Drill-Induced Hearing Impairment in Otologic Surgery
Summary
Otologic procedures that employ high-speed drilling pose a recognised risk to auditory function through mechanical noise and vibration transmitted to the inner ear. The transmission of drill-generated acoustic energy and bone-conducted vibration can precipitate temporary or permanent sensorineural threshold shifts by inducing metabolic stress and microtrauma to cochlear hair cells and supporting structures. Contributory factors include burr design, rotational speed, contact pressure, irrigation technique and duration of exposure, as well as the proximity of drilling to the stapes footplate and round window. Clinically, incidences of postoperative sensorineural hearing impairment vary between 3 % and 5 %, manifesting as high-frequency hearing loss, tinnitus or vestibular symptoms. Surgical refinements—such as optimised irrigation, suction-wrapped burrs and the exploration of alternative energy modalities—aim to mitigate inner-ear trauma. As millions of mastoid and middle-ear operations are performed globally each year, understanding the mechanisms of drill-induced cochlear injury is critical for improving patient outcomes and guiding consent discussions.
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Drill-Induced Hearing Impairment in Otologic Surgery publication trend
The graph below shows the total number of articles in drill-induced hearing impairment in otologic surgery across all publications each year (not limited to Nature Index journals).
Technical terms
Sensorineural hearing loss (SNHL): Impairment of auditory perception originating from damage to inner‐ear sensory cells or the auditory nerve pathways.
Ossicular chain: The three-bone linkage (malleus, incus, stapes) in the middle ear that mechanically transmits sound vibrations to the cochlea.
Bone conduction threshold: The minimum sound level (in decibels) at which vibration conducted through the skull is perceived by the patient.
Decibel sound pressure level (dB SPL): A logarithmic unit quantifying acoustic pressure relative to a standard reference, commonly used to gauge intensity of surgical noise.
References
- Discussion and expostulations on postoperative worsening of hearing following middle ear surgeries. The Egyptian Journal of Otolaryngology (2022).
- Creation of an incus recess for a middle-ear microphone using a drill or laser ablation: a comparison of equivalent noise level and middle ear transfer function. European Archives of Oto-Rhino-Laryngology (2022).
- Post Operative Sensorineural Hearing Loss Following Middle Ear Surgery—A Study of 100 Cases. International Journal of Otolaryngology and Head & Neck Surgery (2018).
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