[Therapeutic effect of ossicular reconstruction with bioceramic or porous macromolecular polyethylene partial ossicular replacement prosthesis in patients with tympanosclerosis].

OBJECTIVE: To evaluate the effect of ossicular reconstruction with partial ossicular replacement prosthesis (PORP) in patients with tympanosclerosis. METHODS: The data of 31 cases of tympanosclerosis treated between 1992 and 2009 were reviewed. Of the 31 patients, 17 (17 ears) underwent ossicular reconstruction with porous macromolecular polyethylene PORP, and 14 (14 ears) with bioceramic PORP. All the patients were followed up for 3-24 months. RESULTS: Significant improvement was found in postoperative speech frequency (500, 1000, 2000 Hz) pure tone average (PTA) and air-bone gap (ABG) (P < 0.05) after the treatments without statistically significant differences between the two groups (P > 0.05). CONCLUSION: Porous macromolecular polyethylene and bioceramic are valuable ossicular prosthesis for tympanosclerosis.

[Pure tone audiology for Meniere disease: a clinical analysis of 75 cases].

OBJECTIVE: To analyze clinical pure tone test data in patients with Meniere disease and study the changes in the audiometic curve configuration. METHODS: A retrospective analysis was conducted of the pure tone test data in 75 cases (82 ears) from 1984 to 2008. The audiometic curve configuration was divided into 6 categories to analyze the relationship between the main curve types and the clinical stages. RESULTS The most common audiogram was the peak type (46.34%), followed by the falling type (19.51%) and the mountain type (12.19%), and the dip type was relatively rare (2.43%). No significant differences were found in the rate of peak audiograms between the clinical stages. The common audiogram peak frequency occurred at 2 kHz (47.39%). The top curve of 1-2 kHz had the largest proportion in mountain type audiograms (70%, 7/10 ears). CONCLUSION: The peak type and mountain type configuration are one of the audiological characteristics of Meniere disease, especially for 2 kHz peak, which may serve as the diagnostic features of Meniere disease in the vertigo patients on their first visit.

[Clinical analysis of 118 patients with tympanosclerosis].

OBJECTIVE: To study the incidence of tympanosclerosis (TS) and the major risk factors of hearing loss. METHODS: A total of 118 TS patients (137 ears) were compared with 265 patients with chronic otitis media (COM) (311 ears) for gender, age and course of disease. The disease regions and hearing loss of the TS patients were analyzed. RESULTS: TS showed higher prevalence in women of older ages. Sclerosis was seen most frequently in the tympanic membrane, followed by the malleus, incus, incudomalleolar joint, other regions, ariticulus incudostapedius and stapes. The patients with sclerosis or deterioration in the ossicular chain had worse hearing loss than the other patients. Carhart notch occurred in 45 ears (32.85%), an incidence similar to that of inverted "V"-shaped curve of air-conduction audiometry near 2 kHz (47 ears, 34.31%). The factors contributing to the hearing loss, listed in the order of their importance, included pathologies in the incus, malleus, incudomalleolar joint, ariticulus incudostapedius, stapes, other regions, tympanic membrane, and gender. CONCLUSIONS: Female patients may had increased risk of TS. The presence of Carhart notch and inverted "V"-shaped curve in air-conduction audiograph may indicate myringosclerosis or ossicular chain sclerosis. Abnormal ossicular chain is the leading factor contributing to hearing loss.

[Effect of surgical reconstruction of congenital aural atresia via the mastoid antrum approach: analysis of 48 cases].

OBJECTIVE: To assess the effect of surgical reconstruction of congenital aural atresia via the mastoid antrum approach and investigate method for preventing postoperative atresia of the reconstructed aural canal. METHODS: From 2000 to 2008, aural canal reconstruction and tympanoplasty was performed via the mastoid antrum approach. In 48 patients with congenital aural atresia (54 ears, including 45 ears of type II, 9 ears of type III). All the patients were followed-up for 18 months to assess the therapeutic effect. RESULTS: The mastoid antrum was located uneventfully for all the 54 ears, all showing ossicular chain anomalies involving most frequently the malleus and the incus followed by the upper structures of the stapes. Facial nerve abnormalities were seen in 23 ears (42.6%). Hearing improvement to over 20 dB was achieved in 45 ears (83.3%) and to over 25 dB in 25 ears (46.2%) one year later. CONCLUSION: The mastoid antrum approach for surgical reconstruction of congenital aural atresia is safe and reliable. Maintenance of the width of the aural canal and prevention of lateral healing of the transplanted tympanic membrane are crucial in the treatment of congenital aural atresia.

[Audiological assessment in 88 patients with otosclerosis].

OBJECTIVE: To analyze the clinical data of the hearing in otosclerosis patients and explore their association with the clinical manifestations. METHOD: A retrospective analysis of 88 otosclerosis cases (162 ears) was performed. Pure tone audiometry was performed in all the cases 1 to 3 days before the operation for speech analysis at the frequencies of 500, 1 k, 2 kHz and to determined the average pure-tone hearing threshold (PTA) and gas Bone gap (ABG). The incidence of carhart notch was observed in patients with simple conductive hearing loss and mixed hearing loss, and in the early, middle and late stage of otosclerosis. RESULTS: Carhart notch occurred at significant higher incidence in patients with simple conductive hearing loss and in early otosclerosis (P<0.05). CONCLUSION: For common otosclerosis, the lesion invades initially the vestibular window, round ligament and stapes floor, followed by the base of the cochlea, and therefore observation of the carhart notch may help determine the disease course.

[Therapeutic effects of small fenestra stapedotomy with semiconductor diode laser: a comparison with microdrill].

OBJECTIVE: To compare the effects of small fenestra stapedotomy with semiconductor diode laser and microdrill in patients with otosclerosis. METHODS: Twenty-six patients (29 ears) undergoing stapedotomy with semiconductor diode laser and 19 patients (21 ears) with microdrill were compared for the hearing results and complication rates. RESULTS: No statistically significant differences were found in postoperative speech frequency and high frequency pure tone average in closing the air-bone gap between the two groups. The ears treated by stapedotomy with semiconductor diode laser showed significantly better preoperative minus the postoperative air-bone gap and milder dizziness. CONCLUSION: In spite of the good hearing outcomes in both groups, small fenestra stapedotomy with semiconductor diodelaser can achieve better results and reduce the incidence of complications.

[Establishment of tympanosclerosis by intratympanic injection of Staphylococcus aureus in guinea pigs].

OBJECTIVE: To establish a guinea pig model of tympanosclerosis and investigate the development and progression of tympanosclerosis in the tympanic membranes and middle ear mucosa. METHODS: Twenty-one healthy guinea pigs were subjected inoculation of 1x10(8)/L Staphylococcus aureus into the left middle ear cavities under general anaesthesia, with the right ears as the control, to establish models of chronic purulent otitis media. The animals were sacrificed by decapitation after 1, 3 and 6 months after model establishment for histological examination of the middle ear mucosa. RESULTS: The histological changes of tympanosclerosis occurred in some of the animals 3 months after model establishment, and the extent of calcium deposition and fibrosis across the mucosa were positively correlated with the duration of chronic purulent otitis media. CONCLUSION: Tympanosclerosis may occur in some guinea pigs after inoculation of Staphylococcus aureus into the middle ear cavity, and this model can be useful for study of tympanosclerosis.

[Influence of stapedectomy on the hearing of guinea pigs].

OBJECTIVE: To compare the influences of stapedectomy and small fenestra stapedotomy on the hearing of guinea pigs. METHODS: Twenty-four (48 ears) guinea pigs were randomized equally into two groups, and the left ears were subjected to stapedectomy and total stapes replacement with a prosthesis, or sham operation (12 ears) to expose the footplate of the stapes and the round window. Each guinea pig was tested by ABR perioperatively. Four guinea pigs were chosen randomly from each group and decapitated for morphological examination by light microscopy and scanning electron microscopy after ABR test. RESULTS: In the sham operation group, the post-operative latencies of each wave, the intervals and the hearing threshold exhibited no significant changes other than prolonged latency of wave I. In stapedectomy group, the hearing threshold increased to 23.75-/+3.77 dBSPL 1 h after operation with significantly prolonged post-operative latencies of all the waves and intervals but for III-IV interval, which was shortened. The latencies of each wave (especially waves I and III) in the stapedectomy group were increased by a greater magnitude than those in the sham operation group, but the intervals were comparable between the two groups. No significant difference was noted in the parameters of ABR either 1 h or 1 day after the operation between the two groups, in which the architecture of cochleas remained intact with similar number of spiral ganglion cells. The stereocilia of the outer hearing cells (OHC) were normal in the sham operation group while in stapedectomy group, slight stereocilia disorder occurred but became normal 1 day after operation. No obvious changes were found in the stereocilia of the inner hearing cell (IHC) in either groups. CONCLUSION: Stapedectomy can induce mild hearing loss without seriously damaging the function of the cochlea in guinea pigs.

[Audiological assessment in 79 patients with tympanosclerosis].

OBJECTIVE: To conduct audiological assessment in patients with tympanosclerosis. METHODS: A retrospective review was conducted in 79 patients with tympanosclerosis (involving 79 ears) with complete records, including 30 patients (30 ears) with fixed Malleus-incus complex, 29 (29 ears) with fixed stapes, and 20 (20 ears) with fixations of both the stapes footplate and the Malleus-incus complex. Audiometry was performed for all the patients one or two days before operation, and the audiological features of the patients were compared between the 3 groups. RESULTS: Most of the patients (65.8%) suffered conductive hearing loss, 32.9% had mixed deafness, and one patient had sensorineural hearing loss. No statistically significant differences was noted in the speech frequency (0.5, 1, and 2 kHz) air conduction pure tone average (PTA) or the air-bone gap (ABG) in the 3 groups (P<0.05). CONCLUSION: Most of the patients with tympanosclerosis suffer conductive hearing loss, and the severity of hearing loss is not associated with the site of tympanosclerosis.

[Analysis of auditory steady-state response to multiple simultaneous stimuli and cochlea morphology in guinea pigs with posterior semicircular canal fistula].

OBJECTIVE: To observe the changes of auditory steady-state response (ASSR) threshold in guinea pigs with posterior semicircular canal fistula. METHODS: In 10 guinea pigs, a window was opened in the posterior semicircular canal of the left ear with the right ear serving as the control for testing the ASSR under anesthesia with pentobarbital sodium. RESULTS: The mean and standard deviation of ASSR threshold (dB SPL) at 0.5, 1, 2, and 4 kHz in the left ear was 35.00+/-14.33, 25.50+/-12.37, 20.00+/-9.37 and 20.00+/-9.18, respectively, and was 31.00+/-16.19, 25.50+/-12.34, 18.00+/-6.96 and 18.50+/-6.71 in the right ear, respectively. Paired-sample t test showed no significant difference in the ASSR at the same frequency between the two ears. CONCLUSION: Small fistula by surgery causes no significant hearing loss in guinea pigs.

[Effects of small fenestra stapedotomy in comparison with total stapedectomy].

OBJECTIVE: To compare the effect of small fenestra stapedotomy and total stapedectomy in patients with otosclerosis. METHODS: Twenty-seven patients (30 ears) undergoing small fenestra stapedotomy and 36 patients (43 ears) receiving total stapedectomy were compared for hearing results and complication rates. RESULTS: No statistically significant differences were seen in postoperative speech pure tone average in closing air-bone gap between the two groups. The ears treated by small fenestra stapedotomy showed statistically better air-bone gap closure at high frequencies with lower rates of sensorineural hearing loss at high frequencies and milder dizziness. CONCLUSION: In spite of the successful hearing outcomes in both groups, small fenestra stapedotomy can achieve better results at high frequencies and reduce the incidence of complications.

[Effects of ossicular reconstruction with partial ossicular replacement prosthesis in patients with tympanosclerosis].

OBJECTIVE: To evaluate the effect of ossicular reconstruction with partial ossicular replacement prosthesis (PORP) in patients with tympanosclerosis. METHODS: The data of 28 cases of tympanosclerosis treated between 1992 and 2006 were reviewed. Of the 28 patients, 14 (14 ears) underwent ossicular reconstruction with PORP and 14 (14 ears) had ossicular mobilization, and all the patients were followed-up for 3-24 months. RESULTS: Significant improvement was found in postoperative speech frequency (500, 1000, 2000 Hz) pure tone average (PTA) and air-bone gap (ABG) closure after in the operation the two groups. Ossicular reconstruction using PORP resulted in statistically better ABG closure and PTA (P<0.05). CONCLUSION: In ossicular attic fixation, ossicular reconstruction using PORP can yield better results than mobilization of the major ossicles in patients with tympanosclerosis.

[Intranasal endoscopic surgery on the anterior cranial fossa via the anterior skull base].

OBJECTIVE: To explore the possibility of performing anterior cranial fossa surgery by an intranasal endoscope via the anterior skull base. METHOD AND RESULTS: A rare case of accidental insertion of chopstick into the anterior cranial fossa as deep as 6.5 cm was reviewed and analyzed. The residue of the plastic chopstick was successfully taken out from the anterior skull cavity by an intranasal endoscope that was insorted into the earity via the anterior cranial base followed by surgical management of the cerebrospinal fluid rhinorrhea with the skull defect repair. Complete postoperative recovery of the child was achieved. CONCLUSION: The foreign material near the anterior cranial base of the anterior skull cavity can be removed via intranasal endoscope through the anterior cranial base.

[Preparation and clinical application of Teflon-wire piston and stapes height measurer].

With Teflon, and a tiny stainless steel needle of a number 7 injector and an acupuncture needle,Teflon-piston and a measurer of the stapes height were prepared respectively of stapedectomy for treatment of otosclerosis. Good clinical results were achieved with these simple and useful devices.