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At least 217 records · Page 12Linked to original sources
PubMed1992

Long-term results of revision stapes surgery.

Results of 45 re-operations for persistent or recurrent conductive deafness after primary stapes surgery were studied. The mean follow-up period after the revision surgery was 7.6 years. Long-term hearing results were found to be disappointing, air-bone gap to within 10 dB was achieved in only 46 per cent of the patients. Mean hearing levels improved by 11 dB or more in 73 per cent. Outcome of surgery was dependent on the surgical pathology, the best hearing results were obtained in cases with re-fixation after stapes mobilization operation. Sensorineural hearing loss as a result of surgical trauma to the inner ear occurred in revision surgery more frequently than in primary operations, cases with regrowth of otosclerotic bone to the oval window after stapedectomy having the greatest risk of labyrinthine trauma.

Adult↗
PubMed2006

Malleus-stapes assembly: experience with two prostheses.

Tympanoplasty is often a necessary part of middle-ear surgery, the most common defect being that between an intact, mobile stapes and the malleus handle. The most readily available tissue is the patient's incus, reshaped to bridge the space between an intact stapes and the malleus. When the incus cannot be used, the hydroxyapatite Wehrs incus prosthesis can be used as an alternative.Twenty-six patients had an autograft incus ossiculoplasty and 20 patients underwent modified Wehrs incus prosthesis ossiculoplasty. The average post-operative air-bone gaps (ABGs) were 16.2 dB hearing loss (dBHL) and 17.2 dBHL, respectively. Air-bone gap closure to within 15 dBHL was achieved for 48 per cent of incus autografts and for 57 per cent of Wehrs prostheses, and to within 20 dBHL for 77 per cent and 62 per cent, respectively. Over four years follow up, the reconstruction was stable for each group, the ABGs being 17.7 dBHL and 17.1 dBHL, respectively.

Chronic Disease↗
PubMed2006

Experimental study on heat transmission to the vestibule during CO2 laser use in revision stapes surgery.

We studied the transmission of heat to the vestibule during revision stapes surgery with a piston in situ, using a CO2 laser, in an in vitro model. A type K thermocouple was placed around the medial end of stainless steel and fluoroplastic wire pistons in a 'vestibule' filled with saline. The effect of laser hits on fluoroplastic wire and stainless steel stapes prostheses was investigated. The effect of introducing a vein graft to seal the stapedotomy was also examined. Greater temperature rises occurred with stainless steel than with fluoroplastic wire pistons. The addition of the vein graft reduced heat transmission. Application of the CO2 laser to fluoroplastic wire pistons, using the power settings suggested by the manufacturer, is not likely to damage the inner-ear structures. Application of 6 W laser energy to stainless steel pistons can potentially disturb the inner-ear function.

Hot Temperature↗
PubMed1978

[Syndrome of symphalangism and stapes fixation: an autosomal dominant hereditary disease (author's transl)].

The autosomal dominant hereditary syndrome of symphalangism and stapes fixation consists of multiple synostoses, most frequently symphalangism, in addition to synostoses of carpal and tarsal bones and radio-ulnar synostoses, various other malformations of the limbs (restricted joint movement or syndactylism) and variable degrees of conduction disorders due to stapes fixation, starting in childhood. A family tree of four successive generations with various forms of the syndrome is described.

Child↗
PubMed1999

Analysis of the best site on the stapes footplate for ossicular chain reconstruction.

Experiments were performed in 22 fresh human temporal bones to compare the relative acoustic function of three stapes footplate sites for an incus stapes superstructure replacement prosthesis (I-SRP). The three sites evaluated were the anterior, centre and posterior footplates. A new round window (RW) measurement method was used to make the comparisons. A small glass microsphere was placed in the centre of the RW as a target. A Polytec laser Doppler vibrometer was used to measure round window displacement in response to 50 pure tones between 200 and 10,000 Hz presented at 80 dB SPL at the tympanic membrane (TM). After a baseline measurement of RW displacement in the intact temporal bone, the incus was removed and a cement I-SRP (CIRP) formed between the mid-malleus handle and each of the three test footplate sites, in random order. RW displacement was again measured after placement of the CIRP at each of three sites. We found the centre site to be 3.0-7.0 dB better than the anterior site above 2,000 Hz. There were no differences between the anterior and centre sites below 2,000 Hz. The posterior site was the worst at all frequencies.

Aged↗
PubMed2000

Scanning electron microscopy images and energy-dispersive X-ray microanalysis of the stapes in otosclerosis and Van der Hoeve syndrome.

OBJECTIVE/HYPOTHESIS: The objective of this study was to evaluate the morphological and microchemical changes that affect sclerotic stapes in otospongiosis and van der Hoeve syndrome. METHODS: A scanning electron microscope equipped with an energy-dispersive x-ray analyzer was used in the experiments. RESULTS: In otosclerosis, focal lesions are poorly mineralized, with low calcium salt and reduced calcium-to-phosphorus (Ca/P) ratio (1.9:1). This finding correlates with a spongiotic type of lesion and indicates unstable mineralization with possible change from hydroxyapatite to calcium triphosphate. In van der Hoeve syndrome the presence of magnesium in stapes suggests osteoclastic function stimulation. The osteoclasts secrete many protons, causing an acidified microenvironment. Brushite is formed, and Ca/P ratio decreases in comparison with that of control patients (2.0:1 vs. 2.6:1).

Electron Probe Microanalysis↗
PubMed2003

Retrospective analysis of early postoperative hearing results obtained after stapedotomy with implantation of a new titanium stapes prosthesis.

OBJECTIVE: To evaluate the early postoperative hearing results of a new titanium stapes prosthesis (K-Piston) implanted in patients with otosclerosis. STUDY DESIGN: A retrospective analysis of preoperative and early postoperative hearing thresholds. SETTING: One tertiary referral and teaching hospital. PATIENTS: Eighteen men and 40 women, mean age 47 years, with otosclerosis. INTERVENTION: Primary stapedotomy. MAIN OUTCOME MEASURE: Main outcome measures were the mean gains in bone-conduction and air-conduction pure-tone thresholds, and pure-tone averages for different frequency combinations. Success and failure of the individual cases were presented using Amsterdam Hearing Evaluation Plots. RESULTS: The overall postoperative air-bone gap for the frequency combination 0.5-1-2-4 kHz was 8.4 (standard deviation: 5.2) dB. In 79% of the patients the postoperative air-bone gap was less than 10 dB. Air-conduction improved even in higher frequencies, while the Carhart effect was not seen in most cases. In three patients a deterioration of bone-conduction was observed ranging from 11 to 16 dB sound pressure level (SPL), and in four patients the gain in air-conduction was insufficient (3-29 dB SPL) to close the preoperative air-bone gap to within 20 dB. CONCLUSION: The new low-weight, full-titanium stapes prosthesis with its slight rough surface and its good mechanical stability and biocompatibility can safely and successfully restore the function of the middle ear when implanted in patients with otosclerosis.

Adult↗
PubMed2006

Who should be a stapes surgeon? An otologist or a generalist?

PURPOSE OF REVIEW: The overall experience with stapes surgery has declined, both within residency training programs, as well as in clinical practice. Does this change in the environment suggest that subspecialists rather than generalists manage patients with otosclerosis? RECENT FINDINGS: A decreasing availability of patients with clinical otosclerosis has encouraged trainees and practitioners to adopt strategies that will enable the maintenance of quality care to these patients. SUMMARY: Well trained generalists should be prepared to perform stapes surgery. Lack of experience or infrequent exposure to disease suggests that optimal care can be achieved by referring the patient to an experienced otologic surgeon.

Clinical Competence↗
PubMed1991

Reflection of retrograde waves within the cochlea and at the stapes.

A number of authors [de Boer and Viergever, Hear. Res. 13, 101-112 (1984); de Boer et al., in Peripheral Auditory Mechanisms (Springer-Verlag, Berlin, 1986); Hear. Res. 23, 1-7 (1986); Viergever, in Auditory Frequency Selectivity (Plenum, New York, 1986), pp. 31-38; Kaernbach et al., J. Acoust. Soc. Am. 81, 408-411 (1987)] have argued that backward-traveling waves, in striking contrast to waves traveling forward towards the helicotrema, suffer appreciable reflection as they move through the basal turns of the cochlea. Such reflection, if present, would have important consequences for understanding the nature and strength of otoacoustic emissions. The apparent asymmetry in reflection of cochlear waves is shown, however, to be an artifact of the boundary condition those authors impose at the stapes: conventional cochlear models are found not to generate reflections of waves traveling in either direction even when the wavelength changes rapidly and the WKB approximation breaks down. Although backward-traveling waves are not reflected by the secular variation of the geometrical and mechanical characteristics of the cochlea, they are reflected when they reach the stapes. The magnitude of that boundary reflection is computed for the cat and shown to be a large, rapidly varying function of frequency.

Acoustics↗
PubMed1996

Possible autosomal recessive inheritance of progressive hearing loss with stapes fixation.

Four sibs with progressive, bilateral conductive hearing loss are presented. Symmetrical hearing loss averaging 30-60 dB (0.125-8 kHz) became apparent between 8 and 24 years of age. Tympanotomy showed a fixed stapes either through ossified stapedius tendon or through ossified stapedius tendon or through a bony bridge from the stapes to the pyramidal eminence in all patients. After surgical removal of the bony tendon hearing was normal. Both parents, four other sibs, and all grandparents had normal hearing. This family and a further published case suggest a possibly recessive inheritance of this form of conductive hearing loss.

Adult↗
PubMedDate not supplied

The annular ligament attachment to the normal human stapes footplate. A scanning electron microscopic study.

Following disarticulation of the stapes from the oval window, the free edge of the adult human stapes was examined with the scanning electron microscope. Regions of the articulating surface of the rim were examined and found to vary considerably. Anterior, posterior, and lateral ligaments are described, each with tympanic, intermediate, and lateral components.

Adult↗
PubMedDate not supplied

Air conduction thresholds after myringoplasty and stapes surgery: a conventional and high frequency audiometric comparison.

A comparison has been made of air conduction thresholds after myringoplasty and stapes surgery for otosclerosis in both the conventional (0.25 to 8 kHz) and high frequency (8 to 20 kHz) ranges. Significant threshold losses occurred in the high frequencies following both procedures. Threshold improvement was significantly greater at the lower frequencies following stapes surgery, while high frequency threshold deterioration was significantly less in the myringoplasty group. High frequency audiometry may prove to be a sensitive monitor of middle ear surgical techniques.

Adolescent↗
PubMedDate not supplied

Collagen components of bovine fetal and guinea pig cochlear bone and human stapes.

Collagenous components were isolated chemically from fetal bovine or guinea pig cochlear bone and human stapes after stapedectomy, and the purified protein was characterized by immunoblot assay and amino acid analysis. The results of this study suggest that these are mixtures of type I and type II collagens. The presence of type II collagen in the human stapes also was demonstrated by immunohistologic methods using monoclonal antibody. The presence of type II collagen in these tissues is significant, since it has been postulated as an autoantigen in autoimmune inner ear disease.

Amino Acids↗
PubMed1998

Correlations between pathologic changes in the stapes and conductive hearing loss in otosclerosis.

The goal of this temporal bone study was to quantify the relationship between specific histologic changes at the stapes footplate and the magnitude of the air-bone gap in otosclerosis. The study material comprised 26 specimens with otosclerosis and 37 age-matched controls. Detailed anatomic measurements were made on each histologic section through the stapes footplate in each bone, resulting in 30 different measurement parameters for each bone. For frequencies 250 to 2,000 Hz, the conductive hearing loss correlated highly with (p < .01) and appeared to be caused primarily by narrowing and loss of the annular ligament, especially at the posterior stapediovestibular joint space. The size of the air-bone gap appeared to be determined by the extent and degree of this pathologic change. Schuknecht's hypothesis that bony ankylosis of the footplate would be associated with an air-bone gap of >30 dB was supported by our data. However, the degree and extent of bony footplate ankylosis could not be reliably predicted by the size of the air-bone gap.

Aged↗
PubMed1999

Relationship of the utriculus and sacculus to the stapes footplate: anatomic implications for sound-and/or pressure-induced otolith activation.

One hundred thirty human temporal bones that were sectioned in the vertical plane were examined to evaluate the relationship between the stapes footplate and the otolith organs. The shortest distance between the footplate and the utriculus was 0.58+/-0.10 mm in the posterior third of the oval window, 1.04+/-0.20 mm in the middle third, and 1.51+/-0.20 mm in the anterior third. The distance from the sacculus to the footplate was 1.33+/-0.20 mm in the middle third of the oval window and 1.31+/-0.18 mm in the anterior third. Membranous connections extending between the utriculus and the footplate were found in 26% of temporal bones. These membranous connections in coexistence with additional anatomic factors such as stapes hypermobility and/or dehiscence of bone within labyrinthine structures may predispose patients to sound- and/or pressure-induced otolith activation. The findings may have implications for different causes of the Tullio phenomenon.

Acoustic Stimulation↗
PubMed2003

Transmission of heat to the vestibule during revision stapes surgery using a KTP laser: an in vitro study.

The transmission of heat to the vestibule during revision stapes surgery with a piston in situ has been studied using a KTP laser in an in vitro model. A type K thermocouple was placed around the medial of each piston tested in a 'vestibule' filled with saline. The effect of laser hits on fluoroplastic, fluoroplastic-wire and stainless steel stapes prostheses was investigated. The effect of adding blood to the operative field, of introducing a vein graft to seal the stapedotomy and of vaporizing soft tissue in the oval window were also examined. Greater temperature rises occurred with stainless steel than with the other piston types and smaller rises occurred when there was a vein graft in situ. The maximum temperature rise recorded was 2.6 degrees C. We conclude that the use of the KTP laser to clear soft tissue from the oval window is safe when operated at the power levels recommended by the manufacturer.

Hot Temperature↗
PubMed2000

Vertigo after stapes surgery: the role of high resolution CT.

CT findings in patients with vertigo after stapes surgery include a prosthesis shaft entering the vestibule and compressing the saccule, a complete dislocation of the stapes prosthesis, air bubbles and fluid collections within the vestibule and outside the oval window indicating a perilymphatic fistula, and bony fragments leading to compression of the basal saccule. Although immediate post-operative vertigo is often transient, patients with persistent or recurrent vertigo should be imaged as high resolution CT will determine the underlying cause in the majority of cases.

Fistula↗
PubMed1991

Use of the excimer laser in stapes surgery and ossiculoplasty of middle ear ossicles: preliminary report of an experimental approach.

Surgery of the stapes may cause a number of complications, including hearing deficits and balance disorders. This has made it necessary to look for improved techniques. Small-fenestra stapedotomy has recently been popularized. Lasers have been advocated for use in fenestrating the stapes footplate. On the other hand, sculpting the middle ear ossicles during tympanoplasty is often necessary for the reconstruction of the ossicular chain and the improvement of sound conduction. Using an excimer laser with a wavelength of 193 nm, fenestrations of the footplate and ossicular sculpting were performed on ossicles obtained during ear surgery and from human cadaver temporal bones. The results indicate that the excimer laser can be used effectively and accurately on an experimental basis and that further research is needed before this method can be used for clinical purposes.

Cerebrospinal Fluid↗