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PubMed1997

Normal and opacified middle ears: CT appearance of the stapes and incudostapedial joint.

PURPOSE: To establish the computed tomographic (CT) visibility of the incudostapedial joint and of the stapes superstructure in normal and opacified middle ears. MATERIALS AND METHODS: Two independent observers reviewed CT studies with 1-mm section thickness of the temporal bone in 75 normal ears and in 33 opacified middle ears (13 of which had definitive proof of disease) to establish the rate of visualization of the stapes and incudostapedial joint. RESULTS: In normal ears, both the stapes crura and the continuity between the incus and stapes were seen in almost 100% of cases, whereas the actual incudostapedial joint was identified in 86% (86 observations) and 67% (67 observations) of cases in the axial and coronal planes, respectively. The position of the incudostapedial joint was below footplate level on the axial images and mostly at or anterior to the midportion of the foot-plate on the coronal images. In 13 clinically confirmed diseased middle ears, the status of the stapes superstructure in all cases and that of the incus in 11 cases was correctly predicted with CT. CONCLUSION: It is now possible to visualize routinely the incudostapedial joint and stapes superstructure at CT. Absence of these structures in an opacified middle ear strongly indicates abnormality.

Ear Diseases↗
PubMedDate not supplied

Reconstruction of the stapes superstructure with a combined glass-ceramic (Bioverit) implant in guinea pigs.

BACKGROUND: Reconstruction of the stapes superstructure continues to be a problem for otologists. Optimal fixation of implants on the stapes footplate has not yet been achieved. METHODS: We postulated that bony fixation, between implant and stapes, could be confined exclusively to the footplate region by modifying the bioactivity of the implant material. Therefore, after removal of the superstructure in guinea pigs a combined biovitro ceramic implant (Bioverit I and Bioverit II) was placed on the stapes footplate in 10 guinea pigs. As a control, we employed a group of 6 animals in which the stapes superstructure was removed without placing any implant. RESULTS: After 25 weeks the implants were found to be dislocated laterally. We observed fixation with the wall of the middle ear. In the control group we also found new bone formation and even a bow shaped regeneration of the stapes superstructure. CONCLUSION: Combined Bioverit stapedial implants were found to routinely fix to the middle ear wall of the guinea pig. The guinea pigs' enormous potential for bone regeneration in the middle ear ossicular chain make this species unsuitable for exploring hypotheses on human middle ear reconstruction.

Animals↗
PubMed1990

[Holographic observation of the tympanic membrane vibration after stapes fixation].

Sclerosis of auditory ossicle was experimentally induced by fixation of the stapes, and its effect on the tympanic membrane vibration was examined using fresh 10 canine temporal bones by means of holographic interferometry. By changing the sound pressure (from 90 to 110dB) and the frequency (from 250Hz to 8kHz) in steps, vibration of the membrane was induced in a free field. At each frequency, the vibration of the membrane was photographed by the time averaged method using He-Ne laser. A small hole was created in the tympanic bulla and the stapes was fixed with an adhesive (Alon Alpha), followed by closure of the hole. Before stapes fixation, the posterior part of the membrane showed a simple vibration pattern, forming cocentric interference circles at frequencies from 250Hz to 2kHz. At 3kHz, segmental vibration began to be noted, and complex segmental vibration was seen at frequencies 4.5 and 6kHz. The vibration after stapes fixation became simpler at frequencies over 3kHz, accompanied by decrease in the number of segmental vibrations. Vibration amplitude in the posterior part of the membrane decreased from 250Hz to 3kHz, while it increased at frequencies over 4kHz. In the anterior part of the membrane, the amplitude decreased at frequencies under 2kHz, remained unchanged at 3kHz and increased at frequencies over 4kHz after stapes fixation. In the tip of the manubrium mallei, the amplitude decreased at frequencies under 3kHz and increased at frequencies over 4kHz. Thus, a shift of peak vibration to high sound region was observed after stapes fixation at every part of tympanic membrane.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1999

A human temporal bone study of stapes footplate movement.

OBJECTIVE: This study was designed to determine whether stapes movement is pistonlike or complex. BACKGROUND: The literature provides conflicting information on whether stapes footplate motion is only pistonlike or has other types of movement, such as hingelike or rocking. METHODS: Using 10 freshly harvested human cadaver temporal bones, 3 targets were placed on the stapes footplate through an extended facial recess approach. The targets were 0.5-mm pieces of reflective adhesive material positioned on the long axis of the footplate at the anterior crus, central footplate, and posterior crus. Displacement and phase of the three targets were measured from 0.2 to 10 kHz at a 90dB sound pressure level input at the tympanic membrane. The measuring system was a sophisticated laser Doppler vibrometer (LDV). A computer program (Tymptest) calculated footplate displacement and relative phase at the three sites and the ratio of anterior-posterior rocking movement of the footplate long axis to displacement at the center. RESULTS: Below 2.0 kHz, stapes vibration is predominately pistonlike. Above 2.0 kHz, anterior-posterior rocking motion increases logarithmically with frequency, and, near 4.0 kHz, rocking and pistonlike motion are approximately equal. CONCLUSIONS: Stapes footplate vibration is primarily pistonlike up to 2.0 kHz but becomes more complex at higher frequencies because of an increase in anterior-posterior rocking motion. Hingelike movements were not observed. This information may be helpful in the design of ossicular replacement prostheses that mimic or improve upon normal stapes vibration.

Adult↗
PubMed2004

A novel laser-assisted stapedotomy technique for congenital stapes fixation.

OBJECTIVE: To investigate whether a novel laser-assisted stapedotomy technique is effective in treating congenital stapes fixation. METHODS: With this surgical method, the suprastructure of the stapes is vaporized continuously from the superior half of the anterior crus to the inferior part of the posterior crus using a potassium-titanyl-phosphate (KTP) laser. The midmost point of the vaporization is the head of the stapes. This method was used to treat three patients with congenital stapes fixation (total of four ears). RESULTS: The average hearing gain using this method was 32.2 dB, which lasted for at least 1 year. No complications were observed. CONCLUSIONS: This novel laser-assisted stapedotomy technique is an excellent method for the treatment of congenital stapes fixation.

Adolescent↗
PubMed2003

Characterization of a stapes ankylosis family with a NOG mutation.

OBJECTIVE: To characterize the otologic phenotype in a family with autosomal dominant stapes ankylosis, hyperopia, and skeletal abnormalities caused by a mutation in the noggin gene (NOG). STUDY DESIGN: Case series. SETTING: Academic tertiary care center. PATIENTS: Eight affected and 3 unaffected family members. MAIN OUTCOME MEASURES: History, physical and radiologic examination, and surgical outcomes. RESULTS: Although affected members were initially presumed to have typical nonsyndromic otosclerosis, the clinical data were most consistent with an autosomal dominant congenital stapes ankylosis syndrome. Eight of eight affected family members had bilateral low-frequency conductive hearing loss. Six of eight underwent fenestration procedures and/or stapedectomies. All members with initial postoperative closure of the air-bone gap returned to their baseline conductive loss within 2 years. Two affected family members had documented maximal conductive hearing loss by age 4, and two members without previous otologic surgery have not experienced sensorineural hearing loss. High-resolution temporal bone computed tomography showed stapes ankylosis and indistinction of the incudomalleal junction bilaterally and bony regrowth over the stapedotomy for those with stapedectomies. Detailed physical and radiologic examination identified multiple other skeletal abnormalities. CONCLUSIONS: Although this phenotype may present as classic otosclerosis to the otolaryngologist, detailed investigation revealed a congenital stapes ankylosis syndrome. Because is essential in regulating normal bone development and maturation, mutations in this gene may be associated with excessive bony overgrowth and refixation of the stapes footplate after initial successful surgery. Patients with hereditary conductive hearing loss should be assessed to rule out subtle features of a skeletal syndrome.

Ankylosis↗
PubMed2005

Fixation of the stapes footplate in children: a clinical and temporal bone histopathologic study.

OBJECTIVE: To clarify the anatomic characteristics, cause, and surgical outcomes relating to fixation of the stapes footplate in children. STUDY DESIGN: Retrospective case review and four-center histopathologic study of temporal bones. SETTING: Tertiary referral center. PATIENTS: We reviewed charts and histologic specimens from 12 children, aged 7 to 13 years, who underwent surgery for footplate fixation. We also studied stapes footplates in 288 temporal bones from 181 children ranging from newborn (20-44 weeks of gestation) to 13 years of age. MAIN OUTCOME MEASURE: Anomalies of the stapes footplate in children. RESULTS: The average age of diagnosis of hearing loss was 6.6 years. Criteria for a diagnosis of otosclerosis were progression of a conductive hearing loss and an intraoperative finding of fixation of the anterior stapediovestibular joint in five patients. In contrast, a nonhomogeneous, thickened, fixed footplate and the absence of an annular ligament were indicators of congenital fixation in six children. In one child, there was neither new bone from the otic capsule nor any obvious otosclerotic foci. In the temporal bone study, 17 of 181 (9.4%) children had anomalies of the stapes footplates, with ankylosis in 4 (2.2%). In two subjects (1.1%), there was an otosclerotic focus not in contact with the stapes footplate. CONCLUSION: Children younger than 6 years with various congenital anomalies are more likely to have congenital footplate fixation, which will present intraoperatively as a thickened footplate with a partial or absent annular ligament. Children older than 6 years with progressive conductive hearing loss are more likely to have otosclerosis, which presents as fixation of the anterior stapediovestibular joint. The difference in surgical outcomes is probably related to different degrees of footplate abnormality.

Adolescent↗
PubMed2000

Assessment of stapes mobility by use of a newly developed piezoelectric ceramic device. A preliminary experiment in dogs.

A piezoelectric device was developed for assessment of stapes mobility during middle ear surgery. The device comprises a pair of ceramic bimorph elements: one for activation of the stapes and the other to pick up the vibration as an electric output, which varies in accordance with the stapes mobility, ie, the inverse of the cochlear input impedance (Zsc). The device is compact and easily manipulated even in the narrow surgical field of the ear. However, the measuring range is restricted to between 1 and 10 kHz. Measurement of Zsc was conducted with this device in 5 ears of 5 dogs. The mean magnitude of Zsc increased with frequency in the range from 1 to 10 kHz: 0.95 megohm at 1 kHz and 8.8 megohms at 10 kHz. After fixation of the stapes with dental cement, the magnitude increased to more than 10 megohms, except at 1 kHz. The results suggest that the device is useful in detecting decreases in stapes mobility in patients with chronic otitis media.

Animals↗
PubMed2004

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↗
PubMed1995

Stapedectomy for congenital fixation of the stapes.

Because several cases of profuse cerebrospinal fluid leakage (perilymph gushers) have been reported during stapedectomy for congenitally fixed stapes in children, many otologists advise against surgical intervention. The pathophysiologic mechanism of perilymph gusher and its association with congenital fixation of the stapes is, however, poorly understood. This retrospective study was designed to examine the preoperative presentation and hearing results of children undergoing stapedectomy for congenital fixation of the stapes. Stapedectomy was performed on 10 ears for this condition. No perilymph gushers or significant sensorineural hearing loss were encountered. All but one case resulted in closure of the air-bone gap at the speech frequencies to within 20 dB, with the average air-bone gap being 11.2 dB. Minor congenital abnormalities of the stapes superstructure were seen in three cases. A review of case reports in the literature would seem to indicate that the perilymph gusher in association with surgical manipulation of the congenitally fixed stapes occurs almost exclusively in males, and that the pathophysiology involves a defect in the internal auditory canal as opposed to a patent cochlear aqueduct. A pre-existing sensorineural hearing loss may also be a risk factor for perilymph gusher.

Adolescent↗
PubMed1989

Morphology of a columellaform stapes.

A columellaform stapes found in male patient 18 years old with a conductive hearing loss, has been examined by SEM and light microscopy. The ossicle was smaller than a normal stapes. The head was linked to the base by a crural plate, probably formed by the fusion of the material of the two crura. Microscopy showed a slightly less interwoven structure of the fibrillar bone present mainly at the cranial aspect of the crural plate. Honeycomb-like bone was confined to the caudal part of the crural plate. Microscopy revealed a cavity in the centre of the stapes at the transition between the base and the plate. During surgery, a bony structure was found linking the posterior side of the head of the stapes to the pyramidal eminence. Post-operative audiograms revealed improved hearing with some residual conductive loss of about 10 dB. This case illustrates that a columellaform stapes may occur without forming part of a syndrome.

Adolescent↗
PubMed1998

[Postoperative results of stapes revision].

BACKGROUND: In this retrospective study indications, intraoperative findings, reconstruction techniques and postoperative hearing results in revision stapes surgery were evaluated. PATIENTS: Between March 1988 and January 1996, 150 patients underwent stapes revision. Indications for surgery were the presence of conductive hearing loss (132), dizziness (12), sensorineural hearing loss (3), deafness (2), and tinnitus (1). RESULTS: Intraoperative findings were lateral migration of the implant, regrowth of bone in the oval window niche, erosion of incus, cholesteatoma, and others. In most cases a new prosthesis (gold piston) was inserted between incus and vestibulum. In cases with incus erosion, a malleovestibulopexy was performed. Seventy-three percent of patients who underwent revision stapes surgery because of conductive hearing loss showed a hearing improvement of 20 dB or more. All patients who underwent revision stapes surgery because of dizziness reported an improvement of their symptoms postoperatively. CONCLUSIONS: Revision stapes surgery should be approached by experienced surgeons, because the risk of severe sensorineural hearing loss is higher than at the time of primary stapedectomy. Informed consent is mandatory.

Adolescent↗
PubMed2003

Stapes prosthesis attachment: the effect of crimping on sound transfer in otosclerosis surgery.

OBJECTIVES/HYPOTHESIS: Although in stapes surgery successful hearing improvement may be achieved in the majority of patients, unsatisfactory closure of the air-bone gap can be recorded. One of many reasons for unexpected failures of stapes surgery may be the insufficient crimping of a stapes prosthesis onto the incus. The objectives of the study were to assess the amount of sound transmission loss in response to the quality of prosthesis crimping and to identify a required loop attachment pattern to obtain good sound transmission results. STUDY DESIGN: Experimental. METHODS: A temporal bone model was developed to measure the sound transmission properties between incus and prosthesis on 17 fresh human temporal bones. The attachment of a titanium stapes piston was assessed without crimping, followed by loose crimping and tight fixation to the incus, using scanning laser Doppler interferometry, endoscopic photography, micro grinding technique, and scanning electron microscopy. An algorithm had to be developed to simulate acoustical stimulation using electromechanical stimulation. RESULTS: Optimal tight crimping of the stapes piston revealed consistent good sound transfer function ranging from 0 to 7 dB loss, and loss remained, on average, at 2 dB. The mean transmission losses for conditions of loose crimping and no crimping were surprisingly small (within 10 dB). However, these unusual crimping conditions allowed a wide range of losses up to 28 dB. A close coupling at least at two opposite points was obligatory to obtain consistently good results. CONCLUSIONS: Perfect hearing reconstruction necessitates ideal crimping of a prosthesis to obtain consistently good results. However, the final functional gain depends on many different intraoperative and postoperative factors.

Acoustic Stimulation↗
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↗
PubMed2005

Malleus-to-footplate versus malleus-to-stapes-head ossicular reconstruction prostheses: temporal bone pressure gain measurements and clinical audiological data.

HYPOTHESIS: Several clinical reports suggest that if the stapes superstructure is intact, ossicular reconstruction should be made to the stapes head rather than the footplate to achieve a better hearing outcome. To test this hypothesis, we compared the in situ mechanical performance of hydroxylapatite (HA) malleus-to-stapes-head (MSH) ossicular reconstruction prosthesis (ORP) with malleus-to-footplate (MFP) ORP, both manufactured by Project HEAR. BACKGROUND: ORPs are commonly used to replace a missing or deficient incus. However, hearing outcomes are highly variable, depending on the ORP material, design, surgical technique, and ORP positioning. METHODS: Cochleo-vestibular pressure measurements in human cadaveric temporal bones for the HA MFP ORP have been reported by Puria et al. (2005). In the present study, the ear canal pressure Pe and cochleovestibular pressure Pv were measured in cadaveric temporal bones with intact incus, removed incus, and MSH ORP reconstruction. The relative loss in gain, Lmsh, is defined as the ratio of Pv with reconstructed MSH ORP to intact incus and compared with Lmfp. A retrospective clinical audit of the pre- and postoperative audiologic results of patients who had undergone ossiculoplasty with either MSH or MFP ORP was conducted for comparison. RESULTS: For the 0.5 to 3 kHz frequency range, Lmsh magnitude is 6.2 dB lower than the Lmfp magnitude (p = 0.05). The retrospective audit of audiologic results after ossiculoplasty with either MSH or MFP ORP revealed a similar difference in gain between the two ORP designs with air-bone gap differences of 7.6 dB (p = 0.04) and air conduction threshold differences of 8.0 dB (p = 0.13) for these patients. CONCLUSION: The MFP ORP showed better average pressure gain compared with the MSH ORP across the speech frequencies. Surgeons performing ossiculoplasty with designs similar to Project HEAR HA ORPs, where there is direct columella-like connection between the malleus and stapes, should consider using the MFP ORP design to achieve a better postoperative audiologic result, even when the stapes superstructure is intact.

Aged↗
PubMed1993

Composition of the otosclerotic stapes: electron microprobe analyses.

For the first time, otosclerotic stapes have been distinguished from unafflicted controls at a high level of significance by using a spectrum of elements measured by energy-dispersive spectrometer-electron probe microanalyses (EDS/EPMA). Discriminant analyses of the maximum concentration of 13 elements measured at several sites within each of 32 stapes differentiated otosclerotic from unafflicted individuals well above the 95% confidence level. Eight of the 9 control (unafflicted) and 21 of the 23 afflicted stapes were correctly classified. In descending order of contribution to the discriminant function, the elements are Zn > Cr > K > Ca > Si > Mn > Na > Al > Mg > P > Fe > S > Ti. Zinc and chromium account for much of the difference, but discriminant analyses excluding them still distinguish the two groups at the 95% confidence level. These results are consistent with previous reports of high levels of alkaline phosphatase, a zinc-containing enzyme, in afflicted stapes. But the broad spectrum of elements capable of distinguishing otosclerotic stapes warrants study of additional zinc-containing and other metal-containing or metal-activated moieties.

Cluster Analysis↗
PubMed1996

Effects of continuous-wave laser systems on stapes footplate.

BACKGROUND AND OBJECTIVE: The aim of the present study was to clarify which of the presently available continuous-wave laser systems are best suited for application in stapes surgery. STUDY DESIGN/MATERIALS AND METHODS: Isolated human stapes and bovine compact-bone platelets were used to investigate the connections between the parameters of various laser systems and their effects on bone tissue. The purpose was to optimize the laser parameters required to achieve a perforation measuring 500 microns to 600 microns in diameter. Three different laser systems were applied: the argon and CO2 laser in continuous wave (cw) mode and the CO2 laser in superpulse mode. RESULTS: The suitability of the argon laser for stapedotomy is doubtful in view of the lower absorption coefficient of the stapes for the argon beam and the considerable influence which the degree of pigmentation of the irradiated medium exerts on its effect with the resultant poor reproducibility of the perforation diameter. The beam of the CO2 laser is far better absorbed at the footplate than that of the argon laser. This results in higher effectivity, lower thermic side effects, and better reproducibility of the perforation. The two modes of the CO2 laser do not show any appreciable differences. CONCLUSION: The experimental results presented indicate that the CO2 laser in cw and superpulse mode is the most suitable of the systems now clinically applied in stapes surgery.

Animals↗
PubMed2002

[Reconstruction of the superstructure of the stapes in guinea pigs with biovitro ceramic and silicone foil].

BACKGROUND: The reconstruction of the stapes superstructure is still a problem. Efforts for the fixation of implants on the footplate did not show satisfying results yet. METHODS: In 6 guinea pigs a biovitro ceramic (Bioverit) was placed on the stapes footplate after removal of the superstructure. The exclusive bony fixation of the implants on the footplate should be achieved by the use of silicone foils. For control purposes replantation of autologous ossicles was done in one group of 3 animals and a sham operation was performed without any use of implants in the other group of 6 guinea pigs. RESULTS: After 21 weeks not only bony fixation of the implant with the footplate was observed, but furthermore with the wall of the middle ear. Bone formation was detected along the silicone foils. In the first control group of animals we found bony fixation of the replanted ossicles and even a bow-shaped reconstruction of the stapes superstructure in the second. CONCLUSIONS: The guinea pig was not an ideal model for questions of middle ear reconstructions due to its enormous potential for bone formation. In this animal model bony fixation of glass-ceramic with the stapes-footplate could be induced.

Animals↗