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At least 379 records · Page 21Linked to original sources
PubMed2005

How we do it: ionomeric cement to attach the stapes prosthesis to the long process of the incus.

Keypoints * The successful use of glass-ionomeric cement in primary stapes surgery for attachment of the wire loop of the stapes prosthesis to the long process of the incus is reported. * Early hearing outcomes were similar in patients where cement was used for stapes prosthesis attachment compared with those with standard wire crimping technique. * Use of glass-ionomeric cement to attach the stapes prosthesis to the incus may prevent stapes prosthesis displacement and loosening. * This technique may decrease rates of revision stapes surgery and allow the safe use of magnetic resonance image scanning.

Female↗
PubMed1999

Outcomes after laser stapedotomy with and without preservation of the stapedius tendon.

Our goal was to investigate the postoperative differences in hearing between patients who had their stapedius tendon sacrificed and those whose stapedius tendon was preserved during laser stapes surgery for otosclerosis. To that end, we performed a retrospective review by mailing extensive questionnaires to patients who had been operated on between 1994 and 1997. We also performed routine and special audiometric testing to augment the subjective data. Seventy-nine of 124 questionnaires (64%) were returned. Of the respondents, 75 patients had undergone additional pre- and/or postoperative audiometric testing, including tests to evaluate "hearing in noise" and to determine the "uncomfortable loudness level" (dynamic range). We found no statistically significant differences between the two groups with respect to their subjective responses and their audiologic test results. The responses to the questionnaire indicated that in most cases, hearing was improved by stapes surgery. We conclude that the stapedius tendon should be preserved whenever possible during stapes surgery, provided that it does not jeopardize the exposure or outcome.

Adult↗
PubMed2006

Stapedectomy: demographics in 2006.

OBJECTIVE: To evaluate whether the performance of stapes surgery by residents during residency has decreased during the last 40 years, and if so, whether such a decrease has impacted the number of general otolaryngologists performing stapedectomy in the private practice setting. STUDY DESIGN: Survey questionnaire of members of the American Academy of Otolaryngology-Head and Neck Surgery. METHODS: A short questionnaire was mailed to 1,700 members of the American Academy of Otolaryngology-Head and Neck Surgery. Data collected included age, year of residency graduation, fellowship (if any), practice setting, geographic location, number of stapedectomies performed in residency, and number of stapedectomies performed currently. RESULTS: Seven hundred fifty-six (44%) of 1,700 surveys were returned; 558 (74%) of 756 respondents did not complete a fellowship and were included in the general otolaryngologist group. Overall, 41% of general otolaryngologists are performing stapes surgery. There was a significant decline in the number of resident stapedectomies performed between 1960 and 1986; since 1986, this number has plateaued to an average of 8 to 9 (self-reported) cases per resident. More recent graduation from residency trended toward decreased inclination to do stapedectomy, although the result was not statistically significant. Increasing number of stapedectomy cases performed in residency correlated with an increased likelihood of performing the operation in practice. CONCLUSION: Despite a decreasing case volume of stapes surgery in residency, stapedectomy remains an operation performed by general otolaryngologists.

Adult↗
PubMed1997

[Erosion and necrosis of the long process of the incus after otosclerosis operation].

The frequency and possible causes of erosion and necrosis of the long process of the incus induced by various types of prostheses following stapes surgery for otosclerosis are discussed. Between 1987 and 1995, 1144 stapes operations were performed including 117 revisions of stapes surgery performed by third parties and 27 revisions performed by the author. For the first time, necrosis of the long process of the incus caused by teflonplatinum piston is described on the basis of findings in five cases, in which the platinum loop had completely transmigrated the incudal process in a medial direction. By using pictures of the teflon-platinum piston and a gold piston taken by a scanning electron microscopy and a comparison between the use of a teflon-wire piston and a gold piston in two operations, an hypothesis is made that the winding grooves in the surface of the teflon shaft together with impaired middle ear mechanics were the main causes of a scar being contracted in the direction of the oval window niche with resulting necrosis of the incudal process. Requirements for an optimum stapes prosthesis are summarized as a result of the operative observations made.

Adult↗
PubMed1987

Otosclerosis surgery in a resident training program.

Controversy exists regarding the appropriateness of offering all residents training in stapes surgery due to dwindling case loads in residency programs nationally. A recent study indicated poorer results for stapes surgery performed by residents than results obtained by practicing otologists. One hundred consecutive stapedectomies performed by residents over a three-year period at our institution were reviewed retrospectively, with the objective of determining whether these results should be generalized.

Adult↗
PubMed1996

[Otoacoustic emissions (TEOAE and DPOAE) after middle ear operation].

BACKGROUND: The behavior of transitory evoked otoacoustic emissions (TEOAE) and distortion products (DPOAE) in patients after middle ear surgery is unknown. METHODS: We examined TEOAEs and DPOAEs in 37 ears following stapes surgery, 16 ears following tympanoplasty type I, and nine ears after reconstruction of the ossicular chain. In all patients, the postoperative conductive hearing loss was less than 15 dB HL. In some cases, there was additional sensorineural hearing loss in the high frequencies. RESULTS: Surprisingly, TEOAEs were present only in 10 of 62 ears postoperatively compared to all 22 control subjects. TEOAEs were detected in four of 37 ears after stapes surgery, in six of 16 ears after tympanoplasty type I, and in none of the nine ears who had undergone reconstruction of the ossicular chain. DPOAEs were detected in only four of 31 ears postoperatively compared to all 22 control ears. CONCLUSIONS: These results and their relation to the retrograde OAE transmission in the middle ear are discussed. Changes enhancing the stiffness of the middle ear seem to have a greater effect than those enhancing the mass.

Adolescent↗
PubMed1990

Small fenestra stapedotomy using a fiberoptic hand-held argon laser in obliterative otosclerosis.

Obliterative otosclerosis has been a challenge since the advent of stapes surgery. "Drill-out" procedures have had a generally poorer prognosis than conventional stapes surgery because of excessive bleeding, acoustic trauma from the burr, and reclosure of the oval window by otosclerosis. In this report, we describe our early experience using a hand-held fiberoptic argon laser for small fenestra stapedotomy in 10 cases of obliterative otosclerosis. Closure of the air-bone gap to within 10 dB was seen in 100% of the patients. There was no significant sensorineural hearing loss, vertigo, or facial weakness. Argon-laser stapedotomy using a hand-held fiberoptic system is a safe and effective alternative to drill-out stapedotomy in cases of obliterative otosclerosis.

Fenestration, Labyrinth↗
PubMed1998

[Postoperative results of stapes revision].

BACKGROUND: In this retrospective study indications, intraoperative findings, reconstruction techniques and postoperative hearing results in revision stapes surgery were evaluated. PATIENTS: Between March 1988 and January 1996, 150 patients underwent stapes revision. Indications for surgery were the presence of conductive hearing loss (132), dizziness (12), sensorineural hearing loss (3), deafness (2), and tinnitus (1). RESULTS: Intraoperative findings were lateral migration of the implant, regrowth of bone in the oval window niche, erosion of incus, cholesteatoma, and others. In most cases a new prosthesis (gold piston) was inserted between incus and vestibulum. In cases with incus erosion, a malleovestibulopexy was performed. Seventy-three percent of patients who underwent revision stapes surgery because of conductive hearing loss showed a hearing improvement of 20 dB or more. All patients who underwent revision stapes surgery because of dizziness reported an improvement of their symptoms postoperatively. CONCLUSIONS: Revision stapes surgery should be approached by experienced surgeons, because the risk of severe sensorineural hearing loss is higher than at the time of primary stapedectomy. Informed consent is mandatory.

Adolescent↗
PubMed2004

[Indications of HR-CT in the early postoperative phase of stapedotomy].

PURPOSE: This is an analysis of high-resolution computed tomography (HR-CT) performed in patients with and without symptoms after stapes surgery during the early postoperative phase. MATERIALS AND METHODS: We examined 37 patients who underwent stapes surgery between January 1995 and December 2000. HR-CT of the temporal bone was performed in axial and coronal planes with 1-mm-slice thickness and table feed. A reoperation was performed in 7 patients. CT findings were compared with clinical follow up and surgical findings. RESULTS: All patients showed postoperative opacification of the tympanic cavity and external auditory canal as well as partial opacification of the mastoid on CT scans. A dislocation of the prosthesis was found in 11 cases and air bubbles were seen in the vestibule of 5 patients. In one case, small bone fragments were detected in the vestibule. In 6 of 7 cases, CT results were confirmed by retympanotomy. CONCLUSIONS: Due to overlapping of normal and pathological findings in the early postoperative period, indications for HR-CT are limited in this period.

Adult↗
PubMed1997

From posterior crus stapedectomy to 0.6 mm stapedotomy--towards reliability in otosclerosis surgery.

In the 1980s, in Oulu, clinical otosclerosis was primarily managed with posterior crus stapedectomy and in the 1990s, the method was changed to stapedotomy. This retrospective study was carried out to assess the results of different methods of stapes surgery in the hands of one surgeon. Subsequent primary stapes operations in 1989-1990 (91 operations including 74 posterior crus stapedectomies and 1 Causse stapedotomy) and in 1993-1994 (117 operations including 1 posterior crus stapedectomy, 95 Causse pistons) were analysed. Changes in air and bone conduction thresholds were compared 5 weeks, 7 months and 19 or more months postoperatively. There was a significant difference in hearing (air-conduction-AC and bone-conduction-BC) in favor of Causse 0.6 mm teflon piston prostheses as compared to posterior crus stapedotomies at 7 months and 19 or more months. Likewise, the 4 kHz gain at the same time was also significantly better with Causse 0.6 mm all teflon piston. At 5 weeks, 81% of posterior crus stapedectomies and 78% of Causse stapedotomies had air conduction thresholds within 10 dB of preoperative bone conduction. However, at 7 months, the corresponding figures were 68% and 89%. Re-operations were performed in 26.7% posterior crus stapedectomies but only in 1% Causse 0.6 mm teflon piston stapedotomies. In the hands of the senior author (KL), the change from posterior crus stapedectomy technique to stapedotomy with 0.6 mm Causse teflon piston in primary stapes surgery proved to be successful. Surprisingly, the AC and BC hearing in the Causse stapedotomy group kept on improving during the follow-up.

Follow-Up Studies↗
PubMed1994

Carhart notch and electric bone-conduction audiometry.

The Carhart notch is a depression in the bone-conduction audiogram of patients with clinical otosclerosis. The middle frequencies from 0.5 to 2 kHz, which correspond to the resonance frequency of the middle ear, can be substantially improved following successful stapes surgery. Twenty-nine consecutive patients with clinical otosclerosis were tested 2 weeks before and 7 months after stapes surgery with conventional air-conduction (AC) and bone-conduction (BC) audiometry and electric bone-conduction (EBC) audiometry using an Audimax 500 audiometer. The BC thresholds improved at 0.5-2.0 kHz corresponding to the Carhart notch. On average, the EBC thresholds remained more stable, showing no Carhart phenomenon, which supports the concept that EBC stimulation is not entirely equivalent to conventional BC audiometry, but has a different mode of action on the inner ear.

Adult↗
PubMed1990

'Collective stapedectomy' (an approach to the numbers problem).

The results of a first series of fifty stapedectomies, using newly adopted 'Fisch stapedotomy technique' are presented and contrasted with 'world results' and results of leading otologists. The essential points in the evolution of stapes surgery are outlined. In the light of the small number of deaf otosclerotics the philosophy of who should be performing stapes surgery and who should be trained to perform it, is discussed. The title 'Collective Stapedectomy' denotes personal system of collecting patients from the waiting list in batches and operating on each stapedectomy batch in consecutive fashion.

Humans↗
PubMed2000

[Revision surgery of otosclerosis: a review of 26 cases].

OBJECTIVES: The aim of this study was to identify causes of primary stapedectomy failures and to evaluate hearing results in revision stapes surgery. MATERIAL AND METHODS: We retrospectively reviewed a series of 26 revision stapedectomies. Patient characteristics, preoperative findings, causes of failure and complication of primary stapedectomy and postoperative hearing results were noted. RESULTS: Conductive hearing loss was the most common reason for revision surgery (77 %). Leading causes of stapedectomy failure included prosthesis malfunction (42 %), fibrous adhesions (37,5 %), incus erosion (12,5 %) and otosclerotic regrowth (12,5 %). When revision was indicated because of cochleo-vestibular complication, middle ear exploration revealed 3 problems: oval window granuloma or excessively long prosthesis or perilymphatic fistula. In this series, postoperative air-bone gap was closed to less than 10 dB in 57 % of cases, to less than 20 dB in 71 % of cases and we did not observed any sensorineural hearing loss. CONCLUSION: The results of this series are comparable with previously published studies. Revision stapes surgery is not as successful as primary stapedectomy, but the risk of sensorineural hearing loss does not appear to be higher than in primary surgery. Revision surgery is a challenging problem that must be performed by an experienced surgeon.

Adult↗
PubMed1983

Changing patterns of otosclerosis surgery in teaching institutions.

The rapidly dwindling number of patients with otosclerosis suitable for surgery has made a severe impact on this aspect of training and experience in our medical centers. Results secured in the past and expected in the future are now difficult to achieve. This trend has been analyzed with particular reference to the experience in the last 3 years at the University of Miami--Jackson Memorial Hospital--Veterans Administration Hospital Medical Center. The analysis of results and complications also compared patients operated on by residents vs. faculty. Hearing loss as a consequence of improperly performed stapes surgery or complications thereof can seldom be salvaged. Stapes surgery should be performed in medical centers and community hospitals only by designated "stapes surgeons."

Adolescent↗
PubMed2006

[Importance of laser in the surgical technique of otosclerosis and its results].

The authors bring up the matter of the usefulness of laser in otosclerosis surgery. They set out some advantages of laser utilization. A bibliografic review is done and some important authors are found explaining the advantages of this instrument. Some new tendencies on stapes surgery are presented. Teaching on otosclerosis surgery problems are stated, with some different criteria. The idea that improvement of audiologic results in stapes surgery is not easy is strengthened, because the results obtained with the classic techniques are excellent, but some of these methods increase the surgical comfort and reduce the potential risks to the patient.

Humans↗
PubMed1989

Small fenestra stapedotomies with and without KTP laser: a comparison.

The results of 33 small fenestra stapedotomies performed using conventional techniques were compared with the results of 33 stapedotomies performed using the argon or KTP laser. The ossicular chain was reconstructed using a Teflon wire piston of 0.6 mm diameter, and follow-up was at least 1 year. Over-closure of the air-bone gap or closure to within 10 dB was accomplished in 91% of the laser-treated group versus 72% of the conventionally treated group (p less than 0.10). The hearing results were statistically better in the laser group (p less than 0.05). Transient delayed vestibular symptoms, lasting from 1 to 3 weeks, were present in 39% of the laser-treated group and in 12% of the patients treated by conventional techniques (p less than 0.05). The KTP laser stapedotomy, using a micromanipulator mounted on the microscope, is a safe, efficient technique that reduces some of the technical difficulties associated with conventional stapes surgery. The main advantage of the laser is that it enables the surgeon to make an atraumatic, bloodless opening in a fixed or mobile stapes footplate without mechanical manipulation of the stapes. Using a lower wattage to vaporize the footplate and waiting several seconds between laser bursts may decrease the incidence of postoperative vestibular symptoms. The use of the KTP laser in stapes surgery represents a major advance in surgery for otosclerosis.

Fenestration, Labyrinth↗