To compare the clinical, radiological, and audiological features of otosclerosis across two tertiary centers in Switzerland and China. We included 478 adult patients (540 operated ears) who underwent primary stapes surgery for otosclerosis between 2015 and 2023 at a Swiss hospital (LH) and a Chinese hospital (PH). All patients underwent preoperative high-resolution CT and pure-tone audiometry. A semiquantitative CT scoring system was used to assess involvement at four anatomical subsites. Pre- and postoperative audiometric data were compared, and associations between CT findings and hearing outcomes were evaluated using correlation and regression analyses. Patients from PH were significantly younger, with a less balanced age distribution. Antefenestral and footplate CT scores were significantly higher in the LH group. PH patients showed worse preoperative air conduction (AC) thresholds. Preoperative bone conduction (BC) thresholds correlated modestly with regional and total CT scores. Postoperative BC and AC thresholds were also weakly associated with total and cochlear CT scores. Postoperative AC thresholds and ABG were significantly better in the LH group. Logistic regression identified hospital site and preoperative ABG as significant predictors of achieving ABG ≤ 10 dB HL. This dual-center study reveals distinct clinical profiles of otosclerosis between Chinese and Swiss patients. Although operated at a younger age, Chinese patients had worse hearing but milder CT changes. Both groups improved after surgery, yet complete ABG closure was more frequent in the Swiss group. This study emphasizes the need for population-sensitive treatment strategies and expectations in otosclerosis.

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

OBJECTIVE:This retrospective study aimed to establish a robust rating system for assessing post-operative outcomes in congenital aural atresia patients undergoing auricular reconstruction. The newly introduced EAR scale, a weighted grading system, not only considers anatomical landmarks but also factors such as ear alignment. In addition, the outer-ear cartilage scale and the visual analogue scale (VAS) were introduced. These scales were compared among themselves and against two established scales. METHODS:Nine raters assessed 17 eligible patients who underwent auricular reconstruction between 2001 and 2020. RESULTS:The study compared inter-rater agreement among scales, with the EAR scale proving the most reliable (Krippendorff's alpha coefficient, α = 0.45), outperforming existing measures. The outer-ear cartilage scale and the VAS exhibited lower inter-rater agreement, indicating inferiority in assessing aesthetic outcomes. CONCLUSION:The EAR scale emerged as an effective tool for evaluating post-operative outcomes in congenital aural atresia auricular reconstruction.

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.

Zusammenfassung Hintergrund Die Otosklerose ist ein häufig gesehenes Krankheitsbild in der HNO-ärztlichen Sprechstunde und führt durch einen Knochenumbau der otischen Kapsel zu einer progredienten Schwerhörigkeit. Die bildgebenden Methoden, insbesondere die Computertomographie (CT) und die digitale Volumentomographie (DVT), gewinnen in der Diagnose der Otosklerose zunehmend an Bedeutung. Ziel der Studie Gibt es eine Korrelation zwischen dem Ausmaß der Otosklerose in der Bildgebung mittels CT oder DVT und der Hörminderung im Reintonaudiogramm? Material und Methoden Aus bereits publizierten Einteilungskriterien zur Beurteilung von Otoskleroseherden wurde eine Klassifikation erarbeitet. Die präoperativen CT-Datensätze der im Zeitraum zwischen 2015 und 2019 operierten Patient*innen mit Otosklerose wurden von zwei unabhängigen HNO-Ärzt*innen evaluiert und klassifiziert. Die präoperativen Audiogramme wurden ausgewertet und mit den CT-Befunden verglichen. Resultate Eingeschlossen wurden 168 Ohren von 156 Patient*innen mit intraoperativ bestätigter Otosklerose. Eine Korrelation zwischen der Ausdehnung der Otoskleroseherde bzw. dem errechneten Score und der Hörminderung (Luftleitung, Knochenleitung und Air-Bone-Gap) im Reintonaudiogramm konnte nicht nachgewiesen werden. Schlussfolgerung Eine präoperative Diagnostik mittels CT ist nicht obligat. Die Bildgebung, bevorzugt mit einer DVT, kann jedoch zum Ausschluss weiterer Mittel- und Innenohrpathologien sowie zur Planung eines operativen Eingriffs im Kontext von Otoskopie und Audiometrie durchaus begründet sein. Eine Korrelation zur gemessenen Hörminderung bleibt weiterhin unklar und konnte in unserer Kohorte nicht nachgewiesen werden.

Nowadays, several options are available to treat patients with conductive or mixed hearing loss. Whenever surgical intervention is not possible or contra-indicated, and amplification by a conventional hearing device (e.g., behind-the-ear device) is not feasible, then implantable hearing devices are an indispensable next option. Implantable bone-conduction devices and middle-ear implants have advantages but also limitations concerning complexity/invasiveness of the surgery, medical complications, and effectiveness. To counsel the patient, the clinician should have a good overview of the options with regard to safety and reliability as well as unequivocal technical performance data. The present consensus document is the outcome of an extensive iterative process including ENT specialists, audiologists, health-policy scientists, and representatives/technicians of the main companies in this field. This document should provide a first framework for procedures and technical characterization to enhance effective communication between these stakeholders, improving health care.

Objective: To evaluate the audiological and subjective benefit from hearing rehabilitation with an active bone conduction implant in subjects with single-sided sensorineural deafness (SSD). Study Design: Prospective, multicenter, single-subject repeated measures. Setting: Tertiary referral center, five clinics in Germany and Switzerland. Patients: Seventeen subjects aged 18 years and older with severe to profound unilateral sensorineural hearing loss and contralateral normal hearing were followed up for 24 months. Intervention: Active bone conduction implant. Main Outcome Measures: Speech understanding in noise was assessed in three situations: with signal from front, deaf, or normal hearing side (with noise from front in all set-ups). Subjective benefit was evaluated using the Speech, Spatial, and Qualities of Hearing (SSQ-B) and Bern Benefit in Single-Sided Deafness (BBSS) questionnaire. Results: When the signal was coming from the deaf side the mean improvement of the speech reception threshold in noise ranged from 1.5 up to 2.2 dB with the device and was statistically and clinically significant at all tested timepoints. No significant difference between the aided and unaided situation was found when signal and noise were coming from the front. With the signal from the normal hearing side no clinically significant difference, that is, greater than 1 dB between the aided and unaided situation was found. The SSQ-B and BBSS questionnaire showed an overall improvement with no significant difference between time points. Conclusions: The study demonstrates long-term efficacy and benefit of the device in adults with SSD. Patients reported substantial and persistent subjective benefit from the active bone conduction implant.

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.