Hearing Results After Type I Tympanoplasty With Versus Without Mastoidectomy

Background and Objectives The purpose of the mastoidectomy and tympanoplasty is to improve the hearing by removing the middle ear lesion and reconstructing the hearing mechanism. The purpose of this study is to verify whether several factors, including the presence of mastoidectomy can affect the hearing outcome of tympanoplasty patients.Subjects and Method From 1989 to 2018, 1260 patients with chronic otitis media who had been followed up for more than 6 months after type 1 tympanoplasty were selected. The each patient group was divided into 2 groups based on the last audiometry; Group A (post operative air-bone gap [ABG] ≤10 dB HL) and Group B (post operative ABG >10 dB HL). We analyzed the various factors including patency of E-tube or mastoid aeration for each group to figure out which factors affect the post operative hearing outcome.Results In conclusion, even with mastoidectomy, the final hearing after surgery was worse than that of the group who underwent tympanoplasty only (final ABG; tympanoplasty only vs. tympanoplasty with mastoidectomy; 6.59±9.09 vs. 9.71±8.94). In both with and without mastoidectomy group, the size of the perforation and external ear canal diameter before surgery did not affect the final hearing outcome. On the otherhand, in the group with mastoidectomy, mastoid pneumatization and E-tube patency affected the postoperative prognosis, but not in the case without mastoidectomy.Conclusion In this study, the factors affecting postoperative hearing success were analyzed. The results can be used to predict the postoperative hearing prognosis and to help select surgical treatment.

An Analytical Study of the Factors Affecting Hearing Improvement after Ossiculoplasty – A Retrospective Study, Mathura, Uttar Pradesh

BACKGROUND Otologists always yearn to improve the hearing outcome of their patients with chronic suppurative otitis media. There are different options for ossiculoplasty to choose from, depending on the extent of disease, condition of ossicular chain and availability of implant material and there has always been a quest to make appropriate decision with a predictable outcome. In this study, we have tried to analyse various factors which can affect hearing outcome after Ossiculoplasty. METHODS A retrospective study was done to study the effect of implant material, condition of ossicular chain and disease in the mastoid on post-operative hearing improvement on 200 patients, who underwent tympanoplasty or tympanomastoidectomy from January 2018 to January 2020, in Department of Otorhinolaryngology and Head and Neck Surgery, K.D. Medical College, Mathura. Decision of ossiculoplasty was made based on intra-operative findings. Autograft incus, Teflon TORP (total ossicular replacement prosthesis) and cartilage columella were used based on availability and feasibility. RESULTS Mean improvement in average air-bone gap of 200 patients was found to be 18.57 dB, with autograft incus, it was 19.99 dB, with Teflon TORP (total ossicular replacement prosthesis), 19.53 dB and with cartilage columella 16.73 dB (P = 0.023). Mean hearing improvement was 18.98 dB when handle of malleus was present and 15.59 dB when it was absent (P = 0.023). Mean hearing improvement was 19.42 dB when stapes superstructure was present and 16.92 dB when it was absent (P = 0.016). Even though the hearing outcome was better when mastoid was disease free (19.57 dB) compared to when it was diseased (18.30 dB), the difference was not statistically significant. (P = 0.177) CONCLUSIONS In our study, we found autograft incus to be the best material for ossiculoplasty and presence of handle of malleus and stapes superstructure improved postoperative hearing outcome significantly but involvement of mastoid by disease did not significantly affect the hearing outcome post-operatively. KEYWORDS Chronic Suppurative Otitis Media, Ossiculoplasty, Tympanoplasty, Ossicular Prosthesis, Autograft

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

Background Stapedotomy 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. Results Total 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%. Conclusions Endoscopic 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.

Shifting from postauricular to transcanal microscopic tympanoplasty may have similar frequency-specific improvements with better air-bone-gap closure at low frequencies and a minimal learning-curve effect

The shift from postauricular to transcanal microscopic tympanoplasty brings potential advantages of minimal morbidity, less postoperative pain, patient comfort, and surgical ease and speed, but also uncertainties of unfamiliar grafting material, an inadequate operation view, and an uncertain learning curve. These challenges might affect the successful repair rate and the frequency-specific hearing outcome, which is important for hearing perception. Rare studies reported frequency-specific hearing outcome with the learning curve for shifting from postauricular to transcanal microscopic tympanoplasty. Here, from Jul. 2013 to Nov. 2018, we compared patients in a shift from postauricular approach (35 ears) to transcanal approach (35 ears) of microscopic type-1 tympanoplasty. The results show that both of postauricular and transcanal microscopic tympanoplasties reduced the mean air-bone gap, 0.5k Hz gap, and 1k Hz gap after the surgery. The further analyses on gap change as a function of frequency (0.5, 1, 2, and 4k Hz) show that both of postauricular and transcanal tympanoplasties improved postoperative air-bone gap among the levels of frequency. The post hoc comparisons display a common gap reduction difference between 0.5k and 4k Hz. The successful repair rate did not differ between the 2 groups. There was no correlation between the postoperative mean gap change and the surgery date, suggesting a minimal learning-curve effect. The results of similar frequency-specific improvements and a minimal learning-curve effect may help to ease the concerns of those uncertainties before the shift.

To compare the efficacy of Titanium versus Teflon piston on hearing outcome in terms of Air conduction gain and Air Bone Gap closure in LASER Stapedotomy – A retrospective study

Aim: To determine the efficacy of Titanium versus Teflon piston on hearing outcome in terms of Air Conduction Threshold (ACT) gain and Air Bone Gap (ABG) closure in patients undergoing LASER Stapedotomy. Methods: This retrospective study was conducted at the department of ENT and Head and Neck Surgery, AIIMS Patna. 40 patients underwent LASER stapedotomy. Both Teflon (0.4mm and 0.6mm D, Grace Medical Devices) and Titanium (0.4mm D, Kurz Medical Devices) pistons were inserted randomly. Crimping of titanium Kurz piston was not required due to its unique design which fits on to the incus long process like a clip whereas all the Teflon pistons required crimping.Titanium (Kurz Medical Devices) pistons are costlier in comparison to Teflon (Grace Medical Devices) pistons. Preoperative and 3 monthly postoperative Pure Tone Audiograms (PTA) wereobtained. ACT (Air conduction threshold) gain and ABG (Air Bone Gap) closure were measured.Data was analyzed with IBM SPSS Statistics software Version 20. Descriptive analysis,paired and unpaired t-tests were applied. P-value of <0.05 at 95% confidence levels was considered statistically significant. Results: 40 patients (M: F: 3:7) underwent LASER stapedotomy.Titanium piston was utilized in 11and Teflon in 29 patients. Patients with titanium piston experienced a mean ACT gain of 21.51±05.42dBand mean ABG closure of 12.27±05.18 dB. Those with Teflon piston gained a meanACT gain of 18.54±04.43 dB and mean ABG closure of11.96±06.12 dB.Both groups experienced statistically significant hearing gain (p <0.05).Both groups were however comparable and the difference between these parameters was statistically insignificant (p>0.05).Conclusion: Both titanium and Teflon pistons are equally efficacious in improving postoperative hearing gain in LASER stapedotomy patients in terms of ACT gain and ABG closure. Titanium Kurz pistons do not require crimping making it easier to use in comparison to the Teflon pistons which needs to be crimped every time though cost may be a limiting factor in the usage of Titanium pistons.Both types of pistons can be satisfactorily employed in this surgical procedure if we consider the hearing gain post operatively. Study design: A retrospective observational study Keywords: Otosclerosis, Teflon, Titanium, Air Conduction Threshold (ACT), Air Bone Gap (ABG) closure

Does concurrent adenoidectomy or tonsillectomy affect the graft success rate of cartilage myringoplasty in adults?

Background The objective of this study was to evaluate the graft success and hearing outcomes of concurrent adenoidectomy or tonsillectomy and myringoplasty. Methods Medical case notes were reviewed for all adult patients with dry perforations who had undergone myringoplasty, with or without concurrent throat surgery, from December 2015 to February 2018. The study population was divided into concurrent myringoplasty and throat surgery (Group A) and single myringoplasty (Group B) groups. The air–bone gap (ABG) and graft success rate were evaluated in both groups. Results A total of 131 ears of 131 patients were included in this study. In total, 33 ears of 33 patients were assigned to Group A and 98 to Group B. Of the 33 patients in Group A, adenoid residue was detected in 3, chronic tonsillitis in 21, and tonsil hypertrophy in 9. The graft success rate was 96.9 % in Group A and 96.9 % in Group B at 6 months postoperatively (p = 0.993). In addition, the graft success rate was 87.9 % in Group A and 92.8 % in Group B at 24 months postoperatively (p = 0.372). Reperforation occurred in three patients in Group A and four in Group B; the difference was not significant. No significant group differences were observed in preoperative (p = 0.654) or postoperative (p = 0.791) ABG values or mean ABG gain (p = 0.439). No patient in either group developed cholesteatoma of the middle ear. Conclusions Simultaneous adenoidectomy or tonsillectomy and myringoplasty is feasible but does not improve the graft success rate or hearing outcome.

Cochlear Implantation in Vestibular Schwannoma: A Systematic Literature Review

Objective Ipsilateral cochlear implantation (CI) in vestibular schwannoma (VS) has been an emerging trend over the last two decades. We conducted the first systematic review of hearing outcomes comparing neurofibromatosis 2 (NF2) and sporadic VS undergoing CI. A comparison of the two populations and predictor of outcome was assessed. This is an update to a previously presented study. Data Sources Systemic data searches were performed in PubMed NCBI and Scopus by an academic librarian. No restrictions based on the year of publication were used. Study Selection Studies were selected if patients had a diagnosis of NF2 and a CI placed in the affected side with reports of hearing outcome. Two independent reviewers screened each abstract and full-text article. Data Extraction Studies were extracted at the patient level, and the assessment of quality and bias was evaluated according to the National Institutes of Health Quality Assessment Tool. Main Outcome Measures Outcome predictors were determined by using the chi-square test and Student's t-test. Results Overall, most CI recipients functioned in the high-to-intermediate performer category for both sporadic and NF2-related VS. Median AzBio (Arizona Biomedical Institute Sentence Test) was 72% (interquartile range [IQR]: 50) in NF2 patients and 70% (IQR: 7.25) in sporadic patients. Larger tumor size predicted a poorer final audiometric outcome. Conclusions Categorization of hearing outcome into superior performance and inferior performance based on sentence recognition revealed a generally good hearing outcome regardless of treatment or patient population. Select patients with sporadic and NF2 VS may benefit from CI.