The Long-Term Stability of Fat-Graft Myringoplasty in the Closure of Tympanic Membrane Perforations and Hearing Restoration.

BACKGROUND/AIMS: This study was conducted to evaluate the long-term stability of fat-graft myringoplasty (FGM) for chronic tympanic membrane perforations, analyzing the perforation closure rate and re-gained hearing outcome with respect to the size and location of the perforations. METHODS: Between August 2007 and June 2018, a total of 193 patients who underwent FGM due to chronic tympanic membrane perforation at a tertiary referral center were enrolled and analyzed. RESULTS: The mean follow-up was 14.6 months (range 6-39). The complete perforation closure rate after FGM was 89.6%, with no statistical difference among the perforation size groups. The mean postoperative air-bone gap (ABG) was 11.0 dB and mean ABG improvement was 4.9 dB. CONCLUSION: Our FGM technique had a favorable tympanic closure rate for small to large perforations, and yielded relatively good hearing improvement in the mid-size perforation cases over long-term follow-up periods. According to the topographic evaluation of FGM, this procedure resulted in a reliable perforation closure rate and audiological results regardless of the perforation site.

Effect of middle ear gelfoam on hearing and healing process after tympanoplasty: A prospective randomized case-control study.

PURPOSE: This prospective randomized case-control study was performed to compare the surgical outcomes of our swing-door overlay tympanoplasty with or without absorbable gelatine sponge (AGS, gelfoam) packing in the middle ear cavity, according to the surgical procedure. METHODS: Fifty-seven patients who underwent swing-door overlay tympanoplasty by a single surgeon were enrolled in the study. The data of 30 patients of the gelfoam-packing group (GPG) and 27 patients of the non-gelfoam-packing group (NGPG) were prospectively collected and compared. RESULTS: Closure of the tympanic membrane was found to be successful in all patients at postoperative 3 months evaluation. NGPG showed a statistically better healing process compared to GPG; earlier epithelialization and less fascia edema in NGPG than in GPG (P < 0.05). The air-bone gap (ABG) measured at postoperative 1 and 2 months was smaller in NGPG than GPG, although there were no statistical differences. CONCLUSION: This study revealed earlier healing process and faster recovery of ABG in NGPG, thereby indicating that the gelfoam in the middle ear may interfere with both hearing recovery and the healing process of neodrum.

Surgical results of infected preauricular sinus: No need for delay.

OBJECTIVES: This study was performed to propose the proper surgical timing of infected preauricular sinus (PAS) by comparing surgical results of active infection PAS group (AIPASG) to infection-controlled/or non-infected PAS group (IC/NIPASG). METHODS: Two hundred and twelve patients with PAS who underwent surgical excision using minimal supra-auricular approach by one surgeon (S.N.P) in a tertiary referral center between Apr 1999 and Dec 2016 were enrolled in this study. Medical records of 36 patients of AIPASG at surgical time point and 176 patients of IC/NIPASG were collected and their surgical results were compared. Postoperative wound infection, recurrence, need of drain insertion or external compression dressing and other clinical parameters including age, sex, follow up duration and previous incision & drainage (I&D) history were investigated and statistically compared between two groups. RESULTS: There were no significant differences of various clinical parameters between two groups, except previous I&D history (24 among 36 patients of AIPASG and 12 among 176 patients of NI/ICPASG, P < 0.05). Post-operative immediate but mild wound erythema was observed in 11 among 212 patients with no statistical difference between two groups (4 among 48 ears of AIPASG and 7 among 219 NI/ICPASG, P = 0.105) and was controlled by short-term antibiotics and conservative management. Only 1 patient of NI/ICPASG needed a revision surgery of wound exploration and curettage. No more recurrence of infection during their long-term follow-up period was observed in both groups. CONCLUSION: There was no significant difference in the surgical results of minimal supra-auricular approach of PAS excision between AIPASG and NI/ICPASG. Therefore, we suggest that this surgical technique can be performed even in the infected PAS which does not quickly respond to the conservative treatment.

Clinical efficacy of standard simple elliptical incision following drain-less and subcutaneous suture technique in preauricular sinus surgery.

BACKGROUND: The purpose of this study was to review our surgical strategy and outcomes of drain-less, subcutaneous suture technique in standard simple elliptical incision on preauricular sinus (PAS) cases. METHODS: The clinical records of 198 patients (247 ears) with PASs who were operated via standard simple elliptical incision with drain-less, subcutaneous suture technique by a single surgeon (K.H.P.) between January 2008 and December 2018 were reviewed for analysis. Patients' demographics, location of PASs, previous incision and drainage (I&D) history, previous surgical excision history, duration of follow-up, postoperative infection after surgery, and recurrence after surgery were analysed. RESULTS: Out of 247 PASs, 18 (7.3%) cases had postoperative infections and 11 (4.5%) cases showed recurrence. Postoperative infection rate were higher in previous I&D groups (PIDGs, 9.8%) and previous fistulectomy groups (PFGs, 10%), and also recurrence rates of PFGs (10%) was higher than those of fresh cases. However, there were no statistically significant differences between these groups. In addition, PAS patients with postoperative complications such as infection and recurrence were more common in male patients. CONCLUSION: We report a method of drain-less standard simple elliptical incision for the surgical removal of PAS and the outcomes of the surgery. Our method showed a low recurrence rate and low chance of wound infection postoperatively not only in fresh cases but also in pre-operative I&D cases and even previous fistulectomy cases. In conclusion, our method is proposed as an effective and safe method in all kind of patient groups, without presenting post-operative discomfort to patients.

A pilot study to investigate the therapeutic effect of Valsalva maneuver on otitis media with effusion in adults.

OBJECTIVE: This pilot study was performed to investigate the therapeutic effect of Valsalva maneuver on otitis media in adults and to evaluate the prognostic factors for the good response. METHODS: Thirty nine ears of 32 adult patients who were diagnosed as otitis media with effusion and managed by one-week Valsalva maneuver (>20/day) without any other medication were included in this study. Its therapeutic efficacy was evaluated and the prognostic factors which predict the response of Valsalva maneuver were analyzed by comparing various clinical and audiological factors between success and failure groups. RESULTS: Mean duration of otitis media in the study subjects was 30.9 days (SD 31.6 days). A success rate of 1-week Valsalva maneuver as a single therapeutic modality was up to 64.1% (25/39 ears) and hearing was significantly recovered in success group. No recurrence or side effects were observed. Successful Valsalva maneuver checked and confirmed as bulging of the tympanic membrane by otoendoscopic examination was an excellent indicator of therapeutic response in a week (p<0.05). Age, sex, duration of otitis media, history of previous upper respiratory tract infection, initial hearing levels and type of audiogram were not significant prognostic factors for the therapeutic efficacy of Valsalva maneuver. CONCLUSION: One-week Valsalva maneuver seems to be considered as a first line therapeutic modality in otitis media with effusion in adult patients who demonstrate the successful maneuver result on oto-endoscopic examination.

Cartilage Fascia Composite Canalplasty for External Auditory Canal Cholesteatoma: Case Analysis and Long-term Surgical Results.

OBJECTIVE: To analyze surgical outcomes of cartilage-fascia composite canalplasty (CFCC) for external auditory canal cholesteatoma (EACC). STUDY DESIGN: Retrospective case review study. SETTING: Tertiary referral center. PATIENTS: A total of 13 patients with EACC (n = 14 ears due to one patient with bilateral EACC). INTERVENTION: Surgical method of CFCC using well designed-conchal cartilage and temporalis muscle fascia after complete removal of EACC. MAIN OUTCOME MEASURES: Clinical characteristics and EACC stages were determined by oto-endoscopic examination and computed tomography (CT) findings. The surgical results of CFCC were analyzed. RESULTS: The median age of patients was 43 years (range, 12-75 yr), with a male to female ratio of 6 to 7. EACC stages were from II to IV. Cortical bone erosion in the inferior part of the bony EAC was the most common finding. All patients had satisfactory results: no more ear symptoms related with cholesteatoma and no need of dressing. Postoperative hearing gain was observed in four patients. No complications or recurrence occurred during the mean follow-up period of 34.4 months. CONCLUSION: Surgical technique of CFCC was effective for EACC not responding to conservative management.

Superiority of Second Stage Ossiculoplasty.

OBJECTIVE: To compare hearing results of single stage ossiculoplasty with second stage ossiculoplasty, and to provide a proper indication of operation options (single stage or second stage ossiculoplasty) according to patients' clinical conditions. STUDY DESIGN: Retrospective case review study. SETTING: Tertiary referral center. PATIENTS: A total of 175 patients with chronic otitis media. INTERVENTIONS: Tympanoplasty or mastoidectomy with tympanoplasty (M&T) as well as ossiculoplasty of either single or second stage between January 2009 and March 2016 by one surgeon (S.N.P.). MAIN OUTCOME MEASURES: Hearing outcomes evaluated by mean postoperative air-bone gap (ABG) and success rates in various subgroups of middle ear surgeries and different types of ossiculoplasty were analyzed. RESULTS: Among 175 patients, 120 underwent single stage ossiculoplasty, and 55 underwent second stage ossiculoplasty. The benefit of second stage ossiculoplasty in hearing results both at 3 months visit (p < 0.001) and 2 years visit (p = 0.003) were observed. The superiority of second stage ossiculoplasty was found in 20 dBHL cut off value with a statistical significance. The subgroups of canal wall down mastoidectomy and the first, non-revision middle ear surgery showed statistically significant benefits with second stage ossiculoplasty. CONCLUSION: Second stage ossiculoplasty has overall advantage in hearing results compared with single stage ossiculoplasty and could be more advantageous to the patient who needs canal wall down mastoidectomy or whose operation is the first middle ear surgery.

Effect of sound generator on tinnitus and hyperacusis.

OBJECTIVE: Sound generator (SG) plays a role as effective sound therapy of tinnitus retaining therapy (TRT) in patients with severe tinnitus (Category 1) or hyperacusis (Category 3). This study was performed to evaluate the therapeutic effect of SGs. METHODS: A total of 120 tinnitus patients who visited our tinnitus clinic and were treated with SG along with TRT from January 2008 to December 2016 were included. The patients were divided into two groups by tinnitus category; 78 patients of category 1 and 42 patients of category 3. Their medical records including questionnaires regarding tinnitus severity were retrospectively reviewed to evaluate the therapeutic effect of SGs on tinnitus and hyperacusis. RESULTS: Category 3 patients included more female patients, were younger than category 1 patients (p = .001), and were prescribed SG earlier due to their severe symptom of hyperacusis. (p = .004) All patients showed significant improvements on all categories of tinnitus visual analogue scale (VAS) scores and tinnitus handicap inventory (THI) scores after six months use of SG (p < .05). Loudness discomfort levels measured by pure tone audiometry were significantly improved in category 3 group after six months use of SGs. CONCLUSION: SG with TRT seems to be an effective treatment modality for all tinnitus patients, especially those with comorbid hyperacusis.

Long-Term Effects of Middle Ear Tendon Resection on Middle Ear Myoclonic Tinnitus, Hearing, and Hyperacusis.

OBJECTIVE: To evaluate the therapeutic effects of middle ear tendon resection (METR) on middle ear myoclonic tinnitus (MEMT) and to investigate its long-term effects on hearing and hyperacusis. MATERIALS AND METHODS: Thirty-seven patients with MEMT with a mean age of 33.2 ± 11.8 years were included in this study. METR was performed on all 37 MEMT patients (41 ears) between November 2004 and August 2016. The mean follow-up period was 16.1 months. We examined changes in tinnitus and accompanying stress and depression in patients after surgery, and examined the hearing changes and the occurrence of complications including hyperacusis. RESULTS: After surgery, 34 (91.9%) patients exhibited complete resolution of MEMT during their follow-up period, and 3 patients showed a partial response. The mean Visual Analog Scale (VAS) scores for tinnitus severity, the Tinnitus Handicap Inventory (THI), and stress index decreased significantly after surgery (p < 0.05, paired t test). No patient developed hearing loss or hyperacusis following surgery. Preexisting hyperacusis even improved in most of the patients with intractable MEMT after surgery. Recurrence of the symptom occurred in only 1 patient, who underwent revision surgery with improvement. We observed 1 case of postoperative delayed facial palsy with complete recovery in 2 weeks. CONCLUSIONS: METR seems to be an effective and safe treatment option for intractable MEMT, considering its high control rate of tinnitus and no long-term harmful effects on hearing and hyperacusis.

Comparison of tinnitus and psychological aspects between the younger and older adult patients with tinnitus.

OBJECTIVE: To explore the differences in various tinnitus-related features and psychological aspects between the younger and older adult patients with tinnitus. METHODS: We retrospectively reviewed the clinical data of the adult patients who visited our tinnitus clinic in 2013 and completed full tinnitus assessment including audiometry, tinnitus matching, standardized tinnitus questionnaires, and psychometric questionnaires. The younger group included patients aged 20-45 years (n=64), and the older group, those older than 65 years (n=76). Clinical features, hearing levels, matched tinnitus pitches and loudness, self-report tinnitus severity scores, Beck depression inventory scores, and stress scores were compared between the groups. RESULTS: Tinnitus duration was longer in the older group (p=0.002). Mean PTAs were 16dB HL in the younger, and 38dB HL in the older groups (p<0.001). Eighty-nine percent of the younger patients had normal hearing, while 82% of the older patients had hearing loss (p<0.001). Matched tinnitus loudness was greater in the older group (64dB HL vs. 36dB HL, p<0.001). All of the self-report tinnitus, depression, and stress scores did not differ between the groups. CONCLUSION: The older patients seemed to be more receptive to tinnitus. The majority of older tinnitus patients had concomitant hearing loss, and thus hearing rehabilitation should be considered preferentially for tinnitus management in this age group. Subjective tinnitus severity, depressive symptoms, and the stress levels were similar between the younger and older tinnitus patients. Therefore, treatment could be planned based upon the comprehensive understanding of the tinnitus characteristics and psychological aspects in each patient irrespective of age.

Cochlear function tests in estimation of speech dynamic range.

OBJECTIVES: The loss of active cochlear mechanics causes elevated thresholds, loudness recruitment, and reduced frequency selectivity. The problems faced by hearing-impaired listeners are largely related with reduced dynamic range (DR). The aim of this study was to determine which index of the cochlear function tests correlates best with the DR to speech stimuli. METHODS: Audiological data on 516 ears with pure tone average (PTA) of ≤55 dB and word recognition score of ≥70% were analyzed. PTA, speech recognition threshold (SRT), uncomfortable loudness (UCL), and distortion product otoacoustic emission (DPOAE) were explored as the indices of cochlear function. Audiometric configurations were classified. Correlation between each index and the DR was assessed and multiple regression analysis was done. RESULTS: PTA and SRT demonstrated strong negative correlations with the DR (r = -0.788 and -0.860, respectively), while DPOAE sum was moderately correlated (r = 0.587). UCLs remained quite constant for the total range of the DR. The regression equation was Y (DR) = 75.238 - 0.719 × SRT (R(2 )=( )0.721, p < 0.001). The other variables such as audiometric configurations and DPOAE sum were excluded from the final model. CONCLUSION: SRT was the most predictive of the DR among the indices of the cochlear function tests. A reduced DR in cochlear hearing loss was the product of an elevated audiometric threshold and a relatively constant UCL level. The results enable prediction of the DR from SRT and possibly PTA using the suggested regression equation.

Major factors affecting severity of obstructive sleep apnea.

Computed tomography (CT) has become a common method for evaluating obstructive sleep apnea (OSA). The aim of this study was to analyze the relationships between CT parameters and clinical parameters in OSA patients to determine major factors affecting the severity of OSA. The records of 128 consecutive snoring patients (98 males, 30 females) diagnosed with OSA were retrospectively reviewed. Polysomnography was performed for each patient. On CT scans, airway areas were measured at the level of the hard palate, the soft palate, and the base of the tongue. Polysomnographic parameters were compared by gender and age using the Mann-Whitney U test. Pearson's correlation coefficient was used to analyze relationships between variables and the AHI in each age group. The women were significantly older than the men (p < 0.01). The AHI and apnea index were significantly higher in men than in women. Stage 1 sleep and rapid eye movement sleep were more frequent in men than in women. The area at the base of the tongue was significantly smaller in women than in men (p = 0.027). In the 50-60 age group, the AHI was significantly higher in men (41.47 ± 19.67) than in women (17.14 ± 15.63) (p = 0.001). OSA severity varies with age, gender, and upper airway area. The OSA prognosis could be improved by evaluating the major factors and treating OSA patients according to epidemiological characteristics and anatomical structures.