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Song B, Koh SM, Kim J, Cho YS. Audiologic Outcomes After Vestibulotomy in Patients With Congenital Absence of the Oval Window. Otol Neurotol 2024; 45:e427-e434. [PMID: 38693092 DOI: 10.1097/mao.0000000000004182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To examine the clinical features and surgical outcomes in patients with congenital absence of the oval window (CAOW), and to investigate the potential factors that affect audiologic results. STUDY DESIGN A retrospective chart review. SETTING A tertiary academic center. PATIENTS AND INTERVENTION A total of 17 ears among 16 patients were confirmed to have CAOW. Among them, 13 ears underwent vestibulotomy for hearing reconstruction. Clinical parameters associated with the hearing outcomes were analyzed. MAIN OUTCOME MEASURES A mean air-bone gap (ABG) after 6-month and long-term follow-up was compared with preoperative measurements. RESULTS Intraoperative findings showed that anomalies of the malleus or incus were observed in 11 ears (64.7%), stapes anomalies were present in all ears (100%), and facial nerve anomalies were present in 10 ears (58.8%). Because of unfavorable facial nerve anomalies, hearing reconstruction was aborted in four cases (23.5%). In the hearing reconstruction group, the mean ABG at 6 months postoperation was significantly reduced after compared with the preoperative value (44.0 ± 8.4 dB versus 58.8 ± 9.1 dB, p = 0.006). After dividing ears into a success subgroup (ABG ≤ 30 dB, seven ears) and non-success subgroup (ABG > 30 dB, six ears), the use of a drill during vestibulotomy was significantly related to a poor hearing outcome (100% versus 16.7%, p = 0.015). The long-term follow-up result (mean, 60 mo) revealed no deterioration compared with the 6-month postoperative result. Five ears (29.4%) underwent revision surgery, and three of them showed ABG improvements. No serious complications were reported. CONCLUSION Vestibulotomy is an effective and safe option for hearing restoration in patients with CAOW, particularly when the use of a drill is not required. The long-term audiologic outcome is also reliable.
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Affiliation(s)
- Bokhyun Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ottaiano AC, Gomez GD, Freddi TDAL. The Facial Nerve: Anatomy and Pathology. Semin Ultrasound CT MR 2022; 44:71-80. [PMID: 37055142 DOI: 10.1053/j.sult.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The facial nerve is the seventh cranial nerve and consists of motor, parasympathetic and sensory branches, which arise from the brainstem through 3 different nuclei (1). After leaving the brainstem, the facial nerve divides into 5 intracranial segments (cisternal, canalicular, labyrinthine, tympanic, and mastoid) and continues as the intraparotid extracranial segment (2). A wide variety of pathologies, including congenital abnormalities, traumatic disorders, infectious and inflammatory disease, and neoplastic conditions, can affect the facial nerve along its pathway and lead to weakness or paralysis of the facial musculature (1,2). The knowledge of its complex anatomical pathway is essential to clinical and imaging evaluation to establish if the cause of the facial dysfunction is a central nervous system process or a peripheral disease. Both computed tomography (CT) and magnetic resonance imaging (MRI) are the modalities of choice for facial nerve assessment, each of them providing complementary information in this evaluation (1).
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Jang P, Lee SJ, Koo JW, Song JJ. "Cement Bridge Over Troubled Incus" Technique in Patients With Oval Window Atresia and Anomalous Incus: A Preliminary Report. Clin Exp Otorhinolaryngol 2022; 15:197-199. [PMID: 35255662 PMCID: PMC9149235 DOI: 10.21053/ceo.2021.01823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/16/2021] [Accepted: 01/19/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Pilkeun Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Jae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ja-Won Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Gao M, Zhao C, Yang J, Chen P, Liu Y, Wang D, Zhao S. Bone-conduction hearing aid is effective in congenital oval window atresia. Acta Otolaryngol 2021; 141:321-327. [PMID: 33439071 DOI: 10.1080/00016489.2020.1866211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Implantable bone-conduction hearing aids (BCHA) are effective in patients with congenital ear malformations.However, there is no large sample study to verify the efficacy of Bonebridge in patients with congenital oval window atresia. OBJECTIVES To investigate efficiency of implantable bone-conduction hearing aids in Mandarin-speaking patients with congenital oval window atresia. MATERIAL AND METHODS We retrospectively analyzed 15 patients, who were confirmed with either unilateral or bilateral congenital oval window atresia by temporal bone CT. All patients were implanted with a bone-conduction hearing device between July 2016 and July 2019 at Beijing Tongren Hospital, Capital Medical University. Pure tone audiometry (PTA), air-bone gap (ABG), speech discrimination scores (SDSs), and hearing thresholds were performed. RESULTS Postoperative complications including facial paralysis were particularly rare. Unaided mean sound field threshold was 62.2 ± 10.5 dBHL and that with implantable bone-conduction hearing aids was 39.1 ± 13.2 dBHL (p < 0.01). The mean speech discrimination scores improved greatly (p < 0.01), specifically with regard to sentence and disyllabic words. CONCLUSIONS Patients with congenital oval window atresia often show moderate to severe conductive hearing loss. Implantable bone-conduction hearing aids are considerably safe and stable for hearing rehabilitation. It is a novel treatment modality for Mandarin-speaking patients with congenital oval window atresia.
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Affiliation(s)
- Mengdie Gao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
| | - Chunli Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
| | - Jinsong Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
| | - Peiwei Chen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
| | - Yujie Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
| | - Danni Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
| | - Shouqin Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
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Hempel JM, Epp A, Volgger V. [Hearing rehabilitation with the Vibrant Soundbridge in patients with congenital middle ear malformation]. HNO 2021:10.1007/s00106-021-01004-5. [PMID: 33599810 DOI: 10.1007/s00106-021-01004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Congenital aural atresia, which is usually unilateral, causes hearing loss and aesthetic impairment. Besides tympanoplasty with/without canalplasty and bone conduction devices, active middle ear implants are also available for functional rehabilitation. OBJECTIVE This article aims to present a contemporary review on the treatment possibilities for middle ear malformations, with a focus on audiological rehabilitation with the Vibrant Soundbridge. MATERIALS AND METHODS A selective literature search for treatment possibilities was performed in PubMed up to October 2020, and personal clinical experiences are reported. RESULTS The Vibrant Soundbridge, which is approved for children ≥ 5 years, is suitable for treatment of middle ear malformations with a Jahrsdoerfer score ≥ 5. Although implantation of a Vibrant Soundbridge is surgically more demanding than implantation of a bone conduction device, the method is safe, delivers good auditory results (superior to bone conduction devices in terms of speech understanding and spatial hearing), does not involve intensive postsurgical care, and rarely requires revision surgery. The Vibrant Soundbridge can be coupled to (remnants of) the ossicular chain or the round window. CONCLUSION The Vibrant Soundbridge is an appropriate treatment method in patients with middle ear malformations who have suitable anatomical preconditions.
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Affiliation(s)
- J M Hempel
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, LMU Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
| | - A Epp
- Kinderklinik, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - V Volgger
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, LMU Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland
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Beger O, Vayisoğlu Y, Güven O, Adanır SS, Taghipour P, Çakır S, Dağtekin O, Talas DÜ. Anatomic features of the fetal round and oval windows, and their relations with the tympanic nerve. Surg Radiol Anat 2021; 43:1203-1221. [PMID: 33438111 DOI: 10.1007/s00276-020-02672-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The study aimed to examine morphometric properties of the round window (RW) and oval window (OW) and to show their relation with the tympanic nerve (the Jacobson's nerve, JN) in human fetuses from the otologic surgeon's perspective. METHODS Thirty temporal bones of 15 fetal cadavers (8 males, 7 females) aged with 24.40 ± 3.71 weeks were included in the study. The height, width and surface area of the RW and OW and also distance from the JN to the OW and RW were measured. RESULTS The height, width and surface area of the RW in this work were measured as 1.48 ± 0.25 mm, 1.57 ± 0.37 mm, and 2.05 ± 0.69 mm2, respectively. The RW was detected as round-shaped (8 cases, 26.7%), oval-shaped (15 cases, 50%), and dome-shaped (7 cases, 23.3%). The height, width and surface area of the OW were measured as 1.42 ± 0.26 mm, 2.90 ± 0.44 mm, and 3.63 ± 0.74 mm2, respectively. The OW was observed as oval-shaped (15 cases, 50%), kidney-shaped (10 cases, 33.3%), D-shaped (4 cases, 13.3%), and trapezoid-shaped (1 case, 3.3%). The JN was found 1.21 ± 0.60 and 1.18 ± 0.54 mm away from the RW and OW, respectively. CONCLUSION This study containing morphological data about the shapes, diameters and area of the RW and OW may be useful to predict surgical difficulty, and to select implants of suitable size preoperatively for the windows. Knowing the relationship between the JN and the windows can be helpful to avoid iatrogenic injuries of the nerve.
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Affiliation(s)
- Orhan Beger
- Faculty of Medicine, Department of Anatomy, Gaziantep University, Gaziantep, Turkey
| | - Yusuf Vayisoğlu
- Faculty of Medicine, Department of Otorhinolaryngology, Mersin University, Ciftlikkoy Campus, 33343, Mersin, Turkey
| | - Onurhan Güven
- Faculty of Medicine, Department of Otorhinolaryngology, Mersin University, Ciftlikkoy Campus, 33343, Mersin, Turkey
| | - Saliha Seda Adanır
- Faculty of Medicine, Department of Anatomy, Gaziantep University, Gaziantep, Turkey
| | | | - Salim Çakır
- Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Oykut Dağtekin
- Department of Histology and Embryology, Mersin City Hospital, Mersin, Turkey
| | - Derya Ümit Talas
- Faculty of Medicine, Department of Otorhinolaryngology, Mersin University, Ciftlikkoy Campus, 33343, Mersin, Turkey.
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Zhang N, Li Y, Ma X, Wang D, Li S, Yan F, Zhao S. Isolated Congenital Middle Ear Malformations: Comparison of Preoperative High-Resolution CT and Surgical Findings. Ann Otol Rhinol Laryngol 2019; 129:216-223. [PMID: 31631685 DOI: 10.1177/0003489419883659] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives: To compare preoperative temporal bone high-resolution computed tomography (HRCT) readings to intraoperative findings during exploratory tympanotomy for suspected cases of isolated congenital middle ear malformations (CMEMs) and summarize the malformations that can and cannot be diagnosed with HRCT. Methods: A retrospective study was conducted. All cases were confirmed as isolated CMEMs during surgery. Detailed clinical records were reviewed, with a focus on imaging and surgical findings. Results: One hundred and thirty-two patients and 145 ears were reviewed. Ninety cases (62.1%) could be identified as isolated CMEMs and at least one as middle ear anomaly using preoperative HRCT. Fifty-five cases (37.9%) were reported to be completely normal and the patients underwent exploratory tympanotomy to determine the final diagnosis. Stapes fixation, either alone or associated with other ossicular chain anomalies, contributed to 53.1% of the cases. Most cases of aplasia or dysplasia of the ossicular chain, for example, aplasia/dysplasia of the long process of the incus, aplasia of the stapes’ superstructure, and atresia of the oval window were easily identified in preoperative HRCT. However, fixation of the ossicular chain can be elusive in HRCT, and exploratory tympanotomy is needed for a definitive diagnosis. Conclusions: HRCT provides helpful preoperative clinical information in CMEM and may obviate the need for middle ear exploration in some cases. The negative findings (anomalies that are difficult to identify through preoperative HRCT) and the positive findings (anomalies that are relatively easy to identify through preoperative HRCT) were summarized.
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Affiliation(s)
- Na Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery (Ministry of Education), Beijing Institute of Otolaryngology, Beijing, China
| | - Yi Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery (Ministry of Education), Beijing Institute of Otolaryngology, Beijing, China
| | - Xiaobo Ma
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery (Ministry of Education), Beijing Institute of Otolaryngology, Beijing, China
| | - Danni Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery (Ministry of Education), Beijing Institute of Otolaryngology, Beijing, China
| | - Shuling Li
- Department of Radiology, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Fei Yan
- Department of Radiology, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Shouqin Zhao
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery (Ministry of Education), Beijing Institute of Otolaryngology, Beijing, China
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Gungor V, Atay G, Bajin MD, Yarali M, Sarac S, Sennaroglu L. Comparison of various bone cement ossiculoplasty techniques and functional results. Acta Otolaryngol 2016; 136:883-7. [PMID: 27118255 DOI: 10.3109/00016489.2016.1172255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In this study, functional results of different bone cement ossiculoplasty techniques are compared. METHODS Retrospective case review at a tertiary referral center. Patients who underwent middle ear surgery and bone cement ossiculoplasty between 2006-2012 were included. A total of 52 patients, including 30 patients with 'Incus to stapes' (Group 1) and 13 patients with 'malleus to stapes' (Group 2), five patients with 'incudoplasty + stapedotomy' (Group 3), and four patients with 'malleus to incus' (Group 4) ossiculoplasty were enrolled in the study. Pre-operative and post-operative audiological findings of each group were evaluated. RESULTS The mean hearing gain (the difference between pre-operative and post-operative air bone gap (ABG)) was 13 dB for Group 1, 30 dB for Group 2, 24 dB for Group 3, and 9 dB for Group 4. The pre-operative air pure tone averages (PTA) of groups 1, 2, and 3 improved significantly in the post-operative period (p < 0.05). Closure of post-operative ABG of patients to less than 20 dB and 10 dB were as follows: ∼70% and 43% in group 1; 86% and 76% in group 2; 100% and 60% in group 3; and 75% and 50% in group 4, respectively. CONCLUSIONS The results showed that glass ionomer cement is a simple and effective method for reconstruction of ossicular discontinuity in various ossicular chain pathologies and can be an alternative to conventional rebridging techniques such as sculpted incus interposition or partial ossicular replacement prosthesis (PORP).
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Affiliation(s)
- Volkan Gungor
- a Department of Otorhinolaryngology Head and Neck Surgery , Ankara Numune Education and Research Hospital , Ankara , Turkey
| | - Gamze Atay
- b Department of Otorhinolaryngology Head and Neck Surgery , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - M Demir Bajin
- b Department of Otorhinolaryngology Head and Neck Surgery , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Mehmet Yarali
- c Department of Audiology , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Sarp Sarac
- d Department of Otorhinolaryngology Head and Neck Surgery , Koc University Faculty of Medicine , İstanbul , Turkey
| | - Levent Sennaroglu
- b Department of Otorhinolaryngology Head and Neck Surgery , Hacettepe University Faculty of Medicine , Ankara , Turkey
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