Preoperative Bone Conduction Research Articles

A study to assess hearing improvement after fat graft myringoplasty

<p class="abstract"><strong>Background:</strong> Tympanic membrane perforations result mainly from infectious and traumatic etiologies. Postoperative outcomes of reconstructive surgeries of hearing mechanism have routinely been assessed by take up rates and air bone gap closure on pure tone testing. The present study was conducted to assess hearing improvement after fat graft myringoplasty.</p><p class="abstract"><strong>Methods:</strong> The present prospective study was conducted from 1<sup>st</sup> January 2017 to 30<sup>th</sup> June 2018. The study population consists of patients of age 18 to 60 years. The subjects with safe or tubotympanic type of chronic suppurative otitis media with small dry central perforation or perforation of the pars tensa less than 3 mm were included in the study. Pure tone audiometry (PTA) was consigned to an audiologist who was blind to the study. Air conduction threshold level was measured at frequencies 0.25 to 8 kHz and bone conduction threshold level was measured at frequencies 0.5 to 4 kHz; average air bone gap of each patient was calculated preoperatively and postoperatively at one and three months at the frequencies 500 Hz, 1000 Hz and 2000 Hz. </p><p class="abstract"><strong>Results:</strong> Among 30 patients, 15 (50.00%) had pre-operative bone conduction threshold in the range of 0-10 dB HL and rest 15 (50.00%) had between 11-20 dB HL. Majority of them i.e. 20 had post-operative air bone gap in the range of 0-10 dB HL whereas 02 had pre op air bone gap in this range, followed by 07 with air bone gap in the range of 11-20 dB HL as compared to 18 in the pre op and 03 in the range of 21-30 dB HL as compared to 10 in the pre op. Paired t test reveals results are significant.</p><p class="abstract"><strong>Conclusions:</strong> Postoperative audiometry at the end of 1 month revealed majority i.e. 14 had air bone gap in range of 0-10 dB HL thus showing improvement in hearing. Postoperative audiometry at the end of 3 months revealed maximum number of patients i.e. 20 in the range of 0-10 dB HL which showed further improvement in hearing in the form of decrease in air bone gap.</p><p class="Default"> </p>

Does Drilling Induce Hearing Loss after Modified Radical Mastoidectomy? A Retrospective Study

Introduction Incidence of sensory neural hearing loss following mastoid surgery varies from 1.2 – 4.5%.There are various causes for postoperative sensorineural hearing loss during mastoid surgery. This study aims to identify whether there is any correlation between drilling and postoperative sensory neural hearing loss.
 MethodsA retrospective study was conducted in the Department of ENT from January 2018 to June 2019. A total number of 68 patients above five years of age who underwent modified radical mastoidectomy for chronic otitis media squamous were included. Revision surgery, preoperative sensorineural hearing loss, injury to the ossicular chain during surgery, patients with lack of follow up or doubtful reports in mentally challenged were excluded from the study. The average bone conduction threshold was calculated from 500, 1000, 2000, 4000 Hz and compared using the Wilcoxon signed-rank test.
 ResultsThere were 43 males and 25 females in the study with a median age of 23.5 years (16-55). The mean preoperative bone conduction threshold in the four frequencies of 500 Hz, 1kHz, 2kHz, 4kHz were -2.06dB, -2.06dB, 3.31dB, 4.63 dB respectively and the mean postoperative bone conduction thresholds were 1.03, 1.32, 5.29, 4.04 respectively. There was a decline of mean of 3.09 dB and 3.38dB only at the low-frequencies (500Hz and 1kHz) BC threshold respectively which were statistically significant, whereas at higher frequency there was no decline in average postoperative BC threshold.
 ConclusionThere is no definite role of drill in inducing hearing loss and if present other causes of hearing loss should be sought in postoperative sensorineural hearing loss.

Does Drilling Induce Hearing Loss after Modified Radical Mastoidectomy? A Retrospective Study

Introduction: Incidence of sensory neural hearing loss following mastoid surgery varies from 1.2 – 4.5%. There are various causes for postoperative sensorineural hearing loss during mastoid surgery. This study aims to identify whether there is any correlation between drilling and postoperative sensory neural hearing loss. Methods: A retrospective study was conducted in the Department of ENT from January 2018 to June 2019. A total number of 68 patients above five years of age who underwent modified radical mastoidectomy for chronic otitis media squamous were included. Revision surgery, preoperative sensorineural hearing loss, injury to the ossicular chain during surgery, patients with lack of follow up or doubtful reports in mentally challenged were excluded from the study. The average bone conduction threshold was calculated from 500, 1000, 2000, 4000 Hz and compared using the Wilcoxon signed-rank test. Results: There were 43 males and 25 females in the study with a median age of 23.5 years (16-55). The mean preoperative bone conduction threshold in the four frequencies of 500 Hz, 1kHz, 2kHz, 4kHz were -2.06dB, -2.06dB, 3.31dB, 4.63 dB respectively and the mean postoperative bone conduction thresholds were 1.03, 1.32, 5.29, 4.04 respectively. There was a decline of mean of 3.09 dB and 3.38dB only at the low-frequencies (500Hz and 1kHz) BC threshold respectively which were statistically significant, whereas at higher frequency there was no decline in average postoperative BC threshold. Conclusion: There is no definite role of drill in inducing hearing loss and if present other causes of hearing loss should be sought in postoperative sensorineural hearing loss.

Intraoperative quantification of floating mass transducer coupling quality in active middle ear implants: a multicenter study

PurposeEvaluating the effectiveness of intraoperative auditory brainstem responses (ABRs) to stimulation by the Vibrant Soundbridge (VSB) active middle ear implant for quantifying the implant’s floating mass transducer (FMT) coupling quality.MethodsIn a diagnostic multicentric study, patients (> 18 years) who received a VSB with different coupling modalities were included. Pre- and postoperative bone conduction thresholds, intraoperative VSB-evoked ABR thresholds (VSB-ABR) using a modified audio processor programmed to preoperative bone conduction thresholds, postoperative vibrogram thresholds, and postoperative VSB-ABR thresholds were measured. Coupling quality was calculated from the difference between the pure tone average at 1000, 2000, and 4000 Hz (3PTA) vibrogram and postoperative 3PTA bone conduction thresholds.ResultsTwenty-three patients (13 males, 10 females, mean age 56.6 (± 12.5) years) were included in the study. Intraoperative VSB-ABR response thresholds could be obtained in all except one patient where the threshold was > 30 dB nHL. Postoperatively, an insufficient coupling of 36.7 dB was confirmed in this patient. In a Bland–Altman analysis of the intraoperative VSB-ABRs and coupling quality, the limits of agreement exceeded ± 10 dB, i.e., the maximum allowed difference considered as not clinically important but the variation was within the general precision of auditory brainstem responses to predict behavioral thresholds. Five outliers were identified. In two patients, the postoperative VSB-ABR thresholds were in agreement with the coupling quality, indicating a change of coupling before the postoperative testing.ConclusionThe response thresholds recorded in this set-up have the potential to predict the VSB coupling quality and optimize postoperative audiological results.

Does bilateral otosclerosis make pre-operative bone conduction more inaccurate?

ObjectivesTo assess whether bilateral otosclerosis renders pre-operative bone conduction more inaccurate by increasing the Carhart effect. MethodsRetrospective review of a database of pre and post-operative audiograms of 745 ears with otosclerosis treated with stapedectomy from 2013 to 2020 in a tertiary centre. Main outcome measuresChange in bone conduction after stapedectomy for otosclerosis in: unilateral otosclerosis (U1); bilateral otosclerosis undergoing first side surgery (B1); bilateral otosclerosis undergoing second side surgery (B2). The magnitude of change in bone conduction post-operatively within and between each group. ResultsThe average difference in pre and post-operative bone conduction was significant within in all groups (T-stat > 2 and P-value <0.05) with the greatest change observed in the U1 group. Analysis of average change in bone conduction between groups did not reach statistical significance (P-value = 0.37). Analysis of change per frequency demonstrated the greatest change in bone conduction post-operatively at 2000 Hz in all groups. The magnitude of change at 2000 Hz was the greatest in the bilateral groups; however, it did not reach statistical significance when compared to the unilateral group (P-value = 0.36). ConclusionsThis is the first study in the literature to assess the accuracy of pre-operative bone conduction in bilateral versus unilateral otosclerosis. There is no evidence that pre-operative bone conduction in bilateral otosclerosis is more inaccurate than in unilateral disease. In order to assess accuracy of pre-operative bone conduction in otosclerosis a reliable method of assessing post-operative bone conduction is required, without assumption of its equivalence to cochlear reserve.

Audiological and subjective outcomes of 100 implanted transcutaneous bone conduction devices and preoperative bone conduction hearing aids in patients with bilateral microtia-atresia

Background: Bonebridge (BB) and bone conduction hearing aid (BCHA) are effective in patients with bilateral congenital microtia-atresia (CMA).Objectives: To investigate and compare the outcomes of these devices in a large sample size.Materials and methods: This single center prospective study involved 100 patients with bilateral CMA who were implanted with BBs and used BCHAs before implantation. Sound field threshold (SFT), speech reception thresholds (SRTs) and word recognition scores (WRSs) were compared between unaided, BCHA used and implanted patients. The Abbreviated Profile of Hearing Aid Benefit (APHAB) was used to evaluate subjective satisfaction.Results: Compared to unaided condition, the SFT, WRS and SRT of BCHA and BB were significantly improved. With BCHA or BB, the three subscale scores of the APHAB (ease of communication, background noise and reverberation) significantly reduced. However, the aversiveness subscale scored significantly higher than unaided condition. All outcomes were better in BB condition than BCHA.Conclusions: BB or BCHA use can be considered as effective methods to improve audiological outcomes and subjective satisfaction. Although not as good as BB, BCHA use is critical for improving hearing in the early period of language and auditory pathway development before the skull is suitable for BB implantation.

Active Transcutaneous Bone Conduction Implant: Audiometric Outcomes Following a Novel Middle Fossa Approach With Self-Drilling Screws.

To present surgical and audiometric outcomes of patients implanted with an active transcutaneous bone conduction implant following the novel middle fossa surgical approach with self-drilling screws. Retrospective review. Tertiary care center. Thirty-seven adults with either conductive or mixed hearing loss that met indications for an active transcutaneous bone conduction implant were consecutively implanted from April, 2013 to May, 2018. Unilateral middle fossa implantation of an active transcutaneous bone conduction implant. Patient charts were reviewed for surgical outcomes and complications over the 6-year period. Preoperative air conduction, preoperative bone conduction, and 3-month postoperative aided thresholds were recorded. Speech perception was assessed using CNC words and AzBio sentences. Pure-tone averages (PTAs; measured at 0.5, 1.0, 2.0 and 3.0 kHz), air-bone gap, and functional gain were calculated. Mean air conduction and bone conduction PTAs (±standard deviation) of the implanted ear were 66.8 dB (±14.9 dB) and 21.9 dB (±14.0 dB), respectively. Mean aided PTA was 26.5 dB (± 8.5 dB). The average functional gain was 40.3 dB (±19.0 dB). Favorable speech perception outcomes were observed. No complications or instances of revision surgery were reported, with a mean follow-up time of 32 months (range, 9-71 mo). This is the first paper to describe outcomes of patients implanted with an active transcutaneous bone conduction implant via the middle fossa with self-drilling screws. Favorable surgical outcomes were observed with a follow-up of up to 6 years.

Hearing gain after myringoplasty in relation to the size of tympanic membrane perforation

Objectives: To assess hearing gain after successful myringoplasty in relation to the size of tympanic membrane perforation.&#x0D; Methods: This cross-sectional study was done in the department of otolaryngology and head neck surgery, BSMMU, Sahbag, Dhaka during the period of January 2009 to December 2010.A total of 60 patients were under went myringoplasty operation after taking detailed history, clinical examination and investigation. Preoperative and postoperative hearing assessment was done. Analysed data presented by various tables, graphics and figures.&#x0D; Results: In case of small size perforation preoperative mean bone conduction threshold was 7.66 dB, mean air conduction threshold was 34.14 dB and mean air bone gap was 26.48 dB. In case of medium size perforation preoperative mean bone conduction threshold was 9.61 dB, mean air conduction threshold was 44.48 dB. Mean air bone gap was 34.87 dB. In case of large size perforation preoperative mean bone conduction threshold was 13.12 dB, mean air conduction threshold was 59 dB, and mean air bone gap was 45.88 dB. Hearing loss increases with increasing size of perforation. Ahmed and Rahim (1979) showed in the study that hearing loss increases with increasing the size of the perforation which was relevant in the study. After myringoplasty post-operative mean air bone gap was 21.24 dB in small size, 21.74 dB in medium sized and 24 dB in large size. From the record improvement of mean air bone gap or hearing gain was 5.24 dB in small size perforation respectively. The different of air bone gap closure between small and medium size perforation was statistically significant by unpaired’ test.&#x0D; Conclusion: Hearing gain after myringoplasty is better in large size perforation.&#x0D; Bangladesh J Otorhinolaryngol; April 2019; 25(1): 54-59

Stapes Surgery for 121 Patients With Mixed Hearing Loss

This study aims to determine the benefit of stapes surgery for otosclerosis in 121 patients with a mixed hearing loss and a preoperative bone conduction (BC) threshold >30 dB. Average postoperative air conduction (AC) improved from 61.5 dB to 34.3 dB. Average air-bone gap closed from 27.1 dB to 6.1 dB. Bone conduction improved from 34.3 dB to 28.2 dB, with 38% of patients achieving a postoperative AC of <30 dB. Glasgow Benefit Inventory scores showed significantly increased quality of life postoperatively in the 88 patients who responded to follow-up, with an average score of 56. There was a mean reduction in daily hearing aid use postsurgery of 5.48 hours, with 56% of patients who responded to follow-up questionnaire no longer needing to use one. When assessing suitability for stapes surgery, surgeons should consider that preoperative BC thresholds may be a poor indicator of the true cochlear reserve and therefore the potential for improvement in AC thresholds and quality of life.

Hearing status before and after Stapes surgery in otosclerotic patients

Background: Otosclerosis is a disease of the otic capsule that is characterized by resorption and redeposition of bony tissue. Stapes surgery has established its position as the primary treament of conductive hearing loss in otosclerosis. It is anticipated that the hearing level of approximately 90% of patients should improve after surgery.&#x0D; Objective: To evaluate the hearing status of an otosclerotic patient and compare their preoperative and postoperative hearing status.&#x0D; Methods: In this prospective study, 34 patients with otosclerosis from head-Neck Surgery department of Sir Salimullah Medical College &amp; Mitford Hospital, Bangladesh ENT Hospital, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Period from January 2008 to December 2008. The patients were examined and hearing assessment after admission into the hospital pre-operatively and in the post-operative period.&#x0D; Results: In this study most of the cases were age group 21-30 years (50%), male (64-71%), middle socio economic condition (67-71%), rural (58-82%), primary educated (35-29%). It was observed that most common symptom was progressive deafness; duration of hearing loss was 2-5 years, pre-operative conductive type of hearing loss (50-55 dB). It was also observed that after surgery, hearing status were improved in 82.35% cases, the most of the patients were within 21-30 years age group.&#x0D; Conclusion: Stapedotomy obtaining closure of the air-bone gap to within 10dB of the preoperative bone conduction level in 90% of their patients. So, it is supperior to other procedures&#x0D; Bangladesh J of Otorhinolaryngology; October 2018; 24(2): 137-142

Surgical treatment of otosclerosis leading to changes in postural control and quality of life.

Evaluating postural function in patients with otosclerosis by assessing otoneurological function and balance-related quality of life before and 6 weeks after surgical treatment. Correlations between and clinical features were investigated. Thirty-three patients affected by otosclerosis underwent otoneurological examination, video Head Impulse Test (vHIT), and static posturography before and after stapedotomy. Quality of life and dizziness-related handicap were screened by means of validated questionnaires. Correlation analysis was performed in order to discover possible relations with audiological pre- and postoperative parameters. A significant improvement in posturographic parameters was found. Correlation analysis yielded a negative correlation between preoperative bone conduction auditory threshold and both vHIT scores and postural performance improvement, evaluated by spectral analysis. Moreover, a positive correlation was also found between improvements in posturographic scores and quality-of-life questionnaires. The study results demonstrated an improvement in postural function and self-reported measures in a cohort of patients with otosclerosis 6 weeks after stapedotomy. The inverse correlation with preoperative auditory levels may reflect lesser chance for balance restoration in cases with worse sensorineural function. Possible implications for daily activities and overall quality of life were suggested by improved self-report questionnaire results. 4 Laryngoscope, 130:2448-2454, 2020.

Endoscopic Stapedotomy: A New Dimension to the Conventional Microscopic Procedure

Introduction&#x0D; Endoscopes are not only complementing microscopic ear surgery but are also establishing their independent role in recent years.&#x0D; Materials and Methods&#x0D; This observational study was conducted from February 2018 to February 2019. Thirteen patients with clinical and audio-tympanometric features suggestive of stapedial otosclerosis underwent unilateral endoscopic stapedotomy from February to July 2018. They were followed up for a minimum of 6 months, till February 2019. Zero degree naso-endoscopes were exclusively used. Details of the surgical technique, its usefulness and subjective drawbacks are described.&#x0D; Results&#x0D; Two patients with sequel of otitis media with effusion evident at surgery were excluded. With a female predilection, the average age of the subjects was 31 years (range: 17-56 years). Curettage of the posterosuperior wall was needed in 7 patients; significant canalplasty was performed in 2 of them where the endoscope was difficult to negotiate. The chorda tympani required mobilization in only 3 patients, including those requiring significant canalplasty. Per-operative complications included injury to the chorda, tearing of tympanomeatal flap, and instability of the long process of incus in 1 patient each. One patient was lost to follow up. Average pre-operative bone conduction was 10±5dB with an air-bone gap at 35±5dB. At 6 months follow up, air-bone gap of &lt;10dB was achieved in 5 patients, and that at10-20dB in 4. One patient developed moderate sensorineural component. Otherwise, there was no significant complication at 6 months following surgery.&#x0D; Conclusion &#x0D; Endoscopic stapedotomy is a safe and effective approach towards stapes surgery, with better surgical field of view and minimal tissue trauma

Analysis of factors affecting postoperative functional outcome in patients with otosclerosis

ObjectiveThis study aimed to analyze the factors affecting postoperative hearing results of patients with otosclerosis. MethodsMedical records of 245 patients with clinical otosclerosis who underwent stapes surgery at our center from January 2009 to December 2018 were reviewed. The retrospectively collected data included patients’ demographics, clinical characteristics, pre- and postoperative audiometric data, size of preoperative air-bone gap (ABG) (small/large). The patients were categorized into two groups according to the postoperative functional outcome: Group 1 consisted of patients with a postoperative ABG of ≤10dB and Group 2 comprised those with a postoperative ABG of >10dB. Evaluation of factors affecting functional outcome were performed by logistic regression analysis. Receiver operating characteristics (ROC) curve was generated to obtain the cut-off points for preoperative ABG. ResultsThere were no statistically significant differences between the two groups in terms of age group (p=0.393), gender (p=0.670), operated side (p=0.370), and laterality of disease (p=0.607). There were 42 patients (31.6%) with a small ABG and 91 patients (68.4%) with a large ABG in group 1, and six (13.6%) and 38 patients (86.4%), respectively in group 2. There was a statistical significant difference between the groups in terms of the size of preoperative ABG (p=0.020). In group 1, the mean preoperative air conduction (AC) threshold and preoperative ABG were significantly lower than in group 2 (p<0.001 and p<0.001, respectively). There was no statistically significant difference between the groups in terms of the preoperative bone conduction (BC) threshold (p=0.406). Preoperatively, the AC threshold and large ABG were found to be significantly poorer prognostic factors (p<0.001; 95%CI: 1.031–1.210 and p=0.037; 95%CI: 1.063–7.023, respectively). Preoperative ABG cut-off threshold for functional success was found to be 34.5dB. The functional success rate was significantly higher in patients with a preoperative ABG of <34.5 than in patients with a preoperative ABG of ≥34.5dB (p<0.001). ConclusionThe preoperative AC threshold and large ABG were poor prognostic factors for postoperative hearing outcome in patients with otosclerosis. The functional outcomes were similar in patients with a preoperative small ABG and those with a preoperative ABG of <34.5dB. A preoperative ABG cut-off value of <34.5dB should be possibly considered as a parameter for predicting surgical success in otosclerosis and seems to be useful in clinical practice.

Intraoperative Estimation of the Coupling Efficiency and Clinical Outcomes of the Vibrant Soundbridge Active Middle Ear Implant Using Auditory Brainstem Response Measurements.

Purpose This study intraoperatively measured the coupling efficiency of the Vibrant Soundbridge (VSB), with the aim of avoiding revision surgery due to insufficient outcome. This method can also be used to test the integrity of the implant at the end of the implantation surgery and to evaluate aided thresholds. In addition, this method makes it possible to objectively test how well the VSB has been fitted, provide assistance in fitting handicapped patients or children, evaluate hearing degradation, or test for a drop in coupling efficiency before revision surgeries. In order to analyze the feasibility of these new VSB-aided auditory brainstem response (ABR) thresholds, they were compared to behavioral thresholds from the Vibrogram and the preoperative bone conduction thresholds. Method The study included 30 patients with mild-to-severe hearing loss implanted with a VSB (VORP503). Intraoperative ABR thresholds during the VSB implantation were recorded using a VSB-optimized chirp stimulus. The new method is compared to the bone conduction threshold of the study sample and the aided Vibrogram thresholds. Speech intelligibility results up to 24 months after surgery are also presented. Results A reliable correlation between the bone conduction thresholds and the intraoperative ABRs was found and was higher in comparison to the Vibrogram. Furthermore, speech intelligibility outcomes were stable over time. Conclusion ABR measurements can be used intraoperatively to estimate the coupling efficiency of the VSB and test the integrity of the implant at the end of surgery.

Audiometric Results of Stapedotomy Surgery for Otoscelorsis: Influence of the Radiological Stage.

The objective of this study was to identify a correlation between the radiological stage of otosclerosis and the pre- and postoperative audiometric results of patients who underwent a stapedotomy. Ninety-three patients with radiologically and surgically confirmed otosclerosis who underwent stapedotomy surgery and CT scanning within 18 months before the operation were included. The CT scans were interpreted by an otologist and a specialised radiologist to determine their radiological stage according to the classification of Veillon and Fraysse. The patients received a pre- and postoperative audiogram in the short and long term. The preoperative bone conduction thresholds were higher in patients who presented with an advanced radiological stage of otosclerosis: 32.7 dB ± 12.4 compared with those who presented with a less advanced radiological stage: 24.3 dB ± 10.0. The preoperative air conduction thresholds were higher in patients who presented with an impairment of the round window: 58.1 dB ± 13.5 compared with those who presented with no impairment of the round window: 48.7 dB ± 14.5. The postoperative improvement in the air-bone gap was significantly higher for the localised foci: 16.9 dB ± 8.6 versus 11.0 dB ± 9.2, but only in the short term. There was a clinical radiological correlation with the preoperative results: In BC, there was a correlation with the radiological stage of Veillon and in AC, there was a correlation with impairment of the round window. The link between the radiological stage of otosclerosis and the postoperative audiometric results is less obvious. In the short term, the audiometric improvements in the air-bone gap were greater in patients in the early stages according to the Veillon classification, but this result was not sustained in the long-term.

Outcome prediction for Bonebridge candidates based on audiological indication criteria

ObjectiveTo re-evaluate current indication criteria and to estimate the audiological outcomes of patients with Bonebridge bone conduction implants based on preoperative bone conduction thresholds. MethodsWe assessed the outcome of 28 subjects with either conductive or mixed hearing loss (CMHL) or single-sided deafness (SSD) who were undergoing a Bonebridge implantation. We used linear regression to evaluate the influence of preoperative bone conduction thresholds of the better/poorer ear, indication group, and language (German- and French-speaking patients) on aided sound field thresholds. In addition, aided word recognition scores at 65dB sound pressure level were fit with a logistic model that included preoperative bone conduction thresholds of the better/poorer ear, indication group, and language as effects. ResultsWe found that both aided sound field thresholds and word recognition were correlated with the preoperative bone conduction thresholds of the better hearing ear. No correlation between audiological outcomes and the preoperative bone conduction thresholds of the poorer ear, language, or indication group was found. ConclusionBone conduction thresholds of the better hearing ear should be used to estimate the outcome of patients undergoing Bonebridge implantation. We suggest the indication criteria for Bonebridge candidates considering maximal bone conduction thresholds of the better ear at 38dB HL to achieve an aided sound field threshold of at least 30dB hearing level and an aided word recognition score of at least 75% for monosyllabic words.

Cochlear Implantation in Chronic Otitis Media: Investigation of Long-term Speech Comprehension and Rate of Complications.

To analyze the long-term speech comprehension and rate of complications of cochlear implantation in chronic otitis media. Retrospective data analysis. Tertiary referral center with a large cochlear implant program. Speech perception scores in quiet and background noise and rate of complications. Forty ears from a total of 38 patients with a mean age of 63.28 ± 2.16 years at the time of implantation were included. Patients with a history of multiple ear surgeries, with no alternative option for hearing restoration than a cochlear implant, were implanted with satisfactory results in regard to speech comprehension. Preoperative bone conduction PTA4 correlated to postoperative speech comprehension scores in background noise. The rate of complications was low, but higher than in cases of cochlear implantation in normal middle ears. Cochlear implantation in chronic otitis media can be a satisfactory and safe procedure, if the surgery technique and aftercare is appropriate to the altered anatomy.

A Cohort Study of Hearing Outcomes Between Middle Fossa Craniotomy and Transmastoid Approach for Surgical Repair of Superior Semicircular Canal Dehiscence Syndrome.

To compare postoperative hearing outcomes between transmastoid and middle fossa craniotomy (MFC) approaches for surgical repair of superior semicircular canal dehiscence syndrome (SCDS) in a tertiary referral center. Historical cohort study. Tertiary referral center. Twelve consecutive SCDS cases who underwent transmastoid plugging of the superior canal; "controls" were 18 audiogram-matched patients who underwent MFC plugging and resurfacing. Differences between preoperative, 7-day postoperative, and long-term (>6 wk) postoperative air and bone conduction, speech discrimination scores (SDS), and pure-tone averages (PTA) in TM cases versus MFC controls. MFC controls were selected by matching preoperative bone conduction (BC) pure-tone thresholds from the TM cases within 10-dBs NHL in ≥80% of recorded frequencies. Wilcoxon signed-rank tests were performed to compare primary outcomes between matches, with a Bonferroni corrected p value of 0.004 (n = 13 variables measured at each time period). No statistically significant differences were found in long-term postoperative air conduction and BC thresholds at any frequency both during the immediate postoperative period as well as at long-term follow-up (p > 0.004). Similarly, there were no differences in long-term SDS or PTA (p > 0.004). In this pilot study, there were no long-term significant differences in hearing outcomes between the two repair techniques for SCDS. We recommend continuing with the established practice for recommending surgical repair based on individual patient characteristics and preferences in managing both vestibular and auditory function.

Successful hearing improvement with direct acoustic stimulation in a patient with schizophrenia

A direct acoustic cochlear implant provides its power directly to the inner ear by vibrating the perilymph via a conventional stapes prosthesis. Our experience with a patient with severe mixed hearing loss due to otosclerosis is described.Case reportThe patient, a 47-year-old male, had a pre-operative speech recognition score of 10 per cent and had been treated for many years for schizophrenia, both of which made him a poor candidate for a direct acoustic stimulation device. Nevertheless, the surgery was performed, which preserved the pre-operative bone conduction level and significantly improved hearing. His speech recognition score rose to 100 per cent. He uses the device all day and his auditory hallucinations have subsided. Improvement of schizophrenia symptoms has enabled the patient to reduce his psychiatric medications intake. Hearing restoration was the main reason for the reduction of auditory hallucinations in our patient. Hearing loss is a potentially reversible risk factor for psychosis, but this association is often overlooked.

To Evaluate and Compare the Result of Ossiculoplasty Using Different Types of Graft Materials and Prosthesis in Cases of Ossicular Discontinuity in Chronic Suppurative Otitis Media Cases.

Chronic suppurative otitis media, with and without cholesteatoma, frequently results in disruption of the ossicular chain. The present study was designed to compare the outcome using autologous ossicle and titanium prosthesis in two groups of suitable patients presenting with chronic suppurative otitis media for middle ear reconstructive surgeries. A prospective study done from July 2012 to December 2013, at Mahatma Gandhi Medical College and Hospital, Sitapura, Jaipur (Rajasthan). The target group included patients with chronic suppurative otitis media admitted and planned for reconstructive middle ear surgery. The study group patients among the target group requiring certain ossicular reconstruction. The patients included were patients with CSOM with or without cholesteatoma in which there was ossicular discontinuity. The patients were divided in two groups A and B. In group A patients autologous incus was used and in group B titanium prosthesis either TORP or PORP was used for ossicular replacement. Out of 340 patients as target group, 88 patients were included in study group. Further 88 patients of study group, 51 patients were included in group A; rest 37 patients were included in group B. In group B patients partial ossicular replacement platinum prosthesis was used in 31 patients while in rest 6 patients a total ossicular replacement prosthesis was used. Out of 88 patients, 79 were primary cases and 9 were revision cases. Pre and post operative air bone gap were noted. Pre operatively both of the groups were identical in relation to air-bone gap. The postoperative air-bone gap was calculated as the difference between postoperative air conduction and preoperative bone conduction. On comparison of preoperative and post-operative hearing results there was improvement in air conduction threshold and air bone gap in both the groups. Post operatively difference in air bone gap closure between group A and group B was found statistically significant (P value=0.032) suggesting better hearing outcomes after using titanium ossicular replacement prosthesis. On comparing partial or total ossicular replacement prosthesis no significant difference was found for the audiological outcome (P=0.434). Various prognostic factors were also noted for air bone gap closure. Titanium ossicular replacement prosthesis have better outcome, and no significant difference found in audiological outcome for TORP and PORP.