Malformations of the lateral semicircular canal correlated with data from the audiogram.

OBJECTIVES: Lateral semicircular canal (LSCC) malformations  are one of the most common inner ear malformations. The purpose of this study is to analyze the prevalence and type of hearing losses associated with LSCC malformations, compared to a control group. MATERIALS AND METHODS: We retrospectively included 109 patients (166 ears) presenting with a CT-confirmed LSCC malformation, compared to a control group (24 patients). The bony island surface and the width of the inner portion of the LSCC were measured to confirm the malformation. There results were correlated to audiogram data: sensorineural (SHNL), mixed (MHL) or conductive hearing loss (CHL) by an otologist. RESULTS: In the LSCC group, 60.9% of patients presented with an audiogram-confirmed hearing loss, especially SNHL (39.2%, n = 65) and MHL (12.7%, n = 21). Hearing was normal in 39.2% (n = 65) of the cases. Bilateral LSCC malformations (n = 57) were frequently associated with hearing loss (80.7%), SNHL in most of the cases (33.3%). Unilateral LSCC malformations were associated with hearing alterations (51.9%, n = 27), but we also observed a high rate (81%, n = 42) of contralateral abnormalities of the audiogram. CONCLUSION: LSCC malformations are commonly associated with hearing loss (61%), especially SHNL (39%). The high rate (81%) of contralateral hearing disturbances in unilateral LSCC malformations should be taken into account in the patient's daily life to avoid triggering or exacerbating any hearing loss. Otologists and radiologists must cooperate to ensure that all malformations are correctly described on CT, especially to improve the patient's education regarding hearing preservation.

Stapes surgery in Sweden: evaluation of a national-based register.

The aim of the National Quality Registries is to monitor the outcome of healthcare given to patients. The Swedish Quality register for otosclerosis surgery is one of the nine official national registers for ear, nose and throat diseases in Sweden. Since 2004, surgical and audiological results and patient satisfaction scores have been systematically collected from a majority of the ear, nose and throat clinics performing stapes surgery in Sweden. The results of 1688 patients who underwent primary operations for otosclerosis were evaluated for 24 out of totally 26 clinics performing stapes surgery, between 2004 and 2010. The most common surgical technique reported was stapedotomy accomplished in an overnight stay. A majority of patients experienced improved hearing, and were satisfied with the preoperative counselling. Successful surgery, defined as an ABG closure ≤10 dB HL, was achieved in 69%, improvement in AC by ≥20 dB in 63% and BC not worsened by more than ≥5 dB in 93% of the patients. An overall low incidence of postoperative complications was reported. The outcome for ABG and BC was demonstrated to be independent of the number of operations performed by each clinic. An evaluation of the register and the results from the SQOS revealed that stapes surgery is a safe procedure with good hearing outcomes, low complication rates and a high rate of patient's satisfaction on a national level.

[A rare case of conductive hearing loss : Isolated fracture of the manubrium mallei as a consequence of digital manipulation in the external auditory meatus]. / Eine seltene Ursache für Schallleitungsschwerhörigkeit : Isolierte Fraktur des Manubrium mallei durch digitale Manipulation im Meatus acusticus externus.

Isolated fracture of the handle of the malleus is a rare cause of conductive hearing loss and represents a challenge for the otolaryngologist in terms of past medical history, diagnostics, and therapy.

[Otitis media with effusion : frequency, diagnosis, and therapy in early childhood]. / Seromukotympanon : Häufigkeit, Diagnose und Therapie im frühen Kindesalter.

BACKGROUND: Otitis media with effusion (OME) as the most common cause of hearing loss in childhood plays an important role in the follow-up after failed newborn hearing screening (NHS). The introduction of the NHS allows OME to be diagnosed and treated in the first months of life. MATERIAL AND METHODS: In 715 children referred to the Department of Phoniatrics and Pedaudiology of the Ear, Nose, Throat University Hospital of Magdeburg during the period 2006-2010, the prevalence and therapy process of OME during follow-up could be determined. RESULTS: OME was diagnosed in 16 % of the patients. Spontaneous resolution was observed in 37 % of the cases, while 46 % of the children were treated surgically. A substantially increased risk for persistent OME was observed in children with craniofacial dysmorphia or cleft palate. CONCLUSION: Using NHS, OME can be diagnosed and treated early, thus, preventing potential problems in the linguistic, social and intellectual development of children.

The effect of Interceed for reducing adhesion as a middle ear packing agent: an experimental study.

BACKGROUND AND OBJECTIVE: Interceed (oxidized regenerated cellulose) has been used to prevent postoperative abdominal adhesion. However, the efficacy and safety of using Interceed in middle ear surgery have not been thoroughly studied. MATERIALS AND METHODS: The animals were divided into two groups: the Interceed group and the Gelfoam (Gelatin sponge) group. In every group, the study was performed on five guinea pigs (ten ears). Under the aseptic condition, the middle ear mucosa was abraded using a pick through a myringotomy incision. Interceed and Gelfoam were then packed into the guinea pigs' middle ear cavities. The auditory brainstem responses (ABRs) were assessed preoperatively and at 3 weeks after the operation with the animals under general anesthesia. Histopathologic study was performed 3 weeks after the operation. RESULTS: The ABR results on postoperative week 3 showed no statistically significant difference for myringotomy and postpacking. The fibrosis, middle ear mucosa thickening and adhesion formation appeared to be less in the Interceed group compared with the Gelfoam group. Any foreign body reaction was not observed in the Interceed group. CONCLUSION: Our results show that Interceed is nonototoxic and biocompatible with the guinea pig's middle ear cavity. Therefore, these results suggest that Interceed could be used safely in the middle ear as a middle ear packing agent during otosurgery.

Significance of internal auditory canal diverticula in ears with otosclerosis.

BACKGROUND: Diverticula in the internal auditory canal (IAC) have been reported in ears with otosclerosis. OBJECTIVE: We evaluated hearing levels and vascular activity in ears with otosclerosis with and without IAC diverticula and clarify the significance of IAC diverticula. MATERIALS AND METHODS: Sixty-one ears from 54 patients who underwent stapes surgery for otosclerosis [fenestral (48 ears) and retrofenestral (13 ears) groups] were included in the present study. Preoperative hearing levels on pure tone audiometry (PTA) and intraoperative measurements of blood flow were compared between the groups. RESULTS: A total of 24 of 61 ears (39.3%) showed IAC diverticula, significantly higher than the frequency in ears without otosclerosis (3.7%). No significant differences in air- and bone-conduction thresholds on PTA were evident between ears with and without IAC diverticula in each group. Ears without IAC diverticula tended to show higher blood flow in the area anterior to the oval window than ears with IAC diverticula, but the difference was not significant. CONCLUSIONS: The incidence of the IAC diverticula in otosclerosis was significantly higher than in cases without otosclerosis. The existence of IAC diverticula was not evidently related to the severity of the disease from the perspective of hearing level and vascular activity.

[Acute complications during middle ear surgery: part 2: Accidents in classical stapes surgery and their solutions]. / Akute Komplikationen in der Mittelohrchirurgie: Teil 2: Missgeschicke in der klassischen Stapeschirurgie und ihre Behebung.

Stapes surgery is remarkably different from regular middle ear surgery. The inner ear space has to be opened and the risk of postoperative deterioration of hearing and deafness is much higher. Peculiarities involve submerged parts of the foot plate into the vestibulum, the overhanging facial nerve with or without bony covering, bleeding from the mucosa, and problems involving the chorda tympani. Labyrinthine reactions during or post surgery are common. Important is the question of whether or when the piston should be removed. Rare cases such as a gusher with a wide connection between perilymph and CSF space are a major challenge in stapes surgery.

[Laser stapedotomy--the modern solution of otosclerotic stapes fixation]. / Lézerstapedotomia--az otoscleroticus stapesfixatio korszeru megoldása.

UNLABELLED: Development of surgical treatment of otosclerotic stapes fixation has been one of the success stories of otology for the past five decades. Nowadays not only stapedectomy and partial stapedectomy, but stapedotomy can also be considered a well established otological procedure. AIM: To introduce this minimally invasive surgical technique into the Hungarian otolaryngology practice, to gain useful experiences, and to analyze the hearing improvements and postoperative complications. METHODS: The authors give account of their first clinical experiences with 14 patients with KTP laser assisted stapedotomies using the self-crimping Nitinol piston. A total of 14 patients (11 females, 3 males) who have undergone the procedure between March 2006 and April 2007 were reviewed. The average age of the patients was 42,2 years, 6 procedures were carried out on left ears and 8 on right ones. The average length of follow-up was 9 months (ranged from 6 weeks to 1 year). RESULTS: Pure tone audiograms documented a hearing threshold improvement of 21,5 dB averaged across 0,5-1-2-3 kHz frequencies. The air-bone gap improvement averaged on the same frequencies was 18,7 dB. After an average 9 months postoperative follow-up period, the average air-bone gap was < 10 dB in 85% of the patients, however, < 20 dB in 100% of the patients. As for the average air conduction result: it was < 30 dB in each patient except for one. In this series, neither facial nerve paresis nor high frequency deterioration of the bone conduction thresholds was reported in the postoperative follow-up period. CONCLUSIONS: Based on the authors' favourable experiences and the review of the literature, KTP laser assisted stapedotomy with the use of Nitinol piston has several advantages: 1) the laser-activated memory effect of the piston prevents the disadvantages of the crimping manoeuvre made around the long process of the incus; 2) vertigo, experienced in the early postoperative period is milder and takes shorter time, reducing the length of hospitalisation; 3) the procedure is cost-effective and minimally invasive; 4) application of KTP laser assures bloodless operating field and minimal cochlear trauma; 5) migration of the prosthesis can be prevented, the degree of the surrounding granulation is less; 6) high frequency hearing improvement can be achieved in the long run; 7) the frequency and seriousness of complications is less, therefore this technique can be recommended for inexperienced ear surgeons, too; 8) the procedure can be used in difficult situations, too, e.g.: in the presence of stapedial artery, obliterative otosclerosis, flooting footplate, abnormal position of the facial nerve in the middle ear, revision cases; 9) the interindividual differences of hearing results are much less. Based on their favourable initial experiences, the authors plan to conduct a long-term follow-up on greater number of patients.

[Prevention of stable hypoacusis in patients with acute otitis media].

We studied 788 patients with acute otitis media caused by cooling, common cold and made an experiment with cooling guinea pigs and white rats that developed noninvasive acute otitis media (AOM). We registered morphological and histochemical changes in the hearing organ at different stages of AOM. We discovered that neurosensory hypoacusis in AOM results from disturbed microcirculation in the ear leading to hypoxia and affection of metabolic processes in the receptors of the hearing system. We propose a scheme of combined therapy at different stages of AOM. We believe that rehabilitation of the hearing system should be started as early as the initial symptoms of acute inflammation of the middle ear and continued to a complete recovery of the acoustic function.

Assessment and management of retraction pockets.

This manuscript intends to review types, pathogenesis, associated risk factors, and potential methods of prevention and treatment of the retraction pockets in adults and children. The importance of retraction pockets (RP) lies in loss of original histological and anatomical structure which is associated with development of ossicular chain erosion, cho¬lesteatoma formation and potentially life threatening complications of cholesteatoma. The trans-mucosal exchange each gas in the middle ear (ME) is towards equalizing its partial pressures with the partial pressure in the environ¬ment. MEs that have abnormalities in the volume and ventilation pathways in the epitympanic may be more suscep¬tible to retraction pockets. Sustained pressure differences and/or inflammation leads to destruction of collagen fibers in the lamina propria. Inflammatory mediators and cytokines lead to release of collagenases result in viscoelastic properties of the lamina propria. The process of changes in the tympanic membrane structure may evolve to the cho¬lesteatoma formation. There are many different staging systems that clinicians prioritize in their decision making in the management of RP. The authors discuss the management possibilities in different clinical situations: RP without and with ongoing or intermittent evidence of Eustachian Tube Dysfunction (ETD), presence of adenoid hypertrophy or re-growth of adenoids, presence or absence of effusion, invisible depth of RP without effusion. invisible depth of RP with effusion, ongoing RP after VT insertion, and finally suspicion of cholesteatoma in a deep RP with ME effusion. A decision algorithm regarding the management of TM retraction and retraction pockets is provided.

[Ototoxicity in head and neck cancers after radiotherapy and chemoradiotherapy: From primary prevention to tertiary prevention]. / Ototoxicité radio-induite et chimio-induite dans les cancers ORL : de la prévention primaire à la prévention tertiaire.

Each year, 15,000 head and neck cancer are treated in France. Prognosis is steadily improving. Consequently, limitation of late toxicities becomes essential. Ototoxicity is common, disabling and undervalued. We aimed to inventory primary, secondary and tertiary prevention measures to reduce ototoxicity induced by radiotherapy and chemotherapy, as well as its impact on quality of life of patients treated for head and neck cancer. External radiation therapy induced 30 to 40% of ototoxicity, including irreversible sensorineural hearing loss. Primary prevention of this risk is based on limiting the dose to the cochlea: 40Gy in case of radiotherapy alone, 10Gy during concomitant chemoradiotherapy with cisplatin. Dose gradients allowed by intensity-modulated radiotherapy help respecting these limits. Concurrent chemotherapy with high dose cisplatin (100mg/m2) also causes hearing loss by cochlear damages. Prescription of carboplatin-5-fluorouracil combination or cetuximab should be preferred in case of high risk of ototoxicity. This risk must be precisely evaluated before treatment. Ototoxicity monitoring during treatment allows early management, and lower long-term impact. Radiosensitivity predictive tests and research of genetic factors predisposing to chemo-induced ototoxicity should enable optimization of therapeutic choices and monitoring.

Preservation of conductive hearing in approaches to tumors of the jugular foramen.

OBJECTIVE: Surgical approaches to the jugular foramen, most often used for the resection of glomus jugulare tumors, may include removal of the external auditory canal wall and overclosure of the meatus, resulting in maximal conductive hearing loss. Modifications have been described that maintain hearing by preserving the canal wall at the price of decreased exposure and are, therefore, suitable only for small and favorably located tumors. Our technique for removal and then reconstruction of the canal wall with hydroxyapatite cement allows for complete anterior translocation of the facial nerve as far proximal as the geniculate ganglion, giving uncompromising exposure of even the most extensive tumors, with the potential for preservation of normal hearing. The purpose of this study was to describe and report our experience with this technique. STUDY DESIGN: : Retrospective review. SETTING: Private otology practice. PATIENTS: Between 2000 and 2005, seven patients between the ages of 34 and 77 years were identified who underwent procedures using this technique. INTERVENTION: Surgical management of jugular foramen tumors. MAIN OUTCOME MEASURES: Successful anatomical reconstruction of the external auditory canal and middle ear. Preoperative and postoperative audiograms are compared, and facial nerve function is reported. Complications are discussed. RESULTS: All seven patients had successful reconstruction of the external auditory canal. Complications were minor and did not require additional surgical intervention. Postoperative pure-tone average differed from the preoperative average by a mean of 7.5 dB. Facial nerve function ranged from House-Brackmann Grades I to III when checked at least 7 months after surgery. CONCLUSION: This study reveals that this technique of external auditory canal reconstruction using hydroxyapatite cement allows complete anterior translocation of the facial nerve, while safely and reliably preserving the potential for normal hearing, without any compromise in exposure of the jugular foramen in the setting of an infratemporal fossa approach.

[Importance and usefulness of laryngological screening of the preschool children population in conductive hypoacusis diagnostics]. / Znaczenie i przydatnosc przesiewowych badan laryngologicznych populacji dziecihcej w wieku wczesnoszkolnym w wykrywaniu niedosluchu przewodzeniowego.

INTRODUCTION: Incidence of upper respiratory tract ailments among children between 2 and 9 years old is very common. Discreet symptoms, like low grade conductive hypoaccusis or articulation's disorders are ignore or imperceptible by parents. The survive of these disorders in the child's development stage has a direct influence on cognitive functions, speech and social development and progress in learning. The aim of the work was to prove the efficiency of laryngological screening among asymptomatic population of preschool children on the basis of comparison of two difference populations: for the first time examined (Szczecinek) and at regular intervals of one year (Wolsztyn). MATERIAL AND METHODS: In the town Szczecinek and in the town Wolsztyn laryngological screening among 1172 (762 and 410 respectively) children was carried out. All the participating individuals were fully laryngological examined and tested with tympanometric audiometry. RESULTS: On the base of these examinations in the town Wolsztyn the following was to state: 46 (11.2%) children were refered to surgical treatment. In this group in 31 (67.4%) pathological tympanometric curve b- and c- type were affirmed. 42 (10.2%) children were refered to conservative treatment. In the town Szczecinek 142 (18.6%) children were refered to surgical treatment. In this group in 81 (57%) pathological tympanometric curve b- and c- type were affirmed. 110 (14.4%) children were refered to conservative treatment. CONCLUSIONS: (1) Usefulness of laryngological screening was confirm of the proportion of laryngological findings in the population of healthy seeming children refered to treatment. (2) The screening role is higher at rural area by low acsses to ENT consultants. Every year repeated screening influence population health, conscious approaching the ENT healthcare.

Evaluation of pure tone audiometry and impedance screening in infant schoolchildren.

STUDY OBJECTIVE: The aims were (1) to evaluate impedance measurements against pure tone audiometry as a screening method for the detection of middle ear changes associated with hearing loss in infant school children; (2) to estimate the costs of the health authority of each method. DESIGN: The study involved two stage screening in which both methods were offered, pure tone audiometry being carried out by school nurses and impedance screening by a doctor. SETTING: 18 infant or primary schools in Langbaurgh, Cleveland, UK. PARTICIPANTS: 610 previously unscreened infant school children took part in the study. MEASUREMENTS AND MAIN RESULTS: Main outcome measures were the sensitivity, specificity, and predictive value of each screening method, using clinical assessment and action as the validating technique. The sensitivity and the predictive value of a positive test in two stage impedance screening was markedly superior to that of pure tone audiometry. The specificity was similar using the two methods. In addition the impedance methods was more rapid and estimated to consume less resource as a screening procedure than pure tone audiometry. CONCLUSIONS: The superiority of the use of impedance screening established in this study should be confirmed in a subsequent audit carried out purely by school nurses.

Double cartilage block ossiculoplasty in chronic ear surgery.

OBJECTIVES/HYPOTHESIS: Multiple techniques of ossicular reconstruction have been advocated for hearing rehabilitation in the setting of chronic otitis media No single method can adequately address the clinical spectrum of disease severity. In the situation of a severely diseased ear requiring a canal wall down (CWD) mastoidectomy in the presence of an intact stapes superstructure, the authors have employed a double cartilage block (DCB) ossiculoplasty. The technique and short-term results are reviewed. STUDY DESIGN: Retrospective chart review in a tertiary referral otologic practice. METHODS: Twenty-three patients underwent a CWD tympanomastoidectomy with DCB ossiculoplasty. Ages ranged from 6 to 85 years (mean, 36.1 y). The majority of ears were actively draining at the time of surgery (83%) and most procedures were revisions of prior mastoidectomies (74%). Audiometric data (mean postoperative follow-up, 19.5 mo) were calculated according to 1995 American Academy of Otolaryngology-Head and Neck Surgery guidelines. RESULTS: Audiometric results were available in 20 patients. The mean air-bone gap (ABG) was 23.8 dB after surgery. Closure of the ABG to within 20 dB was achieved in 10 of 20 patients (50%). No cases of DCB extrusion have occurred to date. CONCLUSIONS: The DCB represents an excellent alternative to biocompatible prostheses for ossicular reconstruction in the setting of severe chronic ear disease. As with all methods of ossiculoplasty, long-term follow-up will be necessary to determine if this technique remains stable in the hostile environment in which it has been employed.

Otitis media, hearing loss, and child development: a NICHD conference summary.

Growing evidence indicates that a significant relationship exists between the conductive hearing loss resulting from recurrent otitis media (OM) during the first 3-5 years of life and subsequent problems in acquisition of language and academic skills. To assess current knowledge of OM and its consequences for cognitive and linguistic development, to exchange viewpoints, and, if possible, to determine directions for future research, a conference was sponsored by the National Institute of Child Health and Human Development (NICHD). Among the epidemiologic studies cited, some found a very high incidence of OM in North American Indians and Eskimos, caused, according to one hypothesis, by a genetically different eustachian tube. Another researcher advised that basic language development should be carefully assessed in all cases of OM in young children. Conferees agreed that intervention programs must be developed and implemented until preventive measures are available. One model program emphasizes prevention of developmental difficulties based on the known and suspected sequelae of OM and on the known principles of language development. Conference participants recommended that all infants and young children, particularly those at risk, be examined for OM during regular medical checkups. In addition to treating the disorder, measures should be taken to deal with any significant hearing loss. If drug therapy is inadequate to clear effusion from the middle ear, surgery should be considered. Speech and language intervention should be undertaken when required.

The effects of etidronate disodium on progressive hearing loss from otosclerosis.

A 2-year prospective double-blind study was performed to evaluate the role of etidronate disodium for the treatment of progressive hearing loss in patients with otosclerosis. A pulsed dosage regimen was used during the 2-year period and the patients were followed up with otologic and audiometric examinations. Although statistically significant differences were not achieved between the study and control groups, the study did reveal a trend toward stabilization or improvement in air conduction thresholds in some frequencies (1000 and 4000 Hz) and in bone conduction thresholds at other frequencies (500, 1000, and 2000 Hz). The incidence of adverse side effects was similar in the treatment and control groups. Although no definite conclusions can be drawn from this pilot study, the findings provide encouragement for performing a larger and longer-term study.

Optimal timing of cleft palate closure.

Treatment objectives for the cleft palate patient--normal speech, normal maxillofacial growth, and normal hearing--are closely related. Controversy about the timing of cleft palate surgery is directed at the need for early palatoplasty for improved speech and hearing versus delayed hard palate repair for undisturbed facial growth. This controversy as to the value of early versus delayed closure continues into the present. The authors present an updated argument regarding this controversy along with a comprehensive literature review. They also present a logical algorithm based on the literature and their personal experience.

Prospective study of the effects of ventilation tubes on hearing after radiotherapy for carcinoma of nasopharynx.

In patients with nasopharyngeal carcinoma, deafness sometimes occurs following radiotherapy. It is usually conductive, but may be sensorineural. Tinnitus is present frequently and usually is distressing. The role of ventilation tubes (grommets) in relieving these problems was assessed in a prospective randomized controlled trial of 115 patients. In the group with grommets, there was an improvement in hearing, with a reduction of the averaged air-bone gap (p less than .01). This was not found in the control group without ventilation tubes, who developed a larger conductive loss (p less than .01) and, in addition, a slight deterioration of the averaged bone conduction threshold (p less than .01). Surprisingly, the group with grommets did not develop this sensorineural loss (p less than .01). In addition, tinnitus was improved significantly by the insertion of ventilation tubes (p less than .01). Neither necrosis nor stenosis of the external auditory meatus was found in either group.

Use of tympanostomy tubes in otitis media.

Tympanostomy tubes (TT) are frequently employed as treatment for otitis media (OM) although there is little-clinical or experimental evidence of their efficacy. Potential detriments of TT include cost, risk of inhalation anesthesia, intraoperative complications, and tympanic membrane (TM) damage. Potential benefits include elimination of the conductive hearing loss (CHL), reduction in the occurrence of acute purulent OM, and avoidance of sequelae. The cost/benefit ratio of TT has never been accurately determined and morbid complications of inhalation anesthesia and the surgical procedure appear to be rate. There is evidence that TT significantly reduce the CHL of OM as well as reduce the incidence of recurrent acute purulent OM and help avoid sequelae. It is therefore determined that the risk of TT insertion for middle ear effusion (occasional TM changes) can be justified, in properly selected patients, by the benefits (immediate improvement in hearing and reduction in the incidence of recurrent acute purulent OM).