Surgical findings & audiological outcomes of Stapedotomy in patients with Otosclerosis

Objective: This study was focused on the assessment of patients improvement in hearing, as measured by pure tone audiometry after stapedotomy for primary otosclerosis. Materials and Methods: This prospective clinical study was performed in a total of 50 patients diagnosed with Primary Otosclerosis, who underwent Stapedotomy at the Department of ENT & Head-Neck Surgery, Combined Military Hospital, Dhaka between June 2012 to January 2014. All patients were evaluated as per the candidacy criteria for stapedotomy and selected patients underwent surgery during the study period and were followed up for a period of 12 months in the Otology clinic. Pre-operative and Post-operative audiometric evaluation was done using conventional pure tone audiometry with standard calibrations. Post-operative audiometry was performed at 03 month, 06 months and 12 months. The bone-conduction & air conduction thresholds and the Air- Bone gap (ABG), were documented and analysed at 0.5 KHz, 1 KHz, 2 KHz and 4 KHz frequencies respectively. The subjective outcomes in hearing were also recorded with a patient satisfaction questionnaire to assess improvement in quality of hearing after stapedotomy. Results: Overall, the frequency specific pre-operative mean averaged Air Conduction thresholds were 63.3dB at 500Hz, 57.5dB at 1 KHz, 55.1dB at 2 KHz and 45.7dB at 4 KHz. The frequency specific post-operative mean averaged Air conduction thresolds were 34.6 dB at 500Hz, 28.9 dB at 1Kz, 30.5dB at 2Kz and 33.3dB at 4Kz.The frequency specific mean average post operative Air Bone Gap (ABG) closure was achieved by 28.7dB at 500Hz, 27.6 dB at 1KHz, 24.6 dB at 2KHz and 12.4 dB at 4KHz by the time of completion of the study at 01 year. A successful closure of AB gap to less than 10dB was achieved in the speech frequencies of 2 KHz and 4 KHz in 84% of cases. Overall, the frequency specific bone-conduction thresholds were unchanged postoperatively in all cases except one, showing that no significant sensori-neural impairment had occured due to the stapedotomy procedure. 1 patient developed post-op severe vertigo which was self-limiting after six weeks. A few interesting cases with anomalous intra-operative findings were also documented and reported herewith. These included monopodal stapes (n=1), anomolous facial nerve (n=1), laterally placed chorda tympani nerve (n=1), high jugular bulb, Malleus ankylosis (n=1) and persistent stapedial artery (n=1). All patients included in our study had significant subjective audiological improvement and responded satisfactorily to the questionnaire formulated to assess their hearing quality after stapedotomy. Conclusions: Our case study confirms that stapedotomy is a safe and successful procedure providing long-term hearing improvement in primary otosclerosis. Obliterative otosclerosis, biscuit or floating footplate, monopodal stapes, anomalous facial nerve and persistent stapedial artery may be special scenarios encountered during stapedotomy and they need judicious management by an experienced surgeon. Our study shows that meticulous selection of cases for stapedotomy will result in highly successful audiological outcomes. DOI: http://dx.doi.org/10.3329/bjo.v20i2.22024 Bangladesh J Otorhinolaryngol; October 2014; 20(2): 87-92

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Validation of a Personalized Hearing Screening Mobile Health Application for Persons with Moderate Hearing Impairment

Journal of Personalized Medicine ◽

10.3390/jpm11101035 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1035

Author(s):

Lok-Yee Joyce Li ◽

Shin-Yi Wang ◽

Jinn-Moon Yang ◽

Chih-Jou Chen ◽

Cheng-Yu Tsai ◽

...

Keyword(s):

Hearing Loss ◽

Hearing Impairment ◽

Pure Tone ◽

Conductive Hearing Loss ◽

Bone Conduction ◽

Pure Tone Audiometry ◽

Hearing Screening ◽

Self Test ◽

Conductive Hearing ◽

Air Conduction

Hearing impairment is a frequent human sensory impairment. It was estimated that over 50% of those aged >75 years experience hearing impairment in the United States. Several hearing impairment–related factors are detectable through screening; thus, further deterioration can be avoided. Early identification of hearing impairment is the key to effective management. However, hearing screening resources are scarce or inaccessible, underlining the importance of developing user-friendly mobile health care systems for universal hearing screening. Mobile health (mHealth) applications (apps) act as platforms for personalized hearing screening to evaluate an individual’s risk of developing hearing impairment. We aimed to evaluate and compare the accuracy of smartphone-based air conduction and bone conduction audiometry self-tests with that of standard air conduction and bone conduction pure-tone audiometry tests. Moreover, we evaluated the use of smartphone-based air conduction and bone conduction audiometry self-tests in conductive hearing loss diagnosis. We recruited 103 patients (206 ears) from an otology clinic. All patients were aged ≥20 years. Patients who were diagnosed with active otorrhea was excluded. Moderate hearing impairment was defined as hearing loss with mean hearing thresholds >40 dB. All patients underwent four hearing tests performed by a board-certified audiologist: a smartphone-based air conduction audiometry self-test, smartphone-based bone conduction audiometry self-test, standard air-conduction pure-tone audiometry, and standard bone conduction pure-tone audiometry. We compared and analyzed the results of the smartphone-based air conduction and bone conduction audiometry self-tests with those of the standard air conduction and bone conduction pure-tone audiometry tests. The sensitivity of the smartphone-based air conduction audiometry self-test was 0.80 (95% confidence interval CI = 0.71–0.88) and its specificity was 0.84 (95% CI = 0.76–0.90), respectively. The sensitivity of the smartphone-based bone conduction audiometry self-test was 0.64 (95% CI = 0.53–0.75) and its specificity was 0.71 (95% CI = 0.62–0.78). Among all the ears, 24 were diagnosed with conductive hearing loss. The smartphone-based audiometry self-tests correctly diagnosed conductive hearing loss in 17 of those ears. The personalized smartphone-based audiometry self-tests correctly diagnosed hearing loss with high sensitivity and high specificity, and they can be a reliable screening test to rule out moderate hearing impairment among the population. It provided patients with moderate hearing impairment with personalized strategies for symptomatic control and facilitated individual case management for medical practitioners.

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Audiological Outcomes of Stapedotomy: Our Experience

Nepalese Journal of ENT Head and Neck Surgery ◽

10.3126/njenthns.v5i2.19427 ◽

2018 ◽

Vol 5 (2) ◽

pp. 1-4

Author(s):

R. Pradhananga ◽

G. Nair ◽

R. Sapathkumar ◽

M. Kameswaran

Keyword(s):

Clinical Study ◽

Pure Tone ◽

Bone Conduction ◽

Prospective Clinical Study ◽

Hearing Improvement ◽

Gap Closure ◽

Age Range ◽

Air Conduction

Objective: This study was aimed to sequentially document the patient’s audiological improvement after stapedotomy as measured by pure tone audiometry.Material and Methods: This prospective clinical study was performed in a total of 100 patients (age range: 20 – 63 years), diagnosed with Otosclerosis who underwent Stapedotomy at the Department of Otology, Madras ENT Research Foundation, Chennai between September 2010 to March 2012. Pre-operative and Post-operative audiometric evaluation was done using the same conventional pure tone audiometer with standard calibrations. Post-operative audiometry was sequentially performed at 6 months, 1 year and 2 years. Bone-conduction and air conduction thresholds and the Air-bone gap (ABG), were assessed at each schedule at 0.5 KHz, 1 KHz, 2 KHz and 4 KHz frequencies respectively.Result: All patients had significant audiological improvement as measured by their sequential pure tone audiometries. Overall, the frequency specific pre-operative mean average Air-Bone gap was 52.3dB at 500Hz, 36.5dB at 1KHz, 39.3dB at 2KHz, 38.7dB at 4KHz and the frequency specific postoperative mean average Air-Bone Gap closure was achieved by 27.8dB at 500Hz, 29.6dB at 1KHz, 13.6dB at 2KHz, 11.4dB at 4KHz, by the time of 2 years of follow up. A successful closure of AB gap >10dB was achieved in these speech frequencies in 80% of cases. The frequency specific bone-conduction thresholds were unchanged postoperatively. Two patients developed post-operative vertigo, out of which 1 developed SNHL after 3 weeks of surgery.Conclusion: The study confirms that stapedotomy is a safe and successful procedure in the hands of a well trained otologist, providing long-term hearing improvement to patients with otosclerosis.

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Diagnostic Pure-Tone Audiometry in Schools: Mobile Testing without a Sound-Treated Environment

Journal of the American Academy of Audiology ◽

10.3766/jaaa.24.10.10 ◽

2013 ◽

Vol 24 (10) ◽

pp. 992-1000 ◽

Cited By ~ 13

Author(s):

De Wet Swanepoel ◽

Felicity Maclennan-Smith ◽

James W. Hall

Keyword(s):

Real Time ◽

Natural Environment ◽

Repeated Measures ◽

Pure Tone ◽

Bone Conduction ◽

Pure Tone Audiometry ◽

Environmental Noise ◽

Absolute Difference ◽

Repeated Measures Design ◽

Air Conduction

Purpose: To validate diagnostic pure-tone audiometry in schools without a sound-treated environment using an audiometer that incorporates insert earphones covered by circumaural earcups and real-time environmental noise monitoring. Research Design: A within-subject repeated measures design was employed to compare air (250 to 8000 Hz) and bone (250 to 4000 Hz) conduction pure-tone thresholds measured in natural school environments with thresholds measured in a sound-treated booth. Study Sample: 149 children (54% female) with an average age of 6.9 yr (SD = 0.6; range = 5–8). Results: Average difference between the booth and natural environment thresholds was 0.0 dB (SD = 3.6) for air conduction and 0.1 dB (SD = 3.1) for bone conduction. Average absolute difference between the booth and natural environment was 2.1 dB (SD = 2.9) for air conduction and 1.6 dB (SD = 2.7) for bone conduction. Almost all air- (96%) and bone-conduction (97%) threshold comparisons between the natural and booth test environments were within 0 to 5 dB. No statistically significant differences between thresholds recorded in the natural and booth environments for air- and bone-conduction audiometry were found (p > 0.01). Conclusions: Diagnostic air- and bone-conduction audiometry in schools, without a sound-treated room, is possible with sufficient earphone attenuation and real-time monitoring of environmental noise. Audiological diagnosis on-site for school screening may address concerns of false-positive referrals and poor follow-up compliance and allow for direct referral to audiological and/or medical intervention.

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Comparison of the application of artificial ossicles and autologous ossicles in the reconstruction of a damaged ossicular chain

The Journal of Laryngology & Otology ◽

10.1017/s0022215118001627 ◽

2018 ◽

Vol 132 (10) ◽

pp. 885-890

Author(s):

L Zhao ◽

J Li ◽

S Gong

Keyword(s):

Facial Nerve ◽

Temporal Bone ◽

Pure Tone ◽

Bone Fractures ◽

Pure Tone Audiometry ◽

Ossicular Chain ◽

Facial Nerve Paralysis ◽

Temporal Bone Fracture ◽

Nerve Paralysis ◽

Ossicular Reconstruction

AbstractObjectiveTo evaluate the therapeutic effect that the titanium partial ossicular reconstruction prosthesis and autologous ossicles have on hearing loss after reconstruction of a damaged ossicular chain.MethodsForty-two medical records of treatments carried out from 2013 to 2015 for ossicular chain damage with facial nerve paralysis due to temporal bone fractures were reviewed. The study assessed: causes of damage, pre-operative pure tone audiometry findings, types of intra-operative ossicular chain damage, intra-operative ossicular chain repair methods (titanium partial ossicular reconstruction prosthesis or autologous ossicles) and post-operative pure tone audiometry results.ResultsThe titanium partial ossicular reconstruction prosthesis was used in 26 cases; the average air–bone gap was 32.3 ± 5.3 dB pre-operatively and 12.8 ± 5.3 dB post-operatively. Autologous ossicles were used in 16 cases; the average air–bone gap was 33.4 ± 4.5 dB pre-operatively and 17.8 ± 7.8 dB post-operatively.ConclusionOssicular chain reconstruction is an effective way of improving hearing in patients with ossicular chain damage. The results suggest that repair with either the titanium partial ossicular reconstruction prosthesis or autologous ossicles can improve hearing following ossicular chain injury with facial nerve paralysis caused by a temporal bone fracture.

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Correlation of the Puretone Audiometry Findings with Intraoperative Findings in Patients with Chronic Suppurative Otitis Media

MVP Journal of Medical Sciences ◽

10.18311/mvpjms/2015/v2/i1/790 ◽

2015 ◽

Vol 2 (1) ◽

pp. 4

Author(s):

Devashri Uday Patil ◽

Kiran S. Burse ◽

Shreeya Kulkarni ◽

Vandana Sancheti ◽

Chaitanya Bharadwaj

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Ossicular Chain ◽

Chronic Suppurative Otitis Media ◽

Suppurative Otitis Media ◽

Number Of Patients ◽

Operative Findings ◽

Air Conduction

Chronic suppurative otitis media is one of the common otological conditions in India for which patients seek advice from an otorhinolaryngologist. Chronic suppurative otitis media is recurrent and progressive disease which is characterized with tympanic membrane perforation and suppurative discharge. Pure tone audiometry is the most common test used to evaluate auditory sensitivity. Since hearing loss is a common complication of chronic suppurative otitis media, we designed this study to evaluate preoperative pure tone audiometry findings in patients with chronic suppurative otitis media and its correlation with the intra-operative findings. Aims and Objectives: 1] To assess the intra-operative findings in patients with chronic suppurative otitis media. 2] To evaluate the correlation between the preoperative pure tone audiometry findings and intra-operative findings in patients with chronic suppurative otitis media. 3] To assess the type of hearing loss and degree of hearing loss in patients with chronic suppurative otitis media. Materials and Methods: This is an Observational study carried over a period of 3 years from August 2011 to August 2013. Total number of patients included in this study was 100. Result: Out of 100 patients studied 69 % of patients had Tubo-Tympanic type of CSOM, 31 % of patients had Attico-antral type of CSOM. In patients of Safe CSOM; Central perforation was seen in maximum cases 46.4 %, anterior central perforations was seen in 8.7 % cases, posterior central perforations seen in 20.2 % cases, and subtotal perforations seen in 24.63 % cases. In patients of Unsafe CSOM posterosuperior cholesteatoma was seen in maximum cases 67.74 %, and attic cholesteatoma was seen in 32.2 % cases. In safe CSOM patients all ossicles were intact and mobile whereas in unsafe CSOM patients only 4 patients had intact ossicular chain, while maximum patients had ossicular defect. Conclusion: Hearing loss depends on size of perforation. Hearing loss increases as the size of perforation increases. Average air conduction threshold and air bone gap did not differ significantly between various groups of ossicular defect. This shows us that neither air conduction nor air bone gap are reliable parameters on basis of which we can predict ossicular status preoperatively.

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Pure-tone audiometry without bone-conduction thresholds: using the digits-in-noise test to detect conductive hearing loss

International Journal of Audiology ◽

10.1080/14992027.2020.1783585 ◽

2020 ◽

Vol 59 (10) ◽

pp. 801-808 ◽

Cited By ~ 1

Author(s):

Karina C. De Sousa ◽

Cas Smits ◽

David R. Moore ◽

Hermanus Carel Myburgh ◽

De Wet Swanepoel

Keyword(s):

Hearing Loss ◽

Pure Tone ◽

Conductive Hearing Loss ◽

Bone Conduction ◽

Pure Tone Audiometry ◽

Noise Test ◽

Conductive Hearing

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Normal Brief-Tone Bone-Conduction Behavioral Thresholds Using the B-71 Transducer: Three Occlusion Conditions

Journal of the American Academy of Audiology ◽

10.3766/jaaa.14.10.4 ◽

2003 ◽

Vol 14 (10) ◽

pp. 556-562 ◽

Cited By ~ 9

Author(s):

Susan A. Small ◽

David R. Stapells

Keyword(s):

Auditory Brainstem Response ◽

Pure Tone ◽

Bone Conduction ◽

Auditory Brainstem ◽

Behavioral Thresholds ◽

Brainstem Response ◽

Occlusion Effect ◽

Response Testing ◽

Brief Tones ◽

Air Conduction

Behavioral thresholds were measured from 31 adults with normal hearing for 500, 1000, 2000, and 4000 Hz brief tones presented using a B-71 bone oscillator. Three occlusion conditions were assessed: ears unoccluded, one ear occluded, and both ears occluded. Mean threshold force levels were 67, 54, 49, and 41 dB re:1μN peak-to-peak equivalent in the unoccluded condition for 500, 1000, 2000, and 4000 Hz, respectively (corrected for air-conduction pure-tone thresholds). A significant occlusion effect was observed for 500 and 1000 Hz stimuli. These thresholds may be used as the 0 dB nHL (normalhearing level) for brief-tone bone-conduction stimuli for auditory brainstem response testing.

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Air and Bone Conduction Change after Stapedotomy and Partial Stapedectomy for Otosclerosis

Otolaryngology ◽

10.1016/j.otohns.2005.03.011 ◽

2005 ◽

Vol 133 (1) ◽

pp. 116-120 ◽

Cited By ~ 36

Author(s):

Nicola Quaranta ◽

Gaspare Besozzi ◽

Rosa Anna Fallacara ◽

Antonio Quaranta

Keyword(s):

Conductive Hearing Loss ◽

Bone Conduction ◽

Neck Surgery ◽

Closure Rate ◽

High Frequencies ◽

Results Of Treatment ◽

The Difference ◽

Similar Good ◽

Conductive Hearing ◽

Air Conduction

OBJECTIVE: The aim of this study was to analyze and compare the results obtained in otosclerosis patient undergoing stapedotomy and partial stapedectomy. STUDY DESIGN AND SETTINGS: Retrospective review of surgical series. The guidelines of the American Academy of Otolaryngology-Head and Neck Surgery for the evaluation of results of treatment of conductive hearing loss were used. RESULTS: Pure tone average (0.5 to 3 kHz) air-bone gap was 6.1 dB in the partial stapedectomy and 6 dB in the stapedotomy group. The air-bone gap (ABG) closure rate did not differ between the 2 groups, except at 4 kHz, where stapedotomy group showed greater closure ( P 0.003). Mean postoperative ABG gain was significantly ( P <0.05) higher in the stapedotomy group at 2, 3, and 4 kHz. Mean postoperative air-conduction gain did not differ significantly. Mean postoperative bone conduction (BC) change (1, 2, and 4 kHz) was 3.68 dB in partial stapedectomy and −0.02 dB in stapedotomy group, the difference being significant ( P 0.007). Differences in BC change between the 2 groups were significant at each frequency. CONCLUSIONS: Similar good results can be obtained in experienced hands using either partial stapedectomy or stapedotomy technique. ABG closure rates were analogous in the 2 techniques as well as the complication rate. Although stapedotomy obtain better results at high frequencies, partial stapedectomy is associated with increased BC threshold at all frequencies.

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A study to assess hearing improvement after fat graft myringoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20210161 ◽

2021 ◽

Vol 7 (2) ◽

pp. 303

Author(s):

Nupur Midha ◽

Gurbax Singh ◽

Rachna Dhingra ◽

Rajwant Kaur

Keyword(s):

Pure Tone ◽

Bone Conduction ◽

Pure Tone Audiometry ◽

Threshold Level ◽

Fat Graft ◽

Hearing Improvement ◽

Suppurative Otitis Media ◽

Bone Conduction Threshold ◽

Tympanic Membrane Perforations ◽

Number Of Patients

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

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Does hearing loss relate to gestational diabetes mellitus?

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20193863 ◽

2019 ◽

Vol 5 (5) ◽

pp. 1244

Author(s):

Devanshu Kwatra ◽

Sunil Kumar ◽

Gautam Bir Singh ◽

Ratna Biswas ◽

Prabhakar Upadhyay

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Postpartum Period ◽

Pure Tone Audiometry ◽

Neck Surgery ◽

Hearing Sensitivity ◽

Significant Difference ◽

Air Conduction

Background: This study aims to check if gestational diabetes mellitus leads to changes in hearing.Methods: A prospective hospital based observational study was performed with total 60 subjects in age group of 18-40 years in the Department of Otolaryngology and Head and Neck Surgery and the Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi between November 2016 to March 2018. Subjects were divided in two groups. The first group included 30 pregnant women with diagnosed gestational diabetes mellitus and the second group had 30 pregnant women not having gestational diabetes mellitus. Pure-tone audiometry and impedance audiometry was performed twice in all the subjects, first during the antepartum period and second time during the postpartum period. Results: Significant difference was seen between the average of air conduction threshold values at speech frequencies between the two groups during both antepartum and postpartum period.Conclusions: The alterations in hearing sensitivity in air conduction between the two groups can be attributed to gestational diabetes mellitus.

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