Active TriCROS: A Simultaneous Stimulation With a (Bi)CROS System and a Hearing Aid in the Worst Ear for Severely Asymmetrical Hearing Loss.

OBJECTIVE: Severely asymmetrical hearing loss (SAHL) is characterized by a moderately severe or severe hearing loss in one side and normal or mildly impaired controlateral hearing in the other. The Active tri-CROS combines the Contralateral Routing-of-Signal System (CROS, or BiCROS if the best ear is stimulated) and the stimulation of the worst ear by an in-the-canal hearing aid. This study aims to evaluate the benefit of the Active tri-CROS for SAHL patients. STUDY DESIGN: This retrospective study was conducted from September 2019 to December 2020. SETTING: Ambulatory, tertiary care. PATIENTS: Patients were retrospectively included if they had received the Active tri-CROS system after having used a CROS or BiCROS system for SAHL for at least 3 years. MAIN OUTCOME MEASURES: Audiometric gain, signal-to-noise ratio, spatial localization, and the Abbreviated Profile of Hearing Aid Benefit and Tinnitus Handicap Inventory questionnaires were performed before equipment and after a month with the system. RESULTS: Twenty patients (mean, 62 yr old) with a mean of 74.3 ± 8.7 dB HL on the worst ear were included. The mean tonal hearing gain on the worst ear was 20 ± 6 dB. Signal-to-noise ratio significantly rose from 1.43 ± 3.9 to 0.16 ± 3.4 dB ( p = 0.0001). Spatial localization was not significantly improved. The mean Tinnitus Handicap Inventory test score of the eight patients suffering from tinnitus rose from 45.5 ± 18.5 to 31 ± 25.2 ( p = 0.016). CONCLUSIONS: The Active tri-CROS system is a promising new therapeutically solution for SAHL.

Sex determination by linear measurements of the bony labyrinth in cone-beam and computed tomography: a practical method.

PURPOSE: The determinism of the sex is of most importance for reconstruction of the biological profile of deceased individuals. In this study, we aim to implement a technique to improve the accessibility of sex determination by the study of the bony labyrinth on cone-beam computed tomography (CBCT) and computed tomography (CT) scans. METHODS: CBCT and CT scans of temporal bones performed between 2014 and 2022 were collected with demographic information. The width of the lateral (LSCw), posterior (PSCw), and anterior semicircular canal (ASCw) was measured. The primary outcome was the diagnostic performance of the individual linear measures and the product of these measures. This analysis is supplemented by establishing thresholds using ROC curves. Inter-judge and intra-judge reliability evaluation was performed blinded in randomly selected exams. RESULTS: One hundred forty-one petrous bones were included for analysis of their imaging. The analysis of the PSCw, ASCw, and ASCw*PSCw for sex determination was associated with area under curves of 0.88 ± 0.11, 0.82 ± 0.14, and 0.84 ± 0.10 respectively and accuracies of 0.74 ± 0.13, 0.78 ± 0.11, and 0.79 ± 0.13 respectively. In ROC-curve analysis, a PSCw*ASCw product > 48.5 allows to determine a male sex with > 95% specificity and a sensitivity of 50.1%. A PSCw*ASCw product ≤ 43 allows to determine a female sex with 88% specificity and 64% sensitivity. Reproducibility analyses showed good to excellent intra-judge and inter-judge reproducibility for ASCw and PSCw. CONCLUSION: Linear measurement of the semicircular canals of the vestibule on CBCT or CT could provide easy-to-use sex determination of the majority of females and males with a good predictive value.

Otosclerosis online: a critical analysis of quality, reliability, readability and content of otosclerosis information.

PURPOSE: Several therapeutic options are usually discussed for otosclerosis management. Patients seek medical advice from an ENT specialist but are also increasingly using the internet for medical issues. This study intends to assess readability and quality of websites with information on otosclerosis. MATERIALS AND METHODS: This is a cross-sectional study performed in a tertiary care centre. The results of the first two pages of a Google search with the keyword "otosclerosis" were reviewed by two independent investigators. Readability was assessed with the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES) and Gunning Fog Index. For quality and reliability assessment, the 16-item DISCERN instrument was used. Spearman's coefficient was used for correlations, and multivariate analyses of variance were used to assess differences. Inter-rater agreement was evaluated with concordance correlation coefficient. RESULTS: 18 websites were included. Two websites (11.0%) were authored by academic institutions, 5/18 (28%) by government agencies, 6/18 (33%) by professional organisations and 5/18 (28%) were medical information websites. The mean DISCERN score of the 18 websites was 40.8 ± 6.7/80 (range 28.7-51.7), corresponding to "fair" quality. The mean FRES score was 43.27 ± 10.6, and the mean FKGL was 11.43 ± 2.30, corresponding to "difficult to read". The mean Gunning Fog index was 12.90 ± 2.19 (range 9.81-18.20), corresponding to a "college freshman" level. CONCLUSIONS: This study shows that internet information on otosclerosis has an overall low readability, while the quality is heterogeneous and varies from "poor" to "good". Efforts should be made to improve the readability of otosclerosis websites.

Carotid-Cochlear Apex Dehiscence: A Family Affair.

We report two cases of carotid-cochlea dehiscence involving the cochlear apex, with, to our knowledge, the first description of this anomaly in two members of a family (mother-daughter). Pure tone audiometry revealed a bilateral mild sensorineural hearing loss predominantly on the left in the daughter, and a left mild mixed hearing loss with a predominance of sensorineural loss in the medium frequencies in the mother Carotid-cochlear dehiscence is a rare anomaly with a multiform expression, which should be investigated in cases of third mobile window symptoms, but also atypical sensorineural hearing loss, or before any cochlear implantation. Laryngoscope, 2023.

Comparison of dislocation rates of Teflon and Titanium stapes prostheses: a retrospective survival analysis on 855 patients.

BACKGROUND: Stapes prosthesis dislocation is the first cause of revision stapes surgery. To our knowledge, there is no data about stability of the incus attachment of manual crimped prosthesis of different materials. This study aimed to compare the dislocation incidence between titanium and fluoroplastic stapes prostheses. METHOD: A monocentric retrospective cohort study was conducted between January 2013 and June 2022 in a tertiary-care center. All patients that underwent a primary stapes surgery with manually crimped fluoroplastic or titanium prostheses were included. Prosthesis dislocation from the incus was identified intraoperatively or with CT scan. The incidence of stapedial prosthesis dislocation over time was estimated using the Kalbfleisch and Prentice survival analysis method. Other indications for revision surgery prior to prosthesis dislocation were considered as competing events. Differences in the cumulative incidence functions between the fluoroplastic group and the titanium group was assessed using the Gray's test. RESULTS: Eight hundred and fifty-five patients underwent primary stapes surgery during the study period. Fluoroplastic prosthesis was used in 758 (88.7%) cases and titanium prosthesis in 97 (11.3%) cases. Median follow-up was 51.7 months (28.4-80.1). Dislocation was observed in 23 (3.0%) patients with fluoroplastic prosthesis and none (0.0%) in the titanium group. The probability of prosthesis dislocation at two years after surgery was 3.5% in the Teflon group and 0.0% in the Titanium group. No significant difference was found in the cumulative incidence of prosthesis dislocation between the fluoroplastic group and the titanium group (p = 0.12). CONCLUSIONS: Despite lack of statistical power, our results suggest a trend in a more stable incus attachment of manually crimped titanium stapes prosthesis compared to fluoroplastic over time. Further prospective randomized studies could be valuable to assess our findings.

Complication of Ear Impression: Foreign Body in the Eustachian Tube Eroding the Carotid Canal.

The realization of customized earing plugs and earmolds for hearing aids requires an impression of the external auditory canal to obtain a siliconized mold. Silicone used for ear impressions is known to be safe and inert but deposition of silicone in the middle ear can middle and inner ear damages. We present a case of accidental injection of silicone in the middle ear and the Eustachian tube resulting in an erosion of the carotid canal. Laryngoscope, 133:3358-3360, 2023.

Endaural microscopic approach versus endoscopic transcanal approach in treatment of attic cholesteatomas.

PURPOSE: Compare the audiological results and postoperative outcomes of the endoscopic approach versus the endaural microscopic approach for treatment of attic cholesteatomas, using a randomized prospective model. MATERIALS AND METHODS: Eighty patients were consecutively enrolled in the study and randomized into two groups of treatment of 40 patients: Group A -tympanoplasty with a microscopic endaural approach; Group B -tympanoplasty with an exclusive trans-meatal endoscopic approach. Preoperative, intraoperative and postoperative outcomes were evaluated. Hearing was assessed preoperatively and at 1 month, 3 months and 6 months after surgery in both groups. RESULTS: There were no differences in the parameters analyzed (CT findings, patient age, disease duration, intraoperative cholesteatoma characteristics,) between the group A and B patients. No statistical difference between the two groups regarding hearing improvement, abnormal taste sensation, dizziness, post-operative pain and healing times emerged. Graft success rate was 94.5 % and 92.1 % for MES and ESS respectively. CONCLUSION: Both microscopic and exclusively endoscopic endaural approaches offer similar and excellent results in the surgical treatment of attic cholesteatomas.

French adaptation and validation of parents' evaluation of aural/oral performance of children (PEACH) scale in children.

OBJECTIVE: Hearing loss can seriously impact children's quality of life. Disease-specific questionnaires are required to optimise medical care. This study aims to translate, adapt and validate the French version of the PEACH score for the auditory performance of children. DESIGN: This is a controlled, prospective study, conducted between April and October 2020. The translation was conducted using a forward-backward technique, and statistical validation was conducted with a test and re-test, on a patient population and a control population. STUDY SAMPLE: Patients were included if they were 1-11 years old, and had at least 30 dB hearing loss in one ear. The mean age was 6 years for the 39 patients and 3.9 years for the 34 controls. RESULTS: Reproducibility, measured by Spearman's coefficient between global scores of the test and re-test was 0.78 (p < 0.001). The test was internally consistent (Cronbach's alpha was 0.89) and item per item construct validity was satisfactory. The ROC curve showed a moderate area under the curve (0.74 p < 0.001) with 67% sensitivity and 73% specificity. CONCLUSIONS: The French PEACH had good statistical properties, although a brief 13-item questionnaire, and can be used for evaluation of the disease-specific quality of life for young children with hearing loss.

French adaptation and validation of the Speech, Spatial and Qualities of Hearing scale for Parents (SSQ-P) and for Children (SSQ-Ch).

OBJECTIVES: Hearing loss can seriously impact children's daily life. This study aims to translate and validate the French versions of the hearing performance questionnaires, SSQ-Parent (for 5-18 years old children), and SSQ-Children (for 11-18 years old children). DESIGN: This controlled prospective trial was conducted between April and October 2020. The forward-backward translation method was used, and a test-retest procedure was carried out on a case and a control population. Cases had at least 30 dBHL hearing loss. STUDY SAMPLE: 54 cases (mean age 10.4 years old) and 32 controls (mean age 12.5 years old) answered the SSQ-Parent. 35 cases (mean age 13.1 years old) and 35 controls (mean age 14.3 years old) answered the SSQ-Children. RESULTS: Spearman's correlation coefficients between global scores of the test and re-test were 0.91 (p < 0.001) for SSQ-Parent, and 0.89 (p < 0.001) for SSQ-Children. Both tests were discriminant (respectively, global score 57.8 vs 92 p < 0.001, 61.2 vs 92.6 p < 0.001), and internally consistent (Cronbach's alpha 0.94 and 0.97). Items-global score correlation was satisfactory. ROC curves showed high area under curve for the SSQ-Children (0.990), and SSQ-Parent (0.988). CONCLUSION: The SSQ-Parent and SSQ-Children revealed excellent statistical properties, and can be used for the evaluation of hearing performance of children.

Place of Tubomanometry in Patulous Eustachian Tube Diagnosis.

OBJECTIVE: The aim of our study was to describe the diagnostic performances of tubomanometry (TMM) and to determine tubomanometric parameter thresholds for the diagnosis of patulous eustachian tube (PET). STUDY DESIGN: We performed a retrospective, monocentric study, including patients treated for PET vs control group. SETTING: This study was performed at the Otolaryngology Department of a tertiary-care hospital in the south of France. METHODS: We collected epidemiologic and clinical data, as well as adjusted opening latency index ("R"-index), rhinopharyngeal pressure threshold of tubal opening (Po), and velar contraction index (IVC) on TMM. Receiver operating characteristic (ROC) curves were used for determination of R index and Po thresholds. RESULTS: Twenty-one patients (26 patulous ears) and 14 controls (24 normal ears) were included. The R index values and Po values were significantly lower in the PET group vs controls (0.46 vs 0.80, respectively; P < .05 for R index and 13.89 vs 26.42 mbar, respectively; P < .05 for Po). No significant difference was reported between the 2 groups on IVC measurement (P = .784). After ROC curve analysis, R index was the most discriminating factor to classify PET patients with 89% specificity and 76% sensitivity with a threshold ≤0.6. Po value ≤10 mbar could support this diagnosis with more than 83% specificity. CONCLUSION: TMM is a reliable noninvasive method for positive diagnosis of PET. TMM could provide an accurate positive PET diagnosis and an objective evaluation for PET management.

French adaptation and validation of the Chronic Otitis Media Questionnaire-12 (COMQ-12).

OBJECTIVE: Chronic otitis media (COM) can seriously impact quality of life (QOL). Disease-specific questionnaires are essential for an accurate assessment of this impact. There is no questionnaire available for French-speaking patients with COM. This study aims to adapt and validate the French version of the COMQ-12 questionnaire. DESIGN: This is a controlled, prospective study, conducted between May 2020 and December 2021. Translation was performed using a forward-backward technique, and statistical validation was performed with a COM patients and a controls adult cohorts. STUDY SAMPLE: 100 patients (mean age 48 ± 16), and 50 controls (mean age 41 ± 16; p = 0.02) completed the test. RESULTS: Internal consistency, assessed by Cronbach's alpha, was 0.870 for the cases group. The mean COMQ-12 total score was 23.92 ± 11.3 for cases versus 3.70 ± 6.15 for controls (p < 0.0001). Individual items all had high discriminatory performances. The three items concerning ear discharge (Q1, Q2, Q9) had weaker correlation with the other items and the global score, but did not have a negative impact on internal consistency. CONCLUSION: The French version of the COMQ-12 is a short and easy-to-use test, with robust statistical properties, for assessing QOL in patients with COM.

Type 1 Tympanoplasty Outcomes between Cartilage and Temporal Fascia Grafts: A Long-Term Retrospective Study.

Background: To compare the functional and anatomical results of two different types of grafts in type 1 tympanoplasty (TPL I). Methods: A retrospective comparative bicentric study was conducted on patients treated with TPL I using temporal fascia or tragal cartilage. We evaluated the functional and anatomical results with intergroup and intragroup analyses. Variables predicting long-term success were also evaluated. Results: A total of 142 patients (98 fascia graft vs. 44 cartilage) were initially assessed, with a mean follow-up of 67.1 ± 3.2 months. No significant differences were observed between the two groups on the intergroup analysis of age, gender, ear side, or pre-operative hearing data (all p > 0.05). At the intragroup analysis of auditory outcomes, both groups demonstrated a significant improvement in post-operative air conduction, with greater gain for the fascia group at 6 months follow-up (p < 0.001 for both); however, at long-term follow-up, cartilage demonstrated better stability results (p < 0.001). When comparing the pre-and post-operative air-bone-gap (ABG), both groups showed a significant gain (p < 0.001); the fascia group showed that at 6 months, a greater ABG increase was found, but the difference was not statistically significant (4.9 ± 0.9 dB vs. 5.3 ± 1.2 dB; p = 0.04). On the contrary, the cartilage group at long-term follow-up at 5 years maintained greater outcomes (10 ± 1.6 dB vs. 6.4 ± 2 dB; p < 0.001). Lower age (F = 4.591; p = 0.036) and higher size of perforation (F = 4.820; p = 0.030) were predictors of long-term functional success. Conclusions: The graft material selection should consider several factors influencing the surgical outcome. At long-term follow-up, the use of a cartilage graft could result in more stable audiological outcomes, especially in younger patients or in case of wider perforations.

Long-Term Anatomical and Hearing Outcomes of Canal Wall down Tympanoplasty for Tympano-Mastoid Cholesteatoma: A 20-Year Retrospective Study.

Background: to evaluate the residual rate and the functional results after ten years from canal wall down tympanoplasty (CWD) for tympano-mastoid cholesteatoma. Methods: All the patients undergoing CWD for chronic otitis media with cholesteatoma at our ENT University Department between January 2002 and December 2022 were initially assessed. We performed clinical and diagnostic evaluation at baseline, 6 months, and then every year until an average follow-up of 10 years was obtained. Patients were consequently divided into two groups according to the presence (group A) or absence (group B) of the stapes superstructure. Results: After the selection process, 176 ears were included. The presence of the stapes superstructure was associated with better hearing outcomes (rate of patients < 30 dB) at 6 months (91.42% vs. 74.46%; p = 0.001) and 10 years (74.46% vs. 24.11%; p < 0.001). Residual cholesteatoma was reported in 10 ears, which included 2/35 ears in group A (5.71 %) and 8/141 in group B (5.67 %) (p = 0.993). The recurrent cholesteatoma rate was respectively 1/35 (2.85%) vs. 3/141 (2.18%) (p = 0.516). Conclusions: the CWD approach to cholesteatoma allows for effective long-term anatomical disease control and good hearing results when the stapes superstructure is preserved.

French translation and validation of the Sinus and Nasal Quality of Life Survey (SN-5) in children.

PURPOSE: Chronic rhinosinusitis (CRS) is a frequent, quality-of-life (QOL) impairing disease in pediatrics. The SN-5 is a reliable, sensitive and reproductible QOL questionnaire, validated in English for evaluation of CRS disease-specific QOL in children. This study aims to adapt and validate the French version of this test. METHODS: The SN-5 score was adapted into French language through a forward-backwards translation process, and validated through a monocentric prospective controlled study. Inclusion criteria were 2-12 years of age, CRS symptoms for at least 12 weeks, or absence of sino-nasal symptom for controls. Reproducibility was assessed through Spearman's correlation between initial answers and a re-test conducted 15 days later. Internal consistency was measured through Cronbach's alpha, construct validity through Spearman's correlation between items, discriminative ability through Mann-Whitney tests. RESULTS: 40 patients and 37 controls filled the score between November 2019 and March 2020. Retest was returned by 35 patients and 35 controls. Mean cases age was 8.5 ± 2.6 years old. 26 patients had primary CRS, 10 had cystic fibrosis, 4 had ciliary dyskinesia. All had diffuse disease. Mean SN-5 overall score was 3.63/7 ± 6.4 for CRS patients and 1.89/7 ± 0.9 for controls (p < 0.001). Test-retest coefficient was 0.84 (0.70-0.92; p < 0.001), Cronbach's alpha was 0.83 for CRS patient. Item per item construct validity was good to excellent. CONCLUSIONS: The French version of the SN-5 showed good statistical properties, with good test-retest reliability, internal consistency, structural validity and discriminative ability between CRS and control patients.

Embolization of Internal Carotid Artery Branches in Juvenile Nasopharyngeal Angiofibroma.

OBJECTIVE: Preoperative embolization of juvenile nasopharyngeal angiofibroma (JNA) is usually performed by the occlusion of branches of the external carotid artery (ECA). However, a significant proportion of JNAs also receive blood from the internal carotid artery (ICA). The objective of this study was to report on the feasibility and clinical impact of superselective embolization of ICA branches in complex cases of JNA. METHODS: This was a single-center retrospective study of all patients operated on for JNA between 2000 and 2018. The patients treated with embolization of branches of the ICA were identified. The results in terms of complications, intraoperative blood loss, and rate of residual disease were analyzed and compared to those of a control group of patients treated only with embolization of ECA branches and matched by age, stage, angiographic pattern, surgical approach, and previous surgery. RESULTS: Ninety-two patients were included. Embolization of branches of the ICA was attempted in 14 cases of advanced or recurrent tumors and was ultimately possible in nine cases. There were no complications after embolization. The mean intraoperative blood loss was 1428 mL. Residual disease was found in three cases (33%). There was no significant difference compared with the control group (mean intraoperative blood loss = 1355 mL, residual disease = 4 (44%); all P > .05). CONCLUSION: In this retrospective study, we report the feasibility of superselective embolization of ICA branches in selected cases of JNA. There was no observed benefit of this technique in terms of intraoperative bleeding or decreased risk of residual disease. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E775-E780, 2021.

Malleostapedotomy for otosclerosis, our experience of nitinol piston on twelve patients.

OBJECTIVE: Malleostapedotomy allows to completely by-pass the incus in otosclerosis surgery. Recently its use has been rivaled by hydroxyapatite cement for cases of mild and moderate necrosis of the incus. However, it remains gold standard for cases of extensive necrosis, incus dislocation, or epitympanic fixation. Modern heat-crimping pistons make surgery easier and safer. This study focuses on our experience with this technique. METHODS: Retrospective analysis of patient's files and pre- and post-operative audiograms, for cases of surgically treated otosclerosis with malleostapedotomy. RESULTS: Twelve patients underwent malleostapedotomy for otosclerosis between 2011 and 2019. Amongst them there were 10 revision surgeries and 2 primary cases. 75% had incus long-process necrosis, 17% had epitympanic fixation and one had a history of incus transposition. Nine patients (75%) had closure of air-bone gap (ABG) of <10 dB (p < 0.001) and 11 (92%) had a threshold of 20 dB (p < 0.001). Mean pre-operative ABG was 31 dB (15 dB-55 dB), and mean post-operative ABG was 7 dB (0 dB-21 dB; p < 0.001). There was no sensorineural hearing loss nor any other post-operative complication. CONCLUSIONS: Malleostapedotomy is a safe and reliable technique, allowing an ABG closure comparable to conventional incus to vestibule prosthesis. It remains the preferred technique whenever the incus cannot be used.

Tophaceous gout of the middle ear.

We present a very rare case of tophaceous gout of the middle ear causing conductive hearing loss, with special emphasis on Computed Tomography presentation.