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PubMed2000

Tinnitus and otosclerosis.

Fifty patients with otosclerosis and tinnitus were studied for the course of the tinnitus after stapes surgery. Tinnitus disappeared in 64% of the cases, improved in 16%, was unchanged in 14%, and worsened in 6%. The reduction in tinnitus was more favorable after a small fenestra stapedotomy than after a partial stapedectomy with removal of the posterior half of the footplate. An unfavorable postoperative course of tinnitus did not appear to be linked to the postoperative audiometric result. In our study the subjective evaluation of pitch and loudness of the tinnitus did not provide significant information regarding its prognosis.

Adult↗
PubMed1993

Initial experience of peroperative electrocochleography monitoring in stapedectomy.

Clinical experience of intraoperative ECochG monitoring during stapes surgery is reported. Selected surgical phases have been taken into consideration, laying particular stress on the phase corresponding to the opening of the labyrinthine spaces. Compound action potential (CAP) amplitude and latency showed, a supposed, an inversely proportional relationship in most of the cases. Abnormal findings were also recorded in some patients, thus giving rise to different electrophysiological hypotheses. A proposal for an "in vivo" model for the study of the electrophysiological changes due to the opening of labyrinthine spaces is made.

Adult↗
PubMed1997

Molecular analysis of the POU3F4 gene in patients with clinical and radiographic evidence of X-linked mixed deafness with perilymphatic gusher.

The molecular defect in some patients with X-linked mixed deafness with perilymphatic gusher at stapes surgery (DFN3) was recently attributed to mutations in the POU3F4 gene. In this manuscript we describe the molecular analysis of the POU3F4 gene in 5 patients with clinical and radiographic evidence of DFN3. Novel mutations were found in 2 of the 5 patients analyzed, while 3 had an entirely normal protein coding sequence. The fact that 3 of the 5 patients with clinical histories and radiographic abnormalities characteristic of X-linked mixed deafness with perilymphatic gusher displayed normal POU3F4 gene sequences supports the possibility that not all patients with the characteristic phenotype have involvement of the POU3F4 gene.

Base Sequence↗
PubMed1997

[Evaluating otolith function with subjective visual vertical discrimination].

This report summarizes our experiences with the subjective visual vertical (SVV) as a clinical neuro-otological tool. In the SVV test, patients have to orient a dim light bar in an otherwise dark surrounding earth-vertical, using a remote-control. Normal subjects in an upright position did not deviate more than 2 degrees from true vertical. After vestibular neurectomy, the SVV was consistently tilted by some 12 degrees toward the affected ear. Smaller tilts (approximately 7 degrees) of the SVV occurred in patients with spontaneous peripheral vestibular diseases. This shift in SVV disappeared within weeks to months, similar to the spontaneous nystagmus. After stapes surgery slight deviations of the SVV towards the unoperated ear were seen in about 20% of the patients, indicating a slight irritation of the otolith organs. Assessed in an upright position, the SVV thus may be regarded as reflecting tonic otolithic input differences between the two ears. Asymmetries in the shifts of the SVV induced by roll tilts of the gravito-inertial vector by eccentric rotations of the subject have been proposed as a test for otolithic sensitivity. In our studies such asymmetries in the shifts of the SVV could not be induced by 26 degrees or 90 degrees roll tilts of subjects towards the affected or healthy ears. A simple clinical test to reveal unilateral otolithic sensitivity (comparable to an otolithic "caloric test") thus still has to be found.

Dark Adaptation↗
PubMed1994

Long-term hearing results following stapedotomy.

Stapedotomy, or small fenestra stapes surgery, offers several advantages over total stapedectomy, including less postoperative vertigo and better closure of the air-bone gap at higher frequencies. Although early postoperative results are encouraging for the small fenestra technique, few data are available for longer follow-up periods. In this retrospective study, the hearing results of 35 stapedotomy patients, representing 37 operated ears, were analyzed. Each patient had a follow-up period ranging from 5 to 11 years, with audiograms obtained preoperatively, postoperatively, and at the longterm follow-up intervals. Data obtained included air conduction, bone conduction, and speech discrimination for both ears. The long-term hearing results of the small fenestra technique compared favorably to those reported for total stapedectomy, although a statistical analysis is difficult because of the differing methods used to report the data. Results showed a linear deterioration of air conduction thresholds over time, which corresponded to a decrease of bone conduction thresholds in the operated ear. The rate of deterioration of bone conduction appeared to be the same as that associated with presbycusis alone. After good initial closure of the air-bone gap at all measured frequencies, there was no significant increase in conductive hearing loss with time. In the nonoperated ear, the bone conduction for the speech frequencies deteriorated at a rate significantly higher than that for the operated ear and was probably related to Carhart's effect.

Adult↗
PubMedDate not supplied

Change of bone conduction thresholds by total footplate stapedectomy in relation to age.

INTRODUCTION: The influence of age on threshold changes of bone conduction after stapedectomy has not been thoroughly studied. Improvement of the Carhart notch by stapes surgery might be related to age as well as an increase in cochlear sensitivity to surgical trauma. PATIENTS AND METHODS: A retrospective study on the outcome of stapedectomy was undertaken. The results of surgery performed on 387 ears in 315 patients for otosclerosis between 1962 and 1989 were obtained. Stapedectomy, performed by a single surgeon, consisted of total stapedectomy, seal of the oval window with tragal perichondrium, and insertion of a free tragal cartilage graft. RESULTS: Analysis of bone conduction changes with stapedectomy shows an average improvement of 5 to 6 dB at 0.5, 1, and 2 kHz with best improvement at 2 kHz. At 4 kHz a mean decrease of 4 dB is recognized. The improvement of bone conduction at 2 kHz is 12 dB in patients younger than 30 years compared with 4 dB in patients older than 60 years (P < .05). The youngest group was improved by 2 dB at 4 kHz, whereas the oldest group deteriorated by 5 dB (P < .05). Age relationship was apparent in all 4 frequencies. CONCLUSIONS: With increasing age there is less improvement in bone conduction at 0.5, 1, and 2 kHz with correction of the Carhart notch and more deterioration at 4 kHz. The cochlear sensitivity to surgical trauma increases with age. In younger patients the preoperative bone conduction levels do not reflect the true cochlear reserve. Patients younger than 40 years of age might profit more from a partial or total footplate removal in stapedectomy, as this better corrects the Carhart notch. Patients older than 40 years of age might profit from a stapedotomy as this better preserves high frequencies.

Adult↗
PubMed2003

Retrospective case study of carbon dioxide laser stapedotomy with lens-based and mirror-based micromanipulators.

Most clinical studies on carbon dioxide (CO2) (lambda = 10.6 mm) laser stapedotomy have been carried out with the laser guided by a conventional lens-based micromanipulator, with the attendant risks of correct aiming (HeNe) and surgical (CO2) beam misalignment. Hence, engineering advances have attempted to improve laser targeting as well as the spot size focus. The development of the mirror-based micromanipulator was a response to this need but no data concerning its use in stapes surgery is available. We performed a retrospective case-series review of patients treated for otosclerosis between 1992 and 2000. Primary laser stapedotomy was performed in 218 consecutive patients. In the first 78 procedures, the aiming beam (HeNe, lambda = 632 nm) and surgical beam (CO2) were guided with a conventional lens-based micromanipulator whereas in the subsequent 140 procedures, they were guided by using a mirror-based micromanipulator. Hearing was tested at six and 12 months. The mean (SD) airbone gap was 5 dB (4.5) and 4.5 dB (3.9). The mean closure was 15 dB (9.9) and 14.4 dB (9.4). The mean change in the high-tone bone-conduction level was 5.5 dB (7.3) and 7.8 dB (7.5). Overheating of the facial canal produced transient facial paralysis in one case and was due to misalignment of the beams with the lens-based micromanipulator. Use of the mirror-based micromanipulator obviated the need to verify alignment. The light-weight and superior optical yield of this system made it possible to reduce the number of impacts on the footplate by the integral restitution of the energy source. This study demonstrated that the CO2 laser is an effective method for performing stapedotomy. In addition, microtrauma to the labyrinth is reduced by its ability to perform calibrated footplate fenestration without mechanical or vibrational injury to the inner ear. The optical reflection micromanipulator simplified beam alignment and enhanced surgical comfort.

Adolescent↗
PubMed1996

[Techniques of iconographic documentation].

The Authors describe modalities of photography and videorecording that should be used in stapes surgery and report the solutions they adopted to get iconographic documentation of high quality standard. As regards videorecording systems, the authors used both S-VHS and U-Matic equipment; with both types high fidelity shootings are obtained in the active documentation of each phase of the operation. Moreover, U-Matic master copying guarantees a final copy of higher quality. Technical difficulties that the authors met in videorecording are connected to the restricted field of view, limited by the speculum, which may itself cause dazzling phenomena or light refraction. A 2/3 inch CCD Sony camera, with a modified ELC(Electronic Light Control), was used to get round these problems, so as to eliminate the reflection of surgical instruments. In order to build up a photographic archive, it is also possible to get slides from single pictures of the recorded tapes, although their definition quality is lower than the one obtained foff photos; these, however, must be taken with reference to precise optical parameters and in particular: for shooting view pictures low enlargements (1,6x) were used with an intermediate aperture (f44), while, to better visualize details(footplate hole, stapedial tendon), it was considered right to u se restricted frames (2,5x) and a low aperture (f22). Such a technical solution, in fact, gives a better relation between depth of field and brightness. Finally the Authors underline that the constant use of the intraoperative videorecording system allows: greater participation of every member of the team in the operation; a delayed critical revision of th e operation; medico-legal documentation of possible intraoperative complications; iconographic material available both for scientific and didactic purposes.

Humans↗
PubMed1997

Stapedectomy vs stapedotomy. Do you really need a laser?

OBJECTIVE: To compare the effectiveness of different techniques of stapes surgery in improving the hearing of individuals with otosclerosis. METHODS AND DESIGN: Large and small fenestra techniques, as well as the instrument used to make the fenestra (drill or laser), were compared with regard to effectiveness and rate of side effects. The charts of 875 patients who underwent primary stapedectomies performed by members of the House Ear Clinic, Los Angeles, Calif, were reviewed. Patients who underwent stapedectomy for reasons other than otosclerosis and those with inadequate post-operative bone conduction threshold data were excluded. A group of 550 patients met the criteria. This group was broken into categories depending on the technique of stapedectomy and the instrument used to create the fenestra. The techniques were then compared using air-bone gap closure at different frequencies, pure tone average, and the rate of significant side effects. RESULTS: The study indicated that small fenestra stapedotomy and large fenestra techniques have similar rates of closure of the air-bone gap. Small fenestra stapedotomy has a slightly lower rate of postoperative sensorineural hearing loss, especially at higher frequencies. With regard to the small fenestra technique, there was no significant difference in either postoperative air-bone gap closure or postoperative sensorineural hearing loss, regardless of whether the fenestra was created by laser or microdrill. CONCLUSIONS: While we did find a statistically significant difference between the large and small fenestra techniques in postoperative sensorineural hearing loss at higher frequency, the difference is small and is probably not clinically significant. Therefore, we find that similar good results can be obtained by the experienced surgeon using either the large or small fenestra technique. Similarly, we found the laser and microdrill to be equally safe and effective in the creation of the fenestra.

Case-Control Studies↗
PubMed2002

Clinical consequences of feedback on ear surgery: the continuous recording of adverse events and complications with regard to reducing the number of surgeons who perform otosclerosis surgery.

Electronically stored data may be used to generate feedback overviews. This paper describes a method for establishing a picture of ear surgery complications. In this prospective study, the working definition of adverse events and complications is "incidents that are not intrinsic to the surgical procedure and that have a potential or actual negative effect on surgical outcome or postoperative morbidity". A simple method is used to categorise otologic adverse events and complications. This scale varies from adverse events (grade A) to death (grade D). All adverse events and complications in ear surgery that met this definition were documented electronically as part of continuous follow-up between 1 July 1992 and 30 June 1999. In the first 3 years, 1,009 ear operations were performed, and in 51 (5%) of them, adverse events or complications were noted during or after surgery. There were 30 (3%) grade A (adverse events), 18 (2%) grade B (minor complications), 3 (0.3%) grade C (major complications) and no grade D complications. Otosclerosis surgery was evaluated additionally, because halfway through a 7-year period, the number of surgeons was changed. Only three experienced, senior members of staff were involved, and inexperienced residents no longer were allowed to perform this kind of surgery. The reduction of surgeon numbers did indeed improve the outcome of the stapes surgery. Our results were comparable to the literature. This monitoring of outcome-results in relation to changes in care can be seen as a study of care quality. A review of this kind links daily clinical practice to the literature and induces an improvement in quality.

Adolescent↗