Pure-tone Average Air-bone Gap Research Articles

Comparative Analysis of the Hearing Effects of Partial Ossicular Replacement Prosthesis Versus Conchal Cartilage in Canal Wall Down Mastoidectomy with Type II Tympanoplasty: A Retrospective Case Review Study.

To investigate the effects of titanium partial ossicular replacement prosthesis (PORP) and conchal cartilage for ossiculoplasty on hearing results in single-stage canal wall down (CWD) mastoidectomy surgery with type II tympanoplasty in patients with cholesteatoma. The patients were performed surgeries for the first time by a senior otosurgeon from 2009 to 2022 and were performed CWD mastoidectomy with type II tympanoplasty in one stage were enrolled. Patients who could not be followed up were excluded. Titanium PORP or conchal cartilage was used for ossiculoplasty. When the stapes head was intact, a cartilage 1.2-1.5mm thick was attached directly to the stapes; when the head of the stapes was eroded, a 1mm high PORP and cartilage of .2-.5mm thick were placed on the stapes simultaneously. 148 patients were included in the study in total. The titanium PORP and conchal cartilage groups showed no statistically significant differences at 500, 1000, 2000, and 4000Hz considering the number of decibels of closure of the air-bone gap (ABG) (P > .05) and pure-tone average ABG (PTA-ABG) (P > .05). Meanwhile, the closure of PTA-ABG between the 2 groups showed no statistically significant differences in the overall distribution (P > .05). For patients with cholesteatoma and mobile stapes who underwent CWD mastoidectomy with type II tympanoplasty in one stage, either PORP or conchal cartilage is a satisfactory material for ossiculoplasty.

Hearing Results in Patients With No Ossicular Chain Reconstruction and Factors Influencing the Outcome.

Ossiculoplasty is aimed at improving or maintaining the conductive portion of hearing in patients subjected to otologic surgery. However, satisfying hearing is frequently observed after tympanoplasty even in the absence of ossicular chain reconstruction. Aims of this article would be to evaluate hearing outcomes, in terms of pure tone average air-bone gap (PTA-ABG), in patients subjected to tympanoplasty for middle ear disease whose ossicular chain has not been reconstructed, and then to investigate factors influencing those outcomes. Retrospective chart review of patients who underwent ear surgery from year 2003 to 2021 at the Otolaryngology-Head and Neck surgery department of the University Hospital of Modena was performed. Audiometric test results from patients who did not receive any ossicular chain reconstruction were collected and analyzed. Tertiary University referral center. The mean patients' follow-up was 34.1 months. Overall, mean PTA-ABG in the study population was 23.5 dB. Integrity of stapes superstructure, malleus handle and malleus head, together with the use of tragal cartilage graft over autologous temporalis fascia to reconstruct the tympanic membrane were found to be significantly associated with better hearing outcomes, as demonstrated by lower PTA-ABG values. Stapes superstructure was found to be associated with more favorable outcomes in multivariate analysis, net of confounding factors. Good hearing performance can be obtained in patients subjected to middle ear surgery, even if the ossicular chain is not reconstructed. Presence of ossicular chain remnants and the use of a rigid material for tympanic membrane reconstruction are the factors that seem to most favorably influence hearing outcomes after surgery for middle ear disease.

Evaluation of outcome of ossiculoplasty with and without an intact malleus

<p class="abstract"><strong>Background: </strong>CSOM is commonly encountered in the clinical practice as a cause of conductive hearing loss. Preoperative evaluation of hearing becomes mandatory for proper management. Ossiculoplasty is usually done in conductive hearing loss due to ossicular chain abnormality in CSOM. The aim of the evaluation of outcome of ossiculoplasty with and without an intact malleus.</p><p class="abstract"><strong>Methods: </strong>Total 40 patients greater than 18 years with mucosal type of CSOM with good cochlear reserve and Eustachian tube function, requiring intact canal wall mastoidectomy onlywere taken. All cases were planned ossiculoplasty with tympanoplasty or tympanomastoidectomy and postoperative follow-up done with measurement of Pure-tone average air-bone gap Ossiculoplasty Outcome Parameter Staging (OOPS) index and complications. Simple random sampling technique is used to calculate the size during the study.</p><p class="abstract"><strong>Results:</strong> Ossiculoplasty was done in all cases in which 50% of patients (n=20) had malleus and 50% (n=20) with no malleus and AB gap in both group have almost similar result.</p><p class="abstract"><strong>Conclusions:</strong> Ossiculoplasty techniques using neo malleus struts combined with assembly prostheses, in middle ear reconstruction was studied and was non-significant.</p>

Transmastoid Repair of Otogenic Encephaloceles in Patients With Canal Wall Down Mastoidectomy.

Description of a series of cases in which otogenic encephaloceles in patients requiring canal wall down (CWD) mastoidectomies were repaired via a transmastoid approach. Case series. Tertiary-care hospital. Eleven cases of otogenic encephaloceles in patients requiring CWD mastoidectomy for chronic ear disease. Surgical repair of an otogenic encephalocele using a transmastoid approach. Success of repair, number and size of defects, materials used for repair, complications encountered in surgery, pure tone average air-bone gap (PTA-ABG). Eleven cases were identified. Two of these patients had a prior CWD cavity while the remainder received CWD mastoidectomy simultaneously with encephalocele repair. None of the patients required revision of encephalocele repair. Mean preoperative PTA-ABG was 30 dB and mean postoperative PTA-ABG was 28 dB (p = 0.66). A single-stage strictly transmastoid approach to otogenic encephalocele repair may be effective in patients with prior CWD mastoid cavities or requiring concurrent CWD mastoidectomy for chronic ear disease and/or cholesteatoma.

Tympanoplasty in high-risk perforation and atelectatic ear using perichondrium-cartilage island graft and temporalis fascia: A comparative analysis

Background: The prevalence of chronic otitis media in the Armed Forces is high. Moreover, management of high-risk perforation and atelectatic ear is an even greater challenge. It is necessary to assess the most viable management approach to achieve an optimal outcome. Aims and Objectives: We aimed to compare anatomical and audiological results in tympanoplasty for high-risk perforation and atelectasis using perichondrium-cartilage island (PCI) graft with temporalis fascia (TF) graft. Materials and Methods: A retrospective study was carried on 110 patients. Fifty-four patients and 56 patients underwent PCI graft and TF tympanoplasty, respectively. Postoperative graft integration rates and hearing outcomes were compared. Chi-square test was carried out to compare postoperative graft uptake. Postoperative audiological outcomes were compared using t-tests. Results: At 2-year follow-up, the graft take-up rate for PCI graft and TF graft was 96.29% and 82.14%, respectively (statistically significant). In the TF group, 17.86% had reperforation and recurrence of retraction pockets. In the PCI group, 3.71% had recurrent perforation. Furthermore, there was a statistically significant in the postoperative long-term improvement in pure-tone average air-bone gap in the cartilage island graft group (15.01 ± 3.53 db vs. 21.96 ± 4.09 db, P < 0.05). Conclusion: PCI graft achieves better morphological and audiological results in comparison to TF graft in high-risk perforation and atelectatic ears. It has a higher graft integration rate and better long-term audiological outcomes.

Short-term hearing outcome of malleus removal for surgery: An observational cohort study

ObjectivesThe main goal of the present study was to assess hearing outcome for malleus removal in cholesteatoma surgery compared to a group with malleus conservation. The secondary aim was to compare the auditory involvement of the stapes between the two groups. Material and methodsA single-center observational study included adult patients operated on by ossiculoplasty for acquired cholesteatoma between 2015 and 2019. Endpoints comprised improvement in pure-tone average air-bone gap (PTA-ABG) and air-bone gap (ABG) at conversational frequencies and, independently, per frequency. 136 patients were included: 95 with conserved malleus (M+) and 41 with malleus removal (M(). Mean time to audiometric follow-up was 9 months in both groups. ResultsThe PTA-ABG improvement was 4.4±12.6dB for the M+ group and 3.8±13.4dB for the M− group, with no significant significance (P=0.8). Better results (not exceeding 7.5dB) were found for the M+ group at 2 and 8kHz (P=0.3 and P=0.052 respectively). Presence or absence of the stapes did not affect the results in either group. ConclusionThose results suggest a negligible role of the malleus in early hearing outcome of tympanoplasty for cholesteatoma. A slight improvement was observed in the M+ group at 2 and 8kHz, but its interpretation remains uncertain.

Silastic sheeting in staged ear surgery: Is there still a role for this procedure?

To review long-term outcomes for chronic otitis media with and without cholesteatoma in staged canal-wall-up tympanoplasty with temporary silastic sheeting and to compare hearing and recurrence results with the literature. Retrospective data analysis of all patients suffering from chronic otitis media with or without cholesteatoma (COMC/COM) and treated by staged canal-wall-up (CWU) technique with silastic insertion between 1992 and 2012. Literature analysis in PubMed 1990-2017. 74 cases were included in the analysis. In COMC (n = 47) a total of 2 (4%) recurrent and 14 (30%) residual cholesteatoma were documented. The postoperative hearing test showed a pure-tone-average (PTA) of 36dB hearing level (HL) and an air-bone-gap (ABG) of 21dB HL. A significant improvement was only observed for stage I disease (PTA 8dB HL and ABG 9dB HL). In COM (n = 27) postoperative PTA and ABG were significantly improved by 33dB HL and 23dB HL, respectively. Mean postoperative follow-up was 47months (12-173) for COMC and 22months (2-120) for COM. The cholesteatoma recurrence rate in this study reflects contemporary published rates. Assessment of hearing outcome is difficult due to the low number of cases and very high heterogeneity of published data. Still, the staged CWU procedure with temporary silastic sheeting seems to bear some advantages in regard to hearing. The role of additional factors such as Eustachian Tube function to assess outcome should be considered. An internationally agreed upon reporting system should be followed, if various surgical approaches are to be compared. 3.

The practices and philosophies of cartilage tympanoplasty in difficult and challenging circumstances: audiological and morphological perspectives

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The main objective of the study was to assess the anatomical and functional results of cartilage tympanoplasty using full thickness cartilage graft (with or without perichondrium) reinforced with fascia in high risk situations.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective non-controlled, non-randomized study included 124 cases of chronic otitis media who underwent cartilage (reinforcement) tympanoplasty (underlay) and ossicular reconstruction with or without mastoidectomy in following seven groups: revision cases, atelectatic cases, subtotal perforation (dry), larger anterior perforations (dry), tympanosclerosis, cholesteatomatous ear, and wet (discharging) ears . Graft success was accepted labelled as an intact graft at the end of six month postoperatively. At the same time, hearing results were also assessed by comparing pre- and post-operative pure tone average air-bone gap (PTA-ABG) of each group using Student “t” test and p&amp;lt;0.05 was considered statistically significant for the hearing outcomes. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Anatomical success rate in this series was 94.36%. The overall mean pre- and post- operative pure tone average air-bone gap (PTA-ABG) were 31.33±10.41 dB and 19.55±12.04 dB, respectively and the difference was statistically significant (p&amp;lt;0.05). Best take up rates were observed in atelectatic and tympanosclerotic group i.e., 100% and 96.55% respectively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study discusses the results of cartilage tympanoplasty in specifically indicated seven situation and reveals good anatomic results in each group (minimum success rate was 86.66% in wet ears) and statistically significant differences in mean pre- and post op PTA-ABG in groups except cholesteatoma and wet ear group.&lt;/p&gt;

The Utility of Numeric Grading Scales of Middle Ear Risk in Predicting Ossiculoplasty Hearing Outcomes.

To assess the usefulness of numeric grading scales of middle ear risk in predicting ossiculoplasty hearing outcomes. Retrospective review. Tertiary care, academic medical center. Adults and children undergoing ossiculoplasty between May 2013 and May 2019 including: synthetic ossicular replacement prosthesis, autograft interposition, bone cement repair, and mobilization of lateral chain fixation. Cases were scored via middle ear risk index (MERI), surgical prosthetic infection tissue eustachian tube (SPITE) method, and ossiculoplasty outcome scoring parameter (OOPS) scale. Preoperative and postoperative hearing outcomes were recorded. Statistical correlation between risk score and postoperative pure-tone average air-bone gap (PTA-ABG). The 179 included cases had average pre and postoperative PTA-ABGs of 30.3dB (standard deviation [SD] 12.7) and 20.3dB (SD 11.1), respectively. Mean MERI, SPITE, and OOPS scores were 4.5 (SD 2.3), 2.8 (SD 1.7), and 3.1 (SD 1.8), respectively. Statistically significant correlations with hearing outcome were noted for all three methods (MERI r = 0.22, p = 0.003; OOPS r = 0.19, p = 0.012; SPITE r = 0.27, p < 0.001). No scale predicted poor (PTA-ABG > 30dB) outcomes; only low SPITE scores predicted excellent (PTA-ABG < 10dB) outcomes (odds ratio [OR] 0.74 [Confidence Interval: 0.57 - 0.97], p = 0.032). Significant weak correlations between each middle ear risk score and hearing outcomes were encountered. Although only the SPITE method predicted postoperative PTA-ABG, it was not overwhelmingly superior. Current grading scale selection may be justified by familiarity or ease of use.

Robot-based assistance in middle ear surgery and cochlear implantation: first clinical report.

Middle ear surgery may benefit from robot-based assistance to hold micro-instruments or an endoscope. However, the surgical gesture performed by one hand may perturb surgeons accustomed to two-handed surgery. A robot-based holder may combine the benefits from endoscopic exposure and a two-handed technique. Furthermore, tremor suppression and accurate tool control might help the surgeon during critical surgical steps. The goal of this work was to study the safety of an otological robot-based assistant under clinical conditions in a limited series of patients. The RobOtol system has been used as an endoscope or a micro instrument holder for this series. Eleven cases were operated on with the robot as an endoscope holder for chronic otitis. Twenty-one cases were operated on with the robot as a micro-instrument holder for otosclerosis (9 cases), transtympanic tube placement (2 cases), or cochlear implantation (10 cases). No complications related to the robot manipulation occurred during surgery nor in postoperative. In the chronic otitis group, all perforations were sealed and 3-month postoperative pure-tone average air-bone gap (PTA ABG) was 15 ± 2.6dB. In the otosclerosis group, 1-month post-op PTA ABG was 10 ± 1dB. For cochlear implantation cases, a scala tympani insertion, a vestibular scala translocation occurred and a full scala vestibuli insertion was observed in 7, 2 and 1 case, respectively. The RobOtol system has reached the clinical stage. It could be used safely and with accurate control as an endoscope holder or a micro instrument holder in 32 cases.

Outcomes Following Revision Stapes Surgery in Children: A Single-Surgeon, Single-Center 15-Year Experience.

To review a single surgeon experience with revision pediatric stapes surgery for congenital stapes fixation (CSF) and tympanosclerosis (TS). Secondly, to determine whether hearing outcomes following revision surgery may be predicted by a thorough work-up aimed at assessing whether an extruded or malpositioned prosthesis is likely to be encountered intraoperatively. Tertiary referral center. Retrospective chart review. Fifteen patients having revision surgery for fixation of the stapes footplate over a 15-year period. Hearing results based on pre- and post-revision pure-tone average air-bone gap (PTA-ABG) and speech recognition threshold testing (SRT). Overall, the mean improvement of PTA-ABG following revision surgery was 11.9 dB (standard deviation [SD] 15.2) while SRTs improved by a mean of 12.3 (SD 19.9). Outcomes were significantly better in patients who reported a history of trauma following their initial surgery, when there was otoscopic evidence of an extruding or extruded prosthesis and/or a pre-revision CT (where performed) suggested an extruded or malpositioned prosthesis. No patients had a significant postoperative sensorineural hearing loss. Revision stapes surgery in children is a safe procedure in experienced hands which nonetheless should only be contemplated in patients in whom preoperative work-up suggests an extruded or malpositioned prosthesis is likely to be encountered intraoperatively.

Improving Sensitivity of the Digits-In-Noise Test Using Antiphasic Stimuli.

The digits-in-noise test (DIN) has become increasingly popular as a consumer-based method to screen for hearing loss. Current versions of all DINs either test ears monaurally or present identical stimuli binaurally (i.e., diotic noise and speech, NoSo). Unfortunately, presentation of identical stimuli to each ear inhibits detection of unilateral sensorineural hearing loss (SNHL), and neither diotic nor monaural presentation sensitively detects conductive hearing loss (CHL). After an earlier finding of enhanced sensitivity in normally hearing listeners, this study tested the hypothesis that interaural antiphasic digit presentation (NoSπ) would improve sensitivity to hearing loss caused by unilateral or asymmetric SNHL, symmetric SNHL, or CHL. This cross-sectional study recruited adults (18 to 84 years) with various levels of hearing based on a 4-frequency pure-tone average (PTA) at 0.5, 1, 2, and 4 kHz. The study sample was comprised of listeners with normal hearing (n = 41; PTA ≤ 25 dB HL in both ears), symmetric SNHL (n = 57; PTA > 25 dB HL), unilateral or asymmetric SNHL (n = 24; PTA > 25 dB HL in the poorer ear), and CHL (n = 23; PTA > 25 dB HL and PTA air-bone gap ≥ 20 dB HL in the poorer ear). Antiphasic and diotic speech reception thresholds (SRTs) were compared using a repeated-measures design. Antiphasic DIN was significantly more sensitive to all three forms of hearing loss than the diotic DIN. SRT test-retest reliability was high for all tests (intraclass correlation coefficient r > 0.89). Area under the receiver operating characteristics curve for detection of hearing loss (>25 dB HL) was higher for antiphasic DIN (0.94) than for diotic DIN (0.77) presentation. After correcting for age, PTA of listeners with normal hearing or symmetric SNHL was more strongly correlated with antiphasic (rpartial[96] = 0.69) than diotic (rpartial = 0.54) SRTs. Slope of fitted regression lines predicting SRT from PTA was significantly steeper for antiphasic than diotic DIN. For listeners with normal hearing or CHL, antiphasic SRTs were more strongly correlated with PTA (rpartial[62] = 0.92) than diotic SRTs (rpartial[62] = 0.64). Slope of the regression line with PTA was also significantly steeper for antiphasic than diotic DIN. The severity of asymmetric hearing loss (poorer ear PTA) was unrelated to SRT. No effect of self-reported English competence on either antiphasic or diotic DIN among the mixed first-language participants was observed. Antiphasic digit presentation markedly improved the sensitivity of the DIN test to detect SNHL, either symmetric or asymmetric, while keeping test duration to a minimum by testing binaurally. In addition, the antiphasic DIN was able to detect CHL, a shortcoming of previous monaural or binaurally diotic DIN versions. The antiphasic DIN is thus a powerful tool for population-based screening. This enhanced functionality combined with smartphone delivery could make the antiphasic DIN suitable as a primary screen that is accessible to a large global audience.

Outcomes of Primary Pediatric Stapedotomy.

To review a single institution experience with pediatric stapedotomy for juvenile otosclerosis (JO), congenital stapes footplate fixation (CSFF), or tympanosclerosis. Retrospective chart review. Tertiary referral center. Pediatric patients undergoing surgery for stapes fixation from 2001 to 2017. Hearing result based on preoperative, first postoperative, and final postoperative pure-tone average air-bone gap (PTA-ABG). Age, sex, diagnosis, procedure performed, prosthesis, and ossicular anomalies were considered. A total of 59 children (4-16 years of age) underwent surgery for stapes fixation (67 ears), with an average postoperative audiogram out to 2.88 years. Final postoperative ABG for tympanosclerosis (30.4 dB ± 10.9 dB) showed some improvement but the outcome was significantly worse than in CSFF (21.0 dB ± 11.4 dB) (p = 0.020) and JO (22.8 dB ± 14.9 dB). Our data suggest, that in our clinic, surgery for stapes fixation is safe to perform in children. While we achieved desirable results for JO and CSFF, patients with tympanosclerosis showed a statistically worse hearing outcome. Tympanosclerosis deserves special consideration and may be better served with a malleovestibulopexy, total ossicular replacement prosthesis (TORP), or amplification in lieu of traditional stapes surgery.

Short-Term Hearing Prognosis of Ossiculoplasty in Pars Flaccida Cholesteatoma Using the EAONO/JOS Staging System.

The aim of the present study was to investigate the prognostic factors for short-term hearing outcomes of ossiculoplasty for primary pars flaccida cholesteatoma according to the European Academy of Otology and Neurotology/Japanese Otological Society (EAONO/JOS) and 2015 JOS staging systems. A total of 34 patients with primary pars flaccida cholesteatoma who underwent one-stage tympanomastoidectomy with partial ossicular reconstruction using double cartilage block were included in the study. The postoperative pure-tone average air-bone gap (PTA-ABG) was calculated, and two criteria of successful hearing outcomes were defined as ≤10 and ≤20 dB. Patients were classified according to the EAONO/JOS and 2015 JOS staging systems. Cochran-Armitage test was used to statistically analyze staging, and Fisher's exact test was used to analyze other factors. Successful hearing outcome with postoperative PTA-ABG ≤10 and ≤20 dB occurred in 23.5% and 55.9% of cases, respectively. When postoperative PTA-ABG ≤20 dB was defined as successful, the success rate significantly decreased with increase in EAONO/JOS stage, and S0 pathological status of the stapes (no involvement) was a significantly favorable predictive factor. When postoperative PTA-ABG ≤10 dB was regarded as successful, the significantly favorable predictive factors were S0 pathological status of the stapes and development of mastoid cells with MC2-3 (better developed cells). Favorable prognostic factors for hearing outcomes of tympanomastoidectomy with partial ossicular reconstruction for primary pars flaccida cholesteatoma were low stage following the EAONO/JOS staging system and no stapes involvement and better development of mastoid cells following the 2015 JOS staging system.

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 benefit of trans-attic endoscopic control of ossicular prosthesis after cholesteatoma surgery.

To show the efficiency of using transmastoid atticotomy (TMA) endoscopy on the outcome of ossiculoplasty in patients with cholesteatoma. TMA is often performed as part of the surgical management of patients with middle ear cholesteatoma extending to the epitympanum. TMA can also be used as an access for endoscopic view to confirm the right alignment and stability of the ossicular prosthesis because the reconstruction of the tympanic membrane will obscure the visualization of the prosthesis. A retrospective study was done at a tertiary referral institute, including 133 ears with cholesteatoma that underwent canal wall-up tympanomastoidectomy (CWU) with ossicular reconstruction using titanium prosthesis between August 2013 and August 2015. Post packing of the ear canal and position, stability, and axis of the prosthesis were checked using endoscope positioned in the attic through TMA. A postoperative pure-tone average air-bone gap (ABG) of 20 dB or less was considered as a successful hearing result. Results are compared with historical control groups. Of the 133 ears, 88 patients underwent reconstruction with partial ossicular replacement prosthesis (PORP), whereas the rest (45 patients) had total ossicular replacement prosthesis (TORP). A postoperative ABG ≤ 20 dB was obtained in 77.4% of all the patients (79.5% for PORP; 73.3% for TORP). Endoscopic assessment of the ossicular prosthesis via the attic, after repositioning of the tympanomeatal flap and packing the ear canal, decreases the risk of immediate ossiculoplasty failure and improves the functional outcome after ossicular chain reconstruction in cholesteatoma surgery. 4 Laryngoscope, 129:2754-2759, 2019.

Long-term Outcomes of Ossiculoplasty With and Without an Intact Malleus.

To compare long-term hearing outcomes following ossiculoplasty with cartilage tympanoplasty with (M) and without (M) the malleus present. Retrospective chart review. Tertiary referral center. One twenty-six patients (18-88 yr of age) undergoing ossiculoplasty with tympanoplasty or tympanomastoidectomy using cartilage tympanic membrane grafts from 1998 to 2012 with at least 5 years of documented postoperative follow-up. Short-term hearing results (pure-tone average air-bone gap [PTA-ABG] measured between 60 d and 1 yr after surgery), long-term hearing results (PTA-ABG measured ≥5 yr after surgery), Ossiculoplasty Outcome Parameter Staging (OOPS) index, and complications. There were 46 patients in the M group and 80 in the M group. Preoperative PTA-ABG was 23.8 dB for M and 34.5 dB for M (p = 0.00001). Short-term postoperative PTA-ABG was 19.3 dB for M and 18.5 dB for M (p = 0.727). Long-term postoperative PTA-ABG was 18.2 dB for M and 19.6 dB for M (p = 0.500). The OOPS index was 4.11 and 6.41 for M and M, respectively, (p = 0.00001). Thirteen patients (10.3%) experienced complications. Our data suggest that the malleus is not statistically significant with regard to its impact on final audiometric outcome following ossiculoplasty. This has implications in our clinic, particularly in our use of the OOPS index as a prognostic tool, and will likely lead to its revision. These data may further support the coupling theory of acoustic gain and weaken the catenary lever theory.

Maximising Graft Take-Up in Type1 Tympanoplasty Using Peripheral Cartilage Ring and Perichondrium.

The aim of this study is to evaluate the results of closure of big central and subtotal perforation by Tympanoplasty using underlay technique with Composite graft of tragal perichondrium supported by a ring of cartilage peripherally. Our hypothesis was that the cartilage support offers an extremely reliable method for reconstruction of the tympanic membrane in cases of advanced middle ear pathology and Eustachian tube dysfunction and also revision cases. Prospective study of patients undergoing tympanoplasty in big central and subtotal perforation with graft supported by a ring of cartilage peripherally between June 2016 and August 2016. Hearing results were reported using four frequency (500, 1000, 2000 and 3000) pure tone average air-bone gap. During the study period, composite graft comprising of tragal perichondrium and peripheral ring of cartilage prepared from ipsilateral tragus was used for tympanic membrane reconstruction in 30 patients. Overall graft take rate was 93.33%. Complications included residual perforation in 6.67%. Cartilage ring support offers an extremely reliable method for reconstruction of tympanic membrane in cases of high-risk perforation (big central perforation, subtotal perforation, anterior perforation of tympanic membrane, revision cases).

Long-Term Hearing Results After Ossiculoplasty.

To determine if the OOPS index is predictive of long-term hearing results after ossiculoplasty. Case series with retrospective chart review. Tertiary care otology practice. Adult and pediatric patients (3-88 years of age). Ossiculoplasty with cartilage tympanoplasty, with or without mastoidectomy. Primary outcome measures included short-term hearing results (pure-tone average air-bone gap [PTA-ABG] measured between 60 days and 1 year after surgery), long-term hearing results (PTA-ABG measured ≥5 years after surgery), and the rate of successful ABG closure to ≤20 dB. Secondary measures included the need for revision surgery, delayed tympanic membrane graft failure, worsening conductive hearing loss (after an initially satisfactory hearing result), and recurrence of cholesteatoma. There was no significant difference between adults and children for short-term hearing results (average post-op PTA-ABG was 18.9 dB vs. 19.8 dB, respectively; p = 0.544), long-term hearing results (average final PTA-ABG was 19.3 dB vs. 19.4 dB, respectively; p = 0.922), or rate of ABG closure to less than 20 dB (63.1% vs. 58.0%, p = 0.282). Spearman's rank-order correlation (ρ) identified a strong positive correlation between OOPS index score and average post-operative PTA-ABG (ρ = 0.983; p < 0.001; 2-tailed), as well as average long-term PTA-ABG (ρ = 0.950, p < 0.001; 2-tailed). The OOPS index makes it possible to accurately prognosticate hearing outcomes in adult and pediatric patients undergoing ossiculoplasty in both the short term and the long term.

Long-term Outcomes After Secondary Mastoid Obliteration.

To assess long-term outcomes after secondary mastoid obliteration. Case series with chart review. Tertiary care center. Adult patients (20-80 yr of age) undergoing secondary mastoid obliteration. Hearing results (improvement in pure-tone average air-bone gap [PTA-ABG] from baseline) at the time of postoperative audiometry and at least 5 years after surgery, anatomic outcomes (rate of successful tympanic membrane graft healing), and the incidences of observed complications. An average improvement in PTA-ABG by 16.9 dB (p = 1.8 × 10) was noted. Postoperatively, the PTA-ABG was successfully closed to ≤20 dB in 39.5% (17/43) of patients. The average final PTA-ABG (obtained at least 5 years after surgery) was 25.3 dB, which was also a significant improvement over the preoperative baseline PTA-ABG (p <<< 0.01). Significant complications were observed in 14.0% (6/43) of patients, with 9.3% (4/43) requiring a subsequent surgery. Although 69.8% (30/43) of patients experienced otorrhea preoperatively, otorrhea was only observed in 4.7% (2/43) at any point in time postoperatively. Secondary mastoid obliteration with reconstruction of a more natural posterior canal wall, cartilage tympanoplasty, and ossicular chain reconstruction is a hybrid technique that allows for creation of a safe, dry ear with significant, long-term improvement in hearing and functional outcomes in patients with unstable mastoid cavities.