ObjectivesThis review sought to establish expectations for hearing improvement with specifically titanium partial (PORP) and total ossicular replacement prostheses (TORP) to give surgeons an acceptable goal for postoperative hearing results and to counsel patients on their expected results.Databases ReviewedMEDLINE/PubMed, EMBASE, and Cochrane Library.MethodsA systematic review of the literature was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases (MEDLINE/PubMed, EMBASE, Cochrane library) were searched using relevant key search terms to identify studies evaluating outcomes of titanium prostheses. A title/abstract and full article review was then done, and the results from the remaining studies were analyzed with Review Manager 5.4 Software to perform a meta-analysis using a random-effects model.ResultsForty articles were analyzed after full article review based on the inclusion and exclusion criteria. For PORPs, the average improvement in air-bone gap (ABG) and pure-tone average were 12.1 and 13.5 dB, respectively. For TORPs, the average improvements in ABG and pure-tone average were 16.7 and 17.0 dB, respectively. Preoperatively, the average ABG was 7.0 dB better for PORP than TORP patients, and postoperatively, the ABG improved an average of 4.9 dB more for the PORP cohort. Seventy percent of PORPs and 57% of TORPs subjects had a postoperative ABG less than 20 dB.ConclusionsOverall, reconstruction of the ossicular chain with titanium prostheses reliably improves patients' hearing outcomes, and this study gives relevant information for counseling patients preoperatively on realistic hearing outcomes.

Objective: To find a more objective method of assessing which patients should be screened for a vestibular schwannoma (VS) with magnetic resonance imaging (MRI) using a deep-learning algorithm to assess clinical and audiometric data. Materials and Methods: Clinical and audiometric data were collected for 592 patients who received an audiogram between January 2015 and 2020 at Duke University Health Center with and without VS confirmed by MRI. These data were analyzed using a deep learning-based analysis to determine if the need for MRI screening could be assessed more objectively with adequate sensitivity and specificity. Results: Patients with VS showed slightly elevated, but not statistically significant, mean thresholds compared to those without. Tinnitus, gradual hearing loss, and aural fullness were more common in patients with VS. Of these, only the presence of tinnitus was statistically significant. Several machine learning algorithms were used to incorporate and model the collected clinical and audiometric data, but none were able to distinguish ears with and without confirmed VS. When tumor size was taken into account the analysis was still unable to distinguish a difference. Conclusions: Using audiometric and clinical data, deep learning-based analyses failed to produce an adequately sensitive and specific model for the detection of patients with VS. This suggests that a specific pattern of audiometric asymmetry and clinical symptoms may not necessarily be predictive of the presence/absence of VS to a level that clinicians would be comfortable forgoing an MRI.