Objectives Nonautologous graft materials may solve several dilemmas in tympanoplasty by obviating the need for graft harvest, facilitating consistent wound healing, and permitting graft placement in the clinical setting. Prior studies of nonautologous grafts in humans have shown variable outcomes. In this systematic review, we aim to 1) summarize clinical outcomes and 2) discuss limitations in the literature regarding nonautologous grafts for tympanoplasty in humans. Methods A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) recommendations. The study size, etiology and duration of perforation, type of nonautologous graft, and postoperative closure rate were assessed. Results The PRISMA approach yielded 61 articles, including 3,247 ears that met inclusion criteria. Studies evaluated nonautologous grafts including paper patch, gelatin sponge, growth factors, porcine small‐intestinal submucosa, among others. Traumatic perforations (62.3%) were most commonly studied, whereas postinfectious perforations (31.9%) and other etiologies (5.8%) comprised a minority of cases. Acute perforations of <8 weeks duration constituted just over half of all treated ears. Overall closure rate was 82.1%, with significantly higher closure rates in acute (89.9%) versus chronic perforations (64.9%, P < .01), regardless of material. A median postoperative air‐bone gap of 5.6 dB was found in the 23% of studies reporting this metric. Conclusions The majority of publications reviewing nonautologous materials in tympanoplasty evaluate acute or traumatic perforations, and few rigorously report hearing outcomes. Given available data, porcine submucosa and basic fibroblast growth factor may hold promise for chronic perforation closure. Future studies should report closure rates and hearing outcomes in perforations >8 weeks duration. Laryngoscope, 131:392–400, 2021

Introducción: Los estrógenos son hormonas ligadas a las diferentes fases del sistema reproductivo femenino y también tiene efectos simultáneos sobre el sistema vestibular. Se realizó una revisión de la literatura acerca de los cambios estrogénicos en el sistema vestibular, según cada etapa del desarrollo madurativo femenino. Materiales: búsqueda bibliográfica en las bases de datos PubMed, Cochrane, Scielo, Google Scholar y Bvsalud de artículos publicados entre los años 1964 y 2020 con los términos ‘estrogen and dizziness’, ‘estrogen and vertigo’, ‘estrogen and vestibular disorders’. Se encontraron 207 artículos, 29 en idioma inglés los cuales contenían información relevante, acerca de los cambios estrogénicos en el sistema vestibular. Resultados: Desde la menarca hasta la menopausia, se han encontrado manifestaciones relacionadas con el oído interno tales como vértigo, acúfenos, plenitud aural e hipoacusia. Conclusiones: De acuerdo con cada etapa madurativa estrogénica, se han reportado cambios a nivel del sistema audiovestibular. Palabras claves: estrógeno; vértigo; acúfeno; hipoacusia

Age-related hearing loss (presbycusis) is a prevalent condition attributed primarily to inner ear dysfunction. Little is known about age-related changes in the ossicular joints or their contribution to presbycusis. Herein, we performed a histopathologic analysis of the incudomalleolar joint (IMJ) in specimens from the National Temporal Bone Registry with audiometrically confirmed presbycusis but without histologically observed sensory, neural, strial, or mixed features. Seventeen “indeterminate” presbycusis (IP) ears and 13 young, normal-hearing ears were examined. The age was 73.2 ± 9.5 years for the IP group and 32.1 ± 9.5 for the young group ( P < .05). The joint space between the 2 ossicles was 23% wider in the IP group (139 ± 26.2 µm) compared to young ears (113 ± 49.0 µm) ( P = .02). We report that IP ears have a wider IMJ than young ears. These findings have implications for understanding the etiology of presbycusis in indeterminate cases. Level of Evidence: Retrospective study.

Objective Labyrinthitis ossificans (LO) may occur following meningitis and, in cases where cochlear implantation is indicated, complicate electrode insertion. LO is critical to identify for successful cochlear implantation, and histopathology is more sensitive than imaging for identification of LO. Herein we utilize otopathologic techniques to study the timing and location of intracochlear tissue formation following meningitic labyrinthitis (ML). Study Design Retrospective review. Setting Academic institution. Methods Temporal bone specimens with a history of bacterial ML were histologically evaluated. The location and extent of intracochlear tissue formation within the scala tympani (ST) and scala vestibuli (SV) were graded, and spiral ganglion neurons were counted. Results Fifty-one temporal bones were identified: 32 with no intracochlear tissue formation, 9 with fibrosis alone, and 10 with LO. Fibrosis was identified as early as 1.5 weeks after ML, while ossification was found only in specimens that survived multiple years after ML. All LO cases showed ossification of the ST at the round window membrane (RWM) with continuous extension throughout the basal turn. Extent of SV ossification correlated with that in the ST but showed frequent isolated distal involvement of the cochlea. Spiral ganglion neuron counts were lower than those in age-matched controls. Conclusion In this human temporal bone study, we found that postmeningitic LO results in ossification at the RWM with continuous extension into the ST of the basal turn and variable involvement of the SV. Identification of a patent basal turn beyond RWM ossification of the ST should permit full electrode insertion. Level of Evidence Retrospective review.

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.

During pregnancy, physical, hormonal, and psychological changes may occur from conception to labor. Balance is also impacted throughout this time, leading to symptoms such as vertigo and unsteadiness. These symptoms may appear at any time and can cause disability and physical impairment. Little has been published about vertigo in pregnancy. We performed a narrative review of vertigo in pregnant patients. Vertigo in pregnant females may be associated with hormonal changes in peripheral structures and inner ear organs. Meniere’s disease, vestibular migraine, and benign paroxysmal positional vertigo are usually exacerbated during pregnancy. Specific changes to hearing and proprioception in the physical examination are also noted between the second and third trimester of pregnancy. These symptoms are usually seen in pregnant patients throughout this time. Some types of vertigo may be exacerbated and others may present at any time of pregnancy. Further research is needed to understand the clinical and pathological association of audiovestibular symptoms during pregnancy.

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.

Vertigo is a common complaint in the general population affecting 5% of adults in one year. At least 29.5% of adults have referred vertigo during life. Even though the prevalence of vertigo is well known in adults the epidemiologic data in adolescents is sparse. To date, it is known that adolescent females are usually affected by vertigo and some conditions such as depression and anxiety are found in this population. However, the lack of information about the prevalence of most common types of vertigo in adolescents, predisposing factors, challenges, and controversies in clinics in the literature, present a challenge for clinicians regarding the approach and follow-up of this population. Herein, we performed a literature review including data about the prevalence, most common types of vertigo and controversial events in the approach of vertigo in adolescents over the last two decades.