Rinze A. Tange

Efficacy of Evaluation of Audiometric Results After Stapes Surgery in Otosclerosis. II. A Method for Reporting Results from Individual Cases

To standardize the reporting of hearing results after middle ear surgery, the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery proposed 2 levels of guidelines: level 1 for reporting summary data and level 2 for reporting raw data. The Committee encourages the reporting of raw data from each individual case. However, in studies in which the examined population is too large, this can yield difficulties. With respect to this point, we designed a method for a simple visual presentation of hearing results in an attempt to provide data from each individually operated ear in a patient group. In this method the relation between the preoperative and postoperative bone-conduction levels is evaluated to assess overclosure and iatrogenic cochlear damage, and the relation between postoperative gain in air conduction and the preoperative airbone gap is evaluated as a measure of technical success rate. This results in 2 plots, which we called the Amsterdam Hearing Evaluation Plots. Audiometric data from 451 stapes operations were used to demonstrate the use of the Amsterdam Hearing Evaluation Plots. (Otolaryngol Head Neck Surg 2001; 124:84-9.)

Efficacy of evaluation of audiometric results after stapes surgery in otosclerosis. I. The effects of using different audiologic parameters and criteria on success rates

The Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery proposed guidelines to provide more uniformity in reporting hearing results after middle ear surgery. One of the proposals was to include the hearing thresholds at 0.5, 1, 2, and 3 kHz in a 4-frequency pure-tone average (PTA) and to use postoperative bone-conduction (BC) levels rather than preoperative BC levels in describing postoperative air-bone gaps (ABGs). The hearing results of 451 stapes operations were evaluated to analyze to what extent the choice of different audiologic criteria affects success rates. It appeared that choice of PTA significantly affects postoperative gain in air-conduction thresholds and ABG levels. If one takes the improvements in speech-reception thresholds as the gold standard, the gain in air-conduction correlates best with a gain in speech-reception threshold if a higher frequency, such as 3 or 4 kHz, is included in a 4-frequency PTA. Also, choice of preoperative or postoperative BC in computing postoperative ABGs had a significant effect on the mean postoperative ABG levels, showing more favorable results with the use of preoperative BC thresholds. (Otolaryngol Head Neck Surg 2001; 124:76–83.)

Spread of Excitation Measurements for the Detection of Electrode Array Foldovers: A Prospective Study Comparing 3-Dimensional Rotational X-ray and Intraoperative Spread of Excitation Measurements

Objective: The optimal positioning of electrode arrays in the cochlea is extremely important. Our standard approach is to use a 3-dimensional rotational x-ray for the intraoperative determination of the position of the electrode array. We wanted to see if spread of excitation (SOE) is useful for determining the electrode array position within the cochlea. Study Design: Prospective blind study design. Setting: Tertiary University Referral Center (Cochlear Implantation Center Amsterdam-Academic Medical Center, University of Amsterdam). Patients: Seventy-two implanted ears with a Cochlear Freedom device. Intervention: After cochlear implantation, we compared the 3-dimensional rotational x-ray imaging and SOE measurements. The investigators were blinded for the intraoperative surgeon findings and also for the imaging findings. Outcome Measure(s): Electrode array foldovers within the cochlea and the reliability of the SOE measurements. Results: We placed implants in 72 ears in this study, and all procedures seemed to be surgically uneventful. To our surprise, we discovered 4 electrode foldovers in this group. Of the 4 foldovers, 3 were corrected intraoperatively. Conclusion: We found that intraoperative imaging and/or electrophysiologic measurements such as the SOE provide very useful information regarding electrode position within the cochlea. Spread of excitation is effective in detecting electrode array foldovers if the audiologist is experienced. Some software modifications are suggested.

Ototoxic reactions of quinine in healthy persons and patients with Plasmodium falciparum infection

Audiometric changes following quinine administration were studied in healthy Caucasian subjects and patients suffering from falciparum malaria disease. Quinine-dihydrochloride was administered intravenously as a single dose of 300 mg to 12 healthy subjects and as multiple doses of 600 mg in 4 h every 8 h in 10 Plasmodium falciparum malaria patients. The hearing function was monitored by conventional and high frequency audiometry. In nine healthy subjects hearing loss was documented at 2-4 h after infusion of Quinine-dihydrochloride at a mean maximal plasma quinine concentration of only 2 mg/l. In one healthy subject a persistent loss occurred of 20 dB at 14 kHz in one ear. In all malaria patients severe hearing losses and adverse effects related to ototoxicity were documented, but all the audiograms had returned to normal after 1 week and side effects disappeared. This study has shown that ototoxicity induced by quinine is almost completely reversible in healthy volunteers and in malaria patients.

Vascular Inner Ear Partition:A Concept for Some Forms of Sensorineural Hearing Loss and Vertigo

The results of a series of scanning electron microscopical studies were used to construct a model for the vascular pathways in the inner ear. Corrosion cast preparations of the vessels of the inner ear of the adult rat were used in this study. The inner ear is, like a hand, an end organ containing four sense organs (cochlea, saccule, utricle and the cristae ampullaris). All these specific inner ear structures have their own vascular supply. We have developed a blood flow diagram of the inner ear. This model was used for a classification of different types of ischemia in the inner ear and forms a concept for some forms of sensorineural hearing loss and vertigo. Four types of inner ear ischemia are proposed. In type I (a or b) of inner ear ischemia only the vessels of the cochlea are involved resulting in two types of hearing loss without vertigo. Type II is characterized by ischemia of a part of the cochlea and a part of the vestibular system. In type III (a or b) only the vestibular system is involved, while in type IV no blood circulation will be present in the inner ear resulting in total deafness and severe vertigo. Inner ear partition at ultramicroscopical level of these structures may be possible in the future and new imaging techniques will probably support the vascular schematic model presented in this study.

Comparison of two approaches to the surgical management of cochlear implantation

Our study was designed to compare two surgical approaches that are currently employed in cochlear implantation.

Reparative granuloma seen in cases of gold piston implantation after stapes surgery for otosclerosis

OBJECTIVE to determine the occurrence of the unusual side effect of a reparative granuloma after the implantation of a pure gold piston in cases of otosclerosis. STUDY DESIGN a retrospective case review study of 475 stapes operations with a pure gold piston. SETTING Department of Otorhinolaryngology of the University of Amsterdam, The Netherlands and the HNO clinic in Luenen (Brambauer) in Germany. PATIENTS four hundred and seventy five patients (328 women, 147 men, average age: 45.2 years), who clinically and per-operatively had otosclerosis, underwent a stapedotomy using a pure gold piston prosthesis. Therapeutic intervention: in cases of suspicion of a reparative granulomas or those cases that did not have improvement of the hearing after the stapedotomy, a re-operation by transcanal approach was performed. RESULTS in seven cases a reparative granuloma was diagnosed by this revision surgery. The postoperative incidence of these granulomas following stapedotomy using the pure gold piston turned out to be 1.5%. CONCLUSION reparative granulomas can occur after stapedotomy with a pure gold stapes piston although the incidence is low. The role of grafting material to seal the oval window niche and the treatment of these reparative granulomas following stapes surgery are discussed.

Ionomeric Cement in the Human Middle Ear Cavity: Long-Term Results of 23 Cases

Objectives The long‐term results of the implantation of glass ionomer cement in the human mastoid and middle ear were studied.

A retrospective study of the hearing results obtained after stapedotomy by the implantation of two Teflon pistons with a different diameter

This study reports the evaluation of hearing results after implantation of a Teflon piston of a different diameter in cases of otosclerosis requiring stapedotomy. By random selection, a Teflon piston with a shaft diameter of 0.3 mm was inserted in 34 cases and a piston with a shaft diameter of 0.4 mm in 26 cases. A retrospective analysis of the pre- and postsurgery audiological results of these two patient groups was carried out by microcomputer. A repeated statistical measures analysis of variance was used to test and estimate the air-conduction frequency-specific differences between the two prostheses with respect to changes in pre- and postoperative healing. The results of this comparative study of the two Teflon pistons with different diameters indicate statistically a greater hearing gain for the 0.4-mm prosthesis, especially in the lower frequencies.

The suprameatal approach: a safe alternative surgical technique for cochlear implantation.

Objective: To report on surgical complications arising postoperatively in 104 patients undergoing cochlear implantation surgery using the suprameatal approach (SMA). Second, to examine the advantages and disadvantages of the SMA technique compared with the classic mastoidectomy using the posterior tympanotomy approach. Study Design: Retrospective study assessing surgical complications in deaf adults and children undergoing cochlear implantation. Setting: Tertiary referral center for cochlear implantation (Academic Medical Centre). Patients: The mean age at the time of surgery was 39.6 years (1.0-82.3 yr), and the mean duration of deafness was 26.3 years (0.3-66.0 yr). The main cause was a congenital hearing loss (30.8%) and a progressive sensorineural hearing loss e.c.i. (25.0%), followed by meningitis (12.5%) and otosclerosis (6.7%). The mean duration of follow-up after surgery was 25.7 months (range, 3.0-59.0 mo). Results: The overall major complication rate was 3.7% (4 of 107). All complications developed postoperatively. The major complications consisted of extrusion of the implant due to wound infection (n = 2), a wrong route for the electrode (n = 1), and device failure (n = 1). The minor complication rate was 23.4% (25 of 107). The mean time taken for cochlear implantation was 111.7 minutes (range, 60.0-261.1 min). Conclusion: This study confirms the SMA is a safe, simple, and quick technique that is feasible for cochlear implantation in most cases. Although the stretching of the electrode array when it enters the scala tympani and a low-lying dura could present a potential restriction for the SMA technique, our results do not support this hypothesis.