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At least 307 records · Page 17Linked to original sources
PubMed2001

Efficacy of evaluation of audiometric results after stapes surgery in otosclerosis. II. A method for reporting results from individual cases.

To standardize the reporting of hearing results after middle ear surgery, the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery proposed 2 levels of guidelines: level 1 for reporting summary data and level 2 for reporting raw data. The Committee encourages the reporting of raw data from each individual case. However, in studies in which the examined population is too large, this can yield difficulties. With respect to this point, we designed a method for a simple visual presentation of hearing results in an attempt to provide data from each individually operated ear in a patient group. In this method the relation between the preoperative and postoperative bone-conduction levels is evaluated to assess overclosure and iatrogenic cochlear damage, and the relation between postoperative gain in air conduction and the preoperative air-bone gap is evaluated as a measure of technical success rate. This results in 2 plots, which we called the Amsterdam Hearing Evaluation Plots. Audiometric data from 451 stapes operations were used to demonstrate the use of the Amsterdam Hearing Evaluation Plots.

Adult↗
PubMed2001

Efficacy of evaluation of audiometric results after stapes surgery in otosclerosis. I. The effects of using different audiologic parameters and criteria on success rates.

The Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery proposed guidelines to provide more uniformity in reporting hearing results after middle ear surgery. One of the proposals was to include the hearing thresholds at 0.5, 1, 2, and 3 kHz in a 4-frequency pure-tone average (PTA) and to use post-operative bone-conduction (BC) levels rather than preoperative BC levels in describing postoperative air-bone gaps (ABGs). The hearing results of 451 stapes operations were evaluated to analyze to what extent the choice of different audiologic criteria affects success rates. It appeared that choice of PTA significantly affects postoperative gain in air-conduction thresholds and ABG levels. If one takes the improvements in speech-reception thresholds as the gold standard, the gain in air-conduction correlates best with a gain in speech-reception threshold if a higher frequency, such as 3 or 4 kHz, is included in a 4-frequency PTA. Also, choice of preoperative or postoperative BC in computing postoperative ABGs had a significant effect on the mean postoperative ABG levels, showing more favorable results with the use of preoperative BC thresholds.

Adolescent↗
PubMed1995

Value of computed tomography in patients with persistent vertigo after stapes surgery.

RATIONALE AND OBJECTIVES: The value of computed tomography was evaluated in 14 patients with persistent vertigo after otosclerosis operation. METHODS: High-resolution computed tomography was performed with 1-mm slice thickness and table feed in the axial and coronal planes. RESULTS: Computed tomography scans showed in 13 case findings that related to symptoms. An air bubble at the end of the prosthesis as a new, indirect sign of a perilymphatic fistula was found in 6 cases. An incorrect position of the stapes prostheses was diagnosed in 7 patients. One patient had recurrence of otosclerosis, and two others developed scarring around the prosthesis. In 1 case, an incus necrosis was found. Some patients showed two signs simultaneously. The computed tomography results were confirmed by retympanotomy in 12 cases. CONCLUSIONS: Computed tomography proved to be a valuable method in the diagnosis of persistent vertigo after otosclerosis operation. The indication for a repeat operation was facilitated by the use of computed tomography.

Follow-Up Studies↗
PubMed1999

Stapes surgery in a residency training program.

OBJECTIVES: Determine parameters for successful stapedectomy and whether this procedure can be performed safely by residents in a teaching hospital. STUDY DESIGN: Retrospective analysis of techniques and results for 71 stapedectomy procedures. MATERIALS AND METHODS: Charts were reviewed for technique, audiological test results, complications, operative time, and anesthetic used. RESULTS: Overall, closure of the air-bone gap at 10 dB was achieved in 87% of patients. Use of general anesthesia and a laser-assisted, small-fenestra technique allowed residents to complete more operations. No severe sensorineural hearing loss was noted. CONCLUSIONS: Residents can safely and successfully perform stapes surgery using a laser-assisted, small-fenestra technique.

Clinical Competence↗
PubMed1989

Stapes surgery in osteogenesis imperfecta.

Between 1968 and 1986 stapes surgery has been performed in the Nijmegen University Department of Otorhinolaryngology in 11 patients (14 ears) with osteogenesis imperfecta. Detailed information about pre- and postoperative hearing levels, findings at surgery, and the follow-up period are presented. In most cases the stapedectomy has been successful.

Follow-Up Studies↗
PubMed2002

Photoacoustic effects of carbon dioxide lasers in stapes surgery: quantification in a temporal bone model.

HYPOTHESIS: The use of the CO2 laser in stapes surgery creates sound waves that could damage hearing. BACKGROUND The application of a laser to any medium has absorption, reflection, and thermal effects. To date, the majority of research on the safety of CO2 laser stapedotomy has focused on the thermal effects of the laser alone. Because of the properties of the CO2 laser, its absorption also presents some risk to the inner ear. This absorbed energy can be converted to photoacoustic or photochemical effects. The goal of this paper is to measure these photoacoustic effects (sounds) produced by the CO2 laser. METHODS: Using a variety of settings, a Sharplan 150 XJ Laser and a Contour model Erbium:YAG laser were applied to the oval window of human temporal bones. Perilymph was simulated by fixing the temporal bone in a normal saline bath. Photoacoustic waves were measured by a hydrophone 2 mm beneath the oval window. Measurements were made with and without a simulated tissue seal over the window. RESULTS: No detectable sounds were created below 4 watts (continuous mode) or 60 mJ (superpulse mode). Above those settings, intensities of 90 dB sound pressure level and higher were detected when the laser was applied directly to the perilymph. With the tissue seal in place, no detectable sounds were identified. The accuracy of this model was confirmed by comparing these results with previously published results using the Erbium:YAG laser. CONCLUSIONS: Below 4 watts in continuous wave mode and below 60 mJ in superpulse mode, any sound generated by the laser is small. Above these thresholds, however, impact sounds are produced that could result in threshold shifts with repeated applications.

Humans↗
PubMed2003

Long-term hearing results after stapes surgery: a 20-year follow-up.

OBJECTIVE: The aim of this study was to evaluate the results of stapes surgery after 20 years of follow-up and to compare the results between large fenestra versus small fenestra stapedotomy. STUDY DESIGN: Retrospective clinical study. SETTING: Tertiary referral center (university hospital). PATIENTS: One hundred forty-two patients with otosclerosis treated by surgery. INTERVENTION: Eighty patients had a total stapedectomy with House-wire prosthesis and 62 patients a stapedotomy with Teflon-piston prosthesis. MAIN OUTCOME MEASURES: Preoperative, postoperative, and long-term hearing thresholds were compared. Patients filled in a questionnaire about the impact of surgery on the quality of life and postoperative symptoms. RESULTS: The long-term pure tone average improvement did not differ significantly between the techniques compared with the preoperative values. The air-bone gap tended to enlarge as a function of time. The change in the pure tone average was 0.9 dB per year for both techniques. In the questionnaire, some patients reported vertigo, tinnitus, loud noise intolerance, and taste disturbances. Loud noise intolerance seemed to persist in the long term. Surgery had no effect on preoperative tinnitus. CONCLUSIONS: There were no statistically significant differences between the techniques regarding hearing results. Over the long term, both techniques are safe and effective in restoring hearing and improving quality of life.

Adult↗
PubMed2005

Ferromagnetic movements of middle ear implants and stapes prostheses in a 3-T magnetic resonance field.

HYPOTHESIS: A 3-T magnetic resonance field may cause motion or displacement of middle ear implants not seen in studies with 1.5-T magnets. BACKGROUND: Previous publications have described the safety limitations of some otologic implants in 1.5-T magnetic resonance fields. Several company-wide recalls of implants were issued. No studies to date have been reported for otologic implants within a 3-T magnetic resonance field, nor have there been comparisons with a 1.5-T field strength. METHODS: Eighteen commonly used middle ear implants and prostheses were selected. In Part 1, the prostheses were placed in Petri dishes and exposed to a 3-T magnetic resonance field. In Part 2, the particular prostheses that showed movement in Part 1 were placed into their intended use positions within temporal bone laboratory specimens and exposed to a 3-T field. Both parts were repeated in a 1.5-T field. RESULTS: In Part 1, three prostheses moved dramatically from their start positions when exposed to the 3-T magnetic resonance field. In Part 2, the three particular prostheses that showed movement in Part 1 showed no gross displacement or movement from their start positions within the temporal bone laboratory specimens. No implants moved in the 1.5-T field in either Part 1 or Part 2. CONCLUSION: Certain stapes prostheses move dramatically in Petri dishes in 3-T fields. When placed into temporal bone laboratory specimens, the same prostheses show no signs of movement from the surgical site in a 3-T field, and it appears that the surgical position holds the implants firmly in place. Results of published 1.5-T field studies should not be used directly for safety recommendations in a 3-T magnetic resonance. Heat, voltage induction, and vibration during exposure to the magnetic resonance fields should be considered as additional possible safety issues. Preference should be given to platinum and titanium implants in manufacturing processes and surgical selection.

Contraindications↗
PubMed2005

Stapes ankylosis in a family with a novel NOG mutation: otologic features of the facioaudiosymphalangism syndrome.

OBJECTIVE: To report the phenotype-genotype correlation in a Belgian family that was ascertained to have a novel missense mutation in the NOG gene mapping to chromosome 17q22. STUDY DESIGN: To describe the phenotype, a retrospective case study was performed based on the otologic, audiologic, ophthalmologic, and radiologic data of the mutation carriers of the NOG gene. SETTING: Tertiary referral center. PATIENTS: All members of a Belgian kindred who carried the novel missense mutation in the NOG gene (NOG, Trp205Cys [W205C]; 1426G>C). INTERVENTIONS: Diagnostic otologic and ophthalmologic examination, audiometric analysis, and radiologic imaging. MAIN OUTCOME MEASURES: Phenotype-genotype correlations. RESULTS: All five mutation carriers had a typical facies. Bilateral proximal symphalangism and hyperopia were present in 80%. Five of 10 ears also had progressive early-onset conductive hearing loss caused by stapes ankylosis. CONCLUSIONS: So far, 14 independent NOG mutations have been identified. The autosomal dominant disorder described in the present family was caused by a novel NOG missense mutation (NOG, Trp205Cys [W205C]; 1426G>C). The phenotype correlated well with the facioaudiosymphalangism syndrome. The mutation carriers demonstrated progressive multiple joint fusions, hyperopia, early-onset conductive deafness, and a typical facies.

Abnormalities, Multiple↗
PubMed1983

Perilymphatic gusher and stapes surgery. A predictable complication?

The cases of 3 patients who had 'perilymph gushers' following stapes surgery are reported. The similarities in their clinical histories and examinations are discussed. All 3 were males and had progressive mixed deafness presenting in early childhood. Polytomography revealed anomalies in both the vestibule and internal auditory meatus in 1 patient; the stapedial reflex was unexpectedly large in all 3. Further preoperative evaluation of these features in other patients and patients affected by the X-linked deafness syndrome is indicated in order to assess the validity of the above criteria.

Adult↗
PubMed2006

Middle ear cavity and ear canal pressure-driven stapes velocity responses in human cadaveric temporal bones.

Drive pressure to stapes velocity (V(st)) transfer function measurements are collected and compared for human cadaveric temporal bones with the drive pressure alternately on the ear canal (EC) and middle ear cavity (MEC) sides of the tympanic membrane (TM), in order to predict the performance of proposed middle-ear implantable acoustic hearing aids, as well as provide additional data for examining human middle ear mechanics. The chief finding is that, in terms of the V(st) response, MEC stimulation performs at least as well as EC stimulation below 8 kHz, provided that the EC is unplugged. Plugging the EC causes a reduced response for MEC drive below 2 kHz, due to a corresponding reduction of the pressure difference between the two sides of the TM. Between 8 and 11 kHz, the MEC drive transfer functions feature an approximately 17 dB drop in magnitude below the EC drive case, the cause of which remains unknown. The EC drive transfer functions reported here feature significantly less magnitude roll-off above 1 kHz than previous studies [with a slope of -2.3 vs -6.7 dB/octave for Aibara et al., Hear. Res. 152, 100-109 (2001)], and significantly more phase group delay (134 vs 62 micros for Aibara et al.).

Artifacts↗
PubMed1975

Artificial stapes - a fourteen-year report.

This paper is based on 3,500 cases of otosclerosis operated on during the past 14 years restoring the continuity of the ossicular chain by means of an artificial stapes. Eighty percent showed practically a closure of the air-bone gap. There was no hearing gain in 17 percent of the patients, many of which showed reversal to preoperative levels. Three percent of the patients suffered sensori-neural hearing loss and 1 percent cophosis. Necrosis of the incus occurred in 0.3 percent of the patients and perilymphatic fistula in 0.2 percent. Only one case of inflammatory granuloma was observed as a complication of stapedectomy.

Artificial Organs↗
PubMedDate not supplied

Fistula of stapes footplate caused by pulsatile cerebrospinal fluid in inner ear malformation.

Congenital malformations of the inner ear are well described, though the combination with cerebrospinal fluid (CSF) leaks remains controversial. In this paper a case of a bilateral Mondini malformation with a CSF otorrhea on one side is reported. The malformed stapes contains a perforation in the middle of the footplate and associated thinning analogous to a pothole in a mountain stream. The histological findings support the hypothesis of pulsatile flow of CSF as origin of the perforation of the footplate.

Cerebrospinal Fluid Otorrhea↗
PubMed2004

Stapes surgery in osteogenesis imperfecta in Finland.

We present the surgical findings and audiometric results of ear surgery performed between 1961 and 2002 on 33 Finnish patients (43 operations) with osteogenesis imperfecta (OI). The mean age at the time of the first operation was 30.1 years. The typical surgical findings were a thick, fixed, or obliterated footplate, thick and vascular mucosa with an excessive tendency to bleed, and elastic, fractured, or atrophic stapes crura. As compared with previous studies, the hearing gain was poorer and the remaining postoperative gap was greater for the 43 operations analyzed. The results of this nationwide study, however, may not be directly comparable with operative results of non-population studies. On the other hand, the hearing gain in our study was better in university hospitals than in central hospitals and, furthermore, was comparable with that of previous studies after surgery performed by a single surgeon in a university hospital. Conductive hearing loss related to OI may be successfully treated with surgery in most patients. The rarity of the disease, leading to small annual numbers of operations, the variable surgical findings, and the profuse bleeding tendency of the middle ear, as well as the audiometric results in this study, support centralization of ear surgery in OI patients.

Adolescent↗
PubMedDate not supplied

Trends and profiles in stapes surgery.

Stapedectomy has become recognized as the procedure of choice in the surgical treatment of clinical otosclerosis. Based on results obtained in stapes surgery performed in 1977, profiles were established for hearing improvement, vertigo, tinnitus, chorda tympani injury and temporary threshold shift of high tones. Tympanometric and stapedial muscle reflex tests in cases of proved clinical otosclerosis also are discussed. The profiles indicate that stapedectomy performed on a regular basis and under ideal conditions is highly successful for the improvement of hearing. The incidence and probable causes of complications are presented and discussed. This study reveals, however, that the number of new patients with otosclerosis has decreased steadily since its peak in 1964. Should the number of surgical cases continue to diminish, it may be impossible for the practicing otologist to maintain sufficient expertise for the performance of an occasional stapedectomy. Also, it may become impossible to provide sufficient experience in otosclerosis surgery for all trainees in otolaryngology.

Acoustic Impedance Tests↗
PubMedDate not supplied

Hair-clip type piston artificial stapes and the safety auger.

A hair-clip artificial stapes prosthesis was used in the surgical treatment of otosclerosis in 22 ears. In nine patients followed an average of 15 months the air-bone gap stabilized at 6-7 dB. Further advantages of the prosthesis design and technique are that they minimize the risk of ischemic necrosis and perilymphatic fistula formation.

Female↗
PubMedDate not supplied

Perception of sound through direct oscillation of the stapes using a piezoelectric ceramic bimorph.

An ossicular vibrator of original design made from a piezoelectric ceramic bimorph was described. To test its effectiveness, the vibrator was temporarily implanted during tympanoplasty in four selected patients who had suffered extensive damage to the middle ear. By use of a special applicator, the vibrator was connected to either the stapes or the columella and was then excited by pure tone and speech signals. The subjects could hear well with the vibrator and distinguish speech signals. Thus a vibration threshold curve and a vibratory speech discrimination score were obtained. Comparing these with the results of conventional audiometry, the vibrator proved to be a highly efficient sound-conducting device. This study furthermore calls attention to some practical applications of this device, particularly to the possibility of implanting the vibrator as part of an implantable hearing aid.

Adult↗