Microdrill stapedotomy for otosclerosis with small and large preoperative air-bone gap: a retrospective comparison of results.

Background: In otosclerosis mixed hearing loss is the most frequent symptom and arises when the focus involves the stapes footplate. Surgeons usually prefer to wait a minimum air-bone gap of 25 - 35 dB before surgery.Objectives: To evaluate the outcome of microdrill stapedotomy for otosclerosis in patients with a preoperative air-bone gap (ABG) <25 dB versus patients with a preoperative gap ≥ 25 dB.Material and methods: For this retrospective study, the outcomes and complications after microdrill stapedotomy were compared between adult patients with a preoperative small ABG (n = 127, ABG <25 dB) and those with a large ABG (n = 254, ABG ≥25 dB).Results: The postoperative ABG was significantly smaller than the preoperative ABG (p < .05) in both groups; there were no differences in complications rates (severe sensorineural hearing loss, footplate fracture or early postoperative vertigo) between the two groups.Conclusions: Our findings show that microdrill stapedotomy is safe and can be performed even in patients with a preoperative small ABG without increasing the risk of sensorineural hearing loss due to inner ear damage.

A new bone conduction hearing aid to predict hearing outcome with an active implanted device.

PURPOSE: We compared our historical medium-term data obtained with an active semi-implanted bone conduction device and the hearing results of a new passive bone conduction hearing device to determine its predictive value for the hearing results with the semi-implanted device. METHODS: The study sample was 15 patients with an active bone conduction implant (mean follow-up 26 months). Pure tone audiometry was performed with headphones, sound field speech audiometry was conducted unaided, and free-field speech audiometry was carried out with both the active bone conduction system and the passive device switched off. RESULTS: As compared with the unaided condition, speech reception was significantly improved with both devices. Comparison of speech reception threshold at 100% of word recognition showed no difference between the active and the passive device. At lower intensity the difference in speech perception was significant in the patients with monaural fitting (group A) and was non-statistically significant in those with binaural fitting (group B); the speech reception threshold at 50% of word recognition was 26.00 dB (± 10.22) with the active implant and 30.50 dB (± 7.98) with the passive device in group A (p = 0.047) and 24.00 dB (± 5.48) and 29.00 dB (± 2.24) in group B (p = 0.052), respectively. CONCLUSIONS: The hearing outcome after active bone conduction implant was comparable to published data. Compared with the unaided condition, speech recognition was significantly improved with the passive device. The device may also provide value to predict the hearing outcome with the implanted device, especially at higher intensities. LEVEL OF EVIDENCE: IV.

Comparison of VEMPs, VHIT and caloric test outcomes after vestibular neurectomy in Menière's disease.

OBJECTIVE: Selective unilateral vestibular neurectomy (VN) is considered a reliable surgical treatment in case of recurrent vertigo in Menière's disease (MD) because of hearing preservation and a minimally invasive posterior fossa retrosigmoid approach. The present study aimed to assess the quality of life and the long-term vestibular function in patients submitted to yearly follow-up after VN because of intractable MD. METHODS: Retrospective series of 15 MD patients undergoing retrosigmoid VN for recurrent vertigo. Outcome measures included cVEMPs and oVEMPs (cervical and ocular vestibular evoked myogenic potentials), VHIT (Video Head Impulse Test) and caloric test, besides to DHI (Dizziness Handicap Inventory) and PTA (Pure Tone Audiometry). RESULTS: Mean DHI score resulted within normal values in 74% of patients, significantly correlated to the duration of the follow-up. In the operated side, cVEMPs and oVEMPs have not been elicited respectively in 11 patients (73%) and 13 patients (87%), whereas it was not possible to evoke any response at bithermal caloric test in 4 cases. The gain of VOR from VHIT resulted always below normal values after VN except in one patient, who has also undergone an episode of posterior BBPV. The difference between average PTA threshold before and after VN resulted not significant. CONCLUSION: The vestibular outcomes prove VN to be an effective and safe surgery in MD; furthermore, the unexpected occurrence of BPPV after VN can justify the presence of neural anastomosis between the inferior vestibular nerve and the cochlear nerve, allowing to still perceive vestibular symptomatology despite of a proper neurectomy.

Oval and round window vibroplasty: a comparison of hearing results, risks and failures.

The aim of this study was to compare oval and round window vibroplasty. Eighteen (18) patients implanted with Vibrant Soundbridge (VSB) were enrolled. Two groups were formed depending on FMT placement: on round window in ten cases (RW group) and on oval window in eight (OW group). Pre and postoperative audiological tests were performed both under headphones and free-field settings, VSB on and off. One (1) RW patient experienced sudden hearing loss at the operated side after 4 months from surgery and was excluded from the analysis. Both groups showed good hearing results. Significant differences were measured at free-field pure-tone test with VSB on at 0.5 kHz (RW better than OW, p = 0.026) and 4 kHz (OW better than RW, p = 0.043). Both techniques share similar good results and are considered safe. However, we had one failure with deep and sudden hearing threshold worsening after some months of good results. From a surgical point of view OW vibroplasty is easier and safer to perform, when the stapes suprastructure is absent, as it does not require any drilling and should be preferred in such cases. More reports are needed to explain if RW vibroplasty is risky in a mid to long term.