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Henkemans SE, Rovers J, Thomeer HGXM. Surgical outcome in class 4 congenital anomalies of the ossicular chain: a systematic review of the literature. Eur Arch Otorhinolaryngol 2023; 280:4327-4337. [PMID: 37410147 PMCID: PMC10477222 DOI: 10.1007/s00405-023-08091-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: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To review hearing and surgical outcomes after reconstructive middle ear surgery in class 4 congenital middle ear anomalies (CMEA), e.g., patients with oval- or round window atresia of dysplasia. DATA SOURCES Pubmed/Medline, Embase and Cochrane library. REVIEW METHODS Articles containing data on hearing outcomes and complications after reconstructive ear surgery in class 4 anomalies were analyzed and critically appraised. The following data were included and reviewed: patient demographics, audiometric testing, surgical techniques, complications, revision surgeries and their outcomes. Risk of bias was determined, and GRADE certainty of evidence was assessed. Primary outcomes were postoperative air conduction thresholds (AC), change in AC, and success rates (closure of the ABG to within 20 dB), the occurrence of complications (most importantly sensorineural hearing loss) and the long-term stability of hearing results (> 6-month follow-up) and occurrence of recurrence of preoperative hearing loss. RESULTS Success rates varied from 12.5 to 75% at long-term follow-up with larger cohorts reporting success rates around 50%, mean postoperative gain in AC varied from 4.7 to 30 dB and - 8.6 to 23.6 dB at, respectively, short- and long-term follow-up. No postoperative change in hearing occurred in 0-33.3% of ears, and recurrence of hearing loss occurred in 0-66.7% of ears. SNHL occurred in a total of seven ears across all studies of which three experienced complete hearing loss. CONCLUSION Reconstructive surgery can be an effective treatment option which should be considered in patients with very favorable baseline parameters, while also considering the substantial risk of recurrence of hearing loss, the possibility of unchanged hearing despite surgery and the rare occurrence of SNHL. LEVEL OF EVIDENCE 2c.
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Affiliation(s)
- S E Henkemans
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, 3508 GA, Utrecht, The Netherlands
| | - J Rovers
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, 3508 GA, Utrecht, The Netherlands
| | - H G X M Thomeer
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, 3508 GA, Utrecht, The Netherlands.
- Brain Center, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Parmeggiani G, Gualandi F, Limarzi M, Ferlini A, Brotto D, Martini A, Sensi A. A familial case of NOG -related symphalangism spectrum disorder due to a novel NOG variant. Clin Dysmorphol 2022; 31:185-190. [PMID: 36004948 DOI: 10.1097/mcd.0000000000000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Francesca Gualandi
- Azienda Ospedaliero-Universitaria di Ferrara, Medical Genetics Unit, Ferrara
| | | | - Alessandra Ferlini
- Azienda Ospedaliero-Universitaria di Ferrara, Medical Genetics Unit, Ferrara
| | - Davide Brotto
- Neurosciences Department, Università di Padova, Otorhinolaryngology Unit, Padova, Italy
| | - Alessandro Martini
- Neurosciences Department, Università di Padova, Otorhinolaryngology Unit, Padova, Italy
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Santos A, Gradela A, Faria M. Anatomical and morphometric study of goat middle ear ossicles (Capra aegagrus hircus). ARQ BRAS MED VET ZOO 2021. [DOI: 10.1590/1678-4162-12482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The social and economic roles of goat farming in Northeastern Brazil, allied to the fact that the use of goat middle ear ossicles for research and human ear surgery training has not yet been proposed, justify the study of their applicability as an experimental model. The middle ears of 19 goats (Capra aegagrus hircus) from the bone collection of the Laboratory and Didactic Anatomy Museum of Domestic and Wild Animals of the Federal University of Vale do São Francisco (UNIVASF) were dissected. The malleus, incus, and stapes were evaluated regarding their macroscopic morphology and biometry (length, width, and height). Ossicle morphology was similar to sheep, human, and bovine morphology. The malleus was 1.3 times heavier and 2.2 times longer than the incus, and 9.0 times heavier and 3.7 times longer than the stapes. The size relationship was positive between the stapes and the malleus and negative between the stapes and the incus. It is concluded that the middle ear size and the anatomical similarities with human ossicles make goats a useful model for experimental scientific studies, reconstructive surgery practice of the ossicular chain, and human ear surgery training.
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Affiliation(s)
- A.C. Santos
- Universidade Federal do Vale do São Francisco, Brazil
| | - A. Gradela
- Universidade Federal do Vale do São Francisco, Brazil
| | - M.D. Faria
- Universidade Federal do Vale do São Francisco, Brazil
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Henkemans SE, Smit AL, Stokroos RJ, Thomeer HGXM. Congenital Anomalies of the Ossicular Chain: Surgical and Audiological Outcomes. Ann Otol Rhinol Laryngol 2021; 131:388-396. [PMID: 34116598 PMCID: PMC8899814 DOI: 10.1177/00034894211025405] [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] [Indexed: 11/17/2022]
Abstract
Objectives: In this study, we aim to analyze audiometric outcomes of middle ear surgery
in patients with congenital middle ear anomalies. Methods: In this single center retrospective cohort study, audiological outcomes were
extracted from patient files. Patients with a congenital middle ear anomaly
treated surgically in a tertiary referral center between June 2015 and
December 2020 were included. Pre- and postoperative short- and long-term
audiometric data (at ≥3 and ≥10 months respectively) were compared to
analyze hearing outcomes. Results: Eighteen ears (15 patients) were treated surgically with an exploratory
tympanotomy. At short term follow up statistically significant improvements
in air conduction thresholds and air-bone gaps were found. Hearing improved
in 94.4% (17/18) of operated ears. Successful outcome, defined as an
air-bone gap closure to within 20 dB after surgery, was reached in 44.4%
(8/18). Serviceable hearing (air conduction ≤30 dB) was reached in 55.6%
(10/18). Negative outcome (any significant deterioration in hearing)
occurred in 1 patient: in this ear otitis media occurred during the
postoperative course. At long term follow up, available for 50% of the
cohort, hearing remained stable in 5 ears, improved in 1 ear and
deteriorated in 3, all of which underwent revision surgery. Sensorineural
hearing loss due to surgery, or other complications, were not
encountered. Conclusion: middle ear surgery was found to be an effective treatment option to improve
hearing in this cohort of patients with congenital middle ear anomalies.
Surgical goals of obtained gain in air conduction thresholds and serviceable
hearing levels were met by most patients without the occurrence of any
iatrogenic sensorineural hearing loss.
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Affiliation(s)
- Sara E Henkemans
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Adriana L Smit
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.,Brain Centre Rudolf Magnus, University Medical Centre Utrecht, The Netherlands
| | - Robert J Stokroos
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.,Brain Centre Rudolf Magnus, University Medical Centre Utrecht, The Netherlands
| | - Hans G X M Thomeer
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.,Brain Centre Rudolf Magnus, University Medical Centre Utrecht, The Netherlands
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Nada A, Agunbiade SA, Whitehead MT, Cousins JP, Ahsan H, Mahdi E. Cross-Sectional Imaging Evaluation of Congenital Temporal Bone Anomalies: What Each Radiologist Should Know. Curr Probl Diagn Radiol 2020; 50:716-724. [PMID: 32951949 DOI: 10.1067/j.cpradiol.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/09/2020] [Accepted: 08/21/2020] [Indexed: 11/22/2022]
Abstract
Hearing loss in pediatric age group is associated with many congenital temporal bone disorders. Aberrant development of various ear structures leads into either conductive or sensorineural hearing loss. Knowledge of the embryology and anatomical details of various compartments of the ear help better understanding of such disorders. In general, abnormalities of external and middle ears result in conductive hearing loss. Whereas abnormalities of inner ear structures lead into sensorineural hearing loss. These abnormalities could occur as isolated or part of syndromes. Temporal bone disorders are a significant cause of morbidity and developmental delays in children. Imaging evaluation of children presented with hearing loss is paramount in early diagnosis and proper management planning. Our aim is to briefly discuss embryology and anatomy of the pediatric petrous temporal bones. The characteristic imaging features of commonly encountered congenital temporal bone disorders and their associated syndromes will be discussed.
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Affiliation(s)
- A Nada
- Diagnostic Radiology Resident, Department of Radiology, University of Missouri Health care. One Hospital Drive, Columbia, MO.
| | - S A Agunbiade
- Diagnostic Radiology Resident, Department of Radiology, University of Missouri Health care. One Hospital Drive, Columbia, MO
| | - M T Whitehead
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC; George Washington University Hospital, Washington, DC
| | - J P Cousins
- Diagnostic Radiology Resident, Department of Radiology, University of Missouri Health care. One Hospital Drive, Columbia, MO
| | - H Ahsan
- Diagnostic Radiology Resident, Department of Radiology, University of Missouri Health care. One Hospital Drive, Columbia, MO
| | - E Mahdi
- Diagnostic Radiology Resident, Department of Radiology, University of Missouri Health care. One Hospital Drive, Columbia, MO
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Zhang C, Mi J, Long D, Deng Y, Sun Q, Liu Z. Endoscopic Ossiculoplasty for the Management of Isolated Congenital Ossicular Chain Malformation: Surgical Results in 16 Ears. EAR, NOSE & THROAT JOURNAL 2020; 100:585-592. [PMID: 32495647 DOI: 10.1177/0145561320931218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The aim of this study is to describe the clinical characteristics and intraoperative findings and further evaluate the efficacy of endoscopic ossiculoplasty for the management of isolated congenital ossicular chain malformation. METHODS A retrospective study was performed on 16 ears (15 patients) with the isolated congenital ossicular chain malformation who underwent endoscopic ossiculoplasty in our department from May 2017 to January 2019. Endoscopic exploratory tympanotomy was conducted to check the ossicular chain; at the same time, endoscopic ossiculoplasty was performed depending on intraoperative findings. Air-conduction thresholds, bone-conduction thresholds, and air-bone gaps (ABGs) were measured before and after surgery, and the hearing outcome was assessed at 6 months postoperatively. RESULTS The most common malformations of ossicular chain were the missing of the incus long process and stapes suprastructure. A serial assessment of the hearing status was conducted before and 6 months after surgery. It showed the mean postoperative pure-tone average (PTA) was significantly reduced, and the mean postoperative ABG was obviously closed, respectively (P < .001). The mean PTA gain was 36.3 ± 8.6 dB, and the ABG closure was 35.1 ± 8.3 dB; ABG closure to 20 dB or less and ABG closure to 10 dB or less were achieved in 14 cases (87.5%) and 5 cases (31.3%), respectively. No differences were observed in postoperative hearing outcome between type Ⅲ cases and type Ⅳ cases; however, cases with partial ossicular replacement prosthesis implantation showed a larger hearing gain (P = .049) and a higher proportion of postoperative ABG less than 10 dB (P = .021). No facial palsy and significant sensorineural hearing loss occurred; all patients completed the surgery without the need of canalplasty, and the chorda tympani nerve was preserved in all patients. CONCLUSIONS This research showed endoscopic surgery was effective in the diagnosis and management of isolated congenital ossicular chain malformation; the endoscopic ossiculoplasty provides an alternative method to manage congenital ossicular chain malformation, with comfortable hearing outcome and the advantage of excellent vision and less invasion.
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Affiliation(s)
- Chunlin Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Jiaoping Mi
- Department of Otolaryngology, Head and Neck Surgery, The 5th Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Dan Long
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.,Postgraduate College of Zunyi Medical University, Zunyi, Guizhou, China
| | - Yuan Deng
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Qiang Sun
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.,Postgraduate College of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zhaohui Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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Han SA, Choe G, Kim Y, Koo JW, Choi BY, Song JJ. Beware of a Fragile Footplate: Lessons from Ossiculoplasty in Patients with Ossicular Anomalies Related to Second Pharyngeal Arch Defects. J Clin Med 2019; 8:jcm8122130. [PMID: 31816982 PMCID: PMC6947221 DOI: 10.3390/jcm8122130] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 11/24/2019] [Accepted: 12/01/2019] [Indexed: 12/16/2022] Open
Abstract
Background and objectives: We review the intraoperative findings and postoperative outcomes of ossiculoplasty in subjects with second pharyngeal arch (SPA)-derived ossicular anomalies. We summarize potential intraoperative complications and recommend precautions that may reduce the risk of fracture. Materials and Methods: Twenty-four patients with SPA-derived ossicular anomalies were included, and pre- and postoperative audiometric results were compared. Results: The mean air conduction threshold (56.0 ± 12.4 dB HL) was significantly improved 1 month (27.6 ± 10.1 dB HL) and 6 months (23.8 ± 13.2 dB HL) after surgery (p < 0.001). The preoperative air–bone gap (ABG) (40.4 ± 7.4 dB HL) was significantly decreased at 1 month (15.1 ± 5.9 dB HL) and 6 months (11.3 ± 8.9 dB HL) postoperation. ABG closure was successful (<20 dB HL) in 21 (87.5%) patients 6 months after surgery. Intraoperative footplate fractures occurred in 3 of 24 patients. The fractures were managed successfully, and the ABG closure was successful in all cases. Conclusions: The stapes footplate is likely to be relatively thin in subjects with SPA-derived ossicular anomalies because the footplate is partially or totally derived from the SPA. Thus, a fragile footplate should be expected, and care is needed when handling the footplate. However, when complications are overcome, the audiological outcomes are excellent in most cases.
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Affiliation(s)
| | | | | | | | | | - Jae-Jin Song
- Correspondence: or ; Tel.: +82-31-787-7408; Fax: +82-31-787-4057
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9
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Unilateral congenital malformations of middle ear with intact external ear: a review of 64 cases. Eur Arch Otorhinolaryngol 2018; 275:2467-2472. [DOI: 10.1007/s00405-018-5099-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
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Vincent R, Wegner I, Derks LSM, Grolman W. Congenital ossicular chain malformations with mobile stapes in children: Results in 17 cases. Laryngoscope 2015; 126:682-8. [DOI: 10.1002/lary.25351] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 04/02/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Robert Vincent
- Causse Ear Clinic (r.v.); Traverse de Béziers Colombiers France
| | - Inge Wegner
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht the Netherlands
| | | | - Wilko Grolman
- Department of Otorhinolaryngology-Head and Neck Surgery; University Medical Center Utrecht; Utrecht the Netherlands
- Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht the Netherlands
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Esteves SDS, Silva APD, Coutinho MB, Abrunhosa JM, Sousa CAE. Congenital defects of the middle ear - uncommon cause of pediatric hearing loss1,2. Braz J Otorhinolaryngol 2014; 80:251-6. [PMID: 25153111 PMCID: PMC9535481 DOI: 10.1016/j.bjorl.2013.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 10/01/2013] [Indexed: 12/22/2022] Open
Abstract
Introduction In children, hypoacusis, or conductive hearing loss, is usually acquired; otitis media with effusion is the most common etiology. However, in some cases this condition is congenital, ranging from deformities of the external and middle ear to isolated ossicular chain malformations. The non-ossicular anomalies of the middle ear, for instance, persistent stapedial artery and anomaly of the facial nerve, are uncommon but may accompany the ossicular defects. Objective This study aimed to describe the clinical presentation, diagnostic tests, and therapeutic options of congenital malformations of the middle ear. Methods This was a retrospective study of cases followed in otolaryngologic consultations since 2007 with the diagnosis of congenital malformation of the middle ear according to the Teunissen and Cremers classification. A review of the literature regarding the congenital malformation of the middle ear and its treatment is presented. Conclusion Middle ear malformations are rarely responsible for conductive hearing loss in children. As a result, there is often a late diagnosis and treatment of these anomalies, which can lead to delays in the development of language and learning.
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Congenital Oval or Round Window Anomaly With or Without Abnormal Facial Nerve Course. Otol Neurotol 2012; 33:779-84. [DOI: 10.1097/mao.0b013e3182595282] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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