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PubMed2001

[Stapedectomy in the treatment of otosclerosis in children].

In the years 1994-2000 in the Laryngology Department Silesian Medical Academy in Zabrze 167 stapedectomy were performed in 143 patients with otosclerosis. In this group of patients 11 stapedectomies in 8 children aged from 9 to 17 years were performed. 5.6% of all the patients with otosclerosis treated in our Department were children. The purpose of this study was to analyze the audiologic results of stapedectomies in children. The postoperative evaluations were performed in the period from 6 months to 6 years after the surgical treatment. In the estimation of the hearing state we analyzed the change of the air-bone gap, an average air conduction hearing improvement, the rate of percentage hearing improvement and an average hearing loss by Bell Telephone Laboratories. In all the operated children we observed the decrease of the air conduction hearing level. Stapedectomy was successful (postoperative air bone gap within 10 dB of the preoperative bone conduction) in 63.6% of the patients. In 3 cases the air bone gap was lower than 20 dB (27.3%). In one case it was greater then 20 dB. The air bone gap closure was at the average of 5.75 dB level. The results were comparable with the other authors. Stapedectomy can be an effective procedure for correcting conducting hearing losses due to the otosclerosis in the pediatric patients.

Adolescent↗
PubMed1975

[Otosclerosis in children (author's transl.)].

11 children (13 ears) have been operated upon for otosclerosis. In ten cases the stapes footplate was found totally fixed, with histological verification of the diagnosis of otosclerosis. Conservative surgery of the oval window was possible in only four cases. All other patients required total removal of staples or footplate. Findings indicate that clinical otosclerosis occurring in childhood results in an otosclerotic process in the oval window region with total fixation of the footplate. Thus, correction usually requires removal of at least the entire footplate.

Adolescent↗
PubMed2002

[Results of surgical treatment of otosclerosis].

UNLABELLED: The aim of the study is to assess the results of surgical treatment in otosclerosis patients. The study included 68 patients (51 women and 17 men) aged 19-61 (mean age: 42) operated on for otosclerosis. MATERIAL AND METHOD: 77 surgical procedures were performed (67 stapedotomies and 10 stapedectomies). The operation on the second ear was performed in 9 cases. Tonal audiometry and stapedius reflex were performed in all the patients. Mean hearing loss was determined by applying five frequency: 250 Hz, 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz. Audiometric examinations were done before and 8 to 20 days after the operation. RESULTS: Mean hearing loss of the patients was 63.6 dB. Mean hearing improvement in the stapedotomy patients group was 26.6 dB and in the stapedectomy patients group: 29.5 dB. The lack of hearing gain was observed in 4 patients. A decrease of air-bone gap below 10 dB or its closure was shown in 74% of the cases. In 16% of the patients the air-bone gap after the surgical procedure ranged from 11 to 20 dB, in 10% of the cases overdrew 21 dB. Early complications, up to one month after the operation, appeared in 4 patients in the form of vertigo, balance disorders, tinnitus and the feeling pressure in the ear. In one patient, tinnitus in the operated ear appeared 12 months after the surgery. CONCLUSION: The surgical procedure in otosclerosis patients has improved their hearing. In the first few days after the operation, balance disorders were observed.

Adult↗
PubMed2002

[Change in otosclerosis presentation over two decades].

Presentation of otosclerosis in eighties and nineties was compared on the basis of analysis of patients' documentation. A group I of 80 patients treated in 1980-1990 and a group II of 148 patients treated in 1991-2000 were compared with regard to sex, age, incidence of oval window obliteration and bilateral disease. Bone conduction and air conduction threshold and air-bone gap were also compared. There was no difference between two groups regarding sex, age and bone conduction threshold. Oval window obliteration was found in 8 (10%) patients of group I and in 7 (4.7%) patients of group II and the difference was not significant. Bilateral otosclerosis was diagnosed in 77 (96.3%) patients of group I and in 121 (81.8%) patients of group II and the difference was significant (p < 0.01). Air conduction threshold and air-bone gap in patients treated in nineties were significantly smaller than in eighties (p < 0.001). In the last decade patients with otosclerosis presented with smaller hearing loss, smaller air-bone gap and had bilateral disease less frequently than patients in eighties.

Adult↗
PubMed2003

[Epidemiological aspects of otosclerosis (1). Its frequency in comparison with other ear pathologies, incidence and prevalence].

A planned study was made with the group of patients seen for first time at Otologic External Consulting Department of ENT Service of the universitary Hospital Complex of Santiago de Compostela. The total amount 1,050 patients, 83 of them suffering otosclerosis. Most frequently diagnosed was sensorineural deafness (29.1%), in second place were chronic middle otitis (27.8%) and as last one was otosclerosis (8.7%). Clinic otosclerosis amounted for 19.20 cases of each 100,000 inhabitants yearly and stapedectomies performed 7.78. Prevalence was evaluated at 7.13 by 1,000 (10.86 women and 3.14 men). Higher value compared with other series published previously are linked to differences on sanitary development as well as health concept and the type of community where people lived through.

Adolescent↗
PubMed2000

[The hereditary liability of otosclerosis and the strategies for treatment and prevention].

OBJECTIVE: Otosclerosis is a disease of hereditary liability. It might be related to an autosomal dominant inheritance. The genetic penetrance is determined by multifactorial influences. This paper was designed to study the reasonable strategies for prevention and treatment of this disease. METHODS: A retrospective review derived from data of the management and follow-up of 14 cases in 6 families. According to the special pathological features of active phase of the otospongiosis, the suitable strategies for prevention and treatment of this disease were suggested. RESULTS: Diagnosis of 14 cases were confirmed by audiological, operative and/or pathological examinations. Eleven of fourteen cases underwent stapedectomy, in which 10 cases had the surgery on the ear with severer hearing loss, and one case on both sides. In all of the surgical cases, hearing levels improved significantly. Three cases have not yet received the stapedectomy, in which two cases scheduled for the surgery are currently treated by chondroitin sulfate and one case refused the surgical treatment due to financial shortage. CONCLUSION: Examination of the ear function at regular intervals (6-12 months) is recommended for the adults among the family members with high-incidence of otosclerosis. Audiological and radiological examination play an important role in early diagnosis and treatment. Attention should be paid to the medicine for management and prevention of this disease. Stapedectomy is an optimal choice for clinical otosclerosis not only due to its capacity to improve the hearing level but also to prevent the advance of hearing loss. Hearing aid is the suitable choice if stapedectomy is contraindicated.

Audiometry↗
PubMedDate not supplied

[Studies of perilymph protein fractions in patients with otosclerosis].

Studies of the blood serum in 20 patients and perilymph in 10 patients with otosclerosis showed stability in concentration of total protein as compared with similar control data obtained from cadavers. In this case proteinograms of the blood serum and perilymph of patients with otosclerosis exhibit a statistically significant decrease in albumin and an increase in globulin fractions mainly at the expense of beta- and gamma-globulins with respect to the control. The data obtained evidence the presence of immunological disorders in patients with otosclerosis.

Adult↗
PubMed2004

Effects of stapedectomy on tinnitus in patients with otosclerosis.

Tinnitus frequently accompanies hearing loss in patients with otosclerosis and has been correlated with distinct otosclerotic pathologies. The objective of our study was to evaluate the effect of stapedectomy on tinnitus in patients with otosclerosis. Forty patients were retrospectively interviewed for assessment of preoperative versus postoperative levels of tinnitus distress using the standardized Klockhoff-Lindblom (K/L) classification system. Audiometric data also were examined with respect to tinnitus grades. Of the 40 patients, 34 (85%) had improved K/L tinnitus grades after stapedectomy, 5 (12.5%) had no change, and 1 (2.5%) had a worse K/L grade postoperatively. Twenty-one (52.5%) patients reported complete resolution of tinnitus. Postoperative air-bone gap was less for patients with decreased tinnitus than for those with no change. Significant improvement was seen in the degree of tinnitus distress after stapedectomy for otosclerosis.

Adolescent↗
PubMed2004

Long-term follow-up of tinnitus in patients with otosclerosis after stapes surgery.

We prospectively studied 48 otosclerosis patients over a 2-year interval. Forty-four had stapedotomy, and four had stapedectomy. Demographics, clinical history, and pre- and postoperative audiometry results were recorded. A questionnaire asking about tinnitus (intensity, pitch) and including a visual analog scale quantifying the degree (1-10) of annoyance caused by the tinnitus was completed pre- and postoperatively (4-10 months and 14-48 months, respectively). Ninety-one percent of the otosclerosis patients reported the presence of tinnitus, and 39.58% reported severe disabling tinnitus (SDT; 7-10 on the visual analog scale). High-pitch (whistle) tinnitus was present in most patients, and white noise (radio static, waterfall, rain) was present in others. No patient described the tinnitus as a low-tone noise (buzzing). Ninety-one percent of patients reported tinnitus reduction or total remission after surgery. Ten of 19 patients with SDT reported complete remission of tinnitus, 7 reported improvement postoperatively, and 2 reported no change. No patient reported worsening of tinnitus. Small postoperative air-bone gaps (four tonal average) correlated with remission or reduction of tinnitus in SDT patients. Tinnitus pitch, gender, and age of patients were not related to decrease of tinnitus postoperatively. A larger preoperative air-bone gap correlated with larger reduction of tinnitus after successful surgery. A lower preoperative bone conduction level correlated with more intense tinnitus before surgery and greater reduction postoperatively. We contacted 25 patients from 14 to 48 months after surgery, and all reported that their tinnitus status had not changed since the early follow-up. Tinnitus is very prevalent in otosclerosis patients; almost one-half of patients have SDT preoperatively, and stapes surgery improves this symptom in 91% of cases. Preoperative air-bone gap and bone conduction level and a postoperative airbone gap seem to influence the degree of postoperative tinnitus reduction.

Adolescent↗
PubMed2005

[Surgical experience by 95 malformed stampedes and otosclerosis].

OBJECTIVE: To investigate the effect of stapes surgery for conductive hearing loss with intact tympanic membrane and eustachian tube. METHOD: Stapes surgery data of 95 conductive hearing loss patients, which with intact tympanic membrane and eustachian tube, was retrospective analyzed,and the surgical effect of otosclerosis, middle ear deformities and external canal stenosis was summarized. RESULT: Postoperative (4 weeks after the surgery) pure tone threshold test demonstrated that the effect of Vestibulotomy was better than incus-footplate connection (incus and footplate is connected by a cortical bone ) ( P <0.05). The surgery to the patients with external canal stenosis was better than those with otosclerosis or middle ear deformities ( P <0.05). There was no statistic significance between physiological stapedectomy and Vestibulotomy. The follow-up of 1-3 years showed that the pure tone threshold of 8 out of 14 cases reverted to the preoperative level, while the hearing improvement in the other cases still remained. CONCLUSION: Stapes surgery to the patients with stapes-oval window deformities is of significance compared with those with otosclerosis.

Adolescent↗
PubMed2005

[Treatment of otosclerosis in children].

Between 1994 and 2004 in the ENT Department Silesian Medical University Zabrze 330 stapedotomy were performed in patients suffered from otosclerosis. In this group of patient's 16 stapedotomies in 13 children aged from 9 to 17 years were performed. 4.85% of all the patients with otosclerosis treated in our Department were children. The purpose of this study was to analyze the audiologic results of stapedotomies in children. The postoperative evaluations were performed in the period from 6 months to 8 years after the surgical treatment. In the hearing state evaluation we analyzed the change of the air-bone gap, an average air conduction hearing improvement, the rate of percentage hearing improvement and an average hearing loss by Bell Telephone Laboratories. In all the operated children we observed the decrease of the air conduction hearing level. Stapedotomy was successful (postoperative air bone gap within 10 dB) in 62.5% of the cases. In 5 cases the air bone gap was lower than 20 dB (31.25%). In one case it was greater then 20 dB. The air bone gap closure was at the average of 4.39 dB level. The results were comparable with the other authors. Stapedotomy can be an effective procedure for correcting conducting hearing losses due to the otosclerosis in the pediatric patients.

Adolescent↗
PubMed1990

Cochlear otosclerosis: does bone formation affect cochlear implant surgery?

This study aimed to demonstrate that new bone formation in the scala tympani of patients deaf from otosclerosis does not preclude cochlear implant surgery. In seven temporal bones from patients with otosclerosis, we measured the extent of new bone from the round window to the distal part of the new growth. We compared results to surgical data on the extent of drilling and depth and ease of placement of the electrode in 20 patients deaf from otosclerosis. We also examined clinical performance and voltage requirements for long-term implant use in patients with and patients without ossification of the scala tympani. Findings in our limited sample of patients and bones show that obstruction of the basal turn, which occurs in some otosclerotic patients, does not preclude implant surgery. The dynamic range in the studied sample was relatively stable long-term and clinical performance did not differ between groups with and without an ossified scala tympani.

Adult↗
PubMed1990

[Our surgical approach in the treatment of otosclerosis over the past 10 years].

The most frequently used technique of surgery of otosclerosis used during the past ten years in the Central Military Hospital was Schuknecht's technique of wire and fat. 575 thus operated patients account for 89.4% of the total number of 643 operations. A compensation of the bone reserve to 0-10 dB was achieved in the late results of 56.3% of the operated patients, in another 30% there were auditory gains of speech frequencies, on average above 10 dB. Favourable late results were thus achieved in 86.3% of the operated patients, deterioration of hearing was recorded in 4.8% (13 operated patients). Pistons of Schuknecht's type were used in 23 patients with the obliterating form of otosclerosis. As to late results, in 21 of the evaluated patients compensation of the bone reserve to 0-10 dB was recorded in 28.6%. The mean auditory gains as regards speech frequencies higher than 10 dB were achieved in 47.6%. Favourable late results were thus recorded in 76.2% of operated patients with the obliterating form of otosclerosis. Deterioration of hearing occurred in this group in one operated patient (4.8%).

Humans↗
PubMed1989

Lasers for otosclerosis: CO2 vs. Argon and KTP-532.

The concept of using laser energy to perform stapedotomy and stapedectomy revision is an attractive one. Precision of vaporizing a perfectly round 0.6- to 0.8-mm hole in the stapes footplate, regardless of its thickness or degree of fixation, would introduce an elegant simplicity to a sometimes difficult operation while eliminating mechanical trauma to the inner ear. When revising a previously failed stapedectomy, lasers should enable the otologic surgeon to atraumatically vaporize the obliterating oval window tissue and thus precisely diagnose the cause of the failure. A laser stapedotomy could then be performed in the membranous oval window, thus minimizing the risk of recurrent prosthesis migration. To accomplish these objectives, lasers must possess physical properties which permit the precise controlled delivery of laser energy to the microscopic operative field. Tissue characteristics of this laser energy should permit the vaporization of the stapes footplate or oval window soft tissue without thermal effect to the vestibule and without passing through the perilymph to damage the delicate structures of the inner ear. Two types of lasers have been successfully used for otosclerosis surgery: the visible lasers (Argon and KTP-532) and the invisible CO2 laser. This paper explores relative merits and disadvantages of each. The visible lasers possess ideal optical properties for microsurgery and, until recently (1984), were the only group of lasers optically precise enough for safe use on the oval window. Unfortunately, the short wavelength of these visible lasers (0.5 mu) impart tissue properties which are less than ideal for otosclerosis surgery. Visible laser is only partially absorbed by the white stapes footplate and readily passes through the perilymph to be absorbed by pigmented tissue of the inner ear (blood vessels, neuroepithelium, etc.). Therefore, the Argon and KTP-532 lasers should be used with caution while performing stapedotomies. Visible lasers should not be used for stapedectomy revisions since direct application of visible laser energy to the open vestibule produces dramatic temperature rises (up to 175 degrees C) in the vestibule at the level of the utricle and saccule. The long wavelength of the invisible CO2 laser (10.6 mu) imparts many optical problems which limit its precision for microscopic surgery. Until recently, the CO2 laser was too inaccurate for otosclerosis engineering advances for CO2 microsurgery. A newly designed microslad optical delivery system could deliver a 0.3-mm spot size CO2 beam at 250-mm focal length which was satisfactorily par-focal and coaxial with the aiming HeNe beam.(ABSTRACT TRUNCATED AT 400 WORDS)

Argon↗
PubMed1989

[Surgical treatment of otosclerosis. Effects and risks].

Surgical treatment of otosclerosis involves an opening of the labyrinth and, accordingly, a risk of complications from that organ: vertigo and sensorineural hearing loss or anacusis. During the past decade, the number of new patients with otosclerosis has stabilized at a low level in Danish ENT-departments. Thus, typically the number of stapedectomies per year per department is between 10 and 25. The study elucidates effects and risks at the operation, focusing in particular on the question whether this treatment ought to be centralized. In a seven-year period, a total of 75 stapedectomies in 73 patients with otosclerosis were performed at the ENT-department, Glostrup Hospital, Copenhagen. No revision operations were included. Hearing gain was obtained in all patients except two and the conductive hearing loss was eliminated in 87% of the cases. One patient developed severe sensorineural hearing loss caused by granuloma around the prosthesis, a very rare complication of uncertain cause. Thus, the results were satisfactory but in this series all operations except two were performed by the same expert surgeon in a department with high activity in otosurgery for other diseases. If similar conditions are not available a certain degree of centralization should be considered. The long-term results and the question of bilateral stapedectomy are discussed.

Adult↗
PubMed1985

[Endogenous steroids and otosclerosis].

The level of serum hydrocortisone dehydroepiandrosteron-sulphate and testosterone was measured in 11 men and 11 women suffering from otosclerosis, whose surgically removed stapes were histologically proven to be otosclerotic. In one third of the cases, the serum levels of steroid hormones were abnormal. Men had lower levels of dehydroepiandrosteron-sulphate, i.e. adrenocortical hypofunction, while women had higher levels of testosterone. Significant correlation was not shown with duration of symptoms, age, speech discrimination, pure tone audiogram, air-bone gap and/or any connection between otosclerosis and adrenocortical hypofunction. In patients with normal hormone serum levels the mean values of bone conduction did not exceed 15 dB on the speech frequencies, whereas in patients with otosclerosis, and altered levels of steroid hormone the threshold values on pure tone audiometry showed a hearing loss of 25 dB.

Adult↗
PubMed1988

[Imaging of capsule otosclerosis using computerized tomography].

To investigate whether otosclerotic foci in the bony capsule of the cochlea and labyrinth can be demonstrated by high-resolution computed tomography, CT images from 31 patients suspected of having cochlear otosclerosis were submitted to a retrospective analysis. Fourteen of the patients had a clinically confirmed otosclerosis associated with an advanced mixed hearing loss. In four of these cases, fresh otospongiotic foci were detected in the bone of the cochlear capsule, while older otosclerotic foci were not demonstrated. In fifteen patients with progressive, purely sensorineural hearing loss, no otospongiotic foci were detected in the cochlear capsule. In contrast, such foci were observed in two deaf patients in whom otosclerosis had been suspected.

Adult↗
PubMed1988

Radioanatomy of cochlear and stapedial otosclerosis.

Otospongiosis of the otic capsule is a primary focal disease, which can be reproduced by both conventional multidirectional tomography and computed tomography. The final stage of otospongiosis, otosclerosis has a complete different appearance in radiography. When the otospongiosis focus is located at the oval window a progressive conductive hearing loss will result, which in its final stage will have the character of otosclerosis with fixation of the stapes in the oval window. The radiographic diagnosis with either conventional multidirectional tomography or CT is more or less pathognomonic and will easily confirm the audiologic examinations results. The diagnosis of otospongiosis by computed tomography is advantageous to conventional tomography. With both methods high resolution technique is mandatory for safeguarding both diagnosis and evaluation of the extent of the lesion. Minor otospongiotic or otosclerotic lesions of the oval window with fixation of the footplate are still a challenge to high resolution radiographic imaging. In most cases stapedial otosclerosis is advantageously diagnosed by otoscopy and audiometry. High resolution radiographic imaging is a valuable confirmative method to corroborate clinical diagnoses and differentiating the disease from other conditions based on other morphologic lesions.

Cochlea↗