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Faramarzi M, Faramarzi A, Roosta S, Abbasi N, Monabati A. Comparison of subcutaneous soft tissue versus temporalis fascia as a tympanoplasty graft material: a retrospective cohort study. J Laryngol Otol 2024; 138:153-161. [PMID: 37218630 DOI: 10.1017/s0022215123000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE This research compares the efficacy of subcutaneous soft tissue and temporalis fascia in tympanic membrane grafting for large tympanic membrane perforations. METHODS A retrospective cohort study compared tympanic membrane graft success rate and hearing outcomes in 248 patients who underwent tympanoplasty using subcutaneous soft tissue (n = 118) or temporalis fascia (n = 130) via the post-auricular approach. RESULTS Comparable results were observed in both groups. Tympanic membrane graft success rate was 98.3 per cent (116 ears) in the subcutaneous soft tissue group and 98.5 per cent (128 ears) in the temporalis fascia group. The rate of air-bone gap closure within 20 dB was 54.2 per cent (64 ears) and 60.0 per cent (78 ears) in the soft tissue and temporalis fascia groups, respectively (p = 0.360). CONCLUSION Subcutaneous soft tissue is a reliable and readily available tympanic membrane graft material in both revision and primary tympanoplasty for large tympanic membrane perforations.
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Affiliation(s)
- Mohammad Faramarzi
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Faramarzi
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sareh Roosta
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nadia Abbasi
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Monabati
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
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2
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Lou Z, Li C, Yu D, Wang J, Chen Z, Yin S. Comparison of healing of acute total tympanic membrane perforation between rats with and without excision of the mallear handle. Laryngoscope Investig Otolaryngol 2023; 8:1648-1656. [PMID: 38130269 PMCID: PMC10731538 DOI: 10.1002/lio2.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/15/2023] [Accepted: 10/06/2023] [Indexed: 12/23/2023] Open
Abstract
Objective We compared the histological changes and hearing restoration during the healing of acute total tympanic membrane (TM) perforations between Sprague-Dawley (SD) rats with and without excision of the mallear handle. Materials and methods Bilateral, acute, and total TM perforations were created in 36 male SD rats. The mallear handle was preserved in the left ear (handle-preserved ear [HPE]) and excised from the right ear (handle-excised ear [HEE]). Endoscopical examination, auditory brainstem response (ABR) thresholds, histopathological, and scanning electron microscope (SEM) analysis were performed. Results Endoscopic photographs showed that all perforations in the 18 SD rats were closed. The mean closure times were 6.83 ± 0.85 and 8.50 ± 0.71 days in the HPE and HEE groups, respectively (p < .001). SEM images showed radial arrangement of fiber bundles in a single direction in HPEs, although normal arrangement was not achieved. In contrast, HEEs showed disorganized arrangement. At 1 month after perforation closure, the ABR thresholds at high frequencies were significantly higher in the HEE group than in the HPE group (p = .029 and p = .017 for 16 and 32 kHz, respectively). Additionally, the changes in ABR threshold were significantly different at high frequencies (p = .011 and p = .017 for 16 and 32 kHz, respectively) before and 1 month after perforation closure between the HPE and HEE groups, although the differences were not statistically significant at the remaining frequencies. Conclusion Although the malleus handle may not affect the closure of total perforation in SD rats, it contributes to accelerate the perforation closure by possible guide the migration of proliferative epithelial cell on the upper halves of the annulus. Additionally, resection of the malleus handle impairs high frequency hearing recovery following spontaneous closure of the TM.
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Affiliation(s)
- Zihan Lou
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Chunyan Li
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Dongzhen Yu
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Jingjing Wang
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Zhengnong Chen
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Shankai Yin
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
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3
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Li C, Xiong Z, Zhou L, Huang W, He Y, Li L, Shi H, Lu J, Wang J, Li D, Yin S. Interfacing Perforated Eardrums with Graphene-Based Membranes for Broadband Hearing Recovery. Adv Healthc Mater 2022; 11:e2201471. [PMID: 35899802 DOI: 10.1002/adhm.202201471] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Indexed: 01/28/2023]
Abstract
Eardrum perforation and associated hearing loss is a global health problem. Grafting perforated eardrum with autologous tissues in clinic can restore low-frequency hearing but often leaves poor recovery of high-frequency hearing. In this study, the potential of incorporating a thin multilayered graphene membrane (MGM) into the eardrum for broadband hearing recovery in rats is examined. The MGM shows good biocompatibility and biostability to promote the growth of eardrum cells in a regulated manner with little sign of tissue rejection and inflammatory response. After three weeks of implantation, the MGM is found to be encapsulated by a thin layer of newly grown tissue on both sides without a significant folded overgrowth that is often seen in natural healing. The perforation is well sealed, and broadband hearing recovery (1-32 kHz) is enabled and maintained for at least 2 months. Mechanical simulations show that the high elastic modulus of MGM and thin thickness of the reconstructed eardrum play a critical role in the recovery of high-frequency hearing. This work demonstrates the promise of the use of MGM as a functional graft for perforated eardrum to recover hearing in the broadband frequency region and suggests a new acoustics-related medical application for graphene-related 2D materials.
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Affiliation(s)
- Chunyan Li
- Department of Otorhinolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Zhiyuan Xiong
- Department of Chemical Engineering, The University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Lei Zhou
- Department of Otorhinolaryngology-Head and Neck Surgery, Zhongshan Hospital affiliated to Fudan University, Shanghai, 200032, China
| | | | - Yushi He
- Shanghai Electrochemical Energy Devices Research Center, School of Chemistry and Chemical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Linpeng Li
- Department of Otorhinolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Haibo Shi
- Department of Otorhinolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Jiayu Lu
- Department of Stomatology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Jian Wang
- School of Communication Science and Disorders, Dalhousie University, Halifax, B3J 1Y6, Canada
| | - Dan Li
- Department of Chemical Engineering, The University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Shankai Yin
- Department of Otorhinolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
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4
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Remenschneider AK, Cheng JT, Rosowski JJ. Methods for the calibration of bone conduction transducers at frequencies from 5 to 20 kHz. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 151:2945. [PMID: 35649943 PMCID: PMC9064400 DOI: 10.1121/10.0010381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 05/03/2023]
Abstract
Techniques for standardizing the output of bone conduction transducers over the 5-20 kHz range are presented. The techniques include definitions of the standard artificial mastoid (AM) impedance and force sensitivity in that high-frequency range using an impedance head coupled to a vibration source. The AM impedance is shown to vary with the contact area of the vibration source. The AM force sensitivity does not vary with the contact area but does exhibit sharp frequency dependences over the 14-20 kHz range. The sharp frequency dependence complicates the use of the AM force sensor as a stand-alone calibration device at these high frequencies. An alternative calibration scheme that uses an accelerometer interposed between the vibrator and the AM impedance is described. Comparisons of the two schemes demonstrate that the accelerometer method produces more consistent results. Comparisons of the force and acceleration output of one bone conduction vibrator at high frequencies suggest those outputs depend on the driven load. The loads used in the two calibration schemes are compared to what is known of the impedance of the skin-covered head.
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Affiliation(s)
- Aaron K Remenschneider
- Department of Otolaryngology, UMass Memorial Medical Center, UMass Chan Medical School, Worcester, Massachusetts 01655, USA
| | - Jeffrey Tao Cheng
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University Medical School, Boston, Massachusetts 02114, USA
| | - John J Rosowski
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University Medical School, Boston, Massachusetts 02114, USA
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Liu Y, Wu C, Chen T, Shen Q, Xiong Y, Chen Z, Li C. Evaluation of acoustic changes in and the healing outcomes of rat eardrums with pars tensa and pars flaccida perforations. Laryngoscope Investig Otolaryngol 2022; 7:816-824. [PMID: 35734049 PMCID: PMC9194967 DOI: 10.1002/lio2.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/11/2022] [Accepted: 04/09/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives To systematically explore the differences in acoustic changes and healing outcomes of tympanic membranes (TMs) with pars flaccida perforation (PFP) and pars tensa perforation (PTP). Methods We created PFPs and PTPs of various sizes in Sprague–Dawley rats, and evaluated TM umbo velocity and hearing function using laser Doppler vibrometry and auditory brainstem response (ABR) measurement before and immediately after perforation. Two weeks later, hearing was reevaluated and TMs were investigated by immunohistochemical staining. Results Small PFPs and PTPs did not significantly affect umbo velocity and hearing function. Large PFPs increased umbo velocity loss at low frequency (1.5 kHz) and elevated ABR thresholds within 1–2 kHz. Large PTP caused significant velocity loss at low frequencies from 1.5 to 3.5 kHz and threshold elevations at full frequencies (1–2 kHz). Two weeks after the perforation, the hearing function of rats with healed PFPs recovered completely. However, high‐frequency hearing loss (16–32 kHz) persisted in rats with healed PTPs. Morphological staining revealed that no increase in the thickness and obvious increase in collagen I level of regenerated par flaccida; regenerated pars tensa exhibited obvious increase in thickness and increased collagen I, while the collagen II regeneration was limited with discontinuous and disordered structure in regenerated pars tensa. Conclusion The hearing loss caused by large PFP limits at low frequencies while large PTP can lead to hearing loss at wide range frequencies. PFP and PTP have different functional outcomes after spontaneous healing, which is determined by the discrepant structure reconstruction and collagen regeneration.
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Affiliation(s)
- Yaoqian Liu
- Otolaryngology Research Institute Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
| | - Cuiping Wu
- Otolaryngology Research Institute Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
| | - Tingting Chen
- Department of Hearing and Language Rehabilitation Zhejiang Chinese Medicine University Hangzhou China
| | - Qiyue Shen
- Department of Hearing and Language Rehabilitation Shanghai University of Traditional Chinese Medicine Shanghai China
| | - Yuanping Xiong
- Department of Otolaryngology Head and Neck Surgery First Affiliated Hospital of Nanchang University Nanchang China
| | - Zhengnong Chen
- Otolaryngology Research Institute Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
- Department of Otolaryngology‐Head and Neck Surgery Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
| | - Chunyan Li
- Otolaryngology Research Institute Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
- Department of Otolaryngology‐Head and Neck Surgery Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
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6
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Roychowdhury P, Polanik MD, Kempfle JS, Castillo‐Bustamante M, Fikucki C, Wang MJ, Kozin ED, Remenschneider AK. Does stapedotomy improve high frequency conductive hearing? Laryngoscope Investig Otolaryngol 2021; 6:824-831. [PMID: 34401508 PMCID: PMC8356860 DOI: 10.1002/lio2.599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022] Open
Abstract
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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Affiliation(s)
- Prithwijit Roychowdhury
- Department of Otolaryngology‐Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | - Marc D. Polanik
- Department of Otolaryngology‐Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | - Judith S. Kempfle
- Department of Otolaryngology‐Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyUMASS Memorial Medical CenterWorcesterMassachusettsUSA
| | - Melissa Castillo‐Bustamante
- Department of Otolaryngology‐Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard UniversityBostonMassachusettsUSA
| | - Cheryl Fikucki
- Department of AudiologyUMASS Memorial Medical CenterWorcesterMassachusettsUSA
| | - Michael J. Wang
- Department of OtolaryngologyUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | - Elliott D. Kozin
- Department of Otolaryngology‐Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard UniversityBostonMassachusettsUSA
| | - Aaron K. Remenschneider
- Department of Otolaryngology‐Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
- Department of OtolaryngologyUMASS Memorial Medical CenterWorcesterMassachusettsUSA
- Department of OtolaryngologyHarvard UniversityBostonMassachusettsUSA
- Department of AudiologyUMASS Memorial Medical CenterWorcesterMassachusettsUSA
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Eberhard KE, Masud SF, Knudson IM, Kirubalingam K, Khalid H, Remenschneider AK, Nakajima HH. Mechanics of Total Drum Replacement Tympanoplasty Studied With Wideband Acoustic Immittance. Otolaryngol Head Neck Surg 2021; 166:738-745. [PMID: 34281437 DOI: 10.1177/01945998211029541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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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Affiliation(s)
- Kristine Elisabeth Eberhard
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Copenhagen University Hospital-Righospitalet, Copenhagen, Denmark
| | - Salwa Fatima Masud
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | | | - Keshinisuthan Kirubalingam
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,School of Medicine, Queen's University, Kingston, Canada
| | - Hamza Khalid
- Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Aaron K Remenschneider
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, University Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Hideko Heidi Nakajima
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston, Massachusetts, USA
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8
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Lin X, Meenderink SWF, Stomackin G, Jung TT, Martin GK, Dong W. Forward and Reverse Middle Ear Transmission in Gerbil with a Normal or Spontaneously Healed Tympanic Membrane. J Assoc Res Otolaryngol 2021; 22:261-274. [PMID: 33591494 DOI: 10.1007/s10162-020-00779-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022] Open
Abstract
Tympanic membranes (TM) that have healed spontaneously after perforation present abnormalities in their structural and mechanical properties; i.e., they are thickened and abnormally dense. These changes result in a deterioration of middle ear (ME) sound transmission, which is clinically presented as a conductive hearing loss (CHL). To fully understand the ME sound transmission under TM pathological conditions, we created a gerbil model with a controlled 50% pars tensa perforation, which was left to heal spontaneously for up to 4 weeks (TM perforations had fully sealed after 2 weeks). After the recovery period, the ME sound transmission, both in the forward and reverse directions, was directly measured with two-tone stimulation. Measurements were performed at the input, the ossicular chain, and output of the ME system, i.e., at the TM, umbo, and scala vestibuli (SV) next to the stapes. We found that variations in ME transmission in forward and reverse directions were not symmetric. In the forward direction, the ME pressure gain decreased in a frequency-dependent manner, with smaller loss (within 10 dB) at low frequencies and more dramatic loss at high frequency regions. The loss pattern was mainly from the less efficient acoustical to mechanical coupling between the TM and umbo, with little changes along the ossicular chain. In the reverse direction, the variations in these ears are relatively smaller. Our results provide detailed functional observations that explain CHL seen in clinical patients with abnormal TM, e.g., caused by otitis media, that have healed spontaneously after perforation or post-tympanoplasty, especially at high frequencies. In addition, our data demonstrate that changes in distortion product otoacoustic emissions (DPOAEs) result from altered ME transmission in both the forward and reverse direction by a reduction of the effective stimulus levels and less efficient transfer of DPs from the ME into the ear canal. This confirms that DPOAEs can be used to assess both the health of the cochlea and the middle ear.
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Affiliation(s)
- Xiaohui Lin
- VA Loma Linda Healthcare System, Loma Linda, CA, 92374, USA
| | | | | | - Timothy T Jung
- VA Loma Linda Healthcare System, Loma Linda, CA, 92374, USA.,Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Health, Loma Linda, CA, 92350, USA
| | - Glen K Martin
- VA Loma Linda Healthcare System, Loma Linda, CA, 92374, USA.,Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Health, Loma Linda, CA, 92350, USA
| | - Wei Dong
- VA Loma Linda Healthcare System, Loma Linda, CA, 92374, USA. .,Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Health, Loma Linda, CA, 92350, USA.
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9
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Polanik MD, Trakimas DR, Castillo‐Bustamante M, Cheng JT, Kozin ED, Remenschneider AK. Do high-frequency air-bone gaps persist after ossiculoplasty? Laryngoscope Investig Otolaryngol 2020; 5:734-742. [PMID: 32864446 PMCID: PMC7444777 DOI: 10.1002/lio2.418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/29/2020] [Accepted: 05/26/2020] [Indexed: 11/09/2022] Open
Abstract
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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Affiliation(s)
- Marc D. Polanik
- Eaton‐Peabody LaboratoriesMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyUMass Memorial Medical CenterWorcesterMassachusettsUSA
- University of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | - Danielle R. Trakimas
- Department of Otolaryngology‐Head & Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | | | - Jeffrey T. Cheng
- Eaton‐Peabody LaboratoriesMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology‐Head & Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Elliott D. Kozin
- Eaton‐Peabody LaboratoriesMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology‐Head & Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Aaron K. Remenschneider
- Eaton‐Peabody LaboratoriesMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyUMass Memorial Medical CenterWorcesterMassachusettsUSA
- University of Massachusetts Medical SchoolWorcesterMassachusettsUSA
- Department of Otolaryngology‐Head & Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
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