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12.10.2015
How to cite this article:Baradaranfar MH, Shahbazian H, Behniafard N, Atighechi S, Dadgarnia MH, Mirvakili A, Mollasadeghi A, Baradaranfar A. How to cite this URL:Baradaranfar MH, Shahbazian H, Behniafard N, Atighechi S, Dadgarnia MH, Mirvakili A, Mollasadeghi A, Baradaranfar A. 21.Mehrparvar AH, Mirmohammadi SJ, Davari MH, Mostaghaci M, Mollasadeghi A, Bahaloo M, et al. The effect of drill-generated noise in the contralateral healthy ear following mastoid surgery: The emphasis on hearing threshold recovery time.
Evaluation of the usefulness of a silicone tube connected to a microphone in monitoring noise levels induced by drilling during mastoidectomy and cochleostomy.
Does drill-induced noise have an impact on sensorineural hearing during craniotomy procedure?
Sensorineural high-frequency hearing loss after drill-generated acoustic trauma in tympanoplasty. The contralateral ear after translabyrinthine removal of acoustic neuromas: Is there a drill-noise generated hearing loss?
Scanning electron microscopic study of the organ of Corti in normal and sound-damaged guinea pigs. Rock drills used in South African mines: A comparative study of noise and vibration levels. The effects of oral isotretinoin (13-Cis retinoic acid) on the inner ear: A clinical study. Influence of drilling on the distortion product otoacoustic emissions in the non-operated ear. Contralateral normal ear after mastoid surgery: Evaluation by otoacoustic emissions (mastoid drilling and hearing loss).
Conventional audiometry, extended high-frequency audiometry, and DPOAE for early diagnosis of NIHL. The present study aimed to assess hearing threshold recovery in the contralateral healthy ear after acoustic trauma following mastoid surgery. The patients had been selected consecutively from two hospital clinics of Shahid Sadoughi University of Medical Sciences (Shahid Sadoughi and Shahid rahnemoon hospital clinics), but the site where the audiologist did the primary and postoperative acoustic evaluation and the hospital where each patient was operated on were the same (Shahid Sadoughi Hospital).All patients had normal contralateral ear.
In addition, the type of surgery, side of the involved ear, and mean time of drilling were also noted by reviewing the records files of the operating room.
This study was the result of a residency thesis at Shahid Sadoughi Hospital of Shahid Sadoughi University of Medical Sciences and was approved by the Ethics Committee of Research and the Vice-Chancellor of the University.


Written consent forms were assigned by our patients for their informed participation in the present study (in Persian). The target ear (the healthy one) was normal in each patient in all otoscopic, microscopic, and audiometric presurgical examinations. Audiological assessment toolsPure-tone audiometry (PTA)Standard PTA (AC40, Interacoustic, Assens, Denmark, headphone: TDH39) was performed before the tympanomastoidectomy and 24 h, 48 h, 72 h, and 96 h after the surgery.
Pure-tone air and bone conduction audiometries for the frequencies of 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz, and 8000 HZ were measured for all targeted contralateral healthy ears. The data were evaluated by an optoacoustic emission (OAE) software (Otoscreen OAE screening and Noah-based software, Assens, Denmark).
The stimuli levels were pointed constant levels at L1 = 65 dB SPL (sound pressure level) and L2 = 55 dB SPL. The groups were compared using Student's t-test or the Mann-Whitney U test for the continuous variables and the chi-square test (or Fisher's exact test, if required) for the categorical variables. Changes in quantitative parameters after the exercise test compared with before the test were detected by a paired t-test or the Wilcoxon signed-rank test. There was no significant statistical difference in hearing recovery time between different frequencies according to patients' gender or the side of the affected ear.
Regarding the level of hearing based on PTA, there was a significant difference in hearing level 24 h after surgery compared to that before surgery at frequencies of 3000-8000 Hz. Also, the difference in the level of hearing based on PTA was shown in two cases 96 h after surgery at two frequencies of 6000 Hz and 8000 Hz, which was not statistically significant. Furthermore, according to DPOAE analysis, the difference in the level of hearing was found 6 h and 24 h after surgery at frequencies of 2000-8000 Hz.
The difference in hearing levels at 48 h and 72 h after surgery compared to before surgery was significant at the frequencies of 4000 Hz, 6000 Hz, and 8000 Hz. However, this difference was found in none of frequencies at 96 h after surgery when compared to before surgery. At the beginning of the study, if a patient forgot to smention any particular drug that he used to take for any other medical disorder, such as acne vulgaris (isotretinoin), because in his opinion, that drug was not related to the ear problem, we were forced to omit him from the study because that very drug has been proved to have significant effects on PTA hearing levels. At all frequencies at 96 h after surgery, the survival rate of hearing loss was determined to be 0%. In fact, we aimed to determine the time point for achieving complete healing and recovery of hearing in the healthy ear after drilling of the mastoid. In fact, following the drilling in the mastoidectomy procedure, hearing loss especially at the frequencies higher than 2000 Hz may occur that is mainly temporary and reversible, leading to complete recovery after 72 h.


After the various individual fluctuations, the DPOAE amplitudes remained decreased in some of the patients at the end of the study. The burs used during mastoid surgery can cause temporary hearing threshold changes in the contralateral ears. This hearing loss was recorded above the upper frequency limit of conventional audiometers.
On the contrary, in Man and Winerman's survey, [3] no changes in hearing were found in the contralateral ear, and it was thus suggested that there may be no damage exclusively due to drill noise during mastoid surgery.
Also, Urquhart [10] showed that sensorineural hearing loss soon after mastoid surgery was not due to the noise generated by the drill and concluded that in the event of any hearing loss during this period, other causes should be sought. It seems that besides noise generated by drilling, other underlying factors may affect the normal hearing threshold, but according to recent reports, demographic characteristics, type of surgery, and even the parameters of drills may not have any effect. In this study, by considering normal hearing thresholds, we considered the range of thresholds within the spectrum of less than 15 dB for children and up to 25 dB for adults. These ranges include different variations of hearing sensitivities among the normal population.
First, because of including a small sample size, the assessment of survival of hearing loss in nonoperated ears could not be assessed in different subgroups, such as of patient demographics, types of surgeries, and also duration of drilling. Second, because of the probable effects of drill characteristics on hearing loss, roles of these characteristics, such as the drill's diameter and type, need to be assessed in further studies. With regard to patients' feelings about changes in their hearing levels, there was a similarity in hearing level before and after surgery at 24 h, 48 h, 72 h, and 96 h after surgery. Statistically it has been demonstrated that what people feel about their hearing level has a significant relationship with their DOPAE hearing levels but not their PTA results. This issue is comparable with the results of previous studies, which imply that DPOAE is a more sensitive technique for the early diagnosis of outer hair cell functional impairments in the context of noise-induced hearing loss. Following drilling in mastoidectomy, hearing loss, especially at frequencies higher than 2000 Hz, may occur that is mainly temporary and reversible, leading to complete recovery after 72 h. Some patients with a small amount of hearing changes are completely asymptomatic, while others complain of tangible effects. Explaining this recovery time to patients helps alleviate the anxiety after mastoidectomy procedures.



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