Abir K. Bhattacharyya Consultant ENT Surgeon, Whippe Cross Hospital, London, U.K. Forty years of Stapes Surgery (1998) John J Shea The American Journal o f Otology; 19 : 52-55,

T h i s is a report of the results of 14, 449 stapedectomy operations performed during the past 40 years, by one of the great Otologists of our time. It's a retrospective review of approximately 100 operations from each of the past 40 years, totalling to 5,444 operations.

chronic otitis media with or w i t h o u t cholesteatoma. The aim of this study was to assess the prognostic value of anatomic and technical factors affecting the functional outcome of tympanoplasty.

The main outcome of this article is to report the change in hearing after stapes surgery. Using the hearingofthe average for 500. 1000 and 2000 Hz, the criteria for success were defined as closure of the air - bone gap to 10 db or less and no decline in speech discrimination of > 10% . The result showed, after primary stapedctomy, the success was 95.1% after I year, which went down to 62.5% after > 30 years. In revision stapedectomy group, the success was 71 .I % after I year, and 59.4% after 6-36 years.

This study showed that the status of the mucosal lining, the mastoidectomy, the availability of the malleus handle and the tympanic membrane perforation were all significantly predictive of the hearing outcome but with differing importance. A better knowledge of these predictive factors may become useful in the functional outcome of tympanoplasty.

In conclusion, Dt. Shea stated that the decline in hearing began 6-10 years after stapedectomy, which increased after 20 and 30 years. Complete sensorineural hearing loss occured in 0.6% of patients. In approximately 30% of his patients, a significant sensorineural hearing loses occured after 20 years. According to the author, this is due to invasion of cochlea by the otosclerotic process, plus the natural hearing loss that comes with age. To prevent this, the author routinely administers sodium fluoride and calcium for 2 years to those with widespread otosclerosis at operation or with rapidly progressive sensorineural hearing loss or both.

Prognostic Factors in Tympanoplasty 1998 ] S Albu, G Babighiau, F Trabalzini | The American Journal o f Otology ; 19 : 1364 140, ! T h i s is a retrospective review of the records of 544 patients, who underwent surgery for 1-1208

Is Chronic Otltls Media with cholesteatoma Associated With Neurosensory HearingLoss? (1998) D J Eisenman, S C parisier The American Journal o f Otology; 19 : 2025. T h i s is a retrospective review of 145 patients who had unilateral CSOM with cholesteatoma. The contralateral ear was normal, which was used as control. Bone conduction and speech discrimination score was used to find out the difference in hearing between cholesteatomatous and control ears. The study showed statistically significant decrease in neurosensory function with cholesteatoma, even in the absence of direct inner ear involvement. The authors suggested that it may be due to passage of inflammatory mediators through round window membrane, but there is no definite proof for this hypothesis.

lJO & HNS. Vol, 50 No. 2, April-June, 1998