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PubMedDate not supplied

[Some structural characteristics of articulation of the incus and stapes in man].

Structural characteristics of human incudostapedial articulation (ISA) have been studied on a series of histological sections from temporal bone decalcified pyramids in three planes and by means of macro-micropreparation of tympanal structural elements from 96 human fetuses at various terms of gestation. It was established that the surface of the lenticular process has a spherical form. Its length surpasses its width. The articular surface on the head of the stapes presents a dome-shaped lacuna. The capsule is usually thicker in its posterior part than in the anterior one. It can endure deviation of the long lenticular process up to 3 mm without rupture. When the deviation overruns 3.5 mm, the articular bursa and round ligament of the base of the stapes break. This property of the capsule should be kept in mind when operating on the stapes.

Fetus↗
PubMed1996

Reporting operative hearing results in stapes surgery: does choice of outcome measure make a difference?

In a prior study, findings indicated that when reporting results of chronic ear surgery, neither choice of pre-versus postoperative bone-conduction scores nor choice of frequencies to include a averaging makes a substantial difference in reported outcome. In this study, audiologic data from 240 stapes-surgery patients at three different institutions were used to generate a variety of outcome measures. Use of preoperative rather than postoperative bone-conduction values in computing postoperative air-bone gap resulted in an approximately 5-dB smaller mean gap and a 2% higher success rate. Frequencies included in averaging made little difference in mean computed air-bone gap, although success rate (gap < 10 dB) was lower by 6% when 4 kHz was used in a four-frequency average rather than 3 kHz. Results for air conduction were similar to those for air-bone gap regarding choice of frequencies to include in averaging. When using air-conduction pure-tone average (PTA) as the outcome measure, those with normal preoperative sensorineural hearing had a > 20% higher success rate than the general population of stapes-surgery patients. The greatest differences in success rate were based on definition of and criteria for success. Success rate was higher when based on air-bone gap than when based on air-conduction PTA. As in the prior chronic ear study, differences in outcome were more drastically affected by criteria for "success" than by frequencies included. Unlike similar data from chronic ear surgery, however, success rate differed depending on choice of air-bone gap or air-conduction PTA as the definition for success. Further, air and bone scores from the same test interval must be used to accurately reflect air-bone gap in stapes surgery.

Adolescent↗
PubMed1996

Reporting operative hearing results in stapes surgery: does choice of outcome measure make a difference?

PURPOSE: Findings of a prior study indicated that neither choice of pre- versus postoperative bone-conduction scores nor choice of frequencies to include in averaging makes a substantial difference in reported outcomes of chronic ear surgery. METHODS: In this study, audiologic data from 240 stapes surgery patients at three different institutions were used to generate a variety of outcome measures. RESULTS: Use of preoperative rather than postoperative bone-conduction values in computing postoperative air-bone gap resulted in an approximately 5-dB smaller mean gap and a 2% higher success rate. Frequencies included in averaging made little difference in mean computed air-bone gap, although success rate (gap < or = 10 dB) was lower by 6% when 4 kHz was used in a four-frequency average rather than 3 kHz. Results for air conduction were similar to those for air-bone gap regarding choice of frequencies to include in averaging. When we used air-conduction pure-tone average (PTA) as the outcome measure, those with normal preoperative sensorineural hearing had a > 20% higher success rate than the general population of patients with stapes surgery. CONCLUSIONS: The greatest differences in success rate were based on definition of and criteria for success. Success rate was higher when based on air-bone gap than when based on air-conduction PTA. As in the prior chronic ear study, differences in outcome were more drastically affected by criteria for "success" than by frequencies included. Unlike similar data from chronic ear surgery, however, success rate differed depending on choice of air-bone gap or air-conduction PTA as the definition for success. Further, air and bone scores from the same test interval must be used accurately to reflect air-bone gap in stapes surgery.

Adolescent↗
PubMed1996

Acoustic input impedance of the stapes and cochlea in human temporal bones.

The acoustic input impedance of the stapes and cochlea ZSC represents the mechanical load driven by the tympanic membrane, malleus and incus. ZSC was calculated from broad-band measurements (20 Hz to 11 kHz) of stapes displacement made with an optical motion sensor and of sound pressure at the stapes head in a human temporal-bone preparation. Measurements were made in 12 fresh temporal bones with the round window insulated from the sound stimulus. Below 1 kHz, the magnitude of ZSC was approximately inversely proportional to frequency, and ZSC angle was between 0.10 and -0.20 periods. This behavior is consistent with a mixed stiffness and resistance. Between 1 and 4 kHz, ZSC was resistance-dominated with a magnitude between 40 and 100 mks acoustic G omega that was roughly independent of frequency, and its angle was between -0.12 and 0 periods. Between 4 and 7 kHz, the magnitude of ZSC was either constant or increased with frequency while ZSC angle was near 0. Between 7 and 8 kHz, both ZSC magnitude and angle decreased sharply with frequency, and both increased somewhat at higher frequencies. The input impedance of the cochlea ZC was estimated in one ear from ZSC measurements made before and after draining the inner ear fluids. ZC was stiffness-dominated below 100 HZ, and resistance-dominated from 100 Hz to 5 kHz. The frequency-dependent magnitude of ZSC in our bones is similar to those reported by other investigators in cadaver temporal bones (Nakamura et al., 1992; Kurokawa and Goode, 1995). Our ZSC measurements are qualitatively similar to theoretical predictions (Zwislocki, 1962; Kringlebotn, 1988), but are a factor of 3 greater in magnitude, implying that ZSC may be more resistive and stiffer than previously thought. We found inter-ear variations of a factor of 4 (12 dB), which may explain some of the clinically observed variations in size of the air bone gap in individuals with middle ear lesions or after middle-ear reconstructive surgery.

Acoustic Impedance Tests↗
PubMed1997

A meta-analysis review of revision stapes surgery with argon laser: effectiveness and safety.

OBJECTIVE: To determine whether there is an advantage in safety and outcome efficacy with the use of argon laser in revision stapes surgery as compared with conventional instruments. DATA SOURCES: A search of the published English-language literature, 1970-1995, was conducted using the following key words: revision, surgery, stapes, laser, stapedotomy, and argon laser. STUDY SELECTION: The following inclusion criteria were used to select articles for the meta-analysis: revision cases only, a comprehensive review of intraoperative pathological findings that led to the failure, and accurate documentation by the author, confirmed by our statisticians using a modified chi 2 test. Eleven studies without the use of the laser (n = 1,147 patients) and four studies with the use of the laser (n = 170 patients) including our own patients (n = 23) were entered into the model. DATA EXTRACTION: The data had to meet strict audiometric criteria, including preoperative and postoperative audiogram pure tone average air-bone gap; postoperative audiograms had to include five classifications, and these audiograms had to be obtained a minimum of 6 months after revision surgery. DATA SYNTHESIS: A log-linear model was developed for this meta-analysis study, with each study analyzed individually and collectively. CONCLUSION: Revision stapes surgery using the laser demonstrated statistically significant (p = 0.002) advantage in both safety and efficacy over revision procedures using conventional instruments.

Audiometry↗
PubMed2006

Magnetic properties of middle ear and stapes implants in a 9.4-T magnetic resonance field.

HYPOTHESIS: A 9.4-T magnetic resonance (MR) field may cause motion displacement of the middle ear and stapes implants not previously observed with 1.5- and 3.0-T magnets. BACKGROUND: Publications have described the safety limitations of some otologic implants in 4.7-T field and resulted in several companywide patient safety-related recalls. To date, no studies have been reported for otologic implants in a 9.4-T MR field nor have comparisons been made with 4.7-T field strengths. METHODS: Twenty-three commonly used middle ear and stapes prostheses were selected and exposed to 9.4-T MR fields in vitro within petri dishes, and eight of the 23 implants were further studied ex corpus in human temporal bones (TBs) in a 9.4-T MR field. This study has been approved by the institutional review board. RESULTS: Eight prostheses in petri dishes grossly displaced at 9.4 T, three of which had not previously moved in either the 1.5- or 3.0-T magnets. The eight TB preparations showed no avulsions or motion indicators after exposure at 9.4 T. CONCLUSION: Middle ear and stapes implants can move dramatically in petri dishes at 9.4-T MR field, more so than at 1.5 and 3.0 T. The absence of avulsions in the TB group strongly suggests that the surgical means used to fixate the middle ear implants to the middle ear structures successfully overcomes the magnetic moment produced at MR field strengths up to 9.4 T. The use of MR imaging is not contraindicated by this study's findings.

Cadaver↗
PubMed1977

Surgery and histopathology of the stapes in osteogenesis imperfecta tarda.

Fourteen stapedectomies were performed on ten patients with osteogenesis imperfecta tarda. Clinically, the footplates were softer and more tenuously fixed than in otosclerosis and floating footplates seemed more common. Stapes and stapes fragments from all 14 operations were examined microscopically. The histopathology of osteogenesis imperfecta was contrasted to that of otosclerosis. We believe that the greater degree of structural disorganization and greater area occupied by resorption spaces clearly distinguish the new bone formed in osteogenesis imperfecta from otosclerosis.

Adolescent↗
PubMed1978

Allograft stapes-incus assembly. A new ossiculoplasty.

In 45 patients with absence of the stapedial arch, including 24 with a history of radical surgery and without ossicles, the head of an allograft stapes was placed on the patient's footplate and on top of this an incus body, either as allograft or autograft. The results of this assembly, judging by different methods of analysis, are the same as in 45 ears having approximately the same pathologic condition treated by an autograft or allograft incus as the columella between the footplate and eardrum. The allograft stapes-incus assembly is an alternative method to the commonly used incudal columella, particularly in patients previously subjected to radical surgery in whom all ossicles are absent.

Ear Ossicles↗
PubMed1985

Proximal symphalangia and stapes ankylosis.

A father and his two sons had an autosomal-dominant syndrome of proximal symphalangia and conductive hearing loss. Exploratory tympanotomy revealed a congenitally fixed stapes and incus in the oldest boy. Surgical intervention resulted in normal hearing. To our knowledge, this is the first such histologic report of a stapes in this syndrome.

Adolescent↗
PubMed1991

X-linked deafness, stapes gushers and a distinctive defect of the inner ear.

The association of X-linked mixed deafness with stapes gusher has been recognized for 20 years, and imaging studies by polytomography have shown dilatation of the lateral end of the internal auditory meatus (IAM) in some cases. We have made genetic linkage studies in 7 pedigrees in whom deafness was inherited in an X-linked manner. All patients had a full range of audiometric and vestibular function tests. Thin section high resolution CT in two planes was used to assess the state of the middle and inner ears. We found a distinctive inner ear deformity in some of the deaf males characterised not only by a wide bulbous IAM but more importantly, by deficient or absent bone between the lateral end of the IAM and the basal turn of the cochlea. We believe that this results in a communication between the subarachnoid space in the IAM and the perilymph in the cochlea, leading to perilymphatic hydrops and a "gusher" if the stapes is disturbed. Moreover, some of the obligate female carriers seem to have a milder form of the same anomaly associated with slight hearing loss. Genetic studies on some of the deaf males with apparently normal inner ear anatomy suggest a different locus on the X chromosome and hence a different pathogenesis for the deafness.

Audiometry↗
PubMed2003

[Clinical and molecular genetic analysis of monozygotic twins displaying stapes gusher syndrome (DFN3)].

BACKGROUND: DFN3 ( "stapes gusher") is the most frequent form of X-linked hearing impairment. It accounts for up to 0.5% of all cases of severe childhood hearing disorders. PATIENTS AND METHODS: Monozygotic twins with suspected stapes gusher syndrome, their mother, and control individuals were analyzed clinically and genetically. RESULTS: The clinical investigations confirmed a DFN3 phenotype in both brothers who displayed all typical symptoms. A molecular genetic investigation of the POU3F4 gene, which plays an essential role in the development of DFN3, was also performed. No chromosomal aberrations within the coding region of POU3F4were detected. Since several authors have described mutations in the 5' untranslated region of the gene also resulting in a DFN3 phenotype, we screened this area by microsatellite analysis and detected a double deletion localized in the critical interval. This is the first description of a double deletion in the non-coding region of POU3F4 leading to DFN3 phenotype. CONCLUSION: Interestingly, in spite of having an identical genotype, the twins displayed significant phenotypic differences. This underlines the importance of exogenous factors in the development of inherited pathological processes.

Audiometry, Pure-Tone↗
PubMed2005

Safety of gold in stapes surgery.

Gold prostheses in middle ear surgery were found to have a higher extrusion rate than prostheses made from titanium. Incidences of deafness after insertion of a gold piston into the vestibule during stapes surgery have been observed. The aim of this study was to find out to what degree gold cations can diffuse from the prosthesis piston into the perilymph. For this, gold prostheses were incubated in artificial perilymph for four months, after which the gold content of the perilymph was analysed. As gold exhibits a special behaviour in complex fluids like the perilymph, a new analysing method was developed. The results show that gold does leak out of the pistons, that it can be reliably measured and that the amount of gold reaching the perilymph depends on the contact area. As the amount of gold measured in the perilymph stays far below the toxic level, it is very unlikely that the gold cations diffusing from a stapes prosthesis into the perilymph have a toxic effect on the inner ear hair cells. Inflammatory or allergic reactions to gold induced by direct tissue contact, however, cannot be excluded.

Animals↗
PubMed2006

Stapedectomy in congenital stapes fixation: are hearing outcomes poorer?

OBJECTIVE: To evaluate outcomes of stapedectomy surgery for congenital stapes fixation. STUDY DESIGN: Retrospective chart review. METHODS: The charts of 463 stapedectomies performed by 1 surgeon from 1996 to 2003 were reviewed. Patients with a history of childhood hearing loss and operative findings consistent with congenital fixation of the stapes were included. Patients with a history of trauma or chronic otitis media and those with otosclerosis were excluded. Thirty-six patients underwent stapedectomy for congenital fixation. Revision cases and those with inadequate postoperative bone or air conduction data were excluded. Inclusion criteria were met for 25 patients. Operative findings and hearing outcomes were evaluated. RESULTS: The study group was comprised of 25 stapedectomies. Closure of the air-bone gap to less than 10 dB was achieved in 48% of cases, and 80% had closure within 20 dB. A gap of more than 30 dB remained in 3 cases. There were 2 cases of sensorineural hearing loss with worsening of the bone conduction thresholds by 15 dB and 30 dB. There were no instances of perilymph gusher. In addition to an excluded case that was not reconstructed because of facial nerve position, 3 of the included patients were found to have a dehiscent facial nerve at surgery. There were no facial nerve injuries, and fixation of the malleus or incus was not found in any of the included patients. When hearing outcomes were compared with our results for otosclerosis over the same time period, rates of closure to within 10 dB and 20 dB were significantly worse in the congenital group. CONCLUSION: Closure of the air-bone gap in this population differs from our results in stapedectomy done for otosclerosis. This difference likely reflects subtle anatomic variations in the congenital group that affect the effectiveness of the prosthesis. Despite the difference in results, stapedectomy for congenital fixation remains an effective method to achieve significant hearing improvement in the majority of patients. EBM RATING: B-3b.

Adolescent↗
PubMed2005

[Congenital absence of the stapes suprastructure].

Congenital absence of the stapes suprastructure is an unusual anomaly, consequence of a developmental aberration involving partial absence of a derivate from the second branchial arch. Sometimes, exploratory tympanotomy may be the only mean of diagnosis when known conductive hearing loss is seen. This anomaly can appear isolated or associated to other major or minor anomalies. The treatment is surgical. We review the literature about the absence of the isolated stapes suprastructure.

Adolescent↗
PubMed1993

Familial stapes superstructure fixation.

Congenital stapes superstructure fixation was found in a mother in both ears and her daughter in one ear. The head of the stapes was fixed to the pyramid by a bony bar which lay immediately superior to a normal stapedius muscle. Removal of the bony bar resulted in normal hearing, which has been maintained. We believe that these are the first reported cases of this abnormality.

Adult↗
PubMed1994

Large vestibular aqueduct syndrome and stapes fixation.

An abnormally large vestibular aqueduct has a well recognized association with inner ear anomalies and it has been assumed previously to be a variant of a Mondini type of deformity (Shuknecht, 1980; Emmett, 1985). The sole radiological finding in some patients with progressive sensorineural loss has been a large vestibular aqueduct (Valvassori and Clemis, 1978; Valvassori, 1983), which is now accepted as a separate clinical entity, i.e. the large vestibular aqueduct syndrome (LVAS). A case is presented which is believed to be the first reported with unilateral LVAS and stapes fixation and also the first stapes gusher described in association with LVAS.

Adult↗
PubMed1992

[Stapes surgery in otosclerosis and small middle ear abnormality].

Stapes surgery in otosclerosis (first and revision operation) and in minor middle ear malformation follows the same principles, but the surgical problems are rather different. When analyzing three groups of patients, which had been operated on the same technique, we could show that the risks of the operation in malformation and revision surgery are not greater than they are in primary otosclerosis surgery. The audiologic results are more satisfying in the latter; malformation surgery and revision surgery have almost the same results which are lying somewhat below those of primary otosclerosis surgery. In the hands of an experienced surgeon, who is able to adopt his surgical technique at the individual situation, stapes surgery is nearly without risk in all these indications; an improvement of the air-conducting level of 18-23 dB can be expected and a social hearing above 35 dB can be provided in 83% of otosclerosis patients, in 79% of malformation patients and in 57% of revision patients.

Audiometry, Pure-Tone↗
PubMed2003

The incudostapedial joint angle: implications for stapes surgery prosthesis selection and crimping.

OBJECTIVE: To evaluate the role of the incudostapedial joint (ISJ) angle in stapes prosthesis size selection and crimping. METHODS: The ISJ of 13 cadaveric human temporal bones were photographed, then measured using computer-aided design software. The relationship of ISJ angle to prosthesis length was modeled. A literature review evaluated factors contributing to stapedectomy failure. RESULTS: The mean ISJ angle was 93.0 degrees (SD = 8.3 degrees ) (range, 75.0 degrees -104.0 degrees ). The mean ISJ angle deviation from 90 degrees was 7.35 degrees (SD = 4.45 degrees ) (range, 0.3 degrees -15.0 degrees ). The mean distance along the incus accessible for prosthesis placement was 3.21 mm (SD = 0.55 mm) (range, 2.00-4.00 mm). CONCLUSIONS: Significant deviation of the ISJ angle from 90 degrees was found (P <.0001). The length along the incus accessible for prosthesis placement was sufficient to result in errors in prosthesis size selection and crimping with only small variations in the ISJ angle. Incorrect prosthesis sizing and crimping are frequently associated with stapedectomy failure. Variations in ISJ anatomy should be considered when selecting stapes prostheses lengths and may affect crimping technique.

Culture Techniques↗