Postoperative Speech Reception Threshold Research Articles

Insertion Results and Hearing Outcomes of a Slim Lateral Wall Electrode.

The clinical outcomes of cochlear implantation vary for several reasons. It is necessary to study the different electrodes and variables for further development. The aim of this study is to report the clinical outcomes of a new slim lateral wall electrode (SlimJ). Data of 25 cochlear implantations in 23 patients with the SlimJ electrode were retrospectively collected. The insertion results were assessed by image fusion of the preoperative computed tomography (CT), magnetic resonance imaging (MRI), and postoperative cone-beam CT. The hearing outcomes were evaluated by the improvement of speech recognition in noise, measured preoperatively and at follow-up. Postoperative pure-tone thresholds were obtained in cases with preoperative functional low frequency hearing [PTA (0.125-0.5 kHz) ≤ 80 dB HL]. The preoperative mean speech reception threshold (SRT) was +0.6 dB signal-to-noise ratio (SNR) (SD ± 4.2 dB) and the postoperative -3.5 dB SNR (SD ± 2.3 dB). The improvements between the preoperative and postoperative SRT levels ranged from 0.0 to 15.1 dB, with a mean improvement of 4.2 dB (SD ± 3.6 dB). Residual hearing in low frequencies (mean PTA(125-500 Hz)) was preserved within 30 dB HL in 70% and within 15 dB HL in 40% of patients who had preoperatively functional low frequency hearing. Mean insertion depth angle (IDA) was 401° (SD ± 41°). We observed scalar translocations from scala tympani to scala vestibuli in 2 ears (9%). The relatively atraumatic insertion characteristics make the SlimJ array feasible for hearing preservation cochlear implantation. The hearing outcomes are comparable to those reported for other electrodes and devices.

Comparison of the underlay and over-underlay tympanoplasty: A randomized, double-blind controlled trial.

We aimed to compare the graft success rate and hearing outcomes in patients with large tympanic membrane (TM) perforation in underlay and over-underlay approaches. This is a prospective double-blind randomized controlled clinical trial with a parallel design. Patients aged 15-75 years old with large TM perforation (more than 50% of TM) who operated at Khalili hospital affiliated with Shiraz University of Medical Science, Iran, were enrolled. Exclusion criteria were recent otorrhea, revision surgery, and pathologic intraoperative findings such as the presence of cholesteatoma, cholesterol granuloma, ear canal polyp, or damaged ossicle. In the first group, the underlay method and in the second group over-underlay method were performed. Graft success rate, atelectasis, and audiology outcomes were evaluated after 6months. The investigation was conducted on 84 patients in the underlay and 67 patients in the over-underlay group. Although there was a higher rate of graft failure (9%) in the over-underlay group in comparison with the underlay group (4.8%), the difference was not statistically significant (p-value=.34). No atelectasis was seen in both group. Although, between-groups comparison of the preoperative and postoperative speech reception thresholds (SRT) and air-bone gaps (ABG) values showed statistically significantly lower SRT and ABG in the over-underlay technique, the difference was clinically negligible. Both techniques provide the same graft success rate, but SRT and ABG were significantly lower in the over-underlay technique after the operation. 1b.

Congenital cholesteatoma: Clinical features and surgical outcomes

ObjectivesA typical presentation of congenital cholesteatoma (CC) is asymmetric conductive hearing loss (CHL). As CHL is usually associated with middle ear effusion, diagnosis of CC is frequently delayed. This study aimed to describe the clinical characteristics, treatment and outcomes of children with CC. MethodsThe medical files of children diagnosed with CC at a large tertiary pediatric medical center during 2000–2019 were reviewed. The primary outcome measures were: presenting symptoms, surgical findings, stage of disease, recurrence rate and hearing outcome. Imaging findings and the size of mastoid air cells were assessed in CT scans. ResultsThirty-nine children were diagnosed with CC. The presenting symptom was unilateral CHL in 85%, with an average speech reception threshold of 41.5 ± 13.7 dB in the affected ear. The mean time from first symptoms to diagnosis was 1.3 years. The surgical approach was exploratory tympanotomy in 25% and canal wall up mastoidectomy in 69%. Seventy percent of the children presented with Potsic stage III-IV. The mean postoperative speech reception threshold was 26.4 ± 12.2 dB (P = 0.002). Recurrence of cholesteatoma occurred in 38% of the patients, mostly in stage III-IV. Mastoid air cell size was significantly smaller on the affected than the unaffected side. ConclusionsIn children with persistent unilateral or asymmetric conductive hearing loss, CC should be suspected. Late diagnosis of CC is associated with a high recurrence rate. This highlights the need to promote awareness to the disease among primary physicians in the community health care system.

Otosclerosis: Experience With Stapes Surgery.

IntroductionOtosclerosis is a disorder in which the footplate of the stapes is replaced by an abnormal bone, thereby affecting sound transmission to the inner ear at the level of the oval window. The solution to this condition is to reestablish this mechanism back to normal via the ossicular chain to the inner ear. The aim of stapes surgery is to improve the hearing level to thresholds appropriate enough to obviate the need for hearing aid. The hearing improvement achieved after surgery often lasts for many years. The purpose of the current study was to review our experience and find out the rate of success related to hearing outcomes after stapedotomy.MethodsThe patients who were operated for otosclerosis between January 2000 and December 2010 at Aga Khan University Hospital, Karachi, Pakistan were included in the study. The charts were reviewed to collect clinical data regarding stapes surgery. The values of speech reception threshold (SRT) were recorded, and the preoperative and postoperative means were compared with a t-test. The bone conduction (BC) and air conduction (AC) thresholds were evaluated at 0.5 kHz, 1.0 kHz, 2.0 kHz, and 3.0 kHz. The preoperative and postoperative means of air-bone gap (AB-gap) were compared with a t-test. The descriptive frequency was calculated to evaluate postoperative AB-gap in individual patients; patients were grouped with a difference of 10 dB of AB-gap. The SPSS Statistics software (IBM, Armonk, NY) was used for statistical analysis.ResultsA total of 46 patients were included in the study. There were 15 males and 31 females. The mean age was 35 years (range: 20-56). Thirty-three patients had bilateral otosclerosis; two patients had surgery for both ears, taking the total number of ears operated to 48. The mean preoperative AB-gap was 39, while the mean postoperative AB-gap was 11. The means were compared with a t-test and a p-value of <0.05 was considered significant. The means of preoperative and postoperative SRT were 56.25 and 24.27 respectively. Both means were compared with a t-test, and a p-value of <0.05 was considred significant. Postoperatively, 34 ears had AB-gap of 10 dB (70.8%), 11 (22.9%) had within 20 dB, and three (6.3%) had within 30 dB.ConclusionsThe success rate related to hearing outcomes in patients operated for otosclerosis was excellent and comparable to that found in the current literature. The wide AB-gap noticed in the majority of our patients may represent a delayed presentation to otolaryngologists, which requires further evaluation.

Management of Incus Defects in Children: Comparison of Incus Transposition Versus Glass Ionomer Cement

The aim of this study was to investigate the functional results of glass ionomer cement (GIC) and incus transposition (IT) used for treatment of incus long process defects in pediatric patients. The medical records of 40 patients, aged 10 to 16 years, who underwent ossicular reconstruction due to incus long process defect between January 2010 and July 2017 were reviewed for age and gender, types of ossiculoplasty technique, types of graft used for tympanic membrane repair, preoperative-postoperative audiological examinations, and length of follow-up. The mean preoperative air-bone gap (ABG) was 29.40 (8.47) dB, the mean postoperative ABG was 15.25 (8.55) dB in the entire group, and the difference was statistically significant (P < .001). The functional outcome (ABG ≤ 20 dB) was 80% (32 patients) in the entire group. The mean hearing gain was 18.83 (9.43) dB and postoperative mean ABG was 20 dB or better in 17 (94.4%) patients in the GIC group. The mean hearing gain was 10.31 (9.44) dB, and postoperative mean ABG was 20 dB or better in 14 (63.6%) patients in the IT group. The mean hearing gain was significantly higher in the GIC group than in the IT group (P = .026), and the postoperative mean ABG was significantly higher in the IT group than in the GIC group (P = .045). The functional success rates were significantly higher in GIC group than in IT group (P = .020). There were no statistically significant differences between groups in terms of postoperative speech reception threshold and word recognition scores (P = .628, P = .260, respectively). The graft success rates were 94.4% (17 patients) in the GIC group and 90.9% (20 patients) in the IT groups. There was no statistically significant difference between groups in operated side (P = 1.000). Reconstruction of small incus long process defects using GIC is a valuable technique and can be safely used in pediatric patients. The hearing outcomes are significantly better in GIC rebridging technique when compared with a sculpted IT technique.

Factors influencing hearing outcomes in pediatric patients undergoing ossicular chain reconstruction

ObjectiveOssicular chain disruption in children leads to conductive hearing loss. Few studies have focused on factors influencing successful results in pediatric ossicular chain reconstruction (OCR). We aim to determine whether demographic or surgical factors affect hearing outcomes in pediatric OCR. MethodsWe conducted a retrospective chart review of 120 patients undergoing OCR at our institution, a tertiary care hospital, between 2003 and 2014, with median length of follow-up of 2.2 years (range 0.1–9.3 years). Pediatric patients (<18 years old at time of surgical procedure) who had current procedural terminology (CPT) codes of OCR, and available pre- and post-operative audiograms were included in the study. Demographic information, surgical details, and pre- and post-operative pure-tone averages (PTA), speech reception thresholds (SRT), and air-bone gaps (ABG) were recorded from clinic notes, audiograms and operative reports. Differences between PTA, SRT and ABG pre- and post-operatively, as well as demographic and surgical factors, were evaluated using Wilcoxon rank-sum tests. Factors influencing revision were evaluated using Log-rank tests. ResultsA total of 120 patients (123 ears) were included. 35.8% of cases were revised, most commonly due to displaced prostheses. 28.5% of surgeries resulted in normal hearing (PTA ≤25 dB) post-operatively. Post-operative SRT and ABG were significantly better in patients with partial ossicular replacement prosthesis (PORP) compared with those with total ossicular replacement prosthesis (TORP) (p = 0.016, 0.027). Titanium prostheses resulted in better post-operative PTA and larger changes in PTA compared with all other materials (p = 0.034, p = 0.038). ConclusionsIn our experience, children with titanium prostheses had better hearing outcomes than those with other materials, and children with PORP had better hearing outcomes than those with TORP.

Comparison of Fluoroplastic Causse Loop Piston and Titanium Soft-Clip in Stapedotomy.

Different types of prosthesis are available for stapes replacement. Because there has been no published report on the efficacy of the titanium soft-clip vs the fluoroplastic Causse loop Teflon piston, we compared short-term hearing results of both types of prosthesis in patients who underwent stapedotomy due to otosclerosis. A total of 57 ears were included in the soft-clip group and 63 ears were included in the Teflon-piston group. Pre-operative and post-operative air conduction, bone conduction, air-bone gaps, speech discrimination score, and speech reception thresholds were analyzed. Post-operative speech reception threshold gains did not differ significantly between the two groups (P=0.919). However, better post-operative air-bone gap improvement at low frequencies was observed in the Teflon-piston group over the short-term follow-up (at frequencies of 0.25 and 0.50 kHz; P=0.007 and P=0.001, respectively). Similar post-operative hearing results were observed in the two groups in the short-term.

Emergence of Binaural Summation After Surgical Correction of Unilateral Congenital Aural Atresia.

To investigate the emergence of binaural summation in patients with unilateral congenital aural atresia undergoing surgical correction. Preoperative and postoperative audiometric testing in a prospective cohort of 10 patients with unilateral congenital aural atresia. University-based tertiary care center. Ten patients (ages 6-53) with an average 69 dB (±9 dB sd) unilateral conductive hearing loss, normal hearing in the nonatretic ear, and normal bone conduction in the atretic ear. Pre- and postoperative hearing in noise test in quiet and in noise. Levels of sentences presented from a single central speaker were adaptively varied to determine a speech reception threshold (SRT), first in quiet and then with simultaneous multitalker babble at 65 dB SPL from the same speaker. Preoperative SRT was worse than normal controls in both quiet (p = 0.001) and in noise (p = 0.05), as expected. Postoperative SRT in quiet improved 3.5 dB (marginally significant with one-tailed p value of 0.05); thresholds in noise improved an insignificant 0.8 dB (one-tailed p = 0.2). Converting results to dB-worse-than normal, atresia patients did better in noise (relative to normal) than in quiet (p = 0.008). The expected summation effect (3 dB) occurs after atresia surgery in quiet but not in noise. Relative to normal, these patients performed better in noise than quiet, perhaps because these patients develop skills attending to threshold-level speech in noise during their years without binaural benefit.

Long-term Outcomes of Titanium Ossiculoplasty in Chronic Otitis Media.

The primary objective is to report long-term hearing outcomes (>2 years) after titanium ossiculoplasty in patients with chronic otitis media. Case series with chart review. Tertiary care hospital. In total, 156 patients with chronic otitis media undergoing titanium ossiculoplasty were included. The primary outcome measure was the long-term postoperative ABG. The stability of hearing over time was determined by comparing short-term and long-term postoperative air-bone gap (ABG). Secondary outcome measures included ΔABG, postoperative speech reception thresholds, air-conduction pure-tone average (AC PTA), word recognition scores, and percentage of patients achieving ABG ≤20 dB. Revision and extrusion rates were examined. At short-term follow-up (<6 months), mean postoperative ABG was 18.4 ± 10.6 dB and AC PTA was 31.7 ± 15.2 dB; 67% of patients achieved ABG ≤20 dB. At long-term follow-up (>2 years), mean ABG was 20.0 dB ± 15.4 and AC PTA was 35.3 ± 16.1 dB; 60% of patients achieved ABG ≤20. At both short- and long-term follow-up, ABG and AC PTA were significantly improved compared with preoperative values. No difference in hearing outcomes was observed when comparing partial titanium ossicular prostheses (PORPs) to total titanium ossicular prostheses (TORPs) at either short- or long-term follow-ups. In patients with both short- and long-term follow-up (n = 50), deterioration in hearing was noted (3.4 dB, P = .04). When analyzed by type of prosthesis, PORPs demonstrated statistically significant deterioration in ABG over time (4.9 dB, P = .02), while TORPs did not (2.5 dB, P = .50). The long-term extrusion rate was 3.2%. With a minimum follow-up of 2 years, titanium ossiculoplasty provides good long-term hearing results. Modest deterioration in hearing is noted over time.

Bilateral Sequential Cochlear Implantation in Patients With Enlarged Vestibular Aqueduct (EVA) Syndrome.

To analyze audiometric outcomes after bilateral cochlear implantation in patients with isolated enlarged vestibular aqueduct (EVA) syndrome and associated incomplete partition (IP) malformations. Secondary objective was to analyze rate of cerebrospinal fluid (CSF) gusher in patients with IP-EVA spectrum deformities and compare this with the existing literature. Retrospective chart review. Thirty-two patients with EVA syndrome who received unilateral or bilateral cochlear implants between June 1999 and January 2014 were identified in the University Hospitals Case Medical Center cochlear implant database. Isolated EVA (IEVA) and Incomplete Partition Type II (IP-II) malformations were identified by reviewing high-resolution computed tomography (HRCT) imaging. Demographic information, age at implantation, surgical details, postimplantation audiometric data including speech reception thresholds (SRT), word, and sentence scores were reviewed and analyzed. Intra- and postoperative complications were analyzed as well and compared with the literature. Seventeen patients (32 implanted ears) had pediatric cochlear implantation for EVA-associated hearing loss. Data from 16 controls (32 implanted ears) were used to compare audiometric and speech outcomes of EVA cohort. Mean age at implantation was 6.8 years for EVA cohort and 6.0 years for controls. There was no statistically significant difference in long-term postoperative SRT, monaurally aided word scores, and binaurally tested word scores between pediatric EVA group and controls. The EVA patients had a long-term mean sentence score of 85.92%. A subset of EVA patients implanted at mean age of 3.18 years (n = 15 ears) had similar audiometric outcomes to another control group with Connexin 26 mutations (n = 20 ears) implanted at a similar age. Further subset analysis revealed no significant differences in age at implantation, SRT, and word scores in patients with IEVA and IP-II malformation. There was no significant association between size of vestibular aqueduct and age at implantation. There was no CSF gusher or other intra- or postoperative complications reported in our series. Bilateral sequential cochlear implantation can be performed safely in patients with EVA. Audiometric outcomes are excellent and comparable to pediatric cochlear implant patients with no malformations. CSF gusher rates can be minimized by trans-round window approach. Further long-term studies are needed to identify differences within IP-EVA spectrum deformities, audiometric outcomes, and proportions of EVA patients who will need cochlear implantation for hearing rehabilitation.

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

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

Hearing Outcomes of Atresia Surgery Versus Osseointegrated Bone Conduction Device in Patients With Congenital Aural Atresia

To perform a systematic review, comparing hearing outcomes of atresiaplasty versus osseointegrated bone conduction device (OBCD) in congenital aural atresia (CAA) patients. Approximately 107 studies, published from 1975 to 2012, evaluating hearing outcomes after atresiaplasty and/or OBCD in CAA patients were identified through a PubMed search. Articles that evaluated external auditory canal stenosis alone, did not report speech reception threshold (SRT), pure tone average (PTA), hearing gain, or air-bone gap (ABG) or had less than 5 patients were excluded. For authors or institutions with multiple reports, the largest or most recent study was included. Forty-one articles satisfied our inclusion and exclusion criteria. The number and percentage of ears with a postoperative SRT, PTA, ABG less than 30 dB, and/or average hearing gain were extracted. The total number of ears and the timing of the postoperative audiogram were also noted. Of the atresiaplasty ears, 73.8% (95% CI, 62.2%-85.4%), had a SRT less than 30 dB (338 ears), 60.3% (95% CI, 45.8%-74.8%) had a PTA less than 30 dB (390 ears), and 68.9% (95% CI, 59.4%-78.3%) had an ABG less than 30 dB (852 ears). The average hearing gain was 24.1 dB (95% CI, 21.62-26.51) for 516 ears. Hearing outcomes deteriorated with time. Of OBCD patients, 95.9% (95% CI, 91.5%-100.0%) had a PTA less than 30 dB (77 ears), and 98.2% (95% CI, 94.5%-100.0%) had an ABG less than 30 dB (47 ears); the average hearing gain was 38.0 dB (95% CI, 33.14-45.22) in 100 ears. The OBCD has better hearing outcomes compared with atresiaplasty in patients with CAA.

Cochlear implantation outcomes in patients with far advanced otosclerosis

ObjectivesTo compare hearing outcomes in patients with far advanced otosclerosis (FAO) undergoing cochlear implantation to an age-matched group of controls, to describe the effects of cochlear ossification on hearing, and to review the adverse effects of implantation in patients with FAO. HypothesisHearing performance in patients with FAO after cochlear implantation is comparable to similarly treated postlingually deafened adults without FAO. Ossification or retrofenestral otosclerosis does not predict poor hearing outcomes. Modiolar-hugging technology reduces postoperative facial nerve stimulation. Study DesignRetrospective chart review. SettingAcademic neurotologic tertiary referral center. PatientsThirty patients with FAO, who metaudiological criteria for cochlear implantation, were compared to 30 age-matched controls, postlingually deafened by non-otosclerotic causes. Main Outcome MeasuresAudiometric pre- and postoperative speech reception threshold, word, and sentence scores were analyzed. The presence of retrofenestral findings on computed tomography or intraoperative cochlear ossification were noted. ResultsIn the FAO group, radiographic abnormalities were noted in 26.4% of patients. Intraoperative ossification requiring drillout was seen in 29.4% of patients. None developed postoperative facial nerve stimulation. There was no difference between the FAO and control groups in the mean short-term and long-term postoperative speech reception threshold, word, and sentence scores (P = .77). The presence of radiographic abnormalities did not predict hearing outcome. Intraoperative cochlear ossification was not associated with worse short-term word and sentence scores (P = .58 and 0.79, respectively), and for the long-term hearing outcome (P = .24). ConclusionsIn patients with FAO, effective and safe hearing rehabilitation can be accomplished with cochlear implantation.

Revision Aural Atresia Surgery

To determine the most common indications for revision congenital aural atresia (CAA) surgery and the postoperative healing and hearing outcomes of revision surgery. Retrospective case review. Tertiary care academic otologic practice. Patients undergoing revision surgery for CAA. Revision surgery for CAA. Indications for revision atresiaplasty, time to revision surgery, postoperative external auditory canal (EAC) patency, incidence of chronic drainage and/or infection, and postoperative speech reception thresholds (SRTs), and air-bone gaps. Indications for 75 ears (69 patients) undergoing 107 revision operations for CAA included 58% for EAC stenosis, 19% for chronic drainage and/or infection, and 20% for conductive hearing loss (CHL) alone. Fifty ears (67%) required a single revision. Twenty-five ears (33%) required more than 1 revision. With follow-up longer than 3 months (mean, 41 mo), 69% of ears revised for EAC stenosis achieved a patent canal (29% required >1 revision); 75% of ears revised for chronic drainage and/or infection (mean follow-up, 53 mo) realized a dry canal (22% required >1 revision). For all revision surgeries with adequate follow-up (n = 80), the mean postoperative short-term SRT of 24 dB HL was a significant improvement from the mean preoperative SRT of 39 dB HL (p < 0.01, paired t test). EAC stenosis is the most common indication for revision atresiaplasty. Despite the challenges of revision surgery, improvement in canal patency, epithelialization, and hearing utcomes can be achieved.

The totally implantable middle ear device ‘Esteem’ for rehabilitation of severe sensorineural hearing loss

Conclusion: The Esteem device proved to offer beneficial results in subjects suffering from high frequency, severe bilateral sensorineural hearing loss (SNHL) and may be considered as an alternative procedure to conventional hearing aids (HAs) or electroacoustic stimulation (EAS) systems. Objectives: Since the Esteem totally implantable device has been shown to offer positive results among patients with moderate SNHL, this middle ear implant has also been suggested for subjects with a worse degree of hearing loss in order to predict its extended application, also in the nearly cochlear implantation range. Methods: Esteem implantation was carried out in 21 subjects with a mild (n = 3), moderate (MHL, n = 9) or severe (SHL, n = 9) degree of SNHL. The two latter groups, i.e. MHL and SHL, were compared in terms of preoperative versus postoperative pure tone and speech reception thresholds (SRTs). Similarly, they were also compared for the outcome from quality of life (QoL) questionnaires, such as the general Glasgow Benefit Inventory (GBI) and COSI. Results: In the whole sample, mean hearing threshold levels improved from 70 to 48 dB; in the MHL group the mean hearing threshold level improved from 64 to 42 dB; in the SHL group the mean hearing threshold level improved from 82 to 58 dB. GBI and COSI scores were only slightly better in the MHL group than in the SHL group.

The Jahrsdoerfer Grading Scale in Surgery to Repair Congenital Aural Atresia

To determine the predictive ability of the Jahrsdoerfer grading scale score in congenital aural atresia surgery. Retrospective review of medical records. Tertiary referral center. One hundred eight patients with aural atresia. Demographic data, preoperative Jahrsdoerfer score, and postoperative audiometric outcomes were reviewed. One month postoperative, 4-tone pure-tone averages and speech reception thresholds were compared between ears scoring 6 or lower, 7, and 8 or higher on the Jahrsdoerfer grading scale. The percentage of ears with a speech reception threshold of 30 dB hearing level or lower for each group was calculated and compared between groups. Individual anatomical structures on the Jahrsdoerfer grading scale were evaluated for their ability to predict postoperative audiometric success. Of 116 ears evaluated, postoperative 4-tone pure-tone averages and speech reception thresholds were significantly poorer in ears scoring 6 or less on the Jahrsdoerfer grading scale compared with ears scoring 7 or higher (P < .02, t test). Ears scoring 6 or less had a 45% chance of achieving a postoperative speech reception threshold of 30 dB hearing level or lower, while ears scoring 7 or higher had an 89% chance (P < .01, chi(2) test). Lack of middle ear aeration was the only anatomical factor predictive of poor audiometric outcome. Compared with patients with a Jahrsdoerfer score of 6 or lower, patients with a score of 7 or higher had significantly better hearing postoperatively. Middle ear aeration may be the most important predictor of postoperative hearing outcome. The Jahrsdoerfer grading scale is an invaluable tool in the preoperative evaluation of patients with congenital aural atresia.

A Comparison of Cartilage Palisades and Fascia in Type 1 Tympanoplasty in Children

To assess the anatomic and functional results of primary Type1 cartilage tympanoplasty performed with the palisade technique and to compare them with the results of primary Type 1 tympanoplasty performed with temporalis fascia in children. Retrospective case review. Tertiary referral center. The records of 45 children with intact ossicular chain and no history of mastoidectomy or tympanic perforations occupying more than 50% of the membrane area were evaluated. Patients with similar age and middle ear pathologic findings were selected in an effort to make the groups as homogeneous as possible. Of those, 21 children were included in the cartilage study group, and 24 patients were included in the fascia group. An over-under tympanoplasty technique using either a palisaded tragal cartilage or temporalis muscle fascia. Successful outcome was defined as full, intact healing of the graft without perforation, retraction, or lateralization for at least 12 months after the operation and with improvement of hearing. Postoperative speech reception thresholds and postoperative air-bone gap were compared with preoperative levels within and between the groups. Tympanoplasty with the palisade cartilage technique resulted in a significantly higher graft acceptance rate (100%) than with the fascia technique (70.2%; p = 0.008). Speech reception threshold levels, pure-tone average, and air-bone gaps improved significantly with surgery in both the palisade and fascia groups (p < 0.001). Comparison of audiologic results between the groups did not reveal any statistically significant difference (p > 0.05). Palisade tympanoplasty in children yielded good anatomic and functional results. The anatomic results obtained using this technique were superior to those obtained using temporalis muscle fascia. Children who underwent Type 1 tympanoplasty with palisaded cartilage had equivalent postoperative audiometric results compared with children who underwent Type 1 tympanoplasty with temporalis fascia. Thus, palisade cartilage tympanoplasty is an effective technique for both tympanic membrane closure and hearing improvement in children.

Hearing Results After Stapedotomy With a Nitinol Piston Prosthesis

To compare the hearing results in patients with otosclerosis who underwent a stapedotomy with either a platinum wire prosthesis or a commercially available, heat-activated nitinol stapes piston prosthesis. Retrospective medical chart review. Academic tertiary care medical center. Seventy-nine consecutive patients diagnosed as having otosclerosis who underwent primary stapedotomy (33 men and 46 women) were included in this study (41 ears per group). Stapedotomy. The operative records of the senior surgeon (B.J.G.) were retrospectively reviewed, and hearing results were obtained. The hearing results of the patients who received a platinum wire prosthesis were compared with those who received a nitinol prosthesis. Results for the platinum wire prosthesis group revealed a postoperative mean (SD) air-bone gap (ABG) of 7 (6) dB, a mean (SD) ABG closure of 21 (12) dB, and a postoperative mean (SD) speech reception threshold of 25 (16) dB. Results for the nitinol prosthesis group revealed a postoperative ABG of 8 (6) dB, an ABG closure of 25 (10) dB, and a postoperative speech reception threshold of 25 (12) dB. These data show that the nitinol prosthesis is equivalent to the platinum wire prosthesis in closing the ABG in patients with otosclerosis. Comparable efficacy combined with the ease and safety of heat-activated crimping supports the continued use of this prosthesis for stapes surgery.

Congenital Aural Atresia

To review the short- (<1 yr) and long-term (>1 yr) surgical and hearing outcomes for congenital aural atresia and to analyze the stability of surgical results over time. Retrospective chart review of 45 patients (54 ears) who underwent surgery for congenital aural atresia during a 5-year period at a tertiary care institution. Preoperative and postoperative speech reception thresholds, air-bone gaps (ABGs), and pure-tone averages were compared and further analyzed for outcome stability over time. The complication rate was reviewed and compared with results from similar studies. Approximately 50% of patients achieved a speech reception threshold of 30 dB or better both in the short and long term. The average improvement in ABG was 22 dB, resulting in a postoperative ABG of 30 dB or less in three of four patients. Short- and long-term outcomes were not significantly different. Patients with an intact ossicular chain did not seem to have a significant advantage in hearing when compared with patients with a prosthetic reconstruction prosthesis. We report a low incidence of meatal stenosis compared with other similar reviews and describe surgical modifications that may attribute to this outcome. Overall, the mean hearing outcome for this group collectively did not significantly degrade over time and compared favorably with other series. However, there was significant variability among individual patients. The safety of this procedure and the demonstrated hearing improvement makes it a reasonable option in patients with congenital aural atresia with favorable anatomy.

Hearing results after primary cartilage tympanoplasty.

Cartilage-perichondrium grafting of the tympanic membrane has been used in an effort to reduce recurrence or progression of middle ear disease. The rigidity of cartilage has obvious benefit in preventing tympanic membrane retraction, but concern has been raised regarding its sound conduction properties Few studies in the literature address hearing results after cartilage tympanoplasty. The purpose of this study was to investigate the hearing results after primary cartilage tympanoplasty and compare them with results after primary tympanoplasty with temporalis fascia. A retrospective review of all ear surgeries using cartilage between 1994 and 1999 was performed. Only primary cases in which the ossicular chain was intact and no mastoid surgery was performed were included. Indications for surgery included tympanic membrane perforation, retraction, and cholesteatoma Pre- and postoperative speech reception thresholds and air-bone gaps at 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz were compared. Eleven patients comprised the cartilage study group, and there were 11 age- and temporally matched control subjects. The mean improvement in speech reception threshold for both the study group and the control group was 10 dB. The majority of patients in both groups had ABG closure to within 10 dB at all frequencies examined. There were no statistically significant differences in speech reception threshold improvement or air-bone gap closures between the two groups. These results demonstrate that hearing results after cartilage tympanoplasty are comparable to those after temporalis fascia tympanoplasty. Therefore, when indicated, a cartilage-perichondrium graft can be used for prevention of disease recurrence or progression without fear of impairing hearing.