N-Acetylcysteine combined with prednisolone treatment shows better hearing outcome than treatment with prednisolone alone for patients with idiopathic sudden sensorineural hearing loss: a retrospective observational study.

OBJECTIVES: Internationally, corticosteroids are still the mainstay treatment for patients with idiopathic sudden sensorineural hearing loss (ISSHL). This is a retrospective monocentric study investing the impact of adding N-acetylcysteine (NAC) to prednisolone treatment on patients with ISSHL at a tertiary university otorhinolaryngology department. METHODS: 793 patients (median age 60 years; 50.9% women) with a new diagnosis of ISSHL from 2009 to 2015 were included in the study. 663 patients received NAC administration in addition to standard tapered prednisolone treatment. Univariate and multivariable analysis were performed to identify independent factors regarding negative prognosis of hearing recovery. RESULTS: Mean initial ISSHL and hearing gain after treatment in 10-tone pure tone audiometry (PTA) were 54.8 ± 34.5 dB and 15.2 ± 21.2 dB, respectively. In univariate analysis, treatment with prednisolone and NAC was associated with a positive prognosis of hearing recovery in the Japan classification in 10-tone PTA. In multivariable analysis on Japan classification in 10-tone PTA including all significant factors from univariate analysis, negative prognosis of hearing recovery were age > median (odds ratio [OR] 1.648; 95% confidence interval [CI] 1.139-2.385; p = 0.008), diseased opposite ear (OR 3.049; CI 2.157-4.310; p < 0.001), pantonal ISSHL (OR 1.891; CI 1.309-2.732; p = 0.001) and prednisolone alone without NAC treatment (OR 1.862; CI 1.200-2.887; p = 0.005). CONCLUSIONS: Prednisolone treatment combined with NAC resulted in better hearing outcomes in patients with ISSHL than treatment without NAC.

Ears with Cholesteatoma: Outcomes of Canal Wall Up and Down Tympano-Mastoidectomies-A Comparative Prospective Study.

This prospective study has been carried out to observe the outcomes of canal wall up (CWU) and canal wall down (CWD) Tympano-mastoidectomies in ears with cholesteatoma. Outcomes of the procedures have been done in terms of recurrence of cholesteatoma, complications, graft uptake rates and post-operative hearing gain. This study was carried out in the Department of Otorhinolaryngology of a reputed tertiary teaching hospital of North India from January 2016 to June 2020, with a mean follow-up of 32 months. The study included 100 patients of otitis media with cholesteatoma. In Canal Wall Up Tympano-mastoidectomy (CWUT) group, the number of males and females were 22 each. On the other hand, 36 males and 20 females underwent Canal Wall Down Tympano-mastoidectomy (CWDT). Each surgery was done as a single-staged and at the end of the surgical procedure angled oto-endoscopes were used for ensuring complete removal of the disease. Though there is no statistically significant difference in recurrence of cholesteatoma and complications rate in CWU and CWD Tympano-mastoidectomy techniques, but CWUT is superior to CWDT in terms of better graft uptake (p = 0.0156), and better average audiological gain (8.56 ± 0.93 dB) with p value = 0.0315. A diligent post-operative follow-up is must for assessing the outcomes of different types of mastoidectomies. This study shows no statistical difference in the disease recurrence and complication rates between Canal Wall Up and Down Tympano-mastoidectomies, though the anatomical changes and creation of the mastoid cavity in canal wall down procedure may affect the graft uptake and post-operative hearing gain. Use of Oto-endoscopes in cholesteatoma surgery helps in improving the outcomes of both techniques and thus recommended if the facility for the same is available.

Type 1 Revision Tympanoplasty Using Tragal Cartilage in a Tertiary Care Centre: A Prospective Observational Study.

To evaluate graft success rate and hearing outcome in type 1 revision tympanoplasty using tragal cartilage graft. It is a prospective observational study conducted at Department of ENT, Bangalore Medical College and Research Institute from July 2017 to June 2019. Forty four patients between the age group 18-60 years undergoing type 1 revision tympanoplasty, with conductive hearing loss were enrolled.There were 27 males and 17 female patients in the study group. Cartilage tympanoplasty was done using thin tragal cartilage graft . Postoperative hearing gain and graft uptake was assessed at third month. Graft uptake and hearing improvement was assessed 3 months postoperatively in 44 patients. Forty patients had graft uptake (90.90%). The postoperative hearing gain was 7.12 ± 2.99 dB (p = 0.001) which was statistically significant. Tragal cartilage is a good option as graft material in revision cases in terms of ease of graft placement, better graft uptake and audiological outcome with no complications like lateralization of graft, medialization of graft, epithelial pearl formation and anterior blunting.

Efficacy of steroid treatment for sudden sensorineural hearing loss in patients with vestibular schwannoma.

BACKGROUND: Sudden sensorineural hearing loss (SSNHL) has several aetiologies and may be a presenting symptom of vestibular schwannoma (VS). OBJECTIVES: The aim of this study was to investigate the recovery rate after steroid treatment and the prognostic factors of SSNHL with VS. MATERIALS AND METHODS: This was a retrospective observational study wherein 32 patients with VS who presented with SSNHL were analysed at a tertiary referral centre. Hearing gain and prognostic factors were the main outcome measures for steroid treatment intervention. RESULTS: Among the 1698 patients presenting with SSNHL, VS was found in 43 (2.5%) patients. Eleven cases (34.3%) showed good recovery, with significant improvements in the pure-tone audiometry values. Even though age was a significant factor, there were no associations between steroid response and initial hearing level, presence of vertigo, tumour size, and tumour extension. CONCLUSIONS AND SIGNIFICANCE: Our study showed that hearing recovery of SSNHL does not exclude a VS diagnosis. We suggest that steroid treatment be considered in patients with VS presenting SSNHL.

The Effect of Anteriorly Located Sigmoid Sinus on Postoperative Hearing Gains: A Case-Control Study.

There are many studies on the effects of temporal bone anatomical variations on a mastoid pneumatization. Considering the effects of the anatomic variations on mastoid pneumatization, it is considered that many anatomic variations may affect graft success rates and postoperative hearing threshold gains. We aimed to evaluate the effects of various anatomic variations on postoperative hearing gains among patients undergoing tympanoplasty. This retrospective cohort study conducted in a tertiary-care university hospital. This study enrolled 57 patients who underwent primary type 1 tympanoplasty operation using the temporal muscle fascia. The patients were divided into two groups as those with an anteriorly located sigmoid sinus (group 1), and no anatomic variation (group 2). Airway gain values at the frequency range of 250 Hz-8000 Hz and pure tone average (PTA) value were calculated preoperatively and at postoperative sixth month. The gains attained by the patient groups with anatomic variations were compared with group 2. There were significant differences between Group 1 and Group 2 in terms of the airway frequencies of 250, 500, 2000, 4000 Hz, and PTA value. We detected a lesser postoperative hearing gain in patients with an anteriorly located SS. We believe that anatomic variations that may affect middle ear and mastoid cavity may also affect postoperative hearing gain.

Vertical Strut Ossiculoplasty: A Versatile Alternate to Conventional Techniques-A Randomized study.

INTRODUCTION: Various ossicular reconstruction materials and techniques have been described in literature using autologous ossicle, cortical bone, autologous cartilage, synthetic materials and implants like total/partial ossicular replacement prosthesis (TORP/PORP) etc., but it has always been a topic of controversy in terms of the efficacy, longevity and complications of the material or method used. MATERIAL AND METHODS: This is a prospective, interventional, comparative, double-blind randomized control study which was done at a tertiary care center to compare outcomes of conventional and carved conchal cartilage (vertical strut) type III Tympanoplasty in terms of graft uptake and hearing gain. A total number of 52 cases were enrolled, randomized and allocated to 2 groups (26 each) i.e. group A (conventional type III) and group B (vertical strut technique). RESULTS: Graft uptake was seen in 25 (96.16%) patients in group B while it was observed in 23 (88.5%) cases in group A. Hearing gains were also better in group B. CONCLUSION: This study suggests that Vertical Strut technique can be studied further as it gives better gains in Air Conduction threshold and A-B Gap along with graft uptake as it provides better middle ear space and ossicular / tympanic membrane interface resulting in better hearing.

Is It Wise to Wait for Ear to Become Dry in Indian Scenario?

Tympanoplasty is the standard and well-established procedure for closure of tympanic membrane perforations. Tympanoplasty in wet ear is still a topic of debate among ENT surgeons. This study discusses the balance between wait and watch policy and early intervention in wet ear. It also compares the rate of graft uptake and hearing improvement in Type I tympanoplasty in dry and wet ears. This is a hospital based, observational, descriptive and comparative study. Total 246 patients enrolled in the study. Two groups were created with 123 patients in each group. One included dry ears and another included wet ears. All patients had mucosal type of chronic otitis media. They all underwent Type I tympanoplasty. Graft uptake rate and hearing was compared between both groups. The overall success rate (graft uptake) was 91.06% (224). The success rate in dry ear group was 93.50% (115) and in wet ear group it was 88.62% (109). This study concluded that there is no added advantage of drying the ear rather the delay in treatment increases morbidity and drop outs in Indian scenario.

Results of Hearing Outcome According to the Alloplastic Ossicular Prosthesis Materials.

The aim of this study is to compare the functional results and extrusion rates according to the type of ossciular alloplastic prosthesis. In this study, a retrospective analysis was performed. Sixty-one patients were involved in partial ossicular replacement (POR) cases and 70 patients were involved in total osscicular replacement (TOR) cases. In POR cases, Plastipore was used in 21 cases, hydroxyapatite in 20 cases, and titanium in 20 cases. In TOR cases, Plastipore was used in 20 cases, hydroxyapatite (HA) in 25 cases and titanium in 25 cases. We reviewed postoperative ABG (less than 20 dB or more than 20 dB) and the extrusion rate for more than 1 year follow-up period. In POR cases, ABG less than 20 dB were 71.4, 80.0, 85.0 % in plastipore, HA, and titanium prosthesis and in TOR cases, ABG less than 20 dB were 25.0, 28.0, 32.0 % in plastipore, HA, and titanium prostheses, respectively. In POR cases, extrusion rates (ER) were 9.5, 5.0, 5.0 % in plastipore, HA, and titanium prosthesis, respectively. In TOR cases, ER were 15.0, 8.0, 4.0 % in plastipore, HA, and titanium prosthesis, respectively. There were no significant differences in hearing gain results among plastipore, HA, and titanium in both POR and TOR cases, but the ER was significantly low in titanium. Clinically relatively better hearing gain and low-rate of extrusion were found in titanium prosthesis and thus this material is recommended in cases of ossicular alloplastic replacement surgery.

Comparison between clinical and audiological results of tympanoplasty with modified sandwich technique and underlay technique / Comparação entre os resultados clínicos e audiológicos de timpanoplastia com a técnica "sanduíche" modificada e a técnica underlay

Abstract Introduction: Surgical repair of the tympanic membrane, termed a type one tympanoplasty is a tried and tested treatment modality. Overlay or underlay technique of tympanoplasty is common. Sandwich tympanoplasty is the combined overlay and underlay grafting of tympanic membrane. Objective: To describe and evaluate the modified sandwich graft (mediolateral graft) tympanoplasty using temporalis fascia and areolar fascia. To compare the clinical and audiological outcome of modified sandwich tympanoplasty with underlay tympanoplasty. Methods: A total of 88 patients of chronic otitis media were studied. 48 patients (Group A) underwent type one tympanoplasty with modified sandwich graft. Temporalis fascia was underlaid and the areolar fascia was overlaid. 48 patients (Group B) underwent type one tympanoplasty with underlay technique. We assessed the healing and hearing results. Results: Successful graft take up was accomplished in 47 patients (97.9%) in Group A and in 40 patients (83.3%) Group B. The average Air-Bone gap closure achieved in Group A was 24.4 ± 1.7 dB while in Group B; it was 22.5 ± 3.5 dB. Statistically significant difference was found in graft healing rate. Difference in hearing improvement was not statistically significant. Conclusion: Double layered graft with drum-malleus as a 'meat' of sandwich maintains a perfect balance between sufficient stability and adequate acoustic sensitivity.

Resumo Introdução: O reparo cirúrgico da membrana timpânica, denominado timpanoplastia tipo 1, é uma modalidade de tratamento já bem estabelecida. As técnicas overlay ou underlay de timpanoplastia são comuns. A timpanoplastia "sanduíche" é a técnica de enxerto de membrana timpânica overlay e underlay combinadas. Objetivo: Descrever e avaliar a timpanoplastia com a técnica "sanduíche" modificada (timpanoplastia mediolateral) utilizando fáscia temporal e fáscia aureolar. Comparar o desfecho clínico e audiológico da timpanoplastia com a técnica "sanduíche" modificada com o da timpanoplastia com a técnica underlay. Método: Foram estudados 88 pacientes com otite média crônica, 48 (Grupo A) foram submetidos à timpanoplastia tipo 1 com enxerto "sanduíche" modificado. A fáscia temporal foi utilizada na técnica underlay e a fáscia areolar na técnica overlay. 48 pacientes (Grupo B) foram submetidos à timpanoplastia tipo 1 com a técnica underlay. Foram avaliados os resultados da cicatrização e da audição. Resultados: O sucesso do enxerto ocorreu em 47 pacientes (97,9%) no Grupo A e em 40 (83,3%) do Grupo B. O fechamento médio do gap aéreo-ósseo no Grupo A foi de 24,4 ± 1,7 dB, enquanto no Grupo B foi de 22,5 ± 3,5 dB. Houve diferença estatisticamente significativa na taxa de cicatrização do enxerto. A diferença na melhora auditiva não foi estatisticamente significante. Conclusão: O enxerto de camada dupla e o tímpano-martelo posicionados como o "recheio" do sanduíche mantém um equilíbrio perfeito entre a estabilidade necessária e adequada sensibilidade acústica.

Comparison between clinical and audiological results of tympanoplasty with modified sandwich technique and underlay technique.

INTRODUCTION: Surgical repair of the tympanic membrane, termed a type one tympanoplasty is a tried and tested treatment modality. Overlay or underlay technique of tympanoplasty is common. Sandwich tympanoplasty is the combined overlay and underlay grafting of tympanic membrane. OBJECTIVE: To describe and evaluate the modified sandwich graft (mediolateral graft) tympanoplasty using temporalis fascia and areolar fascia. To compare the clinical and audiological outcome of modified sandwich tympanoplasty with underlay tympanoplasty. METHODS: A total of 88 patients of chronic otitis media were studied. 48 patients (Group A) underwent type one tympanoplasty with modified sandwich graft. Temporalis fascia was underlaid and the areolar fascia was overlaid. 48 patients (Group B) underwent type one tympanoplasty with underlay technique. We assessed the healing and hearing results. RESULTS: Successful graft take up was accomplished in 47 patients (97.9%) in Group A and in 40 patients (83.3%) Group B. The average Air-Bone gap closure achieved in Group A was 24.4±1.7dB while in Group B; it was 22.5±3.5dB. Statistically significant difference was found in graft healing rate. Difference in hearing improvement was not statistically significant. CONCLUSION: Double layered graft with drum-malleus as a 'meat' of sandwich maintains a perfect balance between sufficient stability and adequate acoustic sensitivity.

Effects of early intratympanic steroid injection in patients with acoustic trauma caused by gunshot noise.

CONCLUSION: This study evaluated the efficacy of concurrent administration of ITSI and systemic steroids in delayed treatment of NIHL after gunshot noise exposure. The results showed additional hearing benefits with administration of ITSI. Further evaluation is warranted to confirm this efficacy. OBJECTIVE: This investigation evaluated the effects of early administration of an intratympanic steroid injection (ITSI) in combination with systemic steroids treatment in patients with acoustic trauma caused by gunshot noise. METHODS: Nineteen patients eligible under the criteria established concerning delayed treatment for noise-induced hearing loss (NIHL) were enrolled in this study. Patients were divided into two groups: those who received prednisolone (PD) only (n = 8), and those who received PD with ITSI (n = 11). ITSI treatment was initiated simultaneously alongside systemic PD administration. These patients received ITSI every other day for a total of four treatments. Pure-tone air conduction threshold audiometry, to record the pure-tone average (PTA) at 2, 4, and 8 kHz, was conducted upon each patient's initial visit, and 1 month after starting treatment, to evaluate the degree of hearing gain (hearing gain (dB) = (initial PTA) - (final PTA)). RESULTS: The initial PTA in PD-only and PD with ITSI groups were 52.75 ± 15.50 dB and 50.27 ± 12.01 dB, respectively. There were no significant differences in the baseline characteristics of the two groups, which include age and the number of days that treatment was delayed. In the multivariable linear regression analysis, both the initial PTA and the treatment method showed a significant association (R2 = 0.41). The unstandardized regression coefficient of the initial PTA was 0.47 (p = 0.02). Patients with additional ITSI showed significant improvement in the degree of hearing gain compared with the PD-only group (unstandardized regression coefficient =11.48, p = 0.03).

The effects of surgery type and different ossiculoplasty materials on the hearing results in cholesteatoma surgery.

To investigate the effects of surgery type [intact canal wall (ICW) or canal wall down (CWD) mastoidectomy] and different ossiculoplasty materials on hearing outcome in single-staged cholesteatoma surgery. A retrospective case-control study. A total of 116 cases (97 adults, 29 children) underwent surgery, including ossiculoplasty, between 2012 and 2015 for cholesteatoma. Patients who had undergone surgery for the first time, and whose grafts were successful, were included in the study. Patients with adhesive otitis media, unsuccessful grafts, revision and recurrent cases, radical mastoidectomy, and craniofacial anomalies were excluded. Audiogram examinations of the enrolled patients were performed 3-6 months after surgery, and the audiometric results were analyzed according to the criteria of the American Academy of Otolaryngology, Head and Neck Surgery. All ossiculoplasties were performed during the first operation. The preoperative average air-bone gap (ABG) of the patients was decreased from 31.37 ± 10.1 to 27.42 ± 10.4 dB; this decrease was found to be highly significant (p = 0.0001). Concerning the ICW technique, statistical evaluation of the hearing gain at frequencies of 500, 1000, and 2000 Hz, as well as the mean frequency, showed a high level of significance. Improvement at 4000 Hz was not found to be statistically significant. When the ABGs at 500, 1000, 2000, and 4000 Hz, and the mean frequency in patients with an hydroxyapatite-partial ossicular replacement prosthesis (HA-PORP) or autograft-partial ossicular replacement prosthesis (APORP), were evaluated, it was found that, at 4000 Hz, the APORP significantly reduced the ABG (p = 0.02). No significant difference was determined between patients with the hydroxyapatite-total ossicular replacement prosthesis (HA-TORP) and those with the autograft-total ossicular replacement prosthesis (ATORP) (p = 0.565). Although the use of the malleus as an APORP was found to be less effective than other autografts, the degree of advantage of using the incus, malleus, cortical bone, and cartilage did not significantly differ between materials (p = 0.152). Despite the effects of the incus, malleus, and cortical bone not differing in terms of the postoperative ABG (p = 0.160), incus usage was highly beneficial for hearing gain (p = 0.009). Despite CWD tympanoplasty affecting all frequencies, it has a particularly negative effect on the hearing threshold at 1000 Hz. In patients with partial ossicular replacement, autogenous grafts are more successful in restoring hearing at high frequencies, particularly at 4000 Hz. Although autogenous materials do not differ in terms of partial replacement effectiveness, the incus has been shown to be most effective for total replacement.

Ganancia auditiva en timpanoplast¡a tipo I, Hospital de Especialidades N2 del Centro Médico Nacional del Noroeste "Lic. Luis Donaldo Colosio Murrieta" / Hearing gain in tympanoplasty type I, Lic. Luis Donaldo Colosio Murrieta Northwest Specialty Hospital Nº2

Objetivo: determinar si existe ganancia auditiva posterior a la realización de timpanoplastía tipo 1 en pacientes con otitismedia crónica e hipoacusia conductiva.Material y Métodos: Este estudio se realizó en servicio de otorrinolaringología del Hospital de especialidades N°2, unidadmédica de alta especialidad, centro médico nacional del noroeste en ciudad Obregón, Sonora. Se llevó a cabo un estudiode cohorte retrospectivo, analítico, longitudinal. Descripción general del estudio. Se revisó el expediente clínicos de lospacientes con diagnóstico de secuelas de otitis media crónica, posoperados de timpanoplastía tipo 1, atendidos en elservicio de esta institución de marzo 2011 a abril 2014. Se tomaron datos como edad, sexo, lugar de procedencia, siexistieron complicaciones postquirúrgicas, nivel promedio de audición previo y posterior a intervención quirúrgica.Resultados: De un total de 237 expedientes revisados, se encontraron 51 expedientes completos, de los cuales 33pacientes fueron femeninos (64.7%) el rango de edad fue de 9 a 71 años, con media de 36.7 años. el lado operado más frecuente fue el derecho en 33 pacientes (64.7%). No se documentó ninguna complicación en los expedientes revisados. La evaluación de la audiometría previa la cirugía, se observó algún grado de hipoacusia en 46 pacientes (90.19%) y normal en 5pacientes (9.8%). Postquirúrgicamente se mostró audiometría normal en 38 pacientes (74.5%), y anormal en 13 pacientes(25.49%) con una p <.0001. Existe ganancia auditiva estadísticamente significativa con timpanoplastía tipo 1 en pacientescon secuelas de otitis media crónica en la unidad médica alta especialidad, cd. Obregón, Sonora.Conclusión: En la mayoría de nuestros pacientes la timpanoplastía tipo 1, presentaron mejoría en la audición. Estosresultados son similares a los que encontraron otros autores como shrestha y et al.

Objective: to determine if there is a hearing gain after performing a tympanoplasty type 1 in patients with mid level chronic otitis and conductive hearing loss. Material and Methods: This study was conducted in the otolaryngology service of the Specialty Hospital N§2, highly specialized medical unit, Northwest National Medical Center in Obregon city, Sonora. A study of a retrospective, analytical and longuitudinal cohort was carried out. Overview of the Study: Clinical records of patients diagnosed with sequale of mid level chronic otitis, tympanoplasty type 1 post surgery patients in this institution from March 2011 to April 2014 were reviewed. Data such age, sex and place of origin were taken and if there were any post surgery complications, average level of hearing previous and after surgery. Results: From a total of 237 reviewed patients, 51 were completed, of which 33 were female (64.7%), range of age was fron 9 to 71 years old with an average of 36.7 years old.The most frequent operated side was the right in 33 patients (64.7%). No complications in the files reviewed were found. In the evaluation of audiometry previous the surgery, certain degree of hearing loss was observed in 46 patients (90.19%) and normal in 5 patients (9.8%). Postsurgically an standard audiometry were foun in 38 patients (74.5%) and anormal in 13 patients (25.49%) with p<.0001. There is a statistically significant hearing gain with tympanoplasty type 1 in patients with sequale of mid level chronic level in the highly specialized medical unit, Northwest National Medical Center in Obregon city, Sonora. Conclusions: In most of our patients tympanoplasty type 1, there was an improvement in hearing. This results are similar to those found in authors such as Shrestha and et al.

Comparison of Partial Thickness and Full Thickness Tragal Cartilage Graft During Modified Cartilage Shield Tympanoplasty for Type I Procedures.

To compare the results, in terms of graft uptake and hearing improvement, of modified cartilage shield technique of tympanoplasty using either partial thickness tragal cartilage or full thickness tragal cartilage for type I procedures. 35 patients were included in group A where a partial thickness tragal cartilage was used and 27 patients included in group B where a full thickness tragal cartilage was used for modified cartilage shield tympanoplasty. Audiometry done at 4 months after surgery and the results compared. The graft take up rate for both these techniques is excellent. There had been no statistically significant difference in hearing gain between these two groups, except at 4,000 Hz, where hearing gain had been more in group A than group B with P value being 0.027. The modified cartilage shield tympanoplasty is a good technique for closure of tympanic membrane perforations. Hearing gain is very much similar between thin and thick cartilage groups, except at 4,000 Hz.

Diode Laser Stapedotomy vs Conventional Stapedotomy in Otosclerosis: A Double-Blinded Randomized Clinical Trial.

OBJECTIVES: To assess and compare the efficacy of diode laser stapedotomy (DLS) and conventional manual stapedotomy (CMS) in the treatment of otosclerosis. STUDY DESIGN: Randomized clinical trial. SETTING: Tertiary health center. SUBJECTS AND METHODS: We randomly assigned 60 patients with otosclerosis planned for primary stapedotomy to receive either DLS or CMS. Primary outcome measure was hearing gain measured by pure-tone audiometry (PTA) performed preoperatively and postoperatively. Hearing gain was compared within and between the groups. Secondary outcome measures were the incidence of intraoperative (bleeding and fractured footplate) and postoperative (vomiting, vertigo, sensorineural hearing loss, tinnitus, facial nerve paralysis, and hospital stay) morbidities. RESULTS: Sixty primary stapedotomies (30 in the CMS group and 30 in the DLS group) done for 60 patients (male, n = 42; female, n = 18) were included in the analysis. Preoperative mean air-bone (AB) gap in the DLS and CMS groups was 38.51 ± 8.643 dB and 36.42 ± 8.678 dB, respectively. Mean AB gap at 6 month was 10.86 ± 5.383 dB and 11.05 ± 5.236 dB in the CMS and DLS groups, respectively. Air conduction was improved by 24.98 ± 5.348 dB in the DLS group and 24.08 ± 5.911 dB in the CMS group at 6 months. No statistically significant differences were found in hearing gain between the 2 groups at 6 months (P > .05). A decreased rate and severity of intraoperative bleeding, postoperative vertigo, and vomiting were observed with the diode laser (0%, 6.6%, and 10%) compared with the conventional technique (16.7%, 16.7%, and 16.7%), but these differences were not statistically significant (P > .05). CONCLUSION: Hearing outcomes and complications of DLS were similar to CMS. These study findings confirm the efficacy of the diode laser in stapedotomy, but DLS offers no advantages over CMS for otosclerosis surgery.

COMPARISON OF NATURAL AND SYNTHETIC MATERIALS TO IMPROVE HEARING AFTER OBLITERATION OF THE MASTOID CAVITY.

BACKGROUND: Indications for removal of mastoid air cells and obliterating the mastoid cavity vary considerably from surgeon to surgeon. Various obliteration techniques have been recommended to eliminate open cavity problems. Here we investigated the difference between natural and synthetic filling materials to improve hearing after obliteration of the mastoid cavity. SETTING: Academic tertiary care medical centers (Al-Azhar and Ain-Shams University Hospitals). STUDY DESIGN: Retrospective comparative study included 60 patients divided into 2 equal groups. METHODS: The study was conducted over 6 years from 2008-14. The mean follow-up time was 3.5 years. RESULTS: We found that serviceable hearing (≤30 dB) was obtained after surgery in 52 patients (86.6%). In cases where natural materials were used in reconstruction, the average gain in AC was 25.5 dB and in BC it was 1.1 dB, while in cases where synthetic materials were used the average gain in AC was 26 dB and in BC it was 0.5 dB. There was significant improvement in the mean postoperative AC compared to the mean preoperative AC. However, there was no statistically significant difference between the use of natural and synthetic materials in improving postoperative hearing. CONCLUSIONS: Both natural and synthetic materials help in improvement of hearing after obliteration of the mastoid cavity. There is no statistically significant difference between the materials.

Efficacy of Intratympanic Methylprednisolone Perfusion for the Treatment of Sudden Sensorineural Hearing Loss / 听力学及言语疾病杂志

Objective To investigate the efficacy of intratympanic methylprednisolone perfusion (IMP) for the treatment of sudden sensorineural hearing loss (SSNHL ) which failed to be fully responsive to conventional treatment .Methods The hearing outcomes of 87 patients with unilateral SSNHL were retrospectively analyzed .All of the patients received IMP after not fully responsive to conventional treatment of varying periods of time .They were hospitalized in our department between January 2008 and December 2012 and were followed up for at least one year to exclude recurrent hearing loss .Results The effective rate was 66 .67% and the mean PTA improvement was (18 .53 ± 13 .54)dB of the patients with the time interval between onset of symptoms and IMP within 15 days , 21 .21% and (5 .92 ± 15 .18)dB of the patients with the interval between 16 and 30 days ,4 .76% and (3 .69 ± 7 .00) dB of the patients with the interval more than 30 days respectively .The significant difference in the effective rates were compared among the three groups(χ2 =25 .91 ,P<0 .01) .Regarding to the PTA improvement ,the group with interval within 15 days was better than the other two groups(F=11 .182 ,P<0 .01) .A total of 30 cases acquired more than 15 dB hearing gain after IMP .One of them was hearing loss in low frequencies and the other 29 cases were hearing loss at all frequencies .The mean hearing gains of the 29 cases in 0 .25 kHz ,0 .5 kHz ,1 kHz ,2 kHz , 4 kHz and 8 kHz were 35 .17 ± 18 .15 dB ,35 .38 ± 15 .90 dB ,31 .28 ± 19 .74 dB ,21 .31 ± 17 .34 dB ,14 .97 ± 16 .00 dB and 13 .80 ± 16 .35 dB ,respectively .The mean hearing gains at lower three frequencies (0 .25~1 kHz)were better than those at higher three frequencies (2 k~8 kHz)(F=9 .494 ,P<0 .01) .Conclusion Receiving IMP earlier might help to acquire better hearing gain for the patients with SSNHL after not fully responsive to conventional treat‐ments .The hearing gains at the lower frequencies were better than those at the higher frequencies after IMP .

A Case of Marked Hearing Improvement after Surgical Removal of Vestibular Schwannoma with Profound Hearing Loss / 대한이비인후과학회지

The preoperative hearing status is one of the important factors to determine the method of surgical approach to the vestibular schwannoma. It has been widely recognized that the hearing preservation surgery is not valuable if the patient has no serviceable hearing. The worldwide reported cases of hearing improvement after surgical removal of vestibular schwannoma with profound hearing disturbance are extremely rare, and so far, there have been no domestic cases reported. The authors have experienced a case of significant hearing improvement after surgical removal of vestibular schwannoma with preoperative unilateral total deafness but with normal otoacoustic emission response. We report this case with literature review.

Effect of Growth Factors on Hearing Restoration in Deafened Animal Model / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sensorineural hearing loss is caused by ototoxic drugs, radiation therapy, noise exposure and trauma, etc. They make irreversible changes in cochlear hair cells and degeneration of spiral ganglion neurons. It is known that neurotrophins and other growth factors have an important role in protectingcochlear hair cells and spiral ganglion neurons. We designed this study to analyze the effect of neurotrophins and growth factors delivered to the inner ear of deafened guinea pig. MATERIALS AND METHOD: Healthy 15 guinea pigs with normal Preyer's reflex were chosen, and were made deaf by infusion of kanamycin and ethacrynic acid. Myringotomy was done to both ears, normal saline injected into the left ear, and BDNF (brainderived neurotrophic factor), GDNF (glial cell derived neurotrophic factor), NT-3 (neurotrophin-3), IGF (insulin-like growth factor), EGF (epidermal growth factor), FGF (fibroblast growth factor) were injected in the right ear. RESULTS: Statistically significant hearing gain was obtained up to 35.00+/-13.78 dB in the group 1 (BDNF, GDNF, NT-3 treated group), and up to 34.0+/-5.47 dB in the group 2 (IGF treated group). However, no statistically significant hearing gain was observed in the group 3 (EGF, FGF treated group). CONCLUSION: We observed statistically important improvement of hearing threshold in the BDNF, GDNF, NT-3 treated group and IGF treated group.

Evaluation of improvement of hearing in type I tympanoplasty & its influencing factors.

study included 40 patients treated for CSOM with central perforation. Only type I tympanoplasty was done in 30 patients with dry central perforation and simple mastoidectomy with type I tympanoplasty was performed in 10 patients with moist or discharging perforation. Type I tympanoplasty utilizing an underlay technique with TFG shows high probability of success (85%). Presence of bilateral perforations lowers the success rate (66.66%). Status of non-operated ear is a significant factor for success rate. An overall hearing gain of about 10db was achieved. Poor pre-operative hearing status of elderly adversely influences post-operative improvement of hearing. Typel tympanoplasty with simple mastoidectomy results excellent surgical success rate (100%) but gives less improvement of hearing (closure of A-B gap= 3.3db). In type I tympanoplasty alone surgical success rate drops to 80-75% but is offers more improvement of hearing (closure of A-B gap = 6.708 db).