[Relations between preoperative findings and mobilization capacity of the stapes in otosclerosis; conclusions from 200 operation results].
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OBJECTIVE: To evaluate the effect of ossicular reconstruction with partial ossicular replacement prosthesis (PORP) in patients with tympanosclerosis. METHODS: The data of 28 cases of tympanosclerosis treated between 1992 and 2006 were reviewed. Of the 28 patients, 14 (14 ears) underwent ossicular reconstruction with PORP and 14 (14 ears) had ossicular mobilization, and all the patients were followed-up for 3-24 months. RESULTS: Significant improvement was found in postoperative speech frequency (500, 1000, 2000 Hz) pure tone average (PTA) and air-bone gap (ABG) closure after in the operation the two groups. Ossicular reconstruction using PORP resulted in statistically better ABG closure and PTA (P<0.05). CONCLUSION: In ossicular attic fixation, ossicular reconstruction using PORP can yield better results than mobilization of the major ossicles in patients with tympanosclerosis.
Causes of vertigo after otosclerosis surgery were studied postoperatively and in long-term follow-up examinations. Pressure and mobility changes in the posterior labyrinth fluids, enzymatic process, and decrease in blood supply at the time of operation appear to be the major causes. Methods of detection, avoiding, and managing vertigo are presented.
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Illustrated by several examples from the past it is demonstrated how difficult it is to predict future developments in neurosurgery. Several determinants can be recognized as exerting a positive or a negative influence in this respect. Careful observation of unexpected events and consequent consideration in combination with a spiritual independency, are aspects which will contribute in a positive way. The reverse will unavoidably lead to abolition of new ideas and concepts. Authority in a personal as well as in an impersonal way, may act as a negative determinant. This aspect is illustrated by some examples regarding the phenomenon of the "medical mandarin" as a personal authority, and the irrational adherence to paradigms as an impersonal one. Based upon recent experiments new ways for neurosurgical activities are indicated, concerning 1st transplantation of fetal central nervous tissue and of adrenal medullary tissue, and 2nd deep long-term stimulation of the beta endorphin-serotonin system for the control of chronic pain.
BACKGROUND AND OBJECTIVE: The audiometric results after stapes surgery in children with isolated stapes footplate fixation were reason enough to analyze intraoperative findings and surgical procedures. PATIENTS/METHODS: A total of 438 stapes surgeries were performed in the years 1985-2000, and a retrospective analysis was made of the anamnestic data, intraoperative findings and audiometric data from 12 children with isolated fixation of the stapes footplate. The average age of the children when operated was 10.2 years (the youngest was 7 and the eldest 13). A loss of hearing had set in 5 years earlier. RESULTS: Taking the anamnestic data and the intraoperative into account, otosclerosis was found in 5 children. One child had a narrow oval window niche, in a further six children a congenital fixation of the stapes footplate was evident. Only 58% (n=7) of the 12 children operated showed acceptable postoperative hearing results. The best hearing results were found in children with juvenile otosclerosis. In three of six children with congenital stapes fixation, a worsening of both bone and air conduction was evident. The average conductive hearing loss was 30 dB at 1, 2 and 4 kHz. CONCLUSIONS: When explorative tympanotomy is indicated, a thin-layer CT scan of the temporal bone should be made to assess the risk of a liquor pressure labyrinth developing.
Although the modern technique of otosclerosis surgery introduced by John Shea on 1st May 1956 has already been used throughout the world for almost fifty years it has not been possible to bring in line the differing opinions of surgeons concerning the optimum operation technique, the problems of the fenestration of the footplate, material and form of stapes replacement prosthetics and kind and place of their anchoring on the incus. Moreover, there is considerable disagreement among surgeons on a realistic evaluation of the findings of early and late results. During the last few decades otosclerosis surgery has become the hallmark of modern ear surgery and has been practiced in very highly specialized departments as well as in outpatient departments. The author, who has been very active in otosclerosis surgery since 1959-since 1979 with a modified personal technique-, wishes to prove that it is both meaningful and essential to modify the operation technique further, which is based on his own experiences and on more than 100 international publications. In this paper he presents his modified method, which has been tested on 1800 ears since 1979, as well as the results, achieved in this way.