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Adams JK, Marinelli JP, De Jong R, Spear SA, Erbele ID. Modern Trends in Otologic Surgery and Implications for Residency Training. Otolaryngol Head Neck Surg 2024; 170:1404-1410. [PMID: 38251771 DOI: 10.1002/ohn.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE Placing a middle ear prosthesis is considered a key competency for the general otolaryngologist, but surgeons struggle to obtain and maintain this skill. The current study aims to characterize pre-coronavirus disease 2019 trends in stapedectomy and ossiculoplasty. STUDY DESIGN Database review. SETTING Tricare beneficiaries are treated at civilian and military facilities. METHODS The Department of Defense beneficiary population of more than nine million persons per year was reviewed for patients undergoing either stapedectomy or ossiculoplasty between 2010 and 2019, identified by the current procedural terminology code. RESULTS A total of 3052 stapedectomies and 7197 ossiculoplasties were performed. Over the 10-year study period, stapedectomy decreased by 23%, with an average annual rate of -2.7% per year (Pearson r = -.91, P = .0003). Ossiculoplasties declined by 18%, an average annual rate of -1.9% (r = -.8, P = .006). In combination, cases declined by 20%, an average annual rate of -2.2% (r = -.87, P = .001). CONCLUSION While declines in stapedectomy surgery have been well reported, here we show steady declines in ossiculoplasty as well. If these trends continue, more cochlear implantations may be performed annually than stapedectomy and ossiculoplasty combined, with cochlear implantation likely to overtake ossicular chain surgery in the near future. These changes in surgical volume have a direct implication on resident education and general otolaryngology expectations after graduation. Strong consideration should be made to replace "Stapedectomy/Ossiculoplasty" as resident key indicator with "Cochlear Implantation," a more professionally meaningful skill.
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Affiliation(s)
- Jason K Adams
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - John P Marinelli
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - Russell De Jong
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - Samuel A Spear
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
- Department of Defense Hearing Center of Excellence, San Antonio, Texas, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Isaac D Erbele
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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2
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Motamedi V, Doyle EJ, Nickel JC, Monetti AR, Kraus EM. Venous Outflow and Otosclerosis: An Unusual Case of Pulsatile Tinnitus. Ear Nose Throat J 2023:1455613231166581. [PMID: 37082922 DOI: 10.1177/01455613231166581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
We report resolution of right-sided pulsatile tinnitus in a 44-year-old male who underwent stapedectomy for fenestral otosclerosis. Initial workup revealed a mixed hearing loss and absent stapedial reflexes consistent with ossicular fixation. CT angiography demonstrated near complete stenosis of the left-sided transverse and sigmoid sinuses and dominant contralateral venous outflow. We hypothesized that the dominant right cerebral venous outflow tract created turbulent flow that was conducted to cochlea. Successful stapedectomy was performed, and the pulsatile tinnitus resolved. This case report demonstrates evidence that the sound of turbulent blood flow can be conducted through bone and an instance where the perception of vascular tinnitus was eliminated with stapedectomy.
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Affiliation(s)
- Vida Motamedi
- Department of Otolaryngology-Head & Neck Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Edward J Doyle
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Joseph C Nickel
- Department of Otolaryngology-Head & Neck Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Alexandra Rose Monetti
- Department of Otolaryngology-Head & Neck Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Eric M Kraus
- Department of Otolaryngology-Head & Neck Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
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3
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Fernandez IJ, Rondini F, Presutti L, Molinari G. Recurrence of conductive hearing loss after stapes surgery: a narrative review. Acta Otorhinolaryngol Ital 2023; 43:S56-S60. [PMID: 37698101 PMCID: PMC10159633 DOI: 10.14639/0392-100x-suppl.1-43-2023-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/17/2023] [Indexed: 09/13/2023]
Abstract
Among the functional failures of stapes surgery is recurrent conductive hearing loss, which can occur after a variable period of hearing improvement, from days/months up to many years after surgery. The most common cause of recurrent conductive hearing loss is prosthesis displacement, while fibrous adhesions or stapedotomy hole/oval window re-obliteration due to otosclerosis, occur less frequently. High resolution computed tomography plays an important role in the identification of the cause of hearing loss recurrence. Parallel to this, intra-operative exploration of the middle ear is crucial to confirm the cause of failure and address its treatment, possibly restoring hearing. While generally worse than after primary surgery, hearing outcomes after revision stapes surgery have improved thanks to advancements in pre-operative assessment, intra-operative view and technical refinements.
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Affiliation(s)
| | | | | | - Giulia Molinari
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Specialistic, Diagnostic and Experimental Medicine, Alma Mater Studiorum University, Bologna, Italy
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4
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Maalouf RR, Marc M, Mukherjee P, Van Rompaey V, Eliezer M, Hautefort C, Verillaud B, Herman P, Kania R. Otosclerosis: audiometric results and quality of life after stapedectomy with interposition or CO 2 laser-calibrated stapedotomy without interposition. Acta Otolaryngol 2023; 143:231-236. [PMID: 36939022 DOI: 10.1080/00016489.2023.2186482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND The surgical treatment of otosclerosis consists of the replacement of the stapes using a piston. AIMS/OBJECTIVES The objective of this study is to assess the audiometric results and quality of life (QOL) of patients who underwent surgery for otosclerosis by stapedectomy with fascia interposition (STIP) or by stapedotomy using CO2 laser (SLaser) without fascia interposition. MATERIAL AND METHODS Ninety-one patients operated on for otosclerosis by STIP (40 patients) and by SLaser (51 patients) were included. Audiometric results were graphically displayed using the Amsterdam Hearing Evaluation Plot and were compared to the Common Otology Database (COD) comprising 660 patients. The patients' QOL was assessed with an otological validated survey. The significance level was p < .05. RESULTS There was no significant difference in hearing improvement between SLaser and STIP-operated patients. There was no significant difference between our results and that of COD. QOL was significantly improved (+3.5/10) postoperatively for both STIP and SLaser in both social and professional fields. CONCLUSIONS AND SIGNIFICANCE By comparing QOL and hearing gain of STIP and SLaser, our results suggest that both surgical techniques are a safe and successful treatment for otosclerotic stapes fixation. Further studies aiming at comparing larger series may confirm and refine these results.
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Affiliation(s)
- Ramzi R Maalouf
- Department of ENT and Head and Neck Surgery, Lariboisière Hospital, Paris, France
| | - Morgane Marc
- Department ENT - Sydney Adventist Hospital, University of Sydney, Australia
| | | | - Vincent Van Rompaey
- Department of ENT and Head and Neck Surgery, Antwerp University Hospital Center, Edegem, Belgium
| | - Michael Eliezer
- Department of Radiology, Lariboisière Hospital, Paris, France
| | - Charlotte Hautefort
- Department of ENT and Head and Neck Surgery, Lariboisière Hospital, Paris, France
| | - Benjamin Verillaud
- Department of ENT and Head and Neck Surgery, Lariboisière Hospital, Paris, France
| | - Philippe Herman
- Department of ENT and Head and Neck Surgery, Lariboisière Hospital, Paris, France
| | - Romain Kania
- Department of ENT and Head and Neck Surgery, Lariboisière Hospital, Paris, France
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5
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Boscoe EF, Banakis Hartl RM, Gubbels SP, Greene NT. Effects of Varying Laser Parameters During Laser Stapedotomy on Intracochlear Pressures. Otolaryngol Head Neck Surg 2023; 168:462-468. [PMID: 35671134 PMCID: PMC10097413 DOI: 10.1177/01945998221104658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Sensorineural hearing loss is a known complication of stapes surgery. We previously showed that laser stapedotomy can result in intracochlear pressures that are comparable to high sound pressure levels. Optimizing laser settings to those that correspond with the lowest pressure changes may mitigate risk for postoperative hearing loss. Here we quantify the effects of various laser parameters on intracochlear pressures and test the hypothesis that intracochlear pressure changes are proportional to the laser energy delivered. STUDY DESIGN Basic and translational science. SETTING Cadaveric dissection and basic science laboratory. METHODS Cadaveric human heads underwent mastoidectomies. Intracochlear pressures were measured via fiber-optic pressure probes placed in scala vestibuli and tympani. Pulses of varied stimulus power and duration from a 980-nm diode laser were applied to the stapes footplate. RESULTS Sustained high-intensity pressures were observed in the cochlea during all laser applications. Observed pressure magnitudes increased monotonically with laser energy and rose linearly for lower stimulus durations and powers, but there was increased variability for laser applications of longer duration (200-300 ms) and/or higher power (8 W). CONCLUSIONS Results confirm that significant pressure changes occur during laser stapedotomy, which we hypothesize may cause injury. Overall energy delivered depends predictably on duration and power, but surgeons should use caution at the highest stimulus levels and longest pulse durations due to the increasing variability in intracochlear pressure under these stimulus conditions. While the risk to hearing from increased intracochlear pressures from laser stapedotomy remains unclear, these results affirm the need to optimize laser settings to avoid unintended injury.
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Affiliation(s)
- Elizabeth F. Boscoe
- Department of Otolaryngology–Head and Neck Surgery, University of Colorado, Aurora, Colorado
| | - Renee M. Banakis Hartl
- Department of Otolaryngology–Head and Neck Surgery, University of Colorado, Aurora, Colorado
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Samuel P. Gubbels
- Department of Otolaryngology–Head and Neck Surgery, University of Colorado, Aurora, Colorado
| | - Nathaniel T. Greene
- Department of Otolaryngology–Head and Neck Surgery, University of Colorado, Aurora, Colorado
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6
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Ricci G, Ferlito S, Gambacorta V, Faralli M, De Luca P, Di Giovanni A, Di Stadio A. Treatment of Far-Advanced Otosclerosis: Stapedotomy Plus Hearing Aids to Maximize the Recovery of Auditory Function-A Retrospective Case Series. Healthcare (Basel) 2023; 11. [PMID: 36900680 DOI: 10.3390/healthcare11050676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/07/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
Far-advanced otosclerosis (FAO) refers to severe otosclerosis with scarce auditory functions. The identification of the best method to correctly listen to sound and speech has a large impact on patients' quality of life. We retrospectively analyzed the auditory function of 15 patients affected by FAO who were treated with stapedectomy plus hearing aids independent of the severity of their auditory deficit before surgery. The combination of surgery and hearing aids allowed excellent recovery of the perception of pure tone sounds and speech. Four patients, because of poor auditory thresholds, needed a cochlear implant after stapedectomy. Despite being based on a small sample of patients, our results suggest that stapedotomy plus hearing aids could improve the auditory capacities of patients with FAO independent of their auditory thresholds at T0. The careful selection of patients is fundamental to obtain the best outcomes.
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7
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Lim J, Goo W, Kang DW, Oh SH, Kim N. Effect of closing material on hearing rehabilitation in stapedectomy and stapedotomy: A finite element analysis. Front Neurosci 2023; 17:1064890. [PMID: 36866333 PMCID: PMC9971570 DOI: 10.3389/fnins.2023.1064890] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023] Open
Abstract
Stapedotomy or stapedectomy operations are often performed to treat otosclerosis. During the operation, the space created by bone removal is usually filled with a closing material such as fat or fascia. In this study, the effect of the Young's modulus of the closing material on the hearing level was investigated through the 3D finite element model of a human head including auditory periphery. The Young's moduli of the closing material used to implement stapedotomy and stapedectomy conditions in the model were varied from 1 kPa to 24 MPa. The results showed that the hearing level improved when the closing material was more compliant after stapedotomy. Therefore, when the stapedotomy was performed using fat whose Young's modulus is lowest among the potential closing materials, the hearing level recovered the best among all simulated cases. On the other hand, in stapedectomy, the Young's modulus did not have the linear relationship between the hearing level and the compliance of the closing material. Hence, the Young's modulus causing the best hearing rehabilitation in stapedectomy was found not at the end of the investigated range of Young's modulus but somewhere in the middle of the given range.
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Affiliation(s)
- Jongwoo Lim
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Woonhoe Goo
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dae Woong Kang
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Ha Oh
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Republic of Korea,Seung Ha Oh,
| | - Namkeun Kim
- Department of Mechanical Engineering, Sogang University, Seoul, Republic of Korea,*Correspondence: Namkeun Kim,
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8
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Shohet JA, Borrelli M, Nasrollahi T, Raskin J. Penetration of the Vestibule Following a History of Stapedectomy. Ear Nose Throat J 2022; 101:33S-36S. [PMID: 36062376 DOI: 10.1177/01455613221121501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This case study describes a 72-year-old female with a history of stapedectomy 40 years prior. She presented experiencing vertigo, fogginess, and imbalance for 9 months. Computed tomography (CT) imaging revealed that the prosthesis was displaced into the vestibule by approximately 2.1 to 2.4 mm. The patient was presented with treatment options, including observation, removal, replacement of the prosthesis, and an oval window patch. The patient opted for observation as the symptoms she was experiencing did not significantly impact her quality of life. Although a stapedectomy may fail for a multitude of reasons, some of the most common causes are prosthesis displacement, especially out of the oval window into the middle ear or away from the incus. Incus necrosis may also play a substantial role in failure.
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Affiliation(s)
- Jack A Shohet
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA.,Shohet Ear Associates, Orange County, CA, USA
| | - Michela Borrelli
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Tasha Nasrollahi
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA.,472525California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Jonathan Raskin
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA.,William Beaumont School of Medicine, 6918Oakland University, Detroit, MI, USA
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9
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Peter MS, Warnecke A, Staecker H. A Window of Opportunity: Perilymph Sampling from the Round Window Membrane Can Advance Inner Ear Diagnostics and Therapeutics. J Clin Med 2022; 11:jcm11020316. [PMID: 35054010 PMCID: PMC8781055 DOI: 10.3390/jcm11020316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/29/2021] [Accepted: 01/06/2022] [Indexed: 12/12/2022] Open
Abstract
In the clinical setting, the pathophysiology of sensorineural hearing loss is poorly defined and there are currently no diagnostic tests available to differentiate between subtypes. This often leaves patients with generalized treatment options such as steroids, hearing aids, or cochlear implantation. The gold standard for localizing disease is direct biopsy or imaging of the affected tissue; however, the inaccessibility and fragility of the cochlea make these techniques difficult. Thus, the establishment of an indirect biopsy, a sampling of inner fluids, is needed to advance inner ear diagnostics and allow for the development of novel therapeutics for inner ear disease. A promising source is perilymph, an inner ear liquid that bathes multiple structures critical to sound transduction. Intraoperative perilymph sampling via the round window membrane of the cochlea has been successfully used to profile the proteome, metabolome, and transcriptome of the inner ear and is a potential source of biomarker discovery. Despite its potential to provide insight into inner ear pathologies, human perilymph sampling continues to be controversial and is currently performed only in conjunction with a planned procedure where the inner ear is opened. Here, we review the safety of procedures in which the inner ear is opened, highlight studies where perilymph analysis has advanced our knowledge of inner ear diseases, and finally propose that perilymph sampling could be done as a stand-alone procedure, thereby advancing our ability to accurately classify sensorineural hearing loss.
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Affiliation(s)
- Madeleine St. Peter
- Department of Otolaryngology-Head & Neck Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Athanasia Warnecke
- Department of Otolaryngology Head and Neck Surgery, Hannover Medical School, D-30625 Hanover, Germany;
| | - Hinrich Staecker
- Department of Otolaryngology-Head & Neck Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA;
- Correspondence:
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10
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Kosyakov SY, Pchelenok EV, Tarasova OY, Ershova EN, Garov EV, Vinnikov AK. [The practice of stapes surgury in Russia]. Vestn Otorinolaringol 2022; 87:19-25. [PMID: 36404686 DOI: 10.17116/otorino20228705119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The aim of this study - to investigate the practice of stapes surgery in Russia using a special questionnaire (Appendix 1). Thirty-three questionnaires were sent to specialists dealing with stapes surgery in various Russian medical institutions. Responses were received from all ENT specialists, of whom 75.7% use stapedotomy as a technique. In most cases, colleagues perform more than 30 operations per year, there were also reports of performing about 100 operations per year and in one case 370 operations annually. 45.5% of respondents preferred a combination of general and local anesthesia for stapes surgery. According to the results of the survey, the titanium K-piston prosthesis is most frequently used. Analysis of the survey results showed that to date there is no unanimous opinion concerning some aspects of stapes surgery; however, in many issues the approaches of Russian surgeons coincide with the general world trends.
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Affiliation(s)
- S Ya Kosyakov
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - E V Pchelenok
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - O Yu Tarasova
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - E N Ershova
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - E V Garov
- Research Clinical Institute of Otorinolaryngology named after. L.I. Sverzhevsky, Moscow, Russia
| | - A K Vinnikov
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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11
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Razavi C, Galaiya D, Vafaee S, Yin R, Carey JP, Taylor RH, Creighton FX. Three dimensional printing of a low-cost middle-ear training model for surgical management of otosclerosis. Laryngoscope Investig Otolaryngol 2021; 6:1133-1136. [PMID: 34693002 PMCID: PMC8513458 DOI: 10.1002/lio2.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical management of otosclerosis is technically challenging with studies demonstrating that outcomes are commensurate with surgical experience. Moreover, experts apply less force on the ossicular chain during prosthesis placement than their novice counterparts. Given the predicted decreasing patient pool and the rising cost of human temporal bone specimens it has become more challenging for trainees to receive adequate intraoperative or laboratory-based experience in this procedure. As such, there is a need for a low-cost training model for the procedure. Here we describe such a model. METHODS A surgical model of the middle ear was designed using computer aided design (CAD) software. The model consists of four components, the superior three dimensional (3D)-printed component representing the external auditory canal, a 90° torsion spring representing the incus, a 3D-printed base with a stapedotomy underlying the torsion spring, and a 3D-printed phone holder to facilitate video-recording of trials and subsequent calculation of the force applied on the modeled incus. Force applied on the incus is calculated based on Hooke's Law from post-trial computer-vision analysis of recorded video following experimental determination of the spring constant of the modeled incus. RESULTS The described model was manufactured with a total cost of $56.50. The spring constant was experimentally determined to be 97.0 mN mm/deg, resulting in an ability to detect force applied to the modeled incus across a range of 1.2 to 5200 mN. CONCLUSIONS We have created a low-cost middle-ear training model with measurable objective performance outcomes. The range of detectable force exceeds expected values for the task.Level of Evidence: IV.
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Affiliation(s)
- Christopher Razavi
- Department of Otolaryngology – Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Deepa Galaiya
- Department of Otolaryngology – Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Seena Vafaee
- Laboratory for Computational Sensing and RoboticsJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Rui Yin
- Laboratory for Computational Sensing and RoboticsJohns Hopkins UniversityBaltimoreMarylandUSA
| | - John P. Carey
- Department of Otolaryngology – Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Russell H. Taylor
- Laboratory for Computational Sensing and RoboticsJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Francis X. Creighton
- Department of Otolaryngology – Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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12
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Lamblin E, Karkas A, Jund J, Schmerber S. Is the Carhart notch a predictive factor of hearing results after stapedectomy? ACTA ACUST UNITED AC 2021; 41:84-90. [PMID: 33746227 PMCID: PMC7982757 DOI: 10.14639/0392-100x-n0213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/26/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Elea Lamblin
- Department of Otolaryngology-Head and Neck Surgery, Grenoble University Hospital, Grenoble Cedex 9, France
| | - Alexandre Karkas
- Department of Otolaryngology-Head and Neck Surgery, Saint Etienne University Hospital, CHU de Saint-Étienne Hôpital Nord, Saint Etienne Cedex 2, France
| | - Jérôme Jund
- Department of Research and Clinical Investigation, Annecy Hospital, Metz - Tessy, Pringy Cedex, France
| | - Sébastien Schmerber
- Department of Otolaryngology-Head and Neck Surgery, Grenoble University Hospital, Grenoble Cedex 9, France
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13
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Qureshi HA, Zeitler DM. Intratympanic Steroid Injection Complicated by Iatrogenic Perilymphatic Fistula: A Cautionary Tale. Laryngoscope 2021; 131:2088-2090. [PMID: 33973652 DOI: 10.1002/lary.29613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 12/31/2022]
Abstract
Intratympanic (IT) steroid therapy is a mainstay treatment for sudden sensorineural hearing loss (SSNHL) for both initial therapy and salvage therapy. We report a rare case of iatrogenic perilymphatic fistula that resulted from trauma during an IT steroid injection for SSNHL. We discuss the diagnosis and treatment in the current case and compare it with previous reports from the literature. Laryngoscope, 131:2088-2090, 2021.
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Affiliation(s)
- Hannan A Qureshi
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Daniel M Zeitler
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center, Seattle, Washington, U.S.A
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14
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Abstract
OBJECTIVES To compare audiometric outcomes and complication rates between primary and revision stapes surgical cases. STUDY DESIGN Retrospective cohort study. SETTING Large single-institution database. METHODS Data on 809 patients (including 170 revisions) undergoing primary and revision stapes surgery were reviewed, with Pearson chi-square and multivariable logistic regression analysis performed. RESULTS Rates of postoperative air-bone gap (ABG) closure to ≤10 dB were significantly worse in the revision group (40.2% vs 61.8%, P < .001), as were those to ≤20 dB (78.1% vs 90.9%, P < .001). The bone conduction pure tone average worsened by >10 dB in 7.1% of primary cases and 13.1% of revisions (P = .016). The mean postoperative ABG for revision cases was significantly higher at 15.5 dB as compared with 11.0 dB for primaries (P < .001), despite a slightly higher preoperative ABG for primary cases (30.6 vs 28.24 dB, P = .010). In multivariate analysis, revision surgery had an odds ratio 0.41 (P < .001) in closing the ABG to ≤10 dB. Postoperative reparative granuloma (2.4% vs 0.2%, P = .001) and hydrops (1.8% vs 0.2%, P = .008) were higher in revision cases. CONCLUSIONS Revision stapes surgery was found to have less predictable and inferior results as compared with primary cases. LEVEL OF EVIDENCE 4 (retrospective observational research).
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Affiliation(s)
- Zachary G Schwam
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Health System, New York, New York, USA
| | - Amy Schettino
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Pennsylvania, USA
| | - Seilesh C Babu
- Department of Neurotology, Michigan Ear Institute, St John Providence Hospital, Michigan, USA
| | - Dennis I Bojrab
- Department of Neurotology, Michigan Ear Institute, St John Providence Hospital, Michigan, USA
| | - Elias M Michaelides
- Department of Otolaryngology-Head and Neck Surgery, Rush University, Illinois, USA
| | - Christopher A Schutt
- Department of Neurotology, Michigan Ear Institute, St John Providence Hospital, Michigan, USA
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15
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Ho S, Patel P, Ballard D, Rosenfeld R, Chandrasekhar S. Systematic Review and Meta-analysis of Endoscopic vs Microscopic Stapes Surgery for Stapes Fixation. Otolaryngol Head Neck Surg 2021; 165:626-635. [PMID: 33528314 DOI: 10.1177/0194599821990669] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To systematically review the current literature regarding the operative outcomes of stapes surgery for stapes fixation via the endoscopic and microscopic approaches. DATA SOURCES PubMed, Embase, and Web of Science. REVIEW METHODS An electronic search was conducted with the keywords "endoscop* or microscop*" and "stapes surgery or stapedectomy or stapedotomy or otosclerosis or stapes fixation." Studies were included if they compared endoscopy with microscopy for stapes surgery performed for stapes fixation and evaluated hearing outcomes and postoperative complications. Articles focusing on stapes surgery other than for stapes fixation were excluded. RESULTS The database search yielded 1317 studies; 12 remained after dual-investigator screening for quantitative analysis. The mean MINORS score was 18 of 24, indicating a low risk of bias. A meta-analysis demonstrated no statistically significant difference between the groups with regard to operative time, chorda tympani nerve manipulation or sacrifice, or postoperative vertigo. There was a 2.6-dB mean improvement in the change in air-bone gap in favor of endoscopic stapes surgery and a 15.2% increased incidence in postoperative dysgeusia in the microscopic group, but the studies are heterogeneous. CONCLUSIONS Endoscopic stapes surgery appears to be a reasonable alternative to microscopic stapes surgery, with similar operative times, complications, and hearing outcomes. Superior visibility with the endoscope was consistently reported in all the studies. Future studies should have standardized methods of reporting visibility, hearing outcomes, and postoperative complications to truly establish if endoscopic stapes surgery is equivalent or superior to microscopic stapes surgery.
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Affiliation(s)
- Sandra Ho
- Department of Otolaryngology, State University of New York at Downstate, Brooklyn, New York, USA
| | - Prayag Patel
- Department of Otolaryngology, State University of New York at Downstate, Brooklyn, New York, USA
| | - Daniel Ballard
- Department of Otolaryngology, State University of New York at Downstate, Brooklyn, New York, USA
| | - Richard Rosenfeld
- Department of Otolaryngology, State University of New York at Downstate, Brooklyn, New York, USA
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16
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Jutila T, Sivonen V, Hirvonen TP. Simultaneous bilateral stapes surgery after follow-up of 13 years. Acta Otolaryngol 2021; 141:39-42. [PMID: 33043736 DOI: 10.1080/00016489.2020.1828621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Eighteen patients underwent simultaneous bilateral stapes surgery in 2003-2006. OBJECTIVES We evaluated the long-term outcomes in this patient group, and assessed their hearing in noise and binaural hearing. MATERIAL AND METHODS Fifteen patients returned questionnaires concerning their hearing, taste function, and balance. Thirteen patients underwent pure-tone and speech audiogram, Finnish matrix sentence test, video head impulse test, and clinical examination on average 13 years after surgery. RESULTS We found no significant difference in air- and bone conduction pure-tone average, speech audiometry, and the air-bone gap between the 1-year and the late postoperative visits. One patient had bilaterally a partial loss of the vestibulo-ocular reflex of unknown cause. CONCLUSIONS AND SIGNIFICANCE The hearing results 13 years after simultaneous bilateral stapes surgery remained good without any significant delayed complications. Simultaneous bilateral stapes surgery is a viable treatment option in selected patients with otosclerosis.
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Affiliation(s)
- Topi Jutila
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ville Sivonen
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Timo P. Hirvonen
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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17
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Abstract
BACKGROUND During stapes surgery, the Teflon wire piston prosthesis is prone to postoperative 'slips' and subsequent necrosis and fracture of the long process of the incus. AIMS/OBJECTIVE We invented and used a novel cup-shaped apatite prosthesis to reduce the incidence of necrosis of the long process of the incus and analysed the postoperative results. MATERIAL AND METHODS Thirty-one ears in 25 patients with otosclerosis who underwent stapes surgery with our apatite prosthesis were evaluated. RESULTS The air conduction improved by 24.0 dB (the average) from pre- to post-operation. Additionally, 84.8% of patients achieved an air-bone gap of ≤10 dB for the 4-frequency measurements (p < .01). CONCLUSIONS Our findings indicate that our new prosthesis was associated with a good postoperative prognosis in patients with otosclerosis. SIGNIFICANCE Our unique prosthesis yielded good outcomes for the treatment of otosclerosis even in the short term.
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Affiliation(s)
- Sho Kanzaki
- Department of Otolaryngology, School of Medicine, Keio University, Tokyo, Japan
| | - J. Kanzaki
- Department of Otolaryngology, School of Medicine, Keio University, Tokyo, Japan
| | - K. Ogawa
- Department of Otolaryngology, School of Medicine, Keio University, Tokyo, Japan
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18
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Szyfter W, Gawęcki W, Bartochowska A, Balcerowiak A, Pietraszek M, Wierzbicka M. Conductive hearing loss after surgical treatment of otosclerosis - long-term observations. Otolaryngol Pol 2020; 75:1-6. [PMID: 33724223 DOI: 10.5604/01.3001.0014.6216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Introduction:</b> For many years, surgical treatment of otosclerosis has been a widely accepted approach. Hearing improvement following stapes surgery is sometimes spectacular, and good treatment results are obtained in many centers in over 90% of patients. However, in the subsequent years after the treatment, some patients develop permanent or progressive conductive hearing loss. <br><b>Aim:</b> The aim of the study is to present a group of patients with conductive hearing loss after the first otosclerosis surgery and to analyze the causes of its occurrence. <br><b>Materials and Methods:</b> The retrospective review covered patients who underwent the initial surgery in the years 2000-2009. We analyzed the patients' medical records from before the end of 2019, which provided results of at least 10 years of postoperative follow-up. The group consisted of 1118 patients aged 14-82, including 802 women and 316 men.<br><b> Results:</b> Reoperations due to conductive hearing loss were performed on 93 patients, who accounted for 8.3% of the originally operated patients. They were much more common in patients after stapedectomies (19.7%) than in patients after stapedotomy (5.5%). Prosthesis dislocation was found to be the most frequent intraoperative observation (44.1%) and was often associated with erosion or necrosis of the long process of incus (28%). Less frequent reasons for hearing loss were: adhesions around the prosthesis (10.8%), too small hole in the stapes footplate (8.6%), too short prosthesis (8.6%), progression of otosclerosis (7.5%), too long prosthesis (6.4%), presence of a granuloma around the prosthesis (5.4 %), and displacement of incus (4.3%). <br>Conclusions:</b> Surgical treatment of otosclerosis is a widely accepted and good method. It allows to achieve an improvement in hearing in the vast majority of patients treated in this way. Unfortunately, over the years some patients develop recurrent conductive hearing loss. Reoperation creates an opportunity for finding the cause and improving hearing in the majority of cases.
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Affiliation(s)
- Witold Szyfter
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Wojciech Gawęcki
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Anna Bartochowska
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Andrzej Balcerowiak
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Marta Pietraszek
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
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19
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Ashman PE, Jyung RW. Perilymphatic Fistula Manifesting as a Pseudomeningocele-Like Presentation Following Stapedectomy. Ear Nose Throat J 2020; 101:NP232-NP234. [PMID: 33035130 DOI: 10.1177/0145561320965200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Peter E Ashman
- Department of Otolaryngology-Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Robert W Jyung
- Department of Otolaryngology-Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, NJ, USA
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20
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Özdemir O, Övünç O, Yiğit Ö. Cleft Palate Patient With Conductive Hearing Loss Due to Stapes Fixation. Laryngoscope 2020; 131:E1279-E1281. [PMID: 32898284 DOI: 10.1002/lary.29076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/22/2020] [Accepted: 08/11/2020] [Indexed: 11/07/2022]
Abstract
Congenital stapes fixation is characterized by congenital conductive hearing loss that is not progressive. This rare disease may be accompanied by additional middle ear anomalies. However, the occurrence of congenital stapes fixation with cleft palate and oligodontia was described by Gorlin et al. in 1973, and no further cases have been reported in the literature. Congenital stapes fixation was detected after the exploratory tympanotomy operation performed on a 15-year-old male patient admitted to our clinic with hearing loss, more prominent on the left. The patient also had a previous operation due to cleft lip and had congenital deficiencies in the upper and lower teeth. We present the second case report in the literature which we think belongs to this syndrome, which is defined as cleft palate, stapes fixation, and oligodontia syndrome by Gorlin et al. Laryngoscope, 131:E1279-E1281, 2021.
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Affiliation(s)
- Ozan Özdemir
- Ear Nose Throat Department, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Okan Övünç
- Ear Nose Throat Department, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Özgür Yiğit
- Ear Nose Throat Department, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
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21
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Totten DJ, Marinelli JP, Spear SA, Bowe SN, Carlson ML. With the Incidence of Otosclerosis Declining, Should Stapedectomy Remain a Key-Indicator Case for Otolaryngology Residents? Otolaryngol Head Neck Surg 2020; 163:1070-1072. [PMID: 32689881 DOI: 10.1177/0194599820941836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stapedectomy remains a joint key-indicator case with ossiculoplasty for otolaryngology residents in the United States. Yet, residents consistently report feeling inadequately prepared to perform stapes surgery following graduation. Applying recently described age- and sex-standardized incidence rates of surgically confirmed cases of otosclerosis to the US populace, upper and lower estimates of residents' case exposure to stapedectomy can be approximated. With this, uppermost projections estimate 6484 new cases of stapes surgery are performed annually nationwide. With approximately 1424 otolaryngology residents nationally, the average case exposure is 7.8 stapedectomies throughout their training, with upper and lower estimates of 17.1 and 4.2 cases, respectively. As such, proficiency in stapedectomy is no longer a realistic expectation for US graduating residents. This reality supports the removal of "stapedectomy" from the list of 14 key-indicator case requirements, leaving ossiculoplasty as its own key-indicator case, thereby reinforcing true competence in this fundamental procedure for the graduating otolaryngologist.
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Affiliation(s)
- Douglas J Totten
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - John P Marinelli
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - Samuel A Spear
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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22
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Abstract
OBJECTIVES Otosclerosis is a disease process that usually starts around the oval window, causing fixation of the stapes, resulting in conductive hearing loss. Treatment of the conductive hearing loss caused by otosclerosis consists of either rehabilitation with hearing aids or performing surgery. Given the risks of hearing impairment and vertigo associated with the surgery, there has been a desire to advance the practice to minimize the complications. The so-called "non-contact" or "no touch" techniques with the use of various lasers are in current practice. This review article will cover the surgical aspects, the theory behind laser and the various types used in stapes surgery. It will also review the evidence of laser versus conventional stapes surgery and the comparison of different laser types. METHODS A literature search up to December 2019 was performed using Pubmed and a nonsystematic review of appropriate articles was undertaken. Keywords used were stapes, surgery, laser, stapedectomy, and stapedotomy. RESULTS Overall, there is no evidence to say laser fenestration is better than conventional fenestration techniques; however, with the micro drill, there is an increased risk of footplate fracture and sensorineural hearing loss. There is an increased risk of tinnitus with the laser compared to conventional techniques. Studies have favored the CO2 laser over potassium titanyl phosphate (KTP) and erbium-doped yttrium aluminium garnet (Erbium-YAG) lasers for postoperative closure of the air-bone gap; and KTP laser has less thermal, mechanical, and sound effects compared with the thulium and carbon dioxide (CO2) lasers. There is an increased risk if inner ear complications with the thulium laser. CONCLUSIONS It can be deduced that theoretically and practically, the thulium laser is less safe compared to the KTP and CO2 lasers. The choice of laser used depends on the surgeon's preference, as well as availability, cost, side effects profile, as well as ease of use.
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Affiliation(s)
- Rishi Srivastava
- Department of ENT, 105590Queens Medical Centre, Nottingham, United Kingdom
| | - Waisum Cho
- Department of ENT, 105590Queens Medical Centre, Nottingham, United Kingdom
| | - Neil Fergie
- Department of ENT, 105590Queens Medical Centre, Nottingham, United Kingdom.,Department of ENT, King's Mill Hospital, Sutton-in-Ashfield, United Kingdom
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23
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Maxwell AK, Shokry MH, Master A, Slattery WH. Sensitivity of High-Resolution Computed Tomography in Otosclerosis Patients undergoing Primary Stapedotomy. Ann Otol Rhinol Laryngol 2020; 129:918-923. [PMID: 32432485 DOI: 10.1177/0003489420921420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the incidence of abnormal otospongiotic or otosclerotic findings on high-resolution computed tomography (HRCT) as read by local radiologists in patients with surgically-confirmed otosclerosis. STUDY DESIGN Retrospective chart review. SETTING Tertiary-referral private otology-neurotology practice. PATIENTS Adults (>18 years old) with surgically-confirmed otosclerosis between 2012 and 2017 with a HRCT performed preoperatively. INTERVENTION Preoperative HRCT then stapedotomy. MAIN OUTCOME MEASURES Positive identification and location of radiographic otosclerosis as reported by the local radiologist. We then correlated the CT with surgical location as documented at time of surgery. Audiometry, demographic data, intraoperative findings, and surgical technique were secondarily reviewed. RESULTS Of the 708 stapes surgeries were performed during the study time frame. Preoperative HRCT scans were available for 68 primary stapedotomy surgeries performed in 54 patients. Otosclerosis was reported in 20/68 (29.4%). Following a negative report by the local radiologist, a re-review by the surgeon and/or collaborating neuroradiologist confirmed otosclerosis in 12/48 additional cases (25.0%). There was an overall sensitivity of 47.1%. Intraoperatively, cases with negative reads tended to have more limited localization at the ligament (8.7%) or anterior crus (39.1%), compared with positive reads, which demonstrated more extensive involvement, with bipolar foci (30.0%) or diffuse footplate manifestations (20.0%) more common. Acoustic reflexes were characteristically absent. CONCLUSIONS While HRCT may aid in the diagnosis of otosclerosis and rule out concomitant pathology in certain cases of clinical uncertainty or unexplained symptoms, its sensitivity for otosclerosis remains low. HRCT should not be relied upon to diagnose routine fenestral otosclerosis.
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Affiliation(s)
| | | | - Adam Master
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, LA, USA
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24
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Rajput MSA, Arain AA, Rajput AA, Adeel M, Suahil A, Awan MS. Otosclerosis: Experience With Stapes Surgery. Cureus 2020; 12:e7927. [PMID: 32499972 PMCID: PMC7265776 DOI: 10.7759/cureus.7927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/02/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction Otosclerosis is a disorder in which the footplate of the stapes is replaced by an abnormal bone, thereby affecting sound transmission to the inner ear at the level of the oval window. The solution to this condition is to reestablish this mechanism back to normal via the ossicular chain to the inner ear. The aim of stapes surgery is to improve the hearing level to thresholds appropriate enough to obviate the need for hearing aid. The hearing improvement achieved after surgery often lasts for many years. The purpose of the current study was to review our experience and find out the rate of success related to hearing outcomes after stapedotomy. Methods The patients who were operated for otosclerosis between January 2000 and December 2010 at Aga Khan University Hospital, Karachi, Pakistan were included in the study. The charts were reviewed to collect clinical data regarding stapes surgery. The values of speech reception threshold (SRT) were recorded, and the preoperative and postoperative means were compared with a t-test. The bone conduction (BC) and air conduction (AC) thresholds were evaluated at 0.5 kHz, 1.0 kHz, 2.0 kHz, and 3.0 kHz. The preoperative and postoperative means of air-bone gap (AB-gap) were compared with a t-test. The descriptive frequency was calculated to evaluate postoperative AB-gap in individual patients; patients were grouped with a difference of 10 dB of AB-gap. The SPSS Statistics software (IBM, Armonk, NY) was used for statistical analysis. Results A total of 46 patients were included in the study. There were 15 males and 31 females. The mean age was 35 years (range: 20-56). Thirty-three patients had bilateral otosclerosis; two patients had surgery for both ears, taking the total number of ears operated to 48. The mean preoperative AB-gap was 39, while the mean postoperative AB-gap was 11. The means were compared with a t-test and a p-value of <0.05 was considered significant. The means of preoperative and postoperative SRT were 56.25 and 24.27 respectively. Both means were compared with a t-test, and a p-value of <0.05 was considred significant. Postoperatively, 34 ears had AB-gap of 10 dB (70.8%), 11 (22.9%) had within 20 dB, and three (6.3%) had within 30 dB. Conclusions The success rate related to hearing outcomes in patients operated for otosclerosis was excellent and comparable to that found in the current literature. The wide AB-gap noticed in the majority of our patients may represent a delayed presentation to otolaryngologists, which requires further evaluation.
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Affiliation(s)
- Muhammad Shaheryar Ahmed Rajput
- Otolaryngology, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
- Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, PAK
- Otolaryngology and Head and Neck Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | | | | | - Mohammad Adeel
- Otolaryngology, Bradford Royal Infirmary, Bradford, GBR
- Otolaryngology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
- Head and Neck Oncology, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, GBR
| | - Anwar Suahil
- Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, PAK
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25
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Moyano ML, Zernotti ME. [Post- stapedectomy tinnitus´ perception. Experience in a university hospital]. Rev Fac Cien Med Univ Nac Cordoba 2020; 77:73-8. [PMID: 32558508 DOI: 10.31053/1853.0605.v77.n2.27743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/20/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCCION La otosclerosis es un trastorno de remodelación ósea caracterizada por disminución de la movilidad del estribo, lo que se traduce en una pérdida auditiva y tinnitus. El tratamiento mas comúnmente utilizado y mas eficaz es la cirugía. El objetivo principal es una mejora significativa en la pérdida auditiva, pero la reducción del tinnitus es un beneficio adicional. OBJETIVOS Determinar los cambios en la sensación del tinnitus después de la estapedectomía en pacientes con otosclerosis operados en nuestro medio; así también como los factores que podrían asociarse con dichos cambios. MATERIALES Y METODOS Realizamos un estudio prospectivo, observacional, analítico y longitudinal, en el que se incluyeron 15 pacientes con otosclerosis operados en el Sanatorio que se sometieron a un examen completo con Audiometría, Acúfenometría y Tomografía computada; se recopilaron datos mediante la Escala de Impresión Clínica Global y el Indice Funcional del Tinnitus, al momento previo a la cirugía y a los tres meses de intervenidos. Se utilizó el Soft R- medic e Infostat para analizar las variables y graficar los resultados. RESULTADOS Las diferencias entre el estado de audición pre y postoperatoria fueron estadisticamente significativas (p<<0.001). Se comprobó además, diferencias estadísticamente significativas entre la percepción del tinnitus antes y despues de la cirugía (p<<0.001). Y que dicha diferencia se relaciona estadíticamente con la mejoría de la audición (p=0.01). DISCUSION- CONCLUSION La mayoría de los pacientes refirieron una mejoría en el estado de percepción del acúfeno; además de la mejoría en su audición; resultando en asociación significativa ambas variables.
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Abstract
HYPOTHESIS Surgical manipulations during laser stapedotomy can produce intracochlear pressure changes comparable to pressures created by high-intensity acoustic stimuli. BACKGROUND New-onset sensorineural hearing loss is a known risk of stapes surgery and may result from pressure changes from laser use or other surgical manipulations. Here, we test the hypothesis that high sound pressure levels are generated in the cochlea during laser stapedotomy. METHODS Human cadaveric heads underwent mastoidectomy. Fiber-optic sensors were placed in scala tympani and vestibuli to measure intracochlear pressures during key steps in stapedotomy surgery, including cutting stapedius tendon, lasering of stapedial crurae, crural downfracture, and lasering of the footplate. RESULTS Key steps in laser stapedotomy produced high-intensity pressures in the cochlea. Pressure transients were comparable to intracochlear pressures measured in response to high intensity impulsive acoustic stimuli. CONCLUSION Our results demonstrate that surgical manipulations during laser stapedotomy can create significant pressure changes within the cochlea, suggesting laser application should be minimized and alternatives to mechanical downfracture should be investigated. Results from this investigation suggest that intracochlear pressure transients from stapedotomy may be of sufficient magnitude to cause damage to the sensory epithelium and affirm the importance of limiting surgical traumatic exposures.
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Affiliation(s)
- Emily S Misch
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
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27
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Abstract
OBJECTIVE The effect of pregnancy on otosclerosis is controversial. If pregnancy physiologically increases the risk of progression, females with children would be expected to receive stapedectomy earlier than childless females and males. Here, we seek to determine whether sex moderates the relationship between number of children and age at stapedectomy. STUDY DESIGN Retrospective observational study of national health care claims. SETTING 2003 to 2016 Optum Clinformatics Data Mart. SUBJECTS AND METHODS In total, 6025 privately insured US adults (3553 females, 2472 males) who received stapedectomy for otosclerosis were queried for age and number of children at the time of initial surgery. RESULTS The average age at stapedectomy was significantly lower in females than males (46.8 vs 48.1 years; t test, P < .0001). Females with children had a significantly lower age at surgery compared to childless females (39.3 vs 49.9 years; t test, P < .0001). Males with children similarly had a significantly lower age at surgery compared to childless males (40.5 vs 51.3 years; t test, P < .0001). A higher number of children was correlated with lower age for both females (Pearson, r = -0.3817, P < .0001) and males (Pearson, r = -0. 3675, P < .0001). Linear regression showed that younger age of surgery could be predicted by female sex and number of children (F(3, 6021) = 336.93, P < .001, R2 = 0.1437) with no significant interaction between sex and number of children (P = .186). CONCLUSION Sex does not moderate the effect of increasing number of children on decreasing age at stapedectomy. Social, rather than biological, factors surrounding parenthood such as increased overall health care utilization may explain prior associations between pregnancy and otosclerosis.
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Affiliation(s)
- Z Jason Qian
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer C Alyono
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.,Stanford Ear Institute, Stanford, California, USA
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28
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Dewyer NA, Rosowski JJ, Nadol JB, Quesnel AM. Otopathology Findings in Otosclerosis With Lateral Semicircular Canal Fenestration. Laryngoscope Investig Otolaryngol 2019; 4:425-428. [PMID: 31453353 PMCID: PMC6703113 DOI: 10.1002/lio2.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 05/18/2019] [Indexed: 12/02/2022] Open
Abstract
A study of clinical records and temporal bone histopathology from a woman with bilateral otosclerosis who was treated with lateral semicircular canal fenestration procedures as well as stapedectomy.
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Affiliation(s)
- Nicholas A. Dewyer
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and Ear/Massachusetts General HospitalBostonMassachusettsU.S.A.
- Department of Otolaryngology–Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsU.S.A.
| | - John J. Rosowski
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and Ear/Massachusetts General HospitalBostonMassachusettsU.S.A.
- Department of Otolaryngology–Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsU.S.A.
| | - Joseph B. Nadol
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and Ear/Massachusetts General HospitalBostonMassachusettsU.S.A.
- Department of Otolaryngology–Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsU.S.A.
| | - Alicia M. Quesnel
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and Ear/Massachusetts General HospitalBostonMassachusettsU.S.A.
- Department of Otolaryngology–Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsU.S.A.
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Wickemeyer J, Achim V, Redleaf M. Stapedectomy Is Rewarding: But How to Prove It? Ann Otol Rhinol Laryngol 2019; 128:911-914. [PMID: 31081345 DOI: 10.1177/0003489419849615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To demonstrate that neurotologists enjoy performing stapedectomies. SUBJECTS A group of survey recipients consisting of 174 neurotologists who perform stapedectomy, a nonoverlapping control group of 145 head/neck oncologists who perform parotidectomy, and a second nonoverlapping control group of 365 pediatric otolaryngologists who perform tonsillectomy. OUTCOME MEASURES Responses to surveys distributed by electronic mail to the 3 nonoverlapping recipient groups during nonoverlapping 4-week periods. RESULTS During the 4-week survey periods, 84 of 174 neurotologists (48%) responded, while 33 of 145 oncologists (23%) and 87 of 365 pediatric otolaryngologists (24%) responded. Most neurotologists performed stapedectomy (80/84; 95% of survey responders), while 33 of 33 (100% of survey responders) oncologists performed parotidectomy and 87 of 87 (100% of survey responders) pediatric otolaryngologists performed tonsillectomy. Seventy-six of the 80 neurotologists who performed stapedectomies (95%) enjoyed performing it, slightly more than the 30 of the 33 oncologists who performed parotidectomies (91%) and appreciably more than the 67 of 87 pediatric otolaryngologists who performed tonsillectomies (77%). Twenty-three neurotologists (30%) would sacrifice vacation time to perform additional stapedectomies, slightly more than 8 oncologists (27%) for additional parotidectomies and more than the 7 pediatric otolaryngologists (10%) for additional tonsillectomies. Ten (13%) of the neurotologists, 3 (9%) of the oncologists, and 1 (2%) of the pediatric otolaryngologists would sacrifice 5 or more vacation days to perform more of the procedures. CONCLUSIONS Our data suggest that neurotologists enjoy performing stapedectomy.
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Affiliation(s)
| | - Virginie Achim
- 1 University of Illinois Health Sciences-Chicago, IL, USA
| | - Miriam Redleaf
- 1 University of Illinois Health Sciences-Chicago, IL, USA
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Patel A, Prinsley P. Our experience of stapes superstructure and incudostapedial joint preservation in otosclerosis surgery. Clin Otolaryngol 2019; 44:479-482. [PMID: 30793516 DOI: 10.1111/coa.13321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/07/2019] [Accepted: 02/15/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Anant Patel
- Norfolk & Norwich University Hospitals, Norwich, UK
| | - Peter Prinsley
- Norfolk & Norwich University Hospitals, Norwich, UK.,James Paget University Hospitals, Norwich, UK
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Gidley PW, Maw J, Gantz B, Kaylie D, Lambert P, Malekzadeh S, Chandrasekhar SS. Contemporary Opinions on Intraoperative Facial Nerve Monitoring. OTO Open 2018; 2:2473974X18791803. [PMID: 31535063 PMCID: PMC6737880 DOI: 10.1177/2473974x18791803] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/27/2018] [Accepted: 07/10/2018] [Indexed: 11/15/2022] Open
Abstract
Objective To examine the current trend in intraoperative facial nerve monitoring (IOFNM) training, performance, and reimbursement by subspecialists. Study Design Cross-sectional survey of the American Neurotology Society, American Otological Society, American Society of Pediatric Otolaryngology, and program directors of otolaryngology-head and neck surgery programs accredited by the Accreditation Council on Graduate Medical Education. Setting American Academy of Otolaryngology-Head and Neck Surgery Intraoperative Nerve Monitoring Task Force. Subjects and Methods The task force developed 2 surveys, which were implemented through Surveymonkey.com: (1) a 10-question survey sent to 1506 members of the societies listed to determine IOFNM practice and reimbursement patterns and (2) a 10-question survey sent to the 107 accredited US otolaryngology residency program directors to examine the state of resident training on facial nerve monitoring. Results Response rates were 18% for practicing physicians and 15% for residency program directors. The majority agreed that IOFNM was indicated for most otologic and neurotologic procedures. In addition to facial nerve monitoring, facial nerve stimulation was used in complex skull base and temporal bone procedures. When queried about reimbursement by Medicare, only 4.4% of surgeons responded that they received reimbursement. Program directors indicated universal exposure of residents to IOFNM, with 61% of programs giving residents formal training. Conclusions IOFNM is widely used among otologists and neurotologists in the United States. The majority of residents receive formal training, and all residents are exposed to the setup, use, monitoring, and troubleshooting of the device. Reimbursement for IOFNM is reported by a paucity of those surveyed.
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Affiliation(s)
- Paul W. Gidley
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Paul W. Gidley, MD, Department of Head and Neck Surgery, UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
| | - Jennifer Maw
- Ear Associates & Rehabilitation Services, San Jose, California, USA
| | - Bruce Gantz
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - David Kaylie
- Duke University Medical Center, Durham, North Carolina, USA
| | - Paul Lambert
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sonya Malekzadeh
- Department of Otolaryngology, Georgetown University Medical Center, Washington, DC, USA
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Marchica CL, Saliba I. The Relationship between Stapes Prosthesis Length and Rate of Stapedectomy Success. Clin Med Insights Ear Nose Throat 2015; 8:23-31. [PMID: 26124693 PMCID: PMC4480435 DOI: 10.4137/cment.s27284] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/25/2015] [Accepted: 05/27/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify whether measurement of the prosthesis length is mandatory in patients requiring otosclerosis surgeries and to assess their postoperative audiometric outcomes. In addition, evaluation of prosthesis length used in revision compared to primary stapedectomy was carried out. STUDY DESIGN Case series with chart review. METHODS Chart review of 393 patients undergoing primary (321) versus revision stapedectomy (72) was performed in a tertiary referral center. The indication for surgery was the presence or persistence/recurrence of an air-bone gap (ABG) greater than 20 dB. Air and bone conduction thresholds (ACT and BCT, respectively), ABG as well as pure tone averages (PTAs) were determined for all patients, and the results were compared preoperatively and postoperatively. RESULTS Prosthesis length used ranged from 3.0 to 6.0 mm without differences between primary and revision groups. Of the revision surgeries, 62.5% were stapedectomies versus stapedotomies (P < 0.001). Patients showed significant decrease in speech discrimination score, with increased air and bone conduction thresholds as well as mean ABG and PTA before the revision surgeries as a first procedure failure. Prosthesis length changes occurred in 73.5% of the cases, with an average absolute change of 0.55 mm. Prosthesis length did not affect postoperative audiometric results between primary and revision groups, in all surgeries combined. When grouping stapes surgery into accurately versus inaccurately measured incus-footplate distance, significant differences were observed in prosthesis length employed (P < 0.01). Hearing outcomes were also better in the group in which an accurately measured prosthesis was chosen, as opposed to “standard-length” prosthesis. CONCLUSIONS This study corroborates postoperative success rates of revision surgeries, which show smaller improvements in hearing compared to a primary intervention. Accurate intra-operative measurement of prosthesis length was correlated with better audiometric results postoperatively.
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Affiliation(s)
- Cinzia L Marchica
- Division of Otolaryngology-Head and Neck Surgery, Montreal University Hospital Center (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Issam Saliba
- Division of Otolaryngology-Head and Neck Surgery, Montreal University Hospital Center (CHUM), University of Montreal, Montreal, Quebec, Canada
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Asik B, Binar M, Serdar M, Satar B. A meta-analysis of surgical success rates in congenital stapes fixation and juvenile otosclerosis. Laryngoscope 2015; 126:191-8. [PMID: 25963343 DOI: 10.1002/lary.25368] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/09/2015] [Accepted: 04/14/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To assess published reports in the literature on surgical success rates in patients with congenital stapes fixation (CSF) and juvenile otosclerosis (JO). DESIGN Systematic review of the literature and meta-analysis of published data. DATA SOURCES PubMed, SAGE, MEDLINE, and Cochrane. REVIEW METHODS A literature search was performed and evaluated based on established criteria. Two independent reviewers (b.a., m.b.) inspected titles and abstracts of the studies. The full texts of the studies were examined to assess their relevance to the meta-analysis. An air-bone gap (ABG) of 0 to 10 dB hearing level was described as success of surgery. RESULTS A random effects model was used to analyze the data. A total of 27 studies were included in the meta-analysis, whereas 934 were excluded. The total number of operated ears was 445 (256 ears with JO and 189 ears with CSF). At the time of surgery, the age of the patients ranged from 3 to 18 years. The success rate was 80.2% for JO and 54% for CSF. The overall success rate was 69.9%. The rate of postoperative sensorineural hearing loss was 3.4% for JO and 2.1% for CSF. CONCLUSIONS Overall, stapes surgery in children with JO or CSF has a moderate success rate (69.9%) to provide ABG closure of 10 dB. The success rate for CSF in the setting of ossicular abnormalities is 54%. This meta-analysis suggests that if JO can be determined before surgery, a higher success rate is possible (80.2%).
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Affiliation(s)
- Burak Asik
- Department of Otolaryngology-Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Murat Binar
- Department of Otolaryngology-Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Muhittin Serdar
- Department of Medical Biochemistery, Acibadem University School of Medicine, Istanbul, Turkey
| | - Bulent Satar
- Department of Otolaryngology-Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey
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Abstract
L'objectif de l’étude est de rapporter notre expérience concernant la prise en charge de l'otospongiose et comparer nos résultats avec ceux de la littérature. Nous rapportons une étude rétrospective concernant 36 cas d'otospongiose colligés au service d'Oto-rhino-laryngologie de l'hôpital militaire Avicenne de Marrakech, entre Janvier 2009 et Décembre 2012. L’âge moyen des patients était de 38 ans avec une nette prédominance masculine (77%). Notre étude a révélé un retard diagnostique (stades audiométriques II et III). Ce diagnostic est le plus souvent simple, très fortement suspecté dès la première consultation devant l'existence d'une surdité de transmission ou mixte à tympan normal qui constitue le signe de découverte le plus prépondérant et constant dans notre série (100%), accompagnée parfois d'acouphènes (41%). L'existence d'antécédents familiaux de la maladie a été retenue chez 33,33%. L'audiométrie tonale liminaire et la tympanométrie ont été réalisées chez tous nos patients (100%) évoquant le diagnostic dans la majorité des cas. La tomodensitométrie, non obligatoire, reste indispensable pour le diagnostic différentiel et surtout permet de prévoir les difficultés opératoires ainsi que les éventuelles associations pathologiques. Tous les patients ont subit une intervention chirurgicale comportant soit une platinectomie partielle ou totale(83%) ou une platinotomie. L’évolution et les résultats ont été généralement satisfaisants, par ailleurs nous avons constaté la survenue d'un cas de fistule périlymphatique, la persistance des acouphènes chez six patients et une surdité de transmission chez trois patients.
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Affiliation(s)
- Brahim Bouaity
- Service d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Mehdi Chihani
- Service d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Mohammed Touati
- Service d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Youssef Darouassi
- Service d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Karim Nadour
- Service d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Haddou Ammar
- Service d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Hôpital Militaire Avicenne, Marrakech, Maroc
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Redfors YD, Olaison S, Karlsson J, Hellgren J, Möller C. Hearing-related, health-related quality of life in patients who have undergone otosclerosis surgery: a long-term follow-up study. Int J Audiol 2014; 54:63-9. [PMID: 25180536 DOI: 10.3109/14992027.2014.948220] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aims of the study were to assess health-related quality of life and hearing-related disability in subjects with otosclerosis 30 years after surgery. DESIGN An observational study was performed. Medical records were reviewed, a clinical examination as well as audiometric assessments were performed. Generic health-related quality of life was assessed by the SF-36v2 and hearing disability by a shortened version of SSQ (speech spatial and qualities of hearing scale). STUDY SAMPLE Sixty-five individuals, who had undergone stapedectomy in 1977-79 at a tertiary referral center. RESULTS Generic health-related quality of life according to SF-36 subscale scores was comparable to that of an age- and sex-matched reference population. The SF-36 mental component summary score (MCS) was, however, significantly better than that of the reference population. The mental and physical summary component scores correlated significantly to hearing disability measured by the SSQ but not to hearing impairment. Hearing disability was displayed in all SSQ sub-scores, especially in more complex listening situations and in the localization of sounds. CONCLUSIONS This study shows that individuals with otosclerosis, 30 years after surgery, have a good generic health-related quality of life, despite moderate to severe hearing loss and significant hearing disabilities.
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Affiliation(s)
- Ylva Dahlin Redfors
- * Department of Otorhinolaryngology Head & Neck Surgery, Sahlgrenska University Hospital, Department of Clinical Science, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
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Mokhtarinejad F, Pour SS, Nilforoush MH, Sepehrnejad M, Mirelahi S. Ear surgery techniques results on hearing threshold improvement. J Res Med Sci 2013; 18:746-9. [PMID: 24381615 PMCID: PMC3872580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 10/24/2012] [Accepted: 04/11/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Bone conduction (BC) threshold depression is not always by means of sensory neural hearing loss and sometimes it is an artifact caused by middle ear pathologies and ossicular chain problems. In this research, the influences of ear surgeries on bone conduction were evaluated. MATERIALS AND METHODS This study was conducted as a clinical trial study. The ear surgery performed on 83 patients classified in four categories: Stapedectomy, tympanomastoid surgery and ossicular reconstruction partially or totally; Partial Ossicular Replacement Prosthesis (PORP) and Total Ossicular Replacement Prosthesis (TORP). Bone conduction thresholds assessed in frequencies of 250, 500, 1000, 2000 and 4000 Hz pre and post the surgery. RESULTS In stapedectomy group, the average of BC threshold in all frequencies improved approximately 6 dB in frequency of 2000 Hz. In tympanomastoid group, BC threshold in the frequency of 500, 1000 and 2000 Hz changed 4 dB (P-value < 0.05). Moreover, In the PORP group, 5 dB enhancement was seen in 1000 and 2000 Hz. In TORP group, the results confirmed that BC threshold improved in all frequencies especially at 4000 Hz about 6.5 dB. CONCLUSION In according to results of this study, BC threshold shift was seen after several ear surgeries such as stapedectomy, tympanoplasty, PORP and TORP. The average of BC improvement was approximately 5 dB. It must be considered that BC depression might happen because of ossicular chain problems. Therefore; by resolving middle ear pathologies, the better BC threshold was obtained, the less hearing problems would be faced.
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Affiliation(s)
- Farhad Mokhtarinejad
- Department of Otorhinolaryngology, Head and Neck Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Soheili Pour
- Department of Otorhinolaryngology, Head and Neck surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hussein Nilforoush
- Department of Audiology, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Mohammad Hussein Nilforoush, Department of Audiology, 1st Floor, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, 1000 Jarib Ave, Isfahan, Iran. E-mail:
| | - Mahsa Sepehrnejad
- Department of Audiology, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Susan Mirelahi
- Department of Otorhinolaryngology, Head and Neck surgery, Isfahan University of Medical Sciences, Isfahan, Iran
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Kojima H, Komori M, Chikazawa S, Yaguchi Y, Yamamoto K, Chujo K, Moriyama H. Comparison between endoscopic and microscopic stapes surgery. Laryngoscope 2013; 124:266-71. [PMID: 23670854 DOI: 10.1002/lary.24144] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 01/21/2013] [Accepted: 03/18/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate whether endoscopic stapes surgery is safer and less invasive than conventional stapes surgery using an operating microscope. STUDY DESIGN Retrospective study. METHODS The subjects were 15 patients (15 ears) who underwent endoscopic stapes surgery for otosclerosis or congenital stapedial fixation. Another 35 patients (41 ears) in whom microscopic stapes surgery was performed by the same surgeon were assigned to the control group. The procedures for endoscopic surgery were fundamentally the same as those for microscopic surgery, unless there was no anterior or posterior auricular skin incision. The two surgical techniques were compared with respect to the operating time, postoperative hearing, complications, postoperative pain, and the extent of drilling at the posterosuperior part of the external auditory canal. RESULTS There were no differences of operating time or postoperative hearing between the endoscopic and microscopic groups. There was very little postoperative pain in the endoscopic group. Postoperative dizziness was mild in all patients who received endoscopic surgery. Drilling at the posterosuperior part of the external auditory canal was less extensive in the endoscopic group than in the microscopic group. CONCLUSION Endoscopic surgery is particularly suitable for stapedial disease. Endoscopic stapes surgery can even be done in patients with a curved and narrow external auditory canal. Endoscopic surgery is also suitable for education: The surgical anatomy can be understood easily and both the surgeon and assistants can observe the procedure on the same monitor. However, it should only be performed by experienced surgeons because one-handed manipulation is required and stereoscopic vision is not available.
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Affiliation(s)
- Hiromi Kojima
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
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Puxeddu R, Ledda GP, Pelagatti CL, Salis G, Agus G, Puxeddu P. Revision stapes surgery for recurrent transmissional hearing loss after stapedectomy and stapedotomy for otosclerosis. Acta Otorhinolaryngol Ital 2005; 25:347-52. [PMID: 16749602 PMCID: PMC2639894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
A total of 20 stapedotomy and 24 stapedectomy cases were retrospectively reviewed to establish the causes of failure, and to evaluate hearing results after revision surgery. Our series included 23 male and 21 female patients. Mean age at revision time was 42 years, and the mean interval from primary surgery and revision stapes surgery was 27 months. The retrospective review of our data, revealed that the most common cause for revision surgery was a displaced prosthesis (47.7%). After revision surgery, the mean post-operative air-bone gap was 14.78 dB. A mean post-operative air-bone gap within 10 dB occurred in 24 patients (54.5%), in 14 patients (31.5%) this was between 11 and 20 dB, in 5 patients (11.5%) between 21 and 30 dB, and in one patient (2.5%) > 30 dB. There were no "dead ears" in this series. Our results compare to other reported series, and confirm that after revision stape surgery, an air-bone gap closure within 10 dB is difficult to obtain. In the present series, the use of the total ossicular replacement prosthesis resulted in the poorest functional hearing results.
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Affiliation(s)
- R Puxeddu
- Department of Surgical Sciences and Organ Transplantation, Section of Otorhinolaryngology, University of Cagliari, S. Giovanni di Dio Hospital, Cagliari, Italy.
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