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At least 199 records · Page 11Linked to original sources
PubMed2005

Shape-memory stapes prosthesis for otosclerosis surgery.

OBJECTIVES: The aim of this study was to determine the efficacy of a shape-memory alloy, Nitinol, as a component of an improved stapes prosthesis. STUDY DESIGN: Prospective laboratory and clinical study to develop a Nitinol stapes prosthesis. METHODS: Various diameters of Nitinol wire and temperature transition variants were analyzed with regard to ease of deformation, response to heating, and strength. The size and geometry of the closed hook was determined by measurement of 50 incus cadaver bones. Several heat sources for activating the shape memory were evaluated, including electrocautery, lasers, and warm water. Trial surgeries were then performed on human temporal bones in the laboratory. The closure characteristics of the Nitinol loop were studied. Magnetic resonance imaging (MRI) testing at 1.5 Tesla was performed to determine safety during MRI studies. Preliminary human subject trials were then instituted. RESULTS: In all cases, a low heat condition was ample to activate the shape memory characteristics of the hook and return it to a closed position after it had been opened. Laser power was generally set well below the power needed for removing bone. The Nitinol loop closed snugly around the incus with application to the top of the hook with a low temperature laser setting. Almost any heat source was effective. MRI testing at 1.5 Tesla showed no movement of the prosthesis. Preliminary results in human subjects showed excellent air-bone closure. The Nitinol loop holds uniform contact around the incus. CONCLUSIONS: The Nitinol piston greatly simplifies the stapedectomy procedure by taking the need for a hand operated instrument out of the surgeon's hands. Because of the nature of the Nitinol wire, it can never over-crimp. All these characteristics make the prosthesis advantageous for otosclerosis surgery.

Alloys↗
PubMedDate not supplied

Klippel-Feil syndrome with conductive deafness and histological findings of removed stapes.

The Klippel-Feil syndrome is usually associated with sensorineural hearing impairment, but rarely is it associated with conductive or mixed deafness. A 22-year-old female presented with fusion of the cervical vertebrae, torticollis, scoliosis, pterygium colli, the Sprengel deformity with an omovertebral bone, concavity of the thorax and conductive hearing impairment of the right ear. Tympanotomy disclosed an atrophic long process of incus and a fixation of the stapes footplate, and stapedectomy was performed with immediate postoperative improvement of hearing. However, she developed a sudden hearing loss with dizziness soon after she had physical exercise on the 15th postoperative day, and revision surgery revealed a perilymph fistula of the oval window. Histological investigations of the removed stapes showed no specific osseous changes but hyperostosis of the posterior edge of the footplate. The literature is reviewed and the etiology of the conductive deafness and the perilymph fistula is discussed.

Adult↗
PubMedDate not supplied

The Robinson stapes prosthesis: a 15-year study.

A report on the stapedectomy procedure using the Robinson stainless steel stapes prosthesis over a 15-year period is presented in a study of 3,200 cases. Short-term results, long-term results, failures, and delayed complications are statistically analyzed. This implant is presently the most frequently used prefabricated stapes prosthesis in the country, and each year more otologic surgeons are adopting this surgical technique.

Adolescent↗
PubMed2002

Traumatic fracture of the stapes suprastructure following minor head injury.

Traumatic fracture of the stapes occurs rarely following head injury. Ossicular dislocation is more commonly encountered. When present, stapes fractures are usually associated with an underlying temporal bone fracture. A higher incidence has been reported in childhood, possibly because of the greater flexibility of the skull in this age group. This report highlights the fact that these fractures can be associated with a relatively minor head injury. This possibility should be kept in mind when evaluating patients, especially children, who have a persistent conductive deafness of more than 30 dB with an intact tympanic membrane following any form of head injury. An exploratory tympanotomy with appropriate ossicular reconstruction, as described in this case, can yield excellent results.

Adolescent↗
PubMed1992

Three-dimensional surgical anatomy for stapes surgery computer-aided reconstruction and measurement.

To define anatomical relationships relevant to stapes surgery, computer-aided three-dimensional reconstruction and measurement were performed on nine normal temporal bones. The mean distance from the inferior portion of the long process of the incus to the center of the oval window was 3.80 mm. The shortest distance from the center of the oval window to the utricular macula, saccular membrane, and macula averaged 1.37, 1.60, and 2.13 mm. Surgery directed posteromedial-superior from the oval window was found to be most dangerous because it would come so close to the utricular macula; a posteromedial-inferior approach was found to be safest. The distance from the inferior margin of the oval window inferiorly to the cochlear duct in the hook portion ranged between 0.58 and 1.29 mm, suggesting that when a drill hole is made on the inferior margin of the oval window to lift up a depressed stapes footplate, the hole should not be greater than 0.5 mm in diameter.

Adolescent↗
PubMed1988

[Variations of the position of the stapes in the fossula of the round window and their surgical value].

The authors studied variations of the position of stapes in the fossula of ovale window on 300 preparations of temporal bones, under operating microscope. They noted three possible positions of the stapes: most commonly downwards to the promontorium (76%), much less frequently (15%) towards the bottom of the fossula, and rarely upwards to the facial canal (9%). Knowledge of these anatomic variations is of great importance in surgical procedures performed in this region.

Adult↗
PubMed1985

Revision stapes surgery: problems with some solutions.

A review of 217 consecutive revision stapes operations performed during a ten-year period revealed that the surgeon encounters more pathological variables than he does during primary operations. Hence, the technical solutions are less stereotyped and the net results less predictable. Prosthesis displacement, with or without incus tip erosion, was the most common primary cause of failure (82%). However, oval window problems such as footplate refixation, perilymph fistula, otosclerotic regrowth, and lateralized oval window membrane in 60% of cases often complicated prosthesis displacement. First revision operations in 174 cases resulted in postoperative bone-air deficit of 10 dB or less in 65% of cases, much better than the 45% for second revision results, and the 25% for third revisions. These statistics provide our practice with a realistic prognosis when discussing revision stapes surgery with the individual surgical candidate.

Bone Conduction↗
PubMed1993

X-linked mixed hearing loss with stapes fixation: case reports.

X-linked mixed hearing loss with stapes fixation is a congenital, recessive anomaly. The condition is characterized by progressive mixed hearing loss, reduced vestibular responses, and congenital fixation of the stapes with perilymph gusher encountered during surgical intervention. This paper describes the audiologic history of a family with two affected male children and one carrier female child. The need for early intervention and the challenges encountered in evaluation and management are discussed.

Audiometry, Pure-Tone↗
PubMed1993

[Reconstruction of the stapes superstructure with bioactive ceramics].

In this study we examined the feasibility of rebuilding a stable stapes superstructure for a new articulated ossicular chain by using bioactive ceramics. Dense hydroxylapatite and ceravital were tested in guinea pigs. The ceramic prosthesis was placed on the remnants of the footplate to create a bony connection without touching the tympanic membrane, thereby protecting it from relative movements. The implants were explanted together with the stapes footplate at six weeks and three months, respectively. Histologically, bony connections were found between all ceramic implants and the remnants of the crura even at six weeks and became more pronounced after three months.

Animals↗
PubMed1975

Human stapes crura. Normal ultrastructure, scanning electron microscopical findings.

The crura of normal human stapes were studied with the scanning electron microscope. Three definite layers were seen: mucosal, periosteal, and bone. The appearance of each layer, as well as of the transition zones, has been presented. Familiarization with the scanning electron microscopic features of the normal human stapes crura should make identification and interpretation of abnormal features of diseased states apparent.

Cilia↗
PubMed2005

In vivo performance of the Nitinol shape-memory stapes prosthesis during hearing restoration surgery in otosclerosis: a first report.

The limitations of manual prosthesis crimping in hearing restoration surgery for otosclerosis are thought to have a key role in the occurrence of incomplete postoperative elimination of conductive hearing loss and postoperative recurrences of conductive hearing loss. To eliminate manual crimping, the self-crimping, shape-memory alloy Nitinol stapes piston was introduced in nine otosclerosis patients. The results were compared with those in a database of surgeries performed with conventional titanium pistons. The effects of the self-crimping Nitinol prosthesis on the postoperative elimination of conductive hearing loss and its postoperative variations were investigated. The variations of postoperative residual conductive hearing loss were significantly smaller and the extent of conductive hearing-loss elimination greater in the Nitinol group. The mean postoperative residual conductive hearing loss was smaller in the Nitinol group. The postoperative stability of conductive hearing loss elimination was similar in both patient groups. Preliminary results suggest that the self-crimping shape-memory alloy Nitinol stapes piston overcomes the drawbacks of manual crimping in hearing restoration surgery for otosclerosis.

Adult↗
PubMed1978

Stapes gusher and Klippel-Feil syndrome.

The stapes gusher which is the most dramatic complication of stapedectomy arises from an abnormal communication between the subarchnoid and perilymphatic spaces. This congenital defect may be associated with other anomalies such as the Klippel-Feil syndrome. Two cases of stapes gusher in patients with congenital fixation of the footplate are described. One of them was combined with Klippel-Feil syndrome. The object of this paper is to emphasize the necessity of a complete preoperative examination of all cases of congenital footplate fixation.

Adolescent↗
PubMed1996

Repair of the ossicular chain with an ionomer cement by an inadequate incus after prior stapes surgery for otosclerosis.

Use of an ionomer bone cement is described for repairing the ossicular middle ear system in revision stapes surgery. The cement was used to enlarge an eroded inadequate incus to allow placement of a new stapes prosthesis. Reconstruction of the incus with this new bone cement was readily performed and hearing results after 2 years of follow-up have been promising.

Adult↗
PubMed1993

Surgery for congenital anomalies of the middle ear with mobile stapes.

In a series of 104 patients with congenital middle ear anomalies operated on from 1964 to 1986, 27 cases were found in which the stapes footplate was mobile and the conductive deafness was due to an anomaly in the remaining part of the ossicular chain. In 8 cases the middle ear anomaly was caused by discontinuity of the ossicular chain owing to congenital malformation. In the other 19 ears, epitympanic fixation of the ossicular chain was observed, whether or not in combination with malformation of the stapes, incus or malleus. Ossicular chain reconstruction produced an improvement of at least 15 dB in 6 of the first 8 cases with discontinuity of the ossicular chain. The mean gain was 31 dB. Epitympanotomy with exposure of the fixed ossicle and if necessary ossicular chain reconstruction led to an improvement of at least 15 dB in 12 of the 19 ears, with a mean gain of 28 dB.

Adolescent↗
PubMed1980

Stapes anomaly and cochlear sensory cell changes. A scanning electron microscope study.

This paper reports the pathological findings in the cochleae of a 66-year-old man examined under a scanning electron microscope (SEM). Columella-shaped stapes, which were the only anomalous changes in the middle ear cleft, were found in both ears. Beside this, giant hair formation and fusion of stereocilia in the inner sensory cells were also observed in the apical part of the lower basal turn. Since the patient had no history of ototoxic drug use or other ear disease episodes, it is suggested that these inner hair cell changes might have been caused by the conductive disorder accompanying the stapes anomaly. Giant hair formation was discussed from the inner ear findings of 14 other cases examined by a SEM.

Adult↗
PubMed2005

[Electronic surveillance of nosocomial infections in head and neck surgery and stapes surgery].

BACKGROUND: Nosocomial infection is generally regarded as the most important postoperative complication. Therefore, on 28 December 2002 a German law was implemented requiring the surveillance of postoperative infections in all hospitals. METHODS: The authors propose using stapes and thyroid surgery to monitor the infection rate in a typical Head and Neck Department. A versatile software (CISS) based on MS Word and MS Excel was developed for this purpose. RESULTS: Postoperative infections were retrospectively analyzed for three subsequent years. The present data confirm the results of previous studies that surveillance itself is a powerful tool in reducing the postoperative infection rate. CONCLUSION: The newly developed software provided an easy tool for the collection of infection data. The reported infection rates in stapes and thyroid surgery are representative of ENT clinics in Germany.

Cross Infection↗
PubMed2005

Abnormal facial nerve course associated with stapes fixation or oval window absence: report of two cases.

Congenital minor ear malformations are very uncommon. Their etiology can be explained by the embryological development of the middle ear structures. Their classification, diagnosis and treatment pose certain problems. We report on one case of congenital stapes fixation and one case of oval window absence, both associated with an abnormal facial nerve course. Good long-term results show that performing a platinotomy or vestibulotomy in cases of congenital stapes fixation or oval window absence can be a relatively safe procedure, even in presence of deviated facial nerve course. The literature and present classifications of minor ear malformations are discussed.

Audiometry↗
PubMed2005

On the coupling between the incus and the stapes in the cat.

The connection between the long process and the lenticular process of the incus is extremely fine, so much so that some authors have treated the lenticular process as a separate bone. We review descriptions of the lenticular process that have appeared in the literature, and present some new histological observations. We discuss the dimensions and composition of the lenticular process and of the incudostapedial joint, and present estimates of the material properties for the bone, cartilage, and ligament of which they are composed. We present a preliminary finite-element model which includes the lenticular plate, the bony pedicle connecting the lenticular plate to the long process, the head of the stapes, and the incudostapedial joint. The model has a much simplified geometry. We present simulation results for ranges of values for the material properties. We then present simulation results for this model when it is incorporated into an overall model of the middle ear of the cat. For the geometries and material properties used here, the bony pedicle is found to contribute significant flexibility to the coupling between the incus and the stapes.

Animals↗