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PubMed1997

Surgery of tympanosclerosis.

Eighty-five cases with tympanosclerosis of the middle ear were treated surgically in this series from 1984 to 1995. Twelve of them were associated with cholesteatoma and had radical surgery performed. An attempt is made here to classify the tympanosclerosis on a patho-physiological basis. A planned two-stage procedure was performed in 36 cases after an interval of 18 months. The majority of patients had stapes surgery carried out by a two-stage procedure. One of the patients who did not have stapes surgery developed anacusis after 18 months post-operatively and in another patient recurrence was observed. Post-operative hearing improvement was found to be satisfactory in the short-term follow-up period of two to five years. The hearing improvement was analysed by using Chi-square value (chi 2) and also plotted in the Glasgow Benefit Plot.

Adolescent↗

PubMed2003

Delayed facial palsy following laser stapedectomy: in vitro study of facial nerve temperature.

Delayed facial palsy following conventional stapes surgery is a rare event, but this complication appears to be more common when a laser is used. We have investigated the temperature in the facial canal during stapes surgery using a KTP laser or a microdrill in preserved human temporal bones. Thermocouples were placed in the facial canal and under the foot plate. The results show maximum rises in temperature of between 1.4 degrees C and 15.2 degrees C in the facial canal during laser surgery (mean 6.1 degrees C, SD 4.5 degrees C), but only between 0.45 degrees C and 2 degrees C during procedures in which a microdrill was used (mean 0.9 degrees C, SD 0.9 degrees C) (P = < 0.009). In addition, the facial nerve undergoes repeated heating and cooling cycles during the laser surgery. We conclude that heating of the facial nerve during laser surgery causes oedema, which in turn leads to compression of the nerve within its bony canal.

Adult↗

PubMed1995

Twenty-five years of experience with stapedectomy.

The purpose of this report is to review the outcomes of patients undergoing stapes surgery by the senior author during the past 25 years, and to compare these results with those obtained in other series. A retrospective analysis of 902 patients who underwent stapes surgery by the senior author from 1970 to 1994 was performed. Twenty-two patients underwent stapedotomy; the remainder underwent stapedectomy. Pure-tone averages for air and bone conduction, air-bone gap closure, technique, complications, and patient satisfaction were compared with results obtained in other stapedectomy and stapedotomy series.

Adolescent↗

PubMedDate not supplied

Postoperative complications in otospongiosis: usefulness of MR imaging.

BACKGROUND AND PURPOSE: Sensorineural hearing loss (SNHL) is a rare complication of stapes surgery that may arise for many reasons. Usually, the pathogenesis of SNHL can be established by clinical and CT examinations. The purpose of this study was to evaluate the utility of MR imaging when CT findings are normal or not contributive. METHODS: Eleven patients with SNHL (in some instances, associated with vertigo) after stapedectomy, in whom CT showed no well-defined cause, were examined by MR imaging. RESULTS: MR studies established the additional findings of reparative intravestibular granuloma (n = 2), intralabyrinthine hemorrhage (n = 1), and bacterial labyrinthitis (n = 1). In five cases, MR findings were similar to CT findings. In two cases, CT and MR results were normal. Revision surgery was performed in five patients and confirmed the MR findings in each case. CONCLUSION: If CT is not contributive as to the origin of SNHL and vertigo occurring after stapes surgery, then MR imaging may be helpful in these patients.

Adult↗

PubMed1996

Otosclerosis update.

The use of lasers for primary and revision stapes surgery has many applications and potential advantages over mechanical techniques. It should be emphasized, however, that the laser is simply a tool, albeit a sophisticated one, and not a substitute for knowledge, experience, judgment, or ability. A laser will not "make" a good stapes surgeon, any more than a scalpel "makes" a good surgeon. There are limitations as well as benefits to lasers. Excellent results for stapes surgery were obtained for years prior to the advent of lasers, which is testimony to the skill and understanding of nonlaser stapes surgeons.

Ear Ossicles↗

PubMed1998

[72 cases of the auditory ossicle malformations but with normal findings in the tympanic membrane].

We evaluated 66 patients (72 ears) with auditory ossicle malformations, but with normal findings in the tympanic membrane, who underwent ossicular reconstruction and stapes surgery at our department between 1984 and 1997. There were 27 men (30 ears) and 39 women (42 ears). Classification of pathologic condition based on surgical findings showed separation of the incus-stapes joint in 43%, fixation of the malleus or incus in 16%, fixation of the stapes footplate in 26%, in incidence of fixation of the auditory oosicles that is higher than that previously reported. In 33% of the patients, conductive hearing loss or mixed hearing loss similar to that observed on the affected side was also present on the contralateral side. Abnormalities in the arrangement of the facial nerves were noted in 4%, inner ear malformation in 1%, and congenital cholesteatoma in 3%. Auditory ossicle reconstruction was performed by the modified type III method in 57% and by the modified type IV method in 37% of the cases. During stapes surgery, 86% underwent small-fenestra stapedectomy. Improvement in hearing after the operation was observed in 90% of the cases and the improvement was relatively high compared with tympanoplasty for chronic otitis media.

Adolescent↗

PubMed1994

Computed tomographic diagnosis of X-linked congenital mixed deafness, fixation of the stapedial footplate, and perilymphatic gusher.

Stapes surgery for fixed footplate associated with X-linked congenital mixed hearing loss usually results in a "gusher" and severe worsening of hearing. Four patients with X-linked deafness were diagnosed by the characteristic temporal bone computed tomography (CT) findings of enlarged internal auditory canal, hypoplasia of the cochlear base, absent bony modiolus, abnormal vestibular aqueduct, and enlarged labyrinthine facial nerve canal. Three patients were scanned after stapes surgery resulted in a gusher and, in two patients, severe worsening of their hearing loss. Stapes fenestration in the other patient was avoided by CT recognition of the dysplasia. The authors believe that young males presenting with congenital mixed hearing loss should be studied with temporal bone CT prior to middle ear exploration.

Adolescent↗

PubMed1997

Effects of pulsed laser systems on stapes footplate.

BACKGROUND AND OBJECTIVE: The aim of the present study was to investigate the tissue ablation capacity of various pulsed lasers at the stapes footplate. STUDY DESIGN/MATERIALS AND METHODS: Isolated human stapes and bovine compact-bone platelets were used to determine the effective laser parameters and appropriate application technique for achieving a perforation measuring 500-600 microns in diameter. Of interest were also the shape and quality of the perforations, the reproducibility of the perforation effect, and the thermically altered marginal zones occurring at the footplate. Three pulsed laser systems were used: excimer, holmium:YAG (Ho:YAG), and erbium:YSGG (Er:YSGG) lasers. RESULTS: The tissue-ablating effect of pulsed laser systems permits a precise and controlled management of the stapes footplate through low and readily reproducible ablation rates. The extent of thermic side effects at the footplate is lower in comparison to the purely thermically acting cw and superpulse laser systems. The Er:YSGG laser exhibits the highest ablation rate at the stapes and is thus the most effective laser for perforation of the stapes footplate. Though somewhat less effective, the Ho:YAG laser also appears to be suitable for stapedotomy. On the other hand, we do not consider the applied excimer laser (308 nm) to be particularly appropriate at the stapes because of its low ablation rates. CONCLUSION: Thus, the erbium laser could represent an alternative to the argon, KTP 532, and CO2 lasers, already clinically successful in stapes surgery. However, further studies are necessary to examine the transmission of thermic energy into the vestibule and the acoustic stress to the inner ear during laser stapedotomy, to be able to make a definitive statement about the safest and most effective laser system for stapes surgery.

Animals↗

PubMed1999

[Postoperative treatment after ear surgery].

The paper gives an overview on postoperative treatment after ear surgery, especially tympanoplastic, mastoid-surgery and stapes-surgery. Suggestions for treatment are given according to the different post-operative stages and situations. Careful cleaning of the ear canal, using the operative microscope, removal of debris, granulations and polyp and drying of the canal are most important.

Ear↗

PubMed1961