1
|
Ding X, Huang Y, Zhao Y, Tian X, Feng G, Gao Z. Accurate Segmentation and Tracking of Chorda Tympani in Endoscopic Middle Ear Surgery with Artificial Intelligence. EAR, NOSE & THROAT JOURNAL 2023:1455613231212051. [PMID: 38083840 DOI: 10.1177/01455613231212051] [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: 12/22/2023] Open
Abstract
Objective: We introduce a novel endoscopic middle ear surgery dataset specifically designed for evaluating deep learning (DL)-based semantic segmentation of chorda tympani. Methods: We curated a dataset comprising 8240 images from 25 patients, divided into a training set (20%, 1648 images), validation set (5%, 412 images), and test set (75%, 6180 images). We employed data enhancement techniques to expand the picture size of the training and validation sets by 5 times (training set: 8240 images, verification set: 2060 images). Subsequently, we employed a multistage transfer learning training method to establish, train, and validate various convolutional neural networks. Results: On the validation set of 2060 labeled images, our proposed network achieved good results, with the U-net exhibiting the highest effectiveness (mIOU = 0.8737, mPA = 0.9263). Furthermore, when applied to the test dataset of 6180 raw images and contrasted with the prediction of otologists, the overall performance of the U-net was excellent (accuracy = 0.911, precision = 0.9823, sensitivity = 0.8777, specificity = 0.9714). Conclusions: Our findings demonstrate that DL can be successfully employed for automatic segmentation of chorda tympani in endoscopic middle ear surgery, yielding high-performance results. This study validates the potential feasibility of future intelligent navigation technologies to assist in endoscopic middle ear surgery.
Collapse
Affiliation(s)
- Xin Ding
- Department of Otorhinolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Dongcheng District, Beijing, China
| | - Yu Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Dongcheng District, Beijing, China
| | - Yang Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Dongcheng District, Beijing, China
| | - Xu Tian
- Department of Otorhinolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Dongcheng District, Beijing, China
| | - Guodong Feng
- Department of Otorhinolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Dongcheng District, Beijing, China
| | - Zhiqiang Gao
- Department of Otorhinolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Dongcheng District, Beijing, China
| |
Collapse
|
2
|
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.
Collapse
Affiliation(s)
| | | | | | - Kavan Babu
- Michigan State University, East Lansing, Michigan
| | - Hugh P Mallany
- University of New England School of Osteopathic Medicine, Biddeford, Maine
| | | |
Collapse
|
3
|
Huang Y, Ding X, Zhao Y, Tian X, Feng G, Gao Z. Automatic detection and segmentation of chorda tympani under microscopic vision in otosclerosis patients via convolutional neural networks. Int J Med Robot 2023; 19:e2567. [PMID: 37634074 DOI: 10.1002/rcs.2567] [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: 10/15/2022] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Artificial intelligence (AI) techniques, especially deep learning (DL) techniques, have shown promising results for various computer vision tasks in the field of surgery. However, AI-guided navigation during microscopic surgery for real-time surgical guidance and decision support is much more complex, and its efficacy has yet to be demonstrated. We propose a model dedicated to the evaluation of DL-based semantic segmentation of chorda tympani (CT) during microscopic surgery. METHODS Various convolutional neural networks were constructed, trained, and validated for semantic segmentation of CT. Our dataset has 5817 images annotated from 36 patients, which were further randomly split into the training set (90%, 5236 images) and validation set (10%, 581 images). In addition, 1500 raw images from 3 patients (500 images randomly selected per patient) were used to evaluate the network performance. RESULTS When evaluated on a validation set (581 images), our proposed CT detection networks achieved great performance, and the modified U-net performed best (mIOU = 0.892, mPA = 0.9427). Moreover, when applying U-net to predict the test set (1500 raw images from 3 patients), our methods also showed great overall performance (Accuracy = 0.976, Precision = 0.996, Sensitivity = 0.979, Specificity = 0.902). CONCLUSIONS This study suggests that DL can be used for the automated detection and segmentation of CT in patients with otosclerosis during microscopic surgery with a high degree of performance. Our research validated the potential feasibility for future vision-based navigation surgical assistance and autonomous surgery using AI.
Collapse
Affiliation(s)
- Yu Huang
- Department of Otorhinolaryngology Head and Neck Surgery, the Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Ding
- Department of Otorhinolaryngology Head and Neck Surgery, the Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, the Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Tian
- Department of Otorhinolaryngology Head and Neck Surgery, the Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guodong Feng
- Department of Otorhinolaryngology Head and Neck Surgery, the Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiqiang Gao
- Department of Otorhinolaryngology Head and Neck Surgery, the Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
4
|
Blijleven EE, Fuchten D, Dullaart MJ, Stokroos RJ, Thomeer HGXM, Wegner I. Systematic review: Validity, reliability, and diagnostic accuracy of the electrogustometer. Laryngoscope Investig Otolaryngol 2023; 8:1068-1079. [PMID: 37621297 PMCID: PMC10446320 DOI: 10.1002/lio2.1108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/07/2023] [Accepted: 06/25/2023] [Indexed: 08/26/2023] Open
Abstract
Objective What are the electrogustometer's (EGM) validity, reliability, and diagnostic accuracy in assessing taste sensation in adults compared to other taste tests? Data Sources PubMed Medline, Elseviers's Embase, and the six databases of Cochrane Library. Methods We conducted a systematic search on December 20, 2022, consisting of synonyms for EGM. We considered randomized controlled trials and observational studies with original data for inclusion if they included adults who underwent electrogustometry. Articles were excluded if no analysis regarding validity, reliability, or diagnostic accuracy had been performed or if these analyses could not be performed with the published data. Results Nineteen articles discussing 18 studies were included for data extraction. The included studies carry a high risk of bias. Overall, the association between a variety of reference taste tests and EGM was moderate or weak with correlation coefficients ranging from -0.51 to 0.40 with one outlier of -0.74 found in one study correlating EGM and taste solutions. Test-retest reliability was good with reported correlation coefficients between 0.78 and 1.0. The sensitivity, specificity, PPV, and NPV of EGM in identifying abnormal taste function varied widely between the four studies on diagnostic accuracy. Conclusion The included studies in this review lack the required standards regarding study design to draw firm conclusions about the validity, reliability, and diagnostic accuracy of the EGM. Future research is needed to assess these measurement properties. Based on the reported results, we would not recommend using the EGM as a screening test for taste disturbance in clinical practice. Level of Evidence NA.
Collapse
Affiliation(s)
- Esther E. Blijleven
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
- University Medical Center Utrecht Brain Center, Utrecht UniversityUtrechtThe Netherlands
| | - Denise Fuchten
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
- University Medical Center Utrecht Brain Center, Utrecht UniversityUtrechtThe Netherlands
| | - Max J. Dullaart
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Robert J. Stokroos
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
- University Medical Center Utrecht Brain Center, Utrecht UniversityUtrechtThe Netherlands
| | - Henricus G. X. M. Thomeer
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
- University Medical Center Utrecht Brain Center, Utrecht UniversityUtrechtThe Netherlands
| | - Inge Wegner
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
| |
Collapse
|
5
|
Coelho DH, Lee S, Yang E, Carli M. Subjective and Objective Taste Change After Stapes Surgery Systematic Review and Meta-Analysis. Otol Neurotol 2023; 44:10-15. [PMID: 36373699 DOI: 10.1097/mao.0000000000003750] [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: 11/16/2022]
Abstract
INTRODUCTION Iatrogenic injury to the chorda tympani (CT) is a well recognized, although potentially underestimated, consequence of stapes surgery. This study aims to review the currently available literature to determine the incidence and prognosis of taste disturbances in these patients. DATA SOURCES PubMed, Embase, and Cochrane Library databases. METHODS Databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Search terms included (chorda tympani OR gustatory OR taste OR chemosensory OR dysgeusia OR nervus intermedius) AND (ear surgery OR middle ear OR stapes OR stapedectomy OR stapedotomy). Patients with prospective data collection including preoperative data were further divided by methodology into "objective" and "subjective" assessments of taste dysfunction. A systematic review was performed for all included studies, with meta-analysis using a random-effects model was used for those with comparable methodology and patient populations. RESULTS Initial search yielded 2,959 articles that were screened according to inclusion and exclusion criteria. Once duplicates were removed, seven studies were identified, representing 173 patients with subjective testing (all seven studies) and 146 with objective testing (five studies). Eighty of 173 patients (46.2%) noted a disturbance in taste at early follow-up, whereas as 26 of 173 (15.0%) noted long-term problems. Objective methodology and result reporting were heterogenous and not amenable to pooled meta-analysis for all studies included. CONCLUSION Changes in taste occur relatively frequently after stapedectomy. Surgeons should continue to counsel prospective patients as to the risks of both short- and long-term taste disturbances.
Collapse
Affiliation(s)
| | - Seong Lee
- Department of Otolaryngology-Head & Neck Surgery
| | - Edward Yang
- Department of Otolaryngology-Head & Neck Surgery
| | - Matthew Carli
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| |
Collapse
|
6
|
Quimby AE, Parekh M, Darwich NF, Hwa TP, Eliades SJ, Brant JA, Bigelow DC, Ruckenstein MJ. Rates of Sensorineural Hearing Loss and Revision Surgery After Stapedotomy: A Single-institution Experience Using the Nitinol Prosthesis. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e025. [PMID: 38516582 PMCID: PMC10950193 DOI: 10.1097/ono.0000000000000025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/20/2022] [Indexed: 03/23/2024]
Abstract
Background Historically, stapedectomy complication rates are quoted as 1% profound postoperative sensorineural hearing loss (SNHL), 5%-10% nonprofound SNHL, and 5%-10% revision surgery. Objective We sought to reassess rates of post-stapedotomy complications based on our experience using contemporary surgical technique. Methods A retrospective case series was carried out at an academic tertiary referral center. Adult patients undergoing stapedotomy from 2013 to 2020 were included. Primary outcomes were rates of hearing loss and revision surgery. Rates of dizziness, tinnitus, dysgeusia, and proportions of patients who achieved air-bone gap (ABG) closure at 8-12 weeks postoperatively were also assessed. Results Four hundred sixty-eight stapedotomies in 399 patients with a median follow-up duration of 99 days (range, 11-5134) were reviewed. One patient (0.21%) suffered profound SHNL and 15 (3.20%) patients suffered nonprofound SNHL. The revision rate for stapedotomies from our institution was 4.49% (21 total revision surgeries). In 277 operations (59.19%), the patient had closure of the ABG within 10 dB. A further 132 (28.21%) had closure of the ABG between 10 and 20 dB. Air pure-tone audiometry scores improved by an average of 25.03 dB. Eighty-three (17.74%) patients complained of postoperative dizziness, which resolved by the time of the first follow-up appointment in all but 26 (5.56%). Seventeen patients (3.63%) complained of tinnitus, and 22 (4.70%) complained of dysgeusia. Conclusions SNHL, complications, and revision rates for stapedotomy in the modern era may be substantially lower than those currently presented to patients based on classic techniques and historical data.
Collapse
Affiliation(s)
- Alexandra E. Quimby
- Department of Otorhinolaryngology—Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Manan Parekh
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Nabil F. Darwich
- Department of Otorhinolaryngology—Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Tiffany P. Hwa
- Department of Otorhinolaryngology—Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA
- Department of Otolaryngology—Head & Neck Surgery, Temple University, Philadelphia, PA
| | - Steven J. Eliades
- Department of Otorhinolaryngology—Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC
| | - Jason A. Brant
- Department of Otorhinolaryngology—Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Douglas C. Bigelow
- Department of Otorhinolaryngology—Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Michael J. Ruckenstein
- Department of Otorhinolaryngology—Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
7
|
Consequences of Stapes Surgery on Tongue Morphological Characteristics in Narrow Band Imaging, Gustatory Function and General Sensation: A Prospective Tertiary Center Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
(1) Background: Chorda tympani (CT) manipulation during stapes surgery affects its functions. We hypothesized that this alters tongue morphology and sensory functions. (2) Methods: Patients undergoing stapes surgery were tested 1 day preoperatively, 1 and 6 months postoperatively. Narrow band imaging contact endoscopy (NBI) was used to determine the number of fungiform papillae (Npapillae) and the total score of blood vessel morphology (NBItotal). The taste was tested with taste strips. General sensation was tested with a static two-point discrimination. Tests were performed on ipsilateral and contralateral side of the tongue. (3) Results: 52 otosclerosis patients were included in the study. There was a statistically significant decrease of NBItotal (p = 0.005), Npapillae (p = 0.009), sensation of sweet (p = 0.003), salty (p = 0.035), sour (p = 0.036), and bitter taste (p = 0.013) within the test side during the follow-up. A statistically significant impact on presence of dysgeusia for sweet was found 1 month postoperatively (p < 0.005). Postoperative decrease in two-point discrimination score did not reach a statistical significance (p = 0.056). (4) Conclusions: CT manipulation affects fungiform papillae density, vascular patterns and taste sensation. The general sensation of the tongue is not influenced by CT manipulation.
Collapse
|
8
|
Hoskison EE, Harrop E, Jufas N, Kong JHK, Patel NP, Saxby AJ. Endoscopic Stapedotomy: A Systematic Review. Otol Neurotol 2021; 42:e1638-e1643. [PMID: 34267093 DOI: 10.1097/mao.0000000000003242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Stapes surgery has evolved from its origins in 1956. Microscopic assisted stapedotomy remains the most common technique but the introduction of endoscopic ear surgery has led to some units using this new approach. The endoscope delivers a wide angled, contextual view of the stapes, and associated pathology. This systematic review provides a critical analysis of the current published endoscopic data, allowing comparison to the established microscopic technique. DATA SOURCES Six databases (PubMed, Medline, Cochrane database, AMED, EMBASE, and CINAHL) were searched for studies within the last 10 years. STUDY SELECTION AND DATA EXTRACTION English language articles including 5 or more cases were included. Primary outcomes included audiological results and reported complications. Data was extracted according to PRISMA guidelines. RESULTS Thirteen papers were identified comprising 361 endoscopic stapes surgeries. Postoperative temporary facial nerve weakness was reported in 3 patients (0.8%) which all resolved within 4 weeks. Chorda tympani injury occurred in 21 cases (5.8%) and vertigo in 61 (16.9%). The audiometric outcomes of endoscopic stapes surgery were available for 259 patients and showed air bone gap closure rates of 71.4% (0-10 dB), 25.9% (11-20 dB), 2.3% (21-30 dB), and 0.4% (>30 dB). CONCLUSIONS Endoscopic stapes surgery has similar audiometric outcomes compared to the traditional microscopic approach with air bone gap closure values of <20 dB in 97.3% of cases. However, the complication rates of chorda tympani damage, postoperative dysguesia, and tympanic membrane perforation for endoscopic stapes surgery are high. Caution should therefore be taken before undertaking stapes surgery with the endoscopic technique. Further studies are required to prove superiority over well established existing microsurgical methods.
Collapse
Affiliation(s)
- Emma E Hoskison
- Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital
| | - Elizabeth Harrop
- Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital
| | - Nicholas Jufas
- Department of Otolaryngology Head and Neck Surgery, Royal North Shore Hospital, Sydney
- Sydney Endoscopic Ear Surgery ('SEES') Research Group
- Discipline of Surgery, Sydney Medical School, University of Sydney, Australia
| | - Jonathan H K Kong
- Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital
- Sydney Endoscopic Ear Surgery ('SEES') Research Group
- Discipline of Surgery, Sydney Medical School, University of Sydney, Australia
| | - Nirmal P Patel
- Department of Otolaryngology Head and Neck Surgery, Royal North Shore Hospital, Sydney
- Sydney Endoscopic Ear Surgery ('SEES') Research Group
- Discipline of Surgery, Sydney Medical School, University of Sydney, Australia
| | - Alexander J Saxby
- Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital
- Sydney Endoscopic Ear Surgery ('SEES') Research Group
- Discipline of Surgery, Sydney Medical School, University of Sydney, Australia
| |
Collapse
|
9
|
Taste impairment after endoscopic stapes surgery: Do anatomic variability of chorda tympani and surgical technique matter? : Post-operative dysgeusia after EStS. Eur Arch Otorhinolaryngol 2021; 279:2269-2277. [PMID: 34236486 DOI: 10.1007/s00405-021-06908-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate how the anatomical configuration of the oval window region (OWR) influences the management of the chorda tympani (ChT) and the curetting of adjacent bony structures, in a setting of patients undergoing endoscopic stapes surgery (EStS); to assess the incidence of early and late post-operative dysgeusia and to identify anatomical and surgical factors influencing taste function after EStS. METHODS Surgical video recordings of 48 patients undergoing EStS for otosclerosis between January 2019 and July 2020 were retrospectively revised, to classify the anatomical variability of selected middle ear structures and the management strategies for the ChT. Clinical records of included patients were reviewed for subjective early and late post-operative taste impairment using a 5-point Likert-scale. RESULTS The most common configuration of the OWR was type III. The extension of the bony curettage resulted inversely proportional to the exposure of the OWR. The long-term rate of preserved post-operative taste function was 85%. Displacement of the ChT was necessary in 43/48 cases (90%), mostly medially (36/48, 75%). CONCLUSION Bone curetting during EStS does not correlate with post-operative taste impairment. Despite 100% ChT preservation rate, dysgeusia may occur in a minority of patients, with no apparent relationship to anatomical variability or intraoperative management of the ChT. The use of CO2 laser could have a role in increasing the risk of post-operative dysgeusia after EStS.
Collapse
|
10
|
Beutner D, Vent J, Seehawer J, Luers JC, Lang‐Roth R, Wrobel C. Taste-strip gustometry in cochlear implanted patients. Laryngoscope Investig Otolaryngol 2021; 6:496-502. [PMID: 34195371 PMCID: PMC8223453 DOI: 10.1002/lio2.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/11/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Investigation of the gustatory function in a large cohort of cochlear implanted patients using lateralized taste-strip tests. PATIENTS AND METHODS One hundred and seven unilaterally or bilaterally profoundly hearing impaired or deaf patients who received cochlear implants (n = 113) were included in this study. Data on gustometry, subjective gustatory dysfunction, and the detailed surgical procedure were acquired retrospectively. Gustatory function, assessed using lateralized taste-strip tests, was performed the day before, 3 days after cochlear implantation, and on the day of the initial CI adjustment (39 days ±7.3 SD). RESULTS Averaged taste-strip scores of the cohort declined significantly from preoperatively 12.3 [11.8; 12.7] (mean [95% confidence intervals]) to 10.5 [9.7; 11.2] on the implanted side about 6 weeks after surgery. Patients with intraoperatively exposed and rerouted, or a severed, chorda tympani nerve (CTN) showed significantly reduced unilateral postoperative scores (10.1 [8.8; 11.4] and 9.3 [8.1; 10.5], respectively), when compared to not exposing or to leaving a bony layer over the CTN. Total taste-strip test scores showed a significant decline 6 weeks postoperatively in CI-patients expressing a subjective gustatory dysfunction (from 23.6 [21.4; 25.8] to 17.5 [14.2; 20.8]), as opposed to patients with a documented subjectively normal taste. CONCLUSION We consider postoperative gustatory dysfunction as a relevant side effect post cochlear implantation, at least within the first month. Taste-strip based gustometry is a suitable diagnostic tool to assess taste function in CI patients and is recommended to be performed routinely. LEVEL OF EVIDENCE 3, retrospective, nonrandomized follow-up study.
Collapse
Affiliation(s)
- Dirk Beutner
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Medical Center GöttingenGöttingenGermany
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical FacultyUniversity Hospital CologneCologneGermany
| | - Julia Vent
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical FacultyUniversity Hospital CologneCologneGermany
| | - Julia Seehawer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical FacultyUniversity Hospital CologneCologneGermany
| | - Jan Christoffer Luers
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical FacultyUniversity Hospital CologneCologneGermany
| | - Ruth Lang‐Roth
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical FacultyUniversity Hospital CologneCologneGermany
| | - Christian Wrobel
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Medical Center GöttingenGöttingenGermany
| |
Collapse
|
11
|
Abstract
Taste disorders, impacting well-being and physical health, can be caused by many etiologies including the use of medication. Recently, taste disturbance is also considered as one of the predominant symptoms of COVID-19 although its pathogenesis requires further research. Localized taste disorders may be overlooked considering that whole-mouth taste perception is insured through several mechanisms. Individuals often fail to discern taste from flavor, and interviews/surveys are insufficient to properly assess taste function. Hence, various taste assessment methods have been developed. Among them, psychophysical methods are most widely applied in a clinical context. Less-biased electrophysiological, imaging, or morphological methods are used to a much lesser degree. Overall, more research is needed in the field of taste.
Collapse
Affiliation(s)
- Y Zhu
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden University Hospital, Dresden, Germany
| | - T Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden University Hospital, Dresden, Germany.
| |
Collapse
|
12
|
Abstract
INTRODUCTION Endoscopic stapes surgery is a technically demanding procedure that is increasing in popularity. Surgical outcomes and complication rates have been demonstrated to be comparable to traditional microscopic techniques. The surgical outcomes for patients undergoing stapes surgery performed by the Sydney Endoscopic Ear Surgery Research Group are presented. STUDY DESIGN Retrospective review from prospectively gathered database. SETTING Tertiary referral centers. PATIENTS A retrospective case review of patients undergoing endoscopic stapes surgery performed by four surgeons between February 2015 and July 2019 was carried out. Sixty nine patients were identified, and assessed for demographics, functional results, and postoperative complications. INTERVENTION Endoscopic stapedotomy. MAIN OUTCOME MEASURE Postoperative hearing results. RESULTS Sixty eight of 69 patients (98.6%) achieved an air-bone gap (ABG) closure of less than 20 dB. Sixty of 69 patients (87%) achieved and ABG closure of less than 10 dB. The average improvement of the ABG over four frequencies achieved was 26.5 dB (range, 0-61). Postoperative complications were infrequent and self-limiting. Six patients experienced dysgeusia without obvious chorda tympani injury, four patients developed short lived vertigo, and two patients experienced tinnitus. CONCLUSIONS Endoscopically assisted stapes surgery represents a safe alternative to traditional microscopic techniques, with similar morbidity and audiological outcomes.
Collapse
|
13
|
Skoloudik L, Krtickova J, Haviger J, Mejzlik J, Chrobok V. Changes of taste perception after stapes surgery: a prospective cohort study. Eur Arch Otorhinolaryngol 2021; 279:175-179. [PMID: 33590337 DOI: 10.1007/s00405-021-06665-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/29/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Taste perception is often affected after stapes surgery despite effort to preserve chorda tympani nerve. The aim was to examine changes of particular taste qualities and their recovery after operation of otosclerosis. MATERIALS AND METHODS Taste function was prospectively investigated with a questionnaire and a taste strip test (TST) preoperatively, 3-5 days and 1 year after stapes surgery with the preservation of CTN. RESULTS In the early postoperative examination, 34/42 patients had a lower TST score, 7/42 decrease of taste in the questionnaire. One year after surgery, 11/42 patients had a lower TST score, 1/42 patients decrease of taste in the questionnaire. The most pronounced decrease in the TST score was in sweet (- 1.76 points, p < 0.001), followed by bitter (- 1.71 points, p < 0.001), salty (- 1.64 points, p < 0.001) and sour taste (- 1.33 points, p < 0.001). The sour taste had a significant lower alteration compared to others. Men had significantly pronounced alteration in salty taste compared to women. The complete recovery was proved in bitter taste. Better recovery in bitter taste was observed in patients younger than 45 years of age. CONCLUSIONS Gustatory changes after stapes surgery are mostly transient with different impairment and recovery rate for particular taste qualities. A sour taste seems to be relatively resistant to damage. The best recovery rate is in a bitter taste, especially in younger patients.
Collapse
Affiliation(s)
- Lukas Skoloudik
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University, Sokolska 581, 50005, Hradec Kralove, Czech Republic.
| | - Jana Krtickova
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University, Sokolska 581, 50005, Hradec Kralove, Czech Republic
| | - Jiri Haviger
- Department of Informatics and Quantitative Methods, Faculty of Informatics and Management, University of Hradec Králové, Hradec Kralove, Czech Republic
| | - Jan Mejzlik
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University, Sokolska 581, 50005, Hradec Kralove, Czech Republic
| | - Viktor Chrobok
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University, Sokolska 581, 50005, Hradec Kralove, Czech Republic
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Taste Changes in Patients With Middle Ear Surgery by Intraoperative Manipulation of Chorda Tympani Nerve. Otol Neurotol 2019; 39:591-596. [PMID: 29561383 DOI: 10.1097/mao.0000000000001780] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of study was to evaluate the subjective changes of taste and salivation after middle ear surgery according to chorda tympani nerve (CTN) injury. STUDY DESIGN Prospective cohort study. SETTING Tertiary referral center. PATIENTS We enrolled 180 patients older than 13 years old who received middle ear surgery. INTERVENTIONS The patients were classified into cut, manipulated, and intact groups according to intraoperative assessments of the CTN. The patients responded taste and salivation surveys preoperatively, and 1, 3, and 6 months postoperatively. MAIN OUTCOME MEASURES We analyzed results of questionnaires including disturbance rates, severity and character to evaluate taste and salivation functions. RESULTS Taste disturbance rate was significantly improved in all groups during follow-up (p < 0.05). The incidence of taste disturbance did not differ significantly between the three groups at each follow-up (p > 0.05). The taste disturbance score improved gradually in the cut and intact groups (p < 0.001), but not in the manipulated group (p = 0.067). Among the patients with taste disturbance, hypoguesia was most common symptom. Incidence of salivation disturbance did not differ between the three groups (p = 0.298). However, this symptom improved significantly only in the intact group (p < 0.001). The taste and salivation disturbance rate was not different between patients with and without chronic otitis media at 3 and 6 months, and both groups showed significant improvement. CONCLUSIONS Prevalence of taste and salivation disturbance was similar between three groups until 6 months. However, taste disturbance did not improve in the manipulated group and salivation disturbance improved only in the intact group.
Collapse
|
16
|
Pradhan P, Preetam C. Endoscopic stapedotomy: a comparison between 4 mm and 3 mm nasal endoscope. Eur Arch Otorhinolaryngol 2019; 276:3035-3041. [DOI: 10.1007/s00405-019-05592-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/01/2019] [Indexed: 01/15/2023]
|
17
|
Gulsen S, Karatas E. Comparison of surgical and audiological outcomes of endoscopic and microscopic approach in stapes surgery. Pak J Med Sci 2019; 35:1387-1391. [PMID: 31489012 PMCID: PMC6717452 DOI: 10.12669/pjms.35.5.439] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Objective: The main objectives of the present study were to compare the surgical and audiological outcomes of endoscopic and microscopic approach in stapes surgery. Methods: Sixty-one patients who underwent the stapes surgery with the endoscopic and microscopic approach between January 2012-November 2018 were included in the study. Patients were divided into two groups as a Group-I (endoscopic) and Group-II (microscopic). The audiometric measurements, duration of surgery, intraoperative findings and complications were recorded and evaluated retrospectively. Results: Mean operative time for the Group-I and II was 45.1±8.4 minutes and 48.7±5.6 minutes, respectively (p>0.05). The preoperative and postoperative average air-bone gap in the Group-I was 27.8±7.2 dB and 8.7±3.4 dB and these values in Group-II were 30.2±5.1 dB and 7.4±4.8 dB, respectively (p<0.001). The requirement of chorda tympani nerve manipulation and scutum curettage were significantly less in Group-I as compared Group-II (p<0.05). Dysgeusia and postoperative pain were observed significantly higher ratios in Group-II relative to Group-I (p<0.05). There was no significant difference between endoscopic and microscopic approach in stapes surgery in terms of difficulty of prosthesis insertion (p>0.05). Conclusion: Endoscopic stapes surgery provides comparable audiological outcomes, shorter operative times, fewer complications rates, and more minimally invasive surgery, relative to the microscopic approach.
Collapse
Affiliation(s)
- Secaattin Gulsen
- Dr. Secaattin Gulsen, MD. ENT Specialist Department of Otorhinolaryngology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Erkan Karatas
- Prof. Dr. Erkan Karatas, MD. Department of Otorhinolaryngology, Inonu University Faculty of Medicine, Malatya, Turkey
| |
Collapse
|
18
|
Das A, Mitra S, Ghosh D, Sengupta A. Endoscopic Stapedotomy: Overcoming Limitations of Operating Microscope. EAR, NOSE & THROAT JOURNAL 2019; 100:103-109. [PMID: 31288532 DOI: 10.1177/0145561319862216] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The study is aimed to assess the scope of endoscopic stapedotomy in overcoming technical challenges faced during conventional stapedotomy using operating microscope. Sixty-four patients with clinical and audiological diagnosis of otosclerosis were randomly assigned into one of the 2 groups-one underwent conventional stapedotomy using operating microscope, while the other group underwent endoscopic stapedotomy, the operating surgeon being the same for both groups, for all cases. The 2 groups were observed in terms of extent of the postero-superior canal bone curettage/drilling, chorda tympani repositioning, visualization of footplate area, surgical time from first incision to ear packing, post-operative morbidity in terms of post-operative pain, vertigo, hearing outcome, and changes in taste sensation. It was observed that irrespective of the width of the external auditory canal, endoscopic approach offered better access to the footplate area requiring lesser bone removal and chorda tympani repositioning. The operating time, post-operative pain, and changes in taste sensation were significantly less in the endoscopic group. However, no difference was noted in terms of the post-operative hearing outcome and incidence of vertigo. Endoscopic stapedotomy has clear advantages in terms of the technicality and accessibility to the working area as well as faster recovery.
Collapse
Affiliation(s)
- Arindam Das
- Department of Otorhinolaryngology and Head Neck Surgery, 30164Institute of Post Graduate Medical Education and Research and SSKM Hospital, Kolkata, West Bengal, India
| | - Sandipta Mitra
- Department of Otorhinolaryngology and Head Neck Surgery, 30164Institute of Post Graduate Medical Education and Research and SSKM Hospital, Kolkata, West Bengal, India
| | - Debasish Ghosh
- Department of Otorhinolaryngology and Head Neck Surgery, 30164Institute of Post Graduate Medical Education and Research and SSKM Hospital, Kolkata, West Bengal, India
| | - Arunabha Sengupta
- Department of Otorhinolaryngology and Head Neck Surgery, 30164Institute of Post Graduate Medical Education and Research and SSKM Hospital, Kolkata, West Bengal, India
| |
Collapse
|
19
|
Surgery for Chronic Otitis Media Causes Greater Taste Disturbance Than Surgery for Otosclerosis. Otol Neurotol 2019; 40:e32-e39. [DOI: 10.1097/mao.0000000000002048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
A modified method of local infiltration for endoscopic stapes surgery: how I do it. Eur Arch Otorhinolaryngol 2018; 276:357-365. [PMID: 30535977 DOI: 10.1007/s00405-018-5238-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/03/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To present a modified method of local infiltration (MMLI) for endoscopic stapes surgery to reduce surgical time, bleeding and complications. MATERIALS AND METHODS This study involved 70 patients who underwent stapes surgery for otosclerosis by endoscopic and microscopic approaches. The MMLI was applied as follows: local infiltration was performed with one hand while the other hand inserted the endoscope into the ear canal to observe vasoconstriction signs on the monitor; the single site of infiltration was located at the center of the anterior conchal cartilage. Operative time, intraoperative blood loss, preservation of anatomical structures, postoperative hearing and complications were evaluated. RESULTS The MMLI allowed for quick bleeding control and a clear and dry operative field. Operative time, intraoperative blood loss and preservation of anatomical structures were significantly reduced in the endoscopic group (P < 0.00) versus the microscopic group. The scutum was removed less frequent in the endoscopic group 7.1% versus 53.6% of the microscopic group (P < 0.00). The chorda tympani was preserved in all cases but it was more manipulated in the microscopic group 39.3% versus 9.5% of the endoscopic group (P < 0.00). No complications were observed and the hearing outcomes were significantly better than the preoperative thresholds. CONCLUSIONS This is the first report on the use of a MMLI for endoscopic stapes surgery. Using this method, the surgeon performs the infiltration at one site and concurrently observes the vasoconstriction signs without the use of a microscope, frontal lamp or speculum. This method provides benefits in terms of operative time and complications.
Collapse
|
21
|
|
22
|
Moneir W, Abd El-fattah AM, Mahmoud E, Elshaer M. Endoscopic stapedotomy: Merits and demerits. J Otol 2018; 13:97-100. [PMID: 30559773 PMCID: PMC6291631 DOI: 10.1016/j.joto.2017.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Surgical microscopes are still preferred to perform stapes surgery; but the use of the endoscopes would offer much benefits such as good panoramic view and easy accessibility to the oval window niche, the stapes and facial nerve. In this study, we aimed to analyze and compare the outcomes and complications of endoscopic versus microscopic stapes surgery. PATIENTS AND METHODS This work was done at the Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Egypt, between September 2015 and July 2016. The patients; diagnosed as having otosclerosis and full filled the selection criteria; were randomly divided into 2 groups. RESULTS The group A (microscopic group) included 28 patients (aged 19-60 years) and the group B (endoscopic group) included 14 patients (aged 22-56 years). Mean follow-up durations were 4.5 months (1-8.5) in the endoscopic group and 5.5 months (1.5-8) in the microscopic group. The difference in preoperative and postoperative air-bone gap in two groups was statistically significant (p = 0.031). But there was no statistical difference for hearing results between two groups and the two techniques have similar audiological outcomes. The main merits of endoscopic stapedotomy are the good quality panoramic image, well identification and visualization of vital structures of the middle ear, minimal handling of chorda tympani nerve if needed with practically no curettage of bony wall. CONCLUSIONS The present series shows that it is possible to perform stapes surgery using only the 4mm in diameter and 18cm long endoscopes of different angulations, without major difficulties.
Collapse
|
23
|
Antonelli PJ. Prevention and Management of Complications in Otosclerosis Surgery. Otolaryngol Clin North Am 2018; 51:453-462. [DOI: 10.1016/j.otc.2017.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
24
|
Rzaev RM, Rzaev RR, Rzaev RR. [The modern state and prospects of development of endoscopic otosurgery]. Vestn Otorinolaringol 2018; 83:74-78. [PMID: 30412182 DOI: 10.17116/otorino20188305174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this review presents data on efficiency endoscopic operations at some ear diseases. Now endoscopic operations are widely applied at primary and residual (or recuring) middle ear cholesteatomas, tympanic membrane perforation, otosclerosis and cochlear implantation. Proceeding from resolving power of endoscopic technology, endoscopic operation can be applied as an independent method, or as an endoscopic assisted, to be combined with otomicrosurgery operation. Efficiency of endoscopic operation in many respects is defined by a possibility of panoramic visualization of anatomical structures of middle and inner ear, and also carrying out high-quality elimination of focus lesion from areas, being remote when performing otomicrosurgery operation.
Collapse
Affiliation(s)
- R M Rzaev
- Department of Otorhinolaryngology - Head and Neck Surgery, Central Azerbaijan Railway Hospital, Baku, Azerbaijan
| | - R R Rzaev
- State Scientific Clinical of Otorhinolaryngology, Federal Medico-Biological Agency, Moscow, Russia
| | - Rd R Rzaev
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia
| |
Collapse
|
25
|
Affiliation(s)
- G Chawdhary
- Northampton General Hospital, Northampton, UK
| | - J Lavy
- Royal National Throat Nose and Ear Hospital, London, UK
| |
Collapse
|
26
|
Surmelioglu O, Ozdemir S, Tarkan O, Tuncer U, Dagkiran M, Cetik F. Endoscopic versus microscopic stapes surgery. Auris Nasus Larynx 2017; 44:253-257. [DOI: 10.1016/j.anl.2016.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 06/21/2016] [Accepted: 07/06/2016] [Indexed: 01/15/2023]
|
27
|
Maeda E, Katsura H, Nin T, Sakaguchi-Fukunaga A, Mishiro Y, Sakagami M. Change of somatosensory function of the tongue caused by chorda tympani nerve disorder after stapes surgery. Laryngoscope 2017; 128:701-706. [PMID: 28397279 DOI: 10.1002/lary.26598] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/20/2017] [Accepted: 03/01/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Patients after middle ear surgery often complain of taste disturbance and a lingual numbness. The purpose of this study was to objectively assess changes in the somatosensation of the tongue and taste function in patients undergoing stapes surgery. STUDY DESIGN Prospective study. METHODS Symptoms of taste disturbance and tongue numbness after surgery were investigated before and after surgery in 41 patients (13 males, 28 females; mean age 41.8 years) who underwent stapes surgery. Twenty-eight patients (9 males, 19 females; mean age 43.1 years) underwent sensory and taste function tests before and after surgery. Sensory function of the tongue was measured at the operated side and the nonoperated side using the 2-point discrimination test and an electrostimulator test. Taste function was assessed with electrogustometry (EGM). RESULTS The chorda tympani nerve (CTN) was gently touched or stretched in all patients. Postoperative thresholds on the operated side were significantly higher than preoperative thresholds in all tests in the patients who underwent all three kinds of tests. Tongue somatosensory symptoms improved significantly earlier than the taste disturbance postoperatively, and the sensory thresholds returned to the baseline along with recovery of symptoms. CONCLUSION These findings suggest that dysfunction of the CTN occurred following surgery even when the CTN was preserved, and that the sensory nerve threshold of the tongue correlated with the symptom of lingual numbness. The CTN may play a role not only in taste function but also in the somatosensory function of the tongue. LEVEL OF EVIDENCE 4. Laryngoscope, 128:701-706, 2018.
Collapse
Affiliation(s)
- Emi Maeda
- Department of Otolaryngology-Head and Neck Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Hirokazu Katsura
- Department of Otolaryngology-Head and Neck Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Tomomi Nin
- Department of Otolaryngology-Head and Neck Surgery, Hyogo College of Medicine, Hyogo, Japan
| | | | - Yasuo Mishiro
- Department of Otolaryngology-Head and Neck Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Masafumi Sakagami
- Department of Otolaryngology-Head and Neck Surgery, Hyogo College of Medicine, Hyogo, Japan
| |
Collapse
|
28
|
Berling Holm K, Knutsson J, Strömbäck K, Danckwardt Lillieström N, Papatziamos G, Rosenblad A, Von Unge M. Taste disturbance after stapes surgery: an evaluation of frequency, severity, duration, and quality-of-life. Acta Otolaryngol 2017; 137:39-43. [PMID: 27540683 DOI: 10.1080/00016489.2016.1217562] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSION The incidence of taste disturbance after stapes surgery is high (61.9%), whereas the majority (94.8%) recovers within 1 year. More severe surgical nerve trauma caused more disturbance, implying that the nerve should be handled carefully during surgery. OBJECTIVES Patients operated on for otosclerosis seem more often to complain about post-operative taste disturbance than those operated on for chronic otitis media, although the chorda tympani nerve more seldom becomes maltreated in stapedotomy. These observations seem paradoxical. It is unclear to what extent a post-operative taste disturbance affects the quality-of-life. This study aims to shed light on the occurrence of post-operative taste disturbances, on possible prognostic factors, and to what extent post-operative taste disturbance impairs the quality-of-life. METHODS One hundred and thirty-four adults undergoing primary stapedotomy were included. Questionnaires on taste disturbance and quality-of-life (SF-36) were answered before and after surgery, until 1 year post-operatively. RESULTS Eighty-three (61.9%) study persons reported post-operative taste disturbance. Seven (5.2%) reported persisting disturbance at 1 year. Surgically more traumatized chorda tympani nerves correlated with more severe taste disturbance post-operatively than less traumatized. Taste disturbance at 1 year post-operatively correlate with a decrease of the physical function domain in the SF-36.
Collapse
|
29
|
Hunter JB, Zuniga MG, Leite J, Killeen D, Wick C, Ramirez J, Rivas JA, Nogueira JF, Isaacson B, Rivas A. Surgical and Audiologic Outcomes in Endoscopic Stapes Surgery across 4 Institutions. Otolaryngol Head Neck Surg 2016; 154:1093-8. [DOI: 10.1177/0194599816633654] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 01/29/2016] [Indexed: 12/27/2022]
Abstract
Objectives To investigate intra- and postoperative outcomes of endoscopic stapes surgery. Study Design Case series with chart review. Setting Four tertiary care otologic centers. Subjects and Methods Sixty-five subjects 18 years and older who underwent endoscopic stapes surgeries were analyzed. Variables analyzed included surgical techniques and intraoperative findings. Outcomes measured included postoperative hearing and complications to date. Results Fifty-one patients met inclusion and exclusion criteria. The average patient age was 48.1 years (range, 26-87 years), with 60.0% female patients. Patients had a median follow-up of 5.13 months (range, 0.8-57.4 months). Of the subjects, 71.7% required scutum removal. The chorda tympani nerve was manipulated in 94.0% of subjects and transected in 12.0%. At last follow-up visit, the median air-bone gap decreased from 34.5 dB hearing level (HL) preoperatively to 9.0 dB HL postoperatively ( P < .0001). Ninety percent of subjects had closure of their air-bone gap ≤20 dB HL. Intraoperative complications included tympanic membrane tears in 8.0% of subjects, all of which resolved at first follow-up. Postoperatively, 10.0% of subjects complained of altered taste. Conclusions The present multicentered study of endoscopic stapes surgery demonstrates similar audiometric and postoperative outcomes previously published in the literature, with a median postoperative air-bone gap of 9.0 dB HL. Future prospective endoscopic stapes surgery studies, addressing the need for scutum removal, postoperative taste changes, and pain scores, are merited.
Collapse
Affiliation(s)
- Jacob B. Hunter
- The Otology Group, Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - M. Geraldine Zuniga
- The Otology Group, Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Daniel Killeen
- Department of Otolaryngology–Head and Neck Surgery, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
| | - Cameron Wick
- Department of Otolaryngology–Head and Neck Surgery, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | - Brandon Isaacson
- Department of Otolaryngology–Head and Neck Surgery, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
| | - Alejandro Rivas
- The Otology Group, Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
30
|
Gauvin DV, Abernathy MM, Tapp RL, Yoder JD, Dalton JA, Baird TJ. The failure to detect drug-induced sensory loss in standard preclinical studies. J Pharmacol Toxicol Methods 2015; 74:53-74. [DOI: 10.1016/j.vascn.2015.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 05/12/2015] [Accepted: 05/27/2015] [Indexed: 12/19/2022]
|
31
|
Ciofalo A, Zambetti G, Romeo M, Vestri AR, Iannella G, Re M, Magliulo G. Taste and olfaction in middle ear surgery. Ann Otol Rhinol Laryngol 2014; 124:312-6. [PMID: 25358610 DOI: 10.1177/0003489414555900] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to assess pre- and postoperative taste ability in patients undergoing middle ear surgery for otosclerosis or chronic otitis media. Olfactory function was also evaluated to rule out taste deficits due to concomitant nasal pathology. METHODS All patients underwent ear, nose, and throat examination, otomicroscopy, nasal endoscopy, anterior rhinomanometry, taste testing, and olfactory testing. Patients were evaluated at 1 to 5 days preoperatively (T0), and at 1 (T1), 6 (T6), and 12 (T12) months postoperatively. RESULTS Both groups of patients experienced worsening of the mean taste threshold postoperatively. This phenomenon was more serious in poststapedotomy patients. Follow-up showed progressive improvement in both groups. All values of olfactory testing were within the normal range for otosclerosis patients. Patients with chronic otitis media showed variable postoperative findings. CONCLUSION Chorda tympani function can be negatively affected by middle ear surgery. Deficits may be more marked in stapedotomy patients than in those undergoing tympanoplasty. Postoperative recovery of taste is satisfactory, although with different timelines for the 2 types of pathology.
Collapse
Affiliation(s)
- Andrea Ciofalo
- Organi di Senso Department, Sapienza University of Rome, Rome, Italy
| | | | - Martina Romeo
- Organi di Senso Department, Sapienza University of Rome, Rome, Italy
| | - Anna Rita Vestri
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | | | - Massimo Re
- Otorhinolaryngology Department, Marche Polytechnic University, Ancona, Italy
| | - Giuseppe Magliulo
- Organi di Senso Department, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
32
|
Barbara M, Volpini L, Monini S. Delayed facial nerve palsy after surgery for the Esteem(®) fully implantable middle ear hearing device. Acta Otolaryngol 2014; 134:429-32. [PMID: 24433055 DOI: 10.3109/00016489.2013.868602] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Delayed facial nerve (FN) impairment was shown to occur after Esteem(®) surgery, and taste disturbances were found in a limited number of subjects. Thus, when this type of active middle ear implant (AMEI) is to be implanted, these specific complications need to be shared with the candidate. OBJECTIVES To report on FN involvement in Esteem(®) AMEI surgery. METHODS A total of 23 males and 11 females, who presented with sensorineural hearing loss of varying severity, underwent surgical implantation of the Esteem(®) AMEI. FN function was assessed according to the House-Brackmann (HB) grading system. A specific question regarding taste impairment was administered to each patient on the first day and 3 months after surgery. RESULTS None of the patients presented with a FN deficit in the first postoperative days. In three patients (8.8%), FN palsy developed after 7 days (two patients) and 10 days (one patient), and the severities were HB 4 (two cases) and HB 5 (one case). All patients fully recovered (HB 1) after 6-8 weeks. In 10 of the 34 implanted subjects (29.4%), taste disturbances were found on postoperative day 1, and these impairments remained in only 6 (17.6%) patients at the 3-month postoperative follow-up.
Collapse
Affiliation(s)
- Maurizio Barbara
- Otolaryngology Clinic, NESMOS Department, Sapienza Rome, Sant'Andrea University Hospital , Rome , Italy
| | | | | |
Collapse
|
33
|
Migirov L, Wolf M. Endoscopic transcanal stapedotomy: how I do it. Eur Arch Otorhinolaryngol 2013; 270:1547-9. [PMID: 23463349 DOI: 10.1007/s00405-013-2420-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 02/21/2013] [Indexed: 02/06/2023]
Abstract
Current paper presents a surgical technique and preliminary results of the first eight consecutive fully endoscopic transcanal stapedotomies. All eight procedures were performed under local anesthesia by the same surgeon using rigid endoscopes of 3-mm diameter, 14-cm length, 0° and 30°. A posterior tympanomeatal flap was elevated transmeatally with the 0° endoscope and then transposed anteriorly. Stapes fixation was confirmed, the stapes tendon was cut with curved micro-scissors, and the stapes was separated from the incus in the incudo-stapedial joint. The anterior and posterior stapedial crus were carefully fractured, and the superstructure was removed. The hole in the foot-plate was created with a Skeeter microdrill using a 0.5-mm-diameter diamond burr. A platinum/fluoroplastic piston prosthesis (0.4-mm diameter) was placed into this hole and fitted along the long process of the incus. The tympano-meatal flap was repositioned, and the external auditory canal was filled with Gelfoam(®). The chorda tympani nerve was preserved in all cases. A 4.5-mm prosthesis was used in six cases and a 4.75-mm prosthesis in two. Pure tone audiograms demonstrated improved air- and bone-conduction threshold averages across the three speech frequencies (0.5-1.2 kHz) 6 months after surgery (64 vs. 29.8 dB and 30.6 vs. 25.1 dB, respectively). The average postoperative air-bone gap was within 10 dB in six ears and between 10 and 15 dB in the other two ears. Our preliminary results indicate that transcanal fully endoscopic stapedotomy is a feasible and safe technique for surgical management of hearing loss associated with otosclerosis.
Collapse
Affiliation(s)
- Lela Migirov
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, 5262l Tel Hashomer, Israel.
| | | |
Collapse
|