Cochlear Implantation in Chronic Otitis Media with and without Cholesteatoma: Surgical Considerations and Auditory Outcomes

ORL ◽  
2021 ◽  
pp. 1-6
Author(s):  
Nagihan Gülhan Yaşar ◽  
Recep Karamert ◽  
Hakan Tutar ◽  
Mehmet Birol Uğur ◽  
Burak Hazır ◽  
...  
Keyword(s):  
Otitis Media ◽  
Hearing Aids ◽  
Surgical Techniques ◽  
Chronic Otitis Media ◽  
Pure Tone Audiometry ◽  
Complication Rates ◽  
Speech Discrimination ◽  
Mastoid Obliteration ◽  
Significant Difference ◽  
The Impact

<b><i>Introduction:</i></b> Cochlear implant (CI) surgery is a safe and standardized procedure in the presence of normal temporal bone anatomy. However, in the surgery of patients with chronic otitis media (COM), the surgeon may encounter several problems. The aim of this study was to evaluate the impact of COM with and without cholesteatoma on surgical and auditory outcomes of CIs. <b><i>Methods:</i></b> The study group consisted of 39 patients with COM who received CIs. Age- and gender-matched 38 standard CI patients served as controls. The surgical techniques and complications, pure tone audiometry (PTA) scores, speech discrimination scores (SDS), and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire results of the groups were compared. <b><i>Results:</i></b> The presence of COM was associated with a higher rate of complication than controls. Staging the surgeries, presence or absence of cholesteatoma, and type of surgical technique were not associated with surgical outcomes and complications (<i>p</i> &#x3e; 0.05). There was no significant difference between the groups in terms of postoperative PTA scores, SDS, and IOI-HA scores (<i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> Postoperative complications like device failure and skin breakdown are increased in cases of COM compared to standard CI surgeries. However, that increase is not associated with staging the surgeries, presence or absence of cholesteatoma, and type of ear surgery performed. It is advocated to close the external ear canal and eustachian tube without mastoid obliteration in the presence of a radical mastoidectomy cavity, which will decrease the postoperative complication rates and allow for radiological follow-up with computed tomography for the possibility of cholesteatoma recurrence. The auditory benefits of CI in patients with and without COM are comparable.

scholarly journals Clinical Trial for Cartilage Conduction Hearing Aid in Indonesia

2021 ◽  
Vol 11 (3) ◽  
pp. 410-417
Author(s):  
Ronny Suwento ◽  
Dini Widiarni Widodo ◽  
Tri Juda Airlangga ◽  
Widayat Alviandi ◽  
Keisuke Watanuki ◽  
...  
Keyword(s):  
Hearing Aids ◽  
Bone Conduction ◽  
Pure Tone Audiometry ◽  
Sound Field ◽  
Ear Reconstruction ◽  
Speech Discrimination ◽  
Aural Atresia ◽  
Hearing Function ◽  
Significant Difference ◽  
The Impact

Hearing improvement represents one of the may valuable outcomes in microtia and aural atresia reconstruction surgery. Most patients with poor development in their hearing function have had a severe microtia. Conventional methods to improve hearing function are bone conduction and bone anchored hearing aids. Cartilage conduction hearing aids (CCHA) represents a new amplification method. This study assessed the outcomes and evaluated the impact and its safety in the patients with microtia and aural atresia whose hearing dysfunction did not improve after surgery for ear reconstruction in our hospital. Hearing functions were evaluated with pure tone audiometry or sound field testing by behavioral audiometry and speech audiometry before and after CCHA fitting. As a result, there was a significant difference between unaided and aided thresholds (p < 0.001). Speech recognition threshold and speech discrimination level also significantly improved with CCHA. The average functional gains of 14 ears were 26.9 ± 2.3 dB. Almost all parents of the patients reported satisfaction with the performance of CCHA, and daily communication in children with hearing loss also became better than usual.

scholarly journals Chronic Otitis Media with Effusion in Chronic Sinusitis with Polyps

2018 ◽  
Vol 97 (8) ◽  
pp. E13-E18 ◽  
Author(s):  
Mary Daval ◽  
Hervé Picard ◽  
Emilie Bequignon ◽  
Philippe Bedbeder ◽  
André Coste ◽  
...  
Keyword(s):  
Otitis Media ◽  
Nasal Polyposis ◽  
Otitis Media With Effusion ◽  
Demographic Data ◽  
Chronic Otitis Media ◽  
Pure Tone Audiometry ◽  
Upper Airway ◽  
Control Group ◽  
Cross Sectional ◽  
Significant Difference

The relationship between otitis media with effusion (OME) and chronic rhinosinusitis with nasal polyposis (CRSwNP) remains unclear. We conducted a cross-sectional study of 80 consecutively presenting patients—42 males and 38 females, aged 15 to 76 years (median: 48)—who were diagnosed with CRSwNP. Our aim was to ascertain the prevalence of OME in CRSwNP patients, to determine whether the severity of CRSwNP affected OME, and to identify risk factors for OME in CRSwNP patients. The severity of CRSwNP was assessed on the basis of nasal symptoms, endoscopic nasal examinations, and Lund-Mackay staging scores. In addition to demographic data, we obtained information on each patient's history of otitis, otoscopic findings, and the results of pure-tone audiometry and tympanometry. We then compared the data between CRSwNP patients with OME (n = 20) and those without (n = 60). In the OME group, a conductive hearing loss was present in 16 patients (80.0%); all patients in the control group had normal hearing. With regard to symptoms, only rhinorrhea appeared to be more common in patients with OME than in those without, although the difference was not statistically significant. We found no significant difference in nasal polyposis grades between the two groups. Also, we found no correlations between the risk of OME and previous surgical treatment, asthma, allergy, aspirin intolerance, aspirin and/or NSAID intolerance, aspirin and/or sulfite intolerance, and aspirin-exacerbated respiratory disease. Based on our findings, we conclude that OME occurs frequently during the evolution of CRSwNP, even when the nasal disease is well controlled. This finding suggests the possible presence, in OME and/or CRSwNP, of a global inflammatory process that involves the epithelium in both the middle ear and upper airway.

scholarly journals Role of pure tone audiometry in assessing ossicular status in patients with mucosal type of chronic otitis media

2020 ◽  
Vol 6 (5) ◽  
pp. 853
Author(s):  
Deepthy Das ◽  
Gurumani Sriraman ◽  
Valli Rajasekaran
Keyword(s):  
Otitis Media ◽  
Pure Tone ◽  
Chronic Otitis Media ◽  
Pure Tone Audiometry ◽  
Ossicular Chain ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Suppurative Otitis Media ◽  
Significant Difference

<p class="abstract"><strong>Background:</strong> Chronic suppurative otitis media (CSOM) is the disease of the middle ear cleft, which presents as hearing loss and ear discharge. This study aimed to assess the role of pure tone audiometry (PTA) in analysing the ossicular erosion in mucosal type of CSOM subjects.</p><p class="abstract"><strong>Methods:</strong> The current cross-sectional study was conducted among 60 people with mucosal CSOM.  Preoperative hearing was assessed by PTA. The surgeries were done and intra operative ossicular status were recorded. IBM SPSS 20 software was used for the analysis. Student t-test was used to correlate ossicular status and PTA findings.  </p><p class="abstract"><strong>Results:</strong> Among 60 subjects, 12 (20%) patients had eroded incus and 53 (88.3%) had normal stapes. The malleus was preserved in all patients. The result of our study showed that an average ABG of 58 dB at 500 Hz, 47 dB at 1 kHz, 41 dB at 2 kHz and 41 dB at 4 kHz in patients with   ossicular erosion. ABG for 500 Hz and 1 kHz were statistically significant for eroded incus. ABG for 500 Hz, 1 kHz, 2 kHz and 4 kHz were all statistically significant for eroded stapes.</p><p class="abstract"><strong>Conclusions:</strong> There is a significant difference between the PTA findings at different frequencies between intact and eroded ossicular chain. Pre-operative ABG helps us to assess the status of incus and stapes.</p>

scholarly journals Development of an electronic conversation aid to support shared decision making for children with acute otitis media

JAMIA Open ◽  
2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Jana L Anderson ◽  
e Silva Lucas Oliveira J ◽  
Juan P Brito ◽  
Ian G Hargraves ◽  
Erik P Hess
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Otitis Media ◽  
Acute Otitis Media ◽  
Medical Knowledge ◽  
Complication Rates ◽  
Shared Decision ◽  
Web Based ◽  
Quality Issue ◽  
The Impact

Abstract Objective The overuse of antibiotics for acute otitis media (AOM) in children is a healthcare quality issue in part arising from conflicting parent and physician understanding of the risks and benefits of antibiotics for AOM. Our objective was to develop a conversation aid that supports shared decision making (SDM) with parents of children who are diagnosed with non-severe AOM in the acute care setting. Materials and Methods We developed a web-based encounter tool following a human-centered design approach that includes active collaboration with parents, clinicians, and designers using literature review, observations of clinical encounters, parental and clinician surveys, and interviews. Insights from these processes informed the iterative creation of prototypes that were reviewed and field-tested in patient encounters. Results The ear pain conversation aid includes five sections: (1) A home page that opens the discussion on the etiologies of AOM; (2) the various options available for AOM management; (3) a pictograph of the impact of antibiotic therapy on pain control; (4) a pictograph of complication rates with and without antibiotics; and (5) a summary page on management choices. This open-access, web-based tool is located at www.earpaindecisionaid.org. Conclusions We collaboratively developed an evidence-based conversation aid to facilitate SDM for AOM. This decision aid has the potential to improve parental medical knowledge of AOM, physician/parent communication, and possibly decrease the overuse of antibiotics for this condition.

scholarly journals Absence of Association between Preoperative Estimated Glomerular Filtration Rates and Postoperative Outcomes following Elective Gastrointestinal Surgeries: A Prospective Cohort Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Sivesh K. Kamarajah ◽  
Behrad Barmayehvar ◽  
Mustafa Sowida ◽  
Amirul Adlan ◽  
Christina Reihill ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Glomerular Filtration ◽  
Elective Surgery ◽  
Gastrointestinal Surgery ◽  
Major Complication ◽  
Postoperative Outcomes ◽  
Queen Elizabeth Hospital ◽  
Complication Rates ◽  
Significant Difference ◽  
The Impact

Background. Preoperative risk stratification and optimising care of patients undergoing elective surgery are important to reduce the risk of postoperative outcomes. Renal dysfunction is becoming increasingly prevalent, but its impact on patients undergoing elective gastrointestinal surgery is unknown although much evidence is available for cardiac surgery. This study aimed to investigate the impact of preoperative estimated glomerular filtration rate (eGFR) and postoperative outcomes in patients undergoing elective gastrointestinal surgeries. Methods. This prospective study included consecutive adult patients undergoing elective gastrointestinal surgeries attending preassessment screening (PAS) clinics at the Queen Elizabeth Hospital Birmingham (QEHB) between July and August 2016. Primary outcome measure was 30-day overall complication rates and secondary outcomes were grade of complications, 30-day readmission rates, and postoperative care setting. Results. This study included 370 patients, of which 11% (41/370) had eGFR of <60 ml/min/1.73 m2. Patients with eGFR < 60 ml/min/1.73 m2 were more likely to have ASA grade 3/4 (p<0.001) and >2 comorbidities (p<0.001). Overall complication rates were 15% (54/370), with no significant difference in overall (p=0.644) and major complication rates (p=0.831) between both groups. In adjusted models, only surgery grade was predictive of overall complications. Preoperative eGFR did not impact on overall complications (HR: 0.89, 95% CI: 0.45–1.54; p=0.2). Conclusions. Preoperative eGFR does not appear to impact on postoperative complications in patients undergoing elective gastrointestinal surgeries, even when stratified by surgery grade. These findings will help preassessment clinics in risk stratification and optimisation of perioperative care of patients.

AGE-RELATED ISSUES OF THE QUALITY OF LIFE IN HEARING IMPAIRED PATIENTS

2021 ◽  
pp. 885-892
Author(s):  
Л. Е. Голованова ◽  
Е. А. Огородникова ◽  
Е. С. Лаптева ◽  
М. Ю. Бобошко
Keyword(s):  
Quality Of Life ◽  
Hearing Loss ◽  
Hearing Aids ◽  
Pure Tone Audiometry ◽  
Hearing Impaired ◽  
Hearing Disorders ◽  
Age Related ◽  
Sf 36 ◽  
Significant Difference

Целью исследования было изучение качества жизни лиц с нарушениями слуха в разных возрастных группах. Обследованы 100 пациентов, обратившихся в городской сурдологический центр для взрослых в связи с нарушением слуха: 50 человек - 34-59 лет, 50 - 60 лет и старше, из которых 32 человека были пожилого возраста (60-74 года)и 18 - старческого (75-86 лет). Степень тугоухости оценивали на основании результатов тональной пороговой аудиометрии. Для исследования качества жизни все пациенты заполняли общий опросник MOS SF-36, отражающий физический и психологический компоненты здоровья, а также специальный опросник HHIА(E)-S для лиц с нарушениями слуха. Установлено, что шкала HHIА(E)-S демонстрирует высокую корреляцию со степенью тугоухости у пациентов моложе 60 лет ( R =0,98; достоверность различий на уровне p <0,05), которая снижается у пациентов 60 лет и старше ( R =0,94; различия в оценках при разной степени тугоухости недостоверны). Значительные трудности в старшей возрастной группе могут быть связаны с тем, что людям пожилого и, особенно, старческого возраста сложно пользоваться слуховыми аппаратами (или они для них неэффективны) и оценивать свои затруднения по шкалам опросника. Целесообразно использовать шкалу HHIА(Е)-S в качестве скринингового инструмента для раннего выявления тугоухости, направления пациентов к сурдологу и своевременного слухопротезирования. The aim of the research was to study the quality of life in hearing impaired patients of different age. 100 patients referred to the city audiology centre because of their hearing disorders were examined: 50 patients from 34 to 59 years old and 50 patients from 60 years and older, from which 32 patients were of older age (60 to 74 years old) and 18 of oldest age (75 to 86 years old). A degree of hearing loss was assessed according to results of pure tone audiometry. To study the quality of life all patients filled in the questionnaire MOS SF-36, which evaluates physical and psychological components of health, and the questionnaire HHIA(E)-S, designed specifically for patients with hearing disorders. The HHIA(E)-S scale was found to show high correlation with hearing loss degree in patients younger than 60 years old ( R =0,98 with statistically significant difference, p <0,05), with decreasing correlation in patients from 60 years and older ( R =0,98; no significant difference while assessing various hearing loss degrees). Considerable difficulties in this age group may be explained by the fact, that older and especially oldest patients have a challenge with hearing aids usage (or they are of low efficiency for them) and with assessing theirs difficulties on the questionnaire scales. The HHIA(E)-S scale is useful as a screening tool for early detection of hearing loss, referral of patients to an audiologist and prompt hearing aid fitting.

Comparison of Hearing Results by Type of Tympanoplasty with Mastoid Obliteration during Chronic Otitis Media Surgery

2009 ◽  
Vol 45 (2) ◽  
pp. 122
Author(s):  
Jeong Uk Choi ◽  
Seung Eun Oh ◽  
Dong Hoon Lee ◽  
Yong Bum Cho ◽  
Hyong Ho Cho
Keyword(s):  
Otitis Media ◽  
Chronic Otitis Media ◽  
Mastoid Obliteration ◽  
Hearing Results

scholarly journals Impact of Acoustic and Interactive Disruptive Factors during Robot-Assisted Surgery—A Virtual Surgical Training Model

Sensors ◽  
2020 ◽  
Vol 20 (20) ◽  
pp. 5891
Author(s):  
Magret Krüger ◽  
Johannes Ackermann ◽  
Daniar Osmonov ◽  
Veronika Günther ◽  
Dirk Bauerschlag ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Video Games ◽  
Surgical Techniques ◽  
Training Model ◽  
German Society ◽  
Surgical Experience ◽  
Robot Assisted ◽  
Cross Sectional ◽  
Significant Difference ◽  
The Impact

The use of virtual reality trainers for teaching minimally invasive surgical techniques has been established for a long time in conventional laparoscopy as well as robotic surgery. The aim of the present study was to evaluate the impact of reproducible disruptive factors on the surgeon’s work. In a cross-sectional investigation, surgeons were tested with regard to the impact of different disruptive factors when doing exercises on a robotic-surgery simulator (Mimic Flex VRTM). Additionally, we collected data about the participants’ professional experience, gender, age, expertise in playing an instrument, and expertise in playing video games. The data were collected during DRUS 2019 (Symposium of the German Society for Robot-assisted Urology). Forty-two surgeons attending DRUS 2019 were asked to participate in a virtual robotic stress training unit. The surgeons worked in various specialties (visceral surgery, gynecology, and urology) and had different levels of expertise. The time taken to complete the exercise (TTCE), the final score (FSC), and blood loss (BL) were measured. In the basic exercise with an interactive disruption, TTCE was significantly longer (p < 0.01) and FSC significantly lower (p < 0.05). No significant difference in TTCE, FSC, or BL was noted in the advanced exercise with acoustic disruption. Performance during disruption was not dependent on the level of surgical experience, gender, age, expertise in playing an instrument, or playing video games. A positive correlation was registered between self-estimation and surgical experience. Interactive disruptions have a greater impact on the performance of a surgeon than acoustic ones. Disruption affects the performance of experienced as well as inexperienced surgeons. Disruption in daily surgery should be evaluated and minimized in the interest of the patient’s safety.

scholarly journals A comparison of screw versus drill and curettage epiphysiodesis to correct leg-length discrepancy

2018 ◽  
Vol 12 (5) ◽  
pp. 509-514 ◽  
Author(s):  
M. Troy ◽  
B. Shore ◽  
P. Miller ◽  
S. Mahan ◽  
D. Hedequist ◽  
...  
Keyword(s):  
Operative Time ◽  
Surgical Techniques ◽  
Leg Length Discrepancy ◽  
Complication Rates ◽  
Leg Length ◽  
Treatment Groups ◽  
Length Discrepancy ◽  
Baseline Activity ◽  
Significant Difference

Purpose To compare two common surgical techniques of epiphysiodesis: drill/curettage epiphysiodesis (PDED) versus cross screw epiphysiodesis (PETS). The hypothesis is that the two techniques have similar efficacy but demonstrate differences in length of hospital stay (LOS), time to return to activity and complication rates. Methods A retrospective review of growing children and adolescents less than 18 years old who required an epiphysiodesis with leg-length discrepancy (LLD) of 2 cm to 6 cm with minimum two years of follow-up was conducted. Characteristics including age at surgery, gender, epiphysiodesis location, side, operative time, LOS and hardware removal were compared across treatment groups. LLD, expected growth remaining (EGR) and bone age were determined preoperatively and at most-recent visit. The correction ratio (change in EGR) was calculated along with a 95% confidence interval (CI) to assess if correction in leg length was achieved. Results A total of 115 patients underwent epiphysiodesis in the femur (53%), tibia (24%) or a combination (24%). The cohort was 47% male, with a mean age of 12.6 years (7.7 to 17.7) at surgery. Median follow-up was 3.7 years (2.0 to 12.7). In all, 23 patients underwent PETS and 92 patients had PDED. Both treatment groups achieved expected LLD correction. There was no significant difference in median operative time, complication rates or LOS. PETS patients returned to activity at a mean 1.4 months (interquartile range (IQR) 0.7 to 2.1) while PDED patients returned at a mean 2.4 months (IQR 1.7 to 3) (p < 0.001). Conclusion Effectiveness in achieving expected correction, LOS and operative time are similar between screw and drill/curettage epiphysiodesis. Patients undergoing PETS demonstrated a faster return to baseline activity than patients with PDED. Level of Evidence: III

scholarly journals Comparison of efficacy of myringoplasty in dry and wet ears in chronic otitis media of tubotympanic type

2017 ◽  
Vol 3 (3) ◽  
pp. 705 ◽  
Author(s):  
Yogeshwar Chandrashekar ◽  
Ravishankar Chandrashekar
Keyword(s):  
Otitis Media ◽  
Statistical Significance ◽  
Chronic Otitis Media ◽  
Pure Tone Audiometry ◽  
Inflammatory Cells ◽  
P Value ◽  
Hearing Improvement ◽  
Female Ratio ◽  
Fascia Graft ◽  
A Prospective Study

<p class="abstract"><strong>Background:</strong> The objective of the study was to compare the outcome of myringoplasty in dry and wet ears in tubotympanic type of chronic otitis media (COM) with respect to graft uptake and hearing improvement.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study done in department of ENT Bangalore Medical College and Research Institute during the study period of November 2014 to May 2016, wherein a total of 60 patients of tubotympanic type COM with 30 cases each of dry and wet ears, aged 15-60 years were included. The hearing impairment was assessed and recorded by pure tone audiometry (PTA). After obtaining informed written consent the patients underwent myringoplasty (temporalis fascia graft, underlay technique). Microbiological examination of discharge in wet ears was done and histopathology of the excised remnant TM analyzed in both groups. Both groups of patients were followed up for 3 months and assessed for graft uptake and hearing improvement. PTA was repeated at 3 months postoperatively.  </p><p class="abstract"><strong>Results:</strong> Our study included 60 patients of tubotympanic type of COM with 30 cases each with dry and wet ears who underwent myringoplasty. Majority of our patients were in second decade in both the groups. There was slight female preponderance in our study with male to female ratio of 0.93:1. Discharge from ears in wet ears was mucoid in consistency and were culture negative. Histopathology of excised remnant TM in wet ears revealed evidence of inflammatory cells and vascularization within stroma of fibroblasts while these were absent in dry ear cases. The overall successful graft uptake following myringoplasty was 88.3% with 86.7% for wet ears and 90% for dry ears with no statistical significance (p value of 0.688&gt;0.05) between the two groups. With respect to hearing improvement post-operatively there was significant hearing improvement in both the groups when compared to preoperative hearing with a mean hearing gain (dB) of 3.43±2.81 in wet ear cases to 3.85±3.05 in dry ear cases, but when compared between the two groups, there was no significant statistical difference (p value of 0.582&gt;0.05).</p><p><strong>Conclusions:</strong> The outcome is equally good for myringoplasty in dry and wet ears in tubotympanic type of chronic otitis media with respect to graft uptake and hearing improvement. </p>

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