Hearing Improvement Rate Research Articles

A multicenter study on the effects of congenital cytomegalovirus infection on hearing loss

Objective: To assess the clinical features and effectiveness of antiviral therapy in newborns with sensorineural hearing loss (SNHL) caused by congenital congenital cytomegalovirus (cCMV) infection, and to speculate the risk factors for poor hearing outcomes. Methods: A multicenter prospective cohort study wasconducted, enrolling 176 newborns diagnosed with cCMV at four research centers in Zhejiang Province from March 1, 2021, to April 30, 2024. Clinical characteristics at birth were recorded and hearing was followed up. The children were divided into groups based on their condition at birth, specifically into asymptomatic, mild symptom, and moderate to severe symptom groups. Additionally, they were divided into SNHL and normal hearing groups based on the results of air conduction brainstem audiometry at birth. And they were also divided into treatment and untreated groups according to antiviral treatment. Mann Whitney U test, and chi square test were used for inter group comparison to analyze the differences in clinical features between different disease groups, and to analyze the effects of clinical features, antiviral therapy, and other factors on hearing improvement. Logistic regression analysis was employed to identify the risk factors influencing hearing outcomes. Results: Among the cohort of 176 children diagnosed infection with cCMV, 90 cases were male and 86 cases were female. Of these, 79 cases were asymptomatic, 12 cases classified as mild cCMV and 85 cases as moderate to severe cCMV. Fifty cases belonged to SNHL group, with different degrees of severity, including 30 cases of mild, 9 cases of moderate, 5 cases of severe, and 6 cases of extremely severe SNHL. Among the 121 cases in the normal hearing group, 2 cases (1.7%) exhibited late-onset hearing loss despite having normal hearing at birth. Among 81 cases (46.0%) who completed the hearing follow-up, 71 cases (87.7%) had good hearing outcomes and 10 cases (12.3%) had poor hearing outcomes. Among the 81 children, 29 cases (35.8%) had SNHL at birth. During follow-up, the hearing threshold improved in 19 cases (65.5%), remained stable in 7 cases (24.1%) and progressed in 3 cases (10.3%). A total of 26 cases in the treatment group and 55 cases in the untreated group completed the hearing follow-up assessment. The rate of hearing improvement in the treatment group was found to be higher compared to the untreated group (13 cases (50.0%) vs. 6 cases (10.9%), χ2=15.00, P<0.01), with individuals in the treatment group having a 4.58 times greater likelihood of experiencing hearing improvement (RR=4.58,95%CI 1.96-10.70, P<0.05). However, no statistically significant difference was observed in hearing outcomes between the antiviral treatment group and the untreated group (RR=0.90, 95%CI 0.57-1.41, P=0.517). Multivariate analysis further confirmed SNHL (OR=11.58, 95%CI 2.10-63.93, P=0.005) and preterm birth (OR=4.98, 95%CI 1.06-23.41, P=0.042) as independent risk factors for poor hearing outcomes. Conclusions: SNHL resulting from cCMV infection presents symptoms at birth and can be improved by antiviral therapy. Poor hearing outcomes are associated with SNHL and prematurity.

Rate and management of tympanic membrane perforations in children with Down syndrome and middle ear disorder

ObjectiveTo characterize the management and outcomes of observation versus surgical intervention of tympanic membrane (TM) perforations in children with Down syndrome (DS). In addition, to estimate the prevalence of TM perforations in children with DS. MethodsRetrospective case review analysis of TM perforation rate in children with DS with history of tympanostomy tube (TT) insertion at a tertiary pediatric referral center. Patients were divided into observation or surgical intervention groups and then further evaluated for the type of intervention, the number of required procedures, and success rate of hearing improvement. Risk factors contributing to perforations were analyzed, including TT type, number of TT surgeries, and perforation size. ResultsThe TM perforation rate in children with DS with TT history was 7.0 %. Tympanoplasty was performed in 41.5 % of perforated ears with a success rate of 53.1 %. There was no statistical difference between the surgical intervention and observation groups regarding perforation characteristics or TT number and type, but the surgical intervention cohort was older. Hearing improvement based on postoperative pure tone average (PTA) threshold was noted in the successful surgical intervention group. ConclusionThe rate of TM perforations in children with DS after TTs is comparable to the general population. Improved PTA thresholds were noted in the surgical success group influencing speech development. The overall lower success rate of tympanoplasty in patients with DS emphasizes the need to factor in the timing of surgical intervention based on the predicted age of Eustachian tube maturation.

Ossicular Reconstruction With Various Degrees of Malleus Preservation in Patients With Chronic Otitis Media.

Objective: We examined the relationship between factors of middle ear conditions and the outcome of ossiculoplasty in chronic otitis media (COM) by measuring the improvement in the air-bone gap (ABG) and air conduction threshold (TAC). Methods: This retrospective study analyzed 76 patients (77 ears) who underwent ossiculoplasty from among 520 COM patients who underwent tympanoplasty based on the maximum preservation of the original ossicles. The reconstructed ossicular chain was performed by preserving or utilizing the remaining malleus in all cases with the presence of the malleus manubrium. Patients with eardrum adhesion, cholesteatoma, and cholesterol granuloma were defined as having a compromised middle ear condition (Group A), and those without as having an uncompromised middle ear condition (Group B). In each group, pure-tone audiometry was performed preoperatively and postoperatively, and improvements in the ABG and TAC were compared. The effects of the types of tympanoplasty and the method of ossiculoplasty (columella versus incus interposition) on postoperative ABG and TAC were also compared. Results: The postoperative ABG improvement in Group B was significantly higher than that in Group A [β = 7.31, 95% confidence interval (CI) = 1.93-12.69, P < .05]. Type III minor columella tympanoplasty yielded significantly better results than type III major and type Vb tympanoplasty (β = 11.42, 95% CI = 5.16-17.68, P < .01). There were no significant differences in the postoperative ABG or TAC between the reconstruction groups with and without preservation of malleus. Conclusions: Our results indicate that complex cases compromised by adhesions, cholesteatoma, and cholesterol granuloma have worse outcomes regarding hearing improvement and success rates, while those with intact stapes suprastructure have better outcomes. Malleus was maximally preserved in the patients of this study; however, this showed no significant prognostic benefit in hearing.

Tympanoplasty in Pediatric Age Group: Meta Analysis Study

Abstract Objectives To evaluate the success rate and audiological results of pediatric tympanoplasty Methods Metanalysis study of articles involving of pediatric patients who underwent myringoplasty between the years 1995 to 2019, in Medline, Cochrane database. Anatomical and functional success were evaluated also ABG improvement. The influence of age on tympanic membrane closure were examined, publication bias was assessed and pooling of estimates were expressed. Our study consisted of 31 studies done on 2546 patients, with a mean age 10 years, DerSimonian-laird random effects and Forest plots were used for analysis. Results The anatomical success and the functional were 87% and 77% respectively. With the increase of age by 1 year the increase in functional success and anatomical success was 1% and 0.1% respectively also the ABG improvement around 0.2648 db. Conclusion Pediatric myringoplasty is associated with high rate of success, with a high rate of hearing improvement. Age under 7 is associated with less success.

Efficacy of gelfoam middle ear packing in type-1 tympanoplasty: systematic review and meta-analysis.

To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) that evaluated the surgical outcomes of type-1 tympanoplasty with and without gelfoam middle ear packing. PubMed, CENTRAL, Scopus, Web of Science, and Google Scholar databases were screened from inception until October 2022. The included RCTs were evaluated for risk of bias, and the quality of each outcome was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Nine RCTs with 773 participants (gelfoam = 381 and non-gelfoam = 392) were analyzed. The overall study quality varied: low risk (n = 4 RCTs), some concerns (n = 3 RCTs), and high risk (n = 2 RCTs). There were no significant differences between both arms regarding the graft uptake rate (moderate certainty), hearing improvement rate (moderate certainty), type of impedance audiometry (moderate certainty), and ear discharge (low certainty). The mean change in air-bone gap was significantly higher in the non-gelfoam arm compared with the gelfoam arm (low certainty). However, the non-gelfoam group had superior hearing improvement in only the early postoperative period (i.e., one month); however, after two, three, and six months, there were no significant differences between both arms. The rate of ear fullness was significantly higher in the gelfoam arm compared with the non-gelfoam arm (moderate certainty). Among patients undergoing type-1 tympanoplasty, the surgical outcomes did not significantly differ between both arms. The practice of middle ear packing with gelfoam needs to be standardized.

Type 1 Tympanoplasty by Interlay Technique for Management of Tympanic Membrane Perforation

Tympanic membrane is the partition between the external ear and middle layer which is a vital component of the human ear. Neglected or maltreated earache, ear discharge and trauma lead to perforation of tympanic membrane. Tympanoplasty is the surgical procedure performed to repair a perforated tympanic membrane, with/without reconstruction of the ossicles, with the aim of preventing reinfection and restoring hearing ability. Type 1 tympanoplasty is the simple closure of the tympanic membrane perforation. To study the outcome of type 1 tympanoplasty operation by interlay technique, a descriptive longitudinal study was conducted among 200 patients in Community Based Medical College Hospital and in private clinics of Mymensingh from January 2012 to December 2021. Our inclusion criteria was population of age ranging from 15 to 55 yrs of both sexes having dry central perforation for at least 6 weeks and exclusion criteria was patient with active stage of chronic suppurative otitis media (CSOM), ossicular discontinuity, sensory neural hearing loss. Data was analyzed by SPSS version 20.0. Prevalence of taking graft was 96.00%. Measured by difference of preoperative air bone gap (ABG) and postoperative ABG of 15 decibel (dB) hearing improvement rate was 90%. Complication was minimal (1%). The complication was infection due to non-compliance with postoperative advice and treatment. Type 1 tympanoplasty done by interlay technique has excellent results both in terms of graft taken and hearing improvement with minimal complications.&#x0D; CBMJ 2023 January: Vol. 12 No. 01 P: 67-72

Assessing the usefulness of inner ear contrast-enhanced magnetic resonance imaging and pure-tone audiometry in estimating the prognostic value of hearing improvement in patients with definite Meniere's disease.

Meniere's disease (MD) is characterized by combined cochlear and vestibular symptoms. However, its underlying cause remains unclear, with low-to-mid-tone hearing impairment being predominantly reported. Moreover, predicting hearing improvement after disease onset is not possible. This study aimed to assess whether hearing improvement in patients with definite MD (DMD) could be predicted using inner ear contrast magnetic resonance imaging (IEC-MRI) and pure-tone audiometry (PTA) at disease attack. Between April 2020 and March 2022, seven outpatients with DMD were enrolled based on the Bárány Society DMD criteria. The patients were divided into two groups: low-tone hearing loss (LTL) group and low-to-mid-tone hearing loss (LMTL) group. Hearing improvement rates as well as the possible inter-relation between endolymphatic hydrops and hearing improvement were evaluated. Endolymphatic hydrops was found in two of four LTL cases. One of three LMTL cases had prominent lymphedema. All patients with LTL but only one patient with LMTL had hearing improvement. Endolymphatic hydrops was not found to be correlated with hearing improvement. Estimating hearing improvement in patients with DMD using IEC-MRI was not possible. However, PTA showed better hearing prognosis in LTL than in LMTL. Therefore, estimating hearing improvement using PTA was possible at disease attack.

Vitamin D: A Factor affecting the Success of Type 1 Tympanoplasty.

Vitamin D (VD) plays role in wound healing and protection against infections. The relationship between plasma VD level and the outcomes of Type 1 tympanoplasty (T1T) has not been studied before. A total of 101 patients with chronic otitis media scheduled for T1T were divided into four groups in relation with their VD levels as severe insufficiency, insufficiency, mild-to-modest deficiency and optimal VD level groups. Graft success, hearing improvement and postoperative infection rates were compared among the groups in 12-month follow-up period. The graft success rate (P = 0.014) and air-bone gap gain (P = 0.004) were significantly higher, and postoperative infection rate was significantly lower (P < 0.001) in optimal VD level group. 25-OH VD deficiency should be considered as a factor for failure in T1T. VD replacement may increase success of tympanoplasty in patients with low preoperative serum VD levels.

Outcomes and learning curve of endoscopic tympanoplasty: A retrospective analysis of 376 patients.

This study aimed to evaluate the procedural outcomes and learning curve of type I endoscopic tympanoplasty (ET) performed by a single surgeon. This was a retrospective study of 376 patients who underwent type I ET performed by a single surgeon over 7 years. We evaluated the pre/post air-bone gap (ABG), time required for surgery, changes in pain after surgery, success, and failure rate of type I ET. Hearing results indicated an ABG of approximately 17.8dB before surgery but decreased significantly to 9.8dB at 6 months after surgery. The time required for the operation gradually decreased. In particular, the time required for the procedure was 67.6min in the first year and decreased to 31.5minutes in the fifth year, a drastic reduction. The graft failure rate up to 6 months after surgery was 13.0% and was the same for both primary and revision surgeries. Graft failure was significantly greater with increasing size of the preoperative tympanic perforation. The success rate varied depending on graft material, and the group with only acellular allogenic dermal matrix showed the lowest success rate. Postoperative pain significantly decreased from 2.01 immediately after surgery to 0.78 points the next day, and there were no severe complications during surgery. ET produces superior cosmetic results with minimal pain and is associated with stable hearing improvement and high success rate. The operation time decreased with surgeon experience and continued to decrease until the fifth and final year of this analysis. 4.

Effect of ear exercises on hearing loss in patients with nasopharyngeal carcinoma after radiotherapy

The objective of the study is to explore the effect of an ear health exercise on hearing loss of patients with nasopharyngeal carcinoma receiving radiotherapy. One hundred and seventeen patients diagnosed with nasopharyngeal carcinoma from June 2018 to January 2020 were selected as research subjects randomly divided into three groups. Thirty-eight cases were in experimental group 1 and given an ear health exercise for 6 months, 38 cases were in experimental group 2 and given an ear health exercise for 12 months, and 41 cases in control group only received hearing health education. The hearing loss of three groups was compared before intervention and at 6 and 12 months after intervention. The value of the average audibility threshold of air conduction, the occurrence rate of abnormal acoustic immittance (ear), the rate of tympanic cavity effusion, and occur rate of secretory otitis media in two experimental groups were lower than control group among different time points. The above indicators of experimental group 2 were lower than those of group 1 (p < .05). The total effective rate of hearing improvement in experimental groups 1 and 2 was higher than that of control group after the intervention. Besides, the total effective rate in experimental group 2 was higher than that in group 1, and the difference was statistically significant (p < .05). There was no serious adverse reaction. An ear health exercise can reduce hearing loss of patients with nasopharyngeal carcinoma receiving radiotherapy. It can be used as daily rehabilitation measures to prevent or delay hearing loss for these patients.

Comparison of Graft Uptake by Underlay and Overlay Technique in Myringoplasty

Objective: The objective of this study was to compare the effectiveness of graft uptake by underlay and overlay technique in patients undergoing myringoplasty Design of the Study: It was a randomized controlled trial Study Settings: Research was conducted at Department of Otorhinolaryngology and Head and Neck surgery Holy Family Hospital, Rawalpindi from January 2021 to June 2021. Material and Methods: In this study, 80 patients underwent myringoplasty for tympanic perforation who were randomly divided into two groups. Patients ranged in age from 20 to 40 years old. Those in Group A had an underlay myringoplasty, while those in Group B had an overlay procedure. One of the study's outcome variables was the procedure's effectiveness, which was observed and compared among groups. Results of the Study: There were 1.2:1 men to women patients, with 44 (55.0%) men and 36 (45.0%) women. Patients who underwent underlay versus overlay myringoplasty had a considerably greater rate of hearing improvement (97.5 percent vs. 77.5 percent ; p=0.007) and a significantly lower rate of complications (5.0 percent vs. 32.5 percent ; p=0.002). Conclusion: Underlay myringoplasty was found to be much more successful than overlay myringoplasty in 95.0 percent of patients compared to 57.5 percent of patients who received overlay myringoplasty. Keywords: Underlay Myringoplasty, Overlay Myringoplasty, Tympanic Perforation, Graft,

Comparison of surgical results between ‘atticosinuplasty’ and canal wall up mastoidectomy for early-stage cholesteatoma

Background We devised a surgical technique called ‘atticosinuplasty’ (AS) for the treatment of early-stage cholesteatoma. Objective This study analyzed the adequacy and applicability of AS compared to canal wall-up mastoidectomy (CWU) in patients treated for early-stage cholesteatoma. Materials and Methods A total of 187 patients with either AS (n = 89) or CWU (n = 98) were compared in terms of postoperative hearing outcome, recurrence and re-operation rate, and radiologic outcome. Results Hearing gain was significant in the AS group (p < 0.001) but not in the CWU group. Air conduction change, air–bone gap (ABG) change, and ABG closure did not significantly differ between the two groups. The frequencies of cholesteatoma recurrence and revision ossiculoplasty were also similar. Of the 32 patients in the AS group with only attic/sinus involvement preoperatively, 20 (62.5%) showed no haziness and 6 (18.8%) had haziness extending to the mastoid postoperatively. Among the 67 patients in the CWU group who had haziness extending to the mastoid preoperatively, in 54 (80.6%) there was no change postoperatively. Conclusions and Significance AS is a surgical technique worth trying in patients with early stage of attic/sinus cholesteatoma in terms of the rate of recurrence and hearing improvement.

A Comparison of Local Endolymphatic Sac Decompression, Endolymphatic Mastoid Shunt, and Wide Endolymphatic Sac Decompression in the Treatment of Intractable Meniere's Disease: A Short-Term Follow-Up Investigation.

BackgroundMeniere's disease (MD) is an inner ear disorder, characterized by recurrent attacks of vertigo, low-frequency sensorineural hearing loss, tinnitus, and aural fullness. Endolymphatic sac surgery is an effective treatment to control vertigo attacks but without causing a hearing loss for intractable MD. However, the methods and effects of endolymphatic sac surgery have been controversial for many years, and the relationship between the vertigo control rates of different endolymphatic sac surgery methods is not well-documented.ObjectivesThis study compared the vertigo control rate, hearing outcome, and quality of life (QOL) among different endolymphatic sac surgery, such as local endolymphatic sac decompression (LESD), endolymphatic sac mastoid shunt (ESMS), and wide endolymphatic sac decompression (WESD).Materials and MethodsWe retrospectively analyzed the patients who underwent endolymphatic sac surgery from January 2008 to June 2019. The control rate of vertigo and QOL scores were compared after 2 years of follow-up. The QOL was scored with validation of the MD patient-oriented symptom-severity index (MDPOSI). The pure tone thresholds of all patients at pre- and postoperation were also compared.ResultsIn total, 83 MD patients with complete follow-up data were included in the study, i.e., 20 patients with LESD, 28 patients with ESMS, and 35 patients with WESD. Results showed a better vertigo control with WESD than the other groups (70% with LESD, 71.4% with ESMS, and 88.6% with WESD). The QOL was improved after surgery in all groups in which the difference was statistically significant (QOL, preoperative vs. postoperative, 38.2 vs. 10.1 with LESD, 37.8 vs. 9.6 with ESMS, and 37.6 vs. 8.3 with WESD), respectively. After endolymphatic sac surgery, the hearing was well-preserved in the three groups [pure tone averages (PTAs), dB, preoperative vs. postoperative, 41.0 ± 19.3 vs. 40.8 ± 17.9 with LESD, 39.7 ± 16.4 vs. 40.8 ± 18.2 with ESMS, and 38.5 ± 18.7 vs. 36.6 ± 19.5 with WESD].ConclusionWide endolymphatic sac decompression has a higher vertigo control rate, better improvement of QOL, and relatively higher hearing stability or improvement rate after surgery in patients with MD compared with LESD and ESMS.

Prognosis of Idiopathic Sudden Sensorineural Hearing Loss: The Nomogram Perspective.

The aim of this study is to create a nomogram for accurately predicting the prognosis of idiopathic sudden sensorineural hearing loss (ISSNHL) and provide a reference for clinical treatment. Three hundred and twenty-three patients with ISSNHL were admitted from September 2014 to November 2020. The clinical data were retrospectively reviewed. Prognostic factors for ISSNHL were assessed based on univariate and multivariate logistic regression analysis and used to create a nomogram. Nomogram performance in terms of predictive and discriminatory ability was evaluated by calculating the concordance index (C-index) and generating calibration plots. The overall hearing improvement rate was 41.4%, comprising complete recovery (13.3%), marked recovery (17.0%), and slight recovery (11.1%). Multivariate logistic regression analysis showed that age, symptoms of vertigo, interval between onset and treatment, low-density lipoprotein, and type of hearing loss were independent predictors of ISSNHL. A nomogram based on these 5 factors had a C index of 0.798 (95% confidence interval 0.750-0.845). Age, vertigo, interval between onset and treatment, low-density lipoprotein level, and type of hearing loss are closely associated with hearing recovery. The nomogram may enable prediction of the prognosis of ISSNHL and facilitate clinical decision-making.

Efficacy of Otomicroscopy Combined with Otoendoscopy Double-Lens Technology-Assisted Tympanic Membrane Repair on Elderly Patients with Chronic Suppurative Otitis Media.

Objective To investigate the effect of otomicroscopy combined with otoendoscopy double-lens technology-assisted tympanic membrane repair on elderly patients chronic suppurative otitis media (CSOM). Methods 120 elderly CSOM patients from January 2017 to July 2019 were selected and divided into the otomicroscopy group (n = 40), the otoendoscopy group (n = 40), and the double-lens group (n = 40) by the random number method. All patients were treated with tympanic membrane repair. The otomicroscopy group was assisted by otomicroscopy, the otoendoscopy group was assisted by otoendoscopy. and the double-lens group was assisted by otomicroscopy combined with otoendoscopy. The three groups of operations status, clinical efficacy, the incidence of adverse reactions, hearing improvement rate, and satisfaction rate with incision after 6 months were compared. Results The operation time, intraoperative blood loss, hospitalization time, and VAS score of the otoendoscopy group and the double-lens group were all lower than those of the otoendoscopy group, and the operation time of the double-lens group was lower than that of the otoendoscopy group (P < 0.05). The clinical efficacy of the double-lens group was better than that of the otomicroscopy group and otoendoscopy group (P < 0.05). The adverse reaction rate of the otoendoscopy group and the double-lens group was lower than that of the otomicroscopy group, and the average postoperative air-bone conductance of the double-lens group was lower than that of the otomicroscopy group and the otoendoscopy group, and the hearing improvement rate was higher than that of the otomicroscopy and otoendoscopy groups (P < 0.05). The satisfaction rate with postoperative incision in the otoendoscopy group and double-lens group was higher than that in the otomicroscopy group (P < 0.05). Conclusion The double-lens technology-assisted tympanic membrane repair has an obvious effect on elderly patients with CSOM. Compared with the single-use otomicroscopy, the operation time, intraoperative blood loss, hospitalization time, patient's dry ear condition, degree of surgical pain, clinical efficacy, adverse reaction rate, hearing improvement rate, and patient's incision satisfaction of the double-lens technology are better. Compared with the single-use otoendoscopy, the operation time, clinical efficacy, and hearing improvement rate of the double-lens technology are better.

Outcomes of an Ear Camp Conducted in Bhutan by Thai Rural ENT Foundation-A Descriptive Study.

The Thai Rural ENT foundation has been conducting ear camps in Bhutan for many years to address the shortage of ENT specialists in the kingdom where patients are examined and treated for various ear illnesses. However, there has been no study conducted to assess the outcomes of such camps. This is the first study of its kind to be carried out in Bhutan. To study the spectrum of ear cases seen during the mobile ear camp, the intervention done and treatment outcomes. The study enrolled patients with ear disorders who presented to the mobile ear camp at Monggar Regional Referral Hospital, Bhutan, from January 6, 2020, to January 8, 2020. The following data were recorded: demographic details, preoperative clinical symptoms and otoscopic findings, preoperative audiogram, treatment or surgery done, postoperative middle ear and mastoid infection, wound infection, graft condition, any complications, and postoperative audiogram of operated cases. Patients who underwent surgery were followed up at 1 day, 6 weeks, and 2 months postoperatively. Two hundred ten patients presented with otologic conditions and 43 underwent surgeries. Otitis media was the commonest disease detected, and tympanoplasty was the commonest surgery performed. The tympanic membrane closure rate was 92.1%, and the rate of hearing improvement was 63.2%. The ear camp had beneficial effect and showed good results.

Myringoplasty in wet and dry ears: an observational study in a tertiary care center

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic otitis media is the most common cause of hearing impairment in the developing countries with serious effects. The aim of the study was to compare the outcome of myringoplasty in dry and wet ears in tubo-tympanic type of chronic otitis media (COM) with respect to graft uptake and hearing improvement.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is an observational study done in the department of ENT, Mamata medical college, Khammam, during the study period of September 2019 to February 2021 on 40 patients of tubo-tympanic type COM. On simple random basis selected patients underwent myringoplasty by underlay technique. All patients were evaluated during post-operative follow-up.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study, majority of patients were in the age group of 26 to 45 years with slight female preponderance, with male to female ratio (0.73:1). In our study, the successful graft uptake was seen 90% in dry ears and 85% in wet ears, which seems to be not significant in difference. With respect to hearing improvement, post-operatively there was significant improvement in both the groups, when compared to pre-operative hearing. The maximum improvement in average hearing threshold after surgery, in dry ears with large perforation (12.66dB) and in wet ears with small central perforation (12.44dB) was almost equal.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this study, the success rate of graft uptake and hearing improvement is found almost equal in dry and wet ears by using underlay technique of myringoplasty. &lt;/p&gt;

Sudden deafness: a comparison between age groups

Objectives This study compared sudden deafness (SD) cases in 20-year age bands to investigate their causes and treatment outcome. Design Retrospective study. Study Samples 178 unilateral SD patients were divided into four 20-year age-groups, namely Groups I (aged 0–19 years, n = 6), II (aged 20–39 years, n = 33), III (aged 40–59 years, n = 63), and IV (aged 60–79 years, n = 76). Methods An inner ear test battery and/or serology assay were performed. Results Incidence of SD in relation to overall neurotological cases did not significantly differ among the four groups. Groups I and II showed two or three audiographic patterns, while Groups III and IV had six audiographic patterns indicating that the aetiology of Groups I and II may be of the same origin, while Groups III and IV had multiple aetiologies. The hearing improvement rate was significantly higher in Groups III (62%) and IV (62%) than in Groups I (16%) and II (33%). Conclusion SD inevitably affects individuals of all ages. Significant differences in the audiographic patterns and speculative causes may account for various outcomes of treatment in each 20-year age band. Those SD patients aged 40–59 and 60–79 years showed significantly better treatment outcomes than those aged 0–19 and 20–39 years.

Hearing Outcome According to the Intratympanic Steroid Injection Starting Timing in Combined Intratympanic and Oral Steroid Treatment for Idiopathic Sudden Sensorineural Hearing Loss

Background and Objectives The combined intratympanic and oral steroid treatment has been accepted as effective treatment strategy for idiopathic sudden sensorineural hearing loss (ISSNHL). However, the treatment protocol of combined treatment for ISSNHL has not been established. In this study, we investigated whether hearing outcome differed according to different starting timing of intratympanic steroid injection (ITSI) in combined treatment for ISSNHL.Subjects and Method Tertiary academic referral center-based retrospective medical records of idiopathic 144 ISSNHL patients who received combined treatment from January 2015 to April 2018 were reviewed. All patients underwent a 2-week oral systemic steroid treatment and multiple ITSI. The hearing results of 3 months after treatment were compared according to the timing of ITSI.Results The mean pure tone audiogram gain was 24.3±23.6 dB. When Siegel’s criteria was applied, the overall rate of hearing improvement was 63.9% (92/144). The rate of hearing improvement was significantly higher in women (p=0.043) statistically, and there was a statistically significant lower rate of recovery in the former history of hearing loss (p＜0.01) or otitis media (p＜0.01). Moreover, the shorter the delay between symptom onset and initial ITSI, greater the statistical significance of hearing recovery rate became (p＜0.01).Conclusion The result of this study suggests that early ITSI during combined intratympanic and oral steroid treatment increases the chance of hearing recovery.

Update on Clinical Manifestation in Acute Low-Tone Hearing Loss

Background and Objectives Acute low-tone hearing loss (ALHL) is gaining attention as an independent disease identity with close association with endolymphatic hydrops and early stage Meniere’s disease (MD). This study aims to compare patients of ALHL with patients exhibiting low-tone hearing loss and ear fullness without vertigo in various audio-vestibular assessments and in progression to overt MD.Subjects and Method A total of 249 patients with low-tone hearing loss with ear fullness without vertigo was enrolled in this study. Of these patients, 58 patients met criteria for ALHL, which was defined as having an average hearing loss of ≥30 dB at 125, 250, and 500 Hz and ≤20 dB at 2, 4, and 8 kHz. Demographics, electrocochleography (ECoG) abnormality, rate of hearing improvement, vestibular functions, and progression to MD were analyzed.Results An average low-tone hearing loss of ALHL patients was 42.8 dB, which recovered to 18.9 dB following a combined treatment of diuretics and oral steroid therapy. The hearing recovery rate of this group was 87.9% and the ECoG abnormality ratio was 42.5%. Also, 15.5% of ALHL patients eventually progressed to MD.Conclusion This study described demographics and characteristics of ALHL, demonstrating a successful response to the combined treatment of diuretics and oral steroid. Also, this report demonstrated a close relationship between the degree of low-tone hearing loss and ECoG abnormality and observed the progression to MD in ALHL patients. These data can be usefully applied in clinical setting to explain clinical outcomes of ALHL.