Stapes surgery: comparison between microdrill and footplate perforator

The study goal was to compare the effect of using footplate perforator and the microdrill on the postoperative hearing results and complications rate during stapes surgery. 70 ears with otosclerosis have been operated upon using microdrill to perforate the footplate in 34 ears and microperforator in 36 ears. All operations were operated upon at the Department of Otolaryngology, Mansoura University Hospitals from 2005 to 2007. The audiological results and complications rate of both groups were compared. There were statistically significant decrease of postoperative air and bone conduction in both groups. There was significant decrease in the mean post operative bone conduction in the microdrill group as compared to the perforator group. The mean postoperative air bone gap [500-4000Hz] was 7.8 dB and 9.3 dB for the microdrill group and the perforator group, respectively, which was statistically insignificant there was no significant SNHL in the microdrill group, while there was one ear [2.7%] had it in the perforator group. Stapedotomy using microdrill or footplate perforator provides good results, however, the use of microdrill may be useful as it is easy, safe and less traumatizing to the inner ear

Evaluation of tinnitus patients with normal hearing sensitivity using TEOAEs and TEN test

Subjective tinnitus may be associated with hearing loss or occurs in normal peripheral hearing patients. It is a complex phenomenon that has many causes and is related to biological and psychological components. Considerable efforts have been devoted to find methods that can describe the psychoacoustical properties of tinnitus. Otoacoustic emissions [OAEs], are low level sounds emitted by the healthy outer hair cells [OHCs] of the cochlea. It is used to delineate some mechanisms in cochlear functioning that might accompany tinnitus by evaluating the condition of OHCs. The threshold equalizing noise test [TEN test] recently developed by Moore in 2000 is a screening diagnostic tool that helps in detecting the presence of dead regions in the cochlea by using noise. Thus might clarify the possibility of inner hair cell damage in such patients. Accordingly, this study was designed to investigate the possibility of underlying cochlear damage whether OHCs or IHCs in tinnitus suffering patients with normal hearing sensitivity, using TEOAEs and TEN test if any. Twenty patients suffering from unilateral tinnitus with normal hearing sensitivity participated in this study. Their other ear acted as control ears. They were subjected to full history taking, otoscopy, basic audiologic evaluation, TEOAEs and TEN test TEOAEs were abnormal in 85% of the tinnitus ears compared to 20% in control ears, this difference was statistically significant. The abnormal TEOAEs frequency bands in the tinnitus ears were statistically significant above 2000 Hz when compared to the control ears and were more common for the 4000Hz and 5000 Hz. This suggests that OHCs dysfunction may be important in the generation of tinnitus. TEN test demonstrated dead regions in the cochlea in 15% of the tinnitus ears only. This might be attributed to increased resistance of IHCs to damage compared to OHCs vulnerability. The affected frequency location was at 500 Hz in 5%, 3000 and 4000 Hz in 10% of tinnitus ears. In conclusion, this work has shown a higher prevalence of OAE abnormalities in tinnitus patients with normal hearing in contrast to TEN test denoting the more vulnerability of OHCs to damage