Postoperative Hearing Research Articles

Clinical experiences with intraoperative electrocochleography in cochlear implant recipients and its potential to reduce insertion trauma and improve postoperative hearing preservation.

Access to low-frequency acoustic information in cochlear implant patients leads to better speech understanding in noise. Electrocochleography (ECochG) can provide real-time feedback about the health of the cochlea during the insertion process with the potential to reduce insertion trauma. We describe our experiences of using this technique. Data from 47 adult subjects with measurable residual hearing and an Advanced Bionics (Valencia, CA) SlimJ (46) or MidScala (1) electrode array were analyzed. ECochGs were recorded intraoperatively via the implant. The surgeon adjusted the course of the electrode insertion based on drops in the ECochG. The final array position was assessed using postoperative imaging and pure tone thresholds were measured before and after surgery. Three different patterns of ECochG response amplitude were observed: Growth, Fluctuating and Total Loss. Subjects in the growth group showed the smallest postoperative hearing loss. However, the group with fluctuating amplitudes showed no meaningful correlation between the ECochG responses and the postoperative hearing loss, indicating that amplitude alone is insufficient for detecting damage. Considering the phase of the signal additionally to the amplitude and reclassifying the data by both the phase and amplitude of the response into three groups Type I–Type III produced statistically significant correlations between postoperative hearing loss and the grouping based on amplitude and phase respectively. We showed significantly better hearing preservation for Type I (no drop in amplitude) and Type II (drop with a concurrent phase shift), while Type III (drop without concurrent phase shift) had more surgery induced hearing loss. ECochG potentials measured through the implant could provide valuable feedback during the electrode insertion. Both the amplitude and phase of the ECochG response are important to consider. More data needs to be evaluated to better understand the impact of the different signal components to design an automated system to alert the surgeon ahead of damaging the cochlea.

Outcomes of Anterior Scutum-Anchoring Tympanoplasty for Reconstruction of Tympanic Membrane Perforation Extending to Anterosuperior Quadrant

Background and Objectives It can be troublesome to repair tympanic membrane (TM) perforation extending to anterosuperior quadrant (ASQ). Underlay technique may cause re-perforation at ASQ, whereas overlay technique may result in anterior blunting or lateral healing of TM, causing conductive hearing loss. Anterior scutum-anchoring tympanoplasty (ASAT) can be a good alternative to repair TM perforation involving ASQ. ASAT is a variant of classic underlay tympanoplasty during which a graft is overlayed only at anterosuperior aspect by way of inserting a graft between the bony and fibrous annulus and anchoring the anterosuperior end of graft on the anterior scutum. This study was performed to assess the outcome of ASAT.Subjects and Method The medical records of patients with chronic otitis media who received type 1 tympanoplasty between April 2014 and August 2019 were reviewed. Depending on the size of the TM perforation, patients were classified into four groups. The tympanic graft success rate, complication rate, and hearing improvement were evaluated by group.Results The 82 ears of 78 patients were included for the study. At the most recent examination after 6 months of surgery, the graft success rate was 100% in all four groups. There were no postoperative complications. The mean hearing threshold was improved at 17.2 dB HL in air-conduction pure tone audiometry after surgery.Conclusion ASAT is a reliable and easily performable technique to repair TM perforation extending to ASQ with a high graft success rate and good postoperative hearing.

P 19 Auditory brainstem implants: Intraoperative electrophysiological measures and hearing outcome

Introduction: Auditory brainstem implants (ABI) are primarily designed for tumour related deafness in neurofibromatosis type 2 (NF2) patients. These neuro-prosthetic devices bypass the auditory nerve and produce hearing sensations by direct stimulation of the cochlear nuclei (CN). This study investigates the importance of intraoperative electrically evoked auditory brainstem responses (EABR) with regards to the auditory outcome. Patients & Methods: Out of a prospectively collected series of ABI implantations from 2005 to 2019, 22 patients (11 male, 11 female) fulfilled inclusion criteria (min. age of 15 y, NF2 diagnosis) and were analysed retrospectively for EABR and hearing outcome. EABR analysis relied on the presence and number of vertex positive peaks P1, P2 and P3 at brainstem stimulation. For post-operative hearing outcome a new Clinical ABI Outcome Classification was developed and applied at 6 to 12 months containing 4 categories: Category 1, Star Performer, with >80% speech understanding in auditory only MTP (mono- to polysyllabic) test and ability for continuous spoken conversation without any lip reading; Category 2, Good Performer, with >40 to 80% in auditory only MTP test and some speech understanding combined with lip reading; Category 3, Useful Performance, communication with some additional measures possible (hearing, lip-reading and written notes); Category 4, Non-useful Performance, no or only scarce sound reception. Results: In 22 patients, 146 EABR recordings at various sites of the implant were evaluated: A three-peak-formation was present in 7, a two-peek-formation in 115 (78,8%), and one-peak in 13 EABRs, while 11 remained without any reproducible responses. EABR waveforms showed some variation: Peak P1 developed just out of or after the stimulus artefact while peaks P2 and P3 sometimes showed melting and larger latency differences. P1 appears to correspond to wave III of the acoustically evoked ABR. Overall auditory outcome was useful (Categories 1, 2 or 3) in 95,5% of cases, with Star or Good Performance in about 77% of patients. EABR presence predicted auditory rehabilitation correctly in 95,5%. Conclusion: False positive EABR are rare and a matter of open discussion such as on lead dislocation or secondary brainstem nuclei degeneration. Overall, intra-operative reproducible EABR are highly predictive of adequate brainstem activation and useful hearing rehabilitation with ABI in deaf NF2 patients and appear indispensable for implant positioning. The most reliable peak P1 of EABR may represent immediate activity of cochlear nuclei. The importance of further peaks P2 and P3 and their anatomic correlation still need further evaluation and possibly correlation with more long-term auditory development. The presented ABI hearing classification includes the internationally accepted MTP test but goes beyond this and proves to be a universal tool to elucidate the patient's capacity for speech communication in real life.

A retrospective analysis of hearing after cholesteatoma surgery: the bony obliteration tympanoplasty versus canal wall up and canal wall down without mastoid obliteration

ObjectiveTo evaluate and compare the hearing outcome after the bony obliteration tympanoplasty (BOT), canal wall up (CWU) without mastoid obliteration and canal wall down (CWD) without mastoid obliteration in a large patient cohort. As the aeration of the middle ear is associated with hearing outcome, we hypothesized that the post-operative hearing after the BOT may be better compared to CWU and CWD without obliteration.MethodsThis is a retrospective cohort study on all adult patients who underwent the BOT, CWU without obliteration or CWD without obliteration for primary or revision cholesteatoma between January 2003 and March 2019 with audiological follow-up at our institution. Pre-operative, short-term post-operative and long-term post-operative hearing tests were analyzed and potential factors influencing post-operative hearing were assessed.Results626 ears were included. We found no significant differences between the short-term and long-term post-operative audiometry. The pre-operative air–bone gap (ABG) was the factor with the largest effect size on change in air–bone gap (ABG) between pre- and post-operative. When stratifying for this factor along with the type of ossicular chain reconstruction to account for differences at baseline, no significant differences in post-operative ABG were found between BOT and non-obliteration CWU and CWD.ConclusionIn this large retrospective cohort study, we found no significant differences in post-operative ABG between the BOT and the non-obliteration CWU and CWD. A solid comparison of hearing between groups remains very challenging as hearing outcome seems to be dependent on many different factors. Hearing outcome seems to be no additional argument to choose for BOT over non-obliteration surgery.

Audioogical Outcome of Stapedotomy for Primary Otosclerosis

Introduction: To find out the audiometric outcome after stapedotomy patients with clinical diagnosis of otosclerosis. Methods: This prospective observational study was performed in a total of 142 patients diagnosed with primary Otosclerosis, who underwent Stapedotomy at the Department of ENT & Head-Neck Surgery, Combined Military Hospital, Dhaka between January 2013 to January 2018. All patients were evaluated as per the candidacy criteria for stapedotomy and selected patients underwent surgery during the study period and were followed up for a period of 12 months in the Otology clinic. Pre-operative and Post-operative audiometric evaluation were done using conventional pure tone audiometry with standard calibrations. Post-operative audiometry was performed at 03 month, 06 month and 12 month. Results: Overall, the frequency specific pre-operative mean average Air-Bone gap was 51.6 dB at 500Hz, 35.7 dB at 1000 Hz, 40.5 dB at 2000 Hz, 38.9 dB at 4000 Hz and the frequency specific postoperative mean average Air- Bone Gap closure was achieved by 28.1 dB at 500Hz, 30.3 dB at 1000 Hz, 12.5 dB at 2000 Hz, 10.8 dB at 4000 Hz, by the time of 1 years of follow up. The difference was statistically significant (p<0.05) between pre-operative Air-Bone gap and post operative Air-Bone gap. After the surgery 88.7% tinnitus patients reported improvement and 11.3 % noted no change in tinnitus. Postoperative sensorineural hearing loss (SNHL) was seen in 1.4 %, failure rate was found 3.8% and 1.4% patients developed post-operative persistent vertigo. Conclusion: Most of the audiometric Results reveal excellent hearing improvement after stapedectomy surgery and worsened bone conduction (postoperative threshold shifts) for primary otosclerosis. It is safe and successful procedure providing long-term hearing expansion in primary otosclerosis with minimum failure rate. J Bangladesh Coll Phys Surg 2022; 40: 116-120

Labyrinthine fistulas: Surgical outcomes and an additional diagnostic strategy

PurposeTo evaluate perioperative findings and audiological and vestibular outcomes in patients operated for cholesteatoma with labyrinthine fistulas. Also to assess radiological fistula size. Materials and methodsPatients who underwent surgery for a labyrinthine fistula caused by a cholesteatoma between 2015 and 2020 in a tertiary referral center were retrospectively investigated. Fistula size was determined on preoperative CT scan. Bone and air conduction pure tone average thresholds were obtained pre- and postoperatively. Clinical outcomes, such as vertigo and otorrea were also evaluated. Main purpose was to determine whether there is a correlation between fistula size and postoperative hearing. Furthermore, perioperative findings and vestibular outcomes are evaluated. Results21 patients (22 cases) with a labyrinthine fistula were included. There was no significant change after surgery in bone conduction pure tone average (preoperatively 27.6 dB ± 26.7; postoperatively 30.3 dB ± 34.3; p = 0.628) or air conduction pure tone average (preoperatively 58.7 dB ± 24.3; postoperatively 60.2 dB ± 28.3; p = 0.816). Fistula size was not correlated to postoperative hearing outcome. There were two patients with membranous labyrinth invasion: one patient was deaf preoperatively, the other acquired total sensorineural hearing loss after surgery. ConclusionsSensorineural hearing loss after cholesteatoma surgery with labyrinthine fistula is rare. Fistula size and postoperative hearing loss are not correlated, however, membranous labyrinthine invasion seems to be related to poor postoperative hearing outcomes. Therefore, additional preoperative radiological work up, by MRI scan, in selected cases is advocated to guide the surgeon to optimize preoperative counselling.

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

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

Comparison of surgical results between ‘atticosinuplasty’ and canal wall up mastoidectomy for early-stage cholesteatoma

Background We devised a surgical technique called ‘atticosinuplasty’ (AS) for the treatment of early-stage cholesteatoma. Objective This study analyzed the adequacy and applicability of AS compared to canal wall-up mastoidectomy (CWU) in patients treated for early-stage cholesteatoma. Materials and Methods A total of 187 patients with either AS (n = 89) or CWU (n = 98) were compared in terms of postoperative hearing outcome, recurrence and re-operation rate, and radiologic outcome. Results Hearing gain was significant in the AS group (p < 0.001) but not in the CWU group. Air conduction change, air–bone gap (ABG) change, and ABG closure did not significantly differ between the two groups. The frequencies of cholesteatoma recurrence and revision ossiculoplasty were also similar. Of the 32 patients in the AS group with only attic/sinus involvement preoperatively, 20 (62.5%) showed no haziness and 6 (18.8%) had haziness extending to the mastoid postoperatively. Among the 67 patients in the CWU group who had haziness extending to the mastoid preoperatively, in 54 (80.6%) there was no change postoperatively. Conclusions and Significance AS is a surgical technique worth trying in patients with early stage of attic/sinus cholesteatoma in terms of the rate of recurrence and hearing improvement.

Tympanoplasty and adenoidectomy in children: Comparison of simultaneous and sequential approaches.

The authors sought to compare simultaneous and sequential tympanoplasty and adenoidectomy surgery in pediatric patients. This retrospective single-center study included 65 children (36 males, 29 females; mean age 9.16 ± 3.82 years; range 3-17 years) requiring both tympanoplasty and adenoidectomy. Simultaneous surgeries were performed on the same day, during single general anesthesia, whereas sequential surgeries were separated at least 12 weeks. The groups were compared with regard to restoration of hearing, tympanic membrane status, and utilization of medical resources. All study participants had a 12-months follow-up period after surgery. No statistically significant differences were observed between the groups regarding pre- and post-operative ABG values and average hearing gains. However, the post-operative ABG was significantly lower than the pre-operative ABG in both groups (p<0.001). There were no significant differences between simultaneous and sequential groups with respect to complete healing rates and complications (all p>0.355). Simultaneous tympanoplasty and adenoidectomy surgery management is associated with a significantly decreased cumulative hospital stay, cumulative operating room time, and cumulative pure surgical time (all p≤0.016). The results of first comparative study of simultaneous versus sequential tympanoplasty and adenoidectomy surgery managements demonstrate no advantages for the sequential approach. The same-day surgery can show the clinical outcomes comparable to those in the sequential group. The simultaneous surgery approach appears to be associated with reduced medical resources consumption. Therefore, simultaneous surgery management is an effective and safe option for children with chronic otitis media and adenoid hypertrophy.

Postoperative Patient Reported Outcomes After Cholesteatoma Surgery.

Results and success measures of cholesteatoma surgery are generally described using objective data whereas subjective data are mostly lacking. Patients experiences and complaints are becoming more important alongside clinical and audiometric outcome measures in cholesteatoma care. To investigate the course of patient-reported complaints, the impact of complaints, audiometric measures and the stability of audiometric measures, and complaints over time after primary and recurrent/residual cholesteatoma surgery. Postoperative patients were prospectively included and divided into primary acquired and recurrent/residual cholesteatoma. The EuroQol 5D (EQ-5D-3L), Otology Questionnaire Amsterdam (OQUA), and the Speech Spatial Questionnaire (SSQ) were completed by 144 patients up to 2 years postoperative. Patient-reported complaints divided in eight separate domains, postoperative hearing and impact on daily life were longitudinally assessed by means of linear mixed models. Hearing loss and tinnitus are the most reported postoperative complaints over time. Patient-reported loss of taste and the impact of all complaints decline over time. All other patient-reported complaints remain stable over time, only itch complaints fluctuate. Primary cholesteatoma patients score significantly higher on hearing loss complaints compared with recurrent/residual patients although they have comparable mean audiometric hearing loss. Furthermore, pure-tone hearing threshold, instead of asymmetric hearing loss, is correlated with the localization domain of the SSQ. This study provides important insights in the course of complaints and its impact on daily life after cholesteatoma surgery. Overall, the postoperative patient-reported complaints after cholesteatoma surgery are generally low in the studied population.

Labyrinthine Fistula in Cholesteatoma Patients: Outcomes of Partial Labyrinthectomy With "Underwater Technique" to Preserve Hearing.

Labyrinthine fistula (LF) is one of the most important complications of cholesteatoma and is defined as an abnormal communication between the inner and the middle ear. This study aims to describe our experience with the partial labyrinthectomy evaluating the post-operative hearing results. Twenty-one patients who presented labyrinthine fistula in the semicircular canals were included in the present study. Hearing impairment was present in 48% of patients (10/21). A pre-operative assessment using the Gardner–Robertson hearing classification showed the following: 52%, Class I; and 48%, Class II. A post-surgical Gardner–Robertson hearing classification evidenced the following: 43%, Class I; and 57%, Class II. The presence of LF is usually considered a negative prognostic factor for hearing preservation. The key point of partial labyrinthectomy surgery is the preservation of structures, keeping them wet with Ringer's solution throughout the procedures, and not performing suction that is close to the opened LF. The bony labyrinth is drilled underwater without suction, removing the entire cholesteatoma matrix and quickly plugging the site before and after the LF. This faster plugging of the labyrinth makes it possible to preserve the peri-lymph and the endo-lymph fluid and the hearing function. This study showed that a partial labyrinthectomy is useful for maintaining serviceable hearing in patients with LF.

Predictors of hearing functional outcome following surgery for cerebellopontine angle meningioma.

Cerebellopontine angle (CPA) meningiomas can affect hearing function and require expeditious treatment to prevent permanent hearing loss. The authors sought to determine the factors associated with functional hearing outcome in CPA meningioma patients treated with surgery and/or radiation therapy in the form of either stereotactic radiosurgery or stereotactic radiation therapy. Consecutive patients with CPA meningiomas who had presented at our hospital from 2008 to 2018 were identified through retrospective chart review. Hearing function (as defined by pure tone average (PTA) and speech discrimination score (SDS) on Audiogram) was assessed before and after surgery for CPA meningioma. Audiograms with PTA > 50dB and SDS < 69% were defined as poor hearing functional outcome. Multivariable Cox Proportional Hazards Regression Model was used to assess the associations between pre-operative hearing functional assessment and post-operative hearing functional outcomes. The study cohort included 31 patients (80.6% females, with a mean age of 61.3 ± 15.2years) with a median clinical follow-up of 5months (range: 1week-98months). The mean pre-operative PTA and SDS were 23.8 ± 11.2dB and 64.4 ± 22.2% respectively. At the last visit, there was significant hearing recovery, with an improvement of 29.7 ± 18.0dB (p < 0.001) and 87.6 ± 17.8% (p < 0.001) in PTA and SDS respectively. After adjusting for age, gender, tumor volume, location, and tumor classification, Multivariable Cox Proportional Hazards Regression Model was conducted which revealed that patients undergoing surgery through retro sigmoid approach [Hazards Ratio (HR): 32.1, 95% Confidence Interval (CI): 2.11-491.0, p = 0.01] and gross total resection (GTR) (HR: 2.99, 95% CI: 1.09-9.32, p = 0.05) had significantly higher risk of poor hearing functional outcome compared to petrosal approach and near/subtotal resection. Moreover, patients with poor preoperative hearing had 85% higher chance of poor hearing functional outcome postoperatively (HR: 0.15, 95%CI: 0.03-0.59, p = 0.007). Postoperative improvement in hearing is a reasonable expectation following surgery for CPA meningioma. Preoperative hearing, surgical approach and extent of surgical resection are predictive factors of postoperative hearing function outcome and can therefore aid in identification of patients at higher risk of hearing loss.

Natural course of residual hearing preservation with a slim, modiolar cochlear implant electrode array

PurposeUnderstanding residual hearing preservation and its natural course following cochlear implantation is important for developing rehabilitation strategies for hearing loss. However, non-uniform evaluation criteria and varying surgical skills pose challenges in fair comparison of the effect of different electrodes on residual hearing preservation. We compared the effect of a slim modiolar electrode (SME) and a slim straight electrode (SSE), implanted by a single surgeon, on progression of residual hearing using different parameters, based on cross-sectional and longitudinal audiological analyses. MethodsPatients with preoperative low-frequency pure-tone average (LFPTA) ≤85 dB at 250 and 500 Hz and who underwent minimally traumatic surgical techniques were included. The progression of residual hearing using threshold shifts, hearing preservation rate according to the HEARRING classification, and maintenance of functional low-frequency hearing potentially qualifying for a hybrid stimulation was analyzed up to five time points throughout the 1-year follow-up period. ResultsThreshold shifts and hearing preservation rates according to the HEARRING classification of the electrodes were comparable from 3 months through 12 months postoperatively. Maintenance of functional low-frequency hearing, required for the usage of a hybrid stimulation, was similar for both electrodes. A substantial proportion of implantees with SME use a hybrid stimulation, resulting in long-term use. However, a difference in the pattern of postoperative residual hearing preservation between the two electrodes is possible, probably due to differences in their physical characteristics and location. Specifically, correlation analysis exhibited that significantly less tight modiolar proximity negatively affect the residual hearing preservation, albeit only at 3 months postoperatively, among patients with the SME. ConclusionCollectively, both SME and SSE implantation showed favorable residual hearing preservation. Our findings further refine the recently proposed hearing preservation with the SME and suggest that the physical characteristics and location of electrodes, in terms of electrode-to-modiolus distance, could affect loss of acoustic hearing in various ways.

Transcanal endoscopic ear surgery for management of ossicular malformation: clinical outcomes of 17 cases

Background In recent years, transcanal endoscopic ear surgery (TEES) is known as an innovative and minimally invasive surgery. Aims To clarify the usefulness of TEES for the ossicular malformation, we performed a retrospective study. Material and methods We examined cases of ossicular malformation performed using TEES at our hospital between April 2015 and April 2020. Results The hearing level results were countable for 16 cases. Post-operative hearing levels were significantly improved. Transient nausea, tongue paralysis, and taste disorders were observed; however, no other complications were observed. In 2015–2018, some of the cases required the assistance of a surgical microscope. In contrast, all the cases were performed by TEES after 2019 using a powered device to curve the canal. Conclusions and significance TEES requires considerable training, and the sensation of depth is difficult to acquire. However, this less invasive method is also helpful for ossicular malformation cases.

Intracochlear New Fibro-Ossification and Neuronal Degeneration Following Cochlear Implant Electrode Translocation: Long-Term Histopathological Findings in Humans.

We aim to assess the histopathology of human temporal bones (TBs) with evidence of cochlear implantation (CI) electrode scalar translocation. Otopathology study. Otopathology laboratory. TBs from patients who had a history of CI and histopathological evidence of interscalar translocation. Specimens with electrode placed entirely within the ST served as controls. Histopathological assessment of human TBs. TBs from each patient were harvested postmortem and histologically analyzed for intracochlear changes in the context of CI electrode translocation and compared to controls. Intracochlear new fibro-ossification, and spiral ganglion neuron (SGN) counts were assessed. Postoperative word recognition scores (WRS) were also compared. Nineteen human TBs with electrode translocation and eight controls were identified. The most common site of translocation was the ascending limb of the basal turn (n = 14 TBs). The average angle of insertion at the point of translocation was 159° ± 79°. Eighteen translocated cases presented moderate fibroosseous changes in the basal region of the cochlea, extending to the translocation point and/or throughout the electrode track in 42%. Lower SGN counts were more pronounced in translocated cases compared to controls, with a significant difference for segment II (p = 0.019). Although final postoperative hearing outcomes were similar between groups, translocated cases had slower rate of improvement in WRS (p = 0.021). Cochlear implant electrode translocation was associated with greater fibroosseous formation and lower SGN population. Our findings suggest that scalar translocations may slow the rate of improvement in WRS overtime as compared to atraumatic electrode insertions.Level of evidence: IV.

A comparative study to evaluate the postoperative results between tympanoplasty alone and tympanoplasty with cortical mastoidectomy in chronic suppurative otitis media

&lt;div class="WordSection1"&gt;&lt;div class="WordSection1"&gt;&lt;p class="keywords"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic suppurative otitis media (CSOM) is a common ear disease presenting to the ENT OPD. It’s the most common cause of hearing dysfunction in our country. Most of these cases requires surgery but still controversial. In the surgical management of CSOM even well experienced otologist have the dilemma whether to combine mastoidectomy with tympanoplasty or not. Objectives of the study was to study and evaluate whether the additional mastoidectomy procedure helps in the outcome in the surgical treatment of CSOM in terms of graft uptake, perforation closure, improvement in hearing, disease eradication and recurrence.&lt;/p&gt;&lt;p class="keywords"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The 40 patients of age group 12 to 65 years diagnosed with CSOM of tubotympanic type in inactive or quiescent stage was taken as study group. Tympanoplasty alone was done in 20 cases and tympanoplasty with cortical mastoidectomy was done in 20 cases. Hearing gain following surgery and factors influencing the outcome were measured. Study done was prospective comparative study.&lt;/p&gt;&lt;p class="keywords"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Graft uptake was seen in 17 cases (85%) in tympanoplasty alone group and 15 cases (75%) in Tymapanomastoidectomy group at the end of 2nd month. Graft uptake was found to be same in terms of significance in both groups. Post-operative hearing gain was observed in 75% of patients in each group&lt;/p&gt;&lt;p class="keywords"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Hearing improvement, graft uptake were statistically incomparable in two groups. Combining cortical mastoidectomy with tympanoplasty will not give additional benefits in terms of hearing gain, graft uptake and disease eradication if the middle ear mucosa is healthy.&lt;/p&gt;&lt;/div&gt;&lt;/div&gt;

A comparative study of temporalis fascia and fascia lata graft in type-1 tympanoplasty

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic Suppurative Otitis Media (CSOM) is most commonly faced otological condition by ENT surgeons. Tympanoplasty is the established surgical management for tympanic membrane perforation. In this study we are comparing temporalis fascia and fascia lata as graft material in type-1 tympanoplasty to compare the graft taken up and post-op hearing improvement.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective study over 80 patients with CSOM of mucosal type, dry ear for more than 6-8 weeks and the age of 15-60 years enrolled in the study. The patients who underwent the surgery for randomly assigned into 2 groups: group-1: tympanoplasty operated with temporalis fascia graft, group-2: tympanoplasty operated with fascia lata graft. All surgeries done under general anesthesia. The patients were evaluated post operatively in terms of graft taken up and hearing status.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;In our study post op tympanoplasty graft taken up with temporalis fascia was 86.36% whereas fascia lata graft contributed 88.88%. Hearing gain on an average with temporalis fascia graft was 11.46 dB while with fascia lata graft was 10.09 dB. Statistical data proved that there was no significant difference between two groups. So both groups had their own merits and demerits.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Overall graft uptake rate and hearing gain with temporalis fascia and fascia lata in type 1 tympanoplasty are almost equal. There was no significant difference in both groups so ultimately it is surgeon choice and level of expertise that decides use of graft material in tympanoplasty.&lt;/p&gt;

STAPEDOTOMİ DENEYİMİ; SONUÇLAR VE KOMPLİKASYONLAR ÜZERİNE KLİNİK BİR ÇALIŞMA

OBJECTIVE: Otosclerosis surgery is one of the otologic surgeries producing the fastest results. It offers crucial advantages such as short operation time, high level of satisfaction during the postoperative hearing recovery and short hospital stay. The purpose of otosclerosis surgery is to relieve the immobility in the ossicular chain due to the disease and to provide the voice transmission again. This study aims to evaluate the postoperative hearing gain rates and complications of patients who underwent stapes surgery for otosclerosis in a tertiary clinic in light of the current literature.MATERIAL AND METHODS: 49 patients who were operated on for conductive hearing loss due to otosclerosis were evaluated retrospectively. Preoperative and postoperative audiological evaluations and intraoperative and postoperative complications were examined. Six of the patients were operated on both ears. A total of 36 patients, six of whom were bilateral, were included in the study (42 cases).RESULTS: As a result of our study, in 37 (88%) of 42 ears of 36 patients operated for otosclerosis,( with the success criterion of air-bone gap limits below 20 dB) functional success incompatible with the literature was obtained. Air bone gap above 30 dB, which is considered to be a failure in the literature, was not detected in any of our patients. All cases were assessed in terms of hearing thresholds preoperatively and postoperatively, resulting in a mean bone conduction gain of 4. 8 dB.CONCLUSIONS: For stapes surgery, in rare cases, surgery can be unsuccessful and it should be kept in mind that serious complications may also be encountered during stapes surger

A Report on Quality of Life Outcomes Following Transmastoid Plugging of Superior Semicircular Canal Dehiscence in a Newly Established Service in a UK Hospital.

This study aimed to evaluate the quality-of-life outcomes following transmastoid plugging of semicircular canal dehiscence in a newly established service in a UK hospital. Quality-of-life outcomes were measured using the Glasgow benefit Inventory score in three patients who underwent transmastoid plugging for superior semicircular canal dehiscence between September 2019 and March 2020. Patients also completed pre- and post-operative symptomatic questionnaires and vestibular-evoked myogenic potential testing. All three patients reported an improvement in overall quality-of-life outcomes with a mean overall Glasgow Benefit Inventory score of +37 (range, +22.2-66.6). There were no immediate post-operative complications and hearing was preserved in all patients. This study reported an initial successful experience with transmastoid plugging of superior semicircular canal dehiscence. In all patients, improvement in quality-of-life measures and symptoms was reported.

Hearing Outcomes of Transmastoid Plugging for Superior Canal Dehiscence Syndrome by Underwater Endoscopic Surgery: With Special Reference to Transient Bone Conduction Increase in Early Postoperative Period.

To investigate the influence on hearing of transmastoid plugging of the superior semicircular canal accompanied with membranous superior canal transection by underwater endoscopic ear surgery (UWEES) for the superior semicircular canal dehiscence syndrome. Retrospective case review. Tertiary referral center. Seven patients underwent plugging with membranous superior canal transection with UWEES from 2017 to 2019. Bone conduction (BC) thresholds (250, 500, 1000, 2000, 4000 Hz) were repetitively examined in early postoperative period. Subjective symptoms and pure-tone audiometry. Transient BC threshold increase was detected in all cases in early postoperative period and hearing levels were ameliorated in 1 to 2 months. The mean maximum BC threshold elevations (dB) during the early postoperative period (within 1 mo) and the postoperative stable hearing period (after 2 mo) were 18.6 and 2.9 at 250 Hz, 24.3 and 8.6 at 500 Hz, 26.4 and 8.6 at 1000 Hz, 28.6 and 7.1 at 2000 Hz, and 30.0 and 0.8 (except for scale-out cases) at 4000 Hz. respectively. The mean maximum BC thresholds in the early period were significantly elevated compared with those in the stable period at each frequency (p < 0.01). Hearing outcomes of transmastoid plugging with transection of the membranous superior canal by using UWEES were found favorable in a long-term follow-up. However, it caused transient reversible hearing loss in all cases. The BC increase in early postoperative period may not cause permanent hearing loss but improvement for the surgical technique may still be necessary.