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At least 415 records · Page 23Linked to original sources
PubMed1997

[Sensorineural hearing loss caused by middle ear surgery].

It is well known that sensorineural hearing loss rarely occurs after middle ear surgery. Five cases of postoperative sensorineural hearing loss were reviewed. These operations amounted to 0.9% of all middle ear operations in which the first author was involved. The causes of hearing loss were believed to be labyrinthitis through the fistula in cholesteatoma case 1, and acoustic trauma from the bone-cutting burr in cases 2 and 3. In cases 4 and 5 postoperative sensorineural hearing loss occurred several months after stapes surgery and the causes of hearing loss were unknown. On the basis of the available literature discussion focused on management of labyrinthine fistula, the acoustic effect of the bone-cutting burr and the possibility of sensorineural hearing loss caused by stapes surgery.

Aged↗
PubMed1992

[Predictive value of high frequency audiometry in otosclerosis].

A study was carried out to evaluate the value of high-frequency audiometry in stapes surgery in cases of otosclerosis. The hearing function was measured pre- and postoperatively by means of conventional and high-frequency audiometry (Demlar 20k). The operative findings of the gradation of otosclerosis were compared with the pre and postoperative audiometrical measurements. The results of this study point out that a clear relation exists between the preoperative high tone audiogram and the gradation of otosclerosis. In conclusion, we state that high-frequency audiometry can predict the state of stapes fixation in otosclerosis and that can be important in stapes surgery.

Audiometry↗
PubMed2006

Revision stapedectomy.

Revision stapedectomy can be a technically demanding operation. The surgeon must be prepared for many pathologic conditions before revision stapes surgery. Appropriate preoperative patient counseling is a must. The best chance for hearing improvement is in those cases that have a delayed conductive hearing loss after primary stapedectomy. This article serves as a guideline for discussing the myriad possibilities that may be encountered during this type of revision stapedectomy. Indications for revision stapedectomy and general surgical guidelines for management of specific pathologic conditions are discussed. The material presented is based on literature review, the authors' personal experience, and a review of temporal bone studies relative to stapes surgery.

Hearing Loss, Conductive↗
PubMed2005

Erbium: yttrium-aluminum-garnet laser application in stapedotomy.

OBJECTIVE: To assess clinical safety and efficacy of the erbium: yttrium-aluminum-garnet (Er:YAG) laser in the stapes surgery; to define and optimize parameters that render the procedure safe for the inner ear. STUDY DESIGN: Retrospective study. MATERIAL AND METHODS: A microscope-integrated Er:YAG laser stapedotomy was performed on 29 patients and a conventional stapedotomy on 41 patients. An early (within 1 to 3 days after stapes surgery) and late (at least 6 weeks) pure-tone bone-conduction threshold audiogram was obtained. RESULTS: No statistically significant differences were found by Student's t test over all measured frequencies between pre- and postoperative bone-conduction thresholds in each group. There was no statistically significant difference for all frequencies between early (3 days) and late postoperative mean bone-conduction thresholds. CONCLUSIONS: The results of our preliminary clinical study showed that erbium laser poses no risk to inner ear function. However, the lack of standardization obliges further investigation to establish safe clinical parameters of the Er:YAG laser.

Adult↗
PubMed1990

Pre- and postoperative high-frequency audiometry in otosclerosis. A study of 53 cases.

A study was carried out to evaluate the results of stapes surgery in 53 cases of otosclerosis. The hearing function was measured pre- and postoperatively by means of conventional and high-frequency audiometry (Demlar 20K). The operative findings of the gradation of otosclerosis were compared with the pre- and postoperative audiometrical measurements. The results of this study point out that a clear relation exists between the preoperative high-tone audiogram and the gradation of otosclerosis. Stapedotomy does not influence the high-frequency threshold postoperatively. In conclusion, high-frequency audiometry can predict the state of stapes fixation in otosclerosis and this can be important in stapes surgery.

Audiometry↗
PubMed1996

[Pathogenesis of otosclerosis. "State of the art"].

Women suffer from otosclerosis 1.6 times more often than males. Histologically, otosclerotic foci can be found in temporal bones of females 1.9 times more often than in those of males. Characteristic topographic regions are the oval window, round window niche and promontory. Otosclerosis can also occur principally in any area of the enchondral/periosteal layer of the otic capsule. Evidence is presented that otosclerosis is an inflammatory tissue reaction associated with macrophages, T- and B-lymphocytes, HLA-DR positive cells and plasma cells. Dependent on the stage of the osteolytic bone disease present deposits of complement and immunoglobulins (IgG, IgA) can be found. These immunoglobulins have been identified as antibodies to measles virus proteins. Using the polymerase chain reaction we were successful in demonstrating RNA sequences of measles viruses in otosclerotic bone from footplates removed during stapes surgery. Since most of the otosclerotic lesions were in direct contact to the perilymphatic space, it may be expected that the endolymphatic sac--as the immune competent organ of the inner ear--specifically reacts to antigens delivered from the otosclerosis focus into the perilymph. Perilymph samples from patients were collected during stapes surgery and their antibody titers against measles were compared with that in corresponding blood serum. All samples revealed a significantly elevated-specific anti-measles IgG amount which was significantly higher than in the corresponding serum. In contrast, antibody titer in the perilymph against herpes simplex or cytomegalo viruses did not differ from that of the serum. These findings indicate that otosclerosis is a measles virus associated inflammatory osteolytic disease of the temporal bone. Since women suffer from severe measles virus infections more often than males, it can be hypothesized that females have a higher susceptibility of their cochleo-vestibular tissues to these infections (organotropism). In addition, estrogens are well-known stimulators of osteocytic activity and may play a dominant role during ossification of an otospongeotic bone lesion. This may explain the onset of a conductive hearing loss due to otosclerosis during pregnancy.

Adult↗
PubMed1997

Incus and stapes footplate simulator.

Prosthesis placement in stapes surgery is difficult to master. Although temporal bone dissection is an important adjunct to operative experience and anatomic knowledge when training residents to perform this procedure, the high cost and scarcity of temporal bones available for teaching purposes limit their convenience as teaching tools. Therefore, to augment training of residents, the authors developed an inexpensive, easily constructed middle ear simulator made from a disposable drinking cup, toothpicks, and a tongue depressor. The device is used with a microscope and ear instruments to manipulate, place, and crimp stapes prostheses. Improved surgical skills can lead to better surgical results, and this middle ear simulator can help to improve otologic surgical skills by giving residents the opportunity to practice techniques necessary to master stapes surgery.

Ear Ossicles↗
PubMed2006

Who should be a stapes surgeon? An otologist or a generalist?

PURPOSE OF REVIEW: The overall experience with stapes surgery has declined, both within residency training programs, as well as in clinical practice. Does this change in the environment suggest that subspecialists rather than generalists manage patients with otosclerosis? RECENT FINDINGS: A decreasing availability of patients with clinical otosclerosis has encouraged trainees and practitioners to adopt strategies that will enable the maintenance of quality care to these patients. SUMMARY: Well trained generalists should be prepared to perform stapes surgery. Lack of experience or infrequent exposure to disease suggests that optimal care can be achieved by referring the patient to an experienced otologic surgeon.

Clinical Competence↗
PubMed1990

Chondrogenic potential of tragal perichondrium: a cause of hearing loss following stapedectomy.

Tragal perichondrium is a widely used tissue seal in the oval window following stapes surgery. Autogenous and easily accessible, it is a suitable substance to cover the vestibule in total stapedectomy, and to seal around the prosthesis in small-fenestra stapedotomy. The incidence of complications from the use of perichondrium in this manner is exceedingly low. We report a case where tragal perichondrium in the oval window resulted in the proliferation of cartilage. The cartilage displaced the stapes prosthesis, resulting in a conductive loss. Although the chondrogenic potential of perichondrium is known, we are not aware of other reports implicating this as a cause of failure in stapes surgery. The pertinent clinical and experimental literature regarding chondrogenesis is reviewed. This information suggests that the formation of cartilage from perichondrium in the oval window might be influenced by mechanical trauma and tissue orientation.

Adolescent↗
PubMed2007

[First experiences with a new nickel-titanium piston with a shape memory feature].

BACKGROUND: The aim of this study was to describe a new stapes prosthesis with memory characteristics for wire crimping (SMart-Piston). PATIENTS AND METHODS: This technique was used in 15 patients (mean age 43.4 years; range 28-71) undergoing routine stapes surgery. SMart-Piston prostheses with a shaft diameter of 0.5 mm and length ranging from 4.25-4.5 mm were used. Heat induced wire crimping was performed by CO2 laser in five patients, and by bipolar diathermy forceps in ten patients. In 15 patients, postoperative audiological testing was performed at an average 21.9 days and in another 10 again after 435 days following surgery. RESULTS: The median observed air-bone-gap (ABG) postoperatively was 8.7 dB+/-7.7 dB. A total of 73% of all patients had an ABG of 10 dB or less, and all patients had less than 20 dB. In the ten patients controlled after 435 days, the ABG was 4.4 dB+/-2.4 dB. It was lower than 10 dB in all individuals. DISCUSSION: A critical point in every stapes surgery, the prosthesis fixation to the incus, is greatly facilitated by this novel technique. Long-term results in a larger group of patients are pending.

Adult↗
PubMed1996

[Stapedotomy vs stapedectomy. Comparison of hearing results].

The Authors investigated 200 patients, selected at random from an operative case-report of 1857 subjects, in order to evaluate hearing results of stapes surgery and to compare the recovery obtained using both small (0.7 mm footplate hole) and large fenestra stapedectomy. More precisely, after 1 week and 6 months, they examined audiological findings (air, bone conduction and cochlear reserve) before performing the operation in order to evaluate the following problems: persisting conductive gap at low frequencies, sensorineural hearing loss at high frequencies, prognosis in advanced stages (compromised pre-operative bone conduction), preservation of hearing over time. Firstly, data from our research indicate extremely successful results in stapes surgery; in particular, hearing improvement seems to be more frequent for middle-low tones (in 98% of patients), due to the higher rate of sensorineural deficit at high frequencies, which are however characterized by a more complete closure of the conductive gap. However with stapedotomy better hearing recovery is obtained and in a greater number of patients with a lower evidence of bone conduction impairment. Such an advantage increases even further from the time of surgery (p significant after 6 months on every frequency) and particularly in cases where disease is advanced.

Adult↗
PubMed2004

CO2 laser stapedotomy with the "one-shot" technique--clinical results.

OBJECTIVE: To further optimize the surgical technique with the CO 2 laser in stapes surgery a scanner system was used to obtain a footplate perforation of 0.5 to 0.6 mm with only 1 laser application ("one-shot" stapedotomy). STUDY DESIGN: 188 patients with otosclerosis were submitted to a primary CO 2 laser stapedotomy with the SurgiTouch scanner. This study surveys the surgical technique and clinical results. RESULTS: An adequately large perforation diameter could be achieved with a single shot in 68% of the patients treated with the SurgiTouch scanner. In 11% of the patients, a second laser application at the same site was necessary. In 21% of the patients, the perforation had to be enlarged by several slightly overlapping laser applications without scanner. The clinical data of this study clearly documents that there is no evidence of laser depending inner ear affections. CONCLUSION: The CO 2 laser combined with modern scanner systems is well suited for application in stapes surgery.

Adult↗
PubMed1993

Mechanics of the middle ear in otosclerosis and stapedoplasty.

Seventy-three otosclerotic patients, 138 subjects who had undergone stapes surgery (50 total stapedectomies, 43 stapedotomies with stapedius tendon section and 45 stapedotomies with stapedius tendon preservation) and 70 normal controls were investigated by susceptance multiple frequency tympanometry. The aims were to evaluate the efficiency of this procedure in diagnosing otosclerosis and to assess the resonance properties of middle ears undergoing different types of stapedectomy. Tympanometry was performed using sweep frequencies ranging from 226 to 2,000 Hz for each pressure step of 12.5 daPa (pressure range from -500 to 400 daPa). The resonance frequency of the system was evaluated by identifying the "W" morphology of susceptance tympanograms. The results of the present investigation indicate that stapes surgery abnormally reduces the stiffness of the tympano-ossicular system. This phenomenon is limited by preservation of the stapedius tendon, which confers a significant degree of stiffness on the conductive system.

Acoustic Impedance Tests↗