Search

Objective: To analyze the clinical feature, diagnosis and treatment of Anca-associated vasculitis with ear symptoms. Methods: In this retrospective study, we summarized the clinical and laboratory examination, pure tone audiometry, aural immittance measurement, CT scan of temporal bone and treatment of 40 patients in the First Medical Center of the PLA General Hospital. Results: A total of 11 cases（27.5%） had the initial symptom in the ear. The most common symptoms were hearing loss, and the other symptoms included a sense of ear fullness, otorrhea and tinnitus. There were 35 cases with hearing loss: 19 cases with conductive hearing loss（47.5%）, 9 cases with sensorineural hearing loss（22.5%）, and 7 cases with mixed hearing loss（17.5%）. 5 cases had a sense of ear fullness or tinnitus, and the results of the hearing test were normal（12.5%）. All of the 40 patients had multi-system involvement, and respiratory system accounted for the most. All patients had a positive result of Anti-neutrophil cytoplasmic antibody（ANCA）. Treatment included systemic hormonal, immunosuppressive, or biologic therapy. There were 3 cases recovered（7.5%）, 22 cases with alleviated ear symptoms（55.0%）, 6 cases with recurrent hearing loss（15%） and 9 cases had no significant improvement（22.5%）. Conclusion: Conductive deafness（secretory otitis media） can be the first manifestation in the early stage of otitis media with AAV（OMAAV）, later it may turn to binaural mixed deafness. Otolaryngologists need to consider OMAAV diagnosis when diagnosing and treating patients with recurrent secretory otitis media. Multi-system symptom consultation and ANCA examination can help identify. Early systemic medication and the application of immunosuppressants or biological agents can help relieve the ear symptoms., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Antlet-Bixler syndrome is a rare congenital multiple malformation. In this report, a child with clinical features of midface hypoplasia, craniosynostosis, and skeletal deformities was diagnosed with Antlet-Bixler syndrome after whole exome sequencing demonstrated compound heterozygous mutations in POR . The audiological findings of affected children with sensorineural, conductive, mixed hearing loss are complex and variable. In this paper, its clinical audiological features and genetic etiology were discussed in combination with relevant literatures., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Implantable bonebridge（BB） is suitable for patients over 5 years with conductive/mixed hearing loss and unilateral deafness, and the surgical approach depends on the anatomical structure of the patient's ear. Recent studies have shown that compared with other implantable hearing devices, implantable BB have more efficient hearing gain and lower incidence of complications. However, the postoperative effect of implantable BB on unilateral deafness patients and the poor compensation of low-frequency hearing threshold need to be further studied. This article reviews the clinical research on implantable BB, so as to provide some reference for clinicians to select hearing devices for patients individually., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To evaluate the application of 10 μm otology CT on evaluation of isolated malleus fixation (IMF) in patients with conductive hearing loss. Methods: A total of 19 patients (25 sides) with idiopathic hearing loss, including 8 males and 11 females, aged between 4 to 50 years, who underwent 10 μm otology CT examination in Department of Radiology, Beijing Friendship Hospital, Capital Medical University from October 2020 to July 2021, were retrospectively collected. For those patients with idiopathic hearing loss, there were 5 cases (6 sides), including 2 males and 3 females, with an average age of 18-70 [65(20,68)] years, with bony connection between malleus and tympanum wall. Eighteen sex-and age-matched cases with normal hearing group, including 6 males and 12 females, with an average age of 20-68 (39±14) years, as the ratio of 1∶3, were included as the controls. The distances of the tegmen tympani between malleus head and horizontal semicircular canal, as well the distances between malleus head and horizontal semicircular canal were retrospectively measured and further compared between the two groups. Results: The incidence of IMF in patients with idiopathic conductive hearing loss without other etiologies was 24.0% (6/25). The specificity of 10 μm otology CT in diagnosing IMF was 100%. The distances of tegmen tympani between horizontal semicircular canal and malleus head in IMF patients were significantly smaller compared with the controls [-0.65(-1.21, -0.35) mm vs 1.34(0.04, 1.68) mm;0.92(0.51, 1.49) mm vs 2.82(1.76, 3.53) mm](both P <0.05, respectively). There was no significant difference in distances between malleus head and horizontal semicircular canal [-1.30 (-1.90, -0.46)mm vs -0.42 (-1.15, 0.05), P =0.057]. Conclusions: IMF is not uncommon in conductive hearing loss without other causes, which can be clearly shown by 10 μm otology CT. Its occurrence is related to the local downward shift of tegmen tympani above the malleus, without upwards displacement of the malleus.

Objective: To evaluate the auditory efficacy and subjective satisfaction of adhesive bone conduction hearing aid in children with unilateral congenital aural atresia (UCAA). Methods: Ten subjects (5 males and 5 females) diagnosed with UCAA with an average age of 8.3 years old (ranged from 5 to 15) were included in Beijing Tongren Hospital, Capital Medical University from January to August 2019. The free sound field hearing threshold, word recognition score in quiet, speech reception threshold in noise and sound localization ability (results were measured by RMS error) tests were performed in unaided and aided situation, respectively. Subjective satisfaction questionnaires were also distributed to subjects. Paired t test and Wilcoxon signed rank test were used as statistical analysis methods. Results: The average hearing threshold in aided condition was improved by (21.9±4.4) dB ( t =15.8， P <0.05). Speech recognition abilities were generally improved both under quiet and noise ( P <0.05);however, when the binaural summation, squelch and head shadow effects were analyzed respectively, the binaural squelch effect was not statistically improved ( P >0.05), while the other effects were improved in aided condition ( P <0.05). In sound localization test, there was no significant difference of the RMS error value between the unaided and aided situation ( P >0.05). The subjects got high satisfaction rates in three subjective questionnaires. Conclusion: The adhesive bone conduction hearing aid can provide significant audiological benefit for children with UCAA as well as raising the quality of their life.

Objective: To investigate the feasibility and safety of auricle reconstruction combined with Bonebridge implantation for bilateral aural atresia patients. Methods: A retrospective analysis was conducted for 36 cases(72 ears) who underwent Bonebridge implantation combined with bilateral auricle reconstruction from February 1, 2017 to January 15, 2020. All cases were bilateral congenital aural atresia and underwent Nagata auricle reconstruction for both sides simultaneously. Bonebridge implantations were performed during the second stage of auricle reconstruction. Results: All 36 patients healed well and had no surgical complications when discharged. The preoperative average bone conduction threshold of the patients was(8.5±5.8) dB HL and postoperative bone conduction threshold was (8.4±5.2) dB HL. There was no significant change after the implantation ( P =0.724). The preoperative average air conduction threshold of was(64.9±7.4)dB HL and postoperative air conduction threshold was (24.0±5.3) dB HL, which had a significant change after the implantation ( P <0.001). The hearing threshold with Bonebridge significantly decreased by 40.9 dB HL compared with the preoperative air conduction threshold( P <0.001). The speech recognition rate of monosyllable words, disyllabic words and short sentences in quiet environment increased by 62.5%, 63.5% and 72.2% respectively. The differences were statistically significant ( P <0.001). The speech recognition rate of monosyllabic words, disyllabic words and short sentences in noise environment were significantly increased by 55.9%, 58.9% and 69.9% respectively ( P <0.001). After a follow-up of 18.3 months in average, the hearing results were stable and the aesthetic outcomes were satisfied. One patient had implant rupture and healed after revision surgery. Conclusions: With an integrated surgical procedure, patients with bilateral congenital aural atresia can complete bilateral auricle reconstruction and hearing implantation within six months. This integrated surgical procedure is safe and efficient, with a stable hearing improvement and good appearance.

Objective: To explore the clinical efficacy of transcanal endoscopic ear surgery in the diagnosis and treatment of conductive hearing loss with intact tympanic membrane. Method: The clinical data of 16 patients with conductive hearing loss with intact tympanic membrane were retrospectively analyzed. They were diagnosed and treated by transcanal endoscopic ear surgery. Result: All patients were diagnosed by exploratory tympanotomy, including 6 cases of congenital middle ear anomalies, 5 cases of congenital cholesteatoma, 2 cases of congenital middle ear anomalies with congenital cholesteatoma, 2 cases of otosclerosis, and 1 case of traumatic ossicular chain disruption. During the tympanic exploration by transcanal endoscopic ear surgery, different methods of hearing reconstruction were applied according to the intraoperative lesions. Among 14 cases（14 ears）, 7 patients underwent reconstruction with partial ossicular replacement prosthesis （PORP）, 5 patients had total ossicular replacement prosthesis （TORP）, and 2 patients had piston. The remaining 2 patients did not undergot ossicular reconstruction. After the operation, the mean air-conductive threshold of 14 patients decreased from （61.7±6.5） dB HL to （29.8±10.7） dB HL （ P <0.01） and the mean ABG decreased from（36.8±3.2） dB HL to （10.7±6.9） dB HL （ P <0.01）. 1 case of congenital middle ear anomalies with congenital cholesteatoma underwent the lesion resection without ossicular reconstruction. Due to lack of suitable Piston, 1 case of congenital middle ear anomalies with fixed stapes did not perform hearing reconstruction. No serious complications occured after operations. Conclusion: Transcanal endoscopic ear surgery was suitable for the diagnosis and treatment of conductive hearing loss with intact tympanic membrane. It was minimally invasive with low complications, and the patients had a good hearing recovery after ossicular reconstruction., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To compare preoperative temporal bone HRCT readings to intraoperative findings during exploratory tympanotomy for suspected cases of isolated congenital middle ear malformations（CMEMs） and summarize the malformations that can be diagnosed with HRCT. Method: A retrospective study was conducted. All cases were confirmed as isolated CMEMs during surgery. Detailed clinical records were reviewed, with a focus on imaging and surgical findings. Result: One hundred and fifty-two patients and 168 ears were reviewed. One hundred and seven cases（63.7%） could be identified as isolated CMEMs and at least one as middle ear anomaly using preoperative HRCT. Sixty-one cases（36.3%） were reported to be completely normal and the patients underwent exploratory tympanotomy to determine the final diagnosis. Stapes fixation, either alone or associated with other ossicular chain anomalies, contributed to 51.2% of the cases.The stapes and incudostapedial complex are the most commonly involved structures. Conclusion: HRCT provides helpful preoperative clinical information in CMEM.Most cases of aplasia or dysplasia of the ossicular chain, e.g., aplasia/dysplasia of the long process of the incus, aplasia of the stapes'superstructure, and atresia of the oval window were easily identified in preoperative HRCT. However, fixation of the ossicular chain can be elusive in HRCT, and exploratory tympanotomy is needed for a definitive diagnosis., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To analyze the common clinical causes and audiological manifestations of unilateral hearing loss in children, and to provide a basis for early prevention and intervention. Method: A retrospective analysis of 20 cases of children diagnosed with unilateral hearing loss was conducted. The medical history was collected, followed by audiological and imaging examinations. Result: The audiological performance of 20 children with unilateral hearing loss: 1 case of conductive deafness, whose hearing curve was flat and showed moderate hearing loss. There were 19 cases of sensorineural deafness, of which 1 case was moderate deafness, 16 cases were severe deafness, and 2 cases were extremely severe deafness. The imaging results showed that there were 1 case with transverse fracture of the temporal bone, 1 case with congenital cholesteatoma, 9 cases with dysplasia of the cochlear nerve, and 4 cases with malformation of the inner ear. The history of the two children was collected and there were clear congenital cytomegalovirus infection and mumps virus infection. The causes of the remaining 3 cases were unknown. Conclusion: Unilateral hearing loss in children is a common clinical diseasewith complex and diverse causes. Carefully analysis should be made to find out the causes and symptomatic treatment to provide a basis for early prevention and intervention of children's hearing., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

The main clinical manifestations of the tumors in the middle ear are hearing loss, intact tympanic membrane, and conductive hearing damage. CT shows soft tissue lesions and abnormal bony lesions in the middle ear. The tumors were completely removed by operation and confirmed by pathology as myxoma and bony structure tumor., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Implantable bone-conduction devices are characterized by the fact that the vibration is transmitted through bone conduction. The technology and surgical techniques in the application of implantable bone-conduction devices have developed considerably in recent years, experiencing a transformation from percutaneous to transcutaneous implantation. This article reviewed current developments in the types, surgical indications, and complications, as well as compared between the various bone-conduction devices to provid references for clinical application.

Objective: The aim of this study is to explore the correlation between radiological classification on HRCT and effects on surgery with hearing improvement in otosclerosis. Method: Thirty three patients (66 ears) with otosclerosis were enrolled to this study, who would be done operation using Fischs stapes surgery technique. All patients were classified according to axial HRCT preoperatively. All patients were evaluated by pure tone test preoperatively and 6 months postoperatively. Correlation between radiological classification and hearing effects were studied. Result: Six months after the surgeries, both of air conduction thresholds and bone conduction thresholds in 33 patients were significantly improved than those before the surgeries ( P <0.01). Compared with mixed type otosclerosis, window type otosclerosis had significantly lower bone conduction threshold preoperatively and postoperatively. Conclusion: Fischs stapes surgery technique have perfect effects on improving otosclerosis air conduction threshold, as well as bone conduction threshold.

There are many deafness patients at present in the world. Bone-anchored hearing aids are well-established solutions for treatment of hearing-impaired patients,such as conductive deafness,mixed deafness and single side deafness. The article aimed to review the basic structure,clinical indications,surgical method and complications of bone anchored hearing aids,and for a new BAHA attract system,we also have a brief discussion. To conclude,the BAHA attract system is an aesthetic,easy,safe and effective hearing aid,and become the patient's preference., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To investigate the clinical and imaging characteristics of chronic otitis media with intact tympanic membrane., Method: Ten patients were retrospective studied in the department of otorhinolaryngology of Guangdong general hospital from December 2006 to January 2015. The clinical characteristics of their manifestations, audiology and imaging examinations were analyzed., Results: All the cases could be divided into two groups: the intracranial complication group who was primarily diagnosed as intracranial complications, and the hearing loss group who primarily complained of hearing loss. Five cases belonged to the first group, which include 1 cerebellar abscess, 3 meningitis and 1 meningoencephalitis, 2 of them were profound hearing loss, 2 were mixed hearing loss, and 1 was normal hearing. The other 5 cases belonged to the hearing loss group, 3 were mixed deafness, 2 were conductive deafness. All the case showed positive high-resolution computed tomography (HRCT) features. In the first group, four cases showed the soft tissue shadow in tympanic antrum/superior tympanic pouch and 1 case showed a wide damage of skull base, in addition to intracranial complications. In the second group, five cases showed soft tissue imaging in tympanic antrum/superior tympanic pouch. Pathology showed that 2 cases were cholesterol granuloma(one was in the first group and the other was in the second group), 4 were intracranial inflammatory(the first group) and 4 were cholesteatoma(the seond group)., Conclusions: In chronic otitis media with intact tympanic membrane, intracranial complications may be the primarily diagnosis, which should be paid much attention by multidisciplinary team. HRCT and audiology were valuable for early diagnosis.

Objective: To explore the technique of hearing reconstruction in the cases of conductive hearing loss with malformed tympanic segment of facial nerve., Methods: Data of 10 cases from July 2010 to March 2015 were collected.The status of tympanic segment of facial nerve, malformed ossicles and the reconstructed methods of ossicular chain were analyzed and discussed based on the embryo anatomy and surgical technique., Results: All facial nerves in 10 cases were exposed and drooping to stapes or cover the oval window.Three patients who had normal stapes, pushed by the exposed facial nerve, were reconstructed with partial ossicular replacement prostheses (PORP). Two patients who had footplate, with partial fixation, were reconstructed with total ossicular replacement prostheses (TORP). Three patients who had atresia of the oval window were implanted with Piston after being made hole in the atresia plate.Another two cases who had atresia of the oval window were implanted with TORP after promontory being drilled out.All cases had no injury of facial nerve and nervous hearing, and no tinnitus.Nine cases had conductive hearing improvement, except one with promontory drilled out., Conclusions: Patients who had conductive hearing loss with malformed tympanic segment of facial nerve can be treated by the technique of hearing reconstruction.The fenestration technique in the bottom of the scala tympani of the basal turn provides us a new method for treating patients whose oval window was fully covered by malformed facial nerve.

Objective: To evaluate auditory developments and the effectiveness of children with congenital bilateral aural atresia after using softband Ponto and to compare them with children with normal hearing., Method: Twenty patients (age ranging from 3 months to 21 months ) with bilateral aural atresia were studied. The air and bone auditory thresholds were assessed by auditory brain stem response (ABR). The infant-todder meaning auditory integration scale (IT-MAIS) was used to evaluate the auditory development at three time levels: baseline, 3 months and 6 months., Result: The average unaided bone conduction hearing thresholds of patients is (17.5 ± 5.9)dB nHL,and the average air conduction hearing thresholds is (72.5 ± 9.3)dB nHL. The average VRA hearing thresholds of 5 patients is (30.5 ± 5.9) dB HL. The IT-MAIS total, detection and perception scores are improved specifically after wearing softband Ponto and approaching the normal level., Conclusion: Softband Ponto is suitable for infants with bilateral atresia. Results from these auditory development testing are encouraging. Softband Ponto should be used as a bridge for surgical implantations when temporal bone is thick enough.