[Assessment of surgical success rate and acoustic test findings in children after tympanostomy tube insertion]

Otoacoustic emissions are low density sounds produced from intact cochlea measurable in the presence of an intact conduction structure. The goal of this study was to assess the surgical success rate after tympanostomy tube insertion by Distortion Product Otoacoustic Emission [DPOAE] and Transient Evoked Otoacoustic Emission [TEOAE] as methods of evaluation of postoperative hearing. A descriptive-analytic study was conducted on 130 patients with OME. Audiometrical tests included TEOAE, DPOAE that were performed before, one month and three months after surgery on patients and results were compared. Prior to surgery, TEOAE and DPOAE responses were not recordable in any of the patients, whereas after surgery, the responses were significant. OAE tests can be used as objective, simple tests in children, especially in toddlers who are not able to cooperate in performing PTA before surgery. These tests can be also be used for follow up of patients for hearing loss improvement and resolvement of middle ear effusion

Sensorineural hearing loss in chronic otitis media

Conductive hearing loss due to chronic otitis media [COM] can be treated by surgery. COM, however, may be associated with functional damage to the inner ear. Sensorineural hearing loss [SNHL] due to COM has been found to be significant by some authors, whereas it has been considered negligible by others. The present study aimed to answer the question; Does COM cause SNHL? 120 patients with unilateral COM admitted for tympano-mastoidectomy were selected for this observational case-control study. Air conduction threshold [ACT] and bone conduction threshold [BCT] averages were calculated at the speech frequencies [500, 1000, 2000Hz] and 4 KHz, in affected [case ear] and non affected [control ear] and then entered in the questionnaire along with intraoperative findings. Multiple statistical tests were used to clarify the relationships between SNHL and COM. COM was seen to be associated with SNHL. The Threshold shift was more accentuated at 4 KHz in older patients. SNHL at 4 KHz seemed to be higher than that at the speech frequencies. There was a significant positive relationship between the elevated BCT and duration of COM. The relationship between elevated BCT and cholesteatoma was also significant. The inner ear is vulnerable to COM. The proximity of the sensory cells to the potential source of harm [inflamed middle ear] may mean higher exposure, as reflected by the fact that sensory cells processing high frequencies are more seriously damaged. SNHL in affected ear is strongly dependant on duration of disease

[Assessment of spontaneous healing rate of traumatic tympanic membrane perforations and three months follow up; Yazd Forensic Medicine]

Traumatic tympanic membrane [TM] perforation is a common injury of the ear with a high rate of spontaneous healing if the patients strictly adhere to water precautions. The purpose of this study was to determine the factors involved in the spontaneous healing of traumatic TM perforations in order to ascertain the best treatment plan including observation, paper patch and finally surgery. In this correlative-descriptive study, we recorded the outcome of each patient with three-month follow up. Included in this study were a total of 202 forensic medicine patients from the Dept. of Otolaryngology Head and Neck Surgery at the Yazd University of Medical Sciences, Yazd, Iran. All patients included in this study had traumatic TM perforation. Based on otoscopic examination, the perforations were classified as pinpoint or large. All patients received an audiometry exam and were followed for three months. The data was collected using a special form and analyzed by chi-square test, Fisher exact test and ANOVA. This study consisted of 118 male and 84 female patients with a mean age of 23.6 years [6-48 years]. The types of trauma included compression injury [104 patients], instrumental injury [59 patients], burn-slag injury [2 patients] and blast injury [1 patient]. One hundred and eighty patients had pinpoint TM perforations, 99.4% of which healed spontaneously by the second month, and 32 patients had large TM perforations, 50% of which healed spontaneously by the second month. During the first month, 87.3% of the patients observing water precautions had healed, however the healing rate was only 5.6% in patients not adhering to water precautions, who suffered from otorrhea. Therefore, during this study, 185 [91.58%] patients had spontaneous healing by two months and only 6 patients of remaining 17 patients healed with paper patch. The mean hearing loss at 500, 1000 and 2000 Hz was 10.55 dB [5-30 dB]. In our experience, patients with traumatic TM perforations have higher spontaneous healing rate when observing water precautions. Furthermore, we recommend observation and paper patching for three months before attempting any surgical intervention in such patients