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PubMed2003

[Postoperative complications in stapes surgery. An analysis of medical and economic aspects].

With the establishment of DRGs in the German hospital financing system, knowledge of therapy costs and the suitability of therapies for reservation planning and medical cost management becomes important. Stapes surgery and its postoperative treatment is relatively standardised. The timing of intervention can be planned and serious complications are rare. We carried out a retrospective evaluation of all stapedectomies performed in Bochum University ENT department over 1 year ( n=46). The course of treatment and differences in expenditure between standard and complicated cases were recorded. We used the official calculation model of the Deutsche Krankenhausgesellschaft and the homogeneneity of the investigated patient groups was evaluated statistically. A total of 6.52% of all patients had complications, mainly temporary inner ear hearing deficit and vertigo, resulting in additional therapy. The average cost of a stapedectomy was 964 EUR for regular cases. The costs if complications occurred ranged from 1,754 EUR to 3,504 EUR. Statistical evaluation showed a strong homogeneity in the group of patients without complications, especially for the costs of surgery. Stapedectomy is suitable for flat rates due to the standardisation of therapy and the homogeneity of the patients. The profitability depends on the future DRG-flat-rate. Stapedectomy surgery seems to be appropriate for resource and cost management. To avoid unfair future losses for the hospitals, a mechanism of compensation for very expensive medical complications should be developed.

Adolescent↗
PubMed2005

[Displacement of a stapes piston as a consequence of whiplash injury with head impact].

We report the case of a 60 year old patient suffering from a displacement of her stapes piston after a rear-end collision with whiplash injury. Immediately after the accident she complained hearing loss and tinnitus. During the following days, the patient developed vertigo with lateropulsion. Diagnostic tympanoscopy showed a piston dislocation with migration into the vestibulum as a result of the blunt head trauma.

Female↗
PubMed2003

An unusual complication of stapes surgery: profuse bleeding from the anteriorly located sigmoid sinus.

Major bleeding during stapes surgery is a rare condition. The anterior course of the sigmoid sinus is comparatively common in contracted mastoid bones, but rare in good pneumatized temporal bones. We report a case of an unusual anterior course of the vertical segment of the sigmoid sinus, which led to profuse bleeding during a stapedotomy operation. The 34-year-old female patient presented with conductive-type hearing loss in the right ear. During the operation, the unintentional sliding movement of a blunt curette caused injury to the anteriorly positioned sigmoid sinus, which was separated from the posterior wall of the external auditory canal by an extremely thin shell of bone. Profuse bleeding from the sigmoid sinus was controlled by pushing the middle part of the oxidised regenerated cellulose inside the lumen, without compromising the sinus flow. After bleeding was restrained, the stapedotomy operation was completed successfully. During the 1-year follow-up, there was neither an air-bone gap nor a sensorineural hearing loss in pure tone audiogram.

Adult↗
PubMed1988

X-linked mixed deafness with stapes fixation in a Mauritian kindred: linkage to Xq probe pDP34.

Molecular linkage analysis was undertaken on a large Mauritian kindred with X-linked mixed deafness, stapes fixation, and perilymphatic gusher (X-LDSF). DNA probe pDP34 (DXYS1) was tightly linked to the disorder, with a lod score of 6.32 at zero recombination. This observation indicates that the gene for this form of deafness maps to the Xq13-q21.1 region and has important implications for carrier screening and antenatal diagnosis.

Chromosome Mapping↗
PubMed1983

Clinical features of female heterozygotes in the X-linked mixed deafness syndrome (with perilymphatic gusher during stapes surgery).

A new pedigree with 9 obligate and 10 probable female carriers of the X-linked mixed deafness syndrome is presented. In the male the syndrome is characterized by a perilymphatic gusher during stapes surgery, a severe progressive mixed hearing loss and lack or strong reduction of vestibular responses. Four of the 9 obligate heterozygote females show similar but much milder audiological abnormalities. The other five obligate female carriers have a normal audiogram. None of the obligate female carriers showed vestibular abnormalities such as observed in the affected males. Ten females, sisters of affected males, have a chance of 50% to be heterozygote carriers. Five of these females have also a hearing loss, the other 5 have normal audiograms. The relevance of these findings for genetic counseling and for identification of affected males is discussed.

Deafness↗
PubMed1996

Hearing loss as a complication of stapes surgery.

During a 10-year period (1984-1994) 1229 stapes operations for otosclerosis were performed at our respective institutions by experienced surgeons well trained in the various techniques. Procedures included 691 stapedectomies, 234 small-fenestrae stapedotomies, and 304 revision operations. These primary and revision cases resulted in 20 ears with severe sensorineural hearing loss or anacusis noted during the immediate postoperative period. This article will critically evaluate those procedures that resulted in profound hearing loss and attempt to determine possible reasons for this occurrence. It is hoped that these data will allow surgeons to identify before and/or during surgery patients at risk for development of this complication and therefore decrease the overall morbidity rate of this exacting procedure.

Adolescent↗
PubMedDate not supplied

Morphologic and immunohistochemical observation of otosclerotic stapes: a preliminary study.

Stapes with otosclerotic lesions obtained during stapedectomies were examined with light microscopy, histochemistry, immunochemistry, and electron microscopy to elucidate the cellular mechanism(s) involved in this disease process. Three types of lesions were identified: cellular (spongiotic), fibrotic, and sclerotic. The cellular type is characterized by monocyte, macrophage, osteoblast, and osteoclast recruitment and their activation. Macrophage recruitment is an early event of otosclerosis. The fibrotic type is characterized by extensive fibrosis of the bone, and the sclerotic type is characterized by a paucity of bone cells. Cytochemical results showed a large accumulation of granular substances positive for periodic acid-Schiff stain along the edge of the marrow spaces coinciding with ultrastructural calcospherite deposits, suggesting that glycosaminoglycans are involved in the mineralization process. Acid phosphatase is largely localized in the osteoclasts, but a sporadic diffusion of this enzyme was observed in the demineralizing front of the preotosclerotic lesion. Immunoglobulin G and complement C3 were colocalized in pericapillary tissue, suggesting deposit of immune complex in the spongiotic lesion. This finding indicates a possibility that immune mechanisms are involved in otosclerosis.

Acid Phosphatase↗
PubMed2005

[Imaging of postoperative failures and complications in stapes surgery for otosclerosis].

Otosclerosis (OS) is a dysplasia of the otic capsule located in most cases on the anterior margin of the oval window or fissula ante fenestrum. Progressive conductive hearing loss is the major clinical symptom, due to stapedovestibular ankylosis. Stapes surgery is the only effective treatment of OS, with excellent functional results in more than 90% of cases. However, failures and complications of the surgery may be observed. In theses cases, the etiologic work-up includes imaging evaluation (CT and MRI). Imaging findings are extremely useful in the therapeutic decision. Surgical failure represents 80% of the causes for surgical revision. The main causes of failure are: displacement of the prosthesis, fibrosis of the oval window, erosion of the long process of the incus, incudo-mallear dislocation, obliterative otosclerosis. CT is essential for diagnosis. MR imaging is rarely indicated in the work-up of surgical failures. Labyrinthine complications account for less than 20% of surgical revisions. Etiologies of labyrinthine complications are: intravestibular penetration of the prosthesis, perilymphatic fistula, intra-vestibular granuloma, labyrinthitis and intravestibular bleeding. CT and MRI are complementary for the work up of these complications.

Adult↗
PubMed2000

Effect of freezing and thawing on stapes-cochlear input impedance in human temporal bones.

The use of thawed frozen temporal bones offers advantages over fresh bones in the study of middle-ear and inner-ear mechanical function. We show, however, that freezing and thawing can cause a reduction in the magnitude of the input impedance of the stapes and cochlea Z(SC) in unfixed temporal bones from human cadavers of as much as a factor of 3-10 over the frequency range 25 Hz-7 kHz. Z(SC) is considered to be the sum of the impedances of the annular ligament Z(S) and the cochlea Z(C) and has been shown to be controlled by Z(S) below 1 kHz and by Z(C) at higher frequencies [Merchant et al., 1996. Hear. Res. 97, 30-45]. Experiments in which the inner ear was opened, drained, and refilled identified two mechanisms by which freezing and thawing can cause a reduction in the magnitude of Z(SC) (/Z(SC)/). Freezing can allow air to enter the inner ear, with the result that /Z(C)/ is reduced above about 1 kHz; and freezing can reduce /Z(S)/ which causes a reduction in /Z(SC)/ below 1 kHz. Changes in the phase angle of Z(SC) induced by freezing were small and were consistent with changes in /Z(SC)/. Removing air from the inner ear returned Z(C) to near its value in fresh bones, but /Z(SC)/ remained lower in some thawed bones by a factor of 2-3. Investigations of middle-ear function for which Z(SC) is critical should use fresh temporal bones only or should allow for the possible reduction in /Z(SC)/ in thawed frozen bones.

Aged↗
PubMed1989

Occasional stapes surgery--a Norwegian experience.

The past history of, and current trend in, stapes surgery are reviewed, and experience from a personal series of 128 procedures over an 18 year period is presented. Results are frequently poorer than many surgeons and their patients anticipate, and more stringent pre-operative case selection and centralisation of surgical activity would appear desirable. Amplification has become a more acceptable management alternative for some patient categories.

Adolescent↗
PubMed1990

Stapes surgery: implications for training.

The worldwide decline in surgery for otosclerosis had been reflected by a similar pattern here in Great Britain. Unless we are prepared to accept poorer results than have formerly been achieved, we will have to adopt measures to ensure that the skills of stapes surgery are transferred to the next generation of surgeons. Using the results of our experience, at the Queen Elizabeth Hospital, over the past 18 years, I have examined the implications for surgical training and for the management of future patients with otosclerosis.

Clinical Competence↗
PubMed1999

Factors affecting hearing results after stapes surgery.

Factors affecting auditory improvement after stapes surgery were investigated retrospectively on a study group of 106 otosclerotic ears (86 subjects). While the closure of the air-bone (A-B) gap after surgery was good at 2 kHz and 4 kHz, it was poor at 8 kHz and at frequencies lower than 1 kHz. Under 1 kHz, the lower the frequency, the worse the A-B gap after surgery. Stapedotomy and partial stapedectomy showed better post-operative hearing gain at 4 kHz than total stapedectomy. Total stapedectomy scored significantly better at 250 Hz and 500 Hz than stapedotomy. There was a close relationship between the pre-operative and post-operative A-B gap at frequencies under 1 kHz. The smaller the pre-operative A-B gap, the better the closure of the post-operative A-B gap at these frequencies. It was speculated that otosclerotic ears with a larger pre-operative airbone gap might have another lesion in the middle ear other than the oval window.

Adult↗
PubMed2006

A bifid intra-tympanic facial nerve in association with a normal stapes.

A rare facial nerve anomaly was incidentally discovered whilst performing a tympanoplasty and ossicular reconstruction on a patient with an acquired unilateral conductive hearing loss. The nerve was seen to bifurcate and straddle a normal stapes superstructure as it ran posteriorly through the middle ear, a unique and as yet unreported combination. This case highlights the importance of vigilance regarding facial nerve anatomical variations encountered during middle-ear surgery thus avoiding inadvertent damage. The purported embryological mechanism responsible for such anomalies of the intra-tympanic facial nerve is discussed.

Facial Nerve↗
PubMed2005

Incus and stapes necrosis associated with diabetes mellitus.

Chronic otitis media is often associated with ossicular defects, the most frequent being necrosis of the long process of incus. Except for infection and cholesteatoma; trauma and local pressure by chorda tympani are uncommon causes leading to incus erosion. In the literature, no case of incus necrosis has been reported associated with type II diabetes mellitus (DM). A patient is presented in this report with incus and stapes suprastructure necrosis and associated type II DM who was admitted to the out-patient clinic with complaints of conductive hearing loss.

Adult↗
PubMed2006

Role of stapes surgery in improving hearing loss caused by otosclerosis.

The aim of our study was to evaluate the functional results of stapes surgery and to compare the effectiveness of small fenestra stapedotomy with that of total stapedectomy in improving hearing in patients affected by otosclerosis. Three hundred and fifty-seven consecutive ears, in 265 patients affected by otosclerosis, underwent surgery. All cases underwent either primary small fenestra stapedotomy (group A, 196/357, 54.91 per cent) or stapedectomy (group B, 161/357, 45.09 per cent). After surgery, 256/357 (71.71 per cent) cases showed a 0-20 dB gap. There were no significant differences in hearing results between the two groups at either early or late post-operative assessment. The mean post-operative pure tone average and air-bone gap results were slightly greater for group B than for group A, at both early and late post-operative assessments, but these differences were not statistically significant. Therefore, in group A, the mean pure tone average at 4 kHz significantly improved, from 56.60 to 47.66 dB at early post-operative assessment and to 52.98 dB at late post-operative assessment. Our study suggests that the technique of microtomy of the oval window is able to improve hearing results especially at high frequencies.

Adult↗
PubMed2002

A study of the intra-operative effect of the Argon and KTP laser in stapes surgery.

The intraoperative effect of the Argon and KTP laser was studied on 20 patients who had primary stapes surgery under local anaesthetic; 10 had Argon and 10 had KTP laser stapedotomy. Symptoms of inner ear disturbance such as dizziness and tinnitus were systematically recorded during the laser procedure. Both dizziness and tinnitus were relatively uncommon when the laser was used on the promontory. When the laser was used to transect the posterior crus, all the patients reported transient dizziness, probably from the thermal effect through the posterior crus into the inner ear. However, tinnitus was unusual during this stage. When the laser was used to fenestrate the footplate, only 30% of patients reported a transient dizziness as less laser energy was used. On the other hand, 55% of the patients experienced tinnitus during this stage, which indicates an acoustic effect on the inner ear. There is no difference between the Argon and KTP laser.

Anesthesia, Local↗
PubMed1994

[Measuring vibrations by laser doppler vibrometry of the human tympanic membrane after stapes fixation].

At times preoperative diagnosis of otosclerosis can prove difficult. Even the objective measurement of the stapes reflex is not very conclusive in patients suffering from more severe hearing loss. Laser-Doppler vibrometry measures the velocity or amplitude of the tympanic membrane (umbo) vibrations. Laser-Doppler vibrometry has a sensitivity that is highly by the factor 10(4) than tympanometry. The herewith presented examinations show, that there is a correlation between the frequency patterns of the displacement amplitudes and experimentally simulated otosclerosis.

Fourier Analysis↗
PubMed1991

[Tensile strength of the stapes footplate. Pressure-induced inner ear damage in operated ears caused by TORP prostheses?].

In a recent textbook concerning ear surgery, it is recommended to put some connective tissue on the stapes footplate before introducing a TORP. This should avoid penetration of the shaft of the TORP into the inner ear. Experimental studies were performed to estimate the pressure needed for pushing a TORP through the footplate. We found those pressures to be much higher than those which might occur by increasing pressure in the external ear canal or decreasing pressure in the middle ear. This means that perforations of the footplate are not due to one big event of changing pressure, but rather by chronic irritations or foreign body reactions. Anyhow, we consider the protection of the footplate by a layer of connective tissue to be very useful.

Ear, Middle↗