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Hamead K, Talaat M, Hafez MA, Gamal R, elAziz AAA, Abdelaal Abdelhady O, Abdelmoneim RA, Hamad AH. Comparison of Bone Cement Fixation for Stapes Prostheses with Different Materials in Endoscopic Primary Stapedectomy. Indian J Otolaryngol Head Neck Surg 2024; 76:3353-3363. [PMID: 39130295 PMCID: PMC11306481 DOI: 10.1007/s12070-024-04687-8] [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: 01/04/2024] [Accepted: 04/04/2024] [Indexed: 08/13/2024] Open
Abstract
Otosclerosis is a complex skeletal condition that originates from both hereditary and environmental factors. Gradual conductive hearing loss is the main character. Aim to contrast and assess the postoperative results, such as hearing improvement, following the use of bone cement to fix the Titanium versus Teflon stapes piston. 50 patients who had endoscopic stapedotomy with different prostheses insertions were included in this prospective, randomized research. They were splitted into two groups in the: group A consisted of 25 ears in which titanium prostheses with bone cement were applied, while group B consisted of 25 ears Teflon prostheses with bone cement were used. A statistically significant difference was observed in average air conduction (better hearing) between groups A and B at 3, 6, and 12 months postoperatively based on audiometric results. When comparing groups B and A after 3, 6, and 12 months after surgery, the average air bone gap (ABG) was greater in group B, and this difference was statistically significant. Between the two groups, there was no discernible variation in any of the preoperative metrics. 96% of groups A and B were successful. Using bone cement in primary stapedotomy may help fix the procedure and reduce the chance of persistent hearing loss in patients with otosclerosis. This is especially true when titanium is used, as titanium has the ideal mass and stiffness to support acoustic transmission with a low rate of adverse effects and better average ABG.
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Affiliation(s)
- Khalaf Hamead
- Department of Otorhinolaryngology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mostafa Talaat
- Department of Otorhinolaryngology, Faculty of Medicine, Minia University, Minia, Egypt
| | | | - Reham Gamal
- Audiology unit, Department of Otorhinolaryngology, Faculty of Medicine, Minia University, Minia, Egypt
| | | | | | | | - AbdelMoneim H. Hamad
- Department of Otorhinolaryngology, Faculty of Medicine, Minia University, Minia, Egypt
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Wang D, Peng F, Lin N, Wang W. Microdrill Versus Diode Laser in Endoscopic Stapedotomy: A Comparative Study. Otol Neurotol 2024; 45:489-494. [PMID: 38530360 DOI: 10.1097/mao.0000000000004177] [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: 03/27/2024]
Abstract
BACKGROUND Microdrill and diode laser are two different methods used in endoscopic stapedotomy for otosclerosis. These two methods have not been compared in endoscopic stapedotomy. AIMS/OBJECTIVES To analyze the differences between microdrill and diode laser in endoscopic stapedotomy for otosclerosis. MATERIALS AND METHODS This is a randomized clinical trial; patients with otosclerosis were randomly divided into microdrill group (group A: n = 69) and diode laser group (group B: n = 62). Differences between the two groups were then compared. RESULTS The preoperative air-bone gap (ABG) was 25.40 ± 10.88 dBHL in group A and 24.84 ± 12.23 dBHL in group B, with no significant between-group difference ( p > 0.05). The postoperative ABG in group A was 13.27 ± 9.91 dBHL versus 11.79 ± 10.82 dBHL in group B, and there was no significant difference between the groups ( p > 0.05). The surgical time in group B (64 ± 31.23 minutes) was significantly longer than that in group A (48 ± 25.62 minutes) ( p = 0.02). There were no significant between-group differences in basic patient-related data, preoperative air conduction (AC), preoperative bone conduction (BC), postoperative AC, distribution of postoperative ABG, preoperative ABG at different frequencies, and postoperative ABG at different frequencies. There was also no significant between-group difference in the average bleeding volume or number of patients with postoperative dizziness. CONCLUSION AND SIGNIFICANCE The postoperative improvement in hearing level in the two group was equivalent, but group A had the advantage of a shorter operation time. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Dan Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University and Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200031, China
| | - Fan Peng
- Department of otolaryngology, Taizhou Central Hospital, Taizhou 318000, China
| | - Nina Lin
- Otolaryngology Treatment Room, Affiliated Eye and ENT Hospital, Fudan University, Shanghai 200031, China
| | - Wuqing Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University and Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200031, China
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Conway RM, Fan CJ, Choi JS, Babu K, Mallany HP, Babu SC. Exoscope-Assisted Stapedotomy: Evaluation of Safety and Efficacy. Otol Neurotol 2023; 44:978-982. [PMID: 37939357 DOI: 10.1097/mao.0000000000004042] [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: 11/10/2023]
Abstract
OBJECTIVE Evaluate the safety and efficacy of exoscope-assisted stapedotomy. STUDY DESIGN Retrospective chart review. SETTING Tertiary care neurotology clinic. PATIENTS Adult patients with otosclerosis undergoing stapedotomy. INTERVENTIONS Primary stapedotomy. MAIN OUTCOME MEASURES Evaluation of audiologic outcomes, including pure-tone average, bone-conduction thresholds, word recognition score, and air-bone gap. Complications, need for scutum removal, and length of surgery were also evaluated. RESULTS A total of 47 patients were identified, and 24 patients underwent surgery with the microscope and 22 with the exoscope. There were significant improvements in pure-tone average, mean bone-conduction thresholds, and air-bone gap for both groups. There was no difference in preoperative or postoperative audiologic status for either group. There was no difference in rates of dysgeusia, chorda tympani nerve damage, dizziness, or facial paresis in either group. CONCLUSIONS This study indicates similar audiologic outcomes, complication profiles, and visualization when comparing exoscopic and microscopic stapedotomy. Demonstrated here, exoscopic stapedotomy can be safely performed in a transcanal manner.
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Affiliation(s)
| | | | | | - Kavan Babu
- Michigan State University, East Lansing, Michigan
| | - Hugh P Mallany
- University of New England School of Osteopathic Medicine, Biddeford, Maine
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Soloperto D, Laura E, Gazzini L, Cerullo R, Ferrulli G, Nocini R, Molteni G, Marchioni D. Exclusive endoscopic ossiculoplasty with autologous material: step-by-step procedure and functional results. Eur Arch Otorhinolaryngol 2023; 280:4869-4878. [PMID: 37160464 DOI: 10.1007/s00405-023-08005-w] [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] [Received: 12/26/2022] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE To describe the surgical procedure of exclusive endoscopic ossiculoplasty (EEO) with autologous grafts and evaluate audiological results, focusing on the advantages or drawbacks compared to the corresponding microscopic technique. METHODS A retrospective review of consecutive adult and pediatric patients affected by chronic otitis media (COM) with or without cholesteatoma who underwent EEO was conducted. Only autologous ossiculoplasty was included in the study. The procedure was performed by experienced surgeons of our institution between November 2014 and September 2019. Hearing outcomes were evaluated using postoperative air-bone gap (ABG) and success rates in different subgroups of patients and different types of ossiculoplasty (OPL) were analyzed. Our results were finally compared with the existing literature regarding both microscopic and endoscopic ossicular chain reconstruction. RESULTS In total, 74 endoscopic ossicular chain repair procedures performed within the study period met the inclusion criteria. Of these, 21 were pediatric patients (28%) and 53 were adults (72%). Surgical reconstruction procedures included 43 partial ossicular reconstructions (POR) and 31 total ossicular reconstructions (TOR). The postoperative ABG improved significantly compared to preoperative measurements, and the mean ABG closure was 7.85 dB HL (p = 0.00064). No statistically significant differences in audiological outcomes between TOR/POR techniques and pediatric/adult groups were found in our study cohort, with p values of 0.10 and 0.88, respectively. CONCLUSIONS At present, EEO can be considered a valid surgical option for re-establishing a functioning ossicular chain with acceptable hearing restoration in children and adults. Further reports in wider case series are required to confirm these results.
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Affiliation(s)
- Davide Soloperto
- Division of Otolaryngology, Head and Neck Surgery Department, University Hospital of Verona, Piazzale L. A. Scuro 10, 37134, Verona, Italy
| | - Elisa Laura
- Division of Otolaryngology, Head and Neck Surgery Department, University Hospital of Verona, Piazzale L. A. Scuro 10, 37134, Verona, Italy
| | - Luca Gazzini
- Otolaryngology-Head and Neck Surgery Department, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Raffaele Cerullo
- Division of Otolaryngology, Head and Neck Surgery Department, University Hospital of Verona, Piazzale L. A. Scuro 10, 37134, Verona, Italy.
| | - Giuseppe Ferrulli
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Riccardo Nocini
- Division of Otolaryngology, Head and Neck Surgery Department, University Hospital of Verona, Piazzale L. A. Scuro 10, 37134, Verona, Italy
| | - Gabriele Molteni
- Division of Otolaryngology, Head and Neck Surgery Department, University Hospital of Verona, Piazzale L. A. Scuro 10, 37134, Verona, Italy
| | - Daniele Marchioni
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
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Colvin S, Lepcha A, Augustine AM, Philip A, Mammen MD. A retrospective study on the outcomes of stapedotomy with vein graft interposition and vein graft surround techniques. J Laryngol Otol 2023; 137:1048-1053. [PMID: 37017076 DOI: 10.1017/s0022215123000580] [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: 04/06/2023]
Abstract
OBJECTIVE This study evaluated audiological outcomes of stapedotomy using two different techniques, vein graft interposition and vein graft surround, for sealing the stapes fenestra. METHOD A retrospective study of 130 patients who underwent stapedotomy for otosclerosis was performed. A total of 84 patients underwent the vein graft surround procedure and 46 underwent the vein graft interposition procedure. Post-operative hearing outcome was compared between them. RESULTS A total of 55 of 130 patients had a post-operative air-bone gap of less than 10 dB. A total of 57 patients had an air-bone gap within 20 dB. The average air-bone gap was 13.16 dB at 3 months with a mean improvement of 22.06 dB (11.98 dB for vein graft interposition and 13.80 dB for vein graft surround; p = 0.79). CONCLUSION There was no significant difference in hearing outcome between the two techniques. The vein graft interposition technique is preferred for large fenestra or stapedectomy cases and in cerebrospinal fluid gusher cases. The vein graft surround technique is easier to perform and preferred in small fenestra stapedotomy.
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Affiliation(s)
- S Colvin
- Department of ENT, Christian Medical College, Vellore, India
| | - A Lepcha
- Department of ENT, Christian Medical College, Vellore, India
| | - A M Augustine
- Department of ENT, Christian Medical College, Vellore, India
| | - A Philip
- Department of ENT, Christian Medical College, Vellore, India
| | - M D Mammen
- Department of ENT, Christian Medical College, Vellore, India
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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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Fernandez IJ, Rondini F, Presutti L, Molinari G. Recurrence of conductive hearing loss after stapes surgery: a narrative review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:S56-S60. [PMID: 37698101 PMCID: PMC10159633 DOI: 10.14639/0392-100x-suppl.1-43-2023-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/17/2023] [Indexed: 09/13/2023]
Abstract
Among the functional failures of stapes surgery is recurrent conductive hearing loss, which can occur after a variable period of hearing improvement, from days/months up to many years after surgery. The most common cause of recurrent conductive hearing loss is prosthesis displacement, while fibrous adhesions or stapedotomy hole/oval window re-obliteration due to otosclerosis, occur less frequently. High resolution computed tomography plays an important role in the identification of the cause of hearing loss recurrence. Parallel to this, intra-operative exploration of the middle ear is crucial to confirm the cause of failure and address its treatment, possibly restoring hearing. While generally worse than after primary surgery, hearing outcomes after revision stapes surgery have improved thanks to advancements in pre-operative assessment, intra-operative view and technical refinements.
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Affiliation(s)
| | | | | | - Giulia Molinari
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Specialistic, Diagnostic and Experimental Medicine, Alma Mater Studiorum University, Bologna, Italy
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8
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Plodpai Y. The utility and safety of diode laser in endoscopic stapes surgery. Laryngoscope Investig Otolaryngol 2023; 8:561-567. [PMID: 37090885 PMCID: PMC10116957 DOI: 10.1002/lio2.1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/23/2023] [Accepted: 03/10/2023] [Indexed: 04/25/2023] Open
Abstract
Objective The advantages of laser stapedotomy are less trauma and more precise and minimally invasive techniques; however, the potential risk of overheating from the laser combined with the endoscope tip must be considered. This study aimed to assess the efficacy and safety of diode lasers for endoscopic stapes surgery. Methods A retrospective review of 56 patients with otosclerosis who underwent primary endoscopic stapedotomy with a diode laser from 2017 to 2020 was conducted. Demographic data, intraoperative findings, preoperative and postoperative audiological assessments, and postoperative complications were analyzed. Results There was no statistically significant difference between the preoperative and postoperative bone conduction thresholds. The mean postoperative air-bone gap (ABG) improved significantly compared to the preoperative ABG (4.07 vs. 35.43 dB, p < .001). The postoperative ABG closure within 10 dB at 6 and 12 months was achieved in 87.50% and 91.07% of patients, respectively. The postoperative pain scores at 4 and 24 h were 2.55 and 0.39, respectively. Immediate postoperative vertigo was reported in 12.50% of patients, with 100% complete recovery 2 months after surgery. The chorda tympani nerve was preserved in all the cases. Postoperative taste disturbances at 2 and 12 months were observed in 17.86% and 1.79% of patients, respectively. Conclusion The diode laser in endoscopic stapedotomy is a safe and effective technique that provides satisfactory hearing outcomes. Temporary taste disturbances during the early postoperative period are a concern. The handheld diode laser delivery system is suitable for an endoscopic approach and is an alternative armamentarium for the treatment of otosclerosis. Level of evidence: IV.
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Affiliation(s)
- Yuvatiya Plodpai
- Department of Otolaryngology Head and Neck Surgery, Faculty of MedicinePrince of Songkla UniversityHat YaiSongkhla provinceThailand
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Hosoya M, Fujioka M, Ogawa K. Hydroxyapatite Prostheses in Endoscopic Transcanal Stapes Surgery for Otosclerosis Cases. EAR, NOSE & THROAT JOURNAL 2023; 102:NP65-NP71. [PMID: 33528270 DOI: 10.1177/0145561321989143] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Hydroxyapatite is a commonly used material for medical applications due to its excellent biocompatibility. We use hydroxyapatite prosthesis for the reconstruction of the ossicular chain in stapes surgery. In this study, we report a case series of endoscopic ear surgery using a basket-type hydroxyapatite prosthesis. METHODS We retrospectively examined 8 cases of endoscopic transcanal stapes surgery using hydroxyapatite prostheses. We evaluated the postoperative results and complications. RESULTS The average postoperative air-bone gaps were within 10 dB in all cases. Postoperative sensorineural hearing loss was not observed in any case. There was an intraoperative complication with the chorda tympani in 1 patient. We were able to preserve the chorda tympani of all patients, including this case. Postoperative transient dizziness and transient taste disorder were observed in 50% of cases. No other complications, including facial nerve palsy, tympanic membrane perforation, or postoperative infection, were observed. CONCLUSIONS The postoperative results and complications were comparable to those of surgery under a microscope. The hydroxyapatite prosthesis could be a possible alternative for the piston-type titanium or polytetrafluoroethylene prosthesis.
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Affiliation(s)
- Makoto Hosoya
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masato Fujioka
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kaoru Ogawa
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
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Tu LJ, Fina M, Golub JS, Kazahaya K, Quesnel AM, Tawfik KO, Cohen MS. Current Trends in Endoscopic Ear Surgery. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e023. [PMID: 38516579 PMCID: PMC10950159 DOI: 10.1097/ono.0000000000000023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/21/2022] [Indexed: 03/23/2024]
Affiliation(s)
- Leona J. Tu
- Drexel University College of Medicine, Philadelphia, PA
| | - Manuela Fina
- Department of Otolaryngology—Head and Neck Surgery, University of Minnesota, Minneapolis, MN
| | - Justin S. Golub
- Department of Otolaryngology—Head and Neck Surgery, Valegos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Ken Kazahaya
- Division of Pediatric Otolaryngology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Alicia M. Quesnel
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Kareem O. Tawfik
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Michael S. Cohen
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
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Molinari G, Fernandez IJ, Melchiorri C, Reale M, Bonali M, Presutti L, Lotto C, Lucidi D. “Hot” vs “Cold” endoscopic stapes surgery: a matched case–control study. Eur Arch Otorhinolaryngol 2022; 280:2257-2263. [PMID: 36380092 PMCID: PMC10066065 DOI: 10.1007/s00405-022-07739-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose
To compare hearing results and complication rates between two groups of patients operated on by endoscopic stapes surgery (ESS) for otosclerosis, either with CO2 fiber laser or microdrill.
Methods
A case–control study was performed. All consecutive cases of CO2 fiber laser ESS operated at a single center during the period 2017–2020 (case group) were matched to a control group of patients operated by traditional technique, according to year of surgery, preoperative mean air–bone gap, sex and age. Audiological data from preoperative and postoperative examinations and complication rates were compared.
Results
46 cases were included. Mean operative time was significantly longer in the laser cohort (65 min) than in the drill one (45 min) (p = 0.003). Similar results were found in the two groups regarding the mean postoperative BC-PTA. The high-frequency bone conduction resulted significantly higher in the laser group (p = 0.002), suggesting an overclosure effect in the laser group. Consistently, a significant improvement of the BC-PTA threshold at 2000 Hz postoperatively was found in the laser group (p = 0.034). The postoperative AC-PTA significantly improved in both groups at all frequencies (p < 0.05), except for the AC threshold at 8 kHz. Similar rates of complications were found in the two groups.
Conclusion
This study is the first to compare hearing results and complications between CO2 fiber laser and microdrill in ESS. Our results demonstrated similar functional outcomes between the two groups, confirming ESS as safe and effective, regardless of the technique used.
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Giri HS, Nayak PD, Giri MR, Solanki G. Endoscopic Versus Microscopic Stapedotomy: Our Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:241-245. [PMID: 36032899 PMCID: PMC9411469 DOI: 10.1007/s12070-020-02029-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 07/29/2020] [Indexed: 12/01/2022] Open
Abstract
With technological improvements leading to enhanced image resolution, as well as recognized acceptance of endoscopes within the field of rhinology, there has been greater implementation of endoscopes in otologic and neurotologic procedures. Surgeons now use endoscopes for a wide range of otological procedure, one such procedure is endoscopic stapedotomy for otosclerosis. This study is done to compare merits and demerits of endoscopic stapedotomy with microscopic stapedotomy. This is a prospective observational study conducted in SMBT Medical College and Hospital, Nashik from January 2018 to January 2020. 40 patients who presented to ENT OPD with clinical features suggestive of otosclerosis and who fulfilled inclusion and exclusion criteria were included in the study. Detailed history, complete ENT examination and audiological investigations were done. Preanesthetic evaluation was done and patients were randomly allotted into two groups. Group A: consisted of twenty patients who underwent microscopic stapedotomy under local anesthesia Group B: consisted of twenty patients who underwent endoscopic stapedotomy under local anesthesia. Data was collected in pre-structured proforma and analyzed. There was no statistically significant difference between microscopic and endoscopic procedure in terms of duration of the surgery, hearing improvements or complications. However, surgeons noted that ease of visualization of middle ear structures and the better image quality favors endoscopic procedure over microscopic procedure. There is no increased risk of complications with endoscopic stapedotomy and hearing improvement is same as that of microscopic stapedotomy however the ease of visualization of middle ear structures and the better image quality favors endoscopic procedure over microscopic procedure. Hence, we conclude that endoscopic stapedotomy is a safe alternative to microscopic stapedotomy.
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Albera A, Parandero F, Andriani R, Albera R, Riva G, Canale A. Prognostic factors influencing postoperative air-bone gap in stapes surgery. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:380-387. [PMID: 36254654 PMCID: PMC9577682 DOI: 10.14639/0392-100x-n0612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/19/2022] [Indexed: 11/23/2022]
Abstract
Objective Otosclerosis is an osteodystrophic disease of the otic capsule, determining conductive or mixed hearing loss, which can be successfully treated with stapedotomy. The aim of the present multicentric retrospective study was to identify prognostic factors related to better auditory outcomes in stapes surgery. Methods 581 patients affected by otosclerosis were submitted to stapedotomy under local anaesthesia in two different hospitals. Both Teflon and titanium prostheses were adopted. Results A statistically significant decrease of postoperative air-conduction thresholds and air-bone gap (ABG) values was seen, whereas the mean bone-conduction threshold did not differ from the preoperative condition. Among the various parameters investigated, the prosthetic material, duration of surgery and intraoperative detection of unexpected anatomical anomalies of the middle ear were found to be related to lower postoperative ABG values. Conclusions All the previously mentioned parameters played a significant role in determining the postoperative auditory outcomes and can therefore be considered prognostic factors for the success of the stapedotomy.
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Affiliation(s)
- Andrea Albera
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Fiorella Parandero
- Section of Ear Nose and Throat, Fatebenefratelli Hospital, University of Milan, Milan, Italy
| | - Roberto Andriani
- Section of Ear Nose and Throat, Fatebenefratelli Hospital, University of Milan, Milan, Italy
| | - Roberto Albera
- Department of Surgical Sciences, University of Turin, Turin, Italy,Correspondence Andrea Albera Department of Surgical Sciences, University of Turin, Via Genova 3, 10124, Turin, Italy Tel. +39 011 6709582 E-mail:
| | - Giuseppe Riva
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Andrea Canale
- Department of Surgical Sciences, University of Turin, Turin, Italy
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Endoscopic Ear Surgery: Our Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:263-271. [PMID: 36032880 PMCID: PMC9411338 DOI: 10.1007/s12070-020-02042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022] Open
Abstract
Endoscopes are presently used as an adjunct to microscopic surgery for better visualization of hidden areas of middle ear or they are used as a primary modality replacing the microscopes. We performed primary endoscopic ear surgery at a tertiary care center to evaluate the scope of endoscopic ear surgeries and to evaluate the anatomical, functional and quality of life outcomes. We evaluated 103 cases of which included patients with chronic otitis media mucosal disease (64), chronic otitis media squamous disease (29), otosclerosis (6), and benign ear tumors (4). In our study, the structural and functional outcomes of endoscopic ear surgeries were comparable to microscopic techniques however it conferred superior patient related outcomes of cosmesis, post-operative pain and early return to daily routine. Thus endoscopic ear surgery is a minimally invasive alternative option to microscopic techniques in the field of otology.
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15
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Predictive Patient Factors for Poor Outcomes Following Stapedotomy for Otosclerosis. Otol Neurotol 2022; 43:619-624. [PMID: 35283465 DOI: 10.1097/mao.0000000000003522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess patient-related risk factors associated with poor outcomes following stapedotomy for otosclerosis. STUDY DESIGN Retrospective study. SETTING Academic tertiary care center. METHODS Retrospective chart review of 107 patients with otosclerosis who underwent stapedotomy between 2013 and 2020. Demographics, comorbidities, and smoking history were obtained. Preoperative and postoperative audiogram data, including air-bone gap (ABG), and complications were collected. Data were analyzed using t test and Fischer's exact test for continuous and categorical variables, respectively. RESULTS Among 107 patients, 29.5% were smokers and 70.1% non-smokers. Overall, the average ABG-gain 3-months postoperatively was 20.2 dB, and intraoperative and postoperative complications were 3.74 and 13.1%, respectively. Those with a history of otologic procedures had a lower mean ABG gain at 3 months compared with those without previous otologic surgery (14.4 dB versus 20.4 dB, p = 0.018). The average ABG gain at 3-months was not significantly different between those with current, former, or no smoking history, respectively (13.5 versus 18.1 versus 20.6, p = 0.08). Current smokers had 4.5 times greater odds of complications compared with non-smokers, although not statistically significant (95% CI 0.9-22.8, p = 0.1912). CONCLUSION Age and history of otologic procedures as independent risk factors did impact hearing outcomes among our patient cohort; however, smoking history did not. Future prospective studies are required to further investigate complication rates by various modifiable risk factors, such as smoking status, body mass index (BMI), and obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) use, for stapedotomy surgeries.
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Polony G, Gáborján A, Tamás L, Székely L. Revision Stapedotomies: the Role of Periprosthetic Scar Tissue Formation in the Development of Unsatisfactory Hearing Results after Stapedotomy. Int Arch Otorhinolaryngol 2021; 26:e422-e427. [PMID: 35846822 PMCID: PMC9282973 DOI: 10.1055/s-0041-1740100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 09/02/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction
Revision stapes surgeries are difficult to perform, and their audiological results are inferior to primary surgeries.
Objective
Our goal was to identify the most common and most influential postoperative reasons that cause persistent air-bone gap (ABG) after the primary surgery. Our focus was concentrated on the mechanical dysfunctions in the middle ear, with special regard to postoperative adhesion formation.
Methods
We performed a retrospective case series study with 23 cases that underwent revision stapedotomies.
Results
A significant improvement was seen in ABG and air conduction levels after surgery. The periprosthetic adhesion formation was seen in 65% of the cases, and it was the primary cause behind the unsatisfactory hearing result in 30% of cases. There was no significant difference in the level of persistent ABGs after the primary surgery, in case of the intratympanic adhesion presence, compared with the presence of other surgical failures. Concerning hearing and ABG gain after revision surgery, the non-inferiority of the negative effect associated with adhesion was shown compared with the other reasons.
Conclusion
The revision stapedotomy is an efficient treatment option in case of persistent ABG. Periprosthetic adhesions are the most common intratympanic reasons for compromised audiological outcomes after stapedotomy.
Adhesion formations have the same negative effect on ABG development as any other surgical failure, and the revision could be more challenging in these cases. These findings highlight the use of the most atraumatic surgical technique and preservation of intact intratympanic mucosa during middle ear surgery.
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Affiliation(s)
- Gábor Polony
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis Egyetem (Semmelweis University), Budapest, Hungary
| | - Anita Gáborján
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis Egyetem (Semmelweis University), Budapest, Hungary
| | - László Tamás
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis Egyetem (Semmelweis University), Budapest, Hungary
| | - László Székely
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis Egyetem (Semmelweis University), Budapest, Hungary
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17
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Eren SB, Vural Ö, Dogan R, Senturk E, Ozturan O. Two-handed endoscopic ear surgery: Feasibility for stapes surgery. Am J Otolaryngol 2021; 42:103111. [PMID: 34273709 DOI: 10.1016/j.amjoto.2021.103111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/02/2021] [Accepted: 06/13/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Endoscopic ear surgery is becoming an increasingly popular approach. Our aim in this study is to evaluate the feasibility of the two-handed endoscopic technique for stapes surgery, which has its own unique steps. METHODS Patients who underwent two-handed endoscopic stapes surgery between September 2017 and February 2018 were included in this study. Preoperative and postoperative pure tone averages and air bone gaps, intraoperative complications were recorded. All procedures were performed under hypotensive general anesthesia by the same surgeon using 0° rigid endoscopes of 2.7-mm diameter, 14-cm length with an endoscope holder. RESULTS Seven endoscopic two-handed stapes surgery were performed between September 2017 and February 2018. Of these, six patients were operated entirely endoscopically because one patient was found to has perilymph gusher and converted to microscopic surgery. There were no intraoperative tympanic membrane injuries, facial nerve paresis or sensorineural hearing losses. The average preoperative ABG of patients who underwent fully endoscopic surgery was 31.3 dB, and the postoperative ABG closed up to 9.6 dB. CONCLUSIONS Adoption of the two-handed technique during endoscopic stapes surgery ensures the surgeon benefits from the advantages of endoscopy while overcoming the disadvantages of the one-handed technique.
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Affiliation(s)
- Sabri Baki Eren
- Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
| | - Ömer Vural
- Baskent University, Department of Otorhinolaryngology, Çankaya, Ankara, Turkey
| | - Remzi Dogan
- Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey.
| | - Erol Senturk
- Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
| | - Orhan Ozturan
- Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
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18
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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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Laura E, Cerullo R, Gazzini L. Video type: "How I do it". Endoscopic stapes surgery: Overcoming the limits of the microscope (with video). Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 Suppl 3:89-90. [PMID: 34215549 DOI: 10.1016/j.anorl.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/09/2021] [Accepted: 01/26/2021] [Indexed: 11/17/2022]
Affiliation(s)
- E Laura
- Division of Otolaryngology, Department of Surgery, Dentistry Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - R Cerullo
- Division of Otolaryngology, Department of Surgery, Dentistry Pediatrics and Gynecology, University of Verona, Verona, Italy.
| | - L Gazzini
- Division of Otolaryngology, "San Maurizio" Hospital, Bolzano, Italy
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20
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Comparing Transcanal Endoscopic Ear Surgery to Post-Auricular Microscope-Guided Surgery in Pediatric Ossiculoplasty: Hearing Outcomes and Post-Operative Pain. Otol Neurotol 2021; 42:e1648-e1651. [PMID: 34172655 DOI: 10.1097/mao.0000000000003235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study compares post-operative hearing outcomes and morbidity after pediatric total ossicular replacement prosthesis (TORP) ossiculoplasty with transcanal totally endoscopic ear surgery (TEES) versus a post-auricular microscope-guided (PAM) approach. PATIENTS Forty-four children who underwent ossiculoplasty with titanium TORP after previous cholesteatoma surgery. INTERVENTION Ossiculoplasty using TEES or PAM approach. MAIN OUTCOME MEASURES Hearing outcome after ossiculoplasty was determined by post-operative air-bone gap (ABG) on audiogram nearest to 1 year after surgery. Post-operative morbidity was measured by total number of opiate doses the child received during hospital stay, along with the highest documented post-operative pain score. Comparisons were made with Mann-Whitney U test. RESULTS Hearing data were available for 41 patients: 21 had undergone TEES (median preoperative ABG 39 dB) and 20 had PAM surgery (median preoperative ABG 39 dB). Post-operatively at 1 year, ABG closed significantly in each group (TEES 21 dB, p = 0.003; PAM 23 dB, p = 0.01), and there was no difference between groups (p = 0.6). 57% who underwent TEES and 50% who underwent PAM surgery experienced serviceable hearing post-operatively, defined as air conduction pure-tone average (PTA) ≤ 30 dB HL. Visual analogue pain scores from 0 (no pain) to 10 (worst pain imaginable) were available for 13 who underwent TEES and 18 who underwent PAM surgery. In children undergoing TEES, only two reported pain above 0, with the highest pain score being 4. Children undergoing PAM surgery had a median pain score of 3 (median difference = 3, p < 0.001). Children undergoing TEES required fewer weight appropriate doses of opiate analgesic (median = 0) than children who underwent PAM surgery (median = 1) (median difference = 1, p = 0.003). Children undergoing TEES had a significantly shorter surgical time (median 135 min) than those who underwent PAM surgery (median 168 min) (median difference = 33 min, p = <0.006). CONCLUSION Hearing outcomes in TORP ossiculoplasty are similar in TEES and PAM surgery, and TEES may decrease post-operative pain.
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21
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Bozzato A, Flockerzi V. [Endoscopically guided reconstruction of the ossicular chain-an introduction]. HNO 2021; 69:797-802. [PMID: 34125235 DOI: 10.1007/s00106-021-01062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2021] [Indexed: 11/29/2022]
Abstract
The term "endoscopic ossiculoplasty" refers to surgical methods with the intention to reconstruct the ossicular chain using endoscopic vision. Apart from malformations and injuries, inflammatory processes cause the majority of indications for ossicular reconstruction. This article offers a commented overview of current literature and preliminary personal experience.
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Affiliation(s)
- Alessandro Bozzato
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Straße, Gebäude 6, 66421, Homburg/Saar, Deutschland.
| | - Veronika Flockerzi
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Straße, Gebäude 6, 66421, Homburg/Saar, Deutschland
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22
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Fernandez IJ, Bonali M, Ghirelli M, Presutti L. Limits in endoscopic ear surgery. HNO 2021; 69:803-810. [PMID: 34037816 DOI: 10.1007/s00106-021-01051-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND In recent decades, endoscopic ear surgery (EES) has been rapidly evolving, expanding its boundaries from the middle ear to the lateral skull base. Nonetheless, the advantages of the endoscopic technique are associated with a number of intrinsic limitations. METHODS AND OBJECTIVE A narrative review was conducted to investigate the current limits of EES, analyzing the different otologic and skull base surgery procedures. RESULTS Limitations of EES can be divided into general and procedure-related. General limitations have been extensively described in the literature and are related to the bidimensional image provided by the endoscope, as well as the one-handed surgical technique and its implications in the management of bleeding. Procedure-related limits are continuously evolving and are also discussed in the present review. CONCLUSION Although endoscope use is intrinsically associated with general limitations, these have been systematically overcome by the refinement of the surgical technique as a consequence of the increasing surgical experience gained over the last 20 years. The main limits of EES are currently associated with specific procedure- and disease-related situations. This review describes the general limitations and their management, as well as the current limits in the endoscopic management of various otologic diseases, from the external ear to the lateral skull base.
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Affiliation(s)
- Ignacio J Fernandez
- Otolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy. .,University Hospital of Modena (Policlinico di Modena, Azienda Ospedaliero-Universitaria di Modena, Università di Modena e Reggio Emilia), Via del Pozzo 71, 41124, Modena, Italy.
| | - Marco Bonali
- Otolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Michael Ghirelli
- Otolaryngology Head and Neck Surgery Department, Ospedale Infermi di Rimini, Rimini, Italy
| | - Livio Presutti
- Otolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
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23
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Re M, Giannoni M, Scarpa A, Cassandro C, Ralli M, De Luca P, Aragona T, Viola P, Cassandro E, Gioacchini FM, Franceschini SS. Cerebrospinal Fluid Leak During Stapes Surgery: The Importance of Temporal Bone CT Reconstructions in Oblique Anatomically Oriented Planes. EAR, NOSE & THROAT JOURNAL 2021; 102:227-230. [PMID: 33624550 DOI: 10.1177/0145561320984569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Stapes gusher is a massive flow of perilymph and cerebrospinal fluid leak that fills the middle ear immediately after surgical opening of the labyrinth, such as during stapedectomy. Stapes gusher usually occurs as the result of a congenital malformation that causes an abnormal communication between the perilymphatic space and the subarachnoid space involving the internal auditory canal or the cochlear duct. To date, the potential risk of stapes gusher cannot be assessed preoperatively, as there are not pathognomonic signs suggestive of this complication. However, high-resolution computed tomography scan (HRCT) of the temporal bone can provide information that may help recognizing patients at risk. Recently, an anatomic evaluation of the inner ear with oblique reformation at HRCT has been described. This reformation offers a new and more detailed topographic vision of temporal bone structures compared to the classic axial and coronal planes and may help identifying anatomical alterations otherwise not visible. In this article, we present a case of stapes gusher and the role of preoperative HRCT with oblique reformation in its prevention.
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Affiliation(s)
- Massimo Re
- Department of Clinical and Molecular Sciences, Section of Otorhinolaryngology, Polytechnic University of Marche, Ancona, Italy
| | - Mirko Giannoni
- Neuroradiology Unit, University Hospital of Ancona, Italy
| | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | | | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Pietro De Luca
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | | | - Pasquale Viola
- Department of Experimental and Clinical Medicine, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Ettore Cassandro
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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Yancey KL, Manzoor NF, Rivas A. Endoscopic Stapes Surgery: Pearls and Pitfalls. Otolaryngol Clin North Am 2020; 54:147-162. [PMID: 33153730 DOI: 10.1016/j.otc.2020.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The endoscopic approach to stapes surgery affords unique advantages but is not without its specific challenges. The following reviews the equipment and surgical steps required to perform endoscopic stapes surgery safely and effectively, highlighting tips and potential points of failure through a series of case examples.
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Affiliation(s)
- Kristen L Yancey
- Department of Otolaryngology-Head and Neck Surgery, The Bill Wilkerson Center for Otolaryngology & Communication Sciences, 7209 Medical Center East South Tower, 1215 21st Avenue South, Nashville, TN 37232-8605, USA.
| | - Nauman F Manzoor
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals, ENT Institute, Case Western Reserve University, 11100 Euclid Avenue, Stop Mail: LKSD 5045, Cleveland, OH 44106, USA
| | - Alejandro Rivas
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals, ENT Institute, Case Western Reserve University, 11100 Euclid Avenue, Stop Mail: LKSD 5045, Cleveland, OH 44106, USA
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25
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Bartel R, Sanz JJ, Clemente I, Simonetti G, Viscacillas G, Palomino L, Asarta I, Lao X. Endoscopic stapes surgery outcomes and complication rates: a systematic review. Eur Arch Otorhinolaryngol 2020; 278:2673-2679. [PMID: 33001293 DOI: 10.1007/s00405-020-06388-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/16/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE These days, the gold standard procedure for otosclerosis treatment is stapes surgery. The endoscopic approach of the procedure is gaining popularity as endoscopic ear surgery develops across the globe. The main objective of this study is to gather and compile well-documented and reliable data regarding surgical outcomes for the endoscopic approach to stapes surgery up to this date. MATERIALS AND METHODS Publications in English were searched in the PUBMED/MEDLINE database and were systematically reviewed. A total of 16 articles were reviewed according to the inclusion criteria, obtaining a total of 573 patients managed surgically for otosclerosis, using an endoscopic approach. Data were systematically extracted and compared across variables. RESULTS Data were obtained as follows: mean age of 43 years; female proportion of 60%; 3 mm endoscope diameter of 51%, 4 mm of 39%; titanium piston-type prostheses of 52% and Teflon of 48%; length of the prosthesis (mode) was 4.5 mm; 0.6 mm diameter of the piston of 81% and 0.4 mm of 19%; mean surgical time was 55 min. Hearing results, mean preoperative air-bone gap (ABG) 31 dB; mean postoperative ABG 9 dB; ABG improvement of 22 dB; an ABG closure rate to 20 dB or less of 92% and an ABG closure rate to 10 dB or less of 77%. Complication rates: intraoperative tympanic membrane perforation of 5%; postoperative vertigo of 11%; postoperative dysgeusia of 10%; reported a postoperative neurosensorial hearing loss of 0.2%; reported gusher phenomenon of one case (0.2%). CONCLUSION Endoscopic stapes surgery is completely achievable using 0º angle and 4-mm-diameter sinus surgery endoscope. Instrument availability should not be an obstacle to the development of this type of surgery in any otolaryngology department. Audiological outcomes are comparable to microscopic approaches.
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Affiliation(s)
- Ricardo Bartel
- Otolaryngology Department, Mutua Terrassa University Hospital, University of Barcelona, Barcelona, Spain. .,Otology Research Group of Young Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS), Paris, France.
| | - Juan Jose Sanz
- Otolaryngology Department, Mutua Terrassa University Hospital, University of Barcelona, Barcelona, Spain
| | - Ignacio Clemente
- Otolaryngology Department, Mutua Terrassa University Hospital, University of Barcelona, Barcelona, Spain
| | - Gabriela Simonetti
- Otolaryngology Department, Mutua Terrassa University Hospital, University of Barcelona, Barcelona, Spain
| | - Guillem Viscacillas
- Otolaryngology Department, Mutua Terrassa University Hospital, University of Barcelona, Barcelona, Spain
| | - Laura Palomino
- Otolaryngology Department, Mutua Terrassa University Hospital, University of Barcelona, Barcelona, Spain
| | - Isabel Asarta
- Otolaryngology Department, Mutua Terrassa University Hospital, University of Barcelona, Barcelona, Spain
| | - Xavier Lao
- Otolaryngology Department, Mutua Terrassa University Hospital, University of Barcelona, Barcelona, Spain
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26
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Lucidi D, Molinari G, Reale M, Alicandri-Ciufelli M, Presutti L. Functional Results and Learning Curve of Endoscopic Stapes Surgery: A 10-Year Experience. Laryngoscope 2020; 131:885-891. [PMID: 33124036 DOI: 10.1002/lary.28943] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess hearing outcomes and complications of endoscopic stapes surgery by a single surgeon in a 10-year period, to compare these data with conventional microscopic procedures by the same operator, and to describe the learning curve of endoscopic stapedotomy. STUDY DESIGN Retrospective study. METHODS This is a retrospective study on patients who underwent endoscopic stapes surgery performed by the same senior surgeon, experienced both in microscopic and endoscopic techniques, between January 2009 and December 2018. Audiological data were compared, and intraoperative and postoperative complications were collected. The surgeon's last 30 cases of microscopic stapedotomy were enrolled as the control group. The results of the first 100 endoscopic stapes surgeries were analyzed separately to create a cumulative sum (CUSUM) control chart for learning curve assessment. RESULTS One hundred seventy-eight endoscopic and 30 microscopic stapes surgeries were included. In the endoscopic group, the mean postoperative air-bone gap was 8.2 dB. No significant differences between the endoscopic and microscopic preoperative and postoperative values were reported. A total of eight complications (4.5%) were observed in the endoscopic cohort, although in the control group, no complication occurred. The mean surgical time was 51.9 minutes in the endoscopic group versus 48.2 minutes in the microscopic group (P > .05). No association between stapedotomy success and the increasing number of procedures was found. CONCLUSIONS Our article demonstrates that functional results from endoscopic stapes surgery are similar to those from microscopic stapes surgery in terms of both safety and efficacy. After gaining endoscopic experience, the surgical duration of stapes surgery will be adequate starting from the first cases. LEVEL OF EVIDENCE 4 Laryngoscope, 131:885-891, 2021.
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Affiliation(s)
- Daniela Lucidi
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Giulia Molinari
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Marella Reale
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | | | - Livio Presutti
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
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27
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Pradhan P, Preetam C, Parida PK. Primary endoscopic stapedotomy using 3 mm nasal endoscope: Audiologic and clinical outcomes. J Otol 2020; 15:133-137. [PMID: 33293913 PMCID: PMC7691826 DOI: 10.1016/j.joto.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/22/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To report the use of a 3 mm rigid nasal endoscope in primary endoscopic stapedotomy and clinical and audiological outcomes. Materials and methods Thirty patients diagnosed with primary otosclerosis underwent endoscopic stapedotomy that was performed using a 3 mm nasal endoscope (Karl Storz). At 6 months follow-up, the patients were evaluated for intraoperative findings, postoperative hearing outcomes and complications. Results Canaloplasty was performed in 2 (6.66%) patients, and no curettage of the canal wall was required in 12 (40%) patients. Transposition of the chorda tympani nerve was conducted in 11 (36.66%) patients. The average duration of surgery was 36 min (range 31–65 min). The air-bone gap (ABG) was 35 dB (range 24–50 dB) preoperatively and 14.63 dB (range 9–20 dB) postoperatively (p = 0.00). At 6 months follow-up, <20 dB ABG was achieved in 93.33% of the patients. No major intraoperative/postoperative complications were detected. Conclusion A 3 mm rigid nasal endoscope can be effectively used in stapedotomy to obtain adequate audiological outcomes. It can be considered as a better alternative to the standard microscope or 4 mm endoscope in preserving the posterior canal wall and chorda tympani nerve while minimizing operative time without causing significant complications.
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Affiliation(s)
- Pradeep Pradhan
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India
| | - Chappity Preetam
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India
| | - Pradipta Kumar Parida
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India
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