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Biomedical subjects

W H Lippy

Publications and source records attributed to W H Lippy.

At least 19 recordsLinked to original sources
PubMed1998

Revision stapedectomy for incus erosion: long-term hearing.

One of the most common ossicular problems in revision stapedectomy is the eroded incus. Revision surgery has been reported as successful in 70% to 80% of cases at 1 year. Little is written about long-term results or the association of erosion with various prostheses. We evaluated 83 cases from 1 to 20 years, including multiple revisions. In 23 cases the erosion was seen at initial stapedectomy. Surgery was performed with the patient under local anesthesia, with the use of the Lippy modified prosthesis. Initial success was seen in 72% (41/57), satisfactory results in 90%, no change in 5%, and none worse. At 10 years, success had declined to 50% (7 of 14), with 80% satisfactory. The numbers for multiple revisions were lower. Success in nonrevision cases was 90% (21 of 23), dropping to 86% at 10 years, with satisfactory results in 100%. The type of prosthesis associated with erosion was a crimped wire in 34% (24 of 70), a plastic strut in 23%, and a Robinsion prosthesis in 17%. We conclude that the risk of incus erosion appears less with the Robinson prosthesis. The Lippy modified prosthesis yields good long-term results, particularly when erosion is seen at initial stapedectomy. Results worsen with subsequent revision.

Adolescent↗
PubMed1998

Prosthesis size in stapedectomy.

Primary stapedectomies were performed on 60 patients with bilateral otosclerosis. Every patient had a 4 mm long Robinson prosthesis with a 0.4 mm wide shaft placed in one ear and a 4 mm long Robinson prosthesis with 0.6 mm wide shaft placed in the opposite ear. With the 0.4 mm wide prosthesis, 54 patients overclosed the air bone gap and 6 were within 10 dB of closing. With the 0.6 mm wide prosthesis, which was placed in the opposite ear, 51 patients overclosed their air-bone gap and 8 were within 10 dB of closing. We conclude that there is no statistical difference in hearing results between the 0.4 mm and the 0.6 mm wide Robinson prosthesis when they are used in a partial stapedectomy with a vein graft covering the oval window.

Adolescent↗
PubMed1998

Short- and long-term results of stapedectomy in children.

Studies have indicated that stapedectomy can be an effective procedure in children for correcting conductive hearing losses due to juvenile otosclerosis. However, because childhood otosclerosis is rare and children commonly choose to use hearing aids in lieu of undergoing surgery, little outcome data are available. The purpose of this retrospective study was to provide additional outcome data in both the short and the long term. Stapedectomies were performed on 47 children. Preoperative hearing results were compared with 6-month postoperative hearing results. Hearing results for the children who had long-term follow-up (5 years or more) were compared with the 6-month postoperative results. Stapedectomy was successful (postoperative air conduction pure-tone average [PTA] within 10 dB of the preoperative bone conduction PTA) in 91.7% of the cases. The mean overclosure of the preoperative bone conduction PTA by the postoperative air conduction PTA was 0.2 dB. The mean PTA hearing improvement was 32.8 dB. Results from the 21 children (28 ears) who had long-term follow-up indicated an average 0.7 dB/year PTA worsening from the 6-month postoperative PTA. Results from this study provide additional evidence that stapedectomy can be an effective procedure for correcting conductive hearing losses due to juvenile otosclerosis.

Adolescent↗
PubMed1998

Word recognition score changes after stapedectomy for far advanced otosclerosis.

OBJECTIVE: This study aimed to examine word recognition score (WRS) changes after stapedectomy for far-advanced otosclerosis (FAO). The WRS changes were examined to determine whether they were consistent with acclimatization or recovery from auditory deprivation changes that have been seen after the restoration of sound by amplification. STUDY DESIGN: Retrospective. SETTING: Private otology practice. PATIENTS: A total of 24 patients were selected by including all the case in which a stapedectomy was performed within the past 10 years to improve the hearing of a severe or profoundly hearing-impaired patient with otosclerosis. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURE: Changes in WRSs. RESULTS: One month after surgery, the mean WRS had improved 16.5%. The WRSs continued to improve an additional 12% or more for 17 (71%) of 24 patients within 2 years after their initial postoperative hearing test. The mean WRS improvement within 2 years of the initial postoperative test was 16.2%. CONCLUSIONS: Initial WRS changes were attributed to hearing thresholds no longer being at or beyond audiometric limits. Additional WRS changes were consistent with reports of acclimatization or recovery from auditory deprivation that have been seen after hearing aid use. The authors believe these additional WRS changes illustrate that at least some improvement in WRSs from acclimatization or auditory recovery may be fairly common after the restoration of sound. Finally, the authors believe the overall WRS improvement (32.7%) should be taken into account when considering stapedectomy for patients with FAO.

Audiometry, Pure-Tone↗
PubMed1998

Clinical utility of the 512-Hz Rinne tuning fork test.

OBJECTIVE: This study aimed to examine the reliability of the 512-Hz Rinne tuning fork test to detect conductive hearing losses. The effects of tester experience, the use of masking, and the interpretation of equivocal (+/-) Rinne results on test reliability also were examined. STUDY DESIGN: Retrospective. SETTING: Private otology practice. PATIENTS: 1,000 adult patients (2,000 ears) seen for their initial otologic evaluation. INTERVENTIONS: Diagnostic. MAIN OUTCOME MEASURE: Sensitivity of the 512-Hz Rinne tuning fork test was assessed by comparing tuning fork results with the pure-tone average air-bone gap. RESULTS: Results showed the 512-Hz Rinne tuning fork test could be very effective at detecting conductive hearing losses when performed by an experienced tester and when masking was used. Sensitivity was lower when masking was not used and lowest when the Rinne was performed by a less-experienced tester. Sensitivity for all groups was improved by interpreting equivocal results as indicating a conductive loss. CONCLUSIONS: Despite reports of poor reliability, the 512-Hz Rinne tuning fork test can be an important tool in an otology practice for the detection of conductive hearing losses and for confirming audiometric findings. In primary care settings, the Rinne would be most effective as part of a screening program for conductive hearing losses, but not as the sole indicator for referral.

Adult↗
PubMed1997

Stapedectomy in patients with small air-bone gaps.

Controversy exists concerning stapedectomy for patients with small air-bone gaps. The purpose of this study was to examine the results for patients who had a stapedectomy to correct a small (10 dB or less) air-bone gap. One hundred fifty-four patients with suspected otosclerosis were explored and a stapedectomy was performed in 136 (88.3%) of these cases. The mean pure-tone average (PTA) improved 16.7 dB and overdosed the preoperative bone conduction PTA by 8.1 dB. The majority of the stapedectomy patients (89.7%) had a PTA closure greater than or equal to 0 dB. These results showed that stapedectomy can be an effective procedure for eliminating and overdosing even small air-bone gaps due to otosclerosis.

Audiometry, Pure-Tone↗
PubMed1997

Practical use of total and partial ossicular replacement prostheses in ossiculoplasty.

The use of porous polyethylene total and partial ossicular replacement prostheses (TOPs and POPs) for ossicular reconstruction in middle ear surgery was retrospectively reviewed at the Warren Otologic Group, a tertiary referral center for otologic problems. Extrusion rates, lower than those previously reported, and improvement in hearing results were found in 250 cases. Follow-up ranged from 6 months to 8 years. This paper details the optimal placement and relationships of the prosthesis, the interposed tragal cartilage, and the drum. Modifications to the prosthesis have increased stability and ease of reconstruction. The hearing results of both TOP and POP reconstruction, and comparison with the literature, will be presented. With TOPs, the air-bone gap was closed to within 20 dB in 67% of cases. With POPs, similar results were obtained in 81% of cases.

Adolescent↗
PubMed1996

Acoustic reflexes, auditory brainstem response, and MRI in the evaluation of acoustic neuromas.

Patient records were reviewed to determine whether persons with absent acoustic reflexes have a higher incidence of abnormal auditory brainstem response (ABR) results in the absence of a cerebellopontine angle (CPA) tumor than those with normal acoustic reflexes. Results showed patients with absent reflexes to have borderline or abnormal ABR results in 45.2% of the cases. Patients with normal reflexes had borderline or abnormal ABR results in 14.2% of the cases. Results indicate that magnetic resonance imaging is a more appropriate test for patients with absent reflexes, since ABR was often nondiagnostic for a CPA tumor in this group.

Evoked Potentials, Auditory, Brain Stem↗
PubMed1996

Prosthesis on a mobilized stapes footplate.

Managing a mobilized footplate in stapedectomy surgery can be challenging. Between 1963 and 1992, 145 footplates were inadvertently mobilized during otosclerosis surgery. After a vein graft, a 4.0-mm Robinson prosthesis was placed on all footplates, making no attempt to remove the footplate. There were 73 thin, blue footplates and 72 thick, white footplates. Hearing results in the thin, blue footplate group was 97% successful and 100% satisfactory at 3 years. No footplate refixed. In the thick, white group, hearing was 60% successful and 72% satisfactory at 6 months. Footplate refixation was found at revision in all but one unsuccessful case. After revision, the thick, white group had 79% successful and 89% satisfactory hearing results at 3 years. No patient in either group was worse. We conclude that placing a vein graft and a Robinson prosthesis is a safe and effective technique for a mobilized footplate. If the footplate is thin and blue, there is little or no risk of refixation. If the footplate is thick and white, approximately 30% will require revision.

Follow-Up Studies↗
PubMed1996

Stapedectomy in the elderly.

Clinical records were reviewed to examine the effectiveness of stapedectomy in patients 70 years and older. A total of 154 patients was studied, including 11 with profound hearing loss with long-standing otosclerosis. Ages at the time of surgery ranged from 70 to 92 years (mean, 76.3 years). The mean pure-tone average (500, 1,000, 2,000, and 4,000 Hz) improved 30.6 dB after surgery for the 143 patients in the main otosclerotic group and 26.8 dB for the patients in the profound-hearing-loss group. The rate of successful stapedectomies for the 70(+)-year-old patients (90.9%) and the younger comparison group (90.0%) were similar. These findings extend the documented range of stapedectomy as a safe and effective procedure through the eighth decade of life.

Aged↗
PubMed1996

Stapedectomy in combat pilots.

Between 1977 and 1995, nine stapedectomies using the Robinson-vein graft technique were performed in six high-performance airplane pilots diagnosed with otosclerosis. All of them returned to full active duty after stapedectomy without any vestibular symptoms. These cases illustrate that it can be safe for fighter or test pilots to return to full flight status after stapedectomy. These cases also suggest that full flight status can be reinstated as soon as 3 months after stapedectomy without endangering flight safety.

Aviation↗
PubMed1994

Far-advanced otosclerosis.

Far-advanced otosclerosis (FAO) is an uncommon diagnosis. Hearing levels in patients with FAO may range from profound loss, by air conduction and fragmentary bone conduction thresholds, to no measurable air or bone conduction thresholds. Thus, FAO may be difficult to distinguish from a sensorineural hearing loss. This report presents the results of surgery in 73 ears with FAO, 77 percent of which had improvement in air conduction thresholds of greater than 20 dB. Discrimination was improved by more than 15 percent in 54 percent of cases, and 75 percent realized improvement in use of a hearing aid. There was no evidence that success was related to preoperative hearing. The surgical results of a subgroup of 14 patients having bilateral FAO were also analyzed. For all 14, similar surgical outcomes were achieved in both the initial and the contralateral ear, with six successes bilaterally and eight failures bilaterally. Although far advanced otosclerosis is uncommon and difficult to diagnose, surgery is worthwhile.

Acoustic Stimulation↗
PubMed1994

Simultaneous presentation of facial nerve neuroma and otosclerosis.

Otosclerosis often occurs as a unilateral mixed or conductive hearing loss. In the absence of retrocochlear findings, otologists usually do not pursue further diagnostic testing. A patient who presented to the Warren Otologic Group with a unilateral mixed hearing loss is discussed. He was followed for 1 year with the intent of scheduling a stapedectomy. Two weeks prior to the surgical date, the patient developed a sudden hearing loss and was admitted to the hospital for treatment. Magnetic resonance imaging demonstrated a tiny, enhancing mass in the lateral internal auditory canal, measuring 7 mm in diameter. At surgery, the tumor was found to originate at the union of the nervus intermedius and the facial nerve. The simultaneous occurrence of facial nerve neuroma and otosclerosis is discussed, with emphasis on a thorough evaluation of all unilateral mixed hearing losses, including those attributable to otosclerosis.

Adult↗
PubMed1990

Staging for cholesteatoma in the child, adolescent, and adult.

A closed tympanomastoidectomy with subsequent staged surgical procedures leading to the excision of cholesteatoma was validated as described. All elements of staging with a 10-year experience of 354 patients are covered according to categories of child (0 to 9 years), adolescent (10 to 15 years), and adult. The child differed from the adolescent and adult in the following manner: more recurring cholesteatomas, greater ossicular necrosis, poorer hearing results, less aggressive residual cholesteatoma, and significantly poorer results with pars flaccida cholesteatoma than pars tensa cholesteatoma. After the end stage, 90% of the cases remained closed, with acceptable hearing in 60% of the patients.

Adolescent↗
PubMed1988

A postoperative audiometric evaluation of cochlear implant patients.

As the benefits of the cochlear implantation become more defined, many investigators hope that these devices can be offered to patients with a lesser degree of hearing loss. Accordingly, it is necessary to investigate the audiometric thresholds in the implanted ear after surgery. Preservation of the residual hearing after implantation would support the claims that surgery and the presence of a cochlear implant do not adversely affect the implanted ear.

Audiometry↗
PubMed1987

Reconstructing the absent lenticular process.

When a surgeon encounters an absent lenticular process of the incus, he must either reposition the incus or attempt to bridge the small gap between the remaining incus long process and the stapes capitulum. Our solution to this problem is to place a Lippy modified Robinson stapes prosthesis on the stapes footplate and attach it to the remaining long process, thus bypassing the stapes superstructure. This modified Robinson prosthesis has a portion of the well removed allowing the eroded long process to enter from the side. The hearing results of 63 cases at 6 months (two-thirds of which had a concurrent tympanoplasty) are 67% within 10 dB and 91% within 20 dB of the preoperative bone hearing level. The use of an existing and proven prosthesis provides both stability and, to date, the most successful hearing results for reconstructing the absent lenticular process.

Ear Ossicles↗