Minimally invasive surgery for the treatment of hyperacusis: New technique and long term results

Silverstein, Herbert; Kellermeyer, Brian; Martinez, Ulyseius

doi:10.1016/j.amjoto.2019.102319

Cited by 5 publications

(8 citation statements)

References 10 publications

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“…AC at 0.25 and 0.50 kHz worsened postoperatively and remained stable from 3 months to 1 year postop (Table 3). This is consistent with slightly increased AC thresholds reported after RWR in humans and temporal bones (12,18,(21)(22)(23). Of note, very few patients complained about that, possibly because elevated AC thresholds protect from triggering external low-frequency sounds.…”

Section: Discussionsupporting

confidence: 91%

Long-Term Outcomes of Round Window Reinforcement for Superior Semicircular Canal Dehiscence Syndrome

Bunne

Andersson

Myhrum

2022

Otology &Amp; Neurotology

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ObjectiveTo report long-term patient reported outcome measures (PROMs) after standardized round window rein-forcement (RWR) with thin cartilage and perichondrium for superior semicircular canal dehiscence syndrome (SSCDS).MethodsCross-sectional survey in 2020 and retrospective longitudinal study of outcomes at 3 months, 1 year, and last follow-up after 28 consecutive RWRs. Endpoints were the last follow-up for PROMs and 1 year postoperatively for audiometry and cVEMP.ResultsAt the last follow-up (mean 2.4 years postoperatively), improvement was reported for 19/28 ears (68%) in symptoms overall; for 17/27 ears (63%) in auditory symptoms, and for 12/24 (50%) in vestibular symptoms. Nine ears (32%) required further surgery. No major complications occurred. On the group level, postoperative improvement at 3 months declined significantly for auditory and vestibular symptoms over time, and stayed stable beyond 1 year. Improved ears had on average 2.9 years follow-up. Improvement correlated significantly with SSCD length, and was associated with contralateral dehiscence. Thirteen ears (46%) had another potential cause of vestibular symptoms. This group showed significantly less improvement. Audiometric test results did not predict PROMs.ConclusionsSince long-term outcomes do not compare with those reported for plugging and repair, RWR is not suggested as a first line intervention for SSCDS. Considering the stable rates of improvement on average 2.9 years postoperatively and the absence of major complications, RWR may be an alternative to plugging or repair in fragile patients who do not accept the risk of complications with more invasive surgery, and who accept that results may deteriorate over time.

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Section: Discussionsupporting

confidence: 91%

Long-Term Outcomes of Round Window Reinforcement for Superior Semicircular Canal Dehiscence Syndrome

Bunne

Andersson

Myhrum

2022

Otology &Amp; Neurotology

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“…Nageris et al (21) demonstrated that round window dampening in an animal model increased the air conduction thresholds with no increase in bone conduction, and demonstrated a further increase in air conduction levels when there was fixation of the oval window in addition. The same outcomes of animal and laboratory testing have not been observed clinically; however, larger sample sizes would likely be required given the small magnitude of the effect (11,12). Our current study also does not find an effect at these lower frequencies.…”

Section: Discussionsupporting

confidence: 59%

“…Given the nature of the surgery, there is concern that dampening these windows may result in a conductive, sensorineural, or mixed hearing loss. A recent article published by Silverstein et al (11) demonstrated a slight increase in PTA between the preoperative and postoperative groups from 25.3 to 31.6 dB HL, though this was not found to be significant. Succar et al (15) presented a study that examined 14 patients who underwent RW plugging for SSCD, finding a subjective improvement in nine of the patients.…”

Section: Discussionmentioning

confidence: 87%

“…Controversy exists as to whether OW and RW reinforcement is a viable option for treatment of third window syndromes (11,14). The procedure's effect on hearing outcomes has also not been well evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…Repair of PLF with this method is generally successful in managing vestibular symptoms but has not been shown to aid in audiologic outcomes (10). Along with PLF, OW and RW reinforcement has been shown to aid in the symptom of hyperacusis (11).…”

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confidence: 99%

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Audiologic Outcomes After Oval and Round Window Reinforcement Surgery

Conway

Pinther

et al. 2021

Otology &Amp; Neurotology

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Introduction:Oval window (OW) and round window (RW) reinforcement surgery has been used for symptomatic treatment of multiple clinical entities, most commonly perilymphatic fistula and superior semicircular canal dehiscence. Owing to the theoretical acoustically negative effect of stiffening the windows, there has been concern of an unfavorable effect on audiologic outcomes due to the procedure. The purpose of this study is to specifically evaluate audiologic outcomes after OW and RW reinforcement.Methods:A retrospective review of patients undergoing transcanal OW or RW reinforcement was completed. Patients were evaluated both as a total group and as two groups separated into “third window” and “two-window” groups based on their specific diagnosis. Primary outcomes included changes in individual pure-tone thresholds, pure-tone average (PTA), air-bone gap, speech reception threshold (SRT), and word recognition scores (WRS) between the preoperative and postoperative groups.Results:Seventy-one patients were included in the study. The combined cohort demonstrated a significant postoperative 2.75 dB increase in the air conduction hearing level at 4000 Hz (p < 0.05). This was almost entirely accounted for by a 2.18 dB increase in the air-bone gap at this frequency (p < 0.05). There were no significant changes in PTA, SRT, or WRS between in the combined group or in the subgroup analysis.Conclusion:OW and RW tissue reinforcement resulted in a statistically significant but likely clinically insignificant decrease in hearing at the 4000 Hz frequency. There was no worsening of PTA, WRS, or SRT.

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