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Ear, Nose, & Throat Journal Jun 2024To analyze the etiology, diagnosis, and treatment of unexplained conductive hearing loss (UCHL) with intact tympanic membrane. A systematic review was conducted based... (Review)
Review
To analyze the etiology, diagnosis, and treatment of unexplained conductive hearing loss (UCHL) with intact tympanic membrane. A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 642 articles were retrieved from databases such as PubMed, Embase, Web of Science, and Cochrane. Fifty-four research articles and 21 case reports were screened out according to the inclusion and exclusion criteria for analysis of the etiology of UCHL. Seven research articles with UCHL who underwent exploratory tympanotomy were selected for data extraction and analysis of clinical characteristics. UCHL is a common manifestation of various diseases, including congenital ossicular anomalies (COA), otosclerosis (OTS), congenital middle ear cholesteatoma (CMEC), oval window atresia, superior semicircular-canal dehiscence, congenital stapedial footplate fixation, middle ear osteoma or adenoma, congenital ossification of stapedial tendon, and so on. A total of 522 patients were included in the 7 articles; among whom OTS showed a tendency to increase with age. The main symptoms were hearing loss, followed by tinnitus, dizziness, ear fullness, ear pain, facial paralysis. A total of 87.5% to 93.0% patients with COA manifested as nonprogressive deafness that occurred since childhood, with tinnitus incidence of 15.6% to 30.2%, and 86.4% to 96.4% patients with OTS presented with progressive hearing loss, with tinnitus incidence of 60.1% to 90.9%. The diagnosis positive rate of high-resolution computed tomography (HRCT) was 33.8% to 87.1%, and CMEC was higher than that of COA (83.3%-100% vs 28.6%-64%). All the articles reported good hearing recovery. The most common surgical complications included taste abnormalities, tinnitus, and dizziness. UCHL presents with similar clinical manifestations and poses challenges in preoperative diagnosis. Exploratory tympanotomy is the primary method for diagnosis and treatment, with good prognosis after removing the lesion and reconstructing hearing during the operation. Children can also safely undergo the surgery.
PubMed: 38895947
DOI: 10.1177/01455613241262129 -
Otology & Neurotology : Official... Sep 2020The purpose of this study was to systematically evaluate the literature to evaluate the rate of and associated factors with aberrant facial nerve stimulation (AFNS)... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The purpose of this study was to systematically evaluate the literature to evaluate the rate of and associated factors with aberrant facial nerve stimulation (AFNS) following cochlear implantation. Additionally, management strategies for AFNS were assessed.
DATA SOURCES
A systematic search was performed in PubMed, Cochrane Database of Systematic Reviews, and Web of Science to identify peer reviewed research.
STUDY SELECTION
Eligible studies were those containing peer-reviewed research in English addressing AFNS following cochlear implantation. Studies with paired data were included in the meta-analysis.
DATA EXTRACTION
Three investigators independently reviewed all articles and extracted data. Bias was assessed using the National Institutes of Health Study Quality Assessment Tool.
DATA SYNTHESIS
Thirty-seven articles were included, representing 5,694 patients. The overall reported AFNS rate was 5.6% (range, 0.68-43%). Array type demonstrated a significant association with AFNS with lateral wall electrodes having a higher odds ratio than perimodiolar electrodes (odds ratio [OR] = 3.92, 95% confidence interval [CI] 1.46-10.47, p = 0.01). CI recipients with otosclerosis were also more likely to experience AFNS compared with non-otosclerosis pathology (OR = 13.73, 95% CI 3.57-52.78, p < 0.01). Patients with cochlear malformations had an overall AFNS rate of 28% (range, 5.3-43%) and those with otosclerosis had an overall rate of 26% (range, 6.25-75%). Reprogramming with or without electrode deactivation was successful for AFNS elimination. Four patients of 3,015 required explantation.
CONCLUSION
Array type and underlying cochlear pathology are associated with AFNS and implant reprogramming is an overall successful management strategy. Further research is needed to elucidate mechanism of AFNS and develop management strategies that limit impact on hearing outcomes.
Topics: Cochlea; Cochlear Implantation; Cochlear Implants; Facial Nerve; Hearing Tests; Humans; Otosclerosis
PubMed: 32558747
DOI: 10.1097/MAO.0000000000002693 -
European Archives of... Jun 2024Revision stapes surgery is a challenging procedure performed in relatively small numbers compared to other middle ear procedures. Despite numerous data on hearing... (Review)
Review
PURPOSE
Revision stapes surgery is a challenging procedure performed in relatively small numbers compared to other middle ear procedures. Despite numerous data on hearing results of different middle ear surgeries, the audiological standards for successful outcome of this procedure are still not clarified. On the basis of well-documented data, we wanted to determine what the expected audiological results and complications are after revision stapes surgery in order to set a realistic threshold for surgical success.
METHODS
After the protocol registration in the PROSPERO database, a systematic review was performed in multiple databases (PubMed, Cochrane, Web of Science, Scopus, ScienceOpen, ClinicalTrials.gov, Google Scholar) according to PRISMA guidelines. Twelve articles were reviewed according to the inclusion criteria. A total of 1032 cases were obtained for evaluation. A modified version of Newcastle-Ottawa Scale (NOS) was used to assess publication quality.
RESULTS
Average air-bone gap (ABG) gain was 17.3 dB, average air conduction (AC) gain was 17.5 dB. The average postoperative air-bone gap was 11.1 dB. The postoperative ABG distribution was the following 0-10 dB: 53.3%, > 10-20 dB: 28.2%, > 20 dB: 18.5%. SNHL as a surgical complication was described in a total of 17 cases (1.6%), no equilibrium disorder was reported.
CONCLUSION
The pooled data suggest that revision stapes surgery is an effective solution after failure of previous stapes surgery. However, the results are clearly inferior to those of primary stapedotomies. Hence, we need to apply different expectations and use different standards in the indication and evaluation of this type of surgery.
PubMed: 38839701
DOI: 10.1007/s00405-024-08741-7 -
European Archives of... Jan 2023This study is to compare the hearing outcomes and complications of stapes surgery and cochlear implantation (CI) in patients with far-advanced otosclerosis (FAO). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This study is to compare the hearing outcomes and complications of stapes surgery and cochlear implantation (CI) in patients with far-advanced otosclerosis (FAO).
DATA SOURCES
A comprehensive electronic search of PubMed/MEDLINE, Scopus, Web of science and Cochrane Library was conducted in June 2021 for articles in the literature till this year.
STUDY SELECTION
Studies are published in English language, conducted on human subjects, concerned with comparison of CI and stapes surgery in the management of FAO, not Laboratory study and not Opinion study. The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis statement 2009 (PRISMA).
DATA EXTRACTION
Twenty-six studies were included with 334 patients in CI group and 241 patients in stapes surgery group. Comparison between both groups was done in terms of postoperative complications, audiological outcomes, rete of revision surgery and patients' satisfaction rate.
RESULTS
Postoperative complications rate was significantly lower in CI (13.6%) than stapes surgery (18.6%). CI had a significantly lower rate of revision surgery (8.1%) than stapes surgery (16.4%). CI had a better mean for pure tone average (29.1 dB) than stapedectomy (52.3 dB) while stapes surgery had a higher mean for recognition of monosyllables and disyllables than CI. CI had significantly higher satisfaction rate than stapes surgery.
CONCLUSION
Both Stapes surgery and CI are reliable treatment options for FAO with close success rates. Statistics of CI are greater than stapes surgery and CI has a consistent improvement in audiometric outcomes in comparison to stapes surgery.
Topics: Humans; Cochlear Implantation; Otosclerosis; Postoperative Complications; Retrospective Studies; Stapes; Stapes Surgery; Treatment Outcome
PubMed: 35687184
DOI: 10.1007/s00405-022-07449-w -
Otology & Neurotology : Official... Mar 2020To determine the correlation between intraoperative changes of electrocochleography (ECochG) responses and traumatic cochlear implant insertions as well as postoperative...
Correlation Between Electrocochleographic Changes During Surgery and Hearing Outcome in Cochlear Implant Recipients: A Case Report and Systematic Review of the Literature.
OBJECTIVE
To determine the correlation between intraoperative changes of electrocochleography (ECochG) responses and traumatic cochlear implant insertions as well as postoperative hearing loss.
METHODS
ECochG, radiological, and audiological data were collected prospectively in a cochlear implant recipient with otosclerosis and assumed cochlear trauma during electrode insertion. A systematic review was conducted within PubMed-NCBI, EMBASE, and the Cochrane Library using the terms "Cochlear implant" and "Electrocochleography." Original studies that evaluated intraoperative ECochG responses and postoperative hearing loss were selected and analyzed.
RESULTS
The case report revealed a drop of intra- and extracochlear ECochG signals during electrode insertion. The postoperative computed tomography scan suggested a scalar dislocation. There was no measurable hearing 4 weeks after surgery. Within the database search, nine articles met the inclusion criteria. All were case series reports (range from 2 to 36 subjects) with a total of 173 subjects. Due to the heterogeneous data, a meta-analysis was unfeasible.
CONCLUSIONS
In concordance with some findings in the literature, the presented case report suggests that a drop of intra- and extracochlear ECochG signals during the insertion of the electrode array is associated with cochlear trauma and postoperative hearing loss in some cases. However, the literature is inconclusive regarding the correlation between intraoperative changes of the ECochG signals and postoperative hearing preservation. More studies investigating the correlation are needed to provide sufficient data.
Topics: Audiometry, Evoked Response; Cochlea; Cochlear Implantation; Cochlear Implants; Hearing; Humans
PubMed: 31834213
DOI: 10.1097/MAO.0000000000002506 -
The Journal of Laryngology and Otology May 2020To evaluate the surgical techniques, approaches, audiological outcomes and complications of endoscopic stapes surgery. (Comparative Study)
Comparative Study
OBJECTIVES
To evaluate the surgical techniques, approaches, audiological outcomes and complications of endoscopic stapes surgery.
METHODS
Systematic searches of the literature were performed in PubMed, Web of Science and Scopus databases, to identify studies of patients who underwent stapes surgery using endoscopic approaches and studies reporting objective post-operative hearing outcomes. The following information was extracted: surgery duration, complications, surgical technique and audiometric results.
RESULTS
Fourteen studies were selected for appraisal, which included a total of 282 ears subjected to endoscopic stapes surgery. Endoscopic stapes surgery seems to provide adequate visualisation of the middle-ear structures, thereby allowing less invasive surgery and potentially equivalent audiological outcomes as compared with a traditional microscopic approach. Other advantages of endoscopic stapes surgery include decreased surgery time, a reduced need for drilling, and auditory results comparable to those of microscopic techniques.
CONCLUSION
Studies have shown that endoscopic stapes surgery has similar surgical and functional advantages as compared with microscopic surgery.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Endoscopy; Female; Hearing Loss; Humans; Male; Microsurgery; Middle Aged; Operative Time; Otosclerosis; Postoperative Complications; Stapes Surgery; Treatment Outcome; Young Adult
PubMed: 32308176
DOI: 10.1017/S0022215120000821 -
European Archives of... Jan 2021Stapes surgery is the gold standard surgical treatment nowadays for otosclerosis. Several controversies on the procedure have been reported; surgical techniques for most... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Stapes surgery is the gold standard surgical treatment nowadays for otosclerosis. Several controversies on the procedure have been reported; surgical techniques for most favorable outcomes are still on discussion. The objective of this study is to present an update of evidence-based medicine concerning the utilization of lasers and drilling for footplate fenestration during stapedotomy surgery. A systematic review and meta-analysis were conducted.
MATERIALS AND METHODS
Publications in English in the last 5 years were searched in the PubMed/MEDLINE database and were systematically reviewed. A total of three articles were included according to the inclusion criteria, obtaining a total of 1531 patients managed surgically for otosclerosis, using laser or drill for footplate fenestration. Data were systematically extracted and hearing results were compared in a meta-analysis.
RESULTS
For the drill group, a total of 978 patients were retrieved and data were obtained as follows: mean age was 50 years old; the female proportion was 62%; mean preoperative air-bone gap (ABG) of 28 dB; mean postoperative ABG of 8 dB; mean ABG improvement of 20 dB; an ABG closure rate to < 10 dB of 74%. For the laser group, a total of 553 patients were retrieved, data were obtained as follows: mean age was 47 years old; the female proportion was 63%; preoperative ABG of 26 dB; postoperative ABG of 8 dB; mean ABG improvement of 18 dB; an ABG closure rate to < 10 dB of 72%.
CONCLUSION
The results from this study reveal that in regard to postoperative hearing results, surgical outcomes are comparable, and there is no statistically significant difference between the utilization of drills and lasers as a surgical instrument for the fenestration of the stapes footplate during stapedotomy surgery.
Topics: Audiometry, Pure-Tone; Bone Conduction; Female; Fenestration, Labyrinth; Hearing; Humans; Lasers; Middle Aged; Otosclerosis; Retrospective Studies; Stapes; Stapes Surgery; Treatment Outcome
PubMed: 32535861
DOI: 10.1007/s00405-020-06117-1 -
European Archives of... Dec 2018To assess all available data regarding the comparative success rates of endoscopic and microscopic stapes surgery. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess all available data regarding the comparative success rates of endoscopic and microscopic stapes surgery.
METHODS
MEDLINE, the Cochrane Library and Web of Science databases as well as other sources were searched by two independent reviewers. Controlled studies comparing endoscopic and microscopic stapedotomy in patients with otosclerosis or congenital stapedial fixation were included. Achievement of a postoperative air-bone gap ≤ 10 decibel was the primary outcome. Secondary outcomes were postoperative dysgeusia, scutum drilling and operation time. In case of homogenous, processable data (I < 60%) a meta-analysis was performed. Odds ratio (OR) and Chi-square test were used to compare the two methods.
RESULTS
Seven studies met the inclusion criteria. The OR analysis showed no significant differences between the two methods (OR 1.41, 95%CI [0.84, 2.38]), but goodness-of-fit analysis showed a correlation of endoscopic stapedotomy with normal hearing restoration (p = 0.00). Dysgeusia and scutum drilling took place significantly less often in the endoscopy group (OR 0.31, 95%CI [0.14, 0.69], p = 0.00 and OR 0.01, 95%CI [0.00, 0.07], p = 0.00 respectively).
CONCLUSION
As of yet, endoscopic surgery does not seem to confer benefit on audiological improvement comparing to conventional microscopic, however, it leads to less scutum drilling and fewer postoperative dysgeusia cases. High-quality, large-sample studies need to be performed in the future.
Topics: Dysgeusia; Endoscopy; Humans; Microscopy; Operative Time; Otosclerosis; Postoperative Complications; Stapes Surgery
PubMed: 30327907
DOI: 10.1007/s00405-018-5166-2