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At least 253 records · Page 14Linked to original sources
PubMed1995

The effect on tinnitus of stapes surgery for otosclerosis.

Among 42 Japanese patients with otosclerosis who underwent stapes surgery, 22 patients including 10 received total stapedectomy, 6 partial stapedectomy and 6 stapedectomy, were investigated on preoperative and postoperative tinnitus by sending questionnaire. The tinnitus was evaluated by "tinnitus score" advocated by the Japan Audiological Society, and the changes of the scores were analyzed according to pre- and postoperative hearing change, type of stapes surgery and pitches of preoperative tinnitus. In these 22 patients, tinnitus score was improved in 68%, unchanged in 27% or worsened in 5%. Tinnitus was completely disappeared in 6 patients or 27.3%. Tinnitus score became more markedly improved in the patients received partial stapedectomy or stapedotomy than those who received total stapedectomy. Tinnitus score was more likely improved in the patients who had a low pitched tinnitus and presumably had no cochlear otosclerosis preoperatively.

Adult↗
PubMed1993

Surgical treatment of stapes fixation by fiberoptic argon laser stapedotomy with reconstruction of the annular ligament.

The goal of surgical treatment of stapes fixation is to restore the impedance transfer of the ossicular chain and the acoustic impedance of the annular ligament of the stapes footplate to achieve normal physiologic vibration of the inner ear fluids. Advances in instrumentation, particularly the introduction of fiberoptic laser handpieces and microdrills, have enabled surgeons to approach this goal in a more precise and delicate fashion. In this article, the authors review their surgical techniques, the biophysics involved, the physics of fiberoptic handpieces for the delivery of argon laser energy, and their results.

Argon↗
PubMed1996

Ossiculoplasty by interposition of a minor columella between the tympanic membrane and stapes head.

This study analyzes short- and long-term results of 436 ossiculoplasties accomplished by a minor columella sculptured in the remnants of the incus and placed between the tympanic membrane and stapes head. Most cases were operated on by a transcanal approach through an ear speculum, under local anesthesia. Cases in which an associated mastoidectomy was performed to remove diseased tissue are excluded. The residual air-bone gap was < 20 dB in 86.1% of cases 2 months after surgery, in 77.0% 1 year later, and then remained stable over time, even in patients seen 5 to 15 years after the operation. Complications were rare. A total sensorineural hearing loss occurred in two cases (0.4%), the cause of which remained unexplained. Other complications included a high-frequency hearing loss in 10 (2.3%) cases, tinnitus in 12 (2.7%), and transitory vertigo in two (0.4%). We conclude that this type of ossiculoplasty is a simple but adequate procedure for primary restoration of hearing in chronic otitis media if the stapes is intact and mobile.

Adolescent↗
PubMed1996

Vein graft in stapes surgery.

Sealing the opening of the oval window during stapes surgery is essential; it prevents postoperative complications, such as perilymph fistula and sensorineural hearing loss. In this small series of 269 cases with otosclerosis, tympanosclerosis, and congenital ossicular abnormality, vein grafting was used to seal the opening of the footplate. Hearing improvement after surgery was acceptable, and none had total hearing loss or perilymphatic fistula. World literature from the last half of this century on grafting the oval window is reviewed. Absorbable gelatin sponge (Gelfoam) seems to be causing more complications, so its use is highly discouraged. Temporalis fascia, fat, and perivenous loose areolar tissue have been used by different authors at different times in footplate surgery. The opening created in the oval window during stapes surgery must not be left uncovered.

Audiometry, Pure-Tone↗
PubMed1996

Barotraumatic fracture of the stapes footplate.

We present a rare case in which barotrauma led to fracture of the stapes footplate and perilymph fistula, resulting in sudden severe sensorineural hearing loss and tinnitus. Surgical repair in this case resulted in excellent hearing recovery. The aetiology and management of inner ear barotrauma and stapes injury is discussed. We believe that early exploration and repair of suspected perilymph fistulae optimises hearing recovery.

Adult↗
PubMed1996

Barotrauma after stapes surgery: a survey of recommended restrictions and clinical experiences.

OBJECTIVE: To identify a consensus on the postoperative barorestrictions after stapes surgery and to examine the clinical barotrauma experience within this patient population encountered by the surveyed physicians. DATA SOURCE: A 34-item survey was developed, allowing for detailed analysis of physician demographic data, practice characteristics, surgical experience, and clinical experience with barotrauma after stapes surgery. The postoperative restrictions addressed by the survey included those for air travel, snorkeling, and scuba diving. Recommendations for the use of ventilation tubes and hyperbaric oxygen therapy were investigated as well. STUDY SELECTION: Surveys were mailed to 419 active members of the American Otological Society and the American Neurotology Society as listed in the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) 1994-1995 Conjoint Directory. A total of 284 (67.8%) surveys were returned, of which 53 were not sufficiently completed and were excluded in the statistical analysis. DATA EXTRACTION: The demographic data and clinical experience were analyzed to determine statistical association with the postoperative recommendations using chi 2 or Fisher's exact tests. The kappa statistic was used as a measure of consistency between physicians' recommended restriction for a specific activity after a stapedectomy or stapedotomy. CONCLUSION: No consensus was demonstrated as to restrictions from activities such as air travel, snorkeling, or scuba diving. Despite this lack of consensus, no significant difference was demonstrated in the prevalence of barotrauma reported within the responding physicians' practices based on their individual recommendations for these activities.

Adult↗
PubMed1997

Stapes surgery: results when performing a moderate number of stapedectomies.

Stapes surgery: results when performing a moderate number of stapedectomies. The short term results of 40 small fenestra stapedectomies over a period of five years are presented. Closure of the air-bone gap is within 10 db in 62.5%, within 20 db in 90% of the cases, with a mean gain in air-bone gap of 27.2 db. Stapes surgery is difficult if not regularly performed. The concept of a learning curve is demonstrated in this study.

Adult↗
PubMed1997

Functional hearing results in revision stapes surgery.

OBJECTIVE: The object of our study was to review the results of 63 revision stapes surgeries performed from 1978 to 1994. RESULTS: The most common cause of failure was the displacement of the prosthesis, followed by ossicular chain problems and oval window fibrosis. Postoperative hearing improvement within a 20-dB air-bone gap was achieved in 58.7% of the patients. Hearing gain was closely linked to the operative findings. Better results occurred when prosthesis problems were found. Evaluation of the hearing results by using Glasgow benefit plot gave evidence of symmetric normal hearing in only 40% of the cases. CONCLUSIONS: Prevention of the cause of failure during the primary stapes surgeries, lessening the surgical trauma, seems to provide the most favorable hearing results.

Adult↗
PubMed1997

Does the stapes reflex remain the same after Bell's palsy?

OBJECTIVE: The authors investigated the integrity and function of nervus stapedius 1 year after facial paralysis. STUDY DESIGN: Patients with Bell's palsy were observed prospectively for 1 year and compared with healthy patients. SETTING: The follow-up of patients was done in the outpatient clinic and tests were applied in the audiology unit. PATIENTS: The mean age of 32 patients was 41.03 years. Eight of 32 patients were grade II (25%), 11 were grade III (35%), and 13 were grade IV (40%) according to House-Brackman grading system. The mean age of the control group (10 persons) was 36.5 years. INTERVENTION: Contralateral stimulus was used in acoustic reflex test at 500 and 1,000 Hz with 80-, 90-, 100-, and 110-dB stimulus intensity. Tests were applied in three ways: normal position, eye-closed position, and grin position. Tests were done in the first 15 days of facial paralysis and repeated at least 1 year thereafter. The millimeter difference in amplitude of impedance recording of middle ear between the normal ear and paralyzed ear was accepted as criterion. MAIN OUTCOME MEASURES: There were 6- to 9-mm amplitude differences between normal side and healed side of grade IV patients with 100- and 110-dB stimuli. RESULTS: In the second test (after 1 year), statistically significant differences were present between control group and grade IV patients on 1,000 and 500 Hz frequencies with 100- and 110-dB stimulus intensity (p < 0.05). There were no significant differences between grade II and control group and between grade III and control group. CONCLUSIONS: A permanent partial denervation is present on the stapedial nerve, especially after grade IV paralysis, and it affects the function of stapes muscle in high decibel sounds. But it does not affect the stapes reflex threshold. No synkinetic innervation was found in the authors' patient group with their test method.

Acoustic Impedance Tests↗
PubMed1998

[Lasers used by a young surgeon for stapes surgery].

We report the results of the first 38 stapes operations performed by a young surgeon. He achieved a perfect closure of the air-one gap (within 10 dB) in 89% of the patients operated on with the laser, compared with 65% of the patients operated on without laser. We discuss the significance of this difference, taking into account the multiple factors influencing the results. In our opinion, the laser helps a young surgeon to accelerate his learning curve in stapes surgery.

Adolescent↗
PubMed1997

Utilization of nickel-titanium shape memory alloy for stapes prosthesis.

A new type of stapes prosthesis made of nickel-titanium shape memory alloy wire was developed and its biocompatibility was examined in 24 ears of 12 cats. The prosthesis was implanted at the long crus of the incus. The incus was examined 27-355 days after operation. In 23 ears, the prosthesis was found macroscopically well implanted at the aimed position. In one ear the prosthesis was found to be dislocated and in another the prosthesis was slightly loosened. The incudes were removed and five specimens were prepared for scanning electron microscopy and the other specimens were observed under light microscopy. Histological studies revealed severe bone resorption of the long crus in the dislocated case and moderate bone resorption in the slightly loosened case. These bone resorptions were found to be caused by the inadvertent removal of the mucosal membrane during the implant operations. In seven ears under a light microscope and in one ear under a scanning electron microscope, slight bone resorption as bone erosion was seen at the contact area of the prosthesis. This bone resorption was induced by the mechanical pressure of the prosthesis and was not progressive due to fading of the pressure of the prosthesis. With the exception of pressure induced bone erosions, there was no progressive bone resorption which was prosthesis induced. The biocompatibility of the nickel-titanium alloy stapes prosthesis with the long crus of the incus was proved. The prosthesis should be implanted loosely at the long crus of the incus without removal of the mucosal membrane.

Animals↗
PubMed2000

[A new self-retaining titanium-gold stapes prosthesis].

Various aspects of stapes surgery have been improved since its introduction in 1958 by Shea. However, fixation of the prosthesis on the long process of the incus remains difficult. Furthermore, the functional result of crimping cannot be predicted. Necrosis of the lenticular process still occurs. A new stapes prosthesis has been developed with the Kurz Co. The use of titanium allowed an innovative design: titanium has a shape memory, and a clip was constructed which uses this memory for fixation on the incus. Two new instruments were also developed to facilitate application of the prosthesis: a prosthesis inserter and a prosthesis crimper. The clip does not strangulate the incus; it is attached only to the superior and inferior surface of the incus, which are the crucial locations for mechanical transmission of the piston-like movements of the ossicular chain. Avoidance of circumferential attachment should reduce the risk of incus necrosis. Once the clip is pushed onto the incus no further crimping is necessary. The piston is of pure gold, as in this company's gold piston which has been in use for many years. In future the prosthesis may be all-titanium.

Gold↗
PubMed1984

Duane's syndrome associated with crocodile tear and ear malformation. A case of stapes anomaly and its reconstruction.

Duane's syndrome is a congenital eye movement disorder characterized by marked limitation or absence of abduction, variable limitation of adduction, and narrowing of the palpebral fissure with retraction of the globe on attempted adduction. We treated a patient with bilateral Duane's syndrome associated with crocodile tear and external, middle, and inner ear anomalies. Exploratory tympanotomy showed an absence of the oval window and a rudimentary superior structure of the stapes that was connected to the abbreviated incudal lenticular process with connective tissue. A small hole was drilled into the vestibulum and the ossicular chain was reconstructed by inserting a Teflon wire piston to minimize the air-bone gap. Pertinent literature is reviewed, and the pathogenesis of Duane's syndrome and the aspect of concomitant anomalies are discussed.

Abnormalities, Multiple↗
PubMed1980

Vestibular fenestration and stapedioplasty in congenital stapes and vestibular window abnormality.

In this paper the results of vestibular fenestration and stapedioplasty in cases of congenital stapes deformity and vestibular window abnormality are presented. The problems in the surgical reconstruction of the middle ear transmission system, especially the importance of the areal ratio between the tympanic membrane and the vestibular window and the ossicular lever action, are discussed. The following conclusions were reached: 1. The area of the new vestibular window should be greater than 2.0 x 1.0 mm, i.e., one third of normal. 2. Hearing gain was about 1.5 times better after incus-stapedioplasty than after malleus-stapedioplasty. It is recommended that an effort be made to adopt incus stapedioplasty whenever possible.

Adolescent↗
PubMed2004

Stickler syndrome type I and Stapes ankylosis.

OBJECTIVE: To report a successful stapedectomy for stapedial fixation in a patient with Stickler syndrome type I (COL2A1). SETTING: University Hospital Department for Otology, Pathology, Ophthalmology and Clinical Genetics. STUDY DESIGN: A clinical and genetic evaluation of a mother and daughter focusing mainly on the otological, ophthalmological, histological and genetical aspects. INTERVENTION: A stapedectomy was performed successfully. RESULTS: Hearing impairment improved after stapedectomy. Postoperatively a shift in high-frequency threshold wa seen related to the stapedectomy. A new mutation in COL2A1 gene was dectected. CONCLUSION: Stapedial fixation can be the cause of hearing impairment in Stickler syndrome type I (COL2A1). The hearing impairment can be improved by stapes surgery.

Abnormalities, Multiple↗
PubMed2006

[Malleostapedotomy in the pathology of the incudomalleolar complex combined with fixation of the stapes].

INTRODUCTION: Stapes fixation combined with disorders of the incudo-malleolar complex disorders requires a sound transmission reconstruction that often is difficult to solve. This circumstance can turn up in several pathologies and also in revision surgery for otosclerosis. PATIENTS AND METHODS: We present our experience with four patients that underwent to malleostapedotomy with removal of the malleus anterior ligament and the malleus anterior apophysis. RESULTS: We discuss the previous findings in each case. Two patients reached a gap closure and the other two patients obtained an auditive gain without complete gap closure. DISCUSSION: We set out the ethiology of malleus and incus hipomobility. We do a bibliographic review on the results of this technique in revision stapedectomy.

Female↗
PubMed2001

Results of stapes surgery on patients with osteogenesis imperfecta.

Osteogenesis imperfecta (OI) is a heterogeneous group of connective tissue disorders. The classic triad of blue sclerae, spontaneous fractures and hearing loss is known as the Van der Hoeve and De Kleyn syndrome. Between 1989 and 2000, six patients with OI presented with conductive hearing loss. Five of them proceeded to stapedotomy. All the patients who had surgery had significant hearing gain. None of the patients had any complications. This study presents a higher incidence of spontaneous fractured crura as the cause of the conductive hearing loss than previously reported, and that the presence of a fractured crura with mobile footplate can be anticipated by the presence of a large conductive hearing loss. The pre- and postoperative results are presented and support the view that stapes surgery in OI can have encouraging results, provided the operator anticipates the possibility of a fractured crura and a mobile footplate.

Adult↗
PubMed1995

[The value of computed tomography in persistent balance disorders following the use of stapes prostheses].

10 of 150 patients had persistent vertigo after implantation of stapes prostheses. These patients were evaluated by high-resolution CT in the axial and coronal plane. Scans showed in all cases findings which related to the symptoms. The CT findings were proved intraoperatively in 9 cases. A new indirect sign of a perilymphatic fistula is described in form of an air bulla at the end of the prosthesis. Retympanotomy could be planned better with the help of HR-CT.

Evaluation Studies as Topic↗