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PubMed1999

Stapedectomy in children.

Stapes surgery for correction of conductive hearing loss in adults with otosclerosis is a well-established procedure. Its effectiveness in children, however, has received less scrutiny in the literature. Previous studies from our and other institutions demonstrated similar results in children and adults. Between 1980 and 1994 stapedectomies were done on 95 ears of 81 patients younger than 18 years (83 primary and 12 revisions). Data regarding age of onset, family history, associated anomalies, surgical findings, technique, hearing results, and complications were reviewed. Two groups were identified: congenital stapedial fixation and juvenile otosclerosis. Patients with congenital stapedial fixation had an earlier onset of hearing loss (3 vs 10 years, P < 0.001), a greater incidence of abnormalities of the malleus and incus (25% vs 3%, P < 0.001), and a slightly greater preoperative air-bone gap (35.2 +/- 12.9 vs 27.8 +/- 8.9, P = 0.002). Patients with otosclerosis had a greater frequency of a positive family history of deafness (53% vs 10%, P < 0.001). Overall, 79% of primary cases and 89% of revision cases had an improvement in hearing, with mean postoperative air-bone gaps of 15 dB and 22 dB, respectively. The gap did not widen significantly during the entire length of follow-up (mean 72 months). In primary cases, 59.1% obtained a postoperative air-bone gap of 10 dB or less. Eighty-two percent of children operated on for otosclerosis obtained excellent results (postoperative air-bone gap < or = 10 dB), compared with only 44% of children with congenital stapedial ankylosis (P = 0.02). In revision surgery, 29% of children obtained excellent results. Poorer results in both cases of congenital stapedial fixation and revision stapedectomy appear to be related to the greater incidence of associated anomalies of the malleus and incus. Indications, technique, complications, and considerations pertinent to childhood stapedectomy are discussed.

Audiometry↗
PubMed1991

Stapedectomy: long-term hearing results.

The initial improvement in hearing following stapedectomy usually deteriorates with the passage of time. We studied the long-term results of stapedectomies performed on 42 patients (49 ears) between 1959 and 1969 who had a minimum follow-up of 18 years. Both air conduction (AC) and bone conduction (BC) thresholds progressively deteriorated over the long term. The degree of BC loss paralleled that expected from presbycusis alone. A greater deterioration was noted in the AC levels, producing a recurrent conductive hearing loss in the speech frequencies. Age at the time of surgery had no effect on the long-term outcome. Comparison of the average preoperative speech discrimination scores (SDS) to the 1-year postoperative SDS and the long-term SDS revealed a 1.1% and 16.7% drop, respectively. The improvement in the average speech reception threshold (SRT) obtained 1 year postoperatively deteriorated by less than 1 dB per year over the long term. Patients with a higher SDS (more than 95%) preoperatively fared better in the maintenance of speech discrimination than those with a lower SDS (less than 95%). The preoperative SRT level was predictive of the timing for the requirement of hearing amplification. The postoperative SRT level was predictive of the timing for the requirement of hearing amplification. The caused by presbycusis, combined with a recurrent conductive loss in the speech frequencies rather than cochlear otosclerosis. Although the decline in hearing following stapedectomy exceeds the rate of hearing loss due to presbycusis, many individuals, after successful stapes surgery, are able to delay the need for hearing amplification for longer periods than had been previously reported.

Audiometry, Pure-Tone↗
PubMed1992

Persistent stapedial artery.

Persistence of the stapedial artery is rare. A case is presented in which the stapedial artery was found over the footplate during stapes surgery. The technical problems encountered are discussed. A wire prosthesis has previously been used in the presence of a persistent stapedial artery and we describe the use of an all Teflon prosthesis. A subsequent CT scan demonstrated the vessel in the middle ear. An outline of the embryology of the stapedial artery is given and the literature reviewed.

Adult↗
PubMed1996

Stapedectomy in profound cochlear loss.

Stapedectomy can be used in certain patients with profound sensorineural hearing loss and stapes fixation to improve hearing to a level at which a hearing aid may be effective. This study reviews the outcomes of 11 patients with profound cochlear loss secondary to otosclerosis who underwent stapes surgery performed by the senior author (M.E.G.) over a 25-year period. Postoperative hearing aid usage was effective in 9 of 11 patients. Preoperatively, these patients derived no benefits from hearing aids. Stapedectomy may be of immense value in patients with the proper history and profound cochlear loss.

Aged↗
PubMed2001

Histologic studies of the posterior stapediovestibular joint in otosclerosis.

OBJECTIVE: To determine the prevalence of ankylosis or otosclerosis at the posterior stapediovestibular joint (SVJ) in temporal bones with otosclerosis, with special reference to stapes surgery. BACKGROUND: Long-term success of the laser stapedotomy minus prosthesis (STAMP) procedure, anterior crurotomy, and similar partial stapedectomy procedures depends on lack of ankylosis and lack of otosclerosis involving the posterior SVJ. Previous work has shown that the air-bone gap in otosclerosis correlates with narrowing and loss of the SVJ space. However, the prevalence and histologic features of otosclerotic involvement of the posterior SVJ space have not been well characterized. METHODS: Histologic assessment of serial sections through the oval window niche in 140 temporal bones with otosclerosis that had been sectioned in the axial plane (age range 20-95 years, mean 68). Bones with stapes mobilization or stapedectomy were excluded. RESULTS AND CONCLUSIONS: Two of 140 bones had otosclerosis exclusively at the posterior SVJ. Of the remaining 138 bones, all of which had otosclerosis at the anterior SVJ, 82 bones also had otosclerosis at the posterior joint. Of the 56 bones without otosclerosis of the posterior joint, there was bony ankylosis of the posterior joint in 3 bones. Thus, 53 bones (38%) had neither ankylosis nor otosclerosis involving the posterior joint, and they would be potentially suitable for a laser STAMP or a similar procedure. There was no correlation between otosclerosis at the posterior SVJ and age, sex, or duration of conductive hearing loss. Otosclerosis at the posterior joint in one ear was significantly associated with its presence at the posterior joint in the opposite ear (p = 0.01). The audiogram could not be used to reliably predict otosclerotic involvement of the posterior SVJ or the degree of footplate pathologic changes, such as ankylosis.

Adult↗
PubMed2000

[Use of auditory field measurement in patients with otosclerosis].

BACKGROUND: Middle ear surgery sometimes leads to unpleasant auditory impressions such as distortion or hyperacusis that cannot be detected by conventional audiometric testing. METHOD: Sixty-one patients with conductive hearing loss caused by otosclerosis underwent audiological evaluation, which included a questionnaire followed by testing of the audiometric threshold, speech audiometry, and assessment and quantification of loudness perception with a commercial system (WESTRA). This investigation includes the postoperative measurement of hearing improvement and the patients' subjective impressions regarding hearing increase, distortion of speech, and hyperacusis. RESULTS: Hearing improved in 88% of the patients. A quantification of this hearing increase was possible with pure tone audiometry and the Freiburg speech discrimination test. Reduced hearing threshold and lack of improvement in speech discrimination was confirmed by conventional hearing measurements. However, the presence of hyperacusis and distortion of speech could be determined by conventional audiometry in only 50% of cases. It was interesting to note that the subjects who reported speech distortion and hyperacusis in the questionnaire were identified by their increased loudness perception using the categorical loudness scaling. CONCLUSION: Category loudness scaling appears to be a valuable additional clinical test to characterize postoperative phenomena as distortion of speech and hyperacusis in patients undergoing stapes surgery.

Adult↗
PubMed1981

Factors influencing hearing after stapedectomy.

Surgical results of stapes surgery have been evaluated postoperatively after 3 years, in 834 subjects with otosclerosis. The following audiological tests were used: (1) the air-bone gap; (2) pre- and postoperative speech reception thresholds (SRT); (3) postoperative SRT related to the air-bone gap; (4) the BC loss at 4000 Hz.

Bone Conduction↗
PubMed1985

Speech discrimination in advanced otosclerosis following stapedectomy.

This paper studies the changes in speech discrimination following stapes surgery in patients with advanced otosclerosis. Two thirds of these patients showed a postoperative improvement in the discrimination score with obvious correlation with closure of bone-air gap. The results were slightly worse in comparison to those obtained on otosclerotic patients with good bone conduction. In advanced otosclerosis even a minimal impairment in bone conduction and/or an incomplete closure of the gap interfere with discrimination.

Bone Conduction↗
PubMed2003

[Revision stapedectomy for otosclerosis: report of 73 cases].

OBJECTIVE: The aim of this study was to determine causes and evaluate results of revision stapedectomy. DESIGN: Retrospective review of 73 revision stapedectomies. SETTING: Revision stapedectomies were performed in two tertiary otolaryngology departments (Fondation Adolphe de Rothschild, Paris, France, and Cliniques universitaires Saint-Luc, Bruxelles, Belgium). METHODS: Patients characteristics, indications for revision, intraoperative findings, and hearing results were noted. MAIN OUTCOME MEASURES: Hearing results were reported as recommended by the American Academy of Otolaryngology-Head and Neck Surgery. We also reported hearing results with and without the use of a laser. RESULTS: Conductive hearing loss was the main indication for revision (78%). Mean intraoperative findings included prosthesis malfunction (50%), fibrous adhesions (32.8%), incus necrosis (8.5%), and otosclerotic regrowth (7%). When revision was performed because of cochleovestibular complication, middle ear exploration revealed three findings: oval window granuloma (30.7%), perilymphatic fistula (30.7%), and a too long prosthesis (23%). Postoperative air-bone gap (ABG) was closed to less than 10 dB in 51.5% of cases and to less than 20 dB in 68.7% of cases, with 9% of sensorineural hearing loss (not exceeding 15 dB in 80% of cases). The use of an argon laser in 14 patients (19%) showed slightly better hearing results (postoperative ABG < 10 dB in 61.5% of cases and < 20 dB in 77% of cases), but this difference was not statistically significant compared with patients operated on without the use of a laser. CONCLUSION: The results of this series are comparable with previously published studies. Revision stapes surgery is not as successful as primary stapedectomy, but good gap closure can be expected in two-thirds of cases with an experienced surgeon.

Adult↗
PubMed2005

A new crimping device for stapedectomy prostheses.

OBJECTIVE: To describe a newly designed microforceps for easy and stable crimping of a prosthesis loop to the incus' long process in stapes surgery RESULTS: We developed a crimping tool with two innovative improvements. First, the tip of the crimping device is arcuated and thus able to span the loop of the prosthesis entirely around the incus long process. Second, a retaining spring is implemented into the handle. This passive opening mechanism of the crimper avoids the switch from flexor to extensor muscle group movements in the forearm of the surgeon while switching from crimping to unclosing the forceps. This maneuver, which is considered the most delicate in ear surgery, can be performed by variations of the flexor muscle group tonus only. CONCLUSION: The new crimping tool has proved to be reliable in firm attachment of the prosthesis' loop to the incus long process. Furthermore, because of the passive open-up mechanism movements of the surgeon's hand, wriggling excursions of the tip of the forceps are minimized and the risk of incus luxation is reduced.

Humans↗
PubMed1986

Stapedectomy for the home temporal bone dissection laboratory.

During the last 15 years, there has been a steady decline in the number of stapedectomies performed. Suggestions have been made to limit the residents' training in stapes surgery as well as to determine who is qualified to perform stapedectomies. It is well recognized that the skills and precision required for a stapedectomy are different from those used in chronic ear surgery and, if these precise techniques are not used on a regular basis, one will lose the dexterity required for this operation. A technique has been developed that enables the resident or infrequent operator to improve his skills with stapedectomy in the laboratory, prior to being confronted with a patient. It should help to improve the residents' surgical experience as well as maintain the surgical skills required for this operation.

Dissection↗
PubMed1979

Long-term effect of otosclerosis on bone conduction.

There have not been many studies of long-term sensorineural function in otosclerosis. The reports of long-term follow-up of lateral canal fenestration cases show a surprising stability of bone conduction. Because the experience of the senior author in stapes surgery suggests that some patients with clinically proven otosclerosis have a tendency for progression of sensorineural hearing loss, a review of over 500 ears in patients with proven otosclerosis was undertaken. Data from the study indicate that patients with otosclerosis have more sensorineural hearing loss than the general population. Also some otosclerotic ears have a tendency for progression of sensorineural hearing loss.

Audiometry↗
PubMed1992

[Long-term results of stapedectomy and stapedotomy].

We have followed up 91 patients for 3 or more years after stapes surgery for otosclerosis, 59 by stapedectomy and 32 by stapedotomy. The surgical technique was chosen randomly. Both surgical techniques achieved significant hearing improvement, but in the higher frequencies (3 kHz) the results of stapedotomy are better and more stable than those after stapedectomy. Surgical revision was necessary in 5 patients--1 after stapedotomy, 4 after stapedectomy.

Audiometry, Pure-Tone↗
PubMed1997

[Surgical treatment of otosclerosis in the aged. Results of retrospective analysis].

Otosclerosis is, per se, a disease which rarely occurs after the age of 50. This is why stapes surgery is seldom performed in advanced age and there are few reports on the topic in the literature. The authors have performed a retrospective analysis of patients over the age of 65 who had undergone surgery for otosclerosis in the last 27 years. Out of a total of 3585 surgical procedures, 106 patients were analyzed. Most of the cases were in the advanced stages. Assessment of the outcome included pre- and post-operative audiometry, one year after surgery. Inner ear performance was established by evaluating air and bone conduction at 0.5, 1, 2, 3 and 4 kHz. The results showed that performing otosclerosis surgery is worthwhile even in the elderly with mixed auditory impairment, as long as the air-bone gap is limited to 20-30 dB and the surgical procedure is through. In this light, stapedotomy appears to be the most adequate technique. When evaluating the results the possibility of adopting a less powerful hearing aid should also be considered a success.

Age Factors↗
PubMed1996

A comparison of the results of KTP and CO2 laser stapedotomy.

Over the last 10 years, lasers have evolved to become an integral part of stapes surgery. Argon, KTP, and CO2 lasers have all been tested for their improved accuracy and safety in the middle ear. Because of the difference in optical properties between visible light (argon, KTP) and infrared (CO2) lasers, discussions have evolved around which laser is better and safer. In an effort to clarify the issues, a prospective comparison was made of 100 consecutive primary stapedotomies by using either the CO2 or KTP laser.

Adult↗
PubMed1999

Hearing in patients operated unilaterally for otosclerosis. Self-assessment of hearing and audiometric results.

The objective of this study was to examine the outcome of unilateral stapes surgery in one patient group with bilateral hearing loss and one group with unilateral hearing loss. The patients' own estimations of improvement in hearing ability and the occurrence of other ear-related symptoms were examined retrospectively and in a follow-up study. Ninety-five of 123 patients operated for otosclerosis in only one ear between 1987 and 1992 responded to a follow-up examination. Observed audiometric findings and changes thereof, along with the patients' own estimations of their hearing handicap pre- and postoperatively, and the occurrence of other ear-related symptoms were studied. Despite good surgical results (closure of air-bone gap within 20 dB in 94%), 33% of the patients had severe hearing disabilities postoperatively, and many of these patients needed further amplification with a hearing aid. Mild dizziness occurred in 33% of the patients postoperatively and did not decrease over time. Discomfort in the operated ear due to strong sounds was reported in 20%. Change in sound quality occurred in 80% of the operated ears, but tended to disappear over time. From the results of this study it may be concluded that surgery in one ear only, leaving the other ear with poor hearing, is not an optimal hearing rehabilitation of patients with otosclerosis. It is important endevour to achieve bilateral hearing in order to give the patient good social hearing. Postoperative dizziness and unpleasant hearing quality do occur frequently, and the patients need to be informed about these problems preoperatively.

Audiometry, Pure-Tone↗
PubMedDate not supplied

Evaluation of second-ear stapedotomy with the Glasgow benefit plot.

This study reports the evaluation of the results after 72 stapedotomies in patients with bilateral otosclerosis. All pre- and postoperative audiological data, together with all relevant information of the operations, were stored in a data base and analyzed retrospectively. The Glasgow benefit plot (GBP) is a useful method to evaluate the hearing results of each individual ear after stapes surgery in a more functional way rather than from a technical standpoint. Therefore, it has been used to assess the benefit obtained after second-ear stapedotomy. From the results it appears that a second operation on the contralateral side increases the chances of achieving at least one 'normal'-hearing ear, and it makes symmetrical 'normal' hearing possible in the majority of the cases.

Adolescent↗
PubMed1989

The effect of stapedectomy on speech intelligibility in noise.

Speech intelligibility in noise was tested pre- and postoperatively after 27 stapedectomy cases and 10 cases of reexploration after previous stapes surgery. We did not find a postoperative threshold shift (signal-to-noise ratio) for the intelligibility of sentences presented in noise. This finding corresponds well with the absence of postoperative high-frequency sensorineural loss in these patients. Using two types of prostheses we found a significant amelioration of speech intelligibility in quiet for the Schuknecht minihole prosthesis as compared to the House wire loop.

Adult↗