Sex differences in patients with hearing impairments caused by otosclerosis

The course of hearing in the non-operated ears was examined in 112 female patients and 63 male patients with bilateral otosclerosis who had operations in one ear only. All patients had a follow-up of at least 5 years. The mean annual impairment of the air conduction thresholds in the female patients (2.0–2.5 dB/year) did not differ significantly from that of the male patients (2.0–2.3 dB/ year). At the last follow-up examination, no difference was found between the sexes in the magnitude of the air-bone gaps. However, a sensorineural component developed in the women more frequently than in the men. Although at the last examination bone conduction thresholds of the female patients were significantly worse than those of the male patients, these were not matched by age. Received: 29 September 1998 / Accepted: 4 December 1998     

Unfavourable prognostic factors in patients treated surgically for otosclerosis

Abstract

Backgrounds: Otosclerosis is the cause of between 5% and 9% of all deafness cases and between 18% and 22% of conductive hearing loss cases. Neurosensory deafness develops in 30% of patients with otosclerosis.

Aims/Objectives: The aim was to seek a correlation that would reflect the dependence of the results of middle ear surgery on the type of abnormalities atypical of otosclerosis but found during the stapedotomy surgery.

Materials and Methods: The analysis included 140 patients who underwent surgery for otosclerosis. The hearing of all patients was assessed using an audiometric test.

Results: In the assessment of changes in the mean bone conduction values, statistically significant differences between the reference group and the subgroup of patients on whom a myringoplasty was performed, as well as in patients with adhesions present in the middle ear spaces, were found only for the 500?Hz frequency.

Conclusion and Significance: The removal of abnormalities, such as the loss of the eardrum (iatrogenic), changes to the lining and adhesions other than those typical of otosclerosis, restores middle ear mechanics after a stapedotomy on the inner ear and leads to a measurable improvement in mean bone conduction values.     

Cochlear implantation in patients with otosclerosis of the otic capsule

Objective

To evaluate outcomes of cochlear implantation of patients with otosclerosis of the otic capsule.

常年性变应性鼻炎HLA的A和B位点抗原检测

为阐明常年性变应性鼻炎患者在ＨＬＡ单倍型方面有无特征表现及其遗传背景的实质，我们用血清学方法对３１例中国南方汉族患者进行了ＨＬＡ－Ａ、Ｂ位点的抗原检测，计算各抗原的出现频率、基因频率和相对风险值。所获结果与７８例贵州籍汉族健康人（对照组）比较，发现患者中ＨＬＡ－Ｂ２７的相对风险值高达８．２５，Ａ３１、Ａ２８、Ｂ１２、Ａ３３分别为２．６８、２．５７、２．５７和２．２７，说明以上抗原的存在可能与患者的遗传易感性呈正关联；Ａ９、Ｂ６０、Ａ２４、Ｂ２２、Ｂ５１、Ｂ１５、Ｂ１６、Ｂ４８、Ｂ４６、Ｂ７、Ａ１１、Ａ２等的相对风险值均小于１，说明以上抗原的存在对变应性鼻炎具有遗传稳定性。其中Ｂ２７和Ａ９的抗原频率与对照组有显著差异。因限于条件，仅做Ａ、Ｂ位点抗原检测，所得结果可供参考     

Cathepsin-B activity in otosclerosis

Summary Cathepsin-B activity was determined fluorimetrically in the otosclerotic stapes footplate, the stapes superstructure, normal temporal cortical bone, and os frontale osteoma. Measurements with a synthetic substrate made determinations in individual samples possible. The cathepsin-B activity in the otosclerotic stapes footplate was one order of magnitude higher than that of the superstructure, which was not affected by the disease. The cortical bone and the superstructure displayed similar activities, as did os frontale osteoma and otosclerosis. The high lysosomal proteinase activity appears to be closely connected to the otosclerotic bone resorption process.     

Isolated otosclerosis of the incus in a Korean woman

We report an isolated otosclerosis of the incus that was removed using a transcanal approach and the ossicular chain was reconstructed using a total ossicular replacement prosthesis due to a tilted stapes.     

HLA antigens in patients with otosclerosis

Seventy-four (50 females and 24 males) consecutively sampled patients with otosclerosis were tissue typed for HLA A and B antigens. There was no significant increase in any A or B antigen, but the frequency of B40 was significantly lower (p less than 0.05) in patients than in blood donors. No significant difference in HLA antigen frequencies was found between men and women, or in patients with vs. without a family history of otosclerosis.     

Tinnitus and otosclerosis

Fifty patients with otosclerosis and tinnitus were studied for the course of the tinnitus after stapes surgery. Tinnitus disappeared in 64% of the cases, improved in 16%, was unchanged in 14%, and worsened in 6%. The reduction in tinnitus was more favorable after a small fenestra stapedotomy than after a partial stapedectomy with removal of the posterior half of the footplate. An unfavorable postoperative course of tinnitus did not appear to be linked to the postoperative audiometric result. In our study the subjective evaluation of pitch and loudness of the tinnitus did not provide significant information regarding its prognosis. Received: 18 April 1999 / Accepted: 22 April 1999     

Analysis of factors affecting postoperative functional outcome in patients with otosclerosis

ObjectiveThis study aimed to analyze the factors affecting postoperative hearing results of patients with otosclerosis.MethodsMedical records of 245 patients with clinical otosclerosis who underwent stapes surgery at our center from January 2009 to December 2018 were reviewed. The retrospectively collected data included patients’ demographics, clinical characteristics, pre- and postoperative audiometric data, size of preoperative air-bone gap (ABG) (small/large). The patients were categorized into two groups according to the postoperative functional outcome: Group 1 consisted of patients with a postoperative ABG of ≤10 dB and Group 2 comprised those with a postoperative ABG of >10 dB. Evaluation of factors affecting functional outcome were performed by logistic regression analysis. Receiver operating characteristics (ROC) curve was generated to obtain the cut-off points for preoperative ABG.ResultsThere were no statistically significant differences between the two groups in terms of age group (p = 0.393), gender (p = 0.670), operated side (p = 0.370), and laterality of disease (p = 0.607). There were 42 patients (31.6%) with a small ABG and 91 patients (68.4%) with a large ABG in group 1, and six (13.6%) and 38 patients (86.4%), respectively in group 2. There was a statistical significant difference between the groups in terms of the size of preoperative ABG (p = 0.020). In group 1, the mean preoperative air conduction (AC) threshold and preoperative ABG were significantly lower than in group 2 (p < 0.001 and p < 0.001, respectively). There was no statistically significant difference between the groups in terms of the preoperative bone conduction (BC) threshold (p = 0.406). Preoperatively, the AC threshold and large ABG were found to be significantly poorer prognostic factors (p < 0.001; 95%CI: 1.031–1.210 and p = 0.037; 95%CI: 1.063–7.023, respectively). Preoperative ABG cut-off threshold for functional success was found to be 34.5 dB. The functional success rate was significantly higher in patients with a preoperative ABG of <34.5 than in patients with a preoperative ABG of ≥34.5 dB (p < 0.001).ConclusionThe preoperative AC threshold and large ABG were poor prognostic factors for postoperative hearing outcome in patients with otosclerosis. The functional outcomes were similar in patients with a preoperative small ABG and those with a preoperative ABG of <34.5 dB. A preoperative ABG cut-off value of <34.5 dB should be possibly considered as a parameter for predicting surgical success in otosclerosis and seems to be useful in clinical practice.     

耳硬化症镫骨手术疗效观察

目的探讨耳硬化症治疗中各种术式的疗效.方法收集我院1964～2003年资料完整的部分耳硬化症病例,分别统计术耳手术前后0.25k、0.5k、1k、2kHz频率平均骨气导差,按不同术式(镫骨撼动术、镫骨足板切除足弓复位术、镫骨切除Teflon小柱植入术及镫骨活塞术)统计手术前后平均骨气导差的缩小值,t检验分析各术式间的差异,x2检验分析各术式再次手术率的差异,随访手术远期效果.结果经t检验发现,镫骨足板切除足弓复位术及镫骨活塞术听力提高明显优于镫骨撼动术及镫骨切除Teflon小柱植入术,镫骨撼动术及镫骨足板切除足弓复位术再次手术率明显高于镫骨切除Teflon小柱植入术及镫骨活塞术;镫骨活塞术术后远期效果较好.结论四种术式中镫骨足板切除足弓复位术听力提高最佳,其次为镫骨活塞术,两者之间无明显差异,明显高于镫骨撼动术及镫骨切除Teflon小柱植入术组;镫骨活塞术是治疗耳硬化症最理想术式,术后近期及远期效果较佳且再次手术率最低.     

不同术式治疗耳硬化症的疗效比较

目的：比较治疗耳硬化症不同术式的疗效。方法：回顾性分析1993～2005年行手术治疗且资料完整的耳硬化症患者70例（76耳）的临床资料，按术式分为3组：镫骨全切除术30例（33耳），足板小孔开窗术24例（27耳）和镫骨撼动或提高术16例（16耳），统计3组患者术后各频率段气骨导差闭合、骨导损失及眩晕发生率等指标，比较3种术式问的差异，同时比较镫骨撼动术5例（5耳）与镫骨提高术11例（11耳）2组手术亚型间的疗效差异。结果：3种术式术后言语频率气骨导差闭合无明显差异，但在高频气骨导差改善及减少术后高频感音神经性听力损失和眩晕方面，足板小孔开窗术和镫骨撼动或提高术明显优于镫骨全切除术，并有统计学意义。镫骨撼动术与镫骨提高术无论在听力改善或术后并发症发生率方面差异均无统计学意义。结论：3种术式在提高耳硬化症患者的听力方面均具有较好的疗效，其中以足板小孔开窗术疗效最佳，其次是镫骨撼动或提高术，并且在减少术后并发症方面均优于镫骨全切除术。足板小孔开窗术是治疗耳硬化症较理想的术式。     

Operative treatment for otosclerosis

Summary This comparative study of long-term results following the substitution of stapes by free cartilage grafts is based on 500 stapedectomies. The patients were operated on by the same surgeon (first author) and followed-up for a period of 5–20 years. Postoperative results, compared with the results of other stapedectomy techniques, demonstrate a statistically significant difference in favour of the cartilage implant technique with respect to the overall functional success rate and the incidence of postoperative complications.     

HLA antigens,nasal polyps and asthma

HLA antigens, nasal polyps and asthma HLA typing has been performed on a selected series of 29 patients with nasal polyps, with or without asthma. Despite the small series there was a significant increase in the haplotype A1/B8 in patients with both nasal polyps and asthma. No association was found in those with polyps alone. However, those with both conditions, who were positive for A1/B8, had more severe polyp disease. Three out of 4 patients with nasal polyps, asthma and sensitivity to aspirin were positive for A1/B8. In patients with nasal polyps, tissue typing might be of use in predicting both those who are most at risk of developing asthma, and also those who are most likely to have severe polyp disease. The association of A1/B8 with severe polyp disease and asthma, may imply that abnormalities of immune response are likely to be associated with the pathogenesis of both conditions.     

Effect of cochlear reserve on postoperative outcome in otosclerosis

Patients with elevated bone conduction (BC) thresholds are not considered a good candidate for otosclerosis surgery. Sometimes, it might be difficult to decide to operate these patients considering relatively poor cochlear function. However, viewpoints may vary among otologists. This study was undertaken to compare hearing outcome following otosclerosis surgery in patients who had bone conduction (BC) thresholds ≥ 30 dB, and to investigate whether BC thresholds >30 dB has a negative impact on hearing outcome. Medical records of 111 patients who had undergone otosclerosis surgery were reviewed. Of 111 patients, 83 had undergone stapedotomy, and 28 stapedectomy. The patients were grouped based on preoperative four-tone BC threshold. Eighty-seven patients had average BC threshold ≤ 30 dB, and were assigned to good-cochlear reserve group. The remaining 24 patients had average BC > 30 dB, and constituted poor-cochlear reserve group. Pre- and postoperative air conduction (AC) and BC thresholds, air-bone (AB) gap, vocal audiometry results and amount of deterioration in BC were determined. Mean postoperative AB gap was almost the same in both groups (14 and 15 dB) (P > 0.05). Percentage of AB gap = 10 dB favored good-cochlear reserve group (41 vs 29%)(P > 0.05). Analysis of mean hearing gain was slightly in favor of good-cochlear reserve group (19 vs 15 dB) (P > 0.05). Better BC thresholds were obtained postoperatively in good-cochlear reserve group (P < 0.001). Deterioration > 10 dB in BC was observed in 5.7 and 12.5% of the patients with good- and poor-cochlear reserve, respectively (P > 0.05). Based on the results of this small sample-size study, even though BC threshold of 30 dB was not considered a negative factor for hearing gain, otosclerosis surgery might have detrimental effects on postoperative BC thresholds in patients who had BC thresholds >30 dB.     

Improvement of bone conduction after stapes surgery in otosclerosis patients with mixed hearing loss depending from surgical technique

This study investigate the effect of stapes surgery on bone conduction (BC) improvement in otosclerotic patients with mixed hearing loss and also compare the effect of three different types of surgery (complete stapedectomy, partial stapedectomy and microfenestration stapedotomy) on this improvement. We retrospectively reviewed surgical database of 84 otosclerotic patients with mixed hearing loss. Sixty-two patients (75%) had significant improvement in BC after surgery (P = 0.03). In 85% of patients with follow-up time longer than 1 year, this improvement had remained. Improvement in BC after surgery was better in partial stapedectomy group (82.6%) and complete stapedectomy group (80.8%) in comparison with microfenestration stapedotomy group (63%) (P = 0.052).     

The clinical characteristics of otosclerosis and benefit from stapedotomy: our experience of 48 patients (58 ears)

Abstract

Background: Stapedotomy has been proved to be one of the most efficient procedure to treat otosclerosis, various factors contribute to the diversity of the outcomes and controversial results exist from previous studies.

Objectives: We evaluated clinical characteristics and outcomes of stapedotomy, as well as possible predictive factors of a successful outcome.

Materials and methods: This retrospective study evaluated 58 ears from 48 patients with demographic data, plus short-term follow-up of hearing outcomes of 28 ears, and evaluated variables using univariate general linear regression analyses.

Results: The average operation age was 41.54?years. A total of 87.5% (42/48) patients presented with bilateral otosclerosis. 39.66% (23/58) ears had CT finding before the surgery. Patients with persistent tinnitus accounted for 53.45% (31/58) and the average preoperative ABG of the 58 ears was 32.22?dB. We achieved good postoperative air-bone gaps (ABGs) overall but poor ABG closure at 4?kHz. No predictive factors were identified in the 28 ears that were followed up.

Conclusions and significance: Delayed surgery may be attributable to insufficient recognition of otosclerosis. The fenestration size could be the reason for poor ABG closure at high frequency. However, more cases and longer follow-ups are required to confirm our findings.     

Loss of vestibular neurons in clinical otosclerosis

Summary Although the principal functional deficit caused by otosclerosis is hearing loss, some patients also experience dysequilibrium and/or vestibular test abnormalities. A study was performed to determine the populations of vestibular neurons in subjects with clinical otosclerosis. Reduced neuronal counts were found when the otosclerotic lesions were large enough to involve the cribrose areas. Decreased cell counts were found principally in the superior division of the vestibular ganglion. In some cases, however, normal populations of neurons were found in spite of involvement of the cribrose areas. In some ears there were bundles of vestibular nerve fibers deviating from their normal course to pass within the focus of otosclerotic bone. It seems probable that a loss in vestibular neuronal population caused by involvement of dendritic fibers in the cribrose areas is at least partially responsible for the dysequilibrium or vestibular test abnormalities occurring in some patients with otosclerosis.Supported by a grant from the Research Fund of the American Otological Society     

Analysis of HLA Antigens in Japanese Patients With Chronic Sinusitis

Objectives: Genetic factors likely play a role in the etiology of chronic sinusitis and this disease is often associated with diffuse panbronchiolitis, which is strongly associated with HLA B54 antigen. The purpose of this study is to examine whether genetic factors are involved in the pathogenesis of chronic sinusitis. Study Design: Eighty-two Japanese patients with intractable chronic sinusitis were selected on the basis of the following criteria: 1) persistent mucous or mucopurulent nasal discharge and/or postnasal dripping for longer than 3 years and 2) opacification in bilateral maxillary sinuses and ethmoid cells in plain X-ray films. Methods: Both class I and class II HLA antigens were analyzed by conventional micro-cytotoxicity assays in these patients and 176 healthy control subjects. Results: In class I antigens, B54 antigen significantly increased in the patient group (antigen frequency = 29.3%, relative risk = 3.23, corrected P value = .037) compared with normal control group (antigen frequency = 11.4%). For class II antigens, no antigens were significantly increased. Conclusion: These data indicate that certain genetic factors play a role in the etiology of chronic sinusitis.     

Fluctuating hearing loss and recurrent vertigo in otosclerosis

Summary This report summarizes audiologic and temporal bone findings in a 47-year-old white female with recurrent attacks of vertigo, tinnitus, and bilateral hearing loss. A series of audiograms, obtained over a 15-year period, showed a fluctuating mixed (sensorineural and conductive) hearing loss with a relatively flat configuration in the left ear and a relatively stable, mild sensorineural loss with a sloping contour in the right ear. Temporal bone studies revealed the existence of otosclerotic foci bilaterally. In the left ear, the otosclerotic focus had grown close to the utricular and lateral ampullary nerves, displaced and ankylosed the stapedial footplate, invaded the endosteal zone (1,000–2,000 Hz area), and deformed the lateral cochlear wall. In the right ear, the otosclerotic invasion was limited to the inferior portion on the promontory (vestibular cecum) and round window niche.Supported in part by NINCDS grant NS-10940, and E. C. McFadden Trust Research Fund