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KRONİK OTİTİS MEDİA HASTALARINDA CARHART NOTCH'UNUN TANISAL ÖNEMİ

Year 2021, Volume: 28 Issue: 4, 585 - 590, 30.12.2021
https://doi.org/10.17343/sdutfd.901212

Abstract

Amaç
Stapes fiksasyonuna bağlı otosklerozun neden olduğu
yanlış sensörinöral kayıp, Carhart çentiği olarak bilinir.
Bu çalışmanın amacı, kronik otitis media (KOM)
hastalarında ameliyat öncesi ve sonrası odyometri
sonuçlarını karşılaştırarak hava-kemik aralığı (HKA)
ve kemik yolu (KY) işitme eşiklerinde meydana gelen
değişiklikleri incelemek, hava yolu (HY) iletiminin
KY iletimi üzerindeki etkilerini araştırmak, postoperatif
HY'de iyileşmenin KY iyileşmesi üzerindeki etkilerini
belirlemek, KOM' da Carhart çentiğinin varlığını tespit
etmek ve cerrahinin Carhart çentiği üzerindeki etkilerini
belirlemektir.
Gereç ve Yöntem
Bu retrospektif çalışmaya kliniğimizde Ocak 2012 –
Mart 2017 tarihleri arasında tip 1 timpanoplasti uygulanan
toplam 104 hasta dahil edildi. Preoperatif ve
postoperatif 6. ay yapılan odyometrik değerlendirme
sırasında ölçülen parametreler, 250-8.000 Hz frekanslarda
HY işitme eşiklerini, 500-4.000 Hz'de KY
işitme eşiklerini ve 500-4.000 Hz aralıklarla HKA değerlerini
içermekteydi.
Bulgular
Cerrahi öncesi 104 hastanın 46'sında (% 44,2) Carhart
çentik mevcuttu. Bu hastaların 25'inde (% 54,3)
ameliyat sonrası Carhart çentiğinin düzeldiği görüldü
(p = 0,029).
Sonuç
Timpanoplasti sonrası, sağlam ve hareketli bir kemikçik
zinciri olan KOM olgularında 2.000 Hz'de HKA'daki
belirgin iyileşme KY'de iyileşmeye yol açabilir. Carhart
çentiği ayrıca KOM'da da mevcut olabilir.

References

  • 1. Carhart R. The clinical application of bone conduction audiometry. Trans Am Acad Ophthalmol Otolaryngol. 1950;54:699-707. PMID: 15443033
  • 2. Sakamoto T, Kakigi A, Kashio A, Kanaya K, Suzuki M, Yamasoba T. Evaluation of the Carhart effect in congenital middle ear malformation with both an intact external ear canal and a mobile stapes footplate. ORL J Otorhinolaryngol Relat Spec. 2011;73:61-67. https://doi.org/10.1159/000323010
  • 3. Lee HS, Hong SD, Hong SH, Cho YS, Chung WH. Ossicular chain reconstruction improves bone conduction threshold in chronic otitis media. J Laryngol Otol. 2008;122:351-356. https://doi.org/10.1017/S0022215107009474
  • 4. Stenfelt S, Hato N, Goode RL. Factors contributing to bone conduction: the middle ear. J Acoust Soc Am 2002;111:947-59 https://doi.org/10.1121/1.1432977
  • 5. Stenfelt S. Middle ear ossicles motion at hearing thresholds with air conduction and bone conduction stimulation. J. Acoust Soc Am 2006;119:2848-58. https://doi.org/10.1121/1.2184225
  • 6. Tonndorf, J. (1971). Animal experiments in bone conduction: Clinical conclusions. In I.M. Ventry, J.B. Chaiklin, & R.F. Dixon (Eds.), Hearing measurement: A book of readings (pp. 130-141). New York, NY: Appleton-Century-Crofts.
  • 7. Kashio A, Ito K, Kakigi A. Carhart Notch 2-kHz Bone Conduction Threshold Dip A Nondefinitive Predictor of Stapes Fixation in Conductive Hearing Loss With Normal Tympanic Membrane. Arch Otolaryngol Head Neck Surg 2011;137:236-40. https://doi.org/10.1001/archoto.2011.14
  • 8. Kumar M, Maheshwar A, Mahendran S, Oluwasamni A., Clayton MI. Could the presence of a Carhart notch predict the presence of glue at myringotomy?. Clin Otolaryngol Allied Sci 2003;28:183-86. https://doi.org/10.1046/j.1365-2273.2003.00682.x
  • 9. Shishegar M, Faramarzi A, Esmaili N, Heydari ST. Is Carhart notch an accurate predictor of otitis media with effusion?. M. Int J Ped Otorhinolaryngol 2009;73:1799-1802 https://doi.org/10.1016/j.ijporl.2009.09.040
  • 10. Ahmad I, Pahor AL. Carhart's Notch: A Finding in Otitis Media With Effusion. Int J Pediatr Otorhinolaryngol 2002;17:165-70. https://doi.org/10.1016/s0165-5876(02)00080-0
  • 11. Wiatr, M., Składzień, J., Wiatr, A., Tomik, J., Stręk, P., & Medoń, D. (2015). Postoperative bone conduction thresholds changes in patients operated on chronic otitis media-analysis. Otolaryngologia Polska, 69(4). https://doi.org/10.5604/00306657.1147030.
  • 12. Wegner A, Bitermann AJN, Hentschel MA, Van der Heijden GJM, Grolman W. Pure-tone Audiometry in Otosclerosis: Insufficient Evidence for the Diagnostic Value of the Carhart Notch 2013;149:528-32. https://doi.org/10.1177/0194599813495661

DIAGNOSTIC IMPORTANCE OF THE CARHART NOTCH IN PATIENTS WITH CHRONIC OTITIS MEDIA

Year 2021, Volume: 28 Issue: 4, 585 - 590, 30.12.2021
https://doi.org/10.17343/sdutfd.901212

Abstract

Objective
The false sensorineural loss caused by otosclerosis
due to stapes fixation is known as the Carhart notch.
To examine the changes in air-bone gap (ABG)
and bone-conduction (BC) hearing thresholds by
comparing the preoperative and postoperative
audiometry results in patients with chronic otitis media
(COM), to investigate the effects of air conduction
(AC) on BC, to determine the effects of postoperative
improvement in AC on BC, to detect the presence
of the Carhart notch in COM, and to determine the
effects of surgery on the Carhart notch.
Material and Methods
A total of 104 patients who underwent type 1
tympnoplasty between January 2012 - March 2017
in our clinic were included in this retrospective study.
Parameters measured during the preoperative and
postoperative sixth month audiometric evaluation
comprised AC hearing thresholds at the frequencies
of 250-8,000 Hz, BC hearing thresholds at 500-4,000
Hz, and ABG values at 500-4,000 Hz intervals.
Results
Before surgery, the Carhart notch was present in
46 (44.2%) of the 104 patients. Postoperatively, the
Carhart notch was observed to have been corrected
in 25 (54.3%) of these patients (p=0.029).
Conclusion
After tympanoplasty, significant improvement in ABG
may lead to improvement in BC at 2,000 Hz in COM
cases with an intact and mobile ossicular chain. The
Carhart notch may also be present in COM.

References

  • 1. Carhart R. The clinical application of bone conduction audiometry. Trans Am Acad Ophthalmol Otolaryngol. 1950;54:699-707. PMID: 15443033
  • 2. Sakamoto T, Kakigi A, Kashio A, Kanaya K, Suzuki M, Yamasoba T. Evaluation of the Carhart effect in congenital middle ear malformation with both an intact external ear canal and a mobile stapes footplate. ORL J Otorhinolaryngol Relat Spec. 2011;73:61-67. https://doi.org/10.1159/000323010
  • 3. Lee HS, Hong SD, Hong SH, Cho YS, Chung WH. Ossicular chain reconstruction improves bone conduction threshold in chronic otitis media. J Laryngol Otol. 2008;122:351-356. https://doi.org/10.1017/S0022215107009474
  • 4. Stenfelt S, Hato N, Goode RL. Factors contributing to bone conduction: the middle ear. J Acoust Soc Am 2002;111:947-59 https://doi.org/10.1121/1.1432977
  • 5. Stenfelt S. Middle ear ossicles motion at hearing thresholds with air conduction and bone conduction stimulation. J. Acoust Soc Am 2006;119:2848-58. https://doi.org/10.1121/1.2184225
  • 6. Tonndorf, J. (1971). Animal experiments in bone conduction: Clinical conclusions. In I.M. Ventry, J.B. Chaiklin, & R.F. Dixon (Eds.), Hearing measurement: A book of readings (pp. 130-141). New York, NY: Appleton-Century-Crofts.
  • 7. Kashio A, Ito K, Kakigi A. Carhart Notch 2-kHz Bone Conduction Threshold Dip A Nondefinitive Predictor of Stapes Fixation in Conductive Hearing Loss With Normal Tympanic Membrane. Arch Otolaryngol Head Neck Surg 2011;137:236-40. https://doi.org/10.1001/archoto.2011.14
  • 8. Kumar M, Maheshwar A, Mahendran S, Oluwasamni A., Clayton MI. Could the presence of a Carhart notch predict the presence of glue at myringotomy?. Clin Otolaryngol Allied Sci 2003;28:183-86. https://doi.org/10.1046/j.1365-2273.2003.00682.x
  • 9. Shishegar M, Faramarzi A, Esmaili N, Heydari ST. Is Carhart notch an accurate predictor of otitis media with effusion?. M. Int J Ped Otorhinolaryngol 2009;73:1799-1802 https://doi.org/10.1016/j.ijporl.2009.09.040
  • 10. Ahmad I, Pahor AL. Carhart's Notch: A Finding in Otitis Media With Effusion. Int J Pediatr Otorhinolaryngol 2002;17:165-70. https://doi.org/10.1016/s0165-5876(02)00080-0
  • 11. Wiatr, M., Składzień, J., Wiatr, A., Tomik, J., Stręk, P., & Medoń, D. (2015). Postoperative bone conduction thresholds changes in patients operated on chronic otitis media-analysis. Otolaryngologia Polska, 69(4). https://doi.org/10.5604/00306657.1147030.
  • 12. Wegner A, Bitermann AJN, Hentschel MA, Van der Heijden GJM, Grolman W. Pure-tone Audiometry in Otosclerosis: Insufficient Evidence for the Diagnostic Value of the Carhart Notch 2013;149:528-32. https://doi.org/10.1177/0194599813495661
There are 12 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Articles
Authors

Ergin Bilgin 0000-0001-7191-6209

Aykut Erdem Dinç 0000-0001-7006-7479

Sultan Şevik Eliçora 0000-0002-2915-3727

Duygu Erdem 0000-0002-7973-2719

Semih Alataş 0000-0002-5492-8918

Publication Date December 30, 2021
Submission Date March 25, 2021
Acceptance Date August 17, 2021
Published in Issue Year 2021 Volume: 28 Issue: 4

Cite

Vancouver Bilgin E, Dinç AE, Şevik Eliçora S, Erdem D, Alataş S. DIAGNOSTIC IMPORTANCE OF THE CARHART NOTCH IN PATIENTS WITH CHRONIC OTITIS MEDIA. Med J SDU. 2021;28(4):585-90.

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