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PubMed1985

Histologic variants in otosclerosis.

A study of 164 temporal bones with otosclerosis revealed stapes fixation in 123. Large lesions (4 mm or larger) were characterized by involvement of the cochlear endosteum, increased cellular activity, and bone resorption. Anatomical sites of predilection were: 1. anterior to the oval window, 2. margins of the round window, and 3. apical-medial wall of the cochlea. Two of the five ears with cochlear otosclerosis were from a patient with severe bilateral hearing loss. The size, cellular activity, and location of otosclerotic lesions showed no correlation with the magnitude of sensorineural hearing loss. Subjects over 69 years of age had greater bone-conduction losses than age-matched controls. Nine ears showed occlusion of the round window niche.

Adult↗
PubMed1986

Temporal bone showing polyarteritis nodosa, otosclerosis, and occult neuroma.

The clinical and general histopathologic manifestations of systemic vasculitis of the polyarteritis nodosa type are well known. Although hearing loss associated with polyarteritis nodosa has been reported, only two temporal bone studies are available. The findings in a 60-year-old man with well-documented hearing loss who had rheumatoid arthritis, polyarteritis nodosa, and otosclerosis are presented. Polyarteritis nodosa extensively involved the subarcuate arteries and arteries of the facial canal. There were decreased nerve fibers to and sensory cells in the crista of the semicircular canals and macula of the utricle and saccule. Focal and diffuse atrophy of the stria vascularis and decreased cellularity in the spiral prominence and ligament were present. There was a loss of outer hair cells. Otosclerosis involved the left and right oval window niches (bilateral stapedectomy had been performed). There was a small Antoni type A neuroma of the superior division of the vestibular nerve on the left.

Hearing Loss, Bilateral↗
PubMedDate not supplied

Collagen fibres in otosclerosis and in osteogenesis imperfecta tarda. A light and electron microscopic study.

Skin biopsies taken from patients with osteogenesis imperfecta tarda and otosclerosis were compared blind by light- and electron microscopy with similar biopsies taken from normal volunteers in an effort to find common pathological features in the collagen fibres from the two patient groups, thus corroborating the theory that osteogenesis imperfecta and otosclerosis might be due to a common genetic anomaly in the form of a mesenchymal hypoplasia. We were not able to find differences in structure or quantity of the collagen-, elastic- or reticular fibres between normals and the two patient groups. We cannot, on the basis of our previous work and on the present morphological investigation, give support to the above-mentioned theory.

Adolescent↗
PubMedDate not supplied

Histomorphometric analysis of iliac trabecular bone in otosclerosis.

With the aim of investigating whether patients with otosclerosis suffer from a generalized bone disorder, a histomorphometric analysis of trabecular bone from the iliac crest was performed. Iliac crest biopsies from 10 patients with otosclerosis and 20 normal controls were obtained after tetracycline double labelling and examined by histomorphometry. No significant differences were found in the estimates of density and remodeling of bone between patients and sex and age-matched normal controls. Qualitatively the bone specimens showed no signs of any generalized bone disorder.

Adult↗
PubMedDate not supplied

HLA antigens in patients with otosclerosis.

Seventy-four (50 females and 24 males) consecutively sampled patients with otosclerosis were tissue typed for HLA A and B antigens. There was no significant increase in any A or B antigen, but the frequency of B40 was significantly lower (p less than 0.05) in patients than in blood donors. No significant difference in HLA antigen frequencies was found between men and women, or in patients with vs. without a family history of otosclerosis.

Female↗
PubMed1980

The cochlear component in operated otosclerosis after a mean period of 16 years. A follow-up study.

107 patients operated on for otosclerosis were studied after an average of 16 years after the operation. The mean age-corrected bone thresholds measured after the postoperative stabilization period and at the follow-up examination did not differ significantly. Our results support the opinion that, in cases of operated otosclerosis, the sensorineural component follows the clinical course of presbyacusis.

Adult↗
PubMed2002

[Long-term results after stapes surgery for otosclerosis].

In a retrospective study, hearing results before and after stapedectomy were compared with those of individuals not undergoing surgery. Subjects were 51 patients who were surgically diagnosed as having otosclerosis and who could be followed up for more than 5 years. Of these, 31 contralateral ears surgically diagnosed as otosclerotic did not undergo surgery (nonsurgery group). Nineteen ears underwent stapedectomy using a wire loop prosthesis (TS group). Thirty-eight ears underwent stapedotomy using a wire piston prosthesis (SFS group). In the nonsurgery ear group, the last air conduction threshold deteriorated equally at all frequencies. Deterioration of the high frequency air conduction threshold seemed to cause deterioration of the bone conduction threshold. Deterioration of the last air conduction threshold in the SFS group was somewhat less than that in the TS group, although not significantly. In patients up to 50 years old, the air conduction loss/year in the SFS group was significantly less than that in the nonsurgery ear group at 0.25 kHz and 0.5 kHz. The bone conduction loss/year in the SFS group was less than that in both the TS group and nonsurgery ear group at 1 kHz. No significant differences was seen in either air or bone conduction loss/year among the 3 groups in patients 51 years or older. We concluded that stapedotomy and wire piston prosthesis are the surgical techniques of choice in the treatment of otosclerosis.

Adult↗
PubMed1999

[Variations and incidents encountered during stapes surgery for otosclerosis].

The aim of this study was to report peroperative variations and incidents encountered during stapes surgery for otosclerosis, from a retrospective series of 293 primary stapedectomies performed in the ENT department of Fondation Adolphe de Rothschild, from january 1990 to december 1996. Pitfalls related to anomalous states or pathological conditions were observed in 81 cases (27.6%) and were classified as follow: narrow oval window niche (12.3%), floating footplate (5.8%), obliterative otosclerosis (4.7%), ossicular chain problems (3.4%), loss of perilymph and/or intravestibular bleeding (2.4%), fixed malleus (1%). Hearing results following surgery are presented. Because of the relatively high incidence of these unforeseen events, the otologic surgeon must be well trained and experienced to be able to use all reasonable stapedectomy or stapedotomy techniques.

Ear↗
PubMed1999

[Otosclerosis surgery: a series of 227 cases. Introduction of CO2 laser].

OBJECTIVES: To evaluate the effects of the size of the footplate opening on the hearing results in surgical treatment of otosclerosis and the use of CO2 laser in this indication. PATIENTS AND METHODS: 190 patients with otosclerosis underwent 227 procedures between 1986 and 1995. Hearing results and symptoms were analyzed to compare the different procedures: 140 stapedectomies, 87 Fisch's stapedotomies, 35 of them with manual perforator, 52 of them with CO2 laser. RESULTS: Air/bone gap closure within 10 dB was obtained in 87, 92 and 97 percent of stapedectomies and in 80, 84 et 90 percent of stapedotomies after 3 months, 1 and 3 years (NS). Bone conduction was improved in 81, 80 et 63 percent of stapedectomies and 87, 97, 60 percent of stapedotomies after the same time (NS). Air/bone gap closure within 10 dB was obtained in 75 and 80 percent of manual perforator stapedotomies and in 84 and 88 percent of CO2 laser stapedotomies after 3 months, and 1 year (NS). Bone conduction was improved in 78 and 96 percent of manual perforator stapedotomies and 95 and 100 percent of CO2 laser stapedotomies after the same time (NS). No facial palsy or prolonged vertigo occurred. There was one case of anucusis following a stapedectomy. CONCLUSION: Although both stapedectomy and stapedotomy produced equivalent air/bone gap closure, reduction of inner ear trauma was noted with Fisch's stapedotomy. CO2 laser technique is a safe procedure, which optimizes the Fisch's stapedotomy.

Adolescent↗
PubMedDate not supplied

[Incidence of otosclerosis in a subpopulation of Galicia, Spain].

We have made a prospective study of the patients who were analysed for the first time at the Outpatients Department in the Otolaryngology Section of the University Complex Hospital of Santiago de Compostela all along 1997. A whole of 1,050 patients have been included in this study. The most frequent diagnosis were neurosensorial hypoacusis (29.1%), chronic otitis media (27.8%) and in the third place, otosclerosis. This appeared in 83 cases, which represents a 8.7% of the fulfilled diagnosis. The incidence for our health area reached 19 new cases of otosclerosis per 100,000 inhabitants a year. When only the number of stapedectomies were included, it reached a 7.8%. The prevalence of the female population was clear, reaching a 77%. Diagnosed patients' age was from 30 to 50 years, although a considerable percentage (37%) were older. The incidence reached by our studies is higher to other values previously published. We think this responds to the fact that the health system covers all the population and to the importance a good audition is given nowadays.

Adolescent↗
PubMed2000

[Analysis of the resonant frequency of the middle ear in otosclerosis].

Multifrequency tympanometry scans pressures and frequencies from 226 to 2000 Hz to analyze the resonant frequency of the middle ear, which determines the balance between stiffness and mass. We studied 143 patients (a total of 200 ears) diagnosed as otosclerosis at the E.N.T. Service of Santiago de Compostela University Hospital Complex, and 136 control subjects. The mean age of patients was 47.7 years; women were predominant (female/male ratio 2.25:1). The mean duration of the disease was 10.4 years. Using the Virtual model 310 tympanometer, we calculated the resonant frequency through the susceptance tympanogram, corresponding to the minimal frequency at which the central notch of the tympanograrn was equal to or less than the negative tail. The mean resonant frequency was 1230 Hz, the tympanometric amplitude was 88.32 daPa, and the admittance of the middle ear was 0.63 cc. We confirmed an increase in the resonant frequency in patients with otosclerosis compared with normal subjects (1132.33 Hz), and a decrease in the admittance of the middle ear. The relation between the two values was significant.

Acoustic Impedance Tests↗
PubMed2000

Fenestration surgery for otosclerosis: CT findings of an old surgical procedure.

Numerous attempts to deal surgically with otosclerosis were made before the current method of stapedectomy with stapes prosthesis was established. We report a case with unique CT findings of a patient who underwent fenestration surgery for otosclerosis in the early 1940s. Recognition of this old surgical procedure on the imaging scans may avoid misdiagnosis of labyrinthine fistulae or middle and inner ear malformations.

Aged↗
PubMedDate not supplied

[Inverted acoustic reflex in patients with otosclerosis].

The presence of inverted acoustic reflex (IAR) was observed in patients with surgically-confirmed otosclerosis. The characteristics of intensity, stimuli, and thresholds were analyzed. IAR was found in 90% of the patients stimulated on the same side at 110 dB HL with 500, 1000, and 2000-Hz frequencies. The intensity of IAR was higher at 1000-Hz and in patients with mixed hearing loss. We conclude that the detection of IAR in patients with conductive hearing loss and normal tympanic membrane allows otosclerosis to be differentiated from other pathologies that produce ossicular chain fixation. This sign can be used as a diagnostic test because it has a high positive predictive value, 98% in our series.

Adult↗
PubMedDate not supplied

[Cochlear otosclerosis].

A rare case of cochlear otosclerosis is described with clinical data, CT and RMN images. The aim of this note is to improve the acknowledgement of in vivo otosclerosis physiopathology.

Adult↗
PubMed2002

[The evaluation of results of the surgical treatment in patients with otosclerosis].

The authors presents hearing results in 216 patients with otosclerosis surgical treated. Averaged cochlear reserve in relation to the bone conduction determined before operation was used in this study. The follow-up was 2 months-10 years. Good results was proved in more than 93%, no change in 5% and deterioration in less than 2%. The cochlear reserve up to 10 dB obtained in 59% of all patients. The cases when no changes (and deterioration) after surgical treatment correlated to large anomaly evolution in the structure of the hole drum and extensive focus with otosclerosis.

Bone Conduction↗
PubMed2002

[Otosclerosis surgical techniques and results in 150 patients].

OBJECTIVES: To analyze outcome after otosclerosis surgery with stamedeotomy with blood clot sealing. PATIENTS AND METHODS: Otosclerosis surgery was performed in 150 adult patients between 1997 and 1999 by five surgical teams (70% of the procedures were performed by senior surgeons) and followed for 18 months. Stapedotomy was carried out under general anesthesia with an intrameatal approach in 96% of the cases. Stapedotomy (n=120, 80%) was performed with a drill in 141 cases and by laser in 9 (6%). Ninety percent of the Teflon prostheses had a 0.4 mm diameter and a 4.5 mm length. The footplate opening was sealed with blood clots. Venous interposition (n=30, 20%) was performed in the event of partial or total stapedectomy which occurred in spite of an initial stapedotomy attempt. RESULTS: The preoperative air-bone gap (ABG) was 32 +/- 10.3 dB. The gain in air conduction was 25 +/- 11.7 dB with 75% of the patients having more than 15 dB gain. The ABG was 10 +/- 5.4 dB with 73% of the patients having less than 5 dB gain. The interaural difference was 0.5 +/- 14.1 dB and the bone conduction (BC) variation was 1 +/- 7.5 dB. Functional failures were related to significant intralabyrinthine bleeding and revision procedure. The following factors had not effect on outcome: i) stapedotomy versus partial or total stapedectomy, footplate opening sealed by clots or vein, ii) diameter of the stapedotomy and/or the prosthesis, iii) surgical procedure performed by a junior surgeon. CONCLUSION: Sealing the stapedotomy opening with blood clots appears to provide reliable and reproducible functional outcome that remains stable over time. In this study, changing from partial to total stapedectomy with vein interposition did not modify the functional outcome.

Adult↗
PubMed2003

[Perilymphatic effusion as a complication of otosclerosis].

INTRODUCTION: Stapes gusher means the leakage of perilymphatic liquid when opening the perilymphatic cistern. The perilymphatic liquid with a high pressure gushes with a great flow out of the cistern when the stapedotomy is executed. Otosclerosis surgery sometime brings to light abnormal contact between the inner ear and the sub-arachnoidian spaces in patients who didn't presented ear malformations. It's a very rare event (1/1000) which is different from a much more common and more moderate form of perilymphatic liquids high pressure (1/200). About 4 clinical observations, we compared our experience with other authors in specialist reviews. PURPOSE OF THE STUDY: About four observations, we confronted our experience with that of the literature. MATERIAL AND METHODS: Retrospective study between 1971 and 1998. It was about 3 males and 1 female, without antecedent except one of them who had been operated 5 years before for the opposite ear without gusher but without good audiometric result. They presented a conductive deafness with no answer of the stapedial reflex. We had 4 geysers during the platinotomia which were sealed with some connective tissue. RESULTS: Two patients had a post operative complete sensory hearing loss, one, a sensitive decline of the conduction thresholds (average 50 dB), the last one kept his bone conduction level with a mild sensory hearing loss. The most recent case had a scanner preoperatively which had not shown abnormality except for the focus of otosclerosis. DISCUSSION: Perilymphatic gusher is an unpredictable event that can not be diagnosed before the surgery, nether with clinical facts nor radiological elements. This involves serious consequences concerning not only the continuation of the surgical operation and the prognostic of the hearing but also concerning the danger of secondary meningeal infections. The best way to proceed in case of favourable cases consists in fitting the ossicular prothesis into the stapedotomy, when it's not to wide. Pieces of muscle can be used in some cases, taped on with biologic glu. Various techniques are used to lower the pression of the cerebrospinal liquid: hypertonic solutes, diuretic drugs, lumbar diversion. In all cases, it is necessary to start a wide spectrum antibiotic treatment and a vaccination against pneumococcis. CONCLUSION: The surgeon has to know all the option of the treatment when confronted with this situation in order to try to avoid tricky defect of the inner ear.

Adult↗
PubMed1992

[Carhart's effect; a study of postoperative outcome of 47 surgically treated cases of otosclerosis].

The Carhart Effect can explain a bone conduction improvement after stape surgery in otosclerosis, because of the mechanical factors in transmission of sound vibrations. The authors have studied 47 cases of total stapedectomy for otosclerosis to point out this bone conduction improvement. A correlation between the bone conduction improvement and others parameters has been searched: a statistic correlation between pre-operative bone curve and the 1000 Hz bone conduction improvement has been found.

Audiometry↗