I read with great interest the article titled “Analysis of 60 patients after tympanotomy and sealing of the round window membrane after acute unilateral sensorineural hearing loss” by Gedlicka et al . Sudden sensorineural hearing loss (SSNHL) is not fatal, but patient’s psychologic stress and social disability may be significant if not recovered. Although the spontaneous recovery rate is 30% to 60% and the recovery rate can be more increased when treated , the novel treatment option that can raise the recovery rate is still needed. Therefore, the authors’ trial gave valuable clinical data to the readers; but I raise some questions in their article.
The first issue is the ethical aspect of the tympanotomy with sealing of the round window, which the authors performed to patients with 3 types of SSNHL during 8 years. Because they did not state the surgical indications or inclusion/exclusion criteria of their study, the readers did not know why the tympanotomy was performed in patients with idiopathic SSNHL. Although the authors reviewed the history of tympanotomy with sealing of round window membrane in cases of perilymphatic fistula (PLF) in the introduction section, they did not suggest the rationale of the invasive surgery for patients whose PLF was not diagnosed. Most references cited in their article are on cases of PLF. In addition, they are old-fashioned and not evidence based.
The second issue is the absence of statistical analysis of their data. I doubt how the authors deducted the conclusions without statistical process. Maybe for that reason, the authors misinterpreted the data of Table 3 in their article. They stated that PLF group might show a better hearing outcome in barotraumas cases, but not in idiopathic or acoustic trauma cases. When I reorganized and analyzed their data of Table 3, I found that there was no significant difference of improvement rate according to presence/absence of PLF in 3 types of acute hearing loss ( Table 1 ; χ 2 test, P = .656 in barotrauma, P = 1.000 in idiopathic hearing loss, and P = 1.000 in acoustic trauma).
| Barotrauma (n = 19) | Idiopathic hearing loss (n = 37) | Acoustic trauma (n = 4) | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Improved | Not improved | Improvement rate (%) | Improved | Not improved | Improvement rate (%) | Improved | Not improved | Improvement rate (%) | |
| Leak (+) | 5 | 2 | 71 | 3 | 1 | 75 | 1 | 0 | 100 |
| Leak (−) | 7 | 5 | 58 | 23 | 10 | 70 | 1 | 2 | 33 |
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