Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Stapes Surgery”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 451 records · Page 25Linked to original sources
PubMed1993

Reducing footplate complications in small fenestra microdrill stapedotomy.

Some surgeons have altered their technique for small fenestra stapedotomy in order to avoid footplate complications. This study aimed to determine what surgical step changes reduced footplate complications and improved hearing results. Operative reports provided data on surgical technique and complications in 151 consecutive primary stapes surgery patients. Comparisons of preoperative and postoperative audiograms provided hearing results of surgery. Fenestrating the footplate after, rather than before, stapes arch removal and fracturing the stapes arch after dividing one crus with a nipper were two surgical steps that reduced fractures. Hearing results were better after fenestration of the footplate with a microdrill compared to results with a hand drill.

Audiometry, Pure-Tone↗
PubMed2001

CT and MR imaging after middle ear surgery.

This article describes the current value of imaging in patients after stapes surgery and surgery after chronic otitis media including cholesteatoma. Possibilities and limits of computed tomography (CT) and MRI are described and most important investigation parameters are mentioned. After otosclerosis surgery, CT is the method of first choice in detection of reasons for vertigo and/or recurrent hearing loss in the later postoperative phase. CT may show the position and condition of prosthesis, scarring around the prosthesis and otospongiotic foci. Sometimes, it gives indirect hints for perilymphatic fistulas and incus necrosis. MRI is able to document inner ear complications. CT has a high negative predictive value in cases with a free cavity after mastoidectomy. Localized opacities or total occlusion are difficult to distinguish by CT alone. MRI provides important additional information in the differentiation of cholesterol granuloma, cholesteatoma, effusion, granulation and scar tissue.

Cholesteatoma↗
PubMed1993

Reporting the benefits from middle ear surgery using the Glasgow Benefit Plot.

In the past, otologists have reported the results of middle ear surgery to improve hearing, either by tympanoplasty or by stapes surgery, mainly in terms of closure of the air-bone gap. This is valid as a measure of the technical success of the operation provided any change in the bone conduction thresholds, particularly at the higher frequencies, is also reported. Unfortunately, technical success in surgery does not always equate with patient benefit, primarily because, in most conditions, listening is a binaural condition. Disability in such circumstances is dictated by the hearing in the better hearing ear, which, quite correctly, is usually the nonoperated ear. Hence, it is important to define the relationship, before and after surgery, between the hearing in the operated and that in the nonoperated ear. This is the basis of the Glasgow Benefit Plot, which is drawn up from pure-tone audiometric data before and after surgery.

Audiometry, Pure-Tone↗
PubMed2003

[Stapedotomy, stapedectomy and revision surgery performed with laser techniques. Revision of literature].

The usefulness of laser in otologic surgery, and specifically the suitability of its use in stapes surgery, is still under discussion. We intend to support the use of this method in the surgical treatment of otosclerosis, as well as to elucidate which type of laser is the most advisable one, establishing also in which stages of surgery it should be used. For this, we carry out a revision of the main opinions published in this regard in the international literature, commenting on the results and observations gathered in it. We end by setting out a number of conclusions which are the result of the analysis of the criteria put forward in the bibliography.

Humans↗
PubMed1995

[Revision of the stapes foot plate with various laser systems. 1: Continuous laser irradiation].

During stapedotomy, the small dimensions and highly sensitive anatomic structures present require the highest degree of precision and safety. The risk of damage to middle and inner ear structures through manipulation with conventional instruments can be reduced by non-contact perforation of the footplate with the laser beam. The present study was devised to clarify which of the presently available laser systems was best suited for use in stapes surgery and thus represent a significant alternative to conventional stapedotomy. Isolated human stapes and bovine compact-bone platelets were used to investigate the connections between the parameters of various laser systems and their effects on bone tissue. The aim was to optimize the laser parameters required to achieve a perforation of 500 microns to 600 microns in diameter. In addition, the thermal effects of laser irradiation were assessed. Three different systems were employed: the argon and CO2 lasers in continuous wave (cw) modes and the CO2 laser in superpulse mode. The lasers investigated offered the advantage of achieving an adequately large perforation with one or a few juxtaposed applications but caused in part extensive thermal side effects at the stapes footplate. To reduce thermal effects, footplate perforation was best performed by several juxtaposed single shots at low power, short pulse duration and small beam diameter. The suitability of the argon laser for stapedotomy was rendered doubtful in view of the lower absorption coefficient of the stapes for the argon laser beam and the considerable influence exerted by the degree of pigmentation of the irradiated tissue sites with a resultant poor reproducibility of the perforation diameter.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Fiberoptic argon laser stapedotomy: is it safe?

The history of otosclerosis surgery has been marked by major advances in both surgical technique and instrumentation. Fenestration, stapes mobilization, total stapedectomy, and stapedotomy were important advances in technique. Loupes, binocular microscopy, speculum holders, and microdrills similarly advanced instrumentation. What about fiberoptic argon laser handpieces for use in laser stapedotomy? Do they represent a significant advance in instrumentation, or are they merely another gimmick? Are fiberoptic argon laser handpieces safe? Experimentally, the thermal effects of argon laser, delivered via fiberoptic handpieces to a cadaver stapes and model vestibule, were studied. No significant temperature elevations within a model vestibule were observed during stapedotomy. There were significant temperature elevations within the laser plume at the level of the facial nerve. These findings are consistent with our experience in over 2200 primary and revision stapedotomies. To date, there have been no cases of significant hearing loss or permanent facial paralysis related to the use of these fiberoptic handpieces. We believe fiberoptic argon laser handpieces are as safe as conventional microsurgical instruments in stapes surgery.

Ear Diseases↗
PubMed1985

Carbon dioxide laser stapedotomy. Thermal effects in the vestibule.

Small-fenestra stapedotomy has recently been popularized in efforts to reduce the incidence of sensorineural hearing loss following stapes surgery for otospongiosis. Lasers have been advocated as a tool to fenestrate the stapes footplate. Conversion of radiant energy from the laser into heat in the vestibule represents the greatest potential risk to the inner ear. Using a carbon dioxide laser with a focal point of 150 microns at 300 mm, fenestrations of the stapes footplate were performed in a series of 14 anesthetized cats. The laser power output ranged from 0.47 to 3.05 W, with pulse durations of 0.2 and 0.5 s. Resultant temperature elevations in the vestibule, measured by a thin-wire thermocouple, ranged from 0 to 4.4 degrees C (0 to 8 degrees F) and directly correlated to wattage and duration of the laser-beam pulse. Temperature changes could be reduced by use of lower wattage, shorter pulse duration, timed intervals between pulses, and convection cooling of the promontory.

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↗
PubMedDate not supplied

Comparison of argon and CO2 laser stapedotomy in primary otosclerosis surgery.

PURPOSE: The primary use for the laser in otosclerosis surgery is to create a stapes footplate fenestration that obviates the need for mechanical footplate removal. Experimental studies that evaluate the potential safety of visible (argon and potassium-titanyl-phosphate [KTP]) and invisible (CO2) light laser systems in stapes surgery report conflicting results. The purpose of this study is to compare the clinical safety and efficacy of the CO2 and argon laser systems when used for primary laser stapedotomy. MATERIALS AND METHODS: A retrospective case review of 124 primary laser stapedotomies using either the argon (n = 59) or CO2 (n = 65) laser was performed. Data consisted of pre- and postoperative air and bone conduction audiometry, speech discrimination scores (SDS), intraoperative findings, and postoperative complications. Between group differences (argon v CO2) were sought using standard statistical methodology. RESULTS: The argon and CO2 laser groups were comparable with regards to age, sex, preoperative air-bone gap, and laterality. Mean preoperative air and bone conduction pure-tone average (PTA) and SDS were somewhat higher in the CO2 laser group (P < .05). Postoperatively, both groups showed similar results in mean change in air conduction PTA, air-bone gap, and SDS, as well as in the frequency of complications. There were no anacoustic ears in either group. CONCLUSIONS: The results suggest that the argon and CO2 laser systems are comparable with regards to safety and efficacy when used by experienced surgeons for stapedotomy.

Adult↗
PubMed1996

Stapes fixation associated with symphalangia.

We describe a 10-year-old boy and his 9-year-old sister, both of whom had bilateral hearing loss associated with ankylosis of the proximal interphalangeal joints (symphalangia). They had no other abnormal findings except hearing loss and ankylosis of the joints of some fingers and toes on systemic examination. The cause of conductive hearing loss in both cases was bony fusion between the stapes and the bone of the oval window niche. There were no other anatomical abnormalities in the middle or the external ear. The patients' hearing improved markedly after stapes surgery. Histopathologic examination of the stapes revealed an abnormal zone of ossification near the anterior annular ligament and calcification in the annular ligament, which seemed to be the cause of the stapes fixation.

Child↗
PubMed1994

Update of reparative granuloma: survey of the American Otological Society and the American Neurotology Society.

Members of the American Otological Society and the American Neurotology Society were polled regarding stapes surgery and reparative granuloma. Of 467 questionnaires, 176 (38%) were returned, and 319,410 stapes cases were statistically analyzed: 329 reparative granulomas were reported after stapedectomy (incidence = 0.1%) and 29 after stapedotomy (incidence = 0.07%); 77 surgeons reported having encountered at least one reparative granuloma; and 50 surgeons related the occurrence of a reparative granuloma to a specific graft material. Gelfoam was the most common graft material reported when a reparative granuloma was encountered, followed by fat, and vertigo was the most frequently reported presenting symptom. Reported operative techniques as well as manifestations, management, and outcome are discussed.

Adult↗
PubMed1997

Hearing results in otosclerosis surgery after partial stapedectomy, total stapedectomy and stapedotomy.

Hearing results in a consecutive series of 407 patients with otosclerosis undergoing primary stapes surgery were analysed (437 operated ears). Partial stapedectomy was performed in 70 ears (16%), total stapedectomy in 205 ears (47%), in both groups using the House steel wire prosthesis on fascia in the oval window. The remaining 162 ears (37%) underwent stapedotomy using the Fisch 0.4 mm teflon-platinum piston. No case of cochlear loss (> 15 dB) occurred in the total series. The comparison between the three groups one year postoperatively showed that the air-bone gap was smaller for partial and total stapedectomy for all frequencies except 4 kHz. The air-bone gap was calculated as the difference between the preoperative bone conduction and the postoperative air conduction thresholds. Partial and total stapedectomy also showed larger improvements of bone conduction thresholds compared with stapedotomy for all frequencies but 4 kHz. At the 3-year follow-up, the hearing gain for all frequencies (250-8000 Hz) was larger for partial and total stapedectomy. Yet, when comparing the decline of hearing from 1 to 3 year postoperatively, the hearing gain achieved with partial and total stapedectomy seemed to deteriorate at a higher rate, which was considered to be caused by impaired sensorineural function. Our results show that in the short-term perspective partial or total stapedectomy can still compete for better hearing results even at higher frequencies, but stapedotomy seems to yield more stable hearing results over time and should therefore be considered as the method of choice.

Adolescent↗
PubMed1988

Otosclerosis masking coexistent acoustic neuroma.

The coexistence of an acoustic neuroma with otosclerosis can prove to be a great diagnostic dilemma. In such cases, the diagnosis of acoustic neuroma is usually delayed while more common causes of sensorineural hearing loss associated with otosclerosis or its surgery are considered. Any asymmetric progression of a sensorineural loss or shift in discrimination after stapes surgery, whether sudden or gradual, should provoke suspicion of a second pathologic process. These include perilymph fistula, labyrinthine otosclerosis or ischemia, and acoustic neuroma. The use of auditory brainstem response and acoustic reflex testing and various imaging techniques is essential for accurate diagnosis. This paper includes two cases that demonstrate this dual pathology, bringing the total to 15 such cases reported in the literature. The purposes of this paper are to alert the clinician to the diagnostic problem of acoustic neuroma coexisting with otosclerosis and to propose a means of evaluating these patients.

Adult↗
PubMed1979

Otosclerosis surgery: reassessment of its value in 1978.

Today, surgical correction is the treatment of choice for the hearing loss associated with footplate otosclerosis. Experience with stapes surgery reveals this to be functionally and economically superior to the long-term use of hearing aids. There is, however, a predictable rate of surgical complications. Sensorineural hearing loss, dizziness and/or facial nerve palsy have an immense social and economic impact upon the patient, the family and the surgeon. Otosclerosis surgery will be presented in the perspective of benefits, untoward results, and alternate forms of treatment. A cost analysis of the foregoing will shed light on the future of otosclerosis surgery.

Adult↗
PubMedDate not supplied

[Surgical treatment of otosclerosis].

A significant step forward in otosclerosis surgery was made in 1956 with the advent of stapedectomy. This led to a significant reduction in surgical complications and to a high level of patient satisfaction. Hearing aids are the alternative to surgery, and have themselves undergone considerable technical improvements. In advanced otosclerosis, cochlear implants can improve hearing when stapes surgery and a conventional hearing aid are inadequate. These advances are modifying the surgical indications.

Adult↗
PubMed2000

[Inner ear depression after middle ear interventions].

BACKGROUND: Any type of otosurgical procedure involves the risk of inner ear damage. As middle ear surgery is also performed for functional reasons this risk should be taken into consideration. The aim of this study was to analyse the frequency and the nature of sensorineural hearing loss following chronic ear surgery. PATIENTS: A total of 3989 middle ear cases operated on between 1991 and February 1999 at the Department of Otorhinolaryngology, Head and Neck Surgery, University of Würzburg, Germany were studied retrospectively: 781 type I tympanoplasties, 2408 type III tympanoplasties and 800 cases of stapes surgery. The pre- and the postoperative audiograms in the frequency range between 500 and 8000 Hz were analysed and correlated to the different intraoperative findings. RESULTS: Sensorineural hearing loss occurred in a total of 1.3% of 2224 patients with normal preoperative bone conduction thresholds: 0.2% became deaf, 0.8% acquired a high tone loss at 4 kHz and in 0.3% patients also 2 kHz was affected. None of the documented intraoperative complications such as bleeding, unexpected opening of a semicircular canal, extensive manipulation at the ossicular chain or a gusher phenoma showed a relevant effect on postoperative bone conduction thresholds. The incidence of high tone loss was not increased in cases of extensive drilling of the temporal bone. An unexpected opening of the vestibulum led to a small, but statistically significant change in postoperative bone conduction thresholds. CONCLUSIONS: Our results demonstrated that the risk for sensorineural hearing loss caused by middle ear surgery is low. None of the analysed factors seems to be a relevant prognostic risk factor for postoperative inner ear depression.

Adolescent↗
PubMed1993

The role of KTP laser in revision stapedectomy.

In recent years, the safety and efficacy of revision stapedectomy has come under scrutiny. Experienced surgeons report that the results of such surgery are often worse than the results after primary surgery and that the risks of sensorineural hearing loss, tinnitus, and vertigo are increased. With the addition of laser technology to revision stapes surgery, the procedure to open the neomembrane over the oval window and gain access to the inner ear can now be performed safely. This allows positive identification of the oval window and assures placement of the prosthesis through the fenestra rather than on an intermediate segment of scar or bone in the region of the footplate. Our studies have shown the laser to be an important tool that enhances the safety and efficacy of revision stapedectomy.

Audiometry↗