Comparison of wire-vein and wire-gelfoam prostheses in stapedectomy for otosclerosis

Is gelfoam sealing necessary in stapes surgery?

BACKGROUND

Sealing the oval window around the piston after fenestration with Gelfoam^® is a common practice in stapes surgery for otosclerosis.

OBJECTIVES

To analyse the effect of using or not using Gelfoam^® as a sealing material.

METHODS

A retrospective study was performed on 418 patients who underwent stapes surgery from 2013 until 2019. Data were collected from medical records in a tertiary centre. 215 cases in the Gelfoam group and 203 cases in the control group without sealing were included. The main comparisons were made between these two groups in terms of vestibular (primary outcome) and audiological outcomes and complications.

RESULTS

The patients' mean age was 47 years with a mean follow up of 50 months and a female predominance (65.6%, p = .049). There was no significant difference in terms of postoperative vertigo (11.6% vs 8.4%) or audiological outcomes in between Gelfoam and control group respectively. The average postoperative air-bone gap in the Gelfoam group was 4.6 dB vs. 5.3 dB in the control group (p = .634).

CONCLUSION AND SIGNIFICANCE

No difference were identified in vestibular or audiological outcomes during stapes surgery when using or not using Gelfoam^® in the middle ear.

Comparing Gelfoam vs fat as a sealing material in stapedotomy: A prospective double-blind randomised clinical trial

OBJECTIVES

One research aspect of stapes surgery is various materials that are used to seal the oval window. Several materials are used to seal the oval window, for example adipose tissue, perichondrium, vein graft, gelatin sponge (Gelfoam), blood clot and soft connective tissue. Up to now, there has been no randomised clinical trial that has evaluated the effects of different types of sealing material on hearing outcomes after stapedotomy. Hence, the present study aimed to find out which of these materials; fat or Gelfoam was associated with better hearing outcome, when used as a sealing material.

DESIGN

This prospective, double-blind, randomised clinical trial was carried out on ears that had undergone stapedotomy.

SETTING

Dastgheib Hospital affiliated to Shiraz University of Medical Sciences, a referral otology centre in southern Iran.

PARTICIPANTS

A total of 176 primary stapedotomies were analysed. Fat harvested from the ear lobule was used in 86 ears and Gelfoam in 90 ears.

MAIN OUTCOME MEASURES

Preoperative and postoperative pure tone audiometric data and incidence of sensorineural hearing loss were evaluated.

RESULTS

Total of 90.7% of all ears in the fat group and 87.8% of ears in Gelfoam group achieved postoperative air-bone gap (ABG) within 20 dB, and this difference was not significant. There was no case of sensorineural hearing loss (defined as 10 dB or more reduction in BC threshold) in both groups in mean frequencies of 0.5-3 kHz. There were 9 cases of sensorineural hearing loss at 4 kHz in the fat group vs 4 in the Gelfoam group. The occurrence of sensorineural hearing loss in different frequencies was not significant between the two groups (P > 0.05). In addition, there was no case of dead ear in either group.

CONCLUSIONS

We found similarity between hearing outcome in the Gelfoam and fat as sealing materials in stapedotomy. We believe that the first limitation of this study was the short-term follow-up in stapedotomy. The other issue is that one has to be cautious when using our result, which might not be applicable in larger fenestra stapedectomy.

Revision surgery for otosclerosis: An overview

Stapes surgery for otosclerosis has been proved to be a very satisfying procedure. However, the condition is difficult for the patients with no or little hearing gain after surgery and for those who had sudden or gradual hearing loss after a successful air-bone gap closure in the follow-up period. The issue of re-exploring the middle ear is challenging. A general review of this subject from several points of view remains lacking. In this study, articles related with the revision surgery for otosclerosis have been reviewed after a PubMed research and common and/or contradictory points were documented. The aim of this study is to give an insight to diagnostic and therapeutic approaches for the clinicians in patients who need a revision surgery. In conclusion, prosthesis problems, loose prosthesis in stapedotomy and migrated prosthesis in stapedectomy are the most common causes for revision surgery. Most important indicators which effect better hearing outcome following revision surgery are those ears with the presence of incus, with no obliteration of oval window, with small fenestra stapedotomy and the experience of surgeon. The risk of neurosensorial hearing loss in revision cases is not high but the hearing gain is limited as compared to primary cases. The rate of 10 dB air-bone gap closure is around 60%-70% at most and even less promising results have been reported. Patient’s demands and expectations have to be clarified in a realistic way.

[Auditory results used to compare a Teflon prosthesis vs a Schucknecht type wire/Teflon prosthesis]

PURPOSE

To compare a Teflon prosthesis to a piston-type wire/Teflon prosthesis assessing auditory results post-Stapedectomy.

MATERIAL AND METHODS

We conducted a randomized controlled blinded clinical study from June 2003 to August 2004 at the Otorhinolaryngology, and Head and Neck Surgical Wards at the highly specialized medical unit of "La Raza" General Hospital National Medical Cen ter in Mexico City. The study group was comprised by patients receiving a Teflon prosthesis (Fluoroplastic piston) while the control group received a Schuckneckt type piston wire/Teflon prosthesis. A pre- and post-auditory assessment was done obtaining the average at low, medium and high airway frequencies, the air/bone frequency differences and the total, at the Audiology and Otoneurology Service at the same hospital using a Madzen Minimate 602 brand audiometer. The results were analyzed using SPSS statistical software version 8.0.

RESULTS

138 patients were studied: 68 were included in the study group (Fluoroplastic prosthesis) and 70 in the control group (wire/Teflon prosthesis). A statistically significant difference was found between the groups (p < 0.04) according to the Mann-Whitney U test. The air/bone closure difference was statistically significant (p < 0.001) at low and high frequency ranges for the study group.

Success rate in revision stapes surgery for otosclerosis

OBJECTIVE

The aim of this study was to evaluate the hearing results of revision stapes surgery performed because of previously failed operations and to determine the causes of failure.

STUDY DESIGN

Retrospective review of revision stapes operations.

SETTING

Tertiary referral center.

PATIENTS

Sixty-three consecutive revision stapes operations were performed in 56 patients over a period of 12 years (1992-2004). The indication for revision surgery was recurrent or persistent air-bone gap greater than 20 dB after primary surgical treatment of otosclerosis of the oval window.

RESULTS

All patients were operated on to improve hearing. Sixty-three revision stapes operations resulted in closure of the air-bone gap to 10 dB or less in 52.4% of cases. The average postoperative air-bone gap was 13.1 dB, and the mean pure-tone average improvement was 12.9 dB. In six patients (9.5%), revision surgery produced no change in hearing, and in four (6.3%) the hearing decreased by 5 dB or more. In one patient, the operation resulted in a profound hearing loss. Prosthesis malfunction was the most common primary cause of failure (60.3%). The original prosthesis was replaced with a new one in 48 cases. In 30 of these (62.5%), closure of the air-bone gap to within 10 dB was achieved. In 15 cases, the prosthesis was not replaced, and in only four of these (26.7%), closure of the air-bone gap within 10 dB was obtained (p < 0.022).

CONCLUSION

Revision stapes surgery is less likely to be successful than the primary operation. Closure of the air-bone gap to within 10 dB was achieved in 52.4% of patients. The success rate was better in cases where the original prosthesis was replaced with a new one. The risk for decreased bone-conduction threshold does not seem to be higher than in primary surgery.

Poststapedectomy Hearing Gain: Comparison of a Teflon (fluoroplastic ASTM F 754) Prosthesis with a Schuknecht-type Wire/Teflon Prosthesis

We conducted a retrospective study to compare poststapedectomy hearing gain in study-eligible patients who had received a Teflon (fluoroplastic ASTM F 754) prosthesis (study group; n = 76) with hearing gain achieved in a matched group (by age, sex, and degree of hypoacusis) of patients who had received a Schuknecht-type wire/Teflon prosthesis (control group; n = 70). All procedures had been performed by the authors at our institution between Jan. 2, 1994, and Dec. 31, 1997. Airway averages at low, medium, and high frequencies were estimated on the basis of pre- and postoperative audiologic evaluations, as were total air-bone gaps at 7 frequencies between 125 and 8,000 Hz. We found that the study group achieved a significantly greater degree of hearing gain at 125 and 250 Hz and significantly better closure of the air-bone gap at 250, 500, 1,000, 2,000, and 4,000 Hz. The hearing outcomes among patients in the study group were excellent.

Stapedectomy in military aircrew

Stapedectomy in military aircrew is generally considered to be the end of an aviation career. Perilymphatic fistulae, prosthesis dislodgement, and perforation of the vestibule are recognized complications of stapedectomy. Consequently, barotrauma, G forces, and otherwise hostile conditions and their effects on the poststapedectomy ear are usually cited as reasons for grounding. Data supporting such a restrictive policy, however, are limited. This study examined the aeromedical outcome of 16 U.S. Air Force aircrew members who returned to flight duty after stapedectomy between 1965 and 1992. Selected patients were subjected to centrifuge and altitude chamber testing before they returned to flight duty. No episodes of sudden hearing loss or vestibulopathic conditions have occurred in the entire study group. Guidelines for surgical technique, reconstruction materials, and postoperative aeromedical testing are proposed for evaluating selected stapedectomy patients before their return to flight status.

Stapedectomy results in a residency training program

As the total number of stapedectomy procedures has declined, the adequacy of residency training for this procedure must be evaluated. Results of 5 years of stapedectomies performed by the resident otology service at the Massachusetts Eye and Ear Infirmary from Oct 1, 1979, through Sept 30, 1984, are reviewed and compared with other published results. A suggestion is made for improving the residency teaching program.