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Objectives: To assess the impact of race and ethnicity on 30-day complications after tympanoplasty surgery., Methods: The National Surgical Quality Improvement Program database was queried for tympanoplasty procedures from 2005 to 2019. Demographic, comorbidity, and postoperative complication data were compared according to race using univariate and binary logistic regression analyses., Results: A total of 11,701 patients were included, consisting of 80.3% White, 3.0% Black, 7.7% Asian, 5.7% Hispanic, 2.5% American Indian/Alaska Native, and 0.8% other. Binary logistic regression model indicated that Black patients had increased odds of unplanned readmittance (p = 0.033; odds ratio [OR], 3.110) and deep surgical site infections (p = 0.008; OR, 6.292). American Indian/Alaska Native patients had increased odds of reoperation (p = 0.022; OR, 6.343), superficial surgical site infections (p < 0.001; OR, 5.503), urinary tract infections (p < 0.001; OR, 18.559), surgical complications (p < 0.001; OR, 3.820), medical complications (p = 0.001; OR, 10.126), and overall complications (p < 0.001; OR, 4.545)., Conclusion: Although Black and American Indian/Alaskan Native patients were more likely to have complications after tympanoplasty surgery after adjusting for comorbidities, age, and sex, these results are tempered by an overall low rate of complications. Future studies should be devoted to understanding the drivers of these health inequities in access to otologic care and surgical treatment to improve outcomes and achieve equitable care., Competing Interests: Sources of support and disclosure of funding: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. No funding was received for this article., (Copyright © 2022, Otology & Neurotology, Inc.)

Background: An ear surgery can be performed via transcanal, endaural, or postauricular approach according to the surgeon's desicion. The postauricular one is the most commonly performed approach., Objective: The objective of this study was to evaluate whether preferring postauricular approach during ear surgery cause auricular protrusion in over time., Methods: Thirty-six patients who underwent tympanoplasty operation with postauricular incision were included in this study. Any patient who was under 18 years of age, those with auricular deformity and patients who underwent tympanoplasty operation with mastoidectomy were excluded from this study. The distances from mastoid area to superior and mid-point of helix were measured preoperatively and 1 year postoperatively., Results: A total of 36 patients' data were analyzed. There were 13 males and 23 females. The mean age was 28.2 ± years (18-59). The preoperative mean distance from mastoid area to superior point of helix was 15.03 ± 2.86 mm, whereas it was 17.92 ± 2.96 mm at mid-helix level. At postoperative 1 year, the same distances were measured 14.67 ± 3.12 mm and 17.25 ± 3.17 mm, respectively. There were no statistically significant differences between preoperative and postoperative measures., Conclusion: Although the structures that provide the stability of the auricle are cut during postauricular sulcus incision, long-term follow-up of patients did not show any protrusion of auricula.

: Tympanosclerosis in the middle ear space is common in Ethiopia and often involves the ossicles and particularly the stapes. Ear operations in Ethiopia are relatively expensive in this country of limited medical resources and a low average living wage. In this setting, 2-stage operations using prostheses become prohibitively expensive. Therefore, the recommended 2-stage approach for tympanic membrane perforation with tympanosclerosis and stapes fixation is impractical for Ethiopia.We present a series of 67 patients who had a single stage tympanoplasty, removal of tympanosclerosis from the stapes suprastructure, and ossicular chain reconstruction using ossicular interposition. Crucial is the surgical technique employed for peeling the mound of tympanosclerotic plaque off of the stapes, which we term the stapes release. Controls were 67 patients with similar perforations and air-bone gap, but no tympanosclerosis. Most controls had ossciular discontinuity and were reconstructed with type III tympanoplasty.Air-bone gap improved in both groups: 18 dB (11 dB standard deviation) in the stapes release group, and 23 dB (11 dB standard deviation) in the control group. Paired t test found these improvements in each group significant at p < 0.001. Among the preoperative subjects there were 40 with air-bone gap greater than 45 dB, and none less than 20 dB. Among the postoperative subjects, none had air-bone gap worse than 45 dB, while 25/67 (37%) stapes release and 44/67 (66%) controls had air-bone gap better than 20 dB. Three patients in each group failed to close their perforations completely (96% closure rate).The only complications were two early cases of transient facial nerve weakness, which was avoided in subsequent cases by an alteration in technique. There was no deterioration of sensorineural hearing levels in either group's subjects postoperatively.In conclusion, stapes release with ossicular interposition can be performed at the same time as tympanoplasty without exacerbation of sensorineural hearing loss. Tympanic membrane closure and hearing levels were similar between patients with and without stapes fixation from tympanosclerosis.

Objective: To assess the effectiveness and safety of tympanoplasty in elderly patients and the effect of frailty on the results., Study Design: Retrospective chart review., Setting: Tertiary referral center., Patients: Thirty-one ears in 30 patients aged 65 years and older were included and matched with 31 controls, based on the type of surgery, of a pool of 133 patients aged 35 to 55 years., Intervention: Therapeutic., Main Outcome Measure: Success was defined as tympanic membrane closure and resolution of presenting complaints. Complications were assessed. Frailty was defined by assessing multimorbidity and polypharmacy. Fisher's exact test was used to compare success and complication rates between the age groups. Linear logistic regression analysis using generalized linear models was performed on success and complication rate., Results: Success rates in both the groups were 84%. Complication rate in the elderly group was 16% versus 6% in the control group. This difference was not statistically significant in the Fisher's exact test. In the generalized linear model analysis age group, multimorbidity and polypharmacy had no significant influence on both success and complication rate., Conclusion: There was no difference in success and complication rate in elderly undergoing tympanoplasty compared with younger adults. Having multimorbidity or polypharmacy did not correlate with failure of the tympanic membrane closure or a higher complication rate.

Purpose of Review: Total endoscopic ear surgery is becoming more popular given the improved visualization of the middle ear and its related pathology as compared to the microscope. Whereas the endoscope has been used for close to two decades in cholesteatoma surgery with several significant studies, few studies have outlined the surgical outcomes, and also the complications, in patients undergoing endoscopic tympanoplasties and stapes surgeries. This review highlights those few studies., Recent Findings: Few articles exist regarding endoscopic tympanoplasty and stapes procedures. In summarizing the literature over the previous 12 months, the perforation closure rate with total endoscopic ear surgery tympanoplasty is reported to range from 84.0 to 97.2%, with postoperative air-bone gaps ranging from 5.3 to 13.8 dB. As for endoscopic stapes, the rates of air-bone gap closures to under 10 dB are reported between 56.0 and 86.7%. Complication rates for both procedures are comparable to the microscopic literature., Summary: Although endoscopic tympanoplasty and stapes procedures appear to be well tolerated with comparable complication profiles to microscopic procedures, future studies exploring patient-centered outcomes, and also anticipated evolution of results, are warranted.

Objective: To elucidate the degeneration process of fungiform taste buds after severing the chorda tympani nerve (CTN) by confocal laser scanning microscopy in vivo., Study Design: Prospective study., Setting: University hospital., Patients: Seven consecutive patients whose CTN was severed during tympanoplasty for middle ear cholesteatoma., Intervention: Diagnostic., Main Outcome Measures: Preoperative and postoperative gustatory functions were assessed by electrogustometry (EGM). An average of 10 fungiform papillae (FP) in the midlateral region of the tongue were periodically observed, and the number of taste buds was counted using a confocal laser microscope. Among them, 2 to 3 reference FPs were selected based on the typical form of the FP or characteristic arrangements of taste pores. Observation was performed before surgery, 1 or 2 days after surgery, 2 or 3 times a week until 2 weeks after surgery, once a week between 2 and 4 weeks, and every 2 to 4 weeks thereafter until all taste buds had disappeared., Results: EGM thresholds showed no response within 1 month after surgery in all patients. The initial change in the degeneration process was the disappearance of taste pores. The surface of taste buds became covered with epithelium. Finally, taste buds themselves atrofied and disappeared. The time course of degeneration differed depending upon individuals, each FP, and each taste bud. By employing the generalized linear mixed model under the Poisson distribution, it was calculated that all taste buds would disappear at around 50 days after surgery., Conclusion: Confocal laser scanning microscopy was useful for clarifying the degeneration process of fungiform taste buds.

Objective: To determine outcomes of type 1 cartilage tympanoplasty in a cohort of pediatric patients with a history of cleft palate repair., Patients and Outcome Measures: Retrospective chart review and comparison with a historical control group of patients with no cleft palate anomaly undergoing the same procedure by the same surgeon at a tertiary care pediatric hospital. A total of 37 patients between ages 4 and 19 years inclusive (45 ears), with a history of repaired cleft palate, underwent type 1 cartilage tympanoplasty with or without primary tube insertion from September 2004 to October 2012. Demographics, type of cleft palate, surgical indication, middle ear status, complications, history of myringotomy tube insertion, and auditory outcomes were collected. Results were compared with those for a non-cleft palate cohort that had undergone the same procedure, which had been previously published., Results: The unadjusted average preoperative and postoperative pure-tone averages for patients with a history of cleft palate were 22.06 and 7.29, respectively, compared with 18.34 and 8.32, respectively, for non-cleft patients. Despite significantly worse preoperative hearing levels among the cleft palate group, there was no statistically significant difference in outcomes with regard to hearing results between the two groups. One patient in the cleft palate group required revision type 1 cartilage tympanoplasty for graft failure, which is comparable to that reported for non-cleft palate patients. Post-tympanoplasty secondary tympanostomy intubation was slightly higher for the cleft palate population., Conclusion: Type 1 cartilage tympanoplasty, when performed in a pediatric population with a history of cleft palate, can achieve closure and hearing results that are comparable of those in patients with no such anomaly.

Background: The pathogenesis of recurrent cholesteatoma can be roughly divided into residual lesions and re-retraction of the epithelium. To prevent both residual and re-retraction cholesteatoma, we performed canal wall down tympanoplasty with mastoid obliteration using the bone pate plate for canal wall reconstruction as a fundamental surgical treatment for patients with acquired cholesteatoma. We attempted to achieve the complete extirpation of cholesteatoma in the wide surgical field made by the canal wall down procedure and simultaneously prevent recurrent retraction cholesteatoma and regain the physiologic canal wall, in which patients can have a "maintenance-free ear.", Objective: The surgical method used in the present study was described, and the long-term postoperative results of this method were evaluated., Study Design: Retrospective study., Patients: Participants were 118 patients with acquired cholesteatoma who underwent canal wall down tympanoplasty with mastoid obliteration and could be followed-up for more than 5 years., Main Outcome Measures: Postoperative changes in the reconstructed canal wall, the rate of otorrhea, and exposure of the material were examined using endoscopic images, medical charts, and CT scans., Results: A total of 113 ears (95.8 %) achieved the nearly physiologic appearance of the external auditory canal, and these conditions were maintained throughout the follow-up periods. However, recurrent cholesteatoma was not observed during the follow-up periods. Postoperative otorrhea was observed in 2.5% of ears. Exposure of the bone pate was only noted in 1 patient (0.8 %). Postoperative CT scans confirmed that ossification developed in the bone pate used in the reconstructed canal wall and mastoid surface., Conclusion: Canal wall down tympanoplasty with mastoid obliteration using the bone pate plate for canal wall reconstruction prevents both recurrent and residual cholesteatoma and contributes to a good quality of life for the patient.

Objective: Determine predictive values of preoperative stages of pars tensa retractions, coexisting attic retraction and preoperative air conduction for ossicular destruction in isolated and combined pars tensa retraction, and predictors for successful tympanic grafts after surgery., Study Design: Prospective case series study., Settings: Tertiary referral center., Patients: Forty-eight children ears without cholesteatoma were included in the study: 23 with isolated pars tensa retraction (median age, 11), 25 with combined pars tensa and attic retractions (median age, 13)., Intervention(s): Otomicroscopy, pure tone audiometry, and impedancmetry were carried out preoperatively. Three surgical procedures for isolated retractions were used: ventilation tube insertion alone or together with fascia graft or cartilage graft. Two surgical procedures for combined retractions were used: ventilation tube insertion alone and with cartilage graft., Main Outcome Measures: Incidence of ossicular destruction, postoperative retraction of the grafts., Results: Stage of pars tensa retraction and preoperative air conduction thresholds do not predict long incus process defect in isolated group. Coexistence of an attic retraction predicts combined, long incus process and stapes superstructure defect (Chi = 3.943, p = 0.047, OR = 12.00). Retractions of grafts are predicted by mode of surgery, favoring cartilage graft (isolated group: Chi = 4.306, p = 0.0372,OR = 4.69; combined group Chi = 4.7836, p = 0.0287, OR = 0.1364). Stage of pars tensa retraction predicts poor outcome of fascia graft (Chi = 4.5347, p = 0.0332, OR = 12.00)., Conclusion: Absence of correlation between stage of pars tensa retraction and air conduction thresholds with ossicular defects justifies surgical exploration of the auditory ossicles, even in lower stages of retraction. Combined ossicular defect is expected in combined retractions. The usage of cartilage graft proved to be more appropriate.

Objective: To understand the third mobile window effect of chronic otitis media with cholesteatoma with inner ear fistula on the bone conduction threshold, we examined changes in the bone conduction audiogram after tympanoplasty with mastoidectomy for chronic otitis media with cholesteatoma with canal fistula., Study Design: Retrospective case review., Setting: Tertiary referral center., Patients: According to the intraoperative classification of Dornhoffer and Milewski, we focused especially on Type IIa (anatomic bony fistula with no perilymph leak). We checked the bone conduction threshold at least 3 times: just before, just after, and 6 months after surgery in 20 ears with Type IIa lateral semicircular canal fistula., Intervention: Tympanoplasty with mastoidectomy., Main Outcome Measure: Bone conduction thresholds before and after tympanoplasty with mastoidectomy., Results: Compared with the preoperative bone conduction threshold, 6 cases were better, 12 cases were unchanged, and 2 cases were worse within the first postoperative week. Finally, 1 case was better, 15 cases were unchanged, and 4 cases were worse at the sixth postoperative month. Patients with a better bone conduction threshold in the low-tone frequencies immediately after surgery had a tendency to show no preoperative fistula symptoms. Postoperative spontaneous nystagmus had a tendency to be observed in patients with a worse bone conduction threshold in the high-tone frequencies., Conclusion: The better bone conduction threshold at low-tone frequencies immediately after tympanoplasty with mastoidectomy and no preoperative fistula symptoms might imply the third mobile window theory. The worse bone conduction threshold in high-tone frequencies with spontaneous nystagmus after surgery might indicate inner ear damage.

Objective: To find the etiology, frequency, and prognosis of delayed facial nerve weakness (DFW) in our department after intact canal wall tympanomastoidectomy for a tubotympanic (TT) type of chronic suppurative otitis media (CSOM) without cholesteatoma., Study Design: Retrospective case review., Setting: Tertiary care center., Subjects and Methods: A total of 315 patients who underwent intact canal wall tympanomastoidectomy for TT type of CSOM without cholesteatoma in our department for the past 3 years were selected. Patients with facial nerve weakness after 72 hours of surgery were noted and assessed for a history of herpes zoster virus infection. There were 6 patients who developed DFW; of these, blood samples of 4 patients for serum antibody titers to varicella zoster virus and herpes simplex type 1 were sent on the 3rd day of developing DFW. Blood samples of each of the remaining 2 patients were sent on the 13th day and 1st day of developing DFW. All 6 patients were treated with prednisolone and acyclovir, and their prognosis was assessed., Main Outcome Measure: House-Brackmann facial nerve grading system and serum antibody titers for varicella zoster virus and herpes simplex type 1., Results: Six patients (1.9%) developed DFW in this study. All patients had a history of herpes zoster virus infection. Serology results of 4 patients showed positive immunoglobulins M and G for varicella zoster virus and had significantly elevated titers of serum immunoglobulin G for varicella zoster virus, thus confirming the etiology., Conclusion: The incidence of DFW after tympanomastoidectomy is low and is due to viral reactivation, that is, varicella zoster. The overall prognosis seems impressive because all of the patients' facial nerve function improved by the end of 6 weeks. This study also illustrates the medicolegal importance of informing the patients with a history of herpes zoster virus infection the chance of developing DFW after undergoing tympanomastoidectomy.

Objective: To evaluate whether regenerated fungiform taste buds after severing the chorda tympani nerve can be detected by confocal laser scanning microscopy in vivo., Study Design: Retrospective study., Setting: University hospital., Patients: Six patients with a normal gustatory function (Group 1), 9 patients with taste function recovery after severing the CTN (Group 2), and 5 patients without taste function recovery (Group 3) were included. In Groups 2 and 3, canal wall up (closed) tympanoplasty or canal wall down with canal reconstruction tympanoplasty was performed in all patients., Intervention: Diagnostic., Main Outcome Measures: The severed nerves were readapted or approximated on the temporalis muscle fascia used to reconstruct the eardrum during surgery. Preoperative and postoperative gustatory functions were assessed using electrogustometry. Twelve to 260 months after severing the CTN, the surface of the midlateral region of the tongue was observed with a confocal laser microscope., Results: EGM thresholds showed no response 1 month after surgery in all patients of Groups 2 and 3. In Group 2, EGM thresholds showed recovery 1 to 2 years after surgery and before confocal microscopy (-1.3 ± 6.5 dB). There was a significant difference between Group 1 (-5.7 ± 2.0 dB; p < 0.01) and Group 2. In Group 3, EGM thresholds showed no response for more than 2 years. In the control group (Group 1), 0 to 16 taste buds were observed in each FP, and 55 (79.7%) of 69 FP contained at least 1 taste bud. The mean number of taste bud per papilla was 3.7 ± 3.6. In patients with a recovered taste function (Group 2), 0 to 8 taste buds were observed in each FP. In this group, 54 (56.2%) of 94 FP contained at least 1 taste bud. The mean number of taste bud per papilla was 2.0 ± 2.2 (p < 0.01). In Group 3, without recovery, the FP was atrophied, and no taste bud was observed., Conclusion: Regenerated fungiform taste bud could be observed in vivo using confocal laser scanning microscopy, indicating that regenerated taste bud can be detected without biopsy.

Objective: To compare the incidence of regeneration of the chorda tympani nerve (CTN) and taste function recovery between pediatric and adult patients after severing the CTN., Study Design: Retrospective study., Setting: University hospital., Patients: Consecutive 31 pediatric patients and 61 adult patients who underwent staged tympanoplasty (86 patients) or reoperation (6 patients) because of chronic otitis media with (89 patients) or without cholesteatoma (3 patients) and whose CTN was severed during primary surgery were included., Intervention: Therapeutic., Main Outcome Measures: The severed nerves were readapted or approximated on the temporalis muscle fascia used to reconstruct the eardrum. During secondary surgery, we tried to detect regenerated CTN. Preoperative and postoperative gustatory function was assessed using electrogustometry., Results: Regenerated CTN was detected during secondary surgery in 58.1% (18/31) of pediatric patients and 31.1% (19/61) of adults (p < 0.05). However, the number of patients with preoperatively elevated electrogustometry threshold was greater in adult patients. When the subjects were limited to those with preoperatively normal taste function, there was no significant difference between the 2 groups. Among patients with CTN regeneration, the incidence of taste function recovery was higher (12/18; 66.7%) in children than that (6/19; 31.6%) in adults (p < 0.05). However, there was no significant difference when the subjects were limited to those with preoperatively normal taste function., Conclusion: Chronic inflammation may not severely affect the CTN in pediatric patients, resulting in higher incidences of CTN regeneration and gustatory function recovery after severing the nerve, compared with those in adult patients.

Objective: To investigate the benefits and problems of tympanoplasty in elderly patients older than 70 years., Study Design: Retrospective case review., Setting: Referral hospital otolaryngology department., Patients: Among 1,014 patients who underwent tympanoplasty for chronic otitis media from 2006 to 2011, those aged over 70 years were eligible for inclusion., Main Outcome Measures: Clinical characteristics including tympanosclerosis and preoperative severe complications were investigated. In chronic otitis media group, hearing outcomes (air-bone gap at 500-Hz and 1- and 2-kHz frequency) and postoperative ear condition were investigated. In chronic otitis media with cholesteatoma, clinical characteristics including postoperative bone conduction hearing threshold (at 500-Hz and 1- and 2-kHz frequency) were investigated., Results: Ninety-seven ears of 83 patients were included. Eighteen ears had obvious findings of tympanosclerosis (18/97 = 18.6%). In chronic otitis media without cholesteatoma (52 ears/47 patients), no preoperative complications were noted. The mean air-bone was 30.8 and 16.1 dB before and after the operation, respectively (p < 0.001). Otorrhea disappeared in 51 ears (98.1%). In chronic otitis media with cholesteatoma (42 ears/33 patients), we noted preoperative severe complications including labyrinthine fistula (7/97 = 7.22%), widely exposed dura (1/97 = 1.03%), and facial palsy 1 (1/97 =1.03%). The mean bone conduction hearing threshold was 39.6 dB and 40.89 dB, respectively (p = 0.7). Three ears of 3 patients had operated ears with open mastoid and underwent canal wall reconstruction tympanoplasty., Conclusion: Tympanoplasty in elderly patients older than 70 years seems to be as safe as when performed in younger patients.

Objective: To describe a case of the atlantoaxial rotary subluxation (AARS) after tympanoplasty and discuss its mechanism and management., Patients: A 10-year-old boy., Interventions: Cervical spine plain radiography followed by cervical traction., Main Outcome Measures: Range of motion and radiologic follow-up., Results: The patient showed painful torticollis and rotation and fixation of the head to the right side (cock robin sign). Increased atlantodens interval and asymmetry between facet joints were found on cervical plain radiography. Full functional recovery and reduction of subluxation were achieved by conservative cervical traction., Conclusion: Forced surgical positioning of head rotation to the contralateral ear down and restriction during otologic surgery under general anesthesia may complicate AARS, especially in pediatric otologic surgery patients.

Objective: An ossicular chain defect represents a challenging situation for otosurgeons. Despite modern reconstruction techniques, unsatisfying postoperative hearing results regularly occur. These are commonly caused by prosthesis dislocation. Whereas the reasons for prosthesis dysfunction occurring months or years after implantation are related to independent chronic conditions, early events of dislocations are more related to the technical fixation of the prosthesis inside the middle ear cavity. Consequently, a safe coupling between prosthesis head and tympanic membrane is essential for a successful type III tympanoplasty. Our study evaluated the use of a new prosthesis design with the aim to reduce short-term postoperative prosthesis dislocation in mind., Study Design: Prospective experimental and clinical study., Methods: A modified titanium total ossicular replacement prosthesis (TORP), whose head had spikes that extend into the cartilaginous neotympanic membrane, was designed and tested experimentally and then clinically. The lateral holding force of the new prosthesis head against lateral shift was measured and compared with common prosthesis heads without spikes. After proving this design experimentally, the prostheses were used intraoperatively in 35 tympanoplasty type III operations. Results were analyzed prospectively and compared with 35 retrospectively analyzed controls with conventional TORP prostheses., Results: The lateral holding forces for the spike prosthesis heads were significantly higher (134 mN) than those for common prosthesis heads (92 mN) at a contact pressure of 100 mN. Postoperatively, pure-tone audiometry revealed satisfying hearing results. Spiked and conventional titanium TORPs yielded postoperative air-bone gaps (ABGs) of 20.9 and 18.6 dB with 54% and 57% ABG closure, within 20 dB, respectively. The air-bone gap was reduced by an average of 14 and 15 dB, respectively. However, these differences were not statistically significant. Both in the study and in the control group, no signs of prosthesis dislocation were discovered., Conclusion: The experimental data show that the new modified prosthesis head has an increased lateral holding force and thus reduces the risk of dislocation at the coupling side of the tympanic membrane. The postoperative hearing results are comparable to those of conventional prostheses. To confirm the advantage of the modified prosthesis plates over conventional prostheses, future studies with larger study populations are necessary.

Hypothesis: A superior semicircular canal dehiscence affects hearing by introducing a third window into the inner ear that 1) lowers cochlear input impedance, 2) shunts air-conducted sound away from the cochlea resulting in conductive hearing loss, and 3) improves bone-conduction thresholds by increasing the difference in impedance between the vestibule and the round window., Background: Superior semicircular canal dehiscence has been linked to a "conductive" hearing loss characterized by a decrease in the sensitivity to air-conducted sound and hypersensitivity to bone-conducted sound., Methods: Four investigations were performed: 1) laser-Doppler vibrometer measurements of sound-induced umbo velocity in patients with computed tomographic scan-confirmed superior semicircular canal dehiscence; 2) laser-Doppler vibrometry of sound-induced motions of the vestibular lymph (either perilymph or endolymph) exposed in a chinchilla model of superior semicircular canal dehiscence; 3) studies in chinchillas of the effect of superior semicircular canal dehiscence on the cochlea's sensitivity to bone-conducted sounds; and 4) anatomically based theoretical analyses of sound flow through the human cochlea and semicircular canals., Results: The low-frequency umbo velocity in superior semicircular canal dehiscence patients without previous middle ear surgery ranged from normal through high normal. This tendency toward hypermobility suggests a decrease in cochlear impedance. Measurements of sound-induced velocity of the lymph within a superior semicircular canal dehiscence in chinchillas demonstrated sound flow through the dehiscence. Measurements of the cochlear potential demonstrated a superior semicircular canal dehiscence-induced increase in response to bone-conducted sound in eight of nine chinchillas. An anatomically based model of the human ear predicts changes in auditory sensitivity similar to audiometric changes in superior semicircular canal dehiscence., Conclusion: The results suggest that superior semicircular canal dehiscence can affect hearing function by introducing a third window into the inner ear.

Objectives: The purpose of this report is to provide data on the incidence of delayed facial palsy (DFP) after tympanomastoid surgery, compare incidence among various otologic and neurotologic procedures, and discuss the possible etiology., Study Design: The study design was a retrospective case review., Setting: The study was conducted at a tertiary referral center., Patients: The records of 486 patients with normal facial function before tympanomastoid surgery were reviewed., Intervention: Patients underwent tympanomastoid surgery., Outcome Measures: Delayed facial palsy was defined as facial palsy occurring more than 72 hours after surgery., Results: Seven of 486 (1.4%) patients had DFP after tympanomastoid surgery. In two patients, the DFP was caused by a postoperative wound infection. Facial palsy in the other five patients likely was caused by viral reactivation., Conclusions: Published data for otologic surgery suggest a rising incidence of DFP with increased manipulation of the sensory branches of the facial nerve. Viral reactivation is postulated to be an important contributing mechanism in the development of DFP. A number of viruses could potentially cause this phenomenon, but observations in this study implicate the varicella zoster virus. Patients with a history of viral reactivation may be at greater risk for development of this complication.

Osteomas of the middle ear are extremely rare lesions. Of the nine cases reported, eight presented with conductive hearing loss. We recently treated two patients whose osteomas, of the promontory and of the posteroinferior tympanic wall, were asymptomatic. We suggest that middle ear osteomas need not be removed when they do not impinge on the sound conduction system.

Fifty-seven of 98 children with cholesteatoma treated between 1976 and 1985 were available for long-term follow-up. The clinical records of the 57 children were analyzed retrospectively. The purpose of this study was to compare the incidence of recurrent and/or residual cholesteatoma, postoperative otorrhea, and hearing results between two groups of patients. One group (n = 40) of children was treated with a radical mastoidoepitympanectomy (RMET) and the other group (n = 17) was treated with intact canal wall tympanoplasty/mastoidectomy (ICWT). Residual cholesteatomas were twice as frequent (17% versus 7.5%) in the ICWT group while recurrent disease was the same. There was no difference in postoperative otorrhea between the two patient groups. Hearing results were equally good in the Type III and in the ICWT group with staged TORP. It is concluded that a Type III tympanoplasty is an excellent one-stage method of hearing reconstruction in patients with good eustachian tube function and an intact stapes and that a correctly performed RMET offers a safe trouble free alternative to ICWT. In selected patients with limited disease and a well pneumatized mastoid, ICWT is still used.

The results of 11 years experience with 1,577 otologic surgical procedures performed in The Ear & Nose-Throat Clinic, P.A. in Little Rock, Arkansas, a freestanding outpatient surgical setting, are analyzed and compared to 703 hospitalized inpatient cases performed during the same time period. This study includes tympanoplasty, stapedectomy, mastoidectomy, labyrinthectomy and other otologic procedures. Analysis of results in these cases compares hearing results, graft take rates and the occurrence of complications in both the outpatient and inpatient settings. No significant differences are seen between the results or complications in these settings, thus supporting the use of outpatient surgical settings for most standard otologic procedures.

The purpose of this report is to compare closed tympanoplasty (canal wall up) and open tympanoplasty (canal wall down) performed in ears with extensive cholesteatoma operated on and followed up during the past 11 years. The study has demonstrated that there are no significant differences between open and closed tympanoplasties in terms of both postoperative subjective problems and auditory results. The only definite difference relates to recurring cholesteatoma: canal wall-up operations are complicated by recurrence of cholesteatoma in a not insignificant number of ears and require a planned two-stage procedure in all the cases. By contrast, the postoperative clinical course of open tympanoplasties has been only rarely affected by cholesteatomatous complications. It is concluded that reduction of cholesteatoma recurrence to the greatest degree possible necessitates removal of the canal wall. Open tympanoplasty is an effective alternative for closed tympanoplasty in all cases in which there is a contraindication to preserving the canal wall and in all patients whose medical or social conditions prevent scheduling an operation in more stages.