An audit of ‘dead ear’ after ear surgery

Risk of hearing loss in the opposite ear after tympanomastoidectomy

PURPOSE

The definitive treatment for chronic suppurative otitis media is surgery. Surgical technique and procedure varies according to individual case findings and pathology and may require mastoidectomies in which the canal wall is preserved or lowered to eradicate disease from mastoid air cells. Surgical treatment of chronic middle ear disease carries a risk of damage to the inner ear. The aim of this study was to investigate whether the noise produced by the tour system following chronic ear surgery causes sensorineural hearing loss, a condition for which not many studies have been published in the literature.

METHODS

The study consisted of a total of 49 patients with type I, type II and type III canal wall preservation and 62 patients with tympanoplasty with canal wall preservation and lowering. Bone and air thresholds were compared before and after middle ear surgery. Changes in bone and air thresholds were compared according to the type of tympanoplasty.

RESULTS

In the ICW-I, ICW-II and ICW-III tympanoplasties, and in the ICW and CWD tympanoplasties, the preoperative and postoperative values of the opposite ear hearing measurements were performed, and did not differ according to the type of surgery. There is no correlation drilling duration and hearing for the opposite ear.

CONCLUSION

The prevention of postoperative sensorineural hearing loss depends on multiple factors, and assessing the magnitude of hearing loss in relation to these factors is important in determining the success of the surgery.

Audit of middle-ear surgery outcomes in a tertiary referral Australian teaching hospital

OBJECTIVE

This study aimed to audit middle-ear surgical procedures, provide a record of Australian experiences and allow comparisons with other published audits.

METHOD

A retrospective continuous series audit was conducted on 274 patients who underwent tympanoplasty, mastoidectomy and stapedotomy surgery at Westmead Hospital, Sydney. All consecutive surgical procedures, performed by multiple operators at various stages of training but under the care of a single surgeon, were included.

RESULTS

Graft uptake was 86.9 per cent in tympanoplasty. Well healed cavities were seen in 72 per cent of mastoidectomies. Although 42 per cent of the patients had one or more co-morbidities, this did not influence the outcome. Hearing improvement was dramatic in stapedotomy and minimally changed in mastoidectomy. Post-operative complications were minimal.

CONCLUSION

All forms of middle-ear surgery were effective in achieving their surgical goals. Aural discharge and inflammatory diseases were well controlled with tympanoplasty and mastoid surgery.

Meta-analysis of hearing outcomes of chronic otitis media surgery in the only hearing ear

OBJECTIVE

To assess the hearing outcomes of surgery for patients with chronic otitis media (COM) with or without cholesteatoma in case of the only hearing ear (OHE).

METHODS

This meta-analysis included COM patients with hearing in only one ear. The PubMed, Scopus, and Cochrane databases were reviewed.

RESULTS

Thirteen studies were included, 252 excluded. The total number of operated ears was 229. The patients' ages ranged from 6 to 78 years. A change greater than 10 dB in hearing thresholds in the OHE was considered as a significant result. When both the COM with (cCOM) and without cholesteatoma (ncCOM) cases were considered, the air bone gap (ABG), air conduction (AC) and bone conduction (BC) thresholds were stable or improved in 91.06% (95% CI:81.94-97.19%), 87.91% (82.14-92.34%), and 94.99% (95% CI:90.20-97.97%) of patients, respectively. Stable or improved ABG, AC and BC thresholds were observed in 92.36% (95% CI:81.67-97.86%), 87.36% (95% CI:71.46-96.23%), and 94.85% (95% CI:81.36-99.49%) of those with ncCOM, respectively. For patients with cCOM, the results were 85.96% (95% CI:81.36-99.49%), 85.20% (95% CI:76.04-91.87%), and 97.01% (95% CI:89.62-99.63%), respectively. There were no significant differences in these thresholds between either category.

CONCLUSION

Hearing deterioration in AC and BC thresholds can be expected in about 13-15% and 5-3%, respectively, of patients, with ncCOM or cCOM. Our results should not be construed as a guide for determining surgery eligibility in patients with COM in the OHE.

Ear, Nose, and Throat Surgery: Postoperative Complications After Selected Head and Neck Operations

Unanticipated complications of ENT surgeries may have profound functional and esthetic consequences for patients. Herein, we provide a broad overview of postoperative complications after ENT surgery, illustrating their unique nature, impact, and principles of management. The discussion is organized by subspecialty to highlight the great anatomic complexity of the head and neck and the importance of critical neurovascular and sensory structures that make ENT an impactful, yet challenging surgical specialty.

Sensorineural Hearing Loss After Surgery to Treat Chronic Otitis Media

OBJECTIVE

We investigated the incidence of sensorineural hearing loss (SNHL) after chronic otitis media (COM) surgery and determined the associated factors.

METHODS

Data were collected via retrospective medical chart review.

RESULTS

Of the 192 patients, 82 underwent tympanoplasty, 26 underwent canal wall up mastoidectomy with tympanoplasty, and 84 underwent canal wall down mastoidectomy with tympanoplasty. After surgery, the average air conduction (AC) hearing threshold improved significantly, from 125 to 1000 Hz, but the average high-frequency AC and bone conduction (BC) hearing thresholds deteriorated significantly. In 21 (11%) cases, the BC hearing threshold worsened by more than 15 dB at 4000 Hz. When we compared these 21 cases to patients in whom hearing was preserved, the former group was found to be significantly younger and had a higher frequency of cholesteatomatous otitis media. However, when comparing the severity of inflammation in patients with temporal bone computed tomography, there was no significant difference between the 2 groups.

CONCLUSIONS

High-frequency SNHL may develop after surgery to treat COM, especially in young patients with cholesteatoma.

Comparison of bilateral same-day and sequential endoscopic cartilage myringoplasty for bilateral chronic tympanic membrane perforation

Background: There is debate over the applicability of bilateral same-day myringoplasty in patients with bilateral chronic tympanic membrane perforations (TMPs) requiring ear surgery on both sides.Objectives: To evaluate the healing and hearing outcomes of bilateral endoscopic 'push-through' cartilage myringoplasty in patients with bilateral chronic TMPs with mucosal chronic otitis media (COM) on the same day.Material and methods: The medical records of 60 patients (120 ears) with bilateral chronic TMPs who underwent bilateral same-day or sequential endoscopic push-through cartilage myringoplasty between January 2014 and March 2019 were evaluated.Results: Of the 60 patients with 120 ears, 26 patients with 52 ears were in the bilateral same-day group and 34 patients with 68 ears in the sequential group. The overall graft success rate at 3 months was 92.3% (48/52) in the same-day group and 94.1% (64/68) in the sequential group. None of the sensorineural HL and retraction pockets occurred in two groups.Conclusions and significance: Bilateral push-through cartilage myringoplasty can be performed safely for the patients with bilateral chronic TMPs in the same day, it significantly reduced the medical costs and shortened the operation time and length of stay compared to sequential myringoplasty.

Long-term results of a hearing test in patients operated for chronic otitis media

<b> Introduction: </b>Chronic otitis media is characterized by tympanic membrane perforation and conductive hearing loss. In the active form of this disease, there will also be periodic or permanent otorrhea. With a number of surgical techniques available depending on intraoperative findings, otosurgery is the treatment of choice in such cases, the extent of which depends on the type and extent of the pathological changes. <br><b>Material and Method:</b> We carried out an analysis of 79 patients with chronic otitis media undergoing surgery at the Department of Otolaryngology, Jagiellonian University Medical College in Kraków between 2005 and 2014. Total audiometry was used as a part of hearing assessment, before the surgery, 6 months after the surgery and in the distant 10-year observation period. In addition, each patient completed the questionnaire and was examined by an otolaryngologist. <br><b> Results:</b> The analysis included 79 patients operated on due to chronic otitis media. The mean bone conduction (for frequencies 500,1000 and 2000 Hz) before surgery was 31.8 dB, it did not differ significantly (p = 0.355) after 6 months after surgery (32.8 dB), while it significantly increased (p < 0.001) in a distant 10-year control of 43.4 dB. The mean air conduction (for frequencies 500, 1000 and 2000 Hz) before the procedure was 57.6 dB, it significantly improved in the early control by 50.5 dB, at p < 0.001. In long-term follow-up it increased again to 61.3 dB and was significantly different from the early postoperative period (p < 0.001). The mean air-bone gap for frequencies 500, 1000 and 2000 Hz before surgery was on average 26.4 dB, it was significantly (p < 0.001) reduced in the postoperative period by 17.6 dB. The level of air-bone gap remained at a similar level in distant control. <br><b>Conclusions:</b> (1) A completely preserved ossicular chain in the absence of active chronic otitis media is the best prognosis for stable hearing improvement over the years with normal inner ear function; (2) Reoperation worsens the long-term results of a hearing test compared to the first operation.

Post-operative Sensorineural Hearing Loss After Middle Ear Surgery

Chronic suppurative otitis media is managed by tympanomastoid surgery often requires mastoid drilling. Sometimes patients develop sensorineural hearing loss after middle ear surgery. Objective of the study was to compare pre and post operative bone conduction thresholds after middle ear surgeries. The study was conducted on 90 patients who had undergone middle ear surgeries, 30 patients of tympanoplasty (group I), modified intact canal wall mastoidectomy and tympanoplasty type-I (group II) and modified radical mastoidectomy (group III) each ware included. Demographic and clinical data were reviewed. Duration of surgery, ossicular and middle ear status and drilling time noted. Pre operative and post operative (after 3-4 months) bone conduction thresholds were compared statistically. A value of p < 0.05 was considered statistical significant. The average pre-operative hearing loss of study group was 43.78 ± 14.22 dB. Though postoperatively mean air conduction threshold improved to 36.07 ± 13.05 dB, six patients presented with deterioration of hearing. Mastoidectomy has been performed in all six. Post-operative worsening of bone conduction was seen in three patients (13.75-21.5 dB), one patient of group II and two patients of group III developed postoperative worsening of bone conduction thresholds. Significant hearing losses may occur after tympanomastoid surgery in few patients. While we are evaluating the results besides reporting average results such individual patient should be identified.

Results of revision myringoplasty: are they different to those of primary myringoplasty?

Audit question: Does revision myringoplasty have worse outcomes than primary surgery?

METHODS

The International Otology Database has been used to record data on surgery for middle-ear disease in Norfolk, UK, over nine years. The data show the results of all myringoplasty cases and the results of revision cases. Outcome measures are perforation and hearing change. Comparison is made with benchmark centres of excellence.

RESULTS

A total of 611 operations included myringoplasty; 356 (58 per cent) of cases had a recorded follow up at 3 months. Twenty-nine patients (8.1 per cent) had a post-operative perforation. Benchmark centres performed 2319 operations; 1284 (55 per cent) of these had a follow up at 3 months, and 82 patients (6.4 per cent) had a perforation at follow up. Sixty-nine of the Norfolk patients were revision cases. Six of the 69 patients (8.7 per cent) had a perforation at follow up. The average hearing gain in the revision myringoplasty patients in Norfolk was 7 dB.

CONCLUSION

The results of the revision myringoplasty cases are the same as those for the primary myringoplasty cases in this series.

Hearing loss following myringoplasty - implications for informed consent

BACKGROUND

There are many reports of operations performed to successfully close ear drum perforations. Hearing deterioration after myringoplasty is not a widely published topic. This paper presents an audit of this complication.

METHODS

A six-year retrospective analysis of a series of myringoplasty operations was performed using electronic patient records. Patients with post-operative hearing loss were identified and those with hearing loss greater than 10 dB were further scrutinised.

RESULTS

Out of 187 patients who underwent myringoplasty procedures, 44 (23.53 per cent) experienced a reduction in hearing thresholds. In seven cases (3.74 per cent), the hearing loss was greater than 10 dB. A case note review revealed no obvious predictive factors, although posterior perforations and the possibility of ossicular chain manipulation were considered.

CONCLUSION

Hearing loss following myringoplasty is not rare, and this may alter the consent process for this procedure.