High‐Frequency Conductive Hearing following Total Drum Replacement Tympanoplasty

Polanik, Marc D; Trakimas, Danielle R.; Black, Nicole L.; Cheng, Jeffrey; Kozin, Elliott D.; Remenschneider, Aaron K.

doi:10.1177/0194599820907600

Cited by 12 publications

(24 citation statements)

References 28 publications

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“…By utilizing a low‐frequency biased PTA calculation, traditional reporting methods do not recognize both the persistent high‐frequency conductive deficits following ossiculoplasty and the significantly different magnitude of ABG improvement between high and low frequencies. Likewise, published data of our own demonstrate similar discrepancies between traditional and frequency‐specific reporting of audiometric outcomes in patients undergoing type 1 tympanoplasty 17 …”

Section: Discussionsupporting

confidence: 69%

Do high‐frequency air‐bone gaps persist after ossiculoplasty?

Polanik

Trakimas

Castillo‐Bustamante

et al. 2020

Laryngoscope Investig Oto

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Objectives Conventional reporting of postoperative hearing outcomes utilizes a pure‐tone averaged air‐bone gap (ABG) that is biased toward low frequencies. Consequently, a high‐frequency ABG after otologic surgery may go unnoticed. In this study, we evaluate changes in low‐ and high‐frequency ABG following ossiculoplasty. Study design Retrospective review. Subjects and setting Consecutive series of patients who underwent ossiculoplasty at a single tertiary care center. Patients with pre‐ and postoperative audiograms were included. Methods Low‐frequency ABG was calculated as the mean ABG at 250, 500, and 1000 Hz. High‐frequency ABG was calculated at 4 kHz. Pre‐ and postoperative ABGs were compared. Results Thirty‐seven consecutive patients were included. Mean age at surgery was 38 years (range, 7‐77 years). Reconstruction materials included: cartilage (N = 4), hydroxyapatite cement (N = 5), and partial or total ossicular replacement prostheses (N = 20 and N = 8, respectively). Postoperatively, the mean low‐frequency ABG improved by 11.9 ± 15.1 dB (P < .0001) and the mean high‐frequency ABG improved by 5.9 ± 16.0 dB (P = .030). Low‐frequency ABG closure was significantly larger than high‐frequency ABG closure (P = .007). Mean postoperative persistent high‐frequency ABG was 22.0 ± 13.8 dB. Conclusion In this series, ossiculoplasty improved ABG across all frequencies, but greater improvements were observed at low frequencies when compared to high frequency. Current reporting standards may not identify persistent high‐frequency ABG. Additional study of the mechanisms of high‐frequency sound conduction in reconstructed middle ears is needed to improve high‐frequency hearing outcomes in ossiculoplasty. Level of evidence Level 4.

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Section: Discussionsupporting

confidence: 69%

Do high‐frequency air‐bone gaps persist after ossiculoplasty?

Polanik

Trakimas

Castillo‐Bustamante

et al. 2020

Laryngoscope Investig Oto

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“…Our secondary analysis of the results from over 700 patients published by Pauli 2019 shows a more complete closure of the ABG at low frequencies than high frequencies with similar magnitudes to our data set. Our prior work on high‐frequency conductive hearing following middle ear surgery 9 , 10 suggests that across middle ear surgical procedures, post‐operative high frequency ABGs persist and may be under‐reported using current PTA 4 standards. 8 …”

Section: Discussionmentioning

confidence: 99%

“…A 2018 review by Cheng et al, demonstrated the short and long‐term durability of hearing improvements following stapedotomy using PTA data from several published series 6 . However, the traditional pure‐tone average (PTA 4 ) recommended by the American Academy of Otolaryngology‐Head and Neck Surgery (AAO‐HNS), 7,8 may not sufficiently communicate changes in high‐frequency (HF) conductive hearing 9,10 . HF bone conduction thresholds following stapes surgery have not been robustly studied and reported outcomes are variable 5,11‐13 …”

Section: Introductionmentioning

confidence: 99%

“… 6 However, the traditional pure‐tone average (PTA 4 ) recommended by the American Academy of Otolaryngology‐Head and Neck Surgery (AAO‐HNS), 7 , 8 may not sufficiently communicate changes in high‐frequency (HF) conductive hearing. 9 , 10 HF bone conduction thresholds following stapes surgery have not been robustly studied and reported outcomes are variable. 5 , 11 , 12 , 13 …”

Section: Introductionmentioning

confidence: 99%

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Does stapedotomy improve high frequency conductive hearing?

Roychowdhury

Polanik

Kempfle

et al. 2021

Laryngoscope Investig Oto

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Objectives Stapedotomy is performed to address conductive hearing deficits. While hearing thresholds reliably improve at low frequencies (LF), conductive outcomes at high frequencies (HF) are less reliable and have not been well described. Herein, we evaluate post‐operative HF air‐bone gap (ABG) changes and measure HF air conduction (AC) thresholds changes as a function of frequency. Methods Retrospective review of patients who underwent primary stapedotomy with incus wire piston prosthesis between January 2016 and May 2020. Pre‐ and postoperative audiograms were evaluated. LF ABG was calculated as the mean ABG of thresholds at 250, 500, and 1000 Hz. HF ABG was calculated at 4 kHz. Results Forty‐six cases met criteria. Mean age at surgery was 54.0 ± 11.7 years. The LF mean preoperative ABG was 36.9 ± 11.0 dB and postoperatively this significantly reduced to 9.35 ± 6.76 dB, (P < .001). The HF mean preoperative ABG was 31.1 ± 14.4 dB and postoperatively, this also significantly reduced to 14.5 ± 12.3 dB, (P < .001). The magnitude of LF ABG closure was over 1.5 times the magnitude of HF ABG closure (P < .001). The gain in AC decreased with increasing frequency (P < .001). Conclusion Hearing improvement following stapedotomy is greater at low than high frequencies. Postoperative air bone gaps persist at 4 kHz. Further biomechanical and histopathologic work is necessary to localize postoperative high frequency conductive hearing deficits and improve stapedotomy hearing outcomes. Level of Evidence 4, retrospective study.

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“…3,4,8-11 Literature reports that for the majority of patients, postoperative air-bone gap (ABG) is >10 dB and on average ~15 dB. 3,4,6,7,10,11 Interestingly, studies demonstrate frequency-dependent hearing outcomes with the lack of improvement in the high-frequency ranges, 10-12 possibly due to specific graft materials. 12-14…”

mentioning

confidence: 99%

Mechanics of Total Drum Replacement Tympanoplasty Studied With Wideband Acoustic Immittance

Eberhard

Masud

Knudson

et al. 2021

Otolaryngol.--head neck surg.

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Objective Poor hearing outcomes often persist following total drum replacement tympanoplasty. To understand the mechanics of the reconstructed eardrum, we measured wideband acoustic immittance and compared the mechanical characteristics of fascia-grafted ears with the normal tympanic membrane. Study Design Prospective comparison study. Setting Tertiary care center. Methods Patients who underwent uncomplicated total drum replacement with temporalis fascia grafts were identified. Ears with healed grafts, an aerated middle ear, and no other conductive abnormalities were included. All patients underwent pre- and postoperative audiometry. Wideband acoustic immittance was measured with absorbance and impedance computed. Fascia-grafted ears were compared with normal unoperated ears. Results Eleven fascia-grafted ears without complications were included. Postoperatively, the median air-bone gap was 15 dB (250-4000 Hz), with variation across frequency and between ears. Fifty-six control ears were included. Absorbance of fascia-grafted ears was significantly lower than that of normal ears at 1 to 4 kHz ( P < .05) but similar below 1 kHz. Impedance magnitude demonstrated deeper and sharper resonant notches in fascia-grafted ears than normal ears ( P < .05), suggesting lower mechanical resistance of the fascia graft. Conclusion The mechanics of fascia-grafted ears differ from the normal tympanic membrane by having lower absorbance at mid- to high frequencies and thus poor sound transmission. The lower resistance in fascia-grafted ears may be due to poor coupling of the graft to the malleus. To improve sound transmission, grafts for tympanic membrane reconstructions would benefit from refined mechanical properties.

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High‐Frequency Conductive Hearing following Total Drum Replacement Tympanoplasty

Cited by 12 publications

References 28 publications

Do high‐frequency air‐bone gaps persist after ossiculoplasty?

Do high‐frequency air‐bone gaps persist after ossiculoplasty?

Does stapedotomy improve high frequency conductive hearing?

Mechanics of Total Drum Replacement Tympanoplasty Studied With Wideband Acoustic Immittance

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