Shouqin Zhao

Vestibulotomy above a severely displaced facial nerve

Conclusions. Vestibulotomy above a severely displaced facial nerve represents a new surgical approach to achieve serviceable hearing. The lack of facial nerve injury and the potential for hearing restoration make this procedure feasible in patients who would otherwise be marginal or poor surgical candidates. Objective. To investigate the feasibility of vestibulotomy above a severely displaced facial nerve. Material and methods. Eight patients with severe congenital conductive hearing loss underwent vestibulotomy above a severely displaced facial nerve and hearing reconstruction between January 2000 and January 2002. All patients had congenital middle ear deformities. The facial nerves overhung and concealed the oval window niche or lay inferior to the oval window. The facial nerves were transposed in order to reach the oval window niche in four of eight cases. Results. Hearing gain was 15 dB in 2 ears, 16–25 dB in 3 and > 26 dB in 3. There were no cases of postoperative facial paresis.

Facial nerve course in congenital aural atresia – identified by preoperative CT scanning and surgical findings

Conclusions. The facial nerve courses shown by preoperative CT imaging coincide with the surgical findings in most congenital aural atresia cases. CT scanning is critical in evaluation of a patients candidacy for atresia surgery. Objectives. To evaluate the diagnostic value of preoperative CT scanning of the facial nerve course in congenital aural atresia. Subjects and methods. All inpatients (135 cases) with congenital aural atresia had routine preoperative CT examination. The facial nerve courses were observed in the operation and compared with the preoperative CT imaging. Results. CT imaging showed that the mastoid portions of the facial nerves in 57% of cases (77/135) were located at the level of the round window, and 17% (23/135) were located at the levels of the oval window and the cochlea. Differential overlapping of the oval window by the facial nerve could also be shown in most of the cases. In the majority of cases (75%, 61/81) the tympanic portions of the facial nerve on CT imaging could be confirmed by surgical findings. In severe overlapping of the oval window or cases with anterior displacement, stapedectomy or tympanoplasty, respectively, could not be performed as usual.

Integrated protocol of auricle reconstruction combined with hearing reconstruction

Abstract Conclusions: Auricle reconstruction combined with hearing reconstruction can help patients with microtia to obtain practical hearing improvement as well as cosmetic improvement. The integrated procedures can facilitate the incision design and obtain a natural-looking three-dimensional shape of the reconstruction auricle. Objectives: To discuss the advantages of an integrated protocol for auricle reconstruction combined with hearing reconstruction. Methods: We retrospectively analyzed the clinical information and follow-up results of 1300 cases (1460 ears) of congenital aural atresia with microtia who underwent auricle reconstruction combined with hearing reconstruction from January 1988 to December 2007 in Tongren Hospital. In the first stage, rib cartilage was harvested to sculpt the framework then implanted into the subcutaneous pockets in the desired position. In addition, hearing reconstruction was carried out by the antrum approach. In the second stage, the auricle framework was elevated to accomplish the auricle reconstruction. Results: In all, 1445 of 1460 ears were closed by primary healing. The other 15 ears were successfully reconstructed with revision surgeries without graft failure complications. The three-dimensional profiles were well defined in 1248 ears. Total satisfaction rate was 85.5%. During the long-term follow-up, no cartilage resorption was found and all auricles retained good cosmetic effects.

Development and validation of a multidimensional quality of life questionnaire for congenital aural atresia

Abstract Conclusion: The psychometric characteristics of the Congenital Aural Atresia Questionnaire (CAAQ) are proposed to be reliable and sensitive to determine clinical changes in a patients quality of life (QOL) and the questionnaire has potential for clinical application. Objective: The aim of this study was to develop a quantifiable, self-assessed, and health-related QOL questionnaire for patients with congenital aural atresia and to explore its reliability and validity. Methods: An initial QOL questionnaire for patients with congenital aural atresia was constructed according to widely used available QOL questionnaires. A total of 140 patients with congenital aural atresia were recruited into this study. After pretest and item sifting, the QOL questionnaire was constructed, and its reliability and validity were evaluated. Results: An 18-item QOL questionnaire for patients with congenital aural atresia was constructed, which included 3 principal domains: symptoms and impact (physical, 8 items), mental status (psychological, 6 items), and social interaction (4 items). The retest reliability was 0.878; split-half reliability coefficient and Cronbachs alpha coefficient were 0.927 and 0.899, respectively. The factor analysis results indicated satisfactory construct validity.

Early detection of hearing impairment in patients with diabetes mellitus with otoacoustic emission. A systematic review and meta-analysis

Abstract Conclusions: The distortion product otoacoustic emission (DPOAE) amplitudes in diabetics were significantly lower than those in controls when pure tone audiometry (PTA) was within normal limits, implying cochlear function impairment in the early stage of diabetes mellitus. Retrocochlear damage was suggested by elongated wave latencies and the wave interval of auditory brainstem response (ABR) in diabetics. Objectives: This study aimed to systematically analyze the application of DPOAE in evaluation of the hearing function of diabetics. Data sources and review methods: Eligible articles were identified through searches of nine different electronic databases. Two investigators reviewed the original articles independently, with pre-defined inclusion and exclusion criteria. Meta-analyses were conducted by using Metan module. Results: There were seven articles eligible for the analysis. PTA thresholds were within normal limits in all diabetics at low–middle frequencies. The mean DPOAE amplitudes of diabetics were significantly lower than those of controls. The standardized mean difference (SMD) (95% CI) was −0.49 (−0.70, −0.27), −0.46 (−0.63, −0.30), and −0.60 (−0.77, −0.43) at 1, 2, and 4 kHz, respectively. The latencies of waves I, III, and V in diabetes were significantly longer than those of controls (0.43 (0.23, 0.64), 0.54 (0.33, 0.75), and 0.56 (0.35, 0.77), respectively). The wave interval I–V was significantly longer in diabetics (p < .001, 0.47 [0.24, 0.70]).

Round window application of an active middle ear implant (AMEI) system in congenital oval window atresia

Abstract Conclusion: Application of the Vibrant Soundbridge to the round window (RW) membrane can be utilized as an efficient therapy for congenital oval window (OW) atresia. Objective: To report the surgical technique and auditory outcome of an active middle ear implant (AMEI) system used in patients with congenital OW atresia. Methods: Nine subjects with congenital OW atresia (six males and three females, ranging in age from 5.5 to 25 years, average 12.5 years) were implanted with an AMEI (Vibrant Soundbridge) at the round window (RW-Vibroplasty). Five cases were diagnosed as having isolated congenital OW atresia while four patients presented with combined external/middle ear malformation. Results: An improvement of 30 dB in average pure-tone air conduction thresholds (0.5–4 kHz) was achieved, with the high frequencies showing greater results. The subjects achieved postoperative speech recognition scores of 80–100% on the Computerized Mandarin Speech Test System (CMSTS) sentence test. Bone conduction thresholds were confirmed as stable in all subjects postoperatively. Decline in auditory benefit was noticed in two subjects, who then underwent revision surgery. One of these revision surgery patients then experienced stable hearing recovery, while the other patient’s hearing declined.

The formation of sinus in congenital stenosis of external auditory canal with cholesteatoma

Conclusions. In congenital stenosis of the external auditory canal (CSEAC) with cholesteatoma, the bony wall of the external auditory canal (EAC) is most commonly involved. This involvement will lead to bone erosion of the EAC and may subsequently lead to the formation of postaural or cervical sinuses. High-resolution computed tomography (HRCT) of temporal bone can show characteristic signs of soft tissue mass in EAC, with adjacent bone erosion. Objective. To investigate the clinical features, differential diagnosis and management of CSEAC with cholesteatoma. Patients and methods. The clinical information for 10 cases of CSEAC with cholesteatoma was retrospectively reviewed. Results. The patients’ ages ranged from 4.75 to 22 years (average 12 years). The diameter of EACs was < 2 mm. All 10 ears had a history of postaural fistulae or sinuses. Bone erosion of EAC was distinctly shown in HRCT of all cases, as well as soft tissue masses, which led to enlargement of the bony canals. All patients underwent canaloplasty; eight ears received hearing reconstructions at the same time. Cholesteatoma in EACs was confirmed during the operations, accompanied by compression and destruction of the post-superior and/or inferior bony wall. Postoperative pathologic examinations proved the diagnosis of cholesteatoma, and excluded any tissue of bronchial cleft cyst or fistula. After a follow-up of 1–3 years, no recurrent cholesteatoma was found in any of the 10 cases. All reconstructed EACs were clean and smooth. The hearing levels in the eight ears that received hearing reconstructions increased 20–35 dBHL.

Classification of facial nerve aberration in congenital malformation of middle ear: Implications for surgery of hearing restoration

Objectives Facial nerve aberration is the most troublesome situation in congenital malformations of middle ear. The aim of our study is to investigate its imaging and clinical features as well as relevant choice of surgical techniques for hearing improvement. Methods A retrospective study involving review of clinical data of 227 patients (256 ears) with congenital middle ear anomaly was undertaken, including preoperative computed tomography (CT) data, surgical records and videos. Results Aberration involving intratemporal facial nerve was found in 82/256 ears (32.03%) with congenital middle ear anomaly. The most common forms of aberration included overhanging over the oval window (50/82 ears, 60.98%), bifurcation (3/82 ears, 3.66%) and transverse over the promontory (3/82 ears, 3.66%), counting for 68.29% (56/82) of the cases with facial nerve aberration. Concomitant stapes malformation was found in 76/82 ears (92.68%) and atresia or stenosis of the oval window in 27/82 ears (32.93%). In 9/82 ears (10.98%) both stapes and oval window was absent. Elective surgeries for the purpose of hearing improvement included stapodotomy + piston implantation, labyrinthotomy, labyrinthotomy + total ossicular replacement prosthesis (TORP) implantation and Vibrant Soundbridge (VSB) implantation. Conclusion The majority of facial nerve aberration in congenital malformation of middle ear involves displacement of facial nerve, in addition to concomitant malformations of the stapes and/or oval window, which may influence the choice of surgery for hearing improvement. VSB implantation may be considered as a useful option.

Audiological features in congenital bony atresia of external auditory canal with temporal-mandibular joint retroposition

OBJECTIVES To facilitate the diagnosis, treatment and surgical options for congenital bony atresia of external auditory canal (EAC) with temporal-mandibular joint (TMJ) retroposition by analyzing its audiological features and the morphology of temporal bone on CT scan. MATERIALS AND METHODS Two cohorts of patients with congenital EAC bony atresia with (n=23) or without (n=21) TMJ retroposition were recruited from September 2012 to July 2014 at Beijing Tongren Hospital, Capital Medical University. The patients with TMJ retroposition were set as the group A and those without as group B. Based on the degree of TMJ retroposition, group A was further divided into two sub-groups A1 (n=13) and A2 (n=10). The temporal bone CT scan, pure tone average (PTA) and air-bone gap (ABG) were obtained for the main outcome measurements. SPSS 17.0 was used for the statistics analysis with t and t test. RESULTS For group A, the average air conduction (AC) was 55.22±12.53dBHL, the average bone conduction (BC) was 7.07±3.34dBHL, and the average ABG was 50.69±8.60dBHL. For the sub-groups A1 and A2, the average AC was respectively 45.77±8.43dBHL and 59.50±7.43dBHL, BC 7.07±3.34dBHL and 6.89±4.37dBHL, and ABG 47.31±7.92dBHL and 53.00±7.91dBHL. For group B, the average AC was 70.24±5.63dBHL, BC 6.78±4.37dBHL, and ABG 60.19±6.09dBHL. CONCLUSIONS The degree of TMJ retroposition is negatively related to the severity of hearing loss among patients with congenital EAC bony atresia, and those with TMJ have suffered less severe hearing loss than those without. Although TMJ retroposition might be a disadvantage for patients undergoing EAC plasty and tympanoplasty, it must be considered for its influence on hearing loss severity and auditory canal abnormality when planning the surgical treatment. Different from normal surgical protocol for congenital EAC bony atresia, we commend other hearing reconstruction methods such as BAHA and VSB, even without intervention.

Preoperative assessment of stapes implantations of the vibrant SoundBridge for congenital aural atresia patients

Abstract Objective: The objective of this study is to retrospectively analyze the imaging characteristics of patients with congenital aural atresia who underwent Vibrant Soundbridge implantation, and to investigate the importance of preoperative evaluation of vibroplasty. Materials and methods: The study included 16 patients with bilateral congenital aural atresia aged 6–25 years (mean age, 14.7 years). All patients underwent Vibrant Soundbridge implantations. Results: Among the 16 patients, 15 successfully underwent stapes implantation. The average height of the stapes of these 15 patients was 2.93 mm, which was significantly different from that of the control group with normal hearing (p ≤ .001). The average distance between the tympanic segment of the facial nerve and the stapes was 1.41 mm in patients in whom the oval window was occluded by the displaced facial nerve. In the non-occluded group, the average distance was 2.00 mm. No significant difference was observed between the two groups (p = .08). Conclusion: The distance between the facial nerve and stapes, as well as the height of the stapes, could be important predictors of successful stapes implantation of Vibrant Soundbridge.