Contralateral delayed endolymphatic hydrops: clinical features and long term outcome

BACKGROUND: Contralateral delayed endolymphatic hydrops (CDEH) is a clinical entity characterized by fluctuating low frequency hearing loss and/or vertigo, mimicking Ménière’s disease (MD), that manifests after the appearance of severe non-hydropic hearing loss (NHHL) at the other ear. OBJECTIVES: to describe the clinical features and the course of 57 patients affected by CDEH. METHOD: this is a retrospective study; 57 patients affected by CDEH, out of 1065 patients seen in the same period and affected by MD, were subjected to otoscopy, PTA threshold evaluation, impedance testing, ABR, research of positioning nystagmus, vestibular function evaluated by means of bithermal caloric test under video-oculographic, and MRI with gadolinium. RESULTS: the CDEH was definite in 24 cases (42%), probable in 2 (4%) and possible in 31 (54%). The mean PTA threshold at the hydropic ear was 41 dB. At the last follow-up, 40 patients (70%) did not report vertigo or fluctuating hearing loss. Among the 17 patients who still reported symptomatology, 11 (64%) were affected by fluctuating hearing loss alone, 4 (23%) reported a subjective worsening of hearing loss and 2 (12%) an acute vertigo crisis. CONCLUSIONS: contralateral delayed endolymphatic hydrops is a relatively rare form of Ménière disease that manifests more frequently as a definite form or with fluctuating low-frequency hearing loss. The prognosis at a long term follow-up is relatively good in terms of vertigo resolution. Contralateral delayed endolymphatic hydrops rarely determines a severe hearing loss in the better ear

Prognostic factors influencing postoperative air-bone gap in stapes surgery

Objective. Otosclerosis is an osteodystrophic disease of the otic capsule, determining conductive or mixed hearing loss, which can be successfully treated with stapedotomy. The aim of the present multicentric retrospective study was to identify prognostic factors related to better auditory outcomes in stapes surgery.Methods. 581 patients affected by otosclerosis were submitted to stapedotomy under local anaesthesia in two different hospitals. Both Teflon and titanium prostheses were adopted.Results. A statistically significant decrease of postoperative air-conduction thresholds and air-bone gap (ABG) values was seen, whereas the mean bone-conduction threshold did not differ from the preoperative condition. Among the various parameters investigated, the prosthetic material, duration of surgery and intraoperative detection of unexpected anatomical anomalies of the middle ear were found to be related to lower postoperative ABG values.Conclusions. All the previously mentioned parameters played a significant role in determining the postoperative auditory outcomes and can therefore be considered prognostic factors for the success of the stapedotomy

Transcanal Endoscopic Ear Surgery for Cholesteatoma: Royal Belgian Society of Otorhinolaryngology

Objective: Surgery for cholesteatoma is traditionally based on microscopic approach. For several years, endoscopy developed from a combined approach as a complementary device to microscope to an exclusive transcanal approach in various fields of ear surgery. The objective of this article is to present principles, surgical techniques, and results of endoscopy in cholesteatoma surgery. Methods: All principles of transcanal exclusive endoscopic ear surgery and combined approach as a complementary device to microscopy are presented. Surgical techniques are described through surgical videos and comments. Results are reported through a review of international literature. Results: Endoscopic ear surgery in the treatment of cholesteatoma shows similar results to those of microscopic surgery according to residuals, recurrence, and hearing outcomes. Endoscopic surgery is a more complex 1-hand technique that requires time to be experienced and to have wide understanding of endoscopic ear anatomy, for dissection of anatomical space and ossicular chain, and for transcanal drilling techniques. Middle ear is the main surgical field for endoscopic ear surgery. Surgical strategy when cholesteatoma extends beyond posterior epitympanum depends on surgical experience in performing large atticotomy or microscope-assisted mastoidectomy. Conclusion: The question is not to decide whether endoscopy must substitute microscopy. The ear surgeon must be able to choose the best- suited technique for the patient. The use of one or another technique depends on the surgeon’s habits. Learning both endoscopy and micros- copy allows the surgeon to adapt his surgical strategy