KRONİK OTİTİS MEDİA HASTALARINDA CARHART NOTCH'UNUN TANISAL ÖNEMİ

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.

Keywords

• Carhart notch
• saf ses odyometri
• kronik otitis media
• Timpanoplasti

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

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.

Keywords

• Carhart notch
• pure tone audiometry
• chronic otitis media
• tympanoplasty

References

1. 1. Carhart R. The clinical application of bone conduction audiometry. Trans Am Acad Ophthalmol Otolaryngol. 1950;54:699-707. PMID: 15443033
2. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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