Preoperative Mean Air Conduction Research Articles

Outcomes of Palisade Cartilage Tympanoplasty in Chronic Otitis Media: Our Experience at a Tertiary Care Centre.

To evaluate the anatomical and functional success rates of palisade cartilage tympanoplasty in chronic otitis media. Thirty patients with chronic otitis media with subtotal perforation underwent palisade cartilage tympanoplasty and were assessed prospectively. The outcomes evaluated were graft uptake and hearing gain. Overall graft uptake was 90% with failure in 3 cases. The preoperative mean air conduction threshold was 22.087 ± 6.120dB which was improved to 13.387 ± 5.253dB postoperatively at 12weeks which was statistically significant. The mean postoperative ABG closure was 8.700dB with a p value of 0.001 which was statistically significant. Palisade cartilage tympanoplasty demonstrates that subtotal perforations, which are at high risk for graft failure, can be treated efficiently and a durable and resistant reconstruction of the tympanic membrane with reasonable hearing can be achieved.

Long-Term Follow-Up After Fat Graft Myringoplasty: Do Size and Location Matter?

To assess clinical and functional outcomes of a fat graft myringoplasty under local in an office setting. Prospective case series. Tertiary care facility. Patients with a tympanic membrane (TM) perforation presenting between December 2005 and June 2019. Inclusion criteria included perforation size >25% of the surface of the pars tensa of the TM, entire perforation margins visualized through a transcanal view, and lack of spontaneous closure at the 6-month follow-up. The exclusion criteria were the presence of cholesteatoma, wet appearance of the mucosa in the tympanic cavity, ear discharge in the 3 months before surgery, or signs of ossicular inconsistency. In-office fat graft myringoplasty technique under local anesthesia. Complete perforation closure rate and audiometric outcomes. A total of 121 patients underwent the procedure, of whom 21 had bilateral sequential procedures (total 142 ears). Average age was 51.1 ± 18.4 years (range, 3-78 years). The size of perforation was <25% of TM in 39 (27.5%) ears, 25% to 50% of TM in 49 (34.55%) ears, 50% to 75% of TM in 34 (23.91%) ears, and 75% to 100% of TM in 20 (14.10%) ears. Complete perforation closure was evident in 130 (91.55%) of the 142 ears. Preoperative mean air conduction threshold was 59.3 dB (17-95 dB) and significantly improved into 35.6 dB (10-85 dB; P < .0004) after surgery. Preoperative air-bone gap was 30.2 dB (5-70 dB) and also significantly improved into 10.2 dB (5-65 dB; P < .0001) after surgery. In office fat graft myringoplasty, in adult and pediatric patients with variable perforation sizes, is a well-tolerated procedure with very satisfactory clinical results.

A prospective study of outcome of boomerang-shaped chondroperichondrial graft in Type i tympanoplasty

Context: Cartilage has proven to be an excellent graft material inside the middle ear. The use of cartilage for tympanic membrane grafting may provide additional benefits in some difficult situations. Aims: The study was planned to evaluate the graft uptake and hearing after placement of “boomerang-shaped chondroperichondrial graft” in Type I tympanoplasty. Settings and Design: The prospective study was conducted on 40 patients having chronic suppurative otitis media with no active disease at least for last 6 weeks in a tertiary care center of North India. Patients having cholesteatoma and ossicular erosion/or necrosis were excluded from the study.Subjects and Methods: Those patients underwent tympanoplasty Type I by postaural approach and underlay grafting using “boomerang-shaped chondroperichondrial graft” from tragal cartilage and were followed up for 3 months. Hearing evaluation was performed preoperatively and postoperatively after 3 months. Statistical Analysis Used: The mean, range, and standard deviation of air conduction and air-bone gap were calculated and compared with preoperative findings. Results: The mean age of study group was 26.23 ± 12.46 years. Ear discharge (100%) and hearing impairment (87.5%) were the chief presenting complaints. The mean duration of ear discharge was 6.67 ± 6.75 years. Type I tympanoplasty was performed in all cases using “boomerang-shaped chondroperichondrial graft” harvested from tragal cartilage. Graft was taken up at the 3rd month in all patients. The preoperative mean air conduction was 43.21 ± 7.17 dB, which at the 3rd month improved to 36.49 ± 6.60 (P = 0.00004). Preoperative mean air-bone gap was 25.45 ± 8.44 dB which was improved to 19.31 ± 8.18 dB postoperatively at the 3rd month (P = 0.0014). Conclusions: Boomerang-shaped chondroperichondrial graft has excellent “take rate” in Type I tympanoplasty.

Pediatric type 1 cartilage tympanoplasty outcomes: A comparison of short and long term hearing results

ObjectiveTympanoplasty is a commonly used procedure in children as in adults. The purposes of this study were to evaluate and report the long term results of type 1 cartilage tympanoplasty in pediatric population. Short term and long term hearing outcomes were compared according to age and perforation location. MethodsWe retrospectively evaluated a total of 76 of 93 patients who had regularly come to visits (38 male and 38 female) with chronic otitis media (COM) and who were younger than 16 years (range, 9–16 years) and underwent a primary type 1 tympanoplasty in tertiary medical center. We divided our population into 2 groups; a younger group (age <12 years) and an older group (age ≥12 years). Age, gender, follow-up time, prior to surgery and at postoperative 6th and minimum 48th month follow-up pure tone audiometry (PTA) thresholds and if any residual perforation were noted. ResultsSuccessful closure occurred 74 in 76 patients and success rate was 97,03%. The mean 6th month follow-up bone conduction threshold values were 7,61±3,89 and 6,89±6,28 <12 years old and ≥12 years old children, respectively. The mean 48th month follow-up bone conduction threshold values were 6,93±4,00 and 7,12±6,40, <12 years old and ≥12 years old children, respectively. The mean 6th month follow-up air conduction threshold values were 23,75±8,38 and 24,73±10,41 <12 years old and ≥12 years old children, respectively. The mean 48th month follow-up air conduction threshold values were 17,15±6,04 and 20,30±10,30, <12 years old and ≥12 years old children, respectively. Among all children; preoperative mean air conduction differed significantly from postoperative 6th and 48th month follow-up mean air conduction thresholds (p<0.001). They had significant improvement in their ABG compared with their preoperative ABG scores. In addition according to groups, there was no significantly difference between pre and postoperative ABG improvement in both 6th and 48th month follow-up between <12 years old and ≥12 years old patient group. ConclusionIn pediatric patients type 1 tympanoplasty with cartilage graft, gives statistically significant success in long term follow up. Long term hearing results of primary type 1 cartilage tympanoplasty is seem to be better than short term hearing results as well. We consider that cartilage graft could be the best graft material for pediatric tympanoplasty for long term success.

Butterfly Cartilage Tympanoplasty Long-term Results: Excellent Treatment Method in Small and Medium Sized Perforations.

Objectives The aim of this study was to evaluate and report the long-term results of the butterfly cartilage tympanoplasty. Short-term and long-term hearing outcomes were compared according to age and perforation location as well.Methods Ninety-three patients who were diagnosed with noncomplicated chronic otitis media and underwent microscopic transcanal butterfly cartilage tympanoplasty due to anterior, posterior, and central tympanic membrane perforation were included. Age, gender, follow-up time, pre- and postoperative pure tone audiometry thresholds (both air and bone conduction), pre- and postoperative air-bone gaps (ABGs), if any residual perforation was noted.Results At the end of the follow-up period, successful closure occurred in 88 of 93 patients and success rate is 94.6%. In all patients, including those with residual perforations, the mean preoperative bone conduction threshold was 15.9 dB (range, 5 to 50 dB) among all groups whereas mean air conduction threshold was 36.4±15.1 dB (range, 10 to 90 dB) preoperatively and 28.8±14.3 dB in 6th month follow-up and 24.9±14.1 dB 24th month follow-up. Preoperative mean ABG was 22.1±7.1 dB (range, 5 to 40 dB) whereas 13.3±5.9 dB 6 months after surgery and 11.9±5.5 dB 24 months after surgery. There was a significant difference between pre- and postoperative ABG in both 6th and 24th month follow-up (P6 mo-24 mo<0.05). Furthermore, preoperative mean air conduction differed significantly from postoperative 6th and 24th month follow-up mean air conduction thresholds (P<0.05).Conclusion We suggested that butterfly cartilage tympanoplasty can be safely performed in small, moderate, and even large perforations, as the hearing outcomes and successful closure rate are similar to those of other surgical methods. Moreover, it can be performed under local anaesthesia and it has low complication rates.

Endoscopic "Push-Trough" Technique Cartilage Myringoplasty in Anterior Tympanic Membrane Perforations.

ObjectivesTo evaluate endoscopic push-through technique cartilage myringoplasty results.MethodsThis prospective study was performed on patients with anterior tympanic membrane perforations and endoscopic push-through technique cartilage myringoplasty was performed between 2011 and 2013. The patients who did not have any cholesteatoma or otorrhea in the previous 3 months, and had an air bone gap ≤25 dB in their preoperative audiograms were included in the study. They were followed up with endoscopic examination and audiograms at 2nd, 6th, 12th, and 24th postoperative months. Pure tone averages were calculated at 0.5, 1, 2, and 4 kHz frequencies.ResultsOf 32 patients, 19 were females and 13 were males. The mean age was 40.3 years (range, 16 to 62 years), and the mean follow-up period was 12.4 months (range, 6 to 24 months). Graft success rate was 87.5% in this study. Preoperative mean air conduction hearing threshold was 25.9 dB, and the mean air-bone gap was 11.9 dB while these values improved to 19.5 dB and 5.3 dB respectively in the postoperative period. The mean hearing gain was 6.4 dB. The analysis of preoperative and postoperative mean air conduction thresholds and air bone gap values of the patients revealed statistically significant differences.ConclusionUnderlay cartilage myringoplasty with endoscopic push-through technique in anterior quadrant tympanic membrane perforations is an effective, minimally invasive and feasible method.

Combined Subtemporal–Supralabyrinthine Approach to Geniculate Ganglion for Management of Facial Paralysis in Temporal Bone Fracture

ObjectiveTo investigate the clinical outcomes of facial never decompression via a combined subtemporal–supralabyrinthine approach to geniculate ganglion for management of facial paralysis in temporal bone fracture. MethodsEighteen patients with unilateral facial paresis due to temporal bone fracture were treated between March 2003 and March 2011. Facial function was House–Brackmann(HB) grade III in 6 patients, HB grade V in 9 patients and HB grade VI in 3 patients. The preoperative mean air conduction threshold was 52 dB HL for the 15 cases with longitudinal temporal bone fracture and showed severe sensorineural hearing loss in the 3 cases with transverse temporal bone fracture. Fracture lines were detected in 15 cases on temporal bone axial CT scans and ossicular disruption was determined in 11 cases by virtual CT endoscopy. The geniculate ganglion or the tympanic mastoid segment of the facial nerve showed an irregular morphology on curved planar reformation images of the facial nerve canal. After an intact canal wall mastoido–epitympanectomy, the ossicular chain damage was evaluated. If the ossicular chain was intact, the supralabyrinthine recess was opened by drilling through the cells between the tegmen tympani and ossicular chain. If the ossicular chain was disrupted, the incus was removed to access the supralabyrinthine recess. The geniculate ganglion and the distal labyrinthine segment of the facial nerve were exposed. After completing facial nerve decompression, the dislocated incus was replaced, or a fractured incus was reshaped to bridge the space between the malleus and the stapes. ResultsPronounced ganglion geniculatum swelling was found in 15 cases of longitudinal temporal bone fracture, with greater petrosus nerves damage in 3 cases and bleeding in 5 cases. Disrupted ossicular chains were seen in 11 cases, including dislocated incus resulting in crushing of the horizontal portion of the facial nerve in 3 cases and fracture of the incus long process in 1 case. In 3 cases of transverse fractures, dehiscence on the promontory, semicircular canal or oval window was found. All cases had primary healing with no complication. At follow–ups ranging from 0.5 to 3 years (average 1.2 years) , facial nerve function recovered to HB grade I in 11 cases, II in 5 cases and III in 2 cases. Overall hearing recovery was 33 dB. ConclusionThe clinical outcomes concerning facial nerve function and hearing recovery are satisfactory via a combined subtemporal–supralabyrinthine approach to the geniculate ganglion for facial nerve decompression in temporal bone fracture patients with facial paralysis.

Lateral semicircular canal fenestration for congenital conductive hearing loss: Solution for a dilemma

Objective To determine functional results after lateral semicircular canal fenestration on congenital conductive hearing loss. Study Design Case series with chart review. Setting Amir-Alam otolaryngology tertiary referral center. Subjects and Methods Twenty patients with congenital oval window malformations who were not candidates for ossicular reconstruction underwent lateral semicircular canal fenestration. A skin graft was placed over the perforated fascial graft on the fenestrated area. Results The median preoperative mean air conduction (MAC) was 56.9 dB (50.0 dB median air-bone). Postoperative median MAC gain of 34.3 dB ( P < 0.001) and the median air-bone gap of 18.8 dB were observed. The mean bone conduction (MBC) did not show any significant changes postoperatively ( P = 0.12). No sensorineural hearing loss, tinnitus, or imbalance was observed. Conclusion We demonstrated hearing improvement after lateral semicircular canal fenestration. This technique can be considered as an alternative for patients with middle ear anomalies who are not candidates for ossicular reconstruction.

Effect of preoperative hearing level on success of stapes surgery

Objective We evaluated functional results after stapedotomy in terms of the influence of preoperative hearing threshold. Study Design Case series and chart review. Subjects and Methods We classified 141 patients according to preoperative mean air-conduction threshold: 40 to 54 dB, group 1; 55 to 69 dB, group 2; and 70 to 89 dB, group 3. Speech discrimination scores also were noted. Results All groups showed significant improvement. The greatest increase in postoperative speech discrimination score was seen in group 3. Group 1 improved from moderate hearing loss (mean, 49 dB) to normal (mean, 24 dB); group 2, from moderately severe loss (mean, 61.2 dB) to mild (mean, 28 dB); and group 3, from severe loss (mean, 76.4 dB) to moderate (mean, 41.1 dB). Conclusion Success in treating otosclerosis does not depend on extent of preoperative hearing loss. Patients with severe loss improved to moderate, increasing the benefit from use of a hearing aid. The patients attained good auditory function, improving their quality of life.

Reliability of Microdrill Stapedotomy

To assess the hearing outcomes and complications of the microdrill and pick stapedotomy techniques. We assessed 123 primary otosclerosis operation in 103 patients who had more than 1 year follow-up (71 microdrill; 52 pick stapedotomies). There were 87 women and 36 men in the study group (mean age, 44 +/- 11.2 years) at surgery. Stapedotomy for otosclerosis. Pure tone hearing thresholds and clinical evaluation for complications. In the microdrill group, preoperative mean air conduction was 61 dB, and mean bone conduction was 27 dB, postoperatively, these values improved to 31 dB and 16 dB, respectively. In the pick group, mean air conduction was 61 dB, and mean bone conduction was 27 dB, which improved postoperatively to 33 dB and 18 dB, respectively. Postoperative hearing gains were similar in both groups (p > 0.005). The mean postoperative gain in bone conduction was significant (p < 0.001) in each group: 11 dB in the microdrill group and 9 dB in the pick group, with no significant difference between the two groups. The preoperative air-bone gap was 34 dB in both groups, and improved to 15 dB in both. Complication rates were similar. The microdrill and pick stapedotomy techniques produced similar hearing results and complication rates. Within the limitations of the present study, we found no evidence of microdrill-induced acoustic trauma. The microdrill can be a useful technique in performing a stapedotomy and seems to produce similar results to those associated with pick stapedotomy.