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PubMed1998

Preservation of the stapedius tendon in laser stapes surgery.

OBJECTIVES/HYPOTHESIS: The stapedius tendon is routinely transected during stapes surgery. The objective of this study was to evaluate the technique of stapedial tendon preservation during stapes surgery and to compare results of these cases with cases where the stapedial tendon was not preserved. STUDY DESIGN: Retrospective study. METHODS: Four groups of patients were evaluated. Two groups had undergone stapes surgery with preservation of the stapedial tendon. One of these groups underwent a laser stapedotomy minus prosthesis (laser STAMP) procedure, while the other group had a prosthesis inserted. The other two groups had undergone laser stapedotomy with one of two different prostheses being used. Audiometric data were obtained and reviewed both preoperatively and at approximately 6 weeks postoperatively. RESULTS: All groups had overall successful results demonstrating that stapedial tendon preservation is technically possible and does not compromise outcomes. CONCLUSIONS: Based on the results, it is recommended that the stapedius tendon be preserved whenever possible during laser stapes surgery. Reasons justifying its preservation are discussed.

Adult↗
PubMed2004

Delayed vertigo after stapes surgery.

OBJECTIVES: Stapes surgery restores partial or total hearing in almost 95% of cases, and in case of failure, revision surgery may often resolve the problem. Delayed vertigo is commonly related to perilymphatic fistula. The aim of this study is to report experience gained in revision stapes surgery in cases of delayed vertigo. STUDY DESIGN: This is an intervention study, before-after trial; it includes follow-up between 12 and 84 months that was based on clinical history and audiometric evaluations. METHODS: The work was carried out in the otologic surgery referral center of Piemonte in outpatient surgery. Nine patients (4 males and 5 females, between 43 and 60 years of age) who presented with delayed vertigo after stapes surgery were retrospectively reviewed. All nine underwent clinical history evaluation, pure tone audiogram, investigation of the vestibular system with a bithermal binaural caloric test, and fistula test. Vestibular tests were performed with electronystagmography recording. In all nine subjects, functional middle ear exploration was carried out by way of a transmeatal approach using local anesthesia. The demonstration of a perilymphatic leak was positive in only three (33%) cases, but the oval window region was filled with fibrin glue in all nine cases. RESULTS: At follow-up, vertigo was resolved in all cases with revision surgery, even though perilymph leak was positive only in three cases. CONCLUSION: From the results obtained, we feel that exploration of the middle ear should be always carried out in cases of delayed vertigo after stapes surgery with suspected perilymphatic fistula.

Adult↗
PubMed2002

Stapes surgery: how precisely do different prostheses attach to the long process of the incus with different instruments and different surgeons?

HYPOTHESIS: The goal of this study was to compare the attachment of stapes prostheses with differently shaped loops to the long process of the incus. BACKGROUND: In stapes surgery, the attachment of the prosthesis to the long process of the incus plays an important role concerning the gain in hearing and the development of late complications such as incus erosion and necrosis. Band-shaped and spiral loops have been developed to achieve a broad, firm attachment to the long process of the incus. During stapes surgery, the view at the prosthesis is restricted, making it impossible to evaluate the effects of the differently shaped loops. METHODS: Gold, steel/Teflon, platinum/Teflon, and two different titanium stapes prostheses were inserted in 30 specially prepared temporal bones by three experienced surgeons using the Fisch technique with the McGee and straight alligator forceps for the crimping of the loops. Photographs were taken with 0- and 70-degree rod lens telescopes at defined views. RESULTS: In all prostheses, a sufficiently firm attachment to the long process of the incus was achieved. The attachment of band-shaped loops proved to be better with the straight alligator forceps. The band-shaped loops showed a better contact with the incus than did the wire loops. However, the broad spiral-shaped loops led to a loss of the perpendicular axis of the piston to the long incus process. CONCLUSION: The geometry of the loop affects the final length of the piston in the vestibule and its angle to the long process of the incus.

Equipment Design↗
PubMed2002

Stapedotomy for tympanosclerotic stapes fixation: is it safe and efficient? A review of 68 cases.

OBJECTIVE: Performing stapedotomy in cases of tympanosclerotic stapes fixation is controversial. The procedure is traditionally considered to carry a high risk of postoperative sensorineural hearing loss. The aim of this study was to report the hearing results in surgically treated cases of stapes fixation. STUDY DESIGN: A retrospective review of tympanosclerosis of the oval window with stapes fixation. SETTING: The study was performed at the Jean Causse Ear Clinic in Clombiers, France. PATIENTS: Sixty-five patients who underwent surgery for tympanosclerotic stapes fixation between January 1992 and October 1999. INTERVENTION: Stapedotomy with vein graft interposition and reconstruction with a Teflon piston, or a total prosthesis in cases of incudal erosion. MAIN OUTCOME MEASURES: Preoperative and postoperative audiometric evaluation using conventional audiometry. Air-bone gap, bone conduction threshold, air conduction threshold, and Glasgow Benefit Plot were measured. RESULTS: Postoperative air-bone gap closure to within 10 dB was achieved in 39% of cases. An air-bone gap less than 20 dB was obtained in 70% of cases. Significant postoperative improvement of air conduction thresholds, more than 20 dB, was found in 46% of cases. The postoperative bone conduction thresholds were unchanged in 92% of cases. No significant sensorineural hearing loss was seen in this series. CONCLUSION: This series demonstrates that safe and successful stapedotomy is possible if certain rules are respected.

Adolescent↗
PubMed2005

Safety of magnetic resonance imaging of stapes prostheses.

OBJECTIVE: Assess the safety of performing magnetic resonance imaging (MRI) on patients with stapes prostheses. STUDY DESIGN: Survey and animal model. METHODS: A survey regarding implant usage, MRI procedures, and adverse outcomes after MRI in patients previously undergoing stapes procedures. Guinea pigs implanted with ferromagnetic 17 to 4 stainless steel, 316L nonferromagnetic stainless steel, titanium, and fluoroplastic stapes prostheses underwent a MRI in a 4.7 Tesla MR system. RESULTS: : Three adverse outcomes were reported on the clinical survey. One adverse event occurred during an MRI performed on a recalled ferromagnetic prosthesis. The other two adverse events were probably not secondary to MRI exposure. No damage or inflammation was observed in the region of the oval window or vestibule of implanted guinea pigs exposed to a 4.7 Tesla MR system. CONCLUSIONS: The combination of prior studies, the clinical survey, and the absence of histopathologic evidence of damage in the guinea pigs is compelling evidence that MRI for patients with stapes prostheses is safe. Implanting physicians should feel comfortable clearing a patient for a MRI in a 1.5 Tesla or 3.0 Tesla MRI. It is imperative for the physician to qualify the field strength when clearing a patient to undergo a MRI.

Alloys↗
PubMed2006

Detection of osteoprotegerin and TNF-alpha mRNA in ankylotic Stapes footplates in connection with measles virus positivity.

HYPOTHESIS: Otosclerosis is a bone remodeling disorder of the otic capsule causing conductive and sensorineural hearing loss. Persistent measles virus infection of the temporal bone with increased tumor necrosis factor (TNF)-alpha and decreased osteoprotegerin mRNA expression is supposed to be the main etiologic factor in otosclerosis. BACKGROUND: Determinants of measles virus infection and reactive inflammation were studied in otosclerosis. The presence of measles virus was shown in otosclerotic patients by reverse transcriptase-polymerase chain reaction (RT-PCR) amplification of the viral RNA. No report is available, however, about the role and interactions of bone-specific cytokines in otosclerosis. METHODS: : Nucleic acid was extracted from stapes footplates of clinically otosclerotic patients. Measles virus nucleoprotein RNA was amplified by seminested RT-PCR. TNF-alpha and osteoprotegerin mRNA coexpression was detected by RT-PCR in otosclerotic bone and was correlated to measles virus positivity. RESULTS: Among 154 clinically stapes fixation otosclerotic patients, 99 stapedes contained measles virus RNA. TNF-alpha mRNA was detectable in 88 virus-positive and in 6 virus-negative stapes footplates. Osteoprotegerin mRNA expression was significantly lower in the TNF-alpha-positive specimens (P < .0001) that was independent from virus positivity. CONCLUSION: Detection of TNF-alpha mRNA demonstrates activated osteoclast functions and inflammatory pathways in otosclerotic stapes footplates associated with measles virus presence. Increased expression of TNF-alpha and its action on RANK production inhibits the protective functions of osteoprotegerin on normal bone turnover in the otic capsule.

Adult↗
PubMed1995

A 3-D finite element analysis of the natural frequencies of vibration of a stapes prosthesis replacement reconstruction of the middle ear.

In this work, the natural frequencies of vibration of two different stapes prosthesis replacement reconstructions have been analysed using the finite element method. Prosthesis 1 was constructed of fine stainless steel wire and a Teflon base, while prosthesis 2 was made entirely of Teflon. The results have indicated that generally, the first natural frequency of vibration falls as the prostheses become larger and more bulky. However, the fall in the first natural for prosthesis 1 was modest when compared with that of the isolated tympanic membrane. An important variable influencing frequencies and mode of vibration of the reconstruction was the tightness of fit of the prostheses within the remaining ossicular chain. The tightness of fit in this work was modelled as a range of spring constants applied at the stapes pseudo footplate, together with a series of joint elements at the incus tip/prosthesis head for the Teflon implant. When these spring constraints were below approximately 10 N/mm, the reconstruction exhibited normal mode 1 vibration behaviour, but at larger spring values, an abnormal mode 1 became established resembling the normal mode 2 vibration characteristics. The formation of new geometries and surfaces following reconstruction, introduces new constraints between umbo and stapes footplate particularly at the natural/artificial interfaces. These unnatural constraints may inhibit and modify the natural movements normally occurring at the stapes footplate leading to abnormal modes of vibration.

Ear Ossicles↗
PubMed2005

A prospective evaluation of the Essen titanium stapes prosthesis.

OBJECTIVES: This is the first clinical trial to evaluate the suitability of a new titanium stapes prosthesis, which we developed jointly with the Kurz Company (Dusslingen). DESIGN: In a prospective clinical study, patients with otosclerosis underwent stapes surgery using our new titanium stapes prosthesis during a period of 14 months. One year after surgery pre- and postoperative audiograms were performed and all patients participated in a structured interview. SETTING: Tertiary otorhinolaryngological university department PARTICIPANTS: Of 49 patients with otosclerosis, entering the study, two patients were excluded, because they were not located any more. MAIN OUTCOME MEASURES AND RESULTS: All patients experienced a hearing improvement of 21 dB on average except one patient. Sixty percentage of patients achieved a reduction of the air-bone gap to less than 10 dB and 31% of patients having their air-bone gap closed to within 20 dB--averaged across 0.5, 1.0, 2.0 and 4 kHz. The hearing level improved significantly in the air and in the bone conduction thresholds. CONCLUSIONS: This paper presents our first '1 year postimplantation' results of our titanium stapes prosthesis. We consider the development of this implant to be beneficial. The results confirm significant improvement in hearing status and tinnitus levels.

Adult↗
PubMed2005

Development of the stapes and associated structures in human embryos.

The objective of this study was to clarify the development of the stapes in humans and its relationship with the cartilage of the second branchial arch. The study was carried out in 25 human embryos between 6 and 28 mm crown-rump length. The stapes develops at the cranial end of the second branchial arch through an independent anlage of the cartilage of this arch. Between the stapedial anlage and the cranial end of the Reichert's cartilage there is a formation called the interhyale, the internal segment of which gives rise to the tendon of the stapedial muscle. The stapedial anlage is a unique formation with two distinct parts: the superior part that will comprise the base and the inferior part that will be crossed by the stapedial artery during embryonic development and will constitute the limbs and the head of the stapes. According to the results, the otic capsule is not involved in formation of the base of the stapes.

Arteries↗
PubMed2001

Effects of draining cochlear fluids on stapes displacement in human middle-ear models.

Displacement-frequency characteristics of the stapes footplate were measured in five human temporal bones before and after draining the vestibule. Measurements were made in the 0.125-8 kHz range at 80 dB input sound pressure level, using a laser Doppler vibrometer. A circuit model was also used to predict stapes displacement. The temporal bone studies show a slight decrease in stapes footplate displacement at low frequency, and little change above 1 kHz. The displacement change is not as great as that found by other investigators or predicted by the model. There is little difference in stapes motion in temporal bones when the inner ear is intact or drained.

Cochlea↗
PubMed2001

Intraoperative assessment of stapes movement.

A method is described that allows, for the first time, intraoperative vibration modes assessment of the acoustically stimulated stapes by means of scanning laser Doppler interferometry (LDI). The study was designed to answer the following questions: 1) Is LDI practical for taking measurements during surgery? 2) Are the results comparable to the findings in temporal bone preparations? and 3) Do the vibration characteristics of the stapes change after the posterior incudal ligament is detached from the incus? Seven patients with profound bilateral hearing loss who were undergoing cochlear implantation were included in the study. The measurement system was easily applicable for intraoperative measurements and allowed contact-free analysis with very high accuracy. No major differences in the results from the live human subjects and temporal bone preparations were observed. The stapes movement was predominantly pistonlike at the lower frequencies and became complex at higher frequencies. Sacrificing the posterior incudal ligament had no statistically significant effect on stapes vibration.

Acoustic Stimulation↗
PubMedDate not supplied

A scanning electron microscopic study of the normal human stapes.

The structure of the normal human stapes was studied with the scanning electron microscope. Specimens were obtained 48 hours after death from adult human temporal bones free from obvious inflammatory disease. The specimens were fixed, dissected, critical-point dried and coated with gold. In this scanning electron microscopic study an attempt has been made to systematically demonstrate the average scanning electron microscopic features of various areas of the normal human stapes. An emphasis has been placed upon demonstrating as clearly as possible the details previously unclear or unrecognized and duplication of many excellent earlier light and electron microscopic studies has been attempted. The typical appearance of the stapes head, neck, arch, crura and footplate has been presented. It is apparent that there exists a high degree of structural specialization particularly in the stapes arch and footplate area.

Ear Ossicles↗
PubMed2004

[CO2 laser assisted stapedotomy with artificial stapes prosthese].

OBJECTIVE: To apply CO2 laser assisted Ugo Fisch stapedotomy with artificial stapes prostheses and to observe its outcome. METHOD: Between October 2001 and June 2003, 24 patients with clinical diagnosis of otosclerosis were performed with CO2 laser assisted Ugo Fisch stapedotomy. Among them 14 were males and 10 were females with a age of 24-65 years (averaged 36.5 years). The preoperative air bone gap of speech frequency is 25.00 to 48.25 dB, with an average of 36.25 dB. Follow-up was done once two months until 6 months. The key techniques are: (1) first disarculate the incudostapedial joint; (2) 0.3 mm or 0.4 mm piston is selected according to the space between horizontal segment of facial nerve and the suprastructure of stapes; (3) fenestrate on the footplate, insert the piston before dealing with stapedial muscle tendon and suprastructure of stapes; (4) deal with stapedial muscle tendon and suprastructure of stapes with CO2 laser. RESULT: A postoperative air bone gap < or = 15 dB is achieved in 23 cases (95.8%), a postoperative air bone gap < or = 10 dB is achieved in 21 cases (87.5%), with a mean of 8.5 dB. The postoperative complication is slight, without sickness and vomit, and 22 patients could walk immediately after surgery. CONCLUSION: CO2 laser assisted stapedotomy is the first choice for treating otosclerosis, which is of significant outcome, high safety and slight postoperative complication.

Adult↗
PubMed2005

[Long-term effect of stapes surgery on tympanosclerosis].

OBJECTIVE: To study the long-term effect of stapes surgery on tympanosclerosis and its influence factors. METHODS: The effect of stapes surgery on tympanosclerosis was retrospectively summed up in 119 patients (149 ears) in General Hospital of people's Liberation Army from April 1984 to March 2002. The Stata 7.0 software was used as a statistical tool. RESULTS: The average of hearing threshold (hearing level) of air conduction was (50.7 +/- 12.1) dB before operation, and the hearing loss was mostly on low frequency. Following-up the half-year post-operation, the average of hearing threshold of air conduction was (25.6 +/- 15.2) dB. The total successful rate of post-operation half year, 1 year, 2 and 5 years were 50.3%, 45.8%, 41.3% and 34.5%, respectively. Comparing the different operation methods, stapedotomy (piston technique) owned the best effect on hearing recovery (62.5%), then was stapedectomy (43.1%), but the last one was stapediolysis (30.8%). There was significant difference effect among three different operation methods (P < 0.05). The average of hearing threshold of air conduction was steadily within the first five-years following-up (Ridit analysis, P > 0.05), but obviously increased more than 5 years after operation (Ridit analysis, P < 0.05). The influence factors to successful rate were the following-up time post-operation, pathological changes of stapes, operative methods, and complications during operation, respectively. CONCLUSION: Stapes surgery is the effective method to treat tympanosclerosis, but the long-term effect is not good enough as expectation. It is important to select proper operation methods for better hearing results.

Adolescent↗
PubMed1995

Experimental results concerning the reconstruction of the stapes superstructure with bioactive ceramics.

We examined the feasibility of rebuilding a stable stapes superstructure in the middle ear for a new articulated ossicular chain by using bioactive ceramic and glass ceramic in guinea pigs. The ceramic implants were placed on the stapes footplate without touching the tympanic membrane, thus protecting it against relative movements. The implants were removed together with the stapes footplate after six weeks, three and six months respectively. After six weeks, histological evidence of bony connections between all ceramic implants and the remnants of the crurae were found, being more pronounced after three and six months. We propose a new implant for the reconstruction of the stapes superstructure.

Animals↗
PubMed1992

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↗
PubMed2005

Ossiculoplasty with intact stapes and absent malleus: the silastic banding technique.

OBJECTIVE: To report an original method of ossicular reconstruction with intact stapes and absent malleus. Ossiculoplasty is performed with a total ossicular replacement prosthesis positioned from the stapes footplate to the under-surface of the tympanic membrane, using a Silastic banding technique to stabilize the prosthesis. STUDY DESIGN: A prospective study of ossicular reconstruction using the Silastic banding technique. A consecutive series of cases with intact stapes superstructure and missing malleus handle (Austin-Kartush Group C) is presented. SETTING: One tertiary referral center. PATIENTS: Ninety-nine patients who underwent total ossicular reconstruction with Silastic banding technique were enrolled in the study from January 2000 to December 2002. INTERVENTIONS: Ossiculoplasty with total ossicular replacement prostheses with Silastic Rubber Band for chronic otitis media and non-inflammatory disease. MAIN OUTCOME MEASURES: Preoperative and postoperative audiometric evaluation using conventional audiometry. Air-bone gap, bone-conduction threshold, and air-conduction threshold were assessed. Postoperative audiometry was performed at the 6th, 9th, 12th, 18th, 24th, and 36th months. RESULTS: Overall, a postoperative air-bone gap closed to within 10 dB was achieved in 61.5% of cases. An air-bone gap smaller than 20 dB was obtained in 77% of cases. Postoperative improvement of air-conduction thresholds by at least 20 dB was found in 51% of cases. There was no case of postoperative sensorineural hearing loss. One case of extrusion of the prosthesis was seen (1%). CONCLUSION: Stabilizing the total ossicular replacement prosthesis with the Silastic banding technique when performing ossicular reconstruction is a safe, effective method when the stapes supra-structure is present and the malleus absent.

Adolescent↗
PubMed1999

Estimation of the stapes-bone thickness in the stapedotomy surgical procedure using a machine-learning technique.

Stapedotomy is a surgical procedure aimed at the treatment of hearing impairment due to otosclerosis. The treatment consists of drilling a hole through the stapes bone in the inner ear in order to insert a prosthesis. Safety precautions require knowledge of the nonmeasurable stapes thickness. The technical goal herein has been the design of high-level controls for an intelligent mechatronics drilling tool in order to enable the estimation of stapes thickness from measurable drilling data. The goal has been met by learning a map between drilling features, hence no model of the physical system has been necessary. Learning has been achieved as explained in this paper by a scheme, namely the d-sigma Fuzzy Lattice Neurocomputing (d sigma-FLN) scheme for classification, within the framework of fuzzy lattices. The successful application of the d sigma-FLN scheme is demonstrated in estimating the thickness of a stapes bone "on-line" using drilling data obtained experimentally in the laboratory.

Deafness↗