OBJECTIVES:This study aimed to assess long-term audiological outcomes in 465 primary myringoplasties and evaluate factors influencing surgical success. METHODS:A retrospective analysis was conducted on 442 patients (465 procedures) between 2001 and 2024. Outcomes were evaluated based on perforation location and surgical period. RESULTS:Mean air-bone gap improved from 19.1 dB to 9.8 dB post-operatively. Air-bone gap closure less than 10 dB was achieved in 53 per cent of patients. Posterior perforations yielded significantly better outcomes (8.7 dB vs. 10.2 dB; p = 0.0226). CONCLUSION:A residual air-bone gap of 8-12 dB is common despite anatomical success. Accurate reporting must include long-term data and high-frequency (4 kHz) analysis.

INTRODUCTION:Total ossicular chain reconstruction may be performed using autologous cartilage or bone, or with a total ossicular replacement prosthesis (TORP). It is unclear if one method offers better hearing outcomes. The goal of this study was to compare hearing outcomes following total ossicular chain reconstruction with autologous material or TORPs. METHODS:A single-institution prospective database was queried to identify patients who underwent total ossicular chain reconstruction and had available audiometric tests. Preoperative and postoperative air-bone gaps (ABG) at 0.5 to 4 kHz were compared between patients who underwent total ossicular chain reconstruction with autologous material (cartilage or bone) or a TORP. Univariate and multivariate analyses were used to assess the impact of revision surgery, canal wall down surgery, cholesteatoma, mucosal pathology, and pneumatization on postoperative outcomes. RESULTS:One hundred and twenty-three patients underwent 134 surgeries for total ossicular chain reconstruction. The improvement in ABG was better in the TORP group compared with those who received autologous grafts ( P <0.001; ΔABG 95% CI: -11.6 to -5.6 dB). Cholesteatoma ( P =0.01; 95% CI: 1.7-15.4 dB), and middle ear mucosal pathology ( P =0.03; 95% CI: 0.4-8.7 dB) were associated with less improvement in ABG on multivariate regression. Autologous bone fused to the surrounding bone in 2 (28.6%) cases. There were 2 (2.7%) cases of TORP extrusion. CONCLUSION:TORPs may offer superior hearing outcomes compared with autologous grafting materials for total ossicular chain reconstruction. Patients with cholesteatoma and middle ear mucosal pathology have less favorable hearing outcomes. Bone frequently fuses to the surrounding bone in the middle ear and should be used with caution. Autologous cartilage reconstruction remains a reasonable option in high-risk ears or in patients where minimizing the risk of prosthesis extrusion or revision surgery is critical.

In recent years, new techniques have been added to cholesteatoma surgery, and established microsurgical approaches are being reconsidered. This study aims to present the importance of individualized decision-making for the selection of an intact canal wall (CWU) or canal wall down (CWD) surgical procedure for each patient. Using the “ChOLE” classification we categorized 264 operations retrospectively. 162 CWU and 102 CWD surgeries were performed. We focus to determine why a CWD procedure was chosen quite frequently despite some low-stage cases. Furthermore, we evaluated recidivism and hearing outcomes. Smaller cholesteatomas (Ch-stage 1a, 1b 2a) were found in 182 patients (70

The correction of prominent ears is a rewarding operation. When choosing a surgical technique, we prefer a cartilage-sparing technique to a cartilage-splitting technique to achieve natural-looking long-term results. In this article, we present our preferred technique of an anterior scoring technique combined with concha-mastoid sutures step by step.

INTRODUCTION:Chronic rhinosinusitis is a prevalent condition with significant implications for both patients and society at large. The diagnostic and treatment approaches are primarily guided by the EPOS2020 guidelines in Europe, which increasingly delve into the molecular -mechanism of the disease and its resulting phenotypes. In recent years, biologics have emerged as a promising option, in particular for cases that are refractory to conventional therapies. However, the management landscape has become more intricate, necessitating consideration and potential concurrent treatment of comorbidities. Moreover, the utilization of biologics is accompanied by substantial costs, warranting personalized assessment for each patient. Hence, the establishment of specialized boards comprising clinicians from diverse disciplines to collaborate on treatment recommendations is imperative.

Purpose In primary cholesteatoma patients, incus destruction with an intact and mobile stapes is a frequent finding. Different techniques have been described to restore the ossicular chain, including incus interposition, stapes augmentation and type III tympanoplasty. Controversy about postoperative hearing results in open versus closed surgical techniques exist. Methods We performed a retrospective analysis of clinical, surgical and audiometric data of patients with primary cholesteatoma surgery operated between 2010 and 2020, and a mobile stapes and one-stage ossicular reconstruction. Pre- and post-operative audiograms were compared for the different surgical groups, mainly focusing on postoperative air–bone gap. Mastoid pneumatization and ventilation was also considered. Results The mean postoperative air–bone gap (0.5–4 kHz) of the 126 included patients was 20 dB. Hearing after type III tympanoplasty (26 dB) was worse than incus interposition (19 dB) and stapes augmentation (20 dB). Hearing after an open (23 dB) versus closed (19 dB) surgical technique was significantly different. No improvement in air–bone gap was observed for the higher frequencies. Conclusion A residual postoperative air–bone gap should be considered after primary cholesteatoma surgery with intact and mobile stapes. Incus interposition in closed cavity operation is the optimal situation, but open cavity surgery should not be avoided because of hearing. Extent of the disease is prioritized and poorer ventilation before and after surgery may affect postoperative hearing.

BACKGROUND:The impact of tight stapes crimping on hearing is a matter of debate. Several studies postulate that tight crimping is essential for lifelong success, whereas others have debated whether firm attachment leads to incus necrosis. Several types of prostheses with different coupling mechanisms have been developed, and manual crimping remains the most frequently used technique. This study investigates whether tightness really does affect hearing outcome. METHODS:The hearing results of patients who underwent primary stapedotomies using three different titanium pistons were analysed. The surgeons categorised the firmness of the piston attachment into 'tight' and 'loose' crimping groups. Hearing outcome and reasons for revision surgical procedures were investigated. RESULTS:The mean post-operative air-bone gap for frequencies of 0.5-4 kHz was 8.80 dB for the tight crimping group (n = 308) and 9.55 dB for the loose crimping group (n = 39). No significant difference was found (p = 0.4650). Findings at revision procedures were comparable (1.6 per cent vs 5 per cent). CONCLUSION:Although firm crimping is strongly advised, a movable loop upon palpation does not lead to unsatisfactory hearing results, and does not mandate piston replacement or bone cement use.

Introduction Chronic otitis media (COM) with a central perforation or a concomitant cholesteatoma are both inflammatory lesions, however, with different etiologies. Both entities may present with an intact chain, and the final reconstruction is quite similar. Does it also apply for the hearing outcome? Objectives In a retrospective analysis, we investigated the preoperative hearing and the final hearing outcome of two groups of patients: those with COM and those with cholesteatoma, and compared various factors. Methods Patients operated between 2010 and 2019 were entered prospectively into a research database, and the integrity of the ossicular chain, the extent of the cholesteatoma, and the findings on computed tomography (CT) scans were retrospectively analyzed and correlated to the final hearing outcome. Results Out of 210 tympanoplasties for COM, 162 (80%) presented with an intact chain, and 85 (40%) ears could be analyzed. Out of 283 cholesteatoma surgeries, 53 (19%) ears presented with an intact chain. The preoperative air-bone gap (ABG) was worse in the COM group, but the postoperative ABG over the frequencies of 0.5 kHz and 4 kHz was the same (10 dB to 12 dB) in both groups, and remained within 20 dB in 90% (40 and 78 patients, respectively). The extension of the disease was rather limited in the cholesteatoma group (stages Ch1a and 1b), and better pneumatization and ventilation were beneficial for a good result. Postoperatively, the frequency of 4 kHz had the largest ABG (14 dB and 18 dB). Conclusion Overall, 80% of the patients with COM and less than 20% of those with cholesteatoma had an intact and mobile chain at surgery. Using equivalent surgical techniques for the tympanoplasty, the final outcome was almost the same for both groups, with a mean ABG of 10 dB to 12 dB.

OBJECTIVES:An increasing proportion of patients who are candidates for endoscopic sinus surgery can be treated as an outpatient. A preoperative risk assessment is needed to evaluate eligibility for day surgery. This study analyses the effectiveness of a risk assessment scoring system which examines medical, procedure-related, and socioeconomic factors.DESIGN:Prospective multicenter study.SETTING:Three center study including Klinik Hirslanden, Zurich, Switzerland, Luzerner Kantonsspital, Lucerne, Switzerland and HNO-Klinik München-Bogenhausen, Munich, Germany.PARTICIPANTS:Patients with endoscopic sinus procedures between January 1st, 2017 and December 31st, 2018.MAIN OUTCOME MEASURES:The "day surgery risk score" consisted of three subgroups with medical, procedure-related and socioeconomic risk factors were assessed to determine if these predicted the severity of postoperative complications.RESULTS:Three-hundred and one patients who underwent endoscopic sinus surgery were included. The score resulted in a median value of 5 [5, 5]. In the Receiver-Operating Curve (ROC-the true-positive rate against the false-positive rate), the Area Under the Curve (AUC) was 0.59 with 95% confidence interval from 0.49 to 0.69, indicating that the "day surgery risk score" may be no better at predicting the likelihood of a complication than a random classification model.CONCLUSIONS:The "day surgery risk score" is a straightforward risk assessment which combines medical, procedure-related, and socioeconomic factors. The score is easy to use but in trying to decide whether a patient is eligible for ambulatory endoscopic sinus surgery it did not predict whether a complication was more likely to occur.

Objective:To compare the effectiveness of primary malleostapedotomy with revision malleostapedotomy for otosclerosis.Methods:From April 2002 to December 2017, 70 consecutive patients with otosclerosis who underwent malleostapedotomy were reviewed. Depending on the primary malleostapedotomy (P-MS) or revision malleostapedotomy (R-MS), the patients were divided into P-MS group or R-MS group.The intraoperative findings and hearing results before and after surgery were compared between the two groups. ALL data were analyzed using SPSS 23.Results:Totally 73 malleostapedotomy were performed in 73 ears of 70 patients, including 38 P-MS and 35 R-MS. There was no significant difference between the two groups in sex ratio, age and operated ears ( P>0.05 for all). The most common finding at P-MS was incus fixation (50.0%, 19/38) versus prosthesis displacement for R-MS (60.0%, 21/35) . Overall, the air-bone gap (ABG) improvement in P-MS were (18.1±8.2) dB in 0.5-3 kHz and (18.3±8.5) dB in 0.5-4 kHz, without significant difference to those in R-MS ( P>0.05) . 31.4% of R-MS in 0.5-3 kHz and 22.9% R-MS in 0.5-4 kHz achieved an ABG<10 dB, significantly lower than those of P-MS (65.8% in 0.5-3 kHz and 57.9% in 0.5-4kHz; P<0.05). Failure (postoperative ABG>30 dB) occurred in 11.4% in R-MS and 0 in P-MS (for 0.5-3 kHz and 0.5-4 kHz). The incidence of postoperative sensorineural hearing loss (>10 dB increase in bone conduct) in R-MS group was 8.6% in 0.5-3 kHz and 0.5-4 kHz, without significant difference to those in P-MS ( P>0.05) . 80.0% (20/25) of first R-MS achieved ABG<20 dB, compared to 37.5% (3/8) of second R-MS with ABG<20 dB. Conclusions:Although both P-MS and R-MS can significantly improve hearing, with similar risk of inner ear damage, R-MS is less effective and poses a higher risk of failure than P-MS. For patients with insufficient hearing improvement after first R-MS, conventional hearing aids or implantable hearing devices may be considered as an alternative.

BACKGROUNDThe lack of nasal tip support resulting in poor protection and projection of the nose is a common cause of nasal obstruction and cosmetic impairment. Although septal cartilage is preferred for restoration of nasal tip support, there is often not enough septal cartilage available. We describe an intercrural columellar strut graft in a circumferential soft tissue pocket: the I-Beam technique.METHODOLOGYIn this cohort study over an 8-year period the clinical and biometrical long-term results after restoration of nasal tip support with an autologous auricular cartilage graft, the I-Beam technique, is evaluated.RESULTSOut of the 72 consecutive septorhinoplasties with the I-Beam technique, we studied 66 patients in the median long-term follow-up of 89 months. In all patients a significant improvement in nasal tip projection was found. A functional improvement in nasal breathing was achieved in 86%. The overall satisfaction with the I-Beam graft was of 83%. No deterioration in smell perception was found after surgery.CONCLUSIONSThe I-Beam technique using back-to-back sutured autologous auricular cartilage is a safe and effective technique and gives long-term structural support and enhances tip projection.

BACKGROUND:Septal perforation closure is still often invasive and complex, with relatively low closure rates.OBJECTIVES:We aimed to provide the first results of a case series of 20 patients with nasal septal perforations who underwent septal perforation repair by both an open and a minimally invasive technique by using a graft that consisted of temporoparietal fascia and a polydioxanone (PDS) plate without mucosal flaps. Between 2014 and 2016, we tested, for the first time, the feasibility of the insertion of this graft via a hemitransfixion incision at our institution. The rationale for the closed approach was to avoid any visible nasal scars. We reported our results of both approaches.METHODS:The septal perforations were closed by insertion of a graft, which consisted of a 0.25-mm PDS flexible plate enveloped by temporoparietal fascia, into the perforation. The insertion of the graft was performed either via a columellar incision (open approach) or via a cosmetically advantageous hemitransfixion incision (closed approach) in an underlay technique. No attempts were made to close the perforation by mucosal flap rotation and/or advancement. Protective silastic sheeting to both sides of the perforation provided fixation to the graft while natural mucosal healing occurred over the perforation in the course of 3 to 8 weeks.RESULTS:Eighteen of 20 perforations were closed by mucosa at the last follow-up. The mean follow-up was 8.7 months. Thirteen patients had surgery via the closed approach.CONCLUSION:We showed, for the first time, that the insertion of a graft that consisted of a PDS flexible plate enveloped in temporoparietal fascia via a hemitransfixion incision was feasible and resulted in complete mucosal closure of nasal septal perforations in most patients. By performing the hemitransfixion incision, we avoided any visible nasal scars.

Objective: Identification of the causative mutation using next-generation sequencing in autosomal-dominant hereditary hearing impairment, as mutation analysis in hereditary hearing impairment by classic genetic methods, is hindered by the high heterogeneity of the disease.Patients: Two Swiss families with autosomal-dominant hereditary hearing impairment.Intervention: Amplified DNA libraries for next-generation sequencing were constructed from extracted genomic DNA, derived from peripheral blood, and enriched by a custom-made sequence capture library. Validated, pooled libraries were sequenced on an Illumina MiSeq instrument, 300 cycles and paired-end sequencing. Technical data analysis was performed with SeqMonk, variant analysis with GeneTalk or VariantStudio. The detection of mutations in genes related to hearing loss by next-generation sequencing was subsequently confirmed using specific polymerase-chain-reaction and Sanger sequencing.Main Outcome Measure: Mutation detection in hearing-loss-related genes.Results: The first family harbored the mutation c.5383+ 5delGTGA in the TECTA-gene. In the second family, a novel mutation c. 2614-2625delCATGGCGCCGTG in the WFS1-gene and a second mutation TCOF1-c. 1028G>A were identified.Conclusion: Next-generation sequencing successfully identified the causative mutation in families with autosomal-dominant hereditary hearing impairment. The results helped to clarify the pathogenic role of a known mutation and led to the detection of a novel one. NGS represents a feasible approach with great potential future in the diagnostics of hereditary hearing impairment, even in smaller labs.

Cochlear implant (CI) surgery is the standard of care for postlingual deafness in adults. A hearing aid (HA) for the non-implanted ear is normally used if residual hearing is available. There is limited data on bimodal stimulation in elderly patients. We compare the outcome of bimodal stimulation and analyzed the correlation of bimodal benefit and residual hearing in elderly patients. 22 patients≥70 years were implanted with a single-sided CI from 2002 till 2014. 17 patients use a HA on the non-implanted ear (bimodal). In a retrospective chart review we analyzed the audiological benefit (pure tone average, speech recognition). Time to follow-up was 6 month to 12 years. The subjective benefit was assessed using a structured questionnaire. The speech recognition (monosyllabic word testing in quiet @ 65 dB SPL) showed a score of 61% in bimodal condition vs. 53% with CI alone (p=0.35). There was no statistically significant correlation between residual hearing in the lower frequencies (250 Hz, 500 Hz and 1 kHz) and bimodal benefit. Most elderly patients benefit from bimodal stimulation. In quiet and in comparison with CI alone, most patients showed some improvement in word recognition scores using bimodal fitting, and all of them were using the contralateral hearing aid all day long. Postlingual deafened elderly patients fitted with a unilateral CI require a short rehabilitation period. In case of contralateral hearing aid fitting, regular control of the hearing aid should not be overlooked.

This study aimed to evaluate the benefit but also the extrusions, dislocations, and failures of a titanium incus prosthesis along with the long-term audiological outcomes. We prospectively collected data from 139 patients undergoing ossiculoplasty using the Fisch titanium incus prosthesis between 2001 and 2016. Overall, 126 patients with at least 6 months of follow-up (mean 4.5 years, range 6–155 months) were analyzed. Patients were grouped as “extrusion” (n = 9, 7%) if the prosthesis extruded, “failure” (n = 22, 18%) if a reoperation was needed concerning the prosthesis, and “stable” (n = 95, 75%) if the prosthesis remained functional in the middle ear. Mean postoperative air bone gaps (ABG) for 0.5–3 kHz for the overall group and the stable group were 19.8 (±11.9) and 15.3 (±7.5), respectively. Long-term results of stable group revealed an ABG (0.5–3 kHz) below 10 dB in 25% and below 20 dB in 81% of the patients. Atelectasis was the most frequent cause of extrusion, which occurred after a mean time of 28.7 months (range 15–48 months). Mean timing for reoperation was 30.7 months (range 5–131 months) in the failure group. There was no significant difference in mean postoperative ABG among patients with or without cholesteatoma, primary or staged ossiculoplasty in cholesteatoma, presence or absence of malleus head at the time of ossiculoplasty, open or closed cavity surgeries, or the degree of pneumatization of the temporal bone. The Fisch titanium incus prosthesis is a reliable alternative to using autologous incus for interposition ossiculoplasty, with similar hearing outcomes. Using this prosthesis, a 15 dB ABG should be expected.

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Eine 46-jährige Patientin wurde wegen einer therapieresistenten Otitis externa rechts zugewiesen. Es fand sich ein komplett zugeschwollener, feuchter und geröteter äusserer Gehörgang rechts, wobei das Trommelfell nicht einsehbar war. Die Stimmgabelprüfung deutete auf eine Schallleitungsschwerhörigkeit rechts hin.

OBJECTIVE:In 2009, we had introduced the active middle ear implant (aMEI) round window coupling in patients undergoing a subtotal petrosectomy and reported our first results. In the current study, we evaluated the long-term firmness of the vibranting floating mass transducer (FMT) within the round window niche, the long-term audiologic results and the patient's perspective of wearing the speech processor over time.PATIENTS AND INTERVENTION:Of 10 patients, 6 female and 1 male patients (age range from 30 to 71 yr) had undergone subtotal petrosectomy with aMEI round window vibroplasty and were available for a long-term follow-up. Indications were recurrent or chronic ear infections with preserved inner ear function and inability for ossicular chain reconstruction. A thin piece of fascia was placed between the FMT and the round window membrane once the round window niche had been enlarged by drilling. The operative cavity was filled with fat and a muscle flap in all cases.MAIN OUTCOME MEASURES:Audiologic evaluations included pre- and postoperative pure-tone audiometry, Freiburger syllable and numeric tests. All patients underwent preoperative computed tomographic (CT) scans and magnetic resonance imaging (MRI) examination. Postoperative follow-up included CT scans at 1 and preferentially 3 to 5 years to confirm the correct positioning of the FMT and the complete removal of the underlaying pathology. Subjective benefit was rated by the Glasgow Hearing Aid Benefit Profile.RESULTS:There were no immediate postoperative complications. CT scans confirmed the correct and durable positioning of the FMT. Audiometric tests revealed a stable and adequate functional gain in all patients with limited adjustments over time. Subjective rating reached a high satisfaction score, and all patients remained long-term implant users. One patient developed a skin necrosis over the implant because of excessive pressure exerted by the retaining magnet of the headpiece. Revision was performed using local skin flaps with preservation of the functioning implant.CONCLUSION:Our radiologic, audiometric, and subjective data show stable long-term results of round window vibroplasty in patients undergoing subtotal petrosectomy, and we continue to recommend this treatment option instead of another mastoid revision procedure.