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At least 55 records · Page 3Linked to original sources
PubMed1998

[Lasers used by a young surgeon for stapes surgery].

We report the results of the first 38 stapes operations performed by a young surgeon. He achieved a perfect closure of the air-one gap (within 10 dB) in 89% of the patients operated on with the laser, compared with 65% of the patients operated on without laser. We discuss the significance of this difference, taking into account the multiple factors influencing the results. In our opinion, the laser helps a young surgeon to accelerate his learning curve in stapes surgery.

Adolescent↗
PubMedDate not supplied

Air conduction thresholds after myringoplasty and stapes surgery: a conventional and high frequency audiometric comparison.

A comparison has been made of air conduction thresholds after myringoplasty and stapes surgery for otosclerosis in both the conventional (0.25 to 8 kHz) and high frequency (8 to 20 kHz) ranges. Significant threshold losses occurred in the high frequencies following both procedures. Threshold improvement was significantly greater at the lower frequencies following stapes surgery, while high frequency threshold deterioration was significantly less in the myringoplasty group. High frequency audiometry may prove to be a sensitive monitor of middle ear surgical techniques.

Adolescent↗
PubMed2002

Stapes surgery: how precisely do different prostheses attach to the long process of the incus with different instruments and different surgeons?

HYPOTHESIS: The goal of this study was to compare the attachment of stapes prostheses with differently shaped loops to the long process of the incus. BACKGROUND: In stapes surgery, the attachment of the prosthesis to the long process of the incus plays an important role concerning the gain in hearing and the development of late complications such as incus erosion and necrosis. Band-shaped and spiral loops have been developed to achieve a broad, firm attachment to the long process of the incus. During stapes surgery, the view at the prosthesis is restricted, making it impossible to evaluate the effects of the differently shaped loops. METHODS: Gold, steel/Teflon, platinum/Teflon, and two different titanium stapes prostheses were inserted in 30 specially prepared temporal bones by three experienced surgeons using the Fisch technique with the McGee and straight alligator forceps for the crimping of the loops. Photographs were taken with 0- and 70-degree rod lens telescopes at defined views. RESULTS: In all prostheses, a sufficiently firm attachment to the long process of the incus was achieved. The attachment of band-shaped loops proved to be better with the straight alligator forceps. The band-shaped loops showed a better contact with the incus than did the wire loops. However, the broad spiral-shaped loops led to a loss of the perpendicular axis of the piston to the long incus process. CONCLUSION: The geometry of the loop affects the final length of the piston in the vestibule and its angle to the long process of the incus.

Equipment Design↗
PubMed1985

Revision stapes surgery: problems with some solutions.

A review of 217 consecutive revision stapes operations performed during a ten-year period revealed that the surgeon encounters more pathological variables than he does during primary operations. Hence, the technical solutions are less stereotyped and the net results less predictable. Prosthesis displacement, with or without incus tip erosion, was the most common primary cause of failure (82%). However, oval window problems such as footplate refixation, perilymph fistula, otosclerotic regrowth, and lateralized oval window membrane in 60% of cases often complicated prosthesis displacement. First revision operations in 174 cases resulted in postoperative bone-air deficit of 10 dB or less in 65% of cases, much better than the 45% for second revision results, and the 25% for third revisions. These statistics provide our practice with a realistic prognosis when discussing revision stapes surgery with the individual surgical candidate.

Bone Conduction↗
PubMed1997

Stapes surgery in osteogenesis imperfecta patients.

Osteogenesis imperfecta (OI), or the Van der Hoeve-de Kleyn syndrome, is a heterogeneous group of connective tissue disorders. The key features in this disease are bone fragility with a tendency to spontaneous fractures and deformations. The classical traid of symptoms involves a conductive and/or sensorineural hearing impairment together with a tendency to spontaneous bone fractures and blue sclerae. Between January 1988 and December 1994, ear surgery was performed on eight ears of six OI patients who presented with mixed hearing loss preoperatively. Pathological changes observed in the middle ear were atrophy and/or fractures of the stapedial crura in combination with thickening and fixation of the stapes footplate. Partial stapedectomy was performed in seven cases and a neo-window was created in the promontory of one patient when an overhanging facial canal obscured visualization of the oval window niche. Pre- and postoperative bone conduction thresholds did not differ in any of the patients. Postoperatively, mean values of the air-bone gap in the main speech frequency range were below 10 dB. Functional results following stapes surgery in patients with otosclerosis during the same time interval (n = 857) did not differ significantly. These data indicate that stapes surgery in OI patients can be performed with the same functional predictability as in otosclerosis patients, even though the underlying etiology is considerably different.

Adult↗
PubMed2006

Experimental study on heat transmission to the vestibule during CO2 laser use in revision stapes surgery.

We studied the transmission of heat to the vestibule during revision stapes surgery with a piston in situ, using a CO2 laser, in an in vitro model. A type K thermocouple was placed around the medial end of stainless steel and fluoroplastic wire pistons in a 'vestibule' filled with saline. The effect of laser hits on fluoroplastic wire and stainless steel stapes prostheses was investigated. The effect of introducing a vein graft to seal the stapedotomy was also examined. Greater temperature rises occurred with stainless steel than with fluoroplastic wire pistons. The addition of the vein graft reduced heat transmission. Application of the CO2 laser to fluoroplastic wire pistons, using the power settings suggested by the manufacturer, is not likely to damage the inner-ear structures. Application of 6 W laser energy to stainless steel pistons can potentially disturb the inner-ear function.

Hot Temperature↗
PubMed1989

Occasional stapes surgery--a Norwegian experience.

The past history of, and current trend in, stapes surgery are reviewed, and experience from a personal series of 128 procedures over an 18 year period is presented. Results are frequently poorer than many surgeons and their patients anticipate, and more stringent pre-operative case selection and centralisation of surgical activity would appear desirable. Amplification has become a more acceptable management alternative for some patient categories.

Adolescent↗
PubMed2004

[30 years of stapes surgery].

This study reports the results of otosclerosis surgery performed during the past thirty years (1973-2002) in the ENT Clinic in Katowice. The authors present difficult anatomic relationships in the tympanic cavity which might have an influence on stapes surgery. Audiometric evaluation of 100 bilateral stapedotomies performed in 50 patients revealed that a small--hole stapedotomy is a safe technique and could be performed bilaterally. The group of 55 stapedotomies with stapedial tendon preserved was compared to the group of 55 stapedotomies with dissected tendon. SRT was better in the group where the tendon was preserved. In the group of 32 patients ABR before and after stapedotomy was recorded. The latency of V wave after the operation was reduced to the normal values what indicated a correct function of the ossicular chain postoperatively. In the group of 60 patients DPOAE prior and after stapedotomy was evaluated. Prior to the operation no signal of otoacoustic emission was registered, in 37 patients out of 60 the signal was present after the operation. DPOAE obtained postoperatively indicated successful ossicular chain restoration and inner ear function. Audiometric evaluation in reference to the group of 905 stapedotomies performed in years 1992-2001 showed that most of the patients were in group B--443/905 and C--402/905 according, in A group--60/905 according to Shambaugh. A-B gap < or = 10 dB was obtained in 469/905 (51.8%), the mean of the hearing threshold at 500, 1000, 2000 and 4000 Hz was 24.3 dB (+/- 8.3, med. 25.0) in A group and 32.0 dB in B and C group. The result of stapedotomy in reference to tinnitus based on the patients' subjective opinion. We may conclude that the key to the stapes surgery lies in the training and skillfulness of the surgeon using save small hole technique with stapedial tendon preservation to obtain the optimal physiologic function of the middle ear and to gain the best hearing results.

Adolescent↗
PubMed2003

An unusual complication of stapes surgery: profuse bleeding from the anteriorly located sigmoid sinus.

Major bleeding during stapes surgery is a rare condition. The anterior course of the sigmoid sinus is comparatively common in contracted mastoid bones, but rare in good pneumatized temporal bones. We report a case of an unusual anterior course of the vertical segment of the sigmoid sinus, which led to profuse bleeding during a stapedotomy operation. The 34-year-old female patient presented with conductive-type hearing loss in the right ear. During the operation, the unintentional sliding movement of a blunt curette caused injury to the anteriorly positioned sigmoid sinus, which was separated from the posterior wall of the external auditory canal by an extremely thin shell of bone. Profuse bleeding from the sigmoid sinus was controlled by pushing the middle part of the oxidised regenerated cellulose inside the lumen, without compromising the sinus flow. After bleeding was restrained, the stapedotomy operation was completed successfully. During the 1-year follow-up, there was neither an air-bone gap nor a sensorineural hearing loss in pure tone audiogram.

Adult↗
PubMed2000

Vertigo after stapes surgery: the role of high resolution CT.

CT findings in patients with vertigo after stapes surgery include a prosthesis shaft entering the vestibule and compressing the saccule, a complete dislocation of the stapes prosthesis, air bubbles and fluid collections within the vestibule and outside the oval window indicating a perilymphatic fistula, and bony fragments leading to compression of the basal saccule. Although immediate post-operative vertigo is often transient, patients with persistent or recurrent vertigo should be imaged as high resolution CT will determine the underlying cause in the majority of cases.

Fistula↗
PubMed1992

Three-dimensional surgical anatomy for stapes surgery computer-aided reconstruction and measurement.

To define anatomical relationships relevant to stapes surgery, computer-aided three-dimensional reconstruction and measurement were performed on nine normal temporal bones. The mean distance from the inferior portion of the long process of the incus to the center of the oval window was 3.80 mm. The shortest distance from the center of the oval window to the utricular macula, saccular membrane, and macula averaged 1.37, 1.60, and 2.13 mm. Surgery directed posteromedial-superior from the oval window was found to be most dangerous because it would come so close to the utricular macula; a posteromedial-inferior approach was found to be safest. The distance from the inferior margin of the oval window inferiorly to the cochlear duct in the hook portion ranged between 0.58 and 1.29 mm, suggesting that when a drill hole is made on the inferior margin of the oval window to lift up a depressed stapes footplate, the hole should not be greater than 0.5 mm in diameter.

Adolescent↗
PubMed2005

Success rate in revision stapes surgery for otosclerosis.

OBJECTIVE: The aim of this study was to evaluate the hearing results of revision stapes surgery performed because of previously failed operations and to determine the causes of failure. STUDY DESIGN: Retrospective review of revision stapes operations. SETTING: Tertiary referral center. PATIENTS: Sixty-three consecutive revision stapes operations were performed in 56 patients over a period of 12 years (1992-2004). The indication for revision surgery was recurrent or persistent air-bone gap greater than 20 dB after primary surgical treatment of otosclerosis of the oval window. RESULTS: All patients were operated on to improve hearing. Sixty-three revision stapes operations resulted in closure of the air-bone gap to 10 dB or less in 52.4% of cases. The average postoperative air-bone gap was 13.1 dB, and the mean pure-tone average improvement was 12.9 dB. In six patients (9.5%), revision surgery produced no change in hearing, and in four (6.3%) the hearing decreased by 5 dB or more. In one patient, the operation resulted in a profound hearing loss. Prosthesis malfunction was the most common primary cause of failure (60.3%). The original prosthesis was replaced with a new one in 48 cases. In 30 of these (62.5%), closure of the air-bone gap to within 10 dB was achieved. In 15 cases, the prosthesis was not replaced, and in only four of these (26.7%), closure of the air-bone gap within 10 dB was obtained (p < 0.022). CONCLUSION: Revision stapes surgery is less likely to be successful than the primary operation. Closure of the air-bone gap to within 10 dB was achieved in 52.4% of patients. The success rate was better in cases where the original prosthesis was replaced with a new one. The risk for decreased bone-conduction threshold does not seem to be higher than in primary surgery.

Adolescent↗
PubMed1983

Perilymphatic gusher and stapes surgery. A predictable complication?

The cases of 3 patients who had 'perilymph gushers' following stapes surgery are reported. The similarities in their clinical histories and examinations are discussed. All 3 were males and had progressive mixed deafness presenting in early childhood. Polytomography revealed anomalies in both the vestibule and internal auditory meatus in 1 patient; the stapedial reflex was unexpectedly large in all 3. Further preoperative evaluation of these features in other patients and patients affected by the X-linked deafness syndrome is indicated in order to assess the validity of the above criteria.

Adult↗
PubMed1994

Revision stapes surgery with and without laser: a comparison.

In this study, the results of 76 revision stapes surgeries performed from 1974 to 1992 were reviewed. Either the KTP or the argon laser was used in 40 operations. Prosthesis problems were the most common cause for revision (63%) followed by eroded/necrotic incus (29%) and adhesions (29%). Overall "success" in air-bone gap closure (air-bone gap < or = 10 dB) was 46% for first revisions and 33% for second or greater revisions. The "improvement" rate (air-bone gap < or = 20 dB) was 65% for first revisions and 53% for second or greater revisions. There was no statistically significant difference in hearing results between laser surgery and conventional technique. However, an absence of adhesions was noted when the laser had been used in the primary procedure.

Adolescent↗
PubMed2002

Photoacoustic effects of carbon dioxide lasers in stapes surgery: quantification in a temporal bone model.

HYPOTHESIS: The use of the CO2 laser in stapes surgery creates sound waves that could damage hearing. BACKGROUND The application of a laser to any medium has absorption, reflection, and thermal effects. To date, the majority of research on the safety of CO2 laser stapedotomy has focused on the thermal effects of the laser alone. Because of the properties of the CO2 laser, its absorption also presents some risk to the inner ear. This absorbed energy can be converted to photoacoustic or photochemical effects. The goal of this paper is to measure these photoacoustic effects (sounds) produced by the CO2 laser. METHODS: Using a variety of settings, a Sharplan 150 XJ Laser and a Contour model Erbium:YAG laser were applied to the oval window of human temporal bones. Perilymph was simulated by fixing the temporal bone in a normal saline bath. Photoacoustic waves were measured by a hydrophone 2 mm beneath the oval window. Measurements were made with and without a simulated tissue seal over the window. RESULTS: No detectable sounds were created below 4 watts (continuous mode) or 60 mJ (superpulse mode). Above those settings, intensities of 90 dB sound pressure level and higher were detected when the laser was applied directly to the perilymph. With the tissue seal in place, no detectable sounds were identified. The accuracy of this model was confirmed by comparing these results with previously published results using the Erbium:YAG laser. CONCLUSIONS: Below 4 watts in continuous wave mode and below 60 mJ in superpulse mode, any sound generated by the laser is small. Above these thresholds, however, impact sounds are produced that could result in threshold shifts with repeated applications.

Humans↗