Mobilizing in a case of congenital fixed stapes.
Explore the source record for details and available documents.
Ear Ossicles↗
SEARCH · Search PubMed
Results for “Stapes Mobilization”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
[Surgery of the footplate of the stapes excluding otospongiosis: critical study of a series of 60 cases].
Operations on the foot of the stapes, excluding for otosclerosis, were performed in 60 patients: 5 mobilizations and 55 excisions. Surgery was for aplasia in 7 cases, injury in 5 cases, tympanosclerosis with a closed membrane in 17 cases (mobilization was performed in 5 of these patients), elective excision with a healthy cavity in 16 cases, and 15 involuntary excisions including 10 with an open membrane. Stapedectomy is a serious operation when the ear is open, whether it is performed for simple chronic otitis, or cholesteatomatous or tympanosclerotic otitis, risks being independent of age. The use of an appropriate technique can provide substantial functional gain in aplasias and tympanosclerosis with a closed membrane.
Adolescent↗
A personal history of stapedectomy.
Aristotle has said the essential ingredient of tragedy is first hubris. Fame leads to the hubris that offends the gods, who send great punishment. This is so true in the history of stapedectomy. The three distinct eras of surgery for otosclerosis teach us a lot about what happens in science and in life. The first stapes era began in Europe, ahead of its time, and in those halcyon days before the turn of the century, the Belle Epoch, proceeded, uncorrected to its tragic extreme, and then was stopped suddenly, quite rightly, by the establishment. The fenestration era proceeded to an extreme, when its technical master Julius Lempert would allow no criticism or improvement in "his" one-stage endaural technique, however good, nor would he accept the new mobilization and stapedectomy operations, and he and it ended badly. The fact that Jenkins and Holmgren would make an opening in the lateral semicircular canal and then close it in the epitympanum, not open to the ear canal, to expect to improve hearing is amazing. Until Sourdille went to Stockholm and saw one closed fenestration operation performed by Holmgren and devised his "open to the ear canal technique," the closed fenestration operation was not reasonable. Then Sourdille came to New York City, and Lempert heard him speak and read and reread his publication and greatly improved on his operation. It was Lempert's one-stage endaural open operation that gave the fenestration operation the worldwide acceptance it gained. The second stapedectomy era began before the fenestration era ended with the accidental and originally unrecognized mobilization of the stapes by Rosen and my resurrection of stapedectomy. I realized in reading the literature of the past that stapedectomy was not necessarily fatal to the ear or the patient as was generally believed, and what was needed was to seal the oval window with a living elastic membrane and reconstruct the sound-conducting mechanism of the middle ear with a biocompatible implant prosthesis to make it successful. But for me, in 1955-1956, the "Zeitgeist" was finally right. I realized the stapes could be removed and covered the oval window with a vein graft, and Harry Treace made me a biocompatible implant prosthesis out of the newly discovered Teflon. For a new technology to be accepted, it must be much better than what it replaces, and stapedectomy was much better than fenestration. In the new microsurgical era of otology that began, improvements in the stapedectomy operation came from everywhere and were readily accepted. Stapedectomy has now become so successful, like many treatments in medicine, the problem has now largely disappeared. If the measles virus is the cause of the growth of the otosclerotic focus, as it seems to be, then vaccination against measles eventually will eliminate the hearing loss of otosclerosis completely. What the history of stapedectomy reveals is the truth of the quotation from Ecclesiastes, "There is nothing new under the sun." Progress is only made when the Zeitgeist is right, by someone who puts together the truths of the past with the new discoveries of the present.
Ear Diseases↗
[Abnormalities in the tympanic cavity in otosclerotic patients].
UNLABELLED: The aim of the thesis is the analysis of the anatomical abnormalities and atypical conditions in the middle ear encountered during the surgery for otosclerosis and their influence for the course of the operation. These atypical conditions could result either from the congenital anomalies or from the disease itself. MATERIAL AND METHODS: The material comprises 572 stapedectomies performed in ENT Department of the Pomeranian Academy of Medicine in Szczecin (Poland) between 1969 and 2004. Partial stapedectomy was performed with removal of the stapes crura and usually posterior part of the footplate. RESULTS: Among 572 ears which underwent the operation different abnormalities in the tympanic cavity were found in 134 cases (23,4%). These included: narrowed oval window niche in 71 cases, stapes anomalies in 46 cases, obliterative otosclerosis in 20 cases, red otospongiosis of the stapes in 9 cases, increased perilymph pressure in 7 cases, malleus and incus bony fixation in 3 cases. The presented abnormalities were the reasons of many failures at the time of the operation. While in the 438 ears with normal anatomical status in the tympanic cavity failures during the operation occurred in only 6 cases (1,4%), in the 134 ears with such abnormalities failures happened in 33 cases (24,6%). The most frequent failure - 20 cases - was premature mobilization of the stapes followed by other consequences. In the other 9 cases the operation was discontinued for different reasons. Another failure was the floating footplate in 2 ears, facial nerve paresis in 1 ear and incus subluxation also in 1 ear. In a few cases in which the operation was stopped the successful stapedectomy was performed at the 2nd stage. Only in 3 ears the stapedectomy was totally given up what makes 0,5% out of the 572 ears operated on.
Adolescent↗
Laser stapedotomy minus prosthesis (laser STAMP): absence of refixation.
OBJECTIVE: To determine what percentage of patients with otosclerosis could successfully undergo a laser stapedotomy minus prosthesis over a 5-year period, and to determine the percentage of patients in whom refixation develops during follow-up. STUDY DESIGN: Retrospective case review of 136 patients (137 ears) who underwent primary surgery for otosclerosis. SETTING: An otology/neurotology tertiary referral center. PATIENTS: Patients were chosen if they had clinical evidence of otosclerosis without a history of otologic surgery. INTERVENTIONS: A standard stapes approach was used for all patients. For the laser stapedotomy minus prosthesis, a hand-held laser probe was used to vaporize the anterior crus of the stapes and perform a linear stapedotomy across the anterior one third of the footplate. If otosclerosis was confined to the fissula ante fenestram, the stapes became completely mobile. The stapedotomy opening was sealed with an adipose tissue graft from the ear lobe. MAIN OUTCOME MEASURES: Pure-tone audiometry with appropriate masking and auditory discrimination testing was performed before surgery, 6 weeks after surgery, and every year thereafter. RESULTS: Of the 137 cases, favorable anatomy and minimal otosclerosis allowed 46 (33.6%) of these patients to undergo laser stapedotomy minus prosthesis. Fifty-seven patients (41.6%) could not undergo the procedure because of extensive otosclerosis. The remaining 34 patients (24.8%) did not receive laser stapedotomy minus prosthesis because of other anatomic or technical difficulties. Of the 34 patients in the laser stapedotomy minus prosthesis group with more than 4 months follow-up, the average air-bone gap was closed from a mean of 22 dB (SD 10 dB) to 6 dB (SD 4 dB) 6 weeks postoperatively. Follow-up periods ranged from 5 months to 53 months (mean 767 days, SD 437 days). The long-term air-bone gap improved slightly to an average of 5 dB (SD 6 dB) in comparison with the sixth postoperative week value. CONCLUSION: Laser stapedotomy minus prosthesis is a minimally invasive procedure, which over the follow-up period has a very low incidence of refixation, as evidenced by a lack of progressive conductive hearing loss. The success of this procedure depends on the correct selection of cases. This procedure has been successfully performed on 33.6% of patients undergoing primary stapes surgery. Laser stapedotomy minus prosthesis seems to be a viable alternative to conventional stapedotomy that yields good results without evidence of refixation over an extended time.
Adipose Tissue↗
Tympanosclerosis of the stapes: hearing results for various surgical treatments.
When tympanosclerosis involves the tympanic membrane or the lateral ossicles, treatment is usually straightforward and uncomplicated. When the stapes is involved, therapy is more controversial and may be more difficult. We report our results in 154 patients who underwent different surgical procedures for tympanosclerosis of the stapes. Followup was up to 10 years. Pure-tone average threshold was significantly improved (p < 0.05) in patients who underwent mobilization procedures or stapedectomy for definitive treatment. The air-bone gap was less than 20 dB at 6 months postoperative in 72% of patients and less than 30 dB in 90%. At 6 months, 2 years, and 5 years there were no statistically significant differences in hearing results between stapedectomy and mobilization patients, some of whom were followed for up to 10 years. No patient had a profound hearing loss after surgery. Surgical treatment for tympanosclerosis of the stapes is a safe procedure, with hearing results similar to those of surgery for other chronic ear diseases involving the ossicular chain.
Adult↗
The anterior and superior malleal ligaments in otosclerosis: a histopathologic observation.
HYPOTHESIS: The aim of this study was to assess, in otosclerosis, whether the anterior and superior malleal ligaments show histologic changes that can lead to reduced malleal mobility and eventual fixation, and also to evaluate whether these changes are related to the degree of histologic otosclerosis. BACKGROUND: Fixation of the malleus seems to be one of the most controversial clinical entities in the acquired condition of otosclerosis. It has even been postulated that persistent conductive deafness, or progression of conductive deafness after initial improvement after stapedotomy, could be due to unsuspected malleus fixation. METHODS: Fifty eight temporal bones with known otosclerosis and 43 normal temporal bones were selected. In addition, 10 temporal bones of fetuses and children were also studied. Otosclerosis of the footplate and otic capsule was graded as none, mild, moderate, and severe. The histologic changes in the ligaments also were graded from none to severe. RESULTS: The median ages of patients in the otosclerotic and normal groups were 62 and 60 years, respectively. In the anterior malleal ligament of the otosclerotic bones, 10% mild (+), 60% moderate (++), and 30% severe (+++) degrees of hyalinization were observed. In the anterior malleal ligament of the nonotosclerotic bones, 14% showed no hyalinization, 24% had only a tinge of hyalinization (minimal), 51% had mild (+) hyalinization, and 11% had moderate (++) hyalinization. Superior ligament hyalinization appears to be related to the severity of anterior ligament hyalinization. The severity of otosclerosis in the footplate or the otic capsule did not appear to be related to the severity of hyalinization. CONCLUSION: From this study, it is apparent that otosclerotic bones have a significantly high incidence of hyalinization of the anterior malleal ligament. This seems to be related to the duration rather than the severity of otosclerosis. It is important to properly evaluate malleal mobility during all stapes surgery.
Adult↗
Review. Six years experience of Plastipore.
A 6 year personal experience in the performance of Plastipore prostheses in middle ear reconstruction is presented. The good hearing results at 12 months are not maintained with TORPs or PORPs and 41.6% have been rejected. Better results are obtained with a tube prosthesis between a mobile malleus and stapes. The use of TORP and PORP has now been abandoned in favour of ossicles or homograft cartilage.
Biocompatible Materials↗
Symposium: Methods of reconstruction in tympanoplasty. I. Management of fixation of malleolus head and incudal body in tympanoplasty.
Depending upon the presence or absence of stapedial mobility, treatment of ossicular fixation will vary. Methods and indication to preserve the fixed malleolar head and neck are discussed and positive indications for removal of the incus are enumerated. A description of various surgical techniques of interposition of the incus between the mobile malleus and stapes to relieve stapes fixation and restore continuity are described in detail.
Ear, Middle↗
[Unilateral patulous eustachian tube with tinnitus, inner ear damage, vertigo and sudden deafness--collagen injection].
In elderly patients an unilateral sensorineural hearing loss is frequently associated with a relatively more patent eustachian tube on the involved side. A simple method of investigation is observation under the operating microscope during tubal inflation by the patient. In right-handed patients the abnormally patent tube most often lay on the left side. Powerful self inflation in these patients induces acute hearing loss and vertigo. Acute hearing loss is commoner on the left side. The air bone gap is greater at higher frequencies due to mobility of the stapes, loosening of the incudal joints and the tympanic membrane. In contrast the air bone gap is greater at lower frequencies in otosclerosis or malleus head ankylosis. Minor degrees improve after self inflation is prohibited. In most patients with abnormally patent eustachian tubes further therapy is not necessary after the patient has received precise advice. In only about 20% of the cases is the patient disturbed by a feeling of fullness in the ear, autophony and tinnitus. After stabilisation of weight and blood pressure, a septoplasty with correction of the posterior turbinates may reduce the exspiratory resistance. The most drastic treatment is a collagen injection around the tube. Patients with depression should be treated appropriately.
Aged↗
[A practical application of brainstem evoked response audiometry (author's transl)].
After a brief review of Brainstem Evoked Response Audiometry (BERA) for clinical diagnosis of middle and inner ear hearing losses (Fig. 2, 3) and retrocochlear damages a new practical application is presented: Brainstem Evoked Response Audiometry in Tympanoplasty. Recordings of acoustically evoked brainstem potentials have been made in middle ear surgery in order to get direct objective information about the mobility of the stapes (Fig. 4) and the sound conducting mechanism of the middle ear after tympanoplasty (Fig. 5). Because of the damping factor of the middle ear after tympanoplastic reconstruction quantitative evaluation of sound transmission to the internal ear. Via brainstem potentials evoked by loudspeakers or probe tubes is difficult. Therefore, a special mechanical vibrating system for direct stimulation of the middle ear apparatus at various locations will have to be developed.
Audiometry↗
Bone cement reconstruction of the ossicular chain: a preliminary report.
OBJECTIVE: To determine the feasibility and efficacy of using a bone cement, Oto-Cem, to reconstruct the ossicular chain. STUDY DESIGN: Prospective clinical trial on nine consecutively chosen adult patients with ossicular chain defects. PATIENTS AND SETTING: Nine patients with ossicular chain defects involving the long process of the incus were treated at the Carolina Ear and Hearing Clinic. The ossicular chain was reconstructed using bone cement by itself or in conjunction with a stapes prosthesis. MAIN OUTCOME MEASURES: Preoperative audiograms were compared with audiograms 3, 6, and 12 months after reconstruction. RESULTS: There was a mean pure-tone average (PTA) improvement of 15 dB in patients undergoing incus to stapes suprastructure reconstruction with the bone cement. The incus to mobile footplate reconstruction (using a stapes prosthesis attached to the newly reconstructed incus) resulted in a 34-dB PTA postoperative improvement. Two of the three patients with incus to oval window repairs experienced a 10-dB improvement in PTA. One of the three patients experienced a loss in speech discrimination and a 2-dB loss in PTA. CONCLUSIONS: Despite the limited number of patients, this preliminary study demonstrates the effectiveness of Oto-Cem in reconstructing a foreshortened incus. There was a substantial hearing improvement in all but one patient in the incus to stapes or the incus to footplate categories.
Auditory Threshold↗
Ossiculoplasty by interposition of a minor columella between the tympanic membrane and stapes head.
This study analyzes short- and long-term results of 436 ossiculoplasties accomplished by a minor columella sculptured in the remnants of the incus and placed between the tympanic membrane and stapes head. Most cases were operated on by a transcanal approach through an ear speculum, under local anesthesia. Cases in which an associated mastoidectomy was performed to remove diseased tissue are excluded. The residual air-bone gap was < 20 dB in 86.1% of cases 2 months after surgery, in 77.0% 1 year later, and then remained stable over time, even in patients seen 5 to 15 years after the operation. Complications were rare. A total sensorineural hearing loss occurred in two cases (0.4%), the cause of which remained unexplained. Other complications included a high-frequency hearing loss in 10 (2.3%) cases, tinnitus in 12 (2.7%), and transitory vertigo in two (0.4%). We conclude that this type of ossiculoplasty is a simple but adequate procedure for primary restoration of hearing in chronic otitis media if the stapes is intact and mobile.
Adolescent↗
Linkage of otosclerosis to a third locus (OTSC3) on human chromosome 6p21.3-22.3.
Clinical otosclerosis (OMIM 166800/605727) has a prevalence of 0.2-1% among white adults, making it the single most common cause of hearing impairment in this group. It is caused by abnormal bone homeostasis of the otic capsule with the consequent development of sclerotic foci that invade the stapedio-vestibular joint (oval window) interfering with free motion of the stapes. Impaired ossicular chain mobility results in a conductive hearing loss. We identified the first locus for otosclerosis (OTSC1) on chromosome 15 in 1998 and reported a second locus (OTSC2) on chromosome 7 last year. Here we present results of a genome wide linkage study on a large Cypriot family segregating otosclerosis. Results of this study exclude linkage to OTSC1 and OTSC2 and identify a third locus, OTSC3, on chromosome 6p. The defined OTSC3 interval covers the HLA region, consistent with reported associations between HLA-A/HLA-B antigens and otosclerosis.
Chromosome Mapping↗
[Piston-malleus. III (author's transl)].
Among the many procedures proposed for re-establishing bone continuity in cases with a mobile foot of the stapes, an effective solution has been found to be the employ of a malleus-foot of the stapes prosthesis. Austins prosthesis is surtable in such cases, but must be modified to adapt to different situations and to avoid complications. Surtably adapted in this way, good results can be obtained in the sequelae of chronic otitis and injuries.
Cochlear Implants↗
Mixed hearing loss in otosclerosis: indication for long-term follow-up.
This retrospective study of 146 ears with long-term follow-up after otosclerosis surgery evaluated the stability of hearing results, the incidence of sensorineural hearing loss, and the effect of fluoride treatment. Follow-up was at least 15 years (mean, 25.2 yr; range, 15-44 yr). There were 97 large fenestra stapedectomy operations, 23 lateral canal fenestrations, 7 mobilizations, and 19 revision stapes operations. The level of air-bone gap achieved at surgery remained stable over time; the mean deterioration rate was only 0.2 dB per year. Profound sensorineural hearing loss ( > or = 65 dB bone conduction average) at the most recent follow-up occurred in 13 ears (8.9%). Such hearing loss occurred in all operative groups. Mean bone conduction average immediately postoperatively was significantly higher in these ears than in others in the study. This finding indicates that a mixed hearing loss at surgery is a factor that increases the risk of later profound cochlear loss. Only 3 percent of ears with pure conductive hearing loss, but 28 percent of patients with mixed hearing loss at surgery eventually suffered profound cochlear loss. Sodium fluoride was used to treat 11 ears with progressive cochlear loss. The rate of bone conduction hearing deterioration decreased in all ears after treatment, and none developed profound hearing loss. Follow-up after the first postoperative year is not necessary if pure conductive hearing loss is present at surgery. Annual follow-up with audiograms is recommended if a mixed hearing loss is present. Fluoride treatment is recommended if inner ear hearing loss progresses.
Adult↗
Unexplained conductive hearing loss.
We report a series of unusual clinical cases which exhibit what we have referred to as unexplained conductive hearing loss. Audiometrically, these cases typically display mild to moderate conductive or mixed-type hearing loss and good word discrimination (80% to 100%). The otologic evaluations also lend support to the audiometric findings. When polytome roentgenograms were obtained thr results showed a normal inner ear system. Most often, the otologists' clinical impression was a fixed malleus or congenital stapes fixation, and exploratory tympanotomy with inspection of the ossicular chain was recommended. In each case, the ossicular chain was found to be intact. When the incudostapedial joint was separated the malleus and incus were seen to be mobile. Further, palpation of the stapes resulted in good round window reflexes. Possible explanations for this phenomenon are considered.
Adult↗
[Stapes plastic surgery for the purpose of preservation of function of the sound conduction chain after opening of the oval window in unsuccessful mobilization].
Explore the source record for details and available documents.
Humans↗