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At least 415 records · Page 23Linked to original sources
PubMed2002

The use of malleus allografts in ossiculoplasty.

OBJECTIVE: To assess the functional performance of remodeled malleus allografts in a malleus-footplate assembly in terms of hearing results and mid long-term stability. STUDY DESIGN: A retrospective study of 60 consecutive patients who underwent a malleus allograft ossiculoplasty from 1993 until 2000. In all cases the incus and the stapedial arch were missing as the result of cholesteatoma (49), chronic otitis (5), incus necrosis resulting from stapes prosthesis (5), and congenital ossicular malformations (1). In all cases malleus allografts were remodeled to form a malleus-stapes assembly. RESULTS: The audiometric results, using such an ossiculoplasty, revealed an overall median gain of 18.3 dB at 2 months, 22.3 dB at 6 months, and 25 dB 1 year postoperatively on Fletcher frequencies. An air-bone gap closure within 20 dB was achieved in 81% of all cases 1 year postoperatively. No cases of extrusion have been seen in our series. CONCLUSION: Our findings suggest that malleus allografts are capable of generating good and stable functional results as malleus-stapes assembly.

Adolescent↗
PubMed2001

Hearing results of ossiculoplasty in Austin-Kartush group A patients.

OBJECTIVE: To compare hearing results in patients who underwent ossiculoplasty for Austin-Kartush group A impairments (incus erosion, malleus handle present, stapes superstructure present) with the results in patients with an intact ossicular chain who required only myringoplasty. The literature on hearing results of ossiculoplasty with different types of prostheses and different techniques is reviewed. PATIENTS AND STUDY DESIGN: This study retrospectively reviews a series of 181 consecutive ossiculoplasties and 204 consecutive myringoplasties. SETTING: The study was carried out partly at a private practice and partly in an academic tertiary referral center. MAIN OUTCOME MEASURES: This study complies with levels 1 and 2 of the guidelines recommended by the American Academy of Otolaryngology--Head and Neck Surgery (1995). RESULTS: When success was defined as a postoperative air-bone gap within 10 dB, the success rate was higher for myringoplasty (81%) than for ossiculoplasty (55%). When success was defined as a postoperative air-bone gap within 20 dB, the success rate was 97% in myringoplasties and 85% in ossiculoplasties. There was no significant deterioration over time of the mean postoperative air-bone gap for any frequency. CONCLUSION: Cumulative data from several authors show that -50% of patients undergoing partial ossiculoplasty have a postoperative air-bone gap of 0 to 10 dB, and 80% have a postoperative air-bone gap of 0 to 20 dB. Equally good results may be achieved with autograft (no difference was found between interposition of the incus or the head of the malleus), homograft, or alloplastic partial prostheses. With alloplastic total prostheses, 36% of patients have a postoperative air-bone gap of 0 to 10 dB, and 74% have a postoperative air-bone gap of 0 to 20 dB.

Adult↗
PubMed2001

Cholesteatoma behind an intact tympanic membrane: histopathologic evidence for a tympanic membrane origin.

BACKGROUND: Several theories have been proposed with respect to the origin and pathogenesis of cholesteatoma behind an intact tympanic membrane. CASE REPORT: The authors describe a case of cholesteatoma behind an intact tympanic membrane in a 71-year-old man with a history of tympanic membrane retraction fixed to the incus without evidence of a perforation. The membrane eventually became detached, and remnants of keratinizing squamous epithelium were found on the incus. DISCUSSION: Mechanisms such as metaplasia, ectopic epidermis rests, or ingrowth of meatal epidermis have been proposed to explain the pathogenesis of cholesteatoma behind an intact tympanic membrane. These findings, based on temporal bone histopathology, support the role of an acquired epidermal rest. CONCLUSIONS: This case report provides evidence that cholesteatoma behind an intact tympanic membrane can be established from a resolved retraction of the pars tensa of the tympanic membrane.

Aged↗
PubMed2003

Twenty-year review of revision stapedectomy.

OBJECTIVE: To evaluate surgical findings and techniques, patient management techniques, and audiometric results of 522 revision stapedectomies. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary otologic referral center. PATIENTS: A total of 522 revision stapedectomies over a 20-year period in Warren, Ohio, and Israel. The audiologic criterion for revision was an air-bone gap greater than 20 dB over the three-frequency range 0.5 to 2 kHz. RESULTS: Of the 522 revision cases, a total of 483 patients were operated on to improve hearing. The remainder of the patients were operated on for various other noted reasons. Closure of the air-bone gap to within 10 dB was achieved in 71% of patients (343 of 483). The mean pure-tone average improvement was 17.8 dB, with an average postoperative air-bone gap of 7.3 dB. The most common surgical findings were prosthesis malfunction at the oval window, incus, or both (58%). Since beginning the use of the Argon laser for surgical problems, the success rate has increased to 80%. A subgroup of 35 Argon laser revision stapedectomies resulted in a larger hearing gain (25.2 dB) and 91.4% closure of the air-bone gap to less than 10 dB. CONCLUSIONS: More than 70% of revision stapedectomy cases for hearing improvement have had successful closure of their air-bone gap. Since the introduction of the laser 5 years ago, the success rate has increased to 80%. In those specific cases where the laser was required, the success rate increased to 91.4%. Regardless of the revision technique, hearing results were the least successful when the incus could not be used for reconstruction.

Animals↗
PubMed2005

Stapedectomy outcomes: titanium versus teflon wire prosthesis.

OBJECTIVE: To compare the effectiveness of two stapes prostheses in hearing improvement of patients undergoing stapes surgery for otosclerosis. STUDY DESIGN: Retrospective chart review. METHODS: Titanium and Teflon wire stapes prostheses were compared with regard to effectiveness in closing the air-bone gap. The charts of 461 stapedectomies performed by one surgeon from 1996 to 2001 were reviewed. Patients who underwent stapedectomy for reasons other than otosclerosis, revision cases, and those with inadequate preoperative or postoperative bone-conduction threshold data were excluded. Small fenestra technique using either laser or drill was used for all patients. Inclusion criteria were met by 218 patients. Patients were then grouped according to type of prosthesis used, and hearing outcomes were compared. Measured outcomes were four frequency air-bone gap closure, pure-tone threshold, and rate of sensorineural hearing loss (SNHL). RESULTS: The study group was comprised of 35 titanium and 183 Teflon wire prostheses. Closure of the air-bone gap to less than 10 dB was achieved in 86% of the patients with Teflon prosthesis compared with 71% of those with titanium prostheses. The groups were equivalent in regard to site of otosclerotic disease as well as technique, laser or drill, used to create the fenestra. Rate of SNHL was low for both groups and not significantly different. CONCLUSIONS: Both prostheses provided comparable results, although the Teflon platinum wire prosthesis was slightly superior. The smaller numbers in the titanium group may confound these results. The design of the titanium prosthesis provides a crimp that is circumferential around the incus, and that prosthesis was selected in cases with a narrow incus. The selection bias may also influence the results seen in this study.

Adolescent↗
PubMed1980

Functional middle ear reconstruction: experience with prostheses and tissue graft.

The transmission of sound to the internal ear passes across the tympanic membrane to vibrate the ossicle chain formed by the malleus, incus and stapes. Movements of the stapes footplate set up complex wave formation within the cochlear fluids to excite the sensory nerve endings of the organ of Corti. Microsurgery for the relief of middle ear deafness has been progressively developed since 1946 and is concerned with the restoration of this collection of sound by an intact flexible ear drum and transmission of oscillation across the middle ear by a free, mobile chain of ossicles. Otosclerosis is a deafness of genetic origin caused by bony overgrowth immobilizing the stapes footplate and is treated with a 95% success rate by selective stapedectomy and fenestration of the footplate. A prosthesis or one limb of the stapes is attached on to the incus and inserted into the fenestration, often with the use of using a tissue graft as a sealing membrane. Over twenty years' experience has originated many differing contours and materials for the stapes prosthesis--in scale some 4 mm or 5 mm in length and 0.3 mm to 0.8 mm in diameter--which will be illustrated and discussed. These prostheses lie deep within a healthy tympanic cavity, and it is most exceptional for a prosthesis to detach or extrude. In our large series subsequent reexploration usually reveals a prosthesis sheathed in mucosa without visible foreign body reaction.

Ear Ossicles↗
PubMed1986

Stapes prosthesis: evaluation with CT.

We used computed tomography (CT) to evaluate 44 patients who had undergone stapedectomy with insertion of a prosthesis. Several patients had poor surgical results, including recurrent conductive hearing loss, vertigo, and sensorineural hearing loss. Conductive hearing loss occurring immediately after the procedure was most often caused by anatomic limitations or surgical technique. Causes of delayed or recurrent conductive hearing loss included reparative granuloma formation, incus necrosis (at the attachment of the wire), prosthesis subluxation (most often posterior), and regrowth of otosclerosis, which occasionally is further complicated by incus dislocation. We found that CT is often diagnostic when these complications occur. Immediate sensorineural hearing loss or vertigo can be self-limited if caused by serous labyrinthitis. When delayed, these symptoms may be due to perilymph fistula. If caused by the latter, CT may not yield abnormal findings unless subluxation of the prosthesis into the vestibule has occurred.

Adult↗
PubMedDate not supplied

Semibiologic middle ear prostheses: ossicle cup and ossicle columella.

As a natural step in ossicular reconstruction technique, two semibiologic prostheses are introduced. The prosthesis designed for incus replacement is called the "ossicle cup." A hole is drilled in the body of an incus or head of the malleus, and the synthetic shaft of the ossicle cup is placed into the hole. The synthetic cup fits over the stapes capitulum, forming a joint. The ossicle keeps the synthetic portion from touching the tympanic membrane. The prosthesis designed for total ossicular replacement is called the "ossicle columella." In like manner, the shaft is inserted into a shaped ossicle and placed on the remaining footplate. The ossicle columella has a synthetic footplate that rests on the remaining footplate and provides stability and safety. The adaptability of the semibiologic prostheses solves the problems of a laterally healed tympanic membrane, absent stapes capitulum, remaining footplate crura, low-lying stapes, and retracted malleus. The hearing results of the ossicle cup prosthesis indicate 87% of cases with successful hearing at one year. The ossicle columella results in 71% of cases with successful hearing at one year. To date, the extrusion rate is less than 1%.

Bioprosthesis↗
PubMed1983

Stapedectomy revision of the wire-Gelfoam prosthesis.

Revision procedures in which a vein graft with a Robinson stapes prosthesis was used are reviewed in 100 patients. In all cases a wire-Gelfoam stapes prosthesis had been used initially. The surgical findings were prosthesis malfunction, 48%; eroded incus, 16%; negative findings, 14%; footplate not removed, 11%; oval window fistula, 7%; and incus problems, 4%. Postoperatively, hearing in 70.5% of the patients with conductive hearing loss was within 10 dB and 84.5% within 20 dB. The high success rate is affected by the fact that patients with conductive hearing loss were separated from those with sensorineural hearing loss, a piston prosthesis on tissue was used in the revision surgical procedure, and patients with otosclerosis regrowth did not undergo revision. Surgical directives to minimize hearing loss included use of a tissue seal over the oval window; not reopening the oval window; monitoring the patient for dizziness; performing audiometric tests during surgery; leaving the wire in place in certain cases; and not revising the prosthesis in patients with otosclerosis regrowth.

Adolescent↗
PubMed1992

Hydroxylapatite ossicular replacement prostheses: a four-year experience.

Between 1987 and 1991, I have used 215 hydroxylapatite middle ear implants, in various styles, for hearing reconstruction. The first such implants were composed entirely of hydroxylapatite. Because of intraoperative difficulties in shaping and trimming these prostheses, hybrid prostheses using Plasti-Pore were developed. For each of four implant designs (incus, incus-stapes, PORP, and TORP), the head is constructed from hydroxylapatite and the shaft from Plasti-Pore. Extrusion rate for the hybrid prostheses is low (4.3%). Hearing results from 47 patients with the hybrid hydroxylapatite prostheses, 140 patients with total hydroxylapatite prostheses, and 75 control group patients with homograft bone or Plasti-Pore prostheses were compared. A "successful" hearing result was achieved in 51.1%, 51.4%, and 60.0% of the three groups, respectively. Surgical technique for use of the new hybrid hydroxylapatite prostheses is described.

Adolescent↗
PubMed2001

In vitro study of a multi-layer piezoelectric crystal attic hearing implant.

We have developed a prototype middle-ear hearing implant which uses a multilayer piezoelectric actuator. In this series of experiments the actuator was attached to the medial wall of the attic so that it makes contact with the body of the incus. Initial in vitro evaluation has been carried out using a laser vibrometer (Polytec CLV) to measure stapes velocity. Stapes displacement is calculated by mathematical integration. The device used in this way is particularly effective at transmitting high frequency sound to the stapes. When switched off the actuator impairs the transmission of sound to the ossicular chain at low frequencies, but this effect is only 7 dB at most. The stapes displacements resulting from the action of the implant have a linear relationship with the voltages used to drive the system. The high capacitance of the present actuator means that its power requirements are higher than that of other comparable devices. An optimal method of coupling the device to the incus has yet to be identified.

Acoustic Stimulation↗
PubMed2002

A comparison of the user-friendliness of hydroxyapatite and titanium ossicular prostheses.

Both hydroxyapatite (Ha) and titanium (Ti) are well-accepted alloplastic materials for ossicular prostheses. Many different designs of Ha and Ti prostheses are presently available. Fourteen surgeons of different seniority and surgical experience were asked to 'test-drive' four different types of ossicular prostheses in cadaveric temporal bones to investigate the user-friendliness of these protheses. The Goldenberg design Ha incus prosthesis and the Dusseldorf design Bell Ti prosthesis were used as partial ossicular replacement prostheses (PORP). The Richards design Ha incus-stapes prosthesis and the Dusseldorf design Aerial Ti prosthesis were used as a total ossicular replacement prostheses (TORP). Nine out of 14 surgeons found the Ha PORP to be more user-friendly because of the notch design in the head. The Ti prosthesis was found to be more difficult to manipulate because it was too light. Half of the surgeons preferred the Ti TORP because of the open design of the top-plate. The Ha TORP was thought to be too top-heavy and to have a tendency to fall over.

Attitude of Health Personnel↗
PubMed1976

The use of tragal cartilage in ossicular reconstruction.

Readily available tragal cartilage has been found to be a very beneficial autogenous graft source for construction of prostheses to correct those defects in the ossicular chain that frequently occur when the incudostapedial joint is destroyed by middle ear pathology, particularly by the retraction of the posterior, superior quadrant of the tympanic membrane against and/or around the incudostapedial connection. This is true whether there be only erosion of the incus just at the joint, or whether there is erosion of the entire long process of the incus together with the superstructure of the stapes. The various types of deformity and the particular tragal cartilage prosthesis tailored for each deformity, and designed for maximum gain in hearing, are presented together with representative pre- and postoperative audiograms for the variety of types.

Ear Cartilage↗
PubMed1981

Revision stapedectomy: a review of 258 cases.

We reviewed the records of 258 revision stapedectomy operations performed at the Otological Medical Group during an eight year period. Displacement of the prosthesis to the inferior edge of the window was the commonest cause of failure (41%) and occurred predominately in wire-Gelfoam pad cases. An oval window fistula, a short prosthesis or bony closure of the window were causes of failure in 9% each. Incus necrosis was the cause of failure in 5%. Less than 50% of the operations resulted in postoperative conductive deficit of 10 db or less. The results were better than this in incus bypass procedures, in revisions of cases in which a tissue graft was used over the oval window and in revisions of ears initially operated on elsewhere. Severe sensorineural hearing impairment was the result in 7% of the operations and half of these impairments were dead ears. The majority of these adverse results followed a repeat drill out of obliterative otosclerosis or followed reopening of the oval window in patients with a postoperative inner ear problem other than a fistula. We concluded that 1. revision stapedectomy is a less satisfactory procedure than primary stapedectomy; 2. there is rarely an indication for a repeat drill out of obliterative otosclerosis; and 3. the oval window membrane usually should not be disturbed in revision stapedectomy in a patient with inner ear symptoms unless there is a fistula.

Adult↗
PubMed1983

Solving ossicular problems in stapedectomy.

Three unusual ossicular problems encountered in stapedectomy are: floating stapes footplate, partial absence of the incus long process, and otosclerosis combined with a fixed malleus. The surgical techniques advocated in solving these problems are: placing a Robinson prosthesis on the floating footplate, utilizing the Lippy modification of the Robinson prosthesis for the problem incus, and performing only a stapedectomy for malleus fixation and otosclerosis. The hearing results in 242 cases were quite satisfactory and no patient had a further sensorineural loss.

Ear Ossicles↗
PubMed1983

Homograft tympanoplasty in perspective. A long-term clinical-histologic study of formalin-fixed tympanic membranes used for the reconstruction of 125 severely damaged middle ears.

This seven and a half year clinical-histologic study evaluates the effectiveness of buffered, formaldehyde-fixed homograft tympanic membranes for reconstructing the severely damaged middle ear in 125 consecutive patients. Indications for use of homograft tympanoplasty were limited to those cases in which standard tympanoplasty had already failed to produce a satisfactory hearing or anatomic result (i.e., recurrent perforations or draining radical mastoidectomy cavity), or to those cases in which there was a high risk of unsatisfactory result with standard tympanoplasty techniques (i.e., total perforation with absent malleus or congenital aural atresia). Anatomic data was documented with serial postoperative photomicrography. Audiograms were performed at yearly intervals and long-term hearing results were analyzed. Histologic studies were performed on 2 homograft tympanic membranes removed 6 months and 6 years postoperatively. Postoperative photographs of the healing donor tympanic membrane and histologic studies confirmed that the homograft collagen attracts host angioblasts, fibroblasts and epithelial cells. The initial inflammatory response (primarily lymphocytic) subsides and the host produces collagen and elastin fibers interspersed among the donor collagen. Gradually the donor collagen is resorbed. At the completion of this study, 95% (119/125) of the homograft tympanoplasties are currently intact. There were 13 immediate postoperative perforations, but 11 were repaired with a second stage underlay fascia tympanoplasty. Long-term hearing results were analyzed according to the type of ossicular reconstruction employed (mean follow-up 4 years). In 87 patients with chronic otitis media, 94% of the type I repairs maintained an air-bone gap of 25 dB or less, 85% of the type II, and 81% of the type III. Forty-four patients presented with an absent malleus and absent tympanic membrane and were reconstructed with a homograft tympanic membrane with attached malleus and a shaped incus columella. At 4 years postoperatively, 83% of these patients maintained an average air-bone gap of 25 dB or better. A similar group of 38 patients presenting with absent malleus, incus, and stapes were reconstructed with isograft temporalis fascia and a cartilage covered TORP. Only 18% of the TORP patients maintained an air-bone gap of 25 dB 4 years postoperatively. Thirty-three patients with draining radical mastoidectomy cavities were reconstructed; 97% (32/33) had a dry, self-cleansing ear with no activity restriction. Only 59% maintained an air-bone gap closure of 25 dB or better in the long-term follow-up; 30% (10/33) developed persistent eustachian tube dysfunction, usually in the second through fourth postoperative years.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1988

Anomalies of the middle ear.

Malformations of the ossicles in 52 ears of 48 patients were analyzed on the basis of surgical findings. The external meatus of each of these ears was patent. The long process of the incus and the stapes are frequently involved in this series of observations. There are distinct groups of ossicular anomalies, in each of which patients show similar degrees of hearing loss and ossicular findings. These include spindle handle, malleus bar, and dislocated annulus. Spindle handle gets its name from the shape of the malleus handle. There is disconnection between the long process of the incus and the capitulum of the stapes. Malleus bar is a kind of malleus fixation, in which a small bony bar connects the tip of the malleus handle to the posterior wall of the tympanic cavity. In the dislocated annulus, the annulus is dislocated cranially in relation to the middle-ear structures. Anomalies of the ossicle are usually present. Surgical repairs for these conditions are discussed.

Adult↗
PubMed1991

Revision stapes surgery.

With the decline in primary cases of otosclerosis surgery, revision stapes operations are becoming a higher percentage of otosclerosis practice. Are the results from revision stapes surgery today comparable with those of surgeons trained prior to the present decline? A retrospective review of 559 consecutive stapes operations performed by the author revealed 109 revision operations. A retrospective review of these cases reveals that the most common cause for revision surgery was displaced prostheses and incus necrosis. The hearing results are dependent on the surgical pathology. In this series, the airborne gap was closed to less than 10 dB in 58% of cases, there were 64% of cases of displaced prostheses, and 57% of cases of incus necrosis, which is comparable with previously reported studies.

Cochlear Implants↗