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Clinical Diagnosis and Surgical Strategies Update on Ear Disorders

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Otolaryngology".

Deadline for manuscript submissions: 15 June 2025 | Viewed by 8836

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Special Issue Editors

Dr. Andrea Albera

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Guest Editor

Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
Interests: otology; otoneurology; middle ear surgery; cochlear implants; bone-conduction hearing aids

Dr. Eleonora M.C. Trecca

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Guest Editor

Department of Otolaryngology, University Hospital of Foggia, 71100 Foggia, Italy
Interests: otorhinolaryngologic diseases; regenerative medicine; rhinology; otology; otolaryngology

Special Issue Information

Dear Colleagues,

Recent advances in neurosciences, technology and imaging techniques have greatly improved our understanding and treatment of ear disorders. Electrophysiology and neuroscientific approaches are crucial for improving our understanding of the mechanisms underlying pathologies, such as congenital or acquired sensorineural hearing loss, autoimmune or metabolic hearing loss, otogenic facial palsy, Menière's disease, tinnitus, etc.

We are now in an era of "minimally invasive surgery": chronic otitis media, cholesteatoma, otosclerosis, profound deafness and acoustic neuroma can now be treated both microscopically and endoscopically, furthermore, other interventions are starting to consider lasers, robotic surgery, and image-guided navigation as other viable options.

The aim of this Special Issue is to present original studies and state-of-the-art systematic reviews related to clinical updates on middle and inner ear diseases, as well as cutting-edge original research on innovative surgical techniques, both in children and adults.

Dr. Andrea Albera
Dr. Eleonora M.C. Trecca
Guest Editors

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Keywords

middle ear
inner ear
endoscopic ear surgery
cholesteatoma
Menière’s disease
hearing loss
robotic surgery
otosclerosis

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Published Papers (7 papers)

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15 pages, 1582 KiB

Open AccessArticle

Tinnitus and Its Comorbidities: A Comprehensive Analysis of Their Relationships

by Stefani Maihoub, Panayiota Mavrogeni, Viktória Molnár and András Molnár

J. Clin. Med. 2025, 14(4), 1285; https://doi.org/10.3390/jcm14041285 - 15 Feb 2025

Viewed by 808

Abstract

Objectives: This study aimed to explore the demographic and clinical features of tinnitus individuals and analyse its correlation with associated comorbidities. Methods: The study population comprised 147 participants (66 men, 81 women; median age: 52 years) who experienced persistent tinnitus. Comprehensive assessments were carried out, including audiological examinations, scoring using the Tinnitus Handicap Inventory, and thorough medical evaluations. Statistical analyses were applied to explore the correspondences between tinnitus, hearing loss, and various comorbidities, including cardiovascular conditions, metabolic disorders, gastroesophageal reflux disease, autoimmune diseases, pulmonary diseases, and allergic rhinitis. Results: The analysis indicated a slight predominance of females, comprising 55.1% of the participants, with a median onset of tinnitus around the age of 50. Chronic tinnitus was noted, lasting approximately 46 months. Hearing loss was noted in 52.4% of patients, with bilateral tinnitus being the most prevalent type, affecting 44.2% of individuals. Dyslipidaemia was found to significantly predict bilateral tinnitus (p = 0.003*) and left-sided tinnitus (p = 0.023*). Additionally, atherosclerosis was associated with hearing impairment (p = 0.006*) and right-sided tinnitus (p = 0.044*). Dyslipidaemia was also significantly correlated with elevated intensity values (p = 0.04*). Furthermore, atherosclerosis was significantly associated with higher levels of hearing loss (p < 0.00001*). Conclusions: The study emphasises the complex nature of tinnitus and its links to cardiovascular, metabolic, and other comorbidities, highlighting the necessity for comprehensive, interdisciplinary management. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Surgical Strategies Update on Ear Disorders)

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11 pages, 1326 KiB

Open AccessArticle

Correlation Between the Pitch and Loudness of Tinnitus, Hearing Levels, and Tinnitus Handicap Inventory Scores in Patients with Chronic Subjective Tinnitus

by Panayiota Mavrogeni, András Molnár, Viktória Molnár, László Tamás and Stefani Maihoub

J. Clin. Med. 2024, 13(23), 7261; https://doi.org/10.3390/jcm13237261 - 29 Nov 2024

Cited by 2 | Viewed by 1193

Abstract

Objectives: The aim of this study was to investigate the relationships between tinnitus pitch and loudness, the frequency of hearing loss, hearing level, and the Tinnitus Handicap Inventory (THI) scores reported by patients. Methods: In total, 139 patients (50 men and 89 women; mean age ± SD, 60.19 ± 11.47 years) who suffered from chronic primary tinnitus associated with sensorineural hearing loss were included in the study. Participants underwent pure-tone audiometry and tinnitus pitch matching assessments. Additionally, all participants completed the Hungarian version of the THI questionnaire. Correlations were assessed using simple linear, Spearman’s, and Pearson’s correlation tests, and a linear regression model was applied. The Mann–Whitney U test was also used. Results: This study identified a significant correlation between the pitch of tinnitus and the frequency of hearing loss (p = 0.000 *; rho = 0.549). There was also a significant correlation between tinnitus noise and hearing levels (p = 0.000 *; rho = 0.375). Age was shown to significantly affect tinnitus loudness (p = 0.016 *) and hearing levels (p = 0.000 *) as determined by a linear regression model. Tinnitus duration only significantly influenced tinnitus loudness (p = 0.022). There was no significant effect of sex on tinnitus or audiometry parameters. Total THI scores were influenced solely by tinnitus loudness (p = 0.021 *). Furthermore, sex did have an effect on total THI scores, with women reporting higher scores (p = 0.000 *). Conclusions: This study concluded that there is a significant correlation between the pitch and loudness of tinnitus and hearing levels, suggesting a connection in their underlying mechanisms. The intensity of tinnitus and hearing level are primarily affected by ageing processes. Furthermore, the severity of self-perceived tinnitus is mainly related to the loudness of tinnitus. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Surgical Strategies Update on Ear Disorders)

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17 pages, 4378 KiB

Open AccessArticle

The Third Mobile Window Syndrome: A Clinical Spectrum of Different Anatomical Locations—Characterization, Therapeutic Response, and Implications in the Development of Endolymphatic Hydrops

by Joan Lorente-Piera, Raquel Manrique-Huarte, Nicolás Pérez Fernández, Diego Calavia Gil, Marcos Jiménez Vázquez, Pablo Domínguez and Manuel Manrique

J. Clin. Med. 2024, 13(23), 7232; https://doi.org/10.3390/jcm13237232 - 28 Nov 2024

Viewed by 1003

Abstract

Background/Objectives: Multiple dehiscences of the otic capsule can exhibit behavior similar to Ménière’s disease, not only from a clinical perspective but also in the results of audiovestibular tests. The main objective of this study is to characterize third mobile window etiologies from an audiovestibular perspective, while also evaluating the therapeutic response to four different treatment protocols. Furthermore, we aim to explore a potential association with the development of radiologically defined endolymphatic hydrops (EH). Methods: This is a retrospective cohort study conducted from 2017 to 2024 at a tertiary-level otology and otoneurology unit. All patients underwent pure tone audiometry, vHIT, cVEMP, and oVEMP. Some of these patients, selected under rigorous inclusion criteria based on clinical and audiometric findings, were subjected to a 4-h delayed intravenous gadolinium-enhanced 3D-FLAIR MRI. Results: We obtained a sample of 86 patients, with a mean age of 52.2 ± 7.64 years: 62.76% were female (n = 54) and 37.21% were male (n = 32); 88.37% (n = 76) were diagnosed with superior semicircular canal dehiscence syndrome (SSCDS), while 11.62% (n = 10) had other forms of otic capsule dehiscence. The most common symptom observed was unsteadiness (44%). While surgery is the only curative treatment, other medical treatments, such as acetazolamide, also helped reduce symptoms such as autophony, falls, instability, and vertigo attacks, with a relative risk reduction (RRR) exceeding 75% (95% CI, p < 0.05). The results of the MRI in EH sequences indicate that 7.89% of the patients diagnosed with SSCDS also developed radiological EH, compared to 40.00% of the patients with other otic capsule dehiscences, a difference that was statistically significant (p = 0.0029. Conclusions: Otic capsule dehiscences are relatively unknown conditions that require clinical diagnosis. Although VEMP testing is useful, imaging studies are necessary to localize and characterize the defect, most commonly found in the superior semicircular canal. We should consider these dehiscences in cases where there is a suspicion of EH development. Further research, including in vivo neuroimaging studies using hydrops sequences, is required to better understand their relationship to potential Ménière’s disease. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Surgical Strategies Update on Ear Disorders)

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28 pages, 26315 KiB

Open AccessArticle

Comprehensive Management of Cholesteatoma in Otitis Media: Diagnostic Challenges, Imaging Advances, and Surgical Outcome

by Cristina Popescu, Renata Maria Văruț, Monica Puticiu, Vlad Ionut Belghiru, Mihai Banicioiu, Luciana Teodora Rotaru, Mihaela Popescu, Arsenie Cristian Cosmin and Alin Iulian Silviu Popescu

J. Clin. Med. 2024, 13(22), 6791; https://doi.org/10.3390/jcm13226791 - 11 Nov 2024

Cited by 2 | Viewed by 2358

Abstract

Background: This study presents a comprehensive analysis of cholesteatoma of the middle ear, focusing on its clinical presentation, diagnostic imaging, and treatment outcomes. Cholesteatomas are defined by the keratinized squamous epithelium within the middle ear, leading to significant bone erosion, often affecting the ossicular chain and surrounding structures. Methods: The study explores various mechanisms involved in cholesteatoma progression, including enzymatic lysis, inflammatory responses, and neurotrophic disturbances. The study conducted a retrospective clinical and statistical review of 580 patients over a 20-year period (2003–2023), highlighting the role of advanced imaging, including computed tomography (CT) and diffusion-weighted magnetic resonance imaging (DWI), in preoperative planning and postoperative follow-up. Results: Findings revealed that early detection and intervention are crucial in preventing severe complications such as intracranial infection and hearing loss. Surgical treatment primarily involved tympanoplasty and mastoidectomy, with a recurrence rate of 1.55% within two years. The study underscores the importance of integrating imaging advancements into clinical decision-making to enhance patient outcomes and suggests further investigation into molecular mechanisms underlying cholesteatoma progression and recurrence. Histopathological and microbiological analysis was performed to identify pathological patterns and microbial agents. Conclusions: The study highlights the importance of early diagnosis and intervention to prevent complications such as intracranial infections and permanent hearing loss, while also emphasizing the role of advanced imaging techniques in the management and long-term monitoring of cholesteatoma patients. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Surgical Strategies Update on Ear Disorders)

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11 pages, 788 KiB

Open AccessArticle

A French Preoperative Cholesteatoma Management: Current Preoperative Consultation and Tendencies

by Benjamin Reliquet, Mireille Folia, Paul Elhomsy, Serge Aho-Ludwig and Caroline Guigou

J. Clin. Med. 2024, 13(18), 5651; https://doi.org/10.3390/jcm13185651 - 23 Sep 2024

Viewed by 893

Abstract

Objectives: This study aimed to characterize the information delivery during preoperative consultations for cholesteatoma removal surgery in 2024. The secondary objective was to identify any factors influencing the information delivered. Methods: This study was a practice survey which included 33 closed-ended questions and 1 open-ended question. Seven questions concerned the participants’ characteristics and 2 questions concerned the physiopathology of cholesteatoma. Nine questions focused on surgical information, six questions focused on the procedure modalities and ten questions focused on the risks of complications from the intervention. Results: Eighty-two surgeons answered the survey. In 75% of the cases, an information form written by a professional society was provided. The risk of recurrence or residual post-operative cholesteatoma was systematically stated in 78% of cases (n = 64), while the risk of aesthetic sequelae was only stated in 1% (n = 1). Participants working in a university hospital were more likely to inform patients about the risks of vertigo (p = 0.04), aesthetic risks (p = 0.04), poor functional outcomes (p = 0.04), surgical revision (p = 0.05) and the risk of peripheral facial paralysis (p = 0.05). Surgeons who mainly practiced otology were more likely to inform patients about the risks of recurrence and/or residual cholesteatoma (p = 0.02) and taste disturbances (p = 0.02). Conclusions: Cholesteatoma surgery was well explained to patients during the preoperative consultation, mostly with written support, even if the information given was not the same for all complication risks. It could be useful to create an information form dedicated to cholesteatoma surgery to improve comprehensive information and maintain a trustworthy relationship with patients. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Surgical Strategies Update on Ear Disorders)

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12 pages, 1007 KiB

Open AccessArticle

Client Oriented Scale of Improvement in First-Time and Experienced Hearing Aid Users: An Analysis of Five Predetermined Predictability Categories through Audiometric and Speech Testing

by Pietro Salvago, Davide Vaccaro, Fulvio Plescia, Rossana Vitale, Luigi Cirrincione, Lucrezia Evola and Francesco Martines

J. Clin. Med. 2024, 13(13), 3956; https://doi.org/10.3390/jcm13133956 - 5 Jul 2024

Viewed by 1147

Abstract

Objectives: The aim of our investigation was to explore the relationship between unaided pure-tone and speech audiometry and self-reported aided performance measured according to five predetermined COSI categories among first-time hearing aid users and experienced hearing aid users. Methods: Data from 286 patients were retrospectively evaluated. We divided the sample into first-time hearing aid users (G1) and experienced hearing aid users (G2). The correlation between unaided tonal and speech audiometry and five preliminary selected client-oriented scale of improvement (COSI) categories was studied. Results: A greater percentage of hearing aid users aged >80 years and a higher prevalence of severe-to-profound hearing loss in G2 group were observed (p < 0.05). For the total cohort, a mean hearing threshold of 60.37 ± 18.77 db HL emerged in the right ear, and 59.97 ± 18.76 db HL was detected in the left ear (p > 0.05). A significant statistical difference was observed in the group of first-time hearing aid users for the “Television/Radio at normal volume” item, where patients with a lower speech intellection threshold (SIT) were associated with higher COSI scores (p = 0.019). Studying the relationship between the speech reception threshold (SRT) and the COSI item “conversation with 1 or 2 in noise” evidenced worse speech audiometry in patients who scored ≤2 among experienced hearing aid users (p = 0.00012); a higher mean 4–8 kHz frequencies threshold for the better ear was found within the G2 group among those who scored ≤2 in the COSI item “conversation with 1 or 2 in quiet” (p = 0.043). Conclusions: Our study confirms a poor correlation between unaided tonal and speech audiometry and self-reported patient assessment. Although we included only five COSI categories in this study, it is clear that unaided audiometric tests may drive the choice of proper hearing rehabilitation, but their value in predicting the benefit of hearing aids remains limited. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Surgical Strategies Update on Ear Disorders)

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12 pages, 1421 KiB

Open AccessSystematic Review

Nitinol Prosthesis in Stapes Surgery: Evolution from Heat-Activated to Superelastic Nitinol: A Systematic Review

by Andrea Achena, Ludovica Pacelli, Carmine Prizio, Gabriella Mantini, Angelo Placentino, Remo Accorona, Valerio Valenzise, Francesco Pilolli, Giorgio Luigi Ormellese, Niccolò Mevio and Alberto Dragonetti

J. Clin. Med. 2025, 14(4), 1069; https://doi.org/10.3390/jcm14041069 - 7 Feb 2025

Viewed by 632

Abstract

Background/Objectives: Stapes surgery is a well-established treatment for conductive hearing loss caused by otosclerosis, with the choice of prosthesis playing a pivotal role in audiological outcomes and safety. Heat-activated and superelastic nitinol prostheses are widely used, but their comparative effectiveness and complication profiles remain debated. This systematic review and meta-analysis aimed to evaluate the audiological outcomes, complication rates, and overall performance of these two prosthesis types. Methods: A systematic review was conducted following PRISMA guidelines. Seven studies involving 273 patients were included. Data on mean air–bone gap (ABG) reduction, complication rates, and follow-up outcomes were extracted. Meta-analyses were performed using a random-effects model, and odds ratios (OR) with 95% confidence intervals (CI) were calculated for comparative analysis. Results: The pooled mean ABG reduction was 20.2 dB (95% CI: 19.47–20.95), indicating substantial and comparable improvements in hearing for both prosthesis types. Heat-activated prostheses achieved slightly higher ABG reduction in individual studies, while superelastic prostheses offered advantages in procedural simplicity. Complication rates were 6.0% for heat-activated and 5.6% for superelastic prostheses. The most common complications included sensorineural hearing loss (2.0–2.4%) and incus-related issues such as necrosis and lateralization. Conclusions: Both prosthesis types provide comparable audiological outcomes and surgical success rates. However, the slightly lower complication rate observed with superelastic prostheses emphasizes their safety and predictability. The choice of prosthesis should be guided by patient anatomy, surgeon expertise, and procedural considerations. Future studies should prioritize long-term outcomes and standardized reporting to further refine prosthesis selection. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Surgical Strategies Update on Ear Disorders)

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