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Székely L, Uri I, Luka Á, Gáborján A, Tamás L, Polony G. Audiological outcomes after revision stapes surgeries: a systematic review. Eur Arch Otorhinolaryngol 2024; 281:5051-5059. [PMID: 38839701 PMCID: PMC11416404 DOI: 10.1007/s00405-024-08741-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/15/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE Revision stapes surgery is a challenging procedure performed in relatively small numbers compared to other middle ear procedures. Despite numerous data on hearing results of different middle ear surgeries, the audiological standards for successful outcome of this procedure are still not clarified. On the basis of well-documented data, we wanted to determine what the expected audiological results and complications are after revision stapes surgery in order to set a realistic threshold for surgical success. METHODS After the protocol registration in the PROSPERO database, a systematic review was performed in multiple databases (PubMed, Cochrane, Web of Science, Scopus, ScienceOpen, ClinicalTrials.gov, Google Scholar) according to PRISMA guidelines. Twelve articles were reviewed according to the inclusion criteria. A total of 1032 cases were obtained for evaluation. A modified version of Newcastle-Ottawa Scale (NOS) was used to assess publication quality. RESULTS Average air-bone gap (ABG) gain was 17.3 dB, average air conduction (AC) gain was 17.5 dB. The average postoperative air-bone gap was 11.1 dB. The postoperative ABG distribution was the following 0-10 dB: 53.3%, > 10-20 dB: 28.2%, > 20 dB: 18.5%. SNHL as a surgical complication was described in a total of 17 cases (1.6%), no equilibrium disorder was reported. CONCLUSION The pooled data suggest that revision stapes surgery is an effective solution after failure of previous stapes surgery. However, the results are clearly inferior to those of primary stapedotomies. Hence, we need to apply different expectations and use different standards in the indication and evaluation of this type of surgery.
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Affiliation(s)
- László Székely
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Semmelweis Egyetem (Semmelweis University), Szigony Utca 36, Budapest, 1083, Hungary.
| | - Imre Uri
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Semmelweis Egyetem (Semmelweis University), Szigony Utca 36, Budapest, 1083, Hungary
| | - Ágnes Luka
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Semmelweis Egyetem (Semmelweis University), Szigony Utca 36, Budapest, 1083, Hungary
| | - Anita Gáborján
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Semmelweis Egyetem (Semmelweis University), Szigony Utca 36, Budapest, 1083, Hungary
- Department of Voice, Speech and Swallowing Therapy, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - László Tamás
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Semmelweis Egyetem (Semmelweis University), Szigony Utca 36, Budapest, 1083, Hungary
- Department of Voice, Speech and Swallowing Therapy, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Gábor Polony
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Semmelweis Egyetem (Semmelweis University), Szigony Utca 36, Budapest, 1083, Hungary
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Ni G, Monos S, Kortebein S, Symms J, Ettyreddy A, Hillman TA, Chen DA. Comparison of Outcomes with the Use of Different Heat-Activated Crimping Prostheses in Stapedotomy. Otol Neurotol 2024; 45:907-912. [PMID: 39142311 DOI: 10.1097/mao.0000000000004276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
OBJECTIVE To determine differences in failure rate and hearing outcomes of a completely encircling heat-activated crimping prosthesis (SMart 360°) compared to partially encircling prosthesis (SMart). STUDY DESIGN Retrospective chart review. SETTING Private neurotology tertiary referral center. PATIENTS Patients who underwent stapedotomies performed by the senior authors from 2008 to 2019 using the SMart prosthesis and SMart 360° prothesis. INTERVENTIONS Stapedotomy operations with placement of a SMart or SMart 360° prosthesis. MAIN OUTCOME MEASURES Incidence of early failure requiring revision surgery. Differences in preoperative air-bone gap (ABG) compared to postoperative ABG at 3 months, 1 year, and 2 years after surgery. RESULTS A total of 228 stapedotomies were performed (SMart n = 48 and SMart 360° n = 180). Mean preoperative ABG for SMart and SMart 360° were 26.15 and 29 dB, respectively. The mean difference in ABG for the SMart at 3 months, 1 year, and 2 years were 17, 18, and 11 dB, respectively. The mean difference in ABG for the SMart 360° at 3 months, 1 year, and 2 years were 20, 20, and 19 dB. ABG differences at 3 months (p = 0.10) and 1 year (p = 0.36) were not statistically different. The failure rate for the SMart prosthesis was 12.5% and for the SMart 360° 2.2% (p = 0.002). CONCLUSIONS There were no statistically significant differences in ABG changes for SMart compared to SMart 360°. The Smart 360 corrects the problem with early failure seen with the Smart prosthesis. PROFESSIONAL PRACTICE GAP AND EDUCATIONAL NEED Determination of most efficacious stapes prosthesis. LEARNING OBJECTIVE Which stapes prosthesis produces better hearing results with fewer failures. DESIRED RESULT To disseminate information necessary to choose the best stapes prosthesis for patients. LEVEL OF EVIDENCE Level III. INDICATE IRB OR IACUC 2022-029-agh.
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Affiliation(s)
- Garrett Ni
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Stylianos Monos
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | | | - John Symms
- Department of Otolaryngology-Head and Neck Surgery, St. Luke's Hospital, Bethlehem, Pennsylvania
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Bevis N, Hüser MA, Oestreicher D, Beutner D. Safety and efficacy of the mAXIS stapes prosthesis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08854-z. [PMID: 39069576 DOI: 10.1007/s00405-024-08854-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 07/16/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Otosclerosis leads to a fixed stapes footplate and thus to hearing loss. The predominant treatment method is surgery, with various types of stapes prostheses available. The aim of this study was to investigate the safety and efficacy of the new mAXIS Stapes Prosthesis. METHODS 34 cases of otosclerosis were implanted with the new mAXIS Stapes Prosthesis. Comprehensive clinical assessments, including pre- and postoperative pure tone audiometry was performed at short-term (ST) follow-up at 25 (± 15) days and mid-term (MT) follow-up at 181 (± 107) days. The pure tone average of 0.5, 1, 2 and 3 kHz (PTA4) was calculated. RESULTS In all cases, the application of the prosthesis was successful and straightforward. The postoperative PTA4 air-bone gap was 10.7 ± 5.2 dB at ST follow-up (n = 34) and 8.3 ± 4.1 dB at MT follow-up (n = 18). In 61% of cases, the ABG-closure was within 10 dB and in 100% of cases within 20 dB at MT follow-up. CONCLUSION Findings of this study support that the mAXIS Stapes Prosthesis is safe for implantation and shows promising audiological outcome. Future investigations will contribute its long-term efficacy and safety profile.
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Affiliation(s)
- Nicholas Bevis
- Department of Otorhinolaryngology, Head and Neck Surgery, Nicholas Bevis, University Medical Center Goettingen, Robert-Koch- Straße 40, 37075, Goettingen, Germany.
| | - Marc A Hüser
- Department of Otorhinolaryngology, Head and Neck Surgery, Nicholas Bevis, University Medical Center Goettingen, Robert-Koch- Straße 40, 37075, Goettingen, Germany
| | - David Oestreicher
- Department of Otorhinolaryngology, Head and Neck Surgery, Nicholas Bevis, University Medical Center Goettingen, Robert-Koch- Straße 40, 37075, Goettingen, Germany
| | - Dirk Beutner
- Department of Otorhinolaryngology, Head and Neck Surgery, Nicholas Bevis, University Medical Center Goettingen, Robert-Koch- Straße 40, 37075, Goettingen, Germany
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Couvreur F, Schlegel-Wagner C, Linder T. Impact of manual crimping on stapedotomy outcomes. J Laryngol Otol 2023; 137:1027-1033. [PMID: 36263732 DOI: 10.1017/s0022215122002316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The impact of tight stapes crimping on hearing is a matter of debate. Several studies postulate that tight crimping is essential for lifelong success, whereas others have debated whether firm attachment leads to incus necrosis. Several types of prostheses with different coupling mechanisms have been developed, and manual crimping remains the most frequently used technique. This study investigates whether tightness really does affect hearing outcome. METHODS The hearing results of patients who underwent primary stapedotomies using three different titanium pistons were analysed. The surgeons categorised the firmness of the piston attachment into 'tight' and 'loose' crimping groups. Hearing outcome and reasons for revision surgical procedures were investigated. RESULTS The mean post-operative air-bone gap for frequencies of 0.5-4 kHz was 8.80 dB for the tight crimping group (n = 308) and 9.55 dB for the loose crimping group (n = 39). No significant difference was found (p = 0.4650). Findings at revision procedures were comparable (1.6 per cent vs 5 per cent). CONCLUSION Although firm crimping is strongly advised, a movable loop upon palpation does not lead to unsatisfactory hearing results, and does not mandate piston replacement or bone cement use.
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Affiliation(s)
- F Couvreur
- Department of Otorhinolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, AZ Sint-Jan Hospital, Bruges, Belgium
| | - C Schlegel-Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - T Linder
- Department of Otorhinolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
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Sharaf K, Müller J. [Revision surgery after stapedectomy]. HNO 2023; 71:535-546. [PMID: 37470870 DOI: 10.1007/s00106-023-01326-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/21/2023]
Abstract
Revision stapes surgery is considered to be significantly more demanding than primary stapes surgery, both in terms of the indication and the surgical approach. This article reviews common indications for revision after stapedectomy as well as the surgical approaches and intraoperative findings. A distinction is made between revision surgeries, which are usually carried out because of conductive hearing loss a long time after stapes surgery, and acute or subacute revisions that become necessary in the immediate postoperative course. With the shortening of postoperative observation times under inpatient conditions as a result of increasing economization and the associated shift of the immediate postoperative phase to the outpatient setting, the recognition of postoperative irregularities is also becoming increasingly important for otorhinolaryngologists in private practice, even if they do not perform these highly specialized interventions themselves.
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Affiliation(s)
- Kariem Sharaf
- Klinik und Poliklinik für Hals‑Nasen-Ohrenheilkunde, LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland
| | - Joachim Müller
- Klinik und Poliklinik für Hals‑Nasen-Ohrenheilkunde, LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland.
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Normant S, Gendre A, Boucher S, Godey B, Bordure P, Michel G. Predictive factors of revision stapes surgery in otosclerosis. J Laryngol Otol 2023; 137:906-909. [PMID: 36511130 DOI: 10.1017/s0022215122002572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study aimed to investigate predictive factors for revision surgery in otosclerosis. METHODS This was a retrospective, multicentre study in four tertiary centres. The primary objective was to investigate factors that were predictive of the need for revision stapes surgery. RESULTS The 'revision' group included 145 patients, and the 'control' group included 143 patients. This study identified statistically significant predictive factors for the need for revision surgery: younger age, active smoking status, dyslipidaemia and high blood pressure. There was no statistically significant difference between the two groups in terms of surgical technique or stapedotomy technique. CONCLUSION This study showed that patients who are candidates for primary stapes surgery with younger age, active smoking status, dyslipidaemia and high blood pressure are at higher risk of needing revision surgery. A holistic approach prior to stapes surgery with multidisciplinary assessment is recommended. These results are important for better patient counselling on expected outcomes and risks.
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Affiliation(s)
- S Normant
- Department of Otorhinolaryngology, University Hospital of Nantes, France
| | - A Gendre
- Department of Otorhinolaryngology, University Hospital of Nantes, France
| | - S Boucher
- Department of Otorhinolaryngology, University Hospital of Angers, France
| | - B Godey
- Department of Otorhinolaryngology, University Hospital of Rennes, France
| | - P Bordure
- Department of Otorhinolaryngology, University Hospital of Nantes, France
| | - G Michel
- Department of Otorhinolaryngology, University Hospital of Nantes, France
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Vliet SM, Markey KJ, Lynn SG, Adetona A, Fallacara D, Ceger P, Choksi N, Karmaus AL, Watson A, Ewans A, Daniel AB, Hamm J, Vitense K, Wolf KA, Thomas A, LaLone CA. Weight of evidence for cross-species conservation of androgen receptor-based biological activity. Toxicol Sci 2023; 193:131-145. [PMID: 37071731 PMCID: PMC10796108 DOI: 10.1093/toxsci/kfad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
The U.S. Environmental Protection Agency's Endocrine Disruptor Screening Program (EDSP) is tasked with assessing chemicals for their potential to perturb endocrine pathways, including those controlled by androgen receptor (AR). To address challenges associated with traditional testing strategies, EDSP is considering in vitro high-throughput screening assays to screen and prioritize chemicals more efficiently. The ability of these assays to accurately reflect chemical interactions in nonmammalian species remains uncertain. Therefore, a goal of the EDSP is to evaluate how broadly results can be extrapolated across taxa. To assess the cross-species conservation of AR-modulated pathways, computational analyses and systematic literature review approaches were used to conduct a comprehensive analysis of existing in silico, in vitro, and in vivo data. First, molecular target conservation was assessed across 585 diverse species based on the structural similarity of ARs. These results indicate that ARs are conserved across vertebrates and are predicted to share similarly susceptibility to chemicals that interact with the human AR. Systematic analysis of over 5000 published manuscripts was used to compile in vitro and in vivo cross-species toxicity data. Assessment of in vitro data indicates conservation of responses occurs across vertebrate ARs, with potential differences in sensitivity. Similarly, in vivo data indicate strong conservation of the AR signaling pathways across vertebrate species, although sensitivity may vary. Overall, this study demonstrates a framework for utilizing bioinformatics and existing data to build weight of evidence for cross-species extrapolation and provides a technical basis for extrapolating hAR-based data to prioritize hazard in nonmammalian vertebrate species.
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Affiliation(s)
- Sara M.F. Vliet
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Computational Toxicology and Exposure, Scientific Computing and Data Curation Division, Duluth, MN, USA
| | - Kristan J. Markey
- U.S. Environmental Protection Agency, Office of Pesticide Programs, Endocrine Disrupter Screening Program, Washington, DC, USA
| | - Scott G. Lynn
- U.S. Environmental Protection Agency, Office of Pesticide Programs, Endocrine Disrupter Screening Program, Washington, DC, USA
| | | | | | | | | | | | | | | | | | | | - Kelsey Vitense
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Computational Toxicology and Exposure, Scientific Computing and Data Curation Division, Duluth, MN, USA
| | | | - Amy Thomas
- Battelle Memorial Institute, Columbus, OH, USA
| | - Carlie A. LaLone
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Computational Toxicology and Exposure, Great Lakes Toxicology and Ecology Division, Duluth, MN, USA
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8
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Audiological outcome after stapes surgery in relation to prosthesis type. Eur Arch Otorhinolaryngol 2023; 280:3171-3176. [PMID: 36707432 DOI: 10.1007/s00405-023-07822-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/02/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE Different techniques are used to fix crimp and CliP® Piston stapes prostheses to the long process of the incus (LPI). The CliP® Piston provides a stiff connection in contrast to the static bended loop of the crimp prosthesis, which imitates the physiological incudostapedial joint (ISJ) and thereby potentially leads to different hearing outcome. METHODS In a retrospective single-center study of German-speaking one hundred and ninety patients who underwent stapes surgery CliP® Piston or crimp prostheses between the years of 2016 and 2019 by the same surgeon and in the same setting. Pre- and postoperative bone- (BC) and air-conduction (AC) pure-tone thresholds, pre- and postoperative air-bone gap (ABG) for 0.5, 1, 1.5, 2, 3, 4 kHz and the surgery time were examined. RESULTS The postoperative bone conduction thresholds were significantly lower in the frequencies between 0.5 and 3 kHz and the mean ABG was < 10 dB in most cases independent of the prosthesis used. Crimp prosthesis showed a significantly better closure of the ABG at 0.5 kHz. CONCLUSIONS The audiological outcome after stapes surgery is dependent on the type of prosthesis used, as reflected by the frequency-specific air-bone gap. The better ABG closure with the crimp prosthesis might be the result of the connection to the LPI imitating the physiological ISJ. The crimp prosthesis may be the better choice if use of hearing aids is expected postoperatively.
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Long-Term Audiometric Outcomes of a Self-Crimping Stapes Prosthesis With CO 2 Laser Stapedotomy. Otol Neurotol 2022; 43:1005-1010. [PMID: 36026603 DOI: 10.1097/mao.0000000000003662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate our experience with a self-crimping stapes prosthesis. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS All patients diagnosed with otosclerosis who underwent surgery between June 2013 and June 2020. Inclusion criteria were 18 years or older, isolated stapes ankylosis, and at least 1 year of postoperative audiologic data. INTERVENTIONS CO 2 laser stapedotomy undertaken by the same surgeon using the same CO 2 laser stapedotomy technique and the same prosthesis. MAIN OUTCOME MEASURES Preoperative and postoperative audiologic data including air-bone gap (ABG) measurements, average speech discrimination score and pure-tone averages (PTAs). Postoperative hearing assessments were performed at 3 weeks, 3 months, 6 months, 1 year, and annually thereafter. RESULTS Two hundred fourteen patients were included in the study, of whom 17 had bilateral sequential surgery for a total of 231 ears. Mean preoperative air conduction-PTA was 58.8 dB and mean preoperative bone conduction-PTA 24.2 dB, a preoperative ABG of 34.6 dB. One year postoperatively, mean air conduction-PTA improved to 31.2 dB ( p < 0.0001). ABG showed a significant improvement from 34.6 to 5.5 dB ( p < 0.0001). Closure of the ABG to within 10 dB was achieved in 87% ears at 3 months, in 91% at 6 months, and in 93% at 1 year. There was no significant difference in preoperative and postoperative average speech discrimination score. CONCLUSION The current study demonstrates favorable audiologic outcomes in a large cohort of patients using a self-crimping stapes prosthesis. These results were stable for up to 7 years on follow-up.
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Stapes and Stapes Revision Surgery: Preoperative Air-Bone Gap Is a Prognostic Marker. Otol Neurotol 2021; 42:985-993. [PMID: 34260505 DOI: 10.1097/mao.0000000000003145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Stapes surgery is considered an effective treatment in otosclerosis, but controversy remains regarding predictors of surgical outcome. STUDY DESIGN Retrospective cohort study. SETTING Tertiary referral center. PATIENTS One hundred sixty three cases of stapes surgery between 2012 and 2019 were reviewed. MAIN OUTCOME MEASURES Primary outcome measures were relative hearing improvement (relHI), defined as preoperative minus postoperative air conduction divided by preoperative air-bone gap (ABG), as well as relative ABG closure (relABGc), defined as preoperative ABG minus postoperative ABG divided by preoperative ABG. Univariate and multivariate linear regression analyses were performed to determine independent predictors for these outcomes. RESULTS Higher preoperative bone conduction (BC) and primary surgery (compared with revision) were independently associated with increased relHI (p = 0.001 and p = 0.004, respectively). Lower preoperative BC, higher preoperative ABG, primary surgery, and age were independently associated with increased relABGc (p = 0.0030, p < 0.001, p = 0.0214, and p = 0.0099, respectively). Sex did not predict surgical outcome. In patients with less than 20 dB preoperative ABG, likelihood of negative relABGc was increased (compared with 20-30 dB or >30 dB preoperative ABG, p = 0.0292, Fisher's exact test). This tendency was not significant for relHI (p = 0.074). CONCLUSIONS Our findings demonstrate that calculating HI and ABGc in relation to preoperative ABG can reliably predict outcomes of stapes surgery. Both primary and revision stapes surgery are effective treatment options, but relative improvement is higher in primary cases. Preoperative BC, preoperative ABG, and age predict surgical outcomes as well. Otosclerosis patients with low preoperative ABG, especially less than 20 dB, should be counseled and selected cautiously regarding stapes surgery.
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Comparing intermediate-term hearing results of NiTiBOND and Nitinol prostheses in stapes surgery. The Journal of Laryngology & Otology 2021; 135:795-798. [PMID: 34266511 DOI: 10.1017/s0022215121001821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To statistically analyse the hearing thresholds of two cohorts undergoing stapedotomy for otosclerosis with two different prostheses. METHOD A retrospective study was conducted comparing NiTiBOND (n = 53) and Nitinol (n = 38) prostheses. RESULTS Average follow-up duration was 4.1 years for NiTiBOND and 4.4 years for Nitinol prostheses. The post-operative air-bone gap was 10 dB or less, indicating clinical success. The p-values for differences between (1) pre- and post-operative values in the NiTiBOND group, (2) pre- and post-operative values in the Nitinol group, (3) pre-operative values and (4) post-operative values in the two groups were: air-bone gap - p < 0.001, p < 0.001, p = 0.631 and p = 0.647; four-frequency bone conduction threshold - p = 0.076, p = 0.129, p < 0.001 and p = 0.005; four-frequency air conduction threshold - p < 0.001, p < 0.001, p = 0.043 and p = 0.041; three-frequency (1, 2 and 4 kHz) bone conduction threshold pre-operatively - p = 0.639, p = 0.495, p = 0.001 and p = 0.01; and air conduction threshold at 4 kHz: - p < 0.001, p < 0.001, p = 0.03 and p = 0.058. CONCLUSION Post-operative audiological outcomes for NiTiBOND and Nitinol were comparable.
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De Vito A, Mandalà M, Soprani F, Iannella G, Roustan V, Viberti F, Livi L, Pelucchi S, Napoli G, Maniaci A, Cocuzza S, Vicini C. Conventional approaches versus laser CO2 surgery in stapes surgery: a multicentre retrospective study. Eur Arch Otorhinolaryngol 2021; 279:2321-2327. [PMID: 34115200 DOI: 10.1007/s00405-021-06926-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/31/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To analyze and compare surgical and audiological outcomes of conventional approaches versus laser CO2 surgery in stapes surgery. METHODS 333 patients who underwent stapes surgery were enrolled in the study; the patient population was divided into three groups: group 1: 170 patients treated with conventional stapedotomy with manual microdrill (average age 49.13 years); group 2: 119 patients treated with conventional stapedotomy with electrical microdrill (average age 51.06 years); group 3: 44 patients (average age 50.4 years) who underwent CO2 laser stapedotomy. Intra-operative, postoperative outcomes and audiological results were investigated. RESULTS The average surgical time of laser CO2 surgery was longer than for other surgical procedures. No statistical differences emerged in post-operative abnormal taste sensation. There was also no difference in postoperative dizziness. Air-bone gap (ABG) went down from 29.7 ± 10 dB (group 1) and 27.32 ± 9.20 (group 2) to 10 ± 6.9 dB (group 1) and 10.7 ± 6.03 dB (group 2). In group 3 the preoperative ABG was lowered from 28.3 ± 10.1 to 11.8 ± 10.9, with a statistical difference in auditory recovery (p = 0.0001); The group of patients treated with laser CO2 showed a percentage of patients with an ABG closure of between 0 and 10 dB higher than in the group treated with manual microdrills (77.2% vs. 60%, respectively; p = 0.03). CONCLUSION Overall surgical results of CO2 laser and conventional stapedotomy are comparable without any significant difference; however, the group treated with CO2 laser appears to have a percentage of patients with an ABG closure 0-10 dB higher than the group treated using the conventional technique.
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Affiliation(s)
- Andrea De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, "Santa Maria Delle Croci" Hospital, Ravenna, Italy
| | - Marco Mandalà
- Department of Otolaryngology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Francesco Soprani
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, "Santa Maria Delle Croci" Hospital, Ravenna, Italy
| | - Giannicola Iannella
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy. .,, Via Satrico 7, 00183, Rome, Italy.
| | - Valeria Roustan
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, "Santa Maria Delle Croci" Hospital, Ravenna, Italy
| | - Francesca Viberti
- Department of Otolaryngology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Ludovica Livi
- Department of Otolaryngology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Stefano Pelucchi
- Department ENT and Audiology, University of Ferrara, Ferrara, Italy
| | - Gloria Napoli
- Department ENT and Audiology, University of Ferrara, Ferrara, Italy
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy.,Department ENT and Audiology, University of Ferrara, Ferrara, Italy
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Conway RM, Babu SC, Sioshansi PC, Howard AL, Tu NC, Minutello K, Schettino AE, Bojrab DI, Schutt CA. Effect of Surgical Start Time on Stapedotomy Outcomes. Otol Neurotol 2021; 42:e987-e990. [PMID: 34049326 DOI: 10.1097/mao.0000000000003204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine if performing stapedotomy as the first case of the day provides improved outcomes compared with those performed later in the day. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Adult patients undergoing stapedotomy for otosclerosis. MAIN OUTCOME MEASURES Patients were separated into either a first case group or a later case group based on surgical start time. Audiologic outcomes and complications were compared between the two groups. RESULTS The first case group had a smaller postoperative air-bone gap (ABG) compared with the later case group of 9.81 dB HL compared with 11.73dB HL and 3.79 dB HL compared with 6.29 dB HL at 1000 and 2000 Hz, respectively (p = 0.03, p < 0.01). The mean postoperative ABG was 10.63 dB HL for the first start group compared with 12.12 dB HL for the later start group, which was statistically significant (p = 0.05). CONCLUSIONS First start stapedotomy is associated with slightly improved audiologic outcomes compared with those starting later in the day, although both groups had significantly improved postoperative outcomes overall. There was no significant difference in complications when comparing stapedotomy by case start time.
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Affiliation(s)
- Robert M Conway
- Department of Otolaryngology-Head and Neck Surgery, Ascension Macomb-Oakland Hospital, Madison Heights
| | | | | | - Anthony L Howard
- Department of Otolaryngology-Head and Neck Surgery, Ascension Macomb-Oakland Hospital, Madison Heights
| | | | - Katrina Minutello
- Michigan State University College of Osteopathic Medicine, East Lansing, Michigan
| | - Amy E Schettino
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philidelphia, Pennsylvania
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Abstract
OBJECTIVE To evaluate the influence of different piston variables on hearing following stapedotomy. METHODS Data were analysed in groups according to: piston material (titanium vs fluoroplastic), shaft diameter (0.4 mm vs 0.5 mm) and crimping style (manual crimping vs self-crimping). Pre- and post-operative average air-bone gap, air-bone gap difference, success rate and operative time were evaluated. RESULTS AND CONCLUSION Fifty-one patients (58 ears) were included. A post-operative air-bone gap of 10 dB or lower was achieved in 44 cases, with a success rate of 75.9 per cent; 52 cases (89.7 per cent) had an air-bone gap of 20 dB or lower. The success rate was higher, but not significantly, in fluoroplastic than in titanium pistons (85 per cent vs 70 per cent). Pistons with shaft diameters of 0.5 mm and 0.4 mm had success rates of 79 per cent and 72 per cent, respectively. No significant differences were found for any audiometric parameters. There were no significant differences between manual crimping and self-crimping pistons in terms of audiometric results or success rate.
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Martinez-Monedero R, Danielian A, Angajala V, Dinalo JE, Kezirian EJ. Methodological Quality of Systematic Reviews and Meta-analyses Published in High-Impact Otolaryngology Journals. Otolaryngol Head Neck Surg 2020; 163:892-905. [PMID: 32450783 DOI: 10.1177/0194599820924621] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the methodological quality of intervention-focused systematic reviews (SRs) and meta-analyses (MAs) published in high-impact otolaryngology journals. DATA SOURCES Ovid Medline, Embase, and Cochrane Library. REVIEW METHODS A comprehensive search was performed for SR and MA citations from 2012 to 2017 in the 10 highest impact factor otolaryngology journals. Abstracts were screened to identify published manuscripts in which the authors indicated clearly that they were performing an SR or MA. Applying a modified typology of reviews, 4 reviewers characterized the review type as SR, MA, or another review type. A simplified version of the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews 2) tool was used to assess the reporting and methodological quality of the SRs and MAs that were focused on interventions. RESULTS Search and abstract screening generated 499 manuscripts that identified themselves as performing an SR or MA. A substantial number (85/499, 17%) were review types other than SRs or MAs, including 34 (7%) that were literature reviews. In total, 236 SRs and MAs focused on interventions. Over 50% of these SRs and MAs had weaknesses in at least 3 of the 16 items in the AMSTAR 2, and over 40% had weaknesses in at least 2 of the 7 critical domains. Ninety-nine percent of SRs and MAs provided critically low confidence in the results of the reviews. CONCLUSION Intervention-focused SRs and MAs published in high-impact otolaryngology journals have important methodological limitations that diminish confidence in the results of these reviews.
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Affiliation(s)
- Rodrigo Martinez-Monedero
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of USC, California, USA
| | - Arman Danielian
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Varun Angajala
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Jennifer E Dinalo
- Health Sciences Libraries, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Eric J Kezirian
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of USC, California, USA
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Dziendziel B, Skarzynski H, Gos E, Skarzynski PH. Changes in Hearing Threshold and Tinnitus Severity after Stapes Surgery: Which Is More Important to the Patient's Quality of Life? ORL J Otorhinolaryngol Relat Spec 2019; 81:224-233. [PMID: 31315120 DOI: 10.1159/000500992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/15/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Stapes surgery is a common method of treatment of otosclerosis, and its effectiveness is reported based on audiometric hearing thresholds. Audiometric tests do not gauge the impact of tinnitus severity and auditory function on quality of life (QOL) after stapes surgery. OBJECTIVE To measure self-assessed QOL in otosclerosis patients after stapedotomy in terms of three major factors: change in audiometric hearing threshold, subjective hearing benefit, and tinnitus severity. METHOD This prospective clinical study included 191 patients who underwent stapedotomy between April and October 2017 due to otosclerosis. All patients were tested by pure tone audiometry and filled in a questionnaire before surgery and 6 months afterwards. Subjective hearing was assessed with the Abbreviated Profile for Hearing Aid Benefit (APHAB); tinnitus severity was established using the Tinnitus Functional Index (TFI), and the QOL was measured by the Glasgow Benefit Inventory (GBI). RESULTS Statistical analysis showed that the average GBI total score (mean = 33.7; SD = 23.7) was statistically significantly higher than zero (t = 19.7; p < 0.001). Based on a regression model, all the three variables studied - audiometric hearing thresholds change, APHAB change, and TFI change - had a significant effect on QOL after stapedotomy. Interestingly, the highest beta value (b = 0.040; p < 0.001) was for TFI change, implying that TFI change had the greatest effect on QOL. CONCLUSION Although the improvement of QOL after stapes surgery undoubtedly depended on improvement in both audiometric and self-reported hearing, the reduction of tinnitus severity had the greatest impact on increase in QOL.
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Affiliation(s)
- Beata Dziendziel
- Teleaudiology and Screening Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Henryk Skarzynski
- Oto-Rhino-Laryngology Surgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Elzbieta Gos
- Teleaudiology and Screening Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Piotr H Skarzynski
- Teleaudiology and Screening Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland, .,Heart Failure and Cardiac Rehabilitation Department, 2nd Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland, .,Institute of Sensory Organs, Kajetany, Poland,
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