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PubMed2006

["One shot" CO2 laser stapedotomy].

BACKGROUND: In order to further optimize the surgical technique with CO(2) laser in stapes surgery, a scanner system was used to obtain a footplate perforation of 0.5-0.6 mm with only one laser application ("one-shot" stapedotomy). PATIENTS AND METHODS: A total of 255 patients with otosclerosis were submitted to primary CO(2) laser stapedotomy with a SurgiTouch scanner. This study discusses 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. In 14% of the patients, a second laser application at the same site was necessary. In 18% the perforation had to be enlarged by several slightly overlapping laser applications without using the scanner. There was no evidence of laser dependent inner ear affections. CONCLUSION: CO(2) laser, combined with modern scanner systems, is well suited for application in stapes surgery.

Adolescent↗
PubMed2003

Surgical treatment of otosclerosis in elderly patients.

OBJECTIVE: The aim of this study was to analyze hearing results of stapes surgery in otosclerotic patients older than 65 years. STUDY DESIGN: Among 473 primary stapedectomies, 16 were performed in patients over 65 years old and were retrospectively reviewed. Hearing results were compared with those of a randomly selected group of 16 patients younger than 65 years old. RESULTS: Improvement in hearing (closure of the air-bone gap to <20 dB) was achieved in all of the cases, and closure of the air-bone gap to less than 10 dB occurred in 87.5% at 1 month and in 81.8% at the last evaluation (mean follow-up, 19.5 months). Hearing results were similar in elderly and younger patients. CONCLUSION AND SIGNIFICANCE: Stapes surgery is an effective procedure in elderly patients with otosclerosis to avoid hearing aid use or to facilitate hearing aid fitting.

Adult↗
PubMed1999

Delayed facial paralysis after stapedotomy using KTP laser.

OBJECTIVE: Delayed facial paralysis after stapes surgery is uncommon and has been reported after traditional, nonlaser techniques for stapedotomy. The purpose of this paper is to inform the reader of the potential risk of delayed facial nerve paralysis associated with the use of the potassium titanyl phosphate (KTP) laser for stapedotomy. Etiologic mechanisms are discussed. STUDY DESIGN: The study was a descriptive study-case report. SETTING: The study was conducted at a university-based otologic practice. PATIENTS: Two patients with otosclerosis and delayed onset facial palsy 5 to 7 days after uncomplicated stapedotomy using the KTP laser were included in the study. INTERVENTION: Potassium titanyl phosphate laser stapedotomy was performed. Patients received treatment of facial palsy with a tapering course of oral steroids. MAIN OUTCOME MEASURE: House-Brackmann facial nerve grade scores were used. RESULTS: Improvement of House-Brackmann facial nerve scores from Grade VI to Grade I-II in one patient, and improvement from Grade IV to Grade I-II in the other was seen. CONCLUSION: The probable etiology of delayed facial palsy is viral neuritis from reactivation of dormant virus within the facial nerve, initiated by thermal stress of the KTP laser. Presentation and resolution of the facial palsy is similar to other types of delayed facial palsy resulting from nonlaser techniques of stapes surgery and other types of middle ear and neurotologic surgeries previously reported.

Facial Nerve↗
PubMed1996

[Evolution of the operative technique. CO2 laser stapedotomy and stapedoplasty].

In recent years in the literature on stapes surgery several changes have been proposed concerning the adoption either of new technologies (Laser) or of surgical techniques preserving middle ear functional structures (stapedoplasty). The Authors carried out a personal case-report on 30 patients suffering from otospongiotic disease, in order to clarify the real advantages and possible applications of the latest developments in small fenestra stapedectomy. Twenty subjects underwent platinotomy with preservation of the stapedial tendon (stapedoplasty), while a simple stapedotomy was performed in the remaining 10 cases, with or without inversion of surgical times (a "rigid system" technique was adopted in 7 patients). CO2 Laser was used on 10 of these patients (33%) in order to carry out certain surgical steps; in particular it was used on 7 subjects who underwent stapedotomy with stapedoplasty (35%) and in 3 cases of traditional stapedotomy (100%). An audiometric examination was conducted on all subjects 1 and 6 months after the operation, in order to evaluate functional recovery; the post-operative stapedial reflex was also studied in patients who underwent stapedoplasty. This research points out the advantages that CO2 Laser gives in the execution of stapes surgery, whatever the type of technique adopted; in particular, the advantages of using this instrument are: -an easier and bloodless performance of the operation, particularly in the case of the preservation of the stapedial tendon; -a greater regularity and precision of the footplate hole than that obtained by drilling, especially in subjects whose stapes are thin, floating, fractured or even obliterated; -less mechanical traumatism on the labyrinth during either the fracturing of the crura or the footplate fenestration, resulting in the reduction of both perceptive hearing loss an dizziness; -a higher incidence of air-bone gap closure mostly in the case of stapedial tendon preservation. On the other hand, the use of inadequate lasers or the lack of reference to exact parameters (beam power and frequence, time of exposure and defocalization), could cause the heating of labyrinthine liquids and so damage the receptorial structures of the inner ear.

Humans↗
PubMed2005

[Results of surgical treatment for advanced otosclerosis].

OBJECTIVE: To assess the effect of stapes surgery on advanced otosclerosis (AO). METHODS: In 300 cases randomly collected of otosclerosis in 1970 to 1999, 68 cases (77ears) were selected for retrospective analysis, which met the criteria of advanced otosclerosis (mixed deafness, with bone-conduction levels exceeding 40 dB and air-conduction levels exceeding 70 dB in 500 - 2000 Hz). RESULTS: The air-conduction of sixty-eight cases (77 ears) were from 77.32 dB to 53.7 dB (500-2000 Hz) after operation, mean decreased 23.62 dB. Of 71 ears (92.21%) obtained air-conduction improved over 10 dB, of 46 ears (59.74%) gained A-B Gap closure in 10 dB. Air-conduction were from 79.01 dB to 58.23 dB (500 - 4000 Hz) after operation and mean decreased 20.78 dB. Of 68 ears (88.31%) obtained air-conduction improved over 10 dB, of 32 ears (41.56%) gained A-B gap closure in 10 dB. After followed up 5-25 years, of 67 ears were retained stabilization, of 28 ears obtained more improve than postoperation. But 4 ears had drop (all was stapes-elevation and re-improvement after them was reviewed). CONCLUSION: Stapes surgery is effective operation to cured otosclerosis, advanced otosclerosis or far-advanced otosclerosis had greater help to improved hearing.

Adult↗
PubMed2005

Video-oculography findings in patients with otosclerosis.

OBJECTIVE: To evaluate the existence of vestibular irritation with video-oculography before and after stapes surgery and to examine whether there would be signs of specific end-organ irritation. STUDY DESIGN: A prospective study of preoperative and postoperative nystagmus, vertigo, and hearing thresholds. SETTING: University hospital, tertiary referral center. PATIENTS: Thirty-three patients (mean age, 47 yr) with otosclerosis. INTERVENTION: Stapedotomy/stapedectomy with laser or microdrill. MAIN OUTCOME MEASURES: Spontaneous, gaze-evoked, and head-shaking nystagmus was measured preoperatively and approximately 1 week, 1 month, and 3 months after the operation. Three dimensions of nystagmus were identified and their slow-phase velocities were calculated. RESULTS: Spontaneous horizontal nystagmus was found preoperatively in 18% (slow-phase velocities, 1.3-3.3 deg/s) and postoperatively in 11 to 19% of the patients (slow-phase velocities, 1.3-3.8 deg/s). Head-shaking nystagmus was not detected preoperatively. After the operation, 11 to 15% of the patients had head-shaking nystagmus (slow-phase velocities, 6.6-17.8 deg/s), but this prevalence did not differ statistically significantly from the preoperative level (p = 0.18). Vertical nystagmus was found equally pre- and postoperatively. Torsional nystagmus was not found. One week after the operation, nine patients (27%) had some sensation of vertigo, but it lasted over 1 month in only one patient. We found no significant correlation with vertigo and the types of nystagmus. CONCLUSION: Nystagmus with a low slow-phase velocity can occur in patients with otosclerosis. However, according to the video-oculographic findings and subjective symptoms, significant vestibular dysfunction seems to be rare and temporary after stapes surgery.

Adult↗
PubMed2000

Perioperative glucocorticoid treatment does not influence early post-laser stapedotomy hearing thresholds.

OBJECTIVE: The aim of this study was to evaluate the efficiency of prophylactic perioperative glucocorticoid treatment during stapes surgery in preventing damage to the inner ear and reducing the frequency of early postoperative complications. STUDY DESIGN: A prospective, randomized, unblinded study design was selected. SETTING: The study was conducted at an academic tertiary referral center. PATIENTS: Ninety-five consecutive patients undergoing erbium:YAG laser-assisted stapedotomy for otosclerosis between 1996 and 1999 were included. MAIN OUTCOME MEASURES: The preoperative minus postoperative (1-4 days and at least 6 weeks) average pure-tone bone conduction thresholds at 1, 2, and 4 kHz were compared in the prednisolone and control groups by the Mann-Whitney U Test. In addition, the occurrences of sensorineural hearing loss of >10 dB, nystagmus, vertigo, and tinnitus were counted and evaluated by use of the Freeman-Halton or Fisher's exact test, respectively. RESULTS: Prophylactic perioperative prednisolone treatment was not able to improve the early postoperative average bone conduction thresholds or reduce the frequency of early sensorineural hearing loss (p > 0.5). The patients who received perioperative prednisolone treatment experienced postoperative vertigo more frequently than did the control patients (p < 0.05). CONCLUSION: Perioperative cortisone prophylaxis for prevention of inner ear damage during stapes surgery is ineffective and is associated with increased postoperative patient discomfort.

Adult↗
PubMed1999

[The choice of the stapes surgical style in treatments of the otosclerosis].

OBJECTIVE: To investigate the effects of the stapes surgery on treatment of the otosclerosis to find out the more suitable surgical style. METHOD: 71 cases including 31 cases with stapes lifting surgery, 34 cases with partial stapcdectomy, 6 cases with total stapedectomy were summed. RESULT: Both the stapes lifting surgery and partial stapedectomy have steady effects on hearing level for a short or long time. CONCLUSION: The stapes lifting surgery should be adopted as the first surgical style for it is easier and the vestibular reaction is slighter. It will not affect the following surgical process even the two crura are broken.

Adult↗
PubMed2006

Auditory function in patients with surgically treated superior semicircular canal dehiscence.

OBJECTIVE: To characterize preoperative and postoperative audiologic findings in patients with superior semicircular canal dehiscence syndrome. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Patients with documented superior semicircular canal dehiscence syndrome (according to history, vestibular testing, and high-resolution computed tomography imaging) who underwent surgical repair of their dehiscence. INTERVENTION: Middle fossa craniotomy for superior semicircular canal plugging and/or resurfacing. MAIN OUTCOME MEASURES: Audiologic testing both before and after surgery with pure-tone threshold measurements of air and bone conduction. RESULTS: Twenty-nine subjects underwent surgical repair of superior semicircular canal dehiscence. Overall, there were no statistically significant differences by paired t test in hearing before or after surgery, in either air-conduction or bone-conduction thresholds, for 19 patients that had no previous surgical history. At least partial closure of air-bone gap was achieved in five patients. One patient with previous stapes surgery had significantly worse hearing both before and after canal repair compared with those without previous surgery. Two patients who had undergone previous middle fossa surgery with incomplete resolution of symptoms developed sensorineural hearing loss after revision surgery. Previous middle-ear exploration and tympanostomy tube placement did not seem to affect audiologic outcomes. Surgical hearing results did not differ according to method of canal repair (plugging versus resurfacing). CONCLUSION: Primary middle fossa repair of superior semicircular canal dehiscence is not associated with sensorineural hearing loss and, in some cases, can lead to normalization of conductive hearing loss. Revision middle fossa repair or previous stapes surgery may be associated with postoperative sensorineural hearing loss.

Adult↗
PubMed1995

Surgery in elderly patients with otosclerosis.

Hearing results and complications of surgery were studied in 42 patients with otosclerosis (46 ears operated on) who were over the age of 60 years at the time of stapedectomy. The mean follow-up period was 8 years. The results were compared with those obtained in 275 patients (330 ears operated on) younger than 60 years of age undergoing stapes surgery during the same time period. Large fenestra stapedectomy with fascia seal to the oval window was used in all cases. Hearing results as judged by postoperative air-bone gaps were as good in the older age group as in the younger patients. In contrast to some earlier reports, complications of surgery such as postoperative sensorineural hearing loss occurred not more frequently among elderly patients than in younger patients. It is concluded that stapes surgery should be offered to elderly patients with the same indications as in younger patients with otosclerosis.

Age Factors↗
PubMed2005

A prospective evaluation of the Essen titanium stapes prosthesis.

OBJECTIVES: This is the first clinical trial to evaluate the suitability of a new titanium stapes prosthesis, which we developed jointly with the Kurz Company (Dusslingen). DESIGN: In a prospective clinical study, patients with otosclerosis underwent stapes surgery using our new titanium stapes prosthesis during a period of 14 months. One year after surgery pre- and postoperative audiograms were performed and all patients participated in a structured interview. SETTING: Tertiary otorhinolaryngological university department PARTICIPANTS: Of 49 patients with otosclerosis, entering the study, two patients were excluded, because they were not located any more. MAIN OUTCOME MEASURES AND RESULTS: All patients experienced a hearing improvement of 21 dB on average except one patient. Sixty percentage of patients achieved a reduction of the air-bone gap to less than 10 dB and 31% of patients having their air-bone gap closed to within 20 dB--averaged across 0.5, 1.0, 2.0 and 4 kHz. The hearing level improved significantly in the air and in the bone conduction thresholds. CONCLUSIONS: This paper presents our first '1 year postimplantation' results of our titanium stapes prosthesis. We consider the development of this implant to be beneficial. The results confirm significant improvement in hearing status and tinnitus levels.

Adult↗
PubMed2005

[Effect of CO2 laser on prostheses used in middle ear surgery].

The use of CO2 laser is advocated in primary and revision stapes surgery. The aim of the study was to assess the effect of CO2 laser on stapes prostheses. CO2 laser was applied on several types of stapes prostheses and PORPs, with power settings suggested by the manufacturer (continuous wave, 2 W and 6 W; 0,05 s). Application of the laser on stainless steel or titanium prosthesis did not exert any effect on the structure of the prosthesis. The use of the laser on the Teflon piston caused superficial burning with power 2 W, and melting and holes in the piston with power settings at 6W. Similar plastipore prostheses were melting. Hydroxyapatite PORP shattered after application of the laser energy. Teflon and hydroxyapatite prostheses are easily damaged by the laser energy, therefore applying a laser on them should be avoided. CO2 laser can be used on stainless steel and titanium prostheses without risk of damaging them. However the possibility of transmission of heat to the vestibule has to be taken into consideration.

Carbon Dioxide↗
PubMed1998

[The influence of age and sex on the results of otosclerosis surgery].

The influence of age and sex on auditory improvement after stapes surgery was investigated retrospectively on 127 otosclerotic ears (99 subjects) that were followed up for 6 months postoperatively. The prostheses used were the Shuknecht-type Teflon wire piston (87 ears), the House-type wire loop (29 ears), and the Cawthone-type Teflon piston (11 ears). While closure of the air-bone gap after surgery was good at 2 kHz, it was poor at 8 kHz and frequencies lower than 1 kHz, and especially poor at 250 Hz. At all frequencies, both air and bone thresholds were significantly improved by the surgery, but the greatest improvements in air and bone thresholds resulted from the use of Teflon wire pistons. Ears receiving Teflon wire prostheses were divided into 5 age groups: under 20 years, 20-29, 30-39, 40-49, and 50 or above. Both air and bone thresholds at higher frequencies before surgery worsened with increasing age. However, there were no significant differences among age groups in the postsurgical improvement of either air or bone thresholds. Similarly, no gender-related differences in either air or bone thresholds were recognized postsurgically. The authors speculate that light cases of otosclerosis are common among Japanese patients, while severe cases are rare even among the elderly.

Adult↗