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PubMed2004

Primary and revision stapedectomy in elderly patients.

PURPOSE OF REVIEW: This review discusses the recent literature on short- and long-term hearing results for primary and revision stapes surgery on young and elderly patients. RECENT FINDINGS: The epidemiology of clinical otosclerosis appears be changing. The average age for patients undergoing primary stapes surgery is increasing, and the percentage of revision stapedectomies is increasing. As the population ages, the otologist should expect to perform more surgeries on elderly patients. Short- and long-term hearing results after primary stapes surgery are good, regardless of age. Approximately 90% of patients obtain closure of their ABG to within 10 dB. Long-term results demonstrate that hearing decreases over time after stapedectomy at a rate of approximately 1 dB/y for both young and elderly populations. Sensorineural hearing loss accounts for most of this decrease and a relatively small ABG is maintained in many patients. However, at least 10 to 20% of patients will redevelop conductive hearing loss after undergoing stapes surgery and will desire revision surgery to correct this hearing loss. With modern otologic equipment, including the laser, most patients undergoing revision stapedectomy should obtain significant improvement in hearing, regardless of age. SUMMARY: Primary and revision stapedectomy are beneficial procedures in the elderly population. The success rate is similar to that in the younger population with otosclerosis.

Aged↗
PubMed1994

Small fenestra stapedotomy for management of progressive conductive deafness.

Progressive conductive deafness may be caused by otosclerosis, a bone fixation of the stapes that causes reduced transmission of sound from the eardrum to the inner ear. Since the late 1950s, stapes surgery has been considered the treatment of choice for alleviating hearing loss due to otosclerosis. Over the past 20 years, there has been a decline in the number of stapes operations done. As a result, there are concerns regarding results of the stapes surgery done today compared with the results of such surgery when it was done more frequently. In this paper, I retrospectively review 603 stapes operations that I did at the Farrior Ear Clinic between 1981 and 1991. There were 484 primary stapes operations. Hearing results using the small fenestra technique showed closure of the air-bone gap to 10 dB or less in 96% of cases. During the same period, 119 revision operations were also done. The surgical technique, operative findings, and hearing results are presented. In both primary and revision stapes surgery, the hearing results of this series are compatible with the results of earlier, larger series. My findings show that stapes surgery is still the treatment of choice for hearing loss due to otosclerosis.

Adolescent↗
PubMed2006

[Delayed facial nerve palsy after otologic surgery].

Delayed facial nerve palsy (DFP) is rarely experienced after otologic surgeries that do not directly touch the facial nerves, such as tympano-mastoidectomy, cochlear implants, and stapes surgery, and is troublesome to both surgeons and patients if it happens. Here, we report 7 cases of DFP, including one case that developed DFP after endolymphatic sac surgery. The ratios of occurrence were as follows: 0.7% (2/305) for tympano-mastoidectomy, 0.8% (3/354) for cochlear implant, 0.4% (1/260) for stapes surgery and 1.0% (1/98) for endolymphatic sac surgery. All otologic surgeries, except for endolymphatic sac surgery, exposed the chorda tympani, and all surgeries, except for stapes surgery, underwent drilling for a mastoidectomy. Furthermore, DFP was always observed ipsilaterally to the operated ear after otologic surgeries and was never seen after benign parotid tumor surgery or total laryngectomy. Therefore, there may be a strong relationship between DFP and the procedures, used during otologic surgeries.

Adult↗
PubMed2003

Characteristics and postoperative course of tinnitus in otosclerosis.

OBJECTIVE: The aim of this study was to determine the incidence and characteristics of tinnitus in otosclerosis and to evaluate the effects of stapes surgery on the course of this symptom. SETTING: Hospital ear, nose, and throat department. PATIENTS AND DESIGN: Sixty-two patients (65 ears) scheduled to undergo stapes surgery were prospectively enrolled in the study. The incidence and characteristics of tinnitus were recorded using a specific questionnaire before surgery and 1 and 6 months after surgery. The frequency range of the tinnitus was noted during standard audiometric examination. Audiometric data were recorded following AAO-HNS guidelines. INTERVENTION: All patients underwent stapes surgery (either stapedectomy or stapedotomy). RESULTS: Tinnitus was present at the time of surgery in 74% of the patients. It was severely disabling for patients in 24.6% of the cases. In patients who were preoperatively free of tinnitus, no tinnitus was noted in the postoperative period (1 and 6 months). In patients with preoperative tinnitus, tinnitus ceased in 55.9%, decreased in 32.4%, remained the same in 8.8%, and increased in 2.9% 6 months after surgery. Statistical analysis did not reveal any significant prognostic factors regarding the course of tinnitus. CONCLUSIONS: In otosclerotic patients who will undergo stapedectomy to improve hearing, stapes surgery may also improve tinnitus in most of them.

Adult↗
PubMed2005

[Surgical experience by 95 malformed stampedes and otosclerosis].

OBJECTIVE: To investigate the effect of stapes surgery for conductive hearing loss with intact tympanic membrane and eustachian tube. METHOD: Stapes surgery data of 95 conductive hearing loss patients, which with intact tympanic membrane and eustachian tube, was retrospective analyzed,and the surgical effect of otosclerosis, middle ear deformities and external canal stenosis was summarized. RESULT: Postoperative (4 weeks after the surgery) pure tone threshold test demonstrated that the effect of Vestibulotomy was better than incus-footplate connection (incus and footplate is connected by a cortical bone ) ( P <0.05). The surgery to the patients with external canal stenosis was better than those with otosclerosis or middle ear deformities ( P <0.05). There was no statistic significance between physiological stapedectomy and Vestibulotomy. The follow-up of 1-3 years showed that the pure tone threshold of 8 out of 14 cases reverted to the preoperative level, while the hearing improvement in the other cases still remained. CONCLUSION: Stapes surgery to the patients with stapes-oval window deformities is of significance compared with those with otosclerosis.

Adolescent↗
PubMed2002

Management of otosclerosis in the UK.

The last 30 years has seen a gradual change in the management of otosclerosis. The aim of this study is to evaluate the current practice among British otolaryngology consultants using a questionnaire, and to compare it with the practice reported in a survey 8 years ago. A total of 353 valid responses (64.5%) were available for analysis. The overall trend is towards centralization, with a reduction in the number of surgeons undertaking stapes surgery (49.9%). The majority of consultants (81.3%) who undertake stapes surgery would operate for a unilateral conductive loss and 75.1% would undertake bilateral stapes surgery. Stapedotomy is the operation of choice (82%), with a few consultants performing partial or rarely total stapedectomies. Postoperative restrictions and follow-up times vary widely amongst surgeons, with the senior surgeons tending to be more conservative than the younger consultants.

Consultants↗
PubMedDate not supplied

History of stapedectomy.

The history of stapedectomy dates back to the late 19th century. Although otologists in both the United States and Europe were performing stapedectomy operations at the turn of the century, stapes surgery ceased in the early 1900s. This paper examines the early and recent history of stapes surgery. An analysis of the early literature elucidates the reasons for the previous discontinuation of stapes surgery.

Europe↗
PubMed2006

[Far-advanced otosclerosis].

OBJECTIVES: The aim of this study was to report a series of patients with far-advanced otosclerosis who were unable to benefit from hearing aids. Among patients with profound hearing loss, it is particularly useful to diagnose far-advanced otosclerosis even if relatively rare, because stapes surgery can improve hearing to a level allowing conventional hearing aid use (sometime the only choice before cochlear implant). MATERIAL AND METHODS: We retrospectively reviewed the charts of 7 patients (9 operated ears) in order to highlight diagnostic criteria, surgical indications and results of stapes surgery (stapedectomy or stapedotomy). RESULTS: Diagnosis of far-advanced otosclerosis was based on clinical presentation, course of hearing loss, positive family history of otosclerosis, and results of CT scan which was helpful in all the cases. Obliterative otosclerosis was found in 55% of the cases. Success of stapes surgery was observed in 89%, with no significant difference between stapedectomy or stapedotomy. CONCLUSION: Although rare, far-advanced otosclerosis must be diagnosed because patients can benefit from stapes surgery (and subsequently fitting of appropriate hearing aids).

Aged↗
PubMed2004

Gold and titanium in the oval window: a comparison of two metal stapes prostheses.

OBJECTIVE: The objective of this study was to evaluate the hearing results of stapes surgery with 2 different full metal stapes prostheses. STUDY DESIGN: Retrospective analyses were carried out on the pre- and postoperative hearing results obtained after primary stapedotomy with 2 different prostheses. PATIENTS: We studied 106 patients with otosclerosis treated by stapes surgery. INTERVENTION: Fifty-three patients had a stapedotomy with a gold piston and 53 patients received a titanium piston after stapedotomy. MAIN OUTCOME MEASURES: The results were compared according to mean audiometric parameters. Furthermore, the individual audiologic results were demonstrated with the Amsterdam Hearing Evaluations Plot (AHEP). This method is a visual presentation of the hearing result for each operated ear. RESULTS: These AHEPs showed that the heavier gold piston (shaft Ø 0.4 mm and weight 10192.0 microg) gives more overclosure gain (28.3%) than the lightweight (shaft Ø 0.4 mm and weight 2541.0 microg) titanium piston (9.4% cases of overclosure). CONCLUSIONS: Because of the different properties of the 2 pistons (gold very malleable, titanium rather stiff), a choice can be made for different anatomic or pathologic situations in the operated middle ear. The "overclosure effect" of the gold piston is higher compared with the titanium piston.

Adult↗
PubMed2001

Diving after stapedectomy: clinical experience and recommendations.

OBJECTIVES: Much controversy exists concerning the risk of inner ear barotrauma after stapes surgery in scuba and sky divers. Uniform consensus has not been established regarding poststapedectomy barorestrictions. The purpose of this study was (1) to determine the prevalence of adverse auditory and/or vestibular sequelae in patients after stapedectomy related to scuba and sky diving, and (2) to offer recommendations on barometric exposure after stapes surgery. STUDY DESIGN: Survey questionnaires were mailed to 2222 patients who had undergone stapedectomies at a single tertiary otologic referral center between 1987 and 1998. Two hundred eight of the initial 917 respondents (22.7%) had snorkeled, scuba, or sky dived after stapes surgery, and 140 of these responded to a second questionnaire detailing dive protocols, otologic symptoms, and their relationship to the diving activities. Of the 140, 28 had scuba or sky dived. Their survey data were analyzed and their medical records were reviewed. RESULTS: Four of the 22 scuba divers (18.1%) experienced otologic symptoms at the time of diving. These included otalgia on descent (3/22; 13.6%), tinnitus (1/22; 4.5%), and transient vertigo on initial submersion (1/22; 4.5%). One patient had sudden sensorineural hearing loss and vertigo develop 3 months after scuba diving, which he related to noise exposure. He was subsequently found to have a perilymph fistula, which was successfully repaired. Of the 9 patients who sky dived, 2 patients (22.2%) reported otologic symptoms during the dive. No significant diving-related long-term effects indicative of labyrinthine injury were seen in any of the 28 patients. CONCLUSIONS: Stapedectomy does not appear to increase the risk of inner ear barotrauma in scuba and sky divers. These activities may be pursued with relative safety after stapes surgery, provided adequate eustachian tube function has been established.

Adolescent↗
PubMed2002

Incidence and characteristics of otosclerosis in the Japanese population.

OBJECTIVE: Otosclerosis is thought to be quite an uncommon disease in Japan. However, in recent years the incidence of this disease seems to have increased. Here we report about the characteristics and incidence of this disease in the Japanese population who underwent stapes surgery in our department. METHODS: A total of 80 patients (115 ears), who underwent stapes surgery by a single surgeon in 21 years and 8 months were included in this study. RESULTS: The incidence of clinical otosclerosis was found to be 0.22% among the outpatients with ear disease. During the first half of the period, the ratio of stapes surgery/tympanoplasty was less than 0.05. While, during the second half of this period, this ratio had increased to 0.08. The average number of stapes surgery performed in the first half period was 3.7 ears/year, and that in the second half was 6.8 ears/year. In contrast to otosclerosis in Caucasians, pure tone threshold in lower frequencies was much higher than that of higher frequencies (except for 8000 Hz). However, the improvement of the threshold after surgery was not so different from that reported in Caucasians. CONCLUSIONS: Taken together, the present results clearly demonstrate that the incidence of otosclerosis in Japan has been increasing. Moreover the rise in the slope of the conduction curve at higher frequencies may be a reflection of the pathological characteristics of otosclerosis in Japanese population, which is less invasive and has limited otosclerotic foci in the temporal bone.

Adult↗