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PubMed1999

[Stapedectomy versus stapedotomy. Our experience].

Otosclerosis surgery has seen three well-differentiated stages of development: a) SHC fenestration; b) stapes mobilization, and c) platinectomy, a procedure introduced in 1960 by Shea. Since then, only one variation has been proposed: platinotomy. After a comparative study of platinectomy versus platinotomy, we, like other authors, concluded that platinotomy was a better technique because of the ease of execution and good functional results.

Adolescent↗
PubMed2001

Current use of implants in middle ear surgery.

OBJECTIVE: The authors report the results of a survey of members of the American Otological Society (AOS) and the American Neurotology Society (ANS) regarding their use of prostheses currently available for ossiculoplasty and stapedectomy. These findings are compared with a similar study presented by one of the authors in 1989. METHODS: Questionnaires were sent to the entire membership of the AOS and ANS with questions regarding biomaterial and prosthesis usage for stapes and chronic ear surgery, as well as satisfaction with each type of prosthesis used. Of the 575 questionnaires mailed, 274 (47%) were returned. Only 248 of the respondents performed middle ear surgery (43%), and their responses constitute the database for this study. RESULTS: For those respondents performing stapes surgery in both 1989 and 1999, the mean number of cases per year has increased from 32 to 37 (p < or = 0.004). The mean number of chronic ear cases has also increased from 95 in 1989 to 110 in 1999 (p < or = 0.001). As a biomaterial, hydroxyapatite prostheses are used by most surgeons (82%), followed by autograft and homograft bone (72%), autograft and homograft cartilage (62%), and Plastipore (59%). (Although 62% of respondents use cartilage, only 4.4% ranked it first in preference.) In 1989, bone was used most (93%), followed by cartilage (78%) and Plastipore (81%). Hydroxyapatite, which had just been introduced as a biomaterial, was used by only 9% of respondents. For stapes prostheses in 1999, the majority of respondents used stainless steel/platinum (71%), bucket handle (69%), or partial fluoroplastic (56%) prostheses. There was a high overall satisfaction rate in the use of most of these prostheses (> 85%), with several exceptions. The lowest satisfaction rate was 71% for Plastipore partial ossicular replacement prosthesis and total ossicular replacement prosthesis. Usage and satisfaction rates are presented for specific types of implants and compared with the earlier survey findings. CONCLUSION: The current use of implants in middle ear surgery demonstrates a specific pattern with a high degree of user satisfaction. The preference for implants by respondents has remained stable over the past 10 years; there has been a decrease in the percentage of use of bone, cartilage, and Plastipore with a corresponding increase in the use of hydroxyapatite.

Biocompatible Materials↗
PubMed1998

Toynbee Memorial Lecture 1997. Middle ear mechanics in normal, diseased and reconstructed ears.

A review of the structure-function relationships in normal, diseased and reconstructed middle ears is presented. Variables used to describe the system are sound pressure, volume velocity and acoustic impedance. We discuss the following: (1) Sound can be transmitted from the ear canal to the cochlea via two mechanisms: the tympanoossicular system (ossicular coupling) and direct acoustic stimulation of the oval and round windows (acoustic coupling). In the normal ear, middle-ear pressure gain, which is the result of ossicular coupling, is frequency-dependent and smaller than generally believed. Acoustic coupling is negligibly small in normal ears, but can play a significant role in some diseased and reconstructed ears. (2) The severity of conductive hearing loss due to middle-ear disease or after tympanoplasty surgery can be predicted by the degree to which ossicular coupling, acoustic coupling, and stapes-cochlear input impedance are compromised. Such analyses are used to explain the air-bone gaps associated with lesions such as ossicular interruption, ossicular fixation and tympanic membrane perforation. (3) With type IV and V tympanoplasty, hearing is determined solely by acoustic coupling. A quantitative analysis of structure-function relationships can both explain the wide range of observed post-operative hearing results and suggest surgical guidelines in order to optimize the post-operative results. (4) In tympanoplasty types I, II and III, the hearing result depends on the efficacy of the reconstructed tympanic membrane, the efficacy of the reconstructed ossicular chain and adequacy of middle-ear aeration. Currently, our knowledge of the mechanics of these three factors is incomplete. The mechanics of mastoidectomy and stapedectomy are also discussed.

Biomechanical Phenomena↗
PubMed2001

Stapes mobilization in otosclerosis.

We performed a retrospective chart study (including surgeon's notes and audiometric results) and an analysis of the archival temporal bones from a patient who had undergone surgery for stapes mobilization in both ears. The stapes footplate was submerged into the vestibule on the right (as a complication of surgery) and absent on the left. One interesting finding was that the patient's hearing had improved on the right despite the presence of the depressed footplate and that the air-bone gap had widened on the left despite the absence of complications on that side.

Aged↗