Objectives: We suggest a simple measurement, called the “basal turn–facial ridge (BT–FR) angle,” for determining the electrode insertion axis using preoperative temporal bone computed tomography (CT) to predict hearing preservation (HP) in cochlear implantation (CI). Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: Eighty-two ears that underwent CI between 2010 and 2018 were included. Ears with preoperative thresholds less than or equal to 80 dB HL at 125, 250, and 500 Hz were enrolled and grouped using the criteria of Skarżyński et al.: Group 1, complete or partial HP; Group 2, minimal HP or complete hearing loss. Intervention: All subjects underwent CI with soft surgery techniques through the round window approach. Main Outcome Measures: The BT–FR angle is the angle between the basal turn line (BT-line), which is a straight line passing through the center of the longitudinal axis of the BT, and the facial ridge line, which is a straight line running from the endpoint of the BT-line to a point just above the facial ridge. Results: The BT–FR angle was 2.5 ± 2.9 degrees in Group 1 and –0.3 ± 2.7 degrees in Group 2 (p = 0.003). The angle and hearing loss showed a significant negative correlation (r = –0.401, p = 0.002). In multiple linear regression, “age at operation” (β coefficient 0.260; p = 0.001) and the “BT–FR angle” (–1.967; p = 0.001) were significant variables affecting the degree of residual hearing loss. Conclusions: The BT–FR angle, which can be measured simply, may be useful to predict residual HP after CI.

Objectives: The purpose of this study was to compare the surgical outcomes of Polycel® and titanium in ossiculoplasty following tympanomastoidectomy (TM). Methods: A total of 221 patients underwent ossiculoplasty following TM by a single surgeon using either Polycel® or titanium as prosthesis. Hearing was tested preoperatively and postoperatively at 6 months by pure-tone audiometry. Successful surgery was defined if postoperative air-bone gap (ABG) was <20 dB, the gain in air conduction (AC) hearing was >15 dB HL, or postoperative AC was <30 dB HL. Multiple linear regression was conducted to identify the factors associated with the surgical outcomes. Results: In canal wall up mastoidectomy (CWUM), both Polycel® and titanium showed favorable successful rates if partial ossicular replacement prosthesis (PORP) was used (64.3% of Polycel® and 67.6% in titanium). If total ossicular replacement prosthesis (TORP) was used, both represented similar outcomes (54.5% of Polycel® and 75.0% in titanium). In canal wall down mastoidectomy (CWDM), significant ABG reductions were observed only in the titanium group (5.2 ± 14.7 dB of Polycel® [ P = .083] and 7.0 ± 14.2 dB of titanium [ P = .002] in PORP; 4.6 ± 13.5 dB of Polycel® [ P = .097] and 9.5 ± 11.2 dB of titanium [ P < .001] in TORP). In multivariate analysis, titanium had a positive effect on the reduction of postoperative AC thresholds (B: −4.772; 95% CI: −8.706-−0.838). Conclusions: Both Polycel® and titanium showed favorable surgical outcomes for ossiculoplasty following CWUM. Titanium prosthesis is recommended for surgery after CWDM.

Objectives When there is a difference in hearing on both ears, where to perform the first cochlear implantation (CI) becomes an important issue. The purpose of the study was to evaluate which ear should be chosen for the first implantation in sequential bilateral CI with a long inter-implant period. Methods The study population consisted of 34 severe-to-profound sensorineural hearing loss pediatrics with the inter-implant period of ≥3 years between the first CI (CI-1) and the second CI (CI-2) before the age of 19 (mean of inter-implant period: 7.1-year). The patients were classified into Group A (CI-1 was performed on the ear with better hearing), Group B (CI-1 on the ear with worse hearing), or Group C (symmetrical hearing in both ears). Speech intelligibility test results were compared between the groups. Results The monosyllabic word scores of CI-1 were excellent in Groups A (91.7±7.9%) and B (92.5±3.6%) but slightly lower in Group C (85.7±14.9%) before the second implantation ( P = .487). At 3 years after the second implantation, all groups demonstrated excellent scores in the bilateral CI condition (95.9±3.0% in Group A; 99.1±.8% in Group B; 97.5±2.9% in Group C, P = .600). However, when the patients were tested in using CI-2 only in Groups A and B after using bilateral CI for 3 years, the scores were inconsistent in Group A (79.6±23.9%; range: 22.2-94.4%), while those were higher and more constant in Group B (92.9±4.8%; 86.8-100.0%). Conclusions The first CI is strongly recommended to perform on a worse hearing ear if they had different hearing levels between ears. Even with the first CI on a worse hearing ear, its performance never deteriorates. In addition, if they receive the second CI several years later, it will be likely that the second one functions better.

Objectives. When performing middle ear operations, such as ossiculoplasty or stapes surgery, patients and surgeons expect an improvement in air conduction (AC) hearing, but generally not in bone conduction (BC). However, BC improvement has often been observed after surgery, and the present study investigated this phenomenon.Methods. We reviewed the preoperative and postoperative surgical outcomes of 583 patients who underwent middle ear surgery. BC improvement was defined as a BC threshold decrease of >15 dB at two or more frequencies. Subjects in group A underwent staged ossiculoplasty after canal wall up mastoidectomy (CWUM), group B underwent staged ossiculoplasty after canal wall down mastoidectomy (CWDM), group C underwent ossiculoplasty only (thus, they had no prior history of CWUM or CWDM), and group D received stapes surgery. We created a hypothetical circuit model to explain this phenomenon.Results. BC improvement was detected in 12.8% of group A, 9.1% of group B, and 8.5% of group C. The improvement was more pronounced in group D (27.0%). A larger gain in AC hearing was weakly correlated with greater BC improvement (Pearson’s r=0.395 in group A, P<0.001; r=0.375 in group B, P<0.001; r=0.296 in group C, P<0.001; r=0.422 in group D, P=0.009). Notably, patients with otosclerosis even experienced postoperative BC improvements as large as 10.0 dB, from a mean value of 30.3 dB (standard error [SE], 3.2) preoperatively to 20.3 dB (SE, 3.2) postoperatively, at 1,000 Hz, as well as an improvement of 9.2 dB at 2,000 Hz, from 37.8 dB (SE, 2.6) to 28.6 dB (SE, 3.1).Conclusion. BC improvement may be explained by a hypothetical circuit model applying the third window theory. Surgeons should keep in mind the possibility of BC improvement when making a management plan.

It is widely accepted that extracts of St. John’s wort (Hypericum perforatum) improve depressive symptoms, and tinnitus patients commonly presented with either mild depression or anxiety. We investigated whether co-administration of St. John’s wort and Ginkgo biloba extracts can suppress tinnitus. Participants with subjective tinnitus aged 30–70 years were randomly assigned to the experimental (co-administration of St. John’s wort and Ginkgo biloba extract; n = 20) or control (Ginkgo biloba extract only; n = 26) group for 12 weeks. Participants were blinded to the group assignments. After 12 weeks of treatment, no significant change in the minimum masking level on the tinnitogram was observed in either group. In the co-administration group, the Tinnitus Handicap Inventory (THI) score decreased from 34.7 (SD, 15.9) to 29.6 (16.0) (p = 0.102). However, the control group showed a significant decrease in THI score, from 30.5 (16.7) to 25.6 (17.1) (p = 0.046). Regarding the Short Form-36 Health Survey (SF-36), only the “Social Functioning” domain score changed significantly after extract co-administration, from 74.5 (21.5) to 83.9 (20.5) (p = 0.047). Co-administration of St. John’s wort and Ginkgo biloba extracts did not improve the symptoms of subjective tinnitus compared to administration of Ginkgo biloba extract alone.

The inner ear is responsible for both hearing and balance in the body, and since the initial development of otic (inner ear) organoids from mouse pluripotent stem cells (PSCs) in 2013, significant advances have been made in this field. Bone morphogenetic proteins, fibroblast growth factors, and Wnt agonists, which are signaling molecules in the early development of the inner ear, can induce PSCs into the otic fate. In the inner ear, hair cells and the surrounding supporting cells are essential for proper function and structure. Recent advancements in otic organoid research have enabled the generation of cells that closely resemble these key components. The developed otic organoids contain both hair cell-like cells and supporting cells, which have been confirmed to have the intrinsic function of those cell types. Otic organoids have been used for disease modeling and are expected to be more widely applied in various areas of research on the inner ear. However, the otic organoids developed to date remain immature. Although they mimic hair cells, their properties resemble vestibular (balance) hair cells more closely than cochlear (auditory) hair cells. The ultimate goal of research on the inner ear is hearing restoration and prevention; thus, it is essential to produce otic organoids that contain cochlear hair cells. In addition, the organ of Corti—a cell arrangement unique to the cochlea—has not yet been simulated. Along with a description of the current status of otic organoids, this review article will discuss future directions for otic organoids in inner ear research.

ObjectiveIntracochlear schwannoma is very rare, and complete loss of hearing is inevitable after the removal of this tumor. Here, we discuss cochlear implantation (CI) performed simultaneously with the removal of an intracochlear schwannoma.Study DesignRetrospective single‐center study.SettingTertiary medical institute.MethodsSimultaneous CI and intracochlear schwannoma removal were performed in 4 subjects. After subtotal cochleostomy, the tumors were removed meticulously, with preservation of the modiolus. A new slim modiolar electrode (Nucleus CI632) was placed in a manner that hugged the modiolus. The surgical outcomes of functional gain, word recognition score (WRS), sound localization, and hearing in noise and speech intelligibility tests were investigated.ResultsIntracochlear schwannomas were removed successfully from the 4 patients, with no remnant tumor. The mean aided hearing threshold 6 months after surgery was 25.0 ± 1.8 dB, and the mean‐aided WRS with a 60 dB stimulus was 36.0 ± 18.8% (range 16%‐60%). The Categorical Auditory Performance (CAP) score of the 3 single‐sided deafness patients under contralateral ear masking was 7. The CAP score of the patient with bilateral sensorineural hearing loss was 6, which improved from a preoperative score of 0.ConclusionWhen an intracochlear schwannoma does not completely invade the modiolus, CI with simultaneous tumor removal can be performed successfully, resulting in good hearing performance. A slim modiolar electrode can be placed stably at the modiolus after schwannoma removal.

No abstract