We reviewed the findings in 1,220 cases of sudden sensori-neural hearing impairment encountered over a nine-year period at the Otologic Medical Group. A thorough neuro-otologic evaluation is indicated in each case. Ten patients had an acoustic tumor. A vasodilator regimen was prescribed in 380 cases and resulted in hearing improvement in 40%. Favorable prognostic findings were a low tone loss and absence of vertigo.

This is an analysis of 1,024 primary cases of mastoid surgery for cholesteatoma operated upon during a ten-year period at the Otologic Medical Group, Inc. Our philosophy of management of the mastoid in these cases has been as follows: 1) avoid an open mastoid cavity when possible; 2) perform the operation in two stages if necessary; 3) reexplore the mastoid and middle ear for residual cholesteatoma when indicated. One-third of 380 revised cases had residual cholesteatoma, disease left by the surgeon. In 260 cases in which the surgeon felt it unlikely that there was residual disease he found it in 23%. In 4% this residual cholesteatoma was found in the mastoid. The incidence of residual cholesteatoma was higher in children and in planned, as opposed to unplanned, revisions. Residual cholesteatoma was detected in the middle ear more frequently than in the epitympanum, and in the epitympanum more frequently than the mastoid. Indications for, and timing of, the reexploration are discussed. Recurrent cholesteatoma refers to a retraction pocket and must be differentiated from residual cholesteatoma; the causes, prevention and treatment are different. Recurrent cholesteatoma was detected in 5%. The most common complication of the disease was a labyrinthine fistula (10%). Operative facial nerve damage occurred in one case. The most common postoperative complication was graft failure (3%). Intact canal wall tympanoplasty with mastoidectomy should be performed as a two-stage procedure in most cases when used in the treatment of aural cholesteatoma.

We reviewed 1042 operations in which a Plasti-Pore prosthesis was used for reconstruction of the sound pressure transfer mechanism. In all cases cartilage was interposed between the prosthesis and the tympanic membrane or graft. The short-term hearing results for these cases are the same as for other techniques but the hearing is more stable in the long run. Other advantages of this technique are a reduced incidence of recurrent and residual cholesteatoma. Extrusion occurred in 7% of the cases but has become less frequent with recent refinements in technique. We intend to continue using Plasti-Pore prostheses in tympanoplasty.

The records of 34 children and teenagers with a conductive hearing impairment and an intact and mobile tympanic membrane have been reviewed; 20 patients had a congenital hearing impairment. Stapedectomy was performed on 13 patients with satisfactory results in 12. In 3 cases the operation was terminated because of oval window or facial nerve abnormalities. In 4 cases there was no evidence of an ossicular problem, a so-called inner ear conductive hearing loss. Fourteen patients had otosclerosis, the youngest being 9 years old. Twenty-four stapedectomies were performed on this group with satisfactory results in 22. We conclude that the results of stapedectomy in children appear to be as satisfactory as results in adults.

\s=b\Charts of 161 patients with unilateral chronic otitis media were reviewed for evidence of sensorineural hearing loss, defined as the difference in preoperative bone conduction thresholds between diseased and normal contralateral ears. Mean bone conduction differences were small but statistically significant, ranging from 5.6 to 12.8 dB across the frequencies. Approximately 45% of the subjects had differences greater than 10 dB for high frequencies, but less than 12% had a difference greater than 20 dB for the pure-tone average. Significant relationships were found between sensorineural hearing loss and the presence of acquired cholesteatoma in the middle ear, diseased mucosa of the promontory and hypotympanum, and diseased ossicles. These findings suggest that more severe middle ear disease may result in sensorineural hearing loss. However, for the majority of subjects, the amount of sensorineural hearing loss was judged not to be clinically significant.(Arch Otolarygol Head Neck Surg. 1989;115:814-816) Chronic otitis media (COM) is asso¬ ciated with various sequelae, including a mixed hearing loss. The conductive component of this hearing loss is acknowledged. Several investi¬ gators have collected data in support of a significant sensorineural compo¬ nent with both experimental animals and clinical studies.18 These investiga¬ tors have emphasized the necessity for prompt clinical action in light of the possibility of sensorineural hear¬ ing loss (SNHL).Other investigators, although find¬ ing evidence of SNHL in patients with COM, have questioned the clinical sig¬ nificance of the degree of hearing loss.9 The clinical impression of two of us (C.S. and J.L.S.) has also been that significant SNHL as a result of COM is not typical. Few studies have direct¬ ly compared the amount of SNHL in COM and control ears. Most studies have compared the percentage of patients meeting specified criteria for SNHL, but have not reported the actual difference in amount of hear¬ ing loss between the diseased and control ears. Those studies that have, report only small average differ¬ ences.9This retrospective study quantified the amount of relative SNHL by com¬ paring COM ears with the normal contralateral ears in patients with unilateral COM, using a matchedpairs approach. In addition, we exam¬ ined the relationship between this rel¬ ative amount of SNHL and other important patient characteristics that reflect the extent of disease. SUBJECTS AND METHODS SubjectsThe subjects included those patients of the Otologie Medical Group, Los Angeles, Calif, who were diagnosed with unilateral COM and who ultimately underwent sur¬ gery. The normal contralateral ear served as the control. The diagnosis of COM was based on a physical examination showing a tympanic membrane perforation, choles¬ teatoma, or ossicular destruction. Subjects were excluded for the following reasons: prior otologie surgery; bilateral disease; history of head trauma; posttraumatic tympanic membrane perforation; labyrin¬ thine fistula; congenital cholesteatoma...