Outcomes in Patients With Autoimmune and Immune-Mediated Inner Ear Disease

To compare hearing outcomes in patients with autoimmune inner ear disease (AIED) undergoing cochlear implantation to a group of controls, postlingually deafened by non-immune-mediated causes. Hearing performance in AIED patients who receive unilateral or bilateral cochlear implants is comparable to similarly treated postlingually deafened adults without AIED. Retrospective chart review. Academic neurotologic tertiary referral center. Ten patients with AIED with 12 implanted ears who met the audiological criteria for cochlear implantation were compared with 12 randomly selected controls, postlingually deafened by non-immune-mediated causes. Cochlear implantation using commercially available devices. Preoperative and postoperative hearing thresholds, words, and sentence scores. A note was made regarding the presence or absence of ossification or fibrosis noted within the scala tympani at the time of implant. The mean age was 49.6 ± 14 years in the AIED group and 56.8 ± 17 years in the control group (p = 0.31). The mean duration of deafness was 14 ± 26 months in the AIED group and 6.5 ± 4 months in the control group (p = 0.34). In the AIED group, 42% were men and 58% were women. In the control group, 33% were men and 67% women. Five patients in the AIED group (6 implanted ears) were found to have cochlear fibrosis and variable degrees of ossification. Two patients in that group required drill-out procedures. All patients had full insertion. The mean preoperative pure-tone averages in the AIED and control groups were 102 ± 18 and 90 ± 13 dB, respectively (p = 0.13). In the AIED, the mean short-term (≤12 mo of follow-up) postoperative word and sentence scores were 74.8% ± 15% and 94% ± 6%, respectively. In the control group, the mean short-term postoperative words and sentence scores were 72% ± 12% and 96% ± 4%, respectively. No statistical difference was present in the short-term postimplantation words (p = 0.7) and sentence scores (p = 0.49) between both groups. The mean long-term (after 12 mo of follow-up) postoperative word and sentence scores in the AIED group were 87.2% ± 11% and 96.8% ± 4%, respectively. In the control group, the long-term words and sentence scores were 77.2% ± 14% and 77.2% ± 7%, respectively. No statistical significance was found in the long-term postimplantation words (p = 0.17) and sentence scores (p = 0.7) between both groups. Cochlear implantation is a safe and viable option for hearing rehabilitation in patients deafened by progressive AIED. Hearing outcomes in AIED patients are excellent and support transition to implantation when hearing is lost or long-term steroid therapy becomes undesirable. Cochlear fibrosis or ossification seems to affect nearly 50% of implanted ears (41.6% of patients) in this study and implies that the cochlea is at risk for ossification changes long term. In appropriate candidates, earlier implantation may be indicated before postinflammatory obliterative changes in the cochlea.

Outcomes of the overlay graft technique in tympanoplasty

This audit was undertaken to review the outcomes achieved with the overlay graft technique of tympanic membrane repair in tympanoplasty surgery. The charts of all patients who underwent tympanoplasty, in whom an overlay graft technique of temporalis fascia tympanic membrane repair was used, between 1994 and 2007 were reviewed. Information with respect to patient demographics, presence of cholesteatoma or active infection and perforation size was documented. Details of the surgical procedure and clinical outcomes and pre- and post-operative hearing thresholds were recorded in a computer database. A total of 147 overlay graft procedures were performed in 130 patients. Graft failure with reperforation occurred following five procedures, for an overall success rate of 96.6%. Eighty Type 1 tympanoplasty procedures were performed in which one failure occurred for a 98.75% success rate. Overlay grafting was combined with intact canal wall mastoidectomy (ICW) in 38 cases and with modified radical mastoidectomy (MRM) in 17 cases for a success rate of 93.8 and 95%, respectively. Delayed graft healing as a result of infection, problems such as epithelial pearl, blunting and myringitis occurred in 39 cases (26.5%). Thirty-one cases underwent procedures for ossicular chain reconstruction, 21 of which were 2nd stage procedures. Hearing outcomes were significantly better with Type 1 tympanoplasty compared with ICW or MRM procedures. This review demonstrates the overlay graft technique of tympanoplasty to be highly successful for tympanic membrane repair, particularly for the more difficult cases such as revision surgery, subtotal perforations and mesotympanic cholesteatoma.

Aided Air Conduction Threshold as a Predictor of Cochlear Reserve in Otosclerosis Patients

Otosclerosis classically presents with conductive deafness. However, mainly in older patients or those with a progressive (active) form of this disease, it presents with elevated bone conduction (BC) thresholds. In many cases, an elevation in the BC threshold during otosclerosis is not a true indicator of ‘cochlear reserve’ and this apparent loss can be corrected by surgery. It is generally accepted that in those patients, elevated BC thresholds are not due to pure sensorineural hearing loss but to the Carhart effect. Speech discrimination tests are routinely done, and the results of these tests determine if a patient is a good candidate for surgery. In most institutions, those with poor speech discrimination scores are considered to be poor candidates due to inadequate cochlear reserve. Using hearing-aid-assisted pure-tone audiometry, we developed an accurate method to identify suitable candidates for surgery among the patients with elevated BC thresholds. This method is meant to complement speech discrimination tests in predicting the success of surgery in those patients. Different variables render speech discrimination tests unreliable in many patients. The rationale behind the current study was the lack of an easy and accurate clinical method to determine if a patient has a good cochlear reserve, and to predict the postoperative hearing threshold outcome.

Laterality of Exostosis in Surfers Due to Evaporative Cooling Effect

1. To correlate exostosis severity with ear canal evaporative cooling. 2. To assess hearing and complications after canalplasty. Retrospective chart review. A retrospective chart review from 1990 to 2007 at a university tertiary referral center. Surfers from the west coast of the United States were twice as likely to have severe exostoses in the right ear compared with the left. Evaporative cooling from a predominant northerly wind direction during the coldest water temperature months in this region may contribute to this lateral bias because surfers on this coast spend most of their time facing west. Few postoperative complications were identified. No cases of facial nerve injury or entry into the temporomandibular joint occurred. Differences in preoperative versus postoperative pure-tone hearing thresholds were not significant. Exostosis severity seems to correspond to the ear that is more exposed to the predominant coastal wind. We propose that evaporative cooling in a cold water environment contributes to greater progression of exostoses in the ear with more exposure to the predominant wind. Exostosis removal using the postauricular approach carries a low complication rate.

Hearing Rehabilitation Counseling for Patients With Otosclerosis-Related Hearing Loss

To standardize preoperative counseling for stapedectomy candidates. Retrospective case review. Tertiary referral center. Preoperative and postoperative hearing thresholds of 54 patients (55 stapedectomies) were retrospectively recorded. Patients (age range, 17-67 yr) were divided into 3 groups that differed significantly in their mean preoperative air conduction (AC) pure-tone averages (PTA) (up to 50, 50-70, and 70-90 dB). Comparison of the gap between the mean hearing thresholds achieved postoperatively and the target threshold (normal hearing) in the 3 groups. Preoperative and postoperative AC thresholds, bone-conduction (BC) thresholds, and air-bone gap at 0.5, 1.0, 2.0, and 4.0 Hz. Patients in the group with a mean preoperative AC below 50 dB had excellent postoperative results and achieved normal hearing thresholds. In the group with a mean preoperative AC of 50 to 70 dB, the postoperative results were good, but normal hearing thresholds were not achieved. Postoperative results in the third group were within the range of moderate hearing loss, allowing these patients to use hearing aids much more successfully than preoperatively. In each of the 3 groups, mean group differences between the preoperative and the postoperative values of AC-PTA thresholds, BC-PTA thresholds, and air-bone gap were statistically significant. Comparisons between each pairing of the stratified groups also yielded statistically significant differences. The preoperative AC-PTA threshold value can be viewed as a convenient, valid, and standardized basis for better informed and more comprehensive counseling of stapedectomy candidates with regard to options for hearing rehabilitation.

Temporalis Fascia and Cartilage-Perichondrium Composite Shield Grafts for Reconstruction of the Tympanic Membrane

We sought to compare the long-term functional results of tympanic membrane reconstruction with temporalis fascia and cartilage shield grafting. This study includes 113 patients who had tympanoplasty type I tympanic membrane reconstruction between 1997 and 2007, 47 with tragal cartilage and 66 with temporalis fascia. Fourteen patients in the cartilage group and 9 patients in the temporalis fascia group also had mastoidectomy. The average follow-up was 3.2 years. The hearing threshold was calculated as the mean value of the thresholds for 500, 1,000, 2,000, and 3,000 Hz. A paired-samples t-test was used for comparison of the preoperative and postoperative air and bone conduction hearing thresholds and air-bone gaps. Significant recovery was found in the postoperative air conduction threshold and air-bone gap in both the temporalis fascia and cartilage groups as compared to those before surgery (p < 0.001). However, the average air and bone conduction thresholds and air-bone gap were found to be statistically different after surgery in the cartilage group as compared to those in the temporalis fascia group. There was no significant difference in hearing parameters before and after surgery in patients with or without mastoidectomy in either the cartilage group or the temporalis fascia group. The hearing gain in patients with cartilage shield grafting was better than that in those who had temporalis fascia tympanoplasty, although experimental analysis shows loss of acoustic energy for thick and large shield cartilage grafts.

Ossicular Reconstruction with Sheehy PORP

ObjectiveTo report tympanoplasty cases completed with Sheehy Partial Ossicular Replacement Prostheses (PORP). MethodsSeventy eight(83 ears) of 89 cases who received Sheehy PORP for ossicular chain reconstructionwere reviewed. These cases were followed for more than 6 months(mean: 21.3 months). The pre- and post-operative average air conduction thresholds and Air-Bone Gap(ABG) at 0.5, 1 and 2kHz were compared. ResultsAll 83 ears showed uneventful healing at 1 month postoperatively. PORPs in 2 ears without cartilage reinforcement were found dislocated at 3 months. Preoperative hearing thresholds were from 35.75 to 68.5 dB HL (mean: 59.13 ± 15.23 dB HL). Postoperative mean hearing threshold improved to 32.23± 13.21 dB HL (P <0.01). Mean air-bone gap(ABG) improved from 36.95 ± 12.19 dB preoperatively to 21.71 ± 12.05 dB after surgery(P < 0.01). In 68 ears (81.9%), postoperative ABGs were either ≤ 20 dB or improved by 15 dB or more compared to before surgery (defined as satisfactory). ConclusionPORP as a ossicular reconstruction material appears to provide satisfactory results. Attention should be paid to avoid of postoperative dislocation. Long-term outcomes remain to be assessed.

Accuracy of diffusion-weighted magnetic resonance imaging in the diagnosis of cholesteatoma

Objectives. Recent interest has focused on various MRI techniques as a way of evaluating patients with cholesteatoma both pre- and post-mastoidectomy.1,2 The aim of this study is to determine the role of diffusion-weighted MRI imaging in detecting primary and recurrent cholesteatoma, and its accuracy in differentiating cholesteatoma from granulations and inflammatory tissue. Methods. We have designed a prospective pilot study evaluating whether diffusion-weighted MRI imaging can accurately distinguish cholesteatoma from inflammatory tissue and fluid within the middle ear and mastoid cavity. We have established a database of consecutive patients placed on the waiting list for mastoidectomy and compared the preoperative reports with the perioperative findings during mastoidectomy. Outcomes were the presence or otherwise of cholesteatoma. Results. Between April and December 2007, 15 patients underwent preoperative ECHO planar MRI imaging and tympanomastoidectomy. Cholesteatoma was identified in six patients at time of surgery. This had been identified preoperatively on diffusion MRI scanning in five patients. In nine patients who did not have cholesteatoma at time of surgery all had negative preoperative scans. The MRI scans had a sensitivity and specificity of 83% and 100%, respectively. Conclusions. We have demonstrated that diffusion-weighted MRI imaging may be useful in the diagnosis and confirmation of cholesteatoma. In particular, a negative diffusion-weighted scan can almost certainly exclude the presence of cholesteatoma. This technique may be particularly valuable following canal-wall up mastoid surgery thus avoiding the requirement for a second-look procedure, on those patients whose postoperative hearing thresholds are satisfactory and do not require ossiculoplasty. References. 1 Vercruysse J.P., De Foer B., Pouillon M. et al. (2006) The value of diffusion-weighted MR imaging in the diagnosis of primary acquired and residual cholesteatoma: a surgical verified study of 100 patients. Eur. Radiol. 16, 1461–1467 2 Stasolla A., Magluilo G., Parrotto D. et al. (2004) Detection of postoperative relapsing/residual cholesteatoma with diffusion-weighted echo-planar magnetic resonance imaging. Otol. Neurotol. 25, 879–884