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PubMed1994

[Evaluation of bone conduction after chronic ear surgery and after stapedectomy].

The bone conduction threshold changes of 295 ears which underwent chronic ear surgery (177 ears) or stapedectomy (118 ears) were determined by comparing last preoperative with 4 to 6 weeks postoperative audiogram. Three types of middle ear operations were evaluated: radical mastoidectomy, modified radical mastoidectomy and intact wall mastoidectomy with tympanoplasty (first stage). A total stapedectomy was performed with adipose seal and tarflen prosthesis. The preoperative mean bone conduction thresholds of radical mastoidectomy at 2000-4000 Hz frequency range was significantly worse when compared to radical modified mastoidectomy and to mastoidectomy with tympanoplasty (first stage). A significant deterioration of mean bone conduction thresholds at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz was observed after open techniques and at 2000 Hz and 4000 Hz after intact wall mastoidectomy with tympanoplasty (first stage). After stapedectomy a positive change (improvement of mean bone conduction) was noted at 1000 Hz and 2000 Hz. It seems that observed changes in the bone conduction thresholds may be due to damaging risk of surgical procedure (chronic ear surgery and stapedectomy) and influence of ossicular chain mobilisation on bone conduction transmission (stapedectomy).

Acoustic Stimulation↗
PubMed1996

Effect of transdermal hyoscine on nausea and vomiting during and after middle ear surgery under local anaesthesia.

The efficacy of transdermal hyoscine in the reduction of nausea, retching and vomiting was compared with placebo during and after stapedo- and tympanoplasty under local anaesthesia in a double-blind, prospective and randomized study. In the placebo group (n = 29), 69% of the patients were free from emetic symptoms during and 41% after the operation. The corresponding figures were 93% (P < 0.05) and 74% (P < 0.05) in the hyoscine group (n = 27). The patients in the placebo group needed more droperidol during and after operation (P < 0.05). The frequency of side effects was similar in both groups. In posturography the patients with emetic sequelae in the placebo group had a markedly deteriorated upkeep of posture (P < 0.05) measured as body sway velocities. A strong correlation was found between motion sickness and emetic sequelae after surgery, and patients with a history of motion sickness benefited most from hyoscine.

Administration, Cutaneous↗
PubMed1987

Revision stapedectomy surgery.

Eighty-two revision stapedectomies were analyzed to determine causes of primary and revision stapedectomy failure. The specific cause of failure can often be anticipated preoperatively by analysis of the patient's audiogram, symptoms, type of prosthesis initially used, and the duration of time between initial surgery and the onset of symptoms. Guidelines for performance of revision stapedectomy are discussed.

Adolescent↗
PubMed1988

Stapedotomy with and without stapedius tendon preservation versus stapedectomy: long-term results.

Stapedectomy and stapedotomy are presently the techniques utilized in the surgical treatment of otosclerosis. The technique of choice at the ENT Department of the University of Verona has changed from stapedectomy to stapedotomy with and without stapedius tendon preservation. From January 1975 to December 1985, 805 ears were operated on for otosclerosis at our department. A statistical analysis has been performed on three groups of patients (stapedectomy, stapedotomy without and with stapedius tendon preservation) at short and long term. The results suggest that stapedotomy with stapedius tendon preservation should be the preferred surgery in the treatment of otosclerosis.

Adolescent↗
PubMed2004

[Stapedectomy as day case surgery].

Day case surgery is increasing and a large proportion of procedures in otolaryngology are already being performed as day cases. There is less experience in otologic surgery and the reports are specially referred to chronic otitis media. A retrospective study of stapedectomy as a day-case procedure is presented in this report. The inclusion criteria: anaesthesic risk: ASA I, II or III; if the patient has a chronic disease it must be well controlled; they must not have postoperative hemorrhagic history; the patient must be accompanied by an adult the first 24 hours postsurgery; must have a vehicle; distance to hospital must not be more than an hour and they must have a telephone. Between October 1998 and December 2002 71 ambulatory stapedectomies were performed in our institution. 91.2% were discharged home the same day of the procedure. Audiological findings obtained six months after surgery that: 87.5% of the patients have an air-bone Uda of 10 dB or less.

Adult↗
PubMed1998

Stapedectomy for far-advanced otosclerosis.

Patients with far-advanced otosclerosis (FAO) may appear to be suffering from profound sensorineural hearing loss and are frequently directed to cochlear implantation programmes. In order to avoid such misdiagnosis, FAO should be considered in patients with non-measurable bone-conduction levels and air-conduction levels exceeding 85 dB. Specific clues can lead the clinician to suspect otosclerosis as the aetiology of hearing loss. A review of eight patients (nine ears) with FAO who underwent stapedectomy from 1985-1995 reveals that six of the eight (75 per cent) who had been unable to use a hearing aid preoperatively obtained serviceable hearing with a hearing aid after surgery. This confirms that cochlear implantation is not the best treatment for all profoundly deaf patients; some are better off with stapedectomy.

Aged↗
PubMed1992

Otosclerosis. Treating progressive hearing loss in young adults.

When a patient presents with bilateral progressive hearing loss and has a family history of hearing loss, otosclerosis should be placed high on the list of possible causes. Primary care physicians should determined whether the hearing loss is conductive or sensorineural with otologic examination and tuning-fork evaluation. Unless there is an obvious reversible cause for the progressive hearing loss, the patient should be referred to an otolaryngologist for more intensive otologic and audiologic examination. The patient's principal concern is the ability to hear and comprehend the spoken word in normal circumstances. Fortunately, most patients can be rehabilitated with surgery or a hearing aid. Fluoride treatment may have a significant role in preventing further hearing loss from otosclerosis.

Adolescent↗
PubMed1991

Argon laser stapedotomy.

Lasers have been used in otology for 10 years. There have been reports of excellent hearing results using laser energy in surgery for otosclerosis. We used the argon laser in 75 consecutive primary stapedotomy procedures. The postoperative air-bone gap was 10 dB or less in 87% of patients and 20 dB or less in 95%. One ear (1.5%) had no postoperative hearing secondary to a granulomatous reaction. Complications were otherwise uncommon and mild. Most patients were treated on an outpatient basis. Our results compare favorably with other reports of laser surgery for otosclerosis. We conclude that excellent hearing results can be obtained using the argon laser for stapedotomy procedures.

Adult↗
PubMed1995

Experimental studies on the suitability of the erbium laser for stapedotomy in an animal model.

Animal experiments in mature guinea pigs were devised to determine whether and to what extent inner ear damage can be caused by in vivo use of the erbium laser for stapedotomy. The present study examined the laser effect in connection with perforation of the basal convolution of the cochlea and subsequent application in the opened cochlea. Acoustic evoked potentials as compound action potentials (CAP) were recorded for changes in inner ear function. Findings demonstrated that five applications of the erbium:YSGG (yttrium-scandium-gallium-garnet) laser (energy, 85 mJ/pulse; energy density, 36 J/cm2) were needed to create a footplate perforation of 500-600 microns and did not lead to CAP alteration in any animal (n = 20). An increase of the repetition rate from 1 to 5 Hz likewise caused no CAP alteration (n = 17). Application of high total energies in the open cochlea (n = 5) to determine the safety of the laser system for stapedotomy revealed that a 10-fold increase in the total energy required for adequate perforation led to irreversible CAP alterations and no CAP could be recorded at a 15-fold increase in total energy. In contrast, a 5-fold maximum increase in total energy caused no CAP alterations. These results demonstrate the safety of the Er:YSGG laser comparable to that of the CO2 laser for stapedotomy, supporting its utility as an alternative method for surgery.

Acoustic Stimulation↗
PubMed1979

[Synthetics and metals in the middle ear (author's transl)].

A short review of synthetics and metals, which are used in middle ear surgery, is given. The own proceeding in otosclerosis and tympanoplasty is described. Special attention is drawn to the use of ventilating tubes for the treatment of sero-mucous otitis.

Acrylates↗
PubMed1995

Endoscope-assisted ear surgery.

Endoscopes deliver the otologic surgeon's view into the temporal bone to provide rapid access to its intricate recesses. The attic, sinus tympani, facial recess, hypotympanum, internal auditory canal, and other recesses are immediately visualized with angled endoscopes, using minimal exposure without the time-consuming removal of overlying bone. This report presents results of 32 otologic and neurotologic operations, performed since 1993, that incorporated endoscope-guided dissection as a principal part of the procedure to reduce incision size, exposure width, and operative time, or to access areas otherwise inaccessible. Included are endoscopic excision of acquired cholesteatoma without mastoidectomy, second-look mastoid procedures, mastoidectomy for biopsy (performed entirely endoscopically), and acoustic neuroma dissection from the lateral internal auditory canal. Endoscopic ear surgery is a valuable adjunct to conventional surgical techniques that require wider exposures and are limited to the direct line of sight.

Adolescent↗
PubMed1985

The bioactive glass ceramic Ceravital in ear surgery. Five years' experience.

Since 1979, various ceramics have been recommended as valuable implant materials in tympanoplasties. Such implants are used for the reconstruction of the ossicular chain or the posterior canal wall. Animal studies on bioinert and bioactive ceramics in the middle ear have been carried out to confirm their biocompatibility. Histologic and clinical findings have made it obvious that aluminum- or borum-aluminum oxide ceramics are well tolerated in the middle ear and may produce functional results, provided they are separated from the tympanic membrane or the footplate of the stapes by an interposition of cartilage. Porous tricalcium phosphate ceramics cannot be recommended for the reconstruction of the ossicular chain because they are degradable, but they may be useful for the obliteration of small mastoid cavities. Our five-year histologic and clinical experience with the bioactive glass ceramic Ceravital revealed in 1983 that this material is suitable for the reconstruction of the ossicular chain as well as of the posterior canal wall, without the need for protection by cartilage. Ceravital implants in fact behave like homologous ossicles.

Animals↗
PubMed1995

Surgical treatment of tympanosclerosis.

Tympanosclerosis as a cause of conductive hearing loss may require corrective surgery in carefully selected cases, although results of treatment have been controversial and must be viewed with caution. Currently available surgical techniques are reviewed and outcomes discussed.

Ear Ossicles↗
PubMed1995

Ear surgery in Treacher Collins syndrome.

The autosomal dominant hereditary Treacher Collins syndrome manifests itself phenotypically in dysmorphogenesis of particularly the first, but also the second branchial arch system. Consequently, 50% of patients with Treacher Collins syndrome have a congenital, generally pure conductive hearing loss resulting from a major or minor ear anomaly. The outcome of surgery to improve patients' hearing varies and is sometimes even disappointing. Thorough analysis of 33 cases (39 operated ears) and the strict application of a classification for the anomaly to each ear enabled us to gain insight into the most suitable surgical policy and to form a prognosis for reconstructive ear surgery.

Adolescent↗
PubMed1987

Obliterative otosclerosis.

A total of 2,985 stapedectomies were done during the 25-year period 1959 to 1984 in a busy urban otologic practice. One hundred twenty-three of these cases were found to have obliterative otosclerosis which resulted in a drill-out stapedectomy. Postoperatively, a minimum of 2 years follow-up yielded 98 of the original 123 drill-out cases constituting the study group. Several parameters will be evaluated: 1. Initial hearing gain (measured 3 months after surgery), 2. long-term hearing results (measured 2 years and beyond), 3. additional sensorineural hearing loss, and 4. probability of bilateral obliterative disease.

Follow-Up Studies↗
PubMed2002

[Results of surgical treatment of otosclerosis].

UNLABELLED: The aim of the study is to assess the results of surgical treatment in otosclerosis patients. The study included 68 patients (51 women and 17 men) aged 19-61 (mean age: 42) operated on for otosclerosis. MATERIAL AND METHOD: 77 surgical procedures were performed (67 stapedotomies and 10 stapedectomies). The operation on the second ear was performed in 9 cases. Tonal audiometry and stapedius reflex were performed in all the patients. Mean hearing loss was determined by applying five frequency: 250 Hz, 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz. Audiometric examinations were done before and 8 to 20 days after the operation. RESULTS: Mean hearing loss of the patients was 63.6 dB. Mean hearing improvement in the stapedotomy patients group was 26.6 dB and in the stapedectomy patients group: 29.5 dB. The lack of hearing gain was observed in 4 patients. A decrease of air-bone gap below 10 dB or its closure was shown in 74% of the cases. In 16% of the patients the air-bone gap after the surgical procedure ranged from 11 to 20 dB, in 10% of the cases overdrew 21 dB. Early complications, up to one month after the operation, appeared in 4 patients in the form of vertigo, balance disorders, tinnitus and the feeling pressure in the ear. In one patient, tinnitus in the operated ear appeared 12 months after the surgery. CONCLUSION: The surgical procedure in otosclerosis patients has improved their hearing. In the first few days after the operation, balance disorders were observed.

Adult↗
PubMedDate not supplied

Success of stapedectomy performed by residents.

A retrospective study of 240 stapedectomies for otosclerosis performed in a teaching department during the last 10 years was done. The results and complications in patients operated on by residents and faculty were compared. Strict criteria for evaluating the surgical outcome were used. "Satisfactory" results obtained by residents during their entire training (79 per cent) were significantly poorer (P greater than 0.05) than those achieved by the faculty (90 per cent). In the second period of residency, however, the residents' success rate (89 per cent) was equal to that of the faculty. There was no statistically significant difference in the complication rate between residents and faculty. Two essential conditions are responsible for good stapedectomy results by residents: experience with sufficient numbers of patients requiring middle-ear surgery (including otosclerosis and chronic middle-ear disease) and close supervision by the faculty in the operating room.

Adult↗