Bone anchored hearing aid (Baha^®) consists of a titanium fixture inserted in the mastoid bone with a skin-penetrating abutment, where a sound processor is coupled. Adverse skin reactions are common complications of Baha surgery. Over the last decades, several surgical techniques have evolved, with the aim of reducing postoperative complications. Currently, the linear incision technique, with subcutaneous tissue preservation, has been advocated as the most promising. The essential considerations for preventing postoperative complications of Baha surgery are (1) avoiding the cranial suture for the implant site, (2) the verticality of the implantation, and (3) choosing the appropriate length of the abutment. This study discusses the preoperative preparation, tips, and management of postoperative complications in Baha surgery.

The auditory brainstem implant (ABI) provides hearing-impaired patients with an opportunity to reacquire auditory sensation through electrical stimulation of the auditory neurons of the cochlear nucleus. The ABI was originally designed for patients with neurofibromatosis type II (NF2), which is characterized by bilateral acoustic neuromas. Tumor removal often results in severe damage to the auditory nerve. Here, we report a case of a patient with an ABI after surgery for NF2. The ABI surgery was performed together with neurosurgeons. One year after the ABI surgery, the patient was able to hear sounds with loudness of 35–55 dB with environmental sounds. She showed an improvement in speech recognition. The ABI may help NF2 patients with profound hearing loss after tumor resection to regain their hearing, although word and sentence recognition scores without lip reading in patients with ABIs are very low. Theoretically, cochlear implantation (CI) is not an option for NF2 patients. However, CI might be an option for NF2 patients with profound hearing loss given the current medical insurance coverage of hearing devices in Japan. Here, we demonstrated the effectiveness of CI surgery for NF2 patients. CI may be an alternative option when patients are appropriately selected by otolaryngologists in consultation with a neurosurgeon.

Thirty cases of auditory ossicular malformations focusing on the differential diagnosis of discontinuity and fixation of the ossicular chain have been reported. The preoperative diagnosis of ossicular discontinuity and fixation based only on audiograms often differs from that based on intraoperative surgical findings. Since tympanograms and the stapedial reflex are not very useful in the differential diagnosis of discontinuity and fixation of the ossicular chain and computed tomography cannot reveal the fixation of the stapes, the author established a quantitative index by assessing the preoperative hearing threshold level using the air-bone gap at 4 kHz and air conduction at 4 kHz.

By drawing receiver operating characteristic curves for each quantitative index, cut-off values of the hearing threshold level were defined to determine ossicular discontinuity and fixation. Accuracy rates of the diagnosis of ossicular discontinuity and fixation calculated by comparing the results of the intraoperative observation of the ossicles with the preoperative diagnosis using this index were >70%. Hence, the author recommends these quantitative indices as new criteria to diagnose ossicular discontinuity and fixation. Intraoperative observation led to the following diagnoses: absence of the incudo-stapedial joint was observed in 12 ears, absence of the stapedial crus in three ears, fixation between the tip of the malleus handle and bony external meatus (malleus bar) in one ear, fixation of the supra-structure of the stapes in two ears, fixation of the malleus and/or incus in four ears, fixation of the foot plate of the stapes in four ears, and absence of the oval window in four ears. According to the guidelines for reporting hearing results following middle ear and mastoid surgery proposed by the Japan Otological Society (2010), postoperative hearing improvement was achieved in 25 of 30 ears (83.3%).

We present the clinical features and postoperative results in 33 patients with congenital cholesteatoma, who underwent middle ear surgery at our department between 2011 and 2018. We investigated the association between the degree of cholesteatoma progression and the overall postoperative results using both the Potsic staging system and the Japan Otological Society (JOS) staging system for middle ear cholesteatoma (2015). Hearing improvement and recurrence rates were evaluated as markers of postoperative results. We observed 5, 8, 7, and 13 patients with Potsic stages I, II, III, and IV, respectively. Furthermore, 1 patient with stage II and 2 patients with stage IV disease developed recurrence, and hearing did not improve in 2 patients with stage IV and 1 patient with stage III disease. Recurrence was observed in 1 patient with stage II and 2 patients with stage IV disease. Hearing did not improve in 2 patients with stage IV and 1 patient with stage III disease. Based on the Potsic staging system, we observed no significant association between the degree of cholesteatoma and recurrence and between the degree of the lesion and postoperative hearing results. Based on the JOS staging system for middle ear cholesteatoma (2015), recurrence was observed in 2 patients with stage II and 1 patient with stage III disease. The tendency for recurrence was higher in patients with advanced stages of the disease; however, no significant difference was observed between the degree of progression and recurrence.

In contrast, with regard to the association between the degree of cholesteatoma progression and postoperative hearing improvement, we observed no hearing improvement in patients with stage II and III disease. A significant association was observed between the degree of cholesteatoma progression and postoperative hearing improvement (p = 0.033). This is the first report that investigated postoperative results in patients with congenital cholesteatoma using the JOS staging system for middle ear cholesteatoma (2015). Future studies performed across other healthcare facilities are warranted to confirm our findings.

Ventilation tube insertion (VTI) is recommended for pediatric recurrent acute otitis media (RAOM) treatment. We evaluated the efficacy, adequate duration, and complications of VTI in pediatric patients with RAOM.

The mean age of the children with RAOM was 15 months (range, 6–47 months). Short-term ventilation tubes (Paparella I type or Starr type) were inserted in 215 children (397 ears). The frequency of otitis decreased from 10.5/year to 0.83/year (t-test, p < 0.001). The mean duration of the VTI was 292 ± 156 days. The VTI re-insertion rates were 42.9%, 16.0%, 2.8%, and 0.0% at 1–3, 3–6, 6–12, and >12 months, respectively.

We evaluated the tympanic membrane perforation rate (PR) using the insertion duration and removal techniques. The PRs of the 18–24 months and over 24 months insertion groups were 14.3% and 30%, respectively, which were higher than the PRs for the 6–12 months and under 6 months groups (2.3% and 1.2%, respectively). We compared PRs between natural tube drop (NTD), removal without surgical treatment (R-without-ST), and removal with surgical treatment (R-with-ST) of the edge refresh and atelocollagen patch. The PR of R-with-ST (1.5%) was significantly lower than that of R-without-ST (11.1%) and was not significantly different from that of NTD (4.3%). When sex, age, otitis frequency, tube removal, without surgical treatment, and over 12 months insertion were included in a logistic regression model, without surgical treatment (OR = 6.76 [95% CI 1.50–30.51]) and over 12 months insertion (OR = 3.27, 95%CI 1.02–10.56) were correlated with PR.

In this study, we confirmed that VTI is substantially effective in controlling RAOM. The recommended duration for the prevention of tympanic membrane perforation is less than 12 months when the RAOM is controlled. In cases where the duration of VTI was >12 months, surgical treatment reduced tympanic membrane perforation.

We considered the causes and treatments of cholesteatoma with a labyrinthine fistula that had a rapidly progressive inner ear disorder, and compared with our own cases. The patient was a 26-year-old man who, 16 days prior to his first visit at our hospital developed a right facial nerve paresis, which was treated with oral steroids for 10 days in at a nearby hospital. He was diagnosed with cholesteatoma after presenting with a six day history of otorrhea and hearing loss in the right ear during his first visit at our hospital. Five days later, he had dizziness and an increased bone conduction threshold. Surgery was done and antibiotics were administered to control infection. The cholesteatoma and infected tissues at the fistula site were completely resected. The causative bacterium identified was Pseudomonas aeruginosa; therefore, sensitive antibiotics were administered postoperatively. His bone conduction hearing recovered, except at a high frequency range.

In a review of seven patients treated at our hospital for cholesteatoma associated with labyrinthine fistula; among five patients with infected ears, two had hearing loss and among three patients with preoperative impaired bone conduction hearing, two were infected with Pseudomonas aeruginosa. Rapidly progressive inner ear disorder is associated with infection; as a result, infection control is important by avoiding missing the timing of surgery and administering sensitive antibiotics.

The present study was designed to estimate the factors affecting postoperative chorda tympani dysfunction during otologic surgery. Methods: We analyzed 159 cases of otologic surgery performed in our hospital. Results: When the preoperative electrical taste threshold was normal, the operation time and treatment of the chorda tympani nerve significantly affected the postoperative chorda tympani function. This effect was not observed when the preoperative electrical taste threshold was not normal. In patients who preserved the chorda tympani nerve, the number of surgeries significantly affected the postoperative chorda tympani function.

To investigate the background of patients with definitive patulous eustachian tube (PET), a retrospective study was conducted on the medical records of 186 patients with definitive PET who visited our hospital between June 2016 and November 2018. The age distribution showed a peak at 30 and 70 years. The males to females ratio of patients with PET was approximately 1:2, which showed a higher predilection for PET in females. Weight loss was the most common cause. The prevalence of autophonia, aural fullness, and hearing own breathing sounds was 91.9%, 76.9%, and 74.2%, respectively. The treatment success rate of conservative treatment (nasal drip of normal saline solution, herbal medicine, and so on) and surgical treatment (insertion of the eustachian tube pin, insertion of a ventilation tube, and ligature of the pharyngeal orifice of the auditory tube) was 55.7% and 76.1%, respectively. Although the principle of Eustachian tube treatment is conservative, for cases where this treatment is ineffective, surgical treatment should be considered. However, there is a possibility that complications and various symptoms may be reported. Therefore, its adaptation requires careful judgement, necessitating a more accurate diagnosis.

Middle ear implants, which are granted a breakthrough device designation, are useful for patients with moderate-to-severe hearing loss, not only in those with inflammatory conditions unresponsive to conventional procedures but also in those with malformations such as congenital aural atresia. Sound waves can be transmitted directly into the inner ear in the form of vibration energy; therefore, it is possible to provide sound with lesser frequency distortion and higher clarity than a hearing aid. We investigated 19 patients with conductive or mixed hearing loss, who underwent middle ear implant (Vibrant Soundbridge) placement between 2012 and 2019. The mean difference between preoperative and unaided postoperative bone conduction thresholds was <5 dB at all frequencies (250–4000 Hz), 20 weeks postoperatively. Compared with unaided preoperative thresholds, the aided postoperative thresholds were significantly improved at all frequencies >250 Hz, 20 weeks postoperatively and at all frequencies >500 Hz even 5 years postoperatively. The word recognition score in the quiet condition was comparable to that observed with use of a hearing aid preoperatively. Postoperative complications included deterioration of bone conduction threshold (4 cases), infection that was controlled by antibiotics (2 cases), dysgeusia (1 case), and cable exposure in the ear canal, necessitating implant removal (1 case).

We reviewed the correlation between hearing levels and preoperative vestibular function in 31 adult patients (33 ears) with a cochlear implant (CI) and nine adult patients (10 ears) who received electric acoustic stimulation (EAS) CI and underwent preoperative vestibular function testing at our hospital between July 2019 and April 2020. To test the vestibular function, we performed cervical vestibular evoked myogenic potential (cVEMP) and caloric tests. There was no significant difference between the preoperative average hearing levels at the three low frequencies and the maximum velocity of the slow phase. However, there was a weak negative correlation (r = –0.35) in the CI group and a moderate negative correlation (r = –0.64) in the EAS group between cVEMP and the average hearing levels at the three low frequencies (p < 0.05). It is suggested that a correlation exists between the inferior vestibular nerve from the saccule and low-frequency hearing levels in high-tone acute sensorineural hearing loss. Recently, the use of bilateral CIs has increased. Therefore, it is necessary to perform preoperative vestibular function testing in patients who receive CIs with EAS.

An elderly man, systemically healthy, complained of stubborn headache and earache, persisting for 3 weeks. Initially, conservative treatment was administered for otitis media; however, no improvement was observed.

Approximately 2 months after the onset, magnetic resonance imaging examination revealed a brain abscess, which was identified as resulting from skull base osteomyelitis. Bacterial analysis of the otorrhea was performed multiple times; however, the causative organism was initially unknown.

Conservative antibiotic treatment was administered, without any improvement. The patient was later diagnosed with Aspergillus infection.

Since the brain abscess was refractory, craniotomy abscess removal and intratympanic drainage were performed by a neurosurgeon. After 24 weeks of antifungal treatment, skull base osteomyelitis and brain abscess owing to Aspergillus were successfully cured.