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Lenkeit CP, Fritz CG, Choi JS, Schutt CA, Hong RS, Babu SC, Bojrab DI. Quantifying the effect of shoulder size on operation duration: an analysis of stapes surgery outcomes. J Laryngol Otol 2024; 138:258-264. [PMID: 37203445 DOI: 10.1017/s0022215123000890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To investigate the effect of body mass index on hearing outcomes, operative time and complication rates following stapes surgery. METHOD This is a five-year retrospective review of 402 charts from a single tertiary otology referral centre from 2015 to 2020. RESULTS When the patient's shoulder was adjacent to the surgeon's dominant hand, the average operative time of 40 minutes increased to 70 minutes because of a significant positive association between higher body mass index and longer operative times (normal body mass index group (<25 kg/m2) r = 0.273, p = 0.032; overweight body mass index group (25-30 kg/m2) r = 0.265, p = 0.019). Operative times were not significantly longer upon comparison of low and high body mass index groups without stratification by laterality (54.9 ± 19.6 minutes vs 57.8 ± 19.2 minutes, p = 0.127). CONCLUSION There is a clinically significant relationship between body mass index and operating times. This may be due to access limitations imposed by shoulder size.
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Affiliation(s)
- Christopher P Lenkeit
- Michigan Ear Institute, Farmington Hills, Michigan, USA
- Department of Otolaryngology - Head and Neck Surgery, McLaren Oakland, Pontiac, Michigan, USA
| | - Christian G Fritz
- Michigan Ear Institute, Farmington Hills, Michigan, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Christopher A Schutt
- Michigan Ear Institute, Farmington Hills, Michigan, USA
- Neurotology Division, St John Providence Health System, Novi, Michigan, USA
- Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Robert S Hong
- Michigan Ear Institute, Farmington Hills, Michigan, USA
- Neurotology Division, St John Providence Health System, Novi, Michigan, USA
- Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA
| | - Seilesh C Babu
- Michigan Ear Institute, Farmington Hills, Michigan, USA
- Neurotology Division, St John Providence Health System, Novi, Michigan, USA
- Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA
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Warhade K, Vaid N, Chandorkar A, Vaze V, Kothadiya A. Frequency-Specific Audit of Audiological Outcomes Following Stapedotomy for Otosclerosis. Indian J Otolaryngol Head Neck Surg 2024; 76:200-207. [PMID: 38440536 PMCID: PMC10908935 DOI: 10.1007/s12070-023-04126-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/27/2023] [Indexed: 03/06/2024] Open
Abstract
Stapedotomy is an effective surgical intervention used for the treatment of conductive hearing loss associated with otosclerosis. The present study aims to quantitatively evaluate the hearing outcomes following primary stapedotomy performed in patients with otosclerosis. It also aims to investigate frequency-specific hearing results of stapedotomy in these patients. This retrospective study enrolled 49 patients with clinical otosclerosis, who underwent primary stapedotomy at a tertiary-care hospital, between January 2014 and December 2019. Pure-tone audiometry (PTA) was performed pre and post-operatively (> 1 year after surgery). Post-operative air conduction (AC) and bone conduction (BC) thresholds were recorded. The primary outcome measure was post-operative air-bone gap (ABG). Low frequency (LF) ABG was calculated as the mean ABG of thresholds at 0.5 and 1 kHz. High frequency (HF) ABG was calculated as the mean ABG of thresholds recorded at 2 and 4 kHz. In all the study patients, the mean post-operative AC and the mean postoperative BC thresholds, showed significant improvement across the tested frequencies of 0.5, 1, 2 and 4 kHz (P < 0.05). The mean post-operative ABG closure was superior at HF, as compared to that at LF (9.54 ± 6.30 dB vs. 12.0 ± 6.63 dB, P = 0.014). A successful surgical outcome (post-operative ABG closure to ≤ 10 dB) was achieved in 61.22% of the study patients. Further, a greater number of patients (71.45%) recorded successful surgical outcome at HF, when compared with those at LF (46.95%, P < 0.05). Favourable hearing outcomes of this study underscore the effectiveness of primary stapedotomy in the treatment of patients with clinical otosclerosis. Better postoperative ABG closure to ≤ 10 dB was recorded at higher frequencies. Further studies assessing post-stapedotomy hearing results at HF are warranted for ensuring better hearing outcomes in the HF range as well. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04126-0.
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Affiliation(s)
- Komal Warhade
- Department of ENT/Otorhinolaryngology, KEM Hospital, Rasta Peth, 489, Sardar Moodliar Road, Pune, Maharashtra 411011 India
- Dr. Vaishampayan Memorial Government Medical College, Court Road, Opp. District Court Rang Bhavan Chowk, Siddheshwar Peth, Solapur, Maharashtra India
| | - Neelam Vaid
- Department of ENT/Otorhinolaryngology, KEM Hospital, Rasta Peth, 489, Sardar Moodliar Road, Pune, Maharashtra 411011 India
| | - Aparna Chandorkar
- Health Science (Freelance) and Radiologist, Pune, Maharashtra 411038 India
| | - Varada Vaze
- Department of ENT/Otorhinolaryngology, KEM Hospital, Rasta Peth, 489, Sardar Moodliar Road, Pune, Maharashtra 411011 India
| | - Ajay Kothadiya
- Department of ENT/Otorhinolaryngology, KEM Hospital, Rasta Peth, 489, Sardar Moodliar Road, Pune, Maharashtra 411011 India
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Conway RM, Sioshansi PC, Babu SC, Tu NC, Schettino AE, Bojrab DI, Schutt CA. Audiologic Outcomes of Footplate Drillout for Obliterative Otosclerosis. Otol Neurotol 2022; 43:29-35. [PMID: 34619729 DOI: 10.1097/mao.0000000000003361] [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: 11/27/2022]
Abstract
OBJECTIVE To evaluate the audiologic outcomes of microdrill fenestration for obliterative otosclerosis compared to traditional stapedotomy technique. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Adult patients undergoing stapedotomy for otosclerosis. MAIN OUTCOME MEASURES Patients were separated into groups that underwent either microdrill or laser fenestration based on intraoperative severity of disease. Audiologic outcomes and complications were compared between the two groups. RESULTS There were 588 ears in 519 patients that were evaluated. There was a significant postoperative improvement in pure tone average, air-bone gap, and mean bone conduction thresholds for both the obliterative and nonobliterative group (p < 0.001). There was no significant difference in the pre- or postoperative hearing status between the two groups. There was no significant difference in complications between the two groups, including no cases of postoperative profound hearing loss in the drill fenestration group. CONCLUSIONS Audiologic outcomes are similar between microdrill fenestration and laser fenestration for otosclerosis. Pure tone average, air-bone gap, and mean bone conduction thresholds all improved postoperatively and were similar between groups.
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Affiliation(s)
- Robert M Conway
- Department of Otolaryngology - Head and Neck Surgery, Ascension Macomb-Oakland Hospital, Madison Heights
| | - Pedrom C Sioshansi
- Department of Otolaryngology - Head & Neck Surgery Wake Forest University School of Medicine Winston-Salem, NC
| | | | - Nathan C Tu
- Department of Otolaryngology-Head and Neck Surgery, Albany Medical Center, Albany, NY
| | - Amy E Schettino
- Department of Otolaryngology - Head and Neck Surgery, Hospital of the University of Pennsylvania, Philidelphia, Pennsylvania
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Abstract
BACKGROUND Increased body mass index (BMI) has been associated with postoperative complications in multiple surgical specialties. In otologic surgery involving the stapes, where appropriate patient positioning and surgical dexterity are necessary for proper prosthesis placement, patients with higher BMI could make surgery more challenging. The purpose of this study is to evaluate the impact of BMI on outcomes after stapes surgery. METHODS Medical records were examined from January 2015 to December 2017 in patients undergoing stapedectomy or stapedotomy at two tertiary care facilities. A retrospective cohort analysis comparing hearing outcomes on postoperative audiogram following procedural intervention with BMI was performed. The primary outcome was postoperative air-bone gap (dB) on audiogram. RESULTS Two hundred sixty three stapedotomy and stapedectomy patients were included in the study. Six percent had BMI less than 18.5 (underweight), 30% had BMI between 18.6 and 24.9 (normal weight), 38% had BMI between 25 and 29.9 (overweight), 24% had BMI above 30 (obese). The mean preoperative and postoperative air-bone gap (ABG) was 27.0 dB (standard deviation [SD] 15) and 10.4 dB (SD 10.6), respectively, with a postoperative ABG less than or equal to 20 dB in 87% of cases. There were no significant differences in postoperative ABG results when comparing the BMI categories (p = 0.11). CONCLUSIONS Stapedotomy and stapedectomy are effective surgeries that can be performed by experienced surgeons with successful hearing improvement. While high BMI patients may be a challenge to position appropriately for their surgery, this does not translate to altered otologic outcomes for these patients.
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Souza JCRD, Bento RF, Pereira LV, Ikari L, Souza SR, Della Torre AAG, Fonseca ACDO. Evaluation of Functional Outcomes after Stapes Surgery in Patients with Clinical Otosclerosis in a Teaching Institution. Int Arch Otorhinolaryngol 2016; 20:39-42. [PMID: 26722344 PMCID: PMC4687999 DOI: 10.1055/s-0035-1563540] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/28/2015] [Indexed: 11/08/2022] Open
Abstract
Introduction Otosclerosis is a primary disease of the temporal bone that leads to stapes ankylosis. Hearing loss is the main symptom. Treatment includes surgery, medical treatment, and sound amplification therapy alone or in combination. Objective To evaluate the functional outcomes of patients with clinical diagnosis of otosclerosis undergoing primary stapes surgery in a teaching institution. Method Retrospective descriptive study. Results A total of 210 ears of 163 patients underwent stapes surgery. Of the 163 patients, 116 (71.2%) underwent unilateral surgery and 47 (28.8%) underwent bilateral surgery. Six of the 210 operated ears had obliterative otosclerosis. The average preoperative and postoperative air–bone gap was 32.06 and 4.39 dB, respectively. The mean preoperative and postoperative bone conduction threshold was 23.17 and 19.82 dB, respectively. A total of 184 (87.6%) ears had a residual air–bone gap <10 dB, and 196 (93.3%) had a residual air–bone gap ≤15 dB. Two patients (0.95%) had severe sensorineural hearing loss. Conclusion Stapes surgery showed excellent functional hearing outcomes in this study. This surgery may be performed in educational institutions with the supervision of experienced surgeons.
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Affiliation(s)
| | - Ricardo Ferreira Bento
- Department of Otolaryngology, Universidade de São Paulo, School of Medicine, São Paulo, São Paulo, Brazil
| | - Larissa Vilela Pereira
- Department of Otolaryngology, Universidade de São Paulo, School of Medicine, São Paulo, São Paulo, Brazil ; Department of Otolaryngology, Anchieta Hospital, Brasília, DF, Brazil
| | - Liliane Ikari
- Department of Otolaryngology, Universidade de São Paulo, School of Medicine, São Paulo, São Paulo, Brazil
| | - Stephanie Rugeri Souza
- Department of Otolaryngology, Universidade de Mogi das Cruzes, Mogi das Cruzes, São Paulo, Brazil
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