Satisfactory Hearing Research Articles

Hearing Outcome after Ossiculoplasty with Teflon Ossicular Replacement Prosthesis in Modified Canal Wall Up Mastoidectomy

Background: Cholesteatoma commonly leads to damage of ossicular chain. Modified canal all up mastoidectomy is one of the commonly performed procedure for cholesteatoma worldwide. Ossiculoplasty means the operation performed to reconstruct the ossicular chain. Aim: To evaluate the hearing outcome after ossiculoplasty with teflon ossicular replacement prosthesis in modified canal wall up mastoidectomy. Methods: A prospective observational study was conducted at the Dept. of Otolaryngology-Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka from March 2018 to June 2020. Total 34 patients with cholesteatoma underwent modified canal wall up mastoidectomy and ossiculoplasty with teflon TORP or PORP were included in this study. All patients were followed up post-operatively upto 6 months with PTA. Results: Hearing improvement was better in ossiculoplasty with PORP. Successful results (ABG closure to within 20dB) were obtained in 35.29% & 70.58% cases in TORP & PORP group respectively after six month post-operatively. Conclusion: Ossiculoplasty with teflon ossicular replacement prosthesis gives satisfactory hearing gain. Bangladesh J Otorhinolaryngology 2024; 30(1): 24-33

Cochlear Implantation in a Patient with Intractable Tinnitus: A Case Report of an Endoscope-Assisted Approach.

Preservation of residual hearing and vestibular function is a crucial factor in cochlear implantation (CI), especially in patients with residual low-frequency hearing thresholds. We report a case of a patient who underwent unilateral endoscope-assisted CI with a challenging surgical view following rigorous posterior tympanotomy. A 53-year-old male presented with left-sided intractable tinnitus due to sudden sensorineural hearing loss that had occurred 10 years prior. Due to the abnormal location of the round window (RW), which was far more posterior and inferior than usual and impeded insertion of the electrode using the conventional RW approach, endoscope-assisted CI was performed. Pure-tone audiometry at 3 months after CI revealed satisfactory hearing thresholds. Furthermore, there was alleviation of the left-sided tinnitus, which was indicated by a marked decrease in both the subjective visual analog scale loudness and Tinnitus Handicap Inventory scores. With proper indications, we strongly recommend applying the RW approach with endoscopic assistance over conventional bony cochleostomy for the preservation of low-frequency hearing thresholds in cases where RW visualization is insufficient following posterior tympanotomy.

Using bone cement in re-bridging incudostapedial joint

Objective: to evaluate the hearing outcomes of using ionomeric bone cement in re-bridging incudostapedial joint discontinuity. Methods: This study included 50 patients who had ossiculoplasty using ionomeric bone cement for re-bridging of incudostapedial joint. There pre and post-operative audiologic outcomes were evaluated and reviewed by using pure tone audiometry averages and the air bone gap values with a follow up period of one year. Results: 42 patients (84%) had a post-operative air bone gap less than 20 dB following one year of surgery. The pre and post-operative mean of pure tune averages were 50.04±7.28 and 32.74±7.07 respectively (P value<0.01). The pre and post-operative mean of air bone gap were 36.56±6.41 and 17.60±5.77 respectively which was statistically significant (P value<0.01). Conclusion: using of ionomeric bone cement is a good grafting material in incudostapedial re-bridging ossiculoplasty being cost effective, easy applicable and biocompatible and give a satisfactory hearing outcome in selected patients.

Auditory Findings in Kabuki Syndrome: Description of a Case Report

Kabuki Syndrome (KS) is a rare disease characterised by a wide spectrum of clinical features including craniofacial, ophthalmological, auditory, cardiovascular, cognitive and neurological abnormalities, among others. We report the clinical case of a 16-year-old girl who was diagnosed with this syndrome in early childhood and has unilateral severe mixed hearing loss. In order to treat said hearing impairment, the patient received an active middle ear implant which provided her with satisfactory hearing gain and performance, as well as helping her academic, psychological and social development.

Modified radical mastoidectomy in chronic otitis media: year outcome post-surgery

Background: Cholesteatoma is defined as erosive process, eroding ossicular chain, scutum, otic-capsule, fallopian canal and tegmun. Surgical management of cholesteatoma includes mastoidectomy. The aim of the study was to focuss on MRM: indications and outcomes of procedure. Methods: This study aims at knowing the indications and outcome of MRM after 1 year in terms of success rate, efficacy and patient’s satisfaction. It involves study over 42 patients who underwent surgery and were followed over a period of one year post surgery. Results: After 1 year of MRM 64.27% showed hearing improvement, 95.2% had dry and settled cavity, and there was no post-operative facial palsy, and SNHL. Conclusions: MRM is a procedure of choice for COM with extensive disease of mastoid. A meticulous and skilled MRM gives a well fashioned mastoid cavity with minimum or no recurrence/post-operative complications with a satisfactory hearing outcome.

Clinical Study of 35 Patients with Acute Acoustic Hearing Disorder

AbstractWe conducted a clinical study on 35 patients (42 ears) with acute acoustic hearing disorder who visited the otolaryngology department of Himeji St. Mary's Hospital during 12 years, from January 2012 to December 2023. The patients' ages ranged from 16 to 81 years, with an average of 34.7 years (median age: 27 years); there were 27 male and 8 female patients. The disease was caused by exposure to shooting sounds in 22 patients (shooting sound group) and exposure to other strong and loud sounds in the remaining 13 patients (other high-intensity sound group). The mean age was significantly lower, and the interval from the onset of symptoms to consultation was shorter in the shooting sound group than in the other high-intensity sound group. Regarding hearing type, the C5-dip type was the most common (11 ears), followed in frequency by the gradually down-sloping, sharply down-sloping, and flat type. The overall hearing improvement was as follows: cured: 40.5%; markedly recovered: 11.9%; recovered: 19.0%; and unchanged: 28.6%. The degree of hearing improvement classified by hearing type was good for all of the C5-dip, dip (2K), and V-shaped types. Patients younger than 30 years, with a short interval from the onset to first visit, and with bilateral hearing loss showed satisfactory hearing improvement. There was a tendency for the degree of hearing improvement to be better in the shooting sound group than in the other high-intensity sound group.

The utility and safety of diode laser in endoscopic stapes surgery.

The advantages of laser stapedotomy are less trauma and more precise and minimally invasive techniques; however, the potential risk of overheating from the laser combined with the endoscope tip must be considered. This study aimed to assess the efficacy and safety of diode lasers for endoscopic stapes surgery. A retrospective review of 56 patients with otosclerosis who underwent primary endoscopic stapedotomy with a diode laser from 2017 to 2020 was conducted. Demographic data, intraoperative findings, preoperative and postoperative audiological assessments, and postoperative complications were analyzed. There was no statistically significant difference between the preoperative and postoperative bone conduction thresholds. The mean postoperative air-bone gap (ABG) improved significantly compared to the preoperative ABG (4.07 vs. 35.43 dB, p < .001). The postoperative ABG closure within 10 dB at 6 and 12 months was achieved in 87.50% and 91.07% of patients, respectively. The postoperative pain scores at 4 and 24 h were 2.55 and 0.39, respectively. Immediate postoperative vertigo was reported in 12.50% of patients, with 100% complete recovery 2 months after surgery. The chorda tympani nerve was preserved in all the cases. Postoperative taste disturbances at 2 and 12 months were observed in 17.86% and 1.79% of patients, respectively. The diode laser in endoscopic stapedotomy is a safe and effective technique that provides satisfactory hearing outcomes. Temporary taste disturbances during the early postoperative period are a concern. The handheld diode laser delivery system is suitable for an endoscopic approach and is an alternative armamentarium for the treatment of otosclerosis. Level of evidence: IV.

Cochlear Implantation in Intralabyrinthine Schwannoma: Case Series and Systematic Review of the Literature

Intralabyrinthine schwannomas (ILS) are rare benign tumours arising from the peripheral branches of the cochlear or vestibular nerves in the membranous labyrinth, intracochlear schwannomas being the most frequent ones. When hearing is no longer feasible on the affected side, surgical removal along with simultaneous cochlear implantation can be proposed to the patient. We hereby present a systematic review of the literature on the topic, as well as two original cases from our centre (Ospedale Università degli Studi di Padova). Cochlear implantation in intracochlear schwannomas is feasible, with overall satisfactory hearing outcomes in accordance with the evidence found in the literature.

The Prevalence of Hearing Aid Use in Children With Single-Sided Sensorineural Deafness in Oxfordshire

The Prevalence of Hearing Aid Use in Children With Single-Sided Sensorineural Deafness in Oxfordshire

Radiological and audiological predictors of stapes destruction in adherent pars tensa.

Progressive adherent pars tensa occasionally induces ossicular erosion. Specifically, stapes discontinuity adversely affects postoperative hearing. However, this irretrievable sequela is challenging to prove preoperatively, partly because perimatrix inflammation on the pars tensa can obscure the visibility of the ossicles or the partial volume effect of computed tomography (CT) imaging can hamper detailed ossicular visualization. Therefore, there is no consensus regarding the ideal timing for switching from a wait-and-see approach to a surgical one. Herein, we aimed to explore the potential predictors of stapes superstructure destruction in adherent pars tensa. This retrospective cohort study enrolled consecutive patients who underwent primary tympanoplasty for adherent pars tensa categorized as grade IV on Sadé's grading scale between April 2016 and September 2021. The impact of features on otoscopy and CT and air-bone gap (ABG) on stapes superstructure destruction was assessed using uni- and multivariable logistic regression analyses. Sixty-four ears were included. Multivariate analysis revealed the presence of debris on the adherent pars tensa (odds ratio [OR] [95% confidence interval {CI}]): 4.799 [1.063-21.668], p = 0.0415), presence of soft-tissue density occupying the oval window (OR [95% CI]: 13.876 [3.084-62.437], p = 0.0006), and a ≥ 20-dB preoperative ABG at 3kHz (OR [95% CI]: 7.595 [1.596-36.132], p = 0.0108) as independent predictors for stapes superstructure destruction. High preoperative awareness of the possibility of destruction of the stapes superstructure would enable the surgeon to make a timely decision to provide surgical intervention before progression to severe stapes destruction, thereby maintaining long-term satisfactory hearing.

Radiological and audiological prediction for hearing outcome in cholesteatoma recidivism surgery.

In cholesteatoma recidivism, achieving satisfactory hearing outcome after revision surgery remains challenging. The presence of concomitant recidivism pathology or related anatomical abnormalities can impact revision reconstruction of the sound transmission system. The current study aimed to identify prognostic factors affecting hearing outcomes after surgery for cholesteatoma recidivism. This retrospective cohort study included consecutive patients whose ears required initial surgery for recidivism between January 2016 and December 2021. Patients followed up for < 6months and those not indicated for ossiculoplasty were excluded. The impact of preoperative otoscopic findings, computed tomography (CT) features, and hearing levels on the prediction of satisfactory hearing (postoperative air-bone gap [ABG] ≤ 20dB) was evaluated using univariate and multivariate logistic regression analyses. Overall, 102 patients were included, with a mean follow-up of 24.8months. Multivariate logistic regression analysis revealed the following independent predictive factors for satisfactory hearing: presence of aeration in the tympanic cavity (odds ratio [OR] [95% confidence interval {CI}]: 13.287 [1.113-158.604], p = 0.0409), absence of soft-tissue density occupying the oval window (OR [95% CI]: 13.445 [3.178-56.887], p = 0.0040), and ≤ 22.5dB preoperative ABG in four-frequency average (OR [95% CI]: 9.339 [2.026-43.050], p = 0.0042). For cholesteatoma recidivism, reliable preoperative prediction based on CT and ABG would facilitate decision-making regarding the probability of efficient revision ossiculoplasty or appropriate preoperative counseling, including early hearing rehabilitation using hearing aids or implementation of simultaneous implantable hearing equipment during surgery for recidivism.

Is the intra-operative morphology of the cochlear nerve a good predictor of the results of simultaneous ipsilateral cochlear implantation in vestibular schwannoma surgery?

There are currently no guidelines for simultaneous vestibular schwannoma surgery and cochlear implantation. This paper therefore provides our experience and our results regarding predictive parameters of good hearing. Morphological appearance of the cochlear nerve after tumour resection was used as the main criterion for implantation in the case series. Patients were then divided into responders and non-responders to cochlear implantation, and potential outcome predicting factors were evaluated in the two groups. Nine of the 16 patients showed a response to cochlear implantation. Pre-surgery serviceable hearing was significantly more common in the responder group, while no difference was found in the two groups for other variables. This study highlights how the morphological appearance of the cochlear nerve can be useful to predict the hearing outcome and indicates that satisfactory hearing results are closely related to pre-surgery serviceable hearing.

Experience in endoscopic stapedotomy technique and its audiological outcome: a case series

BackgroundStapedotomy is being performed endoscopically for otosclerosis in Sudan since 2011 with increasing number of patients. This prospective hospital-based study from Nov 2016 to Nov 2020 states the clinic-demographic features of otosclerosis; it describes this surgical technique and hearing outcome following endoscopic stapedotomy.ResultsTotal number included in the study was 91 patients. Females were 48, and males were 43 with a female to male ratio of 1.1:1. Age ranged from 19 years to 52 with a mean age of 30.6± 7 SD years. The main symptom was decreased hearing in all patients (100%); in 82 patients (90%), it was bilateral, followed by tinnitus in 80 patients (88%) while two patients (2.2%) had vertigo. Family history was stated by 2 patients (2.2%) only. Audiological assessment by pure tone audiogram (PTA) for each ear (total of 182) revealed that conductive hearing loss (CHL) is the commonest type of hearing loss in 148 ears (81.3%), mixed type in 30 ears (16.5%), while 4 ears (2.2%) were normal.Endoscopic stapedotomy was performed for 74 patients; this technique was safe; few complications were managed successfully: one gusher and one revision, with no facial nerve injury. Majority of complications happened during the first year. Mean air bone gap (ABG) gain was 23.3± 7.2 dB, air conduction (AC) gain was 18.3 ± 8 dB, and Carhart notch disappeared in 79.5%.ConclusionsEndoscopic stapedotomy is a safe and effective procedure with a steep learning curve and a satisfactory hearing outcome. The air bone gap (ABG) gain was comparable to international studies.

Endoscopic transcanal management of tympanosclerosis.

The objectives of this study are to describe our experiences in endoscopic transcanal management of tympanosclerosis, to explain our surgical approaches to reconstruct the sound conduction system and to analyze the hearing results obtained with our surgical approaches. A retrospective cohort study, using medical records of 28 cases that underwent endoscopic transcanal tympanoplasty surgery due to tympanosclerosis from January 2016 to January 2020. Private otology clinic PATIENTS: Twenty-eight ears of 26 patients were enrolled into study. Patients were grouped according to Wielinga-Kerr classification and only type II, III and IV patients were included in the study. Exclusively transcanal endoscopic surgery was performed in all cases. Primary goal was to mobilize the affected ossicles by removing the offending TS and reconstruct the ossicular chain. Malleostapediopexy was preferred when attic by-pass procedures were needed. Glass ionemer bone cement was used to reconstruct the ossicular defects. Preoperative and postoperative pure tone average of air conduction and bone conduction and air-bone gap results were evaluated. Operation was considered successful if postoperative ABG < 20dB was achieved. Complications and graft take rate were also evaluated. Single-staged surgery was performed in 23 of 28 cases (82.1%). Graft take rate was 93%. The mean preoperative ABG significantly decreased from 33.9 ± 5.19 to 12.55 ± 5.52dB postoperatively for 23 cases who had single-staged surgeries (p < 0.001, Wilcoxon signed rank test) at the end of the mean follow-up period of 23months. For this group, the mean preoperative AC-PTA significantly improved from 48.64 ± 9.30 to 22.93 ± 7.45dB (p < 0.001, Wilcoxon signed rank test) postoperatively with a mean PTA improvement of 25.71 ± 6.02dB. Success criterion was achieved in 22 of 23 cases (95.7%). There was no sensorineural hearing loss, facial nerve paralysis and postoperative vertigo after the surgical procedures. All patients had been discharged within the first 24h. Surgical treatment of tympanosclerosis is still a controversial issue. Endoscopic surgery seems a safe technique for the management of tympanosclerosis. Single-stage surgery is possible in most of the cases with a satisfactory hearing result. We speculate that addition of endoscopic view may increase the single-stage surgery ratio.

Endoscopic tympanoplasty type I for tympanic perforations: analysis of prognostic factors.

To assess the anatomical and functional outcomes of endoscopic transcanal tympanoplasty type I for tympanic membrane perforations. Eight hundred thirty-five patients who underwent tympanoplasty between January 2011 and January 2019 were selected. Patients with tympanic membrane perforation treated with a transcanal endoscopic tympanoplasty type 1 and a follow-up period longer than 6months have been retrospectively reviewed. The presence of cholesteatoma or ossicular chain dysfunctions were considered exclusion criteria. Eighty-one patients were included in the present study population. The main outcome was the rate of overall graft success. Secondary outcomes included hearing results. Prognostic factors related to both the abovementioned outcomes were assessed. Overall, 66 patients (81.5%) had a successful graft at the last follow-up evaluation. Mean follow-up was 22.1 (range 6-104) months. The anterior quadrants were entailed by the perforation in 62 (76.5%) cases. The overall success rate with cartilage (or cartilage and perichondrium) was 91.2% (p < 0.01). The median preoperative and postoperative ABG were 18.7 (13.4-25.6) and 7.5 (2.5-12.5), respectively, revealing a significant median improvement of 11.2 (p < 0.001). The type of graft and the postoperative tympanic membrane status were significantly associated with the audiologic outcome with p = 0.01 and p = 0.02, respectively. Endoscopic tympanoplasty type I is a reliable technique with reasonable anatomic and audiologic results. Tympanic membrane grafting with cartilage (or cartilage and perichondrium) guarantees a higher rate of perforation closure and satisfactory hearing results. Anterior eardrum perforations can be successfully and safely managed with transcanal endoscopic approach avoiding postauricular approach and canalplasty.

Endoscopic full-thickness cartilage-perichondrium double graft myringoplasty in adhesive perforation: retrospective case series

Background The adhesive perforation could be the sequela of adhesive otitis media, that partial tympanic membrane remnant is bound completely to the medial wall of the middle ear by fibrous adhesions. However, few studies have reported on the repairing of adhesive perforation. Objectives To evaluate the long-term outcome of endoscopic full-thickness cartilage-perichondrium double graft myringoplasty for adhesive perforation. Materials and methods In total, 26 patients with unilateral adhesive perforation associated with chronic otitis media who underwent full-thickness cartilage-perichondrium double graft myringoplasty were included. Outcomes were evaluated in terms of the hearing gain and graft success rate at 12 and 24 months. Results The graft success rate was 96.15% (25/26) at 12 months and 88.46% (23/26) at 24 months. The neovascularization and epithelium covering the lateral surface of the cartilage graft were seen at preoperative 4 weeks, the superficial cartilage graft got complete epithelialization within 4–6 months. CT revealed the well-pneumatized middle ear and mastoid cells at postoperative 24th months in all the patients, no middle ear cholesteatoma formation and keratin pearls were found during the period of follow up. Conclusions Endoscopic full-thickness cartilage-perichondrium double graft myringoplasty without the tympanomeatal flap elevation is a feasible method for repairing adhesive perforations, with a higher graft success rate and satisfactory hearing results.

Bone Cement for Ossicular Chain Defects

Abstract Background: The discontinuity of ossicular chain most commonly affects the incudostapedial joint in 80% of patients an absent incus, or an absent incus and stapes superstructure. This discontinuity leads to a conductive hearing loss of different degrees. The goals of surgery for chronic ear disease are eradication of the disease and reconstruction of a sound transformer mechanism, but reconstructing this defect is a challenging procedure for the surgeon with different treatment options such as total ossicular chain prosthesis, a partial ossicular chain prosthesis, incus interposition, or bone cement utilization. Extrusion of the prosthesis is still a challenge in ossiculoplasty with alloplastic materials, especially in patients with poor eustachian tube function. Bone cement is cost effective, because it is cheaper than other ossiculoplasty materials, and this cost-effectiveness plays an important role in the decision the surgeon has to make, and bone cement has a promising role in this so, there is a rising interest in the otologic surgical field to use bone cement because of its biocompatible profile, its easy application, its suitable cost, and its low extrusion rate. Also, it may have a potentiality of neo-osteogenesis. Aim of Study: To evaluate the post-operative results and usefulness of bone cement application in repairing ossicular chain defects, to discuss surgical technique, and to compare pre-operative and post-operative ABG. Patients and Methods: This study was carried out in the ORL-HNS Department, Hearing and Speech Institute, from April 2015 to March 2018, on 30 patients with ossicular chain defect. Bridging of ossicular discontinuity was done by glass monomer bone cement in all patients. Results: In this study, successful hearing restoration could be achieved in 96% of the patients represented, as 52% of the patients had hearing improvement (dB gain) of more than or equal 10 dB, and 26% of patients had hearing im-provement (dB gain) more than 20 dB, and 18% of patients had hearing improvement (dB gain) of more than 40 dB, after 12 months.Conclusion: Incudostapedial joint rebridging ossiculo-plasty with ionomeric bone cement is a reliable method for ossicular reconstruction that is cost effective and offers satisfactory hearing results in selected patients.

The impact of middle ear aeration on surgical outcome after intact canal wall tympanoplasty for cholesteatoma

ObjectiveThe aeration status of the middle ear is presumed to be one of the factors affecting the outcome in acquired cholesteatoma. The present study investigated the impact of postoperative middle ear aeration on hearing and recurrence after intact canal wall tympanoplasty. MethodsWe conducted a retrospective chart review of 127 pars flaccida cholesteatoma patients who underwent primary intact canal wall tympanoplasty at a tertiary academic medical center. We collected data on clinical characteristics, including extent of cholesteatoma, surgical procedure, pre- and postoperative middle ear aeration, hearing level, and recurrence. The aeration was measured before and at one year after operation on two axial computed tomography (CT) planes: at the lateral semicircular canal (mastoid cavity) and at the oval window (tympanic cavity). Based on the postoperative air-bone gap (ABG), patients were categorized into two groups: the successful hearing (ABG ≤15 dB) group and the unsuccessful hearing (ABG >15 dB) group. We used aeration ratio to assess the relationship between postoperative aeration improvement and hearing outcome or recurrence. Multivariate logistic regression analysis was used to identify the factors associated with hearing outcome. ResultsAt one year after operation, aeration ratio in both mastoid and tympanic cavities was significantly improved than the preoperative status (p < 0.001, p < 0.001, respectively, Wilcoxon signed-rank test). The positive correlation was found between postoperative aeration ratios of mastoid cavity and tympanic cavity (r = 0.348, p < 0.001, Spearman's rank-correlation coefficient). In mastoid and tympanic cavities, the postoperative aeration ratio in successful hearing group (n = 57) was significantly higher than that in the unsuccessful hearing group (n = 45) at one year after operation (p < 0.001, p = 0.028, respectively, Mann-Whitney U test). Multivariate logistic regression analysis demonstrated that postoperative aeration ratio in mastoid cavity and preoperative ABG were significant independent prognostic factors for successful hearing (odds ratio [95% confidence interval]: 2.630 [0.985 - 7.024], p = 0.045; 0.891[0.840 - 0.944], p < 0.001, respectively). However, postoperative aeration ratios did not significantly differ between with (n = 14) and without recurrence (n = 113) groups in both cavities. ConclusionOur results suggest that better postoperative aeration in mastoid cavity is independently associated with satisfactory hearing outcome after intact canal wall tympanoplasty in pars flaccida cholesteatoma. However, no significant differences were observed between middle ear aeration at one year after operation and recurrence.

A Smartphone App to Facilitate Remote Patient-Provider Communication in Hearing Health Care: Usability and Effect on Hearing Aid Outcomes.

Background: Patients often need multiple fine-tuning appointments with their hearing health care provider to achieve satisfactory hearing aid outcomes. A smartphone app that enables patients to remotely request and receive new hearing aid settings could improve hearing health care access and efficiency.Introduction: We assessed the usability of ReSound Assist™, (ReSound America, Bloomington, MN) the remote communication feature of a hearing aid app, and investigated whether hearing aid outcomes are influenced by app-based versus in-person patient-provider communication.Materials and Methods: Thirty adults were fit bilaterally with hearing aids and randomized to intervention and control groups. During a 6-week field trial, participants reported hearing aid problems via ReSound Assist (intervention) or at a scheduled face-to-face follow-up appointment (control). Usability of ReSound Assist was assessed with a questionnaire and interview. Hearing aid performance, benefit, satisfaction, and daily usage were compared for both groups.Results: ReSound Assist was rated as highly usable. Participants identified specific aspects of effectiveness and efficiency that could be improved. Similar problems were reported by intervention and control participants regardless of communication mode (app-based vs. in-person). However, almost half the requests received via ReSound Assist were for problems that required advice from the provider or physical modifications to the hearing aids rather than fine-tuning, highlighting the continued importance of in-person hearing health care. There was no significant difference in hearing aid outcomes between intervention and control participants.Conclusions: Apps enabling remote patient-provider communication are a viable method for hearing aid users to seek and receive help with hearing aid problems that can be addressed through fine-tuning.

Endoscope-Assisted Minimally Invasive Microsurgical Removal of a Medium-Sized Acoustic Neuroma (T3a) through a Retrosigmoid Mini-Craniotomy with Preservation of Hearing.

A 45-year-old male patient with reduced hearing in the right ear was diagnosed with a medium-sized (T3a) acoustic neuroma. The operation was performed through an individually tailored retrosigmoid mini-craniotomy. Endoscope-assisted microsurgical technique was applied to early detect the location of the facial and cochlear nerves as well as to look around the hidden corners during the surgery. The entire operation was performed without using brain retractors. The moderate intrameatal extension of the tumor and the use of angled endoscopes allowed to avoid the drilling of the internal auditory meatus. The lesion could be completely removed and the patient showed a satisfactory hearing recovery in the follow-up examinations 3 months after the surgery. The link to the video can be found at: https://youtu.be/dAYLakih924 .