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At least 73 records · Page 4Linked to original sources
PubMed1991

Use of the excimer laser in stapes surgery and ossiculoplasty of middle ear ossicles: preliminary report of an experimental approach.

Surgery of the stapes may cause a number of complications, including hearing deficits and balance disorders. This has made it necessary to look for improved techniques. Small-fenestra stapedotomy has recently been popularized. Lasers have been advocated for use in fenestrating the stapes footplate. On the other hand, sculpting the middle ear ossicles during tympanoplasty is often necessary for the reconstruction of the ossicular chain and the improvement of sound conduction. Using an excimer laser with a wavelength of 193 nm, fenestrations of the footplate and ossicular sculpting were performed on ossicles obtained during ear surgery and from human cadaver temporal bones. The results indicate that the excimer laser can be used effectively and accurately on an experimental basis and that further research is needed before this method can be used for clinical purposes.

Cerebrospinal Fluid↗
PubMed1992

Long-term results of revision stapes surgery.

Results of 45 re-operations for persistent or recurrent conductive deafness after primary stapes surgery were studied. The mean follow-up period after the revision surgery was 7.6 years. Long-term hearing results were found to be disappointing, air-bone gap to within 10 dB was achieved in only 46 per cent of the patients. Mean hearing levels improved by 11 dB or more in 73 per cent. Outcome of surgery was dependent on the surgical pathology, the best hearing results were obtained in cases with re-fixation after stapes mobilization operation. Sensorineural hearing loss as a result of surgical trauma to the inner ear occurred in revision surgery more frequently than in primary operations, cases with regrowth of otosclerotic bone to the oval window after stapedectomy having the greatest risk of labyrinthine trauma.

Adult↗
PubMed1999

[Variations and incidents encountered during stapes surgery for otosclerosis].

The aim of this study was to report peroperative variations and incidents encountered during stapes surgery for otosclerosis, from a retrospective series of 293 primary stapedectomies performed in the ENT department of Fondation Adolphe de Rothschild, from january 1990 to december 1996. Pitfalls related to anomalous states or pathological conditions were observed in 81 cases (27.6%) and were classified as follow: narrow oval window niche (12.3%), floating footplate (5.8%), obliterative otosclerosis (4.7%), ossicular chain problems (3.4%), loss of perilymph and/or intravestibular bleeding (2.4%), fixed malleus (1%). Hearing results following surgery are presented. Because of the relatively high incidence of these unforeseen events, the otologic surgeon must be well trained and experienced to be able to use all reasonable stapedectomy or stapedotomy techniques.

Ear↗
PubMed1996

Repair of the ossicular chain with an ionomer cement by an inadequate incus after prior stapes surgery for otosclerosis.

Use of an ionomer bone cement is described for repairing the ossicular middle ear system in revision stapes surgery. The cement was used to enlarge an eroded inadequate incus to allow placement of a new stapes prosthesis. Reconstruction of the incus with this new bone cement was readily performed and hearing results after 2 years of follow-up have been promising.

Adult↗
PubMed2003

Transmission of heat to the vestibule during revision stapes surgery using a KTP laser: an in vitro study.

The transmission of heat to the vestibule during revision stapes surgery with a piston in situ has been studied using a KTP laser in an in vitro model. A type K thermocouple was placed around the medial of each piston tested in a 'vestibule' filled with saline. The effect of laser hits on fluoroplastic, fluoroplastic-wire and stainless steel stapes prostheses was investigated. The effect of adding blood to the operative field, of introducing a vein graft to seal the stapedotomy and of vaporizing soft tissue in the oval window were also examined. Greater temperature rises occurred with stainless steel than with the other piston types and smaller rises occurred when there was a vein graft in situ. The maximum temperature rise recorded was 2.6 degrees C. We conclude that the use of the KTP laser to clear soft tissue from the oval window is safe when operated at the power levels recommended by the manufacturer.

Hot Temperature↗
PubMed2003

Long-term hearing results after stapes surgery: a 20-year follow-up.

OBJECTIVE: The aim of this study was to evaluate the results of stapes surgery after 20 years of follow-up and to compare the results between large fenestra versus small fenestra stapedotomy. STUDY DESIGN: Retrospective clinical study. SETTING: Tertiary referral center (university hospital). PATIENTS: One hundred forty-two patients with otosclerosis treated by surgery. INTERVENTION: Eighty patients had a total stapedectomy with House-wire prosthesis and 62 patients a stapedotomy with Teflon-piston prosthesis. MAIN OUTCOME MEASURES: Preoperative, postoperative, and long-term hearing thresholds were compared. Patients filled in a questionnaire about the impact of surgery on the quality of life and postoperative symptoms. RESULTS: The long-term pure tone average improvement did not differ significantly between the techniques compared with the preoperative values. The air-bone gap tended to enlarge as a function of time. The change in the pure tone average was 0.9 dB per year for both techniques. In the questionnaire, some patients reported vertigo, tinnitus, loud noise intolerance, and taste disturbances. Loud noise intolerance seemed to persist in the long term. Surgery had no effect on preoperative tinnitus. CONCLUSIONS: There were no statistically significant differences between the techniques regarding hearing results. Over the long term, both techniques are safe and effective in restoring hearing and improving quality of life.

Adult↗
PubMed2002

A study of the intra-operative effect of the Argon and KTP laser in stapes surgery.

The intraoperative effect of the Argon and KTP laser was studied on 20 patients who had primary stapes surgery under local anaesthetic; 10 had Argon and 10 had KTP laser stapedotomy. Symptoms of inner ear disturbance such as dizziness and tinnitus were systematically recorded during the laser procedure. Both dizziness and tinnitus were relatively uncommon when the laser was used on the promontory. When the laser was used to transect the posterior crus, all the patients reported transient dizziness, probably from the thermal effect through the posterior crus into the inner ear. However, tinnitus was unusual during this stage. When the laser was used to fenestrate the footplate, only 30% of patients reported a transient dizziness as less laser energy was used. On the other hand, 55% of the patients experienced tinnitus during this stage, which indicates an acoustic effect on the inner ear. There is no difference between the Argon and KTP laser.

Anesthesia, Local↗
PubMed1993

Stapes surgery: subjective and objective results revisited.

In 1980 we presented a retrospective review of one surgeon's experience with stapes surgery. The results were disappointing both from the standpoint of hearing results and patient satisfaction. Because of those findings we modified both indications for surgery and our surgical technique. A second subjective and objective review was carried out between 1980 and 1992. We are pleased to report that both the subjective and objective findings are markedly improved, but there is still room for further improvement and our surgical technique will again be modified.

Audiometry, Pure-Tone↗
PubMed2006

Role of stapes surgery in improving hearing loss caused by otosclerosis.

The aim of our study was to evaluate the functional results of stapes surgery and to compare the effectiveness of small fenestra stapedotomy with that of total stapedectomy in improving hearing in patients affected by otosclerosis. Three hundred and fifty-seven consecutive ears, in 265 patients affected by otosclerosis, underwent surgery. All cases underwent either primary small fenestra stapedotomy (group A, 196/357, 54.91 per cent) or stapedectomy (group B, 161/357, 45.09 per cent). After surgery, 256/357 (71.71 per cent) cases showed a 0-20 dB gap. There were no significant differences in hearing results between the two groups at either early or late post-operative assessment. The mean post-operative pure tone average and air-bone gap results were slightly greater for group B than for group A, at both early and late post-operative assessments, but these differences were not statistically significant. Therefore, in group A, the mean pure tone average at 4 kHz significantly improved, from 56.60 to 47.66 dB at early post-operative assessment and to 52.98 dB at late post-operative assessment. Our study suggests that the technique of microtomy of the oval window is able to improve hearing results especially at high frequencies.

Adult↗
PubMedDate not supplied

Trends and profiles in stapes surgery.

Stapedectomy has become recognized as the procedure of choice in the surgical treatment of clinical otosclerosis. Based on results obtained in stapes surgery performed in 1977, profiles were established for hearing improvement, vertigo, tinnitus, chorda tympani injury and temporary threshold shift of high tones. Tympanometric and stapedial muscle reflex tests in cases of proved clinical otosclerosis also are discussed. The profiles indicate that stapedectomy performed on a regular basis and under ideal conditions is highly successful for the improvement of hearing. The incidence and probable causes of complications are presented and discussed. This study reveals, however, that the number of new patients with otosclerosis has decreased steadily since its peak in 1964. Should the number of surgical cases continue to diminish, it may be impossible for the practicing otologist to maintain sufficient expertise for the performance of an occasional stapedectomy. Also, it may become impossible to provide sufficient experience in otosclerosis surgery for all trainees in otolaryngology.

Acoustic Impedance Tests↗
PubMed1988

The gene for X-linked progressive mixed deafness with perilymphatic gusher during stapes surgery (DFN3) is linked to PGK.

A linkage analysis has been performed in a large Dutch kindred with progressive mixed deafness with perilymphatic gusher during stapes surgery (DFN3) using a panel of X-chromosomal RFLPs. Tight linkage (zmax = 3.07 at 0 = theta = 0.00) was demonstrated with the locus for phosphoglycerate kinase (PGK), which is located at Xq13. Tight linkage was excluded for DXS9 (probe RC8) and DXS41 (probe 99.6) on Xp and for blood clotting factor 9 (FIX) on distal Xq. Deafness is one of the predominant clinical features in males with deletions of the Xq21 band. Our results suggest that this association may be due to involvement of the DFN3 gene.

DNA Probes↗
PubMed1980

An evaluation of revision stapes surgery.

The expected success rate in primary stapedectomy is well documented in recent literature, but few reports have commented on the difficulties or the expected results in revision stapes surgery. Reports have dealt with different techniques, but the surgeon and the patients should be aware of the problems and risks involved in revision stapedectomy. The records of 35 patients who had undergone revision stapedectomy were analyzed to determine the following: 1. cause of failure, 2. how to avoid these difficulties, 3. hearing results, and 4. possible identifying factors which might pinpoint those patients with a high risk for sensorineural hearing loss. A review of these cases demonstrates that the results of revision stapedectomy are different than those for primary stapedectomy.

Hearing Loss, Sensorineural↗
PubMed2007

WITHDRAWN: Management of Congenital Incudostapedial Anomalies in Stapes Surgery.

OBJECTIVES:: The management of developmental anomalies of the ossicular chain and otic capsule in stapes surgery tests the otologist's diagnostic skills and flexibility in technique and prosthesis choice. Although congenital malleus fixation and perilymph gusher are important clinical entities that have received considerable attention in the otolaryngology literature, congenital anomalies of the incus and stapes are less well described, can often be subtle, and have a distinct influence on management choice and hearing outcome. STUDY DESIGN AND PATIENTS:: A review of more than 200 stapes procedures yielded eight cases of identified congenital anomalies of the stapes or incudostapedial complex including congenital absence of the oval window with malformed incus and stapes, columellar-type stapes with promontory fixation, stapes superstructure fixation to the fallopian canal, and malformed incus with stapes superstructure fixation to the promontory. The developmental anatomy and surgical technique in each case are reviewed and hearing outcome is presented. RESULTS:: The surgical technique used in each case varied depending on the nuances of the ossicular anomaly and whether both the stapes and incus were affected. All eight ears (seven patients) that underwent a stapes procedure for either an isolated congenital stapes anomaly or a combined incudostapedial anomaly had a favorable hearing outcome with seven ears improving to within 10-dB and one ear to within 13-dB air-bone gap on postoperative audiometry. CONCLUSION:: Despite unanticipated findings of congenital anomalies of the stapes and incus during middle ear exploration for conductive hearing loss, a flexible management approach can lead to successful hearing outcomes.

Journal Article↗