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PubMed1994

[Antibiotic prophylaxis in ORL surgery and oral medicine].

Postsurgical infection has always been a cause for major concern in ENT surgery. Papers on the topic allowed to identify indications for antibiotic prophylaxis. In ear surgery, in the absence of prior infection (stapes surgery, medium dry ear surgery), studies' results are not in favour of antibiotic prophylaxis. On the other hand, however, when the ear is inflamed or infected, the use of antibiotics is indicated, if possible after having first taken a sample. For nose and sinus surgery, antibiotic prophylaxis seems to be worthless in the absence of a prolonged packing. If a packing has to be maintained or if a transplant is used, an antibiotic administration has to be considered; the most appropriate antibiotic and its mode of use still have to be specified. In case of facial trauma, antibiotic prophylaxis using cefazolin reduces the risk of infection of paraymphysis fractures and angle fractures. The postoperative course after tonsillectomy is simplified by a prolonged antibiotic administration based on ampicillin. In clean cervico-facial surgery, without buccopharyngeal opening, the antibiotic prophylaxis seems to be worthless. In the opposite, antibiotherapy is required in case of buccopharyngeal opening. Indeed the presence of potential pathogenic bacteria in the buccopharyngeal cavity, the difficulties of mucosa closing, the importance of the tumoral extension, the length of the procedure, radiotherapy and use of myocutaneous flaps may all be the cause of a high infection rate (80%) in the absence of antibiotic prophylaxis. Two types of antibiotics seem to be suitable, cefazolin and clindamycin. Antibiotics active against Gram negative bacteria seem to be useless. There is a disagreement concerning the duration of antibiotic administration. The populations studied are too small to obtain significant results. Both points of view (prolonged antibiotic administration or true antibiotic prophylaxis) can be considered. Only large scale prospective studies with an adequate methodology will provide credible data for this debate.

Anti-Bacterial Agents↗

PubMed1999

Laser stapedotomy.

Thirty-four ears with conductive hearing loss due to otosclerosis were operated upon using the laser stapedotomy technique. Audiological results were compared with the results of 316 non-laser stapedotomies. The post-operative air-bone gap, calculated as the difference between the post-operative air and bone conduction levels, was smaller with the laser stapedotomy group. Also, the bone conduction showed significant improvement with the use of laser. Significant sensorineural hearing loss was not found in any of the laser-treated patients. According to our results, we concluded that laser is of benefit in stapes surgery for improving the hearing results and minimizing the inner ear trauma.

Adult↗

PubMed2001

Experimental and clinical results of Er:YAG laser stapedotomy.

BACKGROUND AND OBJECTIVE: At the beginning of the 1980s, different laser types were used for stapes surgery to reduce potential harm to inner ear structures through manipulation with conventional instruments during stapedotomy. Most clinical studies were carried out with the CO2 or the argon laser. The Er:YAG laser has been used rarely in patients with otosclerosis. STUDY DESIGN/MATERIALS AND METHODS: In an experimental study on 54 human petrous bones, the optimal laser energy parameter for dissection of the posterior stapes crus and the footplate perforation were determined. With these parameters, stapedotomy was carried out with the Er:YAG laser in 29 patients with otosclerosis with a conventional dissection of the incudostapedial joint and the stapedius muscle tendon. The Er:YAG laser was used (60 or 100 mJ, 3-6 pulses) for dissection of the posterior stapes crus and footplate perforation. RESULTS: No intra- or postoperative complications were observed in all 29 patients. Vertigo and hearing loss were not observed intra- or postoperatively. The postoperative hearing results (improvement of the air-bone gap) was in all cases satisfactory (median remaining air bone gap, 8.1 dB). The median operation time was 29 minutes (15-42 minutes) and did not show a significant prolongation in comparison to the conventional technique. In 1 of the 29 patients, the footplate perforation needed to be carried out conventionally. CONCLUSION: For the first time, Er:YAG laser parameters have been optimized and refined in a human petrous bone model and were then used in a clinical setting. According to the presented results, the Er:YAG laser seemed to be a very suitable instrument for stapedotomy.

Adult↗

PubMed2005

Stapedotomy in osteogenesis imperfecta: a prospective study of 23 consecutive cases.

OBJECTIVE: To prospectively evaluate the hearing results in surgically treated cases of stapes fixation in patients with osteogenesis imperfecta. STUDY DESIGN: A prospective study of osteogenesis imperfecta patients with stapes fixation. SETTING: One tertiary referral center. PATIENTS: Eighteen patients (23 ears) who underwent stapes surgery from 1994 to 2004 were prospectively included. INTERVENTION: Stapedotomy with vein graft interposition and reconstruction with a Teflon piston or a bucket handle (cup) prosthesis. MAIN OUTCOME MEASURES: Preoperative and postoperative audiometric evaluation using conventional audiometry. Air-bone gap, bone-conduction thresholds, and air-conduction thresholds were measured. Postoperative audiometry was performed at 6, 9, 12, 18, and 24 months after surgery and at a yearly interval thereafter. RESULTS: Overall, a postoperative air-bone gap closure to within 10 dB was achieved in 85.7% of cases. Postoperative improvement of air-conduction thresholds superior to 20 dB was found in 57% of cases. The postoperative bone-conduction thresholds were unchanged. CONCLUSION: This study shows that safe and successful stapedotomy is possible in cases of stapes fixation in patients with osteogenesis imperfecta.

Adolescent↗

PubMed1996

Camurati-Engelmann disease presenting as 'juvenile otosclerosis'.

Camurati-Engelmann disease (CED, MIM # 131300) was diagnosed in a 27-year-old woman, who had pain in her lower legs. There was no history of hearing loss (or CED) in her family. She had been suffering from progressive hearing impairment since childhood. Serial audiograms demonstrated progressive mixed hearing loss from the age of 11 years onwards, for which she underwent successful stapes surgery bilaterally at the age of 13-18 years. Clinical ('juvenile') otosclerosis was found with stapes footplate fixation. Unfortunately, the sensorineural hearing loss component proved to be progressive bilaterally after surgery. At the age of 30 years, she experienced more rapid deterioration of her hearing loss in the right ear and episodes of vertigo. Vestibular examinations demonstrated progressive vestibular impairment 'otospongiotic' lesions with encroachment on the cochlear and vestibular labyrinth were found on high resolution CT scans at the age of 40 years; the internal auditory canal was normal bilaterally. CED may have formed a chance combination with juvenile otosclerosis in our patient, or otosclerosis may be part of the CED phenotype.

Adult↗

PubMed2004

Stickler syndrome type I and Stapes ankylosis.

OBJECTIVE: To report a successful stapedectomy for stapedial fixation in a patient with Stickler syndrome type I (COL2A1). SETTING: University Hospital Department for Otology, Pathology, Ophthalmology and Clinical Genetics. STUDY DESIGN: A clinical and genetic evaluation of a mother and daughter focusing mainly on the otological, ophthalmological, histological and genetical aspects. INTERVENTION: A stapedectomy was performed successfully. RESULTS: Hearing impairment improved after stapedectomy. Postoperatively a shift in high-frequency threshold wa seen related to the stapedectomy. A new mutation in COL2A1 gene was dectected. CONCLUSION: Stapedial fixation can be the cause of hearing impairment in Stickler syndrome type I (COL2A1). The hearing impairment can be improved by stapes surgery.

Abnormalities, Multiple↗

PubMed1999

Stapedotomy: does prosthesis diameter affect outcome?

Two hundred ears with otosclerosis have been operated upon using a 0.4-mm diameter Teflon platinum piston in 100 ears and a 0.6-mm diameter Teflon piston in the other 100 ears. The postoperative air-bone gap, calculated as the difference between the postoperative air and bone conduction levels, was smaller in the 0.6 mm group for all frequencies except at 2000 Hz, the differences were statistically insignificant except at 4000 Hz. The mean postoperative air-bone gap was 8.6 dB and 7.4 dB for the 0.4 and 0.6 mm groups, respectively, which is statistically insignificant. We found no postoperative loss of bone conduction exceeding 15 dB, there was a deterioration of more than 10 dB in three ears, one in the 0.4 mm group and two in the 0.6 mm group. According to our results, we conclude that the 0.4 mm and the 0.6 mm Teflon prostheses produce the same hearing improvement in stapes surgery for otosclerosis.

Adult↗

PubMed1994

Revision surgery in otosclerosis--operative findings in 186 patients.

Over a 14-year-period 186 revision operations for otosclerosis were performed. In 90% of the patients the indication for revision was too large an air-bone-gap. A number of different surgical techniques had been used at the primary operation. The purpose of the investigation was to describe the middle ear abnormality at the revision operation. Most often adhesions, acentric prosthesis, reobliteration and necrosis of the long process of the incus were found. The middle ear abnormality found at revision operation was correlated to the primary surgical technique used and the information obtained can be of value, when a revision operation is considered. The surgical technique used at revision operation was determined by the operative findings. The best hearing improvement was obtained when a small-fenestration-technique was used primarily or as the method for revision. In revision stapes surgery, the experience of the surgeon is important and centralization of this type of operation is recommended.

Ear Ossicles↗

PubMed2006

Clinical results after stapedotomy: a comparison between the erbium: yttrium-aluminum-garnet laser and the conventional technique.

OBJECTIVE: The objective of this study was to assess whether the use of the erbium: yttrium-aluminum-garnet (Er:YAG) laser has negative effects on inner ear function and to compare the short- and long-term hearing outcome of patients undergoing conventional stapedotomy versus laser stapedotomy. STUDY DESIGN: Retrospective review of prospectively collected audiometric data of patients with otosclerosis operated on by one experienced surgeon. SETTING: Academic tertiary referral center. PATIENTS: A total of 266 stapes surgeries were evaluated for intraoperative findings, of which 209 patients were evaluated for preoperative and postoperative hearing thresholds after a 6- to 452-week (mean, 22 wk) audiological follow-up. INTERVENTION: One hundred fifteen (43%) of the operations were performed conventionally, using manual perforators for stapedotomy (Group A); in 115 (43%) surgeries, the perforators were used in combination with the Er:YAG laser (Group B), and in 36 (14%) operations, the Er:YAG was used exclusively for footplate perforation (Group C). MAIN OUTCOME MEASURES: Pure-tone audiometry was performed before surgery, 2 days postoperatively (bone conduction only) and at 5, 26, and 57 weeks postoperatively. RESULTS: A postoperative temporary threshold shift of the bone conduction could be found in all groups. In Group C, where the laser was used exclusively for footplate perforation, this threshold shift was not only the most significant, but also-in contrast to the other groups-not totally reversible. In all techniques, a satisfactory air-bone gap closure could be achieved. The best long-term results (96% of the patients had <or=20 dB air-bone gap after 57 wk) could be found in Group B. CONCLUSION: If certain rules to minimize inner ear trauma are followed, the Er:YAG laser is a safe tool in middle ear surgery. Combining both the laser and the conventional technique, instead of the separate use of either technique, leads to superior postoperative hearing results.

Adolescent↗

PubMed1996

[Evaluation of deprivation manifestations of the auditory system in patients with unilateral middle ear deafness before and after surgical therapy].

BACKGROUND: This paper will discuss whether long term conductive hearing loss leads to late onset auditory deprivation as described in the literature in patients suffering from bilateral sensorineural hearing loss and fitted with monaural hearing aids. METHOD: The patients were examined using the Freiburg speech test in the undistorted and distorted forms (according to Dieroff 1985), and the pure tone threshold was ascertained for each patient. Thirty-six preoperative und postoperative results after tympanoplasty and stapes surgery were evaluated. Follow-up was performed six weeks and six months postoperatively. Twenty-one test persons with normal hearing were investigated. RESULTS: Comparison showed that the quotient obtained from undistorted and distorted tests is significantly higher in the affected patients. We even observed a highly significant improvement of this quotient, the speech recognition score (according to Bönninghaus/Röser), and the pure tone threshold after surgery. Seventy-eight percent of our patients showed an improved quotient, and 73% attained a normal value. But in only 29% of all cases did we see a symmetrical quotient in both ears in this period of time. In the statistical evaluation, we were unable to demonstrate a correlation between the patient's age at that moment, the age at the beginning of hearing loss, and this echo quotient. There is also no correlation between the absolute and relative change of the echo quotient and the duration of hearing loss. CONCLUSION: It was evident that the distorted Freiburg speech test is a good method to demonstrate the deprivation of the auditory system. We observed the improvement of the distorted Freiburger speech test at postoperative intervals of six weeks and six months. Hearing training should be applied after surgery in an effort to improve the hearing results.

Adolescent↗

PubMed2000

[Vertigo and objective vestibular symptoms in computer analysis of ENG in otosclerotic patients and after stapes operations].

The aim of this paper was evaluation of vertigo frequency in otosclerotic patients (group I N = 64) in comparison with control group (group II N = 20) and in people after stapedectomy (group III N = 64). Furthermore electronystagmographic recording spontaneous nystagmus, positional nystagmus were made. Computer analyses of ENG-recording and automatic calculation of directional preponderance and canal paresis were used. Vertigo was in 12% otosclerotic patients while in equal of age control group only in 5% subjects. Spontaneous nystagmus in 20% and positional nystagmus in 27% were recorded in otosclerotic patients while that took place in 10% and 15% control group respectively. Asymmetric reaction in-group I was in 21% cases and in 10% subject's in-group II. Real directional preponderance was in 18.8% otosclerotic patient's in-group I and it was absent in-group II. Obtained results revealed existence vestibule disturbances in otosclerotic patients. More frequent labyrinth objective symptoms were registered post stapedectomy. Vertigo in 21%, spontaneous nystagmus in 58%, positional nystagmus in 61%, asymmetric reaction in 48% was noted. Marks of vestibule and organ injury in otosclerosis and post stapedectomy were met. Vestibule disturbances were irritate and inconstant character. It is appears to be needed examination of balance system before stapedectomy in the planning of stapes operation and after operation on stapes. Presence of vestibular symptoms after stapes surgery is not cause less post stapedectomy improvement of hearing but sometimes postoperative improvement of hearing is better for lower frequencies in patients group with vestibular disturbances than in-patients without these symptoms.

Adult↗

PubMed1985

The versatility of presculptured homograft incus prostheses.

A twelve-year experience with banked homograft ossicles has developed into a system of presculptured incus allografts adapted for the correction of many ossicular defects encountered in tympanoplasty and revision stapes surgery. The standardized preparation of a number of variations of modeled incus prostheses for an operating room bank by a well-trained ear homograft laboratory technician has been an effective and time-saving technique.

Ear Ossicles↗

PubMed2000

Meningitis following stapedotomy: a rare and early complication.

Controversy exists concerning stapedotomy for patients with small unilateral air-bone gaps. Surgical treatment of otosclerosis involves an opening to the labyrinth and accordingly, a risk of complications, usually vertigo and sensorineural hearing loss and infrequently anacusis. In this paper we present a 33-year-old woman with a small unilateral air-bone gap, who developed bacterial labyrinthitis with meningitis and anacusis three days after stapes surgery. The patient had a stapedotomy with the small fenestra piston prosthesis technique. Due to the potential for serious complications, patients with unilateral otosclerosis and mild hearing loss should be given the possibility to choose between a hearing aid and surgery. Although stapedotomy in the vast majority of interventions is a highly successful procedure and the best method of treatment for otosclerosis if successful, there is a high price to pay in the event of failure.

Adult↗

PubMed1995

[Modifying the stapes footplate with various laser systems. II. The pulsed laser].

The object of the present study was to examine the tissue ablation capacity of various pulsed lasers at the stapes footplate. Isolated human stapes and bovine compact-bone platelets (thickness 90 microns) were used to determine effective laser parameters for achieving a perforation measuring 500 microns to 600 microns in diameter. Apart from achieving the perforation diameters, particular attention was given to the form and quality of the perforations, reproducibility of the perforation effect and the thermally altered border zones occurring at the footplate. Four pulsed laser systems were used: excimer, Ho:YAG, Er:YSGG and CO2 lasers. An adequately large perforation generally could only be achieved by several repeated shots at the same application site, since only a small amount of tissue was ablated per application. The mechanism of the photoablation caused the extent of the thermal side effects to be markedly lower than with the continuous wave (cw) and superpulse systems. For this reason and because of their highly reproducible perforation effect, they were basically better suited for stapedotomy than the cw systems. It was possible, however, that as a result of the longer application time and the need to repeatedly irradiate the same application site, the higher pulse counts could prove to be disadvantageous in clinical practice. Among the pulsed laser systems, the Er:YSGG laser had the highest ablation rate at the stapes and was thus the most effective laser for interventions at the footplate. Although somewhat less effective than the Er:YSGG laser in our studies, the Ho:YAG and pulsed CO2 lasers also appear to be suitable for stapes surgery. On the other hand, we did not consider the excimer laser (308 nm) to be particularly effective at the footplate because of its low ablation rates.

Animals↗

PubMed2001

Finnish speech in noise test: long-term reproducibility.

A computerized adaptive Finnish speech in noise test was developed recently. As part of the test's evaluation process the long-term stability of speech recognition threshold in noise (SRTN) was determined. The non-operated ears of 164 stapes surgery patients were assessed preoperatively and at 1, 7 and 19 months postoperatively. Short-term and long-term repeatability were equal. The absolute intraindividual differences were 1.5 dB on average.

Audiometry, Pure-Tone↗

PubMed1977

Stapedectomy and fatal meningitis. A human temporal bone study.

Temporal bone histopathology is reported on a case of acute suppurative otitis media, acute suppurative labyrinthitis, and meningitis with death of the patient 20 days after stapes surgery. Purulent exudate invaded the vestibule by the oval window through a displaced footplate. The main pathway of infection to the menings was extension along the branches of the vesticular nerve to the internal auditory meatus and to the subarachnoid space.

Aged↗

PubMed1985

Audiologic features of the X-linked progressive mixed deafness syndrome with perilymphatic gusher during stapes gusher.

Stapes gusher sometimes occurs at the moment the vestibule is opened. A flood of perilymph can be expected as a complication of stapes surgery in all males affected with the X-linked progressive mixed deafness syndrome. Audiologic features, such as a mixed hearing loss and elicitability of stapedial reflexes, are reported for eight affected males in a large Dutch family.

Adult↗

PubMed1996

Revision surgery in otosclerosis--an investigation of the factors which influence the hearing result.

The hearing improvement obtained by revision surgery for otosclerosis has been assessed in 163 patients with a conductive hearing loss. Several different surgical techniques had been used at the primary operation. On average at revision a hearing improvement of 11 dB was obtained. The hearing improvement was related to the surgical technique of the primary operation, the middle ear abnormalities and the surgical technique used at revision. Patients in whom a small-fenestra-technique had been used for the primary as well as the revision procedure, had a better result than patients who had total removal of the footplate. Patients with adhesions and an eccentric prosthesis only showed a small hearing improvement. Patients with necrosis of the long process of the incus were also difficult to manage. Since the complication rate was low it does not seem to be more dangerous to perform a revision than to perform a primary operation. The results obtained by revision are poorer than can be obtained by the primary procedure. This indicates that in stapes surgery the greatest chance for hearing improvement is the first operation, therefore centralization of this type of operation should be considered.

Ear, Middle↗