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PubMedDate not supplied

Comparison of argon and CO2 laser stapedotomy in primary otosclerosis surgery.

PURPOSE: The primary use for the laser in otosclerosis surgery is to create a stapes footplate fenestration that obviates the need for mechanical footplate removal. Experimental studies that evaluate the potential safety of visible (argon and potassium-titanyl-phosphate [KTP]) and invisible (CO2) light laser systems in stapes surgery report conflicting results. The purpose of this study is to compare the clinical safety and efficacy of the CO2 and argon laser systems when used for primary laser stapedotomy. MATERIALS AND METHODS: A retrospective case review of 124 primary laser stapedotomies using either the argon (n = 59) or CO2 (n = 65) laser was performed. Data consisted of pre- and postoperative air and bone conduction audiometry, speech discrimination scores (SDS), intraoperative findings, and postoperative complications. Between group differences (argon v CO2) were sought using standard statistical methodology. RESULTS: The argon and CO2 laser groups were comparable with regards to age, sex, preoperative air-bone gap, and laterality. Mean preoperative air and bone conduction pure-tone average (PTA) and SDS were somewhat higher in the CO2 laser group (P < .05). Postoperatively, both groups showed similar results in mean change in air conduction PTA, air-bone gap, and SDS, as well as in the frequency of complications. There were no anacoustic ears in either group. CONCLUSIONS: The results suggest that the argon and CO2 laser systems are comparable with regards to safety and efficacy when used by experienced surgeons for stapedotomy.

Adult↗

PubMed2003

Technical refinements and precautions during ionomeric cement reconstruction of incus erosion during revision stapedectomy.

OBJECTIVE: The study describes the technical precautions and short-term hearing results of fast-setting ionomeric cement (SerenoCem) for managing incus erosion in revision stapedectomy. STUDY DESIGN: Observational and retrospective chart review. METHODS: Consecutive patients undergoing ionomeric cement incus reconstruction during revision stapedectomy had surgery on an ambulatory basis in a tertiary care referral center. Main outcome measures included technical details, precautions, and recommendations for handling this new material and 6-week hearing outcomes comparing preoperative and postoperative air-conduction and bone-conduction thresholds. RESULTS: A small amount of ionomeric cement on the tip of otological picks applied to the incus remnant successfully reconstitutes the original length of the long process of the incus. In revision stapedectomy, a crimp-on prosthesis may be placed on the cement-lengthened incus. Six-week postoperative audiograms demonstrated significant closure of the air-bone gap in operated cases. Our experience in a failed case leads us to recommend that the setting time for the cement be increased to no less than 20 minutes as opposed to the manufacturer's recommendation of 10 minutes. Also, revision stapedectomy was more likely to be successful when the prosthesis was placed to the incus remnant and stabilized with cement, rather than placing the prosthesis on the cement itself. CONCLUSIONS: Ionomeric cement permits direct reconstruction of a pathologically shortened incus in revision stapedectomy. Surgeons must be aware of precaution and limitations of this new material. Preliminary results indicate significant hearing improvement with this technique when appropriate precautions are taken.

Adolescent↗

PubMedDate not supplied

Candidacy for the bone-anchored hearing aid.

The BAHA (bone-anchored hearing aid) is a bone conduction hearing aid with percutaneous transmission of sound vibrations to the skull. The device has been thoroughly evaluated by various implant groups. These studies showed that, in audiological terms, the BAHA is superior to conventional bone conduction devices. In comparison with air conduction devices, the results are ambiguous. However, a positive effect is found with respect to aural discharge. The most powerful BAHA can be applied to patients with a sensorineural hearing loss component of up to 60 dB HL. It was shown that bilateral BAHA application leads to binaural sound processing. Preliminary results on the application of the BAHA in patients with unilateral conductive hearing loss suggest that stereophonic hearing can be re-established. The application of the BAHA as a transcranial CROS (contralateral routing of signal) device in unilateral deafness minimizes head shadow effects.

Auditory Threshold↗

PubMed2005

[Effect of the middle ear status on the recording of vestibular evoked myogenic potential--VEMP].

The aim of this study was to assess the effect of the middle ear status on the recording of air- and bone-conducted vestibular evoked myogenic potential. Forty eight children were included in the study, ranging in age from 4 to 10 years. All of the children underwent otoscopy, pure tone audiometry, tympanometry and air- and bone-conducted VEMP in response to click. There were 3 groups according to the condition of the middle ear: group I--52 ears (type A and C1 tympanogram, pure tone average < or = 20 dB), group II--23 ears (type C2 and B tympanogram, pure tone average < or = 20 dB), group III--21 (type B tympanogram, pure tone average > 20 dB). The threshold, presence of correct waveform morphology of the response and latency was evaluated. The condition of the middle ear has no significant effect on the recording of VEMP and mean level of the response threshold with bone stimulation, based on the performed studies. However, with air stimulation it has effect on the recording of VEMP, increase of the mean threshold response and shortening of latency p13 and n23.

Acoustic Impedance Tests↗

PubMed1982

[Newborn-audiometry. Review and recent experiences (author's transl)].

After a survey concerning the previous testing methods in Newborn-Audiometry three different examinations are carried out and compared. Thereby the testing by bone conduction is doing best. There are only small intensities necessary. The results are reproducable well and have small scattering. The investigation makes no high demands to the technical equipment, to the personal appointment and the loss the time. The author supposed that the Newborn-Audiometry by bone conduction is a suitable method as a screening test especially for high risk children.

Audiometry↗

PubMed2005

Vestibular responses to sound.

Research into vestibular responses to sound has evolved in four stages. The first, largely the work of Tullio in the 1920s, involved inspection of the eye, head, and postural responses to sound of alert animals with surgical fenestrae into various parts of the bony labyrinth. The second, begun in 1964 by Bickford and his group and continued by our group and then by others in the last 10 years, involves the measurement of evoked myogenic potentials to air-conducted and bone-conducted clicks and tones in normal humans. The third, begun by Mikaelian at about the same time as Bickford and continued by McCue, our group, and others, involves electrophysiological recordings of primary vestibular afferent neuron responses to sound in anesthetized animals. The fourth involves measurements of vestibulo-ocular responses to sound in humans with the Tullio phenomenon. It was begun by Minor and his group in 1998 with the observation that sound-induced nystagmus in humans, the Tullio phenomenon, aligned with the rotation axis of the superior semicircular canal. They then showed a defect in the temporal bone between the apex of the superior semicircular canal and the middle cranial fossa, which was the cause of most, if not all, cases of sound-induced nystagmus. Here some of the key observations made in each of these four stages are reviewed.

Acoustic Stimulation↗

PubMed1988

Human skull vibratory patterns in audiometric and supersonic ranges.

The attenuation of bone-conducted stimuli across the human skull was determined in audiometric, ultrasonic, and supersonic frequency ranges (250 to 64,000 Hz). An increase in attenuation with an increase in frequency, as well as significant resonance effects, was observed. For the audiometric frequency range, bone conduction stimulation of one side of the head results in almost equal stimulation of the other side. In the ultrasonic and supersonic ranges, the contralateral side is progressively isolated.

Audiometry↗

PubMed1998

Cigarette smoking and hearing loss: the epidemiology of hearing loss study.

CONTEXT: Clinical studies have suggested that cigarette smoking may be associated with hearing loss, a common condition affecting older adults. OBJECTIVE: To evaluate the association between smoking and hearing loss. DESIGN: Population-based, cross-sectional study. SETTING: Community of Beaver Dam, Wis. PARTICIPANTS: Adults aged 48 to 92 years. Of 4541 eligible subjects, 3753 (83%) participated in the hearing study. MAIN OUTCOME MEASURES: The examination included otoscopy, screening tympanometry, and pure-tone air-conduction and bone-conduction audiometry. Smoking history was ascertained by self-report. Hearing loss was defined as a pure-tone average (0.5, 1, 2, and 4 kHz) greater than 25-dB hearing level in the worse ear. RESULTS: After adjusting for other factors, current smokers were 1.69 times as likely to have a hearing loss as nonsmokers (95% confidence interval, 1.31-2.17). This relationship remained for those without a history of occupational noise exposure and in analyses excluding those with non-age-related hearing loss. There was weak evidence of a dose-response effect. Nonsmoking participants who lived with a smoker were more likely to have a hearing loss than those who were not exposed to a household member who smoked (odds ratio, 1.94; 95% confidence interval, 1.01-3.74). CONCLUSIONS: These data suggest that environmental exposures may play a role in age-related hearing loss. If longitudinal studies confirm these findings, modification of smoking habits may prevent or delay age-related declines in hearing sensitivity.

Aged↗

PubMed2003

Granule size and composition of bioactive glasses affect osteoconduction in rabbit.

Bioactive glass granules of three different compositions, regarding particularly Si- and Al- content (S53P4, S59.7P2.5, S52P3) and of two different granule sizes (200-250 microm and 630-800 microm) were implanted for 4 and 8 weeks in the distal part of rabbit femur. The effect of glass composition and granule size on bone formation was studied. The results were evaluated using histology, computerized histomorphometry, scanning electron microscopy and energy dispersive X-ray analysis, and used for mathematical description of bone formation. The results showed that both the composition of the glass and the granule size of the granules, have influence on bone growth from the surrounding tissue. Glass S53P4, which from previous observations is known to be an effective bioactive glass and widely used in the Biomaterial Project of Turku, Finland, showed bone bonding and increasing bone growth between the granules. Glass S59.7P2.5 which due to its high Si-content should be inert, showed bone bonding. At 4 weeks the bone growth was significantly more abundant in bone defects filled with large granules (630-800 microm) than in defects filled with small granules (200-250 microm). Glass S52P3 with an alumina content of 3 wt %, showed good bone conduction, possibly even bone bonding for granules of 630-800 microm size. Granules of 200-250 microm with a high alumina content at the surface of the reaction layer, showed hardly any bone contact at all. This data, therefore, gives new information concerning bone bonding and osteoconduction of bioactive glasses with a high silica or alumina content.

Journal Article↗

PubMed2001

A clinical histologic study of bovine hydroxyapatite in combination with autogenous bone and fibrin glue for maxillary sinus floor augmentation. Results after 6 to 8 months of healing.

Biopsies were taken from 16 out of 20 consecutive referral patients 6 to 8 months after maxillary sinus floor augmentation with a mixture of bovine hydroxyapatite (BH), autogenous bone particles and fibrin glue. Four days prior to biopsy retrieval the patients were given a single dose of tetracycline to label bone forming sites. Fluorescence microscopy of 100 microm thick sections revealed active bone formation in conjunction with the BH particles in 14 of 15 specimens analysed. Light microscopy and morphometry of ground sections from 16 patients showed various amounts of mineralised bone tissue in all except one specimen. In the latter case, the BH particles were encapsulated by a dense fibrous connective tissue. Sections from the augmented areas were occupied by non-mineralized tissue (54.1+12.6%), lamellar bone (21.2+24.5%), BH particles (14.5+10.3%) and woven bone (10.2+13.4%). The non-mineralized tissue seen in bone forming areas consisted of a loose connective tissue, rich of vessels and cells, and in the periphery of a more dense fibrous connective tissue. Woven bone with large and scattered osteocyte lacunae was bridging between the BH particles and the lamellar trabecular bone. There were no signs of resorption of the BH particles. The lamellar bone appeared to have originated from the recipient site and was seldom in contact with the BH particles. It is concluded that the tested implant material has bone conducting properties. The bone associated with the BH particles after 6 to 8 months of healing was mainly woven.

Aged↗

PubMed1995

Twenty-five years of experience with stapedectomy.

The purpose of this report is to review the outcomes of patients undergoing stapes surgery by the senior author during the past 25 years, and to compare these results with those obtained in other series. A retrospective analysis of 902 patients who underwent stapes surgery by the senior author from 1970 to 1994 was performed. Twenty-two patients underwent stapedotomy; the remainder underwent stapedectomy. Pure-tone averages for air and bone conduction, air-bone gap closure, technique, complications, and patient satisfaction were compared with results obtained in other stapedectomy and stapedotomy series.

Adolescent↗

PubMed1995

Extended high-frequency thresholds in noise-induced hearing loss.

Air-conduction and bone-conduction thresholds were measured in the conventional audiometric frequency ranges, and air-conduction alone in the extended high-frequency range of 9-18 kHz in 167 males with a history of occupational noise exposure. The subjects were grouped according to age. Hearing loss in the conventional frequency range was classified in different grades. Threshold elevation in the extended high-frequency range was present in all age groups and grades of conventional frequency hearing loss. An age effect in the extended high-frequency range was present only in the lowest grades of conventional frequency noise-induced hearing loss.

Acoustic Stimulation↗

PubMed1990

[Hearing acuity in otitis media with effusion and adhesive otitis media].

The relationship between findings established by the photograph of the tympanic membrane and hypacusia was determined by pure-tone audiometry. Subjects were 352 ears of 267 patients diagnosed as otitis media with effusion (OME) or adhesive otitis media (AdOM). These two diseases were evaluated on the basis of photographs of the tympanic membrane taken from 1983 to 1988. The results were as follows; 1) The effect of aging process on hearing acuity was noted in patients with these diseases, i.e., values of hearing acuity by air and bone conduction were, in descending order, early-, mature-, and advanced-age groups, with significant differences (p less than 0.01). 2) Greater loss of acuity by air conduction in the middle to high frequency ranges was found in patients with OME than with AdOM. In bone conduction, a decrease in low frequency range in the early--and mature--age groups was larger in patients with AdOM than with OME and a significant decrease in 2000-6000 Hz in the advanced-age group was more marked in patients with OME than with AdOM (p less than 0.05). 3) Among patients with AdOM, those with retained fluid in the middle ear showed a significant decrease in air conduction values and a significant increase in air-bone gap compared with those without fluid (p less than 0.05). 4) The degrees of adhesion correlated well with a decrease in hearing acuity. 5) Hearing acuity was not influenced by attic retraction, white plaque, scar and atrophy of their tympanic membranes.

Adolescent↗

PubMed2000

Noise-induced hearing loss among textile workers in Lagos metropolis.

A cross-sectional sample of 204 textile workers was selected randomly from all sections (including the non-production areas), and was initially screened to exclude subjects with pathological middle ear as well as those currently working in sections classified as non-noise but who had been exposed to excessive noise in the past. A total of 17 workers were thus excluded leaving 187 who were then assessed by means of air-conduction and bone-conduction audiograms obtained by the use of a manual (medicor-SA 3L), pure-tone audiometer. All audiometric tests were preceded by an otological examination to rule out the presence of any significant aural pathological conditions. The subjects were divided into 3 groups, based on the noise levels observed at their worksites using a Bruel and Kjaer type 2225 (integrating) sound level meter viz: the noise-exposed group (noise levels > 90 dBA); the less-noise-exposed group (noise levels 85-90 dBA); and the non-noise-exposed group (noise levels < 85 dBA). A comparative analysis of the data on hearing threshold levels of the 3 groups showed that the noise-exposed group had significantly (P < 0.05) elevated hearing threshold levels at all frequencies and in each age group, although the maximal threshold shifts were observed at the 4000 Hz frequency. Also, the hearing threshold levels for the noise-exposed group increased with the duration of noise exposure. The study clearly showed the deleterious effects of uncontrolled occupational noise exposure on unprotected workers. A very high prevalence rate of noise-induced hearing loss (79.8%) was recorded for the noise-exposed group. The less-noise-exposed group recorded a comparatively low figure of 11.3%. The weaving section alone recorded the highest prevalence rate of 84.5%, followed very closely by the spinning section with 71.0%. The lowest prevalence rate (2.9%) was recorded for the administrative staff.

Adolescent↗

PubMed1998

A miniaturized artificial mastoid using a skull simulator.

A miniaturized artificial mastoid of size and weight that allow calibration and measurement of bone conduction hearing aids in a conventional audiometric soundproof box has been developed. Its level of mechanical impedance corresponds to the standard IEC 373 (1990) within the frequency range 250 Hz to 8 kHz. The miniaturized artificial mastoid consists of three parts: coupler, skull simulator (TU-1000), and an external electrical correction filter. The coupler is a highly damped mass-spring system designed to give the miniaturized artificial mastoid mechanical impedance in accordance with the standard IEC 373 (1990). It was found that the miniaturized artificial mastoid yielded results that are in correspondence with results obtained with the Brüel & Kjaer type 4930 artificial mastoid for frequencies above 450 Hz. Thus, at these frequencies, the miniaturized artificial mastoid can be used for audiometer calibration as well as measurement of bone conduction hearing aids.

Bone Conduction↗

PubMed2003

[Results after erbium:YAG-laser stapedotomy].

BACKGROUND: The analysis of postoperative results after Erbium : YAG-Laser stapedotomy in patients with otosclerosis. METHODS: For all operations the microscope-integrated Erbium : YAG-Laser Twin ER (Zeiss, Oberkochen) was used by different surgeons. Data of 53 patients who were operated on between October 1993 and May 1999 were analysed. The mean follow-up time was 17 months. Postoperative bone-conduction and air-conduction thresholds and the presence of postoperative tinnitus and vertigo were analysed. The data were analysed according to the guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (1994). RESULTS: In 49 patients unchanged preoperative minus postoperative pure tone bone conduction averages at 1, 2, and 4 kHz were observed. In 4 patients a slight deterioration between 10 and 20 dB was seen. In 2 patients a new postoperative tinnitus was observed. No patient suffered from vertigo at the time of evaluation. In 22 patients the postoperative air-bone gap was between 0 and 10 dB, in 25 patients between 11 and 20 dB, and in 6 patients between 21 and 30 dB. No patient had a postoperative air-bone gap of more than 30 dB. CONCLUSIONS: The Erbium : YAG-Laser stapedotomy is a safe technique. Good postoperative hearing results may be achieved in patients with otosclerosis.

Adolescent↗

PubMed1988

Assessment of sound in the ear canal caused by movement of the jaw relative to the skull.

To assess whether or not the reduction of threshold to bone-conducted sound on occlusion of the ears (the occlusion effect) is due to compression of the auditory meatus by the jaw, measurements of movement of the skull and mandible and sound in the ear canal are reported from four subjects. The change in bone-conducted sound in the ear canal was also measured when the mandible was moved out and in (presenting more or less of the mandible to compress the auditory meatus) and when vibration was applied directly to the mandible. Sound pressure increased when the jaw was moved out and when vibration was applied to the mandible.

Air Pressure↗

PubMed2003

Improvement of central motor conduction after bone marrow transplantation in adrenoleukodystrophy.

The case is described of a 20-year-old man with adrenoleukodystrophy who showed right spastic hemiparesis and gait disturbance. Brain magnetic resonance imaging disclosed predominant involvement of the left corticospinal pathway. The clinical symptoms improved after bone marrow transplantation. Transcranial magnetic stimulation disclosed significant improvement in various parameters of central motor conduction.

Adrenoleukodystrophy↗