Postoperative Pure-tone Average Research Articles

Cartilage tympanoplasty in children with cleft palate repair.

To determine outcomes of type 1 cartilage tympanoplasty in a cohort of pediatric patients with a history of cleft palate repair. Retrospective chart review and comparison with a historical control group of patients with no cleft palate anomaly undergoing the same procedure by the same surgeon at a tertiary care pediatric hospital. A total of 37 patients between ages 4 and 19 years inclusive (45 ears), with a history of repaired cleft palate, underwent type 1 cartilage tympanoplasty with or without primary tube insertion from September 2004 to October 2012. Demographics, type of cleft palate, surgical indication, middle ear status, complications, history of myringotomy tube insertion, and auditory outcomes were collected. Results were compared with those for a non-cleft palate cohort that had undergone the same procedure, which had been previously published. The unadjusted average preoperative and postoperative pure-tone averages for patients with a history of cleft palate were 22.06 and 7.29, respectively, compared with 18.34 and 8.32, respectively, for non-cleft patients. Despite significantly worse preoperative hearing levels among the cleft palate group, there was no statistically significant difference in outcomes with regard to hearing results between the two groups. One patient in the cleft palate group required revision type 1 cartilage tympanoplasty for graft failure, which is comparable to that reported for non-cleft palate patients. Post-tympanoplasty secondary tympanostomy intubation was slightly higher for the cleft palate population. Type 1 cartilage tympanoplasty, when performed in a pediatric population with a history of cleft palate, can achieve closure and hearing results that are comparable of those in patients with no such anomaly.

Predictive factors and outcomes of cochlear implantation in patients with connexin 26 mutation: A comparative study

PurposeTo compare hearing outcomes in patients with connexin 26 (Cx 26) mutations undergoing cochlear implantation to age matched controls and to examine whether age at implantation, gender and type of mutation were correlated with hearing outcome. Materials and methodsRetrospective chart review of 21 patients with Cx 26 mutations that underwent cochlear implantation compared to 18 age-matched controls. Patients' characteristics, type of mutation and pre- and postoperative short and long-term hearing thresholds, word and sentence scores were analyzed. ResultsThere was no statistically significant difference between the Cx 26 and control group in the mean short term and mean long term post-operative pure tone averages (PTA), speech reception thresholds (SRT), word and sentence scores. Gender, age at implantation and type of connexin 26 mutation did not predict hearing outcomes. ConclusionsIn patients with connexin 26 mutation, cochlear implantation provides an effective mean of auditory habilitation. Mutational status, age and gender do not seem to predict hearing outcomes.

Pediatric ossiculoplasty with titanium total ossicular replacement prosthesis.

To assess the medium-term efficacy of total ossicular reconstruction with a titanium total ossicular replacement prosthesis (TORP) in children. Case series. A consecutive series of children receiving an adjustable-length titanium TORP was identified from a prospective surgical and audiological database. Audiometric testing was obtained preoperatively, 2 months postoperatively, and subsequently at 6- to 12-month intervals. Four-frequency pure-tone averages (PTA) were determined for air conduction (AC) and bone conduction thresholds, as well as air-bone gap (ABG). Pre- and postoperative measures were compared to determine degree of improvement. The proportion with successful outcome (defined as ≤ 30 dB hearing level [HL] AC) was determined over time with Kaplan-Meier analysis. Seventy-five TORPs were inserted in 71 children aged 7 to 18 years, with a median follow-up of 2.7 years (0.6-5.5 years). The mean postoperative PTA AC threshold and ABG at 1 year were 35 dB HL and 29 dB, respectively, with ABG closure of 14 dB. The maximum gain in AC was 40 dB, achieved in eight (11%) cases. Successful outcome was seen in 50% of children at first follow-up. Over the following 1 to 3 years, hearing levels deteriorated to AC > 30 dB HL in an additional 10% of patients. Four patients had revision surgery, one for prosthesis extrusion and three for a lack of improvement in hearing. Titanium TORPs offer children an effective method of ossicular reconstruction, with infrequent extrusion at least in the short term. The hearing improvement achieved in the early postoperative period appears to be maintained over the first year but may not be sustained over longer time periods.

Efficacy of myringoplasty in older people.

The aim of current investigation was to analyze the efficacy of myringoplasty in an elderly population. The medical records of 12 males and 9 females, aged 65-90 years (mean 70.7 years), who underwent myringoplasty between 2007 and 2013 were retrospectively reviewed for age, gender, co-morbidities, perforation size and location, pre- and postoperative pure tone averages of air/bone thresholds at 500, 1,000, 2,000 and 3,000 Hz, graft material, postoperative complications and surgical outcome. The most frequent co-morbidities included hypertension (n = 8), hyperlipidemia (n = 7), diabetes mellitus (n = 5) and ischemic heart disease (n = 4). Fifteen patients had two or more co-morbidities. All surgeries were performed via a trans-canal approach. Seventeen patients had central perforations and four patients had marginal perforations. Temporalis fascia, perichondrium or chondro-perichondrial graft and fat were used as grafting material in 9, 11 and 1 patient, respectively. The post-operative complications were infection (n = 4) and tragal seroma (n = 1). Surgical outcome was successful in 16/21 patients with graft take rates of 89, 72 and 0% for temporalis fascia, perichondrium/cartilage, and fat, respectively. Pre-operative audiometric data were available for all 21 patients; however, the post-operative data were available for only 15 of them. Myringoplasty in older people was a safe procedure with a 76.2% surgical success rate in the current study. The choice of graft material, perforation size, gender and associated co-morbidities had no significant effect on achieving an intact tympanic membrane and a dry ear. The audiometric results did not show significant changes following myringoplasty.

A comparison of hearing results following stapedotomy under local versus general anesthesia

Advances in operative technique, instrumentation, and prosthesis design in otosclerosis surgery continue since Shea performed the first successful surgery. This is the first analysis to specifically compare post-operative hearing outcomes following stapedotomy surgery performed under local versus general anesthesia. Hearing outcomes were further stratified by comparing conventional perforator and Er:YAG laser ablation perforation techniques. Pre- and post-operative audiograms were retrospectively analyzed together with the method of anesthesia and the perforation technique for all patients with otosclerosis who underwent stapedotomy between 1998 and 2007. Pre-operative individual standard audiometry frequency thresholds (IFTs), air (AC) and bone conduction pure tone averages (PTA), and air bone gaps (ABG) were compared against post-operative results. Differences between pre- and post-operative PTAs and ABGs were compared between patients who received stapedotomy under local versus general anesthesia, as well as for patients who underwent conventional versus Er:YAG laser ablation perforations. Eighty-six patients were identified of which 24 % (n = 21) received local and 76 % (n = 65) received general anesthesia. Post-operative audiograms were available for 84 and 48 patients, respectively. Significant improvements were seen across all groups for standard 4-frequency AC-PTA and ABG and for IFTs up to 3 kHz. No significant difference was seen for IFTs between 4 and 6 kHz. A significant decline in post-operative hearing thresholds was seen at 8 kHz. Significant improvements in PTA and ABG were seen for all groups. There was a trend toward general compared to local anesthesia post-operative hearing results furthermore in combination with conventional perforation technique then with laser technique.

Hearing Preservation and Vestibular Schwannoma

This study aimed to evaluate the relationship between cochlear signal on fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) sequences and hearing in patients undergoing hearing preservation surgery for vestibular schwannoma (VS) and to demonstrate a new classification system to be used in imaging evaluation of patients with VS. A search of archived surgical cases at a single institution between January 1, 2006, and January 1, 2012, revealed 51 patients who underwent hearing preservation surgery for VS. Tumor size, patient age and sex, and preoperative and postoperative pure-tone average (PTA) and speech discrimination score (SDS) were recorded. Cochleae on the affected side were examined on preoperative FLAIR sequences and classified as limited hyperintensity (LH) or extensive hyperintensity (EH). Mean patient age was 51 years, and mean tumor size was 1.3 cm. Preoperative FLAIR sequences were classified into LH (n = 36) and EH (n = 15) categories. Preoperative PTA and SDS were 29.5 dB (SD, 16.7), 90% (SD, 14) and 40.6 dB (SD, 13.8), 80% (SD, 25) for LH and EH, respectively. On univariate analysis, preoperative PTA was superior in the LH group (p = 0.04). There was a trend toward superior preoperative SDS and postoperative PTA in the LH group, but these differences were not statistically significant (p = 0.08 and p = 0.06, respectively). The current study is the first to demonstrate a distinct association between cochlear FLAIR signal and pretreatment hearing levels in patients with VS. A new classification system for evaluating cochlear FLAIR signal is proposed. Improvement in FLAIR sequences will allow further investigation of this association.

Comparison of the anatomic and hearing outcomes of cartilage type 1 tympanoplasty in pediatric and adult patients

As a graft material cartilage produces an excellent anatomical result with a low risk of re-perforation. However, there is a controversy among surgeons regarding its sound conduction properties, due to the thickness and stiffness of the cartilage. The aim of this study was to evaluate results of cartilage type I tympanoplasty and to compare anatomic and audiologic results in pediatric and adult patients. Patients with chronic otitis media who underwent cartilage type I tympanoplasty were evaluated retrospectively. Patient age, gender, pre and postoperative hearing levels, surgical technique and postoperative complications were recorded. Hearing outcomes of the patients were measured with tonal audiometry by comparing the pre and postoperative hearing threshold calculated at 0.5, 1, 2, and 4 kHz. Graft success rates and hearing outcomes of the pediatric and adult patients were compared. Of the 136 patients included in the study, 58 were male and 78 were female. The average age was 25.03. Forty-five patients were ≤16-year old and 91 patients were >16-year old. Intact graft was determined in 41 of 45 pediatric patients and 85 of 91 adult patients at the last follow-up visit. The overall graft success rate was 92.6 %. The mean pre and postoperative pure-tone average was 34.8 ± 8.5 and 23.4 ± 9.1 dB in adult patients, and 30.6 ± 7.7 and 17.8 ± 7.8 dB in pediatric patients. Cartilage graft provides a quite satisfactory anatomical result and perfect stability. Hearing outcomes of cartilage tympanoplasty are also acceptable in both children and adult patients.

Hearing results in adults after stapedotomy

Background:Although clinical otosclerosis is considered a rare disease, it is the common cause of hearing loss in patients with an intact tympanic membrane. Also, the hearing loss is amenable to other non-surgical remedies. However, stapes surgery is currently the preferred treatment modality. This study aimed to assess the short-term hearing results in adults after primary stapedotomy, and find, if any, the effects of some variables on post operative hearing.Materials and Methods:This was a retrospective review of the clinical records of all consecutive patients who had primary stapedotomy for otosclerosis at the K. K. Ramalingam Ear, Nose and Throat Hospital and Research institute, Chennai, India between October 2011 and December 2011.Results:A total of 31 adults were studied; 19 (61.3%) were males and 12 (38.7%) were females. Their ages were between 21 years and 69 years; the mean age was 43.67 years, standard deviation (SD) 11.859 (95% CI; 39.24-48.10). The mean duration of symptom was 5.96 years; SD 6.188 (95% CI; 3.65-8.27). The commonest presenting symptoms were hearing loss (96.5%) and tinnitus (48.4%). The overall mean pre-operative pure tone average was 56.54 dB, SD 10.866 (95% CI; 52.55-60.52), while the overall mean post operative pure tone average was 33.75 dB, SD 15.577 (95% CI; 28.03-39.46). This difference was found to be statistically significant (Z = −4.454; P = 0.000). The overall mean pre-operative air bone gap was 43.14 dB; SD 6.824 (95% CI; 40.64-45.64) and the overall mean post operative air bone gap was 19.17 dB; SD 12.368 (95% CI; 14.63-23.70). This difference was found to be statistically significant (Z = −4.701). Nineteen patients (61.3%) had post operative air bone closure within 15 dB. The patient's age significantly correlated with the post operative pure tone average (r = 0.443; P = 0.023). There was no significant correlation between the duration of disease and the post operative pure tone average (r = −0.034; P = 0.870).Conclusions:Primary stapedotomy was effective in improving short term hearing outcome in adults with clinical otosclerosis. In addition, the post operative hearing outcomes were not affected by the duration of the disease; but by an increase in the patient's age.

Long-Term Hearing Outcome After Retrosigmoid Removal of Vestibular Schwannoma

Although many investigators have reported the hearing function in the immediate postoperative period in patients with vestibular schwannoma (VS), little is known about the long-term outcomes of the postoperative hearing. The aim of this study was to analyze the long-term hearing outcomes at a mean follow-up of 5 years in patients with unilateral VS treated via the retrosigmoid approach. Twenty-four patients with immediate postoperative serviceable hearing who underwent repeated audiogram or phone interview were included in this study. During the mean follow-up period (68.8 ± 30.2 months, range 14–123 months), serviceable hearing was preserved in 20 out of the 24 patients (83%). Pure tone average (PTA) was reevaluated within 6 months in seven patients. In the two patients whose PTA deteriorated ≥ 5 dB in 6 months after surgery, their PTA worsened ≥ 15 dB compared to the immediate postoperative PTA. In the remaining five patients whose PTA deteriorated < 5 dB in 6 months after surgery, PTA was maintained within a 15-dB deterioration at the final follow-up (p = 0.04, Fisher's exact test). According to Kaplan–Meier survival plots, the 5-year or 7-year preservation rate of serviceable hearing was 86.2% or 71.8%, respectively. Further study will be needed to clarify the mechanism underlying the long-term decline of serviceable hearing; however, the deterioration of PTA in the early postoperative period may help to predict the long-term outcomes of hearing.

Is cochlear implantation a good treatment method for profoundly deafened elderly?

PurposeTo assess the benefits of cochlear implantation in the elderly.Patients and methodsA retrospective analysis of 31 postlingually deafened elderly (≥60 years of age) with unilateral cochlear implants was conducted. Audiological testing included preoperative and postoperative pure-tone audiometry and a monosyllabic word recognition test presented from recorded material in free field. Speech perception tests included Ling’s six sound test (sound detection, discrimination, and identification), syllable discrimination, and monosyllabic and multisyllabic word recognition (open set) without lip-reading. Everyday life benefits from cochlear implantation were also evaluated.ResultsThe mean age at the time of cochlear implantation was 72.4 years old. The mean postimplantation follow-up time was 2.34 years. All patients significantly improved their audiological and speech understanding performances. The preoperative mean pure-tone average threshold for 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz was 110.17 dB HL. Before cochlear implantation, all patients scored 0% on the monosyllabic word recognition test in free field at 70 dB SPL intensity level. The postoperative pure-tone average was 37.14 dB HL (the best mean threshold was 17.50 dB HL, the worst was 58.75 dB HL). After the surgery, mean monosyllabic word recognition reached 47.25%. Speech perception tests showed statistically significant improvement in speech recognition.ConclusionThe results of this study showed that cochlear implantation is indeed a successful treatment for improving speech recognition and offers a great help in everyday life to deafened elderly patients. Therefore, they can be good candidates for cochlear implantation and their age alone should not be a relevant or excluding factor when choosing candidates for cochlear implantation.

A multivariate analysis of chronic otitis related prognostic factors in determining hearing improvement in tympanoplasty

OBJECTIVE: The aim of this study was to evaluate which factors are best predictors of hearing improvement after tympanoplasty and to evaluate best functional outcome in different forms of pathology in the tympanic cavity and mastoid in chronic otitis media. METHODS: Prospective study included 120 patients who were operated for chronic suppurative otitis media and cholesteatoma in the ENT Department University Clinic Center Banja Luka from 2006 to 2011. Multiple linear regression analysis was used to measure which factors predict better hearing improvement. MAIN OUTCOME MEASURES: A model that evaluates factors related to chronic otitis media: ossicular chain integrity, tympanic tube function, tympanic membrane perforation, type of surgery and condition of tympanic and mastoid walls was used to predict postoperative hearing improvement. Hearing outcome was measured comparing preoperative to postoperative pure-tone average (PTA) and postoperative air-bone gap (ABG). RESULTS: Out of 120 operated patients, we performed primary surgery in 106 and revision surgery in 9 cases due to recurrent cholesteatoma. We observed high correlation and statistically significant contribution of ossicular chain pathology (b=-0.310, t=-3.01, p&lt;0.05), and mastoid bone erosion or defects (b=2.05, t=2.05 , p&lt;0.05), on the variance of PTA. The same variables were highly correlated with ABG closure: ossicular chain pathology (b=-0.230, t=-2.14, p&lt;0.05), and mastoid bone erosion or defects (b= 2.05, t=2.08 , P&lt;0.05). Variance of preoperative to postoperative PTA difference explained by the model as a whole was 24,7%, F(8,119)=4.54 , p&lt;0.01. Variance of preoperative to postoperative ABG difference explained by the model as a whole was 18,3% F(8,119)=3.1, p&lt;0.01. The predictive model in this study included 8 variables related to middle ear pathology proved to be superior to analyzing each variable separately. CONCLUSION: A model that evaluates factors related to chronic otitis media: ossicular chain integrity, tympanic tube function, tympanic membrane perforation, type of surgery and condition of tympanic and mastoid walls has significant predictive value for hearing assessment in tympanoplasty.

Hearing Results Post Tympanoplasty: Our Experience with Adults at the KKR ENT Hospital, India.

Chronic suppurative otitis media is often associated with some degree of hearing loss. Tympanomastoid surgery is considered effective in controlling infection and preventing recurrence. However, opinions differ with regards the post-operative hearing results. This study aims to assess the hearing results, and also ascertain the effects of some variables on hearing in adult patients with chronic suppurative otitis media after primary tympanoplasty. This was a retrospective review of the clinical records of adult patients with chronic suppurative otitis media, who had primary tympanoplasty at the KKR ENT Hospital and Research Institute in Chennai (India), between 1st June and 30th September, 2011. A total of 26 adult patients with a mean age of 35.85years (SD 14.775) were studied. There were 16 males (61.54%) and 10 females (38.46%). The commonest presenting symptoms were ear discharge (80.8%) and hearing loss (76.9%); and the mean duration of symptom was 8.52years (SD 8.599). The overall mean pre-operative pure tone average was 49.58dB (SD 18.608), while the overall mean post-operative pure tone average was 37.38dB (SD 17.837). The difference between the overall mean pre- and post-operative pure tone average (hearing gain) was 12.192dB (SD 12.924); and this was found to be statistically significant (p<0.05). Multiple linear regression model showed that only increasing age was significantly associated with increasing mean post-operative pure tone average. This study found primary tympanoplasty effective in improving hearing results in adults with chronic suppurative otitis media even in those with advanced ossicular lesions.

Vibrant Soundbridge vs BAHA: Outcomes Comparison

Objective1) Evaluate results of the implant Vibrant Soundbridge vs BAHA in conductive or mixed deafness. 2) Compare audiological and satisfaction outcomes.MethodRetrospective study of 50 patients with mixed or conductive deafness. Twenty‐five patients using VSB, 25 using BAHA.ResultsWith VSB 46% were men, and the age at implantation was 39 years (SD, 15 years). A total 96% of cases FMT were placed on the round window. Mean postoperative pure tone average without VSB was 69 (±17) dB HL and with VSB in free‐field condition 33 (±17) dB HL. Mean hearing gain was 34 (±17) dB HL. When comparing with the BAHA users’ group, the hearing gain was 38 (±14), and there were no statistical differences, P =. 37.ConclusionVSB is an efficient alternative for patients with conductive‐mixed hearing losses, comparable to bone anchored hearing device. The use of the FMT on the round window has demonstrated to be effective in well‐selected cases.

Impact of Fundal Extension on Hearing After Surgery for Vestibular Schwannomas

To compare hearing preservation after surgery for intracanalicular vestibular schwannomas with or without fundal extension. Retrospective chart review. Patients with intracanalicular tumors (≤ 10-m maximal dimension) undergoing retrosigmoid craniotomy between 2001 and 2010. Preoperative and postoperative audiograms, preoperative magnetic resonance imaging, and operative reports were reviewed. Preoperative and postoperative hearing (American Academy of Otolaryngology-Head and Neck Surgery classification). Complete data for 53 patients (27 female and 24 male subjects, sex was not recorded for 2 patients) meeting selection criteria was available. Fundal involvement was identified in 39 (73.6%) of the 53 patients. The remaining 14 patients did not have tumor with fundal extension (26.4%). Average tumor size for patients with fundal extension (+FE) was 6.9 ± 2.2 mm and without fundal extension (-FE) was 8.2 ± 1.9 mm (p = 0.05, Student's t test). Average preoperative speech discrimination score for the entire study was 90.5 ± 11.8 (n = 53). After retrosigmoid approach for tumor resection, 79% of patients (42/53) had preserved hearing defined as American Academy of Otolaryngology-Head and Neck Surgery class A, B, or C. Average postoperative speech discrimination score for these patients was 89.3 ± 12.1, and average postoperative pure-tone average was 35.9 ± 9.1%. Eighty-five percent (33/39) of +FE patients had preserved hearing (class A, B, or C). In contrast, 64% (9/14) of -FE patients had hearing preserved (class A, B, or C; Fisher's exact test, p = 0.034). Hearing preservation rate after retrosigmoid craniotomy for intracanalicular vestibular schwannomas may be superior for tumors with fundal extension compared with tumors that do not extend to the fundus.

Surgical treatment of adult cholesteatoma: long-term follow-up using total reconstruction procedure without staging

Conclusions: A total of 330 cases of adult cholesteatoma were operated with canal-wall down (CWD) and total reconstruction procedure (TRP) without staging. Independent of preoperative middle ear conditions, cholesteatoma extent and localization, long-term improvement of hearing with a low incidence of residual and recurrent disease were achieved. Objectives: To evaluate long-term surgical and hearing results using a well-defined surgical technique without staging in adult cholesteatoma. Methods: The same CWD surgical technique, including obliteration of the mastoid cavity, reconstruction of the canal wall, and ossiculoplasty with autologous bone, was used by three senior surgeons (1982–2004). Preoperative and postoperative pure tone average (PTA) for air conduction (AC), bone conduction (BC), and air–bone gap (ABG) were assessed and compared 1, 3, and 6 years after surgery. Various prognostic factors with potential influence on long-term hearing outcome were evaluated. Results: Recurrence of AC occurred in 10%, residual disease in 3%. Six years after surgery all patients except one had a dry ear and over 92% of all cases were water resistant. Three patients developed complete deafness. Long-lasting improvement and/or preservation of hearing, with maintenance of PTA-ABG closure in 68% of all cases within 20 dB, were obtained. Sixty-four (19%) ossicular revisions were performed.

Hearing Outcomes in Canal Wall Down Mastoidectomy with Cartilage Tympanoplasty

Objective: 1) Measure the overall postoperative hearing after both canal wall down mastoidectomy and cartilage tympanoplasty. 2) Assess the air-bone gap postoperatively in patients after both canal wall down mastoidectomy and cartilage tympanoplasty. Method: A retrospective review of all patients who underwent canal wall down mastoidectomy with a cartilage tympanoplasty during the time period of 2000 to 2010. Cases of the appropriate surgery were chosen by operative reports. Indications for surgery largely included cholesteatoma, chronic otitis media, or both. Results: A total of 39 patients were found to have the procedure in question with 30 patients having full audiograms for review. Pre- and postoperative pure tone averages (PTA) along with air-bone gaps (ABG) were reviewed at 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz. Postoperative PTA showed an improvement of 7.2 dB over preoperative PTA. Postoperative ABG showed an improvement of 4.53 dB over preoperative ABG. The ABG improvement was found to be statistically significant with a P value of .0285. Conclusion: The results of this study demonstrate that hearing results following a canal wall down mastoidectomy along with a cartilage tympanoplasty not only have acceptable hearing results but also actually show an improvement over preoperative audiological function.

Ossiculoplasty With Titanium Prosthesis

ObjectivesThe goal of this study was to make a review of the patients who underwent ossicular chain reconstruction with titanium prosthesis during an 8-year period in our Department. MethodsA retrospective study was made on the ossiculoplasty cases over a period of eight years in a Public Hospital District. The information was extracted by clinical process consultation. Between 1999 and 2008, 124 ossiculoplasties using Kurz® titanium prosthesis for chronic otitis media were performed (78 partial ossicular chain reconstructions and 46 total ossicular chain reconstructions). The single stage, staged and revision ossicular chain reconstruction were included in the analysis. All patients had a minimum of 6-month postoperative follow-up (mean 3 years and 4 months). Comparisons of preoperative and postoperative pure tone averages were performed. Air-bone gap and implant extrusion rates were measured. The success of the reconstruction was defined as a postoperative air-bone gap (ABG) of 20dB or better. ResultsSuccessful ossiculoplasty was obtained in 73.1% of partial ossicular chain reconstructions and 30.4% of total ossicular chain reconstructions (P<.05). The postoperative pure-tone average air-bone gaps was 16dB in partial reconstructions and 26.7dB in total reconstructions (P<.05). There were five cases of prosthesis extrusion. ConclusionsThe majority of the ossiculoplasties improved the hearing status satisfactorily. There was no difference in hearing results in one-stage and two-stage partial ossicular chain reconstruction, but there were better hearing results in the cases of two-stage total ossicular chain reconstruction.

Osiculoplastia con prótesis de titanio

Objectives The goal of this study was to make a review of the patients who underwent ossicular chain reconstruction with titanium prosthesis during an eight-year period in our Department. Methods A retrospective study was made on the ossiculoplasty cases over a period of eight years in a Public Hospital District. The information was extracted by clinical process consultation. Between 1999 and 2008, 124 ossiculoplasties using Kurz ® titanium prosthesis for chronic otitis media were performed (78 partial ossicular chain reconstructions and 46 total ossicular chain reconstructions). The single stage, staged and revision ossicular chain reconstruction were included in the analysis. All patients had a minimum of 6 month postoperative follow up (mean 3 years and 4 months). Comparisons of preoperative and postoperative pure tone averages were performed. Air-bone gap and implant extrusion rates were measured. The success of the reconstruction was defined as a postoperative air-bone gap (ABG) of 20 dB or better. Results Successful ossiculoplasty was obtained in 73,1% of partial ossicular reconstruction reconstructions and 30,4% of total ossicular chain reconstructions ( P<.05). The postoperative pure-tone average air-bone gaps was 16 dB in partial reconstructions and 26,7 dB in total reconstructions (P<.05). There were five cases of prosthesis extrusion. Conclusions The majority of the ossiculoplasties improved satisfactorily the hearing status. There was no difference in hearing results in one-stage and two-stage partial ossicular chain reconstruction, but there were better hearing results in the cases of two-stage total ossicular chain reconstruction.

Comparison of different tympanic membrane reconstruction techniques in type I tympanoplasty

The objective of the study was to assess the functional results after type I tympanoplasty with temporal muscle fascia, perichondrium/cartilage island and cartilage palisades. The records of 120 patients who underwent type I tympanoplasty operation between January 2003 and June 2007 were retrospectively reviewed. This study aimed to comprise a homogeneous group of patients to make the comparisons as accurate as possible. For this purpose, primary tympanoplasty cases with subtotal perforations, intact ossicular chain, dry ear for a period of at least 1 month, and normal middle ear mucosa were included in the study. Patients younger than 15 years of age and patients with cholesteatoma were excluded. Temporal muscle fascia was used in 67 (55.8%), perichondrium/cartilage island flap was used in 34 (28.3%), and cartilage palisades were used in 19 (15.8%) of the patients. Pre- and postoperative otoscopic examinations, pure-tone averages, and air-bone gaps were compared pre and postoperatively. Concerning all of the cases, the graft take rate was 85% (102/120). In the perichondrium/cartilage island flap group, the graft take rate was 97.7%, whereas the graft take rates for the fascia group and cartilage palisades group were 80.6 and 79.0%, respectively. In the perichondrium/cartilage island flap group, the pure-tone average was 36.36 dB, whereas the pure-tone averages for the fascia group and cartilage palisades group were 36.07 and 39.79 dB, preoperatively. The postoperative pure-tone averages were 24.54 dB fort he perichondrium/cartilage island flap group, 24.51 dB for the fascia group and 23.23 dB for the cartilage palisades group. Cartilage grafting is not only more enduring against infection and negative middle ear pressure but also it has low re-perforation rates on long-term follow-up. Thus, cartilage may be preferred more often for primary tympanoplasties with high graft rate and hearing improvement.

Functional Results of Vibrant Soundbridge Middle Ear Implants in Conductive and Mixed Hearing Losses

Objective: Our purpose was to evaluate the results of Vibrant Soundbridge (VSB) in conductive or mixed hearing loss. Materials and Methods: Twenty-five adult patients (29 ears) with a mixed or conductive hearing loss and various etiologies were included in this retrospective study. The preoperative ipsilateral pure tone average was 71 ± 3.0 dB, and the average bone conduction threshold was 42 ± 2.8 dB (n = 29). The transducer was placed on the long apophysis of the incus (n = 16), in the round window (n = 10) or on the stapes (n = 3). Results: No complications were noted. The bone conduction threshold remained unchanged. VSB was activated in all cases. The postoperative pure tone average without VSB was 63 ± 3.9 dB (n = 24) and with VSB in free-field condition 24 ± 2.1 dB (n = 22). Conclusions: VSB is safe and efficacious for auditory rehabilitation in conductive and mixed hearing losses.