Preferred CDRH3 lengths for antibodies with defined specificities

OBJECTIVES/HYPOTHESIS: To compare early (<1 y) and longer-term (1.0-7.5 y; mean follow-up, 2.8 y) hearing results following surgery for congenital aural atresia and to analyze revision cases for cause of failure, time of occurrence, and outcome. STUDY DESIGN: Retrospective study of 55 consecutive patients (59 ears) undergoing surgery during an 11-year period for congenital aural atresia. METHODS: The best speech reception threshold (SRT) during the first postoperative year was compared with the most recent SRT beyond the first postoperative year. The complication rate and long-term hearing results (>1 y) for initial and revision surgeries were compared. RESULTS: In the early postoperative period, an SRT of < or =25 dB was achieved in 60% and an SRT of < or =30 dB in 70%. With longer follow-up (mean, 2.8 y), 46% of patients maintained an SRT < or =25 dB. Revision surgery was necessary in approximately one third of patients. Longer-term hearing results following initial surgery only or after revision surgery showed an SRT < or =25 dB in 53% and an SRT < or =30 dB in 64%. For primary and revisions surgeries the incidence of temporary facial paralysis was 1.5% and for significant hearing loss, 3.0%. CONCLUSIONS: Some degradation in hearing does occur as patients are followed beyond the first postoperative year. Revision surgery will be necessary in approximately one third of cases. With revisions, an SRT < or =25 dB can be expected in half of cases and an SRT < or =30 dB in two thirds of cases. The ability to provide these hearing results supports this surgery in unilateral cases.     

An Arabic language version of the health promotion lifestyle profile

BACKGROUND: Characteristic features of cholesteatoma of the middle ear are destruction of the bone and a high tendency for recurrent disease. The choice of surgical procedure is determined by audiological results and the rate of recurrent cholesteatoma. PATIENTS: One hundred fifty patients who underwent primary cholesteatoma surgery were investigated 3-5 years postoperatively. Preoperative and postoperative audiological results and rate of revision surgery were compared for the respective surgical procedures. All cholesteatomas were treated with an open surgical technique. The lateral attic walls and cholesteatomas were removed. RESULTS: Cholesteotoma recurred in 15 patients (10%). Primary reconstruction of the ossicular chain with a tympanoplasty (type III) was performed in 98 patients in the first operation. Approximately 80% of patients treated with a type III tympanoplasty had a maximum postoperative air-bone gap of 20 dB in the main speech range, depending on the frequency. In about 50% of patients, this value was 10 dB or less. Comparison of preoperative and postoperative conductive hearing loss between 250 Hz and 8000 Hz revealed an improvement (p < 0.05) of 10 dB (500 Hz, 3000 Hz, 4000 Hz) and 15 dB (250 Hz, 1500 Hz, 2000 Hz, 8000 Hz). CONCLUSIONS: In our opinion, a second look operation should be performed in cases where a large cholesteatoma cannot be removed with sufficient reliability. This applies especially to a cholesteatoma in the oval window. Here, we suggest second-look surgery after one year.     

Detection of TP53 mutation, loss of heterozygosity and DNA content in fine-needle aspirates of breast carcinoma

We recorded auditory-evoked magnetic responses with a whole-scalp 122-channel neuromagnetometer from seven adult patients with unilateral conductive hearing loss before and after middle ear surgery. The stimuli were 50-msec 1-kHz tone bursts, delivered to the healthy, nonoperated ear at interstimulus intervals of 1, 2, and 4 seconds. The mean preoperative pure-tone average in the affected ear was 57 dB hearing level; the mean postoperative pure-tone average was 17 dB. The 100-msec auditory-evoked response originating in the auditory cortex peaked, on average, 7 msecs earlier after than before surgery over the hemisphere contralateral to the stimulated ear and 2 msecs earlier over the ipsilateral hemisphere. The contralateral response strengths increased by 5% after surgery; ipsilateral strengths increased by 11%. The variation of the response latency and amplitude in the patients who underwent surgery was similar to that of seven control subjects. The postoperative source locations did not differ noticeably from preoperative ones. These findings suggest that temporary unilateral conductive hearing loss in adult patients modifies the function of the auditory neural pathway.     

A comparison of maximal bioenergetic enzyme activities obtained with commonly used homogenization techniques

A retrospective review was made of 719 primary stapedectomies and 48 re-operations carried out between 1975 and 1993. Preoperative and postoperative audiograms (6-12 months) were studied, analyzing 250, 500, 1000, 2000 and 4000 Hz, auditory gain and closure of the air-bone gap < or = 10 dB. Ninety percent had an auditory gain of > or = 10 dB at conversational frequencies. Age, the surgeon, and average preoperative pure tone did not influence the final result. Polyethylene prostheses (70.9%) and steel and teflon pistons (21.1%) were the prostheses used most often. Neurosensorial hearing loss (> 10 dB) occurred in 24 cases (3.3%). In revision stapedectomy, 66.6% of patients had air-bone gap closure of < or = 20 dB and 71% had a hearing gain of < or = 10 dB. Prosthesis displacement (43.7%) and incus necrosis (18.7%) were the most common findings in revision stapedectomy.     

Preservation of hearing in large acoustic neurinomas following removal via suboccipito-lateral approach

A consecutive series of 61 patients with pre-operative hearing underwent surgical removal of a large acoustic neurinoma via the lateral suboccipital approach between 1984 and 1996. Brain-stem auditory evoked potentials (BAEP) were present in all cases before surgery and all patients underwent intra-operative monitoring of BAEP. The average tumour size including the portion within the meatus acusticus internus was 30, 5 mm (range 20 mm-49 mm). Complete tumour removal was achieved in all but three cases. In 43.1% of patients with complete tumour removal hearing was preserved initially after surgery. Delayed postoperative hearing loss was observed in 11 patients and hearing recovery in 2 patients leading to 27.5% definite hearing preservation. Hearing preservation was achieved in 37% of cases with tumour size between 20 mm-29 mm and in 23.5% of case with tumour size larger than 30 mm. These results indicate that even in large neurinoms hearing preservation should be attempted in all patients with documented pre-operative hearing and BAEP.     

Different aspects of hearing preservation in surgery of vestibular schwannoma in women and men

Pre-operative and postoperative auditory function was reviewed retrospectively in 98 patients with vestibular schwannomas. According to their hormonal status, women were categorized as "premenopausal" and "postmenopausal". Before surgery, 48% of the women (65% premenopausal) and 16% of the men presented with sudden hearing loss. The degree of auditory function before operation was similar for women and men. Preservation of pre-operative hearing was possible for 41% of the women (21% premenopausal) and 59% of the men. Further details of the surgery and the results of histopathological examination were also compared for women and men. Our results support substantial evidence that hearing preservation after surgery of vestibular schwannoma is easier to accomplish for men than for women. The finding of significantly more sudden hearing loss in premenopausal women may suggest a hormonal influence on tumour growth, which may also be partially responsible for the difference in hearing prognosis between women and men.     

Macrolides in the management of streptococcal pharyngitis/tonsillitis

OBJECTIVE: This study aimed to compare the hearing changes in the long term after vestibular neurectomy, endolymphatic mastoid shunt, and medical treatment in classic Meniere's disease. STUDY DESIGN: A retrospective case review was conducted based on audiologic follow-up between 5 and 21 years. SETTING: The study was performed at two centers in Bari University Hospital, one performing vestibular neurectomy as the first surgical procedure for Meinere's disease and the other, endolymphatic mastoid shunt. PATIENTS AND INTERVENTIONS: Of 68 patients with intractable idiopathic Meniere's disease, 29 underwent middle fossa vestibular neurectomy, and 17 had endolymphatic mastoid shunt; 22 were offered surgery but declined. MAIN OUTCOME MEASURES: Outcome measures were puretone average (PTA), speech reception threshold, and speech discrimination score before and after treatment. RESULTS: PTA declined by an average of 9.3 dB in neurectomy patients, 13.3 dB in patients undergoing endolymphatic mastoid shunt, and 18.1 dB in patients who were offered surgery but declined. Patients were subdivided into two cohorts based on their preoperative or initial PTA. In the patients who had PTA scores worse than 50 dB initially, the PTA declined an average of 4.3 dB in the vestibular neurectomy group, 11.5 dB in the endolymphatic sac group, and 4 dB in the nonsurgical group. In the patients with PTA > or = 50 dB initially, the PTA declined an average of of 25.3 dB in the vestibular neurectomy group, 16.1 in the endolymphatic sac group, and 26.2 dB in the nonsurgical group. Although shunt patients with good hearing initially deteriorated less than neurectomy patients and less than patients who declined surgery, the difference was not significant. CONCLUSIONS: These results indicate that patients with poor hearing stabilized, while patients with good hearing continued to deteriorate. The same conditions were observed in the patients who had surgery and those who were offered surgery but declined.     

An implantable hearing aid for inner ear hearing loss. Short-term implantation of microphone and transducer

A microphone constructed for implantation in the posterior wall of the auditory canal and a piezoelectric transducer serving as the main components of an implantable hearing aid were temporally implanted in five patients during middle ear surgery under local anesthesia. The microphone was positioned beneath the skin of the auditory canal such that it completely covered the microphone membrane. The vibratory element of the transducer was coupled to the malleus in four patients with normal ossicular chains and directly to the stapes in one patient with missing incus. The microphone and transducer were electrically connected with an external battery-driven signal amplifier. Speech material and music were presented in the operation room at a sound level of 65 dB SPL under free-field conditions. The patients had to estimate the quality of speech, music, and their own voice as well as the effects of bone-conducting noises. All patients were able to hear with the system. An intraoperative talk without vision contact was possible without any problems, as was understanding of numerals ("Freiburger Zahlentest"). Perception of music was judged as "clear and undistorted with all broadband component." The estimation was also valid for one patient with a sensorineural hearing loss. One patient declared the music to be "a little of unnatural." Bone-conducted sound was estimated as normal in two patients, better than without an implant in one patient with sensorineural hearing loss, and "somewhat metallic" in another patient. Hearing the own voice was considered "normal" in two cases "monotonous" in one case, and "a little bit roaring" in another case. An amplification factor that can be technically realized in an implantable hearing aid was necessary for one of the patients with sensorineural hearing loss to perceive music at a pleasant volume. On the basis of this study, essential requirements for the construction of a fully implantable hearing aid are fulfilled.     

Noise-induced hearing loss in young adults: the role of personal listening devices and other sources of leisure noise

CONCEPT: No consensus exists regarding the magnitude of the risk of noise-induced hearing loss (NIHL) associated with leisure noise, in particular, personal listening devices in young adults. OBJECTIVE: Examine the magnitude of hearing loss associated with personal listening devices and other sources of leisure noise in causing NIHL in young adults. STUDY DESIGN: Prospective auditory testing of college student volunteers with retrospective history exposure to home stereos, personal listening devices, firearms, and other sources of recreational noise. METHODS: Subjects underwent audiologic examination consisting of estimation of pure-tone thresholds, speech reception thresholds, and word recognition at 45 dB HL. RESULTS: Fifty subjects aged 18 to 30 years were tested. All hearing thresholds of all subjects (save one-a unilateral 30 dB HL threshold at 6 kHz) were normal, (i.e., 25 dB HL or better). A 10 dB threshold elevation (notch) in either ear at 3 to 6 kHz as compared with neighboring frequencies was noted in 11 (22%) subjects and an unequivocal notch (15 dB or greater) in either ear was noted in 14 (28%) of subjects. The presence or absence of any notch (small or large) did not correlate with any single or cumulative source of noise exposure. No difference in pure-tone threshold, speech reception threshold, or speech discrimination was found among subjects when segregated by noise exposure level. CONCLUSION: The majority of young users of personal listening devices are at low risk for substantive NIHL. Interpretation of the significance of these findings in relation to noise exposure must be made with caution. NIHL is an additive process and even subtle deficits may contribute to unequivocal hearing loss with continued exposure. The low prevalence of measurable deficits in this study group may not exclude more substantive deficits in other populations with greater exposures. Continued education of young people about the risk to hearing from recreational noise exposure is warranted.     

Results of cochlear implantation in patients with severe to profound hearing loss--implications for patient selection

In patients with some residual hearing and minor benefit from conventional hearing aids, the benefits of cochlear implantation have to be weighed carefully against eventual adverse effects. In this study, pre- and post-operative thresholds as well as functional results after cochlear implantation are reported; 17 of 44 implanted adults had residual hearing pre-operatively (mean threshold(250 to 4000 Hz): 106 dB HL) in the implanted ear. Residual hearing in the implanted ear could not, in general, be preserved post-operatively. Seventeen of 44 implanted children had some amount of residual hearing in the implanted ear pre-operatively (implanted ear: 114 dB HL; contralateral ear: 109.9 dB HL; mean thresholds(250 to 4000 Hz))). Contrary to the results in adults, residual hearing in the implanted ear remained statistically unchanged. Hearing in the contralateral ear increased significantly from 109.9 to 101.9 dB HL post-operatively. This increase was mainly attributed to maturation of the central auditory pathway. In adults with residual hearing, the monosyllable word recognition scores increased significantly from 9 per cent pre-operatively to 42 per cent post-operatively. Children with residual hearing tended to perform better on speech-related test material compared to children without prior auditory experience. Cochlear implantation is indicated in adults and children with residual hearing and minor benefit from conventional amplification. The contralateral ear in children should be considered for additional acoustical stimulation.     

Evaluation of an automated auditory brainstem response infant hearing screening method in at risk neonates

An automated auditory brainstem response (ABR) method-the ALGO-1 Plus- has been developed for hearing screening in healthy neonates. The aim of this study was to test the validity of this automated ABR screening method in at-risk neonates in a neonatal intensive care unit. Two hundred and fifty at-risk neonates were selected for screening according to the criteria of the American Joint Commerce on Infant Hearing. All 250 neonates were screened with the ALGO-1 Plus for bilateral hearing loss. When two consecutive screenings pointed to bilateral hearing loss ("refer") further audiological investigations were performed and where necessary therapeutic measures were taken. All children who "passed" the screening unilateral or bilateral enrolled in a nationwide behavioural screening programme at the age of 9 months as well as in a 6-monthly follow up programme documenting speech and language development. A total of 245 (98%) neonates passed the ALGO-1 screening, 230 (92%) at the first attempt and 15 (6%) at the second attempt. Five (2%) were referred with bilateral hearing loss. One of these died of congenital rubella shortly after screening and bilateral congenital hearing loss of > 35 dB was confirmed in the other 4. None of the infants who passed the screening were discovered to have moderate to severe bilateral hearing loss (> 40 dB) with behavioural screening (n = 183/233) or at follow up (n = 233/233). In this study, all at-risk neonates with bilateral congenital hearing loss were detected with ALGO-1 Plus screening. No false-negatives were discovered. CONCLUSION: The ALGO-1 Plus infant hearing screener can be used as a valid automated ABR-screener to detect hearing loss in at-risk neonates in a neonatal intensive care setting.     

Why use clinical pathways rather than practice guidelines?

Chronic suppurative otitis media (CSOM) without cholesteatoma, the surgical treatment of which is still controversial, is a common diagnosis in otologic practice. A retrospective analysis of 323 patients who underwent surgery for noncholesteatomatous chronic otitis media in the Gruppo Otologica, Piacenza, Italy, between April 1983 and December 1993 is presented. Cases were separated into three groups according to different surgical treatment modalities and conditions of the ears at the time of operation. Group I (n = 53) consisted of cases of CSOM treated by tympanoplasty without mastoidectomy (TLWOM). Group II (n = 28) included cases of CSOM treated by tympanoplasty with mastoidectomy (TLWM). Intact canal wall technique was used in these cases. The ears in both these groups were discharging severely at the time of surgery. Group III (n = 242) included patients whose ears were dry at the time of surgery but who had had previous recurrent episodes of suppuration and who were treated by TLWOM. At the last follow-up, graft success rates for groups I, II, and III were 90.5%, 85.7%, and 89.2%, respectively, and mean residual gaps were 17.2 dB, 20.1 dB, and 19.4 dB, respectively. There was no statistically significant difference between the three groups either on graft success rates (p > 0.05) or on final functional hearing outcome (p > 0.05). TLWM is the preferable treatment modality for most surgeons in noncholesteatomatous CSOM. Nevertheless, in our experience TLWOM yields comparable results for this group of patients. In addition, we could not find any significant difference in results of graft success and final functional hearing rates between dry and discharging ears (p > 0.05).     

Brainstem auditory evoked potentials in young children before and after tympanostomy tube placement

To evaluate the effect of tympanostomy tube placement upon the hearing function of infants and young children, brainstem auditory evoked potentials (BAEP) were recorded in a group of young children (mean age 22 mos) receiving this treatment for otitis media with effusion (OME). For comparison, a group of healthy infants with normal behavioral audiometry were also tested with BAEP. Hearing loss was estimated for each ear using peak V latency-intensity curves. To evaluate the immediate effect of tube placement, 98 ears in 52 children were tested immediately before and after tube insertion. The 63 ears with effusion had prolonged peak latencies that decreased significantly (P < 0.001) immediately after tube placement and a mean hearing loss estimate of 22 dB that improved significantly (P < 0.0001) to 11 dB immediately after tube insertion. The 35 ears without effusion at myringotomy had a mean hearing loss estimate of 8 dB that did not change significantly after tube insertion. To evaluate the short-term effect of tube presence, 39 ears in 25 children were tested 3 weeks to 18 months after tube insertion. The 28 ears with dry tubes had a mean hearing loss estimate of 3 dB, and the 11 ears with otorrhea had a mean hearing loss estimate of 31 dB. The magnitude of mean hearing loss estimates in these young children with OME and the improvement in hearing function with tube placement is similar to that reported in older children studied with BAEP and audiometry. The study groups with a history of otitis media that had resolved by the time of testing had isolated prolongation of mean III-V interpeak latencies compared to normals (P < 0.01). These studies show that BAEP techniques are useful in estimating hearing loss in children with OME who are difficult to test by behavioral audiometry and show changes in rostral brainstem transmission in very young children with a history of OME.     

Stapedectomy in the elderly

Clinical records were reviewed to examine the effectiveness of stapedectomy in patients 70 years and older. A total of 154 patients was studied, including 11 with profound hearing loss with long-standing otosclerosis. Ages at the time of surgery ranged from 70 to 92 years (mean, 76.3 years). The mean pure-tone average (500, 1,000, 2,000, and 4,000 Hz) improved 30.6 dB after surgery for the 143 patients in the main otosclerotic group and 26.8 dB for the patients in the profound-hearing-loss group. The rate of successful stapedectomies for the 70(+)-year-old patients (90.9%) and the younger comparison group (90.0%) were similar. These findings extend the documented range of stapedectomy as a safe and effective procedure through the eighth decade of life.     

Safety assurance for occupational tumors in agriculture]

Congenital aural atresia is viewed by many physicians as a poorly characterized, arcane, clinical entity associated with a variety of hearing deficits. In fact, congenital aural atresia represents a disease spectrum predicated on the reliable embryological development of the first and second branchial apparatus. All degrees of microtia, canal atresia, and middle ear structure malformation are identified by this disease process. Many classification schemata have been proffered since the turn of the century to assist the otologist with a better means of assessing the patient's suitability as a surgical candidate. Clinical, audiological, and radiographic evaluation of congenital aural atresia is essential in selecting the appropriate candidates for surgery or hearing amplification. The high resolution CT scan has advanced the understanding and preoperative assessment of this condition. Surgical repair of the external ear and middle ear malformations is effective in properly selected patients. Essential background information, relevant embryology, patient evaluation, treatment, and current controversies related to congenital aural atresia are discussed.     

The rehabilitation of conductive hearing impairment

Conductive hearing loss (CHL) usually is amenable to surgical correction. At times, patients with CHL may not be candidates for surgical correction, or they may refuse to undergo the procedure. In such a situation, the patient should be encouraged to try hearing aids, either conventional or bone conduction, depending on the pathologic condition. After a discussion of bone-conduction implantable hearing aids, the article discusses congenital aural atresia, otosclerosis, and the management of CHL after infratemporal fossa approach and transtemporal approaches.     

Clinically significant hearing loss in renal allograft recipients treated with intravenous erythromycin

BACKGROUND: Hearing loss is generally regarded as a rare side effect of erythromycin therapy. However, our own clinical experiences in erythromycin-treated patients led us to suspect that this complication may be more common among renal allograft recipients. The purpose of this study was to evaluate the incidence, predisposing factors, clinical characteristics, and outcomes of erythromycin-induced hearing loss among renal allograft recipients. METHODS: We reviewed medical records of renal transplant patients treated for pneumonia with intravenous erythromycin lactobionate. Patients were evaluated for the occurrence of clinically significant hearing loss (including onset, duration, and reversibility), other signs and symptoms of ototoxicity (vertigo and tinnitus), daily erythromycin dose and duration of treatment, concurrent ototoxic drug therapy, renal and hepatic function, and history of previous otic disease. RESULTS: Eleven (32%) of 34 courses of intravenous erythromycin therapy resulted in hearing loss. The incidence of hearing loss was 53% (eight of 15 courses) in patients treated with 4 g of erythromycin daily compared with 16% (three of 19 courses) among those receiving 2 g/d (P = .05). In addition, courses of erythromycin were longer in those suffering auditory toxicity (9.6 +/- 4.7 days) than in nontoxic patients (5.7 +/- 3.6 days) (P < .05). Hepatic and renal function did not differ between toxic and nontoxic patients. All episodes of erythromycin-induced hearing loss were reversible. CONCLUSIONS: We conclude that clinically significant hearing loss occurs in more than 30% of renal allograft recipients treated for pneumonia with intravenous erythromycin lactobionate. Patients who require prolonged courses of erythromycin and those treated with 4 g/d are at particular risk for the development of auditory toxicity. With prompt recognition and modification of therapy, erythromycin-induced hearing loss appears to be completely reversible.     

Replacement by homologous recombination of the minK gene with lacZ reveals restriction of minK expression to the mouse cardiac conduction system

Surgical approaches to the inner ear with hearing preservation have valuable implications for neurotologic surgery. In a previous study in guinea pigs, we demonstrated that click-evoked auditory brain stem responses (ABRs) were preserved after transection and plugging of 1 or more semicircular canals but were lost after entering the vestibule (Smouha EE, et al. Otolaryngol Head Neck Surg 1996; 114:777-784). A limitation of that study was that click-evoked ABR might not represent the function of the entire cochlea. In this study we used tone-burst ABR to determine thresholds across a broad range of frequencies (2 to 24 kHz) before and after surgical entry into the labyrinth at the lateral semicircular canal, ampulla, and vestibule. Serial measurements were made, and a sham surgery group was used as a control. The results obtained with tone-burst ABR generally agreed with those previously obtained with click stimuli. Toneburst ABR thresholds were similar across most frequencies tested. Transection of the lateral semicircular canal resulted in preservation of ABR thresholds. Ampullectomy had a variable effect on ABR thresholds. Vestibulotomy usually resulted in substantial hearing loss. We conclude that hearing can be preserved across a range of frequencies after selective surgery of the inner ear. Surgical entry into the membranous labyrinth near the vestibule is the critical factor contributing to hearing loss after partial labyrinthectomy.     

On the role of the olivocochlear bundle in hearing: 16 case studies

Earlier we presented data (Scharf et al. (1994) Hear. Res. 75, 11-26) from a young patient (S.B.) who had undergone a vestibular neurotomy, during which the olivocochlear bundle (OCB) was severed. Those data are complemented by measurements on 15 other patients-some like S.B. with normal audiometric thresholds, none with a loss greater than 35 dB at experimental frequencies. Comparisons of performance for the same ear before and after surgery or between the operated and healthy ears do not provide evidence that the lack of OCB input impairs the following psychoacoustical functions: (1) detection of tonal signals, (2) intensity discrimination, (3) frequency selectivity, (4) loudness adaptation, (5) frequency discrimination within a tonal series, (6) in-head lateralization. Data on single-tone frequency discrimination are equivocal. These mostly negative results apply to listening both in the quiet and, where relevant, in noise. The only clear change in hearing after a vestibular neurotomy is that most patients detect signals at unexpected frequencies better than before. This change suggests an impaired ability to focus attention in the frequency domain. Although limited in scope, our finding that human hearing without OCB input is essentially normal agrees with much of the relevant literature on animal behavior and with the patients' self-reports.     

Revision stapedectomy: intraoperative findings, results, and review of the literature

Seventy-four revision stapedectomies performed consecutively over 10 years (1986 to 1995) were reviewed retrospectively. The most common intraoperative findings were incus erosion, prosthesis displacement, and oval window closure. Incus erosion was more frequently associated with multiple revisions. The postoperative results were reported using the conventional method (postoperative air minus preoperative bone) as well as the guidelines recently published by the American Academy of Otolaryngology--Head and Neck Surgery (postoperative air minus postoperative bone), with success rates of postoperative air-bone gap closure to within 10 dB after revision surgery of 51.6% and 45.6%, respectively. Patients with persistent conductive hearing loss (large residual air-bone gaps) after primary stapedectomy had poorer postrevision hearing results. Sensorineural hearing loss (defined as a drop in bone pure-tone average of more than 10 dB) occurred in four cases (5.4%). The number of revision surgeries, variations in operative techniques using laser or drill, and the ossicle to which the prosthesis was attached did not statistically affect the postoperative air-bone gaps. These results were compared with previously published data.