Canal wall window mastoidectomy for extensive labyrinthine cholesteatoma: total dissection and hearing preservation

This case report highlights outcomes of a 6-year-old patient who preserved functional hearing after complete dissection of an extensive labyrinthine cholesteatoma causing two semicircular canals fistulas with endolymph leak, tympanic and labyrinthine fallopian canal erosion of the facial nerve and internal auditory canal invasion with cerebrospinal fluid leak. The patient preserved 40 dB average of bone conduction threshold and 92% of speech discrimination score at 26 months postoperatively. This article reveals that canal wall window mastoidectomy might be an option even in cases of extensive cholesteatomatous labyrinthine fistula therefore avoiding hearing loss and long life cleaning of a canal wall down mastoid cavity.     

Acquired middle ear cholesteatoma in children with cleft palate: Experience from 18 surgical cases

Objectives

To review an institutional experience with the surgical management of middle ear cholesteatoma in children with cleft palate.

Materials and methods

We analyzed retrospectively 18 children diagnosed with cleft palate who underwent surgery for acquired middle ear cholesteatoma between 2000 and 2007. The following data were recorded: age, sex, history of ventilation tube insertion, status of the contralateral ear, cholesteatoma location and extension, and surgical technique involved. Cholesteatoma recidivism, stable mastoid cavity and hearing levels were the main outcomes measured.

Results

Follow-up ranged from 5 to 12 years (mean 8 years). Twelve children underwent planned staged canal wall up mastoidectomy: a residual cholesteatoma was found and removed during the second-look procedure in 2 ears (16.6%); two children (16.6%) showed a recurrent cholesteatoma and required conversion to canal wall down mastoidectomy. A modified Bondy technique was chosen in two children with an epitympanic cholesteatoma with an intact tympano-ossicular system, while in the remaining four subjects a canal wall down mastoidectomy was performed because of an irreparable erosion of the postero-superior canal wall: no cases of recurrent cholesteatoma were observed in these 6 children; revision mastoidectomy was needed in one patient for cavity granulation. A postoperative air-bone gap result of 0–20 dB was achieved in 11 children (61.1%); in 5 cases (27.7%) postoperative air-bone gap was between 21 and 30 dB, while in 2 (11.1%) was >30 dB. Bone conduction thresholds remained unaffected in all cases.

Conclusions

Our results indicate that most cleft palate children with cholesteatoma can be managed with a canal wall up mastoidectomy with low complication rates. In extensive disease with large erosion of the canal wall as well in presence of a retraction pocket in the contralateral ear, a canal wall down mastoidectomy should be considered. In epitympanic cholesteatomas with an intact tympano-ossicular system and mesotympanum free of disease, the modified Bondy procedure is an effective surgical option. As in the general pediatric population, improvement or preservation of hearing can be obtained in most patients.     

Pre-operative high resolution computed tomography scans for cholesteatoma: Has anything changed?

Objective

CT temporal bone scans are often performed to aid in surgical planning and management of cholesteatomas. With improvements in the resolution of CT scans today, it is now possible to obtain more information from these scans than before. The aim of this study is to compare findings on high resolution CT (HRCT) temporal bone scans to intra-operative findings, so as to determine how well various middle ear structures are assessed by HRCT scanning.

Study design

Retrospective study.

Setting

Otology clinic of a tertiary otolaryngology centre.

Subjects and methods

32 mastoidectomies performed by a single otologist for clinically confirmed cholesteatoma were included. Correlation of CT and intra-operative findings on the status of structures including the ossicles, semicircular canals, facial canal and tegmen was analysed using kappa and AC₁ statistics.

Results

In all patients, a soft tissue mass with bony erosion in keeping with a cholesteatoma was seen on CT. Radiosurgical agreement was excellent for the presence of semicircular canal erosion (k = 0.89, AC₁ = 0.96), facial canal dehiscence (k = 0.74, AC₁ = 0.76), tegmen erosion (k = 0.76, AC₁ = 0.92) and malleus erosion (k = 0.76, AC₁ = 0.85). It was good for incus erosion (k = 0.71, AC₁ = 0.92) and stapes erosion (k = 0.63, AC₁ = 0.73).

Conclusion

There was good to excellent radiosurgical agreement in the assessment of the status of various middle ear structures. Improvement in radiosurgical agreement from existing studies in the literature was noted. This was especially true for features such as facial canal dehiscence. With technological advancements, CT temporal bone scans appear even more valuable for evaluation of patients prior to cholesteatoma surgery.     

Tone burst stimulus for auditory brainstem responses: Prediction of hearing threshold at 1 kHz

Objective

To assess differences in hearing threshold estimation of four different ABR tone-bursts at 1 kHz.

Methods

Twenty-one (21) ears from 11 subjects were tested with pure-tone audiometry (PTA): 5 ears (24%) were normal hearing, 5 (24%) affected by mild hearing loss, 7 (33%) showed moderate hearing loss and 4 (19%) severe hearing loss. After PTA each subject underwent tone-burst ABR test at 1 kHz using a linear gated (L_ABR) or Blackman windowed (B_ABR) stimuli with (nn_ABR) and without ipsilateral notched noise. Stimulation rate and filters settings were unchanged.

Results

Overall correlation between PTA and all ABRs thresholds was high, ranging from 0.84 to 0.94. In normal hearing ears none of the differences was significant, except for those measured with B_nn_ABR, which showed a mean 16 dB overestimation of the pure-tone threshold (p < 0.05). In mild hearing loss group none of the differences between thresholds were significant. In moderate and severe hearing loss groups significant differences were measured with L_nn_ABR (p < 0.05) with a mean 7.5 dB underestimation of PTA.

Conclusions

Although very similar, some significant differences were found when considering specific group of patients with different degrees of hearing loss.     

Surgical management of labyrinthine fistula in chronic otitis media with cholesteatoma

Objective

To present the surgical outcomes of complete removal of the matrix of labyrinthine fistulas in a large series of middle ear cholesteatomas.

Patients and methods

This is a retrospective study. We analyzed 38 of 778 patients who were operated on for cholesteatoma and were proved to have labyrinthine fistula from 1991 to 2007. For this study, a more aggressive strategy was adopted that compromised immediate total removal of the matrix, regardless of size. To evaluate the safety and efficacy of the procedure, pre and postoperative pure-tone audiometry were compared and the recurrence rate was analyzed. Relevant data from the literature using a wide array of strategies were compared with our results.

Results

Only two patients suffered from postoperative hearing deterioration of bone conduction of more than 10 dB HL. There was no relationship between the size of labyrinthine fistulas and postoperative hearing deterioration. Recurrence of labyrinthine fistulas was not found.

Conclusions

Total removal of the cholesteatoma matrix in one step is a safe and effective method for the treatment of labyrinthine fistulas.     

The effect of cleft palate repair technique on hearing outcomes in children

Objective

Otitis media with effusion causing conductive hearing loss is a problem for many children with cleft palate. This study examines the association between palate repair technique and hearing outcomes in children at 3 and 6 years post-repair.

Patients and methods

Retrospective chart review of patients with all types of cleft palate that were repaired between 2001 and 2006 at a tertiary children's hospital. Exclusion criteria included sensorineural hearing loss, ossicular chain abnormalities, and ear canal abnormalities. The primary outcome was pure tone average (PTA) from 0.5 kHz to 2 kHz.

Results

69 patients (138 ears) were analyzed. 30.4% of left ears and 31.9% of right ears had an abnormal (>20 dB) PTA at 3 years; at 6 years this significantly improved to 13.0% (p = 0.008) and 15.9% (p = 0.011). Double-reverse z-plasty was associated with the lowest median PTA of 10.0 dB (p = 0.046) at 6 years. There was no difference in median PTA between children with and without comorbid diagnoses (such as Pierre Robin Sequence, arthrogryposis) at either 3 years or 6 years (p = 0.075, p = 0.331). Multivariate model showed that extent of cleft influenced technique choice (p = 0.027), but only technique choice was associated with significant differences in PTA and only at 6 years post-repair.

Conclusion

The majority of children developed normal hearing by 6 years with palatoplasty and routine tube insertion. Double reverse z-plasty was associated with the best outcome, but is not ideal for hard palate clefts. Randomized controlled trials are needed to elucidate the relationship between technique, middle ear ventilation and time to recovery, irrespective of type of cleft.     

Low-frequency otoacoustic emissions in schoolchildren measured by two commercial devices

Objective

Click evoked otoacoustic emissions in children are known to be good indicators of hearing function when used in the frequency range 1.5–4 kHz. Using two commercial devices, the present study investigates the usefulness of responses in the lower frequency range of 0.5–1 kHz evoked by 0.5 kHz tone bursts.

Methods

Otoacoustic emissions (OAEs) were recorded from the ears of 37 schoolchildren (age 12–13 years). OAE measurements were then made using two devices: the ILO 292 (Otodynamics) and the HearId (Mimosa Acoustics). Each device was used for two measurements: first with a standard click stimulus at 80 dB pSPL (CEOAEs) and a second using a 0.5 kHz tone burst at 80 dB pSPL (TBOAEs). Pure tone audiometry and tympanometry were also conducted. Half-octave-band values of OAE signal to noise ratios (SNRs) and response levels were used to assess statistical differences.

Results

Both devices provided similar SNR results for click and tone burst stimuli, although the ILO device generated slightly higher response levels for clicks. For the 0.5 kHz tone bursts, both devices evoked very weak responses at 0.5 kHz and the peak response occurred at 0.7–1 kHz. Generally, CEOAE SNRs were about 10 dB in the 1–4 kHz range, while SNRs for 0.5 kHz TBOAEs were about 10 dB at 0.7–1 kHz.

Conclusions

0.5 kHz TBOAEs could be measured in children as effectively as CEOAEs. They can provide additional information about the 0.7–1 kHz frequency range, a range over which CEOAEs do not usually contain responses above the noise floor. The main difficulty was that the maxima of the 0.5 kHz TBOAEs occurred at frequencies of 0.7–1 kHz, probably because of spectral splatter from the short tone burst stimulus and from rapidly falling responses of the cochlea and the recording system at low frequencies.     

The effect of caffeine on hearing in a guinea pig model of acoustic trauma

Objective

Caffeine is a widely consumed substance affecting the metabolism of adenosine and cellular metabolism of calcium. Noise also affects these metabolic pathways while inducing hearing loss. The aim of this study was to determine the effect of daily intake of caffeine on hearing loss after an episode of acoustic trauma in guinea pigs.

Materials and methods

In this pilot study, forty guinea pigs were randomly divided into four groups: group I (control, n = 10) received intraperitoneal saline, group II (n = 10) received intraperitoneal caffeine (120 mg/kg/day) for 14 days, group III (n = 10) was exposed to noise (tone of 6 kHz at 120 dB for one hour) and group IV (n = 10) was exposed to noise as group III and received caffeine as group II. Auditory brainstem responses were measured at four different frequencies (8, 16, 20, and 25 kHz) prior to and at intervals of 1 h, 3 days, 10 days, and 14 days after the initial treatment. On day 14, morphological analysis was performed to assess the effects of caffeine on acoustic trauma.

Results

Aggravated hearing loss was observed in group IV after 10 days of follow-up. After 14 days, one of the four frequencies (8 kHz) tested showed statistically significant greater impairment in hearing (8.2 ± 3.6 dB, p = 0.026). Auditory hair cells showed no difference while spiral ganglion cell counts were diminished in group IV (p < 0.05).

Conclusion

These findings indicate that caffeine may have a detrimental effect on hearing recovery after a single event of acoustic trauma.     

A new hearing screening system for preschool children

Objectives

This study aimed to investigate the practical application of Smart Hearing, a new hearing screening system for preschool children.

Methods

The screening system was applied to 6288 preschool children. The system auto-tested hearing thresholds at three frequencies: 1 kHz, 2 kHz, and 4 kHz; a 30 dB hearing level (HL) was the critical intensity for passing. Children with positive results were referred for audiological evaluation (pure tone audiometry, tympanometry and distortion product otoacoustic emissions assessment, etc.). To evaluate the test accuracy, 312 children (5%) were randomly selected to receive audiology assessment.

Results

In this study, 582 children (9.3%) tested positive in the screening, and the referral rate of the four age groups from 3 to 6 years old was 18.8%, 11.9%, 6.5% and 4.0%, respectively. A total of 463 children underwent audiological assessment, of which 12 cases (1.91‰; 95% CI: 0.83‰, 2.99‰) were diagnosed with permanent hearing loss, and 75 cases (1.19%; 95% CI: 0.92%, 1.46%) were diagnosed with temporary conductive hearing loss. No mixed hearing loss was found in this study. The specificity of the system was 92.6% and the sensitivity was only 37.5%.

Conclusions

This screening system is suitable for the universal hearing screening of preschool children above 4 years old, and further improvements of the system are needed to increase its sensitivity.     

Labyrinthine fistulae caused by cholesteatoma. Improved bone conduction by treatment

In five cases of labyrinthine fistulae caused by extensive cholesteatoma, more than 30-dB improvement in bone conduction was observed in four postoperative cases and in one case after preoperative administration of antibiotics. In each case, a fistula of more than 2 mm in length was present at the lateral semicircular canal, and membranous labyrinthine wall was exposed when the cholesteatoma membrane was removed. These five cases were considered to be in the stage of serous labyrinthitis. The experience with these cases shows that emergent antibiotic treatment and surgery are appropriate for cases with reduced bone conduction in which labyrinthine fistula caused by cholesteatoma is suspected. In addition, as the reduction of bone conduction does not necessarily preclude the possibility of good postoperative hearing, tympanoplasty may be appropriate even for cases with markedly reduced bone conduction due to labyrinthine fistulae.     

Hearing gain with a BAHA test-band in patients with single-sided deafness

Purpose

It is assumed that preoperative use of a bone-anchored hearing aid (BAHA) test-band will give a patient lower gain compared to real post-operative gain because of the reduction of energy through the scalp when using a test-band. Hearing gains using a BAHA test-band were analyzed in patients with unilateral hearing loss.

Materials and Methods

Nineteen patients with unilateral sensorineural hearing loss were enrolled. A test-band, which was connected to BAHA Intenso with full-on gain, was put on the mastoid. Conventional air-conduction (AC) pure-tone averages (PTAs) and sound-field PTAs and speech reception thresholds (SRTs) were obtained in conditions A (the better ear naked), B (the better ear plugged), and C (the better ear plugged with a test-band on the poorer mastoid).

Results

Air-conduction PTAs of the poorer and better ears were 91 ± 19 and 18 ± 8 dB HL. Sound-field PTAs in condition B were higher than those in condition A (54 vs. 26 dB HL), which means that earplugs can block the sound grossly up to 54 dB HL through the better ears. The aided PTAs (24 ± 6 dB HL) in condition C were similar to those of the better ears in condition A (26 ± 9 dB HL), though condition C showed higher thresholds at 500 Hz and lower thresholds at 1 and 2 kHz when compared to condition A. The hearing thresholds using a test-band were similar to the published results of BAHA users with the volume to most comfortable level (MCL).

Conclusion

Our findings showed that a BAHA test-band on the poorer ear could transmit sound to the cochlea as much as the better ears can hear. The increased functional gain at 1 and 2 kHz reflects the technical characteristics of BAHA processor. The reduction of energy through the scalp when using a test-band seems to be offset by the difference of output by setting the volume to full-on gain and using a high-powered speech processor. Preoperative hearing gains using a test-band with full-on gain seems to be similar to the post-operative gains of BAHA users with the volume to MCL.     

Effectiveness of MESNA on the success of cholesteatoma surgery

Importance

It is important that chronic otitis media with cholesteatoma be treated successfully in patients to protect them from having repeated surgeries with related surgical co-morbidities and hearing loss.

Objective

To evaluate the effectiveness of MESNA usage on the residual cholesteatoma rates of the patients who underwent surgery due to chronic otitis media with cholesteatoma.

Design

Retrospective single-institution study of a prospectively collected database.

Setting

Tertiary University Hospital.

Participants

Nine hundred and thirty-four patients underwent surgery due to chronic otitis media between September 2000 and March 2012 by the same surgeon. One hundred and forty-one cases out of 934 patients were selected who had cholesteatoma for the study. These randomly selected 141 cases were divided into two groups as follows: I. Forty-six cases were applied MESNA (Sodium 2-mercaptoethanesulfonate) intraoperatively, and II. Ninety-five cases were not applied MESNA intraoperatively. The cases that were followed-up at least one year were included in this study.

Intervention

MESNA (Ureomitexan, MESNA, Baxter oncology, Germany) was diluted with saline (20% MESNA and 80% saline) that was applied, and then a waiting period of approximately 5 min followed to start to dissect cholesteatoma matrix.

Main outcomes and measures

Residual cholesteatoma rates between intraoperative MESNA, a disulfide bond breaking chemical agent, applied and MESNA non-applied cases in the postoperative follow-up period were compared for the success of the surgery.

Results

MESNA was used in 46 patients out of 141 cases intraoperatively. Twenty-four of these patients underwent CWD (canal wall down), and twenty-two patients underwent CWU (canal wall up) mastoidectomy. For the other 95 subjects, 56 patients with CWD and 39 with CWU mastoidectomy, MESNA was not applied. Residual cholesteatoma rates were found to be significantly higher in MESNA non-applied group than MESNA applied group (p < 0.05). Residual cholesteatoma rates between CWD and CWU mastoidectomy procedures were not statistically significant (p > 0.05).

Conclusions and relevance

MESNA application that breaks disulfide bonds in the structure of the matrix in cholesteatoma surgery may assist the elimination of the disease, and increase surgical success by facilitating the elevation of the epithelium. Thereby, it causes a decrease in the possibility of remaining residual epithelium after surgery, which decreases the need for second-look surgery.

Trial registration

The retrospective research protocol was approved by the Inonu University Clinical Research Ethics Committee. Registration number:………     

A technique for concurrent procedure of mastoid obliteration and meatoplasty after canal wall down mastoidectomy

Objective

To present a simple technique for concurrent procedure of mastoid obliteration and meatoplasty after canal wall down mastoidectomy, and to assess the efficacy and the surgical results of this technique.

Methods

Retrospective clinical study of a consecutive series of procedures from 2004 to 2008. One hundred thirteen patients undergone canal wall down mastoidectomy with tympanoplasty and concurrent procedure of mastoid obliteration and meatoplasty that uses an anteriorly based musculoperiosteal flap and a horizontal skin incision on the concha were included. Preoperative diagnoses were classified into cholesteatoma, adhesive otitis media, and chronic suppurative otitis media. The mean duration of follow-up was 38 months, with a range of 12–75 months. We analyzed control of suppuration and creation of a dry mastoid cavity according to the Merchant's grading system for evaluation of the efficacy of this technique, and hearing outcome. We evaluated postoperative complications including development of recurrent or residual cholesteatomas and duration of the mastoid cavity achieving a complete healing.

Results

Seventy-two patients had cholesteatoma, whereas 27 patients had adhesive otitis media and 14 patients had chronic suppurative otitis media. Eighty-three percent of all patients, in 86% of patients with cholesteatoma, in 78% of patients with adhesive otitis media, and in 78% of patients with chronic suppurative otitis media were achieved a dry and self-cleaning mastoid and complete control of infection. Duration of the mastoid cavity achieving a dry and self-cleaning mastoid ranged from 4 weeks to 24 weeks and the mean time of the complete epithelialization was 11.1 ± 4.6 weeks. The average ABGs were 32.4 ± 13.8 dB preoperatively and 23 ± 13.2 dB postoperatively. There were 5 patients with failure of control of infection postoperatively and 3 patients of recidivistic cholesteatoma.

Conclusion

The efficacy of our technique to make a dry and healthy mastoid cavity after a canal wall down mastoidectomy is satisfactory, and the rate of complication is acceptably low. We believe that our technique could be a convenient method to prevent cavity problems after canal wall down mastoidectomy.     

Cholesteatoma labyrinthine fistula: prevalence and impact

Introduction

Labyrinthine fistula is one of the most common complications associated with cholesteatoma. It represents an erosive loss of the endochondral bone overlying the labyrinth. Reasons for cholesteatoma-induced labyrinthine fistula are still poorly understood.

慢性化脓性中耳炎合并迷路瘘管诊治体会(附32例报告)

目的探讨慢性化脓性中耳炎并发迷路瘘管的临床特征及其手术治疗方法。方法回顾分析我科2000—2007年收治的32例（36耳）手术证实的慢性化脓性中耳炎伴迷路瘘管患者的临床资料。其中有眩晕史者24例（75．0％）,诉耳呜者28例（87．5％）,瘘管试验阳性12例（37．5％）。对于小于2mm的骨性半规管瘘,在彻底清除病变后予肌筋膜覆盖。对瘘管大于2mm者,如迷路瘘管处病变难以清除,予保留一薄层胆脂瘤基质,行开放式乳突根治术;如能彻底清除病变者,予带筋膜的耳屏软骨片封闭瘘管,外面再覆盖-层肌筋膜。对瘘管破坏严重者。在彻底清除病变的同时行半规管阻塞术。22耳行开放式乳突根治术后Ⅰ期行鼓室成形术,14耳行改良乳突根治术。结果胆脂瘤型28耳,骨疡型8耳;瘘管位于外半规管30耳（83．4％）,上半规管3耳（8．4％）,两者同时有瘘管1耳（2．7％）,鼓岬部瘘管2耳f5．5％）;面神经骨管破坏致神经裸露16例,3例位于垂直段,7例位于水平段,同时合并有面神经水平段或锥曲段骨管部分缺损6例。30例患者于术后1～12天内（平均3．5天）眩晕缓解。2例行半规管填塞者,术后16天眩晕逐渐缓解。术后纯音测听平均骨导阈值（0．5kHz、1kHz、2kHz和4kHz）,12耳与术前相同,较术前下降10～20dB者16耳,较术前下降20dB以上者8耳。随访3月～6年,眩晕无复发。结论前庭症状存在与否,瘘管试验是否为阳性,以及影像学的改变等都不是术前确诊迷路瘘管的可靠指标,术中探查所见是确诊迷路瘘管最重要的依据。手术方法的选择及对瘘管区病变的处理应根据瘘管的部位、大小及患者听力状况和术者的手术经验而定。     

Abutment-free bone-anchored hearing devices in children: Initial results and experience

Objectives

Bone-anchored implantable hearing devices are widely accepted as a surgical option for certain types of hearing loss in both adults and children. Most commercially available devices involve a percutaneous abutment to which a sound processor attaches. The rate of complications with such bone conduction systems is greater than 20%. Most complications arise from the abutment. Recently, the Sophono (Boulder, CO) Alpha 1, an abutment-free system, has been introduced.

Study design and methods

We conducted a retrospective chart review of the first five patients who underwent implantation with the Sophono abutment-free bone conduction hearing system with the Alpha 1 processor at our institution and report here on these patients’ pre- and postoperative audiometric data and clinical courses.

Results

Average improvement in pure-tone average was 32 dB hearing loss and average improvement in speech response threshold was 28 dB hearing loss. All patients were responding in the normal to mild hearing loss range in the operated ear after device activation. Average improvement across individual frequencies was between 17 and 37 dB (SD 5.5–11 dB).

Conclusion

Our audiometric results to date are promising and have been consistent with published data on other bone-anchored hearing devices.     

Clinical analysis of secondary acquired cholesteatoma

Objective

This study aimed to analyze the clinical features of patients who underwent surgery for secondary acquired cholesteatoma (SAC).

Materials and methods

The subjects were 30 patients who underwent surgery for SAC in 30 ears. We investigated the age distribution, sex, tympanic membrane (TM) findings, temporal bone pneumatization, morphology of TM epidermis invasion, extent of cholesteatoma invasion, ossicular erosion, surgical methods and surgical results.

Results

There were 10 males (33.3%) and 20 females (66.6%), with a mean age 54.9 years. The TM perforation was medium-sized or larger in 27 ears (90%). Temporal bone pneumatization was poor or bad in 90% (18/20) of the evaluated ears. The cholesteatoma invaded from the malleus manubrium to the promontory in 23 ears (76.7%). There were no patients in whom the cholesteatoma invaded the antrum or mastoid. The ossicles were affected in 19 ears (63.3%). Ossiculoplasty with a columella on the stapes was the most frequent procedure, performed for 16 ears (53.3%). There were no hearing results with a postoperative air-bone gap of more than 31 dB.

Conclusions

Although SAC is rare, it is important for the clinician to keep this type of cholesteatoma in mind.     

A middle ear implant with a titanium canal wall prosthesis for a case of an open mastoid cavity

Objective

Open mastoid cavity rehabilitation should focus on both anatomical and functional aspects. We hereby report the technique and results of a combined strategy to reconstruct the external ear canal using a titanium wall implant and the middle ear using a fully implantable active middle ear device.

Methods

A fully implantable active middle ear implant was used to rehabilitate the mixed hearing loss of a 63-year-old woman, and a titanium posterior canal wall prosthesis was used to reconstruct the external ear canal during the same procedure. The middle ear implant was placed directly on the footplate. The auditory results were compared to the preoperative unaided thresholds and to the amplification of a conventional hearing aid.

Results

Following the procedure, there was an anatomically normal external ear canal with a healed tympanic membrane separating the external from the middle ear spaces. The postoperative auditory gains were on average 31.8 dB on pure-tone audiometry, and 20 dB on speech reception threshold. No complications occurred.

Conclusion

The rehabilitation of the external ear canal in an open mastoid cavity allows for clinical follow-up of the patient, and the implantation of an active middle ear implant provides appropriate auditory gains both in pure tones and in speech reception thresholds.     

Revision surgery for chronic otitis media: Characteristics and outcomes in comparison with primary surgery

Objectives

To analyze the characteristics and outcomes of revision surgery for chronic otitis media (COM) with or without cholesteatoma, and to compare with those of primary surgery.

Methods

A retrospective chart review was performed on 208 patients who underwent revision surgery for COM over an 8-year period (1997–2004) and 51 patients who underwent a primary canal wall down mastoidectomy (CWDM), and were followed for more than 12 months.

Results

Recurrent or residual cholesteatoma was found in 49.5% of cases. The mastoid tip and perisinal air cells were the most frequent sites of residual air cells. As a result of revision surgery, a dry and safe ear was achieved in 88.5% of patients. A residual air–bone gap (ABG) of ≤30 dB was achieved in 70.1% of cases with a revision CWDM with ossiculoplasty. In comparison with 51 patients who underwent primary CWDM, the disease control rate was not different. However, postoperative hearing result after ossiculoplasty was worse and longer healing time was required after revision surgery.

Conclusion

The characteristics and surgical outcome of recurrent COM must be fully understood for complete control of the disease.     

中耳胆脂瘤并发迷路瘘管的术后听力回顾性研究

目的探讨手术治疗对中耳胆脂瘤并发迷路瘘管患者听力的影响。方法回顾性分析35例（35耳）中耳胆脂瘤并发迷路瘘管患者的临床资料;其中21例（21耳）患者随访术后听力情况。结果21例（21耳）术后随访纯音测听3个月～5年,12例平均骨导阈值（0．5、1、2,N4kHz）与术前差别小于5dBHL,较术前听力提高者3例,较术前下降者5例,1例于术后3个月成功植入人工耳蜗。21例患者中11例行开放式乳突切开＋鼓室成形术,其手术前后骨气导各频率间（0．5、1、2、4～118kHz）听力阈值未见明显差异（配对样本t检验,P值均大于0．05）。结论中耳胆脂瘤并发迷路瘘管的术后骨导听力阈值无明显变化,有条件者仍可行鼓室成形术保存听力。