PubMed · 583313
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E S Hochmair, I J Hochmair-Desoyer, K Burian. 1979. Experience with implanted auditory nerve stimulator.. https://doi.org/10.1097/00002480-197902500-00068
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A study of 277 ears with chronic otitis media undergoing one-stage tympanoplasty has been carried out. The mean follow-up period was 6.4 years. Ears with intact ossicular chains were excluded. Ossiculoplasty was performed using autologous ossicles or cortical bone. Mean hearing gain was 10.8 dB. Closure of the postoperative air-bone gap to within 20 dB was achieved in 51% of cases. The best results were obtained in ears with intact stapes, while cholesteatomatous ears showed poorer results than other chronic ears. The present findings show that autologous ossicle and cortical bone are still suitable for ossicular reconstruction in chronic ears, especially when one-stage surgery is preferred.
Seventy-seven patients with chronic otitis media were reviewed. Of the 77 patients, 42 underwent tympanoplasty with a columella, and 35 underwent myringoplasty and atticotomy. Twenty-five of the latter 35 patients showed less than 10 dB of hearing improvement with a patch test before operation. The ossicular chain was not disconnected in any of the 25 patients, but the mobility was severely restricted. It was interesting that fixation of the malleus was found at surgery in 80% (20/25) of the patients, whereas the stapes was immobilized in only 16% (4/25). Myringoplasty and atticotomy instead of tympanoplasty with a columella was sufficient to achieve hearing improvement in most of such cases. However, conventional atticotomy was not able to achieve improvement in the mobility of the ossicles because the mobility is usually severely restricted at the malleus. Removal of the anterior tympanic spine is the key to recovery of the mobility of the malleus, resulting in hearing improvement. Rate of success was obtained in 24 of 25 ears (96%).
Hearing aid fitting in children with profound sensorineural hearing loss (greater than 90 dB) has been regarded as problematic because of the risk of a further hearing aid induced damage. Maximal output levels of 125 dB (SPL) were the upper limit in such cases. We believe, that the danger of a further damage to hearing as a consequence of too high output levels has been overestimated. We therefore offer a strategy which may make it possible, to benefit from high output levels (up to 140 dB (SPL)) and at the same time may reduce the risk of further hearing damage. Furthermore the limit between hearing aid fitting an cochlear implantation is discussed.