Proposal for a Unitary Anatomo-Clinical and Radiological Classification of Third Mobile Window Abnormalities

Introduction: An increased number of otic capsule dehiscence (OCD) variants relying on the third window pathomechanism have been reported lately. Therefore, a characterization of the anatomical structures involved and an accurate radiological description of the third window (TW) interface location have become essential for improving the diagnosis and appropriate therapeutic modalities. The purpose of this article is to propose a classification based on clinical, anatomical, and radiological data of third mobile window abnormalities (TMWA) and to discuss the alleged pathomechanism in lesser-known clinical variants.Materials and Methods: The imaging records of 259 patients who underwent, over the last 6 years, a high-resolution CT (HRCT) of the petrosal bone for conductive hearing loss were analyzed retrospectively. Patients with degenerative, traumatic, or chronic infectious petrosal bone pathology were excluded. As cases with a clinical presentation similar to those of a TW syndrome have recently been described in the literature but without these being confirmed radiologically, we thought it necessary to be integrated in a separated branch of this classification as “CT - TMWA.” The same goes for certain intralabyrinthine pathologies also recently reported in the literature, which mimic to some extent the symptoms of a TW pathology. Therefore, we suggest to call them intralabyrinthine TW-like abnormalities.Results: Temporal bone HRCT and, in some cases, 3T MRI of 97 patients presenting symptomatic or pauci-symptomatic, single or multiple, unilateral or bilateral OCD were used to develop this classification. According to the topography and anatomical structures involved at the site of the interface of the TW, a third-type classification of OCD is proposed.Conclusions: A classification reuniting all types of TMWA as the one proposed in this article would allow for a better systematization and understanding of this complex pathology and possibly paves the way for innovative therapeutic approaches. To encompass all clinical and radiological variants of TMWA reported in the literature so far, TMWAs have been conventionally divided into two major subgroups: Extralabyrinthine (or “true” OCD with three subtypes) and Intralabyrinthine (in which an additional mobile window-like mechanism is highly suspected) or TMWA-like subtype. Along these subgroups, clinical forms of OCD with multiple localization (multiple OCD) and those that, despite the fact that they have obvious characteristics of OCD have a negative CT scan (or CT – TMWA), were also included.

Relationship between Primary Tumors of Nasopharyngeal Carcinoma with the Degree of Conductive Hearing Loss in Dr. Mohammad Hoesin Hospital Palembang

Background. Nasopharyngeal carcinoma is a malignant tumor that grows in the nasopharyngeal area with predilection in the fossa Rossenmuller and the nasopharyngeal roof adjacent to the Eustachian tube, so one of NPC’s early symptoms is ear symptoms. Hearing loss is a common symptom found in people with NPC due to dysfunction of the Eustachian tube, a continuing middle ear disorder that can result in conductive hearing loss.This study aims to find out the relationship between primary tumor of NPC and the degree of conductive hearing loss at dr. Mohammad Hoesin Hospital Palembang. Methods. This is a cross sectional study that obtained 42 samples from the medical records at Dr. Mohammad Hoesin Hospital Palembang that met the inclusion and exclusion criteria. The study subjects collected in total sampling have been conducted audiometry examinations at the ORLHNS clinic of Dr. Mohammad Hoesin Hospital Palembang during the period January 2019 - April 2021. Results. The proportion of hearing loss in NPC patients in this study was 30 subjects (71.4%) with the highest proportion of hearing loss complaints being 33.3%. The proportion of conductive hearing loss of nasopharyngeal carcinoma patients in the study was 33 subjects (78.5%) right ear and 28 subjects (66.7%) left ear. There was a significant association between the degree of the NPC primary tumor and the incidence of conductive deafness of the left ear, but there was no significant association in the right ear. There is a significant correlation between NPC primary tumors and left ear hearing thresholds at frequencies of 500 Hz and 4000 Hz, but there is no significant association between the degree of NPC primary tumor and right ear hearing loss. Conclusions. There is significant correlation between the primary tumor of NPC and the hearing threshold of the left ear but there was no significant association in the right ear.

Endoscopic and Robotic Stapes Surgery: Review with Emphasis on Recent Surgical Refinements

Purpose of Review Stapes surgery has been established as the gold standard for surgical treatment of conductive hearing loss in otosclerosis. Excellent outcomes with very low complication rate are reported for this surgery. Recent advances to improve surgical outcome have modified the surgical technique with endoscopes, and recent studies report development of robotical assistance. This article reviews the use of endoscopes and robotical assistance for stapes surgery. Recent Findings While different robotic models have been developed, 2 models for stapes surgery have been used in the clinical setting. These can be used concomitant to an endoscope or microscope. Endoscopes are used on a regular base regarding stapes surgery with similar outcomes as microscopes. Endoscopic stapes surgery shows similar audiological results to microscopic technique with an advantage of less postoperative dysgeusia and pain. Its utility in cases of revision surgery or malformation is emphasized. Summary Endoscopic stapes surgery is used on a regular basis with excellent outcomes similar to the microscopic approach, while reducing surgical morbidity. Robotic technology is increasingly being developed in the experimental setting, and first applications are reported in its clinical use.

Role of Radiologic Imaging in Otosclerosis

Purpose of Review To review the role of imaging in otosclerosis with an emphasis on pre- and post-operative imaging evaluation. Recent Findings Pre-operative CT imaging can help define the extent of bone involvement in otosclerosis and may help avoid surgical complications due to variant anatomy or unsuspected alternative causes of conductive hearing loss. In patients with recurrent hearing loss after surgery, CT imaging can clarify prosthesis position and re-assess anatomy. Summary CT imaging complements otologic exam and audiometry findings in patients with suspected otosclerosis, for pre-operative planning, and post-operative assessment for patients with recurrent symptoms.

MYRINGOTOMY FOR THE TREATMENT OF OTITIS MEDIA WITH EFFUSION; A COMPARISON IN THE OUTCOME WITH AND WITHOUT GROMMET INSERTION

Objective: To compare the outcome of myringotomy with and without grommet insertion in the patients of otitis media with effusion in terms of improvement of hearing in a one-month follow-up. Study Design: Quasi experimental study. Place and Duration of Study: Pakistan Airforce Hospital Jacobabad and Combined Military Hospital Lahore Pakistan, from Jan to Dec 2020. Methodology: A total of 28 patients aged 4-12 years diagnosed to have conductive hearing loss due to otitis media with effusion not responding to medical treatment were included. Non probability convenience sampling was done. Children aged less than 4 years and above 12 years were not included in the study. They were randomly divided into two groups of 14 patients each using lottery method. Group A underwent myringotomy alone whereas group B underwent myringotomy with grommet insertion. Patients in both groups also underwent adenoidectomy on case-to-case basis. Both groups were compared in terms of improvement in hearing post operatively in a one-month follow-up. Results: There was statistically significant reduction in air bone gap at the end of follow up period as compared to preoperative air bone gap in group B (p=0.007). In group A there was statistically significant reduction in air bone gap at one week (p=0.002) however this improvement was not maintained at 4 weeks (p=0.386). Conclusion: Myringotomy with grommet insertion had significantly more patients with improved hearing as compared to myringotomy alone after one month.

A study to evaluate bone and cartilage ossiculoplasty in patients of ossicular disruption due to chronic suppurative otitis media

<p class="abstract"><strong>Background:</strong> Ossiculoplasty for ossicualar disruption in patients of chronic otitis media (COM) can be done by using either bone or cartilage. The present study was planned to compare bone and cartilage ossiculoplasty in patients of ossicular disruption due to COM.</p><p class="abstract"><strong>Methods:</strong> The prospective observational study was carried out in patients, who were admitted in the department of otorhinolaryngology of a tertiary care teaching hospital of Rajasthan during two years from November 2017 to November 2019. All patients with ossicular disruption due to COM and conductive hearing loss more than 40db were included in the study. Patients with sensorineural hearing loss were excluded from the study. Pure tone audiometry (PTA) was done before surgery. Hearing improvement was assessed 3, 6 and 12 months after surgery. </p><p class="abstract"><strong>Results:</strong> In the present study 20 patients underwent bone ossiculoplasty using autologous incus and autologous cartilage was used in 80 patients for ossiculoplasty. Post-operative hearing gain was significantly more in autologous incus patients (22.7±4.2 db) compared to autologous cartilage (19.5±3.4 db) (p=0.002).</p><p><strong>Conclusions:</strong> The present study concluded that post-operative hearing gain was significantly better with autologous incus compared to autologous cartilage although both showed good results in terms of hearing gain. </p>

A Case Report of a Middle Ear Mass Originated From Cartilage-like Tissue Treated With Transcanal Endoscopic Ear Surgery

Middle ear tumors are relatively rare, and among them, the diagnoses of middle ear lesions originating from cartilage-like tissue are even rarer. Use of transcanal endoscopic ear surgery (TEES) has increased in recent years because of its advantages, such as clear visual field and minimally invasive procedure. Here, we report a middle ear mass originating from cartilage-like tissue treated with TEES. A 62-year-old woman presented with progressive right-sided hearing loss. A white mass was revealed through the tympanic membrane, and pure-tone audiometry detected a mean 50.0 dB conductive hearing loss. Computed tomography showed a mass in the tympanic cavity. TEES was performed for diagnosis and treatment. A white translucent tumor was observed intraoperatively, and it was completely resected. Histopathological examination confirmed the diagnosis of a mass originating from degenerated cartilage-like tissue. To the best of our knowledge, this is the first study of a middle ear mass originating from cartilage-like tissue treated with TEES. TEES with its clear visual field and precise techniques was beneficial in treating the middle ear lesions circumscribed in the tympanic cavity.

A Genotyped Case of Townes–Brocks Syndrome with Absent Pulmonary Valve Syndrome from Turkey

Townes–Brocks syndrome (TBS) is a rare syndrome characterized by triad of anal, ear, and thumb anomalies. Further malformations/anomalies include congenital heart diseases, foot malformations, sensorineural and/or conductive hearing impairment, genitourinary malformations, and anomalies of eye and nervous system. Definitive diagnosis for TBS is confirmed by molecular analysis for mutations in the SALL1 gene. Only one known case of TBS with absent pulmonary valve syndrome (APVS) has been previously described to our knowledge. Here, we report a newborn diagnosed with TBS with APVS and tetralogy of Fallot (TOF) who was found to carry the most common pathogenic SALL1 gene mutation c.826C > T (p.R276X), with its surgical repair and postoperative follow-up. To our knowledge, this is the first genotyped case of TBS from Turkey to date. TBS should be suspected in the presence of ear, anal, and thumb malformations in a neonate. If a patient with TBS and TOF-APVS needs preoperative ventilation within the first months of life, this implies prolonged postoperative intubation and increased risk of mortality.

Correction: Conductive Hearing Loss: A Case Report

Editor's Note: This reprint of the September 2021 article Conductive Hearing Loss: A Case Report; Figure 2 was erroneously ommited from the original article and is now included alongside Figure 1 for appropriate context. AAO sincerely apologizes for the omission of the second figure in the original publication of this article.