Can myringoplasty close the air-bone gap?

OBJECTIVE: The aim of this study is to evaluate whether closure of a tympanic membrane perforation with an intact ossicular chain results in a closure of the air-bone gap. STUDY DESIGN: Prospectively collected data from 154 patients undergoing temporalis fascia myringoplasty for chronic otitis media simplex were identified. SETTING: Tertiary referral center. PATIENTS: Between 2001 and 2009, overall, 106 patients with a central tympanic membrane perforation and, an intact ossicular chain were further analyzed. INTERVENTIONS: All patients underwent myringoplasty using temporalis fascia in an underlay technique. MAIN OUTCOME MEASURES: Comparison of the preoperative and postoperative hearing results in patients undergoing myringoplasty for chronic otitis media simplex. RESULTS: The mean postoperative air-bone gap (ABG) was 8.2 dB for the frequencies 0.5 to 4 kHz. Eighty-three patients (78%) showed postoperatively a mean ABG of 10 dB or lower. The ABG difference (improvement) was statistically significant for each single frequency (0.5, 1, 2, 3, and 4 kHz) (p < 0.0001). There is a linear correlation between the preoperative tympanic membrane perforation size and the postoperative ABG (p = 0.0017) for the frequencies 0.5 to 4 kHz. No statistical significant correlation was seen between the state of the middle-ear mucosa, temporal bone pneumatization, tympanometric middle-ear/mastoid volume, and the postoperative ABG. CONCLUSION: Complete ABG closure by myringoplasty could be achieved in only approximately 20% of the cases. 80% respectively presented with a mean residual ABG of 8 dB. We found a significant linear correlation between the preoperative size of the tympanic membrane perforation and the postoperative ABG, whereas mastoid volume, temporal bone pneumatization, and the condition of the mucosa did not affect the outcome.

Functional correlations of tympanic membrane perforation size.

OBJECTIVE: The correlation between tympanic membrane perforations and hearing loss was studied. STUDY DESIGN: Prospective data from 220 patients, who underwent primary surgery for simple chronic otitis media with a perforated eardrum, were analyzed. SETTING: Tertiary referral center. PATIENTS: One hundred fifty-one patients with 155 eardrum perforations, which were checked for correct diagnosis, normal middle-ear status, and integrity of the ossicular chain, were included. INTERVENTIONS: All patients underwent primary myringoplasty. MAIN OUTCOME MEASURES: Preoperative conductive hearing loss due to eardrum perforations. RESULTS: Hearing loss shows a linear relationship with increasing eardrum perforation size. Umbo involvement shows a worsening of the hearing by 5 to 6 dB (p < 0.0001). The least impact of a perforation is seen at the resonance frequency of 2 kHz. Above and below 2 kHz, an 'inverted V shape' of the air-bone gap is a consistent finding. If the air-bone gap exceeds the 'inverted V-shape' pattern, additional pathology behind the eardrum must be assumed and addressed. CONCLUSION: We propose using standardized photographs or drawings to document preoperative perforation sizes. A linear relationship between the size of a perforation and the conductive hearing loss does exist. Umbo involvement at the perforation margin may worsen the hearing by 5 to 6 dB, whereas the position of the perforation itself does not play a role. The least impact of a perforation is seen at the resonance frequency of 2 kHz. An "inverted V-shape" pattern, above and below 2 kHz, of the air-bone gap is a consistent finding. If the air-bone gap exceeds this pattern, additional pathology behind the eardrum perforation must be assumed and addressed.

A superior semicircular canal dehiscence syndrome multicenter study: is there an association between size and symptoms?

OBJECTIVE: The aim of this investigation was to determine if there is any association between the size of the canal dehiscences and the symptoms and signs of patients presenting with the superior semicircular canal dehiscence syndrome. STUDY DESIGN: Prospective multicenter study. SETTING: Tertiary referral center. PATIENTS: Twenty-seven patients, 14 females and 13 males, aged 25 to 83 years, coming from Switzerland, France, Belgium, or Italy, with dehiscence of the superior semicircular canal diagnosed by high-resolution computed tomographic scans of the temporal bone. INTERVENTIONS: Audiologic tests, a battery of vestibular tests (Tullio phenomenon, Hennebert sign, Valsalva maneuver), vestibular evoked myogenic potentials (VEMPs), and high-resolution computed tomographic scans of the temporal bone. MAIN OUTCOME MEASURES: Association between the symptoms/signs and the size of the superior canal dehiscence. RESULTS: Clinically patients could be divided into three different groups: Superior canal dehiscences (> or =2.5 mm) presented predominantly with cochleovestibular symptoms and/or signs (sensitivity, 91.7%; specificity, 70%), whereas smaller one's showed either cochlear or vestibular dysfunction. Patients with larger dehiscences were significantly more associated with vestibulocochlear symptoms/signs, lower VEMP thresholds, and objective vestibular findings (e.g., Tullio phenomenon) than subjects with smaller bony defects. No significant association between the size of the dehiscence and the audiogram pattern or individual findings could be found. The location of the dehiscence seemed to have no influence on the clinical manifestation and findings. CONCLUSION: Patients with larger superior canal dehiscences show significantly more vestibulocochlear symptoms/signs, lower VEMP thresholds, and objective vestibular findings compared with smaller ones. Smaller dehiscences mainly present with either cochlear or vestibular dysfunction.