Average Preoperative Air-bone Gap Research Articles

A novel technique in treatment of advanced tympanosclerosis: results of malleus replacement and loop prostheses combination; pure endoscopic transcanal approach.

The objectives of the present clinical trial are to describe our surgical technique for advanced tympanosclerosis (TS) and to present the comparison of pre-and postoperative audiometric results. 21 patients suffering from advanced TS (Only type III and IV patients according to Wielinga-Kerr classification) were enrolled in this prospective study. A pure transcanal endoscopic approach was preferred for all patients included in the study. Titanium malleus replacement prosthesis (MRP) and polytetrafluoroethylene (PTFE) loop prosthesis combination were used to bypass fixed ossicles to achieve sound transmission to the inner ear. Pre-and postoperative pure tone audiometry (PTA) measurements and air-bone gap (ABG) results compared, and surgical technique was considered successful if postoperative ABG was less than 20dB. Six of the 21 patients had been operated on before and the tympanic membrane (TM) was intact. The remaining 15 of the 21 patients were the primary cases, and TM perforation repair and ossiculoplasty using combination of the MRP and PTFE loop prosthesis were performed at single-staged operation. The average preoperative ABG values significantly improved from 37.1 ± 6.2 to 14.5 ± 1.2dB postoperatively (p < 0.001). The mean preoperative air conduction threshold (ACT) significantly decreased from 51.7 ± 11.4 to 28.5 ± 9.1dB (p < 0.001). TS surgery is still a controversial issue particularly in stapes footplate fixation. However, our surgical and audiological results in this study are quite promising. The combination of titanium MRP and PTFE loop prosthesis for restoring sound transmission in advanced TS cases is reliable, effective and novel treatment option via endoscopic transcanal approach.

Contemporary Plural Deliberations and Perspectives in Revision Middle Ear Surgery. Causes, Outcomes and Lessons Learned.

The indications for revision middle ear surgery are inter-linked to the objectives of surgery and needs of the patient. Revision middle ear surgery is often challengingly arduous not only for the patient but for the surgeon as well. This study concentrates on the causes of failures of primary ear surgery, indications, techniques, outcomes and lessons learned in revision ear surgery. This retrospectivedescriptive study included 22 cases (12.29%) of revision surgery,with a follow up of at least one year, out of total 179 cases of middle ear surgeries performed over a period of 5 years.These revision cases included tympanoplasty, cortical mastoidectomy and modified radical mastoidectomy alongwith ossiculoplasty and scutumplasty, wherever required. Hearing improvement, closure of perforation, and prevention of recrudescence were the main outcome parameters. The overall morphologic success of revision surgery in our series was 90.90%.There was one graft failure, one attic retraction and the main complication observed was post-operative worsening of hearing.Mean postoperative pure-tone average air -bone gap (ABG) was 20.86 ± 11.29 dB compared with preoperative ABG of 29.64 ± 10.63 dB and the difference was statistically significant ( p < 0.05) with p value 0.0112 on paired t-test. Detailed knowledge and anticipation of the cause of failure is a must in preventing another failure in revision ear surgeries. Hearing preservation must be considered in a pragmatic perspective and accordingly surgical indications must complement the realistic and reasonable expectations of the patients.

Is routine preoperative computed tomography imaging justified in otosclerosis? A retrospective single-centre analysis

Objectives The improvement in the quality of CT imaging in recent years has led to increasing use in the preoperative workup before primary stapedotomy. The aim of this study is to determine whether routine CT scanning is justified by analysing whether the detectability of otoclerotic foci in the CT imaging is associated with a different clinical picture or surgical outcome. Methods Retrospective analysis of patient charts, CT data sets, preoperative and postoperative audiograms of 41 patients who underwent 47 primary stapedotomies. The preoperative and short-term postoperative audiometric thresholds were analysed at 0.5, 1, 2 and 4 kHz. Results In 36 of 47 ears (76.5%), fenestral otosclerosis was observed in the CT scans. Among those 36 ‘CT-positive’ ears, five ears (13.8%) showed additional signs of retrofenestral (cochlear) otosclerosis. The preoperative audiogram results showed no significant differences in the air conduction threshold, bone conduction threshold or air-bone gap between the CT-positive and CT-negative groups. The overall average preoperative air-bone gap (26.4 dB ± 8.3 dB) improved to 12 dB (±7.6 dB) postoperatively, without a significant difference between the CT-positive and CT-negative groups. Conclusion The detectability of otosclerotic foci on CT scans did not correlate with the preoperative audiogram or the ability to close the air-bone gap postoperatively. The CT scans did not reveal new information that influenced the decision to operate or which side to operate. The findings do not support routine preoperative CT scanning in suspected otosclerosis cases. CT imaging may complement audiological tests in atypical cases. Even in straightforward cases, preoperative CT scanning may be offered to patients in order to guide the preoperative counselling. However, the patients should be made aware of the associated radiation risks.

Stapedotomy in Congenital Fixation with Cochlear Hypoplasia: A New Concept Among the Treatment Options for Cochlear Hypoplasia.

Objectives:To introduce the concept of stapedotomy as a new treatment alternative in cochlear hypoplasia (CH) and propose a new guideline for its management.Methods:Forty-two primary cases out of 355 presented with congenital stapes fixation between January 2003 and September 2015 were included in the study. Computed tomography scans of all cases with congenital stapes fixation were reviewed, and cases with inner ear anomalies were taken into account. Eleven cases had various inner ear anomalies, and 9 cases had various types of CH. In the present paper, only the CH cases with stapes fixation, all of whom underwent stapedotomy, are reviewed regarding preoperative audiological and radiological characteristics as well as surgical findings and postoperative audiological results.Results:The patients were aged between 4 and 22. There were 2 males (3 ears) and 4 females (6 ears). Three cases had bilateral stapedotomy. The remaining 3 cases had unilateral surgery. The average preoperative air–bone gap (ABG) was 50.3 dB. Postoperative hearing: preoperative ABG was 50.3 dB. Postoperative ABG was calculated as 20.1 dB hearing.Conclusion: Hearing loss (HL) in hypoplastic cochlea demonstrates the full spectrum of HL types. CH is a unique inner ear anomaly that can be treated with all of the available rehabilitation modalities. As a result of current findings, a new treatment algorithm for CH is proposed.KEYWORDS: Congenital stapes fixation, cochlear hypoplasia, congenital hearing loss, inner ear malformations, stapedotomy

Hearing Outcome of Stapes Surgery in NIENT, Bangladesh

Objective: The aim of this study was to evaluate hearing outcome after stapedotomy in patients with Otosclerosis.&#x0D; Methods: This cross sectional study was carried out from July 2017 to January 2019 in National Institute of ENT, Unit V. About 22 patients with Otosclerosis were included in this study. Diagnosis of Otosclerosis was based on the history, medical status with Otoscopy, Tuning fork tests and Audiometric tests. We compiled data on the pre and post operative air-bone gap (ABG) at 0.5, 1, 2 KHZ. The ABG was Calculated using AC and BC thresholds on the same audiogram. Post operative hearing gain was then Calculated from the ABG before the operation minus the ABG of the last follow up examination&#x0D; Results: In this study most of the cases were age group 14-30 years (72.7%), female (54.5%). Most common symptoms was progressive hearing loss, tinnitus (77.8%).The average preoperative hearing loss in this study was (AC) was 48.31±7.68. The average post opt. hearing (AC) at follow up was 28.95±10.30 with an average hearing gain of 15.40±8.53 dB which was significant. The average pre-operative ABG was 28.99 dB ± 8.10. The average post opt. ABG was analyzed at 1 follow up showed ABG 13.18±8.09 dB which was found to be significant.&#x0D; Conclusion: Stapedotomy is an effective surgical procedure for the treatment of otosclerosis which leads to improvement in patient’s quality of life. A favorable hearing outcome can be obtained by the combination of experienced hands with minimal surgical trauma and appropriate surgical technique.&#x0D; Bangladesh J Otorhinolaryngol; April 2020; 26(1): 31-36

Endoscopic Management of Tympanic Membrane Retraction Pockets: A Two Handed Technique with Endoscope Holder.

The tympanic membrane retraction pocket is a pathological invagination of tympanic membrane into the middle ear space. The most common sites for formation of retraction pocket are pars flaccida and postero-superior parts. Decision about the procedure and the timing of the treatment of retraction pockets is debatable and depends on the functional and anatomic condition of the ear. To evaluate the results of the technique of two handed endoscopic management of retraction pockets with sliced tragal cartilage. Prospective Non Randomized Clinical Study. The study included 41 ears operated with the technique of two handed endoscopic cartilage tympanoplasty for retraction pockets with endoscope holders from November 2013 to May 2016 with a follow up period ranging from 22 to 53months. Cases of cholesteatoma and tympanic membrane perforation were excluded from the study. Pre and postoperative symptoms and air-bone gaps were recorded. The average preoperative air-bone gap in the study group was 24.53 ± 4.326dB. 28 ears were of pars tensa retractions (stage II-4, stage III-15, and stage IV-9) and 13 were pars flaccida retractions (stage III-8 and stage IV-5). 24 ears had ossicular erosion. The follow up revealed that, the results of two handed endoscopic sliced cartilage tympanoplasty for retraction pockets were stable and there was no recurrence of the retraction and the post-operative air-bone-gap closure was achieved to 13.62 ± 4.78, 14.13 ± 5.91dB, 14.32 ± 3.46 and 14.57 ± 3.88dB at 6months, 1 year, 2 years, 3 years respectively. Though, indications for surgery are based mostly on anatomic status and observation of behaviour of retraction pocket over time, we recommend early management of retraction pockets by the technique of endoscopic sliced tragal cartilage tympanoplasty with tragal cartilage of 0.5mm thickness using endoscope holder. Level of Evidence: Level 4.

Study of hearing results of ossiculoplasty in patients with safe chronic suppurative otitis media

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Ossicular discontinuity can occur as a result of erosion by chronic otitis media or due to trauma. Reconstruction of the ossicular chain aims to surgically optimize the middle ear transformer mechanism. The goal of this study was to devise a protocol to manage the ossicular discontinuity, provide good hearing to the patients and to demonstrate that use of ossicle for ossicular reconstruction is a safe, physiological, practical, successful and cost effective method.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present study is retrospective study of 50 patients who underwent ossiculoplasty in our institute over the period of 2 years. Most patients presented to us with a history of chronic intermittent ear discharge and decreased hearing. Detailed clinical examination included general examination and local examination of ear, nose and throat. Examination of ear included otoscopy, tuning fork tests, and examination under microscope. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The average pre-operative air-bone gap in patients with ossicular disruption was 34.95 dB and after ossiculoplasty was 12.93 dB. The mean air-bone closure after surgery was 27.88 dB. In most cases the post-operative air bone closure was within the range of 20 dB. The hearing results in ossiculoplasty are dependent on various factors but middle ear status in one of the most important factor in deciding the final outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The ossiculoplasty using autograft has stood the test of time and the results are superior to that of prosthesis. They have less rate of complications, are economic and easily available. The expertise to sculpt the ossicle can be easily developed with practice.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Anatomical and frequencies-specific hearing results of retrograde mastoidectomy.

The aim of this study was to evaluate the long-term anatomical and frequency-specific hearing results of canal wall down (CWD) and canal wall up (CWU) mastoidectomy by retrograde mastoidectomy (RM) surgical method. Patients underwent CWU and CWD procedures with method of RM, 53 and 59 patients between January 2010 and June 2015 were evaluated retrospectively. The pre- and post-operative pure tone average air-bone gap (ABG) values of these patients were recorded in detail at 0.5, 1, 2 and 4 kHz. Pre and post-operative ABG were evaluated in detail in each group in each frequency. In addition, at least two years follow-up recurrence rates were evaluated. In the CWU method, post-operative ABG decreased significantly at low-frequencies compared to pre-operative ABG (p < 0.05), especially at 2 kHz (p < 0.001). But, auditory improvement was not achieved at 4 kHz. In the CWD procedure, auditory improvement was not achieved both 1 kHz and 4 kHz. CWU and CWD recurrence rates were respectively 9.4% and 10.1%. Postoperative hearing results of both surgical methods provide good auditory outcome at low-frequencies. This improvement is evident in CWU especially at 2 kHz. This may be related to the protection of the external ear canal. In both surgical methods of RM, a satisfactory anatomical success was achieved with recurrence rates of around 10%. RM is a good surgical technique alternative to classical canal wall down procedure with both auditory results and low recurrence rates.

The effects of surgery type and different ossiculoplasty materials on the hearing results in cholesteatoma surgery.

To investigate the effects of surgery type [intact canal wall (ICW) or canal wall down (CWD) mastoidectomy] and different ossiculoplasty materials on hearing outcome in single-staged cholesteatoma surgery. A retrospective case-control study. A total of 116 cases (97 adults, 29 children) underwent surgery, including ossiculoplasty, between 2012 and 2015 for cholesteatoma. Patients who had undergone surgery for the first time, and whose grafts were successful, were included in the study. Patients with adhesive otitis media, unsuccessful grafts, revision and recurrent cases, radical mastoidectomy, and craniofacial anomalies were excluded. Audiogram examinations of the enrolled patients were performed 3-6months after surgery, and the audiometric results were analyzed according to the criteria of the American Academy of Otolaryngology, Head and Neck Surgery. All ossiculoplasties were performed during the first operation. The preoperative average air-bone gap (ABG) of the patients was decreased from 31.37±10.1 to 27.42±10.4dB; this decrease was found to be highly significant (p=0.0001). Concerning the ICW technique, statistical evaluation of the hearing gain at frequencies of 500, 1000, and 2000Hz, as well as the mean frequency, showed a high level of significance. Improvement at 4000Hz was not found to be statistically significant. When the ABGs at 500, 1000, 2000, and 4000Hz, and the mean frequency in patients with an hydroxyapatite-partial ossicular replacement prosthesis (HA-PORP) or autograft-partial ossicular replacement prosthesis (APORP), were evaluated, it was found that, at 4000Hz, the APORP significantly reduced the ABG (p=0.02). No significant difference was determined between patients with the hydroxyapatite-total ossicular replacement prosthesis (HA-TORP) and those with the autograft-total ossicular replacement prosthesis (ATORP) (p=0.565). Although the use of the malleus as an APORP was found to be less effective than other autografts, the degree of advantage of using the incus, malleus, cortical bone, and cartilage did not significantly differ between materials (p=0.152). Despite the effects of the incus, malleus, and cortical bone not differing in terms of the postoperative ABG (p=0.160), incus usage was highly beneficial for hearing gain (p=0.009). Despite CWD tympanoplasty affecting all frequencies, it has a particularly negative effect on the hearing threshold at 1000Hz. In patients with partial ossicular replacement, autogenous grafts are more successful in restoring hearing at high frequencies, particularly at 4000Hz. Although autogenous materials do not differ in terms of partial replacement effectiveness, the incus has been shown to be most effective for total replacement.

Three-point fix tympanoplasty

Conclusion: The three-point fix tympanoplasty procedure is a stable and effective technique – with a high degree of graft take and satisfactory hearing results – for reconstruction of most tympanic membrane (TM) perforations. Objective: It is difficult to repair a TM perforation, including subtotal perforation, involving the anterior part of the annulus. Reperforation can occur when an underlay graft technique is used. An overlay graft technique may result in anterior blunting/lateralization. We introduce a three-point fix tympanoplasty procedure, which can provide additional support to yield a stable graft. Methods: The study enrolled a total of 234 patients who underwent a three-point fix tympanoplasty procedure from November 2005 to June 2011. Anatomic success was defined as an intact, repaired TM, while functional success was defined as a significant decrease in the air–bone gap at the end of follow-up compared with preoperative hearing (air–bone gap). The complication rate was also analyzed. Results: The anatomic success rate was 93.2% (218/234 patients). The functional success rate after an average of 1 year was 73.5%. The postoperative average pure-tone air–bone gap (15.4 ± 11.4 dB) decreased successfully in comparison with the preoperative average air–bone gap (20.6 ± 12.1 dB). There were few postoperative complications (7.7%).

Preparation and placement of cartilage island graft in tympanoplasty

IntroductionCartilage graft tympanoplasty has a better success rate in the treatment of chronic otitis media if regularly prepared and placed. ObjectiveTo prepare cartilage island material and evaluate its effect on the success rate of tympanoplasty. MethodsThe medical records of 87 patients (48 males and 39 females; mean age, 27.3±11.2 years; range, 14–43 years) with chronic otitis media without cholesteatoma who underwent intact canal-wall-up tympanoplasty and revision surgery between December of 2007 and October of 2011 were retrospectively evaluated. Surgery was performed under general anesthesia via a retroauricular approach. ResultsThe overall success rate of this technique was 93% in terms of perforation closure. No graft lateralization or displacement into the middle ear occurred. The overall average preoperative air bone gap was 37.27±12.35dB, and the postoperative air bone gap was 27.58±9.84dB. The mean postoperative follow-up period was 15.3 months (range: 7–21 months). ConclusionIf cartilage graft is properly prepared and placed, cartilage graft tympanoplasty appears to provide better success rates and hearing results.

Outcome measures in stapes surgery: postoperative results are independent from preoperative parameters

The aim of this study was to compare audiometric results before and after stapes surgery and identify potential prognostic factors to appropriately select patients with otosclerosis who will most likely benefit from surgery. We enrolled 126 patients with otosclerosis (162 consecutive ears) in our study who underwent stapes surgery between 2007 and 2012 at our institution. Preoperative and postoperative data including pure-tone audiometry, speech audiometry, stapedial reflex audiometry and surgical data were analyzed. The average preoperative air-bone gap (ABG) was 28.9 ± 8.6 dB. Male patients and patients older than 45 years of age had greater preoperative ABGs in comparison to females and younger patients. Postoperative ABGs were 11.2 ± 7.4 dB. The average ABG gain was 17.7 ± 11.1 dB. Preoperative audiometric data, age, gender and type of surgery did not influence the postoperative results. Stapes surgery offers predictable results independent from disease progression or patient-related factors. While absolute values of hearing improvement are instrumental in reflecting audiometric results of a cohort, relative values better reflect individual's audiometric data resembling the patient's benefit.

CO2 Laser Myringoplasty

1) To describe a cost-effective, minimally invasive technique for treating tympanic membrane atelectasis, and 2) to present data on hearing improvement in patients receiving this as the basis for a future prospective study. Report of hearing and clinical outcome over a 4-year period. Tertiary center. Patients with tympanic membrane atelectasis and hearing loss. Valsalva, hydrodissection, or manual dissection reinflated the atelectatic segment under mask anesthesia. A CO2 laser hand-held fiber contracted the tympanic membrane. Then, myringotomy and pressure equalizing tube placement was performed. Status of the tympanic membrane, patency of the tubes, and pure tone average air-bone gap on preoperative, postoperative, and most recent audiograms. Laser myringoplasty was performed on 60 ears of 43 patients. The average preoperative air-bone gap was 15 dB, and this significantly improved to 7 dB (p < 0.001) postoperatively. Hearing improvement remained significant in the 17 patients with greater than 2 years' follow-up (7 dB, p = 0.007). Patients with effusion had worse preoperative air-bone gap (19 dB) compared with dry ears (12.5 dB, p = 0.02). However, postoperative and long-term air-bone gaps were not significantly different in the 2 groups (p = 0.3). Patients with myringostapediopexy that required or failed mechanical elevation did not have significant hearing improvement. Laser myringoplasty for treatment of tympanic membrane atelectasis using a hand-held flexible fiber CO2 laser is feasible and may improve hearing immediately and long term. It is not useful in severe adherent atelectasis. More studies are indicated to confirm its overall cost-effectiveness and competitiveness with traditional methods of managing atelectasis.

Hearing Outcomes After Surgical Plugging of the Superior Semicircular Canal by a Middle Cranial Fossa Approach

To determine postoperative hearing outcomes after surgical plugging via middle cranial fossa approach for superior semicircular canal dehiscence syndrome (SCDS). Clinical review. Tertiary care medical center. Forty-three cases of SCDS based on history, physical examination, vestibular function testing, and computed tomography imaging confirming the presence of a dehiscence. All patients underwent surgical plugging of the superior semicircular canal via middle cranial fossa approach. Pure tone audiometry was performed preoperatively and at 7 days and at least 1 month postoperatively. Change in air-bone gap (ABG) and pure tone average (PTA). Preoperative average ABG across 0.25, 0.5, 1, and 2 kHz was 16.0 dB (standard deviation [SD], 7.5 dB). At 7 days postoperatively, average ABG was 16.5 dB (SD, 11.1; p = 0.42), and at greater than 1 month was 8.1 dB (SD, 8.4; p < 0.001). 53% (95% confidence interval, 33-69) of affected ears had greater than 10 dB increase in their 4-frequency (0.5, 1, 2, and 4 kHz) PTA measured by bone-conduction (BC) threshold 7 days postoperatively and 25% (95% confidence interval, 8-39) at greater than 1 month postoperatively. Mean BC PTA of affected ears was 8.4 dB hearing loss (HL) (SD, 10.4) preoperatively. Compared with baseline, this declined to 19.2 dB HL (SD, 12.6; p < 0.001) at 7 days postoperatively and 16.4 dB HL (SD, 18.8; p = 0.01) at greater than 1 month. No significant differences in speech discrimination score were noted (F = 0.17). Low-frequency air-bone gap decreases after surgical plugging and seems to be due to both increased BC thresholds and decreased AC thresholds. Surgical plugging via a middle cranial fossa approach in SCDS is associated with mild high-frequency sensorineural hearing loss that persists in 25% but no change in speech discrimination.

Total Ossiculoplasty in Children&lt;subtitle&gt;Predictive Factors and Long-term Follow-up&lt;/subtitle&gt;

To evaluate the long-term results and predictive factors of a good outcome with the use of a total ossicular replacement prosthesis in children. Retrospective case review. Tertiary referral center. The study included 114 children (116 ears). A total of 116 ears underwent total ossicular chain reconstruction with a titanium prosthesis. Cartilage was always used for tympanic membrane reconstruction. Audiological results were evaluated according to the guidelines of the American Academy of Otolaryngology-Head and Neck Surgery. Predictive factors of audiological results were determined. Logistic regression and χ(2) tests were used for statistical analysis. The mean age at surgery was 9.8 years. Ossiculoplasty was performed during second-look surgery in 91 ears (78.4%) and during another stage in 25 ears (21.6%). The first-stage procedure was always performed for cholesteatoma. Audiometric results were available for 116 ears at 1 year, for 89 ears (76.7%) at 2 years, and for 42 ears (36.2%) at 5 years. Closure of the average air-bone gap (ABG) to within 20 dB was achieved in 65 ears (56%) at 1 year. The mean (SD) preoperative and postoperative (at 1 year) ABGs were 41.0 (9.5) dB and 22.4 (12.6) dB, respectively. There were no cases of extrusion, but 17 luxations of the prosthesis were confirmed by computed tomography. Luxation occurred on average at 31.4 months. Only three 4000-Hz degradations of bone conduction were reported, with no dead ears. We examined 3 predictive factors of auditory results: preoperative ABG, footplate status, and postoperative otoscopic findings. Total ossiculoplasty is a reliable technique in children. Long-term hearing outcomes are stable and satisfactory, but luxation can occur at any time. Preoperative ABG and footplate status are negative predictive factors of auditory results.

Cartilage Shield Tympanoplasty in Children

To assess the efficacy of partial ossicular chain reconstruction using autologous cartilage. Prospective study (April 1, 1997, through January 1, 2008). Tertiary academic children's hospital. Two hundred forty-eight children (268 ears) underwent partial ossicular chain reconstruction using a shaped block of tragal cartilage interposed between the head of the stapes and an underlay tympanic membrane reconstruction along with tragal cartilage and its perichondrium. Anatomical and audiologic results were evaluated according to the American Academy of Otolaryngology-Head and Neck Surgery guidelines. χ² Tests and multivariate analysis were used for statistical evaluation. Mean age at surgery was 10.9 years. Single-stage surgery was performed in 124 ears (46.3%) (62.9% for cholesteatomas and 32.3% for retraction pockets). Second-look patients (53.7%) included 93.8% of staged surgery. Audiometric results were available for 222 ears at 1 year and for 78 ears at 5 years. Closure of the average air-bone gap (ABG) to within 20 dB was achieved in 62.2% of ears at 1 year. The mean (SD) preoperative and 1-year postoperative ABGs were 25 (11.8) dB and 18.9 (10.3) dB, respectively. Anatomical results were satisfactory in 87.3%. No cases of extrusion, resorption, or displacement of the cartilage were encountered. No statistically significant difference was found between audiometric results at 1 and 5 years. Multivariate analysis showed a significant negative correlation between preoperative and postoperative ABGs and between postoperative otitis media with effusion and postoperative ABG (P < .05). Cartilage ossiculoplasty is a reliable technique for partial ossicular replacement. Long-term hearing outcomes remain stable and satisfactory. Preoperative ABG and postoperative otitis media are the predictive factors of the hearing outcome.

Improving Hearing in Stapedectomy With Intraoperative Auditory Brainstem Response

To determine the efficacy of using intraoperative auditory brainstem response (ABR) in improving immediate hearing results of patients undergoing primary laser stapedotomy. Case series with chart review. Community hospital. The study included 32 consecutive patients, with 34 ears undergoing primary stapedotomy by a single surgeon at a single institution using a single prosthesis design. Intraoperative ABR was performed at the beginning of each surgery and after the stapes prosthesis was inserted. Surgical adjustments were made if initial ABR results did not demonstrate hearing improvement. ABR then was repeated at the conclusion of the procedure. Audiometry was performed postoperatively in all patients. There were 22 left ears and 12 right ears studied. Two patients underwent bilateral staged surgery. Eight patients, or 23% of the group, had intraoperative adjustments made to improve hearing results. Hearing was improved in 33 of 34 ears, or 97%. The surgical revision rate was 3%. The average preoperative air-bone gap (ABG, calculated as an average from 250, 500, and 1000 Hz) was 29.0 dB HL in the left ear group and 26.6 dB HL in the right ear group. The average postoperative ABG was 9.9 dB HL in the left ear group and 9.4 dB HL in the right ear group. All patients had postoperative audiometric results consistent with final intraoperative ABR results. Intraoperative ABR may significantly improve immediate hearing results in patients and greatly reduce the need for revision surgery.

Surgery of Idiopathic Malleus Fixation

To describe and compare 2 different surgical techniques used in treatment of malleus fixation syndrome. A retrospective study including 24 patients (25 ears). In 11 of them, the attical fixation was removed via a transmastoid approach without disruption of the ossicular chain. In 14 patients, an ossiculoplasty was performed via a transcanal approach; the malleus head was removed with the incus, and the ossicular chain was reconstructed either by incus interposition (9 cases) or by using a partial ossicular replacement prosthesis (5 cases). The hearing results were analyzed according to the Committee on Hearing and Equilibrium Guidelines of the American Academy of Otolaryngology. In the group of attical fixation removed via a transmastoid approach, the preoperative air-bone gap (ABG) attained 25.2 dB, and the postoperative ABG at 1 year followup was 9.1 dB. In the group of ossiculoplasty, the average preoperative ABG reached 26.5 dB, and the postoperative ABG at 1-year follow-up was 8.2 dB. There was no statistically significant difference (p = 0.79) between the 2 surgical techniques used to improve hearing in malleus head fixation.

To POP or Not: Ossiculoplasty in Congenital Aural Atresia Surgery

To examine indications for ossiculoplasty (OP) in aural atresia surgery and to compare audiometric results and surgical revision rates between patients undergoing OP and those undergoing intact native chain reconstruction (INCR). Retrospective chart review. Charts of patients undergoing surgery for congenital aural atresia were reviewed for demographic data, preoperative Jahrsdoerfer score, ossicular chain status, and audiometric data. Patients undergoing OP were compared with an equal number of age and Jahrsdoerfer grade-matched patients who had an INCR. The preoperative and postoperative average air-bone gap (ABG), speech reception thresholds (SRT), and rates of revision surgery were compared between the two groups. Nineteen patients (20 ears) underwent OP during aural atresia repair and were compared with 20 matched patients who had INCR. Mean age, Jahrsdoerfer score, preoperative ABG, and SRT were similar for both groups. Mean postoperative audiometric follow-up was 33.1 months for the OP group and 20.4 months for the INC group (P = .24). Mean postoperative ABG was 33.8 dB HL for OP and 23.8 dB HL for INCR (P < .05). Mean improvement in ABG was 16.8 dB HL for OP and 29.9 dB HL for INCR (P < .001). Mean improvement in SRT was 24.6 dB HL for OP and 34.8 dB HL for INCR (P < .05). Nine ears (45%) in the OP group and four ears (20%) in the INCR group underwent revision surgery (P = .09). Patients reconstructed with their own intact native chain during aural atresia surgery have better audiometric outcomes than those undergoing OP and are less likely to undergo revision surgery.

Analysis of long-term hearing after tympanosclerosis with total/partial stapedectomy and prosthesis used

Conclusion. Long-term hearing gain results are good after prosthetic reconstruction of the stapes in the tympanosclerotic ear. The type of stapedectomy, whether partial or total, does not affect the result of the surgery very much. Objectives. Comparative evaluation of the hearing results of total/partial stapedectomy technique and the prosthesis used within a 10-year follow-up period after stapedectomy in cases with dense tympanosclerosis and completely fixed stapes. Patients and methods. Twenty-five cases with completely fixed stapes due to generalized tympanosclerosis were included in this retrospective study between 1995 and 2005. Two-stage canal wall up procedure was planned for all cases, and stapedectomy was performed at the second stage. After the second stage, 25 ears in the sixth month, 18 ears in the first year, 14 ears in the second year, and 7 ears in the tenth year were available for follow-up. Preoperative and postoperative air–bone gap values of the patients and their hearing gain were compared. Total stapedectomy was carried out in 17 of the patients and partial stapedectomy in 8 of them. For ossiculoplasty, a plastipore total ossicular replacement prosthesis was used in 17 patients, homograft ossicle in 2 patients, and Teflon piston in 6 patients. Results. In 17 cases in which we used total stapedectomy, the average preoperative air–bone gap value improved from 40.23 to 18.47 in the sixth month, and from 38.4 dB to 9.6 dB in the tenth year. In eight cases in which we used partial stapedectomy, the average preoperative air–bone gap improved from 38.63 dB to 24.38 dB and from 35 dB to 17 dB, respectively. The average postoperative hearing gain with total stapedectomy was 21.76 dB in the sixth month and 28.8 dB in the tenth year. Hearing gain with partial stapedectomy was successively 14.25 dB and 18 dB. When we compared the results of total prosthesis and Teflon pistons among the materials used in ossiculoplasty, although hearing gain with total prostheses was better, the results were not statistically significant.