High frequency hearing 25 years after transmyringeal ventilation tube treatment.

OBJECTIVES: The main aim of the study was to compare hearing outcome between a healthy control group and patients treated with transmyringeal ventilation tubes, 25 years after primary surgery. Another aim was to analyse the relation between ventilation tube treatment in childhood and the occurrence of persistent middle ear pathology 25 years later. METHODS: In 1996, children treated with transmyringeal ventilation tubes were recruited for a prospective study on the outcome of ventilation tube treatment. In 2006, a healthy control group were recruited and examined together with the original participants (case group). All participants in the 2006 follow-up were eligible for this study. A clinical ear microscopy examination including eardrum pathology grading and high frequency audiometry (10-16 kHz) was carried out. RESULTS: A total of 52 participants were available for analysis. Hearing outcome was worse in the treatment group (n = 29) compared to the control group (n = 29), both in regard to standard frequency range hearing, (0.5-4 kHz), and high frequency hearing (HPTA3 10-16 kHz). Almost half the case group (48%) had eardrum retraction to some extent, compared to 10% in the control group. No case of cholesteatoma was found in this study and eardrum perforation was rare (<2%). CONCLUSION: In the long term, high frequency hearing (HPTA3 10-16 kHz) was more often affected in the patients with transmyringeal ventilation tube treatment during childhood compared with the healthy controls. Middle ear pathology of greater clinical significance was rare.

Hearing outcome after myringoplasty in Sweden: A nationwide registry-based cohort study.

OBJECTIVES: To present hearing results after successful primary myringoplasty surgeries registered in the Swedish Quality Registry for Myringoplasty and to evaluate the chance of hearing improvement and the risk of hearing loss. DESIGN: A retrospective nationwide cohort study based on prospectively collected registry data between 2002 and 2012. SETTINGS: Registry data from secondary and tertiary hospitals performing myringoplasty. PARTICIPANTS: Patients with healed tympanic membrane after primary myringoplasty surgery performed from 2002 to 2012 in Sweden. MAIN OUTCOME MEASURES: Postoperative hearing results, hearing gain and air-bone gap (ABG). RESULTS: In 2226 myringoplasties, air conduction audiograms were recorded, and the average preoperative pure tone average (PTA4 ) of the group was 28.5 dB, which improved postoperatively to 19.6 dB with an average of 8.8 dB improvement. Bone conduction was measured for 1476 procedures. Closure of the ABG to 10 dB or less was achieved in 51% of the ears and to less than 20 dB in 89% of the ears. Sixty-one percent of patients with preoperatively deteriorated hearing experienced improved hearing, but 3% of all patients experienced deteriorated hearing. After the surgery, 93% of the patients were satisfied. CONCLUSIONS: Hearing results after successful myringoplasty surgery are often favourable, but although the tympanic membrane is healed, hearing improvement is not guaranteed, and hearing deterioration can also occur.

Tinnitus and taste disturbances reported after myringoplasty: Data from a national quality registry.

OBJECTIVES/HYPOTHESIS: Postoperative tinnitus and taste disturbances after myringoplasty are more common than previously reported. STUDY DESIGN: This study was a retrospective analysis of prospectively collected data from the Swedish National Quality Registry for Myringoplasty. METHODS: The analysis was performed on extracted data from all counties in Sweden collected from database A from 2002 to 2012 and database B from 2013 to 2016. Tinnitus and taste disturbance complications 1 year after myringoplasty were analyzed in relation to gender, age, procedure, and success rate. In database A, physicians reported tinnitus and taste disturbances. In database B, patients reported the complications. RESULTS: A major difference was found when the complications were reported by physicians compared to when the complications were reported by patients. In database A, tinnitus was reported in 1.2% of the patients and taste disturbances in 0.5%. In database B, the frequencies were 12.3% and 11.2%, respectively. Tinnitus and taste disturbances were more frequent after conventional myringoplasty compared to those after fat grafting and were more frequent after primary compared to those after revision surgery when reported by physicians. Patients, however, reported the same frequency of tinnitus after fat graft myringoplasty compared to that after conventional myringoplasty (12.0% vs. 12.6%) and fewer taste disturbances after revision surgery. In follow-up assessments, complications persisted after surgery over a long time period. CONCLUSION: Tinnitus and taste disturbances are more common after myringoplasty when patients report their symptoms than when physicians report the symptoms. LEVEL OF EVIDENCE: 2b Laryngoscope, 129:209-215, 2019.

Myringoplasty Outcomes From the Swedish National Quality Registry.

OBJECTIVES/HYPOTHESIS: Data from patients registered for myringoplasty during 2002 to 2012 in the Swedish National Quality Registry for Myringoplasty. STUDY DESIGN: Both conventional myringoplasty and fat-graft techniques were used aimed at healing the tympanic membrane in noninfected ears. METHODS: Analysis was performed on data in a national database collected from 32 ear, nose, and throat clinics. Surgical procedures and outcomes, and patient satisfaction from a questionnaire were studied. RESULTS: The database was comprised of 3,775 surgical procedures, with follow-up available for analysis. One-third were children under the age of 15 years. The most common indication for surgery was infection prophylaxis. The overall healing rate of the tympanic membrane after surgery was 88.5%, with a high mean patient satisfaction. Complications registered were postoperative infection, tinnitus, or taste disturbance that occurred in 5.8% of patients. CONCLUSIONS: Swedish results for a large number of patients who completed myringoplasty are presented. The success rate in this study is comparable to other studies, and good patient-reported outcome measures of myringoplasty are presented. Databases for surgical procedures and clinical audits are systematic processes for continuous learning in healthcare. This study shows that clinical databases can be utilized to analyze national results of surgical procedures. LEVEL OF EVIDENCE: 2b Laryngoscope, 127:2389-2395, 2017.

Transmyringeal ventilation tube treatment in children: hearing outcome after 10 years.

OBJECTIVE: This ten-year cohort study intended to determine any hearing impairment and eardrum sequelae comparing children treated with ventilation tubes (VT) with an age- and gender-matched control group. METHODS: A cohort of children who received ventilation tubes in 1996 was during 2006 compared with a control group, with no history of VT treatment, using standard audiometry, high frequency audiometry and otomicroscopy. RESULTS: In the spectrum of the standard audiometry, the differences between the groups were minimal. In the high frequency spectrum, even in a subgroup with normal eardrums, there were significant and major differences with inferior hearing thresholds in treated ears compared with the ears of the control group. The ventilation tube treated group presented a higher prevalence of eardrum pathology. CONCLUSION: The ears treated with ventilation tubes had significantly higher hearing levels than the control group in the high frequency spectrum. This could be caused by the history of middle ear disease, the VT treatment or both combined.

Loud noise exposure and acoustic neuroma.

The results from studies of loud noise exposure and acoustic neuroma are conflicting. A population-based case-control study of 451 acoustic neuroma patients and 710 age-, sex-, and region-matched controls was conducted in Sweden between 2002 and 2007. Occupational exposure was based on historical measurements of occupational noise (321 job titles summarized by a job exposure matrix) and compared with self-reported occupational noise exposure. We also evaluated self-reported noise exposure during leisure activity. Conditional logistic regression was used to estimate odds ratios. There was no statistically significant association between acoustic neuroma and persistent occupational noise exposure, either with or without hearing protection. Exposure to loud noise from leisure activity without hearing protection was more common among acoustic neuroma cases (odds ratio = 1.47, 95% confidence interval: 1.06, 2.03). Statistically significant odds ratios were found for specific leisure activities including attending concerts/clubs/sporting events (odds ratio = 1.82, 95% confidence interval: 1.09, 3.04) and participating in workouts accompanied by loud music (odds ratio = 2.84, 95% confidence interval: 1.37, 5.89). Our findings do not support an association between occupational exposure to loud noise and acoustic neuroma. Although we report statistically significant associations between leisure-time exposures to loud noise without hearing protection and acoustic neuroma, especially among women, we cannot rule out recall bias as an alternative explanation.

Long-term mobile phone use and acoustic neuroma risk.

BACKGROUND: There is concern about potential effects of radiofrequency fields generated by mobile phones on cancer risk. Most previous studies have found no association between mobile phone use and acoustic neuroma, although information about long-term use is limited. METHODS: We conducted a population-based, nation-wide, case-control study of acoustic neuroma in Sweden. Eligible cases were persons aged 20 to 69 years, who were diagnosed between 2002 and 2007. Controls were randomly selected from the population registry, matched on age, sex, and residential area. Postal questionnaires were completed by 451 cases (83%) and 710 controls (65%). RESULTS: Ever having used mobile phones regularly (defined as weekly use for at least 6 months) was associated with an odds ratio (OR) of 1.18 (95% confidence interval = 0.88 to 1.59). The association was weaker for the longest induction time (≥10 years) (1.11 [0.76 to 1.61]) and for regular use on the tumor side (0.98 [0.68 to 1.43]). The OR for the highest quartile of cumulative calling time (≥680 hours) was 1.46 (0.98 to 2.17). Restricting analyses to histologically confirmed cases reduced all ORs; the OR for ≥680 hours was 1.14 (0.63 to 2.07). A similar pattern was seen for cordless land-line phones, although with slightly higher ORs. Analyses of the complete history of laterality of mobile phone revealed considerable bias in laterality analyses. CONCLUSIONS: The findings do not support the hypothesis that long-term mobile phone use increases the risk of acoustic neuroma. The study suggests that phone use might increase the likelihood that an acoustic neuroma case is detected and that there could be bias in the laterality analyses performed in previous studies.

Transmyringeal ventilation tube treatment: a 10-year cohort study.

OBJECTIVE: This ten-year cohort study was intended to determine the incidence and expected outcome of ventilation tube treatment at a clinic that serves a community with 300,000 inhabitants. METHODS: All children aged 0-10 years, who received their first ventilation tube during 1996, were followed over 10 years, at the department of Otorhinolaryngology, county hospital Ryhov, Jönköping, Sweden. All acute and planned visits were recorded and analyzed, but no extra visits were scheduled due to participation in the study. RESULTS: In 1996 the overall incidence of tube insertion in the age group 0-10 years was 1 percent. A total of 155 children were entered, and 146 (94 percent) fulfilled the study. During the 10 years' follow up, a total of 409 acute visits and 1485 planned visits were made. In approximately 50 percent of the cases the first ventilation tube was still in place after one year. Infection occurred in 53 percent of the treated ear(s) at least once; the risk for infection was higher if the indication for ventilation tube placement was recurrent acute otitis media. In 45 percent of the children at least one more tube insertion was needed. A permanent perforation after tube treatment was seen in 2 percent of the treated ears. After 5 years, one half of the children were declared free from middle ear disease, but at the termination of the study 17 percent of the children were still in need of regular visits to an otologist due to residual ear problems. CONCLUSION: This study shows the natural course of treatment with middle ear ventilation tubes in a cohort of children aged 0-10 years during a ten-year period. The incidence of ventilation tube treatment was 1 percent. It is evident that many children need a prolonged contact with an ear-nose and throat specialist when treated with a ventilation tube.

Role of tobacco use in the etiology of acoustic neuroma.

Two previous studies suggest that cigarette smoking reduces acoustic neuroma risk; however, an association between use of snuff tobacco and acoustic neuroma has not been investigated previously. The authors conducted a case-control study in Sweden from 2002 to 2007, in which 451 cases and 710 population-based controls completed questionnaires. Cases and controls were matched on gender, region, and age within 5 years. The authors estimated odds ratios using conditional logistic regression analyses, adjusted for education and tobacco use (snuff use in the smoking analysis and smoking in the snuff analysis). The risk of acoustic neuroma was greatly reduced in male current smokers (odds ratio (OR) = 0.41, 95% confidence interval (CI): 0.23, 0.74) and moderately reduced in female current smokers (OR = 0.70, 95% CI: 0.40, 1.23). In contrast, current snuff use among males was not associated with risk of acoustic neuroma (OR = 0.94, 95% CI: 0.57, 1.55). The authors' findings are consistent with previous reports of lower acoustic neuroma risk among current cigarette smokers than among never smokers. The absence of an association between snuff use and acoustic neuroma suggests that some constituent of tobacco smoke other than nicotine may confer protection against acoustic neuroma.

Facial palsy and Wegener's granulomatosis.

Facial palsy can occur as a result of various pathological processes, which are not always amenable to early diagnosis. This article is a case presentation of a patient with facial palsy, after an acute otitis media manifestation, as a first symptom of Wegener's granulomatosis. The clues leading to diagnosis consist of the practitioner's clinical suspicion of the disease, the use of the appropriate serological measurements (c-antineutrophil cytoplasmic autoantibody), and the histological confirmation. The early initiation of treatment leads to high rates of remission of an otherwise lethal disease.