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At least 469 records · Page 26Linked to original sources
PubMed1993

Far-advanced otosclerosis.

Profound deafness has received increasing attention in recent years, largely because of the availability of cochlear implants. Consequently, it is especially important for otolaryngologists to remember that a "blank" audiogram does not necessarily mean total or even profound deafness. Patients with far-advanced otosclerosis may have no measurable hearing with routine audiometric testing even in the presence of serviceable sensorineural hearing. Review of nine patients (10 ears) who underwent stapedectomy from 1980 to 1987 reveals that seven of the nine (78%), who had been unable to use a hearing aid preoperatively, obtained serviceable hearing with hearing aids following surgery. Otolaryngologists should depend on a good history and tuning fork examination to avoid being misled by the audiogram, and should not hesitate to offer stapes surgery to patients with far-advanced otosclerosis.

Aged↗
PubMedDate not supplied

Success in surgery for otosclerosis: hearing improvement and other indicators.

PURPOSE: This retrospective study investigates the general outcome and subjective impression of patients who have undergone surgery for otosclerosis. Postoperative complaints and complications, as well as hearing results, are also reported. MATERIALS AND METHODS: Questionnaire and audiomeric results of 246 stapes surgery patients (270 operations) were studied. RESULTS: Hearing results showed a mean improvement in pure-tone average of 26 dB and air-bone gap closure to within 10 dB in 214 cases (79%). No serious complications or profound sensorineural hearing loss occurred. Patients were generally pleased with surgery, and subjective evaluation of benefit corresponded with objective audiometric result. However, a variety of complaints, such as vertigo, tinnitus, loud noise intolerance, pain, chorda tympani symptoms, and sound distortion problems, were reported. Most of these symptoms correlated significantly with the patients' subjective opinion of the surgical outcome. CONCLUSION: Patients as well as surgeons consider hearing improvement as the main indicator of success in surgery for otosclerosis. However, postoperative symptoms and complaints can be expected in a certain percentage of patients. Because these can influence the general outcome of surgery, the ear surgeon should try to painstakingly refine his technique in an effort to minimize their sources. They should also be discussed in preoperative patient counseling.

Adult↗
PubMed1991

[Cochlear damage caused by middle ear surgeries].

A prospective study was set up to study the reaction of the cochlea after the trauma of middle-ear surgery. For this purpose, the bone conduction of 50 patients was tested every day, beginning on the first post-operative day. To collect information on possible damaging mechanisms, three surgical techniques were studied: Stapes surgery with the opening of the inner ear; mastoidectomy with drill-generated noise; tympanoplasty with manipulations at the stapes. The comparison of the bone conduction thresholds with audiometry results after completed healing of the ear, disclosed that even under the ear-packing, bone conduction can give reliable information on cochlea function, if a 10-15 dB variance due to methodological causes is taken into account. Excessive drilling may result in a temporary threshold shift, which has already resolved at the time of unpacking the ear. No signs of hydraulic damage after manipulation at the stapes could be discovered.

Auditory Threshold↗
PubMed2005

[Results of stapedotomy in the cases of "floating footplate"].

One of the problems in the stapes surgery is the floating footplate. The frequency of incidence of this complication is 2% to 5.8% of all operations. The authors present the results of stapes operations in a group of 28 cases (2.5%) from all the 1120 operations, in which the surgeon experienced a floating footplate. The hearing results were evaluated on the base of the average gain of air-conduction thresholds and air-bone gap levels at 500, 1000, 2000 and 3000 Hz. The improvement of hearing we observed in 24 patients, 4 patients heard worse.

Adult↗
PubMed2006

Congenital stapes ankylosis: study of 28 cases and surgical results.

OBJECTIVE: The objective of this study was to analyze functional results after stapes surgery in patients with congenital nonprogressive conductive deafness resulting from an isolated fixation of the stapes according to age and surgical procedure. STUDY DESIGN: The authors conducted a retrospective case series from March 1993 to December 2003 in patients from two tertiary referral centers. METHODS: Twenty-eight patients were operated on by stapedotomy or partial stapedectomy using Teflon stapes prostheses. The median age at surgery was 14.2 years (range, 8.3-29.1 years). Main outcome measures were clinical and audiometric evaluation before and after surgery. Mean air conduction (MAC) and bone conduction (MBC) thresholds were recorded at 0.5, 1, 2, and 4 kHz. The evaluation of functional outcome was based on the MAC gain, the MBC comparison, and the mean postoperative and residual air-bone gaps. RESULTS: The median preoperative MAC was 50 dB (range, 19.0-65.0 dB) with a 35.0 dB median dB air-bone gap. With a mean follow up of 19 months, postoperative hearing improvement was statistically significant: median gain of 32.5 dB (P<.001) and median residual air-bone gap of 3.5 dB. The MBC was also statistically improved with median pre- and postoperative MBC of 11.5 and 6.5 dB, respectively (P<.001). Results were not dependent on the age group or type of surgery (stapedotomy or partial stapedectomy). No perceptive hearing loss was observed despite one gusher case. CONCLUSION: Surgical treatment of isolated congenital stapes ankylosis allows good functional results regardless of age or type of surgery.

Adolescent↗
PubMed2001

Short- and long-term results of stapedotomy and stapedectomy with a teflon-wire piston prosthesis.

We analyzed the results of 604 cases of primary stapes surgery performed between 1974 and 1997 with replacement of the stapes by a 0.6- or 0.8-mm Schuknecht Teflon-wire piston. At long-term follow-up (1 to 21 years; mean, 7 years), the residual air-bone gap was 10 dB or less in 79% of the cases. The hearing results and postoperative complications were comparable to those reported by authors who used the same evaluation criteria. Although the aim of the surgery was to perform a small stapedotomy with a narrow footplate perforation (0.8 mm), a large stapedotomy or a stapedectomy was performed in 134 cases (22.2%) because of surgical or anatomic conditions. Our results show that the larger footplate perforations allowed a better correction of the air-bone gap at the lower frequencies. The ears with larger perforations did not show a higher incidence of sensorineural hearing loss.

Adolescent↗
PubMed1997

[Long-term effects of stapes elevation].

To assess the clinical value of stapes elevation, 38 cases had been followed-up for 1-12 years (average 6.7 years). The results revealed that hearing improvement rate (over 10 dB) was 94.7% in short term and 86.8% in long term follow-up. The long term regression rate was similar to that in stapedectomy, and no severe sensorineural hearing loss occurred. In addition, the vestibular reaction was slight, especially in reoperated cases. The stapes elevation was easy to perform as compared with stapedectomy. Therefore, this technique may be the first choice for stapes surgery.

Adolescent↗
PubMed2001

Malleostapedotomy in revision surgery for otosclerosis.

PURPOSE: The purpose of this study was to analyze the results of malleostapedotomy and to compare them with those of a conventional incus stapedotomy in a series of 82 consecutive surgical revisions in otosclerotic patients. MATERIALS AND METHODS: 82 consecutive revision stapes surgery cases over 5 years were evaluated. The preoperative and postoperative audiometric data of 80 (97.5%) of the patients were obtained. RESULTS: 71 of the patients underwent a functional revision procedure as malleostapedotomy (56, 79%) or as incus stapedotomy (15, 21%). The most common cause of failure of primary surgery was a displaced or malfunctioning prosthesis (86.2%). Pathologic changes of the oval window were found in 80% of the cases. Problems of the incus were identified in 80% and abnormality of the malleus in 48.6% of the cases. The functional success rate of malleostapedotomy (closure within 10 dB) was found to be higher than that of traditional incus stapedotomy (p < 0.05). Overclosure was seen in 12 patients (17%) and a significant sensorineural hearing loss in 2 patients (3%). There were no dead ears in this series. The postoperative hearing results after first revision surgery were better than those after multiple surgical procedures (p < 0.05). CONCLUSIONS: Malleostapedotomy yields better functional hearing results than incus stapedotomy in revision surgery for otosclerosis. The detection of many malleus fixations was the result of the systematic exposure of the anterior malleal process and ligament through an endaural approach with superior canaloplasty.

Adult↗
PubMedDate not supplied

Argon laser in otosclerosis surgery.

Data are reported from 323 otosclerotic ears in which primary surgery was carried out by using a large fenestra stapedectomy technique with fascial sealing of the window. In 129 ears the footplate was perforated with an argon laser. In the whole series, one ear became deaf (0.3%) as a result of granulomatous reaction in the operated area. Results in the argon laser group were slightly better than those in the group with mechanical footplate perforation and reconstruction with wire and fascia. Use of argon laser facilitates stapes surgery and, when used judiciously, it is a very helpful tool in all types of ear surgery.

Argon↗
PubMed1996

[The small fenestra vs large stapedectomy: comparative evaluation of failures and complications].

The Authors discuss post-operative failures and complications detected in their case-report of 1857 patients, operated for otosclerotic disease between 1982 and 1993 (399 large fenestra and 1458 small fenestra stapedotomies), with reference to the data from international literature. Their study reveals that the most frequent clinical event caused by complications arising is still hypoacusia of various degree, both conductive (2.7%) and sensorineural (6.6%); more precisely, conductive hearing loss points to revision surgery, while sensorineural lesions, often limited to high frequencies (5.7%), may unfortunately take the form of anacousia (0.9%). Some extra-auditory complications (temporary facial paralysis, ear drum perforation, disgeusia, tinnitus) are also present with relative frequency in stapes surgery (4.2%); among them, however, only impairment or appearance of tinnitus (0.6%) turn out to be a persistent disorder. Analysis of the results underlines that the complications rate is higher in the case of coexisting morphological anomalies (such as stenosis of the external ear canal, disjointing or amputation of the incus, difficulty in approaching the oval window, reobliteration of the oval window, facial nerve prolapse) or when intraoperative problems arise (excessive bleeding, profuse perylymph flow), which make the operation more difficult to perform. The data obtained in this study show that stapedotomy (using a 0.6 mm diameter prosthesis), gives a significantly lower rate of sensorineural complications (4.1%), than platinectomy (15.6%), because of the reduction of labirinthine traumatism. Lastly, the Authors performed 64 revision operations, evaluating intraoperative findings and hearing recovery rate. Causes of failure most frequently detected during revision surgery were: incus necrosis (24.6%) and prosthesis displacement (21.3%) with possible reobliteration of the oval window (23%); however it has not always been possible to detect pathogenesis of a postoperative conductive hearing loss. All things considered, results of revision surgery seem to be less satisfactory (56% improvements, 4.9% severe sensorineural hearing loss) than those obtained after the first operation.

Humans↗
PubMed1998

Bilateral stapedotomy in patients with otosclerosis: a disability-orientated evaluation of the benefit of second ear surgery.

This study reports the evaluation of the results of 80 stapedotomies in patients with bilateral otosclerosis. All pre- and postoperative audiological data, together with all relevant information of the operations, were stored in a database and analysed retrospectively. A new approach has been developed in order to evaluate the benefit of second ear stapes surgery in a more disability-orientated way using the AMA-criteria in the Guides to the Evaluation of Permanent Impairment. In all patients the percentage of Binaural Hearing Impairment (BHI) and the percentage of Impairment of the Whole Person (IWP) were determined according to the AMA-criteria. In patients who had both operations at the Academic Medical Centre it was found after the first operation that there was an important decrease in the BHI-percentage (from 26% to 10%) as well as for the IWP-percentage (from 9% to 4%). In addition, the percentages dropped significantly after the second operation (from 11% to 7% and from 4% to 2%, respectively). During follow-up there were no serious complications. It is concluded that bilateral stapedotomy is a safe procedure with good results.

Adolescent↗
PubMed2002

Audit of stapedectomy results in a district general hospital.

We report a series of 100 stapes operations performed for otosclerosis. The problems in reporting the results of stapedectomies are discussed. The audit showed a difference in the measured results between two consultants. As a result, the consultant with the worse outcome chose to stop operating on patients with otosclerosis. The advantages and disadvantages of a single surgeon performing all the cases are discussed. We advocate a central registry of all surgeons performing stapes surgery to allow periodic national comparative audits.

Bone Conduction↗
PubMed1996

Post-stapedectomy reparative granuloma: a misnomer.

The pathophysiology of so-called 'reparative granuloma' occurring after stapedectomy has not been determined and universally accepted management of this rare complication has not yet been established. A case is presented in which a mass developed in the middle ear after the use of a fat/wire prosthesis in a stapedectomy. Histological assessment revealed nonspecific granulation tissue and fat necrosis. It is suggested that 'reparative granuloma' is a misnomer as there is no microscopic evidence in this case nor in the literature of granulomatous formation. The condition may follow stapedectomy or stapedotomy. Furthermore, the name leads to confusion with a different condition, giant cell reparative granuloma, which involves the jaws and rarely the temporal bone. An alternative name, 'Stapes surgery induced granulation tissue' (SSIG) is therefore suggested for this condition.

Adult↗
PubMed1991

0.4 mm stapedotomy: a consistent technique for otosclerosis.

With the decline in the number of patients requiring stapes surgery for otosclerosis, there has been increasing concern over the ability of Otololaryngologists to perform these procedures. An approach must be easily learned, consistent and applicable to all operative situations. The technique of stapedotomy utilizing a 0.4-mm diameter fenestra, with placement of the prosthesis prior to removal of the stapes superstructure offers a consistent approach with low potential for morbidity. Fifty-six consecutive procedures of stapedotomy utilizing this approach were performed. Eighty-seven percent of cases had closure of the air-bone gap to within 10 dB, with 96 percent of the patients closing with 20 dB. There were no cases of perilymphatic fistula, sensorineural hearing loss or other otologic complications. This technique has proven reliable, while minimizing vestibular trauma.

Cochlear Implants↗
PubMed1977

Unrelated sensorineural hearing loss in patients with otosclerosis. A report of three cases.

Although it is generally accepted that 20% or more of patients with clinically manifest otosclerosis have a concomitant sensorineural hearing loss, it is still debated whether otosclerosis is the cause of the neural loss. Three cases are presented of other causes of sensorineural loss in otosclerotic patients who underwent stapes surgery. One of these cases, the Mondini malformation, is discussed in detail.

Adult↗
PubMed1992

Argon laser stapedectomy: comparison to traditional fenestration techniques.

A retrospective review of all stapedectomies performed at the Massachusetts Eye and Ear Infirmary over a 13 month period was undertaken to compare the results of argon laser stapedectomy to conventional footplate fenestration techniques. Despite the fact that it was new and unfamiliar to the surgical staff, the complication rate was lower with the argon laser than with footplate fenestration by traditional pick or drill techniques. The incidence of footplate fracture or removal preventing use of a small fenestra technique was five times as likely to occur with traditional instruments as with the argon laser (p < 0.025). In revision stapedectomy sensorineural hearing loss was four times as likely to occur with traditional instruments as with the argon laser (p < or = 0.05). The argon laser did not alter the operating time. Though not ideal for every case, the argon laser endo-otoprobe offers the surgeon a significant new tool to improve the outcome in stapes surgery.

Adolescent↗
PubMed1984

Stapedectomy in residency training.

The number of new patients with otosclerosis seen by the average otolaryngologist has declined over the past several years. As a result, a controversy has arisen regarding the ability to train residents adequately in the technique of stapedectomy. In this regard, we have analyzed 44 consecutive stapedectomies performed by senior residents, under direct faculty supervision, at the University of California, San Francisco. All procedures were total stapedectomies, performed under local anesthesia, utilizing either wire-vein or wire-perichondrium technique. Four of the ears required footplate or promontory drilling. Closure to within 10 dB of the preoperative bone conduction, averaged over the speech frequencies of 500, 1000, and 2000 Hz, was achieved in 75% of ears, and closure to within 20 dB in 93% of ears. In no patient was hearing made worse. While there were no permanent complications, self-limited problems occurred in 9% of the procedures. Despite a declining caseload of otosclerotic ears in residency programs, it is possible to train residents safely in stapes surgery, given a program of consistent technique and close faculty supervision.

Adult↗