Stapes surgery in patients with a small air-bone gap

Audiological outcome after stapes surgery in relation to prosthesis type

PURPOSE

Different techniques are used to fix crimp and CliP® Piston stapes prostheses to the long process of the incus (LPI). The CliP® Piston provides a stiff connection in contrast to the static bended loop of the crimp prosthesis, which imitates the physiological incudostapedial joint (ISJ) and thereby potentially leads to different hearing outcome.

METHODS

In a retrospective single-center study of German-speaking one hundred and ninety patients who underwent stapes surgery CliP® Piston or crimp prostheses between the years of 2016 and 2019 by the same surgeon and in the same setting. Pre- and postoperative bone- (BC) and air-conduction (AC) pure-tone thresholds, pre- and postoperative air-bone gap (ABG) for 0.5, 1, 1.5, 2, 3, 4 kHz and the surgery time were examined.

RESULTS

The postoperative bone conduction thresholds were significantly lower in the frequencies between 0.5 and 3 kHz and the mean ABG was < 10 dB in most cases independent of the prosthesis used. Crimp prosthesis showed a significantly better closure of the ABG at 0.5 kHz.

CONCLUSIONS

The audiological outcome after stapes surgery is dependent on the type of prosthesis used, as reflected by the frequency-specific air-bone gap. The better ABG closure with the crimp prosthesis might be the result of the connection to the LPI imitating the physiological ISJ. The crimp prosthesis may be the better choice if use of hearing aids is expected postoperatively.

Evaluation of stapes mobilization in the 21st century for conductive hearing loss in the otosclerotic ear

PURPOSE

Compare outcomes of stapes mobilization and stapedectomy performed by a single surgeon for the otosclerosis.

MATERIALS AND METHODS

A retrospective chart review of adult patients who underwent stapes mobilization or stapedectomy for otosclerosis was performed. Operative notes reviewed; patients included if diagnosed with otosclerosis without another otologic disease that could contribute to their hearing loss and all required data were available. Pre-and post-operative audiograms at 1, 6, and 12-months were evaluated to compare the air-bone gaps between the mobilization and stapedectomy procedures. The rates of sensorineural hearing loss also were compared. Student t-tests and multiple regression models were used to ascertain the association between improvement in post-operative air-bone gaps, sensorineural hearing loss, and the procedure undertaken.

RESULTS

Sixty-seven (n = 67) patients with 108 procedures were included for analysis. No substantial difference between the surgical subgroups was found when comparing stapes mobilization to stapedectomy, and there was no evidence to suggest that either surgical procedure was superior to the other based on the data obtained and analyzed. Improvements in air-bone gap averaged 15.79 dB for stapes mobilization and 19.23 dB for stapedectomy. The results of the study showed no evidence of post-operative sensorineural hearing loss or change in air-bone gaps when comparing virgin to "revision" stapedectomy largely in patients who had failed previous mobilization.

CONCLUSION

Stapes mobilization provides a conservative approach to otosclerosis patients suffering from conductive hearing loss. Stapedectomy can be used to correct failed mobilization.

Stapes and Stapes Revision Surgery: Preoperative Air-Bone Gap Is a Prognostic Marker

OBJECTIVE

Stapes surgery is considered an effective treatment in otosclerosis, but controversy remains regarding predictors of surgical outcome.

STUDY DESIGN

Retrospective cohort study.

SETTING

Tertiary referral center.

PATIENTS

One hundred sixty three cases of stapes surgery between 2012 and 2019 were reviewed.

MAIN OUTCOME MEASURES

Primary outcome measures were relative hearing improvement (relHI), defined as preoperative minus postoperative air conduction divided by preoperative air-bone gap (ABG), as well as relative ABG closure (relABGc), defined as preoperative ABG minus postoperative ABG divided by preoperative ABG. Univariate and multivariate linear regression analyses were performed to determine independent predictors for these outcomes.

RESULTS

Higher preoperative bone conduction (BC) and primary surgery (compared with revision) were independently associated with increased relHI (p = 0.001 and p = 0.004, respectively). Lower preoperative BC, higher preoperative ABG, primary surgery, and age were independently associated with increased relABGc (p = 0.0030, p < 0.001, p = 0.0214, and p = 0.0099, respectively). Sex did not predict surgical outcome. In patients with less than 20 dB preoperative ABG, likelihood of negative relABGc was increased (compared with 20-30 dB or >30 dB preoperative ABG, p = 0.0292, Fisher's exact test). This tendency was not significant for relHI (p = 0.074).

CONCLUSIONS

Our findings demonstrate that calculating HI and ABGc in relation to preoperative ABG can reliably predict outcomes of stapes surgery. Both primary and revision stapes surgery are effective treatment options, but relative improvement is higher in primary cases. Preoperative BC, preoperative ABG, and age predict surgical outcomes as well. Otosclerosis patients with low preoperative ABG, especially less than 20 dB, should be counseled and selected cautiously regarding stapes surgery.

Impact of surgeons' experience and the single-shot perioperative antibiotic prophylaxis on outcome in stapedotomy

Background

The aim of this study was to evaluate whether surgeons´ experience and perioperative single-shot antibiotic prophylaxis affect outcome of patients undergoing stapes surgery.

Patients and methods

We retrospectively evaluated audiological outcomes and postoperative complications of 538 consecutive patients who underwent stapes surgery at a single tertiary referral center between 1990 and 2017. Effects of different clinical variables, including single-shot antibiotic prophylaxis and surgeons’ experience on outcome were assessed.

Results

538 patients underwent 667 stapedotomies and postoperative complication rate was 7.5% (n = 50). Air conduction and air-bone gap closure improved significantly after surgery (14.2 ± 14.8 dB, p = 0.001; 14.5 ± 12.8 dB, p = 0.001). Multivariate analysis revealed that 6 years or less of surgical experience was independently associated with a higher incidence of persisting or recurrent conductive hearing loss (p = 0.033, OR 5.13) but perioperative application of antibiotics had no significant effect on outcome.

Conclusion

First, clinical outcome regarding persisting or recurrent conductive hearing loss caused by incus necrosis and prosthesis luxation is linked to surgical performance. This underlines the need for a meticulous training and supervision of less experienced surgeons performing stapes surgery. Second, our results do not support the need for perioperative antibiotic prophylaxis in stapes surgery. Potential standard limitations of retrospective cohort studies (selection bias, confusion bias etc.) could play a role in interpreting our results. However, the probability for these limitations is minimized due to the large patient sample.

[Modern ideas about the professional suitability of employees of regulated professions with middle ear pathology and the possibility of their return to work (analytical review of the literature)]

Fitness for work in persons with middle ear disease who are exposed to harmful work environment and their possible return to work was analyzed. Fitness for work expertise procedure in the Russian Federation is disclosed in detail. A list of medical contraindications to work in harmful and/or dangerous work environment according to hearing condition is given. Clinical aspects of middle ear diseases in the industry workers are presented and modern ideas about middle ear surgical treatment, it's functional results, documenting technique and outcome calculation are described in detail. Possibility of returning the employee to work is discussed based on all the analyzed materials.

Stapes Surgery for 121 Patients With Mixed Hearing Loss

This study aims to determine the benefit of stapes surgery for otosclerosis in 121 patients with a mixed hearing loss and a preoperative bone conduction (BC) threshold >30 dB. Average postoperative air conduction (AC) improved from 61.5 dB to 34.3 dB. Average air-bone gap closed from 27.1 dB to 6.1 dB. Bone conduction improved from 34.3 dB to 28.2 dB, with 38% of patients achieving a postoperative AC of <30 dB. Glasgow Benefit Inventory scores showed significantly increased quality of life postoperatively in the 88 patients who responded to follow-up, with an average score of 56. There was a mean reduction in daily hearing aid use postsurgery of 5.48 hours, with 56% of patients who responded to follow-up questionnaire no longer needing to use one. When assessing suitability for stapes surgery, surgeons should consider that preoperative BC thresholds may be a poor indicator of the true cochlear reserve and therefore the potential for improvement in AC thresholds and quality of life.

The clinical characteristics of otosclerosis and benefit from stapedotomy: our experience of 48 patients (58 ears)

Background: Stapedotomy has been proved to be one of the most efficient procedure to treat otosclerosis, various factors contribute to the diversity of the outcomes and controversial results exist from previous studies. Objectives: We evaluated clinical characteristics and outcomes of stapedotomy, as well as possible predictive factors of a successful outcome. Materials and methods: This retrospective study evaluated 58 ears from 48 patients with demographic data, plus short-term follow-up of hearing outcomes of 28 ears, and evaluated variables using univariate general linear regression analyses. Results: The average operation age was 41.54 years. A total of 87.5% (42/48) patients presented with bilateral otosclerosis. 39.66% (23/58) ears had CT finding before the surgery. Patients with persistent tinnitus accounted for 53.45% (31/58) and the average preoperative ABG of the 58 ears was 32.22 dB. We achieved good postoperative air-bone gaps (ABGs) overall but poor ABG closure at 4 kHz. No predictive factors were identified in the 28 ears that were followed up. Conclusions and significance: Delayed surgery may be attributable to insufficient recognition of otosclerosis. The fenestration size could be the reason for poor ABG closure at high frequency. However, more cases and longer follow-ups are required to confirm our findings.

Analysis of factors affecting postoperative functional outcome in patients with otosclerosis

OBJECTIVE

This study aimed to analyze the factors affecting postoperative hearing results of patients with otosclerosis.

METHODS

Medical records of 245 patients with clinical otosclerosis who underwent stapes surgery at our center from January 2009 to December 2018 were reviewed. The retrospectively collected data included patients' demographics, clinical characteristics, pre- and postoperative audiometric data, size of preoperative air-bone gap (ABG) (small/large). The patients were categorized into two groups according to the postoperative functional outcome: Group 1 consisted of patients with a postoperative ABG of ≤10dB and Group 2 comprised those with a postoperative ABG of >10dB. Evaluation of factors affecting functional outcome were performed by logistic regression analysis. Receiver operating characteristics (ROC) curve was generated to obtain the cut-off points for preoperative ABG.

RESULTS

There were no statistically significant differences between the two groups in terms of age group (p=0.393), gender (p=0.670), operated side (p=0.370), and laterality of disease (p=0.607). There were 42 patients (31.6%) with a small ABG and 91 patients (68.4%) with a large ABG in group 1, and six (13.6%) and 38 patients (86.4%), respectively in group 2. There was a statistical significant difference between the groups in terms of the size of preoperative ABG (p=0.020). In group 1, the mean preoperative air conduction (AC) threshold and preoperative ABG were significantly lower than in group 2 (p<0.001 and p<0.001, respectively). There was no statistically significant difference between the groups in terms of the preoperative bone conduction (BC) threshold (p=0.406). Preoperatively, the AC threshold and large ABG were found to be significantly poorer prognostic factors (p<0.001; 95%CI: 1.031-1.210 and p=0.037; 95%CI: 1.063-7.023, respectively). Preoperative ABG cut-off threshold for functional success was found to be 34.5dB. The functional success rate was significantly higher in patients with a preoperative ABG of <34.5 than in patients with a preoperative ABG of ≥34.5dB (p<0.001).

CONCLUSION

The preoperative AC threshold and large ABG were poor prognostic factors for postoperative hearing outcome in patients with otosclerosis. The functional outcomes were similar in patients with a preoperative small ABG and those with a preoperative ABG of <34.5dB. A preoperative ABG cut-off value of <34.5dB should be possibly considered as a parameter for predicting surgical success in otosclerosis and seems to be useful in clinical practice.