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PubMedDate not supplied

[Oscillometry on various stape protheses. Experimental examination of human temporal bone preparations].

In human temporal bone specimens the vibrations of the labyrinthine fluid were measured by a piezoelectric system after application of various techniques of otosclerosis surgery. Compared with the amplitude in the case of a normal stapes, the surgical techniques according to Zangemeister, Shea and Schuknect resulted in considerable transmission losses in the high frequency range, while transmission of low frequencies to the inner ear was almost equivalent to normal transmission via the stapes. For frequencies of more than 3,000 Hertz the damping influence of the fibrous tissue implanted into the oval window was verified. The results of surgery according to Zangemeister, Shea and Schuknechtdid not differ significantly in the low and medium frequency range. Only a Robinson prosthesis implanted like a Teflon piston caused an impairment of transmission, while the method of fitting this prosthesis onto fibrous tissue was equilvalent to the other techniques.

Ear, Middle↗
PubMedDate not supplied

Examination of noncollagen protein composition of the footplate and superstructure of the otosclerotic stapes.

We have differentially precipitated 2 fractions of noncollagen proteins extracted from separately pooled superstructure and footplate of surgically removed stapes of patients from both sexes, who have suffered from otosclerosis. The two fractions were: EDTA-soluble, CaCl2 precipitable (Fraction-1) and EDTA-soluble, CaCl2 non-precipitable proteins. The protein pattern of these two fractions was compared by isoelectric focusing and two-dimensional gel electrophoresis. The phosphoprotein fraction (Fraction-1) of the otosclerotic stapes footplate contained acidic (pI 3-6), low molecular weight (20-40 kD) proteins, which were not detected in the superstructure and temporal cortical bone. Two-dimensional mapping of the Fraction-2 showed predominantly acidic proteins in the footplate and some basic minor components in the superstructure. The lack of the low molecular weight proteins in the superstructure proves the localisation of the otosclerotic process only in the footplate.

Adult↗
PubMed1993

Hearing recovery following large and small fenestra stapes surgery for otosclerosis.

Fifty-five ear of 49 patients with otosclerosis were operated on with either large fenestra stapes (stapedectomy; SDE) or small fenestra stapes (stapedectomy; STO) surgery. Pre-operative average hearing levels for the speech frequency ranges (0.5, 1, 2 kHz) were 56.1 dBHL for SDE and 61.0 dBHL for STO. These improved to 39.0 dBHL and 35.0 dBHL. Statistically, significant hearing recovery was obtained for a frequency range from 0.125 to 2 kHz for SDE and from 0.125 to 4 kHz for STO (p < 0.05, Dunnett's multiple variance test). The degree of post-operative hearing improvement for STO was significantly higher at 0.5, 2 and 8 kHz than that for SDE (p < 0.05, Student's t-test). A pre-operative speech discrimination score of 80% was obtained at 68.9 dB for SDE and at 76.0 dB for STO. These values improved to 56.1 dB and 49.5 dB post-operatively. Thus, it was proved that STO results in better hearing than SDE does.

Adolescent↗
PubMed1995

Nystagmus measured by ENG after stapes surgery.

Much attention has been paid to hearing results after stapes surgery, but the risks of vestibular disturbance has not been extensively studied. Postoperative spontaneous nystagmus was measured daily at bedside by portable ENG in order to evaluate the vestibular damage from stapes surgery. Thirteen patients underwent primary stapedotomy or stapedectomy from August 1, 1992 to June 30, 1993. Nystagmus toward the operated ear was observed in 3 cases, that toward the opposite ear in 2 cases, that changing from toward the operated ear to toward the opposite ear in 2 cases, that changing from toward the opposite ear to toward the operated ear in 2 cases and no nystagmus in 4 cases. There was no relationship between duration of nystagmus and that of dizziness. Nystagmus was thought to be due to the following: i) inner ear damage by operation, ii) postoperative perilymphatic fistula, iii) floating footplate, and iv) stimulation of hair cells by high potassium ion in the perilymph due to blood flow into the inner ear.

Adolescent↗
PubMed2004

[Surgery for tympanosclerotic stapes fixation accompanied by malleus fixation at the anterior malleus: report of 2 cases].

Most tympanosclerotic stapes fixation involves fixation or erosion of the malleus and/or incus. This status of the ossicular chain is one reason that ossiculoplasty for tympanosclerotic stapes fixation is more difficult than that for otosclerosis. In some cases, the malleus is fixed only at the anterior, while the incus is intact. In such cases, anterior spinotomy can recover mobilization of the malleus, then a prosthesis can be used for the long process of the incus during ossiculoplasty. We conducted stapedectomy with anterior spinotomy on 3 ears in 2 patients. Over 15 dB of hearing was regained in all 3 ears 6 months after surgery. No significant sensorineural hearing loss was seen in any ear. To adapt this surgical procedure, it is necessary to evaluate preoperative CT findings and the status of the ossicular chain during surgery.

Adult↗
PubMed1996

[A case report of congenital stapes fixation accompanied by symphalangism and hypermetropia].

A 32-year-old female with bilateral congenital stapes fixation accompanied by bilateral proximal symphalangism and bilateral hypermetropia is reported. This is the 19th case of congenital stapes fixation and symphalangism in Japan. Hypermetropia was speculated to be one of the cardinal symptoms of the disease based on the present case and cases previously reported. In this case hypermetropia was due to pure microphthalmos and this was the first report that revealed the cause of hypermetropia in the syndrome. Bilateral stapedotomy were carried out and her hearing loss was improved to the satisfactory level.

Abnormalities, Multiple↗
PubMed2000

[Stapes surgery in anomalies of the course of the facial nerve].

In 548 stapes operations performed in Berne during the period 1994-1998, an anomaly of the course of the facial nerve was observed in 37 cases. 29 exhibited partial prolapse of the nerve over the oval window, with or without dehiscence of the bony canal, while 5 showed total prolapse of the nerve over the oval window. In one case the nerve was duplicated round the oval window and in a further instance the facial nerve was situated over the promontory and also over the oval window. In one other case the nerve was spread widely over the oval window. Concomitant anomalies of the stapes were frequently observed. The following surgical techniques were employed: in the case of partial prolapse of the nerve, a small piston was placed in the lower part of or in the oval window, which was widened towards the promontory. In cases of total prolapse of the facial nerve the prosthesis was drilled straight into the promontory. Where the nerve was duplicated the prosthesis was placed in the footplate between the nerve branches, and where the nerve ran over the promontory and over the oval window the prosthesis was placed above the oval window. In the case where the nerve was spread widely over the oval window, no prosthesis was inserted. 78% of patients had a residual air-bone gap of 20 dB or less; in only three cases did hearing fail to improve. One patient with Crouzon disease involving a complex anomaly had a hearing impairment of 22 dB. There was no deafness, facial paralysis or vertigo with nystagmus.

Auditory Threshold↗
PubMed2001

Stapes mobilization in otosclerosis.

We performed a retrospective chart study (including surgeon's notes and audiometric results) and an analysis of the archival temporal bones from a patient who had undergone surgery for stapes mobilization in both ears. The stapes footplate was submerged into the vestibule on the right (as a complication of surgery) and absent on the left. One interesting finding was that the patient's hearing had improved on the right despite the presence of the depressed footplate and that the air-bone gap had widened on the left despite the absence of complications on that side.

Aged↗
PubMed2001

Pneumolabyrinth: a late complication of stapes surgery.

As temporal bone imaging techniques continue to improve, it is likely that we will see an increase in the detection of pneumolabyrinth. Several mechanisms have been proposed to explain how air enters the labyrinth. A small number of authors has reported an association between pneumolabyrinth and temporal bone fractures, perilymphatic fistulae, and displaced stapes prostheses. In this article, we describe a new case of pneumolabyrinth that was seen as a late complication of stapes surgery, and we summarize what is known about this rare condition.

Ear, Inner↗
PubMed1999

[The diagnosis and treatment of bilateral congenital absence of stapes and oval window in two members of a family].

OBJECTIVE: To date, bilateral congenital absence of stapes and oval window in two members (elder brother and younger sister) of a family has not been reported previously in the literature to our knowledge. The etiology, diagnosis and management are hereby introduced and discussed. METHODS: The diagnosis was based on history, audiological examinations, high resolution CT scanning and/or the operation. The modified Lempert's fenestration operation of the horizontal semicircular canal was performed on one ear each of the elder brother and the younger sister. RESULTS: Postoperative hearing threshold was 25 dB for speech frequencies with a gain of 47dB for the elder brother, and hearing threshold of 28 dB with a gain of 52 dB for the younger sister. Following up one to eight years individually showed that their hearing gains were steady. CONCLUSION: Patients' parents are relatives of first cousin and have two sons and one daughter. However, there are two family members suffered from bilateral congenital absence of stapes and oval window, and these malformations might be related to inheritance. Good bone conduction and Carhart's notches revealed bilaterally in the patients' audiograms. These are the important indications for diagnosis of this disease. The modified Lempert's fenestration operation of the horizontal semicircular canal is a safe and good choice for treatment.

Adolescent↗
PubMed2004

[30 years of stapes surgery].

This study reports the results of otosclerosis surgery performed during the past thirty years (1973-2002) in the ENT Clinic in Katowice. The authors present difficult anatomic relationships in the tympanic cavity which might have an influence on stapes surgery. Audiometric evaluation of 100 bilateral stapedotomies performed in 50 patients revealed that a small--hole stapedotomy is a safe technique and could be performed bilaterally. The group of 55 stapedotomies with stapedial tendon preserved was compared to the group of 55 stapedotomies with dissected tendon. SRT was better in the group where the tendon was preserved. In the group of 32 patients ABR before and after stapedotomy was recorded. The latency of V wave after the operation was reduced to the normal values what indicated a correct function of the ossicular chain postoperatively. In the group of 60 patients DPOAE prior and after stapedotomy was evaluated. Prior to the operation no signal of otoacoustic emission was registered, in 37 patients out of 60 the signal was present after the operation. DPOAE obtained postoperatively indicated successful ossicular chain restoration and inner ear function. Audiometric evaluation in reference to the group of 905 stapedotomies performed in years 1992-2001 showed that most of the patients were in group B--443/905 and C--402/905 according, in A group--60/905 according to Shambaugh. A-B gap < or = 10 dB was obtained in 469/905 (51.8%), the mean of the hearing threshold at 500, 1000, 2000 and 4000 Hz was 24.3 dB (+/- 8.3, med. 25.0) in A group and 32.0 dB in B and C group. The result of stapedotomy in reference to tinnitus based on the patients' subjective opinion. We may conclude that the key to the stapes surgery lies in the training and skillfulness of the surgeon using save small hole technique with stapedial tendon preservation to obtain the optimal physiologic function of the middle ear and to gain the best hearing results.

Adolescent↗
PubMed2003

A case of congenital bilateral stapes agenesis.

Congenital absence of the stapes and the oval window is an anomaly reported in only sporadic cases. We present a 17-year-old male patient with congenital bilateral conductive hearing loss. The external auditory canal and the tympanic membrane appeared normal on both sides. An exploratory tympanotomy in the right ear revealed dehiscence of the the horizontal segment of the facial nerve, which was displaced inferiorly, occupying the area of the absent oval window. The stapes was totally absent and a malformed long process of the incus was attached by a fibrous band to the promontory. Manipulation of the facial nerve in association with stapedectomy or vestibulotomy was avoided in order not to injure the nerve. Instead, amplification with hearing aids was recommended to the patient.

Adolescent↗
PubMed2005

Revision stapes surgery for recurrent transmissional hearing loss after stapedectomy and stapedotomy for otosclerosis.

A total of 20 stapedotomy and 24 stapedectomy cases were retrospectively reviewed to establish the causes of failure, and to evaluate hearing results after revision surgery. Our series included 23 male and 21 female patients. Mean age at revision time was 42 years, and the mean interval from primary surgery and revision stapes surgery was 27 months. The retrospective review of our data, revealed that the most common cause for revision surgery was a displaced prosthesis (47.7%). After revision surgery, the mean post-operative air-bone gap was 14.78 dB. A mean post-operative air-bone gap within 10 dB occurred in 24 patients (54.5%), in 14 patients (31.5%) this was between 11 and 20 dB, in 5 patients (11.5%) between 21 and 30 dB, and in one patient (2.5%) > 30 dB. There were no "dead ears" in this series. Our results compare to other reported series, and confirm that after revision stape surgery, an air-bone gap closure within 10 dB is difficult to obtain. In the present series, the use of the total ossicular replacement prosthesis resulted in the poorest functional hearing results.

Adolescent↗
PubMed1987

[High-resolution computed tomography in stapes surgery].

Early and delayed complications in the inner or middle ear may follow stapedectomy or stapedotomy and may require revision surgery. Nowadays high resolution middle ear computed tomography (HR-MCT) using a special interpolation technique can demonstrate the smallest structures of the middle ear space, such as the long process of the incus and stapes. Stapes prostheses can also be seen in this way, but to identify the prothesis exactly it is necessary to determine the position of the piston hook in relation to the incus and of the piston shaft to the foot plate and scala vestibuli. Two points were of particular interest to us: HR-MCT identification of various metal and plastic pistons. Clinical significance of HR-MCT in complications following surgery. As the result of our experimental research on cadaver temporal bones, pistons must still be divided into four groups based on their demonstration by HR-MCT: Group I (e.g. Stainless Steel Cup Piston): whole piston visible. Group II (e.g. McGee Stainless Steel Piston): only piston shaft. Group III (Fisch Teflon-Platinum Piston): only hook visible. Group IV (e.g. Fisch Teflon-Wire Piston): piston hardly visible or not at all. In groups I-III it is possible to discover whether the piston is too long or too short, whether it is dislocated or has slipped. Group IV pistons, hooks from group II and the shaft from group III must be changed to allow detection by x-rays. With plastic pistons it might be possible to add an x-ray agent.2+ improvements in manufacture appear to be necessary, dislocation of various prostheses can now be shown.(ABSTRACT TRUNCATED AT 250 WORDS)

Ear, Middle↗
PubMed1985

Audiologic features of the X-linked progressive mixed deafness syndrome with perilymphatic gusher during stapes gusher.

Stapes gusher sometimes occurs at the moment the vestibule is opened. A flood of perilymph can be expected as a complication of stapes surgery in all males affected with the X-linked progressive mixed deafness syndrome. Audiologic features, such as a mixed hearing loss and elicitability of stapedial reflexes, are reported for eight affected males in a large Dutch family.

Adult↗
PubMed1984

Pneumolabyrinth: a new radiologic sign for fracture of the stapes footplate.

A case of fracture of the footplate of the stapes resulting in air in the labyrinth is reported. The pneumolabyrinth was demonstrated by CT scan of the temporal bone but not by complex motion tomography. We consider pneumolabyrinth to be a new diagnostic CT finding in stapes footplate fracture.

Ear Ossicles↗
PubMed1984

[Isolated fractures of the branches of the stapes. Apropos of 2 cases].

Isolated fractures of the limbs of the stapes are relatively rare when compared with other traumatic lesions of the ossicula. Diagnosis, as in two recent cases, is suggested by the history of injury and the persistence of a recordable stapes reflex. Surgical re-establishment of transmission is simple but results are not always as spectacular as might be expected.

Adult↗
PubMed1984

Ultrastructural study on the stapes and skin in a case of type I Osteogenesis Imperfecta.

The results of the ultrastructural study carried out on the stapes and skin from a patient affected by type I Osteogenesis Imperfecta showed the presence of structural alterations of collagenic component. In the stapes the size, the stability and the tridimensional organization of collagen fibrils were affected. In the skin, a reduction of polymeric collagen was observed, chiefly in reticular dermis. The quantitative analysis of the size of collagen fibrils showed that only the collagen fibrils of papillary dermis were significantly thinner than normal. The electron microscope study of the periodic structure of collagen fibrils isolated from the dermis and submitted to negative or positive contrast or to glutaraldehyde fixation, before being negatively stained, showed no significative differences with the controls. These results agree with previous biochemical studies and indicate that both the stability and the processes of growth regulation of collagen fibers and fibrils are affected in this form of the disease, whereas the molecular assembly within the fibrils is normal.

Adult↗