[Preliminary comparative results after plastic surgery of the stapes with and without synthetic materials].
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Humans↗
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Cochlear otosclerosis presenting in children: a case report.
A case of cochlear otospongiosis in a 14-year-old is reviewed. The patient, who had a strong family history of otosclerosis corrected with stapes surgery, presented with a mild-to-moderate predominantly neurosensory hearing loss and absent stapes reflexes. A CT scan demonstrated changes characteristic of otospongiosis. The relevant literature was reviewed and fluorides as a possible therapy discussed.
Adolescent↗
Surgical findings and long-term hearing results in 3,050 stapedotomies for primary otosclerosis: a prospective study with the otology-neurotology database.
OBJECTIVE: To evaluate with a new otologic database the results of primary stapes surgery for otosclerosis with up to 14 years of follow-up in a consecutive series of 2,525 patients operated on by the same surgeon with the same technique (stapedotomy and vein graft interposition) and to provide online access to the complete data of this study for the reviewers. To study the effect of specific operative findings (obliterative otosclerosis and simultaneous malleus ankylosis) and age at the time of surgery on the long-term outcome. STUDY DESIGN: Prospective clinical study using a new computerized otologic database. SETTING: : Tertiary referral center. PATIENTS: Two thousand five hundred twenty-five patients who underwent 3,050 stapedotomies for otosclerotic stapes fixation were enrolled in this study from January 1991 to December 2004. Separate analyses were made for two unique pathologies (92 cases of obliterative otosclerosis and 19 cases of simultaneous malleus ankylosis) diagnosed during surgery and for patients in two age brackets ( or=65 yr [302 patients]). INTERVENTION: Stapedotomy with vein graft interposition and reconstruction with either a Teflon piston, a bucket handle prosthesis, or a total prosthesis. MAIN OUTCOME MEASURES: Preoperative and postoperative audiometric evaluation using conventional audiometry. Air-bone gap (ABG), bone-conduction thresholds, and air-conduction thresholds were all assessed. Postoperative audiometry was performed at 3, 6, 9, 12, 18, and 24 months and then annually for 14 years. RESULTS: Overall, the postoperative ABG was closed to 10 dB in 94.2% of cases. The mean four-frequency postoperative ABG was 1.7 dB compared with 25.6 dB preoperatively. The mean four-frequency bone-conduction thresholds were unchanged postoperatively. A significant postoperative sensorineural hearing loss (SNHL; >15 dB) was seen in 0.5% of cases in this series. Postoperative ABG was achieved to within 10 dB in 95% of cases of obliterative otosclerosis and in 64.7% of cases of simultaneous malleus ankylosis. A significant postoperative SNHL (>15 dB) was seen in 4.8% of cases of obliterative otosclerosis and was not observed in any cases of simultaneous malleus ankylosis. Postoperative ABG was achieved to within 10 dB in 93.5% of cases in the pediatric series and in 94.5% of cases in the senior series. A significant postoperative SNHL (>15 dB) was seen in 0.7% of cases in the senior group but was not observed in the children. CONCLUSION: Using a new otologic database, our series confirms that stapedotomy with vein graft interposition for otosclerotic stapes fixation is a safe and successful treatment for long-term hearing improvement. The deterioration in hearing with time after stapedotomy did not exceed the rate of hearing loss because of presbyacusis. Therefore, argon laser stapedotomy with vein graft interposition is our preferred surgical technique in the treatment of otosclerosis. Obliterative otosclerosis and simultaneous malleus ankylosis may be encountered during stapedotomy. Our study shows that reasonable success rates can still be expected in these situations. Stapedotomy results in the elderly and in children are comparable to those obtained in patients of other groups of age undergoing surgery for otosclerosis without an increased risk for complications.
Adolescent↗
[Experience with 76 cases of plastic surgery of the stapes at the Universitaets-Hals-Nasen-Ohrenklinik Leipzig].
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Humans↗
Spontaneous retraction pockets in chronic otitis media medical and surgical therapy.
Results of a series of 228 spontaneous retraction pockets in chronic otitis media are reported and a classification is proposed. Under medical therapy, 78 retraction pockets of stage I and II (out of 95) were followed for five years. Sixteen percent deteriorated into stage III and were operated on; the others stabilized or improved towards normal tympanic membrane (23%). Different methods of surgical therapy were used in 150 retraction pockets (all the stages III and many stages II). Even with silastic sheeting and strengthening of the tympanic membrane, a recurrent retraction pocket was observed in 24 cases (16%). Functional results were obviously better when the ossicular chain was rebuilt from an intact malleus to an intact stapes and either from an intact malleus to a mobile footplate or from the tympanic membrane to an intact stapes. Surgery of retraction pockets must be used not only to prevent cholesteatoma formation but also to prevent erosion of the stapes.
Adult↗
Rosen mobilization of the stapes: does it have a place in modern otology?
We describe two patients with stapes fixation, in both of whom Rosen mobilization seemed to be the most prudent surgical choice. In both cases, a useful hearing gain was achieved initially. In the patient with otosclerosis, the conductive hearing loss recurred and a stapedectomy was subsequently carried out. In the patient with congenital stapes fixation, the hearing gain was maintained for two years eight months. We believe that this technique still has a place in stapes surgery in rare instances.
Adolescent↗
The effects of fibrin tissue adhesive on the middle ear.
This study investigated the effects of fibrin glue ('Tissucol', Immuno Pty. Ltd.) in the middle and inner ear. Small amounts of the adhesive were used in 36 operations performed on 18 rabbits. The light microscopic examination of these ears four, eight and 12 weeks after surgery showed that the adhesive was well tolerated and that it did not have any toxic effect on the middle ear or membranous labyrinth. The fibrin tissue adhesive can therefore safely be used to facilitate reconstructive middle-ear surgery and, with the aid of fascia, also for the closure of labyrinthine fistulae; or to achieve a definite seal of oval window niche after stapes surgery.
Animals↗
Self-retaining aural speculum: a valuable aid to middle-ear surgery.
We report the use of a self-retaining aural speculum that provides an excellent view of the middle ear through a small endural incision. We have found this instrument of value in tympanoplasty and stapes surgery in particular.
Ear, Middle↗
[Health aspects of diving in ENT medicine. Part II: Diving fitness].
Diving has become increasingly popular. With the growing number of patients who want to dive, there is an increasing number of divers who require their regular medical examination. As ENT problems are the most common disorders in divers, otorhinolaryngologists regularly have to assess the diver's fitness. It should be noted that an ENT examination does not certify complete fitness to dive! Diving can be resumed 3 months after middle ear surgery, especially after tympanoplastic type I, II and III with insertion of a PORP, when there is regular middle ear ventilation without atrophic scars of the tympanic membrane. Even after stapes surgery, diving can be resumed when there are no signs of vestibular irritation during a provocation test. By 3 months after sinus surgery, the diver should perform a test dive under supervision before fitness to dive can be certified. After inner ear barotrauma, the diver remains fit to dive depending on his hearing ability in the involved ear. After inner ear decompression illness, one should look for a vascular right-to-left shunt before diving can be resumed. These and many more aspects are discussed in this article on how to determine whether a diver with ENT problems is fit to dive.
Certification↗
The unilateral stapes gusher.
A stapes gusher is an alarming situation occurring during stapes surgery for mixed hearing loss. It is characterized by the sudden profuse flow of cerebrospinal fluid in the middle ear and external ear canal after opening the vestibule of the inner ear. An adult patient with unilateral stapes gusher is described; he was operated on both ears with a good hearing result on both sides. The stapes on the side with the cerebrospinal fluid leak was malformed, especially in the posterior crus--a finding which may suggest the possibility of a stapes gusher. The small-hole stapedotomy is a safe technique when dealing with a profuse cerebrospinal fluid leak, and it enables the closure of the leak with additional tamponade of the oval niche and the achievement of a good hearing result.
Adult↗
[A new self-retaining titanium-gold stapes prosthesis].
Various aspects of stapes surgery have been improved since its introduction in 1958 by Shea. However, fixation of the prosthesis on the long process of the incus remains difficult. Furthermore, the functional result of crimping cannot be predicted. Necrosis of the lenticular process still occurs. A new stapes prosthesis has been developed with the Kurz Co. The use of titanium allowed an innovative design: titanium has a shape memory, and a clip was constructed which uses this memory for fixation on the incus. Two new instruments were also developed to facilitate application of the prosthesis: a prosthesis inserter and a prosthesis crimper. The clip does not strangulate the incus; it is attached only to the superior and inferior surface of the incus, which are the crucial locations for mechanical transmission of the piston-like movements of the ossicular chain. Avoidance of circumferential attachment should reduce the risk of incus necrosis. Once the clip is pushed onto the incus no further crimping is necessary. The piston is of pure gold, as in this company's gold piston which has been in use for many years. In future the prosthesis may be all-titanium.
Gold↗
[Are titanium implants superior to gold implants in the tympanic cavity?].
BACKGROUND: Gold implants in reconstructive surgery of the middle ear have proved to work sufficiently: That applies to tympanic cavity conditions without signs of chronic inflammation as also to the bacterially infected middle ear. For some years titanium implants are also in the use and established as well. The biocompatibility of titanium, the clinical and the audiological results are satisfactory. When using gold-prostheses in stapes surgery however, the still unsolved problem of occasional deafness has to be considered. PATIENTS: The clinical and functional results of middle ear surgery were examined retrospectively. There was no preselection of patients. 53 patients underwent middle ear surgery with titanium prostheses, 42 patients with gold prostheses. RESULTS: Due to their material properties and due to their delicate shape titanium prostheses (PORP, TORP) can be inserted into the tympanic cavity more simply and with better fit. The audiological results of gold and titanium prostheses are comparable. The extruding rate of the gold prostheses is substantial, whereas the extruding rate of titanium is negligible. CONCLUSION: The functional results of both materials are comparable. Due to the high extruding rates of gold prostheses titanium is clearly superior.
Auditory Threshold↗
[Improvement of hearing function through ear reoperation. The role of tympanic revision for functional indications].
Recurrent middle ear disease may carry a high probability of complications, and there is no doubt of the necessity of revision surgery for either cholesteatoma or tumor. However, failures in function should be individually analyzed before a second procedure is decided upon. A pre-requisite for surgical improvement of hearing is adequate tubal and inner ear function. Chronic suppurative otitis media has a higher tendency for reperforation than cholesteatoma. Adhesive otitis indicates poor tubal function. Tympanosclerosis may cause refixation requiring stapedectomy at a second stage. Middle ear fibrosis recurs in about 50% of cases. Post-operative failures such as extrusion of ossicles, lateralization of the tympanic membrane, and blunting of the anterior tympanomeatal angle as well as failures after stapes surgery are discussed.
Aged↗
The history of the microscope for use in ear surgery.
PURPOSE OF STUDY: To study the historical development of the binocular microscope used in ear surgery. METHOD: Compilation of the texts of the era and books dealing with ear surgery, and a review of the international literature on the subject. RESULTS: The first descriptions of the microscope date to the 17th century; however, it was not until 1921 that the microscope was used for the first time in ear surgery by a Swedish otologist, Carl Olof Nylen. This monocular microscope was rapidly replaced by a binocular microscope developed in 1922 by Gunnar Holmgren. Because of its limited field of vision, very short focal distance, poor light quality, and instability, this microscope was seldom used initially. Despite the development of many different models, it was not until 1951 that a new model appeared, perfected by Littmann and the Zeiss Company. This model replaced all other models progressively, thanks to its ease of use and the possibility of changing the magnification without modifying its focal distance. It allowed for the development of tympanoplasties and stapes surgery. The latest developments include the three-dimensional imaging and navigation systems. CONCLUSION: The microscope followed an evolutionary process that led to the actual binocular microscope, which is found in every institution where otology and ear surgery are performed.
Ear↗
Stapedectomy trends for the resident.
The diminishing number of cases of otosclerosis limits the training experience in stapes surgery during residency. Results are suboptimal. Closure of the preoperative air conduction to within 10 dB of bone conduction was obtained in only 64% of resident cases. Efforts to maximize experience and improve results include closer faculty supervision, use of one stapedectomy technique, and a prospective study of individual residents' performance.
Adolescent↗
Otosclerosis and chronic tinnitus.
Chronic subjective tinnitus is a common feature of clinical otosclerosis. Analysis of the records of 1,014 consecutive cases of clinical otosclerosis, all confirmed by stapes surgery in South Australia between 1960 and 1972, gives a preoperative prevalence of this symptom of 65%. The association of tinnitus with various predictors is considered, and a statistical analysis is presented. Tinnitus has an association with gender (p < .0001), mean preoperative bone conduction (BC) level (p = .0012), mean air conduction (AC) level (p = .0192), and mean air-bone gap (p = .0075). The associations between tinnitus and the age of the patient, the duration of deafness, the presence of Schwartze's sign, and the severity of footplate pathological involvement were all nonsignificant. The association of tinnitus with the AC and BC thresholds is unexpectedly paradoxical. An economic predictive model for tinnitus in otosclerosis has been constructed from the 2 strongly significant variables, gender and mean BC hearing level, by logistic regression. In this large series of cases, the log odds in favor of finding tinnitus are about 0.810 for male subjects and 1.394 for female subjects when the BC level is zero. The log odds fall by 0.014 for each decibel of mean BC rise.
Adolescent↗
Surgery and histopathology of the stapes in osteogenesis imperfecta tarda.
Fourteen stapedectomies were performed on ten patients with osteogenesis imperfecta tarda. Clinically, the footplates were softer and more tenuously fixed than in otosclerosis and floating footplates seemed more common. Stapes and stapes fragments from all 14 operations were examined microscopically. The histopathology of osteogenesis imperfecta was contrasted to that of otosclerosis. We believe that the greater degree of structural disorganization and greater area occupied by resorption spaces clearly distinguish the new bone formed in osteogenesis imperfecta from otosclerosis.
Adolescent↗
[Vascular degeneration in otosclerosis and its influence on the mesenchymal reaction of the mucoperiost].
38 samples of middle ear mucosa were taken from different patients during stapes surgery in otosclerosis. The samples were studied light-and electronmicroscopically without decalcification. Considerable pathologic changes in the organisation of the capillaries (endothelial hydrops, proliferation of the intima and of the adventitia, total obliteration o the vessels) cause pathologic reactions on the mesenchymal elements of the submucosa. Next to fibrolysis or hyalinosis of the collagen fibers the fibrocyts show features of undergoing lysis. Free and cellular bound calcium deposits are located in these lytic areas. The epithelial lining also shows unusual inclusions as glycogen and acid mucopolysaccharides and an alterated basement membrane. We belive that the changes of the connective tissue and of the epithelium are secundary to the capillary obstruction.
Apatites↗