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At least 37 records · Page 2Linked to original sources
PubMed2003

Middle-ear mechanics of Type III tympanoplasty (stapes columella): I. Experimental studies.

OBJECTIVE: To investigate the mechanics of Type III tympanoplasty by developing a cadaveric temporal bone model. BACKGROUND: Type III stapes columella tympanoplasty involves the placement of a tympanic membrane graft, usually made of temporalis fascia, directly onto the stapes head. The procedure is usually done in conjunction with a canal wall down mastoidectomy. Postoperative hearing results vary widely, with air-bone gaps of 10 to 60 dB. The structural features responsible for the wide range in hearing results have not been systematically investigated. METHODS: Canal wall down Type III procedures were performed in eight cadaveric temporal bones. Acoustic stimuli were presented in the ear canal, and round window velocity VRW (used as an index of hearing) was measured, while systematically varying stapes mobility, mechanical properties of tympanic membrane graft, and tightness of connection between tympanic membrane graft and stapes. The effect of interposing a thin cartilage disc between the tympanic membrane graft and stapes head was also assessed. RESULTS: When the middle ear was aerated and the stapes was mobile, VRW was 15 to 30 dB lower than in an intact, normal ear. Stapes fixation led to a significant reduction in VRW; reduction was greatest at low frequencies. There was little effect of varying the tightness of connection between the tympanic membrane graft and stapes head. Sound energy was transmitted from the graft to the stapes as long as the graft was in physical contact with the stapes head. Different tympanic membrane graft materials with a range of mechanical properties (stiffness and mass) resulted in little variation in VRW. Interposing a thin cartilage disc between the tympanic membrane graft and stapes improved VRW in the lower frequencies by 5 to 10 dB. The authors hypothesize that the disc acted to increase the effective vibrating area of the graft. CONCLUSIONS: The feasibility of using a cadaveric temporal bone model to study the mechanics of Type III tympanoplasty was demonstrated. A mobile stapes and aerated middle ear were essential for a successful Type III tympanoplasty. There was little effect of varying the mechanical properties of the tympanic membrane graft or changing the tightness of connection between the graft and stapes head. Improved results were achieved by interposing a thin cartilage disc between the graft and stapes head to increase the effective vibrating area of the graft.

Aged↗
PubMed2003

Middle ear mechanics of Type III tympanoplasty (stapes columella): II. Clinical studies.

OBJECTIVES: To determine the structural features that are responsible for the large variation in postoperative hearing results after Type III stapes columella tympanoplasty, to compare the clinical results after Type III tympanoplasty with predictions based on experimental investigations using a temporal bone model, and to investigate the effectiveness of a modification in surgical technique for Type III reconstruction. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. INCLUSION CRITERIA: The ear was healed with an intact tympanic membrane graft; the status of the stapes was known, whether mobile or fixed; and the postoperative status of aeration of the middle ear was known, whether aerated or not. MAIN OUTCOME MEASURE: Air-bone gap at frequencies 250, 500, 1,000, 2,000 and 4,000 Hz. RESULTS: In ears with temporalis fascia graft onto stapes head: mobile stapes and aerated middle ear (n = 34), mean air-bone gaps at audiometric frequencies were 15 to 30 dB, consistent with predictions of the experimental model; mobile stapes and nonaerated middle ear (n = 16), large air-bone gaps of 35 to 55 dB; fixed stapes and aerated middle ear (n = 4), large air-bone gaps of 30 to 50 dB; fixed stapes and nonaerated middle ear (n = 2), large air-bone gaps of 30 to 70 dB. In ears with a fascia-cartilage graft onto stapes head, where a thin disc of meatal cartilage, 0.3 to 0.5 mm thick and 4 to 6 mm in diameter was interposed between the fascia graft and the stapes head: mobile stapes and aerated middle ear (n = 9), mean air-bone gaps at audiometric frequencies were 10 to 25 dB, about 5 dB better at 250, 500, and 2,000 Hz than in ears with only a fascia graft ( <0.05), improvement consistent with that observed experimentally when a thin cartilage disc was used in the temporal bone model, hypothesis that the cartilage increased the effective vibrating area of the graft; mobile stapes and nonaerated middle ear (n = 2), air-bone gaps were 40 to 50 dB. CONCLUSIONS: Large air-bone gaps of 30 to 70 dB occurred as a result of stapes fixation, nonaeration of the middle ear, or both. When the stapes was mobile and the middle ear was aerated, a fascia graft resulted in air-bone gaps of 15 to 30 dB. Interposing a thin disc of cartilage between the fascia graft and stapes head to improve the effective vibrating graft area gave better hearing, with air-bone gaps of 10 to 25 dB. The clinical Type III results were consistent with predictions based on experimental investigations of mechanics of the Type III procedure in a temporal bone model.

Acoustic Impedance Tests↗
PubMed2007

WITHDRAWN: Management of Congenital Incudostapedial Anomalies in Stapes Surgery.

OBJECTIVES:: The management of developmental anomalies of the ossicular chain and otic capsule in stapes surgery tests the otologist's diagnostic skills and flexibility in technique and prosthesis choice. Although congenital malleus fixation and perilymph gusher are important clinical entities that have received considerable attention in the otolaryngology literature, congenital anomalies of the incus and stapes are less well described, can often be subtle, and have a distinct influence on management choice and hearing outcome. STUDY DESIGN AND PATIENTS:: A review of more than 200 stapes procedures yielded eight cases of identified congenital anomalies of the stapes or incudostapedial complex including congenital absence of the oval window with malformed incus and stapes, columellar-type stapes with promontory fixation, stapes superstructure fixation to the fallopian canal, and malformed incus with stapes superstructure fixation to the promontory. The developmental anatomy and surgical technique in each case are reviewed and hearing outcome is presented. RESULTS:: The surgical technique used in each case varied depending on the nuances of the ossicular anomaly and whether both the stapes and incus were affected. All eight ears (seven patients) that underwent a stapes procedure for either an isolated congenital stapes anomaly or a combined incudostapedial anomaly had a favorable hearing outcome with seven ears improving to within 10-dB and one ear to within 13-dB air-bone gap on postoperative audiometry. CONCLUSION:: Despite unanticipated findings of congenital anomalies of the stapes and incus during middle ear exploration for conductive hearing loss, a flexible management approach can lead to successful hearing outcomes.

Journal Article↗
PubMed1996

Allograft stapes surgery for conductive hearing loss in patients with ossicular chain anomalies.

An allograft stapes was used during surgical intervention for conductive hearing loss due to ossicular malformations in 11 ears of seven patients. The external auditory canal and tympanic membrane were normal in all ears. The surgical findings for the ossicles were stapes fixation (7 ears), stapes fixation with discontinuity of the incudostapedial joint (in both ears of one patient), a deformed incus and stapes crura compressed by the facial nerve (one ear in which the stapes was not fixed) and an anomaly of the incus and stapes combined with a dermoid cyst (in one ear in which the stapes was also not fixed). In all ears, the following procedures were performed: stapedectomy followed by sealing the oval window with a vein graft and placing an allograft stapes between the oval window and the lenticular process of the incus or the handle of the malleus. The allograft stapes was placed with its capitulum on the oval window in all cases, and fibrin glue was used for stabilizing the seal and the allograft stapes. The indications for stapedectomy for conductive hearing loss due to ossicular chain anomalies and the utility of allograft stapes are discussed.

Adolescent↗
PubMed1985

The use of allograft stapes.

Since 1981, we have used the stapes allograft, singly or in combination with homograft incus, in 20 cases of tympanoplasty and in 7 cases of fixed stapes. All of the allograft stapes discussed were procured, processed and stored in 1980 by the Hyogo Ear Bank, the first to be established in Japan. The stapes allograft was used in three situations: an intact posterior canal wall, an open mastoidectomy cavity, or a fixed stapes (postinflammatory, congenital or otosclerotic). Two modalities of positioning of the donor stapes were attempted: (1) the allograft stapes was placed in the normal position and a shaped incus or cortical bone or tragal cartilage was placed on the top of the stapedial head and connected and (2) the allograft stapes was placed in the upside-down position and the columella was placed on the stapes footplate. Better results were obtained with the allograft stapes placed in the normal position. A two-stage operation, first to place an allograft stapes in the normal position with myringoplasty and then ossiculoplasty, was preferable to one-stage middle ear surgery.

Audiometry, Pure-Tone↗
PubMed2000

Isolated congenital stapes ankylosis: an embryologic survey and literature review.

OBJECTIVE: Isolated congenital stapes ankylosis is rare but is a definite entity. Both small series and case reports have been published in various languages. The aim of this study was to review the world literature regarding isolated congenital stapes ankylosis and to critically evaluate the embryonic development of the stapes to explain the possible pathologic development of this ankylosis. DATA SOURCES: All the publications in the English, German, and French literature regarding congenital stapes anomalies were reviewed, and original research articles on the embryonic development of the stapes and related structures were extensively and critically reviewed. STUDY SELECTION: Of the many varieties of congenital stapes anomalies described in the literature, only the isolated congenital stapes fixation due to footplate or suprastructure fixations were selected in this study. DATA SYNTHESIS: After extensive and critical review of the embryonic development of the stapes, the complex and confusing embryonic development is explained in a simplified way with schematic illustrations for easy understanding. The possible theories of congenital stapes ankylosis are explained on an embryologic basis and supplemented with schematic illustrations. CONCLUSION: Based on the development of the stapes an attempt has been made to explain the possible theories for the basis of suprastructure fixation. Theories of congenital fixation of footplate also discussed.

Ankylosis↗
PubMed2004

[CT multiplan reconstruction images of disorder of stapes].

OBJECTIVE: To evaluate the clinical application of multi-planar reformation (MPR) for the stapes with multi-slice spinal thin-section CT in the patients with disorder of stapes before prosthetic ossicular reconstruction and their impact on surgical decision. METHODS: Axial CT scanning of temporal bone was undergone in 50 volunteers. Multiplan reformatted images included coronal, sagittal and oblique MPR, were made. All the MPR images were compared with each other in order to show which one could reveal the whole structures of stapes better. The height of stapes was measured with the oblique MPR. CT findings were evaluated in 102 cases with disorder of stapes. Prosthetic ossicular reconstruction was made in 65 cases. RESULTS: The full stapes cannot be shown in axial, coronal and sagittal MPR images, however, it was shown in oblique MPR in all the cases. The highness of stapes was (3.3 +/- 0.4) mm in the abnormal group. There was chronic otitis media in 69 cases (90 ears) and congenital abnormalities of the stapes in 33 cases (47 ears) which included the dispart of incudostapedial joint in 5 cases (7 ears), defect of head and crus of stapes in 9 cases (13 ears), defect of one side of crus in 3 cases (4 ears) and absence of the oval window in 16 cases (23 ears). CONCLUSIONS: Coronal and oblique MPR images from Axial Spiral CT Data are essential for the pre-operative planning of prosthetic ossicular reconstruction. The ship, structure or defect of stapes can be shown in the oblique MPR images. It is important for the patient to choose the type of operation.

Adolescent↗
PubMed2005

Current multiplanar imaging of the stapes.

PURPOSE: CT analysis of the stapes is difficult in the axial plane (AP), because of its oblique orientation. Oblique axial reformations could provide a more precise analysis of the stapes in normal and pathologic conditions. MATERIALS AND METHODS: CT of the temporal bone was performed in 31 patients. Only the normal side was examined in the AP and oblique axial plane (OAP), in the plane of the stapes superstructure. Conspicuousness of each stapes component was evaluated in both planes by 2 independent readers. Reproducibility between the 2 readers (R1 and R2) and comparison of conspicuousness between the AP and the OAP in the analysis of the stapes crura were evaluated. The normal position of the stapes arch in relationship to the footplate was determined in the OAP by using biometric landmarks. RESULTS: Conspicuousness of the stapes crura was increased by using OAP. The conspicuousness of the anterior crus was enhanced in 38% with the OAP according to R1 (P < .05) and 32% according to R2 (P < .05). The conspicuousness of the posterior crus was enhanced in 35% with the OAP according to R1 (P < .05), but not significantly enhanced in 22% with the OAP according to R2 (P = .095). Analysis of conspicuousness of the stapes crura was reproducible according to the kappa test. A perpendicular line to the footplate intersecting its midportion crosses the stapes head and the long process of the incus in the OAP in normal patients. CONCLUSION: OAP could enhance the CT analysis of the stapes and provide useful biometric landmarks in pathologic conditions.

Adult↗
PubMed2005

Histologic otosclerosis is associated with the presence of measles virus in the stapes footplate.

HYPOTHESIS: Persistent measles virus infection of the otic capsule is presumed to be one of the etiologic factors in otosclerosis. The viral pathogenesis of otosclerosis could be established only by correlative analysis: histologic examination of the stapes footplates and reverse-transcriptase polymerase chain reaction amplification of the viral RNA. At present, histologic analysis of the removed stapes footplates is the only appropriate method of distinguishing otosclerotic and nonotosclerotic stapes fixations. BACKGROUND: The presence of measles virus was shown in otosclerotic patients by reverse-transcriptase polymerase chain reaction amplification of the viral RNA and detecting the viral proteins by immunohistochemistry. METHODS: Nucleic acids (mRNA, vRNA, and DNA) were extracted from ankylotic stapes footplates of stapes fixation patients (n = 44). Measles virus genomic nucleoprotein RNA was amplified by seminested reverse-transcriptase polymerase chain reaction. Amplification results were correlated to postoperative histologic findings. RESULTS: Measles virus RNA was detectable only in histologically otosclerotic stapes footplates (n = 32). Histology for virus-negative footplates (n = 12) excluded otosclerosis. Virus-negative stapes footplates showed annular calcification (n = 8), bone resorption with increased numbers of hemosiderophages (n = 2), and mononuclear cell infiltration with osteolysis (n = 2). CONCLUSION: Stapes ankylosis is a heterogenous disease causing conductive hearing loss with different causes. Nonotosclerotic stapes fixations may belong to degenerative disorders with variable histopathology. Otosclerosis is an inflammatory disease resulting from persisting measles virus infection of the otic capsule.

Adult↗
PubMed2001

[Intraoperative measurement of stapes mobility using a hand-guided electromagnetic probe].

BACKGROUND: The hearing results of otosurgery are still unsatisfactory. Even after successful implantation of middle ear prostheses there often remains an air bone gap of 30 dB or more. As possible reasons dislocation of the prostheses due to scar growth, changes in prostheses' attachment or ventilation disorders are being discussed. Decreased stapes mobility, which has been judged only manually up to now, is supposed to be a further reason. METHOD: We are introducing a new electromagnetic probe. The output signal of this device is proportional to the impedance of the stapes-annular ligament cochlear fluid system at the sensor's resonance frequency (2.4 kHz). The advantage of this system is characterised by its hand-guidance. Injury of the sensitive stapes-annular ligament due to tremor movements of the surgeon can be excluded using a special construction of the sensor head. The maximum force of the sensor's tip onto the stapes during measurement is limited to below 5 mN. RESULTS: Preliminary measurement results of 20 patients are presented with normal and abnormal stapes mobility. These results are compared to the subjective impression of the surgeon, who usually tested the stapes mobility by hand. As a result of our investigations probe measurements can detect more exactly decreased mobility of the stapes than the surgeon. CONCLUSIONS: Our device may help to detect latent stapes fixation caused by chronic inflammation of the middle ear. The intraoperative measurement of stapes mobility may influence the strategy of the surgeon. Furthermore it would be helpful in patient consulting prior to a revision-tympanoplasty with predicting the potential hearing improvement.

Cholesteatoma, Middle Ear↗
PubMed2000

Magnetic resonance imaging of stapes prostheses.

OBJECTIVE: To assess the magnetic resonance imaging (MRI) compatibility of stapes prostheses. DATA SOURCES: A comprehensive review of the English literature evaluating MRI compatibility of stapes prostheses. Multiple series of stapes prostheses from different manufactures placed in a 1.5-tesla MRI field to determine ferromagnetic properties. RESULTS: When MRI was first introduced, reports demonstrated the MRI compatibility of stapes prostheses. The testing was performed on single copies of various prostheses from several manufacturers. Although implant manufacturers have indicated MRI compatibility, several reports of variable ferromagnetic properties of aneurysm clips have been reported. This variability has led to rotation of the clips and hemorrhage in patients with supposed MRI-compatible clips. These findings suggest that testing single stapes prostheses from a manufacturer might not completely assess the safety of MRI on patients with stapes prostheses. We performed MRI compatibility testing on several series of stapes prostheses from Xomed Surgical Products and Smith & Nephew Richards. Two series of Xomed stapes prostheses were found to have ferromagnetic properties. CONCLUSION: Manufacturing variability could lead to stapes prostheses being MRI incompatible. Each prosthesis should be tested before implantation for ferromagnetic properties.

Consumer Product Safety↗