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PubMed1992

[Stapes surgery in otosclerosis and small middle ear abnormality].

Stapes surgery in otosclerosis (first and revision operation) and in minor middle ear malformation follows the same principles, but the surgical problems are rather different. When analyzing three groups of patients, which had been operated on the same technique, we could show that the risks of the operation in malformation and revision surgery are not greater than they are in primary otosclerosis surgery. The audiologic results are more satisfying in the latter; malformation surgery and revision surgery have almost the same results which are lying somewhat below those of primary otosclerosis surgery. In the hands of an experienced surgeon, who is able to adopt his surgical technique at the individual situation, stapes surgery is nearly without risk in all these indications; an improvement of the air-conducting level of 18-23 dB can be expected and a social hearing above 35 dB can be provided in 83% of otosclerosis patients, in 79% of malformation patients and in 57% of revision patients.

Audiometry, Pure-Tone↗
PubMed1996

Vein graft in stapes surgery.

Sealing the opening of the oval window during stapes surgery is essential; it prevents postoperative complications, such as perilymph fistula and sensorineural hearing loss. In this small series of 269 cases with otosclerosis, tympanosclerosis, and congenital ossicular abnormality, vein grafting was used to seal the opening of the footplate. Hearing improvement after surgery was acceptable, and none had total hearing loss or perilymphatic fistula. World literature from the last half of this century on grafting the oval window is reviewed. Absorbable gelatin sponge (Gelfoam) seems to be causing more complications, so its use is highly discouraged. Temporalis fascia, fat, and perivenous loose areolar tissue have been used by different authors at different times in footplate surgery. The opening created in the oval window during stapes surgery must not be left uncovered.

Audiometry, Pure-Tone↗
PubMed1980

Results of stapes surgery - subjective and objective.

A review of subjective and objective results of stapes surgery performed by one general otolaryngologist shows excellent correlation between the two. However, hearing results are poorer, and the complication rate higher than is usually reported. We recommend that patients be informed pre-operatively of the success rate and complication rate in the practice of their surgeon rather than the excellent results reported in the literature. Patients with unilateral hearing loss should be discouraged from undergoing stapes surgery. Approximately half of these patients do not obtain binaural hearing, and thus the success rate does not justify the risk of a complication. Further studies are required to determine whether stapes surgery should be performed only by otologists doing a high volume of such surgery.

Follow-Up Studies↗
PubMed2003

Stapes surgery in osteogenesis imperfecta: results of a new series.

OBJECTIVE: To evaluate the results of stapes surgery in osteogenesis imperfecta. STUDY DESIGN: Audiological and clinical analysis of the results of stapes surgery in a consecutive series of 15 ears in 13 patients with osteogenesis imperfecta. SETTING: Tertiary referral center. RESULTS: Stapedotomy was successful in 11 of 12 ears in 11 patients with osteogenesis imperfecta type I. Air-bone gaps were within 10 dB in four ears and within 20 dB in the seven remaining ears. In one ear, revision surgery with malleovestibulopexy was needed to achieve this result. In another ear, the initial good result within 20-dB air-bone gap decreased to 28 dB; therefore, it is not considered as a success. In one other patient, revision surgery resulted in only marginal improvement in the hearing level. In one case of, probably, osteogenesis imperfecta type III, surgery resulted in a dead ear. CONCLUSION: Stapedotomy successfully improved the hearing of patients with osteogenesis type I. These results are in accordance with those reported in a few previous series. It is questionable whether stapes surgery will be as successful in osteogenesis imperfecta types other than type I.

Adult↗
PubMed1996

Reporting operative hearing results in stapes surgery: does choice of outcome measure make a difference?

PURPOSE: Findings of a prior study indicated that neither choice of pre- versus postoperative bone-conduction scores nor choice of frequencies to include in averaging makes a substantial difference in reported outcomes of chronic ear surgery. METHODS: In this study, audiologic data from 240 stapes surgery patients at three different institutions were used to generate a variety of outcome measures. RESULTS: Use of preoperative rather than postoperative bone-conduction values in computing postoperative air-bone gap resulted in an approximately 5-dB smaller mean gap and a 2% higher success rate. Frequencies included in averaging made little difference in mean computed air-bone gap, although success rate (gap < or = 10 dB) was lower by 6% when 4 kHz was used in a four-frequency average rather than 3 kHz. Results for air conduction were similar to those for air-bone gap regarding choice of frequencies to include in averaging. When we used air-conduction pure-tone average (PTA) as the outcome measure, those with normal preoperative sensorineural hearing had a > 20% higher success rate than the general population of patients with stapes surgery. CONCLUSIONS: The greatest differences in success rate were based on definition of and criteria for success. Success rate was higher when based on air-bone gap than when based on air-conduction PTA. As in the prior chronic ear study, differences in outcome were more drastically affected by criteria for "success" than by frequencies included. Unlike similar data from chronic ear surgery, however, success rate differed depending on choice of air-bone gap or air-conduction PTA as the definition for success. Further, air and bone scores from the same test interval must be used accurately to reflect air-bone gap in stapes surgery.

Adolescent↗
PubMed1997

Stapes surgery: results when performing a moderate number of stapedectomies.

Stapes surgery: results when performing a moderate number of stapedectomies. The short term results of 40 small fenestra stapedectomies over a period of five years are presented. Closure of the air-bone gap is within 10 db in 62.5%, within 20 db in 90% of the cases, with a mean gain in air-bone gap of 27.2 db. Stapes surgery is difficult if not regularly performed. The concept of a learning curve is demonstrated in this study.

Adult↗
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↗
PubMed1995

Nystagmus measured by ENG after stapes surgery.

Much attention has been paid to hearing results after stapes surgery, but the risks of vestibular disturbance has not been extensively studied. Postoperative spontaneous nystagmus was measured daily at bedside by portable ENG in order to evaluate the vestibular damage from stapes surgery. Thirteen patients underwent primary stapedotomy or stapedectomy from August 1, 1992 to June 30, 1993. Nystagmus toward the operated ear was observed in 3 cases, that toward the opposite ear in 2 cases, that changing from toward the operated ear to toward the opposite ear in 2 cases, that changing from toward the opposite ear to toward the operated ear in 2 cases and no nystagmus in 4 cases. There was no relationship between duration of nystagmus and that of dizziness. Nystagmus was thought to be due to the following: i) inner ear damage by operation, ii) postoperative perilymphatic fistula, iii) floating footplate, and iv) stimulation of hair cells by high potassium ion in the perilymph due to blood flow into the inner ear.

Adolescent↗
PubMed2003

Revision stapes surgery: the malleus to oval window wire-piston technique.

OBJECTIVE: To determine the effectiveness of the malleus to oval window wire-piston revision stapes surgery technique. STUDY DESIGN: A retrospective analysis of 243 stapes procedures performed by the senior author over a 10-year period identified 15 revisions. Five patients underwent a malleus to oval window wire-piston technique. All patients were followed for at least 6 months. The surgical outcome including audiologic data and complications are noted. METHODS: Stapes surgery was performed on an ambulatory basis by way of a transcanal approach under local anesthesia with monitored sedation by the same surgeon using a laser technique and a stapes wire-piston prosthesis. RESULTS: Among revision stapes procedures, there was no significant difference in the air-bone gap closure or complication rate between the incus to oval window and the malleus to oval window techniques. The average preoperative air-bone gap in all revisions was 32 dB, whereas the mean postoperative gap was 10 dB hearing loss. CONCLUSIONS: In experienced hands, revision stapes surgery using the malleus to oval window stapes wire-piston prosthesis is safe and effective.

Adult↗
PubMed1995

The effect on tinnitus of stapes surgery for otosclerosis.

Among 42 Japanese patients with otosclerosis who underwent stapes surgery, 22 patients including 10 received total stapedectomy, 6 partial stapedectomy and 6 stapedectomy, were investigated on preoperative and postoperative tinnitus by sending questionnaire. The tinnitus was evaluated by "tinnitus score" advocated by the Japan Audiological Society, and the changes of the scores were analyzed according to pre- and postoperative hearing change, type of stapes surgery and pitches of preoperative tinnitus. In these 22 patients, tinnitus score was improved in 68%, unchanged in 27% or worsened in 5%. Tinnitus was completely disappeared in 6 patients or 27.3%. Tinnitus score became more markedly improved in the patients received partial stapedectomy or stapedotomy than those who received total stapedectomy. Tinnitus score was more likely improved in the patients who had a low pitched tinnitus and presumably had no cochlear otosclerosis preoperatively.

Adult↗
PubMed1988

Thirty years of stapes surgery.

The modern stapedectomy with prosthesis insertion and living oval window seal, like the modern cataract extraction with lens replacement, is now performed, very much the same, throughout the world. I have reviewed the evolution of stapes surgery during these last thirty years and tried to gain some agreement for several important facts about otosclerosis and several basic principals of stapes surgery. While a well-performed stapedectomy can eliminate the conductive component, the sensorineural hearing loss continues and, in about one-third, will progress till the patient, after age 65, must return to a hearing aid. A piston prosthesis gives the best hearing results: 0.6 mm diameter, when half the footplate is removed and a living oval window seal interposed, and 0.6 mm diameter when a small opening is made in the footplate obliterated by otosclerosis. I prefer a teflon prosthesis to stainless steel because it can be altered by the surgeon at operation, and vein as an oval window seal. I have presented a rare group of patients who develop facial palsy 5-1/2 days after uncomplicated stapedectomy, of whom all recover quickly and completely. I am confident that progress will continue to be made in the understanding of otosclerosis, and the performance of stapes surgery, but in these last thirty years we have made a good beginning.

Aged↗
PubMed1997

Functional hearing results in revision stapes surgery.

OBJECTIVE: The object of our study was to review the results of 63 revision stapes surgeries performed from 1978 to 1994. RESULTS: The most common cause of failure was the displacement of the prosthesis, followed by ossicular chain problems and oval window fibrosis. Postoperative hearing improvement within a 20-dB air-bone gap was achieved in 58.7% of the patients. Hearing gain was closely linked to the operative findings. Better results occurred when prosthesis problems were found. Evaluation of the hearing results by using Glasgow benefit plot gave evidence of symmetric normal hearing in only 40% of the cases. CONCLUSIONS: Prevention of the cause of failure during the primary stapes surgeries, lessening the surgical trauma, seems to provide the most favorable hearing results.

Adult↗
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↗
PubMed1994

Revision stapes surgery: a critical evaluation.

Fifty-six revision stapes surgeries performed during the last 9 years were evaluated retrospectively for their preoperative symptoms, intraoperative findings, and postoperative results according to the causes of failure, at the Gruppo Otologico, Piacenza, Italy. The most frequent causes of failure were found to be prosthetic misalignments, a reaction to the surgical trauma in the form of excess fibrous tissue reaction or new bony regrowth at the oval window, and ossicular chain problems. The location of the pathology was found to be an important factor in the outcome. Sixty percent of cases resulted in 0- to 20-dB air-bone gap. The causes of these failures, management, and their prevention during primary surgeries are also discussed.

Adult↗
PubMed2006

The learning curve in stapes surgery and its implication to training.

OBJECTIVE: To identify the stapedotomy learning curve of two U.K. otolaryngologists. STUDY DESIGN: A retrospective review of the outcome of first 100 stapedotomy operations by each surgeon. Included in the study was a postal survey of the incidence of stapes surgery by U.K. otolaryngologists. SETTING: Two tertiary referral centers. PATIENTS: All ears in which primary stapedotomy was performed for otosclerosis. Nonotosclerotic cases and malleus stapedotomy cases were excluded. INTERVENTION: One surgeon used the technique of small fenestra stapedotomy with either a Teflon-wire or titanium piston but without vein graft interposition, whereas the second used the technique of stapedotomy with vein graft interposition and a Teflon piston. MAIN OUTCOME MEASURES: A moving average with a window of 15 dB was used to plot learning curves for the postoperative air-bone gaps. Using a postoperative air-bone gap of 20 dB or better as a definition of 'success,' the success rates with the increase in surgical experience of both surgeons were plotted on graphs, the learning curves. The end point of the learning curve was defined as the point where the curve reached its peak, and the results were sustainable. RESULTS: There was no clear-cut end point in both learning curves, although it appears that there is a landmark point at 60 to 80 cases for both surgeons. Both surgeons also had one "dead ear" in their first 15 cases. The postal survey showed that some trainers only performed small numbers of stapes surgery, whereas some otolaryngologists who performed stapedotomies regularly were not trainers. CONCLUSIONS: The study supports a learning curve in stapes surgery. To maximize the training opportunity of trainee surgeons, it may be advisable for learning centers to form network to provide target training for the trainee who has demonstrated the necessary dexterity and temperament of an otologist.

Adult↗
PubMed1996

Reporting operative hearing results in stapes surgery: does choice of outcome measure make a difference?

In a prior study, findings indicated that when reporting results of chronic ear surgery, neither choice of pre-versus postoperative bone-conduction scores nor choice of frequencies to include a averaging makes a substantial difference in reported outcome. In this study, audiologic data from 240 stapes-surgery patients at three different institutions were used to generate a variety of outcome measures. Use of preoperative rather than postoperative bone-conduction values in computing postoperative air-bone gap resulted in an approximately 5-dB smaller mean gap and a 2% higher success rate. Frequencies included in averaging made little difference in mean computed air-bone gap, although success rate (gap < 10 dB) was lower by 6% when 4 kHz was used in a four-frequency average rather than 3 kHz. Results for air conduction were similar to those for air-bone gap regarding choice of frequencies to include in averaging. When using air-conduction pure-tone average (PTA) as the outcome measure, those with normal preoperative sensorineural hearing had a > 20% higher success rate than the general population of stapes-surgery patients. The greatest differences in success rate were based on definition of and criteria for success. Success rate was higher when based on air-bone gap than when based on air-conduction PTA. As in the prior chronic ear study, differences in outcome were more drastically affected by criteria for "success" than by frequencies included. Unlike similar data from chronic ear surgery, however, success rate differed depending on choice of air-bone gap or air-conduction PTA as the definition for success. Further, air and bone scores from the same test interval must be used to accurately reflect air-bone gap in stapes surgery.

Adolescent↗
PubMed2003

Fixation of the anterior mallear ligament: diagnosis and consequences for hearing results in stapes surgery.

In the search for possible causes of unfavorable results after stapes surgery, the study reported here focused on the anterior mallear ligament, since it has been previously reported that partial mallear fixation (PMF) leads to functional failure in 38% of cases of stapes revision surgery. The aims of the study were to identify effective methods for the diagnosis of PMF and experimentally assess the conductive hearing loss that results from PMF. The study included vibration amplitude measurements of the ossicles by laser Doppler interferometry (LDI) in 19 patients and 5 fresh human temporal bone (TB) specimens. Analysis of their dynamic behavior was performed by finite element modeling (FEM). Similar, significant changes of manubrium vibration patterns for PMF were found by FEM calculations, in TB experiments, and in patients. We could identify PMF either before operation, using LDI, or during operation, by manual palpation. In the TB experiments and FEM calculations, the attenuation of the stapes displacement due to an isolated PMF was approximately 10 dB and frequency-dependent. Untreated anterior mallear ligament fixation produced a persistent air-bone gap of approximately 10 dB after stapedioplasty.

Acoustic Impedance Tests↗
PubMed1996

Barotrauma after stapes surgery: a survey of recommended restrictions and clinical experiences.

OBJECTIVE: To identify a consensus on the postoperative barorestrictions after stapes surgery and to examine the clinical barotrauma experience within this patient population encountered by the surveyed physicians. DATA SOURCE: A 34-item survey was developed, allowing for detailed analysis of physician demographic data, practice characteristics, surgical experience, and clinical experience with barotrauma after stapes surgery. The postoperative restrictions addressed by the survey included those for air travel, snorkeling, and scuba diving. Recommendations for the use of ventilation tubes and hyperbaric oxygen therapy were investigated as well. STUDY SELECTION: Surveys were mailed to 419 active members of the American Otological Society and the American Neurotology Society as listed in the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) 1994-1995 Conjoint Directory. A total of 284 (67.8%) surveys were returned, of which 53 were not sufficiently completed and were excluded in the statistical analysis. DATA EXTRACTION: The demographic data and clinical experience were analyzed to determine statistical association with the postoperative recommendations using chi 2 or Fisher's exact tests. The kappa statistic was used as a measure of consistency between physicians' recommended restriction for a specific activity after a stapedectomy or stapedotomy. CONCLUSION: No consensus was demonstrated as to restrictions from activities such as air travel, snorkeling, or scuba diving. Despite this lack of consensus, no significant difference was demonstrated in the prevalence of barotrauma reported within the responding physicians' practices based on their individual recommendations for these activities.

Adult↗