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Cornu N, Marchioni D, Green A, Hautefort C, Verillaud B, Herman P, Kania R. An Endoscopic Procedure for the Simultaneous Treatment of both Otosclerosis and Malleus Fixation. Laryngoscope 2024; 134:2411-2414. [PMID: 37792383 DOI: 10.1002/lary.31093] [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: 04/26/2023] [Revised: 08/21/2023] [Accepted: 09/13/2023] [Indexed: 10/05/2023]
Abstract
To report the case of the simultaneous treatment of otosclerosis and malleus fixation through an entirely endoscopic transcanal approach. A targeted transcanalar epitympanotomy with annular bony ridge conservation was planned preoperatively, with 3D CT localization of the fixed part of the malleus head. The upper part of the malleus head and the superior ossified ligament of the malleus were drilled. A 0.6 mm stapedotomy was performed and a piston inserted. The patient's recovery was uneventful, with closure of the air-bone gap on her postoperative audiogram, associated with an overclosure in 500Hz, 1kHz, 2 kHz and 4 kHz. Laryngoscope, 134:2411-2414, 2024.
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Affiliation(s)
- Nicolas Cornu
- Department of Otorhinolaryngology-Head and Neck Surgery, Groupe Hospitalier Nord Essonne, Longjumeau, France
| | - Daniele Marchioni
- Otorhinolaryngology Department, University Hospital of Verona, Verona, Italy
| | - Andrew Green
- Department of General Practice, Yorkleigh Surgery, Gloucester, UK
| | - Charlotte Hautefort
- Department of Otorhinolaryngology-Head and Neck Surgery, Hôpital Lariboisière, APHP.Nord University of Paris Cité, Paris, France
| | - Benjamin Verillaud
- Department of Otorhinolaryngology-Head and Neck Surgery, Hôpital Lariboisière, APHP.Nord University of Paris Cité, Paris, France
| | - Philippe Herman
- Department of Otorhinolaryngology-Head and Neck Surgery, Hôpital Lariboisière, APHP.Nord University of Paris Cité, Paris, France
| | - Romain Kania
- Department of Otorhinolaryngology-Head and Neck Surgery, Hôpital Lariboisière, APHP.Nord University of Paris Cité, Paris, France
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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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Emami H, Amirzargar B, Nemati Y, Rahimi N. Endoscopic Versus Microscopic Stapedotomy: A Randomized Clinical Trial. Laryngoscope 2024; 134:2395-2400. [PMID: 38112392 DOI: 10.1002/lary.31241] [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: 08/04/2023] [Revised: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE To determine the outcomes and complications of endoscopic versus microscopic stapes surgery in patients with otosclerosis. STUDY DESIGN Randomized, single-blinded clinical trial. METHODS Patients with otosclerosis who underwent either trans-canal microscopic or endoscopic stapedotomy at a tertiary care hospital were compared. Thirty-two patients were randomly divided into two groups using blocked randomization. Group A consisted of 16 patients who underwent trans-canal microscopic stapedotomy, and group B consisted of 16 patients who underwent trans-canal endoscopic stapedotomy. Postoperative vertigo, ear pain, and complications such as tympanic membrane perforation or chorda tympani nerve injury were evaluated. Three months postoperatively, patients were assessed for dysgeusia and hearing improvement. RESULTS The mean pre-operative air-bone gap (ABG) in the microscopic and endoscopic groups was 32.81 ± 6.82 and 30.00 ± 7.96, respectively. The mean improvement in the ABG was 25.45 ± 11.21 dB in the microscopic group and 23.21 ± 10.68 dB in the endoscopic group. Although both techniques showed improvement in auditory outcomes (p-value <0.001), there were no statistical differences between the endoscopic and microscopic groups in the pre-operative, post-operative, and mean improvement of ABG (p-value >0.05). There were no significant differences between the two methods in chorda tympanic nerve injury, vertigo scores, and the mean operating time (p-value >0.05), but the mean pain score was higher in the microscopic group (2.56 ± 1.55 in the microscopic group versus 1.31 ± 0.70 in the endoscopic group) (p-value = 0.003). CONCLUSIONS Endoscopic stapes surgery can be a preferable alternative to conventional microscopic stapedotomy, as it yields similar hearing outcomes and lower pain scores. LEVEL OF EVIDENCE 2 Laryngoscope, 134:2395-2400, 2024.
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Affiliation(s)
- Hamed Emami
- Otorhinolaryngology Research Center, Department of Otorhinolaryngology-Head and Neck Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Behrooz Amirzargar
- Otorhinolaryngology Research Center, Department of Otorhinolaryngology-Head and Neck Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasaman Nemati
- Otorhinolaryngology Research Center, Department of Otorhinolaryngology-Head and Neck Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Negin Rahimi
- Otorhinolaryngology Research Center, Department of Otorhinolaryngology-Head and Neck Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Dahlin Redfors Y, Björsne A, Finizia C. Psychometric properties of the Swedish version of the international outcome inventory - alternative interventions (IOI-AI) - ear surgery (IOI-AI op). Int J Audiol 2024:1-8. [PMID: 38587069 DOI: 10.1080/14992027.2024.2332774] [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] [Received: 04/19/2023] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE The aims of this study were to adapt the Swedish version of the International Outcome Inventory for Hearing Aids (IOI-HA) to the International Outcome Inventory for Alternative Interventions (IOI-AI) in the context of ear surgery (IOI-AIop) and to test the psychometric properties. DESIGN The validated Swedish questionnaire IOI-HA was adapted to the IOI-AIop by omitting the question about hearing aid use and changing the term "hearing aid" to "surgery" in the remaining items. The validity, component structure and reliability of the IOI-AIop were assessed. STUDY SAMPLE Subjects diagnosed with otosclerosis and undergoing stapedotomy were included in the study (n = 162). RESULTS High mean scores were noted for all items. Ceiling effects were noted, most pronounced for the satisfaction item. Principal component analysis (PCA) yielded a two-component structure explaining 77.5% of the variance. The test-retest reliability measured by intra class correlation coefficient was >0.9, and the internal consistency coefficient measured by Cronbach's alfa was >0.8. CONCLUSION The IOI-AIop showed good psychometric properties. However, ceiling effects were observed. The two-component solution was in line with previous factor analyses of the IOI-HA and the IOI-AI. The comprehensive IOI-AIop is recommended as a useful tool to evaluate patient perspectives after ear surgery.
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Affiliation(s)
- Ylva Dahlin Redfors
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Björsne
- Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Unit of Audiology, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Hearing Organization, Habilitation & Health, Region Västra Götaland, Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Chen PH, Lin KN, Lin HY, Yu RB, Liu PY, Shih WT, Chen JW. Factors Associated With Hearing Outcomes After Stapedotomy in Taiwanese Patients With Clinical Otosclerosis. Ear Nose Throat J 2024; 103:NP76-NP84. [PMID: 34409887 DOI: 10.1177/01455613211037645] [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: 11/15/2022] Open
Abstract
OBJECTIVE To examine the clinical factors associated with the effectiveness of stapedotomy in improving hearing sensitivity in Taiwanese patients with otosclerosis. METHODS In this retrospective study, we reviewed the medical records of 31 patients (36 ears) with otosclerosis undergoing stapedotomy performed by a single surgeon. Preoperative and postoperative hearing results were analyzed to identify factors associated with hearing outcomes after stapedotomy in the Taiwanese population with clinical otosclerosis. RESULTS Compared with preoperative pure tone averages (PTAs), stapedotomy significantly improved postoperative air conduction (AC) thresholds (P < .0001), bone conduction (BC) thresholds (P = .025), and air-bone gaps (ABGs; P < .0001). Postoperative closure of ABGs less than 10 or 20 dB was achieved in 16 (44.4%) and 33 (91.7%) of 36 surgical ears. Improvement in postoperative AC thresholds and ABGs and the size of preoperative ABGs were significantly correlated (r = .650, P < .001 and r = .745, P < .001, respectively). Gender-stratified analysis indicated a stronger correlation between improvement in postoperative AC thresholds and preoperative ABGs in male patients than in female patients (r = .893, P < .001 and r = .476, P = .014, respectively), and in postoperative and preoperative ABGs (r = .933, P < .001 and r = .626, P < .001, respectively). With the more stringent criteria for surgical success, factors including age (≤50 years), type (conductive, BC ≤25 dB), and degree (PTA ≤55 dB) of preoperative hearing loss led to more favorable outcomes. CONCLUSIONS We reported evidence supporting a potential gender difference on hearing outcomes after stapedotomy in Taiwanese patients with otosclerosis. Age, type, and degree of preoperative hearing loss may affect the surgical success rate.
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Affiliation(s)
- Pei-Hsin Chen
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei City
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Taipei City
- * Pei-Hsin Chen, Kai-Nan Lin, and Hsiu-Yin Lin have equal contributions to this study
| | - Kai-Nan Lin
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei City
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Taipei City
- * Pei-Hsin Chen, Kai-Nan Lin, and Hsiu-Yin Lin have equal contributions to this study
| | - Hsiu-Yin Lin
- Department of Audiology, Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital, New Taipei City
- * Pei-Hsin Chen, Kai-Nan Lin, and Hsiu-Yin Lin have equal contributions to this study
| | - Rui-Bin Yu
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei City
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Taipei City
| | - Pi-Yun Liu
- Department of Audiology, Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital, New Taipei City
| | - Wan-Ting Shih
- Department of Audiology, Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital, New Taipei City
| | - Jeng-Wen Chen
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei City
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Taipei City
- Department of Medical Education and Research, Cardinal Tien Hospital, New Taipei City
- Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, New Taipei City
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Mandegari M, Meybodian M, Baradaranfar M, Vaziribozorg S, Vakili M, Dehghanifirouzabadi S. The effect of local dexamethasone on stapedotomy surgery outcomes in patients with otosclerosis. Acta Otolaryngol 2024; 144:35-38. [PMID: 38279924 DOI: 10.1080/00016489.2024.2304062] [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: 11/11/2023] [Accepted: 01/01/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Some studies have shown a positive effect of systemic corticosteroid on hearing results after stapedotomy, but its side effects can limit its routine administration. AIM The aim of this study was to investigate the effect of local dexamethasone on the results of stapedotomy surgery. MATERIAL AND METHODS Fifty two patients undergone stapedotomy surgery for otosclerosis involved. In the case group after stapedotomy we fulfilled the middle ear with dexamethasone and then the placement of the prosthesis was done. In the control group after stapedotomy we did not use dexamethasone in the middle ear. RESULTS Gender, age, nausea, vomiting, postoperative vertigo and nystagmus did not significantly differ between the groups. A significant difference was observed in tinnitus rate between two groups. In the case group ABG decrease was higher and bone conduction thresholds improved at frequencies of 1000, 2000, and 4000 three months after surgery. CONCLUSION Since local dexamethasone had a positive effect on the results of stapedotomy surgery, it can be used instead of systemic corticosteroids to reduce the side effects and increasing surgery's success rate. SIGNIFICANCE If local dexamethasone had a positive influence on the results of stapedotomy surgery, it can be used instead of systemic corticosteroids to reduce the side effects and increasing surgery's success rate.
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Affiliation(s)
- Mohammad Mandegari
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mojtaba Meybodian
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammadhossein Baradaranfar
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sedighe Vaziribozorg
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahmood Vakili
- Department of Community Medicine, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Saeedeh Dehghanifirouzabadi
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Abstract
INTRODUCTION Surgical treatment of patients with far-advanced otosclerosis (FAO) has not yet been standardized. Patients with FAO are the candidates for stapes surgery or cochlear implant (CI). Although many surgeons consider stapes surgery as the first choice, other authors prefer CI because of the excellent hearing results. OBJECTIVE The authors discuss their experience in the treatment of patients with FAO, potentially candidates for CI, who underwent stapedotomy. MATERIALS AND METHODS Eleven adult patients with FAO underwent stapedotomy from 2006 to 2016. Pure-tone average (PTA) between 0.5-1-2-3 kHz and speech perception test with hearing aids were determined before and after stapedotomy. RESULTS The results show a statistically significant improvement in air condition threshold (PTA) and satisfactory results with regard to speech recognition in 9 (81.8%) cases. Postoperative results are not influenced by the type of stapedotomy prosthesis employed and do not change during follow-up (3 years). CONCLUSIONS The authors suggest first performing stapes surgery in patients with FAO and reserving CI in case of failure.
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Affiliation(s)
- Moscillo Luca
- ENT Department, L. Vanvitelli University, Naples, Italy
- ENT Department, "S. Maria delle Grazie" Hospital, Pozzuoli, Naples), Italy
| | | | - Mastella Americo
- ENT Department, "S. Maria delle Grazie" Hospital, Pozzuoli, Naples), Italy
| | | | - Anna Donadio
- ENT Department, L. Vanvitelli University, Naples, Italy
| | - Motta Gaetano
- ENT Department, L. Vanvitelli University, Naples, Italy
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Malafronte G, Filosa B, Trusio A, De Cristofaro G, Colacurcio V, Marra P. Stapedoplasty without sedation in an office-based setting. Acta Otorhinolaryngol Ital 2023; 43:294-296. [PMID: 37488994 PMCID: PMC10366559 DOI: 10.14639/0392-100x-n2549] [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] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/10/2023] [Indexed: 07/26/2023]
Affiliation(s)
| | - Barbara Filosa
- Department of Otolaryngology, AORN San Giuseppe Moscati, Avellino, Italy
| | - Antonio Trusio
- Department of Otolaryngology, AORN San Giuseppe Moscati, Avellino, Italy
| | | | - Vito Colacurcio
- Department of Otolaryngology, AORN San Giuseppe Moscati, Avellino, Italy
| | - Pasquale Marra
- Department of Otolaryngology, AORN San Giuseppe Moscati, Avellino, Italy
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Wedel C, Holm NH, Mirz F, Ovesen T. Otosclerosis and stapedotomy: hearing improvement, complications, and analysis of potential prognostic factors in a series of 93 cases. Acta Otolaryngol 2023; 143:563-569. [PMID: 37471233 DOI: 10.1080/00016489.2023.2231973] [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: 04/05/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Stapedotomy is a common treatment for conductive hearing loss in otosclerosis patients. AIMS/OBJECTIVES Results of stapedotomy were assessed in terms of hearing improvement and risk of complications. Potential prognostic factors affecting outcomes were identified. MATERIAL AND METHODS Retrospectively, 93 stapedotomies were evaluated. The primary outcome was hearing improvement based on postoperative ABG ≤10 dB, Belfast rule of thumb, and AC gain ≥20 dB. Secondary outcomes were postoperative complications. Additionally, prognostic factors potentially affecting outcomes were analyzed (age, gender, comorbidity, preoperative audiometry, tinnitus, or vertigo). RESULTS A mean ABG of ≤10 dB was achieved in 59%. According to the Belfast rule of thumb, 75% achieved interaural symmetry within ≤15 dB and/or a mean AC4 of ≤30 dB. A gain in AC4 of ≥20 dB was achieved in 57% of primary surgeries. The larger the preoperative ABG, the better hearing after surgery. There was no significant difference in hearing improvement at early and late follow-ups. Transient vertigo was the most common complaint (37%). Taste disturbances were the most frequent permanent complication (14%). CONCLUSION AND SIGNIFICANCE Stapedotomy gave good audible improvement with a low risk of complications. Preoperative ABG was the only prognostic factor affecting the hearing outcome. Only one follow-up 6-12 months seems relevant.
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Affiliation(s)
- Charlotte Wedel
- Department of Oto-, Rhino- and Laryngology, University Clinic for Flavour, Balance and Sleep, Goedstrup Hospital, Herning, Denmark
| | - Niels H Holm
- Department of Oto-, Rhino- and Laryngology, University Clinic for Flavour, Balance and Sleep, Goedstrup Hospital, Herning, Denmark
| | - Frank Mirz
- Department of Oto-, Rhino- and Laryngology, University Clinic for Flavour, Balance and Sleep, Goedstrup Hospital, Herning, Denmark
| | - Therese Ovesen
- Department of Oto-, Rhino- and Laryngology, University Clinic for Flavour, Balance and Sleep, Goedstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
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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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Plodpai Y. The utility and safety of diode laser in endoscopic stapes surgery. Laryngoscope Investig Otolaryngol 2023; 8:561-567. [PMID: 37090885 PMCID: PMC10116957 DOI: 10.1002/lio2.1045] [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: 11/22/2022] [Revised: 02/23/2023] [Accepted: 03/10/2023] [Indexed: 04/25/2023] Open
Abstract
Objective The advantages of laser stapedotomy are less trauma and more precise and minimally invasive techniques; however, the potential risk of overheating from the laser combined with the endoscope tip must be considered. This study aimed to assess the efficacy and safety of diode lasers for endoscopic stapes surgery. Methods A retrospective review of 56 patients with otosclerosis who underwent primary endoscopic stapedotomy with a diode laser from 2017 to 2020 was conducted. Demographic data, intraoperative findings, preoperative and postoperative audiological assessments, and postoperative complications were analyzed. Results There was no statistically significant difference between the preoperative and postoperative bone conduction thresholds. The mean postoperative air-bone gap (ABG) improved significantly compared to the preoperative ABG (4.07 vs. 35.43 dB, p < .001). The postoperative ABG closure within 10 dB at 6 and 12 months was achieved in 87.50% and 91.07% of patients, respectively. The postoperative pain scores at 4 and 24 h were 2.55 and 0.39, respectively. Immediate postoperative vertigo was reported in 12.50% of patients, with 100% complete recovery 2 months after surgery. The chorda tympani nerve was preserved in all the cases. Postoperative taste disturbances at 2 and 12 months were observed in 17.86% and 1.79% of patients, respectively. Conclusion The diode laser in endoscopic stapedotomy is a safe and effective technique that provides satisfactory hearing outcomes. Temporary taste disturbances during the early postoperative period are a concern. The handheld diode laser delivery system is suitable for an endoscopic approach and is an alternative armamentarium for the treatment of otosclerosis. Level of evidence: IV.
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Affiliation(s)
- Yuvatiya Plodpai
- Department of Otolaryngology Head and Neck Surgery, Faculty of MedicinePrince of Songkla UniversityHat YaiSongkhla provinceThailand
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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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13
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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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14
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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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15
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Massimilla EA, Testa D, Nunziata M, Donadio A, Romano ML, Motta G. Long Process Incus necrosis in Revision Stapedotomy: Retrospective Clinical Study. Ear Nose Throat J 2023; 102:58-63. [PMID: 33393819 DOI: 10.1177/0145561320986047] [Citation(s) in RCA: 1] [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: 12/16/2022] Open
Abstract
OBJECTIVES We describe our experience with long process incus (LPI) necrosis in revision stapedotomy and discuss the different management methods proposed in the literature to identify surgical techniques that can lead to satisfactory results over time. METHODS Twenty-two stapedotomy revisions, in 21 patients with the necrosis of the long process of the incus, are performed from 1997 to 2017. In cases of erosion or minimal necrosis of LPI, a new prosthesis of the same type or an angled prosthesis was applied higher on the residual incus stump. In cases of partial necrosis of LPI, a Donaldson type ventilation tube reshaped and placed on the residual incus stump to stabilize prosthesis, or glass ionomer bone cement was used. In cases of subtotal necrosis of LPI, a cup piston prosthesis in polycel was applied on incus residual stump. Pre- and postoperative (≥1 year) pure tone audiometry was performed for all cases. Air conduction threshold, bone conduction (BC) threshold, and air-bone gap (ABG) were documented according to the American Academy of Otolaryngology Head and Neck Surgery Committee of Hearing and Equilibrium guidelines. RESULTS At 1-year follow-up, postoperative ABG was reduced to ≤10 dB in 13 (59%) cases and ≤20 dB in 19 (86.4%) cases. The mean postoperative ABG significantly decreased in each group. There was no significant change in postoperative BC thresholds, and there were no cases with postoperative SNHL. CONCLUSION Excellent functional results can also be achieved in cases of long incus process necrosis. The choice of technique should be considered according to the degree of necrosis. Piston replacement with the same type or angled type prosthesis, in cases of erosion or minimal LPI necrosis, and modified Donaldson type ventilation tube, in cases of partial LPI necrosis, provided excellent hearing results.
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Affiliation(s)
- Eva Aurora Massimilla
- Department of Mental Health and Public Medicine, Section of Otorhinolaryngology-Head and Neck Surgery, University of Campania L. Vanvitelli, Napoli, Italy
| | - Domenico Testa
- Department of Mental Health and Public Medicine, Section of Otorhinolaryngology-Head and Neck Surgery, University of Campania L. Vanvitelli, Napoli, Italy
| | - Michele Nunziata
- Department of Mental Health and Public Medicine, Section of Otorhinolaryngology-Head and Neck Surgery, University of Campania L. Vanvitelli, Napoli, Italy
| | - Anna Donadio
- Department of Mental Health and Public Medicine, Section of Otorhinolaryngology-Head and Neck Surgery, University of Campania L. Vanvitelli, Napoli, Italy
| | - Maria Loreto Romano
- Department of Mental Health and Public Medicine, Section of Otorhinolaryngology-Head and Neck Surgery, University of Campania L. Vanvitelli, Napoli, Italy
| | - Gaetano Motta
- Department of Mental Health and Public Medicine, Section of Otorhinolaryngology-Head and Neck Surgery, University of Campania L. Vanvitelli, Napoli, Italy
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16
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Albera A, Parandero F, Andriani R, Albera R, Riva G, Canale A. Prognostic factors influencing postoperative air-bone gap in stapes surgery. Acta Otorhinolaryngol Ital 2022; 42:380-387. [PMID: 36254654 PMCID: PMC9577682 DOI: 10.14639/0392-100x-n0612] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/19/2022] [Indexed: 11/23/2022]
Abstract
Objective Otosclerosis is an osteodystrophic disease of the otic capsule, determining conductive or mixed hearing loss, which can be successfully treated with stapedotomy. The aim of the present multicentric retrospective study was to identify prognostic factors related to better auditory outcomes in stapes surgery. Methods 581 patients affected by otosclerosis were submitted to stapedotomy under local anaesthesia in two different hospitals. Both Teflon and titanium prostheses were adopted. Results A statistically significant decrease of postoperative air-conduction thresholds and air-bone gap (ABG) values was seen, whereas the mean bone-conduction threshold did not differ from the preoperative condition. Among the various parameters investigated, the prosthetic material, duration of surgery and intraoperative detection of unexpected anatomical anomalies of the middle ear were found to be related to lower postoperative ABG values. Conclusions All the previously mentioned parameters played a significant role in determining the postoperative auditory outcomes and can therefore be considered prognostic factors for the success of the stapedotomy.
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Affiliation(s)
- Andrea Albera
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Fiorella Parandero
- Section of Ear Nose and Throat, Fatebenefratelli Hospital, University of Milan, Milan, Italy
| | - Roberto Andriani
- Section of Ear Nose and Throat, Fatebenefratelli Hospital, University of Milan, Milan, Italy
| | - Roberto Albera
- Department of Surgical Sciences, University of Turin, Turin, Italy,Correspondence Andrea Albera Department of Surgical Sciences, University of Turin, Via Genova 3, 10124, Turin, Italy Tel. +39 011 6709582 E-mail:
| | - Giuseppe Riva
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Andrea Canale
- Department of Surgical Sciences, University of Turin, Turin, Italy
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17
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Dutta M, Kundu S, Ghosh B, Ghosh P. Perspectives and early experience on endoscopic stapedotomy from a group of "traditional school" otologists. Ear Nose Throat J 2022:1455613221078183. [PMID: 35259947 DOI: 10.1177/01455613221078183] [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: 11/17/2022] Open
Abstract
Background: This paper evaluates endoscopic stapedotomy from the perspectives of a group of 3 surgeons, each of whose experience in endoscopic and microscopic stapedotomy is 3 years and more than 12 years, respectively.Methods: Thirty-four patients clinically diagnosed with stapedial otosclerosis were alternately assigned for unilateral, microscope- and endoscope-assisted stapedotomy following the selection criteria given. Results were evaluated with predetermined epidemiologic, preoperative, perioperative, and postoperative outcome parameters.Results: The microscope group had 12 ears with otosclerosis and the endoscope-assisted group 14. Ears found to have conditions other than otosclerosis at surgery, and patients lost to follow-up were excluded. Apart from the operative time, the difference in the results of none of the parameters was statistically significant in the two groups. The average operative times for microscope- and endoscope-assisted stapedotomy were 63 minutes and 86.5 minutes, respectively, the difference being statistically significant (P < .001).Conclusions: From the perspectives of otologists in differential positions in the learning curve for microscope- and endoscope-assisted stapedotomy, there were no statistically significant differences between the two procedures in the execution of the steps to achieve "adequate surgical exposure" and in postoperative outcomes, except for operative time.
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Affiliation(s)
- Mainak Dutta
- Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, West Bengal, India
| | - Sohag Kundu
- Department of Otorhinolaryngology and Head-Neck Surgery, Rampurhat Government Medical College and Hospital, Birbhum, West Bengal, India
| | - Bhaskar Ghosh
- Department of Otorhinolaryngology and Head-Neck Surgery, Rampurhat Government Medical College and Hospital, Birbhum, West Bengal, India
| | - Pramit Ghosh
- Indian Council of Medical Research - Regional Medical Research Centre, Dibrugarh, Assam, India
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18
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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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19
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Abstract
OBJECTIVE Limited data are available on the effects of otosclerosis and otosclerosis surgery on the utricle and saccule. This study aimed to determine the effect of otosclerosis and stapedotomy on vestibular-evoked myogenic potentials. METHODS This retrospective study included 16 otosclerosis patients and 18 controls. Thirty-two ears of 16 patients with otosclerosis were divided into 2 groups based on whether the ear had been operated on or not. All patients and subjects underwent 500 Hz air- and bone-conducted ocular and cervical vestibular-evoked myogenic potentials testing. RESULTS Overall comparison of response rates showed a significant difference among the groups. Further statistical tests showed that this difference arose from differences between both operated and unoperated groups and the control group, for air-conducted cervical and ocular vestibular-evoked myogenic potentials. CONCLUSION Otosclerosis and stapedotomy may affect the elicitability of vestibular-evoked myogenic potentials. Otosclerosis is associated with lower response rates for air-conducted ocular and cervical vestibular-evoked myogenic potentials, regardless of whether operated on. Having been operated on does not significantly increase the response rate of air-conducted vestibular-evoked myogenic potentials.
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Affiliation(s)
- B Satar
- Department of Otorhinolaryngology, Gülhane Faculty of Medicine, University of Health Sciences Turkey, Ankara, Turkey
| | - C Karaçaylı
- Department of Audiology, Gülhane Faculty of Health Sciences, University of Health Sciences Turkey, Ankara, Turkey
| | - V K Çoban
- Department of Otorhinolaryngology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - S Özdemir
- Department of Otorhinolaryngology, Gülhane Training and Research Hospital, Ankara, Turkey
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20
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Fang Y, Zhao Y, Pan W, Silverman M, Shu Y, Chen B. Whether cochlea involvement on CT in otosclerosis patients impacts the effect of stapedotomy. Acta Otolaryngol 2021; 141:915-920. [PMID: 34633897 DOI: 10.1080/00016489.2021.1980225] [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: 10/20/2022]
Abstract
BACKGROUND The success rate of stapedotomy in otosclerosis patients with cochlea involvement was unknown. AIMS/OBJECTIVES To determine the difference of surgical outcomes and symptomatology in otosclerosis patients with or without cochlea involvement on CT. MATERIAL AND METHODS 79 otosclerosis patients were included and grouped by HRCT, including cochlear-involved otosclerosis (C-group) or non-cochlear-involved otosclerosis (NC-group, control group). Patients were defined as NC-group in the presence of normal or solely fenestral involvement, or C-group if the hypodensities involve other parts of the labyrinthine bone Patients in the control group were collected at a 2:1 ratio to the C-group with similar follow-up times. Detailed complaints and surgical outcomes were compared between these groups. RESULTS Chief complaints were similar in the C-group and NC-group. Although postoperative AC, BC, and ABG decreased significantly in both groups, the success rate was significantly higher in C-group regarding the postoperative ABG ≤10 dB. Furthermore, diffuse lesions may indicate a more severe disease and a poorer prognosis. CONCLUSIONS AND SIGNIFICANCE Stapedotomy was effective for clinical otosclerosis. The surgical outcome was inferior favorable for cochlea involvement patients, especially for cases with widely involvement. There was no difference in chief complaints among patients with different CT degree of otosclerosis.
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Affiliation(s)
- Yanqing Fang
- ENT Institute and Department of Otorhinolaryngology, State Key Laboratory of Medical Neurobiology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Yu Zhao
- ENT Institute and Department of Otorhinolaryngology, State Key Laboratory of Medical Neurobiology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Wei Pan
- ENT Institute and Department of Otorhinolaryngology, State Key Laboratory of Medical Neurobiology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Matthew Silverman
- Laryngeal Physiology Laboratory, University of Wisconsin – Madison, Madison, WI, USA
| | - Yilai Shu
- ENT Institute and Department of Otorhinolaryngology, State Key Laboratory of Medical Neurobiology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Bing Chen
- ENT Institute and Department of Otorhinolaryngology, State Key Laboratory of Medical Neurobiology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
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21
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Roychowdhury P, Polanik MD, Kempfle JS, Castillo‐Bustamante M, Fikucki C, Wang MJ, Kozin ED, Remenschneider AK. Does stapedotomy improve high frequency conductive hearing? Laryngoscope Investig Otolaryngol 2021; 6:824-831. [PMID: 34401508 PMCID: PMC8356860 DOI: 10.1002/lio2.599] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Stapedotomy is performed to address conductive hearing deficits. While hearing thresholds reliably improve at low frequencies (LF), conductive outcomes at high frequencies (HF) are less reliable and have not been well described. Herein, we evaluate post-operative HF air-bone gap (ABG) changes and measure HF air conduction (AC) thresholds changes as a function of frequency. METHODS Retrospective review of patients who underwent primary stapedotomy with incus wire piston prosthesis between January 2016 and May 2020. Pre- and postoperative audiograms were evaluated. LF ABG was calculated as the mean ABG of thresholds at 250, 500, and 1000 Hz. HF ABG was calculated at 4 kHz. RESULTS Forty-six cases met criteria. Mean age at surgery was 54.0 ± 11.7 years. The LF mean preoperative ABG was 36.9 ± 11.0 dB and postoperatively this significantly reduced to 9.35 ± 6.76 dB, (P < .001). The HF mean preoperative ABG was 31.1 ± 14.4 dB and postoperatively, this also significantly reduced to 14.5 ± 12.3 dB, (P < .001). The magnitude of LF ABG closure was over 1.5 times the magnitude of HF ABG closure (P < .001). The gain in AC decreased with increasing frequency (P < .001). CONCLUSION Hearing improvement following stapedotomy is greater at low than high frequencies. Postoperative air bone gaps persist at 4 kHz. Further biomechanical and histopathologic work is necessary to localize postoperative high frequency conductive hearing deficits and improve stapedotomy hearing outcomes. LEVEL OF EVIDENCE 4, retrospective study.
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Affiliation(s)
- Prithwijit Roychowdhury
- Department of Otolaryngology‐Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | - Marc D. Polanik
- Department of Otolaryngology‐Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | - Judith S. Kempfle
- Department of Otolaryngology‐Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyUMASS Memorial Medical CenterWorcesterMassachusettsUSA
| | - Melissa Castillo‐Bustamante
- Department of Otolaryngology‐Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard UniversityBostonMassachusettsUSA
| | - Cheryl Fikucki
- Department of AudiologyUMASS Memorial Medical CenterWorcesterMassachusettsUSA
| | - Michael J. Wang
- Department of OtolaryngologyUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | - Elliott D. Kozin
- Department of Otolaryngology‐Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard UniversityBostonMassachusettsUSA
| | - Aaron K. Remenschneider
- Department of Otolaryngology‐Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
- Department of OtolaryngologyUMASS Memorial Medical CenterWorcesterMassachusettsUSA
- Department of OtolaryngologyHarvard UniversityBostonMassachusettsUSA
- Department of AudiologyUMASS Memorial Medical CenterWorcesterMassachusettsUSA
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22
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Fang Y, Chen KG, Zhao Y, Menon NA, Scholp AJ, Shu Y, Chen B. Relationship between short-term and mid-term hearing outcomes after stapedotomy in patients with otosclerosis: an investigation. Acta Otolaryngol 2021; 141:603-607. [PMID: 34028329 DOI: 10.1080/00016489.2021.1909748] [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: 10/21/2022]
Abstract
BACKGROUND Although stapedotomy is effective for patients with clinical otosclerosis, the time of hearing stabilization has not yet been consistent. OBJECTIVE To investigate the relationships between post-operative follow-up times, hearing outcomes, and threshold shift after stapedotomy. MATERIALS AND METHODS Fifty-five patients with clinical otosclerosis that underwent stapedotomy were retrospectively studied. Pure tone audiometry tests were conducted within the first month (short-term) and within 1 year (mid-term) postoperatively. Data were analyzed for two rounds of audiometry tests at different postoperative follow-up times. RESULTS Air conduction (AC) and bone conduction (BC) were significantly correlated with preoperative hearing levels (p<.01). AC, BC, and air bone gap (ABG) significantly improved at the short-term (p<.001) and continued to improve at the mid-term (p<.01). The success rate of surgery increased from 87% at short-term to 98% at mid-term. Less than 1/3 of cases encountered BC deterioration at short-term, whereas most improved at mid-term. CONCLUSIONS Hearing results showed a trend of improvement between short-term and mid-term follow-ups after stapedotomy. AC, ABG, and success rate displayed significant improvement several months postoperatively. BC deterioration occurred in less than 30% of patients at short-term. The recovery of BC at 4 kHz was later than that of low frequencies.
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Affiliation(s)
- Yanqing Fang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Ke-guang Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yu Zhao
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Nikita A. Menon
- Department of Surgery, Division of Otolaryngology – Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Austin J. Scholp
- Department of Surgery, Division of Otolaryngology – Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Yilai Shu
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Bing Chen
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
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23
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Mariani C, Carta F, Piras N, Marrosu V, Serra F, De Seta D, Puxeddu R. Evaluation of Audiological Results and Cochleo-Vestibular Subclinical Injury After CO 2 Laser Stapedotomy. Lasers Surg Med 2021; 53:1186-1191. [PMID: 34004037 DOI: 10.1002/lsm.23416] [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] [Received: 12/19/2020] [Revised: 03/18/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Evaluation of the effectiveness and safety of CO2 laser stapedotomy, focusing on the audiological results, and on the surgical cochleo-vestibular trauma. STUDY DESIGN/MATERIALS AND METHODS Retrospective clinical trial on 38 patients with the diagnosis of otosclerosis, who underwent CO2 laser stapedotomy between January 2015 and October 2019. Postoperative air-bone gap (ABG), mean air conduction gain, and postoperative changes of high frequency threshold were evaluated 1, 3, 6, and 12 months after surgery. Videoculography (VOG) was performed to assess the vestibular impairment preoperatively and 1 day, 1 week, and 1 month after surgery. RESULTS Postoperative ABG closure within 10 dB was obtained in 35 cases (92.1%), with a mean postoperative ABG of 4.4 dB and a mean air conduction improvement of 32.3 dB. No significant worsening of high frequency threshold was observed. Spontaneous nystagmus was found preoperatively in 5/38 patients (13.2%), 1 day after surgery in 13/38 patients (34.2%), 1 week after surgery in 12/38 patients (31.6%), and 1 month after surgery in 4/38 patients (10.5%). Positional nystagmus was found preoperatively in 12/38 patients (31.6%), 1 day after surgery in 25/38 patients (65.8%), 1 week after surgery in 22/38 patients (57.9%), and 1 month after surgery in 10/38 patients (26.3%). The occurrence of nystagmus did not always correlate with vestibular symptoms: after surgery, 10 patients (26.3%) experienced vertigo associated with dizziness, 8 patients (21.1%) suffered from dizziness without vertigo, and 14 patients (36.8%) showed nystagmus without any symptomatology. At 1 month after surgery none of the patients complained about vestibular symptoms. CONCLUSION CO2 laser stapedotomy is a safe and effective technique, which allows to obtain good functional results with minimal perioperative cochleo-vestibular trauma.© 2021 Wiley Periodicals LLC.
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Affiliation(s)
- Cinzia Mariani
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100, Cagliari, Italy
| | - Filippo Carta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100, Cagliari, Italy
| | - Nicoletta Piras
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100, Cagliari, Italy
| | - Valeria Marrosu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100, Cagliari, Italy
| | - Federica Serra
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100, Cagliari, Italy
| | - Daniele De Seta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100, Cagliari, Italy
| | - Roberto Puxeddu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100, Cagliari, Italy
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Satar B, Karaçaylı C, Çoban VK, Özdemir S. Do otosclerosis and stapedotomy affect semicircular canal functions? Preliminary results of video head impulse test. Acta Otolaryngol 2021; 141:348-353. [PMID: 33522866 DOI: 10.1080/00016489.2021.1873416] [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: 10/22/2022]
Abstract
BACKGROUND Otosclerosis and stapedotomy have some effects on the vestibular system, but there are very limited data on their effects on semicircular canals (SCCs). OBJECTIVE The aim of the study is to investigate if otosclerosis and stapedotomy have an effect on SCCs and video head impulse test (vHIT). MATERIAL AND METHODS This retrospective study included 11 otosclerosis patients who had undergone stapedotomy and 30 healthy participants. Twenty-two ears of 11 patients with otosclerosis were divided into two groups based on whether the ear had been operated (12 ears) or not (10 ears). All participants underwent vHIT. We compared gains of all SCCs, presence of saccades among the operated ears, unoperated ears and control ears. RESULTS Significant difference (p<.05) was noted in comparisons of gain of lateral SCCs among all groups. Control group had the highest gain, followed by unoperated and operated groups, respectively. Comparison of incidence of covert saccade showed significant difference (p<.05) for lateral and posterior SCCs. CONCLUSIONS AND SIGNIFICANCE Otosclerosis and otosclerosis surgery may have some effects on SCC functions and thereby vHIT. Lateral SCC is the most affected SCC in terms of gain. These findings appear to add important contributions to our knowledge.
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Affiliation(s)
- Bülent Satar
- Department of Otorhinolaryngology, Gulhane Faculty of Medicine, University of Health Science Turkey, Ankara, Turkey
| | - Ceren Karaçaylı
- Department of Audiology, Gulhane Faculty of Health Science, University of Health Science Turkey, Ankara, Turkey
| | - Volkan Kenan Çoban
- Department of Otorhinolaryngology, Gülhane Training and Research Hospital, University of Health Science Turkey, Ankara, Turkey
| | - Songül Özdemir
- Department of Otorhinolaryngology, Gülhane Training and Research Hospital, University of Health Science Turkey, Ankara, Turkey
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Poutoglidis A, Tsetsos N, Vardaxi C, Fyrmpas G, Poutoglidou F, Kilmpasanis A, Vlachtsis K. Conventional Microscopic Stapedotomy: An Obsolete Technique or Still the Gold Standard for the Management of Otosclerosis? Cureus 2021; 13:e14126. [PMID: 33927934 PMCID: PMC8075829 DOI: 10.7759/cureus.14126] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objectives Clinical otosclerosis is a relatively common entity, accounting for 0.5%-2% of the general population. Otosclerosis is characterized by an abnormal bone formation in the temporal bone that eventually causes conductive hearing loss. Bilateral involvement is fairly common. Treatment can be either conservative with medications and a hearing aid, or surgical. Stapedotomy is considered, nowadays, the most effective surgical technique for the management of otosclerosis. The purpose of the present study is to present our long-term results with stapedectomy, the audiological outcome, as well as the complications encountered. Subjects and methods This is a retrospective single-centre study. All patients diagnosed with otosclerosis and treated operatively with a stapedotomy from January 2010 to December 2019 were included in the study. Demographic data, air and bone conduction thresholds, complications and length of the prosthesis were recorded. Results The study included a total of 72 patients. The audiological results showed a statistically significant improvement in the air conduction thresholds in all the affected frequencies (p<0.001). Post-operative complications included deterioration or severe hearing loss up to 100 dB (n=1, 1.39%), loss or distortion of taste (n=4, 5.6%) and tinnitus (n=2, 2.8%). Conclusions Our results demonstrate that stapedotomy is an effective technique for the management of otosclerosis. Stapedotomy, when performed by an experienced surgeon, provides excellent outcomes, with limited complications.
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Affiliation(s)
- Alexandros Poutoglidis
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, GRC
| | - Nikolaos Tsetsos
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, GRC
| | - Chrysa Vardaxi
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, GRC
| | - Georgios Fyrmpas
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, GRC
| | - Frideriki Poutoglidou
- Department of Clinical Pharmacology, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Adamantios Kilmpasanis
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, GRC
| | - Konstantinos Vlachtsis
- Department of Otorhinolaryngology-Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, GRC
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Dahm V, Schwarz–Nemec U, Auinger AB, Arnoldner MA, Kaider A, Riss D, Czerny C, Arnoldner C. Titanium and Platinum-Fluoroplastic Stapes Prostheses Visualization on Cone Beam Computed Tomography and High-Resolution Computed Tomography. Life (Basel) 2021; 11:life11020156. [PMID: 33671447 PMCID: PMC7923124 DOI: 10.3390/life11020156] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: The aim of this study was to evaluate whether stapes prostheses can be visualized with less metal artifacts and therefore more accurately on cone beam computed tomography in comparison to computed tomography imaging. Recent studies have shown that cone beam computed tomography has advantages when imaging metal artifacts. Patients with hearing loss or vertigo, who have undergone stapedotomy, often present a challenge for otologic surgeons. Imaging studies can deliver crucial additional information. Methods: A retrospective analysis of imaging studies and clinical data in a tertiary care center were carried out. Forty-one patients with forty-five implanted ears were evaluated in the study. All included patients had been implanted with a platinum-fluoroplastic (n = 19) or titanium (n = 26) piston and subsequently had undergone imaging months or years after surgery for various reasons. Patients underwent computed tomography or cone beam computed tomography of the temporal bone depending on availability. Piston visualization, prosthesis length, vestibular intrusion and audiologic results were compared between the groups. Piston position on imaging studies were compared to intraoperative findings. Results: Functional length measurements of all prostheses were carried out with a mean error of -0.17 mm (±0.20). Platinum-fluoroplastic protheses were significantly underestimated in length compared to titanium prostheses. To analyze the material-dependent difference in the measurement errors of the imaging techniques the interaction was tested in an ANOVA model and showed no statistically significant result (p = 0.24). The blinded neuroradiologist viewed two implants, both platinum-fluoroplastic pistons, as located outside of the vestibule due to an underestimation of the prothesis length and the missing radiodensity of the lower end of the prosthesis. Conclusion: Surgeons and radiologists should be aware of the different types and radiologic features of stapes prostheses and the missing radiodensity of some protheses parts. Cone beam computed tomography is an imaging alternative with a potential advantage of reduced radiation in patients after stapes surgery suffering from vertigo or hearing loss to evaluate piston position.
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Affiliation(s)
- Valerie Dahm
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (V.D.); (A.B.A.); (D.R.); (C.A.)
| | - Ursula Schwarz–Nemec
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, 1090 Vienna, Austria; (M.A.A.); (C.C.)
- Correspondence: ; Tel.: +43/1/40400-33300
| | - Alice B. Auinger
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (V.D.); (A.B.A.); (D.R.); (C.A.)
| | - Michael A. Arnoldner
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, 1090 Vienna, Austria; (M.A.A.); (C.C.)
| | - Alexandra Kaider
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, 1090 Vienna, Austria;
| | - Dominik Riss
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (V.D.); (A.B.A.); (D.R.); (C.A.)
| | - Christian Czerny
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, 1090 Vienna, Austria; (M.A.A.); (C.C.)
| | - Christoph Arnoldner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (V.D.); (A.B.A.); (D.R.); (C.A.)
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Wierzbicka M, Szyfter W, Greczka G, Gawęcki W. Otosurgery with the High-Definition Three-Dimensional (3D) Exoscope: Advantages and Disadvantages. J Clin Med 2021; 10:jcm10040777. [PMID: 33669166 PMCID: PMC7919662 DOI: 10.3390/jcm10040777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/06/2021] [Revised: 01/27/2021] [Accepted: 02/12/2021] [Indexed: 12/18/2022] Open
Abstract
Background: The aim of the study was to describe our initial experience with the high-definition three-dimensional (3D) exoscope for middle ear surgery versus the operating microscope. Methods: The study included 60 randomly chosen patients diagnosed with otosclerosis (n = 30) or chronic otitis media (n = 30) with a clinical indication for surgery. The primary measurement was the subjective estimation of quality of the visibility of the operating field provided by the 3D exoscope—VITOM-3D (Karl Storz, Tuttlingen, Germany) in comparison to the operating microscope. Results: All procedures, except for two (3.3%) converted to the microscope, were successfully completed using a 3D exoscope. In both stapedotomy and tympanoplasty, the exoscope was superior to the microscope during more superficial portions of the procedures. By contrast, in deeper areas of the middle ear, the exoscope provided significantly worse visibility, but usually not suboptimal. Both intraoperative bleeding and the narrow surgical field substantially reduced the visibility with the 3D exoscope in comparison to the microscope. Conclusions: Overall, our study shows that the 3D exoscope offers excellent, highly magnified, and well-illuminated high-definition images of the surgical field. However, our experience revealed several important limitations of this system, including decreased depth perception in deep areas of the tympanic cavity and reduced visibility in a difficult surgical field, with subsequent need to switch to an operating microscope in select cases.
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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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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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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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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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Job K, Składzień J. The prognostic influence of pre-surgery bone conduction values on the improvement of hearing in patients treated surgically as a result of middle-ear conditions. Otolaryngol Pol 2020; 75:1-5. [PMID: 33949970 DOI: 10.5604/01.3001.0014.5919] [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: 11/13/2022]
Abstract
Background The influence of the mechanics of the middle ear on the function of the inner ear has been studied for many years. Among surgeries performed in the middle-ear area, those restoring full functionality of the system transmitting sound inside the middle ear may be pointed out as those fully restoring the mechanical influence of the middle ear on the function of the inner ear. Aim: The aim of the performed analysis is to find the prognostic importance of measured pre-surgery values of bone conduction on the improvement of hearing in patients operated as a result of middle-ear disorders. Methods The analysis included 271 patients hospitalised and operated on due to otosclerosis or perforation of the tympanic membrane between 2016 and 2019. Only patients who had not had a surgical operation within the middle ear prior to the study were included. An audiological assessment was performed with the use of pure tone thresholds audiometry. Results A beneficial influence of the performed surgery on the improvement of bone conduction was observed in patients, in which the average threshold value of bone conduction measured before the surgery did not exceed 40 dB. In cases of the perceptive component of hearing impairment being higher than 40 dB, no statistically significant, beneficial influence of a performed stapedotomy or myringoplasty on the change of bone conduction thresholds was observed. Conclusion The perception component of hearing impairment up to 40 dB indicates bone conduction improvement after surgical restoration of the influence of middle-ear mechanics on the inner ear in patients treated as a result of otosclerosis, as well as of eardrum perforation.
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Affiliation(s)
| | - Jacek Składzień
- Chair Otolaryngology of the Jagiellonian University Collegium Medicum, Cracow, Poland
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Wiatr A, Job K, Składzień J, Wiatr M. Impact of surgery in otosclerosis on the non-operated ear. Otolaryngol Pol 2020; 75:15-20. [PMID: 33949316 DOI: 10.5604/01.3001.0014.5675] [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: 11/13/2022]
Abstract
Backgrounds Otosclerosis is an underlying disease of the bony labyrinth. The hearing loss is most often of conductive nature, in some cases the involvement of the bony part of the cochlea results in mixed hearing loss. Aims: The aim of the analysis was to answer the question whether a surgery on one of the ears affects the state of the other ear in the course of otosclerosis. Methods The analysis included 140 patients hospitalized and operated on between 2010 - 2016. Only patients who had not had a surgical operation within the middle ear due to otosclerosis prior to the study were included in it. An audiological assessment was performed with the use of pure tone threshold audiometry taking into account. Results In the group of patients with no Carhart's notch, the mean threshold of bone conduction was statistically lower than before the procedure for the frequencies of 500, 1000 Hz and statistically equal for the frequency of 2000 Hz. The same analysis in the group of patients with Carhart's notch present in the pre-surgical tonal audiogram of the non-operated ear showed a statistically significant lower value of the post-surgical threshold bone conduction value. Conclusion It was confirmed the possibility of improving the hearing of the non-operated ear after the stapedotomy of the opposite ear, in the author's own studies by an average of 5 dB in the low-frequency range.
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Affiliation(s)
- Agnieszka Wiatr
- Chair Otolaryngology of the Jagiellonian University Collegium Medicum, Cracow, Poland
| | | | - Jacek Składzień
- Chair Otolaryngology of the Jagiellonian University Collegium Medicum, Cracow, Poland
| | - Maciej Wiatr
- Chair Otolaryngology of the Jagiellonian University Collegium Medicum, Cracow, Poland
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Xie L, Liu A, Shenoy Imrit T, Peng L, Zhou L. [Short-term postoperative outcome of laser-assisted stapedotomy in patients with otosclerosis]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020; 34:1074-1078. [PMID: 33254338 PMCID: PMC10127785 DOI: 10.13201/j.issn.2096-7993.2020.12.005] [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] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 11/12/2022]
Abstract
Objective:To assess the short-term efficacy of laser-assisted stapedotomy in patients with otosclerosis. Method:The clinical data of twenty-one patients with otosclerosis who underwent laser-assisted stapedotomy were retrospectively analyzed . Preoperative and 3-month postoperative standardized audiometric evaluations were carried out in all patients. The occurrence of surgical complications was observed. Result:The mean preoperative and postoperative air conduction (AC) thresholds were (58.2±12.7) dB HL and (43.0±23.1)dB HL respectively; the postoperative AC threshold decreased by 15.2 dB HL which was statistically significant at 0.5, 1, 2, and 4 kHz (P<0.01). The mean preoperative and postoperative bone conduction (BC) thresholds were (31.4±10.3)dB HL and (33.3±16.6)dB HL, and there was not significant difference between them as well as BC thresholds at each frequency. Overclosure >10 dB HL was occured in 3 ears (14.3%) while sensorineural hearing loss>10 dB HL was found in 2 ears (9.5%). The mean ABG decreased by 17.4 dB HL (P<0.01) from preoperative (27.0±9.1) dB HL to postoperative (9.6±9.9) dB HL, and the ABG at each frequency had significant decrease. Fourteen ears (66.7%) had postoperative ABG of ≤10 dB HL while 18 ears (85.7%) had postoperative ABG of ≤20 dB HL. Sensorineural hearing loss occurred in 2 ears (9.5%) after surgery, tinnitus in 15 ears (71.4%) and vertigo in 3 ears (14.3%). But all were relieved on the third day after operation. Conclusion:Laser-assisted stapedotomy is a safe and effective treatment of otosclerosis. Although BC thresholds was slightly increased after surgery, it did not affect the overall hearing outcomes.
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Affiliation(s)
- Li Xie
- Department of Otolaryngology Head and Neck Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430030,China
| | - Aiguo Liu
- Department of Otolaryngology Head and Neck Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430030,China
| | - T Shenoy Imrit
- Department of Otolaryngology Head and Neck Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430030,China
| | - Liyan Peng
- Department of Otolaryngology Head and Neck Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430030,China
| | - Liangqiang Zhou
- Department of Otolaryngology Head and Neck Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430030,China
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Sioshansi PC, Schettino A, Babu SC, Bojrab DI, Sargent EW, Michaelides EM, Luryi AL, Schutt CA. Bone Cement Fixation of Stapedotomy Prostheses: Long-term Outcomes in Primary and Revision Stapes Surgery. Ann Otol Rhinol Laryngol 2020; 130:769-774. [PMID: 33183065 DOI: 10.1177/0003489420971337] [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: 11/15/2022]
Abstract
OBJECTIVES To describe audiologic outcomes following hydroxyapatite bone cement fixation of stapedotomy prostheses. METHODS A retrospective case review at a tertiary neurotology referral center was performed of patients undergoing primary or revision stapedotomy between 2010 and 2017. Patients with hydroxyapatite bone cement fixation of stapes prostheses were assessed. Pre- and postoperative hearing was compared, consisting of air conduction (AC) and bone conduction (BC) pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). Short and long-term outcomes were assessed. RESULTS Forty-six patients with otosclerosis underwent stapedotomy with bone cement fixation: 21 primary cases and 25 revision cases, with an average follow-up time of 17 months. Mean AC PTA was 56 dB preoperatively, and 34 dB postoperatively (P < .0001), while the ABG improved on average from 27 dB to 9 dB (P < .0001). There was no significant difference in postoperative ABG between primary and revision stapes surgery (6 dB vs 10 dB, P = .07). These results persisted through long-term follow-up in a subgroup of patients with significantly longer follow-up time (mean 44 months). There was no significant change in BC PTA or word recognition scores. Three patients underwent subsequent revisions, one patient developed sensorineural hearing loss. CONCLUSION Stapedotomy with bone cement fixation of the prosthesis provides excellent hearing outcomes in both primary and revision treatment of otosclerosis. Results are consistent and stable through long-term follow-up. The use of bone cement should be incorporated into the surgical armamentarium of the otologist for the prevention and treatment of loose-wire syndrome and incus necrosis.
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Affiliation(s)
- Pedrom C Sioshansi
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington Hills, MI, USA
| | - Amy Schettino
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Seilesh C Babu
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington Hills, MI, USA
| | - Dennis I Bojrab
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington Hills, MI, USA
| | - Eric W Sargent
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington Hills, MI, USA
| | - Elias M Michaelides
- Department of Otolaryngology-Head and Neck Surgery, Rush University, Chicago, IL, USA
| | - Alexander L Luryi
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington Hills, MI, USA
| | - Christopher A Schutt
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington Hills, MI, USA
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Varadarajan VV, Dayton OL, De Jesus RO, Antonelli PJ. Prevalence of occult cochlear basal turn patency. Acta Otolaryngol 2020; 140:889-892. [PMID: 32804558 DOI: 10.1080/00016489.2020.1800815] [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 Perilymph gusher (PLG) is a rare complication of otologic surgery attributed to a communication between the cochlea and the internal auditory canal (IAC). Subtle patency between the cochlear basal turn and IAC has recently been identified on computed tomography (CT) as a risk factor, specifically when the defect is > 0.75 mm. OBJECTIVES Investigate the prevalence of radiographic cochlear basal turn patency. MATERIALS AND METHODS Patients with CT of the temporal bones and inner ears interpreted as "normal" were included. An otologist and a radiologist independently reviewed CTs to measure radiographic dehiscence in an oblique plane along the interface of the cochlea and IAC. Known PLGs were excluded. RESULTS Two hundred and ten ears were included (88 conductive or mixed hearing loss, 62 sensorineural hearing loss, 41 audiometrically normal ears). 71 ears (33.8%) were radiographically patent. Mean defect width was 0.41 mm (0.15-0.7 mm). Defect width was not associated with type of hearing loss, age, or gender. No defects were wider than 0.75 mm. CONCLUSIONS Radiographic patency of the cochlear basal turn may be present in patients with hearing loss and normal hearing, but patency > 0.75 mm (i.e. risk for PLG) is rare.
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Affiliation(s)
| | - Orrin L. Dayton
- Department of Radiology, University of Florida, Gainesville, FL, USA
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Lucidi D, Molinari G, Reale M, Alicandri-Ciufelli M, Presutti L. Functional Results and Learning Curve of Endoscopic Stapes Surgery: A 10-Year Experience. Laryngoscope 2020; 131:885-891. [PMID: 33124036 DOI: 10.1002/lary.28943] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess hearing outcomes and complications of endoscopic stapes surgery by a single surgeon in a 10-year period, to compare these data with conventional microscopic procedures by the same operator, and to describe the learning curve of endoscopic stapedotomy. STUDY DESIGN Retrospective study. METHODS This is a retrospective study on patients who underwent endoscopic stapes surgery performed by the same senior surgeon, experienced both in microscopic and endoscopic techniques, between January 2009 and December 2018. Audiological data were compared, and intraoperative and postoperative complications were collected. The surgeon's last 30 cases of microscopic stapedotomy were enrolled as the control group. The results of the first 100 endoscopic stapes surgeries were analyzed separately to create a cumulative sum (CUSUM) control chart for learning curve assessment. RESULTS One hundred seventy-eight endoscopic and 30 microscopic stapes surgeries were included. In the endoscopic group, the mean postoperative air-bone gap was 8.2 dB. No significant differences between the endoscopic and microscopic preoperative and postoperative values were reported. A total of eight complications (4.5%) were observed in the endoscopic cohort, although in the control group, no complication occurred. The mean surgical time was 51.9 minutes in the endoscopic group versus 48.2 minutes in the microscopic group (P > .05). No association between stapedotomy success and the increasing number of procedures was found. CONCLUSIONS Our article demonstrates that functional results from endoscopic stapes surgery are similar to those from microscopic stapes surgery in terms of both safety and efficacy. After gaining endoscopic experience, the surgical duration of stapes surgery will be adequate starting from the first cases. LEVEL OF EVIDENCE 4 Laryngoscope, 131:885-891, 2021.
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Affiliation(s)
- Daniela Lucidi
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Giulia Molinari
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Marella Reale
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | | | - Livio Presutti
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
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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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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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Kriston F, Rovó L, Kiss JG, Jarabin JA. Clinical aspects of otosclerotic ossicular chain fixations. Orv Hetil 2020; 161:780-788. [PMID: 32365050 DOI: 10.1556/650.2020.31701] [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] [Received: 12/05/2019] [Accepted: 01/30/2020] [Indexed: 11/19/2022]
Abstract
Otosclerosis is a human-specific ear disease characterised by complex bone-remodelling with multifactorial aetiology. It affects the bony labyrinth capsule and consequently fixates the stapes to the oval window rim. The fixation of the ossicular chain leads to a decrease in the middle ear's acoustic impedance-fitting and amplifier function that leads to conductive hearing loss. The process is progressive and when it involves the inner ear structures, it deteriorates the sensorineural function as well. The course of the illness can be prevented or delayed if hearing reconstructive surgery is performed on time. The development of stapes surgery spans the 20th century, and despite the major surgical steps - laid down by Shea and Marquet in the 1960s - are quite conservative, fine adjustments are still being made mainly due to technical progress. Several studies confirm that stapedotomy remained the first-to-offer therapeutic option in otosclerosis. With an adequate surgical technique, significant improvement can be achieved in the air conduction threshold, the air-bone gap may be minimalized or ceased over the speech frequencies, which significantly improves the quality of life of the patients. In this quest, we reviewed the Hungarian and the international literature as well in context with otosclerosis, with special attention to the newest methods in diagnostics and treatment management. Orv Hetil. 2020; 161(19): 780-788.
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Affiliation(s)
- Fanni Kriston
- Fül-Orr-Gégészeti és Fej-Nyaksebészeti Osztály,Jahn Ferenc Dél-pesti Kórház és Rendelőintézet Budapest
| | - László Rovó
- Általános Orvostudományi Kar, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika,Szegedi Tudományegyetem Szeged
| | - József Géza Kiss
- Általános Orvostudományi Kar, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika,Szegedi Tudományegyetem Szeged
| | - János András Jarabin
- Általános Orvostudományi Kar, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika,Szegedi Tudományegyetem Szeged
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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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Affiliation(s)
- Marc D Polanik
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts, USA.,University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Aaron K Remenschneider
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts, USA.,University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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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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Abstract
This study aims to determine the benefit of stapes surgery for otosclerosis in 121 patients with a mixed hearing loss and a preoperative bone conduction (BC) threshold >30 dB. Average postoperative air conduction (AC) improved from 61.5 dB to 34.3 dB. Average air-bone gap closed from 27.1 dB to 6.1 dB. Bone conduction improved from 34.3 dB to 28.2 dB, with 38% of patients achieving a postoperative AC of <30 dB. Glasgow Benefit Inventory scores showed significantly increased quality of life postoperatively in the 88 patients who responded to follow-up, with an average score of 56. There was a mean reduction in daily hearing aid use postsurgery of 5.48 hours, with 56% of patients who responded to follow-up questionnaire no longer needing to use one. When assessing suitability for stapes surgery, surgeons should consider that preoperative BC thresholds may be a poor indicator of the true cochlear reserve and therefore the potential for improvement in AC thresholds and quality of life.
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Affiliation(s)
- Jacob J Rapier
- 158988Royal National Throat, Nose and Ear Hospital, London, United Kingdom.,4919UCL Medical School, London, United Kingdom
| | | | - Joseph G Manjaly
- 158988Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Robert Nash
- 158988Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Jeremy A Lavy
- 158988Royal National Throat, Nose and Ear Hospital, London, United Kingdom
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Alessandrini M, Viziano A, Roselli L, Micarelli A. Surgical treatment of otosclerosis leading to changes in postural control and quality of life. Laryngoscope 2019; 130:2448-2454. [PMID: 31804726 DOI: 10.1002/lary.28438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 07/31/2019] [Revised: 10/31/2019] [Accepted: 11/09/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Evaluating postural function in patients with otosclerosis by assessing otoneurological function and balance-related quality of life before and 6 weeks after surgical treatment. Correlations between and clinical features were investigated. METHODS Thirty-three patients affected by otosclerosis underwent otoneurological examination, video Head Impulse Test (vHIT), and static posturography before and after stapedotomy. Quality of life and dizziness-related handicap were screened by means of validated questionnaires. Correlation analysis was performed in order to discover possible relations with audiological pre- and postoperative parameters. RESULTS A significant improvement in posturographic parameters was found. Correlation analysis yielded a negative correlation between preoperative bone conduction auditory threshold and both vHIT scores and postural performance improvement, evaluated by spectral analysis. Moreover, a positive correlation was also found between improvements in posturographic scores and quality-of-life questionnaires. CONCLUSION The study results demonstrated an improvement in postural function and self-reported measures in a cohort of patients with otosclerosis 6 weeks after stapedotomy. The inverse correlation with preoperative auditory levels may reflect lesser chance for balance restoration in cases with worse sensorineural function. Possible implications for daily activities and overall quality of life were suggested by improved self-report questionnaire results. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2448-2454, 2020.
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Affiliation(s)
- Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy
| | - Andrea Viziano
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy
| | - Lucrezia Roselli
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy
| | - Alessandro Micarelli
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy.,ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy.,Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
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46
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Xie J, Zhang LJ, Zeng N, Liu Y, Gong SS. The clinical characteristics of otosclerosis and benefit from stapedotomy: our experience of 48 patients (58 ears). Acta Otolaryngol 2019; 139:843-848. [PMID: 31437058 DOI: 10.1080/00016489.2019.1649459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/26/2022]
Abstract
Background: Stapedotomy has been proved to be one of the most efficient procedure to treat otosclerosis, various factors contribute to the diversity of the outcomes and controversial results exist from previous studies. Objectives: We evaluated clinical characteristics and outcomes of stapedotomy, as well as possible predictive factors of a successful outcome. Materials and methods: This retrospective study evaluated 58 ears from 48 patients with demographic data, plus short-term follow-up of hearing outcomes of 28 ears, and evaluated variables using univariate general linear regression analyses. Results: The average operation age was 41.54 years. A total of 87.5% (42/48) patients presented with bilateral otosclerosis. 39.66% (23/58) ears had CT finding before the surgery. Patients with persistent tinnitus accounted for 53.45% (31/58) and the average preoperative ABG of the 58 ears was 32.22 dB. We achieved good postoperative air-bone gaps (ABGs) overall but poor ABG closure at 4 kHz. No predictive factors were identified in the 28 ears that were followed up. Conclusions and significance: Delayed surgery may be attributable to insufficient recognition of otosclerosis. The fenestration size could be the reason for poor ABG closure at high frequency. However, more cases and longer follow-ups are required to confirm our findings.
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Affiliation(s)
- Jing Xie
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ling-Jun Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Na Zeng
- Clinical Epidemiology and EBM Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yun Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shu-Sheng Gong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Faramarzi M, Roosta S, Aminpour S. Comparing Gelfoam vs fat as a sealing material in stapedotomy: A prospective double-blind randomised clinical trial. Clin Otolaryngol 2019; 44:299-304. [PMID: 30674084 DOI: 10.1111/coa.13291] [Citation(s) in RCA: 5] [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] [Received: 07/26/2018] [Revised: 12/03/2018] [Accepted: 01/19/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVES One research aspect of stapes surgery is various materials that are used to seal the oval window. Several materials are used to seal the oval window, for example adipose tissue, perichondrium, vein graft, gelatin sponge (Gelfoam), blood clot and soft connective tissue. Up to now, there has been no randomised clinical trial that has evaluated the effects of different types of sealing material on hearing outcomes after stapedotomy. Hence, the present study aimed to find out which of these materials; fat or Gelfoam was associated with better hearing outcome, when used as a sealing material. DESIGN This prospective, double-blind, randomised clinical trial was carried out on ears that had undergone stapedotomy. SETTING Dastgheib Hospital affiliated to Shiraz University of Medical Sciences, a referral otology centre in southern Iran. PARTICIPANTS A total of 176 primary stapedotomies were analysed. Fat harvested from the ear lobule was used in 86 ears and Gelfoam in 90 ears. MAIN OUTCOME MEASURES Preoperative and postoperative pure tone audiometric data and incidence of sensorineural hearing loss were evaluated. RESULTS Total of 90.7% of all ears in the fat group and 87.8% of ears in Gelfoam group achieved postoperative air-bone gap (ABG) within 20 dB, and this difference was not significant. There was no case of sensorineural hearing loss (defined as 10 dB or more reduction in BC threshold) in both groups in mean frequencies of 0.5-3 kHz. There were 9 cases of sensorineural hearing loss at 4 kHz in the fat group vs 4 in the Gelfoam group. The occurrence of sensorineural hearing loss in different frequencies was not significant between the two groups (P > 0.05). In addition, there was no case of dead ear in either group. CONCLUSIONS We found similarity between hearing outcome in the Gelfoam and fat as sealing materials in stapedotomy. We believe that the first limitation of this study was the short-term follow-up in stapedotomy. The other issue is that one has to be cautious when using our result, which might not be applicable in larger fenestra stapedectomy.
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Affiliation(s)
- Mohammad Faramarzi
- Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sareh Roosta
- Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Safoura Aminpour
- Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
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Kiryk EA, Kamieniecki K, Kwacz M. Design of a resilient ring for middle ear's chamber stapes prosthesis. Comput Methods Biomech Biomed Engin 2018; 21:771-779. [PMID: 30409041 DOI: 10.1080/10255842.2018.1519070] [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: 10/27/2022]
Abstract
This paper presents the process of designing a new elastic element replacing a membrane in the chamber stapes prosthesis (ChSP). The results of the study are volume displacement characteristics obtained for the prosthesis and physiological stapes. Simulation tests on a 3D CAD model have confirmed that a properly designed ring can stimulate perilymph with the same or greater efficacy as the physiological stapes footplate placed on the elastic annular ligament. The ChSP with a new elastic element creates a good chance of improving hearing in patients suffering from otosclerosis.
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Affiliation(s)
- Emilia Anna Kiryk
- a Institute of Radioelectronics , Warsaw University of Technology , Warsaw , Poland
| | - Konrad Kamieniecki
- b Institute of Micromechanics and Photonics , Warsaw University of Technology , Warsaw , Poland
| | - Monika Kwacz
- b Institute of Micromechanics and Photonics , Warsaw University of Technology , Warsaw , Poland
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Sobolewska A, Clarós P. Surgical treatment in children with otosclerosis and congenital stapes fixation: our experience and outcome. Otolaryngol Pol 2018; 73:23-28. [PMID: 30919820 DOI: 10.5604/01.3001.0012.7217] [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: 11/13/2022]
Abstract
AIM To evaluate outcomes of stapes surgery in children with congenital stapes fixation and juvenile otosclerosis. METHODS A retrospective chart review was performed from 1987 to 2013 to identify patients under 18 years old who underwent a stapes surgery. Patients' age, gender, pre- and postoperative audiograms, intraoperative findings including aetiology of stapes fixation, prosthesis type, and complications were analysed. RESULTS 18 children (6 - 17 years old), all with bilateral conductive hearing loss were identified and 34 stapes surgeries were performed (two patients underwent surgery only on one side). The cause of fixation included juvenile otosclerosis in 88% and congenital stapes fixation in 12%. The mean pre-operative air-bone gap (ABG) was 36,24 dB (SD: 10,86) compared to a postoperative mean ABG of 7,74 (SD: 3,3) (p < 0.000). The profound sensorineural hearing loss was not observed in long-term follow-up. CONCLUSIONS Paediatric stapes surgery has comparable results to stapedectomy in adults regardless of the cause of stapes fixation; however, the better hearing outcome was observed for cases of juvenile otosclerosis rather than congenital stapes fixation.
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Affiliation(s)
- Aleksandra Sobolewska
- Stefan Żeromski Hospital in Cracow, Otolaryngology Department, Scholarship in Clarós Clinic, Barcelona, Spain
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Abstract
BACKGROUND Microscopic stapedotomy is very successful and has long history, but it still has some constraints. Thus, otoendoscopy is increasingly popular nowadays. AIMS/OBJECTIVES The retrospective review study was to investigate the role of endoscopic laser stapedotomy in treating patients with otosclerosis. MATERIALS AND METHODS Seventeen patients who received endoscopic laser stapedotomy from April 2014 to July 2017 were enrolled and compared to 13 patients who had microscopic stapedotomy from February 2009 to March 2012. The anatomical structures, operative time, and postoperative hearing outcomes were assessed in two groups. Relation between external acoustic canal and operative time was also analyzed. RESULTS Using an endoscope, the operative field was clear, with easily identified anatomy, without need to sacrifice bony structures. The operative time was significantly longer in the endoscopic group in 2014 and decreased in the following years. There was no significant difference of hearing improvements between the two groups. There was a weak correlation between the width of the external auditory canal and the operative time. CONCLUSIONS AND SIGNIFICANCE Fully endoscopic stapes surgery is a feasible and safe surgical technique and results in satisfactory hearing outcomes. However, surgeons take longer to master the technique and to achieve shorter endoscopic operative times.
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Affiliation(s)
- Chia-Wei Kuo
- Department of Otolaryngology, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - Hsing-Mei Wu
- Department of Otolaryngology, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
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