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PubMed1982

[Endonasal microsurgery of the ethmoid sinus with reduction of blood pressure on a patient in a half sitting position (author's transl)].

Endonasal ethmoid surgery necessitates similar preconditions as stapes surgery (dry operative field, operation microscope with parallel illumination, antibiotics, operative training on a cadaver). Today, by applying flunitrazepam (thorazine, nitroprussid) the patient can be operated on in amnesia with local anaesthesia and a blood pressure between 70-90 mm Hg. Comparing the historic development in ear and nose surgery we expect a similar spreading of endonasal sinus microsurgery as could be seen in stapes surgery. In more than 3,000 cases we have noticed no complication, apart from a passing blindness lasting less than 40 minutes.

Anesthesia, Local↗
PubMed1999

[The role of areolar tissue on otologic surgery].

Areolar tissue is a loose conjunctive tissue, located between the fascia temporalis superficialis and the temporal aponeurosis. It can be used in several circumstances during otologic surgery. First, in stapes surgery, it can be used as an interposition between the piston and the platinotomy. Its thickness has no equivalent in comparison with other temporal tissues, explaining in part its usefulness in this indication. In perilymphatic fistula surgery, the areolar tissue is especially recommended for round window and oval window grafting because of its spontaneous adhesive capacity. It can be useful in myringoplasty, to reenforce an atrophic tympanic membrane or to close a small perforation. Also areolar tissue can be used as a flap or as a free graft to reconstruction of the external acoustic meatus. It's a good conjunctive support, which can be covered by skin graft. Finally areolar tissue is an interesting and useful material for otologic surgery. Its qualities are complementary to those of the temporal aponeurosis.

Connective Tissue↗
PubMed2004

[Stapes fixation in children].

BACKGROUND AND OBJECTIVE: The audiometric results after stapes surgery in children with isolated stapes footplate fixation were reason enough to analyze intraoperative findings and surgical procedures. PATIENTS/METHODS: A total of 438 stapes surgeries were performed in the years 1985-2000, and a retrospective analysis was made of the anamnestic data, intraoperative findings and audiometric data from 12 children with isolated fixation of the stapes footplate. The average age of the children when operated was 10.2 years (the youngest was 7 and the eldest 13). A loss of hearing had set in 5 years earlier. RESULTS: Taking the anamnestic data and the intraoperative into account, otosclerosis was found in 5 children. One child had a narrow oval window niche, in a further six children a congenital fixation of the stapes footplate was evident. Only 58% (n=7) of the 12 children operated showed acceptable postoperative hearing results. The best hearing results were found in children with juvenile otosclerosis. In three of six children with congenital stapes fixation, a worsening of both bone and air conduction was evident. The average conductive hearing loss was 30 dB at 1, 2 and 4 kHz. CONCLUSIONS: When explorative tympanotomy is indicated, a thin-layer CT scan of the temporal bone should be made to assess the risk of a liquor pressure labyrinth developing.

Adolescent↗
PubMed2001

Comparative electron microscopic study of the surface structure of gold, Teflon, and titanium stapes prostheses.

HYPOTHESIS: The goal of this study was to compare stapes prostheses of different materials with respect to their surface structures and to discuss their suitability for their use in stapes surgery. BACKGROUND: The surface condition of a stapes prosthesis plays an important role in relation to the type of membrane that forms between the stapes piston and the bony edge of the stapedotomy opening. The quality of this membrane in thickness and mobility is one of the determinants for postoperative hearing improvement. METHODS: The surface conditions of gold, Teflon/steel, Teflon/platinum, and titanium stapes prostheses were examined with a scanning electron microscope. The loop, shaft, and end of each prosthesis were studied. RESULTS: The gold piston was the smoothest of the four pistons examined. When it was cut with a scalpel, a very smooth surface was achieved at the end area. The Teflon piston had the roughest surface. However, when it was cut, a smooth surface with a parallel arrangement of fibers resulted. Its steel loop was the smoothest, followed by gold and platinum. The titanium shaft had a scaly surface, which remained when the end of the shaft was shortened. CONCLUSION: Because a certain roughness of the piston surface is necessary for the development of a stable membrane between the piston and the edge of the stapedotomy opening, the titanium prosthesis is considered to be the most suitable for stapes surgery of the three pistons examined.

Gold↗
PubMed1996

Effects of continuous-wave laser systems on stapes footplate.

BACKGROUND AND OBJECTIVE: The aim of the present study was to clarify which of the presently available continuous-wave laser systems are best suited for application in stapes surgery. STUDY DESIGN/MATERIALS AND METHODS: Isolated human stapes and bovine compact-bone platelets were used to investigate the connections between the parameters of various laser systems and their effects on bone tissue. The purpose was to optimize the laser parameters required to achieve a perforation measuring 500 microns to 600 microns in diameter. Three different laser systems were applied: the argon and CO2 laser in continuous wave (cw) mode and the CO2 laser in superpulse mode. RESULTS: The suitability of the argon laser for stapedotomy is doubtful in view of the lower absorption coefficient of the stapes for the argon beam and the considerable influence which the degree of pigmentation of the irradiated medium exerts on its effect with the resultant poor reproducibility of the perforation diameter. The beam of the CO2 laser is far better absorbed at the footplate than that of the argon laser. This results in higher effectivity, lower thermic side effects, and better reproducibility of the perforation. The two modes of the CO2 laser do not show any appreciable differences. CONCLUSION: The experimental results presented indicate that the CO2 laser in cw and superpulse mode is the most suitable of the systems now clinically applied in stapes surgery.

Animals↗
PubMed2006

Association between cupular deposits and otosclerosis.

OBJECTIVE: To evaluate whether otosclerosis is an underlying mechanism for the production of cupular deposits and to study the association between cupular deposits and dysequilibrium in otosclerosis. DESIGN: Retrospective human temporal bone (TB) study. The incidence of cupular deposits in these 70 TBs was analyzed. Correlations between cupular deposits and vestibular symptoms, endosteal involvement of the otosclerotic focus, stapedial fixation, and clinical history of stapes surgery were evaluated. SETTING: Otolaryngology laboratory in a tertiary academic medical center. PATIENTS: The study material consisted of 35 human TBs with otosclerosis and 35 age-matched controls. MAIN OUTCOME MEASURES: Morphometric evaluations of the incidence of cupular deposits, endosteal involvement of the otosclerotic focus, and stapedial fixation were made by light microscopy. Clinical records were reviewed retrospectively for clinical history of stapes surgery and prevalence of vestibular symptoms. The incidence of cupular deposits was compared between the otosclerotic and control groups. Correlations between cupular deposits and vestibular symptoms, endosteal involvement of the otosclerotic focus, stapedial fixation, and clinical history of stapes surgery were evaluated in the subjects with otosclerosis. RESULTS: The incidence of cupular deposits in TBs with otosclerosis was significantly higher than in those without whereas there was no correlation between the incidence of the deposits and dysequilibrium in cases of otosclerosis. An increase in deposits did not correlate with stapedial fixation, stapes surgery, or endosteal involvement. CONCLUSIONS: Our results suggest otosclerosis as an underlying mechanism for the production of cupular deposits; however, we did not find an association between these deposits and vestibular symptoms.

Adult↗
PubMed1999

[Postoperative complication in stapedectomy: excessive introduction of the prothesis in the oval window].

Postoperative failures and complications detected in patients who undergo surgery for otosclerotic disease are not uncommon in stapes surgery. Prosthesis displacement and incus necrosis are the most common findings in review stapedectomy. We report the case of a patient who had tinnitus, vertigo, and non-recovery of air conduction thresholds without neurosensorial lesions after stapes surgery. The suspected diagnosis of excessive introduction of the prosthesis in the oval window was confirmed by computed tomography, which showed the radio-opaque image of the McGee metal prosthesis. The prosthesis replacement and literature review are discussed.

Female↗