Comparison between clinical and audiological results of tympanoplasty with modified sandwich technique and underlay technique / Comparação entre os resultados clínicos e audiológicos de timpanoplastia com a técnica "sanduíche" modificada e a técnica underlay

Abstract Introduction: Surgical repair of the tympanic membrane, termed a type one tympanoplasty is a tried and tested treatment modality. Overlay or underlay technique of tympanoplasty is common. Sandwich tympanoplasty is the combined overlay and underlay grafting of tympanic membrane. Objective: To describe and evaluate the modified sandwich graft (mediolateral graft) tympanoplasty using temporalis fascia and areolar fascia. To compare the clinical and audiological outcome of modified sandwich tympanoplasty with underlay tympanoplasty. Methods: A total of 88 patients of chronic otitis media were studied. 48 patients (Group A) underwent type one tympanoplasty with modified sandwich graft. Temporalis fascia was underlaid and the areolar fascia was overlaid. 48 patients (Group B) underwent type one tympanoplasty with underlay technique. We assessed the healing and hearing results. Results: Successful graft take up was accomplished in 47 patients (97.9%) in Group A and in 40 patients (83.3%) Group B. The average Air-Bone gap closure achieved in Group A was 24.4 ± 1.7 dB while in Group B; it was 22.5 ± 3.5 dB. Statistically significant difference was found in graft healing rate. Difference in hearing improvement was not statistically significant. Conclusion: Double layered graft with drum-malleus as a 'meat' of sandwich maintains a perfect balance between sufficient stability and adequate acoustic sensitivity.

Resumo Introdução: O reparo cirúrgico da membrana timpânica, denominado timpanoplastia tipo 1, é uma modalidade de tratamento já bem estabelecida. As técnicas overlay ou underlay de timpanoplastia são comuns. A timpanoplastia "sanduíche" é a técnica de enxerto de membrana timpânica overlay e underlay combinadas. Objetivo: Descrever e avaliar a timpanoplastia com a técnica "sanduíche" modificada (timpanoplastia mediolateral) utilizando fáscia temporal e fáscia aureolar. Comparar o desfecho clínico e audiológico da timpanoplastia com a técnica "sanduíche" modificada com o da timpanoplastia com a técnica underlay. Método: Foram estudados 88 pacientes com otite média crônica, 48 (Grupo A) foram submetidos à timpanoplastia tipo 1 com enxerto "sanduíche" modificado. A fáscia temporal foi utilizada na técnica underlay e a fáscia areolar na técnica overlay. 48 pacientes (Grupo B) foram submetidos à timpanoplastia tipo 1 com a técnica underlay. Foram avaliados os resultados da cicatrização e da audição. Resultados: O sucesso do enxerto ocorreu em 47 pacientes (97,9%) no Grupo A e em 40 (83,3%) do Grupo B. O fechamento médio do gap aéreo-ósseo no Grupo A foi de 24,4 ± 1,7 dB, enquanto no Grupo B foi de 22,5 ± 3,5 dB. Houve diferença estatisticamente significativa na taxa de cicatrização do enxerto. A diferença na melhora auditiva não foi estatisticamente significante. Conclusão: O enxerto de camada dupla e o tímpano-martelo posicionados como o "recheio" do sanduíche mantém um equilíbrio perfeito entre a estabilidade necessária e adequada sensibilidade acústica.

Ganancia auditiva en timpanoplast¡a tipo I, Hospital de Especialidades N2 del Centro Médico Nacional del Noroeste "Lic. Luis Donaldo Colosio Murrieta" / Hearing gain in tympanoplasty type I, Lic. Luis Donaldo Colosio Murrieta Northwest Specialty Hospital Nº2

Objetivo: determinar si existe ganancia auditiva posterior a la realización de timpanoplastía tipo 1 en pacientes con otitismedia crónica e hipoacusia conductiva.Material y Métodos: Este estudio se realizó en servicio de otorrinolaringología del Hospital de especialidades N°2, unidadmédica de alta especialidad, centro médico nacional del noroeste en ciudad Obregón, Sonora. Se llevó a cabo un estudiode cohorte retrospectivo, analítico, longitudinal. Descripción general del estudio. Se revisó el expediente clínicos de lospacientes con diagnóstico de secuelas de otitis media crónica, posoperados de timpanoplastía tipo 1, atendidos en elservicio de esta institución de marzo 2011 a abril 2014. Se tomaron datos como edad, sexo, lugar de procedencia, siexistieron complicaciones postquirúrgicas, nivel promedio de audición previo y posterior a intervención quirúrgica.Resultados: De un total de 237 expedientes revisados, se encontraron 51 expedientes completos, de los cuales 33pacientes fueron femeninos (64.7%) el rango de edad fue de 9 a 71 años, con media de 36.7 años. el lado operado más frecuente fue el derecho en 33 pacientes (64.7%). No se documentó ninguna complicación en los expedientes revisados. La evaluación de la audiometría previa la cirugía, se observó algún grado de hipoacusia en 46 pacientes (90.19%) y normal en 5pacientes (9.8%). Postquirúrgicamente se mostró audiometría normal en 38 pacientes (74.5%), y anormal en 13 pacientes(25.49%) con una p <.0001. Existe ganancia auditiva estadísticamente significativa con timpanoplastía tipo 1 en pacientescon secuelas de otitis media crónica en la unidad médica alta especialidad, cd. Obregón, Sonora.Conclusión: En la mayoría de nuestros pacientes la timpanoplastía tipo 1, presentaron mejoría en la audición. Estosresultados son similares a los que encontraron otros autores como shrestha y et al.

Objective: to determine if there is a hearing gain after performing a tympanoplasty type 1 in patients with mid level chronic otitis and conductive hearing loss. Material and Methods: This study was conducted in the otolaryngology service of the Specialty Hospital N§2, highly specialized medical unit, Northwest National Medical Center in Obregon city, Sonora. A study of a retrospective, analytical and longuitudinal cohort was carried out. Overview of the Study: Clinical records of patients diagnosed with sequale of mid level chronic otitis, tympanoplasty type 1 post surgery patients in this institution from March 2011 to April 2014 were reviewed. Data such age, sex and place of origin were taken and if there were any post surgery complications, average level of hearing previous and after surgery. Results: From a total of 237 reviewed patients, 51 were completed, of which 33 were female (64.7%), range of age was fron 9 to 71 years old with an average of 36.7 years old.The most frequent operated side was the right in 33 patients (64.7%). No complications in the files reviewed were found. In the evaluation of audiometry previous the surgery, certain degree of hearing loss was observed in 46 patients (90.19%) and normal in 5 patients (9.8%). Postsurgically an standard audiometry were foun in 38 patients (74.5%) and anormal in 13 patients (25.49%) with p<.0001. There is a statistically significant hearing gain with tympanoplasty type 1 in patients with sequale of mid level chronic level in the highly specialized medical unit, Northwest National Medical Center in Obregon city, Sonora. Conclusions: In most of our patients tympanoplasty type 1, there was an improvement in hearing. This results are similar to those found in authors such as Shrestha and et al.

Efficacy of Intratympanic Methylprednisolone Perfusion for the Treatment of Sudden Sensorineural Hearing Loss / 听力学及言语疾病杂志

Objective To investigate the efficacy of intratympanic methylprednisolone perfusion (IMP) for the treatment of sudden sensorineural hearing loss (SSNHL ) which failed to be fully responsive to conventional treatment .Methods The hearing outcomes of 87 patients with unilateral SSNHL were retrospectively analyzed .All of the patients received IMP after not fully responsive to conventional treatment of varying periods of time .They were hospitalized in our department between January 2008 and December 2012 and were followed up for at least one year to exclude recurrent hearing loss .Results The effective rate was 66 .67% and the mean PTA improvement was (18 .53 ± 13 .54)dB of the patients with the time interval between onset of symptoms and IMP within 15 days , 21 .21% and (5 .92 ± 15 .18)dB of the patients with the interval between 16 and 30 days ,4 .76% and (3 .69 ± 7 .00) dB of the patients with the interval more than 30 days respectively .The significant difference in the effective rates were compared among the three groups(χ2 =25 .91 ,P<0 .01) .Regarding to the PTA improvement ,the group with interval within 15 days was better than the other two groups(F=11 .182 ,P<0 .01) .A total of 30 cases acquired more than 15 dB hearing gain after IMP .One of them was hearing loss in low frequencies and the other 29 cases were hearing loss at all frequencies .The mean hearing gains of the 29 cases in 0 .25 kHz ,0 .5 kHz ,1 kHz ,2 kHz , 4 kHz and 8 kHz were 35 .17 ± 18 .15 dB ,35 .38 ± 15 .90 dB ,31 .28 ± 19 .74 dB ,21 .31 ± 17 .34 dB ,14 .97 ± 16 .00 dB and 13 .80 ± 16 .35 dB ,respectively .The mean hearing gains at lower three frequencies (0 .25~1 kHz)were better than those at higher three frequencies (2 k~8 kHz)(F=9 .494 ,P<0 .01) .Conclusion Receiving IMP earlier might help to acquire better hearing gain for the patients with SSNHL after not fully responsive to conventional treat‐ments .The hearing gains at the lower frequencies were better than those at the higher frequencies after IMP .

A Case of Marked Hearing Improvement after Surgical Removal of Vestibular Schwannoma with Profound Hearing Loss / 대한이비인후과학회지

The preoperative hearing status is one of the important factors to determine the method of surgical approach to the vestibular schwannoma. It has been widely recognized that the hearing preservation surgery is not valuable if the patient has no serviceable hearing. The worldwide reported cases of hearing improvement after surgical removal of vestibular schwannoma with profound hearing disturbance are extremely rare, and so far, there have been no domestic cases reported. The authors have experienced a case of significant hearing improvement after surgical removal of vestibular schwannoma with preoperative unilateral total deafness but with normal otoacoustic emission response. We report this case with literature review.

Effect of Growth Factors on Hearing Restoration in Deafened Animal Model / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sensorineural hearing loss is caused by ototoxic drugs, radiation therapy, noise exposure and trauma, etc. They make irreversible changes in cochlear hair cells and degeneration of spiral ganglion neurons. It is known that neurotrophins and other growth factors have an important role in protectingcochlear hair cells and spiral ganglion neurons. We designed this study to analyze the effect of neurotrophins and growth factors delivered to the inner ear of deafened guinea pig. MATERIALS AND METHOD: Healthy 15 guinea pigs with normal Preyer's reflex were chosen, and were made deaf by infusion of kanamycin and ethacrynic acid. Myringotomy was done to both ears, normal saline injected into the left ear, and BDNF (brainderived neurotrophic factor), GDNF (glial cell derived neurotrophic factor), NT-3 (neurotrophin-3), IGF (insulin-like growth factor), EGF (epidermal growth factor), FGF (fibroblast growth factor) were injected in the right ear. RESULTS: Statistically significant hearing gain was obtained up to 35.00+/-13.78 dB in the group 1 (BDNF, GDNF, NT-3 treated group), and up to 34.0+/-5.47 dB in the group 2 (IGF treated group). However, no statistically significant hearing gain was observed in the group 3 (EGF, FGF treated group). CONCLUSION: We observed statistically important improvement of hearing threshold in the BDNF, GDNF, NT-3 treated group and IGF treated group.