Retrospective Study of 157 Patients with Otosclerosis to Evaluate Association Between Carhart Notch on the Preoperative Bone-Conduction Audiogram and Postoperative Hearing and Balance Evaluated by the Vestibular Disorders Activities of Daily Living Scale.

BACKGROUND A Carhart notch in the pure tone audiogram can be an indicator of stapes fixation in otosclerosis. This retrospective study of 157 patients with otosclerosis aimed to evaluate the association between the presence of a Carhart notch on the preoperative bone-conduction audiogram and postoperative hearing and balance evaluated by the Vestibular Disorders Activities of Daily Living scale. MATERIAL AND METHODS Patients with suspected otosclerosis based on medical history and audiometric tests were considered. The analysis included 157 consecutive patients who underwent surgery in the years 2016 to 2019, in whom the diagnosis of otosclerosis was confirmed during surgery. Carhart notch was defined as an impairment in the bone conduction threshold of ≥7.5 dB for 2000 Hz frequencies above the mean thresholds at higher and lower adjacent frequencies. The Vestibular Disorders Activities of Daily Living subjective scale was used in the preoperative period and 4 and 12 months after surgery. RESULTS The preoperative presence of Carhart notch and progressive sensorineural hearing loss were statistically significantly correlated with more common onset of tinnitus and then dizziness (P=0.006). Preoperative vertigo was observed in patients who had Carhart notch observed in the preoperative audiometric test. This vertigo more commonly coexisted with profound sensorineural hearing loss and minor or no improvement in average values of bone conduction after surgery (P=0.002). CONCLUSIONS Preoperative Carhart notch on audiogram and the severity of sensorineural hearing loss were associated with tinnitus and vertigo. However, preoperative Carhart notch was not associated with persistent postoperative tinnitus in patients with cochlear otosclerosis.

Association Between Postoperative Vertigo and Hearing Outcomes After Stapes Surgery for Otosclerosis.

OBJECTIVE: During the postoperative period, most patients with otosclerosis report vertigo and/or nausea caused by interventions within the inner ear. The aim of this study was to evaluate both early and late vertigo associated with hearing improvement after stapes surgery for otosclerosis. METHODS: The analysis included 170 patients admitted to the hospital undergoing their first surgery for otosclerosis. Audiological diagnostics, surgical techniques, and symptoms reported by the patients were all analyzed. RESULTS: A statistical correlation and an unfavorable influence of late, undesired symptoms, such as vertigo, nausea/vomiting, and nystagmus, on final hearing improvement after surgical treatment of otosclerosis were found. Prostheses that were too long or placed too deep within the inner ear space were the most frequent cause of both vertigo and lack of hearing improvement observed after stapedotomy. CONCLUSIONS: A significant negative influence on bone conduction thresholds, particularly at 2000 Hz, was associated with vestibular symptoms persisting for 7 days after the surgery. Symptoms of impaired bony labyrinth function after stapedotomy, persisting for more than 1 year, were associated with insufficient reduction of the air-bone gap and worse improvement in bone conduction thresholds at 1000 and 2000 Hz. The cause of both problems was related to a prosthesis that was too long or placed too deep in the inner ear during stapedotomy.

The Audiometric Assessment of the Effectiveness of Surgical Treatment of Otosclerosis Depending on the Preoperative Incidence of Carhart's Notch.

Objective: The presence of Carhart's notch at 2000 Hz in otosclerosis links the changed bone conduction for this frequency with the otosclerotic process occurring in the oval window. The aim of this study is to perform an audiometric assessment of the effectiveness of surgical treatment of otosclerosis depending on the incidence of Carhart's notch. Methods: The analysis included 116 patients treated surgically for the first time due to otosclerosis. Patients were divided into 4 groups depending on the occurrence of Carhart's notch, determined by pure-tone audiometry (PTA) before the surgery and 36 months afterward. The mean value of bone conduction thresholds was calculated for 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz in the groups in which the Cahart's notch was observed. This value of bone conduction (BC) was a reference point for further analysis in patients who had no preoperative or postoperative Carhart's notch. Results: The analysis indicated that Cahart's notch in preoperative PTA is a statistically significant improvement factor for average BC. It was found that over a longer observation period, the presence of Carhart's notch has adverse effects on the size of the postoperative air-bone gap, and consequently on hearing improvement after surgical treatment. A comparison between patients from the two groups without preoperative Carhart's notch found that no beneficial effects of the surgery on speech comprehension were observed regarding high-level sensorineural hearing loss (SNHL). Conclusions: (1) In a long-term observation post-stapedotomy, average BC values were found to improve. Nevertheless, the improvement is less evident in patients with preoperative Carhart's notch. (2) Disappearance of Cahart's notch after surgical treatment of otosclerosis is a good prognosis of improvement in speech audiometry. (3) Deep SNHL in the absence of Carhart's notch in PTA constitutes a bad prognostic factor for improvement in speech audiometry in patients qualified for surgical treatment of otosclerosis.

Pattern of cholesteatomas under a scanning electron microscope - a risk factor for bone resorption.

OBJECTIVE: The damaging effect of cholesteatomas presents mainly as bone resorption by osteoclasts located in the space between the bone and perimatrix. This process is initiated by the molecular cascade of osteoclast differentiation factors. The aim of the study is to analyse cholesteatoma microstructures via scanning electron microscope (SEM), and associate them with risk and grade of bone erosion. METHODS: Pathological middle ear tissue fragments with cholesteatoma visible under a microscope were collected from 58 patients operated on for chronic otitis media with features of bone defects in the middle ear walls. These fragments were examined under a scanning electron microscope. RESULTS: Analysis of the cholesteatomas' surface under a SEM revealed both regular and irregular structure of the matrix, most being the latter. Irregular matrix structures were observed in cases with a short disease history and in patients for whom this was the first surgical procedure. In our analysis, a cholesteatoma matrix with regular structures was associated with less bone destruction of the middle ear space. CONCLUSIONS: The microstructure of cholesteatomas that showed regular layers under SEM coincides with reduced destruction of the middle ear bone walls. An irregular structure (pathognomonic for a process with a short medical history, and in patients operated on for the first time) is characterised by a tendency towards deeper destruction of bone tissue.

Chronic suppurative otitis media with cholesteatoma and chronic otitis media with granulation by scanning electron microscopy based on analysis of 140 patients.

Objectives Chronic purulent cholesteatoma of the middle ear, as well as to a lesser extent chronic granulomatous otitis media, lead to destruction of bone structures within the middle ear space. Above process is controlled by the OPG/RANKL/RANK system. Material and methods An analysis of 140 patients operated on due to chronic otitis media was performed. For the detailed analysis in the scanning electron microscope, 40 patients were selected who had been diagnosed with chronic cholesteatoma of the middle ear and chronic granulomatous otitis media. Finally the study in SEM included 20 patients. Results The regular structure of cholesteatoma depicted in the Scanning Electron Microscope concerned 5 patients with diagnosed. In the remaining 7 patients, the system was irregular and even chaotic. Lack of regularity can also be observed in the case of granulation tissue, which in the SEM image presented itself as an irregular tissue mass without detectable regularities. Conclusions 1. Regular pattern of the cholesteatoma matrix cells observed in some patients with chronic cholesteatoma of the middle ear reduces the molecular permeability of inflammatory cytokines, concurrently limiting the destructive activity on bone structures. 2. The presence of inflammatory granulation tissue in the middle ear is accompanied by an influx of leukocytes: neutrophils and lymphocytes, which are the source of pro-inflammatory cytokines, the growth of which activates the processes leading to the damage of bone tissue and the development of inflammation. 3. No specimen of acquired cholesteatoma revealed presence of commensalism like organism on the surface of exfoliated human epithelium of Demodex species.

Impact of surgery in otosclerosis on the non-operated ear.

Backgrounds Otosclerosis is an underlying disease of the bony labyrinth. The hearing loss is most often of conductive nature, in some cases the involvement of the bony part of the cochlea results in mixed hearing loss. Aims: The aim of the analysis was to answer the question whether a surgery on one of the ears affects the state of the other ear in the course of otosclerosis. Methods The analysis included 140 patients hospitalized and operated on between 2010 - 2016. Only patients who had not had a surgical operation within the middle ear due to otosclerosis prior to the study were included in it. An audiological assessment was performed with the use of pure tone threshold audiometry taking into account. Results In the group of patients with no Carhart's notch, the mean threshold of bone conduction was statistically lower than before the procedure for the frequencies of 500, 1000 Hz and statistically equal for the frequency of 2000 Hz. The same analysis in the group of patients with Carhart's notch present in the pre-surgical tonal audiogram of the non-operated ear showed a statistically significant lower value of the post-surgical threshold bone conduction value. Conclusion It was confirmed the possibility of improving the hearing of the non-operated ear after the stapedotomy of the opposite ear, in the author's own studies by an average of 5 dB in the low-frequency range.

The prognostic influence of pre-surgery bone conduction values on the improvement of hearing in patients treated surgically as a result of middle-ear conditions.

Background The influence of the mechanics of the middle ear on the function of the inner ear has been studied for many years. Among surgeries performed in the middle-ear area, those restoring full functionality of the system transmitting sound inside the middle ear may be pointed out as those fully restoring the mechanical influence of the middle ear on the function of the inner ear. Aim: The aim of the performed analysis is to find the prognostic importance of measured pre-surgery values of bone conduction on the improvement of hearing in patients operated as a result of middle-ear disorders. Methods The analysis included 271 patients hospitalised and operated on due to otosclerosis or perforation of the tympanic membrane between 2016 and 2019. Only patients who had not had a surgical operation within the middle ear prior to the study were included. An audiological assessment was performed with the use of pure tone thresholds audiometry. Results A beneficial influence of the performed surgery on the improvement of bone conduction was observed in patients, in which the average threshold value of bone conduction measured before the surgery did not exceed 40 dB. In cases of the perceptive component of hearing impairment being higher than 40 dB, no statistically significant, beneficial influence of a performed stapedotomy or myringoplasty on the change of bone conduction thresholds was observed. Conclusion The perception component of hearing impairment up to 40 dB indicates bone conduction improvement after surgical restoration of the influence of middle-ear mechanics on the inner ear in patients treated as a result of otosclerosis, as well as of eardrum perforation.

The suitability of scanning electron microscopy in the evaluation of bone structure surfaces and selection of alloplastic materials for facial skeletal reconstruction.

INTRODUCTION: Functional and aesthetic problems can arise even from small losses created in the facial skeleton. Injuries and oncological surgeries are the most frequent causes of these losses within the facial skeleton. Advances in surgical interventions have allowed for ever-increasing degrees of resections, increasing oncological radicality as well as treatment effectiveness, providing the patient with the chance for a longer life. However, this subsequently requires the use of even more advanced reconstruction techniques in order to restore quality of life and comfort to the patient, as well as enable their return to professional and social activities. The necessity of reconstructive surgery applies not only to patients with cancer, but also to patients with impaired or failing sensory and organ function as a result of inflammatory conditions, injuries, or non-oncological surgeries. There are many available reconstruction procedures, which depend on the location of the loss, the type of tissue lost, the degree of loss and patient-dependent factors. Materials used in reconstruction surgeries may include the patients' tissues when available, and artificial reconstruction materials otherwise. MATERIAL AND METHODS: The analysis involved fragments of bone tissue removed during surgery. Due to the nature of the medical procedure and the inability to replant the tissue, it was regarded as medical waste. The preparations used were observed under an optical microscope and an electron scanning microscope, and a chemical analysis was performed. The chemical composition of samples was analysed using a low vacuum detector (LVD) at an accelerating voltage of 15 kV and 10 kV and at a spot size of 4 and 3.5. The observations were performed in a secondary electron (SE) detection system. RESULTS: Observation of parameters under an optical microscope and of images obtained using an electron scanning microscope showed the presence of typical, compact bone tissue with varied surface shapes in each case (various degrees of unevenness and porosity). Chemical composition analysis confirmed the presence of compounds from the CaO-P2O5-H20 system. The Ca/P (calcium/phosphorus) ratio obtained from the chemical analysis varied from 1.33 to 2.1, and indicated a varied morphology of calcium phosphates forming the bone structures of the facial skeleton. CONCLUSIONS: 1. Calcium phosphates are characterised by excellent biocompatibility because of their chemical affinity to bone, and are ideal for the reconstruction of bone losses within the facial skeleton. 2. Biodegradable polymers have the highest functional potential among several groups of biomaterials used in tissue engineering because of their ability to be tailored individually, in addition to their high biocompatibility.